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 ["A","B","D"]

Explanation

Choice A rationale
Observing mucous membranes for dryness can indicate dehydration.
Choice B rationale

Providing frequent oral care with moist swabs can help alleviate the discomfort of a dry mouth due to NPO status.
Choice C rationale
Offering the client small sips of water is not appropriate as the client is on a diet of nothing by mouth (NPO) except ice chips.
Choice D rationale
Increasing the rate of intravenous (IV) fluids can help prevent dehydration.

A. Chlorhexidine B. Alcohol-based antiseptic C. Povidone-iodine D. Soap and water

Correct Answer is D

Explanation

Choice A rationale
Chlorhexidine is an antiseptic that is used for cleaning the skin or the hands and helps to prevent infections caused by bacteria. However, it is not the recommended cleansing agent for hand hygiene in a Clostridium difficile infection.
Choice B rationale
Alcohol-based antiseptics are commonly used for hand hygiene in healthcare settings. However, they are not effective against Clostridium difficile spores.
Choice C rationale
Povidone-iodine is an antiseptic used for skin disinfection before and after surgery. It may not be effective against Clostridium difficile spores.
Choice D rationale
Soap and water are recommended for hand hygiene when caring for a patient with a Clostridium difficile infection. This is because soap and water are effective in removing C. difficile spores from hands.

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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

The nurse is caring for a client who received a new diet prescription from the physician for nothing by mouth (NPO) except ice chips. Which actions would the nurse take to alleviate the effects of dehydration? Select all that apply

Correct Answer is ["A","B","D"]

Explanation

A nurse is caring for a patient who has a Clostridium difficile infection. Which cleansing agent should the nurse use for hand hygiene?

Correct Answer is D

Explanation

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