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 is analyzing assessment findings. For each finding, identify whether it indicates a Safety Concern, Need for Community Resources, Stable Finding, or any combination of these. You may choose multiple responses for each assessment finding.
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Two recent falls — Safety Concern, Need for Community Resources, or Stable Finding?
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Difficulty preparing meals — Safety Concern, Need for Community Resources, or Stable Finding?
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Shuffling gait — Safety Concern, Need for Community Resources, or Stable Finding?
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Vital signs — Safety Concern, Need for Community Resources, or Stable Finding?
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Missed medications — Safety Concern, Need for Community Resources, or Stable Finding?
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Weight — Safety Concern, Need for Community Resources, or Stable Finding?
Explanation
Explanation
Correct Answers:
A. Two recent falls — Safety Concern and Need for Community Resources B. Difficulty preparing meals — Need for Community Resources C. Shuffling gait — Safety Concern D. Vital signs — Stable Finding E. Missed medications — Safety Concern and Need for Community Resources F. Weight — Safety Concern and Need for Community Resources
Two recent falls in an older adult with Parkinson's disease living alone represent a direct and immediate safety concern due to the high risk of serious injury such as hip fracture or head trauma. They also indicate a need for community resources such as physical therapy, fall prevention programs, home safety modifications, and potentially increased supervision or assistive services.
Difficulty preparing meals does not present an immediate physical safety threat in isolation but clearly signals a need for community resources such as meal delivery programs, homecare assistance, or nutritional support services to ensure the client maintains adequate nutrition and continues to live safely at home.
Shuffling gait is a hallmark motor symptom of Parkinson's disease that significantly increases the risk of falls and injury, making it a direct safety concern. It indicates that the client's mobility and balance place him at ongoing risk, particularly in a two-story home environment.
Vital signs, while important to monitor in a client with hypertension, are not reported as abnormal in this scenario. In the absence of documented abnormalities, vital signs represent a stable finding that requires routine monitoring rather than urgent intervention.
Missed medications in a client with Parkinson's disease and hypertension is both a safety concern and a need for community resources. Missed doses of Parkinson's medications can lead to rapid motor deterioration, and missed antihypertensive medications increase the risk of cardiovascular events. Community resources such as medication management programs, pharmacy blister packs, or homecare nursing visits may be needed to ensure consistent medication adherence.
An 8-pound weight loss is a safety concern because it may indicate malnutrition, disease progression, or depression, all of which can accelerate functional decline and increase vulnerability to illness. It also reflects a need for community resources such as nutritional assessment, dietary support, and meal assistance programs to address the underlying cause and prevent further deterioration.
Correct Answers:
A. Two recent falls — Safety Concern and Need for Community Resources B. Difficulty preparing meals — Need for Community Resources C. Shuffling gait — Safety Concern D. Vital signs — Stable Finding E. Missed medications — Safety Concern and Need for Community Resources F. Weight — Safety Concern and Need for Community Resources
Two recent falls in an older adult with Parkinson's disease living alone represent a direct and immediate safety concern due to the high risk of serious injury such as hip fracture or head trauma. They also indicate a need for community resources such as physical therapy, fall prevention programs, home safety modifications, and potentially increased supervision or assistive services.
Difficulty preparing meals does not present an immediate physical safety threat in isolation but clearly signals a need for community resources such as meal delivery programs, homecare assistance, or nutritional support services to ensure the client maintains adequate nutrition and continues to live safely at home.
Shuffling gait is a hallmark motor symptom of Parkinson's disease that significantly increases the risk of falls and injury, making it a direct safety concern. It indicates that the client's mobility and balance place him at ongoing risk, particularly in a two-story home environment.
Vital signs, while important to monitor in a client with hypertension, are not reported as abnormal in this scenario. In the absence of documented abnormalities, vital signs represent a stable finding that requires routine monitoring rather than urgent intervention.
Missed medications in a client with Parkinson's disease and hypertension is both a safety concern and a need for community resources. Missed doses of Parkinson's medications can lead to rapid motor deterioration, and missed antihypertensive medications increase the risk of cardiovascular events. Community resources such as medication management programs, pharmacy blister packs, or homecare nursing visits may be needed to ensure consistent medication adherence.
