NURS 421 Final

What contributes to neuron death & may progress to Alzheimers?

B-amyloid

An older adult has fewer nephrons in the kidney and therefore a decreased glomerular filtration rate (GFR) than their younger counterparts. This causes issues with: A. Drug excretion B. Drug metabolism C. Drug absorption D. Drug pharmacokinetics

A. Drug excretion

The nurse is teaching a community caregiver about common renal issues in older adult patients. Which statements made by the caregiver indicates the need for further teaching? Select all that apply. A. "Thirst response increases in patients as they age." B. "Dehydration increases in patients as they age." C. "Excretion of drugs and toxins increases in the patient." D. "Hyponatremia increases in the patient." E. "Hyperkalemia increases in patients as they age."

A and C

The nurse is evaluating the statements made by the caregiver about methods to decrease social isolation by an older adult patient. Which statement made by the caregiver indicates a need for further teaching? Select all that apply. A. "I should send the patient to a nursing home." B. "I should ask for the patient's opinion during family discussions." C. "I should encourage the patient to participate in community activities." D. "I should encourage the patient to attend rehabilitation centers." E. "I should encourage the patient to sleep for prolonged hours in his or her room."

A and E

An older male patient has disclosed to the nurse his recent inability to achieve an erection. How should the nurse respond to the patient's statement? A) "It's not unusual for older men to have the problem occasionally, but we need to make sure that it's not the result of something we can change." B) "This is a very normal part of the aging process. Are there other ways of achieving sexual fulfillment that you and your wife could try?" C) "It's a myth that older men have difficulty gaining and maintaining erections, so a thorough medical investigation is likely the best plan." D) "This is often an unintended result of medications. Try withholding your medications for a few days and see if the problem resolves itself."

A) "It's not unusual for older men to have the problem occasionally, but we need to make sure that it's not the result of something we can change."

A nurse taking care of a patient receiving palliative care feels that the patient is uncomfortable with the caregivers' choices. What course of action should the nurse take to alleviate the feeling of moral distress when even the primary health-care provider agrees with the caregivers? A. Discuss the situation with other nurses. B. Discuss the situation with the patient. C. Discuss the situation with the caregivers. D. Discuss the situation with the primary health-care provider.

A. Discuss the situation with other nurses.

A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session? A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age. B) Older adults require simplified learning objectives and slower introduction of new directions. C) Simple association is well executed by older adults but complex analysis is normally absent. D) Successful learning late in life requires a multisensory teaching approach.

A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age.

A nurse is attending to the caregivers of a patient in the palliative care unit who has just died. The nurse notes that the patient belongs to a different culture than he or she. Which statements made by the nurse conform to the appropriate method of communicating with the patient's caregivers? Select all that apply. A. "Please tell me about your funeral practices." B. "Would you like to share anything about the process of grieving in your community?" C. "Tell me about the way in which suffering is dealt with in your community." D. "Please share the dietary preferences of your community." E. "Would you like to talk about the health-care practices followed by your community?"

A, B , and C

The nurse understands that moral distress may result in which of the following? (Select all that apply.) A. Physical exhaustion B. Disagreements among staff C. Anger at family D. Anger at providers E. Feelings of undeserved power

A, B, C, D, and E Rationale: All of the cited examples may be a result of moral distress.

Palliative care is appropriate in which of the following situations? (Select all that apply.) A. The patient is undergoing cancer treatment. B. The patient is diagnosed with congestive heart failure. C. The patient is dying. D. The patient is dependent on technology. E. The patient is not imminently dying.

A, B, C, D, and E Rationale: Palliative care is appropriate for patients at the time of initial diagnosis, even if death is not immi- nent, during the course of active treatment, dependent on technology such as dialysis or artificial ventilation, and for patients who are dying because it focuses on the relief of suffering and promotion of quality of life.

The nurse is concerned that an older patient with renal failure is developing malnutrition. What did the nurse assess in this patient? (Select all that apply.) A) Hematocrit level 30% B) Hemoglobin level 7 g/dL C) Serum albumin level 2.5 g/100 mL D) Blood glucose level 110 mg/dL E) Weight loss of 6% over the last month

A, B, C, and E Rationale: Clinical signs of malnutrition include a weight loss of greater than 5% over the last month, a serum albumin level lower than 3.5 g/100 mL, hemoglobin level below 12 g/dL, and hematocrit level below 35%. Blood glucose level is not used as a clinical indicator of malnutrition.

Nursing care priorities at the end of life include which of the following? (Select all that apply.) A. Communication with the patient and family B. Encouraging the family to get rest C. Rationalizing the patient's pain D. Managing pain and other distressing symptoms E. Providing education about the dying process

A, B, D, and E Rationale: Rationalizing pain is incorrect—we need to treat pain in the dying patient.

Mrs. Jones is receiving hospice care in the nursing home. During the assessment, the nurse observes the patient is unconscious and has wet, noisy respirations and cool, mottled extremities. The nurse understands which of the following actions are indicated? (Select all that apply.) A. Notifying the patient's family B. Requesting an order for an anticholinergic medication C. Notifying the patient's provider D. Performing a sternal rub to assess the patient's response E. Performing a full systems assessment

A, B, and C Rationale: Unconsciousness is not unexpected inthe patient in hospice care. Performing a painful assessment strategy would be inappropriate and performing a full system assessment would be unnecessary as death is expected. We would wantto notify the family and provider of this change and an order for an anticholinergic medication is appropri- ate to help reduce noisy respirations by drying up secretions.

During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply. A) The woman's overall proportion of body water has decreased. B) The client has experienced a loss of cartilage. C) The woman's thyroid hormone levels have declined since the sixth decade. D) The client's vertebrae have thinned. E) Loss of stature is a consequence of the woman's diet. F) The woman's long bones have decreased in length.

A, B, and D

Which parameters can be assessed in an older patient using the Mini Nutritional Assessment (MNA) scale? Select all that apply. A. Mobility B. Body weight C. Body balance D. Psychological stress E. Cognitive impairment

A, B, and D

A student nurse observes caregivers in a long-term care facility where she is employed. Which observations might indicate abusive behavior? (Select all that apply.) A) Failing to close bedside curtains during care activities. B) Use of physical restraints to decrease wandering behavior. C) Providing extra snacks as a reward for good behavior. D) Laughing and talking with co-workers while providing care. E) Speaking negatively about an older adult while in the break room. F) Responding slowly to the call light of a demanding older adult.

A, B, and F

The nurse is evaluating the neurological features of an older adult patient. Which findings would alert the nurse that the patient may have delirium? A. Hypervigilant alertness B. Progression of the condition is slow but even C. Difficulty in distinguishing reality D. Duration is hours to less than a month E. Recent and remote impairment of the memory

A, C, and AD

Which changes lead to constipation in a geriatric patient? Select all that apply. A. Decreased rectal wall sensitivity B. Slow gastric emptying C. Delayed colonic transit D. Decreased colonic contraction strength E. Impaired gastric mucosal barrier function

A, C, and D

Which is true regarding stress-reducing strategies that nurses can implement when providing end-of-life care to patients? Select all that apply. A. Perform postmortem care as a team. B. Refrain from discussing concerns with nursing colleagues when involved in stressful care situations. C. Pause for a moment of silence during the monthly staff meeting to remember those who have died on the ward. D. Refrain from sending a bereavement card to the family member. E. Take part in any employer-provided counseling services.

A, C, and E

Which of the following client statements regarding self-medication administration by an older-adult client requires follow-up teaching by the nurse? A. "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them." B. "I have one pill that needs cut in half. I am going to ask the pharmacist to do that for me." C. "The pharmacist said to keep my pills away from the sunlight, so I put them inside the kitchen cabinet." D. "My daughter comes over each morning and puts my pills into a container that sorts them by the time they are due."

A. "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them."

The nurse suggests that hospice care might be a good option for a dying client. A family member responds negatively to this suggestion, stating "I don't want her to die in a nursing home!" The nurse's best response is: A. "The client can remain in the home with hospice care." B. "The hospice facilities allow visitors." C. "Hospice care will require hospitalization until the time of death." D. "Hospice care will allow the client the best chance of recovery."

A. "The client can remain in the home with hospice care."

The nurse planning to assess the structure of a family should ask which question? A. "Who lives with you in this home?" B. "Who does the grocery shopping?" C. "Who provides support in your family?" D. "How old are the members of your family?"

A. "Who lives with you in this home?" Rationale: The structure of the family includes who is in the family and what their relationship is.

Which patients seen by a nurse working in the emergency department identify a situation that suggests a case of elder mistreatment? A. An 86-year-old patient who has three dime-size burned areas on the upper inner thigh B. A 77-year-old patient who fell at home after tripping over the dog and broke an arm about 30 minutes earlier C. A 73-year-old patient with a history of gastric ulcers who is found to be anemic after vomiting blood 3 hours earlier D. An 85-year-old patient who has several small areas of bruising on the back of the hands and is taking medication for platelets and coagulation

A. An 86-year-old patient who has three dime-size burned areas on the upper inner thigh

A nurse is collecting data from an older adult client who had a right-sided stroke two days ago. For which of the following findings should the nurse notify the provider immediately? A. Increased restlessness B. Weak grip on the left side C. Decreased sensation in the lower left extremity D. Absent gag reflex

A. Increased restlessness

The nurse is providing care to an unconscious client who is dying and anticipates impending death when assessing the clinical manifestation of: A. Mottling and cyanosis of the trunk and extremities. B. Improved appetite. C. Regular, shallow respirations. D. Faster but weaker pulse.

A. Mottling and cyanosis of the trunk and extremities.

A nurse is assisting with the care of an older adult client who has dementia. The client becomes agitated and confused at night and wanders into the hallway. Which of the following actions should the nurse take? A. Place the client's mattress on the floor B. Restrain the client during the nighttime hours C. Provide continuous orientation to the client D. Turn out the lights in the client's room at night

A. Place the client's mattress on the floor

Which of the following statements related to cognitive functioning in the older client is true? A. Reversible systemic disorders are often implicated as a cause of delirium. B. Cognitive deterioration is an inevitable outcome of aging. C. Delirium is very easily distinguished from irreversible dementia. D. Therapeutic drug intoxication is a common cause of senile dementia.

A. Reversible systemic disorders are often implicated as a cause of delirium.

While bathing an elderly client who has limited abilities for self-care, the nurse notices several patches of dry skin on the clients heels, elbows, and coccyx. The nurse cleans and dries all the areas well and applies a moisturizing lotion. The most appropriate immediate follow-up by the nurse to ensure appropriate nursing care for this clients skin is to: A. Revise the client's care plan to show the need for the application of moisturizing lotion B. Assume personal responsibility to apply the moisturizing lotion daily to the client's skin C. Encourage the client to tell whomever bathes her to apply the moisturizing lotion to her areas of dry skin D. Inform the staff that the client's skin is showing signs of breakdown and moisturizing lotion needs to be applied daily

A. Revise the client's care plan to show the need for the application of moisturizing lotion

A nurse at a long-term care facility is assisting with planning care for a group of older adult clients. When planning care, the nurse should consider that older adult clients are most likely to exhibit a decrease in which of the following? A. Short-term memory B. Creative ability C. Decision-making skills D. Cognitive capacity

A. Short-term memory

You are the nurse on-call and receive a call from a continuous care nurse who states that her patient (who is terminal and has a DNR order) has started to have rattling secretions and the patient's wife is very concerned. You know from report that this patient's death is expected to be imminent. What would be the most appropriate response? A. Suction the patient B. Put the patient in the reverse Trendelenberg position C. Sit the patient up in the chair D. Start the patients oxygen

A. Suction the patient

A postsurgical patient is admitted to a palliative care facility due to physiological complications. The patient develops respiratory distress during the active dying phase. What is the first step that the nurse should take in this situation? A. The nurse should elevate the head of the bed. B. The nurse should administer opiates such as morphine. C. The nurse should surround the patient with familiar sights, sounds, and smells. D. The nurse should notify the family members since the patient is in end-of-life care.

A. The nurse should elevate the head of the bed. Rationale: This intervention will help relieve respiratory distress.

The nurse understands the use of morphine sulfate to treat symptoms may result in which of the following? (Select all that apply.) A. Improved mobility B. Relief of pain C. Slowing of respirations D. Relief of nausea E. Improved appetite

B and C Rationale: The use of morphine will not improve mobility or appetite. It does not relieve nausea, but it will relieve pain and slow respirations.

Which statement made by a patient is an example of "Cultural Aspects of Care" domain of palliative care? Select all that apply. A. "I am anxious because I don't know what will happen to my family after my death." B. "Our community does not believe in blood transfusion." C. "I am suffering because God is angry with me." D. "Please do not include nonvegetarian items in my diet as it is against my tradition." E. "In our community, we do not burden children with medical information."

B, D, and E

An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns? A) "It's inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency." B) "It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously." C) "As you age, it's common for your heart rate becomes less regular and this often results in fatigue." D) "The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young."

B) "It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously." Rationale: Cardiac contractility decreases as a part of normal aging.

A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client's prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest: A) Prostate cancer B) A risk of malignancy that should be followed up C) A normal age-related change unlikely to have consequences D) A urinary tract infection

B) A risk of malignancy that should be followed up Rationale: Prostatic enlargement is exceedingly common among older men, but represents a risk of malignancy that necessitates further assessment and follow-up.

A healthy older patient is experiencing sleep problems. What should the nurse instruct the patient about the influence of aging as it relates to sleep? A) As people age, most of them require fewer hours of sleep. B) The normal aging process has minimal effect on the quantity of sleep. C) Older adults are no longer bothered by noise and lights during the night. D) Older people sleep more soundly but awaken more often during the night.

B) The normal aging process has minimal effect on the quantity of sleep.

An older patient takes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for self-treatment of arthritis. For which nutritional health problems will the nurse include when assessing this patient? (Select all that apply.) A) Thirst B) Nausea C) Diarrhea D) Vomiting E) Constipation

B, C, D, and E

A 76-year-old adult female is brought to a neighborhood client after being found wandering around the local park. The client appears disheveled and reports being hungry. Which of the following assessment and interview findings would cause the nurse to suspect elder abuse? (Select all that apply.) A. Falls asleep in the examination room B. Repeatedly states, "Don't hurt me." C. Chafing around wrists and ankles D. Bruises in various stages of healing

B, C, and D

The nurse who cares for patients at an assisted living facility is planning a program to address safer sex in older adults. Why would this program be important? (Select all that apply.) A) Susceptibility to sexually transmitted infections (STIs) increases with age. B) HIV/AIDS is spreading more quickly among older adults than among younger adults. C) Older adults frequently forego condom use because the risk of pregnancy does not exist. D) Many older adults assume that STIs are problems of younger adults only. E) Because of the hormonal changes that accompany menopause, older women are in fact more prone to sexually transmitted diseases than younger adults.

B, C, and D

Which is true regarding aspects of a well-managed death of a patient in the end stages of life? Select all that apply. A. It includes clear communication about decisions made only by the primary health-care provider. B. It includes adequate preparation for death for both the patient and loved ones. C. It includes appropriate pain and symptom management. D. It includes avoiding a prolonged dying process. E. It includes reminding the patient about all the bad things that he or she has done in a lifetime, and not affirming him/her as a worthy person.

B, C, and D

A nurse is caring for the family of a patient receiving palliative care. Which points should the nurse remember while consoling the family of the patient? Select all that apply. A. Refrain from informing the family that the patient is in the final stage of life. B. Encourage the family members to talk with the patient over the phone, if they are unable to make it to the health-care unit. C. Evaluate the family's understanding of the patient's diagnosis and end-of-life care. D. Refrain from involving the family in the daily activities of the patient. E. Suggest the family bring in the patient's favorite music, quilts, and family pictures.

B, C, and E

What are common manifestations found in the older adult related to perfusion? Select all that apply. A. Decrease in BP B. Increase in workload of myocardium C. Decrease in cardiac output D. Increase in BP upon standing E. Increase in arterial stiffening

B, C, and E

Efforts to support family members include which of the following? (Select all that apply.) A. Assuring them that the end is near and it is okay to go home B. Encouraging final private conversations with the patient C. Asking them to bring a few of the patient's favorite things to her room D. Telling them to encourage the patient to hold on for them E. Encouraging active discussions about favorite family memories

B, C, and E Rationale: Sending the family home is inappropriate unless they desire to leave; encouraging the patient to hold on may prolong the dying process; encour- aging private conversations, family discussions, and bringing favorite things from home helps relieve anxiety.

A patient is admitted to the palliative care unit after undergoing multiple bowel resection surgeries. The patient tells the nurse, "I wish to speak to a priest as my soul needs cleansing." Which statement made by the nurse in answer to the patient's request needs correction? A. "I will engage the services of the priest from the local church." B. "A priest does not provide scientific solutions to health problems." C. "What kind of priest would you like to consult with?" D. "Please share your spiritual distress with me. Maybe I will be able to help."

B. "A priest does not provide scientific solutions to health problems."

Mr. Smith's wife is in the terminal stage of chronic obstructive pulmonary disease (COPD). He is very anxious that his wife be comfortable during her last hours. The nurse finds him tearful in the hall outside the room. Which communication should the nurse use first? A. "My aunt had COPD, and she died on a ventilator. Count your blessings that your wife is not on a machine." B. "I can see you're upset, Mr. Smith. Would you like to talk about it?" C. "Is your family here?" D. "Do you think your wife would like a visit from pastoral care?"

B. "I can see you're upset, Mr. Smith. Would you like to talk about it?" Rationale: As a nurse, we would not want to make light of a family member's anxiety. Initiating a conver- sation with Mr. Smith might relieve some of his anxi- eties. We can then refer to other support services as necessary.

While educating the daughter of a client with dementia about the illness, the daughter complains to the nurse that her mother distorts things. The nurse understands that the daughter needs further teaching about dementia when she makes which statement? A. "I understand the misperceptions are part of the disease." B. "I tell her she is wrong and then I tell her what's right." C. "I turn off the radio when we're in another room." D. "I tell her reality, such as, 'That noise is the wind in the trees.'"

B. "I tell her she is wrong and then I tell her what's right."

Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse? A. "I get so frustrated because my father used to be so competent and now cannot feed himself." B. "My dad wanders at night and I can't be bothered with him, so I mix sleeping pills in his dinner so that he will fall asleep" C. "Mom asks me to do everything for her, but I think it is better if she keeps doing as much as she is capable of." D. "Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills."

B. "My dad wanders at night and I can't be bothered with him, so I mix sleeping pills in his dinner so that he will fall asleep"

A gerontological nurse at a nursing home conducts a reminiscence therapy group forresidents with confusion. A member of the group stands up and says, "I just heard my cow. I have to go and milk her now." The nurse's most therapeutic response is: A. "All right, you may leave the group now." B. "Please tell us about your cow." C. "That wasn't a cow; maybe you heard a vacuum cleaner." D. "You live here at the nursing home now, not on the farm."

B. "Please tell us about your cow."

A 78-year-old wealthy white widow lives in a luxury high-rise condominium with her son. She has mild cognitive impairment and needs moderate assistance with activities of daily living. She is admitted to the hospital for pneumonia and is noted to have burns on her upper back. The son states that the patient burned herself when attempting to take a shower. The nurse presents the patient in interdisciplinary rounds, and a discussion ensues on elder mistreatment. Which statement by a member of the team reflects the nurse's need for further education? A. "Even if we are not sure, we should report our suspicions." B. "This could not possibly be elder abuse. She is white and wealthy, abuse does not happen in these circumstances." C. "The incidence of abuse increases with the increased time needed by the caregiver to provide care." D. "Most abusers are either adult children or spouses."

B. "This could not possibly be elder abuse. She is white and wealthy, abuse does not happen in these circumstances."

As an experienced palliative care nurse, your response to Mrs Kelso's nurse when expressing concern that giving pain medication and sedatives may hasten patient death is which of the following? A. "Don't worry, we do this all of the time." B. "We are covered ethically by the principal of double effect." C. "Don't worry, we have a doctor's order." D. "We are covered ethically by the principal of beneficence."

B. "We are covered ethically by the principal of double effect." Rationale: Although the use of morphine in this sit- uation is common, the palliative care nurse should provide a better explanation than "we do this all of the time" or "we have a doctors order" in order to help the nurse understand the situation. It is ethi- cally correct but not because of the principal of beneficence, which means doing or promoting good. Although reliving pain is doing good, the principal of double effect "covers" the nurse ethically. Double effect means it is permissible to perform an act in the pursuit of good knowing that the action may also cause a bad result.

Which of the following statements made by a family member of a client recently diagnosed with early stages of Alzheimer's disease is most reflective of an understanding of this disease process? A. "Dad has always been a fighter; he'll fight this too. He won't give up." B. "We have an appointment with his care provider to see about medication therapy." C. "Good thing we found out about this early so we can prevent this from getting worse." D. "We have a made arrangements to discuss nursing home placement for dad."

B. "We have an appointment with his care provider to see about medication therapy."

Members of Mr. Smith's family are in the waiting area of the intensive care unit. They have just been told that Mr. Smith has amyotrophic lateral sclero- sis, a neurodegenerative disease that is fatal, and are questioning this diagnosis. Later in the day, you meet with the family. What is your best response to the family at this time? A. "Mr. Smith will soon be better. The doctors here are the best." B. "What are your fears at this time?" C. "Families always have a rough time with this information." D. "I will contact pastoral care."

B. "What are your fears at this time?" Rationale: Encouraging the family to express their fears allows them to process their concerns so they can move forward with a plan of care. Response A. is an example of false reassurance. Response C. has the effect of categorizing the family's distress to the general population and does not take into account their individual experience in this place at this time. Response D. is inappropriate; the family should first be asked if they would like to see pastoral care.

Mrs. Foster, aged 84, is in the nursing home with dEmentia, hypertension, and mild renal failure. She has a feeding tube. Mrs. Foster suffers a catastrophic stroke and is taken to the emergency department. The nurse discovers that the patient has an advance directive and does not wish to be put on a ventilator. The nurse brings this to the team's attention during the family meeting to discuss the goals of care. The nurse's behavior is an example of: A. Nonmaleficence B. Advocacy C. Veracity D. Beneficence

B. Advocacy Rationale: Palliative care is appropriate for patients at the time of initial diagnosis, even if death is not immi- nent, during the course of active treatment, dependent on technology such as dialysis or artificial ventilation, and for patients who are dying because it focuses on the relief of suffering and promotion of quality of life

Who can receive palliative care? A. Someone with a terminal illness with a life expectancy of 6 months or less B. Anyone with a serious illness regardless of life expectancy. C. Someone with a terminal illness with a life expectancy of 3 months or less D. Someone with a serious illness with a life expectancy of 6 months or less

B. Anyone with a serious illness regardless of life expectancy.

The nurse inquires about the patient's funeral and burial preferences while caring for the patient in hospice care. Which palliative-care domain explains this situation? A. Social aspects B. Cultural aspects of care C. Care of the imminently dying D. Spiritual, religious, and existential aspects of care

B. Cultural aspects of care

In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging? A. Increased perspiration B. Increased airway resistance C. Increased salivary secretions D. Increased pitch discrimination

B. Increased airway resistance

A client has been recently diagnosed with Alzheimer's disease. When teaching the family about the prognosis, the nurse must explain that: A. Diet and exercise can slow the process considerably B. It usually progresses gradually with a deterioration of function C. Many individuals can be cured if the diagnosis is made early D. Few clients live more than 3 years after the diagnosis

B. It usually progresses gradually with a deterioration of function

The characteristic that puts an older adult at the greatest risk of becoming a victim of elder abuse is A. Older adult living with 62 year old daughter B. Older adult with cognitive impairment C. Older adult without cognitive impairment D. Older adult living with 24 year old daughter E. Older adult living with slightly limited mobility

B. Older adult with cognitive impairment

The nurse is caring for an older patient who is receiving palliative care. Which intervention is the highest priority for this patient? A. Invasive testing B. Pain management C. Aggressive chemotherapy D. Aggressive invasive surgery

B. Pain management Rationale: Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain.

Of the following, which describes dementia? A. Quick onset, irreversible B. Slow onset, chronic C. Acute onset, reversible D. Progressive, terminal

B. Slow onset, chronic

The nurse is providing care for an older client who is experiencing mild cognitive impairment. Which communication technique is MOST likely to bring about a negative outcome? A. Speaking at a slightly slower than normal speed B. Speaking to the family as if the client is not present. C. Repeating instructions and requests and needed D. Using simple sentences and phrasings that are appropriate for the client's level of cognition

B. Speaking to the family as if the client is not present.

A nurse is caring for a patient who is receiving palliative care after having an unsuccessful hernia surgery. What immediate course of action should the nurse take to manage hyperactive delirium in the patient? A. The nurse should request that the primary health-care provider prescribe anticholinergic medications. B. The nurse should request that the primary health-care provider prescribe benzodiazepines. C. The nurse should elevate the head of the bed and administer opiates after getting approval from the primary health-care provider. D. The nurse should perform a sternal rub on the patient after consulting with the nursing supervisor.

B. The nurse should request that the primary health-care provider prescribe benzodiazepines.

Which information obtained by the home health nurse when making a visit to an 88-year-old with mild forgetfulness is of the most concern? A. The patient's son uses a marked pillbox to set up the patient's medications weekly. B. The patient has lost 10 pounds (4.5 kg) during the last month. C. The patient is cared for by a daughter during the day and stays with a son at night. D. The patient tells the nurse that a close friend recently died.

B. The patient has lost 10 pounds (4.5 kg) during the last month.

Which is true regarding physical and psychological changes in the early stage of death? A. The patient may experience a decrease in body temperature and blood pressure. B. The patient may not experience hunger or thirst as the body slows down. C. The patient may experience congestion in the airways that can cause respirations to sound loud and wet. D. The patient may experience a change in skin color as the circulation diminishes.

B. The patient may not experience hunger or thirst as the body slows down.

A patient dies postsurgery due to cardiac failure. What step should the nurse adhere to when providing postmortem care? A. Remove any tubes and catheters from the body before the autopsy is performed. B. Treat the body with respect, and incorporate any applicable religious or cultural practices. C. Refrain from including other nursing staff in the process. D. Refrain from removing any tubes and cleaning soiled areas of the body, if an autopsy is not required.

B. Treat the body with respect, and incorporate any applicable religious or cultural practices.

A nurse at a long-term care facility is contributing to the plan of care for an older adult client who has dementia. Which of the following interventions should the nurse include in the plan? A. Vary the staff members caring for the client B. Use photographs as memory triggers C. Provide a minimum of three activity choices to the client D. Break client tasks down to three or four steps at a time

B. Use photographs as memory triggers

The nurse is identifying the different sleep patterns of assigned patients on a geriatric care unit. Which patient is demonstrating the typical sleep pattern of a patient who is older? A) Age 82 patient sleeps a total of more than 12 hours out of 24 B) Age 90 patient describes the quality of sleep as "better than it ever was" C) Age 80 patient falls asleep early in the evening but wakes up before dawn D) Age 79 patient sleeps in until 9 o'clock each morning despite a lifetime of early rising

C) Age 80 patient falls asleep early in the evening but wakes up before dawn

When administering a mental status examination to a patient with delirium, the nurse should A. give the examination when the patient is well-rested. B. choose a place without distracting environmental stimuli. C. reorient the patient as needed during the examination. D. medicate the patient first to reduce anxiety.

B. choose a place without distracting environmental stimuli.

The most appropriate environment for a person with chronic dementia is one that: A. changes often to decrease boredom. B. contains familiar objects. C. is limited in color and sound. D. is stimulating so as to challenge thought.

B. contains familiar objects.

A 75-year-old patient who sustained a stroke has residual left-sided weakness. Fromthe first day of hospitalization, the patient has been combative and demanding, and hasrefused to swallow any medication. The most constructive nursing action is to: A. continue to attempt to follow the physician's orders. B. determine the patient's premorbid personality. C. restrain the patient and request a change in the route of medication. D. wait for the patient to become more cooperative.

B. determine the patient's premorbid personality.

A patient with Stage 2 Alzheimer disease visits the mental health clinic. During theinterview, the patient becomes hostile and refuses to answer further questions. The gerontological nurse's best action is to: A. ask if the questions upset the patient in any way. B. discontinue the interview. C. explain that the information is needed to plan the patient's care. D. ignore the patient's reaction and proceed.

B. discontinue the interview.

A care aide at a long-term care facility has assured the family of a resident that their father's increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide's statement to the family? A) "It's actually a myth that older people experience changes to their memory." B) "Memory losses are a normal age-related change many people experience." C) "Older adults have less working memory and slower retrieval, but this still requires further assessment." D) "There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia."

C) "Older adults have less working memory and slower retrieval, but this still requires further assessment." Rationale: Older adults often experience delays in retrieval of memories and working memory. Some changes in memory, even in the absence of delirium or dementia, are to be expected but they should not be discounted and would require further assessment.

An older resident with dementia has been pacing and holding his right arm up against his chest. What should the nurse do first to help this patient? A) Notify the physician and get an order for an x-ray B) Document the behavior and report it to the next shift C) Check the resident's record for the history of this resident's behavior D) Medicate the resident with acetaminophen that is available PRN in his record

C) Check the resident's record for the history of this resident's behavior Rationale: A resident with cognitive impairment is not able to communicate pain in the most common way—verbally. It is important that caregivers document normal daily behavior so that any change can help staff-assess pain effectively.

A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is: A) Decline in brain weight B) Reduction of blood flow to the brain C) Flawed response to changes in balance D) Slowed nerve conduction velocity

C) Flawed response to changes in balance

An older patient is demonstrating signs of dehydration. Which action should the nurse initiate first? A) Minimize food intake and maximize fluid intake B) Advocate for the initiation of intravenous rehydration C) Initiate monitoring and recording of fluid intake and output D) Ask that the physician order blood work to confirm or rule out dehydration

C) Initiate monitoring and recording of fluid intake and output

An older patient hospitalized for pneumonia is having difficulty sleeping and is frustrated with the noises at night. What should the nurse do about this situation? A) Obtain an order for a benzodiazepine to be taken at bedtime B) Change the temperature of the client's room to be more conducive to sleep C) Provide a form of white noise and plan to minimize noise during caregiving activities D) Teach the client about the normal changes in sleep quality and quantity that accompany aging

C) Provide a form of white noise and plan to minimize noise during caregiving activities

The nurse is planning to assess the pain level of an older patient who is hearing impaired. Which assessment technique would be the most appropriate for the nurse to use? A) Withhold analgesia until the patient requests it. B) Ask the patient to rate pain on a scale of 1 to 10. C) Show the patient a scale with 0 being a smile and 6 being a crying grimace. D) Show the patient a picture of the body with a pain intensity scale, and use keywords to ask about her pain.

C) Show the patient a scale with 0 being a smile and 6 being a crying grimace.

The nurse wants to acknowledge and accommodate the sexual needs of older residents in a long-term care facility. Which statement provides the most accurate guide for the nurse's practice? A) Erectile dysfunction drugs can be used to significantly enhance older adults' lack of interest in sex. B) The nurse should gently and creatively seek to liberate older adults from the rigid gender roles of their youth. C) The nurse should remember that the general pattern and character of sexual behavior and identity is consistent throughout the life. D) The nurse should recognize that older adults experience an increased desire for emotional comfort and intimacy along with an accompanying decrease in desire for physical, sexual activity.

C) The nurse should remember that the general pattern and character of sexual behavior and identity is consistent throughout the life.

The nurse is caring for each of these older adult patients. Which show signs of dementia? Select all that apply. A. A man who has increasing forgetfulness to take his medications each morning. B. A woman who talks to "the old woman in the chair" when no one is there. C. A woman who asks the nurse several times a day if she has any children. D. A man who forgets which button on his phone calls his daughter, despite being reminded several times and being able to complete this task a month ago. E. A woman with a fractured hip who thinks she can get out of bed and walk to the bathroom independently.

C, D, and E

A nurse is reviewing the basic needs of older adult clients with a group of assistive personnel. Which of the following statements should the nurse include? A. "Caloric needs are increased." B. "Renal function is increased." C. "Deep sleep is decreased." D. "Exercise needs are decreased."

C. "Deep sleep is decreased."

The nurse is counseling a woman who is caring for her 83-year-old father in her home, who is becoming more confused. The nurse knows the daughter understands the father's care needs when she states which of the following? A. "Dad will only need my help for a short time, and then he will get better." B. "I can leave dad alone during the day; I'll just deadbolt the door." C. "I can send dad to the adult daycare; that way I can work and care for him at night." D. "Dad misses mom since she passed; he will be okay in a few weeks."

C. "I can send dad to the adult daycare; that way I can work and care for him at night." Rationale: The father will be cared for at the adult daycare, and it is a nice alternative for the daughter. She will be able to work and know that her father is safe during the day.

After undergoing an unsuccessful open-heart surgery, a patient is admitted into the hospice care unit. The nurse notices that the patient's partner appears anxious and nervous. Which statement is most appropriate for the nurse to use to provide comfort to the partner? A. "It is good that your partner is not on the life support system. Otherwise it could have been really bad." B. "Do not worry; your partner will be fine." C. "I understand that you are worried about your partner, do you have any questions that I can help answer?" D. "Pray to God so that your partner can get well soon."

C. "I understand that you are worried about your partner, do you have any questions that I can help answer?"

A registered nurse is teaching a patient about palliative care (PC). Which information about PC stated by the patient indicates a need for further teaching? A. "It focuses on relief of pain and stress associated with a severe illness." B. "It is provided in hospital, outpatient, and community settings." C. "It focuses on the care of terminally ill patients with less than 6 months to live." D. "It is given simultaneously with curative treatment that meets the patient's goals."

C. "It focuses on the care of terminally ill patients with less than 6 months to live."

A patient is admitted to the palliative care unit after having an unsuccessful kidney transplant surgery. The nurse in charge is educating the caregivers about appropriate symptom management. Which statement made by the nurse is accurate? A. "Administer prescribed anticholinergic medication in case the patient complains of pain." B. "Elevate the head of the bed if you note signs such as facial grimacing and restlessness." C. "Surround the patient with familiar sights, sounds, and smells, in case delirium occurs." D. "Administer benzodiazepines to the patient immediately, if delirium occurs."

C. "Surround the patient with familiar sights, sounds, and smells, in case delirium occurs."

The ethical principle of beneficence involves: A. Assuring that a patient's wishes are honored B. Not doing harm to the patient C. Acting for the good of the patient D. Asking family members about their concerns

C. Acting for the good of the patient Rationale: The good of the patient is the essence of beneficence. Answer A is an example of advocating for the patient. Answer B is an example of non- maleficence. Answer D is an example of the processes of communication and offering practical and emotional support.

The home care nurse is educating an older adult who is moderately confused about medication safety. Which action is most appropriate? A. Repeat the verbal instructions several times and have the patient repeat them back. B. Write down the instructions and place them on the refrigerator. C. Arrange for someone to deliver her medications each day. D. Provide her with easy-to-open prescription bottle caps.

C. Arrange for someone to deliver her medications each day.

A nurse at a long-term care facility is contributing to the plan of care for a client who has Alzheimer's disease and wanders at night. Which of the following interventions should the nurse include in the plan? A. Place the client in wrist restraints at night B. Request a prescription for a psychotropic medication C. Assign the client to a room closer to the nurse's station D. Keep the television on at night

C. Assign the client to a room closer to the nurse's station

The characteristic that increases the likelihood that a caregiver will become an abuser is A. Gender of caregiver B. Age of caregiver C. Caregiver has a history of mental illness such as bipolar disorder, schizophrenia, depression, etc. D. Cultural background of caregiver

C. Caregiver has a history of mental illness such as bipolar disorder, schizophrenia, depression, etc.

A nurse is caring for a patient receiving palliative care. What course of action should the nurse take in case the patient is incapable of making decisions? A. Act as the surrogate decision-maker for the patient. B. Provide equitable access to palliative care. C. Determine the patient's surrogate decision-maker. D. Provide care that is beneficial to the patient.

C. Determine the patient's surrogate decision-maker.

A nurse is collecting data from an 85-year-old client. Which of the following findings should the nurse report to the provider? A. A widened anterior-posterior chest diameter B. Presence of an S4 heart sound C. Differences in pulse strength between lower extremities D. Post-void residual of 75 mL

C. Differences in pulse strength between lower extremities

When a fall results in injury and hospitalization, a cycle of disuse may occur over time. When establishing a care plan for the patient and family to prevent this, it is important to remember disuse is most likely a result of: A. Decreasing muscle strength. B. Decreased joint mobility. C. Fear of repeated falls. D. Changes in sensory perception.

C. Fear of repeated falls.

When performing a comprehensive geriatric assessment of an older adult, focus of the nursing assessment is on the patient's: A. Physical signs of aging. B. Immunological function. C. Functional abilities. D. Chronic illness.

C. Functional abilities.

Which of the following will the nurse use when communicating with a client who has cognitive impairment? A. Pictures or gestures instead of words B. Complete explanations with multiple details C. Short words and simple sentences D. Stimulating words and phrases to capture the client's attention

C. Short words and simple sentences

Which of the following is an expected finding in an older adult? A. Diastolic murmurs B. Cardiovascular disease C. Systolic murmurs D. Weakened pulse

C. Systolic murmurs

An older adult presents with foul smelling urine. The nurse suspects a urinary tract infection. What additional symptom is most commonly seen? A. Elevated white blood cell (WBC) count B. Elevated temperature C. Burning on urination D. Confusion

D. Confusion Rationale: Remember that older adults have suppressed immune systems & decreased sensation

A patient in the active dying phase has been admitted to the palliative care unit. What is the nurse's most important course of action when dealing with the caregivers? A. The nurse should refrain from informing the family members about the transition to the active dying phase. B. The nurse should provide spiritual care based on the patient's preferences. C. The nurse should educate the patient's family members about the signs and symptoms of dying. D. The nurse should instruct the caregivers to administer opioids to the patient.

C. The nurse should educate the patient's family members about the signs and symptoms of dying.

The primary reason an older adult client is more likely to develop a pressure ulcer on the elbow as compared to a middle-age adult is: A. A reduced skin elasticity is common in the older adult B. The attachment between the epidermis and dermis is weaker C. The older client has less subcutaneous padding on the elbows D. Older adults have a poor diet that increases risk for pressure ulcers

C. The older client has less subcutaneous padding on the elbows

Mrs. Kelso's death can be described as a well- managed death because of which of the following statements? A. It allowed enough time for the family to accept it was coming. B. It occurred in the hospice unit. C. There was appropriate pain and symptom management. D. The family accepted the care team's decisions.

C. There was appropriate pain and symptom management. Rationale: A death occurring in the hospice unit and/or an accepted death or team decision are acceptable but do not really reflect a well-manged death. That is when the patient's symptoms are well managed to allow the patient to be as comfortable as possible.

When developing the plan of care for an older adult who is hospitalized for an acute illness, the nurse should A. use a standardized geriatric nursing care plan. B. plan for likely long-term-care transfer to allow additional time for recovery. C. consider the preadmission functional abilities when setting patient goals. D. minimize activity level during hospitalization.

C. consider the preadmission functional abilities when setting patient goals.

A physician has just informed an older adult patient that test results indicate that thepatient has cancer and will require extensive surgery. The patient says, "I know thetests are wrong. I feel fine." The gerontological nurse's most appropriate response is to: A. acknowledge that the patient looks healthy and encourage seeking a secondopinion. B. advise the patient to join a support group. C. convey availability to talk to the patient. D. tell the patient that the tests are reliable and accurate.

C. convey availability to talk to the patient.

The nurse caring for a patient would identify a need for additional interventions related to family dynamics when A. extended family offers to help. B. family members express concern. C. the ill member demands attention. D. memories are shared.

C. the ill member demands attention. Rationale: It is not uncommon for the ill family member to become demanding and indicate that they deserve special treatment and care, and the supportive family may need assistance in understanding the dynamics of the illness in order to continue to be supportive.

The family of an older patient is concerned because the patient at times complains of pain but at other times does not. The family does not know what to believe. What can the nurse explain to the family about aging and pain perception? A) "Older adults become progressively more sensitive to pain." B) "The only pain to be concerned about is pain that lasts longer than 3 months." C) "Older people have been shown to be less sensitive to pain than younger people." D) "It's actually not clear in the research what happens to people's perception of pain as they age."

D) "It's actually not clear in the research what happens to people's perception of pain as they age."

Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? A) An 81-year-old woman's glomerular filtration rate (GFR) is low. B) A 78-year-old male's stomach pH is increased. C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy. D) A 78-year-old man has recently developed urinary incontinence.

D) A 78-year-old man has recently developed urinary incontinence. Rationale: The other answer choices represent normal age-related changes

An older patient is relocating to the home of her daughter who wants to modify the home environment to suit her mother's needs. What information should the nurse provide to the daughter to address the patient's age-related sleeping needs? A) Older people are less active during the day and require less sleep at night. B) Older people are not affected by age-related changes but may have some individual needs. C) Older people stay awake very late into the night and as a result usually sleep late in the morning. D) Older people sleep less soundly and may awaken to noises that would not cause the same reaction in younger adults.

D) Older people sleep less soundly and may awaken to noises that would not cause the same reaction in younger adults.

The nurse observes the skin of an older patient and then asks the patient questions about his nutritional status. How did inspection of the patient's skin guide the nurse to complete a nutritional assessment? A) Purpura may indicate hyperglycemia B) Fungus infections may indicate zinc deficiency C) Poor skin turgor may be an indicator of overhydration D) Persistent "goose bumps" may indicate a vitamin deficiency

D) Persistent "goose bumps" may indicate a vitamin deficiency

The nurse is identifying interventions to help older patients with insomnia. What action should the nurse perform first? A) Educate older patients about how foods and beverages affect sleep B) Identify insomnia as a short-term problem associated with physical or mental illness C) Suggest natural methods to the older patient fall asleep sooner and sleep more soundly D) Recognize insomnia as a symptom and assess for factors that contribute to disrupted sleep

D) Recognize insomnia as a symptom and assess for factors that contribute to disrupted sleep

The nurse is teaching the family members of a dying patient about how to support their family member. Which statement made by the family members indicates a need for further teaching? A. "I should participate in care." B. "I can help the patient with bed baths." C. "I should maintain communication to know the status of the patient." D. "I should provide pain medication to ensure effective pain management."

D. "I should provide pain medication to ensure effective pain management."

Which of the following is NOT the normal changes with aging? A. The cilia become less responsive and less effective B. Diminished cough reflexes C. Chemoreceptor function is altered at the peripheral D. Airwary obstruction

D. Airwary obstruction

Which elderly client is at GREATEST risk for mistreatment in the home setting? A. A 77-year old man, who has a history of coronary bypass surgery, is active and lives with his wife. B. A healthy 75-year old man who is a retired business man living with his son C. An active 70-year old woman with well-controlled diabetes who lives alone D. An 82-year old woman with severe osteoarthritis and macular degeneration who lives with her single daughter and schizophrenic adult grand-daughter.

D. An 82-year old woman with severe osteoarthritis and macular degeneration who lives with her single daughter and schizophrenic adult grand-daughter.

A nurse is caring for a client who has Alzheimer's disease and refused to take her morning anti-hypertensive medication. The client is orientated to name and place and is able to perform ADLs with minimal supervision. Which of the following actions should the nurse take? A. Crush the pills and feed them to the client in applesauce B. Insist the client comply by informing her of the possible implications of missing a dose C. Notify the provider of the need for further evaluation of the client's level of competence D. Ask the client to express her reasons for refusing the medication and document the event

D. Ask the client to express her reasons for refusing the medication and document the event

A nurse is collecting data from an older adult client who lives alone. Although the client is able to answer all questions appropriately, the nurse notes that that client has a decreased attention span, expresses feelings of overwhelming sadness, and has a low energy level. The nurse should identify that the client is exhibiting manifestations of which of the following disorders? A. Delusions B. Dementia C. Delirium D. Depression

D. Depression

The nurse is setting up an education session with an 85-year-old patient who will be going home on anticoagulant therapy. Which strategy would reflect consideration of aging changes that may exist with this patient? A. Show a colorful video about anticoagulation therapy. B. Present all the information in one session just before discharge. C. Give the patient pamphlets about the medications to read at home. D. Develop large-print handouts that reflect the verbal information presented.

D. Develop large-print handouts that reflect the verbal information presented.

The children and wife of a man dying of renal failure are eager to interact with him as much as possible in the days before his death. Consequently, the daughter has questioned the nurse's decision to administer the man's scheduled hydromorphone, stating that he does not appear to be in pain at the present time and that the drug tends to make him drowsy. What is the nurse's most appropriate first action? A. Document the family's reservations and administer the drug after they have completed their visit. B. Administer a partial dose of hydromorphone to the patient. C. Administer an analgesic that is less likely to have a sedative effect D. Explain the rationale for preventative pain control to the family

D. Explain the rationale for preventative pain control to the family

What is the best resource (of those listed below) for identifying information regarding an older adult's current functional ability? A. Psychological tests and related exams B. Diagnostic x-rays and lab tests C. Family members who visit occasionally and call weekly D. Neighbor who visits daily and helps the person to the store weekly.

D. Neighbor who visits daily and helps the person to the store weekly.

A nurse is reviewing the record of a group of older adult clients. Which of the following findings should the nurse identify as an unexpected manifestations of the aging process? A. Decreased absorption of nutrients B. Impaired excretion of medications C. High-pitched frequency hearing loss D. Obesity

D. Obesity

What is a nurse's best self-care action when feeling a sense of loss at the thought of the impending death of a patient in palliative care? A. Inform the family members of the patient that he or she is in the last stage of life. B. Encourage the family to bring in the patient's favorite music and personal items. C. Invite family to care for the patient as they feel comfortable. D. Practice mind/body therapies like yoga, meditation, and/or prayer.

D. Practice mind/body therapies like yoga, meditation, and/or prayer.

An alert and oriented 82-year-old woman, who lives with her daughter, has beenadmitted to the hospital with bruises about the face and head. The daughter reports thather mother fell. Which behavior by the daughter raises the greatest suspicion of elder abuse? A. Becoming defensive when questions are asked B. Complaining about care delivered by hospital staff C. Giving an illogical account of her mother's fall D. Refusing to leave her mother alone to answer questions

D. Refusing to leave her mother alone to answer questions

The nurse understands appropriate actions to take after a distressing discussion with a provider over end-of-life issues for a patient include: A. Avoid communicating with the provider except through the electronic medical record B. Having a drink after work to calm frazzled nerves C. Arguing with colleagues who disagree D. Soliciting support from a nurse manager or ethics consultation

D. Soliciting support from a nurse manager or ethics consultation Rationale: It is best to talk about the stressful conversa- tion with your nurse manager or peers for support before going home and sleeping—the stress may stillbe present upon waking. Drinking or arguing do not help alleviate stress. Also, it is not helpful to avoid face-to-face communication with the provider. After soliciting advice from the nurse manager, a follow up conversation with the provider might be appropriate.

The nurse asks the patient and family members if they have any questions about the patient's diagnosis and plan of care. This is an example of which PC domain? A. Physical aspects of care B. Psychological and emotional aspects of care C. Ethical and legal aspects of care D. Structure and process of care

D. Structure and process of care Rationale: Domain 1: Structure and process of care addresses the plan of care and the patient and family knowledge about the disease course, prognosis, and benefits and risks/burdens of diagnostic evaluation and treatments.

A 90-year-old patient comes to the clinic with a family member. During the health history, the patient is unable to respond to questions in a logical manner. The gerontological nurse's action is to: A. ask the family member to answer the questions. B. rephrase the questions slightly, and slowly repeat them in a lower voice. C. determine if the patient knows the name of the current president. D. ask a few quick questions to determine the patient's cognitive level

D. ask a few quick questions to determine the patient's cognitive level

The most appropriate initial nursing intervention when the nurse notes dysfunctional interactions and lack of family support for a patient would be to A. enforce hospital visiting policies. B. monitor the dysfunctional interactions. C. notify the primary care provider. D. role model appropriate support

D. role model appropriate support Rationale: Nurses can, at times, role model more appropriate interactions or provide suggestions for improving communication and interactions among family members.

TRUE OR FALSE: During hospice care one physician must determine the patient has 6 months to live

FALSE; two physicians

a mini nutritional score between 8 and 11 indicates dehydration. true or false

False

True or false GI age related changes include increased motility, decreased blood flow, increased absorption

False, decreased motility

What should you do before treating a patient with delirium?

Identify the underlying cause

Which of the following are social risk factors for impaired nutrition? Select all that apply. a. isolation b. loneliness c. depression d. poverty

a, b, and d

Lab values associate with poor nutrition include... Select all that apply. a. serum albumin b. increased magnesium c. serum prealbumin d. cholesterol

a, c, and d

An older client admitted to the hospital after having sustained a fall at home is diagnosed with a right hip fracture and experienced a surgical reduction of the fracture. At 2:30 AM, she awakens from sleep insisting that her daughter is in the other room and wants to see her. Attempts to reorient her to the surroundings are unsuccessful. In reviewing the client's record, what data would be considered a primary risk factor for the delirium? a. History of dementia b. Death of the client's husband last month c. The client's age d. History of cardiac disease

a. History of dementia

The major difference between a transient ischemic attack (TIA) and a cerebrovascular accident (CVA) is that: a. TIA symptoms begin to resolve within minutes and are completely resolved within 24 hours. b. TIA symptoms always precede an ischemic CVA. c. TIA symptoms begin to resolve within minutes but are not resolved for up to 72 hours. d. TIA symptoms do not usually involve motor functions.

a. TIA symptoms begin to resolve within minutes and are completely resolved within 24 hours.

When performing a pain assessment on a client who is aphasic, the nurse should consider: a. reports from the family or staff at the nursing home about changes in functional status. b. that the patient is lying quietly in bed so not likely experiencing pain. c. that the patient's previous stroke interrupted pain pathways so she does not feel pain. d. that older adults do not tolerate opioid analgesics well and so exhibit side effects.

a. reports from the family or staff at the nursing home about changes in functional status.

An older client diagnosed with dementia resides with his daughter. When the home care nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, "I don't know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him." How will the nurse respond to the client's daughter? a. "Let's think about what you may have done to anger your father?" b. "Let's try to figure out what your father was trying to say with his behavior." c. "Scratching is usually a sign of untreated pain. Do you think your father is in pain?" d. "Maybe you should consider having a home health provide your father's physical care."

b. "Let's try to figure out what your father was trying to say with his behavior."

The nurse caring for the elderly population understands that movement slows with aging. This is most likely due to: a. Cognitive function b. Changes in musculoskeletal and nervous systems c. Laziness and a feeling that life is over d. A recent change in medical condition

b. Changes in musculoskeletal and nervous systems

When a patient is admitted to a hospital, he or she is asked if an advance directive is available in case terminal care is necessary. What does an advance directive do? a. It gives the patient's family control over terminal care regardless of the patient's wishes b. It gives the patient control over terminal care by appointing an decision maker in the event they cannot make their own decisions c. It gives the hospital control over terminal care d. It gives the attending physician control over terminal care

b. It gives the patient control over terminal care by appointing an decision maker in the event they cannot make their own decisions

Identify the correct statement describing the abuse of elderly persons in the United States. a. Elder abuse is the most often reported form of domestic violence b. Statistically, neglect is the most common form of elder abuse c. Most cases of elder abuse are reported to the proper authorities d. Healthcare practitioners are only mandated to report verified, not suspected, cases of elder abuse

b. Statistically, neglect is the most common form of elder abuse

Mr Reynolds experienced a transient ischemic attack (TIA) 3 weeks ago that had significant effects on his motor and sensory function. Which of the following assessment findings should signal to the nurse to the possibility that Mr Reynolds is experiencing dysphagia? a. Mr. Reynolds complains of being excessively hungry in the mid afternoon and evening b. When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek c. Mr Reynolds drinks large amounts of water, before, during and after meals d. Mr Reynolds prefers to sit in a high fowlers position after meals

b. When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek

Which of the following cases seen by a nurse working in the ED identifies a situation that suggests a case of elder mistreatment? a. an 85 yr old male who has several areas of bruising on the back of the hands and is taking Clopidogrel sisulfate(Plavix) and aspirin daily b. an 86 yr old woman who has 3 dime sized burned areas on her upper inner thigh c. a 77 yr old woman who fell at home after tripping over her dog and broke her arm about 30 minutes earlier d. a 73 yr old male with a history of gastric ulcers who is found to be anemic after vomiting blood 3 hours earlier

b. an 86 yr old woman who has 3 dime sized burned areas on her upper inner thigh

The nurse recognizes that involuntary movements may appear in the elderly patient and be normal. These normal involuntary movements may present as which of the following? a. Seizures b. Tongue protrusions c. Resting tremors d. Eye twitches and spasms

c. Resting tremors

Hospice care is not appropriate in which of these circumstances? a. The patient decides to forego curative treatment. b. The patient's prognosis is 3 to 6 months. c. The patient is undergoing experimental chemotherapy. d. The patient is receiving palliative chemotherapy.

c. The patient is undergoing experimental chemotherapy. Rationale: Hospice care is not appropriate for patients undergoing active curative therapy. All other statements are correct regarding hospice care.

Statistically, which of the following clients is at greatest risk for mistreatment in the domestic setting? a. an active 70 yr old woman with well controlled diabetes who live alone b. a healthy 75 yr old man who is a retied businessman and lives with his son c. an 82 yr old woman with severe osteoarthritis and macular degeneration who lives with her single daughter who has an adult son with cerebral palsy d. a 77 yr old man who has a history of coronary bypass surgery and lives with his wife

c. an 82 yr old woman with severe osteoarthritis and macular degeneration who lives with her single daughter who has an adult son with cerebral palsy

Which of the following are examples of appropriate communication techniques for dealing effectively with persons with dementia? a. Ask open ended questions so the person feels that he or she feels they can make choices b. for people in the later stages of dementia, talk to them as you would a child c. maintain good eye contact and a relaxed and smiling approach d. when a person forgets something, remind them not forget it the next time

c. maintain good eye contact and a relaxed and smiling approach

A 78 yr old woman was diagnosed with colorectal cancer 18 mos ago and underwent chemotherapy. a recent CT scan has shown has metastasized to her lungs and liver. The woman states that she feels well and does not want to undergo any further debilitating chemotherapy. The son and daughter are adamantly opposed to their mother's forgoing treatment and have appealed to the nurse. what factor is the primary consideration in this scenario? a. the family's wishes b. the woman's prognosis c. the woman's autonomy d. the woman's treatment options

c. the woman's autonomy