BASIC GERIATRIC NURSING 7TH EDITION WILLIAMS TEST BANK

BASIC GERIATRIC NURSING 7TH EDITION WILLIAMS TEST BANK (ALL CHAPTERS) BASIC GERIATRIC NURSING 7TH EDITION WILLIAMS TEST BANK Chapter 02: Theories of Aging Williams: Basic Geriatric Nursing, 7th Edition MULTIPLE CHOICE 1. How does a theory differ from a fact? a. A theory proves how different influences affect a particular phenomenon. b. A theory attempts to explain and give some logical order to observations. c. A theory is a collection of facts about a particular phenomenon. d. A theory shows a relationship among facts about a particular phenomenon. ANS: B 2. The biological theory of aging uses a genetic perspective and suggests that aging is a programmed process in which . a. each person will age exactly like those in the previous generation b. a biological timeline predetermines number of cell divisions c. genetic traits can overcome environmental influences d. age-related physical changes are controlled only by genetic factors ANS: B 3. The Gene Theory of aging suggests which of the following ? a. The presence of a “master gene” prolongs youth. b. Genes interact with each other to resist aging. c.d. Specific genes target specific body systems to initiate system deterioration. The activation of harmful genes initiates the aging process. ANS: D 4. The theory that identifies an unstable molecule as the causative factor in aging is the theory. a. free radical b. molecular c. neuroendocrine d. crosslink ANS: A Basic Geriatric Nursing 7th Edition Williams Test Bank 5. A patient uses good health maintenance practices. What aging theory most accurately relates to the patient’s practices? a. Wear-and-tear b. Free radical c. Neuroendocrine d. Molecular ANS: A 6. The patient asks the nurse to describe the neuroendocrine theory of aging. What would be an appropriate response by the nurse? a. It relates thyroid function to age-related changes. b. Adrenal corticosteroids inhibit the aging process. c. The stimulation and/or inhibition of the hypothalamus causes age-related changes. d. The adrenal medulla inhibits epinephrine, causing age-related changes. ANS: C 7. What is true of the psychosocial theories of aging? a. They focus on methods to delay the aging process. b. They are directed at decreasing depression in the older adult. c. They are organized to enhance the perception of aging. d. They attempt to explain responses to the aging process. ANS: D 8. What is the major objection to the disengagement theory? a. The theory justifies ageism. b. The theory addresses the diversity of older adults. c. The theory does not clarify the aging process. d. The theory diminishes the self-esteem of the older adult. ANS: A 9. An 80-year-old teaches Sunday school each week and delivers food for Meals on Wheels. What theory of aging would apply? a. Newman’s developmental b. The life course c. The activity d. The disengagement ANS: C Basic Geriatric Nursing 7th Edition Williams Test Bank 10. The nurse would recognize successful aging according to Jung’s theory when a long-term care facility resident demonstrates which of the following behaviors? a. The resident takes special care to dress for dinner in a manner that pleases his tablemates. b. The resident asks permission to sit on the patio with other residents. c. The resident asks persons in his hall if his television is bothering them. d. The resident wears a large cowboy hat at all times because he likes it. ANS: D 11. How would an elderly female be most likely to reduce the amount of the free radical lipofuscin? a. Avoid animal fat b. Take antioxidants daily c. Build muscle mass d. Perform outdoor exercise three times weekly ANS: B 12. A recently widowed woman moved to an assisted living community because of her hypertension and joined a group to learn how to do water color painting with other women her age. Which theory of aging does the nurse assess the patient to be following? a. Jung b. Havighurst c. Erikson d. Newman ANS: B MULTIPLE RESPONSE 1. What age-related illnesses are thought to cause the accumulation of free radicals? (Select all that apply.) a. Arthritis b. Colon cancer c. Osteoporosis d. Diabetes e. Atherosclerosis ANS: A, D, E 2. The nurse emphasizes that the relatively new theory that correlates restricted caloric intake to slowing of the aging process would probably extend the life span of the person, provided that the person . (Select all that apply.) a. consistently eats high-nutrient, low-calorie foods b. maintains a regular exercise program consumes 2000–3000 mL of fluid a day c. supports the diet with adequate fat-soluble vitamins Basic Geriatric Nursing 7th Edition Williams Test Bank d. eats only organically grown foods ANS: A, B 3. Which would be considered positive outcomes of Erikson’s “life review”? (Select all that apply.) a. Wisdom and integrated self-image b. Comparing self with others c. Understanding self and relationships d. Seeking another’s opinion of his or her achievement e. Acceptance of self ANS: A, C, E 4. Which of the following would be selected for a diet high in antioxidants? (Select all that apply.) a. Fruits b. Vegetables c. Organ meat d. Folic acid e. Atherosclerosis................................................................................................................................... ANS: A, B.............................................................................................................................................. COMPLETION 1. The theory that proposes that defects in ribonucleic acid (RNA) protein production cause a progressive decline in the function of all cells is the theory. ANS: error 2. The nurse clarifies that the biologic theory that proposes that aging is based on the using up of a finite number of breaths or heartbeats is the of theory. ANS: rate living Chapter 04: Health Promotion, Health Maintenance, and Home Health Considerations Test Bank MULTIPLE CHOICE 1. A 70-year-old male patient has been newly diagnosed with hypertension. What would be the most effective health practice to reduce sodium intake? a. Avoid all salty foods. b. Discontinue eating at restaurants. c. Read food labels on food containers carefully. d. Limit the amount of salt added to food. ANS: C Reading labels will prevent the purchase of sodium-laden foods. Sodium-restricted foods are available on most menus. Simply