Gerontologic Nursing, 6th Edition, Prep-U, Study Mode

An 86-year-old patient has been living at home alone for several years. The patient's needs now exceed the ability to remain at home, and the patient is faced with relocating to a nursing home. Which of the following characteristics of the patient's current situation is most likely to prompt this move? A new acute diagnosis of diabetes An exacerbation of weakness secondary to the flu A decline in functional skills A recent loss of a sister in a neighboring state

Correct A decline in functional skills The segment of the population that is older than 85 and whose members have decreased functional abilities is increasing and represents the group typically found in nursing facilities. A new acute diagnosis of diabetes would not change the patient's functional skills or ADL abilities by itself. An exacerbation of motor weakness secondary to the flu will resolve once the short-term flu virus subsides. A recent loss of a sister in a neighboring state, though saddening, would not change the patient's functional skills or cause a decline in the patient's ADL abilities. The loss of functional skills with resulting decline in ADL abilities is the common reason for which patients enter extended care facilities.

A gerontologic nurse practitioner is speaking with the nurses on the hospital unit regarding the geriatric syndromes being managed and identifies aspects of the geriatric triad. The nurse practitioner knows the need for continuing education when which of the following statements is made? "Falls are one of the three items we need to prevent and manage based on risk when geriatric patients present on our unit." "Dietary nutrition is the highest priority for the older adult patient who comes to our hospital unit with this geriatric triad syndrome." "Changes in cognitive status during the older adult's hospitalization need special attention." "Incontinence is the third arm of the geriatric triad, and we need to develop protocols to manage it on our unit."

Correct "Dietary nutrition is the highest priority for the older adult patient who comes to our hospital unit with this geriatric triad syndrome." Dietary nutrition is not part of the geriatric triad. The geriatric triad includes falls, a change in cognitive status, and incontinence. These three conditions need special attention during hospitalization. The advanced practice nurse gerontologist can help a unit develop and implement protocols to care for older adults with these geriatric syndromes.

A 78-year-old patient is being discharged from the hospital to an adult daughter's home after a knee replacement surgery. The nurse is reinforcing the discharge instructions with the patient and adult daughter. The nurse knows to reinforce teaching when the nurse hears the daughter make which of the following statements? "I will change the dressing daily after washing my hands and putting gloves." "I will observe the incision's color, temperature, and any drainage." "I will give two acetaminophen for mild pain every 8 hours as needed." "I will give acetaminophen every 6 hours for the next week."

Correct "I will give acetaminophen every 6 hours for the next week." The recovery after total knee replacement surgery involves treating pain. Pain rated low on a 0-to-10 scale is mild and would respond to acetaminophen when given. However, the patient does not need acetaminophen every 6 hours for a week. Pain that is rated at 4 and above needs to be treated with a stronger pain medicine. The daughter must change the dressing with a dry dressing daily. She will observe the wound and staple line for changes and will look for signs of infection and report them. Pain management requires giving pain medication for pain rated at 3 or higher and using a stepped approach to choosing the right pain medications ordered for the patient. Older adults can respond well to lower doses of narcotics for pain, so lower doses should be tried first and the dosage titrated upward to the smallest dose that is effective to relieve the patient's pain. Pain in older adults has been underreported and undertreated historically. Functional compromise can

Admission to a long-term care facility is typically the result of multiple health deficits coupled with functional health declines. Which of the following diagnoses is most likely to result in admission to a long-term care facility? Chronic kidney disease Myocardial infarction Chronic obstructive pulmonary disease Dementia

Correct Dementia, one of the three qualifying arms of the geriatric triad, is the correct answer. The geriatric triad include falls, a change in cognitive status, and incontinence. These three conditions in an older adult define the need for care, no matter what other health conditions are present (such as chronic kidney disease, myocardial infarction, and chronic obstructive pulmonary disease).

An older adult states, "I'm okay with dying, but I don't want to have any pain when I die." What response by the nurse is best? "We can work together with your primary care provider to establish a plan to manage your pain." "We can evaluate your pain medication regime to ensure it is working." "I would like to know more about your pain and what your concerns are." "The doctor will give orders for how to address your pain, and it will be taken care of."

Correct "I would like to know more about your pain and what your concerns are." The nurse should first assess the patient's pain thoroughly, then discuss with the patient the meaning of pain, the fears or concerns about pain, and then establish a realistic pain goal. The nurse should not guarantee that pain will never be present. Working as a team to develop a plan is the next step which will then be followed by evaluating the plan's effectiveness. Telling the patient that the pain "will be taken care of" is dismissive of his or her concerns and may not be entirely accurate.

A nurse has been working with a patient who has urge incontinence. What statement by the patient indicates that goals for this issue have been met? "I do my Kegal exercises 10 times each morning and 10 times each night." "I make sure the pathway is clear so I can get to the bathroom at night." "I have an appointment with a urologist for urodynamic testing next week." "It was really hard, but I have eliminated all caffeine from my diet."

Correct "It was really hard, but I have eliminated all caffeine from my diet." One goal for the patient with urge incontinence is to recognize triggers. Caffeine is a bladder irritant and can contribute to the problem. When the patient states that caffeine has been eliminated, this shows that goal has been met. Kegal, or pelvic floor, exercises should be done at least 45 times a day in 3-4 sessions. Difficulty accessing the toilet is the hallmark of functional incontinence. Urodynamic testing is indicated for overflow incontinence.

A student nurse initiates teaching for a patient who is an anticholinergic medication for Parkinson's disease. Which of the following would need correction by the nursing faculty? "Avoid getting up quickly from bed first thing in the morning." "Drink eight glasses of fluid daily" "Notify the doctor if you have trouble urinating." "Limit the amount of dietary fiber in your diet."

Correct "Limit the amount of dietary fiber in your diet." The patient's diet should be high in fiber and fluid to prevent constipation. The faculty member would correct the wrong information about fiber in the student's teaching. The other statements are corre

The nurse is consulting with the discharge planner at the local hospital regarding a recently admitted patient who has newly diagnosed pancreatic cancer. In planning for the patient's care on discharge, the nurse wonders if the patient may benefit from hospice. What requirements must the patient meet to be eligible for hospice evaluation (Select all that apply.) A doctor's referral for the hospice evaluation to occur A poor prognosis An aggressive approach to treatment A signed do not resuscitate (DNR) order A life expectancy of 6 months or less A Medicare payer source

Correct A doctor's referral for the hospice evaluation to occur A poor prognosis A life expectancy of 6 months or less The requirements for hospice/palliative care include a physician's referral and a poor prognosis, which includes a life expectancy of 6 months or less. An aggressive approach to treatment of a new cancer diagnosis would not apply to a hospice candidate. The hospice can obtain a signed DNR with a palliative care focus upon evaluation if the patient wants to move forward with hospice services; it is not a prerequisite to hospice care. Medicare is a payer source, but patients with Medicaid and most all private insurances offer a hospice benefit today; it is not an exclusive Medicare benefit.

An older adult patient has been admitted to the hospice after colon cancer had metastasized to the liver and lungs. The nurse is aware that patients can experience symptoms because of end-of-life changes. Which of the following should the nurse anticipate among dying patients? Hyperglycemia Diarrhea Dyspnea Angina

Correct Dyspnea The nurse should anticipate dyspnea. Other common physical problems and symptoms encountered by terminally ill patients include pain, constipation, delirium, altered urinary elimination patterns, altered skin integrity, loss of appetite, dry mouth, nausea and vomiting, restlessness and sleeplessness, difficulty swallowing, and nutritional problems. Family coping and stress, safety needs, and self-care deficits are other important problems. Angina, hyperglycemia, and diarrhea are not common problems or symptoms.

A nurse is collecting data from a patient with a Parkinson's disease. What expected findings would the nurse document? (Select all that apply.) A slowing in the initiation and execution of movement Sudden numbness of face, arm, or leg, especially on one side of the body Increased muscle tone/rigidity Tremors at rest Impaired postural reflexes, ataxic gait Trouble speaking or understanding

Correct A slowing in the initiation and execution of movement Increased muscle tone/rigidity Tremors at rest Impaired postural reflexes, ataxic gait Classic signs of Parkinson's disease (Parkinsonian syndrome) include: a slowing in the initiation and execution of movement, increased muscle tone/rigidity, tremors at rest, and impaired postural reflexes, ataxic gait. Sudden numbness of face, arm, or leg, especially on one side of the body and trouble speaking or understanding are signs of a CVA.

An older adult patient is coming to your unit from the emergency department (ED) with a diagnosis of acute abdominal pain. What nursing procedures are associated with an acute abdomen? (Select all that apply.) Administering intravenous (IV) fluids as ordered Inserting a nasogastric tube to decompress the stomach Monitoring and recording vital signs and reporting abnormal results Monitoring intake and output accurately every hour Performing a full abdominal assessment Completing a medical and surgical history

Correct Administering intravenous (IV) fluids as ordered Inserting a nasogastric tube to decompress the stomach Monitoring and recording vital signs and reporting abnormal results Monitoring intake and output accurately every hour Performing a full abdominal assessment Completing a medical and surgical history Nursing interventions include measures to increase comfort and relieve pain. The nurse should encourage older patients to see their health care provider for a complete evaluation of the abdominal pain. Severe abdominal pain is often known as an acute abdomen. Nursing procedures for an acute abdomen include (1) starting intravenous fluids as ordered, (2) placing a nasogastric tube for decompression of the stomach, (3) monitoring and recording vital signs and reporting abnormal findings, (4) monitoring intake and output accurately every hour, and (5) completing an assessment on the onset of pain, presence of vomiting or diarrhea, presence of fever, and an accurate medical and surgical hist

The nurse works on a palliative care/hospice unit in a skilled care facility. Which of the following nursing activities best represents the principles of palliative care? Administering intravenous chemotherapy at the bedside of a resident with leukemia Administering intravenous hydration at the bedside of a resident with esophageal cancer Administering morphine IV push at the bedside of a resident with colon cancer/liver metastasis Administering whole blood and plasma at the bedside of a resident with colon cancer

Correct Administering morphine IV push at the bedside of a resident with colon cancer/liver metastasis Administering a morphine intravenous push at the bedside of a resident with colon cancer/liver metastasis best represents palliative care. Palliative care/hospice forego aggressive treatment in favor of end-of-life care. Administering chemotherapy, blood, and blood products are part of the care of an oncology patient who is actively pursuing aggressive treatment—not part of palliative care. Oral nutrition and hydration should be maintained as long as a patient is able to swallow safely.

Which of the following statements about conventional treatment for cancer and the older adult is accurate? Older adults are not at risk for more surgical complications than younger patients. Radiation therapy in older adults is not as beneficial as it is for younger patients. Age-related changes in pharmacokinetics require lower doses of chemotherapy. The majority of older patients don't tolerate the rigors of conventional cancer treatment very well.

Correct Age-related changes in pharmacokinetics require lower doses of chemotherapy. The pharmacokinetic process of excretion is altered with the lower glomerular filtration rate associated with older adults. Only the age-related decline in kidney function has been demonstrated to have clinical consequences for drug dosing. Toxic drug levels have been demonstrated for agents that are primarily excreted by the kidney. Older adults are at risk for more surgical complications, and careful preoperative screening is recommended. Research shows that older adult patients respond to radiation in the same ways as younger patients do. Many older adults tolerate conventional therapy for cancer as well as younger patients do.

A healthy 82-year-old patient takes very good care of herself, eats well and exercises regularly. People tell her she looks around 60 years of age. The patient is stunned when the doctor gives a diagnosis of lymphoma. Which of the following factors most likely contributed to the patient's new cancer diagnosis? Age-related changes in the immune system caused the body to not recognize cancer cells. Just being 82 with a lifetime of body wear and tear contributed to the cancer development. Cancer may have been the result of fighting bacterial and viral infections in the patient's lifetime. Autoimmune processes have created the milieu for cancer development.

Correct Age-related changes in the immune system caused the body to not recognize cancer cells. Age-related changes in the immune system are thought to contribute to cancer. Age is considered the most important determinant for cancer risk. The aging cell has a tendency toward aberration or abnormalities as it replicates. Decreased immune surveillance, or immunosenescence, may contribute to the increased development of cancers and their progression. Age along with normal body wear and tear are not sole contributing factors to cancer development. Cancer cannot result from fighting a bacterial or viral infection. Autoimmune processes cannot create the milieu for cancer development.

A gerontologic nurse on a hospital unit is working with a patient admitted with delirium. Which is the priority nursing intervention? Assess for an underlying cause Administer antipsychotic medication Reduce environmental stimuli Use calm therapeutic communication

Correct Assess for an underlying cause Delirium has an acute onset and is often due to a pathological condition such as infection, electrolyte imbalances, or hypoalbuminemia. If the underlying disorder is treated, the delirium is reversed. The priority for the nurse is to assess for such an underlying cause. Antipsychotic medications are a last resort. Reducing stimuli may be beneficial. Calm therapeutic communication is important, but not as important as identifying the causative fac

A patient comes to the urology clinic and reports urinary incontinence (UI) that started two months ago. The patient states "It just happened out of the blue." What action by the nurse is best? Assess the patient for new medications or recent diagnoses. Determine what physical stressors cause leaking of urine. Arrange for the patient to have urodynamic testing. Place the patient on a fluid restriction and bladder diary.

Correct Assess the patient for new medications or recent diagnoses. Acute incontinence has a sudden onset, is generally associated with some medical or surgical condition, and generally resolves when the underlying cause is corrected. Drugs are a common cause and should always be suspected in cases of new-onset incontinence. The nurse would assess first for new medications, then for new diagnoses. The nurse does not yet know what type of UI the patient has, so asking about stressors that cause it is premature. Urodynamic testing is not needed at this point. Patients should not restrict their total daily fluid intake, although a bladder diary

A nurse is collecting data from a patient with an acute flare-up of gouty arthritis. Which of the following symptoms would be associated with acute gouty arthritis? (Select all that apply.) Complaints of severe pain in the affected joints Crepitus noted in affected joints A history of taking diuretics to treat hypertension Hot and reddened affected joints Crackles in lung fields on auscultation An elevated serum potassium level

Correct Complaints of severe pain in the affected joints Crepitus noted in affected joints A history of taking diuretics to treat hypertension Hot and reddened affected joints Manifestations of gout include severe pain and crepitus in affected joints, which may be hot and reddened. Medications such as diuretics, levodopa-carbidopa, and low-dose aspirin can cause gout. Lung crackles and hyperkalemia are not related to gout.

A nurse working on the geriatric medical floor of a community hospital is part of a committee that is developing a frailty assessment tool for the unit. Which of the following characteristics will the nurse choose to include in the assessment tool? (Select all that apply.) Decreased strength Exhaustion Slow walking speed Low physical activity Unintentional weight loss Inability to communicate verbally

Correct Decreased strength Exhaustion Slow walking speed Low physical activity Unintentional weight loss Frailty is defined as being positive for three of the five factors identified as characteristics of a frail older adult. These characteristics are associated with increased functional impairment, falls, prolonged hospitalizations, and death. Frailty is a measure of vulnerability and indicates those at risk for increased mortality and institutionalization. Inability to communicate does not contribute to the frailty assessment tool.

A home health nurse is working with a frail, older adult patient who lives with her daughter and has a diagnosis of stress and urge incontinence. The patient's daughter would like to know how to best work with the patient to lessen nighttime accidents. What does the nurse teach the patient and daughter? Wear incontinence briefs only at night. Give daily fluid intake before dinnertime. Provide plenty of fiber in the diet. Reduce weight to a BMI of 20.

Correct Give daily fluid intake before dinnertime. While the older adult should not reduce total daily fluid intake, ingesting fluids before dinnertime will help reduce the need to get up in the night. Incontinence briefs should only be used as a last resort. Fiber is important but will not reduce nighttime accidents. Weight loss is helpful if the patient is overweight, but the nurse does not know the patient's weight and a BMI of 20 is at the lower end of heal

Which is most likely to keep someone from functioning independently and living alone at home? Inability to prepare meals Inability to transfer from a chair to toilet or bed Inability to bathe Inability to use the telephone

Correct Inability to transfer from a chair to toilet or bed The nurse should screen for safety factors that limit older adults' self-care or their ability to remain in their home independently: (a) confusion, (b) safety awareness, (c) toileting, (d) continence, (e) depression or poor motivation, (f) falls, and (g) transfer ability. The most important physical task for an older adult is the ability to transfer in and out of a bed or chair. A person who cannot transfer from bed to chair or chair to toilet cannot be left alone for long periods. An inability to prepare meals, bathe, and use the phone are not just cause for keeping someone from functioning independently and living home alone.

An 88-year-old patient has fallen in his hospital room. The patient complains of left wrist and hip pain. After assuring the patient is stable, what action by the nurse is most important? Provide the patient with pain medication. Send the patient to get x-rays of the hip and wrist. Document the incident with a variance report. Institute an individualized fall prevention program.

Correct Institute an individualized fall prevention program. After assuring the patient's stability, the most important item for the nurse to address is to determine what caused the fall and to institute patient-specific interventions to prevent another fall. Giving pain medications, documentation, and facilitating x-rays are all appropriate actions, but the nurse must safeguard his or her patients from injury.

An older adult patient newly diagnosed with type 2 diabetic asks the nurse if exercise would be beneficial. Which responses by the nurse are best? (Select all that apply.) Instruction on wearing a medical alert bracelet Instruction on checking the blood sugar prior to exercising Suggestion that afternoon exercise is best, as this is when insulin resistance is greatest Instruction on signs and symptoms of hypoglycemia Suggestion to carry a source of carbohydrate for use if needed Suggestion to stay low on fluids to avoid overhydration during exercise

Correct Instruction on wearing a medical alert bracelet Instruction on checking the blood sugar prior to exercising Instruction on signs and symptoms of hypoglycemia Suggestion to carry a source of carbohydrate for use if needed Once the patient's capabilities and limitations are considered, an exercise program is personalized for the patient. Teaching topics should take account of the safety rules of exercising, which include wearing a medical alert bracelet, checking blood glucose before exercise, identifying signs and symptoms of hypoglycemia, carrying a source of carbohydrate, and avoiding dehydration. Exercise-related complications or injuries are more likely to occur in this population as a result of preexisting conditions such as cardiac, musculoskeletal, and ophthalmic diseases. Precautions and exercise modifications for older adults are therefore indicated to help prevent problems. Older adults may derive the greatest benefit from morning exercise (not afternoon), because that is the time of greatest insulin resistance

A rehabilitation nurse is working with an older adult, focusing on the patient's many accomplishments (improved functional skills) and growth achieved since entering the rehabilitation facility a month earlier. The nurse is implementing which key points of working with older adults? (Select all that apply.) It is important to recognize there is health within illness. A regular, comprehensive assessment is central in the care of older adults. Assessing what is meaningful to older adults helps the nurse plan supportive interventions The rehabilitation of older adults focuses on functional ability. Fitness, health, independence, and socialization are important health promotion incentives to older adults.

Correct It is important to recognize there is health within illness. Assessing what is meaningful to older adults helps the nurse plan supportive interventions Rehabilitation of older adults focuses on functional ability. Fitness, health, independence, and socialization are important health promotion incentives to older adults. By having a positive conversation with the resident and focusing on positive accomplishments (functional skills), the nurse is helping the patient to recognize there is health within illness and is focusing on improved functional ability. The positive focus of the nurse's conversation speaks to the meaningful aspect of the r patient's psychosocial self and fosters the patient's adjustment to the illness or condition. Improved functional abilities speak to health promotion incentives for the patient (such as improved activities of daily living [ADLs] and movement abilities, which are part of rehab), speak to fitness, health, and independence; and foster socialization. The nurse is not performing a comprehensive assessment of the patient.

A nurse is conducting a class for older adults on the benefits of screening for cancers. Which of the following are screening exams designed to promote early detection? (Select all that apply.) Mammogram Pap smear Fecal occult blood test (hemoccult) Complete blood count Rectal exam Colonoscopy

Correct Mammogram Pap smear Fecal occult blood test (hemoccult) Rectal exam Colonoscopy Screening exams for cancer include mammogram, pap smear, fecal occult blood test, rectal exam, and colonoscopy.

A nurse is admitting an older adult patient with a stage IV sacral decubitus ulcer and resultant acute osteomyelitis to a skilled care unit. The patient was discharged from the hospital after being treated for sepsis. What order left by the provider does the nurse question? Oral antibiotics Wound care nurse consultation High protein, high carbohydrate diet Up in chair for all meals

Correct Oral antibiotics It would be highly unusual for a hospitalized patient who has a pressure ulcer with acute septic osteomyelitis to be on an oral prescription for antibiotics immediately after discharge from the hospital. The patient with this presentation will require IV antibiotic treatment for an extended period of time and will arrive at a skilled care facility with IV antibiotic orders to treat the acute osteomyelitis once the septic status has been stabilized in an acute care facility. Treatment typically lasts for months, with an average of 6 weeks of IV treatment required to resolve the osteomyelitis. A wound care nurse consultation, a diet high in protein and carbohydrates for energy and healing, and mobilizing the patient to the extent possible are all appropriate orders.

The charge nurse in a long-term care facility is preparing patient care task assignments for the oncoming shift. One of the staff members is a nursing assistant. Which assignment would the nursing assistant be able to implement? Provide urinary catheter care, empty the drainage bag, and documenting urine output Assess the patient's pain postoperatively after hip surgery and report the finding to the nurse Palpate pedal pulses, and check capillary refill on the extremity after hip replacement surgery Teach the patient how to use an incentive spirometer.

Correct Provide urinary catheter care, empty the drainage bag, and documenting urine output Catheter care, emptying the drainage bag, and recording output are acceptable practices for a nursing assistant. They are tasks. Assessing the patient's level of pain post op, palpating pulses, and are all actions that must be performed by a licensed nurse.

The older adult patient reports chronic constipation. Which of the following age-related changes may contribute to this complaint? Reduced intake of food and fluid Reduced peristalsis Reduced sodium intake Reduced peripheral sensation

Correct Reduced peristalsis Reduced peristalsis may contribute to chronic constipation. Many of the systemic changes in the digestion and absorption of nutrients from the gastrointestinal (GI) tract result from changes in the older adult's cardiovascular and neurologic systems, rather than changes in the GI system. Reduced sodium intake, reduced peripheral sensation, and reduced intake of food and fluid do not yield chronic consti

A 73-year-old patient has a long history of poor eating habits, is 30 pounds overweight, and has been obese for 20 years. The patient's activity level is sedentary. The patient transfers from a seated position to a standing position and from chair to bed to toilet. The patient walks with the aid of a cane at home. The patient is newly diagnosed with type 2 diabetes. Nursing interventions should prioritize which of the following factors? Self-care measures to aid in the management of the disease Education that lifestyle has played in the onset of the disease Maintenance of function and activities of daily living Maintenance of the current sedentary lifestyle to keep the blood sugar in control

Correct Self-care measures to aid in the management of the disease The priority for this patient's interventions would be a self-care approach to aid in the management of the disease. Health promotion is a multidimensional concept that focuses on maintaining or improving the health of individuals, families, and communities. Health promotion in cases of chronic illness involves making behavioral changes for positive lifestyle activities, accepting one's condition and making the necessary adjustments, decreasing the risk of secondary disabilities, and preventing further disease—all while striving for optimal health.

A 65-year-old adult patient presents to the nurse practitioner for an annual physical exam. The patient takes amlodipine 10 mg daily for hypertension and omega-3 fatty acid supplements. His waist circumference is 43 inches, his fasting blood glucose was 112 mg/dL, and his triglycerides were 142 mg/dL. What treatment approach is the best plan for this patient? Start a therapeutic lifestyle change program based on the presentation. Begin an oral hypoglycemic agent, as the patient is clearly insulin resistant. Begin insulin as the clinical presentation supports. Continue management in progress, as no additional changes are indicated.

Correct Start a therapeutic lifestyle change program based on the presentation. Starting a therapeutic lifestyle change program is the best treatment approach for this older adult who has metabolic syndrome. Clinical criteria of metabolic syndrome include increased waist circumference (population specific) plus any two of the following: (1) blood pressure >129/84 mmHg or taking hypertension medication, (2) plasma triglyceride levels over 149 mg/dL or taking triglyceride medication, (3) high-density lipid levels less than 40 mg/dL in men or less than 50 mg/dL in women or taking high-density lipoprotein cholesterol (HDL-C) medication, (4) fasting glucose >99 mg/dL (including patients with diabetes). The American Diabetic Association's 2004 Diagnostic Criteria for Prediabetes and type 2 diabetes include a fasting plasma glucose of 100-125 mg/dL for prediabetes. Lifestyle changes could slow or prevent the onset of Type 2 diabetes mellitus.

A nurse admits an older adult patient to the skilled care unit with symptoms of fatigue, cold intolerance, weight gain, and confusion. Before the primary care provider completes a diagnosis of depression, which of the following lab tests should be completed? Random blood glucose Estrogen and testosterone Serum calcium T4 and thyroid-stimulating hormone (TSH)

Correct T4 and thyroid-stimulating hormone (TSH) Older patients with hypothyroidism are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion. The most specific test finding is a subnormal, serum-free T4 level because it corrects for abnormalities in the T4-binding proteins. A random blood glucose test, estrogen and testosterone test, and serum calcium test would be taken on a patient presenting with fatigue, cold, intolerance, weight gain or confusion

Which of the following signs and symptoms should a nurse recognize as a warning sign of cancer? Cold fingertips and blue lips Joint heat, pain, and swelling Shortness of breath on exertion Unusual bleeding or discharge

Correct Unusual bleeding or discharge Unusual bleeding or discharge qualifies as a warning sign of cancer as published by the American Cancer Association. Nurses should educate older adults to recognize the warning signs of cancer. Other warning signs of cancer as published by the American Cancer Association include: change in bowel or bladder habits, a sore that does not heal, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and a nagging cough or hoarseness. Cold fingertips and blue lips, joint heat, pain and swelling and shortness of breath on exertion are all signs of other issues, not cancer.

A nurse assesses an older adult patient with depression. Which of the following symptoms requires immediate follow-up? A blood sugar of 73 with a weight gain of 2 pounds. The patient saying, "My life isn't worth living anymore. I'm worthless." Withdrawn and crying behavior. A saddened expression with flat affect.

Correct The patient saying, "My life isn't worth living anymore. I'm worthless." Older adults in the United States, especially depressed older adults, are more likely to commit suicide than any other age group, although it is difficult to estimate the true incidence of suicide. Nothing (including withdrawn and crying behavior, a saddened expression, and a low blood sugar of 73) is a higher priority than responding to the threat of suicide expressed by a depressed patie

An older adult patient complains of weakness, malaise, and weight loss. The patient describes crampy abdominal discomfort during bowel movements in the past 2 days. On rectal exam, the nurse practitioner palpates a mass. The nurse tests a small amount of the patient's stool for blood, and it is positive. She orders a serum carcinoembryonic antigen (CEA). The patient asks for information about the test. What information does the nurse practitioner provide? (Select all that apply.) To determine a baseline to gauge the effectiveness of therapy To possibly provide prognostic value To monitor for recurrence during the course of care To determine the preferred chemotherapeutic agent for treatment To determine radiation therapy effectiveness in the treatment plan

Correct To possibly provide prognostic value To monitor for recurrence during the course of care Colorectal cancers produce a wide variety of tumor antigens; the carcinoembryonic antigen (CEA) is the most well known. The CEA level is used to gauge the effectiveness of therapy and may be useful at the time of diagnosis for prognostic value. In addition, it is used to monitor for recurrence. It does not indicate the type of chemotherapy to use or gauge the effectiveness of radiation therapy, which may or may not be used.

Which of the following is classically a disease of relative insulin insufficiency? Insulin resistance Metabolic syndrome Type 2 diabetes Type 1 diabetes

Correct Type 2 diabetes Type 2 diabetes is classically a disease of relative insulin insufficiency. As with metabolic syndrome, the most important variables associated with type 2 diabetes mellitus are obesity and insulin resistance. Type 1 diabetes is an autoimmune destruction of the pancreas and lack of insulin production. Metabolic syndrome typically occurs prior to diabetes type

A nurse is conducting a community educational event for women with urinary incontinence (UI). Which lifestyle changes does the nurse suggest would be helpful for this condition? (Select all that apply.) Weight loss if appropriate Eliminate spices and spicy food Limit caffeine to 20 ounces a day Consume alcohol in moderation Elevate swollen feet in the afternoon

Correct Weight loss if appropriate Elevate swollen feet in the afternoon Some lifestyle changes the nurse would teach include weight loss if appropriate and elevating the feet in the afternoon if they are swollen. Spices and spicy food are not related. Caffeine should be limited or eliminated, so 20 ounces is not appropriate. Alcohol is a bladder irritant and should be avoid

A 72-year-old patient who takes propranolol for hypertension has been kept awake the past couple of nights with severe heartburn. The patient buys cimetidine at the pharmacy. The patient takes both medications and after two days, a family member brings him to the Emergency department, reporting the patient feels dizzy when standing has not urinated all day, and is pale. The family member does not know how to count a pulse but reports it "feels slow." What should the nurse suspect first? A side effect of cimetidine A side effect of propranolol A complication of dehydration A drug-drug interaction

Correct A drug-drug interaction The combination of cimetidine and propranolol will create a drug-drug interaction in older adults, the potential effect of what the family member has reported to you. The interaction is creating the decrease in urination, and bradycardia. Orthostatic changes with pale coloration, bradycardia, and a diminished urinary pattern are not side effects of either drug alone. The urinary decline could be the result of dehydration, but there is no indication that the patient is dehydrated.

A nurse is working with a new patient with arterial insufficiency and an arterial ulcer. The nurse is orienting a new nurse. For which of the following actions would the nurse have to intervene immediately? Applying nonsterile gloves after hand washing Completing a nutrition assessment Applying compression to the lower extremity with the wound Irrigates the open wound with saline using a catheter-tipped syringe

Correct Applying compression to the lower extremity with the wound Compression therapy is not a management option for arterial insufficiency; pain and cyanosis will occur from further impaired circulation. Even mild compression might be too much and could cause collapse of the existing compromised arterial circulation. Use of compression is contraindicated in cases of arterial insufficiency. The other actions are appropriate for patients with arterial wounds.

An older adult patient who is cognitively impaired is groaning and grimacing while holding the patient's right hip and abdomen. How should the nurse assess this older adult's level of pain? Ask the patient to rate the pain from 1 to 10. Ask the patient to point to a picture of how bad the pain feels. Ask the patient to describe what the pain feels like. Ask the patient to describe what works to help make the pain go away.

Correct Ask the patient to point to a picture of how bad the pain feels. When using any pain assessment tool, the nurse must evaluate each patient's ability to give accurate responses with that tool. The use of a second tool may confirm the value obtained with the first tool. The Hartford Institute for Geriatric Nursing (2012) has found that commonly used pain assessment tools, such as the Faces Scale, are valid and reliable for use with older adults, even those with mild to moderate cognitive impairments. The American Geriatric Society (2012) found that the most accurate and reliable indicator of pain intensity and experience is the patient's self-report. Asking an older, cognitively impaired patient to rate pain on a scale of 1-10 will not be as accurate as asking the patient to point to a picture of how bad the pain feels on the Wong-Baker Faces Scale. Asking a patient who is cognitively impaired what the pain feels like or what works to help make the pain go away may require answers that are beyond the patient's capabilities.

An older adult comes to the clinic and reports dizziness and anorexia. The client also reports increased nocturia. What action by the nurse is best? Have the client provide a clean catch urine sample. Listen to the client's heart and lungs. Perform a detailed 3-day nutrition recall. Evaluate the client's ability to ambulate.

Correct Have the client provide a clean catch urine sample. All actions may be appropriate when assessing this client, but the manifestations reported correspond to the atypical presentation of a urinary tract infection in an older adult. The nurse should first obtain a clean catch urinalysis.

The charge nurse in a long-term care facility is preparing a patient care task assignment for the oncoming shift. One of the staff members is a nursing assistant. Which of the following pain-relieving tasks can the nursing assistant perform? Assess the patient's pain level and intensity by checking the patient's vital signs. Offer the patient warm compresses for the painful arthritic knees. Evaluate the level of pain 30 minutes after applying a warm compress to the knees. Apply lidocaine patches to both knees to numb the pain.

Correct Offer the patient warm compresses for the painful arthritic knees. Offering the patient warm compresses and applying them to both knees is within the realm of a nursing assistant's scope of practice. Assessment, evaluation, and application of medication are all outside of the nursing assistant's scope of practice and cannot be delegated to these staff members.

A nurse is conducting a health interview with an older patient. What behavior by the patient would indicate a reduced amount of energy and tolerance for the interview process? (Select all that apply.) Restlessness Slumping in the chair Frequent reminiscing Forgetting the topic Patting the nurse's hand

Correct Restlessness Slumping in the chair Forgetting the topic Restlessness, slumping posture, and reduced attention span can all indicate that the patient is becoming fatigued and the nurse should finish the interview at another time. Frequent reminiscing is common and many older people enjoy touch.

The home care nurse notes that an 82-year-old, single patient lives alone. The patient is having difficulty paying the mortgage, eating regularly, and paying for prescription medications. The patient retired at age 65, and the cost of living is just too high to keep up with. The nurse and patient determine that nutrition is the greatest need. What program would the nurse encourage the patient to apply for? Supplemental Security Income (SSI) Medicaid SNAP A local church food pantry

Correct SNAP All of the programs can provide assistance to help the patient maintain independence in the home, even with a very low monthly income from Social Security. For nutritional needs though, the nurse would recommend SNAP, the Supplemental Nutrition Program. SSI could provide money for rent and medications. Medicaid can help with medical expenses. A local food pantry is helpful, but may not be accessible or available permanently.

A nurse at a local health fair is assisting with a hearing health educational class for older adults. Which of the following is not a behavioral clue indicating difficulty hearing? Trouble following the conversation when two or more persons are talking at the same time Leaning forward to hear better or straining to understand conversations Turning the television down as it is too loud to think Complaining about people mumbling

Correct Turning the television down as it is too loud to think Turning the television down as it is too loud does not signify a hearing difficulty. When someone's hearing is failing, they will turn the television volume up, not down. Complaining about people mumbling, having trouble following the conversation of two or more people, and leaning forward to hear better indicate a potential problem with hearing loss.

Which older patient would the nurse identify as being susceptible to decreasing libido or sexual function as a result of the medication regime? A 72-year-old patient who takes a proton pump inhibitor for reflux. An 83-year-old patient who takes vitamin D and calcium supplements for osteoporosis. An 81-year-old patient who takes Colace and Metamucil for constipation. A 69-year-old patient who takes a diuretic to manage hypertension.

Correct A 69-year-old patient who takes a diuretic to manage hypertension. Many drugs can have an effect on sexual performance and should be considered when working with older adult patients who have sexual needs and performance problems. Diuretics can create decreased libido, erectile dysfunction, and vaginal dryness. The other drugs are not associated with sexual side effects.

Overview of Gerontologic Nursing Which of the following phenomena most likely accounts for the fact that more women than men live alone at age 65 and older? Women are living longer than men because of an increased mortality rate in men from chronic disease.Older women are much more likely to be married than older men. Men have been living longer than women since the 1930s. Women have better access to medical and social services than men.

Correct Women are living longer than men because of an increased mortality rate in men from chronic disease. Women tend to live longer than men and live alone in the United States. Since 1930, women have been living longer than men as a result of reduced maternal mortality, a decreased death rate from infectious disease, and an increased death rate in men from chronic disease. Older men are much more likely to be married than older women by 70% of men versus 45% of women. Older women tend to be poor and live alone, which impacts their health status negatively.

During a home health visit, an older adult patient asks a nurse if it would be wise to include a multivitamin and mineral supplement. What does the nurse tell the patient? "Supplements do not replace the vitamins and minerals we don't take in by eating." "A daily supplement will provide your body with what it needs." "You may overdose on vitamins and minerals, so it's best to avoid a daily multivitamin." "Let's talk about what you have eaten in the last three days."

Correct "A daily supplement will provide your body with what it needs." The first step in the nursing process is assessment. Before recommending supplements, the nurse should first assess the patient's typical dietary intake and determine the reason for the patient's request. Based on that information the nurse could suggest a supplement best suited to what the patient needs

The nurse discusses infection control measures with a nursing assistant regarding clostridium difficile. Which statement by the nursing assistant lets the nurse know that teaching has been effective? "I will use a 10% bleach solution to clean the furniture in the room so visitors don't contract it." "I will wash my hands per protocol after caring for patients with C. difficile." "If I always use gloves for patient care I don't have to wash my hands." "Alcohol wipes are effective for destroying C. difficile on surfaces in the room."

Correct "Alcohol wipes are effective for destroying C. difficile on surfaces in the room." C. difficile is a spore that is generally transmitted via the hands of health care personnel. Hand hygiene per current protocol after caring for any patient is the best way to reduce its spread. Bleach and alcohol will not destroy it. Wearing gloves is important when handling body fluids or stool in the patient with C difficile infection, but hands still need to be washed after taking gloves off.

The nurse is admitting an older adult for home health care. The nurse requests the patient to show all the medications he is taking. To conduct a thorough medication assessment, what other questions should the nurse ask the patient? (Select all that apply.) "Are you a smoker?" "How much alcohol do you drink?" "Do you take any vitamins or supplements?" "Have you been treated for addictions?" "How many care providers do you see?"

Correct "Are you a smoker?" "How much alcohol do you drink?" "Do you take any vitamins or supplements?" "How many care providers do you see?" A complete medication assessment upon admission includes asking specific questions about smoking; drinking; over-the-counter medications such as herbs, vitamins, or supplements; and the number of care providers the patient sees. Substance abuse is underrecognized in the older population. Polypharmacy from using multiple providers and/or multiple pharmacies can lead to many medication problems. Being treated for addiction is not as important as assessing how much the patient currently smokes or drinks.

A nurse is teaching the patient preoperatively care for after cataract surgery. What statement by the patient would indicate the need for further teaching by the nurse? "I should avoid bending lower than my waist level." "I can sleep lying on the same side as the eye that the doctor operated." "I will wash my hands every time before I administer my eye drops." "I need to take stool softeners to prevent straining."

Correct "I can sleep lying on the same side as the eye that the doctor operated." Following cataract surgery, the patient needs to lie on the side opposite the surgical site or eye or on the back. Hand washing, taking a stool softener, and avoiding bending lower than waist level indicate an understanding of preoperative teaching for postoperative care following cataract surgery.

An older adult patient has lost 30 pounds in the past month. The doctor has ordered a home health evaluation, and you are the nurse who visits. Which of the following statements regarding the patient's history indicates a functional deficit that may be contributing to the patient's weight loss? (Select all that apply.) "My daughter calls every week, and I give her a list of the groceries I need. She picks them up when she does her own grocery shopping and brings them by." "I have a problem lifting the skillet in the kitchen because its cast iron and very heavy. It causes pain in my arthritic hands and wrists every time I try to use it." "The arthritis pain in my knees and hips keeps me from walking some days. When I hurt, even after I take my pain medicine, I don't get up and make my dinner. It's just too hard some days. When you hurt, you aren't hungry." "I developed a chest infection and my doctor gave me Biaxin to take for a couple of weeks. When I took this medicine, everything tasted like metal. I stopped eating for a week or two. It was hard to even drink fluids, and I ended up in the hospital." "My daughter-in-law comes over three times a week and helps me clean up and does my laundry for me. I don't know what I'd do without her help."

Correct "I have a problem lifting the skillet in the kitchen because its cast iron and very heavy. It causes pain in my arthritic hands and wrists every time I try to use it." "The arthritis pain in my knees and hips keeps me from walking some days. When I hurt, even after I take my pain medicine, I don't get up and make my dinner. It's just too hard some days. When you hurt, you aren't hungry." "I developed a chest infection and my doctor gave me Biaxin to take for a couple of weeks. When I took this medicine, everything tasted like metal. I stopped eating for a week or two. It was hard to even drink fluids, and I ended up in the hospital." Functional impairment often leads to malnutrition. Older adults with functional impairments may have difficulty performing, or be unable to perform, activities of daily living (ADLs) related to eating. They may be unable to shop for groceries, prepare food, or eat. Conditions that result in shortness of breath, pain, or limited mobility affect an individual's ability or desire to eat. In addition, some medications alter sensory receptors, resulting in greater differences in taste or smell. Flavor, taste, and odor perception generally decline with age and can become exaggerated with some medications. For many older adults, foods that were once cherished and enjoyed as part of their culture now have a different smell and are simply avoided.

A gerontologic nurse is employed by an assisted living facility. The nurse is speaking with a patient who states, "It's getting harder and harder for me to get up and move around lately, and I don't know what I'd do without Sunny Farms to help me bathe, get my meals, and clean my room. My dependency is increasing. Today my aide had to help me stand up from bed and get up to walk to the bathroom. I guess my biggest concern is not to be a burden to anyone. My further decline will put more pressure on my oldest daughter. I hate to do that." How should the nurse respond to the resident's concerns? "It's hard to accept those changes when we see ourselves decline further as we age." "I hear you saying your oldest daughter is the person you'll speak with about the change. Do you make your care decisions together?" "You're no burden to anyone. You raised your daughter, and now it's your turn to receive and hers to give." "This is a normal part of aging and you don't need to fear it. I'm sure your daughter knows you'll decline and won't be able to stay the same forever!"

Correct "I hear you saying your oldest daughter is the person you'll speak with about the change. Do you make your care decisions together?" The gerontologic nurse knows the importance of working with patients and families to plan for the patient's continuing care needs and to look at decline with the appropriate care setting in mind. The nurse should take advantage of this opening by asking if the patient and daughter share decision making. Saying, "it's hard to accept those changes when we see ourselves decline further as we age," it suggests the decline is hard for the patient, which the patient is not expressing. Stating, "you're no burden to anyone. You raised your daughter, and now it's your turn to receive and hers to give," denies the patient's feelings by disagreeing with the patient and telling the patient they are not a burden. This is a communication block. Responding with "This is a normal part of aging and you don't need to fear it. I'm sure your daughter knows you'll decline and won't be able to stay the same forever!" is a general statement that assumes the patient fears the decline, which is not what the patient is communicating.

An 81-year-old patient who has a history of a deep vein thrombosis in the right calf is on warfarin 5 mg by mouth at bedtime. The patient's INR is 1.4. The patient's goal range per doctor's orders is 2-2.5. You ask the patient about eating habits to evaluate the INR in relation to dietary intake. Which of the following statements demonstrate what food is causing the subtherapeutic INR? "I eat oatmeal and drink coffee and juice every morning." "I had a sandwich with turkey, fresh spinach leaves, and sliced tomato on dark rye and coleslaw yesterday." "I usually eat a piece of fruit for a snack at about 2 o'clock." "I like to eat fresh spinach and broccoli from my garden."

Correct "I like to eat fresh spinach and broccoli from my garden." Vitamin K interferes with the anticoagulation action of warfarin. Food sources include deep green leafy vegetables like spinach leaves. The one-time sandwich with coleslaw most likely is not the problem; however, frequently eating spinach out of the garden most likely is.

The nurse is educating an aide about blood glucose testing and diabetic control in older adult patients. The nurse knows further teaching is required when the aide makes which of the following statements? "I will use the Glucometer to check the patient's blood sugar before breakfast and at 11 AM." "I will record the blood sugar reading on the clipboard at the unit." "I will communicate a blood sugar below 70 or over 150 mg/dL to you directly when I check them." "I will dip stick the urine if I can't get the patient's blood sugar with the Glucometer."

Correct "I will dip stick the urine if I can't get the patient's blood sugar with the Glucometer." Urine testing for glucose in older adults is considered unreliable in view of age-related changes in renal function. Checking the patient's blood sugar with a glucometer, recording the blood sugar reading, and communicating a low blood sugar with the nurse are appropriate actions made by an aide.

A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which of the following statements by a resident indicates that the nurse's teaching was not successful? "I will take pain medications before sexual activity if needed." "I will plan for sexual activity at the end of the day when all activities have been completed." "I will use pillows under painful joints during sexual activity if needed." "I will take a warm shower before sexual activity to relax and loosen the joints."

Correct "I will plan for sexual activity at the end of the day when all activities have been completed." Sexual activity should be planned for when the older adult is well rested—not at the end of the day when all activities have been completed. Strategies to enhance sexual function in older adults include taking pain medications before sexual activity, using pillows under painful joints during sexual activity, and taking a warm shower before sexual activity to relax and loosen joints.

The nurse is assessing a patient who was born in 1916 and has congestive heart failure. The nurse assesses the patient's dietary intake after educating the patient about a 2-gram sodium diet. The patient has 3+ edema in the lower extremities. The patient is eating bacon for breakfast daily, has eaten canned soup for lunch 5 out of the past 7 days, and has eaten ham for dinner one night, hot dogs a second night, and the patient's grandson brought cheeseburgers and fries for dinner for 3 of the past 7 nights. What response by the nurse would be most helpful considering the patient's cohort? "You need to order dinner out every night from a local restaurant and have it delivered to reduce the salt intake." "It is your job to help us by following the restricted salt intake your doctor has ordered to treat your heart disease." "People of your generation like to have Meals on Wheels delivered to them, and because that program offers the diet you need, you can learn to eat on that specialized menu." "You're doing badly with your diet orders, and you are demonstrating the consequences of being nonadherent."

Correct "It is your job to help us by following the restricted salt intake your doctor has ordered to treat your heart disease." People who share the experience of a particular event or time in history are grouped together in cohorts. They share similar experiences at similar stages of physical, psychologic, and social development that influence the way they perceive the world. Therefore cohorts develop attitudes and values that are similar. People who reached maturity during the Great Depression of the 1930s learned the value of having a job and working hard to keep it. Generally, people in this cohort have been loyal workers. They feel better if they are doing their jobs. The nurse might increase adherence with a treatment regime by referring to the need for adherence as an older adult's "job." Having a meal delivered every night is not only expensive, but it does not ensure appropriate salt intake. Meals on wheels may not be something that is preferred to this patient and who may not be eligible. The patient is not doing well with the diet orders, as evidenced by the high salt intake and edema, but the nurse should not speak in such a condescending manner to the patient.

The nurse is reinforcing teaching with family of an older adult with obstructive sleep apnea who is being discharged today. Which of the following statements by the patient's spouse would indicate a correct understanding of sleep hygiene? "My spouse should only go to bed when tired." "A few beers are OK since we have the CPAP." "Falling asleep in the recliner is ok if it's comfortable." "Sleeping on the side or stomach will help."

Correct "Sleeping on the side or stomach will help." The goal of sleep hygiene is to achieve normal sleep. Sleep hygiene measures reinforce habits, routines, and attitudes that promote sleep, and they discourage changes in habits and routines that do not contribute to a good night's sleep. Sleep hygiene measures emphasize stable schedules and bedtime routines, a sleep-friendly environment, avoidance of any substances that would interfere with sleep such as alcohol, regular exercise, and stress reduction. One of the basic measures used to reduce episodes of sleep apnea is sleeping on one's side or stomach.

A nurse in an assisted living facility hears an older adult patient discussing problems with vaginal dryness and painful intercourse. The patient is distressed as the patient's upcoming 50th wedding anniversary and the patient wants to be able to have sex. What intervention could be suggested to improve the sexual function of an older adult with this problem? "Use of an artificial water-based lubricant inserted vaginally before intercourse can help." "Contact your doctor and get a prescription for oral estrogen, then start taking it today." "Begin to eat a lot of fruit, as it helps the vagina produce the lubrication it did prior to menopause." "Decrease the amount of time spent in foreplay so the vagina will become sufficiently lubricated."

Correct "Use of an artificial water-based lubricant inserted vaginally before intercourse can help." A water-based lubricant can be purchased over-the-counter and can provide the lubrication needed to increase comfort during intercourse for women with vaginal dryness. Oral estrogen will not help this problem within a week and is typically not taken orally for this reason. There is no evidence fruit will help with anything sexually. The amount of foreplay should be extended, if anything, to help with vaginal lubrication. Shortening the time of foreplay is counterproductive.

Which of the following statements of a nurse who works in an inner-city clinic best conveys cultural sensitivity? "We need to learn more about our patients who belong to cultural and ethnic groups we are not familiar with." "We want to ensure that both minorities and Americans have their health needs met." "It's important to remember that minority groups do not usually express their pain freely." "We need to teach Asian patients that their best approach to our care is to make direct eye contact."

Correct "We need to learn more about our patients who belong to cultural and ethnic groups we are not familiar with." Learning more about the cultural and ethnic groups of patients whom we service is a smart approach to deliver nursing care. Our world is changing and we are looking at increasing diversity in it, with nurses servicing patients from all cultures and ethnic groups in the United States. Learning more about these diverse groups represents a culturally competent care approach and builds bridges. The other responses assume prejudices, generalize, disregard cultural backgrounds, create barriers in their construction, and are not appropriate for cultural sensitivity.

Two older adults have connected. They enjoy each other's company and have gotten closer in the past 3 months of knowing each other. One of the patients asks you what can be done to practice "safe sex." The patient informs you of being HIV positive and wants to have sexual intercourse. The patient does not want to give the disease to the new partner. How does a care provider best respond? "You need to use a condom to prevent the spread of the HIV virus" "You can have unprotected sex because you are older and the HIV virus is quite weakened." "You can have your partner use lubricant to avoid injury the vaginal tissue." "You should abstain because of the immune system changes with aging, it's too easy to acquire HIV."

Correct "You need to use a condom to prevent the spread of the HIV virus" Older adults can have protected sex and prevent the spread of HIV. That means wearing a condom during intercourse. Typically, pregnancy is not a concern so the partners don't think to use condoms. However, the spread of HIV in the older adult group is largely the result of a lack of condom use. Old age does not weaken the HIV virus. Lubricant will decrease the chance of damaging fragile vaginal tissue which makes spread of any disease less likely, but that is not a safe practice to solely rely on. Telling the patient to abstain as there is no safe way to have sex with HIV is incorrect.

The nurse instructs an older adult who has developed pneumococcal pneumonia regarding the risk for future occurrences of the disease. Which of the following statements should the nurse use to educate the patient during this interaction? "Chronic cough can develop after pneumococcal pneumonia is treated." "Pneumococcal pneumonia is relatively difficult to contract." "You should receive the vaccination to prevent future occurrences." "Your family maintain may be chronic carriers of this illness and can spread it."

Correct "You should receive the vaccination to prevent future occurrences." The pneumococcal vaccine is recommended for everyone over the age of 65. Chronic cough does not typically develop after the illness is treated. Pneumococcal pneumonia is fairly easy to contract. People are not chronic carriers of this illness.

An older adult patient's smoking history includes smoking a pack of cigarettes per day from age 16-22. Then, the patient's smoking increased at age 23 to two packs per day for 20 years. At age 43, the patient's marriage ended and stress increased, so smoking increased to three packs per day for the next 3 years. The patient quit smoking at age 44. What is the number of pack-years smoked, which must be added to the medical history information for this patient? 47 pack-years 56 pack-years 59 pack-years 63 pack-years

Correct 56 pack-years The correct answer is 56 pack-years. Multiply each number of packs smoked for the total number of years smoked and add them until the smoking cessation resulted. Therefore 1 pack × 7 years is 7 pack-years of smoking history from 16 to 22 years old. Then, two packs/day × 20 years is 40 pack-years. Lastly, three packs/day × 3 years is 9 pack-years. When you add 7, 40, and 9 you get the number of pack-years smoked based on this patient's smoking history, which is 56 pack-years. 59 pack-years, 63 pack-years, and 47 pack-years are incorrect answ

A nurse should not be confident in ruling out an infection in which of the following patients? A 78-year-old patient post knee replacement who has a temperature of 97.2°F and a good appetite. A 70-year-old patient who is complaining of chest pressure and is oriented times three. A 90-year-old patient, normally mobile, who has standby assistance in order to void. A 73-year-old patient who is newly incontinent of urine, confused, and has a temperature of 98.9°F.

Correct A 73-year-old patient who is newly incontinent of urine, confused, and has a temperature of 98.9°F. Older adults with decreased immune function may not exhibit classic symptoms of infection. Redness, swelling, or inflammation may be reduced with infections. Another classic example of a reduced response to infection is the absence of fever. In older adults with decreased immune function, there may be limited temperature increase or no increase at all. For this reason, a low-grade fever must be taken seriously. Close observation is needed to detect subtle symptoms. Changes in the behavior of patients (such as increased malaise or fatigue, especially combined with other symptoms) may indicate the onset of infection. Fever and inflammation may be reduced, whereas the white blood cell (WBC) count can still reflect an increased value.

An older adult patient presents with a respiratory rate of 25 and a pulse oximetry reading of 89%. The patient's respiratory pattern includes the use of abdominal muscles. The patient has no history of respiratory problems. An increased tidal volume A decreased alveolar surface area A decreased residual volume An increased PaO2 finding

Correct A decreased alveolar surface area A decreased alveolar surface area accounts for the changes in this patient. A PaO2 of 80-100 mmHg is normal in adults. The number can be expected to decline by 1 mmHg per year beginning at age 60. The phrase "70 at 70" originated with this fact. A PaO2 of 70 mmHg for a 70-year-old is a normal finding. An increased residual volume and decreased tidal volume also accounts for changes in this patient. An increased PaO2 finding does no

The nurse is on duty when 74-year-old patient's 70-year-old family member arrives on the unit. The doctor told the patient today that the lung biopsy was positive and the news was not good. The patient has a stage 4 adenocarcinoma, and unfortunately has a poor prognosis. The doctor recommended hospice for the patient. The patient's caregiver wants to know how it went and when the patient will be coming home. The caregiver comments that the patient looks so good after the biopsy! Which of the following guidelines should the nurse follow when suggesting a family meeting so that family members can plan for their loved one's care? (Select all that apply.) A family meeting should be arranged as early as possible after the need for caregiving arises. Everyone who is concerned or may be affected by decisions should be involved, including the patient. Distant family members should be contacted to get their input, and keeping them informed may keep them involved in the decision making. Do not invite any difficult, argumentative family member or one who seldom visits, because such members will just undermine plans and disrupt the group's plan development. Do not invite any person considered "family" who is not a blood relation to the family itself. They are not real family and should be excluded.

Correct A family meeting should be arranged as early as possible after the need for caregiving arises. Everyone who is concerned or may be affected by decisions should be involved, including the patient. Distant family members should be contacted to get their input, and keeping them informed may keep them involved in the decision making. When planning for care, a family meeting should be called as soon as the need for caregiving arises. Everyone concerned and affected by decisions should be involved, including the patient who the decisions are being made for. Contacting distant family members helps them feel involved and keeps them informed on the decision making. It is important to invite those who are argumentative or those who seldom visit; the rationale is their involvement on the plan will help them support it and not undermine it as it unfolds. The term "family" can mean different things to different people. Just because someone is not related by blood, but that the patient considers part of the family, doesn't mean they should not be involved in the decision making process as well.

An older adult patient asks the nurse practitioner for tips on how to maintain a healthy heart. Which treatment plan will the nurse practitioner promote and educate the patient about? (Select all that apply.) A low-sodium, high-potassium, low-fat diet Smoking cessation and alcohol restriction Meditation and relaxation techniques Walking for 30 minutes daily three times a week or more Losing weight if the patient is overweight Disease process, signs and symptoms of hypertension

Correct A low-sodium, high-potassium, low-fat diet Smoking cessation and alcohol restriction Meditation and relaxation techniques Walking for 30 minutes daily three times a week or more Losing weight if the patient is overweight Patient education includes providing information regarding the disease process; signs and symptoms of hypertension; treatment regimen; medications and their actions and side effects, including sexual impotence; and the need for frequent monitoring of blood pressure and risk factors. The nurse should explain the importance of a low-sodium, high-potassium, low-fat, reduced-calorie diet. Weight loss should be encouraged if indicated. A dietitian may assist with meal planning, preparation, and label reading. Foods are healthier if prepared by baking, broiling, or steaming. The nurse should also discuss the importance of alcohol restriction and smoking cessation. Therapeutic medications and aids are available. Alternatives for smoking cessation include hypnotism or behavior modification. Positive reinforcement should be provided whenever possible. The nurse should also explain the relationship between stress, anxiety, anger, and hypertension; identify stressful situations at the patient's home and work; and teach meditation and relaxation techniques. Exercise is beneficial for weight and stress reduction; however, the patient should only walk 10-15 minutes a day, gradually increasing to 1-hour walks three or four times a week. Other activities include mall walking and water aerobics.

The nurse is providing care for several older adults on an acute care unit. The nurse recognizes that a patient with which of the following problems would be the most appropriate candidate for transfer to a subacute unit? A patient requiring an 8-week course of intravenous (IV) antibiotics for treatment of osteomyelitis A patient who has been admitted from the emergency department with a complaint of explosive diarrhea of unknown origin A patient with a hip fracture who is in pain and awaiting surgery A patient who presents with left hemiplegia and an expressive speech aphasia and was admitted to the unit today

Correct A patient requiring an 8-week course of intravenous (IV) antibiotics for treatment of osteomyelitis The patient requiring the 8-week course of IV antibiotics is the best choice for a subacute unit. Though this is an infection, the diagnosis has been made, treatment is in progress, and the patient is considered stable. Staying in a hospital for such a lengthy period of time can have negative effects of the patient's functional status. The other patients have acute care needs: the patient with diarrhea needs diagnosis, the patient will have hip surgery in the hospital, and the patient with stroke signs also needs diagnosis and acute care until stable.

A nurse is planning for the care for an older adult who has been hospitalized with a vancomycin-resistant enterococcus (VRE) urinary tract infection. Which interventions need to be included in this plan of care? (Select all that apply.) Accurate intake and output Follow only standard precautions Monitor WBC levels Restrict fluids Wash hands for 15 seconds using an antimicrobial soap Use a dedicated stethoscope and thermometer

Correct Accurate intake and output Monitor WBC levels Wash hands for 15 seconds using an antimicrobial soap Use a dedicated stethoscope and thermometer Infection control measures should be in place with a colonized or symptomatic VRE culture result in a patient with a VRE infection, which is seen in the skin, intestine, or urinary system. VRE is transmitted person to person via the hands of health care workers. VRE is also transmitted by contaminated medical devices, including electronic thermometers, fluidized beds, and environmental surfaces. To control transmission of VRE, health care workers must perform a meticulous 15-second hand washing with an antimicrobial soap. Dedicated equipment, such as a stethoscope, is required for infected patients. Colonized and infected patients should be isolated in private rooms or grouped with other infected patients in the acute care setting. Barrier precautions, gloves, and gowns should be implemented for patient care. Antibiotics are not used in persons with colonization but no symptoms; symptomatic patients should be treated with antibiotics indicated through culture and sensitivity. Restricting fluids is not an appropriate nursing action in this situation.

The nurse has conducted a pain assessment on a cognitively impaired older adult using the PAINAD tool and has scored the adult's pain at an 8. What action by the nurse is best? Document the findings in the patient's chart. Give the patient a mild analgesic. Ask if the patient would like to be repositioned. Administer an opioid analgesic.

Correct Administer an opioid analgesic. The PAINAD tools 0-2 points in each of 5 categories, with the maximum score of 10 indicating severe pain. At an 8, this patient's pain is very high and should be treated with opioids. The nurse will document, but treating the pain comes first. A mild analgesic will not be sufficient. The patient may not be able to answer the nurse's question, and repositioning the patient may or may not help.

A home health nurse is caring for a patient with a diagnosis of venous ulceration of the right lower extremity. What would the nurse expect to implement in caring for this patient? (Select all that apply.) Administer wound care as ordered. Implement compression therapy. Elevate the lower extremities multiple times daily. Educate the patient regarding the causes of a venous ulcer and its chronic nature. Determine whether support services like Meals on Wheels is required. Advise the patient to report increasing pain, purulent drainage, and a temperature above 100.5°F to the primary care provider.

Correct Administer wound care as ordered. Implement compression therapy. Elevate the lower extremities multiple times daily. Educate the patient regarding causes of a venous ulcer and its chronic nature. Determine whether support services like Meals on Wheels is required. Advise the patient to report increasing pain, purulent drainage, and a temperature above 100.5°F to the primary care provider. Nursing interventions consist of administering wound care, implementing compression therapy, keeping the patient's legs elevated above the heart, and educating the patient regarding the causes of a venous ulcer and its chronic nature, the strategy of compression therapy, and specific wound care. The nurse must stress the need to maintain compression therapy to facilitate healing of ulcers and avoid further breakdown. The nurse should determine whether any community services such as home-delivered meals, grocery shopping assistance, and other support services are needed. Infection is difficult to determine because venous ulcers often have erythematous bases with induration; however, if the patient has increasing pain, purulent drainage, develops a fever above 100.5°F and has tenderness surrounding the ulcer, the provider should be contacted.

A Registered Nurse has taken a job as the Director of an assisted living facility. The nurse is disappointed when residents do not all agree on activities and services that will help keep them healthy. Even individual interventions are not universally successful. What statement best explains this nurse's dilemma? All older people are unique and do not belong to a homogenous group. The Director needs to get to know individual residents better. The Director probably does not have a certification in gerontologic nursing. The frail residents probably cannot attain a higher level of wellness.

Correct All older people are unique and do not belong to a homogenous group. Older people do not belong to a homogenous group and one size will not fit all in programing or meeting health and wellness needs. The director may need to get to know the residents better and may or may not have a certification, but these are not the best answers. Residents in settings such as assisted living and even skilled nursing homes can develop improved health and wellness.

A Registered Nurse is caring for a patient who has a life-threatening chronic illness. The patient is agitated and says "What was the point of my life? Nothing ever went my way and now I'm dying." What intervention by the nurse is most appropriate? Tell the patient that everyone's life is a benefit to others. Ask the patient if having a chaplain visit would be helpful. Call the patient's family and ask them to come see the patient. Assist the patient in conducting a life review.

Correct Assist the patient in conducting a life review. This patient shows incomplete resolution of Ego Integrity v. Despair. The nurse can best assist this patient by participating in a life review, during which the patient can verbalize achievements and satisfaction with life events. Telling the patient that all lives have benefit is patronizing. The patient may or may not want a chaplain or other spiritual leader to visit and may or may not have family he or she wants to see.

The nurse recognizes the patient's wife (and caregiver) is in need of some rest and time for herself. The wife looks out of sorts with unkempt hair and dark circles under her eyes. The wife's communication with the patient is short and angry, and while she is hurrying to get coffee and bring toast to the patient's bedside, the wife trips on the floor. The wife hasn't talked on the phone or gone out to lunch with friends, or even gone to church, for the past month, as the patient needs care 24/7. The nurse recognizes the role as permission giver and makes which suggestion to the wife? Get a replacement, take off for the weekend, and get out of town. Assess her weaknesses as a caregiver, and work diligently to improve one or two of them now. Begin taking regular breaks in caregiving early; it's not selfish. Maintain her methods of care, and she will eventually adjust to the pace and demands of the caregiver role.

Correct Begin taking regular breaks in caregiving early; it's not selfish. Because nurses are viewed as authorities or experts, their messages carry weight with family caregivers. The nurse wants to empower caregivers and encourage them to take care of themselves, stay in contact with friends and maintain involvement in outside activities, and ask for help as a sign of strength. The nurse will encourage the caregiver to take early breaks and to consider the bigger picture by taking into account the needs of all family members, not only what the older adult patient needs. Telling the wife to get a replacement and leave town suddenly is not an appropriate action. Telling the wife to asses her weaknesses implies she may be doing the job wrong. Telling the wife to maintain her methods of care will not solve anything.

The nurse is visiting an older adult who lives alone. The client reports that she has been the victim of fraud but did not report it to anyone. What does the nurse understand as possible reasons for the client to not report the crime? (Select all that apply.) Being embarrassed at being a crime victim "at my age". Not wanting to bother anyone for a second opinion. Not wanting to be rude to "that nice young man." Being prescribed multiple medications that are expensive. Being afraid of physical violence for turning the person away.

Correct Being embarrassed at being a crime victim "at my age". Not wanting to bother anyone for a second opinion. Not wanting to be rude to "that nice young man." Being prescribed multiple medications that are expensive. Older adults are at risk of fraud for several reasons, including being embarrassed, having fewer resources to turn to, not wanting to be impolite, and desiring herbal or other remedies offered in lieu of expensive medications. Being afraid of physical violence when turning someone away at the door is possible, but more typically, the older person does not want to offend.

When reviewing a newly admitted patient's medical history and reconciled medication profile, the nurse sees that metoclopramide has been ordered. The patient tells the nurse that there is no history of gastroesophageal reflux disease (GERD) or gastrointestinal (GI) symptoms. The nurse reviews the record and notes that it mentions "no GERD" and is negative for the review of symptoms for GI. What action does the nurse take? Throw the medication away. Give the medication to the patient as ordered. Call the provider and request that the drug be discontinued. Hold the drug now and determine if it is needed later.

Correct Call the provider and request that the drug be discontinued. The nurse should have a corresponding diagnosis to deliver a medication safely. As this medication has been ordered and neither the patient nor the record indicates a diagnosis to support giving the medication safely, the drug should not be administered. The nurse would consult with the provider and request either a rationale for the drug, or discontinuation of the drug. Throwing the medication away is wasteful, not proper procedure, and does not get to the root of the problem. A medication has been ordered for a condition the patient was not diagnosed with. Giving the medication is not safe; holding the drug now and determining its need later is not appropriate.

A 90-year-old patient has a pulse oximetry reading of 90%. The primary care provider (PCP) has left an order to obtain arterial blood gasses. The patient's arterial partial pressure of oxygen (PaO2) is 75 mmHg. What action by the nurse is most appropriate? Place the patient on high-flow oxygen. Complete a comprehensive respiratory assessment. Obtain blood for complete white cell count. Administer a bronchodilator.

Correct Complete a comprehensive respiratory assessment. The older adult's PaO2 decreases 25% between the ages of 30-80, so the nurse would expect this patient's PaO2 to be slightly lower than the normal adult range of 80-100 mmHg. The nurse would complete a comprehensive respiratory assessment to gather the data needed for further action. The patient may or may not need oxygen or other blood tests. There is no indication that the patient needs a bronchodilator.

A nurse who works in a skilled nursing facility is looking for ways to reduce the incidence of falls among the residents. Which of the following recommendations by the nurse will decrease the greatest number of falls in the facility? Install nightlights in all the residents' bathrooms. Complete a fall history and assessment for each resident upon admission. Refer residents who need assistance with ambulation to occupational therapy. Provide side rails on the beds to keep residents from falling out of bed.

Correct Complete a fall history and assessment for each resident upon admission. Each resident should have a fall risk assessment upon admission to any nursing facility. This will help identify high risk residents. Nightlights will help when going to the bathroom but is not generalized enough to reduce all types of falls. Residents who need assistance to ambulate might need a referral to physical or occupational therapy, but this will not reduce falls as much as comprehensive assessments. Side rails to keep residents in bed are restraints; a better option would be low beds.

An older patient with a history of renal failure is admitted to your unit with a diagnosis of dehydration and hyponatremia. What assessment finding does the nurse identify as consistent with the diagnosis of dehydration? (Select all that apply.) Confusion Shortness of breath Decreased skin elasticity Increased blood urea nitrogen (BUN) Adventitious lung sounds on auscultation

Correct Confusion Decreased skin elasticity Increased blood urea nitrogen (BUN) Confusion, decreased skin elasticity, and increased BUN are associated with dehydration. Shortness of breath and adventitious breath sounds are associated with overhydration.

An older adult patient has come back to the surgical unit after a mastectomy. The nurse implements which of the following interventions to decrease the risk of atelectasis? (Select all that apply.) Deep breathing and incentive spirometer use Intravenous hydration or oral hydration (per orders) Suppository use on the second postoperative day without a bowel movement Position in a chair for 2 hours three times per day beginning on day 1 post-op BRP and ambulation in the hallway on day 2 post-op Indwelling catheter insertion if unable to void 8 hours post-op

Correct Deep breathing and incentive spirometer use Intravenous hydration or oral hydration (per orders) Position in chair for 2 hours three times per day beginning on day 1 post op BRP and ambulation in the hallway on day 2 post op Promotion of deep breathing and spirometry use for effective pulmonary hygiene, adequate hydration, frequent position changes, and early mobility will decrease the risk of developing atelectasis in older adult postoperative patients. A suppository or catheter will not reduce the risk of atelectasi

A nurse practitioner is working with an older patient who is a smoker. The patient tells the nurse about considering quitting after an 88-pack-per-year use of tobacco. A family member who is encouraging the patient to quit, asks the nurse what the best method for quitting is. What does the nurse practitioner do next? Encourage the patient to set a quit date and review preparations for quitting (removing ashtrays). Write the patient a prescription for nicotine patches that can be purchased at a local pharmacy Refer the patient to a pulmonologist for thorough respiratory evaluation. Refer the patient to the American Lung Association's website for more information on the subject

Correct Encourage the patient to set a quit date and review preparations for quitting (removing ashtrays). The first action the nurse should take is assist the patient with smoking cessation by encouraging him or her to set a quit date and review preparations for quitting (e.g., removing associated objects like ashtrays). The patient may or may not need or want medication. A thorough pulmonary evaluation is not needed for the patient to quit smoking. Referring the patient to the American Lung Association website is very helpful, but is not the first (or only) thing the nurse should

A nurse working in an assisted living facility wishes to base nursing practice on psychological theories of aging. What action would the nurse choose to implement to reflect this practice? Encourage the residents to eat a heart-healthy diet. Plan routine activities such as walking outside. Engage the residents in reminiscing therapy. Arrange for a therapy dog to visit once a week.

Correct Engage the residents in reminiscing therapy. According to psychological theories of aging, engaging the older adult in a life review helps them attain a sense of ego integrity and see that their lives have not been "in vain." Diet and exercise would be beneficial under biological theories of aging. A therapy dog would provide benefit under comfort theory.

Two patients are residents of a long-term care facility. They are both physically frail but mentally fit. The night shift nurse walked in to give one patient medication and found both patients engaging in foreplay together. How should care providers best respond to these residents' new sexual relationship? Break it up immediately and remind the patients of the no sexual intercourse policy of the facility. Ensure that each resident's family members are advised of this activity. Excuse your interruption and if possible delay giving the medication. Call the supervisor to report witnessed behavior so the supervisor can work with the residents.

Correct Excuse your interruption and if possible delay giving the medication. In long-term and acute care settings as well as in assisted living settings, lack of privacy often prevents older residents from pursuing sexual relationships. Fear of becoming the topic of conversation among staff members as well as their peers may make older adults hesitant to seek advice from staff or pursue opportunities for sexual fulfillment. The issue of privacy of information becomes a reality for older adults desiring sexual relations. Staff members need to support the sexual relationships between competent, consenting, and caring individuals in an institutional setting. Breaking up the pair is not supportive. Family members are not involved when the members of the duo are competent and can make their own decisions. Calling the supervisor to handle the situation is not appropriate. The nurse should excuse the interruption, and if possible, delay the medication until the couple indicates that they are finished. If it is not possible to delay the medication, the nurse should explain why giving it right now is important.

An older patient who has a history of congestive heart failure and diabetes is admitted to the emergency department, accompanied by a family member. The patient is confused, and the family member tells you the patient became confused about an hour after taking morning medications. When you review the patient's systems, you note that the family member reported an onset of diarrhea last night and complained of heart palpations, which woke the patient up. The patient has a history of congestive heart failure and diabetes. The lab is on the phone giving you results of the stat labs that were drawn: Na 132 mEq/L Blood urea nitrogen (BUN) 25 mg/dL K 4.9 mEq/L Creatinine 1.9 mg/dL Cl 110 mEq/L Digoxin level 3.1 ng/mL Glucose, random 176 mg/dL Calcium 9.8 mg/dL What action by the nurse takes priority? Administer a dose of IV insulin. Place the patient on a cardiac monitor. Prepare to administer digoxin antidote. Give a 500 mL IV fluid bolus.

Correct Give a 500 mL IV fluid bolus. The patient's symptoms and lab values demonstrate digoxin toxicity and the nurse should prepare to administer the antidote (Digibind). The patient's glucose is high, but not high enough that IV insulin is the priority. The patient's potassium and calcium are in the normal range so a cardiac monitor is not the priority. The patient's Na+ is slightly low, indicating possible fluid volume overload. However, the hyponatremia is mild and the patient has a history of heart failure, so a large bolus of IV fluid is not indicated.

A nurse is admitting an older adult, and the patient reports being told about an abnormal amount of fluid in her right eye that can erode the optic nerve over time and may cause loss of eyesight if not treated. The patient uses prescribed eye drops every day, and they have worked to rid the eye of the terrible pain she had prior to using them. What disease of the eye is the patient telling the nurse about? Presbyopia Glaucoma Cataract Retinal detachment

Correct Glaucoma Glaucoma results from a blockage in the drainage of the fluid (the aqueous humor) in the anterior chamber of the eye. If the fluid is formed in the eye faster than it can be eliminated, intraocular pressure (IOP) increases. Pressure is then transferred to the optic nerve, where irreparable damage, possibly even total blindness, can result. Cataracts result from changes in the chemical composition of the lens; these changes may be caused by aging, eye injuries, certain diseases, and heredity. Retinal detachment occurs when the sensory layer of the retina separates from the pigmented layer. In presbyopia, the lens loses its ability to focus on close objects. Accommodation is impaired as the lens thickens and loses its elasticity. The ciliary muscles weaken the lens's ability to contract.

Which patient on a medical hospital unit would be at the highest risk for sleep disturbances? Being treated with intravenous pain medication for pancreatitis Receiving a blood transfusion for a gastrointestinal bleed Has obesity, COPD, and was admitted with angina today Admitted with a urinary tract infection being treated with IV antibiotics

Correct Has obesity, COPD, and was admitted with angina today Many factors can disrupt sleep including environmental factors, pain, lifestyle changes, diet, drug use, medical conditions, depression, and dementia. Obesity is a risk factor for sleep apnea. COPD can lead to shortness of breath and coughing which can disrupt sleep. While all patients listed have risk factors for insomnia, the person with the most risk factors in the obese patient with COPD and angina.

The home care nurse is working with an older adult who relates recently started wearing sun screen and limiting time in direct sunlight to prevent cancer and keep the skin looking young. What type of activity is this older adult participating in? Health promotion Illness prevention Disease management Prophylactic disease prevention

Correct Health promotion Health promotion activities are those taken to stay in an optimum level of health and to prevent disease. The health care delivery system is beginning to focus on disease prevention and health promotion, and older adults must be included in this focus. It is necessary for patient teaching to stress the concept that certain conditions or diseases are not inevitable just because of advancing years. A high level of wellness is needed in advancing years to minimize the potential damage caused by disease in later years.

A nurse practitioner is seeing an older patient. The patient's blood pressure is 168/94 and has been elevated on the previous two visits. What diagnostic testing does the nurse practitioner order? (Select all that apply.) Hemoglobin and hematocrit A urinalysis Serum sodium, potassium, and creatinine levels Fasting plasma glucose level Serum lipid panel An electrocardiogram (ECG) and a chest x-ray

Correct Hemoglobin and hematocrit A urinalysis Serum sodium, potassium, and creatinine levels Fasting plasma glucose level Serum lipid panel An electrocardiogram (ECG) and a chest x-ray The health care provider should obtain a history regarding lifestyle factors and should conduct an in-depth physical examination. The following tests should be included: hemoglobin and hematocrit to exclude anemia or polycythemia; urinalysis to investigate for proteinuria or other signs of renal failure; serum sodium, potassium, and creatinine levels; fasting plasma glucose level to determine whether antihypertensive therapy may be affecting diabetes mellitus, a cardiac risk factor; serum total cholesterol and HDL levels to assess for hyperlipidemia; ECG; and chest x-ray study.

The daughter of an 83-year-old patient asks you about the daily use of vitamins C and E to help her parent maintain health. Which of the following theories will help you most to explain why this supplement is beneficial to the patient? Programmed theory Immunological theory Cross-linkage theory Wear and tear theory

Correct Immunological theory The body does have naturally occurring antioxidants or protective mechanisms such as vitamins C and E. According to the immunological theory, antioxidants postpone the appearance of diseases such as cardiovascular disease and cancer that occur due to the effects of free radicals in the body. Programmed theory, cross-linkage theory, and wear and tear theory do not give the nurse information to explain antioxidant use and its action to maximize health.

Which areas of health promotion are most relevant to the physical fitness of older adults? (Select all that apply.) Increasing physical activity Using medications safely Maintaining healthy nutrition Driving safely Encouraging social health

Correct Increasing physical activity Using medications safely Maintaining healthy nutrition Driving safely Encouraging social health Increasing physical activity, maintaining healthy nutrition, driving safely, using medications safely, and encouraging social health are key areas of health promotion in the physical fitness of older adults

The nurse is conducting a functional assessment of a patient who has just been admitted to the skilled care rehabilitation facility. Which of the following best describes the functional assessment? It excludes the patient's medical diagnosis and history and focuses only on functional ability. It includes an assessment of the patient's physical, cognitive, affective, and social status. It excludes the patient's chief complaint and reason for seeking health care. It includes the new drugs a patient has been placed on when coming to the facility.

Correct It includes an assessment of the patient's physical, cognitive, affective, and social status. The functional assessment is comprehensive and includes the gathering of data in the physical, cognitive, affective, and social status of the patient, thereby providing a comprehensive view of the older adult's total degree of function. It is not a medical diagnosis, history, or physical exam, nor is it a medication profile. It is broader and delineates the patient's level of function and abilities to assist with rehabilitation efforts to maximize function and promote self-care.

A nurse observes the skin between an older adult's thighs. The patient has bright red erythema with a few pustules and papules located at the peripheral margins of the affected areas. The patient complains of discomfort and pain associated with the involved areas. What care orders can the nurse plan to implement to care for the patient? (Select all that apply.) Keep the skin clean and dry by cleansing daily and patting gently to dry the area. Cleanse the skin promptly with incontinence episodes. Apply and antifungal cream as ordered until symptoms resolve. Apply a zinc oxide-based cream, like Desitin, to keep the area protected and allow healing. Apply a cortisone-based over-the-counter or prescription cream to reduce inflammation. Apply a medicated powder or cornstarch to the area.

Correct Keep the skin clean and dry by cleansing daily and patting gently to dry the area. Cleanse the skin promptly with incontinence episodes. Apply and antifungal cream as ordered until symptoms resolve. Apply a zinc oxide-based cream, like Desitin, to keep the area protected and allow healing. The main intervention is keeping the skin dry. Patting the skin dry is the technique of choice. Early and prompt intervention when the patient is incontinent to cleanse the skin and protect the skin, using a zinc oxide product, like Desitin, is recommended as a moisture barrier cream to the buttocks and perineal area. It is important to keep an antifungal cream on the area until treatment is complete. Cortisone cream is essential to treat psoriasis but not candidiasis. Application of cornstarch and powder is not recommended because of clumping and limited long-term skin protection.

Overview of Gerontologic Nursing Why is gerontologic nursing growing in recognition compared with how it was viewed in the past? More people will be presented with the same health care problems. More older adults are living a longer period of time in old age. A greater number of people are surviving the unstable period of adolescence. More older adults are married couples, with men's life expectancies equaling women's.

Correct More older adults are living a longer period of time in old age. With a "gerontology boom" beginning, the specialty of nursing is growing in recognition. Older adults are living longer. They continue to be the fastest growing segment of the population. Gerontologic nursing has seen a growth in recognition since the Baby Boomer generation began turning 65. The health care problems affecting older adults are unique to each individual. There is no great increase in the number of people surviving adolescence. Women typically outlive men.

A nurse practitioner is seeing an older patient. The patient's blood pressure is 168/94 and has been elevated on the previous two visits. What physical assessments does the nurse preform? (Select all that apply.) Neck to detect carotid bruits, jugular venous distention, or an enlarged thyroid Heart to detect abnormalities in rate, rhythm, heaves, lifts, and heart sounds Lungs to detect rales, crackles, cough, or shortness of breath Abdomen to detect bruits, masses, and aortic pulsations Extremities to detect peripheral pulses, skin color and temperature, and edema

Correct Neck to detect carotid bruits, jugular venous distention, or an enlarged thyroid Heart to detect abnormalities in rate, rhythm, heaves, lifts, and heart sounds Lungs to detect rales, crackles, cough, or shortness of breath Abdomen to detect bruits, masses, and aortic pulsations Extremities to detect peripheral pulses, skin color and temperature, and edema The health care provider should obtain a history regarding lifestyle factors and should conduct an in-depth physical examination. It should include examination of the neck, the heart, the lungs, the abdomen, and the ex

A nurse is working with an older adult patient who has a diagnosis of herpes zoster (shingles). What is the priority transmission-based approach to this infectious agent? Institute airborne precautions. No transmission-based precautions are required. Universal precautions are sufficient. Patients need contact isolation.

Correct No transmission-based precautions are required. Herpes zoster, also known as shingles, is caused by the reactivation of latent varicella zoster (chickenpox) virus. The virus remains in the dorsal nerve endings after an episode of chickenpox, which is usually experienced in childhood. The main reason for recurrence is an immune system deficiency. Chickenpox is highly contagious because it is an airborne virus. Herpes zoster is not as infectious because it is related to reactivation of latent varicella zoster. Therefore it is not necessary to isolate a patient with herpes zoster. Cases of contracting shingles after personal exposure have been reported, but these have been in individuals who have not had chickenpox. Consequently, patients with herpes zoster should be cared for only by health care personnel who have had chickenpox or have positive serum varicella titers. As always, universal precautions should be exercised.

A patient has a diagnosis of osteoarthritis of the knees, and the disease has progressed. Degenerative joint disease is now significant, resulting in severe pain and marked loss of function. The nurse would characterize this patient's pain as what type? Nociceptive pain Neuropathic pain Unspecified pain (mixed) Conversion reaction

Correct Nociceptive pain Nociceptive pain may be visceral or somatic and is usually a result of the stimulation of pain receptors. It may arise from tissue inflammation, mechanical deformation, ongoing injury, or destruction of tissue. This type of pain usually responds well to common analgesic medication and nonpharmacologic strategies. In this scenario, the pain originates from the affected bone. Neuropathic pain originates from the peripheral or central nervous system and the pathway is aberrant. Unspecified pain is mixed, a combination of more than one type of pain. Conversion reaction is a psychologic pain with a strong psychologic origin.

Which actions will the nurse take to assess for possible obstructive sleep disorder in a 72-year-old patient? (Select all that apply.) Observe for sleep cessation when the patient is sleeping at night. Review the patient's history for reports of insomnia and excessive daytime sleepiness. Assess the height, weight, and body mass index. Review the patient's cardiovascular disease history. Ask about previous use or orders for continuous positive airway pressure (CPAP) devices. Determine if the patient is using a urinal at bedtime.

Correct Observe for sleep cessation when the patient is sleeping at night. Review the patient's history for reports of insomnia and excessive daytime sleepiness. Assess the height, weight, and body mass index. Review the patient's cardiovascular disease history. Ask about previous use or orders for continuous positive airway pressure (CPAP) devices. The incidence of sleep apnea increases with age. Direct observation of the patient sleeping can supplement the sleep history. Sleep apnea is associated with excessive daytime sleepiness and reports of insomnia. Obesity is a risk factor for obstructive sleep apnea and use of a CPAP device to help maintain an open airway during sleep is the treatment for this disorder. A cardiovascular history of hypertension, smoking, and cardiac risk factors increase the likelihood of developing obstructive sleep apnea. Use of a urinal at bedtime is not necessarily associated with sleep apnea.

A home health nurse sees an 87-year-old patient. The daughter with whom the patient lives reports that the patient has experienced a recent series of falls, which have resulted in blackened eyes, cheeks, and arms. The patient smells of urine, is sitting on top of a shower curtain, and is significantly underweight, unkempt, and anxious while the daughter verbally berates the patient during the nurse's assessment. What is the nurse's responsibility in this situation? Determine the daughter's legal status with regard to the patient's durable power of attorney. Determine if any other family members stay in the home and are available to interview. Report the suspected elder abuse to the appropriate authorities. Obtain medical records regarding prior admissions for similar problems.

Correct Report the suspected elder abuse to the appropriate authorities. A report of suspected abuse may be required on a "reasonable suspicion." This implies that actual knowledge or certainty is not necessary. Most states provide immunity from civil liability from anyone reporting older adult abused based on reasonable suspicion and on good faith, even if later it was shown the reporter was mistaken. In most care settings, nurses are mandated reporters. The nurse's responsibility is to file a report with the authorities in the state. Information concerning the patient's durable power of attorney assignment, any other family members residing in the home, and other medical records regarding prior admissions for similar problems should be explored during the admission assessment.

An older adult patient's urine has an odor, but the patient is not experiencing burning upon urination, frequency or urgency, or incontinence on review of symptoms. The aide working with the patient reports a temperature of 98.4°F taken orally. You notice the patient is a bit confused. What actions by the nurse take priority? (Select all that apply.) Place the patient on strict Intake and Output. Request an order for a urinalysis from the provider. Have the aide offer the patient fluids every hour. Assess the patient's level of orientation. Delegate a daily weight to the nurses' aide.

Correct Request an order for a urinalysis from the provider. Have the aide offer the patient fluids every hour. Assess the patient's level of orientation. Delegate a daily weight to the nurses' aide. Although urine odor is not a definitive sign of a urinary tract infection in older adults, this finding along with the patient's confusion would indicate a possible UTI that should be investigated. The nurse would call the provider to request a UA, have the aide encourage increased fluids, and perform a further assessment of the patient's neurological status, including level of orientation. The patient may or may not need intake and output measurements and daily weights are not indicated by this scenario

A nurse works with a program that performs interviews, blood work, mammograms, and Papanicolaou smears aimed at implementing gynecologic health in older adult women. The program also educates older adult women on the procedure and technique of monthly self-breast exams. The program imparts access by providing older women with transportation to and from the women's center. It also provides multiple durable medical equipment items that women who have had breast or gynecological surgery may need as they go through the recovery process. Which of the following components of health promotion has yet to be implemented in the program? Screening Risk assessment Environmental modification Risk reduction interventions

Correct Risk reduction interventions Risk reduction has not been addressed in the program as it is described. Screening and risk assessment are completed by interview and with lab work/x-rays. Environmental modification results from the follow-up durable medical equipment provided to women who are in need and undergo surgery. Early detection is facilitated by the self-breast monthly exam education.

An older adult patient who has chronic obstructive pulmonary disease (COPD) is consulting with the nurse about the need for oxygen in the home. What are indications for home oxygen the nurse will assess the patient for? (Select all that apply.) Respiratory rate of 25 with use of accessory muscles SaO2 equal to or less than 88% A complaint of dyspnea worsening Hematocrit >55% Diminished lung sounds throughout the chest Negative for peripheral edema

Correct SaO2 equal to or less than 88% Hematocrit >55% Long-term oxygen therapy increases survival rates and improves hemodynamics, exercise and lung capacity, and mental status. Supplemental oxygen therapy is indicated for patients with a resting PaO2 ≤ 55 mmHg or a SaO2 ≤ 88% with or without hypercapnia. Oxygen therapy may also be indicated if the patient's PaO2 is between 55 and 60 mmHg, if the SaO2 is 88% or less, or if there is evidence of pulmonary hypertension, peripheral edema, or polycythemia (hematocrit level >55%). The patient's respiratory rate, use of accessory muscles, and increased dyspnea may indicate an infection if they are new findings. Diminished lung sounds are a nonspecific finding. Peripheral edema is not relate

A nurse is collecting data from a patient with herpes zoster (shingles). Which of the following assessment findings need to be communicated to the patient care provider? (Select all that apply.) Satellite lesions outside of the affected dermatome Complaints of headaches with neck rigidity Pulmonary congestion Clear fluid release with opening of fluid-filled vesicles A mild temperature of 99.2°F Intense pain correlating with the rash at onset of virus activation

Correct Satellite lesions outside of the affected dermatome Complaints of headaches with neck rigidity Pulmonary congestion Satellite lesions outside of the affected dermatome, complaints of headaches with neck rigidity, and pulmonary congestion are signs and symptoms associated with a systemic form of herpes zoster and a primary care provider needs to be called and the symptom set reported. Intense pain correlating with the rash at onset of virus activation is the characteristic of the virus onset that brings patients in to see providers. The intense pain needs to be reported and treatment ordered when it is observed. Clear fluid release with opening of fluid-filled vesicles and a mild temperature of 99.2°F are normal responses of the virus infecting the patient and do not require any additional nursing action.

Nurses understand the impact of sensory deficits on the older adult. Which of the following nursing diagnoses are associated with sensory deficits? (Select all that apply.) Activity intolerance Sensory/perceptual alterations Social isolation Self-esteem disturbance Risk for injury Constipation

Correct Sensory/perceptual alterations Social isolation Self-esteem disturbance Risk for injury Changes to the sensory organs of the older adult create changes that can result in sensory/perceptual alterations, social isolation, self-esteem disturbance, and risk for injury. Activity intolerance and constipation are not related to sensory/perceptual alterations.

An older adult patient calls for emergency transportation to the emergency department (ED). The nurse asks the patient to describe the reason for coming into the ED today, and the patient replies, "I don't feel well at all." The patient proceeds to describe various symptoms to the nurse. Which of the following most accurately captures the complexity involved in assessing the older adult in this scenario? Older adults present with fewer symptoms of illness than do younger patients. Signs and symptoms of illness are often obscure and less predictable in older adults. Care must be taken to always assess normal age-related changes last. Older adults experience fewer acute health problems but more chronic illness than do younger adults.

Correct Signs and symptoms of illness are often obscure and less predictable in older adults. In times of physical and emotional stress, including illness, older people will not always exhibit the expected or classic signs and symptoms. The characteristic presentation of illness in older adults is more commonly one of blunted, vague, or atypical signs and symptoms. Older adults often present with different though not necessarily fewer symptoms than younger adults. Age-related changes must be assessed thoroughly and compared with the patient's actual baseline with an emphasis on the patient's individual baseline. The patient is the reference for comparison to assess the particular age-related changes. Older adults do not experience fewer acute health problems but different manifestations of them.

Modification of which risk factor for cardiovascular disease will bring the most gain to cardiovascular function? Reducing stress Increasing activity in a sedentary lifestyle Smoking cessation Toning down the type A aggressive personality

Correct Smoking cessation Smoking continues to be a major risk factor in the development of heart disease. Smoking doubles an individual's risk for stroke, and smokers are two to four time more likely than nonsmokers to develop coronary heart disease (CHD) (Centers for Disease Control and Prevention [CDC], 2013). Smoking increases platelet aggregation and causes coronary artery spasms. Nicotine increases blood pressure and cardiac demands. Carbon monoxide in tobacco smoke decreases the oxygen-carrying capacity of the blood. Modification of the other cardiac risk factors listed is recommended and would improve cardiovascular health, but none as much as smoking cessat

A nurse is working with an older adult who has a significant amount of hearing loss. The patient lives alone, has little family, but is very independent. Which of the following serious threats to the emotional well-being of the patient should be included in the plan of care? Confusion secondary to the inability to communicate except in writing Social isolation secondary to the hearing loss with the potential for depression Inability to perform activities of daily living (ADLs) as related to the hearing decline Risk for infection related to hearing loss

Correct Social isolation secondary to the hearing loss with the potential for depression Social isolation is a high risk for patients with hearing loss, and the potential depression and withdrawal occurring from difficulty communicating is a risk. The nurse needs to address this problem. There is no evidence the patient is confused, unable to perform ADLs, or at an increased risk of infection resulting from

A male nursing assistant comes to the female charge nurse upset because his patient, an older Muslim woman, would not allow him to bathe her and her husband made the assistant leave the room. What action by the charge nurse is best? Offer to bathe the patient herself. Tell the husband the patient needs a bath. Switch the assignment to a female assistant. Tell the assistant to let the bath go for today.

Correct Switch the assignment to a female assistant. In the Muslim culture, norms may dictate that touch, including personal care, occur only between members of the same gender. In order to provide all the care this patient needs, the charge nurse should switch the assignment with a female nursing assistant for the remainder of the shift.

The patient lives with a son and his family and has a diagnosis of Alzheimer's disease. The condition is worsening and the patient's daughter-in-law, who is the primary caregiver the majority of the day and evening, is frazzled and worn out. She is overwhelmed with the patient's constant barrage of negativity. The patient is accusing her of stealing the patient's home, selling it, and keeping the money she made with the sale. Now, in addition to the patient's verbal attacks, the patient is beginning to raise a fist to her. She is truly afraid it may accelerate to the next level and needs a break. What should the nurse suggest to provide the caregiver and her family with the break she needs? See if the doctor will put the patient in the hospital to evaluate the behavior changes and prescribe new medications to tone down this recent behavior upheaval. Take advantage of a respite program to help the caregiver and family get needed rest for times like this when caregiving becomes overwhelming. Immediately place the patient in a skilled care facility where staff can work with and restrain the patient so the patient won't hurt anyone. Send the patient to stay with another family member so the older adult son's family can get relief for an extended period of time.

Correct Take advantage of a respite program to help the caregiver and family get needed rest for times like this when caregiving becomes overwhelming. A respite program is designed to provide the relief for the caregiver/family that the daughter-in-law needs. Though there is a behavior change, many times medication approaches can be implemented with a home care support staff but rarely does the patient qualify for admission to the hospital in a situation like this. No skilled care facility admission is done "immediately." We would need further information to verify the family would support this move and would have the funds to back up the decision, which on average will cost in the $6,000 range monthly. Medicare only pays for a day's worth of care (less than $90 typically) for qualifying events, but it does not pay for long-term chronic placement of the Alzheimer's patient with behavior changes. We don't know if any other family member would be willing to work with the patient for any period of time, much less an extended period of time.

As part of a functional assessment, the nurse is assessing an older adult's activities of daily living in the home. What piece of assessment data would be considered part of a functional assessment? The ability to transfer and ambulate with an assistive device safely The ability to get to the store, shop, and bring the groceries home The ability to drive the car to the store and back safely The ability to keep the walkway shoveled in the wintertime and the lawn mowed in the summer

Correct The ability to transfer and ambulate with an assistive device safely The ability to transfer and ambulate safely with an assistive device is a functional assessment made by nurses in all practice settings. It is a basic activity that ensures overall health and well-being. The ability to get to the store, shop, bring the groceries home, drive the car, and keep the walkway clear to and from the home are called Instrumental ADLs and are a subset of functional abilities. They are necessary activities to maintain in the home setting, but they may be done by extended family members or paid help at home. They are not core functional abilities. The nurse would assess functional ability best by observing the older adult's ability to transfer and ambulate safely.

The older adult can have atypical acute pain experiences, which are difficult for the nurse to assess. What piece of data gathered in a pain assessment is priority? The older adult patient's report of pain rated 8- 10 A blood pressure of 136/78 mmHg in an older adult with chronic pain A grimace or groan when the affected abdomen is examined Pain from rheumatoid arthritis reported by the older adult's spouse

Correct The older adult patient's report of pain rated 8-10 Pain is what someone says it is. The patient's report is the most accurate and reliable evidence of pain and its intensity. The traditional pain scale has been found to be an effective tool for measuring pain in the older adult. The blood pressure here is normal, as it may be in an older patient experiencing chronic pain. A grimace or groan is the nonverbal congruent information of a pain assessment that supports the patient's oral report of pain and intensity. Pain reported by the spouse verifies the pain experience and notes that it exists; however, it is not the priority assessment.

An 82-year-old patient is at the clinic for a checkup. His blood pressure (BP) is 168/94 mmHg. The patient is 5′5″, 186 pounds, and has a history of controlled hypertension and osteoarthritis. His medications include metoprolol and naproxen. The patient's usual BP is 118/64. Which of the following is most likely to be causing today's higher reading? The patient is obese Increased intake of salt by eating bacon three times a week The patient is taking naproxen which can cause increased blood pressure The patient's blood pressure rising as a normal age-related change.

Correct The patient is taking naproxen which can cause increased blood pressure All prescription and over-the-counter medications need to be assessed for possible causes of elevated blood pressure. Drug-induced hypertension has occurred with the administration of amphetamines and glucocorticoids. Decongestants, phenobarbital, rifampin, and nonsteroidal antiinflammatory drugs (NSAIDs) may adversely affect the action of some medications for hypertension. NSAIDs have been found to cause elevated blood pressure in normotensive older adults. Many older adults take NSAIDs for musculoskeletal problems. These individuals should have their blood pressure closely monitored. The patient's Is overweight, but that alone does not explain the rise in blood pressure. The patient's intake of saturated fat and salt could improve, but without knowing lab values or diet history for a few days, just knowing that the patient consumes bacon or sausage at breakfast three times a week is not enough information to make that conclusion. The patient's blood pressure will continue to rise with age, but this pressure is far higher than baseline and reflects more than an age-relate

An 83-year-old patient with colorectal cancer has undergone chemotherapy for the disease during the past 24 months. The patient's recent computed tomography (CT) scan shows metastasis to the lungs and liver. The patient states "I am refusing anymore chemotherapy." The patient notes how debilitating chemotherapy it is to go through and is more interested in maintaining quality of life. The patient's son and daughter vehemently disagree with decision to refuse the chemo at this time. They are appealing to you for your help to make the patient receive chemo. What factor is priority consideration in this scenario? The patient's prognosis and expectation of morbidity The patient's autonomy and self-determination The patient's ability to consent to treatment and refusal to do so The family's wishes and ability to control the patient's health outcomes

Correct The patient's autonomy and self-determination Informed consent has developed from strong judicial deference toward individual autonomy, reflecting a belief that individuals have a right to be free from nonconsensual interference with their persons, and the basic moral principle that it is wrong to force others to act against their will. Self-determination is the principle that is operational in this scenario and the patient's right to determine what shall be done with his or her own body. The patient's prognosis and family wishes are not priorities. Nothing in the scenario suggests the patient has a handicap in terms of consenting to treatment or understanding treatment.

