GERI FINAL EXAM

The nurse clarifies that the immune system failure theory states that: A. The elderly lose their ability to effectively respond to infections and are more likely to die from them B. The body no longer recognizes itself and begins to attack itself, causing illness C. Toxins and harmful chemicals (free radicals) in the environment cause damage to body cells D. The diminished activity of the elderly makes them susceptible to illness

A. The elderly lose their ability to effectively respond to infections and are more likely to die from them

Which action will help the nurse determine whether a patient's confusion is caused by delirium? A. Ask about FHX of dementia B. CAM Tool (confusion assessment method) C. Ask the patient their birthday, name, and current president D. Ask the patient when they lack took medication

B. CAM Tool (confusion assessment method) Standardized evidence-based tool to identify and recognize delirium quickly and accurately.

An older person hospitalized for pneumonia develops acute renal failure. Which pharmacological issue should the nurse consider as causing the onset of this person's new health problem? A. Inappropriate use of an antibiotic to treat pneumonia B. Change in renal clearance of antibiotics used to treat pneumonia C. Undiagnosed allergy to prescribed medications to treat pneumonia D. Exposure of a renal problem which potentiated the symptoms of pneumonia

B. Change in renal clearance of antibiotics used to treat pneumonia

Which is NOT a common change in the respiratory system in older adults? A. Decreased cilia B. Decreased residual lung volume C. Decreased cough reflex D. Decreased pulmonary diffusion E. Decreased vital capacity

B. Decreased residual lung volume Residual lung volume is the amount of air left in the lungs after exhaling, and this increases with age.

What is a reason for an abnormal (decreased) Hemoglobin/ Hematocrit in the elderly? A. Hypervolemia B. Dehydration C. Constipation D. Obesity

B. Dehydration

Which patient is at the greatest risk for developing pressure ulcers? A. A 42-year old obese woman with type 2 diabetes B. A 78-year old man who is confused and malnourished C. An 80-year old man who is comatose following a head injury D. A 65-year old woman who has urge and stress incontinence

C. An 80-year old man who is comatose following a head injury Although diabetes, malnutrition, and incontinence can increase risk of pressure injuries, an elderly patient, immobilized in an intensive care unit is at the highest risk.

A frail older person with dementia is experiencing frequent episodes of combativeness and disorientation. Which intervention should the nurse implement to support this person's behavioral needs? A. Set limits on the person's behavioral outbursts B. Assign to a private room away from the nurse's stations C. Assign the same caregiver to support the person's care needs D. Vary the activities that need to be completed from day to day

C. Assign the same caregiver to support the person's care needs

A nurse is observing skin integrity on an older adult. Which finding will the nurse document as a normal fining? A. Oily skin B. Faster nail growth C. Decreased elasticity D. Increased facial hair in men

C. Decreased elasticity

An older adult has a Vit B12 deficiency. Why might this be? A. Increased gastric mobility B. Decreased intestinal blood flow C. Decreased gastric acid D. Decreased thirst and hunger drive

C. Decreased gastric acid Vit B12 is absorbed by the body through gastric acid. Decreased stomach acidity // gastric acif reduces the body's ability to remove Vit B12 from the protein in meat.

A patient's documentation indicates he has a stage III pressure ulcer on his right hip. What should the nurse expect to find on assessment of the patient's right hip? A. Exposed bone, tendon, or muscle B. An abrasion, blister, or shallow crater C. Deep crater through subcutaneous tissue to fascia D. Persistent redness (or bluish color in darker skin tones)

C. Deep crater through subcutaneous tissue to fascia A stage III pressure injury involves full thickness skin loss or necrosis of the subcutaneous tissue that may extend down to but not through the underlying fascia A. Stage IV B. Stage II C. Stage III D. Stage I

Mr. Smith, a 78 year old has been admitted to the hospital with pneumonia. Mr. Smith also has metastatic terminal lung cancer. The nurse would like to have a discussion with Mr. Smith concerning his end of life care. Order the steps for this encounter: A. Provide end of life care for the patient B. Obtain a hospice consult C. Discuss end of life care with the patient D. Review the chart for any MOLST orders

C. Discuss end of life care with the patient D. Review the chart for any MOLST orders B. Obtain a hospice consult A. Provide end of life care for the patient Prioritizing care should center on recognizing the patient's terminal condition, learning what the patient wishes are about the condition, Reviewing what medical orders are in place to support or not support these wishes, and providing compassionate end of life care.

A patient is intubated and sedated after a stroke. He is unable to communicate his wishes. The patient did not prepare an AD. Who is responsible for medical decision making in this case? A. Medical staff only B. Hospital must petition the court for a court-appointed power of attorney C. Next of kin (spouse or adult child) D. Hospital must wait until he wakes up before making any medical decisions

C. Next of kin (spouse or adult child)

When planning care for a LTC facility resident with a stage III sacral pressure ulcer, what is the correct order of wound care: A. Assist the resident in the turning Q2 hours B. Complete a Braden Scale for risk factors C. Clean and change the dressing as ordered by MD D. Assess the pressure ulcer and surrounding skin

D, C, B, A Assess the pressure ulcer and surrounding skin. Clean and change the dressing as ordered. Complete a Braden Scale to assess any change in risk, the patient already has a stage III but can help later on. Turning happens every 2 hours to prevent further injury.

A 79-year-old resident in a LTC facility is known to "wander at night" and has fallen in the past. Which of the following is the most appropriate nursing intervention? A. A loose abdominal restraint should be placed on the client during sleeping hours B. The caregivers should check the client frequently during the night C. A radio should be left playing at the bedside to assist in reality orientation D. Reassign the client to a room that is close to the nuring station

B. The caregivers should check the client frequently during the night

What is the appropriate nursing diagnosis for an older adult with a stage 3 pressure injury over their sacral region? A. Altered tissue integrity B. Altered skin integrity C. Risk for infection D. Risk for altered skin integrity

A. Altered tissue integrity Stage III progresses into adipose tissue, therefore there is altered tissue integrity. Stage 1 and 2 would be considered altered skin integrity, because they do not involve the tissue yet, but there is the risk for altered skin integrity. Because it has already occurred for this patient there is no longer a risk for altered skin integrity. There is a risk for infection, but that is not the appropriate diagnosis at this time.

Severe cancer pain is more effectively treated with analgesics given: A. Around the clock with extra doses available PRN B. Around the clock, in titrated doses C. As needed by the client D. Sparingly, to avoid side effects

A. Around the clock with extra doses available PRN

A nurse formulates the following diagnosis for an elderly patient who is having trouble getting to sleep at night. Disturbed sleep pattern: initiation of sleep. Which of the following nursing interventions would the nurse perform related to this diagnosis? Select all that apply: A. Arrange for assessment for depression and treatment B. Discourage napping during the day C. Decreased fluids during the evening D. Administered diuretics in the morning E. Encourage patient to engage in physical activity F. Assess medication for side effects of sleep pattern disturbances G. Ask provider to order a sedative

A. Arrange for assessment for depression and treatment B. Discourage napping during the day E. Encourage patient to engage in physical activity F. Assess medication for side effects of sleep pattern disturbances Decreasing fluids at night and administering diuretics in the morning are both interventions for nocturia which disrupts sleep during the night. and maintaining sleep. They are not interventions that would assist falling asleep. Sedatives are not the first line treatment or intervention for initiating sleep.

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 answer.

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 answer. Older adults are likely to have hearing loss, so it is useful to assess for hearing deficit. Older adults often have presbycusis, difficulty hearing high pitches. May need more time to process and respond and may hold back information, so it is important to look for body language.

The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin? A. Crusting B. Wrinkling C. Deepening of expression lines D. Thinning and loss of elasticity in the skin

A. Crusting Wrinkling, deepening of expression lines, and thinning and loss of elasticity in the skin are are considered normal changes of aging. Crusting is concerning for a pathological condition.

What is the most significant change in kidney function that occurs with aging? A. Decreased glomerular filtration rate B. proliferation of micro blood vessels to renal cortex C. Formation of urate crystals D. Increased renal mass

A. Decreased glomerular filtration rate GFR is the amount of filtrate formed by the kidneys in 1 min. Renal blood flow progressively decreases with age due to a reduce blood supply through the micro-blood vessels of the kidney. Urate crystals result from too much uric acid in the blood in older adults, but not related to aging. Renal mass decreased over time starting around 30-40 yrs/old.

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 Normal Changes to the Musculoskeletal System with Age: loss of bone and muscle mass, decrease in height, decreased ROM

What is a more common potassium electrolyte disturbance seen in the elderly? A. Low Potassium B. No change C. High Potassium

A. Low Potassium

A nurse is caring for a client who is confused. The provider ordered cotton wrist restraints to prevent the client from removing IV and indwelling cath. What are potential complications from restraint use? Select all that apply: A. Nerve damage B. Pressure injuries C. Psychological trauma D. Mania E. Increased muscle mass

A. Nerve damage B. Pressure injuries C. Psychological trauma

Which of the following is an important nursing intervention when administering opioids to an older adult? Select all that apply: A. Recommend a dose reduction if over sedation is noted B. Routinely administer medication with Benadryl to reduce itching C. Administer bowel regimen daily to reduce constipation D. Avoid using opioids to minimize addiction E. Ensure Narcan is available at all times

A. Recommend a dose reduction if over sedation is noted C. Administer bowel regimen daily to reduce constipation E. Ensure Narcan is available at all times Benadryl is on the BEERS list and should be avoided by older adults.

What should the nurse teach the client to do to PREVENT stress incontinence? Select all that apply: A. Use techniques that strengthen the sphincter and structural supports of the bladder; Kegel exercises B. Avoid dietary irritants; caffeine, alcohol, smoking C. Not to laugh when in social gatherings D. Carry an extra incontinence pad when away from home E. Obtain a fluid intake of 500 mL/day

A. Use techniques that strengthen the sphincter and structural supports of the bladder; Kegel exercises B. Avoid dietary irritants; caffeine, alcohol, smoking Carrying an extra incontinence pad could be helpful but it does not help to PREVENT incontinence. Establishing a voiding schedule may be more helpful in the management. Restricting fluids should not be recommended.

A client tells the nurse "every time I come in the hospital you hand me one of these advance directives. Why should I fill one of these out?" Which statement by the nurse is most appropriate? A. "You must fill out this form because Medicare laws require it" B. "An AD lets you participate in decisions about your health care" C. "This paper will ensure no one can override your decisions" D. "It is part of the hospital admission packed and I have to give it to you"

B. "An AD lets you participate in decisions about your health care"

A 90 year old is admitted with a stage III pressure ulcer. The nurse plans to resolve the issue. Order the steps for this encounter: A. Re-dress wound as ordered B. Administer 10 mg of Morphine IM C. Assess wound and surrounding tissue D. Obtain a wound culture

B. Administer 10 mg of Morphine IM C. Assess wound and surrounding tissue D. Obtain a wound culture A. Re-dress wound as ordered Prioritizing care should center on recognizing that a stage III is painful and premedication should be done at the beginning, assessment is key to examining the extent of the wound before applying a dressing and documenting.

