D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
After inserting an indwelling catheter in a male patient, the nurse inflates the balloon but observes leakage of urine around the urethral meatus. What should the nurse do next?
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Deflate the balloon, advance the catheter further, and reinflate.
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Apply tape to secure the catheter.
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Replace the catheter with a smaller size.
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Notify the provider that the balloon is defective.
Explanation
Leakage may occur if the balloon was inflated before the catheter was advanced fully into the bladder. Deflating the balloon and advancing the catheter ensures correct placement before reinflation.
Which statement best illustrates the nurse's understanding of the role of nursing assistive personnel (NAP) when inserting an indwelling urinary catheter in a female patient?
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"Please direct the light to better illuminate the patient's perineal area."
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"You need to be comfortable inserting a catheter in a patient of her size."
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"See if a size 14-French catheter is big enough."
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"Find out if the patient has any allergies to latex or iodine."
Explanation
NAP can assist with tasks that do not require clinical judgment or sterile technique, such as positioning the light to improve visibility during catheter insertion. This support helps the nurse perform the procedure safely and efficiently without breaching sterile technique. Tasks such as selecting catheter size, assessing allergies, or performing the insertion require nursing judgment and are outside the scope of NAP responsibilities. The nurse’s direction reflects an appropriate delegation of supportive duties while maintaining patient safety.
Which nursing action minimizes a patient's risk for injury during removal of an indwelling urinary catheter?
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Using a 5-mL syringe to deflate the balloon
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Using sterile scissors to cut the valve to deflate the balloon
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Tugging gently on the catheter to pull the balloon through the urethra
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Checking the documentation for the volume of fluid used to inflate the balloon
Explanation
Using a syringe to deflate the balloon is the correct method for safely removing an indwelling urinary catheter. Fully deflating the balloon prevents trauma to the urethra and bladder during removal. Cutting the valve or tugging on the catheter can cause urethral injury, and simply checking the documentation does not prevent physical harm. Following proper deflation technique is critical to minimize the risk of injury during catheter removal.
A nurse notes that urine is leaking around a patient’s indwelling catheter. What is the nurse’s best action?
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Assess for obstruction and ensure the catheter is not kinked.
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Inflate the balloon with an additional 5 mL of sterile water.
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Replace the catheter with a larger-sized one immediately.
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Notify the provider to initiate antibiotics.
Explanation
Leakage around a catheter may indicate blockage or kinking of the tubing, which leads to backpressure. The nurse should first assess and correct any mechanical issues before taking other steps. Increasing balloon size or changing catheter size without assessment can cause trauma or worsen leakage.
When providing perineal care to a female patient with an indwelling catheter, what is the correct cleaning technique?
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Clean from front to back around the catheter insertion site.
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Clean from the rectum toward the meatus.
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Wipe circularly around the catheter with one cloth.
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Clean from the urethra outward toward the thighs.
Explanation
Cleaning from front to back prevents the transfer of bacteria from the anal region to the urethra, which reduces infection risk. Each wipe should be done with a clean section of the cloth to maintain asepsis.
Which nursing action is most effective in preventing pressure injuries in an immobile patient?
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Increasing dietary protein
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Turning the patient every 2 hours
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Applying sterile dressings daily
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Changing the bed linens each shift
Explanation
Regular repositioning redistributes pressure and improves circulation, preventing tissue ischemia. While nutrition and hygiene are important, repositioning is the most direct preventive measure.
When preparing to insert an indwelling urinary catheter in a male patient, it is important for the nurse to do what?
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Remove the cotton balls from the kit for later use.
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Advance the catheter 10 to 12 inches or until urine flows.
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Lubricate the first 5 to 7 inches of the catheter.
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Hold the penis at a 45-degree angle during insertion.
Explanation
Lubricating the first 5 to 7 inches of the catheter before insertion helps reduce friction and trauma to the urethra, making the procedure safer and more comfortable for the male patient. Proper lubrication minimizes the risk of urethral injury and facilitates smooth advancement of the catheter. Other actions, such as removing cotton balls, advancing the catheter a set distance without observing urine flow, or holding the penis at a 45-degree angle, do not follow recommended sterile technique and proper anatomical positioning for catheter insertion.
Which statement might the nurse make to nursing assistive personnel (NAP) caring for a patient who has just had an indwelling urinary catheter removed?
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"Teach the patient the signs of a urinary tract infection."
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"Tell me when and how much the patient first voids."
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"Explain that voiding might be uncomfortable for 4 to 5 days."
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"Assess the patient for a distended bladder before the end of the shift."
Explanation
NAP can assist by observing and reporting the patient’s first voiding after catheter removal, including timing and urine output. This information helps the nurse assess bladder function and detect retention or complications. Teaching signs of infection, explaining discomfort, or assessing for bladder distention require nursing judgment and are outside the scope of NAP responsibilities. Delegating observation and reporting ensures accurate monitoring while maintaining appropriate scope of practice.
While setting up the sterile field in preparation for inserting an indwelling urinary catheter, a male patient is incontinent of urine over most of the supplies. What action would the nurse take to reduce the patient's risk for infection?
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Rinse off the supplies that were contaminated with urine.
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Cleanse the patient's urinary meatus.
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Replace all contaminated supplies, and begin the process again.
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Change the patient's bed linens.
Explanation
If sterile supplies are contaminated with urine, they are no longer sterile and must be replaced to prevent infection. The nurse should discard all contaminated supplies and restart the setup to maintain a sterile field and reduce the patient’s risk for infection. Simply rinsing the supplies, cleansing the meatus, or changing bed linens does not restore sterility and would not adequately prevent contamination during catheter insertion.
During intermittent open bladder irrigation, a patient complains of pain. Which action would the nurse take first?
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Examine the drainage tubing for clots, sediment, and kinks.
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Notify the health care provider.
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Leave the irrigation drip wide open.
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Monitor the patient's vital signs.
Explanation
When a patient reports pain during intermittent bladder irrigation, the nurse’s first action is to assess the drainage tubing for clots, sediment, or kinks that could be obstructing urine flow. Obstructions can cause discomfort and increase the risk of bladder distention or injury. Notifying the healthcare provider or monitoring vital signs may follow, but identifying and resolving mechanical obstructions immediately is the priority to relieve pain and prevent complications. Leaving the irrigation wide open without assessment could worsen the problem.
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