Gerontology Exam # 2
An older patient complains of pruritus. The nurse suggests which of the following interventions to alleviate the patient's complaint? (Select all that apply.) a. Use only non-perfumed laundry detergent and fabric softeners b. Avoid sudden temperature changes. c. Wear loose-fitting clothing d. Apply heat to affected areas e. Exercise vigorously for at least 30 minutes daily.
ANS: A, B, C
Symptoms of gastroesophageal reflux disease (GERD) in older adults include: (Select all that apply.) a. heartburn. b. regurgitation. c. abdominal pain within one hour of eating. d. vomiting. e. fever and elevated white blood cell count.
ANS: A, B, C
A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a care plan related to oral care. Which of the following should the nurse consider for this patient? (Select all that apply.) a. Oral care should be provided every four hours. b. Teeth should be brushed with a toothbrush after each tube-feeding. c. Lemon glycerin swabs should be used in between feedings to keep the mouth moist. d. Foam swabs should be used in place of a toothbrush to clean the teeth after each tube-feeding. e. Oral care should be provided only twice daily if the older adult is edentulous.
ANS: A, B
An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga b. Tai Chi c. Swimming d. Pilates e. Weight lifting
ANS: A, B
A nurse cares for an older adult who is described as being "frail." The nurse understands that in order to be characterized as frail an individual must possess which of the following characteristics? (Select all that apply.) a. Slow walking speed b. Low activity level c. Self-reported exhaustion d. Taking at least five prescribed medications. e. A diagnosis of at least two chronic conditions.
ANS: A, B, C
A nurse is educating a group of older adults on the impact of lifestyle changes on hypertension. The nurse includes which of the following in the education? (Select all that apply.) a. Learning how to read and interpret food labels. b. The sodium content of commonly consumed foods c. Techniques to incorporate more physical activity into the daily routine. d. The actions of calcium channel blocker medications on hypertension e. The importance of adhering to pharmacological regimens for treatment of hypertension
ANS: A, B, C
A nurse is teaching a group of older adults about healthy aging. The nurse discusses global lifestyle risk factors for chronic disease. The nurse includes which of the following in the education? (Select all that apply.) a. Smoking cessation and avoidance of tobacco b. Maintenance of high levels of physical activity c. Importance of eating a balanced diet d. Development of advance directives e. Maintenance of blood pressure readings at a level of 120/80 or lower
ANS: A, B, C
The role of a nurse caring for an older patient who is in the stable phase of a chronic illness may include which of the following? (Select all that apply.) a. Coordinating care with members of the interdisciplinary team b. Administering medications to the patient c. Providing assistance with bathing and dressing. d. Ensuring that the patient's immunizations are up to date. e. Providing emergency care.
ANS: A, B, C
Which assessment finding is a contributor to an older client's risk for falls? (Select all that apply.) a. Client is awaiting cataract surgery on right eye. b. Client's type 2 diabetes is poorly controlled with diet and exercise alone. c. Client reports a fall in the last year. d. Client has a history of contact dermatitis and psoriasis. e. Client attends Tai Chi classes at the senior center.
ANS: A, B, C
Which of the following are age-related changes that affect hydration status? (Select all that apply.) a. Decrease in thirst sensation. b. Decrease in total body water. c. Decrease in ability of kidneys to maximally concentrate urine. d. Decrease in bone marrow mass e. Decrease in bladder capacity.
ANS: A, B, C
Which of the following are subscales on the Braden Scale for predicting pressure ulcers? (Select all that apply.) a. Nutrition b. Moisture c. Mobility d. Age e. BMI
ANS: A, B, C
A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.) a. Difficulty placing hearing aid properly in the ear. b. Stigma associated with wearing a hearing aid. c. Difficulty changing the batteries in the hearing aid. d. Ineffectiveness of hearing aids for individuals with age-related hearing loss e. Hearing annoying loud noises
ANS: A, B, C, E
A nurse is caring for a frail older adult in a long-term care facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (Select all that apply.) a. Make sure that the temperature in the resident's room is at least 65 degrees Fahrenheit. b. Cover residents well when in bed and while bathing. c. Provide a head covering for the resident. d. Maintain resident in bed covered with heavy blankets at all times. e. Provide hot, high-protein meals and bedtime snacks.
ANS: A, B, C, E
An otherwise healthy older adult reports having begun to experience problems "holding my water." The nurse shows an understanding of interventions that may help minimize the problem of urinary incontinency when: (Select all that apply.) a. asking whether the client smokes tobacco. b. assessing the average amount of caffeine the client drinks daily. c. asking if the client has been evaluated for diabetes recently. d. suggesting the client keep a record of the amount of fluids ingested daily. e. reviewing the client's current medication list.
