Older Adult Exam #4
25. To help manage the potential side effects of prescribed antipsychotic medications, amantadine (Symmetrel) 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." d. "Older patients seem to have the fewest side effects on this medication."
A
4. An older adult patient who has experienced a left knee replacement asks the nurse, "When will I be back to normal?" The nurse responds that: a. "What did the surgeon tell you about function after the surgery?" b. "Normal means different things to different people." c. "You should be back to normal after 6 to 8 weeks." d. "Surgery will improve your mobility but I'm not sure about being normal."
A
4. 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 a cystocele." 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."
A
5. 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.
A
5. To effectively assess an older adult patient's sexual needs, the nurse must initially: a. reflect on personal feelings that create barriers to effective communication with the patient. b. be familiar with the sexual needs of the older adult population. c. assess the patient's physical capacity to engage in sexual activities. d. inform the patient of the personal nature of the detailed questioning this assessment requires.
A
6. 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."
A
7. 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.
A
7. An older adult reports chronic constipation. When asked why this problem has gotten worse with age, the nurse responds: 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. "It's possible that you 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."
A
9. An older confused patient is recovering from a stage IV sacral pressure ulcer. The nurse 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.
A
9. The daughter of a dependent older patient reports to the nurse that the patient requires regular soapsud enemas to manage chronic constipation. The nurse responds that: a. an alternative management technique should be discussed. b. enemas are generally the most effective interventions for the older adult. c. chronic constipation is best managed with oral medications. d. her mother's diet is the most likely cause of the constipation.
A
9. The 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: a. related to altered venous circulation. b. peripheral related to arterial insufficiency. c. related to diabetic neuropathy. d. open wound related to pressure ulcer.
A
4. A patient has a glomerular filtration rate (GFR) of 19 mL/min/1.73m2. What assessment findings correlate with this condition? (Select all that apply.) a. Fatigue b. Weakness c. Edema d. No specific symptoms e. Headaches
A, B, C
1. The nurse working in long-term care knows there are several barriers to sexual expression for older patients. Which of the following are barriers? (Select all that apply.) a. Decreasing desire b. Medication side effects c. Disease processes d. Social circumstances e. Increased libido
A, B, C, D
2. 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
A, B, C, E
2. The nurse is learning about postmenopausal changes that can affect sexuality in women. Which of the following are included? (Select all that apply.) a. Shortening of the vagina b. Need to void after intercourse c. Vaginal dryness d. Vaginal irritation needs investigation e. Vaginal secretions diminish
A, B, C, E
2. 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. e. Men become bowlegged and waddle.
A, B, D
3. 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.
A, B, D
1. 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?"
A, B, D, E
1. A 72-year-old 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
A, C, D
1. 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
A, C, D
3. An older adult patient is being evaluated for a possible duodenal ulcer (DU). Which of the following assessments supports the diagnoses? (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
A, C, D
4. A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer 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
A, C, D
2. 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
A, C, D, E
2. 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.
A, C, D, E
4. 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 2000 mL daily. c. Suggest he eat more whole grains and fresh fruits. d. Discuss how he should include a walk into his daily routine. e. Ask if he has a history of rectal bleeding.
A, C, D, E
1. An 80-year-old patient has nausea and vomiting related to a gastrointestinal disorder. The nursing intervention most likely to help the patient is to: a. offer sips of 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.
A
1.Which statement made by a nurse reflects a lack of understanding regarding sexual intimacy and the older adult patient? a. "Older adults express less interest in intimacy as both acute and chronic illnesses develop." b. "Sexual expression is considered an enhancement to the quality of the older adult's life." c. "Expressing sexual needs may be difficult or impossible for some older adults." d. "Interest in physical contact tends to persist throughout life for both genders."
A
10. 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
A
11. An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques. The nurse shows an understanding of dementia when sharing with staff that: 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."
A
11. The nurse is caring for an older adult patient prescribed allopurinol (Zyloprim). 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
A
12. 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.
A
12. An 80-year-old patient who is experiencing symptoms of depression and anxiety is reluctant to comply with the prescribed treatment plan. The nurse initially addresses the issue with the patient by asking: a. "How do you feel about how others view your mental health problem?" b. "Are you concerned about paying for your psychiatric medications?" c. "Did you know that depression is common among people your age?" d. "Do you have any questions about your the mental health treatment plan?"
A
12. The nurse notes the patient's chart lists "dyspareunia" as a complaint. What teaching does the nurse plan to provide? a. Use of water-soluble lubricants b. Performing Kegel exercises c. Deep breathing and relaxation d. Use of antifungal medications
A
13. 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.
A
14. A patient's chart contains an assessment of tophi and podagra. What medication does the nurse plan to educate the patient on? a. Allopurinol (Zyloprim) b. Colchicine (Colcrys) c. Levadopa-carbidopa (Sinemet) d. Ibuprofen (Motrin)
A
15. A nurse works in a long-term care facility where many of the residents have osteoporosis. For which resident would alendronate (Fosamax) be contraindicated? a. A patient on a continuous tube feeding b. A wheelchair-bound patient c. A patient over the age of 85 d. A male patient
A
15. 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.
A
15. 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.
A
16. A patient is admitted with infectious diarrhea. What action by the nurse is best? a. Place the patient in contact precautions. b. Place the patient on droplet precautions. c. Use standard precautions to care for the patient. d. Prepare staff to take prophylactic antibiotics.
A
16. 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.
A
16. To best advocate for an older adult patient being prescribed medication to control newly observed signs of confusion and aggressive behavior, the nurse: a. initiates an assessment to determine possible underlying causes of the behavior. b. contacts family to inform them of the new medication therapy being planned. c. discusses possible nonpharmaceutical treatments with the physician. d. documents a detailed description of the behaviors before administering the drugs.
A
17. A patient asks how elevating the legs at night will decrease nocturia. What is the nurse's best response? a. All that fluid gets into circulation before you go to bed. b. Decreased swelling makes it easier to ambulate at night. c. It won't help; that's an old wives' tale you heard. d. This measure helps dehydrate you before bedtime.
A
17. A patient with arthritis has difficulty participating is sex because of joint pain and stiffness. What action by the nurse is best? a. Suggest a warm shower prior to sexual activity. b. Ask the patient if he or she needs more pain medication. c. Explore other ways of expressing sexuality. d. Refer the patient to a rheumatologist.
A
17. An older adult has been recently diagnosed with type 2 diabetes and mild retinal deterioration. To best address the patient's potential for developing situation depression, the nurse: 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.
A
17. An older patient with hepatitis has pruritus. What advise does the nurse provide this patient? a. Keep your fingernails cut short. b. Use diphenhydramine (Benadryl). c. Hot soapy showers will help. d. Butter is a good home remedy for itching.
A
19. 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
A
2. An 87-year-old patient has suddenly become incontinent. What should the nurse's first action be? a. Review the patient's record for medications that may be causing 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.
A
2. An older adult patient reports simple xerosis with mild pruritus. The nurse educates her on the importance of: 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.
A
2. 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
A
2. When preparing to discharge an older patient with mild dysphagia, the nurse suggests that the patient can minimize symptoms by: a. eating small meals every 2 to 3 hours b. cutting a sandwich into bite-sized peicees. c. eating less but choosing nutrient-dense foods. d. drinking thin liquids instead of eating solids.
A
20. A patient has onychomycosis. The nurse should anticipate educating the patient on which of the following drugs? a. Clotrimazole (Lotrimin) b. Terbinafine (Lamisil) c. Itraconazole (Sporanox) d. Methylprednisolone (Solu-Medrol)
A
21. A recently widowed patient reports new onset of sexual dysfunction. There are no new medications or illnesses. What action by the nurse is best? a. Assess the patient's alcohol intake. b. Refer the patient for counseling. c. Ask if there are new partners. d. Have the patient speak to the doctor.
