Med Surg - Chapter 3 - Common Health Problems of Older Adults

The Fulmer SPICES framework, which was developed as part of the NICHE project, identified many serious "marker conditions" that can lead to longer hospital stays, higher medical costs, and even deaths. How many marker conditions were identified? 1 6 2 7 3 9 4 10

1 6 The Fulmer SPICES framework was developed as part of the NICHE project and identifies six serious "marker conditions" that can lead to longer hospital stays, higher medical costs, and even deaths. These conditions are sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown.

A 72-year-old patient has been admitted to the hospital for a knee-replacement surgery. What nursing interventions can help reduce the stress of hospitalization? Select all that apply. 1 Assess the patient's food likes and dislikes. 2 Place a favorite family picture on the patient's bedside. 3 Discourage family and friends from visiting the patient often. 4 Carefully explain all procedures and routines before they occur. 5 Give the patient a warm bath with aromatic oils early every morning.

1 Assess the patient's food likes and dislikes. 2 Place a favorite family picture on the patient's bedside. 4 Carefully explain all procedures and routines before they occur. Several methods can be used to reduce the stress of relocation in an older patient. Carefully explaining all procedures and routines beforehand builds trust between the caregiver and the patient. Placing a familiar or special keepsake at the patient's bedside provides a feeling of being in familiar surroundings. By assessing the patient's food likes and dislikes, the nurse can plan a diet around the patient's food preferences. These interventions make the patient feel safe and cared for, and reduce stress. Instead of giving the patient a warm bath with aromatic oils early every morning, the nurse should assess the patient's usual lifestyle and routine. The patient's family and friends should be encouraged to visit the patient often to prevent loneliness and stress.

A 75-year-old patient is being cared for by an adult child. At an appointment, the patient reports that things have been better at home and they have adjusted into a routine. The patient's child comments, "In the afternoons I give a little medication to sedate my parent so I can take care of bills and chores." How does the nurse respond? 1 By calling Adult Protective Services and reporting that the patient is being abused by the adult child caretaker 2 By praising the caretaker for settling into a routine and acknowledging the challenges of caring for an older parent 3 By providing brochures for a nursing home in case the caretaker decides the current arrangement is too burdensome 4 By suggesting the caretaker speak to the provider to make sure the sedative is compatible with the patient's prescriptions

1 By calling Adult Protective Services and reporting that the patient is being abused by the adult child caretaker The caretaker's behavior of sedating the older adult is considered physical abuse. The nurse is required by law to report suspected abuse and will therefore call Adult Protective Services and report the abuse. The caretaker should not be praised for the abusive behavior of sedating the parent. Suggesting that the sedative should be checked for compatibility with the patient's prescriptions would be condoning the abusive behavior. Providing brochures for a nursing home without taking any other action would be ignoring the abuse, which is unethical and could lead to further harm to the patient.

A nurse is caring for an older patient who has relocation stress syndrome. Which nursing action may increase stress in the patient? 1 Changing the patient's room frequently 2 Explaining the procedures to the patient 3 Assessing the patient's lifestyle and daily activities 4 Asking about the patient's preferred time for bathing

1 Changing the patient's room frequently Relocation stress is most commonly observed in older patients who are moved to a long-term health care setting. Changing the patient's room frequently may further increase stress in that patient. Explaining the procedure to the patient will reduce stress in that patient. Asking about patient's preferred time for bathing also reduces stress in the patient as does assessing the patient's lifestyle and daily activities.

The nurse is caring for an older adult patient receiving antipsychotics. What adverse drug event is most likely to happen? 1 Constipation 2 Tachycardia 3 Hypoglycemia 4 Urinary incontinence

1 Constipation The anticholinergic effect of antipsychotic agents in older adults causes constipation and urinary retention. Antipsychotics such as risperidone and quetiapine cause hyperglycemia. Bradycardia rather than tachycardia is seen as an adverse event of antipsychotics.

Patients who are late old and patients with alcoholism and/or disorders of major body organs are at a high risk of what? 1 Delirium 2 Dementia 3 Hypoxemia 4 Fluid imbalance

1 Delirium High-risk patients for delirium are usually late old or have alcoholism and/or disorders of major body organs. Such patients are not necessarily at a higher risk for dementia. Hypoxemia and fluid imbalance are among the factors that can cause delirium.

Which manifestation of neglect does the nurse identify as most common in older adults? 1 Depression 2 Fractures 3 Skin burns 4 Bruises on the skin

1 Depression The most common manifestation of neglect in older adults is depression; this may occur in an older adult when family members neglect him or her. Fractures, skin burns, and bruises are signs and symptoms of physical abuse, not neglect.

What symptoms are included in geriatric failure to thrive (GFTT)? Select all that apply. 1 Depression 2 Undernutrition 3 Low blood sugar 4 High blood pressure 5 Cognitive impairment 6 Impaired physical functioning

1 Depression 2 Undernutrition 5 Cognitive impairment 6 Impaired physical functioning GFTT is a complex syndrome including depression, undernutrition, cognitive impairment, and impaired physical functioning. Low blood sugar and high blood pressure are not characteristic of GFTT.

Which member of the health care team would the nurse consult when caring for a patient who has difficulty chewing or swallowing? 1 Dietician 2 Psychiatrist 3 Geriatrician 4 Anesthesiologist

1 Dietician If the patient has difficulty chewing or swallowing, the nurse would consult with the speech-language pathologist and dietitian. If there are no dietary restrictions, encourage family members or friends to bring in food that the patient might enjoy. A psychiatrist is a medical practitioner who specializes in the diagnosis and treatment of mental illness. A geriatrician is a doctor of medicine who has completed extra training in caring for older adults. An anesthesiologist is a physician trained in anesthesia and perioperative medicine.

The nurse is preparing to administer several medications to an older adult. What common adverse drug events does the nurse monitor for in this patient? Select all that apply. 1 Edema 2 Diarrhea 3 Hypotension 4 Urinary retention 5 Increased appetite 6 Excessive sweating

1 Edema 2 Diarrhea 3 Hypotension 4 Urinary retention Common adverse drug events in older adults include edema, diarrhea, urinary retention, and hypotension. Other common adverse drug events in patients of this age group include anorexia rather than increased appetite, and dehydration rather than excessive sweating.

An 80-year-old patient reports a fear of falling when moving around at home. What home modifications can help this patient prevent falls? Select all that apply. 1 Handrails 2 Scatter rugs 3 Low toilet seat 4 Nonslip bathmats 5 Adequate lighting

1 Handrails 4 Nonslip bathmats 5 Adequate lighting Handrails provide support while the older adult is moving around the house and help the patient balance the body. Nonslip bathmats prevent falls in the bathroom. Adequate lighting allows the patient to see better, preventing the patient from tripping and falling. A raised, rather than low, toilet seat with a grab-bar within reach makes it easier for the patient to get on and off the toilet. The older patient may trip over scatter rugs lying on the floor, so they should be avoided.

Which older adult population is at a higher risk for disability from chronic disease and mental distress? 1 LGBTQ 2 Asexual 3 Nonsexual 4 Homosexual

1 LGBTQ Significant health disparities are associated with the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) older adult population. Compared with heterosexual adults, LGBTQ older adults are at an elevated risk of disability from chronic disease and mental distress. Asexuals or nonsexuals have risk levels comparable to that of the heterosexual population.

The nurse is teaching a class of older adults about ways to promote their cognitive health. Which collaborative interventions will be most helpful for them? Select all that apply. 1 Learning a new skill 2 Starting a new physical activity 3 Meditating for 30 minutes every day 4 Allowing for increased rest and relaxation time 5 Joining a peer group with a common learning goal 6 Having solitary times to reminisce about life experiences

1 Learning a new skill 2 Starting a new physical activity 5 Joining a peer group with a common learning goal Cognitive health problems (depression, delirium, and dementia) can be offset by social engagement, learning a new skill, and physical activity. Increased rest time, meditation, and increased solitude may be helpful for other aspects of aging but do not benefit the older adult's cognitive capabilities.

What information was used by the nurse to come to the conclusion that an older patient is at risk for errors in medication self-administration? Select all that apply. 1 Lives alone 2 Deaf in the left ear 3 Takes medication every 4 hours 4 Has a daughter who is a physician 5 Uses two pharmacies for prescriptions

1 Lives alone 2 Deaf in the left ear 3 Takes medication every 4 hours 5 Uses two pharmacies for prescriptions Criteria that may increase an older patient's risk for errors with self-medication include living alone, a sensory deficit such as deafness in one ear, taking medications more than once a day such as every 4 hours, and using more than one pharmacy for prescriptions. Having a daughter who is a physician will not increase an older patient's risk for errors with medication self-administration.

What is the most common type of elder abuse? 1 Neglect 2 Physical 3 Financial 4 Emotional

1 Neglect Neglect occurs when a caregiver fails to provide for an older adult's basic needs and accounts for almost half of all cases of elder abuse. Physical abuse is the use of physical force that results in bodily injury. Financial abuse occurs when the older adult's property or resources are mismanaged or misused and is more common than physical abuse. Emotional abuse is the use of threats, humiliation, intimidation, and isolation toward older adults.

The nurse is assessing a patient who was brought by his son to the hospital. The nurse observes that the patient is malnourished and unkempt. What caregiving problem does the nurse suspect? 1 Neglect 2 Physical abuse 3 Financial abuse 4 Emotional abuse

1 Neglect The nurse may suspect a case of neglect if the patient is malnourished and unkempt. Neglect occurs when the caregiver fails to provide for an older adult's basic needs, such as food, clothing, medications, or assistance with activities of daily living. Physical abuse refers to the use of physical force to injure someone. Financial abuse occurs when the older adult's property or resources are mismanaged or misused by the caregiver. Emotional abuse is associated with intentional use of threats, humiliation, intimidation, and isolating older adults.

