A nurse on a postpartum unit is reinforcing discharge teaching for a client who had an episiotomy. Which of the following statements by the client indicates an understanding of the teaching?

A. "A client must sign an Against Medical Advice form if he withdraws consent.": An Against Medical Advice (AMA) form is specifically used when a client chooses to leave a healthcare facility against medical advice, not when they withdraw consent for a procedure. Withdrawing consent does not require an AMA form and follows a separate legal and ethical process.

B. "A client can withdraw consent at any time after signing the informed consent form.": Clients maintain the right to autonomy throughout their care, including the right to withdraw consent at any point before or during a procedure. Signing the form does not waive their right to change their mind, and healthcare providers must respect this decision without penalizing the client.

C. "A client who is involuntarily admitted to a mental health unit cannot withdraw consent for treatment.": Even clients who are involuntarily admitted retain certain rights, including the right to refuse specific treatments unless they are legally deemed incompetent or pose an imminent threat. Involuntary admission does not mean automatic consent to all treatments.

D. "A client must provide a written refusal for a procedure for which he has already signed an informed consent.": Clients can verbally withdraw consent at any time; a written refusal is not legally required. While documentation of the client's decision is necessary for the medical record, insisting on a written refusal is not a legal prerequisite for withdrawal of consent.

A. Decreased bowel sounds: Decreased bowel sounds are often associated with conditions like ileus, abdominal surgery, or bowel obstruction, rather than directly indicating fluid volume excess. Fluid overload typically affects the cardiovascular and respiratory systems first.

B. Urine output of 360 mL/12 hr: While this is a low urine output and could suggest dehydration or renal impairment, it is more indicative of fluid volume deficit rather than fluid volume excess. Excess fluid volume would generally be associated with adequate or increased urine output if renal function is normal.

C. Blood pressure of 100/74 mm Hg: This blood pressure reading is within normal limits for many adults and does not specifically suggest fluid overload. In cases of fluid volume excess, a client might actually exhibit elevated blood pressure due to increased circulatory volume.

D. Distended neck veins: Distended neck veins, also known as jugular venous distention, are a classic sign of fluid volume excess. They occur because increased intravascular volume causes elevated venous pressure, which becomes visible in the neck veins when the client is positioned at a 30- to 45-degree angle.