Test bank of Basic Geriatric Nursing 6e Williams

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Basic Geriatric Nursing 6e Williams

Chapter 06: Maintaining Fluid Balance and Meeting Nutritional Needs

Test Bank

 

MULTIPLE CHOICE

 

  1. What is the lowest recommended daily caloric intake needed to safely meet the nutritional needs of the older adult?
a. 1000
b. 1200
c. 1400
d. 1800

 

 

ANS:  B

The minimal caloric intake for the older adult that will meet nutritional needs is 1200 calories.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 103            OBJ:   2

TOP:   Minimal Calorie Intake                   KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. How often does the MyPlate guidelines recommend physical activity occur?
a. Twice a week
b. Weekly
c. Three times a week
d. Every day

 

 

ANS:  D

The MyPlate guidelines of the USDA recommend that the general population make physical activity an everyday occurrence.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 103            OBJ:   8

TOP:   MyPyramid    KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse recommends that the older patient eat chicken and fish because they contain complete proteins. What is present in complete proteins?
a. Molecules of carbohydrate
b. All the essential amino acids
c. A high fat content
d. A soluble fiber

 

 

ANS:  B

Fish and lean chicken have all the essential amino acids and very little fat content, unlike red meat.

 

DIF:    Cognitive Level: Analysis               REF:   p. 105            OBJ:   2

TOP:   Complete Protein                            KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What makes up high-density lipoproteins (HDL)?
a. Mainly proteins
b. Mostly triglycerides
c. Mainly cholesterol
d. A variety of minerals

 

 

ANS:  A

HDLs are made up primarily of proteins, as opposed to lipids such as triglycerides, which are found in very-low-density lipoproteins (VLDLs) and cholesterol, which is found in low-density lipoproteins (LDLs).

 

DIF:    Cognitive Level: Knowledge          REF:   p. 106            OBJ:   1

TOP:   High-Density Lipoproteins             KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient on a fat-restricted diet is noted to have developed a pressure ulcer and decreased visual acuity. What vitamin deficiency should the nurse suspect?
a. A
b. B6
c. B12
d. C

 

 

ANS:  A

Vitamin A is a fat-soluble vitamin and helps with wound healing and night vision acuity. Persons on low-fat diets may not be able to metabolize vitamin A from food sources because of the decreased fat in their diet.

 

DIF:    Cognitive Level: Analysis               REF:   p. 106            OBJ:   6

TOP:   Vitamin A Deficiency                    KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The home health nurse does an ongoing assessment of the patient who has had a subtotal gastrectomy. What vitamin deficiency should the nurse monitor for?
a. A
b. B6
c. B12
d. C

 

 

ANS:  C

Vitamin B12 is generated from the digestion of protein in the stomach. If part of the stomach is gone (gastrectomy), there is less digestive potential for vitamin B12.

 

DIF:    Cognitive Level: Analysis               REF:   p. 106            OBJ:   3

TOP:   Vitamin B12 Deficiency                 KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient is receiving an iron preparation in capsule form. What should the nurse administer the iron preparation with in order to improve absorption?
a. Orange juice
b. Milk products
c. Water
d. Caffeine drinks

 

 

ANS:  A

Vitamin C, which can be found in orange juice, improves the absorption of iron.

 

DIF:    Cognitive Level: Application          REF:   p. 108            OBJ:   8

TOP:   Iron Administration                        KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The nurse caring for the older adult patient who is taking a diuretic for control of hypertension should monitor the patient closely for signs of which of the following?
a. Hypokalemia
b. Hypocalcemia
c. Hyponatremia
d. Hyperkalemia

 

 

ANS:  A

Diuretics deplete the body of potassium, a necessary mineral.

 

DIF:    Cognitive Level: Application          REF:   p. 109            OBJ:   6

TOP:   Hypokalemia                                  KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The older adult patient in an extended-care facility has a pressure ulcer. The nurse would encourage wound healing by increasing the patient’s intake of zinc from which food sources?
a. Meats
b. Citrus fruits
c. Green leafy vegetables
d. Complex carbohydrates

 

 

ANS:  A

Meat, nuts, and shellfish are dietary sources of zinc.

 

DIF:    Cognitive Level: Application          REF:   p. 109            OBJ:   8

TOP:   Zinc               KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What is the minimum fluid intake for an older adult?
a. 1000 mL
b. 2000 mL
c. 4000 mL
d. 6000 mL

 

 

ANS:  B

The minimum daily fluid requirement is 2000–3000 mL/day.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 123            OBJ:   2

TOP:   Fluid Requirements                        KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Why is an older adult who abuses alcohol at an increased risk for nutritional deficits?
a. Alcohol decreases blood glucose levels.
b. Alcohol alters the function of some minerals.
c. Alcohol interferes with the absorption of nutrients.
d. Alcohol increases the metabolism.

 

 

ANS:  C

Excessive intake of alcohol interferes with the absorption of nutrients because of changes in the stomach lining.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 111            OBJ:   6

TOP:   Factors Affecting Nutrition             KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. Which of the following disease processes would result in a need for an increased caloric intake?
a. Cancer
b. Osteoporosis
c. Arthritis
d. Stroke

 

 

ANS:  A

Persons with an illness such as cancer require increased caloric intake because illness increases metabolism. Diseases that restrict mobility result in a reduced caloric need.

 

DIF:    Cognitive Level: Application          REF:   p. 103            OBJ:   6

TOP:   Changing Caloric Needs                 KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What is the recommended daily allowance of protein for an adult?
a. 200 grams
b. 20 grams
c. 150 grams
d. 50 grams

 

 

ANS:  D

The recommended daily allowance for protein is 46 grams for adult women and 56 grams for adult men.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 104            OBJ:   2

TOP:   Protein Intake Equivalent               KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An older patient is having trouble with hydration. What foods could the nurse suggest to increase fluid intake?
a. Fresh fruits
b. Cooked meats
c. Breads
d. Dried fruits

 

 

ANS:  A

Fresh fruits have a high fluid content. Dried fruits, cooked meats, and breads have a lower fluid content.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 123            OBJ:   2

TOP:   MyPyramid: Fruit                           KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What instructions should the nurse include when teaching a patient regarding a new prescription for an oral iron supplement?
a. Supplements should be taken between meals on an empty stomach.
b. Medication should be drunk from a nonmetal glass.
c. The color of the stool will change to dark green or black.
d. Constipation is likely to occur.

 

 

ANS:  C

Iron supplements can color the stool a dark green or black. Iron should be taken with a meal to reduce gastrointestinal irritation. The preparation should be taken through a straw. The supplement might cause diarrhea.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 108            OBJ:   8

TOP:   Iron Preparations                            KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse encourages a group of extended care residents to sit out on the sunny patio for an hour each day. What vitamin level is the nurse trying to improve?
a. A
b. B12
c. D
d. K

 

 

ANS:  C

Exposure to the sun allows the skin to synthesize vitamin D, which is required for calcium absorption.

 

DIF:    Cognitive Level: Analysis               REF:   p. 106            OBJ:   8

TOP:   Synthesis of Vitamin D                  KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What is the caloric value (in calories per gram [cal/g]) of protein?
a. 9 cal/g
b. 4 cal/g
c. 0 cal/g
d. 7 cal/g

 

 

ANS:  B

Proteins yield 4 cal/g.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 103            OBJ:   1

TOP:   Calorie Values                                KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. What is the caloric value of alcohol?
a. 9 cal/g
b. 4 cal/g
c. 0 cal/g
d. 7 cal/g

 

 

ANS:  D

Alcohol yields 7 cal/g.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 103            OBJ:   1

TOP:   Calorie Values                                KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. What is the caloric value of vitamins?
a. 9 cal/g
b. 4 cal/g
c. 0 cal/g
d. 7 cal/g

 

 

ANS:  C

Vitamins yield no calories.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 103            OBJ:   1

TOP:   Calorie Values                                KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. What is the caloric value of fat?
a. 9 cal/g
b. 4 cal/g
c. 0 cal/g
d. 7 cal/g

 

 

ANS:  A

Fats, which can come from either plant sources or animal sources, yield 9 cal/g.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 103            OBJ:   1

TOP:   Calorie Values                                KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

MULTIPLE RESPONSE

 

  1. When the nurse weighs an edematous patient with congestive heart failure, the weight increase from yesterday is 2.2 lb. What would be included in the plan of care for the patient? (Select all that apply.)
a. Keep a pitcher of water at the bedside.
b. Offer frequent oral hygiene.
c. Limit fresh fruits and vegetables.
d. Avoid changing the patient’s position.
e. Provide hard candy.

 

 

ANS:  B, C, E

The weight gain of 2.2 lb (1 kg) is significant and would signify fluid retention. Fluid restrictions would be expected. Frequent oral hygiene is a comfort measure to combat dry mucous membranes caused by fluid restriction. Fresh fruits and vegetables are high in water content and should be avoided. Hard candy would stimulate the production of saliva. Water should not be kept at the beside of a patient with fluid restrictions. The patient’s position should be changed frequently to prevent skin breakdown.

 

DIF:    Cognitive Level: Application          REF:   p. 122            OBJ:   6

TOP:   Fluid Retention                               KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What factors influence nutritional needs? (Select all that apply.)
a. Bone density
b. Gender
c. Climate
d. Presence of illness
e. Body temperature

 

 

ANS:  B, C, D, E

Bone density is not a factor, but all other options are factors that have a significant effect on nutritional needs.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 102            OBJ:   2

TOP:   Influences on Nutrition                  KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which of the following are vital nutrients that are required by all persons? (Select all that apply.)
a. Carbohydrates
b. Proteins
c. Vitamins and minerals
d. Fats
e. Electrolytes

 

 

ANS:  A, B, C, D

Electrolytes are not nutrients, but all other listed options are considered essential nutrients.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 103            OBJ:   2

TOP:   Essential Nutrients                          KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What are contained in complex carbohydrates that make them important in the diet? (Select all that apply.)
a. Minerals
b. Fats
c. Vitamins
d. Soluble fiber
e. Polysaccharides

 

 

ANS:  A, C, D, E

No fat is contained in complex carbohydrates.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 104            OBJ:   1

TOP:   Complex Carbohydrates                 KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Inadequate fluid intake can make the older adult susceptible to which of the following? (Select all that apply.)
a. Altered absorption of drugs
b. Digestive disorders
c. Constipation
d. Bleeding disorders
e. Reduced appetite

 

 

ANS:  A, B, C, E

Bleeding disorders are not associated with inadequate intake. All other options are problems associated with a fluid deficit.

 

DIF:    Cognitive Level: Application          REF:   p. 109            OBJ:   6

TOP:   Fluid Deficit   KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Older adults plagued with chronic health problems may become undernourished because they __________. (Select all that apply.)
a. are too fatigued to prepare meals
b. become frustrated when attempting to open packaging
c. may be unable to carry groceries any distance
d. have no interest in eating out due to health issues
e. lack stamina to shop for groceries

 

 

ANS:  A, B, C, E

Having no interest in eating out is not going to cause the older adult to be malnourished. Lack of interest in eating or socialization due to a chronic health problem can cause the older adult to be malnourished. All the other options listed can result in the older adult being malnourished.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 110            OBJ:   6

TOP:   Factors Affecting Nutrition             KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. What are barriers to adequate nutrition for the older adult living independently? (Select all that apply.)
a. Difficulty chewing
b. Lack of transportation to shop
c. Use of quick frozen meals
d. Lack of motivation to cook
e. Sensory changes

 

 

ANS:  A, B, D, E

The availability of quick frozen foods, which are easy to prepare, offer a source of better nutrition to the older adult.

 

DIF:    Cognitive Level: Application          REF:   p. 110            OBJ:   6

TOP:   Factors Affecting Nutrition             KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An older adult who is a resident in an extended-care facility would be at risk for which of the following nutritional deficits? (Select all that apply.)
a. Repetitive nature of meals
b. Lack of culturally significant food
c. Environmental odors
d. Reaction to being fed by others
e. Non-nutritious food choices

 

 

ANS:  A, B, C, D

Although the food is nutritious, the repetitive nature of the menu, the lack of culturally significant food, and environmental concerns alter the motivation to have adequate intake.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 112            OBJ:   6

TOP:   Factors Affecting Nutrition             KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. The older adult asks for help selecting foods high in protein. What would be appropriate for the nurse to suggest? (Select all that apply.)
a. Corn
b. Beans
c. Whole-grain foods
d. Cheese
e. Nuts

 

 

ANS:  B, C, D, E

Corn is not a source of protein.

 

DIF:    Cognitive Level: Application          REF:   p. 105            OBJ:   1

TOP:   Protein Consumption                                KEY:              Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse cautions the older adult against taking excess vitamin supplements because some vitamins can be retained in fatty tissue and cause liver damage, including vitamin(s) __________. (Select all that apply.)
a. A
b. B6
c. C
d. D
e. E

 

 

ANS:  A, D, E

Excess fat-soluble vitamins A, D, and E can be retained in fatty tissue and result in hepatic damage.

 

DIF:    Cognitive Level: Application          REF:   p. 107            OBJ:   1

TOP:   Vitamin Intake                                KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

Chapter 07: Medications and Older Adults

Test Bank

 

MULTIPLE CHOICE

 

  1. Why is drug testing done by pharmaceutical companies not always appropriate for the older adult?
a. The testing is not done long enough.
b. The testing does not require adequate follow-up.
c. The testing is not well regulated by the U.S. Food and Drug Administration.
d. The testing is usually conducted on healthy young persons.

 

 

ANS:  D

Long and rigorously regulated drug testing procedures most often use healthy young adults as drug testers.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 130-131   OBJ:   1

TOP:   Drug Testing                                   KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. What is a cause for increased rate of drug absorption in an older patient?
a. Change of the chemical composition of the drug
b. Increased gastric pH
c. Decreased strength of the drug
d. Decreased gastric motility

 

 

ANS:  D

Decreased gastric motility can increase the rate of drug absorption due to an increased amount of time that the medication is in contact with the gastric mucosa.

 

DIF:    Cognitive Level: Analysis               REF:   p. 131            OBJ:   3

TOP:   Drug Absorption                             KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. What age-related changes in the stomach can cause increased drug absorption and possibly drug toxicity?
a. Decreased gastric motility
b. Gastric reflux disease
c. Inability of gastric cells to transport the drug
d. Decreased peristalsis

 

 

ANS:  A

Decreased motility leaves the drug in contact with the gastric mucosa for a longer period of time, which leads to increased absorption. Peristalsis is rhythmic movements of the bowels.

 

DIF:    Cognitive Level: Application          REF:   p. 131            OBJ:   3

TOP:   Increased Absorption                                KEY:              Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. What should an older adult be encouraged to implement in order to prevent lithium toxicity?
a. Increase fluid intake to 3500 mL daily.
b. Have the patient ambulate for 10 minutes after the drug is administered.
c. Prohibit citrus fruit in the diet.
d. Administer a prescribed stool softener to ensure a daily bowel movement.

 

 

ANS:  A

Increase of fluids will help allow water-soluble drugs such as lithium to be diluted in the bloodstream more effectively and excreted more rapidly.

 

DIF:    Cognitive Level: Application          REF:   p. 131            OBJ:   9

TOP:   Distribution    KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Reduction of Risk

 

  1. An older adult is taking diazepam several times a day.  What does the nurse specifically monitor for?
a. Tachycardia
b. A hangover effect
c. Agitation
d. Hypertension

 

 

ANS:  B

Fat-soluble drugs become trapped in the adipose tissue and are slowly released into the bloodstream, increasing the drug’s concentration.

 

DIF:    Cognitive Level: Application          REF:   p. 138            OBJ:   4

TOP:   Distribution    KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. Why would the nurse anticipate an adverse reaction in an older adult who is taking the protein-bound drug warfarin (Coumadin)?
a. Unbound active drug molecules continue to circulate in the bloodstream.
b. The bleeding and clotting times will decrease.
c. The drug becomes ineffective and does not deliver its intended therapeutic action.
d. Renal damage can occur from the altered drug molecules.

 

 

ANS:  A

Unbound drug molecules will still be circulating, leading to excess drug in the bloodstream.

 

DIF:    Cognitive Level: Application          REF:   p. 132 | p. 134

OBJ:   4                    TOP:   Distribution    KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. Why does the nurse frequently assess an older adult who is on a psychotropic drug?
a. Older adults are less active.
b. The older adult has fewer cognitive capabilities.
c. Brain receptors have become hypersensitive.
d. Receptor sites have lower perfusion.