A resident of an assisted living facility has a sprained ankle from tripping on the sole of a shoe that had come apart while walking. Which intervention should the nurse implement first to try to resolve the pain? Administer two 325-mg acetaminophen tablets orally. Use rest, ice, compression, and elevation to treat the pain. Administer two tablets of codeine orally. Administer a 25-mcg fentanyl transdermal patch to the upper right arm.

Correct Use rest, ice, compression, and elevation to treat the pain. Nursing guidelines for approaching pain are to work with nonpharmacologic measures first; then, if needed, provide pain medications based on the patient's reported level of pain using the 0-to-10 scale. Applying the RICE mnemonic to treat the sprained ankle in the first 24 hours is the nonpharmacologic treatment of choice and is priority care in this scenario. If the pain level continues, the next step is to administer two mild analgesics, such as acetaminophen, tablets orally. Opioids are contraindicated for a sprained ankle.

Your older adult patient is looking for financial support to help maintain health and independence at home. You instruct the patient on entitlement programs, and the patient is listening carefully to their names, the types of support they provide, and how the patient might learn more to see if he or she qualifies for some assistance from them. What is one example of an entitlement program? Cash assistance from a family member Donating a dollar a month when you pay your gas bill Veterans Affairs Health Care Bathing services in your home twice a week

Correct Veterans Affairs Health Care Entitlement programs are available to older Americans and require the older adult to meet certain guidelines of income or disability to qualify. The Veterans Affairs Health Care System, also known as the VA, is an entitlement service offered to those who fought for the United States through the military. Because vets are living longer and medical costs have increased, currently priority care is given to those with war-related injuries or disease. The other programs are not entitlement programs. Cash from a family member is a gift or a loan. Donating a dollar a month on your gas bill will benefit someone, but that person may not be an older adult citizen. Bathing services in the home twice a week are not subsidized by any insurance program but are custodial services the patient pays for out of pocket.

The home care nurse assesses all patients for evidence of abuse. Which situation does the nurse report to the Adult Protective Services as the priority for further investigation? Guardian insisting on using patient funds to buy their needed food and supplies Volunteer caretaker leaving the adult alone when her child is sick at school Patient stating that adult child helping with toileting at the mall was embarrassing Family member grabbed the older adult's arm to prevent falling, leaving a bruise

Correct Volunteer caretaker leaving the adult alone when her child is sick at school While all situations have the potential to be considered abusive and should be assessed further, the most glaring example is the caretaker who leaves the older adult to pick up the child at school. This is abandonment if the adult was dependent on having someone present and no other arrangements were made. A guardian logically would want to use the older adult's funds (or insurance or other assistance) to buy needed items. While deliberately embarrassing someone would be psychological abuse, helping with toileting doesn't rise to that level. Trying to prevent harm from falling might lead to bruising.

Your patient has been receiving Social Security benefits and has recently started receiving Medicare insurance. The patient asks you what types of care are covered through Medicare. Which of the following is not covered under Medicare insurance? Doctor visits Hospitalization Durable medical equipment Working out at the local gym

Correct Working out at the local gym Medicare does not cover gym workouts. Medicare is a federal insurance program for individuals over 65 or those of any age who are disabled or who have chronic kidney disease. Part A, the hospital insurance, helps pay for inpatient hospital care and some follow-up care, such as a skilled nursing facility, home health services, and hospice care. Part B is medical insurance coverage and covers doctor visits, outpatient services, and durable medical equipment.

A gerontologic nurse is discussing nutrition and dietary needs with a new group of residents in an assisted living facility. Which statement by the nurse represents accurate information for this population? "Increase the amount of fat you eat every day when you enter your 70s." "Double the amount of fluids you drink to meet demands for hydration." "Decrease the number of calories you consume as you age." "Consume a 1-gram sodium diet if you have a history of heart disease."

Correct AnswerClose "Decrease the number of calories you consume as you age." The basal metabolic rate (BMR) decreases when one gets older, and so older adults need to decrease caloric intake to maintain their current weight. Eating the same amount of food when one has a lower BMR will result in weight gain. Increasing the amount of fat one eats is not recommended, as increases the risk for cardiovascular disease and will add pounds to the frame because fat has a higher calorie content than carbohydrates or proteins. Doubling the fluid intake is not recommended for older adults unless there is a clear reason to do so. Older adults should be encouraged to drink water or other noncaffeinated beverages every 2 hours instead of waiting until they are thirsty. The amount of fluid necessary to maintain normal hydration remains fairly constant into the older adult years. Eating less sodium is a good recommendation for everyone, but a 1-gram sodium diet is extremely restricted and for those who have heart disease, a sodium-restricted diet should be prescribed by a provider.

A new nurse in a community clinic that serves many refugees complains that many patients are noncompliant because they don't keep scheduled appointments, but then go to the Emergency department (ED) for common illness and injuries. What statement by the experienced community nurse would be most beneficial? "You're right; that is also driving up health care costs." "We should do community education on using the ED." "The refugees have a totally different time orientation." "Maybe we should investigate expanding our clinic hours."

Correct AnswerClose "Maybe we should investigate expanding our clinic hours." Although the nurse is correct in stating the refugees may have a different time orientation, that does not help solve the problem. Because they appear to be present-oriented and will seek care when a problem emerges, the clinic would serve the community best by expanding their hours. It is expensive to seek ED care for minor problems, but that statement does not offer any solution. Community education would also be beneficial, but it might prove difficult to change the refugees' time orientation.

An older adult has been in Intensive Care (ICU) for 24 hours for pneumonia when the family notifies the nurse of an acute change in the patient's mental status. The family member who stayed overnight noticed the patient didn't sleep and seemed worse as it became increasingly difficult to keep the patient's attention. What response by the nurse is best? "I will ask the provider to order a neuropsychiatric consultation." "Once the antibiotics start working, you should see an improvement." "Older people often become confused in intensive care units." "I'll try to limit the noise and activity outside the room."

Correct AnswerClose "Once the antibiotics start working, you should see an improvement." This patient has delirium which has a sudden onset, is worse at night, and involves a decrease in attention. It is always due to another cause, in this care pneumonia, and will resolve as the causative factor improves. A neuropsychiatric consultation is not warranted at this time. Older people may become confused in the ICU setting, but this statement does not provide the family with information and is dismissive of their concern. Limiting the noise and activity levels will certainly help but is still not a response that provides information and assurance.

The nurse assesses a patient who reports insomnia with the Epworth Sleepiness Scale. The patient scores an 8. What advise does the nurse give the patient? "Keep doing whatever it is you are already doing." "Don't drive until you can be evaluated by a doctor." "There might be a couple of things we can work on." "Sleeping pills are ok to try for up to a month."

Correct AnswerClose "There might be a couple of things we can work on." The Epworth Sleepiness Scale is scored from 1 to 24. Scores from 1 to 6 indicate adequate sleep. Scores from 7 to 8 are average. Scores 9 and over indicate severe sleepiness and indicates the patient needs evaluation. Since the patient's score is average, there might be a couple of things the nurse can help the patient implement to improve sleeping. Sleeping pills should only be used as a last resort, and generally not for over 2 weeks.

A family is complaining that another resident wanders the hallway loudly at night and frequently enters their loved one's room, interrupting his sleep. They ask the nurse to do something to control the other resident's behavior. What response by the nurse is best? "I'm sorry, there is nothing I can do about the other resident's behavior." "I will call the other resident's family and see if they will agree to sedating her." "We can try to keep the other resident distracted and busy during the night." "You can buy your family member some earplugs and demonstrate how to use them."

Correct AnswerClose "We can try to keep the other resident distracted and busy during the night." The Omnibus Budget Reconciliation Act (OBRA) requires nursing facility patients to be free of unnecessary drugs of all types, chemical restraints (commonly thought of as psychotropic drugs), and physical restraints. Chemical restraints are drugs used to limit or inhibit specific behaviors or movements. Physical restraints are appliances that inhibit free movement (e.g., limb restraints, vest, jackets, and waist belts). The drug use guidelines are based on principles that certain problems can be handled with nondrug interventions and that such forms of treatment must be ruled out before drug therapy is initiated. Drug therapy should not be used for environmental control. Nurses need to problem solve residents' problems in creative ways. The nursing staff should problem solve ways of keeping the resident from disturbing others during the night. Earplugs might be helpful, but will not keep the resident from entering other rooms and it should not be the family's responsibility to attempt to solve the problem

A community health nurse is studying how to promote a higher level of physical fitness in the older adult residents who reside in the nurse's community. Which of the following health promotion activities would improve the physical conditions of older adults who participated in the program? Teaching older adults about fall risk and prevention An awareness program about neighborhood safety A program that implements daily 30-45 minute walks A program to scan for osteoporosis

Correct AnswerClose A program that implements daily 30-45 minute walks A fitness program that implements walking as per recommended guidelines for older adults would do the most to benefit the physical fitness of these residents. Fall risk and prevention, neighborhood safety, and osteoporosis screening will not do as much to improve an older adult's physical fitness status.

A nurse is admitting a patient who requests a Do Not Resuscitate (DRN) order. The patient has metastatic cancer, is frail and weak, and has the following vital signs: BP 80/40 mmHg, pulse 126 beats/minute, respirations 26 breaths/minute, and a temperature of 102.8°F (39.3°C). The patient can only tolerate the head of the bed being raised to 30 degrees. What action by the nurse is the priority? Advise the health care provider of the DNR request by the patient. Request blood cultures and antibiotics to treat the patient's infection. Initiate an IV and begin treatment to rehydrate the patient. Ask the nursing assistant to provide frequent oral care and lip moisturizer.

Correct AnswerClose Advise the health care provider of the DNR request by the patient. As this patient is dying and expresses the wish for a DNR, the priority is to advise the health care provider of this first. The patient's unstable condition is notable. Getting the DNR signed by the patient and witnessed while the patient still can speak of his or her wishes is paramount. As the patient's advocate, the priority is clear. If the patient expires without a signed DNR or an institutional DNR assigned, institutional policy may suggest the need to implement cardiopulmonary resuscitation (CPR). This would create an ethical dilemma, when the patient verbalized DNR wishes to you. To avoid that conflict, facilitate the DNR while the patient's condition supports signing it. The nurse, patient, and health care provider need to agree on what further care the patient desires, such as IV hydration and antibiotics. Frequent oral care is a good intervention for a dehydrated patient, but is not the priority.

The nurse is supervising a student nurse working with an older adult patient. The nurse determines the student needs more education when the student provides which description of health promotion? An activity that helps seniors choose from a list of heart healthy activities to do. An activity for older adults that provides secondary prevention services. An activity where older adults can ask about the medications they are on. An activity that enriches the older adults' minds such as a book discussion club.

Correct AnswerClose An activity that helps seniors choose from a list of heart healthy activities to do. Health promotion is helping people change their lifestyles in order to live healthier lives. Walking and getting exercise regularly, eating a nutritious healthy diet and limiting fat and saturated fat intake daily, and wearing one's seat belt when in a car. The responsibility for health promotion activities lies with the individual. Secondary prevention aims to screen for and quickly diagnose conditions so that treatment can begin quickly. Asking about medications does not imply healthy lifestyle changes and is geared towards disease management. Intellectually enriching activities are important, but are not considered health promotion.

The nurse is admitting a 73-year-old Chinese patient. The patient speaks Chinese and has been newly diagnosed with a stage 4 glioblastoma. The patient was originally brought to the ED with confusion and combativeness, but now is calm. There are no family members. Which intervention is appropriate to foster communication with this patient? Ask an employee who speaks Chinese to come to the unit and act as translator for you. Call the number listed for your organization to send an appropriate interpreter to the unit. Try to communicate to your new patient by using picture boards. Ask the 10-year-old son of a Chinese patient down the hallway to help you.

Correct AnswerClose Call the number listed for your organization to send an appropriate interpreter to the unit. An interpreter is needed anytime the nurse and patient speak different languages, when the patient has limited English proficiency, or when cultural tradition prevents the patient from speaking directly to the nurse. In the United States, people who do not understand English have the right to an interpreter when dealing with health care providers. The more complex the decision making, the more important it is to have the interpreter present, as when determining an older person's wishes regarding life-prolonging measures. Sometimes a facility personnel member does act as interpreter. A translator, however, interprets written documents, not oral conversations. An interpreter is the best solution to this complex health care situation A 10-year old is probably not able to understand the complexities of the situation and would violate the patient's confidentiality. Another employee might work for an emergency but cannot be relied upon to interpret for all the patient's needs.

A resident who lives in an assisted living facility and the resident's spouse is upset that the facility has informed them it plans to transfer the resident to a skilled nursing care facility. The spouse and patient are crying because they do not want to leave. What does the nurse explain about involuntary transfers? They shouldn't worry about it because involuntary transfers are illegal under federal law. They should review their financial status to determine if they can still afford the resident's care. If the facility cannot meet the resident's needs, it has the right to transfer the resident elsewhere. Many states have laws that allow facilities to transfer residents without giving a reason.

Correct AnswerClose If the facility cannot meet the resident's needs, it has the right to transfer the resident elsewhere. The Omnibus Budget Reconciliation Act (OBRA) only allows a facility to transfer or discharge patients in the following situations: (1) if the facility cannot meet the patient's needs, (2) if stay at the facility is no longer required for the patient's medical condition, (3) if the patient fails to pay for the care as agreed to, and (4) if the facility ceases to operate. Since the transfer is occurring from an assisted living to skilled care, the resident most likely needs a higher level of care than the assisted living facility can provide

An older adult patient complains of overwhelming fatigue that begins when getting up from bed every morning and the inability to feel well rested. The patient's partner tells you the patient snores loudly and stops breathing at night, causing the partner to awaken the patient on several occasions. Which health problem should the nurse suspect? Insomnia Central sleep apnea Obstructive sleep apnea Periodic limb movement during sleep

Correct AnswerClose Obstructive sleep apnea In obstructive sleep apnea (OSA), airflow ceases because of complete or partial airway obstruction; respiratory efforts increase in an attempt to open the airway, which leads to snoring. The patient is awakened by the snoring and gasping, or by a partner. Sleep is disrupted, leading to fatigue during the day. Insomnia is an overarching term for the inability to sleep. Central sleep apnea is demonstrated by the lack of movement in the muscles of respiration. Periodic limb movement includes kicking during sleep.

The nurse is caring for a patient who needs immediate surgery for an acute illness. The patient refuses to state that she must have done something to anger God and is being punished. What action by the nurse would be most appropriate? Offer to contact someone from the patient's faith community. Explain why the operation is necessary and urgent. Get a court order to compel the patient to have the operation. Enlist family members to help you convince the patient

Correct AnswerClose Offer to contact someone from the patient's faith community. Patients who have magico-religious beliefs about health and illness might refuse treatment as being disrespectful to God, who is punishing them for some offense. Prayer, laying on of hands, burning candles, and wearing amulets are often used during times of illness. The nurse can offer to contact someone from the patient's faith community to deliver prayers or rites to help regain health. Of course, the patient needs full disclosure about the illness and operation, but that may not be enough to convince her. A court order would not be obtained for a competent adult who is allowed autonomy in decision making. If the family believes as the patient does, it is unlikely they will help persuade her. It would be best to attempt to incorporate her faith beliefs and practices into her care.

information to the older adult and family about driving? (Select all that apply.) Research has shown that making right-hand turns are difficult. Several factors related to driving should all be assessed. People with dementia often rate their driving skills as adequate. Driving during the day and in good weather are less risky practices Having a passenger to navigate is distracting and not encouraged.

Correct AnswerClose Several factors related to driving should all be assessed. People with dementia often rate their driving skills as adequate. Driving during the day and in good weather are less risky practices Driving in older age is a sensitive issue as the older adult's autonomy and freedom are tied to mobility. Multiple factors should be included in a comprehensive driving ability assessment. People with dementia were shown to continue driving even as their scores on cognitive tests declined. Older adults can make some driving modifications to improve safety such as driving only during the day and in good weather. A navigator can improve safety by allowing the driver to concentrate on the driving.

An older adult patient has had a cerebrovascular accident (CVA) with dysphagia. What type of care and treatment orders would the nurse expect for this patient? (Select all that apply.) Liquid at 11 AM and 3 PM All liquids thickened to nectar-thick Pureed diet Speech therapy referral Aspiration precautions Low-fat diet

Correct AnswerClose Speech therapy referral Aspiration precautions Dysphagia is a problem that often affects the nutritional status and can occur because of a CVA, oral or neck cancer treatment, or a neuromuscular or neurologic disorder. Dysphagia after a stroke can be successfully treated with swallowing exercises and retraining. Referral to a speech therapist is indicated for patients who display dysphagia. Aspiration precautions will be important for safety as the patient could aspirate even on saliva. The speech therapist will determine what the patient's needs are for food and fluid consistency. The nurse should not provide liquid at only 2 specified times during the day, plus that order is vague as to how the liquids are to be provided. A low-fat diet is not indicated.

Which of the following health interventions represents a health promotion activity? Providing preoperative teaching to an older adult patient who will receive a mitral valve replacement Teaching an older adult patient how to effectively use a metered dose inhaler for asthma Administering an anticoagulant and an analgesic to an older adult with osteoarthritis Teaching an exercise class to older adult residents in an assisted living center

Correct AnswerClose Teaching an exercise class to older adult residents in an assisted living center Teaching an exercise class for older adult residents is the best example of health promotion. Health promotion facilitates the maintenance of optimal health, and the health-promoting and health-preserving benefits of exercise are well known. Teaching a patient about upcoming surgery, how to use their inhaler with good technique, and administering drugs to a patient are traditional nursing interventions and represent disease treatment and management functions.

The patient is an 80-year-old patient who has degenerative joint disease/osteoarthritis. The patient is waiting for joint replacement surgery in 3 months. The patient is taking pain medication which limits the pain, but also causes unsteadiness when standing or walking. A cane is helping maintain balance, but the patient shares with you, the nurse, feelings of instability and a fear of falling. After assessing the patient, which resource should you reach out to first in order to help the patient remain at home prior to the upcoming surgery? The patient's adult daughter who lives in another state. The patient's adult son who lives in the neighboring suburb. A neighbor who has the key to the patient's home for use in an emergency situation. The patient's older adult sister who lives in a neighboring state.

Correct AnswerClose The patient's adult son who lives in the neighboring suburb. Families play a significant role in the lives of most older persons. Most older people who need long-term care remain at home. This means most care for the older adult is provided in the home environment. Community services are used only when a family's resources have been depleted. Based on this information, you would first call the son who lives close by and assess his ability to provide the care needed to maintain the patient in the home until surgery, during surgery, and after the patient is transferred to an extended care facility for rehabilitation (as well as to provide home health support when the patient returns home). The patient's daughter and older sister should not be called first since they live out of state. The neighbor should not be called first unless the patient has indicated them as a point of contact for medical care

The older adult patient is a new insulin-dependent diabetic and has the flu. The patient has been vomiting for the past 4 hours. The patient's most recent blood glucose was 312 mg/dL. When the patient calls the nurse practitioner, what instruction is best? "Drink 8 ounces of water every hour you have nausea and vomiting." "Drink 8 ounces of regular soda every hour you have nausea and vomiting." "Drink 8 ounces of diet soda every hour you have nausea and vomiting." "Drink sugar-free Gatorade every hour you have nausea and vomiting."

Correct "Drink 8 ounces of regular soda every hour you have nausea and vomiting." The practitioner should instruct the patient to drink 8 ounces of regular soda every hour if the regular diet cannot be tolerated. This will provide carbohydrates to prevent hypoglycemia. Sugar-free beverages should be used to supplement the carbohydrate source.

A nurse is teaching an older adult patient complaining of constipation some general care interventions that can be implemented to provide the best possible bowel movement and regularity. Which of the following factors would the nurse include in these instructions? (Select all that apply.) "Eat a diet high in fiber by choose five servings of fresh fruit and vegetables daily." "Drink plenty of fluids, aiming for 2 quarts minimum daily and water liberally." "Get regular exercise, ideally at least 30 minutes three times a week or more." "Develop a regular toileting program and respond to the urge to defecate." "Take a laxative every day so your bowels move regularly." "Use a suppository a few times a week to ensure complete emptying of the bowel contents."

Correct "Eat a diet high in fiber by choose five servings of fresh fruit and vegetables daily." "Drink plenty of fluids, aiming for 2 quarts minimum daily and water liberally." "Get regular exercise, ideally at least 30 minutes three times a week or more." "Develop a regular toileting program and respond to the urge to defecate." Constipation is treated through dietary measures, such as increasing fluid intake and fiber, combined with light exercise and development of a regular toileting routine that includes responding to the urge to defecate. In teaching older adults about dietary changes, the nurse can instruct them that fiber need not be a medicine; it can be a food. A nurse would not instruct a patient to take a daily laxative or weekly suppository without a physician's order or before initiating these other care interventions.

The mobility, activity tolerance, and overall quality of life of an 82-year-old patient are severely diminished by the shortness of breath resulting from the patient's chronic obstructive pulmonary disease (COPD). The patient now lives with a daughter and son-in-law, both of whom are unsure of how to meet the patient's needs at home. Which of the following teaching points is most appropriate? "Do as much as possible for your dad so he doesn't get too short of breath for activity." "Remind your dad of current limitations and that you don't expect more." "You'll all get by, and the patient will get what is needed if you work together." "Have your dad do whatever he can do independently and continue to encourage him."

Correct "Have your dad do whatever he can do independently and continue to encourage him." Therapeutic regimes emphasize activities that build endurance and self-reliance and that facilitate self-care and quality of life. Older adults and their families must believe that a therapeutic regime aids in recovery or maintenance of the patient's functional level. Encouraging patients to do what they can independently encompasses the spirit of that approach. Doing everything for the patient and reminding the patient of limitations doesn't encourage health maintenance. Saying that "you will all get by" is dismissive of the family's concerns.

The nurse is discussing palliative care with a patient and family. The daughter becomes upset and says, "My parent is not dying!" What response by the nurse is best? "You are confusing hospice with palliative care." "Palliative care focuses on symptom management." "You're right, your dad is not dying so please don't be upset." "I'm sorry, but palliative care requires a terminal diagnosis.

Correct "Palliative care focuses on symptom management." Palliative care is a broad concept that is aimed at reducing and managing distressing symptoms. It does not require a terminal diagnosis, but it is not aimed at curing the patient. Hospice patients require certification from their provider stating they have a likely 6-month life span. Asking the daughter to not be upset is focusing on the response, not the miscommunication.

An older adult patient has developed thrombocytopenia as a consequence of a recent round of chemotherapy for cancer. Which of the following nursing instructions will help prevent injury to the patient's skin and mucous membranes? "Use an electric razor." "Use a firm toothbrush." "Take all temperatures rectally." "Use a nail clipper for nail care."

Correct "Use an electric razor." An electric razor will remove hair and decrease the risk of skin nicks with bleeding. A soft bristle toothbrush, nail file, and avoiding rectal thermometers, suppositories, or enemas are further recommendations the nurse would teach the patient who is thrombocytopenic post chemo.

The nurse working with older adults who have disabling conditions understands what information about stigma? (Select all that apply.) An unknown etiology can increase stigma Patients may place a stigma upon themselves Youth and attractiveness are valued in society Chronic diseases are rarely stigmatized Accomplishments are not related to stigma

Correct An unknown etiology can increase stigma Patients may place a stigma upon themselves Youth and attractiveness are valued in society Individuals with chronic, disabling, or disfiguring conditions are often stigmatized by society or by themselves. Diseases with unknown etiologies generate fear and stigma. Youth and attractiveness are valued by society, so those who are not young or attractive are often stigmatized. Personal accomplishments lead to acceptance and the lack of accomplishments also contributes to stigma.

A nurse at the local wellness center is assisting with exercise for a group of older adults. For which of the following should the nurse immediately call 9-1-1? A participant who complains of being weak, diaphoretic, and hungry A participant who complains of muscle cramping and pain A participant who is unable to speak and is off balance A participant who complains of hand tremors and is drooling

Correct A participant who is unable to speak and is off balance The warning signs of a stroke are sudden numbness of face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking or dizziness, loss of coordination or balance; sudden severe headache with no known cause. This requires 9-1-1 intervention and evaluation in an emergency room. A participant who complains of hand tremors and is drooling suggests someone who may have Parkinson's disease and may want to take a short break. A participant who complains of being weak, diaphoretic, and hungry describes a person who might benefit from some orange juice or a diabetic in need of carbohydrates. A participant who complains of muscle cramping and pain describes a person who is cramping and needs to stop and rest, after which the cramp should subside. Such patents may want to exercise a bit slower if they have not exercised in

You are employed on an oncology unit and are familiar with palliative care goals. A patient is admitted with a diagnosis of colon cancer with liver metastasis. The patient tells you the pain is a 9 on a scale of 0-10. What type of analgesic program would you expect to have available for the patient to best relieve the pain? A stepped-care pain management plan with medication choices for mild, moderate, and severe pain complaints A pain medication that is delivered routinely at timed intervals around the clock to provide baseline pain management Pain medications for use as needed to supplement breakthrough pain Colace, MiraLax, and a Dulcolax suppository ordered to treat constipation

Correct A stepped-care pain management plan with medication choices for mild, moderate, and severe pain complaints Pain is prevalent among individuals who are dying and can have a powerful, negative effect on a patient's quality of life. The pain experience is complex, and its management often difficult. A stepped-care approach is recommended, with the use of aspirin or acetaminophen for mild pain, a moderate opiate such as codeine or oxycodone for more constant pain, and a strong opiate such as morphine for severe pain. Pain medication should be given around the clock to promote stable blood pressure levels. A pain medication that is delivered routinely at timed intervals around the clock and pain medications for use as needed to supplement breakthrough pain are included in the stepped-care pain management approach. Colace, MiraLax, and a Dulcolax are not a pain management options.

A nurse is caring for a patient who had a total hip replacement 3 hours earlier who was just transferred from the Post Anesthesia Care Unit. Which observation would require immediate intervention by the nurse? A surgical drain that is lying on the transfer sheet not located inside of the wound A hip dressing that is intact with serous drainage in an area that is 3 cm × 2.5 cm An intravenous (IV) site that is clean, dry, and intact with D5.45NS running by pump at 75 cc/hr An oral temperature of 96.9°F with good pedal and popliteal pulses to the lower extremities

Correct A surgical drain that is lying on the transfer sheet not located inside of the wound A drain that is not inside of the wound and lying freely in the bed warrants immediate attention. The surgeon is paged and will place the drain and secure it so it can drain the wound and keep it infection free. The nurse circles the drainage and initials, times, and dates the dressing. The nurse uses it to monitor drainage for the shift and reports using the site as a reference point in report at the end of the shift. A hip dressing that in intact with serous drainage in an area that is 3 cm × 2.5 cm, intravenous (IV) site that is clean, dry, and intact with D5.45NS running by pump at 75 cc/hr, and an oral temperature of 96.9°F with good pedal and popliteal pulses to the lower extremities is not the first priority of the nurse.

A student nurse is teaching an older adult patient that medications can contribute to constipation. Which medications mentioned by the student require the Registered Nurse to review the material with the student? (Select all that apply.) Aluminum-containing antacids Lactulose Antidepressants Morphine Calcium channel blockers Digoxin

Correct Aluminum-containing antacids Antidepressants Morphine Calcium channel blockers The following types of medications can contribute to constipation: aluminum- and calcium-based antacids, antidepressants, narcotic pain medications and calcium channel blockers, as well as iron preparations, anticholinergics, antipsychotics, and overuse of laxatives. Lactulose, when used as prescribed, can aid in the relief of constipation. Digoxin does not contribute to constipati

A nurse in a long-term care facility is observing a newly licensed nurse care for a patient with urinary incontinence. What action by the new nurse requires the supervising nurse to intervene? Prepares to measure residual urine volume after the patient voids. Assesses cognitive status prior to recommending a bladder diary. Educates the patient on overflow incontinence for post-void residuals of 75 mL. Places a confused patient on a toileting schedule and delegates this to the aides.

Correct Educates the patient on overflow incontinence for post void residuals of 75 mL. A post void residual (PVR) >100 mL is the hallmark of overflow incontinence. The supervising nurse would intervene if the new nurse taught a resident about this condition when PVRs were less than that amount. The other actions are correct.

A nurse is planning for the care of an older adult patient who has been hospitalized with bacterial pneumococcal pneumonia infection. Which interventions need to be included in this plan? (Select all that apply.) Accurate intake and output Contact isolation precautions Monitoring of WBC levels Restrict fluids Strict hand hygiene procedures Proper disposal of respiratory secretions

Correct Accurate intake and output Monitoring of WBC levels Strict hand hygiene procedures Proper disposal of respiratory secretions Infection control measures should be in place to reduce the risk of illness. Hand washing, monitoring fluids and nutritional intake, and proper disposal of bodily secretions help to manage the spread of infection when it does occur. Fever and inflammation may be reduced, whereas the WBC can still reflect an increased value with infection of an older adult. Contact precautions are not required. Fluids should be encouraged unless another condition prohibits this.

A home care nurse is conducting a home assessment evaluation for an older adult's bathroom. Which findings should the nurse identify as safety issues for the patient? A tub bench in the bathtub Diffuse lighting in the bathroom A liquid soap bottle for the bathtub and sink The absence of grab bars

Correct AnswerClose The absence of grab bars General fall prevention guidelines for the older adult's bathroom include grab bars in the tub, in the shower, and near the toilet. A tub bench in the bathtub ensures a patient a place to sit during a shower and decreases the risk of falls. Good lighting helps the patient see better in the bathroom, and diffuse lighting is often better than one direct light source. Bar soaps should be replaced with liquid soaps.

A home health nurse is completing a home assessment for safety risks for a new older adult patient. Which one of the following home observations is in most need of modification? The temperature of common area rooms is kept at 72°F. Carpeting is glued down with no holes or frayed edges and tile floors are intact. An area rug is placed in front of the sink and toilet in the patient's bathroom. A three-prong grounded extension cord is in good condition.

Correct e An area rug is placed in front of the sink and toilet in the patient's bathroom. Area rugs present a fall risk and should not be used by the older adult in the bathroom. The nurse should identify the risk, instruct the patient to remove the area rug, and ensure that the patient verbalizes an understanding of these instructions. On the second visit, the nurse (or another member of the health care team) should make sure that the rug was removed so that the risk is eliminated. The temperature is pleasant and comfortable and presents no risk. The glued-down carpeting is not movable and does not present a fall risk. The three-prong extension cord is in good condition and out of a common pathway, so it does not present a fall risk.

A 69-year-old patient is admitted with acute irritable bowel syndrome. The patient's albumin level was 3 g/dL and transferrin level was 132 mg/dL. How does the nurse explain the results to the nursing student? The patient's liver is synthesizing protein well and has no protein depletion. The patient's liver is synthesizing protein well and has mild protein depletion. The patient's liver is not synthesizing protein well and has moderate protein depletion. The patient's liver is not to synthesizing protein well and has severe protein depletion.

The patient's liver is not synthesizing protein well and has moderate protein depletion. Serum albumin is the serum protein most frequently cited in reference to malnutrition; it reflects the liver's ability to synthesize plasma protein. Albumin has a half-life of about 21 days, so it does not always reflect a patient's current nutritional status. Albumin levels can also be affected by immune status and hydration. Given these limitations, albumin levels below 3.5 g/dL may indicate some degree of malnutrition. Transferrin is a carrier protein for iron and has a shorter half-life of 8-10 days. It is a more rapid predictor of protein depletion. Levels below 200 mg/dL may indicate mild to moderate depletion. Levels below 100 mg/dL may indicate severe depletion.