Nokea
A client was brought to the school clinic wuth severe, constant, localized abdominal pain. Abdominal muscles are rigid, and rebound tenderness is present. Peritonitis is suspected. The client is hypotensive and tachycardic. The nursing diagnosis most appropriate to the client's signs/symptoms is:
Correct Answer: A
Rationale: The client's signs and symptoms point towards a diagnosis of peritonitis, which is an inflammation of the peritoneum lining the abdominal cavity. The presence of severe, constant abdominal pain, rigid abdominal muscles, rebound tenderness, hypotension, and tachycardia are all indicative of peritonitis. These symptoms are typically seen when there is an infection or inflammation in the abdominal cavity, leading to fluid shifting from the intravascular space to the peritoneal cavity. This shifting of fluid results in hypovolemia, causing hypotension and tachycardia.