GERIATRICS NCLEX PRACTICE QUESTIONS WITH 100% CORRECTLY SOLVED ANSWERS, Exams of Geriatrics

Download GERIATRICS NCLEX PRACTICE QUESTIONS WITH 100% CORRECTLY SOLVED ANSWERS and more Exams Geriatrics in PDF only on Docsity!

GERIATRICS NCLEX PRACTICE

QUESTIONS WITH 100%

CORRECTLY SOLVED ANSWERS

& DETAILED RATIONALES.

1. The healthcare provider is caring for a patient with a diagnosis of hypomagnesemia and a QT interval of 0.50 seconds. Which of these, if noted on the cardiac monitor, is an indication the patient's condition is worsening? A) Premature ventricular contractions B) Narrow QRS complexes C) An R-R interval of 1 second D) A polymorphic ventricular tachycardia -- Correct Answer ✔✔ d) A polymorphic ventricular tachycardia An R-R interval of 1111 second translates to a heart rate of 60606060 beats per minute, which is a normal finding. Narrow QRS complexes are associated with a variety of tachycardias, but is not expected in this situation. The patient's history of hypomagnesemia and prolonged QT interval puts the patient at risk of developing torsade’s de pointes, a polymorphic ventricular tachycardia that can potentially degenerate into a ventricular fibrillation.

2. A patient with a diagnosis of Wolff-Parkinson-White syndrome is undergoing a catheter ablation procedure. When caring for the patient after the procedure, which is the priority intervention? A) Assist the patient to the bathroom to void B) Auscultate apical pulse for a full minute every hour C) Monitor insertion site and distal pulses D) Assess level of consciousness -- Correct Answer ✔✔ c) Monitor insertion site and distal pulses The extremity where the catheter was inserted will be immobilized initially, so the patient will not be allowed out of bed to use the bathroom. The patient will be on a cardiac monitor so auscultation of the apical pulse for one minute is not a priority. Because the catheter may cause trauma to the vessels, the healthcare provider will monitor for hematoma formation and interference of circulation distal to the insertion site.
3. The nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement by the client indicates the need for further teaching regarding measures to improve sleep? A) "I swim three times a week." B) "I have stopped smoking cigars." C) "I drink hot chocolate before bedtime." D) "I read for 40 minutes before bedtime." -- Correct Answer ✔✔ c) "I drink hot chocolate before bedtime." Many nonpharmacological sleep aids can be used to influence sleep. However, the client should avoid caffeinated beverages and stimulants such as tea, cola, and chocolate. The client should exercise regularly, because exercise promotes sleep by burning

off tension that accumulates during the day. A 20-to 30-minute walk, swim, or bicycle ride three times a week is helpful. The client should sleep on a bed with a firm mattress. Smoking and alcohol should be avoided. The client should avoid large meals; peanuts, beans, fruit, raw vegetables, and other foods that produce gas; and snacks that are high in fat because they are difficult to digest.

• Test-Taking Strategy: Note the strategic words need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Options A, B, and D are positive statements indicating that the client understands the methods of improving sleep.

4. A visiting nurse who observes that the older male client is confined by his daughter-in-law to his room. When the nurse suggests that he walk to the den and join the family, he says, "I'm in everyone's way; my daughter-in-law needs me to stay here." Which is the most important action for the nurse to take? A) Say to the daughter-in-law, "Confining your father-in-law to his room is inhumane." B) Suggest to the client and daughter-in-law that they consider a nursing home for the client. C) Say nothing, because it is best for the nurse to remain neutral and wait to be asked for help. D) Suggest appropriate resources to the client and daughter-in- law, such as respite care and a senior citizens' center. -- Correct Answer ✔✔ d) Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens' center. Assisting clients and families to become aware of available community support systems is a role and responsibility of the nurse. Observing that the client has begun to be confined to his

room makes it necessary for the nurse to intervene legally and ethically, so option C is not appropriate and is passive in terms of advocacy. Option B suggests committing the client to a nursing home and is a premature action on the nurse's part. Although the data provided tell the nurse that this client requires nursing care, the nurse does not know the extent of the nursing care required. Option A is incorrect and judgmental.

