A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place
The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient?
A) Apply a cold compress to the pubic area.
B) Notify the urologist.
C) Irrigate the catheter with 30 to 50 mL of normal saline as ordered.
D) Administer a narcotic as ordered.
Ans: C
Feedback: The nurse monitors the drainage tubing and irrigates the system as prescribed to relieve any obstruction that may cause discomfort. Usually, the catheter is irrigated with 50 mL of irrigating fluid at a time. It is important to make sure that the same amount is recovered in the drainage receptacle. The nurse may administer a medication that relaxes smooth muscles. Warm compress or Sitz baths may also help to alleviate symptoms.
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A client who is 6 months pregnant has sought medical attention, saying she fell down the stairs. Which scenario would cause an emergency department nurse to suspect that the woman has been battered?
a. She avoids making eye contact and is hesitant to answer questions. b. The woman and her partner are having an argument that is loud and hostile. c. The woman has injuries on various parts of her body that are in different stages of healing. d. Examination reveals a fractured arm and fresh bruises. Her husband asks her about her pain.
The nurse is working at a clinic, where several clients are waiting to be seen. Which client does the nurse assess first?
a. Client with temporal arteritis with new onset of blurry double vision b. Client with polymyalgia rheumatica with low-grade fever and fatigue c. Client with polymyositis reporting gene-ralized rash and joint pain d. Client with ankylosing spondylitis who presents with back pain and weight loss
Which nursing actions are appropriate when conducting a mental health assessment for a toddler-age child? Select all that apply
1. Observing the child's interaction with family members 2. Asking the caregiver to describe the child's typical day 3. Giving the child a crayon to assess ability to use 4. Determining the number of hours the child sleeps each night 5. Inquiring about recent exposure to communicable diseases
Which of the following statements is an example of reflecting?
A) "Tell me more about how you feel" B) "What is your biggest concern?" C) "Your surgery is scheduled for 10am tomorrow morning" D) "You feel like the world is closing in on you and making it hard to breathe?"