 

 

ANS:  C

Brain receptors in the older adult become hypersensitive as age increases, resulting in an exaggerated response to pharmacologic therapy.

 

DIF:    Cognitive Level: Analysis               REF:   p. 132            OBJ:   7

TOP:   Pharmacodynamics                        KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. What is the major risk of polypharmacy for the older adult?
a. Ignorance about his or her prescriptions
b. Taking over-the-counter preparations
c. Being treated by more than one physician
d. Taking old prescriptions rather than consulting a physician

 

 

ANS:  C

Although all the options may offer an opportunity for polypharmacy, the major risk is that of the patient being treated by more than one physician at the same time.

 

DIF:    Cognitive Level: Application          REF:   pp. 132-133   OBJ:   1

TOP:   Polypharmacy                                           KEY:              Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. The home health nurse would be most concerned about self-medicating errors for the older adult living alone who is a type 1 diabetic and is
a. afflicted with early Parkinson disease.
b. visually impaired.
c. a rheumatoid arthritic with stiffened hands.
d. paralyzed from the waist down.

 

 

ANS:  B

The visually impaired diabetic is at the greatest risk for a medication error by incorrectly preparing an insulin injection.

 

DIF:    Cognitive Level: Analysis               REF:   p. 143            OBJ:   12

TOP:   Sensory Changes                            KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What is the most reliable method of patient identification for administration of medications?
a. A photograph of the patient
b. An identification bracelet
c. Asking the patient to repeat his or her name
d. Use of the patient’s room number

 

 

ANS:  B

The use of an identification bracelet is the most accurate and reliable method to identify the patient.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 139            OBJ:   9

TOP:   Patient Identification                                 KEY:              Nursing Process Step: Assessment

MSC:  NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. The physician has written an order to convert an enteric-coated medication from the pill form to the liquid form. What would be the most appropriate response of the nurse?
a. Transcribe the order and change the medication administration record to show the liquid form.
b. Use up the rest of the tablets by crushing them and giving them dissolved in water.
c. Order the liquid form from the pharmacy as ordered.
d. Inquire if the physician wants the dose to be the same as the pill.

 

 

ANS:  D

Because liquids are absorbed more rapidly, the dose might need to be lowered or the schedule of administration changed to avoid an overdose. Enteric-coated medications should not be crushed.

 

DIF:    Cognitive Level: Analysis               REF:   p. 140            OBJ:   9

TOP:   Liquid Medication                          KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The patient complains that her medications stick in her throat. What would be an appropriate response of the nurse?
a. Suggesting that she take all the pills at one time with a mouthful of water.
b. Offering the patient one pill at a time.
c. Crushing all the pills and mixing them in the patient’s breakfast cereal.
d. Offering a sip of water before and after each pill.

 

 

ANS:  D

Offering water before and after administration counteracts the dry mouth that causes the pills to stick. Offering one pill at a time without water does not address the problem of sticking.

 

DIF:    Cognitive Level: Application          REF:   p. 141            OBJ:   9

TOP:   Pill Administration                          KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. What is a correct method of administering a transdermal medication patch?
a. Apply the patch at the same site every day and carry out documentation.
b. Fold and dispose of the used patch in the sharps container.
c. Warm the patch in his or her hands before application.
d. Cover the patch with tape to prevent dislodgement.

 

 

ANS:  B

The used patch should be folded with the sticky sides together and disposed of in the sharps container for environmental safety.

 

DIF:    Cognitive Level: Application          REF:   Box 7-4, p. 142

OBJ:   6                    TOP:   Transdermal Patches

KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. When the medication nurse offers a pill to the older adult patient, the patient asks, “What is this and what is it for?” What is the best response by the nurse?
a. “I’m not at liberty to discuss your medication. You need to talk to your doctor.”
b. “That’s a ‘feel good’ pill that will make you feel better.”
c. “It’s a cephalosporin that has been ordered to treat your URI.”
d. “It’s an antibiotic for the infection in your urine.”

 

 

ANS:  D

Patients have the right to know what they are taking and given a reasonable rationale for its use that they can understand.

