The nurse assesses a client who is hospitalized with an exacerbation of Crohn disease. Which assessment finding would the nurse expect?

Choice A reason: Hypoactive bowel sounds are typically associated with a paralytic ileus or the later stages of a bowel obstruction. In the acute inflammatory phase of Crohn's disease, the intestinal tract is hyperactive as it attempts to move contents past inflamed or narrowed segments, making dull or absent sounds an atypical initial finding. Choice B reason: Crohn's disease most commonly affects the terminal ileum, located in the right lower quadrant. During an exacerbation, inflammation and partial obstruction of the intestinal lumen lead to borborygmi, which are high-pitched, rushing, or tinkling bowel sounds as the intestine forcefully contracts to push fluid and gas through the narrowed areas. Choice C reason: A positive Murphy sign is a specific clinical indicator of acute cholecystitis, elicited by pain during inspiration while the gallbladder is palpated. Rebound tenderness is more indicative of peritonitis or appendicitis. While Crohn's can cause abdominal tenderness, these specific signs point toward different hepatobiliary or surgical emergencies. Choice D reason: Abdominal pain and cramping in Crohn's disease are typically associated with eating (postprandial) rather than being specifically worse at night. Food intake triggers the gastrocolic reflex and peristalsis, which increases pressure against the inflamed intestinal walls, leading to the characteristic colicky pain experienced by these patients.