A nurse is inserting a catheter into a female patient. When the nurse inserts the catheter, no urine is obtained. The nurse suspects the catheter is not in the urethra.
What should the nurse do?
Fill the balloon with the recommended sterile water.
Remove the catheter, wipe with alcohol, and reinsert after lubrication.
Leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.
Discard the catheter and begin again.
The Correct Answer is C
If the nurse suspects the catheter is not in the urethra, they should leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Purulent drainage is thick and opaque. It can have a yellow, tan, green, or brown color and is a sign of infection.
Choice B rationale
Sanguineous drainage is bright red and indicates active bleeding3.
Choice C rationale
Serosanguineous drainage is typically pink-red and thin. It is made up of blood and serous fluid and is typically seen in a normal, non-infected wound3.
Choice D rationale
Serous drainage is clear and thin, like the fluid from a blister3.
Correct Answer is AANDD
Explanation
Choice A rationale
An ileostomy involves creating a stoma, or opening, in the abdominal wall. The location of the stoma is typically in the right lower abdomen.
Choice B rationale
The end of the stoma should not be painful after the procedure. If the patient experiences pain, it could indicate a complication and should be reported to the healthcare provider.
Choice C rationale
The patient should not expect the stoma to be a purple color. A healthy stoma should be red or pink. A purple stoma could indicate a lack of blood flow, which is a serious issue that needs immediate medical attention.
Choice D rationale
After an ileostomy, the patient will have liquid or semi-liquid stool pass through the stoma. This is because the large intestine, which normally absorbs water and forms solid stool, is bypassed or removed in the procedure.
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