A nurse is caring for a male client who has a spinal cord injury. Which of the following techniques should the nurse use when providing perineal care?
Use water with no soap to prevent skin irritation.
Discard the washcloth after cleansing the urethral meatus.
Don sterile gloves to prevent infection.
Wash the penis from the scrotum to the tip using a spiral motion.
The Correct Answer is B
A. While avoiding harsh soap is important, using water alone may not adequately clean the area.
B. After cleaning the urethral meatus, the nurse should discard the washcloth or use a different part of it to prevent the spread of bacteria.
C. Clean gloves are typically sufficient unless the procedure involves a sterile environment.
D. The penis should be cleaned from the tip to the base (proximal to distal) to reduce the risk of introducing bacteria.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Clean gloves (not sterile) are sufficient for collecting a sputum sample.
B. The best time to collect a sputum specimen is immediately upon waking because secretions accumulate overnight, making it easier to obtain a sample.
C. Waiting a day delays diagnosis and treatment; other techniques can help induce sputum production.
D. Typically, 5 to 10 mL of sputum is sufficient for diagnostic testing.
Correct Answer is C
Explanation
A. "What has helped you through difficult times in the past?": Important but not the priority in a potential crisis.
B. "Has anyone in your family committed suicide?": Relevant but not the first question.
C. "Are you thinking about ending your life?": Directly assesses the client's safety and risk for suicide.
D. "Is there anyone you would like involved in your care?": Supports coping but is not urgent.
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