Chapter 10 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 10

Question 1

Type: MCSA

An elderly patient leaves the home for several hours most days of the week and attends a facility where care is provided specific to the needs of the elderly. The patient is attending which type of community-based nursing care program?

1. Adult day care

2. Health care clinic

3. Residential care facility

4. Outpatient center

Correct Answer: 1

Rationale 1: One type of community-based nursing care setting is adult day care, which provides care specific to the needs of the elderly.

Rationale 2: A health care clinic provides care to patients of different ages.

Rationale 3: A residential care facility is the formal name for the type of facility commonly referred to as board and care living.

Rationale 4: An outpatient center provides care to patients of all ages and for a variety of health care needs.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6

Question 2

Type: MCSA

Upon discharge from the hospital, a patient is going home and will need medication injected weekly, assistance with meal preparation, and minor assistance with activities of daily living. The nurse would identify which community-based care service as appropriate for this patient?

1. Home care

2. Hospice care

3. Ambulatory surgical care

4. Long-term care

Correct Answer: 1

Rationale 1: The patient who is returning home and needs assistance with medications, care, and meals would benefit from the community-based service of home care.

Rationale 2: Hospice care is provided to patients who are approaching the end of life or have a chronic illness.

Rationale 3: Ambulatory surgical care is for patients who need minor surgical procedures on an outpatient basis.

Rationale 4: Long-term care is provided to patients who are in residence at a facility.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6

Question 3

Type: MCSA

A 78-year-old patients respiratory vital capacity measurement is decreased. How would the nurse evaluate this information?

1. The patient will likely also have cardiac insufficiency.

2. This finding can be normal in older patients.

3. This finding indicates neurological deterioration.

4. This patient has had undiagnosed chronic respiratory disease.

Correct Answer: 2

Rationale 1: This finding alone is not sufficient to raise concern about cardiac insufficiency.

Rationale 2: Structural changes of the thoracic cavity are often seen with aging and can affect respiratory function.

Rationale 3: There is not enough information to raise concern about neurological deterioration.

Rationale 4: There is not enough information to indicate undiagnosed chronic respiratory disease.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-2

Question 4

Type: MCSA

An elderly female patient tells the nurse that she is having trouble holding her water and doesnt want to drink fluids anymore. How should the nurse interpret this statement?

1. The patient has a urinary tract infection.

2. The patient needs estrogen cream.

3. The patient has a reduced thirst reflex.

4. The patient is experiencing incontinence.

Correct Answer: 4

Rationale 1: There is not enough evidence to suggest a urinary tract infection.

Rationale 2: The use of estrogen cream would be indicated for atrophic vaginitis or a decrease of estrogen in the vaginal tissues. Those conditions are not indicated by the patients statement.

Rationale 3: The patient states that she does not want to drink fluids, which would not support a reduced thirst reflex.

Rationale 4: One common disorder seen in the genitourinary tract of the elderly is incontinencestress incontinence, urge incontinence, overflow incontinence, or any combination of the three.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-2

Question 5

Type: MCSA

An elderly female patient has a sudden onset of delirium during the first night of hospitalization. What does this episode suggest to the nurse?

1. The patient has an infection.

2. The patient is dehydrated.

3. The cause must be determined immediately because it can signal another health problem.

4. The patient has Alzheimers disease.

Correct Answer: 3

Rationale 1: There is not enough information to specifically suggest an infection.

Rationale 2: There is not enough information to specifically suggest dehydration.

Rationale 3: Delirium is an abnormal mental state, not a disease, and usually a sign of a newly developed disorder that affects about one

third of hospitalized people over the age of 70.

Rationale 4: There is not enough information to suggest Alzheimers in this patient.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-2

Question 6

Type: MCSA

The nurse is planning care for a 70-year-old patient. Which screening should the nurse include in this patients care plan?

1. Biannual eye examinations

2. Hearing test every 5 years

3. Testing for fecal occult blood every 5 years

4. Annual PSA test and digital rectal exam

Correct Answer: 4

Rationale 1: The USPSTF recommends yearly visual screening and a full eye exam for all individuals age 65 and older.

Rationale 2: Hearing loss is the most common sensory impairment in the older adult. The USPSTF recommends yearly hearing impairment screening for all individuals age 65 and older.

Rationale 3: For those age 65 and older, fecal occult blood testing is recommended yearly, sigmoidoscopy every 5 years, and colonoscopy every 10 years.

Rationale 4: The USPSTF recommends a yearly prostate surface antigen (PSA) test and a digital rectal exam (DRE) in males age 65 and older.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 10-3

Question 7

Type: MCSA

A 68-year-old female patient has had a complete hysterectomy, including the removal of the cervix. Which information would the nurse provide regarding long-term screening?

1. Once you have a negative Pap smear, you can reduce the frequency to one every 3 years.

2. You should continue to have annual Pap smears.

3. You should have a Pap smear every 3 years.

4. You no longer need to have Pap smears.

Correct Answer: 4

Rationale 1: This in incorrect planning for this specific patient.

Rationale 2: Annual Pap smears are not indicated for this patient.

