Test Bank for Medical-Surgical Nursing, 7th Edition by Lewis

Test Bank for Medical-Surgical Nursing, 7th Edition

by Lewis

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Lewis: Medical-Surgical Nursing, 7th Edition

Test Bank

Chapter 6: Older Adults

MULTIPLE CHOICE

1. While obtaining a health history from a 68-year-old patient, the nurse learns that the patient
takes daily supplements of antioxidants beta carotene, selenium, and vitamin E. The nurse
recognizes that the use of these substances in slowing the aging process is related to the
biologic aging theory of
a. telomere-telomerase decrease.
b. free radicals.
c. somatic mutation.
d. programmed cell death.

Correct Answer: B
Rationale: Research has focused on the use of antioxidants to slow the oxidative process caused
by free radicals. Use of antioxidants is not proposed as a treatment for telomere-telomerase
decreases, somatic mutation, or programmed cell death.

Cognitive Level: Application Text Reference: p. 69

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

2. Which question will provide the most useful information when the nurse is performing a
comprehensive geriatric assessment of an older adult who is being assessed for admission to
an assisted-living facility?
a. “Do you have a history of heart disease?”
b. “Are you able to prepare your own meals?”
c. “Have you had any recent infections?”
d. “How frequently do you see a doctor?”

Correct Answer: B
Rationale: The patient’s functional abilities, rather than the presence of acute or chronic illness,
are more useful in determining how well the patient might adapt to the assisted-living situation.
The other questions will also provide helpful information but are not as useful in providing a
basis for determining patient needs or for developing interventions for the older patient.

Cognitive Level: Application Text Reference: pp. 71, 77

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-2

3. As the home health nurse is teaching a 72-year-old patient who lives alone about a new
medication, the patient replies “I just don’t learn new information like I used to.” The nurse
will plan to
a. schedule the patient for daily visits for medication administration.
b. teach the patient’s family members to give the medications.
c. spend more time discussing the medications with the patient.
d. tell the patient it is not safe to take medications independently.

Correct Answer: C
Rationale: The process of learning new information is slower in older adults, but there is no
indication that the patient will be unable to learn about the new medications. Because the patient
is living independently, there is no indication that medication administration needs to be done by
the nurse or by family members. There are no data to indicate that self-management of
medications by this patient is not safe.

Cognitive Level: Application Text Reference: p. 79

Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

4. The home health nurse is developing a care plan for an alert and active 85-year-old patient
who takes multiple medications for chronic cardiac and respiratory disease. The patient lives
with family members who work during the day. An appropriate nursing diagnosis is
a. social isolation related to weakness and fatigue.
b. caregiver role strain related to need to adjust family employment schedule.
c. risk for injury related to drug-drug interactions.
d. compromised family coping related to the patient’s many care needs.

Correct Answer: C
Rationale: The patient’s age and multiple medications indicate a risk for injury caused by
interactions between the multiple drugs being taken and a decreased drug metabolism rate.
Because the patient is alert and active, the diagnoses in responses 1 and 4 are not appropriate for
the patient or family. There is no indication that the family’s employment schedule should be
changed to accommodate the needs of this patient.

Cognitive Level: Application Text Reference: pp. 80-81

Nursing Process: Diagnosis
NCLEX: Health Promotion and Maintenance

5. To obtain the most complete information when doing an assessment for an 81-year-old
patient, the nurse will
a. review the patient’s chart for the history of medical problems.
b. interview both the patient and the primary patient caregiver.
c. use a geriatric assessment instrument to evaluate the patient.
d. ask the patient to write down medical problems and medications.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-3

Correct Answer: C
Rationale: The most complete information about the patient will be obtained through the use of
an assessment instrument specific to the geriatric population, which will include information
about both medical diagnoses and treatments and about functional health patterns and abilities. A
review of the chart, interviews of the patient and caregiver, and written information by the
patient will all be included in a comprehensive geriatric assessment.

Cognitive Level: Application Text Reference: p. 77

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

6. When developing the plan of care for an older adult who is hospitalized for an acute illness,
the nurse should
a. use a standardized geriatric nursing care plan.
b. plan for likely long-term-care transfer to allow additional time for recovery.
c. consider the preadmission functional abilities when setting patient goals.
d. minimize activity level during hospitalization.

Correct Answer: C
Rationale: The plan of care for older adults should be individualized and based on the patient’s
current functional abilities. A standardized geriatric nursing care plan is unlikely to address
individual patient needs and strengths. A patient’s need for discharge to a long-term-care facility
is variable. Activity level should be designed to allow the patient to retain functional abilities
while hospitalized and also to allow any additional rest needed for recovery from the acute
process.

Cognitive Level: Application Text Reference: pp. 78-80

Nursing Process: Planning
NCLEX: Health Promotion and Maintenance

7. When caring for an older adult who lives in a rural area, the nurse will plan to
a. assess the patient for chronic diseases that are unique to rural areas.
b. ensure that the patient has transportation to appointments with the health care
provider.
c. obtain adequate medications for the patient to last for 4 to 6 months.
d. suggest that the patient move to an urban area for better health care.

Correct Answer: B

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-4

Rationale: Transportation can be a barrier to accessing health services in rural areas. There are
no chronic diseases unique to rural areas. Because medications may change, the nurse should
help the patient plan for obtaining medications through alternate means such as the mail or
delivery services, not by purchasing large quantities of the medications. The patient living in a
rural area may lose the benefits of a familiar situation and social support by moving to an urban
area.

Cognitive Level: Application Text Reference: p. 70

Nursing Process: Planning
NCLEX: Health Promotion and Maintenance

8. To help prevent drug-drug interactions in an older adult patient taking many medications, the
most appropriate instruction by the nurse is,
a. “Do not take any over-the-counter (OTC) drugs with your prescription drugs.”
b. “Be sure to have all of your prescriptions filled at the same pharmacy.”
c. “Bring all the medications, supplements, and herbs that you use to every health
care appointment.”
d. “Use a medication reminder system so that you won’t forget to take your
medications as scheduled.”

Correct Answer: C
Rationale: The most information about drug use and possible interactions is obtained when the
patient brings all prescribed medications, OTC medications, and supplements to every health
care appointment. The patient should discuss the use of any OTC medications with the health
care provider and obtain all prescribed medications from the same pharmacy, but these
interventions alone will not prevent drug-drug interactions between prescribed drugs, OTC
drugs, and any herbal supplements. Use of a medication reminder system will help the patient
take medications as scheduled but will not prevent drug-drug interactions.

Cognitive Level: Application Text Reference: p. 80

Nursing Process: Implementation
NCLEX: Physiological Integrity

9. The home health nurse is making an 8:00 AM visit to a confused older patient who lives with
a daughter. Which information most indicates a need for further action by the nurse?
a. The patient is unable to remember the nurse’s name.
b. The patient has not yet taken the daily medications.
c. The patient is weaker than on the previous visit.
d. The patient’s daughter asks about respite services.

Correct Answer: C

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 6-5

Rationale: A change in physical status may indicate an acute medical problem such as infection
or elder abuse or neglect. Inability to remember caregiver names is not unusual in confused
patients and simply indicates a need for reintroduction by the nurse. Because it is early in the
day, the patient may take the medications later. The question about respite services does indicate
a need for further action, but this would not be as urgent as the need to assess the patient for
physiologic changes.

Cognitive Level: Application Text Reference: pp. 71, 73

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

10. Ageism is an important concept for the nurse to understand because it

a. provides statistical information regarding the older population.
b. promotes consideration of the diversity of the older population.
c. may lead to poorer health care for older individuals.
d. increases social awareness of the needs of older people.

Correct Answer: C
Rationale: Negative attitudes about aging may lead to disparities in the way older patients are
treated. The concept does not describe statistics about older individuals; consider the diversity of
the older population, or increase the awareness of the needs of the older population.

Cognitive Level: Comprehension Text Reference: p. 67

Nursing Process: Assessment NCLEX: Psychosocial Integrity

11. An alert and well-oriented 78-year-old patient with multiple health problems rarely gets out
of bed and complains of having “no energy” and feeling increasingly weak. The patient has
had an 11-pound weight loss over the last year. The nurse should initially
a. ask the patient about daily dietary intake.
b. schedule regular range-of-motion exercise.
c. discuss long-term care placement with the patient.
d. describe normal changes with aging to the patient.

Correct Answer: A
Rationale: In the frail elderly patient, nutrition is frequently compromised, and the nurse’s
initial action should be to assess the patient’s nutritional status. Active range-of-motion may be
helpful in improving the patient’s strength and endurance, but nutritional assessment is the
priority because the patient has had a significant weight loss. The patient may be a candidate for
long-term-care placement, but more assessment is needed before this can be determined. The
patient’s assessment data are not consistent with normal changes associated with aging.

Cognitive Level: Application Text Reference: p. 71

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 6-6

12. When admitting an 88-year-old patient to the hospital, the nurse should plan to
a. interview the patient before the physical assessment.
b. speak slowly and loudly while facing the patient.
c. determine whether the patient uses glasses or hearing aids.
d. obtain a detailed medical history from the patient.

Correct Answer: C
Rationale: Assistive devices should be in place before assessing the patient to minimize anxiety
and confusion. When a patient is acutely ill, the physical assessment should be accomplished
first to detect any physiologic changes that require immediate action. Not all older patients have
hearing deficits, and it is insensitive of the nurse to speak loudly and slowly to all older patients.
To avoid tiring the patient, much of the medical history can be obtained from medical records.

