Correct Answers
A patient with a suprapubic catheter is complaining of pain. What will the nurse do first
to help this patient?
A. Ensure that the patient is not lying on the drainage tubing.
B. Instruct the patient to increase his or her oral fluid intake.
C. Observe the rate of drainage in the urine collection bag.
D. Notify the health care provider. ✅A. Ensure that the patient is not lying on the
drainage tubing.
Rationale: The nurse will first ensure that the patient is not lying on the drainage tubing
because doing so could obstruct urine flow and cause pain. Increasing oral fluids will
not reduce pain associated with a suprapubic catheter. The nurse would observe the
rate of drainage in the collection bag only after ensuring that the flow of urine had not
been obstructed by the weight of the patient's body on the tubing. Notifying the health
care provider of the patient's complaint of pain would not be the nurse's first action.
What is the primary reason the nurse applies sterile gloves rather than clean ones when
caring for a patient with a newly inserted suprapubic catheter?
A. To protect the nurse and other patients from pathogens
B. To collect a sterile urine sample
C. To reduce the patient's risk for infection
D. To reduce the patient's risk for injury ✅C. To reduce the patient's risk for infection
Rationale: This is the correct answer. When providing care for a newly inserted
suprapubic catheter, the nurse wears sterile gloves to reduce the risk of infecting the
wound at the catheter insertion site. Although it is important to protect the nurse and
other patients from pathogens, doing so is not the primary reason the nurse applies
sterile gloves rather than clean ones when caring for a newly inserted suprapubic
catheter. A sterile urine sample need not be collected from a patient with a newly
established suprapubic catheter unless the provider has ordered one. Putting on gloves,
sterile or clean, does not reduce the patient's risk for injury.
Which statement might the nurse make to nursing assistive personnel (NAP) assigned
to care for a patient with an established suprapubic catheter?
A. "Tell me if the catheter site looks inflamed."
B. "I need to know the patient's temperature each time it's taken."
C. "Wear sterile treatment gloves when you remove the dressing."
D. "Let me know if the patient's catheter is infected." ✅B. "I need to know the patient's
temperature each time it's taken."
, Rationale: Temperature measurement can be delegated to NAP. This statement is
appropriate for the nurse to make. Patient assessment cannot be delegated to NAP.
Wearing sterile gloves is not needed when removing the dressing of an established
suprapubic catheter. Patient assessment cannot be delegated to NAP. In addition, the
dressing should be changed at least once per shift regardless of whether it looks soiled.
Which nursing action reduces the risk for injury in a patient with a suprapubic catheter?
A. Applying sterile gloves before cleansing the catheter insertion site
B. Cleansing the skin surrounding the insertion site
C. Securing the catheter to the abdomen
D. Keeping the drainage bag above the level of the patient's bladder ✅C. Securing the
catheter to the abdomen
Rationale: Securing the catheter to the abdomen will reduce the patient's risk for injury
by ensuring that excess tension is not applied to the catheter. Such tension could
damage the bladder. Applying sterile gloves before cleansing the catheter insertion site
will reduce the patient's risk for infection but will not prevent injury. Cleansing the skin
around the insertion site will reduce the patient's risk for infection but will not prevent
injury. Keeping the drainage bag above the level of the patient's bladder is incorrect. It
should be kept below the bladder.
A newly inserted suprapubic catheter becomes dislodged. What action should the nurse
perform first?
A. Notify the health care provider.
B. Apply pressure over the site.
C. Cover the site with a sterile dressing.
D. Help the patient into a side-lying position. ✅C. Cover the site with a sterile dressing.
Rationale: When a newly inserted suprapubic catheter becomes dislodged, the nurse's
first action is to cover the site with a sterile dressing. The nurse would then notify the
health care provider. Pressure need not be applied over the site, and doing so might
further injure the wound tissue. There is no reason to move the patient into a side-lying
position
Mrs. Carson is frowning, has her arms crossed over her chest, and is looking at her
watch as she waits for her turn. What is her body language conveying?
A. Anger
B. Boredom
C. Happiness
D. Impatience ✅D. Impatience
Rationale: Mrs. Carson's closed posture, frowning expression, and looking at her watch,
taken into context with waiting in line, indicates impatience. Mrs. Carson's closed body
language and frowning expression could indicate anger, but with the context of her
waiting in line and looking at her watch, she is clearly displaying impatience. Mrs.
Carson's closed posture, frowning expression, and looking at her watch, taken into