Elimination

1) The nurse is caring for an older adult client on a medical-surgical unit. The client tells the nurse, "I don't get any sleep at night because I have to get up and use the bathroom every couple of hours!" When providing an explanation for the nocturia, which statement by the nurse is the most appropriate? A) "As you get older, there is a decrease in the number of nephrons." B) "As you get older, there is a decrease in the blood supply to your bladder." C) "As you get older, you may have a decreased bladder capacity." D) "As you get older, there is a decrease in cardiac output, causing these symptoms."

1. Answer: C Explanation: Approximately 70% of older women and 50% of older men have to get up two or more times during the night to empty their bladders due to decreased bladder capacity. A decrease in blood supply causes an increase in urine concentration. A decrease in the number of nephrons decreases the filtration rate. A decrease in cardiac output decreases peripheral circulation, which would decrease urinary output day or night.

1) The nurse is providing care to a client who ignores the urge to defecate when at work. The client states, "I don't like to have a bowel movement anywhere but at home." Which response by the nurse is the most appropriate? A) "This is a common practice, and it will strengthen the reflex later." B) "You will get the urge later, so you should not worry about it." C) "If you continue to ignore the urge to defecate, it can lead to problems." D) "It is better to suppress the urge than to suffer embarrassment at work."

1. Answer: C Explanation: When the normal defecation reflexes are inhibited, these conditioned reflexes tend to be progressively weakened. When the urge to defecate is ignored, water continues to be reabsorbed, making the feces hard and difficult to expel. Ignoring the urge repeatedly will eventually cause the urge to be lost. Embarrassment, while unwarranted, is preferable to losing the urge to defecate. Ignoring the urge will not strengthen the reflex later; it will weaken it.

10) The nurse is providing care to a client who is experiencing urinary retention. Which diagnostic tool does the nurse anticipate will be ordered for this client? A) Ultrasonic bladder scan B) Urinalysis C) Intravenous pyelography (IVP) D) Cystoscopy

10. Answer: A Explanation: An ultrasonic bladder scan is the diagnostic test that is used to examine for residual urine. A urinalysis is often used to monitor the urine for infection. An IVP is used to diagnosis a kidney stone. A cystoscopy allows direct visualization of the bladder wall and urethra. It is often used to remove stones.

10) The nurse is reviewing discharge instructions with the mother of a toddler who was hospitalized for constipation. Which statement made by the toddler's mother indicates the need for further education? A) "I should recognize that when my child walks stiffly on his tiptoes, this could indicate withholding." B) "Rocking and crossing the legs could be a sign of withholding." C) "I need to make sure my child eats a low-fiber diet." D) "Soiling could be a sign of withholding because of involuntary overflow."

10. Answer: C Explanation: This child requires a diet that is high in fiber. This statement indicates the need for further instruction. All of the other statements made by the toddler's mother indicate appropriate understanding of the information presented regarding constipation.

11) The nurse is preparing to teach a class on the prevention of constipation. Which food choice will the nurse include as an example of a high-fiber food? A) Raw fruits B) Cooked vegetables C) White bread D) Cooked fruits

11. Answer: A Explanation: Foods high in fiber include raw fruits, bran products, and whole grain products. Low-fiber foods would include cooked fruits, cooked vegetables, and white bread.

11) The nurse is conducting education regarding urinary health at an assisted living facility. When planning topics to include in the session, which are appropriate for the nurse to consider? Select all that apply. A) Full urinary control usually occurs at 4 or 5 years of age. B) Due to neuromuscular immaturity in infancy, voluntary urinary control is absent. C) The kidneys reach maximum size between 35 and 40 years of age. D) Renal blood flow decreases because of vascular changes and a decrease in cardiac output. E) Urinary incontinence may occur because of mobility problems or neurological impairments.

11. Answer: D, E Explanation: When planning an education session regarding urinary health at an assisted living facility, the nurse would include information that affects the urinary health of the older adult client. Information that is appropriate for the nurse to consider is the decrease in renal blood flow due to vascular changes and that urinary incontinence may occur because of issues with mobility and neurological impairment. While all of the other statements are true regarding urinary health, they are not appropriate for this presentation to older adult clients.

