A nurse is caring for a female client who is postoperative and is having difficulty urinating after the removal of an indwelling urinary catheter. Which of the following techniques should the nurse teach the client to use to promote urination?
Stroking the lower abdomen
Performing Kegel exercises prior to urination
Pouring warm water over the perineum
Leaning backward when sitting and attempting to urinate.
The Correct Answer is C
A. Stroking the lower abdomen. This technique is not a recognized method for stimulating urination.
B. Performing Kegel exercises prior to urination. Kegel exercises strengthen pelvic muscles but do not directly promote urination.
C. Pouring warm water over the perineum. Warm water can stimulate sensory nerves and promote relaxation of the urethral sphincter, helping to initiate urination.
D. Leaning backward when sitting and attempting to urinate. The proper posture for urination is sitting upright or leaning slightly forward, not backward.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "Remove clocks from the client's room." –
Removing clocks can increase confusion and disorientation. Instead, having a visible clock and calendar can help the client stay oriented.
B. "Check on the client frequently while he is in the restroom." –
While frequent monitoring is important, excessive surveillance may increase agitation and distress. A better alternative is to ensure the restroom is safe and accessible.
C. "Encourage physical activity throughout the day to expend energy." –
Engaging the client in physical activity helps reduce restlessness, promotes better sleep, and decreases the likelihood of agitation, which can reduce the need for restraints.
D. "Use full-length side rails on the client's bed." –
Full-length side rails can be considered a form of restraint as they may limit movement and increase the risk of falls or injury if the client tries to climb over them.
Correct Answer is ["A","B","C","D","E","F","G","H"]
Explanation
The key pieces of information that indicate the client is at risk for falls include:
- Admitted following a fall down approximately five steps – Indicates a recent fall history.
- Client's partner reports client possibly hit their head and was a little disoriented for a minute or two – Suggests potential confusion or altered mental status.
- Client has a history of falls and orthostatic hypotension per client's partner – A significant risk factor for future falls.
- Client uses a walker – Indicates mobility impairment.
- Client ordered new glasses following an eye exam last week but has not received them yet – Vision impairment increases fall risk.
- Blood pressure: Lying: 130/90 mm Hg, Sitting: 128/88 mm Hg, Standing: 98/60 mm Hg – Orthostatic hypotension (drop in BP upon standing) can cause dizziness and falls.
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