The nurse notes that an older patient has a blood pressure of 150/90 mm Hg. Which health screening should the nurse recommend for this patient? A. Arthritis B. Diabetes C. Depression D. Cognitive function

B. Diabetes

In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging? A. Increased perspiration B. Increased airway resistance C. Increased salivary secretions D. Increased pitch discrimination

B. Increased airway resistance

After performing a physical assessment, the nurse suspects that a client is experiencing manifestations of osteoarthritis. Which finding supports the nurse's suspicion? Select all that apply: A. Leg tremors B. Joint tenderness C. Reduced joint flexibility D. Crepitation E. Joint stiffness

B. Joint tenderness C. Reduced joint flexibility D. Crepitation E. Joint stiffness

Which of the following assessment findings would be concerning for severe dementia? A. Mini mental status exam score of 28 B. Mini mental status exam score of 10 C. Braden scale score of 13 D. Braden scale score of 23

B. Mini mental status exam score of 10 MMSE score of 10 is indicative of dementia. Braden scale is a skin assessment tool.

A nurse is feeding a newly admitted patient for the first time. He is a 84 year old with a past medical history of CVA with no residual effects. The breakfast tray has arrived. Order the steps for this encounter: A. Monitor for signs and symptoms of dysphagia B. Sit patient up in a high fowler's position C. Begin the feeding D. Document

B. Sit patient up in a high fowler's position C. Begin the feeding A. Monitor for signs and symptoms of dysphagia D. Document Prioritizing care should center on recognizing that older adults may have difficulties with nutritional intake, it is important to be mindful of preventive strategies should aspiration occur, recognize the signs and symptoms of dysphagia and to document findings for other members of the health care team.

Which statement is correct in the relationship of smoking cessation to the pathophysiology of COPD? A. Smoking cessation completely reverses the damage to the lungs B. Smoking cessation slows the rate of disease progression C. Smoking cessation is an important therapy for asthma but not for COPD D. Smoking cessation reverses the effects on the airways but not the lungs

B. Smoking cessation slows the rate of disease progression Lung damage from COPD can not be reversed

Your older female patient is complaining because she is having frequent urinary tract infections. Which normal age-related change is most likely to be a contributing factor? A. Increased nocturnal urine production B. Decreased perception of the need to void C. Decreased bladder muscle tone D. Urinary incontinence

C) Decreased bladder muscle tone Decreased bladder muscle tone leads to increased residual volume of urine and increased possibility of bacterial multiplication. Nocturnal urine production increases with age but does not contribute to UTI's. Perception of the need to void decreases with age but does not contribute to UTI's. Incontinence is not a normal change of aging, but may be a symptom of a UTI.

Which order would you see the following patients to administered pain medications? A. 80-year-old man w/ arthritis, due for scheduled Tylenol for his L knee pain, takes Q6 hours, states his pain is a 2/10 B. 67-year-old women w/ stage III pressure injury, currently resting comfortably in bed but the wound nurse is coming in 30 mins for a dressing change C. 70-year-old man w/ dementia and a hip fx, moaning out in pain after his hath, has a PRN order for oxycodone D. 90-year-old women w/ cancer pain and dementia, sitting in a chair in the dayroom, due for scheduled oxycontin ED, taken Q12 hours

C, B, D, A C. Pt is in acute pain right now and needs to be addressed first B. Need to premeditate this patient before her dressing change to avoid acute pain D. Pt has dementia and would be unable to express full extent of pain, we want to stay on top of her chronic pain and not mess up the oxycontin ER schedule A. Pt is experiencing a very low level of pain and is only receiving Tylenol

For which patient is an order for restraints appropriate? A. 69-year-old male that expresses suicidal ideation B. 91-year-old female that fell trying to get out of bed unassisted last night C. 74-year-old female with delirium from a UTI that ripped out her feeding tube and PICC line multiple times this week despite efforts to avoid including distraction, disguising medical equipment, and increased observation D. 75-year-old female that wonders

C. 74-year-old female with delirium from a UTI that ripped out her feeding tube and PICC line multiple times this week despite efforts to avoid including distraction, disguising medical equipment, and increased observation

