A nurse is reinforcing discharge teaching with a male client who has an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching?

"I will empty my drainage bag once a day."

"I will keep the drainage bag below the level of my waist."

"I will apply antiseptic ointment to the tip of my penis."

"I will clamp the tube when I go for a walk."

Answer and Explanation

The Correct Answer is B

A. "I will empty my drainage bag once a day.": The bag should be emptied when it is half to two-thirds full, or at least every 8 hours, to prevent tension and bacterial growth.

B. "I will keep the drainage bag below the level of my waist.": Keeping the bag lower than the bladder ensures that gravity allows urine to flow out and prevents the backflow (reflux) of contaminated urine into the bladder.

C. "I will apply antiseptic ointment to the tip of my penis.": Routine use of antiseptic ointments at the meatus is not recommended and can actually increase the risk of infection by trapping bacteria.

D. "I will clamp the tube when I go for a walk.": The catheter should never be clamped without a specific medical order, as it causes urine to back up into the bladder and kidneys.

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Correct Answer is C

Explanation

A. "Why don't you want to be touched?": Asking "Why" can make a client feel defensive and is considered non-therapeutic communication.

B. "Would you like some pain medication before getting out of bed?": This ignores the client's immediate assertion of independence and safety risk.

C. "I will stand next to you and help if you need me to.":. This response respects the client's autonomy while ensuring safety by maintaining proximity in case the client becomes unsteady.

D. "We can talk about this after you have gotten out of bed.": This dismisses the client's immediate concern and the potential risk of a fall.

A. Apply a heating pad to the client's neck. B. Offer the client a warm beverage. C. Provide the client with dry clothing. D. Wrap the client in warm blankets.

Correct Answer is C

Explanation

A. Apply a heating pad to the client's neck.: This is an intervention, but not the priority. Rapid external rewarming can sometimes cause "rewarming shock."

B. Offer the client a warm beverage.: This is helpful but is not the priority action for someone with acute exposure.

C. Provide the client with dry clothing.: According to the Nursing Process, the first priority is to stop the loss of body heat. Wet clothing loses heat 25 times faster than dry clothing; removing it is the most immediate way to stabilize the client.

D. Wrap the client in warm blankets.: This is done after removing wet clothing to begin the rewarming process.

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A nurse is reinforcing discharge teaching with a male client who has an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching?

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