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

Choice A reason: Hypoactive bowel sounds in two quadrants suggest reduced peristalsis, indicating persistent postoperative ileus rather than resolution. Normal peristalsis produces active bowel sounds across all quadrants, making this an incorrect indicator of returned gastrointestinal motility in a postoperative client.

Choice B reason: Requesting food indicates appetite but not necessarily peristalsis. Appetite can return before gastrointestinal motility, driven by neurological and hormonal factors. Passage of flatus directly confirms intestinal motility, making appetite a less accurate indicator of peristalsis restoration in this context.

Choice C reason: Passage of flatus is the most accurate indicator of returned peristalsis, as it reflects gastrointestinal motility. Gas movement through the intestines, expelled as flatus, confirms resolution of postoperative ileus, indicating normal bowel function, making this the best sign of recovery.

Choice D reason: Abdominal distention suggests gas accumulation, indicating persistent ileus rather than returned peristalsis. Gas buildup occurs when motility is impaired, causing bloating. Passage of flatus confirms gas movement and restored motility, making distention an incorrect indicator of recovery.

Choice A reason: Bradycardia is not typical in emphysema, where chronic hypoxia and hypercapnia cause tachycardia as the heart compensates for reduced oxygenation. Emphysema’s impact on lung function does not slow heart rate, making this an unexpected finding in this client with chronic respiratory disease.

Choice B reason: Barrel chest is a classic emphysema finding, resulting from chronic air trapping and lung hyperinflation. Over time, the chest wall expands, increasing the anteroposterior diameter, as alveoli lose elasticity, leading to persistent lung hyperinflation, a hallmark of advanced chronic obstructive pulmonary disease.

Choice C reason: Clubbing of the fingers occurs in emphysema due to chronic hypoxia, stimulating vascular changes in the nail beds. This leads to bulbous fingertip enlargement, reflecting long-term oxygen deprivation, a common finding in advanced COPD as the body adapts to chronic respiratory insufficiency.

Choice D reason: Cachectic appearance is common in emphysema due to increased metabolic demand from labored breathing and systemic inflammation. Muscle wasting and weight loss occur as the body prioritizes energy for respiratory effort, making cachexia a frequent finding in advanced emphysema, reflecting chronic disease burden.

Choice E reason: Weight gain is not typical in emphysema, where cachexia is common due to high metabolic demand and inflammation. Weight gain may occur in conditions like heart failure but is not a hallmark of emphysema, making this an unexpected finding in this client.