The nurse is conducting an assessment on a client who is 36 hours postoperative following an appendectomy. During the assessment, the nurse is unable to hear any bowel sounds. The client denies passing flatus (gas). Given this information, which action is most appropriate by the nurse?

One of the highest levels of evidence are randomized, controlled, double-blind studies. This is because these studies reduce the risk of bias and confounding factors by randomly assigning participants to intervention or control groups, blinding the participants and researchers to the group allocation, and using a placebo or standard treatment as a comparison.

Choice B is wrong because ideas, editorials, and opinions are considered low levels of evidence as they are based on personal views and not on rigorous research methods.

Choice C is wrong because the purpose of the hierarchy of evidence is to help the nurse evaluate the quality and strength of the research findings, not to compare patient values with research findings.

Patient values are important for evidence-based practice, but they are not part of the hierarchy of evidence.

Choice D is wrong because all forms of evidence should not be considered equally when determining evidence-based practice. The hierarchy of evidence ranks different types of research designs according to their validity and applicability, and the nurse should use the highest level of evidence available for their clinical question.

These are some of the criteria used to assist in making the diagnosis of chronic fatigue syndrome (CFS) according to the Institute of Medicine (IOM) 2015 report.

Choice B is wrong because recent exposure to influenza is not a criterion for CFS diagnosis. Although some cases of CFS may be triggered by viral infections, such as Epstein-Barr virus or human herpes virus 6, there is no specific evidence that influenza causes CFS.

Choice A is correct because CFS is not caused by a primary condition. CFS is a diagnosis of exclusion, meaning that other possible causes of fatigue, such as sleep disorders, anemia, diabetes, thyroid problems, or mental health issues, must be ruled out before making the diagnosis.

Choice C is correct because unrefreshing sleep is one of the required symptoms for CFS diagnosis. Patients with CFS may not feel better or less tired even after a full night of sleep despite the absence of specific objective sleep alterations. Choice D is correct because fatigue that is not relieved by stress reduction is another required symptom for CFS diagnosis. Patients with CFS experience post-exertional malaise (PEM), which means that their symptoms worsen after physical, mental, or emotional exertion that would not have caused a problem before the illness.

Choice E is correct because severe tiredness for 2 months or more is one of the additional manifestations that must be present for CFS diagnosis. The IOM 2015 report states that the fatigue associated with CFS must last for more than 6 months and occur at least half the time at moderate, substantial or severe intensity.