Gerontologic Nursing 5th Edition by Sue E. Meiner Test Bank

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Gerontologic Nursing 5th Edition by Sue E. Meiner Test Bank

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WITH ANSWERS
Gerontologic Nursing 5th Edition by Sue E. Meiner Test Bank

Chapter 02: Theories of Aging

Meiner: Gerontologic Nursing, 5th Edition

 

MULTIPLE CHOICE

 

  1. The practitioner who believes in the free radical theory of aging is likely to recommend that the older adult:
a. avoid excessive intake of zinc or magnesium.
b. supplement his or her diet with vitamins C and E.
c. increase intake of complex carbohydrates.
d. avoid the use of alcohol or tobacco.

 

 

ANS:  B

Vitamins C and E are two naturally occurring antioxidants that appear to inhibit the functioning of the free radicals or possibly decrease their production in the body. The free radical theory of aging is not related to zinc, magnesium, carbohydrates, or alcohol and tobacco.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-2

TOP:   Nursing Process: Planning              MSC:  Health Promotion

 

  1. To provide effective care to the older adult, the nurse must understand that:
a. older adults are not a homogeneous sociologic group.
b. little variation exists in cohort groups of older adults.
c. health problems are much the same for similar age groups of older adults.
d. withdrawal by an older adult is a normal physiologic response to aging.

 

 

ANS:  A

The key societal issue addressed by the age stratification theory is the concept of interdependence between the aging person and society at large. This theory views the aging person as an individual element of society and also as a member, with peers, interacting in a social process. The theory attempts to explain the interdependence between older adults and society and how they constantly influence each other in a variety of ways. Variation exists among the members of a cohort. Health problems are not the same for every individual of the same age. Withdrawal by an older adult is not a normal response to aging but may be a sign of depression.

 

DIF:    Understanding (Comprehension)    REF:   Page 16          OBJ:   2-2

TOP:   Nursing Process: Planning              MSC:  Health Promotion and Maintenance

 

  1. The nurse is using the eight stages of life theory to help an older adult patient assess the developmental stage of personal ego differentiation. The nurse does this by assisting the patient to:
a. determine feelings regarding the effects of aging on the physical being.
b. describe feelings regarding what he or she expects the future to hold.
c. identify aspects of work, recreation, and family life that provide a sense of self-worth and pleasure.
d. elaborate on feelings about the prospect of his or her personal death.

 

 

ANS:  C

During the stage of ego differentiation versus work role preoccupation, the task for older adults is to achieve identity and feelings of worth from sources other than the work role. The onset of retirement and termination of the work role may reduce feelings of self-worth. In contrast, a person with a well-differentiated ego, who is defined by many dimensions, can replace the work role as the major defining source for self-esteem. Determining feelings related to the effects of aging, future death, or what the future may hold is not part of this theory.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Nursing Process: Implementation   MSC:  Psychosocial Integrity

 

  1. A patient is recovering from a mild cerebral vascular accident (stroke). The home care nurse notes that the patient is talking about updating a will and planning funeral arrangements. Which of the following responses is most appropriate for the nurse to make?
a. You seem to be preoccupied with dying.
b. Is there anything I can do to help you?
c. Are you worried about dying before you get your affairs in order?
d. Lets focus on how you are recovering rather than on your dying.

 

 

ANS:  B

According to Pecks expansion of Eriksons theory, the older adult who has successfully achieved ego integrity and ego transcendence accepts death with a sense of satisfaction regarding the life led and without dwelling on its inevitability. The patients action reflects a healthy transition and should be supported.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Nursing Process: Implementation   MSC:  Psychosocial Integrity

 

  1. Your patients spouse died recently from a sudden illness after 45 years of marriage. The patient was the primary caregiver for the spouse during this time. The patient is now depressed and withdrawn and has verbalized feelings of uselessness. Which action by the nurse is best?
a. Encourage the patient take up a hobby that will occupy some time.
b. Explain that volunteering would be an excellent way to stay useful.
c. Assure the patient that these feelings of sadness will pass with time.
d. Ask the patient to share some cherished memories of the spouse.

 

 

ANS:  B

Volunteering will help the patient to interact with people and feel productive and valued for the ability to help others as stated in the activity theory. A hobby does not offer the chance to help others. Assuring the patient that feelings will pass is false reassurance and does nothing to help the patient to be proactive. Reminiscing is a valued activity, but it is not the best choice for regaining a sense of usefulness.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Nursing Process: Implementation   MSC:  Psychosocial Integrity

 

  1. A patient has recently been diagnosed with end-stage renal disease. The patient has cried often throughout the day and finally confides in the nurse that I am going home to be with my Lord. The nurses best response is:
a. There is no reason to believe the end is near.
b. Do you want me to call your family?
c. We have a wonderful chaplain if youd like me to call him.
d. I think this is the time for us to pray together.

 

 

ANS:  C

It is important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth while addressing spirituality as a component in holistic care without imposing upon the patient. Because the patient has made reference to the Lord, the nurse can safely offer religion-oriented spiritual care. Telling the patient there is no reason to believe that death is near does not help the patient work through emotions. Asking about calling the family is a yes/no question and is not therapeutic. The nurse is assuming too much by saying it is time to pray.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Nursing Process: Implementation   MSC:  Psychosocial Integrity

 

  1. A nurse is responsible for the care of 20 older adults in a unit of an assisted living facility. In order to best address the needs and wants of the entire units population, the nurse:
a. strictly adheres to facility policies so that all patients will be treated equally.
b. encourages specific age cohorts to gather in the dayroom because they share similar interests.
c. has the unit vote on which television programs will be watched each evening.
d. schedules the patients bathing times according to their individual preferences.

 

 

ANS:  D

Older adults continue to feel valued and viewed as active members of society when allowed to maintain a sense of control over their living environment by attention to personal choices and rituals. Adhering strictly to policies does not allow for individualized care. Not all in the same age cohort will have similar interests. Voting on television programs does not ensure each individual feels a sense of worth.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-5

TOP:   Nursing Process: Planning              MSC:  Psychosocial Integrity

 

  1. An older patient who reports being healthy enough to cut my own fire wood is being assessed prior to outpatient surgery. The nurse recognizes which assessment observation as a possible result of the wear-and-tear theory?
a. Swollen finger joints
b. Red, watery eyes
c. Grimacing when raising left arm
d. Bilaterally bruising on the forearms

 

 

ANS:  C

This theory proposes that cells wear out over time because of continued use. The pain caused by movement of the shoulder is the observation most likely a result of the patients practice of cutting his own firewood. The other choices do not demonstrate continued use that is part of the wear-and-tear theory of aging.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-2

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. A nurse cares for many older patients. Which finding should the nurse identify as pathologic in a 72-year-old?
a. Two hospitalizations in 6 months for respiratory infections
b. Patient reports of sleeping only of 5 to 6 hours each night
c. Thinning hair and brittle nails
d. Dry, tissue paperlike skin

 

 

ANS:  A

Although there is an age-related decrease in immune function, reoccurring infections serious enough to require hospitalization are not considered a normal age-related finding. Decreased sleeping, thinning hair, brittle nails, and dry skin are all normal signs of aging.

 

DIF:    Application (Apply)                       REF:   N/A                OBJ:   2-1

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. In planning the care for an older adult patient, the nurse will best promote health and wellness by:
a. encouraging independent living and self-care.
b. scheduling regular cardiac and respiratory health screenings.
c. effectively delivering health-related educational information.
d. promoting a nutritious diet and an age-appropriate exercise routine.

 

 

ANS:  C

Providing well-prepared and effectively delivered health-related educational information will provide the best means of promoting a patients ability to impact his or her wellness and general health. Each of the other options is too narrow to be the most effective way to promote health and wellness.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-5

TOP:   Nursing Process: Planning              MSC:  Health Promotion

 

  1. The student learning about aging theories understands that the main difference between stochastic theories and nonstochastic theories is which of the following?
a. Stochastic theories view aging as a random, cumulative process.
b. Stochastic theories view aging as similar among all people.
c. Nonstochastic theories view aging as a result of psychosocial factors.
d. Nonstochastic theories are backed by research, whereas stochastic theories are not.

 

 

ANS:  A

Stochastic theories view aging as a result of random events and their cumulative effects. Nonstochastic theories view aging as a result of predetermined, timed phenomena. Both are types of biologic theories.

 

DIF:    Remembering (Knowledge)            REF:   Page 17          OBJ:   2-1

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity: Physiologic Adaptation

 

  1. Which theory of aging does the student learn is related to problems with DNA transcription?
a. Radical theory
b. Error theory
c. Cross linkage theory
d. Wear-and-tear theory

 

 

ANS:  B

The error theory poses that errors in DNA transcription lead to aging. The radical theory views the effects of free radicals as critical to aging. The cross linkage theory states that normally separated molecular structures are bound together through chemical reactions and that this interferes with metabolic processes. The wear-and-tear theory postulates that normal activity causes wear and tear on the body, leading to aging.

 

DIF:    Remembering (Knowledge)            REF:   Page 19          OBJ:   2-1

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity: Physiologic Adaptation

 

  1. According to which theory does cancer occur as a possible result of aging?
a. Radical theory
b. Error theory
c. Immunity theory
d. Pacemaker theory

 

 

ANS:  C

Immunosenescence is the term used in immunity theory to describe an age-related decrease in immune functioning. According to this theory, as people age, they are more prone to getting cancer or autoimmune diseases because of this phenomenon. This is a nonstochastic theory. Radical and error theories are both stochastic. The pacemaker theory looks at the interrelated role of the neurologic and endocrine systems and aging.

 

DIF:    Remembering (Knowledge)            REF:   Page 19          OBJ:   2-1

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity: Physiologic Adaptation

 

  1. A nurse assesses an older patient who has lost a great deal of weight in a short time. When asked, the patient states this behavior started after the patient read a magazine article on the benefits of extreme caloric restrictions. What response by the nurse is best?
a. That research was done on rodents and not on humans.
b. You shouldnt restrict your calories so severely.
c. You have lost so much weight you need dietary supplements.
d. You cant believe everything you read in those magazines.

 

 

ANS:  A

The metabolic theory of aging postulates that organisms have a specific metabolic lifetime and that by lowering metabolic rate, life span can be increased. However, this has been demonstrated in rodents and the nurse should educate the patient on this information. The other options do not give information that will help the patient make an informed decision as to whether or not to follow this activity.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-1

TOP:   Communication and Documentation

MSC:  Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is caring for an older patient who is sedentary and does not want to participate in any activities. What action by the nurse is best?
a. Inform the patient about the consequences of immobility.
b. Promote activity by explaining the use it or lose it concept.
c. Tell the patient he or she will feel better by being more active.
d. Explain the relationship of being active and being independent.

 

 

ANS:  D

Activity increases circulation, provides range of motion, and leads to clearer mental functioning. Activity helps a person remain independent and able to perform activities of daily living (ADLs) and instrumental ADLs. Presenting information in a positive light that encourages the patient to take control of ones own health is more likely to be successful than stressing the negative such as consequences of immobility or the concept of use it or lose it. Telling the patient that he or she will feel better does not give concrete information the patient can use to make decisions.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Teaching-Learning                          MSC:  Health Promotion

 

  1. The nurse working with older patients teaches the student that disengagement theory potentially causes which problem?
a. Fear
b. Isolation
c. Anxiety
d. Malnutrition

 

 

ANS:  B

The no-longer supported disengagement theory posed that older people withdrew from society as they aged and that this was a mutually agreed upon behavior. The result would be isolation as the person became focused solely on him- or herself. Fear, anxiety, or malnutrition could be a further consequence, but isolation and withdrawal from society was expected according to this theory.

 

DIF:    Understanding (Comprehension)    REF:   Page 22          OBJ:   2-5

TOP:   Teaching-Learning                          MSC:  Psychosocial Integrity

 

  1. The nurse working in a long-term care facility used the developmental theory of aging in practice. In caring for a frail, nearly bed bound patient, how can the nurse use this theory?
a. Engage the patient in intellectually stimulating activities.
b. Encourage the patient to participate in chair exercises.
c. Ensure that the patient participates in all the group activities.
d. Give the patient small chores to do for the facility.

 

 

ANS:  A

In this theory, being active can mean physical or intellectual activity. The nurse can engage the patient in intellectually stimulating activities that allows the person a sense of satisfaction. The other options all call for physical activity, which the patient may or may not be able to perform.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Nursing Process: Implementation   MSC:  Psychosocial Integrity

 

  1. The nurse working at a long-term care facility notes that one patient who is usually outgoing refuses to participate in games that require keeping score. What action by the nurse is best?
a. Ask the patient why he or she wont participate.
b. Assess the patients level of frustration with these activities.
c. Find other activities for the patient to participate in.
d. Do nothing; the patient can choose activities to engage in.

 

 

ANS:  B

Although it is true that patients should be able to choose activities in which to participate, the best option is to assess the patient for frustration or anxiety associated with these types of activities. Once that is determined, the nurse can find other activities the patient can engage in successfully and is willing to participate in if the games are not an option. Asking why questions often puts people on the defensive and is not a therapeutic communication technique.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Nursing Process: Assessment          MSC:  Psychosocial Integrity

 

  1. The nurse planning community events for older people uses sociologic theories to guide practice. Which activity planned by the nurse best fits these theories?
a. Group exercise programs
b. Volunteering at a day care
c. Healthy cooking classes
d. Reminiscing therapy

 

 

ANS:  B

Using the sociologic theories to guide care, the nurse would plan events that allowed the older adult to remain active in the community and a valued member of society. Volunteering would offer the adult a way to stay engaged and provide a service to successive generations. Exercise and cooking classes would more fit in the biologic theories. Reminiscing therapy is a technique using psychological theories. All are good ideas for activities, but the one that specifically uses sociologic theory is the volunteer work.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-2

TOP:   Nursing Process: Analysis              MSC:  Psychosocial Integrity

 

  1. What statement by a patient most indicates healthy aging according to Jung?
a. I wish I had traveled more when I was younger because now I cant.
b. I am proud of my past accomplishments at work and home raising my kids.
c. My leg amputation makes things harder, but I still find a way to work.
d. I still like to read the paper and novels and enjoy a little gardening.

 

 

ANS:  C

This patient shows acceptance of past accomplishments and finds value in him- or herself despite current limitations, which is healthy aging according to Jung. The person who wants to travel more displays remorse. The focus on past accomplishments does not show current acceptance. Reading and gardening do not show acceptance of past accomplishments.

 

DIF:    Analyzing (Analysis)                                REF:               N/A    OBJ:    2-2

TOP:   Nursing Process: Evaluation           MSC:  Psychosocial Integrity

 

  1. A nurse is trying to teach a hospitalized older patient how to self-inject insulin. The patient is restless and does not seem to be paying attention. What action by the nurse is best?
a. Ask if the patient needs to use the bathroom.
b. Tell the patient youll try again later in the day.
c. Ask if the patient prefers that you teach the family.
d. Refer the patient for home health care services.

 

 

ANS:  A

According to Maslow, physical needs take priority over other activities. This patient may be hungry, cold, tired, or need to use the bathroom. Telling the patient youll try again later, asking if you should teach the family, and referring to home health care does not provide for any unmet physical needs.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-4

TOP:   Nursing Process: Implementation   MSC:  Physiologic Integrity: Basic Care and Comfort

 

  1. The new nurse at a long-term care center asks the director of nursing why he needs to learn so many theories of aging. What response by the director is best?
a. No theories have been proven yet.
b. A wide range of theories allows for holistic care.
c. Its required knowledge for certification exams.
d. All the theories are important, so we use them all.

 

 

ANS:  B

Using a combination of different theories, each with its own focus, allows the nurse to plan individualized, holistic nursing care.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   2-5

TOP:   Communication and Documentation                                         MSC:   Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. According to Maslow, a fully actualized person displays which traits? (Select all that apply.)
a. Spontaneity
b. Self-direction
c. Creativity
d. Ethical conduct
e. Acceptance of self

 

 

ANS:  A, B, C, E

A fully actualized person displays the following characteristics: perception of reality; acceptance of self, others, and nature; spontaneity; problem-solving ability; self-direction; detachment and the desire for privacy; freshness of peak experiences; identification with other human beings; satisfying and changing relationships with other people; a democratic character structure; creativity; and a sense of values. Maslow does not specify ethical conduct.

 

DIF:    Remembering (Knowledge)            REF:   Page 24          OBJ:   2-5

TOP:   Teaching-Learning                          MSC:  Psychosocial Integrity

 

Chapter 14: Pain

Meiner: Gerontologic Nursing, 5th Edition

 

MULTIPLE CHOICE

 

  1. When planning care for the older adult experiencing pain, the nurse bases interventions on the realization that:
a. generally pain control is less effective than it is for younger adults.
b. this cohort is less pain sensitive than younger adults.
c. older adults are more likely to verbally express pain than younger adults.
d. pain is undertreated in this cohort compared to younger adults.

 

 

ANS:  D

Pain is underrecognized, highly prevalent, and undertreated among older adults.

 

DIF:    Remembering (Knowledge)            REF:   Page 256        OBJ:   14-4

TOP:   Nursing Process: Analysis              MSC:  Physiologic Integrity

 

  1. An older patient is observed grimacing whenever walking and getting in and out of bed. When assessed, the patient regularly denies having any pain. To best provide the patient with effective pain control, the nurse initially:
a. discusses the effects of untreated pain on the patients general wellness.
b. offers the patient a prescribed prn analgesic.
c. asks the patient why he is denying the presence of pain.
d. documents the symptoms that the patient is exhibiting.

 

 

ANS:  A

Older adult patients actually underreport pain and are therefore at risk for undertreatment of pain, which may cause unnecessary suffering, exacerbation of the underlying disease, and reduction in activities of daily living (ADLs) and quality of life. Without this information the patient is unlikely to take the prn medication. Why questions are not therapeutic, as they place people on the defensive. The symptoms should be documented, but this should not be the only action.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-2

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity

 

  1. The nurse caring for an older adult patient experiencing carpal tunnel syndrome anticipates the patient will best achieve pain control when prescribed a(n):
a. narcotic (e.g., fentanyl).
b. opioid (e.g., oxycodone).
c. tricyclic antidepressant (e.g., amitriptyline [Elavil]).
d. nonpharmacologic strategy (e.g., wrist bracing).

 

 

ANS:  C

Neuropathic pain results from a pathophysiologic process involving the peripheral or central nervous system. These types of pain respond to unconventional analgesic drugs, such as tricyclic antidepressants. Carpal tunnel syndrome is caused by nerve injury.

 

DIF:    Analyzing (Analysis)                                REF:               N/A    OBJ:    14-8

 

  1. When planning care for the older adult patient with a history of persistent pain, the nurse acknowledges the effects of the mind-body connection by including:
a. regular pain assessments.
b. prompt response to reports of pain.
c. pain consults.
d. relaxation techniques.

 

 

ANS:  D

Some mind-body therapies include meditation, relaxation, guided imagery, and cognitive behavioral counseling. The other actions are appropriate but not related to mind-body therapies.

 

DIF:    Remembering (Knowledge)            REF:   Page 266        OBJ:   14-8

TOP:   Nursing Process: Implementation   MSC:  Physiologic Integrity

 

  1. An older adult patient has been prescribed an opioid to manage chronic pain resulting from a shoulder injury. To eliminate a common barrier to opioid drug compliance, the nurse:
a. encourages the patient to use the opioid only as prescribed.
b. educates the patient about the appropriate management of constipation.
c. assures the patient that dizziness will decrease as therapeutic levels are reached.
d. suggests the patient take the medication with meals or a snack.

 

 

ANS:  B

Older adults have a high rate of discontinuation of opiates because of the resulting constipation. The treatment for constipation, especially that which is opioid induced, is readily available and should be provided as a preventive measure before starting narcotic pain medication. The other actions do not address this issue.

 

DIF:    Understanding (Comprehension)    REF:   Page 263        OBJ:   14-4

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity

 

  1. The nurse is discussing pain control with an older patient who has been prescribed an opiate. When the patient expresses concerns about the diminishing effect that the medication has had on the pain, the nurse responds:
a. It appears that the dosage you take needs to be adjusted upward.
b. We need to be concerned about you developing a drug tolerance.
c. This drug category is well known for its low ceiling effect.
d. Opiate addiction is a concern when tolerance occurs.

 

 

ANS:  A

Tolerance is defined as the diminished effect of a drug while maintaining the same dosage over time. It is a characteristic of opiates when given over time. With opiates, some individuals might need higher and higher doses of a drug to maintain effectiveness. This should not be confused with addiction.

 

DIF:    Understanding (Comprehension)    REF:   Page 263        OBJ:   14-8

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity

 

  1. An older patient is being treated for arthritic pain with a nonsteroidal anti-inflammatory drug (NSAID). Which question best assesses for side effects of this medication class?
a. Have you noticed your heart skipping beats since you began taking this drug?
b. Did you know you should not to stand up too quickly?
c. Are you aware that you should take your pain medication with food?
d. Have you had any episodes of shortness of breath since starting this medicine?

 

 

ANS:  C

The most common complaint associated with NSAIDs is indigestion. Indigestion may be reduced with antacid use or food consumption timed to coincide with analgesic intake.

 

DIF:    Understanding (Comprehension)    REF:   Page 263        OBJ:   14-8

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity

 

  1. The nurse is caring for an older adult patient with terminal cancer who is receiving medication via patient-controlled analgesic (PCA) pump. The nurse shows an understanding of primary end-of-life concerns when asking the patient:
a. Do you have any concerns about receiving your medication intravenously?
b. Are you satisfied with the way your pain is being managed?
c. Are you worried about becoming addicted to the narcotic analgesics?
d. Do you have any questions concerning how to use the PCA properly?

 

 

ANS:  B

Terminally ill patients generally identify their main concern as pain control. The other questions do not address this issue.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-8

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. The nurse is performing a pain assessment when the older adult patient reports pain in his left shoulder that radiates down into the forearm. The nurse immediately:
a. recognizes that the patient is experiencing cardiac distress.
b. alerts the rapid response team to provide emergency care.
c. asks whether he has ever experienced this pain before.
d. questions the patient about additional related symptoms.

 

 

ANS:  C

Assessment is essential in differentiating acute life-threatening pain from longstanding chronic pain. Otherwise, disease progression and acute injury may go unrecognized and be attributed to preexisting disease or illness. The patient may or may not be experiencing cardiac ischemia, the rapid response team does not need to be called, and the nurse can assess for other symptoms after determining if this pain is new or not.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-6

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. An older adult who injured her knee several years ago tells the nurse that she has been managing the resulting intermittent pain with a prescription for propoxyphene (Darvon). The nurse is concerned with this treatment plan, primarily because:
a. less expensive alternative analgesics are available.
b. this long-term need for a narcotic warrants investigation.
c. aspirin would likely be as effective in managing the pain.
d. the knee should not still be causing pain for the patient.

 

 

ANS:  B

The nurse needs to complete a full assessment to determine what type of pain the patient is experiencing and if a narcotic is the best alternative for the patient. Other medications may be more beneficial.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-8

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. The nurse is caring for a 78-year-old with a history of chronic depression. The patient currently reports persistent left shoulder pain since having a fall a year ago. To best address the patients pain, the nurse initially determines:
a. if the patient is still at risk for falls.
b. the severity of the shoulder injury.
c. how effectively depression is being managed.
d. the patients ability to effectively cope with pain.

 

 

ANS:  C

Persistent depression affects a persons ability to cope with the pain, so it must be treated. The nurse should also assess fall risk but that is secondary to determining why the pain has lasted so long and if the patient is able to cope.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-4

TOP:   Nursing Process: Assessment          MSC:  Psychosocial Integrity

 

  1. Acetaminophen (Tylenol) is prescribed for a 70-year-old with chronic pain. When the patient reports to the nurse that the maximum daily dose of medication does not control the pain, the nurse responds:
a. Breakthrough pain can be managed with the addition of another analgesic.
b. Transcutaneous electrical nerve stimulation (TENS) is often helpful.
c. It sounds as though you have developed a tolerance for acetaminophen.
d. We will need to get your physician to prescribe another analgesic for you.

 

 

ANS:  D

The patient needs a comprehensive review of pain strategies, which will probably include changing pain medication. Using the maximum dose of acetaminophen long term can cause liver damage, which is another reason the patient should switch medications if it is not working.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-8

TOP:   Communication and Documentation                                         MSC:   Physiologic Integrity

 

  1. An older adult patient is prescribed an analgesic to manage the joint pain resulting from stiffness in his right shoulder. When the patient asks about alternative therapy techniques that might be helpful, the nurse suggests:
a. applying ice packs to the area three to four times a day.
b. placing a moderately warm heating pad to the shoulder.
c. arranging for a professional massage on a weekly basis.
d. discussing electrical nerve stimulation with the physician.

 

 

ANS:  B

Heat is useful in decreasing pain and discomfort resulting from joint stiffness by increasing the elasticity of muscles. Ice is better for acute exacerbations. Massage may or may not help but would be more expensive. Electrical nerve stimulation is not warranted.

