Study Questions Exam 2 Older Adults

The husband of an elderly woman who is terminally ill and nearing death voices concerns to the nurse. The husband is worried about his wife's lack of dietary intake over the past 36 hours. Which of the following responses by the nurse is indicated at this time? 1. "As death nears, the lack of hunger and thirst are normal." 2. "Perhaps you could have one of her favorite meals prepared to tempt her." 3. "A feeding tube may be justified at this time." 4. "The lack of willingness to eat is an example of your wife attempting to exert control."

1. "As death nears, the lack of hunger and thirst are normal." Correct Rationale: Many clients at the end of life do not eat or drink. This is a normal phenomenon. It is believed to be a nonstressful occurrence. Attempting to cajole the client with food is not indicated at this time. The use of a feeding tube at the end of life would be pointless.

Respiration is accomplished by which of the following? Choose all that apply. 1. Movement of the chest wall 2. Elastic recoil of the lungs 3. Airway resistance

1. Movement of the chest wall 2. Elastic recoil of the lungs 3. Airway resistance

Of the following elderly nursing home residents, which should be assigned the nursing diagnosis, "Risk for aspiration related to inability to swallow effectively"? Select all that apply. 1. 82-year-old female with history of stroke in the midbrain 2. 76-year-old male with Parkinson's disease and poor symptom control 3. 72-year-old confused male with Myasthenia Gravis, who frequently refuses medications for disease management 4. 80-year-old female with Crohn's disease

1. 82-year-old female with history of stroke in the midbrain 2. 76-year-old male with Parkinson's disease and poor symptom control 3. 72-year-old confused male with Myasthenia Gravis, who frequently refuses medications for disease management Correct Rationale: Stroke, especially in the midbrain or the anterior cortical areas, is the most common cause of dysphagia in the older person. Parkinson's disease and Alzheimer's disease may cause dysphagia by inhibiting movements of the tongue, pharynx, or upper esophagus. Myasthenia Gravis affects the muscles of swallowing and medications are to improve swallowing function. Crohn's and ulcerative colitis affect the lower GI mucosa and sub-mucosa, and do not cause esophageal reflux or aspiration.

Question 1 When assessing the respiratory system of an elderly patient, which of the following would not be normal findings? Choose all that apply. 1. A decreased anteroposterior diameter and increased alveolar surface. 2. Bronchovesicular breath sounds throughout the lungs. 3. Increased thoracic expansion and relaxation of elastin tissues. 4. Decreased mobility of the thorax and increased chest wall stiffness. 5. Lung sounds are distant in the frail elderly.

1. A decreased anteroposterior diameter and increased alveolar surface. 2. Bronchovesicular breath sounds throughout the lungs. 3. Increased thoracic expansion and relaxation of elastin tissues. Correct Rationale: The normal response in elderly patients due to aging would be decreased mobility of the thorax and increased chest wall stiffness. The functional implications of these changes are a decreased elastic recoil of the lung that produces increased residual volume, decreased vital capacity, and premature airway closure in dependent portions of the lungs, which often traps air in the lower airways. So little air is moved in the frail elderly that lung sounds are distant. Cognition level: applying

Which of the following medications should the nurse anticipate that the physician would prescribe for "rescue" from sudden onset wheezing, tightness in the chest, or shortness of breath due to an asthma diagnosis? 1. Albuterol inhaler (Proventil, Ventolin) 2. Salmeterol (Servent) 3. Formoterol (Foradil) 4. Cromolyn inhaler (Intal)

1. Albuterol inhaler (Proventil, Ventolin) Correct Rationale: Inhaled beta2-angonists are short-acting medications that are effective bronchodialators for all asthma patients. Both long-and short-acting beta2 agonists are available. Only short-acting beta2-antagonists such as Proventil and Ventolin should be used for rescue from sudden onset of wheezing, tightness in the chest, or shortness of breath. Cognitive level: Applying

The absorption of iron in the elderly may be diminished in the presence of: 1. Antacids. 2. Diuretics. 3. Vitamin C. 4. Milk.

1. Antacids. Correct Rationale: Anything that interferes with the production of hydrochloric acid interferes with the absorption of iron and should be avoided when trying to promote iron absorption. Diuretics, vitamin C, and milk do not affect iron absorption.

REM (Rapid Eye Movement) sleep in the elderly is which of the following? Choose all that apply. 1. Associated with the greatest amount of dreaming. 2. Accompanied by slowing of the heart rate. 3. Characterized by brief muscle contractions. 4. Necessary for daytime concentration and memory consolidation.

1. Associated with the greatest amount of dreaming. 3. Characterized by brief muscle contractions. 4. Necessary for daytime concentration and memory consolidation. Correct Rationale: REM sleep is characterized by an increase in heart rate and blood pressure, intense brain activity, and small, brief muscle contractions. It is sometimes referred to as "dream sleep" and is thought necessary for mental and cognitive health. Cognition level: Knowledge

Which of the following may prevent the nurse from discussing sexuality with elderly patients? Choose all that apply. 1. Belief that the elderly are considered asexual. 2. Viewing incontinence as a barrier to sexual activity. 3. Lack of acceptance of patient's sexual orientation. 4. Belief that impotence is a normal part of aging. 5. Giggling by the patient.

1. Belief that the elderly are considered asexual. 2. Viewing incontinence as a barrier to sexual activity. 3. Lack of acceptance of patient's sexual orientation. 4. Belief that impotence is a normal part of aging. Correct Rationale: Many people think that older adults do not and should not have sexual needs or desires. It is important to assure patients that a wide range of feelings about sexuality are appropriate for seniors, just as they are for younger people. Cognition level: knowledge

Which medications are indicated when delirium occurs in the last days of life? Choose all that apply. 1. Benzodiazepines (lorazepam) 2. Neuroleptics (haloperidol) 3. Local anesthetics (EMLA and topical capsaicin) 4. Higher doses of opioids (morphine and fentanyl) 5. Atropine (Atro-Pen)

1. Benzodiazepines (lorazepam) 2. Neuroleptics (haloperidol) Correct Rationale: Terminal delirium typically presents as confusion, restlessness, or agitation. Benzodiazepines and neuroleptics may be needed to control these symptoms. Pain medication should be continued although higher doses are not necessarily needed at this point. All nonessential medications should be discontinued to avoid drug toxicities. Atropine is used for excessive secretions, but not for delirium. Cognition level: Knowledge

Which of the following would be inappropriate for an older person with dysphagia? Select all that apply. 1. Clear beef broth 2. Mashed potatoes with gravy 3. Tea with lemon 4. Applesauce 5. Pureed peas

1. Clear beef broth 3. Tea with lemon Correct Rationale: Thin liquids are difficult for older persons with dysphagia to swallow because they drain too quickly into the esophagus. To slow the swallowing process, liquids should be thickened according to the speech therapist's or dietician's recommendations. Foods should be in small bites and not too dry. Cognition level: Understanding

Which of the followng are aged-related changes that affect gastrointestinal function? Select all that apply. 1. Decline in sense of taste and smell, decrease in salivary secretion 2. Diminished capacity of the gastric mucosa to resist such factors as Helicobacter pylori 3. Increased esophageal motility 4. Decreases in intestinal absorption, motility, and blood flow

1. Decline in sense of taste and smell, decrease in salivary secretion 2. Diminished capacity of the gastric mucosa to resist such factors as Helicobacter pylori 4. Decreases in intestinal absorption, motility, and blood flow Correct Feedback for all incorrect answers: Rationale: Age-related changes in the GI system begin before age 50 and continue gradually throughout life. Taste buds and salivary glands tend to atrophy with age. Esophageal motility decreases. Gastric mucosa degenerates and atrophies as well and there is a decreased ability to resist H. pylori. Intestinal absorption, motility, and blood flow decrease with age-related changes in the intestinal mucosa.

A patient is being treated for community-acquired pneumonia (CAP). Which of the following drugs would be most appropriate to treat the CAP? Choose all that apply. 1. Erythromycin (Erythrocin) 2. Azithromycin (Zithromax) 3. Amoxicillin (Amoxil) 4. Chlorzoxazone (Paraflex) 5. Cephalexin (Keflex)

1. Erythromycin (Erythrocin) 2. Azithromycin (Zithromax) Correct Rationale: The treatment recommendations for older outpatients with community-acquired pneumonia are an oral macrolide or an oral beta-lactam. Cognitive level: Knowledge: remembering

Which of the following are risk factors for potential aspiration in nursing home residents with dysphagia? Select all that apply. 1. Feeding bed-bound residents in the semi-reclined position 2. Administering thin liquids quickly via a straw 3. Providing thickened liquids to the client during meals 4. Busy and overburdened staff members who are assigned a case-load of several clients to feed at the same scheduled time

1. Feeding bed-bound residents in the semi-reclined position 2. Administering thin liquids quickly via a straw

Patients identified with pulmonary tuberculosis due to M. tuberculosis are usually placed on Isoniazid (INH) to prevent active disease. Patient teaching prior to discharge from a clinic setting would place priority on which of the following postdischarge instructions? Select all that apply. 1. Follow-up care will include reading PPD test within 72 hours. 2. Liver function tests should be monitored routinely. 3. Report headache to your healthcare provider immediately. 4. Weigh yourself daily and record fluid intake accurately. 5. Self-monitor the blood pressure twice a day.

1. Follow-up care will include reading PPD test within 72 hours. 2. Liver function tests should be monitored routinely. Correct Rationale: The PPD test will need to be read by a trained healthcare provider to assess whether the patient has a positive or negative response to the tuberculosis exposure and subcutaneous injection. INH is typically prescribed for 6 months of treatment, and liver function tests are monitored to assess for toxicity to the liver. If this occurs, INH treatment may need to be stopped before the 6 months end. Cognition level: knowledge: remembering

Respiratory functions include which of the following? Choose all that apply. 1. Gas exchange 2. The transfer of oxygen from the air into the blood 3. Removal of carbon dioxide from the blood 4. Entrapping foreign substances 5. Increased blood volume as needed for gas exchange

1. Gas exchange 2. The transfer of oxygen from the air into the blood 3. Removal of carbon dioxide from the blood 4. Entrapping foreign substances

An elderly older patient is confused, having difficulty following instructions and receiving postural drainage treatments. The patient is unable to expel the secretions. The best response by the nurse would be to: 1. Have the patient drink water 2. Suction out the secretions 3. Frequently change the patient's position 4. Administer humidified oxygen

1. Have the patient drink water Correct Rationale: The confused patient may not be willing to accept the humidified oxygen or understand about changing frequent positions to assist in their decreased secretions. Suctioning may not be understood by the confused patient, but drinking water is acceptable for the confused patient; it is nonthreatening but also effective treatment. Cognition level: applying

Risk factors for vitamin B12 deficiency include which of the following? Select all that apply. 1. History of gastric bypass surgery 2. Use of antacids or acid-lowering surgery 3. Folic acid supplementation 4. History of depression

1. History of gastric bypass surgery 4. History of depression Correct Rationale: B12 is absorbed in the ileum bound to intrinsic factor made in the stomach. Gastric bypass and diminished stomach acidity can reduce the absorption of B12. Folic acid supplementation can reverse macrocytic anemia, which often is used as a diagnostic indicator of B12 deficiency. Depression can be a result of B12 deficiency. Cognition level: Knowledge

The nurse is assessing a patient admitted to the hospital with pneumonia. The patient is observed to have a dry cough, decreased breath sounds at the bases of both lungs, and a pulse oximetry reading of 84% at rest on room air. Which of the following should the nurse assign as the priority nursing diagnosis for the patient? 1. Ineffective airway clearance 2. Impaired gas exchange 3. Activity intolerance 4. Hyperthermia

1. Ineffective airway clearance Correct Rationale: The normal response in elderly patients due to aging would be decreased mobility of the thorax and increased chest wall stiffness. The functional implications of these changes are a decreased elastic recoil of the lung that produces increased residual volume, decreased vital capacity, and premature airway closure in dependent portions of the lungs, which often traps air in the lower airways. Cognitive level: Applying

The nurse determines that which statement/s is/are accurate as related to medications used to manage GERD? Select all that apply. 1. Magnesium containing antacids can cause diarrhea 2. Aluminum containing antacids can cause constipation 3. Cimetidine (Tagamet HB) causes osteomalacia and hypophospatemia 4. Misoprostol's (Cytotec) major side effect is GI bleeding

1. Magnesium containing antacids can cause diarrhea 2. Aluminum containing antacids can cause constipation Correct Rationale: Magnesium containing antacids can cause diarrhea and should be used with caution in older persons with renal dysfunction. Aluminum containing antacids can cause constipation, osteomalacia, and hypophosphatemia. Cimetidine has the greatest chance for adverse reactions including erectile dysfunction, gynecomastia, and confusion. Misoprostol's major side effects are diarrhea and abdominal pain. It has been shown that misoprostol helps to prevent NSAID—induced damage to the gastric mucosa.

An elderly client has been prescribed a loop diuretic to aid in the management of hypertension. The nurse is aware that this may cause a sleep disturbance due to: 1. Nocturia. 2. Decreased REM sleep. 3. Nightmares. 4. Sleep walking.

1. Nocturia. Correct Rationale: Diuretics may cause nocturia if taken any time other than morning. Nocturia causes the elderly to awaken and get out of bed, thereby diminishing quality sleep. Diuretics do not cause decreased REM sleep, nightmares, or sleepwalking.

An elderly client, whose best friend died after a year long battle with bone cancer, now complains of mild abdominal pain, 5 pound weight loss, insomnia, and fatigue. When no physiological cause can be found, the nurse suspects these are symptoms of: 1. Normal grieving. 2. Denial. 3. Spiritual distress. 4. Hypochondria.

1. Normal grieving. Correct Rationale: Physiological symptoms are a normal part of grieving, particularly in the early phases. In the absence of pathology, these are signs of normal grieving. Denial, spiritual distress, and hypochondria do not usually manifest themselves with physical symptoms.

Corticosteroid therapy is the most effective anti-inflammatory treatment for asthma. The nurse administering oral corticosteroids should observe the patient for which of the following adverse effects? Choose all that apply. 1. Pathologic fractures 2. Increase in intraocular pressure 3. Weight loss 4. Hyponatremia

1. Pathologic fractures 2. Increase in intraocular pressure 4. Hyponatremia Correct Rationale: Use of inhaled corticosteroids has reduced the morbidity and mortality associated with asthma exacerbations. Adverse effects of inhaled corticosteroids include electrolyte and fluid imbalances in older patients with cardiac or renal disease, the possibility of hypokalemia when the patient is taking a thiazide diuretic, worsening of hypertension, and elevated blood sugar and blood urea nitrogen readings in patients with diabetes. (Please refer to Table 16-2.) Oral corticosteroids can negatively affect cognitive function, accelerate osteoporosis, cause oral thrush, increase intraocular pressure, and aggravate peptic and gastric ulcers. Cognitive level: Applying

Which of the following statements is accurate about clients diagnosed with Zollinger-Ellison syndrome? 1. Peptic ulcer occurs in 95% of clients diagnosed with Zollinger-Ellison syndrome. 2. Zollinger-Ellison syndrome is characterized by gastric hyposecretion because of dysfunction of the parietal cells. 3. Clients with Zollinger-Ellison syndrome with persistent symptoms that do not respond to drug treatment should be referred to a radiologist 4. Treatment of choice for Zollinger-Ellison syndrome is a cholecystectomy.

1. Peptic ulcer occurs in 95% of clients diagnosed with Zollinger-Ellison syndrome. Correct Rationale: Peptic ulcers occur in 95% of clients with Zollinger-Ellison syndrome. Treatment may include tumor removal and surgical resection for older persons without surgical risk. Persons with Zollinger-Ellison syndrome have gastric hypersecretion, and are referred to a gastroenterologist if symptoms persist.

A 65-year-old female is admitted to the GYN unit at the local hospital with complaints of low pelvic pain and low back pain. Endometrial cancer is suspected. The nurse should focus her questions on which of the following in order to arrive at a tentative nursing diagnosis? 1. Post menopausal bleeding 2. Vaginal itching 3. Dysuria 4. Constipation

1. Post menopausal bleeding Correct Rationale: Cancer of the body of the uterus or endometrium is the most common gynecological cancer in older women. The most common symptom is uterine bleeding after menopause, which occurs early in the disease, making early diagnosis and treatment possible. Any older woman who reports postmenopausal uterine bleeding should be assumed to have endometrial cancer until proved otherwise. Cognition level: application

When an elderly person is hospitalized with pneumonia, what would be the best action by the nurse to encourage eating? 1. Provide small, more frequent meals. 2. Secure an order for a daily multivitamin to stimulate appetite. 3. Provide a high calorie snack of the client's choice. 4. Make sure the client is adequately hydrated.

1. Provide small, more frequent meals. Correct Rationale: An elderly person is more likely to eat if portions are small, more frequent, and nutrient dense as opposed to a full meal tray three times a day. A vitamin will not stimulate appetite. Snacks are not necessary if small frequent meals are provided. Hydration is always important but fluids do not provide the nutrients needed for healing.

Which of the following diagnostic studies is most helpful in determining the presence of asthma? 1. Pulmonary function tests (PFTs) 2. Large number of eosinophils in the blood 3. Incentive spirometer 4. Spirometry

1. Pulmonary function tests (PFTs) Correct Rationale: Pulmonary function tests are the most reliable way to diagnose asthma and differentiate it from other illnesses such as COPD. Cognitive level: Understanding

When planning care which of the following nursing diagnoses would be appropriate to assign a client after a video fluoroscope radiographic swallow evaluation? 1. Risk for fecal impaction 2. Risk for severe diarrhea 3. Risk for tetany 4. Risk for pathologic fractures

1. Risk for fecal impaction Correct Rationale: Preparation for the video fluoroscope radiographic evaluation includes drinking of a radiopaque solution, which is a chalk-like mixture. The chalk-like mixture is constipating and could result in fecal impaction.

An elderly comatose client has been admitted to the acute care facility after suffering a serious cerebrovascular accident. The prognosis is poor. The family has made the decision to accept only palliative care. Which of the following interventions should be included in the plan of care? Select all that apply. 1. Support for the family during the bereavement period 2. Pain management 3. Providing a referral to the facility's Social Service Department 4. Assistance with ADLs

1. Support for the family during the bereavement period 2. Pain management 3. Providing a referral to the facility's Social Service Department 4. Assistance with ADLs

The nurse should anticipate that which of the following alpha-blocking agents may be included in the plan of care for the patient with BPH? Choose all that apply. 1. Tamsulosin (Flomax) 2. Doxazosin mesylate (Cardura) 3. Verapamil (Calan) 4. Tamoxifen (Nolvadex) 5. Bivalirudin (Angiomax)

1. Tamsulosin (Flomax) 2. Doxazosin mesylate (Cardura) Correct Rationale: Standard treatments include recommendations to lose weight if overweight, increased exercise, appropriate timing of fluid intake, behavioral modification, and use of anticholinergic medications. If symptoms continue at an unacceptable level, additional interventions are recommended. These include alpha-adrenergic blocking medications such as tamsulosin and doxazosin mesylate. These medications are used to reduce symptoms such as hematuria, pain, UTI, and elevated PSA. Bivalirudin is an anticoagulant. Cognition level: knowledge

The student nurse is assisting the nurse perform postmortem care on a recently deceased elderly client. Which of the following actions by the student nurse indicates the need for additional instruction from the supervising nurse? 1. The student nurse places the client's hands across the chest. 2. The student nurse removes the IV tubing. 3. The student nurse pads the anal area. 4. The student nurse allows the family to sit with the deceased client alone prior to removal from the room.

1. The student nurse places the client's hands across the chest. Correct Rationale: The arms and hands should be placed at the client's sides. The remaining answers are correct.

Which of the following may be barriers to sleep in the hospital? Choose all that apply. 1. Too hot or too cold 2. Frequent awakenings by nurses for care and monitoring 3. Sleeping partner or comfort items are missing 4. Excessive noise and bright lights

1. Too hot or too cold 2. Frequent awakenings by nurses for care and monitoring 3. Sleeping partner or comfort items are missing 4. Excessive noise and bright lights Correct Rationale: Inadequate sleep is common in acute care and is a significant detriment to healing and recovery. There are many unfamiliar challenges to sleep (e.g. noise, lights, uncomfortable temperature and bed). Familiar sleep routines are not present, and nurses who do not pay careful attention to clustering care during the night and ensuring adequate sleep contribute to the problem. Cognition level: Understanding

The most commonly used screening tests for prostate cancer include which of the following? Choose all that apply. 1. Transrectal ultrasound (TRUS) 2. Magnetic resonance imaging of the prostate 3. Digital rectal examination (DRE) 4. Prostate-specific antigen (PSA) testing 5. Prostate biopsy

1. Transrectal ultrasound (TRUS) 3. Digital rectal examination (DRE) 4. Prostate-specific antigen (PSA) testing

An elderly patient is diagnosed with new onset of urinary incontinence (UI) and as a result is afraid to leave her home. Which strategies suggested by the nurse should assist with return to social activities? 1. Use disposable incontinence pads or protective undergarments. 2. Increase intake of carbonated beverages. 3. Establish a voiding schedule beginning with every 4 hours. 4. Increase intake of coffee and tea.

1. Use disposable incontinence pads or protective undergarments. Correct Rationale: Disposable incontinence pads or protective undergarments are supportive interventions to help the elderly patient remain independent and improve quality of life. Carbonated beverages, coffee, and tea are considered bladder irritants and may actually lead to incontinence. Voiding schedules should be every 2 to 3 hours. Cognition level: knowledge

A patient discusses with the nurse her fears of having sleep apnea. Which of the following statements made by the patient is suggestive of sleep apnea? Choose all that apply. 1. "My legs jump and feel tingly off and on during the night." 2. "My husband says I've been waking him up with my snoring." 3. "I just seem to be falling asleep too often during the daytime." 4. "I have to sleep on at least three pillows every night."

2. "My husband says I've been waking him up with my snoring." 3. "I just seem to be falling asleep too often during the daytime." Correct Rationale: Sleep apnea is characterized by heavy snoring and delays in breathing, which are often followed by a snort when breathing begins again. Sleep quality is diminished, which often results in excessive daytime sleepiness and difficulty with concentration. Restless leg syndrome often awakens the person with numbness, tingling, and burning of the extremities. The need to sit upright in bed is often seen with heart failure and obstructive respiratory disorders. Cognition level: Knowledge

A patient has been instructed in pursed-lip breathing. He asks the nurse the purpose behind this breathing pattern. The nurse's best response to this question would be: 1. "Pursed-lip breathing increases the strength of the respiratory muscles." 2. "Pursed-lip breathing prevents airway collapse and enhances effective breathing." 3. "You will be more comfortable if you use pursed-lip breathing techniques." 4. "Pursed-lip breathing exercises help to prevent the accumulation of secretions."

2. "Pursed-lip breathing prevents airway collapse and enhances effective breathing." Correct Rationale: The main physiological effect of pursed-lip breathing is to reduce hyperventilation and thereby increase CO2 levels in the alveoli during and after each respiration. This increased CO2 level in the functioning parts of the lungs relaxes and dilates smooth muscles of the airways. Relative alveolar hypercapnia immediately improves ventilation-perfusion ratio and oxygen levels in the arterial blood. Cognitive level: Applying

The nurse is teaching a group of older patients as part of health promotion about the functions of the respiratory tract. Which of the following statements made by the patients would indicate a need for further teaching? 1. "The respiratory system helps maintain heat balance in our bodies." 2. "The lungs keep our blood pressure in normal range, so we can breathe better." 3. "Parts of our respiratory system help us produce speech and better communication." 4. "Our lungs keep the balance of acids and bases in our bodies."

