Geriatrics Week 3

. A major difference in the diagnosis of chronic disease between younger adults and older adults is that a. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems. b. chronic disease is often diagnosed earlier in older adults since they are more likely to seek medical care. c. chronic disease is usually not identified in older adults because of the many age related changes. d. chronic illness is uncommon in younger adults.

a. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems.

. A nurse will be conducting an educational session on preventing skin cancer at a local senior citizen's center. Which should the nurse include in the session? a. Squamous cell cancer may appear similar to a wart. b. Basal cell carcinoma is more common in women. c. Actinic keratosis begins as a pearly papule. d. Melanoma is characterized by rough, scaly patches

a. Squamous cell cancer may appear similar to a wart.

. A nurse is caring for an older adult who is in the pretrajectory phase of the chronic illness trajectory. The nurse knows that this phase is characterized by which of the following? a. The absence of signs or symptoms of the illness b. Diagnostic testing is being conducted c. There is a progressive decline in physical and or mental status d. A period of temporary remission from the crisis

a. The absence of signs or symptoms of the illness

A nurse admitting and orienting an older adult to the hospital unit discusses fall prevention and demonstrates the use of the call bell to the patient. The patient's daughter asks: "Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?" What is the nurse's best response? a. "Side rails have only proven to be effective in decreasing falls in patients who have already fallen." b. "There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury." c. "Side rails are only effective when used with patients who have dementia" d. "Side rails do not decrease falls, but they do decrease fall related injuries."

b. "There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury."

An older adult admitted for back surgery asks for opioid pain medication. The nurse knows the client asks for pain medication 30 minutes before it is due. Which recommendation should the nurse implement? a. Validate the pain with other assessment data. b. Administer the pain medication as requested by the client. c. Tell the client that it is too soon for pain medication. d. Teach the client alternative comfort measures.

b. Administer the pain medication as requested by the client.

. A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90F outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to what? a. Cognitive changes that diminish the individual's awareness of temperature changes b. Age-related neurosensory changes that diminish awareness of temperature changes c. Delirium-related to an acute illness that is affecting body heat production d. Age-related motor deficiencies that result in self-neglect

b. Age-related neurosensory changes that diminish awareness of temperature changes

. Which of the following interventions should the nurse use when communicating with a hearing impaired older adult client? a. Stand beside the client's chair when speaking. b. Always clearly identify yourself and others with you. c. Exaggerate your voice, depending on the cause of the hearing loss. d. Select colors for paint, furniture, and pictures with rich intensity.

b. Always clearly identify yourself and others with you.

An older adult experiencing tinnitus reports to the nurse that it is very annoying. Which should the nurse implement to alleviate the stress he is experiencing from tinnitus? a. Irrigate the bilateral Eustachian tubes. b. Assess for modifiable risk factors. c. Propose a hearing aid and a masker. d. Use white noise to override the tinnitus.

b. Assess for modifiable risk factors.

An older adult man who is right-handed works as a carpenter, but he has been left with a flaccid right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the plan of care to help this man achieve his optimal state of health and wellness? a. Maintain skin integrity of right arm. b. Collaborate with occupational therapy (OT) . c. Promote plaque-reversing strategies. d. Support effective coping mechanisms.

b. Collaborate with occupational therapy (OT)

. The nurse recommends that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on "being stuck at home." Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization thus minimizing the effects of social isolation b. Helps with minimizing the loss as a factor in causing depression c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client

b. Helps with minimizing the loss as a factor in causing depression

. The nurse is conducting an admission assessment on an older adult and notes a small lesion with a multicolor appearance. Which assessment approach should the nurse use? a. Braden Scale b. Wound staging c. ABCD (asymmetry, border, color, diameter) rule d. Pressure ulcer scale for healing (PUSH) tool

c. ABCD (asymmetry, border, color, diameter) rule

. The overall temperature in the gerontological unit is 62F during the evening shift. In documenting this concern to the administration, which factor is the most important for the health and well-being of older adults? a. It is not fair for older adults to have to deal with an uncomfortable environment. b. Some of the residents are wearing blankets around their shoulders to keep warm. c. An ambient temperature of 62F is unsuitable for older people because they have impaired thermoregulation. d. It feels much warmer in the administration wing than out in the client care areas

c. An ambient temperature of 62F is unsuitable for older people because they have impaired thermoregulation.

. The nurse assesses the quality of which of the following patient characteristics when applying the Get-Up-and-Go test from the Hendrich II Fall Risk Model? a. Stride b. Speed c. Balance d. Flexibility

c. Balance

An older adult client is diagnosed with a chronic illness. Which of the following principles should the nurse apply when answering her questions? a. The most prevalent form of disease in the United States is acute illness. b. Usually, chronic disease has a negligible impact on the family. c. Chronic illness is unending, and coping can be influenced by the perception of uncertainty. d. Older adults successfully cope with chronic disease by learning about the disease

c. Chronic illness is unending, and coping can be influenced by the perception of uncertainty.

. Which of the following is used to treat the most common cause of impairment to an older adult's hearing? a. Hearing aids b. Cochlear implants c. Ear canal irrigation d. Sign language

c. Ear canal irrigation

. The nurse plans the care of an older adult female resident of a nursing home who has experienced a deterioration in visual acuity. Which intervention should the nurse complete first? a. Prevent behavioral and social decline. b. Tell her to hold onto the rails during ambulation. c. Examine her current functional status. d. Use problem solving involving the resident.

c. Examine her current functional status.

An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse? a. Refer the resident for an evaluation for a hearing aid. b. Raise her voice in when speaking to the resident. c. Examine the resident's ears for cerumen impaction. d. Teach the resident to read lips.

c. Examine the resident's ears for cerumen impaction.

The nurse wants to suggest exercise program options for an older client who is recovering losing her balance and falling. Which nursing intervention is suitable for this older adult? a. Tell her to use an assistive device until her balance improves. b. Provide information on group exercises for balance training. c. Help her to learn how to exercise the core group of muscles . d. Instruct her to enroll in a general exercise program for 8 weeks.

c. Help her to learn how to exercise the core group of muscles

Which attempt by the family to prevent an older frail adult from falling causes the home health nurse concern? a. Keeping several low wattage night lights on in the evening b. Installing wooden railings on the stairway to the bathroom c. Keeping the side rails up on the client's bed at night d. Encouraging the client to use a cane when ambulating

c. Keeping the side rails up on the client's bed at night

. Which of the following is a true statement about impaired skin integrity? a. Stage III pressure ulcer cannot regress to stage II because the subcutaneous tissues regenerate . b. Stasis ulcer is another term for pressure ulcer. c. Muscle and fat cannot regenerate. d. Weight reduction is recommended to help prevent pressure ulcers.

c. Muscle and fat cannot regenerate.

An older adult reports experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the client's problem? a. Vitamin B deficiency b. Use of humidifier at home c. History of diabetes mellitus d. Prescription antihistamine use

d. Prescription antihistamine use

An older adult is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the client complains of severe itching at night and has a red rash on the torso. The client is diagnosed with scabies. The client asks the nurse, "How did I get something like this?" What is the nurse's best response? a. "Scabies is highly contagious and spreads easily through physical contact." b. "Scabies is commonly seen in older adults due to normal age-related changes in the skin." c. "Scabies is only seen in older adults who have multiple chronic illnesses." d. "Certain medications can make you more susceptible to contracting scabies."

a. "Scabies is highly contagious and spreads easily through physical contact."

Which of the following is not considered a pharmacological intervention for pain? a. Acupuncture treatments b. Cannabinoids c. Lidocaine patch d. Capsaicin

a. Acupuncture treatments

. The relationship between acute illness and chronic illness is represented by which comparison? a. An emergency department is to a nursing home. b. A hospital staff nurse is to a nurse practitioner. c. Health insurance is to Medicare for older adults. d. In-client surgical care is to out-client medical care.

a. An emergency department is to a nursing home.

A homecare nurse visits an older client who lives in a Smart medical home community environment. What should the nurse understand about Smart Homes? a. An emerging technology to enhance safety of older adults by using environmental control systems b. An assistive technology that keeps data on vital signs, gait, behavior, and sleep without providing an interactive medical-advising system c. An emerging technology to aid in the prevention and later detection of disease through the use of sensors and monitors d. Elder-friendly communities where residents participate in the design and operation of the home

a. An emerging technology to enhance safety of older adults by using environmental control systems

Over 35% of the population, aged 65 years and older, suffers from which one of the following chronic health outcomes? a. Difficulty with physical functioning b. Dementia c. Poor nutrition d. Anxiety

a. Difficulty with physical functioning

An older adult woman has a diagnosis of diabetes mellitus. Which client assessment validates the nurse's conclusion that she is in the foreground perspective of the shifting perspectives model of chronic illness? a. Has an amputation of two toes b. Lives at home with her husband c. Frequently self-checks her blood sugar d. Changes the battery in her glucometer

a. Has an amputation of two toes

An older adult client had hip replacement surgery 1 day ago, and the nurse thinks that the client is also demonstrating dementia. Which client assessment does the nurse use to determine whether this client is experiencing pain? a. Holds abdomen tightly. b. Has stable vital signs. c. Is not verbalizing. d. Moves during sleep.

a. Holds abdomen tightly.

. The nurse plans care to protect the skin covering an older adult's greater trochanter. Which of the following interventions is the nurse's priority when the older adult is positioned on the side? a. Implement a turning schedule . b. Place a cushion between the knees. c. Keep the skin clean and dry. d. Use the Sims' position.

a. Implement a turning schedule

The nurse monitors for which clinical indicator when the older adult reports pruritus? a. Itchy skin b. Brown macule c. Brownish skin d. Regional edema

a. Itchy skin

Which of the following statements is the most suitable for establishing goals when teaching an older adult with a chronic illness about potential changes in the health maintenance regimen? a. Management of the client's chronic disease rests on the client and the caregiver; therefore, the goals should be collaboratively set. b. The client will be able to make needed changes in his or her life if the nurse provides accurate, written instructions. c. Psychological functioning is usually impaired only to a small extent in a client with a chronic illness d. The client's values, culture, and beliefs will have little to do with the types of changes he or she will be able to make.

a. Management of the client's chronic disease rests on the client and the caregiver; therefore, the goals should be collaboratively set.

A home care nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment which provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses due to a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.

a. Older adults are less likely to seek formal and informal help when affected by natural disasters.

A 77-year-old client being treated for primary open-angle glaucoma (POAG) asks the nurse what part of the eye is affected. On what knowledge should the nurse base the response? a. Optic nerve b. Orbicular muscle c. Ciliary muscles d. The retina

a. Optic nerve

. Persons with normal age-related sensory changes are likely to have the most difficulty distinguishing which of the following? a. Spoken pairs of phrases like "she's praised" and "fees raised" b. Orange towel hanging on a beige wall c. "Go" and "to" in lowercase letters in fine print d. Spoken word pairs like "cupful" and "capful

a. Spoken pairs of phrases like "she's praised" and "fees raised"

A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine Shingrix. Which of the following information should the nurse include in the education? a. It should only be given to individuals who have never had an episode of Herpes Zoster (HZ). b. It is recommended for all individuals over age 50 that have no contraindications to the vaccine. c. It should not be given to anyone with a chronic cardiac or respiratory condition. d. It will always prevent an individual from developing Herpes Zoster.

b. It is recommended for all individuals over age 50 that have no contraindications to the vaccine.

. A dermatologist should promptly evaluate which one of the following skin lesions? a. Circumscribed, raised area resembling a blob of brown wax b. Multicolored raised lesion with a fuzzy border c. Bright red, glazed area with satellite lesions around it d. Brown spot on the skin with no raised area

b. Multicolored raised lesion with a fuzzy border

The nurse uses comfort measures to enhance an older adult's pharmacological pain management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adult's pain level? a. Older adult's self-report b. Older adult's pain diary c. FPS-R d. Pain medication frequency

b. Older adult's pain diary

. Which of the following statements is true about a safe, effective care environment for older adults? a. Cold beer with steak and potatoes is a good meal for an older adult on a hot day. b. Older drivers are more likely to be in a fatal motor vehicle accident than younger drivers. c. Barrier-free buses and low fares make public transit a safe transportation option. d. A nurse's perception of temperature is a useful guide for client thermal needs

b. Older drivers are more likely to be in a fatal motor vehicle accident than younger drivers.

The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use? a. Two full-length rails b. One -length rail c. No side rails d. Four -length rails

b. One -length rail

Which of the following describes the nurse's role for an older adult client with a chronic illness? a. Implement an individualized therapeutic regimen that brings about a cure. b. Provide caring to help the client live at the optimal level of health and wellness. c. Suggest that the client accept eventual death to reduce the burdens on the client's family. d. Encourage the client to minimize the use of services to control costs.

b. Provide caring to help the client live at the optimal level of health and wellness.

Which of the following statements is true about analgesic medications for older adults? a. Opioids are less effective in older clients than in younger clients . b. Stool softeners and laxatives should be used with opioids . c. Over-the-counter NSAIDs are generally harmless. d. The dose limit for acetaminophen is difficult to reach for older adults.

b. Stool softeners and laxatives should be used with opioids

An older adult client was oriented and responded appropriately in the hospital, but he is now disoriented and confused in his home after discharge. Which of the following issues is the first that the home nurse should examine to determine whether an environmental issue is contributing to the client's condition at home? a. Complaints of shivering b. Temperature of household c. Types of food preparation d. Presence of radon

b. Temperature of household

. An older client reports having dry skin and asks for advice. Which advice should the nurse offer for improving dry skin? a. Add oil to the bath water to keep skin soft. b. Use tepid bath water. c. Move to a climate with lower humidity. d. Vigorously dry skin with a rough towel after bathing.

b. Use tepid bath water.

A nurse in a long-term care facility notes that there has been an increase in falls on one unit, and that many of the falls are occurring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that a. postural changes in blood pressure are common in older adults and frequently occur around mealtimes. b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. c. residents of long-term care facilities are often on many different medications which are given at meal times. d. it is common practice in to take long-term care residents to the bathroom immediately following meals

b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide.

An older client who was recently admitted to the sub-acute setting after having a knee replacement, is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement? a. Share with the client that it is important to get out of bed and that there is pain medication available if it does hurt. b. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain. c. Offer pain medication, administer the medication, and wait 30 minutes before getting her out of bed. d. Allow the client to remain in bed but share that getting up will be required at least twice a day starting the next morning.

c. Offer pain medication, administer the medication, and wait 30 minutes before getting her out of bed.

. An older adult is vitamin deficient. Which of the following does the nurse offer to the older adult to provide the important missing vitamin for maintaining healthy skin and enhancing tissue repair? a. Carrot sticks b. Nonfat milk c. Orange slices d. Unsalted nuts

c. Orange slices

. Which of the following is an important consideration about the skin of an older adult person? a. Generous amounts of soap should be used for cleansing . b. Sweat gland activity increases. c. Skin becomes more vulnerable to sun damage. d. Skin becomes darker in unexposed areas.

c. Skin becomes more vulnerable to sun damage.

Which nursing intervention is most likely to prevent the creation of an environment conducive to fungal growth? a. Provide oral care with soft-bristled brush. b. Apply nystatin powder to reddened tissue. c. Use mild skin cleansing agents and blot dry. d. Apply gauze soaked with antifungal lotion.

c. Use mild skin cleansing agents and blot dry.

When educating a client on the use of an adjuvant medication, which statement best demonstrates the nurse's understanding of this therapy? a. "These medications are used instead of opioids to decrease the likelihood of addiction." b. "Adjuvant medications are prescribed because they seldom cause any significant side effects." c. "These types of medications are used to eliminate the side effects of opioid medications." d. "These drugs are used in combination with analgesics to increase the effect of the analgesics."

d. "These drugs are used in combination with analgesics to increase the effect of the analgesics."

Which of the following qualities does the nurse need to provide caring? a. Sensitivity to the needs of other nurses b. Longing to help others live a healthy life c. Desire to have a stable career and income d. Ability to create a trusting environment

d. Ability to create a trusting environment

Which one of the following is a true statement about mobility and safety for older adults? a. Use of restraints on older patients helps prevent injuries from falls. b. Falls that do not cause physical injury are not significant. c. The get-up-and-go test provides a measure of a patient's energy and initiative. d. About 50% to 70% of falls in hospitals occur while transferring between bed/chair

d. About 50% to 70% of falls in hospitals occur while transferring between bed/chair

The nurse admits an older adult who had abdominal surgery. Admission vital signs are heart rate (pulse) (P), 73 beats per minute (bpm); respiration rate (R), 20 breaths per minute; blood pressure (BP), 136/84 mm Hg. He is receiving intravenous (IV) fluids but has not requested pain medication since surgery. Seven hours later, his vital signs are P, 98 bpm; R, 26 breaths per minute; and BP, 164/90 mm Hg; and he denies pain. Which intervention should the nurse implement? a. Administer an opioid medication by IV route. b. Check the surgical dressing for bleeding. c. Report the vital signs to the health care provider. d. Ask if he has about discomfort at the surgical site or any other location.

d. Ask if he has about discomfort at the surgical site or any other location.

Compared with acute pain, which of the following statements is true of persistent pain? a. Leads to significantly altered vital signs. b. Is usually described as a burning pain. c. Is generally gone within 4 months. d. Can bring about long-term changes in lifestyle.

d. Can bring about long-term changes in lifestyle.

An older adult client who receives intravenous (IV) fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially? a. Apply bilateral upper extremity restraints. b. Administer haloperidol for agitation. c. Close the door to her room to reduce the noise. d. Determine the patient's needs.

d. Determine the patient's needs.

An older Hispanic man who speaks little English states that he is not having pain, but he had knee replacement surgery 2 days ago. Which is the best pain assessment tool for the nurse to apply for this man? a. Numeric Rating Scale b. Verbal Descriptor Scale c. Iowa Pain Thermometer d. Faces Pain Scale-revised (FPS-R)

d. Faces Pain Scale-revised (FPS-R

Which of the following is a true statement about assistive devices to aid older adults with impaired mobility? a. A walker can be used when climbing stairs. b. Cane tips should be smooth. c. Older adults save money by adapting assistive devices from their friends. d. Improper assistive device use contributes to older adult falls.

d. Improper assistive device use contributes to older adult falls.

. The nurse cares for an older man who has a malignant melanoma. Which intervention should the nurse implement for this man to prevent a recurrence or advancement of this condition in the future? a. Place posters about sunscreen in the halls of his apartment building. b. Promote the application of a sunscreen at his neighborhood health fair. c. Tell him to schedule all outdoor activities after 4 PM daily. d. Instruct him to wear sun-protective clothing and a hat at all times.

d. Instruct him to wear sun-protective clothing and a hat at all times.

The nurse administers an opioid analgesic to an older adult postoperative client in the surgical unit. Which is the most important intervention for the nurse to implement before leaving the client's room? a. Place side rails up 4. b. Position the client to achieve their comfort. c. Offer toileting and a sip of water. d. Instruct the client to ask for help before getting up.

d. Instruct the client to ask for help before getting up.

After assessing the older client in his bed, the nurse determines that he is at high risk for falls. The nurse leaves the room to get a fall risk sign and returns to find him on the floor pleading for help. Which of the following was the most important intervention the nurse should have implemented to prevent this event? a. Call for someone to bring the sign. b. Ensure he can reach his personal items. c. Provide a urinal and drinking water. d. Instruct the client to use call bell for help.

d. Instruct the client to use call bell for help.

Which of the following diseases affects the eyesight of an older adult by damaging the central part of the retina? a. Glaucoma b. Presbyopia c. Cataract d. Macular degeneration

d. Macular degeneration

. Which of the following is a true statement about skin care for older adults? a. A licensed practical nurse is qualified to care for the feet of a client with diabetes. b. Onychomycosis is quickly eradicated with antifungal creams or powders. c. A ram's-horn nail should be cut to give a smooth, rounded edge. d. Maintaining oral hydration may reduce the incidence of xerosis.

d. Maintaining oral hydration may reduce the incidence of xerosis.