Chapter 40: Common Physical Care Problems of the Elderly My Nursing Test Banks

Chapter 40: Common Physical Care Problems of the Elderly

Test Bank

MULTIPLE CHOICE

1. The nurse takes into consideration that of all the physical changes that the elderly experience, the most common cause of most problems is that of:

a.

visual disturbance.

b.

hearing deficit.

c.

loss of muscle mass.

d.

impaired mobility.

ANS: D

Constipation, urinary incontinence, and alteration in nutrition and depression are all problems that are complicated or caused by impaired mobility.

DIF: Cognitive Level: Knowledge REF: p. 815, Table 40-2

OBJ: Theory #1 TOP: Common Physical Care Problems with the Elderly

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

2. While discussing ways to increase exercise with an elderly patient with no musculoskeletal disorders, the nurse should encourage the patient to consider walking at a frequency of:

a.

10 to 20 minutes once or twice a week.

b.

10 to 20 minutes four times a week.

c.

20 to 30 minutes once or twice a week.

d.

20 to 30 minutes three times a week.

ANS: D

It has been proven that walking for 20 to 30 minutes three times per week is very beneficial.

DIF: Cognitive Level: Comprehension REF: p. 816 OBJ: Theory #3

TOP: Mobility KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

3. The home health nurse assesses all of the following relative to a resident in her own home: glasses with a missing eye piece, soft-soled floppy house shoes, walker with wheels, a floor devoid of rugs. The item that is most likely to cause a fall would be the:

a.

broken glasses.

b.

floppy house shoes.

c.

rolling walker.

d.

no rug on floor.

ANS: B

Safe ambulation requires that the patient have an assistive walker and sturdy shoes. A clear floor is a positive step in the direction of fall prevention. The glasses, although they may distort the residents perception, are not as dangerous as the non-supportive shoes.

DIF: Cognitive Level: Analysis REF: p. 819, Health Promotion

OBJ: Theory #4 TOP: Fall Prevention

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: reduction of risk potential

4. An elderly patient is too weak to walk independently after surgery. Based on the services available on the rehabilitation unit, the nurse should work collaboratively with a(n):

a.

exercise physiologist.

b.

nutritionist.

c.

physical therapist.

d.

occupational therapist.

ANS: C

Physical therapists can assist patients with mobility and teach them to use assistive devices as needed, such as walkers and canes.

DIF: Cognitive Level: Application REF: p. 818 OBJ: Theory #3

TOP: Mobility KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

5. The nurse adds to the nursing care plan for a resident with presbycusis. To better communicate with the patient, the staff should use:

a.

written notes.

b.

a slower speed of speech.

c.

a lower, deeper voice.

d.

hand signals.

ANS: C

Speaking in a lower, deeper voice will allow the person with presbycusis to hear better since these persons have difficulty picking up higher-pitched sounds and spoken words.

DIF: Cognitive Level: Application REF: p. 822 OBJ: Theory #2

TOP: Presbycusis KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: physiological adaptation

6. The nursing strategy that may be most helpful in preventing falls in elderly patients on a skilled nursing unit would be to:

a.

answer call bells promptly.

b.

use vest restraints as needed.

c.

keep lights dim for eye protection.

d.

always keep bed rails up.

ANS: A

Nurses should answer call bells promptly to avoid patients unsafe attempts to get out of bed.

DIF: Cognitive Level: Analysis REF: p. 818 OBJ: Theory #3

TOP: Fall Prevention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

7. The home health nurse assesses a hazard for a patient in the home setting. Which of the following assessments is considered a safety hazard?

a.

Throw rugs present in all rooms

b.

Stairways with handrails

c.

Grab bars in the bathroom

d.

Non-skid tape in the bathtub

ANS: A

An elderly patient should avoid the use of throw rugs and should use non-skid mats underneath other rugs.

DIF: Cognitive Level: Analysis REF: p. 818 OBJ: Theory #3

TOP: Fall Prevention at Home KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

8. A nurse is assisting an elderly neighbor to rearrange her kitchen to reduce fall risk. The nurse should encourage her to avoid unnecessary reaching by placing all objects that are needed below the level of the:

a.

knees.

b.

waist.

c.

head.

d.

chest.

ANS: C

Elderly patients should be instructed not to reach for objects that are above head level, causing them to tip their heads backward. Step stools with a wide base of support may also be helpful if objects cannot be stored in this manner.

DIF: Cognitive Level: Comprehension REF: p. 819, Health Promotion

OBJ: Theory #3 TOP: Fall Prevention

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

9. An elderly patient in a skilled nursing facility tells the nurse that he has controlled his incontinence with the herbal remedies of:

a.

black cohosh.

b.

pumpkin seeds.

c.

feverfew.

d.

St. Johns wort.

ANS: B

Pumpkin seeds have been found beneficial in controlling incontinence in men by the reduction of prostate swelling.

DIF: Cognitive Level: Comprehension REF: p. 819 OBJ: Clinical Practice #2

TOP: Urinary Incontinence KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity

10. The nurse uses the behavioral technique of habit voiding with a confused elderly patient to reduce the frequency of urinary incontinence. This means the:

a.

patient is assisted to the bathroom to use the toilet at regular intervals.

b.

patient is being taught to request assistance from nursing staff.

c.

staff are trying to lengthen the time between voiding for the patient.

d.

fluid intake of the patient is being reduced so that voidings are less frequent.

ANS: A

Habit voiding, also called timed voiding, involves taking a confused or cognitively impaired patient to the toilet at regular intervals.

DIF: Cognitive Level: Comprehension REF: p. 819, Box 40-1

OBJ: Clinical Practice #2 TOP: Urinary Incontinence

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: physiological adaptation

11. The nurse reminds the staff that the most effective method in preventing skin breakdown from urinary incontinence is:

a.

reducing fluid intake.

b.

turning frequently.

c.

ambulating frequently.

d.

using protective pads.

ANS: D

Use of protective pads is an effective method of preventing skin breakdown. Discouraging fluid intake will cause dehydration and more concentrated urine, turning frequently will not take care of the problem,

DIF: Cognitive Level: Comprehension REF: p. 819 OBJ: Theory #2

TOP: Methods to Prevent Skin Impairment

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

12. An elderly patient on bed rest has been eating poorly. The patient is exhibiting abdominal distention and cramping and is passing small amounts of liquid stool. The nurse assesses these signs as an indication of:

a.

constipation.

b.

fecal impaction.

c.

diarrhea.

d.

GI tract infection.

ANS: B

Abdominal distention, cramping, and passage of small amounts of liquid stool are signs and symptoms of fecal impaction. The risk factors that contribute to this are bed rest, not eating a normal diet, and the use of pain medication.

DIF: Cognitive Level: Analysis REF: p. 820 OBJ: Theory #5

TOP: Fecal Impaction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

13. When performing a digital rectal examination to determine the presence of fecal impaction, the nurse must be alert for:

a.

increasing blood pressure.

b.

increasing respiratory rate.

c.

reflex incontinence.

d.

decreasing heart rate.

ANS: D

The stimulation of the rectum by digital examination may stimulate the vagus nerve, which then slows the heart rate. This is potentially hazardous, so it is done cautiously and only when allowed by agency policy.

DIF: Cognitive Level: Application REF: p. 820, Safety Alert

OBJ: Theory #2 TOP: Fecal Impaction

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk potential

14. The nurse, in reviewing with an elderly patient the nutritional changes that would be most beneficial, would suggest:

a.

reducing sugar intake.

b.

increasing fat intake.

c.

increasing intake of oils.

d.

decreasing intake of roughage.

ANS: A

Dietary recommendations for the older adult include decreasing sugar and fat intake. Roughage should be increased to maintain proper bowel elimination.

DIF: Cognitive Level: Comprehension REF: p. 821 OBJ: Theory #6

TOP: Nutrition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: physiological adaptation

15. The nurse stresses taking vitamins and minerals to elderly postmenopausal patients. To reduce the risk of osteoporosis, women should increase their intake of:

a.

iron.

b.

magnesium.

c.

calcium.

d.

selenium.

ANS: C

Osteoporosis is the loss of calcium from bone. Calcium intake for postmenopausal and perimenopausal women should be increased to 1000 to 15,000 mg/day, up from 800 mg/day for the general population.

DIF: Cognitive Level: Comprehension REF: p. 820, Table 40-3

OBJ: Theory #5 TOP: Nutrition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

16. The nurse recognizes that of all the interventions to assist a dysphagic patient to eat safely, the most significant to preventing aspiration is to:

a.

sit the patient upright and remind the patient to tuck in the chin when swallowing.

b.

feed small bites of -inch square.

c.

thicken liquids.

d.

offer frequent sips of fluid.

ANS: A

Upright positioning and reminders to tuck in the chin when swallowing are the most effective prevention for aspiration.

DIF: Cognitive Level: Comprehension REF: p. 821 OBJ: Theory #6

TOP: Nutritional Support KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

17. The nurse is aware that the newly admitted resident has age-related macular degeneration (AMD). The nurse will modify the care plan to accommodate the patients:

a.

loss of central vision.

b.

lack of ability to focus on near objects.

c.

inability to adjust from light to dark environments.

d.

increasing pressure in the eye with progressive blindness.

ANS: A

AMD causes loss of central vision as well as color perception.

DIF: Cognitive Level: Comprehension REF: p. 821 OBJ: Theory #1

TOP: Vision and the Elderly KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

18. For a patient with visual impairment who wishes to continue to eat independently, the nurses most helpful intervention would be to:

a.

describe positions of foods on the plate by clock position.

b.

tell the patient to eat all foods that are firmest first.

c.

raise the over-the-bed table so that all food is within 3 inches of the eyes.

d.

have the patient use a spoon instead of a fork.

ANS: A

It is helpful to describe the position of the foods on the plate. The texture of the food has nothing to do with visual impairment. It is not helpful or realistic to raise the over-the-bed table so that the plate is 3 inches away from the eyes. Using a spoon will not help the patient identify foods on the plate.

DIF: Cognitive Level: Analysis REF: p. 822 OBJ: Theory #7

TOP: Vision KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

19. A nurse who is assisting a blind patient to ambulate should:

a.

hold the patients arm firmly to gently push him in the proper direction.

b.

hold the patient by a strap around the patients waist to prevent his falling.

c.

offer the patient an arm for guidance.

d.

acquire a cane for the patient.

ANS: C

Offering the patient an arm or walking in front of the patient with the patients hand on the nurses shoulder gently guides the visually impaired.

DIF: Cognitive Level: Application REF: p. 822 OBJ: Theory #6

TOP: Hearing and the Elderly KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: reduction of risk potential

20. An elderly patient with arthritis is having difficulty using a weekly pillbox as a reminder to take daily medications. The nurse would suggest as the best alternative:

a.

a paper and pencil check-off system.

b.

a colorful calendar.

c.

a homemade egg carton container.

d.

symbol- and color-coded medication bottles.

ANS: C

The egg container will ease the difficulty with the arthritic patient best.

DIF: Cognitive Level: Application REF: p. 824 OBJ: Clinical Practice #4

TOP: Medication System for Elderly KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

21. A nurse is caring for an 86-year-old patient who still takes pride in the fact that he drives. The nurse suggests that his driving be limited to:

a.

back roads.

b.

large shopping centers.

c.

going to church and the grocery store.

d.

daytime driving.

ANS: D

Daytime driving is the safest in areas that are familiar. Back roads may be hard to navigate and help may not always be available.

DIF: Cognitive Level: Application REF: p. 822 OBJ: Theory #1

TOP: Vision KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

22. An elderly Hispanic patient is brought to a clinic. She brings a bag full of medications with her. When the nurse is talking to the patient, a significant question to ask to get a full picture of the patient would be:

a.

Do you live with your family?

b.

Tell me about your diet.

c.

How many doctors prescribe drugs for you?

d.

Are you drinking herbal supplements?

ANS: D

In Hispanic cultures, the use of herbal remedies is very common. This question is appropriate to ask to have a full picture of this patients medical history.

DIF: Cognitive Level: Analysis REF: p. 824 OBJ: Theory #9

TOP: Polypharmacy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

COMPLETION

23. The nurse takes into consideration that the resident in a nursing home has a hearing deficit related to a continuous ringing in his ears, which is a condition called ______________.

ANS:

tinnitus

Tinnitus is a continuous ringing or buzzing in the ear, which causes further hearing loss.

DIF: Cognitive Level: Knowledge REF: p. 822 OBJ: Theory #2

TOP: Tinnitus KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

24. The nurse documents the report of painful intercourse as __________.

ANS:

dyspareunia

Dyspareunia is the occasion of painful intercourse.

DIF: Cognitive Level: Knowledge REF: p. 823 OBJ: Theory #8

TOP: Dyspareunia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

MULTIPLE RESPONSE

25. The nurse lists the most common causes of polypharmacy as: (Select all that apply.)

a.

use of mail order sources.

b.

being prescribed to by several physicians.

c.

sharing drugs with others.

d.

many drugs being prescribed under different names.

e.

availability of OTC medications.

ANS: A, B, D, E

Treatment by several physicians, many drugs prescribed under different names, ordering drugs from mail order sources, and the extensive availability of OTC medications increase the risk for polypharmacy.

DIF: Cognitive Level: Comprehension REF: p. 817, Table 40-2

OBJ: Theory #9 TOP: Polypharmacy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

26. The elderly, especially women, are at high risk for decreased mobility. Which nutrient(s) are critical for women to take to decrease this risk? (Select all that apply.)

a.

Protein

b.

Fat

c.

Carbohydrates

d.

Calcium

e.

Vitamin D

ANS: D, E

Proper treatment for arthritis and osteoporosis will help prevent immobility problems. Estrogen replacement therapy (ERT) and adequate dietary or supplemental calcium and vitamin D in combination with weight-bearing exercise are protective against osteoporosis in women.

DIF: Cognitive Level: Comprehension REF: p. 820, Table 40-3

OBJ: Theory #5 TOP: Mobility and Nutrients KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

27. A nurse reviewing the medication list for an elderly patient notices several drugs that would increase the risk of falls because of orthostatic hypotension, which are: (Select all that apply.)

a.

anticoagulants.

b.

diuretics.

c.

stool softeners.

d.

antihypertensives.

e.

antihistamines.

ANS: B, D, E

Diuretics, hypertensives, and antihistamines contribute to orthostatic hypotension, a common cause of falls.

DIF: Cognitive Level: Comprehension REF: p. 818 OBJ: Theory #2

TOP: Multi-pharmacy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

Leave a Reply