A patient with appendicitis has a rigid (board-like) abdomen, fever, tenderness, and hypotension. Which action taken by a student nurse should be intervened (stopped) by the senior nurse?

1. A

   Rectal enema

2. B

   Administering antibiotics

3. C

   IV fluids

4. D

   Pain assessment

Appeared in: NORCET 10 Mains

Explanation

Listen in Hindi

• The patient's signs (rigid abdomen, fever, hypotension) point to a ruptured appendix and peritonitis, a surgical emergency.
• Administering a rectal enema is strictly contraindicated in this situation.
• Enemas increase intra-abdominal pressure and bowel motility (peristalsis).
• This increased pressure can cause a non-ruptured, inflamed appendix to perforate or can spread existing infectious material from a ruptured appendix throughout the peritoneal cavity.
• Spreading the infection leads to generalized peritonitis and sepsis, which has a high mortality rate.

Why Other Options Were Wrong

• Option B: This is a necessary and life-saving action. The patient has signs of a severe infection (peritonitis/sepsis), and broad-spectrum antibiotics must be started immediately to control it.
• Option C: This is a critical intervention. Hypotension (low blood pressure) is a sign of shock, likely due to sepsis and fluid shifting. IV fluids are required immediately to restore blood volume and maintain organ perfusion.
• Option D: This is a fundamental nursing assessment. Regular pain assessment is essential to monitor the patient's condition. A sudden change in pain (e.g., a sudden decrease) could indicate appendix perforation and must be noted and reported.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Contraindications in the management of complicated appendicitis (peritonitis) to guide bedside assessment, documentation, and the next nursing action.
• A key nursing responsibility is to recognize signs of a deteriorating patient, such as the development of peritonitis from appendicitis.
• Nurses must act as a safety barrier, questioning and stopping any intervention—even if ordered—that could harm the patient, such as giving an enema in suspected appendicitis.
• What if? If the patient had only mild, localized right lower quadrant pain without fever, rigidity, or hypotension (uncomplicated appendicitis), an enema would still be avoided due to the risk of stimulating a rupture. The absolute contraindication is strongest in cases of suspected perforation.

How to Approach the Question

• First, identify this as a negative-stem question by noticing the keywords 'intervened (stopped)'. This means you are looking for the incorrect or harmful action.
• Next, analyze the clinical cues in the stem: 'appendicitis', 'rigid (board-like) abdomen', 'fever', 'hypotension'. Synthesize these to form a clinical picture: this is not simple appendicitis; it is complicated by a likely rupture and peritonitis, a life-threatening condition.
• Evaluate each option in the context of peritonitis. Ask yourself for each option: 'Would this action help or harm a patient with a ruptured appendix?'
• Option A (Rectal enema): Consider the effect of an enema. It increases pressure and movement in the bowel. This would likely spread infection. This is harmful.
• Option B (Antibiotics): Peritonitis is a severe infection. Antibiotics are essential. This is helpful.
• Option C (IV fluids): The patient is hypotensive (shock). IV fluids are essential to treat shock. This is helpful.

Concept Tested & Keywords

• Concept Tested: Contraindications in the management of complicated appendicitis (peritonitis).
• Stem keywords: appendicitis, rigid (board-like) abdomen, fever, hypotension, intervened (stopped)
• Lead-in keywords: Which action...should be intervened (stopped)
• Clinical cues: The combination of rigid abdomen, fever, and hypotension strongly suggests a complication like peritonitis from a ruptured appendix, which elevates the urgency and changes management priorities.
• Negative lead-in flag: The question asks for an action that should be stopped, indicating a search for a contraindicated or harmful intervention.

Question ID

Q_RABiuzHblo3EUKS8ase_

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 184-186

E6 Medicine Harrison 22e Part 2 p. 500-502