Care of Older Adult
e, f, h, i - ANSWER: Which of the following assessment findings would alert the nurse to
possible elder mistreatment (select all that apply)?
e) Agitation
f) Depression
g) Weight gain
h) Weight loss
i) Hypernatremia
j, l - ANSWER: A 67-year-old woman who has a long-standing diagnosis of incontinence
is in the habit of arriving 20 minutes early for church in order to ensure that she gets a
seat near the end of a row and close to the exit so that she has ready access to the
restroom. Which of the following tasks of the chronically ill is the woman enacting
(select all that apply)?
j) Controlling symptoms
k) Preventing social isolation
l) Preventing and managing a crisis
m) Denying the reality of the problem
n) Adjusting to changes in the course of the disease
e - ANSWER: A nurse who is providing care for an 81-year-old female patient
recognizes the need to maximize the patient's mobility during her recovery from surgery.
Which of the following statements provides the best rationale for the nurse's actions?
e) Continued activity prevents deconditioning.
f) Pharmacokinetics are improved by patient mobility.
g) Lack of stimulation contributes to the development of cognitive deficits in older adults.
h) Regularly scheduled physical rehabilitation provides an important sense of purpose
for older patients.
b - ANSWER: Examples of primary prevention strategies include:
a. colonoscopy at age 50
b. avoidance of tobacco products
c. intake of a diet low in saturated fat in a pt with high cholesterol
d. teaching the importance of exercise to a pt with hypertension
c, d - ANSWER: A characteristic of chronic illness is that it (select all):
a. has reversible pathologic changes
b. has a consistent, predictable clinical course
c. results in permanent deviation from the normal
d. is associated with many stable and unstable phases
e. always starts with an acute illness and then progresses slowly
,a - ANSWER: The home care nurse is visiting an older female client whose husband
died 6 months ago. Which behavior by the client indicates ineffective coping?
a. neglecting her personal grooming
b. looking at old snapshots of her family
c. participating in a senior citizens' program
d. visiting her husband's grave once a month
d - ANSWER: The visiting nurse observes that the older male client is confined by his
daughter in law to his room. When the nurse suggests that he walk to the den and join
the family, he says, I'm in everyone's way; my daughter in law needs me to stay here.
The most important action for the nurse to take is to:
a. say nothing, because it is best for the nurse to remain neutral and wait to be asked
for help
b. Suggest to the client and daughter in law that they consider a nursing home for the
client
c. say to the daughter in law, confining your father in law to his room is inhuman
d. suggest appropriate resources to the client and daughter in law, such as respite care
and a senior citizen's center.
c - ANSWER: The home health nurse is visiting a client for the first time. While
assessing the client's medication, it is noted that there are at least 19 prescriptions and
several OTC medications that the client has been taking. Which intervention should the
nurse take first?
a. check for drug-drug interactions
b. determine whether there are any adverse side effects
c. determine whether there are medication duplications
d. call the prescribing physician and report any polypharmacy
b, e, f - ANSWER: Which of the following are normal age related physiological
changes? Select all that apply
a. increased heart rate
b. decline in visual acuity
c. decreased respiratory rate
d. decline in long term memory
e. increased susceptibility to urinary tract infections
f. increased incidence of awakening after sleep onset
The nurse performs a comprehensive geriatric assessment of a patient who is being
assessed for admission to an assisted living facility. Which question is the most
important for the nurse to ask?
a. "Have you had any recent infections?"
b. "How frequently do you see a doctor?"
c. "Do you have a history of heart disease?"
d. "Are you able to prepare your own meals?" - ANSWER: ANS: D
The patient's functional abilities, rather than the presence of an acute or chronic illness,
are more useful in determining how well the patient might adapt to an assisted living
,situation. The other questions will also provide helpful information but are not as useful
in providing a basis for determining patient needs or for developing interventions for the
older patient.
An older patient who takes multiple medications for chronic cardiac and pulmonary
diseases is alert and lives with a daughter who works during the day. During a clinic
visit, the patient verbalizes to the nurse that she has a strained relationship with her
daughter and does not enjoy being alone all day. Which nursing diagnosis should the
nurse assign as the priority for this patient?
a. Risk for injury related to drug interactions
b. Social isolation related to weakness and fatigue
c. Compromised family coping related to the patient's many care needs
d. Caregiver role strain related to need to adjust family employment schedule -
ANSWER: ANS: A
The patient's age and multiple medications indicate a risk for injury caused by
interactions between the multiple drugs being taken and a decreased drug metabolism
rate. Problems with social isolation, caregiver role strain, or compromised family coping
are not physiologic priorities. Drug-drug interactions could cause the most harm to the
patient and is therefore the priority.
The nurse plans to complete a thorough assessment of an older patient. Which method
should the nurse use to gather the most complete information?
a. Use a geriatric assessment instrument to evaluate the patient.
b. Ask the patient to write down medical problems and medications.
c. Interview both the patient and the primary caregiver for the patient.
d. Review the patient's medical record for a history of medical problems. - ANSWER:
ANS: A
The most complete information about the patient will be obtained through the use of an
assessment instrument specific to the geriatric population, which includes information
about both medical diagnoses and treatments and about functional health patterns and
abilities. A review of the medical record, interviews with the patient and caregiver, and
written information by the patient are all included in a comprehensive geriatric
assessment.
An older patient is hospitalized with pneumonia. Which intervention should the nurse
implement to provide optimal care for this patient?
a. Use a standardized geriatric nursing care plan.
b. Minimize activity level during hospitalization.
c. Plan for transfer to a long-term care facility upon discharge.
d. Consider the preadmission functional abilities when setting patient goals. - ANSWER:
ANS: D
The plan of care for older adults should be individualized and based on the patient's
current functional abilities. A standardized geriatric nursing care plan will not address
individual patient needs and strengths. A patient's need for discharge to a long-term
care facility is variable. Activity level should be designed to allow the patient to retain
, functional abilities while hospitalized and also to allow any additional rest needed for
recovery from the acute process.
The nurse cares for an older adult patient who lives in a rural area. Which intervention
should the nurse plan to implement to best meet this patient's needs?
a. Suggest that the patient move to an urban area.
b. Assess the patient for chronic diseases that are unique to rural areas.
c. Ensure transportation to appointments with the health care provider.
d. Obtain adequate medications for the patient to last for 4 to 6 months. - ANSWER:
ANS: C
Transportation can be a barrier to accessing health services in rural areas. The patient
living in a rural area may lose the benefits of a familiar situation and social support by
moving to an urban area. There are no chronic diseases unique to rural areas. Because
medications may change, the nurse should help the patient plan for obtaining
medications through alternate means such as the mail or delivery services, not by
purchasing large quantities of the medications.
Which nursing action will be most helpful in decreasing the risk for drug-drug
interactions in an older adult?
a. Teach the patient to have all prescriptions filled at the same pharmacy.
b. Instruct the patient to avoid taking over-the-counter (OTC) medications.
c. Make a schedule for the patient as a reminder of when to take each medication.
d. Have the patient bring all medications, supplements, and herbs to each appointment.
- ANSWER: ANS: D
The most information about drug use and possible interactions is obtained when the
patient brings all prescribed medications, OTC medications, and supplements to every
health care appointment. The patient should discuss the use of any OTC medications
with the health care provider and obtain all prescribed medications from the same
pharmacy, but use of supplements and herbal medications also need to be considered
in order to prevent drug-drug interactions. Use of a medication schedule will help the
patient take medications as scheduled but will not prevent drug-drug interactions.
A patient who has just moved to a long-term care facility has a nursing diagnosis of
relocation stress syndrome. Which action should the nurse include in the plan of care?
a. Remind the patient that making changes is usually stressful.
b. Discuss the reason for the move to the facility with the patient.
c. Restrict family visits until the patient is accustomed to the facility.
d. Have staff members write notes welcoming the patient to the facility. - ANSWER:
ANS: D
Having staff members write notes will make the patient feel more welcome and
comfortable at the long-term care facility. Discussing the reason for the move and
reminding the patient that change is usually stressful will not decrease the patient's
stress about the move. Family member visits will decrease the patient's sense of stress
about the relocation.
