GERO (VNSG 1126) CH. 18 "Elimination" NCLEX-STYLE QUESTIONS

Most adults experience bowel elimination every ______________ days

1-2

The urge to defecate most commonly occurs ______________ minutes after a meal, when the gastrocolic and defecation reflexes stimulate peristalsis

30-45 minutes

The patient in the clinic is complaining of constipation. The nurse should recommend intake of how much fluid per day? A) 1000 mL B) 2000 mL C) 3000 mL D) 4000 mL

B) 2000 mL The nurse should recommend drinking 2000 mL of fluid each day. Less fluid puts the patient at risk for dehydration and worsened constipation. 3000-4000 mL of fluid puts the patient at risk for fluid volume overload and water intoxication.REF: Page 292

The nurse knows patients with which diseases are at an increased risk for constipation? Select all that apply. A) Hypertension B) Diabetes C) Systemic lupus erythematosus D) Multiple sclerosis E) Parkinson's disease F) Hyperthyroidism

B) Diabetes, C) Systemic lupus erythematosus, D) Multiple sclerosis, E) Parkinson's disease Diabetes, lupus, multiple sclerosis, Parkinson's, hypothyroidism, and other diseases increase the risk for constipation.REF: Page 290

The patient complains of constipation and painful defecation. The nurse knows without proper intervention this patient is at risk for which complication? A) Infection B) Fecal impaction C) Diarrhea D) Malnutrition

B) Fecal impaction Painful defecation can lead to the patient ignoring the urge to defecate, which further suppresses the urge to defecate and can result in fecal impaction. Infection, diarrhea, and malnutrition are not complications of constipation.REF: Page 291

Why isn't frequency of elimination not considered a good measure of adequate bowel elimination?

Because bowel elimination patters can differ widely from person to person

For a nursing diagnosis of urinary retention, which assessment is the nurse most likely to perform? A) Assess patient's ability to safely ambulate to the bathroom B) Inspect the skin for signs of maceration or irritation C) Gentle palpation of the area over the symphysis pubis D) Assess and monitor laboratory values, especially electrolytes

C) Gentle palpation of the area over the symphysis pubis Severe urinary retention can cause bladder distention, and the nurse would gently palpate the bladder area. (p. 297)

The nurse detects a fecal impaction on digital rectal examination. The nurse anticipates administering which medication first? A) Fleet's enema B) Soap-suds enema C) Oil-retention enema D) Bisacodyl (Dulcolax)

C) Oil-retention enema An oil-retention enema is administered to soften and lubricate the stool. Then, a large-volume enema is administered to evacuate the mass. A stimulant-laxative should be avoided due to trauma to the rectum.REF: Page 294

Repeatedly ignoring the urge to defecate can lead to suppression or even extinction of the?

Defecation reflex

Promotes an important role in normal bowel elimination because this indigestible substance is effective trapping moisture and providing bulk to the wastes

Dietary fiber

When is a common time for defecation?

First thing in the morning after consumption of warm beverage

What may cause the urinary pattern to vary from normal?

Fluid consumption, personal habits, and emotional state

What is constipation?

Hard dry stools that are difficult to pass

The typical adult bowel movement consists of a ________ amount of formed brown stool that is passed without difficulty

Moderate

Urea is a byproduct of?

Protein metabolism

_________ control of the external sphincter muscles enables healthy adults to hold larger amounts in the bladder until urination is convenient

Voluntary

The typical adult experiences the urge to urinate when the bladder contains approximately how many milliliters of urine?

300 mL

Most adults void between ________ and ________ times per day.

6-10

Studies show that ________ % of older adults experience constipation and that it is more commonly a problem for women

27%

The patient reports his last bowel movement was 3 days ago. What should the nurse ask first? A) "What is your normal bowel pattern?" B) "How much water do you drink each day?" C) "What medications do you take for your bowel health?" D) "Have you been taking opioid pain medications?"

A) "What is your normal bowel pattern?" A bowel movement every 3 days may be perfectly normal or extremely abnormal, depending on the patient. Fluid intake, bowel health medications, and use of constipating medications are all part of the elimination assessment, but the nurse should first determine what is normal for the patient.REF: Page 289

Which patient has the highest risk for falls? A) 68-Year-old patient with urge incontinence and mild left hemiparesis B) 58-Year-old patient who frequently exercises and has stress incontinence C) 70-Year-old patient with overflow incontinence and diabetic polyuria D) 62-Year-old patient with decreased manual dexterity and function incontinence

A) 68-Year-old patient with urge incontinence and mild left hemiparesis Patients with urge incontinence frequently rush to the bathroom. In addition, even mild one-sided weakness can create problems with balance. (p. 298)

Which breakfast tray represents the best meal for a patient who is experiencing diarrhea? A) Apple juice, chicken broth, white toast and jam B) Coffee with cream and sugar and granola with raisins C) Milk, whole wheat cereal, and mixed fruit salad D) Orange juice, black coffee, and vegetable omelet

A) Apple juice, chicken broth, white toast and jam For a patient with diarrhea, the nurse would offer fluids that are rich in electrolytes (e.g., juices, Gatorade, and broth) instead of plain water and avoid offering fluids high in fiber, caffeine, and milk because they tend to induce diarrhea. (p. 294)

Your patient Mrs. Fawcett has been diagnosed with urge urinary incontinence. Which of the following are appropriate nursing interventions? (Select all that apply.) A) Avoid placing throw rugs in her room B) Offer her a cup of tea to reduce detrusor muscle spasms C) Place her close to the restroom, and remind her of its location D) Secure her pants with safety pins to keep them secure

A) Avoid placing throw rugs in her room C) Place her close to the restroom, and remind her of its location A person with urge UI is at particular risk of falls from rushing to the bathroom; therefore environmental hazards need to be minimized. Caffeine should be avoided, as it stimulates the bladder. Clothing should be easy to maneuver for quick removal, and it is helpful if bathrooms are situated close by and the person with urge incontinence is aware of their location. REF: Pages 298, 300

When caring for an older adult who has a history of cardiac problems, the nurse recognized that it is most important to institute measures to prevent which outcome? A) Constipation B) Diarrhea C) Urinary tract infection D) Bladder incontinence

A) Constipation Straining to have a bowel movement can stimulate the vagus nerve and result in a sudden decrease in heart rate, syncope, or even loss of consciousness. This can be especially dangerous in those with a history of cardiac problems. REF: Page 291

The nurse would ensure a stool softener is co-prescribed with which constipation-inducing medications? Select all that apply. A) Furosemide (Lasix) B) Iron supplement C) Nifedipine (Procardia) D) Oxycodone/acetaminophen (Percocet) E) Diphenoxylate/atropine (Lomotil) F) Azithromycin (Zithromax)

A) Furosemide (Lasix), B) Iron supplement, C) Nifedipine (Procardia), D) Oxycodone/acetaminophen (Percocet) Diuretics, iron supplements, calcium-channel blockers, opioid analgesics, and anticholinergics all cause constipation and a stool softener should be considered. Lomotil is an antidiarrheal; a stool softener would be counterproductive. Antibiotics such as azithromycin cause diarrhea in many patients.REF: Page 290

The home health nurse knows older patients are at risk for constipation due to low dietary bulk most likely caused by which reason? A) High-bulk foods are difficult to chew B) Many individuals do not enjoy high-bulk foods C) High-bulk foods are expensive and difficult to cook D) Many older adults do not understand the importance of high-bulk foods

A) High-bulk foods are difficult to chew Older adults with loose or missing teeth often have difficulty chewing high-fiber foods. Although some individuals may not enjoy the taste of high-fiber foods, which can be expensive, most older adults understand the importance of high-bulk foods and try to include them in their diet whenever possible.REF: Page 290

The nurse is providing education to a patient on ways to promote bowel health. The nurse knows which age-related changes increase the patient's risk for constipation? Select all that apply. A) Laxative abuse B) Decreased fluid intake C) Increased dietary bulk D) Avoidance of enemas E) Increased abdominal muscle tone F) Decreased physical activity

A) Laxative abuse, B) Decreased fluid intake, F) Decreased physical activity Laxative and enema overuse/abuse, decreased fluid intake, inadequate dietary bulk, decreased abdominal muscle tone, and decreased physical activity increase the patient's risk for constipation.REF: Page 290

While caring for an older adult the nurse determines that further teaching regarding bowel elimination is needed when the patient states: A) "I'll do some exercise and increase my daily fluid intake." B) "I'll give myself an enema if I don't have a bowel movement every day." C) "I'll increase my intake of fruits and vegetables." D) "I'll try to eat more whole grain foods, like bran, daily."

B) "I'll give myself an enema if I don't have a bowel movement every day." Many older adults who have had problems with constipation over the years may have developed a habit of taking laxatives or enemas. We now recognize that this is dangerous because the body can become dependent on laxatives and require this assistance to stimulate elimination. Reestablishing normal bowel elimination in a laxative-dependent older person is almost impossible because the body has forgotten how to work on its own. REF: Pages 290-291

An older patient is trying to control episodes of incontinence by decreasing fluid intake. Which suggestion is the most helpful to the patient? A) Drink 2 liters of fluid every day unless your provider says otherwise B) Consume fluids early in the day and reduce fluid intake after 7:00 pm C) Divide total fluid into small portions spread throughout the day D) Restrict fluid intake until alternative methods are tried and successful

B) Consume fluids early in the day and reduce fluid intake after 7:00 pm Avoiding fluids after 7:00 pm helps to decrease incontinence at night, and this is a specific suggestion that helps the patient to gain some control. Drinking 2 liters per day is correct, but this is less helpful, because it does not address the issue of incontinence. Dividing the fluid into small portions is a strategy for patients who must be on fluid restriction for medical conditions, such as end-stage renal failure. Decreasing total fluid intake makes the urine more concentrated and irritating, and incontinence may worsen. Interventions, such as Kegel exercise, environmental modification, or bladder training are preferable to decreasing fluid intake. (p. 300)

The unlicensed assistive personnel reports to the nurse the patient has had several instances of fecal incontinence with small, liquid stools that the patient is unaware of passing. The nurse should be concerned the patient has which condition? A) Hemorrhoids B) Fecal impaction C) Infectious diarrhea D) Irritable bowel syndrome

B) Fecal impaction Fecal impaction can lead to liquid stool oozing around the blockage and out the rectum. Infectious diarrhea would result in large liquid stools passed with the normal force rather than oozing. Irritable bowel syndrome and hemorrhoids are not described by the symptoms.REF: Page 291

The nurse has an order to perform a digital examination of the rectum to determine if an older adult has a fecal impaction. The nurse would exercise particular caution for which health condition? A) History of diabetes mellitus B) History of cardiac dysrhythmias C) History of hypertension D) History of neurogenic bladder

B) History of cardiac dysrhythmias The nurse would use particular caution when examining older persons with a history of cardiac problems, because rectal examination can stimulate the vagus nerve, resulting in a sudden decrease in heart rate, syncope, and loss of consciousness. (p. 291)

An older adult who recently has had small watery bowel movements, complains of pressure in the rectal area and abdominal cramping. Which is the most appropriate nursing action? A) Administer an oil retention enema B) Notify the primary care provider of these observations C) Digitally stimulate the rectal sphincter D) Administer the prn laxative medication

B) Notify the primary care provider of these observations Passage of small, watery bowel movements; complaints of pressure in the rectal area; and abdominal cramping can occur secondary to fecal impaction. The primary care provider should be notified of this situation to determine if a digital examination of the rectum should be done. Sometimes the impacted mass is higher in the intestinal tract and cannot be detected by digital examination. In these cases abdominal x-rays may be necessary. REF: Page 291

The nurse is caring for a patient who has not had a bowel movement in 4 days and is beginning to ooze liquid stool from the rectum. What should the nurse do first? A) Request an order for an abdominal x-ray B) Review the patient's chart for cardiac history C) Explain to the patient the process of digital rectal examination D) Use a generous amount of water-soluble lubricant on a gloved finger

B) Review the patient's chart for cardiac history Digital rectal examination can stimulate the vagus nerve and exacerbate cardiac problems. Therefore, the nurse should be aware of the patient's cardiac history. Then, the nurse should explain the process of the DRE to the patient and generously lubricate a gloved finger. If an obstruction is not felt, it may be necessary to x-ray the patient's abdomen to determine if an obstruction is present higher in the GI tract.REF: Page 291

Which time is the nurse most likely to offer assistance to an older patient in order to help the patient establish a regular bowel pattern to prevent constipation? A) Every 45-60 minutes B) Just before bedtime C) Shortly after meals D) Before taking medications

C) Shortly after meals Offering to assist the patient shortly after meals takes advantage of the gastrocolic and defecation reflexes. Other typical times would be early in the morning or after drinking the first warm beverage of the day. (p. 292)

Decreased abdominal muscle tone, inactivity, immobility, inadequate fluid intake, inadequate dietary bulk, disease conditions, medications, dependence on laxatives or enemas, and various environmental conditions are all increased risks for?

Constipation

An older patient is hospitalized and receiving intravenous therapy for severe diarrhea and vomiting related to ingestion of spoiled food. Which laboratory result is the most important to monitor? A) Platelet count B) Red cell count C) Blood urea nitrogen D) Electrolytes

D) Electrolytes The nurse is always responsible to monitor all laboratory values; however, vomiting and diarrhea can cause serious electrolyte imbalances. (pp. 293-294)

The home health nurse is reviewing the older patient's medication list and sees that the patient is supposed to take psyllium (Metamucil). Which patient behavior is most likely to cause a problem related to the medication? A) Occasionally neglects to take the medication B) Shares the same bottle of medication with spouse C) Eats very small amounts of fresh fruits or vegetables D) Forgets to drink the recommended amount of fluid

D) Forgets to drink the recommended amount of fluid All of these behaviors warrant some reinforcement of medication teaching; however, psyllium can worsen constipation or cause a bowel obstruction if inadequate amounts of fluid are not taken. (p. 293)

An older woman has begun to stay in her apartment, avoiding socializing with her peers in the independent living center. She states that she cannot wait when she needs to urinate. She is afraid that she will have an accident. It is most appropriate for the nurse to: A) Tell her not to worry because many of the other ladies have the same problem. B) Suggest that she begin to wear an adult incontinence garment when she goes out. C) Recommend that she restrict her fluid intake so the problem does not occur as often. D) Provide encouragement and discuss kegel exercises and other approaches to cope with incontinence.

D) Provide encouragement and discuss kegel exercises and other approaches to cope with incontinence Older adults may hesitate to discuss incontinence problems with the physician or nurse because they are embarrassed or because they think that incontinence is simply a problem of aging that they must endure. Therefore the topic must be introduced in a sensitive manner by caregivers. In some cases, incontinence is curable using surgery, medications, or other treatments. In other cases, it can be better managed, thus allowing the older person a more normal lifestyle. REF: Page 297