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Which statement indicates discharge teaching has been effective for the client who is postoperative TURP?
- A. I will call the surgeon if I experience any difficulty urinating.'
- B. I will take my Proscar daily, the same as before my surgery.'
- C. I will continue restricting my oral fluid intake.'
- D. I will take my pain medication routinely even if I do not hurt.'
Correct Answer: A
Rationale: Difficulty urinating post-TURP may indicate obstruction or complications, requiring prompt reporting. Proscar is typically discontinued post-TURP, fluid restriction is unnecessary, and routine pain meds are not advised.
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The client who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the HCP?
- A. The pump keeps sounding an alarm indicating the high pressure has been reached.
- B. Intake is 1,800 mL, NGT output is 550 mL, and Foley output is 950 mL.
- C. On auscultation, crackles and rhonchi in all lung fields are noted.
- D. Client has negative pedal edema and an increasing level of consciousness.
Correct Answer: C
Rationale: Crackles and rhonchi suggest pulmonary edema, a critical complication possibly due to fluid overload, requiring immediate HCP notification. Pump alarms, intake/output, and edema status are less urgent unless associated with other critical findings.
Which nursing intervention is most helpful in assisting the client undergoing hemodialysis to cope with the client and the patient to the patient?
- A. Giving the client literature to read about renal failure
- B. Advising the client's spouse to cook the client's favorite dishes
- C. Keeping the client informed of the latest research findings
- D. Exploring with the client how this disorder has affected life
Correct Answer: D
Rationale: Exploring the impact of the disorder on the client's life fosters emotional coping and supports psychosocial adjustment.
The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement?
- A. Teach the client to carry heavy objects with the right arm.
- B. Perform all laboratory blood tests on the left arm.
- C. Instruct the client to lie on the left arm during the night.
- D. Discuss the importance of not performing any hand exercises.
Correct Answer: A
Rationale: To protect the new AV fistula, the client should avoid stress on the left arm. Carrying heavy objects with the right arm prevents fistula damage. Blood tests should avoid the fistula arm, lying on it risks compression, and hand exercises are encouraged to promote fistula maturation.
As the nurse instructs the client about CBI, which information should the nurse provide? Select all that apply.
- A. You may feel the urge to urinate even though the bladder is empty.
- B. Do not to try to urinate around the catheter, because this will cause bladder spasms.
- C. You need to limit your fluids to 4 glasses per day.
- D. It is normal for the urine to be bloody immediately after surgery.
- E. The catheter will be removed in about a week.
- F. By the time you are ready to go home, your urine should be pink with a few clots.
Correct Answer: A,B,D,F
Rationale: These statements accurately describe CBI effects, expectations, and precautions post-TURP.
Which nursing intervention promotes the spontaneous passage of ureteral stones?
- A. Encouraging ambulation as tolerated
- B. Restricting fluid intake
- C. Administering diuretics
- D. Keeping the client on bed rest
Correct Answer: A
Rationale: Encouraging ambulation promotes gravity-assisted stone movement through the ureter, facilitating spontaneous passage.