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Gerontological Nursing 3rd Edition, Tabloski Test Bank

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Test Bank For Gerontological Nursing 3rd Edition, Tabloski. Note: This is not a text book. Description: ISBN-13: 978-0132956314, ISBN-10: 0132956314.

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Test Bank Gerontological Nursing 3rd Edition, Tabloski

CHAPTER 01

Question 1

Type: MCSA

The nurse is preparing discharge instructions for an 84-year-old patient that includes plans for smoking cessation. The nurse believes that since the patient has been smoking for years, he isn’t going to stop now. Which concept does this nurse’s belief reflect?

  1. Negative stereotyping
  2. Character assessment
  3. Reality orientation
  4. Senescence

Question 2

Type: MCMA

The nurse is planning to conduct a blood pressure screening at a local senior citizen’s high-rise apartment building in the inner-city impoverished location. What are characteristics of the residents living in this location?

Standard Text: Select all that apply.

  1. Older women
  2. Married men and women
  3. Widowed women
  4. Less educated women
  5. Residents living alone

Question 3

Type: MCSA

While completing an admission assessment, the nurse learns that a female adult patient has smoked one pack/day for 20 years and works at a chemical plant. From this information, what is this patient at risk for developing?

  1. Decreased fertility
  2. Increased life expectancy because she is female
  3. No difference in risk because of social and occupational circumstances
  4. Environmental and occupational hazards that may affect life expectancy

Question 4

Type: MCSA

An African American male patient has a blood pressure of 180/104 mm Hg. When asked about the blood pressure, the patient states that he is not on any medication and is unsure if the blood pressure level is unsafe. What should the nurse do?

  1. Nothing since the blood pressure may not be accurate and does not need to be addressed
  2. Initiate secondary prevention to prevent the progression of illness.
  3. Nothing since this is normal for someone in the hospital
  4. Reassess the blood pressure with the patient in a standing position.

Question 5

Type: MCSA

An older patient is worried about the cost of healthcare and supplies now that he has been diagnosed with type 2 diabetes mellitus. How should the nurse respond to this patient’s concerns?

  1. “I believe that some parts of Medicare will cover preventative care, such as diabetes monitoring.”
  2. “You only need to check your blood sugar once a day, so the cost should not be too high.”
  3. “Don’t worry. I don’t think the total bill will be too much.”
  4. “I don’t know anything about insurance.”

Question 6

Type: MCMA

The nurse is assessing an older female patient admitted to the hospital for generalized weakness and a cough. Which assessment findings would be considered normal changes related to aging?

Standard Text: Select all that apply.

  1. Elevated blood pressure
  2. Needing to urinate every 3 hours
  3. Needing to wear eye glasses for reading
  4. Pulse rate 104 beats per minute and thready
  5. Respiratory rate 22 per minute after walking a short distance

Question 7

Type: MCSA

The family of an older male patient asks why the patient needs to be hospitalized for pneumonia when the youngest daughter had the same infection a few months ago and was treated at home. How should the nurse respond to the family?

  1. “The patient has chronic illnesses that put him at risk.”
  2. “I don’t think you can compare your grandfather to yourself.”
  3. “There are some differences between men and women and illness.”
  4. “Aging decreases the body’s ability to restore balance to body systems with an infection.”

Question 8

Type: MCSA

A patient takes herbal supplements in order to “slow down” the aging process. The nurse realizes that the patient is following which theory of aging?

  1. Cross-link
  2. Wear-and-tear
  3. Free radical
  4. Emerging biological

Question 9

Type: MCMA

An older patient is demonstrating signs of sadness and depression. Upon assessment, the patient expresses remorse over not accomplishing much in life and is not looking forward to eventual death. Which theories of aging would be applicable for the nurse to use to help this patient?

Standard Text: Select all that apply.

  1. Endocrine theory
  2. Programmed longevity
  3. Somatic DNA damage theory
  4. Jung’s theory of individualism
  5. Erikson’s developmental theory

Question 10

Type: MCSA

A 62-year-old former professional football player is in the hospital for a total knee replacement as a result of osteoarthritis. Which theory of aging would help explain this patient’s current health problem?

  1. Cross-link
  2. Free radical
  3. Wear-and-tear
  4. Somatic DNA damage

 

CHAPTER 02

Question 1

Type: MCSA

The nurse supports an older patient’s desire to discuss advance directives with the patient’s family. What action is the nurse performing with this patient?

  1. Facilitation of palliative care
  2. Engagement in professional d  aevelopment
  3. Collaboration with the interdisciplinary team
  4. Accountability to protect patient’s rights and autonomy

Question 2

Type: MCSA

The nurse supports an older patient’s decision to stop further chemotherapy treatments after diagnostic testing shows a recurrence of a malignancy. Which ethical principle is this nurse demonstrating?

  1. Justice
  2. Autonomy
  3. Beneficence
  4. Nondisclosure

Question 3

Type: MCSA

The nurse is preparing to assess an older patient using functional health patterns. How does this approach ensure holistic care will be provided to the patient?

  1. Focuses on the effects of diseases
  2. Predicts the outcome for patients with disabilities
  3. Demonstrates the patient’s interaction with the environment
  4. Identifies the potential for rehabilitation early in the process

Question 4

Type: MCSA

Which action by the gerontological nurse demonstrates the role of manager?

  1. Performing blood pressure screenings at a senior citizen health fair
  2. Participating in a skin assessment survey of patients in a nursing home
  3. Writing a letter of support for a patient who is seeking custody of a grandchild
  4. Arranging respite care for a patient while the adult child caregiver recovers from surgery

Question 5

Type: MCSA

The nurse is completing a functional health pattern assessment with an older patient who volunteers for political functions. In which functional health pattern would this information be categorized?

  1. Values-beliefs
  2. Cognitive-perceptual
  3. Coping-stress tolerance
  4. Self-perception-self-concept

Question 6

Type: MCSA

The nurse would document a patient’s religious affiliation and participation in the local parish within which functional health pattern category?

  1. Values-beliefs
  2. Cognitive-perceptual
  3. Coping-stress tolerance
  4. Self-perception-self-concept

Question 7

Type: MCSA

A nurse caring for geriatric patients is considering becoming certified in gerontological nursing. What does this credential indicate?

  1. The nurse has a master’s degree in nursing.
  2. The nurse works in administration at a nursing home.
  3. The nurse has worked full time at least 2 years in gerontological nursing.
  4. The nurse’s clinical competence in gerontological nursing has been validated.

Question 8

Type: MCMA

An older patient with chronic health problems does not want to be admitted to a nursing home for continued care. What can the nurse explain to the patient about nursing homes today?

Standard Text: Select all that apply.

  1. Nursing homes are for short-term stays.
  2. Nursing homes help the patient with activities of daily living.
  3. Nursing homes are being replaced with community-based services.
  4. Nurses in nursing homes provide at least 5 hours of care to each patient each day.
  5. Nursing homes help with bathing, toileting, meals, and medication administration,

Question 9

Type: MCMA

The director of nursing at a skilled facility is implementing knowledge, skills, and attitudes to improve the quality of care of the older residents. Which criteria will be implemented?

Standard Text: Select all that apply.

  1. Safety
  2. Teamwork
  3. Staff incentives
  4. Patient-centered care
  5. Quality improvement

Question 10

Type: MCMA

The nurse has identified a nursing intervention for an older patient that is classified as being Class IIa level B. How effective is this intervention for the patient?

Standard Text: Select all that apply.

  1. Useful and effective
  2. Based on expert opinion or case studies
  3. Usefulness is less established by opinion.
  4. Weight of evidence is in favor of efficacy.
  5. Limited evidence from nonrandomized studies

 

CHAPTER 03

Question 1

Type: MCSA

The nurse is preparing to conduct a health history with an older patient. Which action will the nurse take to ensure the accuracy and efficiency of the patient’s health history?

  1. Scheduling 30 minutes for the medical history interview
  2. Requesting the patient bring a list of current medications taken regularly
  3. Conducting the history in an environment with comfortable seating and proper lighting
  4. Having the patient complete the past medical history form upon arrival for the appointment

Question 2

Type: MCSA

Which nursing intervention will ensure that the nurse will provide culturally competent healthcare to an older patient?

  1. Speak the patient’s primary language.
  2. Use standardized assessment instruments in health evaluations.
  3. Approach patients of a particular ethnic group in the same manner.
  4. Know prevalence, incidence, and risk factors for diseases specific to different ethnic groups.

Question 3

Type: MCMA

The nurse is completing the minimal data set (MDS) for an older patient. What are characteristics of this assessment?

Standard Text: Select all that apply.

  1. Eliminates listing the patient’s prescribed medications
  2. Identifies health insurance coverage that is not Medicare or Medicaid
  3. Provides a multidimensional view of the patient’s functional capacities
  4. Used primarily to determine the amount of funding the patient has for long-term care
  5. Includes a core set of screening, clinical, and functional measures used in patient assessment

 

Question 4

Type: MCMA

When completing an assessment with an older patient, the nurse will focus on which health problems since these are the leading causes of death for this population?

Standard Text: Select all that apply.

  1. HIV/AIDS
  2. Malignant neoplasms
  3. Motor vehicle crashes
  4. Cardiovascular disease
  5. Pneumonia and infections

Question 5

Type: MCSA

Why is it important for the interdisciplinary team to assess an older patient’s level of pain?

  1. Validate that the pain is real.
  2. Ensure pain management is provided.
  3. Differentiate pain symptoms from other symptoms.
  4. Provide the appropriate amount of help for normal activities.

Question 6

Type: MCMA

The nurse is preparing to use the SPICES tool to assess an older patient. Which areas will the nurse assess with this tool?

Standard Text: Select all that apply.

  1. Incontinence
  2. Sleep disorders
  3. Skin breakdown
  4. Evidence of falls
  5. Lower limb function

Question 7

Type: MCSA

The family of an older patient in a nursing home has contacted the ombudsmen program. What will the ombudsman do for the patient?

  1. Investigate the complaint.
  2. Deter the patient from filing a lawsuit.
  3. Pursue a lawsuit on behalf of the patient.
  4. Review the patient’s record and determine if appropriate care has been given.

Question 8

Type: MCSA

Which action should the nurse take to avoid becoming involved in a legal suit with patient care?

  1. Have professional liability insurance.
  2. Avoid conflicts with patients and families.
  3. Document carefully all nursing care provided.
  4. Report concerns about the facility to the supervisor.

Question 9

Type: MCMA

Which statements are included in the Patient’s Bill of Rights?

Standard Text: Select all that apply.

  1. The right to vote
  2. The right to make a will and dispose of property
  3. The right of the ombudsman to enforce the bill of rights
  4. The right to file for malpractice if the rights are violated
  5. The right to be free from chemical and physical restraints

Question 10

Type: MCSA

Which scenario describes a situation in which the performance of the nurse does not meet the standard of care?

  1. A nurse witnesses a patient fall and tries to assist the patient.
  2. A patient with vomiting and nausea does not receive a breakfast tray.
  3. A physician is questioned about an order to administer a medication that is five times the normal dosage.
  4. A patient is medicated with acetaminophen for severe chest pain and the physician is not notified.

 

CHAPTER 04

Question 1

Type: MCSA

The charge nurse is made aware that a 96-year-old patient does not want to be cared for by African Americans. What does this patient’s attitude exemplify?

  1. Culture
  2. Ethnicity
  3. Life trajectory differences
  4. Complexity of the Cultural Care triad

Question 2

Type: MCSA

The husband of a female patient of the Islamic culture asks that only a female doctor examine his wife. How should the nurse respond to the husband?

  1. A female doctor will be provided.
  2. The request is unreasonable and cannot be honored.
  3. Both male and female doctors respect the patient’s privacy.
  4. The patient’s body will be covered during any examinations.

Question 3

Type: MCSA

The nurse learns that a patient of the Jewish faith does not eat certain types of foods and fasts on religious holidays. What should the nurse do to ensure that this patient’s needs are met?

  1. Report the patient’s needs to the oncoming nurse.
  2. Document the patient’s preferences on the assessment form.
  3. Talk with the dietitian to obtain food preferences for the patient’s meals.
  4. Explain to the patient that eating is needed to maintain nutritional status.

Question 4

Type: MCSA

An infant of African origin is being cared for by parents who immigrated to the United States 6 months prior. The mother is using an herbal paste to treat the baby’s diaper rash. What should the nurse do to ensure cultural competence?

  1. Instruct the mother to stop using the paste.
  2. Ask the mother to explain the ingredients in the paste.
  3. Provide the mother with another cream to use for the diaper rash.
  4. Explain to the mother that herbal ingredients are harmful to the baby.

Question 5

Type: MCMA

A patient of the Latino culture is recovering from surgery and has not requested any pain medication. What should the nurse include when assessing this patient for pain?

Standard Text: Select all that apply.

  1. Does pain indicate that death is near?
  2. What is the patient’s cultural perspective towards pain?
  3. Does the patient believe that pain is punishment for past behaviors?
  4. What are the socially acceptable behaviors of pain in the patient’s culture?
  5. Is experiencing pain an expected part of living within the patient’s culture?

Question 6

Type: MCSA

The family of a 95-year-old patient of the Chinese culture is planning on caring for the patient in the home. How can the nurse best meet the patient’s needs?

  1. Discussing how other families have approached this problem
  2. Explaining to the family that resources are available to help the patient
  3. Exploring the resources the family has to meet the patient’s needs in its home
  4. Insisting that the family reconsider its decision and look at other care options

Question 7

Type: MCMA

An older patient is refusing a prescribed course of treatment because it goes against religious principles. The nurse realizes that religion plays what role within ethnocultural heritage?

Standard Text: Select all that apply.

  1. Provides a system of practices
  2. Provides a meaningful philosophy
  3. Gives the patient a frame of reference
  4. Conducive to spiritual harmony and health
  5. Increases morbidity and mortality of older patients

Question 8

Type: MCMA

The nurse is caring for an older patient who only speaks Spanish. To meet the national standards for culturally and linguistically appropriate services in healthcare, what will the nurse do?

Standard Text: Select all that apply.

  1. Offer language assistance services to the patient.
  2. Post signs in the patient’s room written in Spanish.
  3. Encourage the patient’s family members to serve as interpreters.
  4. Explain the cost to employ an interpreter to help the patient with language needs.
  5. Provide a written notice in the patient’s language informing of the right to receive language assistance services.

Question 9

Type: MCMA

An older patient from an Asian background is refusing to eat. What are the consequences if the patient continues to avoid eating?

Standard Text: Select all that apply.

  1. Hostility
  2. Depression
  3. Weight loss
  4. Withdrawal
  5. Dehydration

Question 10

Type: MCMA

While conducting an assessment, the nurse learns that an older patient from a European country practices heritage consistency. What did the nurse assess in this patient?

Standard Text: Select all that apply.

  1. The patient’s name has not been Americanized.
  2. The patient attended social activities at the church.
  3. The patient does not participate in any cultural events.
  4. The patient has returned to the mother land several times.
  5. The patient immigrated to the United States as a young adult.

 

CHAPTER 05

Question 1

Type: MCMA

The nurse is discussing proper nutrition with older community members at a senior citizen center. What should the nurse teach as general guidelines for healthy older individuals?

Standard Text: Select all that apply.

  1. Calcium intake should be 1,000 mg for those over the age of 51 years.
  2. Older individuals need to take supplements of vitamins A, C, E, and K.
  3. Vitamin D intake should be 600 IU up to age 70 and 800 IU if older than 70.
  4. Ingest at least 0.8 grams of protein for each kilogram of body weight each day
  5. Fluid intake each day should be at least 13 cups for men and 9 cups for women.

Question 2

Type: MCMA

A patient prescribed medications for gastroesophageal reflux disease (GERD) is at risk for altered absorption of which nutrients?

Standard Text: Select all that apply.

  1. Iron
  2. Calcium
  3. Folic acid
  4. Vitamin D
  5. Vitamin B12

Question 3

Type: MCSA

An older patient without any major health problems is experiencing decreased strength and endurance while performing some activities. What should the nurse explain as the reason for the change in strength and endurance?

  1. Depression
  2. Decrease in lean muscle mass
  3. Lowered absorption of vitamin D
  4. Increase in cholecystokinin production

Question 4

Type: MCSA

The nurse instructed an older patient on the importance of maintaining adequate hydration. Which statement by the patient indicates that additional teaching is needed?

  1. “I’ll drink water and unsweetened beverages whenever I feel thirsty.”
  2. “I can add an extra cup of decaffeinated coffee with breakfast and dinner.”
  3. “I will set up a schedule to drink a glass of water every 2 hours throughout the day.”
  4. “If I drink a lot of fluids, I’ll have to go to the bathroom more often, but I’ll get more exercise.”

Question 5

Type: MCSA

Which assessment data indicates to the nurse that an older patient is experiencing undernutrition?

  1. Body mass index (BMI) of 20
  2. Unintentional 3% weight loss over a month
  3. Denial of taking a multiple vitamin supplement
  4. Serum albumin slightly below normal, prealbumin and transferrin within normal limits

Question 6

Type: MCSA

Which older patient is at greatest risk for vitamin D deficiency?

  1. The patient with macrocytic anemia
  2. The patient who does not drink milk
  3. The patient who works outdoors daily and does not wear sunscreen
  4. The patient who is taking isoniazid (INH) after a positive tuberculin skin test

Question 7

Type: MCSA

A resident in the nursing home is diagnosed with undernutrition and is unable to take in adequate food despite efforts by the multidisciplinary team and family members. Prior to insertion of a permanent feeding tube, which issue needs to be considered?

  1. Equipment, care, and time needed to administer the feedings
  2. The extent of the surgical intervention, cost and insurance coverage
  3. The patient’s nutritional needs and tolerance of the formula feedings
  4. The patient’s advanced directive and evaluation of risks, benefits, and ethical considerations

Question 8

Type: MCSA

Which observation made by the nurse suggests that a patient is having difficulty swallowing?

  1. Drooling
  2. Cheilosis
  3. Long furrowed tongue
  4. Unintentional weight loss

Question 9

Type: MCSA

An older patient is prescribed diet supplementation to combat unintentional weight loss. How should the nurse provide these supplements to the patient?

  1. Serve at room temperature.
  2. Provide with the next meal.
  3. Provide separate from medications.
  4. Provide more than an hour before the next meal.

Question 10

Type: MCSA

An older patient is receiving feedings through a permanent feeding tube. Which nursing intervention will decrease this patient’s risk of aspiration?

