Urinary Incontinence NCLEX Questions
What should the nurse teach the client to do to prevent stress incontinence? Select all that apply. A) Use techniques that strengthen the sphincter and structural supports of the bladder, such as Kegel exercises. B) Avoid dietary irritants (e.g., caffeine, alcoholic beverages). C) Not to laugh when in social gatherings. D) Carry an extra incontinence pad when away from home E) Obtain a fluid intake of 500 mL/ day.
A Use techniques that strengthen the sphincter and structural supports of the bladder, such as Kegel exercises. B Avoid dietary irritants (e.g., caffeine, alcoholic beverages). Rationale: Laughing may be a part of one's socialization, so it should not be discouraged. In non-restricted clients, a fluid intake of at least 2 to 3 L/ day is encouraged; clients with stress incontinence may reduce their fluid intake to avoid incontinence at the risk of developing dehydration and urinary tract infections. Establishing a voiding schedule would be more effective in the prevention of stress incontinence rather than carrying incontinence pads. Dietary irritants and natural diuretics, such as caffeine and alcoholic beverages, may increase stress incontinence. Kegel exercises strengthen the sphincter and structural supports of the bladder.
5. Which of the following interventions would be most appropriate for a client who has urge incontinence? A) Have the client urinate on a timed schedule. B) Provide a bedside commode. C) Administer prophylactic antibiotics. D) Teach the client intermittent self-catheterization technique. E) Have the client urinate on a timed schedule
A) Have the client urinate on a timed schedule. Rationale: Instructing the client to void at regularly scheduled intervals can help decrease the frequency of incontinence episodes. Providing a bedside commode does not decrease the number of incontinence episodes and does not help the client who leads an active lifestyle. Infections are not a common cause of urge incontinence, so antibiotics are not an appropriate treatment. Intermittent self-catheterization is appropriate for overflow or reflux incontinence, but not urge incontinence, because it does not treat the underlying cause.
8. The catheter slips into the vagina during a straight catheterization of a female client. The nurse does which action? A) Leaves the catheter in place and gets a new sterile catheter. B) Leaves the catheter in place and asks another nurse to attempt the procedure. C) Removes the catheter and redirects it to the urinary meatus. D) Removes the catheter, wipes it with a sterile gauze, and redirects it to the urinary meatus
A) Leaves the catheter in place and gets a new sterile catheter. Rationale: The catheter in the vagina is contaminated and cannot be reused. If left in place, it may help avoid mistaking the vaginal opening for the urinary meatus. A single failure to catheterize the meatus does not indicate that another nurse is needed although sometimes a second nurse can assist in visualizing the meatus
7. During assessment of the client with urinary incontinence, the nurse is most likely to assess for which of the following? Select all that apply. A) Perineal skin irritation B) Fluid intake of less than 1,500 mL/day C) History of antihistamine intake D) History of frequent urinary tract infections E) A fecal impaction
A) Perineal skin irritation B) Fluid intake of less than 1,500 mL/day D) History of frequent urinary tract infections E) A fecal impaction Rationale: The perineum may become irritated by the frequent contact with urine (option 1). Normal fluid intake is at least 1,500 mL/day and clients often decrease their intake to try to minimize urine leakage (option 2). UTIs can contribute to incontinence (option 4). A fecal impaction can compress the urethra, which can result in small amounts of urine leakage (option 5). Antihistamines can cause urinary retention rather than incontinence (option 3).
4. A client has urge incontinence. When obtaining the health history, the nurse should ask if the client has: A) Inability to empty the bladder. B) Loss of urine when coughing. C) Involuntary urination with minimal warning. D) Frequent dribbling of urine.
C) Involuntary urination with minimal warning. Rationale: A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urine retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of a vesicovaginal or urethrovaginal fistula.
10. The goal of nursing care of the client with an indwelling catheter and continuous drainage is largely directed at preventing infection of the urinary tract and encouraging urinary flow through the drainage system. Which of the following interventions encouraged by nurses working with these clients would not be appropriate in meeting this goal? A) Having the client drink up to 2000 mL per day B) Encouraging the client to eat foods that increase the acid in the urine C) Routine hygienic care D) Changing indwelling catheters every 72 hours.
D) Changing indwelling catheters every 72 hours. Rationale: Retention catheters are removed after their purpose is achieved; routine changing of the catheter or drainage system is not recommended. Large amounts of fluid ensure a large urine output, which keeps the bladder flushed out and decreases the likelihood of urinary stasis and subsequent infection. Eating foods that increase the acid in urine helps to reduce the risk of urinary tract infections and stone formation. Hygiene care related to catheters is set by hospital policy.
9. Urinary incontinence is not a normal part of aging. An intervention used by nurses to assist clients to regain or maintain continence with individuals suffering from this problem would not include: A) Bladder training B) Habit training C) Prompted voiding D) Fluid restriction
D) Fluid restriction Rationale: Fluids would be encouraged, to allow the kidneys to be flushed and urine to be formed. Bladder training requires that the client postpone voiding, resist or inhibit the sensation of urgency, and void according to a timetable, rather than according to an urge. Habit training is also referred to timed or scheduled voiding. There is no attempt to motivate the client to delay voiding if the urge occurs. Prompted voiding supplements habit training by encouraging the client to try to use the toilet and reminding the client when to void.
6. The nurse recognizes that urinary elimination changes may occur even in healthy older adults because of which of the following? A) The bladder distends and its capacity increases. B) Older adults ignore the need to void. C) Urine becomes more concentrated. D) The amount of urine retained after voiding increases.
D) The amount of urine retained after voiding increases. Rationale: The capacity of the bladder may decrease with age but the muscle is weaker and can cause urine to be retained (option 4). Older adults do not ignore the urge to void and may have difficulty in getting to the toilet in time (option 2). The kidney becomes less able to concentrate urine with age (option 3).
2. The primary goal of nursing care for a client with stress incontinence is to: A) Help the client adjust to the frequent episodes of incontinence. B) Eliminate all episodes of incontinence. C) Prevent the development of urinary tract infections. D)Decrease the number of incontinence episodes.
D)Decrease the number of incontinence episodes. Rationale: The primary goal of nursing care is to decrease the number of incontinence episodes and the amount of urine expressed in an episode. Behavioral interventions (e.g., diet and exercise) and medications are the nonsurgical management methods used to treat stress incontinence. Without surgical intervention, it may not be possible to eliminate all episodes of incontinence. Helping the client adjust to the incontinence is not treating the problem. Clients with stress incontinence are not prone to the development of urinary tract infection.
3. The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included? A) Avoid activities that are stressful and upsetting. B) Avoid caffeine and alcohol. C) Do not wear a girdle. D)Limit physical exertion.
B) Avoid caffeine and alcohol. Rationale: Clients with stress incontinence are encouraged to avoid substances, such as caffeine and alcohol, that are bladder irritants. Emotional stressors do not cause stress incontinence. It is most commonly caused by relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may want to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.
