Geri Exam 2

10. An older woman who receives intravenous (IV) fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially?

d. Determine the patients needs.

7. An older woman seeks advice from the nurse about preventing further bone loss after being diagnosed with osteopenia. To achieve the womans goal, which of the following patient teachings should the nurse provide to enhance the activity of the osteoblasts?

d. Exercise with weights.

2. Which of the following is a true statement about Medicare for older adults?

a. Eighty percent of Medicares annual expenditures are for individuals with chronic illnesses.

13. An older man who is a non-Hispanic Caucasian has a fasting blood sugar level above 130 mg/dl. Which patient assessment does the nurse use to confirm a high risk for diabetes mellitus in this man?

a. 68 years of age

6. An OA-related fall necessitated hip replacement surgery for an older woman who is entering a rehabilitation facility. Which of the following is the nurses priority goal during this womans rehabilitation?

b. Recapture preoperative mobility status.

8. An older man was oriented and responded appropriately in the hospital, but he is now disoriented and confused in his home after discharge. Which of the following issues is the first that the home nurse should examine to determine whether an environmental issue is contributing to the patients condition at home?

b. Temperature of household

1. The children of an older man believe he is too old to drive a car. Which assessment information about the man warrants further investigation by the nurse to determine his fitness to drive a car safely? (Select all that apply.)

a. Increased rate of tripping on curbs b. Increased frequency of getting lost c. Multiple bruises on lower extremities d. Restricts reading to a well-lit sunroom

5. An older man with diabetes mellitus complains to the nurse that his feet feel like they are burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort?

a. Wear well-fitting, leather shoes

2. The nurse will be educating a group of senior citizens on adaptations for safer driving. Which adaptation(s) should the nurse include? (Select all that apply.)

a. Wide rear-view mirrors b. Pedal extensions c. Global positioning system (GPS) devices

2. An older man with myasthenia gravis lives with his wife. Which patient characteristics should the nurse use to identify areas for nursing care in the disability assessment of this man? (Select all that apply.)

a. Successfully manages his finances. b. Lives in an adults-only community. d. Health care is provided through Medicare. f. Wife is in good health but has poor eyesight.

7. An older adult admitted for back surgery asks for opioid pain medication. The nurse knows the patient asks for pain medication 15 minutes before it is due. Which recommendation should the nurse implement?

b. Administer the pain medication as requested by the patient.

5. Which of the following interventions should the nurse use when communicating with a hearing impaired older patient.

b. Always clearly identify yourself and others with you.

1. The nurse teaches an older adult who has diabetes mellitus and takes metoprolol (Lopressor) to recognize clinical indicators of hypoglycemia. Which clinical indicators of hypoglycemia does the nurse include in patient teaching as the indicators this man is most likely to detect? (Select all that apply.)

b. Dizziness c. Weakness f. Impaired vision

11. The nurse determines that an older adult who has chronic bronchitis is at high risk for falls, but he repeatedly tries to ambulate without assistance. Which alternative measure to restraints is contraindicated for this older adult?

b. Place a concave mattress on the bed.

1. Which of the following types of phases are included in the chronic illness trajectory (CIT)? (Select all that apply.)

b. Plateau c. Instability e. Deterioration

3. Which of the following describes the nurses role for an older patient with a chronic illness?

b. Provide caring to help the patient live at the optimal level of health and wellness.

12. The nurse wants to use exercise according to the recommendations of the American Geriatrics Society (AGS) for an older woman who lost her balance and fell. Which nursing intervention is suitable for this older adult according to the AGS?

b. Provide information on group exercises for balance training.

2. The nurse can place an older adult into one of four patient rooms. Which is the most suitable room for an older adult?

b. Room with orange carpeting and soft lighting

5. Which of the following statements is true about analgesic medications for older adults?

b. Stool softeners and laxatives should be used with opioids.

3. Which of the following is a true statement about joints in older adults?

b. Surgical joint replacement can cure OA.

11. The nurse prepares an older man who has OA for discharge. Which instruction does the nurse include in patient teaching to maintain safety for this man?

c. Report joint instability to the health care provider.

10. An older man who had a gastric resection states that he wants to ambulate but the osteoarthritis (OA) in his knees causes too much pain. Which intervention should the nurse implement to increase the amount of walking this man can perform?

c. Suggest taking pain medication before walking.

11. The nurse assists an older man who has type 2 diabetes mellitus to improve his glucose control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in one day?

c. Supplement caloric intake..

8. An older man comes to a primary care setting, and his reason for seeking health care is to get a prescription for sildenafil (Viagra). Which of the following laboratory reports can help explain why this individual needs sildenafil?

d. Glycosylated hemoglobin (Hgb A1c) over 8%

8. The nurse administers an opioid analgesic to an older male postoperative patient in the surgical unit. Which is the most important intervention for the nurse to implement before leaving the patients room?

d. Instruct him to ask for help before getting up.

7. After assessing the older man in his bed, the nurse determines that he is at high risk for falls. The nurse leaves the room to get a fall risk sign and returns to find him on the floor pleading for help. Which of the following was the most important intervention the nurse should have implemented to prevent this event?

d. Instruct the patient to call for help.

10. Which co-morbidity commonly associated with type 2 diabetes mellitus enhances the development of the microvascular complications of diabetes mellitus?

a. Hyperlipidemia

8. Over 50% of the population, aged 65 years and older, suffers from which one of the following chronic health conditions?

a. Hypertension

3. When teaching a patient about foods that do not increase blood glucose, which should the nurse include?

c. Broccoli

6. The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use?

b. One -length rail

2. Which of the following is used to treat the most common cause of impairment to an older persons hearing?

c. Ear canal irrigation

2. Which population groups are most at risk for developing macular degeneration? (Select all that apply.)

b. Asian American c. Caucasian

12. Which is the best goal when planning nursing care for an older patient with diabetes mellitus?

b. Prevent disease progression.

3. The nurse identifies which risk factor(s) for OA? (Select all that apply.)

c. Old age d. Steroid use

3. An older woman had hip replacement surgery 1 day ago, and the nurse thinks that the woman also has dementia. Which patient assessment does the nurse use to determine whether this woman is experiencing pain?

a. Holds abdomen tightly.

6. Each of the following is a nonpharmacological intervention for pain except which one?

a. Acupuncture treatments

6. Acute illness is to chronic illness as to which of the following comparisons? a. An emergency department is to a nursing home b. A hospital staff nurse is to a nurse practitioner c. Health insurance is to Medicare for older adults d. Inpatient surgical care is to outpatient medical care

a. An emergency department is to a nursing home

9. Which is the most important medication the nurse administers to a patient with diabetes mellitus to attenuate a metabolic disorder that is closely associated with diabetes mellitus and that accelerates the disease processes are associated with diabetes mellitus?

a. Atorvastatin (Lipitor)

4. The nurse is caring for a patient diagnosed with hyperthyroidism. Which signs and symptoms indicate hyperthyroidism? (Select all that apply.)

a. Atrial fibrillation b. Heart failure c. Constipation

1. An older man who has hyperuricemia complains of severe pain in the right ankle. Which instructions should the nurse include in patient teaching to enhance the action of the medication the patient takes for his condition? (Select all that apply.)

a. Avoid dehydration by drinking water. b. Take aspirin when joints are red and hot. d. Avoid game meat, asparagus, and alcohol.

4. The nurse is educating an older woman on foods high in calcium. Which foods should the nurse include? (Select all that apply.)

a. Chinese cabbage b. Soy milk c. Cheese pizza

3. The nurse recognizes which of the following signs and symptoms as an indication of hypothyroidism? (Select all that apply.)

a. Decline in cognitive function b. Decrease in functional status d. Heat intolerance

3. Which of the following is(are) assessed in a fall prevention assessment of an older adult? (Select all that apply.)

a. Environment b. Physical status d. Functional status e. Medical history

3. When preparing a patient teaching session on retinopathy, the nurse should include which intervention(s) when discussing treatments for slowing the progression of the disease? (Select all that apply.)

a. Glucose control b. Blood pressure control c. Laser therapy

1. The nurse plans care to prevent a dangerous thermal environment for an older man who lives in a northern climate of the United States. Which patient assessment data does the nurse recognize that can contribute to his risk of hypothermia? (Select all that apply.)

a. Has a history of a cerebrovascular accident (CVA) b. Has a history of diabetes mellitus c. Builds miniature cars for a hobby e. Gets heat from a boiler in the cellar

10. An older woman has diabetes mellitus. Which patient assessment validates the nurses conclusion that she is in the foreground perspective of the shifting perspectives model of chronic illness?

a. Has an amputation of two toes.

5. Which of the following statements is the most suitable for establishing goals when teaching an older adult with a chronic illness about potential changes in the health maintenance regimen?

a. Management of the patients chronic disease rests on the patient and the caregiver; therefore the goals should be collaboratively set.

2. Which is a healthy practice recommended for a person at risk for OA?

a. Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with spinach covered with melted cheese for dinner; and ice cream for dessert

10. Which assessment is typical for a patient with OA?

a. Narrow joint spaces with crepitus

5. Which factors in the patient care environment should be routinely assessed to decrease the risk of falls? (Select all that apply.)

a. Outdoor grounds b. Appropriate footwear d. Grab bars in place

2. Which of the following statement(s) is(are) true about pain in older adults? (Select all that apply.)

a. Pain is not a normal aging process. d. Opioid analgesics are often the best treatment for persistent pain.

3. Which factor(s) is(are) modifiable health risk behaviors for chronic illness? (Select all that apply.)

a. Physical activity c. Poor nutrition d. Tobacco use

2. Which ethnic groups in the United States have higher rates of diabetes mellitus than non-Hispanic white people? (Select all that apply.)

a. Pima Indians b. Alaskan Natives d. Native Americans e. African Americans f. Mexican Americans

4. The nurse is caring for an older adult who has dementia. The patient has just returned from recovery after a percutaneous endoscopic gastrostomy (PEG) tube placement. Which intervention(s) should the nurse implement? (Select all that apply.)

a. Place IV tubing behind the patient. b. Hang the IV bag behind the patients field of vision. c. Cover the PEG tube with an abdominal binder.

4. Persons with normal age-related sensory changes are likely to have the most difficulty distinguishing which of the following?

a. Spoken pairs of phrases like shes praised and fees raised

14. The nurse uses comfort measures to enhance an older adults pharmacological pain management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adults pain level?

b. Older adults pain diary

11. Which pain sensation is associated with nociceptive pain?

a. Tissue inflammation

8. An older man who has tinnitus complains to the nurse that it is very annoying. Which should the nurse implement to alleviate the stress he is experiencing from tinnitus?

b. Assess for modifiable risk factors.

1. Which conditions are likely to cause an older adult chronic pain? (Select all that apply.)

b. Bone metastasis e. Compression fracture f. Postherpetic neuralgia

1. Which of the following is a true statement about heart disease in older adults?

b. Both excessive urination at night and decreased urination can be signs of heart failure (HF).

7. The most detrimental illness or condition that an older adult with deafness that occurred at birth can experience is which one of the following?

b. Cataracts

7. An older woman has severe osteoporosis in the long bones, impaired mobility, and chronic pain. Which acute illness or condition is this woman most likely to experience as a result of osteoporosis?

b. Chronic stable depression

9. An older man who is right-handed works as a carpenter, but he has been left with a flaccid right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the plan of care to help this man achieve his optimal state of health and wellness?

b. Collaborate with occupational therapy (OT).

1. Which of the following statements is true about diabetes mellitus?

b. Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dl.

5. Which of the following statements is true about a safe, effective care environment for older adults?

b. Older drivers are more likely to be in a fatal motor vehicle accident than younger drivers.

7. The older adult who has type 2 diabetes mellitus has a sensory impairment and unstable blood sugar levels. Which of the following alterations in sensory function does the nurse address in the plan of care for stabilizing the blood sugar?

b. Has difficulty hearing in crowded rooms.

12. An older man who has osteoarthritis (OA) tells the nurse that he has experienced fatigue for the past 2 weeks. Which nursing intervention should the nurse implement to help him manage his fatigue?

b. Help him plan exercise and rest.

8. An older adult who has OA receives a prescription for alendronate (Fosamax). Which instruction should the nurse include in patient teaching?

b. Is available for oral use.

4. Which of the following statements is true about medications taken by individuals with diabetes mellitus?

b. Nateglinide (Starlix) increases the secretion of insulin.

10. The nurse is teaching older adults about maintaining health and wellness. Which recommendation should the nurse include in the teaching to maintain optimal vision?

b. Wear sunglasses that block sun rays.

4. Which of the following statements is true about rehabilitation and restorative care for older adults?

c. A person can learn skills and gain abilities that enable functioning.

4. The overall temperature in your gerontological unit is 62 F during the evening shift. In documenting this concern to the administration, which factor is the most important for the health and well-being of older adults

c. An ambient temperature of 62 F is unsuitable for older people because they have impaired thermoregulation.

6. The nurse plans the care of an older female resident of a nursing home who has experienced a sudden deterioration in visual acuity. Which intervention should the nurse complete first?

c. Examine her mood and functional status.

9. The nurse assesses the quality of which of the following patient characteristics when applying the Get-Up-and-Go test from the Hendrich II Fall Risk Model?

c. Balance

2. An older man in a cardiac rehabilitation exercise class refuses to participate in the cool-down phase of the activity; consequently, 2 minutes later, he passes out but quickly regains consciousness. Which instruction does the nurse include in patient teaching to reinforce the importance of cooling down after exercising to this man?

c. Baroreceptor function diminishes with age.

4. Which of the following statements is true about RA?

c. Can affect body systems other than the joints.

1. An older female patient is diagnosed with a chronic illness. Which of the following principles should the nurse apply when answering her questions?

c. Chronic illness is unending, and coping can be influenced by the perception of uncertainty.

5. Which of the following nursing interventions are suitable for a patient who has gout?

c. Colchicine (Colsalide) by mouth

4. The nurse recognized which of the following as symptoms of wet age-related macular degeneration (AMD)? (Select all that apply.)

c. Decrease in central vision d. Visual distortion

12. The nurse sees an older woman with OA and a low-grade fever. The patient tells the nurse that her pain is changing; it is worse at night and in her shoulder muscles. Which of the following does the nurse perform to prevent complications of this patients condition?

c. Direct her to report temporal or scalp pain.

9. The older adult is at a higher risk for acute psychological pain than a younger adult because older adults:

c. Experience more loss.

2. Which laboratory results are goals for reducing a persons risk for diabetes and heart disease?

c. High-density lipoprotein (HDL) over 40 mg/d

4. The safest opioid analgesic choice for an older patient who has severe acute pain is which of the following?

c. Morphine sulfate (Morphine)

2. An older man who has chronic obstructive lung disease has muscle wasting and poor skin integrity as a result of a long-term therapeutic regimen. Which patient teaching should the nurse use to help reduce his risk of falls? (Select all that apply.)

c. Participate in a progressive regular exercise program. e. Consume a well-balanced diet that is high in calories.

13. An older Hispanic man states that he is not having pain, but he had knee replacement surgery 2 days ago. Which is the best pain assessment tool as recommended by the Hartford Institute for Geriatric Nursing (HIGN) from Try This for the nurse to apply for this man?

d. Faces Pain Scalerevised (FPS-R)

3. Which of the following is a true statement about assistive devices to aid older adults with impaired mobility?

d. A cane is most useful for unilateral disabilities but not bilateral problems.

Which of the following is a true statement about osteoporosis (OA)?

d. A high risk of death follows an OA-related fracture.

11. Which of the following qualities does the nurse need to provide caring?

d. Ability to create a trusting environment

6. An older woman who has diabetes mellitus takes glipizide (Glucotrol) and tells the nurse that her blood sugar levels have been higher than normal since she began using a vaginal cream for hot flashes. Which one of the following interventions is the best for the nurse to implement?

d. Ascertain whether the vaginal cream contains estrogen.

2. The nurse admits an older man who had abdominal surgery. Admission vital signs are heart rate (pulse) (P), 73 beats per minute (bpm); respiration rate (R), 20 breaths per minute; blood pressure (BP), 136/84 mm Hg. He is receiving intravenous (IV) fluids but has not requested pain medication since surgery. Seven hours later, his vital signs are P, 98 bpm; R, 26 breaths per minute; and BP, 164/90 mm Hg; and he denies pain. Which intervention should the nurse implement?

d. Ask if he has about discomfort at the surgical site or any other location.

1. Compared with acute pain, which of the following statements is true of persistent pain?

d. Can bring about long term changes in lifestyle.

1. Which one of the following is a true statement about mobility and safety for older adults?

d. Lowering the bed and fluorescent tapes are interventions to increase safety.

1. Which of the following diseases affects the eyesight of an older adult by damaging the central part of the retina?

d. Macular degeneration

3. Which of the following pain sensation(s) is(are) associated with neuropathic pain? (Select all that apply.)

d. Postamputation lolz why is dis a SATA

2. Which type of pain tends to occur persistently along a well-defined path in a region of the body?

d. Postherpetic pain

9. An older adult complains about experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the patients complaint?

d. Prescription antihistamine use

9. After living with OA for 2 years, an older womans bone density scan shows no improvement, despite consistent bisphosphonate therapy. Which intervention should the nurse implement to reduce bone loss for this older adult?

d. Review her daily nutritional habits.

13. The nurse is discharging an older woman who uses a walker from rehabilitative care. Which observation does the nurse use to determine whether the patient is prepared for discharge?

d. She takes the walker to the elevator.

13. Which of the following characteristics of RA are unlike those of OA?

d. Systemic and symmetrical

3. A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of his forehead. The man is being tested for which of the following?

d. Unilateral conductive hearing loss