Elimination And Bowel/Bladder Care - NCLEX Pn

1. What is the correct technique for routine perineal care for a patient with an indwelling urinary catheter?

   Clean perineum and catheter from meatus outward; no routine disconnection. Reduces infection risk by directing contaminants away from the urinary meatus while maintaining a closed system.

2. Which medication class should be avoided for routine long-term constipation management due to risk of dependence?

   Stimulant laxatives (senna, bisacodyl). Chronic use can lead to bowel dependence and electrolyte imbalances, making them unsuitable for routine management.

3. What is the primary indication for a Coude catheter?

   Enlarged prostate or urethral obstruction requiring curved-tip insertion. The curved tip facilitates passage through obstructions like benign prostatic hyperplasia, reducing trauma during insertion.

4. Which type of laxative is appropriate for long-term prevention of constipation with minimal cramping?

   Stool softener (docusate). Softens stool by drawing water into the feces, minimizing cramping and making it suitable for chronic use without dependence risks.

5. Which peristomal skin finding requires prompt intervention for a new ostomy patient?

   Skin breakdown, weeping, or ulceration around the stoma. Signals irritation from effluent or poor appliance fit, risking further tissue damage and infection if not addressed promptly.

6. Which stool characteristic is expected with an ileostomy compared with a colostomy?

   Liquid to semi-liquid stool with higher output and enzyme content. Ileostomy effluent is more liquid due to bypassing the colon's water absorption, with higher volume and digestive enzymes increasing skin irritation risk.

7. What is the most appropriate fluid-related teaching to help prevent constipation in most adults without restrictions?

   Increase oral fluids as allowed (often about $2$ to $3$ L/day). Adequate hydration softens stool and promotes intestinal motility, reducing constipation risk in unrestricted adults.

8. Which finding is expected for a healthy stoma in the early postoperative period?

   Moist, shiny, and beefy red to pink appearance. Reflects healthy vascularity and mucosal tissue, indicating proper healing without ischemia or infection.

9. Which finding during digital disimpaction requires the nurse to stop the procedure immediately?

   Bradycardia, dizziness, diaphoresis, or syncope (vagal response). Indicates vagal nerve stimulation, which can cause severe bradycardia or hypotension requiring immediate cessation to prevent cardiac events.

10. What is the correct direction for inserting the enema tip in an adult?

    Toward the umbilicus, then slightly posterior, $3$ to $4$ inches. Aligns with rectal anatomy to minimize trauma and ensure proper placement for effective enema delivery.

11. What is the correct position of a urinary drainage bag relative to the bladder?

    Below bladder level at all times; never on the floor. Promotes gravity-dependent drainage to prevent urine backflow and reduce infection risk, while avoiding contamination from floor contact.

12. What is the correct ostomy pouch-emptying guideline to prevent leakage and weight pulling on the seal?

    Empty when $\frac{1}{3}$ to $\frac{1}{2}$ full. Prevents seal disruption from excess weight and overflow, maintaining skin integrity and appliance adherence.

13. Which patient position is best for administering a cleansing enema?

    Left lateral (Sims) position with right knee flexed. Facilitates solution flow into the sigmoid colon via gravity and anatomical alignment, enhancing effectiveness and comfort.

14. Which action best prevents catheter-associated urinary tract infection (CAUTI) in a patient with a Foley catheter?

    Maintain a closed sterile drainage system. Prevents bacterial entry by avoiding breaks in the system, which is a primary cause of ascending infections.

15. Which finding is most consistent with a urinary tract infection (UTI) in an older adult?

    New confusion or acute change in mental status. In older adults, UTIs often manifest atypically with delirium rather than classic dysuria or fever due to age-related immune changes.

16. Which nursing instruction best helps prevent recurrent UTIs in a female patient?

    Wipe front to back after toileting. Prevents fecal bacteria from contaminating the urethra, reducing ascending infection risk in females due to shorter urethral anatomy.

17. Which catheter is most appropriate for short-term straight bladder drainage for a specimen or retention relief?

    Intermittent (straight) catheter. Provides one-time drainage or specimen collection without the infection risks associated with indwelling catheters.

18. Which sign most strongly indicates fecal impaction in a constipated patient?

    Oozing liquid stool with abdominal distention and rectal fullness. Represents paradoxical diarrhea where liquid stool seeps around a hard impaction, accompanied by signs of obstruction.

19. Which option is the best first nursing intervention for functional urinary incontinence in a cognitively intact older adult?

    Scheduled toileting (timed voiding) and prompt access to the toilet. Promotes continence by aligning voiding with natural urges and reducing barriers, addressing mobility or environmental factors in functional incontinence.

20. Which option is the correct method to obtain a sterile urine specimen from an indwelling catheter?

    Use the sampling port after disinfecting; never from the drainage bag. Ensures sample sterility by accessing fresh urine directly from the catheter, avoiding contamination from stagnant bag contents.

21. Which assessment finding most strongly suggests urinary retention rather than urinary frequency?

    Small frequent voids with suprapubic distention or palpable bladder. Indicates overflow incontinence from incomplete bladder emptying, distinguishing retention from simple frequency where the bladder fully empties without distention.

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