A nurse is caring for an older adult client who has confusion and weakness.
The client has an elevated hematocrit (Hct) of 53%, an elevated blood urea nitrogen (BUN) of 25 mg/dL, and an elevated urine specific gravity of 1.032.Which of the following actions should the nurse contribute to the client's plan of care? (Select all that apply).

Choice A rationale

Dysuria, or painful urination, is a common symptom in benign prostatic hyperplasia (BPH) due to the mechanical compression of the urethra by the enlarged prostate, which increases resistance to urine flow. This obstruction leads to bladder overdistention and subsequent irritation, often causing a burning sensation upon voiding as the bladder muscles strain against the increased outflow resistance.

Choice B rationale

Polyuria, characterized by abnormally frequent urination, especially at night (nocturia), is a hallmark of BPH resulting from bladder irritation and incomplete emptying. The residual urine reduces the functional bladder capacity, leading to more frequent urges to void, as the detrusor muscle senses distension at lower volumes, especially during periods of decreased fluid reabsorption at night.

Choice C rationale

While benign prostatic hyperplasia causes an increase in the total amount of prostate-specific antigen (PSA) produced, the levels are usually only mildly to moderately elevated (often <4 ng/mL, though up to 10 ng/mL is possible). Critically elevated PSA levels (e.g., >10 ng/mL or a very high rate of rise) are more suggestive of prostate cancer, not typically benign BPH, which involves non-malignant tissue proliferation.

Choice D rationale

Difficulty starting the flow of urine (hesitancy) is a classic lower urinary tract symptom (LUTS) in BPH caused by the mechanical narrowing of the prostatic urethra. The bladder detrusor muscle must generate significantly increased pressure to overcome this outflow obstruction, resulting in a delay between the sensation of needing to void and the actual initiation of the urine stream.

Choice A rationale

Stating that a pelvic exam is a mandatory requirement for birth control pills introduces irrelevant information and potentially pressures the client. While an exam may be recommended, linking it as a prerequisite for medication fails to address the client's expressed anxiety or nervousness directly. The response is dismissive and non-therapeutic, focusing on procedure rather than emotion.

Choice B rationale

While the nurse may be present, promising to stay during the entire exam may not be within the scope of practice or policy, and it prematurely offers reassurance without exploring the client's underlying fears. This response is a barrier to communication, as it shuts down further discussion about the client's specific concerns, which is critical for anxiety reduction.

Choice C rationale

This is the most appropriate therapeutic response, utilizing the open-ended technique of "Tell me more.”. This invites the client to articulate the specific sources of her nervousness, such as fear of pain, embarrassment, or anxiety about potential findings. This client-centered approach facilitates rapport and allows the nurse to provide targeted education and emotional support.

Choice D rationale

Simply telling a client to "relax" is non-therapeutic and minimizes the client's feelings of anxiety. This can increase stress because the client may feel unable to comply with the directive, potentially leading to increased muscle tension and difficulty with the examination. A therapeutic approach focuses on identifying and addressing the source of the nervousness first.