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 patient has recently been under significant stress and worked long hours. At home, the patient watches television and eats until going to bed. The patient is too tired to exercise and has gained 25 pounds in 1 month. A desired outcome for the patient is to recognize anxiety that precedes binge eating and reduce it. Which intervention addresses the outcome
A. Teach stress-reduction techniques such as relaxation and imagery.
B. Encourage the patient to design and implement an exercise program.
C. Explore ways in which the patient may feel more in control of the environment.
D. Encourage the patient to attend a support group such as Overeaters Anonymous.
Show answer and rationale
Correct answer: A — Teach stress-reduction techniques such as relaxation and imagery.
The correct answer is A: Teach stress-reduction techniques such as relaxation and imagery. This intervention directly addresses the desired outcome of recognizing anxiety that precedes binge eating and reducing it. By teaching stress-reduction techniques, the patient can learn to identify triggers, manage stress, and reduce the likelihood of turning to binge eating. Relaxation and imagery can help the patient relax and focus on positive thoughts, thus breaking the cycle of stress-induced binge eating.
Option B is incorrect because while exercise is beneficial for overall health, it does not directly address recognizing and reducing anxiety that leads to binge eating. Option C is incorrect as feeling more in control of the environment may help, but it does not specifically target anxiety reduction related to binge eating. Option D is incorrect as attending a support group may be helpful for some aspects of recovery, but it does not focus on recognizing and reducing anxiety specifically.
Question 2
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 of restlessness, disorganized behavior, nonsensical speech, disorientation, hot and dry skin, dilated pupils, and significant departure from recent presentation are classic signs of anticholinergic toxicity. Anticholinergic medications can lead to central nervous system and peripheral anticholinergic effects, causing confusion, delirium, hyperthermia, and dilated pupils. Checking vital signs and preparing to use a cooling blanket are appropriate initial interventions to address the symptoms.
Choices B, C, and D are incorrect because they do not align with the patient's symptoms and presentation. Choice B (Relapse of her psychosis) does not fully explain the physical symptoms such as hot and dry skin, dilated pupils, and disorientation. Choice C (Neuroleptic malignant syndrome) typically presents with muscle rigidity, hyperthermia, autonomic instability, and altered mental status, which are not completely consistent
Question 3
A patient has recently been under significant stress and worked long hours. At home, the patient watches television and eats until going to bed. The patient is too tired to exercise and has gained 25 pounds in 1 month. A desired outcome for the patient is to recognize anxiety that precedes binge eating and reduce it. Which intervention addresses the outcome
A. Teach stress-reduction techniques such as relaxation and imagery.
B. Encourage the patient to design and implement an exercise program.
C. Explore ways in which the patient may feel more in control of the environment.
D. Encourage the patient to attend a support group such as Overeaters Anonymous.
Show answer and rationale
Correct answer: A — Teach stress-reduction techniques such as relaxation and imagery.
The correct answer is A: Teach stress-reduction techniques such as relaxation and imagery. This intervention directly addresses the desired outcome of recognizing anxiety that precedes binge eating and reducing it. By teaching stress-reduction techniques, the patient can learn to identify triggers, manage stress, and reduce the likelihood of turning to binge eating. Relaxation and imagery can help the patient relax and focus on positive thoughts, thus breaking the cycle of stress-induced binge eating.
Option B is incorrect because while exercise is beneficial for overall health, it does not directly address recognizing and reducing anxiety that leads to binge eating. Option C is incorrect as feeling more in control of the environment may help, but it does not specifically target anxiety reduction related to binge eating. Option D is incorrect as attending a support group may be helpful for some aspects of recovery, but it does not focus on recognizing and reducing anxiety specifically.
Question 4
A 75-year-old male client is brought to the clinic by his son. The son states, 'Ever since Mom died, Dad hasn't been the same. At first he just seemed sad, but now he seems to get mixed up about everything.' The nurse is aware that based on the client's history, the source of confusion is most likely:
A. Dementia
B. Depression from the loss of his wife
C. Hypoxia of the brain
D. Delirium from medications
Show answer and rationale
Correct answer: B — Depression from the loss of his wife
Correct Answer: B - Depression from the loss of his wife
Rationale: Given the client's recent loss of his wife and subsequent changes in behavior, the most likely cause of his confusion is depression. Depression can manifest as cognitive impairment in older adults, leading to symptoms such as confusion and memory problems. Additionally, grief and loss can exacerbate depressive symptoms in elderly individuals, further contributing to cognitive difficulties.
Summary of other choices:
A: Dementia - Dementia typically presents with gradual cognitive decline over time, not a sudden onset following a specific event like the loss of a loved one.
C: Hypoxia of the brain - Hypoxia would likely present with more acute symptoms and physical signs, such as shortness of breath or cyanosis.
D: Delirium from medications - Delirium is characterized by acute onset and fluctuating course, often related to medication changes or other medical conditions, rather than an emotional trigger like grief.
Question 5
A patient was admitted in a semistuporous catatonic state. Family states that the patient has neither left the apartment nor attended to personal hygiene for several weeks. The patient's last 48 hours have been spent lying in bed, mute and motionless. The nursing diagnosis that should be considered the priority is:
A. self-care deficit.
B. situational low self-esteem.
C. disturbed thought processes.
D. impaired verbal communication.
Show answer and rationale
Correct answer: A — self-care deficit.
The correct answer is A: self-care deficit. This nursing diagnosis should be considered the priority because the patient is unable to attend to personal hygiene and has been lying in bed motionless and mute for 48 hours, indicating a significant impairment in self-care abilities. This is a critical issue that needs immediate attention to prevent further deterioration in the patient's physical and mental health.
Choice B: situational low self-esteem is not the priority as the patient's current state is more indicative of physical neglect rather than a self-esteem issue.
Choice C: disturbed thought processes may be a contributing factor to the patient's presentation, but the priority at this moment is addressing the self-care deficit to ensure the patient's safety and well-being.
Choice D: impaired verbal communication, while important, is not the priority in this scenario as the patient's inability to communicate verbally is secondary to the urgent need for assistance with self-care.
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Question 6
Therapeutic nutrition begins for a patient with anorexia nervosa who is 70% of ideal body weight. Which nursing intervention is most important to add to the plan of care?
A. Communicate empathy for the patient's feelings.
B. Observe for adverse effects associated with refeeding.
C. Teach patient about psychological origins of the disorder.
D. Direct the patient to balance energy expenditure and caloric intake.
Correct answer:
The correct answer is B: Observe for adverse effects associated with refeeding. This is important because refeeding syndrome can occur when a severely malnourished individual is reintroduced to nutrition too quickly, leading to potentially life-threatening electrolyte imbalances. Monitoring for signs such as fluid retention, electrolyte abnormalities, and changes in vital signs is crucial in preventing these complications.
Choice A: Communicating empathy is important in building trust and rapport with the patient, but it is not the most critical intervention in this scenario.
Choice C: Teaching the patient about the psychological origins of the disorder is important for long-term treatment, but it is not the most immediate concern when starting therapeutic nutrition.
Choice D: Directing the patient to balance energy expenditure and caloric intake is important for overall health, but it is not the priority when the patient is severely malnourished and at risk for refeeding syndrome.
A 72-year-old widow has just returned home after 2 weeks in the hospital after a fall. She lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the visiting nurse stopped by 2 days after discharge, he found the woman confused and disoriented, with an unsteady gait. The patient asks him who he is and why he is there. The nurse correctly deduces that the most likely cause for the changes seen in the patient is:
A. Delirium.
B. Dementia.
C. Drug toxicity.
D. None of the above.
Correct answer:
The correct answer is A: Delirium. The patient's sudden onset of confusion, disorientation, and unsteady gait after discharge from the hospital suggests delirium. Delirium is an acute change in mental status with fluctuating symptoms, often caused by underlying medical conditions, medications (such as diazepam), or environmental factors. In this case, the recent hospitalization, multiple medications, and potential stressors like living alone and recent fall increase the risk for delirium.
Incorrect choices:
B: Dementia is a chronic, progressive condition characterized by memory loss and cognitive decline. The sudden onset of symptoms in this case is not consistent with dementia.
C: Drug toxicity could be a possibility given the patient's medication list, but delirium is a more likely explanation due to the acute onset of symptoms post-hospitalization.
D: None of the above is incorrect because delirium is the most likely cause based on the patient's presentation and risk factors.
A 17-year-old client who has anorexia nervosa states she believes she will have fewer problems in college and will be more popular if she continues to lose weight. What nursing intervention would be useful at this time?
