Apatient with a history of cirrhosis tells the nurse that his abdomen seems to be getting larger and that he has gained 9.7 kg (20 lb) in the last 6 months. how will the nurse determine whether the abdominal enlargement is from accumulation of fluid or fat from the weight gain?

There are choices for this question namely:

A. by listening for a fluid wave
B. by percussing the abdomen for shifting dullness
C. by auscultating for lymph nodes
D. by stroking the abdomen to elicit the abdominal reflex

The correct answer is "by percussing the abdomen for shifting dullness". In a patient with liver cirrhosis, there is decreased production of the protein albumin which therefore decreases the plasma oncotic pressure which promotes the leakage of plasma to interstitial tissues as well as in the peritoneum. Excess fluid in the peritoneum is called ascites. By percussing the abdomen for shifting dullness, fat and fluid can be differentiated as dullness in fat remains static and dullness in fluid "shifts".