Geriatrics 2

Question 1

An older patient being treated for pneumonia is given a sedative to sleep. A few hours afterwards, the patient has a respiratory rate of 12 and cannot be aroused. What does this assessment finding indicate to the nurse?

1. The sedative was not absorbed.
2. The sedative has reached a therapeutic blood level.
3. The medication for sleep caused excessive sedation.
4. The patient is experiencing complications of pneumonia.

Answer 1

3: Pharmacodynamic changes, which affect how the drug affects the body, can also occur because of the aging process. However, it is not always clear if changes in therapeutic responses are due to the pharmacodynamics or to the altered pharmacokinetics. An increased drug-receptor response can occur with benzodiazepines resulting in increased sedation.

Question 2

An older patient who takes digoxin for an irregular heart rhythm has been experiencing nausea and vomiting and has not eaten in 2 days. The patient now is exhibiting weakness, bradycardia, and visual disturbances. What laboratory tests would the nurse monitor for this patient?

1. Hemoglobin
2. Urine analysis
3. Calcium levels
4. Serum electrolytes

Answer 2

4: With aging, body water decreases and body fat increases. Older patients are more susceptible to dehydration and prolonged effects of fat-soluble drugs. It would be most appropriate to monitor the therapeutic levels of the medications taken along with the patient’s hydration status. These are best accomplished by the electrolytes and drug levels.

Question 3

An older patient has an elevated blood urea nitrogen (BUN) level, but the creatinine clearance is within normal limits. The nurse notes that the patient’s appetite has been poor the past few days. What should the nurse do about these laboratory findings?

1. Assess urine output.
2. Inform the physician of the BUN result.
3. Assess intake and output and dietary intake of protein.
4. Monitor for medication side effects related to decreased excretion by the kidneys.

Answer 3

3: The nurse should not rely on BUN levels as an indicator of renal function in the older person. BUN is affected by muscle mass, level of hydration, diagnosis of anemia, and dietary intake of protein. The nurse needs to further assess the patient’s intake and output and dietary intake of protein.

Question 4

An older patient admitted with chest pain is prescribed Restoril 15 mg at bedtime. The usual dosage given to adults is 30 mg. What intervention would the nurse use for this patient?

1. Administer the drug as ordered.
2. Monitor the patient’s renal function.
3. Ask the physician to change the dosage to 30 mg.
4. Give the drug and contact the doctor for a second dose if the patient does not fall asleep.

Answer 4

1: The rule of thumb for drug prescriptions in older persons is to “start low, go slow.” Drugs, such as sedatives, are given at one half the recommended adult dosage.

Question 5

An older patient does not take a prescribed diuretic as planned because of the inconvenience of having to urinate frequently, which interrupts scheduled activities. What action should the nurse take with this patient?

1. Insist the drug be taken as prescribed.
2. Contact the physician to order another drug.
3. Advise to take the drug in divided dosages, half in the morning and half in the evening.
4. Discuss the daily activity schedule and adjust the drug administration time accordingly.

Answer 5

4: The administration of diuretics can be scheduled so that the peak diuretic effect does not interrupt activities important to the patient. Assisting the patient to understand this and modifying the schedule would provide the best compliance with the medical plan of care.

Question 6

An older patient experiencing abdominal pain, nausea, and vomiting brown liquid has taken an NSAID type of medication for general muscle aches. What effect might this drug have related to the patient’s manifestations?

1. Diarrhea
2. Constipation
3. Increased BUN
4. Gastric irritation and bleeding

Answer 6

4: NSAIDs cause gastric irritation and can be linked to the manifestations that the patient is experiencing.

Question 7

After completing a medication history, the nurse notes that an older patient is prescribed 22 different medications and sees five different healthcare providers. What should the nurse determine about the patient from this information?

1. A situation of polypharmacy
2. Prone to missing medication doses
3. Multiple health problems requiring a variety of different prescribed medications
4. Cognitive impairment and not remembering the medications prescribed

Answer 7

1: The amount of medications and the number of healthcare providers that this patient sees is excessive, qualifying for what is defined as polypharmacy.

Question 8

An older patient is experiencing a change in mood. For which medications should the nurse assess as the possible cause of this patient's cognitive change?
Standard Text: Select all that apply.
1. Steroids
2. NSAIDs
3. Antibiotics
4. Benzodiazepines
5. Antihypertensives

Answer 8

1: Changes in mood can result from taking steroids.
2: Changes in mood can result from taking NSAIDs.
4: Changes in mood can result from taking benzodiazepines.
5: Changes in mood can result from taking antihypertensives.

Question 9

An older patient is prescribed psyllium seed to prevent constipation. What should the nurse instruct the patient about this medication?
Standard Text: Select all that apply.
1. Do not take this medication with juice.
2. Avoid eating after taking this medication.
3. Take the medication with adequate water.
4. This medication can swell in the esophagus.
5. Limit the intake of water after taking this medication.

Answer 9

3: This medication must be taken with adequate water to ensure it reaches the stomach.
4: This medication can swell in the esophagus and cause an obstruction if not taken with adequate water.

Question 10

An older patient with dementia has been medicated with sedatives. The healthcare provider now prescribes a lower dose of the sedative and the nursing staff is concerned that the patient will resume agitated behavior. What should be explained to the staff about the use of this medication?

1. The patient’s condition warrants physical restraint only.
2. The patient’s physical condition does not warrant use of the drug.
3. The patient’s family members would be upset if they were aware of the use of chemical restraints.
4. The use of psychotropic drugs may be considered excessive and harm the patient’s health.

Answer 10

4: The 1987, Omnibus Budget Reconciliation Act ruled on the appropriate use of medications in institutionalized older persons, especially as their use may constitute a chemical restraint. “Chemical restraints” may only be used to ensure the physical safety of older patients in emergency situations, but these medications have the potential to be used inappropriately to quiet a person or subdue certain behaviors in place of other nonpharmacologic measures. Overuse of psychotropic medications is of concern because of the chance of serious adverse events and syndromes associated with these medications.

Question 11

During a home visit, the nurse learns that an older patient is taking herbal remedies in addition to prescribed medications. What should the nurse instruct the patient about this practice?
Standard Text: Select all that apply.
1. Some herbal remedies interact with medications.
2. Herbal remedies are natural products and do not harm the body.
3. Talk to the healthcare provider about the use of herbal remedies.
4. The Food and Drug Administration does not regulate herbal remedies.
5. For most herbal remedies, no studies have demonstrated effectiveness.

Answer 11

1: Herbs can interact with medications.
3: It is important for the patient to discuss the use of herbal remedies with prescribed medications with the healthcare provider.
4: The Food and Drug administration does not regulate herbal medicines, and these medicines may have different ingredients, purity, dosage, or potency.
5: For most herbal remedies, there have not been sufficient clinical trials to demonstrate their effectiveness or appropriate dosage.

