, NURS 3325 Holistic Care Older Adult
Test #4
1. An older adult admitted to a long-term care facility is diagnosed with type 2 diabetes
and coronary artery disease. The client takes glipizide and isosorbide mononitrate. The
medical history states that the client drank 4 ounces of whiskey per day for many years.
Which action should priority for the admitting nurse?
Assess and observe the client for depression
Evaluate the client for renal failure
Assess the client for hypoglycemia and hypotension
Evaluate the client’s blood work for changes in electrolytes
Rationale: Older adults are more susceptible to developing medication-alcohol
interactions. Age-related changes in body composition can cause higher levels of
alcohol to be absorbed into the bloodstream. Alcohol enhances vasodilation
when an individual takes a nitrate, and there is potentiation of oral
hypoglycemics by alcohol. Central nervous system depression occurs when
alcohol interacts with barbiturates and meprobamate, which this client is not
taking. There is no need to evaluate for renal failure or changes in electrolytes;
these are not known medication-alcohol interactions.
2. A nurse administers medications to a group of older adults in a residential facility. Which
client is most likely to experience adverse effects?
An 84-year-old woman with a hemoglobin of 9.8 mg/dL
An 82-year-old woman with constipation
A 77-year-old man with a creatinine of 3.6
A 78-year-old man with a body mass index of 35
Rationale: Although age-related changes can influence skills related to taking
medications, risk factors that commonly occur in older adults exert a strong
influence. A creatinine of 3.6 reflects renal failure, which will lead to an increase
in serum levels of medications. Iron deficiency anemia, obesity, and constipation
exhibit no impacts to the risk of adverse and altered effects.
3. A nurse reviews the medication list of an older adult upon transfer from an acute care to
a long-term care facility. Which method is most likely to reduce the occurrence of
adverse effects?
Administer medications at the same time every day with meals
Compare the list to the Beers Criteria list and notify the health care provider of
any on the list
Request that the client’s medications be held and restarted one at a time
Stop the administration of gastrointestinal (GI) and narcotic pain medications
Rationale: An important theme of the Beers Criteria and other guidelines is that
medications are determined to be appropriate or inappropriate in relation to the
client’s condition. Some medications are given with meal, while other are not.
, There is no need to stop all medication at this time nor should specific GI and
pain medications be stopped.
4. Having completed a medication assessment and physical assessment of a new client, a
home care nurse is now creating a client plan of care. What factors should the nurse
prioritize in this process?
The importance of the client’s safety
The responsibility to teach the client and minimize liability
The importance of fostering client compliance
The need to maintain the client’s autonomy
Rationale: When dealing with the client’s medications, as in all areas of nursing
practice, client safety is the priority. This supersedes other matters, even though
each may be significant. These include autonomy and client education.
5. A nurse is conducting a medication assessment of an older adult. Which of the
statements by the older adult indicates a need for further education?
“My family provider has me on so many different pills now, so I want to talk
about whether they’re all necessary.”
“I’ve made a reminder system for myself so that I don’t miss any of my pills
during the day.”
“I use a lot of herbs and supplements, but I’m careful to make sure that they’re
all natural.”
“Overall, I much prefer to prevent getting sick than having to rely on different
drugs to stay healthy.”
Rationale: It is a common misconception that because herbs are natural, they
have no potential for harm; the nurse should teach clients about the potential
risks of herbal supplements. It is proactive to act in a manner that will prevent
illness. Implementing a reminder system for drugs is prudent. Similarly,
6. An older adult client is admitted to a nursing unit with the following lab values: sodium =
154 mg/dL, blood urea nitrogen = 27 mg/dL, hematocrit = 56%, and albumin = 6.2 g/dL.
Which client problem is priority?
Imbalanced nutrition: less than body requirements
Constipation
Fluid volume deficit
Impaired tissue perfusion
Rationale: The appropriate nursing diagnosis is fluid volume deficit. In
dehydration, blood values, which may be altered, include elevations in sodium,
hematocrit, creatinine, osmolality, and blood urea nitrogen. While the client may
develop constipation, it is not the priority at this time. Albumin becomes
diminished with poor nutrition but increased with dehydration. An elevation in
these labs does not implicate impaired tissue perfusion.
