You are taking care of an older female adult with severe cognitive impairments. She is unable to tell you when she needs to urinate and, as a result, is often incontinent. What do you realize she is experiencing?

Choice A reason: This statement is incorrect because wellness is not only dependent on the absence of disease, but also on the physical, mental, emotional, social, and spiritual aspects of health. The nurse should educate the client on how to cope with his condition and enhance his quality of life, not focus on the negative aspects of his disease.

Choice B reason: This statement is incorrect because aggressive medical interventions may not be appropriate or beneficial for a terminally ill client. The nurse should respect the client's wishes and preferences regarding his care, and provide comfort and palliative measures, not cause unnecessary pain or suffering.

Choice C reason: This statement is incorrect because wellness is still a real option for a terminally ill client. The nurse should not assume that the client has given up on his health or happiness, but rather support him in finding meaning and purpose in his life, and achieving his goals and values.

Choice D reason: This statement is correct because it reflects the nurse's role in promoting wellness for a terminally ill client. The nurse should provide nursing interventions that can help the client maintain his dignity, autonomy, and sense of control, as well as address his physical, emotional, social, and spiritual needs. The nurse should also empower the client to make informed decisions about his care, and facilitate his communication with his family and health care team.

Choice A reason: Functional incontinence refers to a situation in which the lower urinary tract is intact, but the individual is unable to reach the toilet because of environmental barriers, physical limitations, or severe cognitive impairment. This is the most likely type of incontinence for an older female adult with severe cognitive impairments, as she may not be aware of her bladder sensations, forget where the bathroom is, or have difficulty communicating her needs.

Choice B reason: Stress incontinence is when urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the weakening of the pelvic floor muscles and the urethral sphincter.

Choice C reason: Postvoid residual is when the bladder does not empty completely after urination, causing frequent or constant dribbling of urine. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the obstruction of the bladder outlet, the underactivity of the bladder muscle, or the dysfunction of the bladder nerves.

Choice D reason: Urge incontinence is when you have a sudden, intense urge to urinate followed by an involuntary loss of urine. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the overactivity of the bladder muscle, the irritation of the bladder lining, or the infection of the urinary tract.

Choice E reason: None of the above is not the correct answer, as there is one choice that is the most likely type of incontinence for an older female adult with severe cognitive impairments.