OA final questions

The older adult may fear a loss of independence if problems are disclosed.

During assessment of an older adult, the nurse discovers that the individual has been reluctant to divulge recent losses in activities of daily living to his primary care provider. Which of the following factors has been demonstrated to contribute to such reluctance?

Assist the woman with toileting at timed intervals throughout the day.

Following a prolonged hospital stay due to an exacerbation of congestive heart failure, an older adult woman has returned to the nursing home where she normally resides. The woman became incontinent of urine during her time in the hospital, a problem that nursing staff wish to now resolve. What action should her caregivers take in performing continence training?

Accommodate the residents' relationship and provide them with appropriate privacy.

Mr. Thomas and Mrs. Young are residents of a long-term care facility who are both physically frail but cognitively healthy. Last night, the nurse at the facility discovered Mr. Thomas and Mrs. Young in bed together in Mr. Thomas' room and engaging in foreplay. How should care providers best respond to these residents' new sexual relationship?

Do you ever leak urine? Do you ever wear pads or protective garments to protect your clothing from wetness? Do you have any discomfort or burning when you pass urine?

The nurse assesses an older woman regarding urinary health. Which of the following interview questions are appropriate? (Select all that apply.)

C) Transduction D) Transmission B) Perception A) Modulation

The process of nociception is important in determining the most appropriate analgesic. Place the processes in order: A) Modulation B) Perception C) Transduction D) Transmission

Older adults become more vulnerable to abuse because of cognitive impairment.

Which of the following is true about cognitive impairment and abuse of older adults?

One who has chronic obstructive pulmonary disease and a recent MI

Which of the following older adult clients is most likely to have physiologic barriers to sexual wellness?

Assess own personal attitudes toward sexuality and aging.

Which of the following processes should a nurse address first when assessing sexual function in older adults?

Most older adults experience an interplay between a number of chronic conditions and occasional acute health problems.

Which of the following statements best captures the typical character of health problems in the lives of older adults?

"A combination of lifestyle factors and age-related changes contributes to high rates of diabetes among older adults."

Which of the following statements by the new nurse best conveys an understanding of diabetes in older adults?

A registered nurse is mandated to report abuse or neglect if it is suspected.

Which of the following statements is true about the laws of mandatory abuse reporting?

"Condoms protect you from sexually transmitted diseases including HIV."

While discussing sexual behavior at a sex and aging seminar, one older adult states, "No condoms for me, I can't get pregnant!" Which of the following responses is most appropriate?

Assess the grandchild's understanding of her grandmother's needs.

A 30-year-old grandchild lives with and provides care for the 75-year-old grandparent. The grandparent has congestive heart failure, hypothyroidism, and chronic pain from a compression fracture and osteoporosis. The grandchild supervises the older adult's medications. The home health nurse notes that the older adult has extra diuretic pills and that the pain medications for a month have been used and cannot be refilled for 2 more weeks. The older adult tells the nurse: "Those pain pills don't work, my back is always hurting." The nurse notes that the older adult's ankles are very swollen. Which of the following things should the nurse do first?

"We can't say how long this perimenopausal phase might last."

A 52-year-old woman discusses her menstrual cycles with the nurse. The client states that she still has menses, but that she "never knows when they might begin or end." Which of the following is the most appropriate response by the nurse?

"You are safe to have sex; you can resume sexual relations when you desire."

A 64-year-old man had a myocardial infarction (MI) 2 months ago. He has recovered to the point that he is able to climb up two flights of stairs, but he and his spouse have not resumed sexual relations. Which of the following responses by the nurse is most appropriate?

Use a water-soluble lubricant or estrogen cream.

A 65-year-old woman is speaking to her nurse at the primary care clinic. She states that it is very painful for her when she has sexual relations. She asks the nurse what she could do to alleviate the pain. Which of the following suggestions could the nurse make to the woman?

Readiness for enhanced knowledge

A 66-year-old has been conscientious about health as an adult and is disappointed at having been recently diagnosed with type 2 diabetes. The client had been unwilling to discuss this new diagnosis for the past several weeks but has now begun asking the nurse questions about this disease. Which of the following nursing diagnoses is most appropriate for this client?

Self-care measures to aid in the management of his disease

A 68-year-old client has a long history of poor eating habits and low activity levels. The client now has a diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions should be the priority?

Fluid volume deficit

A 70-year-old client with urosepsis is admitted to a nursing unit. The labs include elevated sodium, blood urea nitrogen, hematocrit, and albumin. Which of the following nursing diagnoses is priority for this client?

Diminished handgrip strength Self-reported exhaustion Slow walking speed

A 73-year-old client is admitted to the hospital. A nurse assesses the client for frailty. Which of the following indicate frailty? (Select all that apply.)

Oxycodone 5 mg PO

A 74-year-old client with a history of osteoarthritis is being treated in the hospital for pneumonia and malnutrition. The nurse administered 650 mg of acetaminophen 90 minutes ago and the client is now requesting another dose. The medication administration record has the following choices; which choice by the nurse is most appropriate?

Client's medication regimen

A 78-year-old home health client has admitted to his nurse that his level of sexual activity with his wife has declined in recent months and become wholly absent over the past several weeks. The client has implied that this is due to a lack of performance, rather than lack of desire, on his part. What assessment should the nurse prioritize in light of this revelation?

"I am here; should I leave you alone for now?"

A 79-year-old experienced a severe stroke several days ago. The client's spouse has been told by the care team that he is unlikely to survive more than a few days and that aggressive treatment would likely be futile. The nurse has just entered the client's room to find the spouse softly crying at the bedside, and makes no attempt to acknowledge the nurse's presence. What is the nurse's most therapeutic response to the client's wife?

Impaired skin integrity

A 79-year-old man was admitted to the hospital for knee arthroplasty (replacement) due to osteoarthritis. During recovery, he developed postoperative pneumonia and became incontinent of urine while recovering from this serious infection. While being treated on the acute medicine unit, he remained in bed for several days. This client's urinary incontinence and other health challenges are most likely to result in what nursing diagnosis?

The need to provide prompt, adequate relief of the woman's pain

A 79-year-old woman had a total knee replacement yesterday; she has rung her call light to report pain. What consideration should the nurse prioritize when choosing an appropriate intervention?

Hormonal factors

A gerontological nurse is aware that the aging process is accompanied by numerous, multifactorial changes that affect sexual wellness in older adults. Among women, which of the following factors is usually the primary cause of changes in sexual functioning?

"I still have to get up two times each night to urinate."

A home care nurse evaluated the plan care for the older woman with urge incontinence. Which of the following statements by the client indicates the need for further teaching?

Assess the client's level and intensity of pain.

A home care nurse notes in the assessment that an older adult expresses anxiety and fatigue. The client sleeps 3 hours at a time at maximum and has had a 10 lb weight loss. Which of the following interventions is priority?

Call emergency services for transport to a hospital.

A home health nurse visits a client who has a history of alcoholism and dementia. The client's words are incoherent, and the client's clothes are filthy. The client is unsteady and leaning to the right, and the room in the rooming house is in disarray. The only word that the nurse can clearly identify is "no." Which action by the nurse is most appropriate at this time?

Dyspnea

A hospice nurse admits an older adult after the metastasis of malignant melanoma. Which of the following health problems should the nurse anticipate?

The competency of the older adult in making decisions needs to be determined.

A neighbor notices an 81-year-old getting water from someone's outside faucet. The neighbor notices that this person's ankles are very swollen and there is an open wound on her left leg. The older adult says, "I stopped taking my pills because the water department turned off my water and I can't use the bathroom. My daughter did not pay the water bill, and she never has time to take me to the doctor so my legs can be checked." The neighbor calls adult protective services. Which of the following interventions is the priority when the nurse visits for an evaluation and does not find any immediate danger?

Reposition the client.

A nurse administers IV pain medication to an older adult in the hospital. Which of the following actions by the nurse is the priority?

"My urine flow starts much faster now."

A nurse administers medications to an older man. Which of the following statements if made by the client indicates understanding of the use of tamsulosin?

Monitor the client closely for worsening cognitive impairment

A nurse administers medications to older adults in a long-term care facility. Which of the following actions is most appropriate when the client with dementia is newly prescribed an antimuscarinic agent for urge urinary incontinence?

Ask permission to enter a room. Knock on door before entering. Redirect inappropriate sexual behaviors.

A nurse administrator incorporates older adults' sexuality into the policies of a long-term care facility. Which of the following should be included in this plan? (Select all that apply.)

Low albumin and red blood cells

A nurse admits a 90-year-old client to the hospital with a diagnosis of failure to thrive. Which of the following laboratory data should the nurse expect?

Nocturia

A nurse assesses a 70-year-old man who has high blood pressure and chronic obstructive pulmonary disease (COPD). He has been prescribed nicardipine and ipratropium inhaler. This medication combines a calcium-channel blocker and an anticholinergic. For which of the following urinary effects should the nurse teach the client to monitor?

Review the client's medications and medical diagnoses.

A nurse assesses an 85-year-old client and finds bruises on the arms and shins and a skin tear on the right hand. Which action is the priority for further nursing assessment?

Sodium

A nurse assesses an older adult 24 hours after a retropubic suspension surgical procedure. The client is confused, exhibits muscle twitching, and states she is nauseated. Which laboratory data should the nurse assess?

The client rates the pain at 8 out of 10.

A nurse assesses an older adult client with confusion related to hyponatremia who reports pain. Which of the following data should the nurse use as a guide for choosing interventions?

"Early treatment of pain helps now and can reduce the incidence of chronic pain."

A nurse assesses an older adult following the repair of an abdominal hernia. The older adult client states, "I really hate to take pain medication." Which response by the nurse is best?

Lung sounds

A nurse assesses an older adult in the assisted living facility who has presbyphagia. Which of the following systems should the nurse auscultate?

"Have you been losing weight?"

A nurse assesses older adults at a senior center. One older adult, age 78, has a body mass index (BMI) of 15. Which response by the nurse is appropriate?

The client rubs hands together.

A nurse assesses the pain of an older adult. Which of the following findings indicates the presence of persistent pain?

Work to identify terms that the older adult comprehends.

A nurse assesses the urinary elimination of older adults. Which of the following actions by the nurse is most appropriate?

Diuretics

A nurse at a rehabilitation unit assesses an 86-year-old woman with a BMI of 30 and a history of heart failure, whose oral intake is declining. Which of the following risk factors is related to this older adult's decline in appetite?

I never thought that I would be this old. My brother died in a work-related accident. I outlived my children and my two wives. I lost an infant to small pox.

A nurse cares for a 100-year-old man in hospice. The client contemplates his perspectives regarding end-of-life care. Which of the following historical perspectives most likely represent how this client's life experiences have had a formative influence on his views on death and dying? (Select all that apply.)

Degenerative changes in the cerebral cortex

A nurse cares for a 92-year-old woman with urinary incontinence. Which of the following age-related changes is the rationale behind assisting client to the bathroom every 2 hours?

Assess the client's spiritual needs.

A nurse cares for an 87-year-old client from India who has noted Hinduism as religious preference on admission records. This client is transferred to the hospice unit. Which of the following actions by the nurse best shows caring?

"I want to talk to you about switching our focus from cure to care."

A nurse cares for an older adult in a residential care program. The client has multiple chronic conditions. The client has developed dyspnea and has lost 105 lb of body weight. Which of the following statements by the nurse is most appropriate?

"I am here for you, how can I be helpful?"

A nurse cares for an older adult who is nonresponsive and surrounded by family. Which of the following statements by the nurse is most appropriate?

"Overall, you don't need to take in as many calories as you used to."

A nurse counsels an older adult regarding nutritional requirements. Which of the following teaching points is priority when discussing age-related changes in nutritional requirements?

Assist the client to the bathroom prior to bedtime.

A nurse develops a plan of care for a family with nursing diagnosis of Caregiver Role Strain related to urinary incontinence. Which of the following interventions is the highest priority?

Risk of death from ovarian cancer is twice as high among women aged 65 and older.

A nurse discusses health promotion with a group of older adult women. The nurse suggests a Pap test every 2 years. One woman states, "I haven't had a Pap since the change, why would I do that now?" Which response by the nurse is best?

The client pockets food in the affected cheek during meals.

A nurse evaluates the plan of care for a client who experienced an ischemic stroke. Which of the following assessment findings should signal the nurse to the possibility that the client has developed dysphagia?

A client who has experienced a stroke and been given 3 months to live.

A nurse explores resources available to assist a client. Which of the following older adults meets the eligibility requirements for hospice care?

Follow the hospital protocol for reporting.

A nurse in a hospital setting assesses an older adult and is unsure if the assessment data warrant notification to the authorities for elder abuse. Which action is most appropriate for the nurse at this time?

"We have to be more conservative in the treatment of the older adults' pain than the younger clients."

A nurse in a postoperative unit educates peers to overcome myths about pain in older adults. Which of the following statements by a peer most clearly warrants further teaching?

Allow the family to remain with the client.

A nurse in an intensive care unit prepares to perform postmortem care on an older Jewish client. Family members are at his bedside. Which of the following actions by the nurse is appropriate?

Discuss the client's menstrual cycle with her.

A nurse in the ambulatory clinic assesses a 53-year-old woman who states, "last night all of the sudden I got really sick, got really hot, and started sweating; then I had chills, and my chest was pounding." Which action by the nurse is priority?

Send her to the emergency department.