 

DIF:    Understanding (Comprehension)    REF:   Page 266        OBJ:   14-8

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity

 

  1. The nurse caring for an older cognitively impaired patient with osteoarthritis in both hands assesses the patient for hand pain by:
a. observing for facial grimacing when the patient uses a fork to eat.
b. being alert for signs of agitation when washing the patients hands.
c. listening to detect moaning when patient makes a fist.
d. watching for signs that the patient is reluctant to shake hands.

 

 

ANS:  B

Cognitively impaired patients in pain may not portray any visible signs of pain or distress or may be unable to communicate their pain. Pain may result in agitation, as well as increased pulse, respiration, blood pressure, and confusion. The other options are not as indicative of pain in the cognitively impaired older adult.

 

DIF:    Remembering (Knowledge)            REF:   Page 258        OBJ:   14-4

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. A director of nursing in a long-term care facility was concerned after reading that as many as 80% of residents have untreated pain. What action by the director is best?
a. Establish protocols for routine assessment.
b. Make a pain plan for every resident.
c. Involve family members in treating pain.
d. Educate the staff on how to assess pain.

 

 

ANS:  A

Nursing begins with assessment. The director should implement a protocol for routine assessments of pain in both cognitively impaired and intact residents. A pain plan cannot be created without this assessment data. Family members should be encouraged to provide input. The staff may or may not need to have education on assessment.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-7

TOP:   Nursing Process: Implementation   MSC:  Physiologic Integrity

 

  1. An older patient who lives alone is brought to the clinic by an adult child who reports the patient has become depressed and no longer wants to go out of the home. What action by the nurse is best?
a. Assess the patient for depression.
b. Ask the patient why activities are avoided.
c. Assess the patient for pain.
d. Assess the patient for elder abuse.

 

 

ANS:  C

Many older adults have pain that goes untreated. Consequences of untreated pain are numerous and include depression and withdrawal. The nurse should first assess for pain. Assessing for depression or elder abuse may be warranted as well. Asking why questions is not therapeutic, as patients tend to become defensive.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-2

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. A confused patient is admitted to the hospital after suffering a fall. When asked about pain, the patient does not respond. What action by the nurse is best?
a. Ask the patient again using different words.
b. Pantomime what you are asking the patient.
c. Observe the patients nonverbal behaviors.
d. Ask the family members if they think the patient has pain.

 

 

ANS:  C

In some situations, the nurse cannot rely on the patients report of pain, so as a second method of assessment, the nurse looks to the patients nonverbal behaviors. The nurse should be aware, however, that the lack of specific pain behaviors does not indicate a lack of pain. The other options may be helpful for individual patients.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-4

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. A patient has just had surgery. What pain control strategy is best?
a. Administer prn medications when requested.
b. Give pain medications around the clock at first.
c. Start with nonopioids then progress to opioids.
d. Ask the patient his or her preference for medication.

 

 

ANS:  B

After surgery the patient is expected to have pain. The best way to control acute pain is through round-the-clock dosing (at least at first) to keep the patients pain from getting out of control. The nurse should assess the patients preferences, but should assess preferences for pain levels, because the patient may not be experienced in receiving pain medications. Opioids are expected for acute pain from surgery.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-8

TOP:   Nursing Process: Implementation   MSC:  Physiologic Integrity

 

  1. An older patient is hospitalized for the first time. After giving a dose of hydromorphone (Dilaudid), what assessment takes priority?
a. Pain level
b. Nausea
c. Urinary retention
d. Respiratory rate

 

 

ANS:  D

Respiratory depression is common with opioid analgesics. All assessments are appropriate; however, respiratory assessment takes priority.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-8

TOP:   Nursing Process: Assessment          MSC:  Safe Effective Care Environment

 

  1. An older adult lives alone at home and is being treated for chronic pain. The home health care nurse notes the adult is disheveled and has dirty dishes piled up in the sink. What action by the nurse is best?
a. Notify adult protective services.
b. Arrange for hospitalization.
c. Assess the patients pain.
d. Assess the patients cognitive status.

 

 

ANS:  C

Although all actions might be appropriate depending on circumstances, because the patient is being treated for pain and has a functional decline, the nurse should assess first for unrelieved pain.

 

DIF:    Applying (Application)                   REF:   N/A                OBJ:   14-8

TOP:   Nursing Process: Assessment          MSC:  Physiologic Integrity

 

  1. A patient has constipation as a side effect of opioid analgesics. What menu

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