A nurse is caring for a client who is 6 hr postoperative following a transurethral resection of the prostate (TURP). Which of the following actions should the nurse include in the plan of care? (Select all that apply.).
Encourage the client to try to void.
Secure the drainage tube to the client's thigh.
Monitor the client's urine output every 2 hr.
Administer antispasmodics for bladder spasms.
Perform intermittent bladder irrigation.
Correct Answer : A,C,D,E
Choice A rationale:
Is appropriate to assess postoperative urinary function after transurethral resection of the prostate (TURP). It helps monitor the return of normal bladder function.
Choice B rationale:
Is not necessary and could potentially cause discomfort and increased risk of tube dislodgment. Securing the tube properly to the bed or clothing is a more appropriate method.
Choice C rationale:
Is essential to assess urinary function, and fluid balance, and identify any potential complications such as urinary retention or excessive bleeding.
Choice D rationale:
Helps alleviate discomfort and prevent spasms after TURP. Bladder spasms can be common after the procedure, and antispasmodics can aid in managing them.
Choice E rationale:
Is necessary to keep the catheter patent and prevent clot formation in the urinary tract. It helps maintain proper drainage and prevents complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Providing a continuous passive motion (CPM) device is not necessary for a client following a total hip arthroplasty. CPM devices are more commonly used after knee arthroplasty to improve joint mobility.
Choice B rationale:
Ensuring the client has an elevated toilet seat at home is important following a total hip arthroplasty. The elevated seat reduces the amount of hip flexion required during toileting, which helps prevent hip dislocation and strain on the surgical site.
Choice C rationale:
Providing a trapeze bar is not essential for a client following a total hip arthroplasty. Trapeze bars are typically used to assist with repositioning in bed for clients with limited mobility, but they are not specific to hip arthroplasty recovery.
Choice D rationale:
Providing a compression garment is not necessary after total hip arthroplasty. Compression garments are often used for conditions like venous insufficiency or to manage swelling, but they are not routinely used for hip arthroplasty recovery.
Correct Answer is A
Explanation
Dispose of the client's feces and urine in a special container.
Choice A rationale:
This is the correct choice. Brachytherapy involves the placement of a radiation source in or near the tumor. To minimize radiation exposure to others, the client's bodily fluids (feces and urine) should be considered radioactive and disposed of properly in a designated container.
Choice B rationale:
While limiting the time of visitors can be a good measure to reduce radiation exposure, it is not the priority intervention. The primary concern is proper handling and disposal of radioactive bodily fluids.
Choice C rationale:
Keeping the client's linens in the room until after removal of the radiation source is not the correct choice. Radioactive linens should be handled and laundered separately, following appropriate safety protocols.
Choice D rationale:
Providing one dosimeter badge for staff to share while caring for the client is not adequate. Each staff member involved in direct care should have their dosimeter badge to monitor their individual radiation exposure levels.
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