The nurse is assessing a patient with a urinary catheter.
Which of the following would be a priority nursing intervention?
Removing the catheter as soon as possible to prevent infection.
Ensuring that the catheter is properly secured to prevent accidental dislodgement.
Encouraging the patient to drink fluids to prevent dehydration.
Administering antibiotics to prevent infection.
Administering antibiotics to prevent infection.
The Correct Answer is A
This is because urinary catheters are a common source of catheter associated urinary tract infections (CAUTIs), which can lead to complications such as pyelonephritis, sepsis, and renal failure. Therefore, the nurse should remove the catheter as soon as possible to reduce the risk of infection and promote normal urinary function.
Choice B is wrong because ensuring that the catheter is properly secured to prevent accidental dislodgement is not a priority intervention for a patient with a urinary catheter.
While this is an important nursing action to prevent trauma and bleeding, it does not address the main complication of catheterization, which is infection.
Choice C is wrong because encouraging the patient to drink fluids to prevent dehydration is not a priority intervention for a patient with a urinary catheter.
While this is a good nursing practice to maintain hydration and renal perfusion, it does not affect the risk of infection associated with catheterization.
Choice D is wrong because administering antibiotics to prevent infection is not a priority intervention for a patient with a urinary catheter.
While this may be indicated for some patients who have signs and symptoms of UTI or who are at high risk of infection, it is not a routine measure for all patients with catheters and may contribute to antibiotic resistance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Angiotensin II is a hormone that stimulates the adrenal cortex to release aldosterone. Aldosterone is a hormone that helps regulate blood pressure by increasing the reabsorption of sodium and water and the excretion of potassium by the kidneys.
Choice A is wrong because renin is not a hormone but an enzyme that catalyzes the conversion of angiotensinogen to angiotensin I1.
Choice B is wrong because angiotensin I is an inactive precursor of angiotensin II that is converted by angiotensin-converting enzyme (ACE) in the lungs.
Choice D is wrong because antidiuretic hormone (ADH) is a hormone that regulates water balance by increasing the reabsorption of water by the kidneys, but it does not affect aldosterone secretion.
Correct Answer is D
Explanation
Nasogastric suction removes gastric secretions that contain potassium, leading to a loss of potassium from the body. This can cause hypokalemia, which is a low level of potassium in the blood.
Choice A is wrong because Addison’s disease causes hyperkalemia, which is a high level of potassium in the blood.
Choice B is wrong because tissue damage can release potassium from the cells into the blood, causing hyperkalemia.
Choice C is wrong because uric acid level is not related to potassium level.
Uric acid is a waste product of purine metabolism that can cause gout or kidney stones if elevated.
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