e, f, h, i - ANSWER: Which of the following assessment findings would alert the nurse to
possible elder mistreatment (select all that apply)?
e) Agitation
f) Depression
g) Weight gain
h) Weight loss
i) Hypernatremia
j, l - ANSWER: A 67-year-old woman who has a long-standing diagnosis of incontinence
is in the habit of arriving 20 minutes early for church in order to ensure that she gets a
seat near the end of a row and close to the exit so that she has ready access to the
restroom. Which of the following tasks of the chronically ill is the woman enacting
(select all that apply)?
j) Controlling symptoms
k) Preventing social isolation
l) Preventing and managing a crisis
m) Denying the reality of the problem
n) Adjusting to changes in the course of the disease
e - ANSWER: A nurse who is providing care for an 81-year-old female patient
recognizes the need to maximize the patient's mobility during her recovery from surgery.
Which of the following statements provides the best rationale for the nurse's actions?
e) Continued activity prevents deconditioning.
f) Pharmacokinetics are improved by patient mobility.
g) Lack of stimulation contributes to the development of cognitive deficits in older adults.
h) Regularly scheduled physical rehabilitation provides an important sense of purpose
for older patients.
b - ANSWER: Examples of primary prevention strategies include:
a. colonoscopy at age 50
b. avoidance of tobacco products
c. intake of a diet low in saturated fat in a pt with high cholesterol
d. teaching the importance of exercise to a pt with hypertension
c, d - ANSWER: A characteristic of chronic illness is that it (select all):
a. has reversible pathologic changes
b. has a consistent, predictable clinical course
c. results in permanent deviation from the normal
d. is associated with many stable and unstable phases
e. always starts with an acute illness and then progresses slowly
,a - ANSWER: The home care nurse is visiting an older female client whose husband
died 6 months ago. Which behavior by the client indicates ineffective coping?
a. neglecting her personal grooming
b. looking at old snapshots of her family
c. participating in a senior citizens' program
d. visiting her husband's grave once a month
d - ANSWER: The visiting nurse observes that the older male client is confined by his
daughter in law to his room. When the nurse suggests that he walk to the den and join
the family, he says, I'm in everyone's way; my daughter in law needs me to stay here.
The most important action for the nurse to take is to:
a. say nothing, because it is best for the nurse to remain neutral and wait to be asked
for help
b. Suggest to the client and daughter in law that they consider a nursing home for the
client
c. say to the daughter in law, confining your father in law to his room is inhuman
d. suggest appropriate resources to the client and daughter in law, such as respite care
and a senior citizen's center.
c - ANSWER: The home health nurse is visiting a client for the first time. While
assessing the client's medication, it is noted that there are at least 19 prescriptions and
several OTC medications that the client has been taking. Which intervention should the
nurse take first?
a. check for drug-drug interactions
b. determine whether there are any adverse side effects
c. determine whether there are medication duplications
d. call the prescribing physician and report any polypharmacy
b, e, f - ANSWER: Which of the following are normal age related physiological
changes? Select all that apply
a. increased heart rate
b. decline in visual acuity
c. decreased respiratory rate
d. decline in long term memory
e. increased susceptibility to urinary tract infections
f. increased incidence of awakening after sleep onset
The nurse performs a comprehensive geriatric assessment of a patient who is being
assessed for admission to an assisted living facility. Which question is the most
important for the nurse to ask?
a. "Have you had any recent infections?"
b. "How frequently do you see a doctor?"
c. "Do you have a history of heart disease?"
d. "Are you able to prepare your own meals?" - ANSWER: ANS: D
The patient's functional abilities, rather than the presence of an acute or chronic illness,
are more useful in determining how well the patient might adapt to an assisted living
,situation. The other questions will also provide helpful information but are not as useful
in providing a basis for determining patient needs or for developing interventions for the
older patient.
