WOCNCB CCCN - Final Test Review (Qns & Ans) - 2025, Exams of Nursing

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CCCN

Final Test Review

(Questions & Solutions)

1. MCQ

Case: A 75-year-old woman in a skilled-nursing facility reports urgency urinary incontinence and voiding six times nightly. Post-void residual (PVR) by bladder scan is 50 mL. Which next step best refines your assessment? A. Refer for urodynamic study B. Start timed voiding every 2 hours C. Prescribe nightly desmopressin D. Teach pelvic-floor muscle exercises ANS : B Rationale: With low PVR and frequency/urgency, bladder training (timed voiding) is the least invasive first step prior to urodynamics or pharmacotherapy.

2. MCQ Case: A 45-year-old woman post-vaginal delivery complains of small urine leaks when coughing. Which diagnostic test most accurately confirms stress urinary incontinence? A. Pad weight test B. Post-void residual measurement C. Cystoscopy D. Urethral pressure profilometry ANS : A Rationale: A standardized pad weight test objectively quantifies leakage with physical stress, confirming stress UI.
3. MCQ Case: A spinal-cord-injured male uses an indwelling catheter and develops chronic bacteriuria. Which intervention most effectively reduces infection risk? A. Change catheter every week B. Switch to clean intermittent self-catheterization (CISC) C. Flush catheter with antiseptic daily

C. Abdominal ultrasound D. Urinalysis ANS : A Rationale: Uroflowmetry measures flow rate and pattern, distinguishing detrusor underactivity from outlet obstruction.

7. MCQ For a woman with mixed urinary incontinence, which pelvic-floor rehabilitation parameter is most predictive of successful long-term improvement? A. Ability to perform 3 fast contractions B. Resting vaginal pressure ≥20 cmH₂O C. Volitional squeeze duration ≥10 seconds D. Onset of contraction within 1 second ANS : C Rationale: Sustained contractions ≥10 seconds correlate with improved support and leak reduction.
8. MCQ A hospitalized patient with fecal impaction develops overflow diarrhea. What is your priority intervention? A. Begin stimulant laxative regimen B. Implement scheduled toileting program C. Perform manual disimpaction D. Start high-fiber diet ANS : C Rationale: Manual disimpaction relieves the obstruction causing overflow, allowing subsequent bowel regimen.
9. MCQ A pelvic-floor physical therapist refers a patient for biofeedback. Which finding most indicates candidacy? A. Inability to feel pelvic-floor contraction B. Stage III uterine prolapse C. Refractory urge incontinence

D. Large PVR volume ANS : A Rationale: Biofeedback is most effective in teaching patients who cannot volitionally contract pelvic muscles.

10. MCQ In an outpatient continence clinic, you review a 72-hour bladder diary showing 12 voids/day, average volume 80 mL, 8 urgency episodes, 4 urge incontinence episodes. Which diagnosis is most likely? A. Detrusor overactivity B. Stress incontinence C. Overflow incontinence D. Functional incontinence ANS : A Rationale: Frequent small-volume voids with urgency and incontinence are hallmark of detrusor overactivity.
11. MCQ A community health nurse plans an educational program on nocturnal enuresis for school-age children. Which learning objective is appropriate? A. Identify fluid restriction strategies before bedtime B. Demonstrate pelvic-floor exercises C. Explain role of cholinergic agonists D. Interpret urodynamic tracings ANS : A Rationale: Fluid management is a first-line, age-appropriate intervention for nocturnal enuresis education.
12. MCQ Case: A patient with long-standing diabetes and peripheral neuropathy reports fecal leakage. Anal manometry shows resting pressure 20 mm Hg (normal > 40 mm Hg). This primarily indicates damage to the: A. External anal sphincter B. Internal anal sphincter C. Puborectalis muscle

D. Apply moisture-barrier ointment after cleansing ANS : D Rationale: Moisture barriers protect skin; super-absorbent pads may help, but barrier is first-line.

16. FIB The “gold standard” to quantify urinary leakage during provocation maneuvers is the __________ test. ANS : pad weight Rationale: The pad weight (gravimetric) test measures urine lost objectively during stress maneuvers.
17. FIB Recording frequency, voided volume, fluid intake, and __________ episodes in a bladder diary helps differentiate incontinence types. ANS : urgency Rationale: Tracking urgency episodes distinguishes overactive bladder from stress patterns.
18. FIB Intermittent catheterization performed by the patient is abbreviated __________. ANS : CISC (clean intermittent self-catheterization) Rationale: CISC is the standard term for patient-performed intermittent catheterization under clean technique.
19. FIB The technique of teaching pelvic-floor exercises using a vaginal or rectal probe and audiovisual feedback is called __________. ANS : biofeedback Rationale: Biofeedback provides patients real-time sensory feedback to improve muscle recruitment.
20. FIB A PVR volume >__________ mL is generally considered abnormal and

warrants further investigation. ANS : 100 Rationale: PVR > 100 mL suggests incomplete bladder emptying and possible underactive detrusor or obstruction.

