A 45-year-old female client has been hospitalized for severe abdominal

A 45-year-old female client has been hospitalized for severe abdominal pain. The health care pro-vider has ordered a PCA pump for the client to help control the pain.

It has been determined that the pain is due to cholelithiasis and the client is scheduled for a cholecystectomy later that day. The client returns to the unit postoperatively with a Foley cathe-ter anchored. The nurse notes that the client’s urine output has decreased. The nurse knows that this is most likely due to:
1. Stress response
2. Preoperative NPO status
3. Kidney failure
4. Post-operative urinary retention

ANSWER

ANS: 1
The stress response releases an increased amount of ADH, which increases water reabsorption. Stress also elevates the level of aldosterone, causing retention of sodium and water. Both of these substances reduce urine output in an effort to maintain circulatory fluid volume. Although the client was NPO postoperatively, she had a pain pump, which indicates that she had a running IV with fluids. It is not indicated that the client had kidney failure, and since the client had an anchored urinary catheter, she would not have urinary retention.