The nurse is providing indwelling catheter care for a patient who is uncircumcised. What intervention will help prevent a catheter associated urinary tract infection?

Obtain daily urine specimens by opening the collection drainage system.

Keep the urine collection bag below the level of the bladder at all times.

Retract the foreskin to clean the catheter tubing and meatus outward leaving the foreskin retracted.

Change the indwelling catheter at least every one week.

Answer and Explanation

The Correct Answer is B

A. Obtain daily urine specimens by opening the collection drainage system: Opening the drainage system increases the risk of introducing bacteria into the catheter, which can lead to infection.

B. Keep the urine collection bag below the level of the bladder at all times: Keeping the bag below the bladder prevents urine from back flowing into the bladder, which reduces the risk of infection.

C. Retract the foreskin to clean the catheter tubing and meatus outward, leaving the foreskin retracted: While the foreskin should be retracted for cleaning, it must always be returned to its normal position to prevent paraphimosis, a condition where the foreskin becomes trapped and restricts blood flow.

D. Change the indwelling catheter at least every one week: Routine catheter changes are not recommended unless there is an indication such as obstruction or infection. Unnecessary changes increase infection risk.

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Correct Answer is A

Explanation

The prescribed dose is 25 mg, and the available tablet strength is 50 mg. To calculate the correct dose:

25 mg ÷ 50 mg= 0.5

Answer: 0.5 tablets

A. Palpate for pedal pulses. B. Turn the patient every three hours. C. Document the stage 1 pressure injury. D. Elevate bilateral heels.

Correct Answer is A

Explanation

A. Palpate for pedal pulses: Cool skin may indicate poor circulation or ischemia. Checking pedal pulses helps assess blood flow. This step provides essential information about the vascular status of the patient's foot, guiding further interventions.

B. Turn the patient every three hours: Patients on bedrest should be turned every 2 hours, not every 3 hours, to prevent pressure injuries.

C. Document the stage 1 pressure injury: Blistering indicates at least a Stage 2 pressure injury, not Stage 1. The nurse must assess further before staging.

D. Elevate bilateral heels: Once assessment confirms the need, elevating the heels can help reduce pressure and promote circulation, potentially preventing further damage and aiding in the healing process.

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The nurse is providing indwelling catheter care for a patient who is uncircumcised. What intervention will help prevent a catheter associated urinary tract infection?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Order: Metoprolol Tartrate 25 mg PO each morning Available: Metoprolol Tartrate 50 mg tablets How many tablets will you administer per dose?

Correct Answer is A

Explanation

While bathing a patient who is on bedrest, the nurse notes an area of blistering and hypopigmentation on the patient's right heel. Upon further assessment, the area is also tender and cooler than the surrounding area. What is the next best action by the nurse?

Correct Answer is A

Explanation

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