Which form of elder abuse does the nurse suspect for a patient who is malnourished and dehydrated? 1 Neglect 2 Physical 3 Financial 4 Emotional

1 Neglect The nurse may suspect that a malnourished and dehydrated patient is a victim of neglect, in which a caregiver fails to provide for the older adult's basic needs. Physical abuse is the use of physical force to cause the patient bodily harm. Emotional abuse involves the use of threats, humiliation, intimidation, and isolation. Financial abuse occurs when the caregiver misuses or mismanages the older adult's financial assets.

The caregiver intentionally refuses to allow the home care nurse into the home of an older patient. This reflects which action? 1 Neglect 2 Physical abuse 3 Emotional abuse 4 Domestic violence

1 Neglect When the caregiver intentionally refuses to allow home care nurses into the home to care for an older patient, it reflects neglect. Physical abuse involves the use of physical force on a person. Emotional abuse refers to the use of threats, humiliation, and intimidation. Domestic violence is an abuse against another in a domestic setting such as marriage.

What is the fastest-growing subgroup of older adults? 1 Old old 2 Elite old 3 Young old 4 Middle old

1 Old old The old old, people aged 85 to 99 years, is the fastest-growing subgroup of older adults. The young old are people aged 65 to 74 years, and the middle old are people aged 75 to 84 years. The elite old are people aged 100 years or older.

An older adult patient is diagnosed with depression that the provider believes is due to insufficient serotonin in the brain. This is described as what? 1 Primary depression 2 Geriatric depression 3 Situational depression 4 Secondary depression

1 Primary depression Primary depression is thought to result from insufficient levels of norepinephrine and serotonin in the brain. Geriatric depression is not a specific classification of depression. Secondary depression can result after a sudden change in a person's life. Situational depression is another term for secondary depression.

Which tool is available to help the nurse focus on factors that increase an older person's risk for falling? 1 STRATIFY 2 Nocturia 3 Restraint 4 Braden Scale

1 STRATIFY The STRATIFY tool was developed to help a nurse focus on factors that increase an older person's risk for falling. Nocturia is a condition in which people wake up during the night to urinate. A restraint is a device or a drug that prevents a patient from moving freely and must be prescribed by a health care provider. The Braden Scale is an assessment scale used to predict the risk for pressure sores.

The nurse is teaching parents of children of a minority community about the benefits of vaccinations for what purpose? 1 To reduce any health disparities 2 To bring a change in the state's laws and policies 3 To reduce the number of U.S. minority communities 4 To learn whether the local hospital has the necessary facilities

1 To reduce any health disparities In explaining the need for vaccination to the parents, the nurse seeks to eliminate a health disparity by getting children vaccinated at the local health care facility. This action will not help bring about a change in the state's laws and policies. The nurse's goal is not to reduce the number of minority communities in the United States but instead to reduce incidence of diseases in the community. In this scenario, the nurse's purpose was not to determine whether the local hospital has the required facilities.

Which finding is frequently seen in older adults who have undiagnosed depression? 1 Under-nutrition 2 Increased falls 3 Increased socialization 4 Spending sprees on unnecessary items

1 Under-nutrition Older adults may respond to depression by not eating, and this can lead to under-nutrition. Many who live alone lose the incentive to prepare or eat balanced diets, especially if they do not "feel well." Falls are not typically the result of undiagnosed depression. Increased socialization is the antithesis of depression. Older adults, especially those with depression, do not typically go on spending sprees.

Which physical restraint can cause serious injury and even death? 1 Vests 2 Mitts 3 Roller belts 4 Wrist restraints

1 Vests Vests are a high restraint device and can cause serious injury and sometimes even death. Mitts, roller belts, and wrist restraints are the least restrictive devices and should be used. None cause serious injury.

What is the best exercise to suggest to an older adult patient who wishes to prevent osteoporosis? 1 Walking 2 Running 3 Kayaking 4 Swimming

1 Walking Walking is a weight-bearing exercise which helps to build bone. Building bone in turn helps prevent osteoporosis. Running is also weight-bearing, but it is likely too intense an exercise for most older adults. Kayaking and swimming are not weight-bearing exercises; while they are good methods of exercise, they do not offer bone-building benefits.

Which statement made by a new nurse about older adult abuse and neglect requires correction from the experienced nurse? 1 "Molesting an older adult is an example of physical abuse." 2 "Hitting an older adult is an example of emotional abuse." 3 "Failing to provide basic needs to an older adult is an example of neglect." 4 "Mismanagement of an older adult's money is an example of financial abuse."

2 "Hitting an older adult is an example of emotional abuse." Molesting, hitting, burning, or pushing a patient are all examples of physical abuse. Hitting an older adult is an example of physical, not emotional, abuse. Failing to provide basic needs to an older adult is an example of neglect. Mismanagement of an older adult's financial resources is an example of financial abuse.

