Deck 4: The Older Adult High-Acuity Patient

Question 1

An older adult patient remarks that she has been experiencing constipation,which has never been a problem for her before now.What questions should the nurse ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)"Do you have a list of your medications?"
B)"How many fluids do you drink each day?"
C)"Do you get enough rest at night?"
D)"What kinds of fruits and vegetables do you eat daily?"
E)"How often do you have a bowel movement?"

Answer 1

"Do you have a list of your medications?"
"How many fluids do you drink each day?"
"What kinds of fruits and vegetables do you eat daily?"
"How often do you have a bowel movement?"

Question 2

A nurse is assessing an 85-year-old patient who presented to the emergency department with a complaint of "not feeling like myself." What should the nurse consider during this assessment?

A)Aging causes sudden loss of function in organ systems.
B)In older adults diseases often present with uncharacteristic symptoms.
C)Many older adults do not participate in activities to support wellness.
D)Since most 85-year-old patients live in an institutional setting they are exposed to more communicable diseases.

Answer 2

In older adults diseases often present with uncharacteristic symptoms.

Question 3

An older adult with osteoarthritis has been told that he cannot have his painful knee replaced because of his cardiac status.The patient is having progressive difficulty with normal self-care activities.The nurse should monitor this patient for which condition?

A)Depression
B)Noncompliance
C)Dementia
D)Delirium

Answer 3

Depression

Question 4

An older adult is admitted to the emergency department (ED)after being the restrained front seat passenger in a motor vehicle accident.The nurse assessing this patient should consider that which physiologic response to hypovolemia is not as likely in an older adult?

A)Decreased blood pressure
B)Tachycardia
C)Decreased cardiac output by hemodynamic monitor
D)Decreased urine output

Question 5

The nurse manages an acute care unit that is beginning to provide care for more and more older adults after surgery.The nurse manager would encourage nurses to add which interventions to the plan of care for these patients?

A)Use of restraints to prevent falls and disruption of invasive lines
B)Early return to ambulation and self-care activities
C)Get patients out of bed to a chair for most of the day
D)Keep patients on bedrest until strength returns

Question 6

An older adult has been prescribed medication to control hypertension.Today she says,"I took this same medication years ago,but I'm having more side effects this time." What should the nurse consider before replying?

A)Many antihypertensive medications have similar names so the patient could have confused the drugs.
B)Older women often decrease oral fluid intake,which would change response to the drug.
C)The older pancreas cannot supply enzymes to metabolize the drugs as early in the digestive system.
D)Changes in the blood-brain barrier may make older patients more sensitive to some side effects.

Question 7

An older adult patient tells the nurse that she is "tired" of having her medication doses changed so many times and wants to find a doctor who "knows what he's doing." How should the nurse respond to this patient?

A)"Have you thought about cutting pills or add pills together to get the correct dose?"
B)"If you seriously want to change providers,know some of the other doctors in the building are taking new patients."
C)"Frequent dose changes are necessary until the correct dose for you is determined."
D)"I know what you mean.It is annoying,but it is necessary."

Question 8

An older adult says,"I cannot believe that I have had a heart attack.I thought I had stomach flu and a backache." What nursing response is indicated?

A)"I am also surprised that you had a heart attack.Your symptoms did not sound that severe."
B)"Usually a patient has chest and arm pain with a heart attack."
C)"The symptoms of heart attack change as people age and may include back pain or stomach problems."
D)"It is rare but a backache and a stomach ache can occur as a signal of a heart attack."

Question 9

The primary nurse reports to the team caring for an older adult that the patient has a low Braden Scale score.The nurse would instruct the team to start interventions to prevent which complication?

A)Skin breakdown
B)Dehydration
C)Falls
D)Drug-food interactions

Question 10

An older adult being treated for a burn on his lower leg and foot is surprised at its severity.He says,"It really didn't hurt very badly when I did it." What should the nurse consider before responding?

