CPNRE CPNRE - Canadian Practical Nurse Registration Examination Gerontological and Palliative Care Questions and Answers 4 — Questions and Answers
Question 1: An elderly client with dementia repeatedly asks to go home during evening hours. Which nursing intervention best addresses sundowning behaviour?
- Administer a sedative as prescribed to calm the client
- Increase lighting in the room and engage the client in a calm activity (Correct answer)
- Restrain the client to prevent wandering
- Ignore the behaviour as it is a normal part of dementia
Correct answer: Increase lighting in the room and engage the client in a calm activity
Increased lighting and calm redirection reduce confusion and agitation associated with sundowning syndrome.
Question 2: A palliative care client reports breakthrough pain rated 8/10 despite scheduled opioid therapy. What is the nurse's priority action?
- Document the pain and reassess in one hour
- Notify the physician and administer prescribed breakthrough analgesic (Correct answer)
- Apply a cold pack to the painful area
- Encourage deep-breathing exercises to manage pain
Correct answer: Notify the physician and administer prescribed breakthrough analgesic
Uncontrolled breakthrough pain requires timely administration of the prescribed PRN analgesic and prompt physician notification.
Question 3: When assessing an older adult for fall risk, which single factor carries the greatest predictive value?
- Age over 65 years
- Use of a walking aid
- History of a previous fall (Correct answer)
- Female sex
Correct answer: History of a previous fall
A prior fall history is the strongest single predictor of future falls in the older adult population.
Question 4: A PN is caring for a dying client whose family insists on continuing aggressive IV hydration against the client's advance directive. The PN's first action is to:
- Continue the IV fluids to satisfy the family
- Consult the palliative care team and refer the conflict to the care team and ethics committee if needed (Correct answer)
- Discontinue the IV immediately without team discussion
- Ask the family to leave the room
Correct answer: Consult the palliative care team and refer the conflict to the care team and ethics committee if needed
Conflicts between family wishes and a valid advance directive require interprofessional consultation and may involve an ethics committee.
Question 5: Which pressure injury stage is characterized by full-thickness skin loss with visible subcutaneous fat but no exposed bone, tendon, or muscle?
- Stage 1
- Stage 2
- Stage 3 (Correct answer)
- Stage 4
Correct answer: Stage 3
Stage 3 pressure injuries involve full-thickness skin loss exposing subcutaneous tissue without deeper structure involvement.
Question 6: An older adult on long-term warfarin therapy is started on a new antibiotic. Which nursing action is most important?
- Increase the warfarin dose prophylactically
- Monitor INR more frequently and observe for signs of bleeding (Correct answer)
- Discontinue the warfarin until the antibiotic course is complete
- Advise the client to take both medications with food
Correct answer: Monitor INR more frequently and observe for signs of bleeding
Many antibiotics potentiate warfarin's anticoagulant effect, so closer INR monitoring and bleeding surveillance are essential.
Question 7: A palliative client develops the 'death rattle' — noisy, wet-sounding respirations. Which intervention should the nurse implement first?
- Suction the airway aggressively to clear secretions
- Reposition the client and explain the sound to the family (Correct answer)
- Administer oxygen via non-rebreather mask
- Increase IV fluid rate to thin secretions
Correct answer: Reposition the client and explain the sound to the family
Repositioning can reduce pooling of secretions, and educating the family about this normal dying process alleviates their distress.
CPNRE CPNRE - Canadian Practical Nurse Registration Examination Gerontological and Palliative Care Questions and Answers 4
An elderly client with dementia repeatedly asks to go home during evening hours.
Which nursing intervention best addresses sundowning behaviour?