Chapter 9- Caring for the Older Adult.rtf (59 kb) Nursing School Test Banks

 

1.

The nurse is caring for an elderly patient on the medical unit admitted for diagnostic testing. He is alert and oriented and lives independently in his own home. Which nursing intervention will be most effective in the prevention of falls for this patient?

A)

Using a gait belt each time he ambulates

B)

Ensuring his glasses are close by his bed

C)

Placing a bed alarm on his bed

D)

Moving him to a room close to the nurses station

Ans:

B

Feedback:

This patient does not require aggressive fall prevention measures since he lives independently, is only having diagnostic testing, and is alert and oriented. Keeping his glasses close by will ensure the use of sensory appliances necessary to prevent falls.

2.

The nurse in a community health clinic is aware of the significant problems with nutrition in the elderly population. What percentage of the eldery living on their own consume fewer than 1,000 calories per day?

A)

8%

B)

16%

C)

24%

D)

32%

Ans:

B

Feedback:

Approximately 16% of community-dwelling older adults consume fewer than 1,000 calories per day. Due to various factors of people 75 years or older, an estimated 40% of men and 30% of women are at least 10% underweight.

3.

The nurse performs an assessment on a newly admitted elderly patient. The patient receives a score of 12 on the Braden scale. What is the risk for impaired skin integrity for this patient?

A)

No risk

B)

Low risk

C)

Moderate risk

D)

High risk

Ans:

D

Feedback:

The Braden scale is used to assess the risk for the development of pressure ulcers. A score of 15-16 indicates a low risk, 13-14 indicates a moderate risk, and a score of 12 or less is indicative of a high risk for pressure ulcer development.

4.

The home care nurse is aware of the growing problem of the mistreatment of the elderly population. How many elderly in the United States are estimated to be mistreated every year?

A)

700,000 to 1.2 million

B)

1.2 to 1.7 million

C)

1.7 to 2.2 million

D)

2.2 to 2.7 million

Ans:

A

Feedback:

As of 2008 it was estimated that 700,000 to 1.2 million elderly adults were the victims of physical, sexual, psychological, or financial mistreatment or neglect.

5.

Which group of individuals in the elderly population are most likely to be widowed?

A)

Women under the age of 65

B)

Men under the age of 70

C)

Men over the age of 75

D)

Women over the age of 75

Ans:

D

Feedback:

Loss and grief are a significant factor in the elderly population. In 2008, almost half of women (42%) were widowed by age 65, compared with 14% of men. Of women 75 years or older, only 28.9% lived with a spouse (AOA, 2009).

6.

The nurse is preparing a presentation on chronic pain management to a group of elderly members of a community senior citizens center. Which chronic disease should the nurse focus on in her presentation?

A)

Rheumatoid arthritis

B)

Amputation

C)

Neuropathy

D)

Osteoarthritis

Ans:

D

Feedback:

The nurse should focus on pain control for individuals with osteoarthritis since this disorder is the most frequent cause of chronic pain in the elderly population.

7.

The student nurse is conducting an informal study on pain management in the elderly population in a local long-term care facility. Which elderly patient population will the student most likely find to receive the least effective pain management?

A)

Residents 85 years or older

B)

Residents that have unaffected cognition

C)

White females

D)

Residents with chronic illness

Ans:

A

Feedback:

Studies indicate that an estimated 80% of nursing home residents have substantial, often unrecognized, and undertreated pain (National Pain Foundation, 2010). Older adults least likely to receive analgesics include those 85 years or older, those of a minority race, and those with low cognitive performance.

8.

An elderly patient tells his home care nurse that he doesnt seem to sleep as well as he used to. The nurse is aware that the sleep changes that occur in the elderly patient that cause a less restful sleep include:

A)

A decrease in stage I of the sleep cycle

B)

A decrease in the deep sleep stage of the sleep cycle

C)

A change in the normal progression of the sleep cycle

D)

An increase in stage II of the sleep cycle

Ans:

B

Feedback:

The changes to the sleep cycle that usually occur in the elderly are an increase in stage I and a decrease in deep sleep. These changes lead to a less restful sleep and more frequent awakenings during the night.

9.

The unit manager at a long-term care facility is concerned with the recent weight loss of several residents. The nurse plans a staff inservice to discuss weight loss in the elderly, including identifying what possible causes? Select all that apply.

A)

Decreased thirst and smell

B)

Alterations in taste

C)

Early satiation (feeling full)

D)

Anorexia

E)

Decline in physical activity

Ans:

A, B, C, D, E

Feedback:

According to the IOM (2010), various physiologic processes are identified as causes for decreased nutrition intake in the elderly. These processes include decreased thirst and smell, alterations in taste, early satiation (feeling full), and anorexia. Decreased dietary intake is also associated with a decline in physical activity that further limits the intake of essential micronutrients.

10.

A nursing student is looking at the demographics related to the older adult and finds that what percent of the elderly population that is institutionalized falls into the age range of 85+ years?

A)

1.3%

B)

2.4%

C)

3.8%

D)

15.4%

Ans:

D

Feedback:

Of the elderly population that is institutionalized, as of 2008 the percentage increases with age with 1.3% of persons 65-74 years, 3.8% of persons 75-84 years and 15.4% of persons 85+ years institutionalized. Approximately 2.4% of the elderly lived in senior housing with at least one supportive service available to their residents.

11.

An elderly patients daughter asks if the doctor can prescribe an antipsychotic medication for her father because he is so confused and agitated much of the time. The nurse is aware that the patient should only be prescribed this medication when which of the following strategies has failed? (Select all that apply)

A)

Behavioral

B)

Environmental

C)

Perceptual

D)

Chemical

E)

Social

Ans:

A, B, E

Feedback:

Due to the side effects and adverse reactions that may occur with antipsychotic medications, behavioral, environmental, and social strategies should be attempted to help improve cognition.

