1. The nurse is delegating to nursing assistive personnel (NAP) the task of assisting with a urinal. The nurse specifies to NAP that the urinal is to be used in bed, not in a standing position, for which patient?

1. Patient admitted for hypertension and diabetes
2. Patient with complete left-sided paralysis caused by a stroke
3. Patient receiving diagnostic tests for esophageal strictures
4. Patient being treated for dehydration from heat exposure

2. Which instruction might the nurse give to nursing assistive personnel (NAP) about applying a condom catheter on a patient?

1. “Check for breaks in the skin before applying the catheter.”
2. “Determine whether the patient is still having problems with incontinence before you put the catheter on him.”
3. “Read the manufacturer’s instructions for applying the adhesive to secure the condom.”
4. “Be sure to get a snug fit between the tip of the penis and the end of the condom catheter.”

3. What would the nurse do for a patient who is complaining of penile pain 15 minutes after having a condom catheter applied?

1. Offer an antiinflammatory medication.
2. Drop the level of the urine drainage bag.
3. Remove the catheter.
4. Ensure that the catheter is not twisted.

4. The nurse has delegated administration of a standard enema for a 72-year-old patient with constipation. Which statement made by nursing assistive personnel (NAP) requires the nurse to follow up?

1. “I’ll warm up the solution before instilling it.”
2. “I’ll place the patient in the left side-lying position with the right knee bent.”
3. “I’ll put a waterproof pad under the patient before I start.”
4. “I’ll instill the solution and then check in on my other patients until I get the call signal.”

5. Which instruction would the nurse give to nursing assistive personnel (NAP) to ensure the patient’s comfort when a condom catheter is applied?

1. Wash the penis before applying the catheter.
2. Clip the drainage bag to the bed.
3. Wear gloves when applying the condom catheter.
4. Use a hair guard before applying the condom catheter.

6. Which action would the nurse take to reduce the risk of infection among patients and staff when administering an enema to an older adult patient with dementia?

1. Lubricate the tip of the rectal tube.
2. Pad the patient’s bed thoroughly.
3. Perform hand hygiene before donning gloves.
4. Help the patient onto a bedpan to expel the enema fluid and stool.

7. The nurse is assisting a patient with the placement of a urinal. The patient tells the nurse, “I’ll call you when I’m done.” What is the nurse’s best response?

1. “All right, my name is Robin, and I’ll be right across the hall. Just call me when you’re finished.”
2. “Fine. Recap the urinal, hang it on your side rail, and use your call light to let me know you’re finished.”
3. “I'll check on you as soon as I get a chance.”
4. “I'll be back in 15 minutes. That should be enough time for you to finish up.”

8. Why would the nurse ensure that a patient’s condom catheter is not twisted?

1. To prevent the catheter from coming off
2. To make sure the catheter is the correct size
3. To ensure an adequate hourly urine output from the kidneys
4. To prevent an allergic response

9. All of the following factors are known to increase the risk of urinary tract infection (UTI) except which one?

1. History of fecal incontinence
2. Use of an indwelling urinary catheter
3. Drainage tubing is kinked
4. Use of plain soap instead of an antiseptic cleanser for perineal hygiene

10. A patient with a nasogastric tube, an intravenous infusion line, and an indwelling urinary catheter needs to be placed on the bedpan. Which action would the nurse take first to ensure the patient’s safety?

1. Close the bedside curtain.
2. Raise the side rail on the side opposite that on which the nurse is working.
3. Obtain help to place the patient on the bedpan.
4. Raise the bed to a comfortable working height.

11. What is the primary reason the nurse ensures that a patient’s indwelling urinary catheter drainage tubing is free of kinks?

1. Kinks in the tubing cause the patient unnecessary discomfort.
2. Kinks allow the drainage bag to become overly full.
3. Kinks are associated with the development of urinary tract infection (UTI).
4. Kinks result in scant, dark amber-colored urine.

12. What is the most effective way to prevent infection when providing catheter care for a patient?

1. Properly dispose of soiled linen.
2. Perform hand hygiene before positioning the patient.
3. Secure the catheter to the patient’s leg or abdomen.
4. Cleanse from the meatus outward.

13. Which action would the nurse take to ensure the safety of an older adult patient who has received an enema?

1. Assess for the presence of external hemorrhoids.
2. Provide assistance to the bathroom for expulsion of fluid and stool.
3. Document the patient’s physical response to the enema.
4. Instruct the patient to attempt to retain the fluid for 2 to 5 minutes.

14. The nurse has delegated to nursing assistive personnel (NAP) the skill of assisting with a bedpan for a patient who has had discomfort when walking to the bathroom. Which statement made by the NAP requires the nurse’s follow-up?

1. “Do you still need a stool sample for the lab?”
2. “If I can get someone to help, I’ll walk her to the bathroom.”
3. “The patient reports that moving is uncomfortable for her. Has she had pain medication recently?”
4. “The patient told me that she’s had problems with hemorrhoids in the past.”

15. While performing catheter care, the nurse moves her hand, allowing the patient’s labia to close around the catheter. Why would the nurse repeat this part of the care?

1. The catheter may have traumatized the labia.
2. The labia have contaminated the area.
3. The patient’s perineal area must be reassessed for infection.
4. The nurse must ensure that the catheter is not pulling on the bladder.

16. The nurse is preparing to administer an enema. How can the nurse best facilitate insertion of the rectal tube?

1. Place the patient in a side-lying position with the right knee flexed.
2. Lubricate the first 6 to 8 cm (2.5 to 3 inches) of the tip of the tube.
3. Flush the tube with the solution
4. Hold the tube in the rectum until all of the fluid has been instilled.

17. Which action promotes infection control when assisting a patient with a urinal?

1. Placing a clean urinal on the overbed table
2. Using a waterproof pad to protect the linen from urine spillage
3. Applying gloves before emptying and cleaning the patient’s urinal
4. Asking if the patient would like to clean the genitals after using the urinal

18. When preparing to apply a condom catheter, the nurse would do what first?

1. Close the door and draw the bedside curtain
2. Obtain the patient’s written informed consent
3. Clamp the drainage tubing
4. Offer the patient a urinal

19. A male patient on bed rest is permitted to stand to use the urinal. Which action would the nurse take to ensure his safety before helping him to a standing position?

1. Determine his risk for orthostatic hypotension
2. Assess his genitals for signs of impaired skin integrity
3. Ask him to demonstrate proper use of a urinal
4. Instruct him to use the call light when he is finished

20. The nurse is assisting with a bedpan for a patient who had knee surgery 24 hours ago. What is the best way for the nurse to maximize comfort while the patient uses the bedpan?

1. Raise the knee gatch.
2. Offer a dose of the patient’s prescribed oral pain medication.
3. Evaluate the patient’s ability to move in bed.
4. Elevate the head of the bed to between 30 and 60 degrees.

21. Why would the nurse assess a patient’s abdomen before helping with the use of a urinal?

1. To determine if the patient needs a bed pan for bowel elimination
2. To assess for abdominal pain
3. To assess for bladder distention
4. To determine if the patient will need help using the urinal

22. The nurse is delegating to nursing assistive personnel (NAP) the administration of an enema for an older adult patient who is recovering from a stroke. The enema order reads, “Enemas until clear.” Which statement made by NAP requires the nurse to follow up?

1. “I’ll need help to turn her onto her side.”
2. “It may take three or four enemas to achieve a clear return.”
3. “I’ll test the water temperature on the inside of my own wrist.”
4. “The enema will wear her out, so I’ll wait until after she ambulates.”

23. After assisting with a bedpan, the nurse notes that the patient’s stool is streaked with bright-red blood. What would the nurse do first?

1. Notify the patient’s health care provider.
2. Ask if the patient has a history of hemorrhoids.
3. Check the medical record to see if the patient has a history of blood in the stool.
4. Document the observation in the medical record, indicating a need for follow-up.

24. The nurse has delegated measurement of a patient’s vital signs and catheter care to nursing assistive personnel (NAP). Which observation should the NAP report to the nurse immediately?

1. Rectal temperature of 99.6° F
2. Pulse rate of 88 beats per minute
3. Redness noted on the external urethral meatus
4. 200 mL of pale yellow urine in the drainage bag

25. A dependent, confused patient is being given a bedpan. How can the nurse best ensure the patient’s safety?

1. Respond promptly to the call light.
2. Raise the side rails on the bed before leaving the room.
3. Slide one hand under the patient’s sacrum to help the patient lift off the bedpan.
4. Check in on the patient every 5 minutes until the bedpan can be removed.