A nurse is reinforcing teaching for a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following should the nurse include in the teaching?

Choice a reason: Starting the flow of urine before passing the container under the stream to collect the specimen is an appropriate instruction. This technique is recommended to ensure that the initial part of the urine, which may contain contaminants from the urethral opening, is not collected. By allowing the first part of the urine to flow into the toilet, the midstream portion is considered cleaner and more representative for diagnostic testing.
Choice b reason: Removing the specimen container before stopping the stream of urine is also an appropriate instruction. This helps to ensure that only the midstream portion of the urine is collected, minimizing the risk of contamination from the skin or other surfaces. It also prevents the urine from splashing or overflowing, which could potentially contaminate the sample or the surrounding area.
Choice c reason: Using the provided towelette to cleanse the area by moving in a back-and-forth motion is incorrect and requires intervention. The proper technique for cleansing the area involves using the towelette to wipe from front to back in a single, continuous motion. This helps to reduce the risk of introducing bacteria from the perineal area into the urinary tract, which can lead to inaccurate test results or urinary tract infections.
Choice d reason: Instructing the client to use their non-dominant hand to spread the labia is an appropriate instruction. This technique helps to ensure that the urinary meatus is exposed and that the urine flows directly into the specimen container. Using the non-dominant hand allows the dominant hand to be used for holding and positioning the specimen container, making the process more manageable and reducing the risk of contamination.

Choice a reason: Encouraging fluid intake to increase urine output is not an appropriate intervention for managing urinary incontinence. While staying hydrated is important, increasing urine output can worsen incontinence symptoms. Clients should maintain a balanced fluid intake to prevent dehydration without exacerbating incontinence.
Choice b reason: Providing frequent reminders for the client to use the restroom is helpful for managing urinary incontinence. This intervention helps establish a regular voiding schedule, reducing the likelihood of accidents by encouraging the client to empty their bladder before it becomes too full.
Choice c reason: Encouraging the client to perform Kegel exercises regularly is highly effective for managing urinary incontinence. Kegel exercises strengthen the pelvic floor muscles, which support the bladder and urethra, improving control over urination and reducing episodes of incontinence. Regular practice of these exercises can lead to significant improvements in bladder control.
Choice d reason: Limiting the client's access to the restroom to promote bladder control is not appropriate. This approach can increase the risk of accidents and cause discomfort. Instead, clients should have easy access to the restroom to manage their incontinence effectively. Promoting regular restroom use and bladder training techniques is more beneficial.