The charge nurse brings a #18 urinary catheter with a 30 mL balloon to the practical nurse (PN) who is preparing to insert a catheter in a female client who weighs 50 kg. Which action should the PN take first?

Obtain a 30 mL syringe and a vial of sterile water.

Ask the client if she has previously been catheterized.

Consult with the charge nurse about the catheter.

Position the client and observe the urinary meatus.

Answer and Explanation

The Correct Answer is C

This is the first action that the PN should take because the catheter size and balloon volume are inappropriate for the client. A #18 urinary catheter is too large for a female client who weighs 50 kg, and a 30 mL balloon may cause bladder trauma or discomfort. The PN should consult with the charge nurse and obtain a smaller catheter (such as #14 or #16) with a 10 mL balloon.

A. Obtaining a 30 mL syringe and a vial of sterile water is not the first action because it does not address the issue of the catheter size and balloon volume.

B. Asking the client if she has previously been catheterized is not the first action because it does not address the issue of the catheter size and balloon volume.

D. Positioning the client and observing the urinary meatus is not the first action because it does not address the issue of the catheter size and balloon volume.

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Correct Answer is B

Explanation

Choice A rationale:

Crushing the medication and administering it in applesauce might alter its pharmacokinetics, rendering it ineffective or causing it to act too quickly. Sublingual tablets are designed to dissolve under the tongue for rapid absorption into the bloodstream. Crushing the tablet and mixing it with applesauce could change its intended mode of action.

Choice B rationale:

Placing the tablet under the client's tongue is the correct action for a sublingual tablet. Sublingual administration allows the medication to dissolve directly into the bloodstream through the sublingual mucosa, bypassing the digestive system and providing rapid onset of action.

Choice C rationale:

Obtaining a liquid form of the medication might be an option, but it may not always be available. Additionally, some medications are not available in liquid forms, and the liquid form might have a slower onset of action compared to the sublingual route.

Choice D rationale:

Placing the tablet inside the client's cheek is known as the buccal route of administration. While this route is also for oral absorption, sublingual administration is preferred for specific medications designed for rapid absorption.

A. Boiled brown rice, 1/2 cup. B. Canned tomato soup, 1/2 cup. C. Fresh orange slices, 1 small. D. Grilled chicken, 3 ounces. E. Vegetables topped with cheddar cheese.

Correct Answer is ["A","C","D"]

Explanation

The correct answer is choice A, C, and D. Choice A rationale: Boiled brown rice is a good option for a client with renal disease needing to limit salt intake. It is low in sodium and does not contribute to fluid retention. Choice B rationale: Canned tomato soup is typically high in sodium, which can lead to fluid retention and increased blood pressure, making it an unsuitable choice for someone with renal disease who needs to limit salt intake. Choice C rationale: Fresh orange slices are low in sodium and high in vitamin C. They do not contribute to fluid retention and are suitable for a client with renal disease on a low-salt diet. Choice D rationale: Grilled chicken, especially if not seasoned with salt, is a low-sodium protein source that fits within the dietary restrictions for a client with renal disease. Choice E rationale: Vegetables are generally a good choice, but topping them with cheddar cheese increases the sodium content significantly, making it an inappropriate choice for someone on a low-salt diet, as cheese is often high in sodium.

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The charge nurse brings a #18 urinary catheter with a 30 mL balloon to the practical nurse (PN) who is preparing to insert a catheter in a female client who weighs 50 kg. Which action should the PN take first?

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Naxlex Comprehensive Predictor Exams

A client is scheduled to receive a sublingual tablet and has difficulty swallowing tablets. Which is the best nursing action?

Correct Answer is B

Explanation

The practical nurse (PN) is reinforcing dietary instructions with a client who has renal disease regarding the need to limit salt intake. Which selections for a lunch meal indicate to the PN that the client is following the diet plan? (Select all that apply.).

Correct Answer is ["A","C","D"]

Explanation

In caring for a client who requires seizure precautions, the practical nurse (PN) should ensure the ready availability of equipment to perform which procedure?

The practical nurse (PN) finds a postoperative client lying in bed with an unsecured surgical dressing as seen in the picture. After reinforcing the dressing, which follow-up assessment is most important for the PN to implement?

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The practical nurse (PN) is preparing for shift change. Which task has the highest priority and should be completed first?