NURS 421 Final exam with complete
solutions
True or false
GI age related changes include increased motility, decreased blood flow,
increased absorption - ANSWER- False, decreased motility
Identify the correct statement describing the abuse of elderly persons in the
United States.
a. Elder abuse is the most often reported form of domestic violence
b. Statistically, neglect is the most common form of elder abuse
c. Most cases of elder abuse are reported to the proper authorities
d. Healthcare practitioners are only mandated to report verified, not suspected,
cases of elder abuse - ANSWER- b. Statistically, neglect is the most common
form of elder abuse
Which of the following cases seen by a nurse working in the ED identifies a
situation that suggests a case of elder mistreatment?
a. an 85 yr old male who has several areas of bruising on the back of the hands
and is taking Clopidogrel sisulfate(Plavix) and aspirin daily
b. an 86 yr old woman who has 3 dime sized burned areas on her upper inner
thigh
c. a 77 yr old woman who fell at home after tripping over her dog and broke her
arm about 30 minutes earlier
d. a 73 yr old male with a history of gastric ulcers who is found to be anemic after
vomiting blood 3 hours earlier - ANSWER- b. an 86 yr old woman who has 3 dime
sized burned areas on her upper inner thigh
Which of the following are examples of appropriate communication techniques
for dealing effectively with persons with dementia?
,a. Ask open ended questions so the person feels that he or she feels they can
make choices
b. for people in the later stages of dementia, talk to them as you would a child
c. maintain good eye contact and a relaxed and smiling approach
d. when a person forgets something, remind them not forget it the next time -
ANSWER- c. maintain good eye contact and a relaxed and smiling approach
Mr Reynolds experienced a transient ischemic attack (TIA) 3 weeks ago that had
significant effects on his motor and sensory function. Which of the following
assessment findings should signal to the nurse to the possibility that Mr
Reynolds is experiencing dysphagia?
a. Mr. Reynolds complains of being excessively hungry in the mid afternoon and
evening
b. When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek
c. Mr Reynolds drinks large amounts of water, before, during and after meals
d. Mr Reynolds prefers to sit in a high fowlers position after meals - ANSWER- b.
When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek
Statistically, which of the following clients is at greatest risk for mistreatment in
the domestic setting?
a. an active 70 yr old woman with well controlled diabetes who live alone
b. a healthy 75 yr old man who is a retied businessman and lives with his son
c. an 82 yr old woman with severe osteoarthritis and macular degeneration who
lives with her single daughter who has an adult son with cerebral palsy
d. a 77 yr old man who has a history of coronary bypass surgery and lives with
his wife - ANSWER- c. an 82 yr old woman with severe osteoarthritis and macular
degeneration who lives with her single daughter who has an adult son with
cerebral palsy
When a patient is admitted to a hospital, he or she is asked if an advance
directive is available in case terminal care is necessary. What does an advance
directive do?
a. It gives the patient's family control over terminal care regardless of the
patient's wishes
b. It gives the patient control over terminal care by appointing an decision maker
in the event they cannot make their own decisions
c. It gives the hospital control over terminal care
,d. It gives the attending physician control over terminal care - ANSWER- b. It
gives the patient control over terminal care by appointing an decision maker in
the event they cannot make their own decisions
A 78 yr old woman was diagnosed with colorectal cancer 18 mos ago and
underwent chemotherapy. a recent CT scan has shown has metastasized to her
lungs and liver. The woman states that she feels well and does not want to
undergo any further debilitating chemotherapy. The son and daughter are
adamantly opposed to their mother's forgoing treatment and have appealed to the
nurse. what factor is the primary consideration in this scenario?
a. the family's wishes
b. the woman's prognosis
c. the woman's autonomy
d. the woman's treatment options - ANSWER- c. the woman's autonomy
Which of the following are social risk factors for impaired nutrition?
