Module 5.2 B- bladder incontinence and retention

The nurse preceptor is reviewing the plan of care for a patient with urinary incontinence created by a graduate nurse. Which dietary intervention submitted by the graduate nurse should the preceptor correct? A. Restricting fluid intake B. Avoiding bladder irritants C. Altering nutrition to maintain a healthy weight D. Promoting a diet that is high in fiber

A The care plan for the patient with urinary incontinence should include nutrition that maintains a healthy weight; a high-fiber diet to prevent constipation; avoidance of bladder irritants such as alcohol, caffeine, acidic food, and spicy food; and maintenance of adequate fluid intake. Adequate fluid intake is vital to promote hydration and urinary function. Overly concentrated urine can irritate the bladder, increasing incontinence.

The nurse is discussing nonpharmacological treatments with the patient who has urinary incontinence. Which information in the patient's history would indicate that the use of a pessary could benefit this patient? A. Spinal cord injury B. History of multiparity C. Benign prostatic hypertrophy D. Functional incontinence

B A pessary is a stiff ring that is inserted into the vagina to hold up the uterus or bladder and rectum. It is a firm ring that presses against the wall of the vagina and urethra to help decrease urine leakage. It is used in patients with a history of uterine prolapse, such as a women who have given birth to many children (multiparity). The treatment for functional incontinence is timed voiding. This would be used in a patient with mobility issues or dementia. Benign prostatic hypertrophy is treated with surgery to remove excess prostate tissue. Incontinence related to spinal cord injuries involves catheterization and/or medications. Complementary and alternative medicine approaches to treat urinary incontinence include: - Kegel exercises. - Vaginal cones. - Biofeedback. - Timed voiding. - Bladder training. - Pessary. - Incontinence briefs.

The nurse is caring for a patient who reports urine leakage with laughter and coughing. Which is an appropriate assessment for the nurse to perform? ANSWER A. Capillary refill B. Bulging of the bladder into the vagina when bearing down C. Lung sounds D. Bilateral strength the inner thigh muscles

B Assessment for bulging of the bladder into the vagina when bearing down aligns with assessment for continence. The inner thigh muscles, lung sounds, and capillary refill are not items that indicate urinary incontinence. Health history to be obtained include: - Chronic disease. - Surgical history. Signs and symptoms of urinary incontinence include: - Odor of urine. - Soiled clothing. - Use of incontinence products. - Anxiety in locating a toilet. - Frequent bathroom breaks. Voiding diary includes: - Frequency of urination. - Volume of urine output. - Activities associated with incontinence. Methods used to deal with incontinence include: - Use of pelvic floor exercises. - Use of medications. - Complementary health approaches. Effects of incontinence or retention include: - Daily activity. - Social activity.

The nurse is caring for an older adult patient in a long-term care setting. The patient's family states, "With our mother's recent memory lapses, we are concerned about her recent urinary accidents." Which statement by the nurse best addresses the patient's risk for urinary incontinence? A. "There are medications we can give your mother." B. "We can institute scheduled toileting for your mother." C. "We can insert a urinary catheter." D. "We can get your mother a wheeled walker to help in getting to the bathroom."

B Dementia is a risk factor for urinary incontinence, because the patient may not have the cognitive ability to reach the bathroom in time. Therefore, timed voiding would be the least invasive and best way to prevent incontinent episodes. An internal catheter would increase the risk for infection. Medications may increase confusion. A person with dementia may not have impaired ambulation; this would be best for a patient with functional incontinence due to impaired mobility. Following are risk factors for urinary retention and incontinence in the older adult. Urinary retention: - Chronic disease. - Polypharmacy. Urinary incontinence: - Obesity. - Limited mobility. - Impaired vision. - Dementia. - Lack of bathroom access. - Privacy.

The nurse is caring for a bedbound female patient. Which intervention should the nurse implement to support voiding and avoid urine retention in the female patient? A. Providing a urinal B. Elevating the head of the bed C. Remaining at the bedside during voiding D. Cooling the bedpan

B Elevating the head of the bed allows the patient to sit in a more natural position. A urinal would be provided to the male patient. Providing privacy for the patient and warming the bedpan help to promote voiding. Positioning involves: - Encourage pushing over the pubic area with the hands. - Encourage leaning forward to increase intra-abdominal pressure and external pressure on the bladder. - Use a bedside commode for women. - Use a urinal for men at the bedside. - Assist to a normal position for voiding. - Standing for males - Squatting or leaning slightly forward when sitting for the female Relaxation involves: - Suggest reading or listening to music. - Provide privacy. - Allow sufficient time to void. - Pour warm water over the perineum. - Sit in a warm bath to promote muscle relaxation. - Apply a hot water bottle to the lower abdomen. - Turn on running water. - Provide ordered analgesics and emotional support. Timing involves: - Assist to void immediately. - Offer toileting assistance to the patient at usual times of voiding. For patients who are confined to bed, it is important to: - Warm the bedpan. - Elevate the head of the bed. - Place a small pillow or rolled towel at the lower back. - Flex the hips and knees in the female.

The nurse is caring for a patient who performs self-catheterization for urinary retention. Which assessment finding indicates a potential complication related to the care of this patient? A. Intake of 3 L of fluids per day B. Fever C. Complete emptying of bladder D. Increased intake of caffeine

B Fever is an indication that there may be a urinary tract infection from urinary catheterization. Fluid intake of 2.5 to 3 L per day promotes normal urine production and voiding. Self-catheterization should result in complete bladder emptying. Caffeine intake may lead to bladder irritation but is not a complication of self-catheterization. The patient performing self-catheterization may experience the complications of urine retention and urinary tract infection (UTI). Manifestations for urine retention include: - Abdominal pain. - Lack of urine flow in collection bag. Manifestations for UTI include: - Malodorous urine. - Abdominal pain. - Fever. - Confusion.

A patient presents to the nurse with complaints of urine leakage with constipation. Which dietary change should the nurse advise to the patient to help diminish urinary incontinence? A. Increasing spicy food B. Increasing fiber C. Increasing caffeine D. Increasing alcohol

B Increasing fiber will combat constipation, helping to prevent stress incontinence. Caffeine, alcohol, and spicy food all contribute to irritation of the bladder, which would promote urinary incontinence. Dietary considerations for urinary incontinence include: - A nutritious diet to support a healthy weight or weight loss if overweight. - Increasing fiber to prevent constipation. - Avoidance of bladder irritants: caffeine, alcohol, spicy food, acidic food. - Adequate fluid intake.

The nurse is teaching the parents of a preschool-age child about the causes of nocturnal enuresis. Which statement is appropriate for the nurse to include in the teaching session with the parents? A. "Your child knows she can get away with this and is just being lazy." B. "Many children wet the bed due to difficulties in arousal from sleep." C. "It is common for children to develop incontinence when stressed." D. "Bedwetting is more common in girls than in boys."

B Nocturnal enuresis is especially prevalent in children who are reported to be deep sleepers, although it can occur at any stage of sleep, and occurs more often in boys. It can also be the result of overproduction of urine at night, and constipation. There is no indication that nocturnal enuresis is caused by the child being too lazy to get out of bed at night to urinate. Stress may play a role in incontinence in pregnant and older adults but not in preschool-aged children. Secondary nocturnal enuresis can be related to stress. Childhood urinary incontinence may not be diagnosed as problematic until after age 6. There is a variety of causes, including: - Bladder irritability. - Weak detrusor muscle. - Constipation. - Structural abnormalities. - Sexual abuse. - Urinary tract infection. - Infrequent voiding. - Illness (e.g., diabetes mellitus). - Stress or emotional trauma.

The nurse is caring for a patient with urinary incontinence related to a urinary tract infection. Which diagnostic test would indicate if a urinary tract infection is contributing to urinary incontinence? A. Bladder diary B. Urinalysis C. 24-hour urine sample D. Post-void residual

B Urinalysis is used to diagnose the presence of a urinary tract infection which contributes to the occurrence of urinary incontinence. A bladder diary helps to diagnose the patient's type of incontinence. A 24-hour urine sample provides information on kidney and bladder function. Post-void residual reveals retention of urine for further investigation of cause.

A patient reports the persistent urgency to urinate. Which classification of drug should the nurse anticipate being ordered for this patient? A. Cholinergic agent B. Anti-flatulence agent C. Anticholinergic agent D. Diuretic

C Anticholinergic agents are used to reduce urgency and frequency by inhibiting bladder contractions and increasing bladder capacity. Cholinergic agents are used to stimulate bladder contractions and facilitate voiding. Diuretics are used to increase fluid excretion and prevent fluid reabsorption. Anti-flatulence agents are used to coalesce gas bubbles and facilitate the passage of gas.

The nurse notes the need for scheduled toileting on a patient's plan of care. For which patient is the nurse caring? ANSWER A. Patient with a urinary tract infection B. Patient with renal calculi C. Patient with dementia who has developed functional incontinence D. Patient with renal failure

C Dementia is a risk factor for urinary incontinence because the patient may not have the cognitive ability to reach the bathroom in time. Therefore, scheduled toileting would be the least invasive and best way to prevent incontinent episodes.

A patient reports urine leakage. The nurse notes the following medical history: obesity, ambulation difficulty, smoking, and hypertension treated with diuretics. Which lifestyle intervention should the nurse suggest to the patient to reduce urinary incontinence? A. Stopping all diuretics B. Switching from cigarette smoking to chewing tobacco C. Reducing physical barriers to toileting D. Decreasing activity

C Reducing physical barriers to toileting promotes a safe path to the bathroom for use of the toilet. Regular exercise supports weight loss. Tobacco cessation would be indicated. A medication review helps to identify contributing factors, but stopping medications would not be instructed without healthcare provider input. Lifestyle considerations for urinary incontinence include: - Regular exercise. - Tobacco cessation. - Medication review. - Reducing physical barriers to toileting.

A patient is admitted to a clinic with urinary retention caused by a mechanical obstruction. The nurse should suspect which condition as the likely cause of the patient's condition? A. Benign prostatic hyperplasia B. Fecal impaction C. Repeated urinary tract infections D. Anticholinergic medications

C Repeated urinary tract infections lead to scarring of structure, which is a functional problem associated with urinary retention. Either mechanical obstruction of the bladder outlet or a functional problem can cause urinary retention. Scarring caused by repeated UTIs subsequently leads to urethral stricture and produces mechanical obstruction. Benign prostatic hypertrophy and fecal impaction are the causes of an obstruction that will lead to urinary retention. Anticholinergic medications may cause retention, but this is not a functional problem. Once the medication is stopped, the urinary retention resolves.

The nurse is evaluating a patient with stress incontinence due to weak pelvic floor muscles who continues to experience leakage. Which question should the nurse ask to investigate ongoing stress incontinence? A. "Are you having trouble ambulating?" B. "Have you decreased your fluid intake?" C. "Have you been performing Kegel exercises?" D. "Have you increased your fiber intake?"

C The nurse would investigate the use of Kegel exercises to strengthen the pelvic floor muscles in the patient with stress incontinence. Fluid intake would be investigated if timing with fluid intake and amount were the cause of incontinence. Fiber intake would be investigated in a patient with constipation. Ambulation issues would be indicated in the person with functional decline.

The nurse is caring for a patient diagnosed with urinary retention. Which medication on the patient's medical administration record should the nurse question? A. Bethanechol chloride B. Acetaminophen C. Diphenhydramine hydrochloride D. Ibuprofen

C The nurse would question the use of an antihistamine, such as diphenhydramine hydrochloride, for a patient with urinary retention. These medications can affect the autonomic nervous system and interfere with the normal urination process. Bethanechol chloride is a medication used to treat urinary retention. Acetaminophen and ibuprofen can be administered safely for a patient with urinary retention. Risk factors for urinary incontinence include: - Epidural analgesia. - High birth weight. - Emergency cesarean delivery. - Prolonged operative time.

A patient reports feeling as if their bladder is always full, requiring frequent trips to the bathroom. The patient also reports difficulty starting their urine stream and a weak urine flow. After a post-voiding catheterization obtained 250 mL of urine, the patient was diagnosed with chronic urinary retention. Which clinical therapy should the nurse anticipate being ordered? A. Lithotripsy B. A vaginal device C. Urethral dilation D. Radiation therapy

C Urethral dilation is often performed to aid in complete emptying of the bladder. Radiation therapy is used to treat cancers of the urinary system. Lithotripsy is used to reduce kidney stones. Vaginal devices are used to prevent the involuntary leakage of urine. Anticholinergics are contraindicated in patients with urinary retention, gastrointestinal motility problems, or uncontrolled narrow-angle glaucoma. Anticholinergic drugs affect the autonomic nervous system and interfere with the normal urination process. This leads to the retention of urine.

Which factor should the nurse consider as a contributing cause of urinary incontinence in older adult patients? A. Urine concentration B. Micturition C. Impaired mobility D. Internal sphincter

C Urinary incontinence in the older adult may be caused by impaired mobility, impaired vision, dementia, and lack of access to toileting facilities and privacy. Urine concentration, micturition, and the internal sphincter are not causes of urinary incontinence. Following are age-related factors for incontinence: CHILDREN - Due to age of toilet-training, not diagnosed as problematic until after age 6. - Bladder irritability. - Weak detrusor muscle. - Constipation. - Structural abnormalities. - Sexual abuse. - UTI. - Infrequent voiding. ADULTS - Pregnancy - Hormonal changes. - Uterine pressure. - Older adults - Limited mobility. - Impaired vision. - Dementia. - Lack of access to toileting facilities. - Privacy. Following are age-related factors for retention: CHILDREN - Congenital structural abnormalities. - Postsurgical complications. ADULTS - Pregnancy - Post-delivery. - Epidural analgesia. - Older adults - Chronic diseases. - Polypharmacy. - Postoperative complications. - Men: benign prostatic hypertrophy.

The labor and delivery nurse is caring for the postpartum mother. Which risk factor places the pregnant and postpartum female at an increased risk for urinary retention? A. Vaginal delivery B. Short course of anesthesia C. Use of analgesia D. Low birth weight

C Use of analgesia with childbirth is a risk factor for urinary retention. A cesarean, not vaginal, delivery, places the mother at higher risk as well as higher birth weight, and a longer operative time with anesthesia. Risk factors for urinary incontinence for a pregnant patient include: - Epidural analgesia. - High birth weight. - Emergency cesarean delivery. - Prolonged operative time. - Postoperative analgesia.

The nurse is assessing a patient with a history of urinary retention who is diagnosed with a urinary tract infection. When reviewing the patient's health history, which finding would most likely be the causative agent? A. Alzheimer disease B. Decreased functional mobility C. Lack of performing Kegel exercises D. Intermittent self-catheterization

D A patient performing intermittent self-catheterization would be at high risk for the development of a urinary tract infection due to the introduction of a foreign object into the sterile urinary tract. Lack of performing Kegel exercises, difficulty ambulating, and Alzheimer disease cause urinary incontinence, not retention and infection. The patient performing self-catheterization may experience the complications of urine retention and urinary tract infection (UTI). Manifestations for urine retention include: - Abdominal pain. - Lack of urine flow in collection bag. Manifestations for UTI include: - Malodorous urine. - Abdominal pain. - Fever. - Confusion.

An 82-year-old female patient is admitted to a long-term care facility because the family found it too difficult to perform care in the home to meet toileting needs. Which nursing action is appropriate when providing care for the patient? A. Reviewing the patient's daily medications and holding those that cause diuresis B. Limiting the patient's fluid intake to less than 1.5 L per day to reduce the number of times she will need to void C. Performing intermittent catheterization on a schedule to keep the patient's clothing and skin dry D. Assessing the patient for physical and mental abilities and limitations, usual voiding pattern, and ability to assist with toileting

D Assessing the patient for physical and mental abilities, usual voiding pattern, and ability to assist with toileting will assist in planning their care. Holding medications that cause diuresis may cause the patient to develop additional health problems with the renal or cardiovascular systems. Performing intermittent catheterization on a routine basis increases the chance for infection. Reducing fluid intake to less than 1.5 L can cause irritation of the bladder due to urine concentration and increase incontinence.

The nurse is caring for a patient with urinary incontinence who has been prescribed bladder-training behavior modification. Which goal of therapy should the nurse include in the teaching session with the patient? A. To improve pelvic floor muscle strength by stopping the urine flow during voiding and holding for a few seconds B. To toilet on a schedule that corresponds with the normal pattern C. To toilet at regular intervals (e.g., every 2-4 hours) D. To gradually increase the bladder capacity by increasing the intervals between voiding and resisting the urge to void between scheduled times

D Bladder training increases the bladder capacity by increasing the intervals between voiding and resisting the urge to void between scheduled times. Habit training is toileting on a schedule that corresponds with the normal pattern. Scheduled voiding is toileting at regular intervals. Kegel exercise is a technique that is done to strengthen the pelvic floor muscles. Patient teaching for urinary incontinence include: - Timed voiding schedule. - Kegel exercises. - Prompt voiding. - Promoting adequate fluid intake. - Mobility assistance for functional incontinence.

The nurse notes in the medical record that the patient's incontinence is related to an overactive detrusor muscle. Which type of urinary incontinence should the nurse suspect the patient is experiencing? A. Stress B. Functional C. Overflow D. Urge

D Urge incontinence is related to an overactive detrusor muscle, which increases bladder pressure. Stress incontinence is related to pelvic muscle relaxation and a weak urethra and surrounding tissues, which cause decreased urethral resistance. Overflow incontinence is related to a lack of normal detrusor muscle function, which causes the bladder to overfill and increases bladder pressure. Functional incontinence is related to the inability to respond to the need to urinate.

A patient with urinary incontinence is scheduled for urodynamic testing. The patient's family asks the nurse, "What is this test for?" Which response by the nurse is accurate? A. "This test will determine how completely the bladder empties with voiding." B. "This test will evaluate detrusor muscle function." C. "This test will identify structural disorders contributing to incontinence." D. "This test will measure bladder strength and urinary sphincter health."

D Urodynamic testing measures bladder strength and urinary sphincter health. Cystometrography is a diagnostic test done to evaluate detrusor muscle function. A cystoscopy identifies structural disorders contributing to incontinence. Post-voiding residual volume determines how completely the bladder empties with voiding. Diagnostic tests for urinary incontinence include: - Bladder diaries kept by the patient. - Urinalysis. - Assessing hormone levels to determine cause (i.e., diabetes mellitus). - Post-void residual. - Urodynamic testing. - Pelvic ultrasound. - Imaging. - Cystogram. - Cystoscopy.

The nurse is assigned to care for four patients today. Which patient is at highest risk for developing acute urinary retention? A. A 60-year-old female with mastitis B. A 50-year-old female with ovarian cancer C. A 28-year-old female one day postpartum D. A 20-year-old female with infertility

The patient who is one day postpartum is at highest risk for urinary retention, secondary to inflammation in the perineal area after delivery. The patients with infertility, ovarian cancer, and mastitis do not have any risk factors for urinary retention. Risk factors for urinary incontinence for a pregnant patient include: - Epidural analgesia. - High birth weight. - Emergency cesarean delivery. - Prolonged operative time. - Postoperative analgesia.

The nurse is preparing a teaching session about use of a pessary device for a patient with urinary incontinence. Which type of urinary incontinence should the nurse suspect? ANSWER A. Stress incontinence B. Urge incontinence C. Reflex incontinence D. Overflow incontinence

A Stress incontinence can be treated with use of a pessary device. Urge incontinence can benefit from pelvic floor exercises and behavioral modifications. Reflex and overflow incontinence can benefit from the use of adult briefs and absorption devices.

During a checkup, a pregnant patient reports urinary incontinence. Which instruction is appropriate for the nurse to provide for this patient? A. Avoiding alcohol B. Performing Kegel exercises C. Consuming more fiber D. Increasing fluid intake

B Kegel exercises may help pregnant women maintain urinary muscle strength and prevent incontinence. Alcohol should be avoided during pregnancy, but abstinence will not address the concern of incontinence. Consuming fiber is an appropriate topic for a patient experiencing constipation. Increasing fluid intake will not help a patient with urinary incontinence. Causes of pregnancy and urinary incontinence include: - Fetal weight pressing on bladder. - Hormonal changes. - Weakened bladder muscles. - Damage to nerve and supporting structures.

The nurse is providing discharge teaching to a patient diagnosed with urinary incontinence. Which patient statement indicates the need for further teaching regarding preventive methods for urinary incontinence? A. "I drink six to eight 8-ounce glasses of water each day." B. "I have switched to a low-fiber diet." C. "I have begun a smoking-cessation program." D. "I have decreased the amount of coffee I drink each day from eight cups to two."

B A low-fiber diet is not indicated as a preventive method of decreasing urinary incontinence. The other patient statements indicate understanding of the teaching session. Nursing interventions for urinary incontinence include: - Performing Kegel exercises. - Avoiding caffeinated drinks. - Maintaining good perineal hygiene. - Establishing timed voiding. - Wearing clothing that is easy to remove for toileting. - Providing patient privacy.

Which assessment finding should the nurse note in a patient diagnosed with urinary incontinence? A. Enlarged prostate B. Hypoactive bowel sounds C. Bladder bulging D. Use of alternative therapies

C During the physical examination for a patient experiencing urinary incontinence, the nurse may find perineal redness, physical or cognitive limitations, and bladder bulging. The use of alternative therapies is assessed during the patient's health history. Bowel sounds are not assessed during a focused urinary assessment. An enlarged prostate tends to cause problems with urinary retention, not incontinence.