ADH 2 Topic 2: Gerontological Nursing (prep-u)

A nurse who provides care to many older adults recognizes the importance of implementing a wellness approach to care. What principle underlies this approach to the health care of older adults?

A holistic approach to caring for older adults can foster their well-being at every stage of life.

Despite the fact that older adults are proportionately the highest users of health care services, many nurses harbor misconceptions and deficits in practice related to gerontological nursing. What is the most likely solution to this problem?

Increased nursing education and clinical experience specific to working with older adults

The charge nurse on a gerontological unit must intervene when making which observation?

Nurses are discussing a client's intake and output results in the hallway.

What type of holistic nursing intervention is the nurse demonstrating when teaching simple exercises to prevent complications for the client who is not tolerating movement and activity?

Strengthening self-care capacity

An older client has been diagnosed with aggressive pancreatic cancer and has been told he may only have a few months to live. The client is married and would need to sell all of the couple's assets in order to afford an unproven new treatment. How should the nurse best address this ethical dilemma?

Talk to the client's wife about her feelings on selling their assets.

The nurse manager on a long-term care unit is working on increasing nurse morale and job satisfaction on the unit. What is the best method to make these positive changes?

Test creative and safe staffing patterns

The nurse is frustrated with constantly thinking about things that have to be done. What self-care activity might be helpful to this nurse?

meditation

The nurse conducts a holistic assessment with an older client. On what should the nurse focus when completing this assessment?

needs related to health promotion and challenges

The nurse desires to become a geriatric nurse practitioner. What would be a major reason for the nurse to seek this advanced practice degree?

positively impact the well-being of older clients

The nurse sits down when talking with an older client who is explaining a new symptom. Which healing behavior is the nurse demonstrating?

presence

The gerontological nurse best demonstrates the role of healer by:

promoting clients' optimal function.

The nurse desires to become certified in gerontological nursing but does not want to have to return to school. Which approach will help the nurse meet this goal?

provide care to older clients for 2 years

The nurse wants to increase physical activity but lives alone in a major metropolitan area. What should the nurse do to enhance this self-care practice?

Find out if a co-worker lives nearby who is willing to be a buddy for physical activity

A nurse completes a physical assessment, orders a bone density scan, and prescribes a calcium supplement for an older female. The interventions are within which nurse's scope of practice?

Gerontological advanced practice nurse

A nursing home resident is experiencing prolonged grief and depression after the death of her husband one year ago. Which gerontological nursing specialist would be of greatest assistance for this resident?

Geropsychiatric nurse

The charge nurse should intervene when overhearing a gerontological nurse make which statement to a client?

"If you don't stay in the bed until I get back, I won't give you your pain medicine."

As part of the orientation for nurses new to the palliative care unit, the nurse is teaching new graduates about the nature of palliative care. Which of the following statements by the new nurse indicates a need for further teaching?

"It certainly requires a change in thinking to understand why we don't provide any medical interventions for patients."

The staff development trainer reviews the concept of holistic care with a group of new graduate nurses. Which statement indicates that additional information about this concept is required?

"It reduces the amount of work when giving care."

The gerontological nurse should educate a new staff nurse when the staff nurse makes which statement about older adult health and wellness?

"Access to medical care is the main determinant of health and wellness."

A nursing instructor has overheard a nursing student state, "When I graduate, I want to work somewhere where I'll be challenged. Working in long-term care seems boring." What is the instructor's most appropriate response?

"Gerontological nursing is a multifaceted specialty requiring fine talent."

A nurse who works with older adults is teaching a colleague about the similarities and differences between gerontology and geriatrics. Which question best conveys the focus of gerontology? "How can we reduce the incidence of falls among older adults who live in care facilities?" "How can we help older adults maintain wellness as they age?" "How can we secure more funding for research and development of drugs specifically for older adults?" "How can we teach older adults about the relationship between their lifestyle and their health?"

"How can we help older adults maintain wellness as they age?" Gerontology is the study of aging and older adults, and the focus of the discipline has shifted in recent decades to an emphasis on wellness and healthy, successful aging. As such, a focus on promoting and maintaining wellness best exemplifies the discipline. Geriatrics is associated with the diseases and disabilities of older people, and geriatric medicine is a subspecialty of internal medicine or family practice that focuses on the medical problems of older people.

The nurse is teaching nursing students about the importance of health promotion among older adults. Which of the following statements by the students indicates a need for further teaching?

"I can see why we would want to promote timely discharge back to the community following hospitalization."

