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NCLEX · Fluid and Electrolyte Imbalances

A post-surgical client has a urine output of 20 mL over the past hour. Normal minimum is 30 mL/hr. What is the LPN's priority action?

Correct answer

Notify the RN immediately — urine output below 30 mL/hr (oliguria) is a critical finding that may indicate inadequate renal perfusion, hypovolaemia, or acute kidney injury requiring prompt assessment and intervention

  1. A Document and recheck in two hours
  2. B Notify the RN immediately — urine output below 30 mL/hr (oliguria) is a critical finding that may indicate inadequate renal perfusion, hypovolaemia, or acute kidney injury requiring prompt assessment and intervention
  3. C Encourage the client to drink more fluids
  4. D Reassure the client this is normal after surgery

Why this is the answer

OLIGURIA (<30 mL/hr or <0.5 mL/kg/hr): This is a critical assessment finding. CAUSES: Hypovolaemia (most common post-surgical — inadequate fluid replacement, haemorrhage); cardiac output reduction (heart failure, MI); renal causes (ATN, contrast nephropathy); obstruction (kinked catheter — check first); PRE-RENAL vs RENAL: Pre-renal oliguria responds to fluids; renal oliguria does not — distinguishing them guides treatment; IMMEDIATE NURSING ACTIONS: Check catheter for kinks, clots, or position issues (simple fix first); assess vital signs (hypotension + oliguria = volume depletion until proven otherwise); notify RN urgently — this requires medical assessment; ANTICIPATED ORDERS: IV fluid bolus if pre-renal; renal panel, BMP; strict intake/output; PN SCOPE: Assess, check equipment, NOTIFY RN IMMEDIATELY — do not wait; time-sensitive finding.
Source: NCLEX-PN Physiological — Post-op Oliguria, Urinary Output Monitoring

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