Exam 2 Flashcards by Ian Elliott

Following an appointment with the primary care provider, the nurse is teaching an independent living older adult about a newly prescribed medication. Which factor is most likely to interfere with the effectiveness of this process?
1. The patient wears a hearing aid.
2. The patient has a history of hypothyroidism.
3. The nurse provided written handouts.
4. The nurse is in a hurry.

Correct answer: 4
Older adults and their families or significant others should be given complete information about the prescribed medications and the proper method for taking them. If possible, nurses should select a time when the older adult’s anxiety level is low, because the individual will be more likely to remember the important points when calm. If the directions are complex, extra time may be necessary to ensure that they are understood completely. Commonly, older persons fail to ask questions because they are afraid of being judged as ignorant or bothersome. If the nurse seems hurried, the older person may not feel comfortable asking necessary questions.
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What is an example of a medication that can be crushed?
1. A potassium tablet
2. Enteric-coated aspirin
3. Sublingual nitroglycerin
4. A calcium tablet

Correct answer: 4
If a liquid form of medication is not available, the tablet or capsule may have to be crushed or broken to facilitate swallowing. Not all medications can be crushed or broken because these activities can alter the action of the drug. A calcium tablet may be crushed. Sustained-release capsules, enteric-coated aspirin, and sublingual nitroglycerine are examples of medications that should not be crushed or chewed.

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You are administering medication through a transdermal patch, What are some precautions?
(Select all that apply.)
1. Remove all old patches before applying a new patch.
2. Use the same location each time for consistent absorption.
3. Cleanse the skin after removing an old patch.
4. Dispose old patches in the toilet.
5. Verify the dosage strength of the patch.
6. Wear gloves.
7. Tape over the patch to keep it secure.

Correct answers: 1, 3, 5, 6
Precautions when using transdermal patches include removal of all old patches and cleansing of the skin before applying a new one, verification of the dosage strength of the patch, and handling the patch so that the skin does not come in contact with the medicated portion wearing gloves is recommended to avoid touching the medicated surface). Tape should never be used to secure a patch.

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A resident in a long-term care facility has an order for digoxin (Lanoxin) 0.25 mg every morning in tablet form. If the nurse assesses that this resident has been having difficulty swallowing, what should the nurse do?
1. Administer the digoxin (Lanoxin) in liquid form.
2. Crush the digoxin (Lanoxin) for administration.
3. Withhold the digoxin (Lanoxin) and document.
4. Discuss the possibility of an order change to liquid form with the primary care provider.

Correct answer: 4
Problems arise when the older person is unable to swallow tablets. Because liquids might be absorbed more rapidly than solids, all changes in medication form require a physician’s order.

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Why are older adults more likely to experience adverse drug reactions?
1. Because of the number of medications they take daily
2. Because of physiologic changes in metabolism and excretion
3. Because of higher percentage of body fluid
4. Because of cognitive changes
5. Because of interactions with foods, OTC preparations, and herbal supplements
6. Because of decreased sense of taste

Correct answers: 1, 2, 4
Factors that increase the risk for medication-related problems in older adults include use of multiple medications, herbal and OTC medications, physiologic changes related to aging, cognitive and sensory changes, drug-testing methodology, knowledge deficits, and financial concerns.

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What should you instruct the independent living older person to do?
1. Take most medications with milk or antacids to avoid stomach upset.
2. Avoid drinking alcohol if taking acetaminophen (Tylenol).
3. Keep daily medications in the kitchen cabinet near the sink.
4. Save prescription drugs in case the care provider orders them again.

Correct answer: 2
Excessive use of acetaminophen (Tylenol) can damage the kidneys, and if the patient uses alcohol heavily, it can also damage the liver.

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You are caring for a new patient who had a heart transplant five years ago. She takes seven medications every day, including antirejection drugs, cardiac medications and inhalers. She mentions feeling “depressed,” and wants your advice about trying a new “natural” remedy she found on the internet. Which of the following would be the best response?
1. “That might be a good idea. I have heard good things about St. John’s Wort.”
2. “My Aunt Judy used to take some of those herbal remedies, and she died from liver failure.”
3. “You really should talk with your doctor first, because many things can interfere with your antirejection and heart medications, even herbs and supplements.”
4. “You’re on too many pills already; you should start an exercise program instead and fresh air to help you feel better.”

Correct answer: 3
Herbs and nutritional supplements, as well as OTC medications, all have the potential to interact with prescription medications a patient takes and actually contribute to the problem of polypharmacy. Some may cause liver failure, many interact with cardiac medications, and some decrease the effectiveness of anti-rejection medications. Although some may be potentially useful, a conversation with the prescribing physician is important to have so that effects can be monitored and dangerous drug-herb interactions can be avoided.

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Under what circumstances is the nursing supervisor of an extended care facility most likely to refer to the STOPP Criteria?
1. Medication aide administers the medication to the wrong resident
2. Older resident is unable to swallow the prescribed medication
3. NSAID is ordered for a resident with severe heart failure
4. Staff nurse requests chemical restraints to control a resident

Answer 3: The STOPP Criteria gives example of drugs that may be inappropriate for older adults under certain circumstances. An order for NSAIDS for a patient with moderate to severe heart failure should be questioned; therefore, the nursing supervisor would contact the provider who ordered this medication (See Table 7-3 for additional information.) The medication aide needs counseling about proper use of patient identifiers. If the patient is unable to swallow, the nurse would use nursing process to assess for reasons and then plan interventions accordingly. Use of chemical restraints for control violates patients’ rights, thus the nursing supervisor would remind the staff nurse about the Omnibus Budget Reconciliation Act (OBRA) of 1987.

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The nurse is caring for an older patient who is receiving gentamicin.
Which patient factors create a concern for an excessive blood level of this medication?
1. Dehydrated with difficulty swallowing
2. Overweight with excessive fatty tissue
3. Urinary retention secondary to enlarged prostate
4. Age-related changes in the gastrointestinal system

Answer 1: Gentamicin is a water-soluble drug; therefore, dehydration results in excessive concentration of the drug. Fatty tissue is a concern when drugs are fat-soluble. Kidney function is necessary for excretion; however urinary retention is not related to serum drug levels unless the retention damages the kidneys. Gentamicin is generally given intravenously, so the gastrointestinal system is not involved.

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During a home health visit, the nurse observes the older patient and her daughter arguing about the patient’s judgment in self-administering medication. What should the nurse do first?
1. Ask the daughter to describe her concerns
2. Ask the patient to describe how she takes her medications
3. Gently suggest that the daughter take over the medications
4. Advise use of a pill box sectioned into days of the week

Answer 2: The nurse would first ask the older patient to describe how she is taking the medications. This shows respect towards the older patient and the answer will give insight to deficits in knowledge or errors in judgment. The nurse may then decide to use the other options.

