Nursing: A Concept-Based Approach to Learning Vol. 1 & 2, 3e (Pearson)
Module 5 Elimination
The Concept of Elimination
1) The nurse is caring for an older adult client on a medical-surgical unit. The client tells the
nurse, "I don't get any sleep at night because I have to get up and use the bathroom every couple
of hours!" When providing an explanation for the nocturia, which statement by the nurse is the
most appropriate?
A) "As you get older, there is a decrease in number of nephrons."
B) "As you get older, there is a decrease in the blood supply to your bladder."
C) "As you get older, you may have a decreased bladder capacity."
D) "As you get older, there is a decrease in cardiac output, causing these symptoms."
Answer: C
Explanation: A) Approximately 70% of older women and 50% of older men have to get up two
or more times during the night to empty their bladders due to decreased bladder capacity. A
decrease in blood supply causes an increase in urine concentration. A decrease in the number of
nephrons decreases the filtration rate. A decrease in cardiac output decreases peripheral
circulation, which would decrease urinary output day or night.
B) Approximately 70% of older women and 50% of older men have to get up two or more times
during the night to empty their bladders due to decreased bladder capacity. A decrease in blood
supply causes an increase in urine concentration. A decrease in the number of nephrons decreases
the filtration rate. A decrease in cardiac output decreases peripheral circulation, which would
decrease urinary output day or night.
C) Approximately 70% of older women and 50% of older men have to get up two or more times
during the night to empty their bladders due to decreased bladder capacity. A decrease in blood
supply causes an increase in urine concentration. A decrease in the number of nephrons decreases
the filtration rate. A decrease in cardiac output decreases peripheral circulation, which would
decrease urinary output day or night.
D) Approximately 70% of older women and 50% of older men have to get up two or more times
during the night to empty their bladders due to decreased bladder capacity. A decrease in blood
supply causes an increase in urine concentration. A decrease in the number of nephrons decreases
the filtration rate. A decrease in cardiac output decreases peripheral circulation, which would
decrease urinary output day or night.
Page Ref: 289
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Implementation
Learning Outcome: 5.6. Differentiate considerations related to the assessment and care of clients
with alterations in urinary elimination throughout the lifespan.
MNL LO: Analyze the concept of elimination and its application to nursing care.
1
Copyright © 2019 Pearson Education, Inc.
,2) A client is diagnosed with high blood pressure that is not responding to medications. The
nurse suspects renal stenosis. When assessing for this condition, which location will the nurse
use for auscultation?
A) Renal arteries
B) Bladder
C) Ureters
D) Internal urethral sphincter
Answer: A
Explanation: A) The nurse should auscultate the renal arteries by placing the bell of the
stethoscope lightly in the areas of the renal arteries, located in the left and right upper abdominal
quadrants. Systolic bruits ("whooshing" sounds) may indicate renal artery stenosis.
B) The nurse should auscultate the renal arteries by placing the bell of the stethoscope lightly in
the areas of the renal arteries, located in the left and right upper abdominal quadrants. Systolic
bruits ("whooshing" sounds) may indicate renal artery stenosis.
C) The nurse should auscultate the renal arteries by placing the bell of the stethoscope lightly in
the areas of the renal arteries, located in the left and right upper abdominal quadrants. Systolic
bruits ("whooshing" sounds) may indicate renal artery stenosis.
D) The nurse should auscultate the renal arteries by placing the bell of the stethoscope lightly in
the areas of the renal arteries, located in the left and right upper abdominal quadrants. Systolic
bruits ("whooshing" sounds) may indicate renal artery stenosis.
Page Ref: 283
Cognitive Level: Analyzing
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Assessment
Learning Outcome: 5.1. Analyze the physiology of urinary elimination in the body.
MNL LO: Analyze the concept of elimination and its application to nursing care.
2
Copyright © 2019 Pearson Education, Inc.
,3) The nurse is caring for a group of clients on a medical-surgical unit. Which client does the
nurse anticipate to be at the greatest risk for alterations in urinary elimination?
A) The client with hypertension who takes a diuretic to manage blood pressure
B) An 80-year-old male client reporting frequent urination at night
C) A 25-year-old female client with low self-esteem
D) A client who had bladder cancer and now has a newly created ileal conduit
Answer: B
Explanation: A) The client who is 80 years old with frequent urination at night may be having
problems with his prostate. Older male adults experience urinary retention due to prostate
enlargement, causing an alteration in urinary elimination. The 25-year-old experiencing low self-
esteem has a psychological problem and will need therapy to find the root of the problem. The
client who had bladder cancer and now has an ileal conduit doesn't have kidney damage, only the
bladder removed. Continued urine production through the ileal conduit will need to be observed
and assessed frequently by the staff. The client with high blood pressure takes medication to
remove excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
B) The client who is 80 years old with frequent urination at night may be having problems with
his prostate. Older male adults experience urinary retention due to prostate enlargement, causing
an alteration in urinary elimination. The 25-year-old experiencing low self-esteem has a
psychological problem and will need therapy to find the root of the problem. The client who had
bladder cancer and now has an ileal conduit doesn't have kidney damage, only the bladder
removed. Continued urine production through the ileal conduit will need to be observed and
assessed frequently by the staff. The client with high blood pressure takes medication to remove
excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
C) The client who is 80 years old with frequent urination at night may be having problems with
his prostate. Older male adults experience urinary retention due to prostate enlargement, causing
an alteration in urinary elimination. The 25-year-old experiencing low self-esteem has a
psychological problem and will need therapy to find the root of the problem. The client who had
bladder cancer and now has an ileal conduit doesn't have kidney damage, only the bladder
removed. Continued urine production through the ileal conduit will need to be observed and
assessed frequently by the staff. The client with high blood pressure takes medication to remove
excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
3
Copyright © 2019 Pearson Education, Inc.
, D) The client who is 80 years old with frequent urination at night may be having problems with
his prostate. Older male adults experience urinary retention due to prostate enlargement, causing
an alteration in urinary elimination. The 25-year-old experiencing low self-esteem has a
psychological problem and will need therapy to find the root of the problem. The client who had
bladder cancer and now has an ileal conduit doesn't have kidney damage, only the bladder
removed. Continued urine production through the ileal conduit will need to be observed and
assessed frequently by the staff. The client with high blood pressure takes medication to remove
excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
Page Ref: 279
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Implementation
Learning Outcome: 5.6 Differentiate considerations related to the assessment and care of clients
with alterations in urinary elimination throughout the lifespan.
MNL LO: Analyze the concept of elimination and its application to nursing care.
4
Copyright © 2019 Pearson Education, Inc.
Module 5 Elimination
The Concept of Elimination
1) The nurse is caring for an older adult client on a medical-surgical unit. The client tells the
nurse, "I don't get any sleep at night because I have to get up and use the bathroom every couple
of hours!" When providing an explanation for the nocturia, which statement by the nurse is the
most appropriate?
A) "As you get older, there is a decrease in number of nephrons."
B) "As you get older, there is a decrease in the blood supply to your bladder."
C) "As you get older, you may have a decreased bladder capacity."
D) "As you get older, there is a decrease in cardiac output, causing these symptoms."
Answer: C
Explanation: A) Approximately 70% of older women and 50% of older men have to get up two
or more times during the night to empty their bladders due to decreased bladder capacity. A
decrease in blood supply causes an increase in urine concentration. A decrease in the number of
nephrons decreases the filtration rate. A decrease in cardiac output decreases peripheral
circulation, which would decrease urinary output day or night.
B) Approximately 70% of older women and 50% of older men have to get up two or more times
during the night to empty their bladders due to decreased bladder capacity. A decrease in blood
supply causes an increase in urine concentration. A decrease in the number of nephrons decreases
the filtration rate. A decrease in cardiac output decreases peripheral circulation, which would
decrease urinary output day or night.
C) Approximately 70% of older women and 50% of older men have to get up two or more times
during the night to empty their bladders due to decreased bladder capacity. A decrease in blood
supply causes an increase in urine concentration. A decrease in the number of nephrons decreases
the filtration rate. A decrease in cardiac output decreases peripheral circulation, which would
decrease urinary output day or night.
D) Approximately 70% of older women and 50% of older men have to get up two or more times
during the night to empty their bladders due to decreased bladder capacity. A decrease in blood
supply causes an increase in urine concentration. A decrease in the number of nephrons decreases
the filtration rate. A decrease in cardiac output decreases peripheral circulation, which would
decrease urinary output day or night.
Page Ref: 289
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Implementation
Learning Outcome: 5.6. Differentiate considerations related to the assessment and care of clients
with alterations in urinary elimination throughout the lifespan.
MNL LO: Analyze the concept of elimination and its application to nursing care.
1
Copyright © 2019 Pearson Education, Inc.
,2) A client is diagnosed with high blood pressure that is not responding to medications. The
nurse suspects renal stenosis. When assessing for this condition, which location will the nurse
use for auscultation?
A) Renal arteries
B) Bladder
C) Ureters
D) Internal urethral sphincter
Answer: A
Explanation: A) The nurse should auscultate the renal arteries by placing the bell of the
stethoscope lightly in the areas of the renal arteries, located in the left and right upper abdominal
quadrants. Systolic bruits ("whooshing" sounds) may indicate renal artery stenosis.
B) The nurse should auscultate the renal arteries by placing the bell of the stethoscope lightly in
the areas of the renal arteries, located in the left and right upper abdominal quadrants. Systolic
bruits ("whooshing" sounds) may indicate renal artery stenosis.
C) The nurse should auscultate the renal arteries by placing the bell of the stethoscope lightly in
the areas of the renal arteries, located in the left and right upper abdominal quadrants. Systolic
bruits ("whooshing" sounds) may indicate renal artery stenosis.
D) The nurse should auscultate the renal arteries by placing the bell of the stethoscope lightly in
the areas of the renal arteries, located in the left and right upper abdominal quadrants. Systolic
bruits ("whooshing" sounds) may indicate renal artery stenosis.
Page Ref: 283
Cognitive Level: Analyzing
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Assessment
Learning Outcome: 5.1. Analyze the physiology of urinary elimination in the body.
MNL LO: Analyze the concept of elimination and its application to nursing care.
2
Copyright © 2019 Pearson Education, Inc.
,3) The nurse is caring for a group of clients on a medical-surgical unit. Which client does the
nurse anticipate to be at the greatest risk for alterations in urinary elimination?
A) The client with hypertension who takes a diuretic to manage blood pressure
B) An 80-year-old male client reporting frequent urination at night
C) A 25-year-old female client with low self-esteem
D) A client who had bladder cancer and now has a newly created ileal conduit
Answer: B
Explanation: A) The client who is 80 years old with frequent urination at night may be having
problems with his prostate. Older male adults experience urinary retention due to prostate
enlargement, causing an alteration in urinary elimination. The 25-year-old experiencing low self-
esteem has a psychological problem and will need therapy to find the root of the problem. The
client who had bladder cancer and now has an ileal conduit doesn't have kidney damage, only the
bladder removed. Continued urine production through the ileal conduit will need to be observed
and assessed frequently by the staff. The client with high blood pressure takes medication to
remove excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
B) The client who is 80 years old with frequent urination at night may be having problems with
his prostate. Older male adults experience urinary retention due to prostate enlargement, causing
an alteration in urinary elimination. The 25-year-old experiencing low self-esteem has a
psychological problem and will need therapy to find the root of the problem. The client who had
bladder cancer and now has an ileal conduit doesn't have kidney damage, only the bladder
removed. Continued urine production through the ileal conduit will need to be observed and
assessed frequently by the staff. The client with high blood pressure takes medication to remove
excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
C) The client who is 80 years old with frequent urination at night may be having problems with
his prostate. Older male adults experience urinary retention due to prostate enlargement, causing
an alteration in urinary elimination. The 25-year-old experiencing low self-esteem has a
psychological problem and will need therapy to find the root of the problem. The client who had
bladder cancer and now has an ileal conduit doesn't have kidney damage, only the bladder
removed. Continued urine production through the ileal conduit will need to be observed and
assessed frequently by the staff. The client with high blood pressure takes medication to remove
excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
3
Copyright © 2019 Pearson Education, Inc.
, D) The client who is 80 years old with frequent urination at night may be having problems with
his prostate. Older male adults experience urinary retention due to prostate enlargement, causing
an alteration in urinary elimination. The 25-year-old experiencing low self-esteem has a
psychological problem and will need therapy to find the root of the problem. The client who had
bladder cancer and now has an ileal conduit doesn't have kidney damage, only the bladder
removed. Continued urine production through the ileal conduit will need to be observed and
assessed frequently by the staff. The client with high blood pressure takes medication to remove
excess fluid from the body, and as long as urine elimination increases, there should be no
problems.
Page Ref: 279
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Implementation
Learning Outcome: 5.6 Differentiate considerations related to the assessment and care of clients
with alterations in urinary elimination throughout the lifespan.
MNL LO: Analyze the concept of elimination and its application to nursing care.
4
Copyright © 2019 Pearson Education, Inc.
