Geri Final Exam Greater Lowell Technical School
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Free Geri Final Exam Greater Lowell Technical School Questions
1. Robert Miller is an 82-year-old man with Parkinson's disease, hypertension, and osteoarthritis. He lives alone in a two-story home. His daughter visits weekly. The daughter reports the following changes over the past month: two falls at home, missed medication doses, missed medical appointments, difficulty preparing meals, wearing the same clothing for several days, increased fatigue, and weight loss of 8 pounds.
The nurse recognizes that Mr. Miller's recent falls place him at increased risk for (1) and indicate a need for (2).
For blank 1, select one: A. Injury B. Infection C. Dehydration
For blank 2, select one: A. Reduction of medications B. Social Worker to complete Health Care Proxy C. Additional support services
- Injury
- Infection
- Dehydration
- Reduction of medications
- Social Worker to complete Health Care Proxy
- Additional support services
Explanation
Explanation
Correct Answer: (1) Injury and (2) Additional support services.
Mr. Miller's two recent falls place him at significantly increased risk for injury, particularly serious injuries such as hip fracture, head trauma, or lacerations, which are leading causes of hospitalization, functional decline, and mortality in older adults. His multiple comorbidities including Parkinson's disease, which causes shuffling gait, postural instability, and impaired balance, compound this risk substantially. Living alone in a two-story home further elevates the danger because he would have limited immediate assistance if a fall were to result in serious harm.
The constellation of changes reported by the daughter, including missed medications, missed appointments, difficulty preparing meals, self-neglect in personal hygiene and clothing, increased fatigue, and significant weight loss, collectively indicate that Mr. Miller is struggling to manage his daily needs independently. These findings point clearly to a need for additional support services such as homecare assistance, meal delivery, medication management support, fall prevention programs, and possible social work involvement to coordinate a comprehensive community-based care plan.
Why the other options are incorrect:
For blank 1, infection and dehydration, while possible concerns in older adults generally, are not the primary risks directly and specifically associated with recent falls. Injury is the immediate and most clinically relevant consequence of falling, particularly in a client with Parkinson's disease and osteoarthritis living alone.
For blank 2, reducing medications is not indicated based on the information provided and could worsen Mr. Miller's Parkinson's disease and hypertension management. Completing a Health Care Proxy is an important legal and advance care planning step but does not address the immediate safety and functional support needs that the daughter's report reveals. Additional support services is the most comprehensive and appropriate response to the multiple unmet needs identified in this scenario.
Correct Answer: (1) Injury and (2) Additional support services.
Mr. Miller's two recent falls place him at significantly increased risk for injury, particularly serious injuries such as hip fracture, head trauma, or lacerations, which are leading causes of hospitalization, functional decline, and mortality in older adults. His multiple comorbidities including Parkinson's disease, which causes shuffling gait, postural instability, and impaired balance, compound this risk substantially. Living alone in a two-story home further elevates the danger because he would have limited immediate assistance if a fall were to result in serious harm.
The constellation of changes reported by the daughter, including missed medications, missed appointments, difficulty preparing meals, self-neglect in personal hygiene and clothing, increased fatigue, and significant weight loss, collectively indicate that Mr. Miller is struggling to manage his daily needs independently. These findings point clearly to a need for additional support services such as homecare assistance, meal delivery, medication management support, fall prevention programs, and possible social work involvement to coordinate a comprehensive community-based care plan.
Why the other options are incorrect:
For blank 1, infection and dehydration, while possible concerns in older adults generally, are not the primary risks directly and specifically associated with recent falls. Injury is the immediate and most clinically relevant consequence of falling, particularly in a client with Parkinson's disease and osteoarthritis living alone.
For blank 2, reducing medications is not indicated based on the information provided and could worsen Mr. Miller's Parkinson's disease and hypertension management. Completing a Health Care Proxy is an important legal and advance care planning step but does not address the immediate safety and functional support needs that the daughter's report reveals. Additional support services is the most comprehensive and appropriate response to the multiple unmet needs identified in this scenario.
2. A 78-year-old woman with COPD and degenerative arthritis affecting her lower back and legs says she cannot exercise. She stays at home and has someone deliver her food and other necessities. What would be an inappropriate intervention?
-
Suggest that she consider moving to a long-term care facility.
-
Explain to her the benefits of exercise at any level.
-
Teach her pursed lip breathing techniques.
-
Suggest that she use a walker or wheelchair, pace herself slowly.
Explanation
Explanation
Recommending long-term care facility placement is inappropriate in this situation because the client is managing at home with community support, has not been assessed as unsafe to remain at home, and has not expressed a desire to relocate. Suggesting institutionalization without a thorough assessment of the client's actual care needs, safety risks, and personal preferences is presumptuous, disrespectful of her autonomy, and inconsistent with the principle of supporting the least restrictive level of care. This response does not address her stated concern about exercise and fails to offer any therapeutic or educational value.
Why the other options are incorrect:
B. Explaining the benefits of exercise at any level is an appropriate and empowering intervention. Even gentle, low-impact activity such as seated exercises or upper extremity movements can improve cardiovascular function, mood, and quality of life in a client with COPD and arthritis.
C. Teaching pursed lip breathing is a well-established, evidence-based technique for clients with COPD that helps slow breathing, reduce air trapping, and improve oxygenation during activity. This is a directly relevant and therapeutic intervention for this client.
D. Suggesting a walker or wheelchair with slow pacing is an appropriate adaptive strategy that promotes safe mobility and allows the client to engage in some level of physical activity despite her physical limitations, supporting both safety and independence.
Recommending long-term care facility placement is inappropriate in this situation because the client is managing at home with community support, has not been assessed as unsafe to remain at home, and has not expressed a desire to relocate. Suggesting institutionalization without a thorough assessment of the client's actual care needs, safety risks, and personal preferences is presumptuous, disrespectful of her autonomy, and inconsistent with the principle of supporting the least restrictive level of care. This response does not address her stated concern about exercise and fails to offer any therapeutic or educational value.
Why the other options are incorrect:
B. Explaining the benefits of exercise at any level is an appropriate and empowering intervention. Even gentle, low-impact activity such as seated exercises or upper extremity movements can improve cardiovascular function, mood, and quality of life in a client with COPD and arthritis.
C. Teaching pursed lip breathing is a well-established, evidence-based technique for clients with COPD that helps slow breathing, reduce air trapping, and improve oxygenation during activity. This is a directly relevant and therapeutic intervention for this client.
D. Suggesting a walker or wheelchair with slow pacing is an appropriate adaptive strategy that promotes safe mobility and allows the client to engage in some level of physical activity despite her physical limitations, supporting both safety and independence.
3. An 84-year-old client is prescribed a medication that is metabolized by the liver and excreted by the kidneys. Which findings would cause the nurse to question the prescribed dose? Choose all that apply.
-
Elevated liver enzymes.
-
Reduced creatinine clearance.
-
Increased stomach acid production.
-
Increased muscle mass.
-
Increased appetite.
Explanation
Explanation
Elevated liver enzymes indicate impaired hepatic function, which would reduce the liver's ability to metabolize the drug effectively. This can lead to higher concentrations of the active drug remaining in the bloodstream for longer periods, increasing the risk of toxicity. The nurse should question whether the prescribed dose is safe given the compromised metabolic capacity. Reduced creatinine clearance is a direct indicator of decreased kidney function. Since the medication is excreted by the kidneys, impaired renal clearance would result in drug accumulation in the body, raising the risk of toxicity. In older adults, creatinine clearance naturally declines with age even when serum creatinine appears normal, making this finding particularly significant and a valid reason to question the prescribed dose.
Why Other Options Are Incorrect:
C. Increased stomach acid production affects the absorption phase of pharmacokinetics rather than metabolism or excretion. Since this medication is metabolized by the liver and excreted by the kidneys, gastric acid levels are not directly relevant to dose safety for this drug.
D. Increased muscle mass is not a typical finding in an 84-year-old client, as aging is associated with sarcopenia or muscle loss. Even if present, muscle mass does not directly affect hepatic metabolism or renal excretion of medications in a way that would necessitate questioning the dose.
