A nurse is providing teaching for a client who has binge-eating disorder and is morbidly obese. The client has been prescribed orlistat. Which of the following statements indicates to the nurse that the client understands the teaching?

A. Fine hand tremors and pill rolling: These symptoms are more indicative of parkinsonism, which is another extrapyramidal side effect of antipsychotic medications but not specifically tardive dyskinesia.
B. Facial grimacing and eye blinking: Facial grimacing and eye blinking are classic signs of tardive dyskinesia. These involuntary movements of the face are often seen in patients who have been on antipsychotic medications for an extended period.
C. Urinary retention and constipation: Urinary retention and constipation are not typically associated with tardive dyskinesia. These symptoms may be related to other medication side effects or unrelated conditions.
D. Involuntary pelvic rocking and hip thrusting movements: These movements are characteristic of tardive dyskinesia. Involuntary pelvic rocking and hip thrusting can occur as part of the abnormal involuntary movements seen in tardive dyskinesia.
E. Tongue thrusting and lip smacking: Tongue thrusting and lip smacking are classic signs of tardive dyskinesia, particularly involving the orofacial region. These movements can be distressing for patients and may interfere with speech and eating.

Inspection:This is the first step because it allows the nurse to gather information through observation without causing any discomfort to the child. It involves looking at the child's abdomen for any visible abnormalities like distension, asymmetry, masses, or discoloration.

Auscultation:After inspection, the nurse listens to the bowel sounds using a stethoscope. This helps assess peristalsis (movement of food through the intestines) and identify potential problems like bowel obstruction or decreased motility.

Superficial Palpation:This gentle palpation helps assess muscle tone, tenderness, and masses. It's performed after auscultation to avoid altering bowel sounds. Since children are often apprehensive about abdominal exams, starting with a gentler touch can help them feel more comfortable.

Deep Palpation (if necessary):Deep palpation is reserved for last as it can be more uncomfortable for the child. It's used to assess for organomegaly (enlarged organs) or masses that may not be palpable with superficial palpation. It's only performed if there are indications from the first three steps.

Here's a breakdown of why this order is important:

Minimize Discomfort:Starting with non-invasive methods like inspection and auscultation helps establish trust and reduces anxiety in the child, making the overall assessment more cooperative.

Maintain Baseline Bowel Sounds:Palpation can alter bowel sounds, so it's important to listen to them first to get an accurate baseline.

Gradual Progression:Moving from gentle to deeper palpation allows the child to adjust to the sensation and helps the nurse identify potential areas of tenderness before applying deeper pressure.