MED SURG 2 CH. 23 EAQ

When educating a patient for whom habit training has been prescribed, the nurse tells the patient that nighttime wetness can be reduced by limiting fluids after what time? 1. 7 pm 2. 8 pm 3. 9 pm 4. 10 pm

1. 7 pm Nighttime wetness can be reduced by limiting fluids after 7 pm. Fluids after 7 pm may lead to nighttime wetness. Text Reference - p. 359

Which foods should the patient with fecal incontinence be instructed to avoid? Select all that apply. 1. Coffee 2. Banana 3. Chocolate 4. Baked potato 5. Oat bran muffin

1. Coffee 3. Chocolate Coffee and chocolate, which contain caffeine, can cause the anal sphincter to relax, thus leading to incontinence. Banana, baked potato, and oat bran muffins are foods that can thicken the stool.

A nurse is observed using an open hand to gently press on the patient's abdomen over the bladder to promote urine passage. What is the nurse demonstrating? 1. Credé technique 2. Valsalva maneuver 3. Bladder suspension 4. Autonomic dysreflexia

1. Credé technique The credé technique involves using the open hand to gently press the abdomen over the bladder and promote urine passage. A patient who is using the Valsalva maneuver holds the breath and bears down as if having a bowel movement. A bladder suspension is a surgical procedure. Autonomic dysreflexia is a neurologic disorder.

Which method is most effective in the management of urge and reflex incontinence? 1. Drug therapy 2. Reflex training 3. Kegel exercises 4. Prompted voiding

1. Drug therapy Drug therapy is most effective in the management of urge and reflex incontinence.

Depending on the type of urinary incontinence, a number of therapeutic measures may be prescribed. Which is the measure considered most effective in the management of urge incontinence and reflex incontinence? 1. Drug therapy 2. Habit training 3. Bladder training 4. Prompted voiding

1. Drug therapy Drug therapy is most effective in the management of urge and reflex incontinence. Habit training is also called timed voiding and is similar to bladder training in that the patient is encouraged to void at scheduled intervals. Bladder training is a behavioral intervention that uses patient education, scheduled toileting, and positive reinforcement to decrease the frequency of incontinent episodes. Prompted voiding is a behavioral intervention that is often used with habit training for patients who are dependent or cognitively impaired; it is intended to help the patient recognize incontinence and to ask caregivers for help with toileting.

Which nursing interventions are appropriate for a patient who is diagnosed with stress urinary incontinence? Select all that apply. 1. Encourage intake of normal amounts of fluid. 2. Empty the bladder every 2 hours when awake. 3. Discuss weight loss if the patient is overweight. 4. Encourage fluids with a diuretic affect such as tea. 5. Instruct the patient on how to perform Kegel exercises.

1. Encourage intake of normal amounts of fluid. 2. Empty the bladder every 2 hours when awake. 3. Discuss weight loss if the patient is overweight. 5. Instruct the patient on how to perform Kegel exercises. The patient should empty the bladder every 2 hours when awake. Extra weight can put pressure on the bladder, so weight loss should be encouraged. The patient should drink a normal amount of fluids, but should avoid fluids with a diuretic effect due to the struggle with continence. Kegel exercises can help strengthen muscles and decrease incidents of stress incontinence.

When providing a history of current medications, a patient reports that he is taking a medication used to treat overflow incontinence associated with prostate enlargement. The nurse knows which medication was prescribed for this purpose? 1. Finasteride 2. Imipramine 3. Oxybutynin chloride 4. Propranolol hydrochloride

1. Finasteride Finasteride is used to treat overflow incontinence associated with prostate enlargement. Imipramine is used to treat urge incontinence. Oxybutynin chloride is used to treat urge incontinence. Propranolol hydrochloride is used to treat stress incontinence.

MEDICAL HISTORY: Allergies, heart failure--started taking furosemide; Chronic obstructive lung disease--takes theophylline. PHYSICAL ASSESSMENT: Heart tones regular, lung sounds clear, abdomen soft, and active bowel sounds VITAL SIGNS: Pulse 72, Respirator 16, and BP 120/70 After reviewing the chart, which finding will help the nurse determine the possible cause of the patient's sudden development of urinary incontinence? 1. Furosemide on the medication record 2. Theophylline on the medication record 3. Vital signs, reflecting a heart rate of 116 4. Abdominal assessment, reflecting distended abdomen

1. Furosemide on the medication record Drugs that might contribute to urinary incontinence are high-ceiling (loop) diuretics (Lasix), major tranquilizers, antihistamines, decongestants, some sedatives or hypnotics, and antiparkinsonian drugs. Vital signs and abdominal assessments are normal. Theo-Dur would lead to urinary retention, not incontinence. Text Reference - p. 355, Table 23-3

A nurse has reinforced teaching with a patient about the medication tolterodine. Which information by the patient would indicate a correct understanding of the teaching? 1. I should take this 1 hour before meals. 2. I am taking this to make my bladder contract. 3. I am using this because I have overflow incontinence. 4. I will have increased bulk around my sphincter to control urine.

