A nurse is caring for a client in the medical-surgical unit.
Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client? Select all that apply.
Use soap and water to provide perineal care.
Place the drainage bag on the bed when transporting the client.
Encourage the client to drink 3000 mL of fluid daily,
Empty the drainage bag when it is half full
Revive the need for the indwelling urinary catheter daily
Change the indwelling urinary catheter tubing every 3 days
Correct Answer : A,D,E
A. Proper perineal hygiene reduces the risk of catheter-associated urinary tract infections (CAUTIs). Using soap and water is recommended over antiseptics, as excessive antiseptic use may disrupt normal flora.
B. The drainage bag should always be kept below the bladder level to prevent urine backflow, which increases UTI risk. The bag should be hung from a non-movable part of the bed or wheelchair.
C. The client has heart failure and is already on a fluid restriction of 1000 mL/day. Encouraging excessive fluid intake could worsen fluid overload and heart failure symptoms.
D. Urinary catheter bags should be emptied regularly (preferably when half full) to prevent urine backflow, which increases the risk of infection. Overfilled bags can create backpressure and promote bacterial growth.
E. Indwelling catheters should be removed as soon as possible to reduce the risk of CAUTIs. Daily assessment ensures that the catheter is removed when no longer necessary.
F. Routine changing of catheter tubing is not recommended unless there are signs of infection, leakage, or blockage. Frequent changes can introduce bacteria and increase infection risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Incorrect – The client should be placed in a supine position, not high-Fowler’s.
B. Incorrect – Dentures should be left in place to maintain facial appearance.
C. Incorrect – Arms should be placed at the sides or across the abdomen, not crossed over the chest.
D. Correct – Gently holding the eyes shut prevents them from remaining open, helping maintain a natural appearance.
Correct Answer is C
Explanation
A. Even lifting objects under 10 lbs should be avoided to prevent increased intraocular pressure.
B. The client should avoid bending at the waist, as it increases pressure on the eye.
C. Reading and light activities like sewing are permitted as they do not increase intraocular pressure.
D. Strenuous activities like jogging are contraindicated for several weeks to prevent retinal detachment recurrence.
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