A nurse is assessing a client who is 4 hr postoperative following an open appendectomy. Which of the following manifestations should indicate to the nurse that the client requires a nasogastric tube with low intermittent suction?

Rationale: A. This option is incorrect because decreased oxygen saturation reflects a respiratory problem, such as hypoventilation, atelectasis, or pneumonia, rather than an issue with gastrointestinal function. While low oxygen saturation is clinically significant and requires intervention, it does not indicate a need for nasogastric (NG) tube insertion. B. This option is correct because abdominal distention after an open appendectomy is a common sign of postoperative ileus or gastric outlet obstruction, both of which can lead to accumulation of gas and fluid in the stomach and intestines. A nasogastric tube with low intermittent suction can decompress the stomach, reduce pressure and discomfort, prevent nausea and vomiting, and lower the risk of complications such as aspiration or wound dehiscence. Early recognition and intervention are essential for client safety and comfort. C. This option is incorrect because decreased bowel sounds are expected in the first several hours after abdominal surgery due to anesthesia and handling of the intestines. While it signals the need for continued monitoring, it alone does not require NG tube placement. Clinical decisions should consider the combination of symptoms, such as distention, nausea, vomiting, and pain. D. This option is incorrect because incisional pain is an expected postoperative finding and is managed with analgesics, positioning, and non-pharmacological methods. Pain alone does not indicate gastrointestinal obstruction or the need for NG suction.