 

DIF:    Cognitive Level: Application          REF:   p. 143            OBJ:   10

TOP:   Right to Know                                           KEY:              Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When the 80-year-old female patient refuses to take a medication because it burns her stomach, what action should be taken by the nurse?
a. Crush the pill and mix it with the dessert on her meal tray.
b. Insist that she take it “for her own good.”
c. Circle and initial the dose time to show non-administration.
d. Document the reason for refusal and report the refusal to the charge nurse.

 

 

ANS:  D

The nurse should carry out documentation of the reason for refusal and report the refusal.

 

DIF:    Cognitive Level: Application          REF:   p. 143            OBJ:   10

TOP:   Refusal of Treatment                                KEY:              Nursing Process Step: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Coordinated Care

 

  1. What is a symptom of theophylline overdose?
a. Tachycardia
b. Confusion
c. Hypotension
d. Constipation

 

 

ANS:  A

Tachycardia is a significant side effect of theophylline.

 

DIF:    Cognitive Level: Knowledge          REF:   Table 7-5, p. 138

OBJ:   7                    TOP:   Drug Overdose

KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. Which assessment finding in a 75-year-old man on a chlorpromazine (Thorazine) protocol should be immediately reported to the physician?
a. Cough
b. Headache
c. Drool
d. Nausea

 

 

ANS:  C

Drooling and difficulty swallowing are signs of drug toxicity to chlorpromazine (Thorazine).

 

DIF:    Cognitive Level: Application          REF:   Table 7-5, p. 138

OBJ:   7                    TOP:   Drug Toxicity

KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. What site would be the best choice for an intramuscular injection to an emaciated 82-year-old patient?
a. Upper outer quadrant of the gluteus maximus
b. Gluteal
c. Deltoid
d. Ventrogluteal

 

 

ANS:  D

The ventrogluteal site is the safest choice for the emaciated patient. The location is easily accessible and free from major nerves of vessels.

 

DIF:    Cognitive Level: Application          REF:   p. 142            OBJ:   9

TOP:   Intramuscular Injection                   KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Reduction of Risk

 

  1. What is the purpose of the Beers criteria?
a. Identifies medications best avoided by the older adult.
b. Identifies diagnostic procedures that are considered inappropriate for a diagnosis.
c. Identifies penalties for extended-care facilities that allow administration of particular drugs.
d. Identifies assessments necessary before the prescription of particular drugs.

 

 

ANS:  A

The Beers criteria lists medications best not prescribed for the older adult. The lists are updated regularly, most recently in 2012.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 133            OBJ:   5

TOP:   Beers Criteria                                  KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk

 

  1. What oral medication can be safely crushed?
a. Plain antihypertensive medication tablet
b. Sublingual tablet of nitroglycerin
c. Timed-release capsule for gastric reflux
d. Enteric-coated aspirin

 

 

ANS:  A

Only the plain tablet can be crushed. Timed-release, sublingual medications, and enteric-coated medications should not be crushed.

 

DIF:    Cognitive Level: Comprehension   REF:   Box 7-3, p. 141

OBJ:   9                    TOP:   Crushing Medication

KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

MULTIPLE RESPONSE

 

  1. What provisions should be included in the plan of care for a 70-year-old extended-care facility resident who will be self-administering his medications? (Select all that apply.)
a. Delivery of adequate supply of medication
b. Payment for medication
c. Locked medication storage at bedside
d. Medication administration record
e. Assessment of effectiveness of medication

 

 

ANS:  A, C, D, E

For self-medication in an extended-care facility, the nurse should make provisions for adequate medication supply, locked storage, medication administration record, and an assessment of the effectiveness of the medication. Payment is not in the purview of the nurse.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 143            OBJ:   12

TOP:   Medication Administration             KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Reduction of Risk

 

  1. What information related to drug administration should be included in the nursing care plan? (Select all that apply.)
a. Schedule for drawing blood values
b. Patient’s need for crushing medication
c. Patient’s preference as to the use of medium in which to give crushed medicines
d. Schedule of medication and dose times
e. Parameters of pulse or blood pressure, if significant to administration

 

 

ANS:  A, B, C, E

Schedule and dose information are not considered part of the nursing care plan.

 

DIF:    Cognitive Level: Application          REF:   pp. 139-140   OBJ:   8

TOP:   Medication Information in the Nursing Care Plan

KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. What measures may the older adult take to reduce the high cost of prescription drugs? (Select all that apply.)
a. Simply not fill a new prescription
b. Take less than prescribed to preserve their supply
c. Fill all prescriptions at once
d. Save old prescription drugs for later use
e. Share medications

 

 

ANS:  A, B, D, E

Filling prescriptions at one time can be costly even with a discount; therefore the older adult may pick and choose which ones to fill. All the other behaviors listed are methods whereby persons on a limited budget will attempt to preserve their supply of medications and contain costs.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 144-145   OBJ:   12

TOP:   Risks Related to Financial Factors  KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. What factors increase the risk of medication-related problems in the older adult? (Select all that apply.)
a. Drug-testing methodology
b. Age-related changes
c. Polypharmacy
d. Cognitive and sensory changes
e. Lack of adequate medical follow-up

 

 

ANS:  A, B, C, D

Lack of follow-up is not identified as a factor in medication-related problems.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 131-133   OBJ:   1

TOP:   Factors in Medication-Related Problems                         KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. Why is self-medication with over-the-counter (OTC) drugs hazardous to the older adult? (Select all that apply.)
a. OTC drugs can increase the effect of a prescribed drug.
b. OTC drugs can interfere with the efficacy of a prescribed drug.
c. OTC drugs can mask significant symptoms of primary disease.
d. OTC drugs are easily obtained.
e. OTC drugs can lead to overdose because they are not considered to be “real drugs.”

 

 

ANS:  A, B, C, E

OTC drugs can increase the effect of a prescribed drug, interfere with the efficacy of a prescribed drug, mask symptoms of primary diseases, and cause overdose.  The fact that OTC drugs are easily obtained is a benefit, not a hazard, unless abused.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 136            OBJ:   11

TOP:   Overuse of OTC Drugs                   KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The nurse crushes a pill and disguises the dose in the mashed potatoes of a resident in a long-term care facility who previously refused the drug. It is then fed to the patient by the nursing assistant. This should be considered an error because it __________. (Select all that apply.)
a. violates the patient’s right to refuse medication
b. involves delegation of medication administration to the nursing assistant
c. increases the amount of time for the drug administration pass
d. becomes impossible to confirm the patient received the entire dose
e. alters the food

 

 

ANS:  A, B, D

Hiding a dose of drug in a food serving that the patient had previously refused is unethical. Delegating the administration of a drug to a nonqualified person is illegal, and because there is no guarantee the entire serving of food will be consumed, the intended dose may not be delivered.

 

DIF:    Cognitive Level: Application          REF:   pp. 140-143   OBJ:   9

TOP:   Disguising Drugs in Food               KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

COMPLETION

 

  1. The nurse clarifies that the term __________ refers to the study of how persons respond to medicines.

 

ANS:  pharmacodynamics

 

DIF:    Cognitive Level: Knowledge          REF:   p. 131            OBJ:   4

TOP:   Medicating the Older Adult            KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. The primary organ of drug metabolism is the __________.

 

ANS:  liver

 

DIF:    Cognitive Level: Knowledge          REF:   p. 132            OBJ:   3

TOP:   Drug Metabolism                            KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. The home health nurse periodically interviews patients relative to their use of _________ because it is the most commonly consumed and abused nonprescription drug used by adults.

 

ANS:  alcohol

 

DIF:    Cognitive Level: Comprehension   REF:   p. 136            OBJ:   11

TOP:   Use of Alcohol                               KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

OTHER

 

  1. Arrange the steps for preparing crushed medications to be given by feeding tube in order of priority.

 

  1. Flush the tube to clear feeding.
  2. Thoroughly crush the medication.
  3. Administer each medication separately.
  4. Dissolve each crushed medication in a medicine cup.
  5. Flush the tube to clear the medication from the tube.
  6. Reconnect the feeding tube.

 

ANS:

B, D, A, C, E, F

 

DIF:    Cognitive Level: Application          REF:   p. 141            OBJ:   6

TOP:   Crushed Medication per Tube        KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies