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Gerontological Nursing The Essential Guide 2nd Edition Tabloski Test Bank

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Gerontological Nursing The Essential Guide 2nd Edition Tabloski Test Bank

9780135038109

 

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Gerontological Nursing The Essential Guide 2nd Edition Tabloski Test Bank

9780135038109

 

 

 

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Free Nursing Test Questions:

 

Chapter 16

The Respiratory System

 

16.1•A change that normally occurs in the respiratory system as a result of aging is

 

  1. a decrease in vital capacity.
  2. an increase in the amount of oxygen carried in the blood.
  3. a decrease in stiffness of the chest wall.
  4. an increase in alveolar surface area.

Answer: 1

 

Rationale: The aging process causes a decrease in the vital capacity or amount of air that moves in and out with each breath. Other changes that occur with aging include a decrease in the amount of oxygen carried in the blood, increased stiffness in the chest wall, and a decrease in the amount of alveolar surface area where gas exchange occurs.

Assessment

Physiological Integrity

Analysis

 

16.2•With aging, there is increased susceptibility to pulmonary diseases, such as influenza, pneumonia, and tuberculosis, in the older client as a result of

 

  1. improved effectiveness of the cilia in removing debris from the airway.
  2. decreased antibody production.
  3. improved response to immunizations.
  4. altered alveolar shape with an increase in alveolar diameter.

Answer: 2

 

Rationale: Older clients are more susceptible to pulmonary diseases because of a decrease in antibody production that occurs with a decline in immune functioning. The cilia, which create a constant whipping motion propelling mucus, are less effective in removing foreign matter from the airways. Even with administration of immunizations, there is less production of antibodies. Aging causes a change in the shape of the alveoli and an increase in the alveolar diameter but these have no affect on the client’s susceptibility to disease.

Diagnosis

Physiological Integrity

Analysis

 

16.3•An older client complains of difficulty breathing and of wheezing. The diagnostic test that is most likely to differentiate the diagnosis as asthma or chronic obstructive pulmonary disease (COPD) is

 

  1. chest x-ray examination (CXR).
  2. electrocardiogram (EKG).
  3. pulmonary function tests (PFTs).
  4. complete blood count (CBC).

Answer: 3

 

Rationale: Pulmonary function tests are the most reliable way to diagnose asthma and differentiate it from other illness such as COPD. Measurement of air during expiration is used in the differential diagnosis. The chest x-ray, electrocardiogram, and CBC will give information related to the pulmonary condition but will not differentiate asthma and COPD.

Assessment

Physiological Integrity

Analysis

 

16.4•Which of the following is a correct statement describing asthma in older clients?

 

  1. asthma is not diagnosed as a new condition in older clients
  2. asthma can be differentiated from chronic obstructive pulmonary disease (COPD) by changes seen on a series of chest x-rays
  3. asthma is treated with the same types of medications in older clients as in younger clients
  4. older clients are less likely to have side effects and drug interactions from asthma medications than younger clients

Answer: 3

 

Rationale: The same types of medications are used to treat asthma in older adults as in younger adults. The older adult is likely to experience more side effects from the medications and drug interactions. Asthma can be a new diagnosis in older clients as well as in younger clients. Asthma is differentiated from COPD by examining pulmonary function test results.

Intervention

Physiological Integrity

Application

 

16.5•Guidelines for using inhaled medications for older clients include which of the following

 

  1. spacers are not recommended for use with inhaled medications.
  2. metered-dose inhalers (MDI) are more easily used than nebulizer treatments for clients with coordination or cognitive impairments.
  3. a client should be taught to rinse the mouth with water and expectorate after using inhaled beta2-agonist medications.
  4. clients who use inhaled corticosteroid medications are at increased risk for oral candidiasis.

Answer: 4

 

Rationale: Clients who use corticosteroid medications in the inhaled form are at risk for oral candidiasis because the normal flora are altered secondary to the immunosuppression from the steroid therapy. Clients should rinse their mouths with water after using inhaled steroid medications and expectorate to reduce the risk of oral candidiasis, gum disease, and tooth decay. Clients should use spacers with MDI because this will allow the client to inhale the medication at a slower rate, reducing the chance of stimulating the cough reflex. Administering medications via nebulizer is better tolerated by clients who are cognitively impaired and those who may have difficulty handling MDI.

Intervention

Physiological Integrity

Application

 

16.6•A peak flow meter

 

  1. is used to administer inhaled medications in dry powder form.
  2. gives feedback to determine whether the client is developing asthma symptoms.
  3. is used to identify specific allergy trigger agents.
  4. can only be used by a respiratory therapist or nurse with special education.

Answer: 2

 

Rationale: The peak flow meter is a device that measures the air flow in and out of the lungs. If measurements show that the airway is narrowing, the client can take medications before the symptoms of asthma occur, either averting or decreasing the severity of the asthma attack. The flow meter is not used to administer medications or identify specific allergens. Clients should be instructed in the use of the flow meter so they can take an active role in managing their diseases.

Intervention

Physiological Integrity

Application

 

16.7•An older client is receiving corticosteroid therapy to treat asthma. The nurse knows that

 

  1. inhaled medications cause less severe adverse effects than systemic forms.
  2. there is a risk of hyperkalemia.
  3. the client may develop hypoglycemia.
  4. the client may experience hypotension.

Answer: 1

 

Rationale: Generally, there is less of the corticosteroid medication absorbed via inhaler administration than if the client received the medication systemically. The client with either method of corticosteroid administration is at risk to develop adverse effects including hypokalemia, elevated blood glucose, and hypertension.

Intervention

Physiological Integrity

Analysis

 

16.8•The manifestation of chronic obstructive pulmonary disease (COPD) that occurs earliest in the course of the disease is

 

  1. clubbing of the fingers.
  2. cyanotic nail beds.
  3. cough in the morning producing clear sputum.

Answer: 4

 

Rationale: The earliest presenting symptom of COPD is a morning cough with clear sputum unless the client develops an infection. Then the sputum would become yellow or green in color. With the progression of COPD the body compensates by producing extra red blood cells. These extra blood cells clog the small blood vessels of the fingers leading to the development of cyanotic nail beds and clubbing of the fingertips. Enlargement and thickening of the right ventricle of the heart often results in dysrhythmias.

Assessment

Physiological Integrity

Application

 

16.9•An elderly client with asthma has a respiratory rate of 28 at rest. Wheezes are audible on inspiration. An appropriate nursing diagnosis for this client is

 

  1. activity intolerance with fatigue.
  2. ineffective airway clearance with cough.
  3. altered tissue perfusion with hypoxemia.
  4. ineffective breathing pattern with tachypnea and wheezing.

Answer: 4

 

Rationale: The client is experiencing an increased respiratory rate and is wheezing, an ineffective breathing pattern. The appropriate nursing diagnosis is ineffective breathing pattern with tachypnea and wheezing.

Diagnosis

Physiological Integrity

Application

 

16.10•A nurse is reading the medical history of an elderly client with chronic obstructive pulmonary disease (COPD). The nurse learns that the client has cor pulmonale. Cor pulmonale is

 

  1. enlargement of the left ventricle.
  2. enlargement of the right ventricle with dysrhythmias.
  3. decreased carbon dioxide.
  4. anemia with shortness of breath.

Answer: 2

 

Rationale: Cor pulmonale is the enlargement and thickening of the right ventricle of the heart. As COPD progresses, decreased amounts of oxygen in the blood cause the blood vessels in the lung to constrict. The heart compensates by enlarging to circulate the blood through the lungs. Dysrhythmias occur as a result of the changes in the right ventricle. Enlargement of the left ventricle is not associated with COPD. Other changes that occur as the body compensates with the progression of COPD include retention of carbon dioxide and secondary Polycythemia, an increase in number of red blood cells. Anemia does not occur.

Diagnosis

Physiological Integrity

Analysis

 

16.11•An elderly client has an order for a tuberculin skin test. The correct technique to give the two-step test purified protein derivative (PPD) is to

 

  1. administer an injection of 5-TU subcutaneously; observe for induration in 48 hours; repeat the test and measure the induration.
  2. administer an injection of 5-TU intradermally and measure the induration in 72 hours; if the test is negative, repeat the test within 1 to 2 weeks and measure the induration in 72 hours.
  3. administer 5 units of BCG vaccine subcutaneously; in 72 hours administer an injection of 5-TU intradermally and measure the induration in 24 hours. Repeat the test in two weeks.
  4. administer an injection of 5-TU intradermally at one site and administer an injection of 5-TU subcutaenously and measure the induration of both sites in 72 hours.

Answer: 2

 

Rationale: The correct technique for a tuberculin skin test using purified protein derivative (PPD) in an older adult is the two-step approach. The older client has a sluggish immune system and may not react adequately to a single dose of PPD. The skin test must be given intradermally using 5-TU. Induration is read at 72 hours. If the test is negative, the test is repeated in 1 to 2 weeks and the induration is read at 72 hours.

Implementation

Physiological Integrity

Application

 

16.12•An active case of tuberculosis

 

  1. is treated with several antibiotics for a 2-month period.
  2. gives active immunity and the client cannot have a relapse.
  3. is verified by a positive two-step tuberculin skin test.
  4. requires isolation with controlled ventilation and reverse airflow until the client has been treated for 2 weeks with recommended antibiotic therapy.

Answer: 4

 

Rationale: Tuberculosis is spread by droplet infection and repeated exposure to a client spreading the droplets is how another person becomes infected. The client must be isolated with controlled ventilation and reverse airflow. Clients who receive adequate treatment with antibiotics for 2 weeks are no longer considered contagious. Clients are treated with several antibiotics for a period of 6 months to a year. Clients do not develop immunity against the tuberculosis bacteria and can have a relapse with reactivation of an old infection. A positive tuberculin skin test signifies that a person has been exposed to the infection and has developed an immune response. These persons are further scrutinized for symptoms of the disease (productive cough, weight loss, loss of appetite, and night sweats); have chest x-ray examinations, which would show changes specific to tuberculosis; and a sputum analysis for acid-fast bacillus (AFB), the specific test for tuberculosis, if indicated.

Planning

Physiological Integrity

Application

 

16.13•Tuberculosis

 

  1. can be spread by persons who have positive skin tests and no symptoms.
  2. presents a higher risk for clients who take immunosuppressant medications.
  3. is caused by a virus related to human immunodeficiency virus (HIV).
  4. in the early stage, causes the client to gain weight and be short of breath.

Answer: 2

 

Rationale: A risk factor for developing tuberculosis is the use of medications that suppress the immune system, such as corticosteroids or anticancer medications. Tuberculosis is spread by droplet infection by persons with active disease. Persons with positive skin tests have been exposed to the infection and have sustained an immune response to the exposure. They usually are given an antibiotic prophylactically. Tuberculosis is caused by mycobacterium tuberculosis, which is an acid-fast, aerobic bacterium. Clients with HIV are at greater risk for tuberculosis because of altered immune status. Symptoms in the early course of the disease are productive cough, weight loss, and night sweats.

Diagnosis

Physiological Integrity

Analysis

 

16.14•In educating an older client about smoking cessation, the nurse should keep in mind that

 

  1. most persons quit smoking several times before they are successful.
  2. buproprion (Zyban) taken orally is safe for clients with seizure disorders.
  3. a piece of nicotine gum should be chewed for 5 minutes of every waking hour.
  4. there is no adverse risk if the client chooses to smoke while wearing a nicotine patch.

