When assessing a client who had a transurethral resection of the prostate (TURP) one day ago, the nurse observes that his scrotum and penis are edematous. Which intervention(s) should the nurse implement? Select all that apply.
Put a pillow under the buttocks.
Apply a cold pack to the scrotal and penile areas.
Obtain a specimen for urinalysis.
Remove the indwelling urinary catheter.
Notify the healthcare provider immediately.
Correct Answer : B,E
Choice A reason: Elevating the buttocks with a pillow is not specifically indicated in the scenario provided. While it might assist in other situations to reduce swelling by using gravity, it isn't a standard intervention for the described situation post-TURP.
Choice B reason: Applying a cold pack to the scrotal and penile areas can help reduce the swelling and discomfort associated with edema. Cold therapy is effective in constricting blood vessels and reducing inflammation, making it an appropriate immediate intervention.
Choice C reason: While obtaining a urinalysis might provide information on the presence of infection or other abnormalities, it does not directly address the immediate issue of the observed edema. Therefore, it is not a primary intervention in this scenario.
Choice D reason: Removing the indwelling urinary catheter without specific orders can lead to complications and is not advised as an initial intervention. The catheter serves a critical purpose post-surgery and should be handled according to protocol or provider direction.
Choice E reason: Notifying the healthcare provider immediately is crucial when unexpected postoperative complications such as edema occur. Prompt communication allows for timely medical intervention and ensures that the patient receives the necessary care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["121"]
Explanation
Calculation Steps:
Step 1: Convert weight from pounds to kilograms: 160 pounds ÷ 2.2 = 72.7 kg. Result = 72.7 kg.
Step 2: Calculate the total daily dose: 5 mg/kg/day × 72.7 kg = 363.5 mg/day. Result = 363.5 mg/day.
Step 3: Calculate the dose per administration: 363.5 mg/day ÷ 3 doses/day = 121.2 mg/dose. Result = 121.2 mg/dose.
Step 4: Round to the nearest whole number: 121.2 mg ≈ 121 mg.
Result = 121 mg.
Correct Answer is B
Explanation
Choice A reason: Recommending that the client's family return to the area to help provide assistance is not always feasible and may place undue stress on the family. It is also not a sustainable long-term solution.
Choice B reason: Advising a case management evaluation of the client's home environment is the best response as it allows for a comprehensive assessment of the client's needs and resources. The case manager can help coordinate care, arrange for necessary services, and provide support for both the client and her husband.
Choice C reason: Suggesting contacting social services to help find a respite care facility for her husband is a reasonable option, but it may not be the most immediate or suitable solution for the client’s concerns. This option should be considered as part of the overall case management plan.
Choice D reason: Telling her to consider hiring a private nurse during the postoperative convalescence may be helpful, but it can be costly and may not be necessary if other support systems are in place. It should be discussed as part of the case management evaluation.
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