RN Nursing · Renal and Urinary Assessment · Practice question
A client is admitted to the emergency department after a fall from a horse, and the primary health care provider (PHCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse would take which action?
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✓
Notify the PHCP before performing the catheterization.
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Use a small-sized catheter and an anesthetic gel as a lubricant.
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Administer parenteral pain medication before inserting the catheter.
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Clean the meatus with soap and water before opening the catheterization kit.
Answer & explanation
Correct: Notify the PHCP before performing the catheterization.
Blood at the urinary meatus following significant trauma — in this case a fall from a horse — is a critical sign that strongly suggests urethral injury. Inserting a urinary catheter through a disrupted urethra can worsen the tear, convert a partial tear into a complete rupture, create false passages, or introduce infection into an already compromised structure. Therefore, the nurse must stop the procedure and notify the primary health care provider before any catheterization is attempted. The provider will likely order a retrograde urethrogram to evaluate urethral integrity before catheter insertion is considered. Using a smaller catheter or anesthetic gel does not eliminate the risk of worsening a urethral injury and is not an appropriate independent nursing response to this finding. Administering parenteral pain medication addresses comfort but does not resolve the safety concern presented by blood at the meatus. Cleaning the meatus with soap and water is a standard pre-procedure step but is irrelevant and insufficient when there is evidence of potential urethral trauma. The priority nursing action is to recognize this as a contraindication signal and communicate immediately with the prescribing provider.
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