NCLEX RN Practice Question # 913

NCLEX Examination.

Practice Question # 913.

When performing an abdominal assessment, the specific order for assessment techniques is inspection, auscultation, percussion, and palpation.

Inspection

• Contour: Look down at the abdomen and then across the abdomen from the rib margin to the pubic bone; describe as flat, rounded, concave, or protuberant.
• Symmetry: Note any bulging or masses.
• Umbilicus: Should be midline and inverted
• Skin surface: Should be smooth and even
• Pulsations from the aorta may be noted in the epigastric area, and peristaltic waves may be noted across the abdomen.

Auscultation

• Performed before percussion and palpation, which can increase peristalsis.
• Hold the stethoscope lightly against the skin and listen for bowel sounds in all 4 quadrants; begin in the right lower quadrant (bowel sounds are normally heard here).
• Note the character and frequency of normal bowel sounds: high-pitched gurgling sounds occurring irregularly from 5 to 30 times a minute.
• Identify as normal, hypoactive, or hyperactive (borborygmus).
• Absent sounds: Auscultate for 5 minutes before determining that sounds are absent.
• Auscultate over the aorta, renal arteries, iliac arteries, and femoral arteries for vascular sounds or bruits with the bell of the stethoscope.