Care Exam 4

Which of the following individuals is most likely to possess an increased risk of developing Alzheimer's disease in the future? A) A man with a family history of Down syndrome B) A woman with a diagnosis of autism C) A man whose admission assessment reveals polypharmacy D) A woman with poorly controlled type 1 diabetes`

A Feedback: A family history of Down syndrome is a risk factor for Alzheimer's disease. Autism is not a noted risk factor and both polypharmacy and poorly controlled blood sugar could contribute to delirium, not dementia.

Early diagnosis of diabetes in the elderly is often difficult because the classic symptoms of diabetes may be absent. What is the most reliable indicator of diabetes in the elderly? A) High blood glucose level B) Glaucoma C) High urinary glucose level D) Kidney failure

A Feedback: A high blood glucose level, as shown by a glucose tolerance test, is the most reliable indicator. Although glycosuria is evident in younger diabetic patients, it may not occur in the elderly, even when they have hyperglycemia. Glaucoma and kidney failure may result from diabetes eventually, but they can also have other causes.

Which of the following older adults is most likely to have his or her health problem characterized as delirium rather than dementia? A) Mr. L, whose wife has brought him to the emergency department because of the forgetfulness and confusion that he has exhibited over the last 48 hours. B) Mrs. O, whose children state that her personality has changed markedly and who has difficulty finding words lately. C) Mr. J, who has developed an unsteady and awkward gait coupled with uncoordinated motor skills in recent months. D) Mrs. Y, who was diagnosed with a brain tumor and who has experienced consequent changes in behavior and cognition.

A Feedback: A rapid onset of cognitive changes is indicative of delirium. Personality and language changes, deterioration in motor skills, and changes attributable to an organic change such as a tumor are more closely associated with dementia.

Based on a 77-year-old client's signs and symptoms, the care team suspects an overactive thyroid gland. Which of the following components of assessment is most likely to yield information that is central to the diagnosis? A) A review of the client's medications, specifically the use of cardiac medications. B) Measurement of the patient's respiration rate, breath sounds, and oxygen saturation. C) Blood work that focuses on liver function. D) Assessment of renal function including a 24-hour urine.

A Feedback: Amiodarone is commonly implicated in cases of hyperthyroidism. Respiratory status and renal and liver function are not directly related to hyperthyroidism.

Which of the following statements best conveys the relationship between hyperglycemia and glycosuria in older adults? A) Older adults' kidneys tolerate higher glucose levels, so hyperglycemia does not necessarily result in glycosuria. B) Because older adults often display atypical signs and symptoms of diabetes, glycosuria coupled with hyperglycemia is considered the most accurate source of a definitive diagnosis. C) Decreased renal filtration capacity in older individuals causes their urine to normally contain more glucose than younger adults'. D) Glycosuria is considered a pathological finding in younger adults but a normal finding in older adults.

A Feedback: An increased renal threshold for glucose means that older adults with hyperglycemia will not necessarily have glycosuria. Hyperglycemia coupled with glycosuria is not, however, considered the most accurate source of diagnosis. Older adults' urine does not normally contain more glucose than younger people's and glycosuria is not considered a normal finding.

The husband of an elderly woman notices that she is posting reminder notes to herself throughout the house and making many lists. He thinks these behaviors might be early signs of Alzheimer's disease. What should he do? A) Be alert for signs of depression. B) Ignore the signs he has noticed. C) Provide his wife with zinc and antioxidant supplements. D) Ask his wife's physician to order blood work.

A Feedback: Depression is a risk in the early stages of Alzheimer's disease. Although the husband may not want to mention the signs to his wife—she may merely be trying to be more organized—he should not ignore them himself, but be alert for further problems. Supplements may be too late if she already has Alzheimer's disease, and their worth has not been proved. At this stage, there is little use having blood work.

Which of the following is most likely to be a cause of dementia in an older adult rather than a cause of delirium in an older adult? A) Genetic predisposition B) Hyperlipidemia C) Creutzfeldt-Jakob disease D) Hypertension

A Feedback: Genetic predisposition is most likely to be a cause of dementia in an older adult. Hyperlipidemia and hypertension are more likely to cause delirium. Creutzfeldt-Jakob disease is likely to be a cause of dementia but it is extremely rare.

Which of the following therapies may be most helpful in slowing the progression of symptoms in Alzheimer's disease? A) Medications that stop or slow the enzyme that breaks down acetylcholine B) Avoiding exposure to aluminum C) Prophylactic use of antibiotics D) Avoiding exposure to zinc

A Feedback: Medications that stop or slow the enzyme that breaks down acetylcholine may be helpful in slowing the progression of symptoms in Alzheimer's disease. Avoiding exposure to aluminum has not been conclusively identified as having a role in the development of Alzheimer's disease. Low zinc levels are present in persons with Alzheimer's disease, although it is not known if this is a cause or a result of the disease. There is no evidence that prophylactic antibiotics can slow the progression of Alzheimer's disease, let alone prevent it.

Patients with newly diagnosed diabetes are often fearful and nervous about coping with the disease. Only some of their fears are unfounded. Which of these concerns is undeniably true? A) "I will have to make lifestyle changes." B) "I can't learn to inject myself with insulin." C) "I will eventually have to enter a nursing home." D) "I can't afford a special diet."

A Feedback: Most people can adapt to injecting themselves with insulin, and some patients may be able to use oral hypoglycemic agents instead. If diabetes is well managed, patients can continue residing at home, working, and in general living their normal lives. The dietary changes do not need to be expensive, although they do require some planning. It is true, however, that if diabetes is to be managed successfully, the patient cannot continue life as usual. Diet, exercise, and medication all will be needed to keep the disease in check.

Which one of the following statements about delirium and dementia is most accurate? A) A person who has dementia can suffer from delirium. B) Dementia and delirium are the same. C) Delirium causes a progressive, irreversible decline in cognition. D) Dementia occurs in all elderly persons.

A Feedback: Persons with dementia can develop delirium as a response to an acute condition but be undiagnosed because changes are not understood or identified. Both dementia and delirium cause cognitive impairment, but there are significant differences in the two disorders. Dementia causes a progressive, irreversible decline in cognition. Dementia occurs in approximately 5% of the elderly population.

A 74-year-old has been diagnosed with type 2 diabetes based on the results of glucose tolerance test during a current hospital stay. The care team has prescribed oral glimepiride. Which of the following guidelines should the patient's nurse use in the administration of the new drug? A) Administer the drug 30 minutes before each meal, beginning the drug with a low dose. B) Give the glimepiride only if blood glucose exceeds 200 mg/dL (11.1 mmol/L). C) Drug levels will be required to determine the therapeutic serum concentration of the drug. D) Hold the drug if the patient exhibits signs and symptoms of hyperglycemia.

A Feedback: Sulfonylurea should be given half an hour before meals and should begin with a lower dose than among younger adults. Administration would not be held if blood glucose was less than 200 mg/dL and hyperglycemia would be an indication to withhold glimepiride. Drug levels are not required.

An autopsy is performed to determine the cause of death in an elderly man who may have been poisoned. His brain tissue shows neuritic plaques and neurofibrillary tangles in the cortex, but no other abnormalities. What would the future have held for him if he had lived? A) Neuronal degeneration in the neocortex and hippocampus B) Dementia associated with smoking and hypertension C) Neuronal atrophy in the frontal lobes D) Lewy body dementia

A Feedback: The man's brain shows signs of Alzheimer's disease. Vascular dementia (B) and frontotemporal dementia (C) have other indications. Lewy body dementia brain tissue would be similar to that in Alzheimer's but would also contain Lewy bodies.

The elderly population has a high incidence of hyperglycemia. Compared with younger adults, what makes the elderly more vulnerable to this disorder? A) Glucose intolerance B) Improved diagnostic tests C) Diabetes prevalence D) Obesity prevalence

A Feedback: The physiologic deterioration of glucose tolerance with age increases the risk of hyperglycemia for the elderly. The other choices increase the risk for the population as a whole, including young people.

A daughter complains that her mother, who has Alzheimer's disease, thinks and acts so slowly that everything must be done for her. What can a nurse advise the daughter that might be helpful for both the patient and herself? A) "Encourage your mother's self-care, but under supervision." B) "Continue doing things for your mother to save time." C) "Investigate respite care for yourself." D) "Allow your mother to self-care, and let her do it independently."

A Feedback: This is a frustrating situation for both the mother and the daughter. Allowing self-care to continue will help the mother's own feelings of independence, but it should be supervised in case she needs some help or is in danger. It may be possible to have an outsider help to give the daughter a break. Longer respites can be helpful for caregivers (and indirectly for patients), but that is a broader issue.

Which of the following would most likely be associated with delirium in older adults? (Select all that apply.) A) Urinary tract infection B) Dehydration secondary to gastroenteritis C) Low zinc levels D) A new medication that causes confusion E) Neurofibrillary tangles

A Feedback: Urinary tract infection, dehydration, and a new medication are all acute conditions that may cause temporary impairment of cerebral circulation and cause disturbances in cognitive function. Low zinc levels and neurofibrillary tangles are present in persons with Alzheimer's disease.

The nurse assesses a group of older adults at a senior center for conditions related to an aging endocrine system. Which of the following assessment findings should the nurse prioritize and address first? A) Blood glucose of 300 in an 88-year-old person B) Metabolic syndrome in a 67-year-old person C) New onset of peripheral edema and constipation in a 72-year-old adult D) The presence of a Dupuytren contracture in a 78-year-old adult

A Feedback: While all are abnormal findings and need addressing, the elevated blood glucose is the priority before the patient develops other issues with the hyperglycemia.

A 70-year-old male resident of a long-term care facility is in the advanced stages of Alzheimer's disease. Consequently, the resident frequently wanders throughout and, on more than one occasion, outside the facility. Due to his cognitive deficits, he is not responsive to patient teaching and redirection. What is the nurse manager's best response to the resident's behavior? A) Provide a controlled and safe place for the patient to wander. B) Work with the resident's family to establish a supervision schedule. C) Administer the minimum effective dose of a sedative when the resident is most restless. D) Begin placing the resident in a wheelchair with a tray when he shows signs of restlessness.

A Feedback: While enlisting the help of family to ensure the resident's safety may be useful, establishing a safe and defined area for the resident to wander is ideal and is preferable to chemical or physical restraint.

The nursing staff at a long-term care facility are providing care for a male resident who requires total assistance owing to his severe Alzheimer's disease. Which of the following nursing actions are likely to foster the resident's dignity, personal worth, and individuality? (Select all that apply.) A) Ensuring that nursing actions are performed in privacy as much as possible. B) Using the resident's name when interacting with him, despite the fact that he is disoriented to person. C) Giving the resident choices and options even though he has difficulty making decisions. D) Attempting to engage the resident in conversation despite his cognitive losses. E) Minimizing stressors by performing as many of his ADLs as possible.

A, B, C, D Feedback: The nursing actions in answers A, B, C, and D can all facilitate the resident's dignity, freedom, and worth. Even if ADLs take longer for the resident to perform them himself, nurses should still allow for them rather than doing them for the resident.

The nurse educated the patient with newly diagnosed diabetes. Which of the learning outcomes would be appropriate? (Select all that apply.) A) To demonstrate the correct method of blood glucose testing B) To demonstrate the proper technique for administration of antidiabetic medication C) To lose 5 lb a week for the next 52 weeks D) To remain with heart rate within normal limits E) To verbalize understanding of diabetes and its management

A, B, E Feedback: Weight loss of 1 to 2 lb a week is suggested if indicated, and no direct cardiovascular effects are expected. Heart rate is not related to this learning outcome.

Which of the following statements by patients on a geriatric medicine unit would be considered suggestive of hypothyroidism? (Select all that apply.) A) "I've never been prone to constipation in the past, but lately I'm only having a bowel movement every 3 or 4 days." B) "I'm having a terrible time getting to sleep at night and I keep waking up early." C) "Lately I just can't manage to stay warm no matter how high I keep the thermostat." D) "I've always been a cheerful person but now I can't shake this blue feeling." E) "I feel like I just don't have the energy that I normally do."

A, C, D, E Feedback: Constipation, cold intolerance, depression, and fatigue are associated with hypothyroidism. Insomnia is more commonly present in cases of hyperthyroidism.

While listening to the posterior chest of a patient who is experiencing acute shortness of breath, the nurse hears these sounds. How should the nurse document the lung sounds? Click here to listen to the audio clip a. Pleural friction rub b. Low-pitched crackles c. High-pitched wheezes d. Bronchial breath sounds

ANS: C Wheezes are continuous high-pitched or musical sounds heard initially with expiration. The other responses are typical of other adventitious breath sounds.

6. A patient diagnosed with delirium is experiencing perceptual alterations. Which environmental adjustment should the nurse make for this patient? a. Provide a well-lit room without glare or shadows. Limit noise and stimulation. b. Maintain soft lighting day and night. Keep a radio on low volume continuously. c. Light the room brightly day and night. Awaken the patient hourly to assess mental status. d. Keep the patient by the nurse's desk while awake. Provide rest periods in a room with a television on.

ANS: A A quiet, shadow-free room offers an environment that produces the fewest sensory perceptual distortions for a patient with cognitive impairment associated with delirium. The other options have the potential to produce increased perceptual alterations.

1. An older adult patient takes multiple medications daily. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of: a. delirium. b. dementia c. amnestic syndrome. d. Alzheimer's disease.

ANS: A Delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded consciousness, perceptual disturbances, and disturbed memory and orientation. The onset of dementia or Alzheimer's disease, a type of dementia, is more insidious. Amnestic syndrome involves memory impairment without other cognitive problems.

4. What is the priority nursing diagnosis for a patient with fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations? a. Risk for injury related to altered cerebral function, fluctuating levels of consciousness, disturbed orientation, and misperception of the environment b. Bathing/hygiene self-care deficit related to cerebral dysfunction, as evidenced by confusion and inability to perform personal hygiene tasks c. Disturbed thought processes related to medication intoxication, as evidenced by confusion, disorientation, and hallucinations d. Fear related to sensory perceptual alterations as evidenced by visual and tactile hallucinations

ANS: A The physical safety of the patient is of highest priority among the diagnoses given. Many opportunities for injury exist when a patient misperceives the environment as distorted, threatening, or harmful or when the patient exercises poor judgment or when the patient's sensorium is clouded. The other diagnoses may be concerns, but are lower priorities.

A patient with acute dyspnea is scheduled for a spiral computed tomography (CT) scan. Which information obtained by the nurse is a priority to communicate to the health care provider before the CT? a. Allergy to shellfish c. Respiratory rate of 30 b. Apical pulse of 104 d. O2 saturation of 90%

ANS: A Because iodine-based contrast media is used during a spiral CT, the patient may need to have the CT scan without contrast or be premedicated before injection of the contrast media. The increased pulse, low oxygen saturation, and tachypnea all indicate a need for further assessment or intervention but do not indicate a need to modify the CT procedure.

On auscultation of a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding? a. Inspiratory crackles at the bases b. Expiratory wheezes in both lungs c. Abnormal lung sounds in the apices of both lungs d. Pleural friction rub in the right and left lower lobes

ANS: A Crackles are low-pitched, bubbling sounds usually heard on inspiration. Wheezes are high-pitched sounds. They can be heard during the expiratory or inspiratory phase of the respiratory cycle. The lower third of both lungs are the bases, not apices. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration.

Which of the following statements is true about dysarthria? a. Does not affect intelligence b. Stems from severe rheumatoid arthritis c. Physical therapy can be beneficial d. Can affect the balance

ANS: A Dysarthria is a speech disorder caused by a weakness or incoordination of the speech muscles. It occurs as a result of central or peripheral neuromuscular disorders that interfere with the clarity of speech and pronunciation; it does not affect intelligence. It does not stem from rheumatoid arthritis. Occupational therapy can help. Dysarthria does not affect balance.

The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea over the past 3 days. Which finding is important for the nurse to report to the health care provider? a. Respirations are 36 breaths/min. b. Anterior-posterior chest ratio is 1:1. c. Lung expansion is decreased bilaterally. d. Hyperresonance to percussion is present.

ANS: A The increase in respiratory rate indicates respiratory distress and a need for rapid interventions such as administration of O2 or medications. The other findings are common chronic changes occurring in patients with COPD.

2. At 10 PM, an older male resident attempts to climb over the bedrails. Which intervention should the nurse implement first? a. Talk to the resident about his behavior. b. Call the physician, and ask for a sedative. c. Apply a vest restraint on the resident. d. Get a companion to keep him in the bed.

ANS: A The resident is expressing a need that the nurse can potentially determine with gentle questioning. Pharmacologic intervention can be necessary but should not replace careful evaluation and management of the underlying cause. Simply restraining the patient will not address the underlying problem, and the imposition of restraints can trigger delirium. Applying a restraint is the last resort, and the nurse must consider the problems that accompany the application of restraints before doing so. Placing a companion in the room can be an effective method of keeping the resident safe if the companion can determine and meet the resident's needs.

1. A patient is scheduled for a computed tomography (CT) scan of the chest with contrast media. Which assessment findings should the nurse report to the health care provider before the patient goes for the CT (select all that apply)? a. Allergy to shellfish b. Patient reports claustrophobia c. Elevated serum creatinine level d. Recent bronchodilator inhaler use e. Inability to remove a wedding band

ANS: A, C Because the contrast media is iodine based and may cause dehydration and decreased renal blood flow, asking about iodine allergies (such as allergy to shellfish) and monitoring renal function before the CT scan are necessary. The other actions are not contraindications for CT of the chest, although they may be for other diagnostic tests, such as magnetic resonance imaging or pulmonary spirometry.

An older adult is diagnosed with Alzheimer's disease (AD). The nurse knows that this diagnosis is made on the presence of which of the following? (Select all that apply.) a. A decline from a previous level of functioning b. Fluctuation of symptoms over the course of a 24-hour period c. An insidious onset d. A gradual decline in cognitive abilities e. The cognitive changes worsen in the evening hours

ANS: A, C, D A diagnosis of a neurocognitive disease attributable to AD requires (1) a decline from a previous level of functioning, (2) that the onset was insidious, and (3) that there has been gradual decline in cognitive abilities. Of important note is that the changes are "greater than expected for the person's age and educational background," and these changes can be documented with standardized neuropsychological testing. The other options are indicative of delirium.

7. Which assessment finding would be likely for a patient experiencing a hallucination? The patient: a. looks at shadows on a wall and says, "I see scary faces." b. states, "I feel bugs crawling on my legs and biting me." c. reports telepathic messages from the television. d. speaks in rhymes.

ANS: B A hallucination is a false sensory perception occurring without a corresponding sensory stimulus. Feeling bugs on the body when none are present is a tactile hallucination. Misinterpreting shadows as faces is an illusion. An illusion is a misinterpreted sensory perception. The other incorrect options apply to thought insertion and clang associations.

5. What is the priority intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations? a. Distraction using sensory stimulation b. Careful observation and supervision c. Avoidance of physical contact d. Activation of the bed alarm

ANS: B Careful observation and supervision are of ultimate importance because an appropriate outcome would be that the patient will remain safe and free from injury. Physical contact during care cannot be avoided. Activating a bed alarm is only one aspect of providing for the patient's safety.

8. Consider these health problems: Lewy body disease, frontal-temporal lobar degeneration, and Huntington's disease. Which term unifies these problems? a. Cyclothymia b. Dementia c. Delirium d. Amnesia

ANS: B The listed health problems are all forms of dementia.

Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? a. Listen to a patient's lung sounds for wheezes or crackles. b. Label specimens obtained during percutaneous lung biopsy. c. Instruct a patient about how to use home spirometry testing. d. Measure induration at the site of a patient's intradermal skin test.

ANS: B Labeling of specimens is within the scope of practice of UAP. The other actions require nursing judgment and should be done by licensed nursing personnel.

The nurse observes a student who is listening to a patient's lungs. Which action by the student indicates a need to review respiratory assessment skills? a. The student compares breath sounds from side to side at each level. b. The student listens during the inspiratory phase, then moves the stethoscope. c. The student starts at the apices of the lungs, moving down toward the lung bases. d. The student instructs the patient to breathe slowly and deeply through the mouth.

ANS: B Listening only during inspiration indicates the student needs a review of respiratory assessment skills. At each placement of the stethoscope, listen to at least one cycle of inspiration and expiration. During chest auscultation, instruct the patient to breathe slowly and a little deeper than normal through the mouth. Auscultation should proceed from the lung apices to the bases, comparing opposite areas of the chest, unless the patient is in respiratory distress or will tire easily.

A new nurse in a long-term care facility is caring for a patient with Parkinson's disease (PD). The nurse should note which one of the following actions related to PD that is observed during the assessment? a. Tremors during sleep b. Cogwheel rigidity c. Frequent blinking d. Fast movements

ANS: B Patients with PD display slow movement, infrequent blinking, masked facies, and cogwheel rigidity. Patients with PD exhibit tremors at rest in their hands, arms, legs, feet, and jaw.

A patient admitted to the emergency department complaining of sudden onset shortness of breath is diagnosed with a possible pulmonary embolus. How should the nurse prepare the patient for diagnostic testing to confirm the diagnosis? a. Ensure that the patient has been NPO. b. Start an IV so contrast media may be given. c. Inform radiology that radioactive glucose preparation is needed. d. Instruct the patient to expect to inspire deeply and exhale forcefully.

ANS: B Spiral computed tomography scans are the most commonly used test to diagnose pulmonary emboli and contrast media may be given IV. Bronchoscopy is used to detect changes in the bronchial tree, not to assess for vascular changes, and the patient should be NPO 6 to 12 hours before the procedure. Positron emission tomography scans are most useful in determining the presence of malignancy and a radioactive glucose preparation is used. For spirometry, the patient is asked to inhale deeply and exhale as long, hard, and fast as possible.

The nurse observes that a patient with respiratory disease experiences a decrease in SpO2 from 93% to 88% while the patient is ambulating. What is the priority action of the nurse? a. Notify the health care provider. b. Administer PRN supplemental O2. c. Document the response to exercise. d. Encourage the patient to pace activity.

ANS: B The drop in SpO2 to 85% indicates that the patient is hypoxemic and needs supplemental O2 when exercising. The other actions are also important, but the first action should be to correct the hypoxemia.

An older man comes to the emergency department after falling at home, and he reports that he cannot walk without losing his balance. Which steps should the nurse implement for this patient? a. Arrange to transfer him immediately to the radiology department. b. Determine symptom onset or when he fell at home. c. Organize the reperfusion recombinant tissue plasminogen activator (rt-PA) infusion. d. Perform a comprehensive neurological assessment.

ANS: B The nurse determines when the symptoms first appeared or the time of the fall to determine whether sufficient time is left to administer reperfusion rt-PA; if indicated, rt-PA must be administered within 3 hours of symptom onset. A patient with clinical indicators of a stroke will need a computed tomography scan to differentiate between a thrombotic stroke and a hemorrhagic stroke; the type of stroke will determine the therapeutic course. The time of symptom onset is a vital piece of information that must be determined before the patient is referred to the radiology department because rt-PA is usually administered in the radiology suite. Administering rt-PA can be contraindicated for this patient; therefore, the preparation of this infusion is delayed until the type of stroke and the plan of care are determined. The nurse will not have enough time to complete a comprehensive assessment and thus will perform a focused assessment in preparation for the trip to radiology.

Which of the following are common side effects of Parkinson's disease (PD) and the medications used to treat it? (Select all that apply.) a. Skin irritation b. Dyskinesias c. Dystonia d. Nausea

ANS: B, C Medication therapy is complicated and must be closely supervised. Hypotension, dyskinesias (involuntary movements), dystonia (lack of control of movement), hallucinations, sleep disorders, and depression are common side effects of both the disease and the medications used to treat it. Nausea is not a side effect of PD.

Which of the following behavior modifications should the nurse instruct a patient to accomplish to help reduce the risk factors for an occurrence of a stroke? (Select all that apply.) a. Increase the intake of green, leafy vegetables. b. Stop smoking. c. Control blood pressure. d. Increase physical activity.

ANS: B, C, D Stopping smoking, keeping blood pressure under control, and incorporating physical activities are all modifiable risk factors. Increasing the intake of green leafy vegetables does not in itself decrease the risk of stroke; however, they are part of a healthy diet if the patient is not taking an anticoagulant medication.

2. A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, "Bugs are crawling on my legs. Get them off!" Which problem is the patient experiencing? a. Aphasia b. dystonia c. Tactile hallucinations d. Mnemonic disturbance

ANS: C The patient feels bugs crawling on both legs, even though no sensory stimulus is actually present. This description meets the definition of a hallucination, a false sensory perception. Tactile hallucinations may be part of the symptom constellation of delirium. Aphasia refers to a speech disorder. Dystonia refers to excessive muscle tonus. Mnemonic disturbance is associated with dementia rather than delirium.

After completing an admission assessment on a patient who recently had a stroke, the nurse should choose which of the following nursing diagnoses as a priority? a. Risk for injury b. Altered thought process c. Altered cerebral perfusion d. Decreased mobility

ANS: C Altered cerebral perfusion is the priority diagnosis. Altered cerebral perfusion may be caused by an interruption in blood flow such as occlusive disorder, hemorrhage, cerebral vasospasm, or cerebral edema. It is important for the nurse to monitor cognitive status and vitals for patients experiencing altered cerebral perfusion. The patient is at risk for injury because of the effects of the stroke; however, it is not the priority diagnosis. This patient may have altered thought processes because of cerebral damage from the stroke; however, this is not the priority diagnosis. This patient may experience a decrease in mobility such as hemiparesis; however, it is not the priority diagnosis.

A patient in metabolic alkalosis is admitted to the emergency department and pulse oximetry (SpO2) indicates that the O2 saturation is 94%. Which action should the nurse expect to take next? a. Complete a head-to-toe assessment. b. Administer an inhaled bronchodilator. c. Place the patient on high-flow oxygen. d. Obtain repeat arterial blood gases (ABGs).

ANS: C Although the O2 saturation is adequate, the left shift in the oxyhemoglobin dissociation curve will decrease the amount of O2 delivered to tissues, so high oxygen concentrations should be given. A head-to-toe assessment and repeat ABGs may be implemented later. Bronchodilators are not needed for metabolic alkalosis and there is no indication that the patient is having difficulty with airflow.

After the nurse has received change-of-shift report, which patient should the nurse assess first? a. A patient with pneumonia who has crackles in the right lung base b. A patient with chronic bronchitis who has a low forced vital capacity c. A patient with possible lung cancer who has just returned after bronchoscopy d. A patient with hemoptysis and a 16-mm induration after tuberculin skin testing

ANS: C Because the cough and gag are decreased after bronchoscopy, this patient should be assessed for airway patency. The other patients do not have clinical manifestations or procedures that require immediate assessment by the nurse.

The nurse completes a shift assessment on a patient admitted in the early phase of heart failure. When auscultating the patient's lungs, which finding would the nurse most likely hear? a. Continuous rumbling, snoring, or rattling sounds mainly on expiration b. Continuous high-pitched musical sounds on inspiration and expiration c. Discontinuous, high-pitched sounds of short duration during inspiration d. A series of long-duration, discontinuous, low-pitched sounds during inspiration

ANS: C Fine crackles are likely to be heard in the early phase of heart failure. Fine crackles are discontinuous, high-pitched sounds of short duration heard on inspiration. Course crackles are a series of long-duration, discontinuous, low-pitched sounds during inspiration. Wheezes are continuous high-pitched musical sounds on inspiration and expiration.

The nurse teaches a patient about pulmonary spirometry testing. Which statement, if made by the patient, indicates teaching was effective? a. "I should use my inhaler right before the test." b. "I won't eat or drink anything 8 hours before the test." c. "I will inhale deeply and blow out hard during the test." d. "My blood pressure and pulse will be checked every 15 minutes."

ANS: C For spirometry, the patient should inhale deeply and exhale as long, hard, and fast as possible. The other actions are not needed. The administration of inhaled bronchodilators should be avoided 6 hours before the procedure.

A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching? a. Have the patient repeat the instructions immediately after teaching. b. Accomplish the patient teaching just before the scheduled discharge. c. Arrange for the patient's caregiver to be present during the teaching. d. Start giving the patient discharge teaching during the admission process.

ANS: C Hypoxemia interferes with the patient's ability to learn and retain information, so having the patient's caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Because the patient is likely to be distracted just before discharge, giving discharge instructions just before discharge is not ideal. The patient is likely to be anxious and even more hypoxemic than usual on the day of admission, so teaching about discharge should be postponed.

The nurse in a rehabilitation center is caring for a patient who has new-onset stroke with right-side hemiparesis. Which intervention should the nurse implement when caring for this patient? a. Orders a two-person assist with a transfer b. May need to incorporate repetition c. Gives the patient a dry erase board d. Raises all four side rails

ANS: C Right-side hemiparesis involves a left-side brain injury. The left side of the brain controls speaking and language. By giving the patient a dry erase board, he or she can communicate easier initially after the stroke. People who have this type of hemiparesis experience difficulty talking. With only one side affected; the nurse should be able to transfer the patient alone. Patients with left-side hemiparesis have short-term memory loss, so often repetition must be incorporated into patient care. The raising of all four side rails up would be considered a restraint.

A patient with a chronic cough is scheduled to have a bronchoscopy with biopsy. Which intervention will the nurse implement directly after the procedure? a. Encourage the patient to drink clear liquids. b. Place the patient on bed rest for at least 4 hours. c. Keep the patient NPO until the gag reflex returns. d. Maintain the head of the bed elevated 90 degrees.

ANS: C Risk for aspiration and maintaining an open airway is the priority. Because a local anesthetic is used to suppress the gag and cough reflexes during bronchoscopy, the nurse should monitor for the return of these reflexes before allowing the patient to take oral fluids or food. The patient does not need to be on bed rest, and the head of the bed does not need to be in the high-Fowler's position.

