Chapter 1

The FANCAPES assessment tool focuses on the older adult's:

Ability to meet personal needs to identify the amount of assistance needed

A nurse is providing glaucoma education for a group of older adults in the senior center. The nurse knows that the following group are most likely to develop glaucoma: (select all)

African Americans Mexican Americans Individuals with family history Individuals with diabetes

An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind sports in the middle of the visual field. He also states that "Strangely enough my peripheral vision continues to be pretty good." The nurse suspects that the patient has which of the following?

Age related macular degeneration

A nurse plans programs for older adults in a senior center. She organizes a series of exercise programs. She sets up one for clients age 64-74, one for clients 74-85, and one for clients over age 85. The nurse is utilizing which theory of aging?

Age-stratification theory

Based on the census reports of 2010, the typical profile of a centenarian in the U.S. includes which of the following characteristics?

A Caucasian woman who lives in an urban area of a southern state

Which of the following are examples of elderspeak? (Select all)

A nursing assistant refers to one of her patients as "grandma" A nurse attempts to medicate a patient and states "Now come on and be a good girl" A nursing assistant tells a patient "it is time for our bath now"

Serious and well-controlled research studies on aging have been available:

Only in the past 60 years

A married couple retired to a life care community after the husband had heart surgery. The wife has always been physically and socially active and joined an aerobic class, knitting groups, and a book club shortly after moving to the community. She walks on a daily basis and swims 2 times a week. Her husband spends his days reading and watching TV. Which of the sociological theories of aging best describes this couple?

Continuity theory

Which of the following factors contribute to poor outcomes for older adults during transitions of care? (select all)

Inability to read and understand discharge instructions Inadequate financial resources to purchase medications

Changes in certified nursing facilities in recent years include which of the following?: (select all)

Increase in the number of subacute beds Decrease in nursing facility length of stay Increase in level of acuity of the residents

Which technique is most effective when communicating with a client who is positioned in bed?

Sitting in a chair at the bedside facing the client

An older man tells a nurse "The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight." The nurse formulates a response based on knowledge that:

The lens of the eye loses elasticity causing a loss of focus of near objects

A nurse is observing a nurse aide perform denture acer for a resident in a nursing home. The nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following?

The nurse aide uses toothpaste to clean the dentures

Which of the following are true statements about the current health care workforce? (select all)

The professions of social work, physical therapy, and psychiatry are demonstrating the same trends as nursing Europe and the developing countries are experiencing similar shortages in health care workers with geriatric expertise as in the U.S. It is anticipated that there will be a need for approximately 3 million additional direct care and professional health care workers by the year 2030

An older adult resident in a senior community tells a nurse: "I am really worried. I joined an exercise class, and I just learned everyone's name yesterday, and I cannot remember them all today. Am I developing Alzheimer's disease?" The best response is:

There is no reason to be concerned. Short-term memory decreases with age

A nurse administers hypodermoclysis to an older adult nursing home resident. The purpose of hypodermoclysis is:

To rehydrate with mild to moderate dehydration

The nurse preparing wellness information for older adult clients is promoting interventions consistent with the concepts of the biological theories of aging when suggestion that they: (select all)

Use moisturizers daily to minimize dry skin Discuss the use of antacids to control heartburn with their health care provider practice stress reduction techniques on a regular basis Consider getting a yearly influenza vaccination

A 66-year-old professional basketball player is admitted to the hospital for a total knee replacement due to osteoarthritis. In preparing preoperative teaching for this patient, the nurse includes which theory of aging to help him understand how the disease has progressed?

Wear-and-tear theory

An older patient is diagnose with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include (select all)

age-related hearing impairment Excessive and loud noises

The nurse implements the concepts of the activity theory of aging when instructing the older client with osteoarthritis to:

continue her daily walking routine

Primary prevention strategies for older adults include which of the following? (select all)

An annual influenza immunization clinic A smoking cessation program

A nurse is caring for an 85-year-old male client with diabetes in a community setting. The nurse promotes functional wellness by which of the following activities?

