A nurse working in a hospital included abdominal assessment as part of patient assessment. In which patient would a nurse expect to find decreased or absent bowel sounds after listening for 5 minutes?

Choice A reason: Offering the bedpan every 2 hours does not directly stimulate peristalsis. While regular toileting may prevent constipation, it lacks the mechanical or physiological stimulus needed to enhance bowel motility, especially in postoperative patients at risk for paralytic ileus.

Choice B reason: Ambulation promotes peristalsis by stimulating abdominal muscles and increasing intra-abdominal pressure, which encourages bowel motility. Early mobilization post-surgery enhances blood flow to the gastrointestinal tract, reducing the risk of paralytic ileus by counteracting slowed motility from anesthesia or immobility.

Choice C reason: Increasing protein intake supports tissue repair but does not directly stimulate peristalsis. Protein metabolism may increase stool bulk over time, but it lacks the immediate mechanical or neural stimulation needed to prevent or treat paralytic ileus in the postoperative period.

Choice D reason: Decreasing fluid intake can worsen bowel motility by reducing stool hydration, leading to harder stools and increased risk of constipation. Adequate hydration is essential for maintaining soft stool and supporting peristalsis, making this intervention counterproductive.

Choice A reason: Pulling fluid into the bowel describes osmotic laxatives (e.g., lactulose), which increase water content to soften stool and stimulate peristalsis. Bulk-forming agents work by absorbing water to increase stool volume, not by osmotically drawing fluid.

Choice B reason: Bulk-forming agents (e.g., psyllium) absorb water in the intestine, swelling to form a bulky, soft stool that stimulates peristalsis. Taken with adequate water, they promote regular bowel movements, making this the accurate description.

Choice C reason: Softening the fecal mass describes stool softeners (e.g., docusate), which reduce stool surface tension to allow water penetration. Bulk-forming agents primarily increase stool volume, not just soften it, distinguishing their mechanism.

Choice D reason: Causing local irritation describes stimulant laxatives (e.g., bisacodyl), which irritate the mucosa to enhance motility and reduce water absorption. Bulk-forming agents work mechanically by adding bulk, not through chemical irritation.