A patient is moving from his or her home to live in a nursing home. The nurse meets with the family to educate them on minimizing the effects of relocation stress as the patient transitions to living in the nursing home. What does the nurse advise the family? 1 "If different rooms become available, you might want to move your family member periodically to keep the environment fresh." 2 "If possible, one of you should come to the nursing home to accompany your family member to the physical therapy sessions." 3 "It's best for you to make decisions about room arrangement and what your family member will bring to decrease the stress of making decisions." 4 "Avoid letting your family member bring too many photos of family and friends, as it will likely make your family member miss home too much."

2 "If possible, one of you should come to the nursing home to accompany your family member to the physical therapy sessions." Having a family member or significant other accompany the patient when he or she needs to leave the unit for therapies and special procedures can help minimize the effects of relocation stress. Unnecessary room changes should be avoided to minimize relocation stress. The patient should be given opportunities to participate in decision-making so that he or she feels empowered; this will also minimize effects of relocation stress. Bringing familiar keepsakes from home, including family photos or special items, can also help minimize effects of relocation stress by making the space seem more familiar.

Which nursing student response about frequent sources of stress and anxiety in older adult patients confirms the need for further teaching by the nursing instructor? 1 "Relocation" 2 "Insurance" 3 "Acute or chronic illness" 4 "Loss of significant others"

2 "Insurance" Financial hardship, not insurance, is a source of stress and anxiety for older adult patients. Relocation, acute or chronic illness, and loss of significant others also cause stress and anxiety among older adults.

When an older adult patient's family visits at the nursing home, they find the patient is restless and agitated. They are distracted from this observation when they see a stuffed bear in the patient's bed. One family member comments, "I was afraid my parent would be treated like a child here, and now I see this bear. It's really insulting." How does the nurse respond? 1 "The bear reminds your loved one, who is suffering from depression, of home and happier times." 2 "Your loved one is experiencing delirium, and the bear provides something with which to fidget so the intravenous tubes aren't pulled out." 3 "Older adults often revert to child-like behaviors including playing with toys such as this bear." 4 "The bear is part of your loved one's therapy for feelings of isolation. The patient talks to the bear when we aren't available."

2 "Your loved one is experiencing delirium, and the bear provides something with which to fidget so the intravenous tubes aren't pulled out." Providing a stuffed animal to a patient with delirium (marked by the patient's agitation and restlessness) can be effective. The patient is able to fidget with the bear instead of with tubes or equipment, protecting the patient's safety. Older adults do not often revert to child-like behaviors and should not be treated like children. There is no evidence that the patient is suffering from depression. Having a patient talk to a stuffed animal would not be part of an effective therapy program.

Since 1996, the Hartford Institute for Gerontological Nursing has worked to ensure that all hospitalized patients be given quality care. What is the age limit mentioned by the institute? 1 57 years and above 2 65 years and above 3 70 years and above 4 80 years and above

2 65 years and above Older adults who are admitted to hospitals and long-term care settings such as nursing homes have special needs and potential health problems. The Joint Commission and other agencies have addressed some of the most common problems seen in older adults. In addition, since 1996, the Hartford Institute for Gerontological Nursing has worked to ensure that all hospitalized patients 65 years of age and older are given quality care.

For which patient is the use of the drug haloperidol appropriate? 1 An 87-year-old patient with severe anxiety 2 A 72-year-old patient who suffers from delusions 3 An 83-year-old patient who has trouble falling asleep at night 4 A 75-year-old patient who becomes uncontrollably agitated at night

2 A 72-year-old patient who suffers from delusions Haloperidol is an antipsychotic drug that is only appropriate for controlling delusions, schizophrenia, and other behavioral problems. Antipsychotic drugs should never be used to treat anxiety or to sedate a patient who has trouble falling asleep. While it has sometimes been used as a physical restraint for patients such as the one who becomes uncontrollably agitated, this use is typically inappropriate.

What are the acronyms for tools used in screening older adults for alcohol misuse and abuse? Select all that apply. 1 EAI 2 ARPS 3 CAGE 4 shARPS 5 SPICES

2 ARPS 3 CAGE 4 shARPS The Alcohol-Related Problems Survey (ARPS), the Short ARPS (shARPS), and the CAGE questionnaire help in screening older adults for alcohol misuse. The Elder Assessment Instrument (EAI) is used to screen for elder abuse and neglect. The SPICES framework identifies conditions that can lead to longer hospital stays, higher medical costs, and even deaths.

Anticholinergic effects, orthostatic hypotension, and Parkinsonism are some of the consequences of the group of medications that are considered antipsychotics. Under which category would this be labeled? 1 Side effects 2 Adverse effects 3 Therapeutic effects 4 Unexpected effects

2 Adverse effects Adults receiving antipsychotics should be monitored for adverse drug events. Side effects are normal, expected events that happen when a medication is taken. Therapeutic effects are the desired outcomes of the medication. Unexpected effects are idiosyncratic events that happen without warning due to a medication.

