Test Bank For Pearson Custom For Older Adult Nursing Care By Nancy

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Test Bank For  Pearson Custom For Older Adult Nursing Care By Nancy J.Brown And Linda

Chapter 6
Question 1
Type: MCSA
The nurse notices a pattern of weight loss in one of the older adult residents in a long-term care facility. Checking the resident’s record, the nurse finds that the resident has been eating progressively less of the food trays served for the past week. Which of the following actions would be most appropriate for the nurse to take at this time?
1. Check the resident’s intake independently for the next few days.
2. Assess the resident’s mouth, checking for sores, bad teeth, or badly fitting dentures.
3. Call the resident’s physician and receive an order for an appetite stimulant medication.
4. Confer with the dietician and the resident’s physician regarding nutritional supplements for the resident.
Correct Answer: 2
Rationale 1: Just checking the resident’s intake could allow the resident’s poor intake pattern to continue; a simple assessment is needed to rule out oral problems, a major cause of poor intake in older adults.
Rationale 2: Correct. A decrease in food intake is often related to problems with teeth or poorly fitting dentures. Assessing the mouth would either confirm or eliminate the reason for the resident’s poor intake.
Rationale 3: Calling the physician would be a premature action to take without more assessment information.
Rationale 4: A conference with the dietician and physician may have to take place, but it would depend on the reason for the resident’s poor intake. Further assessment information would either confirm or deny the need for this action.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging in the gastrointestinal (GI) system.

Question 2
Type: MCSA
A nurse in a long-term care facility observes a nursing assistant feeding a resident so rapidly that the resident barely has time to swallow each bite. The nurse takes the nursing assistant aside for a discussion. What would the nurse identify as being the greatest risk of this nursing assistant’s action?
1. Loss of resident’s dignity
2. Overfeeding resident
3. Potential for aspiration
4. Gastroparesis
Correct Answer: 3
Rationale 1: Although true, loss of dignity would not constitute the greatest risk in terms of prioritization; aspiration is a greater risk.
Rationale 2: Although true, overfeeding the resident would not constitute the greatest risk in terms of prioritization; aspiration is a greater risk.
Rationale 3: Correct. Older adults normally have a diminished gag reflex making them more prone to aspiration and possible aspiration pneumonia, which is life-threatening.
Rationale 4: Gastroparesis is a normal slowing down of the movement of food from the stomach to the intestines; it is not an effect of rapid feeding.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging in the gastrointestinal (GI) system.

Question 3
Type: MCSA
The nurse is teaching an older adult client about expected changes that occur with aging that may predispose the client to constipation. Which of the following information should the nurse include?
1. “You will avoid a lot of problems associated with slowing down of your gut and resulting constipation by taking a regular laxative daily.”
2. “You begin to produce fewer digestive enzymes; this causes your food not to be broken down as well, causing constipation.”
3. “Decreased saliva production interferes with your chewing and swallowing of food, thereby putting you at risk for constipation.”
4. “A decrease in the peristaltic movement of your intestines contributes to content remaining in the intestines longer, which predisposes you to constipation.”
Correct Answer: 4
Rationale 1: Reliance on laxatives can affect the absorption of food for the client and is not a good way to avoid constipation.
Rationale 2: Reduction of digestive enzymes causes the older adult to have a diminished appetite, not constipation.
Rationale 3: Decreased saliva production predisposes the older adult to xerostomia, dysphagia, impaired carbohydrate digestion, loss of appetite, periodontal disease, and dental caries, but not constipation.
Rationale 4: Correct. Slowed peristalsis predisposes the older adult to constipation.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging in the gastrointestinal (GI) system.

Question 4
Type: MCMA
An older adult client asks the nurse to list some foods that would help to promote colon health. The nurse should include which of the following food items on the list?
Standard Text: Select all that apply.
1. Beefsteak
2. Whole grains
3. Broccoli
4. Refined starches
5. Cantaloupe
Correct Answer: 2,3,5
Rationale 1: Red meat is thought to be a causative factor in colon cancer.
Rationale 2: Correct. Whole grains promote colon health.
Rationale 3: Correct. Broccoli promotes colon health.
Rationale 4: Complex carbohydrates, not refined carbohydrates, are healthy for the colon.
Rationale 5: Correct. Cantaloupe promotes colon health.
Global Rationale:

Cognitive Level: Remembering
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the GI system.

Question 5
Type: MCSA
A nurse practitioner assesses several older adult clients in a walk-in clinic. The nurse would find which of the following clients to be most at risk for nutritional deficiencies.
1. Client on a fixed income, paraplegic, receiving physical therapy twice weekly, on food stamps
2. Sedentary client, living alone, wearing dentures, on pain medication every four hours for chronic back pain
3. Female client living with her spouse, walks two miles daily, his her own teeth, and uses a laxative daily
4. Client ambulatory with a walker, does own cooking, has son residing in the home who assists with buying groceries for the home
Correct Answer: 2
Rationale 1: A fixed income is a risk factor, but the client is receiving assistance. The client is also paraplegic but is getting activity.
Rationale 2: Correct. The sedentary client possesses the most risk factors: no real activity, lives alone, wears dentures (which may affect what he eats), and suffers from chronic pain. Chronic pain causes him to take painkillers which slow peristalsis further and can cause depression, anorexia, and weight loss.
Rationale 3: The female client has the risk factor of using a daily laxative, but she is active, doesn’t wear dentures, and doesn’t live alone.
Rationale 4: The client with a son has a disability, but is active with an assistive device, does not live alone, and has some financial assistance from the son.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the GI system.

Question 6
Type: MCSA
An older adult client in an acute care healthcare facility has a history of dysphagia following a stroke. Which of the following nursing actions would be appropriate in the care of this client?
1. Place the client in a supine position immediately after feeding.
2. Make certain the client receives a clear, liquid diet at each meal.
3. Examine the client’s mouth after meals for the presence of food particles.
4. Give the client frequent sips of water with each bite of solid food.
Correct Answer: 3
Rationale 1: A supine position would put the client at risk of aspiration. The recommended position is upright with no less than 30 degrees of incline.
Rationale 2: Clients with dysphagia better tolerate a soft mechanical diet. Also, a thickening agent is added to liquids given to a client with dysphagia.
Rationale 3: Correct. Clients who have had a stroke with subsequent dysphagia may have difficulty swallowing all of the food that is placed in their mouths.
Rationale 4: Clients with dysphagia are at increased risk of aspiration; their liquids are mixed with a thickening agent to improve swallowing.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the GI system.

Question 7
Type: MCMA
A nurse practitioner is teaching an older adult client recently diagnosed with GERD (gastroesophageal reflux disease) actions that can be taken to reduce symptoms. Which of the following advice from the nurse would be appropriate?
Standard Text: Select all that apply.
1. Limit the number of meals per day to 1 or 2.
2. Eat the supper meal within 30 minutes of going to bed.
3. Avoid alcohol, chocolate, mint, and caffeine in the diet.
4. Remain upright for at least an hour after meals.
5. Try to lose any excess weight.
Correct Answer: 3,4,5
Rationale 1: Those with GERD should eat smaller portions more often during the day.
Rationale 2: Those with GERD must be upright for at least an hour after meals.
Rationale 3: Correct. Those with GERD should avoid alcohol, chocolate, mint, and caffeine in their diet.
Rationale 4: Correct. Those with GERD must remain upright for at least an hour after meals.
Rationale 5: Correct. Those with GERD should try to lose any excess weight.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts:
Learning Outcome: Discuss conditions and disorders of the GI system that are common in older adults.

Question 8
Type: MCSA
An older adult client in a long-term care facility has developed persistent diarrhea. Based on the diagnosis, which of the nursing diagnoses would be the highest priority for this client?
1. Risk for Impaired Skin Integrity
2. Disturbed Body Image
3. Bowel Incontinence
4. Risk for Deficient Fluid Volume
Correct Answer: 4
Rationale 1: Although it is an appropriate diagnosis for an older adult client with diarrhea, the Risk for Impaired Skin Integrity would not be the highest priority.
Rationale 2: Although it is an appropriate diagnosis for an older adult client with diarrhea, Disturbed Body Image would not be the highest priority.
Rationale 3: Although it is an appropriate diagnosis for an older adult client with diarrhea, Bowel Incontinence would not be the highest priority.
Rationale 4: Correct. Risk for Deficient Fluid Volume would be the highest priority diagnosis for an older adult client with persistent diarrhea because the client would be at risk for dehydration.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Provide nursing care to older clients with disorders and conditions affecting the GI system.

Question 9
Type: MCSA
An older adult client with diabetes asks the nurse to explain what can be done for signs and symptoms of a “diabetic gut.” Which of the following guidelines should the nurse include?
1. Eat three large meals at regular times daily.
2. Maintain blood sugar within normal limits.
3. Report episodes of bleeding to a physician.
4. Avoid alcohol and caffeine in the diet.
Correct Answer: 2
Rationale 1: It is advised that clients with diabetic gastroenteropathy eat six light meals daily rather than three large meals to help with digestion.
Rationale 2: Correct. Hyperglycemia is noted as a possible cause of diabetic gastroenteropathy.
Rationale 3: It is advised that those with hemorrhoids, not diabetic gastroenteropathy, report episodes of bleeding to a physician.
Rationale 4: It is advised that clients with peptic ulcer disease, not diabetic gastroenteropathy, avoid alcohol and caffeine in the diet.
Global Rationale:

Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Discuss conditions and disorders of the GI system that are common in older adults.

Question 10
Type: Matching
The nurse is preparing to do an abdominal assessment on an older adult client. Drag and drop the assessment techniques in the left column into the correct sequence for an abdominal assessment in the right column.
_____ 1. Palpation _____ 2. Auscultation _____ 3. Percussion _____ 4. Inspection
Correct Answer: A-4, B-2, C-1, D-3

Global Rationale:

Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Describe appropriate assessment techniques for the GI system.