Learn system Gerontology

Question 1

Wotf is a physiologic change that is normally r/t aging that could affect drug dosages in a older pt?

a. increased GFR
b. decreased body fat
c. decreased GI motility
d. decreased gastric pH

Answer 1

c. decreased GI motility - this results in medications remaining in the GI tract for longer periods of time, leading to slow absorption of the drug. The HCP may have to allow for a longer time for medication onset and peak by extending the length of time b/w doses. W/ aging, the GFR decreases - slowing the excretion of drugs. Body fat increases with age, as does gastric pH

Question 2

Ophthalmology clinic, p. referred for possible cataract. Wotf p complaints should the RN recognize as consistent w/ this suspicion?

a. halos and rainbows when looking at lights
b. loss of peripheral vision
c. bright flashes of light and floaters
d. eyestrain and headache w/close work

Answer 2

a. halos and rainbows when looking at lights - Cataracts cause clouding of the lens of the eye. They dvlp slowly and cause gradual visual impairments, which include difficulty seeing at night, halos around lights, glare sensitivity, and decreased visual acuity during the day. They are accelerated when p’s smoke, take cortisone, or have metabolic disease like DM.

Question 3

Loss of peripheral vision occurs w/what eye disorder?

Answer 3

open angle glaucoma, which is a condition of increased intraocular pressure that leads to damaged optic nerves and causes partial vision loss, with blindness as a possible outcome

Question 4

Bright flashes of light and floaters is an expected manifestation of what eye condition?

Answer 4

Retinal detachment. This condition refers to the separation of the light-sensitive membrane in the back of the eye (retina) from its supporting layers. Trauma, aging, severe DM, or certain infla. d/o’s may cause retinal detachment, but it frequently occurs spontaneously

Question 5

RN writing POC for p. who had a CVA. Wotf should the RN ID as a priority goal for this patient?

a. p will maintain intact skin during hospitalization
b. p will verbalize one new word qweek
c. mobility will improve when the p begins to help turn self in bed
d. airway will remain clear AEB clear breath sounds

Answer 5

d. clear airway is the priority. CVA p’s are at high risk for airway obstruction due to loss of muscle control. P’s may not be able to cough, swallow, or control tongue movement and should be place side-lying with the HOB elevated. The other options are important goals too.

Question 6

RN is part of a committee that is dvlping age appropriate care standards. Wotf is the focus for older ps, based on Erikson’s stages of dvlpmt?

a. intimacy
b. identity
c. integrity
d. initiative

Answer 6

c. integrity v. despair is the stage for older adults in which they reflect on their lives and roles. If p has sense of fulfillment towards life, they will accept death with integrity, not fear.

Question 7

Wotf actions should the RN take to best assist older adult residents in reminiscing?

a. establishing a weekly pet therapy visitation program
b. placing a calendar/clock in each room
c. instituting a daily storytelling hour about “the good old days”
d. encouraging all p’s to eat their meals in the dining room

Answer 7

c. Reminiscence therapy typically involves group meetings where p’s are encouraged to talk about past events. For older adults, this helps them to achieve ego integrity, rather than despair.

Question 8

Wotf is appropriate when conducting an admission axmt on an older p?

a. leave the p a written questionnaire to fill out in private
b. allow sufficient time for responses to questions
c. use family members to obtain the p’s H. hx.
d. obtain the H. hx from the p’s medical record

Answer 8

b. it takes them hoes longer to process shit

Question 9

Wotf food choices should the RN recommend to an older p. on bedrest (following DVT) to increase peristalsis?

a. bran muffin
b. hash brown potatoes
c. egg and cheese omelet
d. banana

Answer 9

a. bran muffin - bran foods are high in fiber and promote bowel regularity. Ensure adequate fluid intake too

Question 10

Older p. returns to clinic c/o decreased energy lvl, insomnia, and anorexia. Dx tests performed on the 1st visit were WNL. The RN should assess for?

a. dystonia
b. dementia
c. depression
d. diabetes

Answer 10

c. depression is a very common condition in older adults. S&S= anergia, insomnia, anorexia, sadness, hopelessness, worthlessness… Depression can be a sequela to an acute or chronic illness, or a result of analgesic/antihtn/steroid use.

Question 11

Older p. admitted after a fall and has a fractured hip, malnutrition, and dehydration. Wotf labs indicates that malnutrition is a long-standing problem?

a. increased Na
b. decreased albumin
c. increased BUN
d. decreased BS

Answer 11

b. decreased albumin levels indicate inadequate protein intake and are a common finding in a p who has prolonged malnutrition.

Question 12

Orientating an AP on instructions for promoting communication in HOH, older ps. Wotf instructions correct?

a. maintain eye contact w/the ps and speak slowly
b. stand to one side and speak into the p’s good ear
c. stand close to the p and speak loudly w/ exaggerated enunciation
d. maintain a position in front of the ps and ask only direct questions

Answer 12

a. Many older ps that are HOH use lip-reading and gestures to help understand what is said to them. eye contact and slow speech help with this

Question 13

Community outreach clinic. RN should recognize wotf as an example of co-morbidity in an older adult p who is homeless?

a. inadequate shelter and clothing for the weather
b. malnutrition and poverty
c. dementia and tuberculosis
d. lack of preventative HC and immunizations

Answer 13

c. dementia and tuberculosis. Co-morbidity refers to medical conditions known to co-exist in a p. The number of co-morbid conditions is used to provide an indication of the health status (and risk of death) of ps. Dementia and TB occurring in a p. is an example of co-morbidity and increases risk. All the other options are risk factors for disease

Question 14

Wotf is the most common reason older adults have difficulty performing ADLs?

a. social w/drawal
b. physical disability
c. emotional impairment
d. cognitive dysfunction

Answer 14

b. physical disability is the most common reason p’s have self-care deficits, including activity intolerance, pain, neuromuscular impairments, sensory-perceptual impairments, etc..

Question 15

Health promotion for a group of healthy older adults. Wotf examinations should the RN recommend that all p’s over 50 yo have performed annually?

a. EKG
b. colonoscopy
c. chest x-ray
d. glaucoma examination

Answer 15

d. all older p’s should receive annual glaucoma exams.

Question 16

Caring for a male p. w/dementia who becomes agitated and confused in his room at night, removes all of his clothes and wanders w/ an unsteady gait. WOTF should RN do first?

a. move the p to a room closer to the RN station
b. play soft, soothing music or leave TV on
c. Dress the p and return him to his bed.
d. check on the p frequently during the night

Answer 16

a. the p’s unsteady gait poses a safety risk, a room closer to the nurse’s station will ensure the p is more closely monitored

Question 17

Postmenopausal p. just dx’d w/ osteopenia. Wotf conditions in the p’s history should the RN recognize as a CI to alendronate sodium?

a. duodenal ulcer
b. paget’s disease
c. Esophageal achalasia
d. long-tm corticosteroid use

Answer 17

c. Esophageal achalasia. Alendronate sodium is a bisphosphonate which prevents/slows bone resorption in p’s at risk for osteoporosis. It must be taken in the am on an empty stomach, with a full glass of water. P’s must wait 30 minutes after taking med to eat/drink/take any other med. They must also sit up/stand for these 30 minutes to decrease risk of esophageal injury. Alendronate is CI’d in any p w/ a hx of esophageal abnormalities.

Question 18

Rn is giving an older p an antihistamine. Wotf statements by RN is correct?

a. “antihistamines should used cautiously in p’s who have glaucoma”
b. “older adults require increased doses of antihistamines”
c. “sustained-release antihistamines are CI’d”
d. “you may experience paradoxical hyperexcitability”

Answer 18

a. Most antihistamines have an anticholinergic effect. B/c older p’s have higher incidences of glaucoma, the RN should investigate the p’s medical hx prior to giving the drug. Paradoxical hyperexcitability (restlessness, insomnia, nervousness, euphoria, and tremors) is an AE most commonly seen in pediatric ps

Question 19

While obtaining a H hx for a p. following a CVA, the RN notes a hx of GERD. The RN should understand that this hx places the p at risk for?

a. duodenal ulcer disease
b. aspiration pneumonia
c. viral pneumonia
d. esophageal varices

Answer 19

b. aspiration pneumonia - GERD is a syndrome that results in reflux of gastric secretions into the lower esophagus. The p has a high risk for pneumonia r/t aspiration of these secretions

Question 20

Older p with anemia. RN should suggest eating wotf ideal foods to create new RBCs?

a. yogurt
b. bran muffin
c. peanut butter sandwich
d. green, leafy salad

Answer 20

d. green leafy vegetables are excellent sources of iron.

Question 21

Rn caring for older p w/ osteoarthritis of the rt. hip and lower lumbar vertebrae. Wotf p statements is false?

a. a warm shower will help me relieve morning stiffness when I first get out of bed
b. to relieve the pressure on my back I can use a cane while ambulating
c. I will take my NSAID q6h, as Rxd, to control pain
d. I will remain consistently active throughout the day to prevent stiffness in my joints

Answer 21

d. The patient w/ osteoarthritis needs to balance activity with rest and take frequent rest periods. The p should not engage in constant activity bc this can damage the joints even further. All the other statements are correct

Question 22

Axing an older p for dehydration. Wotf is a normal part of the aging process?

a. elevated urine spec grav
b. thin skin and spidery veins on the hands
c. dry oral mucous membranes
d. poor turgor over the sternum

Answer 22

b. thin skin and spidery veins on the hands is a part of nml aging. An elevated urine spec grav (values above 1.020) indicates concentrated urine r/t dehydration. Xerostomia is a sign of dehydration. Poor skin turgor is a late sign of dehydration.

Question 23

Postmenopausal dietary requirements. What role does folic acid play in the health of older adult woman?

a. women who are postmenopausal need to limit their intake of folic acid to reduce risk of stroke
b. dietary folic acid is not of significant importance after child bearing years
c. healthy woman who are postemenopausal require a daily folic acid supplement
d. Adequate folic acid intake is r/t a reduced risk for heart disease

Answer 23

d. women who are postmenopausal and consume the recommended daily intake of 400mcg of folic acid have significantly lower levels of homocysteine, a rf for heart disease, than those who do not. Most older adult women need to improve their daily folic acid intake, which can be accomplished by increasing daily dietary intake of foods such OJ, beans, legumes, green leafy vegetables, breads and pastas.

Question 24

Older p w/gout who is on a purine restricted diet, and refusing to eat food at the ECF. Family wants to bring food from home, wotf foods is unsafe for the p?

a. lentil soup
b. cheese sandwich
c. yogurt
d. dried fruits

Answer 24

a. lentil soup - purine restricted diets decrease elevated blood and urinary uric acid levels and is used for p’s with gout or renal calculi. Foods high in purine include whole grain breads, oatmeal, wheat germ, wheat bran, meat gravies, fish, beans, organ meats, mushrooms, green peas, spinach, asparagus, baker’s and brewer’s yeast are all high in purine.

Question 25

Older p about to be admitted to postsurgical unit. RN anticipates that the p will require O2 bc hypoxemia occurs in older adults due to wotf?

a. decreased anterior- posterior diameter
b. increased diameter of the small airways
c. increased number of cilia
d. decreased alveolar surface area

Answer 25

d. decreased alveolar surface area. A physiologic change nmlly r/t aging is an increase in the size of the alveolar ducts and resp bronchioles, leading to a decrease in the alveolar surface are. Less surface area for gas exchange means greater risk for hypoxemia. An increased ant-post diameter occurs due to calcification of the bronchial and costal cartilage. Decreased diameter of the small airways occur as well as a decreased number of cilia

Question 26

While teaching a group of volunteers, a nurse at an ECF should explain that older adults are most likely to exhibit a decrease in Wotf?

a. short tm memory
b. creative ability
c. decision-making skills
d. cognitive capacity

Answer 26

a. short term memory - ability to process short-term memories decreases as part of the aging process. Thus, older p’s may require reminders regarding their medications, ADLs, or daily schedules, they might not remember names, may ask the same questions repeatedly, or need assistance remembering recent events

Question 27

Wotf explanations accounts for fasting blood glucose test values being elevated in older p’s?

a. decreased production of insulin by the aging pancreas
b. consumption of a high-carb diet
c. increased rate of glucose metabolism
d. decreased release of glycogen by the aging liver

Answer 27

a. decreased production of insulin by the aging pancreas. The rate of carb metabolism is decreased in older adults bc of a reduced production of insulin by the aging pancreas. This results in an elevated fasting blood glucose. Other changes in the aging pancreas include distention of the pancreatic ducts and decreased lipase production, which results in impaired fat absorption.

Question 28

P. w/ alzheimer’s has been oriented to name and place and is able to perform ADLs w/ minimal supervision. When the p refuses to take his BP pills the RNs first action should be to?

a. crush the pills, if not CI’d, and feed them to the p in applesauce
b. ask the p to express his reason for refusing and document the event.
c. try to convince the p to comply
d. notify the HCP of the need for further evaluation of the p’s level of competence

Answer 28

b. before intervening or making judgments about the p’s competence, the RN should complete an axmt of the patient. The p may be refusing bc for a legit reason

Question 29

Wotf is true regarding pain management for older adults?

a. they have a diminished capacity to perceive pain
b. are sensitive to the analgesic effect of opiates
c. require higher doses of opiates for analgesia
d. possess an increased tolerance for pain

Answer 29

b. are sensitive to the analgesic effect of opiates - older adults are likely to require decreased doses of opioids to provide the same level of analgesia with a reduced risk of SEs