Medical Surgical Nursing 7th edition Ignatavicius Test Bank

Medical Surgical Nursing 7th edition

Ignatavicius Test Bank
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Medical Surgical Nursing 7th edition Ignatavicius Test Bank

Chapter 3: Common Health Problems of Older Adults

Test Bank

MULTIPLE CHOICE

1. An older client is agitated and develops new-onset confusion on admission to the long-term
care unit. What is the best action for the nurse to take to minimize relocation stress syndrome
for this client?
a. Provide reorientation during hourly rounding.
b. Obtain a certified sitter to remain with the client.
c. Speak to the client as little as possible to avoid overstimulation.
d. Provide adequate sedation to lessen fear-provoking situations.
ANS: A
Many nursing interventions can prove helpful to older adults who experience relocation stress
syndrome. If the client becomes confused, agitated, or combative, the nurse should reorient
the client to his or her surroundings. The nurse also can encourage family members to visit
often, keep familiar objects at the client’s bedside, and work to establish a trusting
relationship with the client.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Stress Management)
MSC: Integrated Process: Nursing Process (Implementation)

2. Which intervention would best support a client who relates a feeling of “loss of control” after
having a mild stroke?
a. Explain that such feelings are normal, but that expectations for rehabilitation must
be realistic.
b. Encourage the client to perform as many tasks as possible and to participate in
decision making.
c. Further assess the client’s mental status for other signs of denial or
psychopathology.
d. Obtain an order for physical and occupational therapy evaluations.
ANS: B
Older adults can experience various losses that affect their sense of control over their lives,
including a decrease in physical mobility. The nurse should support the client’s self-esteem
and increase feelings of competency by encouraging activities that assist in maintaining some
degree of control, such as participation in decision making and performing tasks that he or she
can manage. Obtaining an order for therapy evaluations is a normal part of the rehabilitation
process. The other choices imply that the client’s sense of loss is abnormal after a stroke.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Coping Mechanisms; Grief and Loss)
MSC: Integrated Process: Nursing Process (Implementation)

3. What will the nurse teach the older client with hypertension who complains that “food does
not taste good without salt”?
a. Salt can be used as long as blood pressure remains controlled.
b. All salt should be removed from the diet to preserve kidney function.

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 c. Table salt can be used in small amounts in conjunction with diuretics.
d. Herbs and spices can be substituted to season food.
ANS: D
Physical changes associated with aging can affect the intake of nutrients. Diminished senses
of taste and smell, particularly a decline in the ability to taste sweet and salty, may lead the
older adult to overuse sugar and salt. In such cases, the nurse should recommend that the
client use herbs and spices to season food.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)
MSC: Integrated Process: Teaching/Learning

4. What is a priority nursing intervention to prevent falls for an older adult client with multiple
chronic diseases?
a. Providing assistance to the client in getting out of the bed or chair
b. Placing the client in restraints to prevent movement without assistance
c. Keeping all four siderails up while the client is in bed
d. Requesting that a family member remain with the client to assist in ambulation
ANS: A
Advanced age and multiple illnesses, particularly those that result in alterations in sensation,
such as diabetes, predispose this client to falls. The nurse should provide assistance to the
client with transfer and ambulation to prevent falls. The client should not be restrained or
maintained on bedrest without adequate indication. Although family members are encouraged
to visit, their presence around the clock is not necessary at this point.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
Control—Accident/Injury Prevention)
MSC: Integrated Process: Nursing Process (Implementation)

5. An older adult client is in physical restraints. Which intervention by the nurse is the priority?
a. Assess the client hourly while keeping the restraints in place.
b. Assess the client every 30 to 60 minutes, releasing restraints every 2 hours.
c. Assess the client once each shift, releasing the restraints for feeding.
d. Assess the client twice each shift while keeping the restraints in place.
ANS: B
The application of restraints can have serious consequences. Thus, the nurse should check the
client every 30 to 60 minutes, releasing the restraints every 2 hours for positioning and
toileting. The other answers would not be appropriate because the client would not be
assessed frequently enough, and circulation to the limbs could be compromised. Assessing
every hour and releasing the restraints every 2 hours is in compliance with federal policy for
monitoring clients in restraints.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
Control—Use of Restraints/Safety Devices)
MSC: Integrated Process: Nursing Process (Implementation)
6. An older adult client has become agitated and combative toward health care personnel on the
unit. What is the first action that the nurse will take?
a. Obtain an order for a sedative-hypnotic medication to reduce combative behavior.
b. Attempt to soothe the client’s fears and reorient the client to surroundings.
c. Obtain an order to place the client’s arms in restraints to protect personnel.
d. Arrange for the client to be transferred to a mental health facility.
ANS: B
The nurse should establish a trusting relationship with the client, soothe the client’s fears, and
reorient the client to the facility before resorting to physical or chemical restraints. Restraints,
both physical and chemical, may be overused in certain situations. Sedative-hypnotic drugs
may have adverse effects in older adults and should be used sparingly. Physical restraints also
can have serious repercussions. Transfer to a mental health facility requires evaluation by
psychiatric staff and may not be appropriate here.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
Control—Accident/Injury Prevention)
MSC: Integrated Process: Nursing Process (Implementation)

7. An older adult client presents with signs and symptoms related to digoxin toxicity. Which
age-related change may have contributed to this problem?
a. Increased total body water
b. Decreased renal blood flow
c. Increased gastrointestinal motility
d. Decreased ratio of adipose tissue to lean body mass
ANS: B
Decreased renal blood flow and reduced glomerular filtration can result in slower medication
excretion time, potentially leading to toxic drug accumulation. Aging results in decreased total
body water and gastrointestinal motility and an increase in the ratio of adipose tissue to lean
body mass, but is not related to digoxin toxicity.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 20

TOP: Client Needs Category: Health Promotion and Maintenance (Aging Process)
MSC: Integrated Process: Nursing Process (Assessment)

8. A nurse is assessing a client’s understanding of medication therapy. Which statement

indicates that the client needs further instruction?
a. “My husband is on the same medication, so we always take our medications
together in the morning.”
b. “I prepare all my medication for the week and place the pills in a container labeled
for each day.”
c. “When I don’t sleep well at night, I take two thyroid pills the next day instead of
just one.”
d. “I take my Coumadin every day when the noon news comes on the television.”
ANS: C
Changing the dose of medication without a correct understanding of the drug’s use and
appropriate schedule can cause serious problems. The other statements indicate good
understanding of self-administering medications.
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 character of, 93;
wounded, 99;
death of, 100;
burial of, 100
Jenner, Major, murder of, 215
Jombeni Hills, 87
Jora, measurement of, 53
Jumbi ben Aloukeri, 11, 105, 155, 158, 234, 267
Juma, 14, 176

Kamasia, 136
Karanjui, camp at, 84;
fight at, 324
Karama, 147
Kenia, Mount, 34;
first sight of, 66;
again in sight of, 291;
north of, 137
Kibaba, capacity of, 53
Kibuyu, 54
Kilaluma, 43, 343
Kinangop, Mount, 338, 342
Kinuthia, 49-51
Kinyala, song of, 310
Kiongozi, 12
Kirrimar plain, 253
Kitoma, 53
Kolb, Dr., 5, 11;
account of death of, 156
Koranja, 51;
accompanies us, 59;
trepidation of, 62;
bids us farewell, 63;
meeting with, 349
Koromo, meeting with, 104;
makes blood-brotherhood with El Hakim, 113
Kota, 52
Kriger and Knapp, Messrs., 18;
decide to accompany us, 24;
return of, 35
Kriger’s farm, arrival at, 22;
departure from, 25;
return to, 361
Kundu, 53
Kwa-Ngombe, 345

Leeches, 212
Lemoro, 213
Leopard, 35
Lion, number of, 32;
hunt, 156, 279;
El Hakim’s adventure with, 292, 332, 333
Loads, method of carrying, 16
Lokomogo, 213;
present of, 270
Lolokwe, Mount, 136
Longfield, Capt., 353
Lorian, 3, 4;
news of, 246;
the start for, 246;
 where is it?, 258;
dissertation on, 265
Loroghi Mountains, 5, 137
Lubo, 213;
immense possessions of, 232
Lykipia plateau, 52, 137

Mahogo, 52
Makono, measurement of, 53
Malwa, 13
Manga, 51;
indisposition of, 56;
greeted by, 349
Marabout stork, 39
Maranga, arrival at, 51;
abundance of food in, 52;
departure from, 59;
return to, 349;
peculiar method of crossing a river of people of, 356
Maragua river, 46;
bridge across the, 47;
return to the, 358
Maragua bean, 53
Marathwa river, 352
Marazuki, death of, 128
Marisi-al-lugwa-Zambo plateau, 204-245
Marlé tribe, 228
Marsabit, 222
Masai, 242, 338
Materu, camp at, 62
Mau escarpment, 137
M’biri, visit to, 352
M’bu, arrival at, 64;
hostility of natives of, 67;
an anxious journey, 71;
the guides desert, 74;
farewell to, 73
Metama, 52;
matindi, 53
Midges, attacked by, 178
Milindi, 31
Milk, method of adulteration of, 54
Mineral spring, 161;
salts, 162
Mogogodo, 181
Mogoroni river, 345
Moravi, route across, 81
Morio trees, 135, 160
“Morning Whiffs,” terrible results of, 39;
further experiences with, 55
M’thara, arrival at, 90;
purchasing food in, 91;
description of camp at, 98;
camp in danger, 104;
getting supplies of food in, 113;
departure from, 148;
bad news from, 297;
return to the camp at, 302;
farewell to, 331
Muhindi, 52
Mules, 19;
 accident to one of the, 78
Mumoni Hills, 47
Mumunye, 53
Munipara, 11
Munithu, arrival at, 84;
departure from, 84;
return to, 116;
story of the pillaged goods at, 116;
departure from, 131;
attack on, 319
M’wele, 52

Nairobi, 1, 2, 6, 8, 9;
river, 27;
falls, 27;
the return to, 362
Naivasha, 338
N’dizi, 53
N’Dominuki, chief of M’thara, character of, 89;
declining influence of, 90;
is accused of treachery by the Somalis, 106;
explanation of, 108;
offers himself as guide, 111;
fidelity of, 299
N’doro, 341
Neumann, Mr. A. H., 5;
influence over N’Dominuki of, 89;
acquaintance with Dr. Kolb, 155
Ngare Mussoor, 336
Ngare Nanuki, 337
N’gombe, Mount, 178
Noor Adam, 17;
appearance and character of, 94
Nyemps, 136;
the old men of, 330

Oryx, 183

Papyrus reeds, 26;

swamps, 360, 361
Petrie, Prof. Flinders, 276
Photography under difficulties, 260, 262
Pig, 254
Porters, selecting the, 9
Provisions, selecting the, 8
Python, narrow escape from, 207

Rain, 301, 312

Ramathani, 13, 177, 309;
fright of, 356
Rats, troubled by, 117
Rendili, nomadic habits of, 163;
no signs of, 200;
encampment, 203;
arrival at village of, 211;
chiefs, 213;
flocks, 215;
trading with the, 216;
settlements of the, 221;
appearance and dress of the, 227;
ornaments, 228;
women of the, 228;
fondness for children of the, 229;
propensity to falsehood of the, 231;
 small-pox among the, 232, 238;
fighting qualities of the, 235;
love of begging of, 236;
love of tobacco of, 236;
household utensils, 238;
weapons, 239;
saddlery, 239;
courage of the, 240;
dread of the Masai of the, 241;
return to the camp, 268;
fortifying the camp, 273;
burial places, 275;
departure from the, 274
Rendili sheep, 198, 234
Registration of porters, 16
Resarse ben Shokar, 12, 324, 331
Rhinoceros, Lieut, von Hohnel injured by a, 4;
a delicate situation, 28;
encounters with, 34, 45, 149;
pugnacious disposition of, 164;
hunt on mule-back, 173;
hunt, 182;
shot by El Hakim, 185;
shot by author, 186;
hunt, 198;
large numbers of, 250, 253, 257;
adventure with a, 255;
disturbed at night by, 260;
shot by George, 298;
hunt, 295, 341
Rudolph, Lake, 4, 5, 58

Sabaki river, 31
Sadi ben Heri, 11;
death of, 128
Sagana, 45
Salt, failure to procure, 179;
large plain of, 233
Sand rivers, 200, 290
Sand rats, 212
Seton-Karr, Mr., 276
Sirimon river, 337
Sheba, Mount, 164
Sheep, buying from the Rendili, 268;
death of many of the, 314;
the disposal of, 358
“Sherlock Holmes,” 13;
illness of, 340;
death of, 342
Shooting, useful hints on, 146
Skene, Captain, 358
Smallpox, 59, 232, 238, 354
Somali caravan, start of, 17;
news of the, 83;
attacked by the Wa’Embe, 84;
conference with leaders of, 93;
friction with, 141;
meeting with portion of, 201;
disaster to the, 217;
the alarm in the, 271;
the panic in the, 272
Song of Kinyala, 310
Spot, death of, 263
Sulieman, 12;
desertion of, 259
Swahili porters, character of, 7
Sweinfurth Falls, 46
Swamp Camp, 178, 291
Sycamores, 79

Tana river, 4, 45;

the source of the, 343;
flooded, 350;
attempts to cross the, 351, 355;
across the, 357
Teleki, Count Samuel, 4
Thika-Thika river, 17;
crossing the, 42;
building a bridge across the, 359
Thompson, Joseph, F.R.G.S., 3;
description of Kenia by, 66;
description of Masai by, 242, 332, 333
Thorn forest, 88;
terrible experience with thorns, 205
Ticks, abundance of, 28
Tikiti, 53
Tomori people, 85
Trade goods, list of, 15
T’savo river, 31
Turkana people, 222

Uimbe, 52

Viazi, 52
Victoria Nyanza, Lake, 1, 7
Vikwer, 52
Viseli, 132

Wa’Chanjei, visit of the, 316

Wa’Embe, decision to punish the, 94;
plan of attack, 95;
the start, 96;
ambush by the, 98;
the Burkeneji trading with the, 268
Wa’Gnainu, pillage of our goods by the, 116
Wa’Igani, desire to make blood-brotherhood with us, 81
Wa’Imbe, cordial greeting of the, 79;
conference with the, 80;
audacious proposal of the, 80
Wa’kwafi, 136
Wakamba porters, characteristics of, 7
Waller’s gazelle, 205
Wa’Mbu, bad character of the, 57;
hostility of the, 65;
renewed hostility of the, 67;
interview with the chiefs of, 69;
capture of the chiefs of, 69;
farewell to the, 73
Wandorobbo, description of the, 179;
language of the, 181;
guides, 194;
desertion of the guides, 195
Wangwana, 7
WaN’yam-wezi porters, characteristics of, 7
Wargasse, Mount, 136
Waso Nyiro, 3, 4;
tiring march to the, 160;
splendid climate of, 175;
 desolate landscape on the, 249;
crossing the, 291;
the source of the, 338
Washenzi, 7
Waterbuck, 184;
capture of young, 292
Wa’Zuka, cordial reception by the, 75
Weapons, list of our, 9, 10
Whistling trees, 332
Witchcraft, 340
Wild dogs, 292

Zanzibar, 7
Zebra, 33, 43, 336, 341
Zuka, entry into, 75;
camp in, 77
Zura, welcome at, 81

THE END.

PRINTED BY WILLIAM CLOWES AND SONS, LIMITED, LONDON AND

BECCLES.
 PART OF
BRITISH EAST AFRICA
Longmans, Green & Co. London, New York & Bombay.
 Transcriber’s Notes
pg 223 Changed: I endeavoured to yet near enough
to: I endeavoured to get near enough
pg 316 Changed: A deputation from the Wa-Chanjei
to: A deputation from the Wa’Chanjei
pg 317 Changed: These ball cartidges contained
to: These ball cartridges contained
pg 329 Changed: an experience which once befel
to: an experience which once befell
Errata changes from page xvi have been made in text.
 *** END OF THE PROJECT GUTENBERG EBOOK AN IVORY
TRADER IN NORTH KENIA ***

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