Question 12

It has been determined that nonpharmacological approaches will be used to help an older patient manage pain. What should the nurse explain as the reasons for using these approaches?
Standard Text: Select all that apply.
1. Nonpharmacological approaches can alleviate the pain.
2. Nonpharmacological approaches can delay the need for medication.
3. Nonpharmacological approaches can prevent the need for medication.
4. Nonpharmacological approaches can complement current medication therapy.
5. Nonpharmacological approaches do not cost the patient anything to use or implement.

Answer 12

1: Nonpharmacological treatments can alleviate the health condition.
2: Nonpharmacological approaches can delay the need for medication.
3: Nonpharmacological approaches can prevent the need for medication.
4: Nonpharmacological approaches have been used to complement drug therapy.

Question 13

A prescribed medication is not producing the expected therapeutic effect in an older patient. What should the nurse do first in response to this finding?

1. Document that the patient has not been taking the medication.
2. Discuss changing the medication with the healthcare provider.
3. Ask if the patient has enough money to buy food and medicine.
4. Review the patient’s current diet to determine food-drug interactions.

Answer 13

3: If a medication is not demonstrating the expected therapeutic effect, the nurse should investigate if the patient is taking the medication at all because of cost. The patient may be embarrassed to share this information.

Question 14

The nurse is preparing an educational program regarding adverse drug reactions (ADR). What information should the nurse include?
Standard Text: Select all that apply.
1. ARDs refer to harm from a therapeutic regime.
2. ADRs refer to drug side effects that are serious.
3. ARDs are injuries resulting from the use of a drug.
4. Almost 11% of hospital admissions of older adults are associated with ADRs.
5. ADRs can occur from drug-drug interactions and polypharmacy.

Answer 14

2: Adverse drug reaction is a term that refers to drug side effects that are serious.
4: Almost 11% of hospital admissions of older adults are associated with adverse drug reactions.
5: Older persons are more likely to have ADRs because of an inappropriate drug or dosing regimen, drug-drug interactions, polypharmacy, and non-adherence.

Question 15

The nurse is instructing an older patient on ways to prevent esophageal irritation from taking medication. Which information should the nurse include in this teaching?
Standard Text: Select all that apply.
1. Drink at least 8 ounces of water with each pill.
2. Crush the pills to make them easier to swallow.
3. Take several sips of water before taking oral medications.
4. Sit up in a chair for at least 30 minutes after taking oral medications.
5. Report a dull aching pain in the chest or shoulder after taking medication to the physician.

Answer 15

1: One intervention to prevent esophageal irritation from taking medication is to drink at least 8 ounces of water with each pill.
3: One intervention to prevent esophageal irritation from taking medication is to take several sips of water before taking oral medications.
4: One intervention to prevent esophageal irritation from taking medication is to sit up in a chair for at least 30 minutes after taking oral medications.
5: One intervention to prevent esophageal irritation from taking medication is to report a dull aching pain in the chest or shoulder after taking medication to the physician.

Question 16

An older patient has recently been put on high fall precaution after a new medication was started. The patient’s daughter questions why this precaution was put in place. How should the nurse respond to the daughter?

1. “Every older patient is automatically put on high fall risk.”
2. “The patient was recently started on an intravenous fluid infusion.”
3. “The patient has an order to get out of bed. Anyone with this order is put on high fall risk.”
4. “The patient was recently started on a medication for high blood pressure that could impact balance and cause a fall.”

Answer 16

4: Medications have been associated with the occurrence of falls and related injuries. Antihypertensives can cause hypotension, which can result in falls. This would indicate a need to place the patient on high fall risk.

Question 17

The nurse is preparing an educational program about the use of over-the-counter (OTC) medications for residents of an assisted living community. What information should the nurse include in this program?
Standard Text: Select all that apply.
1. OTC medications can be used safely with alcohol.
2. OTC medications can safely be used with all herbal medications.
3. A person can accidentally overdose on medications containing acetaminophen.
4. The use of OTC drugs can result in increased out-of-pocket costs to patients since health insurance usually does not pay for OTC medication.
5. There is an increased risk of drug interactions with prescribed medications or overdose by the use of an OTC drug identical or similar to a prescribed drug.

Answer 17

3: A person could inadvertently experience an overdose when taking multiple medications with acetaminophen in them.
4: The use of OTC medications can result in increased out-of-pocket costs since health insurance usually does not pay for OTC medications.
5: The risk of drug interactions or an overdose is increased when OTC drugs are used that are identical or similar to a prescribed drug or another OTC medication.

Question 18

The nurse is providing a psychotropic medication to an older patient. Which adverse effects of this medication might occur with this patient?
Standard Text: Select all that apply.
1. Dystonia
2. Akathisia
3. Delusions
4. Tardive dyskinesia
5. Schizophreniform disorder

Answer 18

1: Dystonia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later.
2: Akathisia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later.
4: Tardive dyskinesia is recurrent, involuntary movements that may be irreversible and is associated with antipsychotic medication.

Question 19

The nurse is preparing an educational program regarding the appropriate use of antipsychotic medications in older patients. What information should the nurse include?

1. Fidgeting is an appropriate indication for the use of antipsychotic medications.
2. Use of antipsychotic medications would never be considered a chemical restraint.
3. People prescribed antipsychotic drugs must have efforts to discontinue these drugs.
4. Impaired memory is an appropriate indication for the use of antipsychotic medications.

Answer 19

3: There are many federal and state regulations regarding appropriate medication use in long-term care facilities. One such regulation states that residents who use antipsychotic drugs must receive gradual dose reductions, drug holidays, or behavioral programming unless clinically contraindicated, in an effort to discontinue the use of these drugs.

Question 20

Which statement made by a nurse indicates a misunderstanding regarding the nurse’s role in medication management?

1. “I am responsible for monitoring potassium level on a patient who is receiving a thiazide diuretic.”
2. “I am responsible for documenting whether the therapeutic effect of a medication is being achieved.”
3. “I am responsible for teaching a patient how to correctly store, prepare, and self-administer medications.”
4. “I am responsible for a medication error if I administered the medication, not if I delegated that responsibility to an unlicensed person.”

Answer 20

4: Delegation of medication administration to an unlicensed person depends upon the state laws. Delegation does not remove responsibility of the nurse for assessing and monitoring the patient for therapeutic and adverse effects.

Question 21

The nurse is instructing an older patient about medication management. What information should the nurse include?
Standard Text: Select all that apply.
1. Obtain all of your medications from the same pharmacy.
2. Request that medications be placed in childproof packages and caps.
3. Develop a method for remembering if medications have been taken, such as moving it to a different place.
4. Schedule medications at mealtimes or in conjunction with other specific activities unless contraindicated.
5. Establish a routine for taking medications, such as preparing medication for each day in different containers.

Answer 21

1: Encouraging patients to obtain all of their medications from the same pharmacy will help the pharmacist to monitor medication use.
3: One way to help older patients manage medications is to develop a method with the patient for remembering if the medication has been taken, such as moving it to another place.
4: One way to help older patients manage medications is to schedule medications at mealtime or in conjunction with other specific daily activities.
5: One way to help older patients manage medications is to establish a routine for taking medications, such as preparing medications for the day in different containers.

Question 22

Which nursing action indicates that medication reconciliation for an older patient is incomplete?

