601 Final Review Set

The diagnosis and treatment of cancer in older adults is accompanied by complexities that do not exist in younger populations. Which of the following phenomena contribute to the additional complexity of cancer diagnosis and treatment among the elderly? (Select all that apply.)

A). Detection often occurs at later stage in the course of the disease. C). The presence of other chronic health problems makes detection more difficult D). The potentially harmful effects of many treatment options make treatment more challenging.

Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation?

A. A 78-year-old man has recently developed urinary incontinence.

Decreased renal mass and reduced glomerular filtration make it especially important that nursES:

A. Ensure that age-adjusted drug dosages are prescribed

Which assessment finding is most important in determining nursing care for a client with pneumonia?

B). Confusion and restlessness

During a visit to her nurse practitioner, a 68-year-old client is surprised at the nurse's recommendation of immunizations, stating, "I thought those were only for children and teenagers." Which of the following statements provides the most accurate rationale for the nurse's recommendation?

B). Older adults should receive annual influenza vaccinations and tetanus and diphtheria boosters every 10 years.

An older patient who enjoys good health is experiencing a decline in stamina despite being physically active over the years. The nurse recognizes which age-related change as likely affecting the patient's stamina?

B). Reduced heart contractility and a prolonged cardiac cycle

During a neurologic evaluation, the nurse practitioner has asked an 83-year-old client to draw the face of the clock and then tell the nurse what time the clock reads. Which of the following assessment findings would be most indicative of expressive aphasia?

B). The client draws a clock but is unable to state the time.

A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future?

Both life expectancy and the percentage of people over 65 in the population will increase in coming decades.

The clinic nurse teaches the older adult who is receiving the influenza vaccination. Which of the following statements, if made by the client, indicate the need for further teaching?

C). "I want the live attenuated nasal spray vaccine, not the shot."

One step in the functioning of a healthy immune system involves the T cells correctly interpreting that the antigen's protein is foreign. In an elderly adult, this response is affected by which age-related change?

C). The thymus progressively declining in size.

An elderly man is admitted to the hospital for surgery. A day later, he seems confused and disoriented. He imagines there is a trapdoor in the ceiling above his bed. His wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed "sharp as a tack." What should the nurse do first?

Check the patient's chart for medications that can cause delirium.

C in PICO stands for

Comparison (to current standard)

Mr. D was friendly and active as a young adult. Now, as a 75-year-old, he enjoys visiting with his neighbors and attending a variety of sporting and cultural events. Mr. D's behavior is most consistent with which theory of aging?

Continuity Theory

A gerontological nurse teaches a new nurse about older adults and pneumonia. Which of the following teaching points for the new nurse is most accurate?

D). "Pneumonia can often be prevented, but numerous age-related factors conspire to make older adults susceptible to it."

Which assessment finding indicates that an older patient is experiencing congestive heart failure?

D). Moist lung crackles are audible on auscultation with shortness of breath on exertion

Which of the following are typical activities of daily living?

DEATH: Dressing, eating, ambulating, transferring/toileting, hygeine

A nurse is taking the medical history of an elderly patient who has thyroid cancer. What is an especially important question the nurse should ask?

Did you have acne as a teenager?

A 75-year-old female patient, whose marriage ended in divorce after two years, has lived alone for the past 50 years. Feeling as if her life has had little meaning, the patient is terrified of living out her remaining years and of dying. The age-related issue to be resolved is:

Ego integrity versus despair

Mr. J, age 81, has been admitted to hospital for the treatment of diverticulitis. It is noted in his history that Mr. J has a history of depression. Which of the following nursing actions is most likely to foster his mental health?

Encouraging Mr. J to make decisions regarding his routine and care.

Determine which of the following nursing considerations has the highest priority for an elderly adult with dementia.

Ensuring Patient safety

T or F: Influenza and pneumonia account for a greater number of deaths of adults 65 and older in 2014 as compared to 1980, according to the CDC.

False

The nurse discusses hand hygiene with the staff specifically regarding Clostridium difficile. Which of the following should the nurse include in teaching plan?

