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CARE OF OLDER ADULTS - NCLEX EXAM GUIDE QUESTIONS AND ANSWERS
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CARE OF OLDER ADULTS - NCLEXEXAM GUIDE QUESTIONS AND
ANSWERS
The nurse is managing an epidural catheter for a patient diagnosed with cancer. The
patient has developed a spinal headache. Which intervention should be completed at
this time?
A) Increase the dosage of anesthetic.
B) Place in semi-Fowler position.
C) Continue to monitor the patient.
D) Initiate administration of prescribed fluids. - Answer-Answer D. If a headache
develops, the patient should remain flat in bed and should be given large amounts of
fluids (provided the medical condition allows), and the health care provider should be
notified. It is not appropriate to continue to monitor the patient without notifying the
health care provider in this situation.
The nurse is caring for an 80-year-old patient following right hip surgery. When
administering pain medication to this patient, what is important for the nurse to
remember?
A) Elderly patients have a faster metabolism than their younger counterparts.
B) Elderly patients have an increased risk for drug toxicity.
C) Elderly patients have a lower incidence of chronic illness.
D) Elderly patients infrequently use OTC medications. - Answer-Answer B. Elderly
patients have a sensitivity to medications and an increased risk for drug toxicity. They
have slowed metabolism of medications, a higher incidence of chronic illness, and an
increased use of prescription and OTC medications.
A patient has a pancreatic tumor and history of alcoholism. The patient receives
morphine 2 mg subcutaneously every 3 to 4 hours for treatment of pain associated with
the tumor. After 2 days of receiving this dose every 4 hours, the patient tells the nurse
that the medication is needed more frequently to control the pain. What is the nurse's
best response to this situation?
A) The patient is becoming addicted to the morphine, and the medication should be
administered less frequently than every 4 hours.
B) A tolerance to the morphine is developing, and the patient should receive the drug
every 3 hours.
C) Administering the morphine every 3 hours will increase the patient's physical
dependence on the drug.
D) Physical dependence should be avoided at all costs, and the drug should continue to
be administered every 4 hours. - Answer-Answer B. Tolerance occurs when a person
,who has been taking opioids becomes less sensitive to their analgesic properties (and
usually side effects). Tolerance is characterized by the need for increasing doses to
maintain the same level of pain relief.
A patient who had abdominal surgery 5 days ago complains of sharp, throbbing
abdominal pain that ranks 8 on a scale of 0 (no pain) to 10 (worst pain). The patient's
pain rating has averaged at a 3/10 for the first 5 days postoperatively on epidural
administration of hydromorphone. However, narcotic administration via epidural catheter
was discontinued earlier this morning. Which of the following would be the nurse's first
action?
A) Obtain an order to restart the epidural narcotic administration.
B) Assess the patient to rule out possible complications secondary to surgery.
C) Check the patient's chart to determine what additional pain medications can be
administered.
D) Explain to the patient that his pain should not be this severe 5 days postoperatively. -
Answer-Answer B. Usually of recent onset and commonly associated with a specific
injury, acute pain indicates that damage or injury has occurred. Any change in the
patient's condition requires an assessment by the nurse.
What instruction should the nurse stress when teaching the preoperative patient about
correct use of the PCA device?
A) Push the button when you feel the pain beginning rather than waiting until the pain is
at its worst.
B) Push the button every 15 minutes whether you feel pain at that time or not.
C) Instruct your family or visitors to press the button for you when you are sleeping.
D) Try to go as long as you possibly can before you press the button. - Answer-Answer
A. A patient experiencing pain can administer small amounts of medication directly into
the IV, subcutaneous, or epidural catheter by pressing a button. The pump then delivers
a preset amount of medication. The patient should be instructed to administer
medication before the pain becomes severe.
When the nurse is gathering a history from a patient newly diagnosed with glaucoma,
the patient reports the following statement to the nurse. Which statement would be
consistent with the patient's diagnosis?
A) "I began seeing halos around lights and had dim vision."
B) "I had a difficult time matching my blue socks."
C) "My eyes began to tear and itch."
D) "I could see the street signs better than my hand." - Answer-Answer A. Blurred
vision, halos around lights and difficulty focusing and adjusting eyes in low lighting, loss
of peripheral vision are classic signs of glaucoma. Glaucoma is related to peripheral
vision loss and blindness, whereas, color is a feature related to central vision. Itchy and
teary eyes are often associated with conjunctivitis. Hyperopia is a refractive error
whereby people have excellent distant vision and near vision is blurry. Farsightedness
,is related to the eye having a shorter depth and, therefore, the visual image focuses
beyond the retina.
Which statement by the patient diagnosed with viral conjunctivitis indicates that more
teaching is necessary?
A) "I will wash my hands frequently."
B) "I will use a washcloth to clean both my eyes, starting with the infected eye and
moving to the uninfected eye."
C) "I will avoid contact with other people until my symptoms are gone."
D) "I will discard any leftover eye medication when the infection is gone." - Answer-
Answer B. Handwashing is a practice which reduces the transmission of germs in
general. The specific technique of cleaning the uninfected eye and then the infected eye
will reduce the potential for conjunctival spread. Contact with other persons is generally
discouraged for at least 24 hours after antibiotic use in the case of bacterial
conjunctivitis; viral conjunctivitis is also highly contagious but is not treated with
antibiotics; symptoms may persist for 2 weeks. It may not be a realistic goal to keep a
person isolated for this amount of time. Medication is not typically prescribed for viral
conjunctivitis; it is usually a self-limiting process.
The nurse is caring for a baseball player who reports getting hit in the head with a
baseball 1 hour prior to admission in the ED. What assessment requires immediate
reporting?
A) Eye pain
B) Flashing lights in the visual field
C) Headache, pain intensity rated as 2/10
D) Superficial head abrasion - Answer-Answer B. Eye pain is not always directly
associated with head trauma. It may result from a variety of causes and does not
establish imminent danger requiring immediate reporting. Flashing lights, floaters,
cobwebs or a shade across the vision of one eye reported in retinal detachment which
is often associated with head trauma. A mild headache can be caused by many factors.
One would expect serious complications of head trauma to have more than a subtle
headache relieved by Acetaminophen. A superficial head abrasion is not considered
requiring emergent care.
The patient with significant visual impairment requires assistance with ADLs. The nurse
provides support when serving food by performing which action?
A) Leaving the tray on the patient's bedside table
B) Serving hot food as quickly as possible
C) Describing the food on the tray in terms of the face of a clock
D) Ensuring all food is soft - Answer-Answer C. A patient with visual impairment should
not have food left on the bedside table without explanation or support. Hot foods can be
a potential burn hazard to patients with visual impairment. It is better to serve the food
and utensils warm. It is appropriate to describe the location of the food on the tray in
, terms of the face of a clock. Patients with visual impairment do not usually require a soft
diet, unless the swallow reflex is impaired due to accompanying stroke, for example.
A patient, who is seen in the vision clinic, has been diagnosed with glaucoma. What
initial topical medication would the nurse expect to be included in the treatment plan for
this patient?
A) Mydriatic
B) Antifungal
C) Beta blocker
D) Miotic - Answer-Answer C. Beta blockers decrease the production of aqueous humor
with resultant decrease in IOP and are the preferred initial topical medication.
Mydriatics, antifungals, and miotics would not be appropriate for those diagnosed with
glaucoma.
A 56-year-old patient who is hearing-impaired is scheduled for a colonoscopy. Which
nursing action is most appropriate in performing patient education prior to the
procedure?
A) Face the patient directly, smile, and speak slowly.
B) Continue to administer medications while educating the patient.
C) Nod to make up for awkward silence, even if you don't know what is being said.
D) Use only gestures to communicate the highlights of content to be covered. - Answer-
Answer A. Facing the patient and speaking slowly with an engaging smile places the
person with hearing loss at ease. A smile reinforces the concept of trust. Slow speech is
important as it allows for lip reading.
The nurse caring for the patient with Ménière disease restricts the following foods in the
dietary plan. Select all that apply.
A) Coffee
B) Wine
C) Baked potato
D) CheeseMilk - Answer-Answer A and B. Foods high in salt, sugar, alcohol and
caffeine will adversely dizziness and tinnitus. Cheese, milk, and potatoes are not
indicated as problematic.
During preoperative teaching, the 25-year-old patient receiving cochlear implants states,
"I will be able to fully regain my hearing with the implants." What is the nurse's best
response to the patient?"
A) The implants will assist you to detect medium to loud environmental sound and
conversation rather than restoring normal hearing."
B) "The implant will assist you to restore normal hearing fully."
C) "The implants will be immediately effective."
D) "The implant will require minimal rehabilitation in order for you to recognize sounds."
- Answer-Answer A. Cochlear implants do not restore normal hearing, rather they
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