Which of the following should the nurse expect as the primary initial symptom for a patient with perforated duodenal ulcer?

Appeared in: UP CHO - 2018

Explanation

Perforation of a duodenal ulcer allows acidic gastric and duodenal contents to spill into the sterile peritoneal cavity.
This spillage causes immediate, intense chemical irritation of the peritoneum, a condition known as chemical peritonitis.
The hallmark initial symptom of this event is a sudden, severe, sharp, and generalized abdominal pain.
The patient's abdomen often becomes rigid and board-like on palpation due to involuntary muscle guarding.

Option A: Fever is a systemic response to inflammation or infection (bacterial peritonitis), which develops hours after the initial perforation, not at the moment it occurs.
Option C: Bleeding (hematemesis or melena) is a distinct complication of peptic ulcer disease, not the primary symptom of perforation itself.
Option D: Vomiting is not the primary initial symptom. It can occur as a reaction to the severe pain or as a sign of gastric outlet obstruction, another complication of PUD.

Clinical Relevance

Nursing practice connection: Use the key finding related to Signs and symptoms of peptic ulcer disease complications to guide bedside assessment, documentation, and the next nursing action.
Recognizing the sudden, severe abdominal pain of a perforated ulcer is a critical nursing skill, as it signals a life-threatening surgical emergency requiring immediate action.
The nurse's priority actions are to maintain NPO status, establish large-bore IV access for fluid resuscitation, manage pain, administer antibiotics as ordered, and prepare the patient for emergency surgery.
Failure to act quickly can lead to overwhelming bacterial peritonitis, sepsis, shock, and death.

How to Approach the Question

First, identify the keywords in the question: "primary initial symptom" and "perforated duodenal ulcer."
Focus on the pathophysiology of a perforation: a hole forms in the duodenal wall, leaking irritating contents into the abdomen.
Consider the immediate effect of this leakage. The peritoneum is highly sensitive, and its contact with acidic digestive juices will cause an immediate and severe reaction.
Evaluate the options based on this immediate effect. Sudden, severe pain is the most direct and logical initial symptom.
Differentiate this from other complications or later signs. Fever is a later inflammatory response. Bleeding and obstruction are different complications with their own distinct primary symptoms.
Select the option that represents the most immediate and dramatic consequence of the pathological event described.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 143-145

E6 Medicine Harrison 22e Part 2 p. 426-428

Practise the full UP CHO - 2018

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