Gerontology Test
A nurse is caring for an older adult client who reports that she has just retired and expresses feeling of loneliness due to the loss of daily interactions with coworkers. Which of the following responses should the nurse make? A. "Do you know about the local senior citizen group?" B. "You need to take a vacation." C. "But now you can finally relax and enjoy your life." D. "Why don't you go into work and visit with your old friends?"
A. "Do you know about the local senior citizen group?" The nurse should assist the client in the resocialization process by using the therapeutic communication technique of giving information. Becoming involved in an organization might assist the client in resocialization, which is beneficial to clients who have depended upon their employment for social interaction.
A nurse is caring for an older adult client who is unresponsive following a stroke. Which of the following actions should the nurse take while providing oral care? A. Turn the client on his side before starting oral care B. Use the thumb and index finger to keep the client's mouth open C. Cleanse the client's oral mucosa with a toothbrush D. Perform oral care using sterile gloves
A. Turn the client on his side before starting oral care The nurse should place the client in a lateral position to allow excess fluids to run out of his mouth into a basin, which reduces the risk of aspiration of fluids and secretions.
A nurse is reviewing the basic needs of older adult clients with a group of assistive personnel. Which of the following statements should the nurse include? A. "Caloric needs are increased." B. "Renal function is increased." C. "Deep sleep is decreased." D. "Exercise needs are decreased."
C. "Deep sleep is decreased." The sleep architecture, or time spent in various stages of sleep, changes with aging. The older adult spends less time in stages III and IV, which are the stages of deep sleep. This decrease in time spent in deep sleep can delay healing.
A nurse is reinforcing teaching with a client who is to start taking finasteride. Which of the following statements by the client indicates an understanding of the teaching? A. "I will see improvement in my symptoms within one week." B. "I can expect an increased libido with this medication." C. "I should see a decrease in my PSA levels." D. "I must take this medication within 60 min of sexual activity."
C. "I should see a decrease in my PSA levels." The nurse should emphasize that the decrease in PSA levels with this medication will be measured 6 months after starting treatment. The expected decline is 30% to 50% in the PSA level.
A nurse is an assisted living facility is assisting in the care of an older adult client who moved in 3 months ago following the death of his partner. The client reports awakening early in the morning and admits to feeling very sad. The nurse should identify that the client is experiencing which of the following types of grief? A. Anticipatory grief B. Delayed grief C. Acute grief D. Disenfranchised grief
C. Acute grief The client experiencing acute grief will have both somatic and psychological manifestations of distress, such as the inability to sleep well or profound sadness. The nurse should identify that this client is experiencing acute grief and further evaluate his support system, concurrent stressors in his life, and his ability to manage stress.
A nurse is reviewing the record of a group of older adult clients. Which of the following findings should the nurse identify as an unexpected manifestations of the aging process? A. Decreased absorption of nutrients B. Impaired excretion of medications C. High-pitched frequency hearing loss D. Obesity
D. Obesity The nurse should recognize that although obesity is found among a large percentage of the older adult population, this is an unexpected finding and can lead to cardiovascular disease, diabetes, and stroke.
A nurse is transferring an older adult client who has right-sided weakness from the bed to a wheelchair. Which of the following actions should the nurse take to provide a safe transfer? A. Keep the client at arm's length while performing the transfer B. Bend at the waist to get down on the client's level C. Maintain a straight back and bend at the knees D. Place the wheelchair at the head of the bed on the client's right side
C. Maintain a straight back and bend at the knees The nurse should maintain a straight back and bend at the hips and knees when transferring a client in order to allow the larger muscles of the thighs to do the lifting. Good body mechanics are essential in preventing injury to the nurse.
A nurse is reinforcing teaching with a client who is to start taking alendronate sodium. Which of the following recommendations should the nurse include in the teaching? A. "The medication may be crushed if you have difficulty swallowing it." B. "Drink a full glass of milk when you take the medication." C. "Take the medication at bedtime." D. "Discontinue the medication if you develop heartburn."
D. "Discontinue the medication if you develop heartburn." The nurse should instruct the client to stop taking the medication if she develops heartburn or if it worsens and to contact her provider. This is an indication that esophageal irritation has occurred. Ways to avoid this are to take alendronate with 240 mL (8 oz) of water and to avoid lying down for 30 to 60 min after taking the medication.
A nurse is completing medication reconciliation for an older adult client who is receiving multiple medications. Which of the following actions should the nurse take first? A. Clarify the client's list of medications with the pharmacist B. Compare the current list against the new medication prescriptions C. Investigate any discrepancies on the list D. Ask the client about over-the-counter medications she is taking
D. Ask the client about over-the-counter medications she is taking The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. When performing medication reconciliation, it is important that the nurse collect a list of all the medications the client takes in order to compare the full list of medications against any new medications the client will take. The list should include prescriptions, over-the-counter medications, and herbal and nutritional supplements.
A nurse is reinforcing teaching about ways to improve nutritional intake with a client who has chronic obstructive pulmonary disease and has been losing weight. Which of the following statements by the client indicates an understanding of the teaching? A. "I will choose hot foods to decrease the sense of fullness when eating." B. "I should add grated cheese to sauces and vegetables." C. "I will eat my largest meal of the day in the evening." D. "I should consume a diet high in carbohydrates."
B. "I should add grated cheese to sauces and vegetables." The nurse should reinforce that adding cheese to side dishes will increase his protein and calcium intake, as well as increase calories. This will assist the client in regaining weight and stamina.
A nurse is reinforcing teaching with a group of healthy, older adult clients about expected age-related changes and sexual response. Which of the following changes should the nurse include as an age-related change? A. Decreased refractory time B. Decreased vaginal lubrication C. Loss of female client's orgasm ability D. Premature ejaculation
B. Decreased vaginal lubrication The nurse should inform the clients that a decrease in vaginal secretions is an expected age-related change in older adult female clients. Vaginal dryness might result in painful intercourse, which clients can manage with the use of water-soluble lubricants during intercourse.
A nurse in an adult day care facility is contributing to the development of treatment plans for older adult clients. Which of the following therapeutic strategies should the nurse use to help the clients achieve Erikson's developmental task for this age group? A. Music therapy B. Reminiscence therapy C. Meditation therapy D. Pet therapy
B. Reminiscence therapy The nurse should incorporate reminiscence therapy as a therapeutic strategy for the purpose of encouraging clients to engage in life review. The process of sharing memories helps clients to achieve a sense of fulfillment and self-worth and allows a positive outcome to Erikson's developmental task of integrity vs despair.
A nurse is caring for an older adult client who has moderate hearing loss. Which of the following actions should the nurse take to enhance communication? A. Speak with exaggerated lip movement B. Speak at a moderate rate C. Speak in a louder voice D. Speak using a higher pitch
B. Speak at a moderate rate The nurse should slow the rate of speech, as the older adult client has a difficult time understanding rapid speech. However, the nurse should not speak with an exaggerated slowness because this can distort words and make it difficult for the client to understand.
A nurse is reinforcing teaching with an older adult client who is healthy and has chronic constipation about establishing a bowel retraining program. Which of the following statements should the nurse include in the teaching? A. "Limit physical activity during the day." B. "Set a time limit of 10 minutes when attempting to defecate." C. "Increase the fiber content of your diet." D. "Increase your fluid intake to 5,000 milliliters per day."
C. "Increase the fiber content of your diet." The purpose of a bowel training program is to manipulate factors within the client's control to produce the elimination of a soft-formed stool at regular intervals. The increase of fiber in the client's diet will help to increase the effectiveness of a bowel training program.
A nurse is assisting with the admission of an older adult client who has urinary incontinence and smells strongly of urine. The client's partner, who has been caring for her at home, states that he is sorry and embarrassed about the unpleasant smell. Which of the following responses should the nurse make? A. "A lot of clients who are cared for at home have the same problem." B. "Don't worry about it. She will get a bath, and that will take care of the odor." C. "It must be difficult to care for someone who has incontinence." D. "When was the last time that she had a bath?"
C. "It must be difficult to care for someone who has incontinence." The nurse should use therapeutic responses such as acknowledgement and empathy when addressing the client's partner. This response is nonjudgmental and acknowledges the effort the client's partner has made. The use of therapeutic communication also encourages further discussion and provides the nurse with an opportunity to teach and to evaluate the need for assistance in the home.
A nurse is assisting in the planning of an immunization clinic for older adults. At which of the following times should an older adult client receive the influenza vaccine? A. Once during the client's lifetime B. Every 10 years C. Every 5 years D. Annually in the fall
D. Annually in the fall The nurse should recommend that older adult clients receive the influenza vaccine annually. Influenza outbreaks occur annually, and the influenza virus changes constantly. Consequently, an influenza vaccine from a previous year will not protect a client exposed to this year's influenza strain. Influenza in older adults can result in the development of primary viral influenza pneumonia, which causes several deaths a year. An influenza vaccine given in the fall, prior to the onset of flu season, will be most effective in preventing influenza in this target population.
A nurse is caring for an older adult client who is on bed rest. Which of the following foods should the nurse plan to include on the client's breakfast tray to prevent constipation? A. A banana B. Hash brown potatoes C. An egg and cheese omelet D. Stewed prunes
D. Stewed prunes The nurse should include foods that are high in dietary fiber, such as stewed prunes, to help prevent constipation for the client who is on bed rest.
A nurse is caring for an older adult client who has a terminal illness. The client tells the nurse, "I just want to live one more month so I can see my grandchild get married." Which of the following Kubler-Ross stages of grief should the nurse identify the client is experiencing? A. Depression B. Acceptance C. Denial D. Bargaining
D. Bargaining Bargaining is the third stage of grief, according to Kübler-Ross. Bargaining represents a last effort at overcoming death by earning longer life. Trying to put off death for one last major celebration in the client's life, like the marriage of a grandchild, is a form of bargaining.
A nurse is reinforcing teaching with an older adult client about methods to improve sleep. Which of the following statements should the nurse include in the teaching? A. "Go to bed at the same time every night." B. "Watch television in bed until you are sleepy." C. "Drink a glass of wine before going to bed." D. "Engage in physical activity in the evenings."
A. "Go to bed at the same time every night." The nurse should recommend that the client keep consistent sleep and wake times even on the weekends. Having a regular sleep schedule will help minimize the alterations to the circadian rhythm that occurs in the older adult client.
A nurse is reinforcing teaching with a group of older adult clients about dietary needs. Which of the following dietary recommendations should the nurse include in the teaching? A. "You should consume 1,200 milligrams of calcium daily." B. "Consume 4 percent of your diet as fat." C. "You should drink 1,500 milliliters of fluid daily." D. "Consume 40 percent of your diet as protein."
A. "You should consume 1,200 milligrams of calcium daily." The nurse should encourage the older adult client to increase dietary calcium intake to 1,200 mg daily in divided doses. Good sources of dietary calcium include dairy products, green leafy vegetables, beans, and tofu.
A nurse is caring for a client who has cancer and is using a fentanyl transdermal patch for pain control. Which of the following actions should the nurse take when caring for this client? A. Avoid using a heating pad on the area with the patch B. To decreased the dose, cut the patch in half C. Dispose of the used patch by placing it in the trash can D. Assess the client for urinary retention every 8 hr
A. Avoid using a heating pad on the area with the patch Applying heat over the site of the transdermal patch will increase the rate of absorption of the opioid medication and might cause respiratory depression.
A nurse is collecting data from an older adult client who has chronic pain. Which of the following effects of unrelieved pain should the nurse identify as a priority finding to report? A. Impaired mobility B. Decreased independence C. Decreased self-esteem D. Impaired socialization
A. Impaired mobility The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one positing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse should identify that limited mobility will have an effect on the client's skin integrity, respiratory function, and elimination. Complications of the immobility resulting from unrelieved pain include pressure ulcers, pneumonia, and constipation.
A nurse is collecting data from an older adult client who had a right-sided stroke two days ago. For which of the following findings should the nurse notify the provider immediately? A. Increased restlessness B. Weak grip on the left side C. Decreased sensation in the lower left extremity D. Absent gag reflex
A. Increased restlessness The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs to be the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's level of consciousness to evaluate for increases in intracranial pressure that might have occurred. The nurse should identify increased restlessness as a sign of possible increases in intracranial pressure, which requires immediate intervention.
A nurse is caring for an older adult client who is expressing feelings of grief and longing for his earlier life. Which of the following actions should the nurse take? A. Listen attentively and allow the client to talk about the past B. Change the topic of conversation C. Let the client know that this is a common issue for older adult clients D. Tell the client about some younger clients who are in worse shape than he is
A. Listen attentively and allow the client to talk about the past The nurse should encourage the client to reminisce as a means of dealing with his feelings of grief and longing. This is the therapeutic technique of offering self. Listening to the client allows for venting of the client's feelings about the loss of a healthy, active life. According to Erikson's theory, reminiscence is a necessary activity for older adults, who are in the stage of integrity vs despair.
A nurse is reinforcing teaching about skin changes in the older adult client with a newly licensed nurse. Which of the following findings should the nurse identify as a benign, age-related skin change commonly seen in older adult clients? A. Liver spots B. Nevi C. Atopic dermatitis D. Psoriasis
A. Liver spots Liver spots, also known as age spots or lentigines, are flat, brownish-black macules that usually occur in sun-exposed areas of the body. Aging and exposure to sunlight, or other forms of ultraviolet light, can result in increased pigmentation. Liver spots are extremely common after 40 years of age; they occur most often on the forearms, shoulders, face, forehead, and backs of the hands, which are also the areas of highest sun exposure. They are harmless and painless, but they can affect the client's cosmetic appearance.
A nurse is caring for a client who has aphasia following a stroke. Which of the following actions should the nurse take? A. Present one idea in a sentence B. Avoid using nonverbal communication techniques C. Speak loudly D. Use simplified language
A. Present one idea in a sentence The nurse should present one idea or thought in a sentence to avoid creating frustration for the client. Additionally, the nurse should allow time for the client to process and respond to the nurse.
A nurse is collecting data from an older adult female client. Which of the following findings should the nurse identify as a priority? A. Rales heard in the bases of the lungs B. Constipation C. Urinary frequency D. Painful intercourse
A. Rales heard in the bases of the lungs The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore, the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority-setting framework because adequate ventilator effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable to efficiently carrying oxygen to them. Air moving into collapsed airways results in rales and can occur in clients who have bronchitis, pneumonia, or chronic pulmonary disease. This finding is the priority and requires further data collection.
A nurse at a long-term care facility is reinforcing teaching with an older adult client about ambulating with a quad-cane. Which of the following statements should the nurse include in the teaching? A. "Adjust the height of the cane so that you can flex your elbow at 45 degrees." B. "Hold the cane in the hand on the stronger side of your body." C. "Place the flat side of the cane away from your foot." D. "Move the cane and your stronger leg at the same time."
B. "Hold the cane in the hand on the stronger side of your body." The client should hold the cane with the hand on the stronger side of her body so that she can move the cane to support the weaker leg. This action allows for a more normal gait, with the ipsilateral arm and weaker leg moving at the same time.
A nurse is reinforcing teaching with an older adult client who is to start taking warfarin. Which of the following statements indicates the client understands the teaching? A. "If I miss a dose, I will double it the next day." B. "I can continue to eat green salads." C. "I will need to have laboratory blood testing every 6 months to monitor the effects of the warfarin." D. "I should expect my urine to be pink-tinged while I am taking this medication."
B. "I can continue to eat green salads." The client should have a diet that is consistent in foods containing vitamin K, such as green, leafy vegetables. Sudden increases or decreases in this consumption will alter the coagulation effects of the warfarin. The nurse should report any alterations in consumption of foods containing vitamin K.
A nurse is caring for a client who is using a continuous passive motion device following a right total knee replacement. Which of the following actions should the nurse take when applying the CPM device? A. Apply the CPM device in the flexed position B. Line up the frame joints od the CPM device with the client's knee C. Check the range-of-motion settings on the CPM device daily D. Place the head of the client's bed at 45 degrees during CPM use
B. Line up the frame joints od the CPM device with the client's knee To avoid damage to the operative knee, the nurse should line up the joints of the CPM machine with the client's operative knee.
A nurse is caring for an older adult client who has a hip fracture and is rating his pain at 8 on a scale of 0 to 10. Which of the following medications should the nurse administer? A. Capsaicin topical gel B. Oxycodone/acetaminophen 7.5/325 tablet PO C. Celecoxib 200 mg capsule PO D. Aspirin 325 mg tablet PO
B. Oxycodone/acetaminophen 7.5/325 tablet PO A client who rates his pain as 8 on a scale of 0 to 10 is experiencing severe pain, and the nurse should administer an opioid for this type of pain. Oxycodone/acetaminophen is a combination of an opioid and a nonopioid analgesic medication and is an appropriate medication to administer to the client. The nurse should monitor the client for adverse effects, such as respiratory depression, and proactively address constipation that occurs with opioid use.
A nurse is reinforcing teaching with an older adult client who had a total hip arthroplasty about ambulating with a standard walker. Which of the following actions by the client indicates an understanding of the teaching? A. The clients adjusts the height of the walker so the hand grips are at the level of her waist B. The client moves the walker ahead about 15.24 cm and then steps into the walker C. The client uses the walker to pull herself up from a sitting to a standing position D. The client uses the walker to climb the stairs
B. The client moves the walker ahead about 15.24 cm and then steps into the walker The correct technique for using a walker is to balance on both feet; lift the walker and place it in front; walk into the walker, using it for support when standing on the affected limb; and then balance on both feet before repeating the sequence. This provides maximum support for the client.
A nurse at a long-term care facility is contributing to the plan of care for an older adult client who has dementia. Which of the following interventions should the nurse include in the plan? A. Vary the staff members caring for the client B. Use photographs as memory triggers C. Provide a minimum of three activity choices to the client D. Break client tasks down to three or four steps at a time
B. Use photographs as memory triggers The nurse should place photographs on the unit that trigger the client's memories, such as a picture of a toilet at the entrance to the bathroom, or a picture of the client as a young adult at the entrance to her room.
A nurse is reinforcing teaching with an older adult client about osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Cottage cheese is a good source of calcium." B. "Increase your caffeine intake." C. "Brisk walking will help prevent bone loss." D. "Hormone replacement therapy with estrogen will increase your risk of osteoporosis."
C. "Brisk walking will help prevent bone loss." The nurse should encourage weight-bearing exercises to help minimize bone loss in the older adult client. A sedentary lifestyle, on the other hand, leads to a loss of minerals in the bones, especially calcium and phosphorus.
A nurse at a long-term care facility is contributing to the plan of care for a client who has Alzheimer's disease and wanders at night. Which of the following interventions should the nurse include in the plan? A. Place the client in wrist restraints at night B. Request a prescription for a psychotropic medication C. Assign the client to a room closer to the nurse's station D. Keep the television on at night
C. Assign the client to a room closer to the nurse's station The nurse should place the client who wanders in a room that allows for close observation. The nurse should provide clients who wander a safe place to walk and supervision when the client is ambulating.
A nurse is collecting data from an 85-year-old client. Which of the following findings should the nurse report to the provider? A. A widened anterior-posterior chest diameter B. Presence of an S4 heart sound C. Differences in pulse strength between lower extremities D. Post-void residual of 75 mL
C. Differences in pulse strength between lower extremities A difference in pulse strength can indicate a vascular complication. Assessment of the peripheral vascular system should also include temperature, color, sensation, edema, and skin integrity of both the upper and lower extremities. The nurse should identify any differences in symmetry of these findings and report them.
A nurse is collecting data from an older adult client who has right-sided heart failure. Which of the following findings is the nurse's priority to report? A. Oxygen saturation is 92% on room air B. The client consumes 20% of meals C. Weight has increased 0.91 kg in 24 hr D. The client has 1+ edema in the lower extremities
C. Weight has increased 0.91 kg in 24 hr The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs to be the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should evaluate daily weight of client's experiencing heart failure. A weight gain of 0.45 to 0.91 kg (1 to 2 lb) overnight or 1.36 kg (3 lb) within one week is an indication of worsening heart failure.
A nurse is collecting data from an older adult client who lives alone. Although the client is able to answer all questions appropriately, the nurse notes that that client has a decreased attention span, expresses feelings of overwhelming sadness, and has a low energy level. The nurse should identify that the client is exhibiting manifestations of which of the following disorders? A. Delusions B. Dementia C. Delirium D. Depression
D. Depression The client who has an inability to sleep or complete ADLs is exhibiting manifestations of depression. Depression involves a cluster of manifestations that include changes in sleep habits, appetite, and relationships with others. Clients who have depression might have a decreased ability to make decisions or concentrate and, in some cases, complete ADLs. Anhedonia, the inability to feel happy, is another manifestation of depression.
A nurse is collecting data from an older adult client who reports feeling anxious about financial concerns and having difficulty sleeping for several months. Which of the following actions should the nurse take? A. Encourage exercise 1 hr prior to the client's bedtime B. Inquire into the client's financial concerns C. Refer the client to the facility's chief financial officer D. Determine the client's usual sleep habits
D. Determine the client's usual sleep habits The nurse should collect further data from the client regarding usual bedtime rituals, the difficulties he is currently experiencing, and the impact the current sleep pattern has had on his quality of life. The nurse should identify that anxiety is a common factor that interferes with sleep; however, the nurse needs additional information in order to fully understand the scope of the problem.
A nurse is reviewing the medical record of an older adult client. For which of the following medications should the nurse request a hearing assessment of the client? A. Omeprazole B. Ferrous sulfate C. Digoxin D. Furosemide
D. Furosemide Furosemide can cause ototoxicity, especially in the older adult client, because there is a decrease in medication metabolism in the kidneys. The nurse should monitor clients taking ototoxic medications, such as furosemide, and teach the client the signs and symptoms of ototoxicity, such as tinnitus and difficulty hearing.
