The nurse is caring for a 75-year-old client following repair of a femur fracture five days ago. Since surgery, the client has been experiencing frequent episodes of urinary incontinence. The client states, "I've never had this problem. I don't understand why this is happening now." What is the best response from the nurse?
"When you aren't up and moving your bladder becomes hyperactive, the increased bladder activity can cause urine to overflow."
"When you lay in bed for extended periods, your bladder, which is made of muscle, can lose its tone, resulting in loss of control."
"When you lay in a flat position for too long, pressure builds up in the bladder causing spasms and urine leakage."
"When you don't get enough fluids, your bladder doesn't fill enough causing a loss of muscle tone and control."
The Correct Answer is B
A. "When you aren't up and moving your bladder becomes hyperactive, the increased bladder activity can cause urine to overflow.": Hyperactivity and overflow incontinence are distinct pathophysiological mechanisms. Immobility does not typically trigger detrusor instability or hyperactive contractions. Overflow is usually caused by an obstruction or an acontractile bladder rather than simple physical inactivity.
B. "When you lay in bed for extended periods, your bladder, which is made of muscle, can lose its tone, resulting in loss of control.": Prolonged immobility leads to deconditioning of the detrusor muscle and the pelvic floor. In the elderly, bed rest rapidly diminishes the ability of the bladder to store urine effectively and maintain urethral pressure. This explains the sudden onset of functional and urge-related incontinence.
C. "When you lay in a flat position for too long, pressure builds up in the bladder causing spasms and urine leakage.": While supine positioning can change intra-abdominal pressure, it does not cause localized bladder spasms in a healthy organ. The issue is more related to global muscle atrophy and loss of neurological coordination. Spasms are usually indicative of infection or irritation.
D. "When you don't get enough fluids, your bladder doesn't fill enough causing a loss of muscle tone and control.": Low fluid intake actually irritates the bladder lining due to concentrated urine, potentially causing urgency, but it does not cause muscle tone loss. Incontinence in an immobile post-operative patient is primarily a result of skeletal and smooth muscle deconditioning.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["1.25"]
Explanation
Dose prescribed /Dose available=Amount to administer
25mg20mg/ml=1.25ml
Correct Answer is ["A","C","D"]
Explanation
A. urinary stasis. Prolonged bed rest prevents complete bladder emptying due to the loss of gravity-assisted voiding in the supine or semi-fowler position. Residual urine serves as a stagnant medium that promotes the rapid proliferation of uropathogenic bacteria like Escherichia coli. This stagnation is a primary precursor for ascending urinary tract infections in immobile patients.
B. abdominal distention. While gaseous or fluid accumulation in the peritoneal cavity may cause discomfort, it does not directly facilitate bacterial colonization of the urothelium. Distention is typically associated with gastrointestinal pathology or obstructive ileus rather than renal or vesical infection. It is an unrelated clinical finding regarding the risk factors for cystitis.
C. a decreased fluid intake. Insufficient oral hydration results in low urinary output and increased concentration of solutes within the bladder. Reduced crystalline and bacterial flushing allows microbes to adhere more effectively to the bladder wall mucosa. Dilute urine and frequent micturition are necessary to mechanically clear pathogens from the urinary system.
D. recent episodes of diarrhea. Fecal incontinence or frequent loose stools increase the likelihood of perineal contamination by enteric gram-negative bacilli. The short female urethra or proximity of the anus to the urinary meatus facilitates the migration of these pathogens. Poor hygiene following diarrheal episodes significantly elevates the risk of urethral inoculation.
E. pressure injury at the right ischial tuberosity. A localized skin breakdown over a bony prominence indicates impaired tissue integrity but is not a direct source for bladder infection. While it reflects poor overall mobility, the wound itself does not provide a physiological pathway for bacteria to enter the urinary tract. It is a separate integumentary complication of prolonged immobility.
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