A
21. 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
A
22. A patient lives in a long-term care facility and has mild dementia. The patient has been showing interest in another resident. What action by the nurse is best? a. Determining if the resident has decision-making capacity. b. Refusing to allow the residents to be alone together. c. Asking the resident's family if the relationship is okay. d. Providing time for the residents to be together.
A
3. 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 important teaching has been missed? 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
D
5. 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 the: a. patient's ability to follow instructions. b. severity of the impairment of the urinary sphincter. c. patient's ability to sense the need to urinate. d. daughter's ability to support the training.
D
5. The nurse caring for an older patient diagnosed with spinal stenosis encourages the patient to notify her physician 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.
D
6. An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer 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.
D
6. An older adult patient recovering from a radical prostatectomy is discussing his postsurgical care plan with the nurse when he expresses concern about long-term impotence. The nurse initially responds: a. "I'd suggest a consult with a sexuality counselor for you and your partner." b. "When you've healed sufficiently, we can discuss prosthetic devices that help." c. "There are medications called phosphodiesterase inhibitors that minimize that problem." d. "While postsurgical erectile dysfunction is likely, it is generally temporary."
D
6. The nurse caring for an older adult diagnosed with hyperplastic polyps instructs him that: a. this type of polyp is rarely malignant and usually does not require treatment. b. follow-up colonoscopies should be performed every 3 to 4 years after diagnosis. c. stool should be guaiac tested every week for 1 year after diagnosis. d. the presence of blood in the stool requires a repeat sigmoidoscopy examination.
D
7. An older adult woman has a resistant strain of pneumonia. To best minimize her risk of developing acute renal failure, the nurse: a. monitors the patient's serum blood urea nitrogen (BUN) levels via diagnostic laboratory work. 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 (Motrin).
D
7. The charge nurse on an extended care unit recognizes an immediate need for additional unit education regarding sexuality and the older adult when overhearing a staff member state: a. "I've had to tell her to stop touching my breasts twice today." b. "Someone needs to tell him to keep his pants zipped." c. "I realize they have needs, but I'm not sure how to handle that." d. "It's sad that Alzheimer disease causes them to become sexual perverts."
D
7. 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.
D
8. An older adult patient reports episodes of fecal incontinence. The nurse provides appropriate emotional support when assuring the patient that: a. it 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.
D
8. 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 creatinine clearance level
D
9. The nurse is admitting an older patient with benign prostate hyperplasia (BPH). The nurse's priority questioning focuses on: a. family history of prostate disorders. b. onset of symptoms. c. psychosocial impact of the diagnosis. d. typical urinary voiding patterns.
D
9. Through the open door of the patient's room, the nurse observes a male patient and his long-term partner in a romantic embrace. The nurse's priority intervention is directed toward: a. reinforcing for the staff the patient's intimacy needs. b. explaining to the patient the challenges that his relationship poses for the staff. c. offering to discuss the barriers to intimacy that the patient and his partner face. d. quietly closing the door to address the patient's right to privacy.
D
23. The family of a resident in an assisted living facility contacts the director to say they are "appalled" that the resident is allowed to have pornographic magazines in the room. What response by the director is most appropriate? a. "We will take those away immediately." b. "Your loved one has the right to have these." c. "How do you know about these magazines?" d. "He cannot stay here if he has these in the room."
B
24. An older adult is hospitalized for treatment of a mental health disorder and is prescribed clomipramine (Anafranil). The nurse documents that the medication is having the desired effect when the patient: a. begins sleeping 8 hours per night. b. engages in fewer ritualistic behaviors. c. reports fewer episodes of nervousness. d. exhibits no delusionary thinking.
B
3. A type 2 insulin-dependent diabetic 70-year-old recently lost his wife and is experiencing impotence. Besides educating the patient on the normal effects of aging on sexual function, the nurse should initially include information regarding: a. the effect that stress has on sexual performance. b. the effect of diabetes mellitus on the vascular system. c. the link between depression and sexual dysfunction. d. sexual dysfunction related to long-term use of insulin.
B
3. The nurse plans to assess for candidiasis as a priority intervention for a: 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.