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The nurse has been administering medication to the older patient for several days, but today one of the pills has a different shape and the nurse does not recognize the name on the label. What should the nurse do first?
1. Call the pharmacy and ask if they delivered the correct medications
2. Call the health care provider to see if orders were recently changed
3. Use a drug reference to verify the identity and purpose of the medication
4. Give the medication because the pharmacist has checked the order

Answer 3: The nurse would use a drug reference to verify the identity and purpose of the drug. If there is still a question, the nurse would check the orders and then call the pharmacist if the delivered medication does not match the orders. The health care provider is consulted for additional clarification as needed. The nurse would never give an unfamiliar medication before the correct drug is verified.

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The home health nurse discovers that the older patient has been taking a medication every day, but the label says, “Take every other day.” What would the nurse do first?
1. Call the prescriber and report the over dosage
2. Call Poison Control or the pharmacy and ask for advice
3. Assess the patient for adverse or toxic effects
4. Write the label instructions in large block letters

Answer 3: The nurse would first assess the patient for symptoms of distress and adverse effects of toxicity and take vital signs. The nurse would conduct additional assessment about how long the patient has been taking the excessive dose and effects before notifying the prescriber. Before calling Poison Control, the nurse would obtain additional information, such as weight, age, dose and frequency of ingestion, and first-aid. When the patient is safe and the immediate issue is addressed, the nurse needs to conduct additional assessment to identify other problems related to medication and plan interventions accordingly.

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A float nurse is administering a large enteric-coated tablet to an older patient who cannot swallow very well. The patient tells the nurse, “The other nurses always crush this for me.” What should the float nurse do?
1. Crush the tablet, because the patient prefers this method
2. Convince the patient that swallowing the pill is possible
3. Document that the patient refuses to swallow the pill
4. Notify the charge nurse about what the patient said

Answer 4: The float nurse should alert the charge nurse about what the patient said, because this statement needs follow-up. The nurse would conduct additional assessment of the swallowing and based on this assessment the nurse might try to convince the patient to swallow the pill, or the nurse may decide that the provider should be notified to change the medication or form. Because the nurse is a floater, the charge nurse should be involved in the decision-making process and corrective actions.

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The older patient is prescribed a diuretic mediation to help control hypertension. What does the nurse suggest during the medication teaching?
1. Take the medication after the evening meal
2. Take the medication early in the day
3. Take the medication whenever it is convenient
4. Take the medication with milk

Answer 2: If diuretics are taken early in the day, this lessens frequency of trips to the bathroom at night.

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An older patient has recently been admitted to the hospital. On the third day, the patient agrees to take his routine medication but refuses to take medications that have been prescribed for the admitting medical diagnosis. What should the nurse do first?
1. Document the patient’s refusal of the specific medications
2. Ask the patient to explain reasons for refusing the new medications
3. Ask the patient’s significant other to encourage adherence
4. Inform the charge nurse and the health care provider

Answer 2: The nurse would first try to determine why the patient is refusing the newly prescribed medications. If the reason can be established, the nurse can design interventions for the specific cause. For example, the patient may not understand the purpose of the medications or may be having side effects. Based on the assessment, the nurse might also use the other options.

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What signs/symptoms would the nurse assess for which indicate that the patient may be experiencing toxicity or adverse effects related to prescribed digoxin?
1. Visual spots
2. Difficulty urinating
3. Dark tarry stools
4. Feeling cold

Answer 1: For patients who take digoxin, the nurse would assess for visual spots, dizziness, headaches, fatigue, drowsiness, mental changes, numbness around lips or of hands, altered pulse rate or regularity, loss of appetite, nausea, vomiting, diarrhea, or weight loss.

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With aging, which medication increases the risk for gastrointestinal problems, such as nausea, vomiting, and occult blood loss?
1. Theophylline
2. Ranitidine
3. Haloperidol
4. Naproxen

Answer 4: Nonsteroidal anti-inflammatory agents, such as aspirin, ibuprofen, tolmetin, and naproxen increase the risk for gastrointestinal problems.

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Which assessment tool is most highly regarded, and often used to determine the mental status of the older adult?
1. SPICES Assessment Tool
2. The Mini-Cog™
3. Short Test for dementia
4. MDS 3.0

Correct answer: 2
Many assessment tools are available to assist nurses in assessing mental status in older adults. Although others are also well known, the easiest and most highly regarded is the Mini-Cog™

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When assessing the respiratory system of an older adult, the nurse hears continuous, coarse, low-pitched sounds. How would these be reported?
1. Rales (crackles)
2. Wheezes
3. Friction rub
4. Rhonchi (gurgles)

Correct answer: 4
Gurgles (rhonchi) are adventitious lung sounds characterized by continuous low-pitched sounds with a coarse snoring quality. They are cleared by coughing and are heard over the trachea and bronchi.

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When taking a radial pulse of an older adult, the nurse finds it difficult to count a weak and thready pulse. What should the nurse do?
1. Gently apply more pressure with three fingers to obtain a stronger pulse.
2. Take the person’s blood pressure to get the heart rate reading from the machine.
3. Take an apical pulse instead.
4. Record, “Weak, thread pulse, rate N/A.”

Correct answer: 3
Weak, thready pulses are often seen in individuals with fluid volume deficits or electrolyte imbalances; full or bounding pulses may indicate excessive fluid volume. Weakness of a radial pulse may make palpation impossible and necessitate use of the apical route.

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When performing an assessment of the gastrointestinal system of an older adult, the nurse would proceed in what order? Place the parts of a gastrointestinal system assessment in sequence from first to last.
1. Palpate abdomen.
2. Observe abdomen for scars.
3. Obtain a health history.
4. Inspect the oral cavity.
5. Auscultate bowel sounds.

Correct order: 3, 4, 2, 5, 1
Before starting a physical assessment, the nurse will use interviewing techniques to obtain a health history. Once the history is obtained, the nurse is then ready to proceed to the physical assessment.
Complete physical assessment should be done in an orderly manner so that no important observations are missed. Assessment should begin with an overview of the person and proceed with more focused assessments. The most common method of physical assessment is a head-to-toe
approach in which the entire body is assessed systematically. An assessment of the gastrointestinal system of an older adult would begin with the health history and then proceed from head to toe, starting with inspection and progressing to auscultation and lastly palpation.

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When performing an interview with an older adult, the nurse should consider physical environment factors by: (Select all that apply.)
1. Explaining what will take place during the assessment
2. Ensuring privacy and minimum noise levels
3. Selecting a room with a comfortable temperature
4. Ensuring bright lighting to enable the older adult to see clearly
5. Having the interview done by a nurse of the same gender to build rapport
6. Seeking a location in close proximity to a restroom

Correct answers: 1, 2, 3, 6
When performing a patient interview, attention to making the older adult comfortable is important, including providing an environment that is properly illuminated, but not too brightly, as glare can be harsh on the older eyes.
Temperature should be comfortable, and it is important to provide for physical needs (e.g., offering the bathroom before beginning) and privacy. One should begin the interview by explaining what to expect. Providing a nurse of the same gender is generally not required but should be accommodated if requested by the patient.

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During a community health fair a nursing student obtains a blood pressure (BP) reading of 180/106 mm Hg on an older person who has not had his BP evaluated for several years. The older person reports “just having a cup of coffee to relieve a mild headache.” What should the student do first?
1. Have the person rest, repeat the BP, and notify the nursing instructor
2. Have the person lie down, call 911, repeat the vital signs, and assess for other symptoms
3. Repeat the BP on the opposite arm and assist the person to call his health care provider
4. Give a copy of the BP results to the person and advise him to see his health care provider

Answer 1: The nursing student should make the patient comfortable, repeat the BP to verify results, and consult with the nursing instructor for further advice. The person is having a “mild headache,” which should be further assessed. In addition, the patient’s baseline BP is unknown and health history is unknown, so additional assessment should be performed, but this is beyond the capabilities of the student. Based on the assessment findings, the nursing instructor will decide how to advise the older person.

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The nurse is interviewing an older patient. The patient's daughter is present and continually corrects her mother's responses or answers for her mother. What should the nurse do first? 1. Assume that the daughter is the spokesperson for her mother and is better able to answer questions 2. Let the daughter speak freely but maintain direct eye contact and attention toward the patient 3. Direct the questions toward the patient and tactfully ask the daughter to allow the patient to speak 4. Politely ask the daughter to leave and then speak to the daughter afterwards for verification of patient information

Answer 3: The first strategy would be to try to elicit information directly from the older patient. The nurse would be continually assessing the verbal and nonverbal behaviors of the older patient and the daughter and possibly may decide to try the other options as needed.

The unlicensed assistive personnel (UAP) reports to the nurse that a thin older patient's BP is lower than expected. The nurse immediately assesses the patient and repeats the BP. The patient is asymptomatic and the BP is at the patient's baseline. Which question is the nurse likely to ask the UAP about the low BP value? 1. "Did the patient seem upset or agitated when you took the BP?" 2. "What size of cuff did you use on the patient's arm?" 3. "Was the patient lying flat in bed during the procedure?" 4. "Did you palpate the patient's brachial artery first?"

Answer 2: In a thin older patient, the most likely error is using a cuff that is too large. This will produce an artificially low reading. Emotional distress is more likely to temporarily increase BP. Lying flat in bed should not cause a low BP. (If the patient is asleep, the BP could be lower.) Locating the brachial artery before applying the cuff is a correct step that is often omitted, but failure to locate the brachial artery would not alter the BP unless the UAP repeated the procedure over and over again without allowing the blood flow to recover.

A 62-year-old woman, with no known health problems, comes to the clinic for her annual health and wellness examination. Which screening examination is most likely to be performed during this annual visit? 1. Cholesterol levels 2. Hearing screening test 3. Blood Pressure 4. Type 2 diabetes screening

Answer 3 Blood pressure measurement is recommended annually after the age of 40. Cholesterol testing is performed every 5 years. Hearing screening is done every 10 years and diabetes testing is done every 3 years for those with risk factors.

Which symptom in an older adult would alert the nurse to possible thyroid disease? 1. Vague respiratory symptoms 2. Fatigue and reports of "slowing down" 3. Mild abdominal discomfort 4. Low-grade fever

Answer 2: Hypothyroidism can be mistaken as normal aging with feelings of fatigue and a slowing down of body systems. Fatigue and slowing are typically associated with hypothyroidism. In older adults, atypical manifestations of fatigue and "slowing down" could also be seen in hyperthyroidism. In hyperthyroidism, the patient is more likely to be agitated and body systems would be over active. Vague respiratory symptoms and mild abdominal discomfort could signal a "silent" acute abdomen. Low-grade fever or no increase in temperature could accompany serious infections in older adults.

Which sign/symptom is a cause for the greatest concern? 1. Loss of sensation in a swollen leg 2. Emesis with frank blood 3. Rigid abdomen with absent bowel sounds 4. Chest pain with a pulse of 38/min

Answer 4: All of these signs/symptoms are serious and warrant notifying the health care provider; however, chest pain with severe bradycardia is a 911 call in the home setting or requires activation of the rapid response team in acute care inpatient settings.

The nurse is preparing to assess the blood pressure of a patient and measures the patients arm to determine the proper sized cuff. The diameter of the patient s arm is 50 cm. How wide should the blood pressure cuff be?

Older adults developing various disease processes may present with different symptoms from younger adults. The nurse would be concerned about which disease if the patient were to demonstrate a decreased appetite, constipation, and changes to his sleep pattern in which he is awake at night and sleeps during the day?

Depression

An older client reports to a nurse, "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumbles a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which of the following?

Presbycusis

An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse?

Examine the resident's ears for cerumen impaction

An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?" The nurse formulates a response based on the knowledge that:

A cochlear implant directly stimulates the auditory nerve

A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse's teaching plan?

"Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise."

A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (SATA) A: Difficulty placing hearing aid properly in the ear B: Stigma associated with wearing a hearing aid C: Difficulty changing the batteries in the hearing aid D: Ineffectiveness of hearing aids for individuals with age-related hearing loss E: Hearing annoying loud noises

A: Difficulty placing hearing aid properly in the ear B: Stigma associated with wearing a hearing aid C: Difficulty changing the batteries in the hearing aid E: Hearing annoying loud noises

An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (SATA) A: Tumors of the middle ear B: Cerumen impaction C: Infections of the external and middle ear D: Age-related hearing impairment E: Excessive and loud noises

D: Age-related hearing impairment E: Excessive and loud noises

The nurse is most concerned by observing when assisting with an older client's bath:

A slightly raised multicolor lesion with an asymmetrical, irregular border

An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, "How did I get something like this?" The best response by the nurse is:

"Scabies is highly contagious and spreads easily though physical contact"

A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education?

Zostavax is recommended for all individuals over age 60 that have no contraindications to the vaccine

A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right thoracic area. The nurse suspects HZ. The patient asks the nurse, "I really don't understand how I got shingles. I don't even know anyone who has this infection." The nurse includes which of the following in formulating a response to the patient?

HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion

A nurse assesses a nursing home resident's pressure injury to be a "healing stage III" The primary reason reverse staging is never used because:

Not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was

A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patient's plan of care? (SATA) A: Encourage adequate fluid intake B: Encourage daily baths of at least 20 minutes C: Maintain a humid environment D: Apply water-lade emulsions to skin immediately after bathing E: Use only deodorant soaps when bathing

A: Encourage adequate fluid intake C: Maintain a humid environment D: Apply water-laden emulsions to skin immediately after bathing

AN older patient complains of pruritus. The nurse suggests which of the following interventions to alleviate the patient's complaint? (SATA) A: Use only non perfumed laundry detergent and fabric softeners B: Avoid sudden temperature changes C: Wear loose-fitting clothing D: Apply heat to affected areas E: Exercise vigorously for at least 30 minutes daily

A: Use only non perfumed laundry detergent and fabric softeners B: Avoid sudden temperature changes C: Wear loose-fitting clothing

An older patient tells a nurse. "The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still don't understand why this happens to me." The nurse responds based on the knowledge that: (SATA) A: Purpura is due to normal age-related changes B: The incidence of purpura increases with age C: Purpura is precancerous skin condition D: Individuals who take blood thinners are especially prone to purpura E: Individuals prone to purpura should make sure that affected areas are open to the air

A: Purpura is due to normal age-related changes B: The incidence os purpura increases with age D: Individuals who take blood thinners are especially prone

A nurse is educating a group of nursing assistants in LTC on the prevention of skin tears. Which of the following interventions should the nurse include in the education? (SATA) A: Lubricate the resident's skin with moisturizers twice daily B: Ensure that the resident has adequate nutrition and hydration C: Bathe the resident in hot soapy water D: Avoid the use of lifting sheets when transferring the resident E: Dress the resident in long sleeves and long pants to protect the extremities

A: Lubricate the resident's skin with moisturizers twice daily B: Ensure that the resident has adequate nutrition and hydration E: Dress the resident in long sleeves and long pants to protect the extremities

Which of the following are sub scales on the Braden Scale for predicting pressure ulcers? (SATA) A: Nutrition B: Moisture C: Mobility D: Age E: BMI

A: Nutrition B: Moisture C: Mobility

An older adult who is within a normal weight range asks a nurse, " I have heard that it is important to limit the amount of fats in my diet, but I don't know how much I should be taking in daily. Can you help me?" The best response by the nurse is:

"Less than 10% of calories per day should come from saturated fats"

A nursing student asks the instructor, "Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn't obesity bad for everyone?" The best response by the instructor is:

"While there is evidence that obesity in younger people lessens life expectancy, overweight and obese adults do not have the same risk of morbidity and mortality"

A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following:

"Since I am an older person, I need more calories because my metabolic rate is slower"

An older adult asks a nurse, "I hear a lot about getting enough fruits and vegetables in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?" The nurse bases a response on which of the following?

Daily intake should consist of 50% fruits and vegetables; 25% grains; and 25% protein-rich foods

A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is:

An injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization

An older adult's nutritional status is screened by a nurse using the Mini Nutritional Assessment (MNA). The older adult scores a "7" (risk for malnutrition) on the screening portion of the tool. The best action by the nurse is to:

Perform a comprehensive nutritional assessment

A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (SATA) A: Sit the patient upright in a chair at 90 degrees B: Allow the patient to sit upright for 15 minutes after the meal is completed C: Feed the patient only liquids to make swallowing easier D: Place the solid food in the left side of the mouth E: Have the patient swallow twice for every mouthful of food given

A: Sit the patient upright in a chair at 90 degrees E: Have the patient swallow twice for every mouthful of food given

Many older adults have a vitamin B12 deficiency. Reasons for this include which of the following? (SATA) A: Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient B: The major source of vitamin B12 is sunlight, and older adults are less likely to be outdoors and absorb vitamin B12 in this manner C: Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food D: Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B12 E: Vegetarian diets increase the risk of vitamin B12 deficiency

A: Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient C: Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food E: Vegetarian diets increase the risk of vitamin B12 deficiency.:

Symptoms of gastroesophageal reflex disease (GERD) in older adults include: (SATA) A: Heartburn B: Regurgitation C: Abdominal pain within 1 hour of eating D: Vomiting E: Fever and elevated WBC count

A: Heartburn B: Regurgitation C: Abdominal pain within 1 hour of eating

A nurse is developing a care plan for an older adult in a LTC facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (SATA) A: Assign a nursing aide to feed the resident to ensure adequate consumption of meals B: Supervise the resident during meals C: Provide a pleasant eating environment D: Provide nutritional supplements for the resident E: Assess the resident for ability to feed him or herself

B: Supervise the resident during meals C: Provide a pleasant eating environment D: Provide nutritional supplements for the resident E: Assess the resident for ability to feed him or herself

An older woman asks a nurse, "You always seem to be telling me that I need to take in more fluids. How much fluid do really need to drink?" The nurse bases her response on the knowledge that older adults should consume at least:

1500 mL of fluid per day

A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose of hypodermoclysis is:

To rehydrate an individual with mild to moderate dehydration

Which of the following statements describing oral care of the older population is correct?

Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods

In a LTC facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include:

Initiating the action with the expectation that the client will take over

A nurse is observing a nurse aide perform dental care for a resident in the nursing home. The nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following?

The nurse aide uses toothpaste to clean the dentures

Which of the following are age-related changes that affect hydration status? (SATA) A: Decrease in thirst sensation B: Decrease in total body water C: Decrease in ability of kidneys to maximally concentrate urine D: Decrease in bone marrow mass E: Decrease in bladder capacity

A: Decrease in thirst sensation B: Decrease in total body water C: Decrease in ability of kidneys to maximally concentrate urine

A nurse is performing an admission assessment on an older patient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient's skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (SATA) A: Poor skin turgor over the sternum B: Lower extremity weakness C: High fever D: Sunken eyes E: Cough

B: Lower extremity weakness D: Sunken eyes

Which of the following nursing interventions should be implemented to prevent dehydration in hospitalized older adults? (SATA) A: Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection B: Limiting duration of NPO requirements for diagnostic tests and procedures C: Administering IV fluids to all hospitalized older adults D: Limiting the use of diuretic medications in hospitalized older adults E: Making sure that hospitalized patients have easy access to fluids

A: Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection B: Limiting duration of NPO requirements for diagnostic tests and procedures E: Making sure that hospitalized patients have easy access to fluids

An older adult complains of xerostomia. Which of the following interventions should the nurse implement for this patient? (SATA) A: Encourage the patient to brush and floss teeth regularly B: Encourage the patient to have regular dental screenings C: Provide antiseptic mouthwash (Listerine) for the patient D: Encourage adequate intake of water E: Provide saliva substitutes

A: Encourage the patient to brush and floss teeth regularly B: Encourage the patient to have regular dental screenings D: Encourage adequate intake of water E: Provide saliva substitutes

A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a care plan related to oral care. Which of the following should the nurse consider for this patient? (SATA) A: Oral care should be provided every 4 hours B: Teeth should be brushed with a toothbrush at least twice a day C: Lemon glycerin swabs should be used between feedings to keep the mouth moist D: Foam swabs should be used in place of a toothbrush to clean the teeth after each rube-feeding E: Use a soft toothbrush dipped in alcohol-free mouthwash

B: Teeth should be brushed with a toothbrush at least twice a day E: Use a soft toothbrush dipped in alcohol-free mouthwash

A patient tells the nurse, "Every time I laugh or cough, I wet myself" Which type of urinary incontinence is this patient describing?

