Description
Priorities in Critical Care Nursing 6th Edition Urden Stacy Lough Test Bank
ISBN-13: 978-0323074612
ISBN-10: 0323074618
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Urden: Priorities in Critical Care Nursing, 6th Edition
Chapter 07: Gerontological Alterations
Test Bank
MULTIPLE CHOICE
Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.
- Age-related changes in myocardial pumping ability may be evidenced by:
| a. | increased contractility. |
| b. | decreased contractility. |
| c. | decreased left ventricle afterload. |
| d. | increased cardiac output. |
ANS: B
Myocardial collagen content increases with age. Collagen is the principal noncontractile protein occupying the cardiac interstitium. Increased myocardial collagen content renders the myocardium less compliant.
DIF: Cognitive Level: Comprehension REF: Table 7-1
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.
- Age-related pulmonary changes that may affect Mr. Y include:
| a. | increased tidal volumes. |
| b. | weakening of intercostal muscles and the diaphragm. |
| c. | improved cough reflex. |
| d. | decreased sensation of the glottis. |
ANS: B
Strength of the diaphragm and both external and internal intercostal muscles decreases with age. During aging, skeletal muscle progressively atrophies and its energy metabolism decreases, which may partially account for the declining strength of the respiratory muscles.
DIF: Cognitive Level: Comprehension REF: Table 7-1
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.
- Dopamine 5 mcg/kg per minute has been ordered for Mr. Y. What nursing implications should be considered when administering this drug to an older patient?
| a. | No changes are noted in older patients with this drug. |
| b. | Drug effect is enhanced by increased receptor site action. |
| c. | Increased breakdown by liver hepatocytes occurs, increasing dosage requirements. |
| d. | Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity. |
ANS: D
The decreasing ability of the older patient’s liver to metabolize drugs increases the risks of drug toxicity. This reduced drug-metabolizing capacity is caused by a reduction in the activity of the drug-metabolizing enzyme system, microsomal ethanol oxidizing system, and decrease in total liver blood flow.
DIF: Cognitive Level: Application REF: Table 7-4
OBJ: Nursing Process: Intervention TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.
- When caring for Mr. Y, the nurse plans increased attention to skin integrity because of the:
| a. | thickening of the epidermal skin layer. |
| b. | loss of sebaceous glands. |
| c. | increased fragility from loss of protective subcutaneous layers. |
| d. | decreased melanocyte production. |
ANS: C
The nurse may also find multiple ecchymotic areas because of decreased protective subcutaneous tissue layers, increased capillary fragility, and flattening of the capillary bed, which predispose older adults to developing ecchymoses.
DIF: Cognitive Level: Comprehension REF: 72
OBJ: Nursing Process: Intervention TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.
- Mr. Y awakens during the night confused and disoriented. This may be in part because of:
| a. | impaired sensation of peripheral receptors. |
| b. | increased nerve impulse conduction resulting in increased anxiety. |
| c. | changes in neurotransmitter levels, leading to a desynchronization in neurotransmission. |
| d. | inevitable dementia. |
ANS: C
It is suggested that age-related changes in neurotransmitter levels may cause a desynchronization in neurotransmission, thereby affecting many neurological functions. Acetylcholine, dopamine, serotonin, glutamate, and gamma-aminobutyric acid all decrease with increasing age.
DIF: Cognitive Level: Comprehension REF: 70
OBJ: Nursing Process: Diagnosis TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- An older patient is admitted to the hospital with acute onset of mental changes and recent falls. The nurse knows that the most common cause of mental changes is:
| a. | over medication. |
| b. | infection. |
| c. | cerebral vascular accident. |
| d. | electrolyte imbalance. |
ANS: B
Infections in the older adult initially appear as an acute onset of mental status changes, anorexia, urinary incontinence, falls, or generalized weakness. Urinary tract infections and pneumonia are also common infections that should be ruled out.
DIF: Cognitive Level: Application REF: 70
OBJ: Nursing Process: Diagnosis TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- An older patient is started on an angiotensin-converting enzyme (ACE) inhibitor. The nurse knows to monitor for:
| a. | hyperkalemia. |
| b. | irregular heart rate. |
| c. | confusion. |
| d. | pulmonary edema. |
ANS: A
In the critically ill older adult, drugs such as digoxin, ACE II inhibitors, and angiotensin II receptor blockers have delayed excretion, increased serum concentration, and more prolonged duration of action because their excretion parallels glomerular filtration rate, which decreases with age.
DIF: Cognitive Level: Application REF: 72
OBJ: Nursing Process: Evaluation TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- The nurse is teaching an older patient about the signs and symptoms of a myocardial infarction. Which statement by the patient would indicate that the teaching was effective?
| a. | “The pain in my chest may last a long time.” |
| b. | “I will feel like I have an elephant sitting on the center of my chest.” |
| c. | “The chest pain will be sharp and over the center of my chest.” |
| d. | “The pain may not be severe and may not be in my chest.” |
ANS: D
Studies have shown that symptoms of chest pain were absent in up to 50% of older adult patients who sustained a myocardial infarction. Others have also reported that chest pain in the older adult is less intense, of shorter duration, and originates in other areas of the chest besides the substernal region.
DIF: Cognitive Level: Analysis REF: 65
OBJ: Nursing Process: Evaluation TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Which of the following would be a normal assessment finding for an older patient?
| a. | Inability to remember what was eaten yesterday |
| b. | An increase in resting heart rate |
| c. | Hypoactive bowel sounds |
| d. | Brisk papillary response to light |
ANS: A
An older person may have problems with short-term memory, but long-term memory is intact. Resting heart rate decreases. Although gastrointestinal motility changes occur, bowel sounds remain unchanged. Pupillary response to light slows down.
DIF: Cognitive Level: Application REF: 70
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- An older patient is admitted to the hospital with a hip fracture. Which of the following nursing interventions would be a priority?
| a. | Facilitate frequent deep breathing. |
| b. | Palpate pedal pulses. |
| c. | Perform neurological checks. |
| d. | Frequently offer liquids to drink. |
ANS: A
Although all the items are important, older persons are more susceptible to atelectasis and pulmonary infection because of respiratory changes. Nursing care needs to be provided to prevent those complications.
DIF: Cognitive Level: Analysis REF: Table 7-1
OBJ: Nursing Process: Intervention TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys. Which is the best assessment to monitor the patient’s ability to tolerate the medication?
| a. | Liver function tests |
| b. | Drug side effects experienced by the patient |
| c. | Kidney function tests |
| d. | Therapeutic drug levels |
ANS: B
It is well documented that older persons are more susceptible to drug side effects and adverse effects. Although the liver’s ability to metabolize drugs is decreased, no changes in liver function test results occur.
DIF: Cognitive Level: Analysis REF: 72
OBJ: Nursing Process: Evaluation TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- An older patient is receiving a nephrotoxic medication. Which of the following would be a priority for the nurse to monitor?
| a. | Electrocardiogram |
| b. | Lung sounds |
| c. | Blood pressure |
| d. | Level of consciousness |
ANS: C
Because of the decreased number of nephrons and decreased glomerular filtration rate, an older patient’s kidneys are more susceptible to damage from nephrotoxic drugs. The senescent kidney is more susceptible to injury by hypotensive episodes because of the age-related decrease in renal blood flow and reduced pressure gradient across the afferent arteriole.
DIF: Cognitive Level: Analysis REF: 69
OBJ: Nursing Process: Intervention TOP: Gerontology
MSC: NCLEX: Physiological Integrity Physiological Adaptation
- Which of the following can be a normal assessment finding for an older patient?
| a. | Asymptomatic dysrhythmias |
| b. | Decreased urine output |
| c. | Increased respiratory effort |
| d. | Difficulty problem solving |
ANS: A
The incidence of asymptomatic cardiac dysrhythmias increases in older patients. Common dysrhythmias are atrial fibrillation, atrial flutter, or paroxysmal supraventricular tachycardia, premature ventricular contractions, and atrioventricular conduction disturbances. All the other findings are abnormal.
DIF: Cognitive Level: Analysis REF: 66
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Which of the following will remain unchanged in an older person when he or she exercises?
| a. | Cardiac output |
| b. | Heart rate |
| c. | Blood pressure |
| d. | Heart rhythm |
ANS: A
In healthy older individuals there is no age-associated decline in cardiac output during exercise. The maximal heart rate decreases, but the stroke volume increases to compensate.
DIF: Cognitive Level: Comprehension REF: Table 7-1
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- A critically ill older adult is placed on a continuous infusion of high-dose loop diuretic for diuresis. The nurse knows to monitor for:
| a. | hyperkalemia. |
| b. | bradycardia. |
| c. | metabolic acidosis. |
| d. | hyperchloremic alkalosis. |
ANS: C
The rate of absorption, time to peak plasma concentration, and clearance of loop diuretics is reduced, which may necessitate high dosing regimens to facilitate diuresis. This poses an increased risk of metabolic acidosis. The patient should be monitored for hypokalemia, tachycardia, and hypochloremic alkalosis with loop diuretics.
DIF: Cognitive Level: Application REF: 69
OBJ: Nursing Process: Evaluation TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Because of the changes in the ventricles of the elderly patient’s brain, the nurse institutes precautions for which of the following?
| a. | Bleeding |
| b. | Seizure |
| c. | Falling |
| d. | Confusion |
ANS: C
The dilation of the ventricles results in a decrease in the number of Purkinje cells and loss of cells in the vestibular system.
