Which of the following scenarios represents nursing malpractice?

Correct Answer: A

Rationale: The correct answer is A. Administering a drug to a patient with a known allergy, leading to severe harm such as an allergic reaction causing cerebral damage due to anoxia, constitutes nursing malpractice. In this scenario, the nurse failed to adhere to the standard of care by administering a medication that the patient was allergic to, resulting in serious harm, which is a clear example of malpractice in nursing.

Correct Answer: B

Rationale: A positive guaiac test is used to detect the presence of occult (hidden) blood in the stool, suggesting bleeding from the gastrointestinal tract. It is a rapid screening test that can provide immediate information to the healthcare provider about possible gastrointestinal bleeding in patients presenting with symptoms such as nausea, vomiting, diarrhea, and severe abdominal pain.

Correct Answer: D

Rationale: The correct sequence for assessing the abdomen is auscultation, percussion, and palpation. Auscultation allows the healthcare provider to listen for bowel sounds, followed by percussion to assess for areas of tenderness or abnormal distention, and finally palpation to feel for masses or organ enlargement. This sequence ensures a systematic and thorough assessment of the abdomen.

Correct Answer: C

Rationale: High-pitched gurgles heard over the right lower quadrant are a typical finding of **normal bowel sounds** (Option C). These sounds, known as borborygmi, are produced by the movement of gas and fluid through the intestines during peristalsis. The right lower quadrant contains the ileocecal valve, where the small intestine meets the large intestine, a region with frequent peristaltic activity. Normal bowel sounds are intermittent, high-pitched, and occur every 5–15 seconds. Their presence indicates healthy gastrointestinal motility and function, not pathology. Option A (**Increased bowel motility**) is incorrect because hyperactive bowel sounds, often described as loud, rushing, or tinkling, are associated with conditions like diarrhea, gastroenteritis, or early bowel obstruction. These sounds are more frequent and intense than the rhythmic gurgles of normal peristalsis. High-pitched gurgles alone, without other signs of hyperactivity (e.g., frequent or prolonged sounds), do not suggest increased motility. Option B (**Decreased bowel motility**) is incorrect because hypoactive or absent bowel sounds indicate reduced peristalsis, as seen in ileus, peritonitis, or postoperative states. These conditions produce infrequent or silent auscultation findings, often accompanied by abdominal distension or pain. High-pitched gurgles, by definition, are audible and thus incompatible with decreased motility unless they are sparse—which the question does not suggest. Option D (**Abdominal cramping**) is incorrect because cramping is a clinical symptom, not a auscultatory finding. While cramping may coincide with altered bowel sounds (e.g., hyperactive sounds in gastroenteritis), the question focuses on the **interpretation of auscultation findings**, not symptoms. High-pitched gurgles alone lack specificity for cramping; their presence is neutral unless paired with other clinical signs (e.g., tenderness, distension). In summary, high-pitched gurgles in the right lower quadrant are classic normal bowel sounds, reflecting unremarkable peristalsis. The other options either misinterpret the sound’s characteristics (A, B) or conflate auscultation with unrelated symptoms (D). Clinicians must distinguish normal variants from pathologic findings by assessing frequency, context, and accompanying signs.

Correct Answer: C

Rationale: Supine is the correct position for abdominal inspection because it allows for optimal visualization and assessment of the abdominal wall, contours, and any abnormalities. In this position, the abdominal muscles are relaxed, and the abdominal organs are not compressed, enabling the examiner to observe distension, asymmetry, scars, pulsations, or visible peristalsis. The supine position evenly distributes the abdominal contents, making it easier to detect masses, hernias, or other irregularities. Additionally, this position facilitates palpation, percussion, and auscultation, which often follow inspection during a physical examination. The prone position (A) is incorrect because lying face-down compresses the abdomen against the examination table, distorting its natural contours and making it difficult to assess symmetry, masses, or distension. This position also restricts access for subsequent examination techniques like palpation and auscultation. The Trendelenburg position (B), where the patient lies supine with the head lower than the feet, is primarily used for hemodynamic or respiratory support, not abdominal inspection. This position can alter intra-abdominal pressure, potentially obscuring findings such as hernias or fluid shifts, and is not practical for a thorough visual assessment. The side-lying position (D) limits the examiner's ability to evaluate the entire abdomen symmetrically, as gravity causes organs and abdominal contents to shift to the dependent side, potentially masking or exaggerating findings like asymmetry or organomegaly. A comprehensive abdominal inspection requires an unobstructed, relaxed view of the entire abdominal surface, which is best achieved in the supine position. Incorrect positioning can lead to misinterpretation of findings, missed abnormalities, or incomplete assessment, underscoring the importance of proper patient placement during the examination.