HESI Case Study Gerontology: Age-Related Risks

How many mL of fluid should the client drink per day?

2400 mL

The RN sets the insulin drip to deliver how many mL/hr?

3 mL/hr

When using an 8-ounce drinking glass, the client should drink how many glasses per day to ingest 2400 mL in 1 day?

10

The pharmacist delivers Mr. Rogers' dose of ampicillin (omnipen) in a 50 cc bag of 0.9% normal saline. In order to deliver the medication over 30 minutes, the nurse sets the pump at how many cc/hr?

100 cc/hr

Which results of the dipstick urinalysis does the RN recognize as abnormal?

A) +1 ketones D) Scant sediment E) Trace leukocytes

The RN understands that which symptoms are commonly associated with BPH?

A) Bladder distention B) Frequent stopping and starting of urinary stream C) Straining while urinating D) Dribbling at the end of urination

Which data is most important to report to the HCP?

A) Dyspnea

Along with clinical manifestations, which common laboratory findings indicate dehydration? SELECT ALL THAT APPLY

A) Elevated hemoglobin and hematocrit C) Increased serum osmolarity D) Increased serum glucose E) Increased urine specific gravity

Prior to changing the dressing on Mr. Rogers' right heel ulcer, the nurse should first take which actions?

A) Inspect the feet carefully for temperature, sensation, and drainage

The RN understands that which symptoms are associated with diabetic peripheral neuropathy? SELECT ALL THAT APPLY

A) Reduced ability to feel pain or temperature in the extremities D) Problems with erectile dysfunction E) Extreme sensitivity to touch

What other symptom(s) should the RN expect to find in a client with a diagnosis of diabetic retinopathy?

A) Reports of floaters B) Loss of vision D) Difficulty with color perception

Which pattern should the nurse report immediately to the HCP?

A) ST depression and "U" waves

Which of the following actions will help to maintain skin integrity? SELECT ALL THAT APPLY

A) Use heel protectors B) Use special mattress or foot cradles D) Apply skin moisturizers to prevent cracking E) Instruct the client to wear clean white socks

Which antimicrobial medications are safe alternatives for clients with penicillin allergies?

A) Vancomycin (Vancocin) C) Clindamycin (Cleocin) E) Erythromycin (Erythrocin)

Which lab value needs to be reported immediately?

B) Arterial pH 7.05 mg/dL

The RN considers which pharmacological age-related principle(s) when administering medications or monitoring the effects of medications in the elderly client? SELECT ALL THAT APPLY

B) Decreased cardiac output increases the risk for adverse drug reactions D) Drug administered intravenously have a faster absorption rate than oral drug E) Dehydration can decrease the half-life of drugs

Which of the following results can affect drug distribution and influence drug-to-drug interactions?

B) Low serum albumin levels

Which of the following teaching points should be included in this plan of care? SELECT ALL THAT APPLY

B) Notify the HCP if there is headache or irritability C) Report excessive hunger and/or weakness D) Report cold and clammy skin

It is most important for the client to report which potential adverse or side effect associated with gabapentin (neurontin)?

B) Tarry stool

The RN understands that which physiological age-related change is often responsible for dehydration in the elderly

B) Thirst decreases, contributing to less fluid intake

The RN should instruct the client to take which action when collecting a urine sample?

B) Wipe the genital area clean

The RN understands that which information is correct regarding the prescribed insulin?

C) Glargine (lantus) does not have a peak interval

Which of the following objective signs indicate dehydration? SELECT ALL THAT APPLY

C) High creatinine levels D) Postural hypotention E) Heart rate greater than 100 bpm

The RN anticipates that the client will receive which treatment for pernicious anemia?

C) Intramuscular injection of vitamin B-12

What conditions, other than hypoerglyceia, might Mr. Rogers have?

C) Ketonuria D) Osmotic diuresis E) Glycosuria

Which response by the client is of most concern to the RN?

C) My urine had a foul smell this morning

In addition to the insulin, which of the following immediate measures would be indicated in the treatment of Mr. Rogers? SELECT ALL THAT APPLY

C) Potassium supplements D) Sodium bicarbonate E) 0.9% normal saline

Which information about the client is of most concern to the RN?

C) Reports a new onset of blurry vision

The RN understands that which concept is important when addressing the client's physiological and psychosocial needs?

C) The client's diabetes mellitus should not present a problem for community dining

Which of the following statements made by Mr. Rogers indicates the need for further teaching?

C) This medication may cause a rise in my blood pressure

Which recommendation by the RN may help improve mild symptoms of BPH during the "watchful waiting" period?

D) Avoid sources of caffeine

Which laboratory finding is of most concern to the RN?

D) Hemoglobin 11.2 g/dL

Which technique is correct?

D) Use a 1 to 1.5 inch needle

Which instruction related to bath safety is best?

D) Use a bath thermometer to ensure that the temperature is below 102 degrees F

Carl Rogers is a 67-year-old African American male with a 20-year history of type 2 diabetes mellitus. After a scheduled visit and an assessment at the healthcare provider's office (HCP's), Mr. Rogers is directly admitted to the medical unit with a stage II non-healing ulcer on his right heel. The nursing admissions paperwork is completed, and pain medication is administered. During his admissions assessment, Mr. Rogers is diagnosed with a urinary tract infection (UTI) and dehydration.

Mr. Rogers was diagnosed last year with type 2 diabetes mellitus. He explains that he is experienced with self-administration of insulin injections three times per day. Mr. Rogers states that his eating habits are not great, but he never misses his insulin injections. He lives alone and doesn't like to eat by himself, so he rarely cooks. Mr. Rogers explains that other than an occasional walk, he does not exercise.

The RN understands that which statement is accurate regarding type 2 diabetes mellitus in the aging client?

The risk for coexisting diseases such as hypertension and stroke increases with aging