Chapter 19
Which of the following groups would most need adult day care services? a. Caregivers who work all day b. Elderly who are bored staying home alone c. Elderly in whom Alzheimer's has been diagnosed d. Older men who want an opportunity to meet older women e. Older women who want to engage in arts and crafts activities
ANS: A Adult day care provides a safe and supportive environment during the day for adults who cannot or choose not to stay alone. This service is often needed by caregivers who work during regular hours or need respite.
"I don't understand," a woman said. "I know I'm eligible for Medicare part A and it's free. Part B isn't free. When will I ever use it?" Which of the following would be the most appropriate response by the nurse? a. "Part A is only for hospital bills. Most care is given on an outpatient basis. Part B pays a large portion of those costs." b. "Part A is a benefit because you paid into Social Security for more than 10 years. In comparison, part B is optional if you want that additional insurance." c. "Part B is easy to pay for; they take the cost out of your Social Security check each month." d. "Researchers have found that people don't waste health care resources if they have to pay a bit for them."
ANS: A All the responses are true, although the woman may not care about research findings. Further, she may well prefer the money from her Social Security benefit to be paid to her rather than go for additional insurance. However, the reason the woman needs to know why she should pay for part B is that so much care today is given on an outpatient basis, including diagnostic procedures, physicals, speech and occupational therapy, ambulances, durable medical equipment, and some home health care services.
Which of the following is the most common reason for visual impairment in older adults? a. Cataracts b. Glaucoma c. Macular degeneration d. Presbyopia
ANS: A Among older adults, the three most common pathological eye conditions are cataracts, macular degeneration, and glaucoma. Cataracts are the leading cause, as well as the most reversible cause, of visual impairment in older adults. A cataract is a clouding of the normally clear lens of the eye. Age is the single greatest risk factor for cataracts. By age 65 years, some degree of lens clouding has developed in half of all Americans, although it may not impair vision. Presbyopia, loss of elasticity of the lens of the eye causing difficulty with near vision, generally occurs in the 40s
A nurse explained that the elderly are twice as likely to die in a home fire as younger persons and therefore suggested some safety measures. Which of the following strategies would most likely have been suggested by the nurse? a. Have smoke detectors installed in the house b. Invite a family member to sleep in the house at night c. Practice escaping quickly from the house in case of an emergency d. Program your phone so the fire department can be reached by pushing only one button
ANS: A Community health nurses making home visits can assess their elderly client's home for fire risk and teach fire safety, including the importance of home smoke detectors and fire extinguishers. Inviting family members to spend the night, practicing a quick escape, and programming one's phone for the fire department are irrelevant if a smoke detector is not installed to alert the elderly client that there is a fire in the home.
"My health problems are too much to handle," said an elderly woman at her annual clinical checkup. "What's most important for me to do?" Which of the following would be the most appropriate response by the nurse? a. "Focus on eating properly and staying active." b. "Get the shingles immunization along with your flu shot this year." c. "Keep active mentally—do you do crossword puzzles or Sudoku puzzles?" d. "Stay involved with others. Do you ever go to the senior citizens center?"
ANS: A Health care professionals must inform and educate elders about the benefits of health care screenings and examinations, physical activity and fitness, and good nutrition. As the woman was already getting an annual checkup, the nurse should stress nutrition and exercise.
In the supermarket checkout, a young woman complained to her friend, "Old people think we taxpayers should pay for them to be in a nursing home. Seems like a waste of money." Which of the following would be the most appropriate response by the nurse? a. "Did you know more than 90% of all the elderly live in their own homes while fewer than 5% live in care facilities?" b. "Those old people built our society; we owe it to them to support them now." c. "Would it be better to put each person to sleep when they reach a certain age such as 80 years?" d. "You know, you'll get old someday too. Won't you want someone to take care of you when you can't anymore?"
ANS: A In 2009, 93% of Medicare enrollees aged 65 years and over resided in traditional community settings. Three percent resided in community housing with at least one service available, and approximately 4% resided in long-term-care facilities. The other responses do not support a therapeutic response by the nurse in this situation.
An elderly gentleman was shoveling his snow when you arrived for a home visit. You notice that when he comes inside he is very pale, is shivering, and seems a bit confused. His skin is very cold when you touch it. Which of the following actions would be most appropriate for the nurse to take first? a. Apply warm moist towels to his head, neck, chest, and groin b. Give him hot coffee with sugar to drink c. Have him get in a tub of very hot water immediately d. Call 911
ANS: A Initial management is to prevent further loss of heat. Rewarming of the core temperature at a safe, slow rate is important to avoid lethal side effects. The reason for rewarming the core first is to prevent vasodilation that would place the individual in ventricular fibrillation. Measures that can be taken are: (1) remove the individual from the cold area as soon as possible; (2) add more clothing, especially to the head (e.g., use a hat or scarf); (3) provide a warm sweetened drink (no coffee or tea); and (4) apply mild heat to the head, neck, chest, and groin areas using hot water bottles or warm moist towels. Medical help is imperative, and hospitalization may be needed depending on the stage of hypothermia.
A nurse overheard an adult woman, shaking her head in exasperation as she said, "Dad, you're being unreasonable. It's not safe!" Which of the following is the most likely reason for this argument? a. The dad wants to keep driving. b. The dad wants to keep cooking his own meals. c. The dad wants to keep taking care of himself each day without assistance. d. The dad wants to marry some young woman who may just want his money.
ANS: A One of the quality-of-life factors that is important to seniors is the ability to drive. Many older adults depend on driving in order to maintain independence and personal mobility. Age related declines in vision, hearing, and other abilities as well as certain medical conditions and medications can affect driving skills. Thus, safety is a concern for any elderly driver. This safety concern outweighs the other concerns of cooking one's own meals, providing self-care, and marrying a younger woman.
An ambulance medic reported a client was on the way with a traumatic brain injury (TBI). Which of the following symptoms would the nurse expect this client to display? a. Blurred vision and a headache b. Hypotension and tachycardia c. Irregular heart rate d. Fecal incontinence
ANS: A TBI symptoms may be mild, moderate, or severe. Symptoms of mild TBI include headache, confusion, light-headedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, and a change in sleep patterns or thinking. Moderate or severe TBI may demonstrate the same symptoms as mild TBI plus a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. The other symptoms are not indicative of TBI.
A daughter tells the nurse that her mother is frequently confused, but what is really upsetting is that she is incontinent during the night. "All I do is watch her and wash sheets," the daughter says. Which of the following suggestions should the nurse provide to the daughter? a. Explain about respite care or the need to ask other family members to help so the daughter can have some time off b. It's time to have her mother go into a nursing home where they can give her the care she needs. c. Refer the daughter to Adult Protective Services so responsibility for her mother's care may be assumed by an agency prepared for such tasks d. Teach the daughter how to establish a toileting routine for the mother to help control the incontinence
ANS: A The best approach—because the daughter is willing to share her feelings with you—is to see whether there is anyone else in the family to help so the daughter can be less overwhelmed. If the mother has Alzheimer's, any number of resources are available for respite for the caregiver, support groups for both client and family, and day care facilities for the client. Adult Protective Services assists in cases of abuse. The daughter is stressed and may become an abuser if assistance is not found. A toileting routine would probably not be successful during the night. Although a nursing home is possible, many families cannot afford such care or do not want a family member sent there.
A woman said, "I've never been retired before. I didn't plan it but it's OK. I'm still doing what I used to do otherwise; I go to church, make quilts for charity, and babysit my grandkids. Do you think I should be trying to find another job for a few years?" Which of the following would be the most appropriate response by the nurse? a. "For lots of people, retirement, even if unplanned, is much like life has always been." b. "It's okay to slow down at your age; why look for problems?" c. "You really need to get out of your house more and be more active, even if you don't get paid at the position." d. "Without a job, you really don't have an identity. Have you been to the unemployment office?"
ANS: A The continuity theory of aging suggests that a person continues through life in a similar fashion as in previous years. Because the woman stated she is doing what she has previously done, and has not suggested any particular problems other than concern that what she is doing is acceptable behavior, she should be supported. The statement that best supports her decision states that retirement life is much like life has always been. The other statements do not support her current satisfaction with her activities in her life.
A son did not know what to get his mother for her birthday. She refused most gifts, saying they were just something more for her to take care of. Assuming the mother did not have these, which of the following would be a very helpful gift? (Select all that apply.) a. Purchase a new front door with a large peephole so she can see who is ringing the doorbell b. Arrange for Social Security check to be deposited directly into the bank c. Add bars on all the house windows for added security d. Buy a shredder for the mother to use on all personal documents e. Install caller ID on her telephone f. Have strong deadbolts installed on all outside doors
ANS: A, B, D, E, F Measures can be taken to lessen the risk of crime happening to the elderly person. In the home, safety measures include making sure that door and window locks are strong. The elder should note who is at the door before opening the door. The elder can get caller ID service for the telephone; if no number or individual is identified, the elder may choose not to answer the call.
An elderly woman shared that she had six different physicians, each focusing on one particular health problem. Which of the following would be of immediate concern for the home health nurse? (Select all that apply.) a. Whether the client has a family physician who was coordinating her care b. Whether the physicians communicate with each other c. If each physician was prescribing medications, what drug interactions might be occurring? d. Were all these health care providers licensed physicians? e. Who was helping her with transportation to all these physicians? f. Would all these physician visits add up to more than what Medicare would reimburse the client?
ANS: A, C The client needs a family physician or a nurse case manager who is coordinating her care and ensuring that the medications are not having interaction effects. A pharmacist might also do this, but the client may be using several different pharmacies. Errors associated with preventable adverse drug events occur most often at the stages of prescribing and monitoring (i.e., the same medication[s], or different medications for the same condition, being prescribed by different health providers).
A woman admitted, "I did fall once, but it was an accident that I'm sure won't happen again." Which of the following responses would be most appropriate for the nurse? (Select all that apply.) a. "Are you getting lots of calcium and vitamin D? Are you drinking milk or taking calcium pills?" b. "Do you have a couple glasses of wine each evening to relax you before you go to bed?" c. "Do you live in a one-story house and are your floors even without rugs to trip you up?" d. "Let me give you some balance and leg muscle exercises to practice at home each day." e. "Remember that if you start to fall, fall sideways if you can to minimize injury." f. "Review what medications you are taking."
ANS: A, C, D, F Simple exercises that strengthen leg muscles and exercises that can improve balance are recommended to be done daily. Adequate amounts of calcium and vitamin D, obtaining a bone density test, and taking medications that are available for slowing bone loss are activities that can help prevent falls. Seniors can also improve their environment to reduce their risk of falling by checking floor surfaces and curb heights; identifying weather-related problems before venturing outside; wearing supportive, low-heeled shoes; making sure that rooms are well lit; and ensuring that safety equipment is installed in bathrooms and stairwells.
A family member tells the nurse that she is worried about her grandmother driving. Which of the following would be most appropriate for the nurse to suggest? (Select all that apply.) a. Avoid rush hour traffic. b. Buy and drive a very large heavy car. c. Do not converse with any passengers. d. Drive more slowly. e. Drive only during daylight. f. Leave the radio turned off.
ANS: A, C, E, F Some interventions older adults could implement are limiting their driving to daylight hours, planning their trips to avoid rush hour, not listening to the radio, and avoiding talking with passengers. Purchasing a large, heavy car and driving more slowly are not appropriate actions to assist an elderly person with driving.
A nurse always reviewed the medications taken by elderly clients on each home visit. Which of the following best explains the rationale for the nurse's action? (Select all that apply.) a. Age-related changes and polypharmacy make elderly clients vulnerable to drug interactions and dangerous adverse reactions. b. Elderly clients are known to sue if medications taken do not make them feel better, and lawsuits are to be avoided, if possible. c. Folk or herbal medicines are often the same as the generic medications prescribed by health care providers, so elderly often have overdoses. d. Older adults are known to consume many over-the-counter medications, as well as folk or herbal remedies. e. The elderly are known to be particularly noncompliant with pharmaceutical prescriptions. f. With the high prevalence of chronic diseases, elderly clients are taking a large number of medications.
ANS: A, D, F The high prevalence of chronic diseases in the elderly population causes this group to use a large number of medications. Older adults consume slightly more than one third of all prescription drugs and spend billions annually on medications. Older adults also consume many over-the-counter medications, as well as "folk" or herbal remedies which are not typically prescribed by health care providers.
A nurse completed the health assessment but needed to use the elderly woman's bathroom. The nurse noticed perineal pads under the sink. Which of the following questions would the nurse most likely ask the woman? a. "Can you tell me why you need to have perineal pads?" b. "Do you know how to do Kegel exercises to help control your urine?" c. "Does another woman live with you or visit often?" d. "Why do you have perineal pads? Are you bleeding down there?"
ANS: B Because the woman did not mention incontinence, it may be assumed to be very embarrassing. Therefore, the nurse should matter-of-factly address urine control problems by suggesting a self-help intervention of Kegel exercises. It may be assumed that the nurse, having completed a health assessment, would know about bleeding, as well as frequent visitors or family nearby.
Which of the following best describes why grandparents would be the primary caregivers for their grandchildren? a. Because they fell in love with the newborn and wanted that small person to be a part of their lives b. Because the parents were drug abusers or in the prison system c. Raising a grandchild is easier because grandparents have already been experienced parents d. Raising a child gives purpose to life for the grandparents
ANS: B Many older adults are faced with raising their grandchildren, often without the presence of the grandchildren's parents. Reasons include neglect related to parental substance abuse, abandonment, emotional and physical abuse, parental death, mental and physical illness, incarceration, teen pregnancy, and grandparents' assisting adult children who work or attend school.
"Do you have any advice?" a young woman asked. "I'm eating lunch with my dad but he can't hear and he won't wear his hearing aid." Which of the following suggestions should be made by the nurse? a. Encourage your dad to wear his hearing aid—if only for you b. Find a very quiet place with good lighting and very little background noise for lunch c. Repeat yourself several times using exactly the same words and gestures d. Talk very loudly while facing him directly
ANS: B Suggestions include to find a quiet place to talk to help reduce background noise, especially in restaurants and social gatherings; stand in good lighting and use facial expressions or gestures to give clues; face the person and talk clearly; speak a little more loudly than normal, but do not shout; and repeat yourself if necessary, using different words.
Which of the following situations best describes when a person would most likely be very unhappy and perhaps ill after retirement? (Select all that apply.) a. If their family total income is now less than when he or she was employed b. If the retirement was involuntary c. If the person's self-image was based on job role and status d. If the person has no outside interests or leisure activities e. If his or her spouse did not appreciate input into their schedules or activities f. If the person believes others are now taking credit for his or her achievements
ANS: B, C, D, E Retirement can be a happy occasion when it is planned and the person has many activities to which to devote time and energy. Retirement is often a happy occasion when planned and voluntary; however, the opposite may be true if it is involuntary. When older adults retire, they inevitably must cope with a change in social status; this may be difficult for people whose self-concept was based on job status. For retirees who are married, the spouse must also adjust to the changes related to retirement. For elders who have no hobbies or interests, this extra leisure time may be a source of boredom. Family income being less is not necessarily a stressor as many job-related expenses also disappear.
1. Which of the following is the most useful way to discuss aging? a. By divisions—young-old, middle-old, old-old, and elite-old b. Chronological age c. Functional age d. Number of chronic comorbidities
ANS: C Functional age refers to functioning and the ability to perform activities of daily living, such as bathing and grooming, and instrumental activities of daily living, such as cooking and shopping. This definition of aging is a better measure of age than chronological age. After all, most older adults are more concerned with their functional ability than their chronological age. Assisting older adults to remain independent and functional is a major focus of nursing care.
Which of the following best explains why all family members should want their aged relatives to have a living will? a. To confirm that the attorney is serving as guardian and family members do not have to be responsible b. To fulfill the federal Patient Self-Determination Act requirements c. To help family members know what their loved one does or does not want if he or she becomes incapacitated d. To keep physicians from writing a do-not-resuscitate order
ANS: C Living wills are legal documents whose purpose is to allow individuals to specify what type of medical treatment they would or would not want if they became incapacitated or had an irreversible terminal illness. Living wills can direct physicians to withhold life-sustaining procedures and can assist family members in making decisions when they are unable to consult a comatose or medically incompetent relative. The purpose of a living will is not to appoint an attorney as a guardian. The Patient Self-Determination Act requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess an advance directive; it does not require that patients complete one.
A man stated, "I used to work out at the exercise room at work, but now that I'm retired I sit and watch TV. My wife keeps nagging me to do something. What do you think I should be doing at my age?" Which of the following would be the most appropriate response by the nurse? a. "I think you should try to please your wife. What is it she wants you to do?" b. "It's okay to slow down at your age; why look for problems?" c. "You should try to exercise just as you did before. Is there a YMCA or club nearby?" d. "You've worked all your life; you have a right to rest now."
ANS: C The activity theory posits that activity is necessary to maintain life satisfaction and a positive self-concept. Physical activity is beneficial for the health of people of all ages, including older adults. Therefore, because the man has previously been physically active, he should continue to be physically active to maintain satisfaction with his life.
A nurse is making the first home visit to a recently discharged elderly client. Which of the following should the nurse most likely expect to find? a. A client who is unhappy with the disorganization of the house b. A client who will expect the nurse to do everything now that the nurse is at his or her house c. A client who may well have hearing or vision problems or both d. A client who is upset with being discharged while still so ill and having to take on problems at home
ANS: C Visual and hearing impairment are among the most common age-related conditions affecting the elderly population. The prevalence of vision impairment in individuals over the age of 65 years is: 17% of individuals 65 to 74 report some form of vision impairment and 26% of individuals over the age of 75 report some form of vision impairment. A study by physicians at Johns Hopkins University in Baltimore, MD, found hearing loss prevalence in patients 70 years and older to be 60%. Thus, the nurse should be anticipating the needs of the client rather than being concerned about the potential factors that the client may be upset about.
Which of the following is the primary source of income for elderly Americans? a. Employment income b. Pensions c. Savings d. Social Security
ANS: D Aggregate income for the population aged 65 years and over comes largely from four sources: (1) Social Security provides 37%, (2) earnings account for 30%, (3) pensions provide 19%, and (4) asset income accounts for 11%.
A nurse needed to do a quick assessment of a client's lifestyle behaviors to counsel appropriately. Which of the following strategies would be the easiest way to determine the elderly woman's nutritional status? a. Ask the woman to keep a food diary for 2 weeks and bring it to the clinic b. Have the clinic dietitian interview the woman about her eating habits c. Quiz the woman verbally as to her usual meals during the day d. Use the DETERMINE mnemonic
ANS: D All the responses are good approaches. However, the nurse should take a broad view of what assets or barriers are involved in relation to nutrition. A nutrition checklist, described by the mnemonic DETERMINE, reviews warning signs and risk factors of poor nutritional health. (See Table 19-2 in the textbook for more information).
Which of the following is an example of a nonstochastic theory of aging? a. Cross-link theory b. Error theory c. Free radical theory d. Immunologic theory e. Somatic mutation theory f. Wear and tear theory
ANS: D All the theories except one are stochastic theories, that is, theories that are based on the assumption that events occur randomly and accumulate over time, which results in aging. The only nonstochastic theory, which views aging as predetermined, is the immunologic theory.
A wife explained to the nurse that her husband was becoming awfully forgetful, and now he's started getting lost on the way home from the golf club. She's scared he may be getting Alzheimer's disease. Which of the following would be most appropriate action for the nurse to take? a. Ask the husband to explain why he thinks he got lost coming home b. Explain that all elderly persons get a little forgetful and not to worry c. Ask the husband to count backwards by 7 from 100 d. Hand the husband pencil and paper and ask him to draw a clock
ANS: D Clients with Alzheimer's disease are unable to draw a normal clock. As a test for Alzheimer's disease, clock drawing had a sensitivity of 86.7% and a specificity of 92.7%. The clock drawing test is an easily administered, low-cost screening tool, which is useful. This should be the first action taken by the nurse to screen the client for Alzheimer's disease and take appropriate action as necessary.
A wife, who had just come home after major abdominal surgery, explained to the home health nurse that she was really worried about her husband. He had not been sleeping well or eating well, seemed to have no energy, and did not seem to enjoy anything including activities he used to love. Which of the following suggestions should the nurse give to the client? a. Ask what medications the husband is taking, because many medications can affect mood b. Explain her husband has probably been worried sick about her and the surgery, and she should reassure him frequently that she is OK c. Point out that many people get sad during the winter months and he should be fine when spring arrives, but in the meantime put full-spectrum light bulbs in all the household lamps d. Share that her husband seems depressed and that they should see his doctor immediately
ANS: D Depressed people may experience several or all of the following symptoms: changes in appetite or weight, changes in sleep patterns, restlessness, loss of energy, feelings of worthlessness or guilt, and repeated thoughts of death or suicide. If any of these symptoms exist, the client should be referred to a physician for diagnosis. A physician can only make a diagnosis of clinical depression in the presence of five or more of the symptoms mentioned above.
A son explained to the home health nurse that since his mother died, his father did not seem to have any interest in life and had even told his son he was considering suicide. Which of the following would be the most appropriate response by the nurse? a. "If he really wants to kill himself, he will, and there really isn't anything you can do to stop him." b. "If you talk to him about it, you're strengthening the idea." c. "People who talk about suicide rarely do it, so don't worry." d. "Suicide is a serious concern; let's talk to his doctor about what you've noticed."
ANS: D Suicide is a serious health concern related to the elderly, who account for 18% of all suicides. Elder suicide is associated with depression, chronic illness, physical impairment, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Warning signs to watch for in the elderly are loss of interest in things or activities that are usually found enjoyable; cutting back from social interactions, self-care, and grooming activities; not following medical regimens (e.g., going off diets, not taking prescriptions); experiencing or expecting a significant personal loss (e.g., death of spouse or friend); feeling hopeless or worthless; putting affairs in order; giving things away; making changes in will; and stockpiling medications or obtaining other lethal means for committing suicide.
A male nurse is enjoying a very hot summer day at the zoo when he notices a family approaching. An elderly member of the family is moving very slowly and being scolded by another adult, saying "You are not sick. Let's keep moving." The nurse touches the elderly adult who has a flushed face and notices clammy and moist skin. What should the nurse say to the adult? a. "I'm a nurse, and your family member needs to go to the emergency department right now." b. "I'm a nurse, and your family member has heat stroke. I'm calling 911." c. "Take your family member to the air-conditioned restaurant, and have him drink a cold soda immediately." d. "Take your family member to the air-conditioned restaurant, and let your family rest for a while."
ANS: D There is not enough evidence to be quite sure what is wrong with the elderly adult, but clearly the elderly person is suffering from being in the hot sun for a period of time. The elderly adult—and probably the rest of the family as well—needs to be moved to a cooler environment and be made to lie down and rest. Drinking chilled water (not soda with caffeine) would also be helpful. In that cooler environment, the nurse can assess the situation to determine whether further action should be taken.
Which of the following would be a problem for an older adult with a hearing loss? (Select all that apply.) a. Difficulty in finding a hearing aid that is unobtrusive b. Embarrassment at having to wear a hearing aid c. Hearing is not part of a routine health screening d. Long delays in getting an appointment to see an audiologist or otolaryngologist e. Medicare does not cover the costs of hearing aids f. The adult may withdraw, become isolated, and depressed
ANS: E, F In general, Medicare does not cover the costs of hearing aids; Part A covers hospitalization and Part B covers physician and outpatient services, qualified therapies, durable medical equipment, and some home health care services. Consequences of hearing loss may include withdrawal, isolation, and depression. Because of advances in technology, hearing aids are much smaller and less obvious than they previously have been.