Chapter 23: Incontinence
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. What instruction should a nurse provide to a patient scheduled for a postvoid residual (PVR)
test?
a.
Call the nurse immediately after voiding.
b.
After voiding, wait 10 minutes and void again.
c.
Void into a flow meter.
d.
Avoid fluid intake for 8 hours before the test.
2. Bladder training instructions are being given to a patient who has a history of urinary
incontinence. What initial instructions should the nurse give to the patient?
a.
“Wait until you feel the urge to void.”
b.
“Don’t void any more often than every 4 to 6 hours.”
c.
“Void every 2 to 3 hours while awake.”
d.
“Void any time you feel the urge.”
3. A patient with a spinal cord injury has recently begun using reflex training to empty his
bladder. The nurse is doing a catheterization to check for residual volume. What should the
residual volume be to indicate reflex training is effective?
a.
Less than 100 mL
b.
Less than 200 mL
c.
Less than 400 mL
d.
Less than 500 mL
4. A male patient with urinary incontinence has been using an external (condom) catheter. A
nurse is assessing the patient’s technique of applying the device. What techniques
demonstrated by the patient would indicate the need for further instruction?
a.
Washes the penis with warm soapy water and dries the area well before applying
the device
b.
Encircles the penis with tape to secure the device
c.
Uses elastic tape and wraps in a spiral pattern to secure the device
d.
Carefully assesses the penis for any signs of irritation before applying the device
5. A patient being assessed by the physician states, “I wet my pants every time I cough.” The
nurse recognizes this as which type of incontinence?
a.
Reflex
b.
Overflow
c.
Urge
d.
Stress
6. What instruction should a nurse provide to a patient who has been diagnosed with stress
incontinence?
a.
“Restrict fluid intake to less than 1000 mL/day.”
b.
“Avoid fluids such as tea, coffee, and cola.”
c.
“Delay voiding until you feel the urge to void.”
d.
“Void no more often than every 4 hours.”
7. A home health nurse is performing an evaluation of the home of an older adult patient to
assess for any safety issues. What should the nurse recognize as an environmental factor that
could lead to functional incontinence?
a.
Night light in the bathroom
b.
Patient’s room located on the opposite end of the house from the bathroom
c.
Hand rails located around the toilet and bathtub
d.
Caregiver’s room located close to the patient’s room
8. What should a nurse specifically ask a patient when taking the medical history to reveal clues
to the potential cause of urinary incontinence?
a.
Diabetes mellitus
b.
Impetigo
c.
Hypotension
d.
Trigeminal neuralgia
9. A patient, talking to a home health nurse about urinary incontinence, gives the nurse a list of
the current medications she is taking. What medication should the nurse recognize as possibly
contributing to the patient’s urinary incontinence?
a.
Methylcellulose (Citrucel)
b.
Diazepam (Valium)
c.
Simvastatin (Zocor)
d.
Digoxin (Lanoxin)
10. A nurse is instructing a patient on the procedure for a clean-catch urine specimen. The patient
has tried several times but is having difficulty understanding the instructions. What is the best
action for the nurse to implement?
a.
Take whatever specimen the patient can obtain.
b.
Provide the patient with a clean bedpan to obtain the specimen.
c.
Ask the laboratory personnel to come and obtain a urine specimen.
d.
Call the physician for a catheterization order.
11. A patient who is scheduled for an urodynamic test asks the nurse why he is having this test.
What is the nurse’s best response?
a.
“To test the capacity of the bladder.”
b.
“To see how much urine is left in the bladder after you have voided.”
c.
“To test the function of the nerves and muscles of the bladder.”
d.
“To detect involuntary passage of urine.”
12. A nurse has just received a patient who had a cystoscopy from the postanesthesia recovery
unit. The nurse notices that the patient’s urine is tinged with pink. What is the first action the
nurse should implement?
a.
Call the physician.
b.
Record the assessment in the patient’s record.
c.
Encourage the patient to drink plenty of fluids.
d.
Prepare the patient for a return to surgery.
13. A nurse is asked to instruct a patient on performing Kegel exercises. The patient should be
instructed to contract the muscles normally used to stop the flow of urine. Which proper
technique should the nurse explain?
a.
Contract for 3 to 4 seconds and relax for 10 seconds.
b.
Contract for 10 seconds and relax for 10 seconds.
c.
Contract for 10 seconds and relax for 3 to 4 seconds.
d.
Contract for 3 to 4 seconds and relax for 3 to 4 seconds.
14. A patient who uses a pessary to help control incontinence is given instruction for its care.
What should these instructions include?
a.
Remove periodically for cleaning.
b.
Douche daily with a cleansing solution.
c.
Check for proper placement once a month.
d.
Periodically deflate the cuff.
15. A patient who has urinary incontinence is at risk for urinary tract infection and urinary calculi.
What should the nurse teach the patient and family regarding the best way to prevent these
complications?
a.
Restrict the patient’s fluid intake and frequency of incontinence.
b.
Be sure the patient’s voiding schedule is no more often than every 4 hours.
c.
Use an indwelling catheter.
d.
Encourage the patient to void at least every 2 hours and to take at least 2000 mL of
fluid daily.
16. A patient is having problems with fecal incontinence. What should the nurse encourage the
patient to include in the diet to help with this problem?
a.
Raw fruits and vegetables
b.
Potatoes and bread
c.
Coffee and tea
d.
Prune and grape juice
17. What should a nurse include as an essential factor when providing patient education about
managing fecal overflow incontinence?
a.
Daily use of mineral oil
b.
Regular evacuation
c.
Daily administration of enemas
d.
Long-term use of mineral oil
18. A patient tells a nurse that his bowel movements normally occur every morning after
breakfast. What should the nurse understand as the rationale for this occurrence?
a.
Fecal overflow
b.
Gastrocolic reflex
c.
Autonomic dysreflexia
d.
Lack of sphincter control
19. A physician’s admission report states that a patient has a history of tarry stools. What should
the nurse anticipate when assessing characteristics of this patient’s stool?
a.
Brown and formed
b.
Bright red and liquid
c.
Black and sticky
d.
Clay colored and pasty
20. What education should a nurse provide to a patient diagnosed with anorectal incontinence?
a.
Take a daily laxative.
b.
Increase fiber in the diet.
c.
Perform pelvic muscle exercises.
d.
Administer daily enemas.
21. Which result of postvoid catheterization would indicate positive bladder emptying?
a.
Less than 125 mL
b.
Less than 100 mL
c.
Less than 75 mL
d.
Less than 50 mL
22. A nurse is cleaning a patient with fecal incontinence when the patient says, “This is so
embarrassing, and it makes me really angry.” What is the nurse’s best response?
a.
“Don’t worry about it; it’s my job to clean you up.”
b.
“If you would have called me sooner, this wouldn’t have happened.”
c.
“Do you feel angry and embarrassed?”
d.
“Would you rather let your family clean you up?”
23. What foods should a nurse explain to a patient can cause diarrhea?
a.
Cheese
b.
Cabbage
c.
Rice
d.
Yogurt
24. A patient with fecal incontinence should be taught the importance of maintaining good skin
integrity. What should be the focus of a nurse’s teaching?
a.
Cleanse the perianal area thoroughly after each stool.
b.
Use a fecal pouch.
c.
Change incontinence undergarments once a day.
d.
Take an over-the-counter laxative daily.
25. What is the cause of symptomatic incontinence?
a.
Colorectal disease
b.
Gastrocolic reflex
c.
Constipation
d.
Nerve damage
26. A patient asks a home health nurse if the periurethral bulking procedure will be a permanent
remedy to urinary incontinence. On what knowledge regarding the effects of this procedure
should the nurse base a response?
a.
Are permanent
b.
Are only helpful to men
c.
Usually last for approximately 6 months
d.
Remain for 2 or 3 years
27. What does the uroflowmetry diagnostic tool measure?
a.
Voiding duration
b.
Specific gravity of urine
c.
Effectiveness of the detrusor muscle
d.
General bladder tone
MULTIPLE RESPONSE
28. Which statements by a patient would indicate an accurate understanding of cytometry? (Select
all that apply.)
a.
“Drink no fluids for 6 hours after the test.”
b.
“Report a change in my abdominal girth.”
c.
“Notify the doctor if I have difficulty voiding.”
d.
“Sleep on my stomach.”
e.
“Notify my doctor if I experience burning on urination.”
29. What should a nurse include when providing instructions to a patient as to what to do when
feeling the urge to void? (Select all that apply.)
a.
Breathe deeply and try to relax.
b.
Perform several Kegel maneuvers without resting in between.
c.
Walk to the bathroom at a normal pace while performing Kegel maneuvers.
d.
Distract herself with a book or a television program.
e.
Stop what she is doing and sit down or stand quietly.
30. What should the nurse include in the plan of care to protect the skin integrity of an incontinent
patient? (Select all that apply.)
a.
Immediately remove wet garments and linens.
b.
Wash skin with an antiseptic and towel dry.
c.
Inspect for areas of redness and breakdown every morning.
d.
Apply cornstarch to the perineum to absorb moisture.
e.
Apply protective creams per agency policy.
31. Which is true regarding the habit training technique prompted voiding? (Select all that apply.)
a.
Is useful with cognitively impaired persons
b.
Helps the patient to recognize incontinence
c.
Is based on giving praise for staying dry
d.
Strengthens the pelvic floor
e.
Uses the Valsalva maneuver to force urine from bladder
COMPLETION
32. A patient complains, “My allergies make me sneeze and urinate in my pants. I take my allergy
drug and I urinate in my pants even more.” The nurse assesses that the drug the patient is
referring to is a(n) _____.
33. A nurse explains that the normal bladder will empty when it reaches the capacity of _____ to
_____ mL.
34. The method by which a nurse manually expresses urine from the bladder by pressing gently
on the lower abdomen is the _____ method.