Gerontological Nursing: Caring for Older Adults, Exams of Nursing

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Gerontological Nursing Final Exam

A client newly diagnosed with diabetes tells the nurse, "I'm fearful and nervous about having to cope with this disease." Which response by the nurse would be most appropriate? - ANS "It's true that you will have to make some changes but these changes will help control your diabetes." A nurse is conducting an educational program for a client newly diagnosed with type 2 diabetes. The nurse determines that the teaching has been successful based on which outcome? Select all that apply. - ANS - Demonstration of the correct method of blood glucose testing

• Demonstration of the proper technique for medication administration
• Verbalization of understanding of diabetes and its management A 75 - year-old adult is a new attendee at strength training class. Which schedule would be most appropriate for this client to engage in? - ANS Twelve repetitions with low-weight free weights at least twice weekly. The nurse is presenting a seminar for older adults experiencing integumentary problems. Which statement would the nurse most likely provide about the use of alternative therapies? - ANS "You need to tell your health care provider about alternative therapies in use." A nurse is reviewing the plan of care for a 78 - year-old resident of a long-term care facility diagnosed with Parkinson's disease. Which intervention would need to be modified? - ANS Phrase questions and directions in a simple and understandable manner applicable to the client's decreased cognition. A client is prescribed Larodopa as part of the treatment plan for Parkinson's disease. When teaching the client about this drug, which item would the nurse encourage the client to avoid? - ANS Foods high in vitamin B 6 A gerontological nurse is conducting a program for staff nurses at a long-term care facility about older adults and sensory function. When discussing this topic, which information would the nurse most likely include? Select all that apply. - ANS - "Sensory deficits are a threat not only to quality of life but to safety as well."
• "Sensory losses commonly lead to impaired communication."
• "Sensory deficits make it difficult to interpret the older adult's physical environment."
• "Sensory deficits have a negative effect on older adults' social relationships." During client education of a 71 - year-old who has a recent diagnosis of diabetes, the nurse has emphasized the importance of consistently maintaining blood glucose levels within the normal range rather than simply reacting to high or low levels. Which

test would the nurse most likely identify as providing the best evaluation of the client's blood sugar control over time? - ANS Hemoglobin A1c A gerontological nurse is conducting a program for a group of nurses working at the long-term care facility about aging and musculoskeletal functioning. Which statement would the nurse most likely include when describing this relationship? - ANS A combination of age-related reduction in muscle mass and inactivity decreases musculoskeletal function. A 70 - year-old client has just been diagnosed with Parkinson's disease. The nurse is working with the client and family, teaching them about communicating with the client. Which information would the nurse incorporate into the discussion? - ANS The disease progresses slowly with therapy helping to minimize disability. An exercise physiologist approaches the gerontological nurse manager at a local assisted living facility about beginning an exercise program for the clients at the facility. When developing the program, which characteristic would the nurse manager require as being most important for the program to include? - ANS Addressing cardiovascular endurance, flexibility, and strength training The nurse plans care for a client who has had gradual vision loss. Which of the following should the nurse include in the care plan? - ANS A clock that chimes the hour in the client's living room The nurse is assessing an older adult client's hearing. Which finding would lead the nurse to suspect that the client is experiencing a problem? Select all that apply. - ANS - Client looks directly at speaker's lips during interview

• Client leans head to one side
• Client consistently asking, "What did you say?"
• Client asks to have words repeated A gerontological nurse is participating at a community health fair and is providing information to older adults about ways to promote healthy sensory function. Which suggestion would the nurse most likely make? - ANS "Even if you have good vision, it's important to get an eye examination every year." A gerontological nurse is conducting a health promotion program for a group of older adults about activities specific to the integumentary system. The nurse determines that the teaching was successful based on which statement? - ANS "I'm aware that irregularly shaped moles can be associated with melanoma." A gerontological nurse is working with an older adult to develop an individual exercise program. Which information would the nurse need to integrate into the development of the program? - ANS The number and size of muscle fibers decline leading to a decrease in grip strength.

A gerontological nurse is describing the effects of aging on the endocrine system to a client diagnosed with diabetes. Which information would the nurse most likely integrate into the discussion about how aging affects the endocrine system and its hormones? - ANS The endocrine system's ability to regulate body activities decreases. A 79 - year-old male client has a number of health problems, including Parkinson's disease. When assessing this client, which finding would the nurse most likely attribute to the client's diagnosis of Parkinson's disease? - ANS - Emotional instability

