ATI 2.0 GERONTOLOGY EXAM 2020 N212
1. A nurse is providing teaching to an older adult client who has osteoarthritis of the right hip and lower lumbar
... [Show More] vertebrae. Which of the following statements by the client indicates an understanding of the teaching?
A- I should avoid the use of a heating pad on my back
B- to relieve the pressure on my hip, I can use a cane while ambulating
C- I will have steroid injections to my joint has the first medication of choice to treat my pain
D- I will exercise even when it causes pain Answer- b
Using a cane as an assistive device enables the client to compensate for weakness in the spine by providing some relief of hip pressure. Use of a cane can provide joint support and safety for self-care activities.
A- The use of heat and cold are therapeutic treatments in the management of arthritic pain. The preference of the client drives the decision between the two therapies.
C- Acetaminophen is the first medication of choice to treat the older adult client’s pain from osteoarthritis. The nurse should instruct the client to take the medication as prescribed and not to wait until the pain is severe. Steroid joint injections are used for persistent and disabling pain in the joints.
D- The nurse should teach the client to not exercise if exercise causes pain. Goals for clients who have osteoarthritis include balancing rest with activity and avoiding activities that cause pain or discomfort. Consistent activity is not beneficial for a client who has an arthritic joint disease because it can produce further damage to the joints and tissues.
2. A nurse is admitting an older adult client who fell at home 3 days ago. The client has a fractured hip, malnutrition, and dehydration. Which of the following laboratory values, noted on admission, should indicate to the nurse prolonged malnutrition?
A- Increased sodium
B- decreased albumin
C- increased BUN
D- decrease blood glucose
Answer- b
Decreased albumin is indicative of inadequate protein intake, which is a common finding in a client who has prolonged malnutrition.
A- Increased sodium is indicative of dehydration, which is due to a fluid volume deficit. C- Increased BUN is indicative of renal failure, or dehydration, which is due to a fluid volume deficit.
D- Decreased blood glucose is indicative of inadequate intake of glucose, which is a manifestation that can occur rapidly in any client who has not eaten in several days. It is not indicative of prolonged malnutrition.
3. A nurse is planning care for an older adult client following abdominal surgery for a bowel obstruction. Which of the following information about pain management should the nurse consider when planning care?
A- Older adult clients have a diminished capacity to perceive pain
B- older adult clients should not take narcotics for pain control
C- older adult clients have increased pain as a normal part of aging
D- older adult clients are sensitive to the analgesic effects of opiates
Answer- d
An older adult client is likely to require a decreased dose of opiates to provide the same level of analgesia as a younger client, with a reduced risk of side effects.
A- Older adults do not have a diminished capacity to perceive pain. However, older adult clients might have developed excellent coping skills that make it difficult to observe for cues of pain.
B- The nurse can administer narcotic medications safely to older adult clients. Although older adult clients might be more sensitive to narcotics, it does not justify withholding narcotic medication for pain control.
C- Pain is not an expected finding of the aging process. The nurse should assess, diagnose, and manage pain in older adult clients similar to any other client, regardless of age.
4. A nurse and Ophthalmology Clinic is assessing a client referred by the provider for a potential cataract. Which of the following clients report should the nurse recognize is consistent with cataracts?
A- Halos when looking at lights
B- loss of peripheral vision
C- bright flashes of light and floaters
D- eye strain and headache with close work
Answer- a
A cataract is a cloudy or opaque area in the lens of the client's eye. Cataracts in adults usually develop with advancing age and can be hereditary. Cataracts develop slowly and painlessly with a gradual onset of difficulty with vision.
Visual problems include difficulty seeing at night, halos around lights or glare sensitivity, and decreased visual acuity, even in daylight.
Cataracts are accelerated by environmental factors, such as cigarette smoke or other toxic substances, or in response to metabolic diseases, such as diabetes mellitus.
B- Loss of peripheral vision is an initial report by a client who has open-angle glaucoma. Glaucoma is a condition characterized by increased fluid pressure inside the eye, called intraocular pressure. This increased pressure damages the optic nerve, causing partial vision loss, with blindness as a possible outcome.
C- Bright flashes of light, especially in the peripheral visual field, and floaters are associated with retinal detachment. Retinal detachment refers to the separation of the light-sensitive membrane in the back of the eye from its supporting layers. Trauma, the aging process, severe diabetes mellitus, or an inflammatory disorder can cause retinal detachment, but it frequently occurs spontaneously.
