Geriatric Exam 1 NCLEX Practice Questions and Answers, Exams of Nursing

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Geriatric Exam 1 NCLEX Practice Questions and Correct

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1. The charge nurse has provided a staff inservice on the cultural triad and nursing care. Which statement, made by a staff nurse, best indicates an understanding of a healthcare team's difficulty with cultural literacy?

1. "Our healthcare team has limited knowledge of each others' backgrounds."
2. "Each of our perspectives of our own heritage interferes with cultural literacy."
3. "A feeling of being disconnected from our own culture has resulted in cultural illiteracy."
4. "The lack of healthcare policies have contributed to the current state of cultural illiteracy." - ANSAnswer: 1 Explanation:
5. Limited understanding of ethnic, cultural, religious heritages and life trajectories of each other results in difficulty with cultural literacy.
6. The perspective of a person's heritage reflects the consistency with their own heritage.
7. Feeling disconnected from one's own culture and not being able to acculturate to a prevailing culture is a personal experience known as cultural marginality.
8. There is not specifically a lack of healthcare policies that have contributed to cultural illiteracy. However, nurses should recognize the effect of healthcare

policies, delivery systems, and resources on the older adult populations and continue to advocate for their inclusion.

1. The nurse is assessing an older patient in a skilled facility for frailty. During the assessment, the nurse determines frailty through the presence of which characteristics? Select all that apply.

1. Unplanned weight gain
2. Poor endurance
3. Increase in grip strength
4. Low activity tolerance5. Generalized weakness - ANSAnswer: 2, 4, 5 Explanation:
5. Frailty has also been defined as the presence of unplanned weight loss (10 lbs. in the last year).
6. Frailty has also been defined as the presence of poor endurance and energy.
7. Frailty has also been defined as the presence of decline in grip strength and gait speed.
8. Frailty has also been defined as low activity tolerance.
9. Frailty has also been defined as the presence of weakness and exhaustion.

1. The nurse is preparing to conduct a health history with an older client. Which action should the nurse take to ensure the accuracy and efficiency of the client's health history?

1. Scheduling one-half hour for the medical history interview.
2. Requesting the client use the bathroom before starting the interview.
3. Ensuring the client has their identification and insurance card with them upon arrival.
4. Conducting the history in an environment with comfortable seating and proper lighting. - ANSAnswer: 4 Explanation:
5. Patients should have a minimum of 1-hour appointments scheduled. Shorter appointments will result in a hurried interview with missed information.
6. The reference states to be sure there are bathrooms available during the interview.
7. The ID and insurance card are unrelated to gathering data for a health history.
8. To make the older patient comfortable, adequate lighting and seating should be available.

1. The nurse is preparing to discharge an older client with instructions on smoking cessation. The nurse states to a colleague, "This client has been smoking for years and isn't going to stop now." Which negative stereotype of aging does the nurse's statement most reflect?

1. Old people are expected to be sick.
2. Old people are set in their ways.
3. Old people do not value health promotion education.
4. Old people are a drain on societal resources. - ANSAnswer: 3 Explanation:
5. Many older adults have chronic disease but function well.
6. Often people characterize the elderly in a negative way, believing that after a certain age, things cannot be changed. Older people can learn new things and take up new hobbies they can enjoy and give life meaning and pleasure.
7. Although it may not be possible to reverse all the damage, it is never too late to stop smoking cigarettes. People who quit smoking at an older age enjoy better health outcomes.
8. Older people contribute greatly to society by volunteering, helping with grandchildren, mentoring others, and continue working.

1. The nurse supports an older client's desire to discuss advance directives with the client's family. What action is the nurse performing with this client?

1. Facilitating palliative care
2. Educating the family on healthcare services
3. Collaborating with the interdisciplinary team
4. Advocating for client's rights and autonomy - ANSAnswer: 4

Explanation:

1. Palliative care alleviates pain and suffering. There is no information to suggest the client is in need of palliative care.
2. Educating the clients on healthcare services is important, but the nurse is not educating in this role, they are supporting a discussion with the family.
3. Collaboration with the interdisciplinary team would include the nurse working with other professionals to provide client care. The nurse is not collaborating with other professionals regarding the client's desire to complete advance directives.
4. The nurse is advocating for the family and client regarding end-of-life decisions. This is included in the knowledge and skills of gerontological nurses. 10.During an activity in the recreation room the nurse notes a resident staring with a puzzled expression after instructions for a group activity are given. What should the nurse do to assist this resident? A. Talk louder in the future B. Lower the room lights C. Repeat the information after making eye contact D. Hold the resident's hand - ANSC. Repeat the information after making eye contact Rationale: A puzzled look may mean the person cannot hear but is ashamed to interrupt. Because of the puzzled look, the nurse should repeat the information about the activity. Talking louder can be disturbing. There is no reason to lower

the lighting in the room. The resident is not demonstrating an emotion issue, so holding the hand is not appropriate at this time.

10. A 62-year-old former professional football player is in the hospital for a total knee replacement as a result of wear and tear and a medical diagnosis of osteoarthritis. Which biological theory of aging would help explain this patient's current health problem?

1. Cross-link
2. Free radical
3. Wear-and-tear
4. Somatic DNA damage - ANSAnswer: 3 Explanation:
5. The cross-link theory is related to the accumulation of cross-linked proteins causing disease. This theory does not explain the damage done to the patient's joint from playing football.
6. The free-radical theory states that cell damage is a result of accumulation of oxygen radicals. This theory does not explain the damage done to the patient's joint from playing football.
7. Osteoarthritis is characteristic of degeneration that results from joint usage. This disease is characteristic of the aspects of the wear-and-tear theory, which states that there is a "master clock" that controls all organs and cellular functions, which becomes less efficient over time. Abusing one organ or bodily system

through repeated injury that occurs with contact sports may result in premature aging and diseases such as osteoarthritis.

4. The somatic DNA damage theory states that genetic mutations occur and accumulate with increasing age. This theory does not explain the damage done to the patient's joint from playing football.

10. The nurse is caring for an older adult in a long-term care facility. Which statement made by the client best indicates that the client practices heritage consistency?

1. "I look forward to my family visits every Sunday."
2. "The younger generation does not understand me."
3. "My parents were so happy that my spouse shares our culture."
4. "I was so excited to learn English when I came to this country." - ANSAnswer: 1 Explanation:
5. Heritage consistency includes the enjoyment of regular contact with their extended family.
6. A generation difference is a challenge to heritage consistency.
7. Marrying someone from the same culture is not an example of heritage consistency.
8. An older adult demonstrates ties to their ethnicity through dress, language, preferred foods, family celebrations, and holidays.

10. The nurse is concerned that an older patient with a chronic illness is on a trajectory towards frailty and dependence. From the nursing assessment findings listed, which is the priority?

1. Sustained cognitive impairment
2. Conditions controlled with medications
3. Family that phones several times a day
4. A decline in functional ability - ANSAnswer: 4 Explanation:
5. A cognitive impairment may have a greater impact on an older person's function than does osteoarthritis. This client's cognitive impairment is sustained.
6. Many chronic conditions, such as osteoporosis and hypertension, are controllable with medications and do not automatically lead to frailty.
7. Social support from family will prevent the patient from moving on the trajectory towards frailty and dependence.
8. Disabling effects and progression of symptoms may be controlled or halted with careful treatment and monitoring, but if the client is declining in these areas, they may be on a trajectory towards frailty.

10. Which of the following actions by the nurse would meet the standard of care?

1. The nurse questioned a physician about a prescription where the dose was higher than the recommended dose.
2. The nurse medicated a client who reported severe chest pain with aspirin and then called the physician to get a prescription.
3. The nurse brings a breakfast tray into the client's room and puts in on the counter away from the client who is vomiting and nauseous.
4. A nurse leaving the facility at the end of the shift witnesses a client fall. The nurse calls for help and tells the other nurse that during the next shift he or she will fill out the incident report. - ANSAnswer: 1 Explanation:
5. Questioning a medication dosage outside the normal range is a situation in which a reasonable nurse would pursue a similar action and would be considered the standard of care.
6. Medicating a client with aspirin for severe chest pain without a prescription and then notifying the physician would not be considered standard care.
7. The nurse should have withheld the breakfast tray from a client who is nauseated and vomiting or at least left it outside the client's room so the client would not smell the food and possibly exacerbate the symptoms.
8. Assisting a patient who has fallen is a situation in which a reasonable nurse would pursue a similar action and would be considered the standard of care. The nurse would then need to fill out the incident report at the time of the incident, not on the next shift.

11. A multidisciplinary team in a long-term care facility is meeting with the family of a frail older patient to discuss care issues and concerns. What key issues should be addressed in the conference? Select all that apply.