• Blank facial expression
• Slow movement with poor balance
• Walking with a shuffling gait The nurse is working with clients diagnosed with cancer and their families to identify ways to deal with difficult issues. Which reason would the nurse identify as supporting why a diagnosis of malignant melanoma may be extremely difficult for clients to accept? - ANS It is a type of skin cancer that is highly metastatic, making it more deadly. A 78 - year-old resident with a diagnosis of melanoma is experiencing anxiety related to the appearance of the large and highly visible lesion on the right cheek. Which intervention would be most appropriate for the nurse to implement to help decrease the resident's anxiety? - ANS Resolve to interact with and touch the resident no differently than other residents. An older adult client has heart disease, and the client's spouse needs to learn about the cooking methods and recipes that can be used to help with the client's condition. Which individual would be the best source for the spouse to get additional information? - ANS Member of a support group A 79 - year-old female client, admitted for hip replacement surgery, said that she had insomnia the night before. The client received a dose of a prescribed benzodiazepine. Shortly thereafter, the client began displaying signs of delirium that have persisted until the morning change of shift. Which instruction would the night nurse give to the nurse coming on shift? - ANS "Try to keep her level of stimulation as low as you can when you are working with her." An older adult client comes to the clinic for a check-up. Which finding would the nurse identify as suspicious for cancer? - ANS A sore that does not heal The family of a 78 - year-old client is shocked by the recent diagnosis of pancreatic cancer, citing the client's lifelong commitment to a healthy diet, consistent exercise, and avoidance of environmental risk factors. Which factor would the nurse most likely identify as contributing to this client's diagnosis? - ANS Age-related changes to the immune system may have compromised the body's ability to recognize cancerous cells.

A nurse planning a health workshop for senior citizens wants to provide discussion topics that will interest everyone. In a typical group of seniors, which disorder would the nurse most likely identify as affecting the greatest number? - ANS Arthritis A nurse is assessing several older adult clients. The nurse determines that which client is experiencing a health problem characterized as delirium rather than dementia? - ANS An older adult male whose wife has brought him to the emergency department because of forgetfulness and confusion exhibited over the last 48 hours. A 72 - year-old client just recently diagnosed with cancer comes to the clinic for an evaluation. During the visit, the client asks the nurse, "I know that there are different things that can be done to treat cancer, but I'm wondering if my age might affect what can be done?" Which information would the nurse most likely integrate into the response to the client? - ANS Reduced dosages of chemotherapeutic agents will be necessary due to age-related changes in kidney function. A nurse is providing care to an older adult client with dementia. When reviewing the client's history, which condition would the nurse suspect as the most likely cause? - ANS Genetic predisposition A home health care nurse is providing care to an older adult client with chronic conditions. Which intervention would be most appropriate for the nurse to implement to best ensure proper care for a client when the nurse is not present but can be reached by a telephone or pager? - ANS Provide detailed written instructions for all procedures. A gerontological nurse is developing a program for a group of older adult clients at the community health center to address cancer in this population. The nurse understands that cancer affects all age groups, not just older adults, but certain cancers are more prevalent in this age group. Which factor would the nurse need to address when developing the program? - ANS Prolonged exposure to carcinogens An older adult resident becomes violent and physically abusive. Which action would be most appropriate? - ANS Get immediate help to protect self and others. A 78 - year-old client has been diagnosed by his geriatrician as being in the third stage of Alzheimer's disease. Which findings would support this assessment? - ANS The client's wife and children have recently noticed a change in memory and judgment with the client getting easily flustered in social situations. Despite the fact that the client is now receiving palliative care because of the progression of congestive heart failure (CHF), a nurse views the care that was provided for the client as a success. The nurse arrives at this conclusion most likely based on which information? - ANS The client was able to live independently and provide self-care until very late in the progression of the disease.

A 76 - year-old client has been prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which assessment would the nurse most likely identify as the priority during the initial days of the client's drug therapy? - ANS Monitoring for changes in the client's nutritional status A nurse is conducting an in-service program about mental health in the older adult for the staff of a long-term care facility. Which information would be most appropriate for the nurse to include? - ANS Older adults are more likely than younger adults to choose suicide To the embarrassment of his family, an 81 - year-old male client on the subacute unit of a hospital has made repeated, sexually inappropriate statements to female staff members. The client's family is adamant that such behavior is uncharacteristic. Which action would the nurse implement first? - ANS Attempt to identify the underlying cause of the client's behavior. A nurse is counseling an older adult male client about ways to reduce the risk for cancer. Which instruction would the nurse include as a way to reduce the client's risk for prostate cancer? - ANS "Maintaining your weight within an ideal range will reduce the risk." A nurse working in a long-term care facility asks the gerontological nurse, "What can I do to help best assist an older resident with mental health issues?" Which response by the gerontological nurse would be most appropriate? - ANS "Strengthen the client's capacity to manage the condition by promoting the client's health." An older adult is dying of cancer, and a hospice nurse comes to the home every day to oversee the client's care and comfort. Which intervention would be most important for the nurse to provide? - ANS Assuring support A nurse is providing care to an older adult client with dementia. Which intervention would the nurse identify as the priority? - ANS Ensuring client safety An older adult client dying of cancer tells a nurse, "My pain is becoming much worse." Further assessment reveals that the client rates the pain as 9 on a scale of 0 to 10. Which pain relief measure would the nurse anticipate administering? - ANS Morphine or hydromorphone Three gerontological nurses have announced their intention to open a long-term care facility in their community, something that a colleague has disparaged as "making money from older adults' frailty." Which response by the nurses to their colleague's criticism would be most appropriate? - ANS It can actually be in the best interests of residents for experts in care, like nurses, to be in charge of directing care."

