Chapter 26: Urinary Function My Nursing Test Banks

Chapter 26: Urinary Function

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. When caring for older adults, the nurse expects to encounter the normal urinary age-related outcome of:

a.

urinary incontinence.

b.

low-grade bladder infection.

c.

nocturia.

d.

urinary residual volume.

ANS: C

With age, increased urine formation at night leads to nocturia. The other findings are not age-related changes.

DIF: Remembering (Knowledge) REF: Page 542 OBJ: 26-1

TOP: Nursing Process: Assessment MSC: Health Promotion

2. An 87-year-old patient has suddenly become incontinent. What should the nurses first action be?

a.

Review the patients record for medications that may be causing urinary incontinence.

b.

Seek an order for an indwelling urinary catheter to prevent skin breakdown.

c.

Limit the patients fluid intake to reduce the feeling of having to void so often.

d.

Teach the patient to void every 2 hours when awake during the day or night.

ANS: A

Medication is a common cause of incontinence and should always be suspected as a potential cause of new incontinence. A catheter is not needed. Limiting fluids leads to dehydration. Voiding every 2 hours at night will disrupt sleep.

DIF: Understanding (Comprehension) REF: Page 542 OBJ: 26-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. An older adult patient reports losing urine when she bends over or gets out of a chair. What type of incontinence does the nurse plan interventions for?

a.

Overflow

b.

Urge

c.

Functional

d.

Stress

ANS: D

Stress incontinence is commonly seen in older women who involuntarily lose urine as the result of a sudden increase in intraabdominal pressure. Overflow incontinence consists of frequent involuntary losses of small amounts of urine. Functional incontinence is manifested by loss of large volumes of urine because of a lack of awareness of the need to void or a mobility problem. Urge incontinence is accompanied by a sudden urge to void.

DIF: Remembering (Knowledge) REF: Page 543 OBJ: 26-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. When assessing the patient for urinary incontinence, which patient symptom best supports the nursing diagnosis of overflow incontinence?

a.

I have small accidents ever since I developed a cystocele.

b.

It burns so badly after I urinate that I hold it as long as I can.

c.

I cant make it to the toilet when I feel the need to urinate.

d.

I lose small amounts of urine when I sneeze or laugh hard.

ANS: A

Typically, individuals with overflow incontinence complain of frequent losses of small volumes of urine, which are commonly a result of cystoceles. Burning indicates a urinary tract infection. Not making it to the bathroom is generally functional incontinence. Losing control of the bladder with sneezing or laughing is a manifestation of stress incontinence.

DIF: Remembering (Knowledge) REF: Page 543 OBJ: 26-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. An older cognitively impaired adult patient is being discharged to a daughters home. The nurse knows continued success of the patients bladder training for urinary incontinence primarily rests on the:

a.

patients ability to follow instructions.

b.

severity of the impairment of the urinary sphincter.

c.

patients ability to sense the need to urinate.

d.

daughters ability to support the training.

ANS: D

Treating urinary incontinence in individuals with cognitive impairment requires the use of other behavioral techniques that depend on the caregiver rather than the patient. The success of the techniques in large part depends on the availability and motivation of the caregiver. The other actions are not as important for the cognitively impaired persons success.

DIF: Understanding (Comprehension) REF: Page 548 OBJ: 26-7

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

6. An older adult patient is hospitalized for after an automobile crash. The nurse recognizes symptoms suggestive of an upper urinary tract (UTI) infection when the patient:

a.

voids 100 mL of urine over a 3-hour period of time.

b.

is not able to state where he is or what day it is.

c.

has an elevated red blood cell (RBC) count.

d.

reports burning when he urinates.

ANS: B

For many older adults, the presentation of a UTI is confusion or another change in mental status. Burning on urination would signify a lower urinary tract infection. The other two assessments are unrelated.

DIF: Analyzing (Analysis) REF: N/A OBJ: 26-16

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

7. An older adult woman has a resistant strain of pneumonia. To best minimize her risk of developing acute renal failure, the nurse:

a.

monitors the patients serum blood urea nitrogen (BUN) levels via diagnostic laboratory work.

b.

helps the patient select low-sodium foods from her daily menu.

c.

measures and records the patients urinary output.

d.

chooses an analgesic other than ibuprofen (Motrin).

ANS: D

Patients with pneumonia often have mild to moderate pain. Nonsteroidal antiinflammatory drug (NSAIDs) are common analgesics; however, they can cause acute kidney injury. Using another class of drug for pain relief will help protect the patients kidneys. The patient may be at risk of acute kidney injury because of dehydration or the nephrotoxic effects of certain antibiotics.

DIF: Applying (Application) REF: N/A OBJ: 26-11

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

8. An older patient is admitted with possible chronic renal failure (CRF). Which lab value does the nurse notify the physician about as a priority?

a.

Increased calcium level

b.

Increased red blood cells

c.

Decreased BUN level

d.

Decreased creatinine clearance level

ANS: D

The diagnosis of CRF is usually made based on a decrease in creatinine clearance, an elevation of BUN level, and a decrease in red blood cells. The other findings can be documented.

DIF: Applying (Application) REF: N/A OBJ: 26-16

TOP: Communication and Documentation MSC: Physiologic Integrity

9. The nurse is admitting an older patient with benign prostate hyperplasia (BPH). The nurses priority questioning focuses on:

a.

family history of prostate disorders.

b.

onset of symptoms.

c.

psychosocial impact of the diagnosis.

d.

typical urinary voiding patterns.

ANS: D

The purpose of the nursing assessment for an individual with BPH is to determine the extent of prostate enlargement and its effect on function so that appropriate nursing interventions can be planned and implemented. The primary assessment focuses on the patients current voiding patterns.

DIF: Understanding (Comprehension) REF: Page 556 OBJ: 26-16

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

10. A patient in a long-term care facility has incontinence. What assessment by the nurse is most important before designing interventions for this problem?

a.

Cognitive status

b.

Ambulatory status

c.

Cardiovascular status

d.

History of childbirth

ANS: A

Treatment options differ between cognitively impaired and intact individuals. If the person is not intact, he or she has to rely on caregivers to maintain appropriate bladder function. The other assessments can be worked into the treatment plan.

DIF: Applying (Application) REF: N/A OBJ: 26-7

TOP: Nursing Process: Analysis MSC: Physiologic Integrity

11. A male patient has benign prostatic enlargement. He is at risk for what type of acute kidney injury?

a.

Prerenal

b.

Intrarenal

c.

Postrenal

d.

Combined form

ANS: C

BPH would place this patient at risk for postrenal failure. Prerenal failure is often the result of decreased cardiac output or acute fluid volume loss. Intrarenal failure consists of damage to the actual nephrocytes.

DIF: Remembering (Knowledge) REF: Page 551 OBJ: 26-11

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

12. A patient has a history of smoking and now has painless hematuria. After a workup, the patient is told the diagnosis of bladder cancer. What action by the nurse is most important?

a.

Allow the patient to verbalize feelings.

b.

Educate the patient on care of an ileal conduit.

c.

Teach the patient how to manage nausea.

d.

Offer a social work referral to complete a living will.

ANS: A

The first intervention the nurse should provide is to be present for the patient and allow the expression of feelings. It is too early to teach, the patient may or may not have an ileal conduit, and the patient may not be ready to complete a living will or other advance directive.

DIF: Application REF: N/A OBJ: 26-16 TOP: Caring

MSC: Psychosocial Integrity

13. A patient being treated for prostate cancer calls the clinic to report severe back pain. What action by the nurse is best?

a.

Advise the patient to take his pain medication.

b.

Tell the patient to come in to the clinic today.

c.

Make an appointment for the patient next week.

d.

Encourage the patient to rest and use moist heat.

ANS: B

Prostate cancer can metastasize to the bones including the spine. If this happens, spinal cord compression can occur. The patient is advised to come into the clinic today for evaluation. The other options are not appropriate.

DIF: Analyzing (Analysis) REF: N/A OBJ: 26-16

TOP: Communication and Documentation MSC: Physiologic Integrity

14. A male patient reports difficulty starting a urine stream and a weak urine flow. When prompted to seek medical attention, the patient asks why, as its obviously benign prostatic hypertrophy. What response by the nurse is best?

a.

You never know; it could be cancer.

b.

You should have any change checked out.

c.

Only the physician can make a diagnosis,

d.

BPH and prostate cancer have similar symptoms.

ANS: D

The patient should have these new symptoms checked out. Although only the provider can make the diagnosis, the best answer is to explain that symptoms of BPH and cancer are similar. The other options do not give useful information.

DIF: Applying (Application) REF: N/A OBJ: 26-14

TOP: Teaching-Learning MSC: Physiologic Integrity

15. A patient treats chronic kidney failure with peritoneal dialysis. The patient notes the fluid draining out of the abdomen is cloudy and foul smelling. What action by the nurse is best?

a.

Assess the patient for other signs of infection.

b.

Document the findings in the patients chart.

c.

Call the rapid response team immediately.

d.

Request a prescription for an antibiotic.

ANS: A

One of the complications of peritoneal dialysis is infection in the peritoneal space, or peritonitis. The nurse should fully assess the patient for infection and notify the provider. Documentation should occur, but the nurse needs to take action first. The rapid response team is not needed. Antibiotics will probably be used to treat the infection.

DIF: Applying (Application) REF: N/A OBJ: 26-16

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

16. A patient is scheduled to have surgery for prostate cancer in a few weeks. What action by the nurse is most important?

a.

Discuss options and their effect on sexuality.

b.

Ensure the patient has advance directives.

c.

Offer the patient a tour of the operating room.

d.

Determine if the patient prefers outpatient surgery.

ANS: A

Treatment for prostate cancer can affect sexual functioning, so the nurse ensures the patient knows the risks and benefits of his choices. The other options are not necessary, although any patient with a serious illness should have advance directives.

DIF: Applying (Application) REF: N/A OBJ: 26-15

TOP: Teaching-Learning MSC: Psychosocial Integrity

17. A patient asks how elevating the legs at night will decrease nocturia. What is the nurses best response?

a.

All that fluid gets into circulation before you go to bed.

b.

