GERO (VNSG 1126) CH. 3 "Overview of Aging" NCLEX-STYLE QUESTIONS

A nurse suspects that an older adult patient is at a high risk of coronary artery disease. Which statement by the patient helped the nurse reach this conclusion? Select all that apply. A) "I have these sores on my skin that won't heal." B) "I no longer smoke and drink alcohol." C) "I'm always worried about my finances." D) "I have gained 15 pounds in one month." E) "I monitor my blood pressure daily." F) "I tend to eat fast food because it's affordable." - answer-C) "I'm always worried about my finances.", D) "I have gained 15 pounds in one month.", F) "I tend to eat fast food because it's affordable." The risk factors for coronary artery disease include obesity, smoking, lack of exercise, and stress. Financial problems can be a significant source of stress and increase the risk for coronary artery disease. Significant weight gain can lead to obesity and increase the risk of coronary artery disease. Fast food often contains high levels of salt and fat, which increase the risk of coronary artery disease. Consuming alcohol and smoking may further increase the risk of coronary artery disease. Nonhealing skin lesions may be an indication of cancer, not coronary artery disease. Hypertension is a major risk factor of coronary artery disease. Therefore, monitoring blood pressure daily may help in managing the risk. An increased plasma viscosity is one of the hematopoietic and lymphatic changes associated with aging. This change increases the risk of developing which disorder? A) Thrombophlebitis B) Anemia C) Opportunistic infections D) Leukemia - answer-A) Thrombophlebitis An increase in plasma viscosity results in a sluggish blood flow through vessels. This increases the likelihood of clots or thrombophlebitis. A decrease in red blood cells will result in anemia. Infections can occur because of increased immature T cell response and decreased mobilization of neutrophils. Leukemia is not a result of expected changes that occur with aging. (p.49) An older adult is coming to your clinic for treatment for a gastric ulcer. Which treatment would the nurse expect to be ordered? A) Antibiotics B) Stress-related classess C) NSAIDs D) Iron supplements before breakfast and dinner - answer-A) Antibiotics Gastric ulcers are most commonly due to the bacterium H. pylori, and antibiotics will usually be prescribed. NSAIDs are another commonly implicated cause, so these should be eliminated if possible. Iron, especially on an empty stomach, is very irritating to gastric tissues. REF: Page 52 An older patient presents to the clinic and reports transient blurred vision, weakness, slurred speech, and unsteady gait. What is the priority question to ask the patient? A) Have you ever been told that you are anemic? B) Do you have a history of hypertension or diabetes? C) Has this ever happened to you before today? D) When did the symptoms start and how long did they last? - answer-D) When did the symptoms start and how long did they last? The patient is reporting symptoms of a transient ischemic attack; however, it is likely that he or she will be immediately transferred to a stroke center for diagnosis of possible stroke and appropriate treatment. If ischemic stroke is diagnosed, tissue plasminogen activator must be given within 3 hours after symptom onset. (p. 59) An older patient reports that he was supposed to take a combination of isoniazid and rifampin, but he stopped taking the medications several months ago for financial reasons. Which diagnostic test would the nurse anticipate will be ordered to examine the effects of noncompliance with medication regimen? A) Bone density test B) Electrocardiogram C) Sputum culture for acid-fast bacilli D) Uric acid level - answer-C) Sputum culture for acid-fast bacilli Isoniazid and rifampin are prescribed for the treatment of tuberculosis, so the most likely diagnostic test is sputum cultures for acid-fast bacilli. A bone density test is usually ordered for suspected osteoporosis. An electrocardiogram is used to examine the electrical activity of the heart. A uric acid level is drawn if gout is suspected. (p. 42) An older patient tells the nurse that he has piles. Which question would be the most appropriate for the nurse to ask? A) Are you having pain or small amounts of bright red blood? B) Have you noticed a change in the shape or color of the piles? C) Are you having nausea, vomiting, or loss of appetite? D) Do you feel short of breath when you are lying flat in bed? - answer-A) Are you having pain or small amounts of bright red blood? Older people sometimes refer to hemorrhoids as piles. Common complaints would be pain or small amounts of bright red bleeding. (p. 53) For a patient with constipation, which intervention would the nurse suggest to maximize the gastrocolic reflex? A) Increase fluid intake B) Administer stool softeners C) Increase fiber intake D) Encourage defecation after eating - answer-D) Encourage defecation after eating The gastrocolic reflex occurs when the stomach is distended with food, stimulating vigorous peristalsis of the rectum and a desire to defecate. The other measures would also be used for constipation. (p. 51) For a patient with thrombophlebitis, which therapies would be included? (Select all that apply) A) Elevation of the affected leg B) Application of elastic stockings or wraps C) Administration of analgesics D) Anticoagulant therapy E) Ambulation with assistance. - answer-A) Elevation of the affected leg, B) Application of elastic stockings or wraps, C) Administration of analgesics, D) Anticoagulant therapy Typical therapies include rest, elevation of the affected leg, application of elastic stockings or wraps, administration of analgesics, anticoagulant therapy, and sometimes application of heat. Ambulation is usually restricted to prevent possible dislodgment of clots. (pp. 46-47) Nutrition therapy of specific doses of vitamins C and E, beta