Chapter 09: Health Care Delivery Settings and Older Adults My Nursing Test Banks

Chapter 09: Health Care Delivery Settings and Older Adults

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. What action by the nurse is most important for preventing hospital-acquired infections in the older population?

a.

Appropriate hand hygiene

b.

Rapid isolation for infection

c.

Strict sterile procedures

d.

Ensuring patient nutrition

ANS: A

Hand hygiene is the most effective infection control action the nursing staff can take.

DIF: Applying (Application) REF: N/A OBJ: 9-3

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

2. The nurse on a medical acute care unit is preparing for the admission of an 84-year-old patient with several diagnosed chronic illnesses. The nurse begins the plan of care for this patient based on the understanding that the older adult is likely to:

a.

develop hospital-induced delirium.

b.

require special attention related to sensory deficits.

c.

need a social services consult before discharge.

d.

present with a need for a high level of nursing care.

ANS: D

The older adult is not likely to be admitted to the hospital until a high level of acuity or complications exists. The other options may be possible, but the majority of older patients are admitted at a high level of acuity.

DIF: Remembering (Understanding) REF: Page 154 OBJ: 9-1

TOP: Teaching-Learning MSC: Physiologic Integrity

3. The nurse is planning the discharge of a 70-year-old patient who lives alone and is recovering from a fractured ankle. What action by the nurse shows an understanding of factors affecting the patients ultimate return to preinjury function?

a.

Encourages the patient to comply with recommendations made by the physical therapist

b.

Arranges for the patients meals to be delivered daily for several weeks after discharge

c.

Assesses the barriers to self-ambulation that exist in the patients home

d.

Educates the patient on the importance of a diet that promotes both bone and muscle healing

ANS: C

In the hospital setting, health care professionals can become so involved in addressing the acute condition that they fail to appreciate the underlying problems and how these too influence the patients health and recovery. Assessing for ambulation barriers in the patients home has a long-term effect on the patients ability to regain independence.

DIF: Understanding (Comprehension) REF: Page 154 OBJ: 9-1

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

4. The nurse in an acute care facility is caring for a patient recovering from a cerebral vascular accident that has resulted in a mild loss of muscle function in his right arm and leg. The nurse is best addressing the patients need via the functional model of care when:

a.

assessing the patients right-sided muscle strength daily.

b.

reaffirming to the patient that physical therapy will improve his muscle strength.

c.

instructing the patients family on how to properly assist the patient in walking.

d.

placing the telephone where the patient can reach it with his left hand.

ANS: D

The functional models main goal may not be curing the disease but managing the disease, with a focus on self-care and symptom management strategies. Placing the telephone where the patient can reach it for himself is an example of a symptom management strategy. The other actions do not increase the patients functional abilities.

DIF: Applying (Application) REF: N/A OBJ: 9-2

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

5. The nurse is caring for an older adult patient who was admitted with a stage 3 pressure ulcer on the left heel and who also has a history of Parkinson disease and chronic renal failure. To minimize the patients risk of developing an iatrogenic illness, the nurse:

a.

uses sterile technique when changing the heels dressings.

b.

reviews all the patients medications for possible adverse reactions.

c.

instructs the patient to call for assistance when needing to go to the bathroom.

d.

assists the patient in choosing the appropriate foods from the daily menu.

ANS: B

Adverse drug reactions frequently precipitate hospitalizations and, although often unreported, are among the most common iatrogenic events in the acute care setting. The hospital staff needs to get an accurate drug history of a patient, be aware of pharmacokinetic and pharmacodynamic changes related to aging, and have a working understanding of drug-disease, drug-drug, and drug-food interactions in older adults. Nurses should be particularly aware of drugs that may be high risk when used in older adults. The other actions are important for patient safety, but the more frequent cause of iatrogenic problems is related to medication use.

DIF: Understanding (Comprehension) REF: Page 154 OBJ: 9-3

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

6. The nurse best addresses the possible intrinsic factors that contribute to falls experienced by older adult patients in an acute care setting by:

a.

encouraging patients to wear their glasses.

b.

keeping a low-level light on in the room at night.

c.

keeping the patients bed low to the floor.

d.

assessing the room for clutter on the floor.

ANS: A

Risk factors for hospital falls include both intrinsic and extrinsic factors. Intrinsic factors include age-related physiologic changes and diseases, as well as medications that affect cognition and balance. The other actions are important safety measures that are helpful to some patients as well, but good vision is critical for safety.

DIF: Understanding (Comprehension) REF: Page 154 OBJ: 9-6

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

7. The nurse caring for an older patient is concerned when the patient begins experiencing mild confusion. The nurse notes that the vital signs are all within normal limits for this patient. To best assess related symptoms, the nurse initially:

a.

asks the patient to Squeeze my hand as hard as you can.

b.

reviews documentation about how the patient has been eating.

c.

reviews the patients medication for possible adverse reactions.

d.

asks the patients daughter if her mother has been confused before.

ANS: B

Anorexia is a symptom of urinary tract infection, which occurs frequently in older adults. Subclinical infection and inflammation can occur with presenting symptoms such as acute confusion, functional capacity deterioration, anorexia, or nausea rather than the classic symptoms of fever and dysuria. Although all actions are appropriate, the nurse suspecting a urinary tract infection (UTI) will assess eating patterns.

DIF: Applying (Application) REF: N/A OBJ: 9-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

8. The nurse is caring for a confused patient. Which action by the nurse shows the best understanding of managing the cascading effects of iatrogenic illnesses in this population cohort?

a.

Reorienting the patient to person, place, and time frequently

b.

Offering the patient liquids each time there is patient-nurse contact

c.

Repositioning the patient every 2 hours

d.

Using restraints to ensure patient safety only as a last resort

ANS: D

Once older adults are hospitalized, immobilization through enforced bed rest or restraint often results in functional disability, and the subsequent occurrence of iatrogenic illnesses often represents a vicious circle, referred to as the cascade effect, in which one problem increases the persons vulnerability to another one. Gerontologic nurses must be leaders in advocating more appropriate care and treatment of hospitalized older adults to prevent or at least reduce the occurrence of iatrogenic illness. The other actions are good nursing care but do not relate to the cascade effect.

DIF: Applying (Application) REF: N/A OBJ: 9-3

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

9. An 80-year-old patient with visual and hearing deficits is admitted for hip replacement surgery. The patient has begun to show mild confusion and has become resistant to care and treatment. To minimize this problem, the nurse initially edits the patients care plan to include:

a.

frequent reorientation to people in the patients environment.

b.

putting on the patients glasses and hearing aid as a part of activities of daily living (ADLs).

c.

assigning the same staff to provide patient care whenever possible.

d.

minimizing the number of off-unit trips for the patient.

ANS: B

Older adults have a decreased ability to negotiate within and adapt to an unfamiliar environment, which can be initially minimized by the use of hearing aids and eyeglasses, for example. The other actions may be appropriate, but until the sensory deficit is corrected, the patient will most likely remain confused.

DIF: Applying (Application) REF: N/A OBJ: 9-3

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

10. What action by the nurse best shows an understanding of the effects of acute hospitalization on the functional abilities of the older patient?

a.

Setting goals that support a short hospitalization.

b.

Attempting to adapt nursing care to individual needs

c.

Administering a systematic functional assessment

d.

Assessing for a decline from original baseline function

ANS: D

The nurse should assess for new onset signs or symptoms of a decline from baseline function and then implement appropriate interventions before they trigger a downward spiral of dependency and permanent impairment.

DIF: Understanding (Comprehension) REF: Page 156 OBJ: 9-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

11. Which statement by a resident best indicates that the residents psychosocial needs are being met?

a.

Im really enjoying the opportunity to select my own mealtimes.

b.

I miss being at home, but I understand why I must live here.

c.

I appreciate being placed on the waiting list for a private room because I prefer living alone.

d.

Im an independent person who has always made my own decisions, and I will for as long as I can.

