Chapter 16: Elimination

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. A patient tells the nurse, “Every time I laugh or cough, I wet myself.” Which type of urinary incontinence is this patient describing?

a. Urge b. Functional c. Stress d. Mixed

ANS: C

Stress incontinence is defined as the loss of a small amount urine with activities that increase intraabdominal pressure such as coughing, sneezing, exercise, lifting, or bending.

DIF: Cognitive Level: Applying REF: p. 203, Box 16-1

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Mixed incontinence b. Stress incontinence c. Urge incontinence d. Functional incontinence

2. A 78- year-old patient has a history of osteoarthritis and lives alone in a two-story home. The bathroom is on the first level and the bedroom is on the second level. The patient states, “I am so upset. I have been wetting the bed at night.” What type of incontinence does the patient most likely have?

ANS: D

Functional incontinence is defined as incontinence that is due to the individual being unable to get to the toilet as a result of barriers, including environmental barriers.

DIF: Cognitive Level: Applying REF: p. 203, Box 16-1

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Increasing fiber in the diet b. Administering aluminum hydroxide antacids c. Bed rest d. Restricting fluids

3. A nurse implements a nursing care plan for a patient with constipation. Which of the following should the nurse include in the plan?

ANS: A

Fluid intake of at least 1.5 L/day, unless contraindicated, is the cornerstone of constipation therapy, with fluids coming mainly from water. A gradual increase in fiber, either as supplements or incorporated into the diet, is generally recommended. Fiber helps stools become bulkier and softer and move through the body more quickly. Physical activity is important as an intervention to stimulate colon motility and bowel evacuation. Daily walking for 20-30 minutes, if tolerated, is helpful, especially after a meal. Aluminum hydroxide antacids are known to be constipating.

DIF: Cognitive Level: Applying REF: p. 214

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Assess for soiled clothing and change, if necessary. b. Toilet the client and then promptly transport to the dining room. c. Provide peri-care and fresh underclothing. d. Ask the client if toileting is needed and assist as necessary.

4. Which of the following nursing actions would help minimize the psychosocial impact of bladder and/or bowel incontinence for individuals experiencing incontinence prior to going to a group dining room?

ANS: A

Deviations from normal bowel and bladder toileting can lead to chastisement, ostracism, and social withdrawal. By addressing incontinency issues prior to social interactions, such negative responses can be minimized. While toileting is appropriate, it does not directly address the social impact that may result from soiled and/or odorous clothing. Providing peri-care and clean underclothing is necessary only if incontinency has occurred. Asking to toilet the client is not necessarily an effective intervention when the client is consistently incontinent.

DIF: Cognitive Level: Applying REF: p. 200

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

5. An 89- year-old hospitalized female patient tells a nurse, “I go to the bathroom really often, but I manage this by not drinking too much before I go to bed so I can sleep for the night.” The patient has no pain or discomfort with voiding. The nurse considers this finding to be a: a. manifestation of urge incontinence. b. manifestation of a urinary tract infection. c. normal age-related change in an 89- year-old woman. d. manifestation of diabetes.

ANS: C

A decreased bladder capacity is a normal age-related change. Urinating frequently with no other symptoms is not a manifestation of infection or diabetes. Urge incontinence is not a correct response as the patient is not experiencing incontinence.

DIF: Cognitive Level: Applying REF: p. 201

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

Multiple Response

1. The nurse interviewing an older adult for a nursing history recognizes that the client is experiencing symptomology inconsistent with normal aging of the urinary tract when the client reports: (Select all that apply.)

a. finding it more difficult in the last few months to start voiding.

b. having two bladder infections in the last 4 years.

c. getting up once or twice each night to urinate.

d. occasionally experiencing pain when urinating.

e. needing to urinate at least every 2 hours during the day.

ANS: A, D

Difficulty and pain are not characteristics of urination normally attributed to aging. In about 10-20% of well older adults, aging of the urinary tract is associated with an increased frequency of involuntary bladder contractions. These changes may lead to frequency, nocturia, urgency, and vulnerability to infection.

DIF: Cognitive Level: Applying REF: p. 201

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. asking whether the client smokes tobacco. b. assessing the average amount of caffeine the client drinks daily. c. asking if the client has been evaluated for diabetes recently. d. suggesting the client keep a record of the amount of fluids ingested daily. e. reviewing the client’s current medication list.

2. An otherwise healthy older adult reports having begun to experience problems “holding my water.” The nurse shows an understanding of interventions that may help minimize the problem of urinary incontinency when: (Select all that apply.)

ANS: A, B, C, E

Risk factors for urinary incontinence include tobacco use, caffeine consumption, and increased urine resulting from diabetes and certain medications. Keeping record of fluid intake will have little or no impact on urine incontinence.

DIF: Cognitive Level: Applying REF: p. 202, Box 16-4

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. checking documentation to determine if the client has had a bowel movement in the last 24-36 hours. b. questioning staff as to whether the client has any unexplained falls in the last few days. c. asking the client to name all of his or her children and grandchildren. d. requesting that the client’s temperature be taken now and again in 4 hours. e. reviewing the client’s food intake over the last 24-36 hours.

3. A nurse caring for a cognitively impaired older adult client shows an understanding of the unique clinical symptoms of constipation in this population when: (Select all that apply.)

ANS: B, C, D, E

It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person. Frequency of defecation is not necessarily an indicator of constipation since it is such a personal characteristic.

DIF: Cognitive Level: Applying REF: pp. 212–213

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. To assist with incontinence management b. To manage acute urinary retention c. To assist in healing of open sacral or perineal wounds in incontinent patients d. To accurately measure urinary output in critically ill patients e. To prevent falls related to toileting in hospitalized older patients

4. A nurse is caring for an older adult in a hospital who has an indwelling catheter. The nurse assesses the patient based on the knowledge that which of the following are correct indications for an indwelling catheter? (Select all that apply.)

ANS: B, C, D

Indwelling urinary catheters are appropriate in the management of acute urinary retention, to assist in the healing of open sacral or perineal wounds in incontinent patients, and when accurate measurement of urinary output is essential in managing a critically ill patient. Urinary catheters are not an appropriate intervention for the management of incontinence and do not prevent falls related to toileting in hospitalized patients.

DIF: Cognitive Level: Remembering REF: p. 209

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Assess the patient’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. Assist the patient to use the bathroom. e. Request an order for medication to decrease bladder spasms.

5. A 74- year-old woman who is in the 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.)

ANS: A, D

When a patient experiences new onset incontinence, the first step is assessment. Assisting the patient to the bathroom has many beneficial aspects to it and it provides a private setting where the patient is in the most normal physiological position to urinate. Placing an indwelling catheter is not a solution to urinary incontinence. Limiting fluids is not indicated in this patient. There is no indication that this patient is having bladder spasms.

DIF: Cognitive Level: Applying REF: pp. 203–204

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance