A nurse is caring for a client in the medical-surgical unit.

Exhibits

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.

Change the indwelling urinary catheter tubing every 3 days

Encourage the client to drink 3000 ml of fluid daily.

Review the need for the indwelling urinary catheter daily

Place the drainage beg on the bed when transporting the client

Answer and Explanation

Correct Answer : A,D,E

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Correct Answer is B

Explanation

A. Incorrect. A Glasgow coma scale (GCS) rating of 15 indicates that the client is able to obey commands.
B. Correct. A GCS rating of 15 indicates that the client is fully conscious and oriented to person, place, and time.
C. Incorrect. Opening eyes to sound is a response associated with the eye-opening component of the GCS score, but this response does not provide information about the client's orientation.
D. Incorrect. Withdrawing from pain is a response associated with the motor component of the GCS score, but this response does not provide information about the client's orientation.

A. Temporarily discontinue the infusion. B. Give 500 mL of lactated Ringer's solution. C. Administer dextrose 10% in water. D. Slow the TPN infusion rate.

Correct Answer is C

Explanation

A. Incorrect. Temporarily discontinuing the TPN infusion may result in an abrupt decrease in the client's glucose intake, which could lead to hypoglycemia.
B. Incorrect. Giving lactated Ringer's solution would not address the client's TPN needs and may also affect electrolyte balance.
C. Administering dextrose 10% in water wouldprovide the required glucosed as the next bag is awaited
D. Slowing the TPN infusion rate can help stretch the remaining volume until a new bag becomes available. However, it does not adress the body's glucose requirements.

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A nurse is caring for a client in the medical-surgical unit. Exhibits Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client? Select all that apply.

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A nurse is caring for a client in the medical-surgical unit.

Exhibits

Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client?
Select all that apply.