A client with acute pancreatitis presents with a board-like abdomen, guarding and absent bowel sounds. What should the nurse be most concerned about?

Rationale: A. While pleural effusion can occur in acute pancreatitis due to inflammation and fluid shifts, it typically presents with respiratory symptoms such as shortness of breath or decreased breath sounds. It does not directly cause a board-like abdomen, severe guarding, or absent bowel sounds. B. Bowel obstruction can cause abdominal distention and absent bowel sounds, but it usually presents with colicky pain, vomiting, and sometimes constipation. A rigid, board-like abdomen and severe guarding suggest a more acute and dangerous intra-abdominal process. C. A board-like abdomen, severe guarding, and absent bowel sounds are classic signs of peritonitis, which may result from a pancreatic abscess or rupture. This is a life-threatening complication of acute pancreatitis that requires immediate attention, often surgical intervention. The nurse should recognize these signs as an emergency. D. Paralytic ileus can cause absent bowel sounds and abdominal distention, but it usually does not cause severe localized tenderness or a rigid, board-like abdomen. It is serious but less immediately life-threatening than peritonitis from a pancreatic abscess.