Select all that apply.
a. isolation
b. loneliness
c. depression
d. poverty - ANSWER- a, b, and d
a mini nutritional score between 8 and 11 indicates dehydration. true or false -
ANSWER- False
Lab values associate with poor nutrition include... Select all that apply.
a. serum albumin
b. increased magnesium
c. serum prealbumin
d. cholesterol - ANSWER- a, c, and d
What contributes to neuron death & may progress to Alzheimers? - ANSWER- B-
amyloid
What should you do before treating a patient with delirium? - ANSWER- Identify
the underlying cause
, TRUE OR FALSE: During hospice care one physician must determine the patient
has 6 months to live - ANSWER- FALSE; two physicians
Hospice care is not appropriate in which of these circumstances?
a. The patient decides to forego curative treatment.
b. The patient's prognosis is 3 to 6 months.
c. The patient is undergoing experimental chemotherapy.
d. The patient is receiving palliative chemotherapy. - ANSWER- c. The patient is
undergoing experimental chemotherapy.
Rationale: Hospice care is not appropriate for patients undergoing active curative
therapy. All other statements are correct regarding hospice care.
Mrs. Jones is receiving hospice care in the nursing home. During the
assessment, the nurse observes the patient is unconscious and has wet, noisy
respirations and cool, mottled extremities. The nurse understands which of the
following actions are indicated? (Select all that apply.)
A. Notifying the patient's family
B. Requesting an order for an anticholinergic medication
C. Notifying the patient's provider
D. Performing a sternal rub to assess the patient's response
E. Performing a full systems assessment - ANSWER- A, B, and C
Rationale: Unconsciousness is not unexpected inthe patient in hospice care.
Performing a painful assessment strategy would be inappropriate and performing
a full system assessment would be unnecessary as death is expected. We would
wantto notify the family and provider of this change and an order for an
anticholinergic medication is appropri- ate to help reduce noisy respirations by
drying up secretions.
Mr. Smith's wife is in the terminal stage of chronic obstructive pulmonary disease
(COPD). He is very anxious that his wife be comfortable during her last hours.
The nurse finds him tearful in the hall outside the room. Which communication
should the nurse use first?
A. "My aunt had COPD, and she died on a ventilator. Count your blessings that
your wife is not on a machine."
B. "I can see you're upset, Mr. Smith. Would you like to talk about it?"
C. "Is your family here?"
solutions
True or false
GI age related changes include increased motility, decreased blood flow,
increased absorption - ANSWER- False, decreased motility
Identify the correct statement describing the abuse of elderly persons in the
United States.
a. Elder abuse is the most often reported form of domestic violence
b. Statistically, neglect is the most common form of elder abuse
c. Most cases of elder abuse are reported to the proper authorities
d. Healthcare practitioners are only mandated to report verified, not suspected,
cases of elder abuse - ANSWER- b. Statistically, neglect is the most common
form of elder abuse
Which of the following cases seen by a nurse working in the ED identifies a
situation that suggests a case of elder mistreatment?
a. an 85 yr old male who has several areas of bruising on the back of the hands
and is taking Clopidogrel sisulfate(Plavix) and aspirin daily
b. an 86 yr old woman who has 3 dime sized burned areas on her upper inner
thigh
c. a 77 yr old woman who fell at home after tripping over her dog and broke her
arm about 30 minutes earlier
d. a 73 yr old male with a history of gastric ulcers who is found to be anemic after
vomiting blood 3 hours earlier - ANSWER- b. an 86 yr old woman who has 3 dime
sized burned areas on her upper inner thigh
Which of the following are examples of appropriate communication techniques
for dealing effectively with persons with dementia?
,a. Ask open ended questions so the person feels that he or she feels they can
make choices
b. for people in the later stages of dementia, talk to them as you would a child
c. maintain good eye contact and a relaxed and smiling approach
d. when a person forgets something, remind them not forget it the next time -
ANSWER- c. maintain good eye contact and a relaxed and smiling approach
Mr Reynolds experienced a transient ischemic attack (TIA) 3 weeks ago that had
significant effects on his motor and sensory function. Which of the following
assessment findings should signal to the nurse to the possibility that Mr
Reynolds is experiencing dysphagia?
a. Mr. Reynolds complains of being excessively hungry in the mid afternoon and
evening
b. When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek
c. Mr Reynolds drinks large amounts of water, before, during and after meals
d. Mr Reynolds prefers to sit in a high fowlers position after meals - ANSWER- b.