A nurse helps older adults increase healthy behaviors by restructuring. Which communication technique should the nurse use to help the older adult overcome barriers? "Let's talk about the benefits of exercise. When you walk regularly you reduce constipation and muscle pain." "Could you walk with your friend for a half hour after you both come back from the lunch program at the senior center?" "I know it's hard to get outside in the winter, so let's try to identify some ways of getting more exercise indoors during your usual activities." "Your activity has been decreasing during the last 3 years and it is at the point that you are at an increased risk for heart disease."

"I know it's hard to get outside in the winter, so let's try to identify some ways of getting more exercise indoors during your usual activities." Restructuring assists the client to use positive thinking to focus on ways of overcoming barriers (e.g., getting outside in winter). Giving suggestions about when and where to walk might be helpful, but it is best if the client develops the plan of action. Talking about the benefits of exercise reinforces rewards. Discussing consequences of inactivity raises the consciousness of the older adult.

The nurse wants to spend more time on developing relationships. Which statement should the nurse use when explaining this intention to the manager at work?

"I will only work one overtime shift per month."

During a home visit a family caregiver explains how caring for the client can be overwhelming at times. Which response by the nurse demonstrates availability?

"This must be challenging for you."

While the nurse is performing a recently admitted hospital client's morning care, the client states, "I'm pretty sure I'll never see my own apartment again." What response by the nurse best demonstrates effective communication?

"What is it that makes you feel that way, ma'am?"

A gerontological nurse is overheard stating, "I'd love to take a retreat but I just can't afford to travel out of town." What is the nurse coworker's best response?

"You can retreat in your own home."

A 71-year-old male is discharged after hip fracture repair. The client expresses disappointment at not being able to drive to church. What is the nurse's best response according to the holistic model of care?

"Your spirituality sounds important to you."

Which internet sites offer evidence-based guidelines when researching gerontological nursing? Select all that apply.

- www.guideline.gov -www.hartfordign.org -www.cochrane.org

When implementing a plan of care addressing constipation for an older adult, what nursing actions are required when partially assisting the client rather than acting for the client? (Select all that apply.)

-Guide the selection of a diet high in roughage and fluids. -Assist with exercises to promote peristalsis.

An older adult with a diagnosis of heart failure has been admitted to the hospital with an exacerbation of his condition. The nurse would recognize that this patient is at risk of experiencing which of the following consequences of heart failure? (Select all that apply)

-Sleep disorders -Hypotension and falls -Arrhythmias -Drug interactions

A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. What action can the nurse take to potentially minimize these expenses for patients and clients?

Become familiar with the various funding sources and their eligibility requirements.

An organization is planning to implement a gerontological care wing in a facility. Which standards should be used to guide the expectations for staff hired to care for the gerontological client?

ANA Scope and Standards of Practice for Gerontological Nursing

An older adult with a history of arthritis is diagnosed with type 1 diabetes mellitus while hospitalized. What is the nurse's priority holistic concern to address at discharge?

Ability to draw up insulin

The gerontological nurse who commits to self-care and nurturing must make which commitment? Minimize contact with clients who are aggressive or agitated. Be available for all clients all the time. Focus solely on self without distraction of building connections. Accept and work through an ever-changing process.

Accept and work through an ever-changing process. Self-care and nurturing require following positive health care practices (involving mind, body, and spirit), strengthening and building connections, and committing to a dynamic process. It is inappropriate and unnecessary for a nurse to avoid a challenging clients. It is unrealistic for nurses to expect to meet every client's needs at all times.

Which statement is true about nursing care of older adults?

Acute care nurses need to know best practices for geriatric care.

A gerontological nurse who works in a public health setting has limited funding for initiatives. Which of the following prevention and health promotion initiatives is most likely to result in significant benefits for the older adults who participate?

An exercise program for older adults who live in the community

An older client who lives alone is being discharged after having an exacerbation of heart failure. What should the nurse do first to meet this client's needs after discharge?

Ask the client what help might be needed in the home

While completing a home health assessment, the nurse discovers that this older adult enjoys sitting alone on the porch while enjoying nature. What is nurse's best initial action?

Ask the older adult about the adjustment to being alone.

An older adult has left-sided weakness following a stroke. How should the gerontological nurse initially promote optimal health and wellness?

Assess mobility limitations.

An adult son is taking his father home to live with him after being discharged from the skilled care unit. The son and his wife are familiar with caring for older adults as they have already cared for the wife's father before he passed away. What should the gerontological nurse first do to prepare this family for discharge?

Assess the son and daughter-in-law's knowledge and skill level.

An older adult is diagnosed with heart failure in addition to existing diabetes mellitus and hypertension. How can the nurse best promote health in this individual?

Assist with scheduling appointments and coordinating care.

The nurse feels a need to spend more time on spiritual health. What action should the nurse take to support this intention?

Attend a Bible study group on Wednesday evenings when able

The nurse manager praises a staff nurse for serving as a model of holism for the nurses on the care area. What behavior did the manager observe to identify the nurse as being this model? Select all that apply. Attends to emotional needs Practices self-care Models expected behavior Completes care activities on time Documents thoroughly

Attends to emotional needs practices self care models expected behavior Effective nurse healers are models of holism, which begins with good self-care practices. They are attentive to their emotional needs and behave as they want others to behave. A model for holism goes beyond thorough documentation and completing care activities on time.

An older female who is widowed and lives alone has fallen at home and suffered a hip fracture. Upon admission, the client is found to be malnourished as well. What is the best nursing action to prevent complications when addressing her need of improved nutrition?

Check the temperature of foods and drinks before offering them to the client.

Which older client does not exhibit an identified self-care deficit?

Client self-injecting insulin according to prescribed sliding scale

The nurse would expect which older client to exhibit adequate self-care knowledge?

Client teaching his neighbor how to properly change a wound dressing

Gerontological nurses can best foster independence in older adults through which nursing action?

Consider inner resources for self-care

Mr. Dey is a 69-year-old man who has been a cigarette smoker since his late teens. In recent weeks, he has asked the nurse who helps manage his diabetes numerous questions about the potential benefits of quitting smoking, a subject that he has normally avoided in past interactions. The nurse has now explicitly asked Mr. Dey if he would like to quit smoking, to which he has replied that he will "give it some serious thought." Mr. Dey is demonstrating what stage of the transtheoretical model (TTM)?

Contemplation

What is the nurse's best holistic nursing action for an older client facing health challenges?

Identify appropriate interventions for health promotion.

The nurse conducts a holistic assessment with an older client. On what should the nurse focus when completing this assessment?

Identify needs related to health promotion

The nurse prepares to complete a holistic assessment with an older client. What should the nurse keep in mind when conducting this assessment?

Identify needs related to health promotion

The nurse is caring for an 81-year-old man whose current hospital admission has been prompted by an exacerbation of his chronic renal failure. The nurse is aware of the importance of fostering his wellness, a goal that can be achieved by emphasizing which of the following?

Exploring the client's abilities and strengths

The nurse is concerned that an older client's need for connection is not being met. What observation caused the nurse to make this clinical determination?

Family lives in another country

The gerontological nurse should teach that meditation has which advantage over other self-care methods?

Does not require special equipment or expertise

A nurse working in a long-term care facility is providing care to a client who is agitated. Which action by the nurse would be most prudent?

Employ alternatives, such as a bed alarm, with increased staff supervision

When preparing for an older adult teaching session, what is the nurse's best action?

Ensure clients' hearing aids work properly.

The nurse explains to a new graduate that gerontological nursing is challenging yet rewarding. What should the nurse emphasize when explaining a challenge of working with the older population?

Greater diversity in health status that uniquely affects acute illnesses

A rural community nurse sets up a monthly disease screening service. Which justification best supports the screenings? Older adults are less responsive to health promotion interventions. Older adults as a group receive fewer prevention and screening services than other populations. Preventive services are less effective after the onset of chronic illness. Health promotion is essential for older adults because they have complex health care needs.

Health promotion is essential for older adults because they have complex health care needs. Health promotion interventions are cost-effective ways of preventing disease and disability and improving functioning and quality of life for older adults. Older adults as a group, however, receive fewer prevention and screening services than other populations. This is due to misperceptions such as (1) older adults are less responsive to health promotion interventions, and (2) preventive services are less effective after the onset of chronic illness. In reality, health promotion is essential for older adults precisely because they have conditions that are more chronic, have complex health care needs, and use considerably more health care services than younger adults.

The gerontological nurse practitioner prepares teaching material about home safety for an older client. Which standard of practice is the nurse implementing with this activity? Health teaching and promotion Outcome identification Prescriptive authority and treatment Planning

Health teaching and promotion Promoting health and a safe environment is implementing the standard of health teaching and promotion. Developing a plan to attain expected outcomes is the implementation of the standard of planning. Identifying expected outcomes to individualize a plan of care is implementing the standard of outcome identification. Using procedures, treatments, and therapies in accordance with state and federal laws and regulations is implementing the standard of prescriptive authority and treatment.

During a home visit the nurse determines that an older client who lives alone is not capable of living safely in the home. Despite discussing this, the client adamantly refuses to relocate or leave the home environment. What action should the nurse take?

Notify the health care provider about the situation

An older gerontological nurse is contemplating retirement. Which self-care method is most effective to allow this nurse to reflect on her career?

Journaling

Which of the following interventions most closely aligns with the practices of health promotion?

Leading a flexibility and mobility class among older adults

According to the holistic model of care, what is the meaning of health?

Mind, body, and spirit balance

What are some characteristics that enable nurses to engage as healers for older adults? Select all that apply.

Modeling holism Being present in the moment Availability of mind, body, and spirit Making connections

Which of the following statements best captures the typical character of health problems in the lives of older adults?

Most older adults experience an interplay between a number of chronic conditions and occasional acute health problems.

What is the best approach for the gerontological nurse to advance the body of knowledge in this field of nursing?

Networking with nurse researchers

A nurse is providing care to a 71-year-old client who is in the late stages of cancer and who has painful bone metastases. The client is nonresponsive but groans and grimaces intermittently. The nurse is drawing up a breakthrough dose of morphine for the client, but a colleague cautions that, "Sure, that will address his pain, but it could depress his respiratory drive and actually kill him at this stage." The colleague's statement prioritizes which ethical principle?

Nonmaleficence

A gerontological nurse has not taken care of herself during a 12-hour shift. She has not taken time to pray as she usually does before work, has not voided, participated in gossip, and allowed a co-worker's negative attitude to affect her mood. Which lack of self-care activity is priority?

Not voiding

The gerontological care area practices the philosophy of holistic care. What should the nurse do to promote wholeness when caring for an older client? Select all that apply.

Promote self-care behaviors Guide to find meaning in life Help to understand purpose in life Facilitate harmony of the mind, body, and spirit

An older adult has decided to go to a hospice after being diagnosed with a terminal illness. How can the nurse best provide holistic care in this situation?

Provide comfort measures for the client.

A 66-year-old woman has been conscientious about her health for her entire adult life and is disappointed at having been recently diagnosed with type 2 diabetes. She had been unwilling to discuss this new diagnosis for the past several weeks but has now begun asking her nurse questions about relevant laboratory tests and the pathophysiology of her disease. What nursing diagnosis is most appropriate for this client?

Readiness for Enhanced Knowledge

A home assessment is completed and a recommendation to remove throw rugs is made. This recommendation is primarily within whose scope of practice guidelines?

Registered nurse

An older female demonstrates the ability to use the stove and microwave to prepare her own meals at home though the process takes her a long time. What is nurse's next best action?

Reinforce the client's capability for self-care.

Which self-care activity is characterized as a withdrawal from normal activities?

Retreat

The nurse works with a program that performs interviews, blood work, and digital rectal exams aimed at identifying older men with benign prostatic hyperplasia (BPH). The program also facilitates bathroom alterations in older adults' homes to ensure men with BPH have easy access to a toilet. Which of the following components of health promotion has yet to be implemented in the program?

Risk reduction interventions

A nurse is working with an older adult female client newly diagnosed with osteoporosis. Which interaction promotes achievement of wellness outcomes? The nurse plans interventions in light of the body-mind-spirit interconnectedness of the client. The nurse performs strength and mobility training appropriate to the client's age and diagnosis. The nurse teaches the client about how the client's risk factors are a consequence of age. The nurse teaches the client about bone density in older women and the role of vitamin D and calcium intake.

The nurse teaches the client about bone density in older women and the role of vitamin D and calcium intake. Teaching about bone density and the role of vitamin D reflects an acknowledgment that the client's diagnosis is attributable to both the client's age-related changes and risk factors such as inadequate nutrient and mineral intake. Strength and mobility training may well be an appropriate intervention, but it does not necessarily acknowledge the interplay of risk factors and age in the client's diagnosis. The body-mind-spirit interconnectedness is a component of the Functional Consequences Theory, but it does not address the relationship between risk factors and age. Teaching about risk factors as a consequence of age implies that these factors are an inevitable consequence of age, which is not the case.

Staff members at a nursing home have been reminded by management of their responsibility to utilize the Minimum Data Set (MDS) for Resident Assessment and Care Screening. When should the MDS be used?

Upon resident admission and every 3 months after that

The staff development instructor prepares information about aging for a group of newly hired graduate nurses to staff the gerontological care area. What should the nurse emphasize as a principle of this type of nursing practice?

Various factors influence the aging process

The nurse helps an older client sign up for a needed home care service. In which capacity is this nurse functioning? healer educator innovator advocate

advocate Advocacy includes aiding older adults in asserting their rights and obtaining required services. As a healer the nurse helps the older client stay well, overcome or cope with disease, restore function and find meaning and purpose in life. As an educator the nurse shares knowledge and skills related to the care of older clients. As an innovator, the nurse makes conscious decisions and exercises efforts to improve gerontological practice.

An older client takes 30 minutes to complete morning care in the bathroom. What action should the nurse take to support this client's biopsychosocial health?

allow the client to take as much time as required

A nurse plans the care of older adults in a long-term care setting. Which intervention incorporates the residents' connectedness to society? conducting reminiscence therapy arranging regular visits by schoolchildren to the facility allowing residents to have input into the meal planning at the facility ensuring that there are multiple television sets available to residents of the facility

arranging regular visits by schoolchildren to the facility The nurse can foster social connectedness by arranging meaningful contact between older adults and other members of society. TV, reminiscence, and input into routines may all have benefits, but none is likely to create a sense of connectedness with society.

An older client is admitted for treatment of a chronic health problem. Which action should the nurse take if functioning in the role of caregiver?

assess current status

The nurse manager is redesigning the care delivery approach for a geriatric facility. Which action should be analyzed prior to including it in the new care processes?

changing all bed linen by 1100 hours

The nurse schedules a 3-day weekend to go to a mountain resort. What should the nurse take when packing for the weekend?

comfortable clothes

A nurse recognizing the need for improved self-care. The nurse can best demonstrate a connection with self by: reaffirming his or her commitment to clients' well-being. asking colleagues for input and guidance. pursuing meaningful relationships with peers. conducting a detailed and honest self-appraisal.

conducting a detailed and honest self-appraisal. Connection with self depends on a realistic self-appraisal. Reflection is more important than seeking ideas from others or cultivating relationships. It is important to prioritize clients' well-being, but this does not enhance the nurse's connection with self.

While discussing a health problem with an older client the nurse offers a personal situation that was similar to what the client is currently experiencing. What behavior is the nurse demonstrating?

connection

An older client is diagnosed with a new chronic health problem and is concerned about the impact of the disease on the current lifestyle. What should be considered to help this client?

counseling

An older adult client has recently begun integrating more fresh fruit and vitamin supplements in an effort to increase the client's levels of antioxidants. This client's actions indicate an understanding of what theory of aging? free radical theory program theory of aging immunosenescence cross-linkage theory

free radical theory Antioxidants, including beta-carotene and vitamins C and E, are one of the major defense mechanisms against oxidative damage from free radicals. The theory of immunosenescence, cross-linkage theory, and the program theory of aging do not directly prioritize a role for antioxidants in maintaining health.

The child of an older adult client asks the nurse about vitamins, antioxidants, and age-related macular degeneration. Which theory of aging is most appropriate to this topic? immunosenescence theory free radical theory program theory wear-and-tear theory

free radical theory Free radical theory focuses on interventions to modify or prevent the age-related accumulation of free radicals or to diminish the formation of free radicals. Antioxidants, beta-carotene, and vitamins C and E provide defense mechanisms against oxidative damage from free radicals. Immunosenescence (age-related decline of the immune system) theory focuses on the increased susceptibility of older people to diseases, such as cancer and infections. The immune system may even attack healthy cells, leading to autoimmune conditions, such as rheumatoid arthritis. Program theory postulates the life span of about 110 years in humans. Abnormal cells, such as cancer cells, are not subject to this predictable program and can proliferate an indefinite number of times. Wear-and-tear theory postulates the affects to longevity of the human body by the care it receives, as well as by its genetic components.

The nurse writes in a journal every evening before going to sleep. What is the advantage of using this self-care technique?

helps work through issues

The nurse desires to improve the ability to provide holistic are. What would be a good first step for this nurse to do?

implement self-care practices

An older client has been losing weight despite learning that chronic conditions are well-controlled. Which socioeconomic issue should the nurse consider as contributing to this client's change in nutritional status?

lack of transportation to the grocery store

During lunch a group of nurses relate events that occurred while attending school. What behavior is being demonstrated by these nurses?

sharing life stories

The nurse plans an educational session for family caregivers. What should the nurse consider when planning this program?

strategize ways to engage the learners in the program

The nurse is concerned about an older client returning home alone after recovering from hip replacement surgery. What should the nurse do to support this client's needs?

talk with the client about plans to meet self-care needs

The nurse manager schedules a staff meeting to review the most recent care standards. Why is it important for the manager to review these standards with the staff?

they serve as a model to judge practice