carotene, zinc, and copper could reduce the risk for which eye disorder? A) Glaucoma B) Diabetic retinopathy C) Age-related macular degeneration D) Cataracts - answer-C) Age-related macular degeneration A major clinical trial with 3600 participants, the Age-Related Eye Disease Study (AREDS), demonstrated that a specific formula of antioxidants and zinc, the AREDS Formulation, can reduce the risk of developing AMD by 25% (National Eye Institute, 2011). Glaucoma can be delayed and treated with early detection during routine eye examination. Diabetic retinopathy seems to be related to the severity and duration of hyperglycemia. Cataracts develop slowly and can be surgically removed. (p. 63) Signs and symptoms of a hiatal hernia with reflux episodes could resemble which condition? A) Angina attack B) Emphysema C) Bursitis D) Seborrheic keratosis - answer-A) Angina attack Heartburn, acid reflux, or epigastric distress can resemble an angina attack. Hiatal hernia attacks usually occur after meals or at rest. Angina is more likely to occur with exertion. Emphysema is a chronic lung disorder which produces symptoms such as productive cough, wheezing, cyanosis, and dyspnea on exertion. Bursitis commonly results in joint stiffness and pain in the shoulder, knee, and elbow, ultimately leading to restricted or reduced mobility. Seborrheic keratosis is a skin condition with slightly raised, wart-like macules with distinct edges. These lesions may cause discomfort and itching. (p. 52) The 80-year-old patient presents to the clinic for a routine check-up. The nurse notes the patient has a stooped appearance with rounded upper back and head bent forward to the chest. How should the nurse document this observation? A) Lordosis B) Kyphosis C) Osteoporosis D) Osteoarthritis - answer-B) Kyphosis Kyphosis is a condition in which the older adult has a stooped appearance due to shrinkage of the intervertebral disks in the thoracic spine. Lordosis is the excessive curvature of the lumbar spine. Osteoporosis and osteoarthritis are not used to describe this patient's stooped spine.REF: Page 37 The aging patient presents to the clinic with multiple well-defined, small areas of skin that are more darkly pigmented than others on the hands, forearms, and face. How should the nurse document this finding? A) Senile lentigo B) Senile purpura C) Seborrheic keratosis D) Cutaneous papilloma - answer-A) Senile lentigo Senile lentigo, also known as "age spots," are small, well-defined areas of darkened pigmentation found on parts of the skin that are often exposed to the sun, such as the hands, forearms, and face. Senile purpuras are reddish-purple spots caused by fragile capillaries close to the skin. Seborrheic keratosis is characterized by wart-like macules. Cutaneous papillomas are commonly called skin tags.REF: Page 32 The home health nurse sees that the older patient is taking levodopa. Which action is the nurse most likely to perform that is related to the medication? A) Check the results of the last bone density test B) Assess for signs and symptoms of Parkinson disease C) Teach the patient about controlling sodium intake D) Assess the lungs and instruct on deep breathing - answer-B) Assess for signs and symptoms of Parkinson disease Levodopa is a medication that is used to treat Parkinson disease, so the nurse would monitor for signs and symptoms. The effect of the medication lessens over time and the symptoms will worsen. (p. 57) The nurse caring for older adults in the community knows which diseases are the most common causes of disability in this population? (Select all that apply.) A) Hypertension B) Hyperlipidemia C) Diabetes mellitus D) Rheumatoid arthritis E) Cardiovascular disease F) Cerebrovascular accident - answer-A) Hypertension, C) Diabetes mellitus, E) Cardiovascular disease, F) Cerebrovascular accident Common causes of disability in the older adult include hypertension, diabetes, stroke, and heart disease. Rheumatoid arthritis and hyperlipidemia are not among the most common causes of disability of older adults.REF: Page 32 The nurse caring for older adults knows age-related changes to the epidermis affect the older adult in which manner? A) Body temperature regulation is impaired. B) Skin elasticity and strength are decreased. C) Oil production decreases, resulting in dry flaky skin. D) Risk for pressure damage over bony prominences is increased. - answer-A) Body temperature regulation is impaired. The epidermis is the outermost layer of skin, which thins as the individual ages, resulting in difficulties maintaining body temperature. The dermis contains collagen fibers, which decrease in strength and number over time, resulting in decreased skin elasticity. Sebaceous glands in the dermis decrease production of oil, resulting in dry, flaky skin. Adipose tissue in the subcutaneous tissue decreases, resulting in an increased risk for pressure damage over the bony prominences.REF: Page 32 The nurse caring for older adults on a cardiology floor at a hospital understands the hearts of older adults respond to adrenergic stimulation by making which change to increase cardiac output? A) Increase heart rate B) Increase stroke volume C) Increase renal excretion of water D) Increase renal retention of sodium - answer-B) Increase stroke volume Older adults increase stroke volume in order to increase cardiac output in response to adrenergic stimulation, whereas younger adults increase their heart rate. Adrenergic stimulation does not use the kidneys to change cardiac output.REF: Page 44 The nurse encourages the patient to maintain a steady weight in the recommended range to decrease risk of which common endocrine disease observed in older adults? A) Hypothyroidism B) Hyperthyroidism C) Diabetes mellitus D) Diabetes insipidus - answer-C) Diabetes mellitus The incidence of diabetes mellitus (DM) increases with age. The likelihood of acquiring diabetes rises sharply with each decade of life. REF: Page 68