Encouraging the client maintains current levels of physical activity

A 74-year-old client who has experience a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the teaching plan?

Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise

An older nursing home resident reports that her hearing loss is getting worse. What is the first action the nurse should take?

Examine residents ears for cerumen impaction

Which intervention is therapeutic when facilitating communication with a cognitively impaired or older client? (select all)

Explain a task using simple, concise phrasing and one step at a time Allow for additional time for the client to respond to questions or directions Use nonverbal as well as verbal cues to help get your message across to the client

An older person reports hearing whistling in both ears when no external sounds are present and is diagnose with tinnitus. Which of the following are causes of tinnitus? (select all)

Exposure to loud-noises Cerumen buildup Side effects of medications

A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right thoracic area. The nurse suspects HZ. The patient asks the nurse "I really don't understand how I got shingles, I don't even know anyone who has this infection." The nurse includes which of the following in the response?

HZ is caused by a reactivation of dormant varicella zoster within the sensory neuron of the dorsal root ganglion

The "in-between" generation (born between 1915 and 1945) were subject to which of the following health challenges during their childhood? (select all)

Polio Lack of fluoride in the water causing teeth to be soft and cavity prone Pigeon chest: a malformation of the rib cage due to lack of vitamin D

Factors complicate assessment of older adults include: (select all)

Presence of multiple comorbid conditions Atypical presentation of illness Difficulty in differentiating symptoms of disease from normal age-related changes Increase in iatrogenic illness

An older patient tells a nurse. "The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still odnt understand why this happens to me." The nurse responds based on the knowledge that: (select all)

Purpura is due to normal age-related changes The incidence of purpura increases with age Individuals who take blood thinners are especially prone to purpura

Significant factors contributing to the growth of community-based care include: (select all)

Rapidly escalating health care costs older adults' preferences to "age in place"

A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the Zoster vaccine. Which of the following information should the nurse include in the education?

Recommended for all individuals over age 60 that have no contraindications to the vaccine

Which of the following statements describing oral care for the older population is correct?

Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods

A resident of a long-term care facility is assessed by a nurse upon admission to the facility. The assessment includes a comprehensive health, social, and functional profile. The tool the nurse utilizes is:

Resident Assessment Instrument (RAI)

An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse "How did I get something like this?" The best response is:

Scabies is highly contagious and spreads easily through physical contact

nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following:

Since I am an older person, I need more calories because my metabolic rate is slower

An older adult who is within a normal weight range asks a nurse, "I have heard that it is important to limit the amount of fats in my diet, but I don't know how much I should be taking in daily. Can you help me?" The best response is:

Since you are at your ideal weight, you should limit daily fat grams to half your weight

A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (select all)

Sit the patient upright in a chair at 90 degrees Have the patient swallow twice for every mouthful of food given

An older adult client shares with the nurse that "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explaines that aging may cause this change due to the:

Slower ability of the pupil to adjust to changes in lighting

When conducting an admissions interview with an older client, the nurse observes that the client pauses for a period of time before responding to the questions. The nurse responds this client based on the assumption that the client is:

Sorting through his or her vast life experiences in order to answer appropriately

The son of a nursing home resident asks the nurse: "what is the significance of being certified in gerontology? I see that you are, but not all of the nurses are." The best response by the nurse is which of the following?

"National certification as a gerontological nurse is a way to demonstrate special knowledge in caring for older adults."

