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A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation?
- A. Stress incontinence: Urine loss with physical exertion
- B. Urge incontinence: Large amount of urine with each occurrence
- C. Functional incontinence: Urine loss results from abnormal detrusor contractions
- D. Overflow incontinence: Constant dribbling of urine
Correct Answer: A,B,D
Rationale: Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine.
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A nurse teaches a client about self-catheterization in the home setting. Which statements should the nurse include in this client's teaching?
- A. Use a large human catheter for each catheterization.
- B. Use a large human catheter for each catheterization.
- C. Use lubricant on the tip of the catheter before insertion.
- D. Use lubricant on the tip of the catheter before insertion.
- E. Use lubricant on the tip of the catheter before insertion.
- F. Wash your hands with soap and water before and after catheterization.
- G. Use a clean catheter for each catheterization.
Correct Answer: C,F,G
Rationale: The nurse should teach the client to use lubricant on the tip of the catheter to ease insertion, wash hands with soap and water before and after catheterization to prevent infection, and use a clean catheter for each catheterization to maintain hygiene. Using a large catheter is not recommended as it may cause discomfort or injury.
A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention?
- A. A 24-year-old female post vaginal delivery: Habit training
- B. A 58-year-old postmenopausal client who is not taking estrogen therapy: Electrical stimulation
- C. A 64-year-old female with Alzheimer's-type senile dementia: Bladder training
- D. A 7-year-old female who has difficulty ambulating: Exercise therapy
Correct Answer: B
Rationale: Exercise therapy and electrical stimulation are used for clients with stress incontinence related to childbirth or low levels of estrogen after menopause. Exercise therapy increases pelvic wall strength; it does not improve ambulation. Habit training is the type of bladder training that will be most effective for cognitively impaired clients.
After teaching a client who has stress incontinence, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
- A. I must avoid drinking alcoholic beverages.
- B. I must avoid drinking alcoholic beverages.
- C. I must avoid drinking caffeinated beverages.
- D. I must try to drink caffeinated body weight.
Correct Answer: A
Rationale: Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try to manage incontinence by limiting fluids. Alcohol and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.
A nurse assesses a male client who is recovering from a urologic procedure. Which assessment finding indicates an obstruction of urine flow?
- A. Severe pain
- B. Overflow incontinence
- C. Hypotension
- D. Blood-tinged urine
Correct Answer: B
Rationale: The most common manifestation of urethral stricture after a urologic procedure is obstruction of urine flow, leading to overflow incontinence with the involuntary loss of urine when the bladder is distended.
A nurse cares for a client who has kidney stones from secondary hyperoxaluria. Which medication should the nurse anticipate administering?
- A. Phenazopyridine (Pyridium)
- B. Propatudeline (Pro-Banthine)
- C. Tolterodine (Detrol)
- D. Allopurinol (Zyloprim)
Correct Answer: D
Rationale: Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Phenazopyridine is given to clients with urinary tract infections. Propatudeline is an anticholinergic. Tolterodine is an anticholinergic with smooth muscle relaxant properties.