Medical-Surgical Nursing Week 3 Part 2

Since 1996, the Hartford Institute for Gerontological Nursing has worked to ensure that all hospitalized patients be given quality care. What is the age limit mentioned by the institute?

65 years and above

Which group of medications is appropriate for the control of certain behavioral problems, such as delusions, acute psychosis, and schizophrenia?

Anti-psychotic drugs

What tasks can be assigned to unlicensed assistive personnel (UAP)? Select all that apply.

Apply moisture barriers to the patient's skin. Place pressure-relieving mattresses on the bed.

What serious "marker conditions" are listed under the Fulmer SPICES framework that can lead to longer hospital stays, higher medical costs, and even death in older adults? Select all that apply.

Confusion Incontinence Sleep disorders Skin breakdown

Which tool uses nine open-ended questions and a diagnostic algorithm to identify delirium?

Confusion Assessment Method (CAM)

The nurse is conducting a medication assessment on an older adult patient who is being admitted to a long-term care facility for rehabilitation following a hip replacement. With Beers Criteria used as a resource, which drug poses a potential risk for this patient?

D

An older adult who underwent recent knee-replacement surgery is suspected of experiencing delirium. What assessment tools can be used to evaluate the patient for delirium? Select all that apply.

Delirium Index (DI) NEECHAM Confusion Scale Confusion Assessment Method (CAM)

Which statement regarding delirium and dementia is correct?

Delirium is a short-term disorder, and dementia is a long-term illness.

What is also referred to as chronic confusion?

Dementia

The caregiver of a 65-year-old patient reports that the patient has lost interest in eating and social and recreational activities and is not sleeping well. Which condition does nurse anticipate?

Depression

Which manifestation of neglect does the nurse identify as most common in older adults?

Depression

What may listlessness in an older adult in a family indicate?

Neglect

Which adverse drug event increases the risk of falls in an older adult receiving antipsychotic drugs?

Orthostatic hypotension

An 85-year-old patient has fallen twice in the past two weeks getting out of bed at night and wandering the hall. What does the nurse suggest to the health care team to prevent subsequent falls?

Reminding the patient to call for assistance and reorienting him or her to the location of the call button

Which reporting action is mandated by U.S. laws regarding abuse or neglect of older adults?

Reporting suspected abuse or neglect in the hospital or nursing home to a social worker

What was developed to limit the use of physical restraints in hospitals and nursing homes?

The National Patient Safety Goals (NPSGs)

Which is true regarding restraint use for patients in nursing homes?

The law gives patients the right to be restraint-free.

Which skin care precautions would the nurse take when caring for older adult patients on long-term steroid therapy?

Use gentle touch and report any open areas.

Which nursing intervention is most important in preventing injury in an older adult patient who is at high risk for falls?

Use low beds or futon-type beds for the patient.

A nursing instructor asks a nursing student about delirium. What nursing student statement indicates a need for further teaching by the nurse?

"Delirium is a chronic, progressive disorder."

The registered nurse is teaching a nursing student about interventions to prevent sleep disorders in an older patient. Which nursing student statement indicates a need for further teaching by the nurse?

"I should encourage the patient to sleep longer during the daytime."

Which nursing student response about frequent sources of stress and anxiety in older adult patients confirms the need for further teaching by the nursing instructor?

"Insurance"

The nurse working in a nursing home is supervising unlicensed assistive personnel (UAP). The UAP are reporting their activities over the past 24 hours. They repositioned four immobile patients on the floor every two hours, assessed the patients' skin for redness three times during this period, checked the patients' skin to make sure it was clean and dry, and helped the patients get into absorbent briefs before bedtime. What feedback does the nurse give?

"Patients should not be put in absorbent briefs at bedtime."

According to the Healthy People 2020 initiative, what questions regarding medication use should be included during the interview of an older adult? Select all that apply.

"Do you live alone?" "Do you have poor eyesight or hearing?" "Do you take your medications more than once a day?" "Do you take any herbs, vitamins, or other dietary supplement

The nurse is teaching a 65-year-old patient about Medicare benefits. Which patient statement indicates adequate teaching?

"Part A covers inpatient hospital and hospice care expenses."

Which nursing interventions are beneficial to a patient with insomnia? Select all that apply.

Keeping conversations quiet Dimming or turning off the lighting in the room Administering pain medication before bedtime

Which older adult population is at a higher risk for disability from chronic disease and mental distress?

LGBTQ

What factors are responsible for the lag in the health of Hispanic older adults? Select all that apply.

Language barrier Lack of health care access Inadequate health insurance

Which factors contribute to insomnia in the acute and long-term care setting? Select all that apply.

Lighting Excessive pain Chronic disease Staff conversations Environmental noise

Which condition in older adult patients is assessed for thorough completion of a nutritional screening?

Malnutrition

What term is used for waking up at night to urinate?

Nocturia

The nurse is helping a new resident transition to an assisted-living facility. Which actions are effective for minimizing relocation stress? Select all that apply.

Noting what foods the patient likes and dislikes Encouraging the patient's family and friends to visit often Providing opportunities for the patient to assist in decision making

Which evidence-based nursing interventions should the nurse include in a plan of care in order to prevent agency-associated pressure ulcers, as per the National Patient Safety Goals (NPSGs)? Select all that apply.

Offer nutritional support. Reposition and provide support surfaces. Avoid skin injury caused by friction or shearing forces.

What nursing interventions should be implemented for all patients, regardless of a high risk for falls? Select all that apply.

Place objects that the patient needs within his or her reach. Place the patient's bed in the lowest position with the brakes locked. Observe the patient for side effects and toxic effects of drug therapy. Remind the patient to call for help before getting out of bed or a chair.

A patient is unsure about the services covered by Medicare. The patient tells the nurse the services he or she believes are covered. Which indicates a need for further education?

Private Medi-Gap insurance

What should the nurse incorporate in the plan of care for a patient who has fragile skin?

Reduce friction and shearing when moving the patient.

What should the nurse include in the plan of care for a patient suffering from a sleep disorder? Select all that apply.

Refrain from making loud noises such as slamming the doors. Manage the pain by giving the pain medication before bedtime. Keep staff conversations as quiet as possible and away from patient's rooms.

A patient with end-stage lung cancer and metastasis to the brain has been admitted to the medical-surgical unit. After trying all options to provide a safe environment, the nursing staff is required to apply restraints. Which nursing intervention is required for this patient?

Releasing the restraints at least every 2 hours

What would the nurse use to prevent a patient from falling out of a wheelchair?

Restraint

Which tool is available to help the nurse focus on factors that increase an older person's risk for falling?

STRATIFY

Which assessment tools would help a nurse focus on factors that increase an older person's risk for falling? Select all that apply.

STRATIFY Morse Fall Scale Hendrich II Fall Risk Model (HIIFRM)

Which statement does the nurse recognize as accurate regarding depression and its management in older adult patients?

Stroke can lead to secondary depression.

What should the nurse include in the assessment when looking for signs of skin breakdown including pressure ulcers?

Tissue integrity

Why should a patient who is in a restraint be checked every 30 to 60 minutes and have that restraint released at least every 2 hours? Select all that apply.

Turning Toileting Repositioning

Nurses must know about the special needs of older adults, especially as that segment of the population grows. By 2050, it is expected that what percentage of people in the United States will be over 65 years old?

25%

The Fulmer SPICES framework, which was developed as part of the NICHE project, identified many serious "marker conditions" that can lead to longer hospital stays, higher medical costs, and even deaths. How many marker conditions were identified?

6

What percentage of ambulatory care services is reimbursed in Medicare Part B?____%

80

If a person retires between the ages of 55 and 65, by what age are funds most likely to become depleted, causing strain on health care?

80-85 years

Which nursing interventions should the nurse implement for a patient who is at a higher risk for falls?

Use technological devices to alert staff about the patient getting out of bed.

Which physical restraint can cause serious injury and even death?

Vests

Which is an appropriate way for an older adult patient's family to minimize relocation stress syndrome?

Visiting the patient often

The nurse is caring for an older adult. When must the nurse act as a mandatory reporter of suspected elder abuse?

When the nurse assesses that there is evidence to indicate high potential of abuse

For which patient is the use of the drug haloperidol appropriate?

A 72-year-old patient who suffers from delusions

Which statement about older adults and incontinence is correct?

A bladder training program is often helpful in its management.

Which condition can be treated with thiothixene?

Acute psy

Anticholinergic effects, orthostatic hypotension, and Parkinsonism are some of the consequences of the group of medications that are considered antipsychotics. Under which category would this be labeled?

Adverse effects

What medication side effect causes constipation, dry mouth, and urinary retention?

Anticholinergic

Which group of drugs may cause delirium as an adverse side effect?

Anticholinergic

A nursing student is learning about health care law regarding the use of chemical restraints. Which psychoactive drug class will the student identify as most potent, which means it must be used with extreme caution?

Antipsychotic

Which group of drugs is most likely to be prescribed to a patient diagnosed with schizophrenia?

Antipsychotic

Which does the nurse recognize as the likely cause of an older adult patient's constipation, dry mouth, and urinary retention?

Antipsychotic therapy

Which assessment tool is used for older adults when predicting pressure sore risk?

Braden Scale

Which member of the health care team would the nurse consult when caring for a patient who has difficulty chewing or swallowing?

Dietician

What problems prevent older patients from receiving adequate nutrition?

Eating and feeding problems

Which assessment findings does the nurse identify as associated with depression in older adults? Select all that apply.

Fatigue Change in appetite Early morning insomnia

What term is used for the mismanagement or misuse of an older adult's property or resources?

Financial abuse

What is another term for the SPICES framework?

Geriatric marker conditions

Which drugs are considered antipsychotic drugs? Select all that apply.

Haloperidol Thiothixene

A 70-year-old patient admitted to the hospital with heart failure has a history of a fractured hip caused by a previous fall. The patient is taking oxycodone-acetaminophen as needed for pain secondary to a recent dental procedure. Which risk factor puts this patient at greatest risk for a fall?

History of a previous fall

What adverse effect can risperidone cause?

Hyperglycemia