A client has undergone a transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). He is currently being treated with continuous bladder irrigation (CBI) and is complaining of an increase in the severity of bladder spasms. Which intervention should the nurse perform first?

Perform a bladder scan.

Stop the irrigation and note findings in the chart.

Administer an oral analgesic.

Ensure that the catheter is draining properly.

Answer and Explanation

The Correct Answer is D

Choice A Reason
Performing a bladder scan can help determine the volume of urine in the bladder and assess for urinary retention, which could contribute to bladder spasms. However, this is not typically the first intervention. The priority is to ensure that the catheter is patent and draining correctly, as blockages can cause immediate discomfort and increased spasms

Choice B Reason
Stopping the irrigation could be considered if there is a concern that the CBI is contributing to the spasms. However, this would not be the first action taken. It is essential first to assess the catheter's patency and the flow of the irrigation to rule out any obstruction or kinking causing the spasms.

Choice C Reason
Administering an oral analgesic may help alleviate the discomfort caused by bladder spasms, but it does not address the underlying cause. Pain relief is important, but the initial step should be to check for and resolve any mechanical issues with the catheter system that could be causing the spasms.

Choice D Reason
Ensuring that the catheter is draining properly is the first and most crucial intervention. If the catheter is blocked or kinked, it can cause bladder distention and increased spasms. Checking the catheter's patency and the flow of irrigation can quickly resolve the issue and provide relief to the patient. If the catheter is found to be obstructed, resolving the blockage can decrease the severity of the spasms and improve the patient's comfort.

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Correct Answer is B

Explanation

Choice A Reason:
Weekly aerobic exercise at a gym is generally beneficial for joint health and is not a predisposing factor for osteoarthritis. Regular physical activity helps maintain joint flexibility, muscle strength, and overall health, which can actually help prevent the development of osteoarthritis.

Choice B Reason:
Vitamin D deficiency has been associated with an increased risk of osteoarthritis. Vitamin D is essential for bone health, and a deficiency can lead to changes in bone structure and strength, potentially contributing to the development and progression of osteoarthritis.

Choice C Reason:
A weight of less than 60 kg does not typically predispose an individual to osteoarthritis. In fact, maintaining a healthy weight can reduce the risk of developing osteoarthritis, as excess body weight can increase the stress on joints.

Choice D Reason:
Trauma can lead to post-traumatic osteoarthritis, which is a form of osteoarthritis that develops after an injury to a joint. Traumatic injuries can damage the cartilage and bone, leading to degenerative changes and osteoarthritis.

A. Superficially charming. B. Friendly and open. C. Intense and impulsive. D. Guarded and suspicious. E. Guarded and suspicious.

Correct Answer is D

Explanation

Choice A Reason
A client with paranoid personality disorder is typically not described as superficially charming. This description is more often associated with other personality disorders, such as antisocial personality disorder, where individuals may use charm to manipulate others for personal gain.

Choice B Reason
Being friendly and open is generally not characteristic of paranoid personality disorder. Individuals with this disorder are often wary of others and may be perceived as cold or distant due to their mistrust.

Choice C Reason
While intensity and impulsivity can be seen in various personality disorders, they are not the defining features of paranoid personality disorder. These traits are more commonly associated with borderline personality disorder.

Choice D Reason
Guarded and suspicious are hallmark descriptors for someone with paranoid personality disorder. Individuals with this condition are often very distrustful of others, suspecting that others have ulterior motives or are out to harm them. They may be preoccupied with doubts about the loyalty or trustworthiness of friends or associates.

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Naxlex Comprehensive Predictor Exams

A 40-year-old client reports chronic lower back pain and stiffness. X-rays of the lumbar spine confirm the diagnosis of moderate to severe osteoarthritis. The nurse identifies which predisposing factor may have led to these degenerative changes?

Correct Answer is B

Explanation

The edited text with the question and the choices labeled from a to d is as follows: The nurse who assesses a client as having paranoid personality disorder is most likely to describe the client as:

Correct Answer is D

Explanation

The nurse is caring for a client who has just been diagnosed with diverticular disease. What dietary teaching will the nurse provide?

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How can the nurse determine that the outcomes of nursing interventions have been successful for the client diagnosed with a sickle cell crisis? (SELECT ALL THAT APPLY)

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