CRNE Exam Prep

Category - Changes in Health

A nurse is monitoring an 82-year-old male who had a transurethral resection of the prostate 12 hours ago. A three-way urinary catheter is inserted through the client’s urethra and into the bladder for continuous irrigation. A total of 3,000 mL of bladder irrigant has been infused for the past 8 hours. After assessing the client, the nurse immediately contacts the physician for a possible complication of the procedure. Which of the following is most likely noted by the nurse during the assessment?
  1. Urinary output of 3,500 mL for the past 8 hours
  2. Pain and sense of urgency to urinate are reported by the client
  3. Blood pressure of 110/50 mm Hg; 120 bpm
  4. Blood in urine with small clots
Explanation
Answer: C - A low blood pressure with an increase in heart rate indicates a possible case of hemorrhage. A physician should be contacted right away to prevent more severe complications such as shock. Bloody urine is expected after the surgery and is usually resolved by the time the client is discharged. A urinary output that is greater than the intake is adequate. If the output is less than the intake, the client is at risk of clot formation. A sense of urgency to urinate is expected after the surgery.
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