Geriatrics 1

Question 1

The nurse is completing an assessment of an older patient’s oral cavity. Which finding is considered normal because of the aging process? 1. Leukoplakia2. Gum recession3. Increased saliva4. Thickening tooth enamel

Answer 1

2: With age, gums tend to recede leaving the newly exposed area of the teeth below the previous gum line vulnerable to tooth decay.

Question 2

An older patient has several small vesicles with eroded centers on the lips. What does this finding suggest to the nurse?1. Gingivitis2. Leukoplakia3. Herpes simplex4. Oral candidiasis

Answer 2

3: Clusters of vesicles with eroded centers and ulcers on the lips and mucosa can indicate the presence of herpes simplex or zoster.

Question 3

An older patient is experiencing mouth pain rated 6 on a 10 point pain scale. What action should the nurse take first? 1. Medicate the patient with a prescribed mild analgesic.2. Carefully inspect the patient’s mouth, teeth, and tongue.3. Notify the physician in charge about the patient’s problem.4. Instruct the patient to begin rinsing the mouth with an isotonic solution.

Answer 3

2: The first step the nurse should take in response to a patient complaining of mouth pain is to carefully conduct a thorough assessment of the oral cavity and visualize any obvious source for the pain.

Question 4

What should the nurse use for mouth care in an older patient who is unable to perform teeth brushing independently? 1. Nystatin2. Chlorhexidine (Peridex)3. Lemon and glycerin swabs4. Undiluted hydrogen peroxide

Answer 4

2: Chlorhexidine (Peridex) is used with patients in whom mechanical plaque removal is difficult to achieve. This mouth rinse is used to treat gingival and periodontal disease and oral infections.

Question 5

An older patient tells the nurse that tooth brushing is seldom done. What should the nurse assess as reasons why the patient has stopped performing oral hygiene?Standard Text: Select all that apply.1. Vision changes2. Malocclusion of teeth3. Decrease in taste acuity4. Lack of dental insurance5. Loss of manual dexterity

Answer 5

1: Among the reasons why older patients stop participating in oral hygiene practices, such as brushing the teeth, may include the inability to physically perform the action caused by loss in manual dexterity.5: Among the reasons why older patients stop participating in oral hygiene practices, such as brushing the teeth, may include poor vision.

Question 6

An older patient with oral candidiasis is prescribed Nystatin. Which actions will the nurse take when using this preparation with the patient?Standard Text: Select all that apply.1. Plan to use the medication four times a day for 2 weeks.2. Soak dentures in 1 mL of the medication and water for at least 6 hours.3. Teach to hold the solution in the mouth and swish for 2 minutes before swallowing.4. Coat the gums and tongue with the medication and rinse with water after 5 minutes.5. Provide the medication as a troche to be used twice a day if the patient has diabetes.

Answer 6

1: The usual treatment with Nystatin in four times a day for 2 weeks.2: Patients with dentures should remove their dentures before rinsing to ensure that the medication reaches all areas of the oral mucosa. One milliliter of nystatin oral suspension should be added to the water used to soak dentures at nighttime, and dentures should soak for at least 6 hours.3: The nurse should carefully observe older patients to make sure they adequately “swish” for about 2 minutes and then swallow the solution.

Question 7

An older patient has a significant amount of dental plaque. What can the nurse include when instructing the patient about brushing the teeth and gums? 1. Use a foam swab and brush three times a day for 3 to 4 minutes.2. Use a soft-bristled toothbrush at bedtime and brush for 1 minute.3. Use a soft-bristled toothbrush and brush twice a day for 3 to 4 minutes.4. Use a medium to hard-bristled toothbrush and brush twice a day for 3 to 4 minutes.

Answer 7

3: The patient should brush the teeth twice per day for 3 to 4 minutes using a soft-bristled toothbrush, which works well to reach between teeth and remove plaque from teeth and from gingival margins.

Question 8

The nurse is planning interventions for a patient with xerostomia. What will the nurse include in the patient’s plan of care?Standard Text: Select all that apply.1. Use a mouth rinse.2. Avoid artificial lubricants.3. Place a humidifier next to the bed.4. Avoid foods that are difficult to chew or swallow.5. Use sugar-free chewing gum, hard candies, and mints.

Answer 8

1: The use of a mouth rinse is an appropriate intervention to help with xerostomia.3: Placing a humidifier next to the bed is an appropriate intervention to help with xerostomia.4: Avoiding foods that are difficult to chew or swallow is an appropriate intervention to help with xerostomia.5: Using sugar-free chewing gum, hard candies, and mints is an appropriate intervention to help with xerostomia.

Question 9

How should the nurse respond to an older patient who does not receive regular dental examinations? 1. “Losing teeth is considered a normal part of the aging process.”2. “Patients who have no teeth do not need to see a dentist for regular checkups.”3. “Oral malignancies seldom occur in older people so oral examinations are not necessary.”4. “Regular dental examinations can improve an older person’s ability to eat healthful foods.”

Answer 9

4: Patients who receive regularly scheduled dental care are more likely to keep their teeth; maintain the ability to chew properly; and eat healthy foods, such as fruits and vegetables.

Question 10

The nurse is reviewing an older patient’s prescribed medications and realizes the patient is at risk for xerostomia. Which medications would increase the patient’s risk for this disorder?Standard Text: Select all that apply.1. Diuretics2. Antibiotics3. Antihistamines4. Anticoagulants5. Tricyclic antidepressants

Answer 10

1: The most common cause of xerostomia is medication with the most common offenders to include diuretics.3: The most common cause of xerostomia is medication with the most common offenders to include antihistamines.5: The most common cause of xerostomia is medication with the most common offenders to include tricyclic antidepressants.

Question 11

Which actions will the nurse include when performing a complete oral exam on an older cooperative patient? 1. Inform the patient that halitosis is considered normal.2. Do not wear gloves while examining the tongue including the posterior surface.3. Palpate the head and neck lymph nodes and assesses for tenderness and enlargement.4. Tell the patient that white patches on the surface of the oral mucosa is expected with aging.

Answer 11

3: A complete oral exam includes an oral health history, examination of the oral cavity including the teeth, and palpation of the lymph nodes of the head and neck noting enlargement or tenderness.

Question 12

The nurse is planning to teach a nursing assistant to use the hand-over-hand method to assist an older patient with dementia in performing mouth care. Which instruction should the nurse provide to the assistant? 1. Place a hand over the patient’s hand and guide the patient to perform mouth care.2. Use lemon and glycerin swabs to cleanse the gums around the teeth in the front.3. Speak sternly and instruct the patient to open the mouth and brush the teeth quickly.4. Carefully place two fingers of a gloved hand in the patient’s mouth to access the back teeth.

Answer 12

1: The hand-over-hand method involves the caregiver placing a hand over the patient’s hand and guiding the patient in performing the activity.

Question 13

After completing an assessment the nurse determines that an older patient is demonstrating signs of gingivitis. What did the nurse assess in the patient?Standard Text: Select all that apply.1. Red, painful gums2. Foul-smelling breath3. Dry tongue and oral tissue4. White patches on the oral mucosa5. Bleeding gums with toothbrushing

Answer 13

1: Gingivitis is inflammation of the gum tissue and is associated with red and tender gums.5: Gingivitis is inflammation of the gum tissue that is associated gum bleeding with brushing.

Question 14

The nurse determines that an older patient is at risk for periodontal disease. What risk factor did the nurse assess in this patient? 1. Takes calcium supplements2. Experiences excessive saliva3. Smokes two packs of cigarettes per day4. Brushes teeth with a soft-bristled toothbrush

Answer 14

3: Smoking cigarettes greatly increases the risk of periodontal disease and lowers the chances of success of dental treatments.

Question 15

The nurse is planning care for an older patient with stomatitis caused by chemotherapy medication. Which nursing diagnosis should the nurse identify for this patient? 1. Impaired Dentition2. Fluid Volume Deficit3. Altered Physical Mobility4. Impaired Oral Mucous Membranes

Answer 15

4: Stomatitis is inflammation of the mouth and usually consists of erosions and ulcerations of the oral mucous membranes, with the potential for secondary infection. The chemotherapy medication can alter the integrity of oral tissue. Impaired Oral Mucous Membrane is an appropriate nursing diagnosis related to the stomatitis.

Question 16

The nurse is reviewing risk factors for the development of oral cancer with a group of senior citizens at a community center. What will the nurse include in this instruction?Standard Text: Select all that apply.1. Do not use tobacco.2. Limit or refrain from alcohol use.3. Ensure a daily intake of vitamin D.4. Use a sunscreen when out of doors.5. Have dental exams to check for infections.

Answer 16

1: Smoking cigarettes, pipes, and cigars accounts for 90% of oral cancers. Cigar, pipe, and chewing tobacco users have the same risk as cigarette smokers.2: The risks for oral cancer are great for people who chronically use alcohol.4: Limiting sun exposure to the lips by wearing a brimmed hat and lip balm with sunscreen helps reduce the risk of oral cancer.5: Bacterial, viral, and fungal infections of the mouth including the human papilloma virus (HPV16), a common sexually transmitted virus affecting 40 million Americans, has emerged as a serious biologic risk factor for oral cancer.

Question 17

The nurse has completed teaching a group of nursing assistants on oral hygiene approaches for the older patient. Which statement indicates that additional instruction is needed? 1. “Patients should brush teeth twice daily.”2. “A toothbrush is a better tool than a foam swab.”3. “Hydrogen peroxide can be used as a mouth rinse.”4. “Tooth brushing should be done for 3 to 4 minutes.”

Answer 17

3: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients.

Question 18

The nurse assesses the teeth, gums, and tongue of an older patient complaining of mouth pain. What additional actions should the nurse take at this time?Standard Text: Select all that apply.1. Review vital signs.2. Assess respiratory status.3. Encourage the patient to gargle.4. Review the patient’s tooth brushing routine.5. Palpate lymph nodes along the patient’s jaw.

Answer 18

1: When older patients complain of mouth pain the vital signs should be checked to rule out an acute infection.2: When older patients complain of mouth the respiratory status should be checked to rule out an acute infection.5: Patients with a dental abscess will often have swollen or enlarged lymph nodes under the ear or jaw.

Question 19

The nurse notes that several older patients are experiencing halitosis. What should the nurse consider as underlying causes of the condition?Standard Text: Select all that apply.1. Ill-fitting dentures2. Stomach disorders3. The limited amount of fluid intake4. The number of medications being administered5. Limited attention to hygiene caused by problems with manual dexterity

Answer 19

1: Ill-fitting dentures can serve as a source of halitosis.3: Reduced fluid intake can lead to xerostomia, which is a cause of halitosis.4: Multiple medications can cause xerostomia, which is a cause of halitosis.5: Aging may be associated with mobility problems that hinder the individual from performing comprehensive mouth care.

