After a transurethral resection, the nurse notices that the client's urine in the Foley catheter bag is bright red, has numerous clots, and is viscous. The priority nursing action at this time is to
a. add fluid to the balloon end of the catheter.
b. call the physician immediately.
c. force fluids for the next 8 hours.
d. irrigate the catheter with sterile saline.
B
Arterial bleeding is bright red, has numerous clots, and is viscous. Blood pressure may fall, and emergency surgical intervention may become necessary.
You might also like to view...
The nurse is responsible for maintaining intact skin for the compromised client. Appropriate nursing priorities include: Standard Text: Select all that apply
1. Checking pressure points regularly. 2. Regular turning and repositioning schedules. 3. Strict precautions to provide clean care to the wound. 4. Delegation to unlicensed assistive personnel. 5. Documenting care given.
The nurse is taking a class to become more culturally competent when providing care. In this class the nurse learns that the American work ethic is considered to be one that is hardworking and individualistic. The nurse should categorize the work ethic
as being a part of: 1. Culture. 2. Ethnicity. 3. Nationality. 4. Acculturation.
A patient with osteoporosis calls the nurse in the doctor's office to report that she has forgotten to take her weekly bisphosphonate (alendronate [Fosamax]) for 2 days past the weekly time. The nurse should advise the patient to:
a. take the dose now with 8 ounces of water. b. take two doses 3 days apart. c. skip this week and pick up the schedule next week. d. take 2 tablets now with a snack.
Which of the following assessment data provided by a client's family will have the greatest im-pact on the client's care while hospitalized?
1. "Mom falls asleep fastest with the television on." 2. "Dad starts off the day with hot coffee; it regulates his bowels." 3. "My wife's sister died 4 months ago, and she is still grieving over her loss." 4. "My husband doesn't like to let people know his arthritis is bothering him."