Geriatric Test Mix

From the Nursing Center CE collection
http://www.nursingcenter.com/prodev/static.asp?pageid=604058

Call a stroke code! Specialty CE Collections, September 2005
Compliance Behaviors of Elderly Patients With Advanced Heart Failure Specialty CE Collections, September 2005
Presentation of Illness in Older Adults Specialty CE Collections, September 2005
Preventing Perioperative Complications in an Older Adult Specialty CE Collections, September 2005
1.
Which statement about t-PA is correct?
Questions 1-15 are associated with the article, "Call a Stroke Code!"
a. It's used to treat acute hemorrhagic stroke.
b. It's an antifibrinolytic agent
c. Administering it within 3 hours of the onset of symptoms may reopen the occluded cerebral artery
d. Determining the type of stroke before administering it isn't necessary

2.
When a patient with suspected acute ischemic stroke arrives at the ED, which brain study should be performed within 25 minutes?
a. magnetic resonance angiography
b. electroencephalography
c. a noncontrast CT scan
d. positron emission tomography

3.
What should you do first when a patient with suspected acute ischemic stroke arrives in the ED?
a. Assess his ABCs
b. Insert two large-bore I.V. lines and infuse D5W
c. Start an I.V. heparin infusion
d. Prepare for urgent lumbar puncture

4.
How should you assess your patient's level of consciousness if he's suspected of having an acute ischemic stroke?
a. Use the Glasgow coma scale
b. Wait for the neurologist's assessment
c. Review the results of his brain CT scan
d. Assess his response to an I.V. bolus of 50% dextrose

5.
To test for pronator drift, ask your patient to
a. touch his index finger to his nose
b. extend his arms straight ahead, palms up
c. place one heel on his opposite knee and run it down the shin to his big toe
d. alternately touch your finger and his nose several times

6.
Asking your patient to read simple sentences aloud helps assess for
a. extinction
b. ataxia
c. apraxia
d. aphasia

7.
What's the significance of a 190/116 BP in a stroke patient who's a candidate for t-PA therapy?
a. Therapy with t-PA can start immediately
b. Administer heparin before therapy begins
c. A BP that high is usually a contraindication to fibrinolytic therapy
d. An alternative fibrinolytic agent must be used

8.
Assessing for which of the following problems is especially important when an older adult is receiving t-PA to treat ischemic stroke?
a. anaphylactoid reaction
b. bleeding
c. angioedema
d. thromboembolism

9.
Generally, a patient receiving t-PA for acute ischemic stroke with a BP of 175/100 isn't aggressively treated with antihypertensives because adequate BP is primarily needed for
a. conversion of plasmin to plasminogen
b. cerebral perfusion
c. distribution of the drug
d. absorption of the drug

10.
When you're about to administer t-PA therapy, your patient's BP rises to 188/115. Anticipate an order for nitroglycerin paste, enalapril I.V., or
a. sublingual nitroglycerin
b. nitroprusside I.V
c. diazoxide I.V.
d. labetalol I.V

11.
The t-PA dosage for acute ischemic stroke is 0.9 mg/kg to a maximum dose of
a. 90 mg
b. 190 mg
c. 690 mg
d. 900 mg

12.
While receiving t-PA, your patient complains of a severe headache. Which of the following should you do first?
a. Record the finding and observe the patient.
b. Immediately stop the infusion and notify the neurologist
c. Decrease the infusion rate for 15 minutes, then reassess the patient.
d. Increase the infusion rate and reassess the patient every 5 minutes

13.
Patient inclusion criteria for fibrinolytic therapy include age 18 or older, onset of symptoms less than 180 minutes before treatment would begin, and a clinical diagnosis of
a. arteriovenous malformation
b. acute hemorrhagic stroke
c. acute ischemic stroke with measurable neurologic deficit
d. intracranial aneurysm

14.
A patient with which of the following characteristics is most likely to receive t-PA therapy for acute ischemic stroke?
a. age 19, no known significant medical history, onset of symptoms 70 minutes before arrival in the ED, BP of 164/100
b. age 60, acute myocardial infarction 2 months ago, onset of symptoms 45 minutes before arrival in the ED, BP of 190/106
c. age 56, underwent major surgery 2 days ago, onset of symptoms observed during a dressing change 15 minutes ago, BP of 180/110
d. age 45, serious head trauma 2 days ago, onset of symptoms 25 minutes ago, BP of 170/98

15.
Which of the following would exclude a patient as a candidate for t-PA therapy?
a. blood glucose level of 415 mg/dl
b. active internal bleeding
c. post-myocardial-infarction pericarditis
d. lumbar puncture 30 days ago

16.
According to previous studies, about how many hospitalized heart failure (HF) patients 70 or older were readmitted for HF within 90 days of discharge?
Questions 16-30 are associated with the article, "Compliance Behaviors of Elderly Patients with Advanced Heart Failure."
a. 39%
b. 47%
c. 62%
d. 74%

17.
Earlier studies indicate that intensive patient education and counseling of elderly HF patients
a. had no effect on readmission rates.
b. improved medication compliance.
c. showed no short- or long-term effects at all.
d. had little or no effect on medication compliance.

