The nurse is caring for a client on the third day following abdominal surgery and assesses the absence of bowel sounds, abdominal distention, and the client passing no flatus. These findings indicate the client is experiencing which of the following postoperative complications?

Choice A rationale Health care-associated Clostridium difficile infection (CDI) is a gastrointestinal infection that typically manifests with symptoms like watery diarrhea (often profuse), abdominal cramping, and fever. The clinical picture of absent bowel sounds, distention, and no flatus is characteristic of bowel motility failure, not the infectious gastroenteritis caused by CDI. Choice B rationale Paralytic ileus is a form of non-mechanical bowel obstruction caused by the temporary absence of peristalsis (bowel motility). This is a common postoperative complication due to handling of the bowels and the effects of anesthesia/analgesics. Clinical signs include absent bowel sounds, progressive abdominal distention, nausea, vomiting, and the inability to pass flatus or stool. Choice C rationale Incisional infection usually presents with localized signs such as erythema (redness), warmth, edema, pain at the incision site, and often systemic signs like fever and leukocytosis (elevated WBC count). While it may contribute to an ileus, the primary signs of ileus (absent bowel sounds, distention, no flatus) are not the cardinal signs of a superficial surgical site infection. Choice D rationale A fecal impaction is a hard, immovable mass of stool in the rectum, typically causing partial or complete mechanical obstruction. It usually presents with abdominal cramping and often small amounts of liquid stool or "seepage" around the mass, not the complete absence of bowel sounds and flatus that characterizes the diffuse lack of peristalsis seen in paralytic ileus.