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Which sequence does the nurse follow when examining a patient's abdomen?
A. Inspection first, then auscultation, percussion, and palpation
B. Percussion first, then auscultation, palpation, and inspection
C. Auscultation first, then palpation, percussion, and inspection
D. Inspection first, then palpation, auscultation, and percussion
A. Inspection first, then auscultation, percussion, and palpation
Rationale
The correct order for an assessment of the abdomen is inspection, auscultation, percussion, and palpation. This sequence is used because it ensures that there is no disturbance to the abdomen before auscultation. Percussing first, then auscultating, palpating, and inspecting; auscultating, then palpating, percussing, and inspecting; or inspecting, then palpating, auscultating, and percussing would cause false bowel sounds because the nurse would be
touching or pressing on the abdomen during percussion and palpation before auscultation.
B. Living alone
D. Low socioeconomic status
E. Decline in cognitive status
Rationale
Frail older adults may tire easily, have little physical reserve, and are at risk for physical dependence and institutionalization. They are especially at risk for malnutrition and dehydration. These are related to factors such as living alone, depression, and low
socioeconomic status. Other factors, such as dementia, inadequate dental care, sensory deficits, fatigue, and limited mobility, increase the risk for malnutrition and dehydration. Ethnicity and cultural factors do not increase the risk of dehydration and malnutrition.
PATIENT D
Rationale
Risk factors for peptic ulcer disease include age, medications, and lifestyles. The peak age for duodenal ulcers is between 35 and 45 years of old. Smoking,
caffeine, and alcohol contribute to ulcer formation. Therefore Patient D, who is 40 years old, consumes four cups of coffee daily and smokes one pack per day is at highest risk. Patient A is 40 years old, but oral contraception and a parent having GERD does not increase the risk. Patients B and C are younger. Minocycline, testosterone, milk consumption, and exercise do not increase a person's risk for duodenal ulcer formation.