Stress

A 78 year old patient has a history of osteoarthritis and lives alone in a two story home. The bathroom is on the first level and the bedroom is on the second level. The patient states, " I am so upset. I have been wetting the bed at night" What type of incontinence does the patient most likely have?

Functional incontinence

A nurse implements a nursing care plan for a patient with constipation. Which of the following should the nurse include in the plan?

Increasing fiber in the diet

Which of the following nursing actions would help minimize the psychosocial impact of bladder and/or bowel incontinence for individuals experiencing incontinence prior to a group dining room?

Assess for soiled clothing and change, if necessary

An 89 year old hospitalized female patient tells a nurse, "I go to the bathroom really often, but I manage this by not drinking too much before I go to bed so I can sleep for the night" The patient has no pain or discomfort with voiding. The nurse considers this finding to be a:

Normal age-related change in an 89 year old woman

The nurse interviewing an older adult for a nursing history recognized that the client is experiencing symptomology inconsistent with normal aging of the urinary tract when the client reports: (SATA) A: Finding it more difficult in the last few months to start voiding B: Having two bladder infections in the last 4 years C: Getting up once or twice each night to urinate D: Occasionally experiencing pain when urinating E: Needing to urinate at least every 2 hours during the day

A: Finding it more difficult in the last few months to start voiding D: Occasionally experiencing pain when urinating

An otherwise healthy older adult reports having begun to experience problems "holding my water" The nurse shows an understanding of interventions that may help minimize the problem of urinary incontinence when: (SATA) A: Asking whether the client smokes tobacco B: Assessing the average amount of caffeine the client drinks daily C: Asking if the client has even evaluated for diabetes recently D: Suggesting the client keep a record of the amount of fluids ingested daily E: Reviewing the client's current medication list

A: Asking whether the client smokes tobacco B: Assessing the average amount of caffeine the client drinks daily C: Asking if the client has even evaluated for diabetes recently E: Reviewing the client's current medication list

A nurse caring for a cognitively impaired older adult client shows an understanding of the unique clinical symptoms of constipation in this population when: (SATA) A: Checking documentation to determine if the client has had a bowel movement in the last 24-36 hours B: Questioning staff as to whether the client has any unexplained falls in the last few days C: Asking the client to name all of his or her children and grandchildren D: Requesting that the client's temperature be taken now and again in 4 hours E: Reviewing the client's food intake over the last 24-36 hours

B: Questioning staff as to whether the client has any unexplained falls in the last few days C: Asking the client to name all of his or her children and grandchildren D: Requesting that the client's temperature be taken now and again in 4 hours E: Reviewing the client's food intake over the last 24-36 hours

A nurse is caring for an older adult in a hospital who has an indwelling catheter. The nurse assess the patient based on the knowledge that which of the following are correct indications for an indwelling catheter? (SATA) A: To assist with incontinence management B: To manage acute urinary retention C: To assist in healing of open sacral or perineal wounds in incontinent patients D: To accurately measure urinary output in critically ill patients E: To prevent falls related to toileting in hospitalized patients

B: To manage acute urinary retention C: To assist in healing of open sacral or perineal wounds in incontinent patients D: To accurately measure urinary output in critically ill patients

A 74 year old woman who is in the hospital for rehabilitation following hip replacement has been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient's bladder function? (SATA) A: Assess the patients recent voiding pattern B: Request an order for an indwelling catheter from the patient's physician C: Teach the patient how to meet hydration needs while still limiting fluid intake D: Assist the patient to use the bathroom E: Request an order for medication to decrease bladder spasms

A: Assess the patients recent voiding pattern D: Assist the patient to use the bathroom

A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by:

Avoiding daytime napping

When an older adult client is diagnosed with restless leg syndrome/Willis-Ekbom Disease (RLS/WED), the nurse is confident that client education on the conditions's contributing factors has been effective when the client states:

"I've cut way back on my caffeinated coffee, teas, and sodas"

A nurse in a LTC facility notes that an older resident with dementia awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems?

Passive music therapy at bedtime

An older patient asks a nurse, "I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me. He says the are not good for older people. I really dont understand his response. Can you help me?" The best response by the nurse is"

"Sleeping medication have many adverse effects in older people and only have minimal effects in improving sleep"

An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include: (SATA) A: Followed a vegetarian diet for the last 28 years B: Male gender C: A smoking history of 1 pack a day for 45 years D: 30 pounds over ideal weight E: History of Crohn's disease

B: Male gender C: A smoking history of 1 pack a day for 45 years D: 30 pounds over ideal weight

An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite TV shows until 11 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (SATA) A: Go to bed only when sleepy B: If unable to sleep within a reasonable time (15-20min), get out of bed and pursue relaxing activities C: Engages in moderate exercise to induce fatigue D: Do not watch TV or work in bed E: If unable to sleep, engage in enjoyable activities on the computer

A: Go to bed only when sleepy B: If unable to sleep within a reasonable time (15-20min), get out of bed and pursue relaxing activities D: Do not watch TV or work in bed

An older patient is diagnosed with RLS/WEB. Which of the following nonpharmacologic interventions should the nurse include in the plan of care? (SATA) A: Engage in regular mild to moderate physical activity including stretching activities for the lower extremities B: Avoid caffeine, alcohol, and tobacco C: Avoid hot baths D: Relaxation techniques may be helpful E: A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful a

A: Engage in regular mild to moderate physical activity including stretching activities for the lower extremities B: Avoid caffeine, alcohol, and tobacco D: Relaxation techniques may be helpful

A LTC facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit? (SATA) A: Ensuring that all residents receive evening care and are in bed by 8 PM B: Taking as many resident as possible outside for 30 minutes daily C: Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9 PM and 6 AM D: Avoiding waking residents for routine care during the night E: Limiting caffeine and fluids before bedtime

B: Taking as many resident as possible outside for 30 minutes daily C: Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9 PM and 6 AM D: Avoiding waking residents for routine care during the night E: Limiting caffeine and fluids before bedtime

A 75 year old female asks a nurse, "I know I should be moving, but how much is the right amount of exercise for me?" The best response of the nurse is:

"You need to engage in 30 minutes of moderate intensity exercise several days a week"

A nurse is discussing the importance of. exercise with a 78 year old female who states: "I know I should be exercising, but l have arthritis in my knees and it is painful. Can you recommend a type of exercise that would be beneficial and cause me less pain? Which of the following exercises should the nurse recommend?

Swimming

A nurse at a senior center promotes activity by leading a yoga class. Which of the following is a benefit of such exercise?

Facilitates range of motion

A nurse is using the function-focused care approach to care for a hospitalized older adult. The nurse is assisting the patient to transfer from the bed to a chair. Which of the following statements by the nurse is most congruent with this approach to care?

"Place both of your hands on the overbid trapeze and pull yourself up to a sitting position"

A nurse is working with an older individual who has recently started an exercise program. The individual tells the nurse, "This exercise thing is really hard, and I absolutely hate walking on a treadmill going nowhere. I think I am going to call it quits." Which of the following responses by the nurse will be most effective in encouraging the individual to remain in the program?

"What types of exercise do you enjoy doing?"

A nurse caring for an older hospitalized woman is concerned about promoting functional status. Which of the following interventions should the nurse include in the patient's plan of care? (SATA) A: Conduct a baseline functional status assessment of the patient B: Request a physical therapy referral C: Make sure that the patient has all activities of daily living performed for her D: Progressive mobility interventions E: Encouraging the patient to feed herself

A: Conduct a baseline functional status assessment of the patient B: Request a physical therapy referral D: Progressive mobility interventions E: Encouraging the patient to feed herself

A nurse is educating a group of older adults on the benefits of an exercise program. The nurse includes education on when not to exercise. Which of the following should the nurse include in the education? (SATA) A: Do not exercise if you resting HR is over 80 B: Do not exercise is your BP is greater than 200 systolic and 100 diastolic C: It is important to wait 30 minutes after a big meal before engaging in vigorous exercise D: Do not exercise if a joint that you are using is red, warm, and painful E: Do not exercise if you have a fever and muscle aches

B: Do not exercise is your BP is greater than 200 systolic and 100 diastolic D: Do not exercise if a joint that you are using is red, warm, and painful E: Do not exercise if you have a fever and muscle aches

An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (SATA) A: Yoga B: Tai Chi C: Swimming D: Pilates E: Weight lifting

A: Yoga B: Tai Chi

Which attempt by the family to prevent an older, frail adult from falling causes the home health nurse concern?

Keeping the side rails up on the client's bed at night

An 88 year old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of HTN and congestive heart failure and is on a total of 5 different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for Falls. A priority nursing intervention for this client is to:

Perform a fall assessment

A nurse is assessing an older adult's risk for falls. One of the questions that she asks is whether the older adult has fallen in the past year. She asks this because individuals who have fallen:

Have a higher risk of falling again than persons who did not fall in the past year

A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall prevention and demonstrates the use of the call bell to the patient. The patient's daughter asks: "Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?" The best response by the nurse is:

"There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury"

A nurse in a LTC facility notes that there has been an increase in falls on one unit and that many of the falls are occurring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller melas instead of the three traditional meals. The nurse makes this recommendation on the understanding that:

Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide

Which assessment finding is a contributor to an older client's risk for falls? (SATA) A: Client is awaiting cataract surgery on right eye B: Client's type 2 DM is poorly controlled with diet and exercise alone C: Client reports a fall in the last year D: Client has a history of contact dermatitis and psoriasis E: Client attends Tai Chi classes at the senior center

A: Client is awaiting cataract surgery on right eye B: Client's type 2 DM is poorly controlled with diet and exercise alone C: Client reports a fall in the last year

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. Which of the following are hazards in the home? (SATA) A: The absence of railings on the stairway B: Night-lights in all rooms C: Clutter throughout the home D: A small throw rug outside the shower stall E: Grab bars in the bathroom beside the toilet

A: The absence of railings on the stairway C: Clutter throughout the home D: A small throw rug outside the shower stall

A group of older women in an assisted living facility are taking about one of the residents who fell and fractured her hip. The woman asks a nurse the following: "It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?" In formulating a response, the nurse considers which of the following? (SATA) A: Hip fractures are a leading cause of hospitalization for older people B: The major cause of hip fractures is falls C: Women have significantly higher mortality rates from hip fracture than do men D: Nearly all older patients who sustain a hip fracture will regain prefecture mobility status within 1 year E: Hip fracture are associated with very high morbidity and mortality

A: Hip fractures are a leading cause of hospitalization for older people B: The major cause of hip fractures is falls E: Hip fracture are associated with very high morbidity and mortality

A homecare nurse visits a client in the home to conduct a fall risk assessment. The nurse assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (SATA) A: The client has an unsteady gait B: The client uses a cane, but the cane is not the appropriate size for the client C: The client's home is cluttered D: The client is on two different medications that cause orthostatic hypotension E: There are no grab bars in the client's bathroom

B: The client uses a cane, but the cane is not the appropriate size for the client C: The client's home is cluttered E: There are no grab bars in the client's bathroom

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the patient eliminate which of the following? (SATA) A: Night-lights B: Railings on the stairway C: Loose carpeting on the floors D: The use of a cane E: Excess clutter

C: Loose carpeting on the floors E: Excess clutter

The nurse is preparing education material concerning fire safety in the home. What research data will be included in the material?

Fire mortality is highest in adult older than 80 years of age

The nurse is recommending that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on being "stuck at home" Which is the priority outcome expected for this client when attending the group sessions?

Helps with minimizing the loss as a factor in causing depression

A 79 year old client resides independently in the community. The visiting home health nurse finds that despite it being 90 degrees F outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to:

Age-related neurosensory changes that diminish awareness of temperature changes

A homecare nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention?

Older adults are less likely to seek formal and informal help when affected by natural disasters

A homecare nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention?

Older adults are less likely to seek formal and informal help when affected by natural disasters

A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement Community (NORC). The nurse understand that NORCs are:

Neighborhoods or buildings where a large segment of the residents are older adults

What information should be included in an informational program to be presented on burn prevention to a senior citizens group? (SATA) A: Do not smoke in bed or when sleepy B: Wear well-fitted clothing when cooking or when grilling outdoors C: Establish a meeting place for all family members outside of the home in case of a fire D: Establish a plan for exiting each room in your home in the case of a fire E: Have a fire extinguisher readily available in the kitchen

A: Do not smoke in bed or when sleepy B: Wear well-fitted clothing when cooking or when grilling outdoors E: Have a fire extinguisher readily available in the kitchen

Which precaution would be beneficial in minimizing an older adult's risk of being a victim of fraud? (SATA) A: Do not allow uninvited salespersons into your home B: Never provide personal information to telephone sales solicitors C: Rely on the advice of people who only friends have recommended D: Contact the local Medicare or Medicaid service office for information when needed E: Keep your bank account and credit card numbers with you at all times

A: Do not allow uninvited salespersons into your home B: Never provide personal information to telephone sales solicitors D: Contact the local Medicare or Medicaid service office for information when needed

