Nclexpn Quiz: Ng And Urinary Catheter Care

What this quiz covers

This quiz focuses on Ng And Urinary Catheter Care, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexpn.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Hang the drainage bag on the bed frame below bladder level without allowing it to touch the floor (correct answer)
2. Empty the drainage bag into the toilet to decrease the number of supply items used
3. Disconnect the catheter from the tubing and replace the bag with a new sterile bag
4. Clamp the catheter for 2 hours to allow bladder training

Explanation: This question tests risk reduction in NG and urinary catheter care. The key risk in this scenario is infection from contamination when the drainage bag touches the floor, potentially introducing bacteria. Hanging the drainage bag on the bed frame below bladder level without allowing it to touch the floor effectively reduces the risk by preventing microbial ascent and promoting gravity drainage. Emptying into the toilet (B) risks splashing; disconnecting (C) opens the system; clamping (D) causes stasis. A key principle of catheter care is keeping the bag off the floor and below the bladder to control infection. Another principle is maintaining a closed system for patency and hygiene. A strategy for monitoring includes checking bag position during transfers and assessing urine clarity to detect early contamination.

Question 2

1. Stop the suction and assess respiratory status, then notify the registered nurse or provider per facility policy (correct answer)
2. Irrigate the tube with 30 mL of air to confirm patency
3. Offer sips of water to decrease throat irritation
4. Advance the tube back to the previous marking and re-secure it

Explanation: This question tests risk reduction in NG and urinary catheter care. The key risk in this scenario is aspiration or respiratory distress from nasogastric tube displacement into the airway, indicated by coughing and changed markings. Stopping the suction, assessing respiratory status, and notifying the registered nurse or provider per policy effectively reduces the risk by preventing further harm and ensuring prompt intervention. Irrigating with air (B) is unsafe without confirmation; offering water (C) risks aspiration; advancing the tube (D) could worsen displacement. A key principle of catheter care is verifying placement before use to maintain safety. Another principle is immediate response to signs of displacement to prevent complications. A strategy for monitoring includes checking tube markings and respiratory status every shift to detect early dislodgement.

Question 3

1. Assess the suction equipment and tubing for disconnection or kinks and ensure prescribed suction is functioning (correct answer)
2. Administer an antiemetic medication as needed and reassess in 30 minutes
3. Offer oral fluids to relieve nausea since there is no drainage
4. Remove the nasogastric tube to prevent further discomfort

Explanation: This question tests risk reduction in NG and urinary catheter care. The key risk in this scenario is nasogastric tube malfunction causing nausea and potential aspiration from lack of decompression. Assessing the suction equipment and tubing for disconnection or kinks and ensuring prescribed suction is functioning effectively reduces the risk by restoring drainage. Administering antiemetic (B) treats symptom; offering fluids (C) risks aspiration; removing tube (D) is unauthorized. A key principle of catheter care is equipment checks for patency. Another principle is immediate troubleshooting. A strategy for monitoring includes hourly drainage and symptom assessment to detect malfunctions early.

Question 4

1. Assess the catheter tubing for kinks or obstruction and ensure the bag is below the bladder before notifying the registered nurse (correct answer)
2. Irrigate the catheter with 60 mL normal saline without a prescription
3. Remove the catheter and encourage the client to void in a urinal
4. Increase intravenous fluids to improve urine output

Explanation: This question tests risk reduction in NG and urinary catheter care. The key risk in this scenario is urinary catheter obstruction leading to decreased output and abdominal pressure postoperatively. Assessing the catheter tubing for kinks or obstruction, ensuring the bag is below the bladder, and notifying the registered nurse effectively reduces the risk by promoting flow and escalating care. Irrigating without prescription (B) is unauthorized; removing (C) is premature; increasing fluids (D) doesn't address patency. A key principle of catheter care is checking for mechanical issues to maintain patency. Another principle is collaboration for interventions outside scope. A strategy for monitoring includes hourly output measurement and abdominal assessment to detect retention early.

