A nurse is providing postoperative care for a client following a transurethral resection of the prostate to treat benign prostatic hypertrophy. Which of the following actions should the nurse take?

Maintain the client on bed rest for 48 hr following surgery.

Check the tubing for kinks and blood clots at least every 2 hr.

Irrigate the client's bladder continuously using 5% dextrose in Ringer's lactate.

Remove the catheter if the client reports severe bladder spasms.

Answer and Explanation

The Correct Answer is B

A) Maintain the client on bed rest for 48 hr following surgery: While some bed rest is recommended initially post-surgery, maintaining bed rest for 48 hours is excessive and can increase the risk of complications like deep vein thrombosis. Early mobilization is generally encouraged to enhance recovery.

B) Check the tubing for kinks and blood clots at least every 2 hr: Regularly checking the catheter tubing for kinks and blood clots is essential to ensure the continuous flow of urine and prevent catheter blockage. This can help in reducing the risk of complications such as bladder distension and urinary retention.

C) Irrigate the client's bladder continuously using 5% dextrose in Ringer's lactate: Continuous bladder irrigation is often done post-TURP to prevent clot formation, but 5% dextrose in Ringer's lactate is not the recommended solution. Typically, normal saline is used to minimize the risk of electrolyte imbalance and maintain the correct osmolarity.

D) Remove the catheter if the client reports severe bladder spasms: Severe bladder spasms can occur post-TURP, but removing the catheter is not the immediate solution. The catheter is necessary for drainage and should be managed with antispasmodic medications or adjusting the irrigation flow rather than removal.

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Correct Answer is B

Explanation

A) Drink cold beverages to increase peristalsis: While hydration is important for overall health, drinking cold beverages specifically is not a well-supported method for increasing peristalsis. The key to avoiding constipation is adequate fluid intake, but it doesn't need to be cold.

B) Increase daily water intake: Increasing daily water intake is a fundamental and effective strategy to prevent constipation. Adequate hydration helps soften the stool, making it easier to pass and promoting regular bowel movements.

C) Take a daily laxative to soften stools: Relying on a daily laxative is not recommended for long-term management of constipation as it can lead to dependence and disrupt normal bowel function. Dietary and lifestyle changes are preferred for preventing constipation.

D) Eat a low-residue diet: A low-residue diet, which is low in fiber and roughage, is typically used for specific medical conditions and may contribute to constipation rather than prevent it. To avoid constipation, a high-fiber diet is usually recommended to promote healthy bowel movements.

A. "Central vision loss is affected first." B. "Straining during a bowel movement can increase the progression of the disease C. "Plan to include high doses of Vitamin E in your diet." D. "Remove glasses before performing the Amsler grid test at home."

Correct Answer is A

Explanation

A) "Central vision loss is affected first.": This statement is accurate as macular degeneration primarily affects the macula, which is responsible for central vision. Clients with macular degeneration typically experience a loss of central vision first, which can severely impact activities such as reading, driving, and recognizing faces.

B) "Straining during a bowel movement can increase the progression of the disease.": This statement is not supported by evidence related to macular degeneration. While general health and avoiding strain are important, there is no specific connection between straining during bowel movements and the progression of macular degeneration.

C) "Plan to include high doses of Vitamin E in your diet.": Although antioxidants like Vitamin E can be beneficial for eye health, especially in the context of a balanced diet including other vitamins and minerals, there is no specific recommendation for high doses of Vitamin E alone to manage macular degeneration. The AREDS (Age-Related Eye Disease Study) formulation includes a combination of vitamins and minerals.

D) "Remove glasses before performing the Amsler grid test at home.": When using the Amsler grid test to monitor for changes in vision due to macular degeneration, clients should wear their glasses or contact lenses to ensure they are viewing the grid with their usual visual correction. This helps in accurately detecting any distortions or changes in vision.

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A nurse is providing postoperative care for a client following a transurethral resection of the prostate to treat benign prostatic hypertrophy. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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