21. FIB The triad of urodynamic findings—low capacity, involuntary detrusor contractions, and low compliance—defines __________ bladder. ANS : neurogenic Rationale: Neurogenic bladder often presents with these urodynamic abnormalities.
22. FIB Regularly scheduled toileting to prevent incontinence in patients with cognitive impairment is called __________ toileting. ANS : prompted Rationale: Prompted toileting involves staff reminders at set intervals for patient voiding.
23. FIB Establishing a plan for preventing fecal incontinence often begins with evaluating __________ transit time. ANS : colonic Rationale: Slow colonic transit contributes to impaction or leakage; assessing transit time guides bowel regimens.
24. T/F Anticholinergic medications for overactive bladder worsen constipation. ANS : True Rationale: Antimuscarinics reduce smooth-muscle contractions in the gut, slowing transit, and can cause constipation.
25. T/F Overflow urinary incontinence is characterized by involuntary leakage with a distended bladder and small-volume dribbling.

ANS : False Rationale: Sacral neuromodulation can modulate central reflexes even when peripheral reflexes are reduced.

31. MR (select all) Which factors contribute to incontinence-associated dermatitis? A. Enzymatic activity of bile salts B. Prolonged skin exposure to ammonia C. Presence of fecal impaction D. Use of super-absorbent briefs E. Friction from brief changes ANS : A, B, E Rationale: Fecal enzymes and ammonia irritate skin; friction during cleansing exacerbates breakdown; super-absorbent briefs reduce IAD.
32. MR Essential elements of a comprehensive continence assessment include (select all): A. Pelvic-floor muscle strength testing B. Skin allergy patch testing C. Fluid intake and voiding diary D. Neurological exam relevant to bladder/bowel E. Baseline red blood cell count ANS : A, C, D Rationale: Continence assessment requires muscle strength, bladder/bowel diaries, and neuro exam; skin patch testing and CBC are not routine.
33. MR Components of an effective bowel program for fecal incontinence include (select all): A. Scheduled toileting post-meals B. Bulk-forming laxatives C. Digital stimulation D. Low-residue diet

E. Abdominal massage ANS : A, B, C, E Rationale: Scheduled toileting, fiber, stimulation, and abdominal massage promote regularity; low-residue diets worsen impaction risk.

34. MR When teaching CISC, which strategies enhance patient proficiency? (select all) A. Hands-on demonstration with coach assistance B. Reviewing aseptic versus clean techniques C. Using bladder ultrasound for PVR feedback D. Providing a standardized script only E. Observing first several self-catheterizations ANS : A, B, C, E Rationale: Demonstration, technique review, ultrasound feedback, and supervised practice build competence; a script alone is insufficient.
35. MR Outcome measures to evaluate continence interventions include (select all): A. Pad weight reduction B. Quality-of-life questionnaires C. Skin integrity scores D. Serum electrolyte levels E. Frequency of rescue laxative use ANS : A, B, C, E Rationale: Pad weights, QoL tools, skin assessments, and rescue laxative frequency track efficacy; electrolytes are unrelated.
36. MR Best practices in indwelling catheter care to prevent UTIs include (select all): A. Maintain closed drainage system B. Secure catheter to prevent tugging C. Routinely perform catheter irrigation

E. Vesicoureteral reflux ANS : A, B, E Rationale: Low compliance leads to high pressures, small capacity, and reflux; hyperreflexia and large PVR are variable.

40. MR Elements of a quality-improvement project for continence care might include (select all): A. Baseline incidence of catheter-associated UTIs B. Staff education on timed voiding protocols C. Audit of skin integrity documentation D. Patient satisfaction surveys E. Mandatory use of one brand of incontinence brief ANS : A, B, C, D Rationale: Tracking UTI rates, educating staff, auditing documentation, and surveying patients drive improvement; restricting to one brief brand may limit individualized care. A 78-year-old male with a history of stroke and diabetes presents with urinary incontinence. A comprehensive assessment reveals a post-void residual (PVR) of 150 mL. Which of the following is the most likely type of urinary incontinence? a) Stress incontinence b) Urge incontinence c) Overflow incontinence d) Functional incontinence Correct ANS : c) Overflow incontinence Rationale: A PVR of 150 mL indicates incomplete bladder emptying, a hallmark of overflow incontinence. The stroke and diabetes could contribute to bladder dysfunction and neuropathy.

