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Chapter 10: Elimination
Test Bank
MULTIPLE CHOICE
1. Which of the following is a true statement about elimination in older adults?
a. Defecation less than once each day is not necessarily constipation.
b. Mineral oil is recommended as a laxative for the older adult.
c. Excessive sleep can be a symptom of constipation.
d. Leaking liquid feces should be treated as diarrhea.
ANS: A

Constipation is present when fewer than three bowel movements occur per week or when the
frequency decreases. Mineral oil and saline laxatives can be harmful. Fiber, fruit, and fluids
are the first recommendations; stimulant laxatives such as senna and cascara can be used on a
short-term basis. Altered cognitive status, increased agitation, and unexplained falls can be
symptoms of constipation; these behaviors may be the only clinical symptom of constipation
in cognitively impaired older persons. Excessive sleep has not been identified as a symptom.
Liquid feces may be leaking around a fecal impaction, and antidiarrheal treatment can
aggravate the impaction.
PTS: 1
DIF: Remember
TOP: Nursing Process: Assessment

REF: 13-21
MSC: Physiological Integrity

2. Which action should be included in all bladder-retraining programs?
a. Toileting at bedtime
c. Toileting every hour
b. Using adult incontinence pads
d. Providing 1000 ml of fluids daily
ANS: A

Toileting at bedtime should be incorporated for all patients. This intervention decreases the
amount of urine in the bladder during the night. Incontinence pads are not encouraged during
the retraining process. Toileting is not automatically scheduled every hour but is based on the
individual’s needs. The volume of scheduled fluid intake is also based on the individual’s
needs.
PTS: 1
DIF: Apply
MSC: Physiological Integrity

REF: 13-21

TOP: Nursing Process: Planning

3. The nurse understands that stress incontinence occurs:
a. With a urinary tract infection (UTI)
b. Because of emotional strain
c. As a result of increased intraabdominal pressure
d. With a specific amount of urine in the bladder
ANS: C

If intraabdominal pressure increases, then the patient can have dribbling. A UTI causes
frequency as a result of irritation in the bladder. Emotional strain can cause frequency.
Specific volume of urine in the bladder triggers reflex incontinence.

PTS: 1
DIF: Understand
TOP: Nursing Process: Assessment

REF: 5-7
MSC: Health Promotion and Maintenance

4. What is the most important aspect of care for the nurse to maintain when assisting an older

patient with urinary incontinence?
Availability of protective rubber garments
Using indwelling urinary catheters
Using smooth muscle relaxants
Maintaining an attitude that is respectful and positive about resolving the problem

a.
b.
c.
d.

ANS: D

The nurse recognizes that incontinence is a sign of an underlying problem and not an
inevitable result of aging. In addition, the nurse offers dignity, hope, and understanding by
maintaining a positive and respectful manner and by communicating that effective treatments
are available. Rubber garments, in particular, are hot and can cause skin irritation. Internal
catheters should be used only for a short time and under limited circumstances. Using a
smooth muscle relaxant is indicated only for urge incontinence and for an overactive bladder.
PTS: 1
DIF: Understand
TOP: Nursing Process: Implementation

REF: 32 Box 10-3
MSC: Health Promotion and Maintenance

5. Which option is part of a program that addresses bowel incontinence in an older adult patient?
a. Ensuring that a toilet or commode is readily accessible to the patient
b. Encouraging the intake of 1 liter of water each day
c. Expecting a rapid and full recovery
d. Toileting the patient 10 to 15 minutes after meals
ANS: A

Difficult access to facilities within the time available is a factor in bowel incontinence and
bladder incontinence. The intake of 1 L of fluid is less than the recommended amount to
protect against dehydration and constipation. Realistic expectations and goals should be
discussed with the patient. Toileting should occur 20 to 40 minutes after regularly scheduled
meals when the gastrocolic reflex is active.
PTS: 1
DIF: Remember
REF: 38 Box 10-7
MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

6. An older adult who is on bed rest after surgery is prescribed morphine for pain. Which of the

following is the nurse’s priority for preventive care?
c. Poor solid food intake
d. Poor liquid intake

a. Constipation
b. Diarrhea
ANS: A

This older adult is at high risk for developing constipation as a result of being on bed rest and
being prescribed an opiate for pain. A decrease in activity, combined with the use of an opiate,
often leads to constipation, not diarrhea. Appetite can be poor for the first few days after
surgery, but it often returns without incidence. Decreased fluid intake is often supplemented
with intravenous fluids for the first few days after surgery.

