The nurse is preparing to perform an abdominal examination. Which step would be taken first?

Auscultation

Inspection

Percussion

Palpation

Answer and Explanation

The Correct Answer is B

Choice A rationale
Auscultation is an important step in an abdominal examination, but it is not the first step. It is performed after inspection and before percussion and palpation to ensure that the motility of the bowel and bowel sounds are not altered.
Choice B rationale
Inspection is the first step in an abdominal examination. This step involves visually examining the abdomen for any abnormalities, such as distension, discoloration, or visible peristalsis. The

nurse observes the color, shape, and movement of the abdomen, and looks for any visible masses, scars, or skin changes. This step provides valuable information about the patient’s overall health and potential issues that may require further investigation.
Choice C rationale
Percussion is a part of the abdominal examination, but it is not the first step. It is performed after inspection and auscultation. During percussion, the nurse taps on the abdomen to assess the size and position of the abdominal organs, and to detect any fluid or masses.
Choice D rationale
Palpation is the last step in an abdominal examination. It is performed after inspection, auscultation, and percussion. During palpation, the nurse uses their hands to feel the abdomen for any masses, tenderness, or organ enlargement.

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Correct Answer is B

Explanation

Choice A rationale
Ecchymosis of the extremities is not a typical finding in a patient with an obstruction and inflammation of the common bile duct due to cholelithiasis.
Choice B rationale
Fatty stools, or steatorrhea, is a common symptom in patients with cholelithiasis. This is because the obstruction in the common bile duct can prevent the flow of bile, which is necessary for the digestion and absorption of fats.
Choice C rationale

Straw-colored urine is not typically associated with cholelithiasis. Dark urine can be a symptom of this condition, as the obstruction can cause bilirubin to leak into the blood and urine.
Choice D rationale
Tenderness in the left upper abdomen is not a typical symptom of cholelithiasis. Pain associated with this condition is usually located in the right upper quadrant or the middle upper part of the abdomen.

A. No stool noted in the collection bag B. Bluish-Purplish colored stoma C. Edematous stoma D. Slight bleeding of the stoma site

Correct Answer is B

Explanation

Choice A rationale
No stool noted in the collection bag is not an immediate concern as it can take several days for the bowel to start functioning after surgery.
Choice B rationale

A bluish-purplish colored stoma could indicate inadequate blood supply to the stoma, which is a medical emergency and should be reported to the provider immediately.
Choice C rationale
An edematous stoma is a common finding in the immediate postoperative period.
Choice D rationale
Slight bleeding of the stoma site can be a normal finding after colostomy placement.

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The nurse is preparing to perform an abdominal examination. Which step would be taken first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a patient who has an obstruction and inflammation of the common bile duct due to cholelithiasis. Which finding is expected for this condition?

Correct Answer is B

Explanation

A nurse is collecting data from a client who is 12 hr postoperative following a colectomy with colostomy placement. Which of the following findings should the nurse report to the provider?

Correct Answer is B

Explanation

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