Caring for Older Adults: Addressing Common Health Concerns, Exams of Nursing

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GERONTOLOGY HESI RN EXIT TEST

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GERO EXAM 1

1. Which statement is true about rehab and restorative care for older adults? A PERSON CAN LEARN SKILLS AND GAIN ABILITIES THAT ENABLE FUNCTIONING 2. An older adult is in the hospital because of HF and has become incontinent of urine. Which EB resource should the nurse use to guide continence care for this pt? NURSING STANDARD PRACTICE PROTOCOL 3. The nurse understands that stress incontinence occurs? AS A RESULT OF INCEASED INTRAABDOMINAL PRESSURE 4. A large residual urine volume characterizes what type of incontinence? OVERLFOW Which action should be included in all bladder-retraining programs? TOILETING AT BEDTIME 5. The nurse assess a male resident in a NH for urinary incontinence and determines that he is unaware of the problem. Which recommendation should the nurse implement? PROVIDE REGULAR TOILETING 6. The nurse wants to begin helping a resident who is overweight and has urinary incontinence with healthy bladder behavior skills. Which intervention should the nurse implement? SCHEDULE VOIDING AT 2 - 4 HR INTERVALS 7. What is the most important aspect of care for the nurse to maintain when assisting an older pt with urinary incontinence? MAINTAINING AN ATTITUDE THAT IS RESPECTFUL ABOUT RESLOVING THE PROBLEM 8. An older woman tells the NP that she fears her family will place her in a NH because she developed stress incontinence. Which recommendation should the nurse implement? RECOMMEND EXERCISES TO STRENGTHEN THE PELVIC FLOOR 9. The nurse is caring for a pt who has recently had an indwelling catheter placed. The nurse should assess the pt for? A CHANGE IN MENTAL STATUS 10. An older adult who is on bedrest after surgery is prescribed morphine for pain. Which of the following is the nurse’s priority for preventive care? CONSTIPATION 11. Which of the following statements is a true about elimination in older adults? DEFACATION < 1 DAY IS NOT NECESSARILY CONSTIPATION 12. Which option is part of the program that addresses bowel incontinence in an older adult pt? ENSURING THAT A TOILET OR COMMODE IS READILY ACCESSIBLE TO THE PT 13. Which is an important consideration about the skin of an older adult person? THE

SKIN BECOMES MORE VULNERABLE TO DAMAGE

14. Which topical agent is safe to apply? LIGHT MINERAL OIL TO MOISTEN SKIN AFTER BATHING 15. A 70 yr old woman complains of dry skin and asks for advice. Which advice should the nurse offer to this woman for improving dry skin? KEEP BATH WATER BETWEEN 90* AND 105*F 16. The nurse monitors for which clinical indicator when the older adult complains of pruritus? COARSE SKIN 17. Which infection control practice should the nurse implement when caring for an older adult who has active herpes zoster? COVER RUPTURED SKIN LESIONS WITH A NONABSORBENT DRESSING 17. The nurse is conducting an admission assessment on an older adult and notes a small lesion with a multicolor appearance. Which assessment approach should the nurse use? ABCD RULE (ASYMMETRY, BORDER, COLOR, DIAMETER) 18. The nurse cares for an older man who has a malignant melanoma. Which intervention should the nurse implement for this man to prevent a recurrence or advancement of this condition in the future? INSTRUCT HIM TO WEAR SUN-PROTECTIVE CLOTHING AND A HAT AT ALL TIMES 19. Which of the following is a true statement about impaired skin integrity? MUSCLE AND FAT CANNOT REGENERATE 20. An older adult is vitamin deficient. Which of the following does the nurse offer to the older adult to provide the important missing vitamin for maintaining healthy skin and enhancing tissue repair? ORANGE SLICES 21. An older adult woman complains of foot plain from a corn. After assessing her feet, which intervention should the nurse implement to alleviate her from discomfort? CUT OUT AN OVAL CORN PAD TO MAKE A U SHAPE 22. Which of the following statements is true about Medicare for older adults? 80% OF MEDICARE’S ANNUAL EXPENDITURES ARE FOR INDIVIDUALS WITH CHRONIC ILLNESS 23. Acute illness is to chronic illness as to which of the following comparisons? AN ER IS TO A NH 24. An older female pt is dx with a chronic illness. Which principle should the nurse apply when answering her questions? CHRONIC ILLNESS IS UNENDING AND COPING CAN BE INFLUENCED BY THE PERCEPTION OF UNCERTAINTY 25. Over 50% of the population, aged 65 + yrs, suffers from which one of the following chronic health conditions? HTN AND ARTHRITIS

26. Which older adult has the most characteristics associated with becoming frail? MALE, HISPANIC AMERICAN, WITH HYPOPROTEINEMIA 27. Which of the following describes the nurse’s role for an older pt with a chronic illness? PROVIDE CARING TO HELP THE PT LIVE AT THE OPTIMAL LEVEL OF HEALTH AND WELLNESS 28.Which of the following statements is the most suitable for establishing goals when teaching an older adult with a chronic illness about potential changes in the health maintenance regimen? MANAGEMENT OF THE PT’S CHRONIC DISEASE RESTS ON THE PT AND THE CAREGIVER; THEREFORE, THE GOALS SHOULD BE COLLABORATIVELY SET 29. Compared with acute pain, the following is true of persistent pain? IT CAN BRING ABOUT CHANGES IN LIFESTYLE 30. The nurse admits an older male pt who had ABD surgery. On admission, VS signs are: P-73, R-20, BP-136/84. He is receiving IV fluids but has not requested pain meds since surgery. 7 hrs later, his VS are: P-98, R-26, BP-164/90, and he denies pain. Which intervention should the nurse implement? ASK HIM ABOUT DISCOMFORT AT THE SURGICAL SITE. (USE OLD CART – onset, location, duration, characteristics, aggravation, relieving factors, and treatments previously used) 31. An older female adult had hip replacement surgery 1 day ago, and the nurse thinks that the woman also has dementia. Which pt assessment does the nurse use to determine that this woman is experiencing pain? HOLDS ABD TIGHTLY 32. An older male adult who is Hispanic states he is not having pain, but he had knee replacement surgery 2 days ago. Which is the best assessment tool as recommended by the Hartford Institute for Geriatric Nursing from “Try This” for the nurse to apply for this man? FACES PAIN SCALE-REVISED The safest opioid analgesic choice for an older pt who has severe acute pain is which of the following? MORPHINE SULFATE (MORPHINE) 33. An older adult admitted for back surgery asks for opioid pain meds. The nurse knows the pt asked for meds 15 min before it is due. Which recommendation should the nurse implement? ADMINISTER THE PAIN MEDS AS PRESCRIBED 34. The nurse administers an opioid analgesic to an older male postoperative pt on a surgical unit. Which is the most important intervention for the nurse to implement before leaving the pt? INSTRUCT HIM TO ASK FOR HELP BEFORE GETTING UP POSITION THE PT COMFORTABLY 35. The nurse plans the care of an older female resident of a NH who has experienced a sudden deterioration in visual acuity. The nurse administers an opioid analgesic to an older male postoperative pt on a surgical unit. Which is the most important intervention for the nurse complete first? EXAMINE HER MOOD AND FUNCTIONAL STATUS

36. The most detrimental illness or condition that an older adult with deafness that occurred at birth can experience is which one of the following? CATARACTS 37. Which of the following diseases affects the eyesight of an older adult by damaging the central part of the retina? MACULAR DEGENERATION Which population groups are at most risk for macular degeneration? - 60 + YRS - WHITES AND ASIANS - WHITE WOMAN 80 + - GENETIC PREDISPOSITION - SMOKERS - FAMILY HX - EXCESSIVE SUNLIGHT What does the nurse teach the pt with retinopathy to slow its progression? - CONSTANT, STRICT CONTROLS OF BLOOD GLUCOSE, CHOLESTEROL, BP, AND LASER PHOTOCOAGULATION TREATMENTS CAN HALT DISEASE - LASER TREATMENT CAN REDUCE VISION LOSS IN 50% OF PTS AND RECENT EVIDENCE SUGGESTS THAT TREAMENT WITH VARIOUS DRUGS MAY BE BETTER - AVOID WIND, AND HAIR DRYERS - USE HUMIDIFIERS AT HOME - USE ARTIFICAL TEAR OINTMENT AT HS An older adult complains about experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the pt’s complaint? - ANTIHISAMINE PRESCRIPTION - DIURETICS - BETA BLOCKERS - SOME SLEEPING PILLS - VITAMIN A DEFICIENCY 37. The nurse is teaching older adults maintaining health and wellness. Which recommendation should the nurse include in the teaching to maintain optimal vision? WEAR SUNGLASSES THAT BLOCK SUN RAYS How does the nurse approach the hearing impaired elder for conversation? - FACE THE PT, SIT OR STAND ON THE SAME LEVEL, DON’T TURN AWAY WHILE SPEAKING - GAIN THE ATTENTION BEFORE SPEAKING, LOOK DIRECTLY AT PT AT EYE LEVEL - CAREFUL ARTICULATION AND MODERATE SPEED OF SPEECH

