Geriatrics Exam 2

How can the nurse facilitate communication with an older adult? Select all that apply: A. Assess for hearing deficit at the beginning of the interaction. B. Speak more loudly than normal, and at a slightly higher pitch. C. Pay special attention to cues from body language. D. Speak slowly, allowing time for the patient to word his answers.

A. Assess for hearing deficit at the beginning of the interaction. C. Pay special attention to cues from body language. D. Speak slowly, allowing time for the patient to word his answers.

Mr. Lim who is diagnosed of moderate dementia has frequent catastrophic reactions during shower time. Which of the following interventions should be implemented in the plan of care? Select all that apply. A. Assign consistent staff members to assist the client. B. Accomplish the task quickly, with multiple staff members assisting C. Schedule the client's shower at the same time of day D. Sedate the client 30 minutes prior to showering E. Tell the client to remain calm while showering F. Use a calm, supportive, quiet manner when assisting the client

A. Assign consistent staff members to assist the client. C. Schedule the client's shower at the same time of day F. Use a calm, supportive, quiet manner when assisting the client

The nurse is evaluating a patient who is in soft wrist restraints. Which of the following activities does the nurse perform? (Select all that apply.) A. Check the patient's peripheral pulse in the restrained extremity B. Evaluate the patient's need for toileting C. Offer the patient fluids if appropriate D. Release both limbs at the same time to perform range of motion (ROM) E. Inspect the skin under each restraint

A. Check the patient's peripheral pulse in the restrained extremity B. Evaluate the patient's need for toileting C. Offer the patient fluids if appropriate E. Inspect the skin under each restraint

Which age-related changes predispose the elderly patient to drug toxicity and extended duration of action of drugs? (Select all that apply.) A. Decreased body water B. Increased ratio of muscle to fat C. Low serum albumin D. Reduced blood flow to liver

A. Decreased body water C. Low serum albumin D. Reduced blood flow to liver

An older adult diagnosed with Alzheimer disease lives with family. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse. A. Dementia B. Living in a rural area C. Being part of a busy family D. Being home only in the evening

A. Dementia Dementia is a risk factor for abuse. Other risk factors for abuse include social isolation or low levels of social support, female sex, functional impairment, previous interpersonal/domestic violence, and lower income.

The nurse, at change-of-shift report, learns that one of the clients in his care has bilateral soft wrist restraints. The client is confused, is trying to get out of bed, and had pulled out the IV line, which was subsequently reinserted. Which action(s) by the nurse is appropriate? Select all that apply. A. Document the behavior(s) that require continued use of the restraints. B. Ensure that the restraints are tied to the side rails. C. Provide range-of-motion exercises when the restraints are removed. D. Orient the client. E. Assess the tightness of the restraints.

A. Document the behavior(s) that require continued use of the restraints. C. Provide range-of-motion exercises when the restraints are removed. D. Orient the client. E. Assess the tightness of the restraints.

. The nurse documents that the family caregiver of an older person should be assessed for stress during every home visit. What caused the nurse to make this notation in the older person's medical record? A. Family caregiver complaining about the volume of laundry B. The sink is full of dirty dishes C. Person sitting quietly watching TV D. Unread newspaper stacked on the kitchen table

A. Family caregiver complaining about the volume of laundry Caregiver stress is a significant risk factor and many caregivers cannot balance their own needs with the needs of the dependent older adult. These feelings can lead to resentment and possibly abusive or neglectful behavior. Complaining about laundry could be an indication that the family caregiver may be experiencing stress. There is no indication that unwashed breakfast dishes, unread newspapers, or the person's behavior support family caregiver stress.

The nurse suspects that an older person is experiencing an increase in stress. Which finding caused the nurse to make the clinical determination? A. Increased blood pressure B. Mild lower-extremity edema C. Weight loss of 2kg over 1 month D. Urinary frequency during the night

A. Increased blood pressure Stressors are highly individual. The event that one older person perceives as challenging may be stressful for another. Stressors may be physical, emotional, biological, or developmental. Symptoms that indicate the older person may be suffering negative effects of stress include a new onset of hypertension. Edema, weight loss, and urinary frequency are not identified as symptoms of stress in an older person.

The nurse suspects that an older patient is experiencing an altered drug response. Which reason does the nurse identify that this response is being caused by the aging process? A. Increased concentration of water-soluble drugs B. Increased effect of drugs metabolized by the liver C. Increased availability of highly protein-bound drugs D. Increased excretion of drugs because of decreased renal function

A. Increased concentration of water-soluble drugs With aging, there is a decrease in body water (as much as 15%) and an increase in body fat. This could result in increased concentration of water-soluble drugs and more prolonged effects of fat-soluble drugs. Liver mass and overall metabolic activity decrease with aging but they are not usually clinically significant in relation to drug metabolism. Decreases in serum albumin levels or binding capacity may result in increased serum levels of the "free" or unbound proportion of protein-bound drugs. Renal function generally decreases with age and should always be considered in the choice of a drug, in judging the appropriateness of a dose, and in evaluating adverse drug reactions.

