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.
The Correct Answer is A
A. At 6 hours postoperative, difficulty voiding is common due to anesthesia effects and pain. The nurse should begin with noninvasive measures to stimulate urination. Hearing running water can help trigger the micturition reflex and promote voiding safely.
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. This is inadequate fluid intake; normal intake is usually 2,000–3,000 mL/day unless restricted. Furthermore, this does not directly address the immediate 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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
A. Povidone-iodine is not recommended for cleaning around the stoma as it may cause irritation.
B. Ensuring the pouch opening is slightly larger than the stoma helps prevent irritation and ensures proper fit.
C. Regular emptying of the ostomy pouch prevents leakage and skin irritation. It also prevents it from becoming too heavy and pulling away from the skin.
D. The nurse should advise the client to place a piece of gauze over the stoma while changing the pouch to protect it from injury and contamination.
E. A purplish-blue change in the stoma is an indication of impaired blood supply to the stoma and should be promptly reported to the healthcare provider.

Correct Answer is B
Explanation
A. Logrolling is primarily used to move clients without twisting the spine or causing friction on pressure areas, rather than specifically to prevent friction.
B. Logrolling is a technique used to maintain the alignment of the client's spine while turning them, reducing the risk of injury, particularly to the spinal cord.
C. Clients are typically instructed to cross their arms over their chest during logrolling to help maintain alignment and protect their arms.
D. While raising the head of the bed may be necessary for certain procedures or to assist with positioning, it is not specifically required for logrolling.
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