During abdominal palpation, which instruction is correct?

• A. Always palpate the area of the most pain last
• B. Always palpate the area of the most pain first
• C. Begin palpation at the region with no tenderness
• D. Palpate in a circular fashion only

Answer: (A)

During abdominal palpation, the order you use matters because reflex guarding from pain can mask findings. The best approach is to start in areas that are not tender and use light palpation to map texture, firmness, and any guarding. Then gradually work toward regions with tenderness and finish by palpating the area of greatest pain last. This sequence helps reduce guarding and allows you to evaluate the tender area more accurately, including any rebound tenderness or rigidity that may appear when you reach it. Choosing to palpate the most painful area first tends to trigger guarding and pain that distort the exam, and palpating only in a circular fashion isn’t necessary. If there’s no tenderness, you still use a systematic method, but you still finish with the last area that would reveal the most information if it’s tender.