Hand washing is required with running water and soap to remove the spores from the caregivers' hands.

The nurse assesses a client with Parkinson's disease. Which of the following symptoms are unexpected, requiring immediate follow-up?

Hypoglycemia

Which of the following would be symptoms of depression in an elderly person? (Select all that apply.)

Inattention to hygiene Changes in sleep patterns Physical complaints such as anorexia, constipation, headache, and indigestion

I in PICO stands for

Intervention

A 76-year-old woman has been prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of her depression. What assessments should the nurse prioritize during the initial days of the patient's drug therapy?

Monitoring for changes in the patient's cognitive status and nutrition.

Which of the following older adults is most likely to have his or her health problem characterized as delirium rather than dementia?

Mr. L, whose wife has brought him to the emergency department because of the forgetfulness and confusion that he has exhibited over the last 48 hours.

Which one of the following residents of a long-term care facility is most likely exhibiting signs and symptoms of depression?

Mrs. L, age 79, who has withdrawn from her regular bridge games and no longer returns calls to her friends.

The nurse assesses a change in the respiratory status of an older patient. Which findings should be reported to the health care provider immediately? (Select all that apply.)

Neck vein distention C). Elevated blood pressure D). Change in mental status

O in PICO stands for

Outcome (desired)

P in PICO stands for

Patient/Population

Which of the following nursing practices commonly performed in the geriatric medical unit of a hospital is most in need of modification or correction?

Patients at risk for urinary incontinence are catheterized in order to reduce the risk of urinary tract infections.

An elderly patient scheduled for cancer treatments may require age-related adjustments in dosages for some procedures. Which kind of treatment can be administered without any age-related adjustment?

Radiation Therapy

A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future? a. while life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. b. by 2020, it is expected that over one-third of Americans will be over the age of 65. c. both life expectancy and the percentage of people over 65 in the population will increase in coming decades d. chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020

c. both life expectancy and the percentage of people over 65 in the population will increase in coming decades.

A group of nurses is planning to investigate the effectiveness of turning immobilized stroke clients more frequently in order to prevent skin breakdown. The team has begun by formulating a PICO question. Which of the following will the "O" in the team's PICO question refer to? a. turning clients more frequently b. the currently-used turning schedule c. preventing skin breakdown d. clients who have experienced a stroke

c. preventing skin breakdown

The most common symptoms of heart failure include: a. chest pain and palpitations b. sweating and fever c. shortness of breath, feeling tired, and swelling d. orthostatic hypotension and syncope

c. shortness of breath, feeling tired, and swelling

body shrinkage during the aging process is due to:

reduced hydration, loss of cartilage, thinning of the vertebrae

continuity theory of aging

relates personality and predisposition toward certain actions in old age to similar factors during other phases of the life cycle

Delphi study

solicits opinions from groups in an iterative process of answering questions; after each round the responses are summarised and redistributed for discussion in the next round

methodologic survey

studies the sampling of individual units from a population and the associated survey data collection techniques, such as questionnaire construction and methods for improving the number and accuracy of responses to surveys

gerotranscendence

suggests aging entails a transition from a rational, materialistic metaperspective to a cosmic and transcendent vision

immunosenescence

the aging of the immune system

The family of a 78-year-old male patient is shocked by his recent diagnosis of pancreatic cancer, citing his lifelong commitment to a healthy diet, consistent exercise, and avoidance of environmental risk factors. Which of the following factors most likely contributed to the man's diagnosis? a. age-related changes to his immune system may have compromised his body's ability to recognize cancerous cells b. the interplay of existing chronic conditions may have contributed to the etiology of his cancer c. his cancer may have been a consequence of a bacterial or viral infection earlier in life d. autoimmune processes associated with the aging process may have initiated abnormal cell division

a. age-related changes to his immune system may have compromised his body's ability to recognize cancerous cells

