PRACTICE NCLEX QUESTIONS BASED ON THE CARE OF THE OLDER CLIENT PART 11

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PRIORITY CONCEPTS ARE DEVELOPMENT AND SAFETY

KEY POINTS: MUST READ:

  1. Aging and Gerontology:
    1. Aging is the biopsychosocial process of change that occurs in a person between the birth and death.
    2. Gerontology is the study of the aging process
  2. Physiological changes:
    1. Integumentary system:
      1. Loss of pigment in hair and skin.
      2. Wrinkling of the skin.
      3. Thinning of the epidermis and easy bruising and tearing of skin.
      4. Decreased skin turgor, elasticity and perspiration.
      5. Increased nail thickness and decreased nail growth.
      6. Dry, itchy, scaly skin.
      7. Seborrheic dermatitis and keratosis formation.
    2. Neurological system.
      1. Slowed reflexes.
      2. Slight tremors and difficulty with fine motor movements.
      3. Loss of balance.
      4. Increased incidence of awakening after sleep onset.
      5. Increased susceptibility to hypothermia and hyperthermia.
      6. Short-term memory decline.
      7. Long -term memory usually maintained.
    3. Musculoskeletal system
      1. Decreased muscle mass and strength and atrophy of muscles
      2. Decreased mobility, range of motion, flexibility, coordination, and stability
      3. Change of gait, with shortened step and wider base
      4. Posture and stature changes causing a decrease in height, also known as kyphosis
      5. Increased brittleness of the bones due to demineralization
      6. Deterioration of joint capsule components
    4. Cardiovascular system
      1. Diminished energy and endurance, with lowered tolerance to exercise
      2. Decreased compliance of the heart muscle can be due to remodeling of the heart after myocardial infarction or long-standing hypertension
      3. Decreased cardiac output and decreased efficiency of the blood return to the heart
      4. Decreased compensatory response, so less able to respond to increased demands on the cardiovascular system
      5. Decreased resting the heart rate, which may be medication-related
      6. Peripheral pulses can be weak due to lower cardiac output
      7. Increased blood pressure but susceptible to postural hypotension, especially with certain cardiac medications such as diuretics
    5. Respiratory system
    6. Hematological system
    7. Immune system
    8. Gastrointestinal system
    9. Endocrine system
    10. Renal/ Urinary system
    11. Reproductive system
    12. Special senses
  3. Psychological concerns
  4. Mental health concerns
  5. Pain
  6. Infection
  7. Medications
  8. Mistreatment of the older adult

PRACTICE QUESTIONS:

  1. The nurse is providing medication instructions to an older client who is taking digoxin daily. The nurse explains to the client that decreased lean body mass and decreased glomerular filtration rate, which are age-related body changes, could place the client at risk for which complication with medication therapy?
    1. Decreased absorption of digoxin.
    2. Increased risk for digoxin toxicity.
    3. Decreased therapeutic effect of digoxin.
    4. Increased risk for side effects related to digoxin.
  2. The nurse is caring for an older client in a long-term care facility. Which action contributes to encouraging autonomy in the client?
    1. Planning meals.
    2. Decorating the room.
    3. Scheduling haircut appointments.
    4. Allowing the client to choose social activities.
  3. The home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping? Select all the apply.
    1. Neglecting personal grooming
    2. Looking at old snapshots of family
    3. Participating in a senior citizens program
    4. Visiting the spouse’s grave once a month
    5. Decorating a wall with the spouse’s pictures and awards received
  4. The nurse is providing instructions to the assistive personnel AP regarding care of an older client with hearing loss. What should the nurse tell the AP about older clients with hearing loss?
    1. They are often distracted
    2. They have middle ear changes
    3. They respond to low-pitched tones
    4. They develop moist cerumen production
  5. The nurse is providing an educational session to new employees, and the topic is abuse of the older client. The nurse helps the employees identify which client as most typically a victim of abuse?
    1. A man who has moderate hypertension
    2. A man who has newly diagnosed cataracts
    3. A woman who has advanced Parkinson’s disease
    4. A woman who has early diagnosed Lyme disease
  6. The nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement by the client indicates the need for further teaching regarding measures to improve sleep?
    1. I swim 3 times a week
    2. I have stopped smoking cigars
    3. I drink hot chocolate before bedtime
    4. I read for 40 minutes before bedtime
  7. The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin?
    1. Crusting
    2. Wrinkling
    3. Deepening of expression lines
    4. Thinning and loss of elasticity in the skin
  8. The home health nurse is visiting a client for the first time. While assessing the client’s medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first?
    1. Check for medication interactions
    2. Determine whether there are medication duplications
    3. Determine whether a family member supervises medication administration
    4. Call the prescribing primary health care provider (PHCP) and report polypharmacy
  9. The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological changes the nurse should expect to note? Select all that apply.
    1. Increased heart rate
    2. Decline in visual acuity
    3. Decreased respiratory rate
    4. Decline in long-term memory
    5. Increased susceptibility to urinary tract infections
    6. Increased incidence of awakening after sleep onset

ANSWERS

  1. 2
  2. 4
  3. 2,3,4,5
  4. 3
  5. 3
  6. 3
  7. 1
  8. 2
  9. 2,5,6

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