Nurse-initiated Urinary Catheter Removal (Quiz)

1.

A patient is admitted to the hospital for a fall. A urinary catheter was placed in the ED for immobilization/pre-surgery. The x-ray reveals that there is no fracture and surgery is not required. Is there still an indication for the urinary catheter?

Yes

No

Rationale: No. Immobilization pre-surgery with fracture/trauma has been ruled out and the urinary catheter is no longer indicated.

Explanation

Rationale: No. Immobilization pre-surgery with fracture/trauma has been ruled out and the urinary catheter is no longer indicated.

2.

How often should you evaluate the need of your patient's urinary catheter?

Every shift

Every day

Every other day

Once a week

Rationale: a. Every shift. The patient’s need for a urinary catheter should be evaluated at least once a shift.

Explanation

Rationale: a. Every shift. The patient’s need for a urinary catheter should be evaluated at least once a shift.

3.

Which patient meets an indication for a urinary catheter?

A. Patient in ICU admitted for septic shock

B. Patient with a hip fracture going to surgery

C. Patient who had surgery

D. Patient on end of life care

E. All of the above

Rationale: e. All of the above. A patient admitted for septic shock would require strict I&O in the ICU, which is appropriate. A patient immobilized for a hip fracture/trauma is also indicated. Post-operative patients with catheters are also acceptable. And a patient on end of life care meets criteria for a urinary catheter.

Explanation

Rationale: e. All of the above. A patient admitted for septic shock would require strict I&O in the ICU, which is appropriate. A patient immobilized for a hip fracture/trauma is also indicated. Post-operative patients with catheters are also acceptable. And a patient on end of life care meets criteria for a urinary catheter.

4.

A patient is transferred from ICU to a Med/Surg unit with a urinary catheter still in place. The indication for the urinary catheter is documented as "ICU ONLY: Strict I&O". Does this still apply to the patient after the transfer to Med/Surg?

Yes

No

Rationale: No. The indication “strict I&O” can only be applied to critically ill patients in critical care ICU.

Explanation

Rationale: No. The indication “strict I&O” can only be applied to critically ill patients in critical care ICU.

5.

If a criterion for catherterization is not met for a patient, the RN may remove the urinary catheter without a MD/NP order.

True

False

Rationale: a. True. As part of the Nurse-Initiated Urinary Catheter Removal Standardized Procedure, a RN will assess the patient’s indication for urinary catheter using the criteria. If an appropriate indication is NOT MET, the RN may remove the catheter without a MD/NP order (except post-op patients and patients undergoing urological treatment).

Explanation

Rationale: a. True. As part of the Nurse-Initiated Urinary Catheter Removal Standardized Procedure, a RN will assess the patient’s indication for urinary catheter using the criteria. If an appropriate indication is NOT MET, the RN may remove the catheter without a MD/NP order (except post-op patients and patients undergoing urological treatment).

6.

A patient is admitted with a Stage II pressure ulcer on their buttocks. Does this patient meet criteria for a urinary catheter?

Yes

No

Rationale: No. The indication for urinary catheter is a Stage III or IV pressure ulcer with incontinence.

Explanation

Rationale: No. The indication for urinary catheter is a Stage III or IV pressure ulcer with incontinence.

7.

When is it NOT appropriate to discontinue a urinary catheter without a MD/NP order:

A. Urinary catheter was placed in ICU

B. Urinary catheter was placed by urologist

C. Urinary catheter was placed in ED

D. It is never appropriate to discontinue urinary catheter without a MD/NP order

Rationale: b. Urinary catheter was placed by urologist. If urinary catheter was placed by a urologist, DO NOT REMOVE without a MD/NP order.

Explanation

Rationale: b. Urinary catheter was placed by urologist. If urinary catheter was placed by a urologist, DO NOT REMOVE without a MD/NP order.

8.

If a patient's urine output is less than 240mL in 8 hours, what is the most appropriate thing to do?

A. Notify the MD/NP

B. Monitor and endorse to next shift

C. Encourage fluids for patient

D. Do nothing because urine output < 240mL is normal

Rationale: a. Notify the MD/NP. Urine output

Explanation

Rationale: a. Notify the MD/NP. Urine output

9.

A patient's urinary catheter was removed after surgery. The patient hadn't voided in 8hrs, so the nurse bladder scans the patient. The bladder scan shows 950mL. The nurse should:

A. Notify the MD/NP and ask for re-insertion of urinary catheter

C. Initiate bladder protocol (see policy)

D. Re-scan the patient’s bladder in an hour

Rationale: C. Initiate bladder protocol. It is not necessary to call the MD/NP anymore to obtain order for bladder protocol, as it may be initiated by the RN when bladder scan amount is greater than or equal to 240mL.

Explanation

Rationale: C. Initiate bladder protocol. It is not necessary to call the MD/NP anymore to obtain order for bladder protocol, as it may be initiated by the RN when bladder scan amount is greater than or equal to 240mL.