Which of the following manifestations can the nurse expect in a client with upper motor neuron deficit related to a spinal cord injury?

A leakage

B anuria

C flaccid bladder, inability to voluntarily void

D spastic, involuntary voiding

Answer and Explanation

The Correct Answer is D

Choice A Rationale: Leakage is not typically associated with upper motor neuron deficits related to a spinal cord injury.

Choice B Rationale: Anuria (absence of urine production) is not a common manifestation of upper motor neuron deficits in this context.

Choice C Rationale: A flaccid bladder and an inability to voluntarily void are more characteristic of lower motor neuron deficits. Upper motor neuron deficits often lead to spasticity and involuntary voiding.

Choice D Rationale: Spasticity and involuntary voiding are common manifestations of upper motor neuron deficits related to spinal cord injury. This is due to the loss of inhibitory control over reflexes, including the micturition reflex.

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

Explanation

Choice A Rationale: Asking the spouse what she knows about dementia care options is a good starting point to assess her knowledge and provide information and resources, and empowering her to make informed decisions.

Choice B Rationale: Suggesting placement into a long-term care facility should not be the first option but can be explored if necessary, based on the client's condition and the caregiver's needs.

Choice C Rationale: Teaching the spouse about adult day care as a possible respite is a way of offering support and relief for the caregiver, who may experience stress and burnout from the constant demands of caring for a patient with AD.

Choice D Rationale: Suggesting that the spouse consult with the physician for antianxiety drugs is not helpful, as it may imply that the spouse's feelings are abnormal or that she needs medication to cope.

Choice E Rationale: Offering ideas for ways to distract or redirect the patient is not relevant to the spouse's needs, as it does not address her exhaustion and worry.

A. A Drain the bladder with a clean intermittent catheter every hour B. B Decrease fluid intake C. C Observe the urine for a foul odor D. D Keep an indwelling catheter in place at all times

Correct Answer is A

Explanation

Choice A Rationale: The nurse will include instructions on draining the bladder with a clean intermittent catheter at appropriate intervals to prevent urinary retention and complications. This should be done every 3 to 6 hours, depending on the amount of fluid intake and output.

Choice B Rationale: Decreasing fluid intake is not typically recommended for individuals with spinal cord injuries, as adequate hydration is important.

Choice C Rationale: Observing the urine for a foul odor is relevant to monitor for urinary tract infections, but it is not a preventive measure.

Choice D Rationale: Keeping an indwelling catheter in place at all times is not typically recommended due to the increased risk of urinary tract infections and other complications.

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Which of the following manifestations can the nurse expect in a client with upper motor neuron deficit related to a spinal cord injury?

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Naxlex Comprehensive Predictor Exams

The spouse of a 67-yr-old male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am exhausted from worrying all the time. I don't know what to do." Which actions are best for the nurse to take at this time? Select All that Apply

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

Explanation

A nurse is offering teaching to a caregiver about urinary system complications that occur as a result of spinal cord injury. Which of the following will the nurse include in teaching?

Correct Answer is A

Explanation

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