NCWO Continence Care 2 — Questions and Answers
Question 1: Fecal incontinence (FI) associated with loose or liquid stool is most commonly managed initially with:
- Surgical sphincteroplasty
- Dietary fiber supplementation to add bulk and slow transit (Correct answer)
- Permanent colostomy formation
- Biofeedback therapy as the sole intervention
Correct answer: Dietary fiber supplementation to add bulk and slow transit
Dietary fiber bulks the stool and slows intestinal transit, making fecal incontinence associated with loose stools easier to control before escalating to procedural interventions.
Question 2: The anal plug device is used in fecal incontinence management to:
- Stimulate sphincter contraction via electrical current
- Occlude the anal canal to prevent unintended stool passage (Correct answer)
- Deliver topical medication to the anal sphincter
- Dilate a stenosed anal canal
Correct answer: Occlude the anal canal to prevent unintended stool passage
An anal plug is a disposable device inserted into the anal canal to physically block passage of stool, providing a continence barrier for patients with FI.
Question 3: Intermittent catheterization (IC) is preferred over indwelling urethral catheterization for long-term bladder management because IC:
- Requires less patient education and is easier to perform
- Significantly reduces the risk of catheter-associated urinary tract infection (CAUTI) (Correct answer)
- Eliminates the need for fluid management
- Can be performed without hand washing in community settings
Correct answer: Significantly reduces the risk of catheter-associated urinary tract infection (CAUTI)
IC eliminates the continuous foreign body in the urethra and bladder, dramatically lowering CAUTI risk compared to indwelling urethral catheters.
Question 4: Urinary retention post-operatively is most commonly caused by:
- Excessive post-operative fluid intake
- Opioid analgesia and anesthetic effects inhibiting detrusor contractility (Correct answer)
- Compression dressings applied to the abdomen
- Early ambulation causing sphincter spasm
Correct answer: Opioid analgesia and anesthetic effects inhibiting detrusor contractility
Opioids and anesthetic agents inhibit the detrusor muscle and increase urethral sphincter tone, commonly causing post-operative urinary retention.
Question 5: The recommended daily fluid intake for a continent adult to maintain normal voiding and prevent UTI is approximately:
- 500–800 mL/day
- 1000–1200 mL/day
- 1500–2000 mL/day (Correct answer)
- 3000–4000 mL/day
Correct answer: 1500–2000 mL/day
An intake of 1500–2000 mL/day maintains adequate urine output, dilutes urinary irritants, and reduces UTI risk without overloading the bladder.
Question 6: When catheterizing a female patient using clean intermittent catheterization (CIC), the catheter should be inserted:
- 2–4 cm or until urine flows, then advanced 1 cm more (Correct answer)
- 8–10 cm or until resistance is felt
- As far as the catheter will go
- 1 cm into the urethral meatus only
Correct answer: 2–4 cm or until urine flows, then advanced 1 cm more
For female CIC, the catheter is advanced 2–4 cm (approximately 1.5–2 inches) into the urethra until urine flows, then advanced slightly further to ensure full bladder drainage.
NCWO Continence Care 2
Fecal incontinence (FI) associated with loose or liquid stool is most commonly managed initially with: