Medical surgical Nursing Assessment and Management Of Clinical Problems, 8th Edition by Sharon L. Lewis – Test Bank

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Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 5: Chronic Illness and Older Adults

Test Bank

MULTIPLE CHOICE

1. When caring for a patient with type 2 diabetes who has been hospitalized with severe
hyperglycemia, which topic will be most important to include in discharge teaching?
a. Effect of endogenous insulin on transportation of glucose into cells
b. Function of the liver in formation of glycogen and gluconeogenesis
c. Impact of the patient’s family history on likelihood of developing diabetes
d. Symptoms indicating that the patient should contact the health care provider
ANS: D
One of the tasks for patients with chronic illnesses is to prevent and manage a crisis. The
patient needs instruction on recognition of symptoms of hyperglycemia and appropriate
actions to take if these symptoms occur. The other information also may be included in
patient teaching, but is not as essential in the patient’s self-management of the illness.

DIF: Cognitive Level: Application REF: 63
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2. Which question will provide the most useful information when the nurse is performing a
comprehensive geriatric assessment of an older adult who is being assessed for admission
to an assisted-living facility?
a. “Have you had any recent infections?”
b. “How frequently do you see a doctor?”
c. “Do you have a history of heart disease?”
d. “Are you able to prepare your own meals?”
ANS: D
The patient’s functional abilities, rather than the presence of acute or chronic illness, are
more useful in determining how well the patient might adapt to an assisted-living
situation. The other questions also will provide helpful information but are not as useful
in providing a basis for determining patient needs or for developing interventions for the
older patient.

DIF: Cognitive Level: Application REF: 73
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

3. The nurse is planning care for an alert and active 85-year-old patient who takes multiple
medications for chronic cardiac and respiratory disease and lives with a daughter who
works during the day. Which nursing diagnosis is most appropriate?
a. Risk for injury related to drug-drug interactions
b. Social isolation related to weakness and fatigue
c. Compromised family coping related to the patient’s many care needs

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Test Bank 5-2

d. Caregiver role strain related to need to adjust family employment schedule
ANS: A
The patient’s age and multiple medications indicate a risk for injury caused by
interactions between the multiple drugs being taken and a decreased drug metabolism
rate. The patient data do not indicate problems with social isolation, caregiver role strain,
or compromised family coping.

DIF: Cognitive Level: Application REF: 76 TOP: Nursing Process:
Diagnosis
MSC: NCLEX: Health Promotion and Maintenance

4. To obtain the most complete information when doing an assessment for an 81-year-old
patient, the nurse will
a. interview both the patient and the primary patient caregiver.
b. use a geriatric assessment instrument to evaluate the patient.
c. review the patient’s chart for the history of medical problems.
d. ask the patient to write down medical problems and medications.
ANS: B
The most complete information about the patient will be obtained through the use of an
assessment instrument specific to the geriatric population, which includes information
about both medical diagnoses and treatments and about functional health patterns and
abilities. A review of the chart, interviews of the patient and caregiver, and written
information by the patient will all be included in a comprehensive geriatric assessment.

DIF: Cognitive Level: Application REF: 73
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

5. When developing the plan of care for an older adult who is hospitalized for an acute
illness, the nurse should
a. use a standardized geriatric nursing care plan.
b. minimize activity level during hospitalization.
c. plan for transfer to a long-term care facility after the hospitalization.
d. consider the preadmission functional abilities when setting patient goals.
ANS: D
The plan of care for older adults should be individualized and based on the patient’s
current functional abilities. A standardized geriatric nursing care plan will not address
individual patient needs and strengths. A patient’s need for discharge to a long-term care
facility is variable. Activity level should be designed to allow the patient to retain
functional abilities while hospitalized and also to allow any additional rest needed for
recovery from the acute process.

DIF: Cognitive Level: Application REF: 74 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity

6. When caring for an older adult who lives in a rural area, the nurse will plan to

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Test Bank 5-3

a. assess the patient for chronic diseases that are unique to rural areas.
b. ensure transportation to appointments with the health care provider.
c. suggest that the patient move to an urban area for better health care.
d. obtain adequate medications for the patient to last for 4 to 6 months.
ANS: B
Transportation can be a barrier to accessing health services in rural areas. There are no
chronic diseases unique to rural areas. Because medications may change, the nurse should
help the patient plan for obtaining medications through alternate means such as the mail
or delivery services, not by purchasing large quantities of the medications. The patient
living in a rural area may lose the benefits of a familiar situation and social support by
moving to an urban area.

DIF: Cognitive Level: Application REF: 67 TOP: Nursing Process:
Planning
MSC: NCLEX: Health Promotion and Maintenance

7. When the nurse is working in the outpatient clinic, which nursing action will be most
helpful in decreasing the risk for drug-drug interactions in an older adult patient?
a. Teach the patient to have all prescriptions filled at the same pharmacy
b. Instruct the patient to avoid taking over-the-counter (OTC) medications.
c. Make a medication schedule for the patient as a reminder about when to take each

medication.
d. Have the patient bring all the medications, supplements, and herbs to every health

care appointment.
ANS: D
The most information about drug use and possible interactions is obtained when the
patient brings all prescribed medications, OTC medications, and supplements to every
health care appointment. The patient should discuss the use of any OTC medications with
the health care provider and obtain all prescribed medications from the same pharmacy,
but use of supplements and herbal medications also need to be considered in order to
prevent drug-drug interactions. Use of a medication schedule will help the patient take
medications as scheduled but will not prevent drug-drug interactions.

DIF: Cognitive Level: Application REF: 76
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

8. Which action will the nurse take when planning for discharge of a 68-year-old patient
who will need daily assistance with activities such as shopping and transportation?
a. Write to the state Medicaid office.
b. Contact the Area Agency on Aging.
c. Provide documentation to Medicare.
d. Communicate with the patient’s insurer.
ANS: B

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Test Bank 5-4

Funding from the federal Administration on Aging is funneled through local Area
Agencies on Aging to provide community services to older adults. Medicare, Medicaid,
and insurers provide funding for specific medical services, but not for need such as
shopping or transportation.

DIF: Cognitive Level: Application REF: 70-71 TOP: Nursing Process:
Planning
MSC: NCLEX: Safe and Effective Care Environment

9. A 78-year-old patient with multiple health problems complains of having “no energy”
and feeling increasingly weak. The patient has had an 11-pound weight loss over the last
year. The nurse should initially
a. ask the patient about daily dietary intake.
b. schedule regular range-of-motion exercise.
c. discuss long-term care placement with the patient.
d. describe normal changes with aging to the patient.
ANS: A
In the frail elderly patient, nutrition is frequently compromised, and the nurse’s initial
action should be to assess the patient’s nutritional status. Active range-of-motion may be
helpful in improving the patient’s strength and endurance, but nutritional assessment is
the priority because the patient has had a significant weight loss. The patient may be a
candidate for long-term care placement, but more assessment is needed before this can be
determined. The patient’s assessment data are not consistent with normal changes
associated with aging.

DIF: Cognitive Level: Application REF: 68
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

10. When admitting an 88-year-old patient to the hospital, the nurse should plan to
a. speak slowly and loudly while facing the patient.
b. obtain a detailed medical history from the patient.
c. interview the patient before the physical assessment.
d. determine whether the patient uses glasses or hearing aids.
ANS: D
Assistive devices should be in place before assessing the patient to minimize anxiety and
confusion. When a patient is acutely ill, the physical assessment should be accomplished
first to detect any physiologic changes that require immediate action. Not all older
patients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly
to all older patients. To avoid tiring the patient, much of the medical history can be
obtained from medical records.

DIF: Cognitive Level: Application REF: 73 TOP: Nursing Process:
Planning
MSC: NCLEX: Health Promotion and Maintenance

11. The nurse is planning discharge for an alert, homeless 70-year-old with a chronic foot
infection. The most appropriate intervention by the nurse is to

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Test Bank 5-5

a. teach the patient how to assess and care for the foot infection.
b. refer to social services for further assessment of patient needs.
c. schedule the patient to return to outpatient services for foot care.
d. give the patient written information about shelters and meal sites.
ANS: B
A multidisciplinary approach, including social services, is needed when caring for
homeless adults. Even with appropriate education, a homeless individual may not be able
to maintain adequate foot care because of a lack of supplies or a suitable place to
accomplish care. Older homeless individuals are less likely to use shelters or meal sites.
A homeless person may fail to keep appointments for outpatient services because of
factors such as fear of institutionalization or lack of transportation.

DIF: Cognitive Level: Application REF: 67-68
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care
Environment

12. The home health nurse is caring for a 71-year-old patient who lives alone and is taking
seven different prescribed medications for chronic health problems. To ensure medication
compliance, which nursing intervention is best?
a. Use a marked pillbox to set up the patient’s medications.
b. Discuss the option of moving to an assisted-living facility.
c. Remind the patient about the importance of taking medications.
d. Visit the patient daily to administer the prescribed medications.
ANS: A
Since forgetting to take medications is a common cause of medication errors in older
adults, the use of medication reminder devices is helpful when older adults have multiple
medications to take. There is no indication that the patient needs to move to assisted
living or that the patient does not understand the importance of medication compliance.
Home health care is not designed for the patient who needs ongoing assistance with
activities of daily living (ADLs) or instrumental ADLs (IADLs).

DIF: Cognitive Level: Application REF: 77
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

13. Which information obtained by the home health nurse when making a visit to an 88-year-
old with mild forgetfulness is of concern?
a. The patient tells the nurse that a close friend recently died.
b. The patient has lost 10 pounds (4.5 kg) during the last month.
c. The patient is cared for by a daughter during the day and stays with a son at night.
d. The patient’s son uses a marked pillbox to set up the patient’s medications weekly.
ANS: B
A 10-pound weight loss may be an indication of elder neglect or depression and requires
further assessment by the nurse. The use of a marked pillbox and planning by the family
for 24-hour care are appropriate for this patient. It is not unusual that an 88-year-old
would have friends who have died.

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Test Bank 5-6

DIF: Cognitive Level: Application REF: 69-70
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

14. Which information about a 77-year-old patient who is being assessed by the home health
nurse is of most concern?
a. The patient organizes medications in a marked pillbox “so I don’t forget them.”
b. The patient uses three different medications for chronic heart and joint problems.
c. The patient says, “I don’t go on my daily walks since I had pneumonia 3 months

ago.”
d. The patient tells the nurse, “I prefer to manage my life without much help from

others.”
ANS: C
Inactivity and immobility lead rapidly to loss of function in older adults. The nurse
should develop a plan to prevent further deconditioning and restore function for the
patient. Self-management is appropriate for independently living older adults. On
average, a 70-year-old takes seven different medications; the use of three medications is
not unusual for a 78-year-old. The use of memory devices to assist with safe medication
administration is recommended for older adults.

DIF: Cognitive Level: Application REF: 75
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

15. When admitting a 79-year-old patient who has urinary urgency and a possible urinary
tract infection (UTI), the nurse should first
a. assess the patient’s orientation.
b. inspect for abdominal distention.
c. question the patient about hematuria.
d. invite the patient to use the bathroom.
ANS: D
Before beginning the assessment of an older patient with a UTI and urgency, the nurse
should have the patient empty the bladder because bladder fullness or discomfort will
distract from the patient’s ability to provide accurate information. The patient may seem
disoriented if distracted by pain or urgency. The physical assessment data are obtained
after the patient is as comfortable as possible.

DIF: Cognitive Level: Application REF: 73
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

16. Which of these patients assigned to the nurse is most likely to need planning for long-
term nursing management?
a. 22-year-old with appendicitis who has had an emergency appendectomy
b. 56-year-old with bilateral knee osteoarthritis who weighs 350 lbs (159 kg)
c. 34-year-old with cholecystitis who has had a laparoscopic cholecystectomy
d. 62-year-old with acute sinusitis who will require antibiotic therapy for 5 days
ANS: B

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

Test Bank 5-7

The patient’s osteoarthritis is a chronic problem that will require planning for long-term
interventions such as physical therapy and nutrition counseling. The other patients have
acute problems that are not likely to require long-term management.

DIF: Cognitive Level: Application REF: 63
OBJ: Special Questions: Multiple Patients TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity

17. When a hospitalized older patient is at risk of falling because of acute confusion and
weakness, which action should the nurse take first?
a. Utilize a bed alarm system on the patient’s bed.
b. Administer the prescribed PRN sedative medication.
c. Ask the health care provider to order a vest restraint.
d. Place the patient in a “geri-chair” near the nurse’s station.
ANS: A
The use of the least restrictive restraint alternative is required. Physical or chemical
restraints may be necessary, but the nurse’s first action should be an alternative such as a
bed alarm.

DIF: Cognitive Level: Application REF: 77-78
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment

18. The nurse suspects that elder abuse may be occurring when a confused and agitated 76-
year-old patient with a broken arm is brought to the emergency department by a family
member. Which of these actions should the nurse take first?
a. Notify an elder protective services agency about the possible abuse.
b. Make a referral for a home assessment visit by the home health nurse.
c. Have the family member stay in the waiting area while the patient is assessed.
d. Ask the patient how the injury occurred and observe the family member’s reaction.
ANS: C
The initial action should be assessment and interviewing of the patient. The patient
should be interviewed alone because the patient will be unlikely to give accurate
information if the abuser is present. If abuse is occurring, the patient should not be
discharged home for a later assessment by a home health nurse. The nurse needs to
collect and document physiologic data before notifying the elder protective services
agency.

DIF: Cognitive Level: Application REF: 69-70
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

Test Bank 5-8

1. Which nursing actions will the nurse take to assess for possible malnutrition in a 69-year-
old patient (select all that apply)?
a. Observe for depression.
b. Review laboratory results.
c. Assess teeth and oral mucosa.
d. Ask about transportation needs.
e. Determine food likes and dislikes.
ANS: A, B, C, D
The laboratory results, especially albumin and cholesterol levels, may indicate chronic
poor protein intake or high-fat/cholesterol intake. Transportation impacts patients’ ability
to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in
poor condition may decrease the ability to chew and swallow. Food likes and dislikes are
not necessarily associated with malnutrition.

DIF: Cognitive Level: Application REF: 68
OBJ: Special Questions: Alternate Item Format
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.