Chapter 24 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 24

Question 1

Type: MCMA

The nurse is assessing a frail older patient in a skilled facility. Which manifestations should the nurse consider as expected for this patient?

Standard Text: Select all that apply.

1. Low energy

2. Poor endurance

3. Energetic gait speed

4. Low activity tolerance

5. Generalized weakness

Correct Answer: 1,2,4,5

Rationale 1: In the older patient a characteristic of frailty is low energy.
Reference: Page 677

Rationale 2: In the older patient a characteristic of frailty is poor endurance.
Reference: Page 677

Rationale 3: In the older patient a characteristic of frailty is a decline in gait speed and not an energetic gait speed.
Reference: Page 677

Rationale 4: In the older patient a characteristic of frailty is low activity tolerance.
Reference: Page 677

Rationale 5: In the older patient a characteristic of frailty is generalized weakness.
Reference: Page 677

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Describe the causes of and unique presentation of frailty in the older person.

Question 2

Type: MCMA

The nurse is planning care for an older patient to prevent the geriatric cascade. What causes this cascade to occur in older patients?

Standard Text: Select all that apply.

1. Frailty

2. Acute illness

3. Institutional care

4. Lack of health insurance

5. Poor appetite and malnutrition

Correct Answer: 1,2,3

Rationale 1: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. Frailty is a characteristic of this phenomenon.
Reference: Page 677

Rationale 2: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. Acute illness is a characteristic of this phenomenon.
Reference: Page 677

Rationale 3: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. Institutional care is a characteristic of this phenomenon.
Reference: Page 677

Rationale 4: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. A lack of health insurance could contribute to the chronic condition but is not a direct characteristic of this phenomenon.
Reference: Page 677

Rationale 5: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. Poor appetite and malnutrition could contribute to frailty but is not a direct characteristic of this phenomenon.
Reference: Page 677

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 3

Type: MCMA

The nurse manager is concerned about the increased number of medication adverse effects being observed in older patients. What should the manager do to reduce these effects?

Standard Text: Select all that apply.

1. Conduct a quality improvement study every month.

2. Monitor each nurses ability to detect preparation errors.

3. Emphasize the importance of not missing medication doses.

4. Review Pharmacy documentation regarding drugdrug interactions

5. Ensure that the physicians orders are being inputted into the computer correctly.

Correct Answer: 2,3,4,5

Rationale 1: Adverse drug events can result from a variety of causes. Conducting a monthly quality improvement study may or may not help reduce adverse drug events in the older patient.
Reference: Pages 689-690

Rationale 2: Adverse drug events can result from preparation errors.
Reference: Pages 689-690

Rationale 3: Adverse drug events can result from missed medication doses.
Reference: Pages 689-690

Rationale 4: Adverse drug events can result from drugdrug interactions.
Reference: Pages 689-690

Rationale 5: Adverse drug events can result from illegible orders.
Reference: Pages 689-690

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 4

Type: MCSA

The nurse is caring for an older patient who is receiving palliative care. Which intervention is the highest priority for this patient?

1. Invasive testing

2. Pain management

3. Aggressive chemotherapy

4. Aggressive invasive surgery

Correct Answer: 2

Rationale 1: Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain. Invasive testing is not an intervention typically associated with palliative care.
Reference: Page 694

Rationale 2: Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain.
Reference: Page 694

Rationale 3: Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain. Aggressive chemotherapy is not an intervention typically associated with palliative care.
Reference: Page 694

Rationale 4: Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain. Aggressive invasive surgery is not an intervention typically associated with palliative care.
Reference: Page 694

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 5

Type: MCMA

The nurse is planning to use the Hospital Admission Risk Profile (HARP) to assess an older patients risk for developing problems while hospitalized for an acute illness. Which areas are used to assess risk?

Standard Text: Select all that apply.

1. Age

2. Manual dexterity

3. Cognitive function

4. Ability to self-feed

5. Independence with ADLs

Correct Answer: 1,3,5

Rationale 1: The HARP uses age to help determine an older patients risk for problems while hospitalized.
Reference: Page 693

Rationale 2: The HARP does not use manual dexterity as a measurement to determine an older patients risk for problems while hospitalized.
Reference: Page 693

Rationale 3: The HARP uses cognitive function to help determine an older patients risk for problems while hospitalized.
Reference: Page 693

Rationale 4: The HARP does not use ability to self-feed as a measurement to determine an older patients risk for problems while hospitalized.
Reference: Page 693

Rationale 5: The HARP uses independence with ADLs to help determine an older patients risk for problems while hospitalized.
Reference: Page 693

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 6

Type: MCMA

For which reasons is a frail older patient more at risk for poor treatment outcomes in an acute care setting?

