You adjust care for older adults: polypharmacy, skin, confusion, and what family can safely do. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the LPN exams exam guide or more LPN exams practice questions.
Five geriatric questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
A patient has not come out of her room for breakfast. The nurse finds the patient moving restlessly about her room in a disorganized manner. The patient is talking to herself, and her verbal responses to the nurse are nonsensical and suggest disorientation. The nurse notices that the patient's skin is hot and dry, and her pupils are somewhat dilated. All these symptoms are significant departures from the patient's recent presentation. The patient is likely experiencing ______, and the nurse should ______.
A. anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
B. relapse of her psychosis"¦administer PRN antipsychotic drugs and notify her physician
C. neuroleptic malignant syndrome"¦contact her physician for a transfer to intensive care
D. agranulocytosis"¦hold her antipsychotic and draw blood for a complete blood count
Show answer and rationale
Correct answer: A — anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
The correct answer is A: anticholinergic toxicity. The patient's symptoms align with this diagnosis due to the disorganized behavior, nonsensical speech, disorientation, hot and dry skin, dilated pupils, and recent presentation changes. Anticholinergic toxicity can cause confusion, delirium, hyperthermia, and dilated pupils. Checking vital signs and preparing to use a cooling blanket are appropriate actions to manage the symptoms.
Choice B (relapse of psychosis) is incorrect because the symptoms are not typical of a psychotic relapse. Choice C (neuroleptic malignant syndrome) is incorrect as the symptoms do not completely align with this syndrome, which typically includes muscle rigidity and autonomic dysfunction. Choice D (agranulocytosis) is incorrect because it presents with low white blood cell count and not the symptoms described in the scenario.
Question 2
A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has ______, and the nurse should ______.
A. a dystonic reaction"¦administer PRN IM benztropine (Cogentin)
B. tardive dyskinesia"¦seek a change in the drug or its dosage
C. waxy flexibility"¦continue treatment with antipsychotic drugs
D. akathisia"¦administer PRN diphenhydramine (Benadryl) PO
Show answer and rationale
Correct answer: A — a dystonic reaction"¦administer PRN IM benztropine (Cogentin)
The correct answer is A: a dystonic reaction"¦administer PRN IM benztropine (Cogentin).
1. Step: Identify the symptoms - The patient has head rotation, stiff fixed position, and lower jaw thrust forward, indicating dystonia.
2. Step: Understand dystonic reactions - Dystonia is an extrapyramidal side effect of antipsychotic medications like haloperidol.
3. Step: Choose appropriate treatment - Benztropine is an anticholinergic medication used to treat acute dystonic reactions.
4. Step: Administer the medication - IM benztropine is the correct route for acute treatment of dystonia.
Summary:
- Choice B (tardive dyskinesia) is incorrect because the symptoms described are acute and not consistent with the gradual onset of tardive dyskinesia.
- Choice C (waxy flexibility) is incorrect because it is a symptom of catatonia, not a side effect of ant
Question 3
When a patient with anorexia nervosa expresses a fear of weight gain, the nurse should respond by:
A. Minimizing the patient's concerns to avoid anxiety.
B. Encouraging weight loss to meet the patient's goals.
C. Explaining that weight gain is part of the treatment plan.
D. Agreeing with the patient's view on body image to reduce conflict.
Show answer and rationale
Correct answer: C — Explaining that weight gain is part of the treatment plan.
The correct response is C: Explaining that weight gain is part of the treatment plan. This answer is correct because in treating anorexia nervosa, it is essential for patients to understand that weight gain is necessary for recovery and overall health improvement. By explaining this, the nurse can help the patient develop a more positive attitude towards weight gain and recognize it as a crucial aspect of the treatment process.
Choices A, B, and D are incorrect:
A: Minimizing the patient's concerns may invalidate their feelings and hinder therapeutic communication.
B: Encouraging weight loss would be counterproductive and reinforce the patient's negative behaviors and beliefs.
D: Simply agreeing with the patient's view on body image without addressing the need for weight gain would not promote positive change or support the patient's recovery.
Question 4
A patient received maintenance doses of fluphenazine decanoate (Prolixin Decanoate) 25 mg IM every 2 weeks for 2 years. The clinic nurse notes the patient is grimacing and seems to be constantly smacking her lips. On the next clinic visit, the patient's neck and shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of ______ and should ______.
