In the PACU, a patient is noted to have low urine output. What is the most appropriate immediate intervention?
Administer diuretics as prescribed.
Check the patency of the urinary catheter.
Notify the primary surgeon immediately.
Increase the rate of IV fluids.
The Correct Answer is B
A. Administer diuretics: Diuretics should not be the first action for oliguria in a post-surgical patient until the underlying cause is identified. If the low output is due to hypovolemia, diuretics would further deplete the intravascular volume and worsen renal perfusion. They require a specific provider order based on diagnostic data.
B. Check the patency of the urinary catheter: Low urine output in the PACU may be due to mechanical obstruction rather than renal failure or hypovolemia. The nurse must first ensure that the drainage system is not kinked or blocked to get an accurate reading. This simple, non-invasive assessment must precede pharmacological or surgical interventions.
C. Notify the primary surgeon: While the surgeon should be informed of significant changes, the nurse must first perform a basic assessment to provide a complete report. Checking the catheter allows the nurse to determine if the issue is a simple mechanical problem. Notification is the next step if patency is confirmed.
D. Increase the rate of IV fluids: Bolusing fluids is a common treatment for prerenal oliguria, but it should not be done before checking for mechanical obstruction. If the patient has a blocked catheter, increasing fluids will only cause bladder distension and discomfort. Fluid titration must be guided by accurate output measurements.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Antibiotics: These agents are pharmacological substances designed to eradicate or inhibit the growth of pathogenic bacteria during an active infection. While asthma may be exacerbated by respiratory infections, antibiotics do not possess the anti-inflammatory properties required to manage chronic bronchial hyperreactivity. They do not address the underlying eosinophilic or lymphocytic infiltration of the airway.
B. Beta-agonists: These medications act on beta-2 adrenergic receptors to induce smooth muscle relaxation and rapid bronchodilation during acute bronchospasm. While essential for relieving immediate obstructive symptoms, they do not inhibit the underlying inflammatory cascade or reduce mucosal edema. Excessive use without anti-inflammatory coverage can lead to receptor downregulation and poor asthma control.
C. Antihistamines: These drugs antagonize H1 receptors to mitigate the effects of histamine release during Type 1 hypersensitivity reactions, primarily affecting the upper respiratory tract. Although they may assist in managing comorbid allergic rhinitis, they are not effective for the primary management of lower airway inflammation. They lack the potency to suppress the complex cellular inflammation of asthma.
D. Corticosteroids: These potent anti-inflammatory agents inhibit the production of inflammatory mediators, such as cytokines and leukotrienes, while reducing the migration of eosinophils. By suppressing the immune response within the bronchial mucosa, they reduce airway edema and hyperresponsiveness over time. They represent the gold standard for long-term maintenance therapy in chronic asthma.
Correct Answer is D
Explanation
A. 30 gtt/min:This rate would deliver approximately 180 mL per hour, meaning the 500 mL would be finished in less than 3 hours. This is much faster than the 8-hour duration prescribed by the physician. Rapid infusion of saline can lead to fluid overload, especially in patients with cardiac or renal issues.
B. 15 gtt/min:At this drip rate, the patient would receive only about 45 mL per hour, totaling 360 mL over 8 hours. This results in an under-infusion that fails to meet the patient's prescribed fluid requirements. It would take over 11 hours to finish the 500 mL bag at this speed.
C. 35 gtt/min:This setting would deliver 105 mL per hour, resulting in the total volume being infused in under 5 hours. This significantly deviates from the 8-hour order and increases the risk of complications associated with rapid fluid administration. It represents a calculation error in the drip rate formula.
D. 21 gtt/min:Using the formula (500 mL multiplied by 20 gtt/mL) divided by 480 minutes, the result is 20.83. Rounding to the nearest whole number gives 21 drops per minute. This precisely ensures that the 500 mL of normal saline is delivered over the intended 8-hour period.
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