Which clinical manifestation of osteoarthritis (OA) should the nurse include when teaching about osteoarthritis? (Select all that apply.) A. Joint pain with activity B. Pain and stiffness at night C. Abrupt onset D. Mild fever E. Crepitus with movement of joint

A. Joint pain with activity B. Pain and stiffness at night E. Crepitus with movement of joint

The nurse is providing education to a middle-aged female about her changing health needs. The nurse should be sure to include information on which age-related changes? (Select all that apply.) A. Loss of bone mass B. Decrease in height C. Increased circulation D. Decreased muscle mass E. Increased mineral exchange

A. Loss of bone mass B. Decrease in height D. Decreased muscle mass

The nurse has been caring for a patient over the past several years in an outpatient clinical. The nurse notices the patient has been much more withdrawn at visits and reports her children refuse to take her to church any more, an activity the patient has done for years and enjoys. The patient's daughter is also very demeaning to the patient at the visit. The nurse knows these can be signs of: A. Psychological or emotional abuse B. Neglect C. Physical abuse D. Financial abuse

A. Psychological or emotional abuse

An older person states that activities that used to be joyful are now viewed as a nuisance and is experiencing persistent feelings of sadness for several weeks. Which medication should the nurse suspect as the cause of this person's symptoms? A. Ranitidine B. Furosemide C. Gabapentin D. Acetaminophen

A. Ranitidine Depressive symptoms can be side effects of medications the older person is taking for a physical problem. One such medication is ranitidine, an anti-ulcer medication. Furosemide, gabapentin, and acetaminophen are not identified as medications that can contribute to the development of depression in an older person. Press enter after select an option to check the answer

An older person with osteoporosis is prescribed Alendronate. Which information should the nurse emphasize when teaching about this medication? A. Remain upright for 30 min after taking B. Remain upright for 60 min after taking C. Take first thing in the morning with breakfast D. Take 30 minutes after consuming full meal

A. Remain upright for 30 min after taking The nurse is responsible for teaching the older person the specific instructions for taking Alendronate to include remaining upright for 30 minutes after taking. The medication should be taken on an empty stomach first thing in the morning, with 8 ounces of water. Food or fluid should be avoided for 30 minutes after taking the medication. The person should remain upright for 60 minutes after taking Ibandronate.

The manager of a skilled facility is concerned that residents are not receiving required care and are experiencing neglect. Which information caused the manager to make this assumption? A. Resident sitting in urine-saturated clothing for hours B. Pressure ulcer healing rate at 10% C. All residents prescribed the annual influenza vaccination D. Family members visiting more frequently

A. Resident sitting in urine-saturated clothing for hours A resident made to wear and sit in urine-saturated clothing for hours is a form of neglect. Pressure ulcer healing may be delayed in a skilled facility because of the age of the resident, health problems, and nutritional status. Frequency of family visits is not an indication of possible neglect. Long-term care facilities take action to prevent an outbreak of a seasonal infection and will provide the annual influenza vaccination to all residents.

An 80-year old patient is being seen at the primary care clinic for routine care. The nurse performs a physical assessment on the patient. Based on the potential changes in the cardiac system associated with aging, which instructions would the nurse most likely give to this patient? A. Tell the patient to change positions slowly. B. Remind the patient to avoid environmental irritants. C. Explain that the patient should drink 8-10 glasses of water per day. D. Tell the patient that she must cover her mouth when sneezing.

A. Tell the patient to change positions slowly.

An older patient takes garlic to keep blood pressure under control. For which prescribed medication should the nurse assess for adverse effects because of the herbal supplement? A. Warfarin B. Alprazolam C. Cyclosporine D. St. John's Worth

A. Warfarin Garlic increases INR if used with warfarin. Kava causes sedation if taken with alprazolam. Echinacea counteracts the effects of immunosuppressive drugs such as cyclosporine. St. John's wort reduces the plasma concentration of digoxin.

The home health nurse assesses a hazard for a patient in the home setting. Which of the following assessments is considered a safety hazard? A. Throw rugs present in all rooms B. Stairways with handrails C. Grab bars in the bathroom D. Non-skid tape in the bathtub

A. Throw rugs present in all rooms

Which of the following responses by an older-adult client is most reflective of a need for further education by the nurse regarding the physiological changes associated with the older adult? A. "I call a cab if I want to go out after dark." B. "I can't help worrying about becoming forgetful." C. "I have my eyes checked regularly. Can't afford to fall." D. "I really enjoy eating good vanilla ice cream, but I have cut way down."

B. "I can't help worrying about becoming forgetful."

An older person with osteoarthritis asks what can be done to prevent further development of the disorder. Which response should the nurse provide? A. "Avoid beverages containing alcohol and caffeine." B. "Maintain a normal body weight." C. "Limit weight lifting and walking exercises." D. "Increase the intake of calcium and vit. D."

B. "Maintain a normal body weight." The most important risk factor for osteoarthritis that can be modified is obesity. Excess weight can cause pain in the hips, knees, and back. Reducing weight can improve quality of life. Weight lifting and walking exercises are appropriate, if done in moderation, for the person with osteoarthritis. Increasing the intake of calcium and vitamin D are appropriate for osteoporosis, osteomalacia, and Paget disease. Avoiding beverages with alcohol and caffeine are appropriate for osteoporosis.

Which female patients are at risk for developing osteoporosis? Select all that apply. A. 60 year old white aerobic instructor. B. 55 year old Asian American cigarette smoker. C. 62 year old African American on estrogen therapy. D. 68 year old white who is underweight and inactive E. 58 year old Native American who started menopause prematurely.

B. 55 year old Asian American cigarette smoker. estrogen therapy. D. 68 year old white who is underweight and inactive E. 58 year old Native American who started menopause prematurely.

The nurse performs a skin assessment of an older adult. Which finding is abnormal and needs to be reported? A. Increased patches of dark pigmentation on exposed skin. B. A dark, elevated patch that bleeds when touching C. Deep wrinkles and frown lines around the mouth and eyes D. Numerous brown or flesh-colored skin tags around the neck

B. A dark, elevated patch that bleeds when touching

Which older adult is experiencing normal aging changes of the urinary system? A. A man who has difficulty voiding, especially when starting his stream B. A woman who wakes up to void once during the night C. A woman who is experiencing incontinence D. A man who says he has burning when he urinates

B. A woman who wakes up to void once during the night

An older person with a low glomerular filtration rate is experiencing gout. Which medication should the nurse anticipate being prescribed for this person? A. Probenecid B. Allopurinol C. Sulfinpyrazone D. Colchine

B. Allopurinol Allopurinol is a uric acid synthesis inhibitor, which means it lowers formation of uric acid. It is more versatile than uricosuric medications such as probenecid and sulfinpyrazone because it may be given at all levels of renal function. Colchicine is used less often today because of its liver, renal, and bone marrow toxicity.

A patient has moderate macular degeneration. To decrease the possibility of falls at night, you would do what? A. Keep a very bright light burning in her room B. Ask her to call for assistance to the bathroom C. Keep her cane within reach of the bed D. Have an attendant stay with her at night

B. Ask her to call for assistance to the bathroom

An older patient is concerned about the cost of prescribed medications. What should the nurse suggest to this patient? A. Take half of the prescribed dose B. Ask the health care provider for samples C. Take a full dose of the medication every older day D. Consider purchasing the medication from another country

B. Ask the health care provider for samples One intervention to help control the cost of the person's medication is to ask if the health care provider has any free samples. Taking half of the prescribed dose or taking a dose every other day are strategies that older persons may use to control the cost however will not provide the therapeutic effects of the medication. Medications from other countries do not necessarily have the same regulations as those manufactured in the United States. Buying from another country should not be recommended to this person. Press enter after select an option to check the answer

The elder with a sensory impairment as a result of the aging process may: A. Experience an abrupt awareness of the sensory loss B. Be subject to safety problems C. Increase socialization patterns D. Easily adapt to new environments

B. Be subject to safety problems

Your patient assigned to you has pneumonia. You are reviewing the age-related changed involved with the older adult. Select all age-related changes of the respiratory system that apply. A. Decreased in residual lung volume B. Decreased gas exchange C. Decreased cough efficiency D. Increased gas exchange

B. Decreased gas exchange C. Decreased cough efficiency

One reason for medication problems in the elderly is that A. Regular use of laxatives increases absorption of medications B. Decreased renal function slows excretion of drugs C. Enhanced sense of taste of medications D. Increased perception of pain from injections

B. Decreased renal function slows excretion of drugs

The nurse has received shift report and enter the room to assess an older adult client. Upon entering the room, the nurse notes that the client will not make eye contact and is unwilling to engage in a discussion. The client states, "I never sleep well, but I'm tired now, so will you let me sleep tonight?" The nurse recognize this as which common problem experienced by a client of this age? A. Sleep deprivation B. Depression C. Dementia D. Stroke

B. Depression

A nurse reviewing the medication list for an elderly patient notices several drugs that would increase the risk of falls because of Orthostatic hypotension, which are: (select all that apply) A. Anticoagulants B. Diuretics C. Stool softeners D. Anti-hypertensive E. Antihistamine

B. Diuretics D. Anti-hypertensive E. Antihistamine

Identify methods to specifically prevent osteoporosis in postmenopausal women (Select all that apply)? A. Eating more beef. B. Eating 8 oz. of yogurt daily. C. performing weight bearing exercises. D. Spending 15 minutes in the sun each day. E. Taking postmenopausal estrogen replacement

B. Eating 8 oz. of yogurt daily. C. performing weight bearing exercises. D. Spending 15 minutes in the sun each day. E. Taking postmenopausal estrogen replacement

The nurse believes that an antipsychotic medication prescribed for an older patient should be discontinued. Which extrapyramidal symptom did the nurse assess to make this clinical decision? A. Tongue thrusting B. Fidgeting and rocking C. Elevated body temperature D. Sudden onset of muscle rigidity

B. Fidgeting and rocking Extrapyramidal symptoms are neurologic side effects that can occur at any time from the first few days of treatment to years later. Fidgeting and rocking is a symptom of the extrapyramidal symptom of akathisia. Tongue thrusting is an indication of tardive dyskinesia. Elevated body temperature is associated with serotonin syndrome. A sudden onset of muscle rigidity is associated with neuroleptic malignant syndrome.

Which statement is true regarding falls in the elderly? A. Most falls occur in the garage B. Hip fractures resulting from falls are a leading cause of placement in long-term care facilities C. Fall risk decreases with addition of medications D. Sedatives reduce the risk of falls

B. Hip fractures resulting from falls are a leading cause of placement in long-term care facilities

The client is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider? A. Constipation B. Increasing muscle or joint pain C. Hemorrhoids D. Flushing or "hot flash"

B. Increasing muscle or joint pain

An older patient plays Scrabble with family members several times a week. What should the nurse expect when assessing this client? A. Adequate coping skills B. Intact cognitive functioning C. Tolerance for physical changes D. Improvement in short term memory

B. Intact cognitive functioning The use of word games such as Scrabble help an aging person maintain cognitive functioning. This type of activity does not indicate that the person has adequate coping skills or tolerance for physical changes. Word games are not used to improve short-term memory however changes in this type of memory are considered a normal age-related change.

You are performing a physical examination of the spine on an older adult. Which of the following findings is common with aging? A. Lordosis B. Kyphosis C. Ankylosis D. Scoliosis

B. Kyphosis

An older adult has difficulty remembering activities completed the day before yet can relate in detail people who attended a birthday party several decades ago. What should this finding indicate to the nurse? A. Early dementia B. Normal changes C. Untreated delirium D. Symptom of a stoke

B. Normal changes One cognitive change that is identified as being a normal age-related change is a loss of short term member but intact long term memory. This finding does not indicate early dementia, untreated delirium, or symptoms of a stroke.

The administrator is preparing for a site visit of the skilled-nursing facility. Which action indicates that the organization is prepared to address any issues of elder mistreatment to the proper authorities? A. Names and numbers of all organization administrators placed near the unit telephone B. Policy and process to report elder mistreatment placed in a folder posted in the nurse's station C. Contact name and telephone number for the local and state Center for Aging D. Documentation when the most recent staff inservice on fire safety occurred

B. Policy and process to report elder mistreatment placed in a folder posted in the nurse's station Evidence that the organization is prepared to address issues of elder mistreatment include having the organization's policy and procedure on elder mistreatment along with the telephone number and reporting process in a location for all staff to have access. Elder mistreatment is not reported to the Center for Aging. Fire safety is not the same as elder mistreatment. Access to administrator telephone numbers is not helpful when needing to report elder abuse.

An older patient experiences a variety of adverse effects from prescribed medications. Which intervention should the nurse use to help this patient achieve a restful sleep? A. Coach in guided imagery B. Provide a cup of warm milk C. Schedule small frequent meals D. Remove cheese from the meal tray

B. Provide a cup of warm milk Warm milk contains tryptophan which helps with insomnia. Guided imagery is an intervention to reduce anxiety. Small frequent meals help reduce heartburn. Cheese contributes to constipation.

Which ability should Nurse Rebecca expect from a client in the mild stage of dementia of the Alzheimer's type? A. Remembering the daily schedule B. Recalling past events C. Coping with anxiety D. Solving problems of daily living

B. Recalling past events

An older patient babysits toddler grandchildren several times a week. What should the nurse suggest to ensure for safety when the children are in the patients home? A. Place unused medications in the trash B. Request the medication have childproof caps C. Place medications in a purse when the children are present D. Order a 30-day supply of the medication instead of a 90-day supply

B. Request the medication have childproof caps If older persons request that they receive their prescription medications without childproof caps, they need to take special precautions if young children are present in the home, even for a short duration. Unused medication should be disposed of properly. This may include returning the doses to the pharmacy. Toddlers will be able to get to the person's purse. Medications should not be placed there. Changing the number of doses in a prescription does not affect safety.

An older adult diagnosed with dementia lives with family and attends daycare. After observing poor hygiene, the nurse at the center talks with the patient's adult child. This caregiver becomes defensive and says, "It takes all my time and energy to care for my mother. She's awake all night. I never get any sleep." Which nursing intervention has priority? A. Teach the caregiver more about the effects of dementia. B. Secure additional resources for the mother's evening and night care. C. Support the caregiver to grieve the loss of the mother's ability to function. D. Teach the family how to give physical care more effectively and efficiently.

B. Secure additional resources for the mother's evening and night care.

Which goal is a priority for a client with a DSM-IV TR diagnosis of delirium and the nursing diagnosis Acute confusion related to recent surgery secondary to traumatic hip fracture? A. The client will complete ADLs B. The client will maintain safety C. The client will remain oriented D. The client will understand communication

B. The client will maintain safety

Which of the following are instrumental activities of daily living (IADLs)? Select all that apply. A. Bathing B. Shopping C. Transportation within the community D. Transferring E. Paying bills

B. Shopping C. Transportation within the community E. Paying bills Instrumental activities of daily living (IADLs) are slightly more complex skills that allow individuals to remain within the community and include housework, taking medications as prescribed, managing money, shopping, use of telephone, using technology as applicable, and transportation within the community. Bathing and transferring are examples of activities of daily living (ADLs) which are basic self-care tasks.

An older person's daughter is getting divorced and plans to move herself and two toddlers in with the older person. What should the nurse suggest when the older person expresses anxiety over this change in living situation? A. Encourage to charge the daughter rent B. Suggest stress-reduction techniques and exercise C. Recommend an alternative living arrangement for the daughter D. Ask if the older person has considered moving into an adult living community

B. Suggest stress-reduction techniques and exercise A suggestion to help an older person with stress is to encourage or suggest stress-reduction techniques such as yoga or medication. Charging the daughter rent assumes the person's stress is related to finances. Recommending alternative living arrangements for the daughter or the person are not identified as methods to help the older person cope with stress.

The nurse suspects that an older person is at risk for elder mistreatment. Which finding supports the nurse's conclusion? A. Volunteers at the library B. The person is female C. Retired school teacher D. Lives with adult children

B. The person is female Risk factors that increase the possibility of elder mistreatment include begin of the female gender. Employment, volunteer status, or living arrangements do not increase the risk of elder mistreatment.

The administrator of an assisted-living facility cancels a scheduled outing for residents because of an increased risk of falls. What occurred that caused the outing to be cancelled? A. Blood-pressure clinic was scheduled for the same time B. Unexpected snow storm C. Access bus has a flat tire D. Drug representatives arrived with donuts to talk about medication

B. Unexpected snow storm One action to take to prevent falls is to avoid walking on icy sidewalks and slippery floor surfaces. A snow storm would create slippery and icy surfaces which increases the risk for falls. The access bus flat tire would not increase the risk of falls. Blood pressure clinic and a drug representative presentation would not increase the risk of falls.

While observing people walking in the community, the nurse is concerned that an older person is at risk for falling. What did the nurse observe to make this decision? A. Stopping periodically to sit on a park bench B. Wearing shoes that are loose or untied C. Pushing the walker ahead before taking a step D. Talking with others while walking

B. Wearing shoes that are loose or untied Wearing untied shoes is an environmental factor that increases the risk for falling. Talking while walking, stopping periodically to set on a bench, and pushing the walker ahead before taking a step are actions that will not increase this person's risk for falling.

The nurse has administered a presurgical anticholinergic drug about 30 mins ago. Which of the following responses would be of concern and should be reported immediately? A. "Nurse, my throat is dry" B. "I'm feeling a bit anxious. When will the surgeon be here?" C. "I need to leave. I have important business to do!" D. "My nose is suddenly stuffy. I wonder if I have a cold."

C. "I need to leave. I have important business to do!"

The nurse instructs an older patient on ways to prevent esophageal irritation when taking medication. Which patient statement indicates that teaching has been effective? A. "I should lie down after taking medication." B. "Most medication causes chest or shoulder pain." C. "I should take each medication separately with 8-ounces of water." D. "An enteric-coated aspirin is less effective than one without the coating."

C. "I should take each medication separately with 8-ounces of water." To prevent esophageal irritation from drug therapy, the person should swallow medications with at least 8 ounces of liquid and take one medication at a time. The person should remain upright for at least 30 minutes after taking medication. A dull aching pain in the chest or shoulder after taking medication should be reported to the health care provider. A drug causing gastric irritation should be taken as enteric-coated. There is no evidence to support that an enteric-coated aspirin is less effective than one without coating.

The charge nurse is concerned that nursing-assistive personnel (NAP) in a skilled facility are prone to neglecting the needs of the residents. What statement did the nurse hear one of the NAP make to come to this conclusion? A. "I'll be back in a few minutes to take you to the dining room." B. "Your daughter will be here at 10am. How about a shower now to get ready?" C. "Maybe I'll bring you some water, if you behave." D. "Everyone's in the rec room watching a movie! Don't you want to see it too?"

C. "Maybe I'll bring you some water, if you behave." Threatening to withhold water unless the person "behaves" can be a precursor to neglect. The NAP should be counseled because of this statement. Returning in a few minutes, helping a person get ready for family, and asking about watching a movie are not indications that the residents are experiencing neglect.

A 91 year old female comes into the emergency room with symptoms of delirium. Which of the following would NOT be a possible cause of her condition? A. Urinary tract infection B. Dehydration C. Alzheimer's disease D. Recent anesthesia

C. Alzheimer's disease

An 84-year-old female patient is displaying signs of a delirium episode. To prevent the patient from injury, the most appropriate action by the nurse is to: A. Ask the provider about ordering an antipsychotic medication. B. Have the patient's guardian stay with the patient and give reassurance. C. Assign a staff member to remain with patient and provide frequent reorientation. D. Use a soft chest restraint to secure the patient in bed.

C. Assign a staff member to remain with patient and provide frequent reorientation.

The nurse notes that an older person is prescribed a total-protein level. Which physical assessment finding would support this laboratory test being used as an indication of elder mistreatment? A. Shortness of breath with ambulation and mild exertion B. Inability to remember recent events C. Body wounds and bruises at various stages of healing D. Weak hand grasps

C. Body wounds and bruises at various stages of healing Wounds and bruises at various stages of healing could indicate repeated episodes of elder physical mistreatment. Weak hand grasps could be an expected change based upon the person's age. Loss of short-term memory is a sign of cognitive impairment and does not indicate elder mistreatment. Shortness of breath with ambulation could indicate chronic lung disease, bleeding, chronic renal failure, or anemia caused by poor nutritional status.

80-year-old Mr. Stevens is accompanied to the clinic by his son, who tells the nurse that the client's constant confusion, incontinence, and tendency to wander are intolerable. The client was diagnosed with chronic cognitive impairment disorder. Which nursing diagnosis is most appropriate for the client's son? A. Risk for other-directed violence B. Disturbed sleep pattern C. Caregiver role strain D. Social isolation

C. Caregiver role strain

An older person is observed walking slowly down the street. Which age-related change should the nurse consider as most likely contributing to this person's ability? A. Lack of balance B. Poor nutrition C. Change in cartilage D. Fatigue

C. Change in cartilage Hyaline cartilage, which lines the joints, erodes and tears with advancing age, allowing bones to come in direct contact with one another. Knee cartilage is subjected to a great deal of wear and tear, and the result is a thinning as one ages. Thin, damaged cartilage and diminished lubricating fluid result in discomfort and slowness of joint movement. There is no evidence to support that slow ambulation in an older person is because of fatigue, poor nutrition, or lack of balance.

Which of the following would be an abnormal assessment finding for an older adult that the nurse would document and report to the primary care provider? Decreased: A. Reaction time B. Short-term memory C. Intellectual ability D. Cognitive processing speed

C. Decreased intellectual ability

During a home visit the nurse notes that an older person, who lives alone, is being visited by an adult son who is asking their parent for money. After the son leaves, what should the nurse do to ensure for this person's safety? A. Recommend that the person be admitted to a care facility immediately B. Discuss identifying a guardian with an attorney C. Devise a safety plan with the person D. Provide a list of caregiver support groups

C. Devise a safety plan with the person For older adults who possess capacity to make their own decisions and remain in their home living environment, an individualized safety plan should be developed in which emergency phone numbers, location of a safe place to go (if needed), a list of essential items to be taken if a quick exit is required, and consideration of transportation needs. This person is an elders at risk and careful monitoring and follow up is required. Caregiver support groups would be appropriate if the adult son is living with the person. Guardianship and hospital respite care would be appropriate if the adult person is being abused and needs to be removed from the home for safety.

The nurse notes that an older person, who lives alone, demonstrates a flat affect and sadness during the winter months. What should the nurse consider to help this person which symptoms of depression? A. Work on a hobby B. Attend a support group C. Engage in light therapy D. Antidepressant medication

C. Engage in light therapy Light therapy has been shown to be effective for older persons diagnosed with seasonal affective disorder, a cyclic depression that occurs when hours of daylight are short, usually in the fall and early spring. This person is demonstrating signs of seasonal affective disorder since it occurs during the months when there is less sunlight. Hobbies, support groups, and antidepressant medication are not identified as interventions for seasonal affective disorder. Press enter after select an option to check the answer

A 70-year-old patient has not been taking his medications for hypertension and coronary artery disease. The nurse discovers the patient's son who has control of the finances has not been purchasing the medications and the patient's bank account only has a few dollars available. This is an example of which: A. Self-neglect. B. Abandonment. C. Financial or material exploitation. D. Psychological abuse.

C. Financial or material exploitation

During a home visit the older person reminds the nurse to lock the door and keep the blinds closed because the neighbors are outside talking about the older person. What should the nurse include when assessing this client? A. Heart rhythm B. Blood pressure C. Hearing function D. Blood glucose level

C. Hearing function Hearing loss may place older persons at risk for developing paranoia because they may misinterpret the casual conversation of others and believe they are the focus of the conversation. The onset of paranoia is not associated with an irregular heart rhythm, blood pressure level, or blood glucose level.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding in the patient would prompt the nurse to contact the healthcare provider immediately? A. Jaundice B. Drowsiness C. Hematemesis D. Dysmenorrhea

C. Hematemesis

During a home visit the nurse notes that an older patient is not taking a medication as prescribed. Which medication factor is causing this patient to no adhere to the prescribed medication regime? A. Lower cognitive function B. Lack of perceived benefit of medication C. Inability to get the tablet out of the packaging D. Lack of confidence in the health care provider

C. Inability to get the tablet out of the packaging Some medications are packaged in strips with paper on one side and plastic on the other. The dose is obtained by pushing on the plastic covering the medication. If the person has poor strength or limited dexterity, it would be difficulty to push the pill through the paper. Lower cognitive function is a person factor affecting medication adherence. Lack of perceived benefit of the medication is a behavior/attitudes/habits factor affecting medication adherence. Lack of confidence in the health care provider is a health care provider factor affecting medication adherence.

An older person seeks medical attention for a facial laceration that reportedly occurred by hitting the face on the door of an open kitchen cabinet. Which information in the person's medical record will hinder the nurse's ability to discern if the injury is caused by elder mistreatment? A. Cares for an aging spouse with chronic health problems B. Pays for a home-health aid who performs household chores C. Mild cognitive changes associated with Alzheimer's disease D. Lives with adult daughter and three grandchildren

C. Mild cognitive changes associated with Alzheimer's disease Older adults with cognitive impairment are a challenge. Their self-reporting may be questioned for accuracy or they may be unable to express the mistreatment situation due to amnesia, aphasia, agnosia, or apraxia which commonly occur with dementia. It is often difficult to determine whether the older adult's worsening physical condition is a result of the natural progression of illness or mistreatment on the part of a caregiver. Because some frail older individuals are prone to underlying conditions that give rise to trauma, such as instability of gait and poor vision resulting in falls, it may be difficult for clinicians to differentiate accidental from willful injuries. Living with family, being a caregiver, and paying for help in the home does not impact the nurse's ability to discern if the injury is caused by elder mistreatment.

The nurse observes an older person stumble when getting up from sitting in a chair. Which recommendation should the nurse make to this person? A. Encourage to practice scooting on the floor in a seated position B. Hire a personal trainer to develop an exercise plan C. Perform balance exercises when washing the dishes D. Practice crawling on the floor in the prone position

C. Perform balance exercises when washing the dishes Having difficulty getting up from a chair increases the risk for falls. Balance exercises are one way for older adults to increase confidence in their balance and take an active part in preventing falls and fractures. One easy to do exercise is to perform the exercises while washing the dishes in the sink. A personal trainer does not need to be hired. Crawling on the floor prone or in a seated position are actions to take if a fall occurs.

The nurse notes several older persons with family caregivers are waiting to see the healthcare provider for a scheduled appointment. For which person will the nurse make completing the Elder Assessment Instrument a priority? A. Person asking the family caregiver if they can go to the store after the appointment B. Person talking with family caregiver about a magazine article C. Person sitting with head down, hair uncombed, shoes untied D. Person watching the TV while the family caregiver makes a telephone call

C. Person sitting with head down, hair uncombed, shoes untied An older adult appearing disheveled with poor hygiene should be evaluated for potential neglect if there is a responsible caregiver who may be having trouble meeting the caregiving needs of the older person. Talking, asking questions, and watching television are not indications that the older person might be experiencing neglect.

An 87-year-old man is admitted to the hospital for cellulitis of the left arm. He ambulates with a walker and takes a diuretic medication to control symptoms of fluid retention. Which intervention is most important to protect him from injury? A. Leave the bathroom light on. B. Withhold the client's diuretic medication. C. Provide a bedside commode. D. Keep the side rails up.

C. Provide a bedside commode.

During an assessment an older person explains the onset of a health problem in relationship to the date in which the spouse passed away. What should the nurse conclude about this person's response? A. The spouse had the same health problem B. The patient is grieving the death of the spouse C. The patient is using a calendar date as a memory cue D. The health problem was caused by the spouse's death

C. The patient is using a calendar date as a memory cue One way for an older person to cope with normal age-related cognitive changes is to made associations or use memory aids. The person is recalling the onset of a health problem in relationship to the date the spouse died. This is using a calendar date as memory cue. This technique does not indicate that the spouse had the same health problem, the person is grieving the death of the spouse, or that the health problem was caused by the spouse's death.

There are factors that influence the musculoskeletal system associated with aging. The nurse recognizes that with age: A. Men have the greatest incidence of osteoporosis B. Muscle fibers increase in size and become tighter C. Weight-bearing exercise reduces the loss of bone mass D. Muscle strength does not diminish as much as muscle mass

C. Weight-bearing exercise reduces the loss of bone mass

Which nursing intervention is the highest in priority for a client at risk for falls in a hospital setting? A. Keep all of the side rails up. B. Review prescribed medications. C. Complete the "get up and go" test. D. Place the bed in the lowest position.

D. Place the bed in the lowest position.

A nurse suspects her patient may be suffering from delirium. What signs does the nurse observe to support this diagnosis? A. Slurred speech and one-sided weakness B. Mask-like face and tremors C. Gradual onset of forgetfulness reported by family members D. Confusion and visual hallucinations, inattention

D) Confusion and visual hallucinations

An older person reports taking a non-steroidal anti-inflammatory (NSAID) medication several times a day to help with the pain caused by rheumatoid arthritis. Which response should the nurse make after learning this information? A. "They are the treatment of choice for your health problem." B. "Have you considered using acetaminophen instead?" C. Increase the dose if the medication becomes less effective." D. "Do you take anything to protect your stomach."

D. "Do you take anything to protect your stomach." NSAIDs are a common drug category used for RA. However, the high doses required to relieve the inflammation in the older adult often cause toxic side effects such as gastrointestinal bleeding, gastrointestinal perforation, and renal failure. Users of high dose NSAIDs are urged to consider prophylaxis against NSAID-induced ulcers medication to prevent GI bleeds. Acetaminophen is not considered a medication of choice for rheumatoid arthritis. Steroids are the treatment of choice for rheumatoid arthritis. Increasing the dose of an NSAID will increase the toxic effects however has minimal effect on pain control. Topical treatments are preferred over oral treatment in persons over the age of 75.

The nurse instructs a group of senior citizens with osteoporosis on nonpharmacologic measures to prevent further bone deterioration. Which statement indicates that teaching has been effective? A. "I should take a 30 min walk 3 times a week." B. "I should not smoke and have an alcoholic beverage together." C. "I should use antacids with aluminum." D. "I should take my calcium pills first thing in the morning."

D. "I should take my calcium pills first thing in the morning."

An older person is prescribed Escitalopram to help with feelings of depression. Which information in the person's medical history supports the selection of this medication? A. Diverticulitis B. Osteoarthritis C. Orthostatic lymphedema D. Benign prostatic hypertrophy

D. Benign prostatic hypertrophy Some geriatricians prefer to use the selective serotonin reuptake inhibitors (SSRIs) as first-line drugs for many older persons, especially those benign prostatic hypertrophy. Escitalopram is an SSRI and would be appropriate for this person. There is not a specific antidepressant medication identified in the person with a history of diverticulitis, osteoarthritis, or orthostatic lymphedema. Press enter after select an option to check the answer

The nurse notes that an older patient is prescribed a dose of Digoxin that is lower than the recommended amount. Which age-related change explains the reason for this lower dosage? A. Increase in body fat B. Dry mouth and secretions C. Decreased gastric acidity D. Changes in sensitivity of certain drug receptors

D. Changes in sensitivity of certain drug receptors Changes in sensitivity of certain drug receptors increases the effect of any drugs. It is wise to start low and go slow when prescribing medications to an older person. An increase in body fat can possibly increase the toxicity of water-soluble drugs and cause more prolonged and possible increased effects of fat-soluble drugs. Dry mouth and secretions affects the person's ability to swallow medications. Decreased gastric acidity can possibly decrease or delay the absorption of acidic drugs decreasing the peak effect of the medication.

The nurse suspects that an older patient is experiencing a side effect from a prescribed anticholinergic medication. What did the nurse assess to make this clinical determination? A. Pale skin color B. Productive cough C. Constricted pupils D. Elevated temperature

D. Elevated temperature Anticholinergic medication causes an elevated temperature because of the absence of sweating. Anticholinergic medication causing flushing because of the absence of sweating. Anticholinergic medications inhibit secretions. A productive cough is not a side effect of this medication. Anticholinergic medications paralyze the ciliary muscle causing pupil dilation and not constriction.

An older-adult patient in no acute distress reports being less able to taste and smell. What is the nurse's best response to this information? A. Notify the health care provider immediately to rule out cranial nerve damage B. Schedule the patient for an appointment at a smell and taste disorders clinic C. Perform testing on the vestibulocochlear nerve and a hearing test D. Explain to the patient that diminished senses are normal findings

D. Explain to the patient that diminished senses are normal findings

The nurse notes that an older person's thigh muscles are atrophied; however, the muscles of the upper arms are tight and have definition. Which recommendation should the nurse make to this person to improve muscle function? A. Eliminate smoking and alcoholic beverages B. Decrease the intake of protein at meals C. Increase the amount of housework done each day D. Increase the amount and distance of walking

D. Increase the amount and distance of walking The lower extremity muscles tend to atrophy earlier than those of the upper extremity. Routine daily activities most likely keep the upper extremities functioning on a regular basis. By comparison, walking may be limited to a small living area and for short periods of time. Increasing the amount and distance of walking will help improve the muscle tone of the lower extremities. Protein intake is required to maintain muscle strength. Smoking and alcoholic beverages adversely affect bone structure and mass. Increasing the amount of housework will help maintain upper body strength.

A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition? A. Memory loss occurring as part of the natural consequence of aging. B. Difficulty coping with physical and psychological change. C. Severe cognitive impairment that occurs rapidly D. Loss of cognitive abilities, impairing ability to perform ADLs

D. Loss of cognitive abilities, impairing ability to perform ADLs

The nurse arrives for a home visit and suspects that the older person is experiencing financial exploitation. Which observation caused the nurse to make this clinical decision? A. Streaks of stool down the person's legs B. Dry cracked lips C. Rat droppings on the kitchen floor D. No electricity in the home

D. No electricity in the home Signs and symptoms of financial exploitation includes an unexplained inability to pay bills or purchase necessity items such as food, shelter, and medications. The lack of electricity would indicate this type of abuse. Dry cracked lips and stool streaks down the legs would indicate either neglect or self-neglect. Rat droppings would indicate neglect.

The 50-year-old son of an elderly widow brings his mother to the clinic for an examination. He states that she is becoming confused and is falling in the home. When left to be examined by the nurse, the female widow appears fearful, lucid, and says that she has never fallen down in her own home. What type of situation might this elderly widow be experiencing? A. Psychological abuse. B. Financial abuse. C. Social abuse. D. Physical abuse.

D. Physical abuse.

What should the nurse explain when discussing expected changes in the female reproductive system to an older adult? A. Increased pubic hair is expected B. Uterine enlargement is normal C. Vaginal tissues become more vascular D. Production of vaginal secretions decreases

D. Production of vaginal secretions decreases

Which of the following will Nurse Dory use when communicating with a client who has cognitive impairment? A. Complete explanations with multiple details B. Pictures or gestures instead of words C. Stimulating words and phrases to capture client's attention D. Short words and simple sentences

D. Short words and simple sentences

As a mandatory reporter of elder abuse, which of the following must be present before a nurse notifies the authorities? A. Statements from the victim B. Statements from witnesses C. Proof of abuse and/or neglect D. Suspicion of elder abuse and/or neglect

D. Suspicion of elder abuse and/or neglect

As a mandatory reporter of elder abuse, which of the following must be present before a nurse notifies the authorities? A. Statements from the victim B. Statements from witnesses C. Proof of abuse and/or neglect D. Suspicion of elder abuse and/or neglect

D. Suspicion of elder abuse and/or neglect Many health care workers are under the erroneous assumption that proof is required before notification of suspected abuse can occur. Only a suspicion of elder abuse and/or neglect is necessary.

Which of the following outcome criteria is appropriate for the client with dementia? A. The client will return to adequate self-functioning B. The client will learn new coping to handle anxiety C. The client will seek out resources in the community for support D. The client will follow an established schedule for ADLs

D. The client will follow an established schedule for ADLs

During a home visit, the nurse notes that an elderly woman is caring for her bedridden husband. The woman states that this is her duty and that she does the best she can and her children come to help when they are in town. Her husband is unable to care for himself, and she appears thin, weak, and exhausted. The nurse notices that several of his prescription medication bottles are empty. This situation is best described by the term: A. Physical abuse. B. Financial neglect. C. Psychological abuse. D. Unintentional neglect.

D. Unintentional neglect.

A 75-year-old client, hospitalized with a cerebral vascular accident (stroke), becomes disoriented at times and tries to get out of bed, but is unable to ambulate without help. What is the most appropriate safety measure? A. Restrain the client in bed. B. Ask a family member to stay with the client. C. Check the client every 15 minutes. D. Use a bed exit safety monitoring device

D. Use a bed exit safety monitoring device

The spouse of an older patient is concerned because of an acute change in ability to remember how to get dressed in the morning. What should the nurse consider as causing the change in this patient's cognitive functioning? A. Sleep deprivation B. Undiagnosed infection C. Insufficient nutritional intake D. Worsening Alzheimer's disease

D. Worsening Alzheimer's disease Severe changes and sudden loss of cognitive function are usually symptoms of a physical or mental illness such as Alzheimer's disease, stroke, or serious depression. An acute change in remembering how to perform a routine task is not associated with sleep deprivation, infection, or nutritional intake in an older person.

True or False: The majority of adults over 65 live in either assisted living or long-term care facilities.

False 95-96% of adults over 65 live at home.