• USE NONVERBAL APPROACHES- GESTURES, DEMONSTRATIONS, VISUAL

AIDS, WRITTEN MATERIALS

• PAUSE BETWEEN SENTENCES OR PHRASES TO CONFIRM UNDERSTANDING

• REDUCE BACKGROUND NOISE

• VERIFY THAT INFO HAD BEEN CLEARLY UNDERSTOOD – REMEMBER PT

MAY AGREE WITH EVERYTHING YOU SAY

38. Persons with normal age related sensory changes are likely to have most difficulty distinguishing which of the following? SPOKEN PAIRS OF PHRASES LIKE “SHE’S PRAISED” AND “FEES RAISED” 39. Which of the following is used to treat the most common cause of impairment to an older adults hearing? EAR CANAL IRRIGATION 40. A medical illustration shows a man the blunt end of a tuning fork pressed to the center of his forehead. The man is being tested for which of the following? UNILATERAL CONDUCTIVE HEARING LOSS An older man who is non-Hispanic Caucasian has a fasting blood sugar level above 130 mg/dl. Which pt assessment does the nurse use to confirm a high risk for DM in this man? - RISK FACTORS: - 65 + YRS OLD - FASTING GLUCOSE > 126 - NO SMOKING OR SMOKING CESSATION - BP < 130/ - CHOLESTEROL < 200 - LDL < 100 - HDL > 40 - TRIGLYCERIDES > 150 41. Which co-morbidity commonly associated with type 2 DM enhances the development of the microvascular complications of DM? HYPERLIPIDEMIA What concerns the nurse regarding pt with DM that confirms progression to chronic illness? - DIABETIC + TOE REMOVAL = HEALTH PROBLEMS (CHRONIC ILLNESS) - THE FOCUS OF MANAGEMENT IS GEARED MORE TOWARD LIFE EXPECTANCY AND THE REDOGNITION OF THE IMPORTANCE OF CARDIOVACULAR HEALTH PROMOTING STRATEGIES - SELF MANAGEMENT SKILLS: - NUTRITION - EXERCISE PLAN - MED USE - BLOOD GLUCOSE - FEET CARE

42. The nurse assists an older man who has DM type 2 to improve his glucose control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in one day? SUPPLEMENT CALORIC INTAKE - MEN – 60+ NEED 2000 - 2600 - WOMEN 60+ NEED 1600 - 2000 - LIMIT SATURATED FATS FROM DIET - BALANCE EXERCISE AND DIET 43. Which is a true statement about osteoporosis? A HIGH RISK OF DEATH FOLLOWS AN OSTEOPOROSIS-RELATED RX - NEEDS: Vitamin D, Ca, NO SMOKING 44. An older female pt seeks advice from the nurse about preventing further bone loss after being dx with osteopenia. To achieve the woman’s goal, which teaching should the nurse provide to enhance activity of osteoblasts? EXERCISE WITH WEIGHTS (brisk walking with weights) 45. Which are characteristics of RA that are unlike OA? IT IS SYSEMIC AND SYMMETRICAL - RA – degenerative joint disorder, asymmetrical, pain doesn’t resolve - OA – systemic and symmetrical, pain resolves within 30min 46. Which statement is true about joints in older adults? SURGICAL JOINT REPLACEMENT CAN CURE OA (cannot be “cured” without joint replacement – arthroplasty) 47. An osteoporosis related fall necessitated hip replacement surgery for an older female adult who is entering a rehab facility. Which id the nurse’s priority goal during this woman’s rehab? RECAPTURE PREOPERATIVE MOBILITY STATUS 48. Which of the following statements is true about RA? CAN AFFECT BODY SYSTEMS RATHER THAN JOINTS Which of the following nursing interventions are suitable for a pt who has gout? - COLCHICINE (COLSALIDE) BY MOUTH - ALLOPURINOL - PROBENECID - ENCOURAGE 2L/DAY FLUIDS TO FLUSH URIC ACID FROM KIDNEYS 49. Which of the following is a true statement about heart disease in men and women? WOMEN GENERALLY RECEIVE LESS AGFRESSIVE TREAMENT THAN MEN DO - MEN > 55 are dx with ANGINA & ICS - WOMEN > 55 are dx with VAGUE chest pain only – receive fewer meds – same as BLACKS

50. Which assessment is typical for a pt with OA? NARROW JOINT SPACES WITH CREPITUS 51. The nurse prepares an older male adult who has OA for discharge. Which instruction does the nurse include in pt teaching to maintain safety for this man? REPORT JOINT INSTABILITY TO THE HEALTH CARE PROVIDER 52. An older male adult who has OA tells the nurse that he has experienced fatigue for the past 2 weeks. Which nursing intervention should the nurse implement to help him manage fatigue? HELP HIM PLAN EXERCISE AND REST 53. Which classic sign of an AMI can be absent in an older man with an AMI? CRUSHING CHEST PAIN 54. An African-American 58 yr old man in good health has a BP at 120/73 at his annual physical exam. Which of the following is the best goal for the nurse to assist him in maintaining his health and wellness into older age? PREVENT CARDIOVASCULAR DISEASE 55. An older woman has severe ischemic heart disease, HTN, and low cardiac output. Which medication does the nurse administer to counteract the neurohormonal activation of this pt’s cardiovascular status? BETA-ADRENERGIC BLOCKER 56. Which of the following is the most important plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults who have HF? CONTROL FLUID BALANCE 57. An older man in a cardiac rehab exercise class refuses to participate in the cool- down phase of the activity; consequently, 2 minutes later, he passes out but quickly regains consciousness. Which instruction does the nurse include in pt teaching to reinforce the importance of cooling down after exercising to this man? BARORECEPTOR FUNCTION DIMINISHES WITH AGE 58. Which condition is a COPD? BRONCHITIS, ASTHMA, EMPHYSEMA 59. An older woman who has COPD wants to perform self-care activities. Which instruction should the nurse include in pt teaching to help her achieve this goal? BATHE AND EAT SLOWLY WITH PERIODIC REST 60. Which of the following statements is true about cardiopulmonary disease in older adults? MOUTH HYGIENE IS ESSENTIAL TO PREVENT AND TREAT PNEUMONIA 61. Which of the following is a true statement about TB in older adults? OLDER PERSONS, PARTICULARLY THOSE IN NH, ARE AT RISK FOR TB (Homeless too) 62. An older man who is right-handed works as a carpenter, but he has been left with a flaccid right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the POC to help this man achieve his optimal state of health and wellness? COLLABORATE WITH OT

