A post-surgery patient has abdominal distension and discomfort. During physical assessment (inspection, auscultation, percussion, palpation), which finding is abnormal?

1. A

   Dullness with changing position

2. B

   Bowel sounds heard every 10 seconds

3. C

   Bowel sounds change with position

4. D

   All are normal findings

Appeared in: NORCET 10 Prelims-2026

Explanation

Listen in Hindi

• Dullness on percussion that changes with position is known as 'shifting dullness'.
• Shifting dullness is a classic clinical sign of ascites, which is the abnormal accumulation of free fluid in the peritoneal cavity.
• In a post-operative patient, ascites can indicate serious complications like internal hemorrhage, infection (peritonitis), or organ injury.
• This finding is considered abnormal and requires immediate further investigation and reporting to the healthcare provider.

Why Other Options Were Wrong

• Option B: Bowel sounds heard every 10 seconds equates to 6 sounds per minute.
• Option C: It is normal for the location and character of bowel sounds to change with the patient's position.
• Option D: This option is incorrect because 'Dullness with changing position' is a significant abnormal finding.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Abdominal Physical Assessment Findings to guide bedside assessment, documentation, and the next nursing action.
• Recognizing shifting dullness is a critical nursing assessment skill, especially in post-operative, cardiac, or liver failure patients, as it signals significant fluid shifts that may require urgent intervention.
• A nurse identifying shifting dullness must promptly document the finding and report it to the physician, while also closely monitoring vital signs (especially blood pressure and heart rate) for signs of hemodynamic instability.
• What if? If the patient had abdominal distension with dullness that did NOT shift with position, the primary concern would shift from free fluid (ascites) to a localized mass, organomegaly (enlarged organ), or a full bladder.

How to Approach the Question

• First, analyze the question stem: it asks to identify an ABNORMAL finding in a post-surgery patient with abdominal distension.
• Next, evaluate each option against the standards of a normal abdominal assessment.
• Option A: Consider what 'dullness with changing position' signifies. This is the definition of shifting dullness, a sign of ascites (free fluid), which is abnormal.
• Option B: Calculate the rate of bowel sounds. Every 10 seconds is 6 times per minute. Compare this to the normal range (5-35 per minute). This is normal.
• Option C: Think about the physics of the abdomen. Gas and fluid move with gravity. Therefore, it's expected for sounds to change with position. This is normal.
• Based on this analysis, only the finding in Option A is abnormal, making it the correct answer.

Concept Tested & Keywords

• Concept Tested: Abdominal Physical Assessment Findings
• Stem keywords: post-surgery, abdominal distension, physical assessment, abnormal finding
• Lead-in keywords: which finding is abnormal
• Clinical cues: Post-surgery status increases risk for complications like internal bleeding or fluid shifts.
• Negative lead-in flag: false

Question ID

QbW5SISI1t6fJFp8jg9f0s

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 111-113

E6 Nursing Fundamentals Taylor p. 618-620