Basic Geriatric Nursing 6th Edition BY Patricia A - Test Bank

Chapter 01: Trends and Issues Test Bank MULTIPLE CHOICE 1. What fact explains the shift of health care focus toward the older adult in the late 1960s? a. Disability was viewed as unavoidable. b. Complications from disease increased mortality. c. Older adults’ needs are similar to those of all adults. d. Preventive health care practices increased longevity. ANS: D Increased preventive health care practices, disease control, and focus on wellness helped people live longer. DIF: Cognitive Level: Comprehension REF: p. 1 OBJ: 2 TOP: Aging Trends KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 2. To what age group does the term “aged” apply? a. 55–64 years of age b. 65–74 years of age c. 75–84 years of age d. 85 and older ANS: C The term aged refers to persons who are 75–84 years of age. DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 1 TOP: Age Categories KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 3. Which of the following is true of ageism? a. It is discrimination against persons solely on the basis of age. b. It causes a person to fear aging. c. It involves the use of cultural sensitivity to address concerns of aging. d. It focuses on resources for the older adult. ANS: A Ageism is a negative belief pattern that influences persons to discriminate against persons solely on the basis of age and can lead to destructive behaviors toward the older adult. DIF: Cognitive Level: Comprehension REF: p. 4 OBJ: 3 TOP: Ageism KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 4. What is the most beneficial legislation that has influenced health care for the older adult? a. Medicare and Medicaid b. Elimination of the mandatory retirement age c. The Americans with Disabilities Act d. The Drug Benefit Program ANS: A The broadest sweeping legislation beneficial to the older adult is Medicare and Medicaid. The elimination of the mandatory retirement age does not apply to health care. The Americans with Disabilities Act deals with all Americans with disabilities, not just the older adult. The Drug Benefit Program was added to Medicare, but deals only with medications. DIF: Cognitive Level: Comprehension REF: pp. 15-16 OBJ: 6 TOP: Legislation KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 5. What housing option for the older adult offers the privacy of an apartment with restaurant-style meals and some medical and personal care services? a. Government-subsidized housing b. Long-term care facility c. Assisted-living center d. Group housing plan ANS: C Assisted-living arrangements offer the privacy of an apartment or condominium with meals prepared and served, limited medical care, and a variety of personal services. DIF: Cognitive Level: Knowledge REF: p. 13 OBJ: 9 TOP: Housing Options KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The 75-year-old man who has been hospitalized following a severe case of pneumonia is concerned about his mounting hospital bill and asks if his Medicare coverage will pay for his care. What would be the most helpful response by the nurse? a. Medicare Part C pays 50% of all medical costs for persons older than 65. b. Medicare Part B pays hospital costs and physician fees. c. Medicare Part A pays for inpatient hospital costs. d. Medicare Part D pays 80% of the charges made by physicians. ANS: C Medicare Part A pays inpatient hospital costs, Part B pays 80% of physician’s charges, and Part D helps defray prescription drug costs. Medicare Part C allows individuals to receive health insurance through private insurance companies and typically pays entire costs. DIF: Cognitive Level: Application REF: p. 15 OBJ: 6 TOP: Medicare Provisions KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 7. The daughter of a patient who has been diagnosed with terminal cancer asks which documents are required to allow her to make health care decisions for her parent. Which response would provide the most information to the daughter? a. Advance directives indicate the degree of intervention desired by the patient. b. A ‘Do Not Resuscitate’ document signed by the patient transfers authority to the next of kin. c. A durable power of attorney for health care transfers decision-making authority for health care to a designated person. d. A living will transfers authority to the physician. ANS: C A durable power of attorney for health care transfers the authority for decision making to a designated person. An advance directive specifies the type of care an individual desires when he cannot speak for himself. The durable power of attorney is only one type of advance directive. A “Do Not Resuscitate” document states that the patient wishes to die naturally with no intervention. A living will prohibits the use of life-prolonging measures. DIF: Cognitive Level: Application REF: p. 18 OBJ: 11 TOP: Advance Directives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 8. The daughter of a resident in a long-term care facility is frustrated with her 80-year-old mother’s refusal to eat. Which response would be the most appropriate? a. The refusal to eat is an effort to maintain a portion of independence and self-direction. b. The refusal to eat is an indication of approaching Alzheimer disease. c. The refusal to eat is an effort to gain attention. d. The refusal to eat is an indication of the dislike of the institutional food. ANS: A Loss of independence and control is a significant issue for the older adult. Some residents will exercise whatever control they may retain. DIF: Cognitive Level: Application REF: p. 20 OBJ: 11 TOP: Loss of Independence KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 9. When do the conditions of a living will go into effect? a. When the patient declares that desire in writing b. When a family member indicates the desire for curative therapy to cease c. When two physicians agree in writing that the criteria in the living will have been met d. When the physician and a family member agree that the criteria in the living will have been met ANS: C Two physicians must agree in writing that the criteria of the living will have been met before the document can go into effect. DIF: Cognitive Level: Comprehension REF: p. 18 OBJ: 11 TOP: Living Wills KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 10. In the 1980s, Medicare initiated a program of diagnosis-related groups (DRGs) to reduce hospital costs. How did the DRGs reduce hospital costs? a. By classifying various diagnoses as ineligible for hospitalization b. By allotting a set amount of hospital days and prospective payment on the basis of the admitting