Geriatrics 1 Flashcards
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
2: With age, gums tend to recede leaving the newly exposed area of the teeth below the previous gum line vulnerable to tooth decay.
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
3: Clusters of vesicles with eroded centers and ulcers on the lips and mucosa can indicate the presence of herpes simplex or zoster.
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.
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.
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
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.
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
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.
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.
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.
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.
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.
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.
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.
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.”
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.
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
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.
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.
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.
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.
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.
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
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.
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
3: Smoking cigarettes greatly increases the risk of periodontal disease and lowers the chances of success of dental treatments.
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
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.
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.
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.
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.”
3: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients.
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.
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.
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
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.
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.”
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.
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.
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.
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.
4: Dental assessments and cleaning should be performed two times per year.
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.”
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.
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.”
4: Oral cancer may affect sun-exposed areas of the face and mouth.
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.”
2: Bleeding gums may be associated with a deficiency of vitamins C or K. Orange juice will provide vitamin C.
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.
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%.
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.
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.
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
3: Smoking is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.
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
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.
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.”
3: Blurred vision can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus.
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.
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.
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.
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.
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.
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.
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
4: Metformin should not be used by older adults with renal insufficiency.
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.
1: Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing.
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
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.
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
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.
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
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.
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
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.”
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.
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
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.
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”
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.
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
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.
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.”
4: With aging the body gradually reduces the production of insulin.
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.”
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.
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.
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.
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
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.
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.
3: Clostridium difficile can be the cause of diarrhea in an older patient who has recently completed antibiotic use.
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
1: Changes in the gastrointestinal system that occur with the aging process include a decrease in esophageal motility.
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.
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.
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
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.
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
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.
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.
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.
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
2: Histamine blocker medications, such as ranitidine (Zantac), act by reducing acid production by blocking the histamine-2 receptor in the stomach.
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
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.
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
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.
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
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.
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
4: An abdominal computerized tomography (CT) scan will most likely be obtained to assess colonic wall thickness and extra luminal structures for suspected diverticulitis.
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.
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.
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.
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.
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
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.
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
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.
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
4: Milk of Magnesia is an over-the-counter option to manage gastroesophageal reflux and acts to provide a buffer for the gastric pH.
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
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.
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.
2: The first signs of peptic ulcer disease may be serious gastrointestinal bleeding episodes requiring emergency evaluation, treatment, and transfusion.
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.
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.
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.
1: Alcohol stimulates gastric acid secretion which can contribute to the development of peptic ulcers.
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.
3: All older adults with chronic pancreatitis must refrain from drinking alcohol.
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.
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.
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.
1: Soluble fiber (Metamucil) adds bulk to the stool and is sometimes helpful to slow bowel movements in people requiring bulk.
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
3: Many older women will complain of vague symptoms when having a myocardial infarction, including fatigue, sleep disturbances, and epigastric pain.
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
4: New onset atrial fibrillation and other arrhythmias may signal the onset of a serious underlying illness that requires further medical evaluation.
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.
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.
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.
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.
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.
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.
