A nurse is assisting with the care of a client who had an indwelling urinary catheter inserted 3 days ago. Which of the following actions should the nurse take?

Change the catheter bag every 3 days and as needed.

Obtain urine from the drainage bag if a urinary specimen is required.

Use a catheter securing device to hold the catheter in place.

Position the drainage bag higher than the client's bladder.

Answer and Explanation

The Correct Answer is C

A. Change the catheter bag every 3 days and as needed.: Bags are typically changed only if they are leaking, obstructed, or according to specific facility policy; frequent opening of the system increases infection risk.

B. Obtain urine from the drainage bag if a urinary specimen is required.: Urine in the bag is stagnant and colonized with bacteria. Specimens must be taken from the sampling port using a sterile syringe.

C. Use a catheter securing device to hold the catheter in place.: Securing the catheter to the leg prevents traction and trauma to the urethral meatus, reducing the risk of inflammation and infection.

D. Position the drainage bag higher than the client's bladder.: The bag must remain below the level of the bladder to prevent the backflow of urine, which causes UTIs.

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Correct Answer is C

Explanation

A. "Don't worry. Everything will work out for you.": This provides false reassurance and dismisses the client's feelings.

B. "We should talk about your decision later.": This is avoidant and dismisses the client's current need for support.

C. "How will you discuss this decision with your loved ones?": This is an open-ended, therapeutic response that encourages the client to explore their support system and the implications of their decision.

D. "Your quality of life will be compromised if you make this decision.": This is judgmental and uses a "scare tactic" rather than supporting the client's autonomy.

A. Decrease in vitamin intake B. Increase in fluid requirements C. Increase in protein requirements D. Decrease in muscle mass

Correct Answer is D

Explanation

A. Decrease in vitamin intake: While vitamin deficiencies are common in older adults, they generally do not cause weight gain.

B. Increase in fluid requirements: Fluid requirements typically stay the same or slightly decrease; fluid retention causes weight gain, but it is not a normal metabolic factor of aging.

C. Increase in protein requirements: Protein needs remain stable; a lack of protein can lead to muscle wasting, but it doesn't inherently cause weight gain.

D. Decrease in muscle mass: As people age, they often experience sarcopenia (loss of muscle tissue). Since muscle burns more calories than fat, a decrease in muscle mass lowers the basal metabolic rate, making weight gain more likely if caloric intake isn't reduced.

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