Straight catheter procedure

Correct Answer: A

Rationale: In the context of a straight catheter procedure, the correct answer is A) Stop inserting until you see urine backflow. This is because observing urine backflow indicates that the catheter is in the correct position within the bladder, ensuring accurate urine drainage. By stopping insertion at this point, the risk of causing trauma or injury to the urethra or bladder is minimized, promoting client safety. Option B) Provide 10 ml of sterile water in the balloon port is incorrect because this step pertains to the insertion of a Foley catheter, not a straight catheter. Introducing water into the balloon port of a straight catheter can lead to balloon inflation within the urethra, causing discomfort and potential harm to the client. Educationally, understanding the correct steps in catheterization procedures is crucial for healthcare providers to ensure patient safety and prevent complications. By following the correct technique, healthcare professionals can minimize the risks associated with catheter insertion and promote positive patient outcomes. Continuous education and practice in catheterization procedures are essential for healthcare providers to maintain competency and deliver quality care to their clients.

Correct Answer: B

Rationale: In the context of client safety in a community setting, the best method for cleaning hands is handwashing, which is the correct answer (B). Handwashing is a crucial aspect of infection control and prevents the spread of pathogens from one person to another. It is a simple and effective way to remove dirt, germs, and other infectious agents. Proper handwashing technique involves using soap and water, rubbing hands together for at least 20 seconds, including all surfaces of the hands, fingers, and under the nails, and rinsing thoroughly. Option A, autoclave, is not the correct choice for cleaning hands in a community setting. Autoclaving is a method used to sterilize equipment and instruments by using high-pressure steam, which is not suitable for hand hygiene. Option C, boiling water, is also not the best choice for cleaning hands. Boiling water can be used to sanitize certain items, but it is not practical or effective for hand hygiene in a community setting. In an educational context, it is important to emphasize the significance of proper handwashing as a fundamental skill for healthcare providers and individuals in the community to prevent the transmission of infections. Teaching individuals the correct handwashing technique and reinforcing its importance in maintaining client safety is essential in healthcare education and practice.

Correct Answer: D

Rationale: Upper extremity swelling could indicate infiltration, and the PICC will need to be removed. The initial dressing over the PICC site should be changed within 24 hours. This does not require immediate attention, but the swelling does. The dwell time for PICCs can be months or even years. Securement devices are being used more often now to secure the catheter in place and prevent complications such as phlebitis and infiltration. The IV should have one, but this does not take priority over the client whose arm is swollen.

Correct Answer: C

Rationale: The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content.

Correct Answer: A

Rationale: The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability.