An order is written for the client's indwelling urinary catheterization to be discontinued
While observing the new staff nurse providing care to this client and implementing the prescriber's or-der, the unit manager determines that further instruction about catheter removal is required for the new nurse if he or she does which one of the following? a. Drapes the female client between the thighs
b. Obtains a specimen before removal
c. Cuts the catheter to deflate the balloon
d. Checks the client's output for 24 hours after removal
C
The nurse should not cut the catheter to deflate the balloon. The nurse inserts an empty, sterile syringe into the injection port. The nurse slowly withdraws all of the solution to deflate the bal-loon totally. The nurse then pulls the catheter out smoothly and slowly.
The nurse positions the client in the same position as during catheterization. The nurse places a towel between a female client's thighs or over a male client's thighs.
Some institutions recommend collecting a sterile urine specimen before removal of the catheter or sending the catheter tip for culture and sensitivity tests.
The nurse assesses the client's urinary function by noting the first voiding after catheter removal and documenting the time and amount of voiding for the next 24 hours.
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A patient arrives in the emergency department with a bullet wound to the left frontal lobe. The patient is comatose on arrival. What is the nursing care priority at this time?
a. Evaluate neurological status. b. Maintain an open airway. c. Maintain body temperature. d. Evaluate fluid balance.
The breast-feeding mother should be taught a safe method to remove her breast from the baby's mouth. Which suggestion by the nurse is most appropriate?
a. Slowly remove the breast from the baby's mouth when the infant has fallen asleep and the jaws are relaxed. b. Break the suction by inserting your finger into the corner of the infant's mouth. c. A popping sound occurs when the breast is correctly removed from the infant's mouth. d. Elicit the Moro reflex in the baby to wake the baby up, and remove the breast when the baby cries.
Examples of administrative laws that affect nursing are
a. civil rights acts c. nurse practice acts b. substance abuse laws d. negligence laws
A nurse assesses the playground safety at a new community center and notices rope swings and a trampoline. What action should the nurse take?
a. No action is required. b. Explain to the staff that these items are not recommended for playgrounds. c. Supervise the children closely when they are using this equipment. d. Call the police to have the items confiscated.