A nurse preceptor is reviewing the skill of percussing a patient's abdomen with a newly licensed nurse. The preceptor will intervene when the nurse makes which statement?
1. "I will percuss the abdomen using a systematic path.".
2. "I anticipate hearing tympany over stool-filled intestines.".
3. "Dullness is the expected percussion over the liver.".
4. "Percussion is a useful tool for assessing the spleen, kidneys, and liver.".
2
Rationale 1: The nurse should establish a system of assessment.
Rationale 2: Tympany is heard over air-filled organs such as gas-filled intestines. Intestines that are stool-filled, such as in a patient with an ileus or constipation, present dull sounds.
Rationale 3: The liver gives off a dull sound.
Rationale 4: The nurse would percuss over the spleen, kidneys, and liver.
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