AACN CCRN-Adult Exam - Topic 1 Question 4 Discussion

Actual exam question for AACN's CCRN-Adult exam

Question #: 4
Topic #: 1

A patient is experiencing lower left quadrant pain with guarding, as well as abdominal distention and rigidity. KUB reveals free air in the abdominal

cavity. Vital signs are:

BP 76/40

HR 130

RR 32

T 101.7 F (38.7C)

A nurse would suspect

Aperforated bowel.

Bparalytic ileus.

Cappendicitis.

Dacute pancreatitis.

Show Suggested Answer

Suggested Answer: A

The clinical presentation of lower left quadrant pain with guarding, abdominal distention, rigidity, and free air in the abdominal cavity on a KUB (kidney, ureter, and bladder) radiograph strongly suggests a perforated bowel. The presence of free air indicates that there is a breach in the gastrointestinal tract, allowing air to escape into the peritoneal cavity. The patient's vital signs, including hypotension (BP 76/40), tachycardia (HR 130), tachypnea (RR 32), and fever (T 101.7F), are consistent with sepsis and shock, which are common complications of bowel perforation. Reference: CCRN Exam Handbook, AACN, page 30, section on Gastrointestinal.

by Bulah at Mar 08, 2025, 05:15 AM

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Junita

3 months ago

Definitely a perforation, the guarding is a big clue!

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Dallas

3 months ago

Free air? That’s pretty serious, not sure about the other options.

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Micheline

3 months ago

Wait, could it be appendicitis instead?

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Laurene

4 months ago

Totally agree, those vital signs are concerning.

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Clemencia

4 months ago

Sounds like a perforated bowel to me.

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Afton

4 months ago

I thought paralytic ileus could cause distention too, but the free air makes me lean towards perforation.

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Belen

4 months ago

I practiced a similar question about appendicitis, but this case seems more severe with the guarding and free air.

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Janessa

4 months ago

I'm not entirely sure, but I feel like the vital signs suggest shock, which could align with a perforated bowel, right?

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Truman

5 months ago

I remember studying about abdominal pain and guarding, and I think free air in the cavity usually indicates perforation.

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Paris

5 months ago

Yikes, this patient is in rough shape with those vital signs. I'm going to go with perforated bowel since that seems to fit the clinical presentation the best. Gotta act fast on this one.

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Veronica

5 months ago

The free air and abdominal distention and rigidity make me think perforated bowel is the most likely diagnosis. I'll focus on that as my primary answer, but I'll also make sure to review the other options just in case.

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Alesia

5 months ago

Hmm, I'm a little unsure here. The symptoms could also point to appendicitis or even pancreatitis. I'll need to carefully weigh the evidence before selecting an answer.

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Felix

5 months ago

Okay, this looks like a classic case of a perforated bowel based on the free air in the abdomen and the patient's vital signs. I'm pretty confident this is the right answer.

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Lacresha

11 months ago

I don't think so, the free air in the abdominal cavity suggests perforated bowel.

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Minna

11 months ago

I'm just going to go with option A and hope for the best. Perforated bowel sounds dramatic, but at least it's not something boring like appendicitis. Who wants to be the nurse that misses a major abdominal catastrophe, am I right?

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Evangelina

11 months ago

User 3: Definitely need to act fast on this one.

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Adolph

11 months ago

User 2: Yeah, that sounds serious.

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Charlie

11 months ago

User 1: I think it's perforated bowel.

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Anglea

11 months ago

But could it also be acute pancreatitis?

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Nakita

12 months ago

This is a tough one, but I'm leaning towards paralytic ileus. The distention and rigidity could be due to a blockage in the intestines. Plus, the nurse would definitely suspect this, right? It's the most obscure answer, so it must be correct.

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Shelia

12 months ago

Hmm, I'm not so sure. The combination of symptoms makes me think it could be acute pancreatitis. The fever and low blood pressure are concerning, though. I'll go with that just to be different.

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Laine

11 months ago

I suspect acute pancreatitis.

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Laila

11 months ago

I believe it might be appendicitis.

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Cecilia

11 months ago

I'm leaning towards paralytic ileus.

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Santos

11 months ago

I think it's a perforated bowel.

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Azzie

12 months ago

I agree, the symptoms and vital signs point towards that.

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Irma

12 months ago

I'm going with appendicitis. The lower left quadrant pain and guarding are classic signs. Maybe the patient just had a big meal and that's why there's distention and rigidity.

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Pamella

12 months ago

Definitely a perforated bowel. The free air in the abdomen and the patient's vital signs point to a serious abdominal emergency. This is a no-brainer.

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Chauncey

11 months ago

Definitely a perforated bowel. The free air in the abdomen and the patient's vital signs point to a serious abdominal emergency. This is a no-brainer.

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Lashon

12 months ago

A) perforated bowel.

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Filiberto

12 months ago

I think the patient might have a perforated bowel.

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