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?

1. A

   Inform the doctor for immediate intervention

2. B

   Document the findings and continue observation

3. C

   Administer prescribed pain medication

4. D

   Encourage oral fluid intake

Appeared in: NORCET 10 Prelims-2026

Explanation

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• The patient's presentation of a hard, board-like abdomen is a classic sign of peritonitis, which is inflammation of the peritoneum.
• Peritonitis is a life-threatening surgical emergency that can rapidly progress to sepsis and shock.
• The nurse's priority responsibility is to recognize these critical assessment findings and escalate care by immediately notifying the physician or surgeon.
• Prompt intervention is crucial to prevent severe morbidity and mortality.

Why Other Options Were Wrong

• Option B: This action delays critical, life-saving intervention. While documentation is essential, it should never precede or replace immediate escalation for a life-threatening condition.
• Option C: Administering pain medication can mask the cardinal signs of peritonitis, such as abdominal rigidity and tenderness. This would obscure the clinical picture and delay diagnosis.
• Option D: A patient with suspected peritonitis should be kept NPO (nothing by mouth). Oral intake can increase abdominal distension, pain, and the risk of aspiration, especially if emergency surgery is required.

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Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Post-operative complications and nursing priorities in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Recognizing signs of peritonitis is a critical nursing skill in post-operative care. A 'board-like' abdomen is a textbook 'red flag' that requires immediate escalation.
• Patient safety is compromised when a nurse fails to act on critical assessment data. The 'assess, diagnose, plan, implement, evaluate' (ADPIE) process requires the nurse to not just collect data but to interpret it and act accordingly.
• What if? If the patient's abdomen was distended but soft, with diminished bowel sounds, the nurse might suspect a paralytic ileus. The action would still be to notify the doctor, but the urgency level, while high, is different from the surgical emergency of peritonitis. The initial interventions might focus on NPO status and potential nasogastric tube placement rather than immediate surgery.

How to Approach the Question

• First, identify the patient's context: They are two days post-appendectomy, a period with a high risk for specific complications.
• Next, analyze the key assessment findings: 'abdominal distension' and 'hard, board-like rigidity'.
• Recognize that 'hard, board-like rigidity' is a critical, hallmark sign of a severe complication, specifically peritonitis.
• Evaluate the options based on the urgency and safety principles. The situation is a medical emergency.
• The most appropriate action in an emergency is to escalate to a provider who can order definitive treatment. Therefore, informing the doctor is the priority.
• Eliminate other options: Documenting and observing is a delay, giving pain medication masks symptoms, and giving fluids is contraindicated and dangerous.

Concept Tested & Keywords

• Concept Tested: Post-operative complications and nursing priorities
• Stem keywords: appendectomy, abdominal distension, discomfort, hard, board-like rigidity
• Lead-in keywords: most appropriate action
• Clinical cues: The timeline of 'Two days after an appendectomy' is significant for identifying post-operative complications.
• Clinical cues: The assessment finding of 'hard, board-like rigidity' is a critical red flag for peritonitis.

Question ID

Qzjru67rbnh1s-4bjFvNq

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 129-131