1. I should take this 1 hour before meals. Tolterodine should be administered 1 hour before meals. Detrol increases bladder capacity and is used for urge incontinence or overactive bladder. Glutaraldehyde cross-linked (GAX) collagen is used as a bulking agent for the sphincter. Bethanechol chloride is used for overflow incontinence and causes bladder contractions. Alpha-adrenergic antagonists are used for overflow incontinence.

The LPN is caring for a patient who is experiencing the anorectal form of fecal incontinence. Which is the most appropriate teaching point to include in patient teaching? 1. Instructing the patient on Kegel exercises. 2. Teaching the patient how to defecate on a schedule. 3. Teaching the patient how to self-administer an enema. 4. Instructing the patient on how to prepare for diagnostic tests.

1. Instructing the patient on Kegel exercises. A patient who is experiencing the anorectal form of fecal incontinence should be taught Kegel exercises. Preparing for diagnostic tests would be appropriate for the patient who is experiencing symptomatic fecal incontinence. Scheduled toileting would be taught to the patient who is experiencing neurogenic fecal incontinence. Administering enemas would be appropriate for the patient who is experiencing overflow fecal incontinence.

The nurse is teaching the patient how to perform intermittent self-catheterization at home. Which steps should the nurse include in the teaching? Select all that apply. 1. Measure urine output. 2. Restrict fluids before bed. 3. Clean technique may be used. 4. Drain it every 30 minutes initially. 5. Adjust the drain time interval as needed.

1. Measure urine output. 3. Clean technique may be used. 5. Adjust the drain time interval as needed. Urine output should be measured. In a home setting, clean technique rather than a sterile technique is usually taught. Initially the bladder is drained every 4 hours. The time interval of drainage may be adjusted based on urine output. Fluids do not need to be restricted prior to bed.

When determining the cause of a patient's incontinence, which task may be delegated to unlicensed assistive personnel (UAP)? 1. Measuring output 2. Reviewing medications 3. Auscultating the abdomen 4. Discussing treatment options

1. Measuring output It is within the scope of practice of the unlicensed assistive personnel (UAP) to measure output. Reviewing medications, performing assessments, and discussing treatment options are not within the scope of practice for the UAP. Text Reference - p. 357

Constipation in which the entire colon is full of fecal matter can cause which type of fecal incontinence? 1. Overflow 2. Anorectal 3. Neurogenic 4. Symptomatic

1. Overflow Fecal overflow incontinence is caused by constipation in which the rectum is constantly distended. Anorectal incontinence can be caused by weak muscles or rectal prolapse. Neurogenic incontinence occurs when stools pass after meals. Symptomatic incontinence is caused by colon or rectal disease. Text Reference - p. 363

For which type of fecal incontinence are enemas appropriate? 1. Overflow 2. Anorectal 3. Neurogenic 4. Symptomatic

1. Overflow Overflow incontinence is caused by constipation; therefore enemas and laxatives would be appropriate. Anorectal, neurogenic, and symptomatic incontinence are not caused by constipation but are due to weak muscles, gastrocolic reflex stimulation, and disease. An enema is not appropriate for these types of incontinence.

In preconference before clinical experience, a nursing instructor quizzes a student by asking what the term dysuria means. Which is the student's best response? 1. Painful urination 2. Large urine volume 3. Lack of urine production 4. Waking up frequently to urinate at night

1. Painful urination Dysuria means painful urination. Nocturia is the term for waking up frequently to urinate at night. Polyuria is the term for large urine volume. Anuria is the term for lack of urine production. Text Reference - p. 357

The LPN's priority nursing action when caring for a patient who has a pessary should be to document which aspect? 1. Presence of the pessary 2. Patient's follow-up appointment 3. Patient's understanding of the procedure 4. Patient's placement on the surgery schedule

1. Presence of the pessary Documenting the presence of the pessary prevents it from being overlooked. Although the patient will need to have the pessary removed periodically for cleansing and replacement and it is important to verify the patient's understanding of the procedure, the greater priority is documenting the presence of the pessary. The pessary can be used for patients for whom surgery is contraindicated, as well as for those who are awaiting surgery, so documenting the patient's placement on the surgery schedule is not the highest priority.

The LPN is caring for a patient who has been prescribed bethanechol chloride for the treatment of urinary incontinence. The patient tells the nurse that she has a history of asthma. The nurse's most important action would be to notify which member of the health care team? 1. Provider 2. Pharmacy 3. Supervisor 4. Charge nurse

1. Provider The health care provider should be notified because asthma is a contraindication for using this medication. Although the charge nurse should be informed of the need to contact the provider, the LPN can certainly notify the provider of the patient's history of asthma. It is not appropriate to notify the pharmacy or the supervisor at this time. Text Reference - p. 351, Table 23-1

Which foods should the nurse encourage for a patient who is having fecal incontinence? Select all that apply. 1. Rice 2. Eggs 3. Corn 4. Yogurt 5. Oat bran 6. Grape juice

1. Rice 4. Yogurt 5. Oat bran Advise the patient to consume more foods that thicken the stool. These include bananas, rice, bread, potatoes, cheese, yogurt, oatmeal, oat bran, boiled milk, and pasta. Raw fruits, fruit juices (especially prune and grape juice), raw vegetables, cabbage, sweets, alcohol, and very spicy foods stimulate stool production and should be avoided. Eggs can produce odor, and corn can produce gas; both need to be avoided. Text Reference - pp. 362-363

Upon data collection, a nurse found that a patient voluntarily expelled feces that were black and sticky. How should the nurse chart this finding? 1. Tarry stool 2. Micturition 3. Incontinent 4. Detrusor overactivity

1. Tarry stool Tarry is used to describe stools that are shiny, sticky, and black. Incontinence is the term used to describe the involuntary passage of urine (urinary incontinence) or feces (fecal incontinence). The passage of urine is called urination or micturition. Detrusor overactivity is the most common cause of urge incontinence in older adults. Text Reference - p. 364

Which actions should the nurse take when caring for a patient with stress incontinence? Select all that apply. 1. Teach Kegel exercises 2. Use the Credé technique. 3. Avoid tea, coffee, and cola. 4. Empty the bladder every 2 hours while awake. 5. Maintain fluid intake to at least 2000 mL per day.

1. Teach Kegel exercises 3. Avoid tea, coffee, and cola. 4. Empty the bladder every 2 hours while awake. 5. Maintain fluid intake to at least 2000 mL per day. Sometimes stress incontinence is successfully treated with behavioral methods such as pelvic muscle exercises (Kegel exercises) and scheduled voiding (every 2 hours). In addition, the patient is advised to maintain a fluid intake of at least 2000 mL per day. Fluids that have a diuretic effect (e.g., tea, coffee, cola) should be avoided. If the patient has hypertension, heart failure, or renal disease, then consult a registered nurse (RN) about the appropriate recommended fluid intake. The Credé technique is used with overflow incontinence, not with stress incontinence.

What are the four basic types of urinary incontinence? Select all that apply. 1. Urge 2. Stress 3. Distress 4. Overflow 5. Functional 6. Dysfunctional

1. Urge 2. Stress 4. Overflow 5. Functional Urinary incontinence is classified into four basic types: urge, stress, overflow, and functional. A patient may have more than one type at the same time. Distress and dysfunction are not types of urinary incontinence.

A nurse is administering dutasteride to a patient. For which patient is this most likely being administered? 1. A male patient with urge incontinence 2. A male patient with an enlarged prostate 3. A female patient with stress incontinence 4. A female patient with an overactive bladder

2. A male patient with an enlarged prostate Avodart will help shrink the enlarged prostate. Propantheline bromide and oxybutynin chloride are given for urge incontinence. Phenylpropanolamine and propranolol hydrochloride can be given for stress incontinence. Bethanechol chloride and alpha-adrenergic antagonists are given for overflow incontinence.

A male patient is having a hard time voiding. Which action should the nurse take? 1. Restrict fluid 2. Allow the patient to stand 3. Stroke the upper abdomen 4. Pour cool water over the perineum

2. Allow the patient to stand To promote voiding, establish a comfortable position for the patient (males stand) and provide privacy. Stimuli that may encourage voiding include stroking the inner thigh (not abdomen), pouring warm (not cool) water over the perineum, running water in the lavatory or tub, and having the patient drink water while on the toilet.

A patient has fecal incontinence due to nerve damage that has caused the muscles of the pelvic floor to be weak. The nurse recognizes this as which type of incontinence? 1. Overflow 2. Anorectal 3. Neurogenic 4. Symptomatic

2. Anorectal Anorectal incontinence is associated with nerve damage. Overflow incontinence is associated with constipation. Neurogenic incontinence is caused by the gastrocolic reflex. Symptomatic incontinence is caused by colon or rectal disease.

Which classifications of medications are most commonly used for urinary incontinence management? 1. Glutaraldehyde and tricyclic antidepressants 2. Anticholinergic and muscarinic receptor antagonists 3. Alpha-adrenergic agonists and tricyclic antidepressants 4. Serotonin-norepinephrine reuptake inhibitors and zirconium

2. Anticholinergic and muscarinic receptor antagonists The classifications of drugs that are most commonly used for urinary incontinence management are anticholinergic and muscarinic receptor antagonist (antispasmodic) medications. Zirconium oxide beads and glutaraldehyde cross-linked collagen are bulking agents. Alpha-adrenergic agonists, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors may be used but are not as common. Text Reference - p. 350

A patient has been experiencing loose stools for the past week. The nurse suggests increasing intake of which foods to decrease the instance of loose stools? 1. Eggs, coffee, and alcohol 2. Bananas, rice, and potatoes 3. Beans, sweets, and raw fruits 4. Chocolate, cabbage, and bread

2. Bananas, rice, and potatoes Bananas, rice, and potatoes are all foods that thicken the stool. Eggs are gas producing, and coffee stimulates anal sphincters to relax; both can contribute to fecal incontinence. Alcohol can stimulate stool production. Beans are gas producing, and sweets stimulate stool production. Chocolate stimulates relaxation of the anal sphincters, and cabbage stimulates stool production; both can contribute to fecal incontinence. Bread can thicken stool. Text Reference - pp. 362-363

The nurse is teaching a class about low-risk interventions for urinary incontinence. Which interventions should the nurse include in the teaching? Select all that apply. 1. Restrict fluids 2. Habit training 3. Avoid activity 4. Kegel exercises 5. Prompted voiding

2. Habit training 4. Kegel exercises 5. Prompted voiding Habit training, Kegel exercises, and prompted voiding are all low-risk interventions to decrease the frequency of incontinent episodes. Fluid restriction can result in fluid and electrolyte imbalances. Avoiding activity can have a negative impact on the patient's physical and psychological health.

The nurse is reviewing the medications for a patient who has recently developed urinary incontinence. Which of the patient's medications can contribute to urinary incontinence? Select all that apply. 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) 2. Hypnotics 3. Loop diuretics 4. Antihistamines 5. Antidepressants

2. Hypnotics 3. Loop diuretics 4. Antihistamines Hypnotics, loop diuretics, and antihistamines are a few of the many medications that can contribute to urinary incontinence. NSAIDS and antidepressants are not contributing medications. Tricyclic antidepressants are sometimes used to help treat urinary incontinence.

A nurse must assist a cognitively impaired patient with bladder training. Which technique should the nurse use? 1. Reflex training 2. Prompted voiding 3. Scheduled voiding 4. Pelvic muscle rehabilitation

2. Prompted voiding Prompted voiding is often used with habit training for people who are dependent or cognitively impaired. Reflex training is sometimes used by people with a spinal cord injury. With scheduled voiding, the patient is encouraged to delay voiding and void only at scheduled times, which may be hard to do with cognitively impaired patients. Pelvic muscle rehabilitation aims to strengthen the pelvic floor and includes pelvic muscle exercises, with or without biofeedback, pelvic floor electrical stimulation, and vaginal weight training; it is not bladder training.

While attending her yearly gynecologic physical examination, a patient confides in the nurse that she involuntarily urinates every time she tries to exercise by running. The nurse documents the presence of which type of incontinence? 1. Urge 2. Stress 3. Overflow 4. Functional

2. Stress Stress incontinence is the involuntary loss of small amounts of urine during physical activity that increases abdominal pressure. Urge incontinence is the involuntary loss of urine shortly after a strong, abrupt urge to urinate. Overflow incontinence is the involuntary loss of urine associated with an overdistended bladder. Functional incontinence is the term used when a person voids inappropriately because of an inability to get to the toilet or to manage the mechanics of toileting. Text Reference - p. 349

A patient has 80 mL of postvoid residual (PVR). How would the nurse interpret this information? 1. The patient has adequate bladder emptying. 2. The patient has inadequate bladder emptying. 3. The patient has an average amount of residual. 4. The patient has a PVR within the normal range.

2. The patient has inadequate bladder emptying. Normally, less than 50 mL of urine remains after voiding. An amount more than 50 mL reflects inadequate bladder emptying.

The nurse is caring for a patient who has an order for a condom catheter. Which observation warrants immediate action by the nurse? 1. The drain bag is secured to the leg. 2. The tape is wrapped in a vertical pattern. 3. Elastic tape has been used on the penis. 4. Tape is wrapped in a spiral around the penis.

2. The tape is wrapped in a vertical pattern. A condom catheter tape should be elastic and wrapped in a spiral pattern to prevent restriction of circulation, not in a vertical pattern. The urine drain bag may be secured to the leg.

Which patient finding best indicates that the outcome was successfully met for a patient with urinary urge incontinence? 1. Accurately describes treatment plan 2. Time between voiding increases without leakage 3. Normal body temperature and normal white blood count 4. Decreased episodes of involuntary voiding when pressure increases

2. Time between voiding increases without leakage The outcome for urge incontinence is the time between voiding increases without leakage. The outcome for knowledge deficit is accurately describes treatment plan. The outcome for risk for infection is normal body temperature and white blood cell count. The outcome for stress incontinence is decreased episodes of involuntary voiding when under stress (pressure). Text Reference - pp. 353-354

Upon a focused data collection, which comment would the nurse expect to hear from a patient with stress incontinence? 1. When I have the urge to go, I have to go right then. 2. When I pick up a bag of groceries, I leak some urine. 3. When I go, I always lose a small amount of urine all the time. 4. When I am stressed, I can hardly get to the bathroom in time.

2. When I pick up a bag of groceries, I leak some urine. Text Reference - pp. 355-356

A patient asks the nurse to explain how a pessary is used. Which is the nurse's best response? 1. "It will be applied to the penis to compress the urethra." 2. "Electrodes will be implanted to stimulate the pelvic floor muscles." 3. "A catheter will be inserted into the urethra to drain urine from the bladder." 4. "It is a device that will be inserted into the vagina to hold pelvic organs in place."

3. "A catheter will be inserted into the urethra to drain urine from the bladder." A pessary is a device that is inserted into the vagina to hold the pelvic organs in place. A penile clamp is applied to the penis to compress the urethra. Electrostimulation involves implantation of electrodes to stimulate the pelvic floor muscles. A catheter inserted into the urethra to drain urine from the bladder describes urinary catheterization.

A patient comes to the walk-in clinic with complaints of urinary incontinence. "Every time I cough, sneeze, or lift anything heavy, I wet myself." The health care provider prescribes duloxetine. The patient says, "Isn't this an antidepressant? Why is the physician prescribing an antidepressant when I need something for bladder control?" What is the nurse's most appropriate response? 1. "Duloxetine is an antidepressant, but you appear to be upset about being incontinent and this will help." 2. "You seem upset about being prescribed an antidepressant. Would you like to elaborate on those feelings?" 3. "Duloxetine is an antidepressant, but it is also prescribed to help with stress incontinence by sphincter contraction." 4. "Would you rather have a different medication? I can ask your physician before you leave if that will make you happy."

3. "Duloxetine is an antidepressant, but it is also prescribed to help with stress incontinence by sphincter contraction." The nurse should explain that duloxetine is an antidepressant, but it is also prescribed to help with stress incontinence by sphincter contraction. The nurse should be specific about the implications of duloxetine and not accuse the patient of being depressed. It is great to ask the patient about her feelings, but being specific about the drug actions is more important. Offering the patient another medication is not an appropriate response—the physician ordered the medicine he thought to be the most appropriate for this patient. Text Reference - p. 351, Table 23-1

A nurse wants to protect the skin of a female patient who is incontinent of urine. Which action should the nurse take? 1. Apply cornstarch 2. Apply a condom catheter 3. Apply a light dusting powder 4. Apply talc and lotion together

3. Apply a light dusting powder A light dusting powder can be used to absorb moisture that will help protect the skin of the perineum and buttocks of incontinent patients. Cornstarch is not recommended because it promotes the development of yeast infections. Do not use talc and lotion together on the same area because the combination creates an abrasive paste. No external device is in common use at this time for women, although efforts to develop a female external device continue. External urine collection devices are useful for men. These latex sheaths, sometimes called condom catheters drain urine into a bag that is usually secured to the leg.

Which term is used to describe when a person voids inappropriately because of an inability to get to the toilet or to manage the mechanics of the toilet? 1. Urge incontinence 2. Stress incontinence 3. Functional incontinence 4. Urinary overflow incontinence

3. Functional incontinence Functional incontinence can be related to confusion, immobility, or barriers in the environment. Urge incontinence is loss of urine when feeling the urge to void. Stress incontinence is loss of urine during physical exertion. Urinary overflow incontinence involves loss of urine associated with a full bladder.

A patient has reflex incontinence. Which nursing action is priority for this patient? 1. Use the Credé method 2. Document pessary use 3. Maintain bladder drainage 4. Encourage fluids for urinary function

3. Maintain bladder drainage For patients who have reflex incontinence, it is important that bladder drainage is maintained. Overdistention of the bladder may trigger a serious reaction called autonomic dysreflexia, in which the blood pressure rises to life-threatening levels. The Credé method is not used for patients with reflex incontinence. While documenting pessary use is needed, it is not the priority for reflex incontinence, which is from spinal cord injury, radical pelvic surgery, or radiation cystitis. Fluids are not the priority.

