Geriatric Nursing Final Practice Questions

Topics 5, 6, 7, 8, 9, 10, 11, 12, 13, 15 Chapters 11 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 29, 33

What are some recommended practices to promote gastrointestinal health, particularly for older adults? (p. 275)

• plenty of fluid intake

  • especially after increased fiber intake

• diet rich in fruits and vegetables

• regular exercise

• establish a regular time for bowel elimination

• useful for older adults to attempt a bowel movement after breakfast

What are some common causes of dysphagia? (p. 279)

• Gastroesophageal reflux disease (GERD)

• stroke

• structural disorders

What interventions can help manage dysphagia? (p. 279)

• follow the recommendations of speech-language therapist

• soft diet and thickening of liquids are recommended to promote ease of swallowing

• eat in an upright position and remain upright for 30 minutes after

• ingest small bites in an unhurried manner

• have easy access to suction in the event of choking

• monitor food intake and weight

What are some interventions to support patients with selected health conditions? (p. 282)

• comfort measures

• pain management

• promoting nutrition

  • good fluid intake

  • diet rich in fruits and vegetables

  • physical activity

  • establishment of a regular time for bowel elimination

• oral hygiene

  • infections of the oral cavity may lead to respiratory infections

• listening to and talking with the patient

What are the most common nutrient deficiencies observed in older adults, as mentioned in the context of nutritional needs for this age group? (p. 151)

• Niacin

• Riboflavin

• Thiamine

• Vitamin B6

• Vitamin C

• Vitamin D

What are some potential adverse effects or risks associated with the excessive intake of various vitamin supplements? (p. 151)

• Excessive Vitamin D can cause calcium deposits

• Excessive Vitamin K can cause bleeding and prevent blood clotting

• Folic acid can mask a vitamin B12 deficiency

• Excessive calcium increases the chance of kidney stones

• Excessive potassium may cause arrhythmias, cardiac arrest

How does calcium consumption affect kidney health? (p. 151)

Excess calcium consumption (i.e., more than 2,000 mg/d) can lead to problems such as kidney stones and an increased risk of cancer

NOTE: If calcium supplements are used, no more than 500 mg should be taken at any one time because larger amounts are not absorbed as well

What are some interventions for treating constipation? (p. 155)

• Adequate amounts of fluids, vegetables, and physical activity can improve constipation

• Senna is an effective natural laxative that can be consumed in tablet or tea form

• Laxatives should only be considered AFTER other measures have proved unsuccessful

How can the elderly improve sleep patterns at night? (p. 167)

• reduce or limit caffeine and alcohol consumption

• managing pain before bedtime

• regular activity during the day to promote rest and relaxation

• noise control

• exposure to sunlight during the day can facilitate sleep at night

• a warm bath at bedtime

• consuming foods high in carbs or protein snacks (e.g., warm milk)

What are some measures for managing stress effectively? (p. 168)

• Respond to stress in a healthy manner

  • good nutrition, rest, exercise, and sound health practices strengthen the body’s ability to confront stress

• Manage lifestyle

• Relax

• Pray

What are some health risks associated with stress? (p. 168)

unrelieved chronic stress can lead to heart disease, hypertension, cerebrovascular accident, ulcers, and other health disorders

What are the normal sleep patterns of the elderly? (p. 162)

older adults are more likely to fall asleep earlier in the evening and awaken earlier in the morning, a behavior referred to as phase advance

• sleep latency and reduction in REM sleep are prevalent

How can nurses promote restful sleep in older adults? (p. 165 - 166)

• Regular exercise, exposure to sunlight during the day, and non-caffeinated herbal teas at bedtime

• Environmental noise should be controlled

• A protein and carbohydrate snack at bedtime may encourage sleep

• Manage stress

• Valerian root or herbal tincture consumed 45 minutes before bedtime can also facilitate sleep

• Reduce blue light before bed

What are the four stages of sleep? (p. 163 - 164)

• Stage I → lightest sleep

  • heartbeat and breathing slows

  • slow, rolling eye movements

  • sudden jerks or muscle spasms

• Stage II → light sleep

  • slow eye movements stop

  • heartbeat slows even more

  • body temperature begins to drop

• Stage III → deep sleep

  • brain waves slow down even more

  • heartbeat and breathing at its lowest

• Stage IV → Rapid Eye Movement (REM) sleep

  • dreams and memories form

  • heart rate and blood pressure increases

  • eye movements speed up

What are some common changes in older adults during the sleep stages? (p. 163 - 164)

• Reductions in non–rapid eye movement stage sleep and rapid eye movement (REM) stage sleep begin to occur after midlife

• Older adults have a decline in the proportion of time spent in the deeper sleep stages III and IV

• Older people sleep less soundly

• Tend to shift in and out of sleep stage I to a greater degree than do younger adults

• Spend more time in sleep stages I and II

What are some common changes in sleep patterns associated with aging? (p. 165)

• Older adults are more likely to fall asleep earlier in the evening and awaken earlier in the morning.

