The first time that a client voids after cystoscopy, the nurse observes pink-tinged urine. What is the appropriate nursing response?
Document normal findings
Contact the Rapid Response Team
Promptly notify the health care provider
Restrict fluids
The Correct Answer is A
A. Document normal findings: Pink-tinged urine is expected after a cystoscopy due to minor trauma to the urethra or bladder during the procedure.
B. Contact the Rapid Response Team: Pink-tinged urine does not indicate a medical emergency requiring the Rapid Response Team.
C. Promptly notify the healthcare provider: This finding does not require immediate notification unless accompanied by significant bleeding, clots, or other abnormal symptoms.
D. Restrict fluids: Increasing fluid intake helps flush the urinary tract and reduce irritation after a cystoscopy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Mix with 3 mL of normal saline and inject subcutaneously: Fosfomycin is not administered subcutaneously; it is an oral medication.
B. Mix contents with 90-120 mL of water and administer by mouth: Fosfomycin is supplied as a powder that must be mixed with water before oral administration.
C. Pour contents into a soufflé cup and administer by mouth: The medication must be dissolved in water to ensure proper absorption.
D. Pour contents into 60 mL of juice, stir, and administer by mouth: Mixing with juice is not recommended as it may alter the medication's effectiveness.
Correct Answer is D
Explanation
A. Level of fluid intake: While monitoring fluid intake is important, bowel sounds are more critical immediately after surgery to detect potential paralytic ileus or other complications.
B. Keep the bed flat: Postoperative positioning depends on the type of surgery and is not universally necessary.
C. Position on the left side: There is no specific need to position the patient on the left side postoperatively unless otherwise indicated.
D. Bowel sounds: Assessing bowel sounds is crucial to monitor for postoperative complications such as ileus.
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