18.
In the authors’ study of compliance behaviors, the participants who comprised the younger group of HF patients were matched with the elderly group for
a. HF severity.
b. race.
c. HF etiology.
d. educational level.

19.
To validate the accuracy of the HF Compliance Questionnaire, the authors
a. compared the results with prior studies testing compliance in a similar population.
b. administered the same questionnaire to the same participants within three days of the original self-assessment.
c. asked family members living with the participants to evaluate the patients’ compliance.
d. also asked the same participants to complete a similar tool.

20.
In evaluating the internal consistency of the compliance assessment tool, the authors noted that
a. compliance should be about the same for each of the six tested behaviors.
b. consistency across compliance behaviors should be quite high.
c. compliance should vary widely from behavior to behavior.
d. a pattern of compliance across all six behaviors should not have been assumed.

21.
The elderly group of participants reported the most difficulty with
a. smoking cessation.
b. exercise.
c. abstinence from alcohol.
d. taking medications.

22.
Reasons given by the elderly participants for missing scheduled appointments included
a. lack of self-control.
b. forgetfulness.
c. the amount of time involved.
d. poor motivation.

23.
Among the reasons the elderly participants gave for lack of compliance with exercise plans was
a. associated costs.
b. forgetfulness.
c. absence of support and supervision.
d. lack of energy.

24.
The authors suggest that the relatively high compliance rates they found could be attributed to using
a. a self-selected group of participants.
b. flawed statistical methods.
c. participants who lacked strong support systems.
d. participants of varying educational levels.

25.
When working with patients who use self-reporting tools to evaluate their compliance with treatment regimens
a. noncompliance tends to be underreported and compliance overreported.
b. noncompliance tends to be underreported and compliance underreported.
c. noncompliance tends to be overreported and compliance overreported.
d. noncompliance tends to be overreported and compliance underreported.

26.
Which of the following is most likely to add further confusion to an elderly patient’s medication-taking regimen?
a. dispensing aids
b. charts
c. polypharmacy
d. telephone follow-up

27.
According to the authors, Ni et al. (1999) demonstrated that most elderly HF patients know how important it is to restrict sodium and fluid intake. About how many did so?
a. almost all
b. about 80%
c. about 75%
d. less than 50%

28.
Probably the most effective and practical strategy for helping elderly patients with HF to increase exercise compliance is to
a. increase their supervision.
b. outline a cost-benefit ratio.
c. point out that they are poorly motivated.
d. demonstrate the appropriate exercises.

29.
In evaluating smoking cessation compliance, the authors found that
a. most HF patients who smoke were offered smoking cessation assistance.
b. health care providers had not encouraged these patients to quit.
c. knowledge alone ensures compliance in this area.
d. lack of social support is associated with higher rates of noncompliance with smoking cessation.

30.
In evaluating alcohol avoidance compliance, the authors found that
a. most participants continued to drink minimum to moderate amounts of alcohol every week.
b. the vast majority of elderly HF patients did not understand the risks of alcohol use.
c. participants cited conflicting information related to alcohol use as a reason for difficulty in this area.
d. more elderly participants continued to smoke than to drink alcohol.

31.
Each time human cells replicate, their
Questions 31-46 are associated with the article, "Presentation of Illness in Older Adults."
a. chromosomes lengthen.
b. telomeres shorten.
c. walls thicken.
d. nuclei weaken.

32.
Damage to cellular proteins caused by exposure to free radicals is called
a. senescent aging syndrome.
b. oxidative stress.
c. replicative undermining.
d. pathogenic decline.

33.
A primary cause of change in mental status, particularly confusion, in older adults is
a. stress.
b. the aging process.
c. drug toxicity.
d. visual changes.

34.
When evaluating older adults for delirium, which of the following questions is essential?
a. Can the person remember events from many years ago?
b. Does the person recognize family members?
c. Is the person uncooperative or combative?
d. Did the person's signs of confusion have an abrupt onset?

35.
Incontinence can sometimes be a contributing factor to which of the following?
a. dehydration
b. falls
c. dizziness
d. delirium

36.
Using the timed up-and-go test to evaluate problems with balance and gait, you would refer an older adult for further evaluation if the person
a. walks more than 10 feet before completing the task.
b. takes more than 30 seconds to accomplish the task.
c. sits down in a different chair.
d. completes the task in 10 seconds.

37.
The decreased muscle mass of older adults predisposes them to
a. incontinence.
b. delirium.
c. dehydration.
d. depression.