1. Medications prescribed by physicians were the focus.
2. Medications were identified, verified, and compared with the physician’s orders.
3. All medications, including herbal or mineral supplements and vitamins, were reviewed.
4. Medication reconciliation occurred when the patient was transferred to another care area.

Answer 22

1: Medication reconciliation is a process that involves verification of all medications, including herbal or mineral supplements and vitamins that a patient takes, not just medication prescribed by a physician.

Question 23

The nurse has completed an educational program for residents of a retirement community regarding unsafe medication practices. Which statement made by a resident indicates the need for further education?

1. “I will not take medication that is more than 1 year old.”
2. “I will buy all of my medication from the same pharmacy.”
3. “I will not take medication that has been prescribed for someone else.”
4. “Medication can be obtained from an Internet pharmacy, as long as it says the medication was made in the United States or Canada.”

Answer 23

4: The use of medication imported from or obtained in another country is controversial and is considered illegal. Quality standards for drugs approved for use in other countries may not be a stringent as in the United States. Claims for where the medication was made are not always true. Medications should only be obtained from pharmacies licensed in the United States.

Question 24

The home care nurse is reviewing the medications that an older patient is currently taking. Which guidelines should the nurse follow when conducting this review?
Standard Text: Select all that apply.
1. Review the patient’s allergies.
2. Review the drug for number of refills.
3. Review the drugs for duplicate therapy.
4. Review the patient’s medical conditions.
5. Review each drug for interactions with other drugs.

Answer 24

1: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing the patient’s allergies.
3: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing the drugs for duplicate therapy.
4: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing the patient’s medical conditions.
5: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing each drug for interactions with other drugs.

Question 25

An older patient who is repeatedly admitted to the hospital tells the nurse it is because of the inability to purchase prescribed medications. What should the nurse respond to the patient? 1. "Do you not have insurance?" 2. "I'm not surprised that you can't afford them. You are on a lot of medications." 3. "There are ways to reduce the cost of medications, such as using Medicare Part D." 4. "I will contact our social services department so the hospital will provide your medications."

Answer 25

3: Medicare Part D prescription drug coverage has assisted many with drug costs.

Question 26

Which assessment finding places an older patient at the greatest risk factor for the development of Alzheimer's disease? 1. Age 2. Genetic predisposition 3. Environmental exposure 4. History of previous head injury

Answer 26

1: Advanced age is the single greatest factor for the development of Alzheimer's disease.

Question 27

Which treatment should the nurse prepare to provide to an older patient diagnosed with progressive dementia? 1. None 2. Vitamin E 3. Estrogen therapy 4. Gingko biloba extract

Answer 27

1: There is no cure available at the present time for dementia. Treatments are directed at improving function and slowing the progression of the disease.

Question 28

An older patient newly diagnosed with Alzheimer's disease is prescribed galantamine (Razadyne). How will the nurse instruct the patient about this medication? Standard Text: Select all that apply. 1. Take at bedtime. 2. Take the medication with food. 3. The dosage may be changed every 4 weeks. 4. Side effects of this medication are minimal. 5. Do not take the medication with an NSAID.

Answer 28

2: This medication can cause gastrointestinal upset and should be taken with food. 3: This medication is titrated at 4-week intervals. The dosage may be changed every 4 weeks. 5: This medication should be used with caution if also prescribed NSAIDs since this could increase the risk of gastrointestinal bleeding.

Question 29

``` An older patient is diagnosed with dementia caused by Lewy bodies. What will the nurse most likely assess in this patient? Standard Text: Select all that apply. 1. Tremor 2. Rigidity 3. Postural instability 4. Personality changes 5. Visual hallucinations ```

Answer 29

1: Clinical symptoms of dementia caused by Lewy bodies include a tremor. 2: Clinical symptoms of dementia caused by Lewy bodies include rigidity. 3: Clinical symptoms of dementia caused by Lewy bodies include postural instability. 5: Clinical symptoms of dementia caused by Lewy bodies include visual hallucinations.

Question 30

An older patient is diagnosed with early-mild Alzheimer's disease. Which should be done at the time of diagnosis? 1. Discuss treatment options and wishes with the patient. 2. Identify a long-term care facility for immediate transfer. 3. Explain that this stage of the disorder can last up to 10 years. 4. Instruct family members to slowly improve the home environment for safety.

Answer 30

1: Early diagnosis provides the family and the older person with the opportunity to discuss treatment options and wishes while the older person still has decision-making capacity.

Question 31

An older patient is being evaluated for dementia. What manifestations need to be present to diagnose this disorder? Standard Text: Select all that apply. 1. Intermittent forgetfulness 2. Inability to manage finances 3. Misplacing personal belongings 4. Repetitive questions or conversations 5. Difficulty thinking of common words while speaking

Answer 31

2: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Inability to manage finances indicates impaired reasoning and handling of complex tasks. 3: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Misplacing personal belongings indicates impaired ability to acquire and remember new information. 4: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Repetitive questions or conversations indicate impaired ability to acquire and remember new information. 5: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Difficulty thinking of common words while speaking indicates impaired language functions.

Question 32

An older patient with Alzheimer's disease is demonstrating agnosia. Which intervention would be important to include in this patient's plan of care? 1. List choices for the patient to select. 2. Provide deadlines for self-care activities. 3. Refrain from providing verbal instructions. 4. Remove inedible items from the environment.

Answer 32

4: Agnosia is the inability to recognize objects and causes functional impairment and predisposes the patient to safety hazards such as eating inedible objects.

Question 33

What should the nurse teach the family of an older patient with Alzheimer's disease to help with spatial disorientation? Standard Text: Select all that apply. 1. Use color to contrast objects and items. 2. Keep furniture in the same familiar place. 3. Fill the patient's room with memorabilia. 4. Remove cues for exiting the home away from the doors. 5. Place family photos or recognizable familiar items in a prominent spot.

Answer 33

1: The use of color to contrast objects and items is a form of a pop-up cue and helps with spatial disorientation. 2: Keeping furniture in the same familiar place provides landmarks and helps with spatial disorientation. 5: Placing family photos or familiar items in a prominent spot provides landmarks and helps with spatial disorientation.

Question 34

An older patient with Alzheimer's disease has wandered away from the home several times. What can the nurse suggest that the spouse do to reduce the patient's risk for wandering? Standard Text: Select all that apply. 1. Place car keys on a rack by the front door. 2. Install motion detectors on the door of the patient's room. 3. Remove scatter rugs from the kitchen and bathroom areas. 4. Add slide bolt locks at the bottom of exit doors in the home. 5. Place emergency telephone numbers on the refrigerator door.

Answer 34

2: Installing motion detectors on the door of the patient’s room would alert family members that the patient is mobile and could potentially wander from the home. 4: Adding slide bolt locks at the bottom of exit doors in the home provides a mechanical barrier to prevent the patient from wandering.

Question 35

``` After a neurologic assessment, the nurse determines that an older patient is exhibiting normal signs of aging. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. Slow movements 2. Intermittent hand tremor 3. Ataxia with position changes 4. Decreased sensation in the feet 5. Slight impairment of coordination ```

Answer 35

1: Slower movements are a normal neurologic sign of aging. 2: Intermittent hand tremor is a normal neurologic sign of aging. 4: Decreased sensation in the feet is a normal neurologic sign of aging. 5: Slight impairment of coordination is a normal neurologic sign of aging.

Question 36

The nurse instructs an older patient with Parkinson's disease about carbidopa-levodopa (Sinemet). Which patient statement indicates that teaching has been effective? 1. "I will take the medication with my meals." 2. "I will sit up on the side of the bed before standing." 3. "This medication will cure my Parkinson's disease in time." 4. "This medication will not affect my blood pressure medications."

Answer 36

2: The older person may experience postural hypotension. The nurse needs to teach strategies to prevent falling, such as sitting on the side of the bed before standing.

Question 37

``` The nurse suspects that an older patient is experiencing Parkinson's disease. What did the nurse observe in this patient? Standard Text: Select all that apply. 1. Chorea 2. Tremor 3. Apraxia 4. Agnosia 5. Dystonia ```

Answer 37

1: Chorea is involuntary twitching of the limbs or facial muscles which is an extrapyramidal manifestation of Parkinson's disease. 2: A tremor is an extrapyramidal manifestation of Parkinson's disease. 5: Dystonia is involuntary muscle contractions forcing unusual or painful positions and is an extrapyramidal manifestation of Parkinson's disease.

Question 38

The nurse is preparing an educational session on stroke prevention for a group of senior citizens. What information would be important for the nurse to provide to these participants? Standard Text: Select all that apply. 1. Stop smoking. 2. Limit exercise to once a week. 3. Maintain a healthy body weight. 4. Follow a low-sodium diet as prescribed. 5. Take blood pressure medication as prescribed.

Answer 38

1: Healthy aging tips for stroke prevention include smoking cessation. 3: Healthy aging tips for stroke prevention include losing weight if overweight. 4: Healthy aging tips for stroke prevention include ingesting below 2 to 3 grams of sodium each day. 5: Healthy aging tips for stroke prevention include reducing blood pressure to at least 140/90 mm Hg.

Question 39

An older patient begins to experience status epilepticus. Which action will the nurse take to help this patient? 1. Measure vital signs. 2. Orient the patient between seizures. 3. Prevent chilling with warmed bed linens. 4. Ensure an intravenous access line is available.

Answer 39

4: Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient.

Question 40

The nurse suspects an older patient is having a grand mal seizure. What did the nurse observe in the patient? 1. Rhythmic jerking of the muscles 2. Rigid extremities lasting for several minutes 3. Brief loss of attention similar to daydreaming 4. Rigid extremities followed by rhythmic flexion

Answer 40

4: A period of rigidity followed by rhythmic jerking or flexion of the extremities is characteristic of grand mal seizures.

Question 41

An older patient is demonstrating signs of a brain attack. What will the nurse do to assess the degree of cerebral infarct? 1. Obtain a current cardiac rhythm strip. 2. Assess the patient using a stroke scale. 3. Prepare for an emergency electroencephalogram. 4. Obtain orders for immediate blood electrolyte analysis.

Answer 41

2: Usually, the National Institutes of Health (NIH) Stroke Scale is used to gauge the degree of cerebral infarction by determining level of consciousness.

Question 42

The family of an older patient with Alzheimer's disease does not want to discuss long-term care placement for at least "a few years." How should the nurse respond to the family? 1. "Long-term care placement is inevitable with this diagnosis." 2. "It often takes a year for an individual with Alzheimer's disease to be admitted." 3. "Talking about it now gives you time to think about locations and make a decision." 4. "By providing this information now, we will not need to address these concerns later."

Answer 42

3: By discussing placement issues as early as possible in the placement process, hopefully crisis and emergency placement can be avoided, allowing adequate time to investigate all options.

Question 43

An older patient with advanced Alzheimer's disease is being treated for pneumonia. The daughter is not sure if resuscitation efforts should be a part of the plan of care. What information should the nurse provide to the daughter? 1. "Resuscitation is often effective for older adults." 2. "After resuscitation the patient will return to the same level of functioning." 3. "As long as the resuscitation efforts are initiated quickly, the patient will survive." 4. "Resuscitation for cardiac or respiratory arrest will have little probability of success."

Answer 43

4: Resuscitation for an unwitnessed cardiac arrest in the patient with advanced Alzheimer's disease has a very low probability of restoring life.

Question 44

An older patient with Alzheimer's disease has a feeding tube. The family wants to know if the patient will ever be able to eat solid food again. What information should the nurse include when responding to this family's question? 1. The dietitian will decide if this can be done. 2. It depends upon the patient's functional eating abilities. 3. This can be done but the feeding tube has to be removed first. 4. In the patient with dementia, the restoration of natural feeding is highly unlikely.

Answer 44

2: Even older people with advanced Alzheimer's disease can revert to natural feeding after tube feeding. An individualized care plan, based on the older person's target body weight and functional eating abilities, should be developed by an interdisciplinary team that includes a nurse, dietitian, and physician.

Question 45

A care conference is being held with the family of an older patient in the late stages of Alzheimer's disease. The family wants to know if a feeding tube should be placed. How should this question be answered? 1. Tube feeding will aid the patient to gain weight. 2. Tube feeding is associated with a reduced risk of aspiration. 3. Tube feeding reduces the discomfort associated with dehydration. 4. The absence of tube feeding promotes dehydration which reduces pain sensitivity.

Answer 45

4: Dehydration is beneficial during the dying process because it decreases the sensation of pain and prevents edema and excessive respiratory secretions.

Question 46

The nurse is caring for an older patient who has been newly diagnosed with tonic–clonic seizures. About which medication should the nurse prepare to instruct the patient? 1. Diazepam (Valium) 2. Phenytoin (Dilantin) 3. Clonazepam (Klonopin) 4. Valproic acid (Depakene)

Answer 46

2: Phenytoin (Dilantin) is a medication prescribed for tonic–clonic seizures.

Question 47

An older patient with mild Alzheimer's disease abruptly stops taking the prescribed medication donepezil (Aricept). On which area should the nurse focus when assessing this patient? 1. Reflexes 2. Rest and sleep 3. Cognitive function 4. Cardiovascular function

Answer 47

3: Abrupt cessation of donepezil (Aricept) is associated with a reduction in cognitive abilities.

Question 48

``` The nurse is caring for an older patient with unstable blood glucose control from type 2 diabetes mellitus. On which potential neurologic problems should the nurse focus teaching with this patient? Standard Text: Select all that apply. 1. Brain attack 2. Status epilepticus 3. Multiple sclerosis 4. Myasthenia gravis 5. Alzheimer's disease ```

Answer 48

1: Risk factors for a brain attack include diabetes mellitus. 5: Risk factors for Alzheimer's disease include diabetes mellitus.

Question 49

``` An older patient is prescribed gabapentin (Neurontin) for a seizure disorder. When instructing the patient on this medication, which common side effects should the nurse include? Standard Text: Select all that apply. 1. Headache 2. Weakness 3. Irritability 4. Drowsiness 5. Weight gain ```

Answer 49

1: Headache is a common side effect of gabapentin (Neurontin). 5: Weight gain is a common side effect of gabapentin (Neurontin).

Question 50

An older patient with moderate stage dementia frequently cannot remember which room he is assigned in a long-term care facility. Which nursing intervention would help this patient? 1. Reorient the patient when it happens again. 2. Establish landmarks at the patient's bedside. 3. Investigate placing the patient in a private room. 4. Place the patient in restraints to limit ambulation.

Answer 50

2: Landmarks such as pictures and familiar belongings will promote the patient's recognition of the correct room.

Question 51

After assessing an older patient which musculoskeletal changes will the nurse attribute as being a normal part of the aging process? Standard Text: Select all that apply. 1. Loss in height 2. Lower leg muscle atrophy 3. Calcification of the finger joints 4. Swan neck deformity of the hands 5. Decreased range of motion in the shoulders

Answer 51

1: A change in the musculoskeletal status that is a normal part of the aging process is a loss in height. 2: A change in the musculoskeletal status that is a normal part of the aging process is lower leg muscle atrophy. 5: A change in the musculoskeletal status that is a normal part of the aging process is a change in range of motion of the major joints such as the shoulders.

Question 52

An older patient is diagnosed with osteoarthritis. How should the nurse explain this health problem to the patient? 1. A metabolic bone disease 2. Occurs from synovial inflammation 3. Most common in thin, small-built female patients 4. Involves erosion of joint cartilage with new bone formation in joint spaces

Answer 52

4: Osteoarthritis is characterized by progressive erosion of the cartilage within joints, which is then replaced by new bone in the joint spaces.

Question 53

An older patient is brought to the emergency department with a suspected fractured hip. For which diagnostic test will the nurse prepare the patient to confirm the diagnosis? 1. Bone scan 2. X-ray of the hip 3. Bone mineral density (BMD) 4. Magnetic resonance imaging (MRI) of the hip

Answer 53

2: An x-ray of the hip is used to confirm the diagnosis of the fracture. The test is readily available in hospitals, can be done relatively quickly, and details the type of fracture.

Question 54

An older patient is surprised to learn of a diagnosis of rheumatoid arthritis. What should the nurse explain to the patient about this health problem? Standard Text: Select all that apply. 1. It leads to deformities of the hands. 2. It is caused by a vitamin D deficiency. 3. It is diagnosed by a positive pannus blood test. 4. It is characterized by low bone mass and compromised bone strength. 5. It causes systemic problems that can affect the heart, lungs, and kidneys.

Answer 54

1: Rheumatoid arthritis is an inflammatory condition that leads to deformities of the hands. 5: In addition to joint symptoms, patients with severe and advanced RA have systemic and non-joint manifestations of the disease which include pleurisy with effusion, pericarditis and myocarditis, and renal involvement.

Question 55

An older patient is prescribed the medication alendronate (Fosamax). How should the nurse instruct the patient about this medication? Standard Text: Select all that apply. 1. Take the medication with breakfast. 2. Take the medication with 8 ounces of milk. 3. Take the medication with 8 ounces of water only. 4. Take the medication with a calcium supplement at the same time. 5. Remain in an upright position for 30 minutes after taking the medication.

Answer 55

3: This medication should be taken with 8 ounces of water only. 5: The patient should be instructed to remain in an upright position for 30 minutes after taking this medication.

Question 56

While walking in an assisted living facility an older patient falls. Which assessment finding indicates to the nurse that the patient has sustained a hip fracture? 1. Pain relieved by moving the affected extremity 2. Redness, tenderness, and severe swelling at the hip joint 3. Position with the injured leg shortened and externally rotated 4. Bending the injured leg at the knee and internally rotating the leg

Answer 56

3: The patient with a fractured hip is often in extreme pain and assumes a position with the leg shortened on the affected side and externally rotated because of gravity and the pull of the muscles.

Question 57

An older patient with osteoarthritis is prescribed acetaminophen (Tylenol) for pain. What should the nurse teach the patient about this medication? 1. Excessive acetaminophen can cause gastrointestinal irritation. 2. Taking acetaminophen around-the-clock will slow the progression of osteoarthritis. 3. Acetaminophen cannot be used with nonsteroidal anti-inflammatory drugs (NSAIDs). 4. The maximum amount of acetaminophen should not exceed 4 grams in a 24-hour period.

Answer 57

4: Acetaminophen can be given up to 4 g/day with minimal toxicity. Higher doses may cause liver damage.

Question 58

An older patient wants to prevent the onset of osteoporosis. How can the nurse instruct the patient at this time? Standard Text: Select all that apply. 1. Stop smoking and reduce caffeine intake. 2. Ingest adequate amounts of calcium every day. 3. Have an annual bone mineral density (BMD) test. 4. Increase the intake of beverages containing phosphorous. 5. Perform isometric exercises for 30 minutes at least 3 times a week.

Answer 58

1: Risk factors for the development of osteoporosis include smoking and caffeine intake. 2: Inadequate intake of calcium is a risk factor for the development of osteoporosis. 3: A BMD test is used to determine bone strength and risk for osteoporotic fracture. A BMD test is recommended for women under age 65 with risk factors, all women over 65, and after a fracture. BMD tests are sometimes repeated to monitor effects from medications used to treat osteoporosis.

Question 59

At the completion of an assessment the nurse determines that an older patient is at risk for the development of osteoporosis. What did the nurse assess in this patient? 1. Obese with hip pain with ambulation 2. Ingests three glasses of skim milk daily 3. Eats three to five servings of shrimp and liver per week 4. Takes corticosteroids for 10 years for chronic pulmonary disease

Answer 59

4: Long time use of corticosteroids is a risk factor for developing osteoporosis

Question 60

``` While making a visit to an older patient the nurse screens the home environment for potential hazards that could precipitate a fall. What should the nurse urge the patient to eliminate in the home? Standard Text: Select all that apply. 1. Throw rugs 2. Night-lights 3. The use of a cane 4. Railings on the stairway 5. Telephone with a long cord ```

Answer 60

1: Throw rugs in the home environment increase the risk of the older patient tripping over the rugs and falling. 5: Eliminating a telephone with a long cord will reduce the patient's risk of tripping over the cord and falling in the home.

Question 61

An older patient is concerned that many friends are having joint replacements and wants to know what can be done to prevent having to have one as well. Which modifiable risk factor should the nurse suggest the patient focus on at this time? 1. Physical inactivity 2. Cigarette smoking 3. Alcohol consumption 4. Body mass index (BMI)

Answer 61

4: Of all of the modifiable risk factors for osteoarthritis the one that would have the greatest impact to prevent the need for joint replacement is obesity. Body mass index (BMI) is a measurement used to identify obesity.

Question 62

The nurse teaches an older patient with gout about the prescribed medication allopurinol (Zyloprim). What will the nurse explain as the purpose of this medication? 1. Neutralizes uric acid 2. Blocks the excretion of uric acid 3. Lowers the formation of uric acid 4. Increases the excretion of uric acid

Answer 62

3: Allopurinol acts as a uric acid synthesis inhibitor so it acts to lower the formation of uric acid.

