The daughter of an older patient says to a nurse, “I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?” The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.)

1. Report the person to the division of motor vehicles for license suspension.
2. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem.
3. Arrange for alternate transportation for the person.
4. Confiscate the keys to the car.
5. Ask the patient’s physician to write a prescription for the person to stop driving.

B,C

A nurse is caring for a frail older adult in a long-term care facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (Select all that apply.)

1. Make sure that the temperature in the resident’s room is at least 65 degrees Fahrenheit.
2. Cover residents well when in bed and while bathing.
3. Provide a head covering for the resident.
4. Maintain resident in bed covered with heavy blankets at all times.
5. Provide hot, high-protein meals and bedtime snacks.

A,B,C,E

The benefits of telehealth include that it: (Select all that apply.)

1. promotes self-management of illness in rural and underserved areas.
2. facilitates remote physical assessment and monitoring of chronic conditions.
3. decreases costs by replacing the role of the nurse with technology.
4. decreases costs by reducing hospital readmissions.
5. is reimbursed by all health care insurances.

A,B,D

Which precaution would be beneficial in minimizing an older adult’s risk of being a victim of fraud? (Select all that apply.)

1. Do not allow uninvited salespersons into your home.
2. Never provide personal information to telephone sales solicitors.
3. Rely on the advice of people who only friends have recommended.
4. Contact the local Medicare or Medicaid service office for information when

needed.
e. Keep your bank account and credit card numbers with you at all times.

A,B,D

What information should be included in an informational program to be presented on burn prevention to a senior citizens group? (Select all that apply.)

1. Do not smoke in bed or when sleepy
2. Wear well-fitted clothing when cooking or when grilling outdoors
3. Establish a meeting place for all family members outside of the home in case of a fire
4. Establish a plan for exiting each room of your home in the case of a fire
5. Have a fire extinguisher readily available in the kitchen

A,B,E

The greatest risk for injury for a client with progressed Parkinson’s disease is:

1. falls.
2. suicide.
3. bleeding ulcers.
4. respiratory arrest.

A

An older adult with suspected Parkinson’s Disease has a “challenge test” performed in order to confirm the diagnosis. The nurse understands that a “challenge test” will demonstrate which of the following?

1. Immediate reversal of all symptoms of Parkinson’s Disease after administration of levodopa
2. Dramatic improvement of symptoms of Parkinson’s Disease after administration of levodopa

C. Dramatic improvement in gait only after administration of levodopa

D. Dramatic improvement in tremor only after administration of levodopa

B

A nurse is caring for an older adult with Parkinson’s Disease. The patient is receiving the medication levodopa-carbidopa. The nurse understands that in order to maximize effectiveness, the administration schedule for this medication should adhere to which of the following?

1. Administer with meals only
2. Administer first thing in the morning only
3. Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal
4. Administer with a full 8 ounces of water and have the patient sit upright for thirty minutes after

C

While the older African American is at the highest risk for developing Alzheimer’s disease, the nurse demonstrates an understanding of this disease process’s risk factors when assessing this population’s:

1. weight and elimination patterns.
2. heart rate and capillary refill status.
3. blood pressure and serum lipid levels.
4. muscle strength and reflex times.

C

An older adult is diagnosed with Alzheimer’s Disease. The nurse knows that this diagnosis is made on the presence of which of the following? (Select all that apply.)

1. A decline from a previous level of functioning
2. Fluctuation of symptoms over the course of a 24-hour period
3. An insidious onset
4. A gradual decline in cognitive abilities
5. The cognitive changes worsen in the evening hours

A,C,D

A diagnosis of Parkinson’s disease is made based on the presence of which of the following symptoms? (Select all that apply.)

1. Rigidity
2. Resting tremor
3. Bradykinesia
4. Orthostatic hypotension
5. Progressive decline in cognitive function

A,B,C

An older patient is concerned that her neighbor was recently diagnosed with Alzheimer’s Disease and asks a nurse what can be done to decrease the risk of Alzheimer’s Disease. The nurse includes which of the following in the response to the patient? (Select all that apply.)

1. Maintain blood pressure within normal limits
2. Smoking cessation
3. Maintain control of blood sugar (hemoglobin A1C 7)
4. Eliminate fats from the diet
5. Maintain ideal body weight

A,B,C

Differences in the presentation of patients with Neurocognitive Disorder (NCD) Alzheimer’s Disease (AD) and NCD Lewy bodies (LB) are: (Select all that apply.)

