3271 Nursing Care of Adults & Older Adults I - Final Exam Review (Qns & Ans) - OSU 2025, Exams of Nursing

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3271 Nursing Care of Adults &

Older Adults I

Final Exam Review

(Questions & Solutions)

1. Multiple Choice Question: An 82-year-old male with a history of congestive heart failure, chronic kidney disease, and diabetes presents with shortness of breath and confusion. Which initial assessment parameter is most critical to guide the nurse in determining the urgency of his acute decompensation?

• A. Temperature
• B. Oxygen saturation
• C. Blood glucose
• D. Weight changes Correct ANS: B. Oxygen saturation Rationale: In acutely ill older adults, hypoxemia is an immediate threat that may indicate respiratory failure or cardiac decompensation. Reliable measurement of oxygen saturation guides urgent interventions and helps prioritize further assessment.

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2. Fill-in-the-Blank Question: In managing complex patients with both acute and chronic conditions, the systematic approach of the __________ is essential for ensuring individualized, patient-centered care. Correct ANS: nursing process Rationale: The nursing process—assessment, diagnosis, planning, implementation,

Rationale: A comprehensive assessment of acutely and chronically ill adults must include physical, cognitive, nutritional, cultural, and psychosocial parameters to ensure individualized care. An astrological sign (E) is not clinically relevant.

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5. Multiple Choice Question: A 70-year-old female with chronic obstructive pulmonary disease (COPD) and heart failure is admitted with pneumonia and respiratory distress. Which nursing intervention is prioritized to optimize her oxygenation without compromising her cardiac condition?

• A. High-flow oxygen via non-rebreather mask
• B. Initiation of low tidal volume, lung-protective ventilation
• C. Aggressive IV fluid hydration
• D. Administration of systemic corticosteroids Correct ANS: B. Initiation of low tidal volume, lung-protective ventilation Rationale: For patients with COPD and heart failure, low tidal volume, lung- protective ventilation helps minimize ventilator-induced lung injury and prevents exacerbation of cardiac workload while supporting oxygenation. High-flow oxygen may risk CO₂ retention if not carefully adjusted.

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6. Fill-in-the-Blank Question: The process of titrating medications based on an individual’s organ function, particularly in those with renal insufficiency, is based on

calculating the estimated __________ clearance. Correct ANS: creatinine Rationale: Estimating creatinine clearance (using formulas such as Cockcroft–Gault) is essential for safe dosing in patients with renal impairment, reducing the risk of drug accumulation and toxicity.

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7. True/False Question: True or False: In patients with sepsis, timely administration of broad- spectrum antibiotics—ideally within the first hour—is critical to reducing morbidity and mortality. Correct ANS: True Rationale: Early antibiotic initiation in sepsis is a central tenet of advanced care. Early goal-directed therapy has been shown to reduce progression to organ failure and improve patient outcomes, especially among older adults.

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8. Multiple Response Question: Which interventions are evidence-based strategies for managing pain in adults with chronic conditions? (Select all that apply)

• A. Regularly scheduled pain assessments using validated scales
• B. Combining pharmacologic with non-pharmacologic interventions

comorbidities.

10. Fill-in-the-Blank Question: The practice of involving patients and their families in the decision- making process, respecting their preferences and values, is a central component of __________ care. Correct ANS: patient- and family-centered Rationale: Patient- and family-centered care emphasizes collaboration and shared decision-making, particularly crucial in managing chronic and acute conditions. This approach has been shown to improve satisfaction, adherence, and outcomes.

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11. True/False Question: True or False: In the advanced care of adults, particularly older adults, polypharmacy increases the risk of drug interactions and requires regular medication reconciliation. Correct ANS: True Rationale: Polypharmacy is a well-known risk factor for adverse drug events. Regular medication reconciliation ensures that prescriptions, over-the- counter medications, and supplements are reviewed to avoid harmful interactions and side effects.

12. Multiple Response Question: Which critical elements should be included in discharge planning for an acutely ill patient transitioning to home care? (Select all that apply)

• A. Detailed instructions for medication management
• B. Scheduled follow-up appointments and lab tests
• C. Coordination with home health services
• D. Education on warning signs and when to seek help
• E. A broad, non-specific summary of care without follow-up details Correct ANSs: A, B, C, D Rationale: Effective discharge planning requires clear, comprehensive instructions, follow-up arrangements, coordination with home-based services, and patient/family education on red flags. A vague summary (option E) may lead to confusion and adverse outcomes.

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13. Multiple Choice Question: For an adult with chronic obstructive pulmonary disease (COPD) experiencing acute exacerbation, which intervention is critical in addition to pharmacologic therapy?

• A. Aggressive diuresis
• B. Respiratory support with oxygen therapy
• C. High-dose corticosteroids without monitoring
• D. Bed rest for prolonged periods Correct ANS:

Rationale: Chronic disease management is most effective when individualized care plans integrate multiple strategies based on the best available evidence. Such an approach improves adherence, reduces complications, and enhances quality of life.

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16. Multiple Response Question: When planning to manage acute pain in an adult patient with a history of opioid use disorder, which strategies are most appropriate to minimize the risk of relapse and adverse effects? (Select all that apply)

• A. Utilizing multimodal analgesia (non-opioid medications and non- pharmacologic methods)
• B. Involving an interdisciplinary pain management team
• C. Strictly avoiding opioids regardless of severity
• D. Implementing close monitoring and gradual titration if needed
• E. Educating the patient on alternative pain management techniques Correct ANSs: A, B, D, E Rationale: A multimodal approach minimizes the need for high-dose opioids, while interdisciplinary collaboration and close monitoring help ensure safe use. Patient education is vital. An absolute taboo (option C) may lead to undertreatment of pain.

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17. Multiple Choice Question: A 75-year-old woman with a history of cerebrovascular accident and

hypertension presents with new-onset dysphagia and weight loss. What nursing intervention is prioritized in managing her risk for aspiration pneumonia?

• A. Initiate high-calorie oral supplements immediately
• B. Collaborate with a speech-language pathologist for a swallowing evaluation
• C. Place the patient on a strict liquid diet
• D. Advance her diet to soft solids to improve nutritional intake Correct ANS: B. Collaborate with a speech-language pathologist for a swallowing evaluation Rationale: A swallowing evaluation is critical to identify aspiration risk and determine an appropriate diet. This collaboration minimizes complications like aspiration pneumonia and ensures safe feeding practices.

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18. Fill-in-the-Blank Question: 

Advanced multidisciplinary care of acutely ill adults often involves consistent __________ monitoring to guide titration of interventions during rapid response situations. Correct ANS: hemodynamic Rationale: Continuous hemodynamic monitoring allows early detection of instability and guides interventions such as fluid resuscitation and vasopressor adjustments, especially in patients with shock or multi-organ dysfunction.

The patient’s preference of a brand name (E) is not a primary clinical consideration in dosing.

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21. Multiple Choice Question: A nurse is caring for an adult patient with acute renal failure who develops hyperkalemia. Which of the following pharmacologic interventions is most appropriate to protect the heart immediately?

• A. Administer insulin with glucose
• B. Start kayexalate (sodium polystyrene sulfonate)
• C. Infuse lactated Ringer’s solution
• D. Use a beta-agonist inhaler Correct ANS: A. Administer insulin with glucose Rationale: Intravenous insulin with glucose facilitates the cellular uptake of potassium, offering rapid cardioprotection. This intervention is essential while definitive measures to remove excess potassium are initiated.

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22. Fill-in-the-Blank Question: The concept of __________ in clinical practice involves systematically reassessing patient responses to treatment and modifying the care plan accordingly. Correct ANS: evaluation Rationale:

Ongoing evaluation is a cornerstone of the nursing process. In complex care situations, continuously assessing patient responses ensures timely adjustments to interventions and improves outcomes.

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23. True/False Question: True or False: In patients with acute myocardial infarction, beta-blockers are contraindicated in the presence of cardiogenic shock. Correct ANS: True Rationale: While beta-blockers are standard in managing myocardial infarction, they are contraindicated in cardiogenic shock, where further reduction in contractility may worsen hemodynamic instability.

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24. Multiple Response Question: When providing end-of-life care to an older adult with advanced chronic diseases, which interventions are essential for palliative management? (Select all that apply)

• A. Aggressive curative treatments regardless of quality of life
• B. Symptom management (pain, dyspnea, nausea)
• C. Psychosocial and spiritual support
• D. Advance care planning and discussion of patient goals
• E. Involving the family in decision-making processes Correct ANSs: B, C, D, E

Clinical practice guidelines Rationale: Clinical practice guidelines synthesize evidence from multiple studies and expert consensus. They offer standardized recommendations that promote safe and effective chronic disease management.

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27. True/False Question: True or False: In critically ill adults, early mobilization has been shown to reduce complications such as muscle atrophy and thromboembolism, even when patients remain in the intensive care unit. Correct ANS: True Rationale: Early mobilization in the critical care setting supports recovery by reducing the risks of deconditioning and other complications. It is an evidence-based intervention widely adopted for acutely ill patients.

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28. Multiple Response Question: Which of the following environmental or contextual factors can influence the delivery of effective care to acutely ill older adults in the hospital? (Select all that apply)

• A. Noise levels and sleep interruptions
• B. Adequate lighting and orientation cues
• C. Family presence and involvement
• D. Institutional policies on resource allocation
• E. Seasonal weather patterns

Correct ANSs: A, B, C, D Rationale: The physical environment (noise, light), family involvement, and hospital policies all impact patient outcomes and the overall therapeutic milieu for older adults. Seasonal weather patterns (E) are generally less relevant in the controlled hospital setting.

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29. Multiple Choice Question: A nurse is reviewing a case of an older patient with chronic heart failure and renal insufficiency who has become acutely confused. Which medication class should be used cautiously due to its potential to worsen renal function and contribute to encephalopathy?

• A. ACE inhibitors
• B. Beta-blockers
• C. Diuretics
• D. NSAIDs Correct ANS: D. NSAIDs Rationale: NSAIDs can acutely impair renal perfusion and contribute to electrolyte imbalances and encephalopathy. In patients with pre-existing renal insufficiency and heart failure, their use is contraindicated or should be very carefully managed.

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30. Fill-in-the-Blank

Which assessment finding is PRIORITY to monitor in a patient receiving IV morphine for acute pancreatitis? A) Respiratory rate B) Heart rate C) Blood pressure D) Temperature ANS: A Rationale: Respiratory depression is a serious side effect of opioids. Which test is MOST sensitive for the diagnosis of delirium in the hospitalized older adult? A) MMSE B) Confusion Assessment Method (CAM) C) Trail Making Test D) Geriatric Depression Scale ANS: B Rationale: The CAM is designed specifically for the detection of delirium. A nurse is planning care for a 65-year-old with COPD and new onset pneumonia. What intervention is MOST important to include? A) Encourage fluid restriction B) Administer high-flow oxygen via non-rebreather mask C) Monitor for changes in mental status D) Strict bed rest ANS: C Rationale: Hypoxemia may present as acute confusion and should be monitored closely. A patient with type 2 diabetes and chronic leg ulcer is admitted with fever and chills. Which laboratory result warrants immediate action? A) Blood glucose 210 mg/dL B) WBC 18,000/mm³ C) Serum creatinine 1.3 mg/dL D) Lactate 4 mmol/L ANS: D Rationale: Elevated lactate indicates sepsis and requires urgent intervention. Which is the initial step when assessing a patient with possible stroke symptoms?

A) Obtain blood glucose B) Administer aspirin C) Provide supplemental oxygen D) Position patient flat in bed ANS: A Rationale: Hypoglycemia can mimic stroke; blood glucose must be checked first. Which finding BEST indicates effective teaching for a 68-year-old with heart failure? A) Patient restricts sodium intake to 6g/day B) Patient weighs self daily at home C) Patient limits fluid intake to 3 L/day D) Patient avoids all carbohydrates ANS: B Rationale: Daily weights help monitor fluid status in heart failure patients. In a patient with suspected pulmonary embolism, which clinical manifestation requires immediate action? A) Unilateral leg swelling B) Pleuritic chest pain C) Sudden onset dyspnea D) SpO2 of 96% on room air ANS: C Rationale: Sudden dyspnea could signal life-threatening embolism. The nurse suspects elder abuse in a hospitalized patient. What is the nurse’s FIRST priority? A) Notify adult protective services B) Document findings and assess safety C) Confront the caregiver D) Discharge the patient home ANS: B Rationale: Immediate safety assessment and thorough documentation are first steps. Multiple Response Questions (MR) Select all the modifiable risk factors for stroke in older adults: A) Hypertension B) Atrial fibrillation C) Age