Answer: 1

 

Rationale: When teaching clients about smoking cessation, the nurse should emphasize that most persons who successfully quit smoking have tried to quit several times before success. Buproprion is used to suppress the craving for tobacco but is contraindicated for clients with a positive history for seizures. The proper use of nicotine gum is to chew one piece at a time up to 9 to 12 times daily when the urge to smoke occurs. The gum should be chewed several times to soften it and them held in the buccal space for at least 30 minutes to absorb the medication. A client wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems including myocardial infarction.

Intervention

Physiological Integrity

Application

 

16.15•The older client with pneumonia often

 

  1. spikes a temperature and develops hemoptysis.
  2. does not require antibiotic therapy.
  3. is more likely to present with lethargy and loss of cognitive function.
  4. should not receive the pneumonia vaccine after recovering from the infection.

Answer: 3

 

Rationale: The older client with pneumonia is most likely to present with atypical manifestations of an infection as a result of a weaker immune response. Frequently, caregivers or family members note that the client looks generally ill. The client is lethargic, less coherent, and has stopped eating and drinking. The classic sign of infection or fever may not be present. Hemoptysis or bloody sputum is more typical of pulmonary embolism or cough associated with lung cancer. Older persons with pneumonia need to be treated aggressively with antibiotics because the mortality rate is 20%. After the client has recovered from the pneumonia, the client should be immunized with the pneumonia vaccine, which is approximately 80% effective against 23 serotypes of pneumococci.

Diagnosis

Physiological Integrity

Application

 

16.16•A nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which of the following positions will the nurse instruct the client to assume?

 

  1. Sitting up in bed
  2. Side-lying in bed
  3. Sitting in a recliner
  4. Sitting on the side of the bed and leaning on an overbed table.

Answer: 4

Rationale: Sitting up and leaning on an overbed table or resting the elbows on the knees will assist the client with emphysema with breathing. Options 1, 2, and 3 will not enhance breathing.

Application; Physiological Integrity; Implementation

 

16.17•The nurse is providing discharge instruction for a client recently diagnosed with asthma. Which of the following statements by the client indicates a need for further education?

 

  1. “I will use my peak flow meter every day for 2 weeks.”
  2. “I will use my peak flow meter when I feel that I am catching a cold.”
  3. “I will use my peak flow meter prior to going to bed.”
  4. “I will use my peak flow meter before and after taking my medication.”

Answer: 3

Rationale: The peak flow meter should be used upon rising and between noon and 2 pm. Options 1, 2, and 4 are correct information regarding peak flow use.

Analysis; Physiological Integrity; Assessment

 

16.18•The student nurse is performing a physical assessment on a newly admitted client with asthma. Which of the following assessment findings would the nurse expect?

  1. Pleural rub
  2. Barrel chest
  3. Wheezing
  4. Clubbing of the fingers

Answer: 3

Rationale: Asthma is characterized by reversible airflow obstruction. Wheezing is a sign that air is having difficulty passing through airways narrowed by edema, spasm, or mucus. Options 1, 2, and 3 are not typical symptoms of asthma.

Application, Physiological Integrity, Assessment

 

16.19•The nurse is preparing a care plan for a 72-year-old female hospitalized with asthma. The client is currently receiving oxygen at 2 L per nasal cannula. Her vital signs are respiratory rate of 28, heart rate of 86, and blood pressure of 108/52. Which of the following nursing diagnoses would be the highest priority for this client?

 

  1. Altered tissue perfusion, respiratory
  2. Injury, risk for
  3. Activity intolerance
  4. Infection, risk for

Answer: 1

Rationale: Altered tissue perfusion, respiratory would be the highest-priority diagnosis for this client. Options 2, 3, and 4 may also be potential lower-priority diagnoses for this client.

Analysis; Physiological Integrity; Planning

 

16.20•When preparing a community education program on COPD, the student nurse will include which of the following information regarding COPD? Select all that apply.