Rationale 3: This is incorrect planning for this patient.

Rationale 4: Women without a cervix should not have Pap smears.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 10-3

Question 8

Type: MCSA

An 85-year-old male patient is aware of the need for a colonoscopy; however, he has a history of severe electrolyte imbalances associated with bowel preps for diagnostic tests. Which intervention should the nurse plan?

1. Discuss the option of having a flexible sigmoidoscopy instead.

2. Investigate medications the patient can take after the colonoscopy to correct the electrolyte imbalances.

3. Discuss the option of not having the colonoscopy.

4. Consider the option of delaying the colonoscopy for a year.

Correct Answer: 3

Rationale 1: It is not a U.S. Preventive Services Task Force recommendation to substitute a flexible sigmoidoscopy for a colonoscopy. Sigmoidoscopy also requires bowel prep.

Rationale 2: There is not enough information to determine that the patient should have the colonoscopy and be treated for electrolyte imbalances afterward.

Rationale 3: The appropriate age to discontinue colorectal cancer screening is unknown; however, the burden of screening may outweigh the potential benefits in patients of advanced age who have comorbid conditions that limit life expectancy. The patient should discuss the benefits and potential harm associated with the colonoscopy with his health care provider.

Rationale 4: Delaying the colonoscopy for a year will not correct the problem with electrolyte balance and bowel prep.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 10-3

Question 9

Type: MCSA

A hospitalized 72-year-old patient wants to know where her digoxin pill is because she always takes it for her heart. How should the nurse respond?

1. Digoxin is a bad medication to take.

2. The health care provider will likely order a different heart medication.

3. Digoxin doesnt work as well as it used to.

4. Digoxin is no longer manufactured.

Correct Answer: 2

Rationale 1: The nurse should not tell the patient that digoxin is a bad medication.

Rationale 2: The nurse should inform the patient that the health care provider will order a different heart pill than the digoxin. Digoxin toxicity may result because of reduced renal function in older adults. Safer alternatives exist.

Rationale 3: While it is true that digoxin is not beneficial to a patient over age 65, this statement does not address what will be done to replace the medication.

Rationale 4: Digoxin is still being manufactured.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-4

Question 10

Type: MCSA

A 75-year-old female has been brought to the emergency department. She tells the nurse that her son, who has taken care of her, said he would be right back, but she has not seen him for weeks. The nurse is concerned that the patient is describing which possible situation?

1. Neglect

2. Physical abuse

3. Abandonment

4. Self-neglect

Correct Answer: 3

Rationale 1: This situation exceeds the definition of neglect.

Rationale 2: There is no suggestion of physical abuse in the situation described by the patient.

Rationale 3: Abandonment is a form of elder abuse. This patients son has not returned to care for his mother.

Rationale 4: Self-neglect is the refusal or failure of an elderly person to provide him- or herself with adequate food, water, shelter, and health care to the point that personal health or safety is threatened. There is no evidence of self-neglect in this case.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-5

Question 11

Type: MCSA

A patient tells the nurse that she does not bother to bathe anymore and has no appetite, so she eats only a few times a week. The nurse would evaluate this statement as possibly indicating which type of mistreatment?

1. Abandonment

2. Physical abuse

3. Emotional abuse

4. Self-neglect

Correct Answer: 4

Rationale 1: Abandonment occurs when another person stops taking care of a dependent person.

Rationale 2: There is no indication of physical abuse.

Rationale 3: Emotional abuse may have impaired the patients self-esteem, but there is insufficient information to make that determination.

Rationale 4: Self-neglect occurs when an individual who is capable of making decisions and understanding consequences engages in behaviors that threatens his or her safety or well-being.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-5

Question 12

Type: MCSA

An elderly patient tells the nurse that her son cashes her Social Security checks but tells her he does not have enough money to buy her medications. The nurse should investigate this statement because it could reflect which situation?

1. Physical abuse

2. Financial exploitation

3. Emotional abuse

4. Neglect

Correct Answer: 2

Rationale 1: Physical abuse is the use of physical force that may result in injury, pain, or impairment. There is no data to support this concern.

Rationale 2: Financial exploitation is the misuse of an elders money, property, or assets.

Rationale 3: Emotional abuse involves inflicting pain or distress through verbal or nonverbal means such as insults, threats, or forced social isolation. There is no data to support this concern.

Rationale 4: Neglect is the refusal or failure to fulfill duties to an elder. Neglect may be occurring, but this specific situation is another type of mistreatment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-5

Question 13

Type: MCSA

An older patient says that she cannot go home until she can walk independently because she might get kicked out of the apartment. The nurse realizes this patient is describing which type of living facility?

1. A skilled nursing care facility

2. Residential living facility

3. Assisted living facility

4. Adult day care

Correct Answer: 3

Rationale 1: A skilled nursing care facility provides care for a short period to allow recovery from an acute illness or injury after a hospitalization. Many patients in a skilled nursing facility are nonambulatory.

