Diagnostic Evaluation

The diagnosis of peritonitis is based on the following:

- History and physical examination- The patient may present with signs and symptoms such as abdominal pain, tenderness, rigidity, distension, fever, tachycardia, nausea, vomiting, anorexia, and altered bowel sounds. The pain may be diffuse or localized depending on the extent and location of the inflammation. The patient may also have a history of GI disorders, abdominal surgery, trauma, or peritoneal dialysis.

- Laboratory tests- The white blood cell (WBC) count is usually elevated, indicating infection and inflammation. The serum electrolyte levels may be abnormal due to fluid and electrolyte imbalance. The blood urea nitrogen (BUN) and creatinine levels may be increased due to renal impairment. The blood culture may identify the causative organism of the infection.

- Imaging studies- The abdominal X-ray may show air-fluid levels, indicating intestinal obstruction or perforation. The abdominal ultrasound or computed tomography (CT) scan may reveal fluid accumulation, abscess formation, or organ involvement.

- Paracentesis: involves inserting a needle into the peritoneal cavity and withdrawing fluid for analysis. The fluid is examined for appearance, cell count, protein level, and glucose level.

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Questions on Diagnostic Evaluation

Correct Answer is C

Explanation

Diverticulitis is inflammation of the diverticula (small pouches) in the colon and is not related to a ruptured appendix.

Correct Answer is D

Explanation

Sudden-onset severe abdominal pain and tenderness are classic early signs of peritonitis and indicate the need for immediate medical attention.

Correct Answer is C

Explanation

A CBC may show elevated white blood cell count, which is an indication of infection, but it is not a confirmatory test for peritonitis.

Correct Answer is C

Explanation

Bradycardia is not a common side effect of IV antibiotic therapy.

Correct Answer is B

Explanation

Monitoring intra-abdominal pressure is not the purpose of a paracentesis.

Correct Answer is A

Explanation

Bowel rest may be indicated for other conditions but is not the primary intervention for SBP.

Correct Answer is A

Explanation

Constipation may cause abdominal distension, but decreased bowel sounds are not characteristic of constipation.

Correct Answer is D

Explanation

Rapid, shallow breathing is a common early sign of septic shock and indicates the body's attempt to compensate for the decreased cardiac output.

Correct Answer is C

Explanation

A vegetarian diet is not a risk factor for peritonitis.

Correct Answer is D

Explanation

A history of inflammatory bowel disease is a significant risk factor for peritonitis, especially if there are complications such as bowel perforation.

Correct Answer is B

Explanation

GERD is not a risk factor for peritonitis.

Correct Answer is B

Explanation

Chronic lung disease is not directly related to peritonitis.

Correct Answer is C

Explanation

Oral contraceptives do not increase the risk of developing peritonitis.

Correct Answer is A

Explanation

An allergic reaction to the dialysis solution is a possibility but is not the primary reason for an increased risk of peritonitis in clients undergoing peritoneal dialysis.

Correct Answer is C

Explanation

Frequent use of antacids may alleviate symptoms of gastric ulcers but is not directly related to an increased risk of peritonitis in clients with perforated gastric ulcers.

Correct Answer is B

Explanation

Reduced gastrointestinal motility is a normal age-related change but is not directly related to an increased susceptibility to peritonitis in older adults.

Correct Answer is C

Explanation

Shortness of breath is not a common symptom of peritonitis unless there is an associated respiratory complication.

Correct Answer is D

Explanation

The client's elevated temperature, rapid heart rate, and shallow breathing are indicative of a systemic inflammatory response, which is a characteristic feature of peritonitis.

Correct Answer is D

Explanation

The finding of a rigid, board-like abdomen upon palpation is known as guarding, which is a protective response of the abdominal muscles in peritonitis to minimize movement and protect the inflamed peritoneum.

Correct Answer is B

Explanation

Radiating pain is pain that extends from its source to other areas, and it is not specifically described in the scenario.

Correct Answer is B

Explanation

Urinary retention involves the inability to empty the bladder fully and is not related to the findings described in the scenario.

Correct Answer is B

Explanation

Dehydration may result in elevated blood cell counts due to hemoconcentration, but it is not the primary cause of an elevated white blood cell count in peritonitis.

Correct Answer is C

Explanation

Respiratory distress is not directly related to the findings described in the scenario.

Correct Answer is C

Explanation

Renal failure involves impaired kidney function and may present with specific signs, but it is not directly related to the signs described in the scenario.

An abdominal computed tomography (CT) scan is a valuable diagnostic tool for identifying signs of inflammation and infection in the peritoneal cavity, aiding in the confirmation of peritonitis.

Taking a tissue sample from the peritoneal lining is not the purpose of diagnostic paracentesis.

Ultrasonography can provide images of the abdominal organs, but it may not offer the level of detail provided by MRI in assessing peritonitis.