A. agranulocytosis"¦check the patient's complete blood count for changes
B. tardive dyskinesia"¦administer the Abnormal Involuntary Movement Scale
C. Tourette's syndrome"¦consult the patient's physician about a neuro evaluation
D. anticholinergic effects"¦consult the physician about possible medication changes
Show answer and rationale
Correct answer: B — tardive dyskinesia"¦administer the Abnormal Involuntary Movement Scale
The correct answer is B: tardive dyskinesia"¦administer the Abnormal Involuntary Movement Scale.
1. Tardive dyskinesia is a side effect of long-term use of antipsychotic medications like fluphenazine.
2. The symptoms described - grimacing, lip smacking, twisting neck and shoulders - are characteristic of tardive dyskinesia.
3. Administering the Abnormal Involuntary Movement Scale is the appropriate assessment tool for diagnosing tardive dyskinesia.
4. Agranulocytosis (choice A) is a rare but serious side effect of some antipsychotic medications, not associated with the symptoms described.
5. Tourette's syndrome (choice C) typically presents with vocal and motor tics, not the specific symptoms mentioned.
6. Anticholinergic effects (choice D) can cause dry mouth, constipation, and blurred vision, but not the involuntary movements described.
Question 5
What actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community?
A. Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations
B. Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings
C. Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD
D. Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD
Show answer and rationale
Correct answer: A — Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations
The correct answer is A because it addresses the primary prevention of CAD through a multi-faceted approach. Starting a heart-healthy curriculum in first grade promotes early education on healthy habits. Presentations on diet and exercise for the community and special education sessions for high-risk populations help increase awareness and knowledge. This comprehensive strategy targets prevention at different levels of the community, making it more effective in reducing the incidence of CAD.
Choice B focuses more on individual interventions like online activities and screenings, which may not reach the entire community effectively. Choice C emphasizes education and screenings but lacks a comprehensive approach to prevention compared to Choice A. Choice D focuses on clients already diagnosed with CAD rather than preventing it in the community.
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Question 6
A client who is diagnosed with schizoid personality disorder is isolative, does not speak to her peers, and sits through the community meeting without speaking. Her mother describes her as shy and having few friends. Which would be an appropriate nursing diagnosis for this client?
A. Anxiety related to a new environment as evidenced by isolation and not talking with peers
B. Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers
C. Ineffective coping related to new environment as evidenced by isolation and minimal interaction with others
D. Disturbed thought processes related to a new environment as evidenced by isolation and minimal interactions with others
Correct answer:
The correct answer is B: Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers. This is the most appropriate nursing diagnosis because schizoid personality disorder is characterized by a pattern of social detachment and limited emotional expression. The client's behavior of isolating herself and not engaging with peers aligns with impaired social interaction.
Choice A (Anxiety) is incorrect because the client's behavior is more indicative of social detachment rather than anxiety. Choice C (Ineffective coping) is incorrect as there is no evidence to suggest the client is using maladaptive coping strategies. Choice D (Disturbed thought processes) is incorrect as the client's presentation does not indicate any disturbances in thought processes, but rather a lack of social engagement.
An older adult patient who lives with a daughter and attends the Alzheimer day hospital program exhibits bilateral bruising for the second time on both upper outer arms. When the nurse questions the patient about the bruising, the patient starts to cry and pleads, 'Please don't say anything. It's not my daughter's fault. I just bruise easily.' Which intervention reflects the best management of this situation?
A. Call the daughter to discuss both the bruising and her parent's reaction.
B. Report the elder abuse, and inform the patient and the daughter of your intention.
C. Notify the patient's social worker of the bruising after a complete assessment has been completed.
D. Inform the patient and the daughter of your intention to document the bruising and arrange for appropriate counseling.
Correct answer:
The correct answer is B: Report the elder abuse and inform the patient and the daughter of your intention. This is the best intervention as it prioritizes the safety and well-being of the older adult. Here's the rationale:
1. The patient's repeated bruising and fear of disclosure indicate potential abuse.
2. Reporting elder abuse is mandatory to ensure protection for the patient.
3. Informing the patient and daughter shows transparency and involves them in the process.
4. It is crucial to address the situation promptly to prevent further harm.
Summary:
A: Calling the daughter may escalate the situation and compromise the patient's safety.
C: Notifying the social worker without addressing the abuse directly may delay necessary action.
D: Counseling may be beneficial, but addressing the abuse is a priority to ensure the patient's safety.
An elderly female client on the mental unit suddenly becomes upset because she can't remember where she is and she says, 'I can't think straight.' The staff has never witnessed this behavior in the client, and this type of complaint is not documented in the nursing history. What is the client most likely experiencing?
A. Hallucinations
B. Dementia
C. Delusions
D. Delirium
Correct answer:
The correct answer is D: Delirium. Delirium is characterized by sudden onset confusion, disorientation, and impaired cognitive function. In this scenario, the elderly client's sudden confusion and inability to think straight suggest an acute change in mental status, which is indicative of delirium. Delirium is often triggered by underlying medical conditions or medications.
A: Hallucinations involve perceiving things that are not real, which is not described in the scenario.
B: Dementia is a chronic condition with gradual cognitive decline, not sudden onset confusion.
C: Delusions are fixed false beliefs, which are not mentioned in the scenario.
In summary, the client is most likely experiencing delirium due to the sudden onset of confusion and cognitive impairment, which is not consistent with hallucinations, dementia, or delusions.
A patient diagnosed with schizophrenia has been rehospitalized after a relapse. A priority intervention in designing a discharge plan to prevent relapses will be:
A. helping the patient's family develop tolerance for the cognitive symptoms.
B. mobilizing the family to provide structure to reduce social dysfunction.
C. working on self-concept to reduce abolition, anhedonia, and dysphoria.
D. early identification of signs of impending relapse and coping strategies.
Correct answer:
The correct answer is D because early identification of signs of impending relapse and coping strategies are crucial in preventing relapses in schizophrenia. By recognizing early warning signs, the patient can receive timely intervention and support to prevent further deterioration. This proactive approach enables healthcare providers to adjust treatment plans and provide necessary resources, ultimately reducing the likelihood of rehospitalization.
Choice A is incorrect because developing tolerance for cognitive symptoms may be beneficial but not a priority in preventing relapses. Choice B is incorrect as family support is important but solely relying on family for structure may not address all factors contributing to relapse. Choice C is incorrect as working on self-concept may be helpful but not directly related to preventing relapses.
A patient experiencing delirium secondary to corticosteroid toxicity is manifesting paranoid thinking and noisy, assaultive behavior. The patient is currently pacing the hall and shouting. A nurse has placed a call to the physician and is anticipating the following order:
A. the use of supervised restraints.
B. a loading dose of phenytoin.
C. a small dose of prednisone.
D. an IV dose of thiamine.
Correct answer:
The correct answer is A: the use of supervised restraints. In this situation, the patient is displaying agitated and assaultive behavior, posing a risk to themselves and others. Supervised restraints are necessary to ensure the safety of the patient and healthcare providers until the effects of corticosteroid toxicity subside. Restraints should only be used as a last resort when other interventions have failed.
Choice B: A loading dose of phenytoin is incorrect because phenytoin is not indicated for managing delirium secondary to corticosteroid toxicity.
Choice C: A small dose of prednisone is incorrect because adding more corticosteroids would exacerbate the toxicity and worsen the delirium.
Choice D: An IV dose of thiamine is incorrect as thiamine is used to treat thiamine deficiency, not corticosteroid toxicity-induced delirium.
A woman whose husband physically abuses her mentions to the nurse, 'Someday I'll have to leave him.' Which of the following would be the nurse's best response?
A. Yes, you should, before he harms you badly.'
B. Could we talk about developing a safety plan?'
C. Are you afraid of what your family will say?'
D. I don't know why you would stay with him.'
Correct answer:
The correct answer is B: "Could we talk about developing a safety plan?" This response is the best choice as it acknowledges the woman's situation, offers support, and focuses on practical steps to ensure her safety. By suggesting a safety plan, the nurse is addressing the immediate concern of potential harm and empowering the woman to take control of her situation.
Incorrect Choices:
A: This response is too direct and may not take into account the complexities of the woman's situation. It lacks empathy and does not offer a constructive solution.
C: This response shifts the focus away from the woman's safety and onto external factors. It may come across as judgmental and unhelpful.
D: This response is dismissive and fails to acknowledge the seriousness of the situation. It does not offer any support or guidance to the woman in need.
Which of these nursing communications best reflects the nurse's use of an empowerment model with an individual who has been abused?
