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PNR 134 Exam 3: Chapter 17, 18 & 26
Care in Older Adults
Exam Structure:
Subject: Gerontological Nursing
Source: Williams: Basic Geriatric Nursing, 7th Edition Test Bank
Format: Multiple Choice, Multiple Response, & Completion Exam Questions
Chapter 17: Care of Aging Skin and Mucous Membranes Williams:
Basic Geriatric Nursing
MULTIPLE CHOICE
1. The older adult complains of multiple bruises on his extremities.
What are the marks the result of?
A. Arteriosclerotic changes in the vessels
B. Prolonged clotting time
C. Fragility of capillary walls
D. Reduction of subcutaneous fat
Correct Answer: C. Fragility of capillary walls
Rationale:
1. Aging skin undergoes structural changes, including thinning of the
dermis and decreased collagen support.
2. Capillary walls become more fragile and rupture easily with minor
trauma, leading to senile purpura (bruising).
3. This is a normal age-related change, not indicative of a bleeding
disorder.
2. The nurse assesses an area of skin on the patient's upper thigh that
is different in appearance than the surrounding skin. What
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documentation would be the most informative?
A. Red area on upper right thigh. Patient denies discomfort.
B. Erythematous scaly patch 2 × 2 cm on lateral aspect of right thigh.
Patient denies pain.
C. Painless red patch on right thigh 2 × 2 cm.
D. Medium-size red scaly patch on right thigh. 0 drainage. 0 pain.
Correct Answer: B. Erythematous scaly patch 2 × 2 cm on lateral aspect of
right thigh. Patient denies pain.
Rationale:
1. Accurate documentation requires specific, objective, and measurable
data.
2. Option B uses precise terminology (erythematous, scaly), exact
measurements (2 × 2 cm), and exact anatomical location (lateral
aspect of right thigh).
3. The other options are vague ("medium-size," "red area") and lack
descriptive detail needed for continuity of care and wound
assessment.
3. What is the cause of progressively graying hair?
A. Decreased production of melanin
B. Altered blood circulation to the scalp
C. Decreased density of hair
D. Environmental factors
Correct Answer: A. Decreased production of melanin
Rationale:
1. Hair color is determined by melanin produced by melanocytes in the
hair follicles.
2. With aging, melanocyte activity decreases, reducing melanin
production and resulting in gray or white hair.
3. This is a physiological, not pathological, age-related change.
4. A patient's toenails are brittle and thick. What other assessment
should the nurse be sure to include?
A. Respiratory sounds
B. Pedal pulses
C. History of gout
D. Intake of dietary calcium
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Correct Answer: B. Pedal pulses
Rationale:
1. Brittle, thick toenails in an older adult may indicate peripheral
arterial disease (PAD), which impairs blood flow to the extremities.
2. Assessing pedal pulses (dorsalis pedis and posterior tibial) evaluates
arterial perfusion.
3. Poor circulation contributes to nail changes and increases risk for
non-healing ulcers and gangrene.
5. The 80-year-old woman newly admitted to a long-term care facility
complains of intense itching in her axillae and antecubital fossa. There
are small red lesions in linear patterns. What condition does the nurse
suspect?
A. Rosacea
B. Keratosis
C. Pruritus
D. Scabies
Correct Answer: D. Scabies
Rationale:
1. Scabies is caused by the mite Sarcoptes scabiei, which burrows into
the skin, creating linear tracks (burrows).
2. Common sites include interdigital spaces, wrists, axillae, and
antecubital fossa.
3. Intense pruritus, especially at night, and linear lesions are hallmark
signs. Institutional outbreaks are common in long-term care.
6. What preventative action can be taken to prevent skin trauma from
shearing force?
A. Slide the patient across the bed linens to change position.
B. Apply generous amounts of lotion to the patient's skin.
C. Lift the patient on draw sheets when pulling up in bed.
D. Give the patient frequent tub baths to soften the skin.
Correct Answer: C. Lift the patient on draw sheets when pulling up in bed.
Rationale:
1. Shearing force occurs when the skin adheres to the bed surface while
the underlying fascia and bone move in the opposite direction.
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2. Using a draw sheet to lift, rather than drag, the patient eliminates
friction and shear.
3. Sliding the patient (A) increases shear. Lotion and baths (B, D) do not
prevent shear injury.
7. What would be the most effective intervention to prevent pressure
ulcers in the bedridden patient?
A. Perform skin assessment every day.
B. Use a draw sheet to move the patient.
C. Change the patient's position every 2 hours.
D. Remove wet bed linens promptly.
Correct Answer: C. Change the patient's position every 2 hours.
Rationale:
1. Pressure ulcers are caused by unrelieved pressure over bony
prominences.
2. Regular repositioning (at least every 2 hours) is the single most
effective preventive intervention to relieve pressure and restore
capillary blood flow.
3. While all options are important components of pressure injury
prevention, repositioning directly addresses the primary causative
factor: sustained pressure.
8. The admitting nurse gives the new long-term care facility resident a
score of 20 on both the Norton Risk Assessment Scale and the Braden
Scale for Predicting Pressure Sore Risk. These scores indicate that the
resident has:
A. a high probability of developing a pressure ulcer.
B. a moderate risk of developing a pressure ulcer.
C. a low risk of developing a pressure ulcer.
D. at least one pressure ulcer at the time of admission.
Correct Answer: C. a low risk of developing a pressure ulcer.
Rationale:
1. On the Braden Scale, scores range from 6-23; higher scores indicate
lower risk.
2. A score of 20-23 indicates low risk; 15-18 indicates mild risk; 13-14
moderate risk; 10-12 high risk; ≤9 very high risk.
PNR 134 Exam 3: Chapter 17, 18 & 26
Care in Older Adults
Exam Structure:
Subject: Gerontological Nursing
Source: Williams: Basic Geriatric Nursing, 7th Edition Test Bank
Format: Multiple Choice, Multiple Response, & Completion Exam Questions
Chapter 17: Care of Aging Skin and Mucous Membranes Williams:
Basic Geriatric Nursing
MULTIPLE CHOICE
1. The older adult complains of multiple bruises on his extremities.
What are the marks the result of?
A. Arteriosclerotic changes in the vessels
B. Prolonged clotting time
C. Fragility of capillary walls
D. Reduction of subcutaneous fat
Correct Answer: C. Fragility of capillary walls
Rationale:
1. Aging skin undergoes structural changes, including thinning of the
dermis and decreased collagen support.
2. Capillary walls become more fragile and rupture easily with minor
trauma, leading to senile purpura (bruising).
3. This is a normal age-related change, not indicative of a bleeding
disorder.
2. The nurse assesses an area of skin on the patient's upper thigh that
is different in appearance than the surrounding skin. What
, 2|Page
documentation would be the most informative?
A. Red area on upper right thigh. Patient denies discomfort.
B. Erythematous scaly patch 2 × 2 cm on lateral aspect of right thigh.
Patient denies pain.
C. Painless red patch on right thigh 2 × 2 cm.
D. Medium-size red scaly patch on right thigh. 0 drainage. 0 pain.
Correct Answer: B. Erythematous scaly patch 2 × 2 cm on lateral aspect of
right thigh. Patient denies pain.
Rationale:
1. Accurate documentation requires specific, objective, and measurable
data.
2. Option B uses precise terminology (erythematous, scaly), exact
measurements (2 × 2 cm), and exact anatomical location (lateral
aspect of right thigh).
3. The other options are vague ("medium-size," "red area") and lack
descriptive detail needed for continuity of care and wound
assessment.
3. What is the cause of progressively graying hair?
A. Decreased production of melanin
B. Altered blood circulation to the scalp
C. Decreased density of hair
D. Environmental factors
Correct Answer: A. Decreased production of melanin
Rationale:
1. Hair color is determined by melanin produced by melanocytes in the
hair follicles.
2. With aging, melanocyte activity decreases, reducing melanin
production and resulting in gray or white hair.
3. This is a physiological, not pathological, age-related change.
4. A patient's toenails are brittle and thick. What other assessment
should the nurse be sure to include?
A. Respiratory sounds
B. Pedal pulses
C. History of gout
D. Intake of dietary calcium
, 3|Page
Correct Answer: B. Pedal pulses
Rationale:
1. Brittle, thick toenails in an older adult may indicate peripheral
arterial disease (PAD), which impairs blood flow to the extremities.
2. Assessing pedal pulses (dorsalis pedis and posterior tibial) evaluates
arterial perfusion.
3. Poor circulation contributes to nail changes and increases risk for
non-healing ulcers and gangrene.
5. The 80-year-old woman newly admitted to a long-term care facility
complains of intense itching in her axillae and antecubital fossa. There
are small red lesions in linear patterns. What condition does the nurse
suspect?
A. Rosacea
B. Keratosis
C. Pruritus
D. Scabies
Correct Answer: D. Scabies
Rationale:
1. Scabies is caused by the mite Sarcoptes scabiei, which burrows into
the skin, creating linear tracks (burrows).
2. Common sites include interdigital spaces, wrists, axillae, and
antecubital fossa.
3. Intense pruritus, especially at night, and linear lesions are hallmark
signs. Institutional outbreaks are common in long-term care.
6. What preventative action can be taken to prevent skin trauma from
shearing force?
A. Slide the patient across the bed linens to change position.
B. Apply generous amounts of lotion to the patient's skin.
C. Lift the patient on draw sheets when pulling up in bed.
D. Give the patient frequent tub baths to soften the skin.
Correct Answer: C. Lift the patient on draw sheets when pulling up in bed.
Rationale:
1. Shearing force occurs when the skin adheres to the bed surface while
the underlying fascia and bone move in the opposite direction.
, 4|Page
2. Using a draw sheet to lift, rather than drag, the patient eliminates
friction and shear.
3. Sliding the patient (A) increases shear. Lotion and baths (B, D) do not
prevent shear injury.
7. What would be the most effective intervention to prevent pressure
ulcers in the bedridden patient?
A. Perform skin assessment every day.
B. Use a draw sheet to move the patient.
C. Change the patient's position every 2 hours.
D. Remove wet bed linens promptly.
Correct Answer: C. Change the patient's position every 2 hours.
Rationale:
1. Pressure ulcers are caused by unrelieved pressure over bony
prominences.
2. Regular repositioning (at least every 2 hours) is the single most
effective preventive intervention to relieve pressure and restore
capillary blood flow.
3. While all options are important components of pressure injury
prevention, repositioning directly addresses the primary causative
factor: sustained pressure.
8. The admitting nurse gives the new long-term care facility resident a
score of 20 on both the Norton Risk Assessment Scale and the Braden
Scale for Predicting Pressure Sore Risk. These scores indicate that the
resident has:
A. a high probability of developing a pressure ulcer.
B. a moderate risk of developing a pressure ulcer.
C. a low risk of developing a pressure ulcer.
D. at least one pressure ulcer at the time of admission.
Correct Answer: C. a low risk of developing a pressure ulcer.
Rationale:
1. On the Braden Scale, scores range from 6-23; higher scores indicate
lower risk.
2. A score of 20-23 indicates low risk; 15-18 indicates mild risk; 13-14
moderate risk; 10-12 high risk; ≤9 very high risk.