ANS: A

Psychosocial needs are best met when a patient is encouraged to be independent both physically and mentally. Making choices is a good example psychosocial needs being prioritized.

DIF: Understanding (Comprehension) REF: Page 169 OBJ: 9-4

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

12. A 70-year-old patient covered by Medicare is being admitted for stabilization of type 2 diabetes. When asked by the family why their parents care is being co-managed by a geriatric nurse practitioner and a physician, the best explanation is that:

a.

the geriatric nurse practitioner is specially trained to work with older patients.

b.

research has shown that this care model often results in shorter hospital stays.

c.

the physician and nurse practitioner will focus on different needs.

d.

Medicare encourages this team concept of patient care.

ANS: B

Some studies demonstrate a significant decrease in the length of stay when patients are co-managed by a nurse practitioner and an attending physician.

DIF: Understanding (Comprehension) REF: Page 177 OBJ: 9-4

TOP: Teaching-Learning MSC: Safe Effective Care Environment

13. The nurse is going to educate an older patient newly diagnosed with type 2 diabetes on how to test serum glucose levels appropriately. The nurse shows an understanding of the adaptation of teaching techniques for this age group by:

a.

providing both written and verbal instructions on the skill.

b.

asking the patient if he has any hearing or vision deficits.

c.

restating the important points several times.

d.

asking the patient to describe the proper technique in his own words.

ANS: B

This population often experiences sensory deficits that can affect their learning capacity. The other actions are also appropriate, but if the patient has sensory deficits, they must be addressed before teaching begins.

DIF: Understanding (Comprehension) REF: Page 169 OBJ: 9-7

TOP: Teaching-Learning MSC: Physiologic Integrity

14. The nurse at an assisted living facility is caring for a 73-year-old cognitively impaired patient who has recently been admitted. The nurse creates a care plan that strives to help maintain the patients independence by including:

a.

sufficient time for the patient to complete self-care.

b.

encouraging the patient to make decisions regarding self-care.

c.

regular assessment of the patients ability to provide self-care.

d.

regular cueing by staff to direct patient self-care.

ANS: D

Cognitively impaired individuals often need supervision and cueing rather than physical assistance to perform ADLs and instrumental activities of daily living (IADLs).

DIF: Understanding (Comprehension) REF: Page 158 OBJ: 9-4

TOP: Communication and Documentation MSC: Health Promotion

15. An older patient has fallen twice in the hospital in the last 2 days. What action by the nurse is best?

a.

Request restraint orders from the provider.

b.

Assess the patient for undiagnosed illness.

c.

Remind the patient to call for help getting up.

d.

Have a family member stay with the patient.

ANS: B

Falls are commonly associated with a new onset of illness in the older patient. The nurse assesses for this possibility. Restraints are a last resort. The patient may be too confused or forgetful to remember to call for help, plus this places the responsibility for safety on the patient. Family members may not be present or able to stay with the patient continuously.

DIF: Applying (Application) REF: N/A OBJ: 9-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

16. A nurse is caring for an older patient in the intensive care unit. The patient has a sudden onset of confusion. What action by the nurse is best?

a.

Request a sedative from the provider.

b.

Attempt to reorient the patient.

c.

Perform a sepsis screening.

d.

Review lab work for today.

ANS: C

The most common presenting sign of sepsis in the older adult is confusion. The nurse assesses the patient for this condition. Sedatives and restraints are a last resort. The nurse should attempt to reorient the patient, but this is not the most important action. The nurse should also review lab work, but current assessments are more important.

DIF: Applying (Application) REF: N/A OBJ: 9-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

17. Which individual would the nurse refer to the local Area Agency on Aging?

a.

One who needs housekeeping services

b.

One who needs help with preparing taxes

c.

One who needs nutritious meals

d.

One who needs long-term care placement

ANS: C

The AAA provides resources for community members on information and referral for medical and legal advice; psychologic counseling; preretirement and postretirement planning; programs to prevent abuse, neglect, and exploitation; programs to enrich life through educational and social activities; health screening and wellness promotion services; and nutrition services. The patient needing nutritious meals would most benefit from this agency.

