C HAPTER 40: T HE O LDER A DULT P ATIENT
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. An older patient is admitted to the hospital with a hip fracture. Which
nursing intervention would be a priorit y?
a. Encourage frequent deep breathing.
b. Administer stool softeners.
c. Perform neurologic checks.
d. Frequentl y offer liquids to drink.
ANS: A
Although all the items are important, age -related changes in respiratory
mechanics lead to airflow restrictions, which are reflected in decreased
forced expiratory volume in 1 second (FEV1). Age -related decrease in
dynamic lung volume is probabl y caused by decreased chest wall
compliance, small airways closure during forced expiration, and
decreased strength of expiratory muscles. Breathing exercises generate
lung volumes of forced vital capacit y, which is an untimed lung
volume, and FEV1, which is a timed lung volume. These spirometry
tests can assist in assessing restrictive respiratory p atterns. Reduced
timed lung volume is exhibited in chronic obstructive pulmonary
disease, asthma, bronchiectasis, and cystic fibrosis.
, DIF: Cognitive Level: Anal yzing REF: p. 971 | p. 972
OBJ: Nursing Process Step: Intervention TOP:
Gerontology MSC: NC LEX: Physiologic Integrit y
2. An older patient is starting a new medication that is metabolized in the
liver and excreted by the kidneys. Which is the best assessment to monitor
the patient’s abilit y to tolerate the medication?
a. Liver function tests
b. Drug side effects experienced by the patient
c. Kidney function tests
d. Therapeutic drug levels
ANS: B
Adverse drug effects and medication interactions may be related to
pharmacokinetics or the manner in which the body absorbs, distributes,
metabolizes, and excretes a drug. The aging process is associated with
changes in gastric acid secretion, which can alter ionization or
solubilit y of a drug and hence its absorption. Medication distribution
depends on body composition and on physiochemical drug properties.
With advancing age, a patient’s fat content increases, lean body mass
decreases, and total body water decreases, which can alter drug
disposition.
DIF: Cognitive Level: Anal yzing REF: p. 978 OBJ:
Nursing Process Step: Evaluation TOP: Gerontology
MSC: NC LEX: Physiologic Integrit y
3. An older patient is receiving a nephrotoxic medication. Which parameter
would be a priorit y for the nurse to monitor?
, a. Electrocardiogram
b. Lung sounds
c. Blood pressure
d. Level of consciousness
ANS: C
A decrease in number of nephrons does not affect renal function
initiall y, but over time the older adult patient loses renal reserve, and
the aging kidney is unable to concentrate urine, excrete hydrogen, or
maintain sodium/potassium balance. Additionall y, the elderl y are at
high risk for deh ydration and are more vulnerable to injury from
decreases in renal blood flow such as episodes of hypotension leading
to acute kidney injury (AKI) or from extreme changes in body fluid
composition and acid –base balance.
DIF: Cognitive Level: Anal yzing REF: p. 976 OBJ:
Nursing Process Step: Intervention TOP: Gerontology
MSC: NC LEX: Physiologic Integrit y
4. Which sign or symptom can be a normal assessment finding for an older
patient?
a. Asymptomatic dysrhythmias
b. Decreased urine output
c. Increased respiratory effort
d. Difficult y problem solving
ANS: A
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. An older patient is admitted to the hospital with a hip fracture. Which
nursing intervention would be a priorit y?
a. Encourage frequent deep breathing.
b. Administer stool softeners.
c. Perform neurologic checks.
d. Frequentl y offer liquids to drink.
ANS: A
Although all the items are important, age -related changes in respiratory
mechanics lead to airflow restrictions, which are reflected in decreased
forced expiratory volume in 1 second (FEV1). Age -related decrease in
dynamic lung volume is probabl y caused by decreased chest wall
compliance, small airways closure during forced expiration, and
decreased strength of expiratory muscles. Breathing exercises generate
lung volumes of forced vital capacit y, which is an untimed lung
volume, and FEV1, which is a timed lung volume. These spirometry
tests can assist in assessing restrictive respiratory p atterns. Reduced
timed lung volume is exhibited in chronic obstructive pulmonary
disease, asthma, bronchiectasis, and cystic fibrosis.
, DIF: Cognitive Level: Anal yzing REF: p. 971 | p. 972
OBJ: Nursing Process Step: Intervention TOP:
Gerontology MSC: NC LEX: Physiologic Integrit y
2. An older patient is starting a new medication that is metabolized in the
liver and excreted by the kidneys. Which is the best assessment to monitor
the patient’s abilit y to tolerate the medication?
a. Liver function tests
b. Drug side effects experienced by the patient
c. Kidney function tests
d. Therapeutic drug levels
ANS: B
Adverse drug effects and medication interactions may be related to
pharmacokinetics or the manner in which the body absorbs, distributes,
metabolizes, and excretes a drug. The aging process is associated with
changes in gastric acid secretion, which can alter ionization or
solubilit y of a drug and hence its absorption. Medication distribution
depends on body composition and on physiochemical drug properties.
With advancing age, a patient’s fat content increases, lean body mass
decreases, and total body water decreases, which can alter drug
disposition.
DIF: Cognitive Level: Anal yzing REF: p. 978 OBJ:
Nursing Process Step: Evaluation TOP: Gerontology
MSC: NC LEX: Physiologic Integrit y
3. An older patient is receiving a nephrotoxic medication. Which parameter
would be a priorit y for the nurse to monitor?
, a. Electrocardiogram
b. Lung sounds
c. Blood pressure
d. Level of consciousness
ANS: C
A decrease in number of nephrons does not affect renal function
initiall y, but over time the older adult patient loses renal reserve, and
the aging kidney is unable to concentrate urine, excrete hydrogen, or
maintain sodium/potassium balance. Additionall y, the elderl y are at
high risk for deh ydration and are more vulnerable to injury from
decreases in renal blood flow such as episodes of hypotension leading
to acute kidney injury (AKI) or from extreme changes in body fluid
composition and acid –base balance.
DIF: Cognitive Level: Anal yzing REF: p. 976 OBJ:
Nursing Process Step: Intervention TOP: Gerontology
MSC: NC LEX: Physiologic Integrit y
4. Which sign or symptom can be a normal assessment finding for an older
patient?
a. Asymptomatic dysrhythmias
b. Decreased urine output
c. Increased respiratory effort
d. Difficult y problem solving
ANS: A