When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek
Statistically, which of the following clients is at greatest risk for mistreatment in
the domestic setting?
a. an active 70 yr old woman with well controlled diabetes who live alone
b. a healthy 75 yr old man who is a retied businessman and lives with his son
c. an 82 yr old woman with severe osteoarthritis and macular degeneration who
lives with her single daughter who has an adult son with cerebral palsy
d. a 77 yr old man who has a history of coronary bypass surgery and lives with
his wife - ANSWER- c. an 82 yr old woman with severe osteoarthritis and macular
degeneration who lives with her single daughter who has an adult son with
cerebral palsy
When a patient is admitted to a hospital, he or she is asked if an advance
directive is available in case terminal care is necessary. What does an advance
directive do?
a. It gives the patient's family control over terminal care regardless of the
patient's wishes
b. It gives the patient control over terminal care by appointing an decision maker
in the event they cannot make their own decisions
c. It gives the hospital control over terminal care
,d. It gives the attending physician control over terminal care - ANSWER- b. It
gives the patient control over terminal care by appointing an decision maker in
the event they cannot make their own decisions
A 78 yr old woman was diagnosed with colorectal cancer 18 mos ago and
underwent chemotherapy. a recent CT scan has shown has metastasized to her
lungs and liver. The woman states that she feels well and does not want to
undergo any further debilitating chemotherapy. The son and daughter are
adamantly opposed to their mother's forgoing treatment and have appealed to the
nurse. what factor is the primary consideration in this scenario?
a. the family's wishes
b. the woman's prognosis
c. the woman's autonomy
d. the woman's treatment options - ANSWER- c. the woman's autonomy
Which of the following are social risk factors for impaired nutrition?
Select all that apply.
a. isolation
b. loneliness
c. depression
d. poverty - ANSWER- a, b, and d
a mini nutritional score between 8 and 11 indicates dehydration. true or false -
ANSWER- False
Lab values associate with poor nutrition include... Select all that apply.
a. serum albumin
b. increased magnesium
c. serum prealbumin
d. cholesterol - ANSWER- a, c, and d
What contributes to neuron death & may progress to Alzheimers? - ANSWER- B-
amyloid
What should you do before treating a patient with delirium? - ANSWER- Identify
the underlying cause
, TRUE OR FALSE: During hospice care one physician must determine the patient
has 6 months to live - ANSWER- FALSE; two physicians
Hospice care is not appropriate in which of these circumstances?
a. The patient decides to forego curative treatment.
b. The patient's prognosis is 3 to 6 months.
c. The patient is undergoing experimental chemotherapy.
d. The patient is receiving palliative chemotherapy. - ANSWER- c. The patient is
undergoing experimental chemotherapy.
Rationale: Hospice care is not appropriate for patients undergoing active curative
therapy. All other statements are correct regarding hospice care.
Mrs. Jones is receiving hospice care in the nursing home. During the
assessment, the nurse observes the patient is unconscious and has wet, noisy
respirations and cool, mottled extremities. The nurse understands which of the
following actions are indicated? (Select all that apply.)
A. Notifying the patient's family
B. Requesting an order for an anticholinergic medication
C. Notifying the patient's provider
D. Performing a sternal rub to assess the patient's response
E. Performing a full systems assessment - ANSWER- A, B, and C
Rationale: Unconsciousness is not unexpected inthe patient in hospice care.
Performing a painful assessment strategy would be inappropriate and performing
a full system assessment would be unnecessary as death is expected. We would
wantto notify the family and provider of this change and an order for an
anticholinergic medication is appropri- ate to help reduce noisy respirations by
drying up secretions.
Mr. Smith's wife is in the terminal stage of chronic obstructive pulmonary disease
(COPD). He is very anxious that his wife be comfortable during her last hours.
The nurse finds him tearful in the hall outside the room. Which communication
should the nurse use first?
A. "My aunt had COPD, and she died on a ventilator. Count your blessings that
your wife is not on a machine."
B. "I can see you're upset, Mr. Smith. Would you like to talk about it?"
C. "Is your family here?"
