respiratory
The nurse best maximizes an older adults potential to avoid developing a postsurgical respiratory infection by:
a. walking the patient to the bathroom instead of using the bedside commode.
b. encouraging compliance with prescribed antibiotic therapy.
c. evaluating the patients ability to effectively cough and deep breathe.
d. offering fluids every hour while the patient is awake
ANS: D The current publishing of the Standards and Scope of Gerontological Nursing Practice in 2010 incorporates the input of gerontologic nurses from across the United States. It was not intended to promote gerontologic nursing practice within acute care settings, define concepts or dimensions of gerontologic nursing practice, or elevate the practice of gerontologic nursing.
A nurse works in a gerontologic clinic. What action by the nurse takes highest priority?
a. Serving as a patient advocate
b. Educating patients about diseases
c. Helping patients remain independent
d. Referring patients to home health care
ANS: C One of the challenges and priorities of the gerontologic nurse is helping patients maintain their independence.
The nurse is discussing pain control with an older patient who has been prescribed an opiate. When the patient expresses concerns about the diminishing effect that the medication has had on the pain, the nurse responds:
a. It appears that the dosage you take needs to be adjusted upward.
b. We need to be concerned about you developing a drug tolerance.
c. This drug category is well known for its low ceiling effect.
d. Opiate addiction is a concern when tolerance occurs
ANS: A Tolerance is defined as the diminished effect of a drug while maintaining the same dosage over time. It is a characteristic of opiates when given over time. With opiates, some individuals might need higher and higher doses of a drug to maintain effectiveness. This should not be confused with addiction.
When preparing to discharge an older patient with mild dysphagia, the nurse suggests that the patient can minimize symptoms by:
a. eating small meals every 2 to 3 hours
b. cutting a sandwich into bite-sized peicees.
c. eating less but choosing nutrient-dense foods.
d. drinking thin liquids instead of eating solids.
ANS: A Instruction regarding eating habits and maintaining weight and nutrition is important. For example, small, frequent meals, pureed or soft foods, and high-protein, high?calorie foods are helpful. Thin liquids are often harder to swallow than thickened ones. Nutrient-dense foods are important, but so is maintaining calorie requirements.
The nurse recognizes that an older adult on both antihypertensive and antidepressant drug therapies has a specific need for:
a. regular blood pressure monitoring.
b. an effective history focusing on sexual function.
c. an increase in daily fluid intake.
d. frequent assessment of emotional stability.
ANS: B Drugs such as oral contraceptives, hormone replacement, antihypertensives, antidepressants, or sedatives can cause a sexual arousal disorder as a side effect. In women this can manifest as female sexual dysfunction (FSD), and in men it can manifest as erectile dysfunction (ED).
4. The nurse is aware of the typical occurrence of comorbidities in the older adult. Motivated by this knowledge, the nurse assesses a patient with diagnosed respiratory dysfunction for possible:
a. poor wound healing of the legs and feet.
b. ineffective absorption of vitamins and minerals. c. abnormal urine protein levels.
d. visual problems including retinal detachment.
ANS: A In addition, older patients are more likely to have comorbidities involving the cardiovascular and respiratory systems. Peripheral circulation is a possible cardiovascular problem that would result in poor wound healing. The other options are not related to having a respiratory dysfunction
5. The nurse knows that the most common causes of death in the older population result from which diseases? (Select all that apply.)
a. Cerebrovascular disease
b. End-stage kidney disease
c. Heart disease
d. Cancer
e. Diabetes
ANS: A, C, D The most common causes of death in the older population are cerebrovascular disease, heart conditions, and cancer. End-stage renal disease and diabetes are not among the top three causes of death.
An older adult who injured her knee several years ago tells the nurse that she has been managing the resulting intermittent pain with a prescription for propoxyphene (Darvon). The nurse is concerned with this treatment plan, primarily because:
a. less expensive alternative analgesics are available. b. this long-term need for a narcotic warrants investigation.
c. aspirin would likely be as effective in managing the pain.
d. the knee should not still be causing pain for the patient.
ANS: B The nurse needs to complete a full assessment to determine what type of pain the patient is experiencing and if a narcotic is the best alternative for the patient. Other medications may be more beneficial
The nurse is planning to teach an older patient about diverticulitis. What topic does the nurse include?
a. Dietary fiber and fluids will reduce the symptoms.
b. It is unusual to see diverticula in older persons.
c. Abdominal cramping and severe diarrhea should be reported.
d. Diverticulosis rarely reoccurs once it has been treated.
ANS: A Teaching should include the need to eat high-fiber foods and the importance of achieving and maintaining adequate fluid status. Patients should be encouraged to consume up to 2000 mL of fluids each day, unless contraindicated by cardiac status. Older people have diverticulitis commonly. Abdominal cramping and diarrhea are expected findings. Diverticulitis usually reoccurs.
4. The nurse observes signs that a patient being assessed may have an underactive thyroid. The data supporting this suspicion includes:
a. heat intolerance, low-grade fever, and patchy hair loss.
b. polycythemia, tachycardia, and oral candidiasis.
c. muscle cramps, fatigue, and cold intolerance.
d. increased blood pressure, postural hypotension, and blurred vision.
ANS: C Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion, which are symptoms of hypothyroidism that are often attributed to old age. Heat intolerance is often associated with hyperthyroidism. The other options are not related to thyroid dysfunction.
An older patient admitted to the hospital with symptoms strongly suggestive of tuberculosis (TB) has a negative Mantoux test. The nurse correctly anticipates that:
a. the purified protein derivative (PPD) test will be administered.
b. a chest x-ray will be ordered to detect possible infiltration.
c. therapy consisting of a combination of bactericidal drugs will be initiated.
d. the skin test will be repeated to achieve a booster effect.
ANS: D Tuberculin skin testing in older patients is an unreliable indicator of TB because they are more likely to have false-negative results because of reduced immune system activity. If skin testing is used, it is recommended that the standard 5 tuberculin unit (TU) Mantoux test be given and then repeated to create a booster effect. The PPD is not recommended. The skin test is followed up with a chest x-ray. Drug therapy should not begin until the patient has a diagnosis.
3. The nurse is using the eight stages of life theory to help an older adult patient assess the developmental stage of personal ego differentiation. The nurse does this by assisting the patient to:
a. determine feelings regarding the effects of aging on the physical being.
b. describe feelings regarding what he or she expects the future to hold.
c. identify aspects of work, recreation, and family life that provide a sense of self-worth and pleasure.
d. elaborate on feelings about the prospect of his or her personal death.
ANS: C During the stage of ego differentiation versus work role preoccupation, the task for older adults is to achieve identity and feelings of worth from sources other than the work role. The onset of retirement and termination of the work role may reduce feelings of self-worth. In contrast, a person with a well-differentiated ego, who is defined by many dimensions, can replace the work role as the major defining source for self-esteem. Determining feelings related to the effects of aging, future death, or what the future may hold is not part of this theory.
20. An older adult lives alone at home and is being treated for chronic pain. The home health care nurse notes the adult is disheveled and has dirty dishes piled up in the sink. What action by the nurse is best?
a. Notify adult protective services.
b. Arrange for hospitalization.
c. Assess the patients pain.
d. Assess the patients cognitive status.
ANS: C Although all actions might be appropriate depending on circumstances, because the patient is being treated for pain and has a functional decline, the nurse should assess first for unrelieved pain.
An older adult patient reports episodes of fecal incontinence. The nurse provides appropriate emotional support when assuring the patient that:
a. it is a common problem that occurs in response to normal aging.
b. the incontinence is rarely a result of a serious problem.
c. disposable absorbent underwear will help manage the problem.
d. the problem generally responds well to bowel control programs
ANS: D It is important to reassure older patients that control and retraining are achievable because many older adults believe that fecal incontinence is the first step on the road to permanent institutionalization. Disposable garments may be used temporarily or long term if the patient cannot complete bowel retraining. It is not a normal response to aging.
Which documentation demonstrates that the nurse effectively assessed an older adult diabetic patients cardiac status?
a. radial pulse: 88 and regular
b. carotid pulses equal and strong
c. BP 126/78 recumbent and 122/78 sitting
d. nail beds pale in color
ANS: C To assess circulation, the nurse should take an apical pulse, noting rate and rhythm; check pedal pulses bilaterally; and note the presence of hair on the lower extremities. The nurse should take blood pressure measurements with the patient in both recumbent and sitting positions, note any dizziness associated with a change of position, and assess the respiratory rate, depth, and chest sounds.
10. The nurse gives priority to assessing an older patient who presents with symptoms of acute respiratory distress for which other condition?
a. Substernal chest pain
b. A history of panic attacks
c. Any known allergies
d. Bruising on the chest
ANS: A The symptoms of asthma and respiratory distress mimic other conditions such as myocardial ischemia. The nurse assesses for this condition as the priority over the others.
6. A patient has recently been diagnosed with end-stage renal disease. The patient has cried often throughout the day and finally confides in the nurse that I am going home to be with my Lord. The nurses best response is:
a. There is no reason to believe the end is near.
b. Do you want me to call your family?
c. We have a wonderful chaplain if youd like me to call him.
d. I think this is the time for us to pray together.
