CHAPTER 15-29: GERIATRIC NURSING 1ST SEM FINALS

Because of a knowledge of age-related changes in the gastrointestinal system, the nurse encourages regular screenings for which of the following? (Select all that apply.) A. Osteoporosis B. Vitamin B deficiency C. Pernicious anemia D. Enlarged liver E. Iron deficiency anemia

ANS: A, B, C, E By the age of 60, a person's gastric secretions decrease to 70%-80% of those of the average adult. A decrease in pepsin may hinder protein digestion, whereas a decrease in hydrochloric acid and intrinsic factor may lead to malabsorption of iron, vitamin B12, calcium, and folic acid. This, combined with atrophy of the mucosa and a decrease in gastric secretions, increases the incidence of pernicious anemia, osteoporosis, vitamin B deficiency, and iron deficiency anemia.

What actions by the nursing staff in a long-term care facility display an awareness of resident rights? (Select all that apply.) A. Getting informed consent for the use of an antipsychotic medication B. Reminding the unhappy resident and family about grievance processes C. Ensuring that all residents are asked if they wish to vote in an election D. Giving residents information on the ombudsman's name and address E. Assessing residents for their ability to safely administer their medications

ANS: A, B, C, E Long-term care facilities are responsible for honoring the many rights of their residents, including setting up informed consent processes for side rails and chemical restraints, having a posted grievance policy and process, pursuing the residents' right to vote, assessing residents for the ability to safely administer their own medications, and posting information about the ombudsman program.

The nurse explains to the student the benefits of home health care. Which are benefits typically associated with this care? (Select all that apply.) A. Less exposure to iatrogenic risks B. Less chance of becoming confused C. Better management of chronic conditions D. Better reimbursement from Medicare E. Patient remains in control of environment

ANS: A, B, C, E Many benefits exist for home health care including less risk of iatrogenic illness/injury, less chance the patient will be acutely confused by the change of environment, better long-term management of chronic conditions, and control of the environment by the patient.

A nurse working with a dying patient would expect to add interventions to the care plan to address which needs? (Select all that apply.) a. Pain b. Dyspnea c. Delirium d. Dementia e. Restlessness

ANS: A, B, C, E Pain, dyspnea, delirium, and restlessness are common symptoms experienced by patients at the end of life. Dementia may be an issue for some, but it is not considered a commonly experienced symptom.

To minimize the possible complications of polypharmacy among older adult patients, the nurse assesses this population for which of the following? (Select all that apply.) A. Number of physicians providing medical care B. Location of pharmacies where prescriptions are filled C. Presence of chronic illnesses D. Tendency to borrow medication from family or friend E. Use of over-the-counter medication to self-medicate

ANS: A, B, C, E Older adults are especially vulnerable to polypharmacy because many have one or more chronic conditions requiring several medications for management. To complicate matters, patients may see more than one provider for the same health problem and may have prescriptions filled at more than one pharmacy. Additional contributors to polypharmacy include the use of over-the-counter and alternative medicines or supplements in the treatment of conditions. As a result, the patient may end up taking duplicate drugs, similar drugs from the same drug class, and drugs that are contraindicated when taken together. Borrowing medications is not usually an issue.

The nurse working with older adults knows which facts about age-related musculoskeletal changes? (Select all that apply.) A. Muscle mass decreases, causing atrophy. B. Myocytes are replaced by fibrous tissue. C. Vertebral spaces enlarge with fluid retention. D. Posture and gait change, leading to fall risk. Men become bowlegged and waddle.

ANS: A, B, D With age, muscle mass decreases, myocytes are replaced with fibrous tissue, and posture and gait change. Vertebral spaces narrow, leading to shrinkage. Women become bowlegged and develop a waddling gait.

The nurse is assessing an older patient with elevated plasma triglyceride levels. What other assessment finding leads the nurse to suspect metabolic syndrome? (Select all that apply.) A. Blood pressure of 148/90 mmHg B. A fasting blood glucose of 109 mg/dL C. Reports of frequent urination D. W eight measurement of 50 inches E. HDL level of 32 mg/dL

ANS: A, B, D, E The clinical criteria for metabolic syndrome includes increased waist circumference (population specific) plus any two of the following: (1) blood pressure greater than 129/84 mmHg or taking hypertension medication, (2) plasma triglyceride levels over 149 mg/dL or taking triglyceride medication, (3) high-density lipid levels less than 40 mg/dL in men or less than 50 mg/dL in women or taking HDL-C medication, (4) fasting glucose greater than 99 mg/dL.

To assess for osteoarthritis in an older adult patient, the nurse asks which of the following questions? (Select all that apply.) A. "Do you have pain in your finger joints?" B. "Do your knees crackle when you bend down?" C. "Does you get dizzy when you turn your head?" D. "Does it hurt when you get up from a chair?" E. "Does your back creak when you bend over?"

ANS: A, B, D, E The distal interphalangeals, proximal interphalangeals, knees, hips, and spine are the joints most commonly affected by osteoarthritis. These would be the questions most likely to suggest osteoarthritis. Getting dizzy is not a manifestation of this disorder.

When assessing the patient's vision, the nurse should understand that older adults may report common aging changes, including which of the following? (Select all that apply.) A. "My eyelids droop so unattractively." B. "The whites on my eyes seem a bit yellow." C. "The vision in my right eye seems blurry."d. D. "I've started to use over-the-counter eye moisturizing drops. E. "I have noticed the night driving has become more difficult"

ANS: A, B, D, E The eyelids lose tone and become lax, which may result in ptosis of the eyelids, redundancy of the skin of the eyelids, and malposition of the eyelids. The conjunctiva thins and yellows in appearance. In addition, this membrane may become dry because of the diminished quantity and quality of tear production. Peripheral vision decreases, night vision diminishes, and sensitivity to glare increases.

Adherence to prescribed health care treatments by a patient with a chronic disease is best facilitated when the nurse does which of the following? (Select all that apply.) A. Provides the patient with information regarding the disease. B. Assesses the patient's ability to understand the disease. C. Defines "health and wellness" for the patient. D. Helps the patient identify barriers to personal wellness. E. Coordinates support services to facilitate the patient's discharge.

ANS: A, B, D, E The five As of a patient's self-management of care includes assess, advise, agree, assist, and arrange.

A 77-year-old patient is being treated for cardiac arrhythmia. The nurse determines that the patient's cardiac output is adequate with which assessments? (Select all that apply.) A. Urine output of 140 cc over 4 hours B. Systolic blood pressure that remains within 20 mm of baseline C. Denial of substernal pain D. Recollection of the birthdays of all of her grandchildren E. Absence of rales and crackles

ANS: A, B, D, E The patient will maintain an adequate cardiac output, as evidenced by heart rate and rhythm within normal range, stable blood pressure, adequate peripheral pulses, mental alertness, urine output of 30 mL/hr, and clear breath sounds. Normal mentation also denotes good cardiac output, but the patient may have too many birthdays to remember, so this is not the best indicator of cognitive status. Denial of pain does not necessarily denote good cardiac output.

A 69-year-old patient was prescribed a benzodiazepine 3 years ago. The nurse should provide frequent patient assessment for which of the following? (Select all that apply.) A. Daytime sleepiness B. Unsteady gait C. SOB D. Easy Bleeding E. Forgetfullness

ANS: A, B, E Benzodiazepines can cause excessive sedation, impaired memory, decreased psychomotor performance, and balance disturbances and may lead to drug dependence and should not be prescribed for extended periods of time. Shortness of breath and bleeding are not signs of side effects.

The nurse understands what about the Americans with Disabilities Act? (Select all that apply.) A. It outlaws discrimination in the job because of disabilities B. It requires state governments to fund disability services. C. It prohibits discrimination in government services to the disabled. D. It requires all buildings to be retrofitted to allow access. E. It provides funding for barrier-free buildings and parks.

ANS: A, C The ADA outlawed discrimination on the basis of disability in employment, in programs and services provided by state and local governments, and in the provision of goods and services provided by private companies and commercial facilities. It does not mandate government payment for disability services, require buildings to be retrofitted, or provide funding for barrier-free facilities.

An older adult patient is being evaluated for a possible duodenal ulcer (DU). Which of the following assessments supports the diagnosis? (Select all that apply.) A. Passing a moderate amount of dark reddish-brown stool B. Reporting a stabbing pain in the epigastric region C. Asking for "some crackers to stop my stomach cramps" D. Reporting the need to take antacid tablets "most days" E. Having a rigid abdomen about 2 hours after eating

ANS: A, C, D Typically the symptoms of DU are patterned by periods of exacerbation and remission and follow a pain-food-relief pattern. The pain begins 2 to 4 hours after meals, is immediately relieved by food or antacids, is located in the mid epigastrium, and may be described as a burning or cramplike pain. On physical examination, the only abnormality is possibly a tender epigastrium. A rigid abdomen could indicate a perforation of the ulcer. Stabbing epigastric pain is not a manifestation.

A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer's disease. The patient's partner expresses concern about difficulty getting the patient "to eat properly." The nurse suggests which of the following? (Select all that apply.) A. Serving meals at the same time each day B. Offering liquids in place of solid foods when possible C. Offering a calorie-dense snack at bedtime D. Cutting food into bite-sized pieces that will fit into the patient's hand E. Asking the patent to identify favorite foods

ANS: A, C, D It is important to support the ongoing nutrition of individuals with dementia because they may experience decreased hunger and ability to taste food. People who demonstrate symptoms of moderate to severe cognitive impairment may benefit from having meals in the same place at the same time each day. Small, frequent, nutritionally dense meals and snacks should be provided. During later stages of dementia, individuals may need to be reminded to open the mouth and chew. Food should be soft and cut in small pieces. Liquids do not need to be substituted for solid food. The patient may not be able to identify favorite foods, and asking may cause frustration.

An older adult diagnosed with Ménière disease is prescribed meclizine and hydrochlorothiazide. The nurse's educational instructions include which of the following? (Select all that apply.) A. The need to avoid alcoholic beverages B. Instructions to take the medication with food C. Symptoms of electrolyte imbalances D. That drowsiness is a common side effect E. Stopping the medication if chest pain occurs

ANS: A, C, D Meclizine may cause drowsiness; patients should be instructed to avoid alcoholic beverages while taking this drug. A patient on a diuretic such as hydrochlorothiazide needs to be monitored for evidence of fluid or electrolyte imbalances.

A 72-year-old patient is prescribed lithium. The nurse educates the patient on the importance of biannual evaluation of which of the following? (Select all that apply.) A. Renal function B. Serum glucose level C. Liver function D. Thyroid function E. Red blood cell count

ANS: A, C, D Renal, liver, and thyroid studies should be evaluated every 6 months because of the drug's potential toxicity. Glucose and red blood cell count are not affected.

The nurse suspects the older adult patient will require diagnostic testing for possible lung cancer when the patient does which of the following? (Select all that apply.) A. Reports smoking two packs of cigarettes daily. B. Reports severe chest pain. C. Loses 10 pounds in 1 month. D. Takes several naps daily. E. Locates a palpable lump on the left lateral chest.

ANS: A, C, D The classic clinical presentation of lung cancer is a persistent cough, sputum streaked with blood, chest pain, and recurring pneumonia or bronchitis. This constellation of symptoms is also associated with cigarette smoking, and their significance as indicators of cancer may be overlooked. Other symptoms include more systemic complaints such as anorexia, weight loss, and fatigue. Older persons more often experience dyspnea and weight loss, whereas pain is less frequent.

The nurse assessing patients for diabetes looks for the classic signs, including which of the following? (Select all that apply.) a. Polyuria b. Polycythemia c. Polydipsia d. Polyphagia e. Polyandrony

ANS: A, C, D The classic signs of diabetes are polyuria, polydipsia, and polyphagia.

When preparing educational information regarding benign prostatic hyperplasia (BPH) for a group of older male patients, the nurse includes which of the following? (Select all that apply.) A. Eighty percent of males experience the symptoms by age 80. B. Diabetes mellitus is a risk factor. C. It is only as the prostate enlarges that symptoms occur. D. The resulting urinary retention can cause urinary tract infections. E. Symptoms are a result of urethral obstruction.

ANS: A, C, D, E Approximately 80% of men may be diagnosed with BPH by the age of 80. In early prostatic enlargement, the patient may be asymptomatic because the muscles may initially compensate for increased urethral resistance. As the prostate gland enlarges, the patient begins to manifest symptoms of an obstructive process. The symptoms may include hesitancy, a decrease in the force of the urinary stream, terminal dribbling, a sensation of a full bladder after voiding, and urinary retention. Urethral obstruction may cause urinary stasis, UTIs, hydronephrosis, and renal calculi. Diabetes is not a risk factor.

An 82-year-old patient with a history of chronic heart and respiratory problems asks the nurse, "What can I do to keep my hemorrhoids from acting up?" Which of the following responses made by the nurse are appropriate? (Select all that apply.) A. Ask if he experiences constipation with any regularity. B. Encourage him to increase his fluid intake to 2,000 mL daily. C. Suggest he eat more whole grains and fresh fruits. D. Discuss how he could include a walk into his daily routine. E. Ask if he has a history of rectal bleeding

ANS: A, C, D, E Nursing management of an older patient with hemorrhoids includes the prevention and elimination of constipation. This includes a review of high-fiber, high-roughage foods, including indigestible fiber like whole grains, legumes, and fresh fruits and vegetables. An adequate intake of fluids is also important. Older patients should be encouraged to consume up to 2,000 mL of fluids each day unless contraindicated. This patient has heart disease and possibly should not take in that much fluid. The nurse should encourage light exercise on a regular basis and review the importance of a regular toileting routine. Rectal bleeding should be investigated.

A 78-year-old patient was admitted with dehydration. The nurse assesses and documents observations that support a finding of dementia. Which of the following observations are related to dementia? (Select all that apply.) A. Forgetting what she ate for lunch today B. Crying frequently when alone C. Inability to find her way back to her room from the dayroom D. Being impatient with the nursing staff for not closing her door E. Repeatedly asking to call her son

ANS: A, C, D, E Common manifestations of dementia include repeated questions and statements, forgetting to pay bills or take medications, increasing problems with orientation, and geographic disorientation. Other symptoms of AD include pervasive forgetfulness and memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings. Personality changes may include apathy or loss of interest in previously enjoyed activities. Crying is not a classic sign of dementia, although depression often accompanies dementia and this could be a sign of depression.

The student asks the registered nurse for information about the older patient's erythrocyte sedimentation rate (ESR). What information does the nurse provide? (Select all that apply.) A. An elevated ESR indicates an inflammatory process in occurring. B. A decreased ESR indicates the patient has an active infection. C. Mild elevations in ESR may be a normal age-related change. D. An elevated ESR is diagnostic for some type of cancer. E. ESR findings should be interpreted in light of the clinical picture.

ANS: A, C, E The ESR is a measure of inflammation and can be elevated in infection, autoimmune disorders, and caners. Mild elevations can be seen in older adults. Since the ESR is a measure of general inflammation, the results should be analyzed in light of the patient's entire clinical picture.

Which of the following are appropriate steps to take when removing cerumen from an older person's ear? (Select all that apply.) A. Instill a softening agent first. B. Use hot water and hydrogen peroxide. C. Use an ear syringe and warm water for irrigation D. Have the patient lean backward to drain the water. E. Have the patient lean forward toward the affected side to drain the water.

ANS: A, C, E The nurse instills a softening agent and uses warm (not hot) water mixed with hydrogen peroxide or saline to irrigate the ear. An ear syringe is used and is inserted just inside the meatus so the tip is still visible. Tip the patient's head toward the side being irrigated. When draining, the patient can lean forward and toward the affected side.

The nurse is teaching a newly diagnosed diabetic patient about metformin. What information does the nurse include? (Select all that apply.) A. Alcohol intake should be limited and taken with food. B. Overweight patients sometimes poorly tolerate metformin. C. Oral hypoglycemic agents can increase the risk of hyperglycemia. D. Metformin has been the cause of anorexia in older patients. E. Oral hypoglycemic agents affect vitamin D absorption.

ANS: A, D Studies indicate that metformin, classified as a biguanide, may be the drug of choice for overweight patients. Side effects such as anorexia, nausea, and abdominal discomfort may, however, limit its use in older adults. Alcohol can decrease hypoglycemic awareness, so metformin should only be ingested with food. Alcohol use should also be li

What assessment findings support a diagnosis of hyperthyroidism in the older adult? (Select all that apply.) A. Tremors B. Heat intolerance C. Tachycardia D. Palpable goiter E. Atrial fibrillation

ANS: A, D, E The classic gerontologic presentation of hyperthyroidism includes tachycardia, fatigue, tremors, and nervousness in contrast to tachycardia, heat intolerance, and fatigue in younger patients. An enlarged, palpable goiter is present in 60% of older adults with hyperthyroidism. The most common complication, occurring in 27% of gerontologic hyperthyroid patients, is atrial fibrillation that does not convert back to sinus rhythm when a euthyroid state has been achieved.

When teaching older adult asthmatic patients, the nurse stresses the importance of which of the following? (Select all that apply.) A. Being alert for the early signs of breathing problems B. Fostering an effective relationship with your health care provider C. Identifying and avoid personal triggers D. Incorporating regular rest periods into your daily routine E. Increasing vitamin C consumption, especially during winter months

ANS: A,B,C The prognosis for an older adult with asthma is relatively good. Success is based on a partnership between the patient and the health care provider to properly use prescribed medications, avoid asthma triggers, identify early signs of exacerbation, and maintain a healthy lifestyle. Rest may or may not be an issue if the patient has mild asthma. Vitamin C may have immune system benefits

A nurse is assessing a patient who reports moderate tinnitus. The nurse should assess the patient for which of the following? (Select all that apply.) A. Alcohol and caffeine intake B. Unilateral or bilateral symptoms C. Cerumen impaction D. Frequent ear infections E. Exposure to radiation

ANS: A,B,C Important items for the nurse to assess in a patient with tinnitus include alcohol and caffeine intake, whether the symptoms are unilateral or bilateral, and cerumen impaction. Frequent ear infections and radiation exposure are not related.

A patient has a glomerular filtration rate (GFR) of 19 mL/min/1.73 m2. What assessment findings correlate with this condition? (Select all that apply.) A. Fatigue B. Weakness C. Edema D. No specific symptoms E. Headaches

ANS: A,B,C This patient is in stage 4 of chronic kidney disease. Expected assessment findings include weakness, edema, fatigue, hypertension, heart failure, impaired cognition and immune function, dry skin and pruritus, anorexia, nausea, malnutrition, increased bleeding, anemia, peripheral neuropathy, and an overall decreased quality of life. In stages 1 and 2, patients are asymptomatic. Headache is not a finding.

The nurse is coordinating care for a newly admitted older adult. The patient is diagnosed with hypertension, asthma, atrial fibrillation, mild osteoarthritis, and glaucoma. Before administering the patient's corticosteroid medication, the nurse is especially interested in which of the following? (Select all that apply.) A. The name of the patient's hypertension medication B. What the patient uses to manage arthritic pain C. Whether the patient feels the asthma is well controlled D. Whether the patient takes low-dose aspirin regularly E. Whether the patient has ever had glaucoma-related surgery

ANS: A,B,D Asthma may be exacerbated by the use of nonsteroidal anti-inflammatory agents for arthritis, aspirin for circulation, nonselective beta-blockers for hypertension, or glaucoma eye drops that contain beta-blockers. Feeling that the asthma is under control and previous surgery are not directly related.

To minimize an older adult's risk for developing postsurgical atelectasis, the nurse does which of the following? (Select all that apply.) A. Regularly assesses and medicates for pain. B. Teaches effective deep-breathing techniques. C. Provides oxygen via nasal cannula. D. Encourages the patient to drink all fluids on meal trays. E. Assesses lung sounds frequently.

ANS: A,B,D Promotion of deep breathing, effective pain management, adequate hydration, frequent position changes, and early mobility will decrease the risk of developing atelectasis. Providing oxygen and assessing lung sounds will not prevent atelectasis from occurring.

A nurse is caring for a confused and frail patient. Which interventions will best minimize the patient's risk of injury related to the geriatric triad? (Select all that apply.) A. Respond to the patient's call bell promptly. B. Ensure the bed alarm is on at all times. Remain with the patient when eating. C. Assess elimination needs every 2 hours while the patient is awake. D. Offer the patient fluids during each visit.

ANS: A,B,D The geriatric triad includes falls, changes in cognitive status, and incontinence. Responding promptly to call lights, assessing for elimination needs, and having bed alarms limits falling.

The nurse is caring for an older adult patient admitted to the hospital. What assessment findings place the patient at risk for developing delirium during the hospitalization? (Select all that apply.) A. The patent takes medications to manage several chronic illnesses. B. The patent has a history of urinary tract infections. C. The patent is in cancer remission. D. The patent has recently been eating poorly. E. The patent experienced a mild heart attack 2 years ago

ANS: A,B,D The risk factors for delirium include advanced age, central nervous system diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary disorders, cardiopulmonary disorders, and sensory changes. These factors can lead to physiologic imbalances increasing the risk for confusion. Cancer remission and a heart attack 2 years prior do not increase the patient's risk.

An older adult recovering from a myocardial infarction (MI) has been taking subcutaneous heparin but is now to receive oral warfarin. The nurse prepares to teach the patient which topics? (Select all that apply.) A. Administration of both medications for up to 5 days B. Need to use a soft bristle toothbrush C. Use of atropine as an antidote for excessive bleeding D. Need to continue drawing partial thromboplastin times E. Need to drink at least eight cups of fluids daily

ANS: A,B,DHeparin and warfarin are anticoagulants used to prevent the enlargement of existing thrombi and new clot formation after an MI. Therapeutic effects of heparin are monitored by partial thromboplastin times; the antidote is protamine sulfate. Warfarin is monitored by the international normalized ratio (INR); the antidote is vitamin K. Patients who initially receive heparin for anticoagulation and who need oral anticoagulation for maintenance usually take both forms of medication for 3 to 5 days to develop therapeutic blood levels. Bleeding is a complication. Patients need to be taught bleeding precautions. All people should drink at least 8 cups of water a day unless anther medical condition prohibits this

The nurse must be able to distinguish between alcohol intoxication and alcohol withdrawal to intervene appropriately. The nurse suspects alcohol intoxication when the patient does which of the following? (Select all that apply.) A. Slurs his speech when answering questions. B. Has difficulty remembering his address. C. Reports seeing snakes in the corner of the room D. Documents his blood pressure as 168/90. E. Experiences difficulty when walking to the bathroom.

ANS: A,B,E Signs associated with alcohol intoxication include the scent of alcohol on the breath, slurred speech, lack of coordination, unsteady gait, nystagmus, impairment in attention or memory, and stupor or coma. Manifestations of alcohol withdrawal are elevated blood pressure, elevated pulse, and autonomic hyperactivity. In addition, fever; increased hand tremors; insomnia, nausea and vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures may occur.

A 68-year-old patient is reporting a gnawing epigastric pain. What question by the nurse would elicit the most useful information? A. "Does the pain get worse when you eat fatty food?" B. "Do you have a family history of peptic ulcers?" C. "Do you smoke either cigars or cigarettes?" D. "Do you take a lot of acetaminophen for minor pain?"

ANS: B Both genetic and environmental factors have been proposed as the cause of peptic ulcers because both gastric ulcers and duodenal ulcers tend to occur in families. At present, no direct evidence exists that indicates dietary or occupational factors as causes of ulcer disease. Acetaminophen and smoking generally do not cause peptic ulcers.

What information does the nurse share with the student about normal age-related changes in the kidneys? A. Renal mass increases. B. The glomerular filtration rate decreases. C. Poor renal function occurs after age 65. D. There are no real age-related changes.

ANS: B Older adults have a decreased glomerular filtration rate, decreased renal mass, but renal function can remain good up to the ninth decade.

A patient has pernicious anemia. What action by the patient and family indicates teaching for this condition has been effective? A. Proper administration of subcutaneous vitamin B12 shots B. Correct technique for intramuscular (IM) injections C. Choosing aspirin over ibuprofen (Motrin) for pain D. Preparing low-carbohydrate meals

ANS: B Pernicious anemia is typically treated with IM injections of vitamin B12 as oral preparations typically are not well-absorbed in the gastrointestinal tract. However, treatment with high-dose (1,000 mcg) supplements may be effective in some patients. Vitamin B12 is not given subcutaneously. Aspirin or ibuprofen are not related, nor is a low carbohydrate diet.

A nurse is assessing quality of life (QOL) in older individuals with chronic illnesses who attend a community center. What information is most important to assess? A. How many days were lost to exacerbations in the last year? B. How good each individual perceives his or her QOL to be? C. How burdensome the patient's treatment regime is daily? D. How often the patient needs to see a health care provider?

ANS: B QOL is individualized for each patient, and each person is the only one who can rate his or her quality of life. It is not dependent on objective measures such as number of health care visits or how many days were spent sick.

The nurse assesses a patient using the Braden scale. The patient scores a 13. What action is most important to add to the patient's care plan? A. Encourage high-protein meals and snacks. B. Turn the patient every to 2 hours. C. Assess the patient's skin daily. D. Monitor patient's prealbumin weekly.

ANS: B A Braden scale score of 13 indicates high risk for developing a pressure ulcer. The most important intervention is to turn the patient frequently. Good nutrition is important for wound healing and prevention, but a high-protein snack and monitoring prealbumin do not immediately impact the patient's skin condition. Assessing the skin will not prevent an ulcer

A type 2 diabetic patient is admitted to the hospital with a gastrointestinal illness and a blood glucose of 480 mg/dL. After stabilizing the patient, what action by the nurse is best? A. Educate the patient on safe food handling. B. Ask if the patient took the diabetic medication. C. Teach the patient ways to avoid dehydration D. Delegate frequent blood sugars to the aide.

ANS: B A frequent cause of hyperglycemia requiring hospitalization in diabetics is poor sick day management. The type 2 diabetic still makes insulin and so needs antihyperglycemic drugs even when ill. The nurse assesses the diabetic's knowledge of sick day management. The other options are appropriate but not the priority. Better sick day management can possibly keep the patient from further, similar, hospitalizations.

To evaluate an older patient for possible renal failure as a result of chronic untreated hypertension, nurse prepares to A. schedule an ultrasound. B. collect a urine sample. C. monitor intake and output. D. order an abdominal x-ray

ANS: B A urinalysis will investigate for proteinuria or other signs of renal failure. The kidneys are a target organ for damage from hypertension. An ultrasound, intake and output, and abdominal x-rays are not used before a urinalysis.

The nurse shows an understanding of medication-related risk factors common to older adults when asking which question? A. "Are you aware of the possible side effects of your medications?" B. "Do you regularly take any dietary supplements?" C. "How do you keep track of when your medications are due?" D. "How many different physicians are prescribing medications for you?"

ANS: B About 52% of older adults living in the United States take some sort of dietary supplement on a regular basis in addition to prescription medications. This increases the potential for drug-drug interactions. The other questions are also important assessment questions to include in a medication review but do not specifically address risks of interactions between prescription medications and those prescribed.

The presence of which skin assessment finding should cause the nurse to suspect a premalignancy? A. Numerous small red papules on the chest and back B. A rough, reddish macule on the ear C. An irregularly shaped mole on the shoulders D. Brown, greasy lesions on the neck

ANS: B Actinic keratosis begins in vascular areas as a reddish macule or papule that has a rough, yellowish brown scale that may itch or cause discomfort. Actinic keratosis may evolve into N R I G B.Csquamous cell carcinoma (SCUC)Sif nNot trTeated, sOo it should receive prompt attention. Red papules, irregularly shaped moles, and brown greasy lesions are not likely to be precancerous.

Which of the following statements, when made by family members caring for an older patient with dementia, indicates peaceful acceptance of the situation? a. "I'm so pleased that Mother had a good day today. I'm really very hopeful." B. "The hospice nurses are so helpful when I need time for myself." C. "I promised Mother I would take care of her and I'll never leave her." D. "It's the least I can do for Mother since she cared for us all these years."

ANS: B Adjusting to the fact that dementia is irreversible and prolonged places families in situations of dealing with grief over a long period. Nurses need to encourage caregivers to take time out from their task and participate in self-care and health promotion activities. The other statements do not show this acceptance as clearly.

The nurse is caring for an older adult patient who was admitted with a stage 3 pressure ulcer on the left heel and who also has a history of Parkinson's disease and chronic renal failure. To minimize the patient's risk of developing an iatrogenic illness, the nurse does which of the following as the priority? A. Uses sterile technique when changing the heel dressings. B. Reviews all the patient's medications for possible adverse reactions. C. Instructs the patient to call for assistance when needing to go to the bathroom. D. Assists the patient in choosing the appropriate foods from the daily menu.

ANS: B Adverse drug reactions frequently precipitate hospitalizations and, although often unreported, are among the most common iatrogenic events in the acute care setting. The hospital staff needs to get an accurate drug history of a patient, be aware of pharmacokinetic and pharmacodynamic changes related to aging, and have a working understanding of drug- disease, drug-drug, and drug-food interactions in older adults. Nurses should be particularly aware of drugs that may be high risk when used in older adults. The other actions are important for patient safety, but the more frequent cause of iatrogenic problems is related to medication use.

An older patient has been treated for a small basal cell carcinoma on the face. What assessment finding indicates to the nurse that the goals for a priority diagnosis have been met? A. The patient verbalizes relief there is no metastasis. B. Wound edges are approximated without redness. C. The patient expresses satisfaction with the cosmetic outcome. D. The patient relates the need for proper sun protection.

ANS: B All findings indicate positive resolution of various nursing diagnoses. However, physical diagnoses take priority, so the best response is the one that indicates lack of infection.

Because the older adult is not as likely to exhibit the typical signs of ineffective gas exchange, the nurse would assess which patient further? A. An afebrile patient with a nonproductive cough B. Irritability in a usually pleasant patient C. Pale nail beds in a patient of color D. Has an elevated white blood cell (WBC)

ANS: B An early sign of respiratory problems is a change in mental status. Because the physiologic responses to hypoxemia and hypercapnia are blunted in older patients, compensatory changes in heart rate, respiratory rate, and blood pressure may be delayed and cerebral perfusion may suffer. Mental status changes may include subtle increases in forgetfulness and irritability. The other options do not address the age-related change.

An older adult patient is experiencing symptoms commonly associated with hyperglycemia. Which laboratory test is most reliable for detecting hyperglycemia in older adults? A. A random serum glucose B. An oral glucose tolerance test C. An early morning urine test for glucose D. A 24-hour urine glucose test

ANS: B Appropriate glucose testing includes a fasting blood glucose, a random blood glucose, an N R I G B.Coral glucose tolerance test, and the hemoglobin A1C. The oral glucose tolerance test is usually done on pregnant women to assess for gestational diabetes. The other options are not appropriate.

An older adult patient newly diagnosed with peripheral vascular disease (PVD). What assessment finding indicates the patient may have an arterial ulcer resulting from this disease? A. Deep, necrotic, and painless sore B. Shiny, dry, cyanotic skin surrounding the ulcer C. Ulcer appears shallow, crusty with warm skin D. Sore that has dull pain and is oozing

ANS: B As the disease advances, the extremity develops a cyanotic hue and becomes cool. The skin becomes thin, shiny, and dry and has an associated loss of hair and thickened nails, all of which results from the diminished blood supply. This assessment finding indicates an arterial ulcer.

An older adult patient reports burning and itching eyes. On assessment, the nurse notes swelling of the eyelid margins bilaterally. What additional data would the nurse assess for? A. Reports of visual disturbances such as halos. B. The eyelids are reddened from seborrhea. C. The patient is being treated with anticoagulants. D. Small corneal hemorrhages are present.

ANS: B Blepharitis is a chronic inflammation of the eyelid margins that is commonly found in older adults. It can be caused by seborrheic dermatitis or infection. The symptoms include red, swollen eyelids, matting and crusting along the base of the eyelash at the margins, small ulcerations along the lid margins, and complaints of irritation, itching, burning, tearing, and photophobia.

The nurse explains to ancillary staff that caffeine abuse is difficult to diagnose in the older adult patient because caffeine intoxication symptoms A. can be confused with normal effects of aging. B. often mimic those of some cardiac disorders. C. produce fewer symptoms in older adults than in younger adults. D. resemble the side effects of several antihypertensive drugs.

ANS: B Caffeine stimulates the sympathetic nervous system, often producing the rapid pulse associated with cardiac disorders. Caffeine effects are not mistaken for normal signs of aging, produce fewer symptoms in older adults, or resemble side effects of antihypertensives.

A 66-year-old patient has a calcium level of 7.8 mg/dL. The nurse anticipates which other lab result? A. Sodium level 162 mEq/L B. Phosphorus level 5.2 mg/dL C. Magnesium level 1.1 mg/dL D. Glucose level: 138 mg/dL

ANS: B Calcium metabolism is one of the factors that determines phosphorus levels; an inverse relationship is present. Since the patient's calcium level is low, the nurse expects to see a high phosphorus level. There is not a relationship between calcium and sodium levels, or calcium and magnesium levels. Blood glucose is not a related electrolyte.

A nurse is caring for an older patient diagnosed with acute depression. What action by the nurse is most important to help prevent delirium in this patient? A. Reorienting the patient to the day, time, and place frequently B. Being physically present to help the patient with eating meals C. Providing the patient with opportunities to discuss depression D. Administering antidepressive medication as prescribed

ANS: B Depressed older adults may neglect eating or caring for a chronic medical condition, predisposing them to the development of delirium resulting from hypoalbuminemia and possibly electrolyte imbalances. The other actions will not prevent delirium.

The nurse knows a family whose adult child killed several people before taking his own life. The funerals of all involved were held on the same 2 days. The nurse notes the family seems embarrassed, uncomfortable with expressions of sorrow, and wants a very quiet funeral. What type of grief does the nurse suspect the family has? a. Anticipatory b. Disenfranchised c. Masked d. Complicated

ANS: B Disenfranchised grief occurs when the loss cannot be openly acknowledged and causes complications because there is lack of social support for the survivors. In this situation where the adult child died under such terrible circumstances, the family may feel they have no right to grieve when their child caused so many others grief. Anticipatory grief occurs when a death is impending. Masked grief is a self-protective mechanism for those who cannot bear the process of mourning. Complicated grief includes masked grief.

The nurse recognizes that an older adult on both antihypertensive and antidepressant drug therapies has a specific need for A. regular blood pressure monitoring. B. an effective history focusing on sexual function. C. an increase in daily fluid intake. D. frequent assessment of emotional stability.

ANS: B Drugs such as oral contraceptives, hormone replacement, antihypertensives, antidepressants, or sedatives can cause a sexual arousal disorder as a side effect. In women this can manifest as female sexual dysfunction (FSD), and in men it can manifest as erectile dysfunction (ED). The other assessments are not related.

A nurse is assisting a patient with a life review. What action by the nurse is best? a. Ask the patient what his or her job was. b. Ask about memories the patient is proud of. c. Ask the patient about special holiday foods. d. Ask the patient to name children and grandchildren.

ANS: B During the life review, if patients can see that their lives were meaningful and worth living, then a sense of ego integrity emerges. The nurse can best assist this by asking the patient to relate memories that evoke pride in accomplishments. The other topics can be used to guide a life review but are too narrow in focus to be the best answer.

A nurse assesses a newly admitted patient to a nursing home using the Functional Independence Measure (FIM) and rates the patient at 20. What action by the nurse is best? A. Arrange admission to a rehabilitation center. B. Plan care for a nearly dependent person C. Plan care for a nearly independent person D. Tells the family the patient is cognitively impaired

ANS: B Eighteen measures are accounted for in the FIM with scores ranging from 1 (dependent) to 7 (independent). A score of 20 indicates near total dependence. The FIM does not measure cognitive status.

The nurse realizes a patient is likely experiencing exaggerated grief when observing which behavior? A. Keeps telling family and friends that her spouse "can't be dead." B. Rereads her late spouse's diaries nightly since the death 2 years ago. C. Develops severe abdominal pains on each anniversary of her spouse's death. D. Becomes agitated whenever someone refers to the spouse's death or "moving on."

ANS: B Exaggerated grief reactions occur when normal feelings of anxiety, depression, or hopelessness grow to unmanageable proportions. People with exaggerated grief may feel an overwhelming sense of being unable to live without the deceased person. They may lose the sense that the acute grief is transient and may continue in this intense despair for a long time. Rereading diaries each night is the most specific example of this type of grief.

An older patient has fallen twice in the hospital in the last 2 days. What action by the nurse is best? A. Request restraint orders from the provider. B. Assess the patient for undiagnosed illness. C. Remind the patient to call for help getting up.

ANS: B Falls are commonly associated with a new onset of illness in the older patient. The nurse assesses for this possibility. Restraints are a last resort. The patient may be too confused or forgetful to remember to call for help, plus this places the responsibility for safety on the patient. Family members may not be present or able to stay with the patient continuously.

The family of an older adult diagnosed with cancer asks the nurse to explain how gene therapy might be beneficial. The nurse responds A. "The treatment decreases blood flow to the tumor and it dies." B. "A virus is injected into the tumor and then it can't grow." C. "The cancer cell's nucleus is destroyed and the cell shrivels."

ANS: B Gene therapy involves the injection of a virus that makes the cancer cells incapable of reproducing. Gene therapy does not restrict blood flow, destroy the cell's nucleus, or photosensitize the cancer cells

A patient has increased total iron binding capacity and transferrin levels. What action by the nurse is best? A. Prepare to administer vitamin B12. B. Encourage the patient to eat protein. C. Ensure the patient gets sun exposure. D. Prepare the patient for chelating therapy.

ANS: B High levels of transferrin and iron-binding capacity may indicate iron deficiency anemia, so the nurse encourages the patient to eat more protein. B12 would be given for cobalamin deficiency. Sun exposure is related to vitamin D. The patient does not require chelation therapy.

The nurse of a bedridden 74-year-old woman is evaluating whether the family members understand how to position the patient correctly. The nurse is confident the family is capable of effective positioning when it is observed that the family members perform which action? a. Support the arms and legs on two pillows. b. Turn the patient at least every 2 hours. c. Hyperflex the neck using pillows d. Rest elbows on the bed with lower arms elevated.

ANS: B In the 1950s, Kosiak (1958) found that pressure applied to rabbits' ears over 2 hours would result in ulceration. Thus the universal recommendation of turning every 2 hours was established. The family should turn the patient at least every 2 hours, more often if the patient's skin shows signs of pressure injury during that timeframe. The other actions are not proper positioning techniques.

A patient is on hospice care. Which situation would result in an acute hospitalization? a. Progression of disease b. Intractable pain c. New pressure ulcer d. Bladder infection

ANS: B Inpatient care is available when the patient experiences acute or severe pain or symptom management problems. The other conditions are managed without acute hospitalization.

The nurse determines that the daughter of a widowed older adult patient has a poor understanding of the grieving process when she reports that A. "Mom is going to be okay; she is a strong, independent woman." B. "It's been 16 months since Dad died, but Mom still hasn't moved on with her life." C. "My mother has agreed to come and live with me for at least a little while." D. "My mom cries when she looks at pictures of Dad, but I think she needs to c

ANS: B It used to be believed that after the first anniversary of the death, grief should be resolved. This has been shown to be inaccurate; many factors influence the time for adjustment. Older persons who have experienced multiple losses may need more time. For some, the losses may never be resolved; a person may simply learn to live with the feelings of grief. In any case, the time needed for grieving is individualized.

An older patient has been diagnosed with metabolic syndrome. What action by the nurse takes priority? A. Educate the patient on medications. B. Teach lifestyle changes the patient can manage. C. Encourage 60 minutes of aerobic activity daily. D. Instruct the patient on a low-fat diet.

ANS: B Lifestyle changes are the mainstay of treatment for this disorder. Nurses have the primary responsibility for teaching. The patent should be included in planing so that lifestyle changes are reasonable and "doable" for the older patient. Activity and diet are part of the changes needed, but activity does not need to be so extensive and diet should not be the only topic taught. Medications, if used, are in addition to lifestyle changes.

An older adult's chart documents that she has been diagnosed with macular disequilibrium. Based on an understanding of this condition the nurse suggests that the patient A. turn her head very slowly when looking from right to left. B. dangle her legs at the bedside before getting out of bed. C. use the wall for stabilization when ambulating in the hallway. D. be careful to be seated when flexing or hyperextending her neck.

ANS: B Macular disequilibrium is vertigo precipitated by a change of head position in relation to the direction of gravitational force (e.g., severe dizziness when rising from bed). Dangling at the bedside and changing positions slowly will decrease the chance of injury. The other interventions do not relate to this disorder.

The nurse is assessing patients for impending alcohol withdrawal. The nurse assesses the patient with which of the following conditions as a priority? A. Pulse, 58 beats/min; and BP 100/60 B. Pulse, 118 beats/min; and BP 160/90 C. Dozing off in chair and not recognizing staff D. Reporting muscle aches and frequent stumbling

ANS: B Manifestations of alcohol withdrawal are elevated blood pressure, elevated pulse, and autonomic hyperactivity. In addition, fever; increased hand tremors; insomnia; nausea and vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and tonic-clonic seizures may occur. The nurse should see the hypertensive, tachycardic patient as the priority.

The nurse is caring for an older adult who reports severe chronic pain. To best assess age-related physiologic changes that could influence plans for initiating an appropriate drug USNT regimen, the nurse prepares the patient for which laboratory evaluation? A. White blood count B. Glomerular filtration rate C. Serum complement level d. Electroencephalogram

ANS: B Many drugs are renally excreted, and there are age-related reductions in renal function. The nurse wanting to assess for such factors that influence the selection of drugs would most likely anticipate the patient having renal function studies done, including an evaluation of the patient's glomerular filtration rate.

The nurse is preparing information for the caregivers of a patient with chronic respiratory issues. The nurse will make the greatest impact on their ability to provide quality care while maintaining the patient's emotional well-being by including what information? A. Suggestions regarding proper nutrition and exercise B. An explanation on how to preserve the patient's sense of autonomy C. Encouragement for the primary caregiver to take care of themselves D. Referrals to pulmonary rehabilitation or support groups

ANS: B Many patients with respiratory illness feel a loss of control over their lives because of their symptoms. They may become demanding and controlling in dealing with their families and friends. Well-being is enhanced by having some control over one's life. Proper nutrition and exercise, referrals, and the caregiver taking care of him- or herself will not do as much to maintain the patient's emotional well-being as finding ways to give the patient control.

An older adult patient expresses concern about developing cancer in the future and asks the nurse advice about cancer prevention. What response by the nurse is best? A. "Eating foods high in protein promotes cell growth and repair, minimizing the risk." B. "Although can minimize your risk a little, the possibility of developing cancer is usually determined by age 65." C. "Most cancers that develop after age 65 generally respond well to cancer treatment modalities

ANS: B Most cancers are the result of a lifelong exposure, so the risk of developing malignant disease after age 65 is probably already determined by the time one reaches that age. If exposure to promoters can be avoided or reduced and antipromoters can be used, then cancerous transformation may not take place or may be delayed. The other statements are not accurate.

To best identify a risk for injury in an older adult patient, the nurse assesses for which of the following? A. Decreased muscle mass in the legs B. History of falls C. Hyperextension of the spine D. Decreased bone density

ANS: B Musculoskeletal aging changes increase the risk for falls in older adults. Approximately one-third of those age 65 or older have falls each year. The other assessments are appropriate, but a history of falls is most predictive.

An older adult's pulmonary function studies indicate that his vital capacity is reduced and his residual volume is increased. Where does the nurse know these changes will manifest? A. Ineffective cough reflex B. Shallow breathing C. Slow respiratory rate D. Frequent respiratory infections

ANS: B Normal aging results in the progressive loss of elastic recoil of the lung parenchyma and conducting airways as well as reduced elastic recoil of the lung and the opposing forces of the chest wall. The lung becomes less elastic as collagenic substances surrounding the alveoli and alveolar ducts stiffen and form cross-linkages that interfere with the elastic properties of the lungs. Any and all of these structural changes make it more difficult for the older person to ventilate.

2. Aware that older adult patients often present with atypical symptoms of type 2 diabetes mellitus, the nurse is particularly suspicious of a patient reporting A. bouts of diarrhea alternating with periods of constipation. B. recent problems reading and an infected sore on the toe that will not heal. C. periods of depression and severe indigestion after eating D. dizziness when getting up too quickly and a red rash on the hands.

ANS: B Often a newly diagnosed older individual will describe symptoms of fatigue, blurred vision, weight change (gain or loss), and infections. The other symptoms are not related.

An 80-year-old patient with visual and hearing deficits is admitted for hip replacement surgery. The patient has begun to show mild confusion and has become resistant to care and treatment. To minimize this problem, the nurse initially edits the patient's care plan to include A. frequent reorientation to people in the patient's environment. B. putting on the patient's glasses and hearing aid every morning. C. assigning the same staff to provide patient care whenever possible. D. minimizing the number of off-unit trips for the patient.

ANS: B Older adults have a decreased ability to negotiate within and adapt to an unfamiliar environment, which can be initially minimized by the use of hearing aids and eyeglasses, for example. The other actions may be appropriate, but until the sensory deficit is corrected, the patient will most likely remain confused.

The nurse evaluates how an older adult patient will react to the death of a spouse based on how the patient A. expresses concern for his spouse during a prolonged illness. B. reacts when their beloved dog was sent to live with an adult child. C. demonstrates his or her philosophy of health and happiness. D. expresses how his spouse's illness has impacted their life together.

ANS: B One's responses to loss and death are characterized by one's natural reaction to all kinds of losses, not just death. People's responses depend on their perception of the events and the meaning of the loss within the context of their lives and their physical, psychosocial, and spiritual life patterns.

An older patient is in the family practice clinic reporting increasing joint pain, anorexia, and low-grade fever. The patient has a history of osteoarthritis. What action by the nurse is best? A. Document the findings on the patient's chart. B. Assess for joint deformities and nodules. C. Tell the provider the patient needs more pain medicine. D. Encourage the patient to ask for physical therapy.

ANS: B Osteoarthritis does not include systemic symptoms. The nurse should assess for other causes of joint pain, including rheumatoid arthritis, which is manifested by joint deformities and subcutaneous nodules. Findings should be documented. The patient may need a change of pain medication. Physical therapy is an appropriate intervention. However, determining the source of the patient's symptoms comes first.

A patient has severe watery diarrhea from chemotherapy and is embarrassed having to be cleaned up frequently. The nurse notes several open areas on the patient's rectal area that cause pain. What nursing dx takes priority? A. Acute pain B. Impaired skin integrity C. Ineffective coping D. Decreased cardiac output

ANS: B Physical needs take priority over psychosocial ones. The patient has open areas and impaired skin integrity. No information shows decreased cardiac output. The pain is related to the impaired skin, so treating that will diminish the pain.

The nurse shows an understanding of how anemia symptoms present in the older population when A. questioning the patient about dizziness when turning over in bed. B. assessing the patient for pale oral mucous membranes. C. asking whether the patient takes supplementary iron tablets. D. assessing the patient's weekly intake of red meat.

ANS: B Skin color is not a good indicator of pallor because of varying pigmentation. Oral mucous membranes, as well as conjunctivae and nail beds, are better indicators. The other options are not related to symptoms.

A patient has a wound that is a shallow lesion with a red, moist wound bed. What stage pressure ulcer does the nurse chart? A. Stage I B. Stage II C. Stage III D. Stage IV

ANS: B Stage II is a partial thickness ulcer that looks like an abrasion, blister, or shallow crater. The wound bed is pink or red and moist. A stage I pressure ulcer is redness or mottled skin that does not blanch. Stage III ulcers are full thickness deep craters. Stage IV ulcers may extend into the fascia and may be necrotic

A 78-year-old man with a history of alcohol abuse is admitted to the acute care facility for reports of abdominal pain. Based on your understanding of alcohol withdrawal, the nurse USNT knows that if patient is currently abusing alcohol, he will most likely A. experience delirium tremors within 4 hours of hospitalization. B. develop withdrawal symptoms 48 to 72 hours after the last intake of alcohol. C. receive 1 ounce of alcohol every 4 hours while awake. D. be prescribed diazepam for prevention of withdrawals

ANS: B Symptoms tend to peak 48 to 72 hours after a patient's last drink, although they may occur within 4 to 12 hours. The patient may or may not have DTs. The patient should not receive alcohol and may or may not need medication. However, benzodiazepines are not recommended for use in this age group.

The nurse familiar with the older adult population recognizes that the patient who has the greatest potential for successfully committing suicide is the A. 63-year-old Asian female. B. 86-year-old Caucasian male. C. 76-year-old Hispanic female. D. 67-year-old African American male

ANS: B The highest rates of suicide are among men over the age of 85.

An 80-year-old patient is concerned about contracting pneumonia. What information is the most important for the nurse to share with the patient? A. Early recognition of the symptoms B. Being vaccinated per government guidelines C. Minimizing contact with the public during the winter months D. Supplementing one's daily diet with vitamin C

ANS: B The key to pneumonia prevention is being appropriately vaccinated. All individuals should be vaccinated at age 65 unless they have conditions that lead them to earlier vaccination. Revaccination is indicated in certain circumstances. Signs and symptoms are subtle in the aging population but would appear after the patient contracted pneumonia. Minimizing contact during winter months is an appropriate suggestion, just not the best one. Vitamin C may have immune system benefits.

A patient is receiving propranolol for hypertension. Which outcome demonstrates to the nurse that a priority goal related to medications has been met? A. The patient verbalizes the importance of moderate exercise. B. The patient experiences no injuries as a result of dizziness C. The patient's blood pressure stays within normal limits. D. The patient describes symptoms indicative of an adverse drug reaction.

ANS: B The main concerns with the use of antihypertensive medications in older adults are an increased risk of orthostatic hypotension and dehydration. Exercising and maintaining the blood pressure within normal limits are treatment goals but do not impact quality of life like dizziness or fainting. Having an adverse drug reaction would not improve quality of life.

17. Which action does the nurse delegate to the unlicensed assistive personnel (UAP) pertaining to pressure ulcer prevention? A. Assessing the patient's skin daily B. Keeping the patient's skin clean and dry C. Obtaining a special overlay mattress D. Monitoring the patient's nutritional status

ANS: B The nurse can delegate keeping a patient's skin clean and dry to the UAP. The other actions are within the nurse's scope of practice.

Anthe patient appears depressed. What action by the nurse should occur first? A. Assess the patient for depression. B. Review the patient's medications. C. Ask the patient about suicidal ideation. D. Inquire how the patient has been feeling.

ANS: B The nurse should assess the patient for depression; however, prior to doing so, the nurse should review the patient's chemotherapy and other medications. Some drugs used to treat cancer can cause depression, and it may be a confusing picture. This is faster and easier to do than the depression screening, which should occur next. Depending on the results of the screening, asking about self-harm may be appropriate. Inquiring how the patient is feeling is appropriate, but it is not the most important action.

An older patient's BUN is 28 mg/dL and creatinine is 0.6 mg/dL. How does the nurse interpret these findings? A. Normal for all age groups B. Normal for older adults C. High for all age groups D. Low for older adults

ANS: B The older adult may have elevated blood urea nitrogen (BUN) because of age-related decreases in kidney function and a lowered creatinine resulting from decreased muscle mass.

An older patient takes warfarin. The patient's international normalized ratio (INR) is 1.0. What action by the nurse is best? A. Nothing; this level is therapeutic. B. Assess the patient's diet history. C. Prepare to administer vitamin K. D. Double the warfarin dose.

ANS: B The therapeutic INR is 2 to 3 in most cases, so this level is not therapeutic. Foods rich in vitamin K antagonize warfarin. Before consulting the provider about adjusting the dose, the nurse should first assess the patient's diet history to see if too many vitamin K-rich foods are being eaten.

An older patient in the internal medicine clinic reports usually being able to walk 1 mile without complaint. However, in the past 2 weeks, after walking just mile, the patient's legs begin to ache. The pain goes away with rest. What action by the nurse is most appropriate? A. Elevate the patient's legs. B. Assess the pedal pulses. C. Take the patient's blood pressure. D. Measure the patient for TED hose.

ANS: B This patient has intermittent claudication, a sign of peripheral arterial disease. The nurse assesses the patient's pedal pulses. Elevation will further compromise circulation and should be avoided. A blood pressure reading is taken during all health care visits. The patient does not need TED hose for an arterial problem.

The nurse is going to educate an older patient newly diagnosed with type 2 diabetes on how to test serum glucose levels appropriately. The nurse shows an understanding of the adaptation of teaching techniques for this age group by A. providing both written and verbal instructions on the skill. B. asking the patient if he has any hearing or vision deficits. C. restating the important points several times. D. asking the patient to describe the proper technique in his own words.

ANS: B This population often experiences sensory deficits that can affect their learning capacity. The other actions are also appropriate, but if the patient has sensory deficits, they must be addressed before teaching begins

An older adult patient reports "ringing" in the ears. What additional data should the nurse gather to help determine the cause of the patient's problem? A. History of ear surgery B. Use of prescription medications C. Exercise and sleep patterns D. Nutritional status, especially protein intake

ANS: B Tinnitus can be a result of damage to inner structures caused by the toxic effect of certain drugs. The other assessment findings are not as important for this problem.

An older adult patient being treated for chronic obstructive pulmonary disease (COPD) is exhibiting signs of memory loss and confusion. What is the priority for the nurse when planning care for this patient? A. Obtaining an order for a pulmonary function test (PFT) B. Determining the potential of a possible adverse drug reaction C. Reorienting the patient to time, place, and person frequently d. Assessing for a family history of dementia

ANS: B Two of the most common side effects of many medications taken by older adults are mental confusion and disorientation. The initial action should be to determine the possible cause of the symptoms. If a cause can be found, a change might be possible. There is no indication the patient needs a PFT. Reorienting the patient is a good intervention, but it would be better to identify and eliminate the causative factor. Assessing a family history is a potential intervention as well.

The leukocyte count of an older adult patient is elevated. Understanding the effects of aging on body functions, what action by the nurse is best? a. Check for drug allergies before requesting an antibiotic prescription. B. Take vital signs and perform a head to toe assessment. C. Encourage the patient to drink several glasses of water. D Collect a urinalysis as soon as possible, having the patient produce a urine sample and requesting a stat urinalysis.

ANS: B When interpreting laboratory values and deciding the best course of treatment, the older adult should be viewed holistically: signs, symptoms, and test results temperature, should all be taken into account. The nurse would obtain vital signs and complete an assessment, looking for possible causes of the abnormal lab value before taking other action.

When working with older adults with chronic illness and exacerbations, what action by the nurse is most appropriate? A. Continually assess the patients for adherence to the regime. B. Assess the patients for ways they can remain in control. C. Teach the patients about the illness trajectory. D. Routinely review all medications the patients are taking.

ANS: B With exacerbations, the patient loses some control over an acute phase of the illness. The patient can be helped to maintain independence, control, and dignity by reassessing what is still within the patient's ability and desire to control. The patient may or may not be adherent, but the nurse should not assume he or she is not. Teaching about the illness trajectory is one tool for giving control to patients. Medication reviews should be done but are not the best action.

The nurse plans to assess for candidiasis as a priority intervention for which patient? A. 60-year-old with a history of bacterial pneumonia B. 72-year-old incontinence of urine and feces C. 58-year-old with a casted left foot D. 90-year-old receiving antihypertensives

ANS: B Candidiasis is most commonly seen in diaper-clad infants, incontinent patients, and bed-bound individuals and in moisture-prone areas of the body (e.g., skin folds and axillae). The other patients are not as likely to have this disorder as the incontinent patient.

A 70-year-old patient covered by Medicare is being admitted for stabilization of type 2 diabetes. When asked by the family why their parent's care is being comanaged by a gerontologic nurse practitioner and a provider, the best explanation is that A. the gerontologic nurse practitioner is specially trained to work with older patients. B. research has shown that this care model often results in shorter hospital stays. C. the provider and nurse practitioner will focus on different needs. d. Medicare encourages this team concept of patient care.

ANS: B Some studies demonstrate a significant decrease in the length of stay, emergency room visits, and subacute days when patients are comanaged by a nurse practitioner and an attending physician.

A novice nurse learns that normal aging can result in changes in the ECG of a 73-year-old patient. The experienced geriatric nurse explains that these changes may include which of the following? (Select all that apply.) A. An inverted T wave B. A notched P wave C. A prolonged PR interval D. Decreased amplitude of the QRS complex E. A slurred T wave

ANS: B, C, D, E The number of pacemaker cells located in the sinoatrial node decreases with age, which results in less responsiveness of the cells to adrenergic stimulation. Common aging changes that are reflected by the electrocardiogram (ECG) include a notched P wave, a prolonged PR interval, decreased amplitude of the QRS complex, and a notched or slurred T wave.

The nurse working in the gerontology clinic understands which facts related to incontinence? (Select all that apply.) A. It is a normal age-related change. B. It is an independent predictor of nursing home admission. C. It contributes to falls and injuries. D. It can disrupt sleep. E. It can lead to urinary tract infections.

ANS: B, C, D, E Urinary incontinence is not a normal age-related development, although people commonly believe this is true. The other statements are correct.

the effect of aging on the cardiovascular system is evidenced by which symptoms in an older adult performing a stress test? (select all that apply) A. Chest pain during exercise. B. Slow increase of heart rate in response to stress C. Exercise induce dyspnea D. Slow decrease of heart rate post exercise E. Stress-induced arrhythmias

ANS: B, D During stress or stimulation, the heart rate increases more slowly; however, once elevated, it takes longer to return to the resting rate. The other manifestations are not related to age-induced physiologic changes.

A 70-year-old patient has lost 25 pounds since being diagnosed with hepatitis A. To best manage the patient's anorexia, what does the nurse suggest? (Select all that apply.) A. A protein powder supplement added to liquids B. Several small meals eaten during the day C. Megavitamins that include iron and folic acid D. A dietary assessment to identify favorite foods E. A high-carbohydrate, low-fat diet

ANS: B, E A patient with hepatitis best tolerates a high-carbohydrate, low-fat diet. Several small feedings throughout the day will help alleviate the effect of anorexia. Favorite foods can be assessed but should not be encouraged unless they meet the dietary restrictions. Protein powder may be useful but is not necessary. Megavitamins are also not warranted.

An older adult patient has recently diagnosed gastritis. What statement made by this patient indicates the need for further teaching? A. "The abdominal pain is caused by acidity." B. "I should avoid taking aspirin." C. "Smoking has little effect on my stomach problem." D. "I could develop pernicious anemia."

ANS: C Acute gastritis causes transient inflammation, hemorrhages, and erosion into the gastric mucosal lining. Although the cause may be undetermined, it is frequently associated with alcoholism, aspirin or nonsteroidal anti-inflammatory drug (NSAID) ingestion, smoking, and severely stressful conditions such as burns, trauma, central nervous system damage, chemotherapy, and radiotherapy. It can cause abdominal pain. Smoking is a risk factor. The patient could develop pernicious anemia.

An older patient has been admitted with severe nausea and vomiting. What assessment takes priority? A. Respiratory system B. Urine output C. Blood pressure and pulse D. Skin integrity

ANS: C All assessments are appropriate; however, the concern in this older patient is dehydration, so assessment of cardiovascular status comes first. Urine output reflects cardiac output but it does not reflect as up-to-date information as do vital signs. Respiratory system and skin integrity are lower priorities for this patient.

When caring for older adults, the nurse expects to encounter the normal urinary age-related outcome of A. urinary incontinence. B. low-grade bladder infection. C. nocturia. D. urinary residual volume.

ANS: C With age, increased urine formation at night leads to nocturia. The other findings are not age-related changes.

The nurse is admitting a patient to the hospital who has cancer and a neutrophil count of 430/mm3. What action by the nurse is best? A. Place the patient in a private room. B. Use good handwashing with all contact. C. Place the patient in protective precautions. D. Initiate contact precautions.

ANS: C A patient whose neutrophil count is below 500/mm3 is at extreme risk of infection and should be placed on protective isolation. A private room and good hand washing are also necessary, but the best intervention is isolation.

When obtaining a health history, the nurse recognizes that an older adult patient has a risk factor for colorectal cancer when he reports A. that he is a vegetarian who eats soy products. B. that he often needs laxatives for constipation. C. a history of inflammatory bowel disease. D. that diarrhea occurs at least monthly.

ANS: C A personal or family history of colorectal cancer, polyps, or inflammatory bowel disease has been associated with increased colorectal cancer risk. The other options do not increase this patient's risk.

A patient had a heart attack and the nurse identifies the diagnosis as activity intolerance. What assessment finding indicates a priority goal for this diagnosis is being met? A. Mild chest pain getting into the chair B. Feels unsteady when getting out of bed C. O2 saturation 98% after using the commode D. Less dyspnea when changing positions

ANS: C Activity intolerance is measured by changes in vital signs, electrocardiogram (ECG), and symptoms such as chest pain or shortness of breath. The oxygen saturation indicates physiologic tolerance to activity. The other options do not show physiologic tolerance

An older patient has developed moderate muscle weakness on the left side as a result of a cerebral vascular accident (CVA). The nurse determines the patient possesses the healthiest view of self-wellness when heard stating A. "I'll certainly miss hiking, but I guess I'll find something else to do outdoors." B. "I was getting too old to safely practice karate." C. "I've decided to take up oil painting because it's difficult for me to knit." D. "It was getting difficult to work in the garden anyway."

ANS: C After learning and mastering the requirements imposed by the condition, older adults often view themselves as "well." With a wellness-in the-foreground perspective, the disease is only one component of their life and is not their identity, so they substitute lost abilities and resulting pleasures with others.

An older patient is overwhelmed at the number of lifestyle changes needed to manage newly diagnosed cardiovascular disease. What action by the nurse will reduce this barrier to teaching? A. Tell the patient even small changes over time make a big difference B. Tell the patient that smoking is the biggest risk factor and needs to stop. C. Help the patient choose a change and incorporate it into daily life. D. Educate the patient on the consequences of not making changes.

ANS: C Although it is true that small changes over time have a great impact, the nurse needs to do more by helping the patient choose a small change to implement. The nurse should help the patient work on the risk factor he or she is most willing to change. Education is important, but it will not enable the patient to make changes.

The nurse is conducting an admission assessment on a mildly confused older patient. The nurse best assures an accurate history by first A. scoring the client's cognitive responses. B. focusing on the client to respond. C. directing the questions to both patient and family. D. arranging a Mini-Mental State Examination (MMSE)

ANS: C An interview with the friend or family member is an appropriate method to first implement when a patient is exhibiting confused behavior. The other options will not get accurate information for the assessment.

A patient has a purulent, foul-smelling tunneling leg wound. What wound care practice is most appropriate? A. Leave the wound open to the air. B. Administer systemic antibiotics. C. Pack the wound with iodine-impregnated gauze. D. Prepare the patient for operative debridement.

ANS: C Antiseptics are not used on healthy granulating tissue. Iodine-impregnated gauze can be packed into the tunnels of this infected wound. A moist environment is needed for healing; leaving the wound open to air will cause too much drying. The patient may eventually need operative debridement. Systemic antibiotics may or may not be needed.

A male patient has benign prostatic enlargement. He is at risk for what type of acute kidney injury? A. Prerenal B. Intrarenal C. Postrenal D. Combined form

ANS: C BPH would place this patient at risk for postrenal failure. Prerenal failure is often the result of decreased cardiac output or acute fluid volume loss. Intrarenal failure consists of damage to the actual nephrocytes.

An older female patient develops gout and says, "Why did I get this now?" What response by the nurse is best? A. "Gout can strike anyone at any time." B. "Your body apparently makes more uric acid now." C. "Uric acid rarely rises until after menopause." D. "Women actually have more gout than men do."

ANS: C Because of the role of estrogen in the excretion of uric acid, elevated levels are usually not seen before menopause in women. The other statements are incorrect.

The nurse suspects that an older postoperative patient is developing a wound infection. What data best supports this inference? A. A thrombocyte count of 40,000/mm3 B. Decreasing erythrocyte sedimentation rate C. Increasing C-reactive protein level D. Increased partial prothrombin time

ANS: C C-reactive protein is a marker present in the acute phase of an inflammatory response. A thrombocyte count of 40,000 is low, but not related to infection. The ESR is a measure of inflammation, but a decreasing level would indicate a resolving problem. The partial prothrombin time is an indicator of blood clotting.

An older patient is prescribed nifedipine for hypertension. What teaching topic is most important to discuss with this patient? A. Need to monitor blood pressure B. Need to follow low-salt diet C. Need to change positions slowly D. Need to add exercise to daily routine

ANS: C Calcium channel blockers such as nifedipine can cause orthostatic hypotension and dizziness in older adults. The nurse educates the patient on preventing this by slow position changes. The other topics are appropriate for all patients on medication for hypertension.

A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis. The nurse educates the patient to the possibility of developing which other manifestation? A. Alopecia B. Orange-tinged urine C. Yellow-brown nails D. Cherry angiomas

ANS: C Changes in the nails occur in approximately 30% of patients and consist of yellow-brown discoloration with pitting, dimpling, separation of the nail plate from the underlying bed (onycholysis), thickenng, and crumbling

For which patient does the nurse add compression therapy to the nursing care plan? A. Taut, white, shiny skin B. Faint pedal pulses C. Brownish skin and edema D. Large ulcer with skin graft

ANS: C Compression is the mainstay of venous ulcer treatment, and it should be applied when there is brownish skin and edema. The taut white shiny skin and faint pulses indicate arterial insufficiency, and compression will compromise circulation in those extremities even further. A skin graft needs to be protected, as it is vulnerable until healed.

The nurse is assisting a 65-year-old female patient with planning an exercise program to prevent osteoporosis. The nurse shows an understanding of appropriate exercise when stating A. "The local gym offers aerobics for seniors on Tuesday and Thursday evenings." B. "Bicycling along the park's 2-mile trail twice a week would be ideal." C. "Do you have a friend who would walk with you for 30 to 60 minutes?" D. "Are you aware that rowing is an excellent exercise for strengthening bone?"

ANS: C Exercise programs that include weight bearing and resistance have been shown to prevent bone loss. Beneficial exercises for older adults include walking, low-impact aerobics, vigorous water exercises, and racquet sports. Having a walking partner would be the best choice for this patient. The gym costs money and the classes may or may not be low impact. Bicycling and rowing are not weight-bearing exercises and do not promote bone growth.

An older adult man has been the primary caregiver for his chronically ill wife for the past 10 years. When his wife dies, the nurse prepares the family for the likely possibility that their father will express which of the following emotions? A. Guilt that he is alive while she is dead. B. Deep despair for his loss. C. Personal relief that she has died. D. Concern that he could have cared for her better.

ANS: C For some older persons, the grief experience may include feelings of relief and emancipation, especially after prolonged suffering or a difficult relationship. Because this may occur, the nurse should let the family know of its possibility. The other options are possible too; however, the relief response is a more universal experience in this type of situation.

When working with a patient suspected of substance abuse, the nurse is particularly interested in determining the cause of a patient's A. acute abdominal pain. B. recurring insomnia. C. extensive history of falls. D. chlordiazepoxide prescription

ANS: C Frequently, the symptoms of substance abuse are subtle or atypical, or they mimic symptoms of other age-related illnesses and remain undiagnosed. Patients' presenting symptoms may be erratic changes in affect, mood, or behavior; malnutrition; bladder and bowel incontinence; gait disturbances; and recurring falls, burns, and head trauma. Acute abdominal pain, insomnia, and prescriptions for chlordiazepoxide may or may not be related to substance abuse, but falling is.

A nurse is caring for a patient taking furosemide. What assessment finding needs to be reported to the provider immediately? A. Weight gain of pound (1.1 kg) in 24 hours B. 2+/4+ pedal and pretibial edema C. Potassium level: 2.6 mEq/L D. Sodium level: 138 mEq/L

ANS: C Furosemide is a potassium-wasting diuretic and the patient's potassium is critically low. This finding should be reported. The weight gain should be charted but does not need immediate reporting. Without knowing what the patient's baseline edema is, there is no indication this needs to be reported. The sodium level is normal.

A patient has a pulmonary embolism and asks the nurse to explain the purpose of the heparin infusion. What response by the nurse is best? A. "It helps dissolve the clot in your lungs." B. "It keeps you from getting septic." C. "It prevents the clot from getting bigger." D. "It prevents clots from forming in your heart."

ANS: C Heparin keeps the clot from getting bigger and hopefully prevents further clots from forming. It does not dissolve the clot. It does not specifically target the heart. It does not prevent sepsis.

The nursing faculty explains to students the definition of "homebound." Which is the best explanation of this situation? A. person uses a wheelchair for all mobility. B. A person desires services provided at home. C. Leaving home requires great effort. D. No local agency is available to provide service

ANS: C Homebound implies that a person could leave the home for a legitimate medical reason, but he or she must exert a great deal of effort to do so. Being in a wheelchair does not in itself cause a person to be homebound, nor does requesting home services or not having another agency to provide services elsewhere.

A patient had cataract surgery without a lens implant. What teaching point is most important? A. Keep your follow-up appointment with the surgeon. B. Instill your eyedrops just like we have practiced. C. Do not drive and be careful going up or down stairs. D. Take acetaminophen if needed for pain.

ANS: C If cataract surgery was performed without a lens implant, the patient will wear glasses or contact lenses but will have a decrease in depth perception. The patient should not drive and should use extra caution negotiating stairs. The other instructions are appropriate for any patient having cataract surgery.

An 88-year-old patient is hospitalized for a retinal detachment. He is on bed rest, and both eyes are covered with patches. Which nursing diagnosis takes priority at this time? A. Self-esteem disturbance related to decreased independence B. High risk for altered thought processes related to visual impairment C. High risk for injury related to altered sensory perception D. Impaired social interaction related to visual deficit

ANS: C If the eyes are patched, safety precautions, such as keeping call lights, side rails, and necessary items within reach, must be instituted. Finally, assistance must be provided with activities of daily living (ADLs) and walking as needed to promote comfort and safety. The other diagnoses may be appropriate for selected patients.

A patient has Meniere disease. What statement by the patient indicates a good ability to manage the condition? A. "Because it's from dehydration, I can increase salt in my food." B. "There are no medications, so I just have to learn to live with it." C. "If I get dizzy I should lie down immediately and hold my head still." D. "Because I have asthma, I cannot take any medications for Meniere disease."

ANS: C If the patient gets dizzy, he or she should lie down and hold the head still. A low-salt diet may help with fluid retention in the ear. There are several medications for Meniere disease, but because of the anticholinergic properties of some of them, people with asthma, glaucoma, or BPH should be monitored closely.

An older adult patient who has tuberculosis is being treated with the drugs isoniazid 300 mg daily, rifampin 600 mg daily, and pyrazinamide 1,500 mg daily. What information is the priority for the nurse to give the patient? A. Wear tinted glasses when out in the sun. B. Minimize contact with children younger than 3 years old. C. Avoid alcohol while on the drug therapy. D. Eat and drink dairy sparingly.

ANS: C Isoniazid can lead to toxic hepatitis which could be compounded by alcohol intake. Patients should not drink alcohol while taking this medication. The other information is not related to isoniazid.

An older adult patient has been admitted to the hospital with suspected Paget's disease. What clinical manifestation will help the nurse differentiate Paget's disease from other types of musculoskeletal diseases?A. Red, swollen upper and lower extremity joints B. Pain on awakening that subsides with activity C. Ataxia or mild hearing loss D. Back deformity in the absence of pain

ANS: C Manifestations of Paget's disease include bone pain, headache and conductive hearing loss (if the skull is affected), barreling of the chest, kyphosis, skull enlargement, and bowing of the tibia and femur. The other manifestations are not those of this disorder.

When assessing the older adult patient's skin, what finding would indicate the need to notify the provider as the priority? A. Thick, adherent scale with a soft center B. Small, inflamed lesion that bleeds easily C. Irregularly shaped multicolored mole D. Small, purple, hard nodule beneath the skin surface

ANS: C Melanoma's clinical hallmark is an irregularly shaped nevus (mole), papule, or plaque that has undergone a change, particularly in color. The other options do not display the characteristic signs of melanoma. This patient has the highest need for the nurse to communicate with the provider.

A dying older patient has dyspnea, which causes anxiety. What action by the nurse is best? a. Provide oxygen for a saturation less than 90%. b. Provide a cool fan to blow on the patient. c. Administer prescribed morphine sulfate. d. Administer a prescribed bronchodilator.

ANS: C Morphine sulfate is often used for dyspnea and has the added benefit of slight sedation, which will help this patient's anxiety. Providing oxygen based on saturations does nothing for the patient's distress; the patient may feel short of breath, even with an oxygen saturation of 100%. A cool fan may help. There is no indication that the patient needs a bronchodilator. IF the patient has wheezing, this would be appropriate.

The family members of a dying patient are distressed at the patient's restlessness and lack of sleep. They ask the nurse to "just give her something." What response by the nurse is best? A. Administer a sedative or hypnotic. B. Tell the family she'll soon be sleeping enough. C. Try nonpharmacologic comfort measures. D. Explain that medications are not used in this case.

ANS: C Nonpharmacologic comfort measures should be implemented first because of the erratic pharmacokinetics seen at the end of life. Drug responses and side effects vary widely and are difficult to control. If nonpharmacologic measures do not work, medications can be tried but must be monitored continuously.

The nurse best maximizes an older adult's potential to avoid developing a postsurgical respiratory infection with which intervention? A. Walking the patient to the bathroom instead of using the bedside commode B. Encouraging compliance with prescribed antibiotic therapy C. Evaluating the patient's ability to effectively cough and deep breathe D. Offering fluids every hour while the patient is awake

ANS: C Older adults have a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increasing difficulty clearing secretions. The other activities also help avoid atelectasis and infection but evaluating the patient's ability to cough and deep breathe can indicate that other treatment measures may be needed postoperatively.

The nurse observes signs that a patient being assessed may have an underactive thyroid. The data supporting this suspicion includes A. heat intolerance, low-grade fever, and patchy hair loss. B. polycythemia, tachycardia, and oral candidiasis. C. muscle cramps, fatigue, and cold intolerance. D. increased blood pressure, postural hypotension, and blurred vision.

ANS: C Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion, which are symptoms of hypothyroidism that are often attributed to old age. Heat intolerance is often associated with hyperthyroidism. The other options are not related to thyroid dysfunction.

What assessment findings support an older patient's diagnosis of hypothyroidism? A. A 2-cm wound noted on medial aspect of left foot B. An apical rate: 98 beats/minute C. A patient report that "I always wear a sweater" D. A weight loss of 10 pounds over 6 weeks

ANS: C Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion. The other assessments are not related.

A home health care nurse is conducting a functional assessment on an older woman who lives alone. What assessment question is likely to get the best information? A. How do you manage all your medications? B. Who shops and cleans your house for you? C. Can you show me how you prepare a meal? D. What parts of your body can't you wash?

ANS: C Older patients may downplay or deny functional limitations, so the nurse gets more accurate data asking what the patient is able to do, rather than what she or he is not able to do.

While collecting a health history for an older adult patient, the nurse learns that the patient had been prescribed Elavil 3 weeks ago and wants to stop taking it because "It didn't make me feel any better." What information does the nurse share with the patient? A. Sudden withdrawal is likely to cause a hypertensive crisis. B. Depression seldom improves without medication. C. Realistically it will take longer for the patient to feel better. D. In time, people adjust to the side effects.

ANS: C Older patients may need up to 12 weeks of this medication for evaluation of a full response. Psychotropic medications need to be started low and increases should be done slowly. The other options are not correct.

A 77-year-old patient has impacted cerumen. During the nursing assessment, the nurse confirms supporting evidence of the condition when noting A. frothy drainage from the patient's ears B. patient reports of dizziness. C. patient reports of a feeling of fullness in the ears. D. gray, metallic-appearing tympanic membrane.

ANS: C Patients with cerumen buildup may complain of ear fullness, itching, and difficulty hearing. The patient will not have frothy drainage, dizziness, or metallic-appearing tympanic membrane from cerumen.

A patient has peripheral vascular disease. What statement by the patient indicates a need for further teaching? A. "I will have the podiatrist cut my toenails." B. "I will be sure to wear sturdy shoes." C. "I can only walk limited distances now." D. "I will report any injury to my foot or leg."

ANS: C Patients with venous insufficiency are encouraged to begin a graduated exercise program. The other statements show good understanding.

The nurse documents that a newly widowed older adult patient is likely experiencing physical grief responses when she A. becomes hypotensive. B. has difficulty getting up from the chair. C. reports having tightness in the chest. D. develops a red rash over her upper chest and back.

ANS: C Physical symptoms are commonly associated with acute grief responses. Tearfulness, crying, loss of appetite, feelings of hollowness in the stomach, decreased energy, fatigue, lethargy, and sleep difficulties are common symptoms of grief. Other physical sensations may include tension, weight loss or gain, sighing, feeling something stuck in one's throat, tightness in one's chest or throat, heart palpitations, restlessness, shortness of breath, and dry mouth.

An older patient has moved into an adult child's home after an extended stay at a rehabilitation facility. The patient complains the child is now "the boss" and the child complains about caregiving duties. What action by the nurse is best? A. Help the older patient find another place to live. B. Suggest that it is time for assisted living. C. Mediate a family meeting to discuss roles. D. Listen empathetically but let them work it out.

ANS: C Role reversals and role changes are common in families where an older adult has chronic illnesses. These lost roles need to be mourned by all involved. The nurse helps most in this situation by mediating a family meeting where roles, coping, and feelings can be discussed. The nurse can help problem solve by assisting the individuals to identify ways in which they can keep their traditional roles, if even only in a limited capacity.

When assessing for squamous cell cancer (SCC), a home health nurse is particularly concerned about which suspicious lesion? A. Leg of a 60-year-old Asian female B. Neck of a 73-year-old Hispanic female C. Lower lip of a 70-year-old African American male D. Back of a 90-year-old Caucasian male

ANS: C SCC is skin cancer arising from the epidermis and is found most often on the scalp, outer ears, lower lip, and dorsum of the hands. Approximately 90% of lip lesions can be attributed to squamous cell carcinoma. SCC is more common in men and older adults. SCC is the most common skin cancer in African Americans

The patient is an older, female, African American adult who has a 10-year history of type 2 insulin-dependent diabetes. The nurse notes that the patient's greatest risk for developing secondary hypertension is her A. gender. B. ethnic origin. C. vascular system status. D. insulin therapy.

ANS: C Secondary hypertension identified in the vascular system refers to elevated blood pressure caused by underlying disease such as renal artery disease, renal parenchymal disorders, endocrine and metabolic disorders, central nervous system (CNS) disorders, coarctation of the aorta, and increased intravascular volume. Gender, ethnic origin, and insulin therapy are not diseases that cause hypertension.

The nurse observes a suspicious mole on the back of an older adult who is undergoing palliative radiotherapy for brain metastasis. What action by the nurse is best? A. Inform the radiation technician. B. Assess for other warning signs. C. Document the finding. D Alert the oncologist.

ANS: C Since this patient is undergoing palliation for symptom control, there is no need to do anything other than document the finding. Further workup would not be done unless the patient intends to treat the cancer if found.

An older adult patient is undergoing palliative surgery for colon cancer metastasis. The patient's family wants to know hor this will benefit their loved one since the cancer has USNT already spread. What does the nurse tell the family about the purpose of the surgery? A. Prolong the patient's life by several months. B. Improve the effectiveness of the chemotherapy. C. Relieve the pain associated with spread of the tumor. d. Prevent further tumor growth.

ANS: C Surgery may be indicated for palliative care in cases in which large primary or metastatic tumors can be reduced; the size or location of the tumor can create problems such as compression of surrounding tissues and organs, leading to pain, necrosis, or organ failure. Palliative procedures are designed to manage symptoms.

Which individual wold the nurse refer to the local Area Agency on Aging? A. One who needs housekeeping services B. One who needs help with preparing taxes C. One who needs nutritious meals D. One who needs long-term care placement

ANS: C The AAA provides resources for community members on information and referral for medical and legal advice; psychologic counseling; preretirement and postretirement planning; programs to prevent abuse, neglect, and exploitation; programs to enrich life through educational and social activities; health screening and wellness promotion services; and nutrition services. The patient needing nutritious meals would most benefit from this agency.

After a below-the-knee amputation, a patient has disturbed body image. What action by the patient indicates movement toward resolution of this diagnosis? A. The patient names his stump "Pete." B. The patient attends physical therapy. C. The patient begins to change dressings. D. The patient asks questions about prosthetics.

ANS: C The best indication that the patient has accepted this change to body image is participation in stump care. Asking questions is also a good sign but does not necessarily reflect body image. The other two options do not demonstrate resolution of the diagnosis.

An older adult patient is currently undergoing detoxification for alcohol at a rehabilitation center. When assessing the patient using the Clinical Institute Withdrawal Assessment tool, the nurse determines the patient's current score to be 23. What action by the nurse is best? A. Immediately institutes seizure precautions. B. Monitors the patient's vital signs every 2 hours. C. Arranges for the patient to be transferred to an acute care hospital. D. Shares with the patient that the detoxification process is almost complete.

ANS: C The maximum score on this tool is 67, and patients who score higher than 20 should be admitted to a hospital. The nurse may need to institute seizure precautions, but for the ultimate safety of the patient, he or she needs to be transferred. Monitoring vital signs until the patient leaves is important. The detoxification process is not almost complete.

A nurse is caring for an older patient in the intensive care unit. The patient has a sudden onset of confusion. What action by the nurse is best? A. Request a sedative from the provider. B. Attempt to reorient the patient. C. Perform a sepsis screening. D. Review lab work for today.

ANS: C The most common presenting sign of sepsis in the older adult is acute mental status change. The nurse assesses the patient for this condition. Sedatives and restraints are a last resort. The nurse should attempt to reorient the patient, but this is not the most important action. The nurse should also review lab work, but current assessments are more important.

A nurse is preparing to administer metoprolol to an older male patient. What action by the nurse is best regarding endocrine disorders? A. Administer the medication as ordered. B. Check the patient's ID using two sources. C. Say, "Many men experience ED with this drug." D. Tell the patient to discuss the side effects with his provider.

ANS: C The nurse should instruct patients on side effects of medications. The nurse can assess if the patient wants to discuss this issue by opening the conversation with a "normalizing" statement, such as "many men have ED on this drug. Is this something you would like to discuss?" Although side effects do need to be brought up to the provider, the wording of this statement does not indicate a willingness of the nurse to engage in conversation. The other two options are correct but not related to endocrine dysfunction.

