Family Nurse Practitioner Exam

What is the best method for distinguishing between an abdominal wall mass and an intra-abdominal mass?

1. Palpate the abdominal wall while the patient is relaxed

2. Instruct the patient to lift her head while palpating

3. Instruct the patient to lie still for a few seconds

4. Palpate the abdomen deeply and quickly release

The correct answer is: Instruct the patient to lift her head while palpating

Instructing the patient to lift her head while palpating is an effective method for distinguishing between an abdominal wall mass and an intra-abdominal mass. When the patient lifts her head, the abdominal wall muscles contract, which will make any mass that is located within the abdominal wall more prominent during palpation. This contraction can help differentiate whether the mass is superficial (abdominal wall) or deeper (intra-abdominal). A mass that is intra-abdominal will usually move with the underlying organs and not change significantly with muscle contraction. Therefore, if the mass becomes more palpable or more distinct with the contraction of the abdominal muscles, it indicates that the mass is likely within the abdominal wall. Other methods, such as palpating the abdominal wall while the patient is relaxed, may not provide sufficient distinction as both types of masses can be felt without the added tension of muscle contraction. Similarly, instructing the patient to lie still or performing a quick deep palpation may not effectively reveal the relationship of the mass to the abdominal wall and deeper structures. Thus, the method of having the patient lift her head is the most diagnostic approach in this case.