Gero Final

33. What is polypharmacy?

"the administration of many drugs simultaneously or by the administration of an excessive number of drugs" or it could be defined as the use of 5 or more medications daily.

21. Which of the following would most likely be associated with delirium in older adults? (Select all that apply.) A) Urinary tract infection B) Dehydration secondary to gastroenteritis C) Low zinc levels D) A new medication that causes confusion E) Neurofibrillary tangles

Ans: A B D Feedback: Urinary tract infection, dehydration, and a new medication are all acute conditions that may cause temporary impairment of cerebral circulation and cause disturbances in cognitive function. Low zinc levels and neurofibrillary tangles are present in persons with Alzheimer's disease.

20. An older patient with a history of renal failure is admitted with dehydration and hyponatremia. The nurse identifies which assessment findings as being consistent with the diagnosis of dehydration? (Select all that apply.) A) Confusion B) Shortness of breath C) Decreased skin elasticity D) Increased blood urea nitrogen (BUN) E) Adventitious lung sounds on auscultation

Ans: A, C, D Feedback: Confusion, decreased skin elasticity, and increased BUN are all associated with dehydration. Adventitious lung sounds and shortness of breath are not associated with dehydration but rather with overhydration.

19. An older patient has been treated with acetaminophen for chronic pain, and it is no longer effective. What would be the next drug of choice for this patient? A) Codeine B) Ibuprofen C) Oxycodone D) Morphine patch

Ans: B Feedback: NSAIDs are the next drug of choice when treating pain in the elderly. If the first NSAID is not effective, a different NSAID should be used prior to administering an opioid.

11. Which of the following aspects of gerontological nursing would be most likely classified under private law? A) The regulation of who may call himself or herself a "nurse" B) The contract between an older adult resident and the owners of the facility C) The legal criteria for declaring an individual mentally incompetent D) The criminal consequences for instances of elder abuse

Ans: B Feedback: Private law involves relationships between individuals and organizations, such as the contract between an individual and the care facility in question. The other cited examples would fall under the umbrella of public law.

28. The nurse assesses a 94-year-old resident of a nursing home who has diabetes mellitus. For which of the following signs and symptoms should the nurse perform a blood glucose test? A) Restlessness and postural hypotension B) Somnolence and slurred speech C) Perspiration and incontinence D) Numbness and weak pulses

Ans: B Feedback: Rather than the classic symptoms of hypoglycemia that one would anticipate in younger adults, older individuals instead may experience confusion, abnormal behavior, altered sleep patterns, nocturnal headache, and slurred speech. Uncorrected hypoglycemia can cause tachycardia, arrhythmias, myocardial infarctions, cerebrovascular accident, and death.

3. Blood flow to the heart _____________ with aging. A. Increases B. Decreases C. Remains steady D. Stops

Ans: B. Decreases

21.The nurse instructs the patient receiving treatment for hypothyroidism. Which of the following statements, if made by the patient, indicate the need for further teaching? A) "I will continue to take the stool softener until my constipation is better." B) "I will call the office if I have any chest palpitations." C) "I will not need to refill this prescription." D) "I will take one pill today, two tomorrow, and then three pills a day."

Ans: C Feedback: It is important that patients understand that thyroid replacement will most likely be a lifelong requirement. Initially, thyroid replacement is gradually increased under close supervision to prevent cardiac complications.

Body change DT to aging and experienced psych issues DT self-esteem- TRUE or FALSE

True

Older adults get food intolerance DT decrease gastric changes, inactivity and slow peristalsis - True or False

True

38. Section C of POLST is Artificial administered Nutrition- TRUE or FALSE

True Notes: Section A: CPR Section B: Medical intervention Section C: artificial administered nutrition Section D: Information and signatures

What is pharmacokinetics?

- absorption, distribution, metabolism and excretion of drugs

15. Nocturia, or frequent urination during the night, may be the result of an aging _____________. A. Kidney B. Pelvic floor C. Liver D. Bladder

ANS: A. Kidney

8. What is the primary effect of aging on the central nervous system? A. Slowing of functioning B. Mental confusion C. Alzheimer's disease D. All of the above

ANS: A. Slowing of function

11. Older adults may perceive pain as ______________, but that does not mean that they feel less pain. A. More frequent than when they were younger B. Just another facet of aging C. A regular occurrence D. None of the above

ANS: B. Just another facet of aging

13 Constipation can sometimes be prevented by eating several small meals per day, with the heaviest meal at ____________. A. Late morning B. Midday C. Early evening D. Night

ANS: B. Midday

16. _______________ enlargement can cause a difficulty in starting to urinate and a dribbling at the completion. A. Bladder B. Prostate C. Kidney D. Liver

ANS: B. Prostate

10. Confusion and unusual patterns of forgetting or a rapid onset of symptoms are ____________ due to the natural aging process. A. Always B. Usually not C. Never D. Almost always

ANS: B. Usually not

17. What score on the geriatric depression scale would always be indicative of depression? a. 3 b. 5 c. 8 d. 12

ANS: D 12 Rationale: a score greater than 10 points is always indication of depression. A score of greater than 5 points is suggestive of depression and warrants a follow up comprehensive assessment .

9. What is presbyopia? A. Loss of peripheral vision B. Pressure within the eye C. Loss of transparency of the lens D. Decreased ability to focus primarily on near objects

ANS: D. Decreased ability to focus primarily on near objects

17. The most common skin disorders among older adults are seborrheic and actinic keratoses. They are _________________. A. Irritating and should be removed B. Potentially fatal C. Extremely harmful, but treatable D. Harmless and require no medical attention

ANS: D. Harmless and require no medical attention

14 Due to changes in the GI tract, older adults are more prone to developing which of the following? A. Lactose intolerance B. Stomach inflammation after taking aspirin and NSAIDS C. Increased appetite D. Lactose intolerance and stomach inflammation after taking aspirin and NSAIDS

ANS: D. Lactose intolerance and stomach inflammation after taking aspirin and NSAIDS

12 In the stomach, ____________ secretion of enzymes and digestive acids may slow the breakdown and absorption of food. A. Increased B. Inconsistent C. Eliminated D. Reduced

ANS: D. Reduced

26. Fill in the blanks....Most common type of Dementia________________.

Alzheimer's disease

13. Which of the following clients of a nurse practitioner is demonstrative of a growing trend in the role of grandparents in contemporary American society? A) A 70-year-old grandmother is raising her two grandchildren because their mother is in prison. B) An 80-year-old client of the nurse is going through a divorce with her husband of several decades. C) A 79-year-old man laments the fact that he is estranged from his son's children. D) A married couple in their seventies who refuse to provide free child care for their grandchildren on a daily basis.

Ans: A Feedback: A growing number of grandparents have primary responsibility for the care of their grandchildren, a fact that can often be attributed to teen pregnancy, incarceration, or substance abuse. Divorce late in life, estrangement from grandchildren, and refusal to provide care are not noted to be phenomena.

18. Which of the following older adults is most likely to have his or her health problem characterized as delirium rather than dementia? A) Mr. L, whose wife has brought him to the emergency department because of the forgetfulness and confusion that he has exhibited over the last 48 hours. B) Mrs. O, whose children state that her personality has changed markedly and who has difficulty finding words lately. C) Mr. J, who has developed an unsteady and awkward gait coupled with uncoordinated motor skills in recent months. D) Mrs. Y, who was diagnosed with a brain tumor and who has experienced consequent changes in behavior and cognition.

Ans: A Feedback: A rapid onset of cognitive changes is indicative of delirium. Personality and language changes, deterioration in motor skills, and changes attributable to an organic change such as a tumor are more closely associated with dementia.

2. Which of following statements most accurately captures the role of chronic illness in the lives of older adults? A) Chronic illnesses constitute the leading cause of death for older adults. B) More older adults die from acute illnesses than from chronic diseases. C) While chronic diseases used to be the leading cause of death, this is no longer the case. D) While cancer rates have fallen, other chronic diseases remain a common cause of death.

Ans: A Feedback: Chronic illnesses constitute the leading cause of death for older adults, exceeding those attributed to acute illnesses. The presence of heart disease as a cause of death has decreased in recent years, while at the same time cancer has become more prevalent.

8. A hospital clinical educator is espousing the disengagement theory of aging when teaching staff how best to meet the needs of older clients. Which of the nurse's teaching points best captures the disengagement theory of aging? A) "Older adults often benefit from a gradual and controlled withdrawal of their own interests from society's interests." B) "The disengagement between an older adult's abilities and desires can lead to frustration and, ultimately, to illness." C) "The lack of synchronicity between older adults' immune systems and their environments can be the root of many problems." D) "It is imperative that we ensure older adults remain engaged with interests and events beyond themselves."

Ans: A Feedback: Disengagement theory postulates that disengagement between the individual and society is beneficial to both parties. It does not propose that this process of withdrawal be prevented nor that it necessarily leads to frustration or illness. The immune system is not a central component of the theory.

5. Older adults undergoing radiation and chemotherapy require close monitoring for which of The following reasons? A) They are more vulnerable than younger patients to dehydration and infections. B) Older adults are more likely than younger patients to suffer pain. C) They are more sensitive to radiation than are younger patients. D) They are more likely to become suicidal than are younger patients.

Ans: A Feedback: Elderly cancer patients need the same care as younger patients, but their age makes them more vulnerable to dehydration and infections. They suffer no more than younger patients from pain or suicidal feelings.

22. Which of the following is most likely to be a cause of dementia in an older adult rather than a cause of delirium in an older adult? A) Genetic predisposition B) Hyperlipidemia C) Creutzfeldt-Jakob disease D) Hypertension

Ans: A Feedback: Genetic predisposition is most likely to be a cause of dementia in an older adult. Hyperlipidemia and hypertension are more likely to cause delirium. Creutzfeldt-Jakob disease is likely to be a cause of dementia but it is extremely rare.

42. While completing an assessment the nurse learns that an older female patient has many misconceptions about having sex at this time in her life. What did the patient say for the nurse to come to this conclusion? A) Sex can refracture a broken hip. B) Some medications can reduce the desire for sex. C) Menopause changes the amount of estrogen in the body. D) Different positions can be used to help with the limits of arthritis.

Ans: A Feedback: One common misconception about having a fulfilling sex life in old age is that sex can refracture a broken hip. The other statements are not misconceptions about sex in old age.

20. Which one of the following statements about delirium and dementia is most accurate? A) A person who has dementia can suffer from delirium. B) Dementia and delirium are the same. C) Delirium causes a progressive, irreversible decline in cognition. D) Dementia occurs in all elderly persons.

Ans: A Feedback: Persons with dementia can develop delirium as a response to an acute condition but be undiagnosed because changes are not understood or identified. Both dementia and delirium cause cognitive impairment, but there are significant differences in the two disorders. Dementia causes a progressive, irreversible decline in cognition. Dementia occurs in approximately 5% of the elderly population.

13. An 80-year-old male patient who is receiving treatment for COPD in the geriatric medicine unit of a hospital has been displaying frequent signs of anxiety since admission. Which of the following nursing actions should the nurse prioritize? A) Implementing a predictable routine and providing explanations prior to nursing interventions. B) Ensuring that the patient has appropriate benzodiazepines prescribed. C) Explaining to the patient that his prognosis is good and that discharge will take place shortly. D) Working with the occupational therapist to provide the patient with meaningful activity.

Ans: A Feedback: Predictability and routine are more useful than activity in the treatment of anxiety. Medications may or may not be appropriate, and an explanation of the patient's prognosis is less likely to be a useful intervention.

10. Which of the following statements underlie both the error theory of aging and the free radical theory of aging? A) Biochemical damage accumulates over time, leading to cell death. B) The rate of cellular death is genetically programmed. C) The aging body produces fewer growth and repair hormones. D) Environmental agents such as radiation and heavy metals damage DNA.

Ans: A Feedback: That the rate of cell death is genetically programmed is a basic tenet of the programmed theory of aging. That the aging body produces fewer growth and repair hormones is a neuroendocrine theory. Although radiation and heavy metals may damage DNA, they are not free radicals, and they need not be the cause of the mutations assumed by the error theory.

7. An 80-year-old female who enjoys good health explains to her primary care provider that she attributes her health status to her regular intake of berries, fruit juices, and green tea, which she states "help cleanse the damaging molecules out of my body." Which of the following theories of aging underlies the client's health behaviors? A) Free radical theory B) Biogerontology C) Disposable soma theory D) Cross-linking theory

Ans: A Feedback: The free radical theory of aging attributes damage to the accumulation of free radicals that may be countered by the intake of antioxidants. This is not an explicit component of the disposable soma or cross-linking theory of aging. Biogerontology is the study of the relationship between aging and disease.

34. An older patient suffering from chronic exhaustion has an EEG that shows little time is spent in REM sleep. After reviewing the patient's history, what does the nurse suspect might be contributing to the patient's sleep problem? A) Has two or three glasses of wine near bedtime B) Obese and diagnosed with type 2 diabetes 6 years ago C) Takes low-dose aspirin for the prevention of heart disease D) Stressed due to the spouse's new diagnosis of Alzheimer disease

Ans: A Feedback: Certain drugs can decrease REM sleep, including alcohol. The use of aspirin has not been associated with decreased REM sleep. Obesity, type 2 diabetes, and stress have not been linked to specifically reducing the amount of REM sleep although these health problems can negatively impact sleep overall.

37. The nurse wants to ensure that assigned patients are comfortable. What will the nurse use as a measurement of comfort? A) A state of physical, emotional, and spiritual well-being B) An absence of reports, signs, or symptoms of physical pain C) A transcendent emotional and spiritual state that exists regardless of the presence or absence of pain D) A condition of maintaining a patient's self-report of pain being below a self-reported threshold of 1 out of 10

Ans: A Feedback: Comfort is defined as a sense of physical, emotional, social, and spiritual peace and well-being. This may include, but is not limited to, considerations of patient reports of pain. It does not exclude consideration of physical pain. It is debatable if pain is a transcendent emotion and spiritual state.

18. A patient experiencing chronic pain asks the nurse if there is "anything else" that can be done to help with the pain. Which response should the nurse make to address complementary therapies with the patient? A) Complementary therapies provide added options for treating pain. B) Complementary therapies can be explored when medication has failed to relieve pain. C) Complementary therapies are preferable to medications in light of their more holistic nature. D) Complementary therapies often have unproven effectiveness but bring emotional comfort to patients.

Ans: A Feedback: Complementary therapies provide useful additional options for the treatment of pain. Medication need not have failed for alternative therapies to be considered and their effectiveness has been demonstrated. These therapies are not necessarily preferable to medications, but rather should be implemented in addition to medications. Complementary therapies may or may not prove to be effective and are not necessarily preferable to medications.

41. Which approach should the nurse use when considering pain management of an older patient recovering from injuries from a motor vehicle crash? A) Try non-opioids and adjuvant drugs before providing opioid analgesia. B) Implement opioids if complementary therapies have proven to be ineffective. C) Begin with a moderate dose of opioid analgesia and taper down to the lowest effective dose. D) Restrict analgesia options to NSAIDs and adjuvant medications due to the risk of unwanted effects.

Ans: A Feedback: Due to the risk of side effects in older adults, it is best to try non-opioids and adjuvant drugs prior to using opioids. It would be inappropriate to withhold analgesia entirely or until complementary therapies have been proven ineffective, and beginning with a high dose and tapering down is the opposite or the correct approach.

26. Nurse H is providing care in the hospital for a 71-year-old male patient who is in the late stages of cancer and who has painful bone metastases. The client is non-responsive but groans and grimaces intermittently. Nurse H is drawing up a breakthrough dose of morphine for the patient, but Nurse R cautions that, "sure, that will address his pain, but it could depress his respiratory drive and actually kill him at this stage." Which of the following ethical principles is Nurse R prioritizing? A) Nonmaleficence B) Justice C) Beneficence D) Fidelity

Ans: A Feedback: Nurse R's emphasis on preventing harm to the patient, even during an act that may be motivated by altruism, is characteristic of the principle of nonmaleficence.

28. How does guardianship differ from power of attorney? A) The court appoints a guardian. An individual grants a power of attorney to someone else to make decisions on his or her behalf B) Guardianship is legally binding whether or not an individual is competent. Power of attorney applies only to the incompetent C) Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of "reasonable prudence" are met D) Guardianship stays in effect for one calendar year and must be renewed annually. Power of attorney stays in effect until one or both parties choose to revoke it

Ans: A Feedback: The appointment of a guardian to grant consent for an incompetent individual is the responsibility of the court. When a patient's competency is questionable, staff should encourage family members to seek legal guardianship. Power of attorney is a mechanism used by competent individuals to appoint someone else to make decisions for them.

18. The nurse assesses a group of older adults at a senior center for conditions related to an aging endocrine system. Which of the following assessment findings should the nurse prioritize and address first? A. Blood glucose of 300 in an 88 year old person B. Metabolic syndrome in a 67 yr old person C. New onset of peripheral edema and constipation in a 72 year old adult D. The presence of a Dupuytren contracture in a 78 year old adult.

Ans: A Feedback: While all are abnormal findings and need addressing, the elevated blood glucose is the priority before the patient develops other issues with hyperglycemia.

Four patients with terminal cancer are in a hospital ward. A nurse observing them on her rounds realizes that one may be near death. Which patient is it? A) Patient A has a rapid, weak pulse B) Patient B is not perspiring C) Patient C has very red skin D) Patient D's blood pressure has risen suddenly

Ans: A Patient A has one of the many signs that bodily functions are slowing down. Some of the other signs are profuse perspiration, pallor, and decline in blood pressure.

3. Which of the following are interventions that gerontological nurses can implement to prevent and diagnose cancer in older adults? (Select all that apply.) A) Encouraging healthy lifestyles B) Educating patients about cancer screening C) Facilitating patient efforts to obtain appropriate screening tests D) Providing creative, holistic, and skillful nursing interventions to patients diagnosed with cancer E) Supporting the physical, emotional, and spiritual health of individuals

Ans: A, B, C Feedback: Encouraging healthy lifestyle habits in persons of all ages can help reduce the risk factors for developing cancer. Educating patients about cancer screening and facilitating their efforts to obtain tests can enable cancers to be detected in early stages, thereby increasing survival rates. Creative, holistic, and skillful nursing interventions that offer support—physical, emotional, and spiritual—to individuals diagnosed with cancer and their significant others promote the best quality of life in the presence of the disease but are not related to prevention and diagnosis of cancer in older adults.

7. Gero nurse is developing program for LTC facility integrating the principles of gero, which concept will the nurse include as the basis of these programs. SATA A. A need for unique data and knowledge set B. Realistic goals aiming for wholeness C. View of aging as natural and common part of human life D. Advancement health outcomes equal through younger adults E. Focus on the different aspects of self care and human needs of older adults

Ans: A, B, C Feedback: Answers A, B, C are all identified principles of gerontological nursing.

16. During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply. A) The woman's overall proportion of body water has decreased. B) The client has experienced a loss of cartilage. C) The woman's thyroid hormone levels have declined since the sixth decade. D) The client's vertebrae have thinned. E) Loss of stature is a consequence of the woman's diet. F) The woman's long bones have decreased in length.

Ans: A, B, D Feedback: Reduced hydration, loss of cartilage, and thinning of vertebrae can all contribute to loss of stature. Decreased levels of TH, shortening of long bones, and diet are not noted to contribute to this phenomenon.

22. The nurse at a long-term care facility is teaching unlicensed care providers about some of the factors that characterize adverse drug reactions in the elderly residents. Which teaching points are valid? (Select all that apply.) A) "Even when a resident stops taking a drug, a reaction can take place after the fact." B) "Even when a resident has been taking a drug for a long time, a drug reaction can still occur." C) "Most 'drug reactions' are in fact age-related changes that are mistakenly attributed to medications." D) "Older adults often have signs and symptoms of adverse reactions that are very different from those of younger adults." E) "While older adults are prone to adverse reactions, these reactions tend to resolve more quickly than in younger people."

Ans: A, B, D Feedback: An adverse reaction to a drug may be demonstrated even after the drug has been discontinued. Adverse reactions can develop suddenly even with a drug that has been used over a long period of time without problems. The signs and symptoms of an adverse reaction to a given drug may differ in older persons. Most drug reactions are not age-related changes. Adverse drug reactions do not resolve more quickly in older patients than in younger people.

9. Which of the following are problems that older adults may confront that challenge their emotional homeostasis? (Select all that apply.) A) Altered function or body image B) Increased vulnerability to crime and abuse C) Independence from others D) Sensory deficits E) Greater awareness of own mortality

Ans: A, B, D, E Feedback: Problems that older adults may confront that challenge their emotional homeostasis include the following: illness, which can be coping, related self-care demands, pain, altered function or body image; increased vulnerability to crime illness, disability, abuse; sensory deficits including decrease in or loss of function of hearing, vision, taste, smell, and touch; greater awareness of own mortality from increased numbers of deaths among peers. Older adults may not experience independence from others; in fact, many (but not all) elders have increased dependence on others.

9. Which of the following tasks are components of Erickson's description of the old age tasks of reconciling ego integrity with despair? Select all that apply. A) An 80-year-old man is struggling to determine his identity apart from his lifelong career as a business leader. B) A 79-year-old woman has established habits that promote her financial independence in spite of a lack of savings. C) An 80-year-old man revels in his large, happy family rather than focusing on his mobility limitations resulting from Parkinson disease. D) A 77-year-old man is trying to determine whether his life has had deep significance and meaning.

Ans: A, C, D Feedback: Deriving satisfaction from oneself rather than occupational roles, finding pleasure in spite of physical limitations, and determining meaning in the life one has lived are all aspects of Erikson's outcome of ego integrity or despair. Financial independence is not a central component of this outcome.

3. The board of a large chain of hospitals has commissioned a strategic plan in order to meet the care needs of baby boomers in coming years. Which of the following trends constitute a sound basis for understanding the baby boomer generation and conducting future planning? Select all that apply. A) Baby boomers tend to have fewer children than members of earlier generations. B) Adjusted for inflation, baby boomers have lower incomes than their parents had. C) Due to technology, baby boomers have more leisure time than other adults. D) Baby boomers perform physical exercise more frequently than other adults.

Ans: A, D Feedback: Baby boomers have had fewer children than generations that preceded them and they tend to exercise more often. Their incomes tend to be higher while they enjoy less leisure time.

4. Which of the following are symptoms of a "silent" heart attack? SATA A. Indigestion B. Jaw or neck pain C. Migraine D. Diaphoresis (sweating)

Ans: A,B,D

2. Older adults have more challenges and an increase of incidence with cancer as they age because of what reasons? Select all that apply? A. Prolonged exposure to carcinogens B. Enhanced immune system C. The presence of multiple health conditions and comorbidities D. The reduced ability to resist diseases.

Ans: A,C,D

2. If the decreased ability to breathe deeply and to cough is present, you should watch for ________________. A. Respiratory illness, such as pneumonia B. Constipation C. Heart disease D. Malignant melanoma

Ans: A. Respiratory illness, such as pneumonia

6. A gero nurse is conducting a program for nurses new to the gero nursing practice. The nurse emphasize the need for the nurse to do which action to minimize conflict with the facility and client population they will be serving. a. ANA code of ethics b. become aware of values c. maintain beneficence all the time d. adopt an egoistic personality

Ans: B

18. A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse's assessment of the client would recognize which of the following factors as most likely contributed to the suspected injury? A) Bone remodeling in long bones ceases in the seventh or eighth decade. B) Bone minerals and mass are reduced as part of the aging process. C) Bone marrow production of cellular components declines with age. D) Thinning disks and shortened vertebrae are common assessment findings in older adults.

Ans: B Feedback: A decrease in bone minerals and mass is common later in life. Bone remodeling does not, however, cease. Neither thinning disks, shortened vertebrae, nor marrow production of blood cellular components is likely to directly contribute to the client's suspected fracture.

12. Mrs. L has experienced a progressive loss of mobility over the last several years as a consequence of multiple sclerosis. Combined with a narrowing social circle, Mrs. L has characterized her life as "not worth living" and expressed to her nurse a desire to "end it all." How should the nurse best respond to Mrs. L's statement? A) Assure Mrs. L that such challenges are not uncommon in older adults. B) Implement measures to ensure Mrs. L's safety. C) Inform Mrs. L's family about her statements. D) Add "risk for depression" to Mrs. L's nursing care plan.

Ans: B Feedback: All threats of suicide should be taken seriously and safety measures established. Assurances are likely inappropriate and counterproductive, and modifying her care plan would be a less important action. Informing her family would be ethically questionable.

8. Which one of the following statements about providing support to patients and families is most accurate? A) It is selfish of family members to have additional concerns of their own. B) An example of a worry of a family member might be that the cost of treatment may impoverish them. C) It is not useful for the patient to express his or her feelings. D) It is best to keep the patient and family from knowing of the cancer diagnosis and prognosis.

Ans: B Feedback: An example of a worry of a family member might be that the cost of treatment may impoverish them or experience anticipatory grief that the patient may not be present for important milestones. It is not selfish of family members to have additional concerns of their own as they are also likely to share the patients' concern. It is useful for the patient to express his or her own feelings and it is important that the patient learns about the diagnosis, treatment plan, and Prognosis.

20. The nurse interviews the client at a yearly office visit. The client states "I don't really eat that much, I'm not that hungry, but I keep gaining weight. Just look at my fat face!" Which of the following conditions should the nurse suspect? A) Hyperlipidemia B) Hypothyroidism C) Diabetes D) Peripheral vascular disease

Ans: B Feedback: Anorexia, weight gain, and a puffy face are all characteristics of hypothyroidism.

14. A health-conscious resident of an assisted living facility is promoting the value of fiber to a fellow resident. Which statement made by the resident about the benefits of fiber is accurate? A) Improved bowel activity and increased metabolic rate B) Improved bowel activity and decreased serum cholesterol C) Improved gastric emptying and prevention of colon cancer D) Increased nutrient absorption and decreased glucose tolerance

Ans: B Feedback: Fiber is noted to lower serum cholesterol and promote good bowel activity. It is not noted to improve nutrient absorption or gastric emptying or to increase overall metabolic rate.

22. Which of the following older adults is most likely experiencing the effects of age-related changes to endocrine function? A) A 71-year-old whose circadian rhythms are disrupted due to decreased melatonin production by the pineal gland. B) A 78-year-old whose pancreas is releasing insufficient amounts of insulin, resulting in hyperglycemia. C) A 67-year-old who is experiencing hyperthermia and insomnia due to increased thyroid activity. D) A 69-year-old who has experienced decreased sexual responsiveness due to a large decline in testosterone production.

Ans: B Feedback: Insufficient insulin release is considered a common, age-related change, while melatonin levels are not noted to be affected by the aging process. Hyperthyroidism and a significant decline in testosterone production would constitute pathological findings.

15. What is the best action a busy nurse can take to help with the desire of elderly clients to reminisce about their past lives? A) Refer clients to senior centers, where they can share their stories with others of their own age group B) Encourage the recording of stories through diaries and scrapbooks to be shared with younger family members C) Introduce older clients to members of local historical societies who can record their stories for posterity D) Look for ways to steer discussion toward health-promoting habits such as good exercise and adequate nutrition

Ans: B Feedback: It is always important to listen to the stories of seniors and to honor their life histories. Changing the subject is seldom appropriate, and although referrals to senior centers and historical societies may be beneficial in some cases, encouraging elders to record and share their stories with the younger generation is always a good idea.

19. An elderly man is admitted to the hospital for surgery. A day later, he seems confused and disoriented. He imagines there is a trapdoor in the ceiling above his bed. His wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed "sharp as a tack." What should the nurse do first? A) Control environmental temperatures and noises. B) Check the patient's chart for medications that can cause delirium. C) Have the patient evaluated for Alzheimer's disease. D) Tell the wife there is nothing to worry about.

Ans: B Feedback: The rapid onset and the delusion make it likely that this is delirium rather than dementia. The man's medication should be checked immediately, as painkillers used after surgery may have this effect. Controlling the environment may be helpful, but removing the cause of delirium is of the most importance. The wife is quite right to be concerned, but she should be told about the likelihood of delirium in this situation. Evaluation for Alzheimer's disease can take place later if that seems desirable.

16. An 81-year-old female client has presented to the emergency department accompanied by her daughter with whom she lives. The daughter states that her mother has experienced a recent series of falls, which have resulted in her facial and arm bruises. The client smells of urine and is noticeably emaciated, unkempt, and is anxious while the daughter berates her during the nurse's assessment. What is the nurse's responsibility in this situation? A) Determine the daughter's legal status with regard to her mother's financial affairs. B) Report suspected elder abuse to the Adult Protective Services Department. C) Establish whether the client has a durable power of attorney in place. D) Obtain medical records regarding prior admissions for similar problems.

Ans: B Feedback: In cases of suspected elder abuse, the nurse is responsible for reporting his or her suspicions to the relevant authorities. Neither the legal status of the mother and daughter's relationship nor past medical records are primary concerns.

1. After receiving new dentures the nurse provides instruction to an older patient on the use and their care. Which patient statement indicates that teaching about the dentures has been effective? A) "I do not have to brush and floss my teeth every day." B) "I suppose that I'll have to get these resized and adjusted from time to time." C) "I'll have to change my diet to include only soft and pureed foods now I suppose." D) "I've had to go to the dentist so often over the last few years and it's a relief not to have to anymore."

Ans: B Feedback: It is important that older adults realize that dentures still necessitate maintenance and occasional readjustments. Brushing is still necessary, as is visiting the dentist. The diet of adults with dentures is not noted to be restricted to soft and pureed foods.

5. 2. Which of the following facts best accounts for the complexity of gerontological nursing? A) Assessment of older adults is often complicated by the presence of cognitive deficits. B) Multiple health conditions often coexist in older adults and symptoms are often atypical. C) Older adults are expected to have poorer health outcomes than younger clients. D) Evidence-based practice with older adults is more difficult due to the relative lack of research into their unique health needs.

Ans: B Feedback: Older adults frequently experience multiple, overlapping health problems coupled with atypical symptom presentation. While cognitive deficits may exist, this phenomenon is not as pervasive as answer B, and assessment is still possible nonetheless. Expectation of poor health outcomes, a questionable assumption in itself, does not necessarily add to the complexity of care for older adults. There is a significant body of research that addresses elders' health needs.

