What would be the best nursing action to facilitate bladder continence for the client who is cognitively impaired?

Offer toileting reminders every 2 hours

Provide clothing that is easy to manipulate

Explain the need to call for the nurse to help with toileting

Encourage avoidance of fluids between meals

Answer and Explanation

The Correct Answer is A

A. Offer toileting reminders every 2 hours: This is the best nursing action because it helps prevent urinary incontinence by prompting the client to use the bathroom regularly. Clients with cognitive impairment may have difficulty recognizing the need to void or remembering when to do so. Providing frequent reminders helps maintain bladder continence and reduces the risk of accidents.

B. Provide clothing that is easy to manipulate: While providing clothing that is easy to manipulate can be helpful for clients with cognitive impairment to independently manage toileting, it does not directly address the issue of facilitating bladder continence. Easy-to-manipulate clothing may assist with toileting independence but does not address the need for regular voiding to prevent urinary incontinence.

C. Explain the need to call for the nurse to help with toileting: While educating the client about when to seek assistance for toileting needs is important, it may not be sufficient for facilitating bladder continence in a client with cognitive impairment. Clients may still have difficulty recognizing the need to void or remembering to call for assistance, making frequent reminders more effective in promoting continence.

D. Encourage avoidance of fluids between meals: Encouraging avoidance of fluids between meals is not an appropriate strategy for promoting bladder continence. Restricting fluids can lead to dehydration and other health complications. Maintaining adequate hydration is essential for overall health, and clients should be encouraged to drink fluids regularly throughout the day. Additionally, restricting fluids does not address the underlying issue of cognitive impairment affecting toileting behaviors.

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Correct Answer is ["B","C"]

Explanation

A. Quickly resuming the client's normal food intake: This is not recommended, as the client's gastrointestinal system needs time to recover from food poisoning. Resuming normal food intake too quickly may exacerbate symptoms or prolong recovery. It's essential to give the gastrointestinal system time to heal and gradually reintroduce foods as tolerated.

Answer: B. Requesting a prescription for an antidiarrheal drug from the provider.

C. Encouraging easily digestible foods when the diarrhea stops.

Rationale:

When caring for a client with profuse diarrhea from food poisoning, the nurse's interventions should focus on managing symptoms, preventing dehydration, and promoting recovery. Options B and C are appropriate nursing interventions for this scenario:

B. Requesting a prescription for an antidiarrheal drug from the provider: Antidiarrheal medications such as loperamide (Imodium) may be prescribed to help control diarrhea and reduce fluid loss. These medications work by slowing down bowel motility and can provide symptomatic relief, particularly for clients with profuse diarrhea from food poisoning. However, the use of antidiarrheal drugs should be guided by a healthcare provider's prescription to ensure appropriate dosing and monitoring, especially considering individual client factors and potential contraindications.

C. Encouraging easily digestible foods when the diarrhea stops: This is the correct option. Once the diarrhea subsides, it is appropriate to encourage the client to gradually reintroduce easily digestible foods. These foods are gentle on the digestive system and help prevent further irritation or upset. Examples of easily digestible foods include bananas, rice, applesauce, toast (BRAT diet), boiled potatoes, boiled chicken, and clear broths.

D. Limiting the client's fluid intake to about 1000 mL/day: Fluid intake should be encouraged rather than limited, especially in cases of profuse diarrhea. Diarrhea can lead to significant fluid loss and dehydration, so it's crucial to ensure adequate hydration. The client should be encouraged to drink clear fluids such as water, electrolyte solutions, and herbal teas to replace lost fluids and electrolytes.

A. draw a straight line through the error with a black ink pen and initial it. B. use a permanent marker to draw a line through the error and write "mistaken entry". C. cover the mistake with correction fluid and skip a line. D. erase the error and write the correct information.

Correct Answer is A

Explanation

A. Draw a straight line through the error with a black ink pen and initial it: This is the correct action to take when making an error while documenting in the client's chart. Drawing a single line through the error with a black ink pen ensures that the original information remains visible for auditing purposes. The nurse should then write the correct information above or adjacent to the error, initial the correction, and include the date and time. This method maintains the integrity of the documentation while clearly indicating that an error was made and corrected.

B. Use a permanent marker to draw a line through the error and write "mistaken entry": Using a permanent marker is not appropriate because it can make the chart difficult to read and may obscure the original information. Additionally, writing "mistaken entry" does not provide sufficient clarification regarding the nature of the error or the correction made.

C. Cover the mistake with correction fluid and skip a line: Using correction fluid to cover the mistake is not recommended because it can make the chart appear altered or tampered with. Skipping a line does not adequately address the error and correction, and it may lead to confusion when reviewing the documentation.

D. Erase the error and write the correct information: Erasures are not recommended in documentation as they can be perceived as altering or tampering with the chart. Additionally, erasing information may not completely remove it from the chart, and it may still be legible under certain lighting conditions or with the use of special equipment.

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What would be the best nursing action to facilitate bladder continence for the client who is cognitively impaired?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has with profuse diarrhea from food poisoning contracted at a company picnic 12 hours ago. The nurse's care for this client should include: ...

Correct Answer is ["B","C"]

Explanation

The nurse makes an error while documenting in the client's chart. The nurse should:

Correct Answer is A

Explanation

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