Cognitive Level: Application Text Reference: p. 77

Nursing Process: Planning
NCLEX: Health Promotion and Maintenance

13. The nurse is planning discharge for an alert, homeless 70-year-old with a chronic foot
infection and poorly controlled diabetes. The most appropriate intervention by the nurse is to
a. teach the patient how to assess and care for the foot infection.
b. refer to social services for placement in a low-income assisted living facility.
c. give the patient written information about shelters and meal sites.
d. schedule the patient to return to outpatient services for foot and diabetes care.

Correct Answer: B
Rationale: A common reason for homelessness in older adults is the lack of affordable housing.
Assisted-living facilities provide both housing and health care assistance for older adults. Even
with appropriate education, a homeless individual may not be able to maintain adequate foot and
diabetes care because of a lack of supplies or a suitable place to accomplish care. Older homeless
individuals are less likely to use shelters or meal sites. A homeless person may fail to keep
appointments for outpatient services because of lack of transportation or inability to keep track of
dates or times.

Cognitive Level: Application Text Reference: pp. 70-71

Nursing Process: Implementation NCLEX: Physiological Integrity

14. The home health nurse is caring for a 71-year-old patient who lives alone and is taking seven
different prescribed medications for chronic health problems. The nurse will plan to
a. use a marked pillbox to set up the patient’s medications.
b. discuss the option of moving to an assisted-living facility.
c. call the health care provider about stopping some of the medications.
d. visit the patient daily to administer the medications.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 6-7

Correct Answer: A
Rationale: The use of medication reminder devices is helpful when older adults have multiple
medications to take. There is no indication that the patient needs to move to assisted living.
Because the average 70-year-old takes seven medications and the medications have been
prescribed for the patient’s health problems, discontinuing the medications is not appropriate.
Home health care is not designed for the patient who needs ongoing assistance with activities of
daily living (ADLs) or instrumental ADLs (IADLs).

Cognitive Level: Application Text Reference: p. 81

Nursing Process: Planning NCLEX: Physiological Integrity

15. When assessing a 68-year-old Latina patient who has diabetes, which question will the nurse
ask in determining the impact of ethnicity on the patient’s health care choices?
a. “Who helps you with your care at home?”
b. “How do you pay your medical bills?”
c. “What do you think helps people get better?”
d. “Which type of insulin do you use?”

Correct Answer: C
Rationale: This question encourages the patient to discuss any special ethnic beliefs about
practices, medications, foods, etc., that might be used to maintain or improve health. The
information about who cares for the patient does not address the patient’s health care choices.
Ethnicity does not have an impact on how the patient pays health care bills. The type of insulin
used is not impacted by ethnicity.

Cognitive Level: Application Text Reference: p. 72

Nursing Process: Assessment NCLEX: Psychosocial Integrity

16. A 42-year-old who is providing home care for a parent tells the nurse, “I don’t feel
comfortable giving Mom her medications yet, but I think I will be able to do it with a little
more practice.” Which nursing diagnosis is most appropriate?
a. Caregiver role strain related to inability to safely give medications
b. Anxiety related to lack of confidence
c. Risk for situational low self-esteem
d. Readiness for enhanced therapeutic regimen management

Correct Answer: D
Rationale: The caregiver’s statement indicates an interest in learning the new skill and
confidence that it can be learned, consistent with the diagnosis of readiness of enhanced
therapeutic management. There is no indication of caregiver role strain, anxiety related to lack of
confidence, or low self-esteem.

Cognitive Level: Application Text Reference: p. 73

Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 6-8

17. Which information obtained by the home health nurse when making a visit to an 88-year-old
with mild forgetfulness is of concern?
a. The patient’s son uses a marked pillbox to set up the patient’s medications weekly.
b. The patient has lost 10 pounds (4.5 kg) during the last month.
c. The patient is cared for by a daughter during the day and stays with a son at night.
d. The patient tells the nurse that a close friend recently died.

Correct Answer: B
Rationale: A 10-pound weight loss may be an indication of elder neglect or depression and
requires further assessment by the nurse. The use of a marked pillbox and planning by the family
for 24-hour care are appropriate for this patient. It is not unusual that an 88-year-old would have
friends who have died.

Cognitive Level: Application Text Reference: pp. 71, 73-74

Nursing Process: Assessment NCLEX: Physiological Integrity

18. A confused and agitated 76-year-old patient with a broken arm is brought to the emergency
department by a family member. To determine whether elder abuse is the cause of the
patient’s injury, the nurse should
a. have the family member stay in the waiting area while the patient is assessed.
b. ask the patient how the injury occurred and observe the family member’s reaction.
c. make a referral for a home assessment visit by the home health nurse.
d. notify an elder protective services agency about the possible abuse.

Correct Answer: A
Rationale: The patient should be assessed for clinical manifestations of other injuries, such as
bruising and pressure ulcers and these should be documented and photographed. In addition, the
patient should be interviewed alone because the patient will be unlikely to give accurate
information if the abuser is present. If abuse is occurring, the patient should not be discharged
home for a later assessment by a home health nurse. The nurse needs to collect and document
physiologic data before notifying the elder protective services agency.

Cognitive Level: Application Text Reference: p. 74

Nursing Process: Assessment NCLEX: Physiological Integrity

19. The family of an 85-year-old with chronic health problems and increasing weakness is
considering placing the patient in a long-term care facility. Which action by the nurse will be
most helpful in assisting the patient to make the transition?
a. Have the family select a LTC facility that is relatively new.
b. Obtain the patient’s input about the choice of LTC facility.
c. Ask that the patient be placed in a private room at the facility.
d. Explain the reasons for the need to live in LTC to the patient.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 6-9

Correct Answer: B
Rationale: The stress of relocation is likely to be less when the patient has input into the choice
of facility. The age of the long-term-care facility does not indicate a better fit for the patient or
better quality of care. Although some patients may prefer a private room, others may adjust
better when given a well-suited roommate. The patient should understand the reasons for the
move but will make the best adjustment when involved with the choice to move and choice of
facility.

Cognitive Level: Application Text Reference: p. 76

Nursing Process: Implementation NCLEX: Psychosocial Integrity

20. Which information about a 77-year-old patient who is being assessed by the nurse is of most
concern?
a. The patient takes two or three naps during the day and sleeps about 6 hours at
night.
b. The patient uses five different medications for chronic heart and joint problems.
c. The patient says, “I don’t go on my daily walks since I had pneumonia 3 months
ago.”
d. The patient organizes medications in a marked pillbox “so I don’t forget them.”

Correct Answer: C
Rationale: Inactivity and immobility lead rapidly to loss of function in older adults. The nurse
should develop a plan to prevent further deconditioning and restore function for the patient. A
pattern of taking frequent naps during the day to compensate for shorter nighttime sleep periods
is normal in older adults. On average, a 70-year-old takes seven different medications; the use of
five medications is not unusual for a 78-year-old. The use of memory devices to assist with safe
medication administration is recommended for older adults.

Cognitive Level: Application Text Reference: p. 80

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

21. When admitting a 79-year-old patient who has urinary urgency and a possible urinary tract
infection (UTI), the nurse should first
a. assess the patient’s orientation.
b. inspect for abdominal distension.
c. question the patient about hematuria.
d. invite the patient to use the bathroom.

Correct Answer: D

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-10

Rationale: Before beginning the assessment of an older patient with a UTI and urgency, the
nurse should have the patient empty the bladder because bladder fullness or discomfort will
distract from the patient’s ability to provide accurate information. The patient may seem
disoriented if distracted by pain or urgency. The physical assessment data are obtained after the
patient is as comfortable as possible.

Cognitive Level: Application Text Reference: p. 77

Nursing Process: Assessment NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Which nursing actions will the nurse take to assess for possible malnutrition in a 69-year-old
patient? (Select all that apply.)
a. Review laboratory results.
b. Ask about transportation needs.
c. Determine food likes and dislikes.
d. Observe for depression.
e. Assess teeth and oral mucosa.
f. Question about salt use.

Correct Answer: A, B, D, E
Rationale: The laboratory results, especially albumin and cholesterol levels, may indicate
chronic poor protein intake or high-fat/cholesterol intake. Transportation impacts patients’ ability
to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in poor
condition may decrease the ability to chew and swallow. Food likes and dislikes are not
necessarily associated with malnutrition. Salt intake does not impact nutritional status.

Cognitive Level: Application Text Reference: p. 71

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

2. Appropriate approaches used by the long-term care nurse to provide teaching to a 73-year-
old who has just been diagnosed with diabetes include which of the following? (Select all
that apply.)
a. Schedule a visit by another resident who is diabetic.
b. Demonstrate food choices using food photographs.
c. Avoid discussion of the patient’s favorite foods.
d. Remind the patient that a lot of damage has already occurred.
e. Encourage the patient’s family to participate in teaching sessions.
f. Ask the patient about past experiences with lifestyle changes.

Correct Answer: A, B, E, F

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank for Medical-Surgical Nursing, 7th Edition by Lewis

Test Bank 6-11

Rationale: Strategies to promote learning in older adults include peer teaching, visual aids,
family participation, and relating new learning to past experiences. Discussion of the patient’s
favorite foods is needed to determine how old favorites can be adapted to the new diet.
Reminders about the damage already done will indicate that the changes are not worth the effort.

Cognitive Level: Application Text Reference: p. 79

Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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