An 86-year-old patient is experiencing uncontrollable leakage of urine with a strong desire to void and even leaks on the way to the toilet. Which priority nursing diagnosis will the nurse include in the patient's plan of care?

a. Functional urinary incontinence
b. Urge urinary incontinence
c. Impaired skin integrity
d. Urinary retention


ANS: B
Urge urinary incontinence is the leakage of urine associated with a strong urge to void. Patients leak urine on the way to or at the toilet and rush or hurry to the toilet. Urinary retention is the inability to empty the bladder. Functional urinary incontinence is incontinence due to causes outside the urinary tract, such as mobility or cognitive impairments. While Impaired skin integrity can occur, it is not the priority at this time, and there is no data to support this diagnosis.

Nursing

You might also like to view...

The role of nurses as advocates for the removal of barriers to health care can have its' basis in what?

A) The trajectory model B) The interface model C) The phase model D) The nursing process

Nursing

The nurse is caring for a client with a hormone imbalance. Which manifestations does the nurse attribute to this condition? Select all that apply.

A) Hypertension B) Anxiety C) Weight gain D) Fluid retention E) Contusion

Nursing

In 2001 there several cases of Anthrax. Case definitions exist in the literature and in government documents. A clinically compatible case without isolation of the pathogen is known as a:

1. Suspected case 2. Confirmed case 3. Prolonged case 4. Identified case

Nursing

When following up on a client's report of hip pain during an admission assessment, the most nursing conclusive observation would be:

1. The client tearing when being ambulated to the chair 2. A report from the ancillary staff that the client is reporting pain 3. The client observed grimacing when positioning self in the bed 4. Overhearing the client discuss hip pain with family on the phone

Nursing