A nurse is caring for a client who is postoperative following a colon resection.
For which of the following findings should the nurse monitor to identify a pulmonary embolus?

Choice A rationale

Immobility reduces the body's metabolic demand and lowers venous return due to the lack of skeletal muscle pump action, leading to a compensatory decrease in sympathetic activity. This generally results in orthostatic hypotension and a trend toward lower resting blood pressure, or at least a lack of the expected rise in blood pressure, rather than hypertension.

Choice B rationale

Immobility often reduces peristalsis, the coordinated muscular contractions of the gastrointestinal tract, leading to decreased bowel motility. This reduced movement of contents through the colon typically results in constipation and fecal impaction, rather than the rapid transit and loose stools characteristic of diarrhea.

Choice C rationale

Immobility impairs the expansion of the chest wall and diaphragm, leading to shallow respirations and atelectasis, the collapse of alveoli, especially in dependent lung areas. Crackles (rales) are adventitious lung sounds that indicate the presence of fluid in the small airways or alveoli, often a sign of pneumonia or pulmonary congestion, which are common complications of atelectasis.

Choice D rationale

Prolonged immobilization reduces tissue perfusion and subjects localized areas of skin and underlying tissue, particularly over bony prominences, to sustained pressure and shearing forces. This sustained mechanical load impedes capillary blood flow, resulting in ischemia and eventual tissue necrosis, which clinically manifests as pressure ulcers (decubitus ulcers).

Choice E rationale

Lack of active or passive range of motion across a joint causes the periarticular connective tissues, tendons, and muscles to shorten and become fibrotic. Without regular movement to maintain elasticity and joint capsule volume, this structural change results in a fixed position of the joint, limiting motion and leading to the development of contractures of extremities.

Choice A rationale

Dysuria, or painful urination, is a common symptom in benign prostatic hyperplasia (BPH) due to the mechanical compression of the urethra by the enlarged prostate, which increases resistance to urine flow. This obstruction leads to bladder overdistention and subsequent irritation, often causing a burning sensation upon voiding as the bladder muscles strain against the increased outflow resistance.

Choice B rationale

Polyuria, characterized by abnormally frequent urination, especially at night (nocturia), is a hallmark of BPH resulting from bladder irritation and incomplete emptying. The residual urine reduces the functional bladder capacity, leading to more frequent urges to void, as the detrusor muscle senses distension at lower volumes, especially during periods of decreased fluid reabsorption at night.

Choice C rationale

While benign prostatic hyperplasia causes an increase in the total amount of prostate-specific antigen (PSA) produced, the levels are usually only mildly to moderately elevated (often <4 ng/mL, though up to 10 ng/mL is possible). Critically elevated PSA levels (e.g., >10 ng/mL or a very high rate of rise) are more suggestive of prostate cancer, not typically benign BPH, which involves non-malignant tissue proliferation.

Choice D rationale

Difficulty starting the flow of urine (hesitancy) is a classic lower urinary tract symptom (LUTS) in BPH caused by the mechanical narrowing of the prostatic urethra. The bladder detrusor muscle must generate significantly increased pressure to overcome this outflow obstruction, resulting in a delay between the sensation of needing to void and the actual initiation of the urine stream.