Question 63

``` The nurse is caring for an older patient diagnosed with Paget's disease. What will the nurse most likely assess in this patient? Standard Text: Select all that apply. 1. Tinnitus 2. Gingivitis 3. Muscle aches 4. Deep bone pain 5. Bowing of the tibia ```

Answer 63

1: The clinical manifestations of Paget's disease can include tinnitus caused by thickened bony growths on the interior of the skull that impinge cranial nerves and cause hearing problems. 3: The older patient may complain of pain in muscle due to damage or pressure caused by the disease. 4: Bone pain is the most frequently reported symptom that may be described as deep and aching. 5: Mechanical deformities of the long bones may result in bowing of the femur or tibia.

Question 64

The nurse is planning an education program for senior community members on the benefits of exercise. What information will the nurse provide about regular exercise? 1. It increases the need for analgesic medications. 2. If performed in excess as a young adult it will lead to osteoporosis. 3. It prevents muscle atrophy and improves mobility which reduces the risk of falls. 4. It should be avoided in those with rheumatoid arthritis because it causes inflammation.

Answer 64

3: Exercise will slow muscle atrophy that occurs with aging, and promote flexibility and strength, thus improving mobility. This will decrease the likelihood of falls.

Question 65

``` The nurse identifies the diagnosis of impaired physical mobility as being appropriate for an older patient. What defining characteristics did the nurse most likely assess in this patient? Standard Text: Select all that apply. 1. Impaired coordination 2. Difficulty with self-care 3. Limited range of motion 4. Decreased muscle strength 5. Inability to purposefully move ```

Answer 65

1: A defining characteristic for the nursing diagnosis of impaired physical mobility is impaired coordination. 3: A defining characteristic for the nursing diagnosis of impaired physical mobility is limited range of motion. 4: A defining characteristic for the nursing diagnosis of impaired physical mobility is decreased muscle strength. 5: A defining characteristic for the nursing diagnosis of impaired physical mobility is the inability to purposefully move.

Question 66

The nurse is preparing to document an age-related change in posture observed in an older patient. Which term will the nurse most likely use to describe this observation? 1. Scoliosis 2. Lordosis 3. Kyphosis 4. Sway back

Answer 66

3: Kyphosis is a generalized curvature of the spine that affects posture and is associated with aging.

Question 67

A 60-year-old patient, beginning an exercise program of walking and swimming, asks if this activity is wise considering the patient's age. How should the nurse respond to the patient? 1. "Muscle fibers atrophy, preventing training." 2. "Muscle tissue is still able to be trained effectively." 3. "There will be some age-related changes, as you have lost half of your muscle mass." 4. "There may be a reduction in ability to train as a result of a lack of muscle regeneration."

Answer 67

2: Muscle function remains trainable well into advanced age.

Question 68

An older patient with multiple rib fractures is diagnosed with osteomalacia. What should the nurse teach the patient to help prevent further problems from this diagnosis? Standard Text: Select all that apply. 1. Begin steps to stop smoking. 2. Increase the intake of chicken and fish. 3. Ingest dairy products fortified with vitamin D. 4. Engage in weight bearing exercises 3 times a week. 5. Expose the hands and the face for 15 minutes a day to direct sunlight.

Answer 68

3: Osteomalacia occurs with a primary deficiency in vitamin D. The patient should be encouraged to ingest dairy products fortified with vitamin D. 5: Exposing the hands and face for 15 minutes a day to direct sunlight will help synthesize vitamin D through the skin.

Question 69

An older patient with back pain is scheduled for computerized tomography (CT). What information should the nurse provide to the patient about this diagnostic test? 1. Only clear liquids will be permitted the evening prior to the test. 2. An IV will be inserted to administer the isotopes prior to the scan. 3. Clicking noises will occur during the test and ear plugs can be worn. 4. The machine will rotate and provide 180-degree imagery to aid in the diagnostic process.

Answer 69

4: A CT scan is obtained with an X-ray machine that rotates 180 degrees around the patient's body or head.

Question 70

The nurse is designing a teaching plan for a middle-aged patient experiencing arthritis of the hips and hands from constant computer work. What should the nurse include in this instruction? Standard Text: Select all that apply. 1. Apply cold to reduce pain. 2. Apply heat to reduce swelling. 3. Stand up and walk frequently to prevent constant sitting. 4. Alternate weight-bearing with non-weight-bearing exercises. 5. Take frequent rest breaks from using the computer keyboard.

Answer 70

1: Application of cold helps to reduce the pain associated with arthritis. 3: Sitting can be a repetitive movement. The patient should be encouraged to stand up and walk frequently to prevent constant sitting. 4: A strategy to prevent joint loading in the patient with arthritis is to alternate weight-bearing and non-weight-bearing exercises. 5: A strategy to provide rest for repetitive joint movement is to take frequent rest breaks from using the computer keyboard.

