Bladder Incontinence & Retention Pearson Mod 5.2
The nurse at a health fair is educating clients on risk factors associated with urinary incontinence. Which risk factor does the nurse include as a nonmodifiable risk factor for urinary incontinence? A) Age B) Obesity C) Smoking D) Diabetes
Answer: A Age is a nonmodifiable risk factor and is a primary risk factor for the development of urinary incontinence; older individuals experience more frequent incontinence than younger individuals. Obesity, smoking, diabetes, inactivity, pregnancy, and depression are all modifiable risk factors for urinary incontinence.
The nurse is assessing an adult client in a urology clinic. The client reports that she has been having "accidents" and expresses frustration about this "normal part of aging." Which response by the nurse is the most appropriate? A) "Tell me more about the incontinence you are experiencing." B) "You may need to have surgery to manage this problem." C) "I understand you are frustrated about this occurrence." D) "Unfortunately, aging and incontinence go hand in hand."
Answer: A As the body ages, there are anatomic changes that can increase the risk for urinary incontinence; however, this is not a normal part of aging. It is appropriate for the nurse to gather more information regarding the client's incontinence. It is beyond the nurse's scope of practice to recommend surgery to the client. Telling the client the nurse understands does not help to determine the cause of the client's incontinence.
The nurse is providing training for the clinical staff of a skilled care facility that primarily treats elderly clients. The nurse wants to include information on functional incontinence. Which risk factors for functional incontinence will the nurse include in the training? Select all that apply. A) Limited mobility B) Impaired vision C) Lack of access to facilities D) Dementia E) Urinary tract infection
Answer: A, B, C, D An immobilized client may experience incontinence if a call light is not within reach; a client with Alzheimer disease, along with other forms of dementia, may perceive the urge to void but be unable to interpret its meaning or respond by seeking a bathroom. A client with impaired vision may not be able to find the bathroom. Minimal facilities can create problems in urinary control. Urinary tract infection is not usually related to functional incontinence.
The nurse is caring for a client who will be discharged with an indwelling catheter. The nurse has provided education to the client and family in regard to catheter care once the client is discharged. Which client or family action indicates a correct understanding of the information presented? A) Hanging the drainage bag on a towel rod B) Taking a shower each day instead of taking a tub bath C) Restricting the amounts of fluids per day D) Emptying the drainage bag twice a day
Answer: B The client should take a shower rather than a tub bath because sitting in a tub allows bacteria to easily access the urinary tract. The drainage bag should be emptied regularly, not just once a day but at least three times a day. Hanging the drainage bag on the towel rod is too high. The drainage bag should be hung below the bladder. Adequate amounts of fluids should be consumed to help prevent sediments and infections.
The nurse is providing care to a client who is diagnosed with stress incontinence. Which data would nurse expect to collect during the client's health history and physical assessment? Select all that apply. A) Urine leakage while talking B) Urine leakage while coughing C) Urine leakage while laughing D) Skin breakdown on the buttock E) A urinary catheter
Answer: B, C, D Stress incontinence involves a small leakage of urine when a client laughs, coughs, or lifts something heavy, not if a client just carries on a conversation. A client with incontinence would wear some kind of undergarment pad; a urinary catheter is not an expected finding. If the client has been experiencing incontinence, the nurse might expect to see the skin inflamed and irritated because urine is very irritating to the skin.
The nurse is caring for a client with functional incontinence. Which conditions are factors in the development of this type of incontinence? Select all that apply. A) Fecal impaction B) Dementia C) Confusion D) Prostate surgery E) Impaired mobility
Answer: B, C, E Functional incontinence occurs when the ability to respond to the need to urinate is impaired. Contributing factors may include confusion, dementia, or impaired mobility. Fecal impaction is a contributing factor to overflow incontinence and prostate surgery is a contributing factor to stress incontinence.
The nurse conducts education for a client who is experiencing urinary incontinence. Which statement by the client indicates the need for further education? A) "Relaxation of pelvic muscles may be a factor in incontinence." B) "Reduced urethral resistance can be a cause of incontinence." C) "Incontinence is normal with aging." D) "A disturbance of my bladder is a factor in the development of incontinence."
Answer: C Age is a risk factor for incontinence, but incontinence is not a normal result of aging. A disturbance of the bladder, relaxation of the pelvic muscles, and reduced urethral resistance are all potential factors in the development of incontinence.
Urge incontinence is the involuntary loss of urine associated with a strong urge to void and an increased rate of urination. Which condition can contribute to urge incontinence? A) Weakness of the urethra and surrounding tissue leading to decreased urethral resistance B) Disruption to neuronal control of the sacral micturition centers due to tissue damage C) An overactive detrusor muscle leading to increased pressure within the bladder D) Outlet obstruction leading to the overfilling of the bladder and increased pressure
Answer: C An overactive detrusor muscle leading to increased pressure within the bladder is a contributor to urge incontinence. Weakness of the urethra and surrounding tissue leading to decreased urethral resistance is a contributor to stress incontinence. Disruption to neuronal control of the sacral micturition centers due to tissue damage is a contributor to reflex incontinence. Outlet obstruction leading to the overfilling of the bladder and increased pressure is a contributor to overflow incontinence.
The nurse is caring for a client with a history of chronic urinary tract infections. The nurse is planning care for this client based on the priority nursing diagnosis of urinary retention related to scarring. Based on this data, which treatment does the nurse anticipate from the healthcare provider? A) Antibiotic therapy B) An anticholinergic medication C) Intermittent straight catheterization D) Removal of bladder stones
Answer: C The healthcare provider may order straight catheterization so the client can be taught to self-catheterize and manage the urinary retention at home. Antibiotic therapy is not indicated, as the client does not have an infection now. Anticholinergic medications can cause urinary retention. Bladder stones are not the problem; scarring is.
The nurse is reviewing discharge instructions for a client diagnosed with urinary incontinence resulting from a urinary tract infection. Which statement made by the client indicates the need for further education? A) "I should drink plenty of water to prevent damage to my kidneys while I am on the antibiotics for the infection." B) "Drinking cranberry juice will decrease the risk for developing urinary tract infections." C) "I will contact the healthcare provider prior to taking over-the-counter medications while on my antibiotic." D) "I will continue to hold my urine while in public so that I do not get another infection."
Answer: D A client who is diagnosed with urinary incontinence secondary to a urinary tract infection will require specific education. The client who states that he or she will hold their urine while in public to decrease the risk of another infection requires more education. Urinary retention is a contributing factor to urinary tract infections. The other statements are appropriate and indicate appropriate understanding of the information presented.
The nurse is working in a urology clinic and is providing care for a client with stress urinary incontinence. The nurse has chosen the diagnosis of Stress Urinary Incontinence related to sphincter incompetence. Which is the desired outcome for a client with this diagnosis? A) The client will stop the flow of urine when voiding. B) The client will improve her incontinence within 1 month. C) The client will empty her bladder every time she voids. D) The client will perform 4-5 squeezes (Kegel exercises) for 10-15 seconds.
Answer: D Performing 4-5 squeezes for 10-15 seconds is the goal to start with when teaching a client Kegel exercises, which are used for stress and urge incontinence. Emptying the bladder completely every time she voids would not be realistic in the beginning. This will take time. Improved continence takes 3-6 months, so 1 month is not a realistic goal. Clients are not instructed to stop the flow of urine when voiding, because this could lead to retention.