A patient reports having a bowel movement shortly after the first meal of the day. This symptom is consistent with which type of incontinence? 1. Overflow 2. Anorectal 3. Neurogenic 4. Symptomatic

3. Neurogenic Neurogenic incontinence is caused by the gastrocolic reflex. When food enters the stomach, it stimulates activity throughout the digestive tract and causes movement of the fecal mass into the rectum. Overflow incontinence is associated with constipation. Anorectal incontinence is associated with nerve damage. Symptomatic incontinence is caused by colon or rectal disease.

A female patient reports urinary incontinence to the health care provider, who determines that the reason for the incontinence is relaxed pelvic structures. The health care provider recommends a device that is inserted into the vagina to hold the pelvic organs in place as a tool to treat this patient's incontinence until surgical treatment can be performed. The nurse would assist the patient to obtain which device? 1. Cone 2. Clamp 3. Pessary 4. Indwelling catheter

3. Pessary A pessary is a device that is inserted into the vagina to hold the pelvic organs in place. It is sometimes used as a tool to treat incontinence in women with relaxed pelvic structures. Vaginal weights (e.g., cones) are used with pelvic muscle training in women. A penile clamp is a device that is applied to the penis. It compresses the urethra, preventing the passage of urine. No "clamp" is available for women. An indwelling catheter may be ordered to control urinary incontinence, but this treatment is usually recommended when all other measures have failed and skin integrity is endangered.

Which finding would alert the nurse that a patient has inadequate bladder emptying? 1. Wet pad count 2. Blood level of creatinine 3. Postvoid residual of 60 mL 4. Urine culture and sensitivity

3. Postvoid residual of 60 mL A postvoid residual of more than 50 mL reflects inadequate emptying. A wet pad count just lets the nurse know how many times the patient voided. Blood level of creatinine does not measure inadequate bladder emptying. A urine culture and sensitivity assesses for infection. Text Reference - p. 349

Which diagnostic test or procedure is performed to detect involuntary passage of urine when abdominal pressure increases? 1. Cystoscopy 2. Cystometry 3. Provocative stress testing 4. Magnetic resonance imaging

3. Provocative stress testing Provocative stress testing is performed to detect involuntary passage of urine when abdominal pressure increases. The patient may be positioned in a standing or lithotomy position. The health care provider encourages the patient to relax and then to cough vigorously. The examiner observes for urine loss during coughing. Cystoscopy involves a scope inserted through the urethra to visualize the urethra and bladder. Cystometry is used to evaluate the neuromuscular function of the bladder. Magnetic resonance imaging may be ordered to create images of the urinary structures.

Which type of treatment may be used for neurogenic incontinence? 1. Fluid restriction 2. Pelvic exercises 3. Scheduled toileting 4. Consumption of mineral oil

3. Scheduled toileting Neurogenic incontinence is usually treated with scheduled toileting based on the patient's usual time of defecation. Pelvic exercises would not be beneficial to the patient with neurogenic incontinence. Fluid restriction is not indicated and can lead to fluid and electrolyte imbalances. Consumption of mineral oil is not indicated and should be avoided because it interferes with the absorption of fat-soluble vitamins.

A female patient is undergoing a physical examination because of reports of being incontinent of feces. The health care provider plans to perform a pelvic, then rectal examination to assess for prolapse of abdominal organs and to evaluate perineal muscle tone. The nurse prepares the patient for the examination and explains that the rectal examination determines which factor? 1. Bladder distention 2. Presence of abdominal mass 3. Sensation and sphincter tone 4. Prostate contour and consistency

3. Sensation and sphincter tone A rectal examination is performed in female patients to determine sensation, sphincter tone, and presence of fecal impaction. The abdomen is palpated to assess for bladder distention. The abdomen is palpated for the presence of a mass. A distended bladder or abdominal distention associated with constipation is an important finding. This scenario is applicable only to female patients. The prostate is palpated for contour and consistency in the male patient. Text Reference - p. 358

A patient taking bethanechol chloride presents with headache, nausea, and dyspnea. How would the nurse interpret these symptoms? 1. The patient is retaining urine. 2. These side effects are common. 3. These side effects indicate toxicity. 4. The medication dose should be increased.

3. These side effects indicate toxicity. Signs of bethanechol chloride toxicity include nausea, dyspnea, irregular pulse, and headache. The information does not indicate that the patient is retaining urine. Headache, nausea, and dyspnea are not common side effects. The symptoms indicate toxicity; therefore an increased dosage can be very dangerous to the patient and is contradicted.

Which statement indicates that patient teaching regarding pelvic muscle (Kegel) exercises has been effective? 1. "I should do the exercises once a day." 2. "I will notice improvement within 1 week." 3. "I need to do these exercises while lying in bed." 4. "I should practice tightening my perineal muscles."

4. "I should practice tightening my perineal muscles." To identify the correct muscles that need to exercised, the patient should practice tightening the perineal muscles. The exercises should be performed several times a day. Improvement in urinary control may take several weeks. The exercises can be performed anywhere, it is not necessary to be lying in bed.

A patient with urge incontinence has been prescribed amitriptyline. The patient states, "Why are they giving me an antidepressant? I'm not depressed!" Which response made by the nurse is correct regarding the action of this medication? 1. "This medication helps to strengthen your bladder's sphincter." 2. "Research has shown that depression is the primary cause of incontinence." 3. "This medication will shrink your enlarged prostate and increase your bladder size." 4. "This medication can be prescribed for a multitude of reasons including reducing your bladder contractions."

4. "This medication can be prescribed for a multitude of reasons including reducing your bladder contractions." Certain tricyclic antidepressants may be prescribed for urge incontinence due to the action of reduction of overactive bladder contractions. Depression is not the primary cause of incontinence. This medication does not strengthen sphincter tone or shrink the prostate.

A patient has fecal neurogenic incontinence. The staff has tried scheduled toileting, but it was not successful. Which treatment can the nurse expect next? 1. Prepare to use biofeedback. 2. Perform the Valsalva maneuver. 3. Schedule pelvic muscle exercises throughout the day. 4. Administer a constipating drug in the morning and a laxative at night.

4. Administer a constipating drug in the morning and a laxative at night. Neurogenic incontinence is usually treated with scheduled toileting based on the patient's usual time of defecation. If this is not successful, then some physicians order a constipating drug (e.g., codeine) each morning and a laxative (e.g., Senna, milk of magnesia) each night. Anorectal incontinence is treated with pelvic muscle exercises and sometimes biofeedback. The Valsalva maneuver is used in reflex training for urinary situations, not fecal.

Which action will the nurse take for a patient with fecal overflow incontinence? 1. Limit fluids 2. Offer mineral oil 3. Decrease fiber intake 4. Administer daily enemas

4. Administer daily enemas Daily enemas for 7 to 10 days are then needed to empty the entire colon for a patient with fecal overflow incontinence. Increased, not decreased, fluids and fiber may be helpful, but some patients need regular aids to elimination. Mineral oil should be avoided because it interferes with absorption of fat-soluble vitamins and because it may be aspirated, causing lipid pneumonia.

A young woman informs the nurse that she suspects she has a urinary tract infection because she has been experiencing pain and burning with urination. The LPN informs the patient that the laboratory test is usually ordered to assess for this type of infection? 1. Uroflowmetry 2. Urodynamic testing 3. Postvoid residual (PVR) test 4. Clean-catch urinalysis with a culture and sensitivity test

4. Clean-catch urinalysis with a culture and sensitivity test A clean-catch urinalysis with a culture and sensitivity test is usually ordered to assess for infection. Uroflowmetry measures voiding duration and the rate of urine voided. Urodynamic testing is used to assess the neuromuscular function of the lower urinary tract when the cause of incontinence cannot be determined by simpler means. A postvoid residual (PVR) test measures the amount of urine remaining in the bladder to determine whether a patient has inadequate emptying. Text Reference - p. 348

The LPN is contributing to a discharge plan for a patient who will be taking bethanechol chloride to treat urinary incontinence. The most important point that the nurse needs to teach the patient is to call the health care provider if she develops which problem? 1. Feels flushed and is perspiring. 2. Develops a headache and has diarrhea. 3. Voids within 1 hour of taking the medication. 4. Develops a headache and nausea, and is short of breath.

4. Develops a headache and nausea, and is short of breath. Headache, nausea, and dyspnea are indicative of bethanechol chloride toxicity. Voiding within 1 hour of taking bethanechol chloride is an expected outcome. Flushed feeling, perspiration, headache, and diarrhea are side effects of bethanechol chloride.

Which action by the nursing assistant will cause the nurse to intervene when placing a condom catheter on a male patient? 1. Uses elastic tape 2. Explains the procedure 3. Applies in a spiral pattern 4. Encircles the penis with tape

4. Encircles the penis with tape The patient and all caregivers should know NOT to encircle the penis with tape. To do so can restrict circulation. Therefore, the nurse should intervene to prevent harm. Elastic tape should be used and wrapped in a spiral pattern. The nursing assistant can explain the procedure.

The licensed practical nurse (LPN) is caring for a patient who is experiencing overflow fecal incontinence. Which is the most appropriate nursing intervention? 1. Frequently administer skin care. 2. Help the patient learn scheduled toileting. 3. Begin completing the preoperative checklist. 4. Help the patient increase fluid and fiber intake.

