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Gerontology > Final Exam > Flashcards

Final Exam Flashcards

1
Q

An older patient is diagnosed with an infection but has a subnormal body temperature. What should the nurse explain to the patients family as the reason for this discrepancy?

  1. The temperature regulating mechanism changes with aging.
  2. The patient is on medication that drops the body temperature.
  3. The diagnosis of an infection is inaccurate and will be checked.
  4. The temperature was measured incorrectly and will be repeated.
A

1

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2
Q

An older patient has a subnormal body temperature and an infection. How does the nurse best describe this phenomenon?

  1. The temperature regulating mechanism deteriorates with aging.
  2. The patient’s infection is improving with medication treatment.
  3. The diagnosis of an infection is inaccurate and will be checked.
  4. The temperature was obtained incorrectly and is inaccurate.
A

1

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3
Q

An older patient is recovering from abdominal surgery. Which skin changes will the nurse consider when planning care for this patient?
1. The healing time is increased.
(longer healing)
2. The healing time is decreased.
(Increase)
3. There is a need to keep the wound edges taped.
(Tape cause demanded)
4. Skin near the wound needs to be massaged to increase blood flow.

A

1

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4
Q

The home care nurse notes that an older patient who lives alone has a large red mark on the arm. When asked about the mark the patient states unawareness of the injury and believes it occurred from hot water when cooking. How should the nurse interpret this finding?

  1. The patient is at risk for further injury.
  2. The patient is losing short-term memory.
  3. The patient is experiencing friction tears of the skin.
  4. The patient is demonstrating senile purpura of the skin.
A

1

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5
Q

The home-care nurse determines that their patient is at risk for further injury due to normal aging sensation loss when they state the following:

  1. “I have this large red mark on my arm and I think it occurred yesterday from cooking.”
  2. “I can’t remember what I ate for lunch yesterday.”
  3. “I got a small cut on my arm from a zipper when I was getting dressed yesterday.”
  4. “I have some discolorations on my arm, but they have been there for months.”
A

1

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6
Q

An patient is recovering from surgery to repair a fractured hip. What interventions will the nurse use to prevent the development of a pressure ulcer in this patient?
Standard Text: Select all that apply.
1. Avoid sitting unless for meals.
2. Use pillows to protect the skin.
3. Reposition the patient every 2 hours.
4. Keep the skin dry with frequent bathing.
5. Encourage independent position changes.

A

1,2,3,5

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7
Q

What instruction should the nurse provide to a nursing assistant who is assigned to care for an older patient with a stage I pressure ulcer on the right heel?
1. Apply a dry dressing to the site.
2. Apply a donut under the right heal.
(Should not be use)
3. Cleanse the area with tepid water without soap.
4. Keep the head of the bed elevated to a 45-degree angle.

A

3

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8
Q

The nurse is assessing an older patient’s stage III pressure ulcer. What would be indicative of proper wound healing?

  1. An increase in wound depth
  2. Large amount of undermining
  3. Presence of leathery black tissue
  4. Beefy red and moist, grainy appearance
A

4

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9
Q

While assessing an older patients stage III pressure ulcer the nurse notes that the wound is beefy red and grainy, and the depth has decreased by 2 mm but the width has not changed. How should the nurse interpret this assessment finding?

  1. Not healing properly
  2. About to slough off tissue
  3. No longer at risk for infection
  4. Progressing positively toward healing
A

4

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10
Q

The nurse is caring for an older patient who has a healed, sacral pressure ulcer. What would the nurse include in teaching about this new tissue growth?
1. “Your sacral area will heal faster if reinjured.”
(Not)
2. “Your skin will break down faster if your sacrum is reinjured.”
3. “You may have a loss of feeling in the old, pressure ulcer area.”
4. “You are more at risk for infection in the sacral area.”

A

2

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11
Q

The nurse is caring for an older patient who previously had a sacral pressure ulcer that has completely healed. What does the nurse recognize as a characteristic of the previously healed pressure ulcer?
1. Heal faster if reinjured
(Not)
2. Break down faster if reinjured
3. Have no sensation in the injured area
4. Be at risk for infection even with intact skin

A

2

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12
Q

After an assessment the nurse is concerned that an older patient is at risk for pressure ulcer development because of the current nutritional status. What nutritional factors did the nurse assess in the patient?
Standard Text: Select all that apply.
1. Diagnosis of dehydration (need to be hydrated)
2. Hemoglobin level 9 mg/dL (anemia)
3. Treatment for chronic renal failure
4. Serum albumin level below normal (protein)
5. Loss of 20 pounds over the last 3 months (prone to pressure ulcer)

A

1,2,4,5

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13
Q

The nurse is teaching assisted living center residents about over-the-counter skin preparations. Which should be used with caution in an older patient? Select all that apply.