• The quantity of sleep does not change, but the hours in which it occurs may. This change can prove frustrating for older adults who find themselves nodding off during evening activities and wide awake in the early morning hours when everyone else is asleep.

• In addition, daytime naps may be needed to compensate for reductions in nighttime sleep.

What are some environmental interventions to prevent falls? (p. 190, 193)

• lighting → a small light should always be on

• floor surface → should be clear of any towels, hair dryers, rugs, leaks, and other items

• faucets → color-code the faucet

• tubs and shower stalls → should have grab bars on the wall and safety rails on the side of the tub + a shower or bath seat

• toilets → should have grab bars or support frames

What interventions are suggested for individuals with visual deficits? (p. 197)

• approach individuals from the front rather than from the back or side

• furniture and frequently used items should be arranged in full view

What interventions are suggested for individuals with hearing deficits? (p.197)

• individuals should live close to someone with adequate hearing who can alert them when fire alarms or other warnings are sounded

• guide dogs

• during the night, place the earpieces of a stethoscope into the impaired person’s ears and speak into the bell or diaphragm

What interventions are suggested for individuals with sensory deficits (excluding visual and hearing deficits)? (p. 197)

• use gas stoves

• reduced tactile sensation to pressure from shoes, dentures, or unchanged positions can lead to skin breakdown, and the inability to differentiate between temperatures can cause burns

What are some contributing factors for a hip fracture? (p. 194)

• age-related health problems, weak or immobile state

• sensory deficits

• improperly fitted or used mobility aids

• unsafe use of medications

• unsafe environment

• altered mood or cognitive function

What interventions are suggested for individuals with a risk of hip fracture? (p. 194)

• assess risk of injury

• orient to new environments

• encourage patients to wear prescribed eyeglasses, hearing aids, and prosthetic devices

• ensure patients use canes, walkers, and wheelchairs properly

• advise patients to change positions slowly, holding on to a stable object as they do

• keep floors free from litter and clutter

• provide good lighting in all areas

• encourage patients to use handrails and grab bars

• be sure patients wear well-fitted, low-heeled shoes, and robes and pants of an appropriate length

• review home environment for safety risks

What observations can be noted during the assessment of gait abnormalities? (p. 323)

• abnormal gait patterns

  • ataxia

  • foot slapping

  • hemiplegic gait

  • Parkinsonian gait

  • scissors gait

  • spastic gait

• structural abnormalities

• limb dysfunction

• favoring one side

• presence of tremors

• paralysis

• weakness

• limb atrophy

• redness, swelling of a joint

• the use of assistive devices like canes, walkers, or wheelchairs

What is ataxia? (p. 323)

unsteady, uncoordinated, feet raised high while stepping and then dropped flat on floor

What is foot slapping? (p. 323)

wide-based, feet raised while stepping and then slapped down against floor, no staggering or weaving

What is a hemiplegic gait? (p. 323)

unilateral foot drop and foot dragging, leg circumducted, arm flexed and held close to side

What is a Parkinsonian gait? (p. 323)

trunk leans forward, slight flexion of hip and knees, no arm swing while stepping, short and shuffling steps, starts slowly and then increases in speed

What is a scissors gait? (p. 323)

slow, short steps, legs crossed while stepping

What is a spastic gait? (p. 323)

uncoordinated, jerking gait; legs stiff; toes drag

What interventions are recommended for individuals with low bone density or osteoporosis? (p. 328)

• Avoid heavy lifting, jumping, and other activities that could result in a fracture

• Persons providing care for these patients must remember to be gentle when moving, exercising, or lifting them because fractures can occur easily

• Compression fractures of the vertebrae are a potential complication of osteoporosis

• Range-of-motion exercises and ambulation are important to maintain function and prevent greater damage

• Increase vitamin D, vitamin C, protein, and calcium intake.