A nurse in the long-term care facility assesses an 86-year-old woman who has recently become lethargic and difficult to arouse. Her vital signs are all stable and within normal limits. Her breath sounds are diminished. Which action by the nurse should be the priority?

Pelvic organ prolapse Stress incontinence Urge incontinence

A nurse instructs a class of older adult women about Kegel exercises. In which of the following urinary conditions would Kegel exercises be effective? (Select all that apply.)

"I will use a vibrator since my ability to massage is limited."

A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which of the following statements indicates that the nurse's teaching has been successful?

"My husband has an enlarged prostate."

A nurse is discussing sexual activity with older adults in a wellness clinic. Which of the following statements by an individual indicates a need for further exploration?

"It sounds like I might have my dosages increased over time because of tolerance."

A nurse is teaching an older adult about some of the risks associated with using opioid analgesics. Which of the following statements best demonstrates the individual has gained a sound knowledge base?

"You'll find it difficult to provide for your loved one's needs if you yourself don't have a strong support system."

A nurse is teaching an older adult's family about the concept of caregiver burden. Which of the following points is priority for the nurse to communicate to the family?

"It certainly requires a change in thinking to understand why we don't provide any medical interventions for patients."

A nurse is teaching new graduates about the nature of palliative care on her unit. Which of the following statements by a new nurse indicates a need for further teaching?

Guide staff to improve communication with families about end-of-life decision making.

A nurse manager of an intensive care unit develops plans to improve end-of-life care for clients in the unit. Which of the following actions is the priority?

Promote oral care for residents multiple times each day.

A nurse manager of the long-term care facility develops plans to reduce nutritional deficits. Which of the following interventions is appropriate to include in the plan?

Providing an opioid analgesic to a client with bone metastases

A nurse on a geriatric medical care unit consults hospice for a client. Which of the following nursing interventions should the nurse anticipate after the client begins hospice care?

Eight-ounce bottle of water between each meal

A nurse plans care for a client who states that food is no longer appealing. The nurse notes a dry mouth and teeth in poor condition. Which interventions should the nurse include in the plan of care?

Treat pain that is implied by contractures and diagnoses of arthritis.

A nurse plans care for an older adult with advanced dementia. Which of the following plans is most appropriate regarding the pain treatment plan?

"Heart failure is a chronic condition that can be controlled with medication."

A nurse plans discharge instructions of a 78-year-old black client with newly diagnosed dilated heart failure. The client states, "Will I be going home on hospice now that my heart is failing?" Which of the following responses is most appropriate by the nurse?

Provide 55% of calories from complex carbohydrates.

A nurse plans the diet for an older adult with congestive heart failure. Which of these nursing interventions would be most successful to encourage optimal nutrition?

Financial Physical Psychological Sexual

A nurse prepares a presentation regarding elder abuse and neglect. Which of the following types of abuse should the nurse include? (Select all that apply.)

"Excretion of penicillin and cimetidine are decreased in older adults."

A nurse presents at a conference regarding functional consequences related to urinary elimination. Which of the following statements should the nurse include?

Metoprolol (Lopressor) Lisinopril (Prinivil)

A nurse reviews the medications of a 58-year-old man who has erectile dysfunction. Which of the following prescribed medications can interfere with sexual functioning? (Select all that apply.)

If older adults need a medication to promote bowel regularity, a bulk-forming agent is needed daily.

A nurse teaches a health education class for older adults about constipation. Which of the following points should the nurse stress?

Baked chicken, carrots, and angel food cake

A nurse teaches an older adult about changes to nutritional requirements. Which of the following meal choices would give evidence that the older adult understands the teaching?

Identify the correct muscle by making the base of your penis move up and down.

A nurse teaches an older adult man to perform pelvic floor muscle exercises (PFME)? Which of the following should be included in a nurse's instructions?

"My over-the-counter beta-carotene pill is appropriate for long-term use."

A nurse teaches older adults about nutrition. Which of the following statements shows the nurse that the older adult requires further teaching?

Bruising on both ears and both sides of the neck

A nurse who provides care in a clinic comes into contact with numerous older adults, many of whom have bruises of various sizes and stages on their body. What pattern of bruising is most suggestive of possible abuse?

Culture can dictate the appropriate expression of pain.

A nurse who provides care in a large, inner-city hospital comes into contact with older adults from a wide variety of cultural groups. How is culture most likely to influence the assessment and management of pain?

"Let's do all we can to facilitate competent residents' sexual relationships."

A nurse who provides care in a nursing home occasionally encounters colleagues' prejudices and misperceptions around the sexual wellness of residents. Which of the following statements reflects an appropriate view of sexual health in older adults?

