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 RN exams exam guide or more RN 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 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 from the university health clinic. During the initial interview, what priority issue should the nurse address?
A. Losses
B. Sleep patterns
C. School activities
D. Menstrual flow
Show answer and rationale
Correct answer: A — Losses
The correct answer, Losses (choice A), should be the priority issue for the nurse to address during the initial interview with the student. The rationale is as follows:
1. **Emotional Impact of Breakup**: The student's recent breakup is a significant loss that can trigger emotional distress.
2. **Social Isolation**: Slow to make friends at the university could indicate feelings of loneliness and isolation, further exacerbating the impact of the breakup.
3. **Eating Disorder Behaviors**: Eating large quantities and inducing vomiting are maladaptive coping mechanisms linked to emotional distress and loss.
4. **Academic Decline**: The decline in schoolwork could be a manifestation of the student's emotional struggles related to loss.
5. **Relationship with Family**: Close relationship with her mother and sister may also influence how she copes with losses and seeks support.
Summary:
- **Sleep Patterns (choice B)**: While important, sleep patterns are secondary to addressing the student's emotional distress and coping mechanisms related
Question 2
What is the best approach to managing polypharmacy in older adults?
A. Regular use of over-the-counter medications
B. Reducing the number of medications based on patient preferences
C. Regular review and adjustment of medications by healthcare providers
D. Relying solely on herbal supplements
Show answer and rationale
Correct answer: C — Regular review and adjustment of medications by healthcare providers
The correct answer is C: Regular review and adjustment of medications by healthcare providers. This approach is the best because it involves healthcare professionals regularly assessing the appropriateness of each medication, adjusting dosages, and eliminating unnecessary drugs to minimize potential adverse effects and drug interactions in older adults. This proactive management strategy ensures that the patient's medication regimen is optimized for their specific health needs, reducing the risks associated with polypharmacy.
Choice A (Regular use of over-the-counter medications) is incorrect as it does not address the issue of polypharmacy and may actually contribute to it. Choice B (Reducing the number of medications based on patient preferences) is not the best approach as patient preferences alone may not always align with the most effective and safe medication regimen. Choice D (Relying solely on herbal supplements) is also incorrect as herbal supplements can interact with prescribed medications, leading to potential complications.
Question 3
A client with borderline disorder tells the nurse, 'It's hard to figure out who I am. Sometimes I'm sexually attracted to women and sometimes to men.' The nurse using Freudian concepts can analyze this as a developmental problem related to:
A. Lack of separation-individuation
B. Isolation of affect during latency
C. Impaired development of sexual identity during the phallic stage
D. Overdevelopment of latency stage traits related to control issues
Show answer and rationale
Correct answer: C — Impaired development of sexual identity during the phallic stage
The correct answer is C: Impaired development of sexual identity during the phallic stage. According to Freudian theory, the phallic stage occurs around ages 3 to 6 and is when children become aware of their genitals. This stage is crucial for the development of sexual identity. In this case, the client's confusion about their sexual attraction to both men and women suggests a difficulty in establishing a clear sexual identity during this stage. This can lead to ongoing struggles with sexual orientation and identity.
Choice A (Lack of separation-individuation) is incorrect because this concept is related to the development of individuality and autonomy, not sexual identity.
Choice B (Isolation of affect during latency) is incorrect as it refers to a defense mechanism where emotions are separated from their associated ideas or events during the latency stage, not related to sexual identity development.
Choice D (Overdevelopment of latency stage traits related to control issues) is incorrect because it focuses on traits related to the
Question 4
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 5
A nursing diagnosis for a patient with bulimia nervosa is Ineffective coping related to feelings of loneliness and isolation, as evidenced by use of overeating and self-induced vomiting to comfort self. Select the best outcome related to this diagnosis. Within 2 weeks, the patient will:
A. Appropriately express angry feelings.
B. Verbalize two positive things about self.
C. Verbalize the importance of eating a balanced diet.
D. Identify two alternative methods of coping with loneliness and isolation.
Show answer and rationale
Correct answer: D — Identify two alternative methods of coping with loneliness and isolation.
The correct answer is D: Identify two alternative methods of coping with loneliness and isolation.
Rationale:
1. The nursing diagnosis is Ineffective coping related to feelings of loneliness and isolation, indicating the patient struggles with coping mechanisms.
2. The desired outcome is for the patient to identify alternative coping methods, which directly addresses the ineffective coping issue.
3. By identifying two alternative methods, the patient demonstrates an understanding of healthier coping strategies.
4. This outcome focuses on addressing the root cause of the behavior (loneliness and isolation) rather than just surface-level expressions or behaviors.
Summary:
A: Appropriately expressing angry feelings does not directly address coping mechanisms related to loneliness and isolation.
B: Verbalizing positive things about oneself is beneficial but does not address the core issue of ineffective coping.
