geriatrics

The nurse in the office advises a client with ongoing issues with constipation to keep a food journal. During a typical 24-hour period, the client has a bagel and coffee for breakfast, macaroni and cheese for lunch, and soup and salad for supper. What dietary changes should the nurse recommend to this client? A) Gradually increase the amount of fiber in the daily diet B) Eat several small meals each day C) Immediately increase the amount of fiber in the diet to 7 to 10 servings per day D) Increase the amount of soups and cheeses in the menu

A) Gradually increase the amount of fiber in the daily diet

Which interventions would be appropriate for the nurse to use to improve the tissue perfusion of an older patient? (Select all that apply.) A) Reminding about frequent position changes B) Ensuring an adequate body temperature C) Encouraging physical activity when possible D) Assessing for and preventing sources of pressure on the body E) Limiting exercise and ensuring adequate rest between periods of exertion

A) Reminding about frequent position changes B) Ensuring an adequate body temperature C) Encouraging physical activity when possible D) Assessing for and preventing sources of pressure on the body

Despite the fact that the patient is now receiving palliative care because of the progression of her congestive heart failure (CHF), a nurse views the care that was provided for the patient as a success. Which of the following aspects of the patient's situation would most likely lead the nurse to this conclusion? A) The client was able to live independently and care for herself until very late in the progression of her disease B) The client maintained an acceptable cardiac output for the majority of the time that she lived with CHF. C) The client was able to teach other older adults about the experience of living with CHF and the way it affected her life. D) The client remained largely pain-free from the time of diagnosis until the present.

A) The client was able to live independently and care for herself until very late in the progression of her disease

Which approach should the nurse use when considering pain management of an older patient recovering from injuries from a motor vehicle crash? A) Try non-opioids and adjuvant drugs before providing opioid analgesia. B) Implement opioids if complementary therapies have proven to be ineffective. C) Begin with a moderate dose of opioid analgesia and taper down to the lowest effective dose. D) Restrict analgesia options to NSAIDs and adjuvant medications due to the risk of unwanted effects.

A) Try non-opioids and adjuvant drugs before providing opioid analgesia.

1. The nurse is caring for an older client with a history of COPD. The nurse would be alert for an increased risk of adverse reactions If the client is prescribed which medication? Select all that apply. a. Aspirin b. NSAIDs c. Bupropion d. B blockers e. Long acting benzodiazepines

B blockers Long acting benzodiazepines

An older patient is receiving oxycodone for cancer pain. For which side effect should the nurse assess the patient? A) Thirst B) Delirium C) Addiction D) Muscle weakness

B) Delirium

The nurse teaches a group of older adults about diet. Which of following recommendations made by the nurse is most likely to result in the promotion of gastrointestinal (GI) health? A) If possible, eat organic, whole foods B) It's important to emphasize fiber and fluid intake C) Try to maximize the amount of unsaturated fats you eat every day D) You should try to limit your food and fluid intake

B) It's important to emphasize fiber and fluid intake

An older patient is recovering from hip replacement surgery. Which risk factor would most likely affect tissue perfusion in this older patient? A) History of hypotension B) Prolonged immobility after surgery C) The effects of anesthesia after a surgical procedure D) A history of anemia affected by additional blood loss from the surgery

B) Prolonged immobility after surgery

1. An older client is prescribed a large calcium tablet every day but objects because it is difficult to swallow it without choking. Which action would be most appropriate for the nurse to take?

B. ask the provider if it can be discontinued

When administering a proton pump inhibitor to a client with gastroesophageal reflux disease (GERD), the nurse notes that the client has great difficulty swallowing the enteric-coated pill. Which action would be most appropriate for the nurse to do when administering this medication to the client in the future? a. Crush the pill and mix with applesauce b. Split the pill in two parts and give each separately c. Reposition the client and provide more fluid when giving the pill d. Provide an herbal alternative that also reduces stomach acid productions

C reposition the client and provide more fluid

An older adult is brought to the emergency department experiencing extreme confusion. Which action should the emergency department staff take first? A) Order an electrocardiogram B) Administer a stimulant C) Review the drugs being taken D) Check serum electrolyte levels

C) Review the drugs being taken

An older patient who resides in an assisted living facility experiences dizziness and lightheadedness when getting out of bed in the morning and when standing up quickly from a chair. Which intervention would be appropriate at this time? A) Assess the patient's dietary and activity habits B) Plan a weight-loss and exercise regimen together with the patient C) Review the medication regimen and teach appropriate safety measures D) Recommend the use of garlic and hawthorn berries to address hypotension

C) Review the medication regimen and teach appropriate safety measures

An older patient asks for natural methods, instead of medications, to help with falling asleep. What can the nurse suggest to this patient? A) Avoid protein, take a walk every day, and drink a non-caffeinated herbal tea at bedtime B) Avoid carbohydrates, take a walk every day, and drink non-caffeinated herbal tea at bedtime C) Take a walk every day, get exposure to the sun daily, and drink non caffeinated herbal tea at bedtime D) Minimize the amount of exercise, get exposure to the sun daily, and drink non- caffeinated herbal tea at bedtime

C) Take a walk every day, get exposure to the sun daily, and drink non caffeinated herbal tea at bedtime

An older patient is demonstrating signs of dehydration. Which action should the nurse initiate first? A. Minimize food intake and maximize fluid intake B. Advocate for the initiation of intravenous rehydration C. Initiate monitoring and recording of fluid intake and output D. Ask that the physician order blood work to confirm or rule out dehydration

C. Initiate monitoring and recording of fluid intake and output

The nurse is planning care for an older patient with class 3 congestive heart failure (CHF) being admitted to a skilled nursing facility. Which action would be appropriate for this patient during the first week of hospitalization? A) Bed rest B) Digitalis as needed C) Passive range-of-motion exercises every shift D) Assist to a chair on day 1 and progressively increase ambulation each day

D) Assist to a chair on day 1 and progressively increase ambulation each day

During a home visit the nurse notes that an older patient has a tray of many types of vitamins, minerals, and herbal supplements on the kitchen counter. The patient was recently discharged from the hospital after having an acute myocardial infarction. What should the nurse instruct the patient about these supplements? A) Continue taking the supplements but only with meals B) Stop taking the vitamins and other supplements until further notice C) Take the vitamins but do not exceed the recommended daily allowances for older adults D) Check with health provider to identify any supplements that may produce adverse interactions with the prescribed medication

D) Check with health provider to identify any supplements that may produce adverse interactions with the prescribed medication

A newly admitted older patient has severe edema in the lower extremities and no hair on the legs. What do these manifestations most likely indicate to the nurse? A) A diet low in protein B) Exposure to the cold from a lack of heat C) Frequent falls and injuries because of unsteady gain D) Circulatory problems related to age and a chronic illness

D) Circulatory problems related to age and a chronic illness

The nurse discusses nutritional health with an 89-year-old client whose total protein level is 5 (abnormally low). Which of the following physiological changes should the nurse interpret as a potential pathological process rather than a normal age-related change? A) Decreased amounts of pepsinogen released in the stomach B) Decreased peristalsis of the esophagus and stomach C) Decreased taste sensations, decreasing food intake D) Decreased teeth and chewing ability

D) Decreased teeth and chewing ability

An older patient asks the nurse what he can about nausea that occurs after eating because of delayed gastric emptying. What advice should the nurse provide to the patient? A) Changing to a vegetarian, organic diet B) Limiting food intake and taking antacids regularly C) Increasing the amount of soluble and insoluble fiber in his diet D) Eating several small meals throughout the day rather than three larger ones

D) Eating several small meals throughout the day rather than three larger ones

Which assessment finding indicates that an older patient is experiencing congestive heart failure? A) Sharp chest pain with exertion B) Tortuous calf veins and a history of venous ulcers C) History of myocardial infarction and peripheral edema D) Moist lung crackles are audible on auscultation with shortness of breath on exertion

D) Moist lung crackles are audible on auscultation with shortness of breath on exertion

Which of the following statements most accurately captures an aspect of dental health among older adults? A) Clients who wear dentures do not normally require visits to the dentist. B) The incidence of dental caries increases significantly with age. C) Periodontal disease is less common in older adults than in younger clients. D) The presence of dental problems can be indicative of a variety of other diseases.

