A nurse is caring for a client who is 6hrs postoperative following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first?
Irrigate the catheter.
Check the tubing for kinks.
Notify the provider.
Adjust the rate of the bladder irrigant.
The Correct Answer is B
A. Irrigating the catheter may be necessary, but the nurse should first assess for a simpler cause of the obstruction, such as a kink.
B. Checking for kinks is the priority, as it is a common cause of catheter obstruction and can be easily corrected.
C. Notifying the provider is unnecessary unless troubleshooting measures fail to resolve the issue.
D. Adjusting the bladder irrigant rate may be considered, but only after ensuring the tubing is free from kinks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Maintaining bed rest is not typically required after an IVP unless otherwise indicated for the patient's condition.
B. Administering a laxative is not a standard intervention following an IVP unless the patient specifically requires it for bowel preparation or constipation.
C. Encouraging adequate fluid intake is crucial after the administration of contrast medium to help flush the kidneys and minimize the risk of contrast-induced nephropathy.
D. While assessing for hematuria may be appropriate, it is not a primary intervention directly related to the IVP procedure itself.
Correct Answer is D
Explanation
A. Bradycardia is not typical in hypovolemia; tachycardia is more common as the body compensates for fluid loss.
B. Hypotension, rather than hypertension, occurs due to reduced blood volume.
C. Polyuria is not a feature of hypovolemia; decreased urine output is expected.
D. Cool, clammy skin is a classic sign of hypovolemic shock as blood flow to the skin decreases in response to blood loss.
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