  1. Administer formulas that contain fiber.
  2. Keep the head of the bed elevated at a 30 to 45 degree angle.
  3. The risk of aspiration no longer exists after a permanent feeding tube has been placed.
  4. Flush the tube with water before and after each medication administered through the tube.

 

CHAPTER 06

Question 1

Type: MCSA

An older patient being treated for pneumonia is given a sedative to sleep. A few hours afterwards, the patient has a respiratory rate of 12 and cannot be aroused. What does this assessment finding indicate to the nurse?

  1. The sedative was not absorbed.
  2. The sedative has reached a therapeutic blood level.
  3. The medication for sleep caused excessive sedation.
  4. The patient is experiencing complications of pneumonia.

Question 2

Type: MCSA

An older patient who takes digoxin for an irregular heart rhythm has been experiencing nausea and vomiting and has not eaten in 2 days. The patient now is exhibiting weakness, bradycardia, and visual disturbances. What laboratory tests would the nurse monitor for this patient?

  1. Hemoglobin
  2. Urine analysis
  3. Calcium levels
  4. Serum electrolytes

Question 3

Type: MCSA

An older patient has an elevated blood urea nitrogen (BUN) level, but the creatinine clearance is within normal limits. The nurse notes that the patient’s appetite has been poor the past few days. What should the nurse do about these laboratory findings?

  1. Assess urine output.
  2. Inform the physician of the BUN result.
  3. Assess intake and output and dietary intake of protein.
  4. Monitor for medication side effects related to decreased excretion by the kidneys.

Question 4

Type: MCSA

An older patient admitted with chest pain is prescribed Restoril 15 mg at bedtime. The usual dosage given to adults is 30 mg. What intervention would the nurse use for this patient?

  1. Administer the drug as ordered.
  2. Monitor the patient’s renal function.
  3. Ask the physician to change the dosage to 30 mg.
  4. Give the drug and contact the doctor for a second dose if the patient does not fall asleep.

Question 5

Type: MCSA

An older patient does not take a prescribed diuretic as planned because of the inconvenience of having to urinate frequently, which interrupts scheduled activities. What action should the nurse take with this patient?

  1. Insist the drug be taken as prescribed.
  2. Contact the physician to order another drug.
  3. Advise to take the drug in divided dosages, half in the morning and half in the evening.
  4. Discuss the daily activity schedule and adjust the drug administration time accordingly.

Question 6

Type: MCSA

An older patient experiencing abdominal pain, nausea, and vomiting brown liquid has taken an NSAID type of medication for general muscle aches. What effect might this drug have related to the patient’s manifestations?

  1. Diarrhea
  2. Constipation
  3. Increased BUN
  4. Gastric irritation and bleeding

Question 7

Type: MCSA

After completing a medication history, the nurse notes that an older patient is prescribed 22 different medications and sees five different healthcare providers. What should the nurse determine about the patient from this information?

  1. A situation of polypharmacy
  2. Prone to missing medication doses
  3. Multiple health problems requiring a variety of different prescribed medications
  4. Cognitive impairment and not remembering the medications prescribed

Question 8

Type: MCMA

An older patient is experiencing a change in mood. For which medications should the nurse assess as the possible cause of this patient’s cognitive change?

Standard Text: Select all that apply.

  1. Steroids
  2. NSAIDs
  3. Antibiotics
  4. Benzodiazepines
  5. Antihypertensives

Question 9

Type: MCMA

An older patient is prescribed psyllium seed to prevent constipation. What should the nurse instruct the patient about this medication?

Standard Text: Select all that apply.

  1. Do not take this medication with juice.
  2. Avoid eating after taking this medication.
  3. Take the medication with adequate water.
  4. This medication can swell in the esophagus.
  5. Limit the intake of water after taking this medication.

Question 10

Type: MCSA

An older patient with dementia has been medicated with sedatives. The healthcare provider now prescribes a lower dose of the sedative and the nursing staff is concerned that the patient will resume agitated behavior. What should be explained to the staff about the use of this medication?

  1. The patient’s condition warrants physical restraint only.
  2. The patient’s physical condition does not warrant use of the drug.
  3. The patient’s family members would be upset if they were aware of the use of chemical restraints.
  4. The use of psychotropic drugs may be considered excessive and harm the patient’s health.

 

CHAPTER 07

Question 1

Type: MCSA

During an interview, the nurse notes that an older patient is having mild difficulty with some words and forgets the names of people. The patient is alert, oriented to time, person, and place, and makes appropriate responses. What does the nurse determine this patient’s cognitive changes to mean?

  1. Normal signs of aging
  2. Early symptoms of dementia
  3. Indicators of depression in the elderly
  4. Memory impairment that may be related to cerebral ischemia

Question 2

Type: MCSA

An older patient wakes up from sleep, confused, and insists a family member is in the other room. What information within the patient’s medical record should the nurse consider as a source of the patient’s confusion?

  1. The patient is elderly.
  2. The patient’s spouse recently died.
  3. The patient received pain medication.
  4. The patient has a history of cardiac disease.

Question 3

Type: MCSA

The nurse is providing discharge instructions to an older patient that includes the administration of insulin. Which strategy will the nurse use when instructing this patient to adjust to the normal changes experienced with aging?

  1. Giving written materials to compensate for short-term memory losses
  2. Using tools that repeat the information until the information is understood
  3. Considering holding sessions for longer periods than usual so the patient can learn
  4. Providing instruction to relatives so that the patient will not need to learn everything

Question 4

Type: MCSA

The daughter of an older patient tells the nurse that the patient used to be a wonderful cook but now cannot remember how to use a blender. What does this information indicate to the nurse?

  1. Short-term memory loss
  2. Long-term memory loss
  3. Normal cognitive change in an older person
  4. Cognitive change that requires further assessment

Question 5

Type: MCMA

An older patient is concerned about remembering to take prescribed medications. What strategies should the nurse recommend to this patient?

Standard Text: Select all that apply.

  1. Rely on habit to take the medication.
  2. Use an assistive device such as a pillbox.
  3. Suggest a family member provide the medication.
  4. Discuss moving to an assisted living facility for safety.
  5. Discuss reducing the number of medications with the physician.

Question 6

Type: MCSA

An older patient with cardiac disease is having sleep problems and insomnia. Of what health problem should the nurse consider these manifestations?

  1. Normal signs of aging
  2. Predictive signs of respiratory disease
  3. Symptoms of the negative effects of stress
  4. Expected manifestations of cardiac disease

Question 7

Type: MCMA

An older African American patient is diagnosed with a mental health problem that has been untreated for many years. What does the nurse realize as reasons for this patient’s problem not being adequately treated?

Standard Text: Select all that apply.

  1. Ageism
  2. Poverty
  3. Cultural bias
  4. Discrimination
  5. Respecting medical personnel

Question 8

Type: MCSA

An older patient being treated for abdominal pain reports no relief of pain and other somatic complaints after receiving adequate pain medication. What additional intervention is indicated for this patient?

  1. Reviewing the patient’s lab values
  2. Contacting the family to talk to the patient
  3. Further assessment and treatment for depression
  4. Obtaining an order for different pain medication

Question 9

Type: MCMA

An older patient is demonstrating signs of paranoia. What does the nurse identify as possible causes for this type of psychosis?

Standard Text: Select all that apply.

  1. Delirium
  2. Hearing loss
  3. Physical illness
  4. Social isolation
  5. Cognitive impairment

Question 10

Type: MCSA

An older patient tells the nurse that alcohol is used occasionally to combat stress. The patient is a recent widow, retired, and admits to feeling worthless at times. The nurse realizes this patient is at risk for which health problem?

  1. Suicide
  2. Paranoia
  3. Dementia
  4. Liver failure

 

CHAPTER 08

Question 1

Type: MCSA

The nurse is caring for an older patient who is experiencing sleep deprivation. Which manifestation might the nurse assess in this patient?

  1. Improved healing
  2. Visual hallucinations
  3. Fatigue occurring at night
  4. Development of Alzheimer’s disease

Question 2

Type: MCSA

An older patient is telling the nurse about problems with sleeping. What does the nurse realize about sleep and the older adult?

  1. The need for sleep decreases with age.
  2. Disrupted sleep is not associated with depression.
  3. A person should not awaken more than once during the night.
  4. An older person does not have as much deep sleep as a younger person.

Question 3

Type: MCMA

The nurse is concerned that an older patient is experiencing sleep apnea. What did the nurse assess in this patient?

Standard Text: Select all that apply.

  1. Jumpy legs
  2. Sleeping with three pillows
  3. Excessive daytime sleepiness
  4. Excessive snoring upon inspiration
  5. Complaints of choking when waking from sleep

Question 4

Type: MCMA

An older patient is having difficulty sleeping. What can the nurse instruct the patient to help improve the patient’s sleep?

Standard Text: Select all that apply.

  1. Do not nap during the day.
  2. Take a walk an hour before going to sleep.
  3. Have a glass of wine before going to sleep.
  4. Avoid reading or watching television in bed.
  5. If unable to sleep, get up and go to another room.

Question 5

Type: MCSA

The nurse is assessing an older patient who wakes up during the night. Which finding does the nurse identify as a risk factor for disturbed sleep?

  1. Patient has osteoarthritis of both hips
  2. Patient ingests one cup of coffee every morning
  3. Patient takes antidepressant medication in the morning
  4. Patient walks for half an hour before lunch each day

Question 6

Type: MCMA

The nurse is concerned that an older patient with dementia receiving psychotropic medications for sleep is experiencing side effects. What did the nurse assess in this patient?

Standard Text: Select all that apply.

  1. Dizziness
  2. Constipation
  3. Hallucinations
  4. Daytime lethargy
  5. Problems swallowing

Question 7

Type: MCSA

The nurse is concerned that an older patient has undiagnosed sleep apnea and is at risk for which additional health problem?

  1. Underweight
  2. Excessive deep sleep
  3. Increased risk for sudden death and stroke
  4. Excessive tension in the muscles of the throat and soft palate

Question 8

Type: MCMA

The nurse is teaching an older patient about an overnight sleep study to diagnose sleep apnea. What will the nurse include when teaching this patient?

Standard Text: Select all that apply.

  1. Oxygen saturation level will be measured.
  2. An electrocardiogram will be used to measure heart activity.
  3. Pins will be inserted into leg muscles to measure tone and tension.
  4. An electromyogram will be done to measure face and leg movements.
  5. An electroencephalogram will be done to measure brain wave activity.

Question 9

Type: MCMA

An older patient is diagnosed with sleep apnea. Which interventions can the nurse add to the patient’s care plan to address this health problem?

Standard Text: Select all that apply.

  1. Discussing smoking cessation techniques
  2. Encouraging the patient to sleep on the side
  3. Instructing to avoid alcohol before going to sleep
  4. Suggesting sleeping in an upright position in a chair
  5. Consulting with a dietitian to discuss meal planning for weight reduction

Question 10

Type: MCMA

An older patient with sleep apnea is prescribed continuous positive airway pressure (CPAP). What will the nurse explain to the patient about this treatment?

Standard Text: Select all that apply.

  1. Pressure keeps the airway open.
  2. An oral airway is inserted each night.
  3. The machine is noisy and will keep the patient awake.
  4. Noninvasive treatment is administered through a nasal mask.
  5. The face mask is uncomfortable but the patient will get used to it.

 

CHAPTER 09

Question 1

Type: MCSA

An older patient with a history of severe arthritis has not received pain medication for over 18 hours. The patient is currently complaining of severe pain in both legs. What will the nurse attribute as being the reason for the patient’s increase in pain?

  1. Dependency on narcotics
  2. Over-exaggeration of the amount of pain
  3. Need for alternative measures for pain relief
  4. Untreated pain resulting in lower pain threshold

Question 2

Type: MCSA

The nurse is caring for two patients. An older patient reports abdominal pain as being 5 out of 10 on the pain rating scale, whereas a younger patient reports left lower quadrant abdominal pain as being 10 out 10 on the scale. What would the nurse identify as reason for the discrepancy between the two patients’ measurements of pain?

  1. Younger patients tend to be more dramatic when complaining of pain.
  2. Visceral pain is less severe in older patients and may be reported as mild.
  3. Visceral pain is more severe in older patients, but they are less likely to complain.
  4. Visceral pain is less severe in younger patients but is reported as high in intensity.

Question 3

Type: MCSA

An older patient living at home with cancer reports having to take twice as much pain medication over the last 24 hours. What should the nurse do with this information?

  1. Adjust the medication as needed.
  2. Discuss options to treat breakthrough pain.
  3. Try alternative methods for pain relief instead of pain medication.
  4. Talk with the physician to change the medication because of opioid tolerance.

Question 4

Type: MCSA

An older patient with headaches, dizziness, and ataxia takes meperidine for arthritic pain. What impact does this medication have on this patient’s health problems?

  1. This medication is not causing the patient’s symptoms.
  2. This medication is not effective in older patients for pain relief.
  3. This medication is more effective to treat pain than aspirin or acetaminophen.
  4. This medication causes toxic side effects similar to what the patient is experiencing.

Question 5

Type: MCSA

The nurse is caring for an older patient with chronic pain caused by arthritis and uterine cancer. What is the best approach for the nurse to take when managing this patient’s pain?

  1. Administering the pain medication around the clock
  2. Administering the medication when the patient requests it
  3. Consulting the physician to order intravenous pain medication
  4. Administering the medication sparingly to avoid narcotic addiction

Question 6

Type: MCMA

An older patient asks why sustained-release pain medication cannot be chewed. How should the nurse respond to this patient?

Standard Text: Select all that apply.

  1. Chewing deactivates the medication.
  2. The medication is damaging to the teeth and gums.
  3. Chewing destroys their controlled-release properties.
  4. The saliva in the mouth breaks the medication down and makes it toxic.
  5. Chewing causes a rapid absorption of the entire dose and a possible overdose.

Question 7

Type: MCMA

An older patient with a speech deficit from a previous stroke is admitted for a repair of a hip fracture. Which techniques will the nurse use to assess this patient’s pain level?

Standard Text: Select all that apply.

  1. Ask to describe the level of pain.
  2. Observe for tense body posturing.
  3. Listen for sounds such as groaning.
  4. Notice changes in appetite or sleep.
  5. Observe facial expressions such as grimacing.

Question 8

Type: MCSA

An older patient recovering from surgery is prescribed morphine sulfate 2 to 6 mg every 4 hours prn for pain. What approach will the nurse take to manage this patient’s pain?

  1. Administer the lowest dose of 2 mg.
  2. Administer the highest dose of 6 mg.
  3. Avoid the narcotic for risk of addiction.
  4. Administer the dose only when the patient asks for the medication.

Question 9

Type: MCMA

An older patient with a history of constipation is prescribed an opioid analgesic for postoperative pain. What should the nurse include in this patient’s plan of care to avoid the pain management complication of constipation?

Standard Text: Select all that apply.

  1. Mix psyllium in 4 ounces of water.
  2. Provide stool softeners as prescribed.
  3. Monitor for adequate daily fluid intake.
  4. Increase ingestion of fresh fruit each day.
  5. Offer senna tea each evening before sleep.

Question 10

Type: MCSA

The nurse is planning to implement nonpharmacological approaches with an older patient with chronic osteoarthritis pain. What should the nurse keep in mind when implementing these approaches?

  1. The effectiveness of nonpharmacological approaches is questionable.
  2. Nonpharmacological approaches are less effective in the older patient.
  3. Nonpharmacological approaches are more effective in the older patient.
  4. Nonpharmacological approaches are effective when used with pharmacological therapy.

 

CHAPTER 10

Question 1

Type: MCMA

During a home visit, the nurse is concerned that an older patient is experiencing caregiver neglect. What did the nurse assess in this patient?

Standard Text: Select all that apply.

  1. Agitation
  2. Listlessness
  3. Dry, cracked skin
  4. Bruises on both arms
  5. Skin irritation on both inner thighs

Question 2

Type: MCMA

An older patient who just celebrated an 85th birthday comes into the emergency department with a fractured arm and bruises over the chest and back. The nurse suspects the patient is a victim of physical abuse. Which individuals will the nurse specifically assess the patient as being the abuser?

Standard Text: Select all that apply.

  1. Spouse
  2. Nephew
  3. Granddaughter
  4. Next door neighbor
  5. Adult daughter caregiver

Question 3

Type: MCMA

An older patient is accompanied by an adult daughter who is the patient’s primary caregiver for a routine clinic visit. While in the waiting room, the adult daughter is observed sitting quietly and not talking with the patient. During the examination, what should the nurse assess the adult daughter for?

Standard Text: Select all that apply.

  1. Employment
  2. Physical status
  3. Caregiver stress
  4. Substance abuse
  5. History of psychopathology

Question 4

Type: MCSA

Which patients seen by a nurse working in the emergency department identify a situation that suggests a case of elder mistreatment?

  1. An 86-year-old patient who has three dime-size burned areas on the upper inner thigh
  2. A 77-year-old patient who fell at home after tripping over the dog and broke an arm about 30 minutes earlier
  3. A 73-year-old patient with a history of gastric ulcers who is found to be anemic after vomiting blood 3 hours earlier
  4. An 85-year-old patient who has several small areas of bruising on the back of the hands and is taking medication for platelets and coagulation

Question 5

Type: MCSA

The nurse suspects that an older patient has been physically abused. What must be included in the medical workup for this patient?

  1. Pelvic examination
  2. Toxicological screening
  3. Complete blood count and blood chemistries
  4. Complete visual examination with clothing removed

Question 6

Type: MCSA

The nurse is concerned that specific families in a community are at increased risk for transgenerational violence. Which family situation exemplifies the transgenerational theory of violence?

  1. Family with a daughter who abuses alcohol
  2. Family with a daughter who has severe arthritis and finds it increasingly difficult to deal with her forgetful, frail mother
  3. Family with a son who, as a teenager and young adult, had serious arguments with his parents, who were emotionally abusive to him
  4. Family with a daughter who is working two jobs with significant debts and cares for her father, who is becoming more confused and dependent

Question 7

Type: MCSA

An older patient tearfully tells a nurse that she must buy the neighbor’s groceries or the neighbor will not drive the patient to the store. The nurse recognizes this situation as being which type of elder mistreatment?

  1. Abuse
  2. Neglect
  3. Exploitation
  4. Abandonment

Question 8

Type: MCMA

In which situations is institutional mistreatment of older patients most likely to occur?