DIF: Cognitive Level: Synthesis REF: Table 7-1
OBJ: Nursing Process: Implementation TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Changes in the elderly patient’s renal function may alter serum concentrations of medication because of:
| a. | delayed excretion. |
| b. | alterations in urinary pH. |
| c. | increased filtration. |
| d. | adverse drug reactions. |
ANS: A
Drugs associated with management of common disorders seen in critically ill patients—such as digoxin, angiotensin II–converting enzyme inhibitors, and angiotensin-II receptor blockers—show delayed excretion, increased serum concentration, and more prolonged duration of action in the elderly because their excretion parallels glomerular filtration rate (which decreases with age).
DIF: Cognitive Level: Application REF: 72
OBJ: Nursing Process: Evaluation TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- The nurse would implement which of the following interventions to help prevent esophagitis in an elderly patient?
| a. | Encourage intake of fluids. |
| b. | Offer a liquid diet. |
| c. | Offer several small meals daily. |
| d. | Encourage ambulation and elevate the head of the bed. |
ANS: D
Changes in esophageal motility may predispose the patient to erosion of the esophageal wall (recurrent esophagitis) because food remains in the esophagus longer. In addition, bed rest and reclining in a supine position for a prolonged period can cause esophageal reflux, which can also lead to esophagitis.
DIF: Cognitive Level: Application REF: 69
OBJ: Nursing Process: Implementation TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Changes in the diaphragm and accessory and abdominal muscles have what effect on the elderly patient?
| a. | Decreased residual volume |
| b. | Decreased tidal volume |
| c. | Increased residual volume |
| d. | Increased tidal volume |
ANS: C
Increased weakness of the diaphragm and abdominal and accessory muscles leads to decreased ability to inhale and exhale.
DIF: Cognitive Level: Analysis REF: 68
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Calcification of costal cartilage is demonstrated on an elderly patient’s admission chest radiograph. The nurse will plan careful, regular assessment of:
| a. | thoracic wall excursion. |
| b. | respiratory rate. |
| c. | breath sounds. |
| d. | oxygen saturation. |
ANS: A
With advancing age the chest wall (thoracic skeleton) and vertebrae undergo a small degree of osteoporosis, and at the same time the costal cartilages that connect the rib cage together become calcified and stiff. These changes may produce kyphosis and reduced chest wall compliance, respectively. The functional effect is a decrease in thoracic wall excursion.
DIF: Cognitive Level: Analysis REF: 68
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
COMPLETION
- Mineral loss associated with a decrease in bone mass is referred to as __________.
ANS:
osteoporosis
Mineral loss associated with a decrease in bone mass is referred to as osteoporosis.
DIF: Cognitive Level: Knowledge REF: 72
OBJ: Nursing Process: Diagnosis TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
MULTIPLE RESPONSE
- Which of the following contribute to a higher risk for myocardial ischemia in the older patient? (Select all that apply)
| a. | Increased diastolic filling pressures |
| b. | Decreased intracellular free calcium |
| c. | Thinning left ventricular wall thickness |
| d. | Increased myocardial collagen content |
| e. | Increased myocardial oxygen consumption |
ANS: A, D, E
Increased myocardial collagen leads to decreased compliance.
DIF: Cognitive Level: Application REF: 65
OBJ: Nursing Process: Diagnosis TOP: Gerontology
MSC: NCLEX: Physiological Integrity
- The nurse should be alert for immune deficiencies in the older patient because of which of the following? (Select all that apply)
| a. | Nutritional deficiencies |
| b. | Presence of chronic illnesses |
| c. | Insertion of invasive devices |
| d. | Decreased total lung capacity |
| e. | Increased peristaltic action in the esophagus |
ANS: A, B, C
Older patients are at higher risk for infection because of the likely presence of protein-calorie malnutrition, poor dentition, swallowing difficulties that can lead to aspiration, and chronic illnesses that leave the patient in a vulnerable state.
DIF: Cognitive Level: Application REF: 71
OBJ: Nursing Process: Diagnosis TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Muscle rigidity in the elderly is seen primarily in: (Select all that apply)
| a. | hands and wrists. |
| b. | neck and shoulders. |
| c. | hips and knees. |
| d. | back and ankles. |
ANS: B, C
Muscle rigidity increases in the elderly, especially in the neck, shoulders, hips, and knees, possibly causing changes in range of motion.
DIF: Cognitive Level: Knowledge REF: 72
OBJ: Nursing Process: Assessment TOP: Gerontology
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
