Gero Exam 3 Study Guide

8. An older adult has impaired psychosocial functioning. Which of the following consequences should the nurse monitor? A) Anxiety B) Elevated blood glucose level C) Increased independence D) Resilience

Ans: A Feedback: Anxiety is a common result of impaired psychosocial function in older adults. It is less likely to result in hyperglycemia and it is not associated with increased independence or resilience, another positive consequence of healthy psychosocial functioning.

1. A nurse monitors older adults in a long-term care facility. Which of the following symptoms would require follow-up by the nurse to assess for depression in the older adult? A) Anorexia B) Weakness C) Labile affect D) Impaired perceptions

Ans: A Feedback: Appetite disturbances, particularly anorexia, are among the most common physical complaints of depressed older adults. Individuals with dementia have the following symptoms: vague fatigue, labile affect, and physical complaints that are easily forgotten.

4. A nurse addresses the social supports available for an older adult client. Which of the following should the nurse include in the plan? A) Ask the client direct questions about the barriers to the use of social supports. B) Decide which of the programs is the highest quality. C) Determine if family or friends could do the work. D) Provide the client information about services that are available.

Ans: A Feedback: Assessing barriers to support services is particularly challenging because direct questions about these issues often are inappropriate and usually are very threatening. Social supports are often erroneously seen as expensive, impersonal, and hard to arrange. Funding is available for such programs, though less than 20% of eligible adults use them. The quality of care is not necessarily lower than that provided by friends or family and an older adult is not disqualified by virtue of having friends or family available.

11. A nurse prepares to administer scheduled medications to a new resident with mild non-Alzheimer-type dementia. Which of the following type of medication should the nurse administer without concern of worsening delirium? A) An anticholinergic B) An atypical antipsychotic C) A benzodiazepine D) A cholinesterase inhibitor

Ans: A Feedback: Cholinesterase inhibitors are standard treatment for mild-to-moderate Alzheimer disease. Anticholinergics, including benzodiazepines, as well as atypical antipsychotics can all lead to delirium.

4. A nurse teaches a nursing assistant about the impact of culture on older adults' well-being. Which of the following statements by the nursing assistant indicates a need for further teaching? A) "A cultural background has little influence on individuals' standards for 'normal' or 'abnormal' behavior." B) "Western cultures often have a very rigid distinction between health and illness." C) "Culture may influence mental health and illness in individuals." D) "Culture may determine an individual's expression of symptoms or clinical manifestations."

Ans: A Feedback: Cultural background significantly influences how a person defines all aspects of psychosocial function. It is essential to recognize that every society has standards of behavior. Many societies do not have the rigid distinction between health and illness that Western society does.

9. A resident of a nursing home has accused several members of the care staff of stealing jewelry from the overbed table despite the fact that the facility's policy requires residents to keep such valuables in a lock box. The nurse has responded empathically to the accusations and has explained why this is impossible, to no avail. Which of the following conditions is the client experiencing? A) Delusions B) Hallucinations C) Unresolved anger D) Illusions

Ans: A Feedback: Delusions are fixed false beliefs that have little or no basis in reality and cannot be corrected by appealing to reason. Hallucinations are sensory experiences that have no basis in an external stimulus. Delusions are not known to be a manifestation of unresolved anger. Illusions are misperceptions of an external stimulus.

8. Which of the following statements by residents of a nursing home should prompt a nurse to assess for depression? A) "Lately I wake up for the day at 4:00 or 5:00 in the morning and can't fall asleep again." B) "I've got these cravings for sugary and salty snacks more than I used to." C) "I've never been too prone to headaches, but these days I always seem to have one." D) "I don't know why this sore on my ankle just won't heal this time."

Ans: A Feedback: Early morning waking is a sleep disturbance that is characteristic of depression. Headaches and impaired healing may also be linked with depression, but sleep disturbances are more highly associated with the problem. Food cravings are not typical of depression in older adults.

2. A nurse is conducting a class at a senior citizens' center on factors that protect against dementia. Which of the following statements by an older adult in the class indicates a need for further teaching by the nurse? A) "No healthy lifestyle is going to ward off dementia." B) "Eating food high in omega-3 fatty acids will help preserve my thinking processes." C) "Engaging in social activities will help prevent dementia." D) "Engaging in an organized exercise program will help prevent symptoms of dementia."

Ans: A Feedback: Engaging in regular exercise has a positive effect on preventing cognitive decline. Omega-3 fatty acids are nutritional interventions that help preserve cognition. There is evidence that engaging in stimulating and meaningful activities also has a positive effect on preventing cognitive decline. Adopting a healthy lifestyle may help ward off dementia just as it does other diseases.

15. A nurse assesses an 85-year-old Hispanic woman. The client states that her husband was punished by God. To which of the following illnesses is the woman most likely referring? A) Alcohol abuse B) Fainting C) Posttraumatic stress disorder (PTSD) D) Voodoo

Ans: A Feedback: For some Hispanics, mental illness may be viewed as a punishment by a supreme being for past transgressions; Hispanic older adults define mental health problems as alcohol and other drug abuse. PTSD is relatively common in immigrants. Hallucinations are not especially related to Hispanic culture. Those of Caribbean descent may attribute the cause of mental illness to voodoo.

10. A nurse leads a "Healthy Aging" class at a community health center. Which question should the nurse use to generate discussion among participants in this setting? A) "How did you adjust to your move from your house to the assisted living facility Irma?" B) "Are you satisfied with the care that you're getting from your family doctor, Elizabeth?" C) "Donald, could you tell us why your grandson is living with you?" D) "Have you had any tests done on your heart since we last met, Marie?"

Ans: A Feedback: Healthy aging classes are based on the belief that older adults who are beginning to recognize age-related physical and psychosocial changes or who are already dealing with such changes can benefit from sharing their experiences with their peers. Discussion about these adjustments should be the priority in a healthy aging class.

6. A nurse is conducting a comprehensive psychosocial assessment of an older adult who has recently moved to the long-term care facility. How should the nurse best assess the client's motor function? A) Observe the client walking into or out of the room. B) Assess the client's deep tendon reflexes using a hammer. C) Perform passive range of motion exercises on the client's arms and legs. D) Position the client supine and ask the client to perform a leg lift with each leg separately.

Ans: A Feedback: In the context of a psychosocial assessment, motor function includes such assessment parameters as posture, movement, and body language. It is not an assessment of reflexes, strength, or range of motion.

15. An older adult expresses frustration about limitations of aging. Which of the following statements by the nurse promotes wellness? A) "Do you have some words of wisdom to share about that valuable experience?" B) "How does living in these conditions compare to your youth?" C) "Have you met any of your neighbors, they seem like nice people?" D) "What you are saying is that you are frustrated with how they are not listening to you?"

Ans: A Feedback: Instead of asking about current versus historical, the nurse should acknowledge the wisdom of older adults by asking questions such as "Do you have some words of wisdom to share? Asking about neighbors is deflection and not helpful?" Reflection can be appropriate, but at this time positive acknowledgment should be used.

