Chapter 18: Abdomen Flashcards
Mrs. James is 7 months’ pregnant and states that she has developed a problem with
constipation. She eats a well-balanced diet and is usually regular. You should explain that
constipation is common during pregnancy because of changes in the colorectal areas, such as
a. decreased movement through the colon and increased water absorption from the
stool.
b. increased movement through the colon and increased salt taken from foods.
c. looser anal sphincter and fewer nutrients taken from foods.
d. tighter anal sphincter and less iron eliminated in the stool.
ANS: A
Constipation and flatus are more common during pregnancy because the colon is displaced,
peristalsis is decreased, and water absorption is increased. Movement through the colon is
decreased during pregnancy. The colon does not absorb nutrients. A tighter sphincter tone is
not related to pregnancy.
The family history of a patient with diarrhea and abdominal pain should include inquiry about
cystic fibrosis because it is
a. a common genetic disorder.
b. one cause of malabsorption syndrome.
c. a curable condition with medical intervention.
d. the most frequent cause of diarrhea in general practice.
ANS: B
Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the
gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase
deficiency. Steatorrhea and abdominal pain from increased gas production are frequent
complaints.
When assessing abdominal pain in a college-age woman, one must include
a. history of interstate travel.
b. food likes and dislikes.
c. age at completion of toilet training.
d. the first day of the last menstrual period.
ANS: D
Exploring abdominal pain complaints in a young woman can reveal multiple causes related to
the menstrual cycle, including menstrual pain, ovulation discomfort, and abnormal menses.
Asking the patient to tell you the first day of her last menstrual period can help discriminate
among these factors. History of international travel and traveler’s diarrhea can be related to
abdominal pain, but interstate travel usually does not. Food preferences and age at completion
of toilet training are not relevant.
Infants born weighing less than 1500 g are at higher risk for
a. hepatitis A.
b. necrotizing enterocolitis.
c. urinary urgency.
d. pancreatitis.
ANS: B
Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants. It
involves infection and inflammation that cause destruction of the bowel, and it becomes more
apparent after feedings.
ANS: B
Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants. It involves infection and inflammation that cause destruction of the bowel, and it becomes more apparent after feedings.
ANS: C
To help relax the abdominal musculature, it is helpful to place a small pillow under the
patient’s head and under slightly flexed knees. The other techniques are not helpful because
they increase muscle flexion.
Mrs. Little is a 44-year-old patient who presents to the office with abdominal pain and fever. During your examination, you ask the patient to raise her head and shoulders while she lies in
a supine position. A midline abdominal ridge rises. You document this observation as a(n)
a. small inguinal hernia.
b. large epigastric hernia.
c. abdominal lipoma.
d. diastasis recti.
ANS: D
A diastasis recti occurs when the abdominal contents bulge between two abdominal muscles
to form a midline ridge as the head is lifted. It has little clinical significance and usually
occurs in women who have had repeated pregnancies and in obese patients.
Mr. Robins is a 45-year-old man who presents to the emergency department with a complaint
of constipation. During auscultation, you note borborygmi sounds. This is associated with
a. gastroenteritis.
b. peritonitis.
c. satiety.
d. paralytic ileus.
ANS: A
Borborygmi are prolonged loud gurgles that occur with gastroenteritis, early intestinal
obstruction, or hunger. Peritonitis and paralytic ileus result in hypoactive bowel sounds. Food
satiety does not stimulate growling sounds as does hunger.
To document absent bowel sounds correctly, one must listen continuously for
a. 30 seconds.
b. 1 minute.
c. 3 minutes.
d. 5 minutes.
ANS: D
Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes.
Percussion of the abdomen begins with establishing
a. liver dullness.
b. spleen dullness.
c. gastric bubble tympany.
d. overall dullness and tympany in all quadrants.
ANS: D
Percussion begins with a general establishment over all quadrants for areas of dullness and
tympany and then proceeds to specific target organs.
When percussing a spleen, Traube space is a
a. semilunar region.
b. splenic percussion sign.
c. left-sided pleural effusion.
d. solid mass
ANS: A
Percussion of the spleen is more difficult because percussion tones elicited may be caused by
other conditions. Traube space is a semilunar region defined by the sixth ribs superiorly, the
midaxillary line laterally, and the left costal margin inferiorly
Your patient is complaining of acute, intense, sharp epigastric pain that radiates to the back
and left scapula, with nausea and vomiting. Based on this history, your prioritized physical
examination should be to
a. percuss for ascites.
b. assess for rebound tenderness.
c. inspect for ecchymosis of the flank.
d. auscultate for abdominal bruits.
ANS: C
Abdominal pain that radiates to the back could be caused by pancreatitis or a gastric ulcer,
gallbladder pain usually radiates to the right or left scapula but not to the back, pancreatitis
pain can radiate to the left shoulder or scapula, and nausea and vomiting usually occur with
gallbladder, pancreas, or appendix conditions. Pancreatitis is a differential diagnosis for all
these symptoms, so begin the examination by inspecting the flanks for the Grey Turner sign,
an indication of pancreatitis.
To assess for liver enlargement in the obese person, you should
a. use the hook method.
b. have the patient lean over at the waist.
c. auscultate using the scratch technique.
d. attempt palpation during deep exhalation.
ANS: C
If the abdomen is obese or distended, or if the abdominal muscles are tight, you should plan
on auscultating the liver using the scratch method to estimate the lower border of the liver.
An umbilical assessment in the newborn that is of concern is
a. a thick cord.
b. umbilical hernia.
c. one umbilical artery and two veins.
d. pulsations superior to the umbilicus.
ANS: C
Expect two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally close spontaneously by 2 years, and pulsations to the abdomen in the epigastric area are common
Your patient presents with symptoms that lead you to suspect acute appendicitis. Which
assessment finding is least likely to be associated with this condition?
a. Positive psoas sign
b. Positive McBurney sign
c. Consistent right lower quadrant (RLQ) pain
d. Rebound tenderness
ANS: C
A positive psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that
migrates to the RLQ are signs of appendicitis. The absence of pain migration makes
appendicitis less likely.
When using the bimanual technique for palpating the abdomen, you should
a. push down with the bottom hand and the other hand on top.
b. push down with the top hand and concentrate on sensation with the bottom hand.
c. place the hands side by side and push equally.
d. place one hand anteriorly and the other hand posteriorly, squeezing the hands
together.
ANS: B
The bimanual technique uses one hand on top of the other. Exert pressure with the top hand
while concentrating on sensation with the other hand.
