2024 PN Gerontology Practice Exam New Latest Version Best Studying Material, Exams of Nursing

Download 2024 PN Gerontology Practice Exam New Latest Version Best Studying Material and more Exams Nursing in PDF only on Docsity!

2024 HESI PN Gerontology Practice Exam New Latest

Version Best Studying Material with All Questions

and 100% Correct Answers

An older adult client has bruises resembling handprints encircling both arms, but claims this injury was sustained when she slipped in water. The nurse also notes the client becomes very withdrawn when the son visits, and that the client is emaciated. Which action is most appropriate? a. Contact the local law enforcement agency. b. Ask the son if he was the one who injured his mother. c. Ask the client why she is attempting to cover for her son. d. Ask the older adult if she is willing to press charges against the son. ----------- Correct Answer ---------- a. Contact the local law enforcement agency. These findings correlate with elder abuse and neglect. The nurse is legally obliged to report all cases of suspected elder abuse to the appropriate law enforcement agency. It is not appropriate for the nurse to confront the son. Older adults may "cover for" their abuser due to fear of abandonment or reprisal. In many areas, the older adult does not have to press charges against the abuser, charges are filed against the abuser by the state. The practical nurse (PN) delivers a food tray to an older adult Jewish person who has requested a kosher diet. The PN checks the tray and notes that it contains bacon, eggs, toast, oatmeal, and coffee. Which action should the PN take? a. Deliver the tray to the client. b. Ask the client if he wants this tray. c. Call the dietary department and request a new tray. d. Remove the bacon and then deliver the tray to the client. ----------- Correct Answer ---- ------ c. Call the dietary department and request a new tray. Pork is prohibited in a kosher diet. The practical nurse (PN) should request a new tray that follows kosher dietary guidelines for the client. Simply removing the bacon is not satisfactory, as the bacon could have come into contact with other items on the tray. The nurse is assisting with planning care for a group of older adult clients who are interested in disease prevention with immunizations. Which advice is best for the nurse to provide to this group? a. Make sure you get the influenza vaccine every year. b. Make sure you get the pneumonia vaccine every year. c. Make sure you get the tetanus/diphtheria/pertussis vaccine every year.

d. If you did not get chicken pox as a child, get the shingles vaccine every year. ----------- Correct Answer ---------- a. Make sure you get the influenza vaccine every year. All adults, but especially older adults, need an influenza vaccine (flu shot) yearly. The other vaccines are important for older adults, but are not required yearly. An older client who resides in a long-term care facility is hearing-impaired. How should the practical nurse (PN) modify interventions for this client? a. Turn off the client's television and speak very loudly. b. Communicate in writing whenever it is possible. c. Speak very slowly while exaggerating each word. d. Face the client and speak in a normal tone of voice. ----------- Correct Answer ---------- d. Face the client and speak in a normal tone of voice. A hearing-impaired client frequently relies on lip reading and body language to determine what is being said, so face the client and speak in a normal tone of voice. An older adult client is currently being treated for a urinary tract infection (UTI). The nurse has reinforced instructions in ways to prevent future UTIs and realizes the client requires further instructions if the client makes which statements? (Select all that apply.) a. "I should drink as little fluid as possible." b. "I will be able to stop the antibiotics once I feel better." c. "I will go urinate as soon as I feel the urge to urinate." d. "I should drink lots of coffee and sodas every day." e. "If I notice blood in my urine, I should notify my health care provider." ----------- Correct Answer ---------- a. "I should drink as little fluid as possible." b. "I will be able to stop the antibiotics once I feel better." d. "I should drink lots of coffee and sodas every day." A client being treated for a UTI should drink 2 to 3 L of fluid daily if not contraindicated. Antibiotics should be taken for the prescribed course, not stopped if the symptoms reduce or go away. Caffeinated beverages can cause excessive urination. A client with a UTI should void as soon as the need is perceived and should also notify the health care provider if blood is noted in the urine. The home health practical nurse (PN) visits the home of an older client. The PN assesses the environment for fall hazards. Which suggestions made by the PN may prevent the client from falling? (Select all that apply.) a. Use night lights. b. Wax the floors frequently. c. Place a nonskid mat in the shower. d. Keep a throw rug on the kitchen floor.

e. Keep walkways clear inside and outside. ----------- Correct Answer ---------- a. Use night lights. c. Place a nonskid mat in the shower. e. Keep walkways clear inside and outside. Falls in the home can be prevented by ensuring adequate lighting, including night light use, placing nonskid mats in showers and tubs, and keeping all walkways clear, both inside and outside. An older adult client has been diagnosed with lung cancer and will begin receiving hospice services. The nurse expects to see which aspects included in the plan of care? (Select all that apply.) a. Encouraging the client and family to remain hopeful that a cure will be found b. Encouraging the client to continue with chemotherapy and radiation to treat cancer c. Administering medications to relieve symptoms of nausea, vomiting, and diarrhea d. Encouraging the client to continue with spiritual practices that provide comfort e. Waiting until the pain becomes severe to administer narcotics to prevent dependence ----------- Correct Answer ---------- c. Administering medications to relieve symptoms of nausea, vomiting, and diarrhea d. Encouraging the client to continue with spiritual practices that provide comfort The plan of care for a client who is terminally ill and receiving hospice services includes symptom management for distressful symptoms that interfere with the quality of life. The client is also encouraged to use spiritual practices that provide comfort. Hospice care focuses on care, rather than cure and it is nontherapeutic to encourage the client and family to hope for a cure or to continue futile therapy. Pain management is emphasized, without concern of drug dependence. An older adult in a long-term care setting approaches the nurse and states "I have not had a bowel movement today, and I usually have a bowel movement every day." Which action should the nurse take first? a. Encourage the older adult to walk around. b. Ask the older adult to drink additional fluids. c. Determine any changes in the older adult's routine. d. Ask the health care provider for a laxative prescription. ----------- Correct Answer ------- --- c. Determine any changes in the older adult's routine. Recall the steps of the nursing process: data collection is the first step. First determine if there has been any change in the older adult's routine that could have caused the change in bowel activity. Until data collection has been completed, it is fruitless to suggest alterations in the care of the client.

The nurse has reinforced instructions for an older adult regarding adhering to a low sodium diet. The nurse realizes further instruction is needed if the older adult selects which items from the menu? (Select all that apply.) a. Frozen broccoli b. Canned peas c. Fried donuts d. Canned vegetable soup e. Canned peaches ----------- Correct Answer ---------- b. Canned peas d. Canned vegetable soup The older adult should be educated on ways to avoid "hidden sodium" in foods such as canned foods and soups. The other menu items do not contain large amounts of sodium. The nurse is preparing an older adult client for discharge following a wound infection. Which method is best for the nurse to use when evaluating the client's ability to perform a dressing change at home? a. Ask the client to describe the procedure in writing. b. Observe the client change the dressing unassisted. c. Ask the client if he feels comfortable changing the dressing. d. Ask a family member to evaluate the client's ability to change the dressing. ----------- Correct Answer ---------- b. Observe the client change the dressing unassisted. Observing the client directly will allow the nurse to determine if mastery of the skill has been attained, and provide an opportunity for further instructions if needed. Having the client describe the procedure in writing does not allow for adequate evaluation and further teaching. It is possible for the client to feel comfortable changing the dressing, and still not have adequate skills to do the procedure. Having a family member evaluate the client's skill is not appropriate. The home care practical nurse (PN) assesses a client who takes digoxin. Which signs, if exhibited by the client, may lead the PN to suspect digoxin toxicity? (Select all that apply.) a. GI upset b. Tremors c. Diplopia d. Bradycardia e. Photophobia ----------- Correct Answer ---------- a. GI upset c. Diplopia d. Bradycardia e. Photophobia

Signs and symptoms of digoxin toxicity include GI symptoms such as nausea, vomiting, diarrhea, and anorexia; visual disturbances such as diplopia, photophobia, yellow-green halos, and blurred vision; and heart rate abnormalities such as bradycardia. An older client diagnosed with congestive heart failure is taking furosemide 40 mg twice daily. The practical nurse (PN) plans to monitor this client for the development of which complication? a. Hyponatremia b. Hyperchloremia c. Hypercalcemia d. Hypophosphatemia ----------- Correct Answer ---------- a. Hyponatremia Furosemide potentiates the excretion of sodium, causing hyponatremia. An older client is admitted to the hospital with abdominal pain and watery, incontinent diarrhea following a course of antibiotic therapy. Stool cultures show the presence of Clostridium difficile. What information is most important for the practical nurse (PN) to tell the unlicensed assistive personnel (UAP) about caring for this client? a. Hands should be washed with hand sanitizer. b. Follow isolation precautions while caring for the client. c. Clean all solid surfaces with hospital-approved cleaning products. d. Make sure that only visitors don gowns and gloves before entering client's room. ------ ----- Correct Answer ---------- b. Follow isolation precautions while caring for the client. A priority goal for the client with infectious diarrhea due to C. difficile is infection control precautions and the prevention of nosocomial transmission. Everyone who enters the room should wear gown and gloves. The practical nurse (PN) is caring for an older client diagnosed with Alzheimer dementia. Which behavior by the client should the PN be the most concerned about? a. Climbing out of bed b. Refusing to change clothes c. Wandering into other clients' rooms d. Eating food off of other clients' trays ----------- Correct Answer ---------- a. Climbing out of bed The client who is confused is at high risk for falling; thus, climbing out of bed increases the risk of injury from a fall. A client has had cataract surgery. What is the most important postsurgery instruction that the practical nurse (PN) should implement? a. Increase dietary intake of vitamin E.

b. Avoid bending at the waist. c. Instruct the client to look for halos around objects. d. Advise the client that there will be significant changes in vision. ----------- Correct Answer ---------- b. Avoid bending at the waist. The client needs to avoid heavy lifting, straining, and bending to prevent intraocular pressure in the eye. The practical nurse (PN) is caring for a client who is having an exacerbation of congestive heart failure (CHF). The PN should place the client in which position? a. Trendelenburg position b. Lateral lying, with the legs slightly bent c. Upright, with the legs in a dependent position d. Semi-Fowler, with the legs elevated above the heart ----------- Correct Answer ---------- c. Upright, with the legs in a dependent position Clients with congestive heart failure or pulmonary edema should be positioned upright, preferably with the legs dangling over the side of the bed, to decrease venous return and lung congestion. The client complains of nausea and vomiting about 1 hour after taking the morning dose of an oral antidiabetic agent, glyburide. What is the priority nursing intervention? a. Administer an additional dose of glyburide. b. Take the client's blood glucose levels and administer insulin subcutaneously. c. Check the blood glucose level and monitor for signs of hyperglycemia. d. Closely monitor the blood glucose level and watch for signs of hypoglycemia. ----------

• Correct Answer ---------- d. Closely monitor the blood glucose level and watch for signs of hypoglycemia. When a client who has taken an oral antidiabetic agent vomits, the practical nurse (PN) should monitor the blood glucose level and watch for signs of hypoglycemia. An older adult client has developed a urinary tract infection and has antibiotics prescribed. Which instruction is most crucial to reinforce to prevent recurrence of the infection? a. You may take half of the prescribed dose once the symptoms resolve. b. Once symptoms resolve, it is not necessary to continue taking the medication. c. Gradually reduce the drug amount taken to prevent antibiotic resistance. d. Continue taking the antibiotics until the entire prescription is completed. ----------- Correct Answer ---------- d. Continue taking the antibiotics until the entire prescription is completed.

In order to prevent recurrence of the infection, it is important to take all prescribed doses. Reducing the amount of drug taken could actually increase the risk of recurrence. An older client verbalizes to the practical nurse (PN) that he feels a lack of control over his life. The family member who came with the client states that his father has been exhibiting increased passive behavior and an unwillingness to participate in family functions. What word best describes this client's behavior? a. Anxiety b. Fear c. Altered self-esteem d. Powerlessness ----------- Correct Answer ---------- d. Powerlessness The behaviors that the client is exhibiting are most characteristic of powerlessness and could affect the client's safety. The practical nurse (PN) educates the older client about a new hearing aid. Which instruction is the most important for the PN to give the client about the care of the new hearing aid? a. Instruct client to keep extra batteries on hand. b. Tell client to clean it with a toothpick or pipe cleaner. c. Inform client to remove it before bathing. d. Turn it off and remove the battery when not in use. ----------- Correct Answer ---------- c. Inform client to remove it before bathing. Hearing aids should not be used in and around water; therefore, the client should remove his hearing aid for bathing. A frail elderly couple ask the practical nurse (PN) if they have to watch their salt intake because food does not taste as good as it used to so they have to season most foods. What information should the PN offer the couple? ---------- Correct Answer ---------- Taste buds often are dull due to atrophy so older client should use other seasonings instead of salt. An older client who is unconscious is admitted after experiencing a head injury from a fall. Glasgow Coma Scale (GCS) is prescribed to evaluate the client. Which focused assessments should the practical nurse use to determine the client's GCS score? (Select all that apply.) ---------- Correct Answer ---------- A. Verbal response. B. Motor response. C. Eye opening. The home health practical nurse (PN) is changing an older client's wet to dry dressing. Which observation should the PN evaluate as a therapeutic response with the removal

of the dry dressing? ---------- Correct Answer ---------- Debridment and removal of slough and eschar. The home health practical nurse (PN) is observing an older client for a pressure ulcer. Which finding should the PN observe the area for a stage I pressure ulcer? ---------- Correct Answer ---------- Deep pink, red, or mottled skin. A frail elderly woman visits the healthcare provider because she has been getting out of breath easily when walking long distances. Which pulmonary function change should the practical nurse expect to commonly occur with aging? ---------- Correct Answer ------- --- Reduced vital capacity. The practical nurse (PN) is assigned the care of an older client with venous stasis ulcers. A primary goal in the client's plan of care is to decrease swelling in the extremities. What should the PN do to meet this goal? ---------- Correct Answer ---------- Elevate the legs on pillows. A frail elderly client with chronic obstructive pulmonary disease (COPD) is admitted for pneumonia after taking a 10 day course of an antibiotic that was ineffective. The client has a long history of smoking and still smokes a pack of cigarettes a day. Which finding should the practical nurse (PN) report to the charge nurse? ---------- Correct Answer ----- ----- Crackles and pulse oximetry level of 88% The home health practical nurse (PN) visits an older female client with an illegal conduit who has been experiencing chronic urinary tract infections (UTI). Which intervention should the PN recommend the client do to manage the frequency of UTIs? ---------- Correct Answer ---------- Attach a larger drainage bag while sleeping. An older male client returns to the hospital after discharge 4 days ago for a transurethral resection of the prostate (TURP). The practical nurse (PN) evaluates the function of the 3 - way indwelling urinary catheter and the continuous bladder irrigation system. Which finding should the PN report to the charge nurse? ---------- Correct Answer ---------- The tubing that drains the urinary bladder has bright red urine with clots. An older client with chronic kidney disease (CKD) has an arteriovenous fistula (AV) in the left forearm for hemodialysis. After palpating the AV fistula, which finding is an indication that the AV fistula is functioning properly? ---------- Correct Answer ---------- Enlarged veins. An older man returns to the medical surgical floor with a 3-way indwelling urinary catheter after a transurethral resection of the proslate (TURP). The practical nurse (PN) observes the catheter's tubing for drainage when he states he needs to void. What should the PN implement based on this finding? ---------- Correct Answer ---------- Irrigate the bladder through the catheter port.

The practical nurse (PN) is caring for an older female client with a 20 year history of rheumatoid arthritis (RS) who is admitted for carpel tunnel release. Which finding associated with RA should the PN document? ---------- Correct Answer ---------- Small joint involvement in fingers. An older female client who is 3 days postoperative for a right hip repair is admitted to the rehabilitation center for strengthening in activities of daily living (ADL). The practical nurse (PN) is mobilizing the client to go to physical therapy (PT). Which action should the PN implement first? ---------- Correct Answer ---------- Direct client to use the overhead trapeze. An older female client is recently transferred to a rehabilitation facility after a total hip replacement and asks the practical nurse (PN) if she broke her hip because she is old. How should the PN best respond? ---------- Correct Answer ---------- Older women commonly lose bone calcium which increases the risk of fracture. An older client is admitted a preliminary diagnosis of Addison's Disease. Which skin finding should the practical nurse (PN) document that is typical with Addison's? ---------- Correct Answer ---------- Hyperpigmentation. An older female client recently moved to an assisted living facility. The family explain to the practical nurse (PN) that the client is unmanageable and always confused, disoriented, and depressed. The client asks the PN repeatedly, "Where am I?" How should the PN respond? ---------- Correct Answer ---------- Explain that she is in a new home called an assisted living community. An older female client who is a new resident at an assisted living facility can not remember how to get to her room. What action should the practical nurse (PN) implement? ---------- Correct Answer ---------- Show client how to follow hallway signs to her room. An older client who is a new resident is an assisted living facility is having short-term memory loss and confusion. Which activity should the practical nurse (PN) schedule the client to do during the day? ---------- Correct Answer ---------- Daily exercise group. An older male client who is a new resident in an assisted living community is having difficulty going to sleep since his arrival. Which intervention should the practical nurse (PN) implement first? ---------- Correct Answer ---------- Ask the client what has helped him in the past. The practical nurse (PN) is implementing a self-medication program for an older resident who is newly admitted to an assisted living community. Which actions should the PN implement to provide the resident ways to maintain safe medication administration? (select all that apply.) ---------- Correct Answer ---------- A. Locked medication storage in the client's room. B. Medication Administration Record (MAR).

D. Delivery of adequate supply of medication. E. List of findings indicating medication effectiveness. Which age-related changes in the cardiovascular system should the practical nurse (PN) document when evaluating an older client? (select all that apply.) ---------- Correct Answer ---------- C. Cardiac murmurs. D. Widening pulse pressure. An older client who recently moved into an assisted living community refuses to eat or join any activities. When evaluating the client further, what should the practical nurse (PN) focus on during the next examination? ---------- Correct Answer ---------- Depression. The practical nurse (PN) is caring for an elderly client with functional incontinence who lives in an assisted living community. The client is alert, mildly confused, and can self ambulate. Which nursing intervention should the PN implement? ---------- Correct Answer ---------- Offer assistance with toileting q2 hours. The healthcare provider prescribes a new medication, atrovastatin (lipitor), for an older client who arrives at the clinic for an annual physical examination. What common side effect should the practical nurse (PN) advise the client to observe for with this medication? ---------- Correct Answer ---------- Headaches. The practical nurse (PN) is re-enforcing discharge instructions with the family of an older client who was recently admitted for an intestinal obstruction. Which statement indicates that the family understands the instructions? ---------- Correct Answer ---------- Report abdominal distention, constipation, or any nausea and vomiting to the health care provider. An older client asks the practical nurse (PN) how he can reduce his incidents of hemorrhoidal flare ups. What information should the PN offer the client to prevent rectal discomfort?( Select all that apply.) ---------- Correct Answer ---------- A. Increase fiber and liquids in the diet to help prevent constipation and straining. C. Use a therapeutic cushion or frequent repositioning for periods of prolonged sitting. D. Take frequent warm sitz baths and use non-abrasive tissue that can tramatize tissues. E. Establish bowel habits by scheduling time where the client is not rushed to defecate daily. An older male client is seeking counseling about his recent sexual issues with his partner. What issue should the practical nurse explore in this discussion? ---------- Correct Answer ---------- Certain medications may impact sexual function. During the quarterly evaluations of the clients in the assisted living community, the practical nurse (PN) observes for findings of failure to thrive in the gerian population. Which findings should the PN document and report as manifestations related to failure

to thrive? (selct all that apply.) ---------- Correct Answer ---------- A. Unintentional weigh loss B. Increased weakness. C. Increased amounts of sleep. The practical nurse (PN) is reinforcing discharge instructions to the family of an older client with failure to thrive. What information should the PN include to promote nutritional intake for the client? (Select all that apply.) ---------- Correct Answer ---------- A. Minimize stress level by providing the client a quiet environment during meals. B. Provide food variations that the client can manage without assistance. An older woman asks the practical nurse (PN) how she can decrease her chances of getting cystitis. What information should the PN provide? ---------- Correct Answer -------- -- Void and empty bladder completely q2 to 3 hours. An older male client with Parkinson's disease (PD) is discharged home with levopoda- carbidopa (Sinemet) and instructions to his wife for his care. Which statement best indicated to the practical nurse that the wife understands her husband's needs? ---------- Correct Answer ---------- "I will notify the healthcare provider if my husband has increasing involuntary movements of his extremities. The home health practical nurse (PN) visits an older woman with heart failure (HF) who is on complete bed rest. Which intervention is most important for the practical nurse (PN) to suggest to the client to prevent complications related to immobility? ---------- Correct Answer ---------- Perform leg exercises while in bed. An older male client is admitted to the hospital with left sided heart failure (HF). Which finding should the practical nurse document that is consistent of HF? ---------- Correct Answer ---------- Coarse and fine crackles. An older female client who has been taking hydrocodone/ acetaminophen (Lortab) q hours for chronic back pain for the past 5 years, tells the practical nurse (PN) that she cannot live without her pain pills. When asked if she is addicted, the client states that she is not an addict because the healthcare provider prescribed the pain pills. Which coping mechanism should the PN determine the client is using about her addiction? ----- ----- Correct Answer ---------- Rationalization to support narcotic use. An older male client with heart failure (HF) complains of chronic constipation and wants to retrain his bowel. Which information should the practical nurse (PN) offer the client in establishing regular bowel habits ---------- Correct Answer ---------- Add whole grain foods and fibrous vegetables to diet. The home health practical nurse (PN) is visiting an older client with chronic hypertension. What evaluation is most important for the PN to complete with each visit? ---------- Correct Answer ---------- Effectiveness of medication.

An older client is admitted for emergency treatment of acute closed-angle glaucoma. The practical nurse (PN) begins administering the prescribed miotic medications and glycerin (Glycol) therapy. Which intervention is most important for the PN to maintain during the client's therapy? ---------- Correct Answer ---------- Monitor intake and output q2 hours for 24 hours. The practical nurse (PN) is assigned the care of an older client who returns to the unit after surgery for closed angle glaucoma. Which intervention in the plan of care should the PN bring to the attention of the charge nurse? ---------- Correct Answer ---------- Administer morphine 4 mg IM q2 hour PRN pain. The home health practical nurse (PN) is reinforcing instructions to the the family about how to prevent pressure ulcers for their older family member who is bedridden. Which measure should the PN discuss? ---------- Correct Answer ---------- Lift the client when turning instead of sliding. An older female client arrives for an annual visit by the urologist due to a history of changes in serum values related to renal function. What changes should the practical nurse expect for an older client due to normal aging? ---------- Correct Answer ---------- Decrease in glomerular filtration rate (GFR) the practical nurse (PN) is taking the vital signs of an older male client who arrives at the clinic for an annual physical examination. The client states he really came for this visit because he is having intimacy problems with his wife? What information should the PN present to obtain more information from the client? ---------- Correct Answer ---------- Explain that a decrease of testosterone levels can affect libido. The hospice nurse is completing a focused assessment of an older female client with end stage Alzheimer disease who recently fractured her hip. What technique should the practical nurse (PN) use to determine the client's pain? ---------- Correct Answer ---------- Observe for facial grimacing. Older clients are at highest risk for abuse and neglect due to which factors? (select all that apply.) ---------- Correct Answer ---------- A.Needs are greater than the caretaker's abilities. B. Client's declining strength. A frail elderly client is admitted to the unit with a diagnosis of pneumonia. Which finding is most important for the practical nurse (PN) to report the healthcare provider? ---------- Correct Answer ---------- Confusion and dehydration. The practical nurse (PN) is observing the skin of an older client? Which finding should the PN document as consistent with normal aging process? ---------- Correct Answer ---- ------ Decreased elasticity in skin.

An older client is transferred to a telemetry unit after placement of a pacemaker. What action should the practical nurse (PN) take first? ---------- Correct Answer ---------- Establish telemetry monitoring. The practical nurse (PN) is caring for an older female with Raynaud's phenomenon. Which exposure should the PN instruct the client to avoid? ---------- Correct Answer ------ ---- Cold climates A family member brings their aging father to the clinic because he has been alert and oriented during the day but agitated and disoriented in the evening. The practical nurse (PN) reviews the client's list of current medications with the client and family. What rationale supports this action taken by the PN? ---------- Correct Answer ---------- Multiple medications can contribute to sun-downer like symptoms. The practical nurse (PN) is giving medications through a gastric tube (GT) to an older client who is a resident in a long-term care facility. The PN interrupts the continuous GT feeding. In which sequence should the PN implement these actions for administration of crushed medications? (Place in the order from the first to last step) ---------- Correct Answer ---------- 1. Crush the medication into a powder or fine granules.

2. Dissolve each crushed medication in a medicine cup.
3. Flush the feeding tube of feeding solution. 4.Administer each medication separately.
4. Flush GT to clear the medication from the tubing.
5. Reconnect the gastric feeding tube. Osteoporosis increases the risk for a hip fracture in older adults, and women are more likely to have osteoporosis than men. Women of which ethnic group have the highest risk of a hip fracture. (Arrange the highest risk first, on top, and lowest risk last, on bottom.) ---------- Correct Answer ---------- 1. Caucasian
6. Asian
7. Hispanic
8. African American A male client is seen in the clinic for benign prostatic hypertrophy (BPH). Which intervention is essential for the practical nurse (PN) to include in the client's visit? a. Reeducate the client about limiting fluid intake. b. Reassure the client that his BPH is a non-life-threatening condition. c. Assess the client for urinary hesitancy and weak or split urinary stream. d. Inform the client that there may be a genetic predisposition for male family members. ----------- Correct Answer ---------- c. Assess the client for urinary hesitancy and weak or split urinary stream.

These symptoms may indicate progression of BPH to partial obstruction of the urethra, a medical emergency, and need to be reported to the health care provider. Fluids should be encouraged, not limited; hydration needs to be maintained. The oral temperature of a client with a urinary tract infection is 103° F. Which intervention should the practical nurse (PN) implement first? a. Instruct the client on proper hygienic practices. b. Observe the color or odor of urine. c. Recheck the temperature rectally. d. Encourage fluid intake. ----------- Correct Answer ---------- d. Encourage fluid intake. Fluids help to reduce fever as quickly and it is important to lower the temperature as soon as possible. An older adult client is being treated for toxicity related to medication use. When reviewing the client's medical records, the nurse is most likely to find which factor is correlated with this problem? a. The client has forgotten to take several doses of medication. b. The client's white blood cell count has steadily increased. c. The client's liver function has decreased since last year. d. The client has gained 40 pounds (18.2 kg) over 3 years. ----------- Correct Answer ----- ----- c. The client's liver function has decreased since last year. With aging, liver function decreases, affecting drug metabolism and detoxification. Forgetting to take doses of medication would not cause drug toxicity; excessive doses could cause toxicity. Elevated white blood cell counts and weight gain would not likely cause drug toxicity. The practical nurse (PN) assesses the older adult client's skin for signs of breakdown and observes that the skin is intact. What interventions by the PN will help maintain healthy skin integrity? a. Keep the client well hydrated. b. Remove adhesive tape quickly from the skin. c. Avoid creams or lotions to ensure that the skin stays dry. d. Scrub the perineum with a wet cloth after a bowel movement. ----------- Correct Answer ---------- a. Keep the client well hydrated. Keeping the client well hydrated helps prevent skin cracking and infection. The nurse has reinforced education regarding safety aspects for antihypertensive medication with an older adult. Which statement by the client best indicates learning has been effective?

a. "I should rest in bed most of the day when I take this medication." b. "I will be sure to keep this medication out of the reach of children." c. "I will need to make sure that I take this medication with some food." d. "I will make sure that I stand up slowly if I have been sitting down." ----------- Correct Answer ---------- d. "I will make sure that I stand up slowly if I have been sitting down." Older adults are particularly likely to develop orthostatic hypotension after taking medications to treat hypertension. It is not necessary for the older adult to stay in bed while taking this medication. Some medications should be taken with food, others on an empty stomach. Each medication should be individually researched. While it is important to prevent children from consuming medications intended for the older adult, the focus of this question is the safety of the older adult. An older adult client tells the nurse "I do not understand how I could have a sexually transmitted disease! My partner seems like such a nice, clean person." Which explanation should the nurse provide? a. Most people in your age are not interested in sexual relationships. b. You should have discussed this with your family before you started dating. c. Maybe you should go back to just holding hands and hugging on dates. d. Sexually transmitted diseases are possible to have at any age of your life. ----------- Correct Answer ---------- d. Sexually transmitted diseases are possible to have at any age of your life. Sexually transmitted diseases are possible at any age. It is inappropriate, untrue, and ageist to comment that older adults are not interested in sexual relations. It is very judgmental for the nurse to suggest the older adult should have sought their family's input or that the older adult should stop having sexual relations. When observing an older client with dementia for symptoms of Sundowning syndrome, it is most important that the practical nurse (PN) assesses for which finding? a. Observe for agitation at the end of the day. b. Perform a neurological and mental status examination. c. Monitor for medication side effects. d. Assess for decreased gross motor movement. ----------- Correct Answer ---------- a. Observe for agitation at the end of the day. Sundowning syndrome is a pattern of agitated behavior in the evening, believed to be associated with tiredness at the end of the day combined with fewer orienting stimuli, such as activities and interactions. The practical nurse (PN) working at an assisted living facility is visiting with a client whose spouse died 8 months ago. Which behavior by the client suggests ineffective coping with the spouse's death?

a. Frequently neglects to shower and shave. b. Insists on visiting the gravesite once a month. c. Joins an exercise class at the assisted living facility. d. Keeps their photo albums out and looks through them frequently. ----------- Correct Answer ---------- a. Frequently neglects to shower and shave. Ineffective coping is manifested by behaviors that may be physically or psychologically harmful to the individual. Neglecting personal hygiene is an example of ineffective coping. When initially monitoring a client after a fall, which information should the practical nurse (PN) communicate immediately to the health care provider? (Select all that apply.) a. Change in the level of consciousness b. Increasing muscular weakness c. Changes in pupil size bilaterally d. Progressive nuchal rigidity e. Onset of nausea and vomiting ----------- Correct Answer ---------- a. Change in the level of consciousness e. Onset of nausea and vomiting A decrease or change in the level of consciousness is usually the first indication of neurological deterioration. Nausea and vomiting may also be present. An older adult client is seen in the clinic for problems with urinary frequency, urgency, and nocturia. The symptoms are an example of which condition? a. Urinary tract infection (UTI) b. Normal aging changes c. Side effect of the diuretic furosemide d. Partial obstruction of the urethra ----------- Correct Answer ---------- b. Normal aging changes Normal aging changes in the bladder are decreased capacity, increased irritability, and incomplete emptying; these changes lead to frequency, nocturia, urgency, and vulnerability to infection. The majority of UTIs in the older adult are asymptomatic. Classic signs of UTIs are fever, dysuria, and flank pain. An older adult client is recovering from a hip fracture. The health care provider has prescribed home health care nursing upon discharge. Which statement describes the primary goal for the client? a. Return the client to his or her previous lifestyle. b. Avoid dependency on medication therapy. c. Establish self-care and independence.

d. Maintain a friendly relationship with family members. ----------- Correct Answer ---------

• c. Establish self-care and independence. Loss of independence is a significant issue with the aging population and is one of the most important issues for the home health practical nurse (PN) to establish with the client. Establishing the client's individual goals is the primary concern of the home health care PN. An older client at a long-term care facility is to be monitored for early signs of pneumonia. The practical nurse's (PN) observation of the client will most likely show which early sign(s)/symptom(s)? (Select all that apply.) a. Fever b. Abnormal breath sounds c. Tachycardia d. Confusion e. Tachypnea ----------- Correct Answer ---------- c. Tachycardia d. Confusion e. Tachypnea The onset of pneumonia in the older adult may be signaled by general deterioration, confusion, increased heart rate, or increased respiratory rate. Fever and abnormal breath sounds occur later with the older adult. The nurse is assisting with data collection for an older adult who is taking daily aspirin to reduce the risk of a cardiovascular event. Which concern should the nurse report to the health care provider as soon as possible? a. "I feel really cold much of the time." b. "I wish my children would visit more." c. "Lately it's harder to drive a car at night." d. "My stools are sticky and are dark black." ----------- Correct Answer ---------- d. "My stools are sticky and are dark black." Dark tarry stools are an indication of gastrointestinal bleeding, an adverse effect of the daily aspirin this client is taking. There is no immediate need to contact the health care provider about the client feeling cold or wishing children would visit more. This client's inability to drive at night is a concern, and should be discussed, but gastrointestinal bleeding needs to be dealt with first. The nurse is reinforcing education with an older adult regarding smoking cessation. The nurse recognizes teaching has been effective if the client makes which statement? a. "Stopping smoking reverses damage from emphysema." b. "Stopping smoking will not really benefit me at my age anyway." c. "Stopping smoking can also improve my heart's functioning."

d. "Stopping smoking is likely impossible for people my age." ----------- Correct Answer -- -------- c. "Stopping smoking can also improve my heart's functioning." Stopping smoking can improve cardiovascular functioning. Smoking cessation will not reverse damage already done by emphysema. Stopping smoking is possible at any age and will be of benefit. The practical nurse (PN) educates the client diagnosed with Parkinson about levodopa- carbidopa. Which instruction about this medication should the PN include in the client's discharge teaching plan? a. Notify the health care provider immediately if the urine turns bright orange. b. Notify health care provider if tremors worsen. c. Take levodopa-carbidopa with a high-protein meal. d. Client may discontinue medication if side effects occur. ----------- Correct Answer ------ ---- b. Notify health care provider if tremors worsen. The client should call the health care provider if tremors become worse because the dose may need to be adjusted. A bright orange color to the urine is harmless. A client who resides in a long-term care facility has a seizure disorder that has been managed with phenobarbital for several years. Lately, the client has become more difficult to arouse. What intervention should the PN implement? a. Carefully monitor the client's intake and output. b. Hold the medication and notify the health care provider. c. Continue to monitor the client closely for the next 24 hours. d. Determine the amount of medication the client has taken. ----------- Correct Answer --- ------- b. Hold the medication and notify the health care provider. The client is exhibiting signs of antiepileptic drug toxicity (AED), and a serum phenobarbital level needs to be obtained to determine if the client is experiencing drug toxicity. The nurse is caring for an older adult who is at high risk for skin breakdown. Which is the best method for the nurse to determine if the plan of care for this client is effective? a. Reviewing the documentation of the client's turn schedule b. Turning the client at least every 2 hours around the clock c. Assessing the client's skin for pressure ulcers every shift d. Completing a nutritional assessment to determine protein needs ----------- Correct Answer ---------- c. Assessing the client's skin for pressure ulcers every shift The best way to determine if the plan of care to prevent skin breakdown is effective is to actually assess the client's skin. Reviewing documentation and completing a nutritional

assessment will not likely give a complete picture. Turning the client every 2 hours is an intervention, not a method of evaluating the effectiveness of care. An older client is discharged from the hospital with a prescription for digoxin 0.25 mg daily. Which instruction should the practical nurse (PN) include in this client's discharge teaching plan? a. Take the medication in the morning before rising. b. Take and record radial pulse rate daily. c. Expect some vision changes due to the medication. d. Increase intake of foods rich in vitamin K. ----------- Correct Answer ---------- b. Take and record radial pulse rate daily. Monitoring pulse rate is very important when taking digoxin. The client should be further instructed to report pulse rates below 60 or greater than 110 beats/min and to withhold the dosage until consulting with the health care provider. An older client is receiving hospice care and the spouse and family have expressed several concerns. Which concern expressed by the family should the practical nurses (PN) address first? a. The spouse asks about the side effects of the client's pain medication. b. The client's family requests referrals for support groups to help with the grieving process. c. The spouse reports that the client finally slept for more than 2 hours last night. d. The client's spouse wants to know when it is time to call 9- 1 - 1. ----------- Correct Answer ---------- d. The client's spouse wants to know when it is time to call 9- 1 - 1. This statement by the client's spouse about calling 9- 1 - 1 shows that further education is needed about hospice and the end-of-life process. The practical nurse (PN) reinforces nutritional counseling to a group of clients with diabetes. What is the most important purpose of a diabetic diet? a. To manage adults with type 1 diabetes b. To be used during periods of high stress c. To stabilize the blood glucose level through a balanced diet d. To normalize the blood glucose level by eliminating sugar ----------- Correct Answer --- ------- c. To stabilize the blood glucose level through a balanced diet The purpose of the diabetic diet is to stabilize the blood glucose level by providing balanced nutrition. The nurse at a long-term care facility is working with a group of unlicensed assistive personnel (UAPs) and is asking the UAPs to provide oral care to the residents. The

nurse should explain this is important to provide for which vital reasons? (Select all that apply.) a. Inspecting agencies review medical records for compliance b. Frequent oral care reduces halitosis, or bad breath, in older adults c. Dental caries, or cavities, can occur in older adults resulting in teeth loss d. Dry mouth in older adults may cause a decreased appetite, resulting in poor nutrition e. If multiple teeth are missing, the older adult has difficulty eating fresh vegetables ------ ----- Correct Answer ---------- c. Dental caries, or cavities, can occur in older adults resulting in teeth loss d. Dry mouth in older adults may cause a decreased appetite, resulting in poor nutrition e. If multiple teeth are missing, the older adult has difficulty eating fresh vegetables It is important to ensure that older adults receive adequate oral care, because cavities, dry mouth, and missing teeth can lead to teeth loss. This can cause severe nutritional problems due to the inability to chew meats, fresh fruits and vegetables, and other essential food items. While it is true that inspecting agencies often review medical records, this is not the most crucial reason to provide this care. Halitosis can be caused by poor oral hygiene, but this is also not the most crucial reason to provide care. An 83-year-old client diagnosed with type 2 diabetes mellitus has been admitted to home health care for an ulcer on the heel of the left foot. Which changes in the foot should the practical nurse (PN) expect to find? (Select all that apply.) a. Pedal pulses will be weak or absent in the left foot. b. The client states that the left foot is usually warm. c. Flexion and extension of the left foot will be limited. d. Capillary refill of the client's left toes is longer than 2 seconds. e. The client denies any pain in the left foot. ----------- Correct Answer ---------- a. Pedal pulses will be weak or absent in the left foot. e. The client denies any pain in the left foot. Symptoms associated with decreased blood supply are weak or absent pedal and tibial pulses. The client denying any pain is a common complication with type 2 diabetes in the elderly. The client is recently diagnosed with Parkinson disease and is to begin medication therapy. What is the purpose of the client's medication therapy? a. Decrease tremors. b. Slow disease progression. c. Cure Parkinson disease. d. Improve short-term memory. ----------- Correct Answer ---------- a. Decrease tremors. Drug therapy for Parkinson disease is used to reduce symptoms, such as tremors, to improve the client's quality of life.

The nurse is meeting with a group of older adults to encourage the adults to incorporate exercise into their healthy lifestyle. Which type of exercise should the nurse encourage this group to undertake? a. Walking on a daily basis b. Jogging, but only weekly c. Sprinting, but only on weekends d. Exercise is rarely recommended for older adults ----------- Correct Answer ---------- a. Walking on a daily basis Exercise for older adults should be regular and low impact. Daily walking fits this criterion. Weekly or weekend only exercise is not frequent enough. Most health older adults can perform some type of increased activity. The practical nurse (PN) gives written discharge instructions to an older adult client who has undergone cataract surgery on the right eye. Which discharge instruction should the PN reinforce? a. Avoid sleeping on your right side. b. Follow up with the surgeon in 6 weeks. c. Remove the dressing when showering tonight. d. Expect to have a headache for the next 2 to 3 days. ----------- Correct Answer ---------- a. Avoid sleeping on your right side. The client should be advised about any limitations such as not sleeping on the operative side, limiting reading, no heavy lifting, and no strenuous activity. The client usually has a follow up visit with the surgeon in the first week after surgery. An older adult client who has Alzheimer's disease tries to slap a social worker. Which action is most appropriate for the nurse to take first? a. Ask staff members to assist with applying restraints on the client. b. Ask the client to walk away and come join others in the dining room. c. Ask the client to explain the reason he is trying to hurt the employee. d. Calmly explain it is against facility policy to hit facility personnel. ----------- Correct Answer ---------- b. Ask the client to walk away and come join others in the dining room. It is most appropriate to redirect the client's activity if the client's behavior is combative. This is usually effective in reducing the risk of harm to self or staff and should be attempted before applying restraints. When a client has Alzheimer's disease, it is futile to ask the client to explain behavior or to provide detailed information about facility policies. An older client is admitted to the hospital after experiencing confusion, nausea and vomiting, and headache for several days. The client's pulse rate is 43 beats/min. The

practical nurse (PN) is most concerned about the client's history related to what medication? a. Warfarin b. Ibuprofen c. Nitroglycerin d. Digoxin ----------- Correct Answer ---------- d. Digoxin Older adult persons are particularly susceptible to the buildup of cardiac glycosides such as digoxin which leads to a toxic level within their systems. Toxicity can cause anorexia, nausea, vomiting, diarrhea, headache, and fatigue. The practical nurse (PN) emphasizes ways to prevent constipation to the older adult client. Which instruction should the PN reinforce in the client's discharge teaching plan? a. Avoid caffeinated beverages. b. Take a stool softener once a week. c. Drink several glasses of water throughout the day. d. Make sure to chew food completely before swallowing. ----------- Correct Answer ------ ---- c. Drink several glasses of water throughout the day. Adequate hydration is an important measure for preventing constipation. The nurse is providing instructions for safely bathing older clients to a group of newly employed unlicensed assistive personnel (UAPs) in a long-term care unit. Which instruction is most crucial to provide? a. Make sure to bathe the residents according to the facility schedule. b. Check the bath water temperature carefully to prevent burn injuries. c. Ask each resident which type of bath soap the resident prefers to use. d. Ask the resident if a tub bath or shower is the preferred method. ----------- Correct Answer ---------- b. Check the bath water temperature carefully to prevent burn injuries. The most crucial aspect of bathing an older adult is to make sure the bath water is neither too hot nor too cold, as decreased peripheral sensation is common with older adults. Bathing residents according to the facility schedule would not improve safety. Asking about personal preference with bathing promotes independence, but it does not necessarily ensure safety. The nurse is reviewing medical records at a long-term care facility to determine if the older adult clients have received immunization for influenza. The nurse should ensure the clients receive this immunization according to which guideline? a. Annually b. Every 10 years c. After contracting influenza

d. Before having major surgery ----------- Correct Answer ---------- a. Annually Older adults should receive the influenza immunization annually. The practical nurse (PN) is caring for a client who has been diagnosed with early Alzheimer disease. With which activity does the PN expect the client to experience the most difficulty? a. Balancing a checkbook b. Remembering his name c. Performing activities of daily living (ADLs) d. Recognizing friends and family members ----------- Correct Answer ---------- a. Balancing a checkbook In the early stages of Alzheimer disease, the client has difficulty with complex tasks, such as balancing a checkbook. The practical nurse (PN) performs a skin assessment on an older adult client who is on bed rest. The PN notes a circular area of nonblanchable erythema on the coccyx. Which type of skin condition does this indicate? a. Fungal rash b. First-degree burn c. Stage 1 pressure ulcer d. Stage 2 pressure ulcer ----------- Correct Answer ---------- c. Stage 1 pressure ulcer An area of nonblanchable erythema over a bony prominence caused by pressure is a stage 1 pressure ulcer. The older adult client diagnosed with a pulmonary embolus is taking warfarin 5 mg daily. The practical nurse (PN) notes that the most recent international normalized ratio (INR) value is 5.0. Which intervention should the practical nurse (PN) anticipate? a. The provider will increase the dose of warfarin. b. The provider will decrease the dose of warfarin. c. The provider will not change the warfarin order. d. The provider will add heparin to the client's medications. ----------- Correct Answer ----- ----- b. The provider will decrease the dose of warfarin. Warfarin is an anticoagulant, and the INR measures the clotting time of the blood. The therapeutic range for INR is 2 to 4.5, depending on the client's disease process. An INR above the recommended range means that the warfarin should be reduced to prevent bleeding.

An older client diagnosed with benign prostatic hypertrophy (BPH) asks the practical nurse (PN) what will happen if he decides not to have it treated. Which information given by the PN is most accurate regarding BPH? a. Prostatitis results from untreated BPH. b. Painful kidney stones will develop if you do not treat BPH. c. If left untreated, BPH will develop into a severe bladder infection. d. Untreated BPH causes urinary reflux and possibly hydronephrosis. ----------- Correct Answer ---------- d. Untreated BPH causes urinary reflux and possibly hydronephrosis. Untreated BPH leads to urinary reflux and possibly hydronephrosis because of increased pressure in the bladder. When caring for a client on digoxin therapy, the practical nurse (PN) knows to be alert for digoxin toxicity. Which finding would predispose this client to developing digoxin toxicity? a. Low serum magnesium level b. High serum magnesium level c. Low serum potassium level d. High serum potassium level ----------- Correct Answer ---------- c. Low serum potassium level Hypokalemia predisposes the client on digoxin to digitalis toxicity, usually presenting as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of the serum potassium level with prompt correction of hypokalemia is an important intervention for the client taking digoxin. The practical nurse (PN) facilitates an exercise program for older adult clients with type 2 diabetes. Which are the most beneficial outcomes that the clients may experience as a result of participating in the program? Select all that apply.) a. Improved circulation b. Decreased total cholesterol c. Reduced cardiovascular risks d. Eliminated need for a diabetic diet e. Increased insulin resistance and glucose tolerance ----------- Correct Answer ---------- a. Improved circulation b. Decreased total cholesterol c. Reduced cardiovascular risks Benefits of exercise for the diabetic client include improved circulation, decreased total cholesterol, and reduced cardiovascular risks.

The practical nurse (PN) reinforces the instructions to the client after a hip replacement. Which client action indicates the need for further education? a. Lying on the unaffected side b. Flexing and extending the feet c. Ambulating with physical therapy d. Crossing the feet while lying in bed ----------- Correct Answer ---------- d. Crossing the feet while lying in bed Maintaining the knee and hip in proper alignment and avoiding internal or external rotation can prevent hip displacement. Crossing the legs at the feet will cause the hip to rotate internally. An older adult had right hip replacement surgery several days ago and is being prepared for discharge home with relatives. The nurse has reinforced instructions to prevent hip displacement. Which client statement indicates the client needs further instruction? a. "I will ask my son to get a raised toilet seat for the bathroom." b. "I will need to keep a pillow between my legs when I'm in bed." c. "I will need to remember to sleep only on my right side now." d. "I should not cross my right leg over my left leg when I sit." ----------- Correct Answer -- -------- c. "I will need to remember to sleep only on my right side now." The client should not sleep on the right side after surgery. The other options are all actions to take following hip surgery to prevent hip dislocation. The nurse is assisting with data collection regarding an older adult's risk for development of neurological system changes. The presence of which risk factors should the nurse discuss with the health care provider? a. A history of concussion injury in a sibling b. A history of substance abuse as an adult c. A long history of personality disorders d. A history of anoxic brain injury in a parent ----------- Correct Answer ---------- b. A history of substance abuse as an adult A history of substance abuse as an adult is a risk factor for development of neurological system changes. A history of concussion or anoxic brain injury in a family member is not a risk factor for an individual. Personality disorders do not cause neurological system changes. An older adult client is recovering from a myocardial infarction. The cardiologist prescribes docusate sodium with a dosage of one tablet by mouth twice a day. What therapeutic effect does this medication provide for this client?