# A 68-year-old is admitted for acute uncomplicated diverticulitis with WBC 16,000/uL and persistent left lower quadrant pain. Which nursing actions support recovery and reduce the risk of perforation? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372855&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

A 68-year-old is admitted for acute uncomplicated diverticulitis with WBC 16,000/uL and persistent left lower quadrant pain. Which nursing actions support recovery and reduce the risk of perforation? Select all that apply.

1

Avoid laxatives, enemas, and barium contrast studies during the acute inflammatory phase to prevent mechanical perforation.

2

Maintain bowel rest with clear liquids initially, advance to a low-fiber diet as symptoms improve, and resume a high-fiber diet only after full recovery for long-term prevention.

3

Monitor for sudden severe rigid abdomen, rebound tenderness, fever spike, or hypotension — signs of perforation requiring emergent surgical evaluation.

4

Administer the prescribed broad-spectrum antibiotics covering anaerobes and gram-negative enteric flora (for example, ciprofloxacin plus metronidazole) on schedule.

5

Place a heating pad on the lower left abdomen for 15-20 minutes every 2 hours to relieve pain and muscle tension, as this is a common nursing comfort measure.

## Explanation

Acute diverticulitis nursing priorities: bowel rest with staged dietary advancement, scheduled broad-spectrum antibiotics, avoidance of mechanical interventions (enemas/laxatives/barium) that can perforate inflamed diverticula, and vigilant monitoring for perforation signs (rigid abdomen, rebound, fever spike, hypotension). Choice 5 is wrong — local heat to an inflamed/infected area can worsen vasodilation, accelerate inflammation, and potentially obscure the perforation pain pattern; cold may be safer if anything, but the standard answer is to avoid heat in acute abdomen.

## In-depth explanation

The "no enemas, no barium, no laxatives" rule for acute diverticulitis is a classic NCLEX setup — the inflamed diverticulum is one increased-pressure event from perforating. Long-term prevention is high-fiber, but only AFTER the acute phase resolves. Heat to an undiagnosed acute abdomen is the same trap as warming an ischemic limb.

## Clinical scenario

**68-year-old admitted with acute uncomplicated diverticulitis**. WBC **16,000/uL**, low-grade fever, persistent **LLQ pain**, mild guarding without rebound. CT showed sigmoid diverticulitis without abscess or free air.

## Key concepts

- **Diverticulitis** — Inflammation/microperforation of colonic diverticula, most often sigmoid, presenting as LLQ pain, fever, leukocytosis.
- **Bowel rest** — Clear liquids initially, advancing to low-fiber, then high-fiber after full recovery; reduces colonic pressure during inflammation.
- **Perforation warning signs** — Rigid abdomen, rebound tenderness, fever spike, hypotension — emergent surgical consultation indicated.

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