• Physical therapists may be able to suggest appropriate exercises to promote strength and function

What is onychomycosis, and how does it typically affect the appearance and condition of the nail? (p. 330)

a fungal infection of the nail or nail bed in which the toenail appears enlarged, thick, brittle, and flaky

• as the fungus forms under the nail and displaces it up, the sides of the nail are pushed into the skin and cause pain

• antifungal preparations assist in eliminating the infection, but these infections are challenging to treat

What are the rights of safe medication administration (p. 211)?

1. right medication

2. right patient

3. right dose

4. right route

5. right time and frequency

6. right education

7. right documentation

What precautions should be considered for safe medication administration in older adults? (p. 211)

To ensure that oral medications achieve full benefit, encourage good oral hygiene, ample fluids, and proper positioning to facilitate swallowing.

• older adults are at higher risk for adverse effects

• older adults are at risk for circulatory overload during intravenous drug therapy

What effects does furosemide have on the excretion of certain minerals? (Table 5-2 p. 206)

furosemide increases the excretion of calcium, magnesium, potassium, sodium, and zinc

How can aspirin impact the effects of oral anticoagulants? (p. 216 - 217)

Aspirin can increase the effects of oral anticoagulants

• ↑ bleeding

What should nurses monitor for patients taking anticoagulants? (p. 216 - 217)

• prothrombin time (PT) → evaluates ability to clot

• international normalization ratio (INR) → ensures that results from a PT test are the same

What should be considered when administering anticoagulants to maintain consistent blood levels? (p. 216 - 217)

Administer anticoagulants at the same time each day to maintain a constant blood level

What should nurses teach patients to observe when taking anticoagulants? (p. 216 - 217)

signs of bleeding

• blood in urine

• blood in stool

• severe bruising

• prolonged nosebleeds

How can diet affect the effectiveness of anticoagulants? (p. 216 - 217)

A large intake of vitamin K–rich foods can reduce the effectiveness of anticoagulants

• asparagus

• bacon

• beef liver

• cabbage

• fish

• cauliflower

• green leafy vegetables

What foods can increase INR? (p. 216 - 217)

• mango

• papaya

Which vitamin can increase risk of bleeding? (p. 216 - 217)

Vitamin E

Why should vitamin K be readily available for patients receiving anticoagulants? (p. 216 - 217)

Vitamin K acts as an antidote for excessive bleeding

What dietary recommendations are suggested for managing hypertension? (p. 267)

• Dietary Approaches to Stop Hypertension (DASH) diet

  • rich in n fruits, vegetables, whole grains, and low-fat dairy foods

• Heart-healthy diets include…

  • high intake of nuts, fish, as well as fiber-rich whole grains

  • less than 1,500 mg of sodium per day

  • fruits and green vegetables that are rich in essential nutrients, including antioxidants

• Low-sodium diet

What dietary approach is recommended for individuals with poor appetite? (p. 238)

small, frequent meals

What interventions are recommended to manage asthma? (p. 237)

• instruct the patient in breathing exercises

  • A. With one hand on the stomach (below the ribs) and the other over the middle anterior chest, the patient should inhale deeply to the count of one. The hand over the stomach should move outwardly as the diaphragm and stomach move downward; the hand over the chest should not move.

  • B. Expire air slowly to the count of three. The hand over the stomach should be pulled closer to the body as the diaphragm and stomach move upward; the hand over the chest should not move.

• control symptoms (e.g., pain) that could threaten effective respirations

• raise the head of bed at least 30 degrees

• instruct the patient to turn, cough, and deep breathe at least once every 2 hours

• monitor rate, depth, and rhythm of respirations

What position adjustment is recommended for patients experiencing shortness of breath while lying down? (p. 237)

raise the head of the bed at least 30 degrees

What potential conditions or factors are associated with different abnormal colors in urine? (p. 291)

• dark colors can indicate increased urine concentration

• red or rust color usually is associated with the presence of blood.

