CPNRE CPNRE - Canadian Practical Nurse Registration Examination Gerontological and Palliative Care Questions and Answers 5 — Questions and Answers
Question 1: A 78-year-old client is prescribed multiple medications. Which age-related pharmacokinetic change most increases the risk of drug toxicity in older adults?
- Increased gastric acid production
- Decreased renal clearance (Correct answer)
- Faster hepatic metabolism
- Increased total body water
Correct answer: Decreased renal clearance
Declining glomerular filtration rate reduces renal clearance, causing drug accumulation and elevated risk of toxicity in older adults.
Question 2: When using the PAINAD scale to assess pain in a non-verbal client with advanced dementia, the nurse observes rigid body posture and clenched fists but no facial grimacing or vocalization. The nurse should:
- Assume the client is comfortable because there is no facial expression
- Score body language and consult the care team about analgesic management (Correct answer)
- Wait for the client to verbalize discomfort before intervening
- Document 'pain not present' based on the PAINAD score
Correct answer: Score body language and consult the care team about analgesic management
Body language indicators on the PAINAD scale are valid pain indicators; rigid posture and clenched fists indicate discomfort requiring attention.
Question 3: Which dietary modification is most appropriate for an older adult with dysphagia at risk for aspiration?
- Encourage thin fluids to maintain hydration
- Provide minced or pureed foods and thickened liquids as per SLP recommendation (Correct answer)
- Restrict oral intake and place a nasogastric tube immediately
- Advise the client to eat quickly to reduce fatigue during meals
Correct answer: Provide minced or pureed foods and thickened liquids as per SLP recommendation
A speech-language pathologist-guided texture-modified diet reduces aspiration risk while preserving oral nutrition.
Question 4: An older adult residing in a long-term care facility refuses a bath for the third consecutive day. The nurse's best response is to:
- Document the refusal and force hygiene care to prevent skin breakdown
- Explore the reason for refusal and offer alternative hygiene options (Correct answer)
- Report the refusal to the charge nurse as non-compliance
- Withhold activities until the client agrees to bathe
Correct answer: Explore the reason for refusal and offer alternative hygiene options
Exploring barriers and offering choices respects autonomy while addressing hygiene needs through person-centred care.
Question 5: A palliative client on high-dose morphine develops myoclonus. This symptom most likely indicates:
- Opioid allergy requiring immediate discontinuation
- Opioid-induced neurotoxicity potentially requiring opioid rotation (Correct answer)
- Normal progression of the underlying disease
- Seizure disorder requiring anticonvulsant therapy
Correct answer: Opioid-induced neurotoxicity potentially requiring opioid rotation
Myoclonus is a sign of opioid-induced neurotoxicity; opioid rotation to a different opioid may be needed.
Question 6: Which principle of palliative care best describes treating the whole person — physical, emotional, social, and spiritual dimensions — rather than only the disease?
- Curative care
- Holistic care (Correct answer)
- Restorative care
- Preventive care
Correct answer: Holistic care
Holistic care addresses all dimensions of suffering and is a foundational principle of palliative nursing.
Question 7: A frail older adult is admitted with dehydration. Which assessment finding best supports a nursing diagnosis of fluid volume deficit in this population?
- Blood pressure 140/90 mmHg
- Dry oral mucous membranes and elevated serum sodium (Correct answer)
- Bilateral crackles on lung auscultation
- Pitting oedema in the lower extremities
Correct answer: Dry oral mucous membranes and elevated serum sodium
Dry mucous membranes combined with elevated serum sodium are reliable indicators of fluid volume deficit in older adults.
CPNRE CPNRE - Canadian Practical Nurse Registration Examination Gerontological and Palliative Care Questions and Answers 5
A 78-year-old client is prescribed multiple medications.
Which age-related pharmacokinetic change most increases the risk of drug toxicity in older adults?