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
Police bring a 63-year-old woman to the emergency room, reporting that her behavior is disorganized and disruptive, that her speech makes little sense, and that she does not seem able to take care of herself. The woman has had elective surgeries at the hospital previously and was seen in the ER last week after a fall; records show no history of similar symptoms or mental illness. The ER physician speaks with the patient but does not examine her medically, diagnoses her with schizophrenia, and orders admission to the inpatient psychiatric unit. Which response by the nurse would be most appropriate?
A. Ask another physician with more of an interest in psychiatry to also take a look at this patient, explaining that you just want to be as thorough as possible.
B. Suggest that a psychiatric consult be requested before admitting the patient to a psychiatric unit, to validate the diagnosis and speed the initiation of medication.
C. Remind the physician that schizophrenia usually develops earlier in life, that such presentations may be caused by medical problems, and suggest a medical work-up.
D. Note that the patient's blood pressure and respirations were elevated when she arrived, and suggest that they be evaluated before admitting the patient to the psychiatric unit.
Show answer and rationale
Correct answer: C — Remind the physician that schizophrenia usually develops earlier in life, that such presentations may be caused by medical problems, and suggest a medical work-up.
The correct answer is C because it promotes a thorough and systematic approach to the patient's care. First, it challenges the premature diagnosis of schizophrenia without a medical examination. Second, it highlights the importance of considering medical causes for the symptoms presented by the patient. This is crucial as the patient's age and lack of prior history of mental illness suggest that a medical work-up is necessary to rule out underlying medical conditions that could be causing her symptoms. This approach ensures a comprehensive evaluation and appropriate treatment tailored to the patient's specific needs.
Choices A, B, and D are incorrect because they do not address the fundamental issue of exploring potential medical causes for the patient's symptoms before jumping to a psychiatric diagnosis or treatment. A, B, and D focus on seeking additional psychiatric opinions, consulting for medication initiation, and evaluating vital signs, respectively, which do not address the need for a thorough medical evaluation in this case.
Question 2
A client with undifferentiated schizophrenia is readmitted for an acute exacerbation of the disorder. The goal of hospitalization is symptom stabilization. The nurse has documented that, in addition to experiencing auditory hallucinations, the client seems uninterested in activities, has difficulty completing tasks, seems forgetful, and seems puzzled by information and directions given by staff. The nurse's plans for intervention will be effective if these behaviors are attributed to:
A. Social isolation
B. Deficient knowledge
C. Situational low self-esteem
D. Problems in cognitive functioning
Show answer and rationale
Correct answer: D — Problems in cognitive functioning
The correct answer is D: Problems in cognitive functioning. In undifferentiated schizophrenia, cognitive deficits are common, leading to difficulties in memory, attention, problem-solving, and executive functioning. The client's symptoms of forgetfulness, difficulty completing tasks, being puzzled by information, and auditory hallucinations are indicative of cognitive impairment. Interventions should focus on addressing these cognitive deficits to improve the client's ability to function.
Incorrect choices:
A: Social isolation - This choice does not address the cognitive deficits and symptoms described by the client, such as forgetfulness and difficulty completing tasks.
B: Deficient knowledge - While cognitive deficits may contribute to deficient knowledge, the primary concern in this scenario is the client's cognitive functioning impairments.
C: Situational low self-esteem - This choice does not explain the cognitive deficits and symptoms experienced by the client, which are more indicative of problems in cognitive functioning.
Question 3
A client with obsessive-compulsive personality disorder is described by other staff as being perfectionistic, inflexible, and a 'master at procrastination.' The nurse learns that the client is nearly immobilized during times that call for the client to make a decision. The nurse realizes that the most likely hypothesis is this behavior is related to:
A. A need to make others uncomfortable
B. Needing to be the center of attention
C. Wanting someone else to be responsible
D. Fear of making a mistake
Show answer and rationale
Correct answer: D — Fear of making a mistake
The correct answer is D: Fear of making a mistake. This is the most likely hypothesis because individuals with obsessive-compulsive personality disorder often have an intense fear of making errors or mistakes. This fear can lead to excessive preoccupation with details, perfectionism, and procrastination. The client's immobilization during decision-making moments is likely due to the overwhelming anxiety and fear of making the wrong choice, which is a common trait in individuals with this disorder.
Choice A (A need to make others uncomfortable) is incorrect because there is no indication that the client's behavior is driven by a desire to cause discomfort to others. Choice B (Needing to be the center of attention) is incorrect as individuals with obsessive-compulsive personality disorder typically focus more on their own perfectionism rather than seeking attention. Choice C (Wanting someone else to be responsible) is incorrect as this behavior is more about the individual's fear of making mistakes rather than avoiding responsibility.
Question 4
An individual is brought by ambulance to the emergency room. The patient's roommate reports that the patient was weak and confused on awakening and began "rambling and talking crazy"Â about 3 hours ago. A nurse notes that the patient's skin is flushed and dry. When transferred to a bed, the patient strikes out at the staff and shouts, "You're not going to kill me!"Â The most likely analysis of this behavior is:
A. disturbed self-esteem related to catastrophic reaction.
B. disturbed sensory perception related to altered brain function.
C. other-directed violence related to fear associated with hospitalization.
D. impaired environmental interpretational syndrome related to metabolic disturbance.
Show answer and rationale
Correct answer: B — disturbed sensory perception related to altered brain function.
The correct answer is B: disturbed sensory perception related to altered brain function. The patient's presenting symptoms of confusion, rambling speech, physical aggression, and paranoia suggest an altered mental state. The flushed and dry skin may indicate dehydration, which can affect brain function. The behavior is likely a result of the patient's distorted sensory perceptions due to an underlying physiological or neurological issue.
Incorrect choices:
A: disturbed self-esteem related to catastrophic reaction - This choice does not address the patient's specific symptoms and is not supported by the scenario.
C: other-directed violence related to fear associated with hospitalization - While fear of hospitalization may contribute to violence, it does not explain the patient's overall presentation of altered mental status.
D: impaired environmental interpretational syndrome related to metabolic disturbance - This choice does not directly address the patient's symptoms and does not explain the confusion and paranoia displayed.
Question 5
An individual accompanied by a friend was brought by ambulance to the emergency room. A nurse notes that the patient's skin is flushed and dry. Further assessment reveals the patient has not voided or ingested food or fluid in 18 hours. Temperature, pulse, blood pressure, and respirations are elevated, and sensorium alternates between clouded and clear. The physician diagnoses fever of unknown origin. Because the patient is restless and agitated, the plan is to make an effort to orally hydrate before attempting to start an IV line. The intervention most likely to be effective will be:
A. placing a pitcher of water at the patient's bedside.
B. placing a "force fluids"Â sign at the head of the bed.
C. asking the friend to give the patient a drink whenever the patient is alert.
D. staying with the patient to ensure that a glass of liquid is ingested once every hour.
Show answer and rationale
Correct answer: D — staying with the patient to ensure that a glass of liquid is ingested once every hour.
The correct answer is D: staying with the patient to ensure that a glass of liquid is ingested once every hour. This choice is the most effective intervention because the patient is in a state of restlessness and agitation, making it crucial to closely monitor fluid intake. By staying with the patient and ensuring regular liquid consumption, the nurse can help maintain hydration and potentially alleviate symptoms.
Choice A (placing a pitcher of water at the patient's bedside) may not be effective as the patient may not be able to independently drink the water when needed. Choice B (placing a "force fluids" sign at the head of the bed) might not address the patient's agitation and restlessness and could lead to increased anxiety. Choice C (asking the friend to give the patient a drink whenever the patient is alert) may not provide consistent monitoring and support needed for the patient's condition.
Therefore, choice D is the best option as it addresses the patient's need for hydration, agitation, and restlessness effectively
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Question 6
A new nurse asks, 'My elderly patient's CT scan of the head shows many Lewy bodies are present. What should I do about assessing for pain?' Select the best response from the nurse manager.
A. Ask the patient's family if they think the patient is experiencing pain.
B. Use a visual analog scale to help the patient determine the presence and severity of pain.
C. There are special scales for assessing patients with dementia. Let's review how to use them.
D. The perception of pain is diminished by this type of dementia. Focus your assessment on the patient's mental status.
Correct answer:
The correct answer is C because patients with Lewy body dementia may have difficulty expressing pain. Special pain assessment scales designed for patients with dementia can help in accurately assessing pain levels. These scales take into account nonverbal cues and behavioral changes that may indicate pain. By using these specialized tools, the nurse can ensure a more comprehensive assessment of the patient's pain experience.
Choice A is incorrect because relying solely on family members' perceptions may not accurately reflect the patient's actual pain experience.
Choice B is not the best option because a visual analog scale may not be suitable for patients with dementia who may have cognitive impairments affecting their ability to use such tools effectively.
Choice D is incorrect as it assumes that pain perception is diminished in Lewy body dementia without considering that patients may still experience pain but have difficulty communicating it. Focusing solely on mental status may overlook important pain indicators.
A student transfers from a hometown college to a university 200 miles away after breaking up with her boyfriend of 2 years. She was slow to make friends at the university. The history shows a close relationship with her mother and sister. She began eating large quantities when she felt sad, and then she induced vomiting. When the student's schoolwork declined, she sought help. During the initial interview, what priority issue should the nurse address?
A. Losses.
B. Sleep patterns.
C. School activities.
D. None of the above.
Correct answer:
The correct answer is A: Losses. The priority issue the nurse should address is the student's losses, such as the breakup with her boyfriend and the difficulty in making friends at the new university. This is important because these losses may be contributing to her emotional distress and maladaptive coping mechanisms like binge-eating and induced vomiting. The nurse needs to explore these losses to understand the root cause of the student's behavior and provide appropriate support.
Choice B: Sleep patterns, and Choice C: School activities are not the priority issues in this scenario. While sleep patterns and school activities are important aspects of the student's life, the primary concern here is addressing the emotional impact of the losses she has experienced.
Choice D: None of the above is incorrect because losses are indeed the priority issue that needs to be addressed in this situation. Ignoring the emotional impact of the student's losses could hinder the effectiveness of any interventions or support provided.
A nurse is caring for a patient with anorexia nervosa who is refusing to eat. What should the nurse do first?
A. Provide a structured meal plan and encourage the patient to eat.
B. Avoid discussing food intake to reduce anxiety.
C. Allow the patient to skip meals to avoid pressure.
D. Offer incentives for eating a full meal.
Correct answer:
The correct answer is A: Provide a structured meal plan and encourage the patient to eat. This is the first step because patients with anorexia nervosa often struggle with disordered eating behaviors and need guidance and support to establish healthy eating habits. Providing a structured meal plan helps the patient understand the importance of regular and balanced meals. Encouraging the patient to eat helps address their resistance and fear around food.
Incorrect choices:
B: Avoid discussing food intake to reduce anxiety - This choice is incorrect because avoiding discussing food intake does not address the underlying issue and may perpetuate the patient's disordered eating behavior.
C: Allow the patient to skip meals to avoid pressure - Allowing the patient to skip meals enables their unhealthy behavior and does not promote recovery.
D: Offer incentives for eating a full meal - While incentives may be used as a motivational tool, they do not address the core issue of establishing a healthy relationship with food.
A client with obsessive-compulsive personality disorder seeks treatment for depression after the recent breakup of a relationship. The client constantly procrastinated about proposing marriage and said his girlfriend complained that he did not show her affection and that he was too controlling. Now he describes inability to sleep, poor concentration, and loss of energy since the breakup. Which outcome is a priority for the client? The client will:
A. Demonstrate assertive behavior
B. Express hope for developing a new relationship in the future
C. Identify feelings of sadness related to the failed relationship
D. List three new ways to reduce stress
Correct answer:
The correct answer is C: Identify feelings of sadness related to the failed relationship. This is the priority outcome because the client's current symptoms of depression, such as inability to sleep, poor concentration, and loss of energy, are likely related to the breakup. By identifying and processing feelings of sadness, the client can begin to work through the grief and emotional distress caused by the failed relationship, which can help alleviate the depressive symptoms.
Choice A (Demonstrate assertive behavior) is not the priority outcome as the client's primary issue is related to depression and processing emotions, not assertiveness. Choice B (Express hope for developing a new relationship in the future) may be important for the client's overall well-being, but it is not the immediate priority for addressing the current depressive symptoms. Choice D (List three new ways to reduce stress) may be helpful in managing symptoms, but it does not address the core issue of processing emotions related to the breakup.
Which statements about home health care are accurate? (Select one that doesn't apply.)
A. Home health care is just as effective as care provided in the hospital setting.
B. Home health care is typically more affordable than care provided in a skilled nursing facility.
C. IV therapy can be provided through home health care.
D. Care for clients facing a terminal illness is provided through home health care.
Correct answer:
Home health care is typically more affordable than and just as effective as care that people receive in a hospital or skilled nursing facility. Examples of home health care services include wound care, education, IV therapy, nutrition therapy, follow-up with a patient after discharge from the hospital, and monitoring of an unstable or chronic illness. The goal of home health care is to help people get better in their own homes to regain as much independence as possible (Medicare.gov, 2016a). Hospice care focuses on caring for people facing a terminal illness when the goal is no longer curing the disease (National Hospice and Palliative Care Organization [NHPCO], 2016). The goal of hospice care is that each person will die pain free and with dignity. Note: Choices E ('The goal of home health care care is for clients to die with dignity') and F ('The goal of home health care is for clients to regain as much independence as possible') were evaluated, and F is correct for home health care, while E pertains to hospice care.
The nurse is aware, when developing a care plan, that the three major goals of care for the client in whom Alzheimer's disease has been diagnosed include providing for the client's safety and well-being, therapeutically managing the client's behaviors, and:
A. Supporting the client during curative care.
B. Providing support for family, relatives, and caregivers.
C. Arranging for nursing home placement.
D. None of the above.
Correct answer:
The correct answer is B. Providing support for family, relatives, and caregivers is crucial in the care of a client with Alzheimer's disease as it helps to ensure a holistic approach to care. Family members and caregivers often experience significant stress and burden in caring for someone with Alzheimer's, so providing support to them can improve the overall quality of care for the client. Additionally, involving family and caregivers in the care plan can help in maintaining continuity and consistency in the client's care.
Other choices are incorrect because:
A: Supporting the client during curative care is not applicable in Alzheimer's disease as there is currently no cure for the condition.
C: Arranging for nursing home placement may be necessary in some cases, but it is not one of the three major goals of care for a client with Alzheimer's disease.
D: None of the above is incorrect as providing support for family, relatives, and caregivers is a critical aspect of care for clients with Alzheimer's disease.
While auditing care plans for clients with eating disorders, the nurse realizes that a nursing diagnosis appropriate for a client with anorexia nervosa as well as for a client with bulimia nervosa is:
A. ineffective denial.
B. adult failure to thrive.
C. chronic low self-esteem.
D. risk for imbalanced body temperature.
Correct answer:
Rationale for Correct Answer (C): Chronic low self-esteem is appropriate for both anorexia nervosa and bulimia nervosa clients as these disorders are often associated with poor body image and low self-worth. Clients with these disorders commonly struggle with feelings of inadequacy and self-criticism, leading to chronic low self-esteem. This nursing diagnosis addresses the underlying emotional issues that are prevalent in both anorexia and bulimia.
Summary of Incorrect Choices:
A: Ineffective denial is not appropriate as clients with these disorders are often aware of their condition and may even have distorted perceptions about their body image.
