Upon auscultation of the client’s abdomen, the nurse hears hyperactive

Upon auscultation of the client’s abdomen, the nurse hears hyperactive bowel sounds (greater than 35 per minute). The nurse knows that this can indicate which of the following?

1. Paralytic ileus
2. Fecal impaction
3. Small intestine obstruction
4. Abdominal tumor

ANSWER

ANS: 3
Absent (no auscultated bowel sounds) or hypoactive sounds (less than five sounds per minute) occur with paralytic ileus, such as after abdominal surgery. High-pitched and hyperactive bowel sounds (35 or more sounds per minute) occur with small intestine obstruction and inflammatory disorders.