E. Increased appetite has no pharmacokinetic relevance to a medication's hepatic metabolism or renal excretion. It does not influence how the drug is processed or eliminated and would not be a reason to question the prescribed dose.
Elevated liver enzymes indicate impaired hepatic function, which would reduce the liver's ability to metabolize the drug effectively. This can lead to higher concentrations of the active drug remaining in the bloodstream for longer periods, increasing the risk of toxicity. The nurse should question whether the prescribed dose is safe given the compromised metabolic capacity. Reduced creatinine clearance is a direct indicator of decreased kidney function. Since the medication is excreted by the kidneys, impaired renal clearance would result in drug accumulation in the body, raising the risk of toxicity. In older adults, creatinine clearance naturally declines with age even when serum creatinine appears normal, making this finding particularly significant and a valid reason to question the prescribed dose.
Why Other Options Are Incorrect:
C. Increased stomach acid production affects the absorption phase of pharmacokinetics rather than metabolism or excretion. Since this medication is metabolized by the liver and excreted by the kidneys, gastric acid levels are not directly relevant to dose safety for this drug.
D. Increased muscle mass is not a typical finding in an 84-year-old client, as aging is associated with sarcopenia or muscle loss. Even if present, muscle mass does not directly affect hepatic metabolism or renal excretion of medications in a way that would necessitate questioning the dose.
E. Increased appetite has no pharmacokinetic relevance to a medication's hepatic metabolism or renal excretion. It does not influence how the drug is processed or eliminated and would not be a reason to question the prescribed dose.
4. Which of the following statements best describes the advocate role of the nurse in restorative care?
-
Developing an adversarial role with the interdisciplinary team.
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Using his/her influence to promote an environment that supports the goals of restorative care.
-
Confronting the interdisciplinary team when their goals do not address their advocacy role.
-
Intervening when family members do not support the plan of care.
Explanation
Explanation
The nurse's advocate role in restorative care centers on using professional knowledge, relationships, and influence to create and sustain a care environment that prioritizes the resident's independence, dignity, and functional potential. This includes educating and collaborating with the interdisciplinary team, communicating the resident's goals and preferences, and ensuring that the care setting, culture, and daily routines actively support restorative principles. Advocacy in this context is constructive, collaborative, and focused on systemic support for the resident's wellbeing.
Why the other options are incorrect:
A. Developing an adversarial role with the interdisciplinary team is counterproductive and contrary to the collaborative nature of restorative care. Effective advocacy involves constructive communication and partnership with the team, not opposition or conflict.
C. Confronting the interdisciplinary team in an aggressive or combative manner does not reflect professional advocacy. While nurses have a responsibility to raise concerns when resident needs are not being met, this should be done through respectful, solution-focused communication rather than confrontation.
D. Intervening when family members do not support the plan of care may occasionally be necessary, but it is not the defining characteristic of the nurse's advocate role in restorative care. The primary focus of advocacy is promoting the environment and systems that support restorative goals, not managing family disagreements.
The nurse's advocate role in restorative care centers on using professional knowledge, relationships, and influence to create and sustain a care environment that prioritizes the resident's independence, dignity, and functional potential. This includes educating and collaborating with the interdisciplinary team, communicating the resident's goals and preferences, and ensuring that the care setting, culture, and daily routines actively support restorative principles. Advocacy in this context is constructive, collaborative, and focused on systemic support for the resident's wellbeing.
Why the other options are incorrect:
A. Developing an adversarial role with the interdisciplinary team is counterproductive and contrary to the collaborative nature of restorative care. Effective advocacy involves constructive communication and partnership with the team, not opposition or conflict.
C. Confronting the interdisciplinary team in an aggressive or combative manner does not reflect professional advocacy. While nurses have a responsibility to raise concerns when resident needs are not being met, this should be done through respectful, solution-focused communication rather than confrontation.
D. Intervening when family members do not support the plan of care may occasionally be necessary, but it is not the defining characteristic of the nurse's advocate role in restorative care. The primary focus of advocacy is promoting the environment and systems that support restorative goals, not managing family disagreements.
5. The nurse is caring for several older adults in a community health clinic. Which client should the nurse assess first?
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An 81-year-old with chronic pain requesting a warm blanket.
-
A 79-year-old with heart failure who reports increased fatigue and new confusion.
-
A 74-year-old with diabetes requesting assistance with meal planning.
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An 88-year-old with osteoarthritis who reports difficulty opening medication bottles.
Explanation
Explanation
Correct Answer: (B) A 79-year-old with heart failure who reports increased fatigue and new confusion.
New onset confusion in an older adult with a known cardiac condition is a serious and potentially life-threatening change in neurological status that requires immediate assessment. In older adults, confusion and increased fatigue can signal worsening heart failure, decreased cardiac output, hypoxia, electrolyte imbalance, or other acute deterioration. Any acute change in mental status in a medically complex older adult must be treated as a priority, as these symptoms may indicate rapid clinical decline that requires prompt intervention.
Why the other options are incorrect:
A. Chronic pain with a request for a warm blanket represents a comfort need rather than an acute clinical emergency. While pain management is important, this client's condition is stable and does not suggest immediate physiological deterioration.
C. A request for assistance with meal planning is an educational and nutritional need that is important for long-term diabetes management but does not represent an urgent or acute concern requiring immediate nursing assessment.
D. Difficulty opening medication bottles is a functional concern related to osteoarthritis and can be addressed through assistive devices and medication management strategies. While it is clinically relevant, it does not pose an immediate threat to the client's health or safety.
Correct Answer: (B) A 79-year-old with heart failure who reports increased fatigue and new confusion.
New onset confusion in an older adult with a known cardiac condition is a serious and potentially life-threatening change in neurological status that requires immediate assessment. In older adults, confusion and increased fatigue can signal worsening heart failure, decreased cardiac output, hypoxia, electrolyte imbalance, or other acute deterioration. Any acute change in mental status in a medically complex older adult must be treated as a priority, as these symptoms may indicate rapid clinical decline that requires prompt intervention.
Why the other options are incorrect:
A. Chronic pain with a request for a warm blanket represents a comfort need rather than an acute clinical emergency. While pain management is important, this client's condition is stable and does not suggest immediate physiological deterioration.
C. A request for assistance with meal planning is an educational and nutritional need that is important for long-term diabetes management but does not represent an urgent or acute concern requiring immediate nursing assessment.
D. Difficulty opening medication bottles is a functional concern related to osteoarthritis and can be addressed through assistive devices and medication management strategies. While it is clinically relevant, it does not pose an immediate threat to the client's health or safety.
6. A rehabilitation unit reviews monthly quality data and discovers an increase in urinary tract infections among older adults with indwelling catheters. Which action should the nurse recommend?
-
Obtain urine cultures on all residents with a catheter weekly.
-
Restrict fluid intake.
-
Review catheter necessity daily and remove catheters as soon as possible.
-
Increase routine catheter use.
Explanation
Explanation
The most effective evidence-based strategy for reducing catheter-associated urinary tract infections is to minimize the duration of indwelling catheter use. Daily review of whether each catheter remains clinically necessary, followed by prompt removal when no longer indicated, is the gold standard recommendation from infection prevention guidelines including those from the Centers for Disease Control and Prevention. The longer an indwelling catheter remains in place, the greater the risk of bacterial colonization and subsequent infection.
Why the other options are incorrect:
A. Obtaining weekly urine cultures on all catheterized residents is not an evidence-based infection prevention strategy and would result in overdiagnosis and overtreatment of asymptomatic bacteriuria, which is common in catheterized patients and does not require antibiotic treatment unless the patient is symptomatic.
B. Restricting fluid intake is directly contraindicated in urinary tract infection prevention. Adequate hydration dilutes urine, promotes regular bladder flushing, and reduces bacterial concentration in the urinary tract. Restricting fluids would worsen infection risk rather than reduce it.
D. Increasing routine catheter use would directly increase the incidence of catheter-associated urinary tract infections. The evidence overwhelmingly supports limiting catheter use to clearly indicated clinical situations and removing catheters at the earliest opportunity.
The most effective evidence-based strategy for reducing catheter-associated urinary tract infections is to minimize the duration of indwelling catheter use. Daily review of whether each catheter remains clinically necessary, followed by prompt removal when no longer indicated, is the gold standard recommendation from infection prevention guidelines including those from the Centers for Disease Control and Prevention. The longer an indwelling catheter remains in place, the greater the risk of bacterial colonization and subsequent infection.
Why the other options are incorrect:
A. Obtaining weekly urine cultures on all catheterized residents is not an evidence-based infection prevention strategy and would result in overdiagnosis and overtreatment of asymptomatic bacteriuria, which is common in catheterized patients and does not require antibiotic treatment unless the patient is symptomatic.
B. Restricting fluid intake is directly contraindicated in urinary tract infection prevention. Adequate hydration dilutes urine, promotes regular bladder flushing, and reduces bacterial concentration in the urinary tract. Restricting fluids would worsen infection risk rather than reduce it.
D. Increasing routine catheter use would directly increase the incidence of catheter-associated urinary tract infections. The evidence overwhelmingly supports limiting catheter use to clearly indicated clinical situations and removing catheters at the earliest opportunity.
7. A family is discussing moving their father into a memory impairment assisted living community. To ease the transition, the nurse guides the family to provide an environment that is/has:
-
A standardized appearance.
-
Sensory stimulation through colors, furniture, and wall coverings.
-
A stark and unstimulating atmosphere.
-
A homelike, familiar atmosphere with the resident's own belongings.
Explanation
Explanation
For individuals with memory impairment such as dementia, familiar environments, personal possessions, and recognizable objects provide comfort, reduce anxiety, and promote a sense of identity and continuity. Transitioning to a new living environment is inherently disorienting for someone with cognitive decline, and surrounding the resident with their own furniture, photographs, and personal items from home significantly eases this transition by creating a sense of familiarity and safety in an otherwise unfamiliar setting.
Why the other options are incorrect:
A. A standardized appearance refers to a uniform, institutional environment that lacks personal identity or familiarity. For a resident with memory impairment, a generic environment provides no orienting cues and may increase confusion and agitation rather than ease the transition.
B. While some sensory stimulation can be beneficial in dementia care, excessive or overwhelming sensory input through busy colors, patterns, and wall coverings can increase agitation, confusion, and sensory overload in individuals with memory impairment. Stimulation must be carefully calibrated rather than broadly applied.
C. A stark and unstimulating atmosphere is associated with sensory deprivation, which can worsen cognitive decline, increase depression, and contribute to behavioral disturbances in residents with dementia. This type of environment is contrary to evidence-based dementia care principles.
For individuals with memory impairment such as dementia, familiar environments, personal possessions, and recognizable objects provide comfort, reduce anxiety, and promote a sense of identity and continuity. Transitioning to a new living environment is inherently disorienting for someone with cognitive decline, and surrounding the resident with their own furniture, photographs, and personal items from home significantly eases this transition by creating a sense of familiarity and safety in an otherwise unfamiliar setting.
Why the other options are incorrect:
A. A standardized appearance refers to a uniform, institutional environment that lacks personal identity or familiarity. For a resident with memory impairment, a generic environment provides no orienting cues and may increase confusion and agitation rather than ease the transition.
B. While some sensory stimulation can be beneficial in dementia care, excessive or overwhelming sensory input through busy colors, patterns, and wall coverings can increase agitation, confusion, and sensory overload in individuals with memory impairment. Stimulation must be carefully calibrated rather than broadly applied.
C. A stark and unstimulating atmosphere is associated with sensory deprivation, which can worsen cognitive decline, increase depression, and contribute to behavioral disturbances in residents with dementia. This type of environment is contrary to evidence-based dementia care principles.
8. Before establishing any plan of care in rehabilitation, it is important for the LPN to:
-
complete all physical exercises.
-
determine the priorities of needs from the patient's and family's perspective.
-
guarantee the patient independence in all areas of functioning.
-
establish a rapport with the family.
Explanation
Explanation
Correct Answer: (B) Determine the priorities of needs from the patient's and family's perspective.
Before developing any rehabilitation plan of care, the LPN must first assess and understand what the patient and family identify as their most important needs, goals, and priorities. Rehabilitation is a client-centered process, and care planning that does not reflect the patient's and family's values and expectations is unlikely to be effective or meaningful. Identifying these priorities ensures that the care plan is individualized, realistic, and aligned with what matters most to the people receiving and supporting the care.
Why the other options are incorrect:
A. Completing all physical exercises is an intervention that occurs during the implementation phase of care, not before the plan of care is established. No interventions should be initiated before assessment and goal-setting with the client and family have taken place.
C. Guaranteeing independence in all areas of functioning is an unrealistic and inappropriate goal for all rehabilitation clients. Not every client will achieve full independence, and imposing this as a blanket outcome fails to account for individual diagnoses, functional baselines, and realistic prognoses.
D. While establishing rapport with the family is a valuable component of therapeutic relationship-building, it is a communication strategy rather than the foundational step in care planning. Determining the priorities of needs from the patient's and family's perspective is both more comprehensive and more clinically significant as the first step in rehabilitation planning.
Correct Answer: (B) Determine the priorities of needs from the patient's and family's perspective.
Before developing any rehabilitation plan of care, the LPN must first assess and understand what the patient and family identify as their most important needs, goals, and priorities. Rehabilitation is a client-centered process, and care planning that does not reflect the patient's and family's values and expectations is unlikely to be effective or meaningful. Identifying these priorities ensures that the care plan is individualized, realistic, and aligned with what matters most to the people receiving and supporting the care.
Why the other options are incorrect:
A. Completing all physical exercises is an intervention that occurs during the implementation phase of care, not before the plan of care is established. No interventions should be initiated before assessment and goal-setting with the client and family have taken place.
C. Guaranteeing independence in all areas of functioning is an unrealistic and inappropriate goal for all rehabilitation clients. Not every client will achieve full independence, and imposing this as a blanket outcome fails to account for individual diagnoses, functional baselines, and realistic prognoses.
D. While establishing rapport with the family is a valuable component of therapeutic relationship-building, it is a communication strategy rather than the foundational step in care planning. Determining the priorities of needs from the patient's and family's perspective is both more comprehensive and more clinically significant as the first step in rehabilitation planning.
9. The nurse assesses the client's current home environment and notes the patient does not take prescribed noon-time medications. Upon discussion with the son, the nurse learns that the son does not trust his father to take medications properly when left alone at home, largely due to the father's mild cognitive impairment. The son works routine hours during the day and is not home mid-day. The nurse recommends the son pursue:
-
Assisted living.
-
Daily visiting nurse through homecare.
-
Senior center activities.
-
Adult day health care.
Explanation
Explanation
Adult day health care programs provide supervised, structured daytime care in a community-based setting for older adults with cognitive or functional impairments who live at home. The client attends the program during the day while the son is at work and returns home in the evening. Staff at the program can supervise and administer the noon-time medications, directly addressing the safety concern about unsupervised medication taking. This option supports the client's independence, provides social engagement, and allows the son to continue working without compromising his father's medication safety.
Why the other options are incorrect:
A. Assisted living involves relocating the client to a residential facility where around-the-clock care is provided. This is a more restrictive and costly option than what the current situation requires. The client lives at home with family support and only needs supervised midday medication administration, which does not justify the level of intervention that assisted living represents.
B. A daily visiting nurse through homecare would provide clinical oversight but is typically not structured to provide ongoing midday supervision specifically for medication administration on a daily long-term basis. It is also a more costly and clinically intensive service than the situation requires, and homecare nursing visits are generally reserved for clients with skilled nursing needs.
C. Senior center activities offer social programming and engagement but do not include health supervision, medication administration, or structured monitoring of clients with cognitive impairment. This option does not address the medication safety concern that is the central issue in this scenario.
Adult day health care programs provide supervised, structured daytime care in a community-based setting for older adults with cognitive or functional impairments who live at home. The client attends the program during the day while the son is at work and returns home in the evening. Staff at the program can supervise and administer the noon-time medications, directly addressing the safety concern about unsupervised medication taking. This option supports the client's independence, provides social engagement, and allows the son to continue working without compromising his father's medication safety.
Why the other options are incorrect:
A. Assisted living involves relocating the client to a residential facility where around-the-clock care is provided. This is a more restrictive and costly option than what the current situation requires. The client lives at home with family support and only needs supervised midday medication administration, which does not justify the level of intervention that assisted living represents.
