Pearson Custom For Older Adult Nursing Care By Nancy J.Brown – Test Bank

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Sample Question

Brown Older Adult Nursing Care, 1/E Chapter 3 Question 1 Type: Matching Match the definitions of the stages of sleep in the right column with the correct stage of sleep named in the left column.

1.

2.

3.

4.

5.

Stage 1, NREM Stage 2, NREM Stage 3, NREM Stage 4, NREM REM sleep _____

1. Relaxed, light sleep, brain waves slow, no eye movement

_____

2. Vitals signs and metabolism decrease; groggy if awakened

_____

3. Drifting to sleep period; easily aroused

_____

4. Beginning of deeper, more restorative sleep

_____

5. Pronounced muscle relaxation except eyes; very relaxed state.

Correct Answer: A–3, B-1, C-4, D-2, E-5 Global Rationale:

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Learning Outcome: Discuss the changes in the older adult that affect sleep and rest requirements.

Question 2 Type: MCSA An older adult client complains to the nurse about obtaining inadequate rest at night. The client expresses concern about “…getting on yet another prescribed medication,” and asks the nurse to suggest some alternative methods that would promote rest. Which response by the nurse would indicate accurate, helpful information for this client?

1.

“Try to eat your heaviest meal in the evening. This will cause you to feel groggy and get to sleep more easily.”

2.

“Keep your room at a nice warm temperature. This will create a warm, cozy environment which will stimulate sleep.”

3.

“If you nap during the day, make sure that you don’t sleep more than thirty minutes to an hour or you will probably interfere with your nighttime rest.”

4.

“If you drink, try a glass of wine right before bed. This will relax you and help you fall asleep.”

Correct Answer: 3

Rationale 1: Sleep-enhancing therapeutic interventions include avoiding heavy meals 2–3 hours prior to bedtime.

Rationale 2: Sleep-enhancing therapeutic interventions include keeping the room dark, quiet, and cool.

Rationale 3: Limiting daytime sleep to under an hour is a therapeutic intervention to promote sleep.

Rationale 4: Sleep-enhancing therapeutic interventions include avoiding alcohol 2–3 hours prior to bedtime.

Global Rationale:

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Learning Outcome: Discuss the changes in the older adult that affect sleep and rest requirements.

Question 3 Type: MCSA An older adult male client accompanied by his wife is being assessed by a nurse practitioner in a walk-in clinic. The client’s wife reports that the client “…snores very loudly at night, and he stops breathing for almost a minute several times during the night.” With this information, the nurse practitioner suspects that the client is suffering from which of the following disorders affecting sleep?

1.

Chronic obstructive sleep apnea 2.

Gastroesophageal reflux disease (GERD) 3.

Chronic obstructive pulmonary disease (COPD) 4.

Decreased REM sleep pattern Correct Answer: 1 Rationale 1: “The definition of sleep apnea is periodic stoppage of breathing during sleep due to a temporary collapse of structures in the pharynx,” Rationale 2: GERD has different symptoms that are related to gastrointestinal reflux.

Rationale 3: COPD has different symptoms that are related to congestion in the lungs.

Rationale 4: Decreased REM sleep pattern is an effect, not a cause, of a disorder.

Global Rationale:

Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Learning Outcome: Discuss the changes in the older adult that affect sleep and rest requirements.

Question 4 Type: MCMA

A home health nurse is assigned a new older adult client. The nurse visits the client to make an initial assessment. This includes assessing the safety of the client’s home environment. Which of the following potential safety hazards would be necessary for the nurse to note?

Standard Text: Select all that apply.

1.

Water temperature set at 120°F 2.

Use of space heaters in the home 3.

Walker sitting next to the bedside 4.

Throw rugs that are not tacked down 5.

Smoke alarms present in main areas Correct Answer: 2,4 Rationale 1: 120°F is an advised water temperature.

Rationale 2: Space heater use can be a fire hazard.

Rationale 3: A walker close to the bedside is suggested to prevent fall injuries.

Rationale 4: Unsecured throw rugs can cause falls.

Rationale 5: Use of smoke alarms is strongly advised to prevent fire-related injuries.

Global Rationale:

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Learning Outcome: List the main causes of injury and other trauma for the older adult.

Question 5 Type: MCSA A home health nurse and a nurse’s aide see several older adult clients during the day to admit them into home health care. Each client is assessed for risk for falls. Which of the clients listed below would be at highest risk?

1.

A female client living in a one-story facility who practices tai-chi, owns a cat, and takes a nonsteroidal anti-inflammatory medication daily for osteoarthritis.

2.

A client with diabetic neuropathy who is taking two antihypertensive medications and two hypoglycemic agents daily, and who scored 35 seconds on the “Up and Go” test 3.

A male client with osteoporosis who takes calcium supplements daily, exercises with hand weights twice a week, and uses a cane when walking 4.

A client with hypothyroidism and hypertension who takes thyroid preparations and antihypertensive medications daily and, when tested for balance, stood for 5 seconds on one foot before wobbling Correct Answer: 2 Rationale 1: Only osteoarthritis and owning a cat are risk factors. Tai-chi helps with balance.

Rationale 2: This client has the most risk factors. Having diabetic neuropathy, taking at least 4 medications associated with falling, and a score of over 30 on the “Up and Go” test are all risk factors.

Rationale 3: Osteoporosis and use of a cane are risk factors, but other options list more risks for falls.

Rationale 4: Being on antihypertensive medication is the only risk factor listed. Standing for 5 seconds on one foot before wobbling is a normal balance test result.

Global Rationale:

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Learning Outcome: List the main causes of injury and other trauma for the older adult.

Question 6 Type: MCSA An older adult client’s daughter asks the nurse’s opinion concerning whether or not she should take her mother’s car keys from her and prevent her from driving. The nurse would base the response on the assessment of which one of the following risk factors in particular?

1.

Limited range of motion of the arms 2.

Decreased fine motor coordination 3.

Limited range of motion of the neck 4.

Muscle weakness Correct Answer: 3 Rationale 1: Limited range of motion in the arms is not the most critical risk factor.

Rationale 2: Decreased fine motor coordination is not the most critical risk factor.

Rationale 3: Limited range of motion of the neck is the most critical risk factor, because the ability to turn one’s head determines whether one can see oncoming traffic, pedestrians, etc.

Rationale 4: Muscle weakness is not the most critical risk factor.

Global Rationale:

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Learning Outcome: List the main causes of injury and other trauma for the older adult.

Question 7 Type: MCSA An ambulatory older adult client has been assessed by the nursing staff to be a high fall risk due to muscle weakness and orthostatic hypotension. Which of the following nursing interventions would be best to prevent a fall injury in this client?

1.

2.

3.

4.

Confining client to a bedside chair or a wheelchair when the client is awake Use of a vest-type restraint when the client is up in a chair or in a wheelchair Use of hip protectors on the client when the client is up in the hallways Client education regarding slow change of position and use of wall rails in the hallway Correct Answer: 4 Rationale 1: Not allowing the client to walk increases muscle weakness and orthostatic hypotension problems.

Rationale 2: Restraints as an intervention should be a last resort.

Rationale 3: Although this is a method to decrease fall risk, hip protectors may not be necessary for this client.

Rationale 4: Client education is the best response, considering the reasons for the client’s fall risk.

Global Rationale:

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Learning Outcome: Discuss environmental adaptations for the older adult.

Question 8 Type: MCMA The nurse is aware that pharmacokinetics affects older adult clients differently than younger clients.

Which of the following effects, in terms of pharmacokinetics, would be seen in older adult clients?

Standard Text: Select all that apply.

1.

Increased gastrointestinal motility resulting in faster absorption of medications 2.

Higher concentration of water-soluble medications, causing possibility of adverse reactions 3.

Hypertrophy of the kidneys, resulting in faster excretion of medications, preventing therapeutic effects 4.

Decreased drug metabolism and increased half-lives of medications, causing drug accumulation and possible toxicity 5.

