Chapter 04 Gerontologic Assessment

Chapter 04  Gerontologic Assessment

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The geriatric nurse recognizes that the body’s homeostatic mechanisms may be compromised in the:
a.
79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily living (ADLs).
b.
73-year-old with a history of chronic bronchitis who lives with family.
c.
86-year-old who lost a spouse and is moving into an assisted living facility.
d.
69-year-old with peripheral vascular disease who is visited by home health care weekly.

ANS: C
Declining physiologic function and increased prevalence of disease, particularly in the old-old (age 85 or older), are in part a result of a reduction in the body’s ability to respond to stress through all of its homeostatic mechanisms. The important point is that older adults often encounter profound and repeated losses; the time between the occurrences of these losses is often short, resulting in an inadequate period for resolution and return to a baseline state, thus putting them at risk for illness. Although the other patients may have compromised homeostatic mechanisms, the 86-year-old patient is most likely to exhibit this phenomenon.

DIF: Analyzing (Analysis) REF: N/A OBJ: 4-2
TOP: Nursing Process: Diagnosis MSC: Physiologic Integrity

2. To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first:
a.
asks whether the patient has any questions about the interview.
b.
makes sure the interview area is comfortable and private.
c.
explains the reason for asking the questions.
d.
assures the patient that all answers will be kept confidential.

ANS: C
To ensure a successful interview, the nurse should explain the reason for the interview to the patient followed by a brief overview of the format to be followed. This helps alleviate anxiety and uncertainty, and the patient can then focus on providing the information. The other options are all important actions during the assessment interview, but they will not diminish anxiety as much as an explanation of the purpose.

DIF: Applying (Application) REF: N/A OBJ: 4-1
TOP: Nursing Process: Implementation MSC: Emotional Needs Related to Health Problems

3. An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patient’s daughter questions the possibility of pneumonia stating, “He isn’t coughing or having any difficulty breathing.” The nurse responds most appropriately by saying:
a.
“We are lucky to determine the problem in its early stage.”
b.
“Respiratory problems develop only after the infection is well established.”
c.
“People your dad’s age often lack the muscular strength to cough.”
d.
“Older adults frequently lack the typical signs of a respiratory infection.”

ANS: D
The characteristic presentation of illness in older adults is more commonly one of blunted or atypical signs and symptoms. Stating, “we are lucky to determine the problem” does not give any useful information. Respiratory problems are often present early on in younger people. The lack of coughing is not caused by weakness.

DIF: Understanding (Comprehension) REF: Page 57 OBJ: 4-2
TOP: Teaching-Learning MSC: Physiologic Integrity

4. A nurse aide working in the geriatric unit’s dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why she’s “here.” The nurse appropriately directs the nurse aide to:
a.
take the patient back to her room and put her safely in bed.
b.
place a falls risk identification bracelet on the patient and add the status care plan.
c.
immediately take the patient’s vital signs and report them to her.
d.
reorient the patient to time and place frequently and document the patient’s response.

ANS: C
A sudden change in an older adult patient’s cognitive status is likely a symptom of a physiologic stressor such as an infection. The vital signs will allow the nurse to determine the presence of a fever or other deviation from the patient’s baseline vitals. The patient may or may not need or wish to go to bed, but this does not provide any data for the nurse to evaluate. An ill patient may need to be on fall precautions, but again this does not provide data. Reorientation may be necessary, but if the patient has an illness, this needs to be taken care of.

DIF: Applying (Application) REF: N/A OBJ: 4-2
TOP: Nursing Process: Implementation MSC: Physiologic Integrity

5. The nurse most effectively implements guided reminiscence during a patient interview by:
a.
reminding the patient to share important memories of the past.
b.
scheduling several short interviews rather than one long one.
c.
controlling the interview by selecting the memories to be discussed.
d.
encouraging the patient to relive his or her memories while maintaining focus.

ANS: D
This goal-directed interviewing process helps the patient share pertinent information through remembering. The tendency to reminisce may make it difficult for the patient to stay focused on the topic, so it is the nurse’s responsibility to refocus the interview when necessary. Reminding the patient to share memories, using several short interviews, and controlling the interview do not make best use of this technique.

DIF: Applying (Application) REF: N/A OBJ: 4-4
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity