Test Bank Chapter 13: Gerontologic Alterations and Management

Urden: Thelan’s Critical Care Nursing, 5th Edition
Test Bank
Chapter 13: Gerontologic Alterations and Management
MULTIPLE CHOICE
Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior
myocardial infarction.
1. Age-related changes in myocardial pumping ability may be evidenced by

a. increased contractility.
b. decreased contractility.
c. decreased left ventricle afterload.
d. increased cardiac output.
ANS: B
Age-related changes in myocardial pumping ability include decreased strength of the
myocardial muscle, which results in decreased contractility.
DIF: Cognitive Level: Comprehension REF: 228

OBJ: Nursing Process Step: Assessment TOP: Gerontology
MSC: NCLEX: Physiologic Integrity
2. Age-related pulmonary changes that may affect Mr. Y include

a. increased tidal volumes.
b. weakening of intercostal muscles and the diaphragm.
c. improved cough reflex.
d. decreased sensation of the glottis.
ANS: B
Age-related pulmonary changes include weakening of intercostal muscles and the
diaphragm. This decreases lung expansion, increasing risks for decreased ventilatory
effort.

3. Dopamine 3 mcg/kg per minute has been ordered for Mr. Y. What nursing
implications should be considered when administering this drug to an elderly patient?
a. No changes are noted in elderly patients with this drug.
b. Drug effect is enhanced by increased receptor site action.
Copyright © 2006 Mosby, Inc.

c. Increased breakdown by liver hepatocytes occurs, increasing dosage requirements.
d. Drug metabolism and detoxification are slowed, increasing the risks of drug
toxicity.
ANS: D
The decreasing ability of the liver to metabolize drugs that occurs in the elderly increases
the risks of drug toxicity
DIF: Cognitive Level: Knowledge REF: 235

OBJ: Nursing Process Step: Intervention TOP: Gerontology
4. When caring for Mr. Y, the nurse plans increased attention to skin integrity because of
the
a. thickening of the epidermal skin layer.
b. loss of sebaceous glands.
c. increased fragility from loss of protective subcutaneous layers.
d. decreased melanocyte production.
ANS: C
Increased attention to skin integrity is necessary when caring for the elderly because of
the loss of protective subcutaneous layers. The tissue of elderly patients is more
susceptible to injury.
DIF: Cognitive Level: Comprehension REF: 239-240

5. Mr. Y awakens during the night confused and disoriented. This may be in part
because of
a. impaired sensation of peripheral receptors.
b. increased nerve impulse conduction resulting in increased anxiety
c. slowing of reaction times from changes in neurotransmitter synthesis and function.
d. inevitable dementia.
ANS: C
Confusion and disorientation in the elderly may be the result of the slowing of reaction
that occurs with changes in neurotransmitter synthesis and function.

OBJ: Nursing Process Step: Diagnosis TOP: Gerontology

6. An elderly patient is admitted to the hospital with acute onset of mental changes and
recent falls. The nurse knows that the most common cause of mental changes is
usually
a. hypoxia.
b. infection.
c. cerebral vascular accident.
d. electrolyte imbalance.
ANS: B
Infections commonly present with acute changes in mental status.
DIF: Cognitive Level: Application REF: 243

OBJ: Nursing Process Step: Diagnosis TOP: Gerontology
7. An elderly patient is started on an angiotensin-converting enzyme inhibitor. The nurse

knows to monitor for
a. hyperkalemia.
b. irregular heart rate.
c. confusion.
d. pulmonary edema.
ANS: A
The decline in kidney function puts the geriatric patient at greater risk for hyperkalemia.

OBJ: Nursing Process Step: Evaluation TOP: Gerontology
8. The nurse is teaching an elderly patient about the signs and symptoms of a
myocardial infarction Which statement by the patient would indicate that the teaching
was effective?
a. “The pain in my chest may last a long time.”
b. “I will feel like I have an elephant sitting on the center of my chest.”
c. “The chest pain will be sharp and over the center of my chest.”
d. “The pain may not be severe and may not be in my chest.”
ANS: D
The elderly may have an alteration in chest pain sensations.


9. Which of the following would be a normal assessment finding for an elderly patient?
a. Inability to remember what was eaten yesterday
b. An increase in resting heart rate
c. Hypoactive bowel sounds
d. Brisk papillary response to light
ANS: A
An elderly person may have problems with short-term memory, but long-term memory is
intact. Resting heart rate decreases. Although gastrointestinal motility changes occur,
bowel sounds remain unchanged. Pupillary response to light slows down.

10. Which of the following sounds may be difficult for an elderly person to hear?
a. Telephone ringing
b. Clothes dryer running
c. Car horn honking
d. Child crying
ANS: B
The elderly have difficulty hearing both low- and high-pitched sounds. A clothes dryer is
a low, rumbling sound; the other sounds are loud.
DIF: Cognitive Level: Analysis REF: 239

11. An elderly patient is admitted to the hospital with a hip fracture. Which of the
following nursing interventions would be a priority?
a. Facilitate frequent deep breathing.
b. Palpate pedal pulses.
c. Perform neurologic checks.
d. Frequently offer liquids to drink.
ANS: A
Although all the items are important, the elderly are more prone to atelectasis and
pulmonary infection because of respiratory changes. Nursing care needs to be provided to
prevent those complications.


12. An elderly patient is starting a new medication that is metabolized in the liver and
excreted by the kidneys. Which is the best assessment to monitor the patient’s ability
to tolerate the medication?
a. Liver function tests
b. Drug side effects
c. Kidney function tests
d. Therapeutic drug levels
ANS: B
It is well documented that the elderly are more prone to drug side effects and adverse
effects. Although the liver's ability to metabolize drugs is decreased, no changes in liver
function test results occur.

13. An elderly patient is receiving a nephrotoxic medication. Which of the following

would be a priority for the nurse to monitor?
a. Electrocardiogram
b. Lung sounds
c. Blood pressure
d. Level of consciousness
ANS: C
Because of the decreased number of nephrons and glomerular filtration rate, an older
patient’s kidneys are more susceptible to damage from nephrotoxic drugs. This is
especially true for those patients with hypotension, which decreases renal blood flow.

14. Which of the following can be a normal assessment finding for an elderly patient?
a. Asymptomatic dysrhythmias
b. Decreased urine output
c. Increased respiratory effort
d. Difficulty problem solving
ANS: A

The majority of elderly patients have dysrhythmias that do not cause problems. All the
other findings are abnormal

15. Which of the following will remain unchanged in an elderly person when he or she
exercises?
a. Cardiac output
b. Heart rate
c. Blood pressure
d. Heart rhythm
ANS: A
Cardiac output remains normal. The maximal heart rate decreases, but the stroke volume
increases to compensate.

COMPLETION
1. Mineral loss associated with a decrease in bone mass is referred to as __________.
ANS:
osteoporosis
Rationale: Mineral loss associated with a decrease in bone mass is referred to as
osteoporosis.
DIF: Cognitive Level: Knowledge REF: 241

OBJ: Nursing Process Step: Diagnosis
TOP: Gerontologic Alterations and Management
2. __________ is characterized initially by short-term memory loss that progresses to

long-term memory loss.
ANS:
Alzheimer’s disease
Rationale: Alzheimer’s disease is characterized initially by short-term memory loss that
progresses to long-term memory loss.

OTHER
1. Which of the following contribute to a higher risk for myocardial ischemia in the
elderly? Select all that apply.
a. Increased diastolic filling pressures
b. Decreased intracellular free calcium
c. Thinning left ventricular wall thickness
d. Increased myocardial collagen content
e. Increased myocardial oxygen consumption
ANS:
a, d, e
Rationale: Increasing myocardial collagen leads to decreased compliance.
Topic: Gerontologic Alterations and Management
DIF: Cognitive Level: Application REF: 227-228

2. The nurse should be alerted for immune deficiencies in the elderly because of which
of the following? Select all that apply.
a. Nutritional deficiencies
b. Presence of chronic illnesses
c. Insertion of invasive devices
d. Decreased total lung capacity
e. Increased peristaltic action in the esophagus
ANS:
a, b, c
Rationale: The elderly are at higher risk for infection because of the likely presence of
protein-calorie malnutrition, poor dentition, swallowing difficulties that can lead to
aspiration, and chronic illnesses that leave the patient in a vulnerable state.
DIF: Cognitive Level: Application REF: 233-234, 237


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Urden: Thelan’s Critical Care Nursing, 5th Edition

Chapter 13: Gerontologic Alterations and Management

1. Age-related changes in myocardial pumping ability may be evidenced by

DIF: Cognitive Level: Comprehension REF: 228

2. Age-related pulmonary changes that may affect Mr. Y include

DIF: Cognitive Level: Comprehension REF: 231

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Knowledge REF: 235

DIF: Cognitive Level: Comprehension REF: 239-240

DIF: Cognitive Level: Comprehension REF: 237

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Application REF: 243

7. An elderly patient is started on an angiotensin-converting enzyme inhibitor. The nurse

DIF: Cognitive Level: Application REF: 240

DIF: Cognitive Level: Application REF: 228

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Application REF: 235

DIF: Cognitive Level: Analysis REF: 239

DIF: Cognitive Level: Analysis REF: 233

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Analysis REF: 238

13. An elderly patient is receiving a nephrotoxic medication. Which of the following

DIF: Cognitive Level: Analysis REF: 244

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Comprehension REF: 228

DIF: Cognitive Level: Application REF: 230

1. Mineral loss associated with a decrease in bone mass is referred to as __________.

DIF: Cognitive Level: Knowledge REF: 241

2. __________ is characterized initially by short-term memory loss that progresses to

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Application REF: 227-228

DIF: Cognitive Level: Application REF: 233-234, 237

Copyright © 2006 Mosby, Inc.

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