Study for Short Bowel Syndrome
Reduce Symptoms of Short Bowel
Do you have Short Bowel Syndrome? Apply now online to the
[VectivBio] SBS study
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SBS-IF Study
Pain from SBS
Living with SBS-IF and an ostomy bag? Apply to this SBS study.
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Hinv
Study for Short Bowel Syndrome
Frustrated at your bowels
Do you have Short Bowel Syndrome? Apply now online to the
[VectivBio] SBS study
vectivbio.patientwing.com
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Learn About DS Research
Learn About Dravet Syndrome
You, your child or a loved one may qualify for a Dravet syndrome
research study.
skyline.researchstudytrial.com
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Nursing Careers - Texas
Fantastic Benefits
United Regional Health Care Center
unitedregional.org
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3.
The nurse performs a comprehensive geriatric assessment
of a patient who is being assessed for admission
to an assisted living facility. Which question is the
most
important for the nurse to ask?
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 patients functional abilities, rather than the presence of
an acute or chronic illness, are more useful in
determining how well the patient might adapt to an assisted
living situation. The other questions will also
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: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health
Promotion and Maintenance
4.
When caring for an older patient with hypertension who has
been hospitalized after a transient ischemic
(TIA), which topic is the
most
important for the nurse to include in the discharge
teaching?
a.
Effect of atherosclerosis on blood vessels
b.
Mechanism of action of anticoagulant drug therapy
c.
Symptoms indicating that the patient should contact the
health care provider
d.
Impact of the patients family history on likelihood of
developing a serious stroke
ANS: C
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 hypertension and
TIA 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
patients self-management of the illness.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
5.
An older patient is hospitalized with pneumonia. Which
intervention should the nurse implement to provide
optimal care for this patient?
a.
Use a standardized geriatric nursing care plan.
b.
Minimize activity level during hospitalization.
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
39
c.
Plan for transfer to a long-term care facility upon discharge.
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 patients current functional abilities.
A standardized geriatric nursing care plan will not address
individual patient needs and strengths. A patients
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: Apply (application)
TOP: Nursing Process: Planning MSC: NCLEX:
Physiological Integrity
6.
The nurse cares for an older adult patient who lives in a
rural area. Which intervention should the nurse plan
to implement to
best
meet this patients needs?
a.
Suggest that the patient move to an urban area.
b.
Assess the patient for chronic diseases that are unique to
rural areas.
c.
Ensure transportation to appointments with the health care
provider.
d.
Obtain adequate medications for the patient to last for 4 to 6
months.
ANS: C
Transportation can be a barrier to accessing health services
in rural areas. The patient living in a rural area may
lose the benefits of a familiar situation and social support by
moving to an urban area. 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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning MSC: NCLEX: Health
Promotion and Maintenance
7.
Which nursing action will be
most
helpful in decreasing the risk for drug-drug interactions in
an older adult?
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 schedule for the patient as a reminder of when to
take each medication.
d.
Have the patient bring all medications, supplements, and
herbs to each appointment.
ANS: D
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
40
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: Understand (comprehension)
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
8.
A patient who has just moved to a long-term care facility has
a nursing diagnosis of relocation stress
syndrome. Which action should the nurse include in the plan
of care?
a.
Remind the patient that making changes is usually stressful.
b.
Discuss the reason for the move to the facility with the
patient.
c.
Restrict family visits until the patient is accustomed to the
facility.
d.
Have staff members write notes welcoming the patient to
the facility.
ANS: D
Having staff members write notes will make the patient feel
more welcome and comfortable at the long-term
care facility. Discussing the reason for the move and
reminding the patient that change is usually stressful will
not decrease the patients stress about the move. Family
member visits will decrease the patients sense of stress
about the relocation.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning MSC: NCLEX:
Psychosocial Integrity
9.
An older patient complains of having no energy and feeling
increasingly weak. The patient has had a 12pound weight loss over the last year. Which action should
the nurse take
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 associated with aging to the
patient.
ANS: A
In a frail older patient, nutrition is frequently compromised,
and the nurses initial action should be to assess the
patients nutritional status. Active range of motion may be
helpful in improving the patients 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 patients assessment data are not
consistent with normal changes associated with aging.
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
41
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Prioritization TOP: Nursing
Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
10.
The nurse admits an acutely ill, older patient to the hospital.
Which action should the nurse take
first
?
a.
Speak slowly and loudly while facing the patient.
b.
Obtain a detailed medical history from the patient.
c.
Perform the physical assessment before interviewing the
patient.
d.
Ask a family member to go home and retrieve the patients
cane.
ANS: C
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. After the initial
physical assessment to determine the patients current
condition, then the nurse could ask someone to obtain any
assistive devices for the patient if applicable.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Prioritization TOP: Nursing
Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
11.
The nurse cares for an alert, homeless older adult patient
who was admitted to the hospital with a chronic
foot infection. Which intervention is the
most
appropriate for the nurse to include in the discharge plan for
this
patient?
a.
Refer the patient to social services for further assessment.
b.
Teach the patient how to assess and care for the foot
infection.
c.
Schedule the patient to return to outpatient services for foot
care.
d.
Give the patient written information about shelters and meal
sites.
ANS: A
An interdisciplinary approach, including social services, is
needed when caring for homeless older adults. Even
with appropriate teaching, 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: Apply (application)
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
42
TOP: Nursing Process: Implementation MSC: NCLEX: Safe
and Effective Care Environment
12.
The home health nurse cares for an older adult patient who
lives alone and takes several different
prescribed medications for chronic health problems. Which
intervention, if implemented by the nurse, would
best
encourage medication compliance?
a.
Use a marked pillbox to set up the patients 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
Because 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: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
13.
The home health nurse visits an older patient with mild
forgetfulness. The nurse is
most
concerned if
which information is obtained?
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 patients son uses a marked pillbox to set up the
patients 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 86-year-old would have
friends who have died.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX:
Physiological Integrity
14.
Which statement, if made by an older adult patient, would
be of
most
concern to the nurse?
a.
I prefer to manage my life without much help from other
people.
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
43
b.
I take three different medications for my heart and joint
problems.
c.
I dont go on daily walks anymore since I had pneumonia 3
months ago.
d.
I set up my medications in a marked pillbox so I dont forget
to take them.
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, an older adult
takes seven different medications so the use of
three medications is not unusual for this patient. The use of
memory devices to assist with safe medication
administration is recommended for older adults.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health
Promotion and Maintenance
15.
The nurse assesses an older patient who takes diuretics
and has a possible urinary tract infection (UTI).
Which action should the nurse take
first
?
a.
Palpate over the suprapubic area.
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 on diuretics, the nurse should have the
patient empty the bladder because bladder fullness or
discomfort will distract from the patients 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: Apply (application)
OBJ: Special Questions: Prioritization TOP: Nursing
Process: Assessment
MSC: NCLEX: Physiological Integrity
16.
Which patient is
most
likely to need long-term nursing care management?
a.
72-year-old who had a hip replacement after a fall at home
b.
64-year-old who developed sepsis after a ruptured peptic
ulcer
c.
76-year-old who had a cholecystectomy and bile duct
drainage
d.
63-year-old with bilateral knee osteoarthritis who weighs
350 lb (159 kg)
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
44
ANS: D
Osteoarthritis and obesity are chronic problems 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: Apply (application)
OBJ: Special Questions: Multiple Patients TOP: Nursing
Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
17.
When completing an admission assessment on an older
adult, the nurse gives the patient a high fall risk
score. Which action should the nurse take
first
?
a.
Use a bed alarm system on the patients 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 nurses station.
ANS: A
The use of the least restrictive restraint alternative is
required. Physical or chemical restraints may be
necessary, but the nurses first action should be an
alternative such as a bed alarm.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Prioritization TOP: Nursing
Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
18.
An older adult patient presents with a broken arm and
visible scattered bruises healing at different stages.
Which action 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 members 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
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
45
needs to collect and document data before notifying the
elder protective services agency.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Prioritization TOP: Nursing
Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
19.
The family of an older patient with chronic health problems
and increasing weakness is considering
placement in a long-term care (LTC) facility. Which action by
the nurse will be
most
helpful in assisting the
patient to make this transition?
a.
Have the family select a LTC facility that is relatively new.
b.
Obtain the patients input about the choice of a LTC facility.
c.
Ask that the patient be placed in a private room at the
facility.
d.
Explain the reasons for the need to live in LTC to the
patient.
ANS: B
The stress of relocation is likely to be less when the patient
has input into the choice of the facility. The age of
the long-term care facility does not indicate a better fit for
the patient or better quality of care. Although some
patients may prefer a private room, others may adjust better
when given a well-suited roommate. The patient
should understand the reasons for the move but will make
the best adjustment when involved with the choice
to move and the choice of the facility.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX:
Psychosocial Integrity
20.
The nurse manages the care of older adults in an adult
health day care center. Which
action can the nurse delegate to unlicensed assistive
personnel (UAP)?
a.
Obtain information about food and medication allergies from
patients.
b.
Take blood pressures daily and document in individual
patient records.
c.
Choose social activities based on the individual patient
needs and desires.
d.
Teach family members how to cope with patients who are
cognitively impaired.
ANS: B
Measurement and documentation of vital signs are included
in UAP education and scope of practice. Obtaining
patient health history, planning activities based on the
patient assessment, and patient education are all actions
that require critical thinking and will be done by the
registered nurse.
DIF: Cognitive Level: Apply (application)
Test Bank - Lewis's Medical Surgical Nursing (11th Edition by
Harding)
46
OBJ: Special Questions: Delegation TOP: Nursing Process:
Planning
MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1.
Which nursing actions will the nurse take to assess for
possible malnutrition in an older adult 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
malnutritio