Gero Exam 1

**In which context are members of a cohort described when using the age-stratification theory to explain the effect of similar events, conditions, and circumstances? a. Historical b. Biological c. Sociological d. Chronological

**ANS: A In the age-stratification model, historical context is used to understand members of a cohort in terms of similar events, conditions, and circumstances and the effect these have on the group as a whole. A good example of such a cohort is older adults who lived through World War II. Biological context is not important in considering the age-stratification theory. The age-stratification theory is a sociological theory of aging that uses historical context to describe cohorts. Chronological context of a cohort will span a range, but historical context is what describes the cohort. (ch 4 testbank)

You are making a bereavement visit to the 35-year-old daughter and primary caregiver of a female patient who died one month ago. The daughter reports she is experiencing mild breathlessness, loss of appetite, and difficulty concentrating. What is the daughter likely experiencing?

A normal grief reaction

In differentiating between health and wellness in health care, which of the following statements is true? a. Health is a broad term encompassing attitudes and behaviors. b. The concept of illness prevention was never considered by previous generations. c. Wellness and self-actualization develop through learning and growth. d. Wellness is impossible when one's health is compromised.

ANS: A *Health* is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves one's whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growth—as basic needs are met, higher level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is possible when one's health is compromised—even with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible.

According to researchers, which characteristic do most centenarians share? a. Female b. Hispanic c. Living in rural areas d. Located in the Midwestern states

ANS: A Based on the U.S. census report of 2010, centenarians were overwhelmingly white, female, and living in the urban areas of the Southern states.

Which approach requires the nurse to integrate and balance all aspects of an individual's life into the plan of care? a. Holistic nursing b. Healthy People 2020 c. Maslow's hierarchy of human needs d. Orem's self-care requirements

ANS: A Holistic nursing integrates all aspects of an individual's life into the plan of care by balancing an individual's internal and external environment with psychosocial, spiritual, cultural, and physical processes. Healthy People 2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslow's hierarchy of human needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orem's self-care requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness.

An older man asks a nurse: "How do you define aging? Do I meet the criteria of a senior citizen?" The nurse understands that one can define aging in many different manners. If the nurse chooses to define aging as "social aging," the nurse would consider which of the following aspects? a. The man retired from his job as a police officer. b. The man takes six different medications multiple times over the course of the day. c. The man walks with a rolling walker. d. The man celebrated his 65th birthday.

ANS: A Social aging is determined by changes in roles. Taking multiple medications multiple times over the course of the day and walking with a rolling walker are functional determinants of aging. Age refers to chronological aging.

An older female patient is reading a large-print magazine and states that reading is difficult for her in the evening. Which intervention should the nurse implement? a. Put a high-intensity lamp at the head of her bed. b. Explain to her that the gray-yellow ring around her cornea, arcus senilis, is interfering with visual acuity. c. Put more powerful tubes in the fluorescent room lights. d. Examine her retinas for signs of damage.

ANS: A The pupils become gradually smaller with age; therefore, the eye requires three times as much light. A high-intensity light on the object of interest is more effective than increasing the overall room illumination. The arcus senilis does not affect vision. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment. (ch 3 testbank)

An older patient who was just diagnosed with a terminal disease states, "All my life I attended church, but I am still worried about what will happen after death." The nurse's best response is which of the following? a. "The unknown may be frightening. Do you want to talk about this?" b. "Religious people know that God is a good God." c. "People that have had near-death experiences say it is peaceful." d. "You must feel good about attending church most of your life."

ANS: A "Often the unknown is very frightening" uses the reflective technique to identify the patient's feelings regarding the fear of the unknown. "Religious people know that God is a good God" denies the patient's feelings. "People that have had near-death experiences say it is peaceful" focuses on the experience of others. "You must feel good about attending church most of your life" ignores the patient's concern about death. (ch 4 testbank)

The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a. Verbal fluency b. Logical analysis c. Object naming d. Visuospatial skills

ANS: A Allowing residents to read aloud helps improve and maintain verbal fluency because it provides an opportunity to practice these skills. Reading aloud does not usually require analysis. Reading is unlikely to improve object recall unless displaying objects is part of the reading. Visuospatial skills require the ability to perceive the relationship of objects in terms of the space each object occupies; reading is unlikely to improve this skill. (ch 4 testbank)

Which older adult is most likely to have normal mental health? a. An older adult who grieves over the loss of a spouse for 2 years but is traveling again b. An older adult who exhibits long periods of depression with occasional manic episodes c. An older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt d. An older adult who has been treated for chronic depression and whose brother killed himself 1 year ago

ANS: A An older adult who grieves after suffering a major loss for 2 years, which is a length of time for grief that is within normal limits, is beginning to enjoy life again. This individual is most likely to have normal mental health because he or she has worked through the grief and has had the strength to resume normal activities. An older adult who exhibits long periods of depression with occasional manic episodes has clinical indicators of bipolar disorder. An older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt is unlikely to enjoy normal mental health; this older adult's life displays an inability to cope effectively with tragedy, relationships, and personal matters. An older adult who has been treated for chronic depression and whose brother killed himself 1 year ago is at risk for suicide and is unlikely to have normal mental health. (ch 24 testbank)

A nurse is caring for an older patient in the hospital who reports: "I am worried because simple tasks such as balancing my checkbook seem to take me longer. Is there something wrong with me?" The best response by the nurse is: a. "As you age, normal changes in the brain occur that make central processing take longer, so don't worry." b. "You have every reason to be concerned. This is an abnormal finding; we need to contact your physician." c. "As you age, changes in the brain lead to decreased intellectual performance, so don't worry." d. "Any changes in function are a cause for worry. You need to be evaluated immediately."

ANS: A As one ages, central processing slows down, which may make performance of tasks slower. This is not an abnormal finding in older adults. Intellectual performance without brain dysfunction remains constant. Many changes in function are part of normal aging. (ch 3 testbank)

Which of the following is a true statement about sleep in older adults? a. The time spent in bed increases, but the time spent asleep decreases. b. The amount of leg movement during sleep remains steady throughout life. c. Rapid eye movement (REM) sleep becomes more unevenly distributed with age. d. The amount of stage III sleep increases steadily throughout life.

ANS: A Older persons tend to spend less time asleep than younger persons, although they spend more time in bed. This statement is true because sleep takes longer to arrive and is more fragmented. Leg movements during sleep often tend to increase with age. REM sleep becomes more evenly distributed with age. Stage III sleep decreases with age and virtually disappears in older adults. (ch 13 testbank)

An older man has Alzheimer's disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the man's duration of sleep? a. Instruct the wife to increase his daily physical activity. b. Collaborate with the health care provider to administer a hypnotic medication. c. Teach the wife how to apply a vest restraint during sleep. d. Help the wife plan daily periods for napping and activity.

