Free BCEN Certified Emergency Nurse (CEN) Practice Question

In a patient with polycystic ovarian syndrome, the presence of an adnexal mass along with acute onset pain and hemoperitoneum (suggested by free fluid in the pelvis) indicates a high likelihood of ovarian cyst rupture with associated bleeding. Although ovarian torsion can also present with acute pain and an adnexal mass, the stable vital signs and the absence of nausea/vomiting make torsion less likely. Ectopic pregnancy is a possibility given the presence of vaginal spotting and acute pain, but would typically include positive pregnancy test findings, not provided in this scenario. Lastly, appendicitis typically presents with abdominal pain that originally occurs around the umbilicus and then migrates to the right lower quadrant, often accompanied by symptoms like nausea or loss of appetite.