Standard Text: Select all that apply.

  1. Staff burnout
  2. Staffing shortage
  3. Patient aggressiveness
  4. Inadequate staff training
  5. Family members frequently visit

Question 9

Type: MCSA

Which older patient is at greatest risk for mistreatment in the home?

  1. An active older patient with well-controlled diabetes who lives alone
  2. A healthy older patient who is retired from owning a business and lives with an adult son
  3. An older patient with a history of coronary bypass surgery, is active, and lives with the spouse
  4. An older patient with severe osteoarthritis and macular degeneration who lives with a single daughter who has an adult son with cerebral palsy

Question 10

Type: MCSA

An older patient lives alone and has not bathed or changed clothing for several days. An investigator for adult protective services visits and determines this patient is experiencing which type of elder mistreatment?

  1. Self-neglect
  2. Physical abuse
  3. Psychological abuse
  4. Financial exploitation

 

CHAPTER 11

Question 1

Type: MCMA

An older patient with terminal cancer is considering hospice care but is concerned that Medicare will stop payments if the care is provided for longer than 6 months. What can the nurse respond to this patient?

Standard Text: Select all that apply.

  1. Medicare does not limit the hospice benefit.
  2. Medicare regulations discourage a longer use of the benefit.
  3. Hospice costs more than traditional hospital or long-term care.
  4. Patient may enroll when the life expectancy is 6 months or less.
  5. Hospice supports the family for 6 months after the patient’s death.

Question 2

Type: MCMA

During an assessment the nurse determines that an older patient dying from a terminal illness is experiencing common fears. What fears did this nurse assess in the patient?

Standard Text: Select all that apply.

  1. Dying alone
  2. Loss of consciousness
  3. Loss of bladder control
  4. Leaving loved ones behind
  5. Becoming a burden to others

Question 3

Type: MCSA

An older patient dying of end-stage pulmonary disease and dementia receives narcotic medication for chronic pain. Currently the patient is restless and grimacing. How should the nurse interpret these assessment findings?

  1. The patient is in pain.
  2. The patient has an undiagnosed personality disorder.
  3. The patient needs nonpharmacological pain management approaches.
  4. The patient is not experiencing any difference in pain level and no adjustments are needed.

Question 4

Type: MCSA

An older patient dying from a terminal illness reports that the last dose of pain medication provided barely reduced the level of pain. What should the nurse do to help this patient?

  1. Give the patient pain medication every hour.
  2. Contact the physician for an adjustment in pain medication.
  3. Provide the pain medication at the next scheduled dose time.
  4. Give the patient another dose of the medication even though it is before the scheduled time.

Question 5

Type: MCMA

The nurse is planning oral hygiene for an older patient with a terminal illness who has an intact swallowing reflex. Which interventions would be appropriate for this patient?

Standard Text: Select all that apply.

  1. Offer ice chips frequently.
  2. Provide care with soft swabs.
  3. Apply petroleum jelly to the lips.
  4. Brush the teeth three times a day.
  5. Avoid using alcohol-based solutions.

Question 6

Type: MCSA

The family of an older patient dying of liver cancer is concerned that the patient will not eat or drink. The patient is alert and oriented, and expresses no desire to eat. What action would the nurse take?

  1. Force fluids.
  2. Consult the dietician for feeding supplements.
  3. Contact the physician for an order for tube feedings.
  4. Comply with the patient’s wishes despite the family’s concern.

Question 7

Type: MCSA

An older patient with end-stage renal and heart failure is experiencing odd dreams and is talking with people who are not present in the room. What does this finding indicate to the nurse?

  1. Pending death
  2. Ineffective pain medication
  3. Overdose of narcotic medication
  4. Normal visual and auditory hallucinations at the end of life

Question 8

Type: MCSA

While providing postmortem care to a patient who has died the patient elicits a respiratory sound when turned. What should the nurse do?

  1. Check for a pulse.
  2. Reposition the airway.
  3. Continue with the postmortem care.
  4. Report to the physician the patient is still breathing.

Question 9

Type: MCSA

An older patient is not breathing well and has cold, mottled skin. The patient has a living will and requests comfort measures only. What should the nurse do to care for this patient?

  1. Ask the family what they want to be done for the patient.
  2. Contact the physician for orders to control the patient’s breathing.
  3. Provide personal hygiene and skin care as outlined in the care plan.
  4. Withhold pain medication, hygiene, and nutrition until the patient dies.

Question 10

Type: MCSA

The family of an older patient with a terminal illness has been aware of the patient’s pending death and is present when the patient dies. The family’s reaction to the patient’s death was very emotional and demonstrated a state of disbelief. How should the nurse interpret this family’s behavior?

  1. Irrational behavior
  2. Expression of anger
  3. Maladaptive coping of the family
  4. Normal shock when experiencing the loss of a loved one

 

CHAPTER 12

Question 1

Type: MCSA

An older patient is diagnosed with an infection but has a subnormal body temperature. What should the nurse explain to the patient’s family as the reason for this discrepancy?

  1. The temperature regulating mechanism changes with aging.
  2. The patient is on medication that drops the body temperature.
  3. The diagnosis of an infection is inaccurate and will be checked.
  4. The temperature was measured incorrectly and will be repeated.

Question 2

Type: MCSA

An older patient is recovering from abdominal surgery. Which skin changes will the nurse consider when planning care for this patient?

  1. The healing time is increased.
  2. The healing time is decreased.
  3. There is a need to keep the wound edges taped.
  4. Skin near the wound needs to be massaged to increase blood flow.

Question 3

Type: MCSA

The home care nurse notes that an older patient who lives alone has a large red mark on the arm. When asked about the mark the patient states unawareness of the injury and believes it occurred from hot water when cooking. How should the nurse interpret this finding?

  1. The patient is at risk for further injury.
  2. The patient is losing short-term memory.
  3. The patient is experiencing friction tears of the skin.
  4. The patient is demonstrating senile purpura of the skin.

Question 4

Type: MCMA

An older patient is recovering from surgery to repair a fractured hip. What interventions will the nurse use to prevent the development of a pressure ulcer in this patient?

Standard Text: Select all that apply.

  1. Avoid sitting unless for meals.
  2. Use pillows to protect the skin.
  3. Reposition the patient every 2 hours.
  4. Keep the skin dry with frequent bathing.
  5. Encourage independent position changes.

Question 5

Type: MCSA

What instruction should the nurse provide to a nursing assistant who is assigned to care for an older patient with a stage I pressure ulcer on the right heel?

  1. Apply a dry dressing to the site.
  2. Apply a donut under the right heal.
  3. Cleanse the area with tepid water without soap.
  4. Keep the head of the bed elevated to a 45-degree angle.

Question 6

Type: MCSA

While assessing an older patient’s stage III pressure ulcer the nurse notes that the wound is beefy red and grainy, and the depth has decreased by 2 mm but the width has not changed. How should the nurse interpret this assessment finding?

  1. Not healing properly
  2. About to slough off tissue
  3. No longer at risk for infection
  4. Progressing positively toward healing

Question 7

Type: MCSA

The nurse is caring for an older patient who previously had a sacral pressure ulcer that has completely healed. What does the nurse recognize as a characteristic of the previously healed pressure ulcer?

  1. Heal faster if reinjured
  2. Break down faster if reinjured
  3. Have no sensation in the injured area
  4. Be at risk for infection even with intact skin

Question 8

Type: MCMA

After an assessment the nurse is concerned that an older patient is at risk for pressure ulcer development because of the current nutritional status. What nutritional factors did the nurse assess in the patient?

Standard Text: Select all that apply.

  1. Diagnosis of dehydration
  2. Hemoglobin level 9 mg/dL
  3. Treatment for chronic renal failure
  4. Serum albumin level below normal
  5. Loss of 20 pounds over the last 3 months

Question 9

Type: MCMA

Which over-the-counter skin preparations should the nurse instruct an older patient to use with caution?

Standard Text: Select all that apply.

  1. Sunblock
  2. Super-fatted soaps
  3. Emollients that keep the skin moist
  4. Steroid-based ointments and creams
  5. Topical lotion with an antihistamine

Question 10

Type: MCMA

The nurse is preparing to cleanse an older patient’s abdominal wound. Which techniques should the nurse use to perform this action?

Standard Text: Select all that apply.

  1. Pour saline over the wound.
  2. Apply saline-soaked gauze over the wound.
  3. Squeeze a saline-filled syringe over the wound.
  4. Place gauze pads soaked with hydrogen peroxide on the wound.
  5. Apply dry gauze pads over the wound and saturate with sterile water.

 

CHAPTER 13

Question 1

Type: MCSA

The nurse is completing an assessment of an older patient’s oral cavity. Which finding is considered normal because of the aging process?

  1. Leukoplakia
  2. Gum recession
  3. Increased saliva
  4. Thickening tooth enamel

Question 2

Type: MCSA

An older patient has several small vesicles with eroded centers on the lips. What does this finding suggest to the nurse?

  1. Gingivitis
  2. Leukoplakia
  3. Herpes simplex
  4. Oral candidiasis

Question 3

Type: MCSA

An older patient is experiencing mouth pain rated 6 on a 10 point pain scale. What action should the nurse take first?

  1. Medicate the patient with a prescribed mild analgesic.
  2. Carefully inspect the patient’s mouth, teeth, and tongue.
  3. Notify the physician in charge about the patient’s problem.
  4. Instruct the patient to begin rinsing the mouth with an isotonic solution.

Question 4

Type: MCSA

What should the nurse use for mouth care in an older patient who is unable to perform teeth brushing independently?

  1. Nystatin
  2. Chlorhexidine (Peridex)
  3. Lemon and glycerin swabs
  4. Undiluted hydrogen peroxide

Question 5

Type: MCMA

An older patient tells the nurse that tooth brushing is seldom done. What should the nurse assess as reasons why the patient has stopped performing oral hygiene?

Standard Text: Select all that apply.

  1. Vision changes
  2. Malocclusion of teeth
  3. Decrease in taste acuity
  4. Lack of dental insurance
  5. Loss of manual dexterity

Question 6

Type: MCMA

An older patient with oral candidiasis is prescribed Nystatin. Which actions will the nurse take when using this preparation with the patient?

Standard Text: Select all that apply.

  1. Plan to use the medication four times a day for 2 weeks.
  2. Soak dentures in 1 mL of the medication and water for at least 6 hours.
  3. Teach to hold the solution in the mouth and swish for 2 minutes before swallowing.
  4. Coat the gums and tongue with the medication and rinse with water after 5 minutes.
  5. Provide the medication as a troche to be used twice a day if the patient has diabetes.

Question 7

Type: MCSA

An older patient has a significant amount of dental plaque. What can the nurse include when instructing the patient about brushing the teeth and gums?

  1. Use a foam swab and brush three times a day for 3 to 4 minutes.
  2. Use a soft-bristled toothbrush at bedtime and brush for 1 minute.
  3. Use a soft-bristled toothbrush and brush twice a day for 3 to 4 minutes.
  4. Use a medium to hard-bristled toothbrush and brush twice a day for 3 to 4 minutes.

Question 8

Type: MCMA

The nurse is planning interventions for a patient with xerostomia. What will the nurse include in the patient’s plan of care?

Standard Text: Select all that apply.

  1. Use a mouth rinse.
  2. Avoid artificial lubricants.
  3. Place a humidifier next to the bed.
  4. Avoid foods that are difficult to chew or swallow.
  5. Use sugar-free chewing gum, hard candies, and mints.

Question 9

Type: MCSA

How should the nurse respond to an older patient who does not receive regular dental examinations?

  1. “Losing teeth is considered a normal part of the aging process.”
  2. “Patients who have no teeth do not need to see a dentist for regular checkups.”
  3. “Oral malignancies seldom occur in older people so oral examinations are not necessary.”
  4. “Regular dental examinations can improve an older person’s ability to eat healthful foods.”

Question 10

Type: MCMA

The nurse is reviewing an older patient’s prescribed medications and realizes the patient is at risk for xerostomia. Which medications would increase the patient’s risk for this disorder?

Standard Text: Select all that apply.

  1. Diuretics
  2. Antibiotics
  3. Antihistamines
  4. Anticoagulants
  5. Tricyclic antidepressants

 

CHAPTER 14

Question 1

Type: MCSA

The nurse learns that an older patient has a decrease in accommodation. What would the nurse assess in this patient?

  1. Blurred vision
  2. Sensitivity to light
  3. Narrowing of field of vision
  4. Difficulty reading small print

Question 2

Type: MCSA

An older patient has sensitivity to light. What should the nurse teach the patient to help with this problem?

  1. Dim the lights on sunny days.
  2. Place dark patterned rugs on stairs.
  3. Use supplementary lamps near work.
  4. Remove lampshades to provide more light.

Question 3

Type: MCMA

The nurse is reviewing an older patient’s currently prescribed medications. Which medications have side effects that increase visual disturbances?

Standard Text: Select all that apply.

  1. Propranolol (Inderal)
  2. Warfarin (Coumadin)
  3. Tamoxifen (Nolvadex)
  4. Amiodarone (Cordarone)
  5. Calcium carbonate (Tums)

Question 4

Type: MCMA

An older patient has sensorineural hearing loss. Which health problems should the nurse recognize as causing this type of hearing loss?

Standard Text: Select all that apply.

  1. Presbycusis
  2. Meniere’s disease
  3. Impacted cerumen
  4. Otitis media infection
  5. Tympanic membrane perforation

Question 5

Type: MCSA

An otoscopic examination of an older patient reveals a red, bulging membrane with absent distorted light reflex. Which condition would the nurse suspect?

  1. Scar tissue
  2. Otitis media
  3. External otitis
  4. Ruptured tympanic membrane

Question 6

Type: MCMA

Which interventions should the nurse perform when an older patient reports a change in hearing?

Standard Text: Select all that apply.

  1. Perform a Rinne test.
  2. Eliminate extraneous noise.
  3. Review prescribed medications.
  4. Report the change to the physician.
  5. Speak in a tone that includes shouting.

Question 7

Type: MCSA

The nurse documents that an older patient has hypogeusia. What is this patient experiencing?

  1. Dulled sensitivity to touch
  2. Blunting of the sense of taste
  3. A downward and outward deviation of the eye
  4. Dry mouth occurring with salivary gland dysfunction

Question 8

Type: MCSA

An older patient with diabetes has an oral infection and is on antibiotics. Which manifestations might the nurse observe in this patient?

  1. Increased weight
  2. Increased appetite
  3. Increased gustatory sensation
  4. Increased salt or sugar intake

Question 9

Type: MCMA

Which interventions should the nurse use to help a patient with xerostomia?

Standard Text: Select all that apply.

  1. Use a humidifier.
  2. Provide oral fluids after meals.
  3. Provide sugar-free hard candies.
  4. Reinforce regular dental examinations.
  5. Increase medications from once a day to twice a day.

Question 10

Type: MCSA

Which is a pathophysiological cause that the nurse recognizes in an older patient with hyposmia?

  1. Increased neurotransmitters
  2. Injury of the olfactory mucosa
  3. Increased number of sensory cells
  4. Lower thresholds for common odors

 

CHAPTER 15

Question 1

Type: MCSA

An older female patient is experiencing fatigue, nausea, vague complaint of intermittent chest discomfort, and not sleeping well. How should the nurse interpret these symptoms?

  1. Signs of anemia
  2. Pancreatic disease
  3. Myocardial infarction
  4. Normal changes of aging

Question 2

Type: MCSA

During a blood pressure screening at a pharmacy an older person experiences a fluttering in the chest. What should the nurse interpret this finding as being?

  1. Hypothyroidism
  2. Exercise intolerance
  3. Nonspecific cardiac changes with aging
  4. Underlying illness that requires a medical evaluation

Question 3

Type: MCSA

An older patient has a blood pressure reading of 150/88. The patient reports no other symptoms or medical history of illness. What should the nurse instruct the patient to do?

  1. Have the blood pressure rechecked in a month.
  2. Do nothing since this is a normal variant of aging.
  3. Go to the emergency department for further evaluation and treatment.
  4. Contact the primary care provider for further evaluation and treatment.

Question 4

Type: MCSA

During a home visit the nurse learns that an older patient with hypertension takes prescribed medications only when feeling tense. What instruction should the nurse provide to the patient?

  1. Contact the physician for a change in blood pressure medication.
  2. Continue to administer the blood pressure medication as needed.
  3. Teach to take the blood pressure medication as prescribed regardless of feeling tense.
  4. Instruct to take a double dose of the medication for one day then resume the normal schedule.

Question 5

Type: MCSA

The nurse is planning care for an older patient with hypertension who recently fell in the home. Which assessment would the nurse plan for this patient?

  1. Check serum sodium levels.
  2. Check serum creatinine levels.
  3. Check postural blood pressures.
  4. Check blood pressure every 2 hours.

Question 6

Type: MCMA

The nurse is planning a presentation to a group of senior citizens on lifestyle modifications to manage high blood pressure. What major points will the nurse include in this presentation?

Standard Text: Select all that apply.

  1. Keep sodium intake to 2.4 grams per day.
  2. Achieve and maintain a normal body mass index.
  3. Perform aerobic activity for 30 minutes most days of the week.
  4. Limit daily alcohol intake to two drinks for males and one drink for females.
  5. Consumption of fruits and whole grains has little impact on blood pressure.

Question 7

Type: MCSA

An older patient who is prescribed doxazosin mesylate (Cardura) has a lying blood pressure of 124/76 mm Hg and a sitting blood pressure of 100/64 mm Hg. What additional observation is needed for this patient?

  1. Fall risk
  2. Nausea and vomiting
  3. Decreased urine output
  4. Change in mental status

Question 8

Type: MCMA

The nurse is providing discharge instructions for an older patient who is prescribed atorvastatin (Lipitor) for elevated cholesterol. What effects should the nurse advise the patient to report to the healthcare provider?

Standard Text: Select all that apply.

  1. Headaches
  2. Stomachache
  3. Shortness of breath
  4. Muscle pain and weakness
  5. Bruising and excessive bleeding

Question 9

Type: MCSA

An older patient has an increase in pitting edema of both ankles and is experiencing breathlessness. The patient is not experiencing any pain. What action should the nurse take to help the patient at this time?

  1. Allow the patient to rest.
  2. Measure intake and output.
  3. Measure the patient’s weight.
  4. Contact the physician for further evaluation and treatment.