diagnosis c. By specifying particular physicians to treat specified diagnoses d. By using frequency of a particular diagnosis to set a payment schedule ANS: B DRGs set up a system of preset hospitalization time and payment on the basis of the admitting diagnosis. DIF: Cognitive Level: Comprehension REF: pp. 15-16 OBJ: 6 TOP: DRGs KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 11. Which of the following facilities would be recommended for a patient who has had a hip replacement and needs physical therapy? a. Basic care facility b. Skilled care facility c. Subacute care facility d. Assisted-living residence ANS: B Skilled care facilities offer not only basic care but also services from trained licensed professionals such as nurses, physical therapists, speech therapists, and occupational therapists. DIF: Cognitive Level: Application REF: p. 15 OBJ: 9 TOP: Extended-Care Facilities KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 12. The 80-year-old woman who is recovering from a stroke is being sent to a skilled care facility. She is concerned about the expense. The nurse can decrease anxiety by explaining that Medicare will cover extended-care facility costs for what period of time? a. A period of 30 days b. A period of 45 days for physical therapy c. A period of 100 days for needed skilled care d. Until she is able to be discharged home ANS: C Medicare will cover skilled care costs for 100 days. After 100 days, the resident must revert to private pay or ancillary long-term care insurance. DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 8 TOP: Extended Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 13. Which senior citizen political action group uses volunteers and lobbyists to advance the interests of older adults? a. American Association of Retired Persons (AARP) b. National Council of Senior Citizens (NCSC) c. National Alliance of Senior Citizens (NASC) d. Gray Panthers ANS: A The AARP uses volunteers and lobbyists to advance the interests and welfare of older adults. DIF: Cognitive Level: Knowledge REF: p. 11 OBJ: 7 TOP: Political Action Groups KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 14. Which caregiver could be found guilty of elder abuse? a. A daughter who uses her mother’s Social Security money to purchase her mother’s medication b. A son who puts an alarm on the front door to prevent his mother from wandering out of the house c. A wife who allows her mentally competent husband to refuse to take a bath for a week d. A frail spouse who is unable to bathe or change the clothes of her physically dependent husband ANS: D Unintentional abuse or neglect can occur when the caregiver lacks the stamina to meet care needs. Even though physically unable, the frail wife is guilty of elder abuse. The wife should seek assistance to prevent neglect. DIF: Cognitive Level: Analysis REF: p. 21 OBJ: 13 TOP: Elder Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 15. What is the most frequent response to elder abuse by the abused older adult? a. Anger b. Physical retaliation c. Notification of authorities d. Nothing at all ANS: D Fear of retaliation or abandonment keeps most abused older adults silent. DIF: Cognitive Level: Application REF: p. 23 OBJ: 14 TOP: Response to Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 16. What reason is often stated by nurses today for not seeking careers in gerontology? a. The physical work is too difficult. b. Their technical skills are not used. c. There is too much challenge. d. There are limited options for employment. ANS: B Many nurses feel that their technical skills will not be used in the care of the older adult. There are many employment options that offer challenge and fulfillment. DIF: Cognitive Level: Comprehension REF: p. 5 OBJ: 2 TOP: Employment Options KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 17. “Baby boomers” is a term used to classify which of the following persons? a. Those who entered school in 1945 b. Those who served in the military in World War II c. Those who were born between 1946 and 1964 d. Those who were eligible for Social Security benefits in 2000 ANS: C Baby boomers are those born between 1946 and 1964. The impact of the retirement of this cohort is unprecedented in terms of the impact on society. DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 5 TOP: Baby Boomers KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 18. What type of abuse is demonstrated by restraining an older adult in a recliner? a. Physical abuse b. Neglect c. Emotional abuse d. Self-neglect ANS: A Physical abuse is any action that causes physical pain or injury. Inappropriate use of drugs, force-feeding, physical restraints, and punishment of any kind are examples of physical abuse. DIF: Cognitive Level: Application REF: p. 22 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 19. Which type of elder abuse is demonstrated by the nonprovision of medical care? a. Physical abuse b. Neglect c. Emotional abuse d. Self-neglect ANS: B Neglect is a passive form of abuse in which caregivers fail to provide for the needs of the older person under their care. Failure to provide necessary medical care may constitute neglect because with no means of going to the doctor or pharmacy, the older person may suffer or even die. DIF: Cognitive Level: Application REF: p. 22 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 20. Which type of elder abuse is demonstrated by a health care worker eating a resident’s candy without permission? a. Physical abuse b. Neglect c. Emotional abuse d. Self-neglect ANS: C Emotional abuse is more subtle and difficult to recognize than physical abuse or neglect. It often includes behaviors such as isolating, ignoring, or depersonalizing older adults. Health care workers eating a resident’s candy without permission is an ignorant behavior that can be depersonalizing. DIF: Cognitive Level: Application REF: p. 22 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE 21. The nurse is aware that a person’s attitude about aging is influenced mainly by his or her __________. (Select all that apply.) a. life experiences b. income level c. level of education d. current age e. occupation ANS: A, D A person’s current age and life experiences are the main influences on his or her attitude relative to aging. DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 2 TOP: Attitudes Toward Aging KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 22. Gerontology encompasses application to __________. (Select all that apply.) a. appropriate housing b. health care c. public education d. business ventures e. government-sponsored pensions ANS: A, B, C, D Gerontological concerns extend and influence provision of appropriate housing, health care, public education, business ventures, and political stands relative to the welfare of the older adult. DIF: Cognitive Level: Application REF: p. 2 OBJ: 1 TOP: Gerontology KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 23. Medicare Part C allows eligible persons to receive Medicare benefits via the services of private insurance companies through which of the following? (Select all that apply.) a. Health maintenance organization (HMO) b. Preferred provider organization (PPO) c. Provider-sponsored organization (PSO) d. Private fee for service organization (PFFS) e. Medical service organization (MSO) ANS: A, B, C, D Medicare Part C allows benefits via the services of managed care organizations. Medical service organization is not one of them. DIF: Cognitive Level: Comprehension REF: p. 16 OBJ: 6 TOP: Medicare Part C KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 24. Which emotional response would be expected from a family who is coping with an aging loved one’s diminishing abilities and increased care needs? (Select all that apply.) a. Grief b. Anger c. Frustration d. Loss e. Resentment ANS: A, B, C, D As the family witnesses the decline of a loved one and attempts to respond to the increasing care needs, the emotional responses are varied and changing. The responses include grief, anger, frustration, loss, and confusion. DIF: Cognitive Level: Application REF: p. 20 OBJ: 11 TOP: Impact of Aging on the Family KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 25. What characteristics are typical for a caregiver of an aging family member? (Select all that apply.) a. 32 years of age b. Female c. Having full-time employment d. Having a care recipient older than 70 e. Giving care for an average of 18 years ANS: B, C, D, E The average age of the caregiver is 46. DIF: Cognitive Level: Application REF: p. 19 OBJ: 11 TOP: Characteristics of Family Caregiver KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 26. Which of the following are indicators of self-neglect in the aging person? (Select all that apply.) a. Misbalanced checkbook b. Reduced personal hygiene c. Increased alcohol consumption d. Irritability e. Loss of weight ANS: A, B, C, E Indicators may be to manage personal finances, reduced hygiene, substance abuse, and loss of weight due to inability to obtain adequate food. Irritability is not a consistent characteristic. DIF: Cognitive Level: Application REF: p. 21 OBJ: 11 TOP: Self-Neglect KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 27. The nurse reminds a group of prospective caregivers that elder abuse may take the form of __________. (Select all that apply.) a. caring for physical needs b. misappropriation of finances c. psychological intimidation d. emotional depersonalization e. abandonment ANS: B, C, D, E Elder abuse may take the form of physical injury, misusing the older person’s finances for personal gain, psychological intimidation, and depersonalization and abandonment. DIF: Cognitive Level: Application REF: pp. 21-23 OBJ: 13 TOP: Elder Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 28. Research by the National Institute on Aging found which of the following to be correct? (Select all that apply.) a. Older patients receive less information regarding health management than younger patients. b. Information on lifestyle changes were directed at younger people. c. Older patients were denied timely appointments for evaluation of acute illnesses. d. Rehabilitation programs offered limited services to the older adult. e. Older patients receive less evaluation and fewer treatment options for acute illnesses. ANS: A, B, D, E The study showed there was less information on health management and lifestyle changes. Rehabilitation programs were limited in their service to the older adult, and only 47% of physicians interviewed felt the older patient received the same evaluation for acute illnesses. DIF: Cognitive Level: Application REF: pp. 3-5 OBJ: 2 TOP: Attitudes Toward Aging KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 29. The Nursing Competence in Aging initiative advocates enhancing nurses’ __________. (Select all that apply.) a. knowledge in gerontics b. skills in geriatrics c. opportunities for employment d. political sensitivity for the older adult e. attitudes related to the older adult ANS: A, B, E The Nursing Competence in Aging initiative advocates for all nurses greater knowledge, skills, and broader attitudes toward the older adult. DIF: Cognitive Level: Comprehension REF: p. 5 OBJ: 12 TOP: Attitudes Toward Aging KEY: Nursing Process Step: N/A MSC: NCLEX: N/A COMPLETION 30. The nurse clarifies that the term that refers to the promotion of high-level functioning and supportive care to older adults is __________. ANS: gerontics DIF: Cognitive Level: Comprehension REF: p. 2 OBJ: 10 TOP: Gerontics KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 31. The nurse reminds a patient who was born in 1965 that eligibility for full Social Security benefits for persons of this age is now the age of __________. ANS: 67 DIF: Cognitive Level: Knowledge REF: p. 3 OBJ: 2 TOP: Change of Social Security Benefits KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 32. The nurse clarifies that the point at which a person on Medicaid Part D must assume full cost of medication is called the __________ __________. ANS: donut hole The “donut hole” is the point at which the insured has used up the $2850 worth of coinsurance for drugs and must pay the full cost of medication until the amount of out-of-pocket expenses reaches $4750. DIF: Cognitive Level: Comprehension REF: p. 16 OBJ: 8 TOP: Donut Hole KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care Chapter 03: Physiologic Changes Test Bank MULTIPLE CHOICE 1. Why does the nurse modify the environment to keep it warmer for the older adult? a. A change in the metabolic rate b. Decreased subcutaneous tissue c. Changes in the musculoskeletal system d. A weakened peripheral vascular system ANS: B The reduction of subcutaneous tissue as an age-related change causes sensitivity to cold because it is the main insulator of the body. DIF: Cognitive Level: Application REF: pp. 32-33 OBJ: 1 TOP: Sensitivity to Cold KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. A 75-year-old male is worried that his wartlike dark macules with distinct borders are melanomas. What would be the most likely cause for the macules? a. Senile lentigo b. Cutaneous papillomas c. Seborrheic keratoses d. Xerosis ANS: C Dark, slightly raised macules are seborrheic keratoses, which may be mistaken for melanomas. DIF: Cognitive Level: Comprehension REF: p. 32 OBJ: 1 TOP: Seborrheic Keratosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse is accompanying a group of older adults on a July 4th outing to monitor heat prostration. What factor is related to heat intolerance in the older adult? a. An increase in melanin b. A reduction of perspiration c. A reduction in body temperature d. Increased capillary fragility ANS: B Reduction in perspiration related to reduced sweat gland function results in possible heat intolerance from an inability to cool the body by evaporation. DIF: Cognitive Level: Analysis REF: p. 33 OBJ: 2 TOP: Heat Intolerance KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse cautions the Certified Nursing Assistants (CNAs) to use care when transferring or handling older adults. The nurse understands that the vascular fragility of the older adult can result in which of the following conditions? a. Altered blood pressure b. Pressure ulcers c. Pruritus d. Senile purpura ANS: D Increased capillary fragility results in subcutaneous hemorrhage or senile purpura from careless handling by caregivers. DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 7 TOP: Senile Purpura KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Which symptom would be a characteristic of a stage I pressure ulcer on an older adult’s coccyx? a. Clear blister b. Nonblanchable area of erythema c. Scaly abraded area d. Painful reddened area ANS: B A red nonblanchable area is indicative of a stage I pressure ulcer. DIF: Cognitive Level: Analysis REF: p. 34 OBJ: 5 TOP: Pressure Ulcers KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The Certified Nursing Assistant (CNA) caring for an older adult asks if the yellow, waxy, crusty lesions on the patient’s axilla and groin are contagious. Which response shows the nurse’s understanding for the cause of the lesions? a. “Yes. It is cellulitis caused by bacteria.” b. “No. It is seborrheic dermatitis caused by excessive sebum.” c. “Yes. It is an indication of scabies.” d. “No. It is the lesion seen with basal cell carcinoma.” ANS: B Seborrheic dermatitis is a bothersome skin condition resulting from an excess of sebum. DIF: Cognitive Level: Application REF: p. 35 OBJ: 5 TOP: Seborrheic Dermatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. Why would a nurse lead a group of postmenopausal women on a daily 15-minute “walking tour” through the long-term care facility? a. To improve bone strength b. To orient them to their surroundings c. To improve their socialization d. To increase their appetite ANS: A Stress to long bones by weight-bearing and walking will increase bone strength. DIF: Cognitive Level: Analysis REF: p. 35 OBJ: 7 TOP: Bone Strength KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. A 70-year-old woman asks, “How in the world can my bones be brittle when I eat all the right foods?” Which response by the nurse would be the most informative? a. “Calcium loss is expected in the older adult.” b. “Calcium is continuously withdrawn from bone for nerve and muscle function.” c. “Smoking and alcohol consumption speed calcium loss from the bones.” d. “Walking and standing increase calcium loss from the bone.” ANS: B Calcium is constantly withdrawn from the bone for nerve and muscle function and clotting needs. DIF: Cognitive Level: Comprehension REF: p. 35 OBJ: 3 TOP: Calcium Loss KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. A 70-year-old woman complains, “I weigh exactly the same as I did when I wore a size 10 and now I can barely squeeze into a size 16.” Which statement by the nurse would most correctly explain the size change to the woman? a. “Metabolism in the older adult creates increased adipose tissue.” b. “Postmenopausal women gain adipose tissue related to loss of calcium.” c. “Decrease in muscle mass is replaced with adipose tissue.” d. “Kyphosis causes a redistribution of weight.” ANS: C Decrease in muscle mass is replaced with adipose tissue, which frequently changes the appearance of the body, but not the weight. DIF: Cognitive Level: Application REF: p. 38 OBJ: 4 TOP: Loss of Muscle Mass KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. What would be the most helpful response to a 70-year-old postmenopausal woman who asks whether her hormone replacement therapy (HRT) will prevent bone loss? a. “No. HRT is not helpful after the age of 60.” b. “Yes. HRT will prevent bone loss but can cause a stroke, heart attack, or breast cancer.” c. “No. HRT is reliant on some natural estrogen production from the ovaries.” d. “Yes. HRT is a widely accepted therapy for prevention of bone loss.” ANS: B HRT is helpful to prevent bone loss, but the risks of cardiovascular complications and cancer have made the choice of HRT controversial. DIF: Cognitive Level: Analysis REF: p. 38 OBJ: 4 TOP: Hormone Replacement Therapy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. What are Heberden nodes? a. Yellow longitudinal lines in the nails b. Thickened discolored fingernails c. Darkened areas under the fingernail d. Bony enlargements of distal joints of the fingers ANS: D Heberden nodes are bony enlargements of the distal joints of the fingers associated with osteoarthritis. DIF: Cognitive Level: Knowledge REF: p. 39 OBJ: 5 TOP: Heberden Nodes KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. Which care plan modification would be the most beneficial for a 62-year-old woman who is suffering from a flare in her rheumatoid arthritis? a. Increase fluid intake b. Schedule several rest periods to balance activity c. Reduce salt in the diet d. Assist with rigorous finger extension exercises ANS: B Balancing rest and activity allows the resident to remain relatively flexible. Joints may be splinted to reduce contracture. DIF: Cognitive Level: Application REF: p. 39 OBJ: 5 TOP: Rheumatoid Arthritis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. What is the pathophysiology of emphysema? a. Constriction of the bronchial tree, excessive mucus, and nonproductive cough b. Calcification of the alveoli and a dry cough c. Overinflation of the alveoli, making them ineffective for gas exchange d. Inflammation of the trachea and bronchioles, excessive mucus, and productive cough ANS: C Emphysema causes overinflation of the nonelastic alveoli, which disallows gas exchange in the affected alveoli and results in reduced oxygenation. DIF: Cognitive Level: Comprehension REF: p. 41 OBJ: 5 TOP: Emphysema KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. What is the pathophysiology of a myocardial infarct? a. A portion of the myocardium necroses and scars over. b. The coronary vessels are narrowed during the attack. c. The ischemic myocardium causes pain during the attack but is able to regenerate. d. There is damage to the myocardium but no serious alteration of cardiac output. ANS: A The myocardium necroses and scars and does not regenerate. The degree of heart damage is related to the amount of necrosis. DIF: Cognitive Level: Comprehension REF: p. 45 OBJ: 5 TOP: Myocardial Infarct KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. Which of the following assessments are the cardinal signs and symptoms of congestive heart failure? a. Dyspnea and edema b. Myocardial pain and hypotension c. Ventricular arrhythmias and cyanosis d. Atrial arrhythmias and polycythemia ANS: A Dyspnea and generalized edema are the cardinal signs and symptoms of congestive heart failure. DIF: Cognitive Level: Application REF: p. 46 OBJ: 5 TOP: Congestive Heart Failure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. What is a cause of pernicious anemia? a. An iron deficiency b. A deficiency of vitamin B12 c. Low serum potassium level d. Blood loss ANS: B Pernicious anemia results from a deficiency of vitamin B12. DIF: Cognitive Level: Knowledge REF: p. 49 OBJ: 5 TOP: Pernicious Anemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. What would be an acceptable alteration in the plan of care for a patient with a hiatal hernia who is experiencing gastrointestinal reflux? a. Encouraging the patient to lie down after meals b. Drinking two full glasses of liquid after the evening meal c. Eating smaller, more frequent meals d. Using caffeine drinks to assist with digestion ANS: C Eating smaller and more frequent meals does not enlarge the stomach. DIF: Cognitive Level: Analysis REF: p. 52 OBJ: 5 TOP: Hiatal Hernia KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 18. The nurse assesses a diabetic patient and finds the patient to be pale, edematous, and listless with a blood urea nitrogen (BUN) level of 35 mg/dL and a creatinine level of 4 mg/dL. What would the results of the nursing assessment indicate? a. Diverticulitis b. Congestive heart failure c. Chronic renal failure d. Benign prostatic hypertrophy ANS: C The increased BUN and creatinine levels indicate renal failure. DIF: Cognitive Level: Application REF: p. 55 OBJ: 6 TOP: Renal Failure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. A person with Parkinsons disease has a nursing diagnosis of “nutrition, less than body requirements related to difficulty swallowing.” What change would the nurse make in the nursing care plan? a. Feed the patient at each meal. b. Place the patient in a semi-Fowler position for mealtime. c. Offer a thick, high-nutrition shake as a snack. d. Encourage the patient to drink a sip of water after each bite of solid food. ANS: C Thick shakes are easier to swallow without aspiration and will also improve nutrition. DIF: Cognitive Level: Application REF: p. 57 OBJ: 5 TOP: Parkinson Disease KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 20. A person who experienced a hemorrhagic cardiac vascular accident (CVA) to the left hemisphere would demonstrate which type of symptoms? a. Language disturbances b. Poor impulse control c. Inappropriate affect d. Confabulation ANS: A A left hemisphere CVA would most likely cause language disturbances such as aphasia, agraphia, or alexia. DIF: Cognitive Level: Application REF: p. 60 OBJ: 5 TOP: Cerebrovascular Accident KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. How should the nurse provide written discharge instructions for a patient with macular degeneration? a. Write the instructions in bold print. b. Adjust the table and light to assist the patient to use peripheral vision to read. c. Place written document directly in front of the patient to read. d. Read the document to the patient. ANS: B Assist the patient to use peripheral vision because central vision is lost in macular degeneration. DIF: Cognitive Level: Application REF: p. 63 OBJ: 5 TOP: Macular Degeneration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. What is a symptom of inadequate insulin coverage in a patient with diabetes mellitus type I? a. Diminished urine output b. Ketones in the urine c. Shallow and slow respirations d. Extreme diaphoresis ANS: B When there is inadequate insulin coverage for the type 1 diabetic, the diabetic lacks the glycogen to use as energy and attempts to use fat, which creates an acid in the form of ketones. DIF: Cognitive Level: Comprehension REF: pp. 68-69 OBJ: 5 TOP: Diabetes Mellitus Type 1 KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. An 80-year-old extended-care resident comes to the nurse asking for a bandage for a bleeding, dark pigmented mole with irregular shape and border. What does the nurse suspect? a. Melanoma b. Basal cell carcinoma c. Cutaneous papilloma d. Senile lentigo ANS: A Melanomas are dark, irregularly shaped lesions that may cause itching or bleeding. These are potentially deadly and should be reported to obtain quick treatment. DIF: Cognitive Level: Comprehension REF: pp. 33-34 OBJ: 5 TOP: Melanoma KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease MULTIPLE RESPONSE 24. What factors influence the timing and extent of age-related changes? (Select all that apply.) a. Health maintenance b. Ethnicity c. Heredity d. Attitude e. Environment ANS: A, C, E Heredity, environment, and health maintenance affect the timing and magnitude of age-related changes. DIF: Cognitive Level: Comprehension REF: pp. 31-32 OBJ: 1 TOP: Influences on Age-Related Changes KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. What should be avoided by an 82-year-old man with rosacea? (Select all that apply.) a. Stress b. Dairy products c. Sun exposure d. Spicy foods e. Alcohol consumption ANS: A, C, D, E The patient who has rosacea should avoid stress, sun exposure, spicy foods, and alcohol consumption. DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 5 TOP: Rosacea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 26. What vitamins are necessary to support ossification? (Select all that apply.) a. A b. B6 c. C d. D e. E ANS: A, C, D Vitamins A, C, and D are necessary for bone matrix formation and replenishment. DIF: Cognitive Level: Knowledge REF: p. 35 OBJ: 7 TOP: Ossification KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 27. What are risk factors for osteoporosis? (Select all that apply.) a. Menopause b. Smoking c. White female d. Excessive high-impact exercise e. Long-term use of phenytoin (Dilantin) ANS: A, B, C, E Menopausal white women who smoke and have had long-term administration of phenytoin (Dilantin), heparin, or corticosteroids are at risk for osteoporosis. DIF: Cognitive Level: Comprehension REF: p. 38 OBJ: 5 TOP: Risk Factors for Osteoporosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. What age-related changes in the respiratory system explain why the older adult is at risk for infection? (Select all that apply.) a. Reduced ciliary movement b. Decrease in alveolar elasticity c. Pooling of secretions d. Flattened diaphragm e. Calcification of costal cartilage ANS: A, B, C The flattening of the diaphragm and the calcification of cartilages decrease respiratory effectiveness but do not support pathogen growth as do ciliary and alveolar changes. DIF: Cognitive Level: Comprehension REF: pp. 40-41 OBJ: 1 TOP: Age-Related Changes in the Respiratory System KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation COMPLETION 29. The nurse is aware that children with __________ have the treatment and care needs of persons of advanced age. ANS: progeria A rare condition called progeria causes severe premature aging. When they are only 8 or 9 years of age, children with progeria have the physiology and appearance of 70-year-olds. DIF: Cognitive Level: Knowledge REF: p. 31 OBJ: 6 TOP: Progeria KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. The 75-year-old resident in a long-term care facility complains of muscle pain while riding a stationary bicycle. The nurse explains that the discomfort is related to the buildup of __________ __________ in the muscle. ANS: lactic acid Elevated levels of lactic acid may result in muscle fatigue and soreness. DIF: Cognitive Level: Comprehension REF: p. 37 OBJ: 7 TOP: Lactic Acid Buildup KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. When a 75-year-old male resident in an extended-care facility tells the nurse he wants to build up the muscles in his arms, the nurse recommends a(n) __________ exercise program. ANS: isotonic Isotonic exercises such as flexing and extending the arms while holding hand weights build tone and muscle mass. DIF: Cognitive Level: Comprehension REF: p. 37 OBJ: 4 TOP: Isotonic Exercises KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 32. Arrange these common diseases of the older adult in order of their mortality rate. (Separate letters by a comma and space as follows: A, B, C, D) a. Cancer b. Pneumonia c. Stroke d. Chronic obstructive pulmonary disease (COPD) e. Heart disease ANS: E, A, C, B, D The five leading causes of death in older adults are heart disease, cancer, stroke, pneumonia, and COPD. DIF: Cognitive Level: Comprehension REF: p. 32 OBJ: 5 TOP: Diseases Rated by Mortality KEY: Nursing Process Step: N/A MSC: NCLEX: N/A Chapter 07: Medications and Older Adults Test Bank MULTIPLE CHOICE 1. Why is drug testing done by pharmaceutical companies not always appropriate for the older adult? a. The testing is not done long enough. b. The testing does not require adequate follow-up. c. The testing is not well regulated by the U.S. Food and Drug Administration. d. The testing is usually conducted on healthy young persons. ANS: D Long and rigorously regulated drug testing procedures most often use healthy young adults as drug testers. DIF: Cognitive Level: Comprehension REF: pp. 130-131 OBJ: 1 TOP: Drug Testing KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 2. What is a cause for increased rate of drug absorption in an older patient? a. Change of the chemical composition of the drug b. Increased gastric pH c. Decreased strength of the drug d. Decreased gastric motility ANS: D Decreased gastric motility can increase the rate of drug absorption due to an increased amount of time that the medication is in contact with the gastric mucosa. DIF: Cognitive Level: Analysis REF: p. 131 OBJ: 3 TOP: Drug Absorption KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 3. What age-related changes in the stomach can cause increased drug absorption and possibly drug toxicity? a. Decreased gastric motility b. Gastric reflux disease c. Inability of gastric cells to transport the drug d. Decreased peristalsis ANS: A Decreased motility leaves the drug in contact with the gastric mucosa for a longer period of time, which leads to increased absorption. Peristalsis is rhythmic movements of the bowels. DIF: Cognitive Level: Application REF: p. 131 OBJ: 3 TOP: Increased Absorption KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 4. What should an older adult be encouraged to implement in order to prevent lithium toxicity? a. Increase fluid intake to 3500 mL daily. b. Have the patient ambulate for 10 minutes after the drug is administered. c. Prohibit citrus fruit in the diet. d. Administer a prescribed stool softener to ensure a daily bowel movement. ANS: A Increase of fluids will help allow water-soluble drugs such as lithium to be diluted in the bloodstream more effectively and excreted more rapidly. DIF: Cognitive Level: Application REF: p. 131 OBJ: 9 TOP: Distribution KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 5. An older adult is taking diazepam several times a day. What does the nurse specifically monitor for? a. Tachycardia b. A hangover effect c. Agitation d. Hypertension ANS: B Fat-soluble drugs become trapped in the adipose tissue and are slowly released into the bloodstream, increasing the drug’s concentration. DIF: Cognitive Level: Application REF: p. 138 OBJ: 4 TOP: Distribution KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 6. Why would the nurse anticipate an adverse reaction in an older adult who is taking the protein-bound drug warfarin (Coumadin)? a. Unbound active drug molecules continue to circulate in the bloodstream. b. The bleeding and clotting times will decrease. c. The drug becomes ineffective and does not deliver its intended therapeutic action. d. Renal damage can occur from the altered drug molecules. ANS: A Unbound drug molecules will still be circulating, leading to excess drug in the bloodstream. DIF: Cognitive Level: Application REF: p. 132 | p. 134 OBJ: 4 TOP: Distribution KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 7. Why does the nurse frequently assess an older adult who is on a psychotropic drug? a. Older adults are less active. b. The older adult has fewer cognitive capabilities. c. Brain receptors have become hypersensitive. d. Receptor sites have lower perfusion. ANS: C Brain receptors in the older adult become hypersensitive as age increases, resulting in an exaggerated response to pharmacologic therapy. DIF: Cognitive Level: Analysis REF: p. 132 OBJ: 7 TOP: Pharmacodynamics KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 8. What is the major risk of polypharmacy for the older adult? a. Ignorance about his or her prescriptions b. Taking over-the-counter preparations c. Being treated by more than one physician d. Taking old prescriptions rather than consulting a physician ANS: C Although all the options may offer an opportunity for polypharmacy, the major risk is that of the patient being treated by more than one physician at the same time. DIF: Cognitive Level: Application REF: pp. 132-133 OBJ: 1 TOP: Polypharmacy KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 9. The home health nurse would be most concerned about self-medicating errors for the older adult living alone who is a type 1 diabetic and is a. afflicted with early Parkinson disease. b. visually impaired. c. a rheumatoid arthritic with stiffened hands. d. paralyzed from the waist down. ANS: B The visually impaired diabetic is at the greatest risk for a medication error by incorrectly preparing an insulin injection. DIF: Cognitive Level: Analysis REF: p. 143 OBJ: 12 TOP: Sensory Changes KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. What is the most reliable method of patient identification for administration of medications? a. A photograph of the patient b. An identification bracelet c. Asking the patient to repeat his or her name d. Use of the patient’s room number ANS: B The use of an identification bracelet is the most accurate and reliable method to identify the patient. DIF: Cognitive Level: Comprehension REF: p. 139 OBJ: 9 TOP: Patient Identification KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 11. The physician has written an order to convert an enteric-coated medication from the pill form to the liquid form. What would be the most appropriate response of the nurse? a. Transcribe the order and change the medication administration record to show the liquid form. b. Use up the rest of the tablets by crushing them and giving them dissolved in water. c. Order the liquid form from the pharmacy as ordered. d. Inquire if the physician wants the dose to be the same as the pill. ANS: D Because liquids are absorbed more rapidly, the dose might need to be lowered or the schedule of administration changed to avoid an overdose. Enteric-coated medications should not be crushed. DIF: Cognitive Level: Analysis REF: p. 140 OBJ: 9 TOP: Liquid Medication KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 12. The patient complains that her medications stick in her throat. What would be an appropriate response of the nurse? a. Suggesting that she take all the pills at one time with a mouthful of water. b. Offering the patient one pill at a time. c. Crushing all the pills and mixing them in the patient’s breakfast cereal. d. Offering a sip of water before and after each pill. ANS: D Offering water before and after administration counteracts the dry mouth that causes the pills to stick. Offering one pill at a time without water does not address the problem of sticking. DIF: Cognitive Level: Application REF: p. 141 OBJ: 9 TOP: Pill Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 13. What is a correct method of administering a transdermal medication patch? a. Apply the patch at the same site every day and carry out documentation. b. Fold and dispose of the used patch in the sharps container. c. Warm the patch in his or her hands before application. d. Cover the patch with tape to prevent dislodgement. ANS: B The used patch should be folded with the sticky sides together and disposed of in the sharps container for environmental safety. DIF: Cognitive Level: Application REF: Box 7-4, p. 142 OBJ: 6 TOP: Transdermal Patches KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 14. When the medication nurse offers a pill to the older adult patient, the patient asks, “What is this and what is it for?” What is the best response by the nurse? a. “I’m not at liberty to discuss your medication. You need to talk to your doctor.” b. “That’s a ‘feel good’ pill that will make you feel better.” c. “It’s a cephalosporin that has been ordered to treat your URI.” d. “It’s an antibiotic for the infection in your urine.” ANS: D Patients have the right to know what they are taking and given a reasonable rationale for its use that they can understand. DIF: Cognitive Level: Application REF: p. 143 OBJ: 10 TOP: Right to Know KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 15. When the 80-year-old female patient refuses to take a medication because it burns her stomach, what action should be taken by the nurse? a. Crush the pill and mix it with the dessert on her meal tray. b. Insist that she take it “for her own good.” c. Circle and initial the dose time to show non-administration. d. Document the reason for refusal and report the refusal to the charge nurse. ANS: D The nurse should carry out documentation of the reason for refusal and report the refusal. DIF: Cognitive Level: Application REF: p. 143 OBJ: 10 TOP: Refusal of Treatment KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 16. What is a symptom of theophylline overdose? a. Tachycardia b. Confusion c. Hypotension d. Constipation ANS: A Tachycardia is a significant side effect of theophylline. DIF: Cognitive Level: Knowledge REF: Table 7-5, p. 138 OBJ: 7 TOP: Drug Overdose KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 17. Which assessment finding in a 75-year-old man on a chlorpromazine (Thorazine) protocol should be immediately reported to the physician? a. Cough b. Headache c. Drool d. Nausea ANS: C Drooling and difficulty swallowing are signs of drug toxicity to chlorpromazine (Thorazine). DIF: Cognitive Level: Application REF: Table 7-5, p. 138 OBJ: 7 TOP: Drug Toxicity KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 18. What site would be the best choice for an intramuscular injection to an emaciated 82-year-old patient? a. Upper outer quadrant of the gluteus maximus b. Gluteal c. Deltoid d. Ventrogluteal ANS: D The ventrogluteal site is the safest choice for the emaciated patient. The location is easily accessible and free from major nerves of vessels. DIF: Cognitive Level: Application REF: p. 142 OBJ: 9 TOP: Intramuscular Injection KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 19. What is the purpose of the Beers criteria? a. Identifies medications best avoided by the older adult. b. Identifies diagnostic procedures that are considered inappropriate for a diagnosis. c. Identifies penalties for extended-care facilities that allow administration of particular drugs. d. Identifies assessments necessary before the prescription of particular drugs. ANS: A The Beers criteria lists medications