12) The nurse is providing care to newborns in the nursery. When assessing the newborns' urinary output, which does the nurse anticipate as normal daily urinary output? A) 15-60 mL B) 100-300 mL C) 250-450 mL D) 400-500 mL

12. Answer: A Explanation: Normal urinary output for the newborn at 1-2 days of age is 15-60 mL per day. Normal urinary output for a newborn 3 to 10 days of age is 100-300 mL per day. The normal output for the newborn at 10 days of age to the infant at 2 months of age is 250-400 mL per day. Normal output for an infant at 2 months of age through 1 year is 400-500 mL per day

12) Fecal impaction is a mass or collection of hardened feces in the folds of the rectum or colon as a result of prolonged retention and accumulation of fecal material. Which clinical manifestation is common in cases of fecal impaction? A) No passage of stool or fecal material of any kind B) Passage of soft, formed stools C) Passage of lumpy stools that are hard and dry D) Passage of liquid, foul-smelling fecal material in the absence of formed stool

12. Answer: D Explanation: Clients with a fecal impaction pass liquid, foul-smelling fecal material in the absence of formed stool; this is the liquid portion of the feces that seeps around the impacted mass. Passing no stool or fecal material is indicative of an obstruction. Soft, formed stools are generally considered normal. Lumpy stools that are hard and dry are indicative of constipation.

13) The charge nurse is observing a newly licensed nurse conduct an abdominal assessment on a client admitted with an abdominal mass that is affecting bowel elimination. Which actions by the newly licensed nurse would require the charge nurse to intervene? Select all that apply. A) Performing palpation before auscultation B) Performing auscultation before palpation C) Using inspection, auscultation, percussion, and palpation during the abdominal assessment of the client D) Using only inspection, percussion, and palpation during the abdominal assessment of the client E) Using deep palpation during the assessment process

13. Answer: A, D, E Explanation: Physical examination of the abdomen in relation to bowel elimination problems includes inspection, auscultation, percussion, and palpation. Auscultation should precede palpation, because palpation can alter peristalsis. Never use deep palpation on a client who has an abdominal mass, renal transplant, or polycystic kidneys, or who is at risk for hemorrhage.

13) A client presents with acute constipation for the second time in two months. The physician orders a diagnostic barium enema. Based on the testing order, the nurse understands that the client's condition is likely associated with: A) rectal muscle contractions. B) completeness of bowel elimination. C) the efficiency with which the food moves through the gastrointestinal tract. D) the structure of the bowel or the presence of tumors or diverticula.

13. Answer: D Explanation: A barium enema is used to identify bowel structure, tumors, or diverticula; thus, the nurse understands that one of these is likely a causative factor in the client's condition. A defecography is used to assess rectal muscle contractions. An anorectal manometry is used to assess the completeness of bowel elimination. A colorectal transit study is used to determine how efficiently food moves through the gastrointestinal tract

14) The client is experiencing urinary urgency and frequency. Which medication should the nurse anticipate may be prescribed by the healthcare provider? A) Furosemide B) Bumetanide C) Oxybutynin D) Bethanechol chloride

14. Answer: C Explanation: Oxybutynin is an anticholinergic that reduces urgency and frequency by blocking muscarinic receptors in the detrusor muscle of the bladder, thereby inhibiting contractions and increasing storage capacity. The nurse would anticipate an order for oxybutynin. Furosemide is a diuretic and works in a specific place within the nephron to increase fluid excretion and prevent fluid reabsorption. Bumetanide is a diuretic and works in a specific place within the nephron to increase fluid excretion and prevent fluid reabsorption. Bethanechol chloride is a cholinergic agent that stimulates bladder contraction and facilitates voiding.

15) Inadequate fluid intake slows the passage of chyme along the intestines. This slowed passage increases the absorption of fluid from the chyme. How does this decreased intake and increased passage time affect the feces expelled from the body? A) It is drier and harder than normal. B) It is more watery and more soft than normal. C) It is more watery and harder than normal. D) It is drier and more soft than normal.

15. Answer: A Explanation: When fluid intake is inadequate or output is excessive, the passage of chyme slows and the absorption of fluid increases. The end result is feces that is harder and drier than normal. Watery, soft feces is the result of rapid intestinal transit that leads to inadequate fluid absorption.

16) Clients experiencing diarrhea often lose electrolytes. Which of the following best describes the reason for this loss? A) Decreased secretion of intestinal mucus inhibits the absorption of electrolytes from the chyme by the intestine. B) Pathogenic microorganisms that cause diarrhea consume the electrolytes in the chyme, resulting in fewer electrolytes being available for absorption. C) Diarrhea causes rapid passage of chyme through the large intestine, reducing the time available for absorption of electrolytes. D) Intestinal bacteria break down electrolytes during diarrhea and make them unfit for absorption by the intestine.