An elevated white blood cell count (WBC) is a common finding in peritonitis, indicating an inflammatory response and possible infection in the peritoneal cavity.

Hyperactive bowel sounds may occur with gastrointestinal disorders but are not specific to peritonitis.

Pancreatitis is inflammation of the pancreas and may cause abdominal pain, but it is not associated with generalized bloating and distension of the abdomen.

Evaluating lung health would involve pulmonary imaging, not the imaging indicated for peritonitis.

Removal of fluid from the spinal canal would be a lumbar puncture, not a paracentesis.

Encouraging deep breathing and coughing exercises is beneficial for preventing respiratory complications, but it is not the highest priority compared to addressing the infection with antibiotics.

Implementing fall precautions is important for clients at risk of falls, but it is not directly related to potential complications of peritonitis.

Administering prescribed analgesics is essential for managing the client's pain and providing comfort during the treatment of peritonitis.

Administering the antibiotics through a peripheral IV catheter may not be suitable for the client's condition, as peritonitis may necessitate the use of a central line for administration of IV medications.

Promoting bowel rest is the main purpose of continuous gastric suction in the management of peritonitis. By reducing the workload of the gastrointestinal tract, the inflamed peritoneum can heal and recover more effectively.

Restoring fluid balance is a goal of fluid resuscitation, but the primary focus is on preventing circulatory collapse and ensuring adequate tissue perfusion.

Diarrhea is not a common side effect of opioid use in clients with peritonitis.

Using a heating pad for abdominal pain relief may not be recommended for all clients recovering from peritonitis, as it may exacerbate inflammation or lead to complications. Individualized pain management strategies should be discussed with the healthcare provider.

Providing deep breathing exercises is important for preventing respiratory complications, but it is not the highest priority compared to addressing sepsis with antibiotics.

Mild incisional pain is expected after surgery, but it does not indicate the development of abdominal compartment syndrome.

Maintaining fluid and electrolyte balance is crucial in managing acute kidney injury in peritonitis. The nurse should closely monitor the client's fluid intake, output, and electrolyte levels and collaborate with the healthcare team to adjust the fluid therapy as needed.

Gastrointestinal bleeding may present with symptoms such as melena or hematemesis but is not directly associated with hypotension and tachycardia.

Administering enteral nutrition may be a secondary purpose of an NG tube in some cases, but it is not the primary goal in clients with peritonitis.

Administering bronchodilator medication is not the priority intervention in managing acute respiratory distress unless there is a specific indication for its use.

<p>Increased urine output may be a positive finding but does not directly relate to the development of hypovolemic shock.</p>

<p>Providing pain medication as needed is important for the client's comfort but does not directly prevent the spread of infection.</p>

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Diagnostic Evaluation

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client presents to the emergency department with severe abdominal pain, tenderness, and fever. The client reports a recent history of ruptured appendix. The nurse suspects the client may be experiencing: A Cholecystitis B Gastritis C Peritonitis D Diverticulitis Click to see answer

Correct Answer is C

Explanation

Correct Answer is D

Explanation

A client with a history of appendectomy develops peritonitis. The nurse anticipates which diagnostic test to confirm the diagnosis? A Chest X-ray B Electrocardiogram (ECG) C Abdominal ultrasound D Complete blood count (CBC) Click to see answer

Correct Answer is C

Explanation

A client with peritonitis is receiving intravenous (IV) antibiotics. The nurse should monitor the client for which potential side effect of antibiotic therapy? A Hypertension B Hypoglycemia C Allergic reaction D Bradycardia Click to see answer

Correct Answer is C

Explanation

Correct Answer is B

Explanation

A client is diagnosed with spontaneous bacterial peritonitis (SBP). The nurse anticipates the need for which medical intervention? A Intravenous (IV) antibiotics B A high-protein diet C Oral rehydration solutions D Bowel rest Click to see answer

Correct Answer is A

Explanation

A client with peritonitis is experiencing abdominal distension and decreased bowel sounds. The nurse suspects the presence of: A Paralytic ileus B Gastroenteritis C Appendicitis D Constipation Click to see answer

Correct Answer is A

Explanation

A client with peritonitis is at risk of developing septic shock. Which clinical manifestation should the nurse closely monitor to detect early signs of septic shock? A Increased blood pressure B Bradycardia C Warm, flushed skin D Rapid, shallow breathing Click to see answer

Correct Answer is D

Explanation

Correct Answer is C

Explanation

Correct Answer is D

Explanation

Correct Answer is B

Explanation

Correct Answer is B

Explanation

Correct Answer is C

Explanation

A client is undergoing peritoneal dialysis. The nurse recognizes that this client is at an increased risk of developing peritonitis due to: A Infection at the insertion site B High blood pressure C Elevated cholesterol levels D Allergic reaction to the dialysis solution Click to see answer

