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Final review questions for geri
Pharmacology (NUR 3145)
Santa Fe College
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The nurse assesses a patient using the Braden scale. The patient scores a 13. What action is most important to add to the patient’s care plan? a. Encourage high-protein meals and snacks b. Turn the patient every to 2 hours c. Assess the patient’s skin daily d. Monitor patient’s prealbumin weekly ANS: B A Braden scale score of 13 indicates high risk for developing a pressure ulcer. The most important intervention is to turn the patient frequently. Good nutrition is important for wound healing and prevention, but a high-protein snack and monitoring prealbumin do not immediately impact the patient’s skin condition. Assessing the skin will not prevent an ulcer. A patient has a purulent, foul-smelling leg wound. What wound care practice is most appropriate? a. Leave the wound open to the air. b. Administer systemic antibiotics. c. Cleanse the wound with diluted povidone iodine. d. Prepare the patient for operative débridement. ANS: C Antiseptics are not used on healthy granulating tissue. Povidone iodine must be diluted and only used short term. A moist environment is needed for healing; leaving the wound open to air will cause too much drying. The patient may eventually need operative débridement. Systemic antibiotics may or may not be needed.
A patient has a wound that is a shallow crater with surrounding erythema and warmth. What stage pressure ulcer does the nurse chart? a. Stage I b. Stage II c. Stage III d. Stage IV
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ANS: B Stage II is a partial thickness ulcer that looks like an abrasion, blister, or shallow crater. A stage I pressure ulcer is redness or mottled skin that does not blanch. Stage III ulcers are full thickness deep craters. Stage IV ulcers may extend into the fascia and may be necrotic. An older adult patient has an open, draining wound on the lower medial aspect of the right leg. The skin surrounding the wound is reddish brown with surrounding erythema and edema. Based on this information, the nurse edits the patient’s care plan to include impaired skin integrity: a. related to altered venous circulation. b. peripheral related to arterial insufficiency. c. related to diabetic neuropathy. d. open wound related to pressure ulcer. ANS: A Venous ulcers are usually on the medial aspect of the lower leg, with flat or shallow craters and irregular borders, accompanied by varicosities, liposclerosis (brown ruddy color and thickened skin), and itching. Venous ulcers generate a large amount of exudate and are usually surrounded by erythema and edema. Arterial insufficiency would produce shiny, taut, hairless skin. There is no indication the patient is a diabetic. There is no indication the patient has risks for pressure ulcers A patient in a nursing home is confused, nonverbal, but pleasant. The nurse notes the patient has suddenly become agitated and is screaming and scratching at the eyes. While the nurse is examining the patient, the patient vomits. What action by the nurse is best? a. Consult the provider about an ophthalmologic exam. b. Sedate the patient so she won’t injure herself. c. Place mitts on the patient’s hands to avoid scratches. d. Give the patient a prn medication for pain. ANS: A The patient could be having an episode of acute angle closure glaucoma, manifested by severe pain, nausea and vomiting, and visual disturbances. Because the patient is nonverbal, the nurse must assess for pain with behavioral changes. The nurse should contact the provider about obtaining an ophthalmologic exam to determine if the patient has glaucoma. The other
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a. the purified protein derivative (PPD) test will be administered. b. a chest x-ray will be ordered to detect possible infiltration. c. therapy consisting of a combination of bactericidal drugs will be initiated. d. the skin test will be repeated to achieve a booster effect. ANS: D Tuberculin skin testing in older patients is an unreliable indicator of TB because they are more likely to have false-negative results because of reduced immune system activity. If skin testing is used, it is recommended that the standard 5 tuberculin unit (TU) Mantoux test be given and then repeated to create a booster effect. The PPD is not recommended. The skin test is followed up with a chest x-ray. Drug therapy should not begin until the patient has a diagnosis. An older adult patient who has tuberculosis is being treated with the drugs isoniazid 300 mg daily, rifampin 600 mg daily, and pyrazinamide 1500 mg daily. The nurse stresses the importance that the patient: a. wear tinted glasses when out in the sun. b. minimize contact with children younger than 3 years old. c. avoid alcohol while on the drug therapy. d. eat and drink dairy sparingly. ANS: C The nurse is caring for a confused patient. Which action by the nurse shows the best understanding of managing the cascading effects of iatrogenic illnesses in this population cohort? a. Reorienting the patient to person, place, and time frequently b. Offering the patient liquids each time there is patient-nurse contact c. Repositioning the patient every 2 hours d. Using restraints to ensure patient safety only as a last resort ANS: D An older patient has fallen twice in the hospital in the last 2 days. What action by the nurse is best? a. Request restraint orders from the provider. b. Assess the patient for undiagnosed illness. c. Remind the patient to call for help getting up.
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d. Have a family member stay with the patient. ANS: B The nurse is admitting an older patient with benign prostate hyperplasia (BPH). The nurse’s priority questioning focuses on: a. family history of prostate disorders. b. onset of symptoms. c. psychosocial impact of the diagnosis. d. typical urinary voiding patterns. ANS: D A male patient has benign prostatic enlargement. He is at risk for what type of acute kidney injury? a. Prerenal b. Intrarenal c. Postrenal d. Combined form ANS: C A male patient reports difficulty starting a urine stream and a weak urine flow. When prompted to seek medical attention, the patient asks why, as it’s “obviously” benign prostatic hypertrophy. What response by the nurse is best? a. “You never know; it could be cancer.” b. “You should have any change checked out.” c. “Only the physician can make a diagnosis,” d. “BPH and prostate cancer have similar symptoms.” ANS: D When preparing educational information regarding benign prostatic hyperplasia (BPH) for a group of older male patients, the nurse includes which of the following? (Select all that apply.) a. Eighty percent of males experience the symptoms by age 80. b. Diabetes mellitus is a risk factor. c. It is only as the prostate enlarges that symptoms occur.
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b. educates the patient about the appropriate management of constipation. c. assures the patient that dizziness will decrease as therapeutic levels are reached. d. suggests the patient take the medication with meals or a snack. ANS: B A patient has constipation as a side effect of opioid analgesics. What menu choice indicates the patient understands nutritional therapy for this problem? a. Scrambled eggs b. White bread c. Canned fruit d. Oatmeal ANS: D An older patient is hospitalized for the first time. After giving a dose of hydromorphone (Dilaudid), what assessment takes priority? a. Pain level b. Nausea c. Urinary retention d. Respiratory rate ANS: D A nurse aide working in the geriatric unit’s dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why she’s “here.” The nurse appropriately directs the nurse aide to: a. take the patient back to her room and put her safely in bed. b. place a falls risk identification bracelet on the patient and add the status care plan. c. immediately take the patient’s vital signs and report them to her. d. reorient the patient to time and place frequently and document the patient’s response. ANS: C An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patient’s daughter questions the possibility of pneumonia stating, “He isn’t coughing or having any difficulty breathing.” The nurse responds most appropriately by saying:
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a. “We are lucky to determine the problem in its early stage.” b. “Respiratory problems develop only after the infection is well established.” c. “People your dad’s age often lack the muscular strength to cough.” d. “Older adults frequently lack the typical signs of a respiratory infection.” ANS: D When caring for older adults, the nurse expects to encounter the normal urinary age-related outcome of: a. urinary incontinence. b. low-grade bladder infection. c. nocturia. d. urinary residual volume. ANS: C An 87-year-old patient has suddenly become incontinent. What should the nurse’s first action be? a. Review the patient’s record for medications that may be causing urinary incontinence. b. Seek an order for an indwelling urinary catheter to prevent skin breakdown. c. Limit the patient’s fluid intake to reduce the feeling of having to void so often. d. Teach the patient to void every 2 hours when awake during the day or night. ANS: A When assessing the patient for urinary incontinence, which patient symptom best supports the nursing diagnosis of overflow incontinence? a. “I have small accidents ever since I developed a cystocele.” b. “It burns so badly after I urinate that I hold it as long as I can.” c. “I can’t make it to the toilet when I feel the need to urinate.” d. “I lose small amounts of urine when I sneeze or laugh hard.” ANS: A An older cognitively impaired adult patient is being discharged to a daughter’s home. The nurse knows continued success of the patient’s bladder training for urinary incontinence primarily rests on the:
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d. It can disrupt sleep. e. It can lead to urinary tract infections. ANS: B, C, D, E The nurse has administered the Apgar screen tool to assess an older patient’s family function status. Upon determining that the family functions at a 4, the nurse: a. prepares to administer a more detailed tool. b. prepares to report reasonable suspicion of elder abuse. c. asks the patient to identify specific family members to include in care planning sessions. d. notifies social services that the family is not likely to be of much support to the patient. ANS: D A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patient’s claim that she has been physically abused. The nurse manager responds most appropriately when stating: a. “I’ll show you where you can find this state’s reporting requirements.” b. “As a nurse you are considered a ‘mandated reporter’ of elder abuse.” c. “As long as you are reasonably sure abuse has occurred, report it.” d. “You need to report any such claims directly to me.” ANS: A The nurse recognizes that a nursing aide likely to abuse an older patient is one who has: a. ineffective verbal communication skills. b. little experience working with the older population. c. poor stress management skills. d. been a victim of abuse. ANS: C An alert but disoriented older patient lives with family members. The home health nurse, being aware of the role of patient advocate, recognizes the obligation to report possible patient abuse based on:
