A nurse is working with an older adult who is at risk for malnutrition. Which of the following interventions is the most appropriate?

Correct Answer: B

Rationale: The most appropriate intervention for an older adult at risk for malnutrition is to encourage intake of a variety of foods rich in vitamins and minerals (Option B). This is because malnutrition in older adults is often multifactorial and can be due to deficiencies in various nutrients. Encouraging a diverse diet helps ensure the individual receives a wide range of essential nutrients necessary for overall health and well-being. Administering high-calorie supplements (Option A) may not address the specific nutrient deficiencies contributing to malnutrition and could potentially lead to weight gain without addressing the underlying nutritional needs. Restricting caloric intake (Option C) is counterproductive in this situation as it could exacerbate malnutrition and lead to further health complications. Focusing on protein supplements exclusively (Option D) neglects the importance of other essential nutrients needed for overall health and may not adequately address the individual's nutritional needs. In an educational context, it is important for nurses to understand the complexities of nutritional needs in older adults and the importance of promoting a balanced and varied diet to prevent malnutrition. By choosing Option B, the nurse can help ensure the older adult receives a comprehensive array of nutrients to support their health and well-being.

Correct Answer: C

Rationale: In pharmacology, understanding the mechanism of action of a drug is crucial to its proper use. In this case, the correct answer is C) It acts by ablating detrusor spasms. Tolterodine is an antimuscarinic agent used to treat overactive bladder by relaxing the detrusor muscle of the bladder, thereby reducing urgency and frequency of urination. Option A) It should be avoided in men with prostatic hypertrophy is incorrect because tolterodine can actually be used in men with prostatic hypertrophy as it does not specifically target the prostate. Option B) It increases the risk of constipation compared with oral oxybutynin is incorrect as tolterodine is generally associated with fewer anticholinergic side effects like constipation compared to other agents like oxybutynin. Option D) It has a greater risk of adverse effects with its twice-daily formulation is incorrect because the dosing frequency does not necessarily correlate with an increased risk of adverse effects; it is more about the drug's pharmacokinetics and individual patient factors. Educationally, understanding the specific mechanism of action of each drug is vital for safe and effective pharmacological management. Knowing how tolterodine works helps healthcare providers make informed decisions when prescribing it to patients with overactive bladder, leading to better outcomes and patient satisfaction.

Correct Answer: D

Rationale: In this scenario, the correct first step in therapy for the 72-year-old woman experiencing vaginal dryness that interferes with coitus and having a medical history of type 2 diabetes, hypertension, and osteoarthritis while taking glyburide, chlorthalidone, and acetaminophen would be to start a topical vaginal lubricant (Option D). The rationale behind choosing a topical vaginal lubricant as the initial step is based on the patient's symptoms of vaginal dryness, which can be a common side effect of medications like chlorthalidone and possibly worsened by age-related hormonal changes. Topical vaginal lubricants can provide relief by moisturizing the vaginal tissues and improving comfort during intercourse. Stopping glyburide (Option A) or chlorthalidone (Option B) abruptly could lead to uncontrolled diabetes or hypertension, respectively, which could pose serious risks to the patient's health. Discontinuing acetaminophen (Option C) is unlikely to address the vaginal dryness concern as it is not typically associated with this side effect. Educationally, this question highlights the importance of considering medication side effects and individual patient factors when selecting appropriate treatment options. It emphasizes the need to prioritize symptomatic relief while balancing the management of chronic conditions in older adults with multiple comorbidities.

Correct Answer: B

Rationale: The correct answer is B) No because he can be followed with serial carcinoembryonic antigens and CT scans. In this scenario, the patient had a localized colonic adenocarcinoma completely resected without lymph node dissection. Given his age and the absence of lymph node involvement, adjuvant chemotherapy may not be necessary. Instead, close monitoring through serial carcinoembryonic antigen tests and CT scans can be used to detect any recurrence or metastasis early. Option A is incorrect because administering chemotherapy without knowing the complete staging and without clear indication may expose the patient to unnecessary risks and side effects. Option C is incorrect as the presence of severe bleeding does not necessarily indicate advanced disease, especially when the tumor has been completely resected. Option D is incorrect as age alone should not be the sole determinant of treatment decisions, and assuming the patient will not have any problems during his lifetime is not evidence-based. In an educational context, this question highlights the importance of individualized treatment decisions in oncology, considering factors such as tumor characteristics, staging, patient preferences, and risk-benefit analysis. It underscores the significance of regular monitoring and surveillance in cancer care to ensure early detection of any recurrence or progression.

Correct Answer: D

Rationale: The most appropriate medication for the 70-year-old man with bothersome lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH), who values sexual activity, is Tamsulosin (Option D). Tamsulosin is a selective alpha-1 blocker that primarily targets the alpha-1A receptors in the prostate, leading to relaxation of smooth muscle in the bladder neck and prostate, improving urine flow without affecting sexual function significantly. Alfuzosin (Option A) is another alpha-1 blocker used in BPH, but it has a higher incidence of ejaculatory dysfunction compared to Tamsulosin. Ditropan (Option B) is an anticholinergic medication used for overactive bladder, not for BPH. Dutasteride (Option C) is a 5-alpha reductase inhibitor used to reduce prostate size and symptoms in BPH but may lead to sexual side effects like decreased libido and erectile dysfunction. In an educational context, it is crucial for healthcare providers to consider not only the efficacy of medications but also their potential impact on patients' quality of life and preferences, especially in conditions like BPH where sexual function can be affected. Patient-centered care involves discussing treatment options, including potential side effects, and tailoring therapy to individual patient needs and goals.