When assessing an older patient displaying symptoms of delirium, the nurse focuses the assessment on A. the degree and duration of the symptoms. B. the amount of self-care deficiency the symptoms cause. C. identifying processes that commonly result in the symptoms. D. physiologic dysfunction resulting from the symptoms.

ANS: C The treatment of delirium entails the identification and treatment of the underlying cause. The nurse should assess this factor as the priority. The other assessments are of lesser priority

An 87-year-old patient developed herpes zoster after surgical repair of a hip fracture. The priority nursing diagnosis is A. impaired skin integrity related to immunologic deficit. B. self-care deficit related to severe pain and fatigue. C. risk for infection related to impaired skin integrity. D. pain related to inadequate pain relief from analgesia.

ANS: C These vesicles are extremely vulnerable to secondary bacterial infections. The other diagnoses might be appropriate for some patients.

A patient has polymyalgia rheumatica. When teaching about medications, what information does the nurse provide? A. "Take the full dose of antibiotics even if you are feeling better." B. "You need to remain upright 1 hour after taking the medication." C. "Stay away from large crowds and avoid people who are sick." D. "Do not drink alcohol while taking this medication."

ANS: C This disorder is treated with corticosteroids, which can reduce the inflammatory response. Patients should be advised on ways to avoid infection. The other statements do not relate to steroids.

The nurse is caring for an 88-year-old patient who was admitted to the long-term care facility after a series of "accidents" at home. The resident's folic acid level is 2 ng/mL. What action by the nurse is best? A. Orders a high calorie, high protein diet. B. Performs a comprehensive nutrition assessment C. Assesses the patient for alcohol abuse. D. Notifies the patient's provider for further orders.

ANS: C This folic acid level is very low. Alcohol is known to interfere with the absorption of folate. The nurse should perform an alcohol abuse screening. A more detailed nutritional assessment may be warranted if the patient does not have an obvious reason for folate deficiency. Increasing calories and protein will not in itself increase folate levels. The nurse will notify the provider of the results but needs to conduct screening for further data to provide.

A patient has been grieving the loss of a spouse and seems to be doing surprisingly well when a beloved pet dies. The patient demonstrates extreme signs of sadness and despair, saying, "I cannot possibly go on without Kitty." When working with the family, what does the nurse suggest? A. Get the patient another cat. B. Suggest the patient see the provider. C. Refer the patient to a grief therapist. D. Suggest they take the patient on a trip.

ANS: C This patient is demonstrating a delayed or postponed grief reaction. Doing "surprisingly well" may indicate a lack of grief response at the original loss, then an exaggerated reaction to a smaller, subsequent loss. The most appropriate action is to refer the patient and family to a grief counselor who can help the patient work through both losses. Getting another cat dismisses the importance of the first one. A provider visit may be needed, but a grief counselor is more appropriate. Taking the patient on a trip will not help resolve the situation.

Which documentation demonstrates that the nurse effectively assessed an older adult diabetic patient's cardiac status? A. Radial pulse: 88 and regular B. Carotid pulses equal and strong C. BP 126/78 recumbent and 122/78 sitting D. Nail beds pale in color

ANS: C To assess circulation, the nurse should take an apical pulse, noting rate and rhythm; check pedal pulses bilaterally; and note the presence of hair on the lower extremities. The nurse should take blood pressure measurements with the patient in both recumbent and sitting positions, noting any dizziness associated with a change of position.

An older patient is upset with a blood pressure reading of 180/78 mmHg. What response by the nurse is best? A. "It looks like you need blood pressure medicine now." B. "Most people get hypertension when they get older." C. "Let's plan to check it again tomorrow." D. "Don't worry, there are lots of good medications for this."

ANS: C With age, elastin in vessel walls decreases, making them stiffer. Systolic blood pressure (SBP) is increased in older adults because of a loss of arterial distensibility resulting from arterial stiffening. The diagnosis of hypertension is a reading over 130/80 mmHg in older people taken on three different occasions during more than two office visits. The nurse plans for the patient to return for another blood pressure reading. The patient needs a diagnosis of hypertension to begin medications. Many people do have higher blood pressures as they age, but stating this does nothing to ease the patient's concern. Telling the patient not to worry is patronizing and dismissive.

The nurse is caring for an older adult who has been prescribed inhaled corticosteroids for asthma. What does the nurse teach about this medication? (Select all that apply.) A. Taken just before retiring for the night B. Reserved for acute attacks only C. Used in increasing doses as needed D. How to use and rinse the inhaler E. There are few side effects to worry about.

ANS: C, D Corticosteroids are an effective long-term control medication that can be used in increasing doses as needed for asthma and related disorders. It is given by the inhalation method, so the nurse teaches the patient how to use and maintain the inhaler. Inhaled corticosteroids have side effects such as a reduction in bone mineral content. They are not usually taken just before bed and they are considered long-term control medications and so would not be used in an acute attack

An older adult patient's urinary incontinence is being addressed by prompted voiding. The nurse instructs all ancillary staff to do which of the following? (Select all that apply.) A. Provide only minimal fluids after 7 PM. B. Keep the patient on the toilet until voiding occurs. C. Allow the patient to void at times other than those scheduled. D. Offer toileting during the night only when the patient is awake. E. Encourage the patient to toilet himself.

ANS: C, D The goal is to increase a patient's awareness of the need to void and, it is hoped, to increase the frequency of self-initiated toileting. Patients are approached on a regular schedule, asked if they are wet or dry, and then prompted to toilet. A patient should never be forced to toilet or reprimanded for failing to toilet appropriately. Self-initiated toileting should not be discouraged. To relieve the stress that can occur because of sleep disruption for both caregiver and patient, toileting protocols can be modified during the nighttime hours.

The nurse knows that several age-related changes in the integumentary system increase older adults' risk for pressure ulcers. Which factors does this include? (Select all that apply.) A. Poor nutrition B. Living in a nursing home C. Thinning epidermis D. Decreased skin elasticity E. Vessel degeneration

ANS: C, D, E Thinning epidermis, decreased elasticity of the skin, and deterioration of the vasculature are all age-related changes increasing risk of pressure ulcer development. Poor nutrition and living in a nursing home are not expected age-related changes.

An older patient is being taught about oral gingivitis. The nurse has included instruction about maintaining an oral hygiene program, signs and symptoms of oral infection, and the importance of maintaining regular professional dental care. What other important teaching topic should be included? A. Information about when to have teeth removed and dentures made B. The necessity of using a hard-bristled toothbrush to maintain cleanliness C. The importance of avoiding meat and caffeine-containing products D. The importance of adequate nutrition for maintaining oral health

ANS: D Nursing management of an older patient with gingivitis or periodontitis includes promotion of regular oral hygiene, regular preventive dental care, and maintenance of nutritional status. In addition, instructing the patient on the signs and symptoms of oral infections is also an important component of patient education. The other topics are not warranted.

An older adult has a resistant strain of pneumonia. To best minimize the patient's risk of developing acute renal failure, the nurse would do which of the following? A. Monitors the patient's serum blood urea nitrogen (BUN) and creatinine. B. Helps the patient select low-sodium foods from her daily menu. C. Measures and records the patient's urinary output. D. Chooses an analgesic other than ibuprofen.

ANS: D Patients with pneumonia often have mild to moderate pain. Nonsteroidal anti-inflammatory drug (NSAIDs) are common analgesics; however, they can cause acute kidney injury. Using another class of drug for pain relief will help protect the patient's kidneys. The patient may be at risk of acute kidney injury because of dehydration or the nephrotoxic effects of certain antibiotics.

An older adult patient reports "losing urine" when bending over or getting out of a chair. What type of incontinence does the nurse plan interventions for? A. Overflow B. Urge C. Functional D. Stress

ANS: D Stress incontinence is commonly seen in older adults (especially women) who involuntarily lose urine as the result of a sudden increase in intraabdominal pressure. Overflow incontinence consists of frequent involuntary losses of small amounts of urine. Functional incontinence is manifested by loss of large volumes of urine because of a lack of awareness of the need to void or a mobility problem. Urge incontinence is accompanied by a sudden urge to void.

An older patient is admitted with possible chronic renal failure (CRF). Which lab value does the nurse notify the physician about as a priority? A. Increased calcium level B. Increased red blood cells C. Decreased BUN level D. Decreased GFR

ANS: D The diagnosis of CRF is usually made based on a decrease in creatinine clearance, an elevation of BUN level, and a decrease in red blood cells. The other findings can be documented.

An older adult had gastric resection surgery and now is experiencing dizziness, nausea, and diaphoresis after meals. What instruction by the nurse caring is best? A. Stop smoking and drinking alcohol. B. Avoid caffeinated beverages. C. Eat three low-carbohydrate meals daily. D. Drink fluids only between meals.

ANS: D This patient has dumping syndrome. The institution of small, frequent meals that are low in carbohydrates will diminish the incidence of these symptoms. Resting after eating and drinking fluids between (rather than during) meals will also help alleviate these symptoms. Smoking and caffeine are not related, and eating only three meals a day is not warranted.

An older patient had a stroke several months ago. The patient begins to exhibit dysphagia. What action by the nurse is best? A. Consult with a speech-language therapist. B. Discuss the need for enteral feedings. C. Provide the patient swallowing exercises. D. Arrange for a physical exam.

ANS: D This patient has started exhibiting difficulty swallowing months after a stroke, so the stroke is probably not the cause. Difficulty swallowing is a sign of esophageal cancer, however, so the nurse should arrange for the patient to have a physical exam. The patient may still need speech-language therapy and swallowing exercises, but this is not the priority.

An older cognitively impaired adult patient is being discharged to a daughter's home. The nurse knows continued success of the patient's bladder training for urinary incontinence primarily rests on which of the following? A. Patient's ability to follow instructions B. Severity of the impairment of the urinary sphincter C. Patient's ability to sense he need to urinate D. aughter's ability to support the training

ANS: D Treating urinary incontinence in individuals with cognitive impairment requires the use of techniques that depend on the caregiver rather than the patient. The success of the techniques in large part depends on the availability and motivation of the caregiver. The other actions are not as important for the cognitively impaired person's success.

The nurse educates the obese older adult patient that the single most important outcome that will affect his or her cardiac health is A. compliance with drug therapy. B. adherence to the DASH diet. C. 20 minutes of exercise daily. D. a 10% reduction in weight.

ANS: D A 10% reduction of total weight will decrease blood pressure in many overweight individuals. This factor has significance because it underscores the importance of weight reduction in the older adult population. The other factors are important but not as significant to overall cardiac health as is weight loss in this obese patient.

An older diabetic patient has impaired mobility and decreased vision. The nurse examines the patient's feet at each clinical visit. The patient asks why this is necessary. What response by the nurse is best? A. "It's part of our diabetic clinic visit protocol." B. "You may not be able to see a sore on your feet." C. "Limited mobility may keep you from checking your feet. D. "You may get an ulcer and not be able to feel it."

ANS: D A diabetic with peripheral neuropathy may not be able to feel injuries on the feet. The injury may progress to a nonhealing ulcer requiring amputation. If the patient had good sensation to the feet, not being able to see or limited mobility would not be as big of a barrier because the patient could report the symptoms. Foot assessment is part of a diabetic clinic protocol but that answer does not educate the patient.

The nurse is preparing an older widowed patient with several chronic illnesses for discharge to home. The nurse addresses the primary nursing outcome for this patient when A. assuring the patient that social services will arrange for help with medical expenses. B. arranging for in-home assistance with activities of daily living (ADLs) and nursing care as needed. C. educating the patient regarding the safety risks caused by these conditions. D. identifying barriers to ensure adherence to the prescribed drug therapies.

ANS: D A key role for the nurse caring for an older adult with a chronic condition is to help the patient achieve optimal physical and psychosocial health. Staying adherent with drug therapy can help achieve this outcome. Payment through a third party is not guaranteed. In-home assistance may or may not be needed. Education is always needed but is not the priority for achieving optimal wellness.

The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of the scalp should include which actions? A. Cleaning lesions with a weak hydrogen peroxide solution daily B. Cleaning the scalp with a low-dose steroidal shampoo C. Applying hydrocortisone 10% to scalp lesions D. Applying selenium shampoo to the scalp

ANS: D A successful strategy is to wet the hair, apply selenium shampoo, and then proceed with the rest of the bath or shower. The other measures will not be successful.

An older patient is near the end of life and the family is concerned that the patient has a pressure ulcer because, in their view, this denotes poor care. What explanation by the nurse is best? A. "You're right; we will try harder to care for her." B. "I'm so sorry this is upsetting for you to see." C. "We are doing the best we can to care for your loved one." D. "Age-related changes can make it impossible to prevent ulcers."

ANS: D Age-related changes plus changes associated with the end of life can make preventing pressure ulcers nearly impossible, even with the best care. The nurse gently explains this to the family. The other statements do not give the family factual information.

The son of a patient with possible Alzheimer's disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. Which response by the nurse is best? A. An electroencephalogram is often very useful in diagnosing AD. B. A positron emission tomography (PET) scan is a cheap but dependable tool. C. Magnetic resonance imaging (MRI) is often ordered for that purpose. D. Postmortem autopsy is the only definitive diagnostic tool.

ANS: D Autopsy remains the gold standard and only definitive method for the diagnosis of AD.

The nurse at an assisted living facility is caring for a 73-year-old cognitively impaired patient who has recently been admitted. What should the nurse include on the patient's care plan that will best help to maintain the patient's independence? A. Sufficient time for the patient to complete self-care B. Encouraging the patient to make decisions regarding self-care C. Regular assessment of the patient's ability to provide self-care D. Regular cueing by staff to direct patient self-care

ANS: D Cognitively impaired individuals often need supervision and cueing rather than physical assistance to perform ADLs and instrumental activities of daily living (IADLs).

The nurse is caring for an older patient who recently immigrated to the United States from Asia and does not speak English. To best address the patient's apparent resistance to the medical and nursing plan of care, the nurse A. discusses the patient's behavior with Asian staff members. B. researches the patient's cultural views on health care. C. requests a cultural consultation from social services. D. asks family members to discuss the patient's views on health care.

ANS: D Concepts of health and illness are deeply rooted in culture, race, and ethnicity and influence an individual's (and family's) illness perceptions and health and illness behavior. The patient's family should have the best insight into the patient's culturally biased beliefs. Discussing behavior with other staff members might be a privacy violation. Researching culture may be helpful, but each patient is an individual and should not be stereotyped. Social services may or may not be able to provide cultural services.

After a course of chemotherapy for cancer of the throat, an older adult patient is admitted to the hospital with persistent nausea and vomiting. What is the nurse's priority assessment? A. Weight loss and weak gag reflex B. Anemia and poor muscle tone C. Oral inflammation and ulceration D. Dehydration and infection

ANS: D Drug-induced nausea and vomiting can result in dehydration, decreased caloric intake, and weight loss. Chemotherapy in general will impact the immune system's ability to combat infections. All assessments are important, but dehydration and infection (or sepsis) need to be treated immediately.

A dying patient is being cared for at home. The family relates to the hospice nurse that they are distressed that the patient no longer wants favorite food items. What response by the nurse is best? A. "Dying people don't usually want to eat." B. "Your loved one won't starve to death." C. "Why do you insist of trying to feed her?" D. "Is there another way you can show caring?"

ANS: D Dying patients often have anorexia, and research shows that eating and drinking can actually increase distressing symptoms. However, the provision of food is universally seen as an act of caring and people place great emphasis on eating. The nurse can best help the family by helping them identify other ways to show caring. The other options do not give any useful information and could be seen as a cold response.

A 76-year-old patient has been recently diagnosed with cardiac valvular disease. The nurse assesses the patient and recognizes that the medical diagnosis is supported by which finding? A. Cyanotic fingertips B. Weight loss of 10 pounds in 3 months C. Angina pain D. Shortness of breath with activity

ANS: D Individuals with valvular disease may be asymptomatic for many years, but with the deterioration of the valves and hypertrophic changes in the atria or ventricles, symptoms become evident. Exertional dyspnea is frequently the initial symptom. Other symptoms include dizziness, fatigue, weakness, and palpitations. The other signs are not manifestations of valve disease.

The preferred way for the nurse to communicate with a 72-year-old hearing-impaired patient is to A. speak loudly into the patient's unaffected ear. B. exaggerate the form of each word. C. provide all communication in written form. D. speak clearly and directly, facing the person.

ANS: D Interventions for the patient with a hearing impairment focus on aural rehabilitation and facilitation of communication. Patients should be spoken to using a clear voice and face to face, which gives the patient an unobstructed view of the speaker's face and lips. Speaking more loudly will not improve communication nor will exaggerating each work. While some written information will be helpful, it is not necessary to use writing for all communication, unless the patient directs the nurse to do so.

An older adult patient shares with the admitting nurse that she drinks "one shot" of whiskey nightly to help her sleep. What intervention does the nurse add to this patient's care plan? A. Assess the patient for slurred speech, lack of coordination, and nystagmus. B. Address the effects of alcohol abuse with the patient. C. Provide the patient with an alcohol substitute. D. Assess the patient for signs of agitation, as well as anxiety and seizures.

ANS: D It is important to assess older patients for the possibility of alcohol withdrawal if agitation, hallucinations, anxiety, or seizures develop. Because the patient admits to a shot a day, it is possible she drinks more or uses alcohol to self-medicate for problems other than insomnia. The nurse should monitor the patient for signs of withdrawal as a priority, because this is a medical emergency. Slurred speech, lack of coordination, and nystagmus are signs of overindulging. The nurse should not provide an alcohol substitute. It is appropriate to discuss the effects of alcohol, but safety comes first.

A nurse is caring for the older patient who had knee replacement surgery 8 days ago. What assessment by the nurse is most important? A. Determining whether the patient has sensation to the foot B. Asking the patient to rate his or her current pain C. Observing the incision site for redness or drainage D. Monitoring the calf for warmth and tenderness

ANS: D Major complications after joint replacement surgery include thromboembolism (deep venous thrombosis [DVT]), joint or wound infection, blood loss, nerve injury, joint dislocation, and surgical pain. The risk of DVT is highest between the first and second week after surgery. A reddened, tender, warm calf may indicate the presence of a DVT. The other assessments are appropriate but not as critical.

While awaiting the results of testing to determine a diagnosis of cancer, an older adult patient asks a nurse to explain what happens when cancer metastasizes. What response by the nurse is best? A. "It is the result of prolonged exposure to an external agent." B. "Cancer cells convert from transformed cells into small clusters of clonal cells." C. "Cell control mechanisms fail, giving rise to aberrant cell growth." D. "Cancer cells move from one location to another unconnected location."

ANS: D Metastasis involves a change in location of the cancer cells from one organ or part of the body to another that is not directly connected. The other statements are not correct.

The nurse is caring for an older adult who recently lost an adult child as a result of automobile crash. They shared a home and enjoyed a healthy parent-child relationship. The nurse is confident that the patient has progressed appropriately through the mourning process when the patient is observed doing which action? A. Tells family members that her child is "in a better place." B. Arranges for personal grief counseling. C. Cries softly during the family's first year memorial service. D. Plans a summer vacation with friends from work.

ANS: D Mourning is often used to refer to the ritualistic behaviors in which people engage during bereavement. More recently, mourning is the term used for processes related to learning how to live with one's loss and grief. The last task of mourning is emotionally relocating the deceased person and moving on with life. Going on a vacation with friends is a good example of this. The other actions do not show this resolution.

A patient is being dismissed from the emergency department with an arm cast. What statement by the patient indicates more teaching is needed? A. "I will keep the cast clean and dry." B. "I will wiggle my thumb and fingers often." C. "I will elevate my arm on two pillows." D. "I can use a hanger to scratch under the cast."

ANS: D Nothing goes under the cast, so scratching with any type of object is not allowed. The other statements show good understanding.

When teaching an older patient with type 2 diabetes about the importance of regular exercise, what statement is most important? A. Swim 10 laps in the community center pool three times a week. B. Enroll in a daily lunch time aerobics class at the senior center. C. Lift 5-pound weights in a routine of 10 repetitions in each arm. D. Walk on the treadmill each morning for 30 minutes.

ANS: D Older adults may derive the greatest benefit from morning exercise because that is the time of greatest insulin resistance. A 30-minute walk each day is also the healthiest exercise choice. Swimming only 3 laps a week is too little effort, and the weight routine does not specify a frequency. However, any exercise is better than no exercise at all. Aerobic exercise should be balanced with weight training.

A patient has heart failure and takes spironolactone. What diet selection from the menu shows that the patient needs more education? A. A low-fat chicken salad sandwich B. Salt-free vegetable soup C. Broiled fish with lemon D. Salt substitute and pepper

ANS: D Older patients have difficulty excreting potassium because of age-related kidney changes. This patient also takes spironolactone, a potassium-sparing diuretic. If the patient adds a salt substitute, normally high in potassium, the chances of developing hyperkalemia are high. The nurse needs to provide education on other ways to flavor foods. The other diet choices are fine.

An older patient with severe peripheral arterial disease wishes to quit smoking. The nurse provide education to this patient on which of the following? A. "Cold turkey" method B. Gradual reduction C. Nicotine patches D. Bupropion hydrochloride

ANS: D Older patients should be offered assistance to quit smoking. The cold turkey and gradual reduction methods may not work if the patient is a long-term smoker. The patient with peripheral arterial disease should not use nicotine in any form as it causes vasoconstriction. Bupropion hydrochloride is an appropriate choice.

The nurse is caring for a confused patient. Which action by the nurse shows the best understanding of managing the cascading effects of iatrogenic illnesses in this population cohort? A. Reorienting the patient to person, place, and time frequently B. Offering the patient liquids each time there is patient-nurse contact C. Repositioning the patient every 2 hours D. Using restraints to ensure patient safety only as a last resort

ANS: D Once older adults are hospitalized, immobilization through enforced bed rest or restraint often results in functional disability, and the subsequent occurrence of iatrogenic illnesses often represents a vicious circle, referred to as the cascade effect, in which one problem increases the person's vulnerability to another one. Gerontologic nurses must be leaders in advocating more appropriate care and treatment of hospitalized older adults to prevent or at least reduce the occurrence of iatrogenic illness. The other actions are good nursing care but do not relate to the cascade effect.

A patient had hip replacement surgery. What intervention is most appropriate to prevent dislocation? A. Instruct staff to use a fracture pan when the patient needs to toilet. B. Administer ordered pain medication prior to turning. C. Elevate the patient's knee on the affected side with a pillow. D. Apply an abduction splint while the patient is in bed.

ANS: D Patients who have total hip replacement surgery are at risk for hip dislocation. The hip should be maintained in a position of abduction and neutral alignment. Some providers may require the use of pillows or abduction splints while the patient is in bed. The other actions will not prevent dislocation.

The nurse caring for an older patient diagnosed with spinal stenosis encourages the patient to notify her provider if she experiences A. sharp pain when turning her neck side-to-side. B. stabbing pain in her lower back. C. a cramping sensation in her feet. D. a burning sensation in either one or both legs.

ANS: D Patients with spinal stenosis may develop claudication-like symptoms of burning and numbness in their lower extremities. This is a sign of cord compression and needs to be reported. The other symptoms are not as worrisome.

The nurse helps minimize an older adult patient's risk of developing pernicious anemia by which of the following actions? A. Suggesting supplementing vitamin A B.Encouraging regular intake of citrus C. Identifying iron-rich foods D. Suggesting supplementing vitamin B12

ANS: D Pernicious anemia is caused by a deficiency of vitamin B12. The nurse can best help prevent this from occurring by suggesting the older adult supplement this vitamin. The disorder is not related to citrus, iron, or vitamin A.

When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to A. place printed labels on important items, such as the telephone. B. place a clock and calendar in the patient's immediate environment. C. use hand gestures instead of verbal communications to demonstrate meaning. D. show the patient a picture of a toothbrush when it is time for oral hygiene.

ANS: D Reality orientation supports failing memory in early stages of dementia and preserves independent functioning for a longer duration. Although written messages and signs may become meaningless to individuals with advancing dementia, pictures often evoke a response. The other options are not part of this strategy.

The nurse is teaching cardiovascular risk factors to a group of older adults. The nurse stresses that cigarette smokers are four times more likely to die of sudden cardiac death than nonsmokers. What is the reason behind this statement? A. Smoking interferes with the development of collateral coronary vessels. B. Smoking produces coronary artery stricture. C. Smoking results in carbon monoxide poisoning. D. Smoking increases platelet aggregation.

ANS: D Smoking increases platelet aggregation and causes coronary artery spasms. Nicotine increases blood pressure and cardiac demands. Carbon monoxide in tobacco smoke decreases the oxygen-carrying capacity of the blood. Smoking does not interfere with collateral circulation or produce strictures, but it may contribute to higher levels of carbon monoxide in the blood.

An older adult patient asks the nurse why so many of her friends are developing cancers. The nurse responds best when answering A. "Cancer cells generally develop as a result of prolonged exposure to external agents." B. "The longer we live the more exposure we have to environmental toxins." C. "Aberrant cell growth seems to be the risk factor in the older adult." D. "As we age, our cells are less able to regulate replication appropriately."

ANS: D The aging cell has a tendency toward aberration as it replicates. Aberrant cell growth is related to failure of growth control mechanisms, which leads to less cell regulation during replication. Cancer occurs more commonly in replicating than in nonreplicating cell groups, which suggests that changes in internal cellular control mechanisms help give rise to cancer.

An older adult patient diagnosed with colon cancer is being evaluated for surgical removal of the tumor. What does the nurse explain to the student nurse is the primary consideration? A. Absence of any chronic disorders B. Absence of metastasis C. Tumor's staging status D. Patient's presurgical health status

ANS: D The curability of cancer in older adults is largely predicted by an individual's ability to tolerate major surgery. The absence of metastasis and the tumor stage will impact additional treatments. Absence of chronic illness is not a factor in and of itself.

The nurse in an acute care facility is caring for a patient recovering from a cerebral vascular accident that has resulted in a mild loss of muscle function in his right arm and leg. The nurse is best addressing the patient's need via the functional model of care when doing which of the following? A. Assessing the patient's right-sided muscle strength daily B. Reaffirming to the patient that physical therapy will improve his muscle strength C. Instructing the patient's family on how to properly assist the patient in walking D. Placing the telephone where the patient can reach it with his left hand

ANS: D The functional model's main goal may not be curing the disease but managing the disease, with a focus on self-care and symptom management strategies. Placing the telephone where the patient can reach it for himself is an example of a symptom management strategy. The other actions do not increase the patient's functional abilities.

The nurse is confident that an older adult is successfully completing the tasks associated with mourning his wife's death when he A. shares that, "No amount of wishing will bring her back" B. openly cries in the presence of family and friends. c. takes cooking classes at the local community college. d. takes a female acquaintance to the movies.

ANS: D The last task in the process of mourning is the withdrawal of emotional energy and the reinvestment in another relationship; this entails withdrawing emotional attachment to the lost person and continuing on with life. Engaging in a new personal relationship demonstrates this.

What action by the nurse best shows an understanding of the effects of acute hospitalization on the functional abilities of the older patient? A. Setting goals that support a short hospitalization B. Attempting to adapt nursing care to individual needs C. Administering a systematic functional assessment D. Assessing for a decline from original baseline function

ANS: D The nurse should assess for new onset signs or symptoms of a decline from baseline function and then implement appropriate interventions before they trigger a downward spiral of dependency and permanent impairment.

An older adult patient is being assessed for possible alcohol abuse. Which question by the nurse is best? A. "Have you ever experienced a memory loss as a result of consuming alcohol?" B. "Would you drink to relax after a particularly stressful day?" C. "Do you ever drink when you are alone?" D. "How many alcoholic drinks do you consume each week?"

ANS: D The nurse should start the assessment for alcohol abuse by inquiring as to the number of drinks the patient consumes each week. The other questions can be part of an abuse assessment, but it is easiest to start with a simple, quantitative question to open the discussion.

The nurse on a medical acute care unit is preparing for the admission of an 84-year-old patient with several diagnosed chronic illnesses. The nurse begins the plan of care for this patient based on the understanding that the older adult is likely to A. develop hospital-induced delirium. B. require special attention related to sensory deficits. C. need a social services consult before discharge. D. present with a need for a high level of nursing care.

ANS: D The older adult is not likely to be admitted to the hospital until a high level of acuity or complications exists. The other options may be possible, but the majority of older patients are admitted at a high level of acuity.

A male patient reports difficulty starting a urine stream and a weak urine flow. When prompted to seek medical attention, the patient asks why, as it's "obviously" benign prostatic hypertrophy. What response by the nurse is best? A. "You never know; it could be cancer." B. "You should have any change checked out." C. "Only the physician can make a diagnosis." D. "BPH and prostate cancer have similar symptoms."

ANS: D The patient should have these new symptoms checked out. Although only the provider can make the diagnosis, the best answer is to explain that symptoms of BPH and cancer are similar. The other options do not give useful information.

The nurse is admitting an older patient with benign prostate hyperplasia (BPH). The nurse will focus primary assessment on which of the following? A. Family history of prostate disorders B. Onset of symptoms C. Psychosocial impact of the diagnosis D. Typical urinary voiding patterns

ANS: D The purpose of the nursing assessment for an individual with BPH is to determine the extent of prostate enlargement and its effect on function so that appropriate nursing interventions can be planned and implemented. The primary assessment focuses on the patient's current voiding patterns.

A nurse has provided discharge teaching for an older adult patient who had a pacemaker implanted. Which statement by the patient indicates appropriate understanding of the device? A. "The battery will need charging every 2 years or so." B. "I'm supposed to call my doctor if my pulse is within 10 beats of my preset rate." C. "My wife will have to be the one who makes the microwave popcorn." D. "I'll take my pulse each morning before my first cup of coffee."

ANS: D The radial pulse should be taken at the same time daily and recorded. The patient should notify the provider if the pulse is lower than the preset lower limit on the pacemaker. Battery life is longer than 2 years. Microwaves are safe to use.

A man who recently lost his wife of 50 years shares with the nurse that he'll "never get over missing her." The nurse is most therapeutic when responding A. "We are here to help you anyway we can." B. "Focus on the beautiful memories you have of her and your life together." C. "Time will help you adjust to your loss." D. "You'll never get over your loss but you can learn to live with it."

ANS: D The third step in the process of mourning is the adjustment to an environment in which the deceased is missing. Older spouses have reported that they feel as though they will never "get over" their loss; instead, they have learned to live with it. It is nice to let the patient know you are here for him or her, but this does not give any useful information to help the patient. Telling the patient to focus on memories is dismissive. The nurse should not use clichés like "time will help."

An older patient is anxious about an upcoming diagnostic test and requests something to calm the nerves. What medication does the nurse prepare to administer? a. Clonazepam b. Diazepam c. Chlordiazepoxide d. Lorazepam

ANS: D There are two broad categories of benzodiazepines: short-acting (e.g., alprazolam, lorazepam, and oxazepam) and long-acting (e.g., diazepam, chlordiazepoxide, and clonazepam). The short-acting agents are preferred for older adults because of their lower potential for buildup leading to sedation and depression.

A 65-year-old adult who recently lost his spouse is admitted to the hospital after a failed suicide attempt. He presents with a sad affect and is reluctant to interact within the milieu. The nursing diagnosis with priority is A. ineffective coping related to recent loss. B. hopelessness related to death of spouse. C. risk for loneliness related to loss of spouse. C. risk for self-directed violence related to depression.

ANS: D This patient is at risk for another attempt at suicide, so safety is the primary concern.

An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer's disease (AD). The nurse supports that possibility when determining that the patient A. experienced a gastric resection several years ago. B. traveled often to third world countries. C. was employed as a steelworker for 40 years. D. has a history of viral encephalitis.

ANS: D Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD. However, advancing age is the primary risk factor. The other options are not related.

An older adult is diagnosed with rheumatoid arthritis. When discussing exercise with the patient, the nurse makes the greatest positive impact on the patient's quality of life when stating A. "Exercising will be important to the flexibility of your joints." B. "It seems to help if you have someone to exercise with." C. "I'll provide you with a list of gyms where you can exercise. D. "Let's discuss ways for you to exercise your joints."

ANS: D With advances in drug therapy and active participation by the patient in activities to prevent joint deformities, the patient should experience less deformity, increased comfort levels, and understanding of the disease process. By actually discussing exercise, the nurse makes the greatest impact on the patient's quality of life. The other options are appropriate but will not have as great an impact as discussing actual exercises.

When administering medications to older adults, the nurse shows an understanding of the effect of aging on drug distribution by monitoring which of the following most closely? A. Cardiac function B. Liver function C. Red blood cell count D. Plasma albumin levels

ANS: D With age, particularly for malnourished or frail adults, plasma albumin levels may drop and, therefore, should be monitored. As a result of decreased sites for protein binding, the activity of highly protein bound drugs, and any side effects caused by these drugs may be increased. The other options may be appropriate for specific drugs, but not in gene

A patient with diabetes and hypothyroidism is being admitted to an assisted living facility. During the admission assessment, the patient reports difficulty falling asleep. What question by the nurse is most appropriate? A. "Have you ever been prescribed a pain medication?" B. "How do you feel about leaving your home to live here?" C. "How long have you been a diabetic?" D. "Are you taking medication for your thyroid problem?"

ANS: D Insomnia and anxiety are problems that commonly plague older adults. Because insomnia and anxiety often occur secondary to medication side effects or secondary to medical conditions such as dementia, thyroid abnormalities, or depression, proper diagnosis and treatment of any underlying causes of insomnia or anxiety can help this condition. The other questions are appropriate for an intake interview, but not specifically related to the insomnia.

An older adult patient reports episodes of fecal incontinence. What response by the nurse provides appropriate emotional support? A. "This is a common problem that occurs in response to normal aging." B. "The incontinence is rarely a result of a serious problem." C. "Disposable absorbent underwear will help manage the problem." D. "The problem generally responds well to bowel control programs."

ANS: DIt is important to reassure older patients that control and retraining are achievable because many older adults are distressed about its occurrence. The nurse should first focus on reassuring the patient and providing education on bowel retraining. Disposable garments may be used temporarily or long term if the patient cannot complete bowel retraining. It is not a normal response to aging

The morning of her scheduled cataract extraction and intraocular lens placement of the right eye, an older adult patient expresses concern that she will not remember her instructions for home care. Which statement is the best response to the patient's concern? A. "Is your family going to be here while you're in surgery" B. "Are you anxious about the surgery?" C. "I'll reinforce the important points." D. "We will provide you with written instructions."

ANS: DPostoperative care requires teaching the patient and family home care procedures for the period after cataract surgery and should be given orally as well in written form. The patient may or may not have family present. Asking about anxiety could be important, but yes/no questions are not therapeutic. The nurse's idea of what are the important points may differ from the patient's.

An older patient getting cisplatin (Platinol) asks the nurse how it works. What is the best response? A. Prevents RNA transcription and DNA replication. B. Interferes with synthesis of chromosomal nucleic acid. C. Formed from soil fungi; prevents RNA and DNA synthesis. D. Binds to cell proteins and inhibit mitosis.

ANS:A Cisplatin is an alkylating agent, which prevents RNA transcription and DNA replication. Antimetabolites interfere with synthesis of chromosomal nucleic acid. Antitumor antibiotics prevent RNA and DNA synthesis. Plant alkaloids bind to cell proteins and inhibit mitosis.

An older adult patient has been casted for a fractured left wrist. Which action by the nurse takes priority? A. Assessing capillary refill in the nail beds of the fingers of the left hand B. Instructing the patient on how to effectively rate pain on the pain scale C. Teaching the patient to wrap the cast in plastic when the patient showers D. Providing the patient with a protein-enriched milkshake as a bedtime snack

ANS:A Excessive constriction caused by the cast could result in compartment syndrome, leading to ischemia and tissue destruction of the extremity. Any change in capillary refilling, skin color, skin temperature, or excessive pain not controlled with medication should be immediately reported to the provider. This is the priority assessment. Pain is another important assessment, but circulatory status is first. The other actions are appropriate but not the priority.

An older adult diabetic patient is mildly hypertensive. The nurse prepares to educate the patient regarding angiotensin II-blocking agents. What information does the nurse include about these medications? A. Protect the kidney's function. B. Have a well-defined therapeutic window. C. Are more effective than other drugs in the same class. D. Can be given when liver function is compromised.

ANS:A The ACEIs and ARBs also have demonstrated value in decreasing the chance of cardiac mortality in patients with heart failure. They also confer renal protection, which is particularly beneficial for patients with diabetes. The other statements are not related to both the patient's conditions.

A patient in a long-term care facility has incontinence. What assessment by the nurse is most important before designing interventions for this problem? A. Cognitive status B. Ambulatory status C. Cardiovascular status D. History of childbirth

ANS:A Treatment options differ between cognitively impaired and intact individuals. If the person is not cognitively intact, he or she has to rely on caregivers to maintain appropriate bladder function. The other assessments can be worked into the treatment plan.

Although the family of a newly widowed older adult patient lives several hours away, they are interested in providing appropriate support. What suggestion by the nurse would be most helpful? A. Telephone daily and arrange for a neighbor to help with the shopping. B. Assume responsibility for paying the bills and upkeep of the home. C. Encourage the patient to move into a smaller home and learn to drive. D. Include the patient in their yearly vacation plans.

ANS:A Loneliness and problems associated with the tasks of daily living are two of the most common and difficult adjustments for older bereaved spouses. Calling daily will help alleviate the loneliness. Having a neighbor do a specific task for the bereaved will take some of the stress away. Taking over responsibilities may take away the only thing the patient "has left." Learning to drive may be important, but the family should not encourage the patient to make a major life decision like moving now. Taking the patient on vacation is a nice idea, but this occurs yearly versus calling daily.

An older adult with chronic obstructive pulmonary disease (COPD) asks why he should quit smoking now. What response by the nurse is best? A. "It will keep your disease from getting worse." B. "There are many benefits to quitting even now." C. "It will decrease the risk of getting cancer too." D. "You're right; there really isn't a reason to quit."

ANS:B There are many benefits to smoking cessation including reduction in the number of respiratory infections, improvement in the function of the mucociliary clearance of the lungs, decreased coughing and dyspnea, increased appetite, and decreased sputum production. This is a more comprehensive answer than keeping the disease from worsening and lowering the chance of getting cancer. Telling the patient that there really isn't a reason to quit not only is inaccurate, it's dismissive of the patient's desire to improve health habits.

A hospice nurse shows the best understanding of the personal commitment to the dying patient by A. providing the patient with sufficient, effective pain management therapies. B. addressing the patient's need to feel valued by those attending to his or her death. C. being available emotionally and physically throughout the dying process. D. empathizing with the patient and his or her family and friends during the process.

ANS:C Once a nurse becomes committed to working with a patient and family throughout the dying process, it is important to follow through on this commitment as much as possible. The other options are narrower in scope.

When teaching an older patient about diet therapy for diabetes, the nurse plans to assess for barriers to adherence, including which factors? (Select all that apply.) A. Lifelong habits B. Cultural influences C. Finances D. Dependency E. Inability to learn

NS: A, B, C, D Diet therapy can be problematic for older adults who have a lifetime of food habits, cultural influences on food, finances that may be limited, and dependency on others to buy or prepare food. Older adults are not unable to learn.

A nurse is assessing an older patient for the possible cause of his acute urinary incontinence. Which actions by the nurse are most important? (Select all that apply.) A. Asking when his last normal bowel movement was B. Monitoring his intake and output C, Determining if he has been screened for prostatic hypertrophy D. Asking him if he awakens during the night to urinate E. Measuring his abdominal girth

NS: A, C, D Constipation or fecal impaction as well as an enlarged prostate gland (causing frequent nighttime urination) are commonly overlooked causes of incontinence. Intake and output and abdominal girth are not related to possible causes of incontinence.

When preparing to discharge an older patient with mild dysphagia, the nurse suggests that the patient can minimize symptoms by doing which of the following? A. Eating small meals every 2 to 3 hours B. Cutting a sandwich into bite-sized pieces C. Eating less but choosing nutrient-dense foods D. Drinking thin liquids instead of eating solids

ANS: A Instruction regarding eating habits and maintaining weight and nutrition is important. For example, small, frequent meals, pureed or soft foods, and high-protein, high-calorie foods are helpful. Thin liquids are often harder to swallow than thickened ones. Nutrient-dense foods are important, but so is maintaining calorie requirements.

An 87-year-old patient has suddenly become incontinent. What would the nurse do first? A. Review the patient's record for medications that can cause urinary incontinence. B. Seek an order for an indwelling urinary catheter to prevent skin breakdown. C. Limit the patient's fluid intake to reduce the feeling of having to void so often. D. Teach the patient to void every 2 hours when awake during the day or night.

ANS: A Medication is a common cause of incontinence and should always be suspected as a potential cause of new incontinence. A catheter is not needed and increases the chance of infection. Limiting fluids leads to dehydration. Voiding every 2 hours at night will disrupt sleep.

An 80-year-old patient has nausea and vomiting related to a gastrointestinal disorder. Which of the following nursing interventions is most appropriate? A. Offer sips of clear soda every 15 minutes until more is tolerated. B. Encourage the patient to lie in a prone position while nauseated. C. Encourage the intake of high-calorie foods such as milkshakes. D. Keep the patient on a nothing-by-mouth (NPO) order until the nausea subsides.

