Gero midterm CH4 (21,1,2)// CH8//

CH 15 (17, 1-6)

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Ch8 20 (1-3)

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MULTIPLE CHOICE 1. A patient reports to the nurse that he seems to be sleeping less at night but now regularly requires at least two short naps a day. He expresses a concern that "something is wrong." The nurse responds that: 2. What is the best bedtime snack for older adult patients with failure to thrive and insomnia? 3. An older patient is being admitted to an acute care unit after surgical repair of a fractured tibia. To minimize any negative factors affecting the patient's ability to sleep, the nurse's initial intervention is to: 4. A confused older patient has been hospitalized for a cardiac problem that requires both antihypertensive and diuretic therapies. The nurse minimizes the patient's risk of disturbed sleep by: 5. An older frail adult patient has begun displaying symptoms of sleep disturbance while being hospitalized. Since these symptoms were observed, the nurse has arranged for a bed alarm to be placed near the patient because:

a. "Aging alters our sleep patterns, so what you describe is really quite common." d. Cup of cream of broccoli and cheese soup d. ask the patient about usual sleeping habits. c. administering medications at least 4 hours before bedtime. a. lack of adequate sleep can result in delirium.

6. An older adult patient has been taught measures to prevent the development of skin cancer. Which statement, if made by the patient, indicates the need for more teaching? 7. When assessing the older adult patient's skin for indications of melanoma, the nurse should inspect for a(n): 8. An older adult patient newly diagnosed with peripheral vascular disease (PVD) is being educated on the possibility of developing a foot ulcer. What assessment finding indicates the patient may have an ulcer resulting from this disease? 9. An older adult patient has an open, draining wound on the lower medial aspect of the right leg. The skin surrounding the wound is reddish brown with surrounding erythema and edema. Based on this information, the nurse edits the patient's care plan to include impaired skin integrity: 10. When assessing for squamous cell cancer (SCC), a home health nurse is particularly concerned about a suspicious lesion on the:

a. "I will certainly miss my vegetable and flower gardening." c. irregularly shaped multicolored mole. b. Shiny, dry, cyanotic skin surrounding the ulcer a. related to altered venous circulation. c. Lower lip of a 70-year-old African American male.

1. When assessing the patient's 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." d. "I've started to use over-the-counter eye moisturizing drops." e. "I have noticed the night driving has become more difficult."

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: 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: 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: 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: 15. When planning care for the older adult being treated for depression, the nurse addresses the patient's tertiary intervention needs best by:

a. "We will implement new interventions that address the disease's progression." a. "How do you feel about how others view your mental health problem?" b. determining the potential of a possible adverse drug reaction. b. untreated depression can contribute to the patient's morbidity risks. c. discussing with the patient how to implement new coping skills.

21. A nurse is conducting an admission interview with an older patient admitted to a long-term care facility. When the nurse asks about the patient's former occupation, the patient states, "What do you care? I am long retired!" What response by the nurse is best? MULTIPLE RESPONSE 1. A nurse who cares for older adults recognizes which of the following clinical features associated with dementia? (Select all that apply.) 2. The nurse using the SPICES model to assess older patients collects data on which topics? (Select all that apply.)

a. "Your job may have exposed you to some health hazards." a. Failing to remember his or her room number d. Often referring to a cup as a canyon e. Misunderstanding when told "it's raining cats and dogs" a. Sleep disorders b. Problems with eating c. Incontinence d. Falls

MULTIPLE RESPONSE 1. A nurse is assessing an older patient for the possible cause of his acute urinary incontinence. Which actions by the nurse are most important? (Select all that apply.)

a. Asking when his last normal bowel movement was c. Determining if he has been screened for prostatic hypertrophy d. Asking him if he awakens during the night to urinate

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 patient's eyedrop instillation technique.

