A nurse is assessing a client who is 1 day postoperative following a lobectomy and has a chest tube drainage system in place. Which of the following findings by the nurse indicates a need for intervention?

Choice A reason: This is incorrect. Cleansing the perineum from back to front can increase the risk of urinary tract infections, as it can introduce bacteria from the anal area to the urethra. The nurse should instruct the client to cleanse the perineum from front to back, using a mild soap and water, and to change the pad or underwear frequently to prevent bacterial growth.
Choice B reason: This is incorrect. Obtaining a prescription for an indwelling urinary catheter can increase the risk of urinary tract infections, as it can create a direct route for bacteria to enter the bladder. Indwelling catheters should be avoided unless absolutely necessary, and should be removed as soon as possible. The nurse should explore other bladder management options for the client, such as intermittent catheterization, condom catheter, or suprapubic catheter.
Choice C reason: This is incorrect. Offering the client the bedpan every 2 hours can increase the risk of urinary tract infections, as it can cause urinary stasis and bladder distension. The nurse should assess the client's bladder function and determine the optimal frequency of bladder emptying, which may vary depending on the type and level of spinal cord injury. The nurse should also monitor the client's urine output, color, odor, and clarity, and report any signs of infection, such as fever, chills, or flank pain.
Choice D reason: This is correct. Encouraging fluid intake at and between meals can decrease the risk of urinary tract infections, as it can flush out bacteria from the urinary tract and prevent urinary stasis and bladder distension. The nurse should advise the client to drink at least 2 liters of water per day, unless contraindicated by other medical conditions. The nurse should also educate the client about the benefits of cranberry juice, which can inhibit bacterial adhesion to the bladder wall and prevent infection.

Choice A reason: Taking this medication when getting an asthma attack is not a correct way to use montelukast. Montelukast is a leukotriene modifier that helps to reduce inflammation and prevent asthma attacks and exercise induced bronchoconstriction. It is taken once a day in oral form and may cause side effects such as stomach pain, diarrhea, or mood changes. It is not a fast acting rescue medicine for asthma attacks and needs to be taken daily.

Choice B reason: Rinsing the mouth after taking this medication is not necessary or helpful for montelukast. Rinsing the mouth is usually recommended for inhaled corticosteroids, which can cause oral thrush, a fungal infection in the mouth. Montelukast is not an inhaled corticosteroid and does not cause oral thrush.

Choice C reason: Taking this medication once a day in the evening is the correct way to use montelukast. Montelukast works best when taken in the evening, as it can improve the symptoms of asthma and allergic rhinitis that occur at night or early in the morning. Taking it at the same time every day can also help to maintain a steady level of the drug in the body and prevent missed doses.

Choice D reason: Using a spacer device when inhaling this medication is not applicable or useful for montelukast. A spacer device is a tube that attaches to an inhaler and helps to deliver the medication more effectively to the lungs. Montelukast is not an inhaler, but a tablet or a granule that is swallowed.