Geriatric Nursing Practice: Common Conditions and Interventions, Exams of Gerontology

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An older client is near the completion of a series of blood transfusions. The practical nurse (PN) identifies and reports to the nurse that the client has developed a rapid bounding pulse, elevated blood pressure, and swollen superficial veins. Which should the PN suspect is causing these findings? - CORRECT ANSWER -Volume overload.

Rationale

The addition of extra fluid volume during a transfusion may present certain risks for older clients with compromised cardiac function or renal status. Signs such as a rapid bounding pulse, hypertension, and swollen superficial veins should alert the nurse to the possibility of fluid volume overload.

An older client has developed sepsis and SIRS (systemic inflammatory response syndrome) as a result of an infected wound. Which scenario should the practical nurse (PN) recognize as correct to reinforce teaching to a family member on how SIRS affects the body initially? - CORRECT ANSWER -The endothelial lining of blood vessels becomes damaged causing leakage into tissues.

Rationale

SIRS (systemic inflammatory response syndrome) is the result of an injury causing an overwhelming inflammatory response that threatens vital organ changes. This response manifests in the blood vessels that result in damaged endothelium lining that causes leakage of fluid into the body's tissues. As blood flow to the bodies vital organs become compromised resulting in damage and multiple organ dysfunction syndrome (MODS).

The practical nurse (PN) is assisting the nurse who is performing an admission assessment of an older client who has been admitted for severe partial-thickness and full-thickness burns of the legs and buttocks. Which condition is the client at greatest risk developing initially? - CORRECT ANSWER - Hypovolemic shock.

Rationale

Hypovolemic shock produced by burns occurs most often in people with large partial-thickness or full- thickness burns. It is caused primarily by a shift of plasma from the vascular space into the interstitial space.

An older client is admitted with partial-thickness burn injuries, covering 50% of the client's body. Which adverse response to thermal burns is a nursing priority? - CORRECT ANSWER -Hypovolemia.

Rationale

The client with extensive burn injuries is at risk for hypovolemia, especially during the first 36 hours after the injuries have occurred. Insufficient fluid volume is directly related to increased capillary leakage and fluid shift from the intravascular space to the interstitial space after the burn insult.

Which factors are most important for the practical nurse (PN) to identify and report when performing a focused assessment on an older client with possible alcohol abuse? - CORRECT ANSWER -Depression.

Social isolation.

Loss of interest in hobbies.

Rationale

Alcoholism in the older client is often underreported and undertreated. The changes of aging and developmental may contribute to alcohol use. Older clients are often socially isolated, have sensory deficits, and depression which all contribute to substance use.

An older client reports to the practical nurse (PN) about having constipation. Which response should the PN use to clarify the client's report of constipation? - CORRECT ANSWER -"Describe the characteristics of your stools."

Rationale

Bowel elimination patterns can differ widely from person to person. To clarify symptoms of constipation, the nurse should determine if stools are hard, dry, and difficult to pass or if the client has to strain to defecate

Emotional and physical changes may cause anorexia, a loss in appetite. The first step is to assess for any changes in physical status that may have prompted the loss in appetite and refusal of solids food. Due to the refusal of solids should prompt the practical nurse (PN) to examine the client's oral cavity for any signs of ulcerations, possible yeast infection and check the fitting of the client's dentures if applicable. If no physical signs or symptoms are present, then the PN needs to report the findings of the nurse, so the client's emotional and psychological status can be further evaluated.

The practical nurse (PN) is providing care to a postoperative older client who has type 1 diabetes. Which scenario should the PN recognize as a risk factor for the development of diabetic ketoacidosis? - CORRECT ANSWER -Presence of infection.

Rationale

In an older client with type 1 diabetes, there is not enough insulin available to meet increased demands. The practical nurse (PN) should monitor this client for signs and symptoms of postoperative infection, which increases the body's metabolic rate and places the client at greater risk for diabetic ketoacidosis.

An 81-year-old resident in a long-term care facility begins to refuse food, particularly solids, and repeatedly yells, "Leave me alone!" The client has lost a total of 6 pounds over the past month. What is the best initial nursing intervention? - CORRECT ANSWER -Assess to identify changes in emotional or physical status.

Rationale

Emotional and physical changes may cause anorexia, a loss in appetite. The first step is to assess for any changes in physical status that may have prompted the loss in appetite and refusal of solids food. Due to the refusal of solids should prompt the practical nurse (PN) to examine the client's oral cavity for any signs of ulcerations, possible yeast infection and check the fitting of the client's dentures if applicable. If no physical signs or symptoms are present, then the PN needs to report the findings of the nurse, so the client's emotional and psychological status can be further evaluated.