2. Which of the following is the primary role of the gerontological nurse, and for what reason? A) Innovator, because gerontological nursing continues to be an evolving specialty B) Caregiver, because the nurse uses gerontological theory in the conscientious application of the nursing process to the care of elders C) Educator, because the nurse shares knowledge and skills related to the care of older adults with the general public D) Advocate, because the nurse aids older adults in asserting their rights and obtaining required services

Ans: B Feedback: The major role of nurses is that of caregiver for the reason stated. The other roles are important, but they are less frequently called for or exercised.

23. In 19th century Europe, institutions emerged for the care of various disadvantaged groups. How were the groups usually categorized? A) Mentally and physically ill people were separated. B) All groups were housed and cared for together. C) Ill and impoverished people were separated. D) Orphaned children were housed separately from other groups.

Ans: B Feedback: Little public money was available for any of these groups in 19th century Europe, so they had to be housed together. Often, criminals were included as well.

A 79-year-old woman with a longstanding diagnosis of chronic leukemia experienced a blast crisis one week ago and died overnight. Place the stages of the coping mechanisms that the woman's family will go through in the most likely chronological order. Use all the options. A) Anger B) Denial C) Acceptance D) Bargaining E) Depression

Ans: B, A, D, E, C Kübler-Ross' conceptual framework of the coping mechanisms surrounding death progress through stages of denial, anger, bargaining, depression and acceptance.

11. Which of the following would be symptoms of depression in an elderly person? (Select all that apply.) A) Inability to discriminate current reality from the past B) Inattention to hygiene C) Changes in sleep patterns D) Physical complaints of anorexia

Ans: B, C, D Feedback: Symptoms of depression in elderly persons may include inattention to hygiene, changes in sleep patterns, and physical complaints such as anorexia, constipation, headache, and indigestion. The inability to discriminate current reality from the past may be a symptom of dementia.

25. (this one was the one with the options worded differently) Which of the following are common causes of dementia in older adults other than Alzheimer's disease? (Select all that apply.) A) It is a normal consequence of aging. B) Aging, Genetics , Hypertension & Trauma Brain Injury C) Creutzfeldt-Jakob disease. D) Parkinson's disease. E) Vascular dementia.

Ans: B, E Feedback: Ans 2: age, Family, ethnicity, Traumatic brain injury Trauma and vascular dementia can cause dementia. Dementia is not a normal consequence of aging. Creutzfeldt-Jakob disease and Parkinson's disease are non-Alzheimer's disease causes of dementia but are extremely rare and only responsible for a small percentage of dementias, respectively.

7. Weight-bearing exercises are exercises in which the majority of the body weight is supported by the ____________. A. Spine B. Legs C. Shoulders D. None of the above

Ans: B. Legs

11.1. A nurse manager at a long-term care facility is engaged in efforts to change many staff members' inaccurate and negative views of older adults. Which of the following statements made by staff is most clearly indicative of ageism? A) "Older people seem to have so many more chronic health problems than younger people." B) "Older adults' motor skills get progressively slower as they age." C) "It's normal to expect a gradual loss of memory and intelligence with age." D) "A lot of the physical changes that accompany aging are inevitable."

Ans: C Feedback: A common ageist misconception is that senility and loss of intelligence inevitably, and normally, accompany the aging process. Older adults do have more chronic conditions than younger adults, and motor skills become slower. Many of the physical changes that accompany aging are considered normal and largely inevitable.

7. Which of the following patient signs and symptoms should the nurse recognize as a warning sign of cancer? A) Dyspnea on exertion B) Joint pain C) A sore that does not heal D) Increasing forgetfulness

Ans: C Feedback: A sore that does not heal can be a sign of cancer. Dyspnea on exertion, joint pain, and cognitive changes are less likely to suggest cancer.

15. A recreational therapist has proposed an organized program to the nurse manager of a long-term care facility that the therapist claims can significantly improve the self-concept of residents. Which of the following components of the therapist's program is most likely to achieve the stated goal? A) Bringing in a staff member's dog to regularly interact with residents. B) Organizing a series of health promotion classes for residents that will be conducted by staff nurses. C) Holding reminiscence sessions where residents are encouraged to write autobiographical life reviews. D) Beginning a chair aerobics class to increase physical activity by frail residents.

Ans: C Feedback: Activities such as having life-review discussions, recording oral histories, and compiling a scrapbook of life events not only help older adults feel a sense of worth about the lives they have lived but also provide a sense of history and legacy for younger generations. This is more likely to foster residents' self-concepts than exercise, education, or pet therapy.

20. A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is: A) Decline in brain weight B) Reduction of blood flow to the brain C) Flawed response to changes in balance D) Slowed nerve conduction velocity

Ans: C Feedback: Although all the statements are true, the major factor increasing the risk of falls is a flawed response to changes in balance.

24. Which of the following is the best way for nurses to minimize their struggles in making ethical decisions? A) Take no action unless an advance directive, will, and other legally binding documents are in effect B) Act on the recommendations of a patient's healthcare provider, friends, and family members C) Consult the guidelines of the American Nurses Association and the institution's ethics committee D) Maintain nursing's traditional focus on following physicians' orders and providing care and comfort for the patient

Ans: C Feedback: Although legal documents and the views of family members should be taken into account, a nurse may be called on to make ethical decisions without them or occasionally in opposition to them. Retreating into a "care-only' mode does not resolve ethical dilemmas. The best choice among those listed is to seek guidance from professional organizations and committees charged with establishing ethical guidelines for institutions.

The nurse is caring for older patients in a long-term care facility. When ensuring for these patients' dignity, which statement reflects the role of dignity as it relates to the spiritual needs of the older adult? A) Older adults who have lived a life of integrity and service have earned dignity. B) An acknowledgment of spiritual needs is necessary for the presence of dignity. C) Older adults may lack many of the attributes that are valued in society, but they can derive a sense of dignity from spirituality. D) Older adults who have moved successfully through Erikson's stages of development can experience dignity in spite of disability.

Ans: C Feedback: Despite declines in such areas as productivity and physical appearance, older adults can maintain a sense of their intrinsic worth, or dignity, by connecting with the Divine. Acknowledgment of spiritual needs is not necessarily a prerequisite for dignity, given that dignity is by definition inherent in all persons, nor is progression through Erikson's stages or a life of service necessarily required.

19. Older adults in good physical condition have cardiac function comparable to younger persons in poor condition. What is the most likely cause of a rise in systolic blood pressure in the elderly? A) Postural and postprandial hypotension B) Atherosclerosis in the innermost layer of the blood vessels C) Impaired baroreceptor function and increased peripheral resistance D) Cellular proliferation in the tunica intima

Ans: C Feedback: In the middle layer of blood vessels, impaired baroreceptor function and increased peripheral resistance lead to a rise in systolic blood pressure. Reduced sensitivity of the blood pressure regulation with baroreceptors increases problems with postural hypotension and postprandial hypotension; thus, they are an effect, not a cause. Cells proliferate in the innermost layer of vessels and atherosclerosis develops, but these are not the direct causes of increased systolic pressure.

10. Mr. J, age 81, has been admitted to hospital for the treatment of diverticulitis. It is noted in His history that Mr. J has a history of depression. Which of the following nursing actions is most likely to foster his mental health? A) Performing as many of Mr. J's ADLs as possible to minimize his perceived burden of responsibility. B) Organizing a life review to remind Mr. J of the positives that exist in his life. C) Encouraging Mr. J to make decisions regarding his routine and care. D) Selecting a roommate for Mr. J who is social and optimistic.

Ans: C Feedback: It is important to act only for individuals when necessary and to foster a sense of control. Forcing interaction with gregarious individuals or minimizing tasks and responsibilities is unlikely to benefit the patient.

23. A diabetes nurse is providing an educational in-service to nurses who provide care on a geriatric, subacute medical unit of hospital. Which of the following teaching points related to diagnosing diabetes in older adults should be included in the teaching? A) "Older adults with a new onset of diabetes will be hungry and thirsty with copious urine output." B) "Because of an absence of signs and symptoms in older adults with diabetes, diagnosis can be very difficult." C) "Older persons can often display signs and symptoms of diabetes that are more subtle than those in younger adults." D) "Pancreatic biopsy is often required in order to determine a definitive diagnosis of diabetes in the elderly."

Ans: C Feedback: Signs and symptoms of diabetes are often nonspecific, though not absent, in older adults. Pancreatic biopsy is not necessary for the diagnosis of diabetes.

6. When compared with elderly populations of the past, persons entering their senior years between 2015 and 2030 will have: A) Fewer chronic diseases but more acute illnesses B) Greater support from their children and spouses C) Better education and greater wealth D) Fewer needs for hospital or nursing home care

Ans: C Feedback: The baby boomer cohort attained higher levels of education and economic status than past generations. They have, however, fewer children and the same (or greater) burdens of chronic disease and needs for health care as their parents did.

24. During patient education of a 71-year-old who has a recent diagnosis of diabetes, the nurse has emphasized the importance of consistently maintaining blood glucose levels within the normal range rather than simply reacting to high or low levels. Which of the following tests is most likely to gauge the consistency of the patient's blood sugar control over time? A) Random blood glucose B) Triglyceride monitoring C) Hemoglobin A1c D) Glucose tolerance test (GTT)

Ans: C Feedback: The hemoglobin A1c test determines an individual's effectiveness of blood sugar control over the previous 6- to 12-week period. Random glucose testing, triglyceride tests, and the GTT do not achieve this result.

1. Which of the following statements most accurately captures an aspect of the relationship between cancer and aging? A) The incidence and prevalence of cancer in older adults is approximately equal to that of younger adults. B) Cancer is the leading cause of death among persons age 65 and older. C) Age is the most significant risk factor for cancer. D) The prevalence of cancer in older adults is expected to decrease in coming decades.

Ans: C Feedback: The most significant risk factor for cancer is age. The incidence and prevalence exceed those of younger adults and cancer is the second leading cause of death in older adults. The prevalence is expected to increase as the population ages.

1. Which of the following statements most accurately captures the financial status of older adults in the United States? A) The percentage of older people living below the poverty level has been increasing. B) The financial needs of most older adults are well met by Social Security income alone. C) The recent decline in housing prices has made many older adults "asset rich and cash poor." D) Women 65 years of age and older is the fastest growing group of employment.

Ans: C Feedback: The percentage of older people living below the poverty level has been declining, with about 10% now falling into this category. Most older people depend on Social Security for more than half of their income. Although the median net worth of older households is nearly twice the national average because of the high prevalence of home ownership by elders, many older adults are "asset rich and cash poor." The recent decline in housing prices, however, has made that asset a less valuable one for many older adults. There has been a significant rise in the percentage of middle-aged women who are employed, although there has been little change in the labor force participation of women 65 years of age and older.

25. Which older adult client would the nurse identify as being susceptible to decreased libido or sexual function as a result of the medication regimen? A) A 78-year-old woman who takes an antiplatelet aggregator for the prevention of ischemic heart disease. B) An 80-year-old male client with osteoporosis who is taking vitamin D and calcium supplements. C) A 77-year-old man who takes a diuretic and a-adrenergic receptor blocker for the treatment of hypertension. D) An 81-year-old woman who takes HRT and nebulized bronchodilators for her chronic obstructive pulmonary disease.

Ans: C Feedback: Diuretics are noted to diminish sexual function. The other noted medications are not included in the list of medications with this effect.

12. Because many residents in a long-term care facility are experiencing sleep problems, which routine should the nurse reevaluate? A) Offering a light snack at bedtime B) Bathing residents in the evening rather than first thing in the morning C) Activities are concentrated in the morning to ensure evenings are free D) Encouraging residents to refrain from going to bed when they first feel drowsy in the evening

Ans: C Feedback: It is preferable to intersperse activities throughout the day rather than concentrating them in the morning. A bath and a snack in the evening are both conducive to sleep and going to bed too early is not conducive to sustained sleep.

10. Which of the following social changes is increasing the number and complexity of ethical dilemmas that nurses face? A) Outdated medical technologies B) Diminished fiscal constraints C) Greater numbers of older adults D) Expansion of the hospice movement

Ans: C Feedback: Nurses face more ethical dilemmas as a result of new medical technologies and increased fiscal constraints. The complexity is increased by larger numbers of older adults to serve. The expansion of hospice care helps nurses deal with ethical dilemmas.

27. When in doubt about using restraints on an agitated patient, it is prudent for nurses to: A) Restrain the patient for his or her own safety B) Use such minor restraints as a bedside rail or a tray on a wheelchair C) Use alternatives such as a bed alarm with increased staff supervision D) Avoid any device or procedure to limit liability

Ans: C Feedback: The Omnibus Budget Reconciliation Act (OBRA) imposed strict standards on the use of restraints in long-term care facilities. Anything that restricts a patient's movement can be considered a restraint and can result in litigation for false imprisonment and neglect. Thus, it is best to avoid restraints if possible. Bed alarm and staff supervision are effective and nonrestrictive for an agitated patient.

15. An 81-year-old female client was diagnosed 1 year ago with Alzheimer's disease following a noticeable increase in confusion. She now possesses a durable power of attorney. Which of the following statements most accurately conveys an aspect of this legal arrangement? A) The parameters of the arrangement must be revisited if the client's condition declines. B) The arrangement was most likely initiated by court order for a government conservator. C) The client appointed someone to take care of her affairs in the event that she becomes incompetent. D) The family has control of logistical arrangements for the client but must gain court permission around financial affairs.

Ans: C Feedback: Usually, a power of attorney becomes invalid if the individual granting it becomes incompetent, except in the case of a durable power of attorney. A durable power of attorney allows competent individuals to appoint someone to make decisions on their behalf in the event that they become incompetent; this is a recommended procedure for individuals with dementias and other disorders in which competency can be anticipated to decline. It would not have been initiated by the court and it encompasses both logistical and financial issues.

22. Between 1940 and 2002, admissions to long-term-care facilities in the United States increased. Which statement is true about that growth? A) The total number of residents grew, but the number of facilities remained the same. B) The total number of residents grew at a slower rate than the number of facilities. C) The total number of residents grew at a faster rate than the number of facilities. D) The total number of residents grew at the same rate as the number of facilities.

Ans: C Feedback: In 1940, the total number of nursing facilities was 1,200; in 2004, it had increased to 16,081. In 1940, the total number of residents was 25,000; in 2004, it had increased to 1,492,000. The number of residents increased at about three times the rate that the number of facilities increased, reflecting the shift to larger facilities that can provide more services but that may have a less homelike atmosphere.

23. An elderly woman suffering from abdominal pain, nausea, urinary incontinence, fever, and vomiting is brought to the emergency department. What is the most likely preliminary diagnosis? A) Appendicitis B) Aneurysm C) Urinary tract infection D) Colon cancer

Ans: C Feedback: The fever makes an infection more likely than an aneurysm or cancer. In an elderly person, a urinary tract infection is the most common type of infection, and many elderly people have already lost their appendixes.

An elderly dying woman becomes panicky, convinced that she is suffocating. What is a likely cause of the discomfort she is feeling? A) Dyspnea B) Anxiety C) Dropping levels of blood gases D) Hypokalemia

Ans: C One cause of respiratory distress is deteriorating blood gas levels. The respiratory distress (or dyspnea) she is experiencing is common in dying patients; it results in anxiety and fear. Hypokalemia is a lowered blood level of potassium.