D) The presence of dental problems can be indicative of a variety of other diseases.

At a health promotion class at a senior's center, a 67-year-old client asks the nurse, What can be done to help manage my spouse's diverticular disease? What is the Nurse's most appropriate response to this client's query? A) Try to encourage your spouse to drink at least 8 glasses of water each day B) You and your spouse might want to try eating 4 or 5 small meals rather than 3 larger ones each day. C) I'd encourage you and your spouse to integrate more exercise into your daily routine D) Try to increase the amount of fiber that you include in the meals you cook.

D) Try to increase the amount of fiber that you include in the meals you cook.

1. An older client admitted to the hospital with renal failure is overheard asking his family to bring in the licorice from the kitchen. The nurse cautions the client about the use of licorice & possible interaction with the client's prescribed medications. Which adverse effect would the nurse cite? Select all that apply. a. Edema b. Bradycardia c. Hypokalemia d. Hypertension e. Hypernatremia

Edema Hypokalemia hypertension hypernatremia

1. A nurse is assessing an older adult client. This history reveals that the clien tis using an antibiotic that was originally ordered for a previous infection. When talking with the client, which information would be most important for the nurse to keep in mind?

Excessive use of antibiotic

1. An older client with a history of deep vein thrombosis is prescribed daily warfarin therapy, an oral anticoagulant. Which food should the nurse instruct the client to monitor to ensure the effectiveness of the medication regimen? a. Foods high in saturated fat such as bacon and butter b. Foods high in salt and nitrates such as processed meat c. Foods high in complex carbohydrates such as bread & rice

Foods high in vitamin K such as asparagus and green leafy vegetables

1. A nurse at a long-term care facility is teaching a group of unlicensed assistive personnel about medications and their use in older adults. As part of the class, the nurse is addressing factors that characterize adverse drug reactions in older adult residents. Which information would the nurse most likely include? Select all that apply. a. "Even when a resident stops taking a drug, a reaction can take place after the fact" b. Even when a resident has been taking a drug for a long time, a drug reaction can still occur" c. "Most drug reactions are in fact age-related changes that are mistakenly attributed to medications" d. "Older adults often have signs and symptoms of adverse reactions that are very different from those of younger adults" e. "While older adults are prone to adverse reactions, these reactions tend to resolve more quickly than in younger people."

a. "Even when a resident stops taking a drug, a reaction can take place after the fact" b. Even when a resident has been taking a drug for a long time, a drug reaction can still occur" d. "Older adults often have signs and symptoms of adverse reactions that are very different from those of younger adults"

1. The nurse learns that an older client uses antacids after every meal to treat chronic "indigestion". The nurse would assess the client for which condition? a. Urinary incontinence or retention b. Coagulation disorders and anemia c. Hyperlipidemia and arteriosclerosis d. Electrolyte imbalances and cardiac problems

a. Electrolyte imbalances and cardiac problems

An older client with Alzheimer's disease is experiencing episodes of agitation and wandering. The client has been prescribed risperidone (Risperdal), an atypical antipsychotic. The nurse notifies the practitioner about the order based on which reasoning? a. physical restraints should be trialed before using an antipsychotic medication b. using antipsychotics to manage the behavior of clients with dementia is inappropriate c. the sensory changes that accompany antipsychotic use can exacerbate the symptoms of dementia d. Typical antipsychotics are preferable to traditional sedatives for the treatment of agitation and delirium

b. using antipsychotics to manage the behavior of clients with dementia is inappropriate

An older client with history of arthritis has fallen after an episode of dizziness. Laboratory data reveal anemia and stool positive for occult blood. Which assessment question would be most appropriate for the nurse to ask to ascertain the client's health situation? a. "Do you take any medications for your Blood Pressure?" b. "What herbal remedies or supplements do you use regularly?" c. "Do you take aspirin for the treatment of pain or inflammation?" d. "Does your family doctor ask you to get regularly scheduled blood work?"

c. "Do you take aspirin for the treatment of pain or inflammation?"

