Chapter 17 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 17

Question 1

Type: MCSA

An older patient describes having to go to the bathroom more frequently at night. What manifestation is this patient experiencing?

1. Fluid overload

2. Increased glycosuria

3. Normal changes of aging

4. Impairment of drug excretion

Correct Answer: 3

Rationale 1: Older adults have a decreased response to fluid overload by not increasing urine output.
Reference: Page 446

Rationale 2: Older adults also excrete less glucose in the urine, making increased glycosuria not possible.
Reference: Page 446

Rationale 3: The kidneys of older adults excrete more fluid and electrolytes at night than in the daytime. More urine is formed at night, frequently interrupting sleep patterns.
Reference: Page 446

Rationale 4: Although drug excretion may be impaired in the elderly, it would not result in increased urine output.
Reference: Page 446

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe the normal changes of aging in the physiology of the genitourinary and renal systems.

Question 2

Type: MCSA

An older patient who has been experiencing a fever, nausea, and vomiting has a urine specific gravity below normal. The patient denies being thirsty. What should the nurse suspect the patient is experiencing?

1. Dehydration

2. Fluid overload

3. Congestive heart failure

4. Normal changes of aging

Correct Answer: 1

Rationale 1: The elderly are less able to concentrate their urine, making them susceptible to dehydration. In addition, there is a deficit of the thirst response. The patients symptoms of nausea and vomiting suggest decreased intake and increased output through vomiting, placing the patient at risk for dehydration.
Reference: Page 447

Rationale 2: The patient with fluid overload would have respiratory manifestations.
Reference: Page 447

Rationale 3: The patient with heart failure would have respiratory manifestations.
Reference: Page 447

Rationale 4: Fever, nausea, vomiting and a low urine specific gravity are not normal changes of aging.
Reference: Page 447

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 3

Type: MCSA

The nurse is having difficulty inserting a urinary catheter in an older female patient. Which position should the nurse use to help facilitate the insertion of the catheter?

1. Side-lying lifting up the buttock

2. Supine with the bed flat, legs bent and apart

3. Supine with the HOB elevated at 30 degrees

4. Supine with the head of bed (HOB) elevated at 90 degrees

Correct Answer: 1

Rationale 1: Because of estrogen-mediated changes in the perineal area of postmenopausal women, the urinary meatus may be very difficult to visualize. The side-lying position lifting up the buttock is an alternative that provides better visualization of the urinary meatus.
Reference: Page 449

Rationale 2: The supine position, regardless of the leg position or height of the bed, would not increase the visualization of the urinary meatus because it is more distal from the changes in the perineal area.
Reference: Page 449

Rationale 3: The supine position, regardless of the leg position or height of the bed, would not increase the visualization of the urinary meatus because it is more distal from the changes in the perineal area.
Reference: Page 449

Rationale 4: The supine position, regardless of the leg position or height of the bed, would not increase the visualization of the urinary meatus because it is more distal from the changes in the perineal area.
Reference: Page 449

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 4

Type: MCMA

An older female patient asks the home care nurse what can be done to help with painful intercourse. What recommendations should the nurse make to the patient?

Standard Text: Select all that apply.

1. Avoid intercourse.

2. Decrease the frequency of intercourse.

3. Use vaginal lubricants during intercourse.

4. Use the hand to guide the penis into the vagina.

5. Tolerate the problem because it is a normal part of aging.

Correct Answer: 3,4

Rationale 1: Avoiding intercourse does not resolve the problem for the patient.
Reference: Page 466

Rationale 2: Decreasing the frequency of intercourse does not resolve the problem for the patient.
Reference: Page 466

Rationale 3: It is not uncommon for an elderly female to report painful intercourse, which is related to a decrease in vaginal lubrication as well as the lack of elevation of the labia during sexual arousal. Vaginal lubricants can be very effective in reducing the pain experienced during intercourse.
Reference: Page 466

Rationale 4: The older female might be advised to use her hand to guide her partners penis into the vagina.
Reference: Page 466

Rationale 5: Although this is a normal change of aging, patients do not have to tolerate the discomfort.
Reference: Page 466

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 5

Type: MCSA

An older patient with chronic renal failure has not had a bowel movement for two days. What does the nurse realize this patient is at risk for developing?