  1. Sunblock SPF 50
  2. Super-fatted soaps
  3. Emollients that keep the skin moist
  4. Steroid-based ointments and creams
  5. Topical lotion with an antihistamine
A

4,5

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14
Q 
Which over-the-counter skin preparations should the nurse instruct an older patient to use with caution?
Standard Text: Select all that apply.
1. Sunblock
2. Super-fatted soaps
3. Emollients that keep the skin moist
( dry skin)
4. Steroid-based ointments and creams
 5. Topical lotion with an antihistamine
A

4,5

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15
Q

The nurse is preparing to cleanse an older patients abdominal wound. Which techniques should the nurse use to perform this action?
Standard Text: Select all that apply.
1. Pour saline over the wound.
2. Apply saline-soaked gauze over the wound.
3. Squeeze a saline-filled syringe over the wound.
4. Place gauze pads soaked with hydrogen peroxide on the wound.
5. Apply dry gauze pads over the wound and saturate with sterile water.

A

1,2,3

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16
Q

The nurse is preparing to cleanse an older patient’s pressure injury. Which techniques should the nurse use to perform this action? Select all that apply.
1. Pour saline over the wound using a saline-filled syringe.
2. Apply saline-soaked gauze over the wound.
3. Apply hydrogen peroxide over the wound.
(Squeezing))
4. Place gauze pads soaked with Dakin’s solution on the wound.
5. Apply dry gauze pads over the wound and saturate with sterile water.

A

1,2

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17
Q

The nurse provides a seminar on the impact of the sun on the skin with a group of older community members. Which statement indicates the older clients understood the education?

  1. “It is important to wear sunscreen all the time.”
  2. “The sun should be avoided at all times.”
  3. “African Americans can not experience sun damage.”
  4. “The melanocytes in the subcutaneous tissue protect the skin from sun damage.”
A

1

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18
Q

The nurse provides a seminar on the impact of the sun on the skin with a group of older community members. Which statement indicates that additional teaching is necessary?

  1. Sunscreen is important to wear during all daytime hours.
  2. The sun should be avoided between the peak hours of 10 a.m. and 4 p.m.
  3. African Americans can experience sun damage despite the dark skin tones.
  4. The melanocytes in the subcutaneous tissue protect the skin from sun damage.
A

4

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19
Q

While performing a physical assessment, the nurse notes that an older patient has multiple brown and black bands on the finger nails of the thumbs and index fingers. What does this assessment finding indicate to the nurse?
Standard Text: Select all that apply.
1. A fungal infection
2. Damage to the nail matrix
3. Possible melanoma of the nail
4. Benign finding often seen in African Americans
5. Finger nails split in response to recent trauma

A

3,4

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20
Q

The nurse is caring for an older patient diagnosed with melanoma of the nail. What might the nurse find during the physical assessment? Select correct answer.

  1. Decreased skin thickness around the nail beds.
  2. A sore, rough, scaly, reddened papule around the nails.
  3. A longitudinal pigmented band.
  4. Indurated scaly plaques, papules, or nodules near the nail bed.
A

3

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21
Q

An older patient complains about increasing dry skin. What should the nurse explain to the patient about this skin problem?
Standard Text: Select all that apply.
1. There is a reduction in sebum production as the body ages.
2. There is a decrease in the number of sweat glands in the body with aging.
3. There is a change in the keratinization and lipid content in the stratum corneum.
4. There is an increase in body core temperature with aging, resulting in skin drying.
5. There is a change in the structure of the skin cell because of years of using alcohol- based soaps.

A

1,3

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22
Q

An older patient recently diagnosed with skin cancer does not understand why the disease developed since sunbathing has always been avoided. How should the nurse respond to this patient?

  1. Can you tell me more about your feelings?
  2. Sun exposure can happen from driving a car.
  3. We frequently never find out why cancer strikes.
  4. This is unusual, as skin cancer normally only occurs in sunbathers.
A

2

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23
Q 
The nurse is preparing discharge instructions for an older patient. For which medications should the nurse teach the patient to avoid extended sun exposure?
Standard Text: Select all that apply.
1. Aspirin
2. Ibuprofen
3. Amiodarone
4. Promethazine
5. Acetaminophen
A

2,3,4

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24
Q

The nurse is preparing discharge instructions for an older patient. If the patient is prescribed Ibuprofen, what should the nurse specifically educate the patient about? Select correct answer.

  1. The nurse should teach the patient that they may experience a pimply rash on their arms.
  2. The nurse should teach the patient that they may experience blue pigmentation.
  3. The nurse should teach the patient to avoid extended sun exposure.
  4. The nurse should teach the patient that he/she may be at risk for skin melanomas.
A

3

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25
Q

The nurse notes a small, indurated, scaled spot on the upper chest of an older patient. Which type of skin condition did the nurse assess in this patient?

  1. Actinic keratosis
  2. Basal cell carcinoma
  3. Malignant melanoma
  4. Squamous cell carcinoma
A

4

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26
Q

The nurse notes a small, indurated, scaled spot on the upper chest of an older patient. The nurse would suspect the physician to diagnose this condition as:

  1. Actinic keratosis
  2. Basal cell carcinoma
  3. Malignant melanoma
  4. Squamous cell carcinoma
A

4

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27
Q

precancerous condition. The lesion appears as a sore, rough, scaly plaque.

A

Actinic keratosis

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28
Q

presents as a small fleshy bump.

A

Basal cell carcinoma

29
Q

manifests as black, brown, or multicolored nodules or plaques.

A

Malignant melanoma

30
Q

most often appears as a flesh-colored, erythematous, indurated scaly plaque.

A

Squamous cell carcinoma

31
Q

An older patient requests a small, inflated donut to sit on to relieve pressure. What response by the nurse is most appropriate?

  1. I will obtain the device for you.
  2. Using the donut can cause skin breakdown.
  3. I will need to get an order from the physician.
  4. You will need to wait until discharge and use this at home.
A

2

32
Q

The daughter of an older patient sees a reddened area on the patients coccyx and wants to massage the area to improve circulation. What response by the nurse is indicated?

  1. I will record these findings in the medical record.
  2. I will need to obtain an order from the physician to perform a massage.
  3. Massaging the area may actually cause more harm to a potentially compromised area of skin.
  4. Massaging the area twice daily will help restore circulation and should be incorporated into the plan of care.
A

3

33
Q

The nurse is performing a skin assessment on an older African American patient. Which findings would be considered normal for this patient?
Standard Text: Select all that apply.
1. Bluish gums
2. Many small, dark papules on the face
3. Purple, hard ,smooth area on the upper arm
4. Multiple skin tears with clear fluid drainage
5. Freckle-like pigmentation of the tongue borders

A

1,2,5

34
Q

The nurse is performing a skin assessment on an older African American patient. Which findings would be considered normal for this patient? Select all that apply.

  1. Xerosis
  2. Many small, dark papules on the face
  3. Hard, smooth purple area on the upper arm
  4. Multiple skin tears with clear fluid drainage
  5. Freckle-like pigmentation of the tongue borders
A

1,2,5

35
Q

An older patient has a Braden Scale pressure ulcer risk score of 18. What does this score mean to the nurse?

  1. The patient is at a low risk for the development of a pressure ulcer.
  2. This patient is at a high risk for the development of a pressure ulcer.
  3. The score is inconclusive and the assessment repeated within 3 days.
  4. This score is inconclusive and shows no significant risk pressure ulcer development.
A

2

The Braden Scale is used to evaluate a patients risk for the development of pressure ulcers. A score of 16 or less indicates a pressure sore risk and the need for a prevention plan.

36
Q

An older patient has a Braden Scale pressure ulcer risk score of 18. What interventions would be indicated by the nurse?

  1. Provide routine skin care with soap and water daily.
  2. Inspect skin when repositioning, toileting, and assisting with ADLs.
  3. Avoid the use of pillows and foam slabs between bony prominences.
  4. Provide routine activities, score is not concerning.
A

2

37
Q

The nurse is caring for an older patient with a stage II pressure ulcer. Which product will the nurse use to clean the wound at the next dressing change?

  1. Saline
  2. Dakins solution
  3. Povidone-iodine
  4. Hydrogen peroxide
A

1

38
Q

The nurse is treating a skin tear on an older patients lower leg. Which dietary selection contains ingredients that will be most favorable to wound healing for this patient?

  1. Cereal, milk, and toast
  2. Bacon, toast, and coffee
  3. Eggs, toast, and orange juice
  4. Ham slices, milk, and applesauce
A

3

39
Q

The nurse is planning care for an older patient with pneumonia and a stage II pressure ulcer. Which nursing diagnosis would have the greatest priority for this patients care?

  1. Acute Pain related to destruction of tissue
  2. Knowledge Deficit related to care of skin disorder
  3. Risk for Infection related to impaired skin integrity
  4. Potential for Infection related to impaired skin integrity
A

1

40
Q

An older patient has a nonhealing stage III pressure ulcer. Which treatment would be indicated for this patients wound?

  1. Cadexomer
  2. Silver sulfadiazine
  3. Nanocrystalline silver
  4. Topical antibiotic cream
A

2

41
Q

An older patient has a stage III pressure ulcer. Which treatment would the nurse expect the physician to order for the patient’s wound?

  1. Cadexomer
  2. Silver sulfadiazine
  3. Nanocrystalline silver
  4. Topical antibiotic cream
A

2

42
Q

Which actions would the nurse take to prevent skin tears on an older patient with friable skin?
Standard Text: Select all that apply.
1. Avoid harsh soaps.
2. Apply silk tape over dressings.
3. Ensure an adequate fluid intake.
4. Use a lift sheet to reposition in bed.
5. Apply skin-moisturizing cream to arms and legs twice a day.

A

1,3,4,5

43
Q

The nurse is assessing an older patient in a skilled facility for frailty. During the assessment, the nurse determines frailty through the presence of which characteristics? Select all that apply.

  1. Unplanned weight gain
  2. Poor endurance
  3. Increase in grip strength
  4. Low activity tolerance
  5. Generalized weakness
A

2,4,5

44
Q 
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
A

1,2,4,5

45
Q

The nurse is planning care for an older patient who is newly admitted. What nursing interventions are necessary to prevent the geriatric cascade? Select all that apply.

  1. Frequent assessment of pressure ulcers
  2. Frequent monitoring of confusion
  3. Usage of physical and chemical restraints
  4. Usage of indwelling urinary catheters
  5. Monitoring risk of thrombophlebitis
A

1,2,5

46
Q 
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
A

1,2,3

47
Q

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? Select all that apply.

  1. Conduct a monthly quality improvement study.
  2. Monitor each nurse’s ability to detect preparation errors.
  3. Discuss the importance of not missing medication doses.
  4. Review pharmacy documentation regarding drug—drug interactions.
  5. Ensure that the physicians’ orders are legible.
A

2,3,4,5

48
Q

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

  1. Noninvasive testing
  2. Pain management
  3. Management of illness with medications
  4. Invasive surgery
A

2

49
Q

The nurse is assessing an older patient’s risk for developing problems while hospitalized for an acute illness. The Hospital Admission Risk Profile (HARP) tool will be utilize During . Which assessment areas would alert the nurse to a risk? Select all that apply.

  1. Age of 87
  2. Manual dexterity score of 14
  3. Cognitive function score of 7
  4. Ability to self-feed score of 2
  5. Independence IADL’s score of 5
A

1,3,5

50
Q

A frail older patient is more at risk for poor treatment outcomes in an acute care setting due to what factors? Select all that apply.

  1. Increased incidence of nosocomial infections
  2. Increased risk of adverse outcomes from therapeutic interventions
  3. A diagnosis of vague symptoms and problems
  4. Acute illness and diagnosed chronic illnesses
  5. Cognitive impairments
A

1,2,5

51
Q

During a nursing assessment, a frail older patient with cognitive impairment has a higher level of confusion than normal. What symptoms indicative of a urinary tract infection should the nurse further assess?

  1. Flank pain
  2. Fall risk
  3. Blood pressure
  4. Increased appetite
A

2

52
Q

An older client asks the nurse what they can do to live to a healthy old age. Which response by the nurse promotes healthy aging?

