Test bank for caring for older adults holistically 5th edition anderson

PTS: 1 KEY: Nursing Process Step: Planning | Patient Care Area: Musculoskeletal8.. PTS: 1 KEY: Nursing Process Step: Planning | Patient Care Area: Visual 10.. PTS: 1 KEY: Nursing Process

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Test bank for Caring for Older Adults Holistically 5th Edition Anderson

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Chapter 16: Common Clinical Problems: Physiological

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1 When an older adult reports problems with urinary incontinence, the primary goal should be to

a Prevent urinary tract infections

b Identify any reversible or treatable cause of the incontinence

c Ensure that the older person is free from any skin breakdown

d Select the type of incontinence pad that would allow the older person the most freedom

and protection 2 The goal of a bladder retraining program is to

a Increase the older person’s awareness of incontinent episodes

b Have the older person void every 2 hours

c Increase the period of time between voiding

d Increase the older person’s awareness of the urge to void

3 The night nurse reports that, during the night, Mrs Sherman fell on the floor at the foot of her bed She was

uninjured but was incontinent of urine and complained that she “could not get to the bathroom because of the side rails being up.” What is the most appropriate nursing intervention to prevent Mrs Sherman from falling again?

a Put the side rails down during the night

b Place a commode next to Mrs Sherman

c Apply a soft waist restraint on Mrs Sherman at night

d Initiate a toileting program for Mrs Sherman

4 The psychological and social impact of incontinence on an older person includes all of the following except

a Withdrawal from social activities

b Dementia

c Depression

d Diminished self-concept

5 One of the most common causes of urinary incontinence in an immobile older person is

a Fecal impaction

b Dietary indiscretions

c Congestive heart failure

d Lack of awareness of the urge to void

6 Diuretics can increase the incidence of urinary incontinence because of

a Their chemical action on the kidneys that decreases the older person’s awareness of the

urge to void

b The increase in urine volume

c The increased potential for older people to be dehydrated while taking these medications

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d Their ability to induce signs and symptoms of diabetes mellitus

7 Passive range of motion for an immobilized older adult

a Replaces the need for ambulation

b Decreases the risk of falls and skin breakdown

c Maintains joint flexibility and delays muscle wasting

d Increases the risk of deep vein thrombosis

8 Michael George, 78 years old, has left-sided hemiplegia related to a cerebrovascular accident (CVA) 1 month

ago He has been very depressed and noncompliant with the physical therapy regimen Which of the

following nursing interventions is important to initiate to prevent immobility for Mr George?

a Force him to participate in the activity program

b Walk him to the bathroom before and after meals and before bedtime

c Refer him to the facility social worker for counseling

d Change his activity program to activities he can do in his wheelchair

9 Which of the following normal aging changes increase an older adult’s risk of falling?

a Decreased cardiac output

b Decreased aerobic reserve

c Visual changes

d Cognitive changes

10 Immobility is a concern for older adults who are a fall risk Which of the following contributes to immobility?

a Fear of falling

b Restorative ambulation program

c Release of safety restraints

d Decreasing psychoactive medications

11 Mary Malone, 84 years old, gets up to go to the bathroom three times a night She has been complaining of

eye problems, extreme fatigue, weakness, unsteadiness, and depression She asks if this can be related to her changed sleep pattern What is the best response to her concerns?

a “As people get older, they need less sleep”

b “Changes in sleeping patterns are a normal aging change”

c “You may be having symptoms of sleep deprivation”

d “Depression usually changes a person’s sleep patterns”

12 Which of the following is not a risk factor for sleep apnea?

a Smoking history

b Hypertension

c Heart disease

d Obesity

13 Hannah Frazier, 87 years old, was admitted to the hospital with dehydration Her family has been concerned

with her increasing forgetfulness at home, but they are very distressed when they come to visit in the evening, and she is trying to climb out of bed and keeps screaming for help Her daughter is very tearful because Mrs Frazier was acting fine at lunch What may be the explanation for this change in behavior?

a Relocation trauma

b Sundown syndrome

c Reaction to medications

d Dehydration

14 An example of an iatrogenic disorder includes

a CVA

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b Pressure ulcers

c Sensory loss

d Diabetes mellitus

15 Immobility is a serious risk factor for older adults Immobility can result in all of the following except

a Bone dissolution

b A decrease in muscle strength equal to 5% per day

c Parkinson’s disease

d Joint stiffness and decreased range of motion

16 Physical exercise affects the cardiovascular system by

a Decreasing cardiac response to activity

b Increasing cardiac output

c Decreasing cardiac efficiency

d Maintaining pulse rate in response to activity

17 The most significant and overlooked nursing intervention to promote functional ability for an older adult is to

a Decrease stressors

b Promote fluids

c Ensure safety

d Maintain and improve mobility

18 Stress incontinence is

a More common in men

b Most common in long-term care facilities

c A sudden loss of small amounts of urine when coughing, laughing, or lifting

d Caused by bladder obstruction

19 Mr Howe is an immobile 79-year-old man He is complaining of leaking urine and constipation Mr Howe

probably has

a A fecal impaction, causing overflow incontinence

b Diabetes

c Congestive heart failure

d Alzheimer’s disease

20 The advantage of passive range of motion (ROM) for an older adult is to

a Decrease the risk of skin breakdown

b Decrease the need for ambulation

c Maintain joint flexibility and decrease muscle wasting

d Cure deep vein thrombosis

21 Patients with Parkinson’s disease frequently have a shuffling gait and use assistive devices for ambulation

These individuals have a high fall risk because of

a Their gait and balance

b Ability to use their walker and mental status

c Posture and mental status

d Posture and ability to use their walker

22 Which situation would not increase an older adult’s fall risk?

a Having children’s toys and books scattered around the room

b Mood lighting

c Large sunroom with clear path to bedroom and bathroom

d Small bathroom with toilet, sink, and tub

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23 Which of the following statements is false?

a Meat is the most expensive source of protein and iron

b Carbohydrates and fats are filling, less expensive, and equally nutritious as protein

c Vitamin-rich foods are necessary but not necessarily expensive

d Pastas, grains, and breads are examples of carbohydrates

24 Mr Mitchell is 88 years old He refuses to come to meals, and when he does, he cannot sit down long enough

to eat His daughter has commented that his clothes are hanging from his body To improve his nutritional status, you

a Use body restraints for meals

b Increase his food choices

c Call the physician for medication to alter his behavior

d Provide him with sandwiches, small pieces of fruit and cheese, and spill-proof drink

containers 25 Alterations in mobility result primarily from problems with which of the following body systems?

a Respiratory system

b Cardiovascular system

c Musculoskeletal system

d All of the above

26 The mnemonic DRIP aids in remembering possible causes of acute incontinence The letters refer to all of the

following except

a Delirium

b Renal stones

c Infection

d Pharmaceutical and psychological

27 Causes of constipation in an older adult may include all of the following except

a Aluminum-containing antacids

b Diuretics

c Antibiotics

d Sedatives

28 What percentage of nursing home residents with pressure ulcers die from them?

a 25%

b 66%

c 10%

d 40%

29 A stage III pressure ulcer is characterized by

a Full-thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle,

bone, or supporting tissue

b Partial-thickness skin loss involving the epidermis or dermis

c Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue down to,

but not involving, the fascia

d A nonblanchable erythema

30 Care of pressure ulcers should include all of the following except

a Frequent change of position

b Daily bath

c Adequate nutrition

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d Use of gel-filled mattresses

31 An example of an iatrogenic disorder is

a A broken hip caused by falling after taking a sedative to help with sleeping

b Community-acquired pneumonia

c CVA

d URI

True/False

Indicate whether the statement is true or false.

1 Older adults with an acute illness should be put on prolonged bed rest to promote healing

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Chapter 16: Common Clinical Problems: Physiological

Answer Section

MULTIPLE CHOICE

1 ANS: B

Causes of incontinence—such as urinary tract infections, enlargement of the prostate, and inability to get to the bathroom in time to void—all can be reversed with nursing or medical intervention Responses A, C, and

D all are nursing interventions for an older adult experiencing incontinence

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Genitourinary

2 ANS: C

Bladder retraining attempts to increase the capacity of the bladder and increase the time between voiding Responses A, B, and D all can be components of various bladder programs but are not specific to a bladder retraining program

