Skills cpt 33 & 43 Urinary questions Flashcards
Which nursing intervention decreases the risk for catheter-associated urinary tract infection (CAUTI)?
A) Daily cleansing of the urinary meatus with antiseptic solution
B) Hanging the urinary drainage bag below the level of the bladder
C) Changing the urinary drainage bag daily
D) Irrigating the urinary catheter with sterile water
B
Evidence-based interventions shown to decrease the risk for CAUTI include ensuring a free flow of urine in the catheter to the bag. None of the other options have evidence to support their use, and option “D” will increase the risk for CAUTI through repeated opening of the sterile catheter drainage system. (REF: p. 810)
Which intervention is appropriate when an indwelling urinary catheter is secured in a male patient?
A) Secure the catheter drainage tubing to the lower leg.
B) Attach the securement device above the catheter bifurcation.
C) Tape the catheter tubing to the lower abdomen, avoiding traction.
D) Secure the catheter tubing to the upper inner thigh with slight traction.
C
ecuring the catheter, not the drainage tubing, reduces the risk of urethral erosion, CAUTI, or accidental catheter removal. Attachment of the securement device at the bifurcation is recommended to prevent catheter occlusion. Securement of the male catheter to the abdomen reduces traction on the urethra and prevents urethral injury. Catheter traction should always be avoided to minimize risk for urethral trauma. (REF: p. 821)
What is the best nursing action when there is no urine flow after an indwelling urinary catheter is inserted into a female patient?
A) Remove the catheter and start all over with a new kit and catheter.
B) Determine whether the catheter is in the vagina, leave it there, and start over with a new catheter.
C) If misplaced, pull the catheter back and reinsert at a different angle.
D) Ask the patient to bear down, and insert the catheter farther.
B
If misplaced, leave the catheter in the vagina as a landmark, indicating where not to insert, and insert another sterile catheter. Pulling the catheter back and reinserting is poor technique, increasing the risk for CAUTI. (REF: p. 819)
When performing catheter care, what step helps prevent traction on the catheter and CAUTI?
A) Wash the meatus with soap and water.
B) Start cleansing at the meatus and move toward the rectum.
C) Grasp the catheter with two fingers to stabilize the catheter.
D) Retract the foreskin before cleansing.
C
All options help prevent CAUTI, but only option “C” prevents unnecessary traction on the catheter. Pulling on the catheter causes discomfort for the patient and can damage the urethra and the bladder neck. (REF: p. 825)
A postoperative patient is suspected of having a wound infection. Which method would be most appropriate for the nurse to use when obtaining an anaerobic culture?
A) Touching the wound edges with the swab from the culture tube
B) Aspirating the drainage using a 21-gauge needle attached to a syringe
C) Using the culture swab, then crushing the attached medium ampule
D) Aspirating the drainage using the sterile tip of a 10-mL syringe
D
For an anaerobic culture, the specimen must be placed in a special medium container. No needle is used in the wound area to obtain the specimen; the standard culture swab with the attached medium ampule also is not used. (REF: p. 1076)
A patient with suspected sepsis is to have blood cultures obtained but is currently receiving antibiotics. What is the most appropriate nursing action?
A) Call the physician for further clarification of the order.
B) Stop the scheduled antibiotics until the specimens are drawn.
C) Notify the laboratory which antibiotics the patient is receiving.
D) Scrub the venipuncture site for 2 minutes for a sterile specimen.
C
Because antibiotics may interrupt growth of the organism in the laboratory, the nurse must notify the laboratory regarding the antibiotics the patient is currently receiving. It is always best to initiate blood cultures before a patient begins antibiotic therapy, but the patient may develop an infection against which the ordered antibiotic is not effective. The antibiotics should not be stopped. (REF: p. 1078)
A nurse in the diabetic clinic is assessing blood glucose levels in patients ranging from infants to the elderly. Which techniques would best ensure that the nurse obtains an adequate amount of blood for testing any of these patients? (Select all that apply)
A) Hold the area to be punctured in a dependent position.
B) Squeeze the area to be punctured.
C) Warm the area to be punctured.
D) Gently hit the area to be punctured.
A & C
A. Having the puncture site in dependent position increases blood flow to the area. Warming the area to be punctured promotes vasodilation, which facilitates bleeding. Squeezing and gently hitting the area are not appropriate actions. (REF: p. 1088, 1091)
An unconscious elderly patient with poor circulation has to have an arterial blood gas drawn. Which nursing diagnosis would be given priority during and after the procedure?
A) Ineffective airway clearance
B) Impaired gas exchange
C) Risk for injury
D) Deficient knowledge regarding arterial blood gases
C
The site used is of great importance because the patient has poor circulation. Injury could occur if the wrong site was used, or if the technique was inappropriately done. The radial area is often used because a strong pulse is usually palpable. The patient is unconscious, so knowledge deficit would not be an appropriate nursing diagnosis, and the focus of the question is on the procedure, not on the underlying problem for which the procedure is needed. (REF: p. 1091-1092)
A patient needs to expectorate a sputum specimen. The nurse’s teaching has been effective if the patient is seen doing which activity as part of the procedure?
A) Brushing his teeth with toothpaste before producing the specimen
B) Rinsing his mouth with mouthwash before producing the specimen
C) Providing the specimen immediately after awakening before eating
D) Taking a few sips of water to loosen respiratory secretions
C
The sputum specimen will be most concentrated and free of food particles if obtained before breakfast. Toothpaste and mouthwashes decrease the viability of microorganisms and therefore should not be used. (REF: p. 1072)
