A charge nurse is observing a newly-licensed nurse insert an Indwelling urinary catheter for a male client. Which of the following actions by the newly-licensed nurse requires intervention by the charge nurse?
Lubricates the first 2.5 to 5 cm (2 in) of the catheter.
Dons sterile gloves before cleaning the client's meatus.
Secures the tubing to the client's upper thigh.
Pulls gently on the catheter to check for resistance after inflating the balloon.
The Correct Answer is C
A. Lubricating the catheter helps reduce friction and discomfort during insertion.
B. Sterile gloves help prevent the introduction of microorganisms into the urinary tract.
C. Securing the tubing to the client's upper thigh can lead to discomfort and increased risk of skin irritation. The tubing should be secured to the client's lower abdomen or inner thigh to prevent tension and potential complications.
D. Gently pulling on the catheter after inflating the balloon helps ensure that the balloon is fully inflated and properly positioned in the bladder.
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Related Questions
Correct Answer is D
Explanation
A. This option is not the most effective strategy for a bowel training program. While regular trips to the toilet can help establish a routine, taking the client to the toilet every 2 hours may be excessive and not tailored to the individual’s natural bowel patterns. This approach does not align with the client’s specific needs or natural urges and may lead to unnecessary discomfort or disruption.
B. Abdominal cramping can be a sign that the client’s bowels are ready to move. Taking the client to the
toilet after they feel abdominal cramping aligns with their natural physiological signals and can be an effective way to manage bowel movements. It helps ensure that the client responds to their body’s cues, which can promote regular bowel habits.
C. For some individuals, having a bowel movement before a meal can be part of a routine if it aligns with their digestive patterns. However, this strategy might not be effective for all clients, as bowel movements are not necessarily influenced by meal times for everyone. The timing might be more
relevant if it fits the individual’s routine or helps establish a regular pattern.
D. Responding to the client’s natural urge to defecate is the most effective way to manage bowel movements. Encouraging the client to use the toilet when they feel the urge helps to establish a natural and responsive routine, which can be more effective in promoting regular bowel habits and preventing constipation.
Correct Answer is B
Explanation
The current dietary guidelines for adults recommend consuming about 2 1/2 cups of vegetables per day. This amount is consistent with the Dietary Guidelines for Americans and the MyPlate recommendations, which suggest that a variety of vegetables should be consumed daily to meet nutritional needs. This amount provides a balance of essential vitamins, minerals, and fiber.
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