An older female patient is experiencing fatigue, nausea, vague complaint of intermittent chest discomfort, and not sleeping well. How should the nurse interpret these symptoms?
- Signs of anemia
- Pancreatic disease
- Myocardial infarction
- Normal changes of aging
3
- myocardial infarction includes sx of:
- fatigue, nausea, intermittent chest discomfort, not sleeping well
During a blood pressure screening at a pharmacy an older person experiences a fluttering in the chest. What should the nurse interpret this finding as being?
- Hypothyroidism
- Exercise intolerance
- Nonspecific cardiac changes with aging
- Underlying illness that requires a medical evaluatio
4
- new onset atrial fibrillation and other arrhythmias may signal the onset of a serious underlying illness that requires further medical evaluation.
- Chest fluttering= sign of hyperthyroidism.
An older patient has a blood pressure reading of 150/88. The patient reports no other symptoms or medical history of illness. What should the nurse instruct the patient to do?
- Have the blood pressure rechecked in a month.
- Do nothing since this is a normal variant of aging.
- Go to the emergency department for further evaluation and treatment.
- Contact the primary care provider for further evaluation and treatment.
4
*If left uncontrolled, high systolic pressure can lead to stroke, myocardial infarction, heart failure, kidney damage, blindness, or other conditions. Although it cannot be cured once it has developed, isolated systolic hypertension (ISH) can be controlled.
During a home visit the nurse learns that an older patient with hypertension takes prescribed medications only when feeling tense. What instruction should the nurse provide to the patient?
- Contact the physician for a change in blood pressure medication.
- Continue to administer the blood pressure medication as needed.
- Teach to take the blood pressure medication as prescribed regardless of feeling tense.
- Instruct to take a double dose of the medication for one day then resume the normal schedule.
3
*Patients sometimes mistakenly take blood pressure medication only on an as-needed basis. This is incorrect and the patient should take the medication as prescribed on a daily basis.
The nurse is planning care for an older patient with hypertension who recently fell in the home. Which assessment would the nurse plan for this patient?
- Check serum sodium levels.
- Check serum creatinine levels.
- Check postural blood pressures.
- Check blood pressure every 2 hours
3
*Since baroreceptors are less efficient with aging, postural hypotension is more likely to occur. Also, patients treated for hypertension could have an increase in sensitivity to the medications. Postural blood pressure assessment allows the nurse to prevent postural hypotension and falls.
The nurse is planning a presentation to a group of senior citizens on lifestyle modifications to manage high blood pressure. What major points will the nurse include in this presentation?
Standard Text: Select all that apply.
1. Keep sodium intake to 2.4 grams per day.
2. Achieve and maintain a normal body mass index.
3. Perform aerobic activity for 30 minutes most days of the week.
4. Limit daily alcohol intake to two drinks for males and one drink for females.
5. Consumption of fruits and whole grains has little impact on blood pressur
1,2,3,4
An older patient who is prescribed doxazosin mesylate (Cardura) has a lying blood pressure of 124/76 mm Hg and a sitting blood pressure of 100/64 mm Hg. What additional observation is needed for this patient?
- Fall risk
- Nausea and vomiting
- Decreased urine output
- Change in mental status
1
*The patients blood pressure values indicate postural hypotension. In addition, the patient is taking a medication that is an alpha blocker, which increases the risk for postural hypotension. Both factors would place the patient at a risk for falls.
The nurse is providing discharge instructions for an older patient who is prescribed atorvastatin (Lipitor) for elevated cholesterol. What effects should the nurse advise the patient to report to the healthcare provider?
Select all that apply.
- Headaches
- Stomachache
- Shortness of breath
- Muscle pain and weakness
- Bruising and excessive bleding
2,4
*side effects of satin medications include GI distress, muscle pain and weakness
An older patient has an increase in pitting edema of both ankles and is experiencing breathlessness. The patient is not experiencing any pain. What action should the nurse take to help the patient at this time?
- Allow the patient to rest.
- Measure intake and output.
- Measure the patients weight.
- Contact the physician for further evaluation and treatment
4
*The absence of chest pain in the older person does not indicate an absence of ischemic heart disease. Older adults can present with fatigue, weakness, shortness of breath, and gastrointestinal complaints. The nurse needs to contact the physician for further evaluation and treatment.
An older patient with a history of atrial fibrillation has a fall at home and is diagnosed with a hemorrhagic stroke. What will the nurse assess to help determine the cause of this patients bleeding? Select all that apply.
- Current INR
- Platelet level
- Liver function studies
- Hemoglobin and hematocrit
- Dose of warfarin sodium (Coumadin) taken at home
1, 5
An older patient asks the nurse what holistic actions can be used to help lower elevated cholesterol and triglyceride levels. What information should the nurse provide to the patient? Select all that apply.
- Increase dietary fiber.
- Eat fatty fish twice a week.
- Use margarine with phytosterols.
- Increase the intake of soy products
- Limit red meat consumption to 6 days a week
1,2,3,4
When teaching an older patient about the side effects of furosemide (Lasix), the nurse should instruct the patient to eat foods high in which mineral?
- Iron
- Sodium
- Calcium
- Potassium
4
*Lasix is a loop diuretic that depletes the potassium level. Patients who take potassium-depleting diuretics like Lasix should eat foods that replace the electrolyte.
An older patient is diagnosed with heart failure. During the health history what will the nurse most likely assess as the patients first symptom of the disorder?
- Nausea
- Dyspnea
- Anorexia
- Headaches
2
*heart failure symptoms= dyspnea, breathlessness
The nurse instructs an older patient with hypertension on ways to avoid the intake of sodium. Which food item should the patient state to avoid as an indication that instruction has been effective?
- Onions
- Maple syrup
- Lemon juice
- Processed meats
4
*Processed meats are high in sodium
An older patient being treated for hypertension experiences lightheadedness when getting up in the middle of the night to void and when making sudden movements. How should the nurse instruct this patient?
- Restrict activity to 10 minutes a day.
- Increase caffeine intake to help increase blood pressure.
- Move slowly from a lying to a sitting position and then slowly from sitting to standing.
- Decrease fluid intake in the evening to prevent the need to get up in the middle of the night
3
*prevent orthostatic hypotension
An older patient is prescribed a beta blocker to treat hypertension. What effects will the nurse instruct the patient to report to the healthcare professional? Standard Text: Select all that apply. 1. Fatigue 2. Dry cough 3. Dry mouth 4. Cold extremities 5. Exercise intolerance
1,4,5
The nurse is planning care for an older patient with heart failure who is experiencing shortness of breath. Upon assessment the patient stated the inability to purchase medication because of financial limits. Which nursing diagnoses will be of the greatest initial importance when planning care?
- Fluid Volume Excess
- Fatigue related to shortness of breath
- Activity Intolerance related to shortness of breath
- Ineffective Management of Therapeutic Regime related to inability to purchase medications
1
The nurse is planning to assess an older patient’s functional health patterns for cardiovascular disease. Which question will the nurse use to assess the patient’s nutrition/metabolic pattern?
- Do you sleep through the night?
- Do you weigh yourself every day?
- How often do you have a bowel movement?
- How far can you walk without getting short of breath?
2
An older patient with angina complains of prolonged and severe pain that occurs at the same time each day during rest. There are no precipitating factors to the pain. How should the nurse describe this type of angina pain?
- Stable angina
- Unstable angina
- Non-anginal pain
- Atypical angina (Prinzmetal’s angina)
4
*Prinzmetal’s angina also known as atypical angina occurs at the same time each day and typically at rest
The nurse anticipates that an older patient with right-sided heart failure would exhibit which symptoms? Standard Text: Select all that apply. 1. Pallor 2. Edema 3. Wheezing 4. Orthopnea 5. Neck vein distention
2,5
*right sided heart failure= edema, distended neck veins
The nurse is concerned that an older patient is at risk for metabolic syndrome. What did the nurse assess in this patient?
Standard Text: Select all that apply.
1. Heart rate 88 and regular
2. Respiratory rate 18 and regular
3. Waist circumference 40 inches
4. Blood pressure 148/88 mm Hg
5. Fasting capillary blood glucose 110 mg/dL
3,4,5
- Rationale 3: Women’s waist circumference that is equal to or greater than 35 inches is a component to diagnose metabolic syndrome.
- Rationale 4: Blood pressure equal to or greater than 130/85 mm Hg is a component to diagnose metabolic syndrome.
- Rationale 5: Blood glucose equal to or greater than 100 mg/dL is a component to diagnose metabolic syndrome.
During a home visit an older patient with heart disease tells the nurse of plans to shovel the snow as soon as the visit concludes. How should the nurse instruct the patient at this time?
- Shovel the steps only.
- Avoid shoveling at this time.
- Shovel for 30 minutes at a time.
- Shovel for 10 minutes and then stop.
2
*The older heart cannot respond to stressful stimuli as well as the younger heart. The patient should be cautioned not to engage in stressful activities like vigorous shoveling of snow without engaging in a gradual exercise program to build fitness.
An older patient diagnosed with pneumonia does not understand why the health problem occurred since respiratory problems have never been experienced. How should the nurse respond to this patient?
Select all that apply.
- Back joints are stiffer.
- Less oxygen is used with aging.
- Ciliary function decreases with age.
- Retention of carbon dioxide occurs with aging.
- Decreased immune function occurs with aging.
3,5
An older patient with valvular disease is scheduled for an echocardiogram. What should the nurse teach the patient about this diagnostic test?
- Determines the risk for metabolic syndrome
- Analyzes the reasons for high blood pressure
- Visualizes the heart valves as they open and close
- Measures the amount of blood flowing through arteries
3
*An echocardiogram evaluates all heart valve function. This test allows the visualization of the valves as they open and close. Using this test, one can determine valve area, cardiac output, and any regurgitation.