Question 20

An older patient is surprised to learn of the diagnosis of oral candidiasis. What responses should the nurse make to this patient?Standard Text: Select all that apply.1. “It can be seen in people who have diabetes.”2. “It is often caused by eating spicy or irritating foods.”3. “Sometimes people who use oral inhaled steroids for asthma can develop this.”4. “It is a bacterial infection that may be transmitted by contact with dirty utensils.”5. “It is an infection that results when there is an alteration in the normal flora of the mouth.”

Answer 20

1: People who have diabetes and have high or elevated glucose levels are at risk for candidiasis because the oral flora is altered and the organism Candida albicans is encouraged to overgrow.3: Older patients using inhaled steroids to treat asthma should rinse their mouths carefully each time the inhaler is used to prevent the formation of oral candidiasis.5: Candidiasis results when the normal flora is altered.

Question 21

An older patient says that gargling is done every day with hydrogen peroxide and asks the nurse how frequently this should be done. What information should the nurse provide to the patient? 1. Advise to suspend the practice.2. Mix the hydrogen peroxide with mouthwash for gargling.3. Dilute the hydrogen peroxide solution with water prior to gargling.4. Gargle with the hydrogen peroxide only one time per day to reduce irritation.

Answer 21

1: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients. The nurse should advise the patient to suspend the practice.

Question 22

The gerontological nurse is planning a presentation on dental care of older patients for the nursing staff in a skilled facility. What information should the nurse include in the presentation? 1. The older adult should brush the teeth once daily.2. Flossing should be limited to avoid dental complications.3. The use of alcohol-based mouthwashes is helpful to reduce bacteria.4. The older adult should have dental cleaning performed two times per year.

Answer 22

4: Dental assessments and cleaning should be performed two times per year.

Question 23

An older patient reports having a white patch inside the mouth. The nurse assesses a 2 cm by 2 cm lesion on the inner aspect of the left jaw. How should the nurse respond to the patient? 1. “Rinse with a mild solution of hydrogen peroxide and water.”2. “The white patch is the result of aging and no cause for concern.”3. “You should contact your healthcare provider for an evaluation of the area.”4. “I think the patch looks like a bacterial infection and you will most likely need an antibiotic.”

Answer 23

3: The lesion’s description is consistent with leukoplakia. The final diagnosis and treatment of the lesion will need to be made by a physician.

Question 24

An older patient diagnosed with an oral cancer questions how the disease was contracted without a smoking history. Which response by the nurse is most appropriate? 1. “Dietary intake high in fat has been linked to oral cancer.”2. “Your history of periodontal disease is a significant risk factor.”3. “It is highly unusual for a nonsmoker to be affected by oral cancer.”4. “Studies show sun exposure may play a role in the development of oral cancers.”

Answer 24

4: Oral cancer may affect sun-exposed areas of the face and mouth.

Question 25

An older patient with bleeding gums is directed by the physician to make dietary changes. After providing education regarding the diet, which patient statement indicates understanding? 1. "I should avoid cranberry products."2. "I am going to drink orange juice every morning."3. "Adding bananas to my morning smoothie will help manage my condition."4. "Increasing the amount of fiber in my diet will reduce the bleeding in my gums."

Answer 25

2: Bleeding gums may be associated with a deficiency of vitamins C or K. Orange juice will provide vitamin C.

Question 26

While reviewing laboratory results for an older patient the nurse notes that the glycosylated hemoglobin (HbA1c) result is 6.0%. What does this finding indicate to the nurse? 1. The patient needs a referral to a dietician.2. The patient needs additional testing for anemia.3. The patient has undiagnosed type 2 diabetes mellitus.4. The patient's average blood glucose level was 120 over the past 3 months.

Answer 26

4: Glycosylated hemoglobin estimates a patient's blood glucose over the past 3 months by measuring how much glucose is attached to the hemoglobin in red blood cells, which have an average life span of about 4 months. An HbA1c of 6 relates to an average glucose level of 120. Ideally, the glycosylated hemoglobin should be less than 7.0%.

Question 27

The nurse is planning interventions to achieve the goal of maintaining glycemic control for an older patient with type 2 diabetes mellitus. Which interventions will the nurse include in this patient's plan of care?Standard Text: Select all that apply.1. Teach to prevent hypoglycemia.2. Emphasize the role of physical exercise.3. Review the manifestations of complications.4. Stress the importance of avoiding carbohydrates.5. Instruct in self-monitoring of blood glucose levels.

Answer 27

1: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through recognition, treatment, and prevention of hypoglycemia.2: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through regular physical activity.3: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through prevention, early detection, and treatment of chronic complications.5: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through self-management techniques such as self-monitoring of blood glucose levels.

Question 28

Why should the nurse counsel an older patient with a history of occasional high blood glucose levels to stop smoking? 1. To prevent insulin resistance2. To prevent the loss of additional weight3. To reduce the risk of developing type 2 diabetes mellitus4. To ensure that blood glucose levels will remain within normal limits

Answer 28

3: Smoking is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.

Question 29

The healthcare provider has decided to not treat an older patient with type 2 diabetes mellitus aggressively. What would be a risk of aggressively treating this patient? 1. Decreased vision acuity2. Hypoglycemic episodes3. Frequent skin infections4. Development of foot ulcers

Answer 29

2: Aggressive glycemic control increases the risk of hypoglycemic episodes. Older people who live alone, those with cognitive or physical deficits, or those with serious underlying chronic illnesses are more likely to suffer serious consequences from hypoglycemic episodes.

Question 30

While conducting a health interview the nurse suspects an older patient might be experiencing diabetes. What comment did the patient make that could indicate this diagnosis? 1. "I sometimes have muscle aches in my upper legs at night."2. "I feel a bit tired by midafternoon and take a 30-minute nap most days."3. "I've been experiencing blurred vision frequently during the past month."4. "I'm slightly winded when I walk up a flight of stairs but it passes quickly."

Answer 30

3: Blurred vision can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus.

Question 31

Which dietary guideline would be the most important for the nurse to instruct a patient with diabetes mellitus? 1. Include foods rich in calcium at every meal.2. Eliminate as much fat from the diet as possible.3. Eat at regular times including meals and snacks.4. Ingest the majority of daily caloric intake in the morning meal.

Answer 31

3: The patient with diabetes should be encouraged to eat meals and snacks at regular times throughout the day. This consistent food intake is a strategy to maintain the blood glucose levels near normal most of the time.

Question 32

An older male patient with type 2 diabetes mellitus wants to know if he can have an alcoholic drink. What information should the nurse provide about alcohol intake with diabetes?Standard Text: Select all that apply.1. Ingest alcohol with food.2. Alcohol can interact with diabetes medications.3. Consider calories from alcohol as being fat calories.4. Limit consumption to no more than two drinks per day.5. Take alcohol with carbohydrates because it enhances digestion.

Answer 32

1: Alcohol must be consumed with food to prevent hypoglycemia.2: Alcohol can interact with diabetic medications.3: Alcohol must be calculated as part of the total caloric intake and are best substituted for fat calories.4: It is recommended that older adults with diabetes mellitus consume no more than two drinks per day for men.

Question 33

The healthcare provider suggests that an older patient with type 2 diabetes mellitus begin a walking program. What should the nurse include when teaching the patient about this program?Standard Text: Select all that apply.1. Dress in layers.2. Wear shoes with thick flexible soles.3. Walk at least three to five times a week.4. Walk alone to concentrate on the activity.5. Perform warm-up exercises before walking.

Answer 33

1: The nurse should instruct the patient to wear clothes that are dry and comfortable and dress in layers to prevent overheating.2: The nurse should instruct the patient to wear shoes with thick, flexible soles to cushion each step and absorb shock.3: The nurse should instruct the patient to walk at least three to five times per week.5: The nurse should instruct the patient to engage in warm-up exercises before walking.

Question 34

The nurse is reviewing the health history for an older patient newly diagnosed with type 2 diabetes mellitus. For which health problem would the medication metformin be contraindicated? 1. Heart failure2. Hypertension3. Osteoarthritis4. Renal insufficiency

Answer 34

4: Metformin should not be used by older adults with renal insufficiency.

Question 35

An older patient diagnosed with type 2 diabetes mellitus has been prescribed insulin with different onsets and durations of action. Why would this type of insulin be prescribed for this patient? 1. It simplifies the dosing.2. It can be refrigerated when not in use.3. It can be injected into the thigh muscle.4. It reduces the incidence of complications.

Answer 35

1: Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing.

Question 36

During a home visit an older patient demonstrates signs of hypoglycemia. For which situations should the nurse assess the patient?Standard Text: Select all that apply.1. An illness2. Lack of sleep3. Missing a meal4. Unplanned exercise5. Too much medication

Answer 36

1: Hypoglycemia can be caused by the onset of an illness that alters the patient's metabolic needs.3: Hypoglycemia can be caused by missing a meal.4: Hypoglycemia can be caused by unplanned exercise.5: Hypoglycemia can be caused by taking too much medication.

Question 37

After completing a health history the nurse realizes that an older patient is at risk for developing hypothyroidism. What data did the nurse collect during the health history?Standard Text: Select all that apply.1. Prescribed furosemide (Lasix) for hypertension2. Treatment for a non-thyroid autoimmune disease3. Previous treatment of neck cancer with external radiation4. Taking over-the-counter acetaminophen (Tylenol) for arthritis pain5. Five year history of type 2 diabetes mellitus that is controlled by diet

Answer 37

1: Risk factors for the development of hypothyroidism include certain medications such as furosemide (Lasix).2: Risk factors for the development of hypothyroidism include the diagnosis of non-thyroid autoimmune disease.3: Risk factors for the development of hypothyroidism include treatment of neck cancer with external radiation.

Question 38

An older patient is prescribed the preferred treatment for hyperthyroidism. About which treatment will the nurse instruct the patient? 1. Partial thyroidectomy2. Ingestion of radioactive sodium iodine 131I3. Combination treatment with Synthroid and amiodarone4. Large doses of propylthiouracil (PTU) and intravenous propranolol

Answer 38

2: The treatment of choice is ingestion of the radioactive iodine, which is picked up by the thyroid tissue and then destroys the tissue. This treatment avoids surgery, anesthesia, and hospitalization.

Question 39

For which complication of diabetes mellitus would the nurse use a monofilament test to determine a patient's risk? 1. Retinopathy2. Ulcer of the foot3. Diabetic ketoacidosis4. Arterial insufficiency of the lower extremities

Answer 39

2: The monofilament test is used to assess a patient for the presence of protective sensation in the foot, which would alert the patient to the development of a blister or foot ulcer. Patients who can feel the filament at the designated sites are at reduced risk for developing foot ulcers.

Question 40

An older patient with type 2 diabetes mellitus has a capillary blood glucose level of 44 mg/dL. What should the patient ingest to provide an immediate source of carbohydrate? 1. A half cup of orange juice2. A half cup of diet soda pop3. Half of an apple with the peel4. Three to five pieces of sugar-free candy

Answer 40

1: The best choice to treat the hypoglycemia is a concentrated carbohydrate source that can be taken quickly to raise the glucose to a safe level. Orange juice is the best option because it can be taken and absorbed quickly and is a good source of concentrated carbohydrate.

Question 41

The nurse is preparing a teaching plan for a patient with type 2 diabetes mellitus regarding proper foot care. Which instructions should the nurse include in this plan?Standard Text: Select all that apply.1. See a podiatrist for nail care.2. Lubricate dry areas with lotion.3. Dry moist areas between the toes.4. Use an emery board to smooth toe nails.5. Soak feet in hot water and allow to air dry.

Answer 41

1: Foot care for the patient with type 2 diabetes mellitus is to include instructing to see a podiatrist for nail care. The patient should not cut toe nails independently. 2: Foot care for the patient with type 2 diabetes mellitus is to include instructing to lubricate dry areas with lotion.3: Foot care for the patient with type 2 diabetes mellitus is to include instructing to dry moist areas between the toes.4: Foot care for the patient with type 2 diabetes mellitus is to include instructing to use an emery board to smooth toe nails.

Question 42

The nurse is preparing discharge teaching for an older patient receiving insulin injections for diabetes. What should the nurse teach the patient about the insulin? 1. Always keep insulin refrigerated.2. Systematically rotate insulin injection sites.3. Increase the amount of insulin before exercise.4. Ketones in the urine signify a need for less insulin.

Answer 42

2: Insulin injection sites should be rotated to reduce the risk of lipodystrophy. Lipodystrophy occurs as a result of insulin impurity or poor injection technique. Avoid injecting insulin directly into one of these fatty thickenings, as absorption can be delayed.

Question 43

The nurse is concerned that an older patient with type 2 diabetes mellitus is demonstrating signs of hyperglycemia. What did the nurse assess in the patient?Standard Text: Select all that apply.1. Fatigue2. Dizziness3. Blurred vision4. Abdominal pain5. Excessive urination

Answer 43

1: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include fatigue.3: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include blurred vision.4: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include abdominal pain.5: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include excessive urination or polyuria.

Question 44

During a home visit the nurse learns that an older patient with type 2 diabetes mellitus and chronic renal failure is experiencing headache, polydipsia, and lethargy. What is the most important assessment that the nurse should make at this time? 1. Measure the patient's latest urine output.2. Assess the patient's appetite and oral intake.3. Measure the patient's current capillary blood glucose level.4. Determine the amount of fluid the patient has ingested over the last few hours.

Answer 44

3: Measuring the patient's capillary blood glucose level will help the nurse determine if the patient is developing hyperglycemic hyperosmolar nonketotic syndrome, a complication of type 2 diabetes mellitus.

Question 45

The nurse teaches an older patient with type 2 diabetes mellitus how to manage the disorder when becoming acutely ill with a cold or other infection. Which statements indicate that instruction has been effective?Standard Text: Select all that apply.1. "I should call the doctor if I have severe diarrhea."2. "Difficulty breathing means I need to get some more rest."3. "I should continue to take my medication even if I'm vomiting."4. "A large amount of ketones in my urine is nothing to worry about."5. "I should not take my medication if I can't eat and call the doctor."

Answer 45

1: The patient with diabetes should notify the physician for any episodes of severe diarrhea. This statement indicates that teaching has been effective.5: The patient with diabetes should be instructed to not take medication if unable to eat since taking medication could cause hypoglycemia. This statement indicates that teaching has been effective.

Question 46

An older patient is being treated for hypothyroidism. Which manifestations will the nurse assess in this patient?Standard Text: Select all that apply.1. Dry skin2. Hair loss3. Vomiting4. Bradycardia5. Periorbital swelling

Answer 46

1: Dry skin is a manifestation of hypothyroidism.2: Hair loss is a manifestation of hypothyroidism.4: Bradycardia is a manifestation of hypothyroidism.5: Periorbital swelling is a manifestation of hypothyroidism.

Question 47

The nursing instructor asks a student to describe Graves' disease. Which statement by the student indicates an accurate understanding of this disorder? 1. "It is associated with long-term use of amiodarone, a cardiac medication."2. "It is an autoimmune disorder associated with sustained thyroid over activity."3. "It is an autoimmune disorder associated with sustained thyroid under activity."4. "It is associated with a tumor on the thyroid, which leads to thyroid over activity"

Answer 47

2: Hyperthyroidism in the older patient is often due to Graves' disease or toxic goiter, an autoimmune disorder associated with the production of immunoglobulins that attach to and stimulate the TSH receptor, leading to sustained thyroid over activity.

Question 48

The nurse is reviewing the laboratory results for an older patient experiencing a new-onset of atrial fibrillation. On which laboratory value should the nurse focus as a potential cause for this diagnosis? 1. Hgb 13.8 g/dL2. Hgb 11.0 g/dL3. TSH 18 mU/mL4. TSH 0.25 mU/mL

Answer 48

4: This is an abnormally low TSH level which is a diagnostic indicator of hyperthyroidism which could be the cause for the patient's new-onset of atrial fibrillation.

Question 49

A 75-year-old patient newly diagnosed with type 2 diabetes mellitus asks how the disease developed since weight management and exercise have been practiced her entire life. Which response should the nurse make to this patient? 1. "This disease is inevitable since everyone who ages will develop diabetes."2. "The pancreas becomes hardened and unable to produce insulin with aging."3. "The body loses the ability to digest carbohydrates as a normal part of aging."4. "The body gradually reduces the production of insulin as a normal part of aging."

Answer 49

4: With aging the body gradually reduces the production of insulin.

Question 50

The nurse provides a program on self-management of diabetes for a group of senior citizens with type 2 diabetes mellitus. Which participant statement indicates that additional education is needed? 1. "I will keep some hard candy with me at all times."2. "I will start a walking program with my neighbors."3. "If I can't eat, I will call my doctor to see if I should take my insulin."4. "If I start to feel nervous, sweaty, or shaky, I will lie down and take a nap."

Answer 50

4: The older patient with type 2 diabetes mellitus should be instructed to recognize the manifestations of hypoglycemia which include nervousness and diaphoresis so that a carbohydrate source can be ingested.

Question 51

An older resident is complaining of being constipated. Which action should the nurse take first when caring for this patient? 1. Assess the diet for adequacy of fiber and fluids.2. Determine what the patient means by constipation.3. Obtain an order for a laxative and an enema if needed.4. Encourage the patient to increase fluid intake and activity.

Answer 51

2: The nurse should first carefully evaluate the patient's concern and question the person as to what is considered as being constipation. Determining the patient's normal frequency of bowel movement, consistency of stool, and effort in passing stool is important before deciding to act.

Question 52

After an assessment the nurse is concerned that an older patient is at risk for liver cancer. What did the nurse assess in this patient?Standard Text: Select all that apply.1. History of colon polyps2. Diagnosis of diverticulitis3. 50 year history of smoking4. History of hepatitis B infection5. Previous treatment for alcoholism

Answer 52

3: Smoking is a predisposing factor for liver cancer.4: History of hepatitis B infection is a risk factor for liver cancer.5: Excessive alcohol intake is a predisposing factor for liver cancer.

Question 53

An older patient is experiencing diarrhea. Which assessment finding supports that the patient's diarrhea is caused by Clostridium difficile? 1. The patient has a history of ulcerative colitis.2. The patient has been taking prescribed steroids for several months.3. The patient recently completed a course of antibiotics for pneumonia.4. The patient rarely eats fresh fruits and vegetables and self-restricts fluid intake.

Answer 53

3: Clostridium difficile can be the cause of diarrhea in an older patient who has recently completed antibiotic use.

Question 54

Which gastrointestinal change in an older patient does the nurse recognize as being associated with aging? 1. Decreased esophageal motility2. Decreased incidence of cholelithiasis3. Increase in hydrochloric acid in the stomach4. Increased absorption of nutrients in the intestines

Answer 54

1: Changes in the gastrointestinal system that occur with the aging process include a decrease in esophageal motility.

Question 55

Which interventions should the nurse use to reduce the risk of aspiration for an older patient with dysphagia?Standard Text: Select all that apply.1. Monitor during meals for a change in respirations.2. Maintain an upright position for 1 hour after eating.3. Raise the head of the bed to a 90 degree angle during meals.4. Provide pureed solid foods and thin clear liquids during meals.5. Ensure that one bite has been swallowed before providing another.

Answer 55

1: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to monitor the patient during meals for a change in respirations. This could indicate that the patient is aspirating food or fluids.2: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to maintain the patient in an upright position for 1 hour after eating.3: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to raise the head of the bed to a 90 degree angle during meals.5: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to ensure that one bite has been swallowed before providing another.

Question 56

The nurse instructs a family member on how to feed an older patient. Which observation indicates that the family member needs additional instruction? 1. Checks to make sure the patient's dentures are in place2. Makes sure that each bite is swallowed before providing the next bite3. Reminds the patient to chew the food after being placed in the patient's mouth4. Tries to insert a utensil in the patient's mouth and the patient bites down tightly

Answer 56

4: The nurse should reinforce that forceful feeding techniques should not be used. Family members may feel frustrated if the patient does not cooperate with eating. Forcing the issue will likely lead to more power struggles at mealtime and the patient may simply not feel like eating.

Question 57

Which assessment finding should the nurse realize as being a cause for gastroesophageal reflux disease (GERD) occurring more commonly in older adults? 1. Increased amounts of saliva2. Increased incidence of hiatal hernia3. Tightening of the lower esophageal sphincter4. The increase in peristalsis that occurs in the esophagus

Answer 57

2: There is an increased incidence of hiatal hernia that occurs with aging. Hiatal hernia occurs when a small portion of the stomach slides into the chest cavity trapping some of the stomach and its contents.

Question 58

How should the nurse instruct an older patient with gastroesophageal reflux disease (GERD) about heartburn? 1. It improves when lying flat or bending over.2. It is unaffected by the size of meals eaten or the types of food.3. It will not put the older patient at increased risk for esophageal cancer.4. It may cause severe chest pain that causes the patient to fear a heart attack.

Answer 58

4: The heartburn associated with gastroesophageal reflux disease (GERD) can cause chest pain that is so severe and persistent that the older patient is unable to distinguish the pain from cardiac pain and may seek emergency medical attention.

Question 59

An older patient with gastroesophageal reflux disease (GERD) is prescribed ranitidine (Zantac). What should the nurse instruct as the mechanism of action of this medication? 1. Neutralizes stomach acid2. Decreases acid production in the stomach3. Creates a coating that acts as a protective barrier4. Increases motility in the esophagus and stomach

Answer 59

2: Histamine blocker medications, such as ranitidine (Zantac), act by reducing acid production by blocking the histamine-2 receptor in the stomach.

Question 60

Which manifestations that an older patient is exhibiting should the nurse investigate as possibly being caused by peptic ulcer disease?Standard Text: Select all that apply.1. Diarrhea2. Clay-colored stools3. Abdominal distention4. Indigestion with bloating5. Vague and diffuse abdominal pain

Answer 60

3: Abdominal distention is a common symptom but is often not vigorously investigated.4: Indigestion with bloating is a common symptom but is often not vigorously investigated.5: When abdominal pain is present it is often vague and diffuse throughout the abdomen.

Question 61

An older patient is diagnosed with a large peptic ulcer. Which information will the nurse use from the patient's history to help identify the cause for this ulcer?Standard Text: Select all that apply.1. Allergy to penicillin2. History of cataract surgery several months ago3. Taking prescribed medication for hypertension4. Taking ibuprofen (Motrin) for chronic bursitis pain5. Prescribed warfarin (Coumadin) for chronic atrial fibrillation

Answer 61

4: NSAID use increases the incidence of peptic ulcer disease.5: Concurrent use of NSAIDs with an anticoagulant such as warfarin (Coumadin) predisposes older adults to peptic ulcer development.

Question 62

The nurse is concerned that an older patient is at risk for developing diverticulosis. What did the nurse assess in the patient?Standard Text: Select all that apply.1. History of constipation2. Low intake of dietary fiber3. Intake high in protein and calcium4. Diet high in refined carbohydrates5. Physically inactive for many years

Answer 62

1: Constipation is an aggravating factor for diverticulosis.2: Low intake of dietary fiber can encourage the development of diverticulosis.4: A diet high in refined carbohydrates can encourage the development of diverticulosis.5: Physical inactivity is an aggravating factor for diverticulosis.

Question 63

An older patient with diverticular disease is experiencing abdominal pain and fever. For which diagnostic test will the nurse most likely prepare this patient? 1. Colonoscopy2. Barium enema3. Upper GI endoscopy4. CT scan of the abdomen

Answer 63

4: An abdominal computerized tomography (CT) scan will most likely be obtained to assess colonic wall thickness and extra luminal structures for suspected diverticulitis.

Question 64

An older patient is experiencing abdominal discomfort. What should the nurse do when examining this patient's abdominal area?Standard Text: Select all that apply.1. Warm the hands.2. Begin with very light palpation.3. Use moderate pressure on the painful area.4. Palpate in areas farther away from the pain.5. Begin the assessment with the area of most pain.

Answer 64

1: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin with warm hands.2: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin with very light palpation.4: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin in an area as remote from the area of pain as possible.

Question 65

What should the nurse teach an older patient about colorectal cancer? 1. The risk of colorectal cancer decreases with age.2. Colorectal cancer can be detected by measuring carcinoembryonic antigen (CEA).3. Colorectal cancer occurs less frequently in those with a history of ulcerative colitis.4. Colorectal cancer has no symptoms but can be detected by fecal occult blood testing.

Answer 65

4: Colorectal cancer is asymptomatic in the early stages. Screening tools, such as annual fecal occult blood testing can detect the cancer when it is still in the curable stage.

Question 66

The nurse is assisting an older patient with dysphagia to eat an evening meal. Which foods on the patient's tray should be avoided?Standard Text: Select all that apply.1. Hot tea2. Custard3. Pudding4. Milkshake5. Clear broth

Answer 66

1: Thin food and liquids such as tea are difficult for older people with dysphagia to swallow. Thin liquids quickly drain into the esophagus before the swallow reflex is triggered.5: Thin food and liquids such as clear broth are difficult for older people with dysphagia to swallow. Thin liquids quickly drain into the esophagus before the swallow reflex is triggered.

Question 67

The nurse is concerned that an older patient is experiencing dysphagia. What did the nurse assess in this patient?Standard Text: Select all that apply.1. Slurred speech2. Extreme lethargy3. Talking while eating4. Weak voice and cough5. Drooling saliva from the mouth

Answer 67

1: Slurred speech is a manifestation of dysphagia.2: Extreme lethargy is a manifestation of dysphagia.4: A weak voice and cough is a manifestation of dysphagia.5: Drooling saliva from the mouth is a manifestation of dysphagia.

Question 68

An older patient with a history of constipation has been directed to use an over-the-counter medication to help manage symptoms of gastroesophageal reflux by buffering the gastric pH. Which medication would be the best for the patient to use? 1. Pepcid2. Maalox3. Mylanta4. Milk of Magnesia

Answer 68

4: Milk of Magnesia is an over-the-counter option to manage gastroesophageal reflux and acts to provide a buffer for the gastric pH.

Question 69

An older patient with gastroesophageal reflux disease has complications caused by exposure of tissue to gastric acids. Which medication will this patient most likely be prescribed to promote healing? 1. Reglan2. Zantac3. Pepcid4. Carafate

Answer 69

4: Sucralfate (Carafate) is a mucosal protectant agent that aids in mucosal healing by reducing direct tissue exposure to acid. Sucralfate works locally by forming an adherent complex that coats the ulcer site and protects it from further injury from acid, pepsin, and bile salts.

Question 70

The nurse is planning a teaching session regarding gastrointestinal ulcers for the residents of an assisted living complex. Which concept should the nurse include in the presentation? 1. Gastric ulcers are more common than duodenal ulcers.2. The first sign of a peptic ulcer may be serious gastrointestinal bleeding.3. A colonoscopy is the test used to diagnose the presence of a gastric ulcer.4. The individual having a peptic ulcer will most likely experience pain when hungry.

Answer 70

2: The first signs of peptic ulcer disease may be serious gastrointestinal bleeding episodes requiring emergency evaluation, treatment, and transfusion.

Question 71

An older patient, beginning antibiotic therapy for a leg wound, has a history of Clostridium difficile. What should the nurse instruct the patient to do to reduce the risk of this occurring? 1. Eat large amounts of fresh fruits and vegetables.2. Restrict the amount of meat and calcium products.3. Use acidophilus capsules while taking the antibiotic.4. Decrease the amount of fluid taken while on the medication.

Answer 71

3: Acidophilus capsules contain active cultures that can be used to treat a variety of gastrointestinal problems and as an adjunct to antibiotic therapy to prevent antibiotic-associated diarrhea caused by overgrowth of Clostridium difficile.

Question 72

An older patient with a peptic ulcer asks why lifestyle alterations are needed. What should the nurse explain to the patient? 1. Alcohol stimulates gastric acid secretion.2. Alcohol acts to suppress gastric immunity.3. Caffeine is associated with abdominal pain.4. Tobacco reduces the effectiveness of gastric ulcer medications.

Answer 72

1: Alcohol stimulates gastric acid secretion which can contribute to the development of peptic ulcers.

Question 73

The nurse is preparing discharge instructions for an older patient with chronic pancreatitis. Which information should the nurse include in this teaching? 1. Stop smoking.2. Limit fluid intake.3. Do not drink any alcohol.4. Avoid eating organ meats.

Answer 73

3: All older adults with chronic pancreatitis must refrain from drinking alcohol.

Question 74

The nurse is teaching an older patient with diverticulitis on foods that could precipitate a painful attack. How should the nurse instruct this patient? 1. Avoid foods with seeds.2. Restrict the intake of high fiber foods.3. Limit the intake of eggs and dairy products.4. Eat whole grains with sesame seeds for added protein.

Answer 74

1: The patient should be instructed to avoid foods that precipitate painful attacks such as foods with seeds like popcorn, sesame seeds, and poppy seeds. These seeds can become trapped in the diverticula and trigger an infection and inflammatory response.

Question 75

An older patient with intermittent diarrhea has been advised to increase the amount of soluble fiber in the diet. What should the nurse suggest to this patient? 1. Use Metamucil as prescribed.2. Restrict the intake of oranges.3. Limit eating frozen vegetables.4. Do not eat the peels of apples or pears.

Answer 75

1: Soluble fiber (Metamucil) adds bulk to the stool and is sometimes helpful to slow bowel movements in people requiring bulk.

Question 76

An older female patient is experiencing fatigue, nausea, vague complaint of intermittent chest discomfort, and not sleeping well. How should the nurse interpret these symptoms? 1. Signs of anemia2. Pancreatic disease3. Myocardial infarction4. Normal changes of aging

Answer 76

3: Many older women will complain of vague symptoms when having a myocardial infarction, including fatigue, sleep disturbances, and epigastric pain.

Question 77

During a blood pressure screening at a pharmacy an older person experiences a fluttering in the chest. What should the nurse interpret this finding as being? 1. Hypothyroidism2. Exercise intolerance3. Nonspecific cardiac changes with aging4. Underlying illness that requires a medical evaluation

Answer 77

4: New onset atrial fibrillation and other arrhythmias may signal the onset of a serious underlying illness that requires further medical evaluation.

Question 78

An older patient has a blood pressure reading of 150/88. The patient reports no other symptoms or medical history of illness. What should the nurse instruct the patient to do? 1. Have the blood pressure rechecked in a month.2. Do nothing since this is a normal variant of aging.3. Go to the emergency department for further evaluation and treatment.4. Contact the primary care provider for further evaluation and treatment.

Answer 78

4: If left uncontrolled, high systolic pressure can lead to stroke, myocardial infarction, heart failure, kidney damage, blindness, or other conditions. Although it cannot be cured once it has developed, isolated systolic hypertension (ISH) can be controlled.

Question 79

During a home visit the nurse learns that an older patient with hypertension takes prescribed medications only when feeling tense. What instruction should the nurse provide to the patient? 1. Contact the physician for a change in blood pressure medication.2. Continue to administer the blood pressure medication as needed.3. Teach to take the blood pressure medication as prescribed regardless of feeling tense.4. Instruct to take a double dose of the medication for one day then resume the normal schedule.

Answer 79

3: Patients sometimes mistakenly take blood pressure medication only on an as-needed basis. This is incorrect and the patient should take the medication as prescribed on a daily basis.

Question 80

The nurse is planning care for an older patient with hypertension who recently fell in the home. Which assessment would the nurse plan for this patient? 1. Check serum sodium levels.2. Check serum creatinine levels.3. Check postural blood pressures.4. Check blood pressure every 2 hours.

Answer 80

3: Since baroreceptors are less efficient with aging, postural hypotension is more likely to occur. Also, patients treated for hypertension could have an increase in sensitivity to the medications. Postural blood pressure assessment allows the nurse to prevent postural hypotension and falls.

Question 81

The nurse is planning a presentation to a group of senior citizens on lifestyle modifications to manage high blood pressure. What major points will the nurse include in this presentation?Standard Text: Select all that apply.1. Keep sodium intake to 2.4 grams per day.2. Achieve and maintain a normal body mass index.3. Perform aerobic activity for 30 minutes most days of the week.4. Limit daily alcohol intake to two drinks for males and one drink for females.5. Consumption of fruits and whole grains has little impact on blood pressure.

