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NCLEX® QOTD: Altered urinary elimination

Osmosis Team
Published on Jan 31, 2024. Updated on Jan 6, 2024.

Today's NCLEX-RN® question of the day focuses on a nurse who is caring for a 67-year-old woman battling obesity and stress urinary incontinence. With a focus on altered urinary elimination, the nurse envisions a future where the patient actively engages in strategies to reduce incontinence episodes by the next visit. What specific interventions will lead to this desired outcome and improve the patient's quality of life? Can you figure it out?


The nurse is caring for a 67-year-old female patient with obesity and stress urinary incontinence. At the previous appointment, the nurse chose the priority hypothesis, altered urinary elimination, and generated the desired outcome: The patient will take part in strategies to reduce occurrences of urinary incontinence by next visit.

Which finding(s) indicate(s) the patient is progressing as expected? Select all that apply.

Progress Note

Patient presents to the primary care clinic for a follow-up appointment regarding stress urinary incontinence. Since the last visit, the patient has lost 3 lbs and she reports she has attended two pelvic floor physical training sessions with a licensed therapist. She states that it had been difficult to remember to perform Kegel exercises throughout the day. However, the patient reports that she has started setting a reminder on her watch which has helped her to remember to perform Kegels. She reports that she had a small amount of urine leakage in the car on the way to the appointment today following a sneeze. The health care provider plans to update the plan of care and prescribe intravaginal estrogen cream to help reduce pelvic floor atrophy, which the patient states she will consider taking if conditions do not improve.


The correct answer to today's NCLEX-RN® Question is...

Progress Note

Patient presents to the primary care clinic for a follow-up appointment regarding stress urinary incontinence. Since the last visit, the patient has lost 3 lbs and she reports she has attended two pelvic floor physical training sessions with a licensed therapist. She states that it had been difficult to remember to perform Kegel exercises throughout the day. However, the patient reports that she has started setting a reminder on her watch which has helped her to remember to perform Kegels. She reports that she had a small amount of urine leakage in the car on the way to the appointment today following a sneeze. The health care provider plans to update the plan of care and prescribe intravaginal estrogen cream to help reduce pelvic floor atrophy, which the patient states she will consider taking if conditions do not improve.

Major Takeaway

The nurse caring for a patient with altered urinary elimination should use clinical judgment to make clinical decisions about their care by prioritizing hypotheses and generating solutions based on expected outcomes. The nurse will evaluate whether the outcome has been met and if not, whether the plan of care should be revised. The findings that indicate the patient is progressing towards the expected outcome are that she has lost weight and is attending pelvic floor physical therapy and these can strengthen the pelvic muscles and reduce intra-abdominal pressure. Further, the patient setting an alarm to remember to perform Kegel exercises is also an indication that they are progressing towards the outcome. In postmenopausal women, intravaginal estrogen cream can help reduce atrophy of pelvic floor tissues, however since the patient has not taken the medication, it does not yet indicate progression towards the goal. 

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