Test #4
1. An older adult admitted to a long-term care facility is diagnosed with type 2 diabetes
and coronary artery disease. The client takes glipizide and isosorbide mononitrate. The
medical history states that the client drank 4 ounces of whiskey per day for many years.
Which action should priority for the admitting nurse?
Assess and observe the client for depression
Evaluate the client for renal failure
Assess the client for hypoglycemia and hypotension
Evaluate the client’s blood work for changes in electrolytes
Rationale: Older adults are more susceptible to developing medication-alcohol
interactions. Age-related changes in body composition can cause higher levels of
alcohol to be absorbed into the bloodstream. Alcohol enhances vasodilation
when an individual takes a nitrate, and there is potentiation of oral
hypoglycemics by alcohol. Central nervous system depression occurs when
alcohol interacts with barbiturates and meprobamate, which this client is not
taking. There is no need to evaluate for renal failure or changes in electrolytes;
these are not known medication-alcohol interactions.
2. A nurse administers medications to a group of older adults in a residential facility. Which
client is most likely to experience adverse effects?
An 84-year-old woman with a hemoglobin of 9.8 mg/dL
An 82-year-old woman with constipation
A 77-year-old man with a creatinine of 3.6
A 78-year-old man with a body mass index of 35
Rationale: Although age-related changes can influence skills related to taking
medications, risk factors that commonly occur in older adults exert a strong
influence. A creatinine of 3.6 reflects renal failure, which will lead to an increase
in serum levels of medications. Iron deficiency anemia, obesity, and constipation
exhibit no impacts to the risk of adverse and altered effects.
3. A nurse reviews the medication list of an older adult upon transfer from an acute care to
a long-term care facility. Which method is most likely to reduce the occurrence of
adverse effects?
Administer medications at the same time every day with meals
Compare the list to the Beers Criteria list and notify the health care provider of
any on the list
Request that the client’s medications be held and restarted one at a time
Stop the administration of gastrointestinal (GI) and narcotic pain medications
Rationale: An important theme of the Beers Criteria and other guidelines is that
medications are determined to be appropriate or inappropriate in relation to the
client’s condition. Some medications are given with meal, while other are not.
, There is no need to stop all medication at this time nor should specific GI and
pain medications be stopped.
4. Having completed a medication assessment and physical assessment of a new client, a
home care nurse is now creating a client plan of care. What factors should the nurse
prioritize in this process?
The importance of the client’s safety
The responsibility to teach the client and minimize liability
The importance of fostering client compliance
The need to maintain the client’s autonomy
Rationale: When dealing with the client’s medications, as in all areas of nursing
practice, client safety is the priority. This supersedes other matters, even though
each may be significant. These include autonomy and client education.
5. A nurse is conducting a medication assessment of an older adult. Which of the
statements by the older adult indicates a need for further education?
“My family provider has me on so many different pills now, so I want to talk
about whether they’re all necessary.”
“I’ve made a reminder system for myself so that I don’t miss any of my pills
during the day.”
“I use a lot of herbs and supplements, but I’m careful to make sure that they’re
all natural.”
“Overall, I much prefer to prevent getting sick than having to rely on different
drugs to stay healthy.”
Rationale: It is a common misconception that because herbs are natural, they
have no potential for harm; the nurse should teach clients about the potential
risks of herbal supplements. It is proactive to act in a manner that will prevent
illness. Implementing a reminder system for drugs is prudent. Similarly,
6. An older adult client is admitted to a nursing unit with the following lab values: sodium =
154 mg/dL, blood urea nitrogen = 27 mg/dL, hematocrit = 56%, and albumin = 6.2 g/dL.
Which client problem is priority?
Imbalanced nutrition: less than body requirements
Constipation
Fluid volume deficit
Impaired tissue perfusion
Rationale: The appropriate nursing diagnosis is fluid volume deficit. In
dehydration, blood values, which may be altered, include elevations in sodium,
hematocrit, creatinine, osmolality, and blood urea nitrogen. While the client may
develop constipation, it is not the priority at this time. Albumin becomes
diminished with poor nutrition but increased with dehydration. An elevation in
these labs does not implicate impaired tissue perfusion.
