Geriatric Nursing Care: Addressing the Needs of Older Adults, Exams of Nursing

Download Geriatric Nursing Care: Addressing the Needs of Older Adults and more Exams Nursing in PDF only on Docsity! 601 practice questions ONLY Questions With Complete Solutions ( NURS 601) A Which of following statements most accurately captures the role of chronic illness in the lives of older adults? A. Chronic illnesses constitute the leading cause of death for older adults. B. More older adults die from acute illnesses than from chronic diseases. C. While chronic diseases used to be the leading cause of death, this is no longer the case. D. While cancer rates have fallen, other chronic diseases remain a common cause of death. B Which of the following patient histories is most likely for a person older than 65 years of age? A. In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B. Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C. Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D. Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks C A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future? A. While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. B. By 2020, it is expected that over one-third of Americans will be over the age of 65. C. Both life expectancy and the percentage of people over 65 in the population will increase in coming decades. D. Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020. A Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life? A. Women tend to both live longer than men and marry men older than themselves. B. Men tend to have greater access to care facilities due to higher incomes and savings. C. Men are more likely to live with younger family members following the death of a spouse. D. Social pressures tend to stigmatize older men who live alone. Which of the following are typical activities of daily living? (Select all that apply.) A. Cooking B. Moving C. Toiling D. Eating E. Dressing B Which of the following nursing practices commonly performed in the geriatric medical unit of a hospital is most in need of modification or correction? A. The discharge planning process is begun immediately following admission. B. Patients at risk for urinary incontinence are catheterized in order to reduce the risk of urinary tract infections. C. Reality orientation is provided to patients who exhibit cognitive deficits. D. Patients are regularly prompted to practice deep-breathing and coughing exercises in order to mobilize secretions and prevent atelectasis. B An elderly woman suffering from abdominal pain, nausea, urinary incontinence, fever, and vomiting is brought to the emergency department. What is the most likely preliminary diagnosis? A. Colon cancer B. Urinary tract infection C. Aneurysm D. Appendicitis C The nurse discusses hand hygiene with the staff specifically regarding Clostridium difficile. Which of the following should the nurse include in teaching plan? A. The spores are transmitted only from direct contact, so wear gloves when touching the patient. B. Avoid the use of bleach and bleach cleaners in C. difficile isolation rooms, as the bleach does not kill the spores. C. Hand washing is required with running water and soap to remove the spores from the caregivers' hands. D. Use of alcohol-based hand cleansers is appropriate for use before and after each patient contact. C In examining a client with several diseases diagnosed, including hypertension and depression, the nurse examines the physiology of the effect of stress on the immune system. Which of the following physiologic responses affects this client the most strongly? A.A reduction in the level of virus-fighting interferon. B. A reduction in the antibody response to vaccines. C. An increase in the level of serum cortisol. D. An increase the number of immature T cells. B All of the following are primary risk factors for falling except for: A. Poor balance B. Presence of two or more chronic conditions C. Taking more than four medications daily D. Muscle weakness D A 78-year-old man comes for an office visit with his wife, who is concerned about his driving. She says he makes unsafe lane changes and seems to have difficulty with oncoming traffic when turning left. He has history of cervical OA, hypertension treated with ACE that has necessitated a temporary colostomy. The accompanying disturbance in his body image and activities of daily living has caused Mr. O to become depressed. During a visit by his daughter and son-in-law, the nurse brings Mr. O his scheduled medications, to which Mr. O states, "why not bring them all at once so I can end this mess." The daughter dismisses her father's statement as simply an expression of his pessimistic demeanor. Which of the following statements most accurately underlies the response that the nurse will choose? A. While older adults do sometimes commit suicide, the problem is mostly an issue of younger adults. B. The patient's statement requires appropriate follow-up and should be taken seriously. C. Suicidal ideation in older adults is often a consequence of polypharmacy. D. Older people attempt suicide frequently but rarely succeed. D A 76-year-old woman has been prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of her depression. What assessments should the nurse prioritize during the initial days of the patient's drug therapy? A. Monitoring the patient's blood work for fluid and electrolyte imbalances. B. Assessment of the patient's integument for signs of skin breakdown of inadequate circulation. C. Regular assessment of the patient's vital signs. D. Monitoring for changes in the patient's cognitive status and nutrition. C Which of the following older adults is most likely to have his or her health problem characterized as delirium rather than dementia? A. Mr. J, who has developed an unsteady and awkward gait coupled with uncoordinated motor skills in recent months. B. Mrs. O, whose children state that her personality has changed markedly and who has difficulty finding words lately. C. Mr. L, whose wife has brought him to the emergency department because of the forgetfulness and confusion that he has exhibited over the last 48 hours. D. Mrs. Y, who was diagnosed with a brain tumor and who has experienced consequent changes in behavior and cognition. A An elderly man is admitted to the hospital for surgery. A day later, he seems confused and disoriented. He imagines there is a trapdoor in the ceiling above his bed. His wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed "sharp as a tack." What should the nurse do first? A. Check the patient's chart for medications that can cause delirium. B. Tell the wife there is nothing to worry about. C. Control environmental temperatures and noises. D. Have the patient evaluated for Alzheimer's disease. C Which one of the following statements about delirium and dementia is most accurate? A. Dementia occurs in all elderly persons. B. Dementia and delirium are the same. C. A person who has dementia can suffer from delirium. D. Delirium causes a progressive, irreversible decline in cognition. D Determine which of the following nursing considerations has the highest priority for an elderly adult with dementia. A. Providing physical care B. Promoting therapy and activity C. Respecting the individual D. Ensuring patient safety B D) Older adults should receive annual influenza vaccinations and tetanus and diphtheria boosters every 10 years. D A gerontological nurse teaches a new nurse about older adults and pneumonia. Which of the following teaching points for the new nurse is most accurate? A) "The cardinal signs of a new onset of pneumonia are chest pain, fever above 100°F, and a productive cough." B) "Pneumococcal vaccine can significantly reduce the length and severity of pneumonia if given shortly after diagnosis." C) "The presence or absence of pleuritic pain can help differentiate between pneumonia and cardiac problems." D) "Pneumonia can often be prevented, but numerous age- related factors conspire to make older adults susceptible to it." A Which assessment finding is most important in determining nursing care for a client with pneumonia? A) Confusion and restlessness B) Fever C) Mild pleuritic chest pain D) A slight cough and fatigue B, C, D The diagnosis and treatment of cancer in older adults is accompanied by complexities that do not exist in younger populations. Which of the following phenomena contribute to the additional complexity of cancer diagnosis and treatment among the elderly? (Select all that apply.) A) Older adults tend to have atypical presentations of many types of cancer. B) The presence of other chronic health problems makes detection more difficult C) The potentially harmful effects of many treatment options make treatment more challenging. D) Detection often occurs at later stage in the course of the disease. E) Decreased survival rates in older adults mean that treatment is often not cost-effective. A An elderly patient scheduled for cancer treatments may require age-related adjustments in dosages for some procedures. Which kind of treatment can be administered without any age-related adjustment? A) Radiation therapy B) Biologic therapy C) Chemotherapy D) Surgery C A nurse is taking the medical history of an elderly patient who has thyroid cancer. What is an especially important question the nurse should ask? A) Have you ever used artificial sweeteners? B) Have you ever experienced stress? C) Did you have acne as a teenager? D) Have you ever smoked cigarettes? A, B, C The nurse assesses a change in the respiratory status of an older patient. Which findings should be reported to the health care provider immediately? (Select all that apply.) A) Neck vein distention B) Change in mental status C) Elevated blood pressure D) Infrequent cough E) Clear drainage from the nose A Which assessment finding indicates that an older patient is experiencing congestive heart failure? A) Moist lung crackles are audible on auscultation with shortness of breath on exertion C Mr. Jones, age 78, is diagnosed with systolic heart failure. He is unable to perform his ADL's without pausing for rest, uses oxygen around the clock and requires intermittent assistance. He has stopped attending his small garden due to worsening dyspnea with the activity. You would classify his heart failure as which according to the NY Heart Assoication: A) Class I B) Class II C) Class III D) Class IV E) Not able to be classified B During a health promotion seminar, a nurse is teaching a group of older adults at a senior center about some of the normal changes that accompany the aging process. Which of the following statements about the effects of aging on the nervous system is most accurate? A) "It's actually a myth that intellectual performance and verbal skills deteriorate in older adults. B) "Your brain actually becomes smaller as you age and this affects how quickly older adults react." C) "The brain's ability to assimilate new information decreases greatly after age 65." D) "While blood flow through the brain remains consistent across the life span, the electrical activity of the brain declines somewhat later in life." TRUE Secondary symptoms of Parkinson Disease include depression, sleep disturbances, dementia, and dysphagia True False A Which of the following patients on a subacute geriatric medicine unit is likely at the highest risk for experiencing a cerebrovascular accident (CVA)? A) Mr. L, age 79, who has poorly controlled hypertension and smokes half a pack of cigarettes daily. B) Mrs. H, a 90-year-old woman, who has a diagnosis of vascular dementia. C) Mr. J, a 77-year-old man, who has experienced an upper GI bleed and required a transfusion of packed red blood cells. D) Mrs. N, age 83, who has had a recent fall resulting in a broken left wrist and hip. D The nurse administers the initial dose of levothyroxine sodium (Synthroid) to a 76-year-old. Which of the following signs would indicate a complication? A) Anorexia B) Cold Intolerance C) Constipation D) Tachycardia B The nurse teaches a 90-year-old male patient these steps he can take to minimize urinary retention: ensure good fluid intake, massage the bladder area, and run water while he is voiding. The primary reason for this teaching is prevention of which of the following? A) Urinary incontinence B) Urinary tract infections C) Constipation D) Prostatic hypertrophy C The nurse admits a patient to the skilled care unit with symptoms of fatigue, weakness, and lethargy. Before the primary care provider completes a diagnosis of depression, which of the following laboratory tests should be completed? C The nurse instructs the patient receiving treatment for hypothyroidism. Which of the following statements, if made by the patient, indicate the need for further teaching? A) "I will continue to take the stool softener until my constipation is better." B) "I will call the office if I have any chest palpitations." C) "I will not need to refill this prescription." D) "I may need to have my dosage adjusted over time" B The nurse is on a task force to reduce the incidence of falls among residents of a long-term care facility. Which measure should the nurse recommend to prevent the most falls? A. The use of diffuse, natural lighting on the unit B. A fall history and fall risk assessment of each patient on admission C. Psychosocial interventions aimed at reducing individuals' fear of falling D. Use of physical restraints on new patients who have delirium or dementia. E. Use of bed, floor, and chair alarms for residents with dementia. D Which statement should be incorporated into the restraint policy for residents of a long-term care facility? A. Restraints should never be used. B. Physical restraints should only be used with verifiably agitated patients. C. Restraints should only be used when one-to-one staff supervision is not possible. D. Alternatives should be explored before chemical and physical restraints are utilized. D During a morning assessment the nurse notes that the oral temperature of an older patient is 96°F (35.6°C). What guide will the nurse use to make decisions about this assessment finding? A. Older adults are at increased risk for hyperthermia B. Low temperature constitutes a risk to cardiac health C. Older adults often lose body heat in response to infection D. The normal body temperature of older adults is often lower than that of younger people A A group of residents in a skilled nursing facility are sitting outside in the garden enjoying a hot summer day. What primary concern does the nurse recognize for these residents? A. Lack of thirst perception B. Lack of energy and related depression C. Lack of motivation to get out of the sun D. Effects of certain medications on body temperature FALSE True/False: If a person aged 60 or older had a prior case of shingles (Herpes zoster), the shingles vaccine is not recommended. D The nurse at the wellness center promotes activity by leading exercise programs. Which of the following is a benefit of such exercise? A. Cardiovascular stress B. Painful and stiff joints C. Urinary incontinence D. Improvement of mood A The client has been confined to bed for 3 months. Which of the following occurrences should the nurse anticipate secondary to this prolonged immobility? A. Bone demineralization B. Chronic muscle strengthening C. Improved cardiovascular endurance D. Increased joint flexibility B C. Establish whether the client has a durable power of attorney in place. D. Obtain medical records regarding prior admissions for similar problems. B Elements of informed consent include all of the following EXCEPT? A. Purpose of the intervention B. Time required to complete intervention C. Alternatives to intervention D. Expected consequences and risks of intervention A Q: How does guardianship differ from power of attorney? A. The court appoints a guardian. An individual grants a power of attorney to someone else to make decisions on his or her behalf B. Guardianship is legally binding whether or not an individual is competent. Power of attorney applies only to the incompetent C. Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of "reasonable prudence" are met D.Guardianship stays in effect for one calendar year and must be renewed annually. Power of attorney stays in effect until one or both parties choose to revoke it B What is the most important advantage of an advance directive? A. Such a will indicates how property is to be passed on after death and avoids probate for inheritors B. It spares the family the burden of making significant decisions for a patient regarding terminal care C. It settles the issue of guardianship without the expense of going to court for each incident D. It frees health professionals from any liability derived from Do Not Resuscitate orders A The nurse wants to ensure that assigned patients are comfortable. What will the nurse use as a measurement of comfort? A. A state of physical, emotional, and spiritual well- being B. An absence of reports, signs, or symptoms of physical pain C. A transcendent emotional and spiritual state that exists regardless of the presence or absence of pain D. A condition of maintaining a patient's self-report of pain being below a self-reported threshold of 1 out of 10 AC is an 82-year-old Caucasian married male with advanced dementia, FAST stage 6B prior to hospitalization for CVA, with resultant (R) flaccidity, now FAST 7e. When you see him, he presents with a furrowed brow, grimace, and is moaning, moving his left hand across his tray table. You recognize he is at risk for undertreated pain due to: A. The impact of aging on pain perception and tolerance B. Minimal prevalence of pain in older adults C. The change in the patient's ability to communicate as a result of the stroke D. The belief that pain is a normal part of being old E. Both C and E D. Use of sleep aids to initiate sleep A Quantity and quality of sleep can determine an older adult's health and well-being. A. True B. False B Which of the following medications should be used cautiously as a sleep aid with an older adult related to the high risk of anticholinergic side effects? A. Alprazolam (Xanax) B. Diphenhydramine (Benadryl) C. Furosemide (Lasix) D. Gabapentin (Neurontin) A Population projections for the United States support the view that the older population is becoming more ethnically and racially diverse. A. True B. False B A nurse is providing care for an 81-year-old Hispanic woman in the context of a geriatric medicine unit of a hospital. Which of the following phenomena should the nurse anticipate? A. The client's family is likely to advocate for her placement in a nursing home at an early stage. B. The client is likely to prioritize the role of spirituality in the healing process. C. She has maintained her health throughout her older years by seeking preventive services. D. The woman's family will most likely delegate responsibility for her care to the hospital care team. c Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because: A. Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B. Black Americans have a higher incidence of cancer and diabetes than white Americans C. Hypertension and heart disease occur at a higher rate in the black population than in the white population D. Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep A There is a lower life expectancy of black Americans; however, once a black individual reaches the seventh decade of life, survival begins to equal that of a similarly aged white person A. True D). Depression D Mr. T is a 70-year-old male admitted to the orthopedic unit in your hospital. He fractured his right ankle and had an ORIF this AM. As you take report from the day shift nurse, he tells you Mr. T is demanding to go home and keeps getting out of bed. Multiple attempts to explain he is unable to walk safely in his cast have not convinced him and he is now yelling, disturbing patients on the floor. Delirium: A). is self-limiting and requires no intervention B). usually has no identifiable cause C). requires acute assessment D). should be treated symptomatically D Mr. T is a 70-year-old male admitted to the orthopedic unit in your hospital. He fractured his right ankle and had an ORIF this AM. As you take report from the day shift nurse, he tells you Mr. T is demanding to go home and keeps getting out of bed. Multiple attempts to explain he is unable to walk safely in his cast have not convinced him and he is now yelling, disturbing patients on the floor. The causes of delirium include: A). Infection B). Hypoxia C). Medications D). All of the above Mr. T is a 70-year-old male admitted to the orthopedic unit in your hospital. He fractured his right ankle and had an ORIF this AM. As you take report from the day shift nurse, he tells you Mr. T is demanding to go home and keeps getting out of bed. Multiple attempts to explain he is unable to walk safely in his cast have not convinced him and he is now yelling, disturbing patients on the floor. Some strategies to assist in caring for Mr. T include: A). Reality orientation offered in a calm, nonjudgmental manner B). Calling family to visit the patient C). Telling him to relax and his ankle will heal D). Both A and B D Which of the following statements best describes vascular dementia? a. Neuronal atrophy of the frontal lobes of the brain b. Rare disease with a rapid onset and progression of the disease to death c. Behavioral rather than cognitive impairments in the early stages d. Caused by cerebral infarctions and history of cardiovascular disease A Delirium alters the level of consciousness whereas dementia does not. A). True B). False A The nurse is completing discharge teaching for an 80-year-old diabetic patient with a urinary tract infection. What should the discharge plan for this patient include to minimize the reoccurrence of the condition? A). Educate the patient on the association between diabetes and urinary tract infections. B). Discuss age-related changes to the urinary and immune systems and the increased risk for further infection. C) . Assess the primary factors contributing to the development of the urinary tract infection. D). Instruct the patient on proper hydration and hygiene. The nurse develops a plan of care for an 88-year-old new resident of a LTC facility who arrived from the hospital after a cardiac event brought on by heat stroke. The resident was diagnosed with pneumonia this morning. Of the following, which is the most likely explanation for the pneumonia? A). Cardiac events often precede pneumonia B). Pneumonia is directly related to the heat stroke C). Flu season and the increased number of cases D). Elderly predisposition to nosocomial pneumonia C Which of the following statements most accurately captures an aspect of the relationship between cancer and aging? A). The incidence and prevalence of cancer in older adults is approximately equal to that of younger adults. B). Cancer is the leading cause of death among persons age 65 and older. C). Age is the most significant risk factor for cancer. D). The prevalence of cancer in older adults is expected to decrease in coming decades. A he family of a 78-year-old male patient is shocked by his recent diagnosis of pancreatic cancer, citing his lifelong commitment to a healthy diet, consistent exercise, and avoidance of environmental risk factors. Which of the following factors most likely contributed to the man's diagnosis? A). Age-related changes to his immune system may have compromised his body's ability to recognize cancerous cells. B). The interplay of existing chronic conditions may have contributed to the etiology of his cancer. C). His cancer may have been a consequence of a bacterial or viral infection earlier in life. D). Autoimmune processes associated with the aging process may have initiated abnormal cell division. B A 77-year-old male patient who has been diagnosed with lung cancer is discussing treatment options with his oncologist. Which of the following factors is most likely to make the patient's treatment more complicated than that of a younger patient? A). Radiation treatment is not an option for most patients over age 70. B). Age-related decline in kidney function can affect drug therapy. C). The client is unlikely to be a candidate for surgery. D). Fewer pharmacologic treatment options exist for older adult clients. A. ankles, feet, and legs. B. chest and shoulders. C. head and neck. D. sacrum and coccyx C Which of the following statements most accurately captures the role of chronic illness in the lives of older adults? A. while cancer rates have fallen, other chronic diseases remain a common cause of death B. more older adults die from acute illnesses than from chronic diseases C. chronic illnesses constitute the leading cause of death for older adults D. while chronic diseases used to be the leading cause of death, this is no longer the case B The family of an 85 year old man who has been admitted to hospital with exacerbation of COPD has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults? A. payment for long-term care of adults is most often covered by private insurers B. Overall, federal money pays for more care than do older adults themselves or private insurers. C. most older adults have their basic care needs provided in a long-term care facility D. the high value of assets owned by the older adults makes the financial burden of care minimal for most older adults A Which of the following should the nurse consider when planning the care of older adults? A. the diversity of the older adult population B. the fact that most older people live below the poverty line C. the high prevalence of mental impairment among the elderly D. the lack of family support that is the norm among the elderly D Two related and important trends in the elderly population are: A. the growing gap in life expectancy between males and females and the number of women living alone B. the continued burden of acute disease and the low levels of education among the elderly C. the increase in life expectancy of white and black people D. the increased burden of chronic illness and the shifting causes of death with advancing age C What is the most important factor contributing to limitations in self-care and independent living among the elderly? A. low financial assets B. acute illness and injury C. chronic illness D. lack of family support A, B, D while those among non-minorities are expected to decrease B. the proportion of health care consumers who are minorities will increase significantly in the future C. nurses have a moral obligation to achieve cultural competency with all cultural groups D. government and health care organizations have ignored the need for culturally appropriate care A The aging process is accompanied by a number of changes in thermoregulation. Which of the following clinical phenomena in older adults is likely to result from these changes? A. lack of detection of an acute infection B. orthostatic hypotension C. impaired protein synthesis during hot weather D. susceptibility to skin breakdown on bony prominences C The nurse is conducting a study on the needs and living situations of older adults in the community. Which of the following statements should the nurse take into account? A. most older Americans reside in some form on institutional arrangement B. a majority of older Americans will live in a nursing home at some point C. assisted-living arrangements have become increasingly common D. more older men live alone than older women D A nurse who provides care for older adults in a long-term care setting is aware of the importance of maintaining residents' connectedness to society. How can this aspect of quality of life by best achieved? A. allowing residents to have input into the meal planning at the facility B. conducting reminiscence therapy C. ensuring that there are multiple television sets available to residents of the facility D. arranging regular visits by school children to the facility B A 55 year old adult female patient recently learned she has type 2 diabetes. She does water aerobics three times a week, has completed a diabetes education class, and does blood glucose monitoring herself. her blood sugar and hemoglobin A1c have improved and she has lost weight. Which of the following statements best describes this patient's actions? A. age stratification theory B. compression of morbidity C. longevity and senescence theory D. life-course development A, C, D When discussing the effects of stress on the aging process, the nurse should include which conditions? Select all that apply. A. gastic ulcers B. enhanced thyroid function