Geriatric Nursing: Caring for Older Adults, Exams of Nursing

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1. Mrs. Williams is 76 years old and comes in to have a wound checked on her right leg. She fell a month ago and the wound has not healed. She is concerned that something is wrong. The nurse practitioner examines the wound and sees that it has been cleaned properly and has no signs of infection. The edges are approximated, but the skin around the wound is red and tender to touch. The best response regarding Mrs. Williams’ concern is: a. Wound healing for older people may take up to four times longer than it does for younger people. b. Let us talk about what you are eating. c. Had you come in earlier, I would have ordered medicine that would have healed that right up. d. I will order an antibiotic to prevent infection. The correct answer is: Wound healing for older people may take up to four times longer than it does for younger people. 2. The nurse practitioner is conducting patient rounds in a long-term care facility. As she talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin is shearing. The nurse practitioner explains to the staff that Mrs. Jones needs frequent assessment of her skin and protection provided to prevent skin breakdown because: a. Her lack of activity causes the skin to tear. b. Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such as the face, hands, and sacrum. This can result in injury. c. She has lost weight and is in jeopardy of falling. d. She picks at herself and causes skin breakdown. The correct answer is: Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such as the face, hands, and sacrum. This can result in injury. 3. The nurse practitioner is concerned with primary prevention strategies. How can the nurse practitioner implement primary prevention strategies for an 80-year- old male patient who smokes? a. Review home fire safety protocols, including the proper use of smoke alarms, and discuss smoking cessation. b. Inform him that if he does not stop smoking, the nurse practitioner cannot see him again. c. Have a conference with his family about his smoking.

d. Plan a family meeting with the patient to discuss benefits of his smoking cessation. The correct answer is: Review home fire safety protocols, including the proper use of smoke alarms, and discuss smoking cessation.

4. Ms. Rose, 88 years old, comes to the nurse practitioner with a complaint about a growth on her hand. She wants to have a biopsy done. The nurse practitioner asks the following question: a. Have you injured your hand recently? b. Are you using a different detergent? c. Has this growth changed, bled, or is it painful? d. Has this growth made it difficult to put on your rings? The correct answer is: Has this growth changed, bled, or is it painful? 5. Mr. Jones, a 70-year-old male, visits the urgent care and presents symptoms of unilateral eye pain, visual blurring with halos around lights, red eye, and photophobia. He also reports nausea and vomiting. Visual acuity shows a loss in the affected eye. He is immediately referred for a complete ophthalmic examination. Which of the following conditions may Mr. Jones be experiencing? a. Acute glaucoma b. Conjunctivitis c. Hyphema d. Uveitis The correct answer is: Acute glaucoma 6. A 67-year-old female patient comes in for an office visit presenting symptoms of nasal congestion, itching, and sneezing and is diagnosed with rhinitis. Which of the following is true about the types of rhinitis? a. Allergic rhinitis (AR) is a condition of adulthood and is more common in the older adult. b. AR develops when the body’s respiratory system becomes sensitized and overreacts to something in the environment. c. Nonallergic rhinitis (NAR) is most common between ages 10 and 39, declining after age

40. d. NAR is a condition of adulthood and is more common in the older adult.

The correct answer is: NAR is a condition of adulthood and is more common in the older adult.

7. Which of the following is the correct term for the eye condition that presents a sterile mass on the eyelid that is painless and has no reddening? a. Blepharitis b. Entropion c. Hordeolum d. Chalazion 8. The nurse practitioner knows that risk factors for coronary artery disease (CAD) include atherosclerosis. The nurse practitioner includes teaching on these factors that can be remediated to help prevent CAD: a. Low blood pressure. b. Age. c. Advanced age and male gender. d. Cholesterol levels and smoking. The correct answer is: Cholesterol levels and smoking. 9. Mr. Thomas comes in for a health examination with his nurse practitioner. When the nurse practitioner measures his blood pressure, the systolic is 150 mm and the diastolic is 80 mm. When Mr. Thomas asks if that is a good pressure for him, the nurse practitioner responds: a. It is normal for your age. b. Isolated hypertension is usually identified by a systolic blood pressure (SBP) higher than 160 mm Hg. c. When evaluating blood pressure, a higher diastolic blood pressure (DBP) is risky. d. There is a risk of a cardiovascular event for you with an SBP of 150 mm Hg. The correct answer is: Isolated hypertension is usually identified by a systolic blood pressure (SBP) higher than 160 mm Hg. 10. A 58-year-old man is being seen by his nurse practitioner for a cardiac work-up. His cholesterol is 320 mg/d. The nurse practitioner includes teaching about lowering his cholesterol by discussing blood levels and dietary choices. The nurse practitioner says which of the following?

it. a. Your cholesterol level is above normal for your age and we need to address how to lower b. We will discuss food choices that will raise your LDL levels. c. We will discuss food choices that will lower your HDL levels. d. The effects of high cholesterol levels will not be a factor in cardiac disease after you turn 60 years old. The correct answer is: Your cholesterol level is above normal for your age and we need to address how to lower it.

