Author Question: The nurse is caring for a client with abdominal pain. What assessments should the nurse perform to ... (Read 54 times)

bb · **on:** Jul 23, 2018

The nurse is caring for a client with abdominal pain. What assessments should the nurse perform to assess this complaint?

1. Inspect the abdomen.
2. Auscultate the abdomen.
3. Palpate the abdomen.
4. Assess vital signs.
5. Assess peripheral pulses.

Question 2

Which of the following actions by the nurse best exhibits surgical asepsis?

1. Disinfecting an item before adding it to a sterile field
2. Allowing sterile gloved hands to fall below the waist
3. Suctioning the oral cavity of an unconscious client
4. Touching only the inside surface of the first glove while pulling it onto the hand

olivia_paige29 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 1,2,3,4
Rationale 1: The nurse should inspect the client's abdomen.
Rationale 2: The nurse should auscultate the abdomen.
Rationale 3: The nurse should auscultate the abdomen.
Rationale 4: The nurse should assess vital signs.
Rationale 5: Although peripheral pulses may be palpated, this is not specific to a client with abdominal pain.

Answer to Question 2

Correct Answer: 4
Rationale 1: Disinfecting an item is an example of medical asepsis, not surgical asepsis.
Rationale 2: If sterile gloved hands fall below the waist, they are considered to be unsterile.
Rationale 3: Suctioning the oral cavity of a client is considered contaminating.
Rationale 4: Touching only the inside surface of the first glove while pulling it onto the hand is the correct technique when applying sterile gloves. This prevents contamination of the outside of the glove, which must remain sterile.