Question

a nurse is assisting with data collection from a client who is 12 hours postoperative following an open cholecystectomy. which of the following findings should the nurse report to the charge nurse? a. hypoactive bowel sounds b. indwelling urinary catheter output of 25 ml/hr c. heart rate of 96/min d. serous drainage at the surgical incision site

Explanation:

• Hypoactive bowel sounds are common post-surgery due to anesthesia and reduced mobility, so this is expected.
• A heart rate of 96/min is within the normal adult range (60-100/min), so it is not concerning.
• Serous drainage at the incision site is a normal, expected postoperative finding as the wound heals.
• Urinary output less than 30 mL/hr indicates inadequate renal perfusion, which is a sign of potential hypovolemia or renal compromise requiring immediate notification.

Answer:

B. Indwelling urinary catheter output of 25 mL/hr