15. A nurse observes an aide asking a client what he wants for breakfast, lunch, and dinner while assisting him to toilet. Which action by the nurse is most appropriate? A) Direct the aide to present only one idea at a time. B) Encourage this small talk. C) No action is required. D) Tell the aide to avoid conversations while the client is toileting.

Ans: A Feedback: Multiple events/ideas are occurring at once; this increases the risk of overloading the client. Teach the aide to present one idea at a time (e.g., do you like oatmeal?). Directed small talk is appropriate, when the client is dressed and not in a compromised situation.

9. A 70-year-old woman has expressed interest in preventing osteoporosis as a result of the high prevalence of the disease in her peer group. What dietary measures should the nurse recommend? A) High intake of salmon and fortified cereals B) A high-protein, low-carbohydrate diet C) High intake of organic fruits and vegetables D) Vitamin C supplements and a high-potassium diet

Ans: A Feedback: Nurses can also teach older adults and their caregivers about the importance of adequate intake of calcium and vitamin D in the prevention of osteoporosis. Salmon, fortified cereals, and orange juice are sources of both. Measures such as high-protein intake, low-carbohydrate consumption, vitamin C supplements, and a high-potassium diet do not address the risk factors for osteoporosis. A diet high in fruits and vegetables is beneficial, but this will not have as direct an effect as vitamin D and calcium intake.

8. An 82-year-old client walked 2 miles last week to enjoy the spring weather. The client says since that time, "I haven't been doing very much, I'm afraid it will hurt." Which action by the nurse is most appropriate? A) Discuss moderation in activity, encouraging continued movement. B) Obtain a cane for use to improve balance, and reduce the client's fears. C) Encourage the client to walk the 2 miles every day. D) Have the client take ibuprofen (Motrin IB) every morning.

Ans: A Feedback: Practices that are recommended for self-care of osteoarthritis include using moist heat and analgesics for pain, regular low impact exercise, and balancing weight-bearing activities with rest periods. Walking 2 miles is too far for this client (as evidenced by the severe pain after walking that distance previously). The client does not currently have any balance issues; thus, a cane would not reduce the fear of pain.

1. Which of the following is a priority nursing intervention for the management of delirium? A) Giving the client low-dose oxygenation and maintaining his or her fluid and electrolyte balance B) Reducing noise and placing familiar objects in the client's environment C) Giving the client a clock, a watch, and calendars to provide the client with temporal orientation D) Providing psychological support through cognitive and social stimulation

Ans: A Feedback: Priority questions address physiologic integrity. The client needs to be stabilized before the other interventions can be implemented.

5. A nurse manager develops policies to promote a sense of control for older adults in the assisted living facility. Which of the following policies should be included? A) Hold resident council meetings twice monthly and invite all residents to attend. B) Post a meal menu every Sunday and tell the residents that they must notify the kitchen in advance if they want a menu change. C) Design all the emergency pull cords so they blend in with the wallpaper and are inconspicuous. D) Teach the nurses' aides to use the passkey to do spot checks on every resident at least twice during the night to ensure that the residents are safe.

Ans: A Feedback: Resident meetings allow older adults to address personal preferences and to make choices. Posting the meals and later allowing choices is giving the older residents a limited chance to make a choice. Safety should be an ongoing concern.

3. A nurse manager of an extended care facility works to promote psychosocial health. Which of the following interventions should the nurse manager include? A) Adapt the environment to compensate for residents' sensory impairments. B) Dress residents exclusively for ease in going to and from the restroom. C) Plan dining room arrangements according to room and hall assignments. D) Position the residents who are in wheelchairs solely for ease in getting out of the dining area.

Ans: A Feedback: Table and room arrangements should be made in a way that promotes social relationships. Older adults should be allowed to choose between at least two alternatives when dressing. Residents in wheelchairs should be positioned to promote social interaction.

8. A nurse plans activities each month at an assisted living facility. Which of the following activities is most cognitively stimulating? A) Book discussions B) Movie night C) Exercise D) Reminiscence therapy

Ans: A Feedback: The cognitive reserve model suggests that cognitive abilities can be improved through participation in creative and intellectually stimulating activities. Reminiscence may provide some social interaction and movies serve as a distraction. Exercise does increase the blood flow; however, the brain and neural circuits develop in response to environmental stimuli (neuroplasticity).

3. A 99-year-old resident has fallen. Which of the following functional consequences of this fall most strongly impacts the plan of care? A) A 99-year-old is at much higher risk of a fracture from a fall than a younger person. B) A 99-year-old is more likely to have limited range of motion, impacting performance of some activities of daily living (ADLs). C) A 99-year-old who has fallen is unlikely to develop fear of falls. D) A 99-year-old will have diminished muscle strength related to muscle mass loss.

Ans: A Feedback: The functional consequence of the fall is risk for future falls which may include a risk for fractures. Osteoporotic fractures occur with little or no trauma to the older adult, and risk of fractures increases in direct relation to age. While a 99-year-old may have slowed performance of ADLs and decreased muscle mass, the high risk for falls is the most important factor (also note these are not consequences of the fall). Fear of falling is a major concern that impacts many residents of long-term care facilities.

2. While a nurse is performing a recently admitted hospital client's morning care, the client states, "I'm pretty sure I'll never see my own apartment again." Which of the following responses by the nurse best demonstrates effective communication? A) "What is it that makes you feel that way?" B) ""I'm sure that's not going to be the case." C) "All in all, you're doing quite fine." D) "There's a lot that we can do, dear, to make sure that you do."

Ans: A Feedback: The nurse demonstrates empathy and respect, while also facilitating further assessment findings around the client's beliefs for recovery through the use of an open-ended question. The nurse should not demonstrate a false reassurance of recovery, nor downplay the client's concerns. The nurse does not use patronizing terms of address (dear, honey, sweetie).

5. Which of the following older adults is most at risk to develop osteoporosis? A) A 65-year-old white woman with chronic obstructive pulmonary disease who takes corticosteroids B) A 65-year-old white man with rheumatoid arthritis C) A 70-year-old African American man with a seizure disorder D) A 68-year-old Hispanic woman who recently had a partial hysterectomy

Ans: A Feedback: White non-Hispanic women have a higher incidence of osteoporosis. Corticosteroids and antiseizure medications are most frequently associated with secondary osteoporosis. White men and African Americans of both genders have a lower incidence of osteoporosis.

13. A 75-year-old woman who often used to go out to dinner with her friends has stopped from going out because she has been experiencing urinary incontinence and is afraid of having an "accident" in public. When her child asks her why she doesn't go out with her friends anymore, she says, "I'm getting too old for such foolishness." How can the nurse best assist this client? A) Assist the client to view this functional limitation as temporary and treatable. B) Encourage the client to accept this consequence of growing old. C) Rephrase the situation to one of control, and allow the client to make the decisions. D) Teach the client that majority of older adults rate their health as good to excellent.

Ans: A Feedback: The majority of older adults do rate their health as good, but she doesn't and can't until her issue is reframed to one that she can control. Allowing her to make the decisions is good, but her current decision is to passively and inaccurately accept this treatable condition.

5. A nurse develops a plan to addressing dementia-related behaviors in an older adult with dementia. Which of the following interventions should be included in this plan? (Select all that apply.) A) Maintain a clutter-free environment. B) Implement regular rest periods. C) Place pictures of familiar people in very visible places. D) Lay out clothing in the order in which the items are to be donned. E) Test the client's memory with each conversation.

Ans: A, B, C, D Feedback: Implement regular rest periods to compensate for fatigue and loss of reserve energy. Use simple pictures and place pictures of familiar individuals in visible areas. Keep the environment free of clutter and place dangerous substances in an inaccessible area. Avoid persistent testing of memory

3. A nurse monitors for depression in the older adult population. Which of the following are a risk factor and a functional consequence of depression in the older adult? (Select all that apply.) A) Chronic pain B) Functional impairment C) Hypernatremia D) Nutritional deficiencies E) Renal impairment

Ans: A, B, D Feedback: Chronic pain, functional impairment, and nutritional deficiencies are both contributing factors and consequences of depression in the older adult. Renal impairment and hypernatremia are not specifically related to depression.

11. The nurse cares for a client with advanced Alzheimer disease who is not mobile. The nurse has assessed the client as high risk for falls. Which of the following should be included in the fall-prevention program? (Select all that apply.) A) Bright orange sticker on the resident's door B) Padded mattress on the floor next to the resident's bed C) Use of chest restraints when in the wheelchair D) Frequent assessment of resident for toileting needs E) Keep lights on in room and bathroom F) Place sensor pad alarm on bed

Ans: A, B, D, F Feedback: Bright ID stickers, padded mattress on the floor, frequent assessment, and a bed alarm are all appropriate interventions; lights on and use of restraints are not.

10. A nursing home has been the site of numerous falls by residents in recent months. Which of the following environmental factors should the nurse manager change? (Select all that apply.) A) The hallways that lead to the dining room and common areas do not have handrails. B) Each room has a private sink and toilet but there are only two designated rooms for bathing in the facility. C) The bedrails on each resident's bed are kept in a raised position whenever the resident is in bed. D) The majority of care is provided by nursing assistants, with one registered nurse overseeing the care team. E) Medications are administered at each room by the nurse from a rolling cart.

Ans: A, C Feedback: Keeping bedrails raised can constitute a falls risk when residents attempt to leave their bed to go to the washroom and are forced to scale the bedrails. Long hallways, shared bathing facilities, and the particular skills mix of the facility are unlikely to contribute directly to the high incidence of falls.

15. An older adult has developed hallucinations. For which of the following should the nurse assess? (Select all that apply.) A) Digoxin toxicity B) Hyperglycemia C) Infection D) Myocardial infarction E) Stroke

Ans: A, C, E Feedback: Infection, digoxin toxicity, and a stroke can all lead to hallucinations. Hyperglycemia and myocardial infarction generally do not.

15. A nurse teaches an older adult about the antidepressant medication recently prescribed. Which of the following should the nurse include in the teaching? (Select all that apply.) A) Antidepressants can interact with alcohol and over-the-counter medications. B) Depression is uncommon in the older adult population. C) Expect adverse effects of the medicine; stop medication if they occur. D) Don't expect immediate improvement; a fair trial may take up to 12 weeks. E) The medication is to be taken only as needed.

Ans: A, D Feedback: Immediate improvement will not be evident, but a fair trial must be given to the medication as long as serious adverse effects are not noticed. The fair trial may take as long as 12 weeks, but some positive effects should be noticed within 2 to 4 weeks. Antidepressants can interact with alcohol, nicotine, and other medications, including over-the-counter medications, possibly altering the effects of the medication or increasing the potential for adverse effects. Depression is common in older adults, it's treatable, if the client sticks to the treatment plan and takes medication daily (not PRN). Medication should not be stopped without consulting the primary health care provider.

11. A nurse in an assisted living facility develops interventions that focus on improving cognitive abilities in the residents. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A) Book club B) Calisthenics C) Christmas caroling D) Letter writing E) Reminiscence therapy F) Shopping trip

Ans: A, D Feedback: The cognitive reserve model suggests that cognitive abilities can be improved through participation in creative and intellectually stimulating activities, such as art, storytelling, reading, writing, group discussions, and playing musical instruments. Calisthenics, singing traditional tunes, reminiscing, and shopping are not creative and intellectually challenging.

12. A nurse recognizes that depression has functional consequences. Which of the following are functional consequences of late-life depression? (Select all that apply.) A) Decreased functioning B) Dementia C) Higher incidence of a stroke D) Higher level of pain E) Increased risk for suicide

Ans: A, D, E Feedback: Increased risk for suicide, decreased functioning, and higher level of pain are functional consequences of late-life depression. Strokes are a risk factor. Dementia is strongly related to depression but not a consequence.

12. The 64-year-old client who went rock climbing last week and snowboarding this week is at risk for broken bones. Which functional consequence of aging most strongly increases this risk? A) A strong musculoskeletal system helps to protect bones. B) Reduced osteoblastic production of bone matrix C) The long bones have decreased blood flow with aging. D) Weight-bearing activities increase calcium uptake into bones.

Ans: B Feedback: A strong musculoskeletal system helps to protect bone. Weight-bearing activities decrease the risk of injury by strengthening the bone. Blood flow doesn't change. There is impaired bone formation secondary to reduced osteoblastic production of bone matrix which increases the risk.

5. Even in a high acuity situation, a nurse can assess the spiritual needs of a client. Which of the following questions is appropriate for the older adult admitted to the intensive care unit for sepsis? A) "Do you attend church services?" B) "Is there a spiritual leader we can call for you?" C) "What are your beliefs about death?" D) "What religion are you?"

Ans: B Feedback: Asking about religion is less important than asking about spirituality, and while the nurse in the intensive care unit may not be able to complete a full spirituality assessment, they can obtain support for the client. Asking about death beliefs may be appropriate in a full spiritual assessment, but not for the high acuity client.

3. A nurse assesses an older adult's abstract thinking ability. Which of the following questions is most appropriate? A) "Do you know why you are in hospital right now?" B) "What do a dog and a cat have in common?" C) "What goals do you have for your treatment and recovery?" D) "What would you do if you found a stamped, addressed letter on the ground?"

Ans: B Feedback: Asking what traits two similar, but not identical, objects share is a way of gaining insight into a client's ability to think abstractly. Option A addresses insight, not abstract thinking, while Option C is a useful assessment question, but not one that addresses abstract thinking. Option D could be used to assess the client's judgment.

13. A nurse determines that a client does not remember current events and has difficulty using technology. The nurse should consider that the client may have difficulty with which of the following? A) Participating in reminiscence group B) Digitally recording blood glucose monitor C) Remembering to weigh daily D) Understanding when to notify health care provider

Ans: B Feedback: Contextual theories and everyday problem solving emphasize that older adults are able to remember affective and personally relevant information. The client may need to record the blood glucose on paper.

14. The nurse presents at a conference regarding aging and mobility. Which age-related changes should the nurse include? A) Bones decrease resorption due to decreased parathyroid hormone B) Diminished positioning sensations in the lower extremities C) Outgrowth of collagen and elastin cells D) The number of skeletal muscle fibers increases

Ans: B Feedback: Diminished positioning sensations in the lower extremities increase risk for falls. With older adults: bones increase resorption due to increased parathyroid hormone, there is degeneration of collagen and elastin cells, and the number of skeletal muscle fibers decreases.

4. Which of the following nursing interventions should be the priority for a nurse working in a retirement community? A) Using restraints to keep nursing home residents from getting out of chairs unattended B) Establishing a fall-prevention program for residents at risk C) Using cordless phones or emergency call systems for residents in assisted living D) Using a monitoring device for people who live alone in their own home

Ans: B Feedback: Formal fall-prevention programs are implemented in home care and health care settings. These programs can address multiple risk factors, focusing on those who are at risk for falls and the consistent implementation of preventive measures.

10. A nurse interviews a client who is 82 years old and has several chronic conditions, including type 2 diabetes and heart failure. The client expresses feeling of more satisfaction with life now than when younger. Which phenomenon is the client expressing? A) Metamemory B) The paradox of well-being C) Crystallized intelligence D) Neuroplasticity

Ans: B Feedback: Gerontologists have identified a paradox of well-being among older adults, which describes the phenomenon of older adults suffering significant losses of health, cognition, and social functioning but reporting high levels of well-being and positive emotions. Metamemory, crystallized intelligence, and neuroplasticity are phenomena that are not directly related to subjective well-being and satisfaction.

4. A nurse assesses a 61-year-old adult who reveals that he can't process as quickly as when younger, and that "all these people talk about multi-tasking, but I can't do that!" Which of the following responses by the nurse is appropriate? A) "Have you had any other symptoms of cognitive impairment?" B) "Slower processing of information is an age-related change, and there are things you can do to help with this." C) "The declines in cognitive skills usually begin around the age or 60." D) "You shouldn't expect to see a decline the cognitive functions that you use all the time."

Ans: B Feedback: Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. The earliest cognitive changes are due to decreased perceptual speed. The other distracters do not answer his question. It is important for the nurse to address the client's concerns; in this case, the client is asking if it is expected to already have age-related functional consequences. Age-related declines in some cognitive skills begin around the age of 40, but there are substantial individual variations in these changes. Cognitive functions that depend on experience, accumulated knowledge, and well-practiced tasks (e.g., vocabulary) do not decline in healthy older adults, and may even improve.

14. An older adult started an antidepressant 1 week ago. The client states, "I don't want to take that pill, it's not doing anything." Which of the following responses by the nurse is most appropriate? A) "That is fine, it is your right to refuse medications." B) "It is too soon to see effects; positive effects may begin around 3 weeks." C) "Let's notify the primary health care provider to try another type of medication." D) "What side effects are you having?"

Ans: B Feedback: Immediate improvement will not be evident, but a fair trial must be given to the medication as long as serious adverse effects are not noticed. The fair trial may take as long as 12 weeks, but some positive effects should be noticed within 2 to 4 weeks. If one type of antidepressant is not effective, another type may be effective. The right to refusal is the seventh medication right; however, it is the nurses' responsibility to ensure that the client is informed before accepting the refusal.

7. A 69-year-old woman is saddened by her recent diagnosis of type 2 diabetes, which is a stressor that will make numerous demands on her life in the coming years. Which of the following actions demonstrates a problem-focused approach to this stressor? A) Eliciting support and sympathy from her sister and neighbor B) Obtaining diabetic cookbooks and learning to change her cooking habits C) Seeking out a second opinion from another physician D) Deciding to make no lifestyle changes despite her new diagnosis

Ans: B Feedback: Making tangible changes to address a problem, such as changing lifestyle to accommodate a new diagnosis, demonstrates a problem-focused approach to coping. Seeking support is emotion focused and seeking a second opinion is not necessarily a solution.

7. An older adult has been accompanied by an adult child to visit a primary care provider. The child has expressed concern about the client's increasing apathy, isolation, and apparent sadness over the past several months; and the client acknowledges many of the symptoms of depression. Which of the following assessments should the nurse prioritize? A) Functional assessment B) Medication assessment C) Musculoskeletal assessment D) Cardiovascular assessment

Ans: B Feedback: Medications may be risk factors for depression in numerous ways. A functional assessment is necessary, but this is more likely to ascertain the effects, rather than causes, of her depression. Musculoskeletal and cardiovascular assessments are secondary.

5. Which of the following points should the nurse emphasize when educating older adults about memory and cognition? A) Long-term memory loss is normal. B) Using calendars, notes, and imagery can help enhance memory. C) Drinking caffeinated beverages for mental stimulation is a good idea. D) Having a diminished capacity for learning is an inevitable part of growing older.

Ans: B Feedback: Metacognition means that an individual understands his or her own cognitive process, and this process will impact performance. Health education provides information about techniques to enhance cognitive abilities. Older adults benefit from internal and external memory-enhancing techniques, such as calendars, imagery, and notes.

11. An 81-year-old is admitted to the hospital for congestive heart failure. The client is widowed, and the medical staff and client are talking about the client moving to an assisted living facility. Which of the following interventions by the nurse best creates a wellness opportunity? A) Ask the client to explain how cares have been accomplished at home. B) Assist the client to discuss the feelings associated with a potential move to assisted living. C) Describe the options for long-term housing with the client. D) Encourage the client to think positively about this move.

Ans: B Feedback: Nurses promote wellness by asking older adults to talk about the meaning of life events that they have experienced. Asking about how cares have been accomplished does not assist the client. Nurses promote psychosocial wellness by encouraging older adults to express their feelings about decisions (not tell them how to feel) and help them identify effective ways of coping, even when they are not happy about the decision.

1. A 75-year-old woman who often used to go out to dinner with her friends has stopped going out because she has been experiencing urinary incontinence and is afraid of having an "accident" in public. When her child asks her why she doesn't go out with her friends anymore, she says, "I'm getting too old for such foolishness." Her child asks her to go to the doctor for an evaluation, but she refuses to do so. Which of the following is occurring with this older adult? A) She is experiencing learned helplessness and low self-efficacy. B) She sees incontinence as an inevitable consequence of aging. C) She views her incontinence as a negative functional consequence of aging. D) Her doctor is sympathetic; however, the woman and the doctor are unable to find a solution.

Ans: B Feedback: Older adults may use a passive, emotion-focused coping mechanism and try to simply accept the situation. When older adults view functional decline as an inevitable consequence of aging, they are less likely to seek help for some treatable problems.

8. A long-time resident of an assisted living facility has just been diagnosed with Alzheimer disease. A nurse who provides care at the facility has remarked to a colleague, "It's a real shame, but at least she'll never know what's happening to her." What fact should underlie the colleague's response? A) Older adults with Alzheimer disease and other dementias rarely have insight into their cognitive deficits. B) Many persons with dementia are acutely aware of the fact that they are experiencing a cognitive deficit. C) Certain types of dementia are occasionally marked by older adults' awareness of their disease. D) An awareness of dementia is an indication that the condition is either latent or resolving.

Ans: B Feedback: One of the myths associated with dementia is that people with dementia deny their symptoms or have no awareness of their deficits. In recent years, this perception of a high prevalence of so-called denial in people with dementia has diminished, and gerontologists are researching insight and self-awareness through all stages of dementia.

10. A nursing home is in the planning stages of building a new wing that will be specifically designed for the needs of older adults who have dementia. What design characteristic should be included in this new facility? A) Monochromatic walls and floors that are a neutral color B) Pictures, signs, and color codes for identifying places C) Bright, glossy floors that can provide sensory stimulation D) Bright lighting during the day and total darkness at night

Ans: B Feedback: Pictures, signs, and color codes can help to orient persons with dementia. Floors and walls do not need to be one color, and glossy floors and total darkness at night are safety hazards for this population.

10. An older adult was diagnosed with depression shortly after relocating to the nursing home 6 weeks ago. What intervention should the nurse implement to address the depression? A) Teach the client about the problem of suicide in older adults. B) Provide opportunities for the client to engage with other residents. C) Direct the client to list all the positive aspects of her present circumstances. D) Appoint another resident as a "buddy" to accompany the client during the day.

Ans: B Feedback: Social engagement and contact of all types has the potential to aid in the treatment of depression. Appointing a "buddy," however, is likely to be construed as intrusive and is unfair to the other resident. Asking an individual to focus on positives may be seen as simplistic. Teaching about suicide is unlikely to alleviate the signs and symptoms of depression.

14. A nurse differentiates between dementia and depression in an older adult. Which of the following assessment findings leads the nurse to believe that the client has depression? A) The client has socially unacceptable behaviors. B) The client is negativistic. C) The client's mood fluctuates. D) The client's mood is distractible.

Ans: B Feedback: The affect of depressed people is generally sad and negativistic and is not influenced by external circumstances. By contrast, the affect of people who have dementia fluctuates more and changes in response to distractions.

14. A nurse admits an 81-year-old to the hospital for congestive heart failure. The client is widowed, and has recently moved to an assisted living facility. Which of the following contributed the most to this admission? A) Moving changed her daily habits. B) Her age-related changes and risk factors increased. C) The stress of widowhood and relocation stressed her body. D) The assisted living facility serves food high in saturated fats.

Ans: B Feedback: There is a strong connection between chronic stress and health. Studies find that chronic stress increases the risk for onset of major illnesses and exacerbation of chronic illnesses.

3. A nurse teaches a client and care partner about cholinesterase inhibitors. Which of the following statements should the nurse include in the teaching? A) "Rivastigmine (Exelon) has a high chance of interacting with other medications." B) "Nausea, vomiting, diarrhea, and loss of appetite can be prevented or reduced by starting with a low dose." C) "Rivastigmine is only for treatment of mild Alzheimer's disease and will be discontinued as the disease progresses." D) "You should have a 'drug holiday' monthly to improve the medication's functioning."

Ans: B Feedback: When administering medications to older adults, it is imperative to start with lower doses and increase the doses slowly. Exelon is less likely to interact with other drugs and may be safer and better tolerated in people. It will continue and other medications may be added. The effectiveness of cholinesterase inhibitors is diminished significantly if it is stopped and then restarted.

7. A client was diagnosed 3 years ago with a cognitive impairment, a condition that worsened over the next several months and which culminated in his recent death. An autopsy revealed numerous infarcted brain regions resulting from vessel occlusions. This client most likely suffered from which type of dementia? A) Alzheimer disease B) Vascular dementia C) Lewy body dementia D) Frontotemporal degeneration

Ans: B Feedback: While the four major types of dementia are not discrete or mutually exclusive, vascular dementia is characterized by pathophysiologic processes including infarctions from occlusion of blood vessels. This pathophysiology is not characteristic of Alzheimer disease, Lewy body dementia, or frontotemporal lobe dementia.

12. A community health nurse presents a class on "Aging in America: Living the Dream." Which of the following should the nurse stress when discussing retirement? (Select all that apply.) A) Delaying retirement until unable to work can be beneficial. B) Factors such as health, friendship relationships, and resources influence the transition. C) Sometimes the adjustment is more difficult for the partner who has not been employed. D) The adjustment to retirement is best accomplished quickly and with finality. E) A strong work ethic assists in the adjustment to retirement.

Ans: B, C Feedback: Factors such as health, family and friendship relationships, and economic and social resources influence the transition. Sometimes the adjustment is more difficult for the partner who has not been employed. Work ethic in society can diminish the retirees' status, delay of full retirement can assist with the transition, and delay in retirement is best done in a gradual manner (changing to part time, becoming self-employed).

13. A nurse assesses an older adult using a mini-mental status examination. The client is very slow to respond to the questions. Which of the following conditions may be present and will require follow-up by the nurse? (Select all that apply.) A) Lack of education B) Dementia C) Depression D) Confabulation E) Concrete thinking

Ans: B, C Feedback: The nurse assesses the amount of time and effort expended in answering questions. This is particularly important when trying to differentiate between dementia and depression. Lack of education and concrete thinking would not slow the client in responding to assessment tools such as the mini-mental. Confabulation is when the client creates information.

13. A intensive care nurse cares for an 83-year-old with sepsis. The client exhibits illogical thinking and agitation. Which intervention should the nurse implement? (Select all that apply.) A) Administer a benzodiazepine. B) Assess for pain. C) Assure a quiet, dark sleep time. D) Initiate fall prevention program. E) Post pictures of client's family in room.

Ans: B, C, D, E Feedback: Older clients with infection and those in the ICU are at great risk for delirium. Sleep, rest, pain control, and familiar items are interventions to minimize delirium. The client is a greater risk for falls so a fall prevention program should be initiated. Benzodiazepines should be avoided.

6. A nurse assists adults to prepare for the changes that often occur in late adulthood. Which of the following psychosocial consequences occur because of life events during that period? (Select all that apply.) A) A broadening of social networks B) Adjusting to relocation from home C) Adjustment to a lower income D) Adaptation to chronic illnesses E) Coming to terms with one's mortality

Ans: B, C, D, E Feedback: The life events of late adulthood have profound psychosocial ramifications, including reduced income, acknowledgment of mortality, relocation from home, and chronic illness. Social networks typically shrink rather than expand.

7. An older adult is admitted to a geriatric unit in the hospital. The nurse in the emergency department states that the client is oriented to one only. Which of the following actions should the admitting nurse perform? (Select all that apply.) A) Have a conversation with the client about challenges to cognitive functioning. B) Orient the client to the room, unit, and plan of care. C) Post a calendar with dates crossed off. D) Reassess orientation status. E) Repeat orientation as needed.

Ans: B, C, D, E Feedback: The nurse understands that the older adult may take time to orient to new surroundings and may need to be given cues to assist them. Temporary memory impairment because of acute medical problems may impact the orientation questions. Asking the client about his or her subjective cognitive challenges may yield meaningful information, but this does not necessarily gauge orientation.

13. An older adult is admitted to the hospital with weight loss and cognitive impairment. To assist in the diagnosis of major depressive disorder, for which of the following should the nurse assess? (Select all that apply.) A) Decreased deep tendon reflexes B) Loss of interest or pleasure C) Psychomotor agitation D) Respiratory difficulty E) Sleep disturbances

Ans: B, C, E Feedback: Diagnostic criterion for major depression includes depressed mood and/or loss of interest or pleasure along with at least five of the following signs and symptoms: weight loss, appetite change, sleep disturbances, observable, psychomotor agitation or retardation (i.e., slowness), fatigue or loss of energy, feeling worthless or excessively guilty, cognitive impairment, and recurrent thoughts of death or suicide. It does not include deep tendon reflexes or respiratory difficulty.

6. An older adult is brought to the community clinic by an adult child with the concern of increasingly frequent lapses in memory. Which assessment question is most likely to identify potential risk factors for impaired cognitive functioning? A) "What did your mother and father die of?" B) "What line of work were you in?" C) "What medications are you currently taking?" D) "Where are you currently living?"

Ans: C Feedback: Adverse medication effects can have a profound influence on the cognitive functioning of older adults. Genetic, environmental, and occupation factors are potential risk factors, but medications are more commonly implicated.

6. A gerontological nurse conducts an assessment of an older adult who has a history of depression. Assessment reveals that the client has been drinking up to two bottles of wine each day for the last several months. What should the nurse teach the client about alcohol use and depression? A) "If you choose to use alcohol to address your depression, it's best to limit it to four to five drinks each day." B) "We recommend that everyone over the age of 70 abstain from drinking alcohol." C) "Alcohol has been shown to contribute to depression and vice versa." D) "If you quit drinking, your depression will likely improve."

Ans: C Feedback: Alcohol and depression have a synergistic relationship: alcohol causes depression, depression leads to alcohol abuse, which, in turn, exacerbates the depression. Four or five drinks daily is excessive, but abstinence is not necessary for all older adults. Abstinence is not guaranteed to improve symptoms of depression.

2. A nurse is reviewing the side effects of antidepressants with a group of older adults. Which of the following statements by a member of the group indicates that the nurse's teaching has been effective? A) "I will start on the dose that I will take for life." B) "Fluoxetine should be given in the evening because it may help me sleep." C) "I need to maintain my fluid intake while on antidepressant medication." D) "The length of antidepressant treatment is usually 3 months for a first-time depression."

Ans: C Feedback: An increase in fluid intake helps prevent the risk of postural hypotension. Dosages can be increased gradually until maximal therapeutic levels are reached, while observing for adverse effects. Fluoxetine should be given in the afternoon because of agitation. The length of treatment is usually 6 months for a first-time depression.

1. A nurse is leading a word-quiz game with a group of nursing home residents because the nurse knows this activity will assist the residents in maintaining: A) Fluid intelligence B) Adaptive thinking C) Crystallized intelligence D) Psychomotor memory

Ans: C Feedback: Crystallized intelligence refers to vocabulary skills, information, and verbal comprehension. Fluid intelligence involves a person's inherent abilities, such as memory and recognition, and involves adaptive thinking. Memory involves retrieval and storage of information.

9. A nurse providing care in a long-term care setting is aware that the cognitive function of older adults does not necessarily decline on an inevitable trajectory. Which action has the greatest potential to enhance the cognitive function of residents and prevent cognitive declines? A) Encourage older adults to openly express their emotions and opinions. B) Provide residents with four or five low-fat, high-protein meals during the day. C) Encourage older adults to participate in mentally stimulating activities. D) Present older adults with numerous opportunities to make autonomous decisions.

Ans: C Feedback: Healthy diet, decisional autonomy, and emotional expression are all potentially beneficial, but participation in mentally challenging and stimulating activities has the greatest potential to protect and enhance cognition.

12. During an interview with an older adult, the client moves her chair back. Which of the following responses by the nurse is most appropriate? A) Stop the interview and give her recovery time. B) Move own chair closer. C) Sit upright, leaning back. D) Ask the client if she is okay.

Ans: C Feedback: It is important to consider the physical space required for the person to feel at ease when communicating with others. Men usually like to have larger personal space than women. Sit upright and leaning back will give more personal space. The nurse adjusts to cultural needs of clients, including nonverbals. There is no need to stop the interview or ask if she is okay.

8. A nurse performs a psychosocial assessment on an older adult in the hospital. Which of the following statements may suggest low self-esteem? A) "I don't know who's going to take care of my spouse while I'm in the hospital." B) "I know I have to rely on others for some help to get along in life." C) "When I was younger, I worked around the clock and now I can't even make it to the toilet." D) "I'm worried about what's going to happen once I get out of here."

Ans: C Feedback: Lamenting a loss of activities of daily living and function and an increase in dependence may be suggestive of low self-esteem, especially if this is linked with self-worth. Worrying about the future or the care of a loved one may be accurate and warranted and not necessarily indicative of low self-esteem.

15. Which of the following hospitalized older adults is at greatest risk for in-hospital hip fractures from a fall? A) A 79-year-old client B) A client receiving numerous cardiac medications C) A client with a history of hip fractures from a fall D) A client with new-onset dementia

Ans: C Feedback: Prior fracture almost doubles the risk for another fracture. The older the client, the higher the risk. Medications with adverse reactions do increase the risk, and dementia especially moderate to severe increases risk.

11. During an admission interview, a client gives the following response to a question about living arrangements. "I can't stay in my own home. Now that I've fallen and broken my hip, I'm not sure what the doctor will say. My children don't want me." Which response by the nurse is most appropriate? A) "You worry that the doctor will tell you need surgery?" B) "You fell and broke your hip?" C) "Your children don't want..." D) "Where you want to live?"

Ans: C Feedback: Reflection about the children gives feedback about what the nurse heard and leads into further questions about underlying feelings. The client has already expressed that they can't live at home, asking where they want to live when they don't have the choice is not therapeutic. We know that this client has a broken hip, and the conversation is not about surgery.

4. A nurse educator teaches about theories of late-life depression. Which of the following statements by a student shows that the material is understood? A) "Adverse events impair your ability to evaluate yourself." B) "Depression is caused by decreased activity in the hypothalamic-pituitary-adrenal axis." C) "Older adults with depression and chronic illness have more serious negative functional consequences." D) "Researchers have identified a cause-and-effect relationship between depression and dementia."

Ans: C Feedback: Studies consistently find that the co-occurrence of depression with chronic conditions in older adults is associated with more serious negative functional consequences. Cognitive theory says that distorted perceptions, not adverse (unfavorable) events, impair one's ability to appraise oneself and the event constructively. Increased plasma cortisol levels and increased activity of the hypothalamic-pituitary-adrenal axis can lead to depression. Researchers have identified neuropathologic changes but have not identified a specific cause-and-effect relationship between dementia and depression.

5. When risk factors to potential suicide have been identified, a nurse must further assess the actual risk for a suicide attempt. Which of the following questions would be appropriate for initial assessment to determine the presence or absence of suicidal thoughts in an older adult with risk factors? A) "Under what circumstances would you take your life? Have you ever started to act on a plan to harm yourself?" B) "Do you have a plan for taking your life? What action would you take if you were to harm yourself?" C) "Does your life feel worthless? Do you ever think about escaping from your problems?" D) "Do you think about harming yourself? Do you ever think about committing suicide?"

Ans: C Feedback: Suicide assessment is multilevel, and each level of questions depends on the response the client gives to the previous level's questions. Level 1 questions determine the presence or absence of suicidal thoughts. Level 1 questions are indirect; at level 2, they become more direct. Level 2 determines the presence or absence of thoughts about self-harm. Level 3 questions determine whether the client has a realistic suicide plan.

7. A nurse was recently assisting an 84-year-old resident of a nursing home with the resident's biweekly bath. While the nurse was helping the resident transfer out of the bathtub, the resident grabbed on to the nurse forcefully, became rigid, and exclaimed, "Help me quick," despite the fact that the nurse was performing a safe and controlled transfer. Why might this resident have exhibited sudden anxiety during the transfer? A) The resident may be developing a cognitive deficit. B) The resident is experiencing age-related changes. C) The resident may have a fear of falling. D) The resident is ensuring safety.

Ans: C Feedback: The fear of falling, which is the most common reported fear among older adults, has been identified as a public health problem that is of equal importance to falls. This fear goes beyond prudent safety measures and is not a normal, age-related change. The resident's actions do not necessarily indicate a cognitive deficit.

2. A 69-year-old has recently been diagnosed with mild cognitive impairment and has asked the nurse to help her remember things better. Which of the following nursing diagnoses is appropriate for this older adult? A) Knowledge deficit B) Altered thought processes C) Health-seeking behaviors D) Altered health maintenance

Ans: C Feedback: The nursing diagnosis of health-seeking behaviors is defined as "the state in which an individual in stable health actively seeks ways to alter personal health habits and/or the environment in order to move toward a higher level of wellness." The older adult is seeking help from the nurse to remember things better so this is the most appropriate diagnosis.

3. A 70-year-old tells a nurse, "I am worried that I'm losing my mind, I have difficulty remembering names as well as I used to, and I missed two health care appointments in the past month because I forgot about them." The nurse initiates a memory training program, although the nurse has been unable to identify any risk factors that might affect the older adult's cognitive abilities. Which of the following questions is the best approach to evaluating the effectiveness of the memory training program? A) "Have you seen an improvement in your memory?" B) "Are you less worried about your memory now?" C) "How have the memory training techniques helped you?" D) "Are you using the memory training techniques now?"

Ans: C Feedback: The question, "How have the memory training techniques helped you?," allows the older adult to tell the nurse how memory training has helped and is more open-ended than the other options. It also communicates positive expectations. The question helps identify the techniques that are most effective for the individual.

4. Which of the following are examples of appropriate communication techniques for dealing effectively with people with dementia? A) Ask open-ended questions so the person feels he or she can make choices. B) For people in the later stages of Alzheimer disease, talk as you would to a child. C) Maintain good eye contact and use a relaxed and smiling approach. D) When the person forgets something, remind him or her not to forget next time.

Ans: C Feedback: To facilitate communication with people who have dementia, the nurse uses a relaxed and smiling approach. The nurse should avoid infantilization of the older adult and not emphasize the person's memory or cognitive deficits.

1. A nurse is teaching health interventions to an older adult with osteoarthritis. Which of these statements indicates that the individual needs additional teaching? A) "I will avoid high-impact exercises." B) "I will get adequate intake of calcium and vitamin D." C) "I will try to limit my use of walkers and assistive devices." D) "I will lose weight if it turns out that I need to."

Ans: C Feedback: Walkers and other assistive devices help relieve stress on weight-bearing joints and improve balance. Individuals with osteoarthritis need to participate in supervised, low-impact exercises and avoid high-impact activities. Vitamin D is essential for absorption of calcium. The individual needs to lose weight if appropriate.

9. A gerontological nurse has been providing ongoing care for an older adult who has a diagnosis of dementia. What goal should the nurse prioritize when conducting ongoing assessment of this client? A) Identifying strategies that can be used to cure the client's dementia B) Identifying genetic or lifestyle factors that may have contributed to the client's dementia C) Determining whether the client has Alzheimer disease, Lewy body dementia, or frontotemporal lobe dementia D) Identifying factors affecting the client's functioning and quality of life

Ans: D Feedback: A major goal of ongoing assessment of clients with dementia is to identify factors that interfere with the person's level of functioning or quality of life so that interventions can be initiated to alleviate these contributing factors. Medical diagnosis is not a nursing action and causative factors are not a priority after diagnosis. Dementia is not curable.

1. A nurse performs a psychosocial assessment of an older adult living in the community. Which of the following statements best captures the nature of psychosocial assessment? A) It is a formalized psychological test of the individual's condition and needs. B) It aids in identifying and analyzing personality traits of the individual. C) It helps to identify the individual's need for psychiatric care. D) It is a component of holistic nursing care of older adults.

Ans: D Feedback: A psychosocial assessment is one component of the mind-body-spirit nature of holistic nursing care of older adults. It is not a formal psychological examination, nor does it exist to identify specific personality traits or the need for psychiatric intervention.

9. A nurse on an acute care for elders (ACE) unit monitors clients for functional consequences of depression. Which of the following statements by a client is of highest priority for follow-up? A) "I can't shake this feeling that I've got a cloud hanging over me these days." B) "I feel like I've got no appetite these days and it takes everything in me just to eat a little meal." C) "I used to be a powerhouse of energy when I was younger, and now all I can do is sit in a chair." D) "I think it would be better for everyone if I wasn't here anymore."

Ans: D Feedback: All of these statements may be indicative of depression, but an allusion to suicide always constitutes the priority for further follow-up.

12. A 74-year-old client is diagnosed with mild Alzheimer disease. He has no other noted health issues. When speaking with the nurse, he expresses concern regarding the progression of his disease. Which statement by the nurse is most appropriate? A) As you have no other health issues, the progression is usually gradual. B) The medications stop the progression of the disease. C) We never know how fast Alzheimer disease will progress. D) Yes, progression is usually gradual, you might want to start making plans.

Ans: D Feedback: Alzheimer disease is very gradual; it has accelerated decline with concomitant conditions. Medications slow the progression, but don't stop it.

10. A nurse assesses an older adult's insight regarding the care plan. What question may the nurse ask to gauge the client's insight? A) "Where would you go if you were discharged from the hospital today?" B) "How would you spend $100 if you were given it today?" C) "What are the similarities between a doctor and a nurse?" D) "Why do you think that your doctor admitted you to the hospital?"

Ans: D Feedback: Appraising an individual's understanding of why he or she is receiving treatment can help assess insight. Questions about hypothetical responses to situations also assess executive function, but not insight specifically.

12. A nurse assesses an 82-year-old client who has a history of coronary artery bypass surgery and heart failure. In the interview, the family expresses concern because the client's "ability to figure out what is going on" has deteriorated. However, the client remains wise and continues to give solid life advice. Which theory explains this phenomenon? A) Crystallized intelligence declines with age. B) Cognitive skills of older adults are better than younger adults under some conditions. C) Mild cognitive impairment begins with cognitive dissidence. D) Cognitive abilities may be impaired by the client's cardiovascular disease.

Ans: D Feedback: Changes in fluid intelligence are more closely associated with pathologic conditions of the circulatory and nervous system than with age-related changes alone. Crystallized intelligence, except for those processes that depend on the speed of response, does not decline with age. Contextual theories do support the idea that memory and other cognitive skills of older adults are better than those of younger adults under some conditions; however, this does not address the variation between fluid and crystallized intelligence.

14. A 90-year-old client discusses her life review with a nurse and shares information about how she has raised five children and had "ups and downs" with all of them, but overall feels satisfied with her life. Based on Cohen's empowering model, which of the following statements is the client likely to make? A) "I would sum it up this way." B) "I really would like to see the Grand Canyon." C) "I hope to learn how to Skype with my grandchildren." D) "I know I've done the best that I can do, and I expect I will continue to help my family."

Ans: D Feedback: Cohen's empowering model related that those at the end of their life are more likely to reaffirm major themes in their life. From the 50s till the 70s, persons reevaluate life and feel a new sense of inner liberation as expressed in the distracters by discussion of goals. After the late 70s, older adults restate and reaffirm their major themes, including the desire to live well to the very end and have a positive impact on others.

9. A nurse in a long-term care facility organizes a "Healthy Aging" class for residents. Which activity should be prioritized during these classes? A) Present tools that residents can use to develop better psychosocial health. B) Role-play responses to life events that may occur in their near future. C) Assess group members' strategies used to deal with life events. D) Discuss coping strategies helpful in adjusting to challenges of aging.

Ans: D Feedback: Healthy aging classes are based on the belief that older adults who are beginning to recognize age-related physical and psychosocial changes or who are already dealing with such changes can benefit from sharing their experiences with their peers. Such classes are not primarily a venue for assessment or for role-play. Teaching is best performed by having the members share.

7. A nurse discusses recent changes with a 74-year-old client. The client is distraught stating, "I forgot an important appointment; and I lost my wallet!" The older adult has always cherished being intelligent, alert, and informed, so even minor lapses in cognition are a source of stress. How should the nurse best interpret these recent deficits in memory? A) The older adult is likely experiencing the early stages of Alzheimer disease. B) The older adult is likely experiencing a temporary state of delirium that will self-resolve. C) The older adult may be experiencing age-related changes in personality. D) The older adult may be experiencing mild cognitive impairment.

Ans: D Feedback: Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. Longitudinal studies have identified patterns of cognitive change that are likely to occur even in the absence of any pathologic processes. This does not rule out the possibility of dementia or delirium, but a fundamental change in personality is unlikely.

2. An older woman returns to her hospital room after abdominal surgery. As the nurse completes her assessment, the client asks the nurse to pin her "prayer cloth" to her pillow. Which of the following interventions is priority? A) Say, "I will pin it on your pillow in a couple of hours after you are stable." B) Ask, "What is the purpose of a prayer cloth? Did you make it?" C) Ask, "What religion do you practice? Did your minister give the prayer cloth to you?" D) Pin the prayer cloth to her pillow since it is an essential part of her spiritual health.

Ans: D Feedback: In this case, following the client's wishes is an integral part of routine nursing care, as it helps individualize nursing care to this particular client. The nurse must be nonjudgmental and communicate respect for the client's individuality.

2. A nurse is teaching older adults at a senior center how to reduce the incidence of falls. Which of the following statements indicates that the nurse's teaching has been effective? A) "Benadryl is a safe medication to take for sleep." B) "It is safe to have rugs in my kitchen and bathroom." C) "It is safe to take a low dose of Ativan when I am anxious." D) "I understand that over-the-counter medications can cause falls."

Ans: D Feedback: Numerous prescription and over-the-counter medications are implicated in falls. Benzodiazepines have been studied, and it is suggested that their effect on psychomotor function increases the incidence of falls. Benadryl (diphenhydramine) has been associated with significant adverse effects on psychomotor skills.

6. An 80-year-old client was referred to a neurologist after several months of worsening cognitive deficits and has subsequently been diagnosed with Alzheimer disease. Which statement by the nurse to the client's family demonstrates appropriate use of terminology? A) "It's very difficult and stressful when a loved one becomes senile." B) "Even though your parent is demented, we will do all we can to promote his quality of life." C) "This form of organic brain syndrome is a common health problem in the ninth decade of life." D) "We always try our best to foster wellness in persons who have dementia."

Ans: D Feedback: Nurses can use phrases such as "a person with dementia" or a "person with a dementing illness" to accurately refer to the medical syndrome of impaired cognitive function while avoiding pejorative connotations associated with describing older adults as "demented." The terms "senile" and "organic brain syndrome" are no longer in use.

13. The home nurse assesses a frail older adult for fall risk using the Timed Up and Go (TUG) test. Which score places this client at high risk for falls in his home? A) 6 B) 9 C) 12 D) 15

Ans: D Feedback: The TUG test is a reliable measure of gait speed, as well as an indicator of fall risk and ability to safely perform ADLs. Higher scores (i.e., longer time to complete the tasks) are associated with increased risk for falls. Cutoff scores between 12 and 14 seconds are discussed in the literature, but a score of 12.47 seconds is recommended in a review of studies.

6. A 79-year-old woman is scheduled to undergo hip replacement surgery after a fracture that was caused by a fall. Which of the following age-related changes may have contributed to the woman's susceptibility to bone fracture? A) Increased protein synthesis B) Infections within the synovial capsules of the knees and ankles C) Loss of neural control of balance D) Increased bone resorption

Ans: D Feedback: The process of bone resorption accelerates with age, resulting in lower bone density. Changes in various aspects of the nervous system accompany the aging process, but a loss of neural control of balance is not normally among these. Infection is never a normal, age-related change and protein synthesis decreases, not increases, with age.

11. Which of the following clients is at highest risk for suicide? A) An 18-year-old who has made an appointment with his primary health care provider B) A 60-year-old with kidney stones C) A 75-year-old woman living with her child and grandchildren D) An 85-year-old man whose spouse died 1 year ago

Ans: D Feedback: White men aged 85 years and older have the highest suicide rate. One of the commonly identified risks for suicide in older adults is recent bereavement. Presence of chronic or severe pain is a risk factor, as is loneliness.

14. A nurse councils a care partner of a client with dementia. The care partner states "He fights me when I try and bath him; he hasn't had a shower in 2 months!" Which response by the nurse is most appropriate? A) "I hear your frustration." B) "He wants to feel he has a choice. How do you get him to shower?" C) "I would just put him in there, he needs to be clean." D) "Whatever worked before should work now." E) "What other ways have you tried to assure he is clean?"

Ans: E Feedback: There are multiple ways to stay clean, if showering is a trigger, then avoid it. What has worked in the past does not mean it will work again. Forcing a shower is unsafe. They don't get him to shower, it's been months.