The practical nurse (PN) is documenting the insertion of a urinary catheter for a female client with urinary retention. What information should the PN include during the electronic documentation of the procedure? Select all that apply.

Client positioning during procedure.

Amount of lubricant used.

Size of urinary catheter.

Appearance of urine obtained.

Amount of urine obtained.

Answer and Explanation

Correct Answer : A,C,D

A. Client positioning during the procedure should be documented to ensure that the procedure was performed correctly and that the client was appropriately positioned for catheter insertion.
B. The amount of lubricant used is not a standard detail for documenting catheter insertion. Documentation focuses on the procedure's outcomes and specific technical details rather than quantities of materials used.
C. The size of the urinary catheter should be documented as it is a critical detail for future reference and to ensure that the catheter was appropriate for the client’s needs.
D. The appearance of the urine obtained should be documented as it provides important information about the client’s urinary status and can indicate potential issues like infection or hematuria.
E. While the amount of urine obtained might be relevant for assessing urinary retention, it is not a standard part of the initial documentation for catheter insertion unless there was a significant volume change or specific concern.

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Correct Answer is A

Explanation

A. Increased oxygen saturation indicates that the Venturi face mask is effectively delivering the specified concentration of oxygen. This is the primary goal of using a Venturi mask, which provides precise oxygen delivery to improve oxygen saturation levels.
B. Increased cough productivity is not a direct indicator of the effectiveness of a Venturi face mask. The mask's purpose is to deliver oxygen, not to alter cough patterns.
C. Decreased cough frequency is unrelated to the function of the Venturi face mask. The mask's effectiveness is measured by oxygen delivery rather than changes in cough frequency.
D. Decreased breath sounds are not a direct measure of the effectiveness of a Venturi face mask. Breath sounds could indicate other respiratory issues but do not specifically reflect the effectiveness of oxygen therapy.

A. Determine why the UAP was not wearing gloves in the client's room. B. Explain that the hand rub can be completed in less than 2 minutes. C. Encourage the UAP to remain in the client's room until completed. D. Inspect the hands of the UAP after completion of the hand rub.

Correct Answer is B

Explanation

A. Wearing gloves during breakfast service is not always required, and the focus should be on ensuring proper hand hygiene rather than glove use.
B. The hand rub should be completed in 20-30 seconds, and the UAP’s 2-minute hand rub is excessive. Proper hand hygiene techniques should be reinforced.
C. The UAP does not need to remain in the client's room during hand hygiene; the primary issue is the duration of the hand rub.
D. Inspecting the hands for cleanliness is not necessary if the hand hygiene practice is incorrect; instead, correcting the technique is more important.

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The practical nurse (PN) is documenting the insertion of a urinary catheter for a female client with urinary retention. What information should the PN include during the electronic documentation of the procedure? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which assessment finding indicates to the practical nurse that a Venturi face mask is producing the desired effect?

Correct Answer is A

Explanation

The practical nurse (PN) observes an unlicensed assistive personnel (UAP) using an alcohol-based cleanser after delivering a client's breakfast tray to the room. The UAP rubs both hands thoroughly for 2 minutes while standing at the door to the client's room. Which action should the PN take?

Correct Answer is B

Explanation

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