Which group of drugs is most likely to be prescribed to a patient diagnosed with schizophrenia? 1 Antianxiety 2 Antipsychotic 3 Antidepressant 4 Sedative-hypnotic

2 Antipsychotic Of these groups of drugs, antipsychotics are the most potent and therefore the most appropriate for treating schizophrenia. Antianxiety, antidepressant, and sedative-hypnotic drugs are unlikely to be strong enough to treat schizophrenia.

Which tool is used to screen for alcohol misuse in an older patient? 1 Braden Scale 2 CAGE Questionnaire 3 Geriatric Depression Scale 4 Confusion Assessment Method

2 CAGE Questionnaire Screening tools for alcohol misuse in older adults include the CAGE questionnaire. The acronym CAGE comes from four questions: Have you ever tried to cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to settle your nerves to get rid of a hangover (eye-opener)? The Braden Scale is used to determine the risk for pressure ulcer development. The Geriatric Depression Scale is used to determine the presence of depression. The Confusion Assessment Method is used to determine the presence of delirium.

What adverse effect can risperidone cause? 1 Diarrhea 2 Hyperglycemia 3 Excess salivation 4 Urinary incontinence

2 Hyperglycemia Risperidone is an antipsychotic agent that can cause hyperglycemia and diabetes mellitus. It can also cause constipation, not diarrhea. Dry mouth, not excessive salivation, and urine retention, not incontinence, are anticholinergic side effects also caused by risperidone.

Which age-related changes affect drug absorption? Select all that apply. 1 Decrease in liver size 2 Increase in gastric pH 3 Decrease in albumin level 4 Decrease in total body water 5 Decrease in gastrointestinal (GI) motility

2 Increase in gastric pH 5 Decrease in gastrointestinal (GI) motility An increase in gastric pH and a decrease in GI motility can affect drug absorption. A decrease in liver size affects drug metabolism. Decreases in albumin level and total body water affect drug distribution.

The older patient has increased his or her consumption of soft foods such as ice cream, apple sauce, and mashed potatoes. The nurse is concerned that because of this, the patient is experiencing decreased fiber intake and poor nutrition. What is the nurse's priority suggestion? 1 Taking a fiber supplement every day 2 Making an appointment with a dentist 3 Eating more whole fruits and vegetables 4 Varying the texture of foods for more variety

2 Making an appointment with a dentist Older adults may begin to avoid nutritious foods due to tooth loss and poor-fitting dentures. The patient's increased consumption of soft foods may be indicative of this problem. The nurse's suggestion to make an appointment with a dentist will help the patient achieve greater comfort in eating a variety of foods. Taking a fiber supplement will not address the patient's increased intake of sugar and lack of variety in the diet. Eating more fruits and vegetables or varying the texture of foods may be difficult for the patient for whom eating anything but softs foods is uncomfortable.

The nurse is helping a new resident transition to an assisted-living facility. Which actions are effective for minimizing relocation stress? Select all that apply. 1 Assessing the patient's risk for falls 2 Noting what foods the patient likes and dislikes 3 Providing all-new objects for the patient's room 4 Encouraging the patient's family and friends to visit often 5 Providing opportunities for the patient to assist in decision making

2 Noting what foods the patient likes and dislikes 4 Encouraging the patient's family and friends to visit often 5 Providing opportunities for the patient to assist in decision making A move to an assisted-living facility may cause relocation stress for an older adult patient. To minimize this, the nurse can help ease the patient's anxiety with steps such as giving the patient opportunities to make decisions about his or her care, noting what foods the patient does and doesn't like for future reference, and encouraging the patient's family and friends to visit often. While the nurse may assess the patient's risk for falls, this is done to plan for the patient's safety, not to minimize relocation stress. Rather than being given all-new objects for his or her room, the patient should be able to have his or her favorite objects and keepsakes because familiar belongings can be comforting.

What makes up the "colon cocktail" that some older adults may need to take to prevent constipation? 1 Cranberry juice and a stool softener 2 Prune juice, applesauce, and psyllium 3 Applesauce, a stool softener, and rice 4 Prune juice, mashed banana, and water

2 Prune juice, applesauce, and psyllium The "colon cocktail" is made of equal parts prune juice, applesauce, and psyllium. If it is not effective in preventing constipation, the health care provider may recommend a stool softener. The "colon cocktail" does not contain cranberry juice, a stool softener, rice, banana, or water.

Which does the nurse identify as signs and symptoms of neglect in older adults in a family? Select all that apply. 1 Seizures 2 Urine burns 3 Dehydration 4 Hypertension 5 Pressure ulcers

2 Urine burns 3 Dehydration 5 Pressure ulcers Urine burns result from skin that has been in contact with urine for long periods of time, for example, when a patient is incontinent and not provided with hygiene care for hours. Dehydration occurs when a patient is not assisted or reminded to take in fluids. Pressure ulcers can occur when immobile patients are not turned and positioned frequently. Seizures and hypertension are not associated with neglect.

Nurses must know about the special needs of older adults, especially as that segment of the population grows. By 2050, it is expected that what percentage of people in the United States will be over 65 years old? 1 15% 2 20% 3 25% 4 30%

3 25% By 2050, it is expected that 25% of people in the United States will be over 65 years old. The estimates of 15% and 20% are too low, and the estimate of 30% is too high.

Which group of older adults is classified as "old old?" 1 65 to 74 years of age 2 75 to 84 years of age 3 85 to 99 years of age 4 100 years of age or older

3 85 to 99 years of age The older adult population is classified into four subgroups. Patients who are 85 to 99 years of age are classified as "old old." They are also referred to as the advanced older adult population or the "frail elderly." Patients who are 65 to 74 years of age are referred to as the "young old." Those who are 75 to 84 years of age are referred to as the "middle old." Patients who are 100 years of age or older are referred as the "elite old."

Which condition can be treated with thiothixene? 1 Insomnia 2 Anxiety 3 Acute psychosis 4 Alzheimer disease

3 Acute psychosis Antipsychotic drugs such as haloperidol and thiothixene are used to treat problems associated with acute psychosis. An antipsychotic drug like thiothixene is not effective for treating anxiety, insomnia, and Alzheimer disease.

The caregiver of a 65-year-old patient reports that the patient has lost interest in eating and social and recreational activities and is not sleeping well. Which condition does nurse anticipate? 1 Delirium 2 Dementia 3 Depression 4 Parkinson disease

3 Depression Depression is a behavioral disorder that manifests in poor appetite, loss of interest in activities, and poor sleeping habits. Delirium and dementia may manifest as confused thinking and impaired memory. Parkinson disease is a progressive neurological disorder that is associated with tremors and muscle rigidity.

What should an older patient avoid to prevent the development of dehydration? 1 Water 2 Fruit juices 3 Excessive caffeine 4 Carbonated beverages

3 Excessive caffeine Excessive caffeine can cause dehydration. Up to 2 liters of water each day is beneficial to prevent dehydration. Fruit juices and carbonated beverages do not cause dehydration.

What is another term for the SPICES framework? 1 Geriatricians 2 Geriatric syndromes 3 Geriatric marker conditions 4 Acute Care of the Elderly (ACE) unit

3 Geriatric marker conditions The Fulmer SPICES framework was developed as part of the NICHE project and identified six serious "marker conditions" that can lead to longer hospital stays, higher medical costs, and even deaths. Rather than being fully comprehensive, the SPICES framework is intended to be an easy tool that has been called "geriatric vital signs." Geriatricians are the ones who specialize in the care of older adults. Geriatric syndromes include the major health issues that are associated with late adulthood in community and inpatient settings. The Acute Care of the Elderly (ACE) unit has geriatric resource nurses and geriatric clinical nurse specialists.

The nurse is assessing the diet and medication of a patient suffering from arthritis who is taking warfarin for anticoagulation. Which component of the patient's intake concerns the nurse? 1 Yogurt 2 Almonds 3 Ibuprofen 4 Diphenhydramine

3 Ibuprofen The nurse should be concerned about the patient's use of ibuprofen because it inhibits blood clotting and may cause severe bleeding. Yogurt and almonds are healthy foods and not a cause for concern. Consumption of diphenhydramine may cause mild drowsiness, which gradually subsides, but does not have adverse effects with warfarin.

During a home visit, the nurse learns that an older patient places all medications in one jar and selects five pills to take each morning with breakfast. What should the nurse do first about this situation? 1 Discard the medication in the jar. 2 Analyze each pill and place into the correct medication container. 3 Report the patient's medication taking approach to the health care provider. 4 Contact the pharmacy and request refills for all of the patient's medications.

3 Report the patient's medication taking approach to the health care provider. This patient is at high risk for duplicate or noncompliant drug therapy since there is no way of knowing which medications are being taken each day. The safety action for the nurse to take first is to report this behavior to the health care provider, who can provide new prescriptions. The medication jar will need to be discarded; however, this is not the first action. It may be impossible for the nurse to analyze each pill in the jar, and the patient may not have the medication containers. Contacting the pharmacy and requesting refills for all of the patient's medications will need to be performed; however, not as a first step. The health care provider will need to provide prescriptions for this action to be completed.

The nurse is assessing an older patient who shows signs of stress after being shifted from one health care setting to another. Which conditions, in addition to emotional stress, does the nurse anticipate? Select all that apply. 1 Dementia 2 Sore throat 3 Sleep disturbances 4 Tender lymph nodes 5 Gastrointestinal distress

3 Sleep disturbances 5 Gastrointestinal distress Relocation stress syndrome, also known as relocation trauma, is the physical and emotional distress that occurs after a person moves from one long-term setting to another. Some physical symptoms of relocation stress syndrome include sleep disturbances and gastrointestinal distress. Dementia, sore throat, and tender lymph nodes are not symptoms typically associated with relocation stress syndrome.

What should the nurse include in the assessment when looking for signs of skin breakdown including pressure ulcers? 1 Delusions 2 Thiothixene 3 Tissue integrity 4 Acute psychosis

3 Tissue integrity Skin breakdown, especially pressure ulcers, is a major tissue integrity problem among older adults in hospitals and nursing homes. Delusions and acute psychosis are psychiatric disorders. Thiothixene is a drug appropriate only for the control of certain behavioral problems.

The nurse calls the patient to plan a six-month medication assessment. The patient says, "My list from last time should be fine. I have only started taking a couple of herbal supplements this month." What is the best response by the nurse? 1 "I need you to add those to the list so it's complete." 2 "Instead of making a list, you can bring in everything you are taking." 3 "That's fine. We just need to know what medications you are taking." 4 "Herbal supplements can still have dangerous interactions with your drugs."

4 "Herbal supplements can still have dangerous interactions with your drugs." Telling the patient that herbal supplements can still have dangerous interactions with drugs is the most informative response. It offers a reason why the patient should provide a complete list. Simply telling the patient that the list should be complete or saying he or she can bring their medications and supplements to the assessment does not educate the patient on why the list is important. Telling the patient that it's fine not to tell the nurse about the supplements is dangerous, as the nurse will be unable to identify potentially dangerous combinations.

If a person retires between the ages of 55 and 65, by what age are funds most likely to become depleted, causing strain on health care? 1 65-70 years 2 70-75 years 3 75-80 years 4 80-85 years

4 80-85 years If a person retires between age 55 and 65 and lives to 80 or beyond, funds are most likely to deplete and additional income is needed to meet basic needs, including money for prescription drugs. If a person lives to 65-70 years, 70-75 years, or 75-80 years their funds are less likely to become depleted.

Which tool uses nine open-ended questions and a diagnostic algorithm to identify delirium? 1 Mini-Cog 2 Delirium Index (DI) 3 NEECHAM Confusion Scale 4 Confusion Assessment Method (CAM)

4 Confusion Assessment Method (CAM) The Confusion Assessment Method (CAM) is a tool that is used to determine delirium; it consists of nine open-ended questions and a diagnostic algorithm. The Delirium Index (DI), NEECHAM Confusion Scale, and Mini-Cog are also tools used to determine the level of delirium, but these tools do not use the nine open-ended questions and a diagnostic algorithm.

The nurse is assessing a 68-year-old patient's laboratory results, which show a decreased creatinine clearance rate. What will the nurse expect the health care provider to do? 1 Screen the patient for liver disease. 2 Screen the patient for heart disease. 3 Increase the patient's medication doses. 4 Decrease the patient's medication doses.

4 Decrease the patient's medication doses. A reduction in creatinine clearance rate indicates a reduction in the glomerular filtration rate, which causes a slower excretion time for medications leading to toxic serum drug levels that can cause illness or death. Therefore, the nurse can expect the health care provider to decrease the patient's medication doses to avoid toxicity. Liver and heart disease are unrelated to creatinine clearance. The health care provider will not increase the medication doses, as this could cause dangerous toxicity with a reduced creatinine clearance rate.

What is also referred to as chronic confusion? 1 Delirium 2 Hendrich 3 STRATIFY 4 Dementia

4 Dementia Dementia is the correct answer as it is considered chronic confusion and is not reversible. Delirium is related to acute confusion and is often reversible. Hendrich and STRATIFY are the tools that are used to help a nurse focus on factors that increase an older person's risk for falling.

For which do older adults pay to cover prescription drug costs? 1 Medicare Part A 2 Medicare Part B 3 Medicare Part C 4 Medicare Part D

4 Medicare Part D Medicare Part D covers prescription drugs. Medicare Part A pays for inpatient hospital care. Older adults pay for Medicare Part B to reimburse for 80% of ambulatory care services. Medicare Part C allows the provision of Medicare benefits by private health insurance companies.

For what are the Beers criteria used? 1 Screening for evidence of abuse 2 Screening for alcohol dependency 3 Screening for cognitive impairment 4 Screening for medication-related risks

4 Screening for medication-related risks "Beers criteria" is the shortened name for the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. This assessment tool is used to screen for medication-related risks in older adults with chronic health problems. This tool is not related to abuse, alcohol dependency, or cognition.

Upon looking at a patient's screening test results, the nurse is concerned that the patient has a problem with alcohol. This concern is based on the results of which screening test? 1 The CAM 2 The NIA 3 The GDS-SF 4 The SMAST-G

4 The SMAST-G The Short Michigan Alcoholism Screening Test - Geriatric Version (SMAST-G) is used to detect alcohol use or alcoholism. The nurse's concern about the patient's alcohol use is based on the results of this test. CAM is short for Confusion Assessment Method, which is used to screen for delirium. The NIA is the National Institute on Aging. GDS-SF is the acronym for the Geriatric Depression Scale - Short Form.

What percentage of ambulatory care services is reimbursed in Medicare Part B?____%

80 Medicare Part B reimburses 80% of most ambulatory care services.

The nurse preceptor is teaching a nursing student about minimizing the effects of relocation trauma in older adults. Which of the nursing student's statements indicates a need for further teaching by the nurse preceptor? 1 "I should not involve the older patient in decision making." 2 "I should ask the older patient about his or her expectations during the transition." 3 "I should not frequently move belongings around in the room of the older patient." 4 "I should encourage the older adult patient's family members and friends to visit the patient."

1 "I should not involve the older patient in decision making." Relocation stress syndrome in older adults, also known as relocation trauma, is the physical and emotional distress that occurs when a patient is moved to a long-term care facility. It can be minimized by involving the patient in decision making in order to promote the patient's sense of confidence and control. Asking the older patient about his or her expectations can reduce relocation stress. Avoiding changes in the patient's room will minimize stress in the patient. Encouraging the older patient's family to visit the patient will also comfort the patient.

What was developed to limit the use of physical restraints in hospitals and nursing homes? 1 STRATIFY 2 The Braden scale 3 The National Patient Safety Goals (NPSGs) 4 Nurses Improving Care for Healthsystem Elders (NICHE)

3 The National Patient Safety Goals (NPSGs) The Joint Commission developed the National Patient Safety Goals (NPSGs), which has specific standards that limit the use of physical restraints in hospitals and nursing homes. STRATIFY is a fall risk assessment tool nurses use in the hospital setting to determine a patient's risk for sustaining a fall. The Braden scale is used for predicting pressure sore risk. The Nurses Improving Care for Healthsystem Elders (NICHE) project generates evidence-based practice guidelines for older adult care.

The nurse is assessing a new patient in a nursing home. Upon viewing the patient's file, which information alerts the nurse that the patient may be at risk for delirium? 1 The patient has had type 1 diabetes for 60 years. 2 The patient has recently fallen twice in one week. 3 The patient has recently experienced the death of a spouse. 4 The patient has suffered multiple fractures in the past two months.

3 The patient has recently experienced the death of a spouse. Experiencing a major loss like the death of a spouse is a factor that can cause delirium, so this will alert the nurse that the patient may be at risk. Type 1 diabetes is not relevant to delirium. A recent history of falls is a risk factor for subsequent falls, not delirium. Having suffered multiple fractures in a short period of time may be an indicator of abuse, not delirium.

What problems prevent older patients from receiving adequate nutrition? 1 Sleeping problems 2 Depression problems 3 Bowel elimination problems 4 Eating and feeding problems

4 Eating and feeding problems Problems with eating and feeding prevent older patients from receiving adequate nutrition. Problems with sleeping can make dementia symptoms worse. Depression is the most common yet most underdiagnosed and undertreated mental health/behavioral health disorder among older adults. Urinary and bowel elimination issues vary in type and severity and may be caused by many factors, including acute or chronic disease, ADL ability, and available staff.

The nurse is assessing an older patient with reduced vision in the hospital. What teaching does the nurse provide to the patient to prevent risk of falls in the home? 1 Allow daily exposure to sun. 2 Have a tetanus immunization. 3 Exercise three to five times a week. 4 Eliminate the use of rugs and carpets.

4 Eliminate the use of rugs and carpets. The patient should be taught to eliminate the use of rugs and carpets to prevent risk of falls in the home. Daily sun exposure, tetanus immunization, and regular exercise do not help to prevent the risk for falls.

Which does the nurse identify as the intentional use of isolation toward older adults in a family? 1 Neglect 2 Physical abuse 3 Financial abuse 4 Emotional abuse

4 Emotional abuse Emotional abuse is a type of abuse in which family members use threats, humiliation, intimidation, and isolation toward an older person. Neglect refers to the failure of the caregiver to provide for the basic needs of an older adult. Physical abuse involves the use of physical force on a person. Financial abuse refers to mismanaging or misusing someone else's property.

The nurse is reviewing the patient's medications and supplement use. The patient has been prescribed warfarin. Which other item on the list is cause for concern? 1 Insulin 2 Vitamin D 3 Acetaminophen 4 Garlic supplement

4 Garlic supplement Garlic can inhibit clotting. When taken in combination with warfarin, the patient is at risk for serious bleeding. Insulin and vitamin D do not affect clotting. Acetaminophen is a safe pain reliever for patients taking warfarin; unlike ibuprofen and aspirin, it does not inhibit clotting.

Which statement regarding use of restraints is correct? 1 The restraint must be released at least every 2 hours. 2 The most restrictive restraint device should be used first. 3 Restraints are physical devices that prevent a patient from moving freely. 4 Checking a patient every 90 minutes while restrained is required.

The restraint must be released at least every 2 hours. When restraints must be used, the restraint is released at least every 2 hours to turn and reposition the patient and to aid in toileting. If a restraint is needed, the least restrictive restraint is used first to avoid injury to the patient. Restraints are not just the physical devices that prevent patients from moving freely; they also include chemical restraints or psychoactive drugs. The patient in restraints must be checked every 30 to 60 minutes, not every 90 minutes.