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Assessment of a client reveals a distended abdomen with some bulging of the flanks. Which test would be most accurate in confirming nurse's suspicions?

A.

Abdominal x-ray

B.

Shifting dullness

C.

Fluid wave

D.

Ultrasound

Answer and Explanation

The Correct Answer is D

A. Abdominal x-ray: While it can show gas or bowel obstructions, it is less effective for confirming fluid presence.

 

B. Shifting dullness: This physical exam technique can indicate fluid but is less accurate than ultrasound.

 

C. Fluid wave: This physical exam can help suggest the presence of fluid, but it is also less reliable than imaging studies.

 

D. Ultrasound: An ultrasound is the most accurate and non-invasive way to confirm the presence of fluid, such as ascites, in the abdomen. It provides detailed imaging and confirmation without invasive procedures.


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Correct Answer is D

Explanation

A. Flat: A flat abdomen is level with no visible protrusions or concavities.

B. Protuberant: A protuberant abdomen appears swollen or distended, common in obesity or ascites.

C. Rounded: A rounded abdomen has a convex contour, commonly seen in children or adults with mild weight gain.

D. Scaphoid: A scaphoid abdomen appears sunken or concave, often showing visible lower ribs, suggesting malnutrition or dehydration.

Correct Answer is C

Explanation

A. 2 full minutes: Listening for 2 minutes is insufficient to determine the absence of bowel sounds reliably.

B. 1 full minute: One minute is also too brief, as bowel sounds can sometimes be infrequent, especially in certain conditions.

C. 5 full minutes. The absence of bowel sounds is confirmed after listening in each quadrant for a minimum of 5 full minutes. This is necessary to ensure that the lack of sounds is not due to temporary decreased activity and is instead a true absence, which may indicate a medical emergency like a bowel obstruction.

D. 1 1/2 minutes: This time is not long enough to confirm the absence of bowel sounds accurately.

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