16. Answer: C Explanation: Diarrhea causes rapid passage of chyme through the large intestine. This reduces the time available for the large intestine to absorb electrolytes and results in the electrolytes being lost with feces. Diarrhea typically increases secretion of intestinal mucus rather than decreasing it. Pathogenic microorganisms result in inflammation of the mucosa. Bacteria in the intestine cannot break down electrolytes.

17) A client presents in the emergency department exhibiting signs indicative of the onset of a bowel obstruction. Which bowel sounds should the nurse anticipate when auscultating the client's abdomen? A) Gurgling or clicking sounds B) High-pitched tinkling, rushing, or growling sounds C) Absence of sounds D) Continuous medium-pitched hum

17. Answer: B Explanation: High-pitched tinkling, rushing, or growling bowel sounds-known as borborygmus-are indicative of the onset of bowel obstruction. Gurgling or clicking sounds are considered normal. Absence of bowel sounds is indicative of late bowel obstruction, not onset of bowel obstruction. A continuous medium pitched hum-called a venous hum-is indicative of a cirrhotic liver

18) The nurse is interviewing a client who is experiencing constipation. During the interview, the client states, "I don't understand what is going on. I feel the urge to go to the bathroom but, once I am in there and I begin pushing with my abdominal muscles, nothing happens." Which of the following represents the nurse's best response to the client? A) "Try taking an over-the-counter medication containing bismuth salts, such as Kaopectate or Pepto-Bismol. If your symptoms don't subside in 2 days, come back to the office." B) "Stop taking all medications until you have reestablished a normal elimination routine. Medication usage often leads to constipation." C) "Make sure that you are taking proper care of the skin in the anal area. Skin breakdown can result in hesitancy when defecating." D) "Try to avoid straining with the abdominal muscles during defecation. Doing so may actually close the anal sphincter, preventing feces from passing through."

18. Answer: D Explanation: Clients should be instructed to use caution when straining the abdominal muscles during defecation, because it may close the anal sphincter rather than allowing feces to pass through. Bismuth salts are antidiarrheals-not laxatives-and would likely compound the client's problem. Certain medications can lead to constipation in some clients, but it is not appropriate for the nurse to encourage the discontinuation of all medications. Skin care is a concern for clients who are experiencing diarrhea or fecal incontinence, and is not typically an issue for patients with constipation.

19) The nurse is reviewing information about four clients who are coming in to the office today due to concerns about bowel elimination. Which of these clients is most likely to have a daily stool softener added to their treatment regimen? A) A 3-month-old client who is exclusively breastfed B) A 43-year-old client who takes opioid medication for chronic pain C) A 92-year-old client who experiences frequent leakage of feces from the anus D) A 28-year-old client who is anemic and has blood in the stool

19. Answer: B Explanation: Clients taking opioids have an increased risk of developing constipation and may prevent it by taking daily stool softeners. Breastfed infants typically have soft, liquid stools and would not benefit from a stool softener. Leakage of feces from the anus is indicative of bowel incontinence—not constipation—and would not be treated with a stool softener. Anemia and blood in the stool are indicators of potential bowel cancer or other serious conditions; this client would likely undergo testing rather than be prescribed a stool softener.

2) A client is diagnosed with high blood pressure that is not responding to medications. The nurse suspects renal stenosis. When assessing for this condition, which location will the nurse use for auscultation? A) Renal arteries B) Bladder C) Ureters D) Internal urethral sphincter

2. Answer: A Explanation: The nurse should auscultate the renal arteries by placing the bell of the stethoscope lightly in the areas of the renal arteries, located in the left and right upper abdominal quadrants. Systolic bruits ("whooshing" sounds) may indicate renal artery stenosis.

2) A client in the ambulatory care clinic tells the nurse about experiencing frequent constipation. The nurse inquires about the client's diet. Which statement from the client would be of greatest concern for the nurse? A) "I like to eat a bran muffin and applesauce every morning for breakfast." B) "I like to eat popcorn for an afternoon snack." C) "I like to eat cheese, a banana, and a turkey sandwich for lunch." D) "I like to eat baked chicken, whole grain rolls, and a small salad for dinner."

2. Answer: C Explanation: Both cheese and bananas are constipating foods that should be limited. The remaining selections are not associated with constipation.

