Gero exam 2

The nurse is concerned that an older patient has a problem related to regular alcohol consumption. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. Anxiety 2. Malnutrition 3. Social isolation 4. Bruises from falling 5. Dependence on family members

1 2 3 4

Which statement made by an older patient indicates to the nurse that the patient might be contemplating suicide? 1. I wish I could stop all of this pain. 2. God will take me when its my time. 3. Im ready to go when God calls me. 4. Im no use to anyone. I might as well be dead.

4

12. A patient has been admitted to the postanesthesia care unit after a trabeculectomy. What assessment takes priority? a. Airway b. Pain c. Eye patch d. Blood pressure

A

13. The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a.Verbal fluency c.Object naming b.Logical analysis d.Visuospatial skills

A

11. Which of these assessment findings would the nurse expect to see when examining the eyes of a black patient? a. Increased night vision b. Dark retinal background c. Increased photosensitivity d. Narrowed palpebral fissures

B

6. An older adult patient reports ringing in the ears. What additional data should the nurse gather to help determine the cause of the patients problem? a. History of ear surgery b. Use of prescription medications c. Exercise and sleep patterns d. Nutritional status, especially protein intake

B

An older patient is prescribed a monoamine oxidase inhibitor (MAOI) medication. Which meal choice indicates that the patient needs further education regarding this medication? 1. Pepperoni pizza and diet soda 2. Baked chicken, green beans, and cherry pie 3. Fried chicken, creamed corn, and French fries 4. Chicken salad on a croissant, carrot sticks, and fresh fruit

1

An older patient tells the nurse that alcohol is used occasionally to combat stress. The patient is a recent widow, retired, and admits to feeling worthless at times. The nurse realizes this patient is at risk for which health problem? 1. Suicide 2. Paranoia 3. Dementia 4. Liver failure

1

During an interview, the nurse notes that an older patient is having mild difficulty with some words and forgets the names of people. The patient is alert, oriented to time, person, and place, and makes appropriate responses. What does the nurse determine this patients cognitive changes to mean? 1. Normal signs of aging 2. Early symptoms of dementia 3. Indicators of depression in the elderly 4. Memory impairment that may be related to cerebral ischemia

1

Which observation should indicate to the nurse to assess an older patient for depression? 1. Flat affect 2. Hyperactivity 3. Racing thoughts 4. Pressured speech

1

An older patient is concerned about remembering to take prescribed medications. What strategies should the nurse recommend to this patient? Standard Text: Select all that apply. 1. Rely on habit to take the medication. 2. Use an assistive device such as a pillbox. 3. Suggest a family member provide the medication. 4. Discuss moving to an assisted living facility for safety. 5. Discuss reducing the number of medications with the physician.

1 2

An older African American patient is diagnosed with a mental health problem that has been untreated for many years. What does the nurse realize as reasons for this patients problem not being adequately treated? Standard Text: Select all that apply. 1. Ageism 2. Poverty 3. Cultural bias 4. Discrimination 5. Respecting medical personnel

1 2 3 4

The nurse is preparing an educational program for nursing assistants at a long-term care facility about psychiatric issues in older patients. Which symptoms should the nurse include? Standard Text: Select all that apply. 1. Flat affect 2. Fear of death 3. Changes in sleep patterns 4. Delusions and hallucinations 5. Difficulty in performing ADLs

1 2 3 4

What should the nurse instruct an older patient to do to cope with age-associated cognitive changes? Standard Text: Select all that apply. 1. Read daily. 2. Write notes to self. 3. Play computer games. 4. Learn memory enhancement techniques. 5. Expect others to call attention to any gaffes.

1 2 3 4

The nurse is preparing a presentation on grief. What information should be included regarding factors that can affect the duration and course of grieving? Standard Text: Select all that apply. 1. Centrality of loss 2. Nature of the death 3. Health of the survivor 4. Cultural and ethnic influences 5. Survivors religious or spiritual belief system

1 2 3 5

An older patient is demonstrating signs of paranoia. What does the nurse identify as possible causes for this type of psychosis? Standard Text: Select all that apply. 1. Delirium 2. Hearing loss 3. Physical illness 4. Social isolation 5. Cognitive impairment

1 2 4 5

Which cognitive changes does the nurse recognize as being normal in an older patient? Standard Text: Select all that apply. 1. Decline in the ability to draw 2. Decrease in size of vocabulary 3. Difficulty filtering out irrelevant information 4. Difficulty switching attention from one person to another 5. Needing to repeat information to the patient several times

1 3 4 5

The nurse is planning care for an older patient diagnosed with major depression who states that voices are telling the patient to kill himself. Which nursing diagnosis would be a priority for this patient? 1. Social isolation 2. Risk for suicide 3. Disturbed sleep pattern 4. Altered sensory perception

2

The nurse is providing discharge instructions to an older patient that includes the administration of insulin. Which strategy will the nurse use when instructing this patient to adjust to the normal changes experienced with aging? 1. Giving written materials to compensate for short-term memory losses 2. Using tools that repeat the information until the information is understood 3. Considering holding sessions for longer periods than usual so the patient can learn 4. Providing instruction to relatives so that the patient will not need to learn everything

2

An older patient being treated for abdominal pain reports no relief of pain and other somatic complaints after receiving adequate pain medication. What additional intervention is indicated for this patient? 1. Reviewing the patients lab values 2. Contacting the family to talk to the patient 3. Further assessment and treatment for depression 4. Obtaining an order for different pain medication

3

An older patient wakes up from sleep, confused, and insists a family member is in the other room. What information within the patients medical record should the nurse consider as a source of the patients confusion? 1. The patient is elderly. 2. The patients spouse recently died. 3. The patient received pain medication. 4. The patient has a history of cardiac disease.

3

An older patient with cardiac disease is having sleep problems and insomnia. Of what health problem should the nurse consider these manifestations? 1. Normal signs of aging 2. Predictive signs of respiratory disease 3. Symptoms of the negative effects of stress 4. Expected manifestations of cardiac disease

3

During an assessment, the nurse learns that an older patient experiences much stress and feels the heart racing at times. The nurse explains that this is the fight-or-flight response and is associated with which body chemical? 1. Serotonin 2. Dopamine 3. Epinephrine 4. Acetylcholine

3

The nurse caring for older patients in a long-term care facility is organizing a depression screening program for the residents. How will this screening program benefit the older patients? 1. Differentiates dysthymia from delirium 2. Supports care expectations of the older patients family members 3. Depression symptoms are often associated with chronic illness and pain. 4. Depression is the easiest mood disorder to detect and treat in older patients.

3

Type: MCMA The nurse is planning an educational session on suicide in the older patient population. What information should the nurse include in this presentation? Standard Text: Select all that apply. 1. Suicide rates are the highest in teens. 2. A patient should never be questioned about suicide intent. 3. Suicide rates are the highest in people age 65 and older. 4. An older person who contemplates suicide is more likely to complete the act than a younger person. 5. Approximately 70% of older adults who commit suicide had visited their primary care physician within the previous month.

3 4 5

An older patients spouse passed away 4 years ago; however, the patient still sets a place at the dinner table for the spouse and has never removed any clothing or other personal items from the home. What does the nurse suspect the patient is experiencing? 1. Normal grief 2. Hopelessness 3. Survivor guilt 4. Pathological grief

4

The daughter of an older patient tells the nurse that the patient used to be a wonderful cook but now cannot remember how to use a blender. What does this information indicate to the nurse? 1. Short-term memory loss 2. Long-term memory loss 3. Normal cognitive change in an older person 4. Cognitive change that requires further assessment

4

The son of an older patient is concerned about the patients ongoing forgetfulness and asks the nurse to explain what could be wrong with the patient. How should the nurse respond to the son? 1. Memory difficulties are hard for family members to deal with. 2. My parents are the same age as yours, and they cant remember anything. 3. Forgetfulness is common in older adults. Its nothing you need to worry about. 4. Memory difficulties can be due to underlying issues including anxiety, chronic pain, or depression.

4

While organizing a walking program at an assisted living facility, one resident asks why older people should exercise. Which response would be the best for the nurse to make? 1. You arent too old to exercise. 2. Exercise can help increase your blood pressure. 3. Exercise has not been shown to have any benefits for people over 80. 4. Exercise can help reduce the negative effects of stress, which can impact your physical health.

4

1. When examining the eye, the nurse notices that the patients eyelid margins approximate completely. The nurse recognizes that this assessment finding: a. Is expected. b. May indicate a problem with extraocular muscles. c. May result in problems with tearing. d. Indicates increased intraocular pressure.

A

10. An older woman has a wound infection 5 days after a below-the-knee amputation brought about by diabetes mellitus. Which of the following is the nurses priority intervention to prevent cognitive dysfunction and postoperative complications in this older adult? a.Remove invasive devices as soon as possible. b.Minimize the administration of opioid analgesics. c.Allow for self-care and independent activities. d.Administer short-acting benzodiazepines as needed.

A

11. A patient in a nursing home is confused, nonverbal, but pleasant. The nurse notes the patient has suddenly become agitated and is screaming and scratching at the eyes. While the nurse is examining the patient, the patient vomits. What action by the nurse is best? a. Consult the provider about an ophthalmologic exam. b. Sedate the patient so she wont injure herself. c. Place mitts on the patients hands to avoid scratches. d. Give the patient a prn medication for pain.

A

11. A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola

A

11. An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques. The nurse shows an understanding of dementia when sharing with staff that: a. We will implement new interventions that address the diseases progression. b. Its important that we frequently recue the patient to improve her quality of life. c. The patients family needs to be made aware of this decline. d. This poor response to cueing is likely a result of advanced aging.

A

11. Which medication administered for delirium under a controlled environment can reduce the duration and severity of delirium for high-risk patients? a.Haloperidol (Haldol) c.Fluphenazine (Prolixin) b.Thioridazine (Mellaril) d.Chlorpromazine (Thorazine)

A

12. An 80-year-old patient who is experiencing symptoms of depression and anxiety is reluctant to comply with the prescribed treatment plan. The nurse initially addresses the issue with the patient by asking: a. How do you feel about how others view your mental health problem? b. Are you concerned about paying for your psychiatric medications? c. Did you know that depression is common among people your age? d. Do you have any questions about your the mental health treatment plan?

A

12. When differentiating the characteristics of depression, delirium, and dementia, the nurse recognized which of the following as an indicator of delirium? a.Sudden onset c.Insidious b.Recent loss d.Life change

A

13. A client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this clients plan of care? A. A simple, structured daily schedule with limited choices of activities B. A daily schedule filled with activities to promote socialization C. A flexible schedule that allows the client opportunities for decision making D. A schedule that includes mandatory activities to decrease social isolation

A

13. The nurse has conducted a nutrition screen on a patient using the Nutrition Screening Initiative tool. The patient scored a 4. What action by the nurse is most appropriate? a. Refer the patient to a dietician for a nutritional assessment. b. Encourage the patient to add more protein items to the diet. c. Reinforce the patients good eating habits and nutrition. d. Consult the provider about adding an iron supplement.

A

15. A nurse is caring for four patients. On which patient should the nurse plan to conduct a further nutritional assessment? a. The patient who has lost 10% of body weight in 1 month b. The patient who has lost 5 pounds with exercise in 1 month c. The patient who gained 3 pounds while on vacation d. The patient who weighs 12% over ideal body weight

A

15. A patient had a chemical splash into the eye at work. What action by the occupational health nurse takes priority? a. Begin flushing the patients eye with cool water. b. Call emergency medical services. c. Ask about the patients tetanus status. d. Tape the eye closed to prevent injury.

A

16. A patient with glaucoma is on timolol (Timoptic). The patient also takes metoprolol (Toprol) for hypertension. The patient reports to the clinic nurse that the eyedrops Make me dizzy. What assessment by the nurse is most appropriate? a. Assess the patients eyedrop instillation technique. b. Determine how long the patient has been on the drops. c. Assess the patients gait and balance while walking. d. Ask the patient if breakfast is eaten prior to applying the eyedrops.

A

16. A patients vision is recorded as 20/80 in each eye. The nurse interprets this finding to mean that the patient: a. Has poor vision. b. Has acute vision. c. Has normal vision. d. Is presbyopic.

A

16. To best advocate for an older adult patient being prescribed medication to control newly observed signs of confusion and aggressive behavior, the nurse: a. initiates an assessment to determine possible underlying causes of the behavior. b. contacts family to inform them of the new medication therapy being planned. c. discusses possible nonpharmaceutical treatments with the physician. d. documents a detailed description of the behaviors before administering the drugs.

A

17. An older adult has been recently diagnosed with type 2 diabetes and mild retinal deterioration. To best address the patients potential for developing situation depression, the nurse: a. assesses the patients coping skills. b. Encourages the patient to participate in a depression support group. c. assesses the patients ability to manage the symptoms. d. educates the family on early signs of depression.

A

17. When performing the corneal light reflex assessment, the nurse notes that the light is reflected at 2 oclock in each eye. The nurse should: a. Consider this a normal finding. b. Refer the individual for further evaluation. c. Document this finding as an asymmetric light reflex. d. Perform the confrontation test to validate the findings

A

19. An older patient asks why he needs a multivitamin supplement. The patient has always been healthy, has excellent nutrition, and has never needed vitamins. What explanation by the nurse is best? a. Older people tend to eat fewer calories, so its harder to get nutrients. b. You need to have extra nutritional reserves in case of sudden illness. c. Its recommended in all the nutritional guidelines for older adults. d. Now that you are older, your good nutritional habits are not enough.

A

2. At 10 PM, an older male resident attempts to climb over the bedrails. Which intervention should the nurse implement first? a.Talk to the resident about his behavior. b.Call the physician, and ask for a sedative. c.Apply a vest restraint on the resident. d.Get a companion to keep him in the bed.

A

2. The nurse caring for older adult patients best minimizes the patients risk of developing dehydration by: a. identifying the patients oral fluid preferences and offering them regularly. b. carefully monitoring the effects of daily diuretics via blood sodium levels. c. minimizing the patients reliance on laxatives by increasing dietary fiber intake. d. carefully monitoring of the rate of infusion of all intravenous fluids prescribed.

A

2. What education by the nurse is most important to address age-related changes to the senses? a. Installing auditory smoke alarms b. Having regular eye checkups c. Being aware that hearing acuity decreases with age d. Checking the expiration dates on foods such as dairy

A

23. A client is admitted with a diagnosis of persistent depressive disorder. Which client statement would describe a symptom consistent with this diagnosis? A. I am sad most of the time and Ive felt this way for the last several years. B. I find myself preoccupied with death. C. Sometimes I hear voices telling me to kill myself. D. Im afraid to leave the house.

A

24. A client diagnosed with major depressive disorder was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention would be most appropriate to help the client address spirituality as it relates to his illness? A. Encourage the client to bring into awareness underlying sources of guilt. B. Teach the client that religious beliefs should be put into perspective throughout the life span. C. Confront the client with the irrational nature of the belief system. D. Assist the client to modify his or her belief system in order to improve coping skills

A

25. The nurse is examining a patients retina with an ophthalmoscope. Which finding is considered normal? a. Optic disc that is a yellow-orange color b. Optic disc margins that are blurred around the edges c. Presence of pigmented crescents in the macular area d. Presence of the macula located on the nasal side of the retina

A

25. To help manage the potential side effects of prescribed antipsychotic medications, amantadine (Symmetrel) may be prescribed. Which statement best indicates that the nurse understands the appropriateness of this medication for the older adult patient? a. This medication produces few anticholinergic effects. b. Symmetrel is an effective dopamine agonist. c. Extrapyramidal symptoms are best controlled by Symmetrel. d. Older patients seem to have the fewest side effects on this medication.

A

3. The nurse is performing an external eye examination. Which statement regarding the outer layer of the eye is true? a. The outer layer of the eye is very sensitive to touch. b. The outer layer of the eye is darkly pigmented to prevent light from reflecting internally. c. The trigeminal nerve (CN V) and the trochlear nerve (CN IV) are stimulated when the outer surface of the eye is stimulated. d. The visual receptive layer of the eye in which light waves are changed into nerve impulses is located in the outer layer of the eye.

A

35. A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. These findings suggest that she may have: a. Macular degeneration. b. Vision that is normal for someone her age. c. The beginning stages of cataract formation. d. Increased intraocular pressure or glaucoma.

A

4. A 66-year-old patient has been diagnosed with type 2 diabetes mellitus and related vision loss. Which statement demonstrates the ability to manage her condition? a. I schedule my yearly eye examination for the week of my birthday. b. When I notice haloes around lights, Ill know Im developing a problem with retinopathy. c. My sister had diabetic retinopathy, and the vessels in her eyes were scarred. d. I understand that the eye problems need to be diagnosed with an ophthalmoscopic exam.

A

4. A nurse reviews the laboratory data of a 29-year-old client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL B. Potassium (K+ ) level of 4.2 mEq/L C. Sodium (Na+ ) level of 140 mEq/L D. Calcium (Ca2+) level of 9.5 mg/dL

A

4. The nurse is caring for four postsurgical patients who have experienced similar abdominal procedures and are all 68 years of age. The nurse anticipates that the patient with the greatest risk for complications resulting in an extended hospitalization has: a. a history of Crohn disease. b. developed mild confusion. c. an allergy to latex. d. severe postoperative nausea and vomiting.

A

4. Which assessment parameter should the nurse use to differentiate between delirium and depression in an older adult? a.Orientation b.Activity c.Course over the morning hours d.Psychomotor activity

A

6. In which context are members of a cohort described when using the age-stratification theory to explain the effect of similar events, conditions, and circumstances? a.Historical c.Sociological b.Biological d.Chronological

A

7. An older patient who was just diagnosed with a terminal disease states, All my life I attended church, but I am still worried about what will happen after death. The nurses best response is which of the following? a.The unknown may be frightening. Do you want to talk about this? b.Religious people know that God is a good God. c.People that have had near death experiences say it is peaceful. d.You must feel good about attending church most of your life.

A

7. An older patient with presbycusis has been advised to purchase a hearing aid and asks about its function and use. Which information is most accurate to give the patient about the function of hearing aids? a. Hearing aids amplify sound but do not improve the ability to hear. b. Hearing aids improve the ability to hear by intensifying the duration of sound waves. c. Hearing aids control the input of sound waves to eliminate extraneous noise. d. Hearing aids intensify sound waves and improve the ability to hear.

A

7. The nurse is testing a patients visual accommodation, which refers to which action? a. Pupillary constriction when looking at a near object b. Pupillary dilation when looking at a far object c. Changes in peripheral vision in response to light d. Involuntary blinking in the presence of bright light

A

9. A 96-year-old patient reports symptoms of xerostomia. The nurse attempts to minimize the effects of the condition by: a. providing appropriate fluids with the patients meals. b. cutting the patients meat into small bite-sized pieces. c. elevating the head of the patients bed at mealtimes. d. assisting the patient with oral care before each meal.

A

2. The nurse is admitting a patient to a long-term care facility. During the admission, the patient verbalizes a concern about getting dementia now that he is in a nursing home. In what activity(ies) should the nurse encourage the patient to participate to maintain brain health? (Select all that apply.) a.Physical exercise c.Socialization b.Stimulating mental activity d.Increasing dietary intake

A B C

2. The student learning about gerontologic nursing knows that which features are commonly associated with geriatric failure to thrive? (Select all that apply.) a. Impaired physical function b. Depression c. Malnutrition d. Cognitive decline e. Poor dentition

A B C D

3. The nurse is caring for an older adult patient admitted to the hospital. What assessment findings place the patient at risk for developing delirium during the hospitalization? (Select all that apply.) a. The patent takes medications to manage several chronic illnesses. b. The patent has a history of urinary tract infections. c. The patent is in cancer remission. d. The patent has recently been eating poorly. e. The patent experienced a mild heart attack 2 years ago.

A B D

1. When assessing the patients vision, the nurse should understand that older adults may report common aging changes, including which of the following? (Select all that apply.) a. My eyelids droop so unattractively. b. The whites on my eyes seem a bit yellow. c. The vision in my right eye seems blurry. d. Ive started to use over-the-counter eye moisturizing drops. e. I have noticed the night driving has become more difficult.

A B D E

4. A nurse is assessing a patient who reports moderate tinnitus. The nurse should assess the patient for which of the following? (Select all that apply.) a. Use of ibuprofen (Motrin) b. History of excessive cerumen c. Drinking carbonated beverages d. History of frequent headaches e. Presence of hypertension

A B D E

1. Which statements are true about aging and the brain? (Select all that apply.) a.Most areas of the brain do not lose brain cells. b.Memory decline is inevitable as people age. c.Basic intelligence remains unchanged with age. d.The brain does not continue to make new brain cells.

A C

1. A 72-year-old is prescribed lithium. The nurse educates the patient on the importance of biannual evaluation of which of the following? (Select all that apply.) a. Renal function b. Serum glucose level c. Liver function d. Thyroid function e. Red blood cell count

A C D

2. An older adult diagnosed with Mnire disease is prescribed meclizine (Antivert) and hydrochlorothiazide (HCTZ). The nurses educational instructions include which of the following? (Select all that apply.) a. The need to avoid alcoholic beverages b. Instructions to take the medication with food c. Symptoms of electrolyte imbalances d. That drowsiness is a common side effect e. Stopping the medication if chest pain occurs

A C D

4. A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer disease. The patients partner expresses concern about difficulty getting the patient to eat properly. The nurse suggests which of the following? (Select all that apply.) a. Serving meals at the same time each day b. Offering liquids in place of solid foods when possible c. Offering a calorie-dense snack at bedtime d. Cutting food into bite-sized pieces that will fit into the patients hand e. Asking the patent to identify favorite foods

A C D

4. The nurse working in a long-term care facility completes her morning assessment on a new postoperative patient and notes a change in cognitive status from the previous day? The nurse recognizes which of the following as a precipitating factor for delirium? (Select all that apply.) a.Major medical treatment c.Admission to long-term care b.Poor sleep habits d.Pharmacological agents

A C D

2. A 78-year-old patient was admitted with dehydration. The nurse assesses and documents observations that support a finding of dementia. Which of the following observations are related to dementia? (Select all that apply.) a. Forgetting what she ate for lunch today b. Crying frequently when alone c. Inability to find her way back to her room from the dayroom d. Being impatient with the nursing staff for not closing her door e. Repeatedly asking to call her son

A C D E

2. Which of the following is(are) the risk factors for vascular dementia (VaD) after a stroke? (Select all that apply.) a.Smoking b.Male sex c.Hypertension d.Advancing age e.Hyperlipidemia f. African American

A C E

3. Which of the following are appropriate steps to take when removing cerumen from an older persons ear? (Select all that apply.) a. Instill a softening agent first. b. Use hot water and hydrogen peroxide. c. Use a Waterpik inserted just inside the meatus. d. Have the patient lean backward. e. Drain water by having the patient lean forward toward the affected side.

A C E

1. Which types of exercise programs are better for older adults with AD for improving mood and function? (Select all that apply.) a.Balance b.Walking c.Self-paced d.Endurance e.Muscle strength f. Lasting 16 weeks or longer

A D E F

1. An older adult patient reports burning and itching eyes. On assessment, the nurse notes swelling of the eyelid margins bilaterally. What additional data are necessary to confirm the nurses suspicion of blepharitis? a. The patient reports visual disturbances such as rainbow halos. b. The eyelids are reddened from seborrhea. c. The patient is being treated with anticoagulants. d. Small corneal hemorrhages are present.

B

10. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, I heard about something called a monoamine oxidase inhibitor (MAOI). Cant my doctor add that to my medications? Which is an appropriate nursing reply? A. This combination of drugs can lead to delirium tremens. B. A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis. C. Thats a good idea. There have been good results with the combination of these two drugs. D. The only disadvantage would be the exorbitant cost of the MAOI.

B

10. The nurse is reviewing in age-related changes in the eye for a class. Which of these physiologic changes is responsible for presbyopia? a. Degeneration of the cornea b. Loss of lens elasticity c. Decreased adaptation to darkness d. Decreased distance vision abilities

B

12. A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. I cannot drink any alcohol with this medication. B. It is going to take 2 to 3 weeks in order for me to begin to feel better. C. This drug causes physical dependence, and I need to strictly follow doctors orders. D. I cant take this medication with food. It needs to be taken on an empty stomach.

B

12. A nurse works with a patient who is malnourished. What lab value does the nurse assess for the most up-to-date information on the patients status? a. Albumin b. Prealbumin c. Transferrin d. Total iron

B

13. An older adult patient being treated for chronic obstructive pulmonary disease (COPD) is exhibiting signs of memory loss and confusion. In planning his care, the nurse should give priority to: a. obtaining an order for a pulmonary function test (PFT). b. determining the potential of a possible adverse drug reaction. c. reorienting the patient to time, place, and person frequently. d. assessing for a family history of dementia.

B

14. A patients vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that: a. At 30 feet the patient can read the entire chart. b. The patient can read at 20 feet what a person with normal vision can read at 30 feet. c. The patient can read the chart from 20 feet in the left eye and 30 feet in the right eye. d. The patient can read from 30 feet what a person with normal vision can read from 20 feet.

B

14. An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. Well go to the day room when you are ready for group. B. Ill walk with you to the day room. Group is about to start. C. It must be difficult for you to attend group when you feel so bad. D. Let me tell you about the benefits of attending this group.

B

14. The nurse caring for an older adult patient recovering from cardiac surgery recognizes that it is most appropriate to assess this patient for mental health problems because: a. cardiac surgery often results in anxiety-related issues. b. untreated depression can contribute to the patients morbidity risks. c. many in this age cohort have undiagnosed depression. d. hospitalization is both anxiety and depression inducing.

B

15. A client who is diagnosed with major depressive disorder asks the nurse what causes depression. Which of these is the most accurate response? A. Depression is caused by a deficiency in neurotransmitters, including serotonin and norepinephrine. B. The exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role. C. Depression is a learned state of helplessness cause by ineffective parenting. D. Depression is caused by intrapersonal conflict between the id and the ego.

B

16. A patient wants to know what no sugar added on a food label means. What explanation is best? a. The food has no calories. b. No sugar was added during processing. c. The food naturally has no sugar. d. The food has 23% less sugar than normal.

B

17. The nurse teaches older adults to reduce sodium in their diets. What is the daily recommended limit for sodium in this population? a. 1000 mg b. 1500 mg c. 2000 mg d. 2500 mg

B

18. A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, Im feeling a lot better, so you can stop watching me. I have taken up too much of your time already. Which is the best nursing reply? A. I really appreciate your concern but I have been ordered to continue to watch you. B. Because we are concerned about your safety, we will continue to observe you. C. I am glad you are feeling better. The treatment team will consider your request. D. I will forward you request to your psychiatrist because it is his decision.

B

18. An older adult has a medical condition that has required hospitalization at a facility far from home and family. To best minimize the patients risk for depression, the nurse: a. keeps the patient informed of the expected discharge date. b. offers to help the patient telephone family members each evening. c. reassures the patient that early discharge is a nursing goal. d. encourages the patient to place family photographs around the room.

B

18. The nurse is performing the diagnostic positions test. Normal findings would be which of these results? a. Convergence of the eyes b. Parallel movement of both eyes c. Nystagmus in extreme superior gaze d. Slight amount of lid lag when moving the eyes from a superior to an inferior position

B

19. A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client? A. Teach about the effect of suicide on family dynamics. B. Carefully and unobtrusively observe on the basis of assessed data, at varied intervals around the clock. C. Encourage the client to spend a portion of each day interacting within the milieu. D. Set realistic achievable goals to increase self-esteem.

B

2. A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder? A. Altered communication R/T feelings of worthlessness AEB anhedonia B. Social isolation R/T poor self-esteem AEB secluding self in room C. Altered thought processes R/T hopelessness AEB persecutory delusions D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

B

21. An older woman asks the nurse why she suddenly has a deficiency in B vitamins as her eating and cooking habits have not changed. What response by the nurse is best? a. Something has to be different now. b. You cant absorb B vitamins like before. c. Your need for B vitamins has increased. d. The guidelines have been increased.

B

21. The nurse familiar with the old adult population recognizes that the patient who has the greatest potential for successfully committing suicide is the: a. 63-year-old Asian female. b. 86-year-old Caucasian male. c. 76-year-old Hispanic female. d. 67-year-old African-American male.

B

24. An older adult is hospitalized for treatment of a mental health disorder and is prescribed clomipramine (Anafranil). The nurse documents that the medication is having the desired effect when the patient: a. begins sleeping 8 hours per night. b. engages in fewer ritualistic behaviors. c. reports fewer episodes of nervousness. d. exhibits no delusionary thinking.

B

29. The nurse is performing an eye assessment on an 80-year-old patient. Which of these findings is considered abnormal? a. Decrease in tear production b. Unequal pupillary constriction in response to light c. Presence of arcus senilis observed around the cornea d. Loss of the outer hair on the eyebrows attributable to a decrease in hair follicles

B

33. A patient comes to the emergency department after a boxing match, and his left eye is swollen almost shut. He has bruises on his face and neck. He says he is worried because he cant see well from his left eye. The physician suspects retinal damage. The nurse recognizes that signs of retinal detachment include: a. Loss of central vision. b. Shadow or diminished vision in one quadrant or one half of the visual field. c. Loss of peripheral vision. d. Sudden loss of pupillary constriction and accommodation.

B

34. A patient comes into the clinic complaining of pain in her right eye. On examination, the nurse sees a pustule at the lid margin that is painful to touch, red, and swollen. The nurse recognizes that this is a: a. Chalazion. b. Hordeolum (stye). c. Dacryocystitis. d. Blepharitis.

B

38. During a physical education class, a student is hit in the eye with the end of a baseball bat. When examined in the emergency department, the nurse notices the presence of blood in the anterior chamber of the eye. This finding indicates the presence of: a. Hypopyon. b. Hyphema. c. Corneal abrasion. d. Pterygium.

B

4. A nurse is caring for an older patient diagnosed with acute depression. What action by the nurse is most important to help prevent delirium in this patient? a. Reorienting the patient to the day, time and place frequently b. Being physically present to help the patient with eating meals c. Providing the patient with opportunities to discuss depression d. Administering antidepressive medication as prescribed

B

4. Which role is most likely to have a significant effect on the type of aging process experienced by the older adult? a.Grandparent c.Friend b.Spouse d.Parent

B

6. An older adult patient has been prescribed a specialized enteral formula after an extensive surgical procedure. The nurse anticipates and addresses a concern of many patients in this age cohort when assuring the patient that: a. her family can easily manage the formula after she is discharged. b. Medicare will cover the expense of the treatment. c. the treatment will be discontinued as soon as she is able to eat sufficiently. d. this is the most effective form of nutrition for her at this time.

B

6. The nurse is conducting a visual examination. Which of these statements regarding visual pathways and visual fields is true? a. The right side of the brain interprets the vision for the right eye. b. The image formed on the retina is upside down and reversed from its actual appearance in the outside world. c. Light rays are refracted through the transparent media of the eye before striking the pupil. d. Light impulses are conducted through the optic nerve to the temporal lobes of the brain.

B

6. What is the priority reason for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder? A. The attention during the assessment is beneficial in decreasing social isolation. B. Depression is a symptom of several medical conditions. C. Physical health complications are likely to arise from antidepressant therapy. D. Depressed clients avoid addressing physical health and ignore medical problems.

B

8. An older adult patient has experienced severe nausea and vomiting for 2 days since undergoing abdominal surgery. A prealbumin serum blood test is ordered. The nurse explains the rationale for the test to the patients family by saying: a. The provider is interested in whether there is enough available protein in the blood. b. This test is designed to determine how the body is meeting current demands for protein. c. The test will tell us if the vomiting has created a problem with protein metabolism. d. Healing from such a surgery requires protein, and this test measures protein.

B

8. An older adults chart documents that she has been diagnosed with macular dysequilibrium. Based on an understanding of this condition and the resulting vertigo, the nurse suggests that the patient: a. turn her head very slowly when looking from right to left. b. dangle her legs at the bedside before getting out of bed. c. use the wall for stabilization when ambulating in the hallway. d. be careful to be seated when flexing or hyperextending her neck.

B

8. An older woman is recovering from a bowel resection in the intensive care unit but remains intubated and on a mechanical ventilator. Which of the following should the nurse implement to help prevent delirium in this woman? a.Assess cognition with MMSE-2. b.Provide uninterrupted periods of rest and sleep. c.Maintain adequate sedation and pain management. d.Cover the patients eyes with protective ophthalmic ointment.

B

9. Based on recent surveys identifying nutritional information concerning the daily diet of older adults in America, the nurse suggests: a. substituting carbohydrates with lean protein sources. b. adding calories through the addition of fruits and vegetables. c. introducing a protein at each meal. d. relying on foods that are both easy to chew and easy to digest.

B

9. Which of the following should the nurse use to assess a nonverbal older adult for delirium? a.Cranial nerves XI and XII b.Confusion Assessment Method c.MMSE-2 d.Controlled Word Association Test

B

9. Which of the following statements, when made by family members caring for an older patient with dementia, indicates peaceful acceptance of the situation? a. Im so pleased that Mother had a good day today. Im really very hopeful. b. The hospice nurses are so helpful when I need time for myself. c. I promised Mother I would take care of her and Ill never leave her. d. Its the least I can do for Mother since she cared for us all these years.

B

1. A patient is being discharged on total parenteral nutrition (TPN). What topics do the patient and family need to be taught? (Select all that apply.) a. How to work the enteral feeding pump b. Care of a central venous catheter c. How to crush and give medications d. Proper use of an intravenous (IV) pump e. Actions to take if the IV becomes occluded

B D E

1. During an examination, a patient states that she was diagnosed with open-angle glaucoma 2 years ago. The nurse assesses for characteristics of open-angle glaucoma. Which of these are characteristics of open-angle glaucoma?Select all that apply. a. Patient may experience sensitivity to light, nausea, and halos around lights. b. Patient experiences tunnel vision in the late stages. c. Immediate treatment is needed. d. Vision loss begins with peripheral vision. e. Open-angle glaucoma causes sudden attacks of increased pressure that cause blurred vision. f. Virtually no symptoms are exhibited.

B D F

1. A 73-year-old patient is concerned about staying healthy for as long as possible. When asked what lifestyle changes the patient should consider, the nurse suggests: a. As your metabolism slows, you will need to increase your intake of fat. b. If you are having difficulty sleeping, a mild sedative will help you sleep. c. Regular exercise will help you preserve function and reduce your risk for disease. d. Minimize stress by being willing to ask your family for help when you need it

C

11. The nurse notes a patients prealbumin is 2 mg/dL. What action by the nurse is best? a. Tell the patient to add more protein to the diet. b. Conduct a nutritional screening with a standard tool. c. Refer the patient to a registered dietician. d. Instruct the patient to maintain good nutritional habits.

C

13. A patient had cataract surgery without a lens implant. What teaching point is most important? a. Keep your follow-up appointment with the surgeon. b. Instill your eyedrops just like we have practiced. c. Do not drive and be careful going up or down stairs. d. Take acetaminophen (Tylenol) for pain.

C

14. A nurse is caring for an observant Hindu patient who has a protein deficiency. What menu items does the nurse select for the patient? a. Lean beef b. Chicken c. Beans d. Pork

C

14. A patient has Mnire disease. What statement by the patient indicates a good ability to manage the condition? a. Because its from dehydration, I can increase salt in my food. b. There are no medications, so I just have to learn to live with it. c. If I get dizzy I should lie down immediately and hold my head still. d. Because I have asthma, I cannot take any medications for Mnire disease.

C

15. When planning care for the older adult being treated for depression, the nurse addresses the patients tertiary intervention needs best by: a. helping the patient to identify the early symptoms of depression. b. helping the patient deal with the physical symptoms of depression. c. discussing with the patient how to implement new coping skills. d. educating the patient about the importance of being drug compliant.

C

16. What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The clients understanding of the need for regular bloodwork B. The clients mood and affect score, according to the facilitys mood scale C. The clients cognitive ability to understand information about the medication D. The clients access to a support network willing to participate in treatment

C

18. An older adult is worried about potassium intake. What does the nurse teach this patient? a. Unless you take a diuretic, dont worry about potassium. b. You should take a daily potassium supplement. c. You should try to get all your potassium through food. d. Potassium is not a nutrient people generally worry about.

C

2. Which of the following is a true statement about neuropsychiatric function in older adults? a.Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging. b.Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting. c.Nerve cells regenerate in the hippocampus. d.Mood does not influence an older person ability to remember verbal instructions.

C

20. A 60-year-old man is at the clinic for an eye examination. The nurse suspects that he has ptosis of one eye. How should the nurse check for this? a. Perform the confrontation test. b. Assess the individuals near vision. c. Observe the distance between the palpebral fissures. d. Perform the corneal light test, and look for symmetry of the light reflex.

C

20. A diabetic is struggling with the carbohydrate-controlled diet as a result of having a large extended family with many get-togethers. What action by the nurse is best? a. Remind the patient of the consequences of poor control of diabetes. b. Tell the patient that once a month he or she can eat as desired. c. Help the patient make priorities so some favorite foods can be eaten. d. Tell the patient to increase the insulin dose on get-together days.

C

20. The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to help the clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theory

C

20. While collecting a health history for an older adult patient, the nurse learns that the patient had been prescribed Elavil 3 weeks ago and wants to stop taking it because It didnt make me feel any better. In response to this information, the nurse shares with the patient that: a. sudden withdrawal is likely to cause a hypertensive crisis. b. depression seldom improves without medication. c. realistically it will take longer for the patient to feel an improvement. d. in time, people adjust to the side effects.

C

22. A 75-year-old client with a long history of depression is currently on doxepin (Sinequan), 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? A. Risk for ineffective thermoregulation R/T anhidrosis B. Risk for constipation R/T excessive fluid loss C. Risk for injury R/T orthostatic hypotension D. Risk for infection R/T suppressed white blood cell count

C

22. When assessing the pupillary light reflex, the nurse should use which technique? a. Shine a penlight from directly in front of the patient, and inspect for pupillary constriction. b. Ask the patient to follow the penlight in eight directions, and observe for bilateral pupil constriction. c. Shine a light across the pupil from the side, and observe for direct and consensual pupillary constriction. d. Ask the patient to focus on a distant object. Then ask the patient to follow the penlight to approximately 7 cm from the nose.

C

24. In using the ophthalmoscope to assess a patients eyes, the nurse notices a red glow in the patients pupils. On the basis of this finding, the nurse would: a. Suspect that an opacity is present in the lens or cornea. b. Check the light source of the ophthalmoscope to verify that it is functioning. c. Consider the red glow a normal reflection of the ophthalmoscope light off the inner retina. d. Continue with the ophthalmoscopic examination, and refer the patient for further evaluation.

C

3. A definitive diagnosis of Alzheimer disease (AD) can be made by detecting or using which one of the following methods? a.Clinical observation of dementia b.Inability to speak with relevance c.Development of neurofibrillary tangles d.Computed axial tomographic (CAT) scan

C

3. The nurse is conducting an admission assessment on a mildly confused older patient. The nurse best assures an accurate history by first: a. scoring the clients cognitive responses. b. focusing on the client to respond. c. directing the questions to both patient and family. d. arranging a Mini-Mental State Examination (MMSE).

C

3. Your 88-year-old patient is hospitalized for a retinal detachment. He is on bed rest, and both eyes are covered with patches. Which nursing diagnosis takes priority at this time? a. Self-esteem disturbance related to decreased independence b. High risk for altered thought processes related to visual impairment c. High risk for injury related to altered sensory perception d. Impaired social interaction related to visual deficit

C

30. The nurse notices the presence of periorbital edema when performing an eye assessment on a 70-year-old patient. The nurse should: a. Check for the presence of exophthalmos. b. Suspect that the patient has hyperthyroidism. c. Ask the patient if he or she has a history of heart failure. d. Assess for blepharitis, which is often associated with periorbital edema.

C

31. When a light is directed across the iris of a patients eye from the temporal side, the nurse is assessing for: a. Drainage from dacryocystitis. b. Presence of conjunctivitis over the iris. c. Presence of shadows, which may indicate glaucoma. d. Scattered light reflex, which may be indicative of cataracts.

C

32. In a patient who has anisocoria, the nurse would expect to observe: a. Dilated pupils. b. Excessive tearing. c. Pupils of unequal size. d. Uneven curvature of the lens.

C

39. During an assessment, the nurse notices that an older adult patient has tears rolling down his face from his left eye. Closer examination shows that the lower lid is loose and rolling outward. The patient complains of his eye feeling dry and itchy. Which action by the nurse is correct? a. Assessing the eye for a possible foreign body b. Documenting the finding as ptosis c. Assessing for other signs of ectropion d. Contacting the prescriber; these are signs of basal cell carcinoma

C

4. When examining a patients eyes, the nurse recalls that stimulation of the sympathetic branch of the autonomic nervous system: a. Causes pupillary constriction. b. Adjusts the eye for near vision. c. Elevates the eyelid and dilates the pupil. d. Causes contraction of the ciliary body.

C

5. A 77-year-old patient who is quiet and withdrawn may have a hearing deficit related to impacted cerumen. During the nursing assessment, the nurse confirms supporting evidence of the condition when noting: a. frothy drainage from the patients ears. b. patient reports of dizziness. c. patient reports of a feeling of fullness in the ears. d. gray, metallic-appearing tympanic membrane.

C

5. A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. According to learning theory, what is the cause of this clients symptoms? A. Depression is a result of anger turned inward. B. Depression is a result of abandonment. C. Depression is a result of repeated failures. D. Depression is a result of negative thinking.

C

5. The nurse conducting a food recall assessment on an older adult patient shows an understanding of the requirements of the process when: a. having the patient identify any existing food allergies. b. asking the family to verify the patients statements. c. asking how the food being discussed was prepared. d. correlating diet information with signs of malnutrition.

C

5. The nurse recognizes which of the following displays may indicate hyperactive delirium? a.Lethargy b.Withdrawn behavior c.Nonpurposeful repetitive movements d.Decreased psychoactive activity

C

5. When assessing an older patient displaying symptoms of delirium, the nurse focuses the assessment on: a. the degree and duration of the symptoms. b. the amount of self-care deficiency the symptoms cause. c. identifying processes that commonly result in the symptoms. d. physiologic dysfunction resulting from the symptoms.

C

8. A 73-year-old patient diagnosed with vascular dementia is admitted for exacerbation of asthma. The patient has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurses initial response is to: a. identify the patient as being at high risk for falls. b. monitor the patient for signs of benzodiazepine withdrawal. c. notify the admitting physician immediately. d. place the patient on strict intake and output.

C

8. A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out neurocognitive disorder D. To rule out a personality disorder

C

3. The community health nurse is preparing for an educational session on AD for a group of seniors. Which modifiable risk factors should the nurse include? (Select all that apply.) a.Family history c.Smoking b.Sex d.Obesity

C D

1. A client is diagnosed with persistent depressive (dysthymia) disorder. Which should a nurse classify as an affective symptom of this disorder? A. Social isolation with a focus on self B. Low energy level C. Difficulty concentrating D. Gloomy and pessimistic outlook on life

D

1. An older adult is experiencing age-related postural hypotension and he fears something is really wrong because he is the only one in his social group experiencing the problems. The nurse responds: a. Dont be concerned; just be very careful about your risk for falling. b. You have had very thorough testing, so dont worry about it being serious. c. Its just a matter of time before they too have to watch not to get up too quickly. d. You just dont have the compensating mechanisms of your friends.

D

1. Which of the following is a true statement about the theories of aging? a.Research data support the disengagement theory, activity theory, and continuity theory. b.Everyone should be able to achieve the three tasks of Pecks model of integrity. c.The exercise of rights is not a task of aging in Kellys model. d.A person may choose to avoid pursuing inner discovery in older age.

D

1. Which of the following statements is true about cognitive impairments in older adults? a.Loss or interruption of sleep can lead to delirium. b.Confusion is a normal and unavoidable consequence of aging. c.Older patients who are agitated often have a lower cognitive status than those who are quietly sitting. d.The Mini-Mental State Examination2nd edition (MMSE-2) should be administered on admission to detect delirium.

D

10. An older adult patient with a history of a myocardial infarction tells the nurse that he takes his daily dose of prescribed aspirin with breakfast each morning. The nurses response is: a. Food interferes with the drugs absorption, so take it between meals. b. Taking aspirin with food increases your likelihood of stomach upset. c. Taking the drug with food is likely to alter the taste of the food. d. Eating as you take the aspirin is likely to result in constipation.

D

10. The nurse observes older female adults learning advanced knitting techniques. The nurse concludes that this learning activity is suitable for these women because it accomplishes which of the following? a.Helps maintain joint flexibility b.Improves the groups cohesiveness c.Provides a needed social opportunity d.Adds to their existing knowledge base

D

10. The preferred way for the nurse to communicate with a 72-year-old hearing-impaired patient is to: a. speak loudly into the patients unaffected ear. b. exaggerate the form of each word. c. provide all communication in written form. d. speak clearly and directly, facing the person.

D

10. The son of a patient with possible Alzheimer disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. The nurse responds that: a. an electroencephalogram is often very useful in diagnosing AD. b. a positron emission tomography (PET) scan is a cheap but dependable tool. c. magnetic resonance imaging (MRI) is often ordered for that purpose. d. postmortem autopsy is the only definitive diagnostic tool.

D

11. The nurse at a nursing home wants to help decrease the risk of Alzheimer disease in the residents. Which should the nurse do to implement this goal? a.Keep the curtains open in their rooms. b.Offer beads for them to string on yarn. c.Show movies that the residents choose. d.Assist residents with ambulation to meals.

D

12. A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The nurse should: a. Examine the retina to determine the number of floaters. b. Presume the patient has glaucoma and refer him for further testing. c. Consider these to be abnormal findings, and refer him to an ophthalmologist. d. Know that floaters are usually insignificant and are caused by condensed vitreous fibers.

D

12. Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults? a.Increased secretion of cholinesterase b.Decreased secretion of neurotransmitters c.Loss of spinal cord and brainstem neurons d.Atrophy of dendrites in the cerebral cortex

D

15. A patient is unable to read even the largest letters on the Snellen chart. The nurse should take which action next? a. Refer the patient to an ophthalmologist or optometrist for further evaluation. b. Assess whether the patient can count the nurses fingers when they are placed in front of his or her eyes. c. Ask the patient to put on his or her reading glasses and attempt to read the Snellen chart again. d. Shorten the distance between the patient and the chart until the letters are seen, and record that distance.

D

17. A client diagnosed with major depressive disorder states, Ive been feeling down for 3 months. Will I ever feel like myself again? Which reply by the nurse will best assess this clients affective symptoms? A. Have you been diagnosed with any physical disorder within the last 3 months? B. Have you ever felt this way before? C. People who have mood changes often feel better when spring comes. D. Help me understand what you mean when you say, feeling down?

D

19. An older patient is anxious about an upcoming diagnostic test and requests something to calm the nerves. To best address the patients need, the nurse prepares to administer a PRN dose of: a. clonazepam (Klonopin). b. diazepam (Valium). c. chlordiazepoxide (Librium). d. lorazepam (Ativan).

D

19. During an assessment of the sclera of a black patient, the nurse would consider which of these an expected finding? a. Yellow fatty deposits over the cornea b. Pallor near the outer canthus of the lower lid c. Yellow color of the sclera that extends up to the iris d. Presence of small brown macules on the sclera

D

2. During ocular examinations, the nurse keeps in mind that movement of the extraocular muscles is: a. Decreased in the older adult. b. Impaired in a patient with cataracts. c. Stimulated by cranial nerves (CNs) I and II. d. Stimulated by CNs III, IV, and VI.

D

2. The morning of her scheduled cataract extraction and intraocular lens placement of the right eye, an older adult patient expresses concern that she will not remember her instructions for home care. Which statement is the best response to the patients concern? a. Is your family going to be here while youre in surgery? b. Are you anxious about the surgery? c. Ill reinforce the important points. d. We will provide you with written instructions.

D

21. During an examination of the eye, the nurse would expect what normal finding when assessing the lacrimal apparatus? a. Presence of tears along the inner canthus b. Blocked nasolacrimal duct in a newborn infant c. Slight swelling over the upper lid and along the bony orbit if the individual has a cold d. Absence of drainage from the puncta when pressing against the inner orbital rim

D

21. Which client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder? A. Its just a matter of time and I will be well. B. If I ignore these feelings, they will go away. C. I can fight these feelings and overcome this disorder. D. Nothing will help me feel better.

D

22. A 65-year-old adult who recently lost his spouse is admitted to the hospital after a failed suicide attempt. He presents with a sad affect and is reluctant to interact within the milieu. The nursing diagnosis with priority is: a. ineffective coping related to recent loss. b. hopelessness related to death of spouse. c. risk for loneliness related to loss of spouse. d. risk for self-directed violence related to depression.

D

23. The nurse is assessing a patients eyes for the accommodation response and would expect to see which normal finding? a. Dilation of the pupils b. Consensual light reflex c. Conjugate movement of the eyes d. Convergence of the axes of the eyes

D

23. The nurse is caring for a severely depressed older patient. To best effect change in the patients emotional state, the nurses initial goal is to: a. plan interventions that will enhance the patients self-esteem. b. introduce the patient to new coping skills. c. assess the patients potential to self-harm. d. develop a therapeutic nurse-patient relationship.

D

3. A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis? A. The client is disheveled and malodorous. B. The client refuses to interact with others. C. The client is unable to feel any pleasure. D. The client has maxed-out charge cards and exhibits promiscuous behaviors.

D

3. A patient is newly widowed and lives alone. Which suggestion by the nurse will help the adult children maximize the patients nutritional status? a. Help identify possible barriers to their mother achieving good nutritional health. b. Ensure that the patient has an adequate supply of healthy, easily prepared foods available. c. Contact a food delivery service to provide one nutritiously sound meal a day. d. Arrange a schedule that allows someone to have dinner with her each evening.

D

3. Which of the following statements is true about social and emotional health of older adults? a.Contemporary society has strong norms for the behavior of adults older than 80 years. b.The transition to old age entails a declining level of contribution to others as one becomes increasingly dependent on them. c.Computers and the Internet have little to contribute to older adults in their need for social support. d.Nurses are often significant sources of social and emotional support for older adults.

D

36. A patient comes into the emergency department after an accident at work. A machine blew dust into his eyes, and he was not wearing safety glasses. The nurse examines his corneas by shining a light from the side across the cornea. What findings would suggest that he has suffered a corneal abrasion? a. Smooth and clear corneas b. Opacity of the lens behind the cornea c. Bleeding from the areas across the cornea d. Shattered look to the light rays reflecting off the cornea

D

37. An ophthalmic examination reveals papilledema. The nurse is aware that this finding indicates: a. Retinal detachment. b. Diabetic retinopathy. c. Acute-angle glaucoma. d. Increased intracranial pressure.

D

5. The children in an African-American family attended college because their mother worked two jobs as they were growing up. She never finished high school, the children are grown, and she lives alone in retirement. Which noted weakness of sociological theories on aging explains why the social exchange theory is not applicable to this older adult? a.Gender c.Ethnicity b.Culture d.Opportunity

D

5. The nurse is reviewing causes of increased intraocular pressure. Which of these factors determines intraocular pressure? a. Thickness or bulging of the lens b. Posterior chamber as it accommodates increased fluid c. Contraction of the ciliary body in response to the aqueous within the eye d. Amount of aqueous produced and resistance to its outflow at the angle of the anterior chamber

D

6. An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer disease (AD). The nurse supports that possibility when determining that the patient: a. experienced a gastric resection several years ago. b. traveled often to third world countries. c. was employed as a steelworker for 40 years. d. has a history of viral encephalitis.

D

6. Which of the following approaches to hygienic care is beneficial for a patient with dementia? a.Schedule the patients full shower at 7 AM, three mornings every week. b.Have a team give the bath with each member washing a different body area. c.Wash the perineal region first to remove potentially infectious material. d.Explain each step as you go, and keep the patient covered as much as possible while bathing.

D

7. A man who is 60 years of age and lives in the British Isles develops dementia. Which qualities of dementia does the nurse assess to prevent patient injury related to the type of dementia this man most likely has? a.Visual hallucinations c.Visuospatial problems b.Unilateral tremors d.Clumsy movements

D

7. A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)

D

7. During a nutritional assessment, a 79-year-old patient responds, My weight is fine. I weigh the same as I did 15 years ago. The nurse responds based on the understanding that older patients: a. generally guess their weight rather than weigh themselves. b. often rely on how their clothes fit to determine whether their weight has changed. c. sometimes experience altered metabolic problems that hide weight change. d. often exchange lean muscle mass for body fat so weight stays the same.

D

7. When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to: a. place printed labels on important items, such as the telephone. b. place a clock and calendar in the patients immediate environment. c. use hand gestures instead of verbal communications to demonstrate meaning. d. show the patient a picture of a toothbrush when it is time for oral hygiene.

D

8. A patient has a normal pupillary light reflex. The nurse recognizes that this reflex indicates that: a. The eyes converge to focus on the light. b. Light is reflected at the same spot in both eyes. c. The eye focuses the image in the center of the pupil. d. Constriction of both pupils occurs in response to bright light.

D

8. An older man with severe knee pain tells the nurse how he lost his job and his home after starting a new business when he was 48 years old. Now he lives alone and relies on Social Security. Using Jungs theory, what in this individuals life is the most pivotal in his personality development? a.Living alone c.Severe knee pain b.Meager income d.Job and home loss

D

9. A confused client has recently been prescribed sertraline (Zoloft). The clients spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect, and what could be its possible cause? A. Neuroleptic malignant syndrome caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI D. Serotonin syndrome caused by ingestion of two different SSRIs

D

9. The nurse plans care for older adults who are in good health but isolated from their families. If the nurses goal is to move the adults toward gerotranscendence, which intervention should the nurse use in the plan of care? a.Give a daily tea party for the group. b.Call each family to encourage visiting. c.Assist them to resume midlife patterns. d.Help each person with individual activities.

D