Using the illustrated technique, the nurse is assessing for which finding in a patient with chronic obstructive pulmonary disease (COPD)? a. Hyperresonance c. Reduced excursion b. Tripod positioning d. Accessory muscle use

ANS: C The technique for palpation for chest excursion is shown in the illustrated technique. Reduced chest movement would be noted on palpation of a patient's chest with COPD. Hyperresonance would be assessed through percussion. Accessory muscle use and tripod positioning would be assessed by inspection.

3. A definitive diagnosis of Alzheimer's disease (AD) can be made by detecting or using which one of the following methods? a. Clinical observation of dementia b. Inability to speak with relevance c. Development of neurofibrillary tangles d. Computed tomography (CT) scan

ANS: C Confirming the development of neurofibrillary tangles is the only accurate method for diagnosing AD. Patients with AD can be observed for dementia and delirium, but these indicators are nonspecific for the disease. The inability to speak with relevance is a feature of dementia; if other causes of dementia are ruled out, then it may be dementia of the Alzheimer type. A CT scan is the most useful means for diagnosing a stroke.

3. A patient with fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, "Someone get these bugs off me." What is the nurse's best response? a. "No bugs are on your legs. You are having hallucinations." b. "I will have someone stay here and brush off the bugs for you." c. "Try to relax. The crawling sensation will go away sooner if you can relax." d. "I don't see any bugs, but I can tell you are frightened. I will stay with you."

ANS: D When hallucinations are present, the nurse should acknowledge the patient's feelings and state the nurse's perception of reality, but not argue. Staying with the patient increases feelings of security, reduces anxiety, offers the opportunity for reinforcing reality, and provides a measure of physical safety. Denying the patient's perception without offering help does not support the patient emotionally. Telling the patient to relax makes the patient responsible for self-soothing. Telling the patient that someone will brush the bugs away supports the perceptual distortions.

The nurse analyzes the results of a patient's arterial blood gases (ABGs). Which finding would require immediate action? a. The bicarbonate level (HCO3-) is 31 mEq/L. b. The arterial oxygen saturation (SaO2) is 92%. c. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mm Hg. d. The partial pressure of oxygen in arterial blood (PaO2) is 59 mm Hg.

ANS: D All the values are abnormal, but the low PaO2 indicates that the patient is at the point on the oxyhemoglobin dissociation curve where a small change in the PaO2 will cause a large drop in the O2 saturation and a decrease in tissue oxygenation. The nurse should intervene immediately to improve the patient's oxygenation.

The nurse is caring for a patient who has had a stroke. The nurse is concerned the patient will develop contractures. Which intervention should the nurse implement? a. Use tennis shoes while in bed. b. Turn the patient onto the affected side, resting on the shoulder. c. Use paraffin wax for hand soaks. d. Conduct passive range-of-motion movements to the affected extremities.

ANS: D Conducting passive range-of-motion movements will help decrease the risk of contractures. Using tennis shoes in bed helps decrease foot drop. Turning the patient on the affected side, resting on the shoulder, can cause pain. Paraffin wax soaks are often used for patients with arthritis.

Which assessment finding indicates that the nurse should take immediate action for an older patient? a. Weak cough effort c. Dry mucous membranes b. Barrel-shaped chest d. Bilateral basilar crackles

ANS: D Crackles in the lower half of the lungs indicate that the patient may have an acute problem such as heart failure. The nurse should immediately accomplish further assessments, such as O2 saturation, and notify the health care provider. A barrel-shaped chest, hyperresonance to percussion, and a weak cough effort are associated with aging. Further evaluation may be needed, but immediate action is not indicated. An older patient has a less forceful cough and fewer and less functional cilia. Mucous membranes tend to be drier.

An older adult arrives at the emergency department with a probable diagnosis of a hemorrhagic stroke. The nurse understands, based on the patient's age, that the most likely cause is which one of the following? a. Intracranial hemorrhage b. Decreased cardiac output c. Thrombosis d. Uncontrolled hypertension

ANS: D Hemorrhagic strokes are primarily caused by uncontrolled hypertension and less often by malformations of the blood vessels (e.g., aneurysms). Although the exact mechanism is not fully understood, it appears that chronic hypertension causes a thickening of the vessel wall, microaneurysms, and necrosis. When enough damage to the vessel accumulates, it is at risk for rupture. The spontaneous rupture may be large and acute or small with a slow leak of blood into the adjacent brain tissue. In many cases, blood ruptures or seeps into the ventricular system of the brain with damage to the affected tissue through necrosis or death of brain tissue. Hemorrhagic strokes are more life threatening but occur less frequently than ischemic strokes. Decreased cardiac output does not cause this type of hemorrhage. A thrombosis is not related to this type of hemorrhage.

Which of the following statements is true about Parkinson's disease (PD)? a. Drinking large amounts of alcohol can relieve symptoms of essential tremor. b. Motor tremors and slow movement accompany severe cognitive impairment. c. Lewy body dementia (LBD) is the most common form of dementia. d. Older adults taking levodopa-carbidopa (Sinemet) must take it on an empty stomach.

ANS: D Older adults taking Sinemet must take it on an empty stomach; (i.e., 30 to 60 minutes before a meal or 45 to 60 minutes after a meal) for it to be effective. It is given on a set schedule to prevent fluctuation in symptoms. Drinking small amounts of alcohol can relieve symptoms of essential tremor, although heavy drinking should be avoided. The majority of persons with PD remain alert and intelligent, but motor difficulties in facial expression and speech can give a false impression of cognitive impairment. LBD, which can occur in some patients with PD symptoms, is the second most common form of dementia. It accounts for 15% to 20% of all dementias.

1. Which of the following statements is true about cognitive impairments in older adults? a.Loss or interruption of sleep can lead to delirium. b.Confusion is a normal and unavoidable consequence of aging. c.Older patients who are agitated often have a lower cognitive status than those who are quietly sitting. d. The Mini-Mental State Exam-2 (MMSE-2) should be administered on admission to detect delirium.

ANS: D The MMSE-2 or a similar instrument should be administered to a patient at admission to ascertain the patient's baseline cognitive status. The loss or interruption of sleep, in of itself, does not often lead to delirium. It can potentiate delirium in the presence of other factors. Confusion or delirium is not a normal consequence of aging but an indicator of a potentially underlying problem. The hypoactive subtype of delirium can be associated with a worse prognosis than with the hyperactive subtype; it is easily overlooked.

A home health nurse is completing an admission on a patient who recently experienced a transient ischemic attack (TIA). During the assessment, the patient begins to complain of a severe headache and numbness in his left arm. Which action should the nurse take next? a. Instruct the patient to take Tylenol. b. Ask whether patient suffers from migraine headaches. c. Reschedule the visit. d. Call 9-1-1.

ANS: D The home health nurse should immediately call 9-1-1. A TIA is ischemic but clinically different from a stroke in that all of the neurologically associated symptoms begin to resolve within minutes. About one-third of persons who have a TIA and do not receive treatment are likely to have a major stroke within 1 year; 10% to 15% of these persons will have a major stroke within 3 months (Centers for Disease Control and Prevention, 2013). Tylenol would not be advised. The nurse should not leave the patient until the patient is en route to the emergency department.

The nurse admits a patient who has a diagnosis of an acute asthma attack. Which statement indicates that the patient may need teaching regarding medication use? a. "I have not had any acute asthma attacks during the past year." b. "I became short of breath an hour before coming to the hospital." c. "I've been taking Tylenol 650 mg every 6 hours for chest wall pain." d. "I've been using my albuterol inhaler more frequently over the last 4 days."

ANS: D The increased need for a rapid-acting bronchodilator should alert the patient that an acute attack may be imminent and that a change in therapy may be needed. The patient should be taught to contact a health care provider if this occurs. The other data do not indicate any need for additional teaching.

The laboratory has just called with the arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider? a. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97% b. pH 7.35, PaO2 85 mm Hg, PaCO2 50 mm Hg, and O2 sat 95% c. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98% d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

ANS: D These ABGs indicate uncompensated respiratory acidosis and should be reported to the health care provider. The other values are normal, close to normal, or compensated.

The nurse palpates the posterior chest while the patient says "99" and notes absent fremitus. Which action should the nurse take next? a. Palpate the anterior chest and observe for barrel chest. b. Encourage the patient to turn, cough, and deep breathe. c. Review the chest x-ray report for evidence of pneumonia. d. Auscultate anterior and posterior breath sounds bilaterally.

ANS: D To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as "99." After noting absent fremitus, the nurse should then auscultate the lungs to assess for the presence or absence of breath sounds. Absent fremitus may be noted with pneumothorax or atelectasis. The vibration is increased in conditions such as pneumonia, lung tumors, thick bronchial secretions, and pleural effusion. Turning, coughing, and deep breathing is an appropriate intervention for atelectasis, but the nurse needs to first assess breath sounds. Fremitus is decreased if the hand is farther from the lung or the lung is hyperinflated (barrel chest). The anterior of the chest is more difficult to palpate for fremitus because of the presence of large muscles and breast tissue.

The nurse interviews the client at a yearly office visit. The client states "I don't really eat that much, I'm not that hungry, but I keep gaining weight. Just look at my fat face!" Which of the following conditions should the nurse suspect? A) Hyperlipidemia B) Hypothyroidism C) Diabetes D) Peripheral vascular disease

B Feedback: Anorexia, weight gain, and a puffy face are all characteristics of hypothyroidism.

The nurse plans care for residents of a nursing home with diabetes. Which of the following symptoms of hypoglycemia are characteristic of the elderly that the nurse should be attentive to? A) Tachycardia and restlessness B) Poor sleep patterns and slurred speech C) Perspiration and anxiety D) Anxiety and restlessness

B Feedback: Classic symptoms of hypoglycemia in younger people—tachycardia, restlessness, perspiration, and anxiety—may be missing in the elderly. Instead, the first indication of hypoglycemia in the elderly may be behavior disorders, convulsions, somnolence, confusion, disorientation, poor sleep patterns, nocturnal headache, slurred speech, or unconsciousness.

A 78-year-old man has been diagnosed by his geriatrician as being in the third stage of Alzheimer's disease. Which of the following manifestations would be most congruent with the staging of the man's disease? A) The man displays an uncharacteristically flat affect and denies that he is experiencing any cognitive deficits. B) The man's wife and children have recently noticed a change in his memory and judgment and he gets easily flustered in social situations. C) The man is commonly oriented to person but disoriented to time and place. D) The man no longer remembers his wife's name and requires assistance with most of his activities of daily living.

B Feedback: Cognitive changes noticeable by others and anxiety in social settings are indicators of stage 3 Alzheimer's. Choice A reflects stage 4, while choices C and D suggest stages 5 and 6, respectively.

The nurse practitioner assesses an 84-year-old client, who talks about feeling tired and chilly, and having dry skin and coarse hair. Which of the following conditions should the nurse practitioner first consider? A) Hyperlipidemia B) Hypothyroidism C) Diabetes D) Peripheral vascular disease

B Feedback: Her symptoms are typical of hypothyroidism, although they occur in other disorders as well.

Which of the following older adults is most likely experiencing the effects of age-related changes to endocrine function? A) A 71-year-old whose circadian rhythms are disrupted due to decreased melatonin production by the pineal gland. B) A 78-year-old whose pancreas is releasing insufficient amounts of insulin, resulting in hyperglycemia. C) A 67-year-old who is experiencing hyperthermia and insomnia due to increased thyroid activity. D) A 69-year-old who has experienced decreased sexual responsiveness due to a large decline in testosterone production.

B Feedback: Insufficient insulin release is considered a common, age-related change, while melatonin levels are not noted to be affected by the aging process. Hyperthyroidism and a significant decline in testosterone production would constitute pathological findings.

A 79-year-old female patient, admitted for hip replacement surgery, complained of insomnia the night before and was administered lorazepam, a benzodiazepine. She began displaying signs of delirium shortly thereafter, a situation that has persisted until the morning change of shift. Which of the following guidelines should the night nurse provide to the nurse coming on shift to care for the patient? A) "Make sure you get a sedative order from her doctor this morning." B) "Try to keep her level of stimulation as low as you can when you are working with her." C) "Make sure you let the family know that there are effective drug treatments that will resolve her delirium." D) "Work with the discharge-planning nurse to help the family reassess her living arrangement after discharge."

B Feedback: Older adults with delirium benefit from minimal stimulation. Administration of a sedative would not be a preferred intervention and resolution of the problem would not depend on pharmacological interventions. Given the temporary nature of the problem, a reassessment of the patient's living arrangement would not be required.

Determine which of the following nursing considerations has the highest priority for an elderly adult with dementia. A) Promoting therapy and activity B) Ensuring patient safety C) Providing physical care D) Respecting the individual

B Feedback: One of the foremost care considerations is the safety of patients with dementia. All of the other nursing considerations are important, but none as important as ensuring the safety of the elderly adult with dementia.

The nurse assesses a 94-year-old resident of a nursing home who has diabetes mellitus. For which of the following signs and symptoms should the nurse perform a blood glucose test? A) Restlessness and postural hypotension B) Somnolence and slurred speech C) Perspiration and incontinence D) Numbness and weak pulses

B Feedback: Rather than the classic symptoms of hypoglycemia that one would anticipate in younger adults, older individuals instead may experience confusion, abnormal behavior, altered sleep patterns, nocturnal headache, and slurred speech. Uncorrected hypoglycemia can cause tachycardia, arrhythmias, myocardial infarctions, cerebrovascular accident, and death.

Mrs. V is an elderly woman in the final stages of Alzheimer's disease; she is unlikely to live more than a year longer. Breast cancer has been diagnosed, and her surgeon wants to operate. Mrs. V cannot grasp the situation, however, and is becoming agitated about it. Her children think surgery would be painful and not worth the potential benefit. What might a nurse advise Mrs. V's family? A) The patient herself should make the decision. B) The need for surgery is of secondary importance. C) Surgery is definitely indicated. D) The insurer should be involved in the decision.

B Feedback: Surgery for an elderly patient is often more difficult than for a younger patient, and in this case the patient is already unlikely to live much longer. She is no longer capable of making rational decisions. Her peace of mind should take precedence over any other consideration, and the insurer should not be involved.

The nurse at the wellness center plans exercise treatment for the client with diabetes. Why should the nurse advise this patient who is being treated for diabetes to exercise with caution? A) The resting heart rate is lowered. B) Hypoglycemia may occur. C) The heart rate is temporarily increased. D) The absorption of insulin is lowered.

B Feedback: The absorption of insulin is increased during exercise, which can lead to hypoglycemia. The heart rate is temporarily increased during exercise, and the resting heart rate is lowered; these are both usually desirable outcomes.

With aging, the endocrine system experiences changes that can be diverse and interrelated. Which of the following statements accurately describes an effect of aging on the endocrine system and its hormones? A) The action of water-soluble hormones on body cells increases. B) The endocrine system's ability to regulate body activities decreases. C) The response of body cells to hormones increases. D) Hormones become more concentrated.

B Feedback: The endocrine system's ability to regulate body activities decreases with aging. Choices A, C, and D are not true statements about aging and the endocrine system.

An elderly man is admitted to the hospital for surgery. A day later, he seems confused and disoriented. He imagines there is a trapdoor in the ceiling above his bed. His wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed "sharp as a tack." What should the nurse do first? A) Control environmental temperatures and noises. B) Check the patient's chart for medications that can cause delirium. C) Have the patient evaluated for Alzheimer's disease. D) Tell the wife there is nothing to worry about.

B Feedback: The rapid onset and the delusion make it likely that this is delirium rather than dementia. The man's medication should be checked immediately, as painkillers used after surgery may have this effect. Controlling the environment may be helpful, but removing the cause of delirium is of the most importance. The wife is quite right to be concerned, but she should be told about the likelihood of delirium in this situation. Evaluation for Alzheimer's disease can take place later if that seems desirable.

The family of a patient with Alzheimer's disease wants to know more about the implications of the disease for the entire family. What might a nurse tell the patient's childless 35-year-old daughter? A) "Have a brain scan and other testing for Alzheimer's disease." B) "If you become pregnant, undergo fetal testing for Down syndrome." C) "Avoid having any children." D) "Alzheimer's disease is not hereditary, and you do not need to worry."

B Feedback: There is a genetic component to Alzheimer's, and it is linked to Down syndrome. The likelihood of this daughter having a baby with Down syndrome is greater than the average, as is her own chance of developing Alzheimer's disease. At this time, there is little use in finding out whether a young person may later develop Alzheimer's disease, as there is no known cure.

Which of the following are common causes of dementia in older adults other than Alzheimer's disease? (Select all that apply.) A) It is a normal consequence of aging. B) Trauma. C) Creutzfeldt-Jakob disease. D) Parkinson's disease. E) Vascular dementia.

B, E Feedback: Trauma and vascular dementia can cause dementia. Dementia is not a normal consequence of aging. Creutzfeldt-Jakob disease and Parkinson's disease are non-Alzheimer's disease causes of dementia but are extremely rare and only responsible for a small percentage of dementias, respectively.

The nurse practitioner interviews an 80-year-old client who reports that the long-term issue with constipation has stopped and the client now has normal bowel movements. Which of the following conditions should the nurse practitioner suspect that this patient has developed? A) Atrophy of the adrenal gland B) Diabetes C) Hyperthyroidism. D) Hyperlipidemia

C Feedback: Although the client may be pleased with her apparent improvement, following chronic constipation, it can be a danger signal. The primary care provider would most likely suspect hyperthyroidism based on the age and the unexplained change in the bowel habits; the other conditions are not related to increased bowel peristalsis.

The husband of a 74-year-old female patient is distraught at her recent diagnosis of Alzheimer's disease. In an effort to identify a cure, the husband is conducting extensive online research as well as speaking with each member of the care team about possible treatments. How can the nurse best respond to the husband's inquiry? A) "There is presently no cure for Alzheimer's disease but highly promising treatments are expected." B) "Eliminating any exposure to aluminum or mercury has been shown to have a positive impact on people in the early stages of Alzheimer's." C) "There isn't any cure currently available for Alzheimer's but some drugs have been shown to slow the progression of the disease." D) "Drugs that affect the neurotransmitters in the brain are now available that can cure many early cases of Alzheimer's."

C Feedback: Drugs affecting the action of acetylcholinesterase can slow the progression of Alzheimer's but they do not constitute a cure. Aluminum and mercury are implicated in the etiology of Alzheimer's but their removal does not cure the disease. Extensive research in the treatment of Alzheimer's is ongoing, but a cure is not noted to be imminent.

The nurse admits a patient to the skilled care unit with symptoms of fatigue, weakness, and lethargy. Before the primary care provider completes a diagnosis of depression, which of the following laboratory tests should be completed? A) Estrogen and testosterone B) Random blood glucose C) T4 and TSH D) Triglyceride

C Feedback: Fatigue, weakness, lethargy, depression, and disinterest in activities are all characteristic of hypothyroidism. While fatigue and weakness may indicate hypoglycemia, a random blood glucose will not diagnose diabetes.

The nurse instructs the patient receiving treatment for hypothyroidism. Which of the following statements, if made by the patient, indicate the need for further teaching? A) "I will continue to take the stool softener until my constipation is better." B) "I will call the office if I have any chest palpitations." C) "I will not need to refill this prescription." D) "I will take one pill today, two tomorrow, and then three pills a day."

C Feedback: It is important that patients understand that thyroid replacement will most likely be a lifelong requirement. Initially, thyroid replacement is gradually increased under close supervision to prevent cardiac complications.

A 79-year-old in very good health has a lipid screening during a visit to the nurse practitioner. Which of the following values should the nurse interpret as desirable for him? A) Triglycerides 299 mg/dL B) Triglycerides 199 mg/dL C) Triglycerides 149 mg/dL D) Triglycerides 19 mg/dL

C Feedback: People with diabetes are at risk for metabolic syndrome, which includes elevated triglycerides. The American Diabetes Association recommends that people with diabetes maintain their triglyceride levels below 150 mg/dL. A level of 19 mg/dL would be unexpectedly low and may require further assessment.

Nurse Y is providing care for a male patient who is in the late stages of vascular dementia. The nurse is in the habit of reminding the patient who he is, where he is, and what month and year it is when interacting with him. How is nurse Y's action best understood? A) Reorientation is ineffective with patients diagnosed with dementias. B) Reorientation serves only to remind patients with dementia of their cognitive losses, so it is best avoided. C) Reorientation can be a useful intervention when used appropriately. D) Reorientation does not slow the progression of cognitive losses and is thus unwarranted.

C Feedback: Reorientation, or reality therapy, can be a useful intervention in patients for whom it is appropriate in light of the severity of their cognitive deficits. Despite not slowing the progress of the disease itself, it can still be of benefit when living with the effects of dementia.

A diabetes nurse is providing an educational in-service to nurses who provide care on a geriatric, subacute medical unit of hospital. Which of the following teaching points related to diagnosing diabetes in older adults should be included in the teaching? A) "Older adults with a new onset of diabetes will be hungry and thirsty with copious urine output." B) "Because of an absence of signs and symptoms in older adults with diabetes, diagnosis can be very difficult." C) "Older persons can often display signs and symptoms of diabetes that are more subtle than those in younger adults." D) "Pancreatic biopsy is often required in order to determine a definitive diagnosis of diabetes in the elderly."

C Feedback: Signs and symptoms of diabetes are often nonspecific, though not absent, in older adults. Pancreatic biopsy is not necessary for the diagnosis of diabetes.

During patient education of a 71-year-old who has a recent diagnosis of diabetes, the nurse has emphasized the importance of consistently maintaining blood glucose levels within the normal range rather than simply reacting to high or low levels. Which of the following tests is most likely to gauge the consistency of the patient's blood sugar control over time? A) Random blood glucose B) Triglyceride monitoring C) Hemoglobin A1c D) Glucose tolerance test (GTT)

C Feedback: The hemoglobin A1c test determines an individual's effectiveness of blood sugar control over the previous 6- to 12-week period. Random glucose testing, triglyceride tests, and the GTT do not achieve this result.

The husband of a 77-year-old woman is her sole care provider, a responsibility that has become onerous since she was diagnosed with Alzheimer's disease 3 months prior. When working with the husband, which of the following actions is most appropriate? A) Encouraging the husband to independently develop techniques for basic care that he feels work best for him and his wife. B) Emphasizing to the husband the importance of remaining optimistic and enthusiastic when interacting with his wife. C) Encouraging the husband not to feel guilty for needing respite on occasion. D) Organizing outside help to minimize the amount of direct care that the husband provides.

C Feedback: The need for respite is a common need that the nurse should normalize for the husband. Techniques for basic care should be taught, and expecting the husband to exhibit a positive demeanor at all times is unrealistic and likely to foster guilt. While outside help may be required at times, the goal should not be to minimize or eliminate the care the husband himself provides.

The environment of a patient with dementia includes photographs of her family, soft music, and low lighting. She wears her own jewelry—necklaces and rings she had received as gifts. Unused electrical outlets are covered. Once a day, she exercises with a group. What might a nurse suggest is missing from this picture? A) Nutritional supplements B) A walker C) An ID bracelet D) A commode chair

C Feedback: The patient should be wearing an ID bracelet in addition to her necklaces and rings. The patient is ambulatory (she exercises) and so does not require a walker or a commode chair. Supplements may not be needed by this patient.

As per her routine, the daughter of an 82-year-old patient recovering from a prostate resection has come to the hospital in the morning to be with her father at the bedside. The daughter has approached her father's nurse and stated that he is uncharacteristically difficult to rouse this morning, with his only verbal response being occasional nonsensical muttering. What is the care team's most appropriate response? A) Diagnostic imaging to determine the location of any organic brain changes. B) Assessment of the patient's mood and current stressors. C) Assessment to determine the cause of his delirium. D) Screening for risk factors that would suggest Alzheimer's disease.

C Feedback: The patient's rapid onset and obtunded level of consciousness are most indicative of delirium rather than dementia or depression.

Older people are subject to a long list of complications from diabetes, so the disease must be strictly managed. Which of the following statements is true about diabetes and its complications? A) Hyperglycemia is associated with anxiety and insomnia. B) Unmanaged hyperglycemia can cause tachycardia and heart arrhythmias. C) Ketoacidosis can cause gangrene in the limbs and lead to eventual amputation. D) Diabetes can eventually damage nearly every body system.

D Feedback: By affecting metabolism and the elimination of toxic compounds from the body, diabetes eventually can damage every body system.

The home care nurse regularly performs visits to a client's apartment. This client asks about ways that exercise might be able to control his type 2 diabetes. How should the nurse respond to the client's query? A) "Exercise is very beneficial for diabetes control, but if it's too vigorous it can lead to rebound hyperglycemia that is dangerous." B) "Confirm with your doctor, but it's likely best to maintain a low activity levels to keep your glucose levels within normal range." C) "Exercise can be an excellent substitute for oral antihyperglycemic medications." D) "It's important to have an exercise plan that is appropriate specifically for you, because you don't want to bring on hypoglycemia by exercising too hard."

D Feedback: Exercise is therapeutic for older adults, but vigorous physical activity can heighten the use of glucose and result in hypoglycemia, not hyperglycemia. Exercise is beneficial, but not a substitute for medication.

The nurse administers the initial dose of levothyroxine sodium (Synthroid) to a 76-year-old. Which of the following signs would indicate a complication? A) Anorexia B) Cold intolerance C) Constipation D) Tachycardia

D Feedback: Initially, thyroid replacement is prescribed at a low dose and gradually increased under close supervision to prevent cardiac complications. Anorexia, cold intolerance, and constipation are all symptoms of hypothyroidism, the condition which this medicine is to treat.

Before having a blood sugar test, a patient must avoid drugs that affect blood glucose level. In analyzing a patient's blood glucose level, the nurse should be aware of any drugs the patient is taking. Which of the following drugs may lower a patient's blood sugar level? A) Nicotinic acid B) Estrogen C) Diuretics D) Monoamine oxidase inhibitors

D Feedback: Monoamine oxidase inhibitors lower blood glucose level. Nicotinic acid, estrogen, and diuretics raise blood glucose level.

The nurse educates the older adult regarding a new diagnosis of diabetes mellitus. Which of the following educational materials should the nurse consider as appropriate? A) A commercial pamphlet with pictures and font size 12 B) An audio recording. C) Online interactive presentation D) Printed handouts on white paper with font size 16

D Feedback: Original handmade aids suited for the individual's unique needs may have a value equal to or greater than commercially prepared ones. Audio recording is of little benefit to the older person with a hearing problem. A computer presentation may overwhelm the older learner. The print on a commercial pamphlet may appear minute to older eyes.

The nursing staff on a subacute, geriatric medicine unit of a hospital have noted that Mr. R, an 80-year-old patient with a diagnosis of Alzheimer's disease, tends to become agitated in the evening and early in the night. Which of the following nursing actions is most likely to effectively address Mr. R's sundowner syndrome? A) Ensure that Mr. R's room is kept as dark as possible during the times in question. B) Limit Mr. R's fluid intake after 17:00 to prevent nocturia. C) Minimize the amount of touch used in nursing care to avoid stimulating Mr. R. D) Schedule physical therapy and exercise in the afternoon hours to help Mr. R expend energy.

D Feedback: Physical activity in the afternoon can help minimize sundowner syndrome in older adults. The environment should not be kept completely dark. Touch can be a useful tool, and fluids should never be withheld or limited in an effort to control behavior.

A nurse is facilitating a group for family members of recently diagnosed Alzheimer's patients. Which of the nurse's following teaching points about the etiology of Alzheimer's disease is most accurate? A) "There are a number of factors that cause Alzheimer's disease, and modification or removal of many of these can cause a significant improvement in your loved one's condition." B) "Unfortunately we still do not really know anything about what exactly causes Alzheimer's." C) "Science has recently discovered the direct link between diet and the development of Alzheimer's disease." D) "Alzheimer's appears to result from a combination of genetic and environmental factors and no one theory can explain it."

D Feedback: The current understanding of the etiology of Alzheimer's disease is incomplete, but not wholly lacking. The disease appears to be a result of the interplay of genetic and environmental factors. It is not completely attributable to diet and removal of risk factors and contributors does not normally bring about an improvement or recovery.

A 71-year-old man is obese and has poorly controlled hypertension. The man states that while he has been a smoker since his teens, many of his peers have done likewise and still enjoy good health. Over the last 2 to 3 days, his wife has noted that he has become uncharacteristically forgetful and suspicious and he was found wandering outside his house last night. Which of the following health problems is his care team most likely to suspect? A) Creutzfeldt-Jakob disease B) Alzheimer's disease C) Wernicke encephalopathy D) Vascular dementia

D Feedback: The patient's risk factors, course, and symptoms are more characteristic of vascular dementia than Creutzfeldt-Jakob disease, Alzheimer's disease, or Wernicke encephalopathy.

The nurse presents at a seminar on "Aging of the Endocrine Glands" at a senior center. Which of the following should the nurse include in the presentation? A) Blood tests are necessary for initial assessment of endocrine system decline. B) Endocrine function decline can be prevented with exercise and vitamins. C) Glands that secrete hormones decline at a predetermined prescribed rate. D) The thyroid, pancreas, and adrenal glands are at risk for dysfunction in the older adult.

D Feedback: With age, the thyroid gland progressively atrophies, the adrenal gland reduces the secretion of hormones, and there is insufficient release of insulin by the pancreas and reduced tissue sensitivity to circulating insulin.

Among the elderly, delirium a. occurs because drugs are eliminated from their system quickly. b. accounts for a significant number of falls that cause hip fractures. c. is rarely caused by improper medication use. d. is easily attributed to a limited number of causes.

b. accounts for a significant number of falls that cause hip fractures.

The symptoms of delirium tend to develop a. very slowly, over the course of several years. b. very quickly, over the course of a few hours to a few days. c. moderately slowly, over the course of several months. d. either very quickly or very slowly, depending on the cause.

b. very quickly, over the course of a few hours to a few days.