  1. “You should not receive influenza and pneumococcal vaccines.”
  2. “You should decrease nutritional intake of dairy products.”
  3. “You should avoid any weightlifting.”
  4. “You should use available preventive and screening services.”
A

4

53
Q

An older patient with diabetes is prescribed high-dose antibiotic therapy for a wound infection. Which effects of antibiotic therapy should the nurse further assess in relation to the patient?

  1. Diarrhea
  2. Dizziness
  3. Headaches
  4. Lethargy
A

1

54
Q

The nurse is concerned that an older patient with a chronic illness is on a trajectory towards frailty and dependence. From the nursing assessment findings listed, which is the priority?

  1. Sustained cognitive impairment
  2. Conditions controlled with medications
  3. Family that phones several times a day
  4. A decline in functional ability
A

4

55
Q

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. What key issues should be addressed in the conference? Select all that apply.

  1. Consistency with policy
  2. The patient’s preferences
  3. Avoidance of doing harm to the patient
  4. Focus on cost-effective methods
  5. The needs and wishes of the family
A

1,2,3,5

56
Q

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 the most likely cause for the patient’s delirium?

  1. High television volume
  2. Intravenous fluid therapy
  3. Windowless hospital room
  4. Assessments every 4 hours
A

3

57
Q

An older patient admitted for treatment of pneumonia has severe osteoarthritis. The nurse notices that the client is progressing on a trajectory towards frailty. What nursing assessment findings support this?

  1. Poor appetite
  2. Frequent requests for pain medication
  3. Decreased stamina and deconditioning
  4. Compliance with prescribed breathing treatments
A

3

58
Q

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

1,2,4,5

59
Q

An older patient with chronic renal failure is admitted; the healthcare provider is planning modified care for this patient. Nursing interventions for modified level of care would focus on which of the following? Select all that apply.

  1. Management of illness with medications
  2. Symptom and pain management
  3. Noninvasive testing
  4. Minimally invasive surgery
  5. Gentle rehabilitation
A

1,3,4

60
Q

The nurse is caring for an older patient recently diagnosed with cancer. The nurse is concerned about the patient moving towards a trajectory of frailty. What laboratory findings support the nurse’s concern?

  1. Hemoglobin 12 g/dL
  2. Hematocrit 40 g/dL
  3. Serum albumin less than 2.5 g/100 dL
  4. Serum albumin greater than 2.5 g/100 dL
A

3

61
Q

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.
A

2

62
Q

A frail older patient with diabetes is diagnosed with a urinary tract infection. Which statement from the patient would concern the nurse to further assess for complications?

  1. “My stomach is aching.”
  2. “I feel nauseated.”
  3. “I have a headache.”
  4. “My vaginal area is itching.”
A

4

63
Q

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 patient’s care?

  1. Agitation
  2. Wandering behaviors
  3. Sleep disturbances
  4. Polypharmacy
A

4

64
Q

The nurse is planning an education program for other nurses on palliative care. Which information should the nurse include in the program? 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 developing a therapeutic relationship.
  5. Palliative care can be delivered long-term and throughout all phases of treatment.
A

2,3,4,5

65
Q

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 isn’t much that can be done; accidents happen.”
  2. “Medication errors sometimes happen because we are so short-staffed.”
  3. “The physician’s handwriting was misread; we are talking to him about this issue.”
  4. “We are discussing installing a bar-code system to identify patients and medications.”
A

4

66
Q

A nurse assesses a client in their home and determines they are on a pathway towards frailty. What assessment findings lead the nurse to have this concern? Select all that apply.

  1. Chronic use of pain medication
  2. Diagnosis of diabetes and heart disease
  3. Newly incontinent of urine
  4. No children and recent death of spouse
  5. Inability to drive to healthcare appointments
A

2,3,4,5

67
Q

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 it’s in the hospital.”
  2. “An ACE unit isn’t any different than any other unit in the hospital.”
  3. “The key concept of an ACE unit is to return the patients to their nursing homes.”
  4. “An ACE will be guided by nurse-driven protocols.”
A

4

68
Q

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? Select all that apply.

  1. It is important to bring a copy of advanced directives for healthcare.
  2. It is important to bring a list of current medications and current labs.
  3. You should bring valuable jewelry and money to avoid leaving it unattended.
  4. You should bring good walking slippers, a bathrobe, and items such as books.
  5. It is important to bring contact information and insurance information.
A

1,2,4,5

Gerontology (5 decks)

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