Geriatric Nursing Concepts and Care, Exams of Medicine

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Test Bank A+ Guide

CHAPTER 8 NOTES - correct answer ✅✅ Which assessment tool is most highly regarded and often used to determine the mental status of the older adult? - correct answer ✅✅ The Mini-Cog When assessing the respiratory system of an older adult, the nurse hears continuous, coarse, low-pitched sounds. How would these sounds be reported? - correct answer ✅✅ Gurgles (low-pitched wheezes) When taking a racial pulse of an older adult, the nurse finds it difficult to count a weak and thready pulse. What should the nurse do? - correct answer ✅✅ Take an apical pulse instead. When performing an assessment of the gastrointestinal system of an older adult, the nurse would proceed in what order? Place the parts of a gastrointestinal system assessment in sequence from first to last. - correct answer ✅✅ 1.) Obtain a health history 2.) Inspect the oral cavity 3.) Observe abdomen for scars 4.) Auscultate bowel sounds

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5.) Palpate abdomen When performing an interview with an older adult, the nurse should consider physical environment factors by: - correct answer ✅✅ *Explaining what will take place during the assessment *Ensuring privacy and minimum noise levels *Selecting a room with a comfortable temperature *Seeking a location in close proximity to a restroom The nurse is preparing to assess the blood pressure of a patient and measures the patient s arm to determine the proper sized cuff. The diameter of the patient s arm is 50 cm. How wide should the blood pressure cuff be? - correct answer ✅✅ 60 Older adults developing various disease processes may present with different symptoms from younger adults. The nurse would be concerned about which disease if the patient were to demonstrate a decreased appetite, constipation, and changes to his sleep pattern in which he is awake at night and sleeps during the day? - correct answer ✅✅ Depression

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The nurse is assessing a patient and counts a respiratory rate of 8 breaths per minute. The nurse should be concerned about which condition? - correct answer ✅✅ Impending infection The 71-year-old patient presents to the clinic for her routine exam. While reviewing the patient's chart, the nurse notes the patient's most recent blood pressure screening, mammogram, and clinical breast exam were performed at age 70. She last had her cholesterol levels checked at age 68. Her last guaiac test and colonoscopy were performed at age 69. The nurse knows this patient should have which screening test(s) performed? - correct answer ✅✅ * Guaiac test

• Blood pressure
• Screening for obesity The patient presents to the clinic complaining of abdominal pain. Which information should be charted as objective data? - correct answer ✅✅ Patient is hunched in her chair, clutching her abdomen The nurse is recording subjective data of a patient recently admitted following a myocardial infarction. The patient states, "I have never been so scared in my life. On

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Tuesday, it felt like an elephant was sitting on my chest and I couldn't catch my breath." How should the nurse chart this information? - correct answer ✅✅ "The patient stated, 'I have never been so scared in my life. On Tuesday, it felt like an elephant was sitting on my chest and I couldn't catch my breath'" The nurse is interviewing the patient who has recently been admitted to the long term care facility with the patient's son present. Although the nurse directly addresses the patient with each question, the patient's son interrupts and answers the question for the patient. How should the nurse best handle this situation? - correct answer ✅✅ Request the patient's son allow the patient to answer the questions The nurse in the long term care facility knows each resident will be assessed using which comprehensive tool to determine care needs and appropriate interventions? - correct answer ✅✅ Minimum Data Set 3. The nurse palpates for the 78-year-old patient's radial pulse and counts 82 beats in one minute. Then, the nurse auscultates the patient's apical pulse and counts 94 beats per minute. The nurse knows which term describes this discrepancy? - correct answer ✅✅ Pulse deficit

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The nurse is assessing the older adult patient using the SPICES screening tool. Which questions would be helpful to complete the screening tool? - correct answer ✅✅ * "Have you fallen in the past 3 months?"

• "Do you have difficulty getting to the bathroom on time?"
• "Have you noticed your sleep patterns have changed in the past year?" Health screenings are done to - correct answer ✅✅ identify older adults who need further assessment. Which of the following statements is an example of objective data? - correct answer ✅✅ Blood pressure is 150/65 mm Hg. Why is it essential to collect accurate and complete data?

- correct answer ✅✅ Nursing diagnoses and plan of care are formulated based on data It is more precise to - correct answer ✅✅ take a temperature reading.

