A nurse is caring for a client who is 2 hours postoperative following a transurethral resection of the prostate (TURP) gland. Which of the following assessments should the nurse view as an indication of a postoperative complication?
Oral temperature of 38.2°C (100.76°F)
Output of burgundy-colored urine
Pulse rate of 88/min
An urge to void despite having an indwelling urinary catheter
The Correct Answer is A
Choice A reason: An elevated oral temperature of 38.2°C (100.76°F) postoperatively can indicate an infection, which is a common complication after surgical procedures. In the context of TURP, a fever could suggest a urinary tract infection or sepsis, especially if accompanied by other symptoms such as chills or an elevated white blood cell count.
Choice B reason: The output of burgundy-colored urine can be expected in the immediate postoperative period following a TURP due to bleeding. However, it should gradually lighten in color. Persistent or worsening hematuria could indicate a complication, but it is not uncommon to see some blood in the urine shortly after the procedure
Choice C reason: A pulse rate of 88/min is within the normal range (60-100 beats per minute) and is not typically indicative of a postoperative complication. It is important to consider the patient's baseline heart rate and any other symptoms they may be experiencing.
Choice D reason: Feeling an urge to void despite having an indwelling urinary catheter can occur due to bladder spasms or irritation from the catheter itself. While uncomfortable, this sensation is not uncommon after TURP and does not necessarily indicate a complication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason:Scheduling the procedure five days before the expected menses would place it in the late proliferative phase, which risks missing ongoing menstrual bleeding and could coincide with implantation if the client ovulated early. Best practice is to perform the test after menstruation ends but before ovulation—usually within 12 days of the first day of the last period—to ensure the client is not pregnant.
Choice B reason:
Diarrhea is not a common side effect of HSG. The procedure involves the insertion of a dye into the uterine cavity to visualize the fallopian tubes and uterus via X-ray. While some discomfort, cramping, or spotting may occur, diarrhea is not typically expected.
Choice C reason:
There is no requirement for a client to be on a liquid diet following an HSG procedure. The client can usually resume normal activities and diet immediately after the procedure unless otherwise instructed by their healthcare provider.
Choice D reason:
Referred shoulder pain can occur when contrast fluid spills through a patent tube into the peritoneal cavity, irritating the diaphragm’s undersurface and eliciting pain perceived at the shoulder via the phrenic nerve. Clients should be advised this is normal, short-lived, and relieved by positioning or mild analgesics.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A reason: Thyroid stimulating hormone (TSH)
TSH levels can affect sexual function. Both hyperthyroidism and hypothyroidism can lead to ED. Hyperthyroidism can cause premature ejaculation, while hypothyroidism can reduce libido and cause ED. Therefore, assessing thyroid function is important in the evaluation of ED.
Choice B reason: Blood glucose
Diabetes mellitus is a common cause of ED. High blood glucose levels can damage blood vessels and nerves that control erection. Therefore, testing for diabetes with a blood glucose test is a standard part of the ED evaluation.
Choice C reason: Partial thromboplastin time (PTT)
PTT is not typically used to evaluate ED. It measures the time it takes for blood to clot and is usually used to assess bleeding disorders or the effectiveness of blood-thinning medication.
Choice D reason: Testosterone
Low testosterone levels can lead to a decrease in sexual desire and ED. Testosterone replacement therapy may improve the situation if this is the case. Hence, measuring testosterone levels is a critical part of the ED workup.
Choice E reason: Total cholesterol
High cholesterol can lead to atherosclerosis, which can impede blood flow to the penis and cause ED. Therefore, a lipid profile, including total cholesterol, is often checked when evaluating ED.
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