An 82-year-old man is A&O and in good physical health except for some arthritic pain that "slows me down, but I just keep moving." He lives alone in an apartment in a senior citizen complex but enjoys the company of older residents and takes part in the social activity there. His lifestyle is an example of: A. Exception to the expected norm B. Disengagement theory C. Activity theory D. Biologic theory

C. Activity theory

A 50-year-old client confides to the nurse that she is experiencing pain during sexual intercourse. The nurse recommends which of the following for the client? A. Consume alcohol to reduce inhibitors B. Tell the partner that sex is no longer desired C. Use vaginal lubricant D. Reduce sexual contact to once a month

C. Use vaginal lubricant Older women and those experiencing menopause may have decreased vaginal secretions. This can cause dry entry which can be painful and irritating. A lubricant can replace normal sections. It is not appropriate to advise the client to tell their partner sex is no longer desired, and reducing sex does not fix the problem.

An 80 year old has been admitted to the hospital after a fall. The nurse plans to review the older adult's mobility status. Order the steps for this encounter: A. Evaluate the interventions utilized during the encounter B. Obtain a Hendrich II score C. Provide proper footwear if ambulating D. Assess the patient's range of motion and environment

D. Assess the patient's range of motion and environment B. Obtain a Hendrich II score C. Provide proper footwear if ambulating A. Evaluate the interventions utilized during the encounter Prioritizing care should center on recognizing patient safety and evaluating patient mobility by getting an initial assessment of mobility, obtaining any additional information, maintaining basic safety principles, and reviewing their effectiveness/ ineffectiveness

After swallowing, a 73-year-old patient is coughing and has a wet voice. What changes of aging could be contributing to this abnormality? A. Decreased response to hypercapnia B. Decreased number of functional alveoli C. Increased calcification of costal cartilage D. Decreased respiratory defense mechanisms

D. Decreased respiratory defense mechanisms Cilia and coughing are the bodies defense mechanisms against foreign bodies entering the respiratory system. Both of which are decreased in older age, putting them at higher risk for aspiration.

The nurse notes that laboratory data for a person who is not a resident of the skilled facility was accidentally faxed to the care area. What should the nurse do with this information? A. Throw it in the trash B. Place it in biohazard trash C. File in the reusable paper pile D. Destroy it with a paper shredder

D. Destroy it with a paper shredder

The nurse reviews information collected after completing a comprehensive assessment with an older person. For which reason should the nurse recommend lipid-disorder screening for this patient? A. Over the age of 65 B. Body mass index 28.5 C. Blood pressure 140/90 mm Hg D. Diagnosed with peripheral-artery disease

D. Diagnosed with peripheral-artery disease

The nurse is teaching an older adult recently diagnosed with osteoarthritis about interventions to help maintain mobility of the joints. Which should the nurse include? A. Jogging 3x a week B. Routine NSAID use C. Glucosamine and chondroitin supplements D. Physical Therapy

D. Physical Therapy Jogging is a weight bearing exercise and should be avoided, use yoga instead. NSAIDS cause GI bleeding in older adults. PT is the best option and recommendation.

The patient is transferring from another facility with the description of a sore on her sacrum that is deep enough to see the muscle. What stage of pressure ulcers does the nurse expect to see on admission? A. Stage I B. Stage II C. Stage III D. Stage IV

D. Stage IV A stage IV pressure injury involves full-tissue skin loss with destruction extending to muscle, bone, or supporting structures

Which stroke risk factor for a 48-year-old male patient in the clinic is most important for the nurse to address? A. The patient is 25 pounds above the ideal weight. B. The patient drinks a glass of red wine with dinner daily. C. The patient's usual blood pressure (BP) is 170/94 mm Hg. D. The patient works at a desk and relaxes by watching television.

c. The patient's usual blood pressure (BP) is 170/94 mm Hg. HTN is the most important modifiable risk factor. Alcohol, physical inactivity, and obesity are all stroke risk factors as well.