CNA Basic Nursing Skills 13 2 — Questions and Answers

Question 1: When caring for a patient with a urinary catheter, the drainage bag should ALWAYS be positioned:

At the level of the bladder for best drainage
Above the level of the bladder to prevent siphoning
Below the level of the bladder and off the floor (Correct answer)
On the bed mattress alongside the patient

Correct answer: Below the level of the bladder and off the floor

The drainage bag must be kept below the bladder so gravity promotes drainage, but above the floor to prevent contamination and backflow from the bag into the bladder.

Proper urinary catheter drainage bag positioning uses gravity to continuously drain urine from the bladder through the catheter tubing into the bag. The bag must remain consistently below the level of the bladder (usually the level of the patient's symphysis pubis) to prevent urine from flowing back (reflux) into the bladder, which introduces bacteria and causes urinary tract infections (UTIs). The bag must never touch the floor because floor surfaces are contaminated. When transporting a patient, the bag must be kept below bladder level throughout — never held up during transfers.

Question 2: A patient with an indwelling urinary catheter develops a fever, lower abdominal pain, and cloudy urine. These signs suggest:

Normal adjustment to the catheter during the first week
A possible catheter-associated urinary tract infection (CAUTI) (Correct answer)
The catheter is too large for the patient's urethra
Dehydration due to insufficient oral fluid intake

Correct answer: A possible catheter-associated urinary tract infection (CAUTI)

Fever, lower abdominal or flank pain, and cloudy or foul-smelling urine are classic signs of catheter-associated urinary tract infection (CAUTI) and must be reported to the nurse immediately.

CAUTI (catheter-associated urinary tract infection) is one of the most common hospital-acquired infections. Risk increases with catheter duration. Signs and symptoms include: fever, chills, lower abdominal or suprapubic pain, back/flank pain (suggests kidney involvement), cloudy or bloody urine, foul odor, and burning sensation in patients who can sense urethral discomfort. The CNA must immediately report these findings to the charge nurse so a urine culture can be ordered and antibiotic treatment initiated. Prevention includes: maintaining closed drainage system, keeping bag below bladder level, daily catheter hygiene, and advocating for prompt catheter removal when no longer clinically necessary.

Question 3: How should the CNA perform catheter care to prevent infection?

Scrub the catheter vigorously with a circular motion moving toward the body
Wash the catheter from the insertion site outward with mild soap and water in a single stroke (Correct answer)
Apply antibacterial powder around the urethral meatus daily
Clean only the exposed part of the catheter once weekly

Correct answer: Wash the catheter from the insertion site outward with mild soap and water in a single stroke

Catheter care involves cleaning from the urethral meatus outward (away from the body) to prevent drawing bacteria toward the insertion site.

The correct catheter hygiene technique during perineal care: (1) use warm water with mild soap, (2) begin at the urethral meatus and clean in one direction — outward along the catheter for approximately 4 inches, (3) use a fresh cleaning area for each stroke, (4) never move the cleaning cloth back toward the meatus (would deposit bacteria at the insertion site). This technique minimizes colonization at the catheter insertion point, which is the primary entry route for pathogens that travel up the catheter to cause CAUTI. Catheter care is typically performed daily and after every bowel movement.

Question 4: A patient's urinary catheter tubing becomes kinked and urine output decreases. What should the CNA do?

Leave it since reduced output is expected overnight
Irrigate the catheter to restore flow
Straighten the tubing, check for other obstructions, and notify the nurse if output does not improve (Correct answer)
Clamp the catheter temporarily

Correct answer: Straighten the tubing, check for other obstructions, and notify the nurse if output does not improve

A kinked catheter tube prevents drainage and can cause bladder distension. The CNA should straighten the tubing first and notify the nurse if the problem persists.

Catheter tubing kinks are a mechanical cause of decreased urine output that the CNA can immediately address by straightening tubing along its length and ensuring it is not caught under the patient, side rail, or bed frame. After straightening, output should resume within a few minutes. If output remains diminished, the CNA should report to the nurse, who will assess for other causes: catheter obstruction from sediment or mucus, bladder spasm, catheter displacement, or reduced fluid intake. The CNA should never irrigate a catheter (outside scope of practice) or clamp the tubing without a specific order.

Question 5: When emptying a urinary catheter drainage bag, the CNA should:

Allow the drainage port to contact the measuring container
Empty into a measuring container, record the output, and clean the drainage port with an alcohol wipe before recapping (Correct answer)
Drain directly into the toilet without measuring if the patient is stable
Leave the drainage port open briefly to air-dry after emptying

Correct answer: Empty into a measuring container, record the output, and clean the drainage port with an alcohol wipe before recapping

Emptying into a measuring container allows accurate intake/output documentation; cleaning the drainage port with alcohol and recapping maintains the closed sterile system.

Accurate urinary output measurement is critical for fluid balance monitoring. The CNA should: wear gloves, position a graduated measuring container under the drainage port, open the port and allow complete drainage, close the port without allowing it to contact the container or any surface, wipe the port with an alcohol swab before replacing the cap, and record the output amount, color, and any abnormalities in the intake/output record. The closed drainage system must be maintained — any break in the system (disconnection, open port left uncapped) immediately introduces bacteria. Output should be measured and recorded at minimum every shift and more frequently if ordered.

Question 6: Which finding in a catheterized patient requires IMMEDIATE reporting to the charge nurse?

Light yellow urine output of 45 mL per hour
No urine output for 2 hours despite no obstructions in the tubing (Correct answer)
Slightly darker urine color in the morning
Urine output slightly less than fluid intake

Correct answer: No urine output for 2 hours despite no obstructions in the tubing

No urinary output for 2 hours in a catheterized patient with no tubing obstruction indicates possible urinary blockage, catheter displacement, or acute kidney injury and requires immediate assessment.

Normal urinary output for an adult is approximately 30 mL per hour at minimum. For a catheterized patient, the CNA can directly see output in the drainage bag and tubing. Zero output for 2 hours after ruling out tubing kinks or bag positioning problems is an urgent finding. Possible causes: catheter has slipped out of the bladder (balloon deflated or catheter dislodged), catheter is obstructed by sediment/clots, the patient is in urinary retention despite the catheter, or acute kidney injury with decreased urine production. The nurse must assess immediately and may need to check catheter placement, flush the catheter, or contact the physician.

CNA Basic Nursing Skills 13 2

When caring for a patient with a urinary catheter, the drainage bag should ALWAYS be positioned: