Deck 24: Caring for Frail Elders With Comorbidities

Question 1

The nurse is planning care for an older patient who is newly admitted. What nursing interventions are necessary to prevent the geriatric cascade? Select all that apply.
1) Frequent assessment of pressure ulcers
2) Frequent monitoring of confusion
3) Usage of physical and chemical restraints
4) Usage of indwelling urinary catheters
5) Monitoring risk of thrombophlebitis

Answer 1

1, 2, 5

Question 2

The nurse is admitting an older frail patient with dementia as a resident in a long-term care facility. Which problem is a priority when planning interventions for this patient's care?
1) Agitation
2) Wandering behaviors
3) Sleep disturbances
4) Polypharmacy

Answer 2

4

Question 3

The nurse is concerned that an older patient with a chronic illness is on a trajectory towards frailty and dependence. From the nursing assessment findings listed, which is the priority?
1) Sustained cognitive impairment
2) Conditions controlled with medications
3) Family that phones several times a day
4) A decline in functional ability

Answer 3

4

Question 4

A frail older patient with diabetes is diagnosed with a urinary tract infection. Which statement from the patient would concern the nurse to further assess for complications?
1) "My stomach is aching."
2) "I feel nauseated."
3) "I have a headache."
4) "My vaginal area is itching."

Question 5

During a nursing assessment, a frail older patient with cognitive impairment has a higher level of confusion than normal. What symptoms indicative of a urinary tract infection should the nurse further assess?
1) Flank pain
2) Fall risk
3) Blood pressure
4) Increased appetite

Question 6

An older patient with chronic renal failure is admitted; the healthcare provider is planning modified care for this patient. Nursing interventions for modified level of care would focus on which of the following? Select all that apply.
1) Management of illness with medications
2) Symptom and pain management
3) Noninvasive testing
4) Minimally invasive surgery
5) Gentle rehabilitation

Question 7

The nurse is caring for an older patient recently diagnosed with cancer. The nurse is concerned about the patient moving towards a trajectory of frailty. What laboratory findings support the nurse's concern?
1) Hemoglobin 12 g/dL
2) Hematocrit 40 g/dL
3) Serum albumin less than 2.5 g/100 dL
4) Serum albumin greater than 2.5 g/100 dL

Question 8

The nurse manager is concerned about the increased number of medication adverse effects being observed in older patients. What should the manager do to reduce these effects? Select all that apply.
1) Conduct a monthly quality improvement study.
2) Monitor each nurse's ability to detect preparation errors.
3) Discuss the importance of not missing medication doses.
4) Review pharmacy documentation regarding drug-drug interactions.
5) Ensure that the physicians' orders are legible.

Question 9

The nurse is assessing an older patient in a skilled facility for frailty. During the assessment, the nurse determines frailty through the presence of which characteristics? Select all that apply.
1) Unplanned weight gain
2) Poor endurance
3) Increase in grip strength
4) Low activity tolerance
5) Generalized weakness

Question 10

An older patient is diagnosed with cardiovascular disease. The nurse is planning care for him; which factors can contribute to frailty? Select all that apply.
1) Decreased sense of thirst
2) Electrolyte imbalance
3) Digestive abnormalities
4) Inability to walk 10 feet
5) Multiple prescribed medications

Question 11

An older patient is demonstrating delirium since being admitted from a nursing home for treatment of a wound infection. What should the nurse identify as the most likely cause for the patient's delirium?
1) High television volume
2) Intravenous fluid therapy
3) Windowless hospital room
4) Assessments every 4 hours

Question 12

The nurse is caring for an older patient who is receiving palliative care. Which intervention is the highest priority for this patient?
1) Noninvasive testing
2) Pain management
3) Management of illness with medications
4) Invasive surgery

Question 13

The nurse is preparing a community education program focusing on cardiovascular disease in the older patient. Which information should the nurse include?
1) Breast cancer kills more women than heart disease.
2) A woman of 70 is as likely as a man to develop heart disease.
3) Women are more likely than men to develop heart disease in their middle years.
4) For most women, heart disease is a greater problem before they reach menopause.

Question 14

A multidisciplinary team in a long-term care facility is meeting with the family of a frail older patient to discuss care issues and concerns. What key issues should be addressed in the conference? Select all that apply.
1) Consistency with policy
2) The patient's preferences
3) Avoidance of doing harm to the patient
4) Focus on cost-effective methods
5) The needs and wishes of the family

Question 15

The nurse is assessing an older patient's risk for developing problems while hospitalized for an acute illness. The Hospital Admission Risk Profile (HARP) tool will be utilized. Which assessment areas would alert the nurse to a risk? Select all that apply.
1) Age of 87
2) Manual dexterity score of 14
3) Cognitive function score of 7
4) Ability to self-feed score of 2
5) Independence IADL's score of 5

Question 16

An older patient admitted for treatment of pneumonia has severe osteoarthritis. The nurse notices that the client is progressing on a trajectory towards frailty. What nursing assessment findings support this?
1) Poor appetite
2) Frequent requests for pain medication
3) Decreased stamina and deconditioning
4) Compliance with prescribed breathing treatments

Question 17

An older client asks the nurse what they can do to live to a healthy old age. Which response by the nurse promotes healthy aging?
1) "You should not receive influenza and pneumococcal vaccines."
2) "You should decrease nutritional intake of dairy products."
3) "You should avoid any weightlifting."
4) "You should use available preventive and screening services."

Question 18

An older patient with diabetes is prescribed high-dose antibiotic therapy for a wound infection. Which effects of antibiotic therapy should the nurse further assess in relation to the patient?
1) Diarrhea
2) Dizziness
3) Headaches
4) Lethargy

Question 19

A frail older patient is more at risk for poor treatment outcomes in an acute care setting due to what factors? Select all that apply.
1) Increased incidence of nosocomial infections
2) Increased risk of adverse outcomes from therapeutic interventions
3) A diagnosis of vague symptoms and problems
4) Acute illness and diagnosed chronic illnesses
5) Cognitive impairments

Question 20

The nurse is planning a presentation for nursing assistants on caring for older patients. Which criteria should the nurse include when explaining frailty? Select all that apply.
1) Slowness
2) Low activity
3) Short-term memory loss
4) Weakness and exhaustion
5) Unplanned weight loss of at least 10 lbs. in a year

Question 21

The nurse is planning an education program for other nurses on palliative care. Which information should the nurse include in the program? Select all that apply.
1) Palliative care focuses on patients who are close to death.
2) Palliative care can provide respite care for family members.
3) Palliative care focuses on managing pain and troublesome symptoms.
4) Palliative care focuses on developing a therapeutic relationship.
5) Palliative care can be delivered long-term and throughout all phases of treatment.

Question 22

A hospital is planning to implement a unit that focuses on acute care of the elderly (ACE). How should the hospital administrator explain this unit to the nursing staff?
1) "An ACE unit will be run just like a nursing home, except it's in the hospital."
2) "An ACE unit isn't any different than any other unit in the hospital."
3) "The key concept of an ACE unit is to return the patients to their nursing homes."
4) "An ACE will be guided by nurse-driven protocols."

Question 23

The daughter of an older frail patient recovering from receiving the wrong medication asks what the hospital can do to prevent this from happening again. How should the nurse respond to the daughter?
1) "There isn't much that can be done; accidents happen."
2) "Medication errors sometimes happen because we are so short-staffed."
3) "The physician's handwriting was misread; we are talking to him about this issue."
4) "We are discussing installing a bar-code system to identify patients and medications."

Question 24

A nurse assesses a client in their home and determines they are on a pathway towards frailty. What assessment findings lead the nurse to have this concern? Select all that apply.
1) Chronic use of pain medication
2) Diagnosis of diabetes and heart disease
3) Newly incontinent of urine
4) No children and recent death of spouse
5) Inability to drive to healthcare appointments

Question 25

The nurse is preparing a seminar on planning for a hospitalization for residents of an assisted living facility. What information should the nurse include in the seminar? Select all that apply.
1) It is important to bring a copy of advanced directives for healthcare.
2) It is important to bring a list of current medications and current labs.
3) You should bring valuable jewelry and money to avoid leaving it unattended.
4) You should bring good walking slippers, a bathrobe, and items such as books.
5) It is important to bring contact information and insurance information.