Question 5

1. Administer the feeding as scheduled and document the residual amount.
2. Flush the tube with 30 mL of warm water and then start the feeding.
3. Re-instill the residual and delay the feeding for one hour. (correct answer)
4. Position the client in a supine position to facilitate digestion.

Explanation: A gastric residual volume of 150 mL combined with the subjective report of bloating indicates that the client is not adequately digesting the previous feeding and the stomach has not emptied. Adding a bolus feeding on top of an already distended stomach increases the risk of aspiration, vomiting, and abdominal discomfort. The aspirate should be re-instilled into the tube before clamping: this preserves electrolytes and digestive enzymes that would be lost if discarded. The feeding is then delayed for approximately one hour, after which gastric residual is re-checked. The nurse should notify the PHCP if residuals remain elevated at the next assessment or if the client develops worsening symptoms. Proceeding with the feeding despite a high residual (A or B) risks aspiration. Supine positioning (D) is contraindicated for tube feedings — the head of the bed should be elevated at least 30 to 45 degrees.

Question 6

1. Use the dominant hand to insert the catheter 2 to 3 inches (5 to 7.5 cm) into the meatus. (correct answer)
2. Release the labia and use the non-dominant hand to lubricate the catheter tip.
3. Ask the client to take a deep breath and bear down while inserting the catheter.
4. Use the non-dominant hand to pick up the sterile catheter from the tray.

Explanation: Once the non-dominant hand has touched the client to maintain labia exposure during cleansing, that hand is considered contaminated and must remain in position — it cannot touch the sterile field, the catheter, or any sterile equipment. The dominant hand, which has not touched the client and remains sterile, is used to pick up the catheter (already lubricated from the kit preparation step) and insert it into the urethral meatus. For female catheterization, the catheter is advanced 2 to 3 inches (5 to 7.5 cm) or until urine returns. Releasing the labia (B) would close the exposure and risk contaminating the insertion site. Using the non-dominant hand to pick up the catheter (D) is a sterile technique violation because that hand is no longer sterile. Bearing down (C) is not standard technique for catheter insertion — deep breathing and relaxation are encouraged.

Question 7

1. Increase the suction setting to high continuous to clear the line.
2. Document the lack of drainage and notify the provider immediately.
3. Irrigate the NG tube with 30 mL of sterile normal saline.
4. Check the tubing for any kinks or dependent loops of fluid. (correct answer)

Explanation: When an NG tube connected to suction produces no drainage, the nurse must systematically troubleshoot from the least invasive step first. Checking for kinks, dependent loops of fluid in the tubing, or disconnections in the system takes only seconds, does not require touching the client's tube, and can immediately identify the most common cause of drainage loss. If no mechanical obstruction is found, the nurse can then irrigate with 30 mL of sterile normal saline (C) to check tube patency. Increasing to high continuous suction (A) without first investigating the cause risks mucosal injury if the tube is against the gastric wall. Notifying the provider (B) is appropriate if simpler troubleshooting steps fail, but checking for kinks must come first.

Question 8

1. The client's age of 62 years.
2. The presence of a three-way indwelling urinary catheter.
3. The light pink color of the drainage earlier in the shift.
4. The report of severe, sharp pain and a strong urge to urinate. (correct answer)

Explanation: Severe, sharp lower abdominal pain combined with a strong urge to urinate in a client with an indwelling catheter are the primary clinical cues of bladder distension from catheter obstruction. These symptoms occur because the bladder continues to fill with irrigation fluid but cannot drain, creating rapid and painful over-distension. When the nurse subsequently confirms absent drainage and palpable bladder distension (at 1005), the cues align into a clear obstruction presentation. The client's age (A) is a demographic factor that increases surgical risk but does not indicate obstruction. Light pink drainage earlier (C) was an expected and reassuring post-TURP finding — a change from this normal baseline toward absent drainage is the alert. The type of catheter (B) explains the clinical setup but is not a finding indicating obstruction.

