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Chapter 16: Common Clinical Problems: Physiological
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____
1. When an older adult reports problems with urinary incontinence, the primary goal should be to
a. Prevent urinary tract infections
b. Identify any reversible or treatable cause of the incontinence
c. Ensure that the older person is free from any skin breakdown
d. Select the type of incontinence pad that would allow the older person the most freedom
and protection
____
2. The goal of a bladder retraining program is to
a. Increase the older person’s awareness of incontinent episodes
b. Have the older person void every 2 hours
c. Increase the period of time between voiding
d. Increase the older person’s awareness of the urge to void
____
3. The night nurse reports that, during the night, Mrs. Sherman fell on the floor at the foot of her bed. She was
uninjured but was incontinent of urine and complained that she “could not get to the bathroom because of the
side rails being up.” What is the most appropriate nursing intervention to prevent Mrs. Sherman from falling
again?
a. Put the side rails down during the night
b. Place a commode next to Mrs. Sherman
c. Apply a soft waist restraint on Mrs. Sherman at night
d. Initiate a toileting program for Mrs. Sherman
____
4. The psychological and social impact of incontinence on an older person includes all of the following except
a. Withdrawal from social activities
b. Dementia
c. Depression
d. Diminished self-concept
____
5. One of the most common causes of urinary incontinence in an immobile older person is
a. Fecal impaction
b. Dietary indiscretions
c. Congestive heart failure
d. Lack of awareness of the urge to void
____
6. Diuretics can increase the incidence of urinary incontinence because of
a. Their chemical action on the kidneys that decreases the older person’s awareness of the
urge to void
b. The increase in urine volume
c. The increased potential for older people to be dehydrated while taking these medications
d. Their ability to induce signs and symptoms of diabetes mellitus
____
7. Passive range of motion for an immobilized older adult
a. Replaces the need for ambulation
b. Decreases the risk of falls and skin breakdown
c. Maintains joint flexibility and delays muscle wasting
d. Increases the risk of deep vein thrombosis
____
8. Michael George, 78 years old, has left-sided hemiplegia related to a cerebrovascular accident (CVA) 1 month
ago. He has been very depressed and noncompliant with the physical therapy regimen. Which of the
following nursing interventions is important to initiate to prevent immobility for Mr. George?
a. Force him to participate in the activity program
b. Walk him to the bathroom before and after meals and before bedtime
c. Refer him to the facility social worker for counseling
d. Change his activity program to activities he can do in his wheelchair
____
9. Which of the following normal aging changes increase an older adult’s risk of falling?
a. Decreased cardiac output
b. Decreased aerobic reserve
c. Visual changes
d. Cognitive changes
____ 10. Immobility is a concern for older adults who are a fall risk. Which of the following contributes to immobility?
a. Fear of falling
b. Restorative ambulation program
c. Release of safety restraints
d. Decreasing psychoactive medications
____ 11. Mary Malone, 84 years old, gets up to go to the bathroom three times a night. She has been complaining of
eye problems, extreme fatigue, weakness, unsteadiness, and depression. She asks if this can be related to her
changed sleep pattern. What is the best response to her concerns?
a. “As people get older, they need less sleep”
b. “Changes in sleeping patterns are a normal aging change”
c. “You may be having symptoms of sleep deprivation”
d. “Depression usually changes a person’s sleep patterns”
____ 12. Which of the following is not a risk factor for sleep apnea?
a. Smoking history
b. Hypertension
c. Heart disease
d. Obesity
____ 13. Hannah Frazier, 87 years old, was admitted to the hospital with dehydration. Her family has been concerned
with her increasing forgetfulness at home, but they are very distressed when they come to visit in the evening,
and she is trying to climb out of bed and keeps screaming for help. Her daughter is very tearful because Mrs.
Frazier was acting fine at lunch. What may be the explanation for this change in behavior?
a. Relocation trauma
b. Sundown syndrome
c. Reaction to medications
d. Dehydration
____ 14. An example of an iatrogenic disorder includes
a. CVA
b. Pressure ulcers
c. Sensory loss
d. Diabetes mellitus
____ 15. Immobility is a serious risk factor for older adults. Immobility can result in all of the following except
a. Bone dissolution
b. A decrease in muscle strength equal to 5% per day
c. Parkinson’s disease
d. Joint stiffness and decreased range of motion
____ 16. Physical exercise affects the cardiovascular system by
a. Decreasing cardiac response to activity
b. Increasing cardiac output
c. Decreasing cardiac efficiency
d. Maintaining pulse rate in response to activity
____ 17. The most significant and overlooked nursing intervention to promote functional ability for an older adult is to
a. Decrease stressors
b. Promote fluids
c. Ensure safety
d. Maintain and improve mobility
____ 18. Stress incontinence is
a. More common in men
b. Most common in long-term care facilities
c. A sudden loss of small amounts of urine when coughing, laughing, or lifting
d. Caused by bladder obstruction
____ 19. Mr. Howe is an immobile 79-year-old man. He is complaining of leaking urine and constipation. Mr. Howe
probably has
a. A fecal impaction, causing overflow incontinence
b. Diabetes
c. Congestive heart failure
d. Alzheimer’s disease
____ 20. The advantage of passive range of motion (ROM) for an older adult is to
a. Decrease the risk of skin breakdown
b. Decrease the need for ambulation
c. Maintain joint flexibility and decrease muscle wasting
d. Cure deep vein thrombosis
____ 21. Patients with Parkinson’s disease frequently have a shuffling gait and use assistive devices for ambulation.
These individuals have a high fall risk because of
a. Their gait and balance
b. Ability to use their walker and mental status
c. Posture and mental status
d. Posture and ability to use their walker
____ 22. Which situation would not increase an older adult’s fall risk?
a. Having children’s toys and books scattered around the room
b. Mood lighting
c. Large sunroom with clear path to bedroom and bathroom
d. Small bathroom with toilet, sink, and tub
____ 23. Which of the following statements is false?
a. Meat is the most expensive source of protein and iron
b. Carbohydrates and fats are filling, less expensive, and equally nutritious as protein
c. Vitamin-rich foods are necessary but not necessarily expensive
d. Pastas, grains, and breads are examples of carbohydrates
____ 24. Mr. Mitchell is 88 years old. He refuses to come to meals, and when he does, he cannot sit down long enough
to eat. His daughter has commented that his clothes are hanging from his body. To improve his nutritional
status, you
a. Use body restraints for meals
b. Increase his food choices
c. Call the physician for medication to alter his behavior
d. Provide him with sandwiches, small pieces of fruit and cheese, and spill-proof drink
containers
____ 25. Alterations in mobility result primarily from problems with which of the following body systems?
a. Respiratory system
b. Cardiovascular system
c. Musculoskeletal system
d. All of the above
____ 26. The mnemonic DRIP aids in remembering possible causes of acute incontinence. The letters refer to all of the
following except
a. Delirium
b. Renal stones
c. Infection
d. Pharmaceutical and psychological
____ 27. Causes of constipation in an older adult may include all of the following except
a. Aluminum-containing antacids
b. Diuretics
c. Antibiotics
d. Sedatives
____ 28. What percentage of nursing home residents with pressure ulcers die from them?
a. 25%
b. 66%
c. 10%
d. 40%
____ 29. A stage III pressure ulcer is characterized by
a. Full-thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle,
bone, or supporting tissue
b. Partial-thickness skin loss involving the epidermis or dermis
c. Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue down to,
but not involving, the fascia
d. A nonblanchable erythema
____ 30. Care of pressure ulcers should include all of the following except
a. Frequent change of position
b. Daily bath
c. Adequate nutrition
d. Use of gel-filled mattresses
____ 31. An example of an iatrogenic disorder is
a. A broken hip caused by falling after taking a sedative to help with sleeping
b. Community-acquired pneumonia
c. CVA
d. URI
True/False
Indicate whether the statement is true or false.
____
1. Older adults with an acute illness should be put on prolonged bed rest to promote healing.
Chapter 16: Common Clinical Problems: Physiological
Answer Section
MULTIPLE CHOICE
1. ANS: B
Causes of incontinence—such as urinary tract infections, enlargement of the prostate, and inability to get to
the bathroom in time to void—all can be reversed with nursing or medical intervention. Responses A, C, and
D all are nursing interventions for an older adult experiencing incontinence.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Genitourinary
2. ANS: C
Bladder retraining attempts to increase the capacity of the bladder and increase the time between voiding.
Responses A, B, and D all can be components of various bladder programs but are not specific to a bladder
retraining program.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Genitourinary
3. ANS: D
Toileting programs can reduce the incidence of an older adult’s attempting to go into the bathroom without
assistance. Removing side rails (response A) and using restraints (response C) are not good choices.
Commonly, older adults who are restrained have an increased incidence of incontinence. Lowering the side
rails and placing a commode at the bedside (response B) would improve the older adult’s access to toileting
facilities but would not decrease the older adult’s risk of falling.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Genitourinary
4. ANS: B
Urinary incontinence does not cause dementia, but many demented older adults have problems with
incontinence. Responses A, C, and D are noted with older adults who are incontinent.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Genitourinary
5. ANS: A
Fecal impaction, a large amount of stool in the bowel, increases intra-abdominal pressure and places pressure
on the bladder, causing urinary incontinence. Dietary indiscretions (response B) and congestive heart failure
(response C) are not causes of urinary incontinence. Lack of awareness of the urge to void (response D) is not
caused by immobility.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Genitourinary
6. ANS: B
The diuretic effect of diuretic medications causes an increase in urine output. Although diuretics can
contribute to dehydration (response C), they do not cause urinary incontinence. Responses A and D are
incorrect. Diuretics do not induce diabetes mellitus or change the awareness of the urge to void.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Genitourinary
7. ANS: C
Passive range of motion helps to maintain joint flexibility and delay muscle wasting associated with
immobility. Passive range of motion does not replace the need for ambulation (response A), decrease the risk
of falls or skin breakdown (response B), or increase the risk of deep vein thrombosis (response D).
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Musculoskeletal
8. ANS: B
Ambulating Mr. George daily would facilitate his mobility, even if he is not following the physical therapy
program. Forcing Mr. George to participate in the physical therapy program (response A) is inappropriate if
he chooses not to participate. Referral to the social worker (response C) and providing him with activities that
he can do in his wheelchair (response D) are appropriate nursing interventions but would not prevent
immobility.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Musculoskeletal
9. ANS: C
Decreased night vision and accommodation, decreased visual acuity, and decreased peripheral vision place an
older adult at risk for falling. Responses A, B, and D are normal aging changes that do not have a direct effect
on the risk of falling.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Visual
10. ANS: A
When an older adult fears falling, he or she becomes more sedentary and risks becoming immobile.
Responses B, C, and D all are activities that decrease risk of falls and immobility.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Musculoskeletal
11. ANS: C
The symptoms that Mrs. Malone reports and the increased nocturia make sleep deprivation a clear concern.
This response also provides the opportunity to refer her to a physician to treat the nocturia and discuss
possible ways to promote rest and sleep. Responses A, B, and D are true, but they are not sensitive to Mrs.
Malone’s concerns and the seriousness of her symptoms.
PTS: 1
KEY: Nursing Process Step: Assessment | Patient Care Area: Mental health
12. ANS: A
A history of smoking is not a reported risk factor for sleep apnea. Hypertension (response B), heart disease
(response C), and obesity (response D) all are risk factors for the development of sleep apnea.
PTS: 1
KEY: Nursing Process Step: Assessment | Patient Care Area: Respiratory
13. ANS: B
Sundown syndrome is an unexplained exacerbation of confusion in the evening and nighttime hours.
Relocation (response A), medication side effects (response C), and dehydration (response D) all can increase
confusion. The difference that defines this problem as sundown syndrome is the increased confusion at the
end of the day.
PTS: 1
KEY: Nursing Process Step: Assessment | Patient Care Area: Mental health
14. ANS: B
This question is easily answered if you are clear on the definition of iatrogenic disorders. They are disorders
that a patient acquires as a result of receiving treatment by a physician, nurse, or other member of the
health-care team. An iatrogenic disorder also can occur when a patient does not receive a treatment when it
was indicated or receives an incorrect treatment.
PTS: 1
KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable
15. ANS: C
Parkinson’s disease is affected by immobility, but it is not caused by immobility.
PTS: 1
KEY: Nursing Process Step: Nursing Assessment | Patient Care Area: Musculoskeletal
16. ANS: B
Physical exercise increases cardiac output. Immobility prevents physical activity from creating increased
cardiac output. Responses A, C, and D are incorrect.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Cardiovascular
17. ANS: D
An upright position promotes increased bone mass, muscle strength, and psychological well-being.
Maintaining and improving mobility is essential. Fluids, safety, and stressors are important, but they do not
increase functional ability.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Musculoskeletal
18. ANS: C
Stress incontinence is a sudden loss of small amounts of urine when coughing, laughing, or lifting. It is more
common in women than in men, often as a result of damage to the pelvic floor muscles during childbirth
(response A). Urge incontinence, not stress incontinence, is most common in long-term care facilities, where
individuals may not get the immediate help they need (response B). Overflow incontinence is caused by
bladder outlet obstruction creating impaired emptying (response D).
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Genitourinary
19. ANS: A
A fecal impaction causes a bladder outlet obstruction, which can cause overflow urinary incontinence. Signs
and symptoms include constipation and frequent dripping urine. Responses B, C, and D are incorrect.
PTS: 1
KEY: Nursing Process Step: Assessment | Patient Care Area: Genitourinary
20. ANS: C
Passive ROM delays muscle wasting and maintains joint mobility (response C). Nothing can replace the need
for ambulation (response B), although it is not always possible. Passive ROM may decrease the risk of skin
breakdown (response A) as blood circulation improves, but it is not always the primary benefit. Response D is
incorrect; ROM activities cannot cure deep vein thrombosis.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Musculoskeletal
21. ANS: A
Shuffling gait, caused by the inability to lift the foot totally off the floor for each step, and lack of balance
place these patients at a high risk for falls. Although posture may be stooped and mental status may be cloudy
(response C), these would not affect the fall risk. Ability to use a walker may affect fall risk, but it would
decrease it.
PTS: 1
KEY: Nursing Process Step: Assessment | Patient Care Area: Musculoskeletal
22. ANS: C
Poor lighting, clutter, and narrow spaces increase an older adult’s risk of falling. Large, bright, open spaces
allow for greater ease of mobility.
PTS: 1
KEY: Nursing Process Step: Planning | Patient Care Area: Safety
23. ANS: B
Carbohydrates and fats are not as nutritious as proteins. Responses A, C, and D are true statements.
PTS: 1
24. ANS: D
KEY: Nursing Process Step: Assessment | Patient Care Area: Nutrition
Restraining (response A) or medicating (response C) would not increase his nutritional intake. Offering more
choices (response B) may or may not be beneficial. Carrying his food and drink with him adjusts his meals to
accommodate for his behaviors and probably would be effective.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Nutrition
25. ANS: D
The process of aging, combined with the presence of any chronic diseases, places an older adult at risk for
immobility and its consequences. Normal aging changes and any disorders affecting the musculoskeletal,
cardiovascular, and respiratory systems are major causes of immobility. Changes in vision are also important
factors contributing to immobility.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Mobility
26. ANS: B
Renal stones (response B) do not contribute to incontinence. Delirium, restricted mobility, infection, and
pharmaceutical or psychological concerns contribute to incontinence.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Genitourinary
27. ANS: C
Antibiotics do not generally contribute to constipation; they contribute to diarrhea. Certain antacids, diuretics,
and sedatives, along with other drugs, can lead to constipation.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Gastrointestinal
28. ANS: B
Approximately 66% of residents in nursing homes who develop pressure ulcers die. Pressure ulcers are a very
serious health problem that can lead to pain, prolonged hospital stays, and infection.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Integumentary
29. ANS: C
A stage III pressure ulcer manifests as a deep crater. It involves full-thickness skin loss involving damage to
or necrosis of subcutaneous tissue down to, but not involving, the fascia. Response A describes a stage IV
pressure ulcer; response B, a stage II pressure ulcer; and response D, a stage I pressure ulcer.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Integumentary
30. ANS: B
Older adults do not need daily baths. Excessive bathing and rubbing while drying can damage the skin.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Integumentary
31. ANS: A
An iatrogenic disorder occurs as a result of a treatment by a physician, nurse, or other member of the
interdisciplinary team or from incorrect or nonexistent treatment. The sedative made the patient groggy,
resulting in a fall and broken hip. Although URI can be iatrogenic, resulting from catheter use, it may also
have other causes. CVA and community-acquired pneumonia are incorrect responses.
PTS: 1
TRUE/FALSE
1. ANS: F
KEY: Nursing Process Step: Implementation | Patient Care Area: Not applicable
In contrast to a younger patient, an older adult who is on bed rest deteriorates rapidly and may develop
irreversible complications, such as pneumonia, contractures, thrombophlebitis, constipation, dehydration, and
psychological problems related to depression and sensory deprivation.
PTS: 1
KEY: Nursing Process Step: Implementation | Patient Care Area: Rest