Standard Text: Select all that apply.

1. Nosocomial infections

2. Iatrogenesis of therapeutic interventions

3. Diagnoses of vague symptoms and problems

4. Assessment of the effects of acute illness on diagnosed chronic illnesses

Correct Answer: 1,2

Rationale 1: Nosocomial infections are considered complications of hospitalizations and can contribute to poor treatment outcomes in a frail older patient.
Reference: Page 681

Rationale 2: Careful monitoring of the older persons status and effectiveness of the overall plan of care is indicated because frail older adults with poor function are at increased risk of iatrogenesis or adverse outcomes of therapeutic interventions.
Reference: Page 681

Rationale 3: Diagnoses of vague symptoms and problems do not place the frail older patient at risk for poor treatment outcomes.
Reference: Page 681

Rationale 4: Assessment of the effects of acute illness on diagnosed chronic illnesses does not place the frail older patient at risk for poor treatment outcomes.
Reference: Page 681

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 7

Type: MCSA

A frail older patient with cognitive impairment develops a urinary tract infection. Which manifestation should the nurse expect when assessing this patient?

1. Flank pain

2. High fever

3. Hypertension

4. Increased confusion

Correct Answer: 4

Rationale 1: A person with a mild cognitive impairment who develops a urinary tract infection might become more confused as a result of the infection. This confusion may limit the older persons ability to recognize or communicate the urinary symptoms. As a result, the urinary tract infection may go undiagnosed or untreated. Flank pain is not an expected manifestation of a urinary tract infection.
Reference: Page 681

Rationale 2: A person with a mild cognitive impairment who develops a urinary tract infection might become more confused as a result of the infection. This confusion may limit the older persons ability to recognize or communicate the urinary symptoms. As a result, the urinary tract infection may go undiagnosed or untreated. Older patients experience a drop in body temperature as a sign of aging. With an infection, the temperature elevation will be slight.
Reference: Page 681

Rationale 3: A person with a mild cognitive impairment who develops a urinary tract infection might become more confused as a result of the infection. This confusion may limit the older persons ability to recognize or communicate the urinary symptoms. As a result, the urinary tract infection may go undiagnosed or untreated. Hypertension is not a typical manifestation of a urinary tract infection.
Reference: Page 681

Rationale 4: A person with a mild cognitive impairment who develops a urinary tract infection might become more confused as a result of the infection. This confusion may limit the older persons ability to recognize or communicate the urinary symptoms. As a result, the urinary tract infection may go undiagnosed or untreated.
Reference: Page 681

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. State the impact of age-related changes and comorbidities on organ function.

Question 8

Type: MCSA

Which action should the nurse recommend to a patient to promote living to a healthy older age?

1. Limit smoking.

2. Decrease nutritional intake.

3. Increase physical inactivity.

4. Use recommended preventive health services.

Correct Answer: 4

Rationale 1: Americans can improve their chances for a healthy old age by simply taking advantage of recommended preventive health services and by making healthy lifestyle changes. About 70% of the physical decline that occurs with aging is related to failure to use preventive and screening services.
Reference: Page 685

Rationale 2: Decreasing nutritional intake can lead to poor nutrition which increases fatigue, weakness, and loss of muscle mass.
Reference: Page 685

Rationale 3: Exercise should not be limited because it is needed to increase capacity and ability to use oxygen to derive energy for work; decrease myocardial oxygen demands; alter lipid and carbohydrate metabolism; prevent cardiovascular disease; maintain or increase muscle tone and strength; and increase physical fitness.
Reference: Page 685

Rationale 4: Americans can improve their chances for a healthy old age by simply taking advantage of recommended preventive health services and by making healthy lifestyle changes. About 70% of the physical decline that occurs with aging is related to modifiable factors such as smoking, poor nutrition, physical inactivity, and failure to use preventive and screening services.
Reference: Page 685

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe the causes of and unique presentation of frailty in the older person.

Question 9

Type: MCSA

An older patient with diabetes is prescribed high dose antibiotic therapy for a wound infection. For which effects of antibiotic therapy should the nurse assess the patient?

1. Diarrhea

2. Constipation

3. Nausea and vomiting

4. Increased urine output

Correct Answer: 1

Rationale 1: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism. These higher doses place the person at risk for medication side effects and drug interactions, including development of antibiotic-associated diarrhea.
Reference: Page 687

Rationale 2: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism. These higher doses place the person at risk for medication side effects and drug interactions, including development of antibiotic-associated diarrhea. Constipation is not a typical effect of antibiotic therapy.
Reference: Page 687

Rationale 3: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism. These higher doses place the person at risk for medication side effects and drug interactions, including development of antibiotic-associated diarrhea. Nausea and vomiting may or may not be associated with antibiotic therapy.
Reference: Page 687

Rationale 4: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism. These higher doses place the person at risk for medication side effects and drug interactions, including development of antibiotic-associated diarrhea. Increased urine output is not a typical effect of antibiotic therapy.
Reference: Page 687

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. State the impact of age-related changes and comorbidities on organ function.

Question 10

Type: MCSA

The nurse is concerned that an older patient with a chronic illness is on a trajectory towards frailty and dependence. What did the nurse assess in this patient?

1. Ability to halt progression of chronic disease manifestations

2. Osteoarthritis causing more difficulty than cognitive impairment

3. Family that phones several times a day and visits every weekend

4. Limited health insurance coverage that does not include a pharmacy plan

Correct Answer: 4

Rationale 1: The patient will not be able to halt the progression of chronic disease manifestations without careful treatment and monitoring.
Reference: Page 683

Rationale 2: Some conditions are more disabling than others. A cognitive impairment will have a greater impact on an older persons functioning than osteoarthritis.
Reference: Page 683

Rationale 3: Social support from family will prevent the patient from moving on the trajectory towards frailty and dependence.
Reference: Page 683

Rationale 4: Limited health insurance coverage that does not include a pharmacy plan will place the patient on a trajectory towards frailty and dependence. Older patients with chronic illnesses need these resources to have better outcomes.
Reference: Page 683

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. State the impact of age-related changes and comorbidities on organ function.

Question 11

Type: MCMA

A multidisciplinary team in a long-term care facility is meeting with the family of a frail older patient to discuss care issues and concerns. Which are key issues that should be addressed in the conference?

Standard Text: Select all that apply.

1. Consistency with policy

2. The patients preferences

3. Avoidance of doing harm to the patient

4. Focus on cost-effective methods

5. The needs and wishes of the family

Correct Answer: 1,2,3,5

Rationale 1: The provision of care for the seriously ill long-term care resident should be consistent with accepted public policy.
Reference: Page 688

Rationale 2: The provision of care for the seriously ill long-term care resident should honor the residents preferences.
Reference: Page 688

Rationale 3: The provision of care for the seriously ill long-term care resident should not inflict undue burden or harm to the resident without a reasonable chance of success.
Reference: Page 688

Rationale 4: The provision of care for the seriously ill long-term care resident should honor the residents preferences, reflect the needs and wishes of families, be consistent with accepted public policy, and not inflict undue burden or harm to the resident without a reasonable chance of success. The focus is not on cost-effective methods when providing care.
Reference: Page 688

Rationale 5: The provision of care for the seriously ill long-term care resident should reflect the needs and wishes of families.
Reference: Page 688

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 12

Type: MCSA

An older patient is demonstrating delirium since being admitted from a nursing home for treatment of a wound infection. What should the nurse identify as a cause for the patients delirium?

1. High television volume

2. Intravenous fluid therapy

3. Windowless hospital room

4. Assessments every 4 hours

Correct Answer: 3

Rationale 1: Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium. High television volume is not associated with delirium.
Reference: Page 690

Rationale 2: Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium. Intravenous fluid therapy is not associated with delirium.
Reference: Page 690

Rationale 3: Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium.
Reference: Page 690

Rationale 4: Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium. Assessments every 4 hours are not associated with delirium.
Reference: Page 690

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 13

Type: MCSA

An older patient admitted for treatment of pneumonia has severe osteoarthritis. Which assessment finding indicates to the nurse that the patient may be on a trajectory towards frailty?

1. Poor appetite

2. Frequent requests for pain medication

3. Decreased stamina and deconditioning

4. Compliance with prescribed breathing treatments

Correct Answer: 3

Rationale 1: Signs of frailty in an older person with musculoskeletal problems do not include a poor appetite.
Reference: Page 687

Rationale 2: Signs of frailty in an older person with musculoskeletal problems do not include frequent requests for pain medication.
Reference: Page 687

Rationale 3: Signs of frailty in an older person with musculoskeletal problems may include decreased stamina and physical deconditioning.
Reference: Page 687

Rationale 4: Signs of frailty in an older person with musculoskeletal problems do not include compliance with prescribed breathing treatments.
Reference: Page 687

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 14

Type: MCMA

The nurse is planning a presentation for nursing assistants on caring for older patients. Which criteria should the nurse include when explaining frailty?

Standard Text: Select all that apply.

1. Slowness

2. Low activity

3. Short-term memory loss

4. Weakness and exhaustion

5. Unplanned weight loss of at least 10 lbs. in a year

Correct Answer: 1,2,4,5

Rationale 1: Frailty has been defined as the presence of three or more specific criteria which include slowness.
Reference: Page 677

Rationale 2: Frailty has been defined as the presence of three or more specific criteria which include low activity.
Reference: Page 677

Rationale 3: Frailty has been defined as the presence of three or more specific criteria. These criteria do not include short-term memory loss.
Reference: Page 677

Rationale 4: Frailty has been defined as the presence of three or more specific criteria which include weakness and exhaustion.
Reference: Page 677

Rationale 5: Frailty has been defined as the presence of three or more specific criteria which include an unplanned weight loss of at least 10 lbs. in one year.
Reference: Page 677

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1. Describe age-related changes that affect overall health and function and that contribute to frailty.

Question 15

Type: MCMA

An older patient with chronic renal failure is admitted for treatment of pneumonia. The healthcare provider is planning modified interventions for this patient. What should the nurse expect that this patient will receive while hospitalized?

Standard Text: Select all that apply.

1. Symptom control

2. Pain management

3. Noninvasive testing

4. Medication adjustments

5. Minimally invasive surgery

Correct Answer: 3,4,5

Rationale 1: Symptom control is a feature of palliative and hospice care.
Reference: Page 691

Rationale 2: Pain management is a feature of palliative and hospice care.
Reference: Page 691

Rationale 3: Noninvasive testing is a feature of modified care.
Reference: Page 691

Rationale 4: Medication adjustments are a feature of modified care.
Reference: Page 691

Rationale 5: Minimally invasive surgery is a feature of modified care.
Reference: Page 691

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 16

Type: MCSA

The nurse is caring for an older patient recently diagnosed with cancer. What laboratory data should the nurse identify to support the diagnosis of frailty in this patient?

1. Hemoglobin 12 g/dL

2. Hemoglobin 23 g/dL

3. Serum albumin less than 2.5 g/100 dL

4. Serum albumin greater than 2.5 g/100 dL

Correct Answer: 3

Rationale 1: Hemoglobin level is not used to diagnose frailty in an older patient.
Reference: Page 685

Rationale 2: Hemoglobin level is not used to diagnose frailty in an older patient.
Reference: Page 685

Rationale 3: Signs and symptoms of frailty in a person with cancer include serum albumin level less than 2.5 g/100 dL.
Reference: Page 685

Rationale 4: Signs and symptoms of frailty in a person with cancer include serum albumin level less than 2.5 g/100 dL. A serum albumin level greater than 2.5 g/100 dL does not support the diagnosis of frailty.
Reference: Page 685

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Describe the causes of and unique presentation of frailty in the older person.

Question 17

Type: MCSA

The nurse is preparing a community education program focusing on cardiovascular disease in the older patient. Which information should the nurse include?