Answer 81

1: One lifestyle modification is to keep sodium intake to 2.4 grams per day.2: One lifestyle modification is to achieve and maintain a normal body mass index.3: One lifestyle modification is to perform aerobic activity for 30 minutes most days of the week.4: One lifestyle modification is to limit daily alcohol intake to two drinks for males and one drink for females.

Question 82

An older patient who is prescribed doxazosin mesylate (Cardura) has a lying blood pressure of 124/76 mm Hg and a sitting blood pressure of 100/64 mm Hg. What additional observation is needed for this patient? 1. Fall risk2. Nausea and vomiting3. Decreased urine output4. Change in mental status

Answer 82

1: The patient's blood pressure values indicate postural hypotension. In addition, the patient is taking a medication that is an alpha blocker, which increases the risk for postural hypotension. Both factors would place the patient at a risk for falls.

Question 83

The nurse is providing discharge instructions for an older patient who is prescribed atorvastatin (Lipitor) for elevated cholesterol. What effects should the nurse advise the patient to report to the healthcare provider?Standard Text: Select all that apply.1. Headaches2. Stomachache3. Shortness of breath4. Muscle pain and weakness5. Bruising and excessive bleeding

Answer 83

2: Gastrointestinal distress is a side effect of statin medication and should be reported to the healthcare provider.4: Muscle pain and weakness is a side effect of statin medication and should be reported to the healthcare provider.

Question 84

An older patient has an increase in pitting edema of both ankles and is experiencing breathlessness. The patient is not experiencing any pain. What action should the nurse take to help the patient at this time? 1. Allow the patient to rest.2. Measure intake and output.3. Measure the patient's weight.4. Contact the physician for further evaluation and treatment.

Answer 84

4: The absence of chest pain in the older person does not indicate an absence of ischemic heart disease. Older adults can present with fatigue, weakness, shortness of breath, and gastrointestinal complaints. The nurse needs to contact the physician for further evaluation and treatment.

Question 85

An older patient with a history of atrial fibrillation has a fall at home and is diagnosed with a hemorrhagic stroke. What will the nurse assess to help determine the cause of this patient's bleeding?Standard Text: Select all that apply.1. Current INR2. Platelet level3. Liver function studies4. Hemoglobin and hematocrit5. Dose of warfarin sodium (Coumadin) taken at home

Answer 85

1: The INR is a laboratory test that measures the therapeutic level of anticoagulant medications and could indicate the cause of the patient's bleeding.5: Patients with atrial fibrillation are at risk for development of blood clots. A primary treatment is the use of anticoagulant drugs, such as warfarin sodium (Coumadin). Anticoagulant drugs place the patient at risk for hemorrhage, especially after a fall.

Question 86

An older patient asks the nurse what holistic actions can be used to help lower elevated cholesterol and triglyceride levels. What information should the nurse provide to the patient?Standard Text: Select all that apply.1. Increase dietary fiber.2. Eat fatty fish twice a week.3. Use margarine with phytosterols.4. Increase the intake of soy products5. Limit red meat consumption to 6 days a week.

Answer 86

1: The fiber found in oat bran, apples, citrus, and whole-grain products is particularly effective in reducing cholesterol.2: Consumption of fish oil and ingestion of omega-3 fatty acids also have been shown to reduce cholesterol levels prompting the recommendation by the American Heart Association that fatty fish be eaten at least two times a week.3: Phytosterols (plant sterols) are found in whole grains and many fruits and vegetables, and have the ability to interfere with the intestinal absorption of cholesterol. These products have been added to certain margarines and salad dressings, and the FDA has approved statements that consumption of these products may reduce the risk of coronary heart disease.4: Soybeans have been shown to lower LDL blood levels and triglycerides and thus lower the risk of developing coronary heart disease. Soy products can be incorporated into the diet by drinking soy milk, eating tofu, or eating any product made with soybeans. The FDA has allowed the statement that inclusion of soy products in a diet low in saturated fat and cholesterol promotes heart health.

Question 87

When teaching an older patient about the side effects of furosemide (Lasix), the nurse should instruct the patient to eat foods high in which mineral? 1. Iron2. Sodium3. Calcium4. Potassium

Answer 87

4: Lasix is a loop diuretic that depletes the potassium level. Patients who take potassium-depleting diuretics like Lasix should eat foods that replace the electrolyte.

Question 88

An older patient is diagnosed with heart failure. During the health history what will the nurse most likely assess as the patient's first symptom of the disorder? 1. Nausea2. Dyspnea3. Anorexia4. Headaches

Answer 88

2: Most heart failure symptoms include breathlessness or dyspnea.

Question 89

The nurse instructs an older patient with hypertension on ways to avoid the intake of sodium. Which food item should the patient state to avoid as an indication that instruction has been effective? 1. Onions2. Maple syrup3. Lemon juice4. Processed meats

Answer 89

4: Processed meats are high in sodium.

Question 90

An older patient being treated for hypertension experiences lightheadedness when getting up in the middle of the night to void and when making sudden movements. How should the nurse instruct this patient? 1. Restrict activity to 10 minutes a day.2. Increase caffeine intake to help increase blood pressure.3. Move slowly from a lying to a sitting position and then slowly from sitting to standing.4. Decrease fluid intake in the evening to prevent the need to get up in the middle of the night.

Answer 90

3: Patients taking antihypertensive medications should be instructed to change positions slowly. Rising too quickly from lying to standing position can result in pooling of blood in the extremities and reduced blood flow to the head. This can cause orthostatic hypotension, which is experienced as light headedness or syncope.

Question 91

An older patient is prescribed a beta blocker to treat hypertension. What effects will the nurse instruct the patient to report to the healthcare professional?Standard Text: Select all that apply.1. Fatigue2. Dry cough3. Dry mouth4. Cold extremities5. Exercise intolerance

Answer 91

1: Fatigue is a side effect of a beta blocker.4: Reduced peripheral circulation which can manifest as cold extremities is a side effect of a beta blocker.5: Exercise intolerance is a side effect of a beta blocker.

Question 92

An older patient with angina complains of prolonged and severe pain that occurs at the same time each day during rest. There are no precipitating factors to the pain. How should the nurse describe this type of angina pain? 1. Stable angina2. Unstable angina3. Non-anginal pain4. Atypical angina (Prinzmetal's angina)

Answer 92

4: Atypical or Prinzmetal's angina often occurs at the same time each day and typically at rest.

Question 93

The nurse anticipates that an older patient with right-sided heart failure would exhibit which symptoms?Standard Text: Select all that apply.1. Pallor2. Edema3. Wheezing4. Orthopnea5. Neck vein distention

Answer 93

2: Physical signs of right-sided heart failure include edema in the extremities.5: Physical signs of right-sided heart failure include dilated neck veins.

Question 94

The nurse is concerned that an older patient is at risk for metabolic syndrome. What did the nurse assess in this patient?Standard Text: Select all that apply.1. Heart rate 88 and regular2. Respiratory rate 18 and regular3. Waist circumference 40 inches4. Blood pressure 148/88 mm Hg5. Fasting capillary blood glucose 110 mg/dL

Answer 94

3: Women's waist circumference that is equal to or greater than 35 inches is a component to diagnose metabolic syndrome.4: Blood pressure equal to or greater than 130/85 mm Hg is a component to diagnose metabolic syndrome.5: Blood glucose equal to or greater than 100 mg/dL is a component to diagnose metabolic syndrome.

Question 95

An older patient is diagnosed with arterial peripheral vascular disease. What will the nurse assess in this patient?Standard Text: Select all that apply.1. Leg ulcers2. Pain with walking3. 40-year history of smoking4. Pain relieved when legs dangle5. History of working as a computer operator

Answer 95

2: Pain with walking is a symptom associated with arterial occlusion.3: Smoking is a risk factor for the development of arterial peripheral vascular disease.4: Pain relieved when dangling the legs is an indication of arterial peripheral vascular disease.

Question 96

During a home visit an older patient with heart disease tells the nurse of plans to shovel the snow as soon as the visit concludes. How should the nurse instruct the patient at this time? 1. Shovel the steps only.2. Avoid shoveling at this time.3. Shovel for 30 minutes at a time.4. Shovel for 10 minutes and then stop.

Answer 96

2: The older heart cannot respond to stressful stimuli as well as the younger heart. The patient should be cautioned not to engage in stressful activities like vigorous shoveling of snow without engaging in a gradual exercise program to build fitness.

Question 97

An older patient diagnosed with pneumonia does not understand why the health problem occurred since respiratory problems have never been experienced. How should the nurse respond to this patient?Standard Text: Select all that apply.1. Back joints are stiffer.2. Less oxygen is used with aging.3. Ciliary function decreases with age.4. Retention of carbon dioxide occurs with aging.5. Decreased immune function occurs with aging.

Answer 97

3: Ciliary function is decreased with aging, which makes the older person more susceptible to pneumonia.5: Decreased immune function occurs with aging and makes the older person more susceptible to pneumonia.

Question 98

An older patient with valvular disease is scheduled for an echocardiogram. What should the nurse teach the patient about this diagnostic test? 1. Determines the risk for metabolic syndrome2. Analyzes the reasons for high blood pressure3. Visualizes the heart valves as they open and close4. Measures the amount of blood flowing through arteries

Answer 98

3: An echocardiogram evaluates all heart valve function. This test allows the visualization of the valves as they open and close. Using this test, one can determine valve area, cardiac output, and any regurgitation.

Question 99

The nurse is planning care for an older patient with heart failure who is experiencing shortness of breath. Upon assessment the patient stated the inability to purchase medication because of financial limits. Which nursing diagnoses will be of the greatest initial importance when planning care? 1. Fluid Volume Excess2. Fatigue related to shortness of breath3. Activity Intolerance related to shortness of breath4. Ineffective Management of Therapeutic Regime related to inability to purchase medications

Answer 99

1: Although all diagnoses listed are appropriate for this situation, Fluid Volume Excess is the priority diagnosis for this patient.

Question 100

The nurse is planning to assess an older patient's functional health patterns for cardiovascular disease. Which question will the nurse use to assess the patient's nutrition/metabolic pattern? 1. "Do you sleep through the night?"2. "Do you weigh yourself every day?"3. "How often do you have a bowel movement?"4. "How far can you walk without getting short of breath?"

Answer 100

2: The question "Do you weigh yourself everyday?" would assess the patient's nutrition/metabolic pattern.

Question 101

Which change in the respiratory system of an older patient does the nurse recognize as an expected finding with aging? 1. Decrease in vital capacity2. Increase in alveolar surface area3. Decrease in stiffness of the chest wall4. Increase in the amount of oxygen carried in the blood

Answer 101

1: The aging process causes a decrease in the vital capacity or amount of air that moves in and out with each breath.

Question 102

Why will the nurse plan interventions to reduce an older patient's risk of developing a pulmonary disease? 1. There is an increase in alveolar diameter.2. The older patient has decreased production of antibodies.3. The older patient has an improved response to immunizations.4. The cilia of an older patient is more effective in removing debris from the airway.

Answer 102

2: With aging there is an increased susceptibility to pulmonary diseases because of a decrease in antibody production.

Question 103

An older patient who is having difficulty breathing and is wheezing is scheduled for a test to differentiate the health problem as being asthma or chronic obstructive pulmonary disease (COPD). For which diagnostic test should the nurse prepare the patient? 1. Chest x-ray2. Electrocardiogram3. Complete blood count4. Pulmonary function tests

Answer 103

4: Pulmonary function tests are the most reliable way to diagnose asthma and differentiate it from other illness such as COPD. Measurement of air during expiration is used in the differential diagnosis.

Question 104

What will the nurse keep in mind when planning care for an older patient diagnosed with asthma? 1. Asthma is not diagnosed as a new condition in older patients.2. Asthma is treated with the same types of medications in older patients as in younger patients.3. Older patients will have fewer side effects and drug interactions from asthma medications than younger patients.4. Asthma can be differentiated from chronic obstructive pulmonary disease (COPD) by changes seen on a series of chest x-rays.

Answer 104

2: The same types of medications are used to treat asthma in older adults as in younger adults.

Question 105

An older patient is prescribed an inhaled corticosteroid as part of treatment for asthma. What will the nurse instruct the patient about the use of this medication?Standard Text: Select all that apply.1. It can cause oral thrush or candidiasis.2. Use a spacer when taking this medication.3. It has no effect on any other health problems.4. Rinse the mouth and spit after using this medication.5. It is the most effective anti-inflammatory treatment for asthma.

Answer 105

1: Inhaled corticosteroids can cause oral thrush (candidiasis).2: Patients should be urged to use spacers with their metered-dose inhalers.4: Patients should be urged to rinse and spit after use of inhaled corticosteroids.5: Inhaled corticosteroid therapy is the most effective anti-inflammatory treatment for asthma.

Question 106

When should the nurse instruct an older patient with asthma to use a peak flow meter?Standard Text: Select all that apply.1. After eating dinner in the evening2. If feeling like cold symptoms are occurring3. When wheezing or tightness in the chest occurs4. In the morning after awakening and between noon and 2 p.m.5. Every day for the first 2 weeks when medication treatment changes

Answer 106

2: The nurse should instruct an older patient with asthma to use a peak flow meter with cold symptoms.3: The nurse should instruct an older patient with asthma to use a peak flow meter with chest tightness or wheezing.4: The nurse should instruct an older patient with asthma to use a peak flow meter in the morning after awakening and between noon and 2 p.m.5: The nurse should instruct an older patient with asthma to use a peak flow meter every day for the first 2 weeks when medication treatment changes.

Question 107

An older patient with asthma is prescribed rescue inhalers. What should the nurse instruct the patient about this medication?Standard Text: Select all that apply.1. Refrigerate unused canisters.2. Place the canisters near the bed.3. Label the canisters with bright red tape.4. Obtain a prescription for extra canisters.5. Keep several inhalers in different areas in the home

Answer 107

3: Patients who require the use of rescue inhalers should label them with bright red tape so they can be easily seen if needed quickly.4: Patients who require the use of rescue inhalers should obtain prescriptions for extra canisters.5: Patients who require the use of rescue inhalers should keep several inhalers in strategic places in the home.

Question 108

Which manifestation of chronic obstructive pulmonary disease (COPD) that occurs early in the disease will the nurse assess in an older patient? 1. Dysrhythmias2. Cyanotic nail beds3. Clubbing of the fingers4. Cough in the morning producing clear sputum

Answer 108

4: The earliest presenting symptom of COPD is morning cough with clear sputum unless the patient develops an infection. Then the sputum would become yellow or green in color.

Question 109

Which nursing diagnosis would the nurse select for an older patient with asthma that has a respiratory rate of 28 and audible wheezes on inspiration? 1. Activity Intolerance2. Altered Tissue Perfusion3. Ineffective Airway Clearance4. Ineffective Breathing Pattern with tachypnea and wheezing.

Answer 109

4: Ineffective Breathing Pattern is appropriate since this diagnosis is used if the patient is experiencing wheezing.

Question 110

What steps will the nurse follow when administering a two-step purified protein derivative (PPD) tuberculin skin test to an older patient?Standard Text: Select all that apply.1. Repeat the PPD test in 1 to 2 weeks.2. Measure the area of injection in 48 hours.3. Measure the area of injection in 72 hours.4. Administer 5 units of the BCG vaccination serum.5. Administer an injection of 0.1 mL of 5 TU intradermally.

Answer 110

1: When administering the two-step PPD tuberculin skin test to an older patient the nurse should administer an injection of 0.1 mL of 5 TU intradermally, measure the area of injection in 72 hours, and repeat the test in 1 to 2 weeks.3: When administering the two-step PPD tuberculin skin test to an older patient the nurse should administer an injection of 0.1 mL of 5 TU intradermally, measure the area of injection in 72 hours, and repeat the test in 1 to 2 weeks.5: When administering the two-step PPD tuberculin skin test to an older patient the nurse should administer an injection of 0.1 mL of 5 TU intradermally, measure the area of injection in 72 hours, and repeat the test in 1 to 2 weeks.

Question 111

What manifestations will the nurse assess in an older patient with active tuberculosis?Standard Text: Select all that apply.1. Weight loss2. Night sweats3. Ankle edema4. Bloody sputum5. Loss of appetite

Answer 111

1: Weight loss is an early symptom of tuberculosis.2: Night sweats are an early symptom of tuberculosis.4: Bloody sputum is a chronic symptom of tuberculosis.5: Loss of appetite is an early symptom of tuberculosis.

Question 112

What should the nurse instruct an older patient who is newly diagnosed with tuberculosis? 1. In the early stage, it causes weight gain and shortness of breath.2. It is caused by a virus related to human immunodeficiency virus (HIV).3. It can be spread by persons who have positive skin tests and no symptoms.4. It presents a higher risk for patients who take immunosuppressant medications.

Answer 112

4: A risk factor for developing tuberculosis is the use of medications that suppress the immune system, such as corticosteroids or anticancer medications.

Question 113

What should the nurse keep in mind when teaching an older patient about smoking cessation? 1. Most people quit smoking several times before they are successful.2. Bupropion (Zyban) taken orally is safe for patients with seizure disorders.3. A piece of nicotine gum should be chewed for 5 minutes of every waking hour.4. There is no adverse risk if the patient chooses to smoke while wearing a nicotine patch.

Answer 113

1: Nurses should be persistent in educating and urging older patients to quit. The smoking addiction is difficult to beat. Many older people try to quit several times before they are ultimately successful.

Question 114

Which manifestations should the nurse investigate as indicating possible pneumonia in an older patient?Standard Text: Select all that apply.1. Fever2. Dyspnea3. Tachycardia4. Behavior changes5. Substernal chest pain

Answer 114

2: Nonbacterial pneumonia may be accompanied by dyspnea.3: New-onset of tachycardia is an important clue to an illness with both viral and bacterial pneumonia.4: Subtle changes in behavior can indicate pneumonia in an older patient.5: Nonbacterial pneumonia may be accompanied by substernal chest pain.

Question 115

An older patient with chronic obstructive pulmonary disease (COPD) develops a dysrhythmia. Which health problem should the nurse consider is occurring with this patient? 1. Anemia2. Asthma3. Cor pulmonale4. Left ventricular hypertrophy

Answer 115

3: 3: In cor pulmonale the right ventricle enlarges and thickens, which can result in abnormal rhythms. Older patients with cor pulmonale suffer from rhythm disturbances and are at risk for heart failure.

Question 116

The nurse is caring for an older patient with chronic obstructive pulmonary disease (COPD) who is having difficulty clearing secretions from the respiratory tract. Which actions can the nurse take to help this patient?Standard Text: Select all that apply.1. Restrict oral fluids.2. Use postural drainage.3. Apply chest percussion.4. Teach controlled coughing.5. Perform tracheal suctioning.

Answer 116

2: Postural drainage uses gravity to force secretion upward and stimulates a cough reflex.3: Chest percussion loosens secretions.4: Controlled coughing contracts the diaphragm to maximize the cough response5: Tracheal suctioning is used to remove secretions in those who are too frail or near end of life.

Question 117

The nurse is preparing to use a peak flow meter for an older patient with asthma. For which reasons will the nurse use this device?Standard Text: Select all that apply.1. Evaluate effects of stress.2. Measure response to medications.3. Recognize the need for emergency care.4. Determine if medications need changed.5. Establish the presence of medication side effects.

Answer 117

1: The peak flow meter can alert the patient and the healthcare provider by evaluating the effects of stress.2: The peak flow meter can alert the patient and the healthcare provider by measuring the patient's response to medications.3: The peak flow meter can alert the patient and the healthcare provider by recognizing the need for emergency care.4: The peak flow meter can alert the patient and the healthcare provider by determining if medications need to be changed.

Question 118

An older patient asks the nurse what can be done to prevent a respiratory infection during the winter months. How should the nurse respond to this patient?Standard Text: Select all that apply.1. Stay active with daily exercise.2. Don't smoke and avoid secondhand smoke.3. Wash the hands often and get a flu vaccination.4. Eat a healthy diet and maintain a normal weight.5. Visit with a variety of people to build up immunity.

Answer 118

1: Tips to keep a healthy respiratory system include staying active with daily exercise.2: Tips to keep a healthy respiratory system include not smoking and avoiding secondhand smoke.3: Tips to keep a healthy respiratory system include frequent hand washing and getting a flu vaccination.4: Tips to keep a healthy respiratory system include eating a healthy diet and maintaining a normal weight.

Question 119

The nurse is preparing a care plan for an older patient with asthma. The patient is receiving oxygen and has a respiratory rate of 28, heart rate of 86, and blood pressure of 108/52. Which nursing diagnosis would be the priority for this patient? 1. Risk for Injury2. Risk for Infection3. Activity Intolerance4. Ineffective Peripheral Tissue Perfusion

Answer 119

4: Ineffective Peripheral Tissue Perfusion is the appropriate diagnosis for the patient with hypoxemia.

Question 120

When assessing an older patient with chronic obstructive lung disease (COPD) the nurse sees calluses on both of the patient's elbows. What does this finding indicate to the nurse? 1. The patient lifts weights.2. Use of the tripod position.3. An allergy to a medication.4. The patient falls frequently.

Answer 120

2: Older patients with COPD often have calluses on their elbows as a result of leaning over tables to stretch out their torsos so that more air can enter and exit during respiration. It is often referred to as the "tripod" position.

Question 121

What will the nurse instruct an older patient with asthma to do to control house dust?Standard Text: Select all that apply.1. Wash the hands frequently.2. Remove carpets from the bedroom.3. Reduce indoor humidity to less than 50%.4. Stay out of a room that is being vacuumed.5. Do not sleep or lie on upholstered furniture.

Answer 121

2: Removing carpets from the bedroom is an action to control house dust.3: Reducing indoor humidity is an action to control house dust.4: Staying out of a room that is being vacuumed is an action to control asthma symptoms caused by house dust.5: Avoiding upholstered furniture is an action to control house dust.

Question 122

The nurse is reviewing new medication orders for an older patient with asthma. Which medication should the nurse question before providing it to the patient? 1. Aspirin2. Antibiotic3. Anticoagulant4. Calcium channel blocker

Answer 122

1: Certain medications should be avoided when treating patients with asthma because adverse reactions can exacerbate asthmatic problems. Sudden, potentially life-threatening bronchospasm has been associated with aspirin use in older patients.

Question 123

An older patient is prescribed isoniazid (INH) for 6 months. What should the nurse instruct the patient about this medication? 1. Avoid vitamin supplements.2. Use alcohol in small amounts.3. Report yellow eyes or skin immediately.4. Expect the finger and toe tingling to occur.

Answer 123

3: Serious side effects of isoniazid include jaundice. The patient should report yellow eyes or skin immediately.

Question 124

The nurse has identified the diagnosis of Ineffective Airway Clearance for an older patient with pneumonia. Which intervention should the nurse include when planning care for this patient? 1. Chest percussion2. Limiting fluid intake3. Smoking cessation education4. Administering the pneumococcal vaccine

Answer 124

1: Chest percussion can help clear secretions.

Question 125

The nurse has instructed an older patient on ways to prevent the development of pneumonia. Which patient statement indicates further instruction is needed? 1. "I will get the influenza vaccine every year."2. "I will get the pneumococcal vaccine every fall."3. "I can't get the influenza vaccine due to my allergy to eggs."4. "I will get the pneumococcal vaccine as soon as I recover from this pneumonia."

Answer 125

The pneumococcal vaccine is administered once. Revaccination is only recommended in persons with renal failure, those who have had a splenectomy, those with malignancies, and those with HIV/AIDS.

Question 126

A Health Risk Assessment (HRA):a. is advised every 2-3 years for adults under age 70b. can be completed over the phone that is interactivec. is primarily focused on chronic diseasesd. must be conducted by either a physician or nurse practitioner.

Answer 126

B: can be completed over the phone that is interactive.

Question 127

It is especially important to evaluate the functional status of older adults:a. in their normal environment.b. because older adults under report symptoms.c. to help determine overall health status.d. to determine need for placement in long-term care

Answer 127

C: to help determine overall health status

Question 128

Which of these is an indicator of declining IADL performance:a. the patient ambulates with a caneb. the patient's daughter has begun to pay the monthly billsc. the patient wears a hearing aidd. the patient takes public transportation instead of driving

Answer 128

B: the patient's daughter has begun to pay the monthly bills

Question 129

In terms of fall risk, environmental hazards are classified as a :a. nonmodifiable intrinsic riskb. modifiable intrinsic riskc. nonmodifiable extrinsic iskd. modifiable extrinsic risk

Answer 129

D; modifiable extrinsic risk

Question 130

A diagnosis of Alzheimer Disease:a. can often be determined during the Annual Wellness Visit (AWV)b. is made using a standard assessment toolc. should incorporate an interprofessional approachd. should be assessed in a memory care unit

Answer 130

D: should be assessed in a memory care unit

Question 131

Depression in older adults:a. may accompany chronic medical conditionsb. can be a normal part of agingc. is frequently accompanied by overeatingd. is irreversible unless treated early

Answer 131

A: may accompany chronic medical conditions

Question 132

Which statement concerning frailty screening is accuratea. clinical findings are not useful predictors of frailtyb. a physical therapist should conduct the initial screeningc. the SHARE-FI tool has been validated for use in primary cared. Older adults may purposefully under report symptoms

Answer 132

D: Older adults may purposefully under report symptoms

Question 133

Which statement about nutrition in older adults is true:a. malnutrition is a natural consequence of agingb. weight loss of 5% in 6 months is clinically significantc. the Meals on Wheels mnemonic can identify risk for weight lossd. the Mini-Nutritional Assessment Short Form is a useful tool for primary care

Answer 133

D: the Mini-Nutritional Assessment Short Form is a useful tool for primary care

Question 134

Wounds without adequate vascular supply should bea. left uncoveredb. debrided frequentlyc. kept dryd. considered untreatable

Answer 134

C: kept dry

Question 135

The Braden Scale includes a subscale fora: medicationsb: skin temperaturec. blood pressuerd. nutrition

Answer 135

D: Nutrition

Question 136

Wet-to-dry dressings are recommended for:a. clean granulating chronic woundsb. full-thckness skin tearsc. wounds with necrotic tissued. wounds without exudate

Answer 136

C: wounds with necrotic tissue

Question 137

Adherent dressings are NOT indicated for skin tears because they:a. are very expensive to useb. cause contact irritationc. do not provide appropriate protectiond. damage healing skin during removal

Answer 137

D: damage healing skin during removal

Question 138

All patients at risk for PrUs should be:a. repositioned every 2 hoursb. repositioned on schedules influenced by their support surfacec. supported with viscoelastic foam mattressesd. seated on donuts at all times

Answer 138

B: repositioned on schedules influenced by their support surface

Question 139

The National Pressure Ulcer Advisory Pancel (NPUAP) recommendations supported by indirect evidence are characteried as:a. A levelb. B levelc. C leveld. unrated

Answer 139

C: C level

Question 140

A PrU with full-thickness tissue loss without visible tendon, muscle, or bone is classified as:a. stage Ib. stage IIc. stage IIId. Stage IV

Answer 140

C: stage III

Question 141

The criterion standard for treating venous ulcers is:a: adherent dressingsb: wet-to-dryc: hyperbaric oxygend: compression wraps

Answer 141

D: compression wraps

Question 142

The best choice for routinely cleaning chronic wounds is:a. sterile waterb. wound cleanserc. povidone-iodined. antiseptic solution

Answer 142

B: wound cleanser

Question 143

Predictable phases of the normal wound healing process include all of the following except:a. remodelingb. macerationc. proliferationd. inflammation

Answer 143

B: maceration

Question 144

A key role of a blood clot in the initiation of the wound healing process includes:a. inhibiting bacterial adhesionb. improving inflammatory responsec. acting as a reservoir of growth factorsd. stimulating angiogenesis within a wound

Answer 144

C: acting as a reservoir of growth factors

Question 145

With topical application, Solanum xanthocarpum demonstrated increased:a. scar formationb. wound epithelializationc. ischemia activityd. anti-inflammatory activity

Answer 145

B: wound epithelialization

Question 146

North American cranberry phytochemicals of key interest to researchers include:a. tanninsb. saponinsc. ellagic acidd. Madhu ghrita

Answer 146

C: ellagic acid

Question 147

Cranberry extracts appear to have inhibitory effects on tissue adhesion by:a. virusesb. gram-negative bacteriac. gram-positive bacteriad. protozoa

Answer 147

B: gram-negative bacteria

Question 148

A Study by Shivananda et al found that wounds treated with cranberry or grape extracts exhibited:a. no difference in healing from the control groupb. a significant reduction in surface areac. erosion of granulation tissued. less hydroxyproline content in excised granulation tissue

Answer 148

B: a significant reduction in surface area

Question 149

Fruit extracts may have a positive effect on chronic wounds through:a. pH modulationb. creating alkaline wound fluidc. formation of a blood clot in woundd. stimulation of protease activity

Answer 149

A: pH modulation

Question 150

Data from small in vitro studies suggest that phytochemicals can exert a positive effect on all of the following except:a. VEGF expressionb. protein degradationc. wound contractiond. granulation tissue formation

Answer 150

B: protein degradation

Question 151

Concern over infections caused by Clostridium difficile has increased because of which of the following:a. the mortality rate for infections caused by this organism is greater than 80%b. new hypervirulent strains of the organism have recently been identifiedc. the annual cost of hospital-acquired C difficile infection s (CDIs) is about $200 milliond. there is a lack of effective treatment options for CDIs

Answer 151

B: new hypervirulent strains of the organism have recently been identified

Question 152

Which of the following statements is INCORRECT regarding the incidence of CDIsa. C difficile causes more than 500,000 infections each yearb. the severity of illness associated with CDI has increasedc. the majority of CDI are community acquired in origind. mortality for CDI is greater than that for all other coded admissions

Answer 152

C: the majority of CDIs are community acquired in origin

Question 153

The increased virulence associated with the NAP-1/027 strain of C dificile is believed to result from which of the following:a. lower rates of germination that occur in this strainb. its ability to produce large amounts of toxins A and Bc. mutation of a gene responsible for enhancing toxin transcription during bacterial growthd. its higher resistance to antifungal agents

Answer 153

B: Its ability to produce large amounts of toxins A and B

Question 154

Which of the following statements describes the association between CDIs and the use of antibiotics:a. Only the use of fluoroquinolones and cephalosporins has been linked to CDIb. Antibiotic use alters normal gastrointestinal flora and facilitates proliferation of C difficilec. The greatest risk for CDI occurs within 1 month of receiving a/an antibiotic(s)d. Immunosuppression and the use of proton pump inhibitors pose a greater risk for CDI than do antibiotics

Answer 154

B: Antibiotic use alters normal gastrointestinal flora and facilitates proliferation of C difficile

Question 155

Clinical manifestations of complicated CDI, or fulminant colitis, may include all except which of the following:a. Severe abdominal pain and worsening diarrheab. Hypotension requiring vasopressor supportc. Decreased white blood cell count and elevated lactate levelsd. respiratory failure requiring intubation

Answer 155

C: Decreased white blood cell count and elevated lactate levels

Question 156

Which of the following statements is correct regarding laboratory diagnosis of C difficile:a. can be accomplished with a number of different laboratory testsb. should be confirmed according to strict guideline criteriac. can be performed on any type of stool specimend. is best validated through an anaerobic culture

Answer 156

A: can be accomplished with a number of different laboratory tests.