Question 71

``` An older patient with rheumatoid arthritis describes severe pain during times of inflammation. What should the nurse teach the patient to do to help minimize episodes of inflammation? Standard Text: Select all that apply. 1. Lose weight. 2. Rest painful joints. 3. Splint the specific joints. 4. Use larger joints when possible. 5. Perform full ROM exercises daily. ```

Answer 71

1: Steps to reduce joint stress during times of inflammation include losing weight. 2: Steps to reduce joint stress during times of inflammation include resting painful joints. 3: Steps to reduce joint stress during times of inflammation include splinting specific joints. 4: Steps to reduce joint stress during times of inflammation include using larger joints when possible.

Question 72

The nurse is caring for an older patient recovering from a total hip replacement. Which intervention will prevent dislocation of the hip prosthesis? 1. Encourage early ambulation. 2. Provide pain medication as needed. 3. Apply intermittent compression devices. 4. Place a wedge between the legs to keep the hip in abduction.

Answer 72

4: An intervention to prevent dislocation of the hip prosthesis is the placement of a wedge, splint, or two pillows between the legs to keep the hip in abduction.

Question 73

The nurse instructs an older patient on ways to manage acute episodes of gout at home. Which patient statement indicates that teaching has been effective? 1. "Ice packs to the painful areas will be helpful." 2. "I will need to reduce my fluid intake to 2 L/day." 3. "I should eat liver at least one or two times per week to promote healing." 4. "Application of heat to my joints is recommended to manage the discomfort."

Answer 73

1: The use of ice packs to manage gout-related pain is recommended.

Question 74

The nurse is concerned that a patient with arthritis is at an increased risk for falling. What did the nurse observe in this patient? 1. Sitting down in a chair 2. Able to turn while walking 3. Rocking to get up from a chair 4. Raising the foot completely off of the floor when walking

Answer 74

3: The patient who needs to rock to get up from sitting in a chair is at risk for falling.

Question 75

An older patient with arthritis is prescribed to begin an exercise regimen. How should the nurse instruct the patient about exercising? 1. Perform resistive exercises daily with weights. 2. Perform active range of motion to all joints every day. 3. Overstretch all muscle groups for 20 minutes each day. 4. Use high intensity when performing isometric exercises.

Answer 75

2: The nurse should instruct the patient to perform active range of motion daily to all joints.

Question 76

What does the nurse recognize as the reason for the immune system to develop long-lasting protection against specific antigens? 1. Memory 2. Tolerance 3. Specificity 4. Self-recognition

Answer 76

1: Memory means that the immune system has the capacity to develop long-lasting protection against specific invaders. A residual set of cells that are specific to each antigen remains in the body, to be stimulated when the antigen presents itself at a later time. Each successive time the antigen is encountered, a quicker and more intense reaction is stimulated by the immune system in the healthy older person.

Question 77

Why should the nurse remind an older patient to receive a pneumococcal vaccination at the age of 65? 1. Increased production of IgE 2. Decline in antibody response 3. Decreased antibody production to self 4. Increased speed of the cellular response

Answer 77

2: To prevent serious complications, all people 65 years of age and older should receive a pneumococcal vaccine. Antibody response is often lower in the older person and may decline after 5 to 10 years.

Question 78

The nurse is reviewing the white blood cell count for an older patient. Which white blood cell has the ability for self-recognition, specificity, and memory? 1. Monocytes 2. Neutrophils 3. Lymphocytes 4. Thrombocytes

Answer 78

3: Lymphocytes are the primary cells concerned with the development of immunity. Of all white blood cells, only lymphocytes have the ability for self-recognition, specificity, and memory.

Question 79

The nurse suspects an older patient is experiencing a type I hypersensitivity response. What did the nurse assess in this patient? 1. A drug reaction causing a rash 2. Reaction after getting a vaccination 3. Anaphylactic reaction after eating shrimp 4. Dermatitis resulting from a response to a brand of soap

Answer 79

3: Type I hypersensitivity responses occur immediately and include anaphylactic reactions.

Question 80

An older patient is diagnosed with asthma. What should the nurse teach the patient about this health problem? Standard Text: Select all that apply. 1. It is a type I hypersensitivity response. 2. Items that precipitate attacks must be identified. 3. It is not particularly prevalent in the older person. 4. Symptoms of the disorder likely were present earlier in life. 5. Medications to treat may aggravate other medical problems.

Answer 80

1: Asthma is a common hypersensitivity type I problem that is often underdiagnosed in the older person. 2: Interventions should be aimed at identifying allergens that precipitate attacks and reducing them in the home. 4: Patients with asthma are more likely to have had symptoms earlier in life. 5: Asthma medications may aggravate coexisting medical conditions.

Question 81

An older patient is surprised to learn of the diagnosis of rheumatoid arthritis. What can the nurse explain to the patient about this disorder? Standard Text: Select all that apply. 1. Antibodies form against the person's own IgG. 2. The onset of the disorder is slower in older adults. 3. It is a delayed hypersensitivity response to an antigen. 4. There can be abnormalities in both B and T immunity cells. 5. Inflammatory process is stimulated by T cells and destroys articular cartilage.

Answer 81

1: Rheumatoid arthritis is a type III hypersensitivity response where antibodies form against the person's own IgG causing the complex to be identified as foreign. 5: In rheumatoid arthritis, the inflammatory process is stimulated by infiltrating T cells and gradually destroys articular cartilage.

Question 82

What does the nurse realize as the reason for an older patient to be diagnosed with HIV/AIDS late in the disease process? 1. Older patients have improved immunity to fight the infection 2. Older patients are usually less ill with the initial infection than younger patients with HIV/AIDS. 3. Older patients often have symptoms that may be attributed to other conditions associated with age. 4. Older patients are more likely to have contracted the disease from contaminated blood or blood products.

Answer 82

3: Since many symptoms of AIDS mimic those of normal aging, such as memory loss, fatigue, and weight loss, physicians can miss a diagnosis of HIV infection.

Question 83

``` An older patient is diagnosed with a disease caused by a secondary immunodeficiency disorder. For which disorders should the nurse be prepared to plan care? Standard Text: Select all that apply. 1. HIV 2. Cirrhosis 3. Medications 4. Malnutrition 5. Diabetes mellitus ```

Answer 83

2: Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens such as cirrhosis. 3: Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens. Many factors can lead to the development of secondary immunodeficiency disorders, including pharmacological factors from medications. 4: Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens. Many factors can lead to the development of secondary immunodeficiency disorders, including nutritional disorders such as malnutrition. 5: Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens such as diabetes mellitus.

Question 84

For which older patient should the nurse suspect a decline in the responsiveness of the immune system? 1. 78-year-old patient with pneumonia and temperature of 99.5°F 2. 68-year-old patient with a red itchy rash from contact with poison ivy 3. 80-year-old patient with swelling and redness around an abdominal incision 4. 66-year-old patient with 8 mm induration from a mumps skin test 72 hours earlier

Answer 84

1: The febrile response that signals infections may be blunted in the older person. The baseline body temperature in older people is approximately 1°F lower than the normal temperature in younger people. A rise in body temperature may not be immediately evident.

Question 85

An older patient asks the purpose of receiving an annual flu vaccination if the pneumonia vaccination was received just a few years ago. How should the nurse respond to this patient? 1. "That is an error and it is not necessary." 2. "Everyone needs a flu vaccination regardless of age." 3. "Pneumonia can develop as a complication from the flu." 4. "The incidence of flu is higher in older people than younger people."

Answer 85

3: More than 90% of the deaths during previous U.S. influenza epidemics were attributed to pneumonia as a complication of influenza. The vaccine reduces influenza-related morbidity and mortality by 70% to 90% among vaccinated individuals.

Question 86

``` An older patient is diagnosed with bacteremia. What should the nurse suspect as being the cause of this patient's health problem? Standard Text: Select all that apply. 1. Pneumonia 2. Herpes zoster 3. Antibiotic use 4. Infected leg wound 5. Urinary tract infection ```

Answer 86

1: Bacteremia is the introduction of bacteria into the blood stream and can be a complication of pneumonia. 4: Bacteremia is the introduction of bacteria into the blood stream and can be caused from an infected leg wound. 5: Bacteremia is the introduction of bacteria into the blood stream and can be caused by a urinary tract infection.

Question 87

An older patient is diagnosed with tuberculosis. What should the nurse explain to the patient about this infection? Standard Text: Select all that apply. 1. It can affect other body tissue. 2. It spreads by airborne transmission. 3. It is a chronic infection of the lungs. 4. It is most controlled in nursing homes 5. Older people are at higher risk for the disease.

Answer 87

1: Tuberculosis is a chronic extrapulmonary infectious disease which means it affects body tissues other than the lungs. 2: Tuberculosis spreads from person to person by airborne transmission. 3: Tuberculosis is a chronic pulmonary infectious disease. 5: The number of cases of tuberculosis is highest in people over 65 years of age.

Question 88

What should the nurse explain as the cause for shingles in an older patient? 1. Erysipelas 2. Bacteremia 3. HIV/AIDS 4. Herpes zoster

Answer 88

4: The reactivation of the herpes zoster virus that has lingered in nerve tissue for years following a chickenpox infection can lead to shingles.

Question 89

An older patient is hesitant to receive a vaccination against shingles because he does not understand what shingles are. What should the nurse explain to this patient? 1. They are seldom painful. 2. They should be treated with antibiotics. 3. They cause vesicular lesions along spinal nerves. 4. They result from reactivation of a herpes simplex virus.

Answer 89

3: Shingles causes vesicular lesions along spinal nerves, most frequently affecting T3 to L2 nerves and the fifth cranial nerve.

Question 90

Which action will help reduce the risk of a nosocomial infection in an older patient? 1. Limit the sanitization of equipment. 2. Begin aspiration precautions for dysphagia. 3. Provide antibiotics as prescribed for viral infections. 4. Insert an indwelling urinary catheter for urinary incontinence.

Answer 90

2: Nosocomial infections are those which are acquired in an institution. Using aspiration precautions with patients who have dysphagia will decrease the likelihood of aspiration and the pneumonia that often results.

Question 91

``` The healthcare provider suggests that an older patient take daily vitamin supplements to enhance immunity. On which supplements should the nurse instruct the patient? Standard Text: Select all that apply. 1. Zinc 2. Iodine 3. Vitamin D 4. Vitamin C 5. Magnesium ```

Answer 91

1: Zinc is a micronutrient that helps maintain many body homeostatic mechanisms, including the effectiveness of the immune system. Zinc is required for proper production of many enzymes and proteins in the body, and for cellular proliferation. Zinc deficiency results in impaired immune response and the development of degenerative diseases. 3: Evidence is accumulating on the beneficial effects of vitamin D in improving the health of the immune system. 4: Vitamin C contributes to the cellular immune response.

Question 92

The nurse is preparing a program for senior citizens about the influenza vaccination. Which information should the nurse include in the program? Standard Text: Select all that apply. 1. A new vaccination is needed annually. 2. The vaccination is given once after the age of 65. 3. It should not be taken if diagnosed with a chronic disease. 4. The only contraindication to the influenza vaccine is an allergy to eggs. 5. Most people who receive the pneumonia vaccination do not need the influenza vaccine.

Answer 92

1: The flu virus changes annually necessitating a vaccination every year. 4: The flu vaccination should not be taken by those with an allergy to eggs.

Question 93

An older patient recovering from pneumonia asks what can be done to stay healthier in the future. What should the nurse include when responding to this patient's question? Standard Text: Select all that apply. 1. Maintain a healthy weight. 2. Restrict the intake of dairy products. 3. Take a daily multivitamin/mineral supplement. 4. See the physician for any signs of an infection. 5. Engage in regular moderate exercise 30 minutes a day, 5 days a week.

Answer 93

1: Actions to improve the immune system for the older patient include maintaining a healthy weight. 3: Actions to improve the immune system for the older patient include taking a daily multivitamin/mineral supplement. 4: Actions to improve the immune system for the older patient include reporting increased infections to the healthcare practitioner. 5: Actions to improve the immune system for the older patient include engaging in regular moderate exercise 30 minutes a day, 5 days a week.

Question 94

``` An older patient with rheumatoid arthritis rates current pain as being a 3 on a scale from 1 to 10. Which nonpharmacological interventions can the nurse provide to help this patient? Standard Text: Select all that apply. 1. Massage 2. Warm soaks 3. Diversion activities 4. Relaxation techniques 5. Immobilization of painful areas ```

Answer 94

1: Nonpharmacological comfort measures include massage. 2: Nonpharmacological comfort measures include warm soaks. 3: Nonpharmacological comfort measures include diversion activities. 4: Nonpharmacological comfort measures include relaxation techniques.

Question 95

The nurse is planning care for an older patient recently diagnosed with HIV who wants to remain sexually active. Which would be a priority nursing diagnosis for this patient? 1. Self-care deficit related to depression 2. Social isolation related to fear of AIDS 3. Risk for infection related to immunodeficiency 4. Knowledge deficit related to preventing transmission of HIV

Answer 95

4: Knowledge deficit related to preventing transmission of HIV would be the priority diagnosis for this patient due to the statement of wanting to remain sexually active.

Question 96

The staff development instructor is planning an inservice for nursing staff on the theories of aging. What should the instructor include about immune dysregulation? 1. Immune cells attack the normal body tissues. 2. The ability to differentiate between invaders and normal tissues diminishes with age. 3. The immune system is not able to defend the body from foreign invaders with age. 4. Changes in the immune system disrupt the regulation of immune process components.

Answer 96

4: Immune dysregulation is caused by changes in the immune system which disrupt the regulation between the components of the immune process.

Question 97

An older patient experiences an allergic reaction to latex. Which should the nurse explain to the patient about this allergy? 1. "You probably never realized that you had a latex allergy." 2. "Allergic reactions happen more often when you are sick." 3. "Allergic reactions can take up to 2 weeks with a latex allergy." 4. "You were receiving medication that caused the reaction to latex."

Answer 97

3: Type IV hypersensitivity is also called delayed hypersensitivity. The normal reaction occurs within 1 to 14 days after exposure but it is slower in older adults. A latex allergy is type IV hypersensitivity.

Question 98

An older patient is frustrated because of two hospitalizations within a year for a lung infection. Which response by the nurse is most appropriate? 1. "With aging the immune system just quits working." 2. "With aging there in an overall increase in the speed and strength of the immune response." 3. "With aging there is an increase in the number of B cells in the circulation which hinders the immune response." 4. "With aging there is a decrease in the speed and strength of the immune system, which increases the risk for developing an infection."

Answer 98

4: As a person grows older, there is an overall decrease in the speed and strength of the immune response. This is called immunosenescence.

Question 99

The nurse planning to implement a tai chi program at a senior center is meeting resistance by program attendees. How should the nurse respond to the resistance? 1. "Tai chi is the only type of exercise that will benefit the immune response in older people." 2. "There is no research to show that tai chi has benefits, but just getting out and moving helps." 3. "Studies have shown that tai chi will help reduce the levels of IgG and IgM in the circulatory system." 4. "Studies have been shown that tai chi is beneficial to cardiorespiratory function, mental control, flexibility, and the immune system."

Answer 99

4: Studies have shown that tai chi is beneficial to cardiorespiratory function, mental control, flexibility, balance control, muscle strength, and the immune system.

Question 100

The nurse is planning interventions to help improve the immune function of an older patient. What should be included in this patient's plan of care? Standard Text: Select all that apply. 1. Teach to avoid alcohol. 2. Educate on the effects of stress. 3. Encourage to take daily vitamin supplements. 4. Remind to obtain a yearly influenza vaccination. 5. Encourage to utilize positive coping strategies to stress.

Answer 100

2: An intervention to improve the immune function of an older patient is to educate the patient on the effects of stress. 3: An intervention to improve the immune function of an older patient is to encourage the patient to take daily vitamin supplements. 4: An intervention to improve the immune function of an older patient is to remind the patient to obtain a yearly influenza vaccination. 5: An intervention to improve the immune function of an older patient is to encourage the patient to utilize positive coping strategies for stress.