A&E!!I!!Comprehensive!!Testban
k
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
The!!nurse!!cares!!for!!an!!alert,!!homeless!!older!!adult!!patient!!who!!was!!admitted!!to!!
the!!hospital!!with!!a!!chronic!!foot!!infection.!!Which!!intervention!!is!!the!!most!!appropr
iate!!for!!the!!nurse!!to!!include!in!!the!!discharge!!plan!!for!!this!!patient?
a) Teach!!the!!patient!!how!!to!!assess!!and!!care!!for!!the!!foot!!infection.
b) Refer!!the!!patient!!to!!social!!services!!for!!assessment!!of!!resources.
c) Schedule!!the!!patient!!to!!return!!to!!outpatient!!services!!for!!foot!!care.
d) Give!!the!!patient!!written!!information!!about!!shelters!!and!!meal!!sites.
ANS:!!B
An!!interprofessional!!approach,!!including!!social!!services,!!is!!needed!!when!!caring!!f
or!!homeless!!older!!adults.!!Even!!with!!appropriate!!teaching,!!a!!homeless!!individual!!
may!!not!!be!!able!!to!!maintain!adequate!!foot!!care!!because!!of!!a!!lack!!of!!supplies!!or!!a!!
suitable!!place!!to!!accomplish!!care.!!Older!!homeless!!individuals!!are!!less!!likely!!to!!us
e!!shelters!!or!!meal!!sites.!!A!!homeless!!person!!may!!fail!!to!!keep!!appointments!!for!!out
patient!!services!!because!!of!!factors!!such!!as!!fear!!of!!institutionalization!!or!!lack!!of!!tr
ansportation.
The!!home!!health!!nurse!!cares!!for!!an!!older!!adult!!patient!!who!!lives!!alone!!and
takes!!several!different!!prescribed!!medications!!for!!chronic!!health!!problems.!!
!!
Which!!intervention,!!if!!implemented!!by!!the!!nurse,!!would!!best!!encourage!!med
ication!!compliance?
a) Use!!a!!marked!!pillbox!!to!!set!!up!!the!!patient’s!!medications.
1
, A&E!!I!!Comprehensive!!Testban
b) Discuss!!the!!option!!of!!kmoving!!to!!an!!assisted!!living!!facility.
c) Remind!!the!!patient!!about!!the!!importance!!of!!taking!!medications.
d) Visit!!the!!patient!!daily!!to!!administer!!the!!prescribed!!medications.
ANS:!!A
Because!!forgetting!!to!!take!!medications !!is!!a!!common!!cause!!of!! medication!!errors!!in!
older!!adults,!!the!!use!!of!!medication!!reminder!!devices!!is!!helpful!!when!!older!!adults!!
!
have!!multiple!!medications!!to!take.!!There!!is!!no!!indication!!that!!the!!patient!!needs!!to!!
move!!to!!assisted!!living!!or!!that!!the!!patient!!does!!not!!understand!!the!!importance!!of!!
medication!!compliance.!!Home!!health!!care!!is!!not!!designed!!for!!the!!patient!!who!!nee
ds!!ongoing!!assistance!!with!!activities!!of!!daily!!living!!or!!instrumental!!ADLs.
The!!home!!health!!nurse!!visits!!an!!older!!patient!!with!!mild!!forgetfulness.!!Which!!ne
w!!information!is!!of!!most!!concern!!to!!the!!nurse?
a) The!!patient!!tells!!the!!nurse!!that!!a!!close!!friend!!recently!!died.
b) The!!patient!!has!!lost!!10!!lb!!(4.5!!kg)!!during!!the!!past!!month.
c) The!!patient!!is!!cared!!for!!by!!a!!daughter!!during!!the!!day!!and!!stays!!with!!a!!son!!at!!
night.
d) The!!patient’s!!son!!uses!!a!!marked!!pillbox!!to!!set!!up!!the!!patient’s!!medications!!we
ekly.
ANS:!!B
A!!10-
pound!!weight!!loss!!may!!be!!an!!indication!!of!!elder!!neglect!!or!!depression!!and!!requir
es!!further!assessment!!by!!the!!nurse.!!The!!use!!of!!a!!marked!!pillbox!!and!!planning!!by!!t
he!!family!!for!!24-
hour!!care!!are!!appropriate!!for!!this!!patient.!!It!!is!!not!!unusual!!that!!an!!86-yr-
old!!would!!have!!friends!!who!!have!!died.
2
, A&E!!I!!Comprehensive!!Testban
Which!!statement,!!if!! madek!!by!!an!!older!!adult!!patient,!!would!!be!!of!!most!!concern!!t
o!!the!!nurse?!!a.
“I!!prefer!!to!!manage!!my!!life!!without!!much!!help!!from!!other!!people.”
a) “I!!prefer!!to!!manage!!my!!life!!without!!much!!help!!from!!other!!people.”
b) “I!!take!!three!!different!!medications!!for!!my!!heart!!and!!joint!!problems.”
c) “I!!don’t!!go!!on!!daily!!walks!!anymore!!since!!I!!had!!pneumonia!!3!!months!!ago.”
d) “I!!set!!up!!my!!medications!!in!!a!!marked!!pillbox!!so!!I!!don’t!!forget!!to!!take!!them.”
ANS:!!C
Inactivity!!and!!immobility!!lead!!rapidly!!to!!loss!!of!!function!!in!!older!!adults.!!The!!nur
se!!should!!develop!!a!!plan!!to!!prevent!!further!!deconditioning!!and!!restore!!function!!f
or!!the!!patient.!!Self-
!! management!!is!!appropriate!!for!!independently!!living!!older!!adults.!!On!!average,!!an!
older!!adult!!takes!!seven!!different!!medications!!so!!the!!use!!of!!three!!medications!!is!!n
!
ot!!unusual!!for!!this!!patient.!The!!use!!of!!memory!!devices!!to!!assist!!with!!safe!!medicati
on!!administration!!is!!recommended!!for!!older!!adults.
The!!nurse!!assesses!!an!!older!!patient!!who!!takes!!diuretics!!and!!has!!a!!possibl
e!!urinary!!tract!infection!!(UTI).!!Which!!action!!should!!the!!nurse!!take!!first?
a) Palpate!!over!!the!!suprapubic!!area.
b) Inspect!!for!!abdominal!!distention.
c) Question!!the!!patient!!about!!hematuria.
d) Request!!the!!patient!!empty!!the!!bladder.
ANS:!!D
Before!!beginning!!the!!assessment!!of!!an!!older!!patient!!with!!a!!UTI!!and!!on!!diuretics,!
the!!nurse!!should!!have!!the!!patient!!empty!!the!!bladder!!because!!bladder!!fullness!!or!!
!
discomfort!!will!!distract!from!!the!!patient’s!!ability!!to!!provide!!accurate!!information.!!
3
, A&E!!I!!Comprehensive!!Testban
k
The!!patient!!may!!seem!!disoriented !!if!d istracted!!by!!pain!!or!!urgency.!!The!!physical!!as
sessment!!data!!are!!obtained!!after!!the!!patient!!is!!as!comfortable!!as!!possible.
Which!!patient!!is!!most!!likely!!to!!need!!long-term!!nursing!!care!!management?
a) 72-yr-old!!who!!had!!a!!hip!!replacement!!after!!a!!fall!!at!!home
b) 64-yr-old!!who!!developed!!sepsis!!after!!a!!ruptured!!peptic!!ulcer
c) 76-yr-old!!who!!had!!a!!cholecystectomy!!and!!bile!!duct!!drainage
d) 63-yr-old!!with!!bilateral!!knee!!osteoarthritis!!who!!weighs!!350!!lb!!(159!!kg)
ANS:!!D
Osteoarthritis!!and!!obesity!!are!!chronic!!problems!!that!!will!!require!!planning!!for!!long-
term!!interventions!!such!!as!!physical!!therapy!!and!!nutrition!!counseling.!!The!!other!!pati
ents!!have!!acute!problems!!that!!are!!not!!likely!!to!!require!!long-term!!management.
An!!older!!adult!!being!!admitted!!is!!assessed!!at!!high!!risk!!for!!falls.!!Which!!action!!s
hould!!the!!nurse!take!!first?
a) Use!!a!!bed!!alarm!!system!!on!!the!!patient’s!!bed.
b) Administer!!the!!prescribed!!PRN!!sedative!!medication.
c) Ask!!the!!health!!care!!provider!!to!!order!!a!!vest!!restraint.
d) Place!!the!!patient!!in!!a!!“geri-chair”!!near!!the!!nurse’s!!station.
ANS:!!A
The!!use!!of!!the!!least!!restrictive!!restraint!!alternative!!is!!required.!!Physical!!or!!chemic
al!!restraints!may!!be!!necessary,!!but!!the!!nurse’s!!first!!action!!should!!be!!an!!alternative!!
such!!as!!a!!bed!!alarm.
An!!older!!adult!!patient!!presents!!with!!a!!broken!!arm!!and!!visible!!scattered!!brui
ses!!healing!!at!different!!stages.!!Which!!action!!should!!the!!nurse!!take!!first?
a) Notify!!an!!elder!!protective!!services!!agency!!about!!possible!!abuse.
