EXAM 3 GERO- Chapter Urinary

5. The nurse practitioner assesses a 65-year-old client with anemia and intermittent bloody urine. The client denies pain, cloudy urine, and dysurea. Which of the following conditions does the nurse practitioner suspect? A) Glomerulonephritis B) Renal calculi C) Bladder cancer D) Prostatic hypertrophy

Ans: C Feedback: The most common presenting symptom for bladder cancer is painless hematuria.

16. An elderly male patient complains of urinary frequency and the feeling that he cannot completely empty his bladder. Which of the following is most often associated with these symptoms? A) Enlargement of the prostate B) Urinary incontinence C) Diverticular disease D) Constipation

Ans: A Feedback: The primary cause of urinary retention in men is prostatic hypertrophy, which is present to some degree in most older men.

15. On admission to the hospital, an 81-year-old woman is recognized to be at risk for polypharmacy since she is under the care of multiple care providers in the community. Which of the following components of her extensive medication regimen would constitute the greatest threat to the woman's continence? A) The woman takes a diuretic for treatment of hypertension and over-the-counter antihistamines during allergy season. B) The woman takes an ACE inhibitor and a -blocker for the treatment of her hypertension. C) The woman takes prednisone and uses a topical corticosteroid for the treatment of dermatitis. D) The woman is currently taking a broad-spectrum antibiotic for the treatment of a venous ulcer.

Ans: A Feedback: Antihistamines and diuretics are often implicated in cases of incontinence. The other cited drugs are less commonly associated with incontinence.

22. An 85-year-old client with limited mobility is incontinent of urine. An expected outcome of the plan of care is to maintain skin integrity. Which of the following interventions most appropriate? A) Assess the patient for wetness every 2 hours B) Complete ultrasound bladder scans after each void to measure residual volume of urine C) Ensure the client remains free of urine odor D) Obtain an order for the insertion of an indwelling catheter

Ans: A Feedback: Catheter use should be avoided. Checking the patient for wetness is critical to maintaining skin integrity and would supersede the importance of odor. Postvoid residual scans would be helpful for incomplete emptying of the bladder

21. Which of the following individuals is at greatest risk for bladder cancer? A) Male aged 70 years who retired as a manager for a dye factory B) Female aged 70 years who retired as a manager for a dye factory C) Male aged 70 years with a history of hypertension and diuretics treatment D) Female aged 70 years with a history of hypertension and diuretics treatment

Ans: A Feedback: Chronic irritation of the bladder, exposure to dyes, and cigarette smoking all contribute to the risk of bladder cancer, with older men at three times higher risk than women.

23. A nurse conducts a class for family caregivers of elderly relatives. A woman in the audience asks about her mother's frequent urinary tract infection. What changes should the nurse suggest to the family?

Ans: A Feedback: Dietary changes can prevent a variety of urinary tract problems. Acidic urine is beneficial in preventing infection and can be enhanced by ingestion of cranberries, prunes, plums, eggs, cheese, fish, and grains.

24. The nurse in the emergency department assesses a 76-year-old female. The woman's bladder is visibly distended and the woman has not voided since the previous evening. Which of the following assessment questions made by the nurse is most relevant to the source of the woman's condition? A) "When was your last bowel movement?" B) "Have you been receiving hormone replacement therapy?" C) "What did you have to eat yesterday?" D) "Do you have a history of kidney disease?"

Ans: A Feedback: Given that fecal impaction is the most common cause of urinary retention in women, questions relating to the patient's recent bowel pattern are most relevant.

13. A 75-year-old client has presented to the emergency department with complaints of recent fatigue, nausea, and vomiting. The patient's temperature is 101.8°F orally and urinalysis indicates proteinuria and slight hematuria. Which of the following diagnoses is the care team most likely to suspect? A) Glomerulonephritis B) Renal calculi C) Bladder cancer D) Prostatic hypertrophy

Ans: A Feedback: The presence of fever, nausea, vomiting, and proteinuria are more closely associated with glomerulonephritis than the other cited health problems.

14. A 74-year-old woman who is in hospital for rehabilitation following hip replacement has been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient's bladder function? (Select all that apply.) A) Determine and assess the woman's recent voiding pattern. B) Request an order for an indwelling catheter from the patient's physician. C) Teach the patient how to meet hydration needs while still limiting fluid intake. D) Offer to assist to the commode every 2 hours while awake. E) Assess the client for contributing factors such as constipation.