2. "The lungs keep our blood pressure in normal range, so we can breathe better." Correct Rationale: The patients need to understand the functions of the heart and vascular system as well as the respiratory center. The lungs occupy the thoracic cage and stretch from the trachea to below the heart. This coordinated system enables the lung to perform its primary function of rapidly exchanging oxygen from inhaled air with the carbon dioxide in the blood. Cognitive level: Analyzing

Which is true of GERD in the elderly? Select all that apply. 1. It occurs more often in women than in men. 2. Hiatal hernias contribute to increased incidence of GERD. 3. The main cause of GERD in the elderly is overproduction of hydrochloric acid. 4. The pain of GERD is sometimes confused with chest pain or angina. 5. Aspiration pneumonia can occur.

2. Hiatal hernias contribute to increased incidence of GERD. 3. The pain of GERD is sometimes confused with chest pain or angina. 4. Aspiration pneumonia can occur. Correct Rationale: The cause of the problem in most older adults is not overproduction of acid, but length and frequency of esophageal acid exposure. There is a higher incidence among men than women. Hiatal hernia, decreased salivation, and certain drugs can contribute to the development and progression of GERD in older adults. Because the pain of GERD can resemble that of cardiac ischemia, a thorough evaluation needs to be done to rule out cardiac disease. There is an increased risk of aspiration pneumonia with GERD. Cognition level: Knowledge

Which of the following statements made by a nurse to a family inquiring about hospice for their father are true? Choose all that apply: 1. Your father must be in a home setting to receive hospice care." 2. "Your father cannot receive any curative care once he is enrolled in hospice." 3. "Eligibility criteria for hospice includes a physician's statement that life expectancy is expected to be 6 months or less." 4. "Medicare payment for hospice care will automatically stop when your father has been enrolled for 6 months." 5. "You will not be seeing your regular doctor. The hospice doctor will care for you."

2. "Your father cannot receive any curative care once he is enrolled in hospice." 3. "Eligibility criteria for hospice includes a physician's statement that life expectancy is expected to be 6 months or less." Correct Rationale: The expected life expectancy must be 6 months or less for a person to qualify for hospice care. However, payment by Medicare does not stop automatically at 6 months. While the most common setting is in the home, hospice care can be delivered in long-term care, hospital, or a free-standing hospice facility. When patients enter hospice, they sign a statement choosing hospice rather than curative therapies to treat their terminal illness. However, this does not mean that any health problem that might develop but is not related to the terminal diagnosis cannot be treated for the purpose of maximizing comfort and quality of life. Hospice organizations remain in contact with the referring physician. Cognition level: Understanding

What type of diet will the nurse recommend to most healthy elderly clients? 1. A balanced 1,100-calories per day diet 2. A diet high in complex carbohydrates and fiber 3. A diet low in fat and protein 4. A diet low in fat with a moderate amount of carbohydrates

2. A diet high in complex carbohydrates and fiber Correct Rationale: Complex carbohydrates and fiber provide some protein in addition to necessary vitamins and minerals. They aid digestion and have a lower glycemic load. For an active, healthy elderly person 1,200 calories per day will not be adequate to prevent weight loss. Inadequate protein does not allow for tissue maintenance and repair. High carbohydrate diets do not provide adequate balance to caloric distribution.

Continuous positive airway pressure (CPAP) is which of the following? Choose all that apply. 1. An invasive method used to keep the airway partially open 2. A noninvasive treatment administered through a nasal mask 3. Involves use of an oral airway 4. 100% effective, if used correctly

2. A noninvasive treatment administered through a nasal mask 4. 100% effective, if used correctly Correct Rationale: CPAP is the most common treatment for sleep apnea. The 5-20cm of air delivered under pressure through a mask has been found to be 100% effective in keeping the airway open, if the face mask fits correctly and it is used regularly. Cognition level: Understanding

The elderly client who wants to take an herbal supplement for arthritis symptoms should be advised to: 1. Read labels very carefully prior to making a selection because the supplements are usually quite expensive. 2. Consult his or her healthcare provider about possible interactions with current medications. 3. Verify the supplement's effectiveness with friends or family members who have taken it. 4. Reconsider the idea because the supplement may have serious side effects.

2. Consult his or her healthcare provider about possible interactions with current medications. Correct Rationale: Herbal supplements may be of unknown quality and may also interact with medications. Serious side effects are more likely when used with some prescription medications. Family or friends are not the best source of health information.

Which of the following are significant renal changes at the ninth decade of life? Choose all that apply. 1. Decreased serum blood urea nitrogen (BUN) and creatinine 2. Decreased glomerular filtration rate 3. Lower creatinine clearance rate 4. Less concentrated urine specific gravity 5. Increased blood flow through the kidney

2. Decreased glomerular filtration rate 3. Lower creatinine clearance rate 4. Less concentrated urine specific gravity Correct Rationale: Renal function begins to decline around the age of 40, but does not create significant issues for the healthy individual until the ninth decade of life. At that time, decreased glomerular filtration rate, renal blood flow, maximal urinary concentration, and response to sodium loss are marked. Decreased serum BUN and creatinine increases with age. Cognition level: application

Typical sleep pattern changes that occur with aging include: 1. Late morning awakening. 2. Diminished time in deep sleep. 3. Longer daytime naps. 4. Decreased sleep latency.

2. Diminished time in deep sleep. Correct Rationale: A normal part of aging is a decreased amount of time at deeper levels of sleep. Diminished deep sleep can lead to increased daytime sleepiness, which causes the elderly to take naps. The elderly frequently awaken early in the morning and have increased sleep latency.

Which medication is least likely to be recommended as a sleep aid for an elderly person? 1. Zolpidem (Ambien) 2. Diphenhydramine (Benadryl) 3. Zaleplon (Sonata) 4. Sustained-release melatonin

2. Diphenhydramine (Benadryl) Correct Rationale: Antihistamines such as Benadryl should not be used because of their anticholinergic side effects. Ambien and Sonata can be used safely in low doses and for short periods of time. Melatonin, also, is considered safe for short periods of time, but is recommended in a sustained-release formula for maintaining sleep throughout the night. Cognition level: Knowledge

When working with the elderly, the nurse recognizes that the elderly frequently have problems with sleep. Most notably they: 1. Fall asleep more rapidly than any group except young children. 2. Have a significant decline in stage 4 sleep. 3. Require less sleep than middle-aged adults. 4. Find it difficult to become fully alert after sleeping at night.

2. Have a significant decline in stage 4 sleep. Correct Rationale: Stage 4 sleep is characterized by large, slow patterns of brain activity. In the elderly, who awaken frequently, this high-quality sleep is diminished. Many elderly have problems with insomnia. They require the same amount of sleep as all adults and find it no more difficult to become fully alert on awakening than other adults.

Good dietary sources of vitamin D include which of the following? Select all that apply: 1. Cheeses and yogurt 2. Liver 3. Fortified milk 4. Fish and oils

2. Liver 3. Fortified milk 4. Fish and oils Correct Rationale: While good sources of calcium, cheese and yogurt are not mandated to be fortified with vitamin D. It would take approximately 6 cups of milk per day to meet the daily recommendations for vitamin D (note: The prevalence of lactose intolerance increases in the elderly). Intake of vitamin D is insufficient for many elderly, who will need supplementation to meet minimum requirements of 800 IU if over age 70. Cognition level: Knowledge

A nurse is uncomfortable discussing spiritual concerns with a dying client. The most helpful action for the client would be for the nurse to plan to: 1. Seek personal counseling to improve skills in this area. 2. Request a member of the pastoral care staff visit the client. 3. Ask to be removed from the care of that client. 4. Make an attempt to meet the client's needs in this area, even if uncomfortable.

2. Request a member of the pastoral care staff visit the client. Correct Rationale: Pastoral care is available at most sites, and if a nurse is uncomfortable with spiritual issues the pastoral care services may be better able to meet the spiritual needs of the client. A nurse would plan to get education, rather than counseling, on how to meet the needs of dying clients. Discomfort with a situation is not a reason for asking to be removed from caring for that client.