DIF: Understanding (Comprehension) REF: Page 160 OBJ: 9-4

TOP: Communication and Documentation

MSC: Safe Effective Care Environment

18. The nursing faculty explains to students the definition of homebound. Which is the best explanation of this situation?

a.

A person uses a wheelchair for all mobility.

b.

A person desires services provided at home.

c.

Leaving home requires great effort.

d.

No local agency is available to provide service.

ANS: C

Homebound implies that a person could leave the home for a legitimate medical reason, but he or she must exert a great deal of effort to do so. Being in a wheelchair does not in itself cause a person to be homebound, nor does requesting home services or not having another agency to provide services elsewhere.

DIF: Understanding (Comprehension) REF: Page 162 OBJ: 9-9

TOP: Teaching-Learning MSC: Health Promotion

19. A patient is on hospice care. Which situation would result in an acute hospitalization?

a.

Progression of disease

b.

Intractable pain

c.

New pressure ulcer

d.

Bladder infection

ANS: B

Inpatient care is available when the patient experiences acute or severe pain or symptom management problems. The other conditions are managed without acute hospitalization.

DIF: Remembering (Knowledge) REF: Page 167 OBJ: 9-12

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

20. Which action does the nurse delegate to the unlicensed assistive personnel (UAP) pertaining to pressure ulcer prevention?

a.

Assessing the patients skin daily

b.

Keeping the patients skin clean and dry

c.

Obtaining a special overlay mattress

d.

Monitoring the patients nutritional status

ANS: B

The nurse can delegate keeping a patients skin clean and dry to the UAP. The other actions are within the nurses scope of practice.

DIF: Applying (Application) REF: N/A OBJ: 9-17

TOP: Communication and Documentation

MSC: Safe Effective Care Environment

MULTIPLE RESPONSE

1. A nurse is caring for a confused and frail patient. Which interventions will best minimize the patients risk of injury related to the geriatric triad? (Select all that apply.)

a.

Respond to the patients call bell promptly.

b.

Ensure the bed alarm is on at all times.

c.

Remain with the patient when eating.

d.

Assess elimination needs every 2 hours while the patient is awake.

e.

Offer the patient fluids during each visit.

ANS: A, B, D

The geriatric triad includes falls, changes in cognitive status, and incontinence. Responding promptly to call lights, assessing for elimination needs, and having bed alarms limits falling.

DIF: Applying (Application) REF: N/A OBJ: 9-6

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

2. The nurse explains to the student the benefits of home health care. Which are benefits typically associated with this care? (Select all that apply.)

a.

Less exposure to iatrogenic risks

b.

Less chance of becoming confused

c.

Better management of chronic conditions

d.

Better reimbursement from Medicare

e.

Patient remains in control of environment

ANS: A, B, C, E

Many benefits exist for home health care including less risk of iatrogenic illness/injury, less chance the patient will be acutely confused by the change of environment, better long-term management of chronic conditions, and control of the environment by the patient.

DIF: Understanding (Comprehension) REF: Page 162 OBJ: 9-9

TOP: Teaching-Learning MSC: Physiologic Integrity

3. What actions by the nursing staff in a long-term care facility display an awareness of resident rights? (Select all that apply.)

a.

Getting informed consent for the use of an antipsychotic medication

b.

Reminding the unhappy resident and family about grievance processes

c.

Ensuring that all residents are asked if they wish to vote in an election

d.

Giving residents information on the ombudsmans name and address

e.

Assessing residents for their ability to safely administer their medications

ANS: A, B, C, E

Long-term care facilities are responsible for honoring the many rights of their residents, including setting up informed consent processes for side rails and chemical restraints, having a posted grievance policy and process, pursuing the residents right to vote, assessing residents for the ability to safely administer their own medications, and posting information about the ombudsman program.

DIF: Remembering (Knowledge) REF: Page 169 OBJ: 9-15

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

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