CHAPTER 17 The Genitourinary and Renal Systems

CHAPTER 17 The Genitourinary and Renal Systems

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

17.1•An 80-year-old woman describes having to go to the bathroom more frequently at night. The nurse interprets this assessment data to be symptoms of

1. increased glycosuria.
2. normal changes of aging.
3. fluid overload.
4. impairment of drug excretion.

Answer: 2

Rationale: Unlike younger adults, the older kidney excretes more fluid and electrolytes at night rather than during the daytime. This can result in more urine produced at night, potentially interrupting elders’ sleep patterns. Older adults also excrete less glucose in the urine, making increased glycosuria not possible. Older adults have a decreased response to fluid overload by not increasing urine output, and although drug excretion may be impaired in the elderly, it would not result in increased urine output.

Assessment

Physiological Integrity

Analysis

17.2•A 92-year-old client is brought to the emergency department with complaints of fever, nausea, and vomiting for the past 2 days. The client denies thirst, and urine specific gravity is below normal values. The nurse would interpret this finding to be consistent with

1. fluid overload.
2. normal changes of aging.
4. congestive heart failure.

Answer: 3

Rationale: The elderly are less able to concentrate their urine, making them susceptible to dehydration. In addition, there is a deficit of the thirst response. The client’s symptoms of nausea and vomiting suggest decreased intake and increased output through vomiting, placing the client at risk for dehydration. Congestive heart failure and fluid overload would present with respiratory difficulty and peripheral edema.

Assessment

Physiological Integrity

Analysis

17.3•The nurse is attempting to place a urinary catheter in a 96-year-old female client. The nurse is unable to visualize the client’s urinary meatus. An alternate position to facilitate the insertion of the catheter would include

1. supine with the head of bed (HOB) elevated at 90.
2. supine with the bed flat, legs bent and apart.
3. supine with the HOB elevated at 30.
4. side-lying lifting up the buttock.

Answer: 4

Rationale: Because of estrogen-mediated changes in the perineal area of postmenopausal women, the urinary meatus may be very difficult to visualize. The side-lying position lifting up the buttock is an alternative that provides better visualization of the urinary meatus. The supine position, regardless of the leg position or height of the bed, would not increase the visualization of the urinary meatus because it is more distal from the changes in the perineal area.

Implementation

Physiological Integrity

Application

17.4•The nurse is conducting a home care visit of a 78-year-old female client. The client confides in the nurse about pain experienced during intercourse. The nurse would instruct the client to

1. avoid intercourse.
2. use vaginal lubricants during intercourse.
3. tolerate this problem because it is a normal part of aging.
4. decrease the frequency of intercourse to decrease the pain.

Answer: 2

Rationale: It is not uncommon for an elderly female to report painful intercourse, which is related to a decrease in vaginal lubrication as well as the lack of elevation of the labia during sexual arousal. Vaginal lubricants can be very effective in reducing the pain experienced during intercourse. Although this is a normal change of aging, clients do not have to tolerate the discomfort. Avoidance and decreasing frequency of intercourse would not resolve the problem for the client. It is stereotypical to assume the client would have less of a desire for intercourse at an older age.

Implementation

Health Promotion and Maintenance

Application