A 17-year-old female client is brought to the emergency department (ED) by her mother. She reports dull pain around the umbilicus

A 17-year-old female client is brought to the emergency department (ED) by her mother. She reports dull pain around the umbilicus, which started 20 minutes ago. She has had constant nausea since the pain started. 1728 Client vomits; she tells the nurse her pain was worse right before she vomited. 1735 BP: 118/76 mm Hg HR: 98 bpm RR: 20 breaths/min. pO2: 97% Temp.: 100.2oF (37.9oC) 1738 Client tells the nurse her pain is now more severe, sharp and colicky, and localized to her right lower abdomen. 1740 Client has guarding with even light palpation of the abdomen; abdomen is stiff. She has rebound tenderness to the right lower quadrant.