Title: ASN 210 Week 7 Post Quiz (Remotely Proctored)
Course: 16SP-ASN-210-GH1A1-ADV NUR THROUGH LIFESPAN I > Section: Week 7

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Q: An older client had hip replacement surgery and the surgeon prescribed morphine sulfate for pain. The client is allergic to morphine and reports pain and muscle spasms. When the nurse calls the surgeon, which medication should he or she suggest in place of the morphine?
- Cyclobenzaprine (Flexeril)
- Hydromorphone hydrochloride (Dilaudid)
- Ketorolac (Toradol)
- Meperidine (Demerol)
A: Hydromorphone hydrochloride (Dilaudid)
If right: Cyclobenzaprine (used for muscle spasms), ketorolac, and meperidine (both used for pain) are all on the Beers list of potentially inappropriate medications for use in older adults and should not be suggested. The nurse should suggest hydromorphone hydrochloride.
If wrong: Cyclobenzaprine (used for muscle spasms), ketorolac, and meperidine (both used for pain) are all on the Beers list of potentially inappropriate medications for use in older adults and should not be suggested. The nurse should suggest hydromorphone hydrochloride.

Q: An older adult recently retired and reports “being depressed and lonely.” What information should the nurse assess as a priority?
- History of previous depression
- Previous stressful events
- Role of work in the adult’s life
- Usual leisure time activities
A: Role of work in the adult’s life
If right: Often older adults lose support systems when their roles change. For instance, when people retire, they may lose their entire social network, leading them to feeling depressed and lonely. The nurse should first assess the role that work played in the client’s life. The other factors can be assessed as well, but this circumstance is commonly seen in the older population.
If wrong: Often older adults lose support systems when their roles change. For instance, when people retire, they may lose their entire social network, leading them to feeling depressed and lonely. The nurse should first assess the role that work played in the client’s life. The other factors can be assessed as well, but this circumstance is commonly seen in the older population.

Q: An older adult is brought to the emergency department because of sudden onset of confusion. After the client is stabilized and comfortable, what assessment by the nurse is most important?
- Assess for orthostatic hypotension.
- Determine if there are new medications.
- Evaluate the client for gait abnormalities.
- Perform a delirium screening test.
A: Determine if there are new medications.
If right: Medication side effects and adverse effects are common in the older population. Something as simple as a new antibiotic can cause confusion and memory loss. The nurse should determine if the client is taking any new medications. Assessments for orthostatic hypotension, gait abnormalities, and delirium may be important once more is known about the client’s condition.
If wrong: Medication side effects and adverse effects are common in the older population. Something as simple as a new antibiotic can cause confusion and memory loss. The nurse should determine if the client is taking any new medications. Assessments for orthostatic hypotension, gait abnormalities, and delirium may be important once more is known about the client’s condition.

Q: An older adult client takes medication three times a day and becomes confused about which medication should be taken at which time. The client refuses to use a pill sorter with slots for different times, saying “Those are for old people.” What action by the nurse would be most helpful?
- Arrange medications by time in a drawer.
- Encourage the client to use easy-open tops.
- Put color-coded stickers on the bottle caps.
- Write a list of when to take each medication.
A: Put color-coded stickers on the bottle caps.
If right: Color-coded stickers are a fast, easy-to-remember system. One color is for morning meds, one for evening meds, and the third color is for nighttime meds. Arranging medications by time in a drawer might be helpful if the person doesn’t accidentally put them back in the wrong spot. Easy-open tops are not related. Writing a list might be helpful, but not if it gets misplaced. With stickers on the medication bottles themselves, the reminder is always with the medication.
If wrong: Color-coded stickers are a fast, easy-to-remember system. One color is for morning meds, one for evening meds, and the third color is for nighttime meds. Arranging medications by time in a drawer might be helpful if the person doesn’t accidentally put them back in the wrong spot. Easy-open tops are not related. Writing a list might be helpful, but not if it gets misplaced. With stickers on the medication bottles themselves, the reminder is always with the medication.

Q: An older adult client is in the hospital. The client is ambulatory and independent. What intervention by the nurse would be most helpful in preventing falls in this client?
- Keep the light on in the bathroom at night.
- Order a bedside commode for the client.
- Put the client on a toileting schedule.
- Use siderails to keep the client in bed.
A: Keep the light on in the bathroom at night.
If right: Although this older adult is independent and ambulatory, being hospitalized can create confusion. Getting up in a dark, unfamiliar environment can contribute to falls. Keeping the light on in the bathroom will help reduce the likelihood of falling. The client does not need a commode or a toileting schedule. Siderails used to keep the client in bed are considered restraints and should not be used in that fashion.
If wrong: Although this older adult is independent and ambulatory, being hospitalized can create confusion. Getting up in a dark, unfamiliar environment can contribute to falls. Keeping the light on in the bathroom will help reduce the likelihood of falling. The client does not need a commode or a toileting schedule. Siderails used to keep the client in bed are considered restraints and should not be used in that fashion.