 

  1. Cigarette smoking is the number one cause of COPD.
  2. COPD is actually two different diseases, chronic bronchitis and emphysema.
  3. There is no cure for COPD.
  4. Once diagnosed with COPD, there is no need for the client to quit smoking.

Answer: 1, 2, 3

Rationale: Options 1, 2, and 3 are all correct concerning COPD. Option 4 is incorrect. The client can still benefit from stopping smoking. This can help prevent progression of the disease.

Application; Physiological Integrity; Planning

 

16.21•A nurse is preparing a care plan for a newly admitted client with COPD. The client currently is receiving oxygen at 4 L per nasal cannula. Her oxygen saturation is 82%, respiratory rate is 32, heart rate is 98, and blood pressure is 102/68. Which of the following is the highest-priority nursing diagnosis for this client?

 

  1. Activity intolerance
  2. Altered tissue perfusion: respiratory
  3. Ineffective airway clearance
  4. Ineffective management of therapeutic regimen, individual

Answer: 2

Rationale: Altered tissue perfusion: respiratory is a priority nursing diagnosis for a client with hypoxemia. Options 1, 3, and 4 are also potential lower-priority nursing diagnoses for a client with COPD.

Analysis; Physiological Integrity; Planning

 

16.22•An older client is being screened for tuberculosis. The client questions why PPD testing is done twice. Which of the following is the most appropriate response by the nurse?

 

  1. “The treatment for TB is 6 months of medication, and we want to make sure the first PPD was done correctly prior to starting the medication.”
  2. “Different medication is used in the second PPD.”
  3. “The first PPD was not interpreted in the correct time frame of 48 to 72 hours.”
  4. “The second PPD provides a more accurate reading because the older person’s immune system may be sluggish and not adequately react to the first exposure.”

Answer: 4

 

Rationale: PPD testing is done in a two-step process due to the slowing of the older adult’s immune system. Options 1, 2, and 3 are incorrect information regarding the PPD.

Application; Physiological Integrity; Implementation

 

16.23•A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to

 

  1. use alcohol in small amounts.
  2. report yellow eyes or skin immediately.
  3. increase intake of Swiss or aged cheeses.
  4. avoid vitamin supplements.

Answer: 2

Rationale: A side effect of INH is liver damage. Yellow eyes or skin can be a symptom of this. Alcohol can cause further liver damage. Swiss and aged cheeses contain tyramine, which can cause a reaction if ingested with INH. Vitamin B6 supplementation is encouraged during the course of INH therapy.

Application; Physiological Integrity; Planning

 

16.24•A nursing student is writing a care plan for a client hospitalized with pneumonia. Her priority nursing diagnosis is ineffective airway clearance. Which intervention should the nursing student include?

 

  1. Administration of the pneumococcal vaccine
  2. Smoking cessation education
  3. Limit fluid intake
  4. Chest percussion

Answer: 4

 

Rationale: Chest percussion can help clear secretions. Options 2 and 4 are important in treating a client with pneumonia; however,  they would be aligned with a different nursing diagnosis. Clients with pneumonia are encouraged to increase fluid intake.

Application; Physiological Integrity; Planning

 

16.25•The student nurse has assisted with providing discharge instructions for a client diagnosed with pneumonia. Which of the following statements made by the client would suggest that further instruction is needed?

 

  1. “I will get the pneumococcal vaccine every fall.”
  2. “I will get the pneumococcal vaccine as soon as I recover from this pneumonia.”
  3. “I will get the influenza vaccine every year.”
  4. “I can’t get the influenza vaccine due to my allergy to eggs.”

Answer: 1

Rationale: The pneumococcal vaccine is administered once. Revaccination is only recommended in persons with renal failure, those who have had splenectomies, those with malignancies, and those with HIV/AIDS. Options 2, 3, and 4 are all correct information.

Analysis; Physiological Integrity; Assessment

 

 

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