1. Consistency with policy
2. The patient's preferences
3. Avoidance of doing harm to the patient
4. Focus on cost-effective methods
5. The needs and wishes of the family - ANSAnswer: 1, 2, 3, 5 Explanation:
6. The provision of care for the seriously ill long-term care resident should be consistent with accepted public policy.
7. The provision of care for the seriously ill long-term care resident should honor the resident's preferences.
8. The provision of care for the seriously ill long-term care resident should not inflict undue burden or harm to the resident without a reasonable chance of success.
9. The provision of care for the seriously ill long-term care resident should honor the resident's preferences, reflect the needs and wishes of families, be consistent with accepted public policy, and not inflict undue burden or harm to the resident without a reasonable chance of success. The focus is not on cost-effective methods when providing care.

5. The provision of care for the seriously ill long-term care resident should reflect the needs and wishes of families.

11. An older patient is refusing to receive the influenza and pneumococcal vaccinations because he believes he is "too old." How should the nurse respond to this patient?

1. "I understand your feelings."
2. "I will report your concerns to the physician."
3. "You are likely to get sick if you do not take the vaccines."
4. "It is never too late in life to begin health promotion activities." - ANSAnswer: 4 Explanation:
5. Telling the patient that the nurse understands the patient's feelings does not help the patient understand the importance of health promotion activities.
6. Reporting the concerns to the physician does not help the patient understand the importance of health promotion activities.
7. While the patient has an increased likelihood of developing an illness if the vaccines are not taken, stating this does little to meet the patient's voiced concerns.
8. Receiving vaccinations for communicable diseases is a form of health promotion. The patient should be advised that age should not restrict health- saving activities.

11. The nurse that lives in a predominantly Spanish-speaking community is learning to speak Spanish. Which describes the best use of learning Spanish?

1. The nurse will be able to communicate better with the clients' families.
2. Speaking a second language will facilitate the professional growth of the nurse.
3. A second language will help when communicating with others in the community.
4. The nurse can gain a great deal of personal accomplishment after learning a second language. - ANSAnswer: 1 Explanation:
5. The best use for a nurse learning to speak Spanish is the ability to communicate with their clients and their families effectively.
6. Learning a second language can help facilitate the professional growth of the nurse but will be of best use when communicating with the clients and their families.
7. A second language will help facilitate communication with others in the community but will be of best use for communicating with the clients and their families.
8. The nurse can derive a great deal of personal satisfaction from learning a second language, but the language will be of best use when communicating with the clients and their families.

11. What actions will the nurse follow when using restraints for an older client in a long-term care facility? Select all that apply.

1. Use restraints for 2 hours or less.
2. Use restraints for emergency situations only.
3. Utilize waist restraints to prevent client falls.
4. Obtain a physician's order before using restraints.
5. Remove the client's eyeglasses when applying restraints. - ANSAnswer: 1, 4 Explanation:
6. Restraints are now limited to short-term use of 2 hours or less.
7. Restraints may be necessary in other situations other than just in emergency situations.
8. Waist restraints are not proven to be the best approach to prevent client falls. Nurses are urged to develop alternatives to physical restraints such as addressing client and environmental factors.
9. Restraints are used only with a physician's order.
10. The nurse should ensure the client is wearing eyeglasses, which would reduce the need to use a restraint.

12. A nursing student is preparing a program to review health concerns for seniors. Which statement should the student include in the presentation?

1. "Heart disease is the leading cause of death for senior citizens."

2. "Decreases have been shown in the rate of Alzheimer's disease."
3. "The rate of heart-disease death for senior citizens is steadily increasing."
4. "Cancer is currently steady within the senior citizen population." - ANSAnswer: 1 Explanation:
5. Heart disease is the leading cause of death in the senior population, even though it has decreased by 2.4% between 2009 and 2010.
6. The death rate increased significantly from 2009 to 2010 for Alzheimer's disease.
7. The rate of heart disease in the senior population has decreased by 2.4% between 2009 and 2010.
8. Cancer is among the top causes of death but is not the number one cause of death.

12. An older patient is demonstrating delirium since being admitted from a nursing home for treatment of a wound infection. What should the nurse identify as the most likely cause for the patient's delirium?

1. High television volume
2. Intravenous fluid therapy
3. Windowless hospital room
4. Assessments every 4 hours - ANSAnswer: 3

Explanation:

1. Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium. High television volume is not associated with delirium.
2. Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium. Intravenous fluid therapy is not associated with delirium.
3. Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium.
4. Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium. Assessments every 4 hours are not associated with delirium.

12. The gerontological nurse is planning health promotion actions for an older client. Which of the following information should the nurse focus on when planning these actions? Select all that apply.

1. Client has type 2 diabetes mellitus.
2. Client walks for 30 minutes 3 times a week.
3. Client uses BIPAP machine for sleep apnea.
4. Client attends religious services every Sunday morning.
5. Client lives alone and volunteers at the local library most afternoons. - ANSAnswer: 2, 4, 5

Explanation:

1. Health promotion for the older adult is not focused on disease or disability. Type 2 diabetes would not be a focus when planning health promotion.
2. Health promotion for the older adult is focused on individual strengths, abilities, and values. Walking for 30 minutes 3 times a week would be taken into consideration for the patient.
3. Health promotion for the older adult is not focused on disease or disability. Using a BIPAP machine for sleep apnea would not be a focus when planning health promotion.
4. Health promotion for the older adult is focused on individual strengths, abilities, and values. Attending religious services every Sunday would be taken into consideration for the patient.
5. Health promotion for the older adult is focused on individual strengths, abilities, and values. Living alone and volunteering at the local library most afternoons would be taken into consideration for the patient.

12. The nurse is caring for an older client that has requested time to pray. Which interventions are most appropriate to facilitate the client's ability to perform the ritual? Select all that apply.

1. Request a chaplain
2. Defer scheduled activities
3. Remain with the client during prayer

4. Encourage the client to pray when family are visiting
5. Ask questions about the client's beliefs - ANSAnswer: 2, 5 Explanation:
6. The nurse should offer the services instead of requesting a chaplain. Requesting a chaplain is an assumption the client would like their services.
7. The nurse that is practicing cultural competence will defer scheduled activities for the client to pray.
8. The nurse should offer privacy to the client for prayer.
9. Encouraging a client to pray when family are visiting does not address the client's immediate spiritual needs.
10. Show a sincere interest in learning about their culture. When you do not understand a person's actions, politely and respectfully seek information.

13. An older patient admitted for treatment of pneumonia has severe osteoarthritis. The nurse notices that the client is progressing on a trajectory towards frailty. What nursing assessment findings support this?

1. Poor appetite
2. Frequent requests for pain medication
3. Decreased stamina and deconditioning
4. Compliance with prescribed breathing treatments - ANSAnswer: 3 Explanation:

1. Signs of frailty in an older person with musculoskeletal problems do not include a poor appetite.
2. Signs of frailty in an older person with musculoskeletal problems do not include frequent requests for pain medication.
3. Signs of frailty in an older person with musculoskeletal problems may include decreased stamina and physical deconditioning.
4. Signs of frailty in an older person with musculoskeletal problems do not include compliance with prescribed breathing treatments.

13. The nurse is preparing to admit an elderly patient who is deaf. What should the nurse do to ensure effective communication with the patient?

1. Use the hospital-approved interpreter program.
2. Use the patient's family members to communicate with the patient.
3. Ask the patient to read assessment questions off of the computer screen.
4. Ask if anyone who is currently working could help communicate with the patient. - ANSAnswer: 1 Explanation:
5. Using the hospital-approved interpreter program is the intervention of choice when communicating with any patient who is deaf or has limited English proficiency.

2. Using family members can interfere with confidentiality and also does not ensure that the information is being communicated correctly.
3. Asking the patient to read assessment questions off of the computer screen does not ensure that the patient will understand the questions that are being asked.
4. Using other coworkers can interfere with confidentiality and also does not ensure that the information is being communicated correctly.

13. The nurse provides care to patients in a long-term care facility that embraces the Continuity Theory of Aging. Which actions will the nurse plan to promote this theory? Select all that apply.

1. Plan rest periods between activities.
2. Introduce patients to a wide variety of new activities.
3. Encourage family members to visit with the patients.
4. Suggest participating only in activities that bring satisfaction.
5. Remind patients that withdrawing from activities is expected. - ANSAnswer: 1, 3, 4 Explanation:
6. In the Continuity Theory of Aging, the pace of activities may be slowed, so rest periods between activities would be appropriate.

2. In the Continuity Theory of Aging, older age is not viewed as a time for major life readjustments but rather as a time to continue being the same person. Introducing patients to new activities does not support this theory.
3. In the Continuity Theory of Aging, successful aging involves maintaining family ties. Encouraging family members to visit with the patients would be appropriate.
4. In the Continuity Theory of Aging, activities pursued in life that did not bring satisfaction may be dropped. Suggesting that patients avoid activities that do not bring satisfaction would be appropriate.
5. In the Continuity Theory of Aging, successful aging involves maintaining values, habits, and preferences that formed the basic underlying structure of adult life. Reminding patients that withdrawing from activities is expected supports the Disengagement Theory.

