A nurse is preparing a sterile field for the insertion of a urinary catheter. Identify the sequence of actions the nurse should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Perform hand hygiene.

Place the sterile package on the work surface.

Open the outermost flap of the package away from the body.

Open the side flaps of the package.

Open the innermost flap of the package toward the body.

Use the inner surface of the package as a sterile field.

Answer and Explanation

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

To prepare a sterile field for the insertion of a urinary catheter, the nurse should follow the sequence of actions in the following order:

1. Perform hand hygiene.

2. Place the sterile package on the work surface.

3. Open the outermost flap of the package away from the body.

4. Open the side flaps of the package.

5. Open the innermost flap of the package toward the body.

6. Use the inner surface of the package as a sterile field.

Following this sequence ensures that the nurse maintains proper hand hygiene, prepares the sterile package, and opens it in a way that maintains sterility. Opening the flaps in the correct order helps create a sterile field within the package, which can be used for the insertion of the urinary catheter.

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Correct Answer is B

Explanation

When reinforcing teaching about cimetidine with a client who has peptic ulcer disease, the nurse should include the following information:

"Wait at least 1 hour after taking the medication before taking an antacid.": Cimetidine is a histamine-2 receptor antagonist that reduces stomach acid production. Taking an antacid too close in time to cimetidine may decrease its effectiveness as antacids can interfere with its absorption. The nurse should advise the client to follow the healthcare provider's instructions regarding the timing and administration of cimetidine and antacids.

The following statements are incorrect or not applicable:

"Expect breast tenderness while taking this medication.": Breast tenderness is not a common side effect of cimetidine. If the client experiences any unusual symptoms or side effects while taking the medication, they should consult their healthcare provider for further evaluation.

"Take this medication on an empty stomach.": To reduce stomach upset, this medication should be taken with food or milk

"Take ibuprofen for occasional aches and pains.": Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of gastrointestinal complications, including ulcers. In individuals with peptic ulcer disease, it is generally recommended to avoid NSAIDs unless specifically prescribed by a healthcare provider. The nurse should emphasize the importance of discussing any pain management strategies or medications with the healthcare provider before use.

A. "I don't have as much heartburn after I eat anymore." B. "I noticed that I have had less urge to smoke lately." C. "I occasionally have stomach pain and dark stools. D. "I can sleep while lying flat again. E. "I have not been as dizzy as I was before."

Correct Answer is ["A","D"]

Explanation

From the given statements, the nurse can identify the following statements as indicating the effectiveness of cimetidine treatment:

"I don't have as much heartburn after I eat anymore.": Cimetidine is a histamine-2 receptor antagonist commonly used to reduce stomach acid production. Decreased heartburn after eating suggests that the medication has been effective in reducing excessive acid production and relieving heartburn symptoms.

"I can sleep while lying flat again.": Cimetidine can help alleviate symptoms of gastroesophageal reflux disease (GERD) by reducing stomach acid. Improved ability to sleep while lying flat suggests that the medication has successfully reduced acid reflux and related symptoms.

The following statements do not directly indicate the effectiveness of cimetidine treatment: ● "I noticed that I have had less urge to smoke lately."

● "I occasionally have stomach pain and dark stools."

● "I have not been as dizzy as I was before."

These statements may be unrelated to the effects of cimetidine or may require further assessment to determine their significance. It's important for the nurse to address any concerns or symptoms mentioned by the client and evaluate their overall response to the medication

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A nurse is preparing a sterile field for the insertion of a urinary catheter. Identify the sequence of actions the nurse should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching about cimetidine with a client who has peptic ulcer disease. Which of the following information should the nurse include in the teaching?

Correct Answer is B

Explanation

A nurse is caring for a client who is taking cimetidine. Which of the following client statements indicates to the nurse that the cimetidine treatment has been effective? (Select all that apply.)

Correct Answer is ["A","D"]

Explanation

A charge nurse overhears a newly licensed nurse providing instructions to a female client on the proper steps to collect a midstream urine specimen. Which of the following statements made by the newly licensed nurse requires the charge nurse to intervene?

A charge nurse planning care for a group of clients is delegating tasks to an assistive personnel (AP). Which of the following tasks should the nurse delegate to the AP?

A nurse is caring for a client who has a prescription for a stool guaiac test. The client asks the nurse about the purpose of the test. The nurse should respond by stating that the stool guaiac is testing for which of the following findings in the client's feces?

A nurse assisting a provider with a sterile procedure prepares to pour a sterile solution onto a piece of gauze. In which order should the nurse perform the steps of pouring the solution? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

A nurse is caring for a client who has cirrhosis and a prescription for lactulose. Following administration, the nurse should monitor the client for which of the following adverse effects?

A nurse is administering a tap-water enema to a client. The client reports cramping as the nurse instills the irrigating solution. Which of the following actions should the nurse take to relieve the client's discomfort?

A nurse is reinforcing teaching with a client who is taking hydrochlorothiazide. Which of the following information should the nurse include in the teaching?

A nurse is preparing to administer liquid famotidine 20 mg PO every 6 hr for GERD. Available is famotidine 40 mg/5 ml. How many ml. should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)