ANS: A Nursing interventions for nausea and vomiting include many self-help measures, including drinking clear liquids, progressing from eating bland foods to solid foods, and small frequent feedings. If vomiting occurs, fluid replacement should be a priority. Sips of fluids every 15 minutes until more can be tolerated may decrease episodes of dehydration. The position of the patient is unimportant. The patient should avoid nonclear liquids such as milkshakes. If the patient cannot keep even sips down, he or she may be prescribed NPO status.

A patient treats chronic kidney failure with peritoneal dialysis. The patient notes the fluid draining out of the abdomen is cloudy and foul smelling. What action by the nurse is best? A. Assess the patient for other signs of infection. B. Document the findings in the patient's chart. C. Call the rapid response team immediately. D. Request a prescription for an antibiotic.

ANS: A One of the complications of peritoneal dialysis is infection in the peritoneal space, or peritonitis. The nurse should fully assess the patient for infection and notify the provider. Documentation should occur, but the nurse needs to take action first. The rapid response team is not needed. Antibiotics will probably be used to treat the infection.

An older patient with hepatitis has pruritus. What advice does the nurse provide this patient? A. Keep your fingernails cut short B. Use diphenhydramine. C. Hot soapy showers will help. D. Butter is a good home remedy for itching.

ANS: A Pruritus is intense itching. The patient's fingernails should be kept short to avoid injury to the skin and possible infection. Diphenhydramine is not recommended in older patients. Tepid water with little soap is best. Butter is not a home remedy for itching.

The daughter of a dependent older patient reports to the nurse that the patient requires regular soapsuds enemas to manage chronic constipation. What response by the nurse responds is best? A. "Let's talk about a different way to manage the constipation." B. "Good, enemas are generally the most effective interventions for the older adult." C. "Chronic constipation is best managed with oral medications." D. "Your mother's diet is the most likely cause of the constipation."

ANS: A Soap suds enemas lead to mucosal irritation and should not be used. Alternative methods to managing constipation include dietary changes and medications when needed. The nurse would suggest discussing the different options. Telling the daughter that the diet is to blame is probably true, but does not offer anything in the way of education on treatment.

The nurse is planning to teach an older patient about diverticulitis. What topic does the nurse include? A. Dietary fiber and fluids will reduce the symptoms. B. It is unusual to see diverticula in older persons. C. Abdominal cramping and severe diarrhea should be reported. D. Diverticulosis rarely reoccurs once it has been treated.

ANS: A Teaching should include the need to eat high-fiber foods and the importance of achieving and maintaining adequate fluid status. Patients should be encouraged to consume up to 2,000 mL of fluids each day, unless contraindicated by cardiac status. Older people have diverticulitis commonly. Abdominal cramping and diarrhea are expected findings. Diverticulitis usually reoccurs.

An older adult reports chronic constipation. When asked why this problem has gotten worse with age, what response by the nurse is best? A. "As we age, our bodies require more fiber to bring about healthy bowel function." B. "We need to discuss the proper use of laxatives to minimize constipation." C. "You might have lost the ability to feel when you need to move your bowels." D. "Aging brings about decreased gastric motility that often results in constipation."

ANS: A The most widespread cause of constipation in older adults is diet. Diets need to be high in fiber and include plenty of water unless contraindicated by another condition. Some changes in nerve function and gastric motility are also possible causes, but the major cause is diet. Laxatives should only be used as a last resort.

A patient is scheduled to have surgery for prostate cancer in a few weeks. What action by the nurse is most important? A. Discuss options and their effect on sexuality. B. Ensure the patient has advance directives. C. Offer the patient a tour of the operating room. D. Determine if the patient prefers outpatient surgery.

ANS: A Treatment for prostate cancer can affect sexual functioning, so the nurse ensures the patient knows the risks and benefits of his choices. The other options are not necessary, although any patient with a serious illness should have advance directives.

When assessing the patient for urinary incontinence, which patient symptom best supports the nursing diagnosis of overflow incontinence? A. "I have small accidents ever since I developed multiple sclerosis." B. "It burns so badly after I urinate that I hold it as long as I can." C. "I can't make it to the toilet when I feel the need to urinate." D. "I lose small amounts of urine when I sneeze or laugh hard."

ANS: A Typically, individuals with overflow incontinence complain of frequent losses of small volumes of urine, which are commonly a result of urethral blockage (e.g., BPH, scar tissue, stones), weakened bladder muscles, nerve injury or damage (e.g., diabetes, Parkinson's disease, and multiple sclerosis), constipation, or drugs. Burning indicates a urinary tract infection. "Not making it" to the bathroom is generally functional incontinence. Losing control of the bladder with sneezing or laughing is a manifestation of stress incontinence.

On assessing the laboratory data of an older adult patient, the nurse notes the serum potassium level is 5.3 mEq/L. What action by the nurse is best? A. Asks if the patient has been using a nonsteroidal antiinflammatory drug (NSAID). B. Determines if the patient is receiving a diuretic that promotes potassium loss. C. Suggests several potassium-rich foods to supplement dietary potassium intake. D. Monitors the patient's urinary output for possible fluid retention

ANS: A A potassium level of 5.3 mEq/L is high. NSAIDs such as ibuprofen interfere with potassium excretion. The other answers are not related to hyperkalemia.

An older adult has been admitted for dehydration. Which laboratory value correlates with this condition? A. Na+: 160 mEq/L B. Na+: 128 mEq/L C. K+: 3.5 mEq/L D. K+: 5.2 mEq/L

ANS: A A sodium level of Na+: 160 mEq/L is high and can be seen in cases of dehydration. Overhydration will produce a low sodium level. Potassium levels are not related.

A patient has been admitted to the post anesthesia care unit after a trabeculectomy. What assessment takes priority? A. Airway B. Pain C. Eye patch D. Blood pressure

ANS: A Airway always comes first when prioritizing care.

A nurse works in a long-term care facility where many of the residents have osteoporosis. For which resident would alendronate be contraindicated? A. patient on a continuos tube feeding B. A wheelchair-bound patient C. A patient over the age of 85 D. A male patient

ANS: A Alendronate must be taken 1 hour before meals. This would probably not be the most appropriate medication for a patient on a continuous tube feeding. The other patients are appropriate candidates for this medication.

The nurse is caring for an older adult patient prescribed allopurinol. What action by the nurse is best? A. Offering fresh, cold water frequently during the day B. Monitoring temperature every 4 hours C. Ensuring sufficient protein intake D. Assessing for depression symptoms daily

ANS: A Allopurinol is given to patient with gout, and a side effect is renal calculi. To discourage the formation of renal stones, the patient should be encouraged to have a daily intake of 2 to 3 L of fluid unless contraindicated. The other actions are not related to preventing this adverse effect

To help manage the potential side effects of prescribed antipsychotic medications, amantadine may be prescribed. Which statement best indicates that the nurse understands the appropriateness of this medication for the older adult patient? A. "This medication produces few anticholinergic effects." B. "Symmetrel is an effective dopamine agonist." C. "Extrapyramidal symptoms are best controlled by Symmetrel."

ANS: A Amantadine, a dopamine agonist prescribed to manage EPS, may be used, especially in older patients and in those with cardiovascular dysfunction, because of its reduced anticholinergic effects. The other statements are not accurate.

What education by the nurse is most important to address age-related changes to the senses? A. Installing auditory smoke alarms B. Having regular eye checkups C. Being aware that hearing acuity decreases with age D. Checking the expiration dates on foods such as dairy

ANS: A An age-related reduction in the senses makes it less likely that an older person will smell smoke from a fire. Loud fire alarms are important for home safety. The other factors are not as directly related to safety.

A patient was admitted for heart failure, and over the past 3 days the patient's brain natriuretic peptide has increased. What action by the nurse is best? A. Prepare to administer extra diuretics. B. Continue with the plan of care. C. Prepare to intubate and ventilate the patient. D. Discuss end-of-life care with the patient.

ANS: A An increasing BNP indicates more fluid volume in the heart, indicating that treatment measures for CHF are not working. The nurse prepares to administer an extra dose of diuretics. It would be inappropriate to continue the current plan of care, which is not working. There is no indication that the patient needs to be intubated and ventilated. There is also no indication that this patient is near the end of life.

A hospice nurse is caring for a patient and notes the patient's spouse engaged in anticipatory grieving. What action by the spouse best demonstrates this reaction? A. Spending time learning about the business owned by the patient B. Receiving many visitors from church and social organizations C. Delegating household tasks so the spouse can stay with the patient D. Taking long walks outside then napping for extended periods

ANS: A Anticipatory grieving includes the processes of mourning, coping, and planning that are initiated when the impending loss of a loved one becomes apparent. It serves to reduce shock, confusion, and depression. The spouse learning about a business he or she will likely have to take over shows future planning. The other actions do not.

The family of a patient who has type 2 diabetes calls the clinic to report a very small sore on the patient's foot. What action by the nurse is best? A. Have the patient come to the clinic today. B. Have the family wash and bandage it. C. Tell the patient to check for a fever. D. Have the patient go to the emergency room.

ANS: A Any ulcer or sore on a foot requires medical attention because on superficial inspection, the true degree of injury can be hidden. The patient should come to the clinic today for early intervention. The family should not attempt to care for the wound and the patient does not need to take a temperature before coming in. The patient does not need to go to the emergency department at this time.

An 85-year-old patient's blood gasses are as follows: pH 7.4, PaO2 75 mmHg, PaCO2 38. A patient's brain natriuretic peptide (BNP) was elevated on admission from the emergency department. Two days later, it has been reduced by half. What explanation of these findings by the nurse is best? A. "It shows your heart failure may be resolving." B. "Your heart is pumping much better now." C. "The ventricles can relax to hold more blood."

ANS: A BNP is released due to increased fluid volume that stretches the vasculature. It shows the patient's heart failure may be resolving as excess fluid is removed. The BNP cannot differentiate between systolic (pumping) and diastolic (filling) problems. It is not related to a heart attack.

A frail, older patient is in the emergency department in severe respiratory distress. The patient has had repeated hospitalizations for the same thing. After stabilizing the patient, which action by the nurse is most appropriate? A. Determine what the patient's end-of-life wishes are. B. Assess the family caregiver for compliance with treatment. C. Administer intravenous (IV) fluids at a rapid rate. D. Prepare to vaccinate the patient against pneumonia.

ANS: A Because of the lifesaving modalities needed to care for such a patient, the nurse and physician work together to determine what the patient's end-of-life wishes are. In the emergency department, patient stabilization comes first, but once this has been accomplished a discussion should occur with the patient and family about further treatment desires. The family caregiver may or may not be adherent, or the patient may assume all self-care. IV fluids should not be given at a rapid rate because of the risk of heart failure. The patient should receive an immunization against pneumonia per guidelines.

A nurse is planning an educational program on cancer for a group of older adults. What information regarding cancer and racial and ethnic patterns in this country does the nurse include? A. The incidence of cancer is highest among African Americans. B. Native Americans have the highest overall incident rates of cancer. C. Incidence rates for lung cancer are lowest for white women. D. Hispanic women have the lowest incidence rates of cervical cancer.

ANS: A Cancer affects Americans of all racial and ethnic groups; however, the incidence of cancer does demonstrate patterns according to racial and ethnic origins. African Americans have higher overall incidence rates than whites, whereas Hispanic Americans and Native Americans have lower incidence rates overall.

An older adult patient with breast caner is reluctant to agree to the suggested treatment plan because "I have heard such horrible things about radiation therapy." What response by the nurse is best? A. "Radiation therapy no longer causes such terrible side effects." B. "Your chances of recovery are best when radiation is included." C. "Ask the oncologist if there are alternative treatments." D. "Actually, there is very effective symptom control now."

ANS: A Cancer care has changed dramatically over the years; however, many older adults remember friends or relatives who were treated with now outdated therapies that had devastating side effects. The other statements do not address the primary concern, which is side effects of the treatment.

A patient has been taught about nutrition related to COPD. Which menu selection may indicate a need for further teaching? A. Bagel and cream cheese B. Broiled chicken breast C. Beans and peas D. Tofu stir-fry

ANS: A Carbohydrates should not make up more than 50% of the daily intake of calories because they break down into carbon dioxide, worsening breathing. The other selections show good understanding. Of course, the nurse needs to take into consideration the amount of carbohydrates in the entire day and not just one selection.

A patient has onychomycosis. The nurse should anticipate educating the patient on which of the following drugs? A. Clotrimazole b. Terbinafine c. Itraconazole d. Methylprednisolone

ANS: A Clotrimazole is used as a cream for several months on this toe fungal infection. Terbinafine and itraconazole are generally not used in older adults. The steroid methylprednisolone is not indicated.

The nurse is preparing to provide an older, newly diagnosed diabetic patient with information regarding type 2 diabetes. The nurse initially A. asks if the patient prefers a video or a pamphlet. B. invites the patient's spouse to be present during the instruction. C. selects a quiet, well-lighted space for the class. D. ensures that the patient is pain-free and comfortably seated.

ANS: A Cognitive function and learning styles vary, so knowing the patient's preferred learning style facilitates education. Some individuals prefer to learn by visual methods, others by listening, and still others by experiencing contact in a hands-on approach. Controlling pain and ensuring the patient is comfortable will also facilitate learning, but it is more important to meet the patient's preferred learning style. The other options are helpful but not as vital.

A 71-year-old patient has a triglyceride level of 112 mg/dL. What action by the nurse is best? A. Assess the patient for cardiovascular risk factors. B. Educate the patient on a lower-fat diet. C. Congratulate the patient for a normal result. D. Document the findings in the patient's chart.

ANS: A Desired triglyceride levels are based on a person's risk factors for cardiovascular events. Patients with established heart disease and another risk factor such as smoking are recommended to have the LDL cholesterol level at less than 70 mg/dL. Those at high risk but without established disease are recommended to have the LDL level at less than 100 mg/dL. Patients considered at moderate risk for heart disease should maintain the LDL level at less than 130 mg/dL; and those at low risk for heart disease hould have the LDL level at less than 160 mg/dL. The nurse needs to gather information on risk factors before choosing the appropriate action. The nurse will document, but needs to take other action too.

When administering metoprolol to an older adult patient with hypertension, the nurse is careful to have the patient's care plan include A. frequent assessment for dizziness or syncope. B. education of the signs and symptoms of thromboembolism. C. regular evaluation of the patient's muscle strength. D. regularly scheduled serum potassium levels.

ANS: A Dizziness is an adverse reaction to beta-blockers such as metoprolol.

A novice nurse requires additional education on arterial vascular deficiency when suggesting the condition's symptoms include A. 2+ edema in calf and foot of left leg. B. a 2-cm ulcer between two toes on the left foot. C. skin on the left leg is cool to the touch. D. toenails on the left foot are thick and brittle.

ANS: A Edema is not generally observed in cases of arterial deficiency, but rather in venous insufficiency. The other options are manifestations of arterial vascular deficiency.

Your patient reports frequent constipation as a result of prescription medications and asks the nurse for advice about using a daily over-the-counter laxative. The most appropriate response by the nurse is to do which of the following? A. Tell the patient to consult the health practitioner before using nonprescription drugs. B. Educate the patient about the side effects of regular laxative use. C. Tell the patient to avoid laxatives because they can interfere with medications already being taken. D. Tell the patient to consult a dietician about ways to correct chronic constipation.

ANS: A Education regarding the importance of contacting the health practitioner (physician or pharmacist) before taking nonprescription medication is essential for reducing the number of unintentional medication interactions. Educating the patient on side effects and teaching the patient nonpharmaceutical ways to manage constipation are also appropriate.

The nurse caring for patients using continuous positive airway pressure (CPAP) knows what about treatment effectiveness? A. Effectiveness depends on compliance. B. It's too expensive for many older adults. C. It is rarely effective for sleep apnea. D. Complicated settings make it hard to use.

ANS: A Effectiveness is determined by compliance for nearly any regime, and unfortunately noncompliance with CPAP is 29-83%. The other statements are incorrect.

A patient is admitted to the hospital for chemotherapy and has severe mucositis. What action by the nurse is best? A. Provide frequent oral care with saline. B. Have the family bring the favorite mouthwash. C. Document the patient's oral assessment. D. Ensure teeth are brushed with a firm toothbrush.

ANS: A Frequent oral care is a must for patients with mucositis. However, commercial products contain alcohol, and the patient needs gentle products that do not contain alcohol. Saline is a good option. Documentation should occur, but the nurse should act to address the problem. A soft toothbrush or swab is preferred for comfort.

What action by the nurse is most important for preventing hospital-acquired infections in the older population? A. Appropriate hand hygiene B. Rapid isolation for infection C. Strict sterile procedures D. Ensuring patient nutrition

ANS: A Hand hygiene is the most effective infection control action the nursing staff can take.

An older patient with presbycusis has been advised to purchase a hearing aid and asks about its function and use. Which information is most accurate to give the patient about the function of hearing aids? A. Hearing aids amplify sound but do not improve the ability to hear. B. Hearing aids improve hearing by intensifying the duration of sound waves. C. Hearing aids control the input of sound waves to eliminate extraneous noise. D. Hearing aids intensify sound waves and improve the ability to hear.

ANS: A Hearing aids amplify sound but do not improve the ability to hear. The other statements are not accurate regarding hearing aids.

An older adult has chronic fatigue from several illnesses. The patient is frustrated at this symptom. What action by the nurse is best? A. Ask the patient to prioritize activities. B. Have the patient keep a fatigue diary. C. Encourage the patient to rest in the day. D. Instruct the patient on good sleep hygiene.

ANS: A Helping the patient cope with fatigue is an important nursing intervention. The nurse should first ask the patient to prioritize the activities she or he most wants to do. Then the nurse and patient can plan strategies that will allow the patient to participate in these activities. Keeping a diary is helpful but knowing what interests the patient most is more important. Rest and sleep are important, but they are not the priorities.

A patient's oxygen saturation is 98%, but the patient reports shortness of breath with activity. What action by the nurse is best? A. Assess the patient's hemoglobin. B. Apply oxygen at 2 L/nasal cannula. C. Consult respiratory therapy. D. Administer a bronchodilator.

ANS: A If the patient's hemoglobin is low, there may not be sufficient oxygen in the blood for the patient's needs. The nurse assess the hemoglobin level. Applying oxygen may help the patient feel better but does not get to the root of the problem. Respiratory therapy and a bronchodilator are not indicated.

The nurse works with patients diagnosed with chronic disease processes for the probability of hospitalization because of the exacerbation of related symptoms. The nurse recognizes that the patient with the highest probability is a(n) A. 72-year-old male with congestive heart failure (CHF). B. 82-year-old male with type 2 diabetes. C. 72-year-old female with chronic bronchitis. D. 82-year-old female with osteoporosis

ANS: A Individuals with chronic conditions typically have repeated hospitalizations to treat exacerbations of their illness. The most common reasons for hospitalization in older patients are heart disease, cancer, pneumonia, and stroke. The 72-year-old male with CHF is at highest risk.

A 73-year-old patient has been diagnosed with congestive heart failure (CHF). The nurse provides the greatest support for this patient's positive view of self-wellness by presenting information regarding A. how to minimize the exacerbation of symptoms. B. locally available supportive services. C. the importance of adherence to medical treatment. D. the need to report symptoms promptly.

ANS: A Many older adults now seek education about health promotion and management of their illness. The nurse can support older adults by teaching self-care management in these areas. The other actions are also valued but learning how to control symptoms gives patients the feeling of accomplishment.

In creating community education on various types of skin cancer, the nurse places the highest priority on early diagnosis of melanoma because A. it accounts for the largest number of mortalities. B. extensive surgery can be avoided if caught early. C. once it has spread there is no chance of curing it. D. it is the most commonly occurring skin cancer.

ANS: A Melanoma is a malignant neoplasm of pigment-forming cells that is capable of metastasizing to any organ of the body, even before the lesion is noted; therefore early detection is crucial. Therefore it is critical that the condition is diagnosed promptly. Basal cell carcinoma is the most common type of skin cancer.

An older diabetic patient reports a candidiasis infection. When asked, the patient states all blood sugars have been within the target range. What action by the nurse is best? A. Facilitate having a hemoglobin A1C drawn. B. Teach the patient preventive measures. C. Teach the patient about the side effects of medications. D. Review the patient's medication history.

ANS: A Often candidiasis infections in diabetics indicate hyperglycemia. The patient may or may not be truthful about the blood sugar reports, or the patient may be missing periods of hyperglycemia when testing. The nurse should consult with the provider about checking an A1C. The other options are appropriate as well but do not give information as to the background cause.

A nurse is working with a patient who was diagnosed with type 2 diabetes 4 months ago. The patient's blood sugars have stayed under control. What action by the nurse is best? A. Ask the patient what barriers to wellness still exist. B. Remind the patient about the A1C in 2 months. C. Review side effects of medications with the patient. D. Ask the patient how she or he feels about diabetes.