D- Eyestrain and headache with close work is associated with decreased visual acuity. Both nearsightedness, which is an error of visual focusing that makes distant objects appear blurred, and farsightedness, which is an age-associated progressive loss of the focusing power of the lens that results in difficulty seeing objects close-up, can cause eyestrain and headache. Changes in visual acuity may represent primary eye disease, aging, eye trauma, or a generalized, systemic, illness, but whatever the cause, the nurse should not ignore visual changes. Decreased vision is a significant threat to the quality of life of older adult clients.
5. The nurse at an assisted living center is conducting an orientation session for a group of newly hired assistive Personnel AP. Which of the following instructions should the nurse include regarding clients who are hearing impaired?
A- Maintain eye contact with the clients
B- stand to one side of the clients and speak into their good ears
C- speak loudly with exaggerated enthusiasm
D- ask only questions with yes or no answers
Answer- a
Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. Maintaining eye contact and speaking slowly will promote lip-reading.
B- Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. Speaking to one side of the client will not give him the ability to use lip-reading or see gestures.
C- Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. The client can hear better when the nurse speaks in a moderate tone of voice.
D- This is not a helpful action. To respond, even with just a yes or no, the clients must be able to hear or understand what is being said to them.
6. A nurse is caring for an older adult client who has moderate hearing loss. Which of the following actions should the nurse take to enhance communication?
A- Speak with exaggerated lip movements
B- speak at a moderate rate
C- speak in a louder voice
D- speak using a higher pitch
Answer- b
The nurse should slow the rate of speech for an older adult client who has hearing loss. However, the nurse should not speak with an exaggerated slowness because this can distort words and make it difficult for the client to understand.
A- The nurse should avoid using exaggerated lip movement as this distorts sounds and might make lip reading more difficult for the client.
C- The nurse should speak in a normal voice when working with an older adult client. A louder voice can distort words, making them more difficult to understand.
D- The nurse should use a medium or lower pitch when speaking with an older adult client. Higher pitches are more difficult to understand for the individual who has hearing loss.
7. A nurse is caring for a client who is using a continuous passive motion CPM device following a right total knee replacement. Which of the following actions should the nurse take when applying the CPM device?
A- Apply the CPM device in the flex position
B- line up the frame joints of the CPM device with the clients knee
C- check the range of motion settings on the CPM device daily
D- place the head of the clients bed at 45 degrees during CPM use
Answer- b
To avoid damage to the operative knee, the nurse should line up the joints of the CPM machine with the client’s operative knee.
A- The nurse should apply the CPM device while it is in the extended position for client comfort and to ensure proper placement.
C- The nurse should assess the settings on the CPM device every 8 hr to ensure the appropriate flexion and extension cycle is occurring.
D- The nurse should initially place the client in a supine position when applying the CPM device. Following placement, the nurse should place the head of the bed at 20º if the client is able to tolerate this angle.
8. A public health nurse is planning an immunization clinic for older adults. Which of the following times should an older adult client receive the influenza vaccine? A- Once during the clients lifetime
B- every 10 years
C- every 5 years
D- annually in the fall
Answer- d
The nurse should recommend that older adult clients receive the influenza vaccine annually. Influenza outbreaks occur annually, and the influenza virus changes
constantly. Consequently, an influenza vaccine from a previous year will not protect a client exposed to this year’s influenza strain. Influenza in older adults can result in the development of primary viral influenza pneumonia, which causes several deaths a year. An influenza vaccine given in the fall, prior to the onset of flu season, will be most effective in preventing influenza in this target population.
A- The nurse should recognize that the older adult is at increased risk for developing influenza due to changes in the immune system that occur with age. Prior immunization with the influenza vaccine does not guarantee continued life-long immunity from the illness.
B- The nurse should recognize that the influenza virus changes constantly, eliminating the possibility of long-term immunity.
C- The nurse should recognize that because of constant changes in the influenza virus itself, an immunization received 5 years previous will not protect the client from the illness currently.
9. A nurse is teaching an older adult client about osteoporosis. Which of the following statements should the nurse include in the teaching?
A- Cottage cheese is a good source of calcium
B- increase your caffeine intake
C- brisk walking will help prevent bone loss
D- hormone replacement therapy with estrogen will increase your risk of osteoporosis
Answer- c
The nurse should encourage weight-bearing exercises to help minimize bone loss in the older adult client. A sedentary lifestyle, on the other hand, leads to a loss of minerals in the bones, especially calcium and phosphorus.
A- The nurse should include dietary sources of calcium and vitamin D in the teaching. Cottage cheese, however, is not a good source of calcium as it loses the calcium during processing.
B- The nurse should encourage the client to limit caffeine intake because it enhances the excretion of calcium.
D- The nurse should provide information about medications for prevention and treatment of osteoporosis. Estrogen can reduce the fracture rate in women who have osteoporosis, although there are other complications related to its use, such as cancer.
10. A nurse is performing an assessment on an older adult client who has chronic pain. Which of the following effects of unrelieved pain should the nurse identify as a priority finding to report?
A- Impaired mobility
B- decreased Independence
C- decreased self-esteem
D- impaired socialization
Answer- a
The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one positing the greatest threat is the highest priority. The nurse should use Maslow’s hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse should identify that limited mobility will have an effect on the client’s skin integrity, respiratory function, and elimination.
Complications of the immobility resulting from unrelieved pain include pressure ulcers, pneumonia, and constipation.
B- The nurse should address the limitations to the client’s independence that unrelieved pain causes and the increased need for assistance with ADLs because this can negatively impact the client’s self-esteem and well-being; however, there is another finding that is the priority.
C- The nurse should more fully assess the effect that a decrease in self-esteem has on the client as this can negatively affect nutrition, motivation, and well-being; however, there is another finding that is the priority.
D- The nurse should evaluate the impact the impaired socialization has on the client and assist the client in finding ways to regain social contacts since impaired socialization can have a negative effect on mood and cognition; however, there is another finding that is the priority.
11. A nurse is caring for an older adult client who has a hip fracture and is writing his pain at 8 on a scale of 0-10. Which of the following medications should the nurse administer?
A- Capsaicin topical gel
B- oxycodone/acetaminophen 7.5/325 tablet PO
C- Celecoxib 200 mg capsule PO
D- aspirin 325 mg tablet PO
Answer- b
A client who rates his pain as 8 on a scale of 0 to 10 is experiencing severe pain, and the nurse should administer an opioid for this type of pain.
Oxycodone/acetaminophen is a combination of an opioid and a nonopioid analgesic medication and is an appropriate medication to administer to the client. The nurse should monitor the client for adverse effects, such as respiratory depression, and proactively address constipation that occurs with opioid use.
A- The nurse should administer capsaicin topical gel to a client who has minor pain. C- The nurse should administer celecoxib, an NSAID, to treat mild to moderate pain.
D- The nurse should administer aspirin, an NSAID, to treat mild to moderate pain.
12. The nurse is reviewing the medical record of an older adult client. For which of the following medications should the nurse conduct a hearing assessment of the client?
A- Omeprazole
B- ferrous sulfate
C- digoxin
D- Furosemide
Answer- d
Furosemide can cause ototoxicity, especially in the older adult client, because there is a decrease in medication metabolism in the kidneys. The nurse should monitor clients taking ototoxic medications, such as furosemide, and teach the client the signs and symptoms of ototoxicity, such as tinnitus and difficulty hearing.
A- The nurse should monitor the client who is taking omeprazole for bone loss.
B- The nurse should monitor the client who is taking ferrous sulfate for gastrointestinal effects, such as bloating or changes in elimination.
C- The nurse should monitor the client who is taking digoxin for manifestations of hypokalemia, such as muscle weakness.
13. A nurse is teaching an older adult client who had a total hip arthroplasty about ambulating with a standard Walker. Which of the following actions by the client indicates an understanding of the teaching?
A- The client adjust the height of the Walker so the hand grips are at the level of his waist
B- the client moves the Walker ahead about 15.24 CM or 6in and then steps into the Walker
C- the client uses the Walker to pull himself up from a sitting to a standing position
D- the client uses the Walker to climb the stairs
Answer- b
The correct technique for using a walker is to balance on both feet; lift the walker and place it in front; walk into the walker, using it for support when standing on the affected limb; and then balance on both feet before repeating the sequence. This provides maximum support for the client.
A- The nurse should instruct the client that placing the walker at this height will increase the strain on his upper extremities. The client s [Show Less]