The benefits of Telehealth include that it: (SATA) A: Promotes self-management of illness in rural and underserved areas B: Facilitates remote physical assessment and monitoring of chronic conditions C: Decreases costs by replacing the role of the nurse with technology D: Decreases costs by reducing hospital readmissions E: Is reimbursed by all health care insurances

A: Promotes self-management of illness in rural and underserved areas B: Facilitates remote physical assessment and monitoring of chronic conditions D: Decreases costs by reducing hospital readmissions

A nurse is caring for a frail older adult in a LTC facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (SATA) A: Make sure that the temperature in the resident's room is at least 68 degrees F B: Cover residents well when in bed and while bathing C: Provide a head covering for the resident D: Maintain resident in bed covered with heavy blankets at all times E: Provide hot, high-protein meals and bedtime snacks

A: Make sure that the temperature in the resident's room is at least 68 degrees F B: Cover residents well when in bed and while bathing C: Provide a head covering for the resident E: Provide hot, high-protein meals and bedtime snacks

The daughter of an older patient says to a nurse, "I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?" The nurse recommends which of the following involved type actions strategies for driving cessation? (SATA) A: Report the person to the DMV for license suspension B: Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem C: Arrange for alternate transportation for the person D: Confiscate the keys to the car E: Ask the patient's physician to write a prescription for the person to stop driving

B: Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem C: Arrange for alternate transportation for the person

A nurse is caring for an older adult who is in the pre-trajectory phase of the chronic illness trajectory. The nurse knows that this phase is characterized by which of the following:

The absence of signs or symptoms of the illness

A major difference in the diagnosis of chronic disease between younger adults and older adults is that:

Chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems

A man who is a smoker is hospitalized for orthopedic surgery. A nurse takes the opportunity to provide smoking cessation education. The patient asks the nurse: "I have been smoking for most of my life. Why are you wasting your time telling me to stop smoking? Isn't it too late?" The nurse bases the response on the knowledge that:

If major lifestyle risk factors are eliminated, a significant amount of disease could be prevented

A nurse care for an older adult who is described as being "frail" The nurse understands that in order to be characterized as frail an individual must possess which of the following characteristics? (SATA) A: Slow walking speed B: Low activity level C: Self-reported exhaustion D: Taking at least 5 prescribed medications E: A diagnosis of at least 2 chronic conditions

A: Slow walking speed B: Low activity level C: Self-reported exhaustion

A nurse is planning health education on chronic illnesses for a group of seniors in the community. When deciding upon which illnesses to focus upon, the nurse knows that which of the following are most common diseases in the U.S.? (SATA) A: Heart disease B: Cancer C: Asthma D: Osteoarthritis E: Diabetes

A: Heart disease B: Cancer D: Osteoarthritis E: Diabetes

The role of a nurse caring for an older patient who is in the stable phase of a chronic illness may include which of the following? (SATA) A: Coordinating care with members of the interdisciplinary team B: Administering medications to the patient C: Providing assistance with bathing and dressing D: Ensuring that patient's immunizations are up to date E: Providing emergency care

A: Coordinating care with members of the interdisciplinary team B: Administering medications to the patient C: Providing assistance with bathing and dressing

A nurse is teaching a group of older adults about healthy aging. The nurse discusses global lifestyle risk factors for chronic disease. The nurse includes which of the following in the education? (SATA) A: Smoking cessation and avoidance of tobacco B: Maintenance of high levels of physical activity C: Importance of eating a balanced diet D: Development of advance directives E: Maintenance of BP readings at a level of 120/80 or lower

A: Smoking cessation and avoidance of tobacco B: Maintenance of high levels of physical activity C: Importance of eating a balanced diet

A nurse is auscultating an older patient's heart and notes a systolic murmur (heard between the Sl and S2 heart sounds) The first action by the nurse is to:

Question the patient about the presence of the murmur

A nurse measures an older adult's BP on the right arm and notes a reading of 150/100. The nurse waits 5 minutes and measures the BP again in the right arm and obtains a reading of 152/200. What is the next action of the nurse?

Obtain a second set of measurements at a different time

A nurse is caring for an older hospitalized patient who recently suffered a myocardial infarction (MI). The patient asks the nurse, "I didn't even know that I had a heart attack. I did not have chest pain like you see on TV. Why didn't I?" The best response by the nurse is:

"Older people often do not have the typical signs and symptoms when they have a heart attack"

An older adult who was diagnosed with A-Fib asks a nurse, "I feel fine. I have no symptoms at all with this heart problem, yet am not on a blood thinner medication, which I understand can be very dangerous. Is this really necessary?" The nurse formulates a response based on the understanding that:

The risk of stroke is very high for a person with A-Fib

An older person has sudden onset of a sever headache, left-sided facial drooping, and left arm numbness. The person's daughter calls 911 and the person is transported to the ER. The first diagnostic test that will likely be performed is a(n):

Computed Tomography (CT) scan to differentiate hemorrhagic from ischemic stroke

A nurse assesses the lower extremities of an older adult and notes a small ulcer between the person's great toe and second toe. The ulcer has well-defined edges and there is no bleeding; however, there is a small amount of necrotic tissue present. This would is most likely an):

Arterial ulcer

A nurse is educating a group of older adults on the impact of lifestyle changes on hypertension. The nurse includes which of the following in the education? (SATA) A: Learning how to read and interpret food labels B: The sodium content of commonly consumed foods C: Techniques to incorporate more physical activity into the daily routine D: The actions of calcium channel blocker meds on hypertension E: The importance of adhering to pharmacological regimens for the treatment of hypertension [3

A: Learning how to read and interpret food labels B: The sodium content of commonly consumed foods C: Techniques to incorporate more physical activity into the daily routine

A homecare nurse visits an older female adult at home who has peripheral vascular disease to monitor her status. The nurse determines that the client needs additional teaching when the client states which of the following? (SATA) A: "I need to try and elevate my legs above the level of my heart every time I sit down and all night" B: "I really need to try and avoid sitting in one position for a long period of time" C: "I know that I need to wear these compression stockings 24 hours a day" D: "I will wash my feet and legs with strong antibacterial soap twice daily" E: "I need to examine my feet daily for any cuts, sores, or openings"

C: "I know that I need to wear these compression stockings 24 hours a day" D: "I will wash my feet and legs with strong antibacterial soap twice daily"

An older client is diagnosed with venous insufficiency of the lower extremities. The nurse expects the client to display which of the following signs and symptoms? (SATA) A: Thin, shiny dry skin B: Reddish brown discoloration of the skin of the legs C: Pain when the legs are elevated D: Varicose veins E: Legs are cool to touch

B: Reddish brown discoloration of the skin of the legs D: Varicose veins

An older patient with A-Fib is prescribed warfarin for anticoagulation. Which of the following should the nurse include in the teaching plán? (SATA) A: Frequent blood testing is requires to assure that the level of anticoagulation is in the correct range B: Limit dietary intake of vitamin K C: Increase dietary intake of vitamin D and calcium D: Inform the medical provider if any antibiotics are ordered from any other provider E: Seek medical attention immediately if an injury is sustained

A: Frequent blood testing is requires to assure that the level of anticoagulation is in the correct range B: Limit dietary intake of vitamin K D: Inform the medical provider if any antibiotics are ordered from any other provider E: Seek medical attention immediately if an injury is sustained

The greatest risk for injury for a client with progressed Parkinson's disease is

Falls

An older adult with suspected Parkinson's disease has a "challenge test" performed in order to confirm the diagnosis. The nurse understands that a "challenge test" will demonstrate which of the following?