An older patient who takes multiple medications for chronic cardiac and pulmonary
diseases is alert and lives with a daughter who works during the day. During a clinic
visit, the patient verbalizes to the nurse that she has a strained relationship with her
daughter and does not enjoy being alone all day. Which nursing diagnosis should the
nurse assign as the priority for this patient?
a. Risk for injury related to drug interactions
b. Social isolation related to weakness and fatigue
c. Compromised family coping related to the patient's many care needs
d. Caregiver role strain related to need to adjust family employment schedule -
ANSWER: ANS: A
The patient's age and multiple medications indicate a risk for injury caused by
interactions between the multiple drugs being taken and a decreased drug metabolism
rate. Problems with social isolation, caregiver role strain, or compromised family coping
are not physiologic priorities. Drug-drug interactions could cause the most harm to the
patient and is therefore the priority.
The nurse plans to complete a thorough assessment of an older patient. Which method
should the nurse use to gather the most complete information?
a. Use a geriatric assessment instrument to evaluate the patient.
b. Ask the patient to write down medical problems and medications.
c. Interview both the patient and the primary caregiver for the patient.
d. Review the patient's medical record for a history of medical problems. - ANSWER:
ANS: A
The most complete information about the patient will be obtained through the use of an
assessment instrument specific to the geriatric population, which includes information
about both medical diagnoses and treatments and about functional health patterns and
abilities. A review of the medical record, interviews with the patient and caregiver, and
written information by the patient are all included in a comprehensive geriatric
assessment.
An older patient is hospitalized with pneumonia. Which intervention should the nurse
implement to provide optimal care for this patient?
a. Use a standardized geriatric nursing care plan.
b. Minimize activity level during hospitalization.
c. Plan for transfer to a long-term care facility upon discharge.
d. Consider the preadmission functional abilities when setting patient goals. - ANSWER:
ANS: D
The plan of care for older adults should be individualized and based on the patient's
current functional abilities. A standardized geriatric nursing care plan will not address
individual patient needs and strengths. A patient's need for discharge to a long-term
care facility is variable. Activity level should be designed to allow the patient to retain
, functional abilities while hospitalized and also to allow any additional rest needed for
recovery from the acute process.
The nurse cares for an older adult patient who lives in a rural area. Which intervention
should the nurse plan to implement to best meet this patient's needs?
a. Suggest that the patient move to an urban area.
b. Assess the patient for chronic diseases that are unique to rural areas.
c. Ensure transportation to appointments with the health care provider.
d. Obtain adequate medications for the patient to last for 4 to 6 months. - ANSWER:
ANS: C
Transportation can be a barrier to accessing health services in rural areas. The patient
living in a rural area may lose the benefits of a familiar situation and social support by
moving to an urban area. There are no chronic diseases unique to rural areas. Because
medications may change, the nurse should help the patient plan for obtaining
medications through alternate means such as the mail or delivery services, not by
purchasing large quantities of the medications.
Which nursing action will be most helpful in decreasing the risk for drug-drug
interactions in an older adult?
a. Teach the patient to have all prescriptions filled at the same pharmacy.
b. Instruct the patient to avoid taking over-the-counter (OTC) medications.
c. Make a schedule for the patient as a reminder of when to take each medication.
d. Have the patient bring all medications, supplements, and herbs to each appointment.
- ANSWER: ANS: D
The most information about drug use and possible interactions is obtained when the
patient brings all prescribed medications, OTC medications, and supplements to every
health care appointment. The patient should discuss the use of any OTC medications
with the health care provider and obtain all prescribed medications from the same
pharmacy, but use of supplements and herbal medications also need to be considered
in order to prevent drug-drug interactions. Use of a medication schedule will help the
patient take medications as scheduled but will not prevent drug-drug interactions.
A patient who has just moved to a long-term care facility has a nursing diagnosis of
relocation stress syndrome. Which action should the nurse include in the plan of care?
a. Remind the patient that making changes is usually stressful.
b. Discuss the reason for the move to the facility with the patient.
c. Restrict family visits until the patient is accustomed to the facility.
d. Have staff members write notes welcoming the patient to the facility. - ANSWER:
ANS: D
Having staff members write notes will make the patient feel more welcome and
comfortable at the long-term care facility. Discussing the reason for the move and
reminding the patient that change is usually stressful will not decrease the patient's
stress about the move. Family member visits will decrease the patient's sense of stress
about the relocation.
