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A nurse is caring for a client with peritonitis who is at risk of developing abdominal compartment syndrome. Which assessment finding should the nurse be most concerned about?

Increased urine output

Abdominal distension and firmness

Normal respiratory rate

Mild incisional pain

Answer and Explanation

The Correct Answer is B

Choice A reason:

Increased urine output is not a concerning finding in this context and may indicate adequate fluid resuscitation.

Choice B reason:

Abdominal distension and firmness are concerning findings and may indicate the development of abdominal compartment syndrome, a serious complication of peritonitis.

Choice C reason:

Normal respiratory rate is a positive finding, but it does not directly relate to the development of abdominal compartment syndrome.

Choice D reason:

Mild incisional pain is expected after surgery, but it does not indicate the development of abdominal compartment syndrome.

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Correct Answer is D

Explanation

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.

A. Lying flat in bed B. Using a heating pad on the abdomen C. Deep breathing and coughing D. Administering prescribed analgesics

Correct Answer is C

Explanation

Choice A reason:

Lying flat in bed may provide some comfort for the client and is not likely to exacerbate the abdominal pain associated with peritonitis.

Choice B reason:

Using a heating pad on the abdomen may provide some relief for the client and is not likely to exacerbate the abdominal pain associated with peritonitis.

Choice C reason:

Deep breathing and coughing exercises may worsen the client's abdominal pain due to the stretching and movement of the peritoneum during these activities.

Choice D reason:

Administering prescribed analgesics is essential for managing the client's pain and providing comfort during the treatment of peritonitis.

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A nurse is caring for a client with peritonitis who is at risk of developing abdominal compartment syndrome. Which assessment finding should the nurse be most concerned about?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with peritonitis and observes a rigid, board-like abdomen upon palpation. The nurse recognizes this finding as:

Correct Answer is D

Explanation

A client with peritonitis is experiencing severe abdominal pain. The nurse recognizes that this pain may be exacerbated by which factor?

Correct Answer is C

Explanation

A nurse is assessing a client with suspected peritonitis. Which clinical finding is a hallmark sign of this condition?

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