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:
It is important to keep a Plaster of Paris cast dry because moisture can weaken the cast and irritate the skin underneath. Therefore, the cast should be covered while showering to prevent it from getting wet.
Choice B reason:
Applying ice to the foot after walking can help reduce swelling and provide pain relief. It is a common recommendation for managing discomfort associated with a walking cast. The ice should be applied over the cast at the level of the injury for 15-30 minutes, repeating every few hours for the first few days.
Choice C reason:
While a musty odor can develop over time due to sweat and lack of air circulation, it is not necessarily normal and could indicate a problem such as an infection. If there is a persistent unpleasant odor, it should be evaluated by a healthcare provider.
Choice D reason:
Numbness or pain in the toes can be a sign of compromised circulation or nerve compression and should be reported immediately. It is crucial to monitor for any changes in sensation or increased pain, as these could indicate a serious issue that requires medical attention.
Correct Answer is A
Explanation
Choice A reason: Drink 3L of fluid every day
Drinking adequate fluids, especially water, is one of the most effective ways to prevent kidney stones. Fluids dilute the substances in urine that lead to stones. For someone with a history of kidney stones, drinking about 3 liters of water each day can help prevent stone formation¹².
Choice B reason: Take 3,000 mg of vitamin C daily
High doses of vitamin C can increase the risk of kidney stones as the body converts vitamin C into oxalate, which can then form stones. Therefore, taking 3,000 mg of vitamin C daily is not recommended for individuals prone to calcium oxalate stones².
Choice C reason: Restrict calcium intake to one serving per day
Contrary to what might seem intuitive, restricting calcium intake is not generally advised for preventing calcium oxalate stones. Adequate dietary calcium can help reduce the amount of oxalate being absorbed by the body, thus lowering the risk of stone formation. It's important to consume calcium-rich foods in moderation and not to restrict them severely.
Choice D reason: Eat 12 oz of animal protein daily
A high intake of animal protein can increase the risk of kidney stones in susceptible individuals. Animal protein can increase calcium and oxalate levels in urine and reduce levels of citrate, a substance that prevents stones. Therefore, it's recommended to limit animal protein intake rather than consume large amounts.
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