3) The nurse is caring for a group of clients on a medical-surgical unit. Which client does the nurse anticipate to be at the greatest risk for alterations in urinary elimination? A) The client with hypertension who takes a diuretic to manage blood pressure B) An 80-year-old male client reporting frequent urination at night C) A 25-year-old female client with low self-esteem D) A client who had bladder cancer and now has a newly created ileal conduit

3. Answer: B Explanation: The client who is 80 years old with frequent urination at night may be having problems with his prostate. Older male adults experience urinary retention due to prostate enlargement, causing an alteration in urinary elimination. The 25-year-old experiencing low self-esteem has a psychological problem and will need therapy to find the root of the problem. The client who had bladder cancer and now has an ileal conduit doesn't have kidney damage, only the bladder removed. Continued urine production through the ileal conduit will need to be observed and assessed frequently by the staff. The client with high blood pressure takes medication to remove excess fluid from the body, and as long as urine elimination increases, there should be no problems.

3) The nurse is caring for an older adult client. The client tells the nurse that he is constipated. What is the nurse's initial action? A) Encourage the client to increase fluid intake and activity. B) Assess the client's intake of fiber and fluids. C) Determine what the client means by constipation. D) Obtain an order for a laxative and an enema from the physician.

3. Answer: C Explanation: Many older adults believe that a daily bowel movement is important for health, which leads to an increased incidence of perceived constipation in older adults. The nurse should first carefully evaluate the client's concern and question the person as to what is meant by constipation. Determining the client's normal frequency of bowel movement, consistency of stool, and effort in passing stool is important before deciding to act. The other suggestions—achieving adequate fluid intake, exercising, including fiber in the diet, and using a laxative (and possibly an enema)—may be appropriate once the nurse has adequately assessed the client's concern of constipation.

4) The nurse is caring for a client with a history of urinary tract infections (UTIs). Which action by the nurse would decrease the risk of the client experiencing future UTIs? A) Instruct the client to avoid delaying urination. B) Tell the client to increase caffeine in the diet. C) Encourage the client to use the pelvic floor muscles to force urine flow. D) Remind the client to wipe from back to front.

4. Answer: A Explanation: Suppressing urination increases the risk of urinary tract infections. The pelvic floor muscles should not be used to force urine flow, and doing so is considered a poor toileting habit. The client should wipe from front to back because wiping from back to front would contaminate the urinary meatus. The client should decrease the use of caffeine in the diet because caffeine is a bladder irritant.

4) The nurse is planning care for a newly admitted bedbound older adult client. Which nursing diagnosis would be most appropriate for this client? A) Risk of Bowel Incontinence B) Disturbed Body Image C) Risk for Diarrhea D) Risk for Constipation

4. Answer: D Explanation: Lack of activity, like being bedbound, is a major contributor to constipation. Lack of movement slows bowel movements. Lack of sphincter control, not bedrest, contributes to bowel incontinence. Diarrhea would come from a GI upset triggered by diseases, medication, or diet. Disturbed Body Image would affect a client who has undergone a bowel diversion.

5) The nurse admits a client to the medical unit for a urinary disorder. Which questions are appropriate for the nurse to include when assessing the client's voiding pattern? Select all that apply. A) How many times do you urinate in a 24-hour period? B) Has your pattern of urination changed recently? C) How often do you get out of bed at night to urinate? D) What color is your urine? E) Does your urine have any type of odor?

5. Answer: A, B, C Explanation: When assessing the client's voiding pattern it is appropriate for the nurse to ask how many times the client voids in a 24-hour period; if the pattern of urination has change frequently; and how often the client gets out of bed at night to urinate. Questions regarding the color and odor associated with urine are appropriate when assessing urine characteristics.

5) The nurse is caring for a client who is experiencing intermittent constipation. The client has been advised to increase the amount of dietary fiber. Which food selections by the client indicate that teaching has been effective? Select all that apply. A) Rice B) Carrot slices C) Spinach salad D) Bananas E) Peas

5. Answer: B, C, E Explanation: Dietary fiber increases stool bulk. Vegetable fiber—such as that in carrot slices, spinach, and peas—is an excellent source of dietary fiber. The remaining selections are examples of constipating foods.

6) The nurse is providing care to a client at a local clinic. The nurse suspects that the client is experiencing a urinary tract infection. Which urinalysis result supports the nurse's suspicions? A) pH 5.2 B) Negative glucose C) WBC 10-15 D) Specific gravity 1.012

6. Answer: C Explanation: A urinalysis typically consists of the pH, glucose, specific gravity, protein, and WBC count. The pH, glucose, and specific gravity are all within normal limits. A normal WBC is 3-4. The WBC count for this client is high and indicates infection.

