Which action should the nurse implement when inserting an indwelling catheter for an uncircumcised male client?
Clean the urinary meatus before retracting the foreskin.
Position the sterile field even with the nurse's hips.
Use a swab to wipe the meatus in back-and-forth motions.
Advance the catheter before inflating the balloon.
The Correct Answer is A
A. Clean the urinary meatus before retracting the foreskin is the correct action. Before retracting the foreskin, the nurse should clean the meatus to prevent contamination of the catheterization site. This ensures that any bacteria present are removed before inserting the catheter.
B. Position the sterile field even with the nurse's hips is not directly related to the procedure for an uncircumcised male client. The sterile field should be positioned at a level where the nurse can comfortably reach it without contaminating it, but this does not specifically address the care of an uncircumcised male.
C. Use a swab to wipe the meatus in back-and-forth motions is incorrect. The meatus should be cleaned using a circular motion, starting at the meatus and working outward. Back-and-forth motions could cause contamination of the area.
D. Advance the catheter before inflating the balloon is an appropriate action during catheter insertion; however, this is not specific to the care of an uncircumcised male client. The balloon should be inflated only after the catheter is fully inserted and urine flow is confirmed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Gives the client a hug and says, "It is okay to cry when you are sad" may seem comforting but could invade the client’s personal space and may not be appropriate in a professional setting without the client’s consent.
B. While touching the client's forearm, asks, "Would you like to talk about it?" is correct because it shows empathy, provides emotional support, and invites the client to share their feelings. The light touch conveys care without being intrusive.
C. "This is a bad time. I can see you are upset. I can come back later" dismisses the client’s emotional needs and prioritizes the nurse’s schedule over the client’s well-being.
D. "I am sorry to disturb you at a difficult time. This can wait until later" acknowledges the client’s emotions but does not provide immediate support or address their needs effectively.
Correct Answer is C
Explanation
A. Turgor is not a reliable indicator of fluid balance in clients with fluid volume overload, as it is more commonly used to assess dehydration.
B. Blood pressure is affected by fluid volume but is not a direct or specific measure of fluid balance. Other factors, such as medication or underlying conditions, can influence blood pressure.
C. Weight is the most accurate and sensitive indicator of fluid balance. A change in weight directly correlates with fluid retention or loss, making it the preferred method for evaluating fluid balance.
D. Lung sounds can indicate fluid overload if crackles are present, but they are not a quantitative measure of fluid balance and do not provide ongoing assessment of fluid changes.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