An older woman ask a nurse: "You always seem to be telling me that I need to drink more water. How much water do I really need to drink?" The nurse bases her response on the knowledge that older adults should consume at least:

1500 mL of fluid per day

An older adult asks a nurse, "I hear a lot about limiting the amount of fat in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?" Best response is:

20-35% fat, 45-65% carbs, 10-35% protein

The nurse is most concerned by observing when assisting an older clinets' bath:

A slightly raised multicolor lesion with an asymmetrical irregular border

The nurse shows an understanding of the error group of aging theories when stating: (select all)

Aging is a result of mistakes in our RNA and DNA metabolism The free radical theory is an example of an error theory Aging effects are really random and unpredictable

A limitation of the Katz index of ADL's is that:

All ADLs are weighted equally

A nurse interviews for a job in the hospital that advertises that it is "elderly friendly." The nurse would expect to see which of the following in place? (select all)

An elder-assistance program to help patients remember their appointments and navigate hospital services Rooms furnished with foldout beds for family members/caregivers An initiative to provide gerontological education for all nurses

A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal tray and snacks. One reason that this might be occurring is:

An injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization

You have four rooms to choose from for your older client to be admitted this afternoon. Which room would you choose?

An orange-carpeted room with soft-lighting and yellow walls

A nurse is planning an education program on wellness in a local senior citizen center. The nurse plans to provide education on the importance of immunizations, annual physical examinations, screening for diabetes, and vision and hearing screening. It is important for the nurse to understand which of the following?

Approximately 40% of older adults (ages 65 and older) utilize available preventative services

When caring for an ill adult client, the nurse is particularly concerned that the client communicates well since:

Assessment, planning of care, and even the therapeutic relationship is based on effective communication

A nurse is developing an educational session for a group of older adults at a senior center. Which of the following would the nurse include in the education? (select all)

Attention span, language, and communication skills typically remain stable with increasing age Older brains slow down and take longer to process constantly increasing amounts of information In order to preserve brain function, it is important to engage in challenging cognitive activities

A community health nurse provides an annual flu prevention workshop at a local senior center. The activities include a lecture on preventing infections, which includes hand washing and limiting exposure to individuals who are ill, as well as an influenza immunization clinic. The nurse is basing her activities on which theories of aging?

Autoimmune

The nurse is aware the theory of aging most likely to explain why the older adult population is at risk for autoimmune disorder is known as:

Autoimmune theory

A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant. The nurse includes which of the following in the teaching plan? (select all)

Avoid lifting heavy objects after surgery Avoid bending from the waist after surgery Take stool softeners as needed

An older resident in a long-term care facility reports to the nurse that she has been noticing change in her vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with:

Cataracts

An older adults' nutritional status is screened by a nurse using the Mini Nutritional Assessment. The older adult scores a score of 10 on the screening portion what is the best action by the nurse?

Complete the assessment portion of the tool

A nurse utilizes SPICES to asses an older female patient in the hospital. The nurse notes that the patient has new onset urinary incontinence. The first action of the nurse is to:

Conduct a more in-depth focused assessment of the urinary incontinence

Which of the following are age-related changes that affect hydration status? (select all)

Decrease in thirst sensation Decrease in total body water Decrease in the ability of kidneys to maximally concentrate urine

A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequabtky does not wear the hearing aids, the nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all)

Difficulty placing hearing aid properly in ear Stigma associated with wearing a hearing aid Difficulty changing batteries Hearing annoying loud noises

A nurse manager is providing a novice geriatric nurse with guidelines when encouraging an older client to reminisce about his or her life and past experiences. Which suggestions will be included? (select all)

Don't correct the client when you suspect the memory is incorrect When the focus remains on sad topics, assess the client for possible depression Expect and respect a degree of repetition

A nurse is assessing a patient's activities of daily living. The nurse will assess which of the following? (select all)

Eating Continence Toileting Bathing

A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patients plan of care? (select all)

Encourage adequate fluid intake Maintain a humid environment Apply water-laden emulsions to the skin immediately after bathing

An older adult complains of xerostomia. Which of the following interventions should the nurse implement for this patient? (select all)

Encourage the patient to brush and floss teeth regularly Encourage the patient to have regular dental screenings Encourage adequate intake of water Provide saliva substitutes

A nursing student is preparing a presentation on the Wellness-Based Model for Health Aging. Which of the following concepts should the student include in the presentation? (select all)

Healthy aging is individually defined and change over time There are many strategies to promote healthy aging that are believed to be helpful but do not have empirical evidence to support them Healthy aging cannot be achieved by only focusing on later life, it is a lifelong process

Symptoms of gastroesophageal reflux disease (GERD) in older adults include: (select all)

Heartburn regurgitation abdominal pain within one hour of eating

Which nursing statement shows a true appreciation for an older client's willingness to tell his personal stories about the "war?"