ANS: A Regular exercise can help increase the duration of sleep during the night. Adding a new medication to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Administering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of injury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hostility and combativeness. Excessive napping during the day may be contributing to the problem (ch 13 testbank)

An older woman retires after a long career as an elementary school principal and begins to volunteer in the local library reading to children. The older woman is very pleased with her volunteer activities. This is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory

ANS: A Role theory posits that self-identity is believed to be defined by one's role in society. Successful aging means that as one role is completed, it is replaced by another or comparative value to the individual. (ch 4 testbank)

The family member of a patient asks a nurse if vitamin C will prevent aging. In formulating a response, the nurse considers which of the following theories? a. Free radical theory b. Immunological theory c. Oxidative stress theory d. Telomere theory

ANS: A The free radical theory posits that aging is a result of random damage from free radicals. Research is ongoing on the ability of substances with antioxidant effects to counter the actions of free radicals. For many years, it was thought that consumption of supplemental antioxidants, such as vitamin C, could delay of minimize the effects of aging. (ch 3 testbank)

You are evaluating the plan of care for an older adult who is alcohol dependent. Which patient documentation indicates the need for follow-up nursing interventions by the nurse? a. Patient states that he intends to decrease his alcohol consumption. b. Patient arrives at his group session on time and well-groomed. c. Patient states, "I am an alcoholic because I drink 10 beers a day." d. Patient states that he understands that he needs continued treatment

ANS: A When the patient states that he or she intends to decrease alcohol consumption, this response indicates that the patient continues to believe that his or her alcohol consumption is under his or her control. If the patient arrives at a group session on time and is well-groomed; taking pride in his or her appearance and participating in a group activity are positive signs. Acknowledging that he or she has a problem is a positive sign; older adults cannot be helped until the problem is acknowledged. Acknowledging the need for continuing treatment is a positive sign. (ch 24 testbank)

Which factor(s) is/are associated with the provision of culturally competent care? (Select all that apply.) a. Cultural awareness b. Cultural knowledge c. Cultural skills d. Cultural connections e. Knowledge of specific details of traditions and practices of all the different cultures

ANS: A, B As nurses move toward cultural competence, they increase their cultural awareness, knowledge, and skills. Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. Cultural connections have not been identified as a factor.

Identify the Healthy People 2020 emerging issues in the health of older adults.(Select all that apply.) a. Coordinating care for the older adult population b. Assisting older adults in the management of their own care c. Identifying levels of training for those caring for older adults d. Making community resources available for older adults e. Increase in health disparities for rural older adults

ANS: A, B, C According to United States Department of Health and Human Services' Healthy People 2020, emerging issues in the health of older adults include coordinating care, helping older adults manage their own care, establishing quality measures, identifying minimum levels of training for people who care for older adults, and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults.

A nurse completes a cultural assessment of an older adult who is being admitted to an assisted living facility. Reasons for completing a cultural assessment include (Select all that apply.) a. Culture guides decision making about health, illness, and preventive care. b. Culture provides direction for individuals on how to interact during health care encounters. c. Culture impacts attitudes toward aging. d. All members of a culture react in the same way in similar situations. e. Knowledge of culture eliminates health care disparities.

ANS: A, B, C Although knowledge of culture has the potential to optimize care, not all individuals will respond in the same way to a specific situation. Knowledge of an individual's culture will not eliminate health care disparities.

Alcohol diminishes the effects of what types of medications? (Select all that apply.) a. Oral hypoglycemic b. Anticoagulant c. Anticonvulsants d. Tricyclic antidepressants

ANS: A, B, C Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants. Alcohol increases the effect of tricyclic antidepressants (ch 24 testbank)

When planning care for a patient that has a history of alcohol abuse, the nurse recognizes which of the following medications will interact with alcohol? (Select all that apply.) a. Analgesics b. Antibiotics c. Antidepressants d. Antipyretics

ANS: A, B, C Many drugs that older adults use for chronic illnesses cause adverse effects when combined with alcohol (Box 24-17). Medications that interact with alcohol include analgesics, antibiotics, antidepressants, antipsychotics, benzodiazepines, H2-receptor antagonists, nonsteroidal anti-inflammatory drugs, and herbal medications (e.g., Echinacea valerian). Acetaminophen taken on a regular basis, when combined with alcohol, may lead to liver failure. Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants. All older people should be given precise instructions regarding the interaction of alcohol with their medications. (ch 24 testbank)

According to Healthy People 2020, older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement.(Select all that apply.) a. Diabetes b. Arthritis c. Congestive heart failure d. Dementia e. Cancer f. Pressure ulcers

ANS: A, B, C, D In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia.

The nurse is admitting a patient to a long-term care facility. During the admission, the patient verbalizes a concern about getting dementia now that he is in a nursing home. In which activities should the nurse encourage the patient to participate to maintain brain health? (Select all that apply.) a. Physical exercise b. Stimulating mental activity c. Socialization d. Increasing dietary intake e. Crossword puzzles

ANS: A, B, C, E Many people reach older age and have no memory problems. Having a healthy diet and participation in physical exercise, stimulating mental activity, socialization, and stress management help brain health. Puzzles are a cognitive stimulating activity. An increase in dietary intake has not been shown to influence brain health. (ch 4 testbank)

When caring for an older man patient, the nurse is aware that which changes are associated with the male reproductive system and aging? (Select all that apply.) a. Testes soften. b. Seminiferous tubules thicken. c. Sperm count decreases. d. Ejaculation is slower. e. Incontinence is common.

ANS: A, B, D Although men have the ability to produce sperm throughout their lives, they also experience changes in the functioning of the reproductive and the urogenital organs in later life. The changes are usually more subtle and noticed only as they accumulate, beginning when men are in their 50s. The testes atrophy and soften. The seminiferous tubules thicken, and obstruction caused by sclerosis and fibrosis can occur. Although sperm count does not decrease, fertility may be reduced because of a higher number of sperm lack motility or have structural abnormalities. Erectile changes are also seen; more stimulation is needed to achieve a full erection, ejaculation is slower and less forceful, and refractory periods are longer. Incontinence is not a normal age-related change. (ch 3 testbank)

A nurse performs an assessment of an older adult's oral cavity. Which of the following findings are normal age related changes? (Select all that apply.) a. Missing teeth b. Recession of gums c. A white film on the tongue d. Decreased saliva production e. Gums that bleed easily

ANS: A, B, D There are many age-related changes in the oral cavity. With wear and tear, teeth lose enamel and dentin and become more vulnerable to decay. Without care, teeth may be lost. Gums recede, and there is a decrease in saliva production. Bleeding gums is indicative of infection, and a white film on the tongue is also indicative of an infection. (ch 3 testbank)

Which of the following are true statements about older adults and use of computer technology? (Select all that apply.) a. Older adults comprise the fastest growing population using computers and the Internet. b. Older adults tend to be reluctant to use social networking sites. c. Older adults perceive the Internet as a valuable resource. d. Older adults do not routinely use the Internet to connect with their health care providers. e. Older adults have much difficulty learning to use technology

ANS: A, C Older adults comprise the fastest growing population using computers and the Internet. Older women comprise the fastest growing group using social networking sites such as Facebook, Twitter, and Myspace. Older adults perceive the Internet as a valuable resource and use it to communicate with friends, families, and health care providers and access health-related information. There is no evidence that older adults have difficulty learning to use technology. (ch 4 testbank)

A nurse caring for older adults must be aware of which consequences of ageism in language? (Select all that apply.) a. Reduced sense of self b. Poor nutritional intake c. Lowered sense of self-competence d. Decreased memory performance

ANS: A, C, D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons and fewer of those who are healthy and active. Consequences of ageism have been identified as a reduced sense of self, lowered self-esteem, lowered sense of self-competence, and decreased memory performance. Poor nutritional intake has not been identified as a consequence.

A nurse in a long-term care facility is using the TimeSlips program with a group of cognitively impaired older adults. The nurse is using which of the following techniques? (Select all that apply.) a. Provides a picture for all group members to look at and use to create a story b. Records the number of correct answers that each participant provides c. Records the responses of all participants d. Compliments each member for his or her contribution to the story e. Reads the story back during the session, noting the contributions of each participant

ANS: A, C, D, E Using the TimeSlips format, group members looking at a picture are encouraged to create a story about the picture. All contributions are encouraged and welcomed, there are no right or wrong answers, and everything that the individuals say is included in the story and written down by the scribe. Stories are read back to the participants during the session using their names to identify their contributions. At the beginning of each session, the story from the last session is read to the participants. Care is taken to compliment each member for his or her contribution to the wonderful story. There are no right or wrong answers. (ch 4 testbank)

Which statements are true about aging and the brain? (Select all that apply.) a. Most areas of the brain do not lose brain cells. b. Memory decline is inevitable as people age. c. Basic intelligence remains unchanged with age. d. The brain does not continue to make new brain cells. e. There are decrements in the ability to process information.

ANS: A, C, E Most areas of the brain do not lose brain cells. Although older adults may lose some nerve connections, this can be part of the reshaping of the brain that comes with experience. Basic intelligence remains unchanged with age, and older adults should be provided with opportunities for continued learning. There are decrements in the ability to process information. Many people reach older age and have no memory problems. Having a healthy diet and participation in physical exercise, stimulating mental activity, socialization, and stress management help brain health. (ch 4 testbank)

When discussing electroconvulsive therapy (ECT) with an older chronically depressed adult and his family, which statement will the nurse use to support this intervention? (Select all that apply.) a. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications." b. "ECT has been found to be more effective in older adults than in younger adults." c. "ECT is a safe intervention for those with psychotic ideation." d. "Although there may be some short-term memory loss, most individuals find that their memory comes back within a few days." e. "ECT results in a more immediate response to symptoms."

ANS: A, D, E ECT has been found to be effective in individuals who have psychotic depression and those who do not respond to antidepressant medications. ECT is equally effective in older adults as in younger adults. It is used for individuals with depression, not psychotic ideation. There is some short-term memory loss associated with ECT; however, it does resolve within a short time frame. ECT provides a more immediate response to symptoms than does medication. (ch 24 testbank)

The term health disparity is defined as a. The systematic elimination of the culture of another resulting in decreased wellness. b. Differences in health outcomes among groups. c. The difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. d. The existence of more than one group with differing values and perspective.

ANS: B *Health disparities are defined as differences in health outcomes among groups.* Cultural destructiveness is defined as the systematic elimination of the culture of another. Health inequities are defined as the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. Cultural diversity is defined as the existence of more than one group with differing values and perspective.

An older patient learns that she has metastatic cancer. The patient states: "I must have angered God." This is an example of which type of belief? a. Biomedical b. Magicoreligious c. Naturalistic d. Ayurvedic

ANS: B *Magicoreligious* beliefs view illness as caused by actions of a higher authority. Biomedical beliefs view disease as a result of abnormalities in structure and function and disease caused by intrusion of pathogens into the body. Naturalistic beliefs are based on the concepts of balance; health is seen as a sign of balance. Ayurvedic beliefs are of the oldest known paradigm in the naturalistic system; illness is seen as an imbalance.

Which health belief system uses treatments to repair a body part? a. Holistic b. Biomedical c. Personalistic d. Magicoreligious

ANS: B Because dysfunction or a structural abnormality is thought to cause disease, the biomedical system believes in repairing the structural abnormality. The holistic system holds that health is attained through balance. The personalistic system uses treatments such as meditation, fasting, and praying. The magicoreligious system is the same as the personalistic system.

Which of the following is a true statement about differing health belief systems? a. Personalistic or magicoreligious beliefs have been superseded in Western minds by biomedical principles b. In most cultures, older adults are likely to treat themselves using traditional methods before turning to biomedical professionals c. Ayurvedic medicine is another name for traditional Chinese medicine d. The belief that health depend on maintaining a balance among opposite qualities is a characteristic of magicoreligious belief system

ANS: B Older adults in most cultures have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is common for older adults to pray for cures or wonder what they did to incur an illness as punishment. The Ayurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of holistic or naturalistic approach.

What should the nurse do when providing nursing care to an older adult with a different cultural background? A. Have the family provide care so no customs are violated B. Assess how cultural variables affect the patient's health C. Focus only on the patient's needs and ignore the nurse's beliefs D. Overlook the differences and provide the patient generalized care

ANS: B Promoting healthy aging in cross-cultural settings includes the ability to develop a plan of action that considers the perspective of both the patient and family and the nurse and health care system to negotiate an outcome that is mutually acceptable (ch 1, 2 ppt)

Decreased functioning of which physical structure is likely to result in decreased metabolism in older adults? a. Kidney b. Thyroid gland c. Brain d. Skeleton

ANS: B Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis. (ch 3 testbank)

The holistic health movement has impacted health care in which of the following ways? a. It has focused health care on disease prevention. b. It has reshaped how health and health care are perceived. c. It has improved access to health care. d. It has introduced numerous alternative modalities into health care.

ANS: B The holistic paradigm has reshaped how health and health care are perceived. Wellness is seen as a state of being which can be defined anywhere along the continuum of health.

The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b. Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d. Take them to the library for guest speakers.

ANS: B The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s and 90s were born between 1920 and 1930 and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events, including incontinence and hearing and vision problems.

A nurse is caring for a culturally diverse patient who has missed follow-up appointments with the primary care provider three times over the past year. The patient has a chronic illness that requires periodic monitoring of blood test values. The patient tells the nurse: ―You don't understand—in my culture, we don't do things like that. I cannot be troubled with worrying about appointments in the future; I deal with each day as it comes.‖ The nurse understands which of the following about the patient's culture? a. The culture does not value Western medicine. b. The culture has a different orientation to time than Western medicine. c. The culture is an interdependent culture. d. The culture does not believe in preventative care.

ANS: B Time orientation is a culturally constructed factor. Westernized medical care is future oriented. Conflicts between future oriented Westernized medical care and those with a present or past time orientation may arise. Patients are likely to be labeled as noncompliant for failing to keep appointments.

