Geriatric Class 1

A nurse is providing discharge teaching to a client following hip arthroplasty. Which of the following pieces of furniture should the nurse instruct the client to sit in at home? A reclining chair with an ottoman A straight-backed chair with an elevated seat A couch with plush cushions A rocking chair with a curved back

A straight-backed chair with an elevated seat A straight-backed chair with an elevated seat allows the client to assume proper positioning when sitting. An elevated seat decreases the risk of hip dislocation.

A nurse is teaching a client's family about lightning strike prevention following a lightning injury to the client. Which of the following information should the nurse include in the teaching? Avoid using a corded landline telephone. Move out of the open area by standing by a tree. Lie down on the ground. Seek safety in an isolated shed.

Avoid using a corded landline telephone. The nurse should include in the teaching that lightning is attracted to metal and a landline phone and could cause head and neck trauma, such as tympanic membrane rupture.

A nurse is caring for a client who has fractures of the symphysis pubis and pelvis. The nurse should monitor the client for which of the following findings of a common complication of pelvic fractures? Diarrhea Hematuria Increased thirst Impaired taste

Hematuria Clients who sustain a fracture to the pelvis and symphysis pubis should be monitored for manifestation of internal bleeding, such as blood in the urine and stool.

A nurse on a medical-surgical unit is caring for four clients who are 24 to 36 hr postoperative. Which of the following surgical procedures places the client at risk for deep-vein thrombosis? Myringotomy Laparoscopic appendectomy Hip arthroplasty Cataract extraction

Hip arthroplasty Clients who are postoperative following orthopedic procedures of the lower extremities and clients who were placed in the lithotomy position for a procedure, such as for gynecological or urological surgeries, are at a higher risk of developing deep-vein thrombosis postoperatively.

A nurse is reviewing the laboratory results of a male adult client who is at risk for peripheral arterial disease from atherosclerosis. The nurse should identify that which of the following results places the client at risk? Triglycerides 130 mg/dL Blood glucose 92 mg/dL LDL 172 mg/dL HDL 84 mg/dLastro

LDL 172 mg/dL The nurse should identify that an LDL of 172 mg/dL places the client at risk for peripheral arterial disease from atherosclerosis. The expected reference range for an adult is less than 130 mg/dL.

A nurse is assessing a client to identify risk factors for disease. Which of the following findings is a risk factor for metabolic syndrome? History of asthma Large waist size Hypotension Hypoglycemia

Large waist size Central obesity due to excessive abdominal fat is a risk factor for metabolic syndrome. Metabolic syndrome increases the risk for the development of diabetes and coronary artery disease.

A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about the reason blood was drawn from the client. Which of the following statements should the nurse make regarding cardiac enzymes studies? "These tests help determine the degree of damage to the heart tissues." "Cardiac enzymes will identify the location of the MI." "These tests will enable the provider to determine the heart structure and mobility of the heart valves." "Cardiac enzymes assist in diagnosing the presence of pulmonary congestion."

"These tests help determine the degree of damage to the heart tissues." Cardiac enzyme studies are obtained because the degree of enzyme elevation reflects the degree of damage to the myocardium. The enzymes most commonly measured are CPK and troponin. These enzymes have a characteristic rise and fall pattern after an MI. It may take 4 hr or more after the onset of manifestations for the test to become abnormal and up to 24 hr for the level to peak. Eventually, the levels in the blood fall back to normal. Consequently, serial blood tests must be taken from the client to document and evaluate enzyme levels.

A nurse is caring for a female client in the emergency department who reports shortness of breath and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her heart rate is 110/min, respiratory rate 40/min, and blood pressure 140/80 mm Hg. Her arterial blood gases are pH 7.50, PaCO2 29 mm Hg, PaO2 60 mm Hg, HCO3 20 mEq/L, and SaO2 86%. Which of the following is the priority nursing intervention? Prepare for mechanical ventilation. Administer oxygen via face mask. Prepare to administer a sedative. Assess for indications of pulmonary embolism.

Administer oxygen via face mask. The pH reflects alkalosis, and the low PaCO2 indicates that the lungs are involved, so the client has respiratory alkalosis. The client's oxygen saturation is low, so one priority is to administer oxygen via mask attempting to achieve an oxygen saturation of at least 95%. The greatest risk to this client is hypoxia, thus the priority is to restore oxygenation.

A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of following values? Calcium RBC count Magnesium Amylase

Amylase Amylase is an enzyme that changes complex sugars into simple sugars that can be used by the body. It is produced by the pancreas and salivary glands and released into the mouth, stomach, and intestines to aid in digestion. The amylase level of a client who has acute pancreatitis usually increases within 12 to 24 hr and can remain elevated for 2 to 3 days.

A nurse is reviewing the BUN and creatinine levels of an older adult client who has chronic kidney disease. The nurse should expect which of the following findings? BUN 10 mg/dL and creatinine 0.3 mg/dL BUN 23 mg/dL and creatinine 1.0 mg/dL BUN 8 mg/dL and creatinine 0.7 mg/dL BUN 45 mg/dL and creatinine 8 mg/dL

BUN 45 mg/dL and creatinine 8 mg/dL An elevation of both BUN and creatinine is an expected finding of chronic kidney disease.

A nurse is caring for a client who is receiving cisplatin to treat bladder cancer. After several treatments, the client reports fatigue. Which of the following actions should the nurse take? Check the results of the client's most recent CBC. Assess the client for a hypersensitivity reaction. Evaluate the client for hypercalcemia. Examine the client for hepatomegaly.

Check the results of the client's most recent CBC. The client might have anemia as a result of myelosuppression (bone marrow suppression) from the chemotherapy. If so, she might require treatment for the anemia (transfusion, medication) and the provider might have to delay further chemotherapy until her blood counts are higher.

A nurse is caring for a client following exposure to inhalational anthrax due to bioterrorism. Which of the following medications should the nurse expect as a common medication to treat anthrax? (Select all that apply.) Ciprofloxacin Doxycycline Amoxicillin Penicillin G Cefotaxime

Ciprofloxacin is correct. Recommended treatment for inhalational anthrax includes a combination of antibiotics, including ciprofloxacin, that treats positive serum Gram stain .Doxycycline is correct. Recommended treatment for inhalational anthrax includes a combination of antibiotics, including doxycycline, that treats positive serum Gram stain. Amoxicillin is correct. Recommended treatment for inhalational anthrax includes a combination of antibiotics, including amoxicillin, that treats positive serum Gram stain .Penicillin G is incorrect. Penicillins, such as penicillin G, are not used in the treatment of inhalational anthrax due to alterations in the bacteria resulting in resistance to this form of antibiotic. Cefotaxime is incorrect. Cephalosporins, such as cefotaxime, are not used in the treatment of inhalational anthrax due to alterations in the bacteria resulting in resistance to this form of antibiotic.

A nurse is creating the plan of care for a client who is immunosuppressed. Which of the following precautions should the nurse include in the plan? (Select all that apply.) Don a mask, gloves, and gown. Restrict visitors who have active infections. Limit the client from bathing daily. Instruct the client to eat cooked foods only. Dispose of all linen in the trash after use.

Don a mask, gloves, and gown is correct. The nurse should wear a mask, gloves, and gown to protect the client from contacting an infection from bacteria or virus. Restrict visitors who have active infections is correct. The nurse should restrict visitors who have an active infection to protect the client .Limit the client from bathing daily is incorrect. The nurse should have the client bathe daily to clean bacteria off the skin that can cause an infection. Instruct the client to eat cooked foods only is correct. The nurse should instruct the client eat only cooked foods to protect the client from bacteria in raw foods. Dispose of all linen in the trash after use is incorrect. The nurse should place used linens in a linen bag to be washed.

A nurse is assessing a client who has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect? Excessive thrombosis and bleeding Progressive increase in platelet production Immediate sodium and fluid retention Increased clotting factors

Excessive thrombosis and bleeding The nurse should expect excessive thrombosis and bleeding of mucous membranes because both DIC impairs both coagulation and anticoagulation pathways.

A nurse is caring for a client who is 2 days postoperative following a small bowel resection. Medical History The client has a history of Crohn's disease. The client presented to the emergency department 2 days ago with bowel incontinence accompanied by an abdominal pain rating of 10 on a scale of 0 to 10. It was determined that the client needed to undergo an emergent bowel resection. The client has no other significant medical history. Vital Signs Blood pressure 138/78 mm Hg Pulse 88/min Respiratory rate 22/min Temperature 37.4º C (99.4º F) Physical Examination Abdominal dressing intact with slight amount of dried drainage Left brachial peripherally inserted central catheter (PICC) line with 0.9% sodium chloride infusing at 100 mL/hr Heart sounds are within defined limits Respirations regular, lung sounds slightly diminished in the bases Pain rating of 6 on a scale of 0 to 10 at incision site Diagnostic Results Albumin 3.7 g/dL (3.5 to 5 g/dL) WBC count 18/mm3 (5,000 to 10,000/mm3) RBC count 4.0 µL (4.2 to 6.1 µL) Hgb 10 g/dL (12 to 18 g/dL) Hct 39% (37% to 52%) A nurse is reviewing the client's assessment findings and information. Complete the following sentence by using the list of options. When prioritizing client needs, the nurse should first address the client's Select... followed by notifying the provider of the client's Select... .

Dropdown 1: Blood pressure is incorrect. The client's blood pressure is within the expected reference range. IV infusion is incorrect. This is a safe infusion rate. WBC count is correct. The client's WBC count is above the expected reference range and is an indication of infection. The nurse should notify the provider immediately. Dropdown 2: Incisional pain is correct. It is important that the nurse address the client's incisional pain to aid in the client's recovery. Dressing is incorrect. This is an expected finding for a client who is postoperative. Temperature is incorrect. The client's temperature is within the expected reference range for an adult.

A nurse is caring for a client who is postoperative following vascular surgery. Which of the following signs should indicate to the nurse that the client has developed a thrombus? Positive Kernig's sign Positive Homan's signt. Dull, aching calf pain Soft, pliable calf muscle

Dull, aching calf pain Dull, aching calf pain is a sign of deep-vein thrombosis. Other manifestations are edema, warmth, and redness in the calf.

A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select all that apply.) Dyspnea Bradycardia Barrel chest Clubbing of the fingers Deep respirations

Dyspnea is correct. Emphysema is a lung disease involving damage to the alveoli in which they become weakened and collapse. Dyspnea is seen in clients with emphysema as the lungs try to increase the amount of oxygen available to the tissues. Bradycardia is incorrect. With emphysema, the heart rate will increase as the heart tries to compensate for less oxygen to the tissues. Barrel chest is correct. Clients with emphysema lose lung elasticity; the diaphragm becomes permanently flattened by hyperinflation of the lungs; the muscles of the rib cage become rigid; and the ribs flare outward. This produces the barrel chest typical of emphysema clients. Clubbing of the fingers is correct. Clubbing results from chronic low arterial-oxygen levels. The tips of the fingers enlarge and the nails become extremely curved from front to back .

A nurse is planning care for a client who states he is anxious concerning abdominal surgery. Which of the following actions should the nurse take? Explain to the client that all patients feel that way prior to surgery. Suggest the client talk to the provider. Ask the client what to expect tomorrow. Encourage the client to express negative emotions.

Encourage the client to express negative emotions. The nurse is acknowledging the client's negative emotions, therefore providing open therapeutic communication.

A nurse is assessing a client who is African-American and has jaundice. Which of the following areas is the most reliable for the nurse to inspect the client for jaundice? Palms of the hands Hard palate Conjunctiva Back of the neck

Hard palate According to evidence-based practice, inspecting the client's oral mucous membrane and hard palate are the most reliable methods to determine jaundice for a client who is African-American.

A nurse is caring for a client who is 2 days postoperative following an above-the knee-amputation. Which of the following is an appropriate nursing intervention for this client at this time? Elevate the foot of the bed. Encourage the client to sit up as much as possible. Elevate the client's residual limb on a pillow. Have the client lie prone every 3 hr for 20 min at a time.

Have the client lie prone every 3 hr for 20 min at a time. The nurse should encourage the client to lie prone for 20 to 30 min every 3 to 4 hr to help prevent hip flexion contractures.

A nurse is monitoring a client who was admitted with a severe burn injury and is receiving IV fluid resuscitation therapy. The nurse should identify a decrease in which of the following findings as an indication of adequate fluid replacement? BP Heart rate Urine output Weight

Heart rate When a client's circulating fluid volume is low, the heart rate increases to maintain adequate blood pressure. Therefore, the nurse should identify a decrease in heart rate as in indication of adequate fluid replacement.

A nurse is planning a presentation about HIV for a church-based group. Which of the following information about HIV transmission should the nurse include? It is primarily transmitted through casual contact. It is primarily transmitted through accidental puncture wounds. It is primarily transmitted through direct contact with infected body fluids. It is primarily transmitted through mosquitoes.

It is primarily transmitted through direct contact with infected body fluids. The nurse should include in the teaching that HIV is transmitted through direct contact with infected blood, seminal fluid, vaginal secretions, amniotic fluid, breast milk and other body fluids.

A nurse in a provider's office is assessing a client who has AIDS. The nurse notes that the client has multiple and widespread raised, purplish-brown skin lesions. The nurse should recognize that these findings indicate which of the following conditions? Actinic keratosis Kaposi's sarcoma Toxic epidermal necrosis Basal cell carcinoma

Kaposi's sarcoma Kaposi's sarcoma are AIDS-related malignant skin and mucous membrane lesions that are usually purplish-brown, raised, and edematous.

A nurse is caring for a client who is 1 day postoperative following hip open reduction with internal fixation. The client is scheduled to begin physical therapy in 30 min. Which of the following actions should the nurse take? Position the client's legs in an adducted position. Offer to administer analgesia. Tell the client to bend forward at the waist when getting out of bed. Bathe and dress the client.

Offer to administer analgesia. The nurse should offer to premedicate the client prior to painful procedures, such as physical therapy, to help keep pain under control.

A nurse is caring for a client in the emergency department (ED). Nurses' Notes 0930:The client arrives to the ED and reports a "fluttering" and "racing" heartbeat. The client also reports dizziness and shortness of breath. 0945:Client placed on telemetry, cardiac rhythm is irregular, tachycardia and has unclear P waves. 0955:Doctor in to assess patient. Orders received. Vital Signs 0940:Blood pressure 165/88 mm HgPulse rate 126/minRespiratory rate 22/minOxygen saturation 94% on room air Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

The nurse should obtain a 12-lead ECG and administer an anticoagulant as prescribed because the client is most likely experiencing atrial fibrillation. Atrial fibrillation is characterized by manifestations of a fast, irregular heart rate that appears as a chaotic rhythm with unclear P waves. The nurse should monitor for manifestations of stroke as well as the client's PTT and INR because clients who have atrial fibrillation are at risk for the formation of clots.

A nurse is reviewing risk factors for osteoporosis with a group of nursing students. The nurse should include that which of the following types of medication therapy is a risk factor for osteoporosis? Thyroid hormones Anticoagulants NSAIDs Cardiac glycosides

Thyroid hormones Long-term use of a synthetic thyroid hormone, such as levothyroxine, can accelerate bone loss.

A nurse at an urgent care center is caring for four clients who all have leg or foot injuries. Which of the following client reports should suggest to the nurse that the client has an ankle sprain? Dropped a 4.5 kg (10 lb) weight on his lower leg at a health club Has ankle pain after running a 16 km (10 mile) race Twisted his foot while running bases during a baseball game Was hit by another soccer player on the field

Twisted his foot while running bases during a baseball game A sprain is a stretching injury to ligaments around a joint. Wrenching or twisting motions cause this type of injury.

A nurse is teaching a client who has acute kidney injury about the oliguric phase. Which of the following information should the nurse include in the teaching? Renal function is reestablished. BUN and creatinine levels decrease. Urine output is less than 400 mL per 24 hr. The glomerular filtration rate (GFR) recovers.

Urine output is less than 400 mL per 24 hr. Inadequate urinary output is associated with the oliguric phase of acute kidney injury. The minimum amount of urine needed to rid the body of metabolic waste products is 400 mL. Therefore, a client who is producing less than 400 mL of output in 24 hr is manifesting acute kidney injury

A nurse is caring for a client who is postoperative following an intermaxillary fixation as a result of multiple facial fractures. Which of the following types of equipment should the nurse plan to have at the client's bedside? Wire cutters NG tube Urinary catheter tray IV infusion pump

Wire cutters Establishment and maintenance of a patent airway is a primary goal of nursing management for a client who has facial injuries. Following intermaxillary fixation, the client's jaws will be wired shut for 6 to 10 weeks postoperatively, placing him at increased risk for aspiration in the case that he vomits. Keeping wire cutters at the bedside provides a means of opening the airway by cutting the wires should this occur. In the case that the wires are cut, the client will need to return to the operating room to have his jaws rewired.

A nurse is preparing to administer valproic acid 400 mg PO bid for migraine headaches. Available is valproic acid 250 mg/5mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

X mL = Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) 5 mLX mL = 250 mg Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 5 mL400 mgX mL = × 250 mg1 dose Step 4: Solve for X. X mL = 8 mL Step 5: Round if necessary. Step 6: Reassess to determine whether the amount to administer makes sense. If there are 250 mg/5 mL and the prescription reads 400 mg, it makes sense to administer 8 mL. The nurse should administer valproic acid 8 mL PO per dose.