avoiding salty foods does not guarantee less sodium because there are many foods containing sodium that are not salty. Adding salt should be absolutely restricted, not diminished. DIF: Cognitive Level: Analysis REF: p. 74 OBJ: 1 TOP: Sodium Restriction KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. An older adult states that her physician ordered her to drink a glass of wine daily. The nurse understands that alcohol is occasionally recommended for which of the following reasons? a. Memory enchancer b. Appetite stimulant c. Diuretic d. Food source ANS: B Alcohol is occasionally prescribed as an appetite stimulant in certain situations. DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 7 TOP: Alcohol Abuse KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. When the 70-year-old female patient says, “Keeping up with when to take the flu vaccine is a big hassle. I’m not going to add trying to keep up with a pneumonia vaccine as well. It’s too expensive.” Which response by the nurse would be the most helpful? a. “Both vaccines can be taken at the same time every fall.” b. “The pneumonia vaccine needs to be repeated every 10 years.” c. “It is important to begin getting annual pneumonia shots at 80 years of age.” d. “The flu vaccine must be taken every three years to remain effective.” ANS: B The pneumonia vaccine is given to individuals usually between the ages of 65 and 70 years and is repeated every 10 years. The flu vaccine must be received every year in the fall, because the strain of the virus changes frequently. DIF: Cognitive Level: Application REF: p. 75 OBJ: 9 TOP: Pneumonia Vaccine KEY: Nursing Process Step: Implementation This study source was downloaded by from CourseH on :13:57 GMT -05:00 MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 4. How often should a 75-year-old have a visual screening? a. Every 6 months b. Every 12 months c. Every 2 years d. On an as needed basis ANS: B Annual examinations for vision to check for glaucoma are recommended. DIF: Cognitive Level: Knowledge REF: p. 75 OBJ: 1 TOP: Visual and Hearing Evaluations KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 5. What would be the most important suggestion for the nurse to give her 75-year-old patient in an attempt to prevent a potential drug interaction? a. Seek medical care from only one physician. b. Read up on all drugs that are prescribed. c. Keep a list of drugs that he is currently taking. d. Use only one pharmacy to fill prescriptions. ANS: C Keeping a current drug list as a quick reference for any licensed professional to review before prescribing medication is one method to prevent possible drug-drug interactions. DIF: Cognitive Level: Comprehension REF: p. 76 OBJ: 1 TOP: Preventative Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The 65-year-old overweight, hypertensive male farmer tells the home health nurse that he eats two fried eggs, four pieces of bacon, and biscuits with gravy every morning for breakfast because he believes that a robust breakfast keeps him healthy. What would be the most appropriate response by the nurse? a. “That sort of food is not on your low-sodium diet.” b. “You won’t be healthy long with a diet like that.” c. “One egg and whole wheat toast would be even healthier.” d. “You should eat whole-grain cereal with fruit instead of all that fat and sodium.” ANS: C Health maintenance practices of the older adult are influenced by personal, religious, and cultural beliefs. Using the patient’s beliefs as a basis for changing eating habits will be more successful than radically departing from lifetime habits or suggesting that they are ineffective. DIF: Cognitive Level: Application REF: p. 78 OBJ: 2 TOP: Cultural Beliefs KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 7. The 60-year-old Asian man tells the home health nurse that he has stopped taking his antihypertensive medication because it causes him to be impotent. He reports that he is using acupuncture to control his hypertension. What would be the most effective response by the nurse? This study source was downloaded by from CourseH on :13:57 GMT -05:00 a. “Uncontrolled hypertension is a real health problem.” b. “Does your acupuncturist check your blood pressure?” c. “Let me check your blood pressure to see how acupuncture is working.” d. “You need to talk to your real doctor about stopping this drug.” ANS: C Problems can occur when cultural remedies are used in place of conventional medicine. Assessment of the effectiveness of the alternate therapy for treating hypertension is necessary to encourage further discussion about his treatment choice. Acupuncture can be very effective. DIF: Cognitive Level: Analysis REF: p. 78 OBJ: 2 TOP: Cultural Beliefs KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. The nurse is teaching a newly diagnosed diabetic regarding the diabetic diet. Which of the following factors will have the biggest impact on compliance? a. Clarity of the instructions b. Severity of the disease c. Timing of the instructions d. Motivation of the patient ANS: D Motivation is necessary for mastery of material and compliance with the new health information. DIF: Cognitive Level: Comprehension REF: pp. 78-79 OBJ: 9 TOP: Knowledge and Motivation KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 9. What is the best predictor that a hypertension patient will comply with a newly prescribed low-sodium diet? a. The amount of knowledge about the patient has of the diet. b. The amount of distress the patient has about his illness. c. The patient’s previous ability to lose 15 lbs. through following a weight reduction program. d. The patient’s desire to not suffer from hypertensive complications. ANS: C Previous behavior is a good indicator of future practice. DIF: Cognitive Level: Application REF: p. 79 OBJ: 9 TOP: Predicting Compliance KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 10. An 80-year-old woman injured her foot on a piece of rusty wire. She tells the nurse she had a tetanus booster when she was 75. The nurse’s response will be based on the knowledge that tetanus boosters a. should be repeated every 5 years. b. are not necessary for persons older than 70. c. do little good for the older adult. d. should be repeated with every injury, regardless of the previous booster. This study source was downloaded by from CourseH on :13:57 GMT -05:00 ANS: D Tetanus boosters should be repeated every 10 years, unless an injury prompts the need for a booster. The age of the resident is not relevant. Any age group can contract tetanus. DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 1 TOP: Tetanus Booster KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 11. A 70-year-old male patient taking corticosteroids for rheumatoid arthritis asks the nurse if he should take the vaccination to prevent shingles. What would be the nurse’s most helpful response? a. “No. Persons with impaired immune systems should not take that vaccine.” b. “Yes. It would be a good idea to protect yourself from shingles.” c. “No. That vaccine is only effective in about 10% of the cases.” d. “Yes. The vaccine is very inexpensive and very effective.” ANS: A The shingles vaccine should not be given to anyone with an impaired immune system. Corticosteroids impair the immune system. The vaccine is very expensive and is only effective in about 50% of the cases. DIF: Cognitive Level: Analysis REF: p. 76 OBJ: 1 TOP: Shingles Vaccine KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 12. The home health nurse suggests to the 82-year-old man that he should wear a Medic Alert bracelet. Which of the following health conditions prompted the nurse to make this suggestion? a. Artificial leg b. Congestive heart failure c. Pacemaker d. Eye prosthesis ANS: C Such health information as pacemakers, heparin therapy, and drug allergies should be made available to emergency workers. DIF: Cognitive Level: Application REF: p. 76 OBJ: 9 TOP: Medic Alert Bracelets KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 13. The home health nurse observes that there is still about half a month’s supply of Glucophage in the medicine bottle at the end of the month. What question would be the most appropriate for the nurse to ask? a. “Do you know what inadequately treated diabetes can do?” b. “Have you told your physician you are not taking your prescription?” c. “Are you trying to make the medication stretch for 2 months?” d. “Why are you being so noncompliant?” ANS: C Many older adults with limited finances and limited access to a pharmacy will take less of a prescribed drug to conserve money. This study source was downloaded by from CourseH on :13:57 GMT -05:00 DIF: Cognitive Level: Application REF: p. 80 OBJ: 5 TOP: Limited Access KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. What does the presence of a caregiver provide for the older adult living at home? a. Assurance of safety b. Service for deep housecleaning c. Source of motivation d. Source of care that is free of charge ANS: C A caregiver can be a potent motivational source for adhering to health maintenance practices. The presence of a caregiver does not guarantee safety and housecleaning. Although many caregivers are family members and do not charge for providing care, other caregivers do require a fee. DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 10 TOP: Caregiver Assistance KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 15. The caregiver who provides daily meals and attends to the daily needs of the older adult is classified as the caregiver. a. basic b. organizing c. primary d. designated ANS: C The caregiver responsible for the day-to-day needs of the older adult is classified as the primary caregiver. DIF: Cognitive Level: Knowledge REF: p. 80 OBJ: 10 TOP: Caregiver Classifications KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 16. Which of the following tasks could not be performed by an unlicensed home health aide? a. Transfer the patient into a bathtub. b. Measure or dispense medication. c. Contact family members independently. d. Accompany the patient outside the home. ANS: B Unlicensed persons are not allowed to dispense drugs in any setting. DIF: Cognitive Level: Knowledge REF: p. 82 OBJ: 10 TOP: Home Health Aides KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 17. What would be the most effective action by the home health coordinator when interacting with an unpaid caregiver? a. Tell him or her to call the agency if he or she needs any further assistance. This study source was downloaded by from CourseH on :13:57 GMT -05:00 b. Leave him or her entirely on his or her own so as not to interfere with the care he or she provides. c. Critique care to improve its effectiveness. d. Be generous with positive feedback. ANS: D The recognition of a job well done and morale boosting are essential to the unpaid, frequently overworked, and frustrated caregiver. DIF: Cognitive Level: Comprehension REF: p. 81 OBJ: 10 TOP: Nonpaid Caregivers KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 18. When doing exercises such as walking or swimming, how many minutes must the older adult perform the activity in order for it to be considered beneficial? a. 15 b. 30 c. 45 d. 60 ANS: B As little as 30 minutes preserves muscle mass and keeps joints flexible. DIF: Cognitive Level: Knowledge REF: p. 74 OBJ: 1 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 19. The home health nurse is discussing oral hygiene with the older adult. Which of the following practices would be appropriate to add to the current maintenance plan? a. A dental appointment every 2 years b. Using a fluoride toothpaste c. Thorough flossing every week d. Use of an electric toothbrush ANS: B The use of fluoride toothpaste, daily brushing and flossing, and annual dental care will enhance dental health. An electric toothbrush is not necessary. DIF: Cognitive Level: Knowledge REF: p. 76 OBJ: 1 TOP: Dental Health KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 20. The 84-year-old male complains of dry mouth. What would be appropriate for the nurse to suggest? a. Keep hard candy in his mouth to stimulate salivation. b. Drink iced cola drinks several times daily for hydration. c. Wash his mouth with an astringent mouthwash. d. Limit alcohol intake. ANS: D This study source was downloaded by from CourseH on :13:57 GMT -05:00 The reduction of alcohol will help eliminate dry mouth. Excessive use of hard candies, caffeinated drinks like colas, and astringent mouthwashes will increase the discomfort from dry mouth. DIF: Cognitive Level: Application REF: p. 77 OBJ: 1 TOP: Dry Mouth KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 21. The nurse is reviewing recommended health