Question 1

A 78-year-old patient with multiple health problems complains of having "no energy" and feeling increasingly weak. The patient has had an 11-pound weight loss over the last year. The nurse should initially

Accepted Answer

In the frail elderly patient, nutrition is frequently compromised, and the nurse's initial action should be to assess the patient's nutritional status. Active range-of-motion may be helpful in improving the patient's strength and endurance, but nutritional assessment is the priority because the patient has had a significant weight loss. The patient may be a candidate for long-term care placement, but more assessment is needed before this can be determined. The patient's assessment data are not consistent with normal changes associated with aging.

Question 2

When the nurse is working in the outpatient clinic, which nursing action will be most helpful in decreasing the risk for drug-drug interactions in an older adult patient?

Accepted Answer

The most information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but use of supplements and herbal medications also need to be considered in order to prevent drug-drug interactions. Use of a medication schedule will help the patient take medications as scheduled but will not prevent drug-drug interactions.

Question 3

When caring for a patient with type 2 diabetes who has been hospitalized with severe hyperglycemia, which topic will be most important to include in discharge teaching?

Accepted Answer

One of the tasks for patients with chronic illnesses is to prevent and manage a crisis. The patient needs instruction on recognition of symptoms of hyperglycemia and appropriate actions to take if these symptoms occur. The other information also may be included in patient teaching, but is not as essential in the patient's self-management of the illness.

Question 4

The nurse is planning discharge for an alert, homeless 70-year-old with a chronic foot infection. The most appropriate intervention by the nurse is to

Accepted Answer

A multidisciplinary approach, including social services, is needed when caring for homeless adults. Even with appropriate education, a homeless individual may not be able to maintain adequate foot care because of a lack of supplies or a suitable place to accomplish care. Older homeless individuals are less likely to use shelters or meal sites. A homeless person may fail to keep appointments for outpatient services because of factors such as fear of institutionalization or lack of transportation.

Question 5

When admitting a 79-year-old patient who has urinary urgency and a possible urinary tract infection (UTI), the nurse should first

Accepted Answer

Before beginning the assessment of an older patient with a UTI and urgency, the nurse should have the patient empty the bladder because bladder fullness or discomfort will distract from the patient's ability to provide accurate information. The patient may seem disoriented if distracted by pain or urgency. The physical assessment data are obtained after the patient is as comfortable as possible.

Question 6

The home health nurse is caring for a 71-year-old patient who lives alone and is taking seven different prescribed medications for chronic health problems. To ensure medication compliance, which nursing intervention is best?

Accepted Answer

Since forgetting to take medications is a common cause of medication errors in older adults, the use of medication reminder devices is helpful when older adults have multiple medications to take. There is no indication that the patient needs to move to assisted living or that the patient does not understand the importance of medication compliance. Home health care is not designed for the patient who needs ongoing assistance with activities of daily living (ADLs) or instrumental ADLs (IADLs).

Question 7

The nurse is planning care for an alert and active 85-year-old patient who takes multiple medications for chronic cardiac and respiratory disease and lives with a daughter who works during the day. Which nursing diagnosis is most appropriate?

Accepted Answer

The patient's age and multiple medications indicate a risk for injury caused by interactions between the multiple drugs being taken and a decreased drug metabolism rate. The patient data do not indicate problems with social isolation, caregiver role strain, or compromised family coping.

Question 8

Which action will the nurse take when planning for discharge of a 68-year-old patient who will need daily assistance with activities such as shopping and transportation?

Accepted Answer

Funding from the federal Administration on Aging is funneled through local Area Agencies on Aging to provide community services to older adults. Medicare, Medicaid, and insurers provide funding for specific medical services, but not for need such as shopping or transportation.

Question 9

Which information obtained by the home health nurse when making a visit to an 88-year-old with mild forgetfulness is of concern?

Accepted Answer

A 10-pound weight loss may be an indication of elder neglect or depression and requires further assessment by the nurse. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this patient. It is not unusual that an 88-year-old would have friends who have died.

Question 10

When a hospitalized older patient is at risk of falling because of acute confusion and weakness, which action should the nurse take first?

Accepted Answer

The use of the least restrictive restraint alternative is required. Physical or chemical restraints may be necessary, but the nurse's first action should be an alternative such as a bed alarm.

Question 11

To obtain the most complete information when doing an assessment for an 81-year-old patient, the nurse will

Accepted Answer

The most complete information about the patient will be obtained through the use of an assessment instrument specific to the geriatric population, which includes information about both medical diagnoses and treatments and about functional health patterns and abilities. A review of the chart, interviews of the patient and caregiver, and written information by the patient will all be included in a comprehensive geriatric assessment.

Question 12

When admitting an 88-year-old patient to the hospital, the nurse should plan to

Accepted Answer

Assistive devices should be in place before assessing the patient to minimize anxiety and confusion. When a patient is acutely ill, the physical assessment should be accomplished first to detect any physiologic changes that require immediate action. Not all older patients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly to all older patients. To avoid tiring the patient, much of the medical history can be obtained from medical records.

Question 13

The nurse suspects that elder abuse may be occurring when a confused and agitated 76-year-old patient with a broken arm is brought to the emergency department by a family member. Which of these actions should the nurse take first?

Accepted Answer

The initial action should be assessment and interviewing of the patient. The patient should be interviewed alone because the patient will be unlikely to give accurate information if the abuser is present. If abuse is occurring, the patient should not be discharged home for a later assessment by a home health nurse. The nurse needs to collect and document physiologic data before notifying the elder protective services agency.

Question 14

Which nursing actions will the nurse take to assess for possible malnutrition in a 69-year-old patient (select all that apply)?

Accepted Answer

The laboratory results, especially albumin and cholesterol levels, may indicate chronic poor protein intake or high-fat/cholesterol intake. Transportation impacts patients' ability to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in poor condition may decrease the ability to chew and swallow. Food likes and dislikes are not necessarily associated with malnutrition.

Question 15

Which question will provide the most useful information when the nurse is performing a comprehensive geriatric assessment of an older adult who is being assessed for admission to an assisted-living facility?

Accepted Answer

The patient's functional abilities, rather than the presence of acute or chronic illness, are more useful in determining how well the patient might adapt to an assisted-living situation. The other questions also will provide helpful information but are not as useful in providing a basis for determining patient needs or for developing interventions for the older patient.

Question 16

When caring for an older adult who lives in a rural area, the nurse will plan to

Accepted Answer

Transportation can be a barrier to accessing health services in rural areas. There are no chronic diseases unique to rural areas. Because medications may change, the nurse should help the patient plan for obtaining medications through alternate means such as the mail or delivery services, not by purchasing large quantities of the medications. The patient living in a rural area may lose the benefits of a familiar situation and social support by moving to an urban area.

Question 17

Which information about a 77-year-old patient who is being assessed by the home health nurse is of most concern?

Accepted Answer

Inactivity and immobility lead rapidly to loss of function in older adults. The nurse should develop a plan to prevent further deconditioning and restore function for the patient. Self-management is appropriate for independently living older adults. On average, a 70-year-old takes seven different medications; the use of three medications is not unusual for a 78-year-old. The use of memory devices to assist with safe medication administration is recommended for older adults.

Question 18

Which of these patients assigned to the nurse is most likely to need planning for long-term nursing management?

Accepted Answer

The patient's osteoarthritis is a chronic problem that will require planning for long-term interventions such as physical therapy and nutrition counseling. The other patients have acute problems that are not likely to require long-term management.

Question 19

When developing the plan of care for an older adult who is hospitalized for an acute illness, the nurse should

Accepted Answer

The plan of care for older adults should be individualized and based on the patient's current functional abilities. A standardized geriatric nursing care plan will not address individual patient needs and strengths. A patient's need for discharge to a long-term care facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process.

Quiz 5: Chronic Illness and Older Adults