A nurse is reinforcing bladder management instructions with a client who has urinary incontinence. Which of the following statements by the client indicates an understanding?
"I should use the bathroom at set times during the day."
"I can insert a catheter in my bladder at bedtime."
"I should stop drinking fluids an hour before bedtime."
"I can continue to drink coffee every day."
The Correct Answer is A
A. "I should use the bathroom at set times during the day.": Timed voiding or scheduled toileting helps manage urinary incontinence by training the bladder and reducing episodes of urgency. This strategy promotes better bladder control and prevents accidents. Following a consistent schedule supports the effectiveness of bladder management interventions.
B. "I can insert a catheter in my bladder at bedtime.": Intermittent or indwelling catheterization carries risks of infection and is not recommended as a routine nightly practice for managing incontinence. Catheter use should be reserved for specific medical indications and performed under sterile technique.
C. "I should stop drinking fluids an hour before bedtime.": While reducing fluid intake before sleep may decrease nighttime urination, limiting fluids too aggressively can lead to dehydration and concentrated urine, which may irritate the bladder. Proper bladder management emphasizes scheduled voiding rather than fluid restriction alone.
D. "I can continue to drink coffee every day.": Caffeine is a bladder irritant and can worsen urgency and incontinence. Daily consumption may counteract bladder management strategies. Avoiding or limiting caffeinated beverages is recommended to reduce symptoms and improve control.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Use a standard enema set to irrigate the colostomy: Standard enema sets are not designed for colostomy irrigation and may cause injury to the stoma or colon. Special colostomy irrigation equipment should be used according to prescribed guidelines.
B. Cleanse the skin surrounding the stoma with moisturizing soap: Moisturizing soaps leave a residue that can interfere with the adhesive seal of the ostomy appliance. The skin should be cleansed with mild, non-moisturizing soap and water to maintain adhesion and prevent leaks.
C. Cut the opening in the skin barrier 1/4 inch larger than the stoma: The skin barrier should fit snugly around the stoma to protect peristomal skin. Cutting it larger than the stoma can expose the skin to effluent, increasing the risk of irritation and breakdown.
D. Empty the pouch when it is 1/3 to 1/2 full: Emptying the pouch before it becomes overly full prevents leaks, reduces odor, and decreases the weight pulling on the appliance. This practice supports skin integrity and overall ostomy management.
Correct Answer is B
Explanation
A. Oropharyngeal airway: An oropharyngeal airway is used to maintain an open airway in clients who cannot protect their own airway, not for performing suctioning. It does not assist with clearing secretions and would not replace the function of suction equipment in the home setting.
B. Yankauer catheter: A Yankauer catheter is specifically designed for oropharyngeal suctioning because its rigid tip safely removes oral secretions without damaging tissue. It allows the client or caregiver to maintain airway clearance effectively at home. This is the appropriate device needed for routine oral suctioning.
C. Sterile gloves: While gloves are necessary for infection control, suctioning in the home typically requires clean rather than sterile technique. The environment does not require sterile supplies, and the priority is having the correct suction device available.
D. Water-soluble lubricant: Lubricant is used for procedures such as nasopharyngeal or endotracheal suctioning to reduce tissue irritation. Oropharyngeal suctioning with a Yankauer does not require lubrication because the catheter is inserted only into the mouth. Therefore, lubricant is unnecessary for this procedure.
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