Nursing Elites

1. A client is being taught about self-catheterization in the home setting. Which statements should the nurse include in this client’s teaching? (Select all that apply.)

• A. Wash your hands before and after self-catheterization.
• B. Use lubricant on the tip of the catheter before insertion.
• C. A & B
• D. Self-catheterize at least twice a day or every 12 hours.

Correct answer: C

Rationale: In teaching a client about self-catheterization, it is essential to emphasize proper hand hygiene before and after the procedure to prevent infections. Using lubricant on the catheter helps with insertion and reduces discomfort. Therefore, statements A and B are correct and should be included in the client's teaching. Option D is incorrect because self-catheterization frequency should be individualized based on the client's needs, and a specific time frame like every 12 hours may not be suitable for everyone. Choosing a smaller lumen catheter is preferred over a larger one. Self-catheterization should not be limited to a specific time frame but should be based on the individual's needs and voiding patterns. Therefore, option C is the correct choice as it includes the two essential statements for teaching self-catheterization in the home setting.

2. Which of the following is a sign of hypocalcemia?

• A. Hyperactive reflexes.
• B. Depressed reflexes.
• C. Muscle cramps.
• D. Seizures.

Correct answer: A

Rationale: Hyperactive reflexes are a classic sign of hypocalcemia. Hypocalcemia leads to increased neuromuscular excitability, resulting in hyperactive reflexes. Depressed reflexes (Choice B) are not typically associated with hypocalcemia. Muscle cramps (Choice C) can be seen in hypocalcemia due to muscle irritability but are not a specific sign. Seizures (Choice D) can occur in severe cases of hypocalcemia but are not as common as hyperactive reflexes.

3. After a urography, a client is instructed by a nurse. Which instruction should the nurse include in this client’s discharge teaching?

• A. Avoid direct contact with your urine for 24 hours until the dye clears.
• B. You may experience dribbling of urine for several weeks post-procedure.
• C. Drink at least 3 liters of fluids today to assist in dye elimination.
• D. Your skin may turn slightly yellow from the dye used in this procedure.

Correct answer: C

Rationale: It is important for the client to increase fluid intake to aid in the rapid elimination of the potentially nephrotoxic dye used in urography. This instruction will help prevent any adverse effects related to the dye. Choices A, B, and D are incorrect because the dye used in urography is not radioactive, so there is no need to avoid direct contact with urine, urine dribbling is not a common post-procedure occurrence, and the dye should not cause the client's skin to change color.

4. A child who weighs 10 kg will begin taking oral trimethoprim-sulfamethoxazole (TMP-SMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the child’s dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct?

• A. 5 mL PO BID
• B. 5 mL PO daily
• C. 10 mL PO BID
• D. 10 mL PO daily

Correct answer: A

Rationale: The correct answer is A: '5 mL PO BID.' To calculate the child’s daily dose requirement, you multiply the child's weight (10 kg) by the prescribed dosage per kg, which is 8 mg for TMP and 40 mg for SMX. This results in a total daily requirement of 80 mg of TMP and 400 mg of SMX. To divide this into two doses, each dose should contain half of the total daily requirement, which is 40 mg TMP and 200 mg SMX. Since the liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL, the correct dose per administration is 5 mL. Therefore, 5 mL PO BID is the correct order. Choice B, '5 mL PO daily,' is incorrect as the total daily dose needs to be divided into two doses. Choices C and D, '10 mL PO BID' and '10 mL PO daily,' respectively, are incorrect as they do not align with the calculated dosage requirements based on the child's weight and the prescribed dosage per kg.

5. After checking the urinary drainage system for kinks in the tubing, the nurse determines that a client who has returned from the post-anesthesia care has a dark, concentrated urinary output of 54 ml for the last 2 hours. What priority nursing action should be implemented?

• A. Report the findings to the surgeon.
• B. Irrigate the indwelling urinary catheter.
• C. Apply manual pressure to the bladder.
• D. Increase the IV flow rate for 15 minutes.

Correct answer: A

Rationale: In this situation, the nurse's priority action should be to report the findings to the surgeon. An adult should typically produce about 60 ml of urine per hour, so a dark, concentrated, and low urine output of 54 ml over 2 hours raises concerns. This change in urine output may indicate issues such as dehydration, renal problems, or inadequate fluid intake. Reporting this finding to the surgeon is crucial to ensure appropriate evaluation and intervention. Irrigating the catheter, applying manual pressure to the bladder, or increasing the IV flow rate are not appropriate actions based on the information provided and could potentially worsen the situation.

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