POST Simulation Questions KIM Johnson PDF

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POST-VSIMS ASSESSMENT QUIZ QUESTIONS 100 SCORE...

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POST SIMULATION QUESTIONS KIM JOHNSON

1-The patient was placed in the dorsal recumbent positioned, perineal care was performed prior to the procedure, and visualization of the urinary meatus was assessed. The labia and urinary meatus were cleaned using iodine antiseptic swab stick. About 2 inches from the tip of the catheter were lubricated with a water-soluble gel intermittent catheterization insertion was done on 12/10/2020 at 0903hrs. A 16 French straight, single lumen urinary catheter was used during the procedure. 345 mL urine output collected, color yellow, clear, normal urine odor. Patient tolerated the procedure well. Denies any pain. Record the date and time of intermittent urinary catheter insertion and the size and type of urinary catheter used. Also describe the amount, color, and other characteristics of the urine emptied from the patient's bladder. The nurse is recording fluid intake for Ms. Johnson. Which items on the dinner tray should the nurse include when completing this documentation? (Select all that apply.) a) Ice Cream b) Iced Tea c) Applesauce d) Creamed corn e) Tomato Soup The nurse should include all fluids and foods that are liquid at room temperature. On Ms. Johnson’s tray this would include ice cream, tomato soup, and iced tea. Creamed corn and applesauce are not liquid at room temperature and would not be included. 2-The nurse is preparing to insert an intermittent urinary catheter in a paralyzed female patient. What would be the appropriate action by the nurse? a) Ask a family member to assist you with the catheterization. b) Notify the provider that the procedure could not be completed because

the patient is paralyzed. c) Instruct the patient to turn over on her side. d) Call for a co-worker to help hold the patient’s legs in position. Since the patient is unable to move her legs, the nurse should call a co-worker for assistance. The patient is paralyzed and would not be able to turn over on her side. It would be inappropriate to have the family member to assist the nurse with the catheterization. Paralysis would not be a reason for not completing the procedure 3-The nurse has created a sterile field and is preparing to catheterize a patient. While using sterile cotton balls to clean the patient prior to the procedure, the nurse drops a contaminated cotton ball in the middle of the sterile field. What is the correct action of the nurse at this time? a) Remove the contaminated cotton ball from the field with the nondominant hand. b) Continue with the procedure while avoiding the contaminated cotton ball. c) Ask a co-worker to remove the contaminated cotton ball from the field. d) Obtain a new catheter kit and restart the procedure. The nurse should obtain a new catheter kit and begin again if the sterile field is contaminated. It would be inappropriate for the nurse to continue the procedure, try to remove the cotton ball, or have a coworker remove the cotton ball. 4-The nurse has received an order to collect a urine sample. Which characteristics would the nurse observe for when assessing the patient’s specimen? (Select all that apply.) a) Sediment b) pH c) Clarity d) Odor e) Color When observing a patient’s urine, the nurse should look for color, odor, clarity, and the presence of sediment. While pH (urine alkalinity or acidity) will be measured in the laboratory, it is cannot be determined without additional testing of the specimen. 5-After completing an intermittent catheterization, what information concerning the procedure will the nurse include in Ms. Johnson's medical record? (Select all that apply.) a) Description of the cleansing process preceding the procedure b) Characteristics of the urine obtained c) Description of the patient's tolerance of the procedure

d) Time procedure was performed e) Size of catheter used Record the date, time, and size and type of catheter used. Also describe the amount, color, and other characteristics of urine emptied from the bladder. Describe the patient's tolerance of the procedure. The description of the cleansing process in not recorded. 6-The nurse is providing Ms. Johnson discharge education about intermittent selfcatheterization. What statement, if made by the patient, would indicate the need for further instruction? a) If I do not catheterize myself, I may develop urinary problems. b) There are risks associated with self-catheterization, such as bleeding and infection. c) It is important that I self-catheterize at regular intervals. d) I should maintain sterile technique throughout the procedure. Self-catheterization at home is a clean rather than sterile procedure. Patients may develop urinary problems if they do not catheterize; patients should perform self-catheterization at regular intervals; and self-catheterization is associated with risks such as bleeding and infection. 7-The nurse is completing documentation following the insertion of an intermittent urinary catheter. What should be included in the documentation? (Select all that apply.) a) The length of time for completion of the procedure b) Size of the catheter c) Date the procedure was performed d) Time the procedure was performed e) Patient’s tolerance of the procedure The nurse should document the date, time, size and type of catheter used, and patient’s tolerance of the procedure. Also describe the amount, color, and other characteristics of urine emptied from the bladder. It is not necessary for the nurse to record the length of time the procedure took to complete. 8-Ms. Johnson is being discharged with an order to continue the medication oxybutynin. What information should be included in the teaching session? a) This medication helps reduce bladder spasms. b) You may experience excess saliva production while taking this medication. c) You may have to urinate more frequently while taking this medication.

d) Your urine may appear reddish-orange

9-Ms. Johnson asks: Why do I need to self-catheterize at regular intervals? What would be the appropriate response by the nurse? a) Self-catheterization helps reduce your risk of infection. b) This allows you to accurately measure your urine. c) This helps prevent your bladder from becoming overdistended. d) You will only need to self-catheterize once daily.

10-The nurse is providing patient education on self-catheterization. What statement by Ms. Johnson indicates the need for additional teaching? a) I should report signs and symptoms of potential complications to the provider immediately. b) I should store my reusable catheters in a clean, dry container. c) I may be eligible for free catheters through Medicare. d) I can use either an indwelling or intermittent catheter...