A)Patients can block out portions of painful stimuli if it is overwhelming.
B)Aging can decrease touch sensitivity to the feet and lower legs.
C)Poor circulation has probably resulted in death of the nerve endings in the patient's legs.
D)Burns on the legs often appear very severe because the skin is so thin.

Question 11

The nurse has assessed that an older adult patient is at risk for impaired skin integrity.Which interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Secure IV catheters with paper tape.
B)Apply transparent film dressings to pressure-prone areas.
C)Pull the patient up in bed every hour.
D)Keep the patient warm.
E)Monitor IV sites for infiltration.

Question 12

A 68-year-old patient had a PCV13 pneumonia vaccination 2 years ago.Which information should the nurse provide about this vaccination?

A)"You also need a PPSV23 pneumonia vaccine."
B)"As long as your kidney function is good you do not need a second immunization."
C)"You will never need another pneumonia vaccination."
D)"You should plan to get a pneumonia vaccination every year after September."

Question 13

An older adult patient's testing reveals decreased absorption of calcium,which is a common age-related change.The nurse would consider which nursing problem when creating a care plan for this patient?

A)Swallowing may be impaired.
B)There is a higher risk of constipation.
C)The patient is more likely to be incontinent.
D)Activity intolerance is common.

Question 14

After being medicated for postoperative pain an older patient becomes agitated and combative.Since this behavior has not been previously demonstrated the nurse conducts additional assessment for which most likely condition?

A)Depression
B)Delirium
C)Drug toxicity
D)Dementia

Question 15

An older patient says,"I seem to get chest colds so often now." How should the nurse respond to this report?

A)"How often do you wash your hands?"
B)"Risk for colds and infections increases as we age."
C)"Do other people you are around have frequent colds?"
D)"Maybe you should consider taking antibiotics during the winter."

Question 16

Results of the CAM-ICU testing reveal that an older adult hospitalized in the intensive care unit has delirium.Which nursing interventions should be instituted?

A)Increase environmental stimuli in the patient's room.
B)Limit visiting hours.
C)Sedate the patient until ready for discharge from the intensive care unit.
D)Manage the patient's pain effectively.

Question 17

The nurse is admitting an older adult female who uses two canes for ambulation.The patient is attended by her daughter,who quietly reorients her mother several times during the assessment process.The daughter reports that her mother was a smoker for many years,but has not smoked for the last 5 years.The patient wears incontinence underwear and has problems with constipation.The nurse would evaluate which of these findings as key risk factors from the Hendrich II Fall Risk Model? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)The patient is female.
B)The patient has a history of using tobacco.
C)The patient wears incontinence underwear.
D)The patient requires frequent reorientation.
E)The patient uses a cane.

Question 18

The nurse has received emergency admission orders for an older adult patient who was severely injured in a fall.The nurse would question the use of which medication in this patient?

A)Digoxin 0.125 mg po daily
B)Diazepam 5 mg po every 6 hours prn agitation
C)Morphine sulfate 2 mg IV every hour prn severe pain
D)Furosemide 20 mg po daily

Question 19

The nurse suspects urinary tract infection in an older adult patient who has sudden onset of incontinence.Which symptoms,atypical in a younger adult,would the nurse assess for in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Confusion
B)Vomiting
C)Chills
D)Flank pain
E)Fever

Question 20

The daughter of an older adult calls the emergency department (ED)triage nurse and reports that her father hit his head "very hard" while getting into the car about 10 minutes ago.There is no bleeding.The daughter asks what she should watch for in her father.How should the nurse respond?

A)"As long as he does not develop a severe headache he is probably okay.Be sure to bring him to the ED if that happens."
B)"As long as your father does not begin vomiting he is probably not severely injured.If he does begin to vomit,bring him in immediately."
C)"Watch him for the next hour or two.If he seems okay after that he is not likely to have a severe injury.Bring him in to the ED if you are concerned."
D)"In older adults the changes are very subtle and can develop over several hours or even days.Bring him to the ED if you have any concerns."