Gerontological Nurse Test Chronic Disease Management in the Elderly 1 — Questions and Answers
Question 1: In older adults with type 2 diabetes, which HbA1c target is generally recommended to reduce hypoglycemia risk while maintaining glycemic control?
- Below 6.5%
- Below 7.0%
- 7.0–8.0% for older adults with multiple comorbidities (Correct answer)
- Below 9.0% for all older adults
Correct answer: 7.0–8.0% for older adults with multiple comorbidities
The American Geriatrics Society recommends a target HbA1c of 7.0–8.0% for older adults with multiple comorbidities, prioritizing hypoglycemia prevention over tight glycemic control.
Question 2: Which complication of heart failure is most commonly assessed in older adults by monitoring daily weight?
- Hypertensive crisis
- Fluid retention and early decompensation (Correct answer)
- Cardiac arrhythmias
- Reduced ejection fraction progression
Correct answer: Fluid retention and early decompensation
Daily weight monitoring detects early fluid accumulation in heart failure; a weight gain of 2–3 pounds in 24 hours or 5 pounds in a week typically signals fluid retention and worsening heart failure.
Question 3: An older adult with COPD is prescribed a long-acting bronchodilator. The nurse recognizes that the primary goals of COPD management in older adults include:
- Complete reversal of airflow obstruction and lung function restoration
- Symptom relief, prevention of exacerbations, and maintaining functional independence (Correct answer)
- Aggressive antibiotic therapy to prevent all respiratory infections
- Supplemental oxygen therapy to maintain SpO2 above 99%
Correct answer: Symptom relief, prevention of exacerbations, and maintaining functional independence
COPD in older adults is irreversible; management focuses on optimizing symptom control, preventing exacerbations, and preserving quality of life and functional ability.
Question 4: Which dietary recommendation is the most important for an older adult with stage 3 chronic kidney disease (CKD)?
- High-protein diet to prevent muscle wasting
- Potassium and phosphorus restriction with adequate hydration (Correct answer)
- Unrestricted sodium intake to maintain blood pressure
- High-calcium supplementation to prevent bone disease
Correct answer: Potassium and phosphorus restriction with adequate hydration
In CKD stage 3, the kidneys cannot adequately excrete potassium and phosphorus; dietary restriction of these electrolytes prevents dangerous hyperkalemia and hyperphosphatemia.
Question 5: A patient with osteoporosis suffers a vertebral compression fracture. The nurse expects which symptom as a primary complaint?
- Gradual leg weakness over several weeks
- Sudden acute back pain with height loss (Correct answer)
- Bilateral hip pain aggravated by weight bearing
- Fever and localized spinal tenderness
Correct answer: Sudden acute back pain with height loss
Vertebral compression fractures typically present with sudden acute back pain, and the cumulative effect of multiple fractures leads to progressive loss of height and kyphosis.
Question 6: An older adult with hypertension has a consistently elevated blood pressure despite adherence to antihypertensive medications. The nurse should first assess for:
- Medication-seeking behavior
- White coat hypertension requiring no intervention
- Secondary causes such as sleep apnea, medication interactions, or excessive sodium intake (Correct answer)
- The need to immediately escalate to IV antihypertensive therapy
Correct answer: Secondary causes such as sleep apnea, medication interactions, or excessive sodium intake
Resistant hypertension warrants investigation for secondary causes including obstructive sleep apnea, pain, NSAIDs or other medications that raise blood pressure, and excessive dietary sodium.
Gerontological Nurse Test Chronic Disease Management in the Elderly 1
In older adults with type 2 diabetes, which HbA1c target is generally recommended to reduce hypoglycemia risk while maintaining glycemic control?