Correct Answer is A

Explanation

A nurse is caring for a client with a recent perforated gastric ulcer. The nurse identifies that the client is at risk of developing peritonitis due to: A Excessive alcohol consumption B Sedentary lifestyle C Gastric acid hypersecretion D Frequent use of antacids Click to see answer

Correct Answer is C

Explanation

Correct Answer is B

Explanation

A nurse is assessing a client with suspected peritonitis. Which symptom should the nurse expect the client to report? A Chest pain B Severe headache C Abdominal pain and tenderness D Shortness of breath Click to see answer

Correct Answer is C

Explanation

A client with peritonitis presents with an elevated temperature, rapid heart rate, and shallow breathing. The nurse recognizes these signs as indicative of: A Hypothermia B Hypertension C Hyperventilation D Systemic inflammatory response Click to see answer

Correct Answer is D

Explanation

A nurse is caring for a client with peritonitis and observes a rigid, board-like abdomen upon palpation. The nurse recognizes this finding as: A Rebound tenderness B Paralytic ileus C Abdominal compartment syndrome D Guarding Click to see answer

Correct Answer is D

Explanation

A client with peritonitis reports experiencing sharp, sudden-onset pain that worsens with movement. The nurse recognizes this type of pain as: A Referred pain B Visceral pain C Neuropathic pain D Radiating pain Click to see answer

Correct Answer is B

Explanation

A client with peritonitis experiences abdominal distension and decreased bowel sounds on auscultation. The nurse recognizes these findings as suggestive of: A Hypovolemic shock B Paralytic ileus C Intestinal obstruction D Urinary retention Click to see answer

Correct Answer is B

Explanation

A client with peritonitis develops an elevated white blood cell count. The nurse recognizes this laboratory finding as indicative of: A Anemia B Infection C Hypoalbuminemia D Dehydration Click to see answer

Correct Answer is B

Explanation

A nurse caring for a client with peritonitis observes the client assuming a fetal position and exhibiting restlessness. The nurse interprets these behaviors as indicative of: A Anxiety B Fatigue C Pain D Respiratory distress Click to see answer

Correct Answer is C

Explanation

A client with peritonitis develops a high fever, chills, and profuse sweating. The nurse recognizes these signs as indicative of: A Hypoglycemia B Hyperthyroidism C Sepsis D Renal failure Click to see answer

Correct Answer is C

Explanation

A nurse is assessing a client suspected of having peritonitis. Which diagnostic test is most likely to be performed to confirm the diagnosis? A Electrocardiogram (ECG) B Complete blood count (CBC) C Chest X-ray D Abdominal computed tomography (CT) scan Click to see answer

A nurse is assessing a client with suspected peritonitis. Which clinical finding is a hallmark sign of this condition? A Severe headache and neck stiffness B Rapid and shallow breathing C Abdominal rigidity and tenderness D Hyperactive bowel sounds Click to see answer

A client with peritonitis is experiencing severe abdominal pain. The nurse assesses the client's abdomen and notes that it appears bloated and distended. The nurse recognizes this as a potential sign of: A Ascites B Intestinal obstruction C Appendicitis D Pancreatitis Click to see answer

A client with peritonitis is undergoing diagnostic imaging. The nurse explains to the client that the purpose of this imaging is to: A Assess heart function B Identify bone fractures C Detect inflammation and infection in the peritoneum D Evaluate lung health Click to see answer

A client with peritonitis is experiencing severe abdominal pain. The nurse recognizes that this pain may be exacerbated by which factor? A Lying flat in bed B Using a heating pad on the abdomen C Deep breathing and coughing D Administering prescribed analgesics Click to see answer

A client with peritonitis is prescribed continuous gastric suction. The nurse understands that this intervention is essential to: A Prevent aspiration pneumonia B Reduce intra-abdominal pressure C Manage pain and discomfort D Promote bowel rest Click to see answer

A client with peritonitis is prescribed intravenous (IV) fluid resuscitation. The nurse understands that the primary goal of fluid resuscitation is to: A Correct electrolyte imbalances B Prevent circulatory collapse C Maintain adequate urine output D Restore fluid balance Click to see answer

A client with peritonitis is prescribed intravenous (IV) opioids for pain management. The nurse closely monitors the client for which potential side effect? A Bradycardia B Hypertension C Respiratory depression D Diarrhea Click to see answer

A client with peritonitis develops hypotension and tachycardia. The nurse recognizes these signs as possible indications of which complication? A Abdominal compartment syndrome B Respiratory distress syndrome C Sepsis D Gastrointestinal bleeding Click to see answer

A client with peritonitis is prescribed a nasogastric (NG) tube for decompression. The nurse understands that the primary purpose of the NG tube is to: A Prevent aspiration pneumonia B Relieve abdominal distension C Monitor gastric pH levels D Administer enteral nutrition Click to see answer

A client with peritonitis is at risk of developing hypovolemic shock. Which assessment finding should the nurse be most concerned about? A Bradycardia B Hypotension C bowel sounds D Increased urine output Click to see answer

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