What symptom indicates potential perforation of an ulcer in a client with Peptic Ulcer Disease (PUD)? Select all that apply.

The presence of a rigid abdomen is a key indicator of potential perforation of an ulcer in a client with Peptic Ulcer Disease (PUD). When an ulcer perforates, it can lead to the leakage of gastric contents into the abdominal cavity, causing peritonitis. This condition results in inflammation of the peritoneum, which is the lining of the abdominal cavity. As the abdominal muscles react to this inflammation, they tense up, causing the abdomen to feel rigid or board-like upon palpation. This rigidity is a crucial sign that demands immediate medical attention.

In contrast, while other symptoms such as back pain, vomiting, and heartburn may be associated with various gastrointestinal issues, they are not definitive indicators of ulcer perforation. Back pain can occur due to other complications or discomforts. Vomiting might indicate a variety of conditions, including nausea or gastrointestinal obstruction, but it does not specifically suggest perforation unless accompanied by other signs of severe distress. Heartburn is commonly experienced by those with PUD due to acid reflux but does not indicate a perforation. Therefore, the rigidity of the abdomen stands out as the most critical symptom directly linked to ulcer perforation.