MS Q1 PT 3**

The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first? 1. Check for medication interactions. 2. Determine whether there are medication duplications. 3. Call the prescribing health care provider (HCP) and report polypharmacy. 4. Determine whether a family member supervises medication administration.

2. Determine whether there are medication duplications.

The nurse is caring for an older client in a long-term care facility. Which action contributes to encouraging autonomy in the client? 1. Planning meals 2. Decorating the room 3. Scheduling hair-cut appointments 4. Allowing the client to choose social activities

4. Allowing the client to choose social activities

The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin? 1. Crusting 2. Wrinkling 3. Deepening of expression lines 4. Thinning and loss of elasticity in the skin

1. Crusting

The home care nurse is visiting an older client whose spouse died 6 months ago. Which behavior by the client indicates ineffective coping? 1. Neglecting personal grooming 2. Looking at old snapshots of family 3. Participating in a senior citizens' program 4. Visiting their spouse's grave once a month

1. Neglecting personal grooming

The nurse is providing medication instructions to an older client who is taking digoxin (Lanoxin) daily. The nurse notes that which age-related body change could place the client at risk for digoxin toxicity? 1. Decreased muscle strength and loss of bone density 2. Decreased cough efficiency and decreased vital capacity 3. Decreased salivation and decreased gastrointestinal motility 4. Decreased lean body mass and decreased glomerular filtration rate

4. Decreased lean body mass and decreased glomerular filtration rate

A nurse suspects an older-adult patient is experiencing caregiver neglect. Which assessment findings are consistent with nurse's suspicions? a. flea bites and lice infestation b. left at a grocery store c. refuses to take a bath d. cuts and bruises

a. flea bites and lice infestation

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? a. Ask the patient if the site hurts. b. Turn off the chemotherapy infusion. c. Call the ordering health care provider. d. Administer sterile saline to the reddened area.

b. Turn off the chemotherapy infusion.

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? a. "When your hair grows back, it will be patchy." b. "Don't use your curling iron, and that will slow down the loss." c. "You can get a wig now to match your hair so you will not look different." d. "You should contact "Look Good, Feel Better" to figure out what to do about this."

c. "You can get a wig now to match your hair so you will not look different."

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? a. It is delivered via an Ommaya reservoir and extension catheter. b. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. c. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. d. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

c. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration.

A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? a. Use Dial soap to feel clean and fresh. b. Scented lotion can be used on the area. c. Avoid heat and cold to the treatment area. d. Wear the new bra to comfort and support the area.

c. Avoid heat and cold to the treatment area.

A nurse is caring for an older adult. Which goal is priority? a. adjusting to career b. adjusting to divorce c. adjusting to retirement d. adjusting to grandchildren

c. adjusting to retirement

Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? A. Exercise everyday for 30 minutes B. Follow smoking cessation recommendations C. Follow a vitamin regime is highly recommended D. I recommend excision of the cancer as soon as possible

"Follow smoking cessation recommendations."The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Cigarette smoking is a promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse's role.

The nurse is providing an educational session to new employees, and the topic is abuse of the older client. The nurse helps the employees identify which client as most typically a victim of abuse? 1. A 75-year-old man who has moderate hypertension 2. A 68-year-old man who has newly diagnosed cataracts 3. A 90-year-old woman who has advanced Parkinson's disease 4. A 70-year-old woman who has early diagnosed Lyme disease

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The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological change(s) the nurse expects to note? Select all that apply. 1. Increased heart rate 2. Decline in visual acuity 3. Decreased respiratory rate 4. Decline in long-term memory 5. Increased susceptibility to urinary tract infections 6. Increased incidence of awakening after sleep onset

2. Decline in visual acuity 5. Increased susceptibility to urinary tract infections 6. Increased incidence of awakening after sleep onset

The nurse is providing instructions to the unlicensed assistive personnel (UAP) regarding care of an older client with hearing loss. Which should the nurse tell the UAP about older clients with hearing loss? 1. They are often distracted 2. They have middle ear changes 3. They respond to low-pitched tones 4. They develop moist cerumen production

3. They respond to low-pitched tones

The nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement by the client indicates the need for further teaching regarding measures to improve sleep? 1. "I swim three times a week." 2. "I have stopped smoking cigars." 3. "I drink hot chocolate before bedtime." 4. "I read for 40 minutes before bedtime."

4. "I read for 40 minutes before bedtime."

The visiting nurse observes that the older male client is confined by his daughter-in-law to his room. When the nurse suggests that he walk to the den and join the family, he says, "I'm in everyone's way; my daughter-in-law needs me to stay here." Which is the most important action for the nurse to take? 1. Say to the daughter-in-law, "Confining your father-in-law to his room is inhumane." 2. Suggest to the client and daughter-in-law that they consider a nursing home for the client. 3. Say nothing, because it is best for the nurse to remain neutral and wait to be asked for help. 4. Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens' center.

4. Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens' center.

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 - Rationale: The normal physiological changes that occur in the skin of older adults include thinning of the skin, loss of elasticity, deepening of expression lines, and wrinkling. Crusting noted on the skin would indicate a potential complication. - Geriatric Nursing Exam Questions Test-Taking Strategy: Note the subject , a potential complication. Think about the normal physiological changes that occur in the aging process to direct you to the correct option.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A. A bland, low fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods

A. A bland, low fiber diet Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is mort important for the nurse to ask? A. Have you had a fever? B. Have you lost any weight? C. Has diarrhea been a problem? D. Have you noticed any hair loss?

A. Have you had a fever? An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

recently widowed 80-year-old male is dehydrated and is admitted to the hospital for intravenous fluid replacement. During the evening shift, the patient becomes acutely confused. The nurse's best action is to assess the patient for which of the following reversible causes? (Select all that apply.) a. Electrolyte imbalance b. Hypoglycemia c. Drug effects d. Dementia e. Cerebral anoxia

ANS: A, B, C, E Delirium, or acute confusional state, is a potentially reversible cognitive impairment that is often due to a physiological event. Physiological causes of delirium can include electrolyte imbalances, cerebral anoxia, hypoglycemia, medications, drug effects, tumors, subdural hematomas, and cerebrovascular infection, infarction, or hemorrhage. Unlike delirium, dementia is a gradual, progressive, irreversible cerebral dysfunction.

Which of these assessments of an older adult, who has a urinary tract infection, requires an immediate nursing intervention? a. Presbycusis b. Confusion c. Death of a spouse 3 months ago d. Temperature of 97.6° F

ANS: B Confusion is a common manifestation in older adults with urinary tract infection; however, the cause requires further assessment. There may be another reason for the confusion. Confusion is not a normal finding in the older adult, even though it is commonly seen with concurrent infections. Difficulty hearing, presbycusis, is an expected finding in an older adult. Coping with the death of a spouse is a psychosocial concern to be addressed after the acute physiological concern in this case. Older adults tent to have lower temperatures, so the nurse needs to assess for slight elevations. A temperature of 97.6° F is within normal limits.

The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first? a) Check for medication interactions. b) Determine whether there are medication duplications. c) Call the prescribing health care provider (HCP) and report polypharmacy. d) Determine whether a family member supervises medication administration.

B - Rationale: Polypharmacy is a concern in the older client. Duplication of medications needs to be identified before medication interactions can be determined because the nurse needs to know what the client is taking. Asking about medication administration supervision may be part of the assessment but is not a first action. The phone call to the HCP is the intervention after all other information has been collected. - Test-Taking Strategy: Note the strategic word first . Also note that the nurse is visiting the client for the first time. Options A, C, and D should be done after possible medication duplication has been identified.

The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological change(s) the nurse expects to note? Select all that apply. a) Increased heart rate b) Decline in visual acuity c) Decreased respiratory rate d) Decline in long-term memory e) Increased susceptibility to urinary tract infections f) Increased incidence of awakening after sleep onset

B, E, F - Geriatric Nursing Exam Questions Rationale: Anatomical changes to the eye affect the individual's visual ability, leading to potential problems with activities of daily living. Light adaptation and visual fields are reduced. Although lung function may decrease, the respiratory rate usually remains unchanged. Heart rate decreases and heart valves thicken. Age-related changes that affect the urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory usually is maintained. Change in sleep patterns is a consistent, age-related change. Older persons experience an increased incidence of awakening after sleep onset.

An important nursing action to help a chronically ill older adult is to A. Avoid discussing the future lifestyle changes B. Ensure the patient that the condition is stable C. Treat the patient as a competent manager of the disease D. Encourage the patient to "fight" the disease as long as possible

C. Treat the patient as a competent manager of the disease

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add the plan of care? A. Compromised family coping related to disruption in lifestyle B. Impaired home maintenance related to perceived role changes C. Risk for caregive role strain to burdens of caregiving responsibilities D. Dysfunctional family processes related to effect of illness on family members

D. Dysfunctional family processes related to effect of illness on family members

Which nursing diagnosis is most appropriate for a patient experiencing myelosupporession secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection

D. Risk for infection

A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? A. The cancer is found at the point of origin only B. Tumor cells have been identified in the cervical region C. The cancer has been identified in the cervix and liver D. Your cancer was identified in the cervix and has limited local spread

D. You cancer was identifies in the cervix and has limited local spread

Patients may reduce the risk of developing cancer using health promotion strategies.Identify strategies which can reduce the risk of developing cancer (select all that apply.). Select all that apply. a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake

a, b, c, d, e, f

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years b. Family history of colorectal cancer and consumes a high-fiber diet c. Limits fat consumption and has regular mammography and Pap screenings d. Exercises five times every week and does not consume alcoholic beverages

a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? a. Cells are abnormal and moderately differentiated. b. Cells are very abnormal and poorly differentiated. c. Cells are immature, primitive, and undifferentiated. d. Cells differ slightly from normal cells and are well-differentiated.

a. Cells are abnormal and moderately differentiated.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply.)? Select all that apply. a. Maintain hope. b. Exhibit a caring attitude. c. Plan realistic long-term goals. d. Give them antianxiety medications. e. Be available to listen to fears and concerns. f. Teach them about the types of cancer that could be diagnosed.

a. Maintain hope. b. Exhibit a caring attitude. d. Give them antianxiety medications.

A nurse is caring for an older adult client. The nurse should recognize the client is at risk for which of the following physiological changes? (select all that apply) a. decreased gastric motility b. decreased skin elasticity c. increased pain threshold d. increased metabolic rate e. increased cardiac output

a. decreased gastric motility b. decreased skin elasticity c. increased pain threshold

A nurse is teaching a class of older adults about the expected physiologic changes of aging. Which of the following changes should the nurse include in the discussion? (select all that apply) a. more difficulty seeing due to a greater sensitivity to glare b. decreased cough reflex c. decreased bladder capacity d. decreased systolic blood pressure e. dehydration of interveterbal discs

a. more difficulty seeing due to a greater sensitivity to glare b. decreased cough reflex c. decreased bladder capacity e. dehydration of interveterbal discs

Which information from a co-worker on a gerontological unit will cause the nurse to intervene? a. most older people have dependent functioning b. most older people have strengths we should focus on c. most older people should be involved in care decisions d. most older people should be encouraged to have independence

a. most older people have dependent functioning

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? a. Hypokalemia b. Hypocalcemia c. Hypouricemia d. Hypophosphatemia

c. Hypouricemia

Which patient is statistically and medically at the highest risk of developing cancer? a. A 68-yr-old white woman who has BRCA-1 gene and is obese b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily c. An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol d. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily

A nurse is obtaining a history on an older adult. Which finding will the nurse most typically find? a. lives in a nursing home b. lives with a spouse c. lives divorced d. lives alone

b. lives with a spouse

A nurse is developing a plan of care for an older adult. Which information will the nurse consider? a. Should be standardized because more geriatric patients have the same needs b. needs to be individualized to the patient's unique needs c. focuses on the disabilities that all aging persons face d. must be based on chronological age alone

b. needs to be individualized to the patient's unique needs

The patient is told that her adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? a. It will recur. b. It has metastasized. c. It is probably benign. d. It is probably malignant.

c. It is probably benign

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. Which question would best determine treatment measures for the patient's pain? a. "Where is the pain?" b. "Is the pain getting worse?" c. "What does the pain feel like?" d. "Do you use medications to relieve the pain?"

c. "What does the pain feel like?"

A nurse is teaching a group of older-adult patients. Which teaching strategy is best for the nurse to use? a. provide several topics of discussion at once to promote independence and making choices b. avoid uncomfortable silences after questions by helping patients complete their statements c. ask patients to recall past experiences that correspond with their interests d. speak in a high pitch to help patients hear better

c. ask patients to recall past experiences that correspond with their interests

A nurse is observing skin integrity of an older adult. Which finding will the nurse document as a normal finding? a. oily skin b. faster nail growth c. decreased elasticity d. increased facial hair in men

c. decreased elasticity

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? a. The medications the patient is taking b. The nutritional supplements that will help the patient c. How much time is needed to provide the patient's care d. The time the nurse spends at what distance from the patient

d. The time the nurse spends at what distance from the patient

A patient has multiple myeloma and will be treated with autologous hematopoietic stem cell transplantation because a suitable donor has not been found. In which order will the following procedures occur? (Answer with a letter followed by a comma and a space (e.g. A, B, C, D).) a. Myeloablative chemotherapy is administered. b. Stem cells are infused after chemotherapy has been eliminated from the body. c. Peripheral stem cells are obtained from the peripheral blood in an outpatient procedure. d. Filgrastim, a granulocyte colony-stimulating factor, is administered with plerixafor (Mozobil). e. Stem cells are treated to remove undetected cancer cells then cryopreserved and stored until needed.

d, c, e, a, b

The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia that is schedule for hematopoietic stemm cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? a. "I understand the transplant procedure has no dangerous side effects." b. "After the transplant, I will feel better and can go home in 5 to 7 days." c. "My brother will be a 100% match for the cells used during the transplant." d. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

d. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? a. Firm-bristle toothbrush b. Hydrogen peroxide rinse c. Alcohol-based mouthwash d. 1 tsp salt in 1 L water mouth rinse

d. 1 tsp salt in 1 L water mouth rinse

The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? a. Morphine sulfate b. Ibuprofen (Advil) c. Ondansetron (Zofran) d. Acetaminophen (Tylenol)

d. Acetaminophen (Tylenol)

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? a. Increase intake of liquids at mealtime to stimulate the appetite. b. Serve three large meals per day plus snacks between each meal. c. Avoid the use of liquid protein supplements to encourage eating at mealtimes. d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? a. Bacteria b. Sun exposure c. Most chemicals d. Epstein-Barr virus

d. Epstein-Barr virus

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? a. Metastasis b. Tumor angiogenesis c. Immunologic escape d. Immunologic surveillance

d. Immunologic surveillance

A 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care? a. Provide ice chips to soothe the irritation. b. Weigh the patient every month to monitor for weight loss. c. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. d. Provide high-protein and high-calorie, soft foods every 2 hours.

d. Provide high-protein and high-calorie, soft foods every 2 hours. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in proetin and high in calories to aid healing Extreme temperatures should be avoided. Saline or water should be used to clean the moth (not hydrigen peroxide0 Patients should be weighed at least twice each week to monitor for weight loss

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? a. Weight gain of 6 lb b. Nausea and vomiting c. Urine specific gravity of 1.004 d. Serum sodium level of 118 mEq/L

d. Serum sodium level of 118 mEq/L

An older-adult patient in no acute distress reports being less able to taste and smell. What is the nurse's best response to this information? a. notify the health care provider immediately to rule out cranial nerve damage b. schedule the patient for an appointment at a smell and taste disorders clinic c. perform testing on the vestibulocochlear nerve and a hearing test d. explain to the patient that diminished senses are normal findings

d. explain to the patient that diminished senses are normal findings

An older patient has fallen and suffered a hip fracture. As a consequence, the patient's family is concerned about the patient's ability to care for self, especially during this convalescence. What should the nurse do? a. stress that older patients usually ask for help when needed b. inform the family that placement in a nursing center is a permanent solution c. tell the family to enroll the patient in a ceramics class to maintain quality of life d. provide information and answer questions as family members make choices among care options

d. provide information and answer questions as family members make choices among care options