Unit 4 Questions

Question 1

According to the leading cause of injury-related deaths for older adults, what is the most important teaching point for the nurse to include concerning safety?

a) Check water heater temperature.
b) Frequently empty the bladder.
c) Wear non-skid footwear.
d) Cook meats thoroughly.

Answer 1

ANS: C

Falls are the leading cause of injury-related deaths for older adults. Burns, Salmonella-related gastroenteritis, and urinary tract infections are also causes of safety concern, but the leading cause of injury-related deaths is falls. (less)

Question 2

A 74-year-old man with a history of osteoarthritis is being treated in the hospital for pneumonia. The nurse administered 650 mg of acetaminophen 90 minutes ago and the patient is now requesting another dose. The nurse should understand that

a) the patient is exhibiting early signs of addiction.
b) the patient should have been provided with a patient-controlled analgesic (PCA) pump.
c) the patient is experiencing nociceptive pain.
d) excessive quantities of acetaminophen are hepatotoxic.

Answer 2

ANS D

Levels of acetaminophen must be carefully monitored in older adults to avoid liver damage. While alternative approaches to pain relief may be warranted, this does not necessarily m … (more)

Question 3

A nurse was recently assisting an 84-year-old resident of a nursing home with the resident’s biweekly bath. While the nurse was helping the resident transfer out of the bathtub the resident grabbed on to the nurse forcefully, became rigid, and exclaimed, “Help me quick,” despite the fact that the nurse was performing a safe and controlled transfer. Why might this resident have exhibited sudden anxiety during the transfer?

a) The resident may be developing a cognitive deficit.
b) The resident is experiencing age-related changes.
c) The resident may have a fear of falling.
d) The resident is ensuring safety.

Answer 3

ANS C

The fear of falling, which is the most common reported fear among older adults, has been identified as a public health problem that is of equal importance to falls. This fear goes beyond prudent safety measures and is not a normal, age-related change. The resident’s actions do not necessarily indicate a cognitive deficit. (less)

Question 4

Having completed a medication assessment and physical assessment of a new client, a home care nurse is now creating nursing diagnoses and choosing interventions appropriate to these diagnoses. What factor should the nurse prioritize in this process?

a) The importance of the patient's safety.
b) The need to maintain the client's autonomy.
c) The importance of fostering patient compliance.
d) The nurse's responsibility to teach the patient and minimize liability.

Answer 4

ANS A

When dealing with patients’ and clients’ medications, as in all areas of nursing practice, patient safety is the priority. This supersedes other matters, even though each may be significant. These include autonomy and patient education. (less)