Q: A visiting nurse is in the home of an older adult and notes a 7-pound weight loss since last month’s visit. What actions should the nurse perform first? <b>(Select all that apply.)</b>
- Assess the client’s ability to drive or transportation alternatives.
- Determine if the client has dentures that fit appropriately.
- Encourage the client to continue the current exercise plan.
- Have the client complete a 3-day diet recall diary.
- Teach the client about proper nutrition in the older population.
A: Assess the client’s ability to drive or transportation alternatives.; Determine if the client has dentures that fit appropriately.; Have the client complete a 3-day diet recall diary.
If right: Assessment is the first step of the nursing process and should be completed prior to intervening. Asking about transportation, dentures, and normal food patterns would be part of an appropriate assessment for the client. There is no information in the question about the older adult needing to lose weight, so encouraging him or her to continue the current exercise regimen is premature and may not be appropriate. Teaching about proper nutrition is a good idea, but teaching needs to be tailored to the client’s needs, which the nurse does not yet know.
If wrong: Assessment is the first step of the nursing process and should be completed prior to intervening. Asking about transportation, dentures, and normal food patterns would be part of an appropriate assessment for the client. There is no information in the question about the older adult needing to lose weight, so encouraging him or her to continue the current exercise regimen is premature and may not be appropriate. Teaching about proper nutrition is a good idea, but teaching needs to be tailored to the client’s needs, which the nurse does not yet know.

Q: A nursing student working in an Adult Care for Elders unit learns that frailty in the older population includes which components? <b>(Select all that apply.)</b>
- Dementia
- Exhaustion
- Slowed physical activity
- Weakness
- Weight gain
A: Exhaustion; Slowed physical activity; Weakness
If right: Frailty is a syndrome consisting of unintentional weight loss, slowed physical activity and exhaustion, and weakness. Weight gain and dementia are not part of this cluster of manifestations.
If wrong: Frailty is a syndrome consisting of unintentional weight loss, slowed physical activity and exhaustion, and weakness. Weight gain and dementia are not part of this cluster of manifestations.

Q: The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client’s anxiety and restlessness. Which statement made by the family member indicates understanding of the nurse’s teaching?
- “Maybe we should just hire an around-the-clock sitter to stay with Grandmother.”
- “I have some of her favorite hymns on a CD that I could bring for music therapy.”
- “I don’t think that she’ll need pain medication along with her herbal treatments.”
- “I will burn therapeutic incense in the room so we can stop the anxiety pills.”
A: “I have some of her favorite hymns on a CD that I could bring for music therapy.”
If right: Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client’s inner restlessness. Hiring an around-the-clock sitter does not demonstrate that the client’s family understands complementary therapies. Complementary therapies are used in conjunction with traditional therapy. Complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications.
If wrong: Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client’s inner restlessness. Hiring an around-the-clock sitter does not demonstrate that the client’s family understands complementary therapies. Complementary therapies are used in conjunction with traditional therapy. Complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications.

Q: An intensive care nurse discusses withdrawal of care with a client’s family. The family expresses concerns related to discontinuation of therapy. How should the nurse respond?
- “I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia.”
- “You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support.”
- “I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death.”
- “There is no need to worry. Most religious organizations support the client’s decision to stop medical treatment.”
A: “I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death.”
If right: The nurse should validate the family’s concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about their purpose. If the client’s family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics.
If wrong: The nurse should validate the family’s concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about their purpose. If the client’s family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics.

Q: After teaching a client about advance directives, a nurse assesses the client’s understanding. Which statement indicates the client correctly understands the teaching?
- “An advance directive will keep my children from selling my home when I’m old.”
- “An advance directive will be completed as soon as I’m incapacitated and can’t think for myself.”
- “An advance directive will specify what I want done when I can no longer make decisions about health care.”
- “An advance directive will allow me to keep my money out of the reach of my family.”
A: “An advance directive will specify what I want done when I can no longer make decisions about health care.”
If right: An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client’s residence or financial matters.
If wrong: An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client’s residence or financial matters.

Q: A nurse teaches a client’s family members about signs and symptoms of approaching death. Which manifestations should the nurse include in this teaching? <b>(Select all that apply.)</b>
- Warm and flushed extremities
- Long periods of insomnia
- Increased respiratory rate
- Decreased appetite
- Congestion and gurgling
A: Decreased appetite; Congestion and gurgling
If right: Common physical signs and symptoms of approaching death including coolness of extremities, increased sleeping, irregular and slowed breathing rate, a decrease in fluid and food intake, congestion and gurgling, incontinence, disorientation, and restlessness.
If wrong: Common physical signs and symptoms of approaching death including coolness of extremities, increased sleeping, irregular and slowed breathing rate, a decrease in fluid and food intake, congestion and gurgling, incontinence, disorientation, and restlessness.

Q: A nurse teaches a client who is considering being admitted to hospice. Which statement should the nurse include in this client’s teaching?
- “Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge.”
- “Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms.”
- “Hospice care will not help with your symptoms of depression. I will refer you to the facility’s counseling services instead.”
- “You seem to be experiencing some difficulty with this stage of the grieving process. Let’s talk about your feelings.”
A: “Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms.”
If right: As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.
If wrong: As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.

Q: A nurse plans care for a client who is nearing end of life. Which question should the nurse ask when developing this client’s plan of care?
- “Is your advance directive up to date and notarized?”
- “Do you want to be at home at the end of your life?”
- “Would you like a physical therapist to assist you with range-of-motion activities?”
- “Have your children discussed resuscitation with your health care provider?”
A: “Do you want to be at home at the end of your life?”
If right: When developing a plan of care for a dying client, consideration should be given for where the client wants to die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status should be the client’s decision, not the family’s decision.
If wrong: When developing a plan of care for a dying client, consideration should be given for where the client wants to die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status should be the client’s decision, not the family’s decision.

Q: A nurse is caring for a terminally ill client who has just died in a hospital setting with family members at the bedside. Which action should the nurse take first?
- Call for emergency assistance so that resuscitation procedures can begin.
- Ask family members if they would like to spend time alone with the client.
- Ensure that a death certificate has been completed by the physician.
- Request family members to prepare the client’s body for the funeral home.
A: Ask family members if they would like to spend time alone with the client.
If right: Before moving the client’s body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The client’s family should not be expected to prepare the body for the funeral home.
If wrong: Before moving the client’s body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The client’s family should not be expected to prepare the body for the funeral home.

Q: An interdisciplinary team is caring for a client on a rehabilitation unit. Which team members are paired with the correct roles and responsibilities? <b>(Select all that apply.)</b>
- Speech-language pathologist – Evaluates and retrains clients with swallowing problems
- Physical therapist – Assists clients with ambulation and walker training
- Recreational therapist – Assists physical therapists to complete rehabilitation therapy
- Vocational counselor – Works with clients who have experienced head injuries
- Registered dietitian – Develops client-specific diets to ensure client needs are met
A: Speech-language pathologist – Evaluates and retrains clients with swallowing problems; Physical therapist – Assists clients with ambulation and walker training; Registered dietitian – Develops client-specific diets to ensure client needs are met
If right: Speech-language pathologists evaluate and retrain clients with speech, language, or swallowing problems. Physical therapists help clients to achieve self-management by focusing on gross mobility. Registered dietitians develop client-specific diets to ensure that clients meet their needs for nutrition. Recreational therapists work to help clients continue or develop hobbies or interests. Vocational counselors assist with job placement, training, or further education.
If wrong: Speech-language pathologists evaluate and retrain clients with speech, language, or swallowing problems. Physical therapists help clients to achieve self-management by focusing on gross mobility. Registered dietitians develop client-specific diets to ensure that clients meet their needs for nutrition. Recreational therapists work to help clients continue or develop hobbies or interests. Vocational counselors assist with job placement, training, or further education.

Q: A rehabilitation nurse prepares to move a client who has new bilateral leg amputations. Which is the best approach?
- Use the bear-hug method to transfer the client safely.
- Ask several members of the health care team to carry the client.
- Utilize the facility’s mechanical lift to move the client.
- Consult physical therapy before performing all transfers.
A: Utilize the facility’s mechanical lift to move the client.
If right: Use mechanical lifts to minimize staff work-related musculoskeletal injuries. The bear-hug method and the use of several members of the team to carry the client do not eliminate staff injuries. Physical therapy should be consulted but cannot be depended upon for all transfers. Nursing staff must be capable of transferring a client safely.
If wrong: Use mechanical lifts to minimize staff work-related musculoskeletal injuries. The bear-hug method and the use of several members of the team to carry the client do not eliminate staff injuries. Physical therapy should be consulted but cannot be depended upon for all transfers. Nursing staff must be capable of transferring a client safely.

Q: A rehabilitation nurse is caring for an older adult client who states, “I tire easily.” How should the nurse respond? <b>(Select all that apply.)</b>
- “Schedule all of your tasks for the morning when you have the most energy.”
- “Use a cart to push your belongings instead of carrying them.”
- “Your family should hire someone who can assist you with daily chores.”
- “Plan to gather all of the supplies needed for a chore prior to starting the activity.”
- “Try to break large activities into smaller parts to allow rest periods between activities.”
A: “Use a cart to push your belongings instead of carrying them.”; “Plan to gather all of the supplies needed for a chore prior to starting the activity.”; “Try to break large activities into smaller parts to allow rest periods between activities.”
If right: A cart is useful because it takes less energy to push items than to carry them. Gathering equipment before performing a chore decreases unneeded steps. Breaking larger chores into smaller ones allows rest periods between activities and still gives the client a sense of completion even if the client is unable to complete the whole task. Major tasks should be performed in the morning, when energy levels are high, while lesser tasks should be done throughout the day after frequent rest periods. Someone should be hired to do the chores only if the client cannot do them. The outcome should be achieving independence as close to the pre-disability level as possible.
If wrong: A cart is useful because it takes less energy to push items than to carry them. Gathering equipment before performing a chore decreases unneeded steps. Breaking larger chores into smaller ones allows rest periods between activities and still gives the client a sense of completion even if the client is unable to complete the whole task. Major tasks should be performed in the morning, when energy levels are high, while lesser tasks should be done throughout the day after frequent rest periods. Someone should be hired to do the chores only if the client cannot do them. The outcome should be achieving independence as close to the pre-disability level as possible.

Q: A rehabilitation nurse cares for a client who is wheelchair bound. Which intervention should the nurse implement to prevent skin breakdown?
- Place pillows under the client’s heels.
- Have the client do wheelchair push-ups.
- Perform wound care as prescribed.
- Massage the client’s calves and feet with lotion.
A: Have the client do wheelchair push-ups.
If right: Clients who sit for prolonged periods in a wheelchair should perform wheelchair push-ups for at least 10 seconds every hour. Chair-bound clients also need to be re-positioned at least every 1 to 2 hours. The lower legs, where the wheelchair could rub against the legs, also need to be assessed. Pillows under the heels could exert pressure on the heels; it is better to place the pillow under the ankle. Performing wound care as prescribed is important to improve the healing of pressure ulcers, but this intervention will not prevent skin breakdown. The calves of a client with no or decreased lower extremity mobility should not be massaged because of the risk of embolization or thrombus.
If wrong: Clients who sit for prolonged periods in a wheelchair should perform wheelchair push-ups for at least 10 seconds every hour. Chair-bound clients also need to be re-positioned at least every 1 to 2 hours. The lower legs, where the wheelchair could rub against the legs, also need to be assessed. Pillows under the heels could exert pressure on the heels; it is better to place the pillow under the ankle. Performing wound care as prescribed is important to improve the healing of pressure ulcers, but this intervention will not prevent skin breakdown. The calves of a client with no or decreased lower extremity mobility should not be massaged because of the risk of embolization or thrombus.

Q: A rehabilitation nurse cares for a client who has generalized weakness and needs assistance with activities of daily living. Which exercise should the nurse implement?
- Passive range of motion
- Active range of motion
- Resistive range of motion
- Aerobic exercise
A: Active range of motion
If right: Active range of motion is a part of a restorative nursing program. Active range of motion will promote strength, range of motion, and independence with activities of daily living.
If wrong: Active range of motion is a part of a restorative nursing program. Active range of motion will promote strength, range of motion, and independence with activities of daily living.

Q: A nurse teaches a client with a past history of angina who has had a total knee replacement. Which statement should the nurse include in this client’s teaching prior to beginning rehabilitation activities?
- “Use analgesics before and after activity, even if you are not experiencing pain.”
- “Let me know if you start to experience shortness of breath, chest pain, or fatigue.”
- “Do not take your prescribed beta blocker until after you exercise with physical therapy.”
- “If you experience knee pain, ask the physical therapist to reschedule your therapy.”
A: “Let me know if you start to experience shortness of breath, chest pain, or fatigue.”
If right: Participation in exercise may increase myocardial oxygen demand beyond the ability of the coronary circulation to deliver enough oxygen to meet the increased need. The nurse must determine the client’s ability to tolerate different activity levels. Asking the client to notify the nurse if symptoms of shortness of breath, chest pain, or fatigue occur will assist the nurse in developing an appropriate cardiac rehabilitation plan.
If wrong: Participation in exercise may increase myocardial oxygen demand beyond the ability of the coronary circulation to deliver enough oxygen to meet the increased need. The nurse must determine the client’s ability to tolerate different activity levels. Asking the client to notify the nurse if symptoms of shortness of breath, chest pain, or fatigue occur will assist the nurse in developing an appropriate cardiac rehabilitation plan.