C: Verbalizing the importance of a balanced diet is important but does not directly address coping with loneliness and isolation.
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Question 6
A nurse interviews a patient abducted and raped at gunpoint by an unknown assailant. The patient says, "I can't talk about it. Nothing happened. I have to forget." What is the patient's present coping strategy?
A. Somatization
B. Repression
C. Projection
D. Denial
Correct answer:
The correct answer is D: Denial. The patient's statement of "I can't talk about it. Nothing happened. I have to forget" indicates a denial coping strategy. Denial is a defense mechanism where individuals refuse to acknowledge a stressful situation or event. In this case, the patient is attempting to block out the traumatic experience of being abducted and raped by denying its existence. This coping mechanism helps the individual temporarily avoid the emotional distress associated with the event.
A: Somatization involves expressing emotional distress through physical symptoms, which is not evident in the patient's statement.
B: Repression is the unconscious blocking of unpleasant memories, whereas the patient is consciously trying to forget the event.
C: Projection involves attributing one's own thoughts or feelings to others, which is not demonstrated in the patient's statement.
In summary, the patient's use of denial as a coping strategy is evident in their attempt to minimize the traumatic experience by refusing to acknowledge it.
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
Correct answer:
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.
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.
Correct answer:
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.
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
Correct answer:
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.
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.
Correct answer:
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.
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.
Correct answer:
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.
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 from the university health clinic. During the initial interview, what priority issue should the nurse address?
A. Losses
B. Sleep patterns
C. School activities
D. Menstrual flow
Correct answer:
The correct answer, Losses (choice A), should be the priority issue for the nurse to address during the initial interview with the student. The rationale is as follows:
1. **Emotional Impact of Breakup**: The student's recent breakup is a significant loss that can trigger emotional distress.
2. **Social Isolation**: Slow to make friends at the university could indicate feelings of loneliness and isolation, further exacerbating the impact of the breakup.
3. **Eating Disorder Behaviors**: Eating large quantities and inducing vomiting are maladaptive coping mechanisms linked to emotional distress and loss.
4. **Academic Decline**: The decline in schoolwork could be a manifestation of the student's emotional struggles related to loss.
5. **Relationship with Family**: Close relationship with her mother and sister may also influence how she copes with losses and seeks support.
Summary:
- **Sleep Patterns (choice B)**: While important, sleep patterns are secondary to addressing the student's emotional distress and coping mechanisms related
In planning aftercare for a client with schizophrenia and whose insurance benefits have been exhausted, the nurse who is concerned about overcoming negative symptoms will make provisions for the client to have stimulation, structure, socialization, and support. Which option would best incorporate these factors?
A. Day hospitalization
B. Attending a psychosocial club
C. Living with his elderly mother
D. Spending free time in the mall
Correct answer:
The correct answer is B: Attending a psychosocial club. This option best incorporates the necessary factors of stimulation, structure, socialization, and support for the client with schizophrenia.
- Stimulation: Psychosocial clubs offer various activities to engage the client's mind and keep them occupied.
- Structure: These clubs usually have regular schedules and routines, providing the client with a sense of order and predictability.
- Socialization: Interacting with others in the club can help the client improve social skills and combat feelings of isolation.
- Support: Being part of a community in the club can provide emotional support and encouragement for the client.
Incorrect Choices:
- A: Day hospitalization may offer structure and support but may lack the socialization and stimulation provided by a psychosocial club.
- C: Living with his elderly mother may provide support but may not offer the necessary stimulation, structure, and socialization outside of the home environment.
- D: Spending free time in the mall may offer
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.
Correct answer:
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
A 75 yr old client is recovering from abdominal surgery. The DR. has ordered morphine 2-6 mg every 4 hrs prn for pain. As the nurse plans to administer this medication, what intervention would the nurse choose to administer this drug to an older person?
A. administer the highest dose of 6 mg
B. administer the lowest dose of 2 mg
C. avoid the narcotic because of the risk of addiction
D. administer the dose only when the client asks for the medication 2 times
Correct answer:
The correct answer is B: administer the lowest dose of 2 mg. In older adults, especially the elderly, it is essential to start with the lowest effective dose of medication to minimize the risk of adverse effects. This approach follows the principle of "start low and go slow" when administering medications to older adults due to age-related changes in drug metabolism and increased sensitivity to medications. Administering the lowest effective dose helps to reduce the risk of potential complications such as respiratory depression, sedation, and falls.
Choice A (administer the highest dose of 6 mg) is incorrect because starting with the highest dose can increase the risk of adverse effects in older adults. Choice C (avoid the narcotic because of the risk of addiction) is incorrect as it is important to manage pain effectively in post-operative patients, and opioids can be safely used under proper supervision. Choice D (administer the dose only when the client asks for the medication 2 times) is incorrect as pain management should be
RN exams geriatric practice questions, set 5 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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