BCEN CEN Practice Question

The correct answer is the presence of distant free intraperitoneal air on imaging. While all options are concerning findings in bowel perforation, distant free air is the most specific indicator for emergent surgical intervention. It suggests a large perforation that is unlikely to respond to conservative management. Leukocytosis and elevated lactate, though important, can be seen in various conditions and don't necessarily indicate the need for immediate surgery. Localized peritonitis may sometimes be managed conservatively, especially in diverticulitis-related microperforation. Fluid collection alone might be managed with percutaneous drainage in some cases. Understanding these nuances is crucial for emergency nurses in properly triaging and preparing patients for potential emergent surgery.