Decreased swelling makes it easier to ambulate at night.

c.

It wont help; thats an old wives tale you heard.

d.

This measure helps dehydrate you before bedtime.

ANS: A

Elevating the legs returns dependent fluid into circulation so the kidneys can excrete it sooner. Without elevating the legs, that fluid movement does not happen until the patient goes to bed, contributing to nocturia. The other answers are incorrect.

DIF: Understanding (Comprehension) REF: Page 547 OBJ: 26-16

TOP: Teaching-Learning MSC: Physiologic Integrity

18. What information does the nurse share with the student about normal age-related changes in the kidneys?

a.

Renal mass increases.

b.

The glomerular filtration rate decreases.

c.

Poor renal function occurs after age 65.

d.

There are no real age-related changes.

ANS: B

Older adults have a decreased glomerular filtration rate, decreased renal mass, but renal function can remain good up to the ninth decade.

DIF: Remembering (Knowledge) REF: Page 549 OBJ: 26-10

TOP: Teaching-Learning MSC: Health Promotion

MULTIPLE RESPONSE

1. A nurse is assessing an older patient for the possible cause of his acute urinary incontinence. Which actions by the nurse are most important? (Select all that apply.)

a.

Asking when his last normal bowel movement was

b.

Monitoring his intake and output

c.

Determining if he has been screened for prostatic hypertrophy

d.

Asking him if he awakens during the night to urinate

e.

Measuring his abdominal girth

ANS: A, C, D

Constipation or fecal impaction as well as an enlarged prostate gland (causing frequent nighttime urination) are commonly overlooked causes of incontinence. Intake and output and abdominal girth are not related to possible causes of incontinence.

DIF: Understanding (Comprehension) REF: Page 542 OBJ: 26-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

2. When preparing educational information regarding benign prostatic hyperplasia (BPH) for a group of older male patients, the nurse includes which of the following? (Select all that apply.)

a.

Eighty percent of males experience the symptoms by age 80.

b.

Diabetes mellitus is a risk factor.

c.

It is only as the prostate enlarges that symptoms occur.

d.

The resulting urinary retention can cause urinary tract infections.

e.

Symptoms are a result of urethral obstruction.

ANS: A, C, D, E

Approximately 80% of men may be diagnosed with BPH by the age of 80. In early prostatic enlargement, the patient may be asymptomatic because the muscles may initially compensate for increased urethral resistance. As the prostate gland enlarges, the patient begins to manifest symptoms of an obstructive process. The symptoms may include hesitancy, a decrease in the force of the urinary stream, terminal dribbling, a sensation of a full bladder after voiding, and urinary retention. Urethral obstruction may cause urinary stasis, UTIs, hydronephrosis, and renal calculi. Diabetes is not a risk factor.

DIF: Understanding (Comprehension) REF: Page 556 OBJ: 26-14

TOP: Teaching-Learning MSC: Physiologic Integrity

3. An older adult patients urinary incontinence is being addressed by prompted voiding. The nurse instructs all ancillary staff to do which of the following? (Select all that apply.)

a.

Provide only minimal fluids after 7 PM.

b.

Keep the patient on the toilet until voiding occurs.

c.

Allow the patient to void at times other than those scheduled.

d.

Offer toileting during the night only when the patient is awake.

e.

Encourage the patient to toilet himself.

ANS: C, D

The goal is to increase a patients awareness of the need to void and, it is hoped, to increase the frequency of self-initiated toileting. Patients are approached on a regular schedule, asked if they are wet or dry, and then prompted to toilet. A patient should never be forced to toilet or reprimanded for failing to toilet appropriately. Self-initiated toileting should not be discouraged. To relieve the stress that can occur because of sleep disruption for both caregiver and patient, toileting protocols can be modified during the nighttime hours.

DIF: Understanding (Comprehension) REF: Page 549 OBJ: 26-5

TOP: Nursing process: Implementation MSC: Physiologic Integrity

4. A patient has a glomerular filtration rate (GFR) of 19 mL/min/1.73m2. What assessment findings correlate with this condition? (Select all that apply.)

a.

Fatigue

b.

Weakness

c.

Edema

d.

No specific symptoms

e.

Headaches

ANS: A, B, C

This patient is in stage 4 of chronic kidney disease. Expected assessment findings include weakness, edema, fatigue, hypertension, heart failure, impaired cognition and immune function, dry skin and pruritus, anorexia, nausea, malnutrition, increased bleeding, anemia, peripheral neuropathy, and an overall decreased quality of life. In stages 1 and 2, patients are asymptomatic. Headache is not a finding.

DIF: Applying (Application) REF: N/A OBJ: 26-11

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. The nurse working in the gerontology clinic understands which facts related to incontinence? (Select all that apply.)

a.

It is a normal age-related change.

b.

It is an independent predictor of nursing home admission.

c.

It contributes to falls and injuries.

d.

It can disrupt sleep.

e.

It can lead to urinary tract infections.

ANS: B, C, D, E

Urinary incontinence is not a normal age-related development, although people commonly believe this is true. The other statements are correct.

DIF: Remembering (Knowledge) REF: Page 541-2 OBJ: 26-1

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

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