Gerontology Nursing Care for Older Adults, Exams of Nursing

Download Gerontology Nursing Care for Older Adults and more Exams Nursing in PDF only on Docsity! 1 / ATI Gerontology Final Questions with complete answers /must have revision usu/25 1.a nurse at a long term care facility is contributing to a plan for an older adult client who has dementia. which of the following interventions should the nurse include in the plan?: use photographs as memory triggers 2. a nurse is reinforcing teaching with an older adult client who is healthy and has chronic constipation about establishing a bowel retraining program. which of the following statements should the nurse include in the teaching?- : Increase the fiber content of your diet 3.A nurse is caring for an older adult client who has a terminal illness. the client tells the nurse " I just want to live one more month so i can see my grand child get married" which of the following in Kubler-ross stages of grief should the nurse identify the client is experiencing?: Bargaining bargaining is the third stage of grief according to kubler-ross. bargaining represents a last effort at overcoming death by earning 2 / longer life. trying to put off death for on last major celebration in the client's life, like the marriage of a grandchild, is a form of bargaining 4.A nurse us reinforcing teaching with a client who is to start taking alen- dronate sodium. Which of the following recommendation should the nurse include in the teaching?: Discontinue the medication if you develop heartburn 5.A nurse is completing medication reconciliation for an older adult client who is receiving multiple medications which of the following action should the nurse take first?: Ask the client about over the counter medications the nurse should apply the nursing process priority-setting framework. the nurse can use the nursing process to plan client care and prioritize nursing actions. each step of the nursing process builds on the previous step, beginning with assessment or data collection. before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, she must first collect adequate data from the client. assessing or collecting additional data will provide the nurse with knowledge to make an appropriate 5 / the nurse should maintain a straight back and bend at the hips and knees when transferring a client in order to allow the larger muscles of the thighs to do the lifting. good body mechanics are essential in preventing injury to the nurse 12.A nurse collecting data from an older adult who has right sided heart failure. Which of the following findings is the nurse's priority to report?: Weight has increased 0.91 kg (2 lb) in 24 hr. the nurse should apply the urgent versus non urgent priority-setting framework. using this framework, the nurse should consider urgent needs to be the priority need because they pose more of a threat to the client. the nurse might also need to use maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. the nurse should evaluate daily weight of client's experiencing heart failure. a weight gain of .45 to .91 overnight or 1.36 kg within one week is an indication of worsening heart failure. 13.A nurse is caring for a patient who is using a CPM device 6 / following a right knee replacement. Which of the following actions should the nurse take when applying the CPM device?: Line up the frame s=joints of the CPM to the clients knee. 14.A nurse is reinforcing teaching with an older adult client about methods to improve sleep. Which of the following statements should the nurse include in the teaching?: Go to the bed at the same time everynight the nurse should recommend that the client keep consistent sleep and wake times even on the weekends. having a regular sleep schedule will help minimize the alterations to the circadian rhythm that occurs in the older adult client 15.A nurse is reinforcing teaching about skin changes in the older adult client with a newly licensed nurse. Which of he following findings should the nurse identify as benign, age related change commonly seen in older adult clients?: Liver spots liver spots, also known as age spots or lentigines, are flat brownish- black macules that usually occur in sun exposed areas of the body. 7 / aging and exposure to sunlight, or other forms of ultraviolet light, can result in increased pigmentation. liver spots are extremely common after 40 years of age; they occur most often on the forearms, shoulders, face, forehead, and backs of the hands, which are also the areas of highest sun exposure. they are harmless and painless, but they can affect the client's cosmetic appearance. 