practices with her older patient. What would be included in the teaching? (Select all that apply.) a. Compliance with dietary restrictions b. Performance of regular exercise daily c. Cessation of smoking d. Arrangement for regular medical examinations e. Annual psychological testing ANS: A, B, C, D Psychological testing is not part of the recommended health practices. All of the other options listed are recommended health-seeking behaviors. DIF: Cognitive Level: Knowledge REF: Box 4-6, p. 84 OBJ: 1 TOP: Recommended Health Practices KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 22. What benefits can the older adult female expect with even a small amount of daily exercise? (Select all that apply.) a. Build muscle mass b. Control weight c. Retard bone loss d. Control the blood glucose level e. Promote a sense of well-being ANS: B, C, D, E Regular mild exercise will maintain, not build, muscle mass; control weight and glucose levels; retard bone loss; and promote a sense of well-being. DIF: Cognitive Level: Application REF: p. 74 OBJ: 1 TOP: Exercise Benefits KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 23. What evaluations should be conducted during an older adult female’s routine physical examination? (Select all that apply.) a. Measurement of height and weight b. Blood pressure c. Electrocardiography d. Rectal examination e. Mammography This study source was downloaded by from CourseH on :13:57 GMT -05:00 ANS: A, B, D, E Electrocardiography is not a routine part of a physical examination. DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 1 TOP: Physical Examinations KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 24. When assessing for ineffective health maintenance, what should be assessed? (Select all that apply.) a. Willingness to follow a health maintenance plan b. Possible conflict between a health maintenance plan and culture c. The presence of prohibited items such as sweets, alcohol, and cigarettes d. The family’s perception of effectiveness of a health maintenance plan e. The level of cognitive impairment ANS: A, B, C, E It is the patient’s, not the family’s, perception that the nurse needs to assess. All the other options listed would be a significant barrier to compliance. DIF: Cognitive Level: Comprehension REF: p. 82 OBJ: 6 TOP: Assessing for Noncompliance KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 25. The 80-year-old woman tells the home health nurse, “I can only eat cereal because I just can’t make those dentures work!” What would be the most appropriate suggestion by the nurse? (Select all that apply.) a. Take only tiny bites of food. b. Chew slowly. c. Use a dental adhesive. d. Select soft, nonsticky foods (e.g., ground meat, boiled carrots). e. Purée all food. ANS: A, B, C, D Puréeing food does not address the inability to eat with dentures. DIF: Cognitive Level: Comprehension REF: p. 77 OBJ: 9 TOP: Impaired Nutrition Related to Dentures KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 26. What factors might interfere with the health maintenance activities of a 76-year-old patient? (Select all that apply.) a. A belief that diminished health is part of aging b. Loss of a spouse 3 months ago c. Having a physical examination every year d. Living in an assisted living facility and not driving e. Having no family ANS: A, B, E Belief that age is synonymous with declining health, loss of spouse, and no close family are all impediments to learning new health-seeking behaviors. This study source was downloaded by from CourseH on :13:57 GMT -05:00 DIF: Cognitive Level: Comprehension REF: pp. 77-79 OBJ: 7 TOP: Perceptions of Aging KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease This study source was downloaded by from CourseH on :13:57 GMT -05:00 Chapter 5 communicating with older adults Verbal communications • Involves sending and receiving messages by means of words • Some is formal, structured, and precise; some is informal, unstructured, and flexible • Formal or therapeutic communications have a specific intent and purpose • Informal or social conversations are less specific and are used for socialization Nonverbal communication • Takes place without words • We are communicating all the time, whether we are aware of it or not The importance of understanding nonverbal communication can be summed up in the statement, “What you are saying (nonverbally) is so loud I can’t hear you Therapeutic communications • A conscious and deliberate process used to gather information related to a patient’s overall health status and to respond with verbal and nonverbal approaches that promote the patient’s well-being or improve the patient’s understanding of ongoing care • Knowledge of the individual’s educational background and interests provides nurses with a starting point for conversation • Effective verbal communication requires the ability to use a variety of techniques when sending and receiving messages Social communication • Small talk, pleasantries, and conversations about the weather, a favorite television show, or the latest news can demonstrate that the nurse thinks of the patient as a real person, not just as a patient • Don’t be afraid to be “human” when communicating with older patients • Remember that it’s okay to laugh at yourself, but never at the other person symbols • Uniform styles and colors help patients distinguish the various caregivers • Although nurses may not place much importance on wearing a uniform, it does play a role in communication • Nurses may not always wear a distinguishing uniform or they may wear scrub suits; this may be confusing to the older adult Tone of voice • Because the nonverbal message is so strong, we typically respond to the emotion we perceive from the tone of voice and This smtudayysonuorcte ewvasednowhneloaardetdhbey w10o00rd00s from CourseH on :19:52 GMT -05:00 • Shouting is often associated with anger or displeasure, yet many people shout in an attempt to communicate with someone who is hard of hearing Body lanugage • In situations in which words and body language are conveying two different messages, most people respond to body language • Nurses must be careful not to create barriers between themselves and their patients • Nurses must also watch for the messages that patients are communicating to us through their body language Space, distance, and position • Personal space refers to how close we allow someone to get to us before we feel uncomfortable • Public space • 12 feet or more away; no real positive or negative connection with the other person • Social space • Between 4 and 12 feet; a comfortable distance for a casual relationship, in which communication is at an impersonal level • Personal space • 18 inches to 4 feet; the optimal distance for close interpersonal communication with another person gestures • A specific type of nonverbal communication intended to convey ideas • Highly cultural and generational; those that are acceptable in one culture may be considered offensive in another • Helpful for people who cannot use words Facial expressions • The human face is most expressive, and facial expressions have been shown to communicate across cultural and age barriers • Humans respond to facial expressions from the time they are born • Fear, anger, joy, and a variety of other emotions can be conveyed by a simple change in facial expression Eye contact • When dealing with older adults, it is important to be sensitive to the meaning of eye contact for them • Eye contact is often interpreted to be a sign of attentiveness and acceptance. • Face-to-face contact also maximizes the chance that an older adult with hearing problems can read lips if necessary Pace or speed of communication This study source was downloaded by from CourseH on :19:52 GMT -05:00 • Nurses tend to be substantially younger than the aging people they serve • The resulting difference in rate of speech and movement can be overwhelming and frustrating to older adults • Nurses have often been observed completing sentences for older adults when they should have the patience to wait for the individual to organize his or her thoughts and speak • Patience and active listening are greatly needed skills when working with older adults Time and timing • Delays in response to a call light or direct request from a person may be interpreted as a lack of concern, even if this is not intended • The response to this perception may manifest in anger, displeasure, anxiety, fear, and many other feelings • Many older individuals have an altered sense of time • A message that is communicated too early may lead to either forgetfulness or to repeated questions of “Is it time yet?” • A message that is communicated too late may lead to distress and frustration touch • No words are required, and there is no need for high-level sensory or cognitive functioning • Caring touch is a basic need of all humans, and many older adults suffer from touch deprivation • Use of touch as a method of communication is often difficult and uncomfortable, particularly for young or inexperienced nurses • Affection, understanding, trust, hope, and concern can be communicated by a hand placed on a shoulder, a stroke of the forehead, or a frail hand held by a stronger one silence • Being with another person and remaining silent is difficult for many people, including nurses • At times, words can be intrusive; they can interfere with true communication • During intense grief, pain, or anxiety, simply being there without saying or doing anything may be the most appropriate form of communication nurses can give empathy • The willingness to attempt to understand the unique world of another person • The ability to put oneself in another person’s place and to understand what he or she is feeling and thinking in various situations • Empathetic listening involves actively trying to understand the other person, not just knowing many facts about that person introductions • Effective communication starts with proper introductions T•his sNtuduyrssoeusrcsehwoasudldowdnelotaederdmbiyn1e00h0o00w76e18a2c3h23o2 lfdroemr CaoduursletHsotno03b-2e8-a2d02d1re16s:s1e9:d52 GMT -05:00 • It is better to start by using the older adult’s proper title and name (e.g., Mrs. Quinn, Dr. Jones) and then clarifying which form of address the person prefers • In special situations, such as when a patient has dementia or other alterations in cognition, first names may be most appropriate because that may be the only name that the person can remember listening • Active listening skills are needed in all areas of nursing, but particularly in dealing with older adults • Empathetic listening requires sensitivity to the strengths and limitations of the aging individual • Empathetic listening involves patience when an older adult needs extra time to voice a response, or repeats the same thing many times Hearing impairment • If the person wears a hearing aid, make sure it is clean, that the batteries are working, and that the device is in the correct ear • Many people who are hearing-impaired spontaneously begin to read lips aphasia • A partial or total loss of the ability to use or understand words • It affects the ability to understand and express oneself through words, gestures, and writing but does not necessarily affect intellectual function dementia • Causes both cognitive and language deficits • Depending on the severity of the dementia, the individual may demonstrate different levels of function • Some characteristics of dementia include a limited attention span, inability to focus on more than one thought at a time, confusion of fact and fantasy, and inability to follow complex instruction Cultural differencens • A growing wave of immigration from many European, Central American, African, and Asian countries, bringing immigrants with varied levels of English proficiency, presents increased challenges to health care providers • It is most advantageous if caregivers from similar cultural and ethnic background are available to act as translators • In addition to making adaptations for language, the nurse should pay close attention to nonverbal communications informing • Uses direct statements regarding facts • A good information statement is clear, concise, and expressed in words that the patient can understand • Is the least effective form of communication because the patient is not actively involved Direct questioning This study source was downloaded by from CourseH on :19:52 GMT -05:00 • Too many direct questions can overwhelm an older person and may block rather than expand communication • Helpful when nurses need to obtain specific information or in emergency situations when time is precious • Tend to yield brief answers, often