Answer :
Final answer:
E. Admit the patient, order NPO status, start intravenous (IV) infusion. Postpone surgery until the WBC is greater than 16,000 or her abdomen becomes rigid.
Explanation:
The clinical presentation of a 16-year-old girl with abdominal discomfort, localized right lower quadrant pain, nausea, vomiting, tenderness upon palpation, and an elevated white blood cell count (13,000) is highly suggestive of acute appendicitis. Appendicitis is a medical emergency that often requires surgical intervention, and the next step in the management of this patient should involve hospital admission and careful monitoring.
Option E is the most appropriate choice. It recommends admitting the patient, initiating NPO (nothing by mouth) status to prepare for possible surgery, and starting an intravenous (IV) infusion. Surgery is typically the primary treatment for acute appendicitis, but the decision to operate can be influenced by factors like the patient's clinical condition and white blood cell count. Generally, surgery is considered when the white blood cell count is greater than 10,000, which is the case here. Postponing surgery until the white blood cell count exceeds 16,000 or the abdomen becomes rigid would not be advisable, as the patient's condition may deteriorate further.
The other options are not appropriate. Option A suggests observing the patient until the abdomen becomes rigid, which may result in a delay in necessary treatment. Options B and C (performing a colonoscopy or sending the patient home with instructions to return in 24 hours) are not indicated in this context, as acute appendicitis is a surgical condition. Option D, obtaining a CT scan, may provide additional diagnostic information but should not delay hospital admission for this patient with a high clinical suspicion of appendicitis.
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