Gerontology HESI Practice
For older adult patients who are taking neuroleptic medication, the primary concern is the development of: a. lethargy. b. nausea. c. poor appetite. d. tardive dyskinesia.
d. tardive dyskinesia.
Osteoporosis increase the risk for a hip fracture in older adults, and women are more likely to have osteoporosis than men. Women of which ethnic group have the highest risk for a hip fracture? (arrange with the highest risk first and lowest risk last) - African American - Caucasian - Asian - Hispanic
1. Caucasian 2. Asian 3. Hispanic 4. African American
An older client who is a resident in a long-term care facility is receiving medications through a gastric tube (GT). After interrupting the continuous GT feeding in which sequence should the nurse implement these actions for administration of crushed medications? (arrange in the order from first step to last step) - Flush the feeding tube of feeding solution - Crush the medication into a powder or fine granules - Administer each medication separately - Dissolve each crushed medication in a medicine cup - Flush GT to clear the medication from the tubing - Reconnect the gastric feeding tube
1. Crush the medication into a powder or fine granules 2. Dissolve each crushed medication in a medicine cup 3. Flush the feeding tube of feeding solution 4. Administer each medication separately 5. Flush GT to clear the medication from the tubing 6. Reconnect the gastric feeding tube
An 82-year-old patient has a painful, vesicular rash that burns over the left abdomen. The patient indicates that he or she has tried multiple creams that have not helped. Which question does the gerontological nurse first ask? a. "Did you have the pain before the rash appeared?" b. "Do you have any food or drug allergies?" c. "Have you been around anyone with a rash?" d. "Have your grandchildren visited recently?"
a. "Did you have the pain before the rash appeared?"
A 79-year-old retired actor, who continues to pursue lifelong interests in swimming and singing, exemplifies which theory of aging? a. Continuity. b. Developmental. c. Disengagement. d. Physical.
a. Continuity.
Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which laboratory values does the adult-gerontology primary care nurse practitioner obtain? a. Liver function studies. b. Platelet count. c. Renal function studies. d. White blood cell count.
a. Liver function studies.
When treating an older adult for gastroparesis, which drug does the adult-gerontology primary care nurse practitioner prescribe cautiously, because of possible central nervous system toxicity? a. Metoclopramide (Reglan). b. Nizatidine (Axid). c. Omeprazole (Prilosec). d. Ranitidine (Zantac).
a. Metoclopramide (Reglan).
For two to three months, a 78-year-old patient has not been taking levothyroxine (Synthroid) as prescribed. The patient now has symptoms of increasing constipation, lethargy, and weakness. The adult-gerontology primary care nurse practitioner anticipates that laboratory tests will show that the patient's: a. T4 level decreased, and thyroid-stimulating hormone (TSH) level increased. b. T4 level did not change, and TSH level decreased. c. T4 level increased, and TSH level decreased. d. T4 level increased, and TSH level did not change.
a. T4 level decreased, and thyroid-stimulating hormone (TSH) level increased.
A state ombudsman initiates an investigation after a complaint about the care of a nursing home resident. Which statement about the investigation process is true? a. The ombudsman may proceed with the investigation without identifying the individual who made the complaint, and without obtaining a court order or written consent. b. The ombudsman must identify the individual who made the complaint. c. The ombudsman must obtain a court order to review documentation, if the resident described in the complaint does not give written permission. d. The ombudsman must obtain the written permission of the resident who is described in the complaint.
a. The ombudsman may proceed with the investigation without identifying the individual who made the complaint, and without obtaining a court order or written consent.
An older male client with heart failure (HF) complains of chronic constipation and wants to retrain his bowel. Which information should the registered nurse (RN) offer the client for establishing regular bowel habits? a. add whole grain foods and fibrous vegetables to diet b. drink water and fluids up to 3,000 mL daily c. use a stool softener or glycerin suppository PRN d. plan daily exercise based on fatigue level
a. add whole grain foods and fibrous vegetables to diet Increasing daily fiber with increasing fluid intake are the best tools to use when retraining bowel habits.
A 65-year-old patient exhibits symptoms of hemianopsia. The most appropriate nursing intervention is to: a. arrange the patient's meal tray so that all the food is in the patient's field of vision. b. explain all tasks thoroughly to help allay the patient's fears. c. look directly at the patient when speaking to maximize comprehension. d. minimize the operating stimuli to reduce distractions to the patient.
a. arrange the patient's meal tray so that all the food is in the patient's field of vision.
A frail 80-year-old patient, who cares for a spouse at home without assistance, requires minor surgery. Lacking any family members residing in the area, the patient expresses concern about the spouse's care while the patient is recovering. The gerontological nurse's recommendation is: a. arranging inpatient respite care for the spouse. b. having the patient remain in the hospital during the post operative period. c. hiring around-the-clock help for two weeks. d. hospitalizing the spouse.
a. arranging inpatient respite care for the spouse.
A recently admitted nursing home resident and the resident's family only speak Spanish. One evening during a visit, the resident and the family begin to wail and sob loudly. The gerontological nurse is unable to determine what is wrong. The nurse's most appropriate action is to: a. ask the supervisor to get an interpreter. b. attempt to make the resident and the family comfortable. c. contact the provider for orders. d. find an escort to take the resident and the family to the chapel for privacy.
a. ask the supervisor to get an interpreter.
