A nurse manager is evaluating a nurse who is performing a urinary catheterization on a male client. Which of the following actions by the nurse demonstrates correct aseptic technique?
Grasps the catheter 10.16 to 12.7 cm (4 to 5 in) from the tip
Cleanses the meatus using a clean cotton ball
Cleanses the meatus from the center in a circular motion
Applies clean gloves before beginning the procedure
The Correct Answer is C
A. Grasps the catheter 10.16 to 12.7 cm (4 to 5 in) from the tip The catheter should be held at least 5 to 7.6 cm (2 to 3 inches) from the tip to maintain better control and prevent contamination.
B. Cleanses the meatus using a clean cotton ball Aseptic technique requires a separate antiseptic swab or cotton ball for each stroke to avoid introducing bacteria.
C. Cleanses the meatus from the center in a circular motion Cleaning from the center outward prevents introducing bacteria into the urethra, which is essential for infection prevention.
D. Applies clean gloves before beginning the procedure Sterile gloves, not clean gloves, must be used during catheterization to maintain aseptic technique.
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Related Questions
Correct Answer is B
Explanation
A. "Rest the client's left arm over their chest." Keeping the affected arm across the chest can lead to contractures and shoulder adduction deformities. Instead, the arm should be supported in a neutral position with pillows or a sling to prevent complications.
B. "Apply an orthotic boot to the client's left foot." Clients with hemiplegia are at risk for foot drop due to muscle weakness or paralysis. An orthotic boot helps maintain proper foot alignment, prevents contractures, and promotes mobility.
C. "Place a thick pillow behind the client's head to increase cervical flexion." Excessive cervical flexion can lead to poor airway alignment and discomfort. Instead, the client’s head should be in a neutral, midline position with proper support.
D. "Instruct the client to lean toward the left side when ambulating to avoid falls." Leaning toward the affected (weaker) side increases the risk of imbalance and falls. Instead, the client should be encouraged to maintain proper posture and use assistive devices (e.g., cane, walker) for stability.
Correct Answer is D
Explanation
A. "I should close all doors and windows on the unit." –
This action is part of the "C" (Confine) step, which should be done before attempting to extinguish the fire.
B. "I should evacuate clients who are in immediate danger." –
Rescuing clients is the first step and should be done immediately.
C. "I should activate the facility's fire alarm system." –
Activating the alarm is the second step after rescuing clients.
D. "I should extinguish small fires if it is safe to do so." –
Extinguishing the fire is the last action in the fire safety protocol and should only be attempted if the fire is small and controllable.
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