The nurse should anticipate which of the following changes in the respiratory system during the normal aging process? 1. Vital capacity is increased. 2. Residual volume is decreased. 3. Gas exchange will occur more slowly and less efficiently. 4. The diaphragm becomes stronger.

2. Residual volume is decreased. Correct Rationale: Normal respiratory functions include gas exchanges or the transfer of oxygen from the air into the blood and the removal of carbon dioxide from the blood. Cognitive level: Applying

The nurse determines that a postmenopausal patient has understood teaching related to use of complimentary/alternative therapy to reduce hot flashes if she reports purchasing which of the following? 1. Saw Palmetto extract (Serenoa Repens) 2. Soy products 3. Milk thistle (Silybum) 4. Ginkgo biloba (GBE)

2. Soy products Correct Rationale: Saw palmetto inhibits estrogen and increases testosterone. Milk thistle is used for liver, gallbladder, and treatment of cirrhosis. Ginkgo biloba is typically used to improve memory. Soy products can actually decrease hot flashes due to the phytoestrogens. Cognition level: application

The nurse is assigned to provide care for an elderly client hospitalized for regulation of blood pressure. During the hospitalization, the nurse notices the client is awake often during the night. When questioned, the client reports "I thought I would need more sleep as I got older but I can't sleep more than 3 hours at night." When questioned further, the client reports falling to sleep immediately after getting into bed but waking up repeatedly thereafter. Which of the following statements does the nurse recognize as most correct? 1. Since the client is falling asleep quickly he likely has no significant issues related to sleep. 2. The client is likely demonstrating a manifestation of sleep deprivation. 3. The client has no health implications as a result of his reduced amount of sleep hours. 4. The client is getting adequate sleep each night.

2. The client is likely demonstrating a manifestation of sleep deprivation. Correct Rationale: Individuals who fall asleep immediately upon retiring are often sleep-deprived. Older adults typically need between 6 and 10 hours of sleep each night. Obtaining fewer than 4 hours per night is associated with an increase in mortality rates.

A nurse nearing the end of a long career is reflecting on the changes in care of dying clients with a group of new graduate nurses. Which of the following statements is reflective of the changes in care of the dying over the past several years? 1. The use of nurses to provide care to dying clients is not cost effective. 2. The life span of chronic illness has become extended in many cases. 3. Increasingly technological therapeutic interventions have been linked to improved communication with dying clients and their caregivers. 4. The focus of modern health care has shifted from cure to care.

2. The life span of chronic illness has become extended in many cases. Correct Rationale: The changes in health care have resulted in an infusion of technology. This technology has resulted in clients often living longer with illnesses. The increase in technology has impeded communication between the client, family, and care team. There is an increasing shift to a model stressing cure.

A terminally ill man has been discharged from the acute care facility. He plans to return home for the final days of his life. The client indicates an interest in alternative and complementary methods to manage the symptoms of the end stages of the disease process. While discussing this interest in alternative and complementary methods the client asks for additional information about the use and success of these methods. Which of the following should be included in the nurse's response? Select all that apply. 1. These methods are used only by a small fraction of the terminally ill population. 2. These methods may be associated with a sense of false hope by the terminally ill. 3. Alternative and complementary methods can be used to promote relaxation during the final stages of life. 4. Alternative and complementary methods are often too expensive for many clients to afford.

2. These methods may be associated with a sense of false hope by the terminally ill. 3. Alternative and complementary methods can be used to promote relaxation during the final stages of life. Correct

An 80-year-old nursing home resident is diagnosed with stress incontinence. The registered nurse delegates basic care of the patient to a certified nursing attendant (CNA) with highest priority on which nursing diagnosis based on the problem of stress incontinence? 1. Abdominal exercises 2. Toileting every two hours 3. Ambulating twice a day 4. Aerobic exercises

2. Toileting every two hours Correct Rationale: Bladder training is similar to timed voiding, but the intervals between trips to the toilet are gradually lengthened, training the bladder to hold slightly increased amounts of urine. Pelvic floor exercises, or Kegel exercises, are an intervention to assist or prevent urinary incontinence. The technique works for both urge and stress incontinence. The individual needs to be cognitively intact enough to learn them. Cognition level: knowledge

The nurse is completing a nutritional assessment and asking about her elderly patient's use of vitamins. Which of the following vitamins being taken must be carefully evaluated for risk of toxicity? Select all that apply. 1. Vitamin 12 2. Vitamin A 3. Vitamin D 4. Vitamin E

2. Vitamin A 3. Vitamin D 4. Vitamin E Correct Rationale: Fat-soluble vitamins such as A, D, and E could lead to toxicity. Water-soluble vitamins such as all B vitamins and vitamin C have a low risk of toxicity. Cognition level: Knowledge

Which nutrient is most likely to be deficient in elderly residents of nursing homes? 1. Phosphorus 2. Vitamin D 3. Protein 4. Vitamin B

2. Vitamin D Correct Rationale: The elderly have greater need for vitamin D due to decreased absorption, decreased dietary intake, and lack of exposure to sunlight. Phosphorus, protein, and vitamin B are more readily obtained through dietary means.

The community health nurse is conducting a teaching session for elderly female patients on the normal changes of aging related to the genitourinary system. Which of the following would be accurate information to communicate to the group? 1. Vaginal lubrication is increased with aging. 2. Weakening of the voluntary pelvic floor muscles. 3. The clitoris increases in size.

2. Weakening of the voluntary pelvic floor muscles. Correct Rationale: Incontinence can occur because the pelvic floor muscles become weak and therefore, with coughing, laughing, and/or sneezing, urine is released without control. Cognition level: knowledge

When working with elderly clients who require an increased consumption of complete protein, the nurse recommends: 1. Legumes. 2. Yogurt. 3. Iron fortified cereal. 4. Whole grain bread.

2. Yogurt. Correct Rationale: After eggs and meats, dairy products are the best source of complete protein. Legumes, cereal, and bread have some protein but it is incomplete protein.

Which of the following responses would be accurate if given to the nurse during an initial interview by a patient with benign prostatic hypertrophy (BPH)? 1. "I have pain and swelling of my both ankles." 2. "I frequently drink wine with my evening meals." 3. "I have difficulty starting a stream of urine, and it is a weak stream." 4. "I generally have urinary frequency during the day but can sleep through the night."

3. "I have difficulty starting a stream of urine, and it is a weak stream." Correct Rationale: Benign prostatic hyperplasia (BPH) affects 50% of men between the ages of 51 and 60 years, and 90% of men over age 80. Clinical BPH refers to observable symptoms related to BPH. The growth of the prostate is influenced by the interactions among androgens and estrogens. The symptoms of BPH are sometimes referred to as "nuisances," although they can have a profound effect on daily living. They include difficulty starting a stream of urine, weak stream, straining to urinate, longer time needed to urinate, and a feeling of incomplete bladder emptying. Cognition level: understanding

The terminally ill client reports being concerned about the amount of technology being employed to save the lives of others with conditions similar to her own. The client states that they are not in favor of this technology. Which of the following statements by the nurse is indicated at this time? 1. "You do not have to do anything you do not want to do." 2. "Technology is an important advance in disease management." 3. "Please share your specific concerns with me about technology." 4. "Perhaps technology could be used to promote your quality of life."

3. "Please share your specific concerns with me about technology." Correct Rationale: The use of technology may be a source of fear and concern to the terminally ill elderly client. When caring for this client it will be important to assess the specific source of the concerns. Advising the client she does not need to take any actions that are not desired does little to determine the true source of concern. The client is not concerned about promoting life in this interaction.

The nurse is conducting an educational session for women over 65 at a community center. Which of the following should the nurse include during the teaching session? 1. "Cervical cancer in women over 65 is not a primary concern because the Pap smear is usually negative." 2. "It is important to understand that the human papilloma virus (HPV) is only related to early onset sex, not to older women." 3. "Women over age 65 with history of regular, normal Pap smears and absence of other risk factors should not receive routine Pap smears." 4. "Current recommendations indicate that African -American women over age 65 are at higher risk for cervical cancer and should receive a yearly Pap smear."

