A nurse is caring for a group of clients on a medical surgical unit. Which of the following clients is at greatest risk for urinary retention?

Assessing risk for urinary retention requires understanding how various factors affect bladder muscle contractility and sphincter control. The nurse applies knowledge of pharmacological side effects and surgical complications to identify the client most likely to experience acute voiding dysfunction. Choice A rationale Liver failure typically leads to fluid volume overload and ascites rather than mechanical or functional urinary retention. While hepatorenal syndrome affects kidney filtration, it does not directly impair the detrusor muscle or bladder emptying. Choice B rationale Diets high in calcium oxalate increase the risk for nephrolithiasis or kidney stones. While stones can cause ureteral obstruction and renal colic, they do not typically cause the generalized urinary retention seen with bladder dysfunction. Choice C rationale General anesthesia and opioids used during back surgery depress the parasympathetic nervous system, leading to bladder atony. Surgery near the spinal cord can also disrupt the micturition reflex, making this client the highest risk. Choice D rationale A history of skin infection treated with antibiotics two weeks ago is not a recognized risk factor for urinary retention. There is no physiological link between resolving cellulitis and the mechanical ability to void.