A nurse is preparing to insert an indwelling urinary catheter for a client. Which of the following actions should the nurse plan to take?

Don sterile gloves before inserting the indwelling urinary catheter.

Apply an oil-based lubricant to the indwelling urinary catheter.

Use one cotton swab to clean the client’s genitalia.

Test the balloon on the indwelling urinary catheter before insertion.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Donning sterile gloves before inserting the indwelling urinary catheter is a critical step to prevent infection. The urinary tract is normally sterile, and using sterile gloves helps maintain this sterility during the procedure.

Choice B rationale

Applying an oil-based lubricant to the indwelling urinary catheter is not recommended. Oil- based lubricants can damage latex catheters and increase the risk of infection. A water-soluble lubricant is typically used.

Choice C rationale

Using one cotton swab to clean the client’s genitalia is not sufficient. Proper cleaning and disinfection of the area are crucial to prevent introducing bacteria into the urinary tract during catheter insertion.

Choice D rationale

Testing the balloon on the indwelling urinary catheter before insertion is not typically done. The balloon is usually inflated with sterile water once the catheter is in place to ensure that it remains in the bladder.

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Correct Answer is B

Explanation

The pH of gastric secretions is typically low, reflecting the acidic environment of the stomach. A pH reading of 4.0 would be expected if the nasogastric (NG) tube is correctly placed in the stomach.

A. The patient’s medication history B. The patient’s cholesterol level C. The patient’s prealbumin level D. The patient’s fasting glucose level

Correct Answer is C

Explanation

Choice A rationale

While a patient’s medication history can impact wound healing, in this case, there is no specific information provided about the patient’s medications that would suggest a delay in wound healing.

Choice B rationale

Although the patient’s cholesterol level is elevated, hyperlipidemia is not typically associated with delayed wound healing.

Choice C rationale

Prealbumin is a marker of nutritional status. A low prealbumin level, like in this patient, could indicate malnutrition, which can delay wound healing. Adequate nutrition is essential for wound healing as it provides the necessary building blocks for tissue repair.

Choice D rationale

The patient’s fasting glucose level is within the normal range, so it is unlikely to impact wound healing. While poorly controlled diabetes can delay wound healing, this patient’s diabetes appears to be well-controlled.

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A nurse is preparing to insert an indwelling urinary catheter for a client. Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

Correct Answer is C

Explanation

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