A. Assisting the client to identify the problems causing her concern.
B. Determining what she hopes to gain from the behavior.
C. Explaining that her chances for becoming ill from losing weight are high.
D. Having a physical report sent to college officials indicating her condition.
Correct answer:
The correct answer is A because it focuses on assisting the client to identify the problems causing her concern. By helping the client explore the underlying issues driving her desire to lose weight, the nurse can address the root cause of her behavior. This intervention promotes self-awareness and insight, enabling the client to better understand her motivations and make informed choices.
Option B is incorrect because while determining what the client hopes to gain from the behavior is important, it does not directly address the immediate concern of identifying underlying problems.
Option C is incorrect because simply explaining the risks of becoming ill may not effectively address the client's belief that losing weight will lead to fewer problems and increased popularity.
Option D is incorrect because sending a physical report to college officials without the client's consent may violate confidentiality and trust, and it does not address the client's psychological needs.
A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _____ and should _____.
A. Neuroleptic malignant syndrome"¦place him in a cooling blanket and transfer to ICU
B. Anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
C. Relapse of his psychosis"¦administer PRN antipsychotic drugs and notify his physician
D. Agranulocytosis"¦hold his antipsychotic and draw blood for a complete blood count
Correct answer:
The correct answer is A: Neuroleptic malignant syndrome. The patient is exhibiting symptoms consistent with NMS, a rare but serious side effect of antipsychotic medications like risperidone. The severe muscle stiffness, difficulty swallowing, altered mental status, diaphoresis, elevated temperature, and vital sign changes are classic signs of NMS. Treatment includes immediate cooling to lower the body temperature and transfer to the intensive care unit for close monitoring and supportive care.
Choice B: Anticholinergic toxicity does not fit the patient's presentation as there are no specific signs of anticholinergic toxicity such as dry mucous membranes, dilated pupils, or tachycardia.
Choice C: Relapse of psychosis is unlikely to present with the same constellation of symptoms, including altered mental status, fever, and vital sign changes.
Choice D: Agranulocytosis is characterized by a severe drop in white blood cells, leading to increased risk of infection, but it does
A nurse is planning care for a patient with anorexia nervosa. What is the priority intervention?
A. Encourage the patient to verbalize concerns about body image.
B. Monitor the patient's weight and nutritional intake closely.
C. Provide education on healthy eating and exercise.
D. Offer emotional support to the patient regarding self-esteem.
Correct answer:
The correct answer is B. Monitoring the patient's weight and nutritional intake closely is the priority intervention for a patient with anorexia nervosa as it directly addresses the immediate health risks associated with the disorder, such as malnutrition and weight loss. By closely monitoring these parameters, healthcare providers can assess the patient's progress and make necessary adjustments to prevent further complications.
Choice A is incorrect because while addressing body image concerns is important in the long term, it is not the priority intervention when the patient's physical health is at risk.
Choice C is incorrect as providing education on healthy eating and exercise may not be effective if the patient is not yet in a stable physical condition to absorb and apply the information.
Choice D is incorrect as offering emotional support is valuable, but it is not the priority intervention in this case where the patient's physical health needs immediate attention.
A 75-year-old male client is brought to the clinic by his son. The son states, 'Ever since Mom died, Dad hasn't been the same. At first he just seemed sad, but now he seems to get mixed up about everything.' The nurse is aware that based on the client's history, the source of confusion is most likely:
A. Dementia
B. Depression from the loss of his wife
C. Hypoxia of the brain
D. Delirium from medications
Correct answer:
Correct Answer: B - Depression from the loss of his wife
Rationale: Given the client's recent loss of his wife and subsequent changes in behavior, the most likely cause of his confusion is depression. Depression can manifest as cognitive impairment in older adults, leading to symptoms such as confusion and memory problems. Additionally, grief and loss can exacerbate depressive symptoms in elderly individuals, further contributing to cognitive difficulties.
Summary of other choices:
A: Dementia - Dementia typically presents with gradual cognitive decline over time, not a sudden onset following a specific event like the loss of a loved one.
C: Hypoxia of the brain - Hypoxia would likely present with more acute symptoms and physical signs, such as shortness of breath or cyanosis.
D: Delirium from medications - Delirium is characterized by acute onset and fluctuating course, often related to medication changes or other medical conditions, rather than an emotional trigger like grief.