A. Let me share with you my knowledge of what happens psychologically to individuals who have been abused.'
B. I know you feel that your partner will change, but the current research does not validate your thinking.'
C. It's up to you to end the violence. You are the only one who can set limits on how your partner is allowed to treat you.'
D. Let's consider what you believe your options are in terms of your relationship with your partner in light of the behavior toward you.'
Correct answer:
The correct answer, D, reflects the nurse's use of an empowerment model because it focuses on exploring the individual's beliefs and options, empowering them to make informed decisions. The nurse is not imposing their own knowledge or opinions but instead facilitating the individual's self-reflection and decision-making process. This approach respects the individual's autonomy and promotes empowerment by helping them identify and evaluate their own choices.
Choice A focuses on the nurse sharing knowledge, which may come across as patronizing and disempowering. Choice B dismisses the individual's feelings and relies on research rather than empowering the individual to make their own decisions. Choice C places the responsibility solely on the individual to end the violence, which may feel overwhelming and lacking in support or guidance.
The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a patient with schizophrenia who demonstrates auditory hallucinations, apathy, anhedonia, and poor social functioning. The patient is overweight and has hypertension. Bearing these facts in mind, the drug the nurse should advocate would be:
A. clozapine (Clozaril).
B. haloperidol (Haldol).
C. olanzapine (Zyprexa).
D. aripiprazole (Ability).
Correct answer:
The correct answer is D: aripiprazole (Ability). Aripiprazole is a second-generation antipsychotic that is less likely to cause weight gain and metabolic side effects compared to other antipsychotics like clozapine (A), olanzapine (C), and haloperidol (B). Given that the patient is overweight and has hypertension, aripiprazole would be a better choice to minimize the risk of exacerbating these conditions. Additionally, aripiprazole has a lower risk of sedation, which can be beneficial for a patient with apathy and anhedonia, allowing for improved social functioning. Aripiprazole's unique mechanism of action as a partial dopamine agonist can also be advantageous for managing auditory hallucinations in schizophrenia. Therefore, aripiprazole is the most suitable choice for this patient based on their clinical presentation and comorbidities.
A patient with an eating disorder states, 'I heard people laughing behind me in the check-out line at the department store. I bet they thought it was hysterically funny that I gained a pound in the last few days.' The nurse documents that the patient is exhibiting which cognitive distortion related to maladaptive eating regulation responses?
A. Magnification
B. Personalization
C. Overgeneralization
D. Dichotomous thinking
Correct answer:
The correct answer is B: Personalization. Personalization is a cognitive distortion where an individual takes responsibility for events that are not entirely their fault. In this scenario, the patient is attributing the laughter of people in the check-out line to being about them and their weight gain, when in reality, the laughter may have had nothing to do with them. This distortion can contribute to feelings of guilt, shame, and self-blame.
A: Magnification involves exaggerating the importance or meaning of an event, which is not evident in the scenario.
C: Overgeneralization involves making broad negative conclusions based on a single event, which is not demonstrated here.
D: Dichotomous thinking is the tendency to view situations in black and white terms, with no middle ground, which is not present in the patient's statement.
Which of these nursing communications would be most effective in teaching a patient about abusive behavior?
A. So when your husband says he needs other women because you aren't sexually satisfying his needs, do you believe what he is telling you is true?'
B. You say that your son has been pulling the neighbor's pigtails and you are worried he's becoming violent and abusive like your brother?'
C. You say that you placed your son on an allowance but that you also want to regulate everything he spends and saves?'
D. I noticed that when your mother paid you a compliment about your new hairstyle, you seemed skeptical.'
Correct answer:
The correct answer is A because it directly addresses the issue of abusive behavior in a clear and non-judgmental manner. By framing the question around a specific scenario of abusive behavior and asking for the patient's perspective, it encourages self-reflection and critical thinking. This approach empowers the patient to recognize and acknowledge the abusive behavior, which is crucial for initiating change.
Choices B, C, and D are incorrect because they do not specifically address abusive behavior. Choice B focuses on a different type of behavior (childhood aggression), Choice C addresses financial control rather than abuse, and Choice D discusses skepticism in response to a compliment, which is unrelated to abusive behavior. These choices do not effectively target the issue at hand and may lead to confusion or misinterpretation.
LPN exams geriatric practice questions, set 10 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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