You notice that your older adult male client frequently knocks his arm or hand against door frames or chair backs and then develops a purpura. What do you advise your client to do? (Select all that apply.)

Choice A reason: Serum sodium levels are not the best determination of hydration in this client, as they can be affected by other factors, such as fluid intake, fluid loss, kidney function, or medication use. Serum sodium levels can be normal, high, or low in a dehydrated or overhydrated client, depending on the cause and type of the fluid imbalance.

Choice B reason: BUN stands for blood urea nitrogen, which is a waste product of protein metabolism that is excreted by the kidneys. BUN is not the best determination of hydration in this client, as it can be influenced by other factors, such as protein intake, liver function, or muscle breakdown. BUN can be high or low in a dehydrated or overhydrated client, depending on the cause and type of the fluid imbalance.

Choice C reason: Urine osmolality is the best determination of hydration in this client, as it measures the concentration of solutes in the urine, which reflects the ability of the kidneys to adjust the urine output according to the fluid status. Urine osmolality can indicate the degree of dehydration or overhydration in a client, as it increases or decreases in response to the fluid balance.

Choice D reason: Urine color is not the best determination of hydration in this client, as it can be affected by other factors, such as food, medication, or infection. Urine color can be dark or light in a dehydrated or overhydrated client, depending on the cause and type of the fluid imbalance.

Choice A reason: This is incorrect because using smooth muscle relaxants is not the most important aspect of care for the nurse to maintain when assisting an older client with urinary incontinence. Smooth muscle relaxants are medications that can relax the bladder and reduce the urge to urinate, but they can also cause side effects such as dry mouth, constipation, or blurred vision. They are not suitable for all types of urinary incontinence, and they should be used with caution and under medical supervision.

Choice B reason: This is incorrect because availability of protective rubber garments is not the most important aspect of care for the nurse to maintain when assisting an older client with urinary incontinence. Protective rubber garments are devices that can prevent urine leakage and protect the skin and clothing, but they can also cause skin irritation, infection, or odor. They are not a cure for urinary incontinence, and they should be used as a last resort or in combination with other interventions.

Choice C reason: This is incorrect because using indwelling urinary catheters is not the most important aspect of care for the nurse to maintain when assisting an older client with urinary incontinence. Indwelling urinary catheters are tubes that can drain urine from the bladder and collect it in a bag, but they can also cause complications such as urinary tract infections, bladder spasms, or trauma. They are not recommended for long-term use, and they should be used only when other methods have failed or are contraindicated.

Choice D reason: This is correct because maintaining an attitude that is respectful and positive about resolving the problem is the most important aspect of care for the nurse to maintain when assisting an older client with urinary incontinence. Urinary incontinence can cause embarrassment, shame, isolation, or depression in older clients, and they may be reluctant to seek help or comply with treatment. The nurse should respect the client's dignity, privacy, and preferences, and provide education, support, and encouragement. The nurse should also assess the underlying causes and contributing factors of urinary incontinence, and implement individualized and evidence-based interventions.