A gerontological nurse is discussing the importance of reminiscence with a group of nurses working on the rehabilitative unit. The unit provides care to many older adults. The nurse determines that the discussion was successful when the staff identifies reminiscence as having which effect? Select all that apply. - ANS B. Means of finding meaning in remaining life D. Memory improvement E. Means for resolving past conflicts Upon further questioning, an older adult client who expressed apprehension about upcoming coronary artery bypass surgery admitted, "I had a had a friend who had coronary artery bypass surgery a few years ago and had many complications after the surgery." Which response by the nurse would be most appropriate? - ANS "Bypass surgery has improved over the past 20 years." A client is beginning to awaken after surgery and becomes extremely restless. Which agent would the post-anesthesia care nurse most likely administer first? - ANS Oxygen to correct hypoxia A nurse is providing care to four clients with terminal cancer who are on the unit. While on rounds, the nurse assesses each client and determines that which client may be near death? - ANS Client who has a rapid, weak pulse. A nursing home resident who is bitter about placement in the nursing home by the family, says, "My family doesn't love me." Which situation would the nurse most likely identify as the reason for placement if the client's family fits the typical picture? - ANS A crisis made it necessary. The nursing staff of a palliative care unit are helping an unlicensed care provider, who has had little prior exposure to death, adjust to the unique demands of working in such an environment. Which action would be of benefit for the unlicensed care provider? Select all that apply. - ANS A. The nurses try to help the care provider verbalize emotions and reactions to death and dying. B. The nurses provide a location on the unit where all staff members can retreat during intense encounters. C. The nurses encourage stepping back from intense situations and examining whether strong reactions are impacting the therapeutic relationship. A nurse is providing care to numerous older adult clients on a rehabilitative medicine unit of a hospital. When integrating range-of-motion exercises into the clients' plans of care, which information would the nurse most likely need to consider? - ANS Clients should be encouraged to put all their joints through a range of motion at least once daily. A nurse is implementing a program for hospitalized older adults as part of an initiative to reduce the risk of pressure injuries in this population. The program focuses on maintaining proper positioning when in and out of bed. Which instruction

would the nurse most likely include to promote proper positioning when clients are seated in a chair or in a wheelchair that lacks foot pedals? - ANS "Try to keep your back straight and your head in line with your spine." A nurse is assessing an older adult and a family caregiver. Which statement by a family caregiver would lead the nurse to suspect elder abuse? - ANS "When my dad starts wandering around the house, I give him sleeping pills until he calms down and falls asleep in his chair." A nurse is assessing several families. Which family would the nurse most likely identify as representing a skipped-generation household? - ANS A client who raised her granddaughter until she left for college. A gerontological nurse is implementing a care model that addresses holism and healing. Which assumption would the nurse most likely integrate into the model? Select all that apply. - ANS D. The physical environment can be used as a therapeutic tool. E. Caregivers' presence and interactions affect health, healing, and the quality of nursing facility life. A 92 - year-old client in a medical unit has become acutely confused. The development is of great concern to the care team since the client has no history of cognitive deficits. Which action would be the priority? - ANS Obtain blood samples. A gerontological nurse is conducting a program for a group of nurses involved in providing home care in the community. When describing the status of caregiving, which information would the nurse most likely include? - ANS Women typically spend more time caring for aging parents than they did for their own children. A 79 - year-old client with a long-standing diagnosis of chronic leukemia experienced a blast crisis 1 week ago and died overnight. The nurse is providing comfort to the client's family. The nurse would expect the client's family to experience which stage first? - ANS Denial The family of a 90 - year-old female hospitalized client is worried about the client's chances of making a full recovery from this recent fall once the client returns home. When assessing this client, which factor would the nurse most likely identify as positively contributing to the client's post-discharge health outcomes? Select all that apply. - ANS A. The presence of a reliable and an adequate social support network. B. The presence or absence of other health problems. D. The self-care habits that the client had prior to the fall. E. The client's understanding of current health and prognosis. A gerontological nurse observes a staff nurse infantilizing an older adult client receiving rehabilitative services. The gerontological nurse implements actions to correct the staff nurse's action based on the understanding that the staff nurse was

violating which guideline for rehabilitative nursing? - ANS Equating physical disability with mental disability A nurse is reading a journal article about the development of long-term institutional care and legislation enacted to promote improved care. Enactment of which legislation would the nurse most likely note as being responsible for requiring long- term care facilities to implement a standardized assessment tool? - ANS Omnibus Budget Reconciliation Act A nurse is working with several clients in preparation for discharge. As part of the planning process, the nurse is identifying the client's family structure and relationships. Which relationship structure would the nurse identify as a family? Select all that apply. - ANS C. A client and partner who live together in an apartment D. A client and new "lady friend" who began cohabitating 2 months ago E. A client, daughter, son-in-law, and widowed sister, all of whom share a house