A nurse is preparing to bathe a client with dyspnea. Which of the following actions should the nurse plan to take?

Avoid bathing this patient until they are stable.

Only bathe the perineal area.

Perform the bath in a semi-Fowler's position.

Delegate the task to the assistive personnel.

Answer and Explanation

The Correct Answer is C

A. Avoid bathing this patient until they are stable: Hygiene is essential for preventing infection and promoting comfort. Bathing should not be entirely avoided unless the patient is critically unstable.

B. Only bathe the perineal area: While perineal care is important, other areas also require cleaning, and modifications can be made to prevent excessive exertion.

C. Perform the bath in a semi-Fowler's position: Semi-Fowler's position (30–45°) promotes lung expansion and reduces dyspnea, making it the best position for bathing a patient with breathing difficulty.

D. Delegate the task to the assistive personnel: While an assistive personnel (AP) can assist, the nurse should assess the patient first and be involved in care for clients with respiratory distress.

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Correct Answer is D

Explanation

A. Applying sterile gloves to assist with a procedure: This is part of surgical asepsis (sterile technique) rather than medical asepsis.
B. Inserting an indwelling urinary catheter: This requires sterile technique, not just medical asepsis.
C. Preparing injectable medications: Medication preparation requires aseptic (sterile) technique to prevent contamination.
D. Picking up soiled tissues off of the bedside table: Medical asepsis includes hand hygiene and proper handling of contaminated items to prevent the spread of infection.

A. Transient incontinence and increased urine production B. Increased urine concentration C. Increased output of dilute urine D. A risk of urinary tract infections

Correct Answer is C

Explanation

A. Transient incontinence and increased urine production: While increased urine production is expected, transient incontinence is not a typical finding with furosemide unless the client has preexisting bladder control issues.

B. Increased urine concentration: Furosemide is a loop diuretic that promotes the excretion of sodium and water, leading to dilute urine rather than concentrated urine.

C. Increased output of dilute urine: Furosemide blocks sodium reabsorption in the loop of Henle, resulting in increased urine production that is dilute due to excessive water excretion.

D. A risk of urinary tract infections: Furosemide does not directly increase the risk of urinary tract infections (UTIs). UTIs are more common with urinary retention rather than increased urine flow.

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A nurse is preparing to bathe a client with dyspnea. Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing care for patients on the medical-surgical unit. Which of the following situations requires the nurse to implement medical asepsis?

Correct Answer is D

Explanation

A client has developed edema in her lower legs and feet prompting her physician to prescribe furosemide, a diuretic medication. After the client has begun this new medication, what should the nurse anticipate as a normal finding?

Correct Answer is C

Explanation

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