The nurse's comprehensive assessment of a client who has heart failure includes evaluation of the client's hepatojugular reflux. What action should the nurse perform during this assessment?

The hepatojugular reflux (HJR) test, also called the abdominojugular test, is a clinical maneuver used to assess right-sided heart failure and elevated central venous pressure. To perform the test correctly, the nurse positions the client at a 30–45-degree angle (not flat and not at 90 degrees) so that the jugular veins are partially visible. The nurse then applies firm, sustained pressure over the right upper abdomen (over the liver/right hypochondrium) for approximately 10 seconds while observing the jugular veins. In a patient with right heart failure or elevated venous pressure, this maneuver displaces blood from the hepatic and splanchnic circulation, transiently increasing venous return to the right heart; if the right ventricle cannot accommodate the increased preload, jugular venous distension becomes visible or worsens. Pressing above the symphysis pubis is not part of the HJR assessment and would be used in bladder palpation or other abdominal assessments. Elevating the head to 90 degrees (upright sitting) would make jugular vein assessment unreliable. Laying the client flat would distend veins regardless of cardiac status and is not used for this specific test. The defining action is sustained pressure on the right upper abdomen while watching for jugular distension.