Question 9

1. Acute kidney injury from fluid volume excess.
2. Development of a systemic blood infection.
3. A localized allergic reaction to the catheter material.
4. Bladder rupture or severe hemorrhage. (correct answer)

Explanation: In continuous bladder irrigation, if the outflow channel is blocked while the inflow channel continues running, the bladder rapidly over-distends with irrigating fluid. In the post-TURP surgical client, this is most commonly caused by a blood clot obstructing the catheter tip. Uncorrected, the over-distension can cause severe bladder spasm, stretch injury to the bladder wall, and — in its most serious form — bladder rupture. In a client with a raw TURP surgical site, the increased intravesical pressure can also disrupt the surgical bed and precipitate significant hemorrhage. This is a urological emergency requiring immediate nursing intervention. Acute kidney injury (A) is a more distal consequence of prolonged obstruction — the immediate risk is at the bladder level, not the kidneys. Allergic reaction to catheter material (C) is not an acute complication of acute obstruction. Systemic bloodstream infection (B) is a longer-term risk of catheterization, not the immediate complication of acute outflow obstruction.

Question 10

1. Perform a manual irrigation of the catheter with sterile normal saline. (correct answer)
2. Slow the rate of the continuous bladder irrigation.
3. Encourage the client to increase his oral fluid intake.
4. Place the client in a prone position to help the drainage flow.

Explanation: Post-TURP catheter obstruction is most commonly caused by a blood clot lodging at the catheter tip or within the drainage channel. Manual irrigation with sterile normal saline using a piston syringe is the definitive intervention to mechanically dislodge and flush the clot, restoring outflow. This is an expected and standard nursing skill in post-TURP care. Slowing the CBI rate (B) slightly reduces the rate of fluid accumulation but does not address the existing clot obstruction — the bladder will continue to distend, just more slowly. Increasing oral fluids (C) is completely counterproductive in an obstructed system — adding more fluid when drainage is blocked worsens distension. Prone positioning (D) has no therapeutic effect on catheter obstruction and is inappropriate for a post-operative client with a fresh surgical site.

Question 11

1. Use clean (non-sterile) tap water for the irrigation.
2. Document the irrigation fluid as part of the client's oral intake.
3. Forcefully push 100 mL of fluid into the catheter to break the clot.
4. Use a sterile 60 mL piston syringe to instill the saline gently. (correct answer)

Explanation: Manual bladder irrigation must be performed using sterile technique to prevent introducing bacteria into a post-surgical urinary tract. A 60 mL piston (Asepto) syringe is the appropriate device — it provides enough volume to flush effectively with controlled, gentle pressure. The saline is instilled slowly and smoothly; resistance should be noted and force should never be used. Non-sterile tap water (A) introduces microbial contamination risk into a sterile closed system. Forceful instillation of 100 mL (C) is highly dangerous in a fresh TURP client: the raw surgical site can be traumatized, suture lines disrupted, and the bladder injured by excessive pressure. Irrigation fluid is documented as irrigation fluid intake and output — not as oral intake (B); these are recorded separately and subtracted from output to calculate net urinary output.

Question 12

1. Tape the NG tube firmly to the client's forehead.
2. Clean the skin around the nose and re-secure the tube daily. (correct answer)
3. Apply a thick layer of petroleum jelly inside the nostrils.
4. Leave the old tape in place for at least one week to avoid irritation.

Explanation: Daily NG tube site care involves cleaning the skin around the naris with soap and water or a prescribed antiseptic, assessing the nasal mucosa for signs of pressure injury or irritation, and re-securing the tube with fresh tape or a commercial tube holder — repositioning the point of skin contact slightly to redistribute pressure. This prevents breakdown of the delicate nasal mucosa and naris that are subject to constant pressure from the tube. Taping to the forehead (A) is not a standard or appropriate site for NG tube securement and would create an unusual tube angle causing mucosal pressure. Petroleum jelly inside the nostrils (C) can degrade tape adhesive, increase aspiration risk if applied excessively, and is not standard site care. Leaving old tape in place for a week (D) allows skin maceration, adhesive buildup, and accumulated pressure injury under the tape.

