A client who underwent transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) reports a weak urinary stream, urgency, and difficulty achieving erections. Which statement by the nurse describes the reason for these symptoms?

Rationale for correct answers:

• Pain when swallowing, and aching pain in the middle upper abdomen: Odynophagia (pain when swallowing) and epigastric pain are significant clinical markers. Pain when swallowing can indicate esophageal inflammation, ulceration, or strictures. Upper abdominal pain is the hallmark of peptic ulcers or gastric erosion.
• One episode of emesis prior to arrival: While nausea is common, actual vomiting (emesis) is a higher-priority finding because it can lead to fluid and electrolyte imbalances and may indicate a gastric outlet obstruction or a more severe ulceration.
• Now symptoms occur multiple times per day: This is a critical indicator of disease progression. Symptoms that have increased in frequency from 1–2 times per month to multiple times per day suggest that the underlying condition is no longer being managed and may be approaching a complication like perforation or hemorrhage.

Rationale for incorrect answers:

• Diagnosed with type 2 diabetes / Metformin: While important for the overall care plan and medication reconciliation, this is a known, chronic condition and not the acute reason for the emergency visit.
• Smokes 1 pack of cigarettes per week: This is a significant risk factor for GI irritation and delayed healing, but it is a chronic behavioral habit rather than an acute physical symptom requiring immediate emergency stabilization.
• Previous symptoms started 6 months ago: This provides historical context of a chronic issue, but the change in that history (the increased frequency) is the actual priority.

A. This is the most important intervention for this client. In CKD, the kidneys lose their ability to produce sufficient erythropoietin, a hormone that stimulates red blood cell production. Consequently, anemia is common in CKD and dialysis patients. The nurse should regularly assess for clinical signs such as pallor, fatigue, tachycardia, shortness of breath, and dizziness, and collaborate with the healthcare team for interventions such as erythropoiesis-stimulating agents (ESAs) or iron supplementation. Monitoring anemia is critical because untreated anemia can lead to cardiovascular strain, decreased functional ability, and reduced quality of life.

B. This is contraindicated. Anuric CKD clients are unable to excrete potassium, putting them at high risk for hyperkalemia, which can cause life-threatening cardiac arrhythmias. Nursing care should focus on restricting potassium intake and monitoring serum potassium levels rather than promoting high-potassium foods.

C. While skin care is important, this intervention is less relevant for an anuric client, because the client does not produce urine that could cause moisture-related skin breakdown. Skin care priorities should focus more on mobility, pressure injury prevention, and moisture from perspiration or incontinence of stool if applicable.

D. A toileting schedule is important for clients with urinary incontinence, but it is not necessary for an anuric patient. Since this client does not produce urine, scheduled voiding will not prevent complications and is not a priority intervention.