Ans: A, D, E Feedback: Use the bladder log to begin a prompting voiding program. Constipation is another reversible cause for incontinence. Catheter use should be avoided and limiting fluid intake is inappropriate

7. A nurse is providing care for a 75-year-old man, whom she has noted has not voided urine since the beginning of the shift. The man states that this has happened to him before and that while he presently has the urge to void, he is unable to do so. An ultrasound bladder scan indicates that there is 780 cc of urine in the man's bladder. What is the most likely cause of the man's urinary retention? A) Fecal impaction B) Prostatic hypertrophy C) Neurogenic reflex D) Muscle weakness

Ans: B Among men, prostatic hypertrophy is the most common cause of urinary retention. Fecal impaction is the most common cause of urinary retention in women. Neurogenic (reflex) causes incontinence because of an inability to sense the urge to void or control urine flow. Inefficient neurologic control of bladder emptying and weaker bladder muscles can promote the retention of large volumes of urine; however, it is not as likely as prostatic hypertrophy.

18. The nurse interviews a 65-year-old client with the onset of nocturia. The client gets up two times and sometimes three times a night to void. Which of the following physical changes most likely contributes to this phenomenon? A) Hypertrophy of the bladder muscle interferes when the client is standing for long periods. B) Improved kidney circulation occurs when the client is lying down for a few hours. C) Decreased ability for the bladder to expand reduces its capacity. D) The nocturia is related to the client's development of dementia.

Ans: B Feedback: Although numerous physical changes can contribute to urinary frequency, the most likely cause here is the improved kidney circulation that occurs after an individual has been lying down for a few hours.

9. The nurse visits an 81-year-old man with a recent diagnosis of Alzheimer's disease who lives at home with his wife (his primary caregiver). Recently, the man has begun to be incontinent of urine, a development that his wife states accompanied a decline in his cognition. How would the nurse most likely categorize this incontinence? A) Urge incontinence B) Functional incontinence C) Overflow incontinence D) Stress incontinence

Ans: B Feedback: Incontinence that results from dementia is classified as functional incontinence rather than urge, overflow, or stress incontinence.

4. The nurse determines that the 75-year-old female client is not fully emptying her bladder with each void, contributing to urinary incontinence. Which of the following interventions will enhance the client's ability to void? A) Increase coffee and tea intake B) Massage bladder area with each void C) Run warm water over hands prior to voiding D) Stand upright to void

Ans: B Feedback: Massage using the Crede' maneuver helps to empty the bladder. Standing and warm water help initiate a urine stream. Caffeine should be limited.

20. The nurse completes discharge teaching for a client admitted to the hospital with renal calculi. Which of the following interventions should the discharge teaching emphasize? A) Close observation for toxic kidney output. B) Fluid intake of approximately 2 L each day. C) Interventions for the expected transient incontinence. D) Use of a dipstick to monitor for proteinuria.

Ans: B Feedback: Prevention measures include minimizing urinary stasis, drinking ample fluids, and prompt treatment of urinary tract infections. No incontinence or toxic kidney output is expected. Their urine may be strained but no dipstick assessments are used.

25. The nurse observes that the client voided four times during the night. The client is a 72-year-old man who is in the hospital for treatment of a myocardial infarction. In addition, he has a history of hypertension and congestive heart failure. Which of the following components of his medication regimen is most likely implicated in his nocturia? A) Nitroglycerine patch B) A thiazide diuretic C) An ACE inhibitor D) Morphine sulfate

Ans: B Feedback: The effects of diuretics, even when given in the morning, can continue into the night resulting in nocturia. This effect is less likely with the other listed drugs.

17. The nurse teaches a 90-year-old male patient these steps he can take to minimize urinary retention: ensure good fluid intake, massage the bladder area, and run water while he is voiding. The primary reason for this teaching is prevention of which of the following? A) Urinary incontinence B) Urinary tract infections C) Constipation D) Prostatic hypertrophy

Ans: B Feedback: Urinary retention puts the older adult at risk for urinary tract infections.

1. The nurse assists the client to clean up after an incontinence episode. The client says "I'm sorry that you have to do this...." Which response, if made by the nurse, is most appropriate? A) "Everything is just fine." B) "I'm happy to help you." C) "It's no big deal." D) "You shouldn't worry."

Ans: B Feedback: When incontinent episodes occur, discuss the cause with the patient in a matter-of-fact and therapeutic manner. Everything is not just fine for the patient; it is a big deal to him or her. The nurse should not tell the patient how to feel

12. A 77-year-old client has presented to the primary care provider with a complaint of recent hematuria. Which of the following aspects of the client's history would most clearly signal to the care provider a risk of bladder cancer? A) The client has been a heavy drinker as an adult. B) The client has poor nutritional status and eats a high-salt diet emphasizing processed foods. C) The client has been a smoker since the age of 15. D) The client has a history of recurrent urinary tract infections.

Ans: C Feedback: Cigarette smoking is an identified risk factor for bladder cancer. Alcohol use, poor nutritional status, and urinary tract infections are not noted to be risk factors for bladder cancer.

