A nurse is caring for an older adult client who is 1 hr postoperative following a transurethral resection of the prostate and is receiving continuous bladder irrigation. Which of the following findings should the nurse report to the provider?
Pink-tinged urine
Moderate pain
Decreased urinary output
Client urge to void
The Correct Answer is C
Rationale:
A. Pink-tinged urine: Pink-tinged urine can be a normal finding after a transurethral resection of the prostate (TURP), as it is expected due to the presence of blood in the urine from the procedure. It should improve over time as the bleeding subsides.
B. Moderate pain: Moderate pain is common following TURP, and it typically resolves with appropriate pain management. However, it should still be monitored and managed appropriately.
C. Decreased urinary output: Decreased urinary output is concerning after TURP and could indicate an obstruction, clot retention, or inadequate irrigation flow. This requires immediate attention and should be reported to the provider.
D. Client urge to void: The urge to void after TURP is normal and may occur as the bladder is healing. It may also result from the presence of the catheter. This is not a cause for concern unless accompanied by other signs of complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. "This finding may indicate possible medication toxicity." The red-orange color of the saliva is not indicative of toxicity but is a known, harmless side effect of rifampin. The nurse should reassure the client that this color change is common and not a sign of toxicity.
B. "This is an expected adverse effect of this medication." Rifampin can cause body fluids, including saliva, urine, and sweat, to turn a red-orange color. This is a well-known, expected adverse effect of the medication and does not require discontinuation or interventions.
C. "You will need to increase your fluid intake to resolve this problem." Increasing fluid intake will not affect the color change in body fluids caused by rifampin. The change in color is a benign side effect, and fluid intake does not resolve this issue.
D. "Your provider will prescribe a different medication regimen." The red-orange discoloration is a common side effect of rifampin and is not harmful. There is no need to change the medication regimen unless the client experiences other more serious side effects.
Correct Answer is C
Explanation
Rationale:
A. Pink-tinged urine: Pink-tinged urine can be a normal finding after a transurethral resection of the prostate (TURP), as it is expected due to the presence of blood in the urine from the procedure. It should improve over time as the bleeding subsides.
B. Moderate pain: Moderate pain is common following TURP, and it typically resolves with appropriate pain management. However, it should still be monitored and managed appropriately.
C. Decreased urinary output: Decreased urinary output is concerning after TURP and could indicate an obstruction, clot retention, or inadequate irrigation flow. This requires immediate attention and should be reported to the provider.
D. Client urge to void: The urge to void after TURP is normal and may occur as the bladder is healing. It may also result from the presence of the catheter. This is not a cause for concern unless accompanied by other signs of complications.
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