Question 157

Which of the following describes recommendations for hand hygiene when caring for patients with CDIa. Alcohol-based gels are more effective than soap and water for killing C difficile sporesb. Han hygiene should be performed frequently with either an alcohol-based gel or soap and waterc. Hand hygiene should be performed with soap and water to effectively remove C difficile sporesD. Alcohol-based gel is effective, but a full 3 mL of gel should be used for each application

Answer 157

C: Hand hygiene should be performed with soap and water to effectively remove C difficile spores

Question 158

Which of the following is incorrect regarding medical management of CDIa. oral metronidazole is typically recommended for mild to moderate CDIb. oral vancomycin is preferred for severe cases of CDIc. fidaxomicin (Dificid) is effective, but not commonly used as a first-line therapyd. patients with CDI complicate by ileus should receive intravenous vancomycin

Answer 158

D: patients with CDI complicate by ileus should receive intravenous vancomycin

Question 159

Which of the following statements describes the use of fecal transplant in the setting of CDI?a. studies have shown resolution of CDI in 81%-92% of treated patientsb. significant adverse effects may outweigh the benefits of this treatment optionc. only stool from a blood relative can be used for transplantd. this treatment is now advocated as a first-line therapy for CDI

Answer 159

A: studies have shown resolution of CDI in 81%-92% of treated patients

Question 160

Problems with oral health are associated with which of the following:a. cardiovascular disease, poor glycemic control, and preterm deliveryb. upper respiratory infections, pneumonia, and gastroesophageal reflux disease (GERD)c. endocarditis, lupus, and poor glycemic controld. cardiovascular disease, GERD, and endocarditis

Answer 160

A: cardiovascular disease, poor glycemic control, and preterm delivery

Question 161

Which of the following organisms is associated with increased risk for development of endocarditis in animal models:a. Escherichia colib. Streptococcus mutansc. Staphylococcus epidermidisd. Streptococcus salivarius

Answer 161

B: Streptococcus mutans

Question 162

In the mid-1990s, prior to implementation of bundles to prevent ventilator-associated pneumonia (VAP), the mortality rate for VAP was which of the following:a. 3% to 65%b. 25% to 30%c. 50% to 78%d. More than 80%

Answer 162

A. 3% to 65%

Question 163

Which of the following is one method to reduce microorganisms in the oral cavity:a. direct application of pharmacological agentsb. frequent suctioning of the oral cavityc. administration of intravenous antibioticsd. keep the head of the bead at 30 degrees

Answer 163

A: direct application of pharmacological agents

Question 164

Which of the following is the estimated number of different types of microorganisms harbored by the oral cavity:a. 200 to 300b. 500 to 800c. 700 to 1000d. 850 to 1500

Answer 164

C; 700 to 1000

Question 165

The montessori method helps engage adults with dementia by using activities that build self-esteem and use:a. behavior modificationb. classical conditioningc. fine motor skillsd. gross motor skills

Answer 165

C: fine motor skills

Question 166

To help keep patients with dementia engaged, try to make every activity:a. abstractb. intuitivec. meaningfuld. colorful

Answer 166

C: meaningful

Question 167

When using the Montessori method for patients with dementia, nurses should focus on the activity's:a. processb. final productc. complexityd. value

Answer 167

A: process

Question 168

Montessori techniques help decrease the emotional burden on families by redirecting the patient into behavioral interactions that are:a. intuitiveb. practicalc. repetitived. positive

Answer 168

D: positive

Question 169

Which activity is NOT recommended to provide relaxation for patients with dementia in the acute care setting:a. viewing family photo albumsb. listening to music from the patient's youthc. playing with cardsd. playing simple board games

Answer 169

A: viewing family photo albums

Question 170

The MIND at home project has shown a retention rate in the home setting at the end of 18 months of:a. 70%b. 75%c. 80%d. 85%

Answer 170

A: 70%

Question 171

The goal of dementia care activities is to improve participatory engagement and:a. behavioral functionb. motor skillsc. social interactionsd. cognitive function

Answer 171

C: social interactions

Question 172

What psychological stress is uniquely associated with arterial ulcers:a. 2-to-4 fold increase in likelihood of dyingb. likelihood of permanent immobilityc. potential risk of amputationd. fear of unmanageable pain

Answer 172

C: potential risk of amputation

Question 173

What is the minimum transcutaneous oxygen pressure required for arterial ulcers to heal:a. 0 to 10 mm Hgb. 15 to 20 mm Hgc. 30 to 40 mm Hgd. > 50 mm Hg

Answer 173

C: 30 to 40 mm hg

Question 174

In patients with Raynaud disease, pentoxifylline increases tissue perfusion by:a. increasing permeability of hemoglobin cellsb. facilitating red blood cells deformability to oxygenc. dilating peripheral capillariesd. preventing adherence of platelets to vessel walls

Answer 174

B: facilitating red blood cells deformability to oxygen

Question 175

Which statement about the use of povidone-iodine, chlorhexidine, hydrogen peroxide, and acetic acid is accurate:a. they chemically debride the wound and promote epithelial growthb. they interfere with fibroblast formation and epithelial growthc. they effectively eliminate pathogens and protect the wound from infectiond. they should be reserved for wounds with the best chance of healing.

Answer 175

B: they interfere with fibroblast formation and epithelial growth

Question 176

For an ulcer with unknown adequacy of blood supply, the dressing chosen should have all the following except:a. providing compressionb. bacteria reducingc. moisture reducingd. nonadhering

Answer 176

A: providing compession

Question 177

The patient's resistance to infection depends on the:a. patient's overall nutritional statusb. speed of epithelialization of the woundc. quality of collateral circulationd. partial pressure of oxygen in the wound

Answer 177

D: partial pressure of oxygen in the wound

Question 178

Using the STONEES mnemonic, a minimum of how many signs must be present to justify antimicrobial treatment:a. 6b. 3c. 4d. 5

Answer 178

b: 3

Question 179

Endovascular revascularization methods are excluded for which type of peripheral vascular lesion:a. TASC Ab. TASC Bc. TASC Cd. TASC D

Answer 179

D: TASC D

Question 180

What is the most reliable delivery system for lower concentrations of oxygen:a. oronasal maskb. nasal cannulac. Venturi maskd. nonrebreather mask

Answer 180

C: Venturi mask

Question 181

Compared with $3.8 billion for institutionalized women, the costs of UI for community-dwelling women, according to Wilson and colleagues, were:a. $5.1 billionb. $6.3 billionc. $7.5 billiond. $8.6 billion

Answer 181

D: $8.6 Billion

Question 182

Urinary Incontinence (UI) is defined as:a. the total loss of urine at least once per dayb. a consistent inability to control the flow of urinec. the total loss of urine at least twice per weekd. any involuntary loss of urine

Answer 182

D: any involuntary loss of urine

Question 183

Functional incontinence is the loss of urine due to:a. sphincter weaknessb. urethral laxityc. decreased mobilityd. reduced bladder capacity

Answer 183

C: decreased moblity

Question 184

Which of the following is an appropriate initial approach to treating UI:a. Pharmacologic therapyb. surgical interventionsc. protective clothingd. diet and fluid management

Answer 184

D: Diet and fluid management

Question 185

The goal for normal voiding patterns is to achieve:a. three to four daytime voids and only one nighttime voidb. three to four daytime voids and one or two nighttime voidsc. five to seven daytime voids and no more than one to two nightime voidsd. five to seven daytime voids and no nighttime voids

Answer 185

C: Five to seven daytime voids and no more than one to two nightime voids

Question 186

Risk factors for UI include all the following except:a. increased estrogenb. constipationc. tobacco used. asthma

Answer 186

A: Increased estrogen

Question 187

Susceptibility to postural hypotension occurs in the older adult because:a. baroreceptors respond to quickly to drops in BPc. Blood Pressure drugs act fasterc. excess beta-receptors react more quickly to antihypertensive drugsd. peripheral vasculature does not respond quickly

Answer 187

D: peripheral vasculature does not respond quickly

Question 188

Drug excetion via the lungs in the older adult is affected by the:a. decrease in redisual volumeb. increase in tidal volumec. reduction of waste product product diffused from pulmonary capillariesd. increase in alveolar surface area and decreased residual volume

Answer 188

C: reduction of waste product diffused from pulmonary capillaries

Question 189

An aging liver in the older adult affects drugs by:a. increasing metabolic actionb. prolonging bioavailabilityc. diminishing effectivenessd. inhibiting mechanism of action

Answer 189

B: prolonging bioavailability

Question 190

Which statement about water-soluble drugs is true:a. Water-soluble drugs are not likely to be affected by age-associated changesb. They need to be bound to protein to be effectivec. They lose their potency because of the older adult's high percentage of body waterd. They may achieve higher serum concentrations

Answer 190

D: They may achieve higher serum concentrations

Question 191

In the older adult, drugs may not reach targeted organs because:a. water, now a greater part of body composition dilutes the drugb. tissues may not be well perfusedc. lean muscle mass slows drug distributiond. increased numbers of fat cells diminish the effect of water-soluble drugs

Answer 191

B: Tissues may not be well perfused

Question 192

In comparison to younger people, intramuscular injections in the older adult are:a. absorbed faster because of changes in peripheral blood flowb. absorbed more thoroughly because of decreased muscle massc. not absorbed as well because of decreased peripheral blood flowd. absorbed more slowly because of deceased muscle mass

Answer 192

C: not absorbed as well because of decreased peripheral blood flow

Question 193

One paradox about polypharmacy in the older adult is the:a. influence of pharmaceutical company advertisementsb. healthcare provider addressing too many chronic conditions simultaneouslyc. prescribing of too many quickly absorbed drugsd. likeliness of missing an indicated drug

Answer 193

D: likeliness of missing an indicated drug

Question 194

The simplified Nutritional Appetite Questionnaire is used by the clinician in the long-term-care(LTC) facility to determine the residents risk for:a. proein deficiencyb. significant weight gainc. significant weight lossd. vitamin and mineral deficiencies

Answer 194

C: significant weight loss

Question 195

The clinician assesses an older adult resident in the nursing home for sarcopenia. The clinician is aware that in sarcopenia the decline in skeletal muscle mass is:a. equal in women and in menb. greater in men than in womenc. greater in women than in mend. primarily due to a lack of growth hormone in older adults

Answer 195

B: Greater in men than in women

Question 196

Ms C. has sarcopenia obesity. Because it is an independent risk factor, the clinician realizes that Ms C. should be assessed for:a. anemiab. skin cancerc. type 2 diabetesd. Parkinson disease

Answer 196

C: type 2 diabetes

Question 197

Which daily protein intake would be indicated for a patient with sarcopenia:a. 0.8 g/kg per day divided equally between 3 mealsb. 0.8 g/kg per day eaten predominately at the midday mealc. 1.0 to 1.5 g/kg day divided equally between 3 mealsd. 1.0 to 1.5 g/kg day eaten predominately at the midday meal

Answer 197

C: 1.0 to 1.5 g/kg day divided equally between 3 meals

Question 198

An older adult Mexican American man resides at home with his wife. He has a pressure ulcer and consumes a typical Mexican diet. The clinician recommends that he increase his intake of:a. orangesb. beansc. cornd. rice

Answer 198

b: beans

Question 199

Because of its association with malnutrition and AD, the clinician orders diagnostic studies for:a. regulation of the pituitary glandb. rheumatoid arthritisc. renal impairmentd. respiratory disorder

Answer 199

C: renal impairment

Question 200

The staff at the LTC facility is trying to increase Ms K's independence with eating due to her diagnosis. They provide her with:a. liquid supplementsb. sweet foodsc. finger foodsd. pureed foods

Answer 200

C: finger foods