When assessing a client who had a transurethral resection of the prostate (TURP) one day ago, the nurse observes that his scrotum and penis are edematous. Which intervention(s) should the nurse implement? Select all that apply.
Put a pillow under the buttocks.
Apply a cold pack to the scrotal and penile areas.
Obtain a specimen for urinalysis.
Remove the indwelling urinary catheter.
Notify the healthcare provider immediately.
Correct Answer : B,E
Choice A reason: Elevating the buttocks with a pillow is not specifically indicated in the scenario provided. While it might assist in other situations to reduce swelling by using gravity, it isn't a standard intervention for the described situation post-TURP.
Choice B reason: Applying a cold pack to the scrotal and penile areas can help reduce the swelling and discomfort associated with edema. Cold therapy is effective in constricting blood vessels and reducing inflammation, making it an appropriate immediate intervention.
Choice C reason: While obtaining a urinalysis might provide information on the presence of infection or other abnormalities, it does not directly address the immediate issue of the observed edema. Therefore, it is not a primary intervention in this scenario.
Choice D reason: Removing the indwelling urinary catheter without specific orders can lead to complications and is not advised as an initial intervention. The catheter serves a critical purpose post-surgery and should be handled according to protocol or provider direction.
Choice E reason: Notifying the healthcare provider immediately is crucial when unexpected postoperative complications such as edema occur. Prompt communication allows for timely medical intervention and ensures that the patient receives the necessary care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Administering cefazolin, an antibiotic, is a priority to prevent or treat potential infections in the immediate postoperative period.
Choice B reason: Completing a CBC in the morning is important for ongoing assessment but is not an immediate priority.
Choice C reason: Advancing the diet as tolerated is important but can be done after ensuring infection prevention.
Choice D reason: Straight catheterization is necessary if the client is unable to void but is not the immediate priority compared to preventing infection.
Correct Answer is ["C","D","E"]
Explanation
Choice A reason: Standard precautions and wearing a mask are important but not sufficient alone for MRSA infection control.
Choice B reason: A low bacteria diet is not specifically indicated for osteomyelitis or MRSA infection.
Choice C reason: Contact precautions are essential to prevent the spread of MRSA.
Choice D reason: Sending wound drainage for culture and sensitivity helps identify the causative organism and guide antibiotic therapy.
Choice E reason: Monitoring the white blood cell count helps assess the client's response to infection and treatment.
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