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","B","E"]

Explanation

The nurse should verify the pulse oximeter is intact and properly applied and verify the supplemental oxygen is turned on and functioning. The nurse should also correlate the apical pulse rate with the pulse rate on the oximeter to ensure accuracy.

A. Advances catheter 2-3 inches (5 to 7.6 cm). B. Applies suction intermittently for 20 seconds. C. Moistens catheter prior to insertion. D. Uses non-dominant hand to manipulate catheter.

Correct Answer is C

Explanation

When suctioning a client's nasopharyngeal airway, the nurse should moisten the catheter with sterile saline or water-soluble lubricant prior to insertion. This helps to decrease discomfort and trauma to the client's nasal mucosa.

Advancing the catheter 2-3 inches (5 to 7.6 cm) (a) is not correct because it can cause injury to the client's airway or trachea. The catheter should only be inserted to a distance equal to the distance from the nose to the earlobe (about 6 to 8 inches or 15 to 20 cm).

Applying suction intermittently for 20 seconds (b) is not correct because it can cause hypoxia and trauma to the client's airway. The suction should be applied continuously while withdrawing the catheter, for no more than 10 seconds.

Using the non-dominant hand to manipulate the catheter (d) is not correct because it can cause the catheter to become contaminated with the nurse's non-sterile hand. The dominant hand should be used to manipulate the catheter while maintaining sterile technique.

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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)

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","B","E"]

Explanation

The nurse provides care for a client diagnosed with pneumonia. The client is unable to expectorate respiratory secretions. The nurse suctions the client's nasopharyngeal airway. When is suctioning technique correct?

Correct Answer is C

Explanation

A client receives a clear liquid diet. The nurse removes which item from the client's tray? (Select all that apply)

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)

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