Exam 1

Question 1

young old

Answer 1

age 65-74

Question 2

middle old

Answer 2

age 75-84

Question 3

old old

Answer 3

age 85-99

Question 4

elite old

Answer 4

age 100+

Question 5

most common cause of death among US adults (top 3)

Answer 5

heart disease, cancer, stroke

Question 6

presbycusis

Answer 6

age-related hearing loss; high frequency hearing loss

Question 7

presbyopia

Answer 7

farsightedness caused by loss of elasticity of lens; occurs in old age

Question 8

sclerosis of inner ear

Answer 8

stapes of the ear hardens, impairs sound travel in ear

Question 9

most frequently diagnosed conditions in adults (top 4)

Answer 9

arthritis, hypertension, heart disease, cancer

Question 10

delirium vs. dementia

Answer 10

delirium - acute, fast onset, reversible/temporary

dementia - chronic, slow onset

Question 11

Fulmer’s SPICES purpose

Answer 11

overall assessment tool for older adults

Question 12

Fulmer’s SPICES components

Answer 12

• Sleep disorders
• Problems with eating/feeding
• Incontinence
• Confusion
• Evidence of falls
• Skin breakdown

Question 13

Katz Index of Independence in ADLs (6)

Answer 13

assesses: bathing, dressing, toileting, transferring, continence, feeding

Question 14

frailty causes (3)

Answer 14

chronic illness, harmful social/psychological environment, physiological changes of aging

Question 15

Hendrich Fall Risk Model components (7)

Answer 15

• Confusion, disorientation, impulsivity
• Symptomatic depression
• Altered elimination
• Dizziness/vertigo
• Male gender
• Anti-epileptics
• Benzodiazepines

Question 16

common causes of delirium (8)

Answer 16

• Drugs
• Elimination
• Liver and other organ disorders
• Infection
• Respiratory disorders
• Injury
• Unfamiliar environment
• Metabolic disorders

Question 17

Confusion Assessment Method (CAM)

Answer 17

1. Acute onset and fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered level of consciousness

Question 18

safe and quality care characteristics (STEEEP)

Answer 18

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

Question 19

QSEN Six Competencies

Answer 19

• Patient-centered care
• Evidence-based practice
• Quality improvement
• Informatics
• Safety
• Teamwork and collaboration

Question 20

stage I pressure ulcer

Answer 20

intact skin with non-blanchable redness

Question 21

stage II pressure ulcer

Answer 21

partial thickness loss of dermis; open ulcer with red pink wound bed

Question 22

stage III pressure ulcer

Answer 22

full thickness tissue loss; subcutaneous fat may be visible

slough, undermining, tunneling may be present

Question 23

stage IV pressure ulcer

Answer 23

full thickness tissue loss with exposed bone, tendon, or muscle
slough, eschar, undermining, tunneling may be present

Question 24

unstageable pressure ulcer

Answer 24

full thickness tissue loss, with base covered by slough and/or eschar

Question 25

suspected deep tissue injury (sDTI)

Answer 25

intact skin with purple or maroon discoloration

Question 26

four phases of wound healing

Answer 26

1. Hemostasis
2. Inflammatory phase
3. Proliferative phase
4. Maturation phase

Question 27

serous exudate

Answer 27

clear, watery plasma

Question 28

purulent exudate

Answer 28

thick; yellow, green, tan, or brown

Question 29

serosanguineous exudate

Answer 29

pink, watery; mixture of watery fluid and RBCs

Question 30

sanguineous exudate

Answer 30

bright red

Question 31

Braden Scale purpose

Answer 31

assesses level of risk for development of pressure ulcers

Question 32

Braden Scale components (6)

Answer 32

• Sensory perception
• Moisture
• Activity
• Mobility
• Nutrition
• Friction and sheer

Question 33

six medication rights

Answer 33

• right drug
• right dose
• right route
• right time
• right patient
• right documentation