The physician comments that the client has abdominal borborygmic. The nurse recognizes that which of the following is the best description of borborygmic?

A peritoneal friction rub

Loud continual humming bowel sounds

Hypoactive bowel sounds

Loud gurgling bowel sounds

Answer and Explanation

The Correct Answer is D

A.   A peritoneal friction rub is a grating sound caused by inflamed surfaces of the peritoneum rubbing together.
B.   Borborygmi refers to loud, gurgling bowel sounds often heard with increased intestinal motility.
C.   Hypoactive bowel sounds are abnormally decreased or absent bowel sounds.
D.   Borborygmi describes the normal sounds made by the movement of gas and fluid in the intestines.

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Correct Answer is D

Explanation

A. Listening to speech primarily assesses cranial nerves related to speech and articulation, not cranial nerve II.
B. Identifying scented aromas assesses the olfactory nerve.
C. Clenching teeth primarily assess cranial nerve V (trigeminal nerve).
D. Cranial nerve II is the optic nerve responsible for vision. Testing visual acuity using a Snellen chart assesses this nerve's function.

A. 1 minute in the center of the abdomen. B. 10 minutes in each quadrant. C. 1 minute in each quadrant. D. 5 minutes in each quadrant. E. None F. None

Correct Answer is D

Explanation

A. One minute may not provide a sufficient duration to declare absent bowel sounds, especially if the client has a slower bowel motility.
B.

Listening for 10 minutes in each quadrant is excessive and not supported by clinical guidelines. It would unnecessarily delay care and increase patient discomfort.

C. One minute in each quadrant might not provide an adequate assessment time.
D. This is the correct answer because clinical guidelines recommend auscultating for at least 5 minutes in each quadrant before concluding that bowel sounds are absent. This ensures sufficient time to detect infrequent bowel sounds and accurately assess the situation.

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The physician comments that the client has abdominal borborygmic. The nurse recognizes that which of the following is the best description of borborygmic?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client's cranial nerves. Which of the following methods should the nurse use to assess cranial nerve II?

Correct Answer is D

Explanation

During an abdominal assessment, the nurse is unable to hear bowel sounds in a client's abdomen. How long should the nurse listen before reporting absent bowel sounds?

Correct Answer is D

Explanation

The nurse is assessing the male genital organ. The nurse recognizes that which of the following is an accessory glandular structure for the male genital organs?

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