A nurse is instructing a female client on obtaining a clean catch urine sample. Which of the following statements by the client indicates an understanding of the teaching?

"I should not collect a urine sample when I am menstruating."

"I need to urinate a small amount in the toilet before collecting the sample."

"I should let the urine cool to room temperature before sending it to the lab."

"I will wipe from the back to front with the cleansing cloth."

Answer and Explanation

The Correct Answer is B

A. While menstruation can potentially contaminate the sample, it is still possible to collect a clean catch sample during menstruation if proper technique is used; thus, this statement is not entirely accurate.
B. This is the proper clean catch technique—starting the stream helps flush out any contaminants from the urethra, and then the midstream portion is collected for testing.
C. Urine samples should be sent to the lab promptly while still fresh, or refrigerated if there will be a delay. Letting it cool to room temperature can alter test results.
D. Wiping from front to back is correct to reduce contamination from the perineal area; wiping from back to front increases the risk of introducing bacteria from the rectal area.

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Correct Answer is C

Explanation

A. Non-surgical removal of dead tissue is called debridement, not escharotomy.
B. Skin grafting involves transplanting healthy skin, but this is not the same as an escharotomy.
C. Escharotomy involves making large incisions through the hardened burned tissue (eschar) to relieve pressure and restore circulation.
D. Showering to remove dead tissue refers to wound cleaning, not escharotomy.

A. Urinary output 25 mL/hr B. Difficulty swallowing C. Heart rate 122/min D. Pain of 6 on a scale of 0 to 10

Correct Answer is B

Explanation

A. Urinary output of 25 mL/hr is low and concerning but not immediately life-threatening compared to airway compromise.
B. Burns to the face, ears, and eyelids can cause airway edema and swelling that may rapidly progress to airway obstruction. Difficulty swallowing may indicate swelling of the airway or impending airway compromise, which requires immediate intervention.
C. Heart rate of 122/min indicates tachycardia, which is common in burn patients due to pain, stress, or hypovolemia but is not as urgent as airway concerns.
D. Pain level of 6 requires management but is not a priority over airway or circulatory issues.

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A nurse is instructing a female client on obtaining a clean catch urine sample. Which of the following statements by the client indicates an understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower extremities and is scheduled for an escharotomy. The client's spouse asks the nurse what the procedure entails. Which of the following nursing statements is appropriate?

Correct Answer is C

Explanation

A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of the following is the priority finding to report to the provider?

Correct Answer is B

Explanation

A nurse is caring for a client who has cirrhosis of the liver. Exhibits Which of the following assessment findings require immediate follow-up? Select all that apply.

A nurse is assessing a client who has disseminated Intravascular coagulation (DIC). Which of the following findings should the nurse expect?

A nurse in the emergency department is assessing a newly admitted client who has facial trauma. Which of the following assessments is the nurse's priority?

A nurse is instructing a female client on obtaining a clean catch urine sample. Which of the following statements by the client indicates an understanding of the teaching?

A nurse is monitoring a client who was admitted with a severe burn injury and is receiving IV fluid resuscitation therapy. The nurse should identify a decrease in which of the following findings as an indication of adequate fluid replacement?

A nurse is caring for a client who will have blood sampling for a serum creatinine level and asks what this test shows. Which of the following responses should the nurse make?

A nurse caring for a client with diabetic ketoacidosis (DKA) has initiated the treatment plan. Which of the following electrolyte imbalance will the nurse be monitoring closely for this client?