When assessing a client's abdomen, the nurse recognizes the importance of reserving palpation as the last technique. The rationale for this practice is that:
1. The pressure it causes can interfere with hearing bowel sounds.
2. The technique is likely to increase the client's level of anxiety.
3. Most clients do not like being touched.
4. Early palpation may result in rebound pain.
The pressure it causes can interfere with hearing bowel sounds.
Rationale: When assessing the abdomen, use palpation last because pressure on the abdominal wall and contents may interfere with bowel sounds and cause pain. Palpation itself does not generally contribute to a client's anxiety. The technique does not cause rebound pain, but can cause general pain in a client's abdomen. While some clients may be uncomfortable with being touched, that is not the reason for delaying the technique until last.
You might also like to view...
The nursing faculty explains to a class of nursing students that one difference between telemedicine and telehealth is that
a. electronic medical records are required by law. b. medical ethics are more ingrained in telemedicine. c. telehealth is used by many health care specialties. d. telemedicine is not covered by health insurance.
A home health care agency has major problems but does not want consumers to know about these problems while the agency decides what should be done to improve them. Employees are not told to lie,
but they are advised not to share information. Which of the following is the most likely outcome of this situation? a. As long as employees do not share what they know, the community will be uninformed. b. By law, comparative information will be available to the public via the Internet. c. Only a few informed persons will know about the problems. d. Secrecy will prevail unless the local newspaper does an investigative report.
The RN knows that adherence to standards of care and hospital policies and procedures, as well as exercising care that a reasonable nurse would demonstrate in similar circumstances, will limit risk for common areas of risk in all of the following
EXCEPT: A) Documentation errors B) Attendance errors C) Medication errors D) Patient falls
Rh incompatibility can occur if the woman is Rh negative and her:
a. fetus is Rh positive. b. husband is Rh positive. c. fetus is Rh negative. d. husband and fetus are both Rh negative.