only a yes or no Open-ended techniques • Include open-ended questions, reflective statements, clarifying statements, and paraphrasing • These techniques allow the patient more leeway to respond, thus establishing a more empathetic climate • The patient is more likely to feel that the nurse is interested in him or her personally and not just trying to fill out a stack of forms • Also allow nurses to verify that the information being relayed is accurate confronting • Used when there are inconsistencies in information or when verbal and nonverbal messages appear contradictory • One of the most difficult communication techniques to use; should be used only after good rapport has been established • It is never advisable to confront a highly agitated or confused person, because conflict and a breakdown in communication will result Communicating with visitors and families • Families and friends are interested and concerned about what is happening to their loved ones • Not only do they turn to nurses for information and reassurance, but they can also be a good source of information for the nurse • Often, nurses need to rely on significant other(s) to interpret the behaviors and communications of older adults Delivering bad news • Important concepts include the following: • Prepare yourself • Think through what you want to say • Establish an environment that respects the patient’s privacy • Determine whether anyone else should be present • Important concepts include the following (cont’d.): • Make sure that there is adequate time, free from interruptions • Determine what the person already knows • Recognize that ethical and cultural variations may influence the way information is delivered • Use simple, direct, but sensitive language to begin the message, such as, “I’m afraid I have bad news for you” • Respond to the person’s emotional reaction; “Do you want to talk about how you’re feeling?” This study s•ourceDweavs edolowpnloaadpeldabny f1o00r0f0o07ll6o1w82-3u2p32 from CourseH on :19:52 GMT -05:00 • Communicate significant information to other caregivers as part of a plan of care Difficult conversations • Conflict resolution • Pick a place that is private and a time when you will be free from distractions • Try to focus on a single topic; don’t bring up old grievances that get in the way • If a conversation is not going well, take a look at your own feelings and motivations • Express your feelings using “I” statements, rather than “you” statements • Respect the right of the other person to agree or disagree • Conflict resolution (cont’d.) • Keep a balance between talking and listening • View each communication as a new opportunity to learn something about the other person • Don’t prejudge • Be aware of your own feelings regarding the issue under discussion • Conflict resolution (cont’d.) • Avoid blaming the other person • Be gentle on yourself • Learn from both negative and positive interactions • Try to achieve a win-win solution Communication with physicians • Mutual respect and a willingness to collaborate for the good of the older patient can form a strong basis for good nurse- physician interactions • The nurse can use a number of strategies to decrease frustrations and optimize the efficiency and effectiveness of communication • When you call a physician: • Start by identifying who you are (name and title), the patient(s) you are calling about, and the specific reason for the contact • Plan ahead and have a focus for the communication • Know what you want to report or find out This study s•ourceBweasodrogwannloiazdeedd,bcyl1e0a0r0,0p07r6e1c8i2s3e2,32afnrodmcCoomurpselH on :19:52 GMT -05:00 • Provide background information • Provide all necessary and relevant information that the physician might need • Identify the patient by name, major diagnoses, and any medications related to currently presenting symptoms or concerns • Be prepared to clarify any data or information that the physician may request Patient taching • Adult learners are oriented toward problem solving, and they view learning as most desirable when it is relevant to their own lives • Work in small, discrete blocks of information, proceeding from simple, more familiar concepts to more complex or difficult ones • It is important to pick the right place and time for teaching • Modifications may be needed to compensate for common sensory changes experienced with aging This study source was downloaded by from CourseH on :19:52 GMT -05:00 Chapter 06: Maintaining Fluid Balance and Meeting Nutritional Needs Test Bank MULTIPLE CHOICE 1. What is the lowest recommended daily caloric intake needed to safely meet the nutritional needs of the older adult? a. 1000 b. 1200 c. 1400 d. 1800 ANS: B The minimal caloric intake for the older adult that will meet nutritional needs is 1200 calories. DIF: Cognitive Level: Knowledge REF: p. 103 OBJ: 2 TOP: Minimal Calorie Intake KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. How often does the MyPlate guidelines recommend physical activity occur? a. Twice a week b. Weekly c. Three times a week d. Every day ANS: D The MyPlate guidelines of the USDA recommend that the general population make physical activity an everyday occurrence. DIF: Cognitive Level: Knowledge REF: p. 103 OBJ: 8 TOP: MyPyramid KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse recommends that the older patient eat chicken and fish because they contain complete proteins. What is present in complete proteins? a. Molecules of carbohydrate b. All the essential amino acids c. A high fat content d. A soluble fiber ANS: B Fish and lean chicken have all the essential amino acids and very little fat content, unlike red meat. DIF: Cognitive Level: Analysis REF: p. 105 OBJ: 2 TOP: Complete Protein KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. What makes up high-density lipoproteins (HDL)? a. Mainly proteins b. Mostly triglycerides This study source was downloaded by from CourseH on :26:14 GMT -05:00 c. Mainly cholesterol d. A variety of minerals ANS: A HDLs are made up primarily of proteins, as opposed to lipids such as triglycerides, which are found in very-low-density lipoproteins (VLDLs) and cholesterol, which is found in low- density lipoproteins (LDLs). DIF: Cognitive Level: Knowledge REF: p. 106 OBJ: 1 TOP: High-Density Lipoproteins KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. A