a client is having difficulty voiding after removal of an indwelling urinary catheter what should the nurse do
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Nursing Elites

ATI LPN

ATI PN Comprehensive Predictor 2023 with NGN

1. A client is having difficulty voiding after removal of an indwelling urinary catheter. What should the nurse do?

Correct answer: D

Rationale: The correct answer is to pour warm water over the client's perineum. This action helps stimulate voiding post-catheterization by promoting relaxation and providing sensory input. Assessing for bladder distention after 6 hours (Choice A) is important but not the immediate intervention needed for difficulty voiding. Encouraging the client to use a bedpan in the supine position (Choice B) may not effectively address the issue of post-catheterization voiding difficulty. Restricting the client's intake of oral fluids (Choice C) is not appropriate and can lead to dehydration, which is not helpful in promoting voiding.

2. What are the complications of untreated DVT?

Correct answer: A

Rationale: The correct answer is A: Pulmonary embolism and stroke. Untreated DVT can result in these serious complications, emphasizing the importance of timely intervention. Choices B, C, and D are incorrect because they do not represent common complications associated with untreated deep vein thrombosis. Infection and kidney failure, hypertension and vision loss, as well as dehydration and electrolyte imbalance are not typically direct consequences of untreated DVT.

3. What is the best dietary recommendation for a patient with chronic kidney disease?

Correct answer: A

Rationale: The correct answer is a low-protein diet for a patient with chronic kidney disease. In chronic kidney disease, the kidneys may have difficulty filtering waste products from protein metabolism, leading to a buildup of toxins in the body. Therefore, reducing protein intake can help lessen the workload on the kidneys. Choices B, C, and D are incorrect. A high-protein diet would increase the workload on the kidneys, while a low-sodium diet is beneficial for conditions like hypertension or heart failure but not specifically targeted for chronic kidney disease. A high-sodium diet can worsen fluid retention and hypertension in patients with kidney disease.

4. A nurse manager is updating protocols for belt restraints. Which of the following guidelines should the nurse include?

Correct answer: A

Rationale: The correct answer is A: Document the client's condition every 15 minutes. When using belt restraints, it is crucial to document the client's condition regularly to ensure their safety and well-being. This guideline allows for ongoing assessment of the client's need for restraints and any potential adverse effects. Choice B is incorrect as restraints should not be attached to the bed frame but to a non-moving part of the bed to prevent harm in case of bed movement. Choice C is incorrect as PRN (as needed) restraint prescription should not be a routine practice and should only be considered after other interventions have been attempted. Choice D is incorrect as restraints should be removed and reevaluated based on the client's condition, not solely on a fixed time schedule.

5. What are the nursing responsibilities when administering intravenous (IV) antibiotics?

Correct answer: A

Rationale: When administering IV antibiotics, it is essential for the nurse to verify the antibiotic dosage and check for any allergies the patient may have. This is crucial to ensure that the correct medication is being given at the proper dose and to prevent potential adverse reactions. Choice B is incorrect because administering medication without verification can lead to errors. Choice C is incorrect as it goes against safe medication administration practices. Choice D is incorrect as the focus should be on checking if the patient has allergies to antibiotics, not ensuring the patient is allergic to them.

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