Comprehensive Gero Hesi Review Questions and Answers

A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which finding is most important for the registered nurse (RN) to report to the healthcare provider? A. Fever and chills B. Confusion and dehydration C. Crackles in the lung fields D. Nausea and vomiting Correct answer- B. Confusion and dehydration Rationale: Confusion and dehydration (B) are findings of inadequate oxygenation and perfusion in this frail elderly client. (A), (C) and (D) are all common with pneumonia, but the most important finding is confusion and evidence of dehydration, which require treatment for this frail elderly client. A frail elderly couple asks the registered nurse (RN) if they have to watch their salt intake because food does not taste as good as it used to so they have to season most foods. What information should the RN offer the couple? A. Boredom may influence how the taste of food is perceived, and different seasonings can stimulate taste. B. With age, an increase in sodium intake is needed to compensate for a decrease in renal function. C. Short-term memory loss and confusion may be the reason they want to over-season their food. D. Taste buds often are dull due to atrophy so older clients should use other seasonings instead of salt. Correct answer- D. Taste buds are often dull due to atrophy so older clients should use other seasonings instead of salt. Rationale: Taste buds atrophy with normal aging, which influences an older client's sensitivity to taste and is often compensated for the use of stronger tasting seasonings. (A), (B), and (C) are not normal aging processes related to taste. After taking a 10-day course of an antibiotic that was ineffective, a frail, elderly client with chronic obstructive pulmonary disease (COPD) is admitted for pneumonia. The client has a long history of smoking and still smokes a pack of cigarettes a day. Which finding should the registered nurse (RN) report to the healthcare provider? A. Barrel chest with increased chest diameter B. Crackles and pulse oximetry level of 88% C. Low hemoglobin and hematocrit levels D. Arterial blood gases indicating respiratory acidosis Correct answer- B. Crackles and pulse oximetry level of 88% Rationale: With pneumonia, crackles in the lungs and low O2 saturation (B) can impact adequate oxygenation, which should be reported to the HCP. (A) occurs due to chronic hyperinflation of the lungs and is common in clients with COPD. Anemia (C) is frequently identified in clients with COPD, and respiratory acidosis (D) due to CO2 retention contributes to a lower blood pH. An older female client recently moved to an assisted living facility. The family explains to the registered nurse (RN) that the client is unmanageable and always confused, disoriented and depressed. The client asks the RN repeatedly, "Where am I?". How should the RN respond? A. Explain that she is in a new home called an assisted living community B. Question the client about her perception of where she might be now. C. Distract the client with a scenario that she is on an outing with her family. D. Reassure the client not to worry because she will meet new friends. Correct answer- A. Explain that she is in a new home called an assisted living community. Rationale: Reality re-orientation (A) is the best response for a client who is confused because the response is consistent and true. (B, C, and D) do not provide the client with feedback that is reality based. A new resident in an assisted living facility is an older client who is experiencing short- term memory loss and confusion. Which activity should the registered nurse (RN) schedule the client to do during the day? A. Arts and crafts B. Current events discussion group C. Group sing-along D. Daily exercise group Correct answer- D. Daily exercise group Rationale: A daily exercise group (D) allows the client to mirror the leader and minimizes the client's stress to remember. (A), (C), and a current events discussion group (B) are thought-provoking activities that require attention to detail and short-term memory to participate in the group activity which may be stressful and frustrating to the resident who has difficulty remembering sequence of the details. The hospice nurse is completing a focused assessment of an older female client with end stage Alzheimer's disease, who recently fractured her hip. What technique should the registered nurse (RN) use to determine the client's pain? A. Use the FACE pain scale B. Ask the client to rate pain on a scale of 1 to 10 C. Observe for facial grimacing D. Review documentation of recent eating habits Correct answer- C. Observe for facial grimacing Rationale: Observing for facial grimacing (C) is the best method for evaluating pain for a client who cannot communicate due to Alzheimer disease. (A) and (B) may not be understood by a client with end-stage Alzheimer's disease. (D) is not a helpful tool for pain assessment. An older male client arrives at the clinic for an annual physical examination. While the nurse assesses the client, the client states that he is having intimacy problems with his wife. Which information should the nurse provide to elicit more information from the client? A. Query client to clarify the client's idea of an intimacy problem. B. Discuss benign prostatic hypertrophy (BPH) and ejaculation. C. Explore the frequency that he experiences erectile dysfunction (ED) D. Determine if the client's wife is young enough to get pregnant Correct answer- A. Query client to clarify the client's idea of an intimacy problem. Rationale: Clarification of the client's concern is needed to appropriately address the specific concern about intimacy issues (A). (B), (C), and (D) are details that the client should present, not the RN. The registered nurse (RN) is caring for an older female client with a 20 year history of rheumatoid arthritis (RA), who is admitted for carpel tunnel release. Which finding associated with RA should the RN document? A. Asymmetrical joint deformity B. Small joint involvement in fingers C. Crepitation or grating sensation in joints D. Weight bearing joint involvement Correct answer- B. Small joint involvement in fingers. Rationale: Small joint involvement (B) is common in rheumatoid arthritis. (A), (C) and (D) are findings that different OA from RA. The registered nurse (RN) is re-enforcing discharge instructions with the family of an older client who was recently admitted for an intestinal obstruction. Which statement indicates that the family understands the instructions? A. Increase protein and carbohydrates in the daily diet B. Limit activity to bed rest for the first week and increase mobility incrementally each week C. Report abdominal distention, constipation or any other nausea and vomiting to the healthcare provider D. Drink liquids 2 hours after meals instead of during meals Correct answer- C. Report abdominal distention, constipation, or any nausea and vomiting to the healthcare provider. Rationale: (C) are symptoms that occur with intestinal obstruction and should be addressed immediately. (A, B, and D) are not indicated for a client who has been discharged for intestinal obstruction. An older client is transferred to a telemetry unit after placement of a pacemaker. What action should the registered nurse (RN) take first? A. View incision site B. Obtain a blood pressure C. Establish telemetry monitoring D. Evaluate client for pain Correct answer- C. Establish telemetry monitoring. Rationale: The first action is to establish continuous telemetry monitoring (C) to ensure the pacemaker is functioning properly. (A, B and D) should be implemented after the client's heart rate and rhythm are successfully being monitored. Older clients are at highest risk for abuse and neglect due to which factors? (Select all that apply.) A. Needs are greater than the caretaker's abilities B. Client's declining strength C. Fixed income D. Longer life expectancy E. Lack of exposure to technology and trends Correct answer- A. Needs regretter than the caretaker's abilities B. Client's declining strength Rationale: When needs are not being met due to lack of ability of the caretaker (A), stress and feelings of failure may be expressed through neglect and abuse. Decline in strength (B) increases the older client's vulnerability to resist or respond to elder abuse. (C, D, E) do not increase the risk for neglect and abuse. An older female client who has been taking hydrocodone/acetaminophen (Lortab) q4 hours for chronic back pain for the past 5 years tells the registered nurse (RN) that she cannot live without her pain pills. When asked if she is addicted, the client states that she is not an addict because the healthcare provider prescribed the pain pills. Which coping mechanism should the RN determine the client is using about her addiction? A. Lack of knowledge about narcotic medications B. Rationalization to support narcotic use C. Transfer of blame to healthcare provider D. Justification of narcotic use due to chronic pain Correct answer- B. Rationalization to support narcotic use. Rationale: The client is using rationalization to maintain self-esteem when she is questioned by stating that she is not addicted because she is taking medication prescribed by a healthcare provider. (A) may be possible, but the client is being specifically asked about possible addiction. (C) and (D) underlie the complexity of denial in addiction, but the client is trying to maintain self-esteem through rationalization. A family member brings their aging father to the clinic because he has been alert and oriented during the day but agitated and disoriented in the evening. The registered nurse (RN) reviews the client's list of current medications with the client and family. Which action taken by the RN is most important? A. Medication review with family caregivers is the RN's responsibility B. Multiple medications can contribute to sundowner-like symptoms C. Medication recall is the best way to evaluate the client's memory D. Reviewing medication actions is a component of effective client care Correct answer- B. Multiple medications can contribute to sundowner like symptoms. Rationale: Older clients may see a variety of HCP which can increase the chance of polypharmacy that compounds the workload of metabolic pathways that may be less efficient due to the aging process. Multiple medication interactions may contribute to sundowner like symptoms; reviewing medication actions and interactions provides the information that may indicate polypharmacy leading to sundowner syndromes. Since his arrival in an assisted living community, an older male client is having difficulty going to sleep. Which intervention should the registered nurse (RN) implement first? A. Encourage client to take a warm bath at night B. Ask the client what has helped him in the past C. Recommend that the client not take daytime naps D. Offer the client a glass of warm milk before bedtime Correct answer- B. Ask the client what has helped him in the past. Rationale: Asking the client (B) about his sleeping habits involves the client in his own care and preserves his autonomy as he adapts to living in a new community. (A, C, and D) are common ways to promote nighttime sleep but these should be explored with the client and his preferences. The home health registered nurse (RN) is visiting an older client with chronic hypertension. What evaluation is most important for the RN to complete with each visit? A. Effectiveness of medication B. Ability to ambulate C. Signs of dehydration D. Familial support Correct answer- A. Effectiveness of medication Rationale: The highest priority in the care of an older client with chronic hypertension is evaluation of the effectiveness of blood pressure medication (A) and the client's compliance in order to prevent complications related to chronic disease. (B, C and D) are issues common in the older population, but the effectiveness of the blood pressure management is most important. An older male client with heart failure (HF) complains of chronic constipation and wants to retrain his bowel. Which information should the registered nurse (RN) offer the client for establishing regular bowel habits? A. Add whole grain foods and fibrous vegetables to diet B. Drink water and fluids up to 3,000 ml daily C. Use a stool softener or glycerin suppository PRN D. Plan daily exercise based on fatigue level Correct answer- (A) Add whole grain foods and fibrous vegetables to diet. Rationale: Increasing daily fiber (A) with increasing fluid intake are the best tools to use when retraining bowel habits. (B) may cause fluid overload for this older client and potentially exacerbate HF. (C) should not be advised without the healthcare provider's recommendation. The client's fatigue level may curtail how much daily exercise (D) the client can tolerate. The registered nurse (RN) is observing the skin of an older client. Which finding should the RN document as consistent with the normal aging process? A. Decreased elasticity B. Tough and leathery texture C. Shiny and edematous D. Excessive hair growth on the head Correct answer- (A) Decreased elasticity Rationale: Loss of elasticity is a common finding of the normal aging process (A). The skin of elderly clients becomes thin and fragile with aging, not (B). When a client has peripheral edema, the skin can be shiny and edematous (C), which is not consistent with normal aging changes. Hair thinning and hair loss are common, not excessive hair growth (D). The home health registered nurse (RN) visits an older female client with an ideal conduit who has been experiencing chronic urinary tract infections (UTI). Which intervention should the RN recommend to the client to manage the frequency of UTIs? A. Force fluid intake to 1,000 ml daily B. Change appliance every 4 hours C. Attach a larger drainage bag while sleeping D. Allow bag to fill completely before emptying Correct answer- (C) Attach a larger drainage bag while sleeping Rationale: (C) can prevent urinary reflux if the bag fills to near capacity or greater, which can contribute to UTIs. Forcing fluids is encouraged and should exceed urinary output, which commonly should be greater than 1,000 ml (A). (B) can increase skin irritation and increase risk for infection by exposing the portal of entry frequently. Allowing the bag to fill completely before emptying (D) increases risk of urinary reflux and UTIs. The healthcare provider prescribes a new medication, atorvastatin (Lipitor), for an older client who arrives at the clinic for an annual physical examination. What common side effect should the registered nurse (RN) advise the client to observe with this medication? A. Constipation B. Headaches C. Muscle weakness D. Nausea and vomiting Correct answer- (B) Headaches Rationale: Headaches (B) are the most common side effect with this medication, which the RN should direct the client to report. (A and C) are rare occurrences with this medication. (D) is not considered a side effect of this medication. 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 Correct answer- (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 Correct answer- (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 Correct answer- (A) Unintentional weight loss (B) Increased weakness (C) Increased amounts of sleep