A nurse is assessing a client who is 2 days postoperative following a transurethral resection of the prostate and has an indwelling urinary catheter in place. Which of the following findings should the nurse expect?

Small clots with tissue in the urine

Dark red urine

Urinary output 25 mL/hr

Pain of 8 on a scale of 0 to 10

Answer and Explanation

The Correct Answer is A

A. Small clots with tissue in the urine. It is expected for a client 2 days post-TURP to have small clots and tissue debris in the urine as part of the healing process. Continuous bladder irrigation (CBI) often helps clear these.

B. Dark red urine. Bright red or dark red urine can indicate active bleeding, which is not expected 2 days post-op and requires immediate intervention.

C. Urinary output 25 mL/hr. This is too low (normal output should be at least 30 mL/hr) and could indicate catheter blockage, dehydration, or renal impairment, which is not expected.

D. Pain of 8 on a scale of 0 to 10. Mild discomfort is expected, but severe pain (8/10) is abnormal and could indicate bladder spasms, catheter blockage, or another complication requiring intervention.

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Correct Answer is A

Explanation

A. "I can use chamomile tea to promote sleep." Chamomile has calming properties and is commonly used as a natural remedy to promote relaxation and improve sleep.
B. "Herbal medicines do not interact with conventional medications." Many herbs can interact with prescription medications, potentially causing harmful effects.
C. "I can use ginger to help treat headaches." Ginger is primarily used to reduce nausea and motion sickness rather than for headache relief.
D. "Herbal medicines are regulated by the Food and Drug Administration." Herbal supplements are not regulated by the FDA in the same way as prescription and over-the-counter medications.

A. Tachypnea B. Ketonuria C. Warm skin D. Nervousness

Correct Answer is D

Explanation

A. Tachypnea. Rapid breathing is associated with diabetic ketoacidosis (DKA) rather than mild hypoglycemia.
B. Ketonuria. The presence of ketones in the urine occurs with prolonged hyperglycemia and DKA, not with hypoglycemia.
C. Warm skin. Hypoglycemia typically causes cool, clammy skin due to sympathetic nervous system activation, not warmth.
D. Nervousness. Low blood glucose triggers the release of epinephrine, leading to symptoms such as nervousness, tremors, and sweating.

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Nursing Test Bank

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