The heathcare provider prescribed enteral feedings for an older client with severe sepsis and multi- organ failure. What is the main purpose of this prescription? - CORRECT ANSWER -To reduce bacterial systemic movement through intestinal wall and improve gastrointestinal perfusion.

Rationale

Clients diagnosed with severe sepsis and multi-organ failure will require nutritional support due to being in a hypermetabolic state and are at an increased risk of becoming protein-calorie malnourished. Enteral feedings are usually prescribed early to ensure the clients are receiving adequate amount of calories. The use of enteral feedings helps to improve the gastrointestinal tract perfusion and minimize the absorption of bacteria into the circulatory system movement through the intestinal walls by actively stimulating and increasing peristalsis

An older client has been diagnosed with pernicious anemia. The practical nurse (PN) should anticipate the healthcare provider to prescribe which therapy? - CORRECT ANSWER -Monthly cobalamin (vitamin B12) injections.

Rationale

Pernicious anemia is a type of vitamin B12 deficiency anemia caused by a lack of intrinsic factor, a substance normally secreted by the gastric mucosa that is needed for absorption of vitamin B12. This condition is generally diagnosed around the age of 60 years old. Clients with pernicious anemia are given vitamin B12 injections weekly at first, and then monthly thereafter.

The practical nurse (PN) is reinforcing teaching of medication information with an older client who was prescribed famotidine (Pepcid) for dyspepsia. Which information should the PN include regarding the effects of this medication? - CORRECT ANSWER -Decreases secretions in the stomach.

Rationale

Famotidine (Pepcid) inhibits histamine at H2-receptor sites in the stomach, which inhibits gastric acid production. Although these drugs do not affect the occurrence of dyspepsia directly, they do reduce gastric acid secretion, improve symptoms, and promote healing of inflamed esophageal tissue.

The practical nurse (PN) is reinforcing teaching about hand hygiene to an older client who is immunocompromised. The PN should recognize which statement by the client indicates a correct understanding of hand hygiene? - CORRECT ANSWER -"I should lather my hands and scrub for at least 20 seconds before rinsing."

a self-care measure in the grooming domain. When it becomes evident that an older client is losing the ability to perform ADLs, the client will need assistance.

A widowed older male client who resides alone and has just recently had his driving license revoked, joked he was going to have to hire a chauffeur, when questioned by the practical nurse (PN) about how he was going to handle his transportation needs. Which type of grief should the PN identify the client is demonstrating? - CORRECT ANSWER -Disenfranchised grief.

Rationale

By laughing and joking about a loss, the older client is demonstrating disenfranchised grief. The client may feel that he is not allowed to grieve publicly or be upset about losing his license. Loss of the ability to drive is general harder on older male clients than female clients. The loss of the driver's license to an individual can mean a sense of loss independence and self-worth.

The practical nurse (PN) is reviewing data of an older client's results of a timed test. Although the client has no history of cognitive impairment, the timed test scores for this client are found to be low. The PN is correct to attribute the low scores to which factor? - CORRECT ANSWER -Slower response times.

Rationale

Although the aging process leaves the parameters of mental status mostly intact, response times become slower with advanced age. As a result, performance on timed intelligence tests may be lower for the aging person because it takes longer to respond to the questions, not because intelligence has declined.

The practical nurse (PN) is providing care to a 90-year-old client who lives independently at home. The client reports a decreased sense of taste and smell. The PN should reinforcement which safety recommendations to the client? - CORRECT ANSWER -Ensure the home has working carbon monoxide and smoke detectors.

Rationale

Injury and death caused from fire and carbon monoxide can be avoided with the use of smoke and carbon monoxide detectors. Reduced senses of smell and taste are common age-related changes in older adults and do not necessarily imply illness or disease.

The practical nurse (PN) is assisting an emergency department nurse who is attempting to obtain a health history from an unaccompanied older client who appears to be agitated and upset. Which is the best nursing action to take first? - CORRECT ANSWER -Addressing the client's agitation before continuing with the interview.

Rationale

The depth of information gathered during a health history interview may be compromised if the client is agitated and upset, so investigating the reason for the agitation should be a priority. Finding out the reason why the client is agitated and upset will help improve the quality of information gathered from the interview.

The practical nurse (PN) is assisting the nurse with an eighty-four year-old client with a history of atrial fibrillation who has been admitted with a suspected pulmonary embolism. Which intervention should the PN anticipate to be implemented first? - CORRECT ANSWER -Rationale

A client with suspected pulmonary embolism is at risk of hypoxemia. The first intervention to be implemented should be to administer oxygen.