I learn so much about clients when they share their life story with me

A nurse is performing an admission assessment on an older aptient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patients' skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (select all)

Implementing intake and out put recording for any patients with fever, diarrhea, vomiting, or an infection Limiting duration of NPO requirements for diagnostic tests and procedures Making sure that the hospitalized patients have easy access to fluids

The major goal of the NICHE (Nurses Improving Care for Health System Elders) program includes which of the following?

Improve outcomes for hospitalized older adults

An older female resident in an assisted living facility says the following the nurse: "I am very frightened about getting dementia. I have read a lot about brain exercises, but I am not sure what I should be doing." The nurse formulates a response based on knowledge of which of the following? (Select all)

Individuals should engage in some type of brain fitness activity a couple of times a week for 25 minutes Brain fitness activities may include computer-based games, memory training, board games, reading, and engaging in conversation Individuals should choose brain exercise activities that are unfamiliar, challenging, and fun

A nurse completes a functional status assessment of an older person using the Lawton IADL instrument, a self-reported instrument. The nurse knows that limitations of self-reported measures include that: (select all)

Individuals tend to overestimate their functional ability Self-reports often differ from that of proxy reporters

In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include:

Involving the client in the process of oral hygiene; such as using the hand over hand technique to brush the clients' teeth

A nurse demonstrates understanding of the continuity theory when the nurse provides which of the following advice to an older client? (select all)

It is important to think about the activities that have been most satisfying throughout your adult life and make a plan to continue them singe you enjoyed teaching young children so much, perhaps you would enjoy volunteering in the day-care center

Which statement by the nurse is the strongest example of ageism by professional nurses?

It is so difficult to find nurses who are truly effective geriatric nurses

A nurse is educating a group of nursing assistants in long-term care on the prevention of skin tears. Which of the following interventions should the nurse include in the education? (select all)

Lubricate the residents skin with moisturizers daily Ensure that the resident has adequate nutrition and hydration Dress the resident in long sleeves and long pants to protect extremities

A nurse is planning a fall prevention education refresher session for the residents of a long-term care facility. The individual are all cognitively intact and range in age from 80 to 100. The previous education on fall prevention was presented 2 months ago. What special considerations should the nurse take in relation to teaching this group of older adults? (select all)

Make sure that all pamphlets are in large readable font (14-16) and include upper and lower case lettering Ensure that there is adequate lighting in the room and that the temperature is comfortable Provide ongoing positive feedback during the session

The daughter of an older adult hospitalized patient tells a nurse: "I am worried about my father. His memory is sharper when he is at home. He is forgetful, but is functional. Since he has been hospitalized his memory problems are much worse." The best response by the nurse is:

Memory changes are often worse when an individual is an unfamiliar or stressful situation

A nurse is planning care for a group of super-centenarians in an assisted living facility. The nurse considers which of the following?

Most super-centenarians are functionally independent or require minimal assistance with ADL's

A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he has been very forgetful lately, and she is concerned he might be "senile." The advanced practice nurse administers the clock-drawing test and the patient draws a distorted circular shape and places the number all on one side of the shape. Based on his performance, the nurse concludes that the patient:

Needs further evaluation

Many older adults have a vitamin B 12 deficiency. Reasons for this include which of the following? (select all)

Normal age related changes in the stomach include a lower production of gastric acid making vitamin b12 absorption less efficient Proton pump inhibitors, a frequently prescribed medication in older adults, impairs the absorption of vitamin b12 from food Certain antibiotics and anticonvulsant medication increase the risk of vitamin b12 deficiency

A nurse assesses a nursing home residents pressure ulcer to be "healing stage 3." The primary reason reverse staging is never used is because:

Not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was

A nurse identifies a need to assess a patient's cognitive status. The nurse chooses to use the MMSE. The nurse knows that the patient must have which of the following abilities? (select all)

Number fluency Familiarity with analog clocks Ability to hear and see

Which of the following are subscales on the Braden Scale for predicting pressure ulcers? (select all)

Nutrition Moisture Mobility

A nurse hears a colleague state the following: "Can you believe Mr. Jones daughter just bought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn to use it. " The nurse formulates a response based on research that shows: (select all)

Older adults comprise the fastest growing population using computers and the internet Internet use is less prevalent in individuals over age 75 than those ages 65-74 Technology has the potential to improve quality of life for older adults

Gerotranscendence theory posits that: (select all)

Older adults withdraw from society in order to give the individual an opportunity for self-reflection and self-exploration Time and superficial relationships become less important Material possessions have less meaning

An older patient is diagnosed with diabetic retinopathy. The patient asks the nurse: "is there anything that I can do to prevent progression of this disease and blindness?" The nurse includes which of the following into the response? (select all)

Strict control of blood glucose levels is important in slowing disease progression Laser photocoagulation treatments can stop progression of the disease Control of blood pressure and cholesterol levels are important steps slowing disease progression

A nurse is developing a care plan for an older adult in a long-term care facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (select all)

Supervise the resident during meals Provide a pleasant eating environment Provide nutritional supplements Assess the resident for the ability to feed him/herself

When comparing the older Americans and Services with the Katz index of Adls what is true?

The OARS is a comprehensive assessment tool tat measures ability in five areas; the Katz index measures only ADL performance

Health literacy is defined as:

The capacity to obtain, process, and understand basic health information needed to make appropriate health decisions

A 77-year-old client is being treated for glaucoma asks the nurse what causes it. The nurses response is:

The exact etiology of glaucoma is variable and often unknown

A nurse is conducting an assessment of an older patients' eyes. The nurse expects to see which of the following normal age related changes? (select all)

The eyelids are less elastic and droopy The eyes are very dry The eyelids may not close completely The lower lid may be turned outward

A nursing student asks the instructor: "Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn't obesity bad for everyone?" The best response is:

While there is evidence in younger people that obesity lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults

The family member of a patient asks if vitamin c will prevent aging. In formulating an appropriate response, the nurse considers the:

free radical theory

The impact of the patient protection and affordable care act of 2010 on gerontologicl nursing includes which of the following? (select all)

funding to support advanced education in gerontological nursing funding to support education of the faculty in gerontology funding for advanced training of direct care workers in long-term care

When asked by new parents what life expectancy is for their African American newborn, the nurse replies that "2010 statistics indicate that your son:"

has a good chance of celebrating his 75th birthday

Goals of eldercare workforce alliances include which of the following? (select all)

increasing wages of certified nursing assistants in nursing homes providing loan forgiveness for individuals who assume faculty roles adopting cost-effective care coordination models for older adults across the continuum of care

An older client reports to a nurse: "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is what my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems the be both ears as well." Based on the clients description, the nurse suspects which of the following?

presbycussis

Best practice recommendations for undergraduate nursing education in relation to gerontology include which of the following? (select all)

provision of a "stand-alone" course in gerontological nursing Integration of gerontological content throughout the curriculum Recruitment of nurses with masters and doctoral degrees and a specialty in gerontology faculty roles

A nurse organizes a health fair for older adults. The nurse's goal is to focus on the six priority areas identified by the national prevention council. Which of the following activities should the nurse include? (select all)

smoking cessation depression screening recognize elder abuse

One reason why many "baby boomers" have multiple chronic conditions such as heart disease, diabetes, and arthritis is that:

there was a lack of importance placed on healthy living as they were growing up