• yellow-brown or green-brown color can be caused by an obstructed bile duct or jaundice

• orange urine results from the presence of bile or the ingestion of phenazopyridine

• very dark brown urine is associated with hematuria or carcinoma

What might different odors in urine indicate? (p. 291)

• strong odor can indicate concentrated urine associated with dehydration

• ammonia-like odor can accompany infections

What are some reproductive system health concerns for females? (p. 303)

• vulvitis: itchy and inflamed vulva

• vaginitis

  • soreness

  • pruritus (itching)

  • burning

  • reddened vagina

  • foul-smelling vaginal discharge that is either clear, brown, or white

• breast cancer

  • incidence increases with age

  • older women are least likely to receive mammograms and breast examinations

• vaginal cancer

• cervical cancer

• endometrium cancer

• ovarian cancer

• perineal herniation

• dyspareunia: pain that occurs in the genital area before, during, or after sex

Which type of medication is known to potentially cause nocturia (frequent nighttime urination)? (p. 289)

long-acting diuretics (e.g., thiazides)

How can independence be promoted for patients with neurological conditions? (p. 344)

• encouraging the use of assistive devices

• periodic home visits by a nurse, regular contact with a family member or friend, and a daily call from a local telephone reassurance program can help the patient feel confident and protected

• continuing patience, reassurance, and encouragement are essential to maximize patients’ capacities for independence

What strategies can help compensate for visual deficits? (p. 353)

• face the person when speaking

• use several soft indirect lights instead of a single glaring one

• avoid glare from windows by using sheer curtains or stained windows

• use large print reading material

• place frequently used items within the visual field

• avoid the use of low-tone colors and attempt to use bright ones

• use contrasting colors on doorways and stairs and for changes in levels

• identify personal belongings and differentiate the room and wheelchair with a unique design rather than by letters or numbers

What potential risks or complications might occur following cataract surgery? (p. 353)

• a secondary membrane may form, requiring an additional procedure for discission of the membrane

• eye infection

• loss of vitreous humor

• slipping of the implant

What is age-related hearing loss, and what steps are advised for older adults experiencing this condition? (p. 358)

presbycusis: age-related hearing loss

• encourage audiometric examination

• physical, emotional, and social health can be seriously affected

What are some considerations for cosmetic surgery in older adults? (p. 385)

some older adults want to have a more youthful look

• nurses should also explore patients’ reasons for seeking cosmetic surgery to ensure that it is a rational decision rather than a symptom of an underlying problem, such as depression or a neurotic disorder

• counseling and therapy may be a more pressing need than surgical intervention in some circumstances

What advice is provided to assess changes in moles for potential signs of melanoma (skin cancer)? (p. 384)

think “ABCD”

• A - asymmetry

  • if one half of the mole is not like the other, it could be a sign of melanoma

• B - border irregularity

  • borders may be uneven, ragged, notched, or blurred

• C - color

  • a mole that has changed color over time or is varied in a shade of brown, tan, and black may be cancerous

  • if melanoma has progressed, the mole may become red, blue, or white

• D - diameter

  • cancerous moles may be more than 6 mm in diameter (or ¼ inch)

NOTE: Other mole variations that may indicate melanoma include elevation in height from the skin surface both horizontally or vertically; a change in feeling, such as itchiness, tenderness, or pain; and the tendency to bleed if scratched

What condition involving fixed flexion of the hands might individuals with diabetes mellitus be at risk for? (p. 367)

Dupuytren’s contracture

What are some signs of cancer indicated by the acronym "CAUTION”? (p. 400)

think “CAUTION”

• Change in bowel or bladder habits

• A sore throat that does not heal

• Unusual bleeding or drainage

• Thickening or lump in the breast or elsewhere

• Indigestion or swallowing difficulty

• Obvious change in a wart or mole

• Nagging persistent cough or hoarseness

What are the primary goals of palliative care? (p. 440)

Palliative care focuses on helping patients effectively live in harmony with, rather than cure, the condition.

• maintain or improve self-care capacity

• manage the disease effectively

• boost the body’s healing abilities

• prevent complications

• delay deterioration and decline

• achieve the highest possible quality of life

• die with comfort and dignity

Why might the incidence of cancer increase with age? (p. 396)

the increased incidence of cancer with age could result from age-related changes that reduce the ability to resist the disease or prolonged exposure to carcinogens

What is the most important action to keep hospitalized patient free of infection? (p. 497)

• good hand hygiene

• promoting good hydration and nutritional status

• monitoring vital signs, mental status, and general health status

• maintaining intact skin and mucous membrane

• avoiding immobility

• ensuring pneumococcal and influenza vaccines have been administered (unless contraindicated)

• maintaining a clean environment

• restricting contact with persons who have infections or suspected infections

• storing foods properly

• preventing injuries

• adhering to infection control practice