• Test-Taking Strategy: Note the strategic words most important. Using principles related to the ethical and legal responsibility of the nurse and knowledge of the nurse's role will direct you to the correct option. Option A is a nontherapeutic statement, option B is a premature action, and option C avoids the situation.

5. The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin? A) Crusting B) Wrinkling C) Deepening of expression lines D) Thinning and loss of elasticity in the skin -- Correct Answer ✔✔ a) Crusting The normal physiological changes that occur in the skin of older adults include thinning of the skin, loss of elasticity, deepening of expression lines, and wrinkling. Crusting noted on the skin would indicate a potential complication.

• Geriatric Nursing Exam Questions Test-Taking Strategy: Note the subject , a potential complication. Think about the normal physiological changes that occur in the aging process to direct you to the correct option.

6. The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the

client has been taking. Which intervention should the nurse take first? A) Check for medication interactions. B) Determine whether there are medication duplications. C) Call the prescribing health care provider (HCP) and report polypharmacy. D) Determine whether a family member supervises medication administration -- Correct Answer ✔✔ c) Call the prescribing health care provider (HCP) and report polypharmacy. Polypharmacy is a concern in the older client. Duplication of medications needs to be identified before medication interactions can be determined because the nurse needs to know what the client is taking. Asking about medication administration supervision may be part of the assessment but is not a first action. The phone call to the HCP is the intervention after all other information has been collected.

• Test-Taking Strategy: Note the strategic word first. Also note that the nurse is visiting the client for the first time. Options A, C, and D should be done after possible medication duplication has been identified.

7. The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological change(s) the nurse expects to note? Select all that apply. A) Increased heart rate B) Decline in visual acuity C) Decreased respiratory rate D) Decline in long-term memory E) Increased susceptibility to urinary tract infections F) Increased incidence of awakening after sleep onset -- Correct Answer ✔✔ b) Decline in visual acuity e) Increased susceptibility to urinary tract infections f) Increased incidence of awakening after sleep onset

Geriatric Nursing Exam Questions Rationale: Anatomical changes to the eye affect the individual's visual ability, leading to potential problems with activities of daily living. Light adaptation and visual fields are reduced. Although lung function may decrease, the respiratory rate usually remains unchanged. Heart rate decreases and heart valves thicken. Age-related changes that affect the urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory usually is maintained. Change in sleep patterns is a consistent, age-related change. Older persons experience an increased incidence of awakening after sleep onset.

• Test-Taking Strategy: Focus on the subject , normal age-related changes. Read each characteristic carefully and think about the physiological changes that occur with aging to select the correct items.

8. The healthcare provider is performing an assessment on a patient who is taking propranolol (Inderal) for supraventricular tachycardia. Which assessment finding is an indication the patient is experiencing an adverse effect of this drug? A) Dry mouth B) Bradycardia C) Urinary retention D) Paresthesia -- Correct Answer ✔✔ b) Bradycardia Propranolol is a nonselective beta-adrenergic antagonist
9. Which medication will decrease the heart rate and prolong the action potential and refractory period? A) Potassium channel blocker

B) Adrenergic agonist C) Sodium channel blocker D) Sympathomimetic -- Correct Answer ✔✔ a) Potassium channel blocker

10. A patient is being discharged after the insertion of a permanent pacemaker. Which statement made by the patient indicates an understanding regarding appropriate self-care? A) Every morning I will perform arm and shoulder stretches B) Each day I'll take my pulse and record it in a log C) I'll have to get rid of my microwave oven D) I won't be able to use my electrical blanket anymore -- Correct Answer ✔✔ b) Each day I'll take my pulse and record it in a log Initially, patients should limit arm and shoulder activity on the operative side to prevent dislodgment of the pacing leads. Microwave ovens and electric blankets will not adversely affect the pacemaker. Tracking one's pulse can help the patient know if the pacemaker is working properly
11. A patient who has experienced atrial fibrillation for the past 3 days is admitted to the cardiac care unit. In addition to administering an anti-dysrhythmia medication, the healthcare provider should anticipate which of these orders? A) Initiate a heparin infusion B) Give atropine IV push C) Prepare for immediate cardioversion D) Prepare the pt for AV node ablation -- Correct Answer ✔✔ a) Initiate a heparin infusion

The antidysrhythmic will help control rhythm and rate, so atropine (an anticholinergic) is not indicated. Cardioversion or ablation is usually reserved for patients who have not responded to antidysrhythmic medications. Because blood tends to pool and clot in the fibrillating atria, patients with atrial fibrillation are at high risk for embolic stroke, so heparin will be given

12. T/F "Ventricular depolarization and atrial repolarization occur during this time." -- Correct Answer ✔✔ True This is called the QRS complex The atrial repolarization occurs simultaneously and is masked by the Ventricular depolarization
13. The healthcare provider is examining the electrocardiogram (EKG) of a patient and notes the PR interval is 6 small boxes in length. What is the significance of this finding? A) Stress is causing increased sympathetic stimulation B) This should be documented as an expected finding. C) There may be some scar tissue in one of the ventricles. D) There may be a delay in the conduction through the AV node. -- Correct Answer ✔✔ d) There may be a delay in the conduction through the AV node. The PR interval reflects the time it takes for the atria to depolarize and for the action potential to travel through the AV node and to His-Purkinje system. Each small box on the EKG graph paper equals 0.04 seconds. The normal PR interval is 0.12 - 0.20, point, 20 seconds, which is 3 to 5 small boxes.

This patient's PR interval is longer than normal, which is an indication of a delay in impulse conduction through the AV node.

14. When caring for a patient with a cardiac dysrhythmia, which laboratory value is a priority for the healthcare provider to monitor? A) BUN and creatinine B) Sodium, potassium, and calcium C) Hemoglobin and hematocrit D) PT and INR -- Correct Answer ✔✔ b) Sodium, potassium, and calcium BUN and creatinine levels are always important to monitor when giving any drug, not only antidysrhythmia drugs. The PT and INR will be important for patients who are on warfarin (Coumadin). Because abnormalities in sodium, potassium and calcium levels are likely to affect depolarization and repolarization of cardiac cells, it is most important for the healthcare provider to monitor these laboratory values.
15. Risks and benefits are balanced when giving an antidysrhythmic drug to a treat a cardiac dysrhythmia. When does the need for the drug outweigh the risks? A) When there is impairment in cardiac output. B) When the dysrhythmia becomes chronic. C) If the heart rate is 50 to 60 beats per minute D) After the heart rate reaches a rate faster than 100 beats per minute -- Correct Answer ✔✔ a) When there is impairment in cardiac output.

A heart rate less than 60 beats per minute is usually well tolerated in an otherwise healthy adult. Because antidysrhythmic medications can cause new dysrhythmias or worsen existing dysrhythmias, chronicity of a dysrhythmia is not the only consideration when weighing risks and benefits. If ventricular pumping is impaired so that cardiac output is decreased, the benefits of an antidysrhythmic mediation often outweigh the risks

16. While caring for a patient who is experiencing a postoperative hemorrhage, the healthcare provider notes the rhythm observed on the electrocardiogram (EKG) does not produce a pulse. Which actions should the healthcare provider initiate to resolve this patient's problem? A) Defibrillation B) Administration of IV crystalloid C) Administration of epinephrine D) Cardiopulmonary resuscitation (CPR) E) Administration of vasoconstrictors F) Synchronized cardioversion -- Correct Answer ✔✔ D) Cardiopulmonary resuscitation (CPR) The patient is experiencing pulseless electrical activity (PEA). PEA is not a shockable rhythm. High-quality CPR should be started immediately. An important treatment for PEA is to address the underlying cause.

The underlying cause of PEA in this patient is hypovolemia, which can be treated with IV fluids and vasoconstrictors, along with CPR and epinephrine.