B. A daily visiting nurse through homecare would provide clinical oversight but is typically not structured to provide ongoing midday supervision specifically for medication administration on a daily long-term basis. It is also a more costly and clinically intensive service than the situation requires, and homecare nursing visits are generally reserved for clients with skilled nursing needs.
C. Senior center activities offer social programming and engagement but do not include health supervision, medication administration, or structured monitoring of clients with cognitive impairment. This option does not address the medication safety concern that is the central issue in this scenario.
10. Mrs. Eleanor James is an 82-year-old resident admitted to a long-term care facility 8 months ago with moderate Alzheimer's disease. Her daughter reports that over the past several weeks, Mrs. James has become increasingly confused in the evenings and occasionally accuses staff of "stealing" her belongings. Her medical history includes Alzheimer's disease, hypertension, osteoarthritis, and type 2 diabetes mellitus.
Which assessment finding requires immediate follow-up by the nurse?
-
Increased anxiety during bathing.
-
Requires cueing for dressing.
-
Wandering into other residents' rooms.
-
Eats 50% of meals.
Explanation
Explanation
Consistently eating only 50% of meals is a clinically significant finding that requires immediate follow-up in a resident with type 2 diabetes mellitus and Alzheimer's disease. Inadequate nutritional and caloric intake places this client at immediate risk for hypoglycemia, which is especially dangerous given her diabetes diagnosis. Additionally, poor oral intake can lead to malnutrition, unintended weight loss, dehydration, and accelerated functional and cognitive decline. The combination of reduced food intake with diabetes management medications creates an urgent need for assessment and intervention, including reviewing her current medication doses, monitoring blood glucose levels, and identifying any reversible causes of the reduced appetite such as pain, medication side effects, depression, or dysphagia.
Why the other options are incorrect:
A. Increased anxiety during bathing is a common and well-documented behavioral symptom in residents with moderate to advanced Alzheimer's disease. While it requires ongoing care planning and the use of person-centered bathing approaches, it does not represent an acute safety risk requiring immediate follow-up in the same way that compromised nutritional intake does in a diabetic client.
B. Requiring cueing for dressing is an expected finding in a resident with moderate Alzheimer's disease and reflects the progressive nature of the condition. This finding is consistent with her current stage of disease and would be addressed through routine restorative care planning rather than immediate follow-up.
C. Wandering into other residents' rooms is a safety and behavioral concern that is common in Alzheimer's disease and requires environmental safety measures and care planning. However, it does not carry the same immediate physiological risk as inadequate food intake in a client with diabetes, making it a lower priority for immediate intervention compared to option D.
Consistently eating only 50% of meals is a clinically significant finding that requires immediate follow-up in a resident with type 2 diabetes mellitus and Alzheimer's disease. Inadequate nutritional and caloric intake places this client at immediate risk for hypoglycemia, which is especially dangerous given her diabetes diagnosis. Additionally, poor oral intake can lead to malnutrition, unintended weight loss, dehydration, and accelerated functional and cognitive decline. The combination of reduced food intake with diabetes management medications creates an urgent need for assessment and intervention, including reviewing her current medication doses, monitoring blood glucose levels, and identifying any reversible causes of the reduced appetite such as pain, medication side effects, depression, or dysphagia.
Why the other options are incorrect:
A. Increased anxiety during bathing is a common and well-documented behavioral symptom in residents with moderate to advanced Alzheimer's disease. While it requires ongoing care planning and the use of person-centered bathing approaches, it does not represent an acute safety risk requiring immediate follow-up in the same way that compromised nutritional intake does in a diabetic client.
B. Requiring cueing for dressing is an expected finding in a resident with moderate Alzheimer's disease and reflects the progressive nature of the condition. This finding is consistent with her current stage of disease and would be addressed through routine restorative care planning rather than immediate follow-up.
C. Wandering into other residents' rooms is a safety and behavioral concern that is common in Alzheimer's disease and requires environmental safety measures and care planning. However, it does not carry the same immediate physiological risk as inadequate food intake in a client with diabetes, making it a lower priority for immediate intervention compared to option D.
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