Geriatrics 6 Flashcards
Which assessment finding is considered a normal change in an older patient’s hematological system?
- Mild anemia
- Decrease in lymphocyte function
- Decrease in platelet adhesiveness
- Increased number of stem cells in the bone marrow
2: Changes in the hematologic system that occur with aging include a decrease in the functioning of lymphocytes, including cellular immunity.
While completing an assessment the nurse is concerned that an older patient is experiencing anemia. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. Pallor 2. Joint pain 3. Respiratory rate 14 4. Pulse 68 and regular 5. Dyspnea on exertion
1: Manifestations of anemia in an older patient include pallor.
2: Manifestations of anemia in an older patient can include joint pain.
5: Dyspnea on exertion is a manifestation of anemia in an older patient.
An older patient with chronic renal failure is exhibiting manifestations of anemia. Why is this occurring in the patient?
- The result of renal dialysis
- Loss of the kidney hormone erythropoietin
- Loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels
- Loss of blood through the urine because the failing kidney does not function properly
2: Anemia associated with renal failure is related to the loss of erythropoietin, which is produced by the healthy kidney and stimulates bone marrow to produce red blood cells.
An older patient is diagnosed with hemolytic anemia. What will the nurse teach the patient about this disorder?
- It is caused by blood loss.
- It will be treated with folic acid.
- It causes the red blood cells to be misshaped.
- It is associated with a drop in the number of immature red blood cells produced.
2: All hemolytic anemias require treatment with folic acid because this vitamin is consumed by the increased bone marrow production of red blood cells in response to the anemia.
Which age-related change increases an older patient’s risk for pernicious anemia?
- Laxative dependency
- Increased incidence of cholelithiasis
- Decreased hydrochloric acid in the stomach
- Decreased peristalsis in the gastrointestinal tract
3: Pernicious anemia results when an older person lacks the needed intrinsic factor to absorb vitamin B12. A more common cause of low serum vitamin B12 results from the inability to split vitamin B12 from proteins in food. This inability may be the result of a deficiency of hydrochloric acid.
What will the nurse most likely assess in an older patient with a vitamin B12 deficiency? Standard Text: Select all that apply. 1. Ataxia 2. Imbalanced walking 3. Nausea and vomiting 4. Cognitive impairment 5. Peripheral neuropathy
1: The signs and symptoms of vitamin B12 deficiency include neurologic changes such as ataxia.
2: The signs and symptoms of vitamin B12 deficiency include neurologic changes such as difficulty walking and maintaining balance.
4: The signs and symptoms of vitamin B12 deficiency include mental status changes and cognitive impairment.
5: The signs and symptoms of vitamin B12 deficiency include neurologic changes such as peripheral neuropathy manifested as numbness and tingling in the extremities.
An older patient is prescribed a blood transfusion of two units packed red blood cells. What should the nurse do when providing the blood to this patient?
Standard Text: Select all that apply.
1. Premedicate with an antihistamine.
2. Administer each unit over 2 to 4 hours.
3. Provide a diuretic between the two units as prescribed.
4. Carefully assess the intravenous access site for infiltration.
5. Monitor vital signs and urine output during the transfusion.
2: Transfusions for older people should be given slowly over a 2 to 4 hours period.
3: If several units of packed cells are to be infused often a diuretic is provided between units to prevent fluid overload and congestive heart failure.
4: Older people have more fragile veins. The intravenous site should be frequently assessed for signs of infiltration.
5: Because of the risk of heart failure from fluid overload the nurse should monitor the older patient’s vital signs and urinary output during the transfusion process.
The healthcare provider determines that an older patient is at risk for a stroke. Which medication will the nurse prepare to administer to this patient?
- Aspirin
- Warfarin
- Ibuprofen
- Low-molecular-weight heparin therapy
1: Aspirin irreversibly inhibits platelet aggregation by blocking enzymes in the clotting process and impairing prostaglandin metabolism. Aspirin is used for primary and secondary prevention of myocardial infarction and stroke.
The nurse is reviewing assessment data collected during a routine physical examination. Which finding should be investigated as a pathological process of the hematologic system?
- WBC: 9000
- Enlarged spleen
- Hemoglobin: 15.0%
- Pulse rate 86 beats per minute
2: An enlarged spleen is not a normal assessment finding and should be investigated further.
An older patient is diagnosed with thalassemia. How will the nurse instruct the patient about this diagnosis?
Standard Text: Select all that apply.
1. There is no specific treatment.
2. Iron therapy is the best treatment.
3. A folate supplement may be prescribed.
4. Sulfonamides might need to be avoided.
5. It is an inherited disorder that can go undiagnosed until later in life.
1: There is no specific treatment for thalassemia.
3: It is recommended that a folate supplement be taken.
5: Thalassemia is an inherited disorder and most undiagnosed adults will have the disease in a milder form that may go undiagnosed until later in life.
A patient is prescribed warfarin (Coumadin) for chronic atrial fibrillation. Which laboratory value will be used to monitor the effects of this medication?
- Platelet count
- Hematocrit and hemoglobin
- Partial thromboplastin time (PTT)
- PT reported as international normalized ratio (INR)
4: The PT, a measure of the time required for a firm fibrin clot to form after reagents have been added to the blood sample, is the standard measure of efficacy. It is commonly reported in an international normalized ratio (INR) because the World Health Organization urged the adoption of a standardized reagent so that all laboratories would report standardized results. Warfarin will prolong the INR.
The nurse has completed a physical assessment with an older patient. Which assessment finding suggests the presence of deep-venous thrombosis?
- Two plus palpable pedal pulses
- Shortness of breath after activity
- Swelling in one leg with pitting edema
- Bilateral calf tenderness after walking up a flight of stairs
3: The hallmark of DVT is the rapid onset of unilateral leg swelling with pitting edema.
An older patient receiving warfarin (Coumadin) alternate doses of 2.5 mg/5 mg has an INR of 6.3. What care should the nurse anticipate that this patient will need?
Standard Text: Select all that apply.
1. Prepare to begin a heparin infusion.
2. Administer vitamin K as prescribed.
3. Administer protamine sulfate as prescribed.
4. Withhold several doses of prescribed warfarin.
5. Administer an additional dose of warfarin as prescribed.
2: Vitamin K is the antagonist for warfarin and will most likely be prescribed for the patient. For INRs between 5 and 9 the recommendation may be to administer vitamin K 1.0 to 2.5 mg by mouth.
4: For INRs between 5 and 9, the recommendation may be to omit the next several doses of warfarin.
An older patient is diagnosed with polycythemia vera. What care will this patient most likely be prescribed? Standard Text: Select all that apply. 1. Ticlopidine 2. Splenectomy 3. Hydroxyurea 4. Chemotherapy 5. Periodic phlebotomy
3: In polycythemia vera, hydroxyurea can decrease the risk of thrombosis.
5: Periodic phlebotomy significantly decreases the risk of thrombosis.
Which assessment finding would the nurse expect to find in an older patient suspected of having non-Hodgkin’s lymphoma?
- Pitting edema in one leg
- Ataxia and difficulty with walking
- Severe bone pain in the lower back
- Enlarged lymph nodes in the neck area
4: In non-Hodgkin’s lymphoma, the normal lymphoid tissue is replaced by malignant cells leading to infection and immunodeficiency. Symptoms include cervical lymph node enlargement.
