gero final questions (12, 21-25)
While awaiting the imminent death of her sister, an older woman makes arrangements to bury her sister in the survivor's home state because she cannot reach the other family members. Which step should the nurse implement? a. Ask questions, including questions about the location of her sister's family. b. Instruct this woman that this is not her decision to make. c. Try to contact the family to inform them of the decision. d. Question her about holding behaviors that she will want.
a
An older patient who has end-stage pulmonary disease decides to accept care from the palliative care nurse. This older adult will most likely benefit from the palliative care nurse in which patient needs of Weisman's six needs for the dying? a. Closure b. Control c. Composure d. Cohesiveness
b
Which is the fundamental difference between Medicare Part A and Medicare Part B? a. Hospice care b. Health care setting c. Home care services d. Invasive procedures
b
Which of the following statements is true about conservators? a. A conservatorship entails control over property, whereas a guardianship entails control over the person. b. The most legally restricting way individuals and property can be handled are through conservatorships and guardianships. c. Conservators cannot be members of the conservatee's (patient's) family. d. Because a conservatorship is the least restrictive alternative, a court hearing is not required.
b
Which of the following statements is true about end-of-life care? a. The physician is the ultimate authority in the decision to use or not to use life-sustaining medical treatment. b. The proxy appointed in a living will cannot speak for the testator in health care matters other than terminal illness. c. A patient with dementia cannot be capable of making personal wishes known about life-sustaining treatment. d. The American Nurses Association encourages nurses to participate in assisted suicide.
b
Which of the following statements is true about relationships of older adults? a. Loneliness is evidence of self-centeredness and an unwillingness to love. b. A person may be lonely even when surrounded by other people. c. Hostile behavior indicates that a person prefers to be left alone. d. A pet cannot substitute for human attention.
b
A health care provider asks the nurse about an older man's durable power of attorney (DPA) because consent is needed for a medically necessary invasive procedure. The patient has end-stage disease, is intubated, and is on mechanical ventilation. Which steps should the nurse implement? a. Refer to the patient's advance directive for a name. b. Assist with obtaining informed consent from the patient. c. Use the oral trail-making test to measure cognitive function. d. Apply the Confusion Assessment Method for critical care.
A
4. The nurse working in a long-term care facility completes her morning assessment on a new postoperative patient and notes a change in cognitive status from the previous day? The nurse recognizes which of the following as a precipitating factor for delirium? (Select all that apply.) a. Major medical treatment c. Admission to long-term care b. Poor sleep habits d. Pharmacological agents
ANS: A, C, D Major medical treatment, admission to long-term care, and pharmacological agents are all precipitating factors for delirium. Changes in surroundings often precipitate delirium. The development of delirium is a result of complex interactions among multiple causes. Delirium can result from the interaction of predisposing factors—vulnerability on the part of the individual as a result of predisposing conditions, such as cognitive impairment, severe illness, and sensory impairment; delirium can also result from precipitating factors and insults—medications, procedures, restraints, and iatrogenic events. Although a single factor (e.g., infection) can trigger an episode of delirium, several co-existing factors are also likely to be present. A highly vulnerable older individual requires a lesser amount of precipitating factors to develop delirium. Poor sleep habits is not a contributing factor in of itself.
2. Which of the following is(are) the risk factors for vascular dementia (VaD) after a stroke? (Select all that apply.) a. Smoking b. Male sex c. Hypertension d. Advancing age e. Hyperlipidemia f. African American
ANS: A, C, E Smoking, hypertension, and hyperlipidemia are all risk factors for VaD after a stroke. Male sex, advancing age, and African-American ancestry are risk factor for VaD.
1. Which types of exercise programs are better for older adults with AD for improving mood and function? (Select all that apply.) a. Balance b. Walking c. Self-paced d. Endurance e. Muscle strength f. Lasting 16 weeks or longer
ANS: A, D, E, F Older adults with AD can benefit from regular exercise as demonstrated by more positive affect and mood, improved function, and less disability. Suitable exercises for older adults with AD include exercises that improve balance. Exercises that improve endurance and exercises for muscle strengthening are also both suitable for the older adult with AD. Research data support the claim that exercise programs lasting 16 weeks can help improve function and mood of older adults with AD. Endurance, strength, and balance exercises help improve patients with AD more than walking. Self-paced exercises are unlikely to be suitable for a patient with AD because of cognitive dysfunction.
3. The community health nurse is preparing for an educational session on AD for a group of seniors. Which modifiable risk factors should the nurse include? (Select all that apply.) a. Family history c. Smoking b. Sex d. Obesity
ANS: C, D Smoking cessation and obesity are both modifiable risk factors. The focus of research on AD is on the interaction between risk-factor genes and lifestyle or environmental factors. Increasing evidence strongly points to the potential risk roles of vascular risk factors (VRFs) and disorders (e.g., midlife obesity, dyslipidemia, hypertension, cigarette smoking, obstructive sleep apnea, diabetes, cerebrovascular lesions) and the potential protective roles of psychosocial factors (e.g., higher education, regular exercise, healthy diet, intellectually challenging leisure activities, socially active and integrated lifestyle) in the pathogenesis and clinical manifestations of dementia (especially AD and vascular cognitive impairment). Family history and sex are not modifiable.
An older woman is resisting her son's help to make her money last longer. He wants to have her declared incapacitated so he can manage her finances. Which nursing assessment can be used by the court to declare incapacitation? a. Prepares very few meals and avoids cleaning the house. b. Ambulates around her local community without difficulty. c. Balances her checkbook weekly and pays her bills on time. d. Resists medical advice to remove a stage I malignant tumor.
a
The older adult wants to appoint an attorney-in-fact with DPA for a specific period around a forthcoming surgery. Which should the nurse implement? a. Help the patient find a qualified attorney. b. Explain the legal rights and responsibilities of an attorney-in-fact with a DPA. c. Suggest using a guardian for the surgical period. d. Offer to act as the patient's guardian during surgery.
a
When an older adult client complains of itching and pain and several days later show you a rash, you realize she has: a. Herpes zoster b. Actinic keratosis c. Scabies d. Skin cancer
a
When an older adult is considering long-term care insurance (LTCI), which is an important consideration? a. Carefully scrutinize all exclusions before enrolling. b. Apply at the oldest age possible for lower rates. c. Avoid purchasing LTCI through a group policy. d. Delay application until the government sponsors LTCI.
a
Which disease has become known as the "great imitator?" a. Human immunodeficiency virus (HIV) b. Acquired immunodeficiency syndrome (AIDS) c. Alzheimer disease d. Schizophrenia
a
Which of the following statements describes one of the standards of case management during hospitalization? a. Begin discharge planning on the first day of hospitalization. b. Keep an older adult in the hospital as long as necessary. c. Accept the hospital discharge planner's (HDP) proposal for discharge. d. Assist hospital personnel to focus on the admission complaint.
a
Which of the following statements is true about caregiving? a. Dementia in an older adult can cause grief in the caregiver, comparable with the grief from the older adult's death. b. Middle-aged adults and older parents reverse life-long caregiving roles with increasing age. c. Older adults should relocate to the caregiver's home when long distances separate the two. d. Increasing numbers of adult children who are developmentally disabled become caregivers for their older parents.
a
Which of the following statements is true about case management and care management for older adults? a. A case manager works for a health care system to save time and money. b. Care managers are usually paid from public agencies such as the Area Agency on Aging (AAA). c. One nurse can only perform care management. d. The Outcomes-Based Quality Improvement system is designed to evaluate the expected benefit of a procedure.
a
Which older adult is most likely to have normal mental health? a. The older adult who grieves over the loss of a spouse for 2 years but is traveling again b. The older adult who exhibits long periods of depression with occasional manic episodes c. The older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt d. The older adult who has been treated for chronic depression and whose brother killed himself 1 year ago
a
Which one of the following older adults has the highest economic risk in retirement at the beginning of retirement? a. Divorced woman who has lived in this country for 3 years b. Male veteran who is an above-the-knee amputee and was a teacher c. Female widow who is a primary care nurse practitioner d. Man who immigrated from China and designs computer software
a
You are evaluating the plan of care for an older adult who is alcohol-dependent. Which patient documentation indicates the need for follow-up nursing interventions by the nurse? a. Patient states that he intends to decrease his alcohol consumption. b. Patient arrives at his group session on time and well-groomed. c. Patient states, "I am an alcoholic because I drink 10 beers a day." d. Patient states that he understands that he needs continued treatment.
a
When differentiating the characteristics of depression, delirium, and dementia, the nurse recognized which of the following as an indicator of delirium? a. Sudden onset c. Insidious b. Recent loss d. Life change
a - Delirium can occur suddenly. Recent loss or life changes can precipitate depression. Dementia can be insidious, slow, and occur over the course of several years.
Which medication administered for delirium under a controlled environment can reduce the duration and severity of delirium for high-risk patients? a. Haloperidol (Haldol) c. Fluphenazine (Prolixin) b. Thioridazine (Mellaril) d. Chlorpromazine (Thorazine)
a - Haloperidol administered in low doses can help reduce the severity and duration of delirium for high-risk patients after hip surgery; however, haloperidol therapy does not reduce the incidence of delirium in this group. In addition, atypical antipsychotic medications can also be effective when administered in low doses under controlled circumstances. Thioridazine is a typical antipsychotic agent and is not indicated in the prevention of delirium. Fluphenazine is a typical antipsychotic medication and is not indicated in the prevention of delirium. Chlorpromazine is a typical antipsychotic agent and is not indicated in the prevention of delirium.
*Which assessment parameter should the nurse use to differentiate between delirium and depression in an older adult? a. Orientation b. ADL ability c. Course over the morning hours d. Psychomotor activity
a - Qualities about the patient's orientation are a good method for the nurse to use for distinguishing between delirium and depression; in delirium, orientation is usually impaired, and in depression, orientation is normal. Activity can vary throughout the day and is not a good indicator. Delirium tends to be worse at night, and depression tends to be worse in the morning. The nurse avoids using qualities about the patient's psychomotor activities to distinguish between delirium and depression in an older adult; psychomotor activities in both disorders are highly variable and make distinctions difficult.
At 10 PM, an older male resident attempts to climb over the bedrails. Which intervention should the nurse implement first? a. Talk to the resident about his behavior. b. Call the physician, and ask for a sedative. c. Apply a vest restraint on the resident. d. Get a companion to keep him in the bed.
a - The resident is expressing a need that the nurse can potentially determine with gentle questioning. Pharmacological intervention can be necessary but should not replace careful evaluation and management of the underlying cause. Simply restraining the patient will not address the underlying problem, and the imposition of restraints can trigger delirium. Applying a restraint is the last resort, and the nurse must consider the problems that accompany the application of restraints before doing so. Placing a companion in the room can be an effective method of keeping the resident safe if the companion can determine and meet the resident's needs.
*An older woman has a wound infection 5 days after a below-the-knee amputation brought about by diabetes mellitus. Which of the following is the nurse's priority intervention to prevent cognitive dysfunction and postoperative complications in this older adult? a. Remove invasive devices as soon as possible. b. Minimize the administration of opioid analgesics. c. Allow for self-care and independent activities. d. Administer short-acting benzodiazepines as needed.
a - To help prevent cognitive dysfunction, postoperative complications, and an increased risk of morbidity and mortality, the nurse recognizes that the risk factors this older adult has for delirium include stressors, infection, and surgery; therefore to prevent cognitive decline and additional postoperative complications, the nurse promptly removes invasive devices such as intravenous infusions, urinary catheters, and wound drains. Removing these devices not only reduces the risk of infection, thromboembolic events, blood loss, injury, and fluid imbalance, but they also serve to promote mobility, promote a sense of control for the patient, and reduce the types of situations that can frighten the patient or that the patient can misinterpret. Poor pain management can contribute to delirium in older patients. A patient with multiple stressors and risk factors for delirium needs additional nursing care and attention to provide a calming, caring therapeutic environment. The nurse must assess the patient's functional status before allowing self-care and independent activities. In addition, this older adult is likely to need extensive physical therapy to maintain mobility. Benzodiazepines are a poor pharmacological choice for older adults for sedation or sleep; they can contribute to delirium, are highly addictive, and can cause rebound insomnia if suddenly withdrawn.
A patient loses her husband because of a sudden myocardial infarction, and she blames herself for not recognizing the warning signs. Which patient outcome associated with her loss should the nurse use to plan care? a. Meets her daily responsibilities b. Expresses feelings of guilt, fear, anger, or sadness c. Assesses the causes of the dysfunctional grieving processes d. Identifies problems connected to anticipatory grief
b
After the loss and burial of a beloved pet, an older man loses weight because he eats very little. Three months later, he starts to paint pictures of the pet and his appetite slowly improves. Describe this individual's mourning for his pet. a. Weight loss from inadequate intake b. Pet's burial and painting pictures of the pet c. Loss of his appetite resulting in weight loss d. Increased food intake after painting begins
b
Although the older man who was forced to retire from law enforcement has multiple physical complaints, the primary care health care provider finds nothing abnormal. After the man tells the nurse that his girlfriend just left him, which of the following is the priority nursing intervention to complete before the older adult leaves? a. Ask him how he plans to cope with his loss. b. Use direct questions about access to firearms. c. Collaborate with his provider for antidepressants. d. Allow him to express himself by intently listening.
b
An older woman is brain dead, and the attorney-in-fact or surrogate named in her DPA is opposed to organ donation; the law in the state allows a surrogate with a DPA to make end-of-life decisions. Although she failed to document it, her family states that she wanted to donate her organs. Given the law about a DPA, what does the nurse expect the surrogate to do? a. Deny consent. b. Provide consent. c. Refuse to decide. d. Get a second opinion
b
An older woman recently lost her brother, provides care for her husband who has health needs, and must move to a new location after 35 years in the same home. When she comes to the primary care facility with clinical indicators of influenza, the nurse recognizes which of the following? a. She is exhibiting attention-seeking behaviors. b. Crises and stressors can impair physical health. c. Her greatest need is respite care for her husband. d. Crisis leads to a lower functional status for the victim.
b
Pressure ulcers are defined as an injury to the skin and/or underlying tissue resulting from pressure or in combination with shear, usually over a bony prominence. To prevent pressure ulcers, you know that you must perform all the following EXCEPT: a.Turn immobile clients every 2 hours off bony prominences. b. Keep the skin moist. c. Use lift or draw sheets to move clients in bed. d. Ensure that your client maintains a healthy nutritional status.
b
The children of an older woman ask the nurse for advice about helping their mother heal after her husband's (their father's) death. Which strategy should the nurse share with the family? a. Appoint one family member to take her on outings. b. Coordinate family expressions of care and concern. c. Have each child plan a long trip with her assistance. d. Take her to community events to meet other people.
b
The health care provider believes an older woman has approximately 6 weeks to live. After 2 months, the family remains at the bedside but, in the last few days, are becoming increasingly impatient and irritable. This pattern is least indicative of which of the following statements? a. Family is experiencing anticipatory grief for the older adult. b. Family desires that the patient be relieved of her misery. c. Anticipatory grieving can fail to attenuate acute grief upon death. d. Grievers deal more easily with known losses at known times.
b
The primary difference between the Loss Response Model (LRM) and the Worden model of grief is which of the following? a. In the Worden model, those grieving pass through stages in order. b. The LRM uses a systems approach that acts to uphold stability. c. In the Worden model, the system helps maintain equilibrium. d. In the LRM model, those who are grieving transition through several stages.
b
To help older adults maintain a healthy mental state, the nurse plans activities at a community center to promote the developmental stages of older adulthood. Which nursing intervention is suitable for the nurse's plan? a. Screen for communicable diseases common among older adults. b. Participate at a soup kitchen for other people who are homeless. c. Plan a safety program about falls, fire safety, and home security. d. Have speakers emphasize the need for isolated self-exploration.
b
Which assessment finding of an older adult living in an assisted-living facility indicates the highest risk for suicide? a. Liver failure is due to alcohol abuse; older adult is popular at meals. b. Older adult declines company; is preoccupied with lethal weapons. c. Refuses to allow a large, extended family to help him. d. Older adult had an overdose of acetaminophen 20 years ago; is in a sewing group.
b
Which of the following statements is true about the role of grandparents? a. The usefulness of grandparents declined with the advent of the industrial age. b. Today, many grandparents are the primary caregivers of their grandchildren. c. The value of grandparents is to provide gifts to younger family members. d. Traditionally, parents are subordinate to the grandparents in caregiving.
b
Which one of the following older adults is most likely to need preretirement counseling to avoid significant concerns in retirement? a. African-American woman who is a certified public accountant b. Mexican-American woman who receives cash for cleaning services c. Middle-aged man who has a history of type 1 diabetes mellitus d. Older male clerk who works for the Department of Homeland Security
b
An older woman is recovering from a bowel resection in the intensive care unit but remains intubated and on a mechanical ventilator. Which of the following should the nurse implement to help prevent delirium in this woman? a. Assess cognition with MMSE-2. b. Provide uninterrupted periods of rest and sleep. c. Maintain adequate sedation and pain management. d. Cover the patient's eyes with protective ophthalmic ointment.
b - Providing uninterrupted periods of rest and sleep is a challenge for the nurse in intensive care. Because of the nature of the patients' illnesses, nurses administer medications and treatments and perform invasive procedures on a 24-hour basis, leaving patients little time for rest. Many patients become delirious in the intensive care unit because the noise, activity, brightness, and disturbance tend to persist around the clock, which contribute to delirium. Patients lose their sources for maintaining orientation and stability; that is, bright lighting at all times, as well as unfamiliar and abrupt increases in noise, can lead to a disruption in the circadian rhythm. In addition, patients in intensive care are more likely to receive multiple medications, and medications that are potentially harmful can aggravate the patient's cognitive difficulties. Because this patient is intubated and on mechanical ventilation, the nurse cannot apply the MMSE-2; the patient is unable to perform adequately. Besides, assessing for dementia is not a prophylactic measure. Sedation and pain management, although often needed in the intensive care unit, can contribute to delirium. Covering the eyes of a patient in intensive care with ointment can be necessary to prevent corneal damage; however, it is likely to contribute to delirium because the patient will be unable to see clearly.
*Which of the following should the nurse use to assess a nonverbal older adult for delirium? a. Cranial nerves XI and XII b. Confusion Assessment Method c. MMSE-2 d. Controlled Word Association Test
b - The Confusion Assessment Method is a tool for measuring delirium in patients who are intubated or nonverbal. Assessing the accessory (CN XI) and hypoglossal (CN XII) cranial nerves provides clues about the patient's ability to swallow. The nurse uses the Controlled Word Association Test to assess for a neurologic cause of an older adult's cognitive dysfunction. This tool is an index of frontal lobe functioning and provides an assessment of executive function, including the patient's frontal lobe functioning and his or her ability to refrain from distraction and perseveration. The MMSE-2 is a valid and reliable tool to assess cognitive function; however, it is unable to pinpoint discrete areas of neurologic dysfunction.
*Which of the following is a true statement about psychotic behavior in older adults? a. Usually, hallucinations in older patients are the result of psychological conflicts. b. Illusion, delusion, and hallucination are different terms for the same phenomenon. c. An older adult with psychotic behavior should be assessed for a variety of causes. d. Regardless of the cause, dissimilar hallucinations are treated with similar therapies.
c
After the older adult dies, the brother who has a history of alcohol abuse upsets the family by going on a drinking binge instead of attending the funeral. Which of the following is the best description of the brother's behavior? a. Personality disorder b. Disrespectful attitude c. Disenfranchised grief d. Chronic grief
c
An older man is being abused by his daughter, a single working mother of four children, with whom he lives. The nurse investigates and learns that the abuse is due to situational stress. Which of the following interventions should the nurse implement to address the short-term crisis? a. Immediately remove him from his daughter's home. b. Encourage the daughter to work with social services. c. Arrange respite care or day care for the patient. d. Place the patient in a long-term care facility.
c
An older man, who has activity intolerance as a result pulmonary fibrosis, barks orders and commands at the nursing staff when he cannot help himself. Which of the following is the nurse's first priority patient outcome for planning care to resolve this problem? a. Verbalizes requests in a calm, respectful, and appreciative manner. b. Identifies potential triggers of anger, and positively redirects energy. c. Expresses an understanding of the need to balance rest and exercise. d. Resolves the pulmonary fibrosis to restore baseline activity tolerance.
c
An older woman with dementia exhibits new behaviors including crying and repeatedly verbalizing the same phrase; further, the behavior has increased over 2 days. Which intervention should the nurse implement in response to this behavior? a. Tell her you will remember what she says if she stops crying. b. Attribute these findings to a deterioration in cognitive function. c. Check the medication administration record for missed doses. d. Present probing questions to the patient about her behavior.
c
As the wife of a university president, an older woman met exciting people and traveled extensively until her husband died. Besides losing an intimate partner, the nurse identifies that this woman is most likely to grieve for the loss of which area of her life? a. Self-confidence b. Economic security c. Status in community d. Intellectual stimulation
c
The nurse prepares to discharge an older man who has heart failure and is in stable condition, when his wife states that she will avoid sexual activities with him because of his heart disease. Which of the following factors should the nurse use in patient teaching about sexual activity for an older adult with heart failure? a. An older adult with heart failure should avoid sexual relations because of the demand it places on the heart. b. Sexual relations and climbing six flights of stairs expend the same amount of energy. c. Fear and lack of knowledge can cause older people to reduce their sexual activity unnecessarily. d. Sexuality is a private matter between the older man and his wife.
c
The son of an older adult couple ends his life suddenly and violently. The husband proceeds with living as usual. After 1 year, the wife remains in seclusion and is hospitalized for dehydration. Which steps should the nurse implement to help improve the wife's mental health and wellness? a. Encourage additional fluids and social activity. b. Instruct the husband to display empathy for her. c. Establish a trusting, caring relationship with her. d. Ask social services for a survivor's support group.
c
When the older woman who is close to death asks the family to leave after short visits and acts withdrawn in their presence, the family becomes distraught. Which of the following does the nurse include in family teaching to explain the patient's behavior? a. She is preoccupied with her own death. b. She must have unresolved family issues. c. She can be experiencing anticipatory grief. d. Her body prepares for death in this manner.
c
Which of the following is a true statement about impaired skin integrity? a. Stage III pressure ulcer cannot regress to stage II because the subcutaneous tissues regenerate. b. Stasis ulcer is another term for pressure ulcer. c. Muscle and fat cannot regenerate. d. Weight reduction is recommended to help prevent pressure ulcers.
c
Which of the following is a true statement about loss, dying, and death for older adults? a. Men and women tend to respond similarly to the loss of a spouse. b. Visions on the part of a person who has lost a spouse are not normal grief reactions and should be regarded as signs of underlying defects. c. The grieving process is not rigidly structured. d. Bereaved persons regain their normal capability approximately 6 months after loss, and regressive behavior after that time should be discouraged.
c
Which of the following is an important consideration about the skin of an older adult person? a. Generous amounts of soap should be used for cleansing. b. Sweat gland activity increases. c. Skin becomes more vulnerable to damage. d. Skin becomes darker in unexposed areas.
c
Which of the following statements is true about health care costs for older adults in the United States? a. Older adults become eligible for full Social Security benefits upon reaching the age of 65 years. b. Medicare, Part A, covers physician visits, whereas Part B covers prescription drugs. c. Health maintenance organizations (HMOs) can obtain an exemption from Medicare's per capita spending limit. d. Older adults pay a fixed premium and low out-of-pocket costs in a preferred provider organization (PPO).
c
You notice that your older adult client frequently knocks his arm or hand against door frames or chair backs and then develops a purpura. You advise your client to do all the following EXCEPT: a. Wear a long-sleeved shirt. b. Protect the skin from trauma. c. Tape a nonadherent dressing over the site of a skin tear. d. Remind the health care personnel to be gentle when handling this client's skin.
c
A definitive diagnosis of Alzheimer disease (AD) can be made by detecting