An 8-pound weight loss is a safety concern because it may indicate malnutrition, disease progression, or depression, all of which can accelerate functional decline and increase vulnerability to illness. It also reflects a need for community resources such as nutritional assessment, dietary support, and meal assistance programs to address the underlying cause and prevent further deterioration.
2. With incontinence training for bladder control, the nurse should:
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Increase fluids during the daytime hours and toilet every 1000 mls.
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Restrict fluids during the nighttime hours and toilet the patient at his or her request.
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Increase fluids, especially during the evening hours, and toilet the patient every 4 hours.
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Increase fluids during the daytime hours and toilet patient every two hours.
Explanation
Explanation
Correct Answer: (D) Increase fluids during the daytime hours and toilet patient every two hours.
Bladder training for incontinence involves encouraging adequate fluid intake during daytime hours to maintain bladder tone and establish a predictable voiding pattern, while avoiding excessive evening fluids to reduce nocturia. Toileting the patient on a scheduled basis every two hours establishes a consistent routine that helps retrain the bladder, reduces urgency episodes, and prevents incontinence by ensuring the bladder does not become overfull between voidings. This structured, time-based approach is the foundation of evidence-based bladder retraining programs.
Why the other options are incorrect:
A. Toileting every 1000 mls is not a standard or clinically recognized approach to bladder training. Toileting schedules are based on time intervals rather than fluid volume thresholds, making this an impractical and unsupported method.
B. Toileting the patient only at their request is a reactive rather than a proactive strategy and does not constitute structured bladder training. Patients with incontinence often have impaired urgency recognition, making self-initiated toileting insufficient to retrain the bladder effectively.
C. Increasing fluids during the evening hours is counterproductive for bladder training because it increases the likelihood of nighttime incontinence and nocturia. Fluids should be encouraged during the day and tapered in the evening to promote nighttime continence.
Correct Answer: (D) Increase fluids during the daytime hours and toilet patient every two hours.
Bladder training for incontinence involves encouraging adequate fluid intake during daytime hours to maintain bladder tone and establish a predictable voiding pattern, while avoiding excessive evening fluids to reduce nocturia. Toileting the patient on a scheduled basis every two hours establishes a consistent routine that helps retrain the bladder, reduces urgency episodes, and prevents incontinence by ensuring the bladder does not become overfull between voidings. This structured, time-based approach is the foundation of evidence-based bladder retraining programs.
Why the other options are incorrect:
A. Toileting every 1000 mls is not a standard or clinically recognized approach to bladder training. Toileting schedules are based on time intervals rather than fluid volume thresholds, making this an impractical and unsupported method.
B. Toileting the patient only at their request is a reactive rather than a proactive strategy and does not constitute structured bladder training. Patients with incontinence often have impaired urgency recognition, making self-initiated toileting insufficient to retrain the bladder effectively.
C. Increasing fluids during the evening hours is counterproductive for bladder training because it increases the likelihood of nighttime incontinence and nocturia. Fluids should be encouraged during the day and tapered in the evening to promote nighttime continence.
3. The newly admitted postoperative patient is experiencing acute incontinence. The patient is distressed, stating "I have never had this problem before. What could be causing it?" The nurse replies. Choose all that apply.
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"It could be related to the immobility you are experiencing with your hip fracture."
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"I am sending a urine sample to see if you have a UTI. If you do, that could be a cause."
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"The diarrhea you are having can contribute to urinary incontinence."
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"Anesthesia medication can cause urinary incontinence."
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"Your blood sugar was low today. That can cause incontinence."
Explanation
Explanation
Correct Answers: (A), (B), (D)
Immobility related to a hip fracture is a well-recognized cause of functional incontinence, where the client is unable to reach the toilet in time due to physical limitations rather than a loss of bladder control itself. A urinary tract infection is one of the most common and treatable causes of acute incontinence and should always be investigated in a newly incontinent postoperative client. Anesthesia and sedating medications used perioperatively can temporarily impair the neurological pathways that control bladder function, leading to transient urinary incontinence in the immediate postoperative period.