63. Which is the fundamental difference between Medicare part A and Medicare part B? HEALTH CARE SETTING 64. Which of the following statements is true about health care costs for older adults in the US? HMOs CAN OBTAIN AN EXEMPTION FROM MEDICARE’S PERCAPITA SPENDING LIMIT 65. Managed care systems are most effective for an older adult who does which of the following? SEEKS REGULAR PRIMARY CARE AND PREVENTIVE STRATEGIES TO MAINTAIN HEALTH 66. The older adult wants to appoint an attorney-in-fact with DPA for a specific period around a forthcoming surgery. Which should the nurse implement? HELP THE PT FIND A QUALIFIED ATTORNEY 67. Which of the following qualities does the nurse need to provide caring? ABILITY TO CREATE A TRUSTING ENVIRONMENT 68. Which of the following statements describes one of the following standards of case management during hospitalization? BEGIN DISCHARGE PLANNING ON THE FIRST DAY OF HOSPITALIZATION GERO EXAM 2

1. Which is a common age-related physical change that may affect digestion and food intake? DECREASED MOTILITY IN THE ESOPHAGUS

2. Which of the following is true about nutrition for older adults? TRANSPORTATION CAN BE A CRITICAL FACTOR IN NUTRITIONAL INSUFFICIENCY IN OLDER ADULTS 3. Which of the following is a true statement about dental health in older adults? DENTURES SHOULD BE CLEANED ONCE A DAY BY BRUSHING AND SOAKING IN A CLEANSING SOLUTION 4. Which intervention should the nurse use to decrease the risk of burns during mealtime in pts with mental and physical impairments? ASSIST PTS WITH WARM DRINKS 5. The nurse is trying to improve the nutritional status of residents in the nursing home. Which recommendations should the nurse implement? PROVIDE NUTRITIOUS FOOD ACCORDING TO THE RESIDENTS’ EXPRESSED FOOD PREFERENCES WITH A LIBERAL USE OF SEASONINGS THAT DO NOT EXCEED ANY SODIUM RESTRICTIONS 6. The nurse instructs the UAP to feed an older adult. If the nurse is unable to observe feeding directly, then which action should the nurse use to access the older adult’s risk for aspiration immediately after feeding? INSPECT FOR POCKETING 7. An older adult with a G-tube has difficulty using the dominant hand. Which of the following should the nurse provide to prevent complications of the G-tube? PROVIDE ORAL CARE Q4H 8. The nursing home staff needs assistance to properly food the residents who need assistance with feeding. Which of the following should the nurse implement to ensure that the residents are properly feed? DRAW ON THE AVAILABILITY OF FAMILY MEMBERS WHO ARE ABLE TO FOLLOW DIRECTIONS 9. The nurse is feeding an older adult pt with hemiparesis as a result of a stroke. Which intervention by the nurse is most important when feeding this pt? ALLOW TIME TO EMPTY MOUTH BETWEEN BITES 10. The nurse is educating the pt who has been recently dx with osteoporosis on foods high in Ca. the nurse should include which food choice? PLAIN YOGURT 11. Which increases the risk for chronic dehydration in older adults? POOR COGNITIVE FUNCTION 12. Which of the following is true about fluid intake for older adults? 1500 - 2000 mL DAILY 13. The nurse notices that the older adult’s urine is greenish-brown. Which step should the nurse implement next? DETERMINE FLUID VOLUME STATUS 14. Which of the following is a true statement about sleep in older adults? THE TIME SPENT IN BED INCREASES, BUT THE TIME SPENT ASLEEP DECREASES

15. An older man has AD, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the man’s duration of sleep? INSTRUCT THE WIFE TO INCREASE HIS DAILY PHYSICAL ACTIVITY 16. Exercise is prescribed for an older adults as therapy to improve which of the following qualities? MUSCLE STRENGTH 17. Which of the following is important to include in the initial assessment for older adults who are frail and beginning an exercise program? MED HX AND PHYSICAL EXAM 18. During the night, an older woman complains to the nurse that she has not slept more than 2 hrs since admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman’s sleep? INQUIRE ABOUT HER SLEEP HABITS USED AT HOME 19. What is the difference between rest and sleep? SLEEP IS RESTORATIVE AND RECUPERATIVE 20. An older woman maintains an active lifestyle playing various games with friends. She reports to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this woman’s sleep? INQUIRE ABOUT HER NIGHTLY SLEEP RITUALS 21. The nurse completes an admission assessment on the older adult pt. the nurse identifies which factor that may contribute to sleep problems? POLYPHARMACY 22. The nurse expresses concern about a female nursing home resident in the team meeting. Which resident information determines the team’s priority in planning her care? NEEDS INCREASING HELP WITH PERSONAL HYGIENE 23. A nursing home resident who has type 1 DM is gradually requiring more and more insulin on a PRN basis to treat hyperglycemia. Which of the following should the nurse assess to plan care for improving this individual’s glucose metabolism? TRENDS OVER TIME IN ACTIVITY LEVEL 24. Which one of the following is a true statement about motility and safety for older adults? LOWERING THE BED AND FLOURESCENT TAPES ARE INTERVENTIONS TO INCREASE SAFETY 25. The nurse can place an older adult into one of 4 pt rooms. Which is the most suitable room for an older pt? ROOM WITH ORANGE CARPETING AND SOFT LIGHTING 26. Which of the following is a true statement about assistive devices to aid older adults with impaired mobility? A CANE IS MOST USEFUL FOR UNILATERAL DISABILITIES BUT NOT BILATERAL PROBLEMS 27. The HCP has not ordered the use of a restraint for an alert pt at high risk for falling. The nurse should implement which side rail use? ONE ½ LENGTH RAIL

28. The nurse assess the quality of which of the following pt characteristics when applying the Get-Up and Go test from the Hendrich II Fall Risk Model? BALANCE 29. An older woman who receives IV fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially? DETERMINE THE PTS NEEDS 28. The nurse determines that the older adult who has chronic bronchitis is at high risk for falls, but he repeatedly tries to ambulate without assistance. Which alternative measure to restraints is contraindicated for this older adult? HELP HIM LEARN HOW TO USE AN ASSISTIVE DEVICE 29. The nurse is discharging an older woman who uses a walker from rehabilitative care. Which observation does the nurse use to determine whether the pt is prepared for discharge? SHE TAKES THE WALKER TO THE ELEVATOR 30. Which of the following statements is true about the role of grandparents? TODAY, MANY GRANDPARENTS ARE THE PRIMARY CAREGIVERS OF THEIR GRANDCHILDREN 31. An older man is being abused by his daughter, a single working mother of 4 children, with whom he lives. The nurse investigates and learns that the abuse is due to situational stress. Which of the following interventions should the nurse implement to address the ST crisis? ARRANGE RESPITE CARE OR DAY CARE FOR THE PT 32. Which disease has become known as the “great imitator?” HIV 33. Which is the most important element for older adults to have for enhancing the transition into retirement? PRERETIREMENT PLANNING 34. Which one of the following older adults is most likely to need preretirement counseling to avoid significant concerns in retirement? MEXICAN-AMERICAN WOMAN WHO RECEIVES CASH FOR CLEANING SERVICES 35. The community health nurse delivers a program to middle-aged adults about retirement planning and wants them to choose the yr of their retirement. Which is the most important area of which the participants should focus to ease the transition to retirement? ABILITY TO MAINTAIN A STABLE STANDARD OF LIVING 36. Which of the following older adults has the highest economic risk in retirement at the beginning of retirement? DIVORCED WOMAN WHO HAS LIVED IN THIS COUNRTY FOR 3 YRS 37. As the wife of a university president, an older woman met exciting people and traveled extensively until her husband died. Besides losing an intimate partner, the nurse identifies that this woman is most likely to grieve for the loss of which area of her life? STATUS IN THE COMMUNITY

38. Which of the following statements is true about Parkinson Disease? OLDER ADULTS TAKING RASAGILINE (AZILECT) MUST AVOID EATING FOODS CONTAINING TYRAMINE 39. Which of the following statements is true about dysarthria? DOES NOT AFFECT INTELLIGENCE 40. The nurse prepares to discharge an older man who has HF and is in stable condition, when his wife states that she will avoid sexual activities with him because of his heart disease. Which of the following factors should the nurse use in pt teaching about sexual activity for an older adult with HF? FEAR AND LACK OF KNOWLEDGE CAN CAUSE OLDER PEOPLE TO REDUCE THEIR SEXUAL ACTIVITY UNNECESSARILY 41. An older woman recently lost her brother, provides care for her husband who has health needs, and must move to a new location after 35 yrs in the same home. When she comes to the primary care facility with clinical indicators of influenza, the nurse recognizes which of the following? CRISIS AND STRESSORS CAN IMPAIR PHYSICAL HEALTH 42. Which of the following statements is true about the mental health of older adults? THE NURSE AVOIDS ANTIANXIETY MEDS WITHOUT AN ASSESSMENT FOR FACTORS ASSOCIATED WITH ANXIETY 43. An older female resident lowers her voice and tells the nurse that another resident is looking at her behind her back and is going to make her move tonight with a male staff member. Which ideas should the nurse include in the response to this individual? USE THE CALL BELL If SHE BEOMES FRIGHTENED 44. Which of the following statement is true concerning suicide among older adults? A MAJOR CRISIS EXPERINCED BY THE PT CAN CONTRIBUTE TO THE RISK OF SUICIDE 45. You are evaluating the POC for an older adult who is alcohol-dependent. Which pt documentation indicates the need for follow-up nursing interventions by the nurse? PT STATES THAT HE INTENDS TO DECREASE HIS ALCOHOL CONSUMPTION 46. Which assessment finding for an older adult living in an ALF indicated the highest risk for suicide? OLDER ADULT DECLINES COMPANY, IS PREOCCUPIED WITH LEATHAL WEAPONS 47. To help older adults maintain a healthy mental state, the nurse plans activities at a community center to promote the developmental stages of older adulthood. Which nursing intervention is suitable for the nurse’s plan? PARTICIPATE AT A SOUP KITCHEN FOR OTHER PEOPLE WHO ARE HOMELESS 48. Name the theory of aging that suggests that the adverse physical effects of aging are the result of a gradual loss of control mechanisms in the pituitary and hypothalamus. NEUROENDOCRINE THEORY

GERO EXAM 3

1. An older woman recently lost her brother, provides care for her husband who has health needs, and must move to a new location after 35 years in the same home. When she comes to the

primary care facility with clinical indicators of influenza, the nurse recognizes which of the following? CRISIS AND STRESSORS CAN IMPAIR PHYSICAL HEALTH

2. Which of the following statements is true about the mental health of older adults? THE NURSE AVOIDS ANTIANXIETY MEDS WITHOUT AN ASSESSMENT FOR FACTORS ASSOCIATED WITH ANXIETY 3. Which of the following is a true statement about psychotic behavior in older adults? AN OLDER ADULT WITH PSYCHOTIC BEHAVIOR SHOULD BE ASSESSED FOR A VARIETY OF CAUSES 4. Which of the following statements is true about loss in older adulthood? REFERRING TO THE DECEASED IN THE PAST TENSE CAN ACKNOWLEDGE THE DEATHS REALITY 5. The HCP believes an older woman has approximately 6 weeks to live. After 2 months, the family remains at the bedside but, in the last few days, are becoming increasingly impatient and irritable. This pattern is least indicative of which of the following statements? FAMILY DESIRES THAT THE PT BE RELIEVED OF HER MISERY 6. After the older adult dies, the brother who has a hx of alcohol abuse upsets the family by going on a drinking binge instead of attending the funeral. Which of the following is the best description of the brother’s behavior? DISENFRANCHISED GRIEF 7. Which of the following interventions is recommended for an older adult in the final stages of dying? SUPPORT THE PRESERVATION OF ENERGY 8. Which of the following of statements is true about end-of-life care? THE PROXY APPOINTED IN A LIVING WILL CANNOT SPEAK FOR THE TESTATOR IN HEALTH CARE MATTERS OTHER THAN TERMINAL ILLNESS 9. After the loss and burial of a beloved pet, an older man loses weight because he eats very little. 3 months later, he starts to paint pictures of the pet and his appetite slowly improves. Describe the individual’s mourning for his pet. PET’S BURIAL AND PAINTING PICS OF THE PET 10. The primary difference between the Loss Response Model (LRM) and the Worden model of grief is which of the following? THE LRM USES A SYSTEMS APPROACH THAT ACTS TO UPHOLD STABILITY 11. When the older who is close to death asks the family to leave after short visits and acts withdrawn in their presence, the family becomes distraught. Which of the following does the nurse include in family teaching to explain the pt’s behavior? SHE CAN BE EXPERIENCING ANTIPATORY GRIEF 12. The son of an older couple ends his life suddenly and violently. The husband proceeds with living as usual. After 1 year, the wife remains in seclusion and is hospitalized for dehydration. Which steps should the nurse implement to help improve the wife’s mental health and wellness? ESTABLISH A TRUSTING, CARING RELATIONSHIP WITH HER

13. A pt loses her husband of a sudden MI, and she blames herself for not recognizing the warning signs. Which pt outcome associated with her loss should the nurse use to plan care? EXPRESS FEELINGS OF GUILT, FEAR, ANGER, OR SADNESS 14. The actions of a family member of an older adult who just died are chaotic, and they are unable to decide on a funeral home. Which recommendation should the nurse implement? SUGGEST THEY CALL SOMEONE WHO CAN HELP 15. While awaiting the imminent death of her sister, an older woman makes arrangements to bury her sister in the survivor’s home state because she cannot reach the other family members. Which step should the nurse implement? ASK QUESTIONS, INCLUDING QUESTIONS ABOUT THE LOCATION OF HER SISTER’S FAMILY 16. An older pt who has end-stage pulmonary disease decides to accept care from the palliative care nurse. The older adult will most likely benefit from the palliative care nurse in which pt needs of Weisman’s six needs of the dying? CONTROL 17. Which of the following is true about loss, dying, and death for older adults? THE GRIEVING PROCESS IS NOT RIGIDLY STRUCTURED 18. Which pharmacokinetic parameter is affected most by decreased intestinal motility r/t the aging process? ABSORPTION 19. Which process is increased in the early morning? FIBRINOLYTIC ACTIVITY

20. Which interaction between each prescription and food or nutritional supplement is favorable? TERAZOSIN (HYTRIN) AND INCREASED FLUIDS 21. Which med is correctly matched to the condition given of an older adult pt according to current med knowledge? BUSPIRONE (BUSPAR) FOR CHRONIC ANXIETY STATES 22. In questioning an older adult, which question is likely to elicit the most accurate information about the individual’s adherence to the med plan? HOW MANY DOSES OF DIGOXIN (LANOXIN) DO YOU THINK YOU MISSED?
21. Which of the following is on the list of drugs considered suitable for the older adult? BUPROPION (WELLBUTRIN) 24. A pt receives heparin daily. The nurse should assess for which clinical response that indicated the need to discontinue heparin therapy? HEMATURIA 25. A geriatric nurse practitioner prescribes an antidepressant for a pt. The pt asks, “How long will I have to be on this med before I feel like my old self?” The recalls that a therapeutic response to an antidepressant med most often takes which one of the following? 2 MONTHS 26. The nurse prepares to administer vancomycin (Vancocin) to an older adult. Which lab test should the nurse review before administering this med? CREATININE CLEARANCE

27. The nurse prepares to administer diltiazem (Cardizem LA) to an older adult with ischemic heart disease. What is the optimal time to administer this med to help prevent complications of heart disease associated with rhythmical variations? AT BEDTIME 28. A HCP has ordered alendronate (Fosamax) for an older adult who has been admitted for a hip fx. Which is the best response from the nurse when educating the pt on the new med? TAKE ON AN EMPTY STOMACH 29. When completing reconciliation for an older woman, the nurse notes that the pt is being discharged home on anticoagulant therapy. The nurse also notes that at admission, the pt reported that she uses herbal supplements at home. Which instruction should the nurse include during discharge teaching? AVOID USING CHAMOMILE SUPPLEMENTS WHILE ON ANTICOAGULANT THERAPY 30. The nurse provides instruction about med safety to older adults. Which instruction should the nurse provide? ASK THE HCP TO DESCRIBE THE PURPOSE OF THERAPY 31. An older man is taking Abilify for agitation. Which pt assessment is the nurse’s priority to prevent catastrophic effects of the meds? ORAL AND FACIAL DYSKINSIA 32. An older man is Thorazine, and the nurse helps him choose menu items. To prevent an exacerbation of potential adverse effects of therapy, which menu item does the nurse instruct the man to avoid? COFFEE WITH CREAM 33. Which of the following is a true statement about elimination in older adults? DEFACATION < 1X DAILY IS NOT NECESSARILY CONSTIPATION 34. Which action should be included in all bladder-retraining programs? TOILETING AT BEDTIME 35. The nurse understands that stress incontinence occurs? AS A RESULT OF INCREASED INTRABDOMINAL PRESSURE 36. What is the most important aspect of care for the nurse to maintain when assisting an older pt with urinary incontinence? MAINTAINING AN ATTITUDE THAT IS RESPECTFUL AND POSITIVE ABOUT RESOLVING THE PROBLEM

37. Which option is part of a program that addresses bowel incontinence in an adult pt? ENSURING THAT A TOILET OR COMMODE IS READILY ACCESSIBLE TO THE PT 38. An older adult who is on bed rest after surgery is prescribed morphine for pain. Which of the following is the nurse’s priority for preventive care? CONSTIPATION 39. The nurse is caring for a pt who has recently had an indwelling catheter placed. The nurse should assess the pt for? A CHANGE IN MENTAL STATUS 40. The nurse assesses a male resident in a nursing home for urinary incontinence and determines that he is unaware of the problem. Which recommendations should the nurse implement? PROVIDE REGULAR TOILETING

41. A large residual urine volume characterizes what type of incontinence? OVERFLOW 42. An older adult is in the hospital because of HF and has become incontinent of urine. Which EB resource should the nurse use to guide continence care for this pt? NURSING STANDARD PROTOCOL 43. The nurse wants to begin helping a resident who is overweight and has urinary incontinence with healthy bladder behavior skills. Which intervention should the nurse implement? SCHEDULE VOIDING AT 2 - 4 HR INTERVALS 44. An older woman tells the NP that she fears her family will place her in a nursing home because she developed stress incontinence. Which recommendation should the nurse implement? RECOMMEND EXERCISES TO STRENGTHEN PELVIC FLOOR 45. Which of the following statements of true about DM? DM IS DX AFTER 2 FASTING PLASMA GLUCOSE READINGS OVER 125 mg/dl 46. Which lab results are goals for reducing a person’s risk for DM and heart disease? HDL > mg/dl 47. When teaching a pt about foods that do not increase blood glucose, which should the nurse include? BROCCOLI 48. An older man with DM complains to the nurse that his feet feel like they are burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort? WEAR WELL-FITTING LEATHER SHOES 49. An older woman who has DM takes glipizide (Glucotrol) and tells the nurse that her blood sugar levels have been higher than normal since she began using a vag cream for hot flashes. Which one of the following interventions is the best for the nurse to implement? ASCERTAIN WHETHER THE VAG CREAM CONTAINS ESTROGEN 50. The older adult who has type 2 DM has a sensory impairment and unstable blood sugar levels. Which of the following alterations in sensory function does the nurse address in the POC? HAS DIFFICULTY HEARING IN CROWDED ROOMS GERO HESI V 1.A patient has been taking insulin/diabetes meds and other medication what should the nurse do first – Check glucose level.

2. A patient needs a better view room – Show patient available rooms. 3. Select all that applies- Hyperlipidemia, diabetes mellitus, old age/age related 4. Select all that apply for patient with osteoporosis- A, B, C 5. Patient with stage 3 ulcer in the sacrum- Encourage protein intake 6. Dementia patient who can’t be able to verbalize pain- Give pain meds regularly 7. Alcoholic patient being brought in by son and she states she has been in the mall shopping all day while son says she has been home sleeping - Answer is D and it starts with Con… 8. Patient with flushed face and dry skin after administering Iv fluids whats the next nurses action - Check blood pressure and heart rate 9. Man with shingles that was brought with wife to the hospital, before discharge- Ask if spouse had chickenpox 10. Don’t remember question but answer was BUN 60 and creatinine 4 11. Why patient is taking half the dose of regular medication – Creatinine 3. 12. Patient that is newly diagnosed with cancer and his wife died a year ago- Hopelessness due to loss 13. Son brought bruised mom in the hospital and states that mother just fell - Take mom to private room and ask if someone is hurting her 14. A Chinese man come into the er with a cough and the nurse notices 2.5 cm ecchymosis on his torso - Ask about alternative therapy 15. Patient complains of joint pain with redness while having joint injection- Report the complaints to provider 16. Patient taking hypnotics priority nursing diagnosis- Risk for injury 17. Select all that apply- Raise from bed slowly, Use call light, ensure patient knows how to use call light, tell patient to call nurse before getting out of bed. 18. Daughter states something wrong with her mother’s head- answer C- reevaluate the daughter’s perspective about the situation 19. Patient keeps calling nurse 4 times in 5 hrs. – Check patient’s vital signs/ blood pressure and heart rate 20. Daughter calls about with Parkinson and she is confused select all that apply - Ask if patient fell, ask if she has pain urinating, check temperature 21. Patient coming from PACU how to prevent pulmonary stenosis – have patient sit in the chair one day after surgery when stable 22. Patient with a stroke and been admitted in the long term care facility- let her have uninterrupted rest

23. What to encourage to reduce high risk of osteoporosis- Low fat dairy products 24. Patient receiving blood pressure meds- Check blood pressure before getting out of bed 25. Patient with right sided Paralysis - Perform ROM all extremities 26. Patient who was admitted two days ago and does not want to go eat and calls for assistance in all ADLs - Relocation stress 27. Patient worried about who will take care of husband while having minor surgery- Encourage to take husband to respite care 28. What to do while talking with client with one hearing aid- Pronounce your consonants…. 29. Patient complaining of abdominal pain and experiences dripping of urine- scan bladder for urinary retention 30. Patient who is incontinent- schedule shorter toileting time and encourage Kegel exercise. 31. Patient with arthritis and asked to use rubber jar opener- Will reduce joint pain 32. Patient yelling and wants to call son who died 4 years ago- Redirect with activity 33. Alzheimer patient wondering out of the facility- Asses what triggers the patient’s behavior 34. Patient states he fell 3 days ago what is to be concerned about – Patient complaining about headache 35. Patient fractured ankle and foot – Check both wrist and pedal pulse 36. Patient with oxygen of 80%- Check fingernails for cyanosis 37. Patient with left hip replacement what to worry about – capillary refill greater than 5 seconds 38. Don’t remember question but answer was check cognition state 39. Erickson’s theory- Talk about activities enjoyed in life 40. Nursing home patient showing nurse she has been getting bruises on the top of the hand- Review medication 41. Patient had some irregular shaped brown spots in hands and face- Senile lentigines 42. Patient with hip replacement and complains of back pain when nurse checks the foot is sticking out to the side - Contact provider immediate this might have been a dislocation of joint out of socket 43. Patient with hyper pigmented freckles - Document finding no further action needed. 44. Woman with osteoporosis joining walk- a- thon- Answer was D….. her for choosing weight baring exercise. 45. Don’t remember the question but answer was – determine baseline cognition. Identify the best statement about Geri nursing?

• Purposes of Geri nursing include the promotion of health and support for maximal independence An older adult is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of LTC?
• Facilitate family rituals r/t death and dying Which of the following is a true statement about Geri nursing for pt’s of different races and ethnic backgrounds?
• Facial expressions, body language, posture, and touch are important elements of communication between a nurse and a pt from a different ethnicity Which of the following is a true statement about differing health belief systems?
• In most cultures, older adults are likely to treat themselves using traditional methods before turning to biomedical professionals Which of the following considerations is most likely to be true when working with an interpreter?
• The nurse should face the pt rather than the interpreter Which of the following is most likely to be true about caring for an older African American pt?
• The pt can expect to find support from his church after discharge Which action should the nurse take when addressing an older adult?
• Speak clearly The nurse is aware that cultural competence means having the skills to put cultural knowledge to use in all of the following?
• Assessment The health care provider discusses the need for surgery with an older adult and her family. Which information about the older adult’s culture is important for the nurse to collect before this discussion to facilitate the process of informed consent?
• Rituals for death and dying Which health belief system uses treatments to repair a body part?
• Biomedical