3272 Nursing Care of Adults & Older Adults II - Final Exam Review (Qns & Ans) - OSU 2025, Exams of Nursing

Download 3272 Nursing Care of Adults & Older Adults II - Final Exam Review (Qns & Ans) - OSU 2025 and more Exams Nursing in PDF only on Docsity!

3272 Nursing Care of Adults &

Older Adults II

Final Exam Review

(Questions & Solutions)

1. Multiple Choice Question: An 82-year-old male with a history of heart failure, chronic kidney disease, and diabetes presents to the emergency department with acute dyspnea and confusion. Which initial assessment parameter is most critical in determining his immediate risk of decompensation?

• A. Temperature
• B. Oxygen saturation
• C. Blood glucose
• D. Jugular venous distension Correct ANS: B. Oxygen saturation Rationale: Oxygen saturation is a key indicator of tissue perfusion and respiratory function. In a complex older patient, hypoxemia may be the earliest sign of deterioration. Immediate identification guides prompt interventions, such as oxygen supplementation and further assessment for underlying causes.

---

2. Fill-in-the-Blank Question: The systematic framework consisting of assessment, diagnosis, planning, implementation, and evaluation that underpins individualized patient care is known as the __________. Correct ANS: nursing process Rationale:

A, B, C, D

Rationale: A complete assessment includes both physiologic (vital signs, nutrition) and psychosocial (cognition, cultural beliefs) factors, ensuring a tailored care plan. Astrological sign has no clinical relevance.

---

5. Multiple Choice Question: A 70-year-old female with COPD and heart failure is admitted with severe pneumonia. To optimize her oxygenation and reduce ventilator-induced lung injury, which ventilatory strategy should be implemented?

• A. High tidal volume ventilation
• B. Lung-protective ventilation with low tidal volumes and appropriate PEEP
• C. Pressure-controlled ventilation with minimal PEEP
• D. Immediate transition to non-invasive ventilation Correct ANS: B. Lung-protective ventilation with low tidal volumes and appropriate PEEP Rationale: Low tidal volume (typically ~6 mL/kg predicted body weight) and adequate PEEP minimize ventilator-induced lung injury and are recommended for patients with underlying respiratory pathology, such as COPD and heart failure, especially during pneumonia exacerbations.

---

6. Fill-in-the-Blank Question: When adjusting medication dosages in patients with renal impairment,

nurses use formulas like the Cockcroft–Gault equation to estimate __________ clearance. Correct ANS: creatinine Rationale: Estimating creatinine clearance (CrCl) enables safe dosing of medications cleared renally. It helps prevent drug accumulation and toxic effects, particularly in older adults with decreased renal function.

---

7. True/False Question: True or False: Early goal-directed therapy in septic patients—including prompt antibiotic administration within the first hour—is a key strategy to improve outcomes. Correct ANS: True Rationale: Studies have shown that early intervention in sepsis, including rapid antimicrobial administration and hemodynamic support, decreases mortality and limits end-organ damage, which is especially critical in acutely ill and older patients.

---

8. Multiple Response Question: Which interventions are essential when managing polypharmacy in older adults with multiple comorbidities? (Select all that apply)

• A. Regular medication reconciliation

10. Fill-in-the-Blank Question: Care that actively involves both patients and their families in decision- making, reflecting their preferences and values, is known as __________ care. Correct ANS: patient- and family-centered Rationale: Patient- and family-centered care improves outcomes by ensuring that treatment plans are respectful of and tailored to the patient’s and family’s needs, thereby promoting trust and adherence.

---

11. True/False Question: True or False: Polypharmacy is a common challenge in older adults and requires regular review of all medications to reduce the risk of adverse drug events. Correct ANS: True Rationale: Older adults are at high risk for adverse drug interactions due to polypharmacy, making regular medication reviews and reconciliation essential components of safe care.

---

12. Multiple Response

Question: Which components are essential to include in discharge planning for an acutely ill patient with complex chronic conditions? (Select all that apply)

• A. Detailed medication management instructions
• B. Scheduled follow-up appointments and lab tests
• C. Coordination with home health and rehabilitation services
• D. Clear education on warning signs requiring immediate attention
• E. A generic brochure with no individualized information Correct ANSs: A, B, C, D Rationale: Effective discharge planning is comprehensive—it outlines medication instructions, follow-up care, and safety guidelines. A generic brochure (E) does not address the specific needs of complex patients.

---

13. Multiple Choice Question: 

For an older adult with chronic heart failure experiencing an acute exacerbation, which non-pharmacologic intervention is most important in addition to medical management?

• A. Strict bed rest
• B. Early mobilization as tolerated
• C. Isolation to prevent infection
• D. Complete fluid restriction Correct ANS: B. Early mobilization as tolerated Rationale: Early mobilization helps reduce complications such as muscle atrophy, deep vein thrombosis, and deconditioning even in acutely ill patients,

16. Multiple Response Question: When caring for a critically ill adult, which components of interdisciplinary care are vital to support a comprehensive treatment plan? (Select all that apply)

• A. Collaborative communication among nurses, physicians, and pharmacists
• B. Inclusion of case managers and social workers in discharge planning
• C. Implementation of standardized treatment protocols
• D. Exclusive decision-making by the primary physician
• E. Family involvement in care discussions and planning Correct ANSs: A, B, C, E Rationale: Interdisciplinary collaboration improves care by ensuring all relevant perspectives are considered. Exclusive decision-making (D) limits input and undermines a holistic approach.

---

17. Multiple Choice Question: An older adult with acute renal failure and hyperkalemia is at risk for cardiac arrhythmias. Which immediate intervention is used to minimize cardiac toxicity in such patients?

• A. Administration of calcium gluconate
• B. High-volume fluid resuscitation
• C. Intravenous beta-blockers
• D. Oral potassium-binding agents Correct ANS:

A. Administration of calcium gluconate Rationale: Calcium gluconate stabilizes the cardiac membrane and is critical in managing hyperkalemia to prevent life-threatening arrhythmias while other treatments (such as shifting potassium intracellularly) are initiated.

---

18. Fill-in-the-Blank Question: The use of a __________ assessment is imperative at admission to establish a detailed baseline for acutely ill adults, guiding subsequent evaluation and intervention modifications. Correct ANS: comprehensive Rationale: A comprehensive assessment encompasses physical, cognitive, psychosocial, and functional domains. Establishing a robust baseline is essential for monitoring changes and guiding interventions in complex patients.

---

19. True/False Question: True or False: In patients with acute myocardial infarction, beta-blockers are contraindicated in the setting of cardiogenic shock due to their negative inotropic effects. Correct ANS: True

samples

• B. Withholding all medications until re-assessment
• C. Administering a high-sugar drink to correct hypoglycemia
• D. Requesting a family meeting to discuss long-term care goals Correct ANS: A. Immediate initiation of IV fluid resuscitation after obtaining culture samples Rationale: Fluid resuscitation is prioritized to stabilize hemodynamics and correct dehydration. Obtaining cultures is essential if sepsis is suspected, but addressing volume deficits promptly is vital to prevent further compromise.

---

22. Fill-in-the-Blank Question: 

The principle of __________ care compels nurses to tailor interventions to the unique physical, psychological, and cultural needs of each patient. Correct ANS: individualized Rationale: Individualized care ensures that interventions are specific to the patient’s unique condition, preferences, and circumstances, thereby enhancing outcomes and satisfaction.

---

23. True/False Question: 

True or False: The phenomenon of “silent hypoxia”—where patients have

dangerously low oxygen levels without significant dyspnea—has been recognized in some older adults with acute respiratory conditions. Correct ANS: True Rationale: Silent hypoxia presents with minimal respiratory distress, particularly in older adults or in conditions such as COVID-19. Recognizing this phenomenon demands vigilant monitoring and oxygenation assessment.

---

24. Multiple Response Question: Which of the following nursing interventions are vital in preventing complications in acutely ill patients in the ICU? (Select all that apply)

• A. Strict adherence to infection control practices
• B. Regular monitoring of hemodynamic status
• C. Early mobilization as tolerated
• D. Frequent reassessment of ventilator settings
• E. Prolonged immobilization to conserve energy Correct ANSs: A, B, C, D Rationale: Infection control, hemodynamic monitoring, early mobilization, and careful adjustment of ventilator settings are key interventions that prevent complications. Prolonged immobilization (E) can lead to adverse outcomes such as deconditioning and thromboembolism.