Why the other options are incorrect:
C. Diarrhea is associated with fecal or bowel incontinence, not urinary incontinence. While both involve loss of elimination control, they involve separate physiological mechanisms and organ systems. Attributing urinary incontinence to diarrhea would be clinically inaccurate and potentially confusing to the patient.
E. Low blood sugar, or hypoglycemia, does not directly cause urinary incontinence. While severely altered consciousness from profound hypoglycemia could theoretically impair bladder control, a single episode of low blood sugar is not a recognized or documented cause of acute urinary incontinence and would not be an appropriate explanation to offer the patient.
Correct Answers: (A), (B), (D)
Immobility related to a hip fracture is a well-recognized cause of functional incontinence, where the client is unable to reach the toilet in time due to physical limitations rather than a loss of bladder control itself. A urinary tract infection is one of the most common and treatable causes of acute incontinence and should always be investigated in a newly incontinent postoperative client. Anesthesia and sedating medications used perioperatively can temporarily impair the neurological pathways that control bladder function, leading to transient urinary incontinence in the immediate postoperative period.
Why the other options are incorrect:
C. Diarrhea is associated with fecal or bowel incontinence, not urinary incontinence. While both involve loss of elimination control, they involve separate physiological mechanisms and organ systems. Attributing urinary incontinence to diarrhea would be clinically inaccurate and potentially confusing to the patient.
E. Low blood sugar, or hypoglycemia, does not directly cause urinary incontinence. While severely altered consciousness from profound hypoglycemia could theoretically impair bladder control, a single episode of low blood sugar is not a recognized or documented cause of acute urinary incontinence and would not be an appropriate explanation to offer the patient.
4. 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?
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Obtain urine cultures on all residents with a catheter weekly.
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Restrict fluid intake.
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Review catheter necessity daily and remove catheters as soon as possible.
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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.
5. The LPN assesses the long-term care resident is not sleeping well. What actions would help alleviate sleep disturbances? Choose all that apply.
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Ensure patient has a nap for at least 2 hours during the afternoon.
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Limit po fluids after 6 pm.
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Avoiding caffeine in the afternoon and evening.
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Move patient to a room closer to the nurse's station.
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Provide activities throughout the day.
Explanation
Explanation
Caffeine is a central nervous system stimulant that interferes with the ability to fall and stay asleep. Eliminating caffeine intake in the afternoon and evening is a well-established sleep hygiene intervention that directly reduces sleep latency and nighttime wakefulness. Providing meaningful activities throughout the day promotes physical and mental engagement, which supports natural fatigue and a healthier sleep-wake cycle by the time evening arrives, making it easier for the resident to fall asleep at an appropriate hour.
Why Other Options Are Incorrect:
A. Ensuring a nap of at least two hours in the afternoon is counterproductive to nighttime sleep. Prolonged daytime napping reduces sleep pressure, making it harder for the resident to fall asleep at night and potentially worsening the existing sleep disturbance.
B. Limiting all oral fluids after 6 pm is not an evidence-based sleep intervention and poses a risk of dehydration, particularly in older adults who are already vulnerable to inadequate fluid intake. While limiting excessive fluid intake close to bedtime may reduce nocturia, a blanket restriction from 6 pm is too broad and potentially harmful.
D. Moving the patient to a room closer to the nurse's station would expose the resident to increased noise, light, and activity during the night, all of which are known disruptors of sleep quality. This intervention would be more likely to worsen sleep disturbances rather than alleviate them.
Caffeine is a central nervous system stimulant that interferes with the ability to fall and stay asleep. Eliminating caffeine intake in the afternoon and evening is a well-established sleep hygiene intervention that directly reduces sleep latency and nighttime wakefulness. Providing meaningful activities throughout the day promotes physical and mental engagement, which supports natural fatigue and a healthier sleep-wake cycle by the time evening arrives, making it easier for the resident to fall asleep at an appropriate hour.
Why Other Options Are Incorrect:
A. Ensuring a nap of at least two hours in the afternoon is counterproductive to nighttime sleep. Prolonged daytime napping reduces sleep pressure, making it harder for the resident to fall asleep at night and potentially worsening the existing sleep disturbance.
B. Limiting all oral fluids after 6 pm is not an evidence-based sleep intervention and poses a risk of dehydration, particularly in older adults who are already vulnerable to inadequate fluid intake. While limiting excessive fluid intake close to bedtime may reduce nocturia, a blanket restriction from 6 pm is too broad and potentially harmful.
D. Moving the patient to a room closer to the nurse's station would expose the resident to increased noise, light, and activity during the night, all of which are known disruptors of sleep quality. This intervention would be more likely to worsen sleep disturbances rather than alleviate them.
6. The LPN is caring for an 80-year-old female resident who is currently taking furosemide (Lasix) 40 mg bid, digoxin (Lanoxin) 125 mcg daily, and propranolol (Inderal) 20 mg daily. Which of the following laboratory values would be the primary concern to the nurse?
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Sodium level 134 mEq/L (135-145 mEq/L).
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Potassium level 2.5 mEq/L (3.5-5.2 mmol/L).
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Serum creatinine of 1.3 mg/dL (0.7-1.3 mg/dL).
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Glucose level of 135 mg/dl (70-99 mg/dL).
Explanation
Explanation
A potassium level of 2.5 mEq/L is critically low and represents severe hypokalemia. This is the primary concern in this client because furosemide is a potassium-wasting diuretic that significantly increases the risk of hypokalemia. More critically, hypokalemia dramatically increases the risk of digoxin toxicity. Digoxin has a narrow therapeutic index, and low potassium levels sensitize the myocardium to digoxin's toxic effects, potentially causing life-threatening cardiac arrhythmias. The combination of furosemide-induced hypokalemia and concurrent digoxin therapy makes this laboratory value a critical safety priority requiring immediate reporting and intervention.
Why the other options are incorrect:
A. A sodium level of 134 mEq/L is mildly below the normal range, indicating mild hyponatremia. While this warrants monitoring, it is not as immediately life-threatening as the critically low potassium level in the context of concurrent digoxin therapy.
C. A serum creatinine of 1.3 mg/dL falls at the upper limit of the normal range and may reflect mild renal insufficiency, which is worth monitoring in an older adult on diuretic therapy. However, it does not represent the same level of acute danger as the potassium level in this clinical scenario.
D. A glucose level of 135 mg/dL is mildly elevated above the normal fasting range, which may indicate hyperglycemia or a non-fasting specimen. While this warrants follow-up, it does not represent an acute life-threatening emergency comparable to severe hypokalemia in a client on digoxin.
A potassium level of 2.5 mEq/L is critically low and represents severe hypokalemia. This is the primary concern in this client because furosemide is a potassium-wasting diuretic that significantly increases the risk of hypokalemia. More critically, hypokalemia dramatically increases the risk of digoxin toxicity. Digoxin has a narrow therapeutic index, and low potassium levels sensitize the myocardium to digoxin's toxic effects, potentially causing life-threatening cardiac arrhythmias. The combination of furosemide-induced hypokalemia and concurrent digoxin therapy makes this laboratory value a critical safety priority requiring immediate reporting and intervention.
Why the other options are incorrect:
A. A sodium level of 134 mEq/L is mildly below the normal range, indicating mild hyponatremia. While this warrants monitoring, it is not as immediately life-threatening as the critically low potassium level in the context of concurrent digoxin therapy.
C. A serum creatinine of 1.3 mg/dL falls at the upper limit of the normal range and may reflect mild renal insufficiency, which is worth monitoring in an older adult on diuretic therapy. However, it does not represent the same level of acute danger as the potassium level in this clinical scenario.
D. A glucose level of 135 mg/dL is mildly elevated above the normal fasting range, which may indicate hyperglycemia or a non-fasting specimen. While this warrants follow-up, it does not represent an acute life-threatening emergency comparable to severe hypokalemia in a client on digoxin.
7. During a home visit the nurse learns that an older patient recovering from total knee replacement surgery has not been performing daily exercises as prescribed. What action should the nurse take first?
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Document that the patient is noncompliant with the prescribed medical plan.
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Reinforce the safe use of the walker for ambulation.
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Find out why the patient is not motivated to do the exercises.
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Schedule the physical therapist to return to the home to try again.
Explanation
Explanation
Before taking any action, the nurse must first assess the reason behind the patient's non-adherence to the prescribed exercise regimen. The cause may be pain, fear of injury, misunderstanding of the instructions, depression, lack of social support, or a physical barrier such as fatigue or equipment issues. Identifying the underlying reason is essential to developing an individualized and effective intervention. Assessment always precedes intervention in the nursing process, and labeling the patient as noncompliant or scheduling additional services without first understanding the barrier is premature and potentially ineffective.
Why the other options are incorrect:
A. Documenting noncompliance without first exploring the reason is a judgmental and premature action. The term noncompliant does not reflect the complexity of patient behavior and fails to account for the multiple factors that may be preventing the patient from completing the exercises. Assessment must occur before documentation of a conclusion.
B. Reinforcing walker safety is an important component of post-surgical home care but does not address the specific issue of why the prescribed exercises are not being performed. Providing instruction before understanding the barrier may not result in any change in the patient's behavior.
D. Scheduling the physical therapist to return without first identifying why the patient is not exercising does not guarantee a different outcome and may waste resources if the underlying barrier is not addressed. The nurse's first responsibility is to assess the situation before escalating to additional services.
Before taking any action, the nurse must first assess the reason behind the patient's non-adherence to the prescribed exercise regimen. The cause may be pain, fear of injury, misunderstanding of the instructions, depression, lack of social support, or a physical barrier such as fatigue or equipment issues. Identifying the underlying reason is essential to developing an individualized and effective intervention. Assessment always precedes intervention in the nursing process, and labeling the patient as noncompliant or scheduling additional services without first understanding the barrier is premature and potentially ineffective.
Why the other options are incorrect:
A. Documenting noncompliance without first exploring the reason is a judgmental and premature action. The term noncompliant does not reflect the complexity of patient behavior and fails to account for the multiple factors that may be preventing the patient from completing the exercises. Assessment must occur before documentation of a conclusion.
B. Reinforcing walker safety is an important component of post-surgical home care but does not address the specific issue of why the prescribed exercises are not being performed. Providing instruction before understanding the barrier may not result in any change in the patient's behavior.
D. Scheduling the physical therapist to return without first identifying why the patient is not exercising does not guarantee a different outcome and may waste resources if the underlying barrier is not addressed. The nurse's first responsibility is to assess the situation before escalating to additional services.
8. An 88-year-old patient with heart failure participates in a telehealth visit after hospital discharge. Which nursing action best supports safe use of telehealth technology?
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Confirm the patient can hear and view instructions clearly.
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Limit teaching because telehealth is less effective than in-person visits.
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Speak rapidly to complete the visit efficiently.
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Ask the family to answer all questions for the patient.
Explanation
Explanation
Before proceeding with any telehealth encounter, the nurse must first verify that the patient can adequately see and hear the interaction. In older adults, age-related sensory changes such as decreased visual acuity and hearing loss are common and can significantly impair the patient's ability to engage with telehealth technology. Confirming that the patient has a clear audio and visual connection ensures that teaching, instructions, and assessments are communicated and received accurately, forming the foundation of a safe and effective telehealth visit.
Why Other Options Are Incorrect:
B. Limiting teaching because telehealth is perceived as less effective is not supported by evidence and is not an appropriate clinical decision. When conducted properly with attention to the patient's sensory and cognitive needs, telehealth can be an effective and accessible platform for patient education and post-discharge follow-up.
C. Speaking rapidly to increase efficiency undermines communication effectiveness, particularly with older adults who may need more time to process information, ask questions, and respond. Efficient care does not mean rushed care, and rapid speech increases the risk of miscommunication and missed teaching opportunities.