The daughter of a 79-year-old man with a diagnosis of small-cell lung cancer has learned that her father has been found to have bone metastases. The daughter has approached the oncologist who is caring for him with information that she has found on the Internet that promises to cause remission of cancer through intensive antioxidant therapy. She is adamant that the physician facilitate the treatment and liaise with the providers who are located overseas. Which of the stages of Kübler-Ross' conceptual framework is the daughter most likely experiencing? A) Depression B) Anger C) Denial D) Bargaining

Ans: C The quest for a more positive outcome from unlikely sources is associated with the stage of denial.

8. Which statements does the nurse identify as reasons for many older adults being unable to find a sex partner? (Select all that apply.) A) Most men are married to older women. B) There are many more men over age 65 than women. C) Most older men are married while older women are widowed. D) The number of older women far exceeds the number of older men. E) Most women marry men who are significantly older than themselves.

Ans: C, D, E Feedback: Most older men are married while older women are widowed. The number of older women exceeds the number of older men. And most women marry men who are significantly older than themselves. Most men are not married to older women. And there are not many more men over age 65 than women.

6. The older adult requires about 10% more energy than the younger person to __ A. Engage in moderate exercise B. Perform weight-bearing exercises C. Breathe normally D. Perform basic daily activities

Ans: C. Breathe normally

9. Gero nurse is providing care for several adults?

Ans: COPD patient

12. According to Erickson, the final stage of the life cycle is centered on achieving integrity versus despair. Which of the following situations would signal to the nurse that the client in question is at risk for disappointment and despair as characterized by Erikson? A) An 81-year-old woman has needed to adopt a minced diet following a recent stroke. B) A 78-year-old man has had a pacemaker implanted to address his atrial fibrillation. C) A 90-year-old woman is grieving the recent death of her husband to whom she was married for 66 years. D) An 80-year-old man describes himself as "useless" since he can no longer help his adult children with their yard and garden work.

Ans: D Feedback: A perceived loss of useful function often constitutes a crisis for older men and can be associated with despair rather than integrity in Erikson's typology of the life cycle. A change in diet, a medical intervention, and grief at the loss of a spouse are less closely associated with this conflict.

6. A 72-year-old woman who has been diagnosed with breast cancer has declared her intention to seek an alternative treatment abroad that is claimed to eradicate cancer in nearly all cases. How can the nurse best respond to the woman's statement? A) "Alternative and complementary therapies have been shown to have a valuable role in the holistic treatment of cancer." B) "It would be a good idea to investigate whether your American insurer will reimburse for treatment in another country." C) "It's likely in your best interests to limit your treatment to what your oncologist performs." D) "You might want to investigate why this treatment is not available in the United States."

Ans: D Feedback: A requirement to travel to a foreign country should constitute a warning sign. While alternative therapies are valid, a critical investigation is essential. This would supersede financial concerns.

14. Which one of the following statements about alcohol abuse/dependency or addiction in older populations is most accurate? A) It is easy to determine if an older adult suffers from alcohol abuse. B) Older adults who abuse alcohol have always used it very heavily throughout their lives. C) The incidence of alcohol and illegal drug abuse in elderly persons is declining. D) Alcohol abuse can seriously threaten the physical, emotional, and social health of older persons.

Ans: D Feedback: Alcohol abuse can seriously threaten the physical, emotional, and social health of older persons. Many persons who are addicted to alcohol do not reach old age or they may have used it throughout their lives or began using it as they have grown older. Alcohol abuse/dependency or addiction is often difficult to identify in older persons because it may be unexpected and sometimes mimics symptoms of common geriatric conditions. The incidence of alcohol abuse and illicit drug use in older adults is increasing because the number of people reaching late life is increasing.

4. 18. Which one of the following statements about the patients' choice to use complementary and alternative medicine (CAM) is most accurate? A) CAM therapies are used by 80% of all Americans. B) CAM therapies are not popular in the United States. C) CAM practitioners tend to focus mostly on treating the disease. D) CAM practitioners usually focus on the whole person.

Ans: D Feedback: CAM practitioners are likely to be equally or even more concerned with treating the whole person and not just the disease.

5. What is the most important factor contributing to limitations in self-care and independent living among the elderly? A) Lack of family support B) Low financial assets C) Acute illness and injury D) Chronic illness

Ans: D Feedback: Chronic illnesses are noted to have a significant impact on the quality of life of older adults. These illnesses are more prevalent than acute illnesses and supersede deficits in family and financial support.

4. Gerontological nursing will become an increasingly important profession, compared with in the past, because: A) More people will be presenting with the same health care challenges B) More elderly are living in increasingly squalid living conditions C) A greater number of people are surviving the previously hazardous period of infancy D) More people are spending a longer time span in old age

Ans: D Feedback: More people are achieving and spending longer periods of time in old age than ever before in history. Declines in living conditions, increased prevalence and incidence of the same health problems, and higher survival rates during infancy do not account for the increased importance of gerontological nursing.

14. Nurse S encourages older adult clients to engage in spiritual beliefs and practices that they are familiar with. How can this activity be best characterized? A) Spiritual concerns are less relevant than immediate physical and financial issues. B) Older adults raised in more religious times are more likely to spontaneously express their spirituality. C) Addressing clients' expressions of spirituality is beyond the scope of appropriate nursing. D) Spiritual expression can be useful in facilitating hope in older adults.

Ans: D Feedback: Spiritual expression is useful in fostering hope and is within the scope of nursing practice. Older adults are not necessarily more spontaneously spiritual nor is spirituality secondary to finances and physical health.

Two nurses are discussing the relationship between spirituality and religion. Which statement explains this relationship? A) They are the same. Both connect individuals to the Divine and to other living things. B) They are directly related. The more spiritual the individual, the greater his or her commitment to religion. C) They interact inversely. Heavy involvement in organized religion diminishes spirituality and vice versa. D) They are different. Spirituality is a sense of connection to the Divine; religion is a structure of beliefs, rituals, and rules.

Ans: D Feedback: Spirituality is the essence of our being that transcends and connects us to the Divine and other living organisms. It involves relationships and feelings. Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion.

23. A nurse is facilitating a group for family members of recently diagnosed Alzheimer's patients. Which of the nurse's following teaching points about the etiology of Alzheimer's disease is most accurate? A) "There are a number of factors that cause Alzheimer's disease, and modification or removal of many of these can cause a significant improvement in your loved one's condition." B) "Unfortunately we still do not really know anything about what exactly causes Alzheimer's." C) "Science has recently discovered the direct link between diet and the development of Alzheimer's disease." D) "Alzheimer's appears to result from a combination of genetic and environmental factors and no one theory can explain it."

Ans: D Feedback: The current understanding of the etiology of Alzheimer's disease is incomplete, but not wholly lacking. The disease appears to be a result of the interplay of genetic and environmental factors. It is not completely attributable to diet and removal of risk factors and contributors does not normally bring about an improvement or recovery.

24. A 71-year-old man is obese and has poorly controlled hypertension. The man states that while he has been a smoker since his teens, many of his peers have done likewise and still enjoy good health. Over the last 2 to 3 days, his wife has noted that he has become uncharacteristically forgetful and suspicious and he was found wandering outside his house last night. Which of the following health problems is his care team most likely to suspect? A) Creutzfeldt-Jakob disease B) Alzheimer's disease C) Wernicke encephalopathy D) Vascular dementia

Ans: D Feedback: The patient's risk factors, course, and symptoms are more characteristic of vascular dementia than Creutzfeldt-Jakob disease, Alzheimer's disease, or Wernicke encephalopathy.

17. Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? A) An 81-year-old woman's glomerular filtration rate (GFR) is low. B) A 78-year-old male's stomach pH is increased. C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy. D) A 78-year-old man has recently developed urinary incontinence.

Ans: D Feedback: While a decrease in GFR, increase in stomach pH, and slight left ventricular hypertrophy are considered normal accompaniments to aging, urinary incontinence should be considered a pathological finding that necessitates further assessment.

31. Despite the wishes of her family and the recommendations of the care team, a 70-year-old client with a diagnosis of congestive heart failure, but who is otherwise healthy, wants to have a no-code order in place. Which of the following statements by the care team most clearly prioritizes the patient's autonomy? A) "If this is what is best for everyone then we need to go ahead with the order." B) "Provided it can be demonstrated that she has a potentially poor prognosis, we should certainly consider doing this." C) "It's best that social work get involved at this point to reconcile the family's and the patient's wishes." D) "If that's what she wants, then ultimately we're obliged to respect her wishes."

Ans: D Feedback: Answer D most clearly prioritizes the patient's individual freedom, preference, and rights in this case, and these considerations would override the family's or the care team's conflicting interests.

32. The nurse is providing a seminar for a group of seniors on changing nutritional needs. What should the nurse instruct the participants about the reduced need for calories? A) "You should consume at least three servings of fruits and vegetables daily." B) "You should limit your fat intake to less than 50% of total calories consumed." C) "The consumption of a high-carbohydrate diet prevents the release of glucose." D) "As you age, your basal metabolic rate declines, contributing to weight gain even when you consume the same amount of calories as when you were younger."

Ans: D Feedback: Answer in quiz: fat intake should be below 30% of calories Basal metabolic rate declines with age, a fact that can contribute to weight gain. Carbohydrates stimulate the release of insulin while fat intake should be below 30% of calories and five servings of fruit and vegetables should be consumed daily.

8. Which of the following principles that underlie a gerontological nurse's practice is most in need of reexamination and modification? A) Nursing older adults requires a unique data and knowledge set. B) Aiming for wholeness in physical, social, spiritual, and psychological health is a realistic goal. C) The aging process is a natural and unavoidable part of human life. D) Health outcomes among older adults can be equal to those of younger populations.

Ans: D Feedback: Answers A, B, and C are all identified principles of gerontological nursing. In light of the nature and inevitability of the aging process, however, answer D is neither accurate nor realistic.

1. The nurse assesses a 77-year-old client. Which of the following signs and symptoms should the nurse associate with the development of cataracts? a. The client has eye pain that is described as "a constant dull ache." b. The client states "I often sees double, especially early in the morning." c. The client's most recent eye exam indicated increased intraocular pressure. d. The client states "my vision is becoming more and more blurry."

Ans: D Feedback: Blurry vision is associated with cataracts, while diplopia, increased intraocular pressure and pain are not.

4. The nurse caring for older patients in an acute care facility is aware of the changes in drug metabolism that can occur in older adults. Which statement explains the most important factor that affects pharmacokinetics in older patients? A) Changes in gastrointestinal (GI) motility increase the absorption time for many drugs. B) Drug distribution is unpredictable due to metabolic and body-composition factors. C) Preexisting chronic conditions complicate the distribution and metabolism of drugs. D) Decreased renal and liver function contributes to an increased half-life for many drugs.

Ans: D Feedback: Changes in renal and liver function contribute significantly to the changes in pharmacokinetics that are common in older adults. While changes in GI motility, drug distribution, and preexisting conditions may be true for many patients, these factors are inconsistent.

13. Which statement best captures the predominant societal view of sexuality in general and sexuality in older adults? A) Sexuality has recently become valued and normalized in both older and younger adults. B) There is an acknowledgment that sexual interest and activity do not necessarily decline with age. C) There is societal recognition that the overall importance of sexuality remains high across the life span. D) Stigma and prejudice around sexuality in older adults persists despite changes in the societal view of sexuality in general.

Ans: D Feedback: Inaccuracies and misconceptions around sexuality and older adults persist, despite profound changes in the societal views of the topic of sexuality in general. Sexuality is not commonly valued or recognized by society, and interest and activity are presumed to decline and even disappear in older age.

36. What dietary advice should the nurse provide to an older patient who is experiencing pain and inflammation due to rheumatoid arthritis? A) "Eating fewer calories will minimize inflammation in your joints." B) "A high protein, low-carbohydrate diet has been shown to benefit many arthritis sufferers." C) "A low-cholesterol diet and drinking lots of fluids might help with the pain you're experiencing." D) "Cutting back on your consumption of meat, fatty dairy products and oils might have a positive effect on your pain."

Ans: D Feedback: Individuals with inflammatory conditions should consider avoiding animal products, high-fat dairy products, egg yolks, beef fat, safflower, corn, sunflower, soybean, and peanut oils. The other dietary recommendations do not directly relate to the treatment of inflammatory conditions.

23. A nurse has been providing care for a 69-year-old female client who has recently had her right foot amputated as a result of a chronic diabetic foot ulcer. The nurse undertook to perform debridement of the wound despite lacking the relevant education and experience. The client experienced permanent nerve damage as a result of the nurse's misguided efforts. Which category of legal liability is most likely relevant in this case? A) Larceny B) Assault C) Invasion of privacy D) Negligence

Ans: D Feedback: Negligence involves the commission of an improper act, as exemplified by the nurse's actions. Larceny is tantamount to theft, while assault involves a deliberate threat to harm. The situation would not be categorized as an invasion of privacy.

21. An older patient with multiple health problems asks the nurse for advice about recurrent insomnia. Which statement made by the nurse is most accurate? A) "Caffeine obviously makes it hard for you to sleep, while a moderate amount of alcohol at bedtime is useful." B) "You should try over-the-counter sleep aides for several weeks before you move on to prescription options." C) "It's very normal for the quality of sleep to decrease with age, so this is usually a problem that requires accommodation rather than treatment." D) A lot of medications have the potential to interfere with sleep, so it would be useful to review your medications with your physician or a pharmacist."

Ans: D Feedback: Numerous medications are noted to be detrimental to sleep in older adults. Nonprescription sleep aides carry risks, and alcohol is not a recommended intervention. While sleep quality does decrease with age, this does not mean that measure cannot be taken to address the problem.

17. An older patient complains of overwhelming daytime fatigue, which the spouse attributes to loud snoring and erratic breathing patterns during the night. Which health problem should the nurse suspect as causing this patient's fatigue? A) Insomnia B) Central sleep apnea C) Nocturnal myoclonus D) Obstructive sleep apnea

Ans: D Feedback: Obstructive sleep apnea is characterized by periods without breathing during sleep and is most often accompanied by snoring. Central sleep apnea is not as frequently marked by snoring and neither insomnia nor nocturnal myoclonus is suggested by the patient's particular signs and symptoms.

3. Which of the following nursing actions by a gerontological nurse best exemplifies the role of "advocate"? A) Teaching licensed care staff to perform appropriate assessment of lower limb circulation. B) Providing an environment in which the restoration of a client's mobility post-stroke can be realized. C) Developing new techniques for the wound care of venous ulcers. D) Teaching an older adult how to best deal with a daughter who is attempting to gain power of attorney prematurely.

Ans: D Feedback: The gerontological nurse can function as an advocate in several ways. First and foremost, advocacy for individual clients is essential and can include aiding older adults in asserting their rights, such as the best way to deal with an individual who is attempting to gain control of his or her affairs. Answer A exemplifies the role of educator, while answer B relates to the role of healer. Answer C is indicative of innovation.

24. Even though the provisions of the Omnibus Budget Reconciliation Act (OBRA) of 1987 have greatly improved conditions in long-term-care facilities, problems still occur. Which deficiency in the Haven Nursing Home's conditions may still remain untouched by OBRA 1987? A)No licensed staff available at night B)Uncertified nursing assistants caring for patients C)Poor documentation of patients' medical conditions D)High turnover of staff

Ans: D Feedback: OBRA 1987 requires the presence of licensed staff at all times, certification of nursing assistants, and good documentation. Unfortunately, the turnover of staff is still high. As nurses become more involved in owning and operating long-term-care facilities, their perception of nursing homes and their willingness to work there may improve.