1. individuals with LB develop motor symptoms, and individuals with AD do not.
2. individuals with AD display impairments in judgment whereas individuals with LB do not.
3. the use of traditional antipsychotic medication is contraindicated for individuals with LB.
4. LB usually occurs in individuals under age 60, and AD occurs in individuals only over age 60.
5. individuals with LB develop language symptoms, and individuals with AD do not.

A,C

An older adult is referred to a geriatric nurse practitioner because of changes in memory and reports by family members that “there is something different about her.” The nurse practitioner evaluates the older adult for potentially reversible causes for the changes, which include: (Select all that apply.)

1. depression.
2. delirium.
3. osteoporosis.
4. rheumatoid arthritis.
5. medication side effects.

A,B,E

A nurse understands that the pathophysiology of Parkinson’s Disease includes which of the following? (Select all that apply.)

1. A deficiency of the neurotransmitter dopamine
2. An inability of the neurons to absorb dopamine
3. A reduction of dopamine receptors
4. An accumulation of Lewy Bodies, especially in the basal ganglia
5. The presence of neurofibrillary tangles and amyloid plaques in the brain

A,C,D

When performing a pain assessment on a client who is aphasic, the nurse should consider:

1. reports from the family or staff at the nursing home about changes in functional status.
2. that the patient is lying quietly in bed so she is not likely to be experiencing pain.
3. that the patient’s previous stroke interrupted pain pathways so she does not feel pain.
4. that older adults do not tolerate opioid analgesics well and may exhibit side effects.

A

An older adult is admitted to the hospital after a serious fall. When noting that the client has

been prescribed meperidine (Demerol) for muscle pain, the nurse:

1. administers the medication so as to prevent the client from developing the fear of pain.
2. questions the client and family concerning any allergies to analgesic medications.
3. calls the physician to question the appropriateness of this medication order.
4. conducts a pain assessment and determines the client’s need for an analgesic medication.

C

Compared with acute pain, persistent pain requires the nurse to:

1. monitor vital signs more frequently.
2. document the character of the pain as burning.
3. administer analgesics at least every 4 hours.
4. educate the client to the benefit of specific lifestyle changes.

D

The initial step to effect the safe management of mild to moderate acute pain that has not been controlled with over-the-counter medications is to:

1. begin acetaminophen (Tylenol) every 4 hours for 24 hours.
2. supplement with nonpharmacological interventions.
3. administer a single low dose of short-acting opioid and monitor for relief.
4. titrate dosage of a short-acting opioid upward over 24 hours to achieve relief.

C

An older adult is being treated for severe pain resulting from a history of osteoarthritis. In her discharge teaching, which information is most important to relay for the successful management of the pain?

1. Check for incompatibilities before taking any new medications.
2. Arrange to take a dose of analgesic prior to physical activity.
3. Take the analgesic around-the-clock as prescribed.
4. Be alert for the signs of overdose toxicity.

C

An older client with a history of hypertension and osteoarthritis who has recently fallen and fractured two ribs is prescribed extra strength Tylenol for the pain. What statement by the client requires further evaluation by the nurse?

1. “I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep through the whole night.”
2. “I heard that meditation may help me deal with the pain without taking all that Tylenol.”
3. “Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours around-the-clock and my pain is gone.”
4. “I make sure that I take my Tylenol with breakfast when I first get up.”

C

An older adult with gastric cancer with bone metastases is being discharged from the hospital after beginning a regimen of opioid analgesics to control the metastatic pain. What should be included in the discharge teaching plan?

1. The development of a plan to prevent constipation
2. Benefits of grief counseling
3. Increasing calories in the diet
4. Preventing pressure ulcers

A

An older adult is currently prescribed both aspirin (81 mg) and ibuprofen daily. What instructions are most important for the nurse to provide to assure the expected outcomes for this client?

1. The medications should be taken together to ensure the effectiveness of both medications
2. Take ibuprofen 30 minutes after the aspirin so as to not interfere with its effectiveness
3. The aspirin will negatively affect the analgesic effect of the ibuprofen
4. The medications should be taken at least 4 hours apart to minimize risk of gastric irritation

B

When educating a client on the use of an adjuvant medication, which statement best demonstrates the nurse’s understanding of this therapy?

1. “These medications are used instead of opioids to decrease the likelihood of addiction.”
2. “Adjuvant medications are prescribed because they seldom cause any significant side effects.”
3. “These types of medications are used to eliminate the side effects of opioid medications.”
4. “These drugs are used in combination with analgesics to increase the effect of the analgesics.”

D

An older client who was recently admitted to the subacute setting after having a knee replacement is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement?

1. Share with the patient that it’s important to get out of bed and that there is pain medication available if it does hurt.
2. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain.
3. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed.
4. Allow the patient to remain in bed, but share that getting up will be required at least twice a day starting the next morning.

C

An older aphasic client has severe osteoarthritis, bilateral contractures of the lower extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? (Select all that apply.)

1. “Client slept throughout the night.”
2. “Client winces only when turned and repositioned.”
3. “Client slept during dressing change.”
4. “Client cooperative during morning care.”
5. “Client ate 80% of breakfast, 70% of lunch, and 100% of dinner.”

A,C,D,E

An older adult is seen in the emergency department after falling and sustaining substantial soft tissue bruising. The assessment interview notes a history of arthritic pain in several joints. The client is prescribed 650 mg of acetaminophen (Tylenol) four times per day and 800 mg of ibuprofen (Motrin) four times per day for control of the persistent arthritic pain. When providing discharge teaching, the nurse includes information regarding the signs and symptoms of: (Select all that apply.)

1. gastrointestinal bleeding.
2. renal impairment.
3. medication interactions.
4. confusion.
5. increased anxiety.

A,B,C

When individualizing pain management for a client hospitalized after major surgery, the nurse will: (Select all that apply.)

1. titrate the prescribed analgesic medication to provide effective pain management.
2. assess the client for cultural beliefs that affect individual expression of pain.
3. reassure the client that pain medication is available whenever he or she expresses a need for it.
4. anticipate the client’s need for pain medications.
5. implement nonpharmacological pain management interventions whenever possible.

A,B,D,E

A nurse is caring for an older adult with cognitive impairment who recently had hip surgery. The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.)

1. The client ate all of her meals.
2. The client pushes caregivers away when they attempt to change the dressing on her hip.
3. The client rocks back and forth repetitively when sitting in a chair.
4. The client sleeps soundly throughout the night.
5. The client cries out repeatedly when anyone approaches her.

B,C,E

Which attempt by the family to prevent an older, frail adult from falling causes the home
health nurse concern?
a. Keeping several low wattage night-lights on in the evening
b. Installing wooden railings on the stairway to the bathroom
c. Keeping the side rails up on the client’s bed at night
d. Encouraging the client to use a cane when ambulating

C

An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of hypertension and congestive heart failure and is on a total of five different
medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for Falls. A priority nursing intervention for this client is
to:
a. perform a fall assessment.
b. keep all of the side rails up on the client’s bed at nighttime.
c. place the client on bed rest so that she does not fall.
d. assess the client’s dietary intake for calcium adequacy.

A

A nurse is assessing an older adult’s risk for falls. One of the questions that she asks is whether the older adult has fallen in the past year. She asks this because individuals who have
fallen:
a. have a higher risk of falling again than persons who did not fall in the past year.
b. are more likely to sustain injuries if they fall again than persons who did not fall in the past year.
c. have most likely developed a fear of falling as compared to persons who did not fall in the past year.
d. are most likely to have a balance disorder as compared to persons who did not fall

A

A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall prevention and demonstrates the use of the call bell to the patient. The patient’s daughter asks: “Why don’t you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?” The best response by the nurse is:
a. “Side rails have only proven to be effective in decreasing falls in patients who have already fallen.”
b. “There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury.”
c. “Side rails are only effective when used with patients who have dementia.”
d. “Side rails do not decrease falls, but they do decrease fall-related injuries.”

B

A nurse in a long-term care facility notes that there has been an increase in falls on one unit and that many of the falls are occurring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that:
a. postural changes in blood pressure are common in older adults and frequently occur around mealtimes.
b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be
related to the release of a vasodilatory peptide.
c. residents of long term care facilities are often on many different medications,
which are given at mealtimes.
d. it is common practice to take long term care residents to the bathroom immediately
following meals.

B

Which assessment finding is a contributor to an older client’s risk for falls? (Select all that apply.)
a. Client is awaiting cataract surgery on right eye.
b. Client’s type 2 diabetes is poorly controlled with diet and exercise alone.
c. Client reports a fall in the last year.
d. Client has a history of contact dermatitis and psoriasis.
e. Client attends Tai Chi classes at the senior center.

A,B,C

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. Which of the following are hazards in the home? (Select all that apply.)
a. The absence of railings on the stairway
b. Night-lights in all rooms
c. Clutter throughout the home
d. A small throw rug outside of the shower stall
e. Grab bars in bathroom beside toilet

A,C,D

A definitive diagnosis of Alzheimer disease (AD) can be made by detecting or using which one of the following methods?
a. Clinical observation of dementia
b. Inability to speak with relevance
c. Development of neurofibrillary tangles
d. Computed axial tomographic (CAT) scan

C