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HVCC NSGII- Quiz 4 review Terms in this set (28)Care for an indwelling urinary catheter should include which of the following interventions? a) Insert the catheter using clean technique. c) Remove obvious encrustations from the external catheter surface by washing it gently with soap and water. The nurse is teaching an older female patient how to manage stress incontinence at home. She instructs her to contract her pelvic floor muscles for at least 10 seconds followed by a brief period of relaxation. What is this intervention called? a) Prompted voiding d) Kegel exercises Kegel exercises strengthen the pelvic floor muscles that support the uterus, bladder, and bowel. Doing Kegel exercises regularly can reduce urinary incontinence. These exercises involve tightening and relaxing the muscles around the vaginal area. A client has just voided 50 mL, but reports that his bladder still feels full. The nurse's next actions should include: (Select all that apply.) a) palpating the bladder height. a) palpating the bladder height. -The nurse should palpate the bladder for distention. When caring for a patient with urinary retention, the nurse would anticipate an order for a) Limited fluid intake. b) A urinary catheter. Which assessment question should the nurse ask if stress incontinence is suspected? a) "Does your bladder feel distended?" c) "Do you experience urine leakage when you cough or sneeze?" Stress incontinence can be related to intra-abdominal pressure causing urine leakage, as would happen during coughing or sneezing. To obtain a clean-voided urine specimen for a female patient, the nurse should teach the patient to a) Cleanse the urethral meatus from the area of most contamination to least. c) Hold the labia apart while voiding into the specimen cup. The patient should hold the labia apart to reduce bacterial levels in the specimen. The urethral meatus should be cleansed from the area of least contamination to greatest contamination (or front-to-back). The initial steam flushes out microorganisms in the urethraand prevents bacterial transmission in the specimen. Drink fluids 30 to 60 minutes before giving a specimen. Many individuals have difficulty voiding in a bedpan or urinal while lying in bed because they a) Are embarrassed that they will urinate on the bedding. b) Would feel more comfortable assuming a normal voiding position. The nurse knows that which indwelling catheter procedure places the patient at greatest risk for acquiring a urinary tract infection? a. Emptying the drainage bag every 8 hours or when half full c. Placing the drainage bag on the side rail of the patient's bed Placing the drainage bag on the side rail of the bed could allow the bag to be raised above the level of the bladder and urine to flow back into the bladder. The urine in the drainage bag is a medium for bacteria; allowing it to reenter the bladder can cause infection. A nurse notifies the provider immediately if a patient with an indwelling catheter: a) Complains of discomfort upon insertion of the catheter. c) Has not collected any urine in the drainage bag for 2
hours. If the patient has not produced urine in 2 hours, the physician needs to be notified immediately because this could indicate renal failure. Which nursing actions are acceptable when collecting a urine specimen? (Select all that apply.) a) Growing urine cultures for up to 12 hours b) Labeling all specimens with date, time, and initials The nurse properly obtains a 24-hour urine specimen collection by (Select all that apply.) a. Asking the patient to void and to discard the first sample. a. Asking the patient to void and to discard the first sample. Which of the following is a nursing priority when caring for a male patient with a condom catheter? a) Preventing the tubing from kinking to maintain free urinary drainage a) Preventing the tubing from kinking to maintain free urinary drainage The nurse recognizes that urinary elimination changes may occur even in healthy older adults because of which of the following? a) The bladder distends and its capacity increases d) The amount of urine retained after voiding
increases -The capacity of the bladder may decrease with age but the muscle is weaker and can cause urine to be retained The catheter slips into the vagina during a straight catheterization of a female client. The nurse does which action? a) Leaves the catheter in place and gets a new sterile catheter a) Leaves the catheter in place and gets a new sterile catheter During shift report, the nurse learns that an older female client is unable to maintain continence after she senses the urge to void and becomes incontinent on the way to the bathroom. Which nursing diagnosis is most appropriate? a) stress urinary incontinence d) urge urinary incontinence A practitioner uses a urine specimen for culture and sensitivity via a straight catheter for a patient. What should the nurse do when collecting this urine specimen? a) Use a sterile specimen container. a) Use a sterile specimen container. What anatomical feature makes women more prone to urinary tract infections than men? a) Increased width of the pelvic bones b) Proximity of the urethra to the vagina and anus The nurse is caring for a client who has been diagnosed with a urinary tract infection. Which of the following isolation precautions should be implemented? a)
