A nurse observes the abdomen of a client and notices it to be distended below the umbilicus. The nurse recognizes that this can be caused by which of these conditions? Select all that apply.

Abdominal distension localized below the umbilicus is commonly associated with pelvic organ enlargement, urinary retention, or mass effect within the lower abdominal cavity. These findings reflect space-occupying processes involving the bladder, uterus, or adnexal structures, which displace surrounding peritoneal contents. Assessment of suprapubic fullness and pelvic organ size is essential to differentiate physiologic distension from pathological mass formation. Rationale: A. Tumor of the kidney is typically associated with flank mass effect and upper abdominal or retroperitoneal enlargement rather than isolated suprapubic distension. The kidneys are anatomically located in the posterior retroperitoneum above the umbilical level. Therefore, renal tumors do not usually produce lower abdominal distension below the umbilicus. B. A full bladder causes suprapubic distension due to urinary retention and progressive vesical enlargement. The bladder is located posterior to the pubic symphysis and expands upward when overfilled, producing visible and palpable lower abdominal bulging. This is a classic cause of midline infraumbilical distension. C. Uterine enlargement results in pelvic expansion due to conditions such as pregnancy, fibroids, or uterine neoplasms. As the uterus increases in size, it rises from the pelvis and causes visible lower abdominal protrusion. This enlargement is typically centered below or just above the umbilicus depending on severity. D. Ovarian tumors produce adnexal mass effect, leading to progressive lower abdominal distension. These tumors originate in the pelvic cavity and expand upward as they enlarge. Depending on size, they may cause asymmetrical or midline infraumbilical swelling, contributing to visible abdominal enlargement below the umbilicus.