5. An operating room nurse is assisting with the positioning of a 78-year-old female patient on the operating table prior to the patient's abdominal surgery. Which of the following actions should the nurse prioritize? A) Keeping the patient cool to prevent operative hyperthermia B) Supporting the neck and head to prevent postoperative neck pain C) Placing the patient supine to maximize respiratory status D) Protecting the patient's skin integrity by padding bony prominences

Ans: D Feedback: Older adults require special measures to preserve their skin integrity during surgery. This would supersede supporting the neck and head. Answers A and C do not reflect actual realities of the surgical experience.

The death of an 86-year-old male hospital patient was overshadowed by the fact that his son and his daughter disagreed vehemently on the type and quantity of medical interventions undertaken near the end of their father's life. The daughter insisted, "Dad would want us to do everything reasonable that we could to save him" while the son countered, "He would want to go with dignity, not with tubes sticking out of him." When should the issue of terminal care and life-sustaining measures have been raised? A) When the patient received a diagnosis from his primary care provider B) When a family meeting could be organized by the care team C) When standard interventions had been exhausted D) When the patient was first admitted to the hospital

Ans: D The Patient Self-Determination Act requires that end-of-life care be discussed, and the best time for this to be undertaken is immediately following admission to the hospital or care facility.

5. ______________ of walking or other exercise __________ a week can quickly bring the heart up to the same condition as someone who has engaged in lifelong exercise. A. 60 minutes; 5 times B. 45 minutes; 4 times C. 20 minutes; 2 times D. 30 minutes; 3 times

Ans: D. 30 minutes; 3 times

19. The nurse educated the patient with newly diagnosed diabetes. Which of the learning outcomes would be appropriate? (Select all that apply.) A) To demonstrate the correct method of blood glucose testing B) To demonstrate the proper technique for administration of antidiabetic medication C) To lose 5 lb a week for the next 52 weeks D) To remain with heart rate within normal limits E) To verbalize understanding of diabetes and its management

Ans:A, B, E Feedback: Weight loss of 1 to 2 lb a week is suggested if indicated, and no direct cardiovascular effects are expected. Heart rate is not related to this learning outcome.

35. End of life is crucial to our health system, some challenges/factors to low completion rates of advanced directives are:

Answers: - low literacy rates or first language other than English - discomfort and superstition - others in notes: misconception, attitudes of healthy people

16. T or F 50 % of older adults display symptoms of depression and suicide is the 5th leading cause of death with older adults.

FALSE

True or False: Dementia is part of normal aging_____________________.

FALSE

Mr. E is dying and has a great deal of pain. His oncologist is considering adding some alternative measures, such as hypnosis and acupuncture, to the drugs he already takes. What effect may such alternative measures have? A) They may reduce the required drug dosages or potentiate their effects. B) They may be useful substitutes for the analgesics. C) They may interfere with the effects of the analgesics. D) They may be effective but detract from the nurses' time to care for Mr. E.

Ans: A Alternative measures cannot substitute for drugs but are often useful adjuncts in pain therapy. Such measures are unlikely to interfere with effects of analgesics. The truly time-consuming alternatives will probably be supplied by their practitioners rather than by nurses.

The children and wife of a man dying of renal failure are eager to interact with him as much as possible in the days before his death. Consequently, the daughter has questioned the nurse's decision to administer the man's scheduled hydromorphone, stating that he does not appear to be in pain at the present time and that the drug tends to make him drowsy. What is the nurse's most appropriate first action? A) Explain the rationale for preventative pain control to the family B) Document the family's reservations and administer the drug after they have completed their visit C) Administer an analgesic that is less likely to have a sedative effect D) Administer a partial dose of hydromorphone to the patient

Ans: A An explanation of the principle of preventative pain control may help the family be more at ease with the nurse's administration of the drug and this should constitute the nurse's initial response. If the family remains resistant after an explanation, then the nurse needs to decide about choosing one of the other options or giving the drug.

Even if they are hungry, dying patients may find it difficult to eat and keep food down. To help with this problem, which of the following is best for a hospice nurse to give such a patient? A) Small-portioned meals B) Analgesia with meals C) More nutritious meals D) Reduced fluid intake

Ans: A Appealing but small-portioned meals are more likely than larger ones to be successfully kept down. Analgesia would not necessarily promote intake. Reduced fluid intake would most likely result in constipation.

The nurse manager of a geriatric medicine unit learns that spiritual care services are underutilized by patients and their families. Which phenomenon explains this finding? A) While spiritual needs are a universal part of the human condition, many people do not acknowledge these needs. B) The high-stress environment of a hospital is incompatible with the solace and quiet necessary for addressing spiritual needs. C) Spiritual needs are less apparent during times of immediate and tangible need, such as acute illness requiring hospital treatment. D) Many older adults who have experienced a lifetime of self-sufficiency and practical resourcefulness do not have spiritual needs.

Ans: A Feedback: All humans have spiritual needs regardless of whether they realize or acknowledge them. Some of these needs become relevant in late life when the high prevalence of chronic illness and the reality of death are evident. While a hospital does provide a high-stress environment, this is not mutually exclusive with identifying and providing for patients' spiritual needs.

The nurse is preparing a list of patients who will need the annual influenza inoculation. Which older adult will most likely refuse this vaccination? A) A 71-year-old Christian Scientist B) A 68-year-old man who attends a Unitarian church C) A 68-year-old female patient who identifies herself on admission as a Jehovah's Witness D) A 78-year-old who says that she is a member of the Church of Jesus Christ of Latter Day Saints

Ans: A Feedback: Christian Science is a religion based on the use of faith for healing. Christian Scientists may decline drugs, psychotherapy, hypnotism, vaccination, and some other treatments. The other religions and beliefs do not specify that vaccinations are to be avoided.

At the conclusion of a health history the nurse conducts a spiritual assessment with the patient. Why is this assessment important? A) Strong spiritual beliefs facilitate health and healing B) A spiritual crisis can trigger a psychosomatic disease C) It is the nurse's job to facilitate communication between the patient and the clergy D) The nurse needs to be careful that therapeutic regimens do not violate a patient's religious beliefs

Ans: A Feedback: Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is of therapeutic benefit to support patients' spirituality and assist them in fulfilling spiritual needs. The nurse does not complete a spiritual assessment to avoid the onset of a psychosomatic disease or to facilitate communication between the patient and the clergy. This assessment is also not being done to ensure that therapeutic regimens will not violate the patient's religious beliefs.

A patient is observed sitting on the side of the bed crying. When approached the patient does not say anything but continues to cry and hold the nurse's hand. What should the nurse do to communicate being present with the patient? A) Sit down next to the patient B) Leave the patient alone to cry C) Encourage the patient to stop crying D) Ask the patient to use the call bell if he or she wants to talk

Ans: A Feedback: Nurses need to be available for patients to express their feelings. This means being fully present without being distracted or thinking about other activities. The best action for the nurse to take to communicate being present with the patient is to sit down next to the patient. Leaving the patient alone to cry, encouraging the patient to stop crying, or asking the patient to use the call bell if he or she wants to talk does not communicate being present with the patient.

A patient with cancer asks the nurse to pray with him but the nurse does not feel comfortable with prayer. What should the nurse do? A) Decline politely and ask a coworker to pray with the patient B) Arrange transportation so that the patient can attend prayer meetings at his church C) Pray with the patient after making sure he understands that the nurse would prefer not to D) Pray with the patient realizing that the patient's needs are more important than the nurse's beliefs

Ans: A Feedback: People of faith have long understood the value of prayer, and now growing research evidence supports the positive relationship between prayer and health and healing. One need not be an ordained clergy to hold a patient's hand and offer a prayer. Nurses who are not comfortable offering prayers themselves can ask coworkers to pray with and for their patients who so desire.

An older patient tells the nurse that he meditates to seek enlightenment. Because of this, the nurse might inquire if he wishes to have which item eliminated from his daily dietary intake? A) Beef B) Cereal C) Refined sugar D) Leavened bread

Ans: A Feedback: The belief that enlightenment is found in individual meditation is a characteristic of Buddhism. Buddhists often are vegetarians. Cereal, refined sugar, and leavened bread are not specifically identified as being omitted from the diet of a person who practices Buddhism.

9. A small long-term-care facility employs several unlicensed caregivers and one registered nurse. The nurse consequently holds the responsibility for numerous aspects of residents' care. Which of the following pressing responsibilities should the nurse prioritize and perform as soon as possible? A) Administering the Minimum Data Set (MDS) on a newly admitted patient B) Increasing the dosage of a resident's beta-blocker in light of his high blood pressure today C) Ambulating a resident who has multiple sclerosis D) Choosing the standards that the facility will adopt for the provision of care

Ans: A Feedback: Administering the MDS is a nursing responsibility, while ambulation could be delegated. Adjusting a medication dosage is beyond the nurse's purview. Standards for care are dictated by federal and state authorities.

16. An elderly woman falls in her home. Paramedics are called to help her get up and take her to a nearby hospital. What action is the paramedics' priority? A) Assess her vital signs B) Teach the woman how to fall safely C) Assess the factors that led to her fall D) Request that an X-ray be done at the hospital

Ans: A Feedback: Assessing her condition immediately is most important; she may need to have an EEG or other medical test or treatment at the hospital. If a fracture seems possible, then an X-ray should be requested. The other choices, though important for her future safety, are less important.

20. Despite the nurses' high-quality care and conscientious application of the principles of asepsis, a 78-year-old post-coronary bypass patient has developed an infection in his leg incision. Which of the following factors may have contributed to the man's infection? A) Altered antigen-antibody response B) Decreased intracellular fluid volume C) Decreased cardiac output D) An adverse drug reaction

Ans: A Feedback: Changes in the antigen-antibody response make older adults more susceptible to infection. Hydration, cardiac output, and adverse drug reactions may have other unwanted effects but are less likely to contribute to infection.

7. In the wake of an inspection and audit that revealed serious lapses in care, the recently hired nurse manager of a long-term-care facility has been commissioned with bringing the facility in accordance with standards. Which of the following sources should the nurse use to determine the scope of improvements? A) Federally mandated standards and state standards if the state specifies its own higher standards B) Standards determined by the Joint Commission C) Standards identified by the federal government D) State standards and standards dictated by the American Nurses Association

Ans: A Feedback: Federal standards exist for nursing homes that may be added to by states at their choosing. Standards provided by the Joint Commission are optional. The ANA is not considered a primary source of specific standards.

2. The family of an 84-year-old female resident of a long-term-care facility is profoundly dissatisfied with the environment and the quality of care that the woman is receiving. Which of the following aspects of the facility can be considered a throwback to the pre-20th century history of long-term care? A) The facility has copious rules and rigidly enforced schedules. B) The facility emphasizes psychiatric care over physical care. C) Volunteers provide the majority of direct patient care. D) The facility is entirely dependent on government money for its operation.

Ans: A Feedback: Pre-20th century long-term-care facilities often had abundant rules and rigid routines. Psychiatric care was not prioritized and while care was often provided by charities, volunteers did not account for the majority of direct care. Government funding was not the primary source of income.

6. Three gerontological nurses have announced their intention to open a long-term-care facility in their community, something that a colleague has disparaged as "making money from older adults' frailty." How can the nurses best respond to their colleague's criticism? A) "It can actually be in the best interests of residents for experts in care, like nurses, to be in charge of directing care." B) "One of the freedoms we enjoy in a free-market system is the opportunity to make a profit from a variety of enterprises." C) "If nurses don't control long-term care then it will be controlled by corporate interests that lack any form of conscience." D) "Actually, nursing homes run by nurses can qualify for increased federal and state funding, a situation that ultimately benefits residents."

Ans: A Feedback: Quality care can be ensured when nurses are in a position to direct the character and quality of long-term care. While answer B is true, it does not provide a sound justification for the nurses' enterprise. It is inaccurate to categorically state that a long-term-care facility that is not run by nurses will necessarily be substandard. Qualification for funding is not contingent on ownership by nurses.

6. A nurse is conducting a preoperative assessment of a 76-year-old patient who will be having a transurethral prostatic resection later that day. The patient's wife is concerned about maintaining the patient's medication regimen, stating, "He takes a lot of pills and it's important that he gets them while he's in the hospital." How can the nurse best respond to the wife's concern? A) "The care team will look at his medications and only hold those that can safely be stopped." B) "You're right that it's important, and they'll be continued throughout his stay in the hospital." C) "His medications will have to stop while he's being held without food, but we will restart them as soon as possible." D) "In light of his surgery, your husband probably will not need any of the medications that he used to require."

Ans: A Feedback: Some medications need to be continued in spite of a patient's NPO status; these should be identified by the team and continued. Other medications can be temporarily held without significant risk to the patient. It would be inaccurate to assure the wife that all the husband's medications will continue, that they will be unnecessary, or that they will all be held.

11. As life expectancy and demographics in the United States have changed, the number of residents in long-term-care facilities has increased. In a typical group of older men and women, what is the likelihood of their needing long-term care at some time? A) Nearly 50% for women and 33% for men B) Nearly 33% for women and 50% for men C) Nearly 67% for women and 50% for men D) Nearly 50% for women and 67% for men

Ans: A Feedback: These percentages for people needing long-term care at some time have been calculated from the demographics data showing that the rate is nearly half of all women and one-third of all men.

An older male patient with end-stage renal disease is sad and believes that he will die within a few days. Which interventions should the nurse use to promote hope in the patient? (Select all that apply.) A) Using humor at the bedside B) Facilitating a life review for the client C) Helping the client to find pleasure during current life activities D) Encouraging the client to focus on a time of life that was more pleasant E) Introducing the client to an individual who has a much poorer prognosis and/or health status

Ans: A, B, C Feedback: The tactful use of humor, facilitation of life review, and aiding clients in finding pleasure in activities are noted to instill hope. Encouraging comparison to someone with a worse situation and encouraging focus on a different time of life are not noted to foster the development of hope.

13. What factors are most likely to contribute to the problem of hypothermia that older adults may face intraoperatively and postoperatively? (Select all that apply.) A) The normal body temperature of older adults that is often lower B) The cool temperature of the operating rooms C) The use of medications that slow metabolism D) Fever from infection

Ans: A, B, C Feedback: Factors that contribute to the problem of hypothermia include the lower normal body temperatures of many older persons, the cool temperature of operating rooms, and the use of medications that slow metabolism. Fever does not cause hypothermia.

26. Which of the following are reasons that hospitalized older adults require early and competent discharge planning? (Select all that apply.) A) To prevent complications B) To reduce the risk of rehospitalization C) To minimize stress to themselves and their caregivers D) So that they can leave the hospital in a sicker, more debilitated state

Ans: A, B, C Feedback: Hospitalized older adults require early and competent discharge planning to prevent complications, reduce the risk of rehospitalization, and minimize stress to themselves and their caregivers. It is not a goal of early and competent discharge planning to cause patients to leave the hospital sicker and in a more debilitated state that is a consequence of payers wishing to avoid paying for extended hospital stays.