16.A nurse is reinforcing teaching with a client who is to start taking finas- teride. Which of the following statements by the client indicates an under- standing of the teaching?: I should see a decrease in my PSA levels the nurse should emphasize that the decreased in PSA levels with this medication will be measured 6 month after starting treatment. the expected decline is 30% to 50% in the psa level 17.A nurse is collecting data afrom an older adult client who reports feeling anxious about financial concerns and having difficulty sleeping for several months. Which of the following actions should the nurse take?: Determine the client's usual sleep habits 10 / client is exhibiting manifestations of which of the following disor- ders?: Depression 21.A nurse is collecting data from an older adult client who had a right sided stroke two days ago. For which of the following findings should he nurse notify the provider immediately?: Increased restlessness the nurse should apply the urgent versus non urgent priority setting framework. using this framework, the nurse should consider urgent needs to be the priority need because they pose more of a threat to the client. the nurse might also need to us maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. the nurse should check the client's level of consciousness to evaluate for increases in intracranial pressure that might have occurred. the nurse should identify increased restlessness a a sign of possible increases in intracranial pressure, which requires immediate intervention 22.A nurse is caring for an older adult client who reports that she has just retired and expresses feelings of loneliness due to 11 / the of daily interactions with coworkers. Which of the following responses should the nurse make?: Do you know about the local senior group? the nurse should assist the client in the resocialization process by using the ther- apeutic communication technique of giving information. becoming involved in an organization might assist the client in resocialization, which is beneficial to clients who have depended upon their employment for social interaction 23.A nurse in an adult day care is contributing to the development of treatment plans for older adult clients. Which of the following therapeutic strategies should the nurse use to help clients achieve ericksons developmental task for this age group?: Reminiscence therapy 24.A nurse is caring for an adult older client who is on bed rest. Which of the following foods should the nurse plan to include on the clients breakfast tray to prevent constipation?: Stewed prunes 12 / the nurse should include foods that are high in dietary fiber, such as stewed prunes, to help prevent constipation for the client is on bed rest 25.A nurse is reinforcing teaching with an older adult client who had total hip athroplasty abut ambulating with a standard walker. Which of the following action by the client indicates understanding?: The client moves the walker ahead 15.24 cm (6in) and then steps with the walker the correct technique for using a walker is to balance on both feet; lift the walker and place it in front; walk into the walker, using it for support when standing on the affected lin=mbl and then balance on both feet before repeating the sequence this provides maximum support for the client 26.The nurse is assisting in the planning of an immunization clinic for older adults. At which of the following times should an older adult client receive the influenza vaccine?: Annually in the fall the nurse should recommend that older adult clients receive the 15 / 31.A nurse is assisting with the admission of an older adult client who has urinary incontinence and smells strongly of urine. The clients partner who has been caring for her a home, states the he is sorry and embarrassed about the unpleasant smell. Which of the following responses should the nurse make?: It must be difficult to care for someone who is incontinence the nurse should use therapeutic responses such as acknowledgement and em- pathy when addressing the client's partner. this response is nonjudgmental and acknowledges the effort the client's partner has made, the use of therapeutic communication also encourages further discussion and provides the nurse with an opportunity to teach and to evaluate the need for assistance in the home 32.A nurse is caring for an older adult client who is expressing feelings of grief and longing for his earlier life. Which of the following actions should the nurse take?: Listen attentively and allow the client to talk about the past the nurse should encourage the client to reminisce as a means of 16 / dealing with his feelings of grief and longing. this is the therapeutic technique of offering self. listening to the client allows for venting of the client's feelings about the loss of a healthy, active life. according to erikson's theory, reminiscence is a necessary activity for older adults, who are in the stage of integrity vs despair 17 / 33.A nurse is reinforcing teaching to a client with COPD and has been losing weight about ways to improve his nutritional intake. which of the following statements by the client indicate and understanding of the teaching?: i should add grated cheese to sauces and vegetables the nurse should reinforce that adding cheese to side dishes will increase his protein and calcium intake, as will assist increase calories. this will assist the client in regaining weight and stamina 34.A nurse is caring for an older adult client who has a hip fracture and is rating her pain at 8 on a 0 to 10 scale. Which of the following medications should the nurse adminster?: oxycodone/acetaminophen 7.5/325 tablet PO a client who rates his pain as an 8 is experiencing severe pain nurse should administer an opioid for this pain. 35. A nurse at a long term care facility is contributing to the plan of care for a client who has Alzheimer's disease and wanders at night.