best not prescribed for the older adult. The lists are updated regularly, most recently in 2012. DIF: Cognitive Level: Knowledge REF: p. 133 OBJ: 5 TOP: Beers Criteria KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 20. What oral medication can be safely crushed? a. Plain antihypertensive medication tablet b. Sublingual tablet of nitroglycerin c. Timed-release capsule for gastric reflux d. Enteric-coated aspirin ANS: A Only the plain tablet can be crushed. Timed-release, sublingual medications, and enteric-coated medications should not be crushed. DIF: Cognitive Level: Comprehension REF: Box 7-3, p. 141 OBJ: 9 TOP: Crushing Medication KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies MULTIPLE RESPONSE 21. What provisions should be included in the plan of care for a 70-year-old extended-care facility resident who will be self-administering his medications? (Select all that apply.) a. Delivery of adequate supply of medication b. Payment for medication c. Locked medication storage at bedside d. Medication administration record e. Assessment of effectiveness of medication ANS: A, C, D, E For self-medication in an extended-care facility, the nurse should make provisions for adequate medication supply, locked storage, medication administration record, and an assessment of the effectiveness of the medication. Payment is not in the purview of the nurse. DIF: Cognitive Level: Comprehension REF: p. 143 OBJ: 12 TOP: Medication Administration KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 22. What information related to drug administration should be included in the nursing care plan? (Select all that apply.) a. Schedule for drawing blood values b. Patient’s need for crushing medication c. Patient’s preference as to the use of medium in which to give crushed medicines d. Schedule of medication and dose times e. Parameters of pulse or blood pressure, if significant to administration ANS: A, B, C, E Schedule and dose information are not considered part of the nursing care plan. DIF: Cognitive Level: Application REF: pp. 139-140 OBJ: 8 TOP: Medication Information in the Nursing Care Plan KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 23. What measures may the older adult take to reduce the high cost of prescription drugs? (Select all that apply.) a. Simply not fill a new prescription b. Take less than prescribed to preserve their supply c. Fill all prescriptions at once d. Save old prescription drugs for later use e. Share medications ANS: A, B, D, E Filling prescriptions at one time can be costly even with a discount; therefore the older adult may pick and choose which ones to fill. All the other behaviors listed are methods whereby persons on a limited budget will attempt to preserve their supply of medications and contain costs. DIF: Cognitive Level: Comprehension REF: pp. 144-145 OBJ: 12 TOP: Risks Related to Financial Factors KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 24. What factors increase the risk of medication-related problems in the older adult? (Select all that apply.) a. Drug-testing methodology b. Age-related changes c. Polypharmacy d. Cognitive and sensory changes e. Lack of adequate medical follow-up ANS: A, B, C, D Lack of follow-up is not identified as a factor in medication-related problems. DIF: Cognitive Level: Comprehension REF: pp. 131-133 OBJ: 1 TOP: Factors in Medication-Related Problems KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 25. Why is self-medication with over-the-counter (OTC) drugs hazardous to the older adult? (Select all that apply.) a. OTC drugs can increase the effect of a prescribed drug. b. OTC drugs can interfere with the efficacy of a prescribed drug. c. OTC drugs can mask significant symptoms of primary disease. d. OTC drugs are easily obtained. e. OTC drugs can lead to overdose because they are not considered to be “real drugs.” ANS: A, B, C, E OTC drugs can increase the effect of a prescribed drug, interfere with the efficacy of a prescribed drug, mask symptoms of primary diseases, and cause overdose. The fact that OTC drugs are easily obtained is a benefit, not a hazard, unless abused. DIF: Cognitive Level: Comprehension REF: p. 136 OBJ: 11 TOP: Overuse of OTC Drugs KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 26. The nurse crushes a pill and disguises the dose in the mashed potatoes of a resident in a long-term care facility who previously refused the drug. It is then fed to the patient by the nursing assistant. This should be considered an error because it __________. (Select all that apply.) a. violates the patient’s right to refuse medication b. involves delegation of medication administration to the nursing assistant c. increases the amount of time for the drug administration pass d. becomes impossible to confirm the patient received the entire dose e. alters the food ANS: A, B, D Hiding a dose of drug in a food serving that the patient had previously refused is unethical. Delegating the administration of a drug to a nonqualified person is illegal, and because there is no guarantee the entire serving of food will be consumed, the intended dose may not be delivered. DIF: Cognitive Level: Application REF: pp. 140-143 OBJ: 9 TOP: Disguising Drugs in Food KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies COMPLETION 27. The nurse clarifies that the term __________ refers to the study of how persons respond to medicines. ANS: pharmacodynamics DIF: Cognitive Level: Knowledge REF: p. 131 OBJ: 4 TOP: Medicating the Older Adult KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 28. The primary organ of drug metabolism is the __________. ANS: liver DIF: Cognitive Level: Knowledge REF: p. 132 OBJ: 3 TOP: Drug Metabolism KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 29. The home health nurse periodically interviews patients relative to their use of _________ because it is the most commonly consumed and abused nonprescription drug used by adults. ANS: alcohol DIF: Cognitive Level: Comprehension REF: p. 136 OBJ: 11 TOP: Use of Alcohol KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies OTHER 30. Arrange the steps for preparing crushed medications to be given by feeding tube in order of priority. a. Flush the tube to clear feeding. b. Thoroughly crush the medication. c. Administer each medication separately. d. Dissolve each crushed medication in a medicine cup. e. Flush the tube to clear the medication from the tube. f. Reconnect the feeding tube. ANS: B, D, A, C, E, F DIF: Cognitive Level: Application REF: p. 141 OBJ: 6 TOP: Crushed Medication per Tube KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies