A&E I Comprehensive Testbank
Table of Contents
Week 1 Care of Older Adults: Culture, Spirituality, Communication,
Sexuality, Infection Control
Chronic Illness and Older Adults__________________________________________________3
Cultural Awareness____________________________________________________________10
Older Adult__________________________________________________________________18
Communication_______________________________________________________________28
Patient Education_____________________________________________________________39
Infection Prevention and Control_________________________________________________51
Sexuality____________________________________________________________________69
Spiritual Health______________________________________________________________78
Week 2 Critical Thinking, The Nursing Process, Loss, Death, and Grief
Critical Thinking in Nursing Practice_____________________________________________86
Nursing Assessment___________________________________________________________94
Nursing Diagnosis___________________________________________________________102
Planning Nursing Care________________________________________________________110
Implementing Nursing Care____________________________________________________119
Evaluation__________________________________________________________________128
The Experience of Loss, Death and Grief__________________________________________136
Week 3 Safety and Fall Prevention among Older Adults, Preventing
Complications of Immobility
Patient Safety and Quality_____________________________________________________146
Immobility__________________________________________________________________163
Activity and Exercise__________________________________________________________181
Week 4 Skin and Wound Care Hygiene, Introduction to Pharmacology and
Medication Administration
Medication Administration_____________________________________________________194
Hygiene____________________________________________________________________212
Skin Integrity and Wound Care__________________________________________________231
Week 5 Fluid & Electrolytes, Dehydration
Fluid, Electrolyte and Acid-Base Balance_________________________________________251
Week 6 Pain and Sleep
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, A&E I Comprehensive Testbank
Pain Management____________________________________________________________268
Sleep______________________________________________________________________280
Week 7 Concepts related to Oxygenation, Circulation, and Tissue Perfusion,
Chronic Obstructive Pulmonary Disease
Oxygenation________________________________________________________________295
Obstructive Pulmonary Diseases________________________________________________314
Week 8 Diabetes Mellitus
Diabetes Mellitus____________________________________________________________331
Week 9 Hypertension, Stroke
Hypertension________________________________________________________________341
Stroke_____________________________________________________________________356
Week 10 Documentation and Informatics
Documentation and Informatics______________________________________368
Week 11 Nutrition, Dysphagia_____________________________________382
Week 12 Care of the Surgical Patient________________________________398
Week 1
Care of Older Adults: Culture, Spirituality, Communication,
Sexuality, Infection Control
Chapter 05: Chronic Illness and Older Adults Lewis: Medical-Surgical Nursing,
10th Edition
MULTIPLE CHOICE
1. When caring for an older patient with hypertension who has been hospitalized after a transient
ischemic (TIA), which topic is the most important for the nurse to include in the discharge
teaching?
a) Effect of atherosclerosis on blood vessels
b) Mechanism of action of anticoagulant drug therapy
c) Symptoms indicating that the patient should contact the health care provider
d) Impact of the patient’s family history on likelihood of developing a serious stroke
ANS: C
One of the tasks for patients with chronic illnesses is to prevent and manage a crisis. The patient
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, A&E I Comprehensive Testbank
needs instruction on recognition of symptoms of hypertension and TIA and appropriate actions to
take if these symptoms occur. The other information may also be included in patient teaching but
is not as essential in the patient’s self-management of the illness.
2. The nurse performs a comprehensive assessment of an older patient who is considering
admission to an assisted living facility. Which question is the most important for the nurse to
ask?
a) “Have you had any recent infections?”
b) “How frequently do you see a doctor?”
c) “Do you have a history of heart disease?”
d) “Are you able to prepare your own meals?”
ANS: D
The patient’s functional abilities, rather than the presence of an acute or chronic illness, are more
useful in determining how well the patient might adapt to an assisted living situation. The other
questions will also provide helpful information but are not as useful in providing a basis for
determining patient needs or for developing interventions for the older patient.
3. An alert older patient who takes multiple medications for chronic cardiac and pulmonary
diseases lives with a daughter who works during the day. During a clinic visit, the patient
verbalizes to the nurse that she has a strained relationship with her daughter and does not enjoy
being alone all day. Which nursing diagnosis should the nurse assign as the priority for this
patient?
a) Social isolation related to fatigue
b) Risk for injury related to drug interactions
c) Caregiver role strain related to family employment schedule
d) Compromised family coping related to the patient’s care needs
ANS: B
The patient’s age and multiple medications indicate a risk for injury caused by interactions
between the multiple drugs being taken and a decreased drug metabolism rate. Problems with
social isolation, caregiver role strain, or compromised family coping are not physiologic
priorities. Drug–drug interactions could cause the most harm to the patient and are therefore the
priority.
4. Which method should the nurse use to gather the most complete assessment of an older
patient?
a) Review the patient’s health record for previous assessments.
b) Use a geriatric assessment instrument to evaluate the patient.
c) Ask the patient to write down medical problems and medications.
d) Interview both the patient and the primary caregiver for the patient.
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, A&E I Comprehensive Testbank
ANS: B
The most complete information about the patient will be obtained through the use of an
assessment instrument specific to the geriatric population, which includes information about both
medical diagnoses and treatments and about functional health patterns and abilities. A review of
the medical record, interviews with the patient and caregiver, and written information by the
patient are all included in a comprehensive geriatric assessment.
5. Which intervention should the nurse implement to provide optimal care for an older patient
who is hospitalized with pneumonia?
a) Plan for transfer to a long-term care facility.
b) Minimize activity level during hospitalization.
c) Consider the preadmission functional abilities.
d) Use an approved standardized geriatric nursing care plan.
ANS: C
The plan of care for older adults should be individualized and based on the patient’s current
functional abilities. A standardized geriatric nursing care plan will not address individual patient
needs and strengths. A patient’s need for discharge to a long-term care facility is variable.
Activity level should be designed to allow the patient to retain functional abilities while
hospitalized and also to allow any additional rest needed for recovery from the acute process.
6. The nurse cares for an older adult patient who lives in a rural area. Which intervention should
the nurse plan to implement to meet this patient’s needs?
a) Suggest that the patient move closer to health care providers.
b) Obtain extra medications for the patient to last for 4 to 6 months.
c) Ensure transportation to appointments with the health care provider.
d) Assess the patient for chronic diseases that are unique to rural areas.
ANS: C
Transportation can be a barrier to accessing health services in rural areas. The patient living in a
rural area may lose the benefits of a familiar situation and social support by moving to an urban
area. There are no chronic diseases unique to rural areas. Because medications may change, the
nurse should help the patient plan for obtaining medications through alternate means such as the
mail or delivery services, not by purchasing large quantities of the medications.
7. Which nursing action will be most helpful in decreasing the risk for drug-drug interactions in
an older adult?
a) Teach the patient to have all prescriptions filled at the same pharmacy.
b) Make a schedule for the patient as a reminder of when to take each medication.
c) Instruct the patient to avoid taking over-the-counter (OTC) medications or supplements.
d) Ask the patient to bring all medications, supplements, and herbs to each appointment.
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Table of Contents
Week 1 Care of Older Adults: Culture, Spirituality, Communication,
Sexuality, Infection Control
Chronic Illness and Older Adults__________________________________________________3
Cultural Awareness____________________________________________________________10
Older Adult__________________________________________________________________18
Communication_______________________________________________________________28
Patient Education_____________________________________________________________39
Infection Prevention and Control_________________________________________________51
Sexuality____________________________________________________________________69
Spiritual Health______________________________________________________________78
Week 2 Critical Thinking, The Nursing Process, Loss, Death, and Grief
Critical Thinking in Nursing Practice_____________________________________________86
Nursing Assessment___________________________________________________________94
Nursing Diagnosis___________________________________________________________102
Planning Nursing Care________________________________________________________110
Implementing Nursing Care____________________________________________________119
Evaluation__________________________________________________________________128
The Experience of Loss, Death and Grief__________________________________________136
Week 3 Safety and Fall Prevention among Older Adults, Preventing
Complications of Immobility
Patient Safety and Quality_____________________________________________________146
Immobility__________________________________________________________________163
Activity and Exercise__________________________________________________________181
Week 4 Skin and Wound Care Hygiene, Introduction to Pharmacology and
Medication Administration
Medication Administration_____________________________________________________194
Hygiene____________________________________________________________________212
Skin Integrity and Wound Care__________________________________________________231
Week 5 Fluid & Electrolytes, Dehydration
Fluid, Electrolyte and Acid-Base Balance_________________________________________251
Week 6 Pain and Sleep
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, A&E I Comprehensive Testbank
Pain Management____________________________________________________________268
Sleep______________________________________________________________________280
Week 7 Concepts related to Oxygenation, Circulation, and Tissue Perfusion,
Chronic Obstructive Pulmonary Disease
Oxygenation________________________________________________________________295
Obstructive Pulmonary Diseases________________________________________________314
Week 8 Diabetes Mellitus
Diabetes Mellitus____________________________________________________________331
Week 9 Hypertension, Stroke
Hypertension________________________________________________________________341
Stroke_____________________________________________________________________356
Week 10 Documentation and Informatics
Documentation and Informatics______________________________________368
Week 11 Nutrition, Dysphagia_____________________________________382
Week 12 Care of the Surgical Patient________________________________398
Week 1
Care of Older Adults: Culture, Spirituality, Communication,
Sexuality, Infection Control
Chapter 05: Chronic Illness and Older Adults Lewis: Medical-Surgical Nursing,
10th Edition
MULTIPLE CHOICE
1. When caring for an older patient with hypertension who has been hospitalized after a transient
ischemic (TIA), which topic is the most important for the nurse to include in the discharge
teaching?
a) Effect of atherosclerosis on blood vessels
b) Mechanism of action of anticoagulant drug therapy
c) Symptoms indicating that the patient should contact the health care provider
d) Impact of the patient’s family history on likelihood of developing a serious stroke
ANS: C
One of the tasks for patients with chronic illnesses is to prevent and manage a crisis. The patient
2
, A&E I Comprehensive Testbank
needs instruction on recognition of symptoms of hypertension and TIA and appropriate actions to
take if these symptoms occur. The other information may also be included in patient teaching but
is not as essential in the patient’s self-management of the illness.
2. The nurse performs a comprehensive assessment of an older patient who is considering
admission to an assisted living facility. Which question is the most important for the nurse to
ask?
a) “Have you had any recent infections?”
b) “How frequently do you see a doctor?”
c) “Do you have a history of heart disease?”
d) “Are you able to prepare your own meals?”
ANS: D
The patient’s functional abilities, rather than the presence of an acute or chronic illness, are more
useful in determining how well the patient might adapt to an assisted living situation. The other
questions will also provide helpful information but are not as useful in providing a basis for
determining patient needs or for developing interventions for the older patient.
3. An alert older patient who takes multiple medications for chronic cardiac and pulmonary
diseases lives with a daughter who works during the day. During a clinic visit, the patient
verbalizes to the nurse that she has a strained relationship with her daughter and does not enjoy
being alone all day. Which nursing diagnosis should the nurse assign as the priority for this
patient?
a) Social isolation related to fatigue
b) Risk for injury related to drug interactions
c) Caregiver role strain related to family employment schedule
d) Compromised family coping related to the patient’s care needs
ANS: B
The patient’s age and multiple medications indicate a risk for injury caused by interactions
between the multiple drugs being taken and a decreased drug metabolism rate. Problems with
social isolation, caregiver role strain, or compromised family coping are not physiologic
priorities. Drug–drug interactions could cause the most harm to the patient and are therefore the
priority.
4. Which method should the nurse use to gather the most complete assessment of an older
patient?
a) Review the patient’s health record for previous assessments.
b) Use a geriatric assessment instrument to evaluate the patient.
c) Ask the patient to write down medical problems and medications.
d) Interview both the patient and the primary caregiver for the patient.
3
, A&E I Comprehensive Testbank
ANS: B
The most complete information about the patient will be obtained through the use of an
assessment instrument specific to the geriatric population, which includes information about both
medical diagnoses and treatments and about functional health patterns and abilities. A review of
the medical record, interviews with the patient and caregiver, and written information by the
patient are all included in a comprehensive geriatric assessment.
5. Which intervention should the nurse implement to provide optimal care for an older patient
who is hospitalized with pneumonia?
a) Plan for transfer to a long-term care facility.
b) Minimize activity level during hospitalization.
c) Consider the preadmission functional abilities.
d) Use an approved standardized geriatric nursing care plan.
ANS: C
The plan of care for older adults should be individualized and based on the patient’s current
functional abilities. A standardized geriatric nursing care plan will not address individual patient
needs and strengths. A patient’s need for discharge to a long-term care facility is variable.
Activity level should be designed to allow the patient to retain functional abilities while
hospitalized and also to allow any additional rest needed for recovery from the acute process.
6. The nurse cares for an older adult patient who lives in a rural area. Which intervention should
the nurse plan to implement to meet this patient’s needs?
a) Suggest that the patient move closer to health care providers.
b) Obtain extra medications for the patient to last for 4 to 6 months.
c) Ensure transportation to appointments with the health care provider.
d) Assess the patient for chronic diseases that are unique to rural areas.
ANS: C
Transportation can be a barrier to accessing health services in rural areas. The patient living in a
rural area may lose the benefits of a familiar situation and social support by moving to an urban
area. There are no chronic diseases unique to rural areas. Because medications may change, the
nurse should help the patient plan for obtaining medications through alternate means such as the
mail or delivery services, not by purchasing large quantities of the medications.
7. Which nursing action will be most helpful in decreasing the risk for drug-drug interactions in
an older adult?
a) Teach the patient to have all prescriptions filled at the same pharmacy.
b) Make a schedule for the patient as a reminder of when to take each medication.
c) Instruct the patient to avoid taking over-the-counter (OTC) medications or supplements.
d) Ask the patient to bring all medications, supplements, and herbs to each appointment.
4
