After delegating care to an unlicensed assistive personnel (UAP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the UAP's understanding. Which action indicates the UAP needs additional teaching?
a. Toileting the client after breakfast
b. Changing the client's incontinence brief when wet
c. Encouraging the client to drink fluids
d. Recording the client's incontinence episodes
Question 2A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should the nurse ask the primary health care provider?
a. Do you want daily weights on this client?
b. Will the client be able to return home?
c. Can we discontinue the indwelling catheter?
d. Should we get another chest x-ray today?
Question 3A nurse plans care for a client with overflow incontinence. Which intervention should the nurse include in this client's plan of care to assist with elimination?
a. Stroke the medial aspect of the thigh.
b. Use intermittent catheterization.
c. Provide digital anal stimulation.
d. Use the Valsalva maneuver.
Question 4A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a shift to the left in a client's white blood cell count. Which action should the nurse take?
a. Request that the laboratory perform a differential analysis on the white blood cells.
b. Notify the provider and start an intravenous line for parenteral antibiotics.
c. Collaborate with the unlicensed assistive personnel (UAP) to strain the client's urine for renal calculi.
d. Assess the client for a potential allergic reaction and anaphylactic shock.
Question 5A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis?
a. A 36-year-old female who has never been pregnant
b. A 42-year-old male who is prescribed cyclophosphamide
c. A 58-year-old female who is not taking estrogen replacement
d. A 77-year-old male with mild congestive heart failure