Geriatrics 7

Question 1

The nurse is assessing a frail older patient in a skilled facility. Which manifestations should the nurse consider as expected for this patient?
Standard Text: Select all that apply.
1. Low energy
2. Poor endurance
3. Energetic gait speed
4. Low activity tolerance
5. Generalized weakness

Answer 1

1: In the older patient a characteristic of frailty is low energy.
2: In the older patient a characteristic of frailty is poor endurance.
4: In the older patient a characteristic of frailty is low activity tolerance.
5: In the older patient a characteristic of frailty is generalized weakness.

Question 2

The nurse is planning care for an older patient to prevent the geriatric cascade. What causes this cascade to occur in older patients?
Standard Text: Select all that apply.
1. Frailty
2. Acute illness
3. Institutional care
4. Lack of health insurance
5. Poor appetite and malnutrition

Answer 2

1: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. Frailty is a characteristic of this phenomenon.
2: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. Acute illness is a characteristic of this phenomenon.
3: An older patient can suffer a rapid decline and decompensation as a result of an acute illness or worsening of a chronic condition. The phenomenon of decline is the geriatric cascade and results from the interaction of characteristics. Institutional care is a characteristic of this phenomenon.

Question 3

The nurse manager is concerned about the increased number of medication adverse effects being observed in older patients. What should the manager do to reduce these effects?
Standard Text: Select all that apply.
1. Conduct a quality improvement study every month.
2. Monitor each nurse’s ability to detect preparation errors.
3. Emphasize the importance of not missing medication doses.
4. Review Pharmacy documentation regarding drug–drug interactions
5. Ensure that the physicians’ orders are being inputted into the computer correctly.

Answer 3

2: Adverse drug events can result from preparation errors.
3: Adverse drug events can result from missed medication doses.
4: Adverse drug events can result from drug–drug interactions.
5: Adverse drug events can result from illegible orders.

Question 4

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

1. Invasive testing
2. Pain management
3. Aggressive chemotherapy
4. Aggressive invasive surgery

Answer 4

2: Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain.

Question 5

The nurse is planning to use the Hospital Admission Risk Profile (HARP) to assess an older patient's risk for developing problems while hospitalized for an acute illness. Which areas are used to assess risk?
Standard Text: Select all that apply.
1. Age
2. Manual dexterity
3. Cognitive function
4. Ability to self-feed
5. Independence with ADLs

Answer 5

1: The HARP uses age to help determine an older patient’s risk for problems while hospitalized.
3: The HARP uses cognitive function to help determine an older patient’s risk for problems while hospitalized.
5: The HARP uses independence with ADLs to help determine an older patient’s risk for problems while hospitalized.

Question 6

For which reasons is a frail older patient more at risk for poor treatment outcomes in an acute care setting?
Standard Text: Select all that apply.
1. Nosocomial infections
2. Iatrogenesis of therapeutic interventions
3. Diagnoses of vague symptoms and problems
4. Assessment of the effects of acute illness on diagnosed chronic illnesses

Answer 6

1: Nosocomial infections are considered complications of hospitalizations and can contribute to poor treatment outcomes in a frail older patient.
2: Careful monitoring of the older person’s status and effectiveness of the overall plan of care is indicated because frail older adults with poor function are at increased risk of iatrogenesis or adverse outcomes of therapeutic interventions.

Question 7

A frail older patient with cognitive impairment develops a urinary tract infection. Which manifestation should the nurse expect when assessing this patient?

1. Flank pain
2. High fever
3. Hypertension
4. Increased confusion

Answer 7

4: A person with a mild cognitive impairment who develops a urinary tract infection might become more confused as a result of the infection. This confusion may limit the older person’s ability to recognize or communicate the urinary symptoms. As a result, the urinary tract infection may go undiagnosed or untreated.

Question 8

Which action should the nurse recommend to a patient to promote living to a healthy older age?

1. Limit smoking.
2. Decrease nutritional intake.
3. Increase physical inactivity.
4. Use recommended preventive health services.

Answer 8

4: Americans can improve their chances for a healthy old age by simply taking advantage of recommended preventive health services and by making healthy lifestyle changes. About 70% of the physical decline that occurs with aging is related to modifiable factors such as smoking, poor nutrition, physical inactivity, and failure to use preventive and screening services.

Question 9

An older patient with diabetes is prescribed high dose antibiotic therapy for a wound infection. For which effects of antibiotic therapy should the nurse assess the patient?

1. Diarrhea
2. Constipation
3. Nausea and vomiting
4. Increased urine output

Answer 9

1: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism. These higher doses place the person at risk for medication side effects and drug interactions, including development of antibiotic-associated diarrhea.

Question 10

The nurse is concerned that an older patient with a chronic illness is on a trajectory towards frailty and dependence. What did the nurse assess in this patient?

1. Ability to halt progression of chronic disease manifestations
2. Osteoarthritis causing more difficulty than cognitive impairment
3. Family that phones several times a day and visits every weekend
4. Limited health insurance coverage that does not include a pharmacy plan

Answer 10

4: Limited health insurance coverage that does not include a pharmacy plan will place the patient on a trajectory towards frailty and dependence. Older patients with chronic illnesses need these resources to have better outcomes.

Question 11

A multidisciplinary team in a long-term care facility is meeting with the family of a frail older patient to discuss care issues and concerns. Which are key issues that should be addressed in the conference?
Standard Text: Select all that apply.
1. Consistency with policy
2. The patient’s preferences
3. Avoidance of doing harm to the patient
4. Focus on cost-effective methods
5. The needs and wishes of the family

Answer 11

1: The provision of care for the seriously ill long-term care resident should be consistent with accepted public policy.
2: The provision of care for the seriously ill long-term care resident should honor the resident’s preferences.
3: The provision of care for the seriously ill long-term care resident should not inflict undue burden or harm to the resident without a reasonable chance of success.
5: The provision of care for the seriously ill long-term care resident should reflect the needs and wishes of families.

Question 12

An older patient is demonstrating delirium since being admitted from a nursing home for treatment of a wound infection. What should the nurse identify as a cause for the patient’s delirium?

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

Answer 12

3: Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium.

Question 13

An older patient admitted for treatment of pneumonia has severe osteoarthritis. Which assessment finding indicates to the nurse that the patient may be on a trajectory towards frailty?

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

Answer 13

3: Signs of frailty in an older person with musculoskeletal problems may include decreased stamina and physical deconditioning.

Question 14

The nurse is planning a presentation for nursing assistants on caring for older patients. Which criteria should the nurse include when explaining frailty?
Standard Text: Select all that apply.
1. Slowness
2. Low activity
3. Short-term memory loss
4. Weakness and exhaustion
5. Unplanned weight loss of at least 10 lbs. in a year

Answer 14

1: Frailty has been defined as the presence of three or more specific criteria which include slowness.
2: Frailty has been defined as the presence of three or more specific criteria which include low activity.
4: Frailty has been defined as the presence of three or more specific criteria which include weakness and exhaustion.
5: Frailty has been defined as the presence of three or more specific criteria which include an unplanned weight loss of at least 10 lbs. in one year.

Question 15

An older patient with chronic renal failure is admitted for treatment of pneumonia. The healthcare provider is planning modified interventions for this patient. What should the nurse expect that this patient will receive while hospitalized?
Standard Text: Select all that apply.
1. Symptom control
2. Pain management
3. Noninvasive testing
4. Medication adjustments
5. Minimally invasive surgery

Answer 15

3: Noninvasive testing is a feature of modified care.
4: Medication adjustments are a feature of modified care.
5: Minimally invasive surgery is a feature of modified care.

Question 16

The nurse is caring for an older patient recently diagnosed with cancer. What laboratory data should the nurse identify to support the diagnosis of frailty in this patient?

1. Hemoglobin 12 g/dL
2. Hemoglobin 23 g/dL
3. Serum albumin less than 2.5 g/100 dL
4. Serum albumin greater than 2.5 g/100 dL

Answer 16

3: Signs and symptoms of frailty in a person with cancer include serum albumin level less than 2.5 g/100 dL.

Question 17

The nurse is preparing a community education program focusing on cardiovascular disease in the older patient. Which information should the nurse include?

1. Breast cancer kills more women than heart disease.
2. A woman of 70 is as likely as a man to develop heart disease.
3. Women are more likely than men to develop heart disease in their middle years.
4. For most women, heart disease is a greater problem before they reach menopause.

Answer 17

2: By the time they are in their 70s, men and women get heart disease at equal rates.

Question 18

An older patient is diagnosed with cardiovascular disease. Which factors that can contribute to frailty should the nurse include when planning care for this patient?
Standard Text: Select all that apply.
1. Risk for dehydration
2. Electrolyte imbalance
3. Digestive abnormalities
4. Fatigue and activity intolerance
5. Multiple prescribed medications

Answer 18

1: Cardiovascular factors that can contribute to frailty include the risk for dehydration.
2: Cardiovascular factors that can contribute to frailty include electrolyte imbalances.
4: Cardiovascular factors that can contribute to frailty include fatigue and activity intolerance.
5: Cardiovascular factors that can contribute to frailty include multiple prescribed medications.

Question 19

A frail older patient with diabetes is diagnosed with a urinary tract infection. How should the nurse expect the physician to prescribe antibiotics for this patient?

1. Lower dose for a longer period of time
2. Lower dose for a shorter period of time
3. Higher dose for a shorter period of time
4. Higher dose and for a longer period of time

Answer 19

4: When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism.

Question 20

The nurse is admitting an older frail patient with dementia as a resident in a long-term care facility. Which problem is a priority when planning interventions for this patient’s care?

1. Agitation
2. Dependency
3. Quality of life
4. Polypharmacy

Answer 20

4: Polypharmacy and overmedication are serious problems inherent in the care of the older person with dementia.

Question 21

The nurse is planning an education program for other nurses on palliative care. Which information should the nurse include in the program?
Standard Text: Select all that apply.
1. Palliative care focuses on patients who are close to death.
2. Palliative care can provide respite care for family members.
3. Palliative care focuses on managing pain and troublesome symptoms.
4. Palliative care focuses on providing surgeries and treatments to cure the illness.
5. Palliative care can be delivered long-term and throughout all phases of treatment.

Answer 21

2: Palliative care can provide respite care for families.
3: Palliative care focuses on alleviation of pain and management of troublesome symptoms.
5: Palliative care can be provided to seriously ill older persons at any time during the disease process.

Question 22

The daughter of an older frail patient recovering from receiving the wrong medication asks what the hospital can do to prevent this from happening again. How should the nurse respond to the daughter?

1. “There isn’t much that can be done.”
2. “Medication errors can’t be avoided because we are short-staffed.”
3. “It really depends on the physician’s handwriting to understand what is ordered.”
4. “We are planning to install a bar-code system to identify patients and medications.”

Answer 22

4: There is much that can be done to prevent medication errors. The use of computerized entry systems, monitoring of prescriptions by a clinical pharmacist, and identification of the correct patient and drug using bar-code technology are methods that have been shown to decrease the frequency of medication errors.

Question 23

During a home visit the nurse notes that an older patient is demonstrating signs of frailty. What assistance will the nurse identify as helpful to the patient in the home?
Standard Text: Select all that apply.
1. Socialization
2. Meal preparation
3. Resources for daily care
4. Home maintenance and safety
5. Transportation to healthcare appointments

Answer 23

2: The focus of healthcare for the frail older person includes the provision of nutritious meals.
3: The focus of healthcare for the frail older patient includes mobilizing resources for daily care.
4: The focus of healthcare for the frail older person includes home maintenance and safety.
5: The focus of healthcare for the frail older person includes transportation to healthcare appointments.

Question 24

A hospital is planning to implement a unit that focuses on acute care of the elderly (ACE). How should the hospital administrator explain this unit to the nursing staff?

1. “An ACE unit will be run just like a nursing home, except it’s located in the hospital.”
2. “An ACE unit isn’t any different than any other unit in the hospital except for the age of the patients.”
3. “The key concept of an ACE unit is to return the patients to their nursing homes as quickly as possible.”
4. “Patient-centered interdisciplinary care guided by nurse-driven protocols to address key nursing issues such as mobility, skin care, nutrition, and continence.”

Answer 24

4: One key concept of an ACE unit is to provide patient-centered interdisciplinary care guided by nurse-driven protocols to address key nursing issues such as mobility, skin care, nutrition, and continence.

Question 25

The nurse is preparing a seminar on planning for a hospitalization for residents of an assisted living facility. What information should the nurse include in the seminar?
Standard Text: Select all that apply.
1. Bring a copy of advanced directives for healthcare.
2. Bring a list of current medications and current labs.
3. Bring valuable jewelry and money to avoid leaving it unattended.
4. Bring good walking slippers, a bathrobe, and items such as books.
5. Bring several changes of clothing to avoid wearing a hospital gown.

Answer 25

1: Patients should be encouraged to bring a copy of advance directives for healthcare when being admitted to a hospital.
2: Patients should be encouraged to bring a list of current medications and current labs when being admitted to a hospital.
4: Patients should be encouraged to bring comfort items such as slippers, a bathrobe, and reading material when being admitted to a hospital.