A nurse is collecting a urine specimen for culture and sensitivity from a client who has an indwelling urinary catheter. Which of the following actions should the nurse take?

Place the specimen in a clean specimen cup.

Clamp the catheter tubing below the needleless port.

Clamp the catheter tubing for 60 min.

Remove 45 mL of urine from the catheter with a syringe.

Answer and Explanation

The Correct Answer is B

A) Place the specimen in a clean specimen cup. - Urine collected from an indwelling urinary catheter should be obtained using a sterile technique, not placed directly into a clean specimen cup.
B) Clamping the catheter tubing for 10–30 minutes before collecting the sample allows fresh urine to accumulate in the tubing, ensuring a more accurate culture result. The urine should be collected from the designated port using aseptic technique, not from the catheter bag, as stagnant urine may contain contaminants.

C) Clamp the catheter tubing for 60 min. - Clamping the tubing for an extended period can cause urinary retention and discomfort for the client. It is not appropriate for collecting a urine specimen.
D) Only 3–5 mL of urine is needed for a culture. The nurse should collect the appropriate small amount to avoid unnecessary removal of urine.

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Correct Answer is B

Explanation

A. "I will gently restrain him during seizures."- Restraint during seizures can cause injury and is not recommended.
B. "I will loosen his clothing during seizures."- Loosening tight clothing helps prevent injury and ensures adequate ventilation during a seizure.
C. "I will insert a washcloth in his mouth during seizures."- Inserting objects into the mouth during a seizure can cause injury or obstruct the airway.

D. "I will turn him on his back during seizures."- Placing the client on their back during a seizure can increase the risk of aspiration. The recovery position is preferred

A. Pour 2.54 cm (1 in) of 0.9% sodium chloride solution into the sterile basin. B. Unlock and remove the inner cannula. C. Scrub the inside and outside of the inner cannula with a small brush. D. Cleanse the stoma site with 0.9% sodium chloride solution. E. Wipe the inside of the inner cannula with a folded pipe cleaner.

Correct Answer is A,B,C,E,D

Explanation

Correct Order of Steps: A. Pour 2.54 cm (1 in) of 0.9% sodium chloride solution into the sterile basin. This step ensures the nurse has a sterile solution ready for cleaning the cannula and stoma site. B. Unlock and remove the inner cannula. Removing the inner cannula is necessary to clean it and prevent the buildup of secretions. C. Scrub the inside and outside of the inner cannula with a small brush. Cleaning the cannula thoroughly removes debris and secretions. E. Wipe the inside of the inner cannula with a folded pipe cleaner. The pipe cleaner is used to dry and clear any residual moisture or secretions inside the cannula. D. Cleanse the stoma site with 0.9% sodium chloride solution. Cleansing the stoma site is essential to maintain skin integrity and prevent infection.

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A nurse is collecting a urine specimen for culture and sensitivity from a client who has an indwelling urinary catheter. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

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