Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery?

Correct Answer: C

Rationale: When assessing postoperative pain in an Asian patient, cultural considerations must be taken into account, as many Asian cultures emphasize stoicism and may avoid overt expressions of pain. The correct answer, **C (Immobility, diaphoresis, and avoidance of deep breathing or coughing)**, aligns with common cultural pain responses observed in Asian populations. These patients often exhibit nonverbal cues such as guarding the affected area, limited movement, and physiological signs like sweating (diaphoresis) due to discomfort. They may also avoid deep breathing or coughing to minimize pain, which can lead to complications like atelectasis but reflects their tendency to endure discomfort quietly rather than verbalize it. **Why the other options are incorrect:** **A: Decreased blood pressure and heart rate and shallow respirations** – This is incorrect because postoperative pain typically triggers a sympathetic nervous system response, leading to *increased* blood pressure, heart rate, and respiratory rate due to stress and discomfort. Shallow respirations alone may occur due to pain, but decreased blood pressure and heart rate are more indicative of shock or sedation rather than pain. **B: Quiet crying** – While some patients may cry quietly in response to pain, this is less culturally typical for many Asian patients, who often prioritize emotional restraint. Overt displays of distress, such as crying, are less common in cultures that value composure, making this option less likely. **D: Changing position every 2 hours** – This is an expected postoperative nursing intervention to prevent complications like pressure ulcers, not a sign of pain. Pain would more likely cause patients to remain still to avoid exacerbating discomfort rather than moving frequently. The rationale emphasizes that pain assessment in diverse populations requires an understanding of cultural norms. Asian patients may underreport pain due to cultural values, making nonverbal and physiological cues (such as immobility, diaphoresis, and guarded breathing) more reliable indicators than verbal expressions or atypical vital sign changes. Recognizing these subtle signs ensures appropriate pain management and prevents complications.

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.

Correct Answer: B

Rationale: For a rectal examination, patient positioning is crucial for optimal access, visualization, and comfort. The **Sims position (B) is correct** because it allows the patient to lie on their left side with the right knee and hip flexed toward the abdomen while the left arm rests behind the body. This position provides excellent exposure of the anorectal area, facilitates relaxation of the anal sphincter, and is comfortable for the patient while allowing the clinician easy access for examination or procedures. It is widely recognized as the standard for rectal exams due to its practicality and effectiveness. **Choice A (Genupectoral)** is incorrect because, while it does provide exposure of the anal region, it is not the standard for routine rectal exams. The genupectoral (or knee-chest) position involves the patient resting on their knees and chest, which can be uncomfortable, embarrassing, or physically challenging for many patients, particularly the elderly or those with mobility issues. This position is more commonly used for procedures like sigmoidoscopy rather than a basic rectal examination. **Choice C (Horizontal recumbent)** is incorrect because lying flat on the back does not provide adequate exposure of the rectum for examination. The supine position makes it difficult to access the anal area properly and can lead to poor visualization and an uncomfortable experience for both patient and clinician. Some modified supine positions (e.g., lithotomy) may be used in certain clinical settings, but the standard horizontal recumbent position is impractical for a rectal exam. **Choice D (All of the above)** is incorrect because while multiple positions can technically be used, they are not equally appropriate. Only the Sims position is the universally recommended standard for routine rectal exams due to its balance of accessibility, patient comfort, and clinical effectiveness. Including other positions as equally valid would misrepresent best clinical practices. Thus, the correct answer is **B (Sims)**, as it is the most practical, comfortable, and effective position for a rectal examination, whereas the other options either present disadvantages or are not standard practice. The rationale emphasizes anatomical accessibility, patient comfort, and clinical appropriateness in determining the best choice.