A Resident of long-term care facility has been experiencing pain associated with sciatica, a newly developed health problem. Which intervention would be most appropriate for the nurse to implement first? a. Administer morphine or codeine b. Prepare a dose of acetaminophen c. Implement warm socks to the painful areas d. Give fentanyl or sustained-release oxycodone

c. Implement warm socks to the painful areas

A nurse is reviewing the medication history pf a newly admitted older client. The nurse notes that that client has been taking a B-Blocker for many years despite no apparent history of hypertension or cardiac disease. Which action would the nurse take first? a. Hold the drug in the short term until an indication is determined b. Monitor the client's blood pressure and apical heart rate closely c. Request that the practitioner providing car reconsider the use of the drug

c. Request that the practitioner providing car reconsider the use of the drug

An older client has been prescribed a potassium-sparing diuretic and B-blocker for hypertension. Which action should be a priority for the nurse?

c. ensuring the client does not change a position quickly to prevent a fall

1. A gerontological nurse is working to develop programs to address the major chronic illnesses in the local older adult population. A review of this population reveals that the most common chronic illnesses affecting this group correlated with those identified nationally. Which condition would the nurse identify as the priority? a. Diabetes Mellitus b. Hearing Impairments c. Hypertension d. Arthritis

d. Arthritis

1. A gerontological nurse is caring for older clients in an acute care facility. The clients are receiving various medications as part of their treatment plan. When administering the medications to these clients, the nurse integrates information about changes in pharmacokinetics in this client population, identifying which factor as most important? a. Changes in gastrointestinal (GI) motility increase the absorption time for many drugs. b. Drug distribution is unpredictable due to the metabolic and body-composition factors c. Preexisting chronic conditions complicate the drugs' distribution and metabolism. d. Decreased renal and liver function contribution to an increased half-life for many drugs

d. Decreased renal and liver function contribution to an increased half-life for many drugs

The nurse is performing a home visit to an older client who has a history of obesity and poorly controlled hypertension. Which assessment finding would alert the nurse to the possibility of a problem? a. The client has increased the intake of green tea to obtain more antioxidants b. The client has begun taking low-dose aspirin for the prevention of cardiac disease c. The client takes insulin injections three times daily for the treatment of type I diabetes d. The client has started taking St. John's wort to increase stamina and concentration

d. The client has started taking St. John's wort to increase stamina and concentration

1. The nurse caring for residents in a long-term care facility administers numerous antidepressant medications each day. For which resident a. A 90-year-old resident prescribed a monoamine oxidase inhibitor (MAOI) b. An 81-year-old resident who receiving sertraline for the treatment of her depression secondary to an extreme grief reaction c. An 89-year-old resident who takes citalopram, a selective serotonin reuptake inhibitor, for the treatment of depression d. a 91-year-old resident who has been taking a tricyclic antidepressant since the onset of his physical decline several years prior.

d. a 91-year-old resident who has been taking a tricyclic antidepressant since the onset of his physical decline several years prior.

1. An older client has difficulty swallowing oral medicines and sometimes spits them out after the nurse leaves the client's room. Which action should the nurse take to ensure the client swallows the medications?

giving the client ample fluids to make swallowing easier

1. After completing an assessment of an older adult at home, the nurse determines that the client is at risk for medication errors. Which issue did the nurse most likely assess in this client? Select all that apply. a. Hand weakness b. Hearing deficit c. Use of laxatives d. Limited finances e. Walks with a cane

hand weakness hearing deficit limited finances

1. An older client with reduced kidney function was prescribed a barbiturate. The client experienced a severe adverse reaction, which was nearly fatal? The nurse would identify which event as being the most likely reason for this occurrence?

increased biological half life of the drug