4
k
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
The!!nurse!!cares!!for!!an!!alert,!!homeless!!older!!adult!!patient!!who!!was!!admitted!!to!!
the!!hospital!!with!!a!!chronic!!foot!!infection.!!Which!!intervention!!is!!the!!most!!appropr
iate!!for!!the!!nurse!!to!!include!in!!the!!discharge!!plan!!for!!this!!patient?
a) Teach!!the!!patient!!how!!to!!assess!!and!!care!!for!!the!!foot!!infection.
b) Refer!!the!!patient!!to!!social!!services!!for!!assessment!!of!!resources.
c) Schedule!!the!!patient!!to!!return!!to!!outpatient!!services!!for!!foot!!care.
d) Give!!the!!patient!!written!!information!!about!!shelters!!and!!meal!!sites.
ANS:!!B
An!!interprofessional!!approach,!!including!!social!!services,!!is!!needed!!when!!caring!!f
or!!homeless!!older!!adults.!!Even!!with!!appropriate!!teaching,!!a!!homeless!!individual!!
may!!not!!be!!able!!to!!maintain!adequate!!foot!!care!!because!!of!!a!!lack!!of!!supplies!!or!!a!!
suitable!!place!!to!!accomplish!!care.!!Older!!homeless!!individuals!!are!!less!!likely!!to!!us
e!!shelters!!or!!meal!!sites.!!A!!homeless!!person!!may!!fail!!to!!keep!!appointments!!for!!out
patient!!services!!because!!of!!factors!!such!!as!!fear!!of!!institutionalization!!or!!lack!!of!!tr
ansportation.
The!!home!!health!!nurse!!cares!!for!!an!!older!!adult!!patient!!who!!lives!!alone!!and
takes!!several!different!!prescribed!!medications!!for!!chronic!!health!!problems.!!
!!
Which!!intervention,!!if!!implemented!!by!!the!!nurse,!!would!!best!!encourage!!med
ication!!compliance?
a) Use!!a!!marked!!pillbox!!to!!set!!up!!the!!patient’s!!medications.
1
, A&E!!I!!Comprehensive!!Testban
b) Discuss!!the!!option!!of!!kmoving!!to!!an!!assisted!!living!!facility.
c) Remind!!the!!patient!!about!!the!!importance!!of!!taking!!medications.
d) Visit!!the!!patient!!daily!!to!!administer!!the!!prescribed!!medications.
ANS:!!A
Because!!forgetting!!to!!take!!medications !!is!!a!!common!!cause!!of!! medication!!errors!!in!
older!!adults,!!the!!use!!of!!medication!!reminder!!devices!!is!!helpful!!when!!older!!adults!!
!
have!!multiple!!medications!!to!take.!!There!!is!!no!!indication!!that!!the!!patient!!needs!!to!!
move!!to!!assisted!!living!!or!!that!!the!!patient!!does!!not!!understand!!the!!importance!!of!!
medication!!compliance.!!Home!!health!!care!!is!!not!!designed!!for!!the!!patient!!who!!nee
ds!!ongoing!!assistance!!with!!activities!!of!!daily!!living!!or!!instrumental!!ADLs.
The!!home!!health!!nurse!!visits!!an!!older!!patient!!with!!mild!!forgetfulness.!!Which!!ne
w!!information!is!!of!!most!!concern!!to!!the!!nurse?
a) The!!patient!!tells!!the!!nurse!!that!!a!!close!!friend!!recently!!died.
b) The!!patient!!has!!lost!!10!!lb!!(4.5!!kg)!!during!!the!!past!!month.
c) The!!patient!!is!!cared!!for!!by!!a!!daughter!!during!!the!!day!!and!!stays!!with!!a!!son!!at!!
night.
d) The!!patient’s!!son!!uses!!a!!marked!!pillbox!!to!!set!!up!!the!!patient’s!!medications!!we
ekly.
ANS:!!B
A!!10-
pound!!weight!!loss!!may!!be!!an!!indication!!of!!elder!!neglect!!or!!depression!!and!!requir
es!!further!assessment!!by!!the!!nurse.!!The!!use!!of!!a!!marked!!pillbox!!and!!planning!!by!!t
he!!family!!for!!24-
hour!!care!!are!!appropriate!!for!!this!!patient.!!It!!is!!not!!unusual!!that!!an!!86-yr-
old!!would!!have!!friends!!who!!have!!died.
2
, A&E!!I!!Comprehensive!!Testban
Which!!statement,!!if!! madek!!by!!an!!older!!adult!!patient,!!would!!be!!of!!most!!concern!!t
o!!the!!nurse?!!a.
“I!!prefer!!to!!manage!!my!!life!!without!!much!!help!!from!!other!!people.”
a) “I!!prefer!!to!!manage!!my!!life!!without!!much!!help!!from!!other!!people.”
b) “I!!take!!three!!different!!medications!!for!!my!!heart!!and!!joint!!problems.”
c) “I!!don’t!!go!!on!!daily!!walks!!anymore!!since!!I!!had!!pneumonia!!3!!months!!ago.”
d) “I!!set!!up!!my!!medications!!in!!a!!marked!!pillbox!!so!!I!!don’t!!forget!!to!!take!!them.”
ANS:!!C
Inactivity!!and!!immobility!!lead!!rapidly!!to!!loss!!of!!function!!in!!older!!adults.!!The!!nur
se!!should!!develop!!a!!plan!!to!!prevent!!further!!deconditioning!!and!!restore!!function!!f
or!!the!!patient.!!Self-
!! management!!is!!appropriate!!for!!independently!!living!!older!!adults.!!On!!average,!!an!
older!!adult!!takes!!seven!!different!!medications!!so!!the!!use!!of!!three!!medications!!is!!n
!
ot!!unusual!!for!!this!!patient.!The!!use!!of!!memory!!devices!!to!!assist!!with!!safe!!medicati
on!!administration!!is!!recommended!!for!!older!!adults.
The!!nurse!!assesses!!an!!older!!patient!!who!!takes!!diuretics!!and!!has!!a!!possibl
e!!urinary!!tract!infection!!(UTI).!!Which!!action!!should!!the!!nurse!!take!!first?
a) Palpate!!over!!the!!suprapubic!!area.
b) Inspect!!for!!abdominal!!distention.
c) Question!!the!!patient!!about!!hematuria.
d) Request!!the!!patient!!empty!!the!!bladder.
ANS:!!D
Before!!beginning!!the!!assessment!!of!!an!!older!!patient!!with!!a!!UTI!!and!!on!!diuretics,!
the!!nurse!!should!!have!!the!!patient!!empty!!the!!bladder!!because!!bladder!!fullness!!or!!
!
discomfort!!will!!distract!from!!the!!patient’s!!ability!!to!!provide!!accurate!!information.!!
3
, A&E!!I!!Comprehensive!!Testban
k
The!!patient!!may!!seem!!disoriented !!if!d istracted!!by!!pain!!or!!urgency.!!The!!physical!!as
sessment!!data!!are!!obtained!!after!!the!!patient!!is!!as!comfortable!!as!!possible.
Which!!patient!!is!!most!!likely!!to!!need!!long-term!!nursing!!care!!management?
a) 72-yr-old!!who!!had!!a!!hip!!replacement!!after!!a!!fall!!at!!home
b) 64-yr-old!!who!!developed!!sepsis!!after!!a!!ruptured!!peptic!!ulcer
c) 76-yr-old!!who!!had!!a!!cholecystectomy!!and!!bile!!duct!!drainage
d) 63-yr-old!!with!!bilateral!!knee!!osteoarthritis!!who!!weighs!!350!!lb!!(159!!kg)
ANS:!!D
Osteoarthritis!!and!!obesity!!are!!chronic!!problems!!that!!will!!require!!planning!!for!!long-
term!!interventions!!such!!as!!physical!!therapy!!and!!nutrition!!counseling.!!The!!other!!pati
ents!!have!!acute!problems!!that!!are!!not!!likely!!to!!require!!long-term!!management.
An!!older!!adult!!being!!admitted!!is!!assessed!!at!!high!!risk!!for!!falls.!!Which!!action!!s
hould!!the!!nurse!take!!first?
a) Use!!a!!bed!!alarm!!system!!on!!the!!patient’s!!bed.
b) Administer!!the!!prescribed!!PRN!!sedative!!medication.
c) Ask!!the!!health!!care!!provider!!to!!order!!a!!vest!!restraint.
d) Place!!the!!patient!!in!!a!!“geri-chair”!!near!!the!!nurse’s!!station.
ANS:!!A
The!!use!!of!!the!!least!!restrictive!!restraint!!alternative!!is!!required.!!Physical!!or!!chemic
al!!restraints!may!!be!!necessary,!!but!!the!!nurse’s!!first!!action!!should!!be!!an!!alternative!!
such!!as!!a!!bed!!alarm.
An!!older!!adult!!patient!!presents!!with!!a!!broken!!arm!!and!!visible!!scattered!!brui
ses!!healing!!at!different!!stages.!!Which!!action!!should!!the!!nurse!!take!!first?
a) Notify!!an!!elder!!protective!!services!!agency!!about!!possible!!abuse.
4