1. Breast cancer kills more women than heart disease.

2. A woman of 70 is as likely as a man to develop heart disease.

3. Women are more likely than men to develop heart disease in their middle years.

4. For most women, heart disease is a greater problem before they reach menopause.

Correct Answer: 2

Rationale 1: One in four women will die from heart disease while 1 in 30 will die from breast cancer.
Reference: Page 686

Rationale 2: By the time they are in their 70s, men and women get heart disease at equal rates.
Reference: Page 686

Rationale 3: A woman 60 years old is about as likely to get heart disease as a man of 50.
Reference: Page 686

Rationale 4: For most women, it is only after menopause that heart disease becomes a problem.
Reference: Page 686

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2. State the impact of age-related changes and comorbidities on organ function.

Question 18

Type: MCMA

An older patient is diagnosed with cardiovascular disease. Which factors that can contribute to frailty should the nurse include when planning care for this patient?

Standard Text: Select all that apply.

1. Risk for dehydration

2. Electrolyte imbalance

3. Digestive abnormalities

4. Fatigue and activity intolerance

5. Multiple prescribed medications

Correct Answer: 1,2,4,5

Rationale 1: Cardiovascular factors that can contribute to frailty include the risk for dehydration.
Reference: Page 682

Rationale 2: Cardiovascular factors that can contribute to frailty include electrolyte imbalances.
Reference: Page 682

Rationale 3: Cardiovascular factors that can contribute to frailty do not include digestive abnormalities. Digestive abnormalities are more associated with liver and bowel disorders.
Reference: Page 682

Rationale 4: Cardiovascular factors that can contribute to frailty include fatigue and activity intolerance.
Reference: Page 682

Rationale 5: Cardiovascular factors that can contribute to frailty include multiple prescribed medications.
Reference: Page 682

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 19

Type: MCSA

A frail older patient with diabetes is diagnosed with a urinary tract infection. How should the nurse expect the physician to prescribe antibiotics for this patient?

1. Lower dose for a longer period of time

2. Lower dose for a shorter period of time

3. Higher dose for a shorter period of time

4. Higher dose and for a longer period of time

Correct Answer: 4

Rationale 1: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism.

Rationale 2: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism.

Rationale 3: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism.

Rationale 4: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 20

Type: MCSA

The nurse is admitting an older frail patient with dementia as a resident in a long-term care facility. Which problem is a priority when planning interventions for this patients care?

1. Agitation

2. Dependency

3. Quality of life

4. Polypharmacy

Correct Answer: 4

Rationale 1: Polypharmacy and overmedication are serious problems inherent in the care of the older person with dementia. Control of agitation helps with the quality of life and is often treated with medication.
Reference: Page 688

Rationale 2: Polypharmacy and overmedication are serious problems inherent in the care of the older person with dementia. Dependency will most likely occur in the patient with dementia in a long-term care facility. This is not necessarily a problem.
Reference: Page 688

Rationale 3: Polypharmacy and overmedication are serious problems inherent in the care of the older person with dementia. Quality of life includes the variables of adjustment to the new environment, emotional-behavioral responses, and control of anxiety. Each of these variables may be treated with medication which could contribute to polypharmacy.
Reference: Page 688

Rationale 4: Polypharmacy and overmedication are serious problems inherent in the care of the older person with dementia.
Reference: Page 688

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 21

Type: MCMA

The nurse is planning an education program for other nurses on palliative care. Which information should the nurse include in the program?

Standard Text: Select all that apply.

1. Palliative care focuses on patients who are close to death.

2. Palliative care can provide respite care for family members.

3. Palliative care focuses on managing pain and troublesome symptoms.

4. Palliative care focuses on providing surgeries and treatments to cure the illness.

5. Palliative care can be delivered long-term and throughout all phases of treatment.

Correct Answer: 2,3,5

Rationale 1: Hospice care focuses on patients who are close to death.
Reference: Pages 688-689

Rationale 2: Palliative care can provide respite care for families.
Reference: Pages 688-689

Rationale 3: Palliative care focuses on alleviation of pain and management of troublesome symptoms.
Reference: Pages 688-689

Rationale 4: Acute care focuses on surgeries and treatments to cure an illness.
Reference: Pages 688-689

Rationale 5: Palliative care can be provided to seriously ill older persons at any time during the disease process.
Reference: Pages 688-689

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 22

Type: MCSA

The daughter of an older frail patient recovering from receiving the wrong medication asks what the hospital can do to prevent this from happening again. How should the nurse respond to the daughter?

