A nurse is caring for a patient on the third day following abdominal surgery.
The nurse notes the absence of bowel sounds, abdominal distention, and the patient has not passed any flatus. Which postoperative complication is the patient likely experiencing?

Paralytic ileus

Incisional infection

Fecal impaction

Health care-associated Clostridium difficile

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Paralytic ileus is a common postoperative complication that occurs when the normal movement of the intestines (peristalsis) is slowed or stopped. This can lead to a buildup of gas and fluids in the intestines, causing abdominal distention, nausea, vomiting, and constipation. The absence of bowel sounds, abdominal distention, and the inability to pass flatus are all classic signs of paralytic ileus.

Here are some of the factors that can contribute to paralytic ileus: Manipulation of the intestines during surgery

Anesthesia

Pain medications, especially opioids Electrolyte imbalances

Dehydration

Underlying medical conditions, such as diabetes or kidney disease Treatment for paralytic ileus typically involves:

Resting the bowel by not eating or drinking anything by mouth

Using a nasogastric (NG) tube to suction out gas and fluids from the stomach Providing intravenous (IV) fluids and electrolytes

Encouraging early ambulation

Using medications to stimulate bowel movement, such as metoclopramide or erythromycin

Choice B rationale:

Incisional infection is an infection of the surgical wound. It would typically present with redness, warmth, swelling, and pain at the incision site. The patient may also have a fever. While incisional infections can occur after abdominal surgery, they are not typically associated with the absence of bowel sounds, abdominal distention, and the inability to pass flatus.

Choice C rationale:

Fecal impaction is a severe form of constipation in which a large, hard mass of stool becomes trapped in the rectum. It can cause abdominal pain, bloating, and difficulty passing stool. However, it is not typically associated with the absence of bowel sounds or abdominal distention.

Choice D rationale:

Health care-associated Clostridium difficile (C. difficile) is a bacterial infection that can cause severe diarrhea, abdominal pain, and cramping. It is often associated with antibiotic use. While C. difficile can occur after abdominal surgery, it is not typically associated with the absence of bowel sounds, abdominal distention, and the inability to pass flatus.

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Correct Answer is D

Explanation

Rationale for Choice A:

Diuretics promote fluid loss, increasing the risk of fluid volume deficit.

Heart failure can lead to fluid retention, but diuretic therapy is often used to manage this excess fluid.

However, in this case, the patient is receiving diuretic therapy, which suggests that their fluid status is being actively managed.

Therefore, while this patient is at risk for fluid volume deficit, they are not the most likely candidate among the options presented.

Rationale for Choice B:

Gastroenteritis can lead to fluid loss through vomiting and diarrhea.

However, this patient is receiving oral fluids, which helps to replenish lost fluids and electrolytes.

As long as the patient is able to tolerate oral fluids and is not experiencing excessive fluid losses, they are not at significant risk for fluid volume deficit.

Rationale for Choice C:

End-stage kidney disease can impair the kidneys' ability to regulate fluid balance.

However, dialysis is a treatment that helps to remove excess fluid and waste products from the body.

Therefore, while this patient is at risk for fluid volume imbalances, they are receiving treatment to manage this risk.

Rationale for Choice D:

NPO status means that the patient has been instructed to have nothing by mouth. This means that the patient has not been able to consume any fluids since midnight.

Even in the absence of excessive fluid losses, this prolonged period of fluid restriction can lead to dehydration and fluid volume deficit.

Therefore, this patient is the most likely to be experiencing fluid volume deficit among the options presented.

A. Refer Questions to the nursing supervisor B. Transfer calls directly to the patient’s room C. Acknowledge that the person is a patient on the unit, but give no specific details about the patient’s condition D. Contact the patient’s provider

Correct Answer is C

Explanation

Rationale for Choice A:

Refer Questions to the Nursing Supervisor:

While it's essential to involve the nursing supervisor in situations that require their expertise or authority, it's not always necessary for basic inquiries about a patient's presence on the unit.

Disadvantages of referring calls to the nursing supervisor in this scenario:

It could delay the dissemination of essential information to concerned colleagues.

It could increase the workload of the nursing supervisor, potentially diverting their attention from more critical tasks. It could create a perception of a lack of transparency or openness among staff members.

Rationale for Choice B:

Transfer calls directly to the patient’s room:

Transferring calls directly to a patient's room without their consent breaches their privacy and confidentiality. It could also place undue stress on the patient, especially if they are not prepared to receive calls or discuss their health status.

Disadvantages of transferring calls directly to the patient’s room:

It violates the patient's right to privacy and confidentiality. It could disrupt the patient's rest and recovery.

It could place the patient in an uncomfortable position of having to answer questions about their health when they may not feel ready to do so.

Rationale for Choice C:

Acknowledge that the person is a patient on the unit, but give no specific details about the patient’s condition:

This approach strikes a balance between protecting the patient's privacy and providing necessary information to concerned colleagues. It verifies the patient's presence on the unit without disclosing any sensitive details about their health, thus adhering to ethical and legal guidelines.

Advantages of acknowledging the patient’s presence without providing details:

Respects the patient's right to privacy and confidentiality. Aligns with ethical and legal principles of healthcare.

Provides basic information to concerned colleagues without compromising patient information. Helps to establish trust and transparency among staff members.

Rationale for Choice D:

Contact the patient’s provider:

Contacting the patient's provider for every inquiry about the patient's presence is not practical or efficient. It could overburden the provider and delay the relay of information to concerned colleagues.

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A nurse is caring for a patient on the third day following abdominal surgery. The nurse notes the absence of bowel sounds, abdominal distention, and the patient has not passed any flatus. Which postoperative complication is the patient likely experiencing?

Nursing Test Bank

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Correct Answer is C

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A nurse is caring for a patient on the third day following abdominal surgery.
The nurse notes the absence of bowel sounds, abdominal distention, and the patient has not passed any flatus. Which postoperative complication is the patient likely experiencing?