ANS: A Older patients typically see chronic illness as one part of their lives. The nurse can support older adults by working with them to identify areas that may hinder progress along the wellness continuum and by teaching self-care management in these areas. The nurse should assess the patient's needs from his or her point of view.

An older adult has been recently diagnosed with type 2 diabetes and mild retinal deterioration. What action by the nurse is best in order to address the patient's potential for developing situation depression? A. Assesses the patient's coping skills. B. Encourages the patient to participate in a depression support group. C. Assesses the patient's ability to manage the symptoms. D. Educates the family on early signs of depression.

ANS: A One of the keys to successful aging is adjusting to or, perhaps more accurately, adapting to, although not necessarily accepting, changes that occur in one's life. The nurse assesses the patient's coping skills and methods. The patient does not need a support group before developing depression.

A 66-year-old patient has been diagnosed with type 2 diabetes mellitus and related vision loss. Which statement demonstrates the ability to manage her condition? A. "I schedule my yearly eye examination for the week of my birthday." B. "When I notice haloes around lights, I'll know I have a problem with retinopathy." C. "My sister had diabetic retinopathy, and the vessels in her eyes were scarred." D. "I understand that the eye problems need to be diagnosed with an ophthalmoscopic exam."

ANS: A Patients with diabetes should have a yearly examination by an ophthalmologist. Scheduling the exam for the week of her birthday will keep the patient from forgetting to do so. The other statements are not related to management.

A nurse is reviewing possible first-line medications for a new, older type 2 diabetic. What contraindication does the nurse identify for metformin (Glucophage)? A. Patient drinks three to four alcoholic drinks/day B. Patient's parents both took insulin C. Creatinine 0.9 mg/dL D. Potassium 3.8 mEq/dL

ANS: A Patients with hepatic or renal dysfunction should not take metformin. A patient who drinks as much as three to four alcoholic drinks a day has a real risk of liver disease. The use of insulin by the parent is not related. Both kidney lab values are normal

An older patient has been admitted to the nursing unit after a car crash and surgery. When does the nurse begin planning for rehabilitation? A. On admission B. When the patient is awake C. When the patient is stable d. When the family requests it

ANS: A Planning for rehabilitation, like discharge planning, begins on admission.

An 89-year-old patient diagnosed with dementia was until recently responding well to cognitive cueing techniques. What statement by the nurse to the care team shows an understanding of dementia? A. "We will implement new interventions that address the disease's progression." B. "It's important that we frequently recue the patient to improve her quality of life." C. "The patient's family needs to be made aware of this decline." D. "This poor response to cueing is likely a result of advanced aging."

ANS: A Positive responses to selected interventions may continue for a time but may decline as the disease progresses, which results in the need to reevaluate strategies. The nursing staff cannot evaluate the patient's quality of life; only the patient can, and this patient is not capable. The family should be informed but that is not related to understanding dementia. The change in response is the result of advancing disease, not age.

An older confused patient is recovering fro a stage 4 sacral pressure ulcer. The nurse USNT shows an understanding of this patient's risk for developing osteomyelitis by A. adhering to sterile technique when changing the wound's dressing. B. assessing and documenting the patient's vital signs regularly. C. managing the patient's antibiotic therapy as prescribed. D. ensuring that the patient's diet includes sufficient protein.

ANS: A Prevention of osteomyelitis includes using sterile technique during dressing changes and following strict wound precautions. The other actions are not as important for preventing this complication, although they are part of the patient's nursing care plan.

An older patient has a pressure ulcer that is resistant to healing despite aggressive therapy and has developed pitting pedal edema. The patient's albumin is 3.4 g/dL. What action by the nurse is best? a. Request a prealbumin level from the provider. b. Document the finding as normal for age. c. Consult the Wound-Ostomy nurse. d. Review the results of the patient's BNP.

ANS: A Protein is needed for wound healing and for maintaining oncotic pressure in the vasculature. Low protein would be associated with poor wound healing and edema. The patient's albumin is slightly low, but probably normal for the older adult. However, the albumin does not reflect recent changes in nutritional status, so the nurse should obtain an order for a prealbumin, which will show changes from the last 2 days. The nurse will document the finding but needs to do more. The consultation may be appropriate for the nonhealing wound, but that doesn't address the possible underlying cause. The BNP indicates heart failure (if high) which could lead to edema, but combined with the wound, this more likely points to a nutritional deficit.

The nurse is preparing to apply a topical cream on the arm of a cognitively impaired, anorexic older adult patient in the terminal stage of lung cancer. The nurse carefully monitors the effectiveness of the medication because its effectiveness will be most negatively impacted by the patient's A. age. B. cognitive limitations. C. nutritional status. D. cancer diagnosis.

ANS: A Reduction in subcutaneous fat associated with integumentary changes of aging alters topical drug absorption. These changes may result in impaired absorption of some drugs administered as lotions, creams, ointments, and patches.

The nurse best addresses the possible intrinsic factors that contribute to falls experienced by older adult patients in an acute care setting by doing which of the following? A. Encouraging patients to wear their glasses B. Keeping a low-level light on in the room at night C. Keeping the patient's bed low to the floor

ANS: A Risk factors for hospital falls include both intrinsic and extrinsic factors. Intrinsic factors include age-related physiologic changes and diseases, as well as medications that affect cognition and balance. The other actions are important safety measures that are helpful to some patients as well, but good vision is an iatrogenic risk critical for safety.

The nurse conducting a community-screening event for osteoporosis knows that which woman is at highest risk? A. A slender 84-year-old Asian who smokes B. A heavy set 65-year-old Caucasian C. A 75-year-old taking a steroid "burst" D. A 68-year-old African American who consumes one drink a day

ANS: A Risk factors for osteoporosis include thin body frame, white race, advancing age, alcoholism, and smoking, among others. The 84-year-old who smokes is at highest risk despite being Asian.

An older patient is hospitalized on the general medical floor with pneumonia secondary to influenza and is prescribed antibiotics. What assessment finding would indicate a higher level of care is needed for this patient? A. Spreading infiltrates on chest x-ray B. Creatinine 3.2 mg/dL C. White blood cell count 18,000/mm3 D. Positive sputum cultures for pneumococcus

ANS: A Spreading infiltrates on x-ray or extrapulmonary sites of infection seen on chest x-ray is an indication that the patient needs a higher level of care, perhaps even mechanical ventilation. The creatinine is high, reflecting a renal disorder. The elevated white blood cell count is indicative of infection although many older adults do not mount such an immune response. The type of pneumonia is not a definitive criterion for intensive care placement.

A student learning about the early AIDS epidemic wonders why the patients were stigmatized. What response by the nurse was best? A. Fear of the unknown etiology B. Expense required government assistance C. Patients being ashamed of their illness D. Younger patients not having accomplishments

ANS: A Stigma arises out of specific characteristics of a disease or an unknown etiology, which causes fear. In the early days of the AIDS epidemic, not much was known about transmission, which generated fear in health care workers and the general population.

A patient has a history of smoking and now has painless hematuria. After a workup, the patient is told the diagnosis of bladder cancer. What action by the nurse is most important? A. Allow the patient to verbalize feelings. B. Educate the patient on care of an ileal conduit. C. Teach the patient how to manage nausea D. Offer a social work referral to complete a living will.

ANS: A The first intervention the nurse should provide is to be present for the patient and allow the expression of feelings. It is too early to teach, the patient may or may not have an ileal conduit, and the patient may not be ready to complete a living will or other advance directive.

An adult hospice patient is mourning over the loss of an adult child. The novice hospice nurse shows the best understanding of the nursing role related to mourning when making which statement? A. "I see mourning as a very individualized process." B. "The patient's coping skills need to be assessed regularly." C. "The patient needs all the help I can give to get better." D. "Hopefully the patient will be in a healthy mental state soon."

ANS: A The goal of nursing care for older persons who are grieving and mourning is not to "make them feel better" quickly, although nurses are often tempted to try to do so. Nurses should assist and support bereaved persons through the grieving process, recognizing that pain is a normal and healthy response to loss and allowing bereaved persons to accomplish the tasks of mourning in their own ways.

The nurse impacts the trajectory of a patient's type 2 insulin-dependent diabetes best by A. evaluating the patient's ability to administer insulin appropriately. B. providing the patient with a written copy of the treatment plan. C. explaining to the patient the importance of serum glucose control.

ANS: A The illness trajectory can be modified by actions taken by the health care provider that directly affect the patient's ability/interest to adhere to the treatment plan prescribed. The other actions are important but do not directly affect the illness trajectory.

To best help manage health care costs in older adults, the nurse entrepreneur would do which of the following? A. Create a telehealth system where nurses could check on patients daily. B. Provide local transportation services for older people to keep appointments. C. Create educational videos in multiple languages seen in the community. D. Build a nurse-run clinic to serve the homeless and underinsured population.

ANS: A The majority of health care expenditure is spent on chronic illness. Patients with chronic illnesses have multiple hospitalizations for exacerbations of their conditions. Keeping chronic conditions under control would make a difference in health care cost. A telehealth service in which nurses could assess and counsel patients daily could help accomplish that goal. The other ideas are good too, but tight control of chronic conditions is a priority.

A patient had a chemical splash into the eye at work. What action by the occupational health nurse takes priority? A. Begin flushing the patient's eye with cool water. B. Call emergency medical services. C. Ask about the patient's tetanus status. D. Tape the eye closed to prevent injury.

ANS: A The nurse should begin flushing the eye immediately. While the eye is being irrigated, the nurse can call 9-1-1 and inquire about the patient's last tetanus shot. The eye should not be taped shut.

An older adult patient reports pruritus. The nurse educates the patient on the importance of which action? A. Applying a lanolin-rich cream and avoiding scratching the areas B. Taking warm baths and gently rubbing of affected areas with a terrycloth towel C. Minimizing ingestion of fried foods and use of an antihistamine cream D. Avoiding bath oils and allowing the skin to air-dry after bathing

ANS: A The nurse suggests that the patient apply emollients (e.g., Lubriderm, Moisturel, or Eucerin lotion or cream), which have more lanolin or oily substances than many commercial lotions. Time should be planned to teach the patient and family about etiologic factors and the importance of not scratching. The other options are not helpful and will not decrease the itching.

An older patient is having a colostomy as part of surgery for colon cancer. What assessment by the nurse is most important in this patient? A. Manual dexterity B. Body image C. Fear of dying D. Fluid volume status

ANS: A The older adult with diminished manual dexterity may need assistance with ostomy care. The other assessments are appropriate for patients of all ages.

A patient in a nursing home is confused, nonverbal, but pleasant. The nurse notes the patient has suddenly become agitated and is screaming and scratching at the eyes. While the nurse is examining the patient, the patient vomits. What action by the nurse is best? A. Consult the provider about an ophthalmologic exam. B. Sedate the patient so she won't injure herself. C. Place mitts on the patient's hands to avoid scratches D. Give the patient a prn medication for pain.

ANS: A The patient could be having an episode of acute angle closure glaucoma, manifested by severe pain, nausea and vomiting, and visual disturbances. Because the patient is nonverbal, the nurse must assess for pain with behavioral changes. The nurse should contact the provider immediately about obtaining an ophthalmologic exam to determine if the patient has glaucoma. The other interventions will not help determine the cause of the problem. The nurse should attempt to discover the source of the behavior, not just try to control it.

An older adult patient has been taught measures to prevent the development of skin cancer. Which statement, if made by the patient, indicates the need for more teaching? A. "I will certainly miss my vegetable and flower gardening." B. "I should buy a sunscreen with an SPF of 15 or higher." C. "Now I have a good excuse to wear the straw hat my spouse hates." D. "My cool long-sleeved shirts will work just fine while I'm golfing."

ANS: A The patient is still able to garden as long as he or she takes appropriate sun precautions. The other statements show good understanding.

A patient with glaucoma is on timolol. The patient also takes metoprolol for hypertension. The patient reports to the clinic nurse that the eyedrops "Make me dizzy." What assessment by the nurse is most appropriate? A. Assess the patient's eyedrop instillation technique. B. Determine how long the patient has been on the drops. C. Assess the patient's gait and balance while walking. D. Ask the patient if breakfast is eaten prior to applying the eyedrops.

ANS: A The patient should be using punctal occlusion (closing the lacrimal duct by pressing lightly on the lower eye lid) when instilling these eyedrops to avoid a cumulative, systemic effect from the combination of both beta-blockers. The nurse can assess the other factors as well, but this is the most likely cause of the dizziness.

The nurse gives priority to assessing an older patient who presents with symptoms of acute respiratory distress for which other condition? A. Substernal chest pain B. A history of panic attacks C. Any known allergies D. Bruising on the chest

ANS: A The symptoms of asthma and respiratory distress mimic other conditions such as myocardial ischemia. The nurse assesses for this condition as the priority over the others.

A patient's chart contains an assessment of tophi and podagra. What medication does the nurse plan to educate the patient on? A. Allopurinol B. Colchicine C. Levodopa-carbidopa D. Ibuprofen

ANS: A This patient has manifestations of chronic gout, which is treated with allopurinol. Colchicine is for acute attacks. Levodopa-carbidopa is for Parkinson's disease. Ibuprofen may or may not be needed.

The family of an older patient recently diagnosed with cancer reports that the patient seems USNT to be in denial, refusing to choose treatments and planning an extended vacation. What response by the nurse is best A. Ask the patient how he or she feels about the diagnosis. B. Tell the patient treatment started early has the best results. C. Refer the patient to a licensed mental health professional. D. Tell the family that the patient will get over it in his own time.

ANS: A This patient may be experiencing a compensatory form of grief and not allowing him- or herself to ponder the enormity of the situation at one time. Rather, the patient may be allowing bits of information to seep into his or her existence slowly in order to make sense of it. This is adaptive and the nurse should ask the patient how he or she feels about the cancer. Telling the patient that treatment must start early may be too harsh and the patient may not be ready to make decisions. The patient probably does not need a mental health professional; rather the patient should be left to come to terms with this diagnosis on her or his own terms. Using phrases like "get over it" are judgmental and imply the patient is doing something wrong.

A patient is in the Emergency Department with chest pain and shortness of breath. Which laboratory result does the nurse review as the priority? A. Troponin B. Creatinine C. Creatinine Kinase

ANS: A Troponin is released into the blood with injury to cardiac cells. The nurse, suspecting a possible myocardial infarction, would check this result as the priority. Creatine is associated mainly with kidney function. Creatine kinase can be used to track cardiac muscle injury over time. Lactic dehydrogenase is tracked to follow injuries to the heart, muscles, and liver.

An older adult patient has an open, draining wound on the lower medial aspect of the right leg. The skin surrounding the wound is reddish brown with surrounding erythema and edema. Based on this information, the nurse edits the patient's care plan to include impaired skin integrity related to which factor? A. Altered venous circulation B. Arterial insufficiency C. Diabetic neuropathy D. Pressure ulcer

ANS: A Venous ulcers are usually on the medial aspect of the lower leg, with flat or shallow craters and irregular borders, accompanied by varicosities, liposclerosis (brown ruddy color and thickened skin), and itching. Venous ulcers generate a large amount of exudate and are usually surrounded by erythema and edema. Arterial insufficiency would produce shiny, taut, hairless skin. There is no indication the patient is a diabetic. There is no indication the patient has risks for pressure ulcers.

An older adult patient has been prescribed warfarin. The nurse's primary intervention involves daily assessment of which of the following? A. Prothrombin time B. Body for bruising C. Serum creatinine level D. Reflex tone

ANS: A Warfarin therapy is monitored by the international normalized ratio (INR) or INR with prothrombin time. A patient receiving anticoagulants can have bleeding that leads to bruising, but this is not the priority. Creatinine and reflexes are not related.

An older patient diagnosed with severe osteoarthritis has recently moved in with his son because of a history of falls. The son describes how he and his family have eagerly assumed responsibility for "meeting all Dad's needs." The nurse is most concerned that this environment will result in the patient A. developing a sense of powerlessness and possibly a loss of hope. B. becoming unnecessarily physically and emotionally dependent. C. losing his will to "get better" and become independent again. D. becoming resentful and argumentative with his son's family.

ANS: A With no control over meeting his own needs, the patient may develop a sense of powerlessness, which can result in a loss of hope. The other concerns might be a problem for some patients, but powerlessness and loss of hope remain the priority.

A 96-year-old patient reports symptoms of xerostomia. What action by the nurse will be most helpful in minimizing the effects of this condition? A. Providing appropriate fluids with the patient's meals B. Cutting the patient's meat into small bite-sized pieces C. Elevating the head of the patient's bed at mealtimes D. Assisting the patient with oral care before each meal

ANS: A Xerostomia, commonly referred to as dry mouth, is a subjective sensation of abnormal oral dryness. Reduced salivary flow is a common complaint of older adults. Dry mouth in the older adult can lead to an increased risk of serious respiratory infection, impaired nutritional status, and reduced ability to communicate. Offering appropriate fluids with meals will assist with proper nutrition. The other options will not provide relief for this condition.

A newly-admitted older patient reports taking varenicline. What question by the nurse is most important? A. "How many packs of cigarettes did you smoke a day?" B. "How much alcohol do you typically drink each day?" C. "When was the last time you had your kidney function checked?" D. "Do you frequently lose your prescription medications?"

ANS: A Varenicline is a drug that helps people stop smoking. The nurse would assess the patient's smoking habits.

The nurse is evaluating the effectiveness of an older patient's self-management of asthma. What does the nurse assess as the priority? (Select all that apply.) A. How many times a week a rescue inhaler treatment is needed B. How well the patient is able to avoid the known triggers C. Whether the patient experience frequent respiratory infections C. Whether the patient requires rest periods during the day C. Whether the patient believes he or she has the support of family and friends

ANS: A, B The evaluation of self-management is based on the patient's success in following through with the plan. Determine the frequency of rescue inhaler use, success at avoiding triggers, and the patient's ability to monitor and address lifestyle changes.

The nurse is preparing discharge education for an older patient and his family. The patient's hemoglobin is currently 8.2 mg/dL as a result of cancer treatment therapy. To best address the patient's hematology status, the nurse includes instructions to do what? (Select all that apply.) A. Include eggs or an egg substitute into the daily diet. B. Avoid strenuous exercise until hemoglobin improves. C. Regularly take both a midmorning and a midafternoon nap. D. Have a green leafy salad with vegetables at meals. E. Check for bruising to the extremities and the gums.

ANS: A, B, C, D Instruct the patient and family to increase rest and sleep periods as well as to incorporate foods into the diet that are high in iron, such as eggs, lean meat, green leafy vegetables, carrots, and raisins. These interventions are directed toward conserving energy and providing iron. Avoiding strenuous activity will decrease the chance of injury. Bleeding and bruising would indicate low platelet count.

The nurse encouraging an older patient to start pulmonary rehabilitation shares the benefits of the program, including which of the following? (Select all that apply.) A. Socialization B. Decreased cardiac risks C. Nutrition counseling D. Weight management E. Sports participation

ANS: A, B, C, D There are many aspects to pulmonary rehabilitation, cardiac risks, nutrition counseling, and weight management. Sports are not included, although exercise is.

The student learning about chronic disease and illness in the older population learns which facts about this situation? (Select all that apply.) A. One in two adults, or more than 133,000 Americans, has a chronic condition. B. Chronic disease is the leading cause of death in those over 65. C. About 75% of medical costs each year are spent on managing chronic disease. D. Formerly acute conditions are now manageable chronic diseases. E. The focus of America's health care services is now on chronic illness

ANS: A, B, C, D One in two adults has a chronic illness, and these problems are the leading cause of death in those over 65 and the largest cost to our health care system. One reason for this is that formerly acute, possibly fatal, conditions are now manageable as chronic conditions. America's health care system continues to be focused on acute care.

The nurse teaches an older patient safety rules for exercising. What do these rules include? (Select all that apply.) A. Carry medical identification. B. Check blood glucose before exercising. C. Drink plenty of water. D. Have quick-acting glucose.

ANS: A, B, C, D Rules for safe exercise include all the above except the patient is more likely to experience hypoglycemia, so those signs and symptoms are important related to exercise.

The nurse is using a tool to assess the quality of life of a hospice patient. The nurse addresses the appropriate areas of concern when asking which of the following questions? (Select all that apply.) A. "Are you able to bathe and dress yourself?" B. "How are you coping with being in hospice?" C. "How would you rate your pain on a scale of 1 to 10?" D. "Do you still have concerns about your will?" E. "How often do you get to see your family?"

ANS: A, B, C, D, E Quality of life incorporates more than symptom burden, it is multidimensional and includes things such as functional status and the severity of symptoms but also the patient's ideas about psychological development, sociocultural issues, ethical issues, economic issues, and spirituality. All options above fit into one of these three categories.