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Which environment would be best for conducting an interview with an older adult? - correct answer ✅✅ A warm, diffusely lit patient room with access to a bathroom At first contact, the proper way to address the older adult women is - correct answer ✅✅ Ms., Mrs. Which method is the most commonly used during physical assessment? - correct answer ✅✅ Inspection Which method uses the sense of touch to obtain data? - correct answer ✅✅ Palpation Which method is used to evaluate heart sounds? - correct answer ✅✅ Auscultation The method used least by nurses is - correct answer ✅✅ percussion. Acronym for 6 common "marker conditions" in older adults that can identify potential health-related problems:

- correct answer ✅✅ SPICES

Test Bank A+ Guide

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S-sleep disorders P-problems w/ eating or feeding I-incontinence C-confusion E-evidence of falls S-skin breakdown Mnemonic used for when a serious problem is present or might be developing; a deep, focused assessment: - correct answer ✅✅ FANCAPES

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F-fluid A-aeration (oxygenation) N-nutrition C-cognition, communication A-activity/abilities P-pain E-elimination S-skin/socialization

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What is the tool that allows the evaluation of core function in a resident in a long-term care facility? - correct answer ✅✅ Minimum Data Set CHAPTER 10 NOTES - correct answer ✅✅ Hearing aids are worn by many older people. Which statement regarding hearing aids is false? - correct answer ✅✅ Most people easily adjust to hearing aid use. Which statement should the nurse consider when assessing pain in an older patient? - correct answer ✅✅ * Chronic pain is more common with aging

• Cognitive changes may alter the ability to report and describe pain
• Behavioral changes may be indicators of pain Condition that is progressive and irreversible? - correct answer ✅✅ Dementia Which would be most appropriate when considering the environment for a patient with dementia? - correct answer ✅✅ Placing family pictures around the room

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What is the most appropriate intervention for an older adult with dementia resisting efforts to reposition or ambulate? - correct answer ✅✅ Assess the person using the PAINAD scale Pain Assessment in Advanced Dementia (PAINAD) Scale - correct answer ✅✅ Scale that is used to assess pain in a patient with dementia.

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The observer scores 5 different areas:

• breathing independent of vocalization
• negative vocalization (moaning/calling out
• facial expression
• body language
• consolability Many older adults experience the loss of knowledge and memories that are not recalled frequently. Which term is used to describe this phenomenon? - correct answer ✅✅ Transience

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The nurse is caring for a patient with severe presbycusis. What is the best way for the nurse to begin the morning assessment? - correct answer ✅✅ Touch the patient on the hand and make eye contact before speaking The 73-year-old patient presents to the clinic with her son who reports that, although she is normally completely independent and active, over the past two days, the patient has become increasingly forgetful, is not eating, and stares for hours at a spot on the wall. The patient is unable to recall her name, the year, or their city. The nurse knows which diagnosis is most likely for this patient? - correct answer ✅✅ Delirium The nurse in the long term care facility cares for primarily patients with dementia. Which medication pass is likely to be the most difficult with the patients being the most confused and combative? - correct answer ✅✅ Bedtime The 86-year-old patient presents to the emergency department with acute onset confusion, combativeness, and irritability that began 2 days ago. The nurse knows which condition(s) could explain this patient's symptoms?

- correct answer ✅✅ *Urinary tract infection *Hypercalcemia

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*Myocardial infarction The nurse caring for patients with cognitive disorders knows cognition includes which aspects? - correct answer ✅✅ *Intelligence *Creation of memories *Decision-making The nurse is caring for a patient who has been diagnosed with delirium. Which statement, if made by the patient's wife, indicates a need for further teaching regarding delirium? - correct answer ✅✅ "I am so sad I will never have my real husband back again. But, I will have to learn to love him as he is now" The nurse is performing the morning assessment on a 79- year-old patient admitted with delirium due to a urinary tract infection. When asked, the patient is able to tell the nurse her name, but states the year as being 5 years in the past, her location as being in her own home instead of the hospital, and addresses the nurse as her son. How should the nurse document this information? - correct answer ✅✅ Alert and oriented × 1

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The nurse is caring for a patient with dementia who is unable to remember the date. What is the best way to reorient this patient? - correct answer ✅✅ Provide and refer to clocks and calendars often The patient presents to the emergency department with new onset difficulty speaking. Upon assessment, the nurse notes the patient is becoming frustrated because, although the patient appears to be following the conversation, when the patient attempts to respond, only garbled mumbling is emitted from her mouth. The patient is able to write her responses to the nurse's questions, however. The nurse recognizes these symptoms correspond with which disorder? - correct answer ✅✅ Broca's aphasia An early sign of hearing loss is the inability to hear - correct answer ✅✅ high-pitched sounds. Intelligence tests - correct answer ✅✅ are grounded in the values of a particular culture. Continuity of care refers to - correct answer ✅✅ the same group of caregivers taking care of the patient.

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Perception and interpretation of the sensory stimuli of touch take place in the - correct answer ✅✅ cerebral cortex. One limitation of intelligence testing is that - correct answer ✅✅ it often tests knowledge based on education rather than cognition. If a person is nonverbal, his or her IQ - correct answer ✅✅ can be normal, above average, or below average. When an older adult attempts to acquire new knowledge or skills, - correct answer ✅✅ the person's intelligence is the same, but the recall of information is slower. When talking to a person who is hard of hearing but is able to read lips, the nurse should - correct answer ✅✅ stand close to the person, facing him or her. When a person is said to be confused, he or she - correct answer ✅✅ can be disoriented to several things or one particular thing.

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The activities that a patient with Alzheimer disease can be engaged in should - correct answer ✅✅ be simple, routine, and age appropriate. The ability to make judgements quickly on the basis of unfamiliar stimuli is - correct answer ✅✅ fluid intelligence The center for speech located in the brain is the ? area. - correct answer ✅✅ Broca The person who is unable to identify time, place, or person to the point that he or she is unable to make appropriate decisions is described as ____________. - correct answer ✅✅ confused Acute confusion is often called - correct answer ✅✅ delirium.

• Delirium is reversible and is considered as Rapid Onset. Mnemonic Assessment for DELIRIUM: - correct answer ✅✅ D- drug use E- electrolyte imbalance

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L- lack of drugs I- infection R- reduced sensory input I- intracranial problems U- urinary retention and/or fecal impactions M- myocardial problems Stages of Alzheimer Disease: - correct answer ✅✅ PRECLINICAL ALZHEIMER DISEASE: *measurable biologic changes (biomarkers); specific biomarkers include brain imaging studies & protein in spinal fluid *no obvious symptoms of memory loss or confusion *occurs years to perhaps decades before the next stage MILD COGNITIVE IMPAIRMENT (MCI) CAUSED BY ALZHEIMER DISEASE: *mild changes in memory, reasoning & visual perception *noticeable to person affected, friends, & family *capability of carrying out everyday activities DEMENTIA CAUSED BY ALZHEIMER DISEASE

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*memory impairment *behavioral symptoms *impaired ability to function in daily life CHAPTER 11 NOTES - correct answer ✅✅ What actions can the nurse take to help increase self- esteem in older adults? - correct answer ✅✅ *Schedule time to sit and listen to older adults talk about their concerns. *Develop activities that allow older adults to reminisce about their life. *Allow older adults to make choices during the day regarding their schedule and ADLs. The nurse should assess for changes in behavior that are likely to indicate depression such as which of the following? - correct answer ✅✅ *Increased alcohol consumption *Agitation and irritability *Isolation and withdrawal

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What is true of suicide risk in the older adult? - correct answer ✅✅ Suicide is often triggered by pain, a recent loss, or a stressful life event with the older adult. Which phrase spoken by an older adult would warrant further assessment of their self-perception or self- esteem? - correct answer ✅✅ "I can't do anything right anymore." Which interventions are appropriate for an older adult experiencing anxiety or fear? - correct answer ✅✅ *Place the resident in a populated are to ensure he or she is not alone. *Identify coping strategies that have helped in the past. *Provide explanations of any procedures that are being done. The nurse should recognize what signs of suicide risk in older adults? - correct answer ✅✅ *Loss of a spouse or a close loved one *Increasing complaints of physical ailments *Giving away possessions to friends and family *A new interest in firearms

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The nurse knows that which patient is most likely to be depressed? - correct answer ✅✅ The 73-year-old patient who has had his left hip replaced and is a resident of a long term care facility The nurse is following a plan of care for a patient who recently underwent surgery for creation of a colostomy. Which goal is most likely to be in place for a patient experiencing an altered body image? - correct answer ✅✅ Patient will look at ostomy during a pouch change in two days The nurse and unlicensed assistive personnel (UAP) are preparing to turn in bed a patient who has recently undergone hip replacement surgery. The nurse notes the patient is suddenly tachypneic and diaphoretic with dilated pupils and tensed extremities. What is the best response on the part of the nurse? - correct answer ✅✅ "You seem upset all of a sudden. Please tell me what is bothering you" The nurse is preparing to assist an older adult patient with his activities of daily living. Which approach is most effective for improving the patient's self-esteem? - correct answer ✅✅ "Good morning, Mr. Smith. Would you like to get cleaned up and ready for breakfast now?"

