Gero Exam 2
With which one of the following theoretical frameworks is living with a chronic illness viewed as a progression of phases after a predictable trajectory? A. Chronic Illness Trajectory Model B. Return to Wellness Perspective Model C. The Shifting Perspectives Model of Chronic Illness D. Dual Kingdom Model
A
You suspect an older adult client is having trouble hearing what you say. It is important to first check for which one of the following interferences in hearing? A. Cerumen impaction B. Otosclerosis C. Presbycusis D. Tinnitus
A
While taking care of an older adult client, you recognize that he has health behaviors that place him at risk for a chronic disorder. They would include which of the following? (Select all that apply.) A. He smokes 1½ pack of cigarettes a day. B. He loves to go to the bars, drink, and visit with his buddies. C. His everyday exercise consists of going out to get the mail and newspaper. D. He receives Meals on Wheels 3 days a week. E. He has access to public transportation to his physician's office every month. F. His daughter packs and freezes food on a weekly basis.
A, B, C
An older adult client has been admitted to a skilled nursing facility. Which of the following circumstances can be caused by physical restraints? (Select all that apply.) A. Asphyxiation B. Pressure ulcers C. Nosocomial infections D. Agitation E. Halitosis
A, B, C, D
As a nurse taking care of an older adult with pre-diabetes, you need to teach her which of the following? (Select all that apply.) A. Smoking cessation B. Keeping the fasting blood sugar (FBS) C. Keeping the low-density lipoprotein (LDL) level D. Maintaining her blood pressure (BP) 130/80 mm Hg E. Keeping the triglycerides level >150 mg/dl F. Maintaining a cholesterol level >200 mg/dl
A, B, C, D
As a nurse caring for a cognitively impaired older adult client, you need to observe for which of the following? (Select all that apply.) A. Increased confusion B. Agitation C. Aggression D. Decreased passivity E. Pointing to a grimacing face or crying F. Staring off into space
A, B, C, E
Pain can be which of the following? (Select all that apply.) A. Acute B. Idiopathic C. Nociceptive D. Pathologic E. Adjuvant F. Persistent
A, B, C, F
Which laboratory results are goals for reducing a person's risk for diabetes and heart disease? A. Triglycerides over 150 mg/dl B. Cholesterol 250 mg/dl C. High-density lipoprotein (HDL) over 40 mg/d D. Fasting blood glucose under 150 mg/dl
D
Which of the following is a true statement about osteoporosis (OA)? A. OA is indicative of an underlying health problem. B. The most common site for OA fractures is in long bones. C. African-American women have the highest risk for OA. D. A high risk of death follows an OA-related fracture.
D
Which of the following is a true statement about tuberculosis (TB) in older adults? A. The principal threat from TB is its highly contagious nature. B. The tuberculin purified protein derivative (PPD) is a conclusive test for TB. C. Antimicrobial drugs have made TB an infection of the past. D. Older persons, particularly those in nursing homes, are at risk for TB.
D
Which of the following statements is true about Parkinson disease (PD)? A. Drinking large amounts of alcohol can relieve symptoms of essential tremor. B. Motor tremors and slow movement accompany severe cognitive impairment. C. Lewy body dementia (LBD) is the most common form of dementia. D. Older adults taking rasagiline (Azilect) must avoid eating foods containing tyramine
D
Which of the following therapies would not be beneficial for an older adult client with PD? A. Range-of-motion (ROM) and balance exercises B. Adaptive equipment for eating and self care C. Facial exercises and swallowing techniques D. Nonparticipation in activities as a result of slowed movements and tremors
D
Which one of the following is a true statement about mobility and safety for older adults? A. Use of restraints on older patients helps prevent injuries from falls. B. Falls that do not cause physical injury are not significant. C. The get-up-and-go test provides a measure of a patient's energy and initiative. D. Lowering the bed and fluorescent tapes are interventions to increase safety.
D
Which one of the following terms proposes that premature death will be minimized and disease and functional decline will be compressed into a period of 3 to 5 years before death? A. Chronic illness B. Exacerbation C. Proprioception D. Compressed morbidity
D
You are taking care of a female older adult client with a loss of height and kyphosis. She is also postmenopausal. Which one of the following diagnostic tools would you order? A. Computed tomography (CT) scan of her bones B. Magnetic resonance image (MRI) of her bones C. Bone scan D. Dual-energy x-ray absorptiometry (DEXA) scan
D
You realize your client has suffered a hemorrhagic stroke when or because he: A. Is not experiencing any arrhythmias. B. Has no coagulation disorders. C. Is not dehydrated or hypotensive. D. Is complaining of an explosive, severe headache with no other neurological manifestations.