ANS: A, B, C, E
A nurse is planning health education on chronic illnesses for a group of seniors in the community. When deciding upon which illnesses to focus upon, the nurse knows that which of the following are the most common diseases in the United States? (Select all that apply.) a. Heart disease b. Hypertension c. Asthma d. Osteoarthritis e. Diabetes
ANS: A, B, D
An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (Select all that apply.) a. Go to bed only when sleepy. b. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities. c. Engage in moderate exercise to induce fatigue. d. Do not watch television or work in bed. e. If unable to sleep, engage in enjoyable activities on the computer.
ANS: A, B, D
An older patient asks a nurse, "It seems like all of my friends and I have difficulty sleeping. Is it common among older people?" The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.) a. total sleep time and sleep efficiency are reduced. b. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed. c. sleep requirements for older adults are less than that of younger adults. d. daytime napping is common. e. sleep tends to be deeper in older adults than in younger adults.
ANS: A, B, D
An older patient is diagnosed with RLS. Which of the following nonpharmacologic interventions should the nurse include in the plan of care? (Select all that apply.) a. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities. b. Avoid caffeine, alcohol, and tobacco. c. Avoid hot baths. d. Relaxation techniques may be helpful. e. A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful.
ANS: A, B, D
An older patient tells a nurse. "The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still don't understand why this happens to me." The nurse responds based on the knowledge that: (Select all that apply.) a. purpura is due to normal age-related changes. b. the incidence of purpura increases with age. c. purpura is a precancerous skin condition. d. individuals who take blood thinners are especially prone to purpura. e. individuals prone to purpura should make sure that affected areas are open to the air.
ANS: A, B, D
The benefits of telehealth include that it: (Select all that apply.) a. promotes self-management of illness in rural and underserved areas. b. facilitates remote physical assessment and monitoring of chronic conditions. c. decreases costs by replacing the role of the nurse with technology. d. decreases costs by reducing hospital readmissions. e. is reimbursed by all health care insurances.
ANS: A, B, D
Which precaution would be beneficial in minimizing an older adult's risk of being a victim of fraud? (Select all that apply.) a. Do not allow uninvited salespersons into your home. b. Never provide personal information to telephone sales solicitors. c. Rely on the advice of people who only friends have recommended. d. Contact the local Medicare or Medicaid service office for information when needed. e. Keep your bank account and credit card numbers with you at all times.
ANS: A, B, D
A nurse caring for an older hospitalized woman is concerned about promoting functional status. Which of the following interventions should the nurse include in this patient's plan of care? (Select all that apply.) a. Conduct a baseline functional status assessment of the patient. b. Request a physical therapy referral c. Make sure that the patient has all activities of daily living performed for her d. Progressive mobility interventions. e. Encouraging the patient to feed herself.
ANS: A, B, D, E
An older adult complains of xerostomia. Which of the following interventions should the nurse implement for this patient? (Select all that apply.) a. Encourage the patient to brush and floss teeth regularly. b. Encourage the patient to have regular dental screenings. c. Provide antiseptic mouthwash (e.g., Listerine) for the patient. d. Encourage adequate intake of water. e. Provide saliva substitutes.
ANS: A, B, D, E
A group of older women in an assisted living facility are talking about one of the residents who fell and fractured her hip. The women ask a nurse the following: "It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?" In formulating a response, the nurse considers which of the following? (Select all that apply.) a. Hip fractures are a leading cause of hospitalization for older people. b. The major cause of hip fractures is falls. c. Women have significantly higher mortality rates from hip fractures than do men. d. Nearly all older patients who sustain a hip fracture will regain pre-fracture mobility status within 1 year. e. Hip fractures are associated with very high morbidity and mortality.
ANS: A, B, E
A nurse is educating a group of nursing assistants in long-term care on the prevention of skin tears. Which of the following interventions should the nurse include in the education? (Select all that apply.) a. Lubricate the resident's skin with moisturizers twice daily. b. Ensure that the resident has adequate nutrition and hydration. c. Bathe the resident in hot soapy water d. Avoid the use of lifting shifts when transferring the resident. e. Dress the resident in long sleeves and long pants to protect the extremities.
ANS: A, B, E
What information should be included in an informational program to be presented on burn prevention to a senior citizens group? (Select all that apply.) a. Do not smoke in bed or when sleepy. b. Wear well-fitted clothing when cooking or when grilling outdoors. c. Establish a meeting place for all family members outside of the home in case of a fire. d. Establish a plan for exiting each room of your home in the case of a fire. e. Have a fire extinguisher readily available in the kitchen.
ANS: A, B, E
Which of the following nursing interventions should be implemented to prevent dehydration in hospitalized older adults? (Select all that apply.) a. Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection. b. Limiting duration of NPO requirements for diagnostic tests and procedures. c. Administering IV fluids to all hospitalized older adults. d. Limiting the use of diuretic medications in hospitalized older adults. e. Making sure that hospitalized patients have easy access to fluids.
ANS: A, B, E
A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. Which of the following are hazards in the home? (Select all that apply.) a. The absence of railings on the stairway b. Night-lights in all rooms c. Clutter throughout the home d. A small throw rug outside of the shower stall e. Grab bars in bathroom beside toilet
ANS: A, C, D
A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patient's plan of care? (Select all that apply.) a. Encourage adequate fluid intake. b. Encourage daily baths of at least 20 minutes. c. Maintain a humid environment. d. Apply water-laden emulsions to skin immediately after bathing e. Use only deodorant soaps when bathing.
ANS: A, C, D
An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.) Exposure to loud noises b. Use of a hearing aid c. Cerumen buildup d. Side effects of medications e. Age-related changes in the middle and inner ear
ANS: A, C, D
Many older adults have a vitamin B12 deficiency. Reasons for this include which of the following? (Select all that apply.) a. Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient. b. The major source of vitamin B12 is sunlight, and older adults are less likely to be outdoors and absorb vitamin B12 in this manner. c. Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food. d. Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B12. e. Certain antibiotics and anticonvulsant medication increase the risk of vitamin B12 deficiency.
ANS: A, C, E
A 74-year-old woman who is in the hospital for rehabilitation following hip replacement has been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient's bladder function? (Select all that apply.) a. Assess the patient's recent voiding pattern. b. Request an order for an indwelling catheter from the patient's physician. c. Teach the patient how to meet hydration needs while still limiting fluid intake. d. Assist the patient to use the bathroom. e. Request an order for medication to decrease bladder spasms.
ANS: A, D
The nurse interviewing an older adult for a nursing history recognizes that the client is experiencing symptomology inconsistent with normal aging of the urinary tract when the client reports: (Select all that apply.) a. finding it more difficult in the last few months to start voiding. b. having two bladder infections in the last 4 years. c. getting up once or twice each night to urinate. d. occasionally experiencing pain when urinating. e. needing to urinate at least every 2 hours during the day.
ANS: A, D
A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (Select all that apply.) a. Sit the patient upright in a chair at 90 degrees. b. Allow the patient to sit upright for 15 minutes after the meal is completed. c. Feed the patient only liquids to make swallowing easier. d. Place the solid food in the left side of the mouth. e. Have the patient swallow twice for every mouthful of food given.
ANS: A, E
The daughter of an older patienNtUsa RySs t IoNaGnTur Bse .,C"I Oa Mm so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?" The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.) a. Report the person to the division of motor vehicles for license suspension. b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. c. Arrange for alternate transportation for the person. d. Confiscate the keys to the car. e. Ask the patient's physician to write a prescription for the person to stop driving.
ANS: B, C
A nurse is caring for an older adult in a hospital who has an indwelling catheter. The nurse assesses the patient based on the knowledge that which of the following are correct indications for an indwelling catheter? (Select all that apply.) a. To assist with incontinence management b. To manage acute urinary retention. c. To assist in healing of open sacral or perineal wounds in incontinent patients d. To accurately measure urinary output in critically ill patients e. To prevent falls related to toileting in hospitalized older patients.
ANS: B, C, D
An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include: (Select all that apply.) a. followed a vegetarian diet for last 28 years. b. male gender. c. a smoking history of 1 pack a day for 45 years. d. 30 pounds over ideal weight. e. history of Crohn's disease.
ANS: B, C, D
A long term care facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit? (Select all that apply.) a. Ensuring that all residents receive evening care and are in bed by 8:00 PM b. Taking as many residents as possible outside for 30 minutes daily c. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM d. Avoiding waking residents for routine care during the night. e. Limiting caffeine and fluids before bedtime.
ANS: B, C, D, E
A nurse caring for a cognitively impaired older adult client shows an understanding of the unique clinical symptoms of constipation in this population when: (Select all that apply.) a. checking documentation to determine if the client has had a bowel movement in the last 24-36 hours. b. questioning staff as to whether the client has any unexplained falls in the last few days. c. asking the client to name all of his or her children and grandchildren. d. requesting that the client's temperature be taken now and again in 4 hours. e. reviewing the client's food intake over the last 24-36 hours.
ANS: B, C, D, E
A nurse is developing a care plan for an older adult in a long-term care facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (Select all that apply.) a. Assign a nursing aide to feed the resident to ensure adequate consumption of meals. b. Supervise the resident during meals. c. Provide a pleasant eating environment. d. Provide nutritional supplements for the resident. e. Assess the resident for ability to feed himself/herself.
ANS: B, C, D, E
A homecare nurse visits a client in the home to conduct a fall risk assessment. The nurse assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (Select all that apply.) a. The client has an unsteady gait. b. The client uses a cane, but the cane is not the appropriate size for the client. c. The client's home is cluttered. d. The client is on two different medications that cause orthostatic hypotension. e. There are no grab bars in the client's bathroom.
ANS: B, C, E
A nurse is performing an admission assessment on an older patient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient's skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (Select all that apply.) a. Poor skin turgor over the sternum b. Lower extremity weakness c. High fever d. Sunken eyes e. Cough
ANS: B, D
An older client is diagnosed with venous insufficiency of the lower extremities. The nurse expects the client to display which of the following signs and symptoms? (Select all that apply.) a. Thin, shiny dry skin b. Reddish brown discoloration of the skin of the legs c. Pain when the legs are elevated. d. Varicose veins e. Legs are cool to touch.
ANS: B, D
A nurse is educating a group of older adults on the benefits of an exercise program. The nurse includes education on when not to exercise. Which of the following should the nurse include in the education? (Select all that apply.) a. Do not exercise if your resting heart rate is over 80. b. Do not exercise if your blood pressure is greater than 200 systolic and 100 diastolic. c. It is important to wait 30 minutes after a big meal before engaging in vigorous exercise. d. Do not exercise if a joint that you are using to exercise is red, warm, and painful. e. Do not exercise if you have a fever and muscle aches.
ANS: B, D, E
A homecare nurse visits an older female adult at home who has peripheral vascular disease to monitor her status. The nurse determines that the client needs additional teaching when the client states which of the following? (Select all that apply.) a. "I need to try and elevate my legs above the level of my heart every time I sit down and all night." b. "I really need to try and avoid sitting in one position for a long period of time." c. "I know that I need to wear these compression stockings 24 hours a day." d. "I will wash my feet and legs with strong antibacterial soap twice daily." e. "I need to examine my feet daily for any cuts, sores, or openings."
ANS: C, D
A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the patient eliminate which of the following? (Select all that apply.) a. Night-lights b. Railings on the stairway c. Loose carpeting on the floors d. The use of a cane e. Excess clutter
ANS: C, E
An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction. c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.
ANS: D, E
An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, "How did I get something like this?" The best response by the nurse is: a. "Scabies is highly contagious and spreads easily through physical contact." b. "Scabies is commonly seen in older adults due to normal age-related changes in the skin." c. "Scabies is only seen in older adults who have multiple chronic illnesses." d. "Certain medications can make you more susceptible to contracting scabies."
a. "Scabies is highly contagious and spreads easily through physical contact."
A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following: a. "Since I am an older person, I need more calories because my metabolic rate is slower." b. "Since I am an older person, I need fewer calories since my metabolic rate is slower." c. "Even though I am an older person, I still need the same amount of nutrients in order to be healthy." d. "Even though I am an older person, I still need to pay attention to my diet and activity levels."
a. "Since I am an older person, I need more calories because my metabolic rate is slower."
An older patient asks a nurse, "I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don't understand his response. Can you help me?" The best response by the nurse is: a. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep." b. "Prescription sleeping medications have many adverse effects in older people. Why don't you try using an over-the-counter medication?" c. "Sleeping medications do not provide any improvement in sleep for older people." d. "Sleep problems are common in older people. There really is nothing that you can do to help with that."
a. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep."
A nursing student asks the instructor, "Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn't obesity bad for everyone?" The best response by the instructor is: a. "While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults." b. "Obesity is usually not a concern in older adults, as most older people tend to weigh less than they did when they were younger." c. "Obesity is a concern in all age groups; however, over the past decade obesity in older adults has decreased." d. "Obesity in older adults is less of a concern than we once thought; individuals over age 65 with a higher BMI have a lower mortality rate."
a. "While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults."
A 75-year-old female asks a nurse "I know I should be moving, but how much is the right amount of exercise for me?" The best response of the nurse is: a. "You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week." b. "You need to engage in at least 30 minutes of moderate intensity exercise every day of the week." c. "Since you are 75, the recommendations are 30 minutes of moderate exercise three times a week." d. "There are no specific recommendations for someone of your age; just keep moving."
a. "You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week."
Which of the following nursing actions would help minimize the psychosocial impact of bladder and/or bowel incontinence for individuals experiencing incontinence prior to going to a group dining room? a. Assess for soiled clothing and change, if necessary. b. Toilet the client and then promptly transport to the dining room. c. Provide peri-care and fresh underclothing. d. Ask the client if toileting is needed and assist as necessary.
a. Assess for soiled clothing and change, if necessary.
A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right thoracic area. The nurse suspects HZ. The patient asks the nurse, "I really don't understand how I got shingles. I don't even know anyone who has this infection." The nurse includes which of the following in formulating a response to the patient? a. HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion. b. HZ is caused by the same virus as chickenpox and requires exposure to an individual with active chickenpox. c. HZ is caused by the same virus as chickenpox and requires direct contact with an individual with HZ. d. HZ is caused by the varicella zoster virus and occurs only in individuals who were never previously exposed to the virus.
a. HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion.
A nurse at a senior center promotes activity by leading exercise programs. Which of the following is a benefit of such exercise? a. Improvement of mood b. Cardiovascular stress c. Painful and stiff joints d. Depression
a. Improvement of mood
A nurse implements a nursing care plan for a patient with constipation. Which of the following should the nurse include in the plan? a. Increasing fiber in the diet. b. Administering aluminum hydroxide antacids. c. Bed rest d. Restricting fluids
a. Increasing fiber in the diet.
A homecare nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment that provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses due to a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.
a. Older adults are less likely to seek formal and informal help when affected by natural disasters.
An older client reports to a nurse, "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which of the following? a. Presbycusis b. Otosclerosis c. Tinnitus d. A perforated eardrum
a. Presbycusis
Which of the following statements describing oral care for the older population is correct? a. Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods. b. Losing one's teeth is considered a normal part of the aging process. c. Oral malignancies seldom occur in older adults so oral examinations are of low priority. d. Preventative dental care is covered under Medicare.
a. Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods.
A nurse in a long-term care facility notes that an older resident with Alzheimer's disease awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems? a. Taking the resident outside in the garden for 45 minutes daily. b. Limiting fluid intake for the resident. c. Educating the resident on the association between Alzheimer's Disease and insomnia. d. Administering a mild sedative hypnotic at bedtime.
a. Taking the resident outside in the garden for 45 minutes daily
A nurse is caring for an older adult who is in the pre-trajectory phase of the Chronic Illness Trajectory. The nurse knows that this phase is characterized by which of the following: a. The absence of signs or symptoms of the illness b. Diagnostic testing being conducted. c. A progressive decline in physical and or mental status. d. A period of temporary remission from the crisis.
a. The absence of signs or symptoms of the illness
A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is: a. an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization. b. an injury may cause malabsorption of nutrients. c. most hospitalized older patients do not consume adequate amounts of micro- and macronutrients. d. most hospitalized patients do not have accurate weights recorded upon admission.
a. an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization.
A major difference in the diagnosis of chronic disease between younger adults and older adults is that: a. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems. b. chronic disease is often diagnosed earlier in older adults since they are more likely to seek medical care. c. chronic disease is usually not identified in older adults because of the many age-related changes. d. chronic illness is uncommon in younger adults.
a. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems.
A nurse is assessing an older adult's risk for falls. One of the questions that she asks is whether the older adult has fallen in the past year. She asks this because individuals who have fallen: a. have a higher risk of falling again than persons who did not fall in the past year. b. are more likely to sustain injuries if they fall again than persons who did not fall in the past year. c. have most likely developed a fear of falling as compared to persons who did not fall in the past year. d. are most likely to have a balance disorder as compared to persons who did not fall in the past year.
a. have a higher risk of falling again than persons who did not fall in the past year.
An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for Falls. A priority nursing intervention for this client is to: a. perform a fall assessment. b. keep all of the side rails up on the client's bed at nighttime. c. place the client on bed rest so that she does not fall. d. assess the client's dietary intake for calcium adequacy.
a. perform a fall assessment.
A nurse is auscultating an older patient's heart and notes a systolic murmur (heard between the S1 and S2 heart sounds. The first action by the nurse is to: a. question the patient about the presence of the murmur. b. note it in the chart as this is always a normal finding for an older adult. c. contact the medical provider as this is an abnormal finding. d. immediately implement emergency interventions.
a. question the patient about the presence of the murmur.
An older man who is a smoker is hospitalized for orthopedic surgery. A nurse takes the opportunity to provide smoking cessation education. The patient asks the nurse: "I have been smoking for most of my life, and I am an old man. Why are you wasting your time telling me to stop smoking? Isn't it too late?" The nurse bases the response on the knowledge that: a. smoking cessation as late as age 75 can reduce premature death by up to 50%. b. smoking cessation as late as age 75 can completely eliminate premature death. c. smoking cessation at a late age will not impact the smoker but can reduce exposure of family members to second-hand smoke. d. smoking cessation education is only effective in individuals under age 75.
a. smoking cessation as late as age 75 can reduce premature death by up to 50%.
An older woman asks a nurse, "You always seem to be telling me that I need to drink more water. How much water do I really need to drink?" The nurse bases her response on the knowledge that older adults should consume at least: a. 1000 mL of fluid per day. b. 1500 mL of fluid per day. c. 2000 mL of fluid per day. d. 2500 mL of fluid per day
b. 1500 mL of fluid per day.
An older adult asks a nurse, "I hear a lot about limiting the amount of fat in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?" The nurse bases a response on which of the following? a. 10-15% of total calories should be from fat, 30-40% from carbohydrates, and 35-75% from protein. b. 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein. c. 45-65% of total calories should be from fat, 20-35% from carbohydrates, and 10-35% from protein. d. 20-35% of total calories should be from fat, 10-25% from carbohydrates, and 50-75% from protein.
b. 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein.
A nurse is using the function-focused care approach to care for a hospitalized older adult. The nurse is assisting the patient to transfer from the bed to a chair. Which of the following statements by the nurse is most congruent with this approach to care? a. "Place your hands across your chest and let us move you to the edge of the bed." b. "Place both of your hands on the overbed trapeze and pull yourself up to a sitting position." c. "How do you get yourself out of bed when you are at home? Why can't you do the same thing here?" d. "It is taking you a long time to get yourself into a sitting position. Let me help you sit up."
b. "Place both of your hands on the overbed trapeze and pull yourself up to a sitting position."
An older adult who is within a normal weight range asks a nurse, "I have heard that it is important to limit the amount of fats in my diet, but I don't know how much I should be taking in daily. Can you help me?" The best response by the nurse is: a. "Someone of your age needs to limit fats." b. "Since you are at your ideal weight, you should limit your daily fat grams to half your weight." c. "Fat intake will depend on the presence of any cardiac issues." d. "Read food labels well and focus your diet on low-fat foods."
b. "Since you are at your ideal weight, you should limit your daily fat grams to half your weight."
A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall prevention and demonstrates the use of the call bell to the patient. The patient's daughter asks: "Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?" The best response by the nurse is: a. "Side rails have only proven to be effective in decreasing falls in patients who have already fallen." b. "There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury." c. "Side rails are only effective when used with patients who have dementia." d. "Side rails do not decrease falls, but they do decrease fall-related injuries."
b. "There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury."
The nurse is most concerned by observing when assisting with an older client's bath: a. A firm, irregularly shaped, pink-colored nodule b. A slightly raised multicolor lesion with an asymmetrical, irregular border. c. A pearly papule with prominent blood vessels d. Rough, scaly, sandpaper-like patches that are slightly tender.
b. A slightly raised multicolor lesion with an asymmetrical, irregular border.
The nurse is preparing educational material concerning fire safety in the home. What research data will be included in the material? a. Most fires occur during the daytime hours. b. Fire mortality is highest in adults older than 80 years of age. c. Most people who die in fires are killed by the flames. d. Most fires occur outside the home.
b. Fire mortality is highest in adults older than 80 years of age.
The nurse is recommending that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on "being stuck at home." Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization thus minimizing the effects of social isolation. b. Helps with minimizing the loss as a factor in causing depression. c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client.
b. Helps with minimizing the loss as a factor in causing depression.
A nurse measures an older adult's blood pressure on the right arm and notes a reading of 150/100. The nurse waits 5 minutes and measures the blood pressure again in the right arm and obtains a reading of 152/100. What is the next action by the nurse? a. Immediately contact the medical provider. b. Measure the blood pressure in the left arm. c. Measure the blood pressure in sitting and standing positions. d. Document the findings in the medical record; elevated blood pressures are normal in older adults.
b. Measure the blood pressure in the left arm.
A nurse is discussing the importance of exercise with a 78-year-old female who states: "I know I should be exercising, but I have arthritis in my knees and it is painful. Can you recommend a type of exercise that would be beneficial and cause me less pain?" Which of the following exercises should the nurse recommend? a. Tennis b. Swimming c. Dancing d. Use of a treadmill and elliptical machine in the gym
b. Swimming
A nurse is observing a nurse aide perform denture care for a resident in the nursing home. The nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following? a. The nurse aide places a face cloth in the sink and fills the sink half full of water. b. The nurse aide uses toothpaste to clean the dentures. c. The nurse aide utilizes a specially designed denture brush to clean the dentures. d. The nurse aide stores the dentures in a denture cup filled with denture cleansing solution.
b. The nurse aide uses toothpaste to clean the dentures.
A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education? a. Zostavax should only be given to individuals who have never had an episode of herpes zoster (HZ) b. Zostavax is recommended for all individuals over age 60 that have no contraindications to the vaccine. c. Zostavax should not be given to anyone with a chronic cardiac or respiratory condition. d. Zostavax will always prevent an individual from developing Herpes Zoster
b. Zostavax is recommended for all individuals over age 60 that have no contraindications to the vaccine.
A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90 degrees Fahrenheit outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to: a. cognitive changes that diminish the individual's awareness of temperature changes. b. age-related neurosensory changes that diminish awareness of temperature changes. c. a delirium-related acute illness that is affecting body heat production. d. age-related motor deficiencies that result in self-neglect.
b. age-related neurosensory changes that diminish awareness of temperature changes.
A nurse assesses the lower extremities of an older adult and notes a small ulcer between the person's great toe and second toe. The ulcer has well-defined edges and there is no bleeding; however, there is a small amount of necrotic tissue present. This wound is most likely a(n): a. venous ulcer. b. arterial ulcer. c. pressure ulcer d. surgical wound.
b. arterial ulcer.
An older adult's nutritional status is screened by a nurse using the Mini Nutritional Assessment (MNA). The older adult scores a score of "10" on the screening portion of the tool. The best action by the nurse is to: a. refer the patient to a dietician. b. complete the assessment portion of the tool. c. conduct a 72-hour calorie count. d. initiate nutritional supplements between meals
b. complete the assessment portion of the tool.
An older person has sudden onset of a severe headache, left-sided facial drooping, and left arm numbness. The person's daughter calls 911 and the person is transported to the emergency department. The first diagnostic test that will likely be performed is a(n): a. electrocardiogram (ECG) to assess for atrial fibrillation. b. computed axial tomography (CAT) scan to differentiate hemorrhagic from ischemic stroke. c. international normalized ratio to determine level of anticoagulation. d. lumbar puncture to assess for infection.
b. computed axial tomography (CAT) scan to differentiate hemorrhagic from ischemic stroke.
A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement Community (NORC). The nurse understands that NORCs are: a. purpose-built senior housing communities. b. neighborhoods or buildings where a large segment of the residents are older adults. c. communities where volunteers coordinate access to services for older adults. d. intentional collaborative housing where residents participate in the design and operation of the neighborhood.
b. neighborhoods or buildings where a large segment of the residents are older adults.
A nurse assesses a nursing home resident's pressure ulcer to be a "healing stage III." The primary reason reverse staging is never used is because: a. even though all tissue layers are replaced as a wound heals, the healed skin is not as strong as it originally was. b. not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was. c. reimbursement in nursing homes does not allow for reverse staging to be utilized. d. the collagen layer is not replaced during wound healing.
b. not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was
A nurse in a long-term care facility notes that there has been an increase in falls on one unit and that many of the falls are occurring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that: a. postural changes in blood pressure are common in older adults and frequently occur around mealtimes. b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. c. residents of long term care facilities are often on many different medications, which are given at mealtimes. d. it is common practice to take long term care residents to the bathroom immediately following meals.
b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide.
An older adult who was diagnosed with atrial fibrillation asks a nurse, "I feel fine. I have no symptoms at all with this heart problem, yet I am now on a blood thinner medication, which I understand can by very dangerous. Is this really necessary?" The nurse formulates a response based on the understanding that: a. Atrial fibrillation, while initially asymptomatic, will progress and become symptomatic. b. the risk of stroke is very high for a person with atrial fibrillation. c. untreated atrial fibrillation will likely cause a heart attack. d. atrial fibrillation can cause coronary heart disease.
b. the risk of stroke is very high for a person with atrial fibrillation.
When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse is confident that client education on the condition's contributing factors has been effective when the client states: a. "A warm bath at night instead of in the morning is my new routine." b. "Eating a banana at breakfast assures me the potassium I need." c. "I've cut way back on my caffeinated coffee, teas, and sodas." d. "I elevate my legs on a pillow so as to improve circulation."
c. "I've cut way back on my caffeinated coffee, teas, and sodas."
A nurse is caring for an older hospitalized patient who recently suffered a myocardial infarction (MI). The patient asks the nurse, "I didn't even know that I had a heart attack. I did not have crushing chest pain like you see on television. Why didn't I?" The best response by the nurse is: a. "Older patients do not feel pain in the same way that younger patients do." b. "Oh, that is just television. Hardly anyone has crushing chest pain when he has a heart attack." c. "Older people often do not have the typical signs and symptoms when they have a heart attack." d. "Older people never have chest pain when they have a heart attack."
c. "Older people often do not have the typical signs and symptoms when they have a heart attack."
A nurse is working with an older individual who has recently started an exercise program. The individual tells the nurse, "This exercise thing is really hard, and I absolutely hate walking on a treadmill going nowhere. I think I am going to call it quits." Which of the following responses by the nurse will be most effective in encouraging the individual to remain in the program? a. "If you stop exercising, you will reverse all the good effects that the exercise accomplished." b. "I will have to report that to your physician." c. "What types of exercise do you enjoy doing?" d. "Most older people hate exercising, but they do it anyways."
c. "What types of exercise do you enjoy doing?"
An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse? a. Refer the resident for an evaluation for a hearing aid. b. Raise her voice when speaking to the resident. c. Examine the resident's ears for cerumen impaction. d. Teach the resident to read lips.
c. Examine the resident's ears for cerumen impaction
Which attempt by the family to prevent an older, frail adult from falling causes the home health nurse concern? a. Keeping several low wattage night-lights on in the evening b. Installing wooden railings on the stairway to the bathroom. c. Keeping the side rails up on the client's bed at night. d. Encouraging the client to use a cane when ambulating.
c. Keeping the side rails up on the client's bed at night.
A patient tells the nurse, "Every time I laugh or cough, I wet myself." Which type of urinary incontinence is this patient describing? a. Urge b. Functional c. Stress d. Mixed
c. Stress
In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include: a. speaking to the client sternly and instructing the client to open the mouth and cooperate immediately. b. having another nurse aide assist in holding the client's mouth open with a tongue depressor. c. involving the client in the process of oral hygiene, such as using the hand over hand technique to brush the client's teeth. d. quickly performing oral hygiene without explanation since the client is uncooperative.
c. involving the client in the process of oral hygiene, such as using the hand over hand technique to brush the client's teeth.
An 89-year-old hospitalized female patient tells a nurse, "I go to the bathroom really often, but I manage this by not drinking too much before I go to bed so I can sleep for the night." The patient has no pain or discomfort with voiding. The nurse considers this finding to be a: a. manifestation of urge incontinence. b. manifestation of a urinary tract infection. c. normal age-related change in an 89-year-old woman. d. manifestation of diabetes.
c. normal age-related change in an 89-year-old woman.
A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose of hypodermoclysis is: a. to rehydrate an individual with severe dehydration. b. to quickly administer 4-5 L of fluid within a 24-hour period. c. to rehydrate an individual with mild to moderate dehydration. d. as a supplement to IV hydration to expedite rehydration.
c. to rehydrate an individual with mild to moderate dehydration.
A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse's teaching plan? a. "Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure." b. "With the right hearing aid, you can expect your hearing to be back to normal." c. "Hearing aids are covered by Medicare Part B." d. "Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise."
d. "Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise."
A 78-year-old patient has a history of osteoarthritis and lives alone in a two-story home. The bathroom is on the first level and the bedroom is on the second level. The patient states, "I am so upset. I have been wetting the bed at night." What type of incontinence does the patient most likely have? a. Mixed incontinence b. Stress incontinence c. Urge incontinence d. Functional incontinence
d. Functional incontinence
An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?" The nurse formulates a response based on the knowledge that: a. a cochlear implant is permanent, surgically implanted hearing aid. b. a cochlear implant speeds up the conduction of sound to the auditory nerve. c. a cochlear implant functions as an artificial auditory nerve. d. a cochlear implant directly stimulates the auditory nerve.
d. a cochlear implant directly stimulates the auditory nerve.
A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by: a. doing 10 pushups before bed to encourage a "pleasant tiredness." b. seldom eating a bedtime snack. c. engaging in computer games as a pre-bed activity. d. limiting the afternoon nap to just 30 minutes.
d. limiting the afternoon nap to just 30 minutes.
