A nurse is providing teaching to a client who has stress incontinence. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
"Perform Kegel exercises several times daily."
"Take prescribed diuretics no later than 2000."
"Maintain a daily fluid intake of 1,000 to 1,200 mL/day."
"Attempt to void every 2 hours."
"Maintain optimal body weight for height."
Correct Answer : A,D,E
Rationale:
A. "Perform Kegel exercises several times daily.": Kegel exercises strengthen pelvic floor muscles, improving bladder control and reducing stress incontinence episodes. Regular practice is essential for effectiveness.
B. "Take prescribed diuretics no later than 2000.": Limiting evening diuretic use helps reduce nighttime incontinence but does not address stress incontinence, which is triggered by increased intra-abdominal pressure, not fluid timing.
C. "Maintain a daily fluid intake of 1,000 to 1,200 mL/day.": Restricting fluids excessively can lead to concentrated urine and urinary tract irritation. Adequate hydration is important; fluid restriction is not recommended for stress incontinence.
D. "Attempt to void every 2 hours.": Scheduled voiding helps prevent bladder overfilling, reducing leakage episodes and improving bladder control. This is an effective behavioral strategy.
E. "Maintain optimal body weight for height.": Excess weight increases intra-abdominal pressure, which can worsen stress incontinence. Maintaining a healthy weight helps reduce strain on pelvic floor muscles.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Conduct the assessment before drying the newborn: Performing the assessment before drying exposes the newborn’s wet skin to cooler air and surfaces, increasing heat loss through evaporation, not conduction. The newborn should always be thoroughly dried immediately after birth to conserve body heat.
B. Check the newborn's rectal temperature every hr: Frequent temperature monitoring does not prevent heat loss; it only identifies hypothermia after it occurs. Additionally, rectal temperature measurement may cause mucosal injury and is not routinely recommended for newborns.
C. Place the newborn in an open crib for the initial assessment: Placing the newborn in an open crib exposes the infant to cooler air and surfaces, increasing heat loss through convection and conduction. The initial assessment should occur under a radiant warmer to maintain thermal stability.
D. Cover scale with warm blankets when weighing the newborn: Covering the scale prevents conduction heat loss, which occurs when the newborn’s skin comes into contact with cold surfaces. Using a warm blanket or pad ensures the infant’s body heat is preserved during weighing or handling.
Correct Answer is A
Explanation
Rationale:
A. Sore throat: A sore throat can indicate agranulocytosis, a potentially life-threatening adverse effect of clozapine. Prompt monitoring of WBC counts and reporting symptoms such as fever or sore throat is essential to prevent serious infection.
B. Tinnitus: Tinnitus is not a common or severe adverse effect of clozapine. While it may be bothersome, it does not require immediate reporting to the provider in the context of clozapine therapy.
C. Rhinitis: Mild nasal congestion or rhinitis can occur with clozapine use but is generally not dangerous or indicative of a serious complication. Monitoring is routine, but urgent reporting is not required.
D. Headache: Headaches are a common, nonspecific side effect and do not typically indicate a life-threatening reaction. Routine assessment and symptom management are appropriate.
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