Question 1

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 2

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

Accepted Answer

A common reason for homelessness in older adults is the lack of affordable housing. Assisted-living facilities provide both housing and health care assistance for older adults. Even with appropriate education, a homeless individual may not be able to maintain adequate foot and diabetes 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 lack of transportation or inability to keep track of dates or times.

Question 3

A confused and agitated 76-year-old patient with a broken arm is brought to the emergency department by a family member. To determine whether elder abuse is the cause of the patient's injury, the nurse should

Accepted Answer

The patient should be assessed for clinical manifestations of other injuries, such as bruising and pressure ulcers and these should be documented and photographed. In addition, 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 4

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 5

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 6

When assessing a 68-year-old Latina patient who has diabetes, which question will the nurse ask in determining the impact of ethnicity on the patient's health care choices?

Accepted Answer

This question encourages the patient to discuss any special ethnic beliefs about practices, medications, foods, etc., that might be used to maintain or improve health. The information about who cares for the patient does not address the patient's health care choices. Ethnicity does not have an impact on how the patient pays health care bills. The type of insulin used is not impacted by ethnicity.

Question 7

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 will include 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 8

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. The nurse will plan to

Accepted Answer

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. Because the average 70-year-old takes seven medications and the medications have been prescribed for the patient's health problems, discontinuing the medications is not appropriate. Home health care is not designed for the patient who needs ongoing assistance with activities of daily living (ADLs) or instrumental ADLs (IADLs).

Question 9

The home health nurse is developing a care plan for an alert and active 85-year-old patient who takes multiple medications for chronic cardiac and respiratory disease. The patient lives with family members who work during the day. An appropriate nursing diagnosis is

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. Because the patient is alert and active, the diagnoses in responses 1 and 4 are not appropriate for the patient or family. There is no indication that the family's employment schedule should be changed to accommodate the needs of this patient.

Question 10

While obtaining a health history from a 68-year-old patient, the nurse learns that the patient takes daily supplements of antioxidants beta carotene, selenium, and vitamin E. The nurse recognizes that the use of these substances in slowing the aging process is related to the biologic aging theory of

Accepted Answer

Research has focused on the use of antioxidants to slow the oxidative process caused by free radicals. Use of antioxidants is not proposed as a treatment for telomere-telomerase decreases, somatic mutation, or programmed cell death.

Question 11

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 the assisted-living situation. The other questions will also 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 12

A 42-year-old who is providing home care for a parent tells the nurse, "I don't feel comfortable giving Mom her medications yet, but I think I will be able to do it with a little more practice." Which nursing diagnosis is most appropriate?

Accepted Answer

The caregiver's statement indicates an interest in learning the new skill and confidence that it can be learned, consistent with the diagnosis of readiness of enhanced therapeutic management. There is no indication of caregiver role strain, anxiety related to lack of confidence, or low self-esteem.

Question 13

Ageism is an important concept for the nurse to understand because it

Accepted Answer

Negative attitudes about aging may lead to disparities in the way older patients are treated. The concept does not describe statistics about older individuals; consider the diversity of the older population, or increase the awareness of the needs of the older population.

Question 14

Which information about a 77-year-old patient who is being assessed by the 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. A pattern of taking frequent naps during the day to compensate for shorter nighttime sleep periods is normal in older adults. On average, a 70-year-old takes seven different medications; the use of five 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 15

To help prevent drug-drug interactions in an older adult patient taking many medications, the most appropriate instruction by the nurse is,

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 these interventions alone will not prevent drug-drug interactions between prescribed drugs, OTC drugs, and any herbal supplements. Use of a medication reminder system will help the patient take medications as scheduled but will not prevent drug-drug interactions.

Question 16

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 is unlikely to 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.

Question 17

The family of an 85-year-old with chronic health problems and increasing weakness is considering placing the patient in a long-term care facility. Which action by the nurse will be most helpful in assisting the patient to make the transition?

Accepted Answer

The stress of relocation is likely to be less when the patient has input into the choice of facility. The age of the long-term-care facility does not indicate a better fit for the patient or better quality of care. Although some patients may prefer a private room, others may adjust better when given a well-suited roommate. The patient should understand the reasons for the move but will make the best adjustment when involved with the choice to move and choice of facility.

Question 18

The home health nurse is making an 8:00 AM visit to a confused older patient who lives with a daughter. Which information most indicates a need for further action by the nurse?

Accepted Answer

A change in physical status may indicate an acute medical problem such as infection or elder abuse or neglect. Inability to remember caregiver names is not unusual in confused patients and simply indicates a need for reintroduction by the nurse. Because it is early in the day, the patient may take the medications later. The question about respite services does indicate a need for further action, but this would not be as urgent as the need to assess the patient for physiologic changes.

Question 19

An alert and well-oriented 78-year-old patient with multiple health problems rarely gets out of bed and 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 20

As the home health nurse is teaching a 72-year-old patient who lives alone about a new medication, the patient replies "I just don't learn new information like I used to." The nurse will plan to

Accepted Answer

The process of learning new information is slower in older adults, but there is no indication that the patient will be unable to learn about the new medications. Because the patient is living independently, there is no indication that medication administration needs to be done by the nurse or by family members. There are no data to indicate that self-management of medications by this patient is not safe.

Quiz 6: Older Adults