An older client with chronic obstructive pulmonary disease (COPD) is scheduled for a pulmonary function test. The practical nurse (PN) explains that during the test, the respiratory therapist will ask the client to inspire maximally and then exhale completely into a spirometer. This maneuver measures which pulmonary function? - CORRECT ANSWER -Forced vital capacity.

Rationale

Forced vital capacity is the amount of air that can be forcefully expelled after the lungs are maximally inflated. The amount of air expelled is lower in patients with obstructive pulmonary disease because airways are narrowed.

The practical nurse (PN) should monitor for which clinical indicator when providing care to an older client with cholelithiasis and obstructive jaundice? - CORRECT ANSWER -Dark urine.

Rationale

An older client with cholelithiasis and obstructive jaundice may have increased bile levels in the bloodstream. When bile levels in the bloodstream are high, as in obstructive jaundice, urine appears dark due to bile in the urine.

An older man is brought to the emergency department by ambulance with fever and abdominal pain. He had a colon resection 1 week prior due to colon cancer, and his spouse states that he seems "slower," and that he experiences dizziness upon standing. The client had an IV placed prior to arrival, and the healthcare provider suspects sepsis. Which intervention is the priority? - CORRECT ANSWER -Give a rapid crystalloid fluid bolus as prescribed.

Rationale

In clients with suspected sepsis, the primary concern is to maintain circulation. The preparation to administer crystalloid fluid boluses should be done as prescribed.

A seventy-five-year-old client is being discharged after implantation of a permanent pacemaker. The practical nurse (PN) should reinforce teaching to the client to avoid which item? - CORRECT ANSWER - Security wand.

Rationale

Hand held security wands may interfere with a pacemaker. Clients should show their wallet card to inform security that a pacemaker is present and ask to be hand searched.

An older client has recently begun a new prescription for hypertension. The client has developed a nagging dry cough. The practical nurse (PN) identifies that this respiratory symptom is related to which factor? - CORRECT ANSWER -Using an ACE inhibitor.

Rationale

Angiotensin-converting enzyme (ACE) inhibitor is a class of drugs used to treat hypertension. This medication is associated with a dry, persistent cough in 5%-35% of patients. ACE inhibitors prevent the breakdown of bradykinin and substance P, resulting in an accumulation of these protussive mediators in the respiratory tract, which leads to coughing.

An older client is scheduled for a cardiac catheterization and is taking metformin (Glucophage) for their diabetes. Which prescription from the healthcare provider should the practical nurse (PN) anticipate in regards to this medication prior to the cardiac catheterization? - CORRECT ANSWER -Withhold the medication.

Rationale

Metformin (Glucophage) is an oral medication that is commonly used to control blood glucose levels. Due to an increased risk of lactic acidosis, the practical nurse (PN) should verify that the heathcare provider has requested to withhold metformin prior to any procedure requiring intravascular iodinated contrast.

The practical nurse (PN) is reviewing the electrocardiogram of an older client. The rhythm strip indicates a PR interval of 0.16 seconds. Which is the most accurate interpretation? - CORRECT ANSWER -Normal cardiac rhythm.

Rationale

The PR interval represents the time it takes for the myocardial impulse to spread from the sinoatrial node through the atria to atrioventricular node and throughout the Bundle of His in the ventricles. The PR interval range is 0.12 to 0.2 seconds. Therefore, the practical nurse (PN) should interpret a 0.16- second interval as normal. It is important to monitor ECG measurements of older clients, studies have shown a correlation to prolonged PR intervals and clients at risk for heart failure and atrial fibrillation.

The practical nurse (PN) is caring for an older client who takes warfarin (Coumadin) for atrial fibrillation. Which foods should the PN remind the client to avoid? - CORRECT ANSWER -Leafy green vegetables.

Rationale

Family members who provide care for an older relative may struggle with balancing their own personal and financial responsibilities. Their intentions may be good, but an older client may still experience profound, unintentional neglect. Although unintentional neglect is usually not viewed as a crime, it is still reportable to adult protective service agencies.

The practical nurse (PN) is reviewing data of an older client's results of a timed test. Although the client has no history of cognitive impairment, the timed test scores for this client are found to be low. The PN is correct to attribute the low scores to which factor? - CORRECT ANSWER -Slower response times.

Rationale

Although the aging process leaves the parameters of mental status mostly intact, response times become slower with advanced age. As a result, performance on timed intelligence tests may be lower for the aging person because it takes longer to respond to the questions, not because intelligence has declined.

An older client may have been exposed to tuberculosis. The practical nurse (PN) should implement which type of preventive care? - CORRECT ANSWER -Secondary.

Rationale

Secondary preventive measures include the identification, reporting to healthcare authorities and provision of the treatment of asymptomatic persons who already have certain risk factors or in whom the condition is not yet clinically apparent. Screening tests such as the Mantoux (PPD) tuberculin skin test is example of secondary preventive measures.

The practical nurse (PN) is providing care to a 78-year-old client with leukopenia due to recent treatment for leukemia. The unlicensed assistant personnel (UAP) reported an oral temperature of 98.1°F (36.7° C) several hours earlier, but the client's temperature is now 99.1°F (37.3° C). Which action should the PN take first? - CORRECT ANSWER -Report this finding to the charge nurse.

Rationale

A temperature elevation of even 1° F (0.5° C) above baseline is significant for a patient with leukopenia and indicates infection until it has been unproven otherwise. The nurse should report this finding immediately to the health care provider.

An older client reports to the practical nurse (PN) that she "leaks a little bit of urine" whenever she lifts a heavy object, laughs, or coughs. What type of urinary incontinence best describes this client's symptoms? - CORRECT ANSWER -Stress.

Rationale

Stress incontinence is leakage of urine during circumstances such as exercise, lifting heavy objects, laughing, coughing, or sneezing. This problem is most commonly observed in women who have had multiple vaginal deliveries. The amount of urine lost is generally small.

The practical nurse (PN) is reviewing the electrocardiogram of an older client. The rhythm strip indicates a PR interval of 0.16 seconds. Which is the most accurate interpretation? - CORRECT ANSWER -Normal cardiac rhythm.

Rationale

The PR interval represents the time it takes for the myocardial impulse to spread from the sinoatrial node through the atria to atrioventricular node and throughout the Bundle of His in the ventricles. The PR interval range is 0.12 to 0.2 seconds. Therefore, the practical nurse (PN) should interpret a 0.16- second interval as normal. It is important to monitor ECG measurements of older clients, studies have shown a correlation to prolonged PR intervals and clients at risk for heart failure and atrial fibrillation.

The practical nurse (PN) is providing care to an older client who was diagnosed with temporal arteritis after a recent biopsy of the scalp. Which complication of the temporal arteritis should the PN identify as a medical emergency that requires immediate attention? - CORRECT ANSWER -Sudden changes in vision.

Rationale

Temporal arteritis (also known as giant cell arteritis) is an inflammatory condition that primarily affects the arteries of the scalp in the temporal area, although medium to large vessels may be involved as well.

Heat stroke is a medical emergency. Heat stroke commonly occurs during prolonged episodes of elevated temperatures. Heat stroke is usually a complication from another heat related injury such as heat exhaustion and heat cramps. An individual suffering from heat stroke may have core body temperature rise greater than 104° F (40° C) which in turn can cause complications to the central nervous system. Older individuals are more prone to heat stroke than younger individuals.

An older client reports to the practical nurse (PN) about having constipation. Which response should the PN use to clarify the client's report of constipation? - CORRECT ANSWER -Describe the characteristics of your stools."

Rationale

Bowel elimination patterns can differ widely from person to person. To clarify symptoms of constipation, the nurse should determine if stools are hard, dry, and difficult to pass or if the client has to strain to defecate.

The home health practical nurse (PN) is visiting an older client who has trouble ambulating without assistance. The client's cognition is intact. The client often has urine incontinence despite having normal urethra and bladder function and no evidence of infection. What is likely contributing to the functional urinary incontinence in this client? - CORRECT ANSWER -Difficulty accessing a toilet.

Rationale

Difficulty accessing a toilet due to physical limitation can lead to functional urinary incontinence. Functional urinary incontinence is likely to occur when toilets are difficult to access because of their location, when there are not enough caregivers to provide needed assistance, or when physical restraints prevent free movement. The home health practical nurse (PN) should contact the healthcare provider for a prescription for a bedside commode.

An older client has recently begun a new prescription for hypertension. The client has developed a nagging dry cough. The practical nurse (PN) identifies that this respiratory symptom is related to which factor? - CORRECT ANSWER -Using an ACE inhibitor.

Rationale

Angiotensin-converting enzyme (ACE) inhibitor is a class of drugs used to treat hypertension. This medication is associated with a dry, persistent cough in 5%-35% of patients. ACE inhibitors prevent the breakdown of bradykinin and substance P, resulting in an accumulation of these protussive mediators in the respiratory tract, which leads to coughing.

The practical nurse (PN) is reinforcing teaching of instructions with an older client. Which response from the client indicates an understanding of what poses the greatest fall hazard in their home? - CORRECT ANSWER -"I will have my son install grab bars in the shower."

Rationale

A client who understands the importance of installing grab bars to reduce the risk of falls in the tub or shower has correctly identified the greatest threat for fall injuries in the home. The bathrooms in homes poses the greatest risk for fall occurrences and injuries. Up to 80% of falls occur in the bathroom.

The practical nurse (PN) is providing care to an older client who just had a radical left mastectomy to treat breast cancer. Which is the best position for the client's left arm in order to avoid the post- operative complication of edema? - CORRECT ANSWER -On pillows with the arm lower than the level of the heart.

Rationale

Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. The client should have the head of the bed elevated at least 30 degrees, with the affected arm elevated on a pillow.

The practical nurse (PN) is perfomring a focused assessment and is having difficulty locating the pedal pulses of an older client diagnosed with peripheral artery disease. Which action should the PN perform to help locate the client's pulse? - CORRECT ANSWER -Use a Doppler device to locate the pulse.

Rationale

Cardiovascular changes in the aging population often result in a decrease or complete loss of palpable pulses in the lower extremities. If the pedal pulses are not detectable, the examiner may proceed

An older client reports of sudden severe pain in the right great toe that started in the middle of the night during sleep. The joint is bright purple-red, hot, and painful to touch. The practical nurse (PN) should recognize these are classic signs and symptoms of which condition? - CORRECT ANSWER -Gout.

Rationale

Gout typically starts with an acute attack. The person often reports of sudden and severe pain in the affected joint, typically starting in the middle of the night during sleep. The joint is often bright purple- red, hot, and painful to touch.

An older male client with arthritis increased his dose of ibuprofen (Advil) to manage his joint pain. After several weeks, the client becomes increasingly weak and is admitted to the hospital for severe anemia. Which clinical indicator should the practical nurse (PN) expect to identify when collecting a stool sample? - CORRECT ANSWER -Melena.

Rationale

Ibuprofen irritates the gastrointestinal mucosa and can cause mucosal erosion, resulting in bleeding. Melena (blood in the stool) occurs as the digestive process acts on the blood in the GI tract.

The practical nurse (PN) obtains information from an older client to determine their fall risk. Which is the best predictor of an older adult falling? - CORRECT ANSWER -History of falls.

Rationale

Two-thirds of those who have experienced one fall will fall again within six months. A history of previous falls is the best predictor of future falls.

An older client with osteoarthritis reports increased pain and stiffness in the right knee due to an arthritis exacerbation. Which should the practical nurse (PN) do to support the plan of care to prevent deformities of the knee in this client? - CORRECT ANSWER -Recommend exercises for joint mobility.

Rationale

Exercise of the involved joint(s) is important to maintain optimal mobility and prevent buildup of calcium deposits. Immobilization causes contractures and loss of joint mobility. Exercising will actually help minimize the stiffness and pain in joints. The exercise will help strengthen the surrounding muscles which in turn will help stabilize the arthritic joints. Weight lifting for muscle strengthening and range of motion exercises are beneficial for arthritic joints.

An older client with herpes zoster (shingles) is expecting a visit from their family and is concerned about transmitting the infection to their grandchildren. The practical nurse (PN) should reinforce teaching by providing which response? - CORRECT ANSWER -"Contact with the active lesions can spread the varicella-zoster virus."

Rationale

During an acute attack of herpes zoster, the chickenpox (varicella-zoster) virus is shed. Clients can transmit this infection to susceptible persons through direct contact with active lesions.

The practical nurse (PN) is providing care to a 78-year-old client with leukopenia due to recent treatment for leukemia. The unlicensed assistant personnel (UAP) reported an oral temperature of 98.1°F (36.7° C) several hours earlier, but the client's temperature is now 99.1°F (37.3° C). Which action should the PN take first? - CORRECT ANSWER -Report this finding to the charge nurse.

Rationale

A temperature elevation of even 1° F (0.5° C) above baseline is significant for a patient with leukopenia and indicates infection until it has been unproven otherwise. The nurse should report this finding immediately to the health care provider.

The home health practical nurse (PN) is visiting an older client plans to use a mini-mental health exam during a focused assessment. The PN notices that the client appears to be confused and slow to respond during a conversation. Which action should the PN perform next? - CORRECT ANSWER -Assess the client's sensory status prior to any testing.

Rationale