A nurse is assessing a child diagnosed with appendicitis.Which finding requires immediate intervention?

Choice A rationaleA high elevation in the white blood cell count, or leukocytosis, is an expected inflammatory response in appendicitis. While an elevated WBC count (normal range typically 4,500 to 11,000 cells/mcL) indicates infection or inflammation, it does not necessarily signal immediate, life-threatening complications requiring immediate intervention.Choice B rationaleGuarding, which is the tensing of abdominal muscles upon palpation, and rebound tenderness, pain that worsens when pressure is released, are classic signs of peritoneal irritation associated with appendicitis. These findings suggest inflammation of the peritoneum but do not indicate an immediate, critical emergency in the same way as sudden pain relief.Choice C rationaleSudden relief of pain in a child with appendicitis, followed by a rigid abdomen and fever, is a critical sign of a ruptured appendix and subsequent peritonitis. The rupture releases the pressure causing the initial pain, but the spillage of bowel contents leads to widespread inflammation of the peritoneum, a serious and potentially life-threatening condition requiring immediate surgical intervention to prevent sepsis and other complications.Choice D rationaleAbdominal tenderness in the right lower quadrant (RLQ), often referred to as McBurney's point, is a characteristic finding in appendicitis due to the inflammation of the appendix in this anatomical location. While it warrants investigation and treatment, localized tenderness alone does not indicate an immediate, life-threatening complication.