NURS 601 Exam #2

A nurse is facilitating a group consisting of family members of older adults recently diagnosed with Alzheimer's disease. One of the family members asks the nurse, "What causes this disease?" Which information would the nurse include?

"Alzheimer's disease appears to result from a combination of genetic and environmental factors."

A nurse is teaching older adults at a senior center how to reduce the incidence of falls. Which statement indicates that the nurse's teaching has been effective?

"Both over-the-counter and prescription medications can cause me to fall."

Recognizing the high incidence of breast cancer among older adult women, a public health nurse is including the topic in a health promotion teaching session at a senior center. Which statement would the nurse most likely include in the teaching session about their risk of developing breast cancer?

"Breast cancer is one type of cancer that appears to be heavily influenced by heredity."

A daughter reports that her mother, who has Alzheimer's disease, thinks and acts so slowly that everything must be done for her. Which suggestion would be most appropriate for the nurse to provide initially to the daughter that might be helpful for both the client and herself?

"Encourage your mother's self-care, but do it under supervision."

An older adult client diagnosed with chronic obstructive pulmonary disease (COPD), who has smoked 1 pack per day for 30 years, expresses regret about ever starting smoking. Which response by the nurse would be appropriate?

"Even though you have smoked for a long time, there are still benefits to quitting smoking."

A gerontological nurse is conducting a health promotion program for a group of older adults about activities specific to the integumentary system. The nurse determines that the teaching was successful based on which statement?

"I am aware that irregularly shaped moles can be associated with melanoma."

A client reports symptoms associated with depression. The nurse provides education concerning the effect certain medications have on triggering or worsening depression. What statement by the client demonstrates an understanding of that education?

"I am going to ask my health care provider about prescribing something other than a beta-blocker for my hypertension."

The nurse reviews an older adult client's urinary symptoms. Which statement by the client requires follow up by the nurse?

"I have trouble making it to the restroom on time."

An older adult client taking warfarin for atrial fibrillation reports having trouble falling asleep and tells the nurse they have tried a few supplements and alternative treatments to help fall asleep. Which statement by the client requires further teaching?

"I take melatonin before bedtime."

A nurse works in an acute care unit for older adults and monitors the clients for functional consequences of depression. Which statement by a client is priority for follow-up?

"I think it would be better for everyone if I was not here anymore."

The nurse is reviewing lifestyle changes with an older adult client to support urinary continence. Which statement by the client requires further follow up by the nurse?

"I will stay at home to ensure that I can remain close to the toilet."

The nurse is caring for an older adult client who is prone to developing constipation. The client asks; "What can I do to prevent this from happening?" Which recommendation(s) will the nurse make? Select all that apply. "Increase the amount of water you drink each day." "Get exercise each day." "Instill a saline enema each night before bed." "Take an over-the-counter laxative each day." "Eat more fruits and vegetables."

"Increase the amount of water you drink each day." "Get exercise each day." "Eat more fruits and vegetables."

A client is diagnosed with delirium. Which statement made by a family member supports that diagnosis over one of dementia?

"My parent was fine at bedtime but confused upon getting up the next morning."

The nurse is educating an older adult client about depression onset in later life. Which statement by the client demonstrates understanding of the education provided?

"Older adults with depression and chronic illness have more serious negative functional consequences."

An older adult client, who does not want to take medications, asks the nurse about natural methods to help with falling asleep. Which strategy(ies) will the nurse suggest? Select all that apply. "Take a cool shower at bedtime." "Stay away from carbohydrates close to bedtime." "Take a walk every day." "Get outside in the sun each day." "Drink non caffeinated herbal tea at bedtime."

"Take a walk every day." "Get outside in the sun each day." "Drink non caffeinated herbal tea at bedtime."

An older adult client with chronic pain in the right hip due to osteoarthritis states to the nurse, " I am taking enteric-coated ibuprofen along with an antacid so that it does not bother my stomach." How will the nurse respond?

"Taking antacids with the ibuprofen may decrease the effectiveness of the ibuprofen."

The spouse of a 74-year-old client is distraught at the client's recent diagnosis of Alzheimer disease. To identify a cure, the spouse is conducting extensive online research as well as speaking with each member of the care team about possible treatments. When talking with the spouse, which response would be appropriate?

"There is not currently a cure available for Alzheimer disease, but some drugs have been shown to slow the progression of the disease."

A 71-year-old male client has been diagnosed with colon cancer after a recent colonoscopy. On the first follow-up visit, the client appears anxious about the diagnosis. Which response by the nurse would be appropriate?

"This must be very stressful for you. What people can you rely on for support?"

An older adult client reports chest pain. which question(s) will the nurse use to elicit information about the quality of pain? Select all that apply. "What were you doing when the pain started?" "Does the pain fell sharp?" "What does the pain fell like?" "Are you grimacing because of aching?" "What aggravates the pain?"

"What were you doing when the pain started?" "What does the pain fell like?" "What aggravates the pain?"

An older adult client admits to experiencing urinary incontinence. Which question will the nurse ask first?

"When did it start?"

What are shared risk factors for geriatric syndromes?

1. older age 2. baseline cognitive impairment 3. baseline functional impairment 4. impaired mobility

The nurse is performing an assessment on several client in an outpatient behavioral health clinic. Which client does the nurse identify as being at the highest risk for suicide?

85-year-old male client whose spouse died 1 year ago

Lewy body dementia

A form of dementia characterized by an increase in Lewy body cells in the brain. Symptoms include visual hallucinations, momentary loss of attention, falling, and fainting.

An older adult client comes to the clinic for a check-up. Which finding would the nurse identify as suspicious for cancer?

A sore that does not heal

Which teaching will the nurse include in a urinary health promotion webinar for aging clients?

Adequate fluid intake

Following hip surgery, what is the best way for the nurse to encourage early ambulation in the older adult client?

Administer pain medication before assisting the client out of bed.

While providing care to an older adult client recovering from a stroke, the nurse suspects that the client is experiencing pain. Which finding(s) would the nurse interpret as supporting this suspicion? Select all that apply. Agitation Perspiration Increased appetite Sustained focus Increased blood pressure

Agitation Perspiration Increased blood pressure

Different types of dementia

Alzheimer's Disease Lewy body dementia Vascular dementia Frontotemporal dementia Other (Parkinson's , Huntington's, Wernicke's, Creutzfeldt-Jacob)

An autopsy is performed to determine the cause of death in an older adult who may have been poisoned. Brain tissue shows neuritic plaques and neurofibrillary tangles in the cortex, but no other abnormalities. What would the future have held for him if he had lived?

Alzheimer's disease

Benefiance

An act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation

A nurse is assessing several older adult clients. The nurse determines which client is experiencing a health problem characterized as delirium rather than dementia?

An older adult client experiencing forgetfulness and confusion over the last 48 hours.

In Chapter 8 of Leland, we learn lessons from Ping. Which of the top 10 chronic conditions reviewed in week one of class have we learned has a significantly impact in Ping's quality of life?

Arthritis

An 85-year-old client with limited mobility is incontinent of urine. An expected outcome identified on the plan of care is that the client will maintain skin integrity. Which intervention would the nurse most likely implement?

Assess the client for wetness every 2 hours.

Following a prolonged hospital stay, an older adult client has returned to the nursing home where the client normally resides. The client became incontinent of urine during the time in the hospital, a problem that nursing staff wish to now resolve. What action will the caregivers take in performing continence training?

Assist the client with toileting at timed intervals throughout the day.

signs and symptoms of delirium

Change in mental status and fluctuation course throughout day, inattention, disturbed intellectual function, disorganized thinking; disorientation of time and place, not identity; altered attention span, worsened memory; labile mood; meaningless chatter; poor judgment; altered level of consciousness, including hypervigilance, mild drowsiness, semicomatose status; hallucinations, illusions; disturbances in sleep-wake cycles; restlessness, sleep disturbances; be suspicious, personality changes; shortness of breath, fatigue; slower psychomotor activities

The nurse notes that an older adult client has a 2 cm x 2 cm area of redness at the top of the buttocks after sitting in a chair for 30 minutes. What action will the nurse take?

Change the client's position.

An older adult is admitted to the hospital for surgery. A day later, the client seems confused and disoriented, imagining a trapdoor in the ceiling above the bed. The client's wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that he has always seemed "sharp as a tack." Which action would be the priority?

Checking the client's chart for medications that can cause delirium.

What are geriatric syndromes?

Clinical conditions in older adults that do not fit into specific disease categories

Needs of suicidal older adults

Close observation Careful protection Prompt therapy Treatment of underlying depression Environmental safety Nurses' willingness to listen and discuss thoughts and feelings related to suicide

An older adult male client who consumes an excessive amount of calcium reports lower, right-sided abdominal pain. What should be the nurse's first action after completing a pain assessment?

Collect an urine specimen

What evidence-based practice is used to detect fratility and geriatric syndromes?

Comprehensive Geriatric Assessment (CGA)

The nurse manager notes a reduction in the number of urinary tract infections being diagnosed in older adult clients. Which unit-based protocol likely contributed to this outcome?

Cranberry juice with breakfast

Assessment for depression

Crucial to avoid misdiagnosis During routine health visits Short assessment tools Missed diagnosis factors Atypical presentation of symptoms Assess relationship of life events and/or serious or terminal illness with depression Assess underlying problem Prompt treatment can hasten recovery

Which assessment finding is most significant when determining care for the older adult client with sarcopenia?

Decrease in muscle mass as a result of a reduction in protein synthesis

The nurse is caring for a client experiencing delirium. To successfully manage this change in status, which nursing intervention is priority?

Determine the underlying cause and maintain fluid and electrolyte balance.

A nurse observes the unlicensed assistive personnel (UAP) ask a client what the client wants for breakfast, lunch, and dinner while assisting the client to toilet. Which action by the nurse is appropriate?

Direct the aide to present only one idea at a time.

causes of delirium

Disruption in brain function Onset in acute, rapid; change noted within hours, a day, or days

Nonmaleficence

Do no harm

Autonomy

Each individual patient's right to self-determination and decision-makin

An older adult client is diagnosed with hypertension. Which recommendation will the nurse include in the client teaching?

Eat foods low in sodium

The nurse is providing discharge instructions for a client diagnosed with oropharyngeal dysphagia. Which instruction will the nurse include?

Eat in an upright position to improve swallowing.

A client diagnosed with Alzheimer disease is agitated and keeps trying to leave the unit. Which action will the nurse take?

Ensure the client's basic needs are met.

Assessment for delirium

Establish baseline data to compare Any change in behavior or cognitive pattern warrants evaluation May go unrecognized due to coexisting conditions or considered part of aging Persons with dementia may develop delirium due to undiagnosed acute condition **Prompt treatment may reverse condition and prevent permanent damage

Interventions during initial/acute stage of delirium

Establishing medical stability Minimizing stimulation Consistency in care Prevention of harm to self and others Support and realistic expectations

In chapter six of Leland's (2018) book, he descibes the health expereince of one of the edlers spending "sixty-four days in the hospital or rehab for low blood pressure". Which elder was he talking about?

Fred

The nurse is caring for a client 1 month after a cerebrovascular accident. Which assessment will the nurse perform first?

Gag reflex

In Chapater 7, The Lessons of Fred, John Leland quotes Cicero, stating that (fill in the blank) is "not only the greatest of virtues, but the parent of all others".

Gratitude

A nurse who works on a geriatric long-term care unit is aware that many of the older adult clients on the unit have a documented history of orthostatic hypotension. What measure will the nurse include to ensure the safety of such clients?

Have clients sit on the edge of their beds for a minute or two before ambulating

Suicide

Highest for all males and females aged 75 and older

A nurse is providing ongoing care for an older adult client with a diagnosis of dementia. Which nursing goal will the nurse prioritize when conducting ongoing assessment of this client?

Identify factors affecting the client's functioning and quality of life.

The gerontological nurse is completing the admission database for an older adult client admitted for surgery. What safety component of the nutritional assessment should the nurse prioritize?

Inspection for loose teeth

Suicide gestures

Medication misuse Self-starvation Activities that oppose a therapeutic need Activities that threaten a medical problem Subjecting oneself to unnecessary risks

The nurse is assessing an older adult client brought to the emergency department by a companion. Which finding would lead the nurse to suspect that the client is experiencing congestive heart failure?

Moist lung crackles on auscultation with shortness of breath on exertion

signs and symptoms of depression

Most common: insomnia, fatigue, anorexia, weight loss, constipation, lack of interest in activities previously enjoyed, decreased interest in sex May express self-deprecation, guilt, apathy, remorse, hopelessness, helplessness, feelings of being a burden Problems with personal relationships and social interactions Changes in sleep and psychomotor activity Hygiene neglect Physical complaints: can include headache and indigestion Altered cognition (pseudodementia)

Fidelity

Must remain true to professional promises

An older adult client reports overwhelming daytime fatigue, which the spouse attributes to loud snoring and erratic breathing patterns during the night. Which health problem would the nurse suspect?

Obstructive sleep apnea

A nurse plans care for a frail older adult in long-term care. Which intervention should be included in the plan of care to reduce the risk of respiratory infections?

Oral care

An older client tells the nurse he is stressed because he thinks he has Alzheimer's disease based on his long history of forgetfulness. What is the best nursing response?

Other diseases can mimic Alzheimer's disease, so a comprehensive evaluation is essential to rule out other causes of dementia.

A newly admitted older adult client has severe edema in the lower extremities and no hair on the legs. Based on these findings, which assessment will the nurse perform?

Palpate the peripheral pulses of the legs.

An older adult states experiencing heart palpitations ever since adding a vitamin and nutrient supplement to the diet. The nurse checks the label of the client's supplement. For which vitamin or nutrient is the nurse assessing?

Potassium

A client with cardiovascular disease has a poor appetite. Which intervention should the nurse use to improve this client's nutritional status?

Provide several small meals throughout the day

Treatment for depression

Psychotherapy Antidepressants or CAM Electroconvulsive therapy Complementary/alternative (CAM) therapies Acupressure, acupuncture, guided imagery, light therapy Good basic health practices - Help patient develop a positive self-concept. - Encourage expression of feelings. - Avoid minimizing feelings. - Ensure that physical needs are met - Offer hope.

A nurse administers intravenous pain medication to an older adult in the hospital. Which action by the nurse is the priority?

Reassess the pain level.

Opioids have been prescribed for an older adult client who is suffering from chronic cancer pain. What is the nurse's priority assessment when administering opioids to this client?

Respiratory rate

Which of the following was not listed in the article about geriatric syndromes (O'Hara, 2014) as being among the five most common conditions?

Sarcopenia

Evolving syndromes of the older adult

Sarcopenia, polypharmacy, pain, frailty, polypharmacy

A nurse is preparing to administer an antidepressant medication to an older adult client with depression. Which information would the nurse need to keep in mind?

Side effects that can occur in older adults are likely to be significant.

A client diagnosed with dysphagia has difficulty moving food from the mouth to the esophagus. Which instruction(s) would the nurse provide when teaching the client how to manage this disorder? Select all that apply. Sit upright to avoid choking. Cut food into small bites. Follow a bland diet. Include foods high in fiber. Drink milkshakes or other thickened liquids.

Sit upright to avoid choking. Cut food into small bites. Drink milkshakes or other thickened liquids.

An 88-year-old client is prone to chronic constipation and ask the nurse why. The nurse should explain what age-related physiological change?

Slow peristalsis

An older adult client with a history of environmental exposure to chemicals reports shortness of breath. Assessment of which finding would lead the nurse to suspect that the client has chronic obstructive pulmonary disease (COPD)?

Sticky, translucent, grayish white sputum

Veracity

Telling the truth

A older adult client presents to the clinic reporting anxiousness caused by recurrent respiratory infections. What should the nurse teach this client?

The effects of aging create a situation in which respiratory problems can develop more easily and be more difficult to manage.

An older adult woman is one day postoperative from a total knee replacement. The client rings the call light to report pain. Which consideration will the nurse prioritize when choosing an appropriate intervention?

The need to provide prompt, adequate relief of the client's pain.

The film Alive Inside is a documentary about the therapuetic benefits of music and it's power to awaken memories in people with dementia.

True

The nurse plans care for an older adult client with asthma. Which should be included to help ensure a clear airway?

Turn, deep breathe, and cough every 2 hours.

The nurse is teaching a class to older adults about oral health practices. What health promotion activity should the nurse recommend?

Visit a dentist every six months to detect oral diseases

An older adult client has a history of a deep vein thrombosis. The client should be taught to avoid excessive intake of which vitamin or nutrient?

Vitamin K

A nurse is responsible for the care of a group of older adults on an acute medical unit. Which client should the nurse monitor closely at night for worsening symptomatology?

a client with a diagnosis of chronic obstructive pulmonary disease (COPD)

Alzheimer's disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning characterized by Presence of neuritic plaques and Neurofibrillary tangles in cortex which lead to loss or degeneration of neurons and synapses

Protective factors for older adults at risk of suicide

access to effective MH services problem solving handles stress, conflict family and community support beliefs that discourage suicide

Delirium

acute changes in mental status, may signify medical emergency

An older adult client reports having insomnia because of getting up several times during the night to void. On what should the nurse focus when assessing this client's lack of sleep?

amount of and when in the day fluids ingested

what is the most frequent psychiatric problem treated in older adults?

depression

Justice

fairness; rightfulness

Newly classified syndromes of the older adult

malnutrition, sleeping/eating/feeding problems

5 common conditions of older adults

pressure ulcers, incontinence, falls, functional decline, delirium

Risk for suicide in older adults

previous attempt or family history hx: ETOH, drug misuse isolation, illness barriers to MH treatments or unwillingness to seek help access to lethal methods

The nurse is concerned that an older adult client is experiencing undiagnosed malnutrition. What information may cause the nurse to make this clinical determination?

serum albumin level 2.8 g/dL (28 g/L)

Which modified communication technique will facilitate activity for the older adult client with dementia?

simple sentences that contain only one idea

Confidentiality

the act of holding information in confidence, not to be released to unauthorized individuals