A nurse is planning care for a client who is 2 hours postoperative following a transurethral resection of the prostate (TURP). The client is receiving continuous bladder irrigation. Which of the following interventions should the nurse include?

Restrict the client's oral fluid intake.

Remind the client he might feel a constant urge to void.

Monitor the client's urine output every 6 hours.

Weigh the client every evening.

Answer and Explanation

The Correct Answer is B

Choice A reason:
Restricting the client's oral fluid intake is not typically recommended as part of postoperative care following TURP. In fact, maintaining adequate hydration is important to help flush the bladder and prevent clot formation.

Choice B reason:
It is common for clients to feel a constant urge to void due to the irritation of the bladder from the catheter and the continuous bladder irrigation. Reminding the client that this sensation is normal and expected can help alleviate anxiety and provide reassurance.

Choice C reason:
Monitoring the client's urine output is important to ensure that the bladder irrigation is effective and that there are no signs of obstruction. However, it should be done more frequently than every 6 hours, especially in the immediate postoperative period, to promptly detect any complications.

Choice D reason:
Weighing the client every evening is not directly related to the management of continuous bladder irrigation. While monitoring weight can be part of overall postoperative care, it does not address the specific needs related to TURP and continuous bladder irrigation.

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Correct Answer is B

Explanation

Choice A reason:
Placing the leg under a heat lamp every 3 hours is not recommended for the treatment of cellulitis. Heat lamps can cause burns and excessive drying of the skin, which may worsen the condition.

Choice B reason:
Wrapping a warm, wet towel around the affected area is a safe and effective way to apply heat therapy for cellulitis. It can help improve blood flow and relieve discomfort without the risk of burns associated with dry heat sources.

Choice C reason:
Using a heating pad directly on the skin, especially when lying down, can increase the risk of burns and is not recommended for treating cellulitis. Heating pads can provide uneven heat and may exacerbate swelling and inflammation.

Choice D reason:
Soaking the leg in water is not typically advised for cellulitis, especially if there are open wounds or breaks in the skin. Immersion in water can introduce new bacteria to the affected area and potentially worsen the infection.

A. 10 mm wheal B. 5 mm induration C. 15 mm induration D. 4 mm erythema

Correct Answer is C

Explanation

Choice A Reason:
A 10 mm wheal is not indicative of TB infection. A wheal is a raised, often itchy area of skin that usually signifies an allergic reaction, not an infection. The TST looks for induration, which is a firm swelling, as a sign of TB infection.

Choice B Reason:
A 5 mm induration is considered positive in certain high-risk groups, such as people living with HIV, recent contacts of TB patients, or those with a history of organ transplants. For individuals without these risk factors, a 5 mm induration is not considered a positive result.

Choice C Reason:
A 15 mm induration is considered a positive TST result for individuals with no known risk factors for TB. This indicates that the person's immune system has reacted to the tuberculin purified protein derivative (PPD) injected under the skin, suggesting exposure to TB bacteria.

Choice D Reason:
Erythema, or redness of the skin, is not measured when interpreting TST results. The test measures induration, which is a palpable, raised, hardened area or swelling. Therefore, a 4 mm erythema does not indicate TB infection.

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A nurse is planning care for a client who is 2 hours postoperative following a transurethral resection of the prostate (TURP). The client is receiving continuous bladder irrigation. Which of the following interventions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a client who has a prescription for heat therapy for the treatment of cellulitis of the right lower leg. Which of the following client statements indicates an understanding of the teaching?

Correct Answer is B

Explanation

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Correct Answer is C

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