A nurse is caring for a client who has urinary leakage due to nerve damage following a spinal cord injury. The nurse should identify that the client is experiencing which of the following types of urinary incontinence?
Overflow incontinence
Urge incontinence
Stress incontinence
Reflex incontinence
The Correct Answer is D
Choice A reason: Overflow incontinence is not the type of urinary incontinence that the client is experiencing. Overflow incontinence occurs when the bladder is overfilled and cannot empty properly, causing frequent or constant dribbling of urine. It can be caused by a blockage in the urinary tract, such as an enlarged prostate or a kidney stone, or by a weak bladder muscle that cannot contract enough to empty the bladder.
Choice B reason: Urge incontinence is not the type of urinary incontinence that the client is experiencing. Urge incontinence occurs when the bladder muscle contracts involuntarily and causes a sudden and strong urge to urinate, followed by an involuntary loss of urine. It can be caused by an infection, a neurological disorder, or an overactive bladder.
Choice C reason: Stress incontinence is not the type of urinary incontinence that the client is experiencing. Stress incontinence occurs when the pelvic floor muscles or the urethral sphincter are weakened or damaged and cannot hold urine in the bladder when there is increased abdominal pressure, such as from coughing, sneezing, laughing, or exercising. It can be caused by pregnancy, childbirth, menopause, or surgery.
Choice D reason: Reflex incontinence is the type of urinary incontinence that the client is experiencing. Reflex incontinence occurs when the bladder muscle contracts without the sensation or control of the person, causing urine to leak without warning or awareness. It can be caused by nerve damage that affects the communication between the bladder and the brain, such as from a spinal cord injury, a stroke, or multiple sclerosis..
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: "I will be able to tell how much oxygen I'm getting by looking at the flowmeter." This statement is correct because the flowmeter shows the amount of oxygen delivered in liters per minute. The client should check the flowmeter regularly and adjust it according to the prescription.
Choice B reason: "I should call my doctor if I find it harder to concentrate." This statement is correct because difficulty concentrating can be a sign of low oxygen levels or carbon dioxide retention. The client should monitor their symptoms and report any changes to their doctor.
Choice C reason: "I will wear synthetic clothing and woolen socks when using my oxygen." This statement is incorrect because synthetic clothing and woolen socks can create static electricity and increase the risk of fire when using oxygen. The client should wear cotton clothing and avoid materials that can cause sparks.
Choice D reason: "I will make sure my visitors smoke outside." This statement is correct because smoking near oxygen can cause a fire or explosion. The client should keep oxygen away from open flames, smoking materials, and heat sources.
Correct Answer is B
Explanation
Choice A reason: Eliciting the gag reflex is not a valid way to assess cranial nerve III. The gag reflex is a protective mechanism that prevents choking or aspiration by triggering a contraction of the pharyngeal muscles when the back of the throat is stimulated. The gag reflex is mediated by cranial nerves IX and X, not III.
Choice B reason: Checking the pupillary response to light is a reliable way to assess cranial nerve III. The pupillary response to light is a reflex that causes the pupil to constrict when exposed to bright light and dilate when exposed to dim light. This reflex helps to regulate the amount of light that enters the eye and protects the retina from damage. The pupillary response to light is controlled by cranial nerve III, which innervates the sphincter pupillae muscle that constricts the pupil.
Choice C reason: Observing for facial symmetry is not a relevant way to assess cranial nerve III. Facial symmetry is the degree of similarity between the two halves of the face. Facial symmetry can be affected by various factors, such as genetics, aging, or facial nerve palsy. Facial nerve palsy is a condition that causes weakness or paralysis of the muscles that control facial expression. Facial nerve palsy is caused by damage to cranial nerve VII, not III.
Choice D reason: Testing visual acuity is not a sufficient way to assess cranial nerve III. Visual acuity is the ability to see fine details and distinguish objects at a distance. Visual acuity depends on various factors, such as the clarity of the lens and cornea, the shape of the eyeball, and the function of the retina. Visual acuity is mainly affected by cranial nerve II, which carries visual information from the retina to the brain. Cranial nerve III does not directly influence visual acuity, but it does innervate some of the muscles that move the eye and enable binocular vision.
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