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? 12. A patient has been admitted to the postanesthesia care unit after a trabeculectomy. What assessment takes priority? 13. A patient had cataract surgery without a lens implant. What teaching point is most important? 14. A patient has Ménière disease. What statement by the patient indicates a good ability to manage the condition? 15. A patient had a chemical splash into the eye at work. What action by the occupational health nurse takes priority?

a. Consult the provider about an ophthalmologic exam. a. Airway c. Do not drive and be careful going up or down stairs. c. "If I get dizzy I should lie down immediately and hold my head still." a. Begin flushing the patient's eye with cool water.

16. A patient is scheduled to have surgery for prostate cancer in a few weeks. What action by the nurse is most important? 17. A patient asks how elevating the legs at night will decrease nocturia. What is the nurse's best response? 18. What information does the nurse share with the student about normal age-related changes in the kidneys?

a. Discuss options and their effect on sexuality. a. All that fluid gets into circulation before you go to bed. b. The glomerular filtration rate decreases.

2. When preparing educational information regarding benign prostatic hyperplasia (BPH) for a group of older male patients, the nurse includes which of the following? (Select all that apply.)

a. Eighty percent of males experience the symptoms by age 80. c. It is only as the prostate enlarges that symptoms occur. d. The resulting urinary retention can cause urinary tract infections. e. Symptoms are a result of urethral obstruction.

4. A patient has a glomerular filtration rate (GFR) of 19 mL/min/1.73m2. What assessment findings correlate with this condition? (Select all that apply.)

a. Fatigue b. Weakness c. Edema

3. The geriatric nurse caring for the older female immunosuppressed patient is particularly concerned when the patient reports which of the following? (Select all that apply.)

a. Flulike muscle aching b. Burning upon urination d. Night sweats

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 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

MULTIPLE RESPONSE 1. A nurse planning primary disease prevention interventions for a 64-year-old patient includes which of the following? (Select all that apply.)

a. Giving an influenza vaccination in early autumn of each year. c. Giving a pneumococcal vaccination to celebrate the patient's 65th birthday. d. Identifying several local smoking cessation support groups.

3. Which of the following are appropriate steps to take when removing cerumen from an older person's ear? (Select all that apply.)

a. Instill a softening agent first. c. Use a Waterpik inserted just inside the meatus. e. Drain water by having the patient lean forward toward the affected side.

2. A patient has not followed up with recommendations made by the nurse to participate in cardiac rehabilitation after a myocardial infarction. What factors are most important for the nurse to assess in determining the cause of this behavior? (Select all that apply.)

a. Out-of-pocket costs b. Transportation problems c. Beliefs about the benefits d. Location of the clinic

4. The student learning about immunity understands that the chain of infection contains which parts? (Select all that apply.)

a. Portal of entry b. Susceptible host d. Reservoir

MULTIPLE RESPONSE 1. The nurse caring for an older adult patient engages in appropriate cancer-related health screening when which of the following occur? (Select all that apply.)

a. Preparing a patient for a lung biopsy c. Assisting a patient schedule a mammogram d. Drawing blood for a prostate sensitive antigen (PSA) test

MULTIPLE RESPONSE 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 c. Liver function d. Thyroid function

4. A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer disease. The patient's 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 c. Offering a calorie-dense snack at bedtime d. Cutting food into bite-sized pieces that will fit into the patient's hand

5. A patient is receiving chemotherapy to treat cancer. What instructions does the nurse provide the patient and family to reduce the chance of infection? (Select all that apply.)

a. Take a full bath everyday if possible. b. If you can't bathe, perform pericare. c. Avoid large crowds and ill people. e. Eat high-calorie, high-protein food if able.

2. An older adult diagnosed with Ménière disease is prescribed meclizine (Antivert) and hydrochlorothiazide (HCTZ). The nurse's educational instructions include which of the following? (Select all that apply.)

a. The need to avoid alcoholic beverages c. Symptoms of electrolyte imbalances d. That drowsiness is a common side effect

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. d. The patent has recently been eating poorly.