27. The family of a 90-year-old female hospital patient is worried about her chances of making a full recovery from her recent fall once she returns home. Which of the following factors are likely to have a positive effect on the woman's post-discharge health outcomes? (Select all that apply.) A) The presence of a reliable and an adequate social support network. B) The patient's understanding of her health and her prognosis. C) The presence or absence of other health problems. D) The self-care habits that the woman had prior to her fall. E) Beginning the discharge planning at the time that the woman is being discharged.

Ans: A, B, C, D Feedback: The factors that would have a positive effect on the woman's post-discharge health outcomes include the presence of a reliable and an adequate social support network; the patient's understanding of her health and prognosis; the presence or absence of other health problems; and the self-care habits that the woman had prior to her fall. Beginning the discharge planning at the time that the woman is being discharged is likely to have a negative effect on the woman's post-discharge health outcomes—it should be started upon admission to the hospital.

18. Which of the following are goals that a nurse may have in the case of a myocardial infarction in an elderly person? (Select all that apply.) A) To aid in prompt diagnosis B) To reduce cardiovascular stress C) To minimize or eliminate causative factors D) To prevent and promptly identify complications

Ans: A, B, D Feedback: The goals that a nurse may have in the case of a myocardial infarction in an elderly person include the following: to aid in prompt diagnosis, to reduce cardiovascular stress, and to prevent and promptly identify complications. It would not be appropriate to minimize causative factors as the causative factors for myocardial infarction have already occurred.

The nurse is planning care to address a patient's spiritual distress. Which interventions would be appropriate to include in this plan of care? (Select all that apply.) A) Pray with the patient upon request as needed and desired B) Find a volunteer to read the Bible to the patient upon request C) Remind the patient that spiritual needs are often addressed last D) Contact the patient's church to have the clergy visit the patient E) Help the patient identify factors contributing to spiritual distress

Ans: A, B, D, E Feedback: Interventions to address spiritual distress include praying with the patient upon request and as desired, finding someone to read the Bible to the patient upon request, contacting the patient's church for clergy to visit, and helping the patient identify factors that contribute to spiritual distress. Reminding the patient that spiritual needs are often addressed last will not help with the patient's spiritual needs at this time and would be inappropriate to include in the plan of care.

During an assessment an older male patient states that he has not been happy in life because he does not deserve to be loved. The nurse realizes that this patient believes love has been withheld because of which criteria? (Select all that apply.) A) Productivity B) Social position C) Education level D) Physical condition E) Material possessions

Ans: A, B, D, E Feedback: Spiritual love is unconditional and people need to feel loved regardless of their physical condition, social position, material possessions, or productivity. Educational level is not identified as a condition for being loved.

The nurse determines that a patient is experiencing spiritual distress. What did the nurse assess in this patient? (Select all that apply.) A) Anger B) Smiling C) Complaining D) Poor appetite E) Refusing to make plans

Ans: A, C, D, E Feedback: Signs of spiritual distress include anger, complaining, poor appetite, and refusing to make plans. Smiling would not be a sign of spiritual distress.

19. For which of the following reasons are emergencies in older persons particularly problematic? (Select all that apply.) A) They occur frequently because of the age-related changes that lower resistance and make the body more susceptible to injury and illness. B) They are not as urgent as it is expected that elderly people will die. C) They often present an atypical picture that complicates diagnosis. D) They can be more difficult to treat or stabilize because of older persons' altered response to treatment. E) They carry a greater risk of causing serious complications and death.

Ans: A, C, D, E Feedback: Emergencies in elderly persons are particularly problematic for the following reasons: they occur frequently, they often present an atypical picture, they can be more difficult to treat or stabilize, and they carry a greater risk of causing serious complications and death.

The hospital's nursing staff has become very attached to Rev. M. When he dies, the nurse on duty hugs the son and daughter and cries with them. Which of the following is the best description of the nurse's behavior? A) It is appropriate in any similar situation. B) It is appropriate in this situation. C) It is unprofessional. D) It is inappropriately emotional.

Ans: B A family might not welcome this behavior in some instances, but the nurse has a genuine fondness for Rev. M, and that may help the son and daughter in their own grief. Although nurses must behave with objectivity in making decisions about patient care, warmth and caring are also important aspects of their work.

When a patient is admitted to a hospital, he or she is asked if an advance directive is available in case terminal care is necessary. What does an advance directive do? A) It gives the patient's family control over terminal care. B) It gives the patient control over terminal care. C) It gives the hospital control over terminal care. D) It gives the attending physician control over terminal care.

Ans: B By signing an advance directive, a patient can ensure receiving the terminal care he or she wishes, rather than burdening family members with making those decisions. Without an advance directive, a patient may be resuscitated even if there is no hope of meaningful life returning.

During an interview process as a staff nurse for a geriatric patient care area, the nurse is asked about her philosophy of spirituality. Why is this important when caring for older patients? A) Spirituality becomes more unconditional as people age B) Spirituality often becomes more important to people as they age C) An individual's spirituality remains stable from youth through old age D) As people age, their spirituality becomes more quantitative than qualitative

Ans: B Feedback: All humans have spiritual needs, regardless of whether they realize or acknowledge them. Some of these needs become particularly relevant in late life when the high prevalence of chronic illness and reality of death are evident. Spirituality does not become more unconditional as people age. Spirituality may change throughout the life. There is no evidence to support that spirituality becomes more quantitative than qualitative as people age.

A patient is demonstrating signs of spiritual distress but refuses to be visited by clergy or to participate in religious services. What should the nurse do to help the patient? A) Arrange for a volunteer to read inspirational essays to the patient B) Do not challenge the patient's decision or attempt to change his mind C) Pray that the patient will come to recognize his need for spiritual support D) Talk with the hospital chaplain about looking in on the patient without talking about religion

Ans: B Feedback: Although a nurse should assist patients in their spiritual growth, the nurse's first commitment is to respect patients' wishes. A nurse should not challenge a patient's religious beliefs or attempt to change them. The nurse should not have inspirational essays read to the patient or talk with the hospital chaplain. The nurse may or may not want to pray about the patient's needs for spiritual support.

An older patient just learning of having a terminal illness begins to cry. Which statement or question should the nurse make to facilitate the patient's spiritual health? A) "Remember that everything in life, even the bad things, happens for a reason." B) "Is there anything in your spiritual beliefs or practices that might bring you comfort at this time?" C) "It's not appropriate for me to pray with you, but would you like me to arrange a visit from the chaplain?" D) "It's likely best for you to try to focus on what is going right in your life, even though that's likely hard right now."

Ans: B Feedback: Asking the patient how spiritual needs can be supported is a recognized component of spiritual assessment and acknowledges the patient's spiritual needs while still letting the patient direct the process. Making off-hand statements such as things happening for a reason and encouraging the patient to focus on the good things in life would be inappropriate at this time. It is not inappropriate for a nurse to pray with a patient when circumstances allow.

A patient tells the nurse that she has practiced meditation for years since it has helped her with mental clarity. Which type of meditation should the nurse document that the patient practices? A) Mindfulness B) Concentrative C) Transcendental D) Trans-mutational

Ans: B Feedback: Concentrative meditation calms the person and promotes mental clarity and acuity. Mindfulness meditation promotes a calm nonreactive mental state. Transcendental meditation relaxes the body while keeping the mind alert. Trans-mutational is not a type of meditation.

An older female patient tells the nurse that through periods of trial and tribulation, the Bible has been the source of ongoing strength and support. Which statement supports this patient's beliefs by researched evidence? A) Patients from low socioeconomic levels tend to be more religious. B) Religious commitment has a positive effect on health care outcomes. C) Patients holding strong religious convictions experience great emotional stress during illness. D) Among the elderly, high levels of religiosity correlate with greater levels of physical disability.

Ans: B Feedback: Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is therapeutically beneficial to support patients' spirituality and assist them in fulfilling spiritual needs. The other statements are not supported by researched evidence.

For patients from which of the religious groups would an opportunity to fast in the weeks before Easter be most important? A) Jewish B) Eastern Orthodox C) Seventh-Day Adventist D) Episcopalian (Anglican)

Ans: B Feedback: Fasting during Lent is practiced by members of the Roman Catholic and Eastern Orthodox churches. Fasting is not typically done prior to Easter by those of the Jewish, Seventh-Day Adventist, or Anglican Episcopalian faiths.

Which statement should the nurse use to plan interventions to address the behavior of an older patient sitting quietly alone in a room? A) Spending a lot of time alone is a sign that an elder is lonely or grieving. B) Uninterrupted periods of solitude and inactivity are therapeutic for the elderly. C) Solitude should be discouraged among elders because it leads to social isolation. D) Occupational therapy should be arranged for an elder often observed doing nothing.

Ans: B Feedback: Periods of solitude are therapeutic to the elderly. Unresolved feelings from earlier years may be contemplated and resolved, resulting in personal satisfaction. In reminiscing, evaluating, and understanding the dynamics of life's earlier events and achievements, older persons can find a satisfaction with the quality of their lives that helps compensate for their multiple losses. Spending time alone is not a sign that the patient is lonely or grieving. Solitude does not lead to social isolation. Activities should not be planned for an older patient who is doing nothing.

An older male patient admits to doing many things in life that he is not proud of and is having a difficult time getting them out of his mind. How should the nurse respond to the patient's statement? A) "Remember that no one has lived a perfect life." B) "Is there anyone that you might want to ask forgiveness from?" C) "Is there anything I can do to help you focus on more positive things?" D) "Do you think that you were really any worse than most other people?"

Ans: B Feedback: Seeking forgiveness can be a powerful tool in attaining spiritual health. Urging comparison to others is inappropriate and attempting to change the patient's focus to more positive subjects is not an appropriate intervention.

An older female patient tells the nurse that even though she believes in a higher power she is not interested in information on the hospital's chaplaincy services since she has never been religious. What does the nurse recognize as the relationship between religion and spirituality? A) Some people are religious, while others are spiritual. B) Religion is a particular, structured way of expressing spirituality. C) Religion is the essence of our being that connects us with the Divine. D) All human beings have an innate desire for religious structure and spiritual fulfillment.

Ans: B Feedback: Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion. Not everyone identifies a need for religion, and religion and spirituality are not mutually exclusive. Spirituality, not religion, is defined as the essence of our being that connects us with the divine.

An older female patient in the resident care facility insists that her hair be kept covered at all times. Of which branch of the Jewish faith is she most likely a member? A) Reform B) Orthodox C) Rabbinical D) Conservative

Ans: B Feedback: The covering of the hair of married women is a practice of Orthodox (observant) Judaism. Those who practice Conservative Judaism cover the head during worship and prayer. Those who practice Reform Judaism do not follow laws for covering the head. There is no branch of Rabbinical Judaism.

8. An obese elderly patient is scheduled for surgery. The following diagnostic tests were performed: a chest X-ray, an ECG, a complete analysis of blood samples, a nutritional assessment, and a mental assessment. What test is missing? A) Cardiac enzymes test B) Pulmonary function test C) Transferrin test D) Hemoglobin test

Ans: B Feedback: A pulmonary function test is needed if a patient is obese or a smoker. The other choices are all blood tests that were done as part of the complete analysis of blood samples.

17. Mr. S, a 92-year-old patient in a geriatric medicine unit, has become acutely confused. The development is of great concern to the care team since Mr. S has no history of cognitive deficits. What action should the nurse prioritize? A) Contacting Mr. S's family B) Assessing Mr. S's vital signs and obtaining blood samples C) Moving Mr. S to a bed that is visible from the nursing station D) Supervising Mr. S during transfers

Ans: B Feedback: Assessing vital signs and obtaining blood samples would be prioritized over the other noted interventions. Despite their validity, they are not as time dependent.

3. The colleague of a nurse who provides care in a long-term-care facility consistently refers to their workplace as a "nursing home." Which of the following historical facts may underlie the colleague's choice of words? A) Early care facilities did not provide care for the long term, but rather provided temporary respite by nurses. B) Residential care providers early in the 20th century began to call themselves nurses. C) Government funding for care facilities was tied to their designation as a home staffed by credentialed nurses. D) Long-term-care facilities were differentiated from hospitals by the absence of physician-led care.

Ans: B Feedback: Early in the 20th century, small facilities began to develop, offering room, board, and some personal care. Some of these facilities were operated by nurses or persons who called themselves nurses; thus the term "nursing home" became popularized. They were not necessarily short-term facilities and neither government funding requirements nor the absence of any care by physicians led to the designation.

12. An elderly woman had cardiac surgery that was completed quickly and seemed successful, but she developed an infection and was given cephalosporins and ampicillin. After that, she developed paralytic ileus with a low-grade fever. A chest X-ray appeared normal. Next, her kidneys failed. How might the kidney failure have been prevented in this patient? A) She should have been on a low-protein diet. B) She should have been given different antibiotics. C) Her ileus should have been treated. D) The surgery should have taken longer.

Ans: B Feedback: Kidney failure may occur after certain antibiotics, including cephalosporins and ampicillin, are taken. There is no reason to think the other choices would have helped prevent kidney failure.

21. Haven Care Center tries to provide meals that take residents' medical conditions into account. Some residents have diabetes. How can the dietitian help them? A) Provide lessons in eating correctly for diabetes control B) Have some no-sugar treats available occasionally C) Provide meals for everyone that are safe for diabetic residents D) Tell the diabetics which foods on the menu they should avoid

Ans: B Feedback: Providing diabetes-safe meals for everyone would be unfair to other residents, who may enjoy their desserts and between-meal snacks. Anyone who has had diabetes diagnosed probably knows the dietary restrictions all too well and does not need further instruction. Diabetes can be a depressing disease for many reasons, one of which is the continual need to avoid some foods. Although patients are now allowed small amounts of sugar, they should still be careful; an occasional no-sugar muffin, slice of pie or cake, or other treat can be a great source of satisfaction to them.

25. An 81-year-old female patient has just been admitted to the hospital following a stroke. The patient's daughter is upset that nurses are trying to carry out discharge planning early in the admission, characterizing their efforts as evidence that they "just want to get her out the door as soon as possible." How can a nurse best respond to the daughter's concern? A) "Actually, it's been found that patients who leave the hospital as soon as possible recover better and more quickly than those who stay hospitalized longer." B) "Our goal is not to rush your mother's discharge but rather to have as many supports in place as possible when it does come time for her to go home." C) "Unfortunately, one of the realities of hospital care today is that patients do get discharged earlier than they did in years past." D) "Discharge can often happen with little notice, so we are trying to get as much organized early in her admission as we can."

Ans: B Feedback: The goal of early discharge planning is to establish as many aspects of care as possible, maximizing the patient's chances of a healthy recovery. Answers C and D are often true, but these statements are unlikely to be of benefit to the patient's family, nor do they provide the best justification for early discharge planning. Answer A is not necessarily true.

5. Which of the following factors provided the most significant impetus for the improvement in the quality of nursing homes that occurred in the 1980s? A)Nursing research demonstrating the harmful effects of substandard care B) The risks of losing federal funding faced by deficient nursing homes C) Public relations efforts by families of long-term-care residents and nursing organizations D)Unflattering media reports of long-term-care practices

Ans: B Feedback: Under the Omnibus Budget Reconciliation Act of 1987, sub-par nursing homes faced losing their federal Medicare and Medicaid reimbursement. This prospect, more than any of the other cited factors, brought about increased standards and enforcement.