B
4. 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
B
5. The presence of which skin assessment finding, if noted on an older adult patient, should cause the nurse to suspect a premalignancy? a. Numerous small red papules on the chest and back b. An oozing, rough, reddish macule on the ear c. An irregularly shaped mole on the face or shoulders d. Brown, greasy lesions on the neck
B
6. An older adult patient is hospitalized for after an automobile crash. The nurse recognizes symptoms suggestive of an upper urinary tract (UTI) infection when the patient: a. voids 100 mL of urine over a 3-hour period of time. b. is not able to state where he is or what day it is. c. has an elevated red blood cell (RBC) count. d. reports burning when he urinates.
B
8. An older adult female patient who has multiple sexual partners asks the nurse if the risk for contracting HIV really does increase as we age. The nurse shows the best understanding of this risk when responding: a. "Any time one engages in sex with multiple partners, the risk for contracting HIV increases." b. "Changes in vaginal tissue and immune function increase the risk, especially if sex is unprotected." c. "Unless you are engaging in unprotected oral sex, your risk does not increase substantially." d. "Yes, your risk of contracting a sexually transmitted disease (STD) including HIV, dramatically increases as you age."
B
8. An older adult patient newly diagnosed with peripheral vascular disease (PVD) is being educated on the possibility of developing a foot ulcer. What assessment finding indicates the patient may have an 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
B
9. 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."
B
5. 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.
B, C, D, E
1. 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 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
B, E
1. 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.
C
10. When assessing for squamous cell cancer (SCC), a home health nurse is particularly concerned about a suspicious lesion on the: 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.
C
11. 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: a. alopecia. b. orange-tinged urine. c. yellow-brown nails. d. cherry angiomas.
C
11. 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
C
13. An older patient has been admitted with nausea and vomiting. What assessment takes priority? a. Respiratory system b. Urine output c. Blood pressure and pulse d. Skin integrity
C
14. The patient who recently had a radical prostatectomy has the nursing diagnosis of ineffective sexuality patterns. What assessment by the nurse best indicates that the goals for this diagnosis have been met? a. Patient states he can live without sex. b. Patient says that impotence is temporary. c. Patient states his needs are being met. d. Patient asks about medication for ED.
C
15. When planning care for the older adult being treated for depression, the nurse addresses the patient's tertiary intervention needs best by: a. helping the patient to identify the early symptoms of depression. b. helping the patient deal with the physical symptoms of depression. c. discussing with the patient how to implement new coping skills. d. educating the patient about the importance of being drug compliant.
C
16. What information about sexuality is contrary to research on sexuality in older men? a. Erections are not as firm. b. It takes longer to obtain erections. c. Erectile dysfunction is inevitable. d. Ejaculation may not be a strong.
C
17. 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
C
18. 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.
C
18. An older male patient is seen in the family practice clinic and tells the nurse he no longer takes his metoprolol (Toprol) because "it interferes with my lifestyle." What action by the nurse is best? a. Warn the patient of the complications of hypertension. b. Ask the patient if he can afford the medication. c. Tell the patient this drug often causes erectile dysfunction. d. Take the patient's blood pressure and record the findings.
C
19. A patient has a purulent, foul-smelling leg wound. What wound care practice is most appropriate? a. Leave the wound open to the air. b. Administer systemic antibiotics. c. Cleanse the wound with diluted povidone iodine. d. Prepare the patient for operative débridement.
C
19. 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."
C
2. A 70-year-old female patient shares with the nurse her concern that recently it takes more time to achieve an orgasm. The nurse responds most therapeutically when answering: a. "You've described a common result of aging for both men and women." b. "If you experience difficulty achieving orgasms, you should discuss that with your doctor." c. "Your body produces fewer sex hormones now, and you need more stimulation to climax." d. "I understand your concern. Let's talk more about the changes you've noticed."
C
20. 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." In response to this information, the nurse shares with the patient that: 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 an improvement. d. in time, people adjust to the side effects.
C
3. 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).
C
4. 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.
C
4. 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."
C
4. Upon entering the room of a cognitively impaired older adult patient, the nurse observes that he is exposed and rubbing his genitals. The nurse's initial concern is to: a. alert staff to be aware of this new behavior. b. provide the patient with privacy. c. assess him for possible pain and fever. d. provide a verbal cue for him to stop the behavior.
C
5. 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.
C
6. 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?"
C
7. When assessing the older adult patient's skin for indications of melanoma, the nurse should inspect for a(n): 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.
C
8. A 73-year-old patient diagnosed with vascular dementia is admitted for exacerbation of asthma. The patient has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurse's initial response is to: a. identify the patient as being at high risk for falls. b. monitor the patient for signs of benzodiazepine withdrawal. c. notify the admitting physician immediately. d. place the patient on strict intake and output.
C
8. An older adult patient has been admitted to the hospital with suspected Paget disease. What clinical manifestation will help the nurse differentiate Paget 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
C
14. 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."
D
14. A patient is admitted with copious diarrhea. The patient is dizzy when standing, and skin assessment reveals abrasions around the perianal area. What assessment finding demonstrates that goals for the priority nursing diagnosis have been met? a. Perianal skin abrasions are smaller in size. b. Patient does not fall while hospitalized. c. Patient sits up without dizziness. d. Patient is able to tolerate oral fluids.
D
16. 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."
D
17. A patient has just arrived in the postanesthesia care unit after a below-the-knee amputation. What assessment takes priority? a. Surgical dressing b. Level of pain c. Pulse and blood pressure d. Airway
D
18. 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.
D
19. An older patient is anxious about an upcoming diagnostic test and requests something to calm the nerves. To best address the patient's need, the nurse prepares to administer a PRN dose of: a. clonazepam (Klonopin). b. diazepam (Valium). c. chlordiazepoxide (Librium). d. lorazepam (Ativan).
D
2. 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 circumference on the affected side
D
22. 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. d. risk for self-directed violence related to depression.
D
23. The nurse is caring for a severely depressed older patient. To best effect change in the patient's emotional state, the nurse's initial goal is to: a. plan interventions that will enhance the patient's self-esteem. b. introduce the patient to new coping skills. c. assess the patient's potential to self-harm. d. develop a therapeutic nurse-patient relationship.
D
3. 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.
D
3. An older adult patient reports "losing urine" when she bends over or gets out of a chair. What type of incontinence does the nurse plan interventions for? a. Overflow b. Urge c. Functional d. Stress
D
21. The nurse familiar with the old 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.
B
18. 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.
B
19. A male patient takes carbamazepine (Tegretol). The spouse reports sexual dysfunction, but the patient adamantly denies he has this problem. What response by the nurse is best? a. Telling him, "You need to think of your wife's needs too." b. Telling him this is common and can be discussed if wanted. c. Questioning the patient again about sexual functioning d. Telling the doctor to change the patient's prescription
B
20. A patient has a wound that is a shallow crater with surrounding erythema and warmth. What stage pressure ulcer does the nurse chart? a. Stage I b. Stage II c. Stage III d. Stage IV
B
20. A patient has many sexual partners but does not use condoms. What action by the nurse is best? a. Ask the patient what he or she knows about HIV. b. Assess the patient for barriers to using condoms. c. Give the patient statistics on HIV in older adults. d. Tell the patient safer sex practices should be used.
B
1. To best identify a risk for injury in an older adult patient, the nurse assesses for: a. decreased muscle mass in the legs. b. history of falls. c. hyperextension of the spine. d. decreased bone density.
B
10. The gerontologic nurse wants to begin assessing concerns related to sexuality among the population of patients seen in the clinic. What action by the nurse is best? a. Give the patients questionnaires to fill out. b. Get permission to discuss sexuality with them. c. Tell the patients you are now assessing sexuality. d. Ask the patients if they have concerns about sex.
B
11. A 68-year-old patient is reporting symptoms that suggest a peptic ulcer. The nurse asks the patient if: a. the pain exacerbates when he eats fatty food. b. there is a family history of peptic ulcers. c. he smokes either cigars or cigarettes. d. he uses acetaminophen (Tylenol) for minor pain.
