A nurse has developed a plan of care with nursing interventions designed to meet specific client outcomes. The outcomes are not met by the time specified in the plan. What should the nurse do now in terms of evaluation?

Correct Answer: B

Rationale: The correct answer is B: Make recommendations for revising the plan of care. When client outcomes are not met within the specified time frame, the nurse should reassess the plan of care to identify any potential reasons for the lack of progress. By making recommendations for revising the plan of care, the nurse can adjust interventions to better align with the client's needs and facilitate goal achievement. Continuing to follow the written plan of care (choice A) without modification may not address the underlying issues preventing goal attainment. Asking another health care professional to design a plan of care (choice C) may not be necessary if the nurse can assess and revise the current plan. Stating 'goal will be met at a later date' (choice D) does not address the need for immediate action to reassess and modify the plan for better outcomes.

Correct Answer: C

Rationale: Step 1: The nurse should explain that bladder irrigation is necessary to prevent blood clots from occluding the catheter after a TURP procedure. Step 2: Without irrigation, blood clots could block the catheter, leading to urinary retention and potential complications. Step 3: This explanation addresses the patient's concern about increased pain and highlights the importance of the irrigation in maintaining proper urine flow. Step 4: Choice A is incorrect because the primary purpose of irrigation is not to stop bleeding but to prevent clot formation. Choice B is incorrect because the irrigation is not for administering antibiotics. Choice D is incorrect as it does not address the issue of clot formation.

Correct Answer: C

Rationale: The correct answer is C: Painful and frequent urination. Cloudy penile discharge is a common symptom of urethritis, which is inflammation of the urethra. Painful and frequent urination are classic symptoms of urethritis due to irritation and inflammation of the urinary tract. Throat or rectal infection (choice A) are not typically associated with urethritis. Chancres or vesicles on the genitals (choice B) are more indicative of sexually transmitted infections like syphilis or herpes. Oliguria and flank pain (choice D) are more suggestive of kidney or urinary tract issues rather than urethritis.

Correct Answer: A

Rationale: The correct answer is A: 11mEq/L. In renal failure, the kidneys are unable to excrete excess magnesium, leading to hypermagnesemia. The patient's symptoms of stomach distress and ingesting antacids suggest magnesium intake. A Mg level of 11mEq/L aligns with symptoms like flushed face and weakness. Choices B, C, and D are too low for hypermagnesemia symptoms and would not explain the patient's presentation.

Correct Answer: B

Rationale: Step-by-step rationale for choice B being correct: 1. Dehydration leads to electrolyte imbalances, which can exacerbate cardiac dysrhythmias. 2. Small frequent intake of fluids like juices, broth, or milk helps in gradual rehydration without overwhelming the cardiovascular system. 3. This approach allows for better absorption of fluids and nutrients, promoting hydration without causing sudden shifts in electrolyte levels. Summary of why other choices are incorrect: A: Just drinking a glass of water every hour may not address electrolyte imbalances or provide adequate hydration for a client with cardiac dysrhythmias. C: NG replacement may not be necessary if the client can tolerate oral intake, and it is more invasive than needed. D: A rapid IV infusion may lead to sudden changes in electrolyte levels, potentially worsening the dysrhythmias.