The nurse is caring for a patient with an indwelling urinary catheter caused by severe prostate enlargement. Which is the priority nursing diagnosis for this patient?

a. Risk for infection r/t indwelling urinary catheter
b. Disturbed body image r/t presence of catheter
c. Risk for contamination r/t potential leakage of urine on clothing
d. Urinary retention r/t blockage of bladder outlet


ANS: A
The presence of an indwelling urinary catheter puts the patient at high risk for urinary tract infection, and this is the highest priority diagnosis for the patient. Disturbed body image is not as important as the risk of infection. Risk for contamination does not relate to spillage of urine on clothing. Urinary retention was corrected by placement of the urinary catheter.

Nursing

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