B: Adult failure to thrive is not suitable as this nursing diagnosis is typically used for older adults who are experiencing a decline in health and functioning, not specifically related to eating disorders.
D: Risk for imbalanced body temperature is not relevant as it does not address the psychological and emotional aspects that are central to anorexia and bulimia.
A nurse's family has moved to a rural area to be near her spouse's aging parents. What might the nurse notice about the family's new environment? Select all that apply.
A. It is very difficult to obtain continuing education, except for online programs.
B. Neighbors seem to expect the nurse to know everything about all health care and illness conditions.
C. Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are.
D. People come to the health clinic before their situation becomes relatively serious.
Correct answer:
Step 1: The correct answer is B because it reflects the phenomenon known as "role engulfment." In rural areas, individuals may perceive healthcare professionals as having a broader knowledge base due to limited access to healthcare resources.
Step 2: This expectation can lead neighbors to ask the nurse for advice on various health issues, assuming she has expertise in all areas of healthcare.
Step 3: This can create challenges for the nurse in setting boundaries and managing expectations within the community.
Step 4: Choices A, C, and D are incorrect as they do not directly address the unique challenge of role engulfment faced by healthcare professionals in rural areas.
Step 5: Choice A focuses on continuing education, which may or may not be a challenge in rural areas but is not directly related to the nurse's role perception by neighbors.
Step 6: Choice C addresses general health inquiries but does not specifically highlight the issue of role engulfment.
Step 7: Choice D describes proactive healthcare
The wife of a client newly diagnosed with paranoid schizophrenia asks the nurse, 'My husband was well adjusted until a month ago, and then, after a lot of work stress, he got sick. What can I expect? Will he be this sick for the rest of his life?' What information can the nurse provide about prognosis?
A. This disorder responds well to treatment and, with follow-up, may not recur.'
B. All types of schizophrenia are chronic relapsing disorders.'
C. Outcomes are poor related to client prehospital disorganization.'
D. The usual outcome is that only partial remission is achieved.'
Correct answer:
The correct answer is A: "This disorder responds well to treatment and, with follow-up, may not recur."
Rationale:
1. Paranoid schizophrenia typically responds well to treatment, especially with early intervention.
2. With proper medication and therapy, individuals with paranoid schizophrenia can experience significant improvement and lead fulfilling lives.
3. Follow-up care and support are crucial in maintaining stability and preventing relapses.
Summary of why other choices are incorrect:
B: All types of schizophrenia are chronic relapsing disorders - This is not accurate as outcomes can vary depending on the subtype of schizophrenia.
C: Outcomes are poor related to client prehospital disorganization - This statement is too general and does not specifically address the prognosis of paranoid schizophrenia.
D: The usual outcome is that only partial remission is achieved - This is not always the case, as many individuals with paranoid schizophrenia can achieve full remission with appropriate treatment.
A nursing intervention that will be planned to occur early in the nurse-patient relationship with a client with an eating disorder is:
A. formulating a nurse-client contract.
B. using confrontation to attack denial.
C. placing the client in a therapeutic group.
D. attacking enmeshment by separating client and family.
Correct answer:
The correct answer is A: formulating a nurse-client contract. This intervention is essential early in the nurse-patient relationship with a client with an eating disorder because it establishes clear boundaries, roles, and expectations. By creating a contract, both the nurse and the client can communicate openly about their goals, responsibilities, and treatment plan. This helps build trust, promotes collaboration, and provides a framework for the therapeutic relationship.
Choices B, C, and D are incorrect:
B: Using confrontation to attack denial may be counterproductive and harmful in the early stages of the relationship as it can lead to resistance and damage trust.
C: Placing the client in a therapeutic group may be beneficial at a later stage but not necessarily an appropriate early intervention when individual needs should be addressed first.
D: Attacking enmeshment by separating client and family is not a suitable early intervention as it may cause distress and disrupt important support systems.
LPN exams geriatric practice questions, set 3 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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