3 ANS: D

Toileting programs can reduce the incidence of an older adult’s attempting to go into the bathroom without assistance Removing side rails (response A) and using restraints (response C) are not good choices

Commonly, older adults who are restrained have an increased incidence of incontinence Lowering the side rails and placing a commode at the bedside (response B) would improve the older adult’s access to toileting facilities but would not decrease the older adult’s risk of falling

4 ANS: B

Urinary incontinence does not cause dementia, but many demented older adults have problems with

incontinence Responses A, C, and D are noted with older adults who are incontinent

PTS: 1 KEY: Nursing Process Step: Planning | Patient Care Area: Genitourinary

5 ANS: A

Fecal impaction, a large amount of stool in the bowel, increases intra-abdominal pressure and places pressure

on the bladder, causing urinary incontinence Dietary indiscretions (response B) and congestive heart failure (response C) are not causes of urinary incontinence Lack of awareness of the urge to void (response D) is not caused by immobility

6 ANS: B

The diuretic effect of diuretic medications causes an increase in urine output Although diuretics can

contribute to dehydration (response C), they do not cause urinary incontinence Responses A and D are incorrect Diuretics do not induce diabetes mellitus or change the awareness of the urge to void

7 ANS: C

Passive range of motion helps to maintain joint flexibility and delay muscle wasting associated with

immobility Passive range of motion does not replace the need for ambulation (response A), decrease the risk

of falls or skin breakdown (response B), or increase the risk of deep vein thrombosis (response D)

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PTS: 1 KEY: Nursing Process Step: Planning | Patient Care Area: Musculoskeletal

8 ANS: B

Ambulating Mr George daily would facilitate his mobility, even if he is not following the physical therapy program Forcing Mr George to participate in the physical therapy program (response A) is inappropriate if

he chooses not to participate Referral to the social worker (response C) and providing him with activities that

he can do in his wheelchair (response D) are appropriate nursing interventions but would not prevent

immobility

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Musculoskeletal

9 ANS: C

Decreased night vision and accommodation, decreased visual acuity, and decreased peripheral vision place an older adult at risk for falling Responses A, B, and D are normal aging changes that do not have a direct effect

on the risk of falling

PTS: 1 KEY: Nursing Process Step: Planning | Patient Care Area: Visual

10 ANS: A

When an older adult fears falling, he or she becomes more sedentary and risks becoming immobile

Responses B, C, and D all are activities that decrease risk of falls and immobility

11 ANS: C

The symptoms that Mrs Malone reports and the increased nocturia make sleep deprivation a clear concern This response also provides the opportunity to refer her to a physician to treat the nocturia and discuss

possible ways to promote rest and sleep Responses A, B, and D are true, but they are not sensitive to Mrs Malone’s concerns and the seriousness of her symptoms

PTS: 1 KEY: Nursing Process Step: Assessment | Patient Care Area: Mental health

12 ANS: A

A history of smoking is not a reported risk factor for sleep apnea Hypertension (response B), heart disease (response C), and obesity (response D) all are risk factors for the development of sleep apnea

PTS: 1 KEY: Nursing Process Step: Assessment | Patient Care Area: Respiratory

13 ANS: B

Sundown syndrome is an unexplained exacerbation of confusion in the evening and nighttime hours

Relocation (response A), medication side effects (response C), and dehydration (response D) all can increase confusion The difference that defines this problem as sundown syndrome is the increased confusion at the end of the day

PTS: 1 KEY: Nursing Process Step: Assessment | Patient Care Area: Mental health

14 ANS: B

This question is easily answered if you are clear on the definition of iatrogenic disorders They are disorders that a patient acquires as a result of receiving treatment by a physician, nurse, or other member of the

health-care team An iatrogenic disorder also can occur when a patient does not receive a treatment when it was indicated or receives an incorrect treatment

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

15 ANS: C

Parkinson’s disease is affected by immobility, but it is not caused by immobility

PTS: 1 KEY: Nursing Process Step: Nursing Assessment | Patient Care Area: Musculoskeletal

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16 ANS: B

Physical exercise increases cardiac output Immobility prevents physical activity from creating increased cardiac output Responses A, C, and D are incorrect

PTS: 1 KEY: Nursing Process Step: Planning | Patient Care Area: Cardiovascular

17 ANS: D

An upright position promotes increased bone mass, muscle strength, and psychological well-being