The nurse prepares an older woman, who is Polish, for discharge through an interpreter and notes that she becomes tense during the instructions about elimination. Which intervention should the nurse implement? a. Move on to the discussion about medication. b. Ask the older woman how she feels about this topic. c. Instruct the interpreter to repeat the instructions. d. Have the older woman repeat the instructions for clarity.

ANS: B When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and therefore validates the assessment about the older adult's tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable discussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adult's discomfort. Instructing the older adult to repeat the nurse's instruction ignores her needs.

An older adult says to the nurse, "I don't know why I can't handle booze like I used to when I was younger." The nurse's response is based on the knowledge that a. older adults develop higher blood alcohol levels because of age-related changes in the neurological system. b. older adults develop higher blood alcohol levels because of age-related changes that alter absorption and distribution of alcohol. c. older adults develop higher blood alcohol levels because of slowed reaction times. d. older adults develop higher blood alcohol levels because of cognitive changes.

ANS: B Age-related changes such as increased body fat, decreased lean muscle mass, and decreased total body water content alter absorption and distribution of alcohol, increasing blood alcohol levels. Age-related neurologic changes do not impact blood alcohol levels. Slowed reaction time does not impact blood alcohol levels. Cognitive changes do not impact blood alcohol levels; furthermore, not all older adults experience cognitive changes. (ch 24 testbank)

Which change in the skin is abnormal in an older person? a. Thinner and more fragile skin b. Red, swollen 3-day-old wound c. Greater number of freckles d. Loss of hair on the extremities

ANS: B Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease (ch 3 testbank)

An older patient in an adult day care program tells the nurse that, "I'm very stressed because another neighbor passed away." The most therapeutic response by the nurse is: a. "What do you mean by 'stressed'?" b. "Tell me what you did when your other neighbor passed away." c. "Are you worrying about your own death?" d. "Let's get involved in some activities and not think about sad things."

ANS: B Application of what one has learned from previous situations can help dissipate the intensity of stress. Denial of the stressful event and focusing on blessings or happiness will not lessen the stress and may in turn intensify it. Although it is appropriate to ask the patient to clarify what he or she is saying, it does not help in this situation. This is not necessarily the time to initiate a conversation about the patient's feelings about death because doing so is likely to increase the level of stress. (ch 24 testbank)

An older woman was seen in her physician's office after falling at home. The patient receives a comprehensive assessment, and it is determined that she has a positive urine culture and is started on antibiotic therapy for a urinary tract infection (UTI). The patient is surprised at the diagnosis. The woman reported that she had experienced some pain on urination the previous day but did not think that she had a UTI because her temperature was only 99°F. One reason why the patient may not have developed a higher temperature is a. the patient's UTI was not yet serious enough to cause a significant increase in body temperature. b. normal age-related changes to the immune system function affect an older person's response to illness; a low-grade fever may signify serious illness. c. older adults do not run fevers when they are ill. d. this patient likely has an alteration to her immune system that impacts her response to infection.

ANS: B Change in immune function affect an older person's response to illness consistent with the immunologic theory of aging. Older adults typically have lower core body temperatures. A lack of fever cannot be used to rule out infection. The nurse needs to consider the patient from a holistic perspective. A recent fall is often an atypical presentation of a serious illness or infection. (ch 3 testbank)

Which of the following is a true statement about sleeping in older adults? a. Older adults tend to fall asleep quickly but are awakened throughout the night. b. Sleep disturbances in older adults can be caused by chronic illness. c. Benzodiazepine agents are the medications of choice for sleep disorders. d. The times of day that medications are given has no effect on sleep disturbances.

ANS: B Chronic illness is an internal risk factor that can contribute to sleep disorders. It takes older adults more time to fall asleep, and older adults are awakened throughout the night more frequently than younger people. Benzodiazepines should not be used to induce sleep; these substances are highly addictive, and if their administration is suddenly withdrawn, then rebound insomnia can occur. In addition, older adults who take benzodiazepines for sleeping are more likely to experience a "hangover" after waking that can increase the risk of accidents and injuries. The times of day that medications are given can also contribute to sleep problems—for example, a diuretic given before bedtime or sedating medications given in the morning. (ch 13 testbank)

How should the nurse respond when an older adult asks, "How much alcohol is good for you?" a. "Alcohol isn't good for you, so avoid it as a general rule." b. "Experts in the field recommend only one regular sized drink a day." c. "It's been said that red wine has health benefits, but that doesn't mean you should drink a whole bottle." d. "If you are only drinking on special occasions, limit yourself to two drinks."

ANS: B Clinically significant adverse effects can occur in some individuals consuming as little as two to three drinks per day over an extended period. Because of the increased risk of adverse effects from alcohol use, the National Institute on Alcohol Abuse and Alcoholism defines "at-risk drinking" for men and women aged 65 years and older as more than one drink per day. The other options do not address the patient's question. (ch 24 testbank)

An older married couple move to a continuing care retirement community. The older woman who was always very social and outgoing quickly joins an exercise group, a book club, and a knitting circle. The older man who was always very solitary adopts a routine of a long daily walk and registers for an online course in creative writing. The behaviors of the older couple are consistent with which theory of aging? a. Activity theory b. Continuity theory c. Social exchange theory d. Disengagement theory

ANS: B Continuity theory proposes that individuals develop and maintain a consistent pattern of behavior over a lifetime. Aging, as an extension of earlier life, reflects a continuation of the patterns of roles, responsibilities, and activities. Personality influences the roles and activities chosen and the level of satisfaction drawn from these. Successful aging is associated with one's ability to maintain and continue previous behaviors and roles. (ch 4 testbank)

Mandatory retirement at age 65 years is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory

ANS: B Disengagement theory states that in the natural course of aging, the individual does and should withdraw from society to allow for the transfer of power to younger generations. (ch 4 testbank)

Exercises are prescribed for older adults as therapy to improve which one of the following qualities? a. Relative intensity b. Muscle strength c. Muscle retraining d. Body sculpting

ANS: B Exercises that improve muscle strength are important for balance, strong bones, and metabolic processes. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle definition is a quality valued by bodybuilders, but it is not a therapeutic concern. (ch 13 testbank)

An older woman recently lost her brother, provides care for her husband who has health needs, and must move to a new location after 35 years in the same home. When she comes to the primary care facility with clinical indicators of influenza, the nurse recognizes which of the following? a. She is exhibiting attention-seeking behaviors. b. Crises and stressors can impair physical health. c. Her greatest need is respite care for her husband. d. Crisis leads to a lower functional status for the victim.

ANS: B Her resistance to disease is likely to be lower as a result of the effects of heavy stresses acting simultaneously. She may be seeking attention, but that does not make the stress and illness any less real. Her greatest need at this moment is to be treated for influenza. Respite care may be necessary, but it is not sufficient. Successful coping with a crisis may lead to a higher level of functioning. (ch 24 testbank)

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 what theory of aging? a. Free radical theory b. Immunologic theory c. Oxidative stress theory d. Telomere theory

ANS: B The immunologic theory of aging describes changes in cells of the immune system, which make an older person more susceptible to infection. Prevention of infection is very important in older adults and can be accomplished by education and immunization (ch 3 testbank)

During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a. Exercise with light weights. b. Stand on one foot at a time while supported. c. Train with the use of sit-ups. d. Work out in a swimming pool.

ANS: B The loss of balance from a musculoskeletal perspective is usually caused by a loss of core muscle strength; thus, the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance. (ch 3 testbank)

Which age-related change contributes to anorexia and weight loss in older adults? a. Excessive saliva b. Fewer taste buds c. Wearing dentures d. Softened tooth enamel

ANS: B The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Older adults tend to lose enamel. (ch 3 testbank)

Which assessment finding of an older adult living in an assisted-living facility indicates the highest risk for suicide? a. Liver failure is due to alcohol abuse; older adult is popular at meals b. Older adult declines company; is preoccupied with lethal weapons c. Refuses to allow a large, extended family to help him d. Older adult had an overdose of acetaminophen 20 years ago; is in a sewing group

ANS: B The older adult who prefers to be alone and is preoccupied with lethal weapons has two risk factors for suicide. This individual warrants close observation for additional risk factors and verbalization and indicators of future suicide attempts. The nurse should also increase the frequency of observations and account for his whereabouts at all times. The individual who has a serious illness and a history of alcohol abuse has two risk factors for suicide. However, this older adult also relishes social interaction, which is an indication that suicide is less likely to be imminent or even in the individual's thoughts. The older adult who will not accept help from the family exhibits a potential risk factor for suicide or is an exceedingly proud individual who wants to be self-sufficient. History of a suicide attempt is a risk factor for suicide; however, the acetaminophen overdose could have been accidental. (ch 24 testbank)

The nurse in an assisted living facility (ALF) is preparing a lecture on aging for the residents. The philosophy of the ALF is to approach aging from the viewpoint of health. Based on this philosophy, the nurse includes which of the following topics?(Select all that apply.) a. "The Many Chronic Illnesses of Aging" b. "Channeling Your Inner Strength Toward Wellness" c. "Maximizing Function As You Age" d. "Conserving Your Strength As You Age" e. "Keep Moving, Maintain Your Mobility"

ANS: B, C, D A wellness perspective is based on the belief that every person has an optimal level of wellness independent of functional ability. This viewpoint approaches aging with an emphasis on resilience, strength, resources, and capabilities rather than focusing on existing pathological conditions.

Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply.) a. Fewer T lymphocytes b. Less lean muscle mass c. Decreased thyroid function d. Decreased physical activity e. Left ventricular hypertrophy f. Decreased insulin sensitivity

ANS: B, C, D, F Less lean muscle mass means that the body has fewer insulin receptor sites; thus, glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metabolic rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate, and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, older adults must increase physical activity and decrease food consumption. Fewer T lymphocytes are associated with age-related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it. Type 1 diabetes mellitus is considered an autoimmune disorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes. (ch 3 testbank)

A nurse in an assisted living facility is planning an educational program on exercise for the residents. The nurse needs to consider which of the following when planning the activity? (Select all that apply.) a. Very simple language must be used so that the residents will understand the material. b. Large size fonts must be used on all written material provided to the residents. c. The educational program should be provided in a quiet area without excessive background noise. d. The material discussed should focus only on the consequences of failure to exercise. e. The material discussed should build on the prior knowledge of the residents.

ANS: B, C, E When educating older adults, one needs to pay attention to potential sensory deficits common in this population such as vision and hearing. Older adults do not normally experience a decline in intelligence. When teaching older adults, it is beneficial to present practical information that builds on the prior knowledge of the participants. There is no evidence that older adults learn better by focusing on the effects of nonadherence. (ch 4 testbank)

Which factors interfere with the mental health of older adults because of the effect on adaptation? (Select all that apply.) a. Culture b. Life events c. Physical illness d. Substance abuse e. Cognitive impairment f. Developmental transitions

ANS: B, C, E, F A life event can interfere with the mental health of an older adult because the experience can interfere with the older adult's ability to adapt to the situation. Physical illness can interfere with the mental health of an older adult because the illness can interfere with the individual's adaptive ability. A cognitive impairment can interfere with the mental health of an older adult because this impairment can destroy the older adult's ability to adapt to new situations. Development transitions can interfere with the mental health of an older adult because the individual can lack the suitable skills necessary for adaptation through the transitional period. Culture is likely to influence the mental health of an older adult and influence how the individual adapts but does not necessarily interfere with adaptation. Substance abuse is likely to interfere with the mental health of an older adult but has a variable impact on the ability of the older adult to adapt. (ch 24 testbank)

Which of the following are true statements about depression or depression therapy? (Select all that apply.) a. An older adult who lived through the Great Depression is unlikely to develop depression. b. Complaining and not complaining can be symptomatic of depression. c. Serotonin reuptake inhibitors are rarely used to resolve depression in 2 weeks. d. The nurse should avoid trying to bolster a depressed person's mood.

ANS: B, D An older adult can complain because of having no positive feelings, or an older adult may not bother complaining because of having no hope. The nurse should not deny the older adult's depressed feelings or grief. Older adults who have endured the horrors of the mid-20th century (e.g., the Great Depression, the Holocaust, and World War II) are as prone to depression as other older adults, but they can consider it shameful to acknowledge depressive feelings. Serotonin reuptake inhibitors, usually the drug of choice for depression, can be unsuitable for a specific individual. All antidepressant medications must be closely monitored for side effects and therapeutic response. Only about one-third of depressed older adults achieve remission with any single agent (McGovern et al., 2014). (ch 24 testbank)

The nurse is assessing an older adult from a culture different than the nurse's by asking questions from the explanatory model for culturally sensitive assessment. Which question(s) should the nurse ask to follow this model? (Select all that apply.) a. How can we negotiate to solve the problem? b. What treatment can improve your condition? c. Should we try my plan first to see if it helps? d. Can we discuss differences in our plans now? e. How long have you experienced the problem? e. Who, other than me, can make you feel better?

ANS: B, E, F Asking about potential therapies is a question from the explanatory model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the explanatory model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN model.

Which person is most likely to experience health disparities? A.A 65-year-old affluent Hispanic man living in a city B.A 70-year-old married white man living in a rural area C.A 75-year-old widowed African American woman living alone D.A 80-year-old Asian woman living with her daughter and family

ANS: C A 75-year-old widowed African American woman living alone has the most risk factors. (ch 1, 2 ppt)

Which racial or ethnic group has the highest life expectancy in the United States? a. Native Americans b. African Americans c. Hispanic Americans d. Asian and Pacific Island Americans

ANS: C As shown in Figure 1.4, Hispanic men and women have the highest life expectancy of all. In 2011, for those of Hispanic origin of any race, the overall life expectancy at 65 years of age was 20.7 more years in 2011 (19.1 years for men and 21.8 years for women).

The nurse plans care for an older African American man who is from Jamaica and resides in New York City. Which should the nurse include in planning care? a. Attribute his illness to breaking a voodoo. b. Help him improve social relationships. c. Maintain blood pressure below 120/70 mm Hg. d. Review the principles of the magicoreligious system.

ANS: C Because African Americans tend to be at risk for cardiovascular disease and hypertension, the nurse plans to maintain the patient's blood pressure at or below the current recommendation by the American Heart Association. The nurse can be incorrectly assuming that he practices and believes in the magicoreligious system. The nurse should assess his spiritual beliefs and determine how much they influence his attitudes toward Western health care. The magicoreligious system maintains social relationships in good condition to prevent illness; however, if the older adult does not follow this cultural practice, then this goal can be unsuitable. The older adult may not believe in this system; therefore, the information can be irrelevant.

Which of the following issues in the care of older adults are identified in Healthy People 2020? a. Delineating nursing staffing levels in long term care b. Eradicating pressure ulcers in all care settings c. Identifying minimum levels of training for people who care for older adults d. Instituting mandatory training in identification of elder abuse for all caregivers of older adults

ANS: C Identifying minimum training levels for people who care for older adults is one of the issues identified in Healthy People 2020. The rest of the issues are not discussed in Healthy People 2020.

Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service b. Wheels ambulatory adults to exercise when running late c. Assigns female nurses to older women who are Islamic d. Allows older adults in a nursing home to eat meals alone

ANS: C The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Interrupting an older adult's worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adult's life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in wheelchairs to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, although focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being.

An older adult who is a traditional Chinese man has a blood pressure of 80/54 mm Hg and refuses to remain in the bed. Which intervention should the nurse use to promote and maintain his health? a. Have the health care provider speak to him. b. Use principles of the holistic health system. c. Ask about his perceptions and treatment ideas. d. Consult with a practitioner of Chinese medicine.

ANS: C Using the LEARN model (listen with sympathy to the patient's perception of the problem, explain your perception of the problem, acknowledge the differences and similarities, recommend treatment, and negotiate agreement), the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health-related information. Speaking with the health care provider is premature until the assessment is complete. Unless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can also be unsuitable and insulting for this patient.

A paper on culture and illness would be likely to include the statement that a. culture is the same as ethnicity. b. ethnic groups always share common geographic origin and religion. c. ethnicity involves recognized traditions, symbols, and literature. d. most members of an ethnic group exhibit identical cultural traits.

ANS: C Ethnicity is a complex phenomenon that includes traditions, symbols, literature, folklore, food preferences, and dress. It is a shared identity. Ethnicity is more than just culture. It is social differentiation based on culture. Even within ethnic groups, there is considerable diversity.

A retirement community is divided into different communities with different activities available for the residents of each community. There is one community for individuals ages 65 to 74 years, one for individuals ages 75 to 85 years, and one community for individuals older than age 85 years. This is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory

ANS: C Age-stratification theory is based on the belief that aging can be best understood by considering the experiences of individuals as members of cohorts with similarities to others in the same group. (ch 4 testbank)

A nurse is caring for an older adult who asks the following: "I have heard that it is important to eat a diet that is high in fruits and vegetables to age successfully. Is that correct?" The nurse considers which of the following theories of aging when responding to the older adult's question? a. Oxidative stress theory b. Immunological theory c. Free radical theory d. Telomere theory

ANS: C Although the intake of supplemental antioxidants is deleterious to one's health, there is evidence that diets inclusive of natural antioxidants, such as those high in fruits and vegetables or a Mediterranean diet rich in red wine and olive oil, are healthful. (ch 3 testbank)

The nurse designs a group exercise program at a senior center. Which room should the nurse choose for the program? a. Room with a beautiful hardwood floor tastefully appointed with throw rugs b. Spacious room with no windows but with fluorescent lighting and a natural stone floor c. Room with a hardwood floor and large windows overlooking a garden area d. End room with a linoleum floor and a fan for ventilation to compensate for the room's broken air conditioner

ANS: C The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains may be used. Throw rugs can slide underfoot and can lead to a fall, particularly when the sense of balance has declined with age. Fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat-gland response to heat. (ch 3 testbank)

Which of the following is a true statement about psychotic behavior in older adults? a. Usually, hallucinations in older patients are the result of psychological conflicts. b. Illusion, delusion, and hallucination are different terms for the same phenomenon. c. An older adult with psychotic behavior should be assessed for a variety of causes. d. Regardless of the cause, dissimilar hallucinations are treated with similar therapies

ANS: C The nurse assesses an older adult who is exhibiting psychotic behavior by searching for a reason from a wide variety of potential causes for the behavior. For example, neuroleptic medications can cause extrapyramidal side effects, which can result in movement disorders that are similar to psychotic behavior. Hallucinations in older patients are usually the result of physical disorders, dementias, or sensory function loss. A delusion is a belief that is maintained, although facts can prove that it is incorrect. A hallucination or illusion is the sensory perception of a stimulus that does not exist in the external world. Treatments for hallucinatory states vary according to the cause. (ch 24 testbank)

Researchers hypothesize that most super-centenarians survive and are in good health due to which of the following factors? (Select all that apply.) a. They have a different genetic makeup than other older adults have. b. They tend to live in wealthier areas of the world. c. The exact cause of this phenomenon is not known. d. Contributing factors to their good health include quality medical care and improved social conditions. e. They have large extended families to assist in their care.

ANS: C, D The exact cause of super-centenarians' longevity is not known; researchers describe it as attributable to "rare and unpredictable reasons." Contributing factors include medical care and improved sociopolitical conditions. There is no known difference in biological or sociological factors between super-centenarians and other older adults. Super-centenarians exist all over the world.

A nurse is caring for an older adult in the hospital who reports decreased hearing. Which of the following interventions should the nurse use when communicating with this patient? (Select all that apply.) a. Raise the pitch of the voice when speaking with the patient. b. Speak very slowly using simple words when speaking to the patient. c. Face the patient when speaking. d. Decrease background noise when speaking with the patient. e. Obtain a sign language interpreter to speak with the patient.

ANS: C, D With normal age-related hearing loss, the patient can still hear, so a sign language interpreter would not be appropriate. In addition, it is not known whether or not this patient is able to communicate in sign language. Presbycusis, age-related hearing loss, is primarily the loss of the ability to hear high-frequency sounds. Therefore, raising the pitch of the voice would not help the situation. Speaking very slowly and using simple words may be seen as demeaning to the patient. It is important to face the patient and to decrease background noise. Facing the patient is helpful if the patient reads lips. (ch 3 testbank)

A nurse in the ambulatory care setting is preparing to do an interview with a non-English-speaking client. The nurse secures an interpreter. To have the most effective interview, the nurse should do which of the following? (Select all that apply.) a. Look and speak to the interpreter. b. Use technical terminology to ensure accuracy. c. Allow more time for the interview. d. Watch the client's nonverbal communication. e. Through the interpreter, check whether the client understands the communication.

ANS: C, D, E For the most effective interview the nurse should look and speak directly to the client; avoid the use of jargon and technical terminology; observe the client's nonverbal communications; and clarify understanding by asking the client to state in his or her own words what he or she understood, facilitated by the interpreter. The interview will naturally take longer.

An older adult who lives in an assisted living facility tells a nurse that she is engaged in life review. The nurse understands which of the following about life review? (Select all that apply.) a. Life review is only useful at the very end of an individual's life as he or she is close to death. b. Life review and reminiscence are the same phenomenon. c. Life review is a highly personal activity. d. Life review can help an individual change course or set new goals. e. Life review can be helpful to an individual experiencing a depressive episode.

ANS: C, D, E Life review is considered more of a formal therapy technique than reminiscence and takes a person through his or her life in a structured and chronological order. Life review should occur not only when we are old or facing death but also frequently throughout our lives. This process can assist us to examine where we are in life and change our course or set new goals. Life review may be especially important for older people experiencing depressive symptoms. Life review is a highly personal activity. (ch 4 testbank)

A home care nurse is caring for an older patient from a different culture who is bedbound and high risk for development of a pressure ulcer. The nurse discusses the plan of care with the patient's daughter, emphasizing the importance of turning every 2 hours, and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient's daughter reports that she turns her mother occasionally. She states, "I am taking very good care of my mother. You just don't understand—our ways do not involve doing things on schedules." The best response by the nurse is: a. "You must follow my guidelines and turn her every 2 hours, or I will not be able to take care of her" b. "I understand that you value your culture, but culture cannot stop you from providing good care to your mother." c. "I understand that you care very much for your mother. Perhaps caring for her is too much for you." d. "How can we best work together to provide the best care for your mother?"

ANS: D In providing cross-cultural care, it is important that the nurse work with the patient and family and listen carefully and find a way to include the values and beliefs of the patient in the plan of care.

A man is terminally ill with end-stage prostate cancer. Which is the best statement about this man's wellness? a. Wellness can only be achieved with aggressive medical interventions. b. Wellness is not a real option for this client because he is terminally ill. c. Wellness is defined as the absence of disease. d. Nursing interventions can help empower a client to achieve a higher level of wellness.

ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness in his or her clients. Wellness is defined by the individual and is multidimensional. It is not just the absence of disease. A wellness perspective is based on the belief that every person has an optimal level of health independent of his or her situation or functional level. Even in the presence of chronic illness or while dying, a movement toward wellness is possible if emphasis of care is placed on the promotion of well-being in a supportive environment.

Which action should the nurse take when addressing older adults? a. Speak in an exaggerated pitch. b. Use a lower quality of speech. c. Use endearing terms such as ―honey.‖ d. Speak clearly.

ANS: D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons and fewer of those who are healthy and active. Providers should not assume that all older adults are hearing or mentally impaired. The most appropriate action when addressing an older adult would be to speak clearly. Examples of unintentional ageism in language are an exaggerated pitch, a demeaning emotional tone, and a lower quality of speech.

An older man who resides in a nursing home has a total cholesterol level of 245 mg/dL. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instruct him about increasing dietary fiber. b. Ask the health care provider for a low-fat diet. c. Schedule a consultation for him with the dietitian. d. Review a menu with him to choose suitable foods.

ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adult's collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with hyperlipidemia to achieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input.

Which of the following considerations is most likely to be true when working with an interpreter? a. An interpreter is never needed if the nurse speaks the same language as the patient. b. When working with interpreters, the nurse can use technical terms or metaphors. c. A patient's young granddaughter who speaks fluent English would make the best interpreter because she is familiar with and loves the patient. d. The nurse should face the patient rather than the interpreter.

ANS: D The nurse should face the patient rather than the interpreter is a true statement; the intent is to converse with the patient, not with a third party about the patient. Many reasons may prevent the patient from speaking directly to a nurse. Technical terms and metaphors may be difficult or impossible to translate. Cultural restrictions may prevent some topics from being spoken of to a grandparent or child.

Historical influences that have shaped the lives of the majority of the in-between cohort in the United States today include which of the following? a. Influenza epidemic of 1918 b. World War I c. Child rearing in the Depression d. World War II

ANS: D Those who are in the *in-between cohort* in 2016 were born between 1915 and 1945. The men were likely to have fought in World War II. The last of the Holocaust survivors are in this group. A person who survived the influenza epidemic would be at least 98 years old in 2016 and therefore would be considered old-old or a centenarian. Most of those who are of the in-between cohort had not reached childbearing age by the end of the Depression. Individuals in the in-between cohort would not have been old enough to fight in World War II.

Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults? a. Increased secretion of cholinesterase b. Decreased secretion of neurotransmitters c. Loss of spinal cord and brainstem neurons d. Atrophy of dendrites in the cerebral cortex

ANS: D Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmission of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. The spinal cord and the cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord. (ch 4 testbank)

The nurse at a nursing home wants to help decrease the risk of Alzheimer's disease (AD) in the residents. Which should the nurse do to implement this goal? a. Keep the curtains open in their rooms. b. Offer beads for them to string on yarn. c. Show movies that the residents choose. d. Assist residents with ambulation to meals.

ANS: D Engaging in physical activity and social interaction are associated with a lower risk for AD. Keeping the curtains open can make a resident's room more pleasant but is likely to be counterproductive in lowering the risk; brightening the room can entice the resident to stay in the room and decrease social interaction. Stringing beads is a passive and sedentary activity and therefore unlikely to decrease the risk for AD; physical activity is associated with a lower risk for AD. Watching movies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence. (ch 4 testbank)

The nurse plans care for older adults who are in good health but isolated from their families. If the nurse's goal is to move the adults toward gerotranscendence, which intervention should the nurse use in the plan of care? a. Give a daily tea party for the group. b. Call each family to encourage visiting. c. Assist them to resume midlife patterns. d. Help each person with individual activities

ANS: D In Tornstam's theory, aging offers the potential for gerotranscendence, a culmination of an individual's life, wisdom, and spiritual growth that allows older adults to live contentedly with and without social activities. An older adult spends more time on meditation and solitude and less time on materialism and self-consciousness about body image. Individual activities or self-selected activities are satisfactory. Solitude is satisfactory. Midlife patterns are no longer relevant to contentment. (ch 4 testbank)

The nurse observes older women learning advanced knitting techniques. The nurse concludes that this learning activity is suitable for these women because it accomplishes which of the following? a. Helps maintain joint flexibility b. Improves the group's cohesiveness c. Provides a needed social opportunity d. Adds to their existing knowledge base

ANS: D Learning advanced techniques is a suitable activity for older adults because it builds on knowledge they already have. Furthermore, this activity is suitable because it is concrete and practical for experienced knitters to develop advanced skills. Joint flexibility is a physical activity and not necessarily a learning activity. The members share enjoyment of knitting; other than being women and older, the group has no special bond on which to build. The need for socializing is not evident. (ch 4 testbank)

Which of the following is a true statement concerning suicide among older adults? a. Older adults and younger adults manifest a suicidal intent in a similar manner. b. Older African American women have the highest risk of suicide among older adults. c. Ethics require that the nurse respects a person's intent to terminate his or her own life. d. A major crisis experienced by the patient can contribute to the risk of suicide.

ANS: D Major crises or transitions, such as retirement or relocation to an assisted living or nursing facility, can contribute to the risk of suicide. Putting personal affairs in order, distributing possessions; making a will; or saying something similar to, "I won't be around much longer" can indicate a risk for suicide in a young person but can be a rational and mature act in older age. Men in all countries have a higher suicide rate, and white men are more likely to evaluate their worth solely in terms of their present economic productivity. Chinese American women aged 65 years and older have the highest suicide rate of all women older than the age of 65 years in the United States (National Alliance on Mental Illness, 2011). Health care professionals are obligated to prevent the destruction of life as a permanent solution to what may be a temporary problem (ch 24 testbank)

Aging ordinarily leads to decreases in which of the following? a. Creatinine clearance and insulin secretion b. Blood carbon dioxide and saliva production c. Left ventricle-wall thickness and skin healing time d. Serum triiodothyronine (T3 ) and gastric pepsin

ANS: D Serum T3 and pepsin secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally (ch 3 testbank)

An older female resident lowers her voice and tells the nurse that another female resident is looking at her behind her back and is going to make her move tonight with a male staff member. Which ideas should the nurse include in the response to this individual? a. The staff receives training in ethics. b. Validate the woman's impression. c. Avoid suspicious, paranoid thinking. d. Use the call bell if she becomes frightened.

ANS: D Telling the resident to use the call bell if she becomes frightened offers assurances to the patient that she will be protected, but it neither confirms her suspicions nor makes a promise that cannot be kept. Replying that the staff receives training in ethics sounds as if the nurse is arguing in defense of the male staff member and does not help alleviate the resident's fear, which can lead her to suspect that the nurse is also a part of the plot. Validating the woman's impression contributes to the resident's suspicions; in addition, the nurse increases professional liability risks by speaking about another resident in a negative manner. Telling the resident to avoid suspicious, paranoid thinking only aggravates the struggle for control. (ch 24 testbank)

An older man who had radical surgery for oral cancer is refusing to see visitors and is losing weight despite aggressive nutrition therapy. The nurse assesses this man for ineffective coping related to dysfunctional grieving. Which of the following patient outcomes of nursing care is the most important to implement in response to his mental health status? a. Is able to discuss how his coping mechanisms are overwhelmed b. Performs daily self-feedings through a gastrostomy tube c. Effectively uses nonverbal forms of communication d. Exhibits self-confidence in regaining a sense of control

ANS: D The most important element of the nursing plan of care for this older adult is to create and strengthen selfconfidence to improve his sense of control; doing so is likely to help him effectively manage the other aspects of his health care. The nurse helps create and improve this self-confidence by observing for strengths and integrating them into his daily care and by responding with empathy and encouragement to his expressions of fears, emotions, and desirable goals. Helping this patient gain self-confidence is the most important outcome because this man has clinical indicators for depression—social isolation and weight loss. Before this patient can benefit from discussing his stressors or from patient teaching, the nurse must establish a trusting, caring relationship and build some self-confidence because, at this point, this individual feels hopeless and believes that he has no control. The patient displays a lack of readiness for expressions about emotions, coping, or his stressors; by enhancing his self-confidence, the nurse prepares him to discuss coping mechanisms and stressors. This patient also displays a lack of readiness for learning a new psychomotor activity. Performing daily self-feeding is an outcome that gains importance as the day for discharge approaches. Effectively using nonverbal forms of communication is important for basic communication; however, he displays a lack of readiness for receiving help to achieve this outcome. (ch 24 testbank)

Which of the following statements is true about the mental health of older adults? a. Nurses should discourage denial and regression so older adults can directly face underlying causes of anxiety. b. Anxiety is easily distinguished from depression, dementia, and the effects of disease or medication. c. Compulsive rituals surrounding toileting and sleep are signs of a serious mental disorder. d. The nurse avoids antianxiety medications without an assessment for factors associated with anxiety.

ANS: D Without an adequate assessment, medications can exacerbate a problem. Denial and regression may be necessary to enable an older person to cope with underlying stressors. Depression, dementia, disease, and medications can produce anxious behavior, and the resultant anxiety can be manifested in a similar manner, regardless of the cause. Compulsive rituals can be a way of coping with challenges leading to anxiety. (ch 24 testbank)

Which of the following demonstrates good self-care when taking care of many patients with serious illness and their families?

Establish healthy eating, sleeping, and exercise habits especially when rotating shifts

You are assessing Mrs. Smith's husband's well-being during her recent hospitalization. Mr. Smith has had trouble with heart failure this past year. He tells you that all that matters to him is his wife. He states he does not have time to go to the doctor or get his own prescriptions filled. What is your BEST response?

I am concerned about you too. Keep in mind you can't take care of Mrs. Smith if you get sick; you need to get your prescriptions filled.

You have been working on the end-stage heart failure unit for eight months. Many of your patients have died awaiting transplant. You are aware that you are not sleeping well at night and dread going to work each day. Many of your colleagues are irritating you and you are moody when at home. Which of the following would be best to do FIRST?

Speak with your nurse manager about how you are feeling and ask for help.

Mr. Lopez is the partner of the 50-year-old woman you have been caring for who has just died following a long struggle with breast cancer. He is crying at the bedside and lying across the patient. What is your BEST initial response?

Support his privacy but offer to stay in the room if he would like you to

The hospice interdisciplinary team is creating a bereavement plan for the family of Mr. A, a 50-year-old patient with advanced HIV/AIDS. The patient defines his family as consisting of his husband, his parents, and his four siblings, as well as his two closest friends. In creating the plan, what bereavement interventions MUST the interdisciplinary team include?

Take into account each survivor's cultural practices in mourning and grief reactions.

Which of the following family members is at greatest risk for complicated grief?

The daughter who has a long history of substance use and has just recently returned home to be at her dying mother's bedside.

You are caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, which person is at risk for disenfranchised grief?

The ex-wife of the patient who lives nearby

Mr. C, whose wife of 14 years died five months ago, returns to your unit to thank you all for your great care. He tells you he still cannot get through a week without crying and states that he knows he should be moving on from the death. Which of the following is your BEST response?

This is very hard; can you tell me a bit about what moving on means to you?

Mr. Lopez's partner just died and he has been unable to leave her side. He is grieving and tells you he will never be able to get over losing the love of his life. What is your BEST response?

You must have loved her very much; this has to be so hard for you.