11. The nurse practitioner sees a patient in the emergency department with reports of chest pain and nausea. To analyze the patient’s condition, what further information is needed? a. Whether there has been constipation. b. A description of the pain. c. Information regarding last food intake. d. Information regarding urinary difficulties. The correct answer is: A description of the pain. 12. The nurse practitioner and a student are examining the apical pulse of an 82-year-old man. The student perceives that there is an S 4 sound. The nurse practitioner interprets that this is likely: a. An early ventricular filling. b. Heart blockage. c. Mitral regurgitation. d. Normal, due to the man’s age. The correct answer is: Normal, due to the man’s age. 13. Mr. Borden is 79 years old and lives with his daughter. The daughter provides excellent care for her father and wants to know which changes in his heart and circulatory system are due to aging and which are due to lifestyle choices. The nurse practitioner replies: a. The size of the heart increases with age. b. The left ventricle hypertrophies in response to increasing in age. c. The activity of the heart decreases in its ability to deal with stress, as well as to provide physical strength as one ages.

d. The patient’s diet affects the ability of the heart to balance blood pressure. The correct answer is: The activity of the heart decreases in its ability to deal with stress, as well as to provide physical strength as one ages.

14. The nurse practitioner is seeing patients in the respiratory clinic. An 85-year-old woman comes in with concerns about having difficulty breathing. When considering asthma, the nurse practitioner asks which of the following questions? a. Do you feel out of breath during the day? b. Do you have a cough, especially at night? c. Do you feel a tightness in your chest? d. May I listen for wheezing in your breathing? e. Do you feel any dyspnea? You have correctly selected 1. The correct answers are: Do you feel out of breath during the day?, Do you have a cough, especially at night?, Do you feel a tightness in your chest?, May I listen for wheezing in your breathing? 15. Medications that may cause orthostatic hypotension include: a. Anti-hypertensives. b. Antipsychotics. c. Acetylcholinesterase inhibitors. d. SGLT2 inhibitors. e. None of the above. The correct answers are: Anti-hypertensives., Antipsychotics., Acetylcholinesterase inhibitors., SGLT2 inhibitors. 16. When evaluating a patient with chronic cough, it is not recommended to suppress cough in a patient with stable COPD. True False The correct answer is 'True'. Correct 17. The American Academy of Ophthalmology recommends comprehensive eye examinations every 1 to 2 years for people ages 65 years and older.

True False The correct answer is 'True'.

18. The nurse practitioner assesses a patient’s skin and finds an infectious lesion on the lower leg. The lesion is considered a secondary lesion. The nurse practitioner explains that a secondary lesion is one that: a. Arises from changes to a primary lesion. b. Is a complication of an underlying disease. c. Is difficult to treat. d. Is a normal sign of aging. The correct answer is: Arises from changes to a primary lesion. 19. Oral cancer is a malignant tumor presented by a nonhealing sore in the mouth or lip that causes difficulty chewing or swallowing. Which of the following statements applies to an oral cancer diagnosis? Select one: a. It cannot be prevented. b. It involves unexplained lymph node swelling in the head and neck area. c. It is three times more likely in women than men. d. It involves unexplained lymph node swelling in the axillary area. The correct answer is: It involves unexplained lymph node swelling in the head and neck area. 20. The nurse practitioner is preparing discharge instructions for a 79-year-old man with newly diagnosed asthma. Which of the following are important instructions to include? Select all that apply. a. Infections can lead to an occurrence of asthma. b. Experiencing strong emotions like anger can trigger an asthma episode. c. As you get older, you are more likely to experience difficulty breathing. d. Symptoms of asthma may include a runny nose or postnasal drip. e. There is no need to follow up with your doctor unless your symptoms get worse. The correct answers are: Infections can lead to an occurrence of asthma., Experiencing strong emotions like anger can trigger an asthma episode., Symptoms of asthma may include a runny nose or postnasal drip.