2. Which of the following nursing practices commonly performed in the geriatric medical unit of a hospital is most in need of modification or correction? A) Patients are regularly prompted to practice deep-breathing and coughing exercises in order to mobilize secretions and prevent atelectasis. B) Patients at risk for urinary incontinence are catheterized in order to reduce the risk of urinary tract infections. C) Reality orientation is provided to patients who exhibit cognitive deficits. D) The discharge planning process is begun immediately following admission.

Ans: B Feedback: Urinary catheterization should be minimized and is not an appropriate intervention for the prevention of urinary incontinence. Promotion of deep breathing and coughing, reality orientation, and early discharge planning can help minimize the risks faced by older adults who are hospitalized.

22. Albert, Bob, Charlie, and David wandered into a health food store when they were mall-walking one morning. They decided to try various remedies that might boost their resistance to infection. According to claims made about the following remedies, which man is most likely to increase his immunity? A) Albert, who substituted soy for dairy foods. B) Bob, who began taking vitamins C and A everyday. C) Charlie, who began eating large quantities of onions. D) David, who increased his intake of sugar and began taking Siberian ginseng.

Ans: B Feedback: Vitamin C and A supplements have been recommended for promoting the prevention and management of infections. Soy is a useful substitute when a person is lactose-intolerant, but it has not been claimed to boost immunity. Consumption of onions has not proved to be helpful in promoting immunity. Although taking Siberian ginseng may help increase immunity, including more refined sugar in the diet does not.

A nurse is worried about his health because he believes he carries a gene for a fatal disease. What does he need to do for the sake of his own mental health and for that of his seriously ill patients? A) Work with patients who are likely to recover B) Come to grips with his own mortality C) Work in the maternity ward D) Adopt a cheerful demeanor with all patients

Ans: B Many nurses like the cheerful atmosphere of a maternity ward or other hospital section where patients usually get better and go home. Working in such a section might help him temporarily, but not for long. Also, a nurse may put on a cheerful mask that helps himself and others for a short time, but eventually he needs to confront his own mortality. If he tries to deal with dying patients and their families before doing so, he may deny them the comfort and understanding they need during a crucial time.

Miss L is dying. She is pale and irritable, and the hospice nurse thinks she may be in pain. What should the nurse do? A) Assume that Miss L must be in pain B) Ask Miss L if she is feeling pain C) Provide Miss L pain relief without asking D) Consult Miss L's chart for her previous presentation of pain

Ans: B Patients react in very different ways to pain and express themselves differently. The nurse should assume nothing, but ask Miss L about pain and have her rate it on a scale of 0 to 10. This self-appraisal should be recorded with other information.

At the beginning of her shift, a nurse has entered the room of a 78-year-old male patient who is in the late stages of liver failure. The patient's son, who has interacted with the nurse appropriately in the past, states, "If you all wouldn't have botched his treatment when he first had this problem, he wouldn't be lying here dying." The nurse understands that which of the following phenomena may underlie the son's statement? A) The son is exhibiting the effects of depression common in those experiencing a loss. B) A common manifestation of anger about the death of a loved one is to direct it elsewhere. C) The son is reacting inappropriately to his imminent loss. D) Survivors of a dying individual often attempt to bargain for their return to health.

Ans: B The son is likely exhibiting the effects of the anger stage of the dying process. This is less likely to be an expression of bargaining or depression. It would be simplistic to characterize his statement as inappropriate.

24. Which of the following measures would be particularly important for preventing infections of elderly persons who are being cared for in a health-care institution? (Select all that apply.) A) Ensuring that the older adult has had all childhood immunizations. B) Ensuring that pneumococcal and influenza immunizations have been administered (unless contraindicated). C) Adhering to infection-control practices. D) Restricting contact with persons who have infections or suspected infections.

Ans: B, C, D Feedback: Measures that assist in preventing infections in older adults who are being cared for in a health-care institution include the following: ensuring that pneumococcal and influenza immunizations have been administered (unless contraindicated); adhering to infection-control practices; and restricting contact with persons who have infections or suspected infections. It is not important to ensure that the older adult has had all childhood immunizations.

The nursing staff on a palliative care unit are helping an unlicensed care provider, who has had little prior exposure to death, adjust to the unique demands of working in such an environment. Which of the following actions are likely to benefit the care provider? Select all that apply. A) The nurses encourage the care provider to find a confidante outside the hospital in order to avoid showing emotion openly while on duty B) The nurses encourage stepping back from intense situations and examining whether strong reactions are impacting the therapeutic relationship. C) The nurses teach the care provider how to be therapeutic while still maintaining an emotionally detached relationship from patients and families. D) The nurses try to help the care provider verbalize emotions and reactions to death. E) The nurses provide a location on the unit where all staff members can retreat during intense encounters.

Ans: B, D, E Reflection, verbalization, and the opportunity for retreat can be beneficial to persons who provide care for the dying and their families. Requiring emotions to be stifled while at work and striving for emotional detachment are not appropriate goals.

The 45-year-old son of a dying woman is profoundly uncomfortable with discussions of her expected time of death, funeral preparations, and the signs and symptoms that may signal that death is imminent. Which of the following historical phenomena may have contributed to the son's reluctance to acknowledge the reality of death? A) In the past, death was viewed positively as a welcome transition, while it is now often seen as an undesirable evil. B) The declining death rate means that individuals live longer and survive to experience more unsettling symptoms and discomfort than in past generations. C) Many people now die in institutional settings, limiting the amount of previous exposure to death that many individuals have. D) Modern medical technology and increasing vigilance of treatment has brought about a mistrust of the natural dying process.

Ans: C Because many people now die in hospitals and care facilities rather than homes, many individuals have minimal exposure to the reality of death, exacerbating their fear and discomfort about the process. Death was not necessarily viewed positively in the past and pain and discomfort have always been realities. Fear of the dying process is not necessarily a result of advances in medical technology.

After an elderly hospital patient had a heart attack, his cardiac and pulmonary functions ceased. How is that criterion of death documented? A) Brain death B) Molecular death C) Somatic death D) Cardiopulmonary death

Ans: C Brain death refers to the death of brain cells, as indicated by a flat EEG; molecular death refers to the cessation of cellular function. Somatic death refers to the body and is indicated by cessation of cardiac and pulmonary functions. Cardiopulmonary death sounds correct but is not a technical term.

The spouse of a patient with dementia remains upbeat and is appreciative of having good health and a loving family. The nurse realizes that the spouse is demonstrating which component of spirituality? A) Hope B) Fatalism C) Gratitude D) Transcendence

Ans: C Feedback: Gratitude is characterized by a sense of thankfulness and positivity, as exemplified by the woman's focus on what she has rather that what she lacks. Transcendence involves an awareness of a reality beyond oneself and hope is an expectation that looks to the future. Fatalism is a resignation to the inevitability of life events.

An older female patient, experiencing cancer pain and nausea and vomiting from chemotherapy, asks the nurse to pray for her during this difficult time. How should the nurse respond to the patient's request? A) Facilitate a visit from a chaplain to the client at the bedside. B) First determine whether the client shares a similar religious tradition as the nurse. C) Pray for the client, asking a higher power to intervene and provide peace and relief. D) Explain that praying is beyond the nurse's scope of practice and explore alternative interventions.

Ans: C Feedback: Nurses are justified in praying for clients and can simply ask a higher power to intervene. An identical religious tradition is not a prerequisite and praying need not be delegated to a chaplain. Praying is not beyond the nurse's scope of practice.

7. Upon further questioning, an elderly man who expressed apprehension about his upcoming coronary artery bypass surgery admitted that he had a friend who had coronary artery bypass surgery a few years ago and had many complications postoperatively. Which of the responses by a nurse would be the best? A) "You will feel better immediately." B) "This surgery is always successful at our hospital." C) "Bypass surgery has improved over the past 20 years." D) "You can recover as easily as a young person can."

Ans: C Feedback: Although this surgery has become almost routine in large hospitals, it still poses some dangers. The chances of recovery are good, but they are not as good for elderly persons as for younger ones.

1. Which of the following statements most accurately captures an aspect of long-term care in the United States? A) The acuity of long-term-care facilities is decreasing as the acuity of older hospital patients increases. B) Both the number of long-term-care facilities and the number of residents they house are rapidly increasing. C) Most older adults of the current generation will require some form of long-term care at some point in their lives. D) Interventions that were formerly available in long-term-care facilities are now often restricted to hospital settings.

Ans: C Feedback: Among the current generation of people entering their senior years, 69% will need some type of institutional or community long-term care, and about half of all older women and one-third of all older men will spend some time in a long-term-care facility during their lives. Acuity in such facilities and the number of residents they serve are increasing, while the total number of facilities has recently declined since more rigorous standards were enacted. Interventions that used to be limited to an acute-care context are often available in long-term-care facilities.

4. Nurse R is providing care for a 71-year-old woman who has been admitted to the surgical unit following her post-anesthetic recovery from a bilateral mastectomy. The patient has been physically stable but disoriented to place and time since admission, but the nurse knows that a history of dementia is noted in the patient's chart. The patient's daughter is distraught, however, because "mom was always just a bit forgetful, but nothing at all like this." What would be the most appropriate response by the nurse? A) "If your mother already has dementia, her confusion is to be expected." B) "It is nothing for you to worry about, most elderly persons are forgetful." C) "Delirium can also cause an alteration in mental status and can be caused from a new environment, altered level of consciousness, excess stimuli, adverse drug reactions, and physiologic disturbance, all which your mother has likely experienced as a result of her hospitalization and surgery." D) "Are you blaming us for your mother's confusion?"

Ans: C Feedback: Answer C is the best response because it informs the patient's daughter about what may be occurring with her mother. The daughter has stated that the mother is usually a bit forgetful but not like she is now. This means that the daughter has noticed a difference, which may be attributable to delirium instead of the dementia that the patient already has. Not all elderly persons are forgetful and this does not address the patient's daughter's concern. Answer D is defensive and the patient's daughter has not made any accusations.

3. Elderly hospital patients need special care in some respects. What is one thing a nurse can do to ensure that they leave the hospital in good condition and can return to a normal life? A) Keep the patients in bed as much as possible to help them rest. B) Keep the room temperature between 65°F and 70°F. C) Wash hands between patients and use other infection control practices. D) Use a urinary catheter on a patient who has stress incontinence.

Ans: C Feedback: As soon as patients are able to get out of bed, they should do so. This will help restore normal physiological functioning and make it easier for them to resume their usual activities at home. Most elderly patients are more comfortable when the temperature is 75°F than when it is 70°F. Urinary catheters should be avoided unless absolutely necessary. Many patients acquire infections in the hospital, and it is sometimes a result of staff carelessness about hand washing or other sources of contagion.

9. What is one way of improving the chances for successful anesthesia of an elderly patient? A) Long, careful surgery B) Frequent turning of tissue during surgery C) Particularly close monitoring during surgery D) Use of inhaled agents during surgery

Ans: C Feedback: For an elderly patient, surgery should not be prolonged, and the tissue should not be handled more than necessary. Inhaled agents are eliminated slowly and may prolong anesthesia. Close monitoring during surgery can catch any problems as they develop.

17. Mrs. W is a nursing home resident who is bitter about her family's placing her there, and she feels that they do not love her. If her family is typical, why did they place her there? A)They cannot afford to keep her at home. B)They need more freedom. C)A crisis made it necessary. D)The family home is too small.

Ans: C Feedback: Most families try to avoid placing a parent in long-term care as long as possible. Unless they are without any resources and can qualify for Medicaid, it will cost them more to have Mrs. W in a nursing home than to keep her at home. Even though freedom and space are important to any family, most families make sacrifices for a parent's sake until some medical or emotional crisis precipitates admission to a nursing home. It is important for nurses to realize how painful the decision is for the family, as well as for the patient, and to be supportive of all the family members.

16.How did geriatric nurses respond to the poor conditions in early nursing homes? A)They defined nursing facility care. B)They lobbied for improvements. C)They failed to help conditions. D)They provided a clear model of long-term care.

Ans: C Feedback: Nurses either worked in poor conditions without making an effective effort to change them or left to work elsewhere. Eventually, public outcry about conditions led to legislation that improved care and eventually brought about today's emerging model of what nursing facility care should be like. Being more aggressive about their own working conditions or being entrepreneurial about operating homes themselves would have enabled nurses to participate in the reform.

14. In the early 1980s, Haven Nursing Home was established and began operation. Under the Omnibus Budget Reconciliation Act (OBRA) of 1987, the nursing home lost its license. What was the home doing that could have caused the revocation? A) Using the MDS tool B) Employing a large staff C) Using restraints and psychotropic drugs D) Training of nursing assistants on-the-job

Ans: C Feedback: OBRA 1987 required a reduction in restraints and psychotropic drugs, training for nursing assistants, and an increase in staffing. The MDS tool is for assessment.

14. Nurse R has just entered the hospital room of an 84-year-old female patient after hearing a crash and has found the patient lying on the floor of the room beside her overturned commode. How should the nurse best respond to this situation? A) Initiate a code. B) Assist the patient to a sitting position for an assessment. C) Leave the patient on the floor until her status is determined. D) Position a sling for a mechanical lift under the patient.

Ans: C Feedback: Patients who have fallen should be left in place until their health status can be determined. A fall in and of itself does not constitute a need for a code, though the patient's cardiac or respiratory status may require it.

20. Oakside Care Center appears very attractive to visiting families. Nutritious and appealing meals are served in an attractive dining room with a view of the lake. Plenty of caregivers are in evidence, some of them dispensing medicines from a large cart, others changing bed linens, still others talking and joking with residents. In the large lobby, a group of neat, clean residents is sitting in front of a large television set after lunch. There are no unpleasant odors in hallways or patients' rooms. A special van is at the curb, waiting to take residents to medical appointments at a nearby medical center. Which of the following is the most likely reason that some residents are unhappy here? A)They need more attention from the staff. B)They need better surroundings. C)They need to be more active. D)They need better medical care.

Ans: C Feedback: The facility can seem very attractive and well run to visitors, yet not meet the needs of residents. Instead of passively watching television after lunch, residents could be doing something to make them physically or mentally active. These residents seem to have enough help from the staff, attractive surroundings, and good medical care, but they are probably bored and unchallenged.

Mrs. W, a 70-year-old woman with cancer, has been told she could die at any time. Her illness is more serious than it appears, and her daughter is not sure what to tell the grandchildren, who are aged 10 and 12. Which of the following is the best thing a nurse might tell the grandchildren? A) Tell them that Mrs. W is going to die. B) Tell them nothing until Mrs. W worsens. C) Tell them that Mrs. W is ill and that the nurses are concerned. D) Tell them that Mrs. W is ill but will recover.

Ans: C Lying to children about illness and death is unfair and deprives them of a chance to have some close moments with a dying grandparent. On the other hand, knowing that death is imminent may create a barrier to their normal relationship. If the daughter says nothing to the grandchildren until Mrs. W gets worse, Mrs. W may die so suddenly that there is no chance to prepare the grandchildren for her death. There is no easy answer to this dilemma, but choice C seems to be best.

Mrs. H, aged 80, experienced a severe hemorrhagic stroke 7 days ago, and is not expected to survive the night. Mrs. H's family is gathered at her bedside with a member of her church's clergy. Her son has taken the nurse aside and asked how the family will be able to tell that their mother is about to die. How can the nurse best respond? A) "People usually experience a gradual slowing of their heart rate in the hours before death." B) "A lack of sweating, even though they have a fever, often means that someone is coming to the end." C) "Often as death approaches, the individual's eyes stop responding to light or else respond very slowly." D) "When a person's veins become prominent from the sudden increase in blood pressure, it means the heart is making its final efforts."

Ans: C Slow or absent pupil response is a sign of imminent death, as are diaphoresis, a rapid, thready pulse, and low blood pressure.

Which of the following is the most important nursing action to take during a patient's denial stage of dying? A) Act as a shock absorber for the patient's emotions while the patient confronts reality B) Allow the patient to express the feeling that nothing is right C) Accept the dying patient's reactions and provide an open door for honest dialogue D) Impress upon the patient and his or her family that the inevitable cannot be postponed

Ans: C The nurse must be sensitive to the patient's need for defenses while also being ready to participate in discussion on death when the patient needs to do so. Choice A is a description of the function of denial. Choice B is a nursing action for the anger stage. Choice D is related to the bargaining stage.

Rev. M, a minister in his early 70s, has pancreatic cancer and is expected to die soon. His son and daughter both visit him often. The son causes trouble for the staff by continually criticizing them for no apparent reason. He also asks repeatedly why his father, a good and loving minister, should have to die at a relatively young age. The daughter talks and prays with their father and brings him his favorite books for comfort. Although she is obviously distressed, she is already making tentative plans to move out of the family house and into an apartment. These preparations seem callous to her brother, who becomes further angered. Which stages of grief are the two exhibiting? A) The son has reached the stage of acceptance; the daughter is in the stage of anger. B) The son has reached the stage of bargaining; the daughter is in the stage of denial. C) The son is in the stage of anger; the daughter has reached the stage of acceptance D) The son is in the stage of denial; the daughter has reached the stage of anger.

Ans: C The son's anger about his father's dying is being directed toward the staff and his sister. The daughter is unhappy but has accepted the situation and will be ready to move on after their father dies. Both have passed through denial that he will die, and neither is trying to bargain with God.

Mr. G has been an atheist for many years, although he was raised as a Catholic. In talking with his nurse, he says he wants nothing to do with organized religion. Now he is dying and depressed. What helpful advice might the nurse give his family about dealing with Mr. G's depression? A) Make his physical environment more pleasant B) Bring in a priest to visit with him C) Make an effort to improve his mood D) Stay with him for support

Ans: D At this stage, Mr. G needs to feel the love of his family. There is little use in pretense or cheerfulness. Although he may be silently coming to terms with his lack of religious beliefs, he should not be pushed into being visited by a priest unless he expresses a desire for it; if he does express such a desire, every effort should be made to bring a priest to him.

The nurse is aware of the spiritual dimension in Erikson's conceptualization of the older adult's growth and development. When applying Erikson's theory to the care of older patients, what does the nurse realize as being a spiritual component of Erikson's final development task? A) Awareness that one is loved by others and has provided unconditional love. B) A confidently held hope that a transcendent and positive afterlife awaits one following death. C) A sense of contribution that one's relationships and endeavors have benefited society and one's family. D) A sense of wholeness rooted in the knowledge that life experiences make sense and have served a purpose.

Ans: D Feedback: According to Erikson's description of the final developmental task, healthy psychological aging for the older adult involves achieving a sense of integrity. This integrity, or wholeness, is supported by the belief that life experiences—both good and bad—make sense and have served a purpose. The other choices express needs that older individuals may possess, but these are not components of Erikson's framework.

The nurse is caring for an older patient who is nearing death and realizes that no professional clergy needs to be contacted. This patient is most likely a member of which faith? A) Pentecostal B) Unitarianism C) Seventh-Day Adventists D) Church of Jesus Christ of Latter Day Saints

Ans: D Feedback: The Church of Jesus Christ of Latter Day Saints (Mormons) is the only faith of those listed that has no professional clergy.

What should the nurse use to help guide interventions to meet the spiritual needs of a patient? A) The client's prognosis for recovery B) The nurse's own religious tradition C) The denominational affiliation of the chaplain D) The presence of icons and religious books at the bedside

Ans: D Feedback: The presence and identity of a patient's religious books and symbols can be useful insights into a patient's spiritual belief system. This information would supersede the religious affiliation or tradition of the nurse or chaplain as well as the patient's objective prognosis for recovery.

12. During the 19th century, early long-term-care facilities emerged. What was one of their important characteristics? A) Unscheduled activities B) Activities suited to patients' needs C) Integration into mainstream society D) Similar treatment of all patients

Ans: D Feedback: During the 19th century, all patients were treated similarly, regardless of their individual needs. Activities were rigidly scheduled and planned more for the aims of the institution than for the patients, and the facility was isolated from the surrounding community. All these characteristics led to institutional behavior on the part of the patients.

4. The daughter of an 86-year-old man with stage 3 Alzheimer's disease has suggested exploring long-term-care facilities as a way of meeting his increasing daily needs. The man is strongly opposed to entertaining the possibility, stating, "We put my granddad in one of those 45 years ago and it was a horror for him." Which of the following historical phenomena may explain the man's reaction and his grandfather's negative experience in long-term care? A) Nursing homes in the 20th century often attracted care providers who were unable to meet the standards required for working in a hospital context. B) Philosophies of care in the mid-20th century emphasized minimal assistance with ADLs. C) Evidence-based gerontological nursing did not exist during the era in question. D) Nursing homes in the 1960s proliferated in number, but standards of care were low and enforcement was lacking.

Ans: D Feedback: During the rapid growth in long-term care in the 1960s and 1970s, federal standards were very minimal, and monitoring and enforcement systems were lax. Answers A, B and C are less accurate historical statements.

10. As part of an internal quality review, the nurse directors of a long-term-care facility have identified specific goals for the care that residents of the facility will achieve. Which of the following goals represents the highest level in the hierarchy of residents' needs? A) "Residents will be encouraged to exercise their individual rights despite the presence of health challenges that may limit their independence." B) "Residents will be assured of timely, caring, evidenced-based treatment for their medical conditions." C) "Residents will maintain a high level of self-care in as many aspects of their lives as their abilities permit." D) "Residents will experience a growth in meaning and purpose of life despite the presence of health challenges."

Ans: D Feedback: Establishment of a meaningful and purposeful life is considered a higher level in the hierarchy of needs than the exercise of individual rights, medical treatment, or responsibility for self-care.

13. In the mid-20th century, the number of nursing homes grew quickly. What was most responsible for this increase? A) Institute of Medicine B) Social Security C) Hill-Burton Act D) Medicare and Medicaid

Ans: D Feedback: Medicare and Medicaid, enacted in the 1960s, reimbursed nursing homes for expenses and had the greatest effect on growth. Social Security, enacted in 1935, gave individuals more financial independence than they had had earlier. The Hill-Burton Act (1946) assisted in hospital construction, and early nursing homes were built on the same hospital model. In the 1980s, a study by the Institute of Medicine recommended many changes in long-term care.

21. Infections are common acute conditions that demand prompt attention. A variety of factors can be responsible for the high risk of infection in the elderly. Gerontological nurses should suspect an infection when which of the following phenomena occurs? A) The patient displays reduced activity and lowered resistance. B) Embolus and thrombus are diagnosed. C) A lower body temperature causes atypical fever. D) Any abrupt, unexplained change in physical or mental function is detected.

Ans: D Feedback: Not only do infections develop more easily in the elderly, but they also are more difficult to identify early because of altered symptomatology. That is, the atypical presentation of symptoms can complicate early identification and correction. Infection should be suspected whenever any abrupt, unexplained change in physical or mental function is detected in the elderly patient.

15. Recently, Haven Nursing Home was found deficient in some respects. How can the Omnibus Budget Reconciliation Act of 1987 rules be enforced against the nursing home? A)Haven may no longer receive subsidized foods from the USDA. B)Haven's administrators may go to jail. C)Haven may be fined a large amount of money. D)Haven may lose reimbursement from Medicare.

Ans: D Feedback: Reimbursement from Medicare can cease if a home is found deficient. The USDA does not provide food to nursing homes. Jail or fines might be punishment for administrators found guilty of crimes, but they are not part of the OBRA 1987 regulations.

11. Older patients are particularly subject to several postoperative complications. Which of the following arrays of symptoms is indicative of respiratory complications? A) Reduced activity and lowered resistance B) Fever and dehydration C) Negative chest X-ray thoracic distention D) Decreased lung sounds and a low-grade fever

Ans: D Feedback: Respiratory complications include pneumonia, pulmonary emboli, and atelectasis; with atelectasis there may be decreased lung sounds and low-grade fever, although a chest X-ray may not show the condition. Atelectasis increases the risk of the development of pneumonia.

10. As she began to wake after surgery, Mrs. P became extremely restless. Which of the following should the recovery room nurse likely administer first? A) A narcotic to ease the pain B) Antibiotics to prevent an infection C) Electrolytes to correct an imbalance D) Oxygen to correct hypoxia

Ans: D Feedback: Restlessness after surgery may appear to be caused by pain, but is a symptom of hypoxia. Oxygen may even be given prophylactically, but narcotics may worsen the hypoxia. Antibiotics should never be given unless needed, and there is no indication that Mrs. P needs electrolytes.

1. The husband of a 78-year-old postsurgical patient has approached the nurse, upset that his wife has become incontinent of urine during her hospital stay. The husband states that this is without precedent and he is adamant that the matter be looked into further. The nurse would recognize that which of the following factors may have contributed to this course of events? A) Age-related changes to genitourinary function B) Sensory deprivation C) Changes in diet since admission to the hospital D) Sedative effects of medications

Ans: D Feedback: Sedation can cause incontinence in the hospitalized elderly. The sudden onset makes it unlikely that the wife's incontinence is a result of age-related changes and a change in diet is unlikely to cause incontinence. Sensory deprivation would be less likely to result in incontinence.

15. Mr. A, aged 89, is displaying a furrowed tongue, dry lips, and a thready pulse of 105, causing the care team to strongly suspect that he is dehydrated. Which of the following principles provides the best guide for managing Mr. A's immediate care? A) Older adults cannot tolerate a rapid intake of oral fluids. B) Older adults are more able to tolerate dehydration than younger people, owing to their lower volume of intracellular fluid. C) Fluids should be replaced intravenously rather than orally in older adults. D) Most older adults require between 2 and 3 L of fluid daily.

Ans: D Feedback: Unless otherwise indicated, fluid intake for older adults should range from 2000 to 3000 mL. While some older adults may not be able to tolerate rapid fluid intake, this is not categorically true of all elders. IV administration is not necessarily preferable to oral intake and older adults are more, not less, susceptible to the deleterious effects of dehydration.

Faced with the crushing reality of her imminent death, a 72-year-old female patient with advanced pancreatic cancer has become withdrawn and quiet, with her family stating that they believe she is depressed. Which of the following interventions should the nurse prioritize? A) Create a physical environment with more natural light and privacy B) Emphasize the patient's need for a sustained serotonin reuptake inhibitor (SSRI) to her care team. C) Provide gentle encouragement and assure the patient that the care team will prioritize her pain control. D) Focus on being truly with the patient and using therapeutic touch appropriately.

Ans: D Given the gravity of the dying patient's circumstances, encouragement, modifications to the physical environment or antidepressants are unlikely to be as therapeutic as simple touch and presence.

Knowing that she was dying, Mrs. P tried to use her condition to obtain sympathy and special treatment from the staff. Worse, she became angry at the slightest provocation. If a nurse failed to answer a light signal immediately, Mrs. P started cursing loudly. Once, she threw a saucer at a nursing assistant who annoyed her. How can a nurse who feels disturbed by her handle this patient? A) Accept Mrs. P's anger without comment, and forget about it B) Return Mrs. P's anger to let her feel justified in being difficult C) Turn her or his own anger into a joking response to Mrs. P D) Accept Mrs. P's anger without comment, but talk with a colleague about it

Ans: D Patients vary greatly in behavior and needs, but in general dying patients go through a stage in which they react to everyone with anger. Nurses need to be aware that this will happen and talk with someone about their feelings rather than vent them on the patient. With experience, a nurse may become able to accept the situation without feeling disturbed.

Which of the following interventions is likely to be of greatest benefit to the family of an 81-year-old woman who has just died from a sudden myocardial infarction? A) Begin working with the family immediately after the woman's funeral has been completed. B) Negative emotions toward the deceased woman need to be explored before healing can begin. C) Even though few survivors want to speak directly with a counselor or therapist, it is important to present the opportunity. D) Survivors benefit from medical support, not just spiritual and psychosocial support.

Ans: D Schneidman notes that survivors benefit from medical evaluation and monitoring. It is best to begin working with the family as soon as possible after the tragedy; negative emotions should not be explored early in the process. Very few survivor-victims are resistant to speaking with someone.

An elderly man dying of cancer tells a nurse that his pain is becoming much worse and rates it as 9 on a scale of 0 to 10. What pain relief should be provided? A) Codeine B) Meperidine C) Oxycodone D) Morphine or hydromorphone

Ans: D The patient should receive an analgesic immediately to prevent the pain from becoming even more severe. Morphine or hydromorphone is given for severe pain. Codeine and oxycodone are for moderate pain, and meperidine is contraindicated in elderly patients because it causes psychoses and other adverse effects at low dosages.

19.Mr. R will have to enter a long-term-care facility soon, and he and his family are visiting various local facilities. They have a long list of questions to ask the administrators at each location. Which of these questions is the most important? A)"What types of health insurance are accepted?" B)"What types of medications are given?" C)"What special therapies are prohibited?" D)"What is the organizational structure of the facility?" E)They carry a greater risk of causing serious complications and death.

Ans:A Feedback: Although the other choices may have an impact on patients in the long run, choice A is of most immediate importance for this decision. If the family can find a local facility where Mr. R's long-term-care insurance or Medicare will cover his care, the family should be in good financial hands. If the other choices lead to problems later on while he is still living, he can be moved elsewhere.

8. The wife and daughter of Mr. B, an 80-year-old man, are experiencing guilt and doubt about their recent decision to place him in a long-term-care facility, despite the fact that his declining functional level justifies the move. Which of the following actions by the nurses at the facility is likely to ease the women's anxiety about admitting Mr. B? Select all that apply. A) The nurse manager of the facility has placed the women in contact with another resident's family who have recently gone through the same experience. B) The designated visiting hours are made clear to both Mr. B and his family so that Mr. B does not await their visits when prohibited. C) Staff encourage the family to use an activity room or the outdoors during their visits. D) The nurses explain the rationale for barring the family from bringing food from home to Mr. B.

Ans:A, C, E Feedback: A "buddy system" provision of a room or outdoor location for visits and the opportunity for participation in a loved one's care can help families with the transition to the older adult's admission in a long-term-care facility. Rigidly enforced visiting hours and the prohibition of outside food are not conducive to reducing their anxiety.

18. The medical model of long-term care has limitations. The underlying themes of the new model of long-term care are which of the following? A)Medical supervision and treatment B)Patients' and caregivers' rights C)Holism and healing D)Social and spiritual growth

Ans:C Feedback: The new model of long-term care is based on holism and healing. The fulfillment of hygiene and holism needs provides the foundation for healing to occur. Medical supervision and treatment are the basis of the medical model of long-term care. Patients' rights and the opportunity to grow socially and spiritually are important components of a long-term-care facility that promote holism and healing.