HESI RN GERIATRICS EXAM 2020

HESI RN GERIATRICS EXAM 2020 After a transurethral resection of the prostate (TURP), an older man returns to the medical surgical floor with a 3-way indwelling urinary catheter. The registered nurse (RN) observes the catheter's tubing for drainage when the client states that he needs to void. What should the RN implement based on this finding? A. Irrigate the bladder through the catheter port B. Remove the indwelling catheter C. Explain that urgency is expected D. Notify the healthcare provider of the symptom – (A) Irrigate the bladder through the catheter port Rationale: The feeling of urgency can be caused by blood clots that can occlude drainage of the catheter, which is a common occurrence in the first 72 hours after a TURP. The urgency is an indication that the client's bladder is not emptying, and the RN should irrigate catheter (A) to relieve symptoms caused by a clot. (B) and (C) should not be implemented. (D) should be implemented after determining if the irrigation was effective in relieving the client's complaint. An older client with chronic kidney disease (CKD) has an arteriovenous fistula (AV) in the left forearm for for hemodialysis. After palpating the AV fistula, which finding is an indication that the AV fistula is functioning properly? A. Enlarged veins B. Redness around the site C. Decreased pulses below fistula D. Marked ecchymotic areas – (A) Enlarged veins Rationale: The mixing of arterial and venous blood in an AV fistula causes the veins to enlarge (A), which facilitate cancelation for hemodialysis. (B) may be related to local infection or inflammation and is not a normal finding. (C) and (D) are abnormal findings that should be reported immediately. During the quarterly evaluations of the clients in the assisted living community, the registered nurse (RN) assesses for findings of failure to thrive in the older population. What findings should the RN document and report as manifestations related to failure to thrive? (Select all that apply.) A. Unintentional weight loss B. Increased weakness C. Increased amounts of sleep D. Irritation and agitation E. Seeking constant attention from caregiver – (A) Unintentional weight loss (B) Increased weakness (C) Increased amounts of sleep Rationale: (A, B and C) are correct. Symptoms of failure to thrive in the older population include weight loss, weakness and excessive sleep, which should be documented and evaluated by a healthcare provider immediately. (D and E) are not usual signs and symptoms of failure to thrive but should be reviewed by the healthcare provider. The registered nurse (RN) is reinforcing discharge instructions to the family of an older client with failure to thrive. What information should the RN include to promote nutritional intake for the client? (Select all that apply.) A. Minimize stress levels by providing the client with a quiet environment during meals B. Provide food variations that the client can manage without assistance C. Assist the client with eating meals in bed in a semi-Fowler's position D. Encourage fluid intake before meals to decrease dehydration E. Offer any type of food to the client as long as calories are consumed – (A) Minimize stress level by providing the client with a quiet environment during meals (B) Provide food variations that the client can manage without assistance Rationale: (A and B) are correct and continue to promote independence and decreased stress for the client, which will increase the opportunity for nutritional intake. (C) increases dependence for the older client, which can also cause decreased self-worth and depression. (D) will make the client feel full and will decrease the client's ability to consume nutritional calories. The registered nurse (RN) is assigned the care of an older client who returns to the unit after surgery for closed angle glaucoma. What intervention in the plan of care should the RN bring to the attention of the healthcare team? A. Assist with ambulating to commode B. Monitor intake and output q8 hours C. Administer morphine 4 mg IM q2 hour PRN pain D. Place an eye patch on operative eye during sleep – (C) Administer morphine 4 mg IM q2 hour PRN pain Rationale: Morphine side effects include nausea, vomiting and constipation, causing straining on stool, all of which can increase intraocular pressure and cause intraocular bleeding during the postoperative period. Administration of morphine 0.4 mg IM q2 hours PRN pain (C) should be discussed with the healthcare team to determine the risk of the side effects for the client. (A), (B) and (D) are interventions that do not place the client at risk. After a recent total hip replacement, an older female client, who transferred to a rehabilitation facility placement, asks the registered nurse (RN) if she broke her hip because she is old. How should the RN best respond? A. Hip fractures can occur in any age group and require strength conditioning B. With aging, everything tends to break down more easily the older one gets C. Older people tend to look down instead of ahead, increasing the risk of falls D. Older women commonly lose bone calcium, which increases the risk of fracture - (D) Older women commonly lose bone calcium which increases the risk of fracture. Rationale: The best response is to provide the client with an explanation based on aging and demineralization of the bone (D) in older females, especially after menopause. (A, B and C) offer other responses but are not client centered in response to her expressed self-concern. An older male client is admitted for emergency treatment of acute closed-angle glaucoma. The registered nurse (RN) begins administering the prescribed miotic medications and glycerin (Glycol) therapy. Which intervention is most important for the RN to maintain during the client's therapy? A. Maintain lighting control in the room during therapy B. Monitor intake and output q2 hours for 24 hours C. Place an eye patch over the affected eye during sleep D. Administer the eye drops at the scheduled intervals – (B) Monitor intake and output q2 hours for 24 hours Rationale: Monitoring intake and output (B) is most important during the administration of glycerin (Glycol) due to the rapid acting osmotic diuretic effect of glycerin therapy. (A, C and D) are components of care, but the most important action during glycerin administration is evaluation of output. The home health registered nurse (RN) visits an older woman with heart failure (HF) who is on complete bed rest. Which intervention is most important for the RN to suggest to the client to prevent complications related to immobility? A. Get as much sleep as possible B. Perform leg exercises while in bed C. increase protein intake to combat fatigue D. Invite friends to visit to decrease risk for depression – (B) Perform leg exercises while in bed. Rationale: The client is at risk for complications related to immobility. (B) should be performed frequently to decrease the risk for thrombophlebitis. (A, C and D) are measures to help the client while on bedrest, but the most important complication that the client is at risk for deep vein thrombosis. An older client is admitted with a preliminary diagnosis of Addison's disease. Which skin finding should the registered nurse (RN) document that is typical with Addison's disease? A. Moon face B. Hyperpigmentation C. Excessive acne D. Multiple skin tags – (B) Hyperpigmentation Rationale: Addision's disease is characterized by a deficiency in the production of adrenal cortex hormones, which results in anterior pituitary feedback to secrete stimulating hormones, such as melanocyte stimulating hormone (MSH) that increases melanin production. (B) is seen in clients with Addison's disease. (A and C) are typical of Cushing's syndrome which is due to excessive adrenal cortisol. (D) are not associated with Addison's disease. Osteoporosis increases the risk for a hip fracture in older adults, and women are more