ANS: C It is important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth while addressing spirituality as a component in holistic care without imposing upon the patient. Because the patient has made reference to the Lord, the nurse can safely offer religion-oriented spiritual care. Telling the patient there is no reason to believe that death is near does not help the patient work through emotions. Asking about calling the family is a yes/no question and is not therapeutic. The nurse is assuming too much by saying it is time to pray.
An older patient who lives alone is brought to the clinic by an adult child who reports the patient has become depressed and no longer wants to go out of the home. What action by the nurse is best?
a Assess the patient for depression.
b. Ask the patient why activities are avoided.
c. Assess the patient for pain.
d. Assess the patient for elder abuse.
ANS: C Many older adults have pain that goes untreated. Consequences of untreated pain are numerous and include depression and withdrawal. The nurse should first assess for pain. Assessing for depression or elder abuse may be warranted as well. Asking why questions is not therapeutic, as patients tend to become defensive
A patient is admitted with copious diarrhea. The patient is dizzy when standing, and skin assessment reveals abrasions around the perianal area. What assessment finding demonstrates that goals for the priority nursing diagnosis have been met?
a. Perianal skin abrasions are smaller in size.
b. Patient does not fall while hospitalized.
c. Patient sits up without dizziness.
d. Patient is able to tolerate oral fluids
ANS: D The priority diagnosis for this patient is decreased cardiac output or fluid volume deficit, either of which is evaluated with the lack of dizziness. Falling indicates dehydration or weakness, both brought about by the cardiac output situation. Skin integrity is important but not the priority. Being able to tolerate fluids indicates treatment is going well. However, the priority diagnosis relates to cardiac output and fluid volume.
9. Which assessment findings support the suspicion that an older patient has osteoporosis?
a. The patients reports an allergy to dairy products.
b. A lactase enzyme is a part of the patients drug regime.
c. Bones in one of the patients lower legs are shorter than in the other.
d. The patient is inch shorter than at his or her previous physical.
ANS: D Dorsal kyphosis, chronic back pain, and loss of height are common signs of primary osteoporosis in older persons. The other signs do not relate to this disorder
An older patient with severe peripheral arterial disease wishes to quit smoking. The nurse provide education to this patient on which of the following?
a. Cold turkey method
b. Gradual reduction
c. Nicotine patches
d. Bupropion hydrochloride (Zyban)
ANS: D Older patients should be offered assistance to quit smoking. The cold turkey and gradual reduction methods may not work if the patient is a long-term smoker. The patient with peripheral arterial disease should not use nicotine in any form as it causes vasoconstriction. Zyban is an appropriate choice.
19. The nurse planning community events for older people uses sociologic theories to guide practice. Which activity planned by the nurse best fits these theories?
a. Group exercise programs
b. Volunteering at a day care
c. Healthy cooking classes
d. Reminiscing therapy
ANS: B Using the sociologic theories to guide care, the nurse would plan events that allowed the older adult to remain active in the community and a valued member of society. Volunteering would offer the adult a way to stay engaged and provide a service to successive generations. Exercise and cooking classes would more fit in the biologic theories. Reminiscing therapy is a technique using psychological theories. All are good ideas for activities, but the one that specifically uses sociologic theory is the volunteer work.
An older adult patient is prescribed an analgesic to manage the joint pain resulting from stiffness in his right shoulder. When the patient asks about alternative therapy techniques that might be helpful, the nurse suggests:
a. applying ice packs to the area three to four times a day.
b. placing a moderately warm heating pad to the shoulder.
c. arranging for a professional massage on a weekly basis.
d. discussing electrical nerve stimulation with the physician.
ANS: B Heat is useful in decreasing pain and discomfort resulting from joint stiffness by increasing the elasticity of muscles. Ice is better for acute exacerbations. Massage may or may not help but would be more expensive. Electrical nerve stimulation is not warranted.
17. An older patient with hepatitis has pruritus. What advise does the nurse provide this patient?
a. Keep your fingernails cut short.
b. Use diphenhydramine (Benadryl).
c. Hot soapy showers will help.
d. Butter is a good home remedy for itching.
ANS: A Pruritus is intense itching. The patients nails should be kept short to avoid injury to the skin and possible infection. Diphenhydramine is not recommended in older patients. Tepid water with little soap is best. Butter is not a home remedy for itching.
13. A patient has been admitted with new atrial fibrillation. What additional diagnostic testing does the nurse anticipate?
a. Thyroid hormones
b. Platelet count
c. Urinalysis
d. Blood glucose
ANS: A Hyperthyroidism is often seen with atrial fibrillation. Platelet count, urinalysis, and glucose are often done as part of admission, but they are not directly related to atrial fibrillation as is hyperthyroidism.