Nokea
M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she is afraid it wont go away on its own. She denies any nausea or vomiting, and she cannot remember precisely when her last bowel movement occurred probably it was a few days ago. She reports that she is always constipated. On physical examination, she is tachycardic but otherwise has normal vital signs her abdomen is tensely rigid, but no point tenderness to palpation is appreciated. The entire abdomen percusses as tympanicthere is no distinct dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent. There is rebound tenderness to palpation. The AGACNP suspects
Correct Answer: B
Rationale: The patient's presentation with significant abdominal pain, tachycardia, tensely rigid abdomen, rebound tenderness, hypoactive and intermittent bowel sounds, and tympanic percussion of the entire abdomen is concerning for peritonitis. Peritonitis is inflammation of the peritoneum, which is the lining of the abdominal cavity. It is often caused by an infection or irritation, such as from a perforated bowel, which can lead to the leakage of bowel contents into the peritoneal cavity. The presentation of peritonitis includes severe abdominal pain, guarding, rebound tenderness, abdominal distension, and signs of systemic inflammation like tachycardia and fever. In this case, the lack of point tenderness to palpation and the absence of dullness over the upper quadrants make perforated bowel less likely, while the tense rigidity of the abdomen and rebound tenderness are more suggestive of diffuse peritonitis. Ischem