Following a total thyroidectomy, the nurse plans to observe a client for complications. Which finding indicates that the client has developed a complication?

Choice A reason: Strict bedrest is not indicated for urolithiasis, as movement may aid stone passage by shifting ureteral dynamics. Severe flank pain from ureteral obstruction causes muscle spasms. Straining urine collects stones for analysis, identifying composition to guide treatment, making bedrest less critical than addressing the stone.

Choice B reason: Limiting fluid intake is contraindicated, as high fluids promote urine flow, aiding stone passage and diluting urinary solutes like calcium. Pain results from obstruction, and straining urine identifies stone type. Fluid restriction increases stone formation risk, making this harmful and counterproductive to urolithiasis management.

Choice C reason: Straining all urine collects stones for analysis, determining composition (e.g., calcium oxalate) to guide dietary and pharmacological prevention. Severe flank pain from ureteral obstruction highlights the need for stone identification. This addresses the pathophysiological cause, enabling tailored interventions to prevent recurrence and manage acute symptoms.

Choice D reason: A high-calcium diet is inappropriate, as most kidney stones are calcium-based. Dietary calcium moderation, based on stone analysis from straining urine, prevents recurrence. Pain management requires stone identification, not increased calcium intake, which could exacerbate stone formation, making this counterproductive for urolithiasis.

Choice A reason: Imbalanced nutrition is unrelated to 150 mL residual urine, which indicates incomplete bladder emptying, often from detrusor dysfunction or obstruction. Nutrition affects overall health but does not cause retention. Residual urine increases infection risk due to stasis, making nutrition an irrelevant nursing problem for this urinary issue.

Choice B reason: Deficient fluid volume suggests dehydration, reducing urine output, not causing high residual volumes. Residual urine (150 mL) indicates retention from impaired bladder emptying, not fluid deficit. Hydration prevents stasis, but infection risk from retained urine is more immediate, as bacteria proliferate in stagnant urine.

Choice C reason: Residual urine of 150 mL signifies incomplete bladder emptying, often from obstruction or neurogenic bladder, leading to urinary stasis. This fosters bacterial growth, increasing urinary tract infection (UTI) risk. Including “risk for infection” addresses this pathophysiological concern, guiding interventions like catheterization to reduce infection likelihood.

Choice D reason: Urinary incontinence involves involuntary leakage, not retention, where the bladder fails to empty, as seen with 150 mL residual urine. Retention results from outflow obstruction or weak detrusor, distinct from incontinence’s loss of control, making this nursing problem inappropriate for the client’s condition.