patient on a fat-restricted diet is noted to have developed a pressure ulcer and decreased visual acuity. What vitamin deficiency should the nurse suspect? a. A b. B6 c. B12 d. C ANS: A Vitamin A is a fat-soluble vitamin and helps with wound healing and night vision acuity. Persons on low-fat diets may not be able to metabolize vitamin A from food sources because of the decreased fat in their diet. DIF: Cognitive Level: Analysis REF: p. 106 OBJ: 6 TOP: Vitamin A Deficiency KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The home health nurse does an ongoing assessment of the patient who has had a subtotal gastrectomy. What vitamin deficiency should the nurse monitor for? a. A b. B6 c. B12 d. C ANS: C Vitamin B12 is generated from the digestion of protein in the stomach. If part of the stomach is gone (gastrectomy), there is less digestive potential for vitamin B12. DIF: Cognitive Level: Analysis REF: p. 106 OBJ: 3 TOP: Vitamin B12 Deficiency KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. A patient is receiving an iron preparation in capsule form. What should the nurse administer the iron preparation with in order to improve absorption? a. Orange juice b. Milk products c. Water d. Caffeine drinks ANS: A Vitamin C, which can be found in orange juice, improves the absorption of iron. This study source was downloaded by from CourseH on :26:14 GMT -05:00 DIF: Cognitive Level: Application REF: p. 108 OBJ: 8 TOP: Iron Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 8. The nurse caring for the older adult patient who is taking a diuretic for control of hypertension should monitor the patient closely for signs of which of the following? a. Hypokalemia b. Hypocalcemia c. Hyponatremia d. Hyperkalemia ANS: A Diuretics deplete the body of potassium, a necessary mineral. DIF: Cognitive Level: Application REF: p. 109 OBJ: 6 TOP: Hypokalemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 9. The older adult patient in an extended-care facility has a pressure ulcer. The nurse would encourage wound healing by increasing the patient’s intake of zinc from which food sources? a. Meats b. Citrus fruits c. Green leafy vegetables d. Complex carbohydrates ANS: A Meat, nuts, and shellfish are dietary sources of zinc. DIF: Cognitive Level: Application REF: p. 109 OBJ: 8 TOP: Zinc KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. What is the minimum fluid intake for an older adult? a. 1000 mL b. 2000 mL c. 4000 mL d. 6000 mL ANS: B The minimum daily fluid requirement is 2000–3000 mL/day. DIF: Cognitive Level: Knowledge REF: p. 123 OBJ: 2 TOP: Fluid Requirements KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. Why is an older adult who abuses alcohol at an increased risk for nutritional deficits? a. Alcohol decreases blood glucose levels. b. Alcohol alters the function of some minerals. c. Alcohol interferes with the absorption of nutrients. d. Alcohol increases the metabolism. ANS: C This study source was downloaded by from CourseH on :26:14 GMT -05:00 Excessive intake of alcohol interferes with the absorption of nutrients because of changes in the stomach lining. DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 12. Which of the following disease processes would result in a need for an increased caloric intake? a. Cancer b. Osteoporosis c. Arthritis d. Stroke ANS: A Persons with an illness such as cancer require increased caloric intake because illness increases metabolism. Diseases that restrict mobility result in a reduced caloric need. DIF: Cognitive Level: Application REF: p. 103 OBJ: 6 TOP: Changing Caloric Needs KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. What is the recommended daily allowance of protein for an adult? a. 200 grams b. 20 grams c. 150 grams d. 50 grams ANS: D The recommended daily allowance for protein is 46 grams for adult women and 56 grams for adult men. DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: 2 TOP: Protein Intake Equivalent KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. An older patient is having trouble with hydration. What foods could the nurse suggest to increase fluid intake? a. Fresh fruits b. Cooked meats c. Breads d. Dried fruits ANS: A Fresh fruits have a high fluid content. Dried fruits, cooked meats, and breads have a lower fluid content. DIF: Cognitive Level: Comprehension REF: p. 123 OBJ: 2 TOP: MyPyramid: Fruit KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation This study source was downloaded by from CourseH on :26:14 GMT -05:00 15. What instructions should the nurse include when teaching a patient regarding a new prescription for an oral iron supplement? a. Supplements should be taken between meals on an empty stomach. b. Medication should be drunk from a nonmetal glass. c. The color of the stool will change to dark green or black. d. Constipation is likely to occur. ANS: C Iron supplements can color the stool a dark green or black. Iron should be taken with a meal to reduce gastrointestinal irritation. The preparation should be taken through a straw. The supplement might cause diarrhea. DIF: Cognitive Level: Comprehension REF: p. 108 OBJ: 8 TOP: Iron Preparations KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. The nurse encourages a group of extended care residents to sit out on the sunny patio for an hour each day. What vitamin level is the nurse trying to improve? a. A b. B12 c. D d. K ANS: C Exposure to the sun allows the skin to synthesize vitamin D, which is required for calcium absorption. DIF: Cognitive Level: Analysis REF: p. 106 OBJ: 8 TOP: Synthesis of Vitamin D KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. What is the caloric value (in calories per gram [cal/g]) of protein? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g ANS: B Proteins yield 4 cal/g. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 18. What is the caloric value of alcohol? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g ANS: D Alcohol yields 7 cal/g. This study source was downloaded by from CourseH on :26:14 GMT -05:00 DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 19. What is the caloric value of vitamins? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g ANS: C Vitamins yield no calories. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 20. What is the caloric value of fat? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g ANS: A Fats, which can come from either plant sources or animal sources, yield 9 cal/g. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE 21. When the nurse weighs an edematous patient with congestive heart failure, the weight increase from yesterday is 2.2 lb. What would be included in the plan of care for the patient? (Select all that apply.) a. Keep a pitcher of water at the bedside. b. Offer frequent oral hygiene. c. Limit fresh fruits and vegetables. d. Avoid changing the patient’s position. e. Provide hard candy. ANS: B, C, E The weight gain of 2.2 lb (1 kg) is significant and would signify fluid retention. Fluid restrictions would be expected. Frequent oral hygiene is a comfort measure to combat dry mucous membranes caused by fluid restriction. Fresh fruits and vegetables are high in water content and should be avoided. Hard candy would stimulate the production of saliva. Water should not be kept at the beside of a patient with fluid restrictions. The patient’s position should be changed frequently to prevent skin breakdown. DIF: Cognitive Level: Application REF: p. 122 OBJ: 6 TOP: Fluid Retention KEY: Nursing Process Step: Assessment This study source was downloaded by from CourseH on :26:14 GMT -05:00 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. What factors influence nutritional needs? (Select all that apply.) a. Bone density b. Gender c. Climate d. Presence of illness e. Body temperature ANS: B, C, D, E Bone density is not a factor, but all other options are factors that have a significant effect on nutritional needs. DIF: Cognitive Level: Comprehension REF: p. 102 OBJ: 2 TOP: Influences on Nutrition KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. Which of the following are vital nutrients that are required by all persons? (Select all that apply.) a. Carbohydrates b. Proteins c. Vitamins and minerals d. Fats e. Electrolytes ANS: A, B, C, D Electrolytes are not nutrients, but all other listed options are considered essential nutrients. DIF: Cognitive Level: Knowledge REF: p. 103 OBJ: 2 TOP: Essential Nutrients KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. What are contained in complex carbohydrates that make them important in the diet? (Select all that apply.) a. Minerals b. Fats c. Vitamins d. Soluble fiber e. Polysaccharides ANS: A, C, D, E No fat is contained in complex carbohydrates. DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: 1 TOP: Complex Carbohydrates KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 25. Inadequate fluid intake can make the older adult susceptible to which of the following? (Select all that apply.) a. Altered absorption of drugs b. Digestive disorders c. Constipation This study source was downloaded by from CourseH on :26:14 GMT -05:00 d. Bleeding disorders e. Reduced appetite ANS: A, B, C, E Bleeding disorders are not associated with inadequate intake. All other options are problems associated with a fluid deficit. DIF: Cognitive Level: Application REF: p. 109 OBJ: 6 TOP: Fluid Deficit KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. Older adults plagued with chronic health problems may become undernourished because they . (Select all that apply.) a. are too fatigued to prepare meals b. become frustrated when attempting to open packaging c. may be unable to carry groceries any distance d. have no interest in eating out due to health issues e. lack stamina to shop for groceries ANS: A, B, C, E Having no interest in eating out is not going to cause the older adult to be malnourished. Lack of interest in eating or socialization due to a chronic health problem can cause the older adult to be malnourished. All the other options listed can result in the older adult being malnourished. DIF: Cognitive Level: Comprehension REF: p. 110 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 27. What are barriers to adequate nutrition for the older adult living independently? (Select all that apply.) a. Difficulty chewing b. Lack of transportation to shop c. Use of quick frozen meals d. Lack of motivation to cook e. Sensory changes ANS: A, B, D, E The availability of quick frozen foods, which are easy to prepare, offer a source of better nutrition to the older adult. DIF: Cognitive Level: Application REF: p. 110 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. An older adult who is a resident in an extended-care facility would be at risk for which of the following nutritional deficits? (Select all that apply.) a. Repetitive nature of meals b. Lack of culturally significant food c. Environmental odors d. Reaction to being fed by others e. Non-nutritious food choices This study source was downloaded by from CourseH on :26:14 GMT -05:00 ANS: A, B, C, D Although the food is nutritious, the repetitive nature of the menu, the lack of culturally significant food, and environmental concerns alter the motivation to have adequate intake. DIF: Cognitive Level: Comprehension REF: p. 112 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 29. The older adult asks for help selecting foods high in protein. What would be appropriate for the nurse to suggest? (Select all that apply.) a. Corn b. Beans c. Whole-grain foods d. Cheese e. Nuts ANS: B, C, D, E Corn is not a source of protein. DIF: Cognitive Level: Application REF: p. 105 OBJ: 1 TOP: Protein Consumption KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 30. The nurse cautions the older adult against taking excess vitamin supplements because some vitamins can be retained in fatty tissue and cause liver damage, including vitamin(s) . (Select all that apply.) a. A b. B6 c. C d. D e. E ANS: A, D, E Excess fat-soluble vitamins A, D, and E can be retained in fatty tissue and result in hepatic damage. DIF: Cognitive Level: Application REF: p. 107 OBJ: 1 TOP: Vitamin Intake KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation This study source was downloaded by from CourseH on :26:14 GMT -05:00 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. This study source was downloaded by from CourseH on :45:58 GMT -05:00 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 This study source was downloaded by from CourseH on :45:58 GMT -05:00 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. This study source was downloaded by from CourseH on :45:58 GMT -05:00 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 OB