A lack of albumin, causing too few protein-binding sites, resulting in more free drug and possibility of drug interactions and toxicity Correct Answer: 2,4,5 Rationale 1: Peristalsis in older adults normally slows.

Rationale 2: Correct. Due to an overall lack of body water, water-soluble medications may cause adverse reactions.

Rationale 3: Drug toxicity could result, because kidneys shrink as one ages and medications are excreted at a slower, not a faster, rate.

Rationale 4: Correct. Drug metabolism does decrease in older adults.

Rationale 5: Correct. Reduction in protein-binding sites results in more free drug and greater possibility of drug interactions and toxicity.

Global Rationale:

Cognitive Level: Remembering Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Learning Outcome: Explain the importance of monitoring medications more closely in the older adult.

Question 9 Type: MCMA

A home-health nurse is paying a visit to an older adult client who suffers from severe cardiovascular disease and takes multiple medications and supplements. The nurse needs to keep which of the following facts in mind in order to do an accurate assessment of this client’s medications?

Standard Text: Select all that apply.

1.

All OTC and herbal supplements need to be reviewed due to the danger of possible drug interactions.

2.

Most older adults are compliant when it comes to taking their medications as prescribed.

3.

The client’s renal and cardiac status needs to be considered in relation to the doses of the medications ordered.

4.

Generally speaking, older adults tolerate their prescribed medications well and show little evidence of side effects.

5.

The danger of drug toxicity always needs to be assessed in older adults who have renal or cardiac impairment.

Correct Answer: 1,3,5 Rationale 1: Correct. All OTC and herbal supplements do need to be reviewed.

Rationale 2: Older adults have a medication noncompliance rate of 50%.

Rationale 3: Correct. The client’s renal and cardiac status does need to be considered.

Rationale 4: Due to decreasing kidney and cardiac functioning, older adults often have more side effects and toxic effects associated with their medications.

Rationale 5: Correct. The danger of drug toxicity does need to be assessed in older adults who have renal or cardiac impairment.

Global Rationale:

Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Learning Outcome: Explain the importance of monitoring medications more closely in the older adult.

Question 10 Type: MCSA The nurse is aware pharmacokinetics is affected by physical changes in the older adult. The excretion of medications would be influenced by which of the following physical changes associated with the aging process?

1.

2.

3.

Decreased renal blood flow, decreased kidney size, and loss of nephrons A natural decrease in albumin and an increased amount of fat tissue Shrinkage of the liver, decreased hepatic blood flow, and decreased liver enzyme production 4.

Change in the pH of the stomach, as well as decreased gastrointestinal blood flow and peristaltic movement.

Correct Answer: 1 Rationale 1: Correct. Age-related changes in the kidneys affect excretion of medications.

Rationale 2: Decreased albumin and increased fatty tissue result in changes in distribution, not excretion, of medications.

Rationale 3: Age-related changes in the liver result in changes in metabolism, not excretion, of medications.

Rationale 4: Gastrointestinal changes result in changes in absorption, not excretion.

Global Rationale:

Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Learning Outcome: Explain the importance of monitoring medications more closely in the older adult.

Question 11 Type: MCSA The nurse is reviewing the physician’s orders on several older adult clients’ charts. Which of the following orders would cause the nurse concern?

1. gabapentin (Neurontin) 2. duloxetine (Cymbalta) 3. meperidine (Demerol) 4. propranolol (Inderal) Correct Answer: 3 Rationale 1: Neurontin is an appropriate adjuvant medication for use in older adults for neuropathic pain.

Rationale 2: Cymbalta is appropriate for use in older adults for neuropathic pain.

Rationale 3: Correct. Demerol is inappropriate for use for pain management in older adults.

Rationale 4: Inderal is an appropriate nonanalgesic that aids other medications in treating pain.

Global Rationale:

Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Learning Outcome: Discuss pain management in the older adult.

Question 12 Type: MCSA An older adult client suffering from terminal cancer is about to be discharged from the hospital to go home. The client’s physician orders a fentanyl transdermal patch for the client to manage severe pain. The nurse needs to educate the client about avoiding which of the following activities while wearing the patch?

1.

Taking a hot bath or shower 2.

Eating a large meal 3.

Resting in the bed or in a recliner 4.

Being in close proximity to other people while wearing the patch Correct Answer: 1 Rationale 1: Correct. Taking a hot bath or shower while wearing the patch can cause vasodilation and too rapid absorption of the fentanyl.

Rationale 2: No known problems are associated with eating and the use of the fentanyl transdermal patch.

Rationale 3: Resting while the patch is on is a good idea, and not contraindicated.

Rationale 4: The patch is safe as long as it is on the client and covered by clothing.

Global Rationale:

Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Learning Outcome: Discuss pain management in the older adult.

Question 13 Type: MCSA A nurse is preparing to do a pain assessment on an older adult client who is recovering from abdominal surgery. Which of the following charting entries would denote a complete assessment by the nurse?

1.

“Pain described as a ‘7’ on a 0–10 scale. Describes pain as ‘deep and intermittent,’ and requests prn pain medication.”

2.

“States pain is ‘knifelike-stabbing’ and is located below the incision. Reports the pain to be ‘5’ on a 0–10 scale. Prn pain medication administered.”

3.

“Describes pain as ‘throbbing and deep.’ Reports that the pain is located to the left of the umbilicus. No pain med requested.”

4.

“Rates pain as a ‘6’ on the Faces Pain Intensity Scale. States the pain is located on the left side of the abdomen.”

Correct Answer: 2 Rationale 1: This entry only contains the intensity and the character of the pain, but not the location.

Rationale 2: Correct. This entry contains all aspects of a pain assessment: location, intensity, and character of the pain.

Rationale 3: This entry only contains the location and the character of the pain, but not the intensity.

Rationale 4: This entry only contains the intensity and the location of the pain, but not the character.

Global Rationale:

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Learning Outcome: Discuss pain management in the older adult.

Question 14 Type: MCSA

A nurse caring for an Hispanic older adult client states to the supervisor, “The client never complains of pain when I ask him about it, but from his eyes, I get the feeling that he is in pain.” The nursing supervisor would be most accurate with which one of the following statements?

1.

“If he says that he is not in pain, then we need to honor that. He is the only one who can evaluate his pain.”

2.

“You know how men are. Don’t argue with him or you will be threatening his sense of masculinity and machismo.”

3.

“He probably doesn’t want to bother you with what he feels is a minor concern.

You will need to educate him on the importance of receiving pain medication before the pain is too acute.”

4.

“You are probably letting your own feelings color your pain assessment. Just because you think he may be in a lot of pain doesn’t mean that he is. Maybe you would be, but that’s your perception.”

Correct Answer: 3 Rationale 1: This statement does not take into consideration the client’s cultural background.

Rationale 2: This statement is stereotypical and not considerate of the client’s needs.

Rationale 3: Correct. This statement shows cultural sensitivity, in that Hispanics often do not want to be seen as complaining or bothering the staff.

Rationale 4: This statement discounts the assessment of the nurse and is not considerate of the client’s needs.

Global Rationale:

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Learning Outcome: Discuss pain management in the older adult.

Question 15 Type: MCSA The nurse is evaluating an older adult client’s pain. The client describes the pain as “constant and cramping in the abdominal area.” The nurse would be accurate in categorizing the client’s pain as what type?

1.

Neuropathic 2.

Proprioceptive 3.

Adjuvant 4.

Nociceptive Correct Answer: 4 Rationale 1: Neuropathic pain is neurological in nature and usually described as burning, cutting, tingling, or deep aching.

Rationale 2: Proprioceptive is used to describe being aware of one’s position and movement in relation to the environment, not pain.

Rationale 3: Adjuvant refers to a drug-enhancing agent, not to pain.

Rationale 4: Correct. Nociceptive is somatic or visceral pain and is described as sharp, aching, cramping, or throbbing. It may be continuous or intermittent.

Global Rationale:

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Learning Outcome: Discuss pain management in the older adult.