Ati Fundamentals Proctored Exam(Applied Nursing Skills)
A nurse is assisting with the plan of care for a client who is immobile and is experiencing urinary retention. The nurse should plan to monitor the client for which of the following?
Explanation & Rationale
A. Bladder outlet obstruction is a structural or mechanical issue, not directly caused by immobility. B. Urinary retention increases the risk of urinary stasis, which provides an environment for bacterial growth. Immobile clients are therefore at higher risk for urinary tract infections (UTIs), making this an important complication to monitor. C. Protein in the urine (proteinuria) is more indicative of kidney damage or disease rather than retention from immobility. D. Neurogenic bladder is related to nerve dysfunction, not solely immobility, although immobility may exacerbate voiding difficulties. Monitoring for infection is more immediate and relevant.
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