contact d) standard Which are goals of nursing care for a client with an indwelling urinary catheter? Select all that apply. a) Prevent infection. a) Prevent
infection. Which piece of information is most important for the nurse to obtain prior to removing an indwelling urinary catheter? a) Date of insertion c) Amount of saline in
balloon The nurse would need to know the amount of saline inserted into the balloon prior to removing the catheter. This allows the nurse to use the correct syringe size and to ensure the nurse removes all of the saline before pulling the catheter out. Which condition in older men can result in impaired flow of urine from the bladder into the urethra? a) Renal calculi b) Prostatic hypertrophy The nurse just finished inserting an indwelling urinary catheter into a client and is sitting down to document the procedure. Which information should the nurse include in the medical record? Select all that apply. a) Catheter size a) Catheter size The nurse has an order to obtain a urine specimen for a culture and sensitivity test from a client with an indwelling urinary catheter. Which procedure is accurate for obtaining the specimen? a) Obtaining the specimen from the drainage bag d) Clamping the tubing and withdrawing a fresh specimen from the tubing aseptically What is the purpose of using a drape when inserting a catheter? a) Reduces the risk of infection c) Provides privacy for the client The home health nurse just removed an indwelling urinary catheter from a client per the health-care provider's order. Which instructions should the nurse provide the client? Select all that apply. a)
Report any pain or burning upon urination. a) Report any pain or burning upon
urination. When inserting an indwelling catheter, which level of asepsis is used? a) Medical asepsis c) Surgical asepsis -Medical
asepsis, or clean technique, is not used during catheter insertion. Which is an advantage of intermittent catheterization over indwelling catheters? a) Convenience to the client c) Can be removed immediately and client can void normally A urine specimen is obtained by a client cleaning the exterior meatus, then beginning to void, then collecting the urine sample midstream. Which type of specimen does this describe? a) Freshly voided specimen b) Clean-catch specimen Sets with similar termsPotter-Perry Chapter 45 Urinary Elimination44 terms nurse12314 FUND CHPT 45 URINARY ELIMINATION44 terms DayTribeMom NCLEX Questions CH. 45,4644 terms rnmanda Urinary Elimination Practice Questions44 terms sepudles Sets found in the same folderEvolve - Urination15 terms tina_j_dunlap Removing an indwelling catheter5 terms hewitj Inserting a urinary catheter into a female patient5 terms bsgar Initiating a Transfusion Skills5 terms abbyholloway99 Other sets by this creatorPain18 terms NurseAmandaRose Antibiotic Therapy2 terms NurseAmandaRose Ortho Lab23 terms NurseAmandaRose Rheumatic Disorders33 terms NurseAmandaRose Other Quizlet setsEnglish final185 terms darbyrose6 Children's Memory & Child Witnesses + Attachment (…15 terms chanchristina MGS351 Exam 1159 terms jgrimm19 MODULE 8 REVIEW QUESTIONS35 terms Ciaron_Garcia Related questionsQUESTION What is the gold standard for diagnosing brain tumors? 15 answers QUESTION When ICP goes up, what happens to CPP? 8 answers QUESTION What can alter vitamin D metabolism and thus contribute to Rickets/osteomalacia? 2 answers QUESTION The client is taking enalapril (Vasotec), an angiotensin-converting enzyme (ACE) inhibitor, for hypertension. Which assessment finding with this requires immediate intervention by the nurse? 14 answers What should be included in the management of indwelling urinary catheters?Daily catheter care should include: Labeling on bag insertion date, time and place (e.g. OR, ER). Maintain a closed urinary drainage system to prevent introduction of bacteria into the urinary tract. Adequately secure and anchor the catheter to prevent urethral and bladder-neck tension.
What interventions would you use to prevent infection in a client with an indwelling catheter?If you have an indwelling catheter, you must do these things to help prevent infection:. Clean around the catheter opening every day.. Clean the catheter with soap and water every day.. Clean your rectal area thoroughly after every bowel movement.. Keep your drainage bag lower than your bladder.. How do you care for a female with an indwelling catheter?Clean the area around the catheter twice a day with soap and water. Dry with a clean towel afterward. Do not apply powder or lotion to the skin around the catheter. Do not tug or pull on the catheter.
What are the 6 indications when an indwelling catheter is appropriate?Appropriate indications for urinary catheters include:
Hospice/comfort care/palliative care. Accurate measurement of urinary output in critically ill patients. Required strict immobilization for trauma or surgery. Assistance in healing of severe perineal and sacral wounds in incontinent patients.
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Care for an indwelling urinary catheter should include which of the following interventions Quizlet
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