Pearson Custom For Older Adult Nursing Care By Nancy J.Brown And Linda-Test Bank
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Sample
Test
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. Stage
1, NREM
2. Stage
2, NREM
3. Stage
3, NREM
4. Stage
4, NREM
5. 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. Confining
client to a bedside chair or a wheelchair when the client is awake
2. Use
of a vest-type restraint when the client is up in a chair or in a wheelchair
3. Use
of hip protectors on the client when the client is up in the hallways
4. 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. Decreased
renal blood flow, decreased kidney size, and loss of nephrons
2. A
natural decrease in albumin and an increased amount of fat tissue
3. 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.
Brown Older Adult Nursing Care,
1/E
Chapter 4
Question 1
Type: MCSA
An older adult client in the final stages of terminal cancer
expresses to the nurse his gratitude for a “wonderful, fulfilling life.” The
client expresses pride in his four grown children and grandchildren. He states,
“I have really gotten to do almost everything I have ever wanted to do.” The
nurse is aware that this client is expressing attainment of which of the
developmental levels that Erikson and Maslow described in their theories?
1. Ego
Integrity; Self-Actualization
2. Generativity;
Self-Actualization
3. Ego
Integrity; Positive Reminiscence
4. High
Self-Esteem; Self-Satisfaction
Correct Answer: 1
Rationale 1: Correct. Ego Integrity is
the positive side of Erikson’s last developmental life stage, Ego Integrity vs.
Despair. Self-Actualization is the highest level of Maslow’s Hierarchy of
Needs.
Rationale 2: Generativity describes
Erikson’s middle adult developmental level, not his last.
Rationale 3: Positive Reminiscence
describes a method of increasing self-esteem in the older adult, not a stage in
Maslow’s hierarchy.
Rationale 4: High Self-Esteem and
Self-Satisfaction describe what occurs during this stage of Erikson’s
development, but these are not the correct terms used in Erikson’s and Maslow’s
theories.
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