Gero Mini exam 5 Practice Questions

5. Nearly 30% of all deaths from hypothermia occur in older adults. True or false?

False Rationale: Nearly 50% of all deaths from hypothermia occur in older adults. Hypothermia is produced by exposure to cold environmental temperatures and is defined as a core temperature of less than 35°C (95°F). Hypothermia is a medical emergency requiring comprehensive assessment of neurologic activity, oxygenation, renal function, and fluid and electrolyte balance.

__ is the use of multiple medications that can increase the risk for drug interactions and increase the risk for an adverse event. A. Pharmacokinetics B. Chronopharmacology B. Pharmacodynamics D. Polypharmacy

D. Polypharmacy Rationale: Polypharmacy is the use of approximately five or more medications or the use of multiple medications for the same problem, which can lead to an increase risk for drug interactions and increase the risk of adverse events. Pharmacokinetics refers to the movement of a drug in the body from the point of administration to excretion. Chronopharmacology is the relationship between the biological rhythms of the body and variations pharmacokinetics and pharmacodynamics. Pharmacodynamics refers to the interaction between a drug and the body.

For an older adult client who is having trouble sleeping at night, you would implement all the following EXCEPT A. sleep restriction therapy B. relaxation therapy C. soft music D. administration of a sedative

D. administration of a sedative Rationale: Sedatives and hypnotics should be avoided. Restriction of sleep during the day will assist the client in sleeping at night because he or she will be tired. Relaxation therapy might calm a client enough to enable him or her to sleep. Soft music is a type of relaxation therapy that might help sooth a client

You are visiting your client a few days before a blizzard is expected to hit your town, and you notice that her heater is not working. As a public health nurse, you know that all of the following require early assessment EXCEPT1. environmental temperatures.2. economic conditions.3. medication effects.4. changes in thermoregulatory responses. A. 1, 3, and 4 B. 2 and 3 C. 1, 2 and 3 D. all of the above

D. all of the above Rationale: Environmental temperature extremes impose a serious risk to older persons with declining physical health. Preventive measures require attentiveness to impending climate changes, as well as protective alternatives. Economic conditions often play a role in determining whether an older person living in the community can afford air conditioning or adequate heating. Many drugs affect thermoregulation by affecting the ability to vasoconstrict or vasodilate, both of which are thermoregulatory mechanisms. Neurosensory changes in thermoregulation delay or diminish the individual's awareness of temperature changes and may impair behavioral and thermoregulatory responses to dangerously high or low environmental temperatures

Diabetes, dementia, Parkinson's disease, stroke, and vitamin B deficiencies may cause neurologic damage, leading to A. postprandial hypotension B. traumatic brain injury C. fallophobia D. gait disturbances

D. gait disturbances Rationale; Neurologic damage may result in gait disturbances. Postprandial hypotension occurs after ingesting a carbohydrate meal and may be related to the release of a vasodilatory peptide. A TBI is caused by a bump, blow, or jolt to the head or by a penetrating head injury that disrupts the normal function of the brain. Fallophobia, or fear of falling, is an important predictor of general functional decline and a risk factor for future falls.

The second leading cause of hospitalization for older adults is a. pneumonia. b. myocardial infarction. c. cerebrovascular accident. d. hip fracture.

D. hip fracture Rationale: More than 95% of hip fractures among older adults are caused by falls. Hip fracture is the second leading cause of hospitalization for older people, occurring predominantly in older adults with underlying osteoporosis. Hip fractures are associated with considerable morbidity and mortality.

During an assessment, an older adult client reports that he fell the night before. You should follow up with all the following EXCEPT A. ask about the history or frequency of falls B. ask about the circumstances behind the fall(s) C. evaluate the client for gait and balance D. perform a complete head-to-toe assessment

D. perform a complete head-to-toe assessment Rationale: Performing a head-to-toe assessment is a good idea; however, it will not give you the information you need about the reported fall and can be performed after the initial assessment of the fall. Asking about the frequency of falls will determine whether a fall was an isolated incidence or whether a pattern is developing. The circumstances behind the fall will give the nurse an idea of what to look for in the house, nursing home, or hospital. Some circumstances could possibly be changed to help ensure that a fall does not reoccur. Evaluations for gait and balance will show whether a neurologic issue needs to be addressed.

Which of the following statements are true regarding physical activity for older adults? (Select all that apply.) a. Older people are less likely to receive exercise counseling from their primary care provider. b. As little as 10 minutes of exercise can provide health benefits. c. Extremely frail individuals should engage in strength and balance training. d. Exercise must be performed for 60 minutes per day. e. People over the age of 70 are too old to begin a fitness program.

A, B, C Rationale: The nurse should be knowledgeable about recommended physical activity guidelines, educate individuals about the importance of exercise and physical activity, and provide suggestions on ways to incorporate exercise into daily routines. Many older people mistakenly believe that they are too old to begin a fitness program. Older people are less likely to receive exercise counseling from their primary care providers than younger individuals. Recommendations for all adults are participation in 30 minutes of moderate-intensity physical activity for 5 or more days of the week. People do not have to be active for 30 minutes at a time but can accumulate 30 minutes over 24 hours. As little as 10 minutes of exercise has health benefits and three 10-minute bouts of activity have the same fitness effects as one 30-minute bout. Extremely frail individuals may not be able to engage in aerobic activities and should begin with strength and balance training before engaging in as little as 5 minutes of aerobic training.

Across the country, temperatures are in the high 90s to low 100s °F, and your client has no air conditioning. You know that hyperthermia can result because of the elevated temperatures. Which of the following tips to prevent hyperthermia should you tell your elderly client? (select all that apply) A. drink plenty of fluids B. avoid alcohol C. use cool or tepid water D. minimize exertion E. wear cool clothing such as silk or polyester

A, B, C, D Rationale: Drink 2 to 3 L of cool fluid daily to maintain hydration. Avoid alcohol to prevent dehydration. Take tepid baths or showers or apply cold wet compresses or immerse the hands and feet in cool water. It will help one cool down. Minimize exertion, especially during the warmest times of the day. This prevents sweating and dehydration. Wear hats and loose clothing made of natural fibers when outside; remove most clothing when indoors. Silks and polyester retain heat.

An older adult client has been admitted to a skilled nursing facility. Which of the following circumstances can be caused by physical restraints? A. Death B. Pressure ulcers C. Nosocomial infections D. Agitation E. Halitosis

A, B, C, D Rationale: Physical restraints may actually exacerbate many of the problems for which they are used and can cause serious injury and death. Individuals in restraints, who do not often move or are not turned as often as they should be, develop pressure ulcers. When in restraints, an older adult is susceptible to pneumonia, which is a nosocomial infection. The client does not move around or turn, and the pulmonary secretions sit and become a breading site for bacteria. Many times when older adult clients are placed in restraints, their anxiety level reaches a new high. They tend to become more agitated and restless. Clients with dementia experience high anxiety levels even more so. Clients in restraints do not have an increase of orientation because of restraints. Therefore, they might become more agitated and hostile, but their orientation levels actually decrease. Halitosis is bad breath and is not an injury; it is simply a sign that the patient is not receiving good oral care by the nursing staff.

In visiting with an older adult client in his home, you see that he has more medications left in his bottles than he should have if he were taking them as instructed. You also note that his glasses are on the side table and broken. After calling to have his glasses fixed, you discuss with your client about asking the pharmacy to A. Use a larger font for the instructions on the front of the bottles to ensure that he can more easily read the instructions with his new glasses B. Use color-coded tops on the medication bottles to assist him in determining what times to take the medications or to help him determine which medications are in each bottle C. place his medications in a daily and weekly medication pack to make it easier in determining what medications to take at what time. D. use easy-to-open cap tops on his bottles for easy opening E. make a weekly calendar with medication pockets.

A, B, C, E Rationale: A larger font would make it easier for the client to read the instruction even without glasses. New glasses would also make reading the instructions easier. In addition, pictures of the medications would be beneficial. Color-coded tops on the medication bottles eliminate the need to read the names of the medications on the bottles. However, the client should always be encouraged to read the medication names. Daily and weekly medication packs would reduce the pressure of having to remember what medications to take and when. It would also solve the problem of trying to decipher medication instructions and would give the patient, family members, pharmacist, and nurse a visual on how the client is taking his medications. Weekly calendars with pockets for medications that indicate the day, time, and date can be used. Clear envelopes or sandwich bags containing the medication can be affixed to the dated square on a daily basis. Using easy-to-open cap tops on medication bottles will not necessarily help if the client cannot read the instructions. However, if the client has arthritis, then easy-to-open caps would be necessary

When assessing your patient who has a history of falls, you should pay particular attention to which of the following? A. Orthostatic hypotension B. vision C. cognitive disorders D. preprandial hypotension E. hearing F. antibiotics

A, B, C, E Rationale: Clinically significant orthostatic hypotension is a common clinical finding in frail older adults that can lead to falls. Poor visual acuity, reduced contrast sensitivity, decreased visual field, cataracts, and use of nonmiotic glaucoma medications have all been associated with falls. The presence of neurocognitive disorders, such as dementia and delirium, increases risk for falls Hearing ability is also directly related to fall risk. For someone with only a mild hearing loss, there is a threefold increased chance of having falls. Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide, causing lightheadedness and falls. Medications implicated in increasing fall risk include psychotropics, opioids, antiarrhythmics, digoxin, antihypertensives, and diuretics but not antibiotics.

Hypothermia is a medical emergency defined as a core temperature less than 95°F. Which of the following tips to prevent hypothermia should you tell your elderly client? (select all that apply) A. Use a head covering B. Eat high-protein meals C. Use absorbent incontienent pads D. use your comfort level to set the thermostat E. Layer clothing and bed clothes

A, B, C, E Rationale: Provide a head covering whenever possible—in bed, out of bed, and particularly outdoors. It helps to hold in the core heat generated by the body. Provide hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. Use absorbent pads for incontinent patients rather than allowing urine to wet large areas of clothing, sheets, and bedcovers, which turn cold within minutes. Layer clothing and bedcovers for best insulation. Be careful not to judge your patient's needs by how you feel and maintain a comfortably warm ambient temperature no lower than 65°F. Many frail older adults require much higher temperatures.

What are the components of a postfall assessment (PFA)? (Select all that apply.) a. Medication review b. Fall circumstances c. Documentation of incident report in patient record d. Cardiovascular assessment e. Mobility assessment

A, B, D, E Rationale: Determination of why a fall occurred (PFA) is vital and provides information on underlying fall etiologies so that appropriate plans of care can be instituted. Incomplete analysis of the reasons for a fall can result in repeated incidents. PFAs include a fall-focused history, fall circumstances, medical problems, medication review, mobility assessment, vision and hearing assessment, neurologic examination (including cognitive assessment), and cardiovascular assessment (orthostatic blood pressure, cardiac rhythm irregularities). If an older adult cannot tell you about the circumstances of a fall, information should be obtained from staff or witnesses. Incident reports are filed when a patient falls, but this is not included in the patient's medical record.

Which of the following are intrinsic risk factors associated with falls? (Select all that apply.) a. Unsteady gait b. Cognitive impairment c. Condition of floors d. Inappropriate footwear e. Reduced vision and hearing

A, B, E Rationale: Intrinsic risk factors are unique to each patient and are associated with factors such as reduced vision and hearing, unsteady gait, cognitive impairment, acute and chronic illnesses, and effect of medications. Extrinsic risk factors are external to the patient and related to the physical environment and include lack of support equipment by bathtubs and toilets, height of beds, condition of floors, poor lighting, inappropriate footwear, and improper use of or inadequate assistive devices.