Rationale 2: In a residential living facility, also termed a board and care facility, care is provided by unlicensed personnel, and services such as meals, social activities, housekeeping, laundry, and limited transportation are provided.

Rationale 3: Assisted living facilities are licensed as residential care facilities. Most require individuals to be ambulatory, use a walker, or be able to propel their wheelchairs to a common dining area. These facilities cannot accommodate individuals who are bedbound.

Rationale 4: Adult day care focuses on socialization among elderly people. It is not provided in the patients home.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6

Question 14

Type: MCSA

An elderly patient tells the nurse that her daughter bought her a system that will call for help if she falls. The nurse realizes this patient is describing which technology?

1. Direct dial to the local ambulance company

2. Computerized communication

3. A home alarm system

4. Continuous body monitoring

Correct Answer: 4

Rationale 1: It is unclear from the patients description whether the system is direct dial to the ambulance company.

Rationale 2: Computerized communication would imply that the patient has a computer at home and would need to access it to communicate health needs.

Rationale 3: The nurse has no way of knowing if the patient has a home alarm system.

Rationale 4: Continuous body monitoring is available in many different types. Most body monitoring systems include a device that the elderly person wears that communicates to an ambulance company or other family member that the person needs help or assistance.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-7

Question 15

Type: MCMA

Which situations would the nurse identify as supporting the activity theory of aging?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. An 82-year-old patient continues to live at home and care for her own lawn.

2. A 70-year-old patient who can no longer travel independently joins a group that goes on sightseeing bus trips together.

3. A 65-year-old patient moves to a senior retirement community.

4. A 72-year-old patient does not socialize anymore, preferring to stay at home and watch television.

5. A 74-year-old patient refuses to retire from work.

Correct Answer: 2,3

Rationale 1: This situation most closely exemplifies the continuity theory of aging.

Rationale 2: This patient is extending activities enjoyed in younger life, but with changes to reflect aging. This is an example of the activity theory of aging.

Rationale 3: Moving to a community with others of the same age represents the activity theory of aging.

Rationale 4: This situation represents the disengagement theory of aging.

Rationale 5: This situation represents the continuity theory of aging.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-1

Question 16

Type: FIB

A nurse researcher is preparing to study a group of older adults and their response to a nursing intervention. To meet the legal definition of older adult, the study group should include persons _______ years of age or older.

Standard Text:

Correct Answer: 65

Rationale : The legal definition of older adult is any individual 65 years of age or older.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 10-1

Question 17

Type: MCMA

The nurse is aware that cardiovascular changes are part of the normal aging process. This nurse would consider the position of a patients point of maximal impulse (PMI) normal if it was found at the midclavicular line (MCL) in which intercostal spaces (ICS)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Third

2. Fifth

3. Sixth

4. Seventh

5. Fourth

Correct Answer: 2,3

Rationale 1: The third ICS is too high for a normal PMI.

Rationale 2: The normal location of the PMI is the fifth ICS, MCL.

Rationale 3: In a younger adult, if the PMI is found in the sixth ICS, MCL, the nurse suspects cardiomegaly. In an older adult, this may be a normal finding.

Rationale 4: If the PMI is found in the seventh ICS, MCL, the nurse would suspect cardiomegaly.

Rationale 5: The fourth ICS is too high for a normal PMI.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-4

Question 18

Type: FIB

A 66-year-old patient tells the nurse, It is time for my annual tetanus vaccine. The nurse would respond that it is recommended that a person this age receive the tetanus vaccine every ______ years.

Standard Text:

Correct Answer: 10

Rationale : Immunization against tetanus is recommended every 10 years in adults over 65 years of age.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3

Question 19

Type: MCMA

A 70-year-old patient has been taking over-the-counter cimetidine for a number of years to treat reflux disease. The nurse would closely assess this patient for which adverse responses?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Gastrointestinal bleeding

2. Depression

3. Double vision

4. Confusion

5. Fluid retention

Correct Answer: 2,4

Rationale 1: Gastrointestinal bleeding is not associated with cimetidine use.

Rationale 2: Cimetidine may cause depression in aging patients.

Rationale 3: Cimetidine use is not associated with double vision.

Rationale 4: Cimetidine use may cause confusion in aging patients.

Rationale 5: Fluid retention is not an adverse effect associated with cimetidine use in aging patients.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-4

Question 20

Type: MCMA

A patient reports difficulty hearing when talking to family members on the telephone. Which technologies should the nurse consider when replying to this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. TTY telephones

2. Voice over Internet Protocol (VOIP)

3. Videoconferencing

4. Analog rather than digital telephone

5. Special telephone with higher volume

Correct Answer: 1,2,3,5

Rationale 1: If the patients hearing loss is significant, a TTY phone should be considered. The individual types into a special keyboard that generates tones that are converted to letters by another TTY phone.

Rationale 2: The VOIP allows the individual to communicate in voice, text, or streaming video.

Rationale 3: Videoconference technology allows the patient to interact visually with others.

Rationale 4: The use of an analog telephone would not improve the patients ability to hear the other person.

Rationale 5: Higher-volume telephones are available for those with hearing impairment.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-7

 

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