Nclex Review: Urinary Incontinence

The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included? 1. Avoid activities that are stressful and upsetting. 2. Avoid caffeine and alcohol. 3. Do not wear a girdle. 4. Limit physical exertion.

2. 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.

A client has stress incontinence. Which of the following data from the client's history contributes to the client's incontinence? 1. The client's intake of 2 to 3 L of fluid per day. 2. The client's history of three full-term pregnancies. 3. The client's age of 45 years. 4. The client's history of competitive swimming.

2. The history of three pregnancies is most likely the cause of the client's current episodes of stress incontinence. The client's fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.

A client has urge incontinence. When obtaining the health history, the nurse should ask if the client has: 1. Inability to empty the bladder. 2. Loss of urine when coughing. 3. Involuntary urination with minimal warning. 4. Frequent dribbling of urine.

3. 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.

The primary goal of nursing care for a client with stress incontinence is to: 1. Help the client adjust to the frequent episodes of incontinence. 2. Eliminate all episodes of incontinence. 3. Prevent the development of urinary tract infections. 4. Decrease the number of incontinence episodes.

4. 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.

What should the nurse teach the client to do to prevent stress incontinence? Select all that apply. 1. Use techniques that strengthen the sphincter and structural supports of the bladder, such as Kegel exercises. 2. Avoid dietary irritants (e.g., caffeine, alcoholic beverages). 3. Not to laugh when in social gatherings. 4. Carry an extra incontinence pad when away from home. 5. Obtain a fluid intake of 500 mL/ day.

1, 2. 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.

Which of the following interventions would be most appropriate for a client who has urge incontinence? 1. Have the client urinate on a timed schedule. 2. Provide a bedside commode. 3. Administer prophylactic antibiotics. 4. Teach the client intermittent self-catheterization technique.

1. 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.