Which of the following most accurately indicates that a postoperative client’s peristalsis has returned?

Choice A reason: Fever and tachycardia indicate systemic inflammation in atelectasis, where collapsed alveoli reduce gas exchange, causing hypoxia. Tachycardia compensates for low oxygen, while cytokines from lung collapse trigger fever. These signs necessitate intervention like incentive spirometry to re-expand lungs, preventing complications such as pneumonia or sepsis, which worsen respiratory distress.

Choice B reason: Productive cough with green sputum suggests a bacterial infection, like pneumonia, rather than atelectasis alone. Atelectasis may predispose to infection by impairing mucociliary clearance, but green sputum indicates a secondary process requiring antibiotics, not primary atelectasis interventions like lung re-expansion, making this choice less urgent.

Choice C reason: Chest pain and increased respiratory rate are critical atelectasis symptoms. Pain arises from pleural irritation due to collapsed lung segments, while tachypnea compensates for hypoxia from reduced alveolar ventilation. These indicate significant respiratory compromise, requiring urgent interventions like chest physiotherapy or deep breathing to restore lung volume.

Choice D reason: Diminished breath sounds and dyspnea are hallmark atelectasis signs, reflecting collapsed alveoli and reduced air entry. Dyspnea results from impaired gas exchange, causing hypoxia and hypercapnia. Immediate interventions like positive pressure ventilation or incentive spirometry are needed to re-expand lungs, preventing further respiratory deterioration and ensuring adequate oxygenation.

Choice E reason: Purulent drainage is not typical of atelectasis but suggests an infectious process like an abscess or empyema. While atelectasis can trap secretions, predisposing to infection, purulent drainage requires specific treatments like antibiotics or drainage, not atelectasis-focused interventions like lung re-expansion, making this an incorrect choice for intervention.

Choice A reason: Asking the UAP to reassess delays accurate assessment by a qualified nurse. Pulse 122 and BP 98/72 suggest tachycardia and hypotension, requiring professional validation and intervention, making this less appropriate than direct nurse reassessment and provider notification.

Choice B reason: Reassessing the client validates vital signs (pulse 122, BP 98/72), indicating tachycardia and hypotension, possibly from hypovolemia or sepsis. Accurate nurse assessment ensures reliable data for diagnosis, preventing complications like shock, making this a critical action in this scenario.

Choice C reason: Notifying the provider is essential, as tachycardia (pulse 122) and hypotension (BP 98/72) suggest serious conditions like hypovolemia or sepsis. Prompt reporting ensures timely interventions, such as fluids or diagnostics, preventing deterioration, making this necessary alongside reassessment.

Choice D reason: Sitting the client up may improve breathing but does not address tachycardia and hypotension, which suggest hypovolemia or other issues. These vital signs require reassessment and provider notification to diagnose and treat the cause, making positioning less urgent.