38.
In older adults, a sign of worsening heart failure is
a. decreased appetite
b. elevated temperature
c. orthostatic hypotension
d. chest discomfort

39.
In a patient with dementia, resisting a caregiver's attempts at repositioning may be a sign of
a. defiance.
b. thirst.
c. pain.
d. neuropathy.

40.
In an older adult, the most effective way to monitor function is to
a. use the Katz Index of Activities of Daily Living for evaluation.
b. observe changes from a previously established activity baseline.
c. use the Barthel Index to determine the person's self-care capacity.
d. observe the person carefully for signs of fatigue and overexertion.

41.
A common indicator of aging is
a. decreased resistance to infection
b. urinary incontinence.
c. altered mental status.
d. dizziness.

42.
The lack of mobility caused by osteoarthritis predisposes older adults to
a. low-grade fevers.
b. dehydration.
c. anorexia.
d. constipation.

43.
Right lower-quadrant pain with anorexia and an elevated white blood cell count is likely to reflect which of the following, often overlooked in older adults?
a. diverticulitis
b. lower GI bleeding
c. appendicitis
d. bowel obstruction

44.
In older adults, the most common sign of acute myocardial infarction is
a. crushing chest pain.
b. excessive diaphoresis.
c. chronic indigestion.
d. sudden onset of dyspnea.

45.
Unlike younger adults, older adults with type 2 diabetes may present with
a. dehydration and confusion.
b. weight gain.
c. edema.
d. thirst.

46.
In older adults, a more common sign of hyperthyroidism is
a. fine tremors of the extremities.
b. a mass in the anterior neck.
c. new onset atrial fibrillation.
d. a markedly increased appetite.

47.
When making sure an older adult has given informed consent for a surgical procedure, you should
Questions 47-60 are associated with the article, "Preventing Perioperative Complications in an Older Adult."
a. assume that he is incompetent if he refuses to consent to the procedure.
b. seek the family's consent if he refuses to grant consent.
c. encourage him to consent by emphasizing the risks associated with not having the procedure.
d. determine whether he has an advance directive if he can't make an autonomous, informed decision.

48.
Which statement is correct about anesthesia considerations for the older adult?
a. Maintenance doses for most anesthetic drugs are higher for an older adult.
b. Decreased baroreceptor response increases the risk of hypertension.
c. Controlled ventilation may trigger a significant decrease in cardiac output.
d. Vascular wall rigidity reduces the risk of hypotensive episodes.

49.
Compared with general anesthesia, spinal or epidural regional anesthesia in elderly patients is associated with a lower risk of
a. hypotension.
b. postoperative disorientation.
c. heart failure.
d. urinary retention.

50.
Which statement is correct about older adults with chronic medical conditions?
a. An older adult whose condition is worsening may have atypical symptoms.
b. About 75% of elderly people have at least one chronic condition.
c. An older adult's disease symptoms are usually more dramatic than a younger adult's.
d. Chronic medical conditions in the elderly have little impact on perioperative nursing care.

51.
Which elderly patient with cardiovascular disease is the least likely candidate for elective surgery?
a. A hypertensive patient whose BP is stable at 124/82.
b. A patient who had a myocardial infarction 2 months ago.
c. A patient with asymptomatic first-degree heart block.
d. A patient with a history of heart failure.

52.
What percentage of postoperative complications involves the respiratory system?
a. 20%
b. 30%
c. 40%
d. 50%

53.
Respiratory changes associated with aging include
a. decreased vital capacity.
b. increased chest wall elasticity.
c. increased lung compliance.
d. decreased residual volume.

54.
Which factor increases the older adult's risk of respiratory complications?
a. Body weight within normal limits.
b. A low abdominal incision.
c. Surgery 2 years ago.
d. Anesthesia for more than 3 hours.

55.
Postoperative pneumonia has a mortality rate of
a. 9%
b. 18%
c. 27%
d. 36%

56.
Which condition is usually not reversible?
a. Depression.
b. Delirium.
c. Confusion.
d. Dementia.

57.
Besides age, what factor increases the risk of DVT?
a. Cancer.
b. Regional anesthesia.
c. Surgery lasting less than 2 hours.
d. Peripheral arterial insufficiency.

58.
When assessing an elderly patient's medication history, remember that
a. the average older adult receives 8 to 10 prescriptions annually.
b. the average older adult takes 7 medications daily.
c. supplements and over-the-counter products should be included in the drug history.
d. postoperative recovery is unaffected by maintenance drug therapy.

59.
Integumentary changes that increase an older patient's risk of skin complications include
a. thickening of the dermal layer.
b. increased collagen tissue.
c. greater elasticity.
d. decreased adipose tissue.

60.
When managing an older patients' pain, keep in mind that
a. he may have trouble distinguishing pain intensities.
b. meperidine is a good choice for analgesia.
c. you should give drugs intramuscularly or orally for initial postoperative pain relief.
d. he'll probably experience less pain than a younger adult.