A nurse in a long-term facility is caring for an older adult client who has dementia and begins to have frequent episodes of urinary incontinence. After the provider determines no medical cause for the client’s incontinence, which of the following interventions should the nurse initiate to manage this behavior?
Take the client to the bathroom every 2 hr.
Request a prescription for an indwelling urinary catheter
Remind the client to tell the nurse when he has to urinate.
Use adult diapers to prevent frequent clothing changes.
The Correct Answer is A
Choice A reason: Scheduled toileting every 2 hours establishes a routine, compensating for dementia-related cognitive deficits in recognizing bladder cues. This promotes continence, reduces accidents, and maintains dignity, making it the most effective behavioral intervention.
Choice B reason: Indwelling catheters increase risks of urinary tract infections, skin breakdown, and discomfort, especially in dementia patients unable to communicate issues. They are a last resort, not appropriate for managing incontinence without medical necessity.
Choice C reason: Reminding a dementia patient to report urination needs is ineffective, as cognitive impairment limits their ability to recognize or communicate bladder signals. This approach does not address the underlying issue of incontinence.
Choice D reason: Adult diapers manage accidents but do not promote continence or address the behavior. They may reduce dignity and increase skin breakdown risk, making scheduled toileting a more proactive and dignified intervention.
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Related Questions
Correct Answer is D
Explanation
Choice A reason: Wiping from back to front risks introducing perianal bacteria into the urethra, contaminating the sample. Proper technique involves wiping front to back to minimize contamination, making this statement incorrect and indicative of misunderstanding.
Choice B reason: While menstruation may complicate urine collection, it is not an absolute contraindication. With proper technique (e.g., using a tampon), samples can be collected. This statement reflects a misconception and does not confirm understanding of midstream collection.
Choice C reason: Urine should be sent to the lab promptly or refrigerated to prevent bacterial growth or analyte degradation. Allowing it to cool to room temperature risks inaccurate results, so this statement demonstrates a lack of understanding of proper handling.
Choice D reason: Urinating a small amount into the toilet first flushes out urethral contaminants, ensuring a cleaner midstream sample. This technique is critical for accurate urinalysis or culture, confirming the client’s understanding of the taught procedure.
Correct Answer is B
Explanation
Choice A reason: Irrigating an NG tube requires sterile technique and assessment of patency, which are beyond the UAP’s scope. This task involves clinical judgment to avoid complications like aspiration, making it inappropriate for delegation.
Choice B reason: Assisting a client to the bathroom post-enema is within the UAP’s scope, involving mobility support and safety. This task does not require clinical judgment beyond ensuring the client’s stability, making it appropriate for delegation.
Choice C reason: Digital removal of stool is an invasive procedure requiring assessment for complications like vagal stimulation or rectal trauma. It is outside the UAP’s scope, as it demands nursing judgment and skill.
Choice D reason: Checking tube feeding aspirate pH and auscultating bowel sounds involve clinical assessment to confirm tube placement and gastrointestinal function. These tasks require nursing expertise and cannot be delegated to a UAP.
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