D
Your client has severe hearing loss, and you are finding it increasingly difficult to talk with him. During your visit, you spend time with him to discuss options to assist him with his hearing. Which of the following would not benefit your client? A. Hearing aids B. Personal listening systems C. Alerting devices D. Talking clocks, large print books, or software that converts text into artificial voice output
D
Your older adult client has recently been diagnosed with gout. You will need to teach him which one of the following EXCEPT: A. Side effects of medications B. How to decrease the likelihood of another attack C. Care of the joint D. Reassurance that this is a one-time occurrence
D
Which of the following statements is true about dysarthria? A. Does not affect intelligence. B. Stems from severe rheumatoid arthritis. C. Physical therapy can be beneficial. D. Can affect the balance.
A
An older woman had hip replacement surgery 1 day ago, and the nurse thinks that the woman also has dementia. Which patient assessment does the nurse use to determine whether this woman is experiencing pain? A. Holds abdomen tightly. B. Has stable vital signs. C. Is not verbalizing. D. Moves during sleep.
A
As a nurse, you understand that several specific types of disorders fall under the umbrella of COPD. After assessing an older adult client who has been diagnosed with COPD, you note that his skin color is pink and that he has little sputum production. As a result, you determine that he has which one of the following disorders? A. Emphysema B. Bronchitis C. Asthma D. Pneumonia
A
Diminished tear production that occurs with age is the definition for which of the following terms? A. Keratoconjunctivitis sicca B. Funduscopy C. Lipofuscin D. Drusen
A
Loss of bone mineral density and structure describes which one of the following vocabulary words? A. Osteopenia B. Crepitus C. Bone mineral density D. Osteophyte
A
Older persons with hypertension (HTN) have a higher risk for all the following events EXCEPT: A. Acute renal insufficiency B. Atrial fibrillation C. Heart failure D. Myocardial infarction (MI)
A
Over 50% of the population, aged 65 years and older, suffers from which one of the following chronic health conditions? A. Hypertension B. Renal failure C. Multiple sclerosis D. Cancer
A
Which is a healthy practice recommended for a person at risk for OA? A. Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with spinach covered with melted cheese for dinner; and ice cream for dessert B. Long-term estrogen administration as adjunct therapy C. Alendronate (Fosamax) taken with a snack just before bedtime D. Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog on a high-fiber bun at lunch; cocktails before dinner; steak with brown rice, celery, and red wine for dinner
A
You understand from an older adult client that he experienced a TIA last week. You realize that he would benefit from some education on how to prevent another TIA or stroke. You instruct him in which of the following? (Select all that apply.) A. Stop smoking. B. Maintain blood pressure at levels equal to or less than 130/85 mm Hg. C. Initiate an exercise program. D. Immediately stop all aspirin. E. Monitor for skin breakdown. F. Limit salt and alcohol intake.
A, B, C, F
You have read that your older adult client has a history of thyroid disease. After assessing him, you realize he has signs of hyperthyroidism and note which of the following symptoms? (Select all that apply.) A. Atrial fibrillation B. Muscle weakness C. Slowed thinking D. Heat intolerance E. Diarrhea F. Anorexia
A, B, F
Which of the following describes the nurse's role for an older patient with a chronic illness? A. Implement an individualized therapeutic regimen that brings about a cure. B. Provide caring to help the patient live at the optimal level of health and wellness. C. Suggest that the patient accept eventual death to reduce the burdens on the patient's family. D. Encourage the patient to minimize the use of services to control costs.
B
A client comes into a clinic having had a previous stroke. Family members state that they hope the client does not have another stroke. Which is the best response? A. More fruits and vegetables in his diet will decrease the risk for stroke. B. Prevention is the best way to manage clients who have had strokes. C. Wine daily will decrease any risk factor of having a stroke. D. Because of collateral circulation, the incidence of another stroke is extremely low.
B
A female older adult client is complaining of mild and localized back and shoulder pain and some nausea and heartburn. Your immediate concern might be that she is experiencing which one of the following events? A. Coronary heart disease (CHD) B. Silent MI C. Acute MI D. Heart failure
B
A new nurse in a long-term care facility is caring for a patient with PD. The nurse should note which one of the following actions related to PD that is observed during the assessment? A. Tremors during sleep B. Cogwheel rigidity C. Frequent blinking D. Fast movements
B
An older adult client has been issued a cane to use while ambulatory. Your instructions would include all the following EXCEPT: A. Place your cane firmly on the ground. B. The size and shape of the cane handle is not a priority. C. Wear low-heeled, nonskid shoes. D. Adjust the cane to your height.
B
An older woman has severe osteoporosis in the long bones, impaired mobility, and chronic pain. Which acute illness or condition is this woman most likely to experience as a result of osteoporosis? A. Peripheral neuropathy B. Depression C. Intertrochanteric fracture D. Opioid analgesic addiction
B
In assessing an older adult client, you notice symptoms that include bradykinesia, a reduction in facial muscle movement, and pin-rolling. You realize that this client possibly has which one the following conditions? A. Alzheimer disease B. Parkinson disease (PD) C. Festination disorder D. Huntington disease
B
The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use? A. Two full-length rails B. One ½-length rail C. No side rails D. Four ½-length rails
B
The most common chronic condition for all ages is: A. Arthritis B. Sinusitis C. Obesity D. Hypertension
B
Which of the following is a true statement about heart disease in older adults? A. Myocardial infarction (MI) has many of the same symptoms in older patients as in middle-aged persons. B. Both excessive urination at night and decreased urination can be signs of heart failure (HF). C. Any exertion on the part of an older adult patient with heart disease can bring on another heart attack. D. A person with HF is likely to have trouble breathing, except when lying down.
B
Which of the following statements is true about diabetes mellitus? A. Type 2 diabetes is the result of the failure of the pancreas to produce insulin. B. Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dl. C. Non-insulin-dependent diabetes mellitus is another name for type 1 diabetes. D. The incidence of diabetes mellitus does not increase with age.
B
You realize your client does not understand her diagnosis of osteoporosis when she makes which one of the following statements? A. "I have removed all the throw rugs in my house so I will not trip and fall." B. "I am going to have to quit smoking sometime." C. "I have signed up at the YMCA to do water exercises twice a week." D. "I have asked my son to put grab bars in my bathtub and handrails in the hallway."
B
Current medical and public health care models of care are not meeting the needs of the older adult with chronic illnesses. Several models and programs are under review to help in improving the care for individuals with chronic illnesses and include which of the following? (Select all that apply.) A. Shifting Perspectives Model of Chronic Illness B. Geriatric Resources for Assessment and Care of Elders Model C. Guided Care D. Program of All Inclusive Care for the Elderly E. Compressed Morbidity Model F. Chronic Illness Model
B, C, D
When caring for an older adult client with a chronic respiratory disorder, you realize that nursing interventions are based on palliative care. Your education would include which of the following? (Select all that apply.) A. Reducing the cause of exacerbations B. Breathing retraining C. Providing nutritional support D. Dealing with supplemental oxygen therapy E. Promoting minimal functional capacity F. Smoking cessation
B, C, D, F
When visiting an older adult client, you note that he is unsteady on his feet and you are concerned about him falling. Which of the following factors make him at risk for a traumatic brain injury (TBI)? (Select all that apply.) A. He has grab bars in his bathtub and a ramp for his rolling walker. B. He uses aspirin. C. He has a history of rheumatoid arthritis and vasculitis. D. Throw rugs are throughout the house to "keep his feet warm and off the cold floor." E. He uses a walker to get around his home, both inside and outside. F. He has poor lighting throughout his home.
B, C, D, F
An older adult client is having some vision problems. Which one of the following disorders is caused by oxidative damage to the lens? A. Macular degeneration B. Glaucoma C. Cataracts D. Diabetic retinopathy
C
As a nurse, you realize the symptoms that normally occur in younger adults are often absent in older adults. When visiting an older adult client, you note that he has been falling, has some signs of confusion, is anorexic, and has rapid pulse and respirations rates. You realize that immediate treatment must be instituted for which one of the following conditions? A. Congestive heart failure B. HTN C. Pneumonia D. Chronic obstructive pulmonary disease (COPD)
C
As a nurse, you will be responsible for teaching self-management skills to an older adult client. Which one of the following skills would not be something you would teach your client? A. What to do during periods of other illnesses B. How to use a personal glucose monitor C. The importance of eating fats and carbohydrates D. How to take care of his or her feet
C
Herpes zoster develops in individuals who have had which one of the following disorders in the past? A. Rubella B. Mumps C. Chickenpox D. Meningitis
C
Myxedema can be described as a(n): A. Complication of hyperthyroidism B. Combination of peripheral and central edema C. Serious complication of untreated hypothyroidism in the older adult D. Apathetic thyrotoxicosis
C
The nurse plans the care of an older female resident of a nursing home who has experienced a sudden deterioration in visual acuity. Which intervention should the nurse complete first? A. Prevent behavioral and social decline. B. Tell her to hold onto the rails during ambulation. C. Examine her mood and functional status. D. Use problem solving involving the resident.
C
The overall temperature in your unit is 62° F during the evening shift. In documenting this concern to the administration, which factor is the most important for the health and well-being of older adults? A. It is not fair for older adults to have to deal with an uncomfortable environment. B. Some of the residents are wearing blankets around their shoulders to keep warm. C. An ambient temperature of 62° F is unsuitable for older people because they have impaired thermoregulation. D. It feels much warmer in the administration wing than out in the patient care areas.
C
The safest opioid analgesic choice for an older patient who has severe acute pain is which of the following? A. Meperidine (Demerol) B. Pentazocine (Talwin) C. Morphine sulfate (Morphine) D. Safe opioids do not exist.
C
Which classic sign of an acute myocardial infarction (AMI) can be absent in an older man with an AMI? A. Vague complaints B. Epigastric burning C. Crushing chest pain D. Dyspnea and fatigue
C
Which of the following is used to treat the most common cause of impairment to an older person's hearing? A. Hearing aids B. Cochlear implants C. Ear canal irrigation D. Sign language
C
Which of the following statements is true about RA? A. Strikes unilaterally. B. Affects more men than women. C. Can affect body systems other than the joints. D. Glucosamine can be helpful for patients in the first 2 years of RA.
C
You realize that an older adult client has had a transient ischemic attack (TIA) when: A. He has had no resolution of his symptoms. B. His right side remains nonfunctional. C. His symptoms begin to resolve within minutes. D. He has developed an expressive aphasia.
C
Your client has a history of arthritis. After assessing her condition and finding stiffness with inactivity, pain relieved by rest, and crepitus, you realize she has which one of the following types of arthritis? A. Rheumatic arthritis (RA) B. Gout C. Osteoarthritis (OA) D. Polymyalgia rheumatica (PMR)
C
Your client has been complaining of headaches, poor vision in dim lighting, sensitivity to glare, and impaired peripheral vision, and he has a fixed and dilated pupil. He probably has which one of the following disorders? A. Cataracts B. Diabetic retinopathy C. Glaucoma D. Macular degeneration
C
A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of his forehead. The man is being tested for which of the following? A. Sensorineural hearing loss B. Presbycusis C. Tinnitus D. Unilateral conductive hearing loss
D
An older adult complains about experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the patient's complaint? A. Vitamin B deficiency B. Use of humidifier at home C. History of diabetes mellitus D. Prescription antihistamine use
D
An older man comes to a primary care setting, and his reason for seeking health care is to get a prescription for sildenafil (Viagra). Which of the following laboratory reports can help explain why this individual needs sildenafil? A. Serum potassium 4.5 mEq/L B. Prothrombin time 13 seconds C. Alanine transferase (ALT) 50 units/L D. Glycosylated hemoglobin (Hgb A1c) over 8%
D
Diabetes, dementia, Parkinson disease, stroke, and vitamin B deficiencies may cause neurological damage leading to: A. Postprandial hypotension B. Traumatic brain injury (TBI) C. Fallophobia D. Gait disturbances
D
During an assessment, an older adult client reports that he fell the night before. You should follow up with all the following EXCEPT: A. Ask about the frequency of falls. B. Ask about the circumstances behind the fall(s). C. Evaluate the client for gait and balance. D. Perform a complete head-to-toe assessment.
D
The best gerontological nursing care is that in which: A. Nursing is provided in a judgmental manner. B. The goal of comfort is to lessen pain as much as possible. C. Undertreatment of pain may be caused by a nurse's own definitions of pain. D. The key person in the assessment of pain is the nurse.
D
The nurse admits an older man who had abdominal surgery. Admission vital signs are heart rate (pulse) (P), 73 beats per minute (bpm); respiration rate (R), 20 breaths per minute; blood pressure (BP), 136/84 mm Hg. He is receiving intravenous (IV) fluids but has not requested pain medication since surgery. Seven hours later, his vital signs are P, 98 bpm; R, 26 breaths per minute; and BP, 164/90 mm Hg; and he denies pain. Which intervention should the nurse implement? A. Administer an opioid medication by IV route. B. Check the surgical dressing for bleeding. C. Report the vital signs to the health care provider. D. Ask about discomfort at the surgical site or any other location.
D
When teaching a client about taking his thyroid medication, the nurse needs to ensure that he follows all of the following instructions EXCEPT: (Select all that apply.) A. Take the medication at the same time every day. B. Always take the same brand of medication. C. Do not take mineral products (e.g., calcium) at the same time. D. Take an extra dose if you feel any fluttering in the chest.
D
When taking care of an older adult client, you realize that when assessing his pain level that all of the following considerations would apply EXCEPT: A. He might not be able to express pain. B. He might be depressed. C. Sedation will affect how he expresses his pain. D. You will have to take his culture into consideration. E. You realize that because he is older, he does not feel pain as much.
E
