The nurse is reviewing the prescriptions for a client with severe pain from renal colic.
Which of the following prescriptions should the nurse implement first?

Choice A rationale

Medications, such as phosphodiesterase type-5 inhibitors (e.g., sildenafil), are typically the next line of treatment for erectile dysfunction (ED) after lifestyle modifications fail. These agents enhance blood flow to the penile tissues during sexual stimulation by inhibiting the breakdown of cyclic guanosine monophosphate, facilitating erectile function.

Choice B rationale

Negative-pressure devices, also known as vacuum erection devices, are considered third-line treatments and are typically used in clients for whom oral medications are contraindicated or have failed. These devices work by mechanically increasing blood flow to the penis but are less effective than pharmacological interventions.

Choice C rationale

Penile injections, such as alprostadil, are invasive and used as a later option when oral medications and devices are unsuccessful or contraindicated. These injections directly relax the smooth muscle to increase penile blood flow, but they are generally not first-line treatments.

Choice D rationale

Penis transplants are experimental and not recognized as a standard treatment for erectile dysfunction. This option is far from practical or feasible and is considered unsuitable for most clients, especially given the complexity of the condition.

Choice A rationale

Decreasing caffeine intake is a proven method for managing urinary incontinence. Caffeine stimulates bladder activity, potentially worsening symptoms. Reducing caffeine to one cup per day can decrease urgency and frequency. This recommendation aligns with the scientific understanding that caffeine is a bladder irritant and is supported by clinical guidelines on managing urinary incontinence.

Choice B rationale

Grapefruit juice is acidic and can irritate the bladder lining, worsening urinary incontinence symptoms. Substituting orange juice with grapefruit juice does not address the problem, as both are acidic and contain bladder irritants. Citrus juices, including grapefruit and orange, are often advised against for patients managing urinary incontinence due to their potential to exacerbate symptoms.

Choice C rationale

Kegel exercises strengthen the pelvic floor muscles, enhancing bladder control and reducing incontinence episodes. This evidence-based practice is recommended for individuals with urinary incontinence. Regular Kegel exercise improves urinary sphincter function and supports the overall health of pelvic muscles, which is key for managing incontinence.

Choice D rationale

Establishing a fixed schedule for bathroom visits can prevent overdistension of the bladder and manage symptoms of urinary incontinence effectively. Timed voiding helps train the bladder and reduce episodes of urgency or leakage. It is widely supported as part of behavioral therapy for urinary incontinence management.