You are taking care of an older female adult with severe cognitive impairments. She is unable to tell you when she needs to urinate and, as a result, is often incontinent. What do you realize she is experiencing?

Choice A reason: Older adult's self-report is a subjective measure of pain that may not reflect the actual intensity or quality of pain. It may also be influenced by factors such as cognitive impairment, mood, or cultural norms.

Choice B reason: FPSR stands for Face, Pain Scale-Revised, which is a tool to assess pain in infants and children who cannot verbalize their pain. It is not suitable for older adults, who may have different facial expressions or reactions to pain.

Choice C reason: Pain medication frequency is an indirect measure of pain that may not capture the effectiveness or side effects of pharmacotherapy. It may also vary depending on the type, dose, and route of administration of pain medication.

Choice D reason: Older adult's pain diary is a comprehensive and reliable measure of pain that can track the changes in pain level, quality, and location over time. It can also record the impact of pain on daily activities, mood, sleep, and quality of life. It can help the nurse to evaluate the outcomes of comfort measures and pharmacotherapy, and to adjust the pain management plan accordingly.

Choice A reason: This is incorrect because any exertion on the part of an older adult with heart disease does not necessarily result in death. Exertion can increase the oxygen demand of the heart and cause angina, or chest pain, but it can also be beneficial for the cardiovascular health and fitness of the older adult, if done within the limits of their tolerance and under medical supervision.

Choice B reason: This is incorrect because myocardial infarction is not the same as heart attack, cardiac arrest, or coronary thrombosis, although they are related terms. Myocardial infarction is the medical term for the death of a part of the heart muscle due to lack of blood supply. Heart attack is the common term for myocardial infarction. Cardiac arrest is the sudden loss of heart function, which can be caused by myocardial infarction or other factors. Coronary thrombosis is the formation of a blood clot in a coronary artery, which can lead to myocardial infarction.

Choice C reason: This is correct because both excessive undernutrition and overnutrition can contribute to heart disease. Undernutrition can cause malnutrition, anemia, and low immunity, which can increase the risk of infections and inflammation that can damage the heart. Overnutrition can cause obesity, diabetes, and high cholesterol, which can increase the risk of atherosclerosis and hypertension that can impair the blood flow to the heart.

Choice D reason: This is incorrect because a person with diabetes should have their blood pressure checked regularly, but this is not a statement about heart disease in Kenya. Diabetes is a risk factor for heart disease, as it can damage the blood vessels and nerves that control the heart. However, this statement is applicable to any person with diabetes, regardless of their location.