Gerontological Nursing RN-BC
Gerontological Nursing Review RN-BC
Normal age-associated changes of the genitourinary system include
A. increased serum creatinine levels.
C. urinary incontinence.
D. renal calculi formation.
Answer: A. increased serum creatinine levels.
Urinary incontinence, hematuria, and renal calculi formation are all pathologic processes. A gradual increase in serum creatinine levels, however, is a normal physiological change of aging. Serum creatinine is an easy and reliable test of renal function in younger persons, but it is an unreliable marker in older adults. Standard measures of renal function are frequently affected by confounding variables associated with advancing age. Adequate protein intake is necessary to accurately evaluate blood urea nitrogen levels and adequate muscle mass is essential for interpreting serum creatinine levels. Despite some limitations, creatinine clearance (CCr) (using the Cockcroft-Gault equation), is a validated measure of renal status in older adults.
The immunosuppressive drug most commonly prescribed to older adults is
A. prednisone (Deltasone®).
B. cyclosporin (Sandimmune®).
C. azathioprine (Imuran®).
D. cisplatin (Platinol®).
Answer: A. prednisone (Deltasone®).
Prednisone may be indicated for immunosuppression (e.g., in the solid organ transplant patient) but it is more commonly administered for its antiinflammatory properties. Prednisone is routinely prescribed to older adults with a variety of conditions such as asthma, rheumatoid arthritis, inflammatory bowel syndrome, brain tumors, and COPD. Regardless of the drug's indication, it is important to remember that immunosuppression is an inevitable steroid side effect. Other adverse reactions associated with therapy are hyperglycemia, gastric ulceration, and central nervous system effects that range from depression to psychosis. Cyclosporin and azathioprine are immunosuppressive agents given to prevent rejection in the organ transplant patient. Cisplatin is a chemotherapeutic drug.
Older adults have educational backgrounds that are extremely heterogenous. This suggests that all teaching should be
A. standardized to ensure educational consistency.
B. revised to account for visual and hearing impairments.
C. customized to the educational level of the client.
D. simplified to accommodate cognitive deficits.
Answer: C. customized to the educational level of the client.
The general approach to education of the older adult is similar to that of individualized care planning: customize teaching to meet each client's needs. Despite ageist stereotypes, older adults are capable of gaining new knowledge and changing health behaviors. By evaluating an older adult's individual learning style and health literacy level, the gerontological nurse can facilitate communication and provide successful client teaching regardless of visual, auditory, cognitive, language, or educational deficits.
An adverse event occurred during the use of a piece of client care equipment. The initial action of the nurse should be to
A. initiate disciplinary action against the employee who used the device
B. have the risk management team talk to the client and family about the event.
C. immediately remove the product from service to prevent further injuries.
D. investigate factors that contributed to the event to identify the root cause.
Answer: D. investigate factors that contributed to the event to identify the root cause.
Today's practice of full disclosure of medical errors has resulted in less litigation and less anger from clients and family members. When a disclosure discussion is led by someone trained in facilitating difficult conversations, a good outcome is more likely. It is important to not place blame on the individual employee who was involved in the error. Investigating the system and processes to uncover factors that may have contributed to the adverse event is critical; otherwise the event will likely recur. More times than not, errors are the result of system failure rather than an individual's action. The product may need to be removed from service until the cause is identified, but the investigation should occur before any practice decisions are made.
The most effective health management strategy for preventing severe respiratory disease in frail older adults is
A. oseltamivir (Tamiflu®) prophylaxis.
B. annual influenza immunization.
C. antibiotic prophylaxis.
D. annual pneumonia immunization.
Answer: B. annual influenza immunization.
The Centers for Disease Control and Prevention (CDC) recommend annual seasonal influenza vaccination for all persons older than 50 years. Seasonal flu kills an average of 36,000 people per year in the U.S., chiefly older adults. The CDC recommends pneumonia immunization (Pneumovax®) for everyone over age 65 years. Oseltamivir (Tamiflu®) has been shown to shorten symptom duration in persons with influenza and prophylactic use can reduce flu incidence in sensitive populations. However, certain influenzae strains are resistant to oseltamivir and both the cost and side effects of oseltamivir must be considered. Antibiotic prophylaxis is not indicated for respiratory infections except in rare instances such as meningococcus exposure.
Gerontological Nursing Review RN-BC
Gerontological Nursing Review RN-BC®
Pocket Study Guide Volume 1
Casey R. Shillam PhD RN-BC
Laura M. Criddle PhD ACNS-BC RN-BC FAEN