An older male client reports nocturia with difficulty starting his urine stream. Which additional assessment should the nurse perform to obtain further data related to this information?
Question the client about related symptoms.
Palpate the inguinal area for a bulge.
Inspect the urethral meatus for abnormalities.
Observe the scrotum for swelling.
The Correct Answer is A
Choice A reason: Questioning about related symptoms (e.g., urgency, frequency) clarifies nocturia and hesitancy, suggesting causes like benign prostatic hyperplasia. This comprehensive data guides targeted assessments, ensuring accurate diagnosis and treatment, per urological assessment and patient history standards in elderly male nursing care.
Choice B reason: Palpating for an inguinal bulge assesses hernia, unrelated to nocturia or hesitancy. Questioning related symptoms better identifies urinary issues, guiding diagnosis. Hernias are not primary causes, per urological assessment and differential diagnosis protocols in nursing care for urinary complaints.
Choice C reason: Inspecting the meatus for abnormalities or discharge may follow but is less comprehensive than symptom questioning, which broadens the urinary history. Symptoms like hesitancy suggest internal issues, per urological assessment and benign prostatic hyperplasia diagnostic standards in nursing practice for elderly men.
Choice D reason: Observing scrotal swelling assesses testicular issues, not directly linked to nocturia or hesitancy. Questioning symptoms like weak stream or dribbling prioritizes urinary tract evaluation, per urological and geriatric assessment protocols in nursing care for male urinary symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Dependence is not a primary concern with lithium, a mood stabilizer. Toxicity is critical due to lithium’s narrow therapeutic range, risking severe complications. Dependence is more relevant to other drugs, per psychopharmacology and lithium therapy education standards in nursing.
Choice B reason: Interactions are important but less urgent than toxicity, which can be life-threatening with lithium’s narrow therapeutic index. Toxicity education emphasizes monitoring blood levels to prevent harm, per psychopharmacology and patient safety protocols in lithium therapy teaching.
Choice C reason: Toxicity is the most critical adverse effect to teach, as lithium’s narrow therapeutic index risks severe complications like seizures or renal failure. Monitoring symptoms and blood levels ensures safety, per evidence-based psychopharmacology and patient education protocols for lithium therapy in nursing.
Choice D reason: Tolerance is not a significant issue with lithium, unlike toxicity, which is life-threatening due to its narrow therapeutic range. Teaching toxicity symptoms prioritizes patient safety, per lithium therapy management and psychopharmacological education standards in nursing practice.
Correct Answer is D
Explanation
Choice A reason: A cathartic is contraindicated, as pain, distension, and absent bowel sounds suggest postoperative ileus or obstruction, where peristalsis is impaired. Cathartics risk perforation. A nasogastric tube decompresses the bowel, addressing gastrointestinal stasis, preventing complications like vomiting or rupture.
Choice B reason: Reducing IV fluids does not address pain, distension, or absent bowel sounds, indicating ileus or obstruction. Fluids maintain hydration, but nasogastric tube insertion relieves bowel pressure from gas and fluid, restoring function, making fluid reduction ineffective for this postoperative complication.
Choice C reason: Advancing to liquids is inappropriate with absent bowel sounds and distension, indicating ileus, risking vomiting or aspiration. A nasogastric tube removes gastric contents, allowing bowel recovery. Oral intake worsens obstruction, making this contraindicated compared to decompression for safe recovery.
Choice D reason: Nasogastric tube insertion is critical for pain, distension, and absent bowel sounds, suggesting postoperative ileus or obstruction. It decompresses the stomach, removing gas and fluid, reducing pressure and preventing perforation. This addresses the pathophysiological basis of impaired motility, ensuring safe postoperative recovery.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