1. Hypokalemia

2. Hyperkalemia

3. Metabolic acidosis

4. Increased serum creatinine levels

Correct Answer: 2

Rationale 1: Constipation exacerbates hyperkalemia and it is important to monitor patients with chronic renal failure for daily bowel movements since the potassium levels are already impaired.
Reference: Page 453

Rationale 2: Constipation exacerbates hyperkalemia and it is important to monitor patients with chronic renal failure for daily bowel movements since the potassium levels are already impaired.
Reference: Page 453

Rationale 3: Metabolic acidosis is not directly affected by constipation.
Reference: Page 453

Rationale 4: Serum creatinine levels are not directly affected by constipation.
Reference: Page 453

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 6

Type: MCMA

Which assessment findings does the nurse recognize as being a normal part of aging for an older patient?

Standard Text: Select all that apply.

1. Nocturia

2. Delayed urination

3. Less frequent voiding

4. New onset urinary incontinence

5. Decreased urine specific gravity

Correct Answer: 1,2,3,5

Rationale 1: Nocturia is a normal urinary change found in older people.
Reference: Page 446

Rationale 2: Delayed urination is a normal urinary change found in older people.
Reference: Page 446

Rationale 3: Less frequent voiding is a normal urinary change found in older people.
Reference: Page 446

Rationale 4: Urinary incontinence, although it occurs frequently in the elderly for a variety of reasons, is not a normal part of aging and requires priority assessment of associated factors to determine the cause.
Reference: Page 446

Rationale 5: Decreased urine specific gravity is a normal urinary change found in older people.
Reference: Page 446

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe the normal changes of aging in the physiology of the genitourinary and renal systems.

Question 7

Type: MCSA

An older male patient with benign prostatic hypertrophy (BPH) is experiencing an increase in symptoms. Which finding would explain the reason for this patients change in symptoms?

1. Recent vasectomy

2. Decreased oral intake at night

3. Use of over-the-counter saw palmetto

4. Use of over-the-counter cold medication

Correct Answer: 4

Rationale 1: A vasectomy does not affect the symptoms of BPH.
Reference: Page 460

Rationale 2: A decreased oral intake at night may resolve the symptoms.
Reference: Page 460

Rationale 3: Use of saw palmetto might help resolve the symptoms.
Reference: Page 460

Rationale 4: Urinary retention in men with BPH can be precipitated by several classes of medications, such as over-the-counter medications for the common cold.
Reference: Page 460

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 8

Type: MCMA

An older male patient reports having blood in the urine. For which health problems does the nurse expect the patient will be evaluated?

Standard Text: Select all that apply.

1. Pyuria

2. Renal failure

3. Bladder cancer

4. Prostate cancer

5. Urinary tract infection

Correct Answer: 3,5

Rationale 1: Pyuria is pus in the urine and may be a symptom of bladder cancer or a urinary tract infection but is not related to the pathological process of hematuria.
Reference: Pages 461, 460

Rationale 2: Blood in the urine is not a symptom of renal failure.
Reference: Pages 461, 460

Rationale 3: Blood in the urine is associated with bladder cancer.
Reference: Pages 461, 460

Rationale 4: Blood in the urine is not associated with prostate cancer.
Reference: Pages 461, 460

Rationale 5: Blood in the urine can be a symptom of a urinary tract infection.
Reference: Pages 461, 460

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 9

Type: MCSA

An older patient who is postmenopausal is experiencing uterine bleeding. Which action would be appropriate for the nurse to take at this time?

1. Provide hygienic care.

2. Collect a urine specimen.

3. Direct the patient for evaluation for endometrial cancer.

4. Instruct the patient on normal changes of the reproductive system in the elderly.

Correct Answer: 3

Rationale 1: Hygienic care is important but it is not a priority at this time.
Reference: Page 462

Rationale 2: Collecting a urine specimen may be part of the further assessment but is not a priority.
Reference: Page 462

Rationale 3: Any older woman who reports postmenopausal uterine bleeding should be assumed to have endometrial cancer until proved otherwise. The patient should be directed to seek healthcare to evaluate for the presence of endometrial cancer.
Reference: Page 462

Rationale 4: Uterine bleeding is not a normal change in the older female patient.
Reference: Page 462

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 10

Type: MCSA

The nurse is instructing an older female patient on reproductive cancer screenings. Which information would the nurse include in this teaching?

1. Eliminate Pap smears if high risk factors are absent.

2. Obtain mammography every other year after the age of 40.

3. Avoid hormone replacement therapy for vasomotor symptoms.

4. Eliminate self-examination of the breasts if the patient finds this socially unacceptable.

Correct Answer: 1

Rationale 1: Current recommendations are that women who are over age 65, who have had a regular history of normal Pap smears, and who are not at high risk because of other factors should not receive routine Pap smears.
Reference: Page 462

Rationale 2: Mammography is recommended yearly for women over the age of 40.
Reference: Page 462

Rationale 3: The treatment of vasomotor symptoms is the only recommended use for hormone replacement therapy in menopausal women.
Reference: Page 462

Rationale 4: Regardless of the patients feelings, self-examination of the breasts is an important breast cancer screening tool.
Reference: Page 462

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 11

Type: MCMA

The nurse is reviewing the list of medications prescribed for an older patient. Which medications could lead to toxicity because of renal excretion changes in this patient?

Standard Text: Select all that apply.

1. Aspirin

2. Digoxin

3. Antibiotic

4. Vitamin C

5. ACE inhibitor

Correct Answer: 2,3,5

Rationale 1: Because of renal excretion changes the older patient is prone to toxicity. Aspirin does not cause toxicity.
Reference: Page 448

Rationale 2: Because of renal excretion changes the older patient is prone to toxicity. Digoxin can cause toxicity.
Reference: Page 448

Rationale 3: Because of renal excretion changes the older patient is prone to toxicity. Antibiotics can cause toxicity.
Reference: Page 448

Rationale 4: Because of renal excretion changes the older patient is prone to toxicity. Vitamin C is a water-soluble vitamin and will not cause toxicity.
Reference: Page 448

Rationale 5: Because of renal excretion changes the older patient is prone to toxicity. ACE inhibitors can cause toxicity.
Reference: Page 448

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 12

Type: MCMA

An older patient is diagnosed with chronic renal failure. Which manifestations will the nurse most likely assess in this patient?

Standard Text: Select all that apply.

1. Pruritis

2. Anorexia

3. Generalized edema

4. Postural hypotension

5. Elevated blood pressure

Correct Answer: 1,2,3,5

Rationale 1: Pruritis is a manifestation of chronic renal failure.
Reference: Page 453

Rationale 2: Anorexia is a manifestation of chronic renal failure.
Reference: Page 453

Rationale 3: Generalized edema is a manifestation of chronic renal failure.
Reference: Page 453

Rationale 4: Postural hypotension is a manifestation of acute renal failure and not chronic renal failure.
Reference: Page 453

Rationale 5: Elevated blood pressure is a manifestation of chronic renal failure.
Reference: Page 453

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 13

Type: MCSA

An older patient who is a widower explains that routine sexual encounters remain an important part of his life. What teaching should the nurse provide to this patient?

1. Actions to ensure safe sex

2. Importance of an adequate fluid intake

3. Reasons to abstain from sexual activity

4. Interventions to prevent erectile dysfunction

Correct Answer: 1

Rationale 1: Sexually active older adults are at risk for the same sexually transmitted infections that affect younger adults. They should be offered the same education about safer sex, including the use of condoms.
Reference: Page 467

Rationale 2: An adequate fluid intake is important but this has nothing to do with the patients routine sexual encounters.
Reference: Page 467

Rationale 3: The nurse should not expect an older patient to abstain from sexual activity if this is desired.
Reference: Page 467

Rationale 4: There are no specific interventions to prevent erectile dysfunction. This topic has nothing to do with the patients routine sexual encounters.
Reference: Page 467

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize his or her own biases related to sexuality and aging.

Question 14

Type: MCSA

A 60-year-old male patient is planning to marry a woman in her 30s and is concerned about the need for contraception. How should the nurse respond to this patient?

1. After age 50, you are considered virtually infertile.

2. It is still possible at this time of life to father a child.

3. You should have a vasectomy to avoid fathering a child.

4. You will only need to be concerned about fertility for another few years.

Correct Answer: 2

Rationale 1: Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.
Reference: Page 449

Rationale 2: Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.
Reference: Page 449

Rationale 3: Discussion about a vasectomy is premature at this stage. A vasectomy may not be the best option for this patient.
Reference: Page 449

Rationale 4: Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.
Reference: Page 449

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize his or her own biases related to sexuality and aging.

Question 15

Type: MCMA

When reviewing the hormone levels of a menopausal patient, which findings should the nurse recognize as being expected for the patient?

Standard Text: Select all that apply.

1. Reduced estrogen level

2. Reduced testosterone level

3. Elevated thyroid hormone level

4. Elevated luteinizing hormone level

5. Elevated follicle stimulating hormone level

Correct Answer: 1,2,4,5

Rationale 1: Estrogen levels fall off dramatically and remain at very low levels for the rest of the womans life.
Reference: Page 450

Rationale 2: Because women also produce small amounts of testosterone, loss of libido in an older woman may be related to a decrease in testosterone.
Reference: Page 450

Rationale 3: Thyroid hormone is not affected by menopause.
Reference: Page 450

Rationale 4: Once menopause has occurred, luteinizing hormone stabilizes at levels much higher than in younger women.
Reference: Page 450

Rationale 5: Once menopause has occurred, follicle stimulating hormone stabilizes at levels much higher than in younger women.
Reference: Page 450

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 16

Type: MCSA

The nurse is assessing an older male patient. Which finding indicates the need for further investigation?

1. The absence of libido

2. Orgasms of reduced intensity

3. Difficulty delaying ejaculation

4. An erection that is less firm than in earlier years

Correct Answer: 1

Rationale 1: Although the libido of a man may diminish with aging, the loss of sexual drive should be viewed with concern.
Reference: Page 450

Rationale 2: The characteristics of the orgasm change with age as they are reduced in intensity and force.
Reference: Page 450

Rationale 3: Difficulty anticipating or delaying ejaculation is a normal finding in an older male patient.
Reference: Page 450

Rationale 4: The erection is often less firm but capable of penetration.
Reference: Page 450

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 17

Type: MCMA

An older patient is experiencing overflow incontinence. What should the nurse identify as causes for this change in urinary functioning?

Standard Text: Select all that apply.

1. History of dementia

2. Enlarged prostate gland

3. Treatment for gastric ulcers

4. Diagnosis of diabetes mellitus

5. Prescribed a calcium channel blocker

Correct Answer: 2,4,5

Rationale 1: Functional incontinence is associated with a history of dementia.
Reference: Page 455

Rationale 2: An enlarged prostate gland is associated with overflow incontinence.
Reference: Page 455

Rationale 3: Treatment for gastric ulcers is not associated with any type of urinary incontinence.
Reference: Page 455

Rationale 4: Diagnosis of diabetes mellitus is associated with overflow incontinence.
Reference: Page 455

Rationale 5: Calcium channel blockers are associated with overflow incontinence.
Reference: Page 455

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 18

Type: MCMA

The nurse is planning care for an older patient with stress incontinence. Which interventions would be appropriate for the nurse to suggest to the patient?

Standard Text: Select all that apply.

1. Timed voiding

2. Kegel exercises

3. Bladder training

4. Restricting fluids

5. Increasing citrus juices

Correct Answer: 1,2,3

Rationale 1: Timed voiding has been demonstrated to be effective for older women with stress incontinence.
Reference: Page 458

Rationale 2: Kegel exercises are another intervention that works well for stress incontinence.
Reference: Page 458

Rationale 3: Bladder training is similar to timed voiding, but the intervals between trips to the toilet are gradually lengthened, training the bladder to hold slightly increased amounts of urine.
Reference: Page 458

Rationale 4: Restricting fluids is not an effective method to improve stress incontinence.
Reference: Page 458

Rationale 5: Citrus juices are considered bladder irritants and can aggravate stress incontinence.
Reference: Page 458

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 19

Type: MCSA

The nurse is planning an inservice for a group of nursing assistants about urinary infections. What information should be included in the presentation?

1. Men are most likely to experience descending urinary tract infections.

2. The rate of urinary tract infections is similar between men and women.

3. Men need a longer course of antibiotics to manage a urinary tract infection than women.

4. Catheterization is the only way to get a urine specimen to check for a urinary tract infection.

Correct Answer: 3

Rationale 1: Descending infections are less common than ascending infections of the urinary tract.
Reference: Page 454 and 455

Rationale 2: Women have a higher rate of urinary tract infection than men.
Reference: Page 454 and 455

Rationale 3: Men will usually be prescribed a longer course of therapy to manage a urinary tract infection. They have a longer urethra. When they are infected with an infection to the system, it is typically more complicated than in a woman.
Reference: Page 454 and 455

Rationale 4: A clean catch mid-stream is a reliable means to obtain a urine specimen to check for the presence of infection.
Reference: Page 454 and 455

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 20

Type: MCSA

An older patient tells the nurse about leaking urine when sneezing. To what does the nurse realize that is type of urinary incontinence is attributed?

1. Result of a system blockage

2. Result of bladder overstretching

3. Damage of the urinary apparatus

4. Increase in intra-abdominal pressure

Correct Answer: 4

Rationale 1: A system blockage would result in urinary retention.
Reference: Page 455

Rationale 2: Bladder overstretching would not result in the incontinence being experienced by this patient.
Reference: Page 455

Rationale 3: There is inadequate information to determine the presence of urinary structural damage.
Reference: Page 455

Rationale 4: Incontinence is most often caused by an increase in intra-abdominal pressure combined with an inability to retain the urine in the bladder.
Reference: Page 455

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify the impact of changes in urinary function on the quality of life of older adults.

Question 21

Type: MCSA

The results of an older patients urinalysis reveal bacteria in the urine. What action should the nurse perform next?

1. Notify the physician.

2. Order a repeat urinalysis to confirm the initial test.

3. Order a culture and sensitivity to identify the exact type of bacteria.

4. Review the nursing assessment for reports consistent with a urinary tract infection.

Correct Answer: 4

Rationale 1: Notification of the physician at this time is premature.
Reference: Page 454

Rationale 2: There is no indication that the initial urinalysis is not correct. A repeated test would not be cost effective.
Reference: Page 454

Rationale 3: Ordering a culture and sensitivity is not required at this time. The infection may not be treated if the patient is not bothered by symptoms.
Reference: Page 454

Rationale 4: Many elders with urinary tract infections may be asymptomatic. The nurse should review the data collected to determine if the patient has reported any supportive data.
Reference: Page 454

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify the impact of changes in urinary function on the quality of life of older adults.

Question 22

Type: MCSA

The nurse is teaching bladder retraining to an older patient recovering from bladder surgery. Which patient statement indicates understanding of the teaching provided?

1. I will gradually space my voiding times to longer periods.

2. I should force fluids to promote my bladder to hold more urine.

3. I should try to see how long I can hold my urine before voiding.

4. Research has not supported theories linking dietary intake to bladder irritation.

Correct Answer: 1

Rationale 1: Bladder training is an ongoing process in which the bladder is gradually trained to lengthen times between voiding.
Reference: Page 458

Rationale 2: Forcing fluids will result in a sudden overfilling of the bladder.
Reference: Page 458

Rationale 3: Holding urine for an extended time can result in bladder overfilling.
Reference: Page 458

Rationale 4: Some research has linked certain foods to bladder irritation, and so they should be avoided when possible.
Reference: Page 458

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 23

Type: MCSA

The nurse instructs an older patient with benign prostatic hyperplasia (BPH) on the pathophysiology of the health problem. Which patient statement indicates further teaching is needed?

1. There are nonsurgical treatment options available.

2. This condition may lead to cancer of the prostate.

3. As my condition progresses, I may need to consider surgical management.

4. Alpha blockers can be used to control my symptoms.

Correct Answer: 2

Rationale 1: There are nonsurgical treatment options for BPH.
Reference: Page 460

Rationale 2: BPH is a benign condition and does not lead to cancer of the prostate.
Reference: Page 460

Rationale 3: BPH can be managed surgically.
Reference: Page 460

Rationale 4: Alpha blockers can be prescribed to help control the symptoms.
Reference: Page 460

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 24

Type: MCSA

An older male patient diagnosed with prostate cancer is not prescribed any treatment. What does the nurse realize as the reason for this treatment approach?

1. The cancer is slow growing.

2. The patient will not survive treatment.

3. The patient has less than 10 years to live.

4. The cancer is growing quickly and no treatment will be helpful.

Correct Answer: 1

Rationale 1: Prostate cancer in older men is slow growing, and watchful waiting is a realistic option for older men.
Reference: Page 462

Rationale 2: Treatment for prostate cancer includes surgery, external beam radiation, and radioactive seeds implanted into the prostate. All have similar success rates. If the cancer is more advanced, external radiation or hormonal treatment may be recommended. The older patient should be offered a thorough discussion of all options with an urologist.
Reference: Page 462

Rationale 3: A time period of 10 years is used to decide if the older patient should have a prostate specific antigen level analyzed.
Reference: Page 462

Rationale 4: Treatment for prostate cancer includes surgery, external beam radiation, and radioactive seeds implanted into the prostate. All have similar success rates. If the cancer is more advanced, external radiation or hormonal treatment may be recommended. The older patient should be offered a thorough discussion of all options with an urologist.
Reference: Page 462

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 25

Type: MCMA

The nurse is planning a seminar on ways to ensure healthy genitourinary functioning when aging. What information should the nurse include in this presentation?

Standard Text: Select all that apply.

1. Drink plenty of water.

2. Expect to develop urinary incontinence.

3. Be aware of responses to new medications.

4. It is normal to continue to desire sexual activity.

5. Take steps to prevent sexual transmitted infections.

Correct Answer: 1,3,4,5

Rationale 1: Drinking plenty of water is one way to ensure healthy genitourinary functioning.
Reference: Pages 450-451

Rationale 2: Urinary incontinence is not normal, should not be expected, and should be evaluated by a healthcare provider.
Reference: Pages 450-451

Rationale 3: Be aware of responses to new medications because age-related changes in the kidney may lead to over- or under-dosing.
Reference: Pages 450-451

Rationale 4: It is normal to continue to desire sexual activity. It is also normal to have little interest in sex, particularly if that has been a long-term pattern.
Reference: Pages 450-451

Rationale 5: If going to engage in sexual activity, take appropriate precautions to prevent sexually transmitted infections.
Reference: Pages 450-451

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

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