A 72-year-old widow has just returned home after 2 weeks in the hospital after a fall. She lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the visiting nurse stopped by 2 days after discharge, he found the woman confused and disoriented, with an unsteady gait. The patient asks him who he is and why he is there. The nurse correctly deduces that the most likely cause for the changes seen in the patient is:
A. Delirium.
B. Dementia.
C. Drug toxicity.
D. None of the above.
Correct answer:
The correct answer is A: Delirium. The patient's sudden onset of confusion, disorientation, and unsteady gait after discharge from the hospital suggests delirium. Delirium is an acute change in mental status with fluctuating symptoms, often caused by underlying medical conditions, medications (such as diazepam), or environmental factors. In this case, the recent hospitalization, multiple medications, and potential stressors like living alone and recent fall increase the risk for delirium.
Incorrect choices:
B: Dementia is a chronic, progressive condition characterized by memory loss and cognitive decline. The sudden onset of symptoms in this case is not consistent with dementia.
C: Drug toxicity could be a possibility given the patient's medication list, but delirium is a more likely explanation due to the acute onset of symptoms post-hospitalization.
D: None of the above is incorrect because delirium is the most likely cause based on the patient's presentation and risk factors.
A 17-year-old client who has anorexia nervosa states she believes she will have fewer problems in college and will be more popular if she continues to lose weight. What nursing intervention would be useful at this time?
A. Assisting the client to identify the problems causing her concern.
B. Determining what she hopes to gain from the behavior.
C. Explaining that her chances for becoming ill from losing weight are high.
D. Having a physical report sent to college officials indicating her condition.
Correct answer:
The correct answer is A because it focuses on assisting the client to identify the problems causing her concern. By helping the client explore the underlying issues driving her desire to lose weight, the nurse can address the root cause of her behavior. This intervention promotes self-awareness and insight, enabling the client to better understand her motivations and make informed choices.
Option B is incorrect because while determining what the client hopes to gain from the behavior is important, it does not directly address the immediate concern of identifying underlying problems.
Option C is incorrect because simply explaining the risks of becoming ill may not effectively address the client's belief that losing weight will lead to fewer problems and increased popularity.
Option D is incorrect because sending a physical report to college officials without the client's consent may violate confidentiality and trust, and it does not address the client's psychological needs.
A nurse is planning care for a patient with anorexia nervosa. What is the priority intervention?
A. Encourage the patient to verbalize concerns about body image.
B. Monitor the patient's weight and nutritional intake closely.
C. Provide education on healthy eating and exercise.
D. Offer emotional support to the patient regarding self-esteem.
Correct answer:
The correct answer is B. Monitoring the patient's weight and nutritional intake closely is the priority intervention for a patient with anorexia nervosa as it directly addresses the immediate health risks associated with the disorder, such as malnutrition and weight loss. By closely monitoring these parameters, healthcare providers can assess the patient's progress and make necessary adjustments to prevent further complications.
Choice A is incorrect because while addressing body image concerns is important in the long term, it is not the priority intervention when the patient's physical health is at risk.
Choice C is incorrect as providing education on healthy eating and exercise may not be effective if the patient is not yet in a stable physical condition to absorb and apply the information.
Choice D is incorrect as offering emotional support is valuable, but it is not the priority intervention in this case where the patient's physical health needs immediate attention.
A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _____ and should _____.
A. Neuroleptic malignant syndrome"¦place him in a cooling blanket and transfer to ICU
B. Anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
C. Relapse of his psychosis"¦administer PRN antipsychotic drugs and notify his physician
D. Agranulocytosis"¦hold his antipsychotic and draw blood for a complete blood count
Correct answer:
The correct answer is A: Neuroleptic malignant syndrome. The patient is exhibiting symptoms consistent with NMS, a rare but serious side effect of antipsychotic medications like risperidone. The severe muscle stiffness, difficulty swallowing, altered mental status, diaphoresis, elevated temperature, and vital sign changes are classic signs of NMS. Treatment includes immediate cooling to lower the body temperature and transfer to the intensive care unit for close monitoring and supportive care.
Choice B: Anticholinergic toxicity does not fit the patient's presentation as there are no specific signs of anticholinergic toxicity such as dry mucous membranes, dilated pupils, or tachycardia.
Choice C: Relapse of psychosis is unlikely to present with the same constellation of symptoms, including altered mental status, fever, and vital sign changes.
Choice D: Agranulocytosis is characterized by a severe drop in white blood cells, leading to increased risk of infection, but it does
RN exams geriatric practice questions, set 9 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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