B
11. The nursing manager feels that intimacy needs are not being assessed or addressed by the staff on the unit. What action by the manager is best? a. Tell the staff sexuality is expected to be assessed. b. Provide the staff with education on sexuality. c. Obtain tools for staff to use when assessing sexuality. d. Allow those with cultural objections to opt out.
B
12. 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 patient's: a. arms and legs are supported on two pillows. b. position is changed at least every 2 hours. c. neck is hyperflexed. d. elbows rest on the bed.
B
13. A patient being treated for prostate cancer calls the clinic to report severe back pain. What action by the nurse is best? a. Advise the patient to take his pain medication. b. Tell the patient to come in to the clinic today. c. Make an appointment for the patient next week. d. Encourage the patient to rest and use moist heat.
B
13. 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.
B
14. 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.
B
15. A patient has pernicious anemia. What action by the patient and family indicates teaching for this condition has been effective? a. Proper administration of oral vitamin B12 b. Correct technique for intramuscular (IM) injections c. Choosing aspirin over ibuprofen (Motrin) for pain d. Preparing a low-carbohydrate meal
B
15. An older adult has begun dating after being widowed for many years. The adult confides to the nurse about having several sexual partners. What action by the nurse is best? a. Warn the patient that the family may not appreciate the situation. b. Teach the patient about safer sexual practices including condoms. c. Ask the patient if there are any medical concerns related to sex. d. Tell the patient he or she may begin to have feelings of guilt.
B
16. A patient is scheduled to have a lower extremity amputation. What action by the nurse takes priority? a. Discuss stump management and prostheses. b. Ensure informed consent is on the chart. c. Determine the patient's goal for pain control. d. Administer the preoperative antibiotic.
B
18. An older adult has a medical condition that has required hospitalization at a facility far from home and family. To best minimize the patient's risk for depression, the nurse: a. keeps the patient informed of the expected discharge date. b. offers to help the patient telephone family members each evening. c. reassures the patient that early discharge is a nursing goal. d. encourages the patient to place family photographs around the room.
B
18. 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
B
13. An older adult patient being treated for chronic obstructive pulmonary disease (COPD) is exhibiting signs of memory loss and confusion. In planning his care, the nurse should give priority to: 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.
B 14. The nurse caring for an older adult patient recovering from cardiac surgery recognizes that it is most appropriate to assess this patient for mental health problems because: a. cardiac surgery often results in anxiety-related issues. b. untreated depression can contribute to the patient's morbidity risks. c. many in this age cohort have undiagnosed depression. d. hospitalization is both anxiety and depression inducing. ANS: B
3. 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.
C, D
1. 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
C, D, E
13. The nurse using the permission, limited information, specific suggestions, and intensive therapy (PLISSIT) model offers specific suggestions when: a. Referring the patient to a sex therapist. b. Discussing over-the-counter lubricants. c. Teaching safer sex practices. d. Discussing sexual positioning after hip surgery.
D
1. An older adult is experiencing age-related postural hypotension and he fears "something is really wrong" because he is the only one in his social group experiencing the problems. The nurse responds: a. "Don't be concerned; just be very careful about your risk for falling." b. "You have had very thorough testing, so don't worry about it being serious." c. "It's just a matter of time before they too have to watch not to get up too quickly." d. "You just don't have the compensating mechanisms of your friends."
D
1. The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of the scalp should include: 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.
D
10. A 74-year-old adult is experiencing dumping syndrome after gastric resection surgery. The nurse caring for the patient instructs the patient to: a. stop smoking. b. abstain from beverages that contain caffeine. c. eat three low-carbohydrate meals daily. d. drink only between meals.
D
10. 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."
D
10. The son of a patient with possible Alzheimer disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. The nurse responds that: 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.
D
12. 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."
D
12. What dietary suggestion does the nurse give the older patient to manage age-related changes in taste? a. Add more salt to foods. b. Use a salt substitute. c. Add sugar when possible. d. Use a variety of herbs.
D