12.

The hospice nurse is visiting the elderly wife of a patient 4 weeks after the patient died. Which of the following comments by the wife concerns the hospice nurse the most?

A)

I havent started cleaning out my husbands closet yet.

B)

It is so hard to think that I wont see my husband again.

C)

Sometimes I just sit and cry.

D)

Eating alone is so lonely. I just lose my appetite when I think about it.

Ans:

D

Feedback:

The psychosocial aspects of eating alone after the death of a spouse can lead to problems in maintaining adequate nutrition. Leaving the closet untouched, missing her husband, and crying 4 weeks after the loss are normal grieving responses.

13.

A 76-year-old man is recovering from a myocardial infarction. In regards to his recovery, it is important for the nurse to

A)

Address any questions about sexuality

B)

Have a male counterpart address sexuality

C)

Refer the patient to a therapist

D)

Instruct him to eliminate sex for 1 month

Ans:

A

Feedback:

With regard to sexuality, the nurse should spend time with the older adult; use clear, easy-to-understand language; help the patient feel more comfortable talking about sex; be open minded and talk openly; listen, encourage discussion; give advice or suggestions as needed; and understand that sex is not just for the young.

14.

Which of the following factors contributes to sleep disturbances in older persons?

A)

Exercise

B)

Regular bedtime

C)

Decreased caffeine

D)

Beta-blockers

Ans:

D

Feedback:

Older persons experience impairment of sleep. Beta-blockers contribute to sleep disturbances.

15.

Changes in T-cell function in the elderly will result in

A)

Active immunity

B)

Inadequate nutrition

C)

Risk of infection

D)

Onset of chronic disease

Ans:

C

Feedback:

Humoral immunity declines because of changes in T-cell function, and older adults have lower antibody response to microorganisms that cause pneumonia and infection.

16.

A patient has an unsteady gait related to arthritis. His daughter states he walks better when he is at the grocery store pushing a cart. The nurse should recommend

A)

A total knee replacement

B)

An appointment with the orthopedist

C)

The patient use a wheeled walker

D)

The physician review the medications

Ans:

C

Feedback:

Instituting appropriate interventions relies on a thorough assessment of the persons mobility impairments. Interventions may include muscle strengthening, range-of-motion exercises, gait and balance training, and assistive devices such as canes or walkers.

17.

Which of the following activities performed by an elderly patient would make the patients family suspicious of the onset of dementia?

A)

The patients air conditioning is broken and he has not reported it

B)

The patient is an accountant and has had three episodes of bookkeeping errors

C)

The patient has not attended church services for one month

D)

The patient has become confused with medications since two new medications were added

Ans:

B

Feedback:

Conditions that mimic dementia or depression present distinct challenges because they impair thinking, mood, and communication. Such conditions also affect the older adults ability to manage self-care.

18.

Which group of individuals has the highest rate of suicide in the United States?

A)

Older white men

B)

Older white females

C)

Older African American males

D)

Older Hispanic males

Ans:

A

Feedback:

Currently, older white men have the highest rate of suicide in the United States.

19.

An elderly patient is being treated with a tricyclic antidepressant medication. What adverse reaction should the home care nurse observe for?

A)

Syncope

B)

Atrial fibrillation

C)

Falls

D)

Polyphagia

Ans:

B

Feedback:

Tricyclic antidepressants may induce arrhythmias or may worsen pre-existing heart failure.

20.

An elderly patient informs the nurse, I just dont feel like myself. I cry so easily and my mobility is so bad from my degenerative disc disease in my back. What factor is most likely contributing to the patients depression?

A)

Pain

B)

Shortness of breath

C)

Hearing loss

D)

Diminished vision

Ans:

A

Feedback:

Many factors place an older adult at risk for depression, including recent bereavement, a change in environment, alcohol or substance use, and chronic pain.

21.

When the home care nurse visits a 78-year-old female patient who is recently widowed and finds that the home is cluttered with trash and the patient appears sad and disheveled, the nurse should assess the patient for symptoms of

A)

Fatigue

B)

Presbyopia

C)

Drug overdose

D)

Depression

Ans:

D

Feedback:

Symptoms of depression include poor cognitive performance, sleep problems, and lack of initiative.

22.

A patient with Alzheimers disease becomes agitated and is unable to communicate. The nurse notes that this is a change from his regular demeanor. The nurse performs a thorough assessment of the patient, determining that he has an abscessed tooth. This assessment can be termed

A)

Health promotion

B)

Illness prevention

C)

Validation therapy

D)

Restorative therapy

Ans:

C

Feedback:

Validation therapy is a type of interpersonal interaction in which the health professional attempts to understand and validate the patients current needs.

23.

A patient is in the postoperative phase of an abdominal resection and colostomy. When educating the patient on his ostomy care by providing him with educational materials to read, it is important to assess the patients

A)

Hearing

B)

Vision

C)

Pain

D)

Gait

Ans:

B

Feedback:

Appropriate sensory appliances (glasses and hearing aids) assist older adults in interacting appropriately with their environment.

24.

In 2008, what percentage of older adults resided in nursing homes?

A)

2.5%

B)

3.5%

C)

4.1%

D)

5.5%

Ans:

C

Feedback:

In 2008, 4.1% of older adults resided in nursing homes.

25.

The largest growing population of individuals over 65 years in both the United States and Canada is

A)

65 to 70 years

B)

70 to 79 years

C)

80 to 84 years

D)

85 years and older

Ans:

D

Feedback:

In 2002, the number of people 65 to 74 years was eight times larger than in 1900, the number of people 75 to 84 years was more than 16 times larger, and the number of people 85 years or older was 38 times larger.

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