A nurse is reinforcing discharge teaching with a male client who has an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching?

Correct answer: The client is most at risk of developing atelectasis and paralytic ileus.

Rationale for correct answers:

• atelectasis: The client is 6 hours postoperative, drowsy from morphine, and has shallow breath sounds. Narcotic pain medications suppress the cough reflex and decrease deep breathing, leading to the collapse of alveoli (atelectasis). This is further evidenced by the slight drop in oxygen saturation (95% to 94%) and the decrease in respiratory rate.
• paralytic ileus: The client has hypoactive bowel sounds and has undergone abdominal surgery. General anesthesia and opioid analgesics (morphine) both slow down intestinal motility. If peristalsis does not return or remains severely suppressed, the client can develop a paralytic ileus (a non-mechanical bowel obstruction).

Rationale for incorrect answers:

• urinary tract infection: This is not the primary risk at this time. The client’s urinary catheter was removed, and the client has already successfully voided 350 mL of clear urine, indicating good bladder function and a low immediate risk for UTI.
• delayed wound healing: While a risk for any surgical client, this client denies diabetes and peripheral vascular disease (Exhibit 1), which are the primary risk factors for delayed healing. The dressing is currently dry and intact.
• deep vein thrombosis: Although a general risk for postoperative clients, this client is wearing sequential compression devices (SCDs) and has even pedal pulses with no edema, indicating that preventive measures are in place and working.

A. Gather additional information from the caller to verify their identity.: Even if the identity is verified, the nurse cannot release information without the client’s explicit consent or a pre-established privacy code.

B. Request that the caller contact the client's provider directly.: The provider is also bound by HIPAA and cannot release information to the sibling without consent.

C. Ask the caller to contact the client directly for information.: This protects the client's privacy and ensures that the client remains in control of their own health information.

D. Provide the caller with a brief update.: This is a direct violation of HIPAA regulations regarding client confidentiality.