A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching?

A. "I carry a water bottle with me because I drink a lot of water." Clients with spina bifida and neurogenic bladder are at high risk for Urinary Tract Infections (UTIs). High fluid intake is encouraged to flush the kidneys and bladder. This statement indicates correct understanding. B. "I do wheelchair exercises while watching TV." Clients paralyzed from the waist down rely heavily on upper body strength for transfers (e.g., bed to chair) and ADLs. Strengthening exercises are appropriate and encouraged. C. "I use a suppository every night to have a bowel movement." Neurogenic bowel causes a lack of bowel control. A bowel management program, which often includes scheduled suppositories or enemas to promote emptying, is necessary to prevent constipation and impaction. D. "I only need to catheterize myself twice every day." Clients with neurogenic bladder cannot empty their bladders spontaneously or completely. Leaving urine in the bladder for long periods promotes bacterial growth and infection. Intermittent catheterization should be performed every 4 to 6 hours (roughly 4 to 6 times a day). Twice a day is insufficient and increases the risk of renal damage and UTIs.