G8
- 1.
The nurse is reviewing the post surgical laboratory values of an older adult client. The client’s Erythrocyte sedimentation rate (ESR) is 20 mm/hr. The nurse initially responds to this data by:
- A.
A. asking the client if they have been diagnosed with any chronic inflammatory diseases
- B.
B. recognizing that the value is normal for older adults
- C.
C. notifying the client’s health care provider immediately
- D.
D. requesting that the laboratory re-run the test
Correct Answer
B. B. recognizing that the value is normal for older adultsExplanation
ANS: B
The ESR can be slightly elevated (10 to 20 mm/hr) in healthy older adults, especially those with a chronic disease that results in inflammation. Asking the client if they have such a diagnosis is the initial response. This slight elevation does not warrant immediate notification or re-running of the test.Rate this question:
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- 2.
An older client in a long-term care facility is receiving an annual physical and is ordered laboratory tests that include a complete blood count, serum electrolytes, and thyroid tests. When the client’s son questions why these tests are being ordered by saying, “Dad is 85 and supposed to be sleepy,” the nurse’s response is based on an understanding that:
- A.
A. the healthcare provider ordering the tests needs to explain the rationale to the son
- B.
B. when conducted annually, all of the tests are helpful in promoting maximum health for older adults in the long-term care setting
- C.
C. the tests are useful, but only if clinically indicated
- D.
D. the complete blood count and serum electrolytes are useful screening tests, but the usefulness of the thyroid test should be questioned
Correct Answer
B. B. when conducted annually, all of the tests are helpful in promoting maximum health for older adults in the long-term care settingExplanation
ANS: B
Laboratory tests are a fast and accurate way of assessing key parts of an older person’s physical functioning. It is within the nurse’s scope of practice to answer the son’s question and it does not need to be referred to the healthcare provider. The laboratory tests are being used as annual screening, and therefore do not need to be clinically indicated. Excessive sleepiness is not normal in an 85-year-old and may be a sign of a thyroid disorder.Rate this question:
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- 3.
When asked by an older adult client, “What is the difference between my normal laboratory values and the ones for a 55 year old?” The nurse responds based on the understanding that there are:
- A.
A. age-adjusted ranges for older adults for all of the common laboratory findings, similar to those for infants and children
- B.
B. no age-adjusted ranges for older adults due to the large variations within the age group and the increasing number of factors that influence the results
- C.
C. age-adjusted ranges only for the over-85 age-group; there are no expected changes in the 65- to 84-year-old age-group
- D.
D. age-adjusted ranges only for the hematological tests, which are due mostly to changes in the bone marrow
Correct Answer
B. B. no age-adjusted ranges for older adults due to the large variations within the age group and the increasing number of factors that influence the resultsExplanation
ANS: B
There are no age-adjusted ranges for laboratory values due to the variation within the group as well as the many chronic illnesses of older adults. Variations are more likely to be seen the older one is. Although several age-related hematological changes occur mainly from changes in the bone marrow, few are clinically significant.Rate this question:
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- 4.
An older resident of a long-term care facility diagnosed with dementia has in the last 48 hours become more confused than usual and while usually requiring help with toileting has been incontinent of urine. The client’s healthcare provider orders a complete blood count and serum electrolytes. When the lab tests are all within normal limits the nurse initially:
- A.
A. attributes the changes in the resident’s functioning to advancing dementia
- B.
B. suggests that the resident be placed on broad-spectrum antibiotics to prevent infections
- C.
C. speaks with the healthcare provider regarding the changes in the client’s function and the possibility of obtaining a urine culture
- D.
D. changes the plan of care to include bladder training and implement a 24-hour calorie count.
Correct Answer
C. C. speaks with the healthcare provider regarding the changes in the client’s function and the possibility of obtaining a urine cultureExplanation
ANS: C
Waiting for usual signs of infection or illness in older adults can be fatal. In older adults, signs of infection may be absent or not seen until the patient is septic or very ill. The nurse needs to be alert to the subtle changes in the patient. Laboratory values do not always change in older adults, often not until the patient is very ill. Infections are not prevented by placing a patient on broad-spectrum antibiotics. This action may in fact cause bacteria to become drug resistant. All evidence points to the changes in functioning being attributable to acute illness. The nurse needs to respond to the acute illness firstRate this question:
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- 5.
An older woman with breast cancer has completed a course of external radiation and is receiving chemotherapy. After her recent chemotherapy treatment, she complains of severe weakness, dizziness, and lethargy, and is admitted to the hospital. Her platelet count is 45,000. Based on this scenario, what nursing intervention is of the highest priority?
- A.
A. Preventing falls
- B.
B. Maintaining skin integrity
- C.
C. Preventing infection
- D.
D. Replacing fluids
Correct Answer
A. A. Preventing fallsExplanation
ANS: A
Fall prevention is the highest priority. The patient has at least two significant risk factors for falls (unsteady gait and complaints of dizziness). She has a platelet count of 45,000; a platelet count of less than 50,000 makes one at high risk for spontaneous bleeding. The nurse must observe for overt and covert bleeding. If the patient falls, she is very likely to have a significant injury because of the low platelet count. Maintaining skin integrity would be important in this patient because she has received external radiation, which can cause alterations in skin integrity, but this is not as high a priority. Although preventing infection is an important intervention in a patient with cancer who has received radiation and chemotherapy, there is no evidence that this patient has alterations in her laboratory values related to the treatments, so fall prevention is more critical. There are no specific indications that this patient is experiencing a fluid deficit.Rate this question:
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- 6.
A nurse is working in a community health center that is sponsoring a program that offers both digital rectal exams (DRE) and free prostate-specific antigen (PSA) blood tests to all men older than age 60. A man approaches and asks, “What is this all about?” The nurse responds that:
- A.
A. “A PSA test is one of the primary screening tests for prostate cancer.”
- B.
B. “The PSA test is a definitive way to diagnose prostate cancer.”
- C.
C. “A PSA test is indicated when a man has other symptoms of prostate cancer.”
- D.
D. “The PSA test is unreliable unless a digital rectal exam immediately precedes it.”
Correct Answer
A. A. “A PSA test is one of the primary screening tests for prostate cancer.”Explanation
ANS: A
PSA and a digital rectal examination are the two screening tests for prostate cancer. The PSA is a screening test, not a definitive way of diagnosing the condition. PSA is indicated as a screening tool, whether or not symptoms are present. It is recommended that the PSA be drawn before digital rectal examination because the examination can cause increased levels of PSA.Rate this question:
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- 7.
A 69-year-old patient in the geriatric clinic has an annual physical examination and a complete blood count and serum electrolytes are drawn. While the physical examination was uneventful the laboratory results show an elevated blood urea nitrogen (BUN). The nurse will then:
- A.
A. Ask that the test be rerun since the client showed no physical signs of renal failure.
- B.
B. Review the client’s medication list since BUN can be affected by many specific medications.
- C.
C. Instruct the client on collecting a 24-hour urine specimen for a more detailed analysis
- D.
D. Assure the client that an elevated BUN is normal in older adults.
Correct Answer
B. B. Review the client’s medication list since BUN can be affected by many specific medications.Explanation
ANS: B
BUN can be elevated as a result of certain medication therapies and so the nurse should assess for this possibility. An elevated BUN is not diagnostic of renal failure alone and will not necessarily be reflected in physical symptoms. A 24-hour urine sample will not generally done to determine BUN levels. An elevated BUN is not expected as a normal part of aging. Renal functioning decreases substantially with aging, but in most cases the body is able to compensate adequately with only slight increases in laboratory findings.Rate this question:
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- 8.
When a client’s thyroid panel shows an elevated TSH, the nurse reviews the client’s medication history for a current prescription for
- A.
A. Lithium
- B.
B. Heparin
- C.
C. Aspirin
- D.
D. Phenytoin (Dilantin)
Correct Answer
A. A. LithiumExplanation
ANS: A
THS levels can be elevated as a result of lithium therapy while heparin and aspirin ingestion result in a depression in THS. Dilantin can depress T4 levels.Rate this question:
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- 9.
The client is diagnosed with dyslipidemia. This diagnosis is supported when the client’s lipid panel indicates a: Select all that apply
- A.
A. triglyceride level of triglyceride levels (>2000 mg/dL).
- B.
B. Low Density Lipids (LDL) level of 120 mg/dL.
- C.
C. Total Cholesterol level of 260 mg/dL.
- D.
D. High Density Lipids (HDL) level of 70 mg/dL.
- E.
E. Glucose level of 230 mg/dL
Correct Answer(s)
A. A. triglyceride level of triglyceride levels (>2000 mg/dL).
C. C. Total Cholesterol level of 260 mg/dL.
D. D. High Density Lipids (HDL) level of 70 mg/dL.Explanation
ANS: A, C, D
The lipid panel reflecting dyslipidemia would include a triglyceride level >200 mg/dL, Total Cholesterol >240 mg/dL, HDL >60 mg/dL and LDL >160 mg/dL. Glucose would not be included on a lipid panel.Rate this question:
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- 10.
When a client asks “What could be causing my triglycerides to be so low; I’m really careful about my diet?” the nurse responds by asking the client: Select all that apply
- A.
A. “Is your type 2 diabetes well managed?”
- B.
B. “Have you ever been diagnosed with renal failure?”
- C.
C. “Do you have a history of pancreatitis?”
- D.
D. “Are you on medication for hyperthyroidism?”
- E.
E. “Have you ever been diagnosed with malnutrition?”
Correct Answer(s)
D. D. “Are you on medication for hyperthyroidism?”
E. E. “Have you ever been diagnosed with malnutrition?”Explanation
ANS: D, E
Abnormally low triglyceride levels are suggestive of malnutrition or hyperthyroidism. Reasons for elevated levels include chronic renal failure and poorly controlled diabetes. Severely elevated triglyceride levels (>2000 mg/dL) are a strong risk factor for pancreatitisRate this question:
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Mar 22, 2023Quiz Edited by
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May 10, 2013Quiz Created by
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