Dramatic improvement of symptoms of Parkinson's disease after administration of levodopa

A nurse is caring for an older adult with Parkinson's disease. The patient is receiving the medication levodopa-carbidopa. The nurse understand that in order to maximize effectiveness, the administration schedule for this medication should adhere to which of the following?

Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal

While the older African American is at the highest risk for developing dementia, the nurse demonstrates an understanding of this disease process's risk factors when assessing this population's"

Genetic makeup

An older adult is diagnosed with Alzheimer's disease. The nurse knows that this diagnosis is made on the presence of which of the following? (SATA) A: A decline from previous level of functioning B: Fluctuation of symptoms over the course of a 24-hour period C: An insidious onset D: A gradual decline in cognitive abilities E: The cognitive changes worsen in the evening hours

A: A decline from previous level of functioning C: An insidious onset D: A gradual decline in cognitive abilities

A diagnosis of Parkinson's disease is made based on the presence of which of the following symptoms? (SATA) A: Rigidity B: Resting tremor C: Bradykinesia D: Orthostatic hypotension E: Progressive decline in cognitive function

A: Rigidity B: Resting tremor C: Bradykinesia

An older patient's concerned that her neighbor was recently diagnosed with Alzheimer's disease and asks a nurse what can be done to decrease the risk of Alzheimer's disease. The nurse includes which of the following in the response to the patient? (SATA) A: Maintain blood pressure within normal limits B: Smoking cessation C: Maintain control of blood sugar (HAIC) D: Eliminate fats from the diet E: Maintain healthy body weight

A: Maintain blood pressure within normal limits B: Smoking cessation C: Maintain control of blood sugar (HAIC) E: Maintain healthy body weight

Differences in the presentation of patient with Alzheimer's disease (AD) and dementia with leeway bodies (DLB) are: (SATA) A: Individuals with LB develop motor symptoms, and individuals with AD do not B: Individuals with AD display impairments in judgement whereas individuals with LB do not C: The use of traditional atypical medication is contraindicated for individuals with LB D: LB usually occurs in individuals under age 60, and AD occurs in individuals only over age 60 E: Individuals with LB develop language symptoms and individuals with AD do not

A: Individuals with LB develop motor symptoms, and individuals with AD do not C: The use of traditional atypical medication is contraindicated for individuals with LB

An older adult is referred to a geriatric NP because of changes in memory and reports by family members that "there is something different about her" The NP evaluates the older adult for potentially reversible causes for the changes, which include: (SATA) A: Depression B: Delirium C: Osteoarthritis D: Rheumatoid arthritis E: Medication side effects

A: Depression B: Delirium E: Medication side effects

A nurse understands that the pathophysiology of Parkinson's disease includes which of the following? (SATA) A: A deficiency of the neurotransmitter dopamine B: An inability of the neurons to absorb the dopamine C: A reduction of dopamine receptors D: An accumulation of Lewy bodies, especially in the basal ganglion E: The presence of neurofibrillary tangles and amyloid plaques in the brain

A: A deficiency of the neurotransmitter dopamine C: A reduction of dopamine receptors D: An accumulation of Lewy bodies, especially in the basal ganglion

A client is newly diagnosed with T2DM. Which diagnostic test will best evaluate the management plan prescribed for this client?

Quarterly hemoglobin Alc

What is the most likely reason that T2DM is often difficult to diagnose in older adults?

The classic symptoms may not be presented in older adults

Hyperglycemia is harder to detect in older adults due to which of the following?

There is a higher tolerance for elevated levels of circulating glucose in older adults

A nurse is caring for an older adult who is diagnosed with T2DM. The patient is prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first-line therapy?

Metformin

An older adult with T2DM who is being treated with insulin wants to increase his activity level and begin a walking program. What recommendations should the nurse provide to this patient?

The walking regimen needs to be done on a regularly scheduled basis

A nurse is educating an otherwise healthy older adult with DM about diabetes treatment goals. Which of the following does the nurse recommend? (SATA) A: Hb Alc value <7.5 B: Fasting of preprandial glucose 100-180 mg/dL C: Bedtime glucose 90-150 mg/dL D: TSH level 5-10 units/mL E: BP < 140/90

A: Hb Alc value <7.5 C: Bedtime glucose 90-150 mg/dL E: BP < 140/90

An older patient asks a nurse: "I went to my diabetes doctor and everything was stable. The NP spent the entire time teaching me about decreasing my risks of heart disease. It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why?" The nurse formulates a response based on the understanding that : (SATA) A: Promoting cardiovascular health has the potential to minimize the complications of DM B: There is little evidence that demonstrates that the course of DM can be altered in an older adult C: The benefits of better control of BP and lipid levels are seen much quicker than the benefits of better glycemic control D: Older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease E: Diabetes is not a common chronic condition in older adults

A: Promoting cardiovascular health has the potential to minimize the complications of DM C: The benefits of better control of BP and lipid levels are seen much quicker than the benefits of better glycemic control

A nurse is caring for an older adult who has hyperthyroidism. The nurse knows that the following manifestations are more likely in the older adult: (SATA) A: Depression B: Weight loss C: Heat intolerance D: Dyspnea E: Tremor

A: Depression B: Weight loss D: Dyspnea

A nurse works in an outpatient diabetes clinic. The nurse knows that the minimum standard of care for a patient with diabetes includes assessment of the following at each visit: (SATA) A: Neurological exam B: Inspecting the feet C: Glaucoma testing D: Mood and coping E: Obtaining TSH levels

A: Neurological exam B: Inspecting the feet E: Obtaining TSH levels

A nurse is educating an older adult with diabetes on glucose self-monitoring. When developing the teaching plan, the nurse includes which of the following goals in the teaching plans? The patient will: (SATA) A: Demonstrate the technique for obtaining a blood sample B: Verbalize actions to take when results indicate an error on the machine C: State the correct timing of blood glucose monitoring D: State the signs and symptoms of both hyperglycemia and hypoglycemia E: Demonstrate technique for storing and transporting insulin correctly

A: Demonstrate the technique for obtaining a blood sample B: Verbalize actions to take when results indicate an error on the machine C: State the correct timing of blood glucose monitoring

Exam 2 Flashcards

(157 cards)