NURS 242 Final Exam Questions With
100% Correct Answers Latest Versions
2025 Graded A+
Why does the nurse cleanse a female patient's perineum before inserting an intermittent urinary
catheter? a. To encourage the bladder to drain fully b. To encourage spontaneous voiding c. To
prevent bowel elimination during the procedure d. To reduce the patient's risk of urinary tract
infection - ✔
Which action(s) would minimize the patient's risk for injury during insertion of an indwelling
urinary catheter? a. Assessing the patient for allergies related to latex, antiseptic, tape, and/or
iodine b. Thoroughly cleansing the patient's perineal area with povidone-iodine solution before
inserting the catheter c. Performing proper hand hygiene and applying gloves before inserting the
catheter d. Terminating the insertion if the patient reports pain at any time during the procedure. -
✔ANS:A
At approximately what rate do kidneys produce urine? a. 10-15 mL/hr b. 25-30 mL/hr c. 50-60
mL/hr d. 90-100 mL/hr - ✔ANS:B
How does the nurse properly measure intake and output? a. Recording 50% of ice chip
consumption b. Checking urinary output once every 24 hours c. Do not count chest tube drainage
d. Subtracting liquid medications from the total intake - ✔
Your patient is incontinent of urine and also has an order for strict I&O to be recorded. She is in
stable condition, on a general hospital unit. How should you proceed? a. Tell the physician it is
not possible to record accurate urine output on this patient b. Weigh your patient's brief and bed
pad after each episode of incontinence, since 1g = 1mL of urine c. Use intermittent straight
catheterization Q4 hours to empty patient's bladder d. Insert an indwelling catheter (Foley) - ✔
When inserting a urinary catheter into a female patient, how far should the nurse initially insert
the catheter? - ✔a. 1 to 2 inches b. 2 to 3 inches c. 4 to 6 inches d. 7 to 9 inches
Resistance is encountered during urinary catheterization of a male patient. What should the nurse
do? (Select all that apply) a. Force the catheter through b. Do NOT force the catheter through c.
Try twisting the catheter slightly d. Apply gentle pressure - ✔
Which of the following actions indicates that the nurse has performed the insertion of an
indwelling urinary catheter on a female patient appropriately? (select all that apply) a. Applied
the waterproof sterile drape before donning sterile gloves b. Tested the balloon with fluid from
the prefilled sterile water syringe c. Opened the labia with the nondominant hand and expose the
urethral meatus D. kept labial folds open after cleansing the urethral meatus - ✔
When the balloon on an indwelling urinary catheter is blown up, the patient expresses
discomfort. What should the nurse do? a. Remove the catheter b. Continue to blow up the
, balloon because discomfort is expected c. Aspirate the fluid from the balloon and advance the
catheter d. Pull back on the catheter slightly to determine tension - ✔ANS: C The balloon might
not be fully into the bladder so make sure you are in the bladder by aspirating and then
advancing
The nurse notes that there has only been 100mL of urine output from his patient's Foley catheter
in 6hrs. The nurse should do which of the following first? a. Instruct the patient to drink two
glasses of water b. Notify the MD immediately c. Irrigate the Foley with 30mL of sterile saline d.
Assess the catheter tubing and the patient's abdomen - ✔Ans:D The nurse should first determine
whether urine is being retained in the bladder. This can be accomplished through palpation of the
bladder and/or checking the catheter tubing for kinks.
When discussing the collection of a clean-voided urine specimen, it is important for the nurse to
instruct the patient to: - ✔a. Use a clean specimen cup b. Collect 90-120 mL of urine for testing
b. Void some urine first and then collect the sample d. Wash the perineal area with warm soap
and water immediately before voiding ANS:C After patient has initiated urine stream, pass the
urine specimen container into stream and collect 30 to 60 mL of urine. A sterile specimen
container is used. Pour antisepticsolution over cotton balls. Cotton ball or gauze is used to
cleanse perineum.
A patient asks if she can have an indwelling catheter because she is in too much pain to get up to
the bathroom after surgery. The nurse explains that catheters should be utilized only when
necessary because: a. They are the leading cause of nosocomial infection b. They are too
expensive for routine use c. They contain latex, increasing risk for allergies d. You cannot get up
and walk with them, and ambulation is important - ✔
Which of the following techniques can be used to measure post void residual (PVR)? (Select all
that apply) a. Bladder scanner b. Indwelling catheterization c. Straight/ intermittent
catheterization d. Foley catheterization - ✔ANS:A,C
The nurse needs to obtain a sterile urine specimen for culture and sensitivity (C&S) from a
patient who has an indwelling catheter. The catheter was placed the night before. What must the
nurse do to obtain the specimen? (Select all that apply) a. Obtain the urine from the drainage bag
b. Clamp the drainage tubing for 10-15 minutes c. Draw urine with a 10mL syringe from the
specimen port d. Insert the needle into the silicone catheter - ✔ANS:B
What must the nurse do to collect a midstream urine specimen from an infant? a. Apply a sterile
plastic collection bag to the perineum b. Wring out diapers and collect urine in a specimen
container c. Have infant sit facing the back of the toilet d. Catheterize the infant and collect the
urine using sterile procedure - ✔ANS: A Use a sterile plastic urine collecting bag that adheres to
the perineum of a non-toilet-trained child. Special considerations for boys: Place penis and
scrotum inside the bag. Diapers may be contaminated. Seating on a toilet is generally not
realistic for an infant. Catheterization should be used as a last resort only.
The patient is scheduled for surgery later in the afternoon. He is scheduled to have PCA therapy
after surgery. The nurse should: a. Teach the patient about PCA therapy after the patient comes
out of recovery b. Teach the patient about PCA therapy before surgery and before preoperative
medication administration c. Tell the patient not to use the PCA unless he can no longer tolerate
pain d. Inform the patient's family to watch him carefully and to depress the PCA administration
100% Correct Answers Latest Versions
2025 Graded A+
Why does the nurse cleanse a female patient's perineum before inserting an intermittent urinary
catheter? a. To encourage the bladder to drain fully b. To encourage spontaneous voiding c. To
prevent bowel elimination during the procedure d. To reduce the patient's risk of urinary tract
infection - ✔
Which action(s) would minimize the patient's risk for injury during insertion of an indwelling
urinary catheter? a. Assessing the patient for allergies related to latex, antiseptic, tape, and/or
iodine b. Thoroughly cleansing the patient's perineal area with povidone-iodine solution before
inserting the catheter c. Performing proper hand hygiene and applying gloves before inserting the
catheter d. Terminating the insertion if the patient reports pain at any time during the procedure. -
✔ANS:A
At approximately what rate do kidneys produce urine? a. 10-15 mL/hr b. 25-30 mL/hr c. 50-60
mL/hr d. 90-100 mL/hr - ✔ANS:B
How does the nurse properly measure intake and output? a. Recording 50% of ice chip
consumption b. Checking urinary output once every 24 hours c. Do not count chest tube drainage
d. Subtracting liquid medications from the total intake - ✔
Your patient is incontinent of urine and also has an order for strict I&O to be recorded. She is in
stable condition, on a general hospital unit. How should you proceed? a. Tell the physician it is
not possible to record accurate urine output on this patient b. Weigh your patient's brief and bed
pad after each episode of incontinence, since 1g = 1mL of urine c. Use intermittent straight
catheterization Q4 hours to empty patient's bladder d. Insert an indwelling catheter (Foley) - ✔
When inserting a urinary catheter into a female patient, how far should the nurse initially insert
the catheter? - ✔a. 1 to 2 inches b. 2 to 3 inches c. 4 to 6 inches d. 7 to 9 inches
Resistance is encountered during urinary catheterization of a male patient. What should the nurse
do? (Select all that apply) a. Force the catheter through b. Do NOT force the catheter through c.
Try twisting the catheter slightly d. Apply gentle pressure - ✔
Which of the following actions indicates that the nurse has performed the insertion of an
indwelling urinary catheter on a female patient appropriately? (select all that apply) a. Applied
the waterproof sterile drape before donning sterile gloves b. Tested the balloon with fluid from
the prefilled sterile water syringe c. Opened the labia with the nondominant hand and expose the
urethral meatus D. kept labial folds open after cleansing the urethral meatus - ✔
When the balloon on an indwelling urinary catheter is blown up, the patient expresses
discomfort. What should the nurse do? a. Remove the catheter b. Continue to blow up the
, balloon because discomfort is expected c. Aspirate the fluid from the balloon and advance the
catheter d. Pull back on the catheter slightly to determine tension - ✔ANS: C The balloon might
not be fully into the bladder so make sure you are in the bladder by aspirating and then
advancing
The nurse notes that there has only been 100mL of urine output from his patient's Foley catheter
in 6hrs. The nurse should do which of the following first? a. Instruct the patient to drink two
glasses of water b. Notify the MD immediately c. Irrigate the Foley with 30mL of sterile saline d.
Assess the catheter tubing and the patient's abdomen - ✔Ans:D The nurse should first determine
whether urine is being retained in the bladder. This can be accomplished through palpation of the
bladder and/or checking the catheter tubing for kinks.
When discussing the collection of a clean-voided urine specimen, it is important for the nurse to
instruct the patient to: - ✔a. Use a clean specimen cup b. Collect 90-120 mL of urine for testing
b. Void some urine first and then collect the sample d. Wash the perineal area with warm soap
and water immediately before voiding ANS:C After patient has initiated urine stream, pass the
urine specimen container into stream and collect 30 to 60 mL of urine. A sterile specimen
container is used. Pour antisepticsolution over cotton balls. Cotton ball or gauze is used to
cleanse perineum.
A patient asks if she can have an indwelling catheter because she is in too much pain to get up to
the bathroom after surgery. The nurse explains that catheters should be utilized only when
necessary because: a. They are the leading cause of nosocomial infection b. They are too
expensive for routine use c. They contain latex, increasing risk for allergies d. You cannot get up
and walk with them, and ambulation is important - ✔
Which of the following techniques can be used to measure post void residual (PVR)? (Select all
that apply) a. Bladder scanner b. Indwelling catheterization c. Straight/ intermittent
catheterization d. Foley catheterization - ✔ANS:A,C
The nurse needs to obtain a sterile urine specimen for culture and sensitivity (C&S) from a
patient who has an indwelling catheter. The catheter was placed the night before. What must the
nurse do to obtain the specimen? (Select all that apply) a. Obtain the urine from the drainage bag
b. Clamp the drainage tubing for 10-15 minutes c. Draw urine with a 10mL syringe from the
specimen port d. Insert the needle into the silicone catheter - ✔ANS:B
What must the nurse do to collect a midstream urine specimen from an infant? a. Apply a sterile
plastic collection bag to the perineum b. Wring out diapers and collect urine in a specimen
container c. Have infant sit facing the back of the toilet d. Catheterize the infant and collect the
urine using sterile procedure - ✔ANS: A Use a sterile plastic urine collecting bag that adheres to
the perineum of a non-toilet-trained child. Special considerations for boys: Place penis and
scrotum inside the bag. Diapers may be contaminated. Seating on a toilet is generally not
realistic for an infant. Catheterization should be used as a last resort only.
The patient is scheduled for surgery later in the afternoon. He is scheduled to have PCA therapy
after surgery. The nurse should: a. Teach the patient about PCA therapy after the patient comes
out of recovery b. Teach the patient about PCA therapy before surgery and before preoperative
medication administration c. Tell the patient not to use the PCA unless he can no longer tolerate
pain d. Inform the patient's family to watch him carefully and to depress the PCA administration
