A nurse is caring for four clients.

After administering morning medications, she realizes that the nifedipine (Procardia) prescribed for one client was inadvertently administered to another client.

Which of the following actions should the nurse take first?

Choice A rationale

Anticholinergic medications, such as oxybutynin or tolterodine, are typically used to treat urge incontinence by blocking muscarinic receptors in the bladder, which decreases involuntary detrusor muscle contractions. While they may be considered for mixed or severe stress incontinence, non-pharmacological behavioral therapies, like timed voiding and pelvic floor muscle exercises (Kegels), are the initial, first-line interventions due to their low risk.

Choice B rationale

Voiding immediately prior to activities that increase intra-abdominal pressure, like playing tennis or sneezing, is a primary, first-line behavioral strategy for managing stress incontinence. This action ensures the bladder volume is minimized, reducing the pressure exerted on the urethral sphincter and consequently decreasing the likelihood and volume of urine loss during the activity.

Choice C rationale

Choosing more supportive undergarments, such as specialized incontinence pads or absorbent liners, addresses the management of urine leakage but does not address the underlying cause or provide a preventative strategy for the stress incontinence itself. While helpful for comfort and hygiene, this is a secondary measure, not the initial treatment of choice.

Choice D rationale

Restricting calcium-containing foods is not an established or beneficial intervention for stress incontinence. Dietary restrictions are mainly focused on bladder irritants like caffeine, alcohol, and acidic foods. Furthermore, restricting calcium intake is detrimental to bone health, especially in post-menopausal women who are already at risk for osteoporosis.

Choice A rationale

Bisacodyl (Dulcolax) is a stimulant laxative that acts by irritating the colon mucosa, increasing peristalsis, and promoting fluid accumulation in the colon to facilitate a bowel movement. Therefore, it is used to treat constipation, not diarrhea. Diarrhea management often involves antidiarrheal agents like loperamide or fluid replacement.

Choice B rationale

Bisacodyl is correctly prescribed for the management of constipation, which is characterized by infrequent bowel movements, difficulty passing stools, or hard stools. As a stimulant laxative, it works directly on the nerve plexuses in the bowel wall to enhance colonic motility, typically producing a bowel movement within 6 to 12 hours after oral administration.

Choice C rationale

Bisacodyl is used to relieve the symptom of constipation, and while abdominal discomfort can be a part of constipation, the medication is not a primary treatment for generalized abdominal pain of unknown etiology. Furthermore, excessive use or high doses of bisacodyl can sometimes cause or worsen abdominal cramping.

Choice D rationale

Fecal incontinence is the involuntary passage of stool, which can result from various conditions such as nerve damage or sphincter dysfunction. Bisacodyl, a laxative, would exacerbate fecal incontinence by promoting a bowel movement, making this an inappropriate and potentially harmful indication for its use.