The gerontological nurse collaborates with the wound care team about an older client who has an ulcer. How is this nurse demonstrating leadership in the care of older people?

Choice A: Increase in physical activity

Physical activity can strengthen the muscles that help control urination. Exercises such as Kegels can specifically target these muscles, leading to improvements in urinary incontinence.

Choice B: Blood sugar control

While blood sugar control is important for overall health and can prevent complications from diabetes, it is not directly associated with improvements in urinary incontinence.

Choice C: Smoking cessation

Smoking can lead to coughing which puts pressure on the bladder and can exacerbate symptoms of urinary incontinence. Therefore, smoking cessation can lead to improvements.

Choice D: Weight reduction

Excess weight can put pressure on the bladder and surrounding muscles. Losing weight can reduce this pressure and improve symptoms of urinary incontinence.

There is no Choice E in this case. Each of these interventions can contribute to overall health and may indirectly affect urinary incontinence, but Choices A, C, and D are the most directly related to improvements in this condition.

Choice A reason: This is the correct answer because the nurse should assess the patient's pain level and location, even if he denies pain. The patient's vital signs indicate that he may be experiencing pain, as increased heart rate, respiration rate, and blood pressure are common physiological responses to pain. Pain can also be masked by other factors, such as fear, anxiety, or stoicism. Therefore, the nurse should ask the patient about his comfort and use a valid pain assessment tool, such as the numeric rating scale or the faces pain scale, to measure his pain intensity.

Choice B reason: This is incorrect because the nurse should not administer an opioid medication by IV route without assessing the patient's pain level and location first. Opioid medications are potent analgesics that can relieve severe pain, but they can also cause serious side effects, such as respiratory depression, sedation, nausea, vomiting, constipation, or dependence. The nurse should follow the principles of pain management, such as using the lowest effective dose, titrating the dose according to the patient's response, and monitoring the patient for adverse effects. The nurse should also consider using non-pharmacological interventions, such as ice packs, elevation, or distraction, to complement the pharmacological therapy.

Choice C reason: This is incorrect because the nurse should not check the surgical dressing for bleeding without assessing the patient's pain level and location first. Checking the surgical dressing for bleeding is an important intervention to monitor the patient's wound healing and prevent infection, but it is not the priority in this scenario. The nurse should first assess the patient's pain and provide appropriate pain relief, as pain can impair wound healing and increase the risk of complications. The nurse should also obtain the patient's consent and explain the procedure before checking the surgical dressing, as this can cause discomfort and anxiety.

Choice D reason: This is incorrect because the nurse should not report the vital signs to the health care provider without assessing the patient's pain level and location first. Reporting the vital signs to the health care provider is an important intervention to communicate the patient's condition and obtain further orders, but it is not the priority in this scenario. The nurse should first assess the patient's pain and provide appropriate pain relief, as pain can affect the vital signs and the patient's well-being. The nurse should also document the patient's pain assessment and intervention in the medical record, as this can facilitate the continuity of care and evaluation of outcomes.