4. Help the patient increase fluid and fiber intake. When a patient is experiencing overflow incontinence, the nursing priorities would be to administer laxatives and enemas as ordered and to increase fluids and fiber as appropriate. Frequently administering skin care would be more appropriate for symptomatic fecal incontinence. Helping the patient learn scheduled toileting would be an appropriate intervention for neurogenic fecal incontinence. Completing the preoperative checklist would be appropriate for anorectal fecal incontinence because the patient is likely to have surgery.

Which treatment is appropriate for a patient with anorectal incontinence? 1. Enemas 2. Laxatives 3. Colonoscopy 4. Pelvic exercises and biofeedback

4. Pelvic exercises and biofeedback Anorectal incontinence is associated with weak pelvic muscles, which may be strengthened by pelvic exercises. Enemas and laxatives will not benefit the weak muscles. A colonoscopy is a diagnostic procedure, not a treatment.

The nurse is caring for a patient with new onset of fecal incontinence. When assisting with data collection on this patient, which finding would be significant? 1. Brown formed stool 2. Voluntary bowel evacuation 3. No redness or skin breakdown 4. Recent travel to foreign country

4. Recent travel to foreign country Recent travel to other countries may be significant, because travelers sometimes acquire uncommon intestinal infections. Stool is normally brown in color. Voluntary bowel evacuation is normal; involuntary bowel evacuation is abnormal. No redness or skin breakdown is normal. Text Reference - p. 364

The nurse is contributing to the plan of care for a patient who needs bladder training. Which intervention should the nurse recommend including in the patient's plan of care? 1. Explain Kegel exercises. 2. Advise to void when feels the urge. 3. Encourage to void frequently and often. 4. Schedule voiding every 2 to 3 hours while awake.

4. Schedule voiding every 2 to 3 hours while awake. Initially, voiding is usually scheduled every 2 to 3 hours while the patient is awake. Bladder retraining uses patient education, scheduled toileting, and positive reinforcement. With scheduled voiding, the patient is encouraged to delay voiding and void only at scheduled times. The length of time between voidings is gradually increased. Habit training allows the patient to void whenever the urge is present; bladder training involves delaying voiding. Kegel exercises are performed when pelvic muscle rehabilitation is ordered, not for bladder training.

Which teaching session indicates that the nurse has a correct understanding for teaching patients with urinary problems? 1. Teaches a male to remove the penile clamp once a week 2. Teaches a female to hold the vaginal cones for 5 minutes 3. Teaches a male to use reflex training by performing the Credé technique 4. Teaches a female to use clean technique when inserting a catheter at home

4. Teaches a female to use clean technique when inserting a catheter at home A clean technique rather than a sterile technique is usually taught for catheter use in the home setting. The patient begins with the lightest cone, inserts it, and tries to retain it for up to 15 minutes, not 5, twice daily. To prevent circulatory impairment and pressure sores, a penile clamp must be removed and repositioned frequently. Reflex training is sometimes used by people with a spinal cord injury. This technique uses the Valsalva maneuver, not the Credé technique, with rectal stretching to force urine from the bladder.

. A patient is incontinent of feces. The nurse cleanses the patient with soap and water as soon as possible. What is the primary rationale for the nurse's actions? 1. To increase self-esteem 2. To increase respirations 3. To prevent an impaction 4. To prevent skin breakdown

4. To prevent skin breakdown Cleansing prevents skin breakdown. Praise and grooming will help the self-esteem more than cleansing. Cleansing is to protect the skin, not to increase respirations. Cleansing does not prevent an impaction; fluids, fiber, and ambulation can help prevent an impaction. Text Reference - p. 359

A nurse must test a patient for postvoid residual. Which technique is best for the nurse to use? 1. Using a catheter 2. Using a blood test 3. Using a clean-catch 4. Using an ultrasound device

4. Using an ultrasound device The preferred method is the use of an ultrasound device that estimates the amount of urine remaining in the bladder after voiding. A second method is to catheterize the patient immediately after voiding and measure the amount of urine obtained by catheterization. A blood test and a urine clean-catch cannot determine postvoid residual. Text Reference - p. 349

A patient has urinary urge incontinence. Which intervention should the nurse implement? 1. Use the word diapers. 2. Show disapproval when wet. 3. Insert an indwelling catheter. 4. limit fluids 2 hours before bedtime.

4. limit fluids 2 hours before bedtime. For urge incontinence, limiting fluids 2 hours before bedtime is suggested. Advise caregivers not to refer to incontinence pads and undergarments as diapers, because of that term's association with infants. If the patient has an incontinent episode, those responsible for his or her care should be careful not to show disapproval. Indwelling catheters are usually not used for urge incontinence but can be used for overflow incontinence. Text Reference - p. 359