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

Answer and Explanation

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.

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Correct Answer is A

Explanation

This is because the outcome of the plan is for the client to learn self-glucose testing, which implies that the client can perform the testing correctly on their own. Option A shows that the client has successfully learned and can perform the skill independently, which is the ultimate goal of the plan.

Option B, "Client says 'I can do the testing now'," and option C, "Client explains the testing process to the nurse," may show that the client has some understanding of the testing process, but they do not demonstrate that the client can perform the skill independently.

Option D, "Client observes the nurse test glucose 5 times," is not an appropriate method for evaluating the client's ability to perform self-glucose testing. Observing the nurse perform the skill does not demonstrate that the client has learned the skill themselves.

A. Position the window of the toes B. Apply lotion to the client's lower legs C. Ask the client to lie supine in bed for 15 minutes D. Turn one stocking inside out before applying it to the heel

Correct Answer is C

Explanation

Before applying anti-embolism stockings, the nurse should ask the client to lie supine in bed for 15 minutes. This is because anti-embolism stockings should be applied with the client in a supine position ¹. This helps to promote blood return to the heart and decrease the risk of blood clots ¹.

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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)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse evaluates a client's plan of care. The client has an outcome of 'Client will learn self-glucose testing before discharge'. When evidence best allows the nurse to meet the outcome of the plan?

Correct Answer is A

Explanation

A client recovering from surgery sits in a chair for breakfast. Which action does the nurse take before applying newly prescribed anti-embolism stockings to the client's lower extremities?

Correct Answer is C

Explanation

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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)