Which of the following actions by the nurse would indicate the need fo

Which of the following actions by the nurse would indicate the need for remedial education in the removal of an indwelling catheter?

1. Draping the female client between the thighs
2. Obtaining a specimen before removal
3. Cutting the catheter to deflate the balloon
4. Checking the client’s output for 24 hours after removal

ANSWER

ANS: 3
The nurse should not cut the catheter to deflate the balloon. The nurse inserts an empty, sterile syringe into the injection port. The nurse slowly withdraws all of the solution to deflate the bal-loon totally. The nurse then pulls the catheter out smoothly and slowly. The nurse positions the client in the same position as during catheterization. The nurse places a towel between a female client’s thighs or over a male client’s thighs. Some institutions recommend collecting a sterile urine specimen before removal of the catheter or sending the catheter tip for culture and sensitiv-ity tests. The nurse should assess the client’s urinary function by noting the first voiding after catheter removal and documenting the time.