A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate.
The client reports bladder spasms and the nurse observes decreased urinary output.
Which of the following actions should the nurse take?
Remove the indwelling urinary catheter.
Decrease traction on the catheter.
Administer ibuprofen 400 mg for pain relief.
Flush the catheter manually with 0.9% sodium chloride.
The Correct Answer is D
“Flush the catheter manually with 0.9% sodium chloride.” The client is receiving continuous bladder irrigation following a transurethral resection of the prostate and reports bladder spasms and decreased urinary output.
These symptoms may indicate that the catheter is blocked with blood clots.
Flushing the catheter manually with 0.9% sodium chloride can help to remove any blood clots and restore urinary output.
Choice A is not the correct answer because removing the indwelling urinary catheter would not address the underlying issue of blood clots blocking the catheter.
Choice B is not the correct answer because decreasing traction on the catheter would not address the underlying issue of blood clots blocking the catheter.
Choice C is not the correct answer because while ibuprofen may provide some pain relief, it would not address the underlying issue of blood clots blocking the catheter.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Applying an ice pack can help reduce pain and swelling after total knee arthroplasty.
Placing pillows under the client’s knee (choice A) is not recommended as it can hinder circulation and delay healing.
Performing range-of-motion exercises to the client’s knee (choice B) may be part of the rehabilitation process but should be done under the guidance of a physical therapist and may not be appropriate for immediate pain relief.
Gently massaging the area around the client’s incision (choice D) may not be appropriate as it can cause discomfort and disrupt the healing process.
Correct Answer is A
Explanation
“You should ask your provider about your plan.” The client has expressed a preference for trying vitamins and minerals instead of chemotherapy.
The nurse should encourage the client to discuss their treatment plan with their provider to ensure that they receive the most appropriate care.
Choice B is not the correct answer because while it is important for the client to be informed about their treatment options, the nurse’s primary responsibility is to encourage the client to discuss their concerns with their provider.
Choice C is not the correct answer because it is not within the nurse’s scope of practice to make definitive statements about the effectiveness of holistic treatments.
Choice D is not the correct answer because it is not within the nurse’s scope of practice to make definitive statements about the best way to treat cancer.
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