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 hintervention hshould hthe hnurse himplement hto hprovide hoptimal hcare hfor han holder
hpatient hwho his hhospitalized hwith hpneumonia?
a) Plan hfor htransfer hto ha hlong-term hcare hfacility.
b) Minimize hactivity hlevel hduring hhospitalization.
c) Consider hthe hpreadmission hfunctional habilities.
d) Use han happroved hstandardized hgeriatric hnursing hcare hplan.
ANS: hC
The hplan hof hcare hfor holder hadults hshould hbe hindividualized hand hbased hon hthe hpatient’s
hcurrent hfunctional habilities. hA hstandardized hgeriatric hnursing hcare hplan hwill hnot haddress
hindividual hpatient hneeds hand hstrengths. hA hpatient’s hneed hfor hdischarge hto ha hlong-term hcare
hfacility his hvariable.
Activity hlevel hshould hbe hdesigned hto hallow hthe hpatient hto hretain hfunctional habilities hwhile
hhospitalized hand halso hto hallow hany hadditional hrest hneeded hfor hrecovery hfrom hthe hacute
hprocess.
6. The hnurse hcares hfor han holder hadult hpatient hwho hlives hin ha hrural harea. hWhich
hintervention hshould hthe hnurse hplan hto himplement hto hmeet hthis hpatient’s hneeds?
a) Suggest hthat hthe hpatient hmove hcloser hto hhealth hcare hproviders.
b) Obtain hextra hmedications hfor hthe hpatient hto hlast hfor h4 hto h6 hmonths.
c) Ensure htransportation hto happointments hwith hthe hhealth hcare hprovider.
d) Assess hthe hpatient hfor hchronic hdiseases hthat hare hunique hto hrural hareas.
ANS: hC
Transportation hcan hbe ha hbarrier hto haccessing hhealth hservices hin hrural hareas. hThe hpatient
hliving hin ha hrural harea hmay hlose hthe hbenefits hof ha hfamiliar hsituation hand hsocial hsupport
hby hmoving hto han hurban harea. hThere hare hno hchronic hdiseases hunique hto hrural hareas.
hBecause hmedications hmay hchange, hthe hnurse hshould hhelp hthe hpatient hplan hfor hobtaining
hmedications hthrough halternate hmeans hsuch has hthe hmail hor hdelivery hservices, hnot hby
hpurchasing hlarge hquantities hof hthe hmedications.
7. Which hnursing haction hwill hbe hmost hhelpful hin hdecreasing hthe hrisk hfor hdrug-drug
hinteractions hin han holder hadult?
a) Teach hthe hpatient hto hhave hall hprescriptions hfilled hat hthe hsame hpharmacy.
b) Make ha hschedule hfor hthe hpatient has ha hreminder hof hwhen hto htake heach hmedication.
c) Instruct hthe hpatient hto havoid htaking hover-the-counter h(OTC) hmedications hor
hsupplements.
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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.
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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 hintervention hshould hthe hnurse himplement hto hprovide hoptimal hcare hfor han holder
hpatient hwho his hhospitalized hwith hpneumonia?
a) Plan hfor htransfer hto ha hlong-term hcare hfacility.
b) Minimize hactivity hlevel hduring hhospitalization.
c) Consider hthe hpreadmission hfunctional habilities.
d) Use han happroved hstandardized hgeriatric hnursing hcare hplan.
ANS: hC
The hplan hof hcare hfor holder hadults hshould hbe hindividualized hand hbased hon hthe hpatient’s
hcurrent hfunctional habilities. hA hstandardized hgeriatric hnursing hcare hplan hwill hnot haddress
hindividual hpatient hneeds hand hstrengths. hA hpatient’s hneed hfor hdischarge hto ha hlong-term hcare
hfacility his hvariable.
Activity hlevel hshould hbe hdesigned hto hallow hthe hpatient hto hretain hfunctional habilities hwhile
hhospitalized hand halso hto hallow hany hadditional hrest hneeded hfor hrecovery hfrom hthe hacute
hprocess.
6. The hnurse hcares hfor han holder hadult hpatient hwho hlives hin ha hrural harea. hWhich
hintervention hshould hthe hnurse hplan hto himplement hto hmeet hthis hpatient’s hneeds?
a) Suggest hthat hthe hpatient hmove hcloser hto hhealth hcare hproviders.
b) Obtain hextra hmedications hfor hthe hpatient hto hlast hfor h4 hto h6 hmonths.
c) Ensure htransportation hto happointments hwith hthe hhealth hcare hprovider.
d) Assess hthe hpatient hfor hchronic hdiseases hthat hare hunique hto hrural hareas.
ANS: hC
Transportation hcan hbe ha hbarrier hto haccessing hhealth hservices hin hrural hareas. hThe hpatient
hliving hin ha hrural harea hmay hlose hthe hbenefits hof ha hfamiliar hsituation hand hsocial hsupport
hby hmoving hto han hurban harea. hThere hare hno hchronic hdiseases hunique hto hrural hareas.
hBecause hmedications hmay hchange, hthe hnurse hshould hhelp hthe hpatient hplan hfor hobtaining
hmedications hthrough halternate hmeans hsuch has hthe hmail hor hdelivery hservices, hnot hby
hpurchasing hlarge hquantities hof hthe hmedications.
7. Which hnursing haction hwill hbe hmost hhelpful hin hdecreasing hthe hrisk hfor hdrug-drug
hinteractions hin han holder hadult?
a) Teach hthe hpatient hto hhave hall hprescriptions hfilled hat hthe hsame hpharmacy.
b) Make ha hschedule hfor hthe hpatient has ha hreminder hof hwhen hto htake heach hmedication.
c) Instruct hthe hpatient hto havoid htaking hover-the-counter h(OTC) hmedications hor
hsupplements.
4