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The home health nurse caring for older adult patients knows it is most important to closely screen patients for depression who are taking which categories of medications? - correct answer ✅✅ *Anticholesterolemics *Cardiac glycosides *Antihypertensives *Analgesics The nurse working in the long term care facility knows which factors of life in the long term care facility can lower the patients' self-esteem? - correct answer ✅✅ *Structured meal, medication, and activity schedule *Requiring assistance with toileting *Limited meal and snack choices *Small living areas with limited storage space The nurse who works with older adult patients in a long term care facility knows which is the best way to promote good self-esteem in her patients? - correct answer ✅✅ Allow enough time each day for the patient to perform his or her own activities of daily living

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The nurse in the long term care facility knows which patient is likely to have the highest self-esteem? - correct answer ✅✅ 86-year-old patient with urge incontinence and diabetes whose husband and daughters visit daily The nurse is supervising care of a patient with anxiety by an unlicensed assistive personnel. Which action by the UAP in response to the patient's increased anxiety would prompt the nurse to intervene immediately? - correct answer ✅✅ Offering the patient a cup of coffee The older adult patient presents to the clinic for a routine exam. Which characteristic(s) if exhibited by the patient indicates low self-esteem? - correct answer ✅✅ *Disheveled clothing *Strong and unpleasant body odor *Unshaven face One of the most common fears of older adults is - correct answer ✅✅ loss of independence. One factor that can contribute to poor self-esteem is - correct answer ✅✅ a lack of social support.

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Ageism is defined as a - correct answer ✅✅ negative view of people based on their age. Reminiscing is - correct answer ✅✅ thinking back to earlier times in your life. Reminiscing is characteristic of - correct answer ✅✅ both old and young people. A nurse can help the patient deal with fear effectively by

- correct answer ✅✅ letting the patient express fears. The behavior of a hopeless person is often - correct answer ✅✅ passive and uninterested. Suicide among older adults is - correct answer ✅✅ disproportionately higher than it is in any other age group. If a nurse suspects that the patient is feeling hopeless, the nurse should - correct answer ✅✅ assess the potential for self-destructive behavior or suicide.

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CHAPTER 12 NOTES - correct answer ✅✅ An older woman was widowed about a year ago. What would normal expected behavior at this stage of grieving include? - correct answer ✅✅ Improved energy, interest in new activities and goals. How do roles change as a person ages? - correct answer ✅✅ *Relocation to new environment may separate friends/family and possessions *Loss of roles with death of spouse or family members *Retirement brings loss of previous profession/roles or status What characteristics place an older adult at increased potential for social isolation? - correct answer ✅✅ *Sensory changes *Decreased physical mobility *Advanced age *Limited financial resources *Incontinence *Physical deformity

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What is the most appropriate intervention to use for an older adult who always stays in their room? - correct answer ✅✅ Spend one-on-one time discussing the older adult's concerns Which person is most likely to experience relationship issues? - correct answer ✅✅ One who likes solitary activities and states, "I like to be left alone." What interventions should nurses consider when an older adult is grieving the loss of a role or relationship? - correct answer ✅✅ *Encourage communication with friends and family members *Build a trusting relationship *Be available to discuss loss without stirring up deep emotions or feelings *Identify support groups, counselors, spiritual advisors, and family members who can provide additional support The nurse is preparing to care for an Asian patient by reviewing the Asian culture. The nurse notes the Asian culture 0070 laces heavy emphasis on filial piety. The nurse knows this may manifest itself in which manner? - correct answer ✅✅ The family will work to bring home

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the patient and care for the patient themselves as much as possible The community health nurse knows that, in American society, there are many different cultures and subcultures affecting the way Americans view and utilize health care. The nurse knows which word describes this society? - correct answer ✅✅ Heterogeneous The nurse is caring for a patient who recently learned he will no longer be able to work due to his illness. The nurse should refer to which person's work to help guide the patient through the stages of grief? - correct answer ✅✅ Kubler-Ross The nurse in the long term care facility notes the patient never attends social events in the facility despite encouragement from staff. What is the best intervention for this patient? - correct answer ✅✅ Schedule time to sit with the patient The home health nurse has determined the patient is grieving for the loss of his role as a teacher after being forced to retire due to the onset of dementia. Which is the

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best intervention for a patient who is grieving? - correct answer ✅✅ Spend one-on-one time with this patient The home health nurse is contributing the initial assessment of a patient with poorly controlled diabetes. Which characteristic(s) of the patient indicate to the nurse an increased risk for social isolation? - correct answer ✅✅ *The patient is a retired teacher *The patient's wife passed away 1 year ago *The patient is hard of hearing The nurse is contributing to the admission assessment of a patient. Which questions are most appropriate to determine if the patient is at risk for social isolation? - correct answer ✅✅ *"Is there a faith leader you would like me to contact?" *"What is your marital status?" *"What do you do for a living?" *"Are you involved in any clubs or groups?" What is a major reason that positive interactions between grandparents and grandchildren are not taking place in today's society? - correct answer ✅✅ Families move, resulting in separation.