a nurse is contributing to the plan of care for a client following a transurethral resection of the prostate turp which of the following interventions
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Nursing Elites

ATI LPN

ATI PN Comprehensive Predictor 2024

1. A nurse is contributing to the plan of care for a client following a transurethral resection of the prostate (TURP). Which of the following interventions should the nurse include?

Correct answer: B

Rationale: Irrigating the bladder using sterile technique is crucial in the care of a client following a transurethral resection of the prostate (TURP). This intervention helps prevent infection and maintains patency of the urinary catheter, promoting healing. Administering antibiotics (Choice A) may be necessary if there is an infection present, but it is not a routine intervention following TURP. Avoiding bladder irrigation (Choice C) is not recommended as it can lead to clot retention and other complications. Inserting a urinary catheter (Choice D) is usually already done during the TURP procedure and is not a postoperative intervention.

2. A nurse is teaching a client who has chronic obstructive pulmonary disease (COPD) about breathing exercises. Which of the following instructions should the nurse include?

Correct answer: C

Rationale: The correct answer is C: 'Use pursed-lip breathing during physical activity.' Pursed-lip breathing is a beneficial technique for clients with COPD as it helps improve airflow by keeping the airways open longer. Choice A is incorrect as abdominal breathing may not be as effective in COPD as pursed-lip breathing. Choice B, inhaling quickly and deeply through the nose, is not recommended as it can lead to hyperventilation. Choice D, breathing quickly and deeply during exercise, is also not suitable for clients with COPD as it can cause increased shortness of breath.

3. How can a healthcare professional reduce the risk of falls in elderly patients?

Correct answer: D

Rationale: All of these interventions are crucial in reducing the risk of falls in elderly patients. Encouraging the use of assistive devices helps provide support and stability, clearing walkways minimizes tripping hazards, and ensuring proper lighting enhances visibility and reduces the chances of falls. Therefore, choosing 'All of the above' is the most appropriate answer as each intervention plays a significant role in fall prevention.

4. A nurse is caring for a client who has a prescription for wound irrigation. Which of the following actions should the nurse take?

Correct answer: C

Rationale: The correct action for the nurse to take when caring for a client with a prescription for wound irrigation is to cleanse the wound from the center outwards. This technique helps prevent contamination by pushing debris away from the wound rather than into it. Choice A is incorrect because wearing sterile gloves is important during wound care but not specifically mentioned for wound irrigation. Choice B is incorrect because warming the irrigation solution to a specific temperature is not a standard recommendation and can potentially harm the client. Choice D is incorrect because the size of the syringe may vary based on the wound size and depth, so using a 20 mL syringe is not a universal guideline.

5. How should a healthcare professional assess and manage a patient with ascites?

Correct answer: A

Rationale: Correct! When managing a patient with ascites, monitoring abdominal girth is crucial as it helps assess the extent of fluid retention. Administering diuretics is also essential to help reduce fluid buildup in the body, thereby managing ascites effectively. Option B is incorrect as pain relief is not the primary intervention for ascites. Option C is incorrect as restricting fluid intake can worsen the condition by causing dehydration and further fluid imbalances. Option D is incorrect as administering albumin and checking electrolyte levels are not first-line interventions for managing ascites; these interventions may be considered in specific cases but are not the initial steps in managing ascites.

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