Question 10

Type: MCMA

An older patient with a history of atrial fibrillation has a fall at home and is diagnosed with a hemorrhagic stroke. What will the nurse assess to help determine the cause of this patient’s bleeding?

Standard Text: Select all that apply.

  1. Current INR
  2. Platelet level
  3. Liver function studies
  4. Hemoglobin and hematocrit
  5. Dose of warfarin sodium (Coumadin) taken at home

 

CHAPTER 16

Question 1

Type: MCSA

Which change in the respiratory system of an older patient does the nurse recognize as an expected finding with aging?

  1. Decrease in vital capacity
  2. Increase in alveolar surface area
  3. Decrease in stiffness of the chest wall
  4. Increase in the amount of oxygen carried in the blood

Question 2

Type: MCSA

Why will the nurse plan interventions to reduce an older patient’s risk of developing a pulmonary disease?

  1. There is an increase in alveolar diameter.
  2. The older patient has decreased production of antibodies.
  3. The older patient has an improved response to immunizations.
  4. The cilia of an older patient is more effective in removing debris from the airway.

Question 3

Type: MCSA

An older patient who is having difficulty breathing and is wheezing is scheduled for a test to differentiate the health problem as being asthma or chronic obstructive pulmonary disease (COPD). For which diagnostic test should the nurse prepare the patient?

  1. Chest x-ray
  2. Electrocardiogram
  3. Complete blood count
  4. Pulmonary function tests

Question 4

Type: MCSA

What will the nurse keep in mind when planning care for an older patient diagnosed with asthma?

  1. Asthma is not diagnosed as a new condition in older patients.
  2. Asthma is treated with the same types of medications in older patients as in younger patients.
  3. Older patients will have fewer side effects and drug interactions from asthma medications than younger patients.
  4. Asthma can be differentiated from chronic obstructive pulmonary disease (COPD) by changes seen on a series of chest x-rays.

Question 5

Type: MCMA

An older patient is prescribed an inhaled corticosteroid as part of treatment for asthma. What will the nurse instruct the patient about the use of this medication?

Standard Text: Select all that apply.

  1. It can cause oral thrush or candidiasis.
  2. Use a spacer when taking this medication.
  3. It has no effect on any other health problems.
  4. Rinse the mouth and spit after using this medication.
  5. It is the most effective anti-inflammatory treatment for asthma.

Question 6

Type: MCMA

When should the nurse instruct an older patient with asthma to use a peak flow meter?

Standard Text: Select all that apply.

  1. After eating dinner in the evening
  2. If feeling like cold symptoms are occurring
  3. When wheezing or tightness in the chest occurs
  4. In the morning after awakening and between noon and 2 p.m.
  5. Every day for the first 2 weeks when medication treatment changes

Question 7

Type: MCMA

An older patient with asthma is prescribed rescue inhalers. What should the nurse instruct the patient about this medication?

Standard Text: Select all that apply.

  1. Refrigerate unused canisters.
  2. Place the canisters near the bed.
  3. Label the canisters with bright red tape.
  4. Obtain a prescription for extra canisters.
  5. Keep several inhalers in different areas in the home.

Question 8

Type: MCSA

Which manifestation of chronic obstructive pulmonary disease (COPD) that occurs early in the disease will the nurse assess in an older patient?

  1. Dysrhythmias
  2. Cyanotic nail beds
  3. Clubbing of the fingers
  4. Cough in the morning producing clear sputum

Question 9

Type: MCSA

Which nursing diagnosis would the nurse select for an older patient with asthma that has a respiratory rate of 28 and audible wheezes on inspiration?

  1. Activity Intolerance
  2. Altered Tissue Perfusion
  3. Ineffective Airway Clearance
  4. Ineffective Breathing Pattern with tachypnea and wheezing.

Question 10

Type: MCSA

An older patient with chronic obstructive pulmonary disease (COPD) develops a dysrhythmia. Which health problem should the nurse consider is occurring with this patient?

  1. Anemia
  2. Asthma
  3. Cor pulmonale
  4. Left ventricular hypertrophy

 

CHAPTER 17

Question 1

Type: MCSA

An older patient describes having to go to the bathroom more frequently at night. What manifestation is this patient experiencing?

  1. Fluid overload
  2. Increased glycosuria
  3. Normal changes of aging
  4. Impairment of drug excretion

Question 2

Type: MCSA

An older patient who has been experiencing a fever, nausea, and vomiting has a urine specific gravity below normal. The patient denies being thirsty. What should the nurse suspect the patient is experiencing?

  1. Dehydration
  2. Fluid overload
  3. Congestive heart failure
  4. Normal changes of aging

Question 3

Type: MCSA

The nurse is having difficulty inserting a urinary catheter in an older female patient. Which position should the nurse use to help facilitate the insertion of the catheter?

  1. Side-lying lifting up the buttock
  2. Supine with the bed flat, legs bent and apart
  3. Supine with the HOB elevated at 30 degrees
  4. Supine with the head of bed (HOB) elevated at 90 degrees

Question 4

Type: MCMA

An older female patient asks the home care nurse what can be done to help with painful intercourse. What recommendations should the nurse make to the patient?

Standard Text: Select all that apply.

  1. Avoid intercourse.
  2. Decrease the frequency of intercourse.
  3. Use vaginal lubricants during intercourse.
  4. Use the hand to guide the penis into the vagina.
  5. Tolerate the problem because it is a normal part of aging.

Question 5

Type: MCSA

An older patient with chronic renal failure has not had a bowel movement for two days. What does the nurse realize this patient is at risk for developing?

  1. Hypokalemia
  2. Hyperkalemia
  3. Metabolic acidosis
  4. Increased serum creatinine levels

Question 6

Type: MCMA

Which assessment findings does the nurse recognize as being a normal part of aging for an older patient?

Standard Text: Select all that apply.

  1. Nocturia
  2. Delayed urination
  3. Less frequent voiding
  4. New onset urinary incontinence
  5. Decreased urine specific gravity

Question 7

Type: MCSA

An older male patient with benign prostatic hypertrophy (BPH) is experiencing an increase in symptoms. Which finding would explain the reason for this patient’s change in symptoms?

  1. Recent vasectomy
  2. Decreased oral intake at night
  3. Use of over-the-counter saw palmetto
  4. Use of over-the-counter cold medication

Question 8

Type: MCMA

An older male patient reports having blood in the urine. For which health problems does the nurse expect the patient will be evaluated?

Standard Text: Select all that apply.

  1. Pyuria
  2. Renal failure
  3. Bladder cancer
  4. Prostate cancer
  5. Urinary tract infection

Question 9

Type: MCSA

An older patient who is postmenopausal is experiencing uterine bleeding. Which action would be appropriate for the nurse to take at this time?

  1. Provide hygienic care.
  2. Collect a urine specimen.
  3. Direct the patient for evaluation for endometrial cancer.
  4. Instruct the patient on normal changes of the reproductive system in the elderly.

Question 10

Type: MCSA

The nurse is instructing an older female patient on reproductive cancer screenings. Which information would the nurse include in this teaching?

  1. Eliminate Pap smears if high risk factors are absent.
  2. Obtain mammography every other year after the age of 40.
  3. Avoid hormone replacement therapy for vasomotor symptoms.
  4. Eliminate self-examination of the breasts if the patient finds this socially unacceptable.

 

CHAPTER 18

Question 1

Type: MCMA

After assessing an older patient which musculoskeletal changes will the nurse attribute as being a normal part of the aging process?

Standard Text: Select all that apply.

  1. Loss in height
  2. Lower leg muscle atrophy
  3. Calcification of the finger joints
  4. Swan neck deformity of the hands
  5. Decreased range of motion in the shoulders

Question 2

Type: MCSA

An older patient is diagnosed with osteoarthritis. How should the nurse explain this health problem to the patient?

  1. A metabolic bone disease
  2. Occurs from synovial inflammation
  3. Most common in thin, small-built female patients
  4. Involves erosion of joint cartilage with new bone formation in joint spaces

Question 3

Type: MCSA

An older patient is brought to the emergency department with a suspected fractured hip. For which diagnostic test will the nurse prepare the patient to confirm the diagnosis?

  1. Bone scan
  2. X-ray of the hip
  3. Bone mineral density (BMD)
  4. Magnetic resonance imaging (MRI) of the hip

Question 4

Type: MCMA

An older patient is surprised to learn of a diagnosis of rheumatoid arthritis. What should the nurse explain to the patient about this health problem?

Standard Text: Select all that apply.

  1. It leads to deformities of the hands.
  2. It is caused by a vitamin D deficiency.
  3. It is diagnosed by a positive pannus blood test.
  4. It is characterized by low bone mass and compromised bone strength.
  5. It causes systemic problems that can affect the heart, lungs, and kidneys.

Question 5

Type: MCMA

An older patient is prescribed the medication alendronate (Fosamax). How should the nurse instruct the patient about this medication?

Standard Text: Select all that apply.

  1. Take the medication with breakfast.
  2. Take the medication with 8 ounces of milk.
  3. Take the medication with 8 ounces of water only.
  4. Take the medication with a calcium supplement at the same time.
  5. Remain in an upright position for 30 minutes after taking the medication.

Question 6

Type: MCSA

While walking in an assisted living facility an older patient falls. Which assessment finding indicates to the nurse that the patient has sustained a hip fracture?

  1. Pain relieved by moving the affected extremity
  2. Redness, tenderness, and severe swelling at the hip joint
  3. Position with the injured leg shortened and externally rotated
  4. Bending the injured leg at the knee and internally rotating the leg

Question 7

Type: MCSA

An older patient with osteoarthritis is prescribed acetaminophen (Tylenol) for pain. What should the nurse teach the patient about this medication?

  1. Excessive acetaminophen can cause gastrointestinal irritation.
  2. Taking acetaminophen around-the-clock will slow the progression of osteoarthritis.
  3. Acetaminophen cannot be used with nonsteroidal anti-inflammatory drugs (NSAIDs).
  4. The maximum amount of acetaminophen should not exceed 4 grams in a 24-hour period.

Question 8

Type: MCMA

An older patient wants to prevent the onset of osteoporosis. How can the nurse instruct the patient at this time?

Standard Text: Select all that apply.

  1. Stop smoking and reduce caffeine intake.
  2. Ingest adequate amounts of calcium every day.
  3. Have an annual bone mineral density (BMD) test.
  4. Increase the intake of beverages containing phosphorous.
  5. Perform isometric exercises for 30 minutes at least 3 times a week.

Question 9

Type: MCSA

At the completion of an assessment the nurse determines that an older patient is at risk for the development of osteoporosis. What did the nurse assess in this patient?

  1. Obese with hip pain with ambulation
  2. Ingests three glasses of skim milk daily
  3. Eats three to five servings of shrimp and liver per week
  4. Takes corticosteroids for 10 years for chronic pulmonary disease

Question 10

Type: MCMA

While making a visit to an older patient the nurse screens the home environment for potential hazards that could precipitate a fall. What should the nurse urge the patient to eliminate in the home?

Standard Text: Select all that apply.

  1. Throw rugs
  2. Night-lights
  3. The use of a cane
  4. Railings on the stairway
  5. Telephone with a long cord

 

CHAPTER 19

Question 1

Type: MCSA

While reviewing laboratory results for an older patient the nurse notes that the glycosylated hemoglobin (HbA1c) result is 6.0%. What does this finding indicate to the nurse?

  1. The patient needs a referral to a dietician.
  2. The patient needs additional testing for anemia.
  3. The patient has undiagnosed type 2 diabetes mellitus.
  4. The patient’s average blood glucose level was 120 over the past 3 months.

Question 2

Type: MCMA

The nurse is planning interventions to achieve the goal of maintaining glycemic control for an older patient with type 2 diabetes mellitus. Which interventions will the nurse include in this patient’s plan of care?

Standard Text: Select all that apply.

  1. Teach to prevent hypoglycemia.
  2. Emphasize the role of physical exercise.
  3. Review the manifestations of complications.
  4. Stress the importance of avoiding carbohydrates.
  5. Instruct in self-monitoring of blood glucose levels.

Question 3

Type: MCSA

Why should the nurse counsel an older patient with a history of occasional high blood glucose levels to stop smoking?

  1. To prevent insulin resistance
  2. To prevent the loss of additional weight
  3. To reduce the risk of developing type 2 diabetes mellitus
  4. To ensure that blood glucose levels will remain within normal limits

Question 4

Type: MCSA

The healthcare provider has decided to not treat an older patient with type 2 diabetes mellitus aggressively. What would be a risk of aggressively treating this patient?

  1. Decreased vision acuity
  2. Hypoglycemic episodes
  3. Frequent skin infections
  4. Development of foot ulcers

Question 5

Type: MCSA

While conducting a health interview the nurse suspects an older patient might be experiencing diabetes. What comment did the patient make that could indicate this diagnosis?

  1. “I sometimes have muscle aches in my upper legs at night.”
  2. “I feel a bit tired by midafternoon and take a 30-minute nap most days.”
  3. “I’ve been experiencing blurred vision frequently during the past month.”
  4. “I’m slightly winded when I walk up a flight of stairs but it passes quickly.”

Question 6

Type: MCSA

Which dietary guideline would be the most important for the nurse to instruct a patient with diabetes mellitus?

  1. Include foods rich in calcium at every meal.
  2. Eliminate as much fat from the diet as possible.
  3. Eat at regular times including meals and snacks.
  4. Ingest the majority of daily caloric intake in the morning meal.

Question 7

Type: MCMA

An older male patient with type 2 diabetes mellitus wants to know if he can have an alcoholic drink. What information should the nurse provide about alcohol intake with diabetes?

Standard Text: Select all that apply.

  1. Ingest alcohol with food.
  2. Alcohol can interact with diabetes medications.
  3. Consider calories from alcohol as being fat calories.
  4. Limit consumption to no more than two drinks per day.
  5. Take alcohol with carbohydrates because it enhances digestion.

Question 8

Type: MCMA

The healthcare provider suggests that an older patient with type 2 diabetes mellitus begin a walking program. What should the nurse include when teaching the patient about this program?

Standard Text: Select all that apply.

  1. Dress in layers.
  2. Wear shoes with thick flexible soles.
  3. Walk at least three to five times a week.
  4. Walk alone to concentrate on the activity.
  5. Perform warm-up exercises before walking.

Question 9

Type: MCSA

The nurse is reviewing the health history for an older patient newly diagnosed with type 2 diabetes mellitus. For which health problem would the medication metformin be contraindicated?

  1. Heart failure
  2. Hypertension
  3. Osteoarthritis
  4. Renal insufficiency

Question 10

Type: MCSA

An older patient diagnosed with type 2 diabetes mellitus has been prescribed insulin with different onsets and durations of action. Why would this type of insulin be prescribed for this patient?

  1. It simplifies the dosing.
  2. It can be refrigerated when not in use.
  3. It can be injected into the thigh muscle.
  4. It reduces the incidence of complications.

 

CHAPTER 20

Question 1

Type: MCSA

An older resident is complaining of being constipated. Which action should the nurse take first when caring for this patient?

  1. Assess the diet for adequacy of fiber and fluids.
  2. Determine what the patient means by constipation.
  3. Obtain an order for a laxative and an enema if needed.
  4. Encourage the patient to increase fluid intake and activity.

Question 2

Type: MCMA

After an assessment the nurse is concerned that an older patient is at risk for liver cancer. What did the nurse assess in this patient?

Standard Text: Select all that apply.

  1. History of colon polyps
  2. Diagnosis of diverticulitis
  3. 50 year history of smoking
  4. History of hepatitis B infection
  5. Previous treatment for alcoholism

Question 3

Type: MCSA

An older patient is experiencing diarrhea. Which assessment finding supports that the patient’s diarrhea is caused by Clostridium difficile?

  1. The patient has a history of ulcerative colitis.
  2. The patient has been taking prescribed steroids for several months.
  3. The patient recently completed a course of antibiotics for pneumonia.
  4. The patient rarely eats fresh fruits and vegetables and self-restricts fluid intake.

Question 4

Type: MCSA

Which gastrointestinal change in an older patient does the nurse recognize as being associated with aging?

  1. Decreased esophageal motility
  2. Decreased incidence of cholelithiasis
  3. Increase in hydrochloric acid in the stomach
  4. Increased absorption of nutrients in the intestines

Question 5

Type: MCMA

Which interventions should the nurse use to reduce the risk of aspiration for an older patient with dysphagia?

Standard Text: Select all that apply.

  1. Monitor during meals for a change in respirations.
  2. Maintain an upright position for 1 hour after eating.
  3. Raise the head of the bed to a 90 degree angle during meals.
  4. Provide pureed solid foods and thin clear liquids during meals.
  5. Ensure that one bite has been swallowed before providing another.

Question 6

Type: MCSA

The nurse instructs a family member on how to feed an older patient. Which observation indicates that the family member needs additional instruction?

  1. Checks to make sure the patient’s dentures are in place
  2. Makes sure that each bite is swallowed before providing the next bite
  3. Reminds the patient to chew the food after being placed in the patient’s mouth
  4. Tries to insert a utensil in the patient’s mouth and the patient bites down tightly

Question 7

Type: MCSA

Which assessment finding should the nurse realize as being a cause for gastroesophageal reflux disease (GERD) occurring more commonly in older adults?

  1. Increased amounts of saliva
  2. Increased incidence of hiatal hernia
  3. Tightening of the lower esophageal sphincter
  4. The increase in peristalsis that occurs in the esophagus

Question 8

Type: MCSA

How should the nurse instruct an older patient with gastroesophageal reflux disease (GERD) about heartburn?

  1. It improves when lying flat or bending over.
  2. It is unaffected by the size of meals eaten or the types of food.
  3. It will not put the older patient at increased risk for esophageal cancer.
  4. It may cause severe chest pain that causes the patient to fear a heart attack.

Question 9

Type: MCSA

An older patient with gastroesophageal reflux disease (GERD) is prescribed ranitidine (Zantac). What should the nurse instruct as the mechanism of action of this medication?

  1. Neutralizes stomach acid
  2. Decreases acid production in the stomach
  3. Creates a coating that acts as a protective barrier
  4. Increases motility in the esophagus and stomach

Question 10

Type: MCMA

Which manifestations that an older patient is exhibiting should the nurse investigate as possibly being caused by peptic ulcer disease?

Standard Text: Select all that apply.

  1. Diarrhea
  2. Clay-colored stools
  3. Abdominal distention
  4. Indigestion with bloating
  5. Vague and diffuse abdominal pain

AND MUCH MORE