An older adult male arrives at the healthcare center with lower abdominal discomfort and frequent urination. The nurse asks the client to provide a urine sample. After an extended period of time, the client returns with only a few drops of urine. Which action should the nurse implement?
Instruct the client to attempt to urinate again.
Evaluate the client for bladder distention.
Send the sample for laboratory evaluation.
Give the client 8 ounces (236.5 mL) of water to drink.
The Correct Answer is B
A. Instruct the client to attempt to urinate again. This may not be effective if the client has difficulty urinating due to underlying issues such as bladder retention or obstruction.
B. Evaluate the client for bladder distention. This is the correct action. Bladder distention can indicate urinary retention, a common issue in older adults, especially males with prostate problems.
C. Send the sample for laboratory evaluation. While necessary eventually, this action does not address the immediate concern of possible urinary retention.
D. Give the client 8 ounces (236.5 mL) of water to drink. This may help if the client is dehydrated, but it does not address the potential underlying cause of urinary retention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Increased pigmentation and coarse skin. This is a typical finding in the perianal area, reflecting normal anatomical variation.
B. Flap of tissue at sphincter.This may indicate the presence of a skin tag or hemorrhoid, which is not considered a normal finding.
C. Hypotonic tone of the anal sphincter. This suggests decreased muscle tone, which can be abnormal and may indicate underlying pathology.
D. Dimpled area above anus. A dimpled area could indicate a pilonidal sinus or other abnormality, which is not normal.
Correct Answer is B
Explanation
A. Instruct the client to attempt to urinate again. This may not be effective if the client has difficulty urinating due to underlying issues such as bladder retention or obstruction.
B. Evaluate the client for bladder distention. This is the correct action. Bladder distention can indicate urinary retention, a common issue in older adults, especially males with prostate problems.
C. Send the sample for laboratory evaluation. While necessary eventually, this action does not address the immediate concern of possible urinary retention.
D. Give the client 8 ounces (236.5 mL) of water to drink. This may help if the client is dehydrated, but it does not address the potential underlying cause of urinary retention.
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