6) The nurse is preparing to discharge a client with diarrhea. The healthcare provider prescribes loperamide to manage the client's diarrhea. After providing the client with information on this medication, which client statement indicates the need for further education? A) "If my diarrhea does not get better within 2 days, I will need to call my healthcare provider for further advice." B) "I will need to take the medication after each loose stool." C) "I should continue to take this medication daily until my stools are firm and dry." D) "If I start to have a fever, I need to contact my healthcare provider about continuing to take this medication."

6. Answer: C Explanation: Continuing to take the medication daily until the stools are firm and dry could result in constipation. If constipation occurs, the client will have another issue for resolution. The other statements are correct

7) The nurse provides education and supportive assistance for the family of a preschool-age client diagnosed with encopresis. Which statement indicates parental understanding of appropriate care? Select all that apply. A) "We will establish a limited schedule of activities that has many breaks to provide opportunities to use the toilet regularly." B) "We will schedule an appointment with a play therapist to help our older child adjust to our new baby." C) "We won't change our child's diet because we were afraid it will be stress provoking." D) "We will work on regular elimination after morning and evening meals." E) "We will continue to punish our child for having accidents as the behavior is learned and attention seeking."

7. Answer: A, B, D Explanation: The underlying constipation that leads to encopresis may be caused by the stress of a full schedule of activities or other environmental changes (e.g., birth of a sibling). Dietary changes including incorporating high-fiber foods and limiting refined and highly processed foods and dairy products may be helpful. It takes several months for the bowel to be retrained to respond to sphincter stimulation. It is inappropriate to punish the child for having the accidents because they cannot be helped due to the underlying constipation.

7) The nurse is providing care to a client who is experiencing urinary incontinence. Which independent nursing intervention is the most appropriate for this client? A) Encouraging increased fluid intake B) Providing catheter care C) Instructing on self-catheterization D) Teaching hygiene care

7. Answer: D Explanation: Clients with urinary incontinence must be taught hygiene care—sometimes called incontinence care—to protect against tissue breakdown. Encouraging increased fluid intake is appropriate for a client who is dehydrated. Instructing on self-catheterization and providing catheter care is appropriate for a client who is diagnosed with urinary retention.

8) The nurse is caring for a client with chronic constipation. Which findings in the client's health history could be the cause of the current constipation? Select all that apply. A) Bedrest B) High-fiber diet C) Low-fiber foods D) Chronic laxative use E) Depression

8. Answer: A, C, D, E Explanation: Factors that contribute to chronic constipation include lack of activity, such as bedrest; a diet low in fiber; chronic laxative use; and emotional disturbances such as depression. A high-fiber diet is a treatment option for chronic constipation.

8) The nurse is assigned to a postpartum client who had an anesthetic block during labor and delivery. When providing care for this client, which does the nurse anticipate? A) Nocturnal enuresis B) Risk for hyperkalemia C) Residual urine D) Glycosuria

8. Answer: C Explanation: The postpartum woman is at risk for overdistention, incomplete bladder emptying, and buildup of residual urine (urine that remains in the bladder after voiding). Glycosuria is expected for a client during pregnancy, not during the postpartum period. Nocturnal enuresis and risk for hyperkalemia are anticipated for older adult clients.

9) The nurse is providing care to a client who is experiencing constipation. The healthcare provider prescribes Metamucil, a bulk-forming laxative. Which is a nursing consideration when administering this medication to the client? A) Offering sufficient water B) Administering rectally C) Using to treat acute constipation D) Assessing for tardive dyskinesia

9. Answer: A Explanation: It is imperative that the client take Metamucil with a sufficient amount of water for the medication to be effective. Metamucil is an oral medication, and it is not typically for use in the treatment of acute constipation, as results from the medication are not immediate. Prokinetic drugs such as Reglan may cause tardive dyskinesia. Metamucil is not associated with the cause of tardive dyskinesia.

9) A nurse is caring for a client with congestive heart failure. The healthcare provider prescribes propranolol (Inderal) for the client. Which instruction should the nurse include when administering a beta-adrenergic like propranolol (Inderal) to the client? A) "This medication must be taken on an empty stomach." B) "You will need to discontinue the medication when your symptoms subside." C) "This medication causes constipation. You should take a laxative every day." D) "It is important to notify the healthcare provider if you experience urinary retention."

9. Answer: D Explanation: A beta-adrenergic blocker such as propranolol can cause urinary retention; therefore, it would be important for the client to notify the healthcare provider if this occurs. Clients should always check with their healthcare provider before stopping any medication, because there could be some major complications. Constipation has been reported from clients taking propranolol, but a laxative should not be taken every day, as one can become dependent. This medicine should be taken with food, not on an empty stomach, in order to enhance absorption.