Reflex incontinence is associated with neurologic dysfunction and occurs when no warning or stress precedes periodic involuntary urination.

"You are experiencing stress incontinence. Do you know how to do Kegel exercises?"

"You are experiencing transient incontinence. Have you been administered diuretics or IV fluids lately?"

"You are experiencing total incontinence. Have you had any surgeries or trauma that may be causing this?"

"You are experiencing reflex incontinence. Have you had a spinal cord injury in the past?"

Answer and Explanation

The Correct Answer is D

Choice A rationale: Stress incontinence is characterized by involuntary urine leakage during activities that increase intra-abdominal pressure, such as coughing or sneezing.
Choice B rationale: Transient incontinence is temporary and often related to factors like medications or medical conditions.
Choice C rationale: Total incontinence refers to continuous and unpredictable leakage of urine.
Choice D rationale: Reflex incontinence is associated with neurologic dysfunction, and the lack of warning or stress preceding involuntary urination aligns with this description.

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Correct Answer is D

Explanation

Choice A rationale: Purulent drainage is thick and opaque, often indicating infection.
Choice B rationale: Serous drainage is thin and watery, typically clear or slightly yellow.
Choice C rationale: Sanguineous drainage is bright red and indicates fresh bleeding.
Choice D rationale: Serosanguineous drainage is thin and pale pink-yellow, representing a mixture of serous and sanguineous components.

A. Deep Tissue Injury B. Stage III Pressure Ulcer C. Unstageable Ulcer D. Stage IV Pressure Ulcer

Correct Answer is A

Explanation

Choice A rationale: A deep tissue injury involves intact skin with a purple or maroon localized area of discolored, non-blanchable, deep red or maroon, or a blood-filled blister due to damage of underlying soft tissue from pressure or shear. It is a stage that is more appropriate for the described wound involving the epidermis and dermis.
Choice B rationale: Stage III pressure ulcers involve full-thickness tissue loss, but they do not involve the epidermis and dermis.
Choice C rationale: Unstageable ulcers are covered with slough or eschar, making it difficult to determine the depth of tissue involvement. In this case, the wound's description indicates involvement of the epidermis and dermis.
Choice D rationale: Stage IV pressure ulcers involve full-thickness tissue loss with exposed bone, tendon, or muscle, not just the epidermis and dermis.

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Reflex incontinence is associated with neurologic dysfunction and occurs when no warning or stress precedes periodic involuntary urination.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse caring for a postoperative client observes the drainage in the client's closed wound drainage system. The drainage is thin with a pale pink-yellow color. The nurse documents the drainage as:

Correct Answer is D

Explanation

A nurse is completing a chart audit and finds the following wound documented as a Stage I Pressure Ulcer. The nurse recognizes this is incorrect. How should the wound have been classified?

Correct Answer is A

Explanation

A nurse is assessing a client who has a wound that is healing by first intention. Which of the following findings should the nurse expect?

The nurse uses gait belts when assisting clients to ambulate. Which client would be a likely candidate for this assistive device?

A nurse is teaching a client about the nutritional requirements necessary to promote wound healing. Which of the following nutrients should the nurse include in the teaching?

A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider?

A nurse working in long-term care facility is assessing residents at risk for the development of a pressure injury. Which resident would be most at risk?

A nurse is caring for a client and observes that the client's urine is dark amber, cloudy, and has an unpleasant odor. The nurse should recognize that these findings are associated with which of the following?

A nurse is providing education for an older adult client who reports constipation. Which of the following instructions should the nurse include in the teaching?

A client tells the nurse that he takes laxatives every day but is still constipated. The nurse's response is based on which reasoning?