A nurse is assessing a client with an abdominal aortic aneurysm. Which of the following assessment findings by the nurse is probably unrelated to an aneurysm?
A. Pulsatile abdominal mass.
B. Hyperactive bowel sounds in that area.
C. Systolic bruit over the area of the mass.
D. Subjective sensation of “heart beating” in the abdomen.
Correct Answer: B. Hyperactive bowel sounds in that area
Not all clients with abdominal aortic aneurysms exhibit symptoms. Physical exam should also look for other associated aneurysms. The most common associated aneurysm is an iliac artery aneurysm. Peripheral aneurysms are also associated in approximately 5 % of patients, of which popliteal artery aneurysms are the most common.
Option A: A pulsatile mass may be palpated in the middle and upper abdomen. Palpation of the abdomen usually reveals a non-tender, pulsatile abdominal mass. Enlarging aneurysms can cause symptoms of abdominal, flank, or back pain. Compression of adjacent viscera can cause gastrointestinal (GI) or renal manifestations.
Option C: A systolic bruit may be auscultated over the mass. Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm. Rupture of an abdominal aortic aneurysm is life-threatening. These patients may present in shock often with diffuse abdominal pain and distension. However, the presentation of patients with this type of ruptured aneurysm can vary from subtle to quite dramatic. Most patients with a ruptured abdominal aortic aneurysm die before hospital arrival.
Option D: Those who do describe a feeling of the “heart beating” in the abdomen when supine or be able to feel the mass throbbing. On physical exam, the patient may have tenderness over the aneurysm or demonstrate signs of embolization. The aneurysm may rupture into adjacent viscera or vessels presenting with GI bleeding or congestive heart failure due to the aortocaval fistula.
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