A nurse is caring for a client with peritonitis and observes a rigid, board-like abdomen upon palpation. The nurse recognizes this finding as:
Rebound tenderness
Paralytic ileus
Abdominal compartment syndrome
Guarding
The Correct Answer is D
Choice A reason:
Rebound tenderness refers to increased pain upon release of pressure during palpation and is not related to the finding of a rigid, board-like abdomen.
Choice B reason:
Paralytic ileus refers to a condition in which the intestines stop functioning, causing a lack of bowel sounds and distension, but it is not directly related to the rigid abdomen finding.
Choice C reason:
Abdominal compartment syndrome may cause abdominal distension and increased intra-abdominal pressure, but it does not necessarily result in a rigid, board-like abdomen.
Choice D reason:
The finding of a rigid, board-like abdomen upon palpation is known as guarding, which is a protective response of the abdominal muscles in peritonitis to minimize movement and protect the inflamed peritoneum.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
Severe headache and neck stiffness are signs of meningitis and are not directly related to peritonitis.
Choice B reason:
Rapid and shallow breathing may occur with other respiratory conditions but is not a hallmark sign of peritonitis.
Choice C reason:
Abdominal rigidity and tenderness are hallmark signs of peritonitis and are caused by the inflammation of the peritoneum.
Choice D reason:
Hyperactive bowel sounds may occur with gastrointestinal disorders but are not specific to peritonitis.
Correct Answer is C
Explanation
Choice A reason:
Bradycardia is not a common side effect of opioid use in clients with peritonitis.
Choice B reason:
Hypertension is not a common side effect of opioid use in clients with peritonitis.
Choice C reason:
Respiratory depression is a potential side effect of opioid use and is a significant concern in clients with peritonitis, as they may already have compromised respiratory function.
Choice D reason:
Diarrhea is not
a common side effect of opioid use in clients with peritonitis.
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