A nurse is caring for a client who is 6 hr postoperative following abdominal surgery and is having difficulty voiding. Which of the following actions should the nurse take?

Allow the client to hear running water while attempting to void.

Provide the client a bedpan while lying supine.

Encourage fluid intake up to 1,000 mL daily.

Insert an indwelling urinary catheter and connect it to gravity drainage.

Answer and Explanation

The Correct Answer is C

A. While this technique can sometimes be helpful, it's not the first-line intervention for postoperative urinary retention. Encouraging fluids is a more fundamental step.

B.   Lying supine may make it more difficult for the client to void. Sitting upright or ambulating to the bathroom may be more effective.
C.   Encouraging fluids helps maintain adequate urine output, which is essential for preventing urinary retention after surgery. Dehydration can worsen the difficulty voiding.
D.   Catheterization should be considered only after other interventions to promote voiding have been attempted and failed, as it carries the risk of infection and discomfort.

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Correct Answer is A

Explanation

A. " Loose or uneven carpeting on stairs can increase the risk of falls for clients who have impaired balance or mobility. The nurse should instruct the client to secure carpeting on stairs with tacks or other fasteners to prevent slipping or tripping.
B. Securing extension cords with paper tape may not provide sufficient support and can pose a tripping hazard. It is better to use cable covers or secure them along the baseboard.
C. Placing furniture strategically in hallways increases the risk of falls. Furniture should be placed away from hallways.
D. Rugs in bathrooms can become slippery when wet, increasing the risk of falls. It is safer to use non-slip mats or rugs with rubber backing.

A. A client who has tuberculosis B. A client who has pneumonia C. A client who has shigella D. A client who has strep throat

Correct Answer is A

Explanation

A. Tuberculosis is an airborne infection, requiring airborne precautions to prevent transmission.
B. Pneumonia is typically transmitted through respiratory droplets and does not require airborne precautions.
C. Shigella is transmitted through the fecal-oral route and does not require airborne precautions.
D. Strep throat is typically transmitted through respiratory droplets and does not require airborne precautions.

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A nurse is caring for a client who is 6 hr postoperative following abdominal surgery and is having difficulty voiding. Which of the following actions should the nurse take?

Nursing Test Bank

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