A 77-year-old Hispanic Catholic Nun (retired) who immigrated to the United States 15 years ago lives alone but in an apartment complex where her sister lives as well. She is being discharged home after a hospitalization
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A 77-year-old Hispanic Catholic Nun (retired) who immigrated to the United States 15 years ago lives alone but in an apartment complex where her sister lives as well. She is being discharged home after a hospitalization for congestive heart failure with prescriptions for 8 different medications. She is considered at risk for noncompliance due to the following contributing factors except: 2. A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, you should: 3. A 79-year-old female client resides independently in the community. The client’s daughter is concerned because her mother insists on wearing a sweater and keeps all of the windows closed even though it is 90 degrees Fahrenheit outside. The nurse practitioner initially recognizes that this behavior may be related to: 4. An 88-year-old, being admitted to rule out lung cancer, is assessed using the short form of the Geriatric Depression Scale tool. When it is determines that the earned score is 9, the nurse practitioner initially: 5. The area in which nurse practitioners have the greatest effect on the safe, effective medication therapy of an older client is: 6. The Beers list is an effective tool for healthcare professionals prescribing and/or managing the medication therapy of older adults since it identifies medications that for this population: 7. A client who reported, “a problem sleeping” shows an understanding of good sleep hygiene when: 8. Common causes of dyspnea in the older adult may include which of the following? •Heart failure Asthma Chronic obstructive lung disease Pneumonia 9. Common ethical issues in the nursing home may include which of the following? •Quality of life Decision-making capacity Preservation of autonomy Surrogate decision making 10. The cost of nursing home care is significant. The primary payer for nursing home care is: 11. Each of the following assessment finding is a contributor to an older client’s risk for falls except: 12. Each of the following data supports the diagnosis of sleep apnea in the older adult except: 13. Factors that affect the pharmacokinetics of lipophilic medications in older include: 14. The following precautions are beneficial in minimizing an older adult’s risk of being a victim of fraud except: • Rely on the advice of people who only friends have recommended. 15. In order to focus on the older population with the greatest risk for suicide the nurse practitioner would conduct a depression that targets: 16. In planning teaching for a client with diabetes, which precaution related to fall prevention is particularly important for the nurse practitioner to include? 17. It is imperative that nursing take a leadership role in providing effective health care across the lifespan and in various health care settings. Which intervention will have the greatest impact on achieving positive outcomes concerning that issue? 18. The nurse is most concerned by observing which of the following during an older client’s physical assessment: 19. The nurse is providing care to a client diagnosed with dementia. What option is an example of the appropriate use of implied consent by the nurse? 20. The nurse practitioner demonstrates an understanding of the older client’s preventable risk factors for early death when: •providing clients with information regarding the effectiveness of a nicotine patch monitoring the blood pressure of those living at a homeless shelter each month weighing the clients who visit a walk-in clinic that is located in an economically depressed neighborhood educating the diabetic residents of a low rent apartment complex on how to monitor their blood glucose levels 21. The nurse practitioner documents that an older adult client is living independently in a safe environment. Which assessment data supports this evaluation? •The client demonstrates the home’s security alarm system. Various safety features were installed when the bathroom was remodeled. The nurse observes the client wearing a safety alarm bracelet. The client’s home is within walking distance of a grocery store. 22. The nurse practitioner educates the older client that the greatest risk related to poor foot care results is: 23. The nurse practitioner has the obligation to ask questions and obtain specific information about the use of herbs and supplements. Which of the following statements is most accurate regarding herbal therapy? 24. A nurse practitioner in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention? 25. A nurse practitioner is preparing an educational program focused on herbal supplements. Which of the following is a likely interested target group? 26. The nurse practitioner is preparing educational material concerning fire safety in the home. What research data will be included in the material? 27. The nurse practitioner is providing care for an older client who is experiencing mild cognitive impairment. Which communication technique is most likely to bring about a negative outcome? 28. The nurse practitioner makes the greatest impact on the safe management of an 81-year-old client’s medication administration when included in education is: 29. The nurse practitioner’s first response when told by a client during an assessment interview that they “can’t take furosemide (Lasix)” is to ask: 30. The nurse practitioner suspects that a client is experiencing tardive dyskinesia when observing: 31. The nurse suspects that an older adult client is experiencing symptomology seen in herpes zoster when the client •rates the pain as an 8 out of a possible 10 develops clusters of fluid-filled vesicles reports symptoms focused on one side of the body 32. A nurse suspects that her next-door neighbor, an older woman, is a victim of elder abuse by her daughter. What is the appropriate action for the nurse to do in this situation? 33. Of the following agents, which is least likely to cause a chronic or recurrent cough? 34. Of the following risk factors, which is not 35. An older adult client will require extensive rehabilitative therapy after a fall that resulted in several fractures and reconstructive surgeries. Which intervention will have the greatest impact on the individual’s relocation to a rehabilitation facility? 36. An older adult has recently experienced a number of stressful life events. The client comes to the ambulatory clinic and tells the nurse practitioner that, “On top of all I’ve had to endure; now I’ve got this flu!” In rendering care for this client, the nurse practitioner recognizes that: 37. An older adult is concerned that if her spouse, who recently suffered a stroke, is placed in a nursing home, “they will take everything in order to pay for his care.” What response will the nurse practitioner make? 38. An older adult patient with a history of osteoporosis is hospitalized for wrist surgery. Which medication that is currently being prescribed would be most likely to interfere with bone integrity? 39. An older client diagnosed with dementia resides with his daughter. When the home care nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, “I don’t know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him.” How will the nurse respond to the client’s daughter? 40. An older client prescribed a transdermal morphine patch for severe chronic pain is being educated on the appropriate administration of the medication. The nurse shows an understanding of essential information regarding this route of drug administration when stating: 41. The original intent of Social Security was to: 42. The primary risk for injury experienced by a client diagnosed with asthma is: 43. Research has shown that long-term care (LTC) facility nursing •is comparable to the complexity and demand of intensive care nursing is a nursing intensive environment crosses the continuum of care 44. Snoring is a symptom of which of the following disorders: 45. State Death with Dignity Laws require that the terminally ill client be 46. Weight loss is frequently caused by ingestion of the following drugs. •Antibiotics Digoxin Nonsteroidal anti-inflammatory drugs (NSAIDs) Theophylline 47. What factor is an important contribution to polypharmacy in older adults? 48. What research finding is the basis for care planning of the client receiving palliative care? 49. When a chronically ill 80-year-old client is admitted to your acute care facility in an unconscious state, the nurse practitioner’s priority is to determine: 50. When acting as a fictive kin, in which activity will a paid caregiver engage? 51. When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse practitioner is confident that client education on the condition’s contributing factors has been effective when the client states: 52. When answering an older client’s questions about diet, exercise, and bone integrity, which exercise would the nurse practitioner identify as ineffective at meeting the need for moderately intense aerobic activity? 53. When assessing an older client for indications of depression, the nurse practitioner bases the intervention on the knowledge that: 54. When assessing the intellectual abilities of an older adult, the nurse practitioner demonstrates an understanding of a major barrier to reliable testing of this population when: 55. When caring for an ill adult client, the nurse is particularly concerned that the client communicates well since: 56. When developing a teaching plan for an older, newly diagnosed diabetic client, the nurse practitioner best ensures an understanding of oral hypoglycemic medications when providing: 57. When discussing pharmacological considerations, a 68-year-old client asks, “Why do medications seem to act differently than they did when I was younger?” The nurse practitioner bases the response on the concept that: 58. When educating an older adult about Medicare Part D which information will be included? •It is an elective prescription drug plan with associated out-of-pocket premiums All persons with either Medicare Part A or B can voluntarily purchase a Medicare Part D prescription drug plan. The plan is not voluntary for individuals who are receiving both Medicaid and Medicare. This prescription drug plan requires client co-payments. 59. When performing the initial assessment on a new client in the geriatric outpatient’s practice, the most effective method the nurse practitioner can implement to elicit an accurate medication assessment is to ask that the client: 60. When preparing an educational program on the minimizing the effects of aging to a “seniors’ group,” the nurse practitioner’s discussion on exercise is based upon the fact that: 61. When providing information regarding age-related visual problems, the nurse practitioner recognizes that the target population is: 62. When using the Fulmer SPICES assessment tool, the nurse practitioner expects to ask: 63. When working with a bereaved individual, the goal of nursing interventions is to: 64. Which activity would a couple in the reorientation phase of their retirement engage in? 65. Which behavior suggests that an older adult who has lost their life partner is successfully managing the exploration stage of the adjustment process? 66. Which characteristic is seen in a family’s ‘kin-keeper’? 67. Which client statement indicates an understanding of a primary benefit to be derived from moderately intense aerobic exercise? 68. Which diagnosis is associated with the symptom of early morning awakening and poor quality of sleep: 69. Which factor is the greatest barrier to an older adult living independently? 70. Which form of urinary incontinence is most common in older adults? 71. Which housing arrangement would best address the family who wants to provide housing for an older family member who has a large degree of physical and cognitive independence and a desire to be closely involved with the family? 72. Which intervention addresses a guiding principle for creating an elder-friendly acute care facility? 73. Which intervention addresses a right guaranteed a long-term care facility resident? 74. Which intervention best addresses the principle that is the basis for communicating with a client experiencing post-surgical delirium? 75. Which intervention best demonstrates the nurse practitioner understands safe medication administration of rivastigmine (Exelon) to the older client experiencing symptoms of Alzheimer’s disease? 76. Which intervention demonstrates effective care for an individual who has expressed a wish to “retire sometime soon”? •Asking about when they plan to retire Assessing their ability to handle the stresses of retirement Engaging them in a conversation about their interests Inquiring about the existence of any chronic illnesses 77. Which intervention to manage wandering in clients in a long-term care facility should not be implemented? 78. Which is the most likely reason that Type 2 diabetes mellitus is often difficult to diagnose in older adults? 79. Which nursing intervention will have the greatest impact on minimizing an older adult’s risk for re-hospitalization within 30 days of discharge? 80. Which of the following commonly causes insomnia: •Alcohol consumption Caffeine ingestion Sleep apnea Depression 81. Which of the following does not demonstrate an understanding of the factors affecting physical wellness of the older adult client when: 82. Which of the following is the best advice a nurse practitioner can give an older client who is about to move to a new apartment and needs to feel safe about living alone for the first time? 83. Which older adult client has the greatest risk for readmission into the acute care health system and so is the focus of extensive nursing follow-up post discharge? 84. Which older adult meets the criteria for foster care housing? 85. Which option is an example of which type of elder exploitation? 86. Which pharmacokinetic/pharmacodynamic parameter is least affected by the aging process? 87. Which question will best assess the ability of the LGBT older couple to successfully adjust to the challenges of aging ? 88. Which reaction to the loss of a spouse or long-term partner is a unique example of older adult male bereavement? 89. Which statement correctly describes normal changes of aging? 90. Which statement made by a nurse regarding a resident of a long-term care facility requires follow up by the nurse manager? 91. Which statement made by the resident of a long-term care facility is evidence that the facility is providing care in accordance with the Long-Term Care Residents’ Bill of Rights? 92. Which statement reflects a need for further education on elder abuse? 93. Which statements made by a couple who have recently retired support the nurse’s evaluation that the transition to retirement has been a successful one? 94. Which truism will the nurse practitioner base spousal grief counseling upon? 95. While the older African-American is at the highest risk for developing Alzheimer’s disease, the nurse practitioner demonstrates an understanding of this disease process’s risk factors when assessing this population’s: 96. A widowed grandmother is about to assume the role of custodial parent for her 6-year-old grandchild. Which intervention has priority 97. Your client is cared for at home by his son and daughter-in-law, who are also responsible for the care of their four preschool-aged children. What is true of this “sandwich” generation? 98. You suspect that the spouse of a terminally ill client is experiencing anticipatory grief when they: 99. Of the following risk factors, which is not associated with Alzheimer’s disease (AD)? 100 Which diagnosis is associated with the symptom of early morning awakening and poor quality of sleep:
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