A nurse is caring for a female client who has a prescription for an indwelling urinary catheter. Which of the following actions should the nurse take first?
Clean the perineum from front to back.
Lubricate the catheter.
Explain to the client that she will feel temporary discomfort.
Arrange the sterile items on the sterile field.
The Correct Answer is D
A. Clean the perineum from front to back.
After arranging the sterile items, the next step involves preparing the client for catheter insertion, which includes cleaning the perineum from front to back using appropriate techniques to minimize the risk of infection.
B. Lubricate the catheter.
Following the preparation of the client, the next step involves lubricating the catheter before insertion. Lubrication facilitates the smooth and atraumatic insertion of the catheter.
C. Explain to the client that she will feel temporary discomfort.
Providing information and preparing the client for the procedure is an important aspect, but it typically follows the physical preparation steps. Explaining to the client about potential discomfort should be done before the procedure but after the necessary physical preparations are complete.
D. Arrange the sterile items on the sterile field.
This is the first action to be taken. It involves preparing all the necessary sterile items on a sterile field, ensuring that everything needed for the catheter insertion procedure is organized and ready to maintain aseptic technique.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Ensure the rope knots are away from the pulleys.
While ensuring that rope knots are away from the pulleys is a general principle in traction care to maintain proper functioning, it is not directly related to the specific positioning of the child's feet in Buck's traction.
B. Ensure the child’s feet are against the footboard.
This statement is correct. Ensuring that the child's feet are against the footboard helps maintain proper hip alignment and prevent complications such as contractures. It is an important aspect of care when managing Legg-Calve-Perthes disease in Buck's traction.
C. Apply antibiotic ointment to the pin sites daily.
This action is not applicable to Buck's traction. Buck's traction involves the use of a boot or splint, and it does not include pins or pin sites. The use of antibiotic ointment for pin sites is more relevant in the context of skeletal traction.
D. Reduce the child’s fluid intake.
There is no indication to reduce the child's fluid intake specifically in the context of Buck's traction. Adequate hydration is generally important for overall health, and fluid restriction is not a standard practice for managing Legg-Calve-Perthes disease in Buck's traction.
Correct Answer is A
Explanation
A. Apply a cool, wet compress to the affected area.
This action can help soothe the affected skin and reduce inflammation associated with eczema. It is important to avoid hot water, as it can further dry out the skin.
B. Launder clothing with fabric softener.
Fabric softeners can contain chemicals that may irritate sensitive skin. It is advisable to use mild, fragrance-free detergents and skip fabric softeners.
C. Give bubble baths every day.
Bubble baths can be drying to the skin, and frequent bathing may exacerbate eczema. It is recommended to keep baths short, use lukewarm water, and avoid harsh soaps.
D. Use wool gloves in the wintertime.
Wool can be irritating to sensitive skin, and for individuals with eczema, it's better to use soft, breathable fabrics for gloves to minimize irritation.
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