D. Asking family members to answer all questions for the patient removes the patient from their own care conversation, undermines autonomy, and prevents the nurse from accurately assessing the patient's own understanding, concerns, and health status. Family involvement is encouraged, but the patient must remain the primary participant in their own healthcare interactions.
Before proceeding with any telehealth encounter, the nurse must first verify that the patient can adequately see and hear the interaction. In older adults, age-related sensory changes such as decreased visual acuity and hearing loss are common and can significantly impair the patient's ability to engage with telehealth technology. Confirming that the patient has a clear audio and visual connection ensures that teaching, instructions, and assessments are communicated and received accurately, forming the foundation of a safe and effective telehealth visit.
Why Other Options Are Incorrect:
B. Limiting teaching because telehealth is perceived as less effective is not supported by evidence and is not an appropriate clinical decision. When conducted properly with attention to the patient's sensory and cognitive needs, telehealth can be an effective and accessible platform for patient education and post-discharge follow-up.
C. Speaking rapidly to increase efficiency undermines communication effectiveness, particularly with older adults who may need more time to process information, ask questions, and respond. Efficient care does not mean rushed care, and rapid speech increases the risk of miscommunication and missed teaching opportunities.
D. Asking family members to answer all questions for the patient removes the patient from their own care conversation, undermines autonomy, and prevents the nurse from accurately assessing the patient's own understanding, concerns, and health status. Family involvement is encouraged, but the patient must remain the primary participant in their own healthcare interactions.
9. A 72-year-old is planned for discharge from the rehab unit with the diagnosis of terminal cancer involving the pancreas and liver. His daughter is seeking care assistance for him in his home. What services would be the most appropriate recommendations by the care team?
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Skilled nursing facility.
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Nursing home.
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Hospice.
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Adult day care.
Explanation
Explanation
Correct Answer: (C) Hospice.
Hospice care is specifically designed for clients with a terminal diagnosis who have a prognosis of six months or less to live, and whose focus of care has shifted from curative treatment to comfort and quality of life. Since the client has terminal cancer involving the pancreas and liver and the daughter wishes to provide care at home, hospice services are the most appropriate recommendation. Hospice provides in-home comfort-focused nursing care, pain management, emotional and spiritual support, and caregiver education and respite, all of which align with this client's needs and the family's goals.
Why the other options are incorrect:
A. A skilled nursing facility provides intensive rehabilitative or medical care for clients who require professional nursing services but are not yet ready to return home. This setting is not aligned with end-of-life comfort care in the home environment that the daughter is seeking.
B. A nursing home provides long-term custodial care for individuals who cannot live independently but do not require acute medical services. It does not specialize in terminal illness management or provide the comprehensive comfort-focused services that hospice offers.
D. Adult day care provides supervised daytime programming and social activities for older adults who live at home but need structured daytime supervision. It is not equipped to address the complex medical, palliative, and end-of-life needs of a client with terminal cancer.
Correct Answer: (C) Hospice.
Hospice care is specifically designed for clients with a terminal diagnosis who have a prognosis of six months or less to live, and whose focus of care has shifted from curative treatment to comfort and quality of life. Since the client has terminal cancer involving the pancreas and liver and the daughter wishes to provide care at home, hospice services are the most appropriate recommendation. Hospice provides in-home comfort-focused nursing care, pain management, emotional and spiritual support, and caregiver education and respite, all of which align with this client's needs and the family's goals.
Why the other options are incorrect:
A. A skilled nursing facility provides intensive rehabilitative or medical care for clients who require professional nursing services but are not yet ready to return home. This setting is not aligned with end-of-life comfort care in the home environment that the daughter is seeking.
B. A nursing home provides long-term custodial care for individuals who cannot live independently but do not require acute medical services. It does not specialize in terminal illness management or provide the comprehensive comfort-focused services that hospice offers.
D. Adult day care provides supervised daytime programming and social activities for older adults who live at home but need structured daytime supervision. It is not equipped to address the complex medical, palliative, and end-of-life needs of a client with terminal cancer.
10. 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.
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Elevated liver enzymes.
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Reduced creatinine clearance.
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Increased stomach acid production.
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Increased muscle mass.
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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.
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