3. "Women over age 65 with history of regular, normal Pap smears and absence of other risk factors should not receive routine Pap smears." Correct Rationale: Cervical cancer in the older woman is primarily a concern because of the confusion around screening for the disease. The disease itself is more prevalent in younger women. The risk factors of cervical cancer include infection with human papillomavirus, early onset of sexual activity, history of abnormal Pap smears, HIV-positive status, and many sexual partners. Current recommendations are that women who are over age 65, who have had a regular history of normal Pap smears, and who are not at high risk because of other factors should not receive routine Pap smears. Cognition level: knowledge

The most frequently used diagnostic test for persons suspected of having GERD is: 1. A barium enema. 2. An upper endoscopy. 3. A barium swallow. 4. Acid perfusion tests.

3. A barium swallow. Correct Rationale: Persons with GERD should be referred to a primary care provider for a thorough cardiac evaluation to rule out cardiac disease. The most frequently used diagnostic test is the barium swallow. Upper endoscopy is the best method to assess mucosal injury. Acid perfusion tests are usually not necessary and require the placement of an esophageal probe above the esophageal sphincter to collect esophageal contents.

A nurse is preparing to discuss pain management in the terminally ill with a group of student nurses. During the session, the nurse points out populations that are at an increased risk for the undertreatment of pain during a terminal illness. Which of the following groups is included in this listing? Select all that apply. 1. Young adults 2. Older adults 3. African-Americans 4. Men

3. African-Americans 4. Men Correct

A terminally ill client has been experiencing nausea and vomiting. The client reports that the vomiting is limiting the ability to rest and spend quality time with family members. Which of the following responses by the nurse is indicated? 1. Advise the client that the cause of the nausea is linked to analgesic medications. 2. Advise the client that nausea and vomiting are seen in the majority of clients in this condition. 3. Consult with the physician about prescribing medications to manage the condition. 4. Hold the next dose of analgesic medications.

3. Consult with the physician about prescribing medications to manage the condition. Correct Rationale: The majority of clients at the end of life experience nausea and vomiting. This condition must be managed. The nurse must consult with the physician to manage the condition. Advising the client of the cause and frequency may be done, but they are not the priority actions. Holding the analgesic medication would result in the client becoming increasingly uncomfortable and is not an acceptable option.

Chest percussion has been ordered for a patient on bedrest with respiratory infections and increased secretions. The nurse should use which of the following hand positions to administer chest percussions? 1. Flat hand position 2. Fisted hand position 3. Cupped hand position 4. Flexed hand position

3. Cupped hand position Correct Rationale: Lightly clapping the chest and back helps to loosen secretions. Cognition level: understanding

Which of the following practices regarding hydration is considered most conducive to comfort in the last days of life? 1. Intravenous fluids 2. Feeding tube 3. Dehydration 4. Liquid supplements

3. Dehydration Correct Rationale: As patients stop wanting food and fluids, the nurse should support these wishes. Dehydration at the end of life does not cause distress and may provide several benefits, from the release of endorphins to decreased lung congestion. Parenteral or enteral nutrition at this time neither improves symptoms nor lengthens life. Cognition level: Understanding

Which of the following factors may cause significant arterial damage to penile blood flow resulting in erectile dysfunction? Choose all that apply. 1. Testosterone excess 2. Hypertension 3. Diabetes mellitus 4. Dyslipidemia 5. Presence of nocturnal tumescence

3. Diabetes mellitus 4. Dyslipidemia Correct Rationale: Hypertension, diabetes mellitus, dyslipidemia, and smoking all may cause arterial damage significant enough to lead to erectile dysfunction. Cognition level: application

Sleep is a problem that should be assessed in the elderly because a major potential complication of sleep deprivation is: 1. Sleepwalking. 2. Unremitting fatigue. 3. Disorientation. 4. Cardiac arrhythmias.

3. Disorientation. Correct Rationale: The elderly who do not get enough quality sleep may become disoriented or suffer from hallucinations. Sleep deprivation is not a cause of sleepwalking or cardiac arrhythmias. Unremitting fatigue may cause one to fall asleep anytime or anyplace.

In managing the symptoms associated with gastroesophageal reflux disease (GERD), the nurse should assign highest priority to which of the following interventions? 1. Decreasing daily intake of vegetables and water, and ambulate frequently. 2. Drink coffee diluted with milk at each meal and remain in an upright position for 30 minutes. 3. Eat small, frequent meals and remain in an upright position for at least 30 minutes after eating. 4.Avoid over-the-counter drugs that have antacids included in them

3. Eat small, frequent meals and remain in an upright position for at least 30 minutes after eating. Correct Rationale: Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus.

The nurse in the long-term-care facility is caring for an elderly woman who has recently lost her husband. A client centered intervention to assist the woman would include: 1. Guiding the bereaved individual through the stages of grief in the usual order. 2. Assisting the bereaved individual in achieving a healthy adjustment to the loss. 3. Encouraging verbalization about the loved one. 4. Teaching about the grieving process and offering support.

3. Encouraging verbalization about the loved one. Correct Rationale: Encouraging the client to talk about her husband would be helpful to the bereavement process. The goal of grieving is to adjust to the loss in a time and manner that is culturally acceptable to the individual who experienced the loss. There is no timetable that must be met or defined in order to achieve the goal. Teaching is a nursing goal and is not client centered.

When planning nursing interventions for a patient with COPD, which of the following nursing diagnoses would be the nurse's first priority? 1. Self-care deficit 2. Activity intolerance 3. Ineffective airway clearance 4. Impaired gas exchange

3. Ineffective airway clearance Correct Rationale: When COPD develops, the walls of the small airways and alveoli lose their elasticity and thicken, closing off some of the smaller air passages and narrowing the larger ones. The lungs contain 300 million alveoli whose ultrathin walls form the gas exchange surface. Enmeshed in the wall of each of these air sacs is a network of tiny capillaries that bring blood to the gas exchange surface. Air can enter the alveoli during inspiration; but on expirations, the air becomes trapped because of collapsing airways. Cognition level: applying

A primary goal of dietary intervention for the elderly is to: 1. Prevent complications from chronic conditions. 2. Improve digestion and metabolism. 3. Maintain quality of life. 4. Treat acute conditions.

3. Maintain quality of life. Correct Rationale: Dietary assessment and early intervention can improve the overall quality of life and possibly prevent disease or illness. Most acute conditions are not treated primarily by dietary intervention. Digestion occurs in the GI tract and metabolism occurs at the cellular level.

Which of the following suggestions might the nurse use for an elderly client who lives alone and has insomnia? 1. A mild hypnotic 2. Ear plugs to decrease ambient noise 3. Melatonin supplement 4. A walk around the block just before bed

3. Melatonin supplement Correct Rationale: Melatonin supplements have been found to significantly improve sleep in the elderly with insomnia and have few side effects. The client should check with the healthcare provider before taking a supplement. Hypnotics are for short-term use only. Insomnia has many causes other than noise so ear plugs may not address the main problem. Activity within a couple hours of bed often leads to inability to release into sleep; therefore, activity should be earlier in the day.

Question 2 The older person with chronic renal failure (CRF) may experience generalized edema, altered cognition, anorexia, and weight loss. To help improve the person's quality of life (QOL), which of the following healthcare providers should be contacted promptly? 1. Certified dietitian 2. Infectious disease person 3. Nephrologist 4. Surgeon

3. Nephrologist Correct Rationale: A consequence of the older adult's decreased ability to concentrate urine is increased susceptibility to dehydration, a problem that is further complicated by a deficit in the thirst response; therefore, the older person will not feel thirsty even when significantly dehydrated. Chronic renal failure is caused by irreversible damage to the kidney and is much more common in older adults than in younger adults. As the disease progresses, the older adult may experience pruritus, general lack of well-being, generalized edema, altered cognition, anorexia, nausea, and weight loss. As with acute renal failure, prompt consultation by a nephrologist is critical to improving the older adult's quality of life and long-term survival. Cognition level: Understanding

An elderly person diagnosed with metastatic bone cancer has reached the final stages of life. The individual has been admitted to the long-term-care facility for palliative care. The priority nursing interventions will be: 1. CPR if needed. 2. Assessment of urinary output. 3. Pain relief. 4. Monitoring of oral intake.

3. Pain relief. Correct Rationale: The purpose of palliative care is pain relief when no additional treatment is desired or available. Comfort measures direct the primary nursing intervention and may include medications, or complementary therapies such as massage. Individuals receiving palliative care are not candidates for CPR. Assessment of urinary output and oral intake do not have the highest priority.

An elderly client has been admitted to a nursing home and the nurse completes an assessment. Which finding may lead the nurse to suspect a nutritional alteration? 1. Pale tongue 2. Thinning hair 3. Ridged nails 4. Moist conjunctiva

3. Ridged nails Correct Rationale: Ridged, spoon-shaped nails are signs of long-term nutritional deficiencies. Thinning hair is consistent with aging. Moist conjunctiva are signs of nutritional balance. A pale tongue, in the absence of other pathology, does not signify nutritional inadequacy.

During history taking which of the following herbal preparations might a patient with a history of BPH disclose to the nurse? 1. Hawthorne (Crataegus) 2. Licorice (Glycyrrhiza) 3. Saw Palmetto extract (Serenoa Repens) 4. Ma Haung (Ephedra Sinica)

3. Saw Palmetto extract (Serenoa Repens) Correct Rationale: Saw palmetto is an over-the-counter herbal preparation that has been recommended for improving BPH symptoms; however, empirical studies have not consistently demonstrated its efficacy. Cognition level: knowledge

When reviewing an elderly person's medications during a clinic visit, the nurse will recognize which of the following classifications of medications as one that may cause suppression of REM sleep? 1. Decongestants 2. Beta blockers 3. Stimulants 4. Aminoglycosides

3. Stimulants Correct Rationale: Stimulants cause disruption in REM sleep by their effects on the central nervous system, causing a loss of total sleep time and time in REM sleep. Decreased REM sleep can lead to a feeling of increased daytime sleepiness. The other classifications do not affect REM sleep although they may cause sleepiness or insomnia in some individuals.

The loss of lean muscle mass that occurs with aging can be diminished or reversed by: 1. Anaerobic exercise. 2. High protein diets. 3. Strength training exercises. 4. Small doses of anabolic hormones.

3. Strength training exercises. Correct Rationale: Resistance exercises, such as lifting weights, have been shown to increase muscle mass in the elderly. Anaerobic exercises, high protein diets, and anabolic steroids are not effective in reducing loss of muscle mass or increasing muscle mass.

A nurse who works effectively with elderly clients who are dying and their families recognizes that: 1. Most people are not afraid to die if they have adequate information about what is happening. 2. At least some pain accompanies most deaths. 3. The nurse must be comfortable with his or her own concerns and feelings about death. 4. Hospice services are preferable as death nears.

3. The nurse must be comfortable with his or her own concerns and feelings about death. Correct Rationale: Nurses and other healthcare providers who are comfortable with their own understanding of death can be effective when working with the dying, rather than bringing their conflicted feelings to a stressful situation. Unless the nurse has used some critical thinking to look at and investigate his or her feelings and understandings, they may conflict with those of the client. Many people are indeed afraid of dying, especially if pain may occur. However, pain is not inevitably associated with death. Hospice may not be appropriate or possible for many individuals.

The family members of a recently deceased client is spending some last moments with their loved one. The family members come to the nurse's station reporting they believe they heard a breathing sound from the client when they hugged him. What initial action by the nurse is indicated? 1. The nurse should explain this is not a "life sound." 2. The nurse should contact the physician who is "on call." 3. The nurse should listen for breath sounds again. 4. The nurse should document the report in the medical record.

3. The nurse should listen for breath sounds again. Correct Rationale: Movement of the body may cause a respiratory like sound. This is the sound of air leaving the lungs. To be certain, the nurse should assess for breath sounds. The family should have an explanation of this event. Explaining to the family that this is not a life sound is not prudent and requires a more final assessment. There is nothing to report to the physician at this time. There is nothing definitive to report on the medical record.

Which of the following measures is the most important action in preventing the transmission of pulmonary tuberculosis? 1. Use of a surgical mask by the caregiver 2. Strict hand washing 3. Use of HEPA-filter mask by the patient 4. Adequate ventilation of rooms

3. Use of HEPA-filter mask by the patient Correct Rationale: TB is largely a preventable disease. Hospitals and clinics should take special precautions and isolate patients with active TB. Special filters and ultraviolet light can sterilize the air. Cognition level: knowledge: remembering

An elderly man reports some concerns during a routine physical. The client states he has not really changed his eating patterns or activity in the past several years but has noted some "negative" changes in overall physique. When questioned further he reports he has noticed some loss of muscle tissue. He questions the cause and wonders what he can do to improve. What information should be provided to the client?

4. "Aging is associated with a loss of muscle mass and cannot be reversed." Correct Rationale: The loss of muscle mass is seen in older adults. It is a natural occurrence. Diet and exercise can prolong the phenomena but not totally arrest it. The client has asked specifically about the cause and possible solutions. The other options do not fully address the client's requests for information.

A terminally ill client has decided to avoid pain medications. When questioned by the nurse, the client acknowledges feeling very uncomfortable. Which of the statements reflects information that the nurse should provide to the client? 1. "Avoiding pain medication near the end of life will enable you to have more meaningful communication with your friends and family." 2. "Avoiding pain medications at the end of life will allow you to have more awareness of your surroundings." 3. "Your plan will likely prolong your life." 4. "Failure to take pain medication may actually be counterproductive because of the increased stress you may endure."

4. "Failure to take pain medication may actually be counterproductive because of the increased stress you may endure." Correct Rationale: The experience of unmanaged pain at the end of life will result in reduced communication and interaction with others. Pain can hasten death. Untreated pain can result in psychological distress and sleep disorders.

At 0200 the nurse finds an elderly hospitalized client sitting in a chair beside the bed. When the client says she is unable to sleep, the best action on the part of the nurse is to: 1. Call the physician to obtain an order for a hypnotic. 2. Assist the client back to bed. 3. Provide a glass of warm milk and offer a back rub. 4. Ask about strategies the client has used successfully in the past to fall asleep.

4. Ask about strategies the client has used successfully in the past to fall asleep. Correct Rationale: Very often the client can tell the nurse what has been used in the past to fall asleep—things like soft music, a dark room, or warm milk. The nurse can then plan interventions that are acceptable to the client and will aid in sleep. Merely assisting a client back to bed does not address the problem. Hypnotics should only be prescribed for short-term sleep problems, so a prescription does not address what might be a chronic problem.

A moderately overweight client reports to the clinic for a routine physical examination. During the examination, the client reports recent attempts to lose weight in order to improve overall health. While talking the client states he feels he "eats pretty well" but still does not seem to lose the weight desired. Which of the following assessment tools should the nurse encourage to assist the client in attaining his goal? 1. Completion of a diet diary for a 7 day period 2. Completion of a diet diary for a 2 day weekend period 3. Completion of a diet diary for 5 consecutive days beginning on a Monday 4. Completion of a diet diary for 2 weekdays and 1 weekend day

4. Completion of a diet diary for 2 weekdays and 1 weekend day Correct Rationale: The diet diary will provide a tool to review the dietary intake. This will allow the client the ability to review an accurate accounting of the dietary intake. Recording the dietary intake for more than 3 days is not recommended as it is cumbersome. The recommended time length is 2 weekdays and 1 weekend day.

Which of the following findings is not an indication of diverticulitis? 1. Fever 2. Leukocytosis 3. Pain 4. Diarrhea

4. Diarrhea Correct Rationale: Diverticulitis is an infection from colonic diverticula. Fever, leukocytosis, pain, and/or abdominal tenderness may be indicators of diverticulitis.

What preventive measures might the nurse teach the elderly to prevent constipation? 1. Use a stool softener once a week. 2. Chew food thoroughly before swallowing. 3. Drink coffee or tea only in the morning. 4. Drink a glass of water several times a day.

4. Drink a glass of water several times a day. Correct Rationale: Adequate fluid intake, along with adequate fiber, is the best dietary measures to prevent constipation. Daily stool softeners can lead to dependency on them for bowel movements. Chewing is important but will not prevent or control constipation. Coffee or tea taken only once per day will not supply enough fluid to prevent constipation.

An elderly person who is experiencing sleep deprivation may exhibit: 1. Increased deep tendon reflexes. 2. Blurred vision. 3. Incontinence. 4. Emotional instability.

4. Emotional instability. Correct Rationale: A sleep deficit accumulates and results in a loss of daytime functions. The person may show signs of memory lapse, loss of initiative, and emotional instability. The other symptoms listed are not related to sleep deprivation

The wife of an elderly man on life support expresses the family's desires to suspend treatment for their loved one. Which of the following actions by the nurse would be of the highest priority? 1. Suggest the family reconsider the finality of the decision. 2. Call the physician. 3. Call for pastoral support. 4. Explore the wife's understanding of the consequences of such a decision.

4. Explore the wife's understanding of the consequences of such a decision. Correct Rationale: When respecting a family's autonomy, the nurse recognizes that it is their right to make such a decision. It is important to make sure they understand what such a decision means about the outcome of the disease process. At some point the physician should be notified, but only after discussion with the client affirms the decision. Pastoral support may be needed if the family desires. The role of the nurse is to support a client, not suggest what the client should do.

Persons with sleep apnea: 1. Experience excessive deep sleep. 2. Are often slim and underweight. 3. Experience excessive tension in the muscles of the throat and palate. 4. Have an increased risk for sudden death and stroke.

4. Have an increased risk for sudden death and stroke. Correct Rationale: Obesity and a large neck size are risk factors for sleep apnea, which is caused by relaxation of the muscles in the throat, soft palate, and tongue during sleep. It will result in less deep sleep and REM sleep. Older people who repeatedly suffer hypoxic events during sleep apnea may be more prone to sudden death, stroke, angina, and worsening hypertension. Cognition level: Knowledge

Which of these agents is a major contributing factor in the promotion of peptic ulcer disorder? 1. Candida albicans 2. Staphylococcus infection 3. Streptococcus infection 4. Helicobacter pylori infection

4. Helicobacter pylori infection Correct Rationale: Recurrence of peptic ulcers is related to Helicobacter pylori, use of NSAIDs, smoking, and continued acid hypersecretion.

When assessing the patient with stress incontinence, the nurse should anticipate/report which of these signs/symptoms? 1. Pain on urination 2. A brownish urethral discharge 3. Voiding excessive amounts of urine 4. Loss of urine when laughing, coughing, and or sneezing

4. Loss of urine when laughing, coughing, and or sneezing Correct Rationale: With stress incontinence the external sphincter/pelvic floor is weakened and the individual experiences an increase in intra-abdominal pressure. There is small urine loss during sneezing, laughing, and exercise. Both men and women can experience stress incontinence. Cognition level: knowledge

A nurse is administering a dose of oral potassium chloride to an elderly, hospitalized patient. Which of the following situations would present a possible contraindication? 1. Patient who is taking Miralax for constipation 2. Patient who is hypertensive and taking furosemide 3. Patient who is bradycardic 4. Patient who must lie flat post hip replacement

4. Patient who must lie flat post hip replacement Correct Rationale: Potassium chloride can be injurious to the esophagus of older adults, and they should be advised to remain upright for thirty minutes after taking this drug to minimize this risk. Patients who must remain supine would be at additional risk for esophageal irritation when taking this drug. Cognition level: Application

Which of the following is considered a major sleep disorder of the elderly? 1. Insomnia 2. Hyposomnia 3. Restless leg syndrome 4. Sleep apnea

4. Sleep apnea Correct Rationale: Cessation of breathing that occurs during sleep apnea causes poor quality sleep and, in the presence of other medical conditions, may result in exacerbation of those conditions. The other conditions listed may be frustrating for the individual but are not considered major sleep disorders.

An appropriate dietary intervention for an elderly client with dysphagia is to: 1. Serve smaller, more frequent meals. 2. Serve foods at room temperature. 3. Provide a full liquid diet. 4. Thicken thin liquids.

4. Thicken thin liquids. Correct Rationale: Dysphagia means difficulty with swallowing. Liquids that are thickened are easier to swallow and less likely to cause the client to choke or gag. The frequency or temperature of foods does not affect the ability to swallow.

A major predictor of morbidity and mortality in the elderly is: 1, Social isolation. 2. Polypharmacy. 3. Impaired dentition. 4. Unintentional weight loss.

4. Unintentional weight loss. Correct Rationale: Weight loss that is unplanned and not due to a known cause often signifies an undiagnosed health problem or depression that needs treatment. Isolation, multiple medications, or impaired dentition may contribute to weight loss. However, unintentional weight loss should always be investigated.

A 76 year-old patient is receiving tamoxifen (Nolvadex) for breast cancer. Which of the following side effects would the nurse monitor the patient for? Choose all that apply. 1. Weight loss 2. Signs of dehydration 3. Occasional muscle ache 4. Vaginal discharge

4. Vaginal discharge Correct Rationale: The common side effects of tamoxifen are similar to menopausal symptoms. Other side effects of the tamoxifen drug include vaginal discharge. With the use of tamoxifen the patient's weight will need to be monitored, as these patients tend to lose weight. Cognition level: knowledge

The nurse is reviewing the nutritional intake of a recently admitted nursing home 68-year-old resident. The nurse notes the client's records indicate a recent history of weight between 135 and 138 pounds. The admission weight of the resident is 122 pounds. The resident often leaves about 10-15% of the meal uneaten. The resident has a history of bipolar disorder successfully managed by medications. The resident demonstrates moderate involvement in unit social activities. When evaluating these findings which of the following statements is most correct? 1. The resident demonstrates malnutrition. 2. The resident does not demonstrate malnutrition. 3. The resident is at high risk for the development of malnutrition. 4. The resident is currently at moderate risk for malnutrition.

Correct Rationale: A weight loss of 13 to 16 pounds is reflective of a loss of approximately 10%. The weight loss combined with the dietary intake does not meet the criteria of malnutrition. The resident's mental health history do increase the risk of malnutrition but this risk is somewhat negated by the remission of the condition. A weight loss of 25% accompanied by not eating 25% or more of the provided meals is a strong indicator of malnutrition.

One of the challenges in meeting the nutritional needs of the elderly is that the elderly: 1. Have decreased need for almost all nutrients. 2. Have decreased caloric needs but constant or increased needs for vitamins and minerals. 3. Often have significant problems with dentition that affect their ability to masticate most food. 4. Lose interest in eating a balanced diet.

Have decreased caloric needs but constant or increased needs for vitamins and minerals. Correct Rationale: A decreasing metabolic rate (or resting energy expenditure) means fewer calories are required, but the DRI for most nutrients remains unchanged or may be increased in the elderly thus necessitating careful dietary planning to meet those needs. Loss of interest in food may mean physiologic problems exist. Dental problems for the elderly are not nearly as common today as they were a generation ago.

An elderly client has Alzheimer's disease and frequently gets up during the night and wanders around the house. Which of the following suggestions is most appropriate to give the spouse? 1. Contact the physician to obtain an order for a mild hypnotic or sedative. 2. Try using a soft restraint jacket at night. 3. Make sure the client takes a brief nap during the afternoon. 4. Increase daily activity by going for frequent short walks.

Increase daily activity by going for frequent short walks. Correct Rationale: Activity helps the client remain awake during the day; daytime naps interfere with nighttime sleep. The bed should only be used for sleeping at night. Hypnotics or sedatives are for short-term use only. Restraints only increase agitation.