Fill-in-the-Blank: The American Urological Association (AUA) symptom index is a validated tool used to assess the severity of _ symptoms. Correct ANS : Lower Urinary Tract Rationale: The AUA symptom index is specifically designed to evaluate the severity of symptoms related to the lower urinary tract, including those associated with benign prostatic hyperplasia (BPH). True/False: Pelvic floor muscle training (PFMT) is contraindicated in patients with detrusor overactivity. Correct ANS : False Rationale: PFMT is often a first-line treatment for urge incontinence (detrusor overactivity) and can improve bladder control by strengthening the pelvic floor muscles. Multiple Response: A patient with fecal incontinence reports frequent, small-volume stools and urgency. Which of the following assessment findings would support the diagnosis of fecal incontinence due to anal sphincter weakness? Select all that apply. a) Decreased anal sphincter resting pressure on anorectal manometry. b) Presence of hemorrhoids. c) History of vaginal deliveries. d) Report of constipation. Correct ANS s: a) Decreased anal sphincter resting pressure on

True/False: Biofeedback is only effective when combined with pelvic floor muscle training. Correct ANS : False Rationale: Biofeedback can be used independently or in conjunction with PFMT to improve patient awareness and control of pelvic floor muscles. Multiple Response: Which of the following are potential complications of long-term indwelling catheterization? Select all that apply. a) Urinary tract infections (UTIs). b) Bladder spasms. c) Urethral strictures. d) Improved bladder capacity. Correct ANS s: a) Urinary tract infections (UTIs), b) Bladder spasms, c) Urethral strictures. Rationale: Long-term catheterization increases the risk of UTIs, bladder spasms, and urethral damage. It can also lead to a decrease in bladder capacity. Multiple Choice: A patient with neurogenic bladder secondary to multiple sclerosis (MS) is experiencing urinary retention. Which of the following is the most appropriate intervention?

a) Administering diuretics. b) Encouraging timed voiding. c) Performing intermittent catheterization. d) Restricting fluid intake. Correct ANS : c) Performing intermittent catheterization. Rationale: Intermittent catheterization is a common and effective method to manage urinary retention in patients with neurogenic bladder. Fill-in-the-Blank: A patient with a history of recurrent UTIs should be educated on the importance of _ hygiene. Correct ANS : Perineal Rationale: Proper perineal hygiene is essential to prevent the introduction of bacteria into the urinary tract. True/False: Constipation is not a contributing factor to fecal incontinence. Correct ANS : False Rationale: Constipation can lead to fecal impaction and overflow incontinence. Multiple Response: Which of the following are important components of a comprehensive continence care education plan? Select all that apply. a) Explanation of the underlying pathophysiology.

True/False: The use of indwelling catheters always prevents urinary tract infections. Correct ANS : False Rationale: Indwelling catheters increase the risk of UTIs. Multiple Response: Which of the following are potential causes of overflow incontinence? Select all that apply. a) Bladder outlet obstruction. b) Detrusor underactivity. c) Increased bladder capacity. d) Urge incontinence. Correct ANS s: a) Bladder outlet obstruction, b) Detrusor underactivity. Rationale: Bladder outlet obstruction and detrusor underactivity are common causes of overflow incontinence. Multiple Choice: A patient is prescribed an anticholinergic medication for urge incontinence. Which of the following side effects should the nurse most closely monitor for? a) Diarrhea. b) Urinary retention. c) Hypotension. d) Increased salivation.

Correct ANS : b) Urinary retention. Rationale: Anticholinergics can cause urinary retention. Fill-in-the-Blank: A patient with a spinal cord injury at the T10 level is likely to have a _ bladder. Correct ANS : Neurogenic Rationale: Spinal cord injuries can disrupt the neural pathways that control bladder function, leading to a neurogenic bladder. True/False: Fecal impaction is always treated with manual disimpaction. Correct ANS : False Rationale: While manual disimpaction may be necessary, other methods such as enemas and oral medications are often used first. Multiple Response: Which of the following are important considerations when selecting an absorbent product for a patient with incontinence? Select all that apply. a) The patient's activity level. b) The patient's cognitive status. c) The severity of incontinence. d) The patient's preference. Correct ANS s: a) The patient's activity level, b) The patient's cognitive