Gerontological Nurse Test Gerontological Nursing 5 — Questions and Answers
Question 1: Which finding on a medication reconciliation is MOST concerning in a newly admitted 84-year-old patient?
- Taking a daily aspirin 81 mg for cardiac prophylaxis
- Taking diphenhydramine nightly as a sleep aid (Correct answer)
- Using a calcium supplement with vitamin D
- Taking metoprolol succinate for hypertension
Correct answer: Taking diphenhydramine nightly as a sleep aid
Diphenhydramine is on the Beers Criteria as a potentially inappropriate medication for older adults due to its strong anticholinergic properties, which can cause confusion, urinary retention, constipation, and increased fall risk.
Question 2: A 77-year-old patient refuses to eat meals at the facility. The nurse learns the patient has always eaten culturally specific foods not offered on the menu. What is the BEST initial intervention?
- Document the refusal and notify the physician immediately
- Place a nasogastric tube to ensure adequate nutrition
- Consult dietary services to incorporate culturally appropriate food options (Correct answer)
- Reassure the patient that the facility food is nutritionally adequate
Correct answer: Consult dietary services to incorporate culturally appropriate food options
Respecting cultural food preferences is fundamental to person-centered care; a dietary consult to incorporate culturally appropriate options addresses the root cause of the refusal and supports nutritional intake.
Question 3: Which assessment finding would MOST likely indicate elder mistreatment and require mandatory reporting by the nurse?
- An 80-year-old with multiple bruises in various stages of healing on the trunk (Correct answer)
- A 75-year-old who refuses to take blood pressure medications
- An 83-year-old who is incontinent of urine
- An elderly patient with poor dentition and gum disease
Correct answer: An 80-year-old with multiple bruises in various stages of healing on the trunk
Multiple bruises in various stages of healing on the trunk are a red flag for physical abuse, as accidental bruising in ambulatory older adults typically occurs on the extremities, not the trunk.
Question 4: The nurse is caring for an older adult patient at end of life who is experiencing Cheyne-Stokes respirations. How should the nurse interpret this finding?
- Immediately initiate CPR as this indicates cardiac arrest
- Document as a normal expected physiological change in the dying process (Correct answer)
- Administer supplemental oxygen at 10 L/min via non-rebreather mask
- Place the patient in Trendelenburg position to improve cerebral perfusion
Correct answer: Document as a normal expected physiological change in the dying process
Cheyne-Stokes respirations — a cyclic pattern of waxing and waning breathing with apneic pauses — are a common and expected physiological sign in the final hours to days of life, not a medical emergency.
Question 5: A gerontological nurse assesses a patient using the Timed Up and Go (TUG) test. A result of 20 seconds indicates:
- Normal mobility for age 75 and older
- High fall risk requiring intervention (Correct answer)
- Mild mobility impairment only requiring monitoring
- The test is invalid and should be repeated
Correct answer: High fall risk requiring intervention
A TUG test result of ≥12 seconds is associated with high fall risk in community-dwelling older adults; 20 seconds indicates significantly impaired mobility requiring fall prevention interventions.
Question 6: Which nursing diagnosis is HIGHEST priority for an 81-year-old patient admitted with pneumonia, confusion, and a serum albumin of 2.8 g/dL?
- Deficient Knowledge related to antibiotic therapy
- Imbalanced Nutrition: Less than Body Requirements related to chronic malnutrition
- Impaired Gas Exchange related to infectious process (Correct answer)
- Risk for Social Isolation related to hospitalization
Correct answer: Impaired Gas Exchange related to infectious process
Using Maslow's hierarchy, impaired gas exchange is a physiological survival need and takes priority over nutritional deficits and psychosocial concerns in an acutely ill patient with pneumonia.
Question 7: An 88-year-old resident in a long-term care facility wants to continue smoking despite having COPD. Which response by the nurse BEST reflects ethical gerontological nursing practice?
- Confiscate all cigarettes to protect the resident's health
- Inform the family so they can enforce cessation
- Acknowledge the resident's right to make autonomous decisions while discussing risks and cessation resources (Correct answer)
- Document that the resident is non-compliant and limit outdoor privileges
Correct answer: Acknowledge the resident's right to make autonomous decisions while discussing risks and cessation resources
Respecting patient autonomy means honoring competent adults' right to make decisions about their own lives, including lifestyle choices, while ensuring they have accurate information about risks and available cessation support.
Gerontological Nurse Test Gerontological Nursing 5
Which finding on a medication reconciliation is MOST concerning in a newly admitted 84-year-old patient?