Nokea
The nursing assistant tells you that Mrs. White gained 3 pounds since her daily weigh the previous morning. You are most concerned that Mrs. White
- A. Has been eating too many calories in the past 24 hours.
- B. Is retaining approximately 1.5 liters of fluid since yesterday.
- C. Is not getting enough movement and exercise while in the hospital.
- D. Was dehydrated yesterday and has replaced needed fluids.
Correct Answer: B
Rationale: A 3-pound weight gain in 24 hours likely indicates fluid retention (1 kg ? 1 liter), equivalent to about 1.5 liters, which requires further assessment.
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You will need to push back the foreskin before catheterizing uncircumcised males. After you catheterize the patient, you should
- A. Pull the foreskin back over the glans.
- B. Leave the foreskin retracted.
- C. Lubricate the foreskin with petroleum jelly and then replace it.
- D. Elevate the penis on a folded towel to prevent swelling of the foreskin or glans.
Correct Answer: A
Rationale: Replacing the foreskin over the glans after catheterization prevents paraphimosis, a condition where the retracted foreskin causes swelling.
You are about to catheterize a female patient who is experiencing a decline in her physical condition. In fact, she is being transferred from your unit to the ICU. As you get ready to insert the catheter, the tip lightly brushes against the patient's leg. Which of the following possible actions should you perform next?
- A. You should get a new catheter to insert.
- B. You should report the possible contamination to the nurse in the ICU so that she can get an order for antibiotics.
- C. It is not necessary to mention it as long as you cleaned the urinary meatus according to policy.
- D. You should clean the catheter tip with alcohol or Betadine.
Correct Answer: A
Rationale: A catheter that touches the skin is contaminated and must be replaced to prevent infection.
Which is true of UTIs in children?
- A. They are very common, second only to respiratory infections.
- B. The symptoms are the same as those seen in adults.
- C. They occur more often in boys than in girls.
- D. They may cause a toilet-trained child to have accidents.
- E. They may cause poor feeding, vomiting, and diarrhea.
Correct Answer: A,D,E
Rationale: UTIs are common in children, can cause accidents in toilet-trained children, and may present with nonspecific symptoms like poor feeding, vomiting, and diarrhea.
A single tube with holes at the end that is used to empty the bladder of residual urine or to obtain a sterile urine specimen from the bladder is a
- A. Indwelling catheter
- B. Straight catheter
- C. Condom catheter
- D. Suprapubic catheter
Correct Answer: B
Rationale: A straight catheter is inserted temporarily to drain urine or obtain a sterile specimen and is removed after use.
The size of the balloon for an indwelling catheter is 5 mL.
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: Indwelling catheter balloons typically range from 5 to 30 mL, with 10 mL being common for adults.