13. Which of the following actions, if observed by the charge nurse, would require the charge nurse to intervene?

1. The nurse looks over the physician's shoulder to see the results of an assigned client's labs.
2. The nurse requires a client to fill out a release of information form when the client requests a copy of his or her medical record.
3. The nurse asks another nurse to quickly look up the results of an x-ray of a client since the other nurse is already signed on the computer.

4. The nurse faxed reports of client tests to a machine that is in the office of the client's primary care physician, and a nurse is expecting the report. - ANSAnswer: 3 Explanation:
5. The nurse would not be violating confidentiality if the client and physician are both caring for the client.
6. Clients must sign a release form when they want copies of their medical records.
7. Nurses should never ask another nurse to look up client information if that nurse is not involved in the client's care. This would require the charge nurse to intervene.
8. Faxing client information via fax machine is legal as long as the information is kept private and an authorized person is there to receive the information.

14. A graduate nurse is nervous about caring for older adult patients because of the personality changes that occur with aging. How should the nurse's preceptor respond to this statement?

1. "Personality tends to stay stable through life, rarely showing signs of change during final years."
2. "The losses many elderly experience understandably will impact their personality."

3. "The personalities of the elderly do undergo some significant changes after the eighth decade of life."
4. "After retirement, feelings of disuse cause many elderly to begin demonstrating personality changes." - ANSAnswer: 1 Explanation:
5. Personality is stable throughout adult life and rarely do healthy older people show signs of personality change during their final years.
6. Personality usually does not change radically even as a result of major lifestyle changes such as the death of a loved one.
7. Personality is stable throughout adult life and rarely do healthy older people show signs of personality change during their final years.
8. Personality usually does not change radically even as a result of major lifestyle changes such as retirement.

14. The nurse is planning a presentation for nursing assistants on caring for older patients. Which criteria should the nurse include when explaining frailty? Select all that apply.

1. Slowness
2. Low activity
3. Short-term memory loss
4. Weakness and exhaustion

5. Unplanned weight loss of at least 10 lbs. in a year - ANSAnswer: 1, 2, 4, 5 Explanation:
6. Frailty has been defined as the presence of three or more specific criteria which include slowness.
7. Frailty has been defined as the presence of three or more specific criteria which include low activity.
8. Frailty has been defined as the presence of three or more specific criteria. These criteria do not include short-term memory loss.
9. Frailty has been defined as the presence of three or more specific criteria which include weakness and exhaustion.
10. Frailty has been defined as the presence of three or more specific criteria which include an unplanned weight loss of at least 10 lbs. in one year.

14. The nurse overhears a student nurse discussing the three areas of focus of cultural care nursing. Which statement by the student best indicates a lack of understanding of cultural care nursing?

1. "The nurse must understand the client's background."
2. "A nurse must acknowledge the total context of the client's situation.
3. "When caring for clients, the nurse should be familiar with the client's cultural health practices."

4. "Nursing considerations regarding the client's culture should be incorporated into the care plan." - ANSAnswer: 4 Explanation:
5. Understanding the client's background is a component of providing culturally appropriate care.
6. Considering the context of a client's situation is a component of providing culturally appropriate care.
7. Familiarization with cultural health practices is reflective of culturally appropriate care.
8. A plan of care should incorporate the assessment findings regarding the client's cultural preferences, not nursing considerations.

14. Which of the following situations would be a priority for the nurse to intervene?

1. A client's spouse asks the nurse for the results of an HIV test.
2. Copies of the patient's diagnostic test results are found in the regular trash behind the nurse's station.
3. The charge nurse overhears a physician asking another physician not involved in the client's care to look at a test result.
4. A client's medical record is left unattended on a stretcher outside the radiology department while the client receives an x-ray. - ANSAnswer: 1

Explanation:

1. A breach in patient privacy is the nurse discussing the client's condition with a relative without the client's permission, and if the nurse gives the results, there is no way to undo that information and to protect the client's privacy. This should be the charge nurse's priority.
2. Copies of patient records must be rendered unreadable before being discarded. This would be a violation of HIPAA but not an immediate threat to the client's privacy, so it would not be the priority.
3. The physician should not be asking another physician to look at records unless a formal consult has been ordered; however, this would not be a priority since all doctors should protect client information, so there is no immediate threat of client information being unprotected.
4. Patient records must be secure, especially when used in departments other than the nursing unit. However, this would not be the priority unless the charge nurse saw that someone without authorization was trying to look at the medical record.

15. A patient voices concerns about her body weight despite diligently following a healthy diet. Which age-related change would explain this patient's issue with body weight?

1. Body fat increases until middle age.
2. Body weight increases after middle age.