Prior to insertion of an indwelling urinary catheter, which client information is most important for the nurse to obtain?
Previous history of urinary tract infections.
Client's ability to increase fluid intake.
Client allergies to antiseptic solutions.
Color, clarity, and odor of urine.
The Correct Answer is C
A. While a history of urinary tract infections is important to know for overall assessment and planning of care, it may not directly affect the decision to insert a urinary catheter unless there are specific concerns related to infection prevention.
B. The client's ability to increase fluid intake may be relevant to their overall hydration status and urinary function but is not directly related to the insertion of an indwelling urinary catheter.
C. This is the most important information to obtain because the nurse needs to ensure that the client does not have any allergies to antiseptic solutions that may be used during the catheter insertion procedure to prevent infection.
D. While the color, clarity, and odor of urine are important indicators of urinary health, they are not the most critical information to obtain prior to catheter insertion. However, assessing urine characteristics is important for ongoing monitoring of urinary function and potential
complications post-insertion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Phobia.
A phobia is an irrational fear of a specific object, situation, or activity that leads to a desire to avoid it. The client's behavior is more characteristic of a compulsion rather than a phobia.
B. Obsession.
An obsession is an intrusive, unwanted thought, image, or urge that causes significant anxiety.
While the client's fear of contamination could be an obsession, the handwashing itself is a compulsion.
C. Compulsion.
This is the correct answer because a compulsion is a repetitive behavior or mental act that a person feels driven to perform in response to an obsession. The client's excessive handwashing ritual is a classic example of a compulsion.
D. Addiction.
Addiction involves a compulsive need for and use of a habit-forming substance or behavior, typically involving a sense of euphoria or pleasure, which is not applicable to the client's behavior.
Correct Answer is B
Explanation
A. Lymphangitis is characterized by inflammation of the lymphatic vessels and is often associated with red streaks and tenderness. The absence of inflammation and tenderness suggests a different etiology.
B. Malignancy is suggested by the presence of a large, nontender, hardened lymph node. These characteristics are commonly associated with metastatic spread of cancer to the lymph nodes. Further diagnostic testing, such as biopsy, would be warranted to confirm malignancy.
C. Viral infection may cause lymphadenopathy, but typically, the lymph nodes are tender and may be enlarged but not necessarily hardened. The absence of tenderness and the hardened consistency of the lymph node suggest a different etiology.
D. Bacterial infection can cause lymphadenopathy, which may be tender and enlarged, but the nontender, hardened nature of the lymph node in this case is more indicative of malignancy
rather than a bacterial infection.
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