CRRN Bowel and Bladder Management in Rehabilitation 2 — Questions and Answers
Question 1: A patient with stroke has urge urinary incontinence due to neurogenic detrusor overactivity. Which pharmacological intervention is most commonly used?
- Alpha-blocker such as tamsulosin
- Anticholinergic medication such as oxybutynin (Correct answer)
- Beta-blocker therapy
- Loop diuretic such as furosemide
Correct answer: Anticholinergic medication such as oxybutynin
Anticholinergic medications such as oxybutynin reduce involuntary detrusor contractions, decreasing urge incontinence in patients with neurogenic overactive bladder.
Question 2: A rehabilitation patient is being evaluated for a urinary tract infection. Which clinical finding is a reliable indicator of UTI in a patient with SCI who has no bladder sensation?
- Dysuria reported by the patient
- Increased spasticity, autonomic dysreflexia, cloudy urine with foul odor, and fever (Correct answer)
- Urge incontinence only
- Slightly elevated post-void residual
Correct answer: Increased spasticity, autonomic dysreflexia, cloudy urine with foul odor, and fever
In patients with SCI who lack bladder sensation, UTI presents with systemic and indirect signs including increased spasticity, AD, cloudy/foul urine, and fever rather than dysuria.
Question 3: A patient post-prostatectomy has stress urinary incontinence. Which non-pharmacological intervention is the FIRST LINE treatment?
- Bladder augmentation surgery
- Pelvic floor muscle training (Kegel exercises) (Correct answer)
- Indwelling urinary catheter for 6 weeks
- Anticholinergic medication
Correct answer: Pelvic floor muscle training (Kegel exercises)
Pelvic floor muscle training (PFMT) is the first-line non-pharmacological intervention for stress urinary incontinence post-prostatectomy, strengthening the external urethral sphincter.
Question 4: A rehabilitation nurse is reviewing a clean intermittent catheterization technique with a patient for home use. Which modification distinguishes CLEAN from sterile technique for home IC?
- Single-use sterile catheters and sterile gloves required
- Reusable catheters cleaned with soap and water; handwashing and clean technique are acceptable (Correct answer)
- IC must only be performed by a licensed nurse at home
- Sterile saline irrigation required before each catheterization
Correct answer: Reusable catheters cleaned with soap and water; handwashing and clean technique are acceptable
Clean IC at home uses clean (not sterile) technique with reusable catheters washed with soap and water, which is safe and evidence-based for outpatient neurogenic bladder management.
Question 5: A patient with a neurogenic bowel is experiencing constipation despite a scheduled bowel program. Which dietary intervention is MOST appropriate?
- Decrease fluid intake to prevent loose stools
- Increase dietary fiber to 25–38 grams per day and ensure adequate fluid intake (Correct answer)
- Eliminate all fruits and vegetables from the diet
- Initiate a liquid-only diet for 48 hours
Correct answer: Increase dietary fiber to 25–38 grams per day and ensure adequate fluid intake
Adequate dietary fiber (25–38 g/day) combined with sufficient fluid intake (1.5–2 L/day) promotes stool bulk and motility, improving constipation in neurogenic bowel.
Question 6: A patient has been using an indwelling urinary catheter for 3 weeks during acute rehabilitation. Which complication is the PATIENT AT HIGHEST RISK for?
- Urethral stricture due to catheter size
- Catheter-associated urinary tract infection (CAUTI) (Correct answer)
- Bladder hyperreflexia
- Renal calculi within 72 hours
Correct answer: Catheter-associated urinary tract infection (CAUTI)
Catheter-associated UTI (CAUTI) is the most common healthcare-associated infection and risk increases linearly with duration of indwelling catheter use.
CRRN Bowel and Bladder Management in Rehabilitation 2
A patient with stroke has urge urinary incontinence due to neurogenic detrusor overactivity.
Which pharmacological intervention is most commonly used?