Empower the client and family to maintain as much control as possible.

A nurse who works in a palliative setting is aware of the need to facilitate a "good death" for as many clients as possible. Which of the following interventions should be included?

A daughter changes her mother's incontinence brief only after the urine has soaked through all her clothing because she wants to save money.

A nurse who works with the older population is aware that elder abuse takes many forms. Which of the following examples most clearly constitutes elder abuse?

Unintentional weight loss

A nurse working for human services visits a long-term care facility. Which resident assessment finding indicates poor quality care?

"The provision of holistic care to patients experiencing incurable health states"

A palliative care team has taken over primary responsibility for the care of an older adult who has recently experienced a stroke. A visitor asks, "What is palliative care?" Which of the following is the best response by the nurse?

"They listened to me and stopped the therapy."

A quality care nurse assesses the care given by a hospice. Which of the following statements by the client best reflects dignified end-of-life care?

Increase in the use of hospice services Increasing number of staff trained in palliative care

A quality control nurse for a large group of long-term care facilities assesses the quality of care at the end of life for the residents. Which of the following measures indicate quality care? (Select all that apply.)

Avoid sunlight.

A wellness center nurse teaches a class of older adults about healthy habits. Which of the following interventions will make a difference in the clients' lives and as such be included by the nurse?

"When you say 'gets rough,' what does that look like?"

A wound care nurse is assessing a 76-year-old client. The client has intimated to the nurse that her son sometimes "flies off the handle and gets rough with me." Which response made by the nurse is the best response?

Offer warm packs for joints.

An 80-year-old black woman minimizes her pain in the joints and back as "normal aging." Which of the following actions by the nurse is most appropriate?

Assess whether the older adult is safe in the home environment.

An 80-year-old is seen in the emergency department for a fall. The client has bruises on the upper arms and appears depressed. The client is accompanied by a grandchild, who is unkempt, glassy-eyed, and whose breath smells of alcohol. Which of the following should be a priority with the nurse?

Early in the course of the client's cancer and before symptoms become unmanageable

An 81-year-old client was diagnosed with colon cancer several months ago. Both the patient and the family have been made aware of the potential for metastasis and the poor prognosis associated with this disease. At what point in the client's disease trajectory should the principles of palliative care be implemented?

"He's used to being waited on here, but at our place he's going to have to fend for himself."

An 81-year-old has been living for the past 2 years in a long-term care facility. However, financial pressures have required that the resident move in with the oldest child and spouse. Which of the following statements if made by the child's spouse should signal a potential risk for elder abuse?

Urge incontinence

An 89-year-old woman has developed urinary incontinence. The woman states, "When I have to go, I go. I can't make it to the bathroom before it leaks out." For which type of incontinence should the nurse develop a plan of care?

"Notify your primary health care provider today."

An emergency department triage nurse receives a phone call from an older adult who states, "I am experiencing pain across my left side. It is tingling, and really hurts when it gets touched." Which of the following response by the nurse is most appropriate?

Allow the family to grieve in this manner directing others away.

An emergency room nurse cares for the family of a 70-year-old African American woman who died unexpectedly. In the waiting room, upon hearing of the death, two family members kneel to the floor moaning and do not respond. Which intervention by the nurse is most appropriate at this time?

"A lot of clients do have pain at the end, and we will do all we can to control it for you."

An older adult client on a palliative care unit divulges to his nurse that he fears being in pain during the dying process. How can the nurse best respond to the client's admission?

Review the client's medication list.

An older adult develops diarrhea. Which of the following is the priority intervention for the nurse?

"Slower emptying of your stomach may be the cause."

An older adult states, "I just feel so full so fast, I can't eat any more." Which of the following responses is most appropriate?

Dehydration

An older adult who appears to be between 85 and 95 has been brought to the emergency department by emergency medical services after being found wandering in the street. The older adult is filthy, confused, and exhibits numerous bruises to the face and neck as well as signs of malnutrition and dehydration. What problem should the nurses prioritize for assessment and intervention?

Arrhythmias Drug interactions Hypotension Sleep disorders

An older adult with a diagnosis of heart failure has been admitted to the hospital with an exacerbation of this condition. Which of the following are consequences of heart failure for which the nurse must monitor? (Select all that apply.)

"I will take MiraLAX and a stool softener to reduce my constipation."

An older adult with pain is to be discharged home with a prescription for oral morphine (MSContin) daily for persistent pain. The client historically took an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) for pain. Which statement by the patient shows the nurse that the client understands the plan?