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a. a family member stating, “It’s hard being a caregiver.” b. assessment showing bruises in the genital area. c. observation of mild changes in orientation. d. patient’s report of always being hungry. ANS: B An older patient with presbycusis has been advised to purchase a hearing aid and asks about its function and use. Which information is most accurate to give the patient about the function of hearing aids? a. Hearing aids amplify sound but do not improve the ability to hear. b. Hearing aids improve the ability to hear by intensifying the duration of sound waves. c. Hearing aids control the input of sound waves to eliminate extraneous noise. d. Hearing aids intensify sound waves and improve the ability to hear. ANS: A The preferred way for the nurse to communicate with a 72-year-old hearing-impaired patient is to: a. speak loudly into the patient’s unaffected ear. b. exaggerate the form of each word. c. provide all communication in written form. d. speak clearly and directly, facing the person. ANS: D The nurse documents that a newly widowed older adult patient is likely experiencing physical grief responses when she: a. becomes hypotensive. b. has difficulty getting up from the chair. c. reports having tightness in the chest. d. develops a red rash over her upper chest and back. ANS: C
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The presence of which skin assessment finding, if noted on an older adult patient, should cause the nurse to suspect a premalignancy? a. Numerous small red papules on the chest and back b. An oozing, rough, reddish macule on the ear c. An irregularly shaped mole on the face or shoulders d. Brown, greasy lesions on the neck ANS: B When assessing for squamous cell cancer (SCC), a home health nurse is particularly concerned about a suspicious lesion on the: a. leg of a 60-year-old Asian female. b. neck of a 73-year-old Hispanic female. c. Lower lip of a 70-year-old African American male. d. back of a 90-year-old Caucasian male. ANS: C An older patient has been treated for a small basal cell carcinoma on the face. What assessment finding indicates to the nurse that the goals for a priority diagnosis have been met? a. The patient verbalizes relief there is no metastasis. b. Wound edges are approximated without redness. c. The patient expresses satisfaction with the cosmetic outcome. d. The patient relates the need for proper sun protection. ANS: B An older patient who reports being “healthy enough to cut my own fire wood” is being assessed prior to outpatient surgery. The nurse recognizes which assessment observation as a possible result of the wear-and-tear theory? a. Swollen finger joints b. Red, watery eyes c. Grimacing when raising left arm
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d. Bilaterally bruising on the forearms ANS: C Which theory of aging does the student learn is related to problems with DNA transcription? a. Radical theory b. Error theory c. Cross linkage theory d. Wear-and-tear theory ANS: B A nurse is trying to teach a hospitalized older patient how to self-inject insulin. The patient is restless and does not seem to be paying attention. What action by the nurse is best? a. Ask if the patient needs to use the bathroom. b. Tell the patient you’ll try again later in the day. c. Ask if the patient prefers that you teach the family. d. Refer the patient for home health care services. ANS: A According to Maslow, a fully actualized person displays which traits? (Select all that apply.) a. Spontaneity b. Self-direction c. Creativity d. Ethical conduct e. Acceptance of self ANS: A, B, C, E The nurse on a medical acute care unit is preparing for the admission of an 84-year-old patient with several diagnosed chronic illnesses. The nurse begins the plan of care for this patient based on the understanding that the older adult is likely to:
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An older patient has been admitted to the nursing unit after a car crash and surgery. When does the nurse begin planning for rehabilitation? a. On admission b. When the patient is awake c. When the patient is stable d. When the family requests it ANS: A A nurse assesses a newly admitted patient to a nursing home using the Functional Independence Measure (FIM) and rates the patient at 20. What action by the nurse is best? a. Arrange admission to a rehabilitation center. b. Plan care for a nearly dependent person. c. Plan care for a nearly independent person. d. Tells the family the patient is cognitively impaired. ANS: B An older patient is being admitted to a long-term care facility. The nurse recognizes that the primary purpose of the initial geriatric health assessment is to: a. identify the patient’s physiologic baselines. b. ultimately create a plan of care that prevents disability and dependence. c. initiate the therapeutic nurse-patient relationship. d. document self-care deficiencies that the patient exhibits. ANS: B The nurse admitting a debilitated patient to a long-term care facility initially assesses the patient using the Katz Index. The student asks why the nurse chose that tool. What answer by the nurse is best? a. It is quick and simple for a baseline. b. The Katz Index is mandated by Medicare. c. It is comprehensive in nature.
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d. It shows functioning in 12 areas. ANS: A The Katz Index takes only about 5 minutes to complete and rates patients as to whether they are totally independent or dependent in six basic functions
The staff members in a long-term care facility have noted a decline in cognitive function in one of the residents; however, each time the resident is given the Short Portable Mental Status Questionnaire (SPMSQ), the score does not change. What action by the nursing manager is best? a. Provide in-service education on using this tool. b. Conduct the assessment him- or herself c. Switch to a different screening tool d. Determine that no changes have occurred. ANS: C A nurse is conducting an admission interview with an older patient admitted to a long-term care facility. When the nurse asks about the patient’s former occupation, the patient states, “What do you care? I am long retired!” What response by the nurse is best? a. “Your job may have exposed you to some health hazards.” b. “It helps me get to know you and your background better.” c. “We have several clubs here you might be interested in.” d. “No real reason, it’s just part of our admission interview.” ANS: A A 69-year-old patient who has both Medicare and long-term supplemental health care insurance shares with the nurse that he is in need of a visual examination as a follow-up after his cataract surgery. The nurse suggests that such treatment is most likely covered by: a. Medicare Part A. b. Medicare Part B. c. Medicare Part D. d. Supplemental policy.
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a. “Acute care facilities lack the long-term physical therapy support your dad requires.” b. “Your dad will be much happier in a more serene, private environment.” c. “The subacute facility will focus on helping your dad maintain his independence.” d. “Insurance, including Medicare, will cover only a limited amount of time here.” ANS: C What does the bedside nurse understand about his or her role in nursing research? a. Research is only done by doctorally prepared nurses. b. All nurses have a role in delivering research-based care. c. A bedside nurse can be part of a hospital research team. d. The bedside nurse can collect data if the nurse has been properly trained. ANS: B The nurse is using the eight stages of life theory to help an older adult patient assess the developmental stage of personal ego differentiation. The nurse does this by assisting the patient to: a. determine feelings regarding the effects of aging on the physical being. b. describe feelings regarding what he or she expects the future to hold. identify aspects of work, recreation, and family life that provide a sense of self-worth and c. pleasure. d. elaborate on feelings about the prospect of his or her personal death. ANS: C A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on the: a. physician’s medical orders. b. stated requests of the individual patient. c. care that a responsible geriatric nurse would provide. d. implementation of the nursing process. ANS: C
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A patient takes digoxin (Lanoxin) for heart failure with atrial fibrillation. The patient reports yellow vision and nausea. The patient’s digoxin level is 1 ng/mL. How does the nurse explain the situation to the patient? a. “Even with a normal blood level you may have digoxin toxicity.” b. “You may have a gastrointestinal virus that is causing these symptoms.” c. “You may not be getting a high enough dose of digoxin; I’ll call the doctor.” d. “Your cataracts may be worsening and you may need to have them removed.” ANS: A A nurse is caring for a patient taking furosemide (Lasix). What assessment finding needs to be reported to the provider immediately? a. Weight gain of 1/2 pound (1 kg) in 24 hours b. 2+/4+ pedal and pretibial edema c. Potassium level: 2 mEq/L d. Sodium level: 138 mEq/L ANS: C An older adult patient newly diagnosed with peripheral vascular disease (PVD) is being educated on the possibility of developing a foot ulcer. What assessment finding indicates the patient may have an ulcer resulting from this disease? a. Deep, necrotic, and painless sore b. Shiny, dry, cyanotic skin surrounding the ulcer c. Ulcer appears shallow, crusty with warm skin d. Sore that has dull pain and is oozing ANS: B
An older patient in the internal medicine clinic reports usually being able to walk 1 mile without complaint. However, in the past 2 weeks, after walking just mile, the patient’s legs begin to ache. The pain goes away with rest. What action by the nurse is most appropriate?
Final review questions for geri
Course: Pharmacology (NUR 3145)
University: Santa Fe College
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