Question 13

1. Empty the bag for the client in room 205 and tell me the total amount.
2. Go to room 205, empty the catheter bag into a graduated container, and report the volume to me immediately. (correct answer)
3. The client in 205 needs their bag emptied. You've done this before, so just record it in the chart.
4. Please empty all the catheter bags on the unit and let me know if any look dark.

Explanation: Effective delegation requires that the nurse provide the right direction and communication: clear identification of the client and task, specific instructions on how to perform the task correctly, and explicit instructions on when and what to report back. Choice B identifies the specific room, specifies the measurement device (graduated container) to ensure accurate output recording, and establishes an immediate reporting expectation. Choice A lacks the equipment specification and reporting urgency. Choice C relies on assumption of prior knowledge and delegates charting to the UAP — documentation of output must be verified by the nurse, and delegating charting to a UAP without verification is inappropriate. Choice D directs action on multiple clients simultaneously without individualized oversight and uses vague language ('dark') that could result in inconsistent threshold reporting.

Question 14

1. Aspiration of the enteral feeding into the lungs. (correct answer)
2. An expected response to the presence of the NG tube.
3. A localized infection of the nasal passage.
4. The client's need for a higher concentration of formula.

Explanation: A new, frequent cough and decreasing oxygen saturation in a client receiving NG tube feedings are critical warning signs of pulmonary aspiration — entry of feeding formula into the tracheobronchial tree. Aspiration can cause aspiration pneumonia, which is a serious, potentially fatal complication. The nurse must immediately stop the feeding, position the client upright, suction the airway if needed, notify the PHCP, and prepare for further evaluation including chest X-ray. A new, frequent cough is not an expected response to an NG tube (B) — while mild, occasional throat clearing can occur, a frequent productive cough with falling SpO2 is abnormal and clinically significant. A nasal infection (C) would produce localized nasal symptoms (discharge, tenderness) but not new cough and oxygen desaturation. Formula concentration (D) has no relationship to cough or oxygenation status.

Question 15

1. Normal concentrated urine due to low fluid intake.
2. A potential catheter-associated urinary tract infection (CAUTI). (correct answer)
3. An allergic reaction to the antiseptic used during insertion.
4. A standard side effect of having a foreign object in the bladder.

Explanation: Cloudy urine, foul odor, and periurethral burning or itching in a catheterized client constitute a classic presentation of catheter-associated urinary tract infection (CAUTI). These findings occur because bacteria ascending along the catheter surface colonize the bladder, producing pyuria (white cells that cloud the urine) and bacterial metabolites that create the characteristic odor. The nurse must obtain a urine culture specimen and notify the PHCP for evaluation and possible antibiotic therapy. Concentrated urine from low intake (A) is darker yellow but remains clear, not cloudy — cloudiness indicates cellular or bacterial content, not concentration alone. An allergic reaction to insertion antiseptic (C) would present as a local skin reaction at the time of insertion, not days later with urinary changes. While discomfort from catheter presence (D) is real, cloudy foul urine is never a 'standard side effect' and always warrants investigation.

Question 16

1. Encourage the client to walk to help move gastric contents.
2. Unclamp the NG tube and reconnect it to the prescribed suction. (correct answer)
3. Administer a prescribed PRN dose of an antiemetic medication.
4. Document the findings and re-evaluate the client in two hours.

Explanation: Nausea and abdominal distension while the NG tube is clamped indicate that the client is not tolerating the clamped state — gastric motility is insufficient to move contents through the GI tract, and the stomach is accumulating gas and fluid. The appropriate response is to unclamp the tube and restore suction, which will immediately relieve the accumulation and reduce the risk of vomiting and aspiration. The PHCP should also be notified of the client's intolerance to the clamped state. Ambulation (A) may help overall GI motility but will not provide the immediate decompression needed for active nausea and distension. An antiemetic (C) may be appropriate as a comfort measure but does not address the underlying cause — the stomach needs to be decompressed, not just pharmacologically quieted. Waiting two hours (D) creates an unacceptable safety risk for a client with increasing distension who may vomit and aspirate.