. During the assessment of an 80-year-old female who has recently been admitted to the long-term care facility, the resident mentions to the nurse about her ongoing problems with urinary frequency. The nurse would recognize which of the following age-related changes as contributing to the resident's health problem? A) Neurogenic deterioration of bladder control B) Cognitive changes inhibiting the micturition urge C) Hypertrophy of the bladder muscle and thickening of the bladder D) Decreased tone of the urethral sphincters

Ans: C Feedback: Hypertrophy of the bladder muscle and thickening of the bladder itself are considered normal, age-related changes and can be causative of frequency. The other cited phenomena are not considered normal, age-related changes.

11. Which of the following findings of a nurse who is assessing a 71-year-old female client's urinary function would be most likely considered abnormal and potentially pathological? A) A test for stress incontinence yields a few drops of urine on gauze on the client's perineum. B) The color of the client's urine is pale yellow. C) The pH of urine sample is 9.0 D) The urine has a faint, aromatic odor

Ans: C Feedback: Normal urine pH ranges from 4.6 to 8. A few drops of urine during an urge incontinence test is not abnormal, and a pale yellow coloration and a faint, aromatic odor are considered normal findings.

27. A 71-year-old man has presented to his nurse practitioner's clinic complaining of abdominal and flank pain and blood in his urine for the past 48 hours. Assessment reveals the man's temperature is 102°F orally. Which of the following health problems should the nurse first suspect? A) Bladder cancer B) Benign prostatic hyperplasia (BPH) C) Renal calculi D) Testicular cancer

Ans: C Feedback: Renal calculi are associated with fever, pain, and hematuria. BPH and testicular cancer are unlikely to cause hematuria and bladder cancer is more commonly painless.

2. The 75-year-old client states that when she senses the need to urinate, she is unable to inhibit voiding before she reaches the toilet. What advice would help her incontinence? A) "Don't drink any liquids after 6 pm. This will decrease your urine volume." B) "Make a urination schedule as to when you are incontinent during the day." C) "Remind yourself to urinate every two hours during the day." D) "You need to tell your doctor because this is very unusual."

Ans: C Feedback: Urgency incontinence can be aided by adherence to a toileting schedule, Kegel exercises, biofeedback, and medications.

26. An old-old male patient with type 2 diabetes and negative diabetic urine testing has elevated blood sugar levels. Which of the following age-related changes could cause his elevated blood sugar without any evidence of glycosuria? A) Decreased reabsorption from the filtrate B) Reduced tubular function C) High blood urea nitrogen levels D) Increase in the renal threshold for glucose

Ans: D Feedback: An increase in the renal threshold for glucose, as often occurs in older adults, is a serious concern. False-negative results in diabetic urine testing can occur for this reason.

19. The nurse assesses a client who has recently developed nausea and vomiting, blurred vision, and palpitations. The history reveals that the client recently increased the dosage of digoxin. Which of the following age-related changes are most likely related to these symptoms? A) Cerebral cortex changes causing flu-like symptoms B) Heart changes that are affecting the ability to ingest the digoxin C) Age-related changes in cortical control of micturition D) Kidney changes that affect elimination of the digoxin Ans: D

Ans: D Feedback: Digoxin, a common drug taken by the elderly, is excreted by the kidneys unchanged. Because kidney filtration decreases with age, toxic levels of this type of medication can occur, causing adverse drug reactions.

3. The nurse instructs a class of older adult women about Kegel exercises. In which of the following urinary conditions would Kegel exercises be ineffective? A) Stress incontinence B) Urge incontinence C) Urinary frequency D) Urinary retention

Ans: D Feedback: Kegel exercises are an approach to strengthening the pelvic floor muscles, which can lead to an improvement in control over urine incontinence, not retention.

10. Which of the following older adults would be most likely to benefit from Kegel exercises? A) A 60-year-old female who has a diagnosis of multiple sclerosis. B) A 73-year-old man who has been diagnosed with benign prostatic hypertrophy C) A 70-year-old woman who has been experiencing urgency incontinence since she developed a urinary tract infection D) A 67-year-old female client who has lived with stress incontinence since having her children.

Ans: D Feedback: Kegel exercises are most effective in the management of stress incontinence rather than neurogenic incontinence, overflow incontinence, or urgency incontinence.

8. The nurse educator who directs care at an assisted living facility is conducting a health promotion session with residents. Which of the following pieces of advice about maintaining and promoting bladder health is most accurate? A) "Making your urine more acidic through your diet can reduce the incidence of infections." B) "Resisting the urge to void for a while can increase the volume of each void and prevent frequency." C) "Limiting or avoiding fluids drank after 5:00 p.m. can help you void less frequently." D) "If you do experience frequent voiding at night, requesting a urinary catheter can help in the short term."

Urine pH can be lowered through diet, preventing some infections. The urge to void should not be resisted and older adults should not be encouraged to hold fluids to control their urinary elimination. Catheterization would not normally be warranted in cases of nocturia. ---you can make you urine more acidic by VIT C- cranberries , prune, fish, green.