Ambulatory Care Nurse Certification Practice Exam

A patient with ascites, which is an accumulation of fluid in the peritoneal cavity often due to liver disease, heart failure, or malignancy, will frequently exhibit the finding of shifting dullness during a physical examination. This occurs when the patient is positioned in a lateral decubitus position, causing the fluid in the abdominal cavity to shift with the position. As the caregiver percusses the abdomen, the area over the fluid will sound dull, while areas of the abdomen where gas is present, such as over the intestines, will sound tympanic. The presence of shifting dullness indicates a significant volume of fluid in the abdominal cavity and is a classic clinical sign of ascites.

Other findings, such as hyperactive bowel sounds, are usually not associated with ascites and may suggest other gastrointestinal issues. Excess gas can occur due to different conditions but does not specifically indicate the presence of ascites. Tenderness upon palpation can occur in many conditions and is not unique to ascites; it might suggest inflammation or irritation, but that is a less specific finding. Hence, the presence of shifting dullness is the primary, direct diagnostic indicator of fluid accumulation in cases of ascites.