MULTIPLE RESPONSE 1. When assessing a patient's report of experiencing "problems sleeping," the nurse gathers data related to which of the following? (Select all that apply.)

a. The patient has difficulty falling asleep. b. The patient wakes up frequently during the night. c. The patient finds it difficult to stay asleep.

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 d. History of frequent headaches e. Presence of hypertension

11. The nurse wishes to control infection by manipulating the portal of entry. What action best demonstrates this process? 12. A patient is hospitalized with a nonhealing leg ulcer. Lab work does not demonstrate anemia. What action by the nurse is best? 13. An older patient is hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), for which the patient is on chronic steroid use. The patient also has a fresh dog bite on the arm, which is not reddened, swollen, and only slightly tender. The patient is afebrile, but the nurse finds the patient confused and agitated. What action by the nurse is most appropriate? 14. A patient claims that all food is bland since "I got old." What suggestions does the nurse provide to this patient? 15. A nurse has identified an older patient as being at high risk of infection. Which assessment data indicate that priority goals for this diagnosis have been met?

a. Using sterile technique to insert a catheter c. Consult the physician regarding a serum zinc level. d. Perform a sepsis screening exam. b. Try eating some tart foods. d. The patient's mental status is unchanged.

2. An older adult patient reports simple xerosis with mild pruritus. The nurse educates her on the importance of:

a. applying a lanolin-rich cream and avoiding scratching the areas.

11. A patient in the early stage of Alzheimer disease is being admitted to an assisted living facility. The admitting nurse best addresses the patient's need for appropriate physical activity when: 12. A patient with moderate dementia has been admitted to a long-term care facility. To address the patient's need to be engaged in purposeful activity, the nurse arranges for the patient to: 13. An older patient reported to the clinic nurse that since a grandson moved in a few months ago, the patient has had problems sleeping. Which question by the nurse is most appropriate? 14. The nurse is caring for a hospitalized patient who needs vital signs and assessments every 4 hours. The nurse last assessed the patient at midnight, and at 2 AM the nurse answers the call light and helps the patient to the bathroom. To promote good sleep, what action by the nurse is best? 15. A patient is discussing retirement with a nurse. What suggestion pertaining to sleep does the nurse offer?

a. asking the patient about activities done for recreation. a. fold some of the unit's freshly washed washcloths and towels each afternoon. c. "Has your sleep pattern changed since he moved in?" b. Assess the patient now and again at 6 AM. a. Keep your same bedtime and nighttime routines.

6. To establish a mutually respectful relationship with an older adult patient being admitted to a skilled nursing unit, the nurse first introduces himself and then asks: 7. The nurse showing the best understanding of how personal attitude affects the interview process during a health assessment of an older adult patient is one who: 8. An older patient is being admitted to a long-term care facility. The nurse recognizes that the primary purpose of the initial geriatric health assessment is to: 9. A 76-year-old postsurgical diabetic patient has reported feeling dizzy and clammy. The daily serum glucose level shows the patient's levels to be within normal limits. The geriatric nurse shows an understanding of established health norms for the older adult when stating: 10. A patient is being admitted after a fall that has caused a painful leg injury. In preparing to interview the patient for a health history, the nurse is initially concerned that:

a. how the patient would like to be addressed. d. has self-reflected on his or her own feelings regarding aging. b. ultimately create a plan of care that prevents disability and dependence. a. "This patient's normal may not be within the typical lab norms." d. the patient's pain should be effectively managed.

16. To best advocate for an older adult patient being prescribed medication to control newly observed signs of confusion and aggressive behavior, the nurse: 17. An older adult has been recently diagnosed with type 2 diabetes and mild retinal deterioration. To best address the patient's potential for developing situation depression, the nurse: 18. An older adult has a medical condition that has required hospitalization at a facility far from home and family. To best minimize the patient's risk for depression, the nurse: 19. An older patient is anxious about an upcoming diagnostic test and requests something to calm the nerves. To best address the patient's need, the nurse prepares to administer a PRN dose of: 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 didn't make me feel any better." In response to this information, the nurse shares with the patient that:

a. initiates an assessment to determine possible underlying causes of the behavior. a. assesses the patient's coping skills. b. offers to help the patient telephone family members each evening. d. lorazepam (Ativan). c. realistically it will take longer for the patient to feel an improvement.

16. A male patient complains about the digital rectal prostate exam and blood work for prostate-specific antigen (PSA) and asks, "How long am I expected to do this?" What response by the nurse is best? 17. A nurse routinely assesses patients for alcohol use. What principle guides this assessment? 18. An 80-year-old woman has found a lump in her breast and is in the clinic. What question by the nurse is most appropriate? 19. A nurse wishes to volunteer in a tertiary health care activity. What activity would the nurse choose? 20. A nurse is working with a woman who has been reluctant to start a walking program for her osteoporosis. What assessment by the nurse is most important?

b. "Until you turn 75 years of age." a. The older adult must balance risks to benefits of use. b. If it's cancer, are you willing to treat it? c. Assisting women who are having radiation therapy a. Fear of falling

6. A nurse is assessing a patient's ability to manage existing health problems. What question by the nurse is most helpful? 7. During a home visit, a nurse is assessing the nutritional awareness of an older adult patient who lives alone. The nurse is most effective in obtaining objective information when: 8. The nurse is discussing an older adult's past marital history during the admission assessment. The nurse can best determine that the patient has a healthy ability to cope with emotional stressors when the patient states: 9. An older adult patient has recently experienced some difficulty sustaining an erection as a result of medication he has been prescribed. The nurse best assesses the patient's perception of his own sexuality by asking: 10. The nurse admitting an 89-year-old patient to an assisted living facility notes that the patient is currently taking numerous prescribed and over-the-counter medications. The nurse's initial intervention is to:

b. "What were the results of your most recent A1C blood test?" d. observing the patient eat a meal that he or she has prepared. a. "After my husband died, I managed to raise and educate our two children by myself." c. "What impact has this dysfunction had on your ability to be intimate with your wife?" d. review the listed medications for possible interactions.

3. The nurse plans to assess for candidiasis as a priority intervention for a:

b. 72-year-old incontinence of urine and feces.

21. The nurse familiar with the old adult population recognizes that the patient who has the greatest potential for successfully committing suicide is the: 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: 23. The nurse is caring for a severely depressed older patient. To best effect change in the patient's emotional state, the nurse's initial goal is to: 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: 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?

b. 86-year-old Caucasian male. d. risk for self-directed violence related to depression. d. develop a therapeutic nurse-patient relationship. b. engages in fewer ritualistic behaviors. a. "This medication produces few anticholinergic effects."

5. The presence of which skin assessment finding, if noted on an older adult patient, should cause the nurse to suspect a premalignancy?

b. An oozing, rough, reddish macule on the ear

16. A nurse is working with an older patient in the gerontology clinic. The patient reports a vague decline in function and says, "I guess I'm just getting older." What action by the nurse is best? 17. The nurse admitting a debilitated patient to a long-term care facility initially assesses the patient using the Katz Index. The student asks why the nurse chose that tool. What answer by the nurse is best? 18. A nurse assesses a patient using the Barthel Index and scores the patient as a 98. What inference does the nurse draw from this assessment? 19. The staff members in a long-term care facility have noted a decline in cognitive function in one of the residents; however, each time the resident is given the Short Portable Mental Status Questionnaire (SPMSQ), the score does not change. What action by the nursing manager is best? 20. The nurse has used the Yesavage Geriatric Depression Scale (short form) and scored the patient at a 1. What is the nurse's best action?

b. Assess the patient for an undetected illness. a. It is quick and simple for a baseline. c. The patient is close to independent in the areas measured. c. Switch to a different screening tool d. Document findings in the patient's medical record.

6. The nurse studying immunity understands that which are age-related changes in immune system functioning? (Select all that apply.)

b. Decreased number of T suppressor cells c. Atrophy of the thymic cortex d. Increased numbers of antibodies to self-antigens

2. The nurse is preparing an educational facts sheet on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) for older adults. What information does the nurse include? (Select all that apply.)

b. Delayed recognition of HIV contributes to its poor prognosis. d. There is a short interval from HIV infection to AIDS in older adults.

5. The nurse working in the gerontology clinic understands which facts related to incontinence? (Select all that apply.)

b. It is an independent predictor of nursing home admission. c. It contributes to falls and injuries. d. It can disrupt sleep. e. It can lead to urinary tract infections.

3. The student learns the Medicare guidelines for preventive health and reimbursement policies. Which statement follows the guidelines? (Select all that apply.)

b. Medicare covers annual influenza vaccinations. d. Annual fecal occult blood tests are covered for those who are from 50 to 85 years of age. e. A bone density scan is covered every 2 years (a co-payment is required).

21. The nurse has instituted bedtime routines for patients with dementia in a long-term care facility. What assessment findings best indicate the program is effective?

b. Patients fall asleep within 20 to 30 minutes of going to bed.

2. The nurse who works with older patients explains the age-related changes in sleep to a student. Which statements are consistent with this knowledge? (Select all that apply.)

b. REM sleep is interrupted more by awakening at night. c. People spend more time in the lightest stage of sleep. d. Stages 3 and 4 of non-REM sleep are not as deep. e. Changes in circadian rhythm can affect sleep.

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 nurse's suspicion of blepharitis? 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 patient's concern? 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? 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? 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:

b. The eyelids are reddened from seborrhea. d. "We will provide you with written instructions." c. High risk for injury related to altered sensory perception a. "I schedule my yearly eye examination for the week of my birthday." c. patient reports of a feeling of fullness in the ears.

6. An older adult patient reports "ringing" in the ears. What additional data should the nurse gather to help determine the cause of the patient's problem? 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? 8. An older adult's 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: 9. A 96-year-old patient reports symptoms of xerostomia. The nurse attempts to minimize the effects of the condition by: 10. The preferred way for the nurse to communicate with a 72-year-old hearing-impaired patient is to:

b. Use of prescription medications a. Hearing aids amplify sound but do not improve the ability to hear. b. dangle her legs at the bedside before getting out of bed. a. providing appropriate fluids with the patient's meals. d. speak clearly and directly, facing the person.

6. An immunosuppressed older adult patient reports symptoms of fatigue, facial rash, intermittent low-grade fever, and painfully swollen finger joints. The nurse anticipates that diagnosis will be confirmed by: 7. The geriatric nurse identifies the patient with the greatest risk of immunosuppression as: 8. The nurse caring for an older adult patient currently receiving traditional drug therapy for methicillin-resistant Staphylococcus aureus (MRSA) recognizes that the patient is at risk for developing: 9. The nurse caring for an older adult patient being treated for influenza is especially careful to monitor and document assessment data related to: 10. A patient who is currently being treated for rheumatoid arthritis exhibits symptoms suspicious of tuberculosis (TB). The nurse anticipates that:

b. a positive antinuclear antibody (ANA) blood serum test. c. receiving treatment for rheumatoid arthritis. b. vancomycin-resistant Enterococcus (VRE) infection. b. respiratory function. d. a purified protein derivative (PPD) skin test will likely be negative.

1. When the home health nurse assists the older adult patient with rearranging furniture within the home to prevent the patient from falling, the nurse is demonstrating: 2. The primary focus of the health belief model of health promotion is addressed when the nurse: 3. Financial considerations are a major barrier to the older adult's participation in health promotion because: 4. To engage the older adults who frequently attend a senior citizens' center in primary disease prevention, the nurse: 5. The nurse has the greatest impact on a patient's health promotion when:

b. health protection. d. asks the patient if he believes smoking puts him at risk for lung cancer. b. Medicare often does not cover the cost of preventive services. a. immunizes those attending a weekly luncheon against the H1N1 virus. d. educating the patient about vitamin D and calcium to prevent bone loss.

6. An older adult patient is hospitalized for after an automobile crash. The nurse recognizes symptoms suggestive of an upper urinary tract (UTI) infection when the patient: 7. An older adult woman has a resistant strain of pneumonia. To best minimize her risk of developing acute renal failure, the nurse: 8. An older patient is admitted with possible chronic renal failure (CRF). Which lab value does the nurse notify the physician about as a priority? 9. The nurse is admitting an older patient with benign prostate hyperplasia (BPH). The nurse's priority questioning focuses on: 10. A patient in a long-term care facility has incontinence. What assessment by the nurse is most important before designing interventions for this problem?

b. is not able to state where he is or what day it is. d. chooses an analgesic other than ibuprofen (Motrin). d. Decreased creatinine clearance level d. typical urinary voiding patterns. a. Cognitive status

11. When assessing the older adult for bowel health, the nurse is most effective in obtaining subjective data when asking: 12. Using social cognitive theory, which action by the nurse will have the most impact on older adults' participation in health promotion behaviors? 13. The nurse wishes to participate in a community secondary prevention activity. Which activity does the nurse choose? 14. A patient who is homeless has not followed through with getting an influenza vaccination. What response by the nurse to a student is most appropriate? 15. The nurse is seeing a 68-year old woman for a physical exam in the family practice clinic. The woman complains about having another pelvic exam. What response by the nurse is best?

c. "How often do you usually have a bowel movement?" a. Creating a walking club in the community a. Administering blood pressure screening at a mall a. "It's hard to be proactive when you are hungry." b. "You are past the age where this exam is recommended."

16. An older patient asks the nurse about taking Echinacea to prevent colds. What response by the nurse is best? 17. A student nurse is caring for a patient who has vancomycin-resistant enterococcus (VRE). What action by the student requires the nurse to intervene? ''

c. "This herb may not be well produced." b. Takes own stethoscope and unit Glucometer in the room

6. An older patient reports that sleep was being severely affected by the need to urinate frequently. The patient states he has begun restricting his fluid intake after 5 PM to help with the problem. The nurse responds: 7. An older patient being treated for symptoms of seasonal allergies reports to the nurse that although she is careful about her caffeine intake, she has been having trouble getting to sleep at night. The nurse responds most appropriately to this patient when stating: 8. The daughter of an older cognitively impaired patient responds to the nurse's suggestion to keep her father physically active by stating, "Dad is so easily agitated it would be a major battle to take him on a walk." The nurse's initial response is based on the understanding that: 9. The nurse is preparing to instruct a family member regarding how to appropriately assist a 76-year-old patient incorporate a healthy daily walk into the family's routine. The nurse includes a suggestion that: 10. An older adult patient who has been seen at a neighborhood clinic for years tells the nurse that he will be moving to live with his son in a neighboring state. The nurse impacts the patient's health and wellness the most therapeutically when stating:

c. "You need the same amount over 24 hours, so drink enough by dinnertime." b. "If you are using over-the-counter nasal decongestants, that could be the problem." b. physical exercise has been proven helpful in managing anger in such patients. b. if the patient appears to be having difficulty talking while walking, it is time to stop. d. "Moving often causes temporary sleep disturbances, so stick to your evening routine."

The geriatric nurse recognizes that the body's homeostatic mechanisms may be compromised in the: 2. To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first: 3. An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patient's daughter questions the possibility of pneumonia stating, "He isn't coughing or having any difficulty breathing." The nurse responds most appropriately by saying: 4. A nurse aide working in the geriatric unit's dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why she's "here." The nurse appropriately directs the nurse aide to: 5. The nurse most effectively implements guided reminiscence during a patient interview by:

c. 86-year-old who lost a spouse and is moving into an assisted living facility. c. explains the reason for asking the questions. d. "Older adults frequently lack the typical signs of a respiratory infection." c. immediately take the patient's vital signs and report them to her. d. encouraging the patient to relive his or her memories while maintaining focus.

3. An older adult patient's urinary incontinence is being addressed by prompted voiding. The nurse instructs all ancillary staff to do which of the following? (Select all that apply.)

c. Allow the patient to void at times other than those scheduled. d. Offer toileting during the night only when the patient is awake.

17. For which patient does the nurse add compression therapy to the nursing care plan? 18. The nurse assesses a patient using the Braden scale. The patient scores a 13. What action is most important to add to the patient's care plan? 19. A patient has a purulent, foul-smelling leg wound. What wound care practice is most appropriate? 20. A patient has a wound that is a shallow crater with surrounding erythema and warmth. What stage pressure ulcer does the nurse chart?

c. Brownish skin and edema b. Turn the patient every to 2 hours c. Cleanse the wound with diluted povidone iodine. b. Stage II

11. A male patient has benign prostatic enlargement. He is at risk for what type of acute kidney injury? 12. A patient has a history of smoking and now has painless hematuria. After a workup, the patient is told the diagnosis of bladder cancer. What action by the nurse is most important? 13. A patient being treated for prostate cancer calls the clinic to report severe back pain. What action by the nurse is best? 14. A male patient reports difficulty starting a urine stream and a weak urine flow. When prompted to seek medical attention, the patient asks why, as it's "obviously" benign prostatic hypertrophy. What response by the nurse is best? 15. A patient treats chronic kidney failure with peritoneal dialysis. The patient notes the fluid draining out of the abdomen is cloudy and foul smelling. What action by the nurse is best?

c. Postrenal a. Allow the patient to verbalize feelings. b. Tell the patient to come in to the clinic today. d. "BPH and prostate cancer have similar symptoms." a. Assess the patient for other signs of infection.

MULTIPLE RESPONSE 1. The nurse knows that several age-related changes in the integumentary system increase older adults' risk for pressure ulcers. Which factors does this include? (Select all that apply.)

c. Thinning epidermis d. Decreased skin elasticity e. Vessel degeneration

1. When caring for older adults, the nurse expects to encounter the normal urinary age-related outcome of: 2. An 87-year-old patient has suddenly become incontinent. What should the nurse's first action be? 3. An older adult patient reports "losing urine" when she bends over or gets out of a chair. What type of incontinence does the nurse plan interventions for? 4. When assessing the patient for urinary incontinence, which patient symptom best supports the nursing diagnosis of overflow incontinence? 5. An older cognitively impaired adult patient is being discharged to a daughter's home. The nurse knows continued success of the patient's bladder training for urinary incontinence primarily rests on the:

c. nocturia. a. Review the patient's record for medications that may be causing urinary incontinence. d. Stress a. "I have small accidents ever since I developed a cystocele." d. daughter's ability to support the training.

4. An 87-year-old patient developed herpes zoster after surgical repair of a hip fracture. The priority nursing diagnosis is:

c. risk for infection related to impaired skin integrity.

11. A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis. The nurse educates the patient to the possibility of developing: 12. The nurse of a bedridden 74-year-old woman is evaluating whether the family members understand how to position the patient correctly. The nurse is confident the family is capable of effective positioning when it is observed that the patient's: 13. An older diabetic patient reports a candidiasis infection. When asked, the patient states all blood sugars have been within the target range. What action by the nurse is best? 14. An older patient has been treated for a small basal cell carcinoma on the face. What assessment finding indicates to the nurse that the goals for a priority diagnosis have been met? 15. In creating community education on various types of skin cancer, the nurse places the highest priority on early diagnosis of melanoma because: 16. An older diabetic patient has impaired mobility and decreased vision. The nurse examines the patient's feet at each clinical visit. The patient asks why this is necessary. What response by the nurse is best?

c. yellow-brown nails. b. position is changed at least every 2 hours. a. Facilitate having a hemoglobin A1c drawn. b. Wound edges are approximated without redness. a. it accounts for the largest number of mortalities. d. "You may get an ulcer and not be able to feel it."

MULTIPLE CHOICE 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: 2. What education by the nurse is most important to address age-related changes to the senses? 3. The nurse is conducting an admission assessment on a mildly confused older patient. The nurse best assures an accurate history by first: 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? 5. When assessing an older patient displaying symptoms of delirium, the nurse focuses the assessment on:

d. "You just don't have the compensating mechanisms of your friends." a. Installing auditory smoke alarms c. directing the questions to both patient and family. b. Being physically present to help the patient with eating meals c. identifying processes that commonly result in the symptoms.

16. The nurse caring for older patients would prepare to administer which medication as a short-term sleep aid? 17. A patient reports waking up with frequent headaches and sore throat. What question by the nurse is most appropriate? 18. A patient wants to use an herbal preparation to help with decreased sleep. What response by the nurse is best? 19. The nurse needs to awaken a patient to take medication in the middle of the night. The patient has not had any sleeping medications or other preparations that would cause drowsiness. The nurse has to use vigorous stimulation to awaken the patient. What stage of sleep is this patient most likely in? 20. A patient has chronic, severe asthma and takes many medications during the day. The patient reports difficulty falling asleep at night. What medication does the nurse ask about the patient taking?

d. The nurse would try other measures first b. "Does your partner say you snore at night?" c. "Have you had a physical exam any time recently?" d. Stage 4, non-REM b. Theophylline (Theo-24)

1. The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of the scalp should include:

d. applying selenium shampoo to the scalp.

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: 7. When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to: 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 nurse's initial response is to: 9. Which of the following statements, when made by family members caring for an older patient with dementia, indicates peaceful acceptance of the situation? 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:

d. has a history of viral encephalitis. d. show the patient a picture of a toothbrush when it is time for oral hygiene. c. notify the admitting physician immediately. b. "The hospice nurses are so helpful when I need time for myself." d. postmortem autopsy is the only definitive diagnostic tool.

11. The nurse has administered the Apgar screen tool to assess an older patient's family function status. Upon determining that the family functions at a 4, the nurse: 12. The geriatric nurse admitting a patient to an assisted living facility recognizes the importance of tools such as the Katz and the Barthel indexes because of the impact they have on: 13. An older patient is reluctant to report multiple vague signs and symptoms, including lethargy, incontinence, and weight loss that have persisted for 6 weeks. The nurse recognizes that such symptoms place the patient at great risk for: 14. An older patient is hospitalized after a fall that resulted in a fractured left ankle. By day 4 of the hospitalization, which includes reduction of the fracture and analgesic drug therapy, the patient has become mildly disoriented and is incontinent of urine. The nurse explains to the family that these symptoms reflect the: 15. When unsure about how to address older patients with advanced stage Alzheimer disease, the nurse recognizes that it is best to address the patient by:

d. notifies social services that the family is not likely to be of much support to the patient. c. creating an appropriate, patient-specific nursing care plan. d. physical frailty. a. relationship between aging and both physical and psychosocial responses to trauma. c. the full name, to show respect for the patients as individuals.

1. To educate patients on health promotion measures to minimize the effect of normal age-related changes in immunity, the geriatric nurse: 2. An older adult patient who is generally in good health starts experiencing numerous colds and now pneumonia. What factor from the nursing history most likely has placed the patient at increased risk for the development of these infections? 3. An older patient smoked tobacco most of the adult life. When planning health promotion education for this patient, the nurse includes information that such smoking: 4. An older adult patient is experiencing problems with chewing while recovering from extensive oral surgery. The nurse best affects this patient's risk for infection by: 5. The nurse caring for a cognitively impaired older adult admitted to an acute care facility best minimizes this particular patient's risk for developing a nosocomial infection by:

d. stresses the importance of maintaining intact skin and mucous membranes. a. A beloved pet died 6 months ago. b. is a risk factor for community-acquired pneumonia. d. asking which flavors of protein supplement drink the patient would prefer. c. assigning staff to assist the patient with eating meals.

CH 27 (25, 1-4)

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