---

25. Multiple Choice

27. True/False Question: True or False: In the management of acute exacerbations of chronic illnesses, intermittent monitoring is generally sufficient, as opposed to continuous monitoring. Correct ANS: False Rationale: Acutely ill patients, especially older adults with chronic conditions, benefit from continuous monitoring to promptly detect any deterioration. Intermittent checks may not identify rapid changes, potentially delaying critical interventions.

---

28. Multiple Response Question: Which non-pharmacologic interventions are crucial for supporting recovery in acutely ill adults with complex health issues? (Select all that apply)

• A. Nutritional support and tailored diet recommendations
• B. Physical therapy and early mobilization programs
• C. Psychological support and stress reduction strategies
• D. Strict bed rest without repositioning
• E. Family involvement in care planning and education Correct ANSs: A, B, C, E Rationale: A multidisciplinary approach—including nutritional, physical,

psychological support, and family involvement—is key to holistic recovery. Strict bed rest (D) can lead to deconditioning and is counterproductive.

---

29. Multiple Choice Question: A nurse is caring for an older adult with acute respiratory distress and multiple comorbidities in the ICU. Which evidence-based intervention is most important to minimize ventilator-associated complications?

• A. Routine use of sedatives to keep the patient immobile
• B. Implementing a lung-protective ventilation strategy
• C. Aggressive recruitment maneuvers without monitoring
• D. Delaying weaning until oxygenation parameters are perfect Correct ANS: B. Implementing a lung-protective ventilation strategy Rationale: Lung-protective ventilation (low tidal volumes with appropriate PEEP) is a cornerstone in minimizing ventilator-induced lung injury. It is particularly critical for older adults with underlying lung pathology and multiple health issues.

---

30. Fill-in-the-Blank Question: Before initiating advanced interventions in acutely ill patients with complex, chronic conditions, a thorough __________ assessment must be conducted to establish a baseline and tailor ongoing care appropriately. Correct ANS:

implementation, and evaluation that underpins individualized patient care is known as the __________. Correct ANS: nursing process Rationale: The nursing process ensures that care is both holistic and evidence- based, allowing for ongoing re‐assessment and modification of interventions. It is essential for managing patients with both acute crises and chronic conditions.

---

3. True/False Question: True or False: In older adults, atypical symptoms such as confusion, falls, or general weakness can be the only manifestations of life-threatening conditions like myocardial infarction or sepsis. Correct ANS: True Rationale: Older patients often lack classic symptoms due to physiologic changes and multiple comorbidities. Recognizing atypical presentations is critical to early diagnosis and treatment.

---

4. Multiple Response Question: When performing a comprehensive assessment in an acutely ill adult with chronic conditions, which of the following components are essential? (Select all that apply)

• A. Vital signs and hemodynamic status
• B. Mental status and cognitive function
• C. Nutritional status and weight history
• D. Social and cultural background
• E. Patient’s astrological sign Correct ANSs: A, B, C, D Rationale: A complete assessment includes both physiologic (vital signs, nutrition) and psychosocial (cognition, cultural beliefs) factors, ensuring a tailored care plan. Astrological sign has no clinical relevance.

---

5. Multiple Choice Question: 

A 70-year-old female with COPD and heart failure is admitted with severe pneumonia. To optimize her oxygenation and reduce ventilator-induced lung injury, which ventilatory strategy should be implemented?

• A. High tidal volume ventilation
• B. Lung-protective ventilation with low tidal volumes and appropriate PEEP
• C. Pressure-controlled ventilation with minimal PEEP
• D. Immediate transition to non-invasive ventilation Correct ANS: B. Lung-protective ventilation with low tidal volumes and appropriate PEEP Rationale: Low tidal volume (typically ~6 mL/kg predicted body weight) and adequate PEEP minimize ventilator-induced lung injury and are recommended for patients with underlying respiratory pathology, such