A nurse is ready to insert an indwelling urinary catheter for a female client. Which of the following instructions should the nurse provide to the client as the catheter is inserted?
Bear down.
Exhale slowly.
Contract the pelvic muscles.
Take a sip of water.
The Correct Answer is A
Correct answer: A
A. Bear down:
Bear down: Asking the client to bear down gently (as if to void) helps to expose urethral meatus.Bearing down simulates the act of urination and helps open the urethra.
B. Exhale slowly:
While exhaling slowly might help the client relax, it does not specifically assist with the insertion of the catheter as effectively as bearing down.
C. Contract the pelvic muscles:
Contracting the pelvic muscles (such as squeezing or tightening) might make catheter insertion more challenging by tensing the area where the catheter needs to pass through.
D. Take a sip of water:
Drinking water is not typically instructed during urinary catheter insertion, as it's unrelated to the process and might increase discomfort.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Positioning the client on the right side is not a standard recommendation for gastric lavage. The standard position is typically on the left side to facilitate the drainage of gastric contents.
B. Instilling 1000 mL of sterile saline is not a recommended action for gastric lavage. Gastric lavage involves the removal of stomach contents rather than instilling fluids.
C. Withdrawing fluid until it is clear is the correct action. Gastric lavage is a medical procedure used to empty the stomach contents. The process involves introducing small amounts of fluid (such as saline) into the stomach and then aspirating it back, along with gastric contents, until the aspirate is clear.
D. Connecting the NG tube to high continuous suction is not a standard approach for gastric lavage. Gastric lavage involves intermittent instillation and withdrawal of small amounts of fluid to clear the stomach.
Correct Answer is C
Explanation
A. Administer medications:
While nasogastric tubes can be used to administer medications, this is not the primary rationale for their use in pyloric obstruction. The primary goal is often decompression.
B. Supply nutrients via tube feedings:
Providing nutrients via tube feedings is not the primary purpose in the context of a pyloric obstruction. Decompression is more relevant in this scenario.
C. Decompress the stomach:
Decompressing the stomach is a common use of nasogastric tubes in the context of pyloric obstruction. The tube helps to remove excess air and gastric contents, relieving pressure in the stomach.
D. Determine the pH of the gastric secretions:
While determining the pH of gastric secretions is a possible use, it is not the primary rationale for nasogastric tube placement in pyloric obstruction. The primary goal is often to relieve obstruction and decompress the stomach.
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