Difficulty: Medium
Average Score: 93%
Simulated
A nurse is preparing to perform a physical assessment of a client's abdomen. Identify the sequence in which the nurse should perform the following steps. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Correct answer
E,C,D,B,A
Rationale
The correct sequence for performing a physical assessment of a client's abdomen is as follows:
E: Locate liver and spleen borders by pressing hands 2.5 to 7.5 cm (1 to 3 in) into the abdomen.
C: Percuss all four quadrants of the abdomen to measure sound quality.
D: Check for areas of tenderness by pressing fingers 1.3 cm (0.5 in) into the abdomen.
B: Listen to the abdominal arteries using the bell of a stethoscope.
A: Provide adequate lighting to inspect the abdomen.
Rationale:
- Step E is performed first to locate the liver and spleen borders.
- Step C follows to assess sound quality in all quadrants.
- Step D checks for tenderness, which should be done next.
- Step B involves listening to abdominal arteries for abnormalities.
- Step A provides proper lighting to inspect the abdomen thoroughly.
Other choices are incorrect:
- Choice F and G are not relevant to the
E: Locate liver and spleen borders by pressing hands 2.5 to 7.5 cm (1 to 3 in) into the abdomen.
C: Percuss all four quadrants of the abdomen to measure sound quality.
D: Check for areas of tenderness by pressing fingers 1.3 cm (0.5 in) into the abdomen.
B: Listen to the abdominal arteries using the bell of a stethoscope.
A: Provide adequate lighting to inspect the abdomen.
Rationale:
- Step E is performed first to locate the liver and spleen borders.
- Step C follows to assess sound quality in all quadrants.
- Step D checks for tenderness, which should be done next.
- Step B involves listening to abdominal arteries for abnormalities.
- Step A provides proper lighting to inspect the abdomen thoroughly.
Other choices are incorrect:
- Choice F and G are not relevant to the