A nurse is collecting data on a client who is postoperative following a transurethral resection of the prostate (TURP). The nurse should recognize which of the following findings is the priority?
The client has small blood clots in his urinary catheter.
The client reports a continuous urge to void.
The client reports burning around the urinary catheter.
The client has bright red urine in his urinary catheter.
The Correct Answer is D
Choice A rationale
Small blood clots in the urinary catheter are common after TURP and usually resolve on their own. They are not typically a cause for immediate concern unless they persist or cause blockage.
Choice B rationale
A continuous urge to void is a common symptom after TURP due to irritation of the bladder and urethra. It is uncomfortable but not usually a priority concern.
Choice C rationale
Burning around the urinary catheter can occur due to irritation or infection. While it needs to be addressed, it is not the most critical finding.
Choice D rationale
Bright red urine in the urinary catheter indicates active bleeding, which can be a sign of a serious complication such as hemorrhage. This requires immediate attention to prevent further blood loss and potential shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Osteoarthritis is not caused by inflammation that affects both joints and other body tissues. This description is more characteristic of rheumatoid arthritis, which is an autoimmune disease that causes systemic inflammation.
Choice B rationale
Osteoarthritis does not occur in phases with crystal deposits. This description is more characteristic of gout, which involves the deposition of urate crystals in joints and soft tissues.
Choice C rationale
Osteoarthritis is primarily due to the aging process and results in the disintegration of cartilage in a joint. This leads to pain, stiffness, and reduced joint function.
Choice D rationale
Osteoarthritis is not due to the loss of calcium in the bones. This description is more characteristic of osteoporosis, which is a condition that weakens bones and increases the risk of fractures.
Correct Answer is C
Explanation
Choice A rationale
A high-purine diet can lead to the formation of uric acid stones, which are a type of kidney stone. However, it is not the most common risk factor for urolithiasis. Urolithiasis is more commonly associated with factors such as dehydration, which leads to concentrated urine and promotes stone formation.
Choice B rationale
Female gender is not a significant risk factor for urolithiasis. In fact, men are more likely to develop kidney stones than women. The higher incidence in men is thought to be related to differences in diet, fluid intake, and urinary tract anatomy.
Choice C rationale
Dehydration is a major risk factor for urolithiasis. When the body is dehydrated, urine becomes more concentrated, which increases the likelihood of stone formation. Adequate hydration helps to dilute the urine and reduce the risk of stone formation.
Choice D rationale
Family history is a known risk factor for urolithiasis. Individuals with a family history of kidney stones are more likely to develop them due to genetic predispositions that affect factors such as urine composition and kidney function.
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