1. There isnt much that can be done.

2. Medication errors cant be avoided because we are short-staffed.

3. It really depends on the physicians handwriting to understand what is ordered.

4. We are planning to install a bar-code system to identify patients and medications.

Correct Answer: 4

Rationale 1: There is much that can be done to prevent medication errors. The use of computerized entry systems, monitoring of prescriptions by a clinical pharmacist, and identification of the correct patient and drug using bar-code technology are methods that have been shown to decrease the frequency of medication errors.
Reference: Page 689

Rationale 2: Staffing issues should not be discussed with a patients family.
Reference: Page 689

Rationale 3: The physicians handwriting issue should not be discussed with a patients family.
Reference: Page 689

Rationale 4: There is much that can be done to prevent medication errors. The use of computerized entry systems, monitoring of prescriptions by a clinical pharmacist, and identification of the correct patient and drug using bar-code technology are methods that have been shown to decrease the frequency of medication errors.
Reference: Page 689

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 23

Type: MCMA

During a home visit the nurse notes that an older patient is demonstrating signs of frailty. What assistance will the nurse identify as helpful to the patient in the home?

Standard Text: Select all that apply.

1. Socialization

2. Meal preparation

3. Resources for daily care

4. Home maintenance and safety

5. Transportation to healthcare appointments

Correct Answer: 2,3,4,5

Rationale 1: Socialization is not considered a major area of focus for the older frail patient.
Reference: Page 685

Rationale 2: The focus of healthcare for the frail older person includes the provision of nutritious meals.
Reference: Page 685

Rationale 3: The focus of healthcare for the frail older patient includes mobilizing resources for daily care.
Reference: Page 685

Rationale 4: The focus of healthcare for the frail older person includes home maintenance and safety.
Reference: Page 685

Rationale 5: The focus of healthcare for the frail older person includes transportation to healthcare appointments.
Reference: Page 685

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify risk factors of health for the older person at risk for acute care hospitalization.

Question 24

Type: MCSA

A hospital is planning to implement a unit that focuses on acute care of the elderly (ACE). How should the hospital administrator explain this unit to the nursing staff?

1. An ACE unit will be run just like a nursing home, except its located in the hospital.

2. An ACE unit isnt any different than any other unit in the hospital except for the age of the patients.

3. The key concept of an ACE unit is to return the patients to their nursing homes as quickly as possible.

4. Patient-centered interdisciplinary care guided by nurse-driven protocols to address key nursing issues such as mobility, skin care, nutrition, and continence.

Correct Answer: 4

Rationale 1: An ACE unit is not run like a nursing home.
Reference: Page 692

Rationale 2: An ACE unit is based on four key concepts which are not necessarily a part of every other unit in the hospital.
Reference: Page 692

Rationale 3: Returning the patient back to home or other living arrangements is just one of the key concepts for an ACE unit.
Reference: Page 692

Rationale 4: One key concept of an ACE unit is to provide patient-centered interdisciplinary care guided by nurse-driven protocols to address key nursing issues such as mobility, skin care, nutrition, and continence.
Reference: Page 692

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

Question 25

Type: MCMA

The nurse is preparing a seminar on planning for a hospitalization for residents of an assisted living facility. What information should the nurse include in the seminar?

Standard Text: Select all that apply.

1. Bring a copy of advanced directives for healthcare.

2. Bring a list of current medications and current labs.

3. Bring valuable jewelry and money to avoid leaving it unattended.

4. Bring good walking slippers, a bathrobe, and items such as books.

5. Bring several changes of clothing to avoid wearing a hospital gown.

Correct Answer: 1,2,4

Rationale 1: Patients should be encouraged to bring a copy of advance directives for healthcare when being admitted to a hospital.
Reference: Pages 697-698

Rationale 2: Patients should be encouraged to bring a list of current medications and current labs when being admitted to a hospital.
Reference: Pages 697-698

Rationale 3: Patients should be discouraged from bringing valuables such as jewelry and money when being admitted to a hospital.
Reference: Pages 697-698

Rationale 4: Patients should be encouraged to bring comfort items such as slippers, a bathrobe, and reading material when being admitted to a hospital.
Reference: Pages 697-698

Rationale 5: Patients should be discouraged from bringing personal clothing since a hospital gown will work while a patient is in a hospital.
Reference: Pages 697-698

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.

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