The nurse cares for a client six hours post-operative following a transurethral resection of a prostate (TURP).
The client is demonstrating signs and symptoms of ?
urinary catheter obstruction
shock
hyponatremia
urinary tract infection
The Correct Answer is A
Choice A rationale: The signs and symptoms of urinary catheter obstruction include hematuria with clots, bladder spasms, and a feeling of urinary urgency. The nurse should increase the rate of the continuous bladder irrigation to flush out the clots and relieve the obstruction. The nurse should also monitor the client's vital signs, fluid balance, and pain level. The other options are not consistent with the client's presentation.
Choice B rationale: Shock would cause hypotension, tachycardia, and decreased urine output.
Choice C rationale: Hyponatremia would cause confusion, weakness, and seizures.
Choice D rationale: Urinary tract infection would cause fever, chills, and foul-smelling urine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: In ALS, impaired physical mobility due to decreased motor agility and the inability to ambulate is a direct consequence of the disease.
Choice B rationale: Hopelessness might be a possible emotional response but doesn't address the client's physical limitations due to ALS.
Choice C rationale: Caregiver role strain is related to the family's ability to manage caregiving responsibilities and is not the primary concern for the client's physical mobility.
Choice D rationale: Impaired memory is not the primary issue in ALS; the client's inability to ambulate due to decreased motor function is the main focus for this nursing diagnosis.
Correct Answer is D
Explanation
Choice A rationale: This is incorrect.
Choice B rationale: This describes metabolic syndrome, a collection of risk factors, but not a direct complication of type 1 diabetes.
Choice C rationale: This describes hyperosmolar hyperglycemic state, which is more characteristic of severe hyperglycemia but not the most common complication in type 1 diabetes.
Choice D rationale: Diabetic ketoacidosis (DKA) is a frequent and serious complication in type 1 diabetes, characterized by ketone formation due to the absence of insulin, leading to metabolic acidosis and potential life-threatening symptoms.
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