Maintaining and improving mobility is essential Fluids, safety, and stressors are important, but they do not increase functional ability

18 ANS: C

Stress incontinence is a sudden loss of small amounts of urine when coughing, laughing, or lifting It is more common in women than in men, often as a result of damage to the pelvic floor muscles during childbirth (response A) Urge incontinence, not stress incontinence, is most common in long-term care facilities, where individuals may not get the immediate help they need (response B) Overflow incontinence is caused by bladder outlet obstruction creating impaired emptying (response D)

19 ANS: A

A fecal impaction causes a bladder outlet obstruction, which can cause overflow urinary incontinence Signs and symptoms include constipation and frequent dripping urine Responses B, C, and D are incorrect

PTS: 1 KEY: Nursing Process Step: Assessment | Patient Care Area: Genitourinary

20 ANS: C

Passive ROM delays muscle wasting and maintains joint mobility (response C) Nothing can replace the need for ambulation (response B), although it is not always possible Passive ROM may decrease the risk of skin breakdown (response A) as blood circulation improves, but it is not always the primary benefit Response D is incorrect; ROM activities cannot cure deep vein thrombosis

21 ANS: A

Shuffling gait, caused by the inability to lift the foot totally off the floor for each step, and lack of balance place these patients at a high risk for falls Although posture may be stooped and mental status may be cloudy (response C), these would not affect the fall risk Ability to use a walker may affect fall risk, but it would decrease it

PTS: 1 KEY: Nursing Process Step: Assessment | Patient Care Area: Musculoskeletal

22 ANS: C

Poor lighting, clutter, and narrow spaces increase an older adult’s risk of falling Large, bright, open spaces allow for greater ease of mobility

PTS: 1 KEY: Nursing Process Step: Planning | Patient Care Area: Safety

23 ANS: B

Carbohydrates and fats are not as nutritious as proteins Responses A, C, and D are true statements

PTS: 1 KEY: Nursing Process Step: Assessment | Patient Care Area: Nutrition

24 ANS: D

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Restraining (response A) or medicating (response C) would not increase his nutritional intake Offering more choices (response B) may or may not be beneficial Carrying his food and drink with him adjusts his meals to accommodate for his behaviors and probably would be effective

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Nutrition

25 ANS: D

The process of aging, combined with the presence of any chronic diseases, places an older adult at risk for immobility and its consequences Normal aging changes and any disorders affecting the musculoskeletal, cardiovascular, and respiratory systems are major causes of immobility Changes in vision are also important factors contributing to immobility

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Mobility

26 ANS: B

Renal stones (response B) do not contribute to incontinence Delirium, restricted mobility, infection, and pharmaceutical or psychological concerns contribute to incontinence

27 ANS: C

Antibiotics do not generally contribute to constipation; they contribute to diarrhea Certain antacids, diuretics, and sedatives, along with other drugs, can lead to constipation

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Gastrointestinal

28 ANS: B

Approximately 66% of residents in nursing homes who develop pressure ulcers die Pressure ulcers are a very serious health problem that can lead to pain, prolonged hospital stays, and infection

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Integumentary

29 ANS: C

A stage III pressure ulcer manifests as a deep crater It involves full-thickness skin loss involving damage to

or necrosis of subcutaneous tissue down to, but not involving, the fascia Response A describes a stage IV pressure ulcer; response B, a stage II pressure ulcer; and response D, a stage I pressure ulcer

30 ANS: B

Older adults do not need daily baths Excessive bathing and rubbing while drying can damage the skin

31 ANS: A

An iatrogenic disorder occurs as a result of a treatment by a physician, nurse, or other member of the

interdisciplinary team or from incorrect or nonexistent treatment The sedative made the patient groggy, resulting in a fall and broken hip Although URI can be iatrogenic, resulting from catheter use, it may also have other causes CVA and community-acquired pneumonia are incorrect responses

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Not applicable

TRUE/FALSE

1 ANS: F

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In contrast to a younger patient, an older adult who is on bed rest deteriorates rapidly and may develop irreversible complications, such as pneumonia, contractures, thrombophlebitis, constipation, dehydration, and psychological problems related to depression and sensory deprivation

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Rest

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