A nurse is initiating bladder retraining for a client who has urge urinary incontinence. Which of the following instructions should the nurse give the client?
“Take your diuretic medication with your evening meal."
"Decrease your intake of cranberry juice."
"Plan to urinate every 3 hours while you are awake"
“Limit your fluid intake to 500 milliliters per day."
The Correct Answer is C
A. “Take your diuretic medication with your evening meal." Taking diuretics in the evening can increase nighttime urination, worsening sleep disruption and incontinence. They should generally be taken in the morning to minimize nocturia.
B. "Decrease your intake of cranberry juice." Cranberry juice is often recommended to promote urinary tract health, though it doesn’t directly worsen urge incontinence. It is not necessary to avoid it unless advised by a provider for another reason.
C. "Plan to urinate every 3 hours while you are awake." Scheduled voiding at regular intervals is a key strategy in bladder retraining. It helps reduce urgency episodes and gradually increases bladder capacity and control over time.
D. “Limit your fluid intake to 500 milliliters per day." Severely limiting fluids can lead to dehydration, concentrated urine, and bladder irritation, potentially worsening incontinence. Adequate fluid intake should be maintained unless otherwise directed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Urinary output 120 mL/4 hr. This is on the lower end of normal but not critical. It should be monitored, especially in clients on opioids, but does not require immediate reporting ahead of more life-threatening findings.
B. Pupil diameter 6 mm. Dilated pupils may suggest other issues such as anxiety, medication effects, or pain, but are not a common concern with morphine, which usually causes miosis (pupil constriction). Still, this is not the most urgent concern.
C. Bowel movement 5 days ago. Constipation is a common side effect of opioids, including morphine, and should be addressed with stool softeners or laxatives. However, it is not an emergency.
D. Blood pressure 80/40 mm Hg. This indicates hypotension, a potentially life-threatening side effect of IV morphine, especially if it results in decreased perfusion or shock. It requires immediate intervention and provider notification.
Correct Answer is C
Explanation
A. Remove the safety inspection sticker before plugging in the IV pump. The safety inspection sticker is proof that the equipment has passed a required check. It should not be removed, as doing so may violate facility policies and regulatory standards.
B. Grasp the IV pump cord when unplugging it from the electrical outlet. Pulling on the cord rather than the plug itself can damage the cord or outlet and pose an electrical hazard. Always unplug by gripping the plug directly.
C. Check the cords of the IV pump for fraying. Inspecting cords for fraying or damage is essential before using any electrical equipment. Damaged cords can lead to electric shock, equipment failure, or fire, and must be reported and replaced.
D. Ensure that the electric outlet has two prongs for the IV pump. Medical equipment should be plugged into a three-pronged (grounded) outlet to prevent electrical shock. Two-prong outlets are not grounded and are inappropriate for hospital-grade devices.
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