Although swelling caused by heart failure can occur anywhere in the body, it usually occurs in the: a. ankles, feet, and legs b. chest and shoulders c. head and neck d. sacrum and coccyx

a. ankles, feet, and legs

In what way can a nurse differentiate strong research from poor research? a. by critiquing the study b. through the nurse's own informal investigation c. through author dialogue d. by conducting the research

a. by critiquing the study

Which of following statements most accurately captures the role of chronic illness in the lives of older adults? a. chronic illnesses constitute the leading cause of death for older adults b. more older adults die from acute illnesses than from chronic diseases c. while chronic diseases used to be the leading cause of death, this is no longer the case d. while cancer rates have fallen, other chronic diseases remain a common cause of death

a. chronic illnesses constitute the leading cause of death for older adults

Decreased renal mass and reduced glomerular filtration make it especially important that nurses: a. ensure that age-adjusted drug dosages are prescribed b. look for signs of urinary tract infections c. frequently check urine for glucose d. assist elderly patients with frequent toileting

a. ensure that age-adjusted drug dosages are prescribed

Which of the following are typical ADLs? (select all that apply.) a. moving b. eating c. cooking d. toileting e. dressing

a. moving b. eating c. toileting d. dressing

Which of the following nursing practices commonly performed in the geriatric medical unit of a hospital is most in need of modification or correction? a. patients at risk for urinary incontinence are catheterized in order to reduce the risk of urinary tract infections b. reality orientation is provided to patients who exhibit cognitive deficits c. the discharge planning process is begun immediately following admission d. patients are regularly prompted to practice deep-breathing and coughing exercises in order to mobilize secretions and prevent atelactasis (complete or partial lung collapse)

a. patients at risk for urinary incontinence are catheterized in order to reduce the risk of urinary tract infections

The nurse researcher would like to gather data about the attitudes of young adults on spirituality and health care. What is the most effective form of research on this topic? a. qualitative research b. methodologic survey c. quantitative research d. Delphi study

a. qualitative research

An elderly woman suffering from abdominal pain, nausea, urinary incontinence, fever, and vomiting is brought to the emergency department. What is the most likely preliminary diagnosis? a. urinary tract infection b. colon cancer c. aneurysm d. appendicitis

a. urinary tract infection

Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life? a. women tend to both live longer than men and marry men older than themselves b. men tend to have greater access to care facilities due to higher incomes and savings c. men are more likely to live with younger family members following the death of a spouse. d. social pressures tend to stigmatize older men who live alone

a. women tend to both live longer than men and marry men older than themselves

activity theory of aging

an older person should continue a middle-aged lifestyle, denying the existence of old age as long as possible, and that society should apply the same norms to old age as it does to middle age and not advocate diminishing activity, interest, and involvement as its members grow old

Which diseases and conditions most often damage heart muscle, leading to heart failure? a. CVA and TIA b. CAD, diabetes, and high blood pressure c. Alzheimer's disease and Parkinson Disease d. endocarditis e. both A and B

b. CAD, diabetes, and high blood pressure

A nursing student is reading a research article from a nursing journal. The student is aware that the opening paragraph summarizing the article and the research findings is a good place to start. What part of the article is the nursing student reading? a. conclusions b. abstract c. review of the literature d. results

b. abstract

A 77-year-old male patient who has been diagnosed with lung cancer is discussing treatment options with his oncologist. Which of the following factors is most likely to make the patient's treatment more complicated than that of a younger patient? a. radiation treatment is not an option for most patients over age 70 b. age-related decline in kidney function can affect drug therapy c. the client is unlikely to be a candidate for surgery d. fewer pharmacologic treatment options exist for older adult clients

b. age-related decline in kidney function can affect drug therapy

In examining a client with several diseases diagnosed, including hypertension and depression, the nurse examines the physiology of the effect of stress on the immune system. Which of the following physiologic responses affects this client the most strongly? a. a reduction in the level of virus-fighting interferon b. an increase in the level of serum cortisol c. an increase in the number of immature T cells d. a reduction in the antibody response to vaccines

b. an increase in the level of serum cortisol

The nurse is visiting an older patient who has smoked for 50 years and has emphysema that severely affects the patient's quality of life. The patient has had multiple hospital admissions this past year. What is the nurse's priority when caring for this patient? a. discussing the use of inhalers b. assessing ability to perform activities of daily living c. reviewing deep-breathing exercises d. assessing the air quality in the home

b. assessing ability to perform activities of daily living

A 75-year-old female patient, whose marriage ended in divorce after two years, has lived alone for the past 50 years. Feeling as if her life has had little meaning, the patient is terrified of living out her remaining years and of dying. The age-related issue to be resolved is: a. disengagement vs. activity b. ego integrity vs. despair c. self-determination vs. resignation d. self-esteem vs. self-actualization

b. ego integrity vs. despair

Which of the following is the most common urinary problem among men aged 65 years and older? a. stress incontinence b. frequent urination c. high urinary volume d. glucose in the urine

b. frequent urination

A male client 79 years of age who is postoperative Day 3 following hip replacement surgery has been approached by a nurse researcher and asked to participate in a research study. This study will test a new rehabilitation strategy. What aspect of the nursing research process addresses the client's understanding of the potential risks and benefits of this study? a. meeting with the hospital's institutional review board (IRB) b. going through the informed consent process with the client c. giving the client the opportunity to ask questions about the study d. obtaining the client's signature on a permission document

b. going through the informed consent process with the client

true/false The first line of defense against infection is intact skin and mucous membranes covering body cavities.

true

true/false there is a slight left ventricular hypertrophy with normal aging

true

true/false the elder population is at a greater risk for dehydration

true (this is due to decreased intracellular fluid)

disengagement theory of aging

views aging as a process in which society and the individual gradually withdraw (or disengage) from each other, to the mutual satisfaction and benefit of both

subculture theory of aging

views older adults as a group with distinct norms, beliefs, expectations, habits, and issues that separate them from the rest of society

Which of the following patient histories is most likely for a person older than 65 years of age? a. in the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza b. patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels c. patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals d. patient I has been to the emergency room three times in the past year for ear infections and allergy attacks

b. patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels

Which skill is foundational for a nursing student's participation in the evidence- based practice process? a. publish an article on evidence-based practice b. read and understand a research article c. critically analyze research articles and the findings d. become involved in evidence-based practice research

b. read and understand a research article

Are cancer screening tests considered primary, secondary, or tertiary prevention? a. primary b. secondary c. tertiary d. none of the above

b. secondary

After completing an assessment of an older patient, which finding should the nurse attribute to a pathological process rather than age-related respiratory changes? a. posture is slightly kyphotic b. slight wheeze on exhalation c. uses accessory muscles on expiration d. mucous membranes drier than younger clients'

b. slight wheeze on exhalation

Herpes zoster is what type of infection? a. bacterial b. viral c. fungal d. parasitic

b. viral

What is the most common infection in the elderly? a. pneumonia b. influenza c. UTI d. shingles

c. UTI

Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? a. an 81-year-old woman's glomerular filtration rate (GFR) is low b. a 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy c. a 78-year-old man has recently developed urinary incontinence d. a 78-year-old male's stomach pH is increased

c. a 78-year-old man has recently developed urinary incontinence

Which of the following statements most accurately captures an aspect of the relationship between cancer and aging? a. the incidence and prevalence of cancer in older adults is approximately equal to that of younger adults b. cancer is the leading cause of death among persons age 65 and older c. age is the most significant risk factor for cancer d. the prevalence of cancer in older adults is expected to decrease in coming decades

c. age is the most significant risk factor for cancer

The nurse is completing discharge teaching for an 80-year-old diabetic patient with a urinary tract infection. What should the discharge plan for this patient include to minimize the reoccurrence of the condition? a. educate the patient on the association between diabetes and urinary tract infections b. discuss age-related changes to the urinary and immune systems and the increased risk for further infection c. assess the primary factors contributing to the development of the urinary tract infection d. instruct the patient on proper hydration and hygiene

c. assess the primary factors contributing to the development of the urinary tract infection

age stratification theory of aging

- suggests that society is stratified by age groups - persons within a similar age group generally have similar experiences, beliefs, attitudes, and life transitions that offer them a unique shared history - as each group ages they have their own unique experience with and influence on society, and there is an interdependence between society and the group

In examining a client with several diseases diagnosed, including hypertension and depression, the nurse examines the physiology of the effect of stress on the immune system. Which of the following physiologic responses affects this client the most strongly?

. An increase in the level of serum cortisol

once americans reach their ____ decade, the quality of life is _________ between white and black americans

7th; equal

integrity vs. despair

?

leading cause of death for those over age 65

?

leading chronic condition

?

Which of these is not a criterion for critically evaluating websites when doing a literature review? a. accessibility b. objectivity c. coverage d. currency e. authority

a. accessibility

qualitative research

exploratory research used to gain an understanding of underlying reasons, opinions, and motivations; provides insights into the problem or helps to develop ideas or hypotheses for potential quantitative research

true/false incontinence is a normal stage of aging

false

An elderly woman suffering from abdominal pain, nausea, urinary incontinence, fever, and vomiting is brought to the emergency department. What is the most likely preliminary diagnosis?

UTI

Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life?

Women tend to both live longer than men and marry men older than themselves.

Which one of the following statements about delirium and dementia is most accurate?

a person who has dementia can suffer from delirium

Mr. D was friendly and active as a young adult. Now, as a 75-year-old, he enjoys visiting with his neighbors and attending a variety of sporting and cultural events. Mr. D's behavior is most consistent with which theory of aging? a. activity theory b. disengagement theory c. subculture theory d. continuity theory

d. continuity theory

The nurse develops a plan of care for an 88-year-old new resident of a LTC facility who arrived from the hospital after a cardiac event brought on by heat stroke. The resident was diagnosed with pneumonia this morning. Of the following, which is the most likely explanation for the pneumonia? a. cardiac events often precede pneumonia b. pneumonia is directly related to the heat stroke c. flu season and the increased number of cases d. elderly predisposition to nosocomial pneumonia

d. elderly predisposition to nosocomial pneumonia

The nurse discusses hand hygiene with the staff specifically regarding Clostridium difficile. Which of the following should the nurse include in teaching plan? a. use of alcohol-based hand cleansers is appropriate for use before and after each patient contact b. avoid the use fo bleach and bleach cleansers in C. difficile isolation rooms, as the bleach does not kill the spores c. the spores are transmitted only from direct contact, so wear gloves when touching the patient d. hand washing is required with running water and soap to remove the spores from the caregivers' hands

d. hand washing is required with running water and soap to remove the spores from the caregivers' hands

During an impromptu speech at her 100th birthday party, a client attributes her longevity to an outlook that has always emphasized optimism, faith, and the ability to laugh at herself. A nurse would recognize which of the following phenomena as most accurately underlying the client's statement? a. older adults tend to recall positive events more clearly than negative events b. healthy immune system results in a positive and balanced psychological state c. persons of faith are often able to view life more positively d. humor and a positive psychological state are associated with improved immune function

d. humor and a positive psychological state are associated with improved immune function

A well-constructed problem statement formulated at the beginning of a nursing research study should: a. include significant references b. incorporate nursing theory c. identify benefits of the study d. indicate the population

d. indicate the population

All of the following factors contribute to older adults experiencing infectious disease in greater severity than young adults except for: a. immunosenescence b. prevalence of multiple chronic conditions c. increased rate of hospitalization d. poor immunizations rates among the elderly e. age-related decline of the immune system

d. poor immunizations rates among the elderly

bone density ____ (increases/decreases) as you age

decreases

number of cells ____ (increases/decreases) as you age

decreases

percentage of lean body mass ____ (increases/decreases) as you age

decreases

sense of taste _____ (increases/decreases) as you age

decreases

kidney function ____ (increases/decreases) as you age

decreases (results in urinary frequency, urgency, and nocturia)

quantitative research

emphasis on objective measurements and the statistical, mathematical, or numerical analysis of data collected through polls, questionnaires, and surveys, or by manipulating pre-existing statistical data using computational techniques

percentage of total body fat proportionally ____ (increases/decreases) as you age

increases (body fat overall atrophies but becomes a greater percentage of body composition)