N105: Essentials of Nursing Care - Health Differences

Essentials of Nursing Study Guide

21. The nurse determines that the nursing diagnosis stress urinary incontinence related to decrease pelvic muscle tone is the most appropriate for an oriented adult female client. A therapeutic nursing intervention based on this diagnosis is to: a. Apply adult diapers b. Catheterize the client c. Administer Urecholine d. Teach Kegel exercises 22. An adult client reports to the nurse that she has been experiencing constipation recently and is interested in any suggestions regarding dietary changes she might make. Which of the following suggestions provided by the nurse is most likely to minimize the client’s complaint? a. “Have you tried foods like prunes and bran?” b. “You might find the new flavored bulk laxatives helpful.” c. “What have you tried in the past that hasn’t beenhelpful?” d. “Increase your fluid intake; have some juice withbreakfast.” 23. A client who is 2 days' postoperative reports feeling “constipated” to the nurse. The client has good bowel sounds in all four quadrants and has tolerated liquids well. Her pain is being controlled with an opioid analgesic. Which of the following interventions should the nurse try initially? a. “Let me get you some apple juice.” b. “Ambulating may get your bowelsmoving.” c. “I’ll see about getting a different painmedication.” d. “Your health care provider might prescribe an enema if I call.” 24. Which of the following statements by a client reporting constipation reflects the most informed understanding of interventions that will aid in assuming proper bowel mobility? a. “Could it be that I need to get more exercise, even here in thehospital?” b. “Is it true that drinking coffee often helps stimulate the bowels towork?” c. “I guess a little high-fiber cereal might help. Can you get me some from the cafeteria?” d. “May I have a cup of decaffeinated tea in addition to my breakfast juice? That usually helps.”

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