Two days after an appendectomy, a patient complains of abdominal distension and discomfort. On assessment, the abdomen is distended with a hard, board-like rigidity. What is the most appropriate action by the nurse?

Appeared in: NORCET 10 Prelims-2026

Explanation

The patient's assessment findings—abdominal distension and a hard, board-like rigidity—are classic signs of peritonitis, an inflammation of the abdominal lining.
Peritonitis following an appendectomy is often due to leakage of infectious material and is considered a life-threatening surgical emergency.
The nurse's priority action is to recognize these critical findings and escalate care by immediately informing the physician for urgent intervention to prevent sepsis and other fatal complications.

Option B: This action delays critical, life-saving intervention. While documentation is a key nursing responsibility, it must not precede acting on emergent patient findings.
Option C: Administering pain medication can mask the worsening of symptoms, which are vital for diagnosing and monitoring the progression of peritonitis. The underlying cause must be addressed first.
Option D: This is contraindicated. Patients with suspected peritonitis are made NPO (nothing by mouth) in preparation for potential emergency surgery and to reduce the risk of aspiration.

Visual 1: Illustration: A diagram showing the inflamed peritoneum in peritonitis, contrasting it with a healthy abdomen.
Visual 2: Flowchart: A decision-making flowchart for nurses on assessing postoperative abdominal pain, differentiating between expected pain and signs of complications like peritonitis, and the appropriate actions for each pathway.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Recognition and immediate management of post-surgical complications, specifically peritonitis in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Recognizing a 'board-like' abdomen as a red flag for peritonitis is a critical nursing competency. Immediate escalation can be the difference between recovery and mortality from sepsis.
In any post-abdominal surgery patient, the nurse must have a high index of suspicion for complications. A change from a soft abdomen to a rigid one is a major warning sign.
What if? If the patient's abdomen was distended but soft, with audible bowel sounds, and the patient was complaining of 'gas pains', the most appropriate action would be to encourage ambulation and repositioning, as this is a common and less critical postoperative issue.

How to Approach the Question

Identify the patient's context: Two days post-appendectomy.
Analyze the key assessment findings: 'abdominal distension' and 'hard, board-like rigidity'.
Recognize that 'hard, board-like rigidity' is a specific, classic sign of a severe complication (peritonitis), not just general discomfort.
Frame the question as a priority-setting problem: What is the most important, immediate action in a life-threatening situation?
Evaluate the options based on the principle of 'do no harm' and urgency. Rule out options that delay care (document/observe), mask symptoms (pain meds), or are contraindicated (oral fluids).
Select the option that involves escalating care to the provider who can order definitive diagnostic tests and treatment, which is informing the doctor.

Concept Tested & Keywords

Concept Tested: Recognition and immediate management of post-surgical complications, specifically peritonitis.
Stem keywords: appendectomy, abdominal distension, discomfort, hard, board-like rigidity
Lead-in keywords: most appropriate action
Clinical cues: Two days after an appendectomy: This timeframe is critical for the development of complications like infection or peritonitis.
Clinical cues: Hard, board-like rigidity: This is a cardinal sign of peritonitis, indicating a surgical emergency.

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Attempt every question from this paper in a timed mock, then review the full solution for each one.