A nurse is caring for a client who is day post-op following a transurethral resection of the prostate (TURP) and has a continuous bladder irrigation in place. Which actions should the nurse take? (Select a that apply)
Add the amount of bladder irrigation to the total output
Notify the surgeon if the urine is bright red an appearance or has large clots
Use sterile technique when preparing the irrigation solution.
Contact the surgeon if the client reports a continual need to void.
Ensure the drainage tubing is patent and without obstruction.
Correct Answer : A,B,E
A. The amount of irrigation fluid used must be added to the total output to accurately calculate fluid balance.
B. Bright red urine or large clots may indicate bleeding, which should be reported to the surgeon immediately.
C. Irrigation solution preparation does not require sterile technique; clean technique is sufficient for this task.
D. A continual need to void could be a normal post-op symptom, but if it persists or is severe, it should be investigated.
E. Ensuring the drainage tubing is patent and unobstructed is essential for proper urine flow and preventing complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
A. Asparagus is a moderate source of potassium but is not typically restricted in chronic kidney disease.
B. Green beans are low in potassium and are safe for clients with chronic kidney disease.
C. Avocado is high in potassium and should be limited in a kidney disease diet.
D. Bananas are rich in potassium and should be avoided in chronic kidney disease.
E. Tomatoes are high in potassium and should be limited in the diet of clients with chronic kidney disease.
Correct Answer is ["A","B","E"]
Explanation
A. The amount of irrigation fluid used must be added to the total output to accurately calculate fluid balance.
B. Bright red urine or large clots may indicate bleeding, which should be reported to the surgeon immediately.
C. Irrigation solution preparation does not require sterile technique; clean technique is sufficient for this task.
D. A continual need to void could be a normal post-op symptom, but if it persists or is severe, it should be investigated.
E. Ensuring the drainage tubing is patent and unobstructed is essential for proper urine flow and preventing complications.
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