Brunner & Suddarth’s Textbook Of Medical-surgical Nursing 13th Edition By Hinkle – Test Bank

1. You are providing care for an 82-year-old man whose signs and symptoms of Parkinson disease have become more severe over the past several months. The man tells you that he can no longer do as many things for himself as he used to be able to do. What factor should you recognize as impacting your patient’s life most significantly?
A) Neurologic deficits
B) Loss of independence
C) Age-related changes
D) Tremors and decreased mobility
Ans: B
Feedback:
This patient’s statement places a priority on his loss of independence. This is undoubtedly a result of the neurologic changes associated with his disease, but this is not the focus of his statement. This is a disease process, not an age-related physiological change.

2. A gerontologic nurse practitioner provides primary care for a large number of older adults who are living with various forms of cardiovascular disease. This nurse is well aware that heart disease is the leading cause of death in the aged. What is an age-related physiological change that contributes to this trend?
A) Heart muscle and arteries lose their elasticity.
B) Systolic blood pressure decreases.
C) Resting heart rate decreases with age.
D) Atrial-septal defects develop with age.
Ans: A
Feedback:
The leading cause of death for patients over the age of 65 years is cardiovascular disease. With age, heart muscle and arteries lose their elasticity, resulting in a reduced stroke volume. As a person ages, systolic blood pressure does not decrease, resting heart rate does not decrease, and the aged are not less likely to adopt a healthy lifestyle.

3. An occupational health nurse overhears an employee talking to his manager about a 65-year-old coworker. What phenomenon would the nurse identify when hearing the employee state, “He should just retire and make way for some new blood.”?
A) Intolerance
B) Ageism
C) Dependence
D) Nonspecific prejudice
Ans: B
Feedback:
Ageism refers to prejudice against the aged. Intolerance is implied by the employee’s statement, but the intolerance is aimed at the coworker’s age. The employee’s statement does not raise concern about dependence. The prejudice exhibited in the statement is very specific.

4. The nurse is caring for a 65-year-old patient who has previously been diagnosed with hypertension. Which of the following blood pressure readings represents the threshold between high-normal blood pressure and hypertension?
A) 140/90 mm Hg
B) 145/95 mm Hg
C) 150/100 mm Hg
D) 160/100 mm Hg
Ans: A
Feedback:
Hypertension is the diagnosis given when the blood pressure is greater than 140/90 mm Hg. This makes the other options incorrect.

5. You are the nurse caring for an 85-year-old patient who has been hospitalized for a fractured radius. The patient’s daughter has accompanied the patient to the hospital and asks you what her father can do for his very dry skin, which has become susceptible to cracking and shearing. What would be your best response?
A) “He should likely take showers rather than baths, if possible.”
B) “Make sure that he applies sunscreen each morning.”
C) “Dry skin is an age-related change that is largely inevitable.”
D) “Try to help your father increase his intake of dairy products.”
Ans: A
Feedback:
Showers are less drying than hot tub baths. Sun exposure should indeed be limited, but daily application of sunscreen is not necessary for many patients. Dry skin is an age-related change, but this does not mean that no appropriate interventions exist to address it. Dairy intake is unrelated.

6. An elderly patient has come in to the clinic for her twice-yearly physical. The patient tells the nurse that she is generally enjoying good health, but that she has been having occasional episodes of constipation over the past 6 months. What intervention should the nurse first suggest?
A) Reduce the amount of stress she currently experiences.
B) Increase carbohydrate intake and reduce protein intake.
C) Take herbal laxatives, such as senna, each night at bedtime.
D) Increase daily intake of water.
Ans: D
Feedback:
Constipation is a common problem in older adults and increasing fluid intake is an appropriate early intervention. This should likely be attempted prior to recommending senna or other laxatives. Stress reduction is unlikely to wholly resolve the problem and there is no need to increase carbohydrate intake and reduce protein intake.

7. An 84-year-old patient has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The patient is oriented to name only. The patient’s family is very upset because, before having surgery, the patient had no cognitive deficits. The patient is subsequently diagnosed with postoperative delirium. What should the nurse explain to the patient’s family?
A) This problem is self-limiting and there is nothing to worry about.
B) Delirium involves a progressive decline in memory loss and overall cognitive function.
C) Delirium of this type is treatable and her cognition will return to previous levels.
D) This problem can be resolved by administering antidotes to the anesthetic that was used in surgery.
Ans: C
Feedback:
Surgery is a common cause of delirium in older adults. Delirium differs from other types of dementia in that delirium begins with confusion and progresses to disorientation. It has symptoms that are reversible with treatment, and, with treatment, is short term in nature. It is patronizing and inaccurate to reassure the family that there is “nothing to worry about.” The problem is not treated by the administration of antidotes to anesthetic.

8. The nurse is providing patient teaching to a patient with early stage Alzheimer’s disease (AD) and her family. The patient has been prescribed donepezil hydrochloride (Aricept). What should the nurse explain to the patient and family about this drug?
A) It slows the progression of AD.
B) It cures AD in a small minority of patients.
C) It removes the patient’s insight that he or she has AD.
D) It limits the physical effects of AD and other dementias.
Ans: A
Feedback:
There is no cure for AD, but several medications have been introduced to slow the progression of the disease, including donepezil hydrochloride (Aricept). These medications do not remove the patient’s insight or address physical symptoms of AD.

9. A nurse is caring for an 86-year-old female patient who has become increasingly frail and unsteady on her feet. During the assessment, the patient indicates that she has fallen three times in the month, though she has not yet suffered an injury. The nurse should take action in the knowledge that this patient is at a high risk for what health problem?
A) A hip fracture
B) A femoral fracture
C) Pelvic dysplasia
D) Tearing of a meniscus or bursa
Ans: A
Feedback:
The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition or situation that produced the fall. The other listed injuries are possible, but less likely than a hip fracture.

10. The case manager is working with an 84-year-old patient newly admitted to a rehabilitation facility. When developing a care plan for this older adult, which factors should the nurse identify as positive attributes that benefit coping in this age group? Select all that apply.
A) Decreased risk taking
B) Effective adaptation skills
C) Avoiding participation in untested roles
D) Increased life experience
E) Resiliency during change
Ans: B, D, E
Feedback:
Because changes in life patterns are inevitable over a lifetime, older people need resiliency and coping skills when confronting stresses and change. It is beneficial if older adults continue to participate in risk taking and participation in new, untested roles.