Four hours after applying an external urinary catheter to the client, the nurse observes no urine output in the drainage bag. Which should the nurse implement first?
1. Check catheter tubing for an obstruction.
2. Ask the client if he feels the urge to void.
3. Notify provider of inadequate urine output.
4. Increase client's fluid intake over the next hour.
2
2 and 1. The nurse asks the client if he senses the urge to void because it can indicate a full bladder potentially caused by obstructed tubing. The client can also have uri-nary retention with an urge to void but no urine output. If the client states he has no urge to void, the nurse can scan the bladder to evaluate its contents.
3. It is premature to notify the provider because the nurse has not assessed the client adequately.
4. Increasing the client's intake can be contraindicated but can be effective to in-crease urine output.
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The nurse is administering thrombolytic therapy to a client who had a myocardial infarction. Which intervention does the nurse implement to reduce the risk of complications in this client?
a. Administer prescribed heparin. b. Apply ice to the injection site. c. Place the client in Trendelenburg position. d. Instruct the client to take slow deep breaths.
Which one of the following is a proper technique for the use of a speculum during a vaginal examination?
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Which patient has the greatest risk for overdose with a benzodiazepine? A patient who
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A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets
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