A 14-year-old male patient is concerned about eczema because his twin brother was recently diagnosed with this condition. The three factors that put the patient at risk for eczema are a family history of eczema, a personal history of allergic rhinitis, and a history of: a. asthma. b. bee allergy. c. otitis media. d. psoriasis.
a. asthma.
Which ethical principle underlies nursing actions respecting each patient's values and beliefs? a. autonomy b. beneficence c. justice d. responsibility
a. autonomy
An older male client is seeking counseling about his recent sexual issues with his partner. What issue should the registered nurse (RN) explore in this discussion? a. certain medications may impact sexual function b. normal aging affects sexual function in male clients c. safe sex is not necessary with older sexually active elders d. sexual interest usually declines with aging in male clients
a. certain medications may impact sexual function
The home health registered nurse (RN) is changing an older client's wet to dry dressing. Which observation should the RN evaluate as a therapeutic response with the removal of the dry dressing? a. debridement and removal of slough and eschar b. drainage of purulent exudate from the wound c. moist skin edges around the wound field d. presence of capillary growth in the wound
a. debridement and removal of slough and eschar Wet to dry dressings begin with a wet packing inside of the wound, and then a dry gauze is used to cover the wet packing to wick drainage and bacteria away from the wound to promote healing.
An older female client arrives for an annual visit by the urologist due to a history of changes in serum values related to renal function. What changes should the registered nurse (RN) expect for an older client due to normal aging? a. decrease in glomerular filtration rate (GFR) b. hematuria during urinalysis c. chronic bladder infections d. urinary incontinence
a. decrease in glomerular filtration rate (GFR)
The registered nurse (RN) is observing the skin of an older client. Which finding should the RN document as consistent with the normal aging process? a. decreased elasticity b. tough and leathery texture c. shiny and edematous d. excessive hair growth on the head
a. decreased elasticity
The home health registered nurse (RN) is visiting an older client with chronic hypertension. What evaluation is most important for the RN to complete with each visit? a. effectiveness of medication b. ability to ambulate c. signs of dehydration d. familial support
a. effectiveness of medication
The registered nurse (RN) is assigned to the care of an older client with venous stasis ulcers. A primary goal in the client's plan of care is to decrease swelling in the extremities. What action should the RN take to meet this goal? a. elevate the legs on pillows b. decrease fluid intake c. decrease salt intake in diet d. increase protein intake in diet
a. elevate the legs on pillows
An older client with chronic kidney disease (CKD) has an arteriovenous fistula (AV) in the left forearm for hemodialysis. After palpating the AV fistula, which finding is an indication that the AV fistula is functioning properly? a. enlarged veins b. redness around the site c. decreased pulses below fistula d. marked ecchymotic areas
a. enlarged veins
The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to: a. evaluate standards, risks, benefits, and outcomes. b. identify how to anticipate and resolve similar future situations. c. investigate the need for disciplinary action. d. obtain agreement of all parties with a chosen solution.
a. evaluate standards, risks, benefits, and outcomes.
An older female client recently moved to an assisted living facility. The family explains to the registered nurse (RN) that the client is unmanageable and always confused, disoriented, and depressed. The client asks the RN repeatedly, "Where am I?" How should the RN respond? a. explain that she is in a new home called an assisted living community b. question the client about her perception of where she might be now c. distract the client with a scenario that she is on an outing with her family d. reassure the client not to worry because she will meet new friends
a. explain that she is in a new home called an assisted living community
While providing on-call coverage, the adult-gerontology primary care nurse practitioner answers a patient's telephone call. This patient-provider encounter is described as: a. formal, legally binding, and one for which the responding clinician is fully accountable. b. limited by the policies of the institution that employs the nurse practitioner. c. limited by the primary health provider's existing legal and ethical accountability to the patient. d. measured by the complexity of the oral interaction and the number of contacts between the parties.
a. formal, legally binding, and one for which the responding clinician is fully accountable.
An older male client asks the registered nurse (RN) how he can reduce his incidents of hemorrhoidal flare ups. What information should the RN offer the client about how to prevent rectal discomfort? [select all that apply] a. increase fiber and liquids in the diet to help prevent constipation and straining b. change exercise program to reflect less cardio-exercise and more weight training c. use a therapeutic cushion or frequent repositioning for periods of prolonged sitting d. take frequent warm sitz baths and do not use abrasive paper that can traumatize tissues e. establish bowel habits by scheduling daily time to defecate when the client is not rushed
a. increase fiber and liquids in the diet to help prevent constipation and straining c. use a therapeutic cushion or frequent repositioning for periods of prolonged sitting d. take frequent warm sitz baths and do not use abrasive paper that can traumatize tissues e. establish bowel habits by scheduling daily time to defecate when the client is not rushed Fluids, comfort measures, and establishment of a regular bowel pattern help reduce incidents of hemorrhoid inflammation.
After a transurethral resection of the prostate (TURP), an older man returns to the medical surgical floor with a 3-way indwelling urinary catheter. The registered nurse (RN) observes the catheter's tubing for drainage when the client states that he needs to void. What should the RN implement based on this finding? a. irrigate the bladder through the catheter port b. remove the indwelling catheter c. explain that urgency is expected d. notify the healthcare provider of the symptom
a. irrigate the bladder through the catheter port The feeling of urgency can be caused by blood clots that can occlude drainage of the catheter, which is a common occurrence in the first 72 hours after a TURP. The urgency indication that the client's bladder is not emptying, and the RN should irrigate catheter to relieve the symptoms caused by a clot.
The home health registered nurse (RN) is reinforcing instructions to the family about how to prevent pressure ulcers for their older family member who is bedridden. Which measure should the RN discuss? a. lift the client when turning instead of sliding b. massage directly over reddened sites c. change client's position ever 4 hours d. place pillows under both the knees
a. lift the client when turning instead of sliding Decreasing the chances of friction and shearing while moving the client.
An older resident is newly admitted to an assisted living community. Which action should the registered nurse (RN) implement to provide the resident to maintain safe medication administration? [select all that apply] a. locked medication storage in the client's room b. medication administration record (MAR) c. payment forms for prescribed medications d. delivery of adequate supply of medication e. list of findings indicating medication effectiveness
a. locked medication storage in the client's room b. medication administration record (MAR) d. delivery of adequate supply of medication e. list of findings indicating medication effectiveness
The registered nurse (RN) is reinforcing discharge instructions to the family of an older client with failure to thrive. What information should the RN include to promote nutritional intake for the client? [select all that apply] a. minimize stress level by providing the client with a quiet environment during meals b. provide food variations that the client can manage without assistance c. assist the client with eating meals in bed in a semi Fowler's position d. encourage fluid intake before melas to decrease dehydration e. offer any type of food to the client as long as calories are consumed
a. minimize stress level by providing the client with a quiet environment during meals b. provide food variations that the client can manage without assistance A and B continue to promote independence and decreased stress for the client, which will increase the opportunity for nutritional intake
Older clients are at highest risk for abuse and neglect due to which factors? [select all that apply] a. needs are greater than the caretaker's abilities b. client's declining strength c. fixed income d. longer life expectancy e. lack of exposure to technology and trends
a. needs are greater than the caretaker's abilities b. client's declining strength
A 30-year-old woman who previously was in excellent health complains of weakness. She has had heavy menstrual periods for the past year and recalls that her mother has had a lifelong history of mild, easy bruising. Laboratory tests reveal a hematocrit level of 0.25 (25%), hypochromic and microcytic red blood cells, a white blood cell count of 8000/mm3, and a platelet count of 200,000/mm3. The adult-gerontology primary care nurse practitioner: a. obtains total iron-binding capacity and serum iron level. b. obtains hemoglobin electrophoresis. c. proceeds with an evaluation for a possible hereditary coagulation disorder. d. recommends that the patient begin taking ferrous sulfate.
a. obtains total iron-binding capacity and serum iron level.
The registered nurse (RN) is caring for an elderly client with functional incontinence who lives in an assisted living community. The client is alert and mildly confused and can self ambulate. Which nursing intervention should the RN implement? a. offer assistance with toileting Q2 hours b. use protective disposal undergarment instead of underwear c. ask if the client has attempted to void Q2 hours d. obtain a prescription for intermittent catheterization
a. offer assistance with toileting Q2 hours Toileting assistance maintains independence and self-esteem which are important for an older client with incontinence. A toileting schedule also decreases the clients chances of accidents and embarrassment.
An older male client arrives at the clinic for an annual physical examination. While the nurse assesses the client, the client states that he is having intimacy problems with his wife. Which information should the nurse provide to elicit more information from the client? a. query client to clarify the client's idea of an intimacy problem b. discuss benign prostatic hypertrophy (BPH) and ejaculation c. explore frequency that he experiences erectile dysfunction (ED) d. determine if the client's wife is young enough to get pregnant
a. query client to clarify the client's idea of an intimacy problem
A 58-year-old patient has a blood pressure reading of 138/85 mmHg. The adult-gerontology primary care nurse practitioner instructs the patient to: a. reduce his or her daily salt intake. b. return for re-evaluation in one year. c. return for re-evaluation in six months. d. take garlic supplements.
a. reduce his or her daily salt intake.
During the quarterly evaluations of the clients in the assisted living community, the registered nurse (RN) assesses for findings of failure to thrive in the older population. Which findings should the RN document and report as manifestations related to failure to thrive? [select all that apply] a. unintentional weight loss b. increased weakness c. increased amounts of sleep d. irritation and agitation e. seeking constant attention from caregiver
a. unintentional weight loss b. increased weakness c. increased amounts of sleep Symptoms of failure to thrive in the older population include weight loss, weakness, and excessive sleep, which should be documented and evaluated by a healthcare provider immediately.
An older client who is unconscious is admitted after experiencing a head injury from a fall. Glasgow Coma Scale (GCS) is prescribed to evaluate the client. Which focused assessments should the registered nurse (RN) use to determine the client's GCS score? [select all that apply] a. verbal response b. motor response c. eye opening d. pupillary reaction e. hearing
a. verbal response b. motor response c. eye opening
An older woman asks the registered nurse (RN) how she can decrease her chances of getting cystitis. What information should the RN provide? a. void and empty the bladder completely every 2 to 3 hours b. take warm sitz baths with bubble bath to cleanse the vulva c. decrease fluid volume intake to reduce urgency d. test urine pH daily using over-the-counter (OTC) dipsticks
a. void and empty the bladder completely every 2 to 3 hours
An older male with Parkinson's disease (PD) is discharged home with levopoda-carbidopa (Sinemet) and instructions to this wife for his care. Which statement best indicates to the registered nurse (RN) that the wife understands her husband's needs? a. "It is important to keep my husband in a chair or in bed as much as possible and prevent him from falling." b. "I will notify the healthcare provider if my husband has increasing involuntary movement of his extremities." c. "Since it is difficult for my husband to eat, we should stay in the house instead of going out to dine." d. "I should expect that my husband be incontinent of bowel and bladder as his disease advances."
b. "I will notify the healthcare provider if my husband has increasing involuntary movement of his extremities."
Over the last two months, a 68-year-old patient has sustained an unintended weight loss of 15 lb (6.8 kg) but reports feeling well. The patient's problems include depression, tobacco abuse, obesity, and dyslipidemia. His or her medications are sertralizine (Zoloft), simvastatin (Zocor), and famotidine (Pepcid). The adult-gerontology primary care nurse practitioner performs which two actions? a. Adds a probiotic. b. Conducts a depression screening. c. Decreases the dosage of the statin medication. d. Orders a thyroid-stimulating hormone.
b. Conducts a depression screening.
Since his arrival in an assisted living community, an older male client is having difficulty going to sleep. Which intervention should the registered nurse (RN) implement first? a. encourage client to take a warm bath at night b. ask the client what has helped him in the past c. recommend that the client not take daytime naps d. offer the client a glass of warm milk before bedtime
b. ask the client what has helped him in the past
A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which finding is most important for the registered nurse (RN) to report to the healthcare provider? a. fever and chills b. confusion and dehydration c. crackles in lung fields d. nausea and vomiting
b. confusion and dehydration Confusion and dehydration are findings of inadequate oxygenation and perfusion in this frail elderly client.
After taking a 10-day course of an antibiotic that was ineffective, a frail, elderly client with chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. The client has a long history of smoking and still smokes a pack of cigarettes a day. Which finding should the registered nurse (RN) report to the healthcare provider? a. barrel chest with increased chest diameter b. crackles and pulse oximetry level of 88% c. low hemoglobin and hematocrit levels d. arterial blood gases indicating respiratory acidosis
b. crackles and pulse oximetry level of 88%
The home health registered nurse (RN) is assessing an older client for a pressure ulcer. Which finding should the RN observe the area for a Stage I pressure ulcer? a. superficial skin breakdown and flaking b. deep pink, red, or mottled skin c. subcutaneous damage or necrosis d. skin that blanches pink when pressed
b. deep pink, red, or mottled skin Temporary blanching of the area can last for over a minute due to poor circulation. Deep pink, red, or mottled skin is a finding consistent with a Stage 1 pressure ulcer.
An older client who recently moved into an assisted living community refuses to eat or join any activities. When evaluating the client further, what should the registered nurse (RN) focus on during next examination? a. anxiety b. depression c. exhaustion d. confusion
b. depression Depression is a symptom that an older client is likely to experience with a sudden change in living accommodations when a loss of personal identity can create low self-esteem.
To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: a. charges a fee for patients who arrive late to clinic appointments. b. disseminates research study results to colleagues. c. expresses opinions about alternative therapies with patients who consider such treatments. d. schedules time during clinic hours to meet with pharmaceutical representatives.
b. disseminates research study results to colleagues.
A 75-year-old patient, whose marriage ended in divorce after two years, has lived alone for the past 50 years. Feeling as if life has had little meaning, the patient is terrified of living out the remaining years and of dying. The age-related issue to be resolved is: a. disengagement vs. activity. b. ego integrity vs. despair. c. self-determination vs. resignation. d. self-esteem vs. self-actualization.
b. ego integrity vs. despair.
A 40-year-old patient with rheumatoid arthritis develops a new onset of nocturnal pain and swelling of the fingers. Examination reveals asymmetrical swelling of the small joints of the fingers of the right hand. The patient was recently prescribed hydrochlorothiazide (Microzide) 25 mg daily for hypertension. The patient's new symptoms are caused by: a. carpal tunnel syndrome. b. gout. c. osteoarthritis. d. Reiter syndrome.
b. gout.
The healthcare provider prescribes a new medication, atorvastatin (Lipitor), for an older client who arrives at the clinic for an annual physical examination. What common side effect should the registered nurse (RN) advise the client to observe for with this medication? a. constipation b. headaches c. muscle weakness d. nausea and vomiting
b. headaches Headaches are the most common side effect of atorvastatin (Lipitor).
An older client is admitted with a preliminary diagnosis of Addison's disease. Which skin finding should the registered nurse (RN) document that is typical with Addison's disease? a. moon face b. hyperpigmentation c. excessive acne d. multiple skin tags
b. hyperpigmentation
An 80-year-old patient, who lives at home with a spouse, is instructed to follow a 2 g sodium diet. The patient states, "I've always eaten the same way all my life, and I'm not going to change now." To promote optimal dietary adherence, the gerontological nurse's initial approach is to: a. inform the patient about the need to follow the diet. b. inquire about the patient's current food preferences and eating habits. c. list the variety of foods that are allowed on the diet. d. provide dietary instruction to the patient's spouse, who prepares the meals.
b. inquire about the patient's current food preferences and eating habits.
An older male client is admitted for emergency treatment of acute closed-angle glaucoma. The registered nurse (RN) begins administering the prescribed biotic medications and glycerin (Glycol) therapy. Which intervention is most important for the RN to maintain during the client's therapy? a. maintain lighting control in the room during therapy b. monitor intake and output Q2 hours for 24 hours c. place an eye patch over the affected eye during sleep d. administer the eye drops at the scheduled intervals
b. monitor intake and output Q2 hours for 24 hours Monitoring I&O is most important during the administration of glycerin (Glycol) due to the rapid acting osmotic diuretic effect of glycerin therapy.
During an annual health visit, a 15-year-old female patient is found to have grown 5 in (12.7 cm) over the past year. She has not reached menarche. Her mother is concerned because the patient's sister reached menarche at age 11 and the mother reached menarche at age 12. Examination reveals that the patient's breasts are enlarged, with the areolae forming a mound above the general contour of each breast, and that the left breast is larger than the right. Axillary hair is absent and the pubic hair is dark, coarse, curly, dense, and similar in pattern to that of an adult female. These findings are consistent with a diagnosis of: a. hypothyroidism. b. normal development. c. polycystic ovary syndrome. d. Turner syndrome.
b. normal development.
The home health registered nurse (RN) visits an older women with heart failure (HF) who is on complete bed rest. Which intervention is most important for the RN to suggest to the client to prevent complications related to immobility? a. get as much sleep as possible b. perform leg exercises while in bed c. increase protein intake to combat fatigue d. invite friends to visit to decrease risk for depression
b. perform leg exercises while in bed This client is at risk for complications related to immobility. Active leg exercises should be performed frequently to decrease the risk for thrombophlebitis.
An older female client who has been taking hydrocodone/acetaminophen (Lortab) Q4 hours for chronic back pain for the past 5 years tells the registered nurse (RN) that she cannot live without her pain pills. When asked if she is addicted, the client states that she is not an addict because the healthcare provider prescribed the pain pills. Which coping mechanism should the RN determine the client is using about her addiction? a. lack of knowledge about narcotic medications b. rationalization to support narcotic use c. transfer of blame to healthcare provider d. justification of narcotic use due to chronic pain
b. rationalization to support narcotic use The client is using rationalization to maintain self-esteem when she is questioned by stating that she is not addicted because she is taking medication prescribed by a healthcare provider.
The registered nurse (RN) is caring for an older female with a 20 year history of rheumatoid arthritis (RA), who is admitted for carpel tunnel release. Which finding associated with RA should the RN document? a. asymmetrical joint deformity b. small joint involvement in fingers c. crepitation or grating sensation in joints d. weight bearing joint involvement
b. small joint involvement in fingers Small joint involvement is common in rheumatoid arthritis.
The American Nurses Association's Gerontological Nursing: Scope and Standards of Practice emphasizes: a. that abnormal responses to the aging process determine the appropriate nursing diagnoses. b. that the health status data of older adult patients be documented in a retrievable form. c. the role of the older adult patient as the sole decision maker in planning his or her care. d. the unchanging nature of the goals and plans of care for older adult patients.
b. that the health status data of older adult patients be documented in a retrievable form.
A resident in a nursing home requests a new room because he or she does not like the view from the current room. While the resident is away from the home on a provider visit, the staff moves the resident's belongings to another room with a better view. The resident and the resident's family later file a formal complaint regarding the move. Which statement gives the best justification for the resident's complaint? a. the change was made without a provider's order b. the resident was not included in the decision making c. the resident's belongings were moved without his or her assistance d. the resident's family was not included in the decision making
b. the resident was not included in the decision making
Which question does the gerontological nurse prioritize for an 86-year-old patient with abdominal pain, muscle weakness, and leg cramps? a. "Do you eat a lot of meat?" b. "Do you have heart problems?" c. "Do you take a diuretic?" d. "Do you walk every day?"
c. "Do you take a diuretic?"
Which patient is at greatest risk for developing arteriosclerotic heart disease? a. A 68-year-old female patient with a triglyceride level of 135 mg/dL, and a high-density lipoprotein level of 68 mg/dL. b. A 70-year old male patient with a total cholesterol level of 181 mg/dL, and a low-density lipoprotein level of 90 mg/dL. c. A 75-year old female patient with a triglyceride level of 189 mg/dL, and a low-density lipoprotein level of 149 mg/dL. d. An 86-year-old male patient with a low-density lipoprotein level of 100 mg/dL, and a high-density lipoprotein level of 50 mg/dL.
c. A 75-year old female patient with a triglyceride level of 189 mg/dL, and a low-density lipoprotein level of 149 mg/dL.
A 34-year-old truck driver reports a sharp pain in the lower back that worsens with ambulation. The symptoms began after a strenuous three-day driving trip. During an examination, the patient has difficulty walking on the heels and shows weakness in the extensors of the big toes. The initial differential diagnosis is: a. compression fracture. b. L-1 root irritation. c. L-5 root irritation. d. ruptured disc.
c. L-5 root irritation.
The adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure? a. Comorbidities and length of exposure. b. Location and event intensity. c. Mode of transmission and incubation. d. Premorbid conditions and surveillance rates.
c. Mode of transmission and incubation.
The registered nurse (RN) is assigned the care of an older client who returns to the unit after surgery for closed angle glaucoma. Which intervention in the plan of care should the RN bring to the attention of the healthcare team? a. assist with ambulating to the commode b. monitor intake and output Q8 hours c. administer morphine 4 mg IM Q2 hour PRN pain d. place an eye patch on operative eye during sleep
c. administer morphine 4 mg IM Q2 hour PRN pain Morphine side effects include nausea, vomiting, and constipation, causing straining on stool, all of which can increase intraocular pressure and cause intraocular bleeding during the postoperative period.
The home health registered nurse (RN) visits an older female client with an ideal conduit who has been experiencing chronic urinary tract infections (UTI). Which intervention should the RN recommend to the client to manage the frequency of UTIs? a. force fluid intake to 1,000 mL daily b. change appliance every 4 hours c. attach a larger drainage bag while sleeping d. allow bag to fill completely before emptying
c. attach a larger drainage bag while sleeping
When assessing an older client, which age-related changes in the cardiovascular system should the registered nurse (RN) document? [select all that apply] a. dyspnea b. chest pain c. cardiac murmurs d. widening pulse pressure e. irregular heart rate
c. cardiac murmurs d. widening pulse pressure
The nursing assessment of an older female elicits information that the client is diagnosed with Raynaud's phenomenon. Which exposure should the nurse instruct the client to avoid? a. alcohol consumption b. warm climates c. cold climates d. active exercise
c. cold climates
Signs and symptoms of age-related macular degeneration include: a. decreases in depth perception. b. deficits in peripheral vision. c. distortion of lines and print. d. reports of flashes of light.
c. distortion of lines and print.
A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is: a. amoxicillin (Amoxil). b. doxycycline (Vibramycin). c. erythromycin (E-Mycin). d. trimethoprim-sulfamethoxazole (Bactrim).
c. erythromycin (E-Mycin).
An older client is transferred to a telemetry unit after placement of a pacemaker. What action should the registered nurse (RN) take first? a. view the incision site b. obtain a blood pressure c. establish telemetry monitoring d. evaluate client for pain
c. establish telemetry monitoring The first action is to establish telemetry monitoring to ensure the pacemaker is functioning properly.
Traditionally, an African-American family most respects the insight and wisdom of the: a. father. b. grandfather. c. grandmother. d. mother.
c. grandmother.
The gerontological nurse manager involves the nursing staff in the utilization of trend data and analysis for quality improvement by: a. encouraging staff to volunteer for The Joint Commission's onsite surveys. b. highlighting the quality improvement work of experts in the specialty area. c. informing how data and outcomes are directly related to the staff's daily work. d. using scatter diagrams to identify the root cause of unresolved concerns.
c. informing how data and outcomes are directly related to the staff's daily work.
The most common symptoms of benign prostatic hypertrophy (BPH) are: a. chills, fever, and nausea b. dysuria, abdominal pain, and urinary retention c. intermittency, hesitancy, and dribbling d. nocturia, bladder spasms, and hematuria
c. intermittency, hesitancy, and dribbling
A family member brings their aging father to the clinic because he has been alert and oriented during the day but agitated and disoriented in the evening. The registered nurse (RN) reviews the client's list of current medications with the client and family. Which action taken by the RN is most important? a. medication review with the family caregivers is the RN's responsibility b. multiple medications can contribute to sundowner like symptoms c. medication recall is the best way to evaluate the client's memory d. reviewing medication actions is a component of effective client care
c. medication recall is the best way to evaluate the client's memory Older clients may see a variety of healthcare providers which can increase the chance of poly pharmacy that compounds the workload of metabolic pathways that may be less efficient due to the aging process. Multiple medication interactions may contribute to sundowner like symptoms.
The gerontological nurse is monitoring signs of suspected abuse in an 89-year-old patient who was admitted from home. When planning for the patient's discharge, the nurse's first action is to: a. delay discharge by informing the provider of the suspected abuse b. enlist the help of family members with transitioning the patient home c. notify Adult Protective Services of the patient's discharge d. restrict the family members' access to the patient prior to discharge
c. notify Adult Protective Services of the patient's discharge
The hospice nurse is completing a focused assessment of an older female client with end stage Alzheimer's disease, who recently fractured her hip. What technique should the registered nurse (RN) use to determine the client's pain? a. use the FACES pain scale b. ask client to rate pain on a scale of 1 to 10 c. observe for facial grimacing d. review documentation of recent eating habits
c. observe for facial grimacing
A 35-year-old patient had an upper respiratory viral infection two weeks ago. The patient complains of a gradual onset of shortness of breath accompanied by mid-chest pain, which increases in intensity in a supine position. Physical examination is normal except for a precordial rub heard on auscultation. The diagnosis is: a. dissecting aortic aneurysm. b. esophageal reflex. c. pericarditis. d. pulmonary embolism.
c. pericarditis.
A frail elderly woman visits the healthcare provider because she has been getting out of breath easily when walking long distances. Which pulmonary function change should the registered nurse (RN) expect to commonly occur with aging? a. decreased residual volume b. mild respiratory acidosis c. reduced vital capacity d. increased alveoli function
c. reduced vital capacity
The registered nurse (RN) is re-enforcing discharge instructions with the family of an older client who was recently admitted for an intestinal obstruction. Which statement indicates that the family understands the instructions? a. increase protein and carbohydrates in the daily diet b. limit activity to bed rest for the first week and increase mobility incrementally each week c. report abdominal distention, constipation, or any nausea and vomiting to the healthcare provider d. drink liquids 2 hours after meals instead of during meals
c. report abdominal distention, constipation, or any nausea and vomiting to the healthcare provider These symptoms occur with intestinal obstruction and should be addressed immediately.
A patient has hyperactive reflexes of the lower extremities. The adult-gerontology primary care nurse practitioner assesses for ankle clonus by: a. firmly applying a low-pitched tuning fork to the lateral malleolus. b. flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the percussion hammer. c. sharply dorsiflexing the foot and maintaining this position while supporting the knee. d. stroking the lateral aspect of the sole from the heel to the ball of the foot with the sharp end of the percussion hammer.
c. sharply dorsiflexing the foot and maintaining this position while supporting the knee.
An older female client who is a new resident at an assisted living facility cannot remember how to get to her room. What action should the registered nurse (RN) implement? a. schedule therapy and social activities in her room b. ask another resident to help the client c. show client how to follow hallway signs to her room d. move the client to a room close to the nurses station
c. show client how to follow hallway signs to her room
A 76-year-old male patient reports hesitancy, decreased force of the urinary flow, a sensation of incomplete emptying of the bladder, and dribbling. The gerontological nurse first asks: a. "Have you experienced abdominal pain?" b. "Have you had a daily bowel movement?" c. "Have you had low back pain?" d. "Have you noticed blood in your urine?"
d. "Have you noticed blood in your urine?"
Three months ago, an older adult patient, who lives in an apartment in a housing complex for senior citizens, began residing with an older adult patient from the same complex. Upon learning of the situation, the patient's adult child expresses concern to the housing administrator, who reports that both residents have reported satisfaction with the arrangement. When the child requests advice, the gerontological nurse's initial response is: a. "I can understand why you are upset. Has he or she ever done something like this before?" b. "Why don't we all talk to your parent to get his or her side of the story?" c. "Your parent has the right to do what he or she wants because he or she is mentally competent." d. "Your parent seems to be happy with the arrangement. Have you discussed this situation with him or her?"
d. "Your parent seems to be happy with the arrangement. Have you discussed this situation with him or her?"
The adult-gerontology primary care nurse practitioner reminds a 16-year-old male patient who just received his driver's license to wear a seat belt at all times when in a car. The patient replies that he does not need to wear a seat belt, because nothing will happen to him if he is involved in an automobile collision. According to the health belief model, what chief component does the patient lack? a. Enabling factors. b. Motivation. c. Perceived role conflict. d. Perceived severity.
d. Perceived severity.
A 26-year-old man has had abdominal pain, shaking chills, and a cough productive of rust-colored sputum for the last two days. Findings include a temperature of 103°F (39.4°C) and radiologic confirmation of pulmonary consolidation in the right middle lobe. His white blood cell count is 14,000/mm3 with a shift to the left. A Gram stain of the sputum reveals many Gram-positive diplococci. The diagnosis is which type of pneumonia? a. Chlamydial. b. Haemophilus. c. Legionella. d. Streptococcal.
d. Streptococcal.
An older adult patient, who has end-stage multiple myeloma, is receiving hospice care. Which situation illustrates that the principles of hospice care are being met? a. The caregiver asks if hospice includes weekend care. b. The caregiver has been calling the provider on his or her own. c. The patient reports enjoying daily excursions. d. The patient reports no breakthrough pain medications are needed.
d. The patient reports no breakthrough pain medications are needed.
What factors does the adult-gerontology primary care nurse practitioner need to consider when discussing advanced care planning with a patient? a. Autonomy and patient safety are rarely competitive considerations. b. Decisions regarding a health care representative are a family group decision. c. Family members are not integral components in care planning. d. Trust and rapport with patients are key to patient satisfaction in decisions for care.
d. Trust and rapport with patients are key to patient satisfaction in decisions for care.
An older male client is admitted to the hospital with left-sided heart failure (HF). Which finding should the registered nurse (RN) document that is consistent with HF? a. ascites b. pitting edema c. jugular distention d. course and fine crackles
d. course and fine crackles
A new resident in an assisted living facility is an older client who is experiencing short-term memory loss and confusion. Which activity should the registered nurse (RN) schedule the client to do during the day? a. arts and crafts b. current events discussion group c. group sing-along d. daily exercise group
d. daily exercise group A daily exercise group allows the client to mirror the leader and minimizes the client's stress to remember.
The charge nurse at a nursing home consults the adult-gerontology primary care nurse practitioner about a resident with dementia who fell two weeks ago. The patient's x-ray on the day of the fall was negative, but the resident continues to limp and exhibits increasing agitation. The nurse practitioner advises the charge nurse to: a. administer the prescribed pain medication to the resident. b. apply heat to the affected hip and monitor the resident's ambulation. c. initiate physical therapy for the resident. d. obtain another x-ray of the affected hip and pelvis.
d. obtain another x-ray of the affected hip and pelvis.
After a recent total hip replacement, an older female client, who transferred to a rehabilitation facility placement, asks the registered nurse (RN) if she broke her hip because she is old. How should the RN best respond? a. hip fractures can occur in any age group and require strength conditioning b. with aging, everything tends to break down more easily the older one gets c. older people tend to look down instead of ahead, increasing the risk of falls d. older women commonly lose bone calcium which increases the risk of fracture
d. older women commonly lose bone calcium which increases the risk of fracture
A 64-year-old client is admitted to the hospital with a fractured right hip. One of the concerns following surgical repair is to promote dorsiflexion. Which intervention would a nurse implement? a. begin early ambulation b. monitor pain level c. provide PCA instructions d. provide a foot board
d. provide a foot board A footboard supports the feet in dorsiflexion and helps prevent foot drop throughout the recovery.
A 90-year-old patient comes to the clinic with a family member. During the health history, the patient is unable to respond to questions in a logical manner. The gerontological nurse's action is to: a. ask the family member to answer the questions. b. ask the same questions in a louder and lower voice. c. determine if the patient knows the name of the current president. d. rephrase the questions slightly, and slowly repeat them in a lower voice.
d. rephrase the questions slightly, and slowly repeat them in a lower voice.
An effective way to adequately provide nourishment to a patient with moderate dementia is: a. allowing the patient to choose foods from a varied menu. b. hand feeding the patient's favorite foods. c. routinely reminding the patient about the need for adequate nutrition. d. serving soup in a mug, and offering finger foods.
d. serving soup in a mug, and offering finger foods.
A frail elderly couple ask the registered nurse (RN) if they have to watch their salt intake because food does not taste as good as it used to so they have to season most foods. What information should the RN offer the couple? a. boredom may influence how the taste of food is perceived, and different seasonings can stimulate taste b. with age, an increase in sodium intake is needed to compensate for a decrease in renal function c. short-term memory loss and confusion may be the reason they want to over-season their food d. taste buds often are dull due to atrophy so older clients should use other seasonings instead of salt
d. taste buds often are dull due to atrophy so older clients should use other seasonings instead of salt
An older male client returns to the hospital after discharge 4 days ago for a transurethral resection of the prostate (TURP). The registered nurse (RN) evaluates the function of the 3-way indwelling urinary catheter and the continuous bladder irrigation system. Which finding should the RN report to the healthcare provider? a. irrigation bag of normal saline is hanging at the level of the client's head b. the urinary output is greater than the amount of irrigation fluid instilled c. the irrigation turbine is attached to the irrigation port on the 3-way catheter d. the tubing that drains the urinary bladder has bright red urine with clots
d. the tubing that drains the urinary bladder has bright red urine with clots
A 69-year-old female patient reports dyspareunia. Physical examination reveals sparse hair, an introitus that admits two fingers, and a pale, dry vagina. The adult-gerontology primary care nurse practitioner's initial management is to recommend: a. daily douching. b. topical antibiotic cream. c. topical antifungal cream. d. topical hormonal cream.
d. topical hormonal cream.
When teaching an independent older adult patient how to self-administer insulin, the most productive approach is to: a. facilitate involvement in a small group where the skill is being taught. b. gather information about the patient's family health history. c. provide frequent, competitive skills testing to enhance learning. d. use repeated return demonstrations to promote the patient's retention of the involved tasks.
d. use repeated return demonstrations to promote the patient's retention of the involved tasks.
An 84-year-old patient arrives at the office for an initial visit. The patient questions the need for colorectal screening, since 10 years have passed since the last colonoscopy. The adult-gerontology primary care nurse practitioner recommends: a. a colonoscopy. b. a fecal DNA test. c. flexible sigmoidoscopy. d. watchful waiting.
d. watchful waiting.
The gerontological nurse works with patients with non-insulin dependent diabetes at a senior center in a predominantly Hispanic neighborhood. The nurse demonstrates competency in collaboration by: a. assisting and educating patients on diet restrictions. b. delivering care by preserving and protecting patient autonomy. c. providing written education materials in Spanish. d. working with Hispanic groups in the community.
d. working with Hispanic groups in the community.
