Nokea
After a transurethral resection of the prostate (TURP), a client has bloody urine output with large clots. The nurse implements the postoperative prescription to irrigate the indwelling catheter PRN to maintain the catheter's patency. Which action should the nurse implement?
- A. Clamp the catheter for 30 minutes prior to irrigating with saline
- B. Manually irrigate the catheter with sterile saline as prescribed
- C. Increase the client's oral fluid intake to flush out clots naturally
- D. Remove the catheter and notify the healthcare provider immediately
Correct Answer: A
Rationale: Clamping the catheter before irrigation prevents sudden fluid shifts and ensures that irrigation is performed effectively.
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The nurse is evaluating a male client’s understanding of diet teaching about the DASH (Dietary Approaches to Stop Hypertension) eating plan. Which behavior indicates that the client is adhering to the eating plan?
- A. Uses only lactose-free dairy products
- B. Enjoys fat free yogurt as an occasional snack food
- C. No longer includes grains in his daily diet
- D. Carefully cleans and peels all fresh fruit and vegetables
Correct Answer: D
Rationale: Cleaning and peeling fruits and vegetables is consistent with the DASH plan, which promotes a high intake of fresh produce.
Which of the following statements is incorrect regarding delayed tooth eruption?
- A. Most common cause is idiopathic
- B. Defined as no teeth eruption by 15 months of age
- C. Mechanical blockade can be a cause
- D. Hypothyroidism and hypoparathyroidism should be ruled out
Correct Answer: B
Rationale: Delayed tooth eruption is defined as no teeth eruption by 13 months of age, not 15 months.
Causes of pancytopenia and splenomegaly include:
- A. Low-grade non-Hodgkin's lymphoma
- B. Gaucher's disease
- C. Alcoholic cirrhosis
- D. BI2 deficiency
Correct Answer: B
Rationale: Gaucher's disease, a lysosomal storage disorder, can cause pancytopenia and splenomegaly due to bone marrow infiltration and hypersplenism.
Clinical manifestations of hypoplastic left-heart syndrome in the 1st 48 hr of life include
- A. always obvious color
- B. deep-blue skin
- C. bounding peripheral pulses
- D. occasional association with Turner syndrome
Correct Answer: C
Rationale: Bounding peripheral pulses are not typical in hypoplastic left-heart syndrome.
Tests used in establishing a diagnosis of coeliac disease are:
- A. IgA anti-endomysial antibodies
- B. IgM anti-reticulin antibodies
- C. IgA anti-gliadin antibodies
- D. Duodenal biopsy
Correct Answer: D
Rationale: A duodenal biopsy is the gold standard for diagnosing coeliac disease, as it provides histological confirmation of the disease.