Question 17

1. "I will try to drink at least 6 to 8 glasses of water every day."
2. "I should let the nurse know if I have trouble starting to pee."
3. "I will wait until my bladder is very full and painful before I try to go." (correct answer)
4. "I will wipe from the front to the back after I use the bathroom."

Explanation: Waiting until the bladder is 'very full and painful' before voiding indicates a need for further teaching. Clients should be instructed to respond to the urge to void promptly — typically when the bladder contains 150 to 300 mL — rather than suppressing the urge until the bladder is maximally distended. Chronic over-distension weakens the detrusor muscle, can cause temporary post-catheter urinary retention or difficulty voiding, and increases the risk of urinary tract infection. After catheter removal, the nurse monitors for the client's first void within 4 to 6 hours and volume of at least 200 mL. Choices A (adequate hydration), B (reporting voiding difficulty — which could indicate urinary retention after catheter removal), and D (proper perineal hygiene technique) are all correct self-care behaviors that do not require correction.

Question 18

1. The client's level of anxiety during the procedure.
2. The exact time the nurse began setting up the sterile field.
3. The name of the manufacturer of the catheter kit used.
4. The size of the catheter, the amount of fluid in the balloon, and the urine characteristics. (correct answer)

Explanation: Complete documentation for an indwelling urinary catheter insertion must include: the catheter size (French size), which affects future catheter changes and care planning; the volume of sterile water used to inflate the retention balloon, confirming the balloon was properly inflated; and characteristics of the initial urine output — color (straw-colored, yellow, blood-tinged), clarity, and approximate volume — which establishes a baseline for ongoing monitoring. This information provides the clinical data future care providers need to assess catheter function and urine changes over time. While client anxiety (A) may be documented as a brief subjective note, it is not a clinical priority in catheter insertion documentation. Manufacturer name (C) is not clinically relevant documentation. The exact time the sterile field setup began (B) is procedural detail not routinely required — the procedure time and completion are the relevant temporal data points.

Question 19

1. Keep the drainage bag hanging on the bed rail at the level of your hip.
2. Make sure the drainage bag is always kept below the level of your bladder. (correct answer)
3. Clean the area around the catheter with an alcohol swab three times a day.
4. You should drink at least 500 mL of fluid each day to keep the catheter clear.

Explanation: The drainage bag must always be positioned below the level of the bladder to use gravity to keep urine flowing away from the bladder. If the bag is raised above bladder level, urine in the tubing and bag can reflux back into the bladder, introducing bacteria and dramatically increasing CAUTI risk. The bag should never be placed on the floor, but must remain lower than the bladder at all times — whether the client is in bed, sitting in a chair, or ambulating. Placing the bag at hip level (A) may be at or above bladder level when lying in bed. Alcohol swabs (C) are too harsh for the perimeatal tissue and can cause irritation; the site should be cleansed with soap and water. Fluid intake (D) of only 500 mL/day is far too low — adequate hydration for a catheterized client is 1.5 to 2 liters per day to maintain urinary flow and reduce bacterial proliferation, unless fluid restriction is medically ordered.

Question 20

1. Impaired urinary elimination related to mechanical obstruction. (correct answer)
2. Risk for infection related to the indwelling catheter.
3. Acute pain related to the surgical procedure.
4. Deficient knowledge related to post-operative expectations.

Explanation: Impaired urinary elimination related to mechanical obstruction is the priority hypothesis because it represents the most immediate physiological threat: the bladder is actively distending with fluid that cannot exit, creating risk of tissue injury, hemorrhage, and bladder rupture. Every nursing action at this point is directed at relieving the obstruction and restoring drainage. Risk for infection (B) is a valid ongoing concern for any catheterized client but is not the acute emergency here — infection develops over time, not in the current moment. Acute pain (C) is a real and present finding, but it is a symptom of the obstruction — addressing the obstruction will resolve the pain. Addressing pain independently while leaving the obstruction in place does not eliminate the safety risk. Deficient knowledge (D) is an educational concern for the discharge planning phase, not the acute crisis.