The nurse provides care to a toddler-age client and prescribed catheterization to obtain a urine specimen. Which procedure does the nurse implement? (Select all that apply)
Explain the procedure in detail before beginning
Have the child blow on a pinwheel during insertion
Insert the catheter about 5 cm
Use a size 10 Fr catheter
Insert 2% lidocaine lubricant into the meatus
Use firm pressure if resistance is met
Correct Answer : A,B,D,E
It is important to explain the procedure in detail before beginning to help the child understand what is happening and reduce anxiety. Having the child blow on a pinwheel during insertion can help distract them and reduce discomfort. A size 10 Fr catheter is appropriate for a toddler-age child ¹². Inserting 2% lidocaine lubricant into the meatus can help reduce discomfort during the procedure.
On the other hand, inserting the catheter about 5 cm may not be appropriate as the depth of insertion varies depending on the child's anatomy. Using firm pressure if resistance is met is not recommended as it can cause injury to the urethra.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This action can help enhance the client's nutritional intake by ensuring that the client has enough time to eat without interruptions. It is important for the nurse to prioritize the client's mealtimes and make sure that they are not disrupted by other procedures or activities.
Correct Answer is ["A","C","E","F","G","I"]
Explanation
a) It is important to wear sterile gloves when packing the wound to prevent the introduction of new bacteria into the wound.
c) Donning an eye shield protects the nurse from splash-back or aerosolized particles during irrigation.
e) Sterile normal saline should be used for irrigation to prevent introducing new bacteria to the wound. It should be poured into a sterile irrigation tray.
f) A wound culture should be obtained before the wound bed is irrigated to prevent diluting the specimen with irrigation solution.
g) After irrigating the wound and packing it with sterile gauze, the packing should be covered with an ABD pad to protect the wound and prevent contamination.
h) Assessing pain prior to starting the procedure is important to establish a baseline for pain management and to monitor the client's response to the procedure.
i) Sterile gloves should be worn when removing the old dressing to prevent introducing new bacteria to the wound.
b) Cleaning the skin around the wound with non-sterile gauze is not appropriate as it can introduce new bacteria to the wound.
d) Alcohol-based hand sanitizer is not a substitute for hand washing and should not be used between glove changes as it does not effectively remove all bacteria from the hands.
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