An older adult male client arrives at the clinic reporting that his bladder always feels full. The client also reports a weak urine flow, frequent dribbling after voiding, and increasing nocturia with difficulty initiating the urine stream. Which action should the nurse implement?

Obtain a urine specimen for culture and sensitivity.

Instruct in effective techniques to cleanse the glans penis.

Palpate the client's suprapubic area for distention.

Advise the client to maintain a voiding diary for one week.

Answer and Explanation

The Correct Answer is C

Choice A reason: While obtaining a urine specimen is important for diagnosing infection, it does not address the immediate discomfort and potential urinary retention the client may be experiencing.

Choice B reason: Cleansing the glans penis is part of good hygiene but does not address the client's symptoms of a full bladder and weak urine flow.

Choice C reason: Palpating for suprapubic distention can provide immediate information about bladder fullness and potential urinary retention, which may require prompt intervention.

Choice D reason: Maintaining a voiding diary is useful for tracking symptoms over time but does not provide an immediate assessment or intervention for the client's current symptoms.

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

Explanation

The correct answer is: a, c, d.

Choice A: Avoid prolonged standing or sitting

Reason: Prolonged standing or sitting can exacerbate symptoms of chronic venous insufficiency (CVI) by increasing venous pressure and promoting blood pooling in the legs. Movement helps to enhance venous return and reduce swelling.

Choice B: Cross legs at the knee but not at the ankle

Reason: Crossing legs at the knee can impede blood flow and increase venous pressure, which is counterproductive for managing CVI. It is generally advised to avoid crossing legs at the knee to promote better circulation.

Choice C: Continue wearing compression stockings

Reason: Compression stockings are a cornerstone in the management of CVI. They help to improve venous return, reduce swelling, and prevent blood from pooling in the legs. Compression stockings should be worn as prescribed, typically during the day and removed at night.

Choice D: Use a recliner for long periods of sitting

Reason: Using a recliner can help elevate the legs above heart level, which reduces venous pressure and promotes venous return. This position can help alleviate symptoms of CVI.

Choice E: Maintain the bed flat while sleeping

Reason: Maintaining the bed flat while sleeping is not recommended for CVI management. Elevating the legs while sleeping can help reduce venous pressure and prevent blood from pooling in the legs.

A. Apply a water-soluble lubricant to the catheter. B. Instill 3 mL of 0.9% sodium chloride before suctioning. C. Wear protective goggles while performing the procedure. D. Instruct the client to cough as the suction tip is removed.

Correct Answer is C

Explanation

Choice A reason: Applying a water-soluble lubricant to the catheter is not recommended during tracheostomy suctioning as it may introduce contaminants.

Choice B reason: Instilling sodium chloride before suctioning is not a standard practice and can lead to complications such as edema.

Choice C reason: Wearing protective goggles is important to protect the nurse from potential splashes of bodily fluids during the suctioning process.

Choice D reason: Instructing the client to cough as the suction tip is removed is not recommended as it can cause discomfort and potential harm to the tracheal lining.

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An older adult male client arrives at the clinic reporting that his bladder always feels full. The client also reports a weak urine flow, frequent dribbling after voiding, and increasing nocturia with difficulty initiating the urine stream. Which action should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The home care nurse provided self-care instructions for a client with chronic venous insufficiency caused by deep vein thrombosis. What instruction(s) should the nurse include in the client's discharge teaching plan? Select all that apply.

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

Explanation

Choice A: Avoid prolonged standing or sitting

Choice B: Cross legs at the knee but not at the ankle

Choice C: Continue wearing compression stockings

Choice D: Use a recliner for long periods of sitting

Choice E: Maintain the bed flat while sleeping

When performing suctioning for a client with a tracheostomy, which action should the nurse include?

Correct Answer is C

Explanation

The hospice nurse is teaching the family of a client receiving palliative care at home how to provide care. Which instruction should the nurse provide?

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