Acute Care of the Elderly Final Exam Questions
Course Introduction
This course provides an in-depth examination of the unique challenges and considerations in the acute care management of elderly patients. Students will explore the physiological changes of aging, common acute conditions in older adults, and evidence-based strategies for assessment, diagnosis, and treatment. Emphasis is placed on interdisciplinary care, functional assessment, medication management, delirium prevention, and ethical/legal issues in acute settings. Through case studies and clinical scenarios, students will develop the skills necessary to deliver safe, compassionate, and effective acute care tailored to the needs of the geriatric population.
Recommended Textbook
Gerontologic Nursing 5th Edition by Sue E. Meiner
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29 Chapters
669 Verified Questions
669 Flashcards
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Chapter 1: Overview of Gerontologic Nursing
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Q1) The clinic nurse caring for an older diabetic patient with a sixth grade education anticipates that the patient may experience difficulty (Select all that apply. )
A)recognizing the importance of keeping clinic appointments.
B)following a low-carbohydrate diet.
C)paying for insulin and syringes.
D)deciding on a primary health care provider.
E)naming a health care surrogate.
Answer: A,B,C
Q2) Which of the following statements made by a nurse preparing to complete a health assessment and history on an older patient reflects an understanding of the general health status of this population?
A)"I'll need to document well regarding the medications the patient is currently prescribed."
B)"I would like to understand how supportive the patient's family members are."
C)"Most older patients are being treated for a variety of chronic health care issues."
D)"It will be interesting to see whether this patient sees herself as being healthy."
Answer: D
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Chapter 2: Theories of Aging
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Q1) The student learning about aging theories understands that the main difference between stochastic theories and nonstochastic theories is which of the following?
A)Stochastic theories view aging as a random,cumulative process.
B)Stochastic theories view aging as similar among all people.
C)Nonstochastic theories view aging as a result of psychosocial factors.
D)Nonstochastic theories are backed by research,whereas stochastic theories are not.
Answer: A
Q2) The nurse working in a long-term care facility used the developmental theory of aging in practice.In caring for a frail,nearly bed bound patient,how can the nurse use this theory?
A)Engage the patient in intellectually stimulating activities.
B)Encourage the patient to participate in chair exercises.
C)Ensure that the patient participates in all the group activities.
D)Give the patient small "chores" to do for the facility.
Answer: A
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4
Chapter 3: Legal and Ethical Issues
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Sample Questions
Q1) To meet current guidelines regarding incontinence in a long-term care facility,what action by the director of nursing is best?
A)Assess residents for the ability to participate in a bladder training program.
B)Take all residents to the toilet every 2 hours and after meals.
C)Ensure all residents wear incontinence briefs,which are changed routinely.
D)Ask physicians and other providers to prescribe medications for bladder control.
Answer: A
Q2) The manager of a long-term care facility is evaluating patients' use of drugs.The resident on which of the following medications would be allowed to continue taking medications to control behavior?
A)On anxiolytics;now able to participate in group activities
B)Given a benzodiazepine at night;roommate now sleeps well
C)Given sedatives;eats 100% of meals if resident is fed
D)Taking an antipsychotic;no longer wanders at night
Answer: A
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5
Chapter 4: Gerontologic Assessment
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Q1) An older patient is hospitalized after a fall that resulted in a fractured left ankle.By day 4 of the hospitalization,which includes reduction of the fracture and analgesic drug therapy,the patient has become mildly disoriented and is incontinent of urine.The nurse explains to the family that these symptoms reflect the:
A)relationship between aging and both physical and psychosocial responses to trauma.
B)response exhibited by many older adults who are hospitalized.
C)effects of stress-induced perceptual deficits often seen in the hospitalized older adult. D)results of the pharmacologic pain control therapy.
Q2) The nurse has used the Yesavage Geriatric Depression Scale (short form)and scored the patient at a 1.What is the nurse's best action?
A)Refer the patient to a mental health practitioner.
B)Assess the patient further for depression.
C)Ask the patient about using antidepressant medications.
D)Document findings in the patient's medical record.
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6
Chapter 5: Cultural Influences
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Q1) A patient from a culture that differs from that of the nurse is hospitalized and near death.What action by the nurse best demonstrates cultural care preservation?
A)Allowing the family to remain at the bedside
B)Pinning a healing amulet to the patient's gown
C)Offering the family food and drink in the room
D)Giving the family time to be alone with the patient
Q2) A geriatric nurse practitioner working with a tribe of Native Americans makes the decision to acculturate in an attempt to provide culturally appropriate care.The nurse does this best by:
A)living the values of the tribe.
B)researching the tribe's belief systems.
C)learning the language of the tribe.
D)residing among the tribe members.
Q3) When attempting to provide culturally sensitive care according to the explanatory model,the nurse asks the patient:
A)"Who will be able to help you when you go home?"
B)"Do you think the treatment is helping?"
C)"When did you first notice the problem?"
D)"Has this illness changed your life?"
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Page 7
Chapter 6: Family Influences
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Q1) The nurse working with older patients understands what fact about a health care proxy?
A)It states that no resuscitation should occur if breathing or heartbeat cease.
B)It can specify what treatment measures are or are not acceptable to the patient.
C)It explains patient's wishes regarding treatment if the patient cannot communicate.
D)It designates a surrogate health care decision maker if the patient is incapacitated.
Q2) The nurse is assessing a family caregiver for signs of role stress.Which assessment findings are consistent with this condition? (Select all that apply. )
A)Denial
B)Anger
C)Social withdrawal
D)Irritability
E)Restfulness
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8
Chapter 7: Socioeconomic and Environmental Influences
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Q1) The nurse hears a news report about an older woman having her purse stolen.The assailant said,"Give me your purse,old lady,or I'll kill you." What crimes have been committed? (Select all that apply. )
A)Assault
B)Battery
C)Larceny
D)Robbery
E)Burglary
Q2) A patient is not competent to manage financial affairs.What legal recourse does the older person have?
A)Guardian
B)Conservator
C)Health care proxy
D)Social worker
Q3) An older patient appears to have few friends and little family.What action by the nurse is best?
A)Encourage the patient to stay in contact with remaining family members.
B)Help the patient find new social outlets and support systems.
C)Assess the patient for depression or substance abuse.
D)Ask the patient why there are so few friends and family.
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Chapter 8: Health Promotion and Illnessdisability
Prevention
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Sample Questions
Q1) The student learns the Medicare guidelines for preventive health and reimbursement policies.Which statement follows the guidelines? (Select all that apply. )
A)Medicare pays for an annual pneumococcal vaccination.
B)Medicare covers annual influenza vaccinations.
C)Pap smears and pelvic exams are covered once every 2 years.
D)Annual fecal occult blood tests are covered for those who are from 50 to 85 years of age.
E)A bone density scan is covered every 2 years (a co-payment is required).
Q2) During a home visit,a nurse is assessing the nutritional awareness of an older adult patient who lives alone.The nurse is most effective in obtaining objective information when:
A)asking to see what types of foods the patient keeps readily available.
B)reviewing the components of a healthy diet with the patient.
C)asking the patient to describe what he or she ate for all three meals yesterday.
D)observing the patient eat a meal that he or she has prepared.
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Page 10
Chapter 9: Health Care Delivery Settings and Older Adults
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Sample Questions
Q1) A patient is on hospice care.Which situation would result in an acute hospitalization?
A)Progression of disease
B)Intractable pain
C)New pressure ulcer
D)Bladder infection
Q2) The nurse at an assisted living facility is caring for a 73-year-old cognitively impaired patient who has recently been admitted.The nurse creates a care plan that strives to help maintain the patient's independence by including:
A)sufficient time for the patient to complete self-care.
B)encouraging the patient to make decisions regarding self-care.
C)regular assessment of the patient's ability to provide self-care.
D)regular cueing by staff to direct patient self-care.
Q3) The nursing faculty explains to students the definition of "homebound." Which is the best explanation of this situation?
A)A person uses a wheelchair for all mobility.
B)A person desires services provided at home.
C)Leaving home requires great effort.
D)No local agency is available to provide service.
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11
Chapter 10: Nutrition
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Sample Questions
Q1) Based on recent surveys identifying nutritional information concerning the daily diet of older adults in America,the nurse suggests:
A)substituting carbohydrates with lean protein sources.
B)adding calories through the addition of fruits and vegetables.
C)introducing a protein at each meal.
D)relying on foods that are both easy to chew and easy to digest.
Q2) A 73-year-old patient is concerned about staying healthy for as long as possible.When asked what lifestyle changes the patient should consider,the nurse suggests:
A)"As your metabolism slows,you will need to increase your intake of fat."
B)"If you are having difficulty sleeping,a mild sedative will help you sleep."
C)"Regular exercise will help you preserve function and reduce your risk for disease."
D)"Minimize stress by being willing to ask your family for help when you need it."
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Chapter 11: Sleep and Activity
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Q1) A confused older patient has been hospitalized for a cardiac problem that requires both antihypertensive and diuretic therapies.The nurse minimizes the patient's risk of disturbed sleep by:
A)keeping the door shut so noise from the hallway is not disruptive.
B)organizing care to minimize the number of times the patient is awakened.
C)administering medications at least 4 hours before bedtime.
D)offering to toilet the patient whenever the nurse finds the patient awake during the night.
Q2) A patient reports waking up with frequent headaches and sore throat.What question by the nurse is most appropriate?
A)"Does acetaminophen (Tylenol)provide relief?"
B)"Does your partner say you snore at night?"
C)"Do you drink enough water during the day?"
D)"Do you ever wake up with night sweats?"
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13
Chapter 12: Safety
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Sample Questions
Q1) The student asks the nurse why ground beef and other ground meat products are more likely to be contaminated and cause food-borne illness.What response by the nurse is best?
A)It's because they are handled more.
B)They are from cheaper cuts of meat.
C)They are not kept cold during shipping.
D)They are made from leftover meats.
Q2) A patient is being discharged after hip replacement surgery.The geriatric nurse recognizes that the most effective intervention to minimize the potential of a fall injury is to:
A)identify the most common causes of falls that the patient is likely to encounter.
B)discuss what kind of in-home assistance the patient will need.
C)impress the patient with the importance of being careful not to fall.
D)educate the patient that falling is not a normal part of aging.
Q3) Which action is best to reduce burns in the home?
A)Instruct patients to install smoke detectors,
B)Tell patients to have their water heaters checked,
C)Encourage patients to switch from gas to electric stoves,
D)Teach patients not to smoke in their houses,
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Page 14
Chapter 13: Sexuality and Aging
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Sample Questions
Q1) Upon entering the room of a cognitively impaired older adult patient,the nurse observes that he is exposed and rubbing his genitals.The nurse's initial concern is to:
A)alert staff to be aware of this new behavior.
B)provide the patient with privacy.
C)assess him for possible pain and fever.
D)provide a verbal cue for him to stop the behavior.
Q2) The nurse working in long-term care knows there are several barriers to sexual expression for older patients.Which of the following are barriers? (Select all that apply. )
A)Decreasing desire
B)Medication side effects
C)Disease processes
D)Social circumstances
E)Increased libido
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15
Chapter 14: Pain
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Sample Questions
Q1) An older adult lives alone at home and is being treated for chronic pain.The home health care nurse notes the adult is disheveled and has dirty dishes piled up in the sink.What action by the nurse is best?
A)Notify adult protective services.
B)Arrange for hospitalization.
C)Assess the patient's pain.
D)Assess the patient's cognitive status.
Q2) Acetaminophen (Tylenol)is prescribed for a 70-year-old with chronic pain.When the patient reports to the nurse that the maximum daily dose of medication does not control the pain,the nurse responds:
A)"Breakthrough pain can be managed with the addition of another analgesic."
B)"Transcutaneous electrical nerve stimulation (TENS)is often helpful."
C)"It sounds as though you have developed a tolerance for acetaminophen."
D)"We will need to get your physician to prescribe another analgesic for you."
Q3) A patient has just had surgery.What pain control strategy is best?
A)Administer prn medications when requested.
B)Give pain medications around the clock at first.
C)Start with nonopioids then progress to opioids.
D)Ask the patient his or her preference for medication.
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Page 16
Chapter 15: Infection
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Sample Questions
Q1) An immunosuppressed older adult patient reports symptoms of fatigue,facial rash,intermittent low-grade fever,and painfully swollen finger joints.The nurse anticipates that diagnosis will be confirmed by:
A)the presence of subcutaneous nodules on the hands.
B)a positive antinuclear antibody (ANA)blood serum test.
C)a liver biopsy that confirms cirrhosis.
D)the presence of bilateral ocular scleritis.
Q2) An older adult patient who is generally in good health starts experiencing numerous colds and now pneumonia.What factor from the nursing history most likely has placed the patient at increased risk for the development of these infections?
A)A beloved pet died 6 months ago.
B)The patient was diagnosed with osteoarthritis 5 years ago.
C)The patient worked as an oncology nurse before retiring.
D)The patient's spouse is immunosuppressed.
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17
Chapter 16: Chronic Illness and Rehabilitation
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Q1) Adherence to prescribed health care treatments by a patient with a chronic disease is best facilitated when the nurse does which of the following? (Select all that apply. )
A)Provides the patient with information regarding his disease
B)Assesses the patient's ability to understand his disease
C)Defines "health and wellness" for the patient
D)Helps the patient identify barriers to his personal wellness
E)Coordinates support services to facilitate the patient's discharge
Q2) To best assist an older adult patient to cope with a new diagnosis of chronic renal failure,the nurse:
A)asks the patient to describe her usual coping strategies.
B)provides the patient with descriptions of new coping strategies.
C)initiates discussions with the patient to explain the disease.
D)offers to arrange a meeting with another patient with the diagnosis.
Q3) When working with older adults with chronic illness and exacerbations,what action by the nurse is most appropriate?
A)Continually assess the patients for adherence to the regime.
B)Assess the patients for ways they can remain in control.
C)Teach the patients about the illness trajectory.
D)Routinely review all medications the patients are taking.
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Page 18
Chapter 17: Cancer
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Sample Questions
Q1) When planning an educational program on cancer for a group of older adults,the nurse incorporates information regarding racial and ethnic patterns of cancer in the United States that includes evidence that:
A)the incidence of cancer is highest among African Americans.
B)Native Americans have the highest overall incident rates of cancer.
C)incidence rates for lung cancer are lowest for white women.
D)Hispanic women have the lowest incidence rates of cervical cancer.
Q2) The nurse is using a tool to assess the quality of life of a hospice patient.The nurse addresses the appropriate areas of concern when asking which of the following questions? (Select all that apply. )
A)"Are you able to bathe yourself?"
B)"Did your grandson get the grass cut like he planned?"
C)"How would you rate your pain on a scale of 1 to 10?"
D)"Do you still have concerns about your will?"
E)"Can we talk about why you never remarried?"
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Chapter 18: Loss and End-Of-Life Issues
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Q1) A hospice nurse shows the best understanding of the personal commitment to the dying patient by:
A)providing the patient with sufficient,effective pain management therapies.
B)addressing the patient's need to feel valued by those attending to his or her death.
C)being available emotionally and physically throughout the dying process.
D)empathizing with the patient and his or her family and friends during the process.
Q2) An older adult man has been the primary caregiver for his chronically ill wife for the past 10 years.When his wife dies,the nurse prepares the family for the likely possibility that their father will express:
A)guilt that he is alive while she is dead.
B)deep despair for his loss.
C)personal relief that she has died.
D)concern that he could have cared for her better.
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Chapter 19: Laboratory and Diagnostic Tests
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Q1) A patient takes digoxin (Lanoxin)for heart failure with atrial fibrillation.The patient reports yellow vision and nausea.The patient's digoxin level is 1.9 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."
Q2) A patient has heart failure and takes spironolactone (aldactone).What diet selection from the menu shows that the patient needs more education?
A)A low-fat chicken salad sandwich
B)Salt-free vegetable soup
C)Broiled fish with lemon
D)Salt substitute and pepper
Q3) An older patient's BUN is 28 mg/dL and creatinine is 0.6 mg/dL.How does the nurse interpret these findings?
A)Normal for all age groups
B)Normal for older adults
C)High for all age groups
D)Low for older adults
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Chapter 20: Pharmacologic Management
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Q1) A 69-year-old was prescribed a benzodiazepine 3 years ago.This medication regimen increases the patient's risk for injury related to drug abuse and requires frequent patient assessment for which of the following? (Select all that apply. )
A)Daytime sleepiness
B)Unsteady gait
C)Shortness of breath
D)Easy bleeding
E)Forgetfulness
Q2) A 67-year-old woman presents at the emergency department with symptoms that suggest possible abuse of a narcotic analgesic.To best assure the patient's safe care,the nurse asks:
A)"When did you first start using the analgesic?"
B)"Have you experienced withdrawal symptoms before?"
C)"Why did you initially need an analgesic?"
D)"What prescribed drugs are you currently taking?"
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Chapter 21: Cardiovascular Function
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Q1) An older patient is overwhelmed at the number of lifestyle changes needed to manage newly diagnosed cardiovascular disease.What action by the nurse will reduce this barrier to teaching?
A)Tell the patient even tiny changes over time make a big difference.
B)Tell the patient that smoking is the biggest risk factor and needs to stop.
C)Help the patient choose a change and incorporate it into daily life.
D)Educate the patient on the consequences of not making changes.
Q2) The nurse educates the obese older adult patient that the single most important outcome that will affect cardiac health is:
A)compliance with drug therapy.
B)adherence to the DASH diet.
C)20 minutes of exercise daily.
D)a 10% reduction in weight.
Q3) To evaluate an older patient for possible renal failure as a result of chronic untreated hypertension,nurse prepares to:
A)schedule an ultrasound.
B)collect a urine sample.
C)monitor intake and output.
D)transport the patient to radiology.
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Page 23
Chapter 22: Respiratory Function
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Q1) The nurse is caring for an older adult who has been prescribed inhaled corticosteroids for asthma.What does the nurse teach about this medication?
A)Taken just before retiring for the night
B)Reserved for acute attacks only
C)Used in increasing doses as needed
D)How to use and rinse the inhaler
Q2) When teaching older adult asthmatic patients,the nurse stresses the importance of which of the following? (Select all that apply. )
A)Being alert for the early signs of breathing problems
B)Fostering an effective relationship with your health care provider
C)Identifying and avoid personal triggers
D)Incorporating regular rest periods into your daily routine
E)Increasing vitamin C consumption,especially during winter months
Q3) A patient has been taught about nutrition related to COPD.Which menu selection may indicate a need for further teaching?
A)Bagel and cream cheese
B)Broiled chicken breast
C)Beans and peas
D)Tofu stir-fry
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Page 24
Chapter 23: Endocrine Function
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Q1) The nurse teaches an older patient safety rules for exercising.What do these rules include? (Select all that apply. )
A)Carry medical identification.
B)Check blood glucose before exercising.
C)Drink plenty of water.
D)Have quick-acting glucose.
E)Knowing signs of hyperglycemia.
Q2) A patient has been admitted with new atrial fibrillation.What additional diagnostic testing does the nurse anticipate?
A)Thyroid hormones
B)Platelet count
C)Urinalysis
D)Blood glucose
Q3) The nurse teaching a 79-year-old with type 2 diabetes about the importance of regular exercise suggests that the patient:
A)swim 10 laps in the community center pool three times a week.
B)enroll in a daily lunch time aerobics class at the senior center.
C)lift 5 pound weights in a routine of 10 repetitions in each arm.
D)walk on the treadmill each morning for 30 minutes.
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Page 25
Chapter 24: Gastrointestinal Function
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Q1) An older patient had a stroke several months ago.The patient begins to exhibit dysphagia.What action by the nurse is best?
A)Consult with a speech-language therapist.
B)Discuss the need for enteral feedings.
C)Provide the patient swallowing exercises.
D)Arrange for a physical exam.
Q2) A 70-year-old patient has lost 25 pounds since being diagnosed with hepatitis A.To best manage the patient's anorexia,what does the nurse suggest? (Select all that apply. )
A)A protein powder supplement added to liquids
B)Several meals eaten during the day
C)Megavitamins that include iron and folic acid
D)A dietary assessment to identify favorite foods
E)A high-carbohydrate,low-fat diet
Q3) An older patient with hepatitis has pruritus.What advise does the nurse provide this patient?
A)Keep your fingernails cut short.
B)Use diphenhydramine (Benadryl).
C)Hot soapy showers will help.
D)Butter is a good home remedy for itching.
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Chapter 25: Musculoskeletal Function
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Q1) To best identify a risk for injury in an older adult patient,the nurse assesses for:
A)decreased muscle mass in the legs.
B)history of falls.
C)hyperextension of the spine.
D)decreased bone density.
Q2) An older adult patient who has experienced a left knee replacement asks the nurse,"When will I be back to normal?" The nurse responds that:
A)"What did the surgeon tell you about function after the surgery?"
B)"Normal means different things to different people."
C)"You should be back to normal after 6 to 8 weeks."
D)"Surgery will improve your mobility but I'm not sure about being normal."
Q3) A patient is scheduled to have a lower extremity amputation.What action by the nurse takes priority?
A)Discuss stump management and prostheses.
B)Ensure informed consent is on the chart.
C)Determine the patient's goal for pain control.
D)Administer the preoperative antibiotic.
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Chapter 26: Urinary Function
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Q1) A patient has a history of smoking and now has painless hematuria.After a workup,the patient is told the diagnosis of bladder cancer.What action by the nurse is most important?
A)Allow the patient to verbalize feelings.
B)Educate the patient on care of an ileal conduit.
C)Teach the patient how to manage nausea.
D)Offer a social work referral to complete a living will.
Q2) 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."
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Chapter 27: Cognitive and Neurologic Function
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Q1) A 73-year-old patient diagnosed with vascular dementia is admitted for exacerbation of asthma.The patient has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior.The nurse's initial response is to:
A)identify the patient as being at high risk for falls.
B)monitor the patient for signs of benzodiazepine withdrawal.
C)notify the admitting physician immediately.
D)place the patient on strict intake and output.
Q2) When assessing an older patient displaying symptoms of delirium,the nurse focuses the assessment on:
A)the degree and duration of the symptoms.
B)the amount of self-care deficiency the symptoms cause.
C)identifying processes that commonly result in the symptoms.
D)physiologic dysfunction resulting from the symptoms.
Q3) When planning care for the older adult with advanced dementia,the nurse recognizes that the best way to implement reality orientation is to:
A)place printed labels on important items,such as the telephone.
B)place a clock and calendar in the patient's immediate environment.
C)use hand gestures instead of verbal communications to demonstrate meaning.
D)show the patient a picture of a toothbrush when it is time for oral hygiene.
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Page 29
Chapter 28: Integumentary Function
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20 Flashcards
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Sample Questions
Q1) For which patient does the nurse add compression therapy to the nursing care plan?
A)Taut,white,shiny skin
B)Faint pedal pulses
C)Brownish skin and edema
D)Large ulcer with skin graft
Q2) 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.
Q3) A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis.The nurse educates the patient to the possibility of developing:
A)alopecia.
B)orange-tinged urine.
C)yellow-brown nails.
D)cherry angiomas.
To view all questions and flashcards with answers, click on the resource link above.
Chapter 29: Sensory Function
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Sample Questions
Q1) 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.
Q2) An older adult patient reports burning and itching eyes.On assessment,the nurse notes swelling of the eyelid margins bilaterally.What additional data are necessary to confirm the nurse's suspicion of blepharitis?
A)The patient reports visual disturbances such as rainbow halos.
B)The eyelids are reddened from seborrhea.
C)The patient is being treated with anticoagulants.
D)Small corneal hemorrhages are present.
To view all questions and flashcards with answers, click on the resource link above.