PTS: 1
DIF: Apply
TOP: Nursing Process: Planning

REF: 35-36 Box 10-5
MSC: Health Promotion and Maintenance

7. The nurse is caring for a patient who has recently had an indwelling catheter placed. The

nurse should assess the patient for:
a. An increase in oral fluid intake
b. A change in mental status

c. Upper back pain
d. A decrease in activity

ANS: B

The nurse assesses the older adult’s mental status. Changes in mental status, character of
urine, decreased appetite, abdominal pain, chills, low back pain, urethral discharge in men,
new onset of incontinence, or even respiratory distress may signal a possible UTI in older
people. An indwelling catheter does not often cause a decrease in activity.
PTS: 1
DIF: Apply
TOP: Nursing Process: Assessment

REF: 11
MSC: Physiological Integrity

8. The nurse assesses a male resident in a nursing home for urinary incontinence and determines

that he is unaware of the problem. Which recommendation should the nurse implement?
c. Apply absorbent undergarment.
d. Encourage frequent rest periods.

a. Limit oral fluid intake.
b. Provide regular toileting.
ANS: B

The nurse provides regular toileting to promote voiding and to prevent incontinence for a
resident with a potential cognitive impairment. The nurse avoids limiting oral fluid intake;
older adults, especially those living in residential facilities, are at higher risk for dehydration
than younger people. Using absorbent undergarments may be unnecessary if the incontinence
can be controlled with regular toileting. Nursing research supports the claim that ambulatory
residents are less likely to be incontinent. This resident may have dementia, but maintaining
mobility will have a greater impact in preventing incontinence.
PTS: 1
DIF: Apply
TOP: Nursing Process: Planning

REF: 32-35 Boxes 3 & 4
MSC: Health Promotion and Maintenance

9. A large residual urine volume characterizes what type of incontinence?
a. Urge
c. Overflow
b. Stress
d. Functional
ANS: C

Dribbling, hesitancy, and a large residual urine volume characterize overflow incontinence.
Both urge incontinence and stress incontinence are associated with a small residual urine
volume. Functional incontinence is not associated with residual urine volume.
PTS: 1
DIF: Remember
TOP: Nursing Process: Assessment

REF: 5-7
MSC: Physiological Integrity

10. An older adult is in the hospital because of heart failure and has become incontinent of urine.

Which evidence-based resource should the nurse use to guide continence care for this patient?

a.
b.
c.
d.

Nursing Standard Practice Protocol
The Borun Center training modules
Toolkit from the American Geriatrics Society
The Centers for Medicare and Medicaid Services

ANS: A

The Nursing Standard Practice Protocol is a resource for urinary incontinence in older adults
admitted to acute care. The Borun Center provides training modules suitable for nurses
managing incontinence in residents in long-term care facilities. The American Geriatrics
Society helps with managing urinary incontinence in primary care settings. The Centers for
Medicare and Medicaid Services supply guidelines for managing urinary incontinence in
long-term care facilities.
PTS: 1
DIF: Understand REF: 5-10
MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

11. The nurse wants to begin helping a resident who is overweight and has urinary incontinence

with healthy bladder behavior skills. Which intervention should the nurse implement?
Begin a low-calorie diet for weight management.
Schedule voiding at 2- to 4-hour intervals.
Instruct the resident to practice abdominal exercises.
Reduce the time between an urge to void and voiding.

a.
b.
c.
d.

ANS: B

Healthy bladder behavior skills include scheduling voiding at 2- to 4-hour intervals for
residents either independently or with prompting. Beginning a low-calorie diet can be a
reasonable approach to urinary incontinence, but the nurse first applies low-cost behavioral
techniques. Pelvic floor exercises will help control urinary incontinence. Bladder training
involves increasing the time between the urge to void and voiding.
PTS: 1
DIF: Apply
TOP: Nursing Process: Implementation

REF: 32-35 Boxes
MSC: Health Promotion and Maintenance

12. An older woman tells the nurse practitioner that she fears her family will place her in a

nursing home because she developed stress incontinence. Which recommendation should the
nurse implement?
a. Tell her to eliminate the use of caffeinated beverages.
b. Coordinate a family conference with the older adult.
c. Recommend exercises to strengthen the pelvic floor.
d. Schedule voiding for every 2 hours around the clock.
ANS: C

The nurse practitioner recommends pelvic floor exercises to strengthen the pelvic floor and
the muscles that surround the urethra, vagina, and rectum to decrease the incidence of stress
incontinence. Stress incontinence is usually due to weakened pelvic floor muscles; therefore
eliminating caffeinated beverages can be an ineffective treatment. Arranging a family
conference is premature and potentially embarrassing for the older adult. Many therapies are
available to decrease this older adult’s incontinence. Scheduled voiding is recommended at 2to 4-hour intervals during the day and at 4-hour intervals at night.

PTS: 1
DIF: Apply
TOP: Nursing Process: Implementation

REF: 32-35 Boxes
MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE
1. Which signs and symptoms are characteristic of a urinary tract infection (UTI) in an older

adult? (Select all that apply.)
Fever
Uremia
Dysuria
Anorexia
Flank pain
Turbid urine

a.
b.
c.
d.
e.
f.

ANS: D, F

Anorexia is a more reliable indicator of a UTI in an older adult. In addition, individuals,
including older adults, are likely to void cloudy urine when a UTI is present. Fever, uremia,
dysuria, and flank pain are all unreliable indicators of a UTI in the older adult.
PTS: 1
DIF: Remember
TOP: Nursing Process: Assessment

REF: 11-13
MSC: Health Promotion and Maintenance

2. Long-term use of external catheters can lead to which complication(s)? (Select all that apply.)
a. Fungal skin infections
b. Penile skin maceration
c. Atrophy
d. Edema
e. Phimosis
ANS: A, B, D, E

Long-term use of external catheters can lead to fungal skin infections, penile skin maceration,
edema, fissures, contact burns from urea, phimosis, UTIs, and septicemia. The catheter should
be removed and replaced daily and the penis cleaned, dried, and aired to prevent irritation,
maceration, and the development of pressure ulcers and skin breakdown. If the catheter is not
sized appropriately and applied and monitored correctly, then strangulation of the penile shaft
can occur. Atrophy has not been identified as a complication.
PTS: 1
DIF: Remember
TOP: Nursing Process: Assessment

REF: 11
MSC: Health Promotion and Maintenance

3. Continuous indwelling catheter use is indicated for which condition(s)? (Select all that apply.)
a. Urethral obstruction
c. Stress incontinence
b. Urinary retention
d. Severely impaired skin integrity
ANS: A, B, D

Continuous indwelling catheter use is indicated for those with urethral obstruction or urinary
retention because these patients are unable to empty their bladder without this device. Stress
incontinence is not a condition that warrants a continuous indwelling catheter. Continuous
indwelling catheter use is indicated for patients with severely impaired skin integrity to
decrease the risk of further deterioration of skin integrity.
PTS: 1
DIF: Remember
TOP: Nursing Process: Assessment

REF: 10
MSC: Health Promotion and Maintenance

OTHER
1. The nurse evaluates the urinalysis (UA) of a female patient with an indwelling urinary

catheter. The UA report shows gross contamination of the urine. Rank the nursing
interventions in order, beginning with the first intervention the nurse should implement.
A. Provide perineal hygiene.
B. Provide urinary catheter care.
C. Check the duration of catheterization.
D. Obtain a urine specimen from a sterile port.
ANS:

C, B, A, D
Gross contamination of a urine specimen is a costly error because contaminated urine is
unsuitable for evaluation. The nurse responds to the report of contamination by determining
how long the catheter has been in place; increased duration increases the risk of a UTI from
fecal contamination and can affect subsequent nursing interventions. The second intervention
is providing catheter care. Regardless of the cause of the specimen contamination, catheter
care is a suitable nursing intervention because it decreases the colony count on the catheter.
Third, the nurse progresses to perineal care. This intervention follows catheter care because of
the principle of asepsis regarding working from the least contaminated to the most
contaminated area. Finally, the nurse obtains another urine specimen from a sterile port.
Although the catheter has been washed, the nurse rubs the port with alcohol and withdraws
urine with a sterile needle and syringe to prevent the introduction of contaminants into the
specimen.
PTS: 1
DIF: Analyze
TOP: Nursing Process: Planning

REF: 10-13| 29 Box 10-1
MSC: Health Promotion and Maintenance

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