A nurse is planning a low-protein diet for a client who has chronic renal failure.
The client states, "Why do I have to be concerned with protein?". Which of the following responses is appropriate?

Choice A rationale

Requesting an indwelling urinary catheter is highly discouraged for managing incontinence in clients with dementia due to the significant risk of Catheter-Associated Urinary Tract Infections (CAUTIs). The catheter provides a conduit for microbial entry, bypassing normal defense mechanisms, thus dramatically increasing morbidity and potentially mortality in the elderly.

Choice B rationale

Using adult diapers as a primary strategy for incontinence can negatively impact skin integrity, leading to moisture-associated dermatitis and pressure injuries due to prolonged contact with urine. Furthermore, this approach fails to engage any remaining bladder control or cognitive function, potentially hastening dependency.

Choice C rationale

Implementing an every-2-hr toileting schedule (timed voiding) is a behavioral intervention that bypasses the need for the client with dementia to verbally communicate the urge to void, which is often impaired. This proactive strategy prevents the bladder from becoming over-distended, thereby reducing the likelihood of a high-volume incontinence episode.

Choice D rationale

Reminding a client with dementia to communicate the need to void is ineffective because their cognitive impairment, particularly in the cerebral cortex, often disrupts the neuronal pathways necessary for sensing bladder fullness and executing the motor and verbal request for assistance. This approach does not address the underlying neurological deficit.

Choice A rationale

Enoxaparin sodium is a low molecular weight heparin (LMWH) that is administered subcutaneously, preferably into the anterolateral or posterolateral abdominal wall. Injection should be given at least two inches away from the umbilicus, surgical scars, and other lesions to ensure good absorption and minimize hematoma risk. This site has ample subcutaneous tissue for absorption.

Choice B rationale

Massaging the injection site following the administration of enoxaparin is contraindicated. The mechanical action of massage can increase the risk of bruising and hematoma formation at the injection site due to its anticoagulant properties, as it can disrupt local blood vessels and increase drug dispersion.

Choice C rationale

Subcutaneous injections typically utilize a shorter needle, often 5/8 inch, to deposit the medication into the subcutaneous tissue layer. A 1-inch needle is typically used for intramuscular (IM) injections, which would deliver the enoxaparin too deeply, potentially causing unnecessary discomfort and poor absorption.

Choice D rationale

Subcutaneous injections are typically administered with a 25-gauge or 27-gauge needle to minimize tissue trauma and pain. A 22-gauge needle is larger (has a wider lumen) and is typically used for thicker intramuscular injections or intravenous access, making it inappropriate for the intended subcutaneous route.