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A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding?
- A. Use a slipper bedpan.
- B. Apply a cold compress to the perineum.
- C. Have the patient lie in a supine position.
- D. Provide privacy for the patient.
Correct Answer: D
Rationale: Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the patient with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.
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A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the patients cardiopulmonary status is stable, what aspect of care should the nurse prioritize?
- A. IV fluid administration
- B. Insertion of an indwelling urinary catheter
- C. Pain management
- D. Assisting with aspiration of the stone
Correct Answer: C
Rationale: The patient with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the patients need for IV fluids or for catheterization. Kidney stones cannot be aspirated.
A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?
- A. Stress incontinence
- B. Reflex incontinence
- C. Overflow incontinence
- D. Functional incontinence
Correct Answer: A
Rationale: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to reach the toilet in time for voiding.
A nurses colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurses management of urinary incontinence in older adults?
- A. Diuretics should be promptly discontinued when an older adult experiences incontinence.
- B. Restricting fluid intake is recommended for older adults experiencing incontinence.
- C. Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence.
- D. Urinary incontinence is not considered a normal consequence of aging.
Correct Answer: D
Rationale: Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.
A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment?
- A. Clearly explain the potential benefits of pelvic floor muscle exercises.
- B. Ensure the patient knows that surgery will be required if the exercises are unsuccessful.
- C. Arrange for biofeedback when the patient is learning to perform the exercises.
- D. Contact the patient weekly to ensure that she is performing the exercises consistently.
Correct Answer: C
Rationale: Research shows that written or verbal instruction alone is usually inadequate to teach an individual how to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted pelvic muscle exercise (PME) uses either electromyography or manometry to help the individual identify the pelvic muscles as he or she attempts to learn which muscle group is involved when performing PME. This objective assessment is likely superior to weekly contact with the patient. Surgery is not necessarily indicated if behavioral techniques are unsuccessful.
The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patients bladder?
- A. Insertion of a suprapubic catheter
- B. Scheduling the patient immediately for a prostatectomy
- C. Application of warm compresses to the perineum to assist with relaxation
- D. Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours
Correct Answer: A
Rationale: When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.