GERO HESI

A patient who requires entral feeding longer than 30 days will require which of the following?

*Gastrostomy tubes. Nasoenteric tubes. Nasogastric tubes. Treitz tube.

Which instruction would the nurse provide to the client who has cerumen impaction?

"Nausea and vomiting are expected when you irrigate." Correct2 *"Wash the external ears daily with soap and water." 3 "Use cool water to irrigate your ear." 4 "Insert 70 mL of irrigating fluid each time."

The nurse is communicating with a deaf client. Which intervention by the nurse is beneficial to promote communication? Select all that apply. One, some, or all responses may be correct.

*Giving the client a chance to speak 2 Assuming the client is being uncooperative 3 Chewing gum while talking to the client 4 *Making sure that the client knows you are speaking 5 *Keeping the communication concise

Which priority nursing intervention would the nurse include in the plan of care for an older adult who sustained a right hip fracture?

Oxygen therapy 2 Cardiac monitoring 3 Nutrition supplements Correct4 *Venous thromboembolism (VTE) prevention

An older adult is having urinary incontinence. Which nursing interventions would help the client? Select all that apply. One, some, or all responses may be correct.

Provide nutritional support. 2 *Provide voiding opportunities. 3 *Avoid indwelling catheterization. 4 Provide beverages and snacks frequently. 5 *Promote measures to prevent skin breakdown

In which of the following situations are you most likely to do a focused assessment with a patient?

When a patient reports for her routine annual physical. When a patient is first admitted to the hospital in preparation for heart surgery. *When a patient returns for a follow-up visit after a hip replacement. When a patient is brought to the ED after displaying symptoms of a stroke.

Which of the following is NOT a risk posed by cardiogenic shock?

*Hypothermia. Liver damage. Brain damage. Kidney damage.

Which skin damage is caused by chronic exposure to ultraviolet rays? Select all that apply. One, some, or all responses may be correct.

Dryness 2 *Photoaging 3 Vascular lesions 4 *Wrinkling of skin 5 Benign neoplasm

A patient who uses a walking stick but can otherwise walk up to 50 yards unaided would receive which of the following scores for mobility on the Barthel Index?

10 *3 6 0

Which principles would promote learning in older adults? Select all that apply. One, some, or all responses may be correct.

Emphasize abstract material. 2 *Use past experiences while teaching. 3 Teach by presenting multiple examples at a time. 4 *Keep the environmental distractions to a minimum. 5 *Use audio, visual, and tactile cues to enhance learning.

The cleansing of the stomach with solution delivered through a nasogastric tube is known as what?

Gavage. Emesis. *Lavage. Stomach pumping.

When treating a client with allergic rhinitis what education information should the GNP include?

Remain inside during allergy season. Avoid working in the garden or yard. Use a surgical-type mask when going outdoors. *Monitor air quality and the allergy index.

An older adult with a history of small cell lung carcinoma reports muscle cramping, thirst, and fatigue. The primary health care provider diagnoses the client with a pituitary disorder and is treating the client accordingly. Which is an effective outcome of the treatment?

Urine output of 10 L/day 2 *Urine specific gravity less than 1.025 3 Urine osmolarity of 80 mOsm/kg (80 mmol/kg) 4 Serum osmolarity of 600 mOsm/kg (600 mmol/kg)

Which finding in older adult clients is associated with aging?

*Decrease in height 2 Decreased neck rigidity 3 Increased fine-motor dexterity 4 Increased range of motion (ROM)

Which theory proposes that older adults experience a shift from a materialistic to cosmic view of the world?

Activity theory 2 Continuity theory 3 Disengagement theory 4 *Gerotranscendence theory

The NP is prescribing a drug for Type II diabetes that prevents simple sugars from being absorbed and digested from the gastrointestinal tract? Which drug is it?

Metformin. Insulin. *a- Glucosidase inhibitors. Sulphyonylureas.

When conducting a health assessment with a geriatric patient, all but which of the following are appropriate steps?

Minimize distractions in the room. Speak slowly and clearly to the patient. *Speak slowly and loudly to the patient. Speak to a family member if necessary to clarify information you receive from the patient.

Which dietary suggestion would the nurse provide while teaching a group of geriatric female clients who have reduced amounts of circulating estrogen?

"Include fish in your diet." 2 "Include fruits in your diet." Correct3 *"Include yogurt in your diet." 4 "Include legumes in your diet."

The chest x-ray of a healthy older adult client reveals shrinkage of the thymus gland. Which is the primary cause of the client's condition?

Immunodeficiency 2 *Immunosenescence 3 Immunosuppression 4 Immunocompetence

Which characteristic of a therapeutic milieu would the nurse consider important for a confused older adult with socially aggressive behavior?

*Sets limits 2 Has variety 3 Is group oriented 4 Allows freedom of expression

The GNP knows that the following are all possible causes of false dementia except:

depression nutritional deficits *failing eyesght metabolic disorders

The nurse administers a pneumococcal vaccine to a 70-year-old client. The client asks, "Will I have to get this every year like I do with the flu shot?" How would the nurse respond?

"You need to receive the pneumococcal vaccine every other year." 2 "The pneumococcal vaccine should be received in early autumn every year." 3 "You should get the flu and pneumococcal vaccines at your annual physical examination." 4 *"It is unnecessary to have any follow-up injections of the pneumococcal vaccine after this dose."

Which age-related effects on the immune system occur in the older client?

*Increased autoantibodies 2 Increased expression of IL-2 receptors 3 Increased delayed hypersensitivity reaction 4 Increased primary and secondary antibody responses

When nurses are conducting health assessment interviews with older clients, which step would be included?

Leave a written questionnaire for clients to complete at their leisure. 2 Ask family members rather than the client to supply the necessary information. 3 *Spend time in several short sessions to elicit more complete information from the clients. 4 Keep referring to previous questions to ascertain that the information given by clients is correct

The nurse assists an older adult client in squirting warm water over the perineum. Which outcome indicates effective nursing care?

The client will not have nocturia. 2 The client will not have a bladder infection. 3 *The client will not have a tendency to retain urine. 4 The client will not have urinary stress incontinence.

The nurse leans toward the client while talking. Which would this posture convey?

The nurse is relaxed and comfortable with the client. 2 *The nurse is involved and interested in the interaction. 3 The nurse is there to listen and is interested in what the client is saying. 4 The nurse is involved and has a willingness to listen to what the client is saying

Which physiological change occurs in older adults and warrants the nurse teaching the client about safety tips to prevent falls?

Slowed movement 2 Cartilage degeneration 3 *Decreased bone density 4 Decreased range of motion (ROM)

Which activity would the nurse ask an older adult client to do when testing short-term memory?

Subtract serial sevens from 100. 2 Copy one simple geometric figure. 3 *State three random words mentioned earlier in the examination. 4 Name two common objects when the nurse points to them.

A client who has severe back pain is found to have a vertebral compression fracture. Which cause of fracture would the nurse consider when planning interventions?

*Collapse of the vertebral bodies 2 Demineralization of the spinal cord 3 Wear and tear of the spinous processes 4 Bulging of the spinal cord from the vertebra

23. A 79-year-old retired actor, who continues to pursue lifelong interests in swimming and singing, exemplifies which theory of aging?

*Continuity. Developmental. Disengagement. Physical.

The nurse is caring for a community-dwelling older adult who is suffering from confusion. Which are the correct nursing interventions in this situation? Select all that apply. One, some, or all responses may be correct.

*Provide a protective environment. 2 *Assist with personal hygiene. 3 Educate the client about correct body mechanics. 4 *Promote activities that reinforce reality. 5 Teach the client's caregiver proper feeding techniques.

Which important step(s) would the community nurse take when dealing with older adults with a confusional states problem? Select all that apply. One, some, or all responses may be correct.

*Provide a protective environment. 2 Monitor blood pressure and weight. 3 *Recommend applicable community resources. 4 *Demonstrate proper hygiene to the primary caretaker. 5 Educate about polypharmacy and drug-drug and drug-food interactions

Which approach would the nurse take for an older adult client who is confused, does not recognize family members, and often soils clothing with feces and urine?

*Toileting the client every 2 hours 2 Placing the client in orientation therapy 3 Supervising the client's bathroom activities closely 4 Explaining to the client how offensive the behavior is to others

After assessing your patient, you write in her chart that she is exhibiting signs of dyspepsia. She happens to look over as you write the term and asks what it means. What do you tell her?

*Upset stomach. Severe headache. Dry mouth. Difficulty swallowing.

There are environmental factors that affect people and these cannot be modified. The following are all examples of these with the exception of:

*pollution altitude climate temperature

An elderly patient is diagnosed with hyperlipidemia. The NP is prescribing a medication that may have the following effects on her LDL, HDL and Triglyceride levels: LDL-10 to 20% decrease, HDL - 3 to 5% increase and Triglyceride - May increase. Which of the following drugs is the NP MOST likely prescribing?

Lipitor. Gemfibrozil. Nicotinic acid. *Colestipol.

A patient has dementia. What is the best method for gathering information?

Ask the patient. *Ask family. Medicate the patient before asking questions. Rely on visual assessment.

As a GNP you recognize that falls are a significant source of morbidity and mortality in the elderly. Which of the following statements about falls in the elderly is false?

*For adults 65 years old and older, most falls happen in public places. Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes. Approximately 2/3 of long-term care residents experience falls each year. Of elderly adults who fall, 10-30% sustain moderate to severe injuries that reduce mobilty and independence.

The GNP knows that when treating depression with selective serotonin reuptake inhibitors the patient may exhibit:

weight gain and hypoglycemia *weight loss and decrased libido cognitive changes and urinary retention sleepiness and decreased libido

Which intrinsic factors may contribute to falls in older adults? Select all that apply. One, some, or all responses may be correct.

*Lack of exercise 2 *Impaired vision 3 Inappropriate footwear 4 Improper use of assistive devices 5 Unfamiliar environment of hospital room

Which findings in the older adult client are associated with a urinary tract infection (UTI)? Select all that apply. One, some, or all responses may be correct.

Fever 2 Urgency 3 *Confusion 4 *Incontinence 5 *Slight rise in temperature

Mr. Johnson has been diagnosed with Tinea unguium. This is an infection of the _____.

Scalp. Beard. *Nails. Elbows.

An 85-year-old client has a 3-day history of nausea, vomiting, and diarrhea. The client develops weakness and confusion and is admitted to the hospital. To best monitor the client's rehydration status, which would the nurse assess?

Skin turgor 2 *Daily weight 3 Urinary output 4 Mucous membranes

Your 71-year-old patient presents with dyspepsia, early satiety, and abdominal fullness. After testing, you determine she is positive for Ovarian Cancer. Which of the following would LEAST likely be a differential diagnosis for Ovarian Cancer?

*Impaired glucose tolerance. Colitis. Endometriosis. Fibroids.

While caring for an older adult client, which symptom would require an immediate reassessment of the client's needs and plan of care?

*Memory loss or confusion 2 Neglect of self-care 3 Increased daily fatigue 4 Withdrawal from usual activities

An older client with Alzheimer type dementia, consistently sleeps in a semi-Fowler position in bed. Which area of the client's body would the nurse consider a high risk for developing a pressure injury?

*Sacrum 2 Scapulae 3 Ischial spine 4 Greater trochanter

The nurse is caring for an older adult client with dementia. Which client need would the nurse prioritize while providing care?

*Safety 2 Self-esteem 3 Self-actualization 4 Love and belonging

Which physiological changes of the musculoskeletal system would the nurse associate with aging? Select all that apply. One, some, or all responses may be correct.

*Slowed movement Correct2 *Cartilage degeneration 3 Increased bone density 4 Increased range of motion Correct5 *Increased bone prominence

Which factor would the nurse consider when planning activities for an older resident in a long-term care facility with a diagnosis of neurocognitive disorder?

Varied activities that will keep the resident occupied Correct2 *Familiar activities that the resident can complete successfully 3 Challenging activities to maintain the resident's contact with reality 4 Unit activities to ensure that the resident actively participates daily

Which action would the nurse take when caring for an older adult with a history of recent memory loss?

Instruct the client to move slowly when changing positions. 2 Remind the client to look where he or she places the feet while walking. 3 Adjust the daily schedule to accommodate sleep pattern. Correct4 *Employ electronic devices that provide alerts.

You are prescribing Lisinopril for your 70-year-old patient with heart failure. What is the maximum daily dosage the patient can take of this medication?

4 mg/day. 20 mg once per day. *40 mg/day. 16 mg/day.

The nurse instructs a 70-year-old client to dress warmly in cold weather. Which physical changes seen in the client necessitate this instruction? Select all that apply. One, some, or all responses may be correct.

Reduced sebum production 2 Degeneration of elastic fibers 3 Decreased dermal blood flow 4 *Thinning of the subcutaneous layer 5 *Decreased vasomotor responsiveness

Which action would the nurse take for an older resident in a nursing home with Alzheimer disease who hoards leftover food and other seemingly valueless articles and stuffs them into pockets "so the others won't steal them"?

Remove the resident's unsafe and soiled articles during the night. Correct2 *Give the resident a small bag in which to place selected personal articles and food. Incorrect3 Explain to the resident why the nursing home's policy for cleanliness and safety must be followed. 4 Tell the resident that the staff is required to keep harmful objects out of reach in the resident's closet

The nurse finds that an older adult has a new onset of decreased consciousness, fatigue, and hallucinations. Which condition would the nurse suspect in the client?

*Delirium 2 Dementia 3 Depression 4 Alzheimer disease

A 68-year-old client with a new ileostomy remarks to the nurse, "It will be difficult for my wife to care for a helpless old man." Which conflict according to Erikson does this comment exhibit?

Initiative versus guilt 2 *Integrity versus despair 3 Industry versus inferiority 4 Generativity versus stagnation

Your elderly patient has developed a disorder as a result of toxin-induced aminoglycosides. Of the following, which type of disorder did he MOST likely develop?

*Neuromuscular. Central nervous system. Increased CO2 production. Pleural.

Which age-related changes would the nurse expect to find when assessing the reproductive health of an older female client? Select all that apply. One, some, or all responses may be correct.

*Smaller clitoris 2 *Shrunken vulva 3 Dimpled breasts 4 *Narrowed vaginal opening 5 Green vaginal discharge

5. A recently admitted nursing home resident and the resident's family only speak Spanish. One evening during a visit, the resident and the family begin to wail and sob loudly. The gerontological nurse is unable to determine what is wrong. The nurse's most appropriate action is to:

*ask the supervisor to get an interpreter. attempt to make the resident and the family comfortable. contact the provider for orders. find an escort to take the resident and the family to the chapel for privacy.

"My vision is best when I dim the lights." 2 "I always see halos around lights, especially at night." 3 "I can't see objects in my periphery vision." Correct4 "I can't see objects in the center of my vision field."

Industry versus inferiority 2 Identity versus role confusion Correct3 *Generativity versus stagnation 4 Autonomy versus shame/doubt

When teaching about aging, the nurse explains that older adults usually have which characteristic?

Inflexible attitudes Incorrect2 Periods of confusion Correct3 *Slower reaction times 4 Some senile dementia

The nurse is advising an older adult client to apply moisturizer when the skin is moist. Which physical change in the client is associated with this advice?

Thinning subcutaneous layer 2 Degeneration of elastic fibers 3 *Decreased dermal blood flow 4 Benign proliferation of capillaries

Which adverse effect would the nurse continually assess for in a client receiving valproic acid?

*Yellow sclerae Incorrect2 Motor restlessness 3 Ringing in the ears 4 Torsion of the neck

Which ocular symptom would the nurse expect a client with a diagnosis of dry age-related macular degeneration to report?

*Loss of central vision 2 Attacks of acute pain 3 Constant blurred vision Incorrect4 Decreased peripheral vision

An 80-year-old client is admitted to the hospital with severe dehydration. The client's daughter asks the nurse how her mother could have become dehydrated. Which response by the nurse is correct?

"The body's fluid needs decrease with age because of tissue changes." 2 "Access to fluid may be insufficient to meet the daily needs of the older adult." 3 "Memory declines with age, and the older adult may forget to ingest adequate amounts of fluid." 4 *"The thirst reflex diminishes with age, and the recognition of the need for fluid is decreased."

Which statement would the nurse say to an older adult, accompanied by family members, who is admitted to a long-term care facility with symptoms of neurocognitive disorder?

"You're a little disoriented now, but don't worry. You'll be all right in a few days." 2 *"I'm your nurse, and the staff is here to help you." 3 "I will be on duty today. You're in a long-term care facility. Your family can stay about 30 minutes." 4 "Let me introduce you to the staff here first. In a little while I'll get you acquainted with our unit routine."

Which response would the nurse make to a client's daughter who asks when it would be best to visit her mother who has Alzheimer disease?

*"Around 2:30 in the afternoon would be a good time to visit." 2 "Whenever is most convenient for you. She'll be glad to see you." 3 "Come at noon. You'll be able to go to the dining room and visit while she eats." 4 "The longest uninterrupted time begins after supper and extends until bedtime, at 8:30 PM."

Which question would the nurse ask to test the older adult client's capacity for abstract thinking?

*"How are a television and a radio alike?" 2 "Can you give me today's complete date?" 3 "What would you do if you fell and hurt yourself?" 4 "Repeat the following numbers for me: 8, 3, 7, 1, 5."

Which gerontologic assessment findings of the auditory system are related to the inner ear? Select all that apply. One, some, or all responses may be correct.

*Hair cell degeneration 2 *Reduced blood supply to the cochlea 3 Atrophic changes of the tympanic membrane 4 Decline in the ability to filter out unwanted sounds 5 *Less effective vestibular apparatus in the semicircular canals

Which is the purpose of block and parish nursing?

*To provide services to older clients 2 To promote health throughout a school curriculum 3 To provide nursing services with a focus on health promotion and education 4 To deliver primary care to a client population living in a community

Which nursing action(s) may help in the effective assessment of older clients? Select all that apply. One, some, or all responses may be correct.

*he nurse makes eye contact with the client. 2 The nurse leans backward during the interaction. 3 *The nurse smiles at the client during the interaction. 4 The nurse shrugs her shoulders in response to a client's question. 5 The nurse asks the client to express details as quickly as possible

An older adult client who is accustomed to taking enemas periodically to avoid constipation is admitted to a long-term care facility and is bedbound. Which nursing action would be included in the initial plan of care to prevent the client from developing constipation?

Arrange to have enemas prescribed for the client. 2 Obtain a prescription for a daily laxative for the client. 3 Place a commode by the bedside to facilitate defecation. 4 *Offer a large glass of prune juice with warm water each morning

The NP has prescribed a medicine for insomnia to her elderly patient. She informs her patient that the medication should be taken for a 1-month maximum. What is MOST likely the drug that the NP has prescribed?

Barbiturates. Benzodiazepines. *Zolpidem. Zaleplon.

Which age-related finding would the nurse discover when assessing the health of a 69-year-old client?

Big, wide opened eyes 2 Presence of facial hair 3 A bruise on the elbow 4 *Walking with neck bent forward

Which precipitating factors for depression would be common in the older adult without neurocognitive problems? Select all that apply. One, some, or all responses may be correct.

Dementia Correct2 *Multiple losses Correct3 *Declines in health 4 A milestone birthday 5 A traumatic injury

Tubes placed below the ligament of Treitz will reduce the risk of what?

Diarrhea. *Aspiration. IVP (intravenous pyelogram) IAP (intra-abdominal pressure)

Which clinical manifestations are associated with actinic keratosis in a client? Select all that apply. One, some, or all responses may be correct.

Firm, nodular lesions 2 *Small papules with dry skin 3 *Wrinkled, weather-beaten skin 4 Pearly papules with a central crater 5 Irregularly shaped, pigmented papule

When listening to your 71-year-old patient's heart murmur, you note that it is quiet but as soon as you place the stethoscope, you can hear it. How do you grade the murmur?

III/VI. IV/VI. I/VI. *II/VI.

Which approach would the nurse use for a nursing home client with Alzheimer disease who is confused, agitated, and at times unaware of the presence of others?

Initiating a program of unplanned interaction 2 Explaining the nature and routines of the unit 3 Exploring in depth the reasons for the admission 4 *Arranging for the constant presence of a staff member

Which conclusion would the home care nurse make regarding an older adult client with mild Alzheimer disease?

Must be supervised closely at all times 2 Needs a live-in home health aide to assist with activities of daily living Correct3 *Should be allowed to function independently if therapeutically possible 4 Ought to be responsible for carrying out daily self-care activities without assistance

You prescribe a medication for your elderly patient and note it should be p.o. What does this mean?

Three times a day. As directed. In each eye. *Taken by mouth.

Which therapeutic communication strategy is involved when the older client is recalling the past?

Touch 2 *Reminiscence 3 Reality orientation 4 Validation therapy

An older adult who has an endocrine disorder is scheduled for a diagnostic study with contrast medium. The nurse identifies that it is essential for which laboratory test to be performed before the procedure?

Urine pH 2 *Serum creatinine 3 Serum albumin 4 Creatinine clearance

As a GNP you know that the major cause of respiratory disability in older adults is which of the following?

pneumonia lung cancer *COPD heart disease

Ms. Chatham, a 65-year-old patient is determined to have a systolic blood pressure reading of 125. This patient is ______.

*Prehypertensive. Stage I Hypertension. Stage II Hypertension. Normal.

Nurses care for clients in a variety of age groups. In which age group is the occurrence of chronic illness the greatest?

*Older adults 2 Adolescents 3 Young children Incorrect4 Middle-aged adults

25. Three months ago, an older adult patient, who lives in an apartment in a housing complex for senior citizens, began residing with an older adult patient from the same complex. Upon learning of the situation, the patient's adult child expresses concern to the housing administrator, who reports that both residents have reported satisfaction with the arrangement. When the child requests advice, the gerontological nurse's initial response is:

"I can understand why you are upset. Has he or she ever done something like this before?" "Why don't we all talk to your parent to get his or her side of the story?" "Your parent has the right to do what he or she wants because he or she is mentally competent." *"Your parent seems to be happy with the arrangement. Have you discussed this situation with him or her?"

Your elderly patient's MCHC indicates that he is Hyperchromic. Of the following figures, which does NOT indicate a Hyperchromic reading?

*30 g/dL. 42 g/dL. 39 g/dL. 37 g/dL.

A 65 year female patient with chest pain is being diagnosed to determine the etiology of her atrial fibrillation. An echocardiogram was recently performed to check the function of the left ventricle, valvular function, atrial size and for the presence of cardiac thrombi. The transthoracic echo is negative, the GNP should then consider:

Chest x-ray. 12-lead electrocardiogram. Ventilation-perfusion scan. *Transesophageal echo.

Which kind of service does block nursing offer to the elderly clients?

Diagnostics 2 Health screening 3 *Running errands 4 Communicable disease control

Which action is appropriate when caring for an elderly client admitted to a health care facility?

Ensure that the room is brightly lit. 2 Speak to the client in a loud voice. 3 Stand close to the client's ear while speaking. 4 *Invite a family member to join the conversation

Which intervention would the nurse include when developing a plan of care for an older client with dementia?

Explain to the client the details of the regimen. 2 Demonstrate interest in the client's various likes and dislikes. 3 Be firm when dealing with the client's attitudes and behaviors. 4 *Provide consistency in carrying out nursing activities for the client

Mrs. Frasier, an 50-year-old patient, presents with a mosquito bite that she is concerned about. How do you diagnose this?

Cyst. Bulla. *Wheal. Plaques.

For which condition is an adult client with a weakened urinary sphincter at risk?

Bladder distention Correct2 *Skin irritation 3 Tendency to fall 4 Urinary retention

Which step listed by the nursing student indicates a need for additional training regarding communicating with older adults with hearing problems?

"Refrain from speaking extremely slowly." 2 *"Speak clearly by exaggerating his or her lip movements." 3 "Allow the client to ask questions when necessary." 4 "Ensure that the client knows that the nurse is talking."

A patient who otherwise eats independently but requires help cutting meat or buttering bread would receive which of the following scores on the Barthel Index?

5 2 0 *1

Which action would be used to decrease risk for postoperative respiratory complications in an older client with decreased vital capacity?

Give prescribed intravenous antibiotic. 2 Administer oxygen per nonrebreather mask. 3 *Teach the client coughing and deep-breathing exercises. 4 Keep the client on the mechanical ventilation for several days

Which information, if reported by a client within 4 hours after repair of a retinal detachment, would the nurse plan to communicate to the primary health care provider?

Has not voided 2 Cannot open the eye 3 Cannot remember the date 4 *Has sharp pain in the eye

17. A 76-year-old male patient reports hesitancy, decreased force of the urinary flow, a sensation of incomplete emptying of the bladder, and dribbling. The gerontological nurse first asks:

"Have you experienced abdominal pain?" "Have you had a daily bowel movement?" "Have you had low back pain?" *"Have you noticed blood in your urine?"

Which response would the nurse make to the son who says, "I should never have allowed my father to live alone like he wanted to because he has Alzheimer disease. I'm to blame! He didn't even recognize me"?

"I don't think that anybody can blame you. You did what he wanted. Your being here tells us that you care." 2 "I realize that you're upset now. You can visit again when he is more responsive. I'm sure you'll see a change." 3 "Why do you think your father's condition has deteriorated? His forgetfulness is temporary. You'll help if you don't cry." 4 *"This must be a difficult time for both of you. Please share some of your other observations with us—that will help us plan his care."

The nursing student counsels an older 70-year-old female client about changes caused by aging. Which statement made by the client indicates effective learning?

"I should reduce my calcium intake." 2 "I should limit my Kegel exercises." 3 *"I should have regular breast examinations." 4 "I should avoid eating protein."

The nurse instructs an older client's adult child about age-related immune system changes and associated care measures. Which statement indicates a need for further instruction?

"My parent has a private room at home." 2 "My parent has received the pneumococcal vaccination recently." 3 *"My parent comes in for checkups only when experiencing a fever." 4 "My parent has been given a second dose of the pertussis vaccination.

Which instructions would the nurse give to an older adult with decreased perception of touch? Select all that apply. One, some, or all responses may be correct.

"Use a cane for support when walking." Correct2 *"Hold on to handrails while ambulating." Correct3 *"Look where your feet are placed while walking." Correct4 *"Wear shoes that give good support while walking." Correct5 *"If you are unable to change your position frequently, request assistance."

Which response would the nurse make to a depressed older client who has not been eating well since admission to the hospital and repeatedly states, "No one cares"?

"We all care about you; now please eat." 2 "We all care about you; you have to eat to stay alive." 3 *"I care about you. What are some foods you especially like?" 4 "I care about you. Will you please eat some of this food for me?"

Which response would the nurse make to a hospitalized older depressed client who tells the nurse that life is no longer worth living?

"Why do you want to die?" 2 "Are you having thoughts about suicide?" 3 "You must be very depressed to feel that way." 4 "Let's focus on something positive in your life."

8. An 82-year-old patient has a painful, vesicular rash that burns over the left abdomen. The patient indicates that he or she has tried multiple creams that have not helped. Which question does the gerontological nurse first ask?

*"Did you have the pain before the rash appeared?" "Do you have any food or drug allergies?" "Have you been around anyone with a rash?" "Have your grandchildren visited recently?"

You are educating other nurse practitioners about some of the myths surrounding aging. Which of the following is one of these myths?

*Mental function declines with age. People age in different ways. Sexuality is still important and needed. People learn until very late in life.

Which statement is true about older adults and type 2 diabetes?

*Older adults seldom develop ketoacidosis. 2 Older adults secrete no endogenous insulin. 3 Older adults have a lower risk of complications. 4 Older adults develop a sudden onset of symptoms

You prescribe a medication for your elderly patient and note it should be taken t.i.d. What does this mean?

*Three times a day. As directed. In each eye. Taken by mouth.

18. A 65-year-old patient exhibits symptoms of hemianopsia. The most appropriate nursing intervention is to:

*arrange the patient's meal tray so that all the food is in the patient's field of vision. explain all tasks thoroughly to help allay the patient's fears. look directly at the patient when speaking to maximize comprehension. minimize the operating stimuli to reduce distractions to the patient.

12. A frail 80-year-old patient, who cares for a spouse at home without assistance, requires minor surgery. Lacking any family members residing in the area, the patient expresses concern about the spouse's care while the patient is recovering. The gerontological nurse's recommendation is:

*arranging inpatient respite care for the spouse. having the patient remain in the hospital during the post operative period. hiring around-the-clock help for two weeks. hospitalizing the spouse.

You see a 65-year-old Native American female in the office who is on an antiepileptic medication for seizure disorder. The GNP understands that this medication:

*is usually discontinued after 4 years of no seizure activity and a normal EEG must be given to all patients who experience a seizure must be taken indefinitely is usually given in combination with other antiepileptics or sedatives to reduce the seizure threshold

A patient who is 74 years old and still active was diagnosed with type 2 diabetes several years ago. He has not done well on oral agents and a decision to use insulin has been made. What would be the goal post prandial glucose for him?

100-120 mg/dL 120-150 mg/dL less than 150 mg/dL *less than 180 mg/dL

Mr. Billings, an elderly patient is within the normal range for Hct. Which of these would it be?

38%. 56%. *48%. 59%.

16. Which patient is at greatest risk for developing arteriosclerotic heart disease?

A 68-year-old female patient with a triglyceride level of 135 mg/dL, and a high-density lipoprotein level of 68 mg/dL. A 70-year old male patient with a total cholesterol level of 181 mg/dL, and a low-density lipoprotein level of 90 mg/dL. *A 75-year old female patient with a triglyceride level of 189 mg/dL, and a low-density lipoprotein level of 149 mg/dL. An 86-year-old male patient with a low-density lipoprotein level of 100 mg/dL, and a high-density lipoprotein level of 50 mg/dL.

The GNP has knowledge that effective communication includes all of the following except:

All communication is privileged and confidential *Recording information and sharing information is not part of the communication process. Good communication is a necessity when providers are interviewing and teaching patients. Written documentation is subject to specific standards.

Which action would the nurse take for an older client with Alzheimer disease who has laid out several outfits on the bed to wear to a recreational session but is still wearing nightclothes?

Assist the client to dress and explain when residents are expected at the activity. 2 Prompt the client to dress more quickly to avoid delaying the other residents. 3 *Help the client select appropriate attire and offer to help the client get dressed. 4 Allow the client time to dress but explain that the client has missed the opportunity to attend the activity

You are providing care to a patient who has recently begun dialysis. Her daughter, with whom she lives and who prepares many of her meals, asks what types of foods she should incorporate into her diet and which she should avoid. Which of the following is NOT a food that this patient should be advised to avoid?

Avocado. *Lean red meat. Dried fruit. Bananas.

What is true regarding overweight older adults and their state of health?

BMI is a good way to assess nutritional states in the elderly. There are no potential metabolic or functional benefits to weight loss in the elderly. There is clearly associated increased mortality with overweight older adults. *Mortality in the elderly related to overweight states declines over time.

Oral lesions are often asymptomatic and commonly found during routine examination, especially in patients with dentures. An additional risk for oral candidiasis includes:

Beta blockers. Non-steroidal anti-inflammatory drugs (NSAID). *Insulin. Topical steroids.

Which age-related finding would the nurse identify while assessing the reproductive health of an older adult female?

Breast dimpling 2 Painful intercourse 3 *Decreased amount of pubic hair 4 Green discharge from the vulva

The nurse is preparing discharge instructions for a client who has begun to demonstrate signs of early Alzheimer dementia and lives alone, with adult children living nearby. According to the prescribed medication regimen, the client is to take medications six times throughout the day. Which nursing intervention is correct to assist the client with taking the medication?

Contact the client's children and ask them to hire a private-duty aide who will provide round-the-clock care. 2 Develop a chart for the client, listing the times the medication should be taken. 3 *Contact the primary health care provider and discuss the possibility of simplifying the medication regimen. 4 Instruct the client and client's children to put medications in a weekly pill organizer.

When assessing a patient with heart failure, the nurse can determine side of the failure based on the signs or symptoms. A sign of right-sided heart failure includes:

Cough with blood-tinged sputum. Pulsus alternans. Dyspnea. *Hepatomegaly with hepatojugular reflex.

Which finding by the nurse when assessing a 75-year-old client would be most important to report to the health care provider?

Decreased lung sounds at bases 2 Kyphosis with barrel-shaped chest 3 Oxygen saturation at rest 93% Correct4 *Expiratory wheezes bilaterally

An 85-year-old client has just been admitted to a nursing home. When designing a plan of care for this older adult, the nurse recalls which expected sensory losses associated with aging? Select all that apply. One, some, or all responses may be correct.

Difficulty in swallowing 2 *Diminished sensation of pain 3 Heightened response to stimuli 4 *Impaired hearing of high frequency sounds 5 Increased ability to tolerate environmental heat

Which age-related change would the nurse consider when formulating a plan of care for an older adult? Select all that apply. One, some, or all responses may be correct.

Difficulty in swallowing 2 Increased sensitivity to heat 3 *Increased sensitivity to glare 4 *Diminished sensation of pain 5 Heightened response to stimuli

An 80-year-old client with depression requires the prescription of antidepressant medication. Which tricyclic antidepressant medication causes fewer complications in older clients?

Doxepin 2 Amoxapine 3 *Nortriptyline 4 Trimipramine

Which is the most important nursing intervention when working with an older adult client?

Encouraging frequent naps 2 Strengthening the concept of ageism 3 *Reinforcing the client's strengths and promoting reminiscing 4 Teaching the client to increase calories and focusing on a high-carbohydrate die

Which type of bone tumor occurs most commonly in elderly clients?

Endochroma 2 Osteosarcoma 3 *Chondrosarcoma 4 Osteochondroma

Which health care factors create barriers that prevent older adults from participating in health care promotion and disease prevention? Select all that apply. One, some, or all responses may be correct.

Finance Incorrect2 Activity level 3 Transportation Correct4 *Personal motivation Correct5 *Previous health care experience

Which are extrinsic factors responsible for falls in older adults? Select all that apply. One, some, or all responses may be correct.

Impaired vision 2 Cognitive impairment 3 *Environmental hazards 4 *Inappropriate footwear 5 *Improper use of assistive devices

Which are extrinsic factors responsible for falls in older adults? Select all that apply. One, some, or all responses may be correct.

Impaired vision Incorrect2 Cognitive impairment Correct3 *Environmental hazards Correct4 *Inappropriate footwear Correct5 *Improper use of assistive devices

The nurse is preparing to teach a community health program for senior citizens. Which physical findings would the nurse include that are typical in older adults?

Increased skin elasticity and an increase in testosterone production 2 Impaired fat digestion and an increase in pepsin production 3 *Increased blood pressure and decreased cardiac output 4 An increase in body warmth and some swallowing difficulties

An 85-year-old client is alert and able to participate in care. According to Erikson, which developmental stage will the client need to adjust to?

Industry versus inferiority 2 Identity versus role confusion 3 *Generativity versus stagnation 4 Autonomy versus shame/doubt

When meeting the preoperative teaching needs of an older adult, the nurse plans a teaching program based on which principle about learning?

It reduces general anxiety. 2 It is negatively affected by aging. 3 *It requires continued reinforcement. 4 It necessitates readiness of the learner.

The nurse recognizes which mental process is associated with deterioration that accompanies aging?

Judgment 2 Intelligence 3 Creative thinking 4 *Short-term memory

Aging involves the concept of loss. Which of the following losses is not one of the psychosocial losses associated with aging?

Loss of spouse, children or friends. Loss of role in the workplace and in the family. *Loss of intelligence level. Loss of socioeconomic status.

Which program would the nurse suggest for the 70-year-old client who needs to undergo heart surgery but cannot afford it?

Medicaid 2 *Medicare 3 Managed care organization 4 Preferred care organization

A client with dementia is having trouble with person, place, and time. Which action by the nurse would be appropriate in this situation?

Minimize environmental stress to reduce confusion. 2 *Let the client continue to think in his or her own way. 3 Prompt the client to recognize the correct date and time. 4 Ask the client to recall the past to understand the present situation

As per the Health Belief Model, what "includes personality variables, patient satisfaction, and socio-demographic factors"?

Motivation. *Modifying factors. Rationale. None of the above.

Which condition is due to decreased elasticity of the ocular lens?

Myopia 2 Hyperopia Correct3 *Presbyopia 4 Astigmatism

Your elderly patient has developed a disorder as a result of intracranial hypertension. Of the following, which type did he MOST likely develop?

Neuromuscular disorder. *Central nervous system disorder. Increased CO2 production. Pleural disorder.

Which essential approach would the nurse use when caring for a confused older client?

Offer space for privacy. 2 Provide group involvement. 3 *Establish trusting relationships. 4 Encourage activities that are varied

Which of the following is NOT a potential complication when managing persistent pain in an older adult patient?

Older patients often take several daily medications to manage a chronic condition. Older adults are a higher risk of drug interactions than younger patients. Older adults tend to have a higher sensitivity to analgesics than do younger patients. *Older adults often exaggerate pain.

A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse expect to be prescribed for the client?

Oral hydroxyurea Correct2 *Vitamin B12 injections 3 Oral iron supplements 4 Erythropoietin injections

A debilitated older client who has glaucoma places great value on independence. What would the nurse encourage the client to do after discharge from the hospital?

Prevent stressful events that can increase symptoms 2 Conserve eyesight by not reading or watching television 3 Perform household chores and shopping without assistance 4 *Self-administer eye medications using appropriate technique

Which nursing interventions would the nurse provide to an older client with hypertension? Select all that apply. One, some, or all responses may be correct.

Provide skin care. Correct2 *Advise the client to limit salt intake. Correct3 *Teach stress management. Correct4 *Instruct the client to quit smoking. 5 Advise the client to eat finger foods.

Which nursing intervention would be helpful in meeting the needs of an older adult with Alzheimer disease?

Providing nutritious foods that are high in carbohydrates and protein 2 Offering opportunities for choices in the daily schedule to stimulate interest 3 Developing a consistent plan with a fixed time schedule to fulfill emotional needs 4 *Simplifying the environment as much as possible by limiting the need for decisions

The nurse listens to and validates the feelings expressed by a confused older adult. Which element(s) would the nurse convey in this situation? Select all that apply. One, some, or all responses may be correct.

Recalling 2 *Respecting 3 *Reassuring 4 Reinforcing 5 *Understanding

The nurse listens to and validates the feelings expressed by a confused older adult. Which element(s) would the nurse convey in this situation? Select all that apply. One, some, or all responses may be correct.

Recalling Correct2 Respecting *Correct3 Reassuring 4 Reinforcing *Correct5 Understanding *Validation therapy is an alternative approa

Which psychosocial health concern involves accepting descriptive statements stated by a confused older client?

Reminiscence 2 Reality orientation Correct3 *Validation therapy 4 Therapeutic communication

Which intervention would the nurse implement first when providing care for an older adult male client who is immobile and incontinent of urine?

Restrict the client's fluid intake. 2 *Regularly offer the client a urinal. 3 Apply incontinence pants. 4 Insert an indwelling urinary catheter.

Which genitourinary factor contributes to urinary incontinence in older adult clients and needs to be considered by the nurse when planning the care for these clients?

Sensory deprivation 2 *Urinary tract infection 3 Frequent use of diuretics 4 Inaccessibility of a bathroom

The nurse is caring for an older adult client with dementia who has developed dehydration as a result of vomiting and diarrhea. Which assessment information best reflects the fluid balance of this client?

Skin turgor Incorrect2 Intake and output results 3 Client's report about fluid intake Correct4 *Blood lab results

A 93-year-old client in a nursing home has been eating less food during mealtimes. Which is the correct nursing intervention?

Substitute a supplemental drink for the meal. 2 Spoon-feed the client until the food is completely eaten. 3 *Allow the client a longer period of time to complete the meal. 4 Arrange a consultation for t

An elderly patient has Type II diabetes that cannot be controlled with diet, exercise, or oral agents. She is asking the NP what would be the next course of action. What would the NP most likely say?

Sulphonylureas Metformin Thiazolidinedions *Insulin.

You are about to administer medication to a patient. You have already verified the medication label against the medication order. Which of the following is your next step?

Tell the patient the name of the medication. *Show the patient the medication. Ask the patient to swallow the medication. Tell the patient it's time for her pills.

All of the following are requirements of the Omnibus Budget Reconciliation Act of 1987 (OBRA) except:

Temperature, humidity and odor levels must be acceptable. *Furnishings must be comparable or better than what would be found at home. Lighting levels must be adequate. Non-smoking areas must be defined.

22. An older adult patient, who has end-stage multiple myeloma, is receiving hospice care. Which situation illustrates that the principles of hospice care are being met?

The caregiver asks if hospice includes weekend care. The caregiver has been calling the provider on his or her own. The patient reports enjoying daily excursions. *The patient reports no breakthrough pain medications are needed.

The health care provider prescribes haloperidol 0.5 mg intramuscularly (IM). The haloperidol is available in a vial that contains 2 mg/mL. How much solution will the nurse administer? Record your answer using two decimal places. Include a leading zero if applicable. ___ mL

The prescribed dose is 0.5 mg. The available concentration is 2 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse would administer.

An 82-year-old retired schoolteacher is admitted to a nursing home. During the physical assessment, the nurse would identify which ocular problem common to persons at this client's developmental level?

Tropia 2 Myopia 3 Hyperopia Correct4 *Presbyopia

An older client is apprehensive about being hospitalized for the first time. Which intervention is correct for the nurse to perform to limit the client's stress?

Use the client's first name. 2 Visit with the client frequently. 3 *Explain what the client can expect. 4 Listen to what the client has to say.

Which intrinsic factor is associated with the fall of an older adult?

Wet floors 2 Poor lighting Correct3 *Lack of exercise 4 Inappropriate footwear

There has been a recent shift of the health care delivery toward the provision of nonacute care from the hospital setting to the ambulatory care setting and the home. Nursing research that was previously conducted in hospitals:

is now applicable to all in-hospital providers of care. is now relevant in the new settings, as patient care is unchanged. *is no longer applicable to the delivery of patient care. is needed to be applied directly to patient care that is provided in the new settings.

How far should the external bumper of a PEG be from the abdominal wall?

3 or 4 mm. 1 or 2 mm. 3 or 4 cm *1 or 2 cm.

Which age-related skin change occurs in older adult clients and increases their potential for developing pressure ulcers?

Atrophy of the sweat glands 2 *Decreased subcutaneous fat 3 Stiffening of the collagen fibers 4 Degeneration of the elastic fibers

Family members received discharge instructions for an older adult male recovering from a urinary tract infection. Which statement indicates family understanding of age-related changes and required care?

"I place a small glass of water at his side to ensure sipping before bedtime." 2 "I respond immediately with the urinal whenever he indicates a need to void." Correct3 *"I provide privacy and standby assistance to help him void." Incorrect4 "I encourage him to use the urinal at least every 2 hours during the day.

The registered nurse (RN) is teaching the nursing student about interventions for cognitively impaired older adults. Which statement made by the nursing student indicates a need for further education?

"I should encourage fluid intake." 2 *"I should provide conditional positive support." 3 "I should promote social interaction based on abilities." 4 "I should provide ongoing assistance to family caregivers."

The registered nurse (RN) is teaching the nursing student about providing care to an older adult with dementia. Which statement made by the nursing student indicates a need for further education?

"I should serve food that is easy to eat." 2 "I should assist the client with eating." 3 *"I should monitor weight and food intake once a month." 4 "I should offer food supplements that are tasty and easy to swallow."

An older client asks, "How do I know that the medications that I take are safe?" Which response by the nurse is correct? Select all that apply. One, some, or all responses may be correct.

*"Ask your health care provider how and when you should be taking your medications." 2 "Stop taking a prescribed medication if you are not feeling better in a few days." 3 "Discard medications into the toilet that have exceeded the expiration date on the bottle." 4 *"Check the name, dose, and instructions about administration of medications each time before leaving the pharmacy." 5 *"Inform your health care provider of the over-the-counter medications, recreational drugs, and amount of alcohol you ingest."

Which instruction would the nurse give an older adult to promote wellness and reduce the risk of disability?

*"Engage in physical activities to stay fit." 2 "Don't exhaust yourself by engaging in physical activities." 3 "Pay no heed to your financial problems if you want to stay healthy." 4 "Stay away from people so as to prevent anxiety and stress disorders."

The nurse suspects that a client has diabetes mellitus. Which statements made by the client helped the nurse reach this conclusion? Select all that apply. One, some, or all responses may be correct.

*"I am 65 years old." 2 *"I quite often feel thirsty." 3 *"I eat food every 2 hours." 4 "I have excessive sweating." 5 "I sometimes experience shortness of breath."

Mr. French asks the GNP the maximum number he can have for his LDL Cholesterol level in order to be considered at a borderline high amount. What answer does she give him?

62 mg/dL. *159 mg/dL. 83 mg/dL. 95 mg/dL.

Your elderly patient's MCV indicates that he is Normocytic. Of the following figures, which does NOT indicate a Normocytic reading?

85 fL. 92 fL. 100 fL. *75 fL.

In order for effective teaching to take place, it is crucial that the GNP use the proper teaching style for each patient. What teaching style would BEST suit a patient with a "Dependent Learner" style?

Facilitator. Delegator. *Authority, expert. Salesperson, motivator.

An older adult has undergone chemotherapy. Which agent could be administered to decrease the risk of a potentially contagious common viral infection?

Famciclovir 2 Gabapentin 3 *Zoster vaccine 4 Herpes simplex virus type 1 (HSV-1) vaccine

You are treating a 68-year-old male who is suffering with alcoholism. The most helpful approach for him is:

Inform the patient of the long-term health consequences of alcohol abuse. Tell the patient to stop drinking. Refer the patient to Alcoholics Anonymous. *Counsel the patient that alcohol abuse is a treatable disease.

Which initial nursing intervention would the nurse take for an older adult with delirium who begins acting out while in the dayroom?

Instructing the client to be quiet 2 Allowing the client to act out until fatigue sets in 3 Guiding the client from the room by gently holding the client's arm 4 *Giving the client one simple direction at a time in a firm, low-pitched voice

The registered nurse is teaching isometric exercises to an 80-year-old client. Which change as a result of aging requires this intervention?

Kyphotic posture 2 *Muscular atrophy 3 Decreased bone density 4 Cartilaginous degeneration

Which guideline would the nurse consider when planning care for a hospitalized older client with Alzheimer disease?

Physical contact will increase dependency needs. 2 *Routines provide stability for clients with neurocognitive disorders. 3 Regressive behavior should be interrupted immediately. 4 Procedures do not have to be explained to clients with neurocognitive disorders

Which nursing interventions help reduce the severity of an older adult client's kyphotic posture and widened gait condition? Select all that apply. One, some, or all responses may be correct.

Teach the client correct use of isometric exercises. 2 Teach the client safety tips to prevent falls. 3 *Teach the client proper body mechanics. 4 Prevent pressure on bony prominences of the client. 5 *Instruct the client to sit in supportive chairs with arms

Which nursing intervention is indicated for an aging client with decreased bone density?

Teaching the client isometric exercises 2 Advising the client to take a warm shower 3 Providing supportive armchairs to the client 4 *Demonstrating weight-bearing exercises to the client

Your 75-year-old male patient presents with a lump on his breast. How would you proceed with this?

Tell him that since he is male there is no risk of cancer. *Evaluate the lump and proceed with a mammogram and ultrasound. Tell him that this is common in men his age and that he should not worry that it is cancer. Palpate the lump and do an ultrasound.

Which of the following is true when using the Tinetti Assessment?

The lower the patient's score, the lower his/her risk of fall. The higher the patient's score, the higher his/her risk of fall. *The lower the patient's score, the higher his/her risk for falls. None of the above.

You are educating a patient who is being discharged after a colostomy. The patient asks what type of dietary changes he needs to make for the period until his colostomy is removed. Which of the following should NOT be part of this patient's education?

The patient should avoid gas producing foods such as cabbage, broccoli, and cauliflower. *The patient should eat a very low-fiber diet. The patient should eat normal foods and avoid those that cause him discomfort. A food diary may be helpful. The patient should choose higher fiber foods such as whole grains.

Late adulthood involves all of the following ranges except:

young-old (65-74 years old) old (75-84 years old) *older-old (80-90 years old) old-old (85 years of age and older)

1. Which ethical principle underlies nursing actions respecting each patient's values and beliefs?

*Autonomy. Beneficence. Justice. Responsibility.

Which of the following is the recommended daily dose of naproxen sodium for older adults?

220 mg. *440 mg. 600 mg. 4 g.

2. The most common symptoms of benign prostatic hypertrophy are:

chills, fever, and nausea. dysuria, abdominal pain, and urinary retention. *intermittency, hesitancy, and dribbling. nocturia, bladder spasms, and hematuria.

20. For older adult patients who are taking neuroleptic medication, the primary concern is the development of:

lethargy. nausea. poor appetite. *tardive dyskinesia.

Which instruction from the nurse to an 80-year-old client with thinning of a subcutaneous layer would be beneficial?

*Dress warmly in cold weather. 2 Use soaps with high fat content. 3 Change the position of bed once every 5 hours. 4 Apply moisturizer 2 hours after bathing.

Aging brings on changes in the cardiovascular system. As a GNP you know that all of the following are true regarding the cardiovascular systems of aging persons except:

Age-related changes in the cardiovascular system predispose the older person to developing dysrhythmias. Cardiac output decreases as a result of a decrease in heart rate and stroke volume. *Cardiac output decreases because vessels gain elasticity. Diastolic murmurs are present in over one half of older adults because the mitral and aortic valves become thick and rigid.

11. Signs and symptoms of age-related macular degeneration include:

decreases in depth perception. deficits in peripheral vision. *distortion of lines and print. reports of flashes of light.

3. The gerontological nurse is monitoring signs of suspected abuse in an 89-year-old patient who was admitted from home. When planning for the patient's discharge, the nurse's first action is to:

delay discharge by informing the provider of the suspected abuse. enlist the help of family members with transitioning the patient home. *notify Adult Protective Services of the patient's discharge. restrict the family members' access to the patient prior to discharge.

The U.S. Department of Agriculture (USDA) food pyramid and other research suggests all of the following except:

diet should have substantial fiber use sweets, fats, and oils sparingly *vegetables: 6-8 servings daily fruits: 2-4 servings daily

Which action would the nurse take for an older adult resident with Alzheimer disease who often talks about the "good old days" at the ranch?

*Allowing the resident to reminisce about the past and listening with interest 2 Involving the resident in interesting diversional activities with a small group 3 Reminding the resident that those times are in the past and should focus on the present 4 Introducing the resident to other residents with the same diagnosis to share past experiences

Which interventions would the nurse implement when providing health education to an elderly client? Select all that apply. One, some, or all responses may be correct.

*Assess the client for pain before teaching. 2 Take notes while talking to the client. 3 *Ensure that the client is not preoccupied or anxious. 4 *Explain one concept at a time based on the client's interest. 5 Teach a family caregiver if the client does not respond quickly

9. Which question does the gerontological nurse prioritize for an 86-year-old patient with abdominal pain, muscle weakness, and leg cramps?

"Do you eat a lot of meat?" "Do you have heart problems?" *"Do you take a diuretic?" "Do you walk every day?"

Which initial response would the nurse make during a routine yearly physical to an older adult who says, "I haven't had sex lately because I can't get an erection anymore"?

*"Let's discuss this concern a little more." 2 "Be sure to tell your primary health care provider about this problem." 3 "There is medication available for erectile dysfunction." 4 "This is an expected physiological response to getting older."

Which instructions would the nurse give a 60-year-old client who is at an increased risk for corneal damage? Select all that apply. One, some, or all responses may be correct.

*"Use saline drops." 2 "Increase humidity at home." 3 *"Wear prescribed lens for best vision." 4 *"Have corrective lenses solely for reading.

In the older adult client with decreased cell division in the epidermal layer of the skin, which interventions would the nurse include in the client's plan of care? Select all that apply. One, some, or all responses may be correct.

*Advise the client to prevent exposure to skin trauma. 2 *Advise the client to protect open areas of skin. 3 Advise nonalcohol-based lotions for excessive dryness or moisture. 4 Handle the client carefully to reduce skin friction. 5 Advise the client to change positions every 2 hours

A 70-year-old client is diagnosed with cartilaginous degeneration. Which action would the nurse take?

*Advise the client to take warm showers. 2 Teach the client isometric exercises. 3 Provide the client with supportive armchairs. 4 Demonstrate weight-bearing exercises to the client.

The nurse reviews the medical records of four male clients. Which client would the nurse note as having the highest risk for development of clinical manifestations related to prostate cancer?

*African American 55-year-old 2 White 45-year-old 3 Asian 55-year-old 4 Hispanic 45-year-old

You determine your patient is suffering from polyphagia. She asks what that means. What do you tell her?

Excessive sweating. Excessive thirst. *Excessive uncontrolled eating. Excretion of excessive urine.

An older client who has a fractured femur asks the nurse, "Will I be able to walk again?" Which response would the nurse make?

"I have no idea because only time will tell." 2 "You only broke a bone. It could have been worse." 3 "You'll walk again. This is a common issue in older people." 4 *"Tell me your concerns about being able to walk."

Which age-related changes are associated with the female genitalia? Select all that apply. One, some, or all responses may be correct.

*Dry vagina 2 Firm breasts 3 Erect nipples 4 *Graying pubic hair 5 *Shrinking of the labia majora

The nurse provides discharge teaching to an older adult about care associated with activities of daily living. Which factor is the priority that the nurse would consider when counseling the client on how often to take a tub bath?

*Condition of the skin 2 Ability of the client to provide self-care 3 Degree of orientation to the environment 4 Type of allergic reactions experienced by the client

Which of the following is NOT an element of Bowen's Family System Theory?

*Family flaws. Family rules. Family roles. Adaptation.

A 90-year-old resident fell and fractured the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. Which general fact about the older adult would the nurse consider when caring for this client?

Aging causes a lower pain threshold. 2 *Aging reduces the physiological coping defenses. 3 Most confused states result from dementia. 4 Older adults psychologically tolerate changes well.

You are providing patient education to a 65 year old male patient who will undergo a prostatectomy in the near future. He asks about possible complications of the surgery. Which of the following is NOT among the risks of this patient's procedure?

Erectile dysfunction. Urine leakage. *Fecal incontinence. Stress incontinence.

Which important points would the nurse keep in mind when caring for an older adult to promote health? Select all that apply. One, some, or all responses may be correct.

Focus on achieving the highest level of health and absence of disease. Correct2 *Encourage regular physical activity and the use of stress-management strategies. 3 Encourage the client to accept help for carrying out activities of daily living (ADLs). Correct4 *Consider the client's social environment, and strengthen social support to promote health. *Correct5 Assess the client for fear of falling, and provide support by making environmental changes

Which information about benign prostatic hyperplasia (BPH) is important for the nurse to consider when caring for a client with that condition?

It is a congenital abnormality. 2 A malignancy usually results. 3 *It predisposes to hydronephrosis. 4 Prostate-specific antigen decreases.

10. When teaching an independent older adult patient how to self-administer insulin, the most productive approach is to:

facilitate involvement in a small group where the skill is being taught. gather information about the patient's family health history. provide frequent, competitive skills testing to enhance learning. *use repeated return demonstrations to promote the patient's retention of the involved tasks.

For alcohol withdrawal symptoms, the preferred benzodiazepine is lorazepam. This is used when there is concomitant history of:

folate-deficiency anemia *hepatic disease seizure disorder multiple substance abuse

The nurse practitioner is prescribing Digoxin and antiarrhythmic to her 85 year old patient. The patient asks about risks associated with the combination. What does the NP say is a potential risk?

*Bradycardia. Hyperkalemia. Electrolyte imbalance. Sedation.

The client has a visual impairment. Which technique would the nurse use to communicate?

Face the caregiver while speaking. 2 Provide bright, diffuse, glare lighting. 3 Stand or sit far away from the client while remaining in the client's full view. Correct4 *Encourage the older adult to use assistive devices such as eyeglasses.

A 67-year-old man states, "I drink way too much and don't know how to stop." According to Prochaska's change framework, the statement is most consistent with a person at the stage of:

action preparation precontemplation *contemplation

A client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation will alert the nurse to the fact that the client may be developing a life-threatening response to the medication?

*Paroxysmal nocturnal dyspnea 2 Supraventricular tachycardia 3 Malignant hypertension 4 Hyperglycemia

An older adult client who is receiving chemotherapy for cancer has severe nausea and vomiting and becomes dehydrated. The client is admitted to the hospital for rehydration therapy. Which nursing actions have specific gerontological implications the nurse must consider? Select all that apply. One, some, or all responses may be correct.

*Assessment of skin turgor 2 Documentation of vital signs 3 Assessment of intake and output 4 *Administration of antiemetic medications 5 *Replacement of fluid and electrolytes

A client with Parkinson disease is admitted to the hospital. Which medication is prescribed to improve the physical manifestations of Parkinson disease?

*Carbidopa-levodopa 2 Isocarboxazid 3 Dopamine 4 Pyridoxine (vitamin B6)

Which assessment finding is associated with depression?

*The client has islands of intact memory. 2 The client has impaired recent and remote memory. 3 The client has impaired recent and immediate memory. 4 The client needs step-by-step instructions for simple tasks.

An emaciated older adult with dementia develops a large pressure ulcer after refusing to change position for extended periods. The family blames the nurses and threatens to sue. Which is considered when determining the source of blame for the pressure ulcer?

*The client should have been turned regularly. 2 Older clients frequently develop pressure ulcers. 3 The nurse is not responsible to the client's family. 4 Nurses should respect a client's right not to be moved

Which of the following is NOT a sign of depression in an older adult?

*His speech is impaired. His speech is slow but clear. He reports difficulty sleeping. He expresses concern over being a burden to his children.

The nurse assesses an older adult client with cognitive impairment. Which statement(s) made by the client confirm the nurse's conclusion? Select all that apply. One, some, or all responses may be correct.

*I have difficulty judging things." 2 "I forget to take medicines." 3 *"I am unable to do financial calculations." 4 "I get confused about the proper date and time." 5 *"I am unable to recall words during conversations with my family.

Which situation would the nurse address to meet the safety and security needs of the client according to Maslow's hierarchy of needs?

"Because my teeth hurt when I eat, I drink fruit juices and prefer a liquid diet." Correct2 *"I do not want to talk to any stranger because I fear that they might take away my things." 3 "My blood pressure level keeps on fluctuating, although I take medications regularly." 4 "Ever since my family members came to know about my problem, they are trying to avoid me."

An elderly client states, "Disease occurs when supernatural elements enter the body." Which variable influences the client's health beliefs in this scenario?

*Spiritual factors 2 Emotional factors 3 Intellectual background 4 Perception of functioning

15. A state ombudsman initiates an investigation after a complaint about the care of a nursing home resident. Which statement about the investigation process is true?

*The ombudsman may proceed with the investigation without identifying the individual who made the complaint, and without obtaining a court order or written consent. The ombudsman must identify the individual who made the complaint. The ombudsman must obtain a court order to review documentation, if the resident described in the complaint does not give written permission. The ombudsman must obtain the written permission of the resident who is described in the complaint.

Which intervention would the nurse provide while caring for an older adult client who is reported to have decreased estrogen production?

*Use minimal tape on client's skin 2 Cover the client with warm clothing 3 Perform blood glucose test for the client 4 Monitor for bradycardia

An older client who has been undergoing months of treatment for osteomyelitis reports perianal itching and diarrhea. Which assessment finding would the nurse expect to identify?

*Whitish-yellow lesions in the oral cavity 2 Presence of glucose and ketones in urine 3 Flexion contracture of the lower extremities 4 Overgrowth of genital wart-like lesions

24. A 75-year-old patient, whose marriage ended in divorce after two years, has lived alone for the past 50 years. Feeling as if life has had little meaning, the patient is terrified of living out the remaining years and of dying. The age-related issue to be resolved is:

disengagement vs. activity. *ego integrity vs. despair. self-determination vs. resignation. self-esteem vs. self-actualization.

7. An effective way to adequately provide nourishment to a patient with moderate dementia is:

allowing the patient to choose foods from a varied menu. hand feeding the patient's favorite foods. routinely reminding the patient about the need for adequate nutrition. *serving soup in a mug, and offering finger foods.

19. An 80-year-old patient, who lives at home with a spouse, is instructed to follow a 2 g sodium diet. The patient states, "I've always eaten the same way all my life, and I'm not going to change now." To promote optimal dietary adherence, the gerontological nurse's initial approach is to:

inform the patient about the need to follow the diet. *inquire about the patient's current food preferences and eating habits. list the variety of foods that are allowed on the diet. provide dietary instruction to the patient's spouse, who prepares the meals.

The nurse is assessing an older adult male client. Which clinical finding(s) are expected response(s) to the aging process? Select all that apply. One, some, or all responses may be correct.

*Slowed neurological responses Lowered intelligence quotient Long-term memory impairment *Forgetfulness about recent events *Reduced ability to maintain an erection

Which approach would the nurse use for a client with Alzheimer disease who expresses fear and anxiety upon admission to a long-term care facility?

Exploring the reasons for the concerns 2 *Reassuring the client with the presence of 1 or 2 staff members 3 Providing the client with a written schedule of planned interactions 4 Explaining to the client why the admission to the facility is necessary

Which nursing action is most appropriate to help reduce the likelihood of an older adult client falling during the night?

Moving the client's bedside table closer to the bed 2 Encouraging the client to take an available sedative Correct3 *Instructing the client to call the nurse before going to the bathroom 4 Assisting the client to telephone home to say goodnight to the spouse

Mr. Fellows' fasting blood glucose is tested three times. The first reading is 135. The second is 133 and the third, 140. What does this mean?

*He is diabetic. He is in a coma. His blood glucose is normal. He is prediabetic.

The home health care nurse visits an older adult couple living independently. The wife cares for the husband, who has dementia. Which interventions would the nurse implement for them? Select all that apply. One, some, or all responses may be correct.

*Assess the wife for caregiver burden. 2 Arrange hospice care for the husband. 3 Make health care decisions for the couple. 4 *Assess the husband for signs of physical abuse. 5 *Identify social support within the community.

While assessing the skin of an older adult, the nurse finds redundant flesh around the eyes. Which changes in the skin are responsible for this condition? Select all that apply. One, some, or all responses may be correct.

*Decrease in muscle laxity 2 Increase in capillary fragility 3 *Decrease of subcutaneous fat 4 Decrease of extracellular water 5 Increase in focal melanocytes in the basal layer

Which intervention would the nurse include in the nursing home plan of care for an older adult with Alzheimer disease who has nighttime wandering?

Order a vest restraint for the client to be applied at night. 2 Obtain a prescription for a sedative so the client will sleep better at night. 3 Request that the family provide a companion to stay with the client at night. 4 *Assign the client to a room near the nurses' station for closer supervision at night.

Which initial response would the nurse make to a 67-year-old man with type 2 diabetes who sadly confides in the nurse that he has been unable to have an erection for several years?

"At your age, sex isn't that important." 2 "That is a natural occurrence at your age." 3 *"You sound upset about not being able to have an erection." 4 "Maybe it's time for you to speak to your primary health care provider about this."

The registered nurse teaches a 70-year-old client with kyphosis about self-care measures. Which statement made by the client indicates effective learning?

"I should take warm baths." 2 "I should do isometric exercises." 3 *"I should sit in supportive armchairs." 4 "I should position myself quickly.

The nurse is teaching an older client about proper medication use. Which statement made by the client indicates the need for further education?

"I will ask the pharmacist to give generic medications." Correct2 *"I will use over-the-counter medicines along with prescribed medications." Incorrect3 "I will continue my treatment by consulting a single health care provider." 4 "I will know the names and times of administration of the medications I am taking."

The nurse is caring for an older adult who was admitted to the hospital to be treated for dehydration. While the nurse is providing discharge teaching, the client asks what to do about itchy, dry skin. Which response by the nurse is appropriate?

"Wear plenty of warm clothes to keep moisture in the skin." 2 *"Use a moisturizer on the skin daily to help reduce itching." 3 "Take hot tub baths only twice a week to reduce drying of the skin." 4 "Expose the skin to the air to help reduce the sensation of itching."

An older adult client is brought to the hospital by a family member because of deep partial-thickness burns on the arms and hands. The client protests being hospitalized and asks, "Why can't I just go home and have my spouse care for me?" Which is the best response by the nurse?

"You sound upset, but your primary health care provider knows best. You should do what is prescribed." 2 "Your spouse is very capable, but if your burns get infected, a family member can't give you the injections you will need." 3 "Your burns are more serious than you think, and we have specially trained people here just to take care of you." 4 *"You may heal more slowly because of your age, and you may need the special care and equipment available in the hospital."

While assessing the skin of an older client, the nurse finds skin transparency and fragility. Which nursing instructions will benefit the client?

*"Do not place tape on the skin." 2 "Take multiple vitamins on a daily basis." 3 "Refrain from exposure to skin irritants." 4 "Keep an eye on any pigmented lesions.

Which characteristic about confusion would the nurse keep in mind when an older client with Alzheimer disease is admitted to a long-term care facility?

*Occurs with a transfer to new surroundings 2 Will be unchanged despite reality orientation 3 Is a common finding and expected with normal aging 4 Results from brain changes that make interventions futile

While reviewing the result of an intravenous pyelogram, the nurse discovers that the client has a shortened urethra. Which nursing intervention helps prevent complications associated with this condition?

*Providing thorough perineal care after each voiding 2 Encouraging the client to use the toilet or bedpan every 2 hours 3 Responding quickly to the client's indication of the need to void 4 Applying voiding stimulants to the perineum

You are addressing a group of older adults about age-related physiological changes. You would tell them all but which of the following?

*With age, hunger sensations increase. Arteriosclerosis increases with age and can cause cardiovascular problems. The capacity of the bladder decreases by one-half. Secretion of progesterone and testosterone decreases.

Which action would the nurse take for an older client with Alzheimer disease who has intermittent episodes of urinary incontinence?

Point out the behavior to the client. 2 Obtain incontinence pads for the client. Correct3 *Take the client to the bathroom at regular intervals. 4 Encourage the client to call for help when there is an urge to urinate.

4. A resident in a nursing home requests a new room because he or she does not like the view from the current room. While the resident is away from the home on a provider visit, the staff moves the resident's belongings to another room with a better view. The resident and the resident's family later file a formal complaint regarding the move. Which statement gives the best justification for the resident's complaint?

The change was made without a provider's order. *The resident was not included in the decision making. The resident's belongings were moved without his or her assistance. The resident's family was not included in the decision making.

21. The gerontological nurse works with patients with non-insulin dependent diabetes at a senior center in a predominantly Hispanic neighborhood. The nurse demonstrates competency in collaboration by:

assisting and educating patients on diet restrictions. delivering care by preserving and protecting patient autonomy. providing written education materials in Spanish. *working with Hispanic groups in the community.

An older patient has tourette syndrome. The GNP knows that part of the management of this condition includes all of the following except:

behavior therapy and biofeedback *high doses of diazepam have been known to be effective. individual education plans, including classroom modifications family support and counseling

The GNP knows that before prescribing an exercise program for any patient, a thorough history and physical examination should be done assessing for all of the following EXCEPT:

cardiac murmurs, clicks, and hums carotid bruits excessive bruising *menstrual flow

A 65-year-old male with suppurative conjunctivitis is in the office for treatment. The GNP has knowledge that all of the following ophthalmic preparations can be used to cure this except:

ciprofloxacin *penicillin bacitracin-polymyxin B erythromycin

What should the Geriatric Nurse Practitioner assess in a patient who reports a fall but does not have serious physical injury?

color recognition ability to sit in a chair blood pressure in sitting position *medication list

6. The gerontological nurse manager involves the nursing staff in the utilization of trend data and analysis for quality improvement by:

encouraging staff to volunteer for The Joint Commission's onsite surveys. highlighting the quality improvement work of experts in the specialty area. *informing how data and outcomes are directly related to the staff's daily work. using scatter diagrams to identify the root cause of unresolved concerns.

14. The American Nurses Association's Gerontological Nursing: Scope and Standards of Practice emphasizes:

that abnormal responses to the aging process determine the appropriate nursing diagnoses. *that the health status data of older adult patients be documented in a retrievable form. the role of the older adult patient as the sole decision maker in planning his or her care. the unchanging nature of the goals and plans of care for older adult patients.

Which intervention would the home health nurse perform when conducting an initial visit to an older depressed client who lives alone and performs all tasks of daily living?

*Supporting the client's usual routine 2 Helping the client in setting new goals 3 Assisting the client in focusing on the future 4 Arranging for the client to have help in the home

Which response reported by an older adult client would the nurse identify as consistent with the diagnosis of macular degeneration?

"My vision is best when I dim the lights." 2 "I always see halos around lights, especially at night." 3 "I can't see objects in my periphery vision." Correct4 *"I can't see objects in the center of my vision field."

To ensure antibody-mediated immunity, which actions would the nurse instruct an older client to implement? Select all that apply. One, some, or all responses may be correct.

*Obtain a shingles vaccination. 2 *Receive a tetanus booster injection. 3 *Obtain the pneumococcal vaccination. 4 Receive annual testing for tuberculosis. 5 *Receive an annual influenza vaccination. 6 Avoid obtaining the pertussis vaccination

An older client with shortness of breath is admitted to the hospital. The medical history reveals and a diagnosis of pneumonia 3 days ago. Which vital sign assessment would be seen as a sign that the client needs immediate medical attention?

*Oxygen saturation: 89% 2 Body temperature: 101°F 3 Blood pressure: 130/80 mm Hg 4 Respiratory rate: 26 beats/minute

13. A 90-year-old patient comes to the clinic with a family member. During the health history, the patient is unable to respond to questions in a logical manner. The gerontological nurse's action is to:

ask the family member to answer the questions. ask the same questions in a louder and lower voice. determine if the patient knows the name of the current president. *rephrase the questions slightly, and slowly repeat them in a lower voice.

A married older adult couple lives independently and has three adult children. The husband, who is alert but forgetful, has an enlarged prostate with infrequent urinary incontinence. The wife has diabetes mellitus, rheumatoid arthritis, and walks with difficulty. The nurse identified the couple's need for assistance with bathing, dressing, and meal preparation. Which option would the nurse suggest, which best meets the needs of this couple?

Admit them together to an extended care facility (nursing home). 2 Place them in an apartment together, within an assisted-living facility. 3 *Keep the couple in their home and schedule assistance with a home health aide. 4 Encourage the couple to move in with one of their children for safety reasons

The nurse assesses an older adult client with a diagnosis of dehydration. Which finding is an early sign of dehydration?

Sunken eyes 2 Dry, flaky skin 3 *Change in mental status 4 Decreased bowel sounds

The nurse is caring for an older adult with a hearing loss secondary to aging. Which would the nurse expect to identify when assessing this client? Select all that apply. One, some, or all responses may be correct.

*Dry cerumen 2 Tears in the tympanic membrane 3 *Difficulty hearing high pitched voices 4 Decrease of hair in the auditory canal 5 Overgrowth of the epithelial auditory lining

Which characteristic would the nurse consider when attempting to assess the defense mechanisms of an older adult client with neurocognitive disorder due to vascular impairment?

Avoids use of any defense mechanisms 2 Uses one method of defense for every situation 3 *Makes exaggerated use of old, familiar mechanisms 4 Attempts to develop new defense mechanisms for the current situation

Your 89-year-old patient presents with dyspepsia and nausea. After testing, you determine she is positive for Peptic Ulcer Disease. Of the following, which would LEAST likely be a differential diagnosis for Peptic Ulcer Disease?

Cholecystitis. *Migraines. Gastric carcinoma. Cardiovascular disease.

The nurse is caring for a 60-year-old client diagnosed with dementia. The nurse understands that which antipsychotic medications would be contraindicated for the client? Select all that apply. One, some, or all responses may be correct.

Quetiapine 2 *Haloperidol 3 Aripiprazole 4 Risperidone 5 *Chlorpromazine

The registered nurse is teaching a coworker about the care of clients who have neurological changes associated with aging. Which statement by the coworker indicates a need for further instruction?

*Clients with decreased sensory perception of touch should be carefully monitored for infection." 2 "Clients with recent memory loss should be taught by repetition and use memory aids that provide recurrent alerts." 3 "Clients with slower processing time should be provided with sufficient time to respond to questions or directions." 4 "Clients with decreased coordination should be instructed to hold handrails when ambulating."

Which action would the nurse take for a daughter who states that she gives sleeping pills to her live-in mother who has dementia to stop wandering at night?

*Explore hiring a home health aide to stay with the client at night. 2 Discuss the possibility of having the client placed in a nursing home. 3 Suggest moving the client among family members on a monthly basis. 4 Empathize with the daughter but suggest that wrist restraints would be preferable

Which observation by the nurse indicates a client's decrease in hearing acuity? Select all that apply. One, some, or all responses may be correct.

*Frequent use of words such as "what" 2 *Postural changes while listening to the speaker 3 *Bending toward the other person while talking 4 *Mismatch between the questions asked and the responses given 5 Startled expression to any unexpected sound in the environment

An older adult in acute care has a risk of skin breakdown. Which intervention(s) is/are beneficial to the client? Select all that apply. One, some, or all responses may be correct.

*Providing thorough skin care Correct2 *Reducing shear forces and friction 3 Providing beverages and snacks frequently Incorrect4 Using a support surface base all the time Correct5 *Avoiding pressure with proper positioning

The nurse recognizes that a common conflict experienced by older adults is the conflict between which?

Youth and old age 2 Retirement and work 3 *Independence and dependence 4 Wishing to die and wishing to live

What should the Geriatric Nurse Practitioner be aware of with diuretic use in the elderly patient?

They have increased ability to excrete potassium. *They have diminished ability to conserve sodium. They often develop sensitivity or allergy to these medications. They have continued response to a thiazide despite increasing creatinine.

The nurse is teaching a group of student nurses about psychotherapeutic medications in older adult clients. Which statement made by a student indicates to the nurse that additional teaching is required?

"Tricyclic antidepressants may increase anxiety in older adult clients." 2 "The normal dosage of lithium may result in lithium toxicity in older adult clients." 3 "Older adult clients on antipsychotic medications are susceptible to orthostatic hypotension." 4 *"Low serum levels of the medication are reported in older adult clients on psychotherapeutic medications."

The nurse is performing a male reproductive system assessment of an older adult client. The nurse expects which age-related finding?

Asymmetrical testes 2 *Reduced size of testes 3 Absence of pubic hair 4 The foreskin that is difficult to retract

There are a good many diseases affecting the elderly that are the result of smoking. Counseling regarding smoking cessation is part of the GNP's job. The components of brief intervention for treating tobacco use are:

Counsel, Document, Caution, Describe, Demonstrate Advise, Confer, Describe, Document, Prescribe Advise, Counsel, Intervene, Prescribe, Follow-up *Ask, Advise, Assess, Assist, Arrange

Which approach would the nurse use for an older adult client with Alzheimer disease who frequently switches from being pleasant and happy to being hostile and unhappy without apparent external cause?

Pointing out reality to the client 2 *Providing nursing care when the client is receptive 3 Encouraging the client to talk about personal feelings 4 Restraining the client when hostility is being exhibited

The registered nurse (RN) is teaching a nursing student about how to educate clients based on their developmental capacity. Which statements made by the nursing student are applicable for older adults? Select all that apply. One, some, or all responses may be correct.

"I would encourage independent learning." 2 *"I would keep the teaching sessions short." 3 *"I would involve the client in any discussion or activity." 4 "I would encourage learning through pictures and short stories." 5 "I would teach the client psychomotor skills to maintain his or her health."

Which points require correction regarding wellness promotion in the older adult? Select all that apply. One, some, or all responses may be correct.

"Older adults need to prevent injuries when promoting wellness." 2 *"Curing diseases or other illnesses completely is essential i to promote wellness in the older adult." 3 "It is important to assess the level of fear of falling and provide support accordingly when caring for older adults." 4 *"It is necessary to prevent older adults from taking part in physical activities to keep them from sustaining injuries." 5 *"An older adult should live in social isolation to prevent stress.

The nurse was assessing an older adult client and recorded the pulse rate as 85. After assessment the nurse determined the cardiac output as 5950. Which would be the approximate stroke volume?

*70 mL 2 60 mL 3 50 mL 4 40 mL

Which precaution would the nurse teach a client prescribed selegiline for the treatment of Parkinson disease?

*Change to a standing position slowly. 2 Take the medication between meals. 3 Perform self-blood glucose monitoring. 4 Withhold the next dose if nausea occurs.

An 82-year-old client is scheduled for physical therapy after a fracture of the arm. Considering the older population, the nurse recalls that mild exercise is likely to have which effect on the client's respirations?

*Increase to 24 breaths per minute 2 Become progressively more difficult 3 Decrease in rate as their depth increases 4 Become irregular but remain within normal rates

While assessing an older adult client before noon, the nurse smells alcohol on the client's breath. Which additional signs and symptoms would the nurse then monitor for? Select all that apply. One, some, or all responses may be correct.

*Irritability Correct2 *Poor hygiene Correct3 *Family conflict Incorrect4 Good nutritional habits Correct5 *Excessive mood swings 6 Strong cognitive skills

For which clinical manifestations would the nurse assess the client diagnosed with Alzheimer disease? Select all that apply. One, some, or all responses may be correct.

*Loss of recent memory 2 Focused attention span 3 *Perceptual disturbances 4 Willingness to accept change 5 *Difficulty learning something new

An older adult experiencing delirium suffers from a leg fracture caused by a fall. Which interventions would the nurse follow to prevent future falls? Select all that apply. One, some, or all responses may be correct.

*Minimizing sedating medications 2 *Modifying the home environment 3 Teaching clients about the safe use of the Internet 4 *Manage foot and footwear problems 5 Providing information about the effects of using alcohol

Which administration guidelines would the nurse follow when administering midazolam to an older client?

*The increments should be smaller, and the rate of injection should be slower. 2 The medication should be given as a rapid intravenous push. 3 It is important to monitor for spikes in blood pressure elevation during administration. 4 During the procedure, the medication should be given as needed for pain management.

Which priority factor would the nurse consider when planning care for a nursing home client who demonstrates numerous disorganized behaviors related to disorientation and cognitive impairment?

Level of interest in unit activities 2 Orientation to time, place, and person 3 *Ability to perform tasks without becoming frustrated 4 Cognitive impairment, which will increase until adjustment to the home is accomplished

A 78-year-old client who has hypertension is beginning treatment with furosemide. Considering the client's age, which would the nurse teach the client to do?

Limit fluids at bedtime. 2 *Change positions slowly. 3 Take the medication between meals. 4 Assess the skin for breakdown daily.

Which intervention would the nurse implement with a healthy older adult client who has decreased bone density?

Teaching the client to do isometric exercises Correct2 *Encouraging the client to do weight-bearing exercise 3 Instructing the client to sit in supportive chairs with arms 4 Providing moist heat such as a shower or moist compresses

Which would the nurse assess to determine whether a 75-year-old individual is meeting the developmental tasks associated with aging?

Achievement of a personal philosophy 2 Adaptation to the children leaving home Correct3 *Attainment of a sense of worth as a person 4 Adjustment to life in an assisted-living facility

The nurse is caring for an older adult client who has constipation. Which independent nursing intervention helps reestablish a normal bowel pattern?

Administer a mineral oil enema. 2 Offer 1 cup of fluid every hour. 3 Manually remove fecal impactions. Correct4 *Offer a cup of prune juice

Which principle of teaching would the nurse consider when providing instructions to an older client recently diagnosed with diabetes mellitus?

Knowledge reduces general anxiety. 2 Capacity to learn decreases with age. Correct3 *Continued reinforcement is advantageous. 4 Readiness of the learner precedes instruction

Which immune function change places older clients at risk for bacterial and fungal infections?

Decline in natural antibodies 2 Reduction of neutrophil function 3 *Decrease in circulating T lymphocytes 4 Reduction of colony-forming B lymphocytes

While assessing the skin of an older adult, the nurse observes that the skin has a dry and uneven color. Which change is responsible for this condition?

Decreased subcutaneous fat 2 Decreased extracellular water 3 Decreased proliferation capacity Correct4 *Decreased activity of sebaceous glands

Which change in the joint may result in joint pain for older adults?

Dehydration of discs 2 Loss of muscle mass 3 Decreased elasticity in the ligaments Correct4 *Increased cartilage erosion

Which priority parameter would the nurse assess when caring for an older adult client with a neurocognitive disorder who demonstrates disorientation and numerous unmanageable behaviors?

Orientation to time, place, and person 2 Ability to perform daily activities without assistance from others 3 *Stressors that appear to precipitate the client's disruptive behavior 4 Cognitive impairments until complete adjustments are accomplished

Based upon the information in the chart, which action would be priority when an older adult presents to the clinic with reports of nausea, headache, and episodes of double vision during the past few days?

Perform an in-depth cardiac assessment. 2 Arrange for an ophthalmic consultation immediately. 3 Initiate a conversation about the son's cancer diagnosis. Correct4 *Inquire when the client began therapy for hypertension.

Which actions would be considered in the collaborative plan of care for a client with increased lens density? Select all that apply. One, some, or all responses may be correct.

Performing keratoplasty 2 *Performing phacoemulsification 3 Monitoring for pain and eye redness 4 *Monitoring the client's blood glucose levels 5 *Assessing if the client is on antiplatelet medication

Which clinical manifestation indicates a need for the nurse to contact the health care provider to increase the intravenous fluid infusion for an older client with an infection?

Pruritus 2 Erythema Correct3 *Acute confusion 4 General malaise

Which findings are expected when assessing the skin of an older adult? Select all that apply. One, some, or all responses may be correct.

Scaly skin 2 *Tenting of skin 3 *Transparent skin 4 *Increased wrinkles 5 *Pigmented lesions