Chapter 05: Chronic Illness and Older Adults
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. 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 patient’s 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 may also be
included in patient teaching but is not as essential in the patient’s self-management of the
illness.
DIF: Cognitive Level: Analyze (analysis)
REF: 60
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
2. The nurse performs a comprehensive assessment of an older patient who is considering
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 patient’s 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: Analyze (analysis)
REF: 62
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
3. An alert older patient who takes multiple medications for chronic cardiac and pulmonary
diseases lives with a daughter who works during the day. During a clinic visit, the patient
verbalizes to the nurse that she has a strained relationship with her daughter and does not
enjoy being alone all day. Which nursing diagnosis should the nurse assign as the priority for
this patient?
a. Social isolation related to fatigue
b. Risk for injury related to drug interactions
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c. Caregiver role strain related to family employment schedule
d. Compromised family coping related to the patient’s care needs
ANS: B
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. Problems with
social isolation, caregiver role strain, or compromised family coping are not physiologic
priorities. Drug–drug interactions could cause the most harm to the patient and are therefore
the priority.
DIF: Cognitive Level: Analyze (analysis)
REF: 73
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Health Promotion and Maintenance
4. Which method should the nurse use to gather the most complete assessment of an older
patient?
a. Review the patient’s health record for previous assessments.
b. Use a geriatric assessment instrument to evaluate the patient.
c. Ask the patient to write down medical problems and medications.
d. Interview both the patient and the primary caregiver for the patient.
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 medical record, interviews with the patient and caregiver, and written
information by the patient are all included in a comprehensive geriatric assessment.
DIF: Cognitive Level: Analyze (analysis)
REF: 74
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
5. Which intervention should the nurse implement to provide optimal care for an older patient
who is hospitalized with pneumonia?
a. Plan for transfer to a long-term care facility.
b. Minimize activity level during hospitalization.
c. Consider the preadmission functional abilities.
d. Use an approved standardized geriatric nursing care plan.
ANS: C
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: Apply (application)
REF:
69
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
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6. The nurse cares for an older adult patient who lives in a rural area. Which intervention should
the nurse plan to implement to meet this patient’s needs?
a. Suggest that the patient move closer to health care providers.
b. Obtain extra medications for the patient to last for 4 to 6 months.
c. Ensure transportation to appointments with the health care provider.
d. Assess the patient for chronic diseases that are unique to rural areas.
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)
REF:
64
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. Make a schedule for the patient as a reminder of when to take each medication.
c. Instruct the patient to avoid taking over-the-counter (OTC) medications or
supplements.
d. Ask the patient to bring all medications, supplements, and herbs to each
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: Analyze (analysis)
REF: 65
OBJ: Special Questions: Prioritization
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
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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 patient’s stress about the move. Family
member visits will decrease the patient’s sense of stress about the relocation.
DIF: Cognitive Level: Apply (application)
REF:
69
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 12-lb weight loss over the past 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 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: Analyze (analysis)
REF: 65
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
10. The nurse is admitting an acutely ill, older patient to the hospital. Which action should the
nurse take?
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 patient’s 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 patient’s current condition, then the
nurse could ask someone to obtain any assistive devices for the patient if applicable.
DIF: Cognitive Level: Apply (application)
REF:
70
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. Teach the patient how to assess and care for the foot infection.
b. Refer the patient to social services for assessment of resources.
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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
An interprofessional 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: Analyze (analysis)
REF: 65
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 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
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
or instrumental ADLs.
DIF: Cognitive Level: Apply (application)
REF:
73
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
13. The home health nurse visits an older patient with mild forgetfulness. Which new information
is of most concern to the nurse?
a. The patient tells the nurse that a close friend recently died.
b. The patient has lost 10 lb (4.5 kg) during the past 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 86-yr-old would have
friends who have died.
DIF: Cognitive Level: Apply (application)
REF:
74
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.”
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b. “I take three different medications for my heart and joint problems.”
c. “I don’t go on daily walks anymore since I had pneumonia 3 months ago.”
d. “I set up my medications in a marked pillbox so I don’t 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)
REF:
71
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. Request the patient empty the bladder.
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 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: Analyze (analysis)
REF: 69
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-yr-old who had a hip replacement after a fall at home
b. 64-yr-old who developed sepsis after a ruptured peptic ulcer
c. 76-yr-old who had a cholecystectomy and bile duct drainage
d. 63-yr-old with bilateral knee osteoarthritis who weighs 350 lb (159 kg)
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: Analyze (analysis)
OBJ: Special Questions: Multiple Patients
MSC: NCLEX: Safe and Effective Care Environment
REF: 64
TOP: Nursing Process: Planning
17. An older adult being admitted is assessed at high risk for falls. Which action should the nurse
take first?
a. Use a bed alarm system on the patient’s bed.
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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: Analyze (analysis)
REF: 74
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 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 data before
notifying the elder protective services agency.
DIF: Cognitive Level: Analyze (analysis)
REF: 69
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. Ask the patient’s preference for the choice of a LTC facility.
c. Explain the reasons for the need to live in LTC to the patient.
d. Request that the patient be placed in a private room at the facility.
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: Analyze (analysis)
REF: 69
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)?
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a.
b.
c.
d.
Obtain information about food and medication allergies from patients.
Take blood pressures daily and document in individual patient records.
Choose social activities based on the individual patient needs and desires.
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)
REF:
75
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. Assess for depression.
b. Review laboratory results.
c. Determine food preferences.
d. Inspect teeth and oral mucosa.
e. Ask about transportation needs.
ANS: A, B, D, E
The laboratory results, especially albumin and cholesterol levels, may indicate chronic poor
protein intake or high-fat or high-cholesterol intake. Transportation affects the patient’s 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: Apply (application)
REF:
65
TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
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