Telehealth in the older adult community would allow the nurse or primary care provider to remotely monitor patient assessment data. Which of the following factors are driving the adoption of telehealth? (Select all that apply. a. Rising health care costs b. Privacy concerns c. Limited reimbursement d. Increasing comfort with technology e. The desire to age in place

A, D, E Rationale: Telehealth offers exciting possibilities for managing medical problems in the home or other setting, including reducing health care costs and promoting self-management of illness, particularly in rural and underserved areas. Factors driving the adoption of telehealth include rising health care costs, the desire to age in place, increasing comfort with technology, the new generation of nurses who expect to incorporate technology into their practice, and the profit motive of device manufacturers. Factors slowing widespread development include concerns about privacy, fear of diminishing human contact and caring, and limited reimbursement. Telehealth is especially effective in managing patients with chronic disease conditions such as congestive heart failure, chronic obstructive pulmonary disease, and diabetes. Information obtained from daily monitoring of the patient in the home can be used to prevent exacerbations.

You want to encourage your older adult client to exercise and recommend all the following EXCEPT A. one hour a day of moderate intensity aerobic activity B. muscle strengthening activities C. stretching and balance exercises D. playing with the Wii game

A. one hour a day of moderate intensity aerobic activity Rationale: Approximately 2 hours and 30 minutes of moderate intensity aerobic activity is recommended, not 5 to 7 hours. Muscle strengthening activities on 2 or more days that work all major muscle groups is recommended each week. Stretching and balance exercises, particularly for older people who are at risk of falling, are recommended. The Wii game system offers other possibilities for exercise at all levels and is increasingly being used in nursing homes and assisted living facilities.

When assessing an older adult client about his sleeping patterns at home, you will ask: (select all that apply) A. Do you have a bowel movement before going to bed B. What time do you go to bed C. Do you have any specific rituals at bedtime D. What is the room environment E. Do you experience any leg twitches in the hours before going to bed

B, C, D Rationale; Determining the time an older adult goes to bed will assist the nurse to meet the client's needs. Individuals often have specific rituals before they go to bed, which might include a bedtime snack, watching television, listening to music, or reading. All of these rituals are crucial to the individual's ability to fall asleep. The room environment includes temperature, ventilation, and illumination. All play a part in how well a patient can or will sleep. Assessing how many times the client wakes up at night might signify other problems that should be addressed. Asking about a bowel movement before bed might be part of a nighttime ritual; however, it does not affect the client's sleeping pattern. Restless leg syndrome is a disorder characterized by unpleasant leg sensations that disrupt sleep.

When visiting an older adult client in his home, you note that he is unsteady on his feet, and you are concerned about him falling. Which of the following functional issues make him at risk for a traumatic brain injury (TBI)? A. He has grab bars in his bathtub and a ramp for his rolling walker B. He has gnarled hands and feet because of a history of rheumatoid arthritis C. Throw rugs are throughout the house to "keep his feet warm and off the cold floor" D. He uses a walker to get around his home, both inside and outside E. He has poor lighting throughout his home

B, C, E Rationale: Gnarled hands and feet do not allow the person to hold on to things easily, and gnarled feet might cause him to trip, placing him at risk for a fall, resulting in a TBI. Older adults frequently slip and fall on throw rugs, which leads to the possibility of a TBI. Poor lighting in the home environment is conducive to falls and the possibility of a TBI. Grab bars and a ramp are safety devices to help keep a client from falling. The use of adequate assistive devices will help a client prevent falls and thus prevent TBIs

Which of the following older adults are at greatest risk during or after a natural disaster? (Select all that apply.) a. Older married couples b. Older adults with limited mobility c. A 62-year-old woman with dementia d. A 65-year-old man with independent functioning e. Residents of nursing homes

B, C, E Rationale: Older adults at most risk include, but are not limited to, those who depend on others for daily functioning; those with limited mobility; and those who are socially isolated, cognitively impaired, or institutionalized. Older people may be less likely to seek formal or informal help during disasters and may not get as much assistance as younger individuals. A recent study found that the majority of community-living adults aged 50 years of age and older in the United States may not be prepared for a serious flood, earthquake, tornado, or other natural calamity. Individuals older than the age of 80 years were significantly less prepared than 65- to 79-year-old individuals. Nursing home residents make up a particularly vulnerable group because of their frailty, and nursing homes need to be prepared for disasters.

A 90-year-old client has early dementia and wants to stay in her home for as long as possible. Which of the following technologies would be appropriate for this client? (select all that apply) A. Telemedicine B. SmartSoles C. Motion Sensors D. QuietCare system

B, D Rationale: SmartSoles, shoe insoles with an embedded GPS device, are being developed and may be an aid to locate individuals with dementia who wander from their homes. The QuietCare 24-hour monitoring system uses an ordinary home security infrastructure to monitor the house and transfers information about the occupant's daily living activities, triggering when a normal routine is broken. Caregivers and family can perform virtual check-ins with their older relative over the Internet. Telemedicine is defined as "the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration." Smart medical homes are being studied as a way to aid in the prevention and early detection of disease through the use of sensors and monitors.

Regular recurrence of certain phenomena linked to the 24-hour day by time cues, defines which one of the following? A. Non-rapid eye movements B. Circadian rhythm C. obstructive sleep apnea D. insomnia

B. Circadian Rhythm Rationale: The circadian sleep-wake rhythm, which is the regular recurrence of certain phenomena in cycles of approximately 24 hours, is the most important biorhythm, second only to body temperature, pulse, blood pressure, and hormonal levels. Four stages of non-rapid eye movement and a fifth stage of rapid eye movement occur with sleep. The obstruction of the upper airway causes obstructive sleep apnea and is the most common of the sleep apneas. Insomnia is defined as "a complaint of disturbed sleep in the presence of an adequate opportunity and circumstance for sleep."

The change in the effectiveness of two or more substances when used in combination refers to which one of the following terms? A. Biotransformation B. Potentiation C. Bioavailability D. Iatrogenic

B. Potentiation Rationale: Potentiation is the strengthening of the effect of two or more substances (e.g., food, another drug) when used in combination. Biotransformation is a series of chemical alterations of a drug that occur in the body. Bioavailability is the amount of a drug that becomes available to effect changes in the target tissues. Iatrogenic is a result of something that is performed or administered to a person in the context of providing care

As a nurse, you know that sleep and rest are physiological and mental necessities for survival. Which of the following statements is incorrect about rest and sleep? A. Sleep is a basic need B. Sleep occupies half of our lives C. Rest occurs with sleep D. Deprivation of sleep may adversely affect older adults

B. Sleep occupies half of our lives Rationale: Sleep occupies approximately one third of our lives and is a vital function and basic need. Sleep is a basic need and is an extension of rest, both of which are physiological and mental necessities for survival. Rest occurs with sleep in sustained unbroken periods. Sleep deprivation and fragmentation of sleep in older adults may adversely affect cognitive, emotional, and physical functioning, as well as the quality of life.

You, as a nurse, have been working with an older adult client who is starting a new medication. Over the past 2 to 3 days, you notice that that he has become confused and lethargic, more so than in the past. You suspect that he is experiencing A. polypharmacy B. an adverse drug reaction (ADR) C. Chronopharmacology D. misuse of drugs

B. an adverse drug reaction (ADR) Rationale: An older adult client is experiencing an unwanted pharmacological effect. ADRs can occur when a client starts taking a drug dose that is inappropriately high or one that necessitates laboratory monitoring

The onset of hyperthermia in the older adult can be exacerbated by which of the following? a. Perspiration b. Diuretics c. Ambient temperatures of 86°F d. Overhydration

B. diuretics Rationale: Diuretics and low intake of fluids exacerbate fluid loss and can precipitate the onset of hyperthermia in hot weather. Hyperthermia is a temperature-related illness and is classified as a medical emergency. Annually, there are numerous deaths among elders from temperature extremes, so prevention and education are very important nursing responsibilities. Interventions should be initiated when ambient temperatures exceed 90F.

You notice that your 85-year-old grandfather is having some trouble with his visual, motor, and cognitive skills. You would recommend the following driving adaptations EXCEPT A. a booster cusion B. tinted windows C. a wider rear-view mirror D. electronic detectors

B. tinted windows Rationale: Tinted windows are not a recommended adaptation for safer driving. A booster cushion would allow him to see over the steering wheel easier. A wider rear-view mirror will allow for more vision if the client is unable to turn his head or his peripheral vision is distorted. Electronic detectors in front and back signal when the car is getting too close to other cars, drifting into another lane, or likely to hit center dividers or other highway infrastructures.

3. Before beginning an exercise program, which of the following interventions should be encouraged and taught to the individual? (Select all that apply.) a. Assume that the doctor will approve the program. b. Collaborate with the person to set general goals. c. Assess barriers to exercise and provide tips on how to overcome them. d. Design a program that can be used at home or elsewhere. e. Provide self-monitoring methods to visualize progress.

C, D, E Rationale: Before beginning any exercise program, the individual should check with his or her physician to be screened. Short- and long-term goals should be specific and achievable and should match perceived needs, health, cognitive abilities, culture, gender, and interests. Barriers to exercise should be assessed and the person should be provided tips on how to overcome them. The program should be designed for use at home or elsewhere. The individual should be provided with self-monitoring methods to assist in visualizing progress.

Which classification of drugs is on the list of potentially inappropriate medications (PIM) for older adults and should be avoided except in extreme cases? A. Warfarin B. Acetaminophen C. Benzodiazepines D. Narcotic analgesics

C. Benzodiazepines Rationale: Benzodiazepines are associated with an increased risk for accidental injury and are on the PIM list and not recommended for older adults. Warfarin is prescribed for many older adults who have pacemakers, who have had transient ischemic attacks, or have cardiac issues. Close monitoring of the client's international normalized ratio must be conducted. Acetaminophen is an over-the-counter medication that, if taken as directed, will cause no problems. Narcotic analgesics can be prescribed; however, the older adult's age and condition are considerations.

Hypotension that occurs after ingestion of a carbohydrate-rich meal is known as which of the following? a. Orthostatic b. Malignant c. Postprandial d. Pseudohypotension

C. postprandial Rationale: Postprandial hypotension (PPH) occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. PPH is more common in people with diabetes and Parkinson disease but has been found in approximately 25% of persons who fall. Orthostatic hypotension is considered a decrease of 20 mm Hg (or more) in systolic pressure or a decrease of 10 mm Hg (or more) in diastolic pressure with position change from lying or sitting to standing. Malignant is a term associated with hypertension and pseudohypotension is not associated.

What is the most common type of crime against older adults? a. Identity theft b. Fraud c. Property crime d. Neglect

C. property crime Rationale: Property crime is the most common crime against persons age 65 years and older. Older people are more likely to be victims of consumer fraud and scams that include telemarketing fraud, email scams, and undelivered services. Older people also experience rising problems with identity theft. Nurses can be instrumental in reducing fear of crime and assisting elders in exploring ways they may protect themselves and feel more secure. Nurses can also work with families of elders to plan interventions that will protect the elder from scams (e.g., unlisted phone numbers, mail delivered to postal boxes instead of homes).

What type of physical activity is recommended for individuals with arthritis or mobility limitations? a. Yoga b. Dancing c. biking d. swimming

d. swimming Rationale: The high prevalence of joint diseases, such as osteoarthritis, may hamper successful performance of aerobic exercises that cause joint impact. Muscle-strengthening exercises without weight bearing provide more joint stability. Swimming is a low-risk activity that provides aerobic benefit, and water-based exercises are particularly beneficial for individuals with arthritis or other mobility limitations. Biking and dancing are activities aimed at improving cardiovascular fitness. Yoga is useful for flexibility.