A nurse is implementing a bladder-training program for a client. For which of the following actions by the assistive personnel (AP) who is helping with the client's care should the nurse intervene?

Encourages oral fluid intake during waking hours

Assists the client to the bathroom every 2 hr

Offers the opportunity to urinate 15 min prior to bathing

Instructs the client to urinate whenever the urge occurs

Answer and Explanation

The Correct Answer is D

Choice A reason: Encourages oral fluid intake during waking hours is not an action that the nurse should intervene. Encouraging oral fluid intake during waking hours is a part of a bladder-training program, as it helps to maintain adequate hydration and prevent urinary tract infections. The nurse should instruct the AP to limit the client's fluid intake before bedtime, as it may cause nocturia and disrupt the bladder-training schedule.

Choice B reason: Assists the client to the bathroom every 2 hr is not an action that the nurse should intervene. Assisting the client to the bathroom every 2 hr is a part of a bladder-training program, as it helps to establish a regular pattern of voiding and reduce the risk of incontinence. The nurse should instruct the AP to gradually increase the interval between bathroom visits, as the client's bladder capacity and control improve.

Choice C reason: Offers the opportunity to urinate 15 min prior to bathing is not an action that the nurse should intervene. Offering the opportunity to urinate 15 min prior to bathing is a part of a bladder-training program, as it helps to prevent the stimulation of the micturition reflex by warm water and reduce the risk of accidental voiding. The nurse should instruct the AP to avoid giving the client diuretics, caffeine, or alcohol, as they may increase the urine output and frequency.

Choice D reason: Instructs the client to urinate whenever the urge occurs is an action that the nurse should intervene. Instructing the client to urinate whenever the urge occurs is not a part of a bladder-training program, as it does not help to improve the bladder function and may worsen the urge incontinence. The nurse should instruct the AP to teach the client some techniques to suppress the urge, such as pelvic floor exercises, deep breathing, or distraction.

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Correct Answer is ["A","D","E"]

Explanation

Choice A: Iron supplements are used to treat iron-deficiency anemia, but they can also reduce the motility of the gastrointestinal tract and make the stools harder and drier¹². This can lead to difficulty in passing stools and increased straining.
Choice B: Magnesium-containing antacids are used to treat heartburn and acid reflux, but they can also have a laxative effect and cause diarrhea¹³. This is because magnesium draws water into the intestines and stimulates bowel movements.
Choice C: Antibiotics are used to treat bacterial infections, but they can also disrupt the normal flora of the gut and cause diarrhea¹⁴. This is because antibiotics can kill the beneficial bacteria that help digest food and prevent the overgrowth of harmful bacteria that cause inflammation and infection.
Choice D: Anticholinergics/antispasmodics are used to treat overactive bladder, irritable bowel syndrome, and other conditions that involve muscle spasms in the gut, but they can also slow down the movement of the intestines and relax the muscles that help push the stools out¹ . This can lead to reduced frequency and difficulty in defecation.
Choice E: Opioid narcotics are used to treat moderate to severe pain, but they can also block the signals from the brain to the gut and inhibit the contraction of the intestinal muscles¹ . This can lead to decreased bowel activity and accumulation of hard and dry stools.

A. Metabolic alkalosis B. Respiratory acidosis C. Respiratory alkalosis D. Metabolic acidosis

Correct Answer is B

Explanation

Choice A reason: Metabolic alkalosis is a condition in which the blood pH is elevated due to an excess of bicarbonate or a loss of acid. It can be caused by vomiting, diuretics, or excessive antacid intake. It is not associated with COPD.

Choice B reason: Respiratory acidosis is a condition in which the blood pH is lowered due to an accumulation of carbon dioxide. It can be caused by hypoventilation, airway obstruction, or lung diseases such as COPD. It is the most common acid-base imbalance in COPD patients.

Choice C reason: Respiratory alkalosis is a condition in which the blood pH is elevated due to a loss of carbon dioxide. It can be caused by hyperventilation, anxiety, fever, or aspirin overdose. It is not common in COPD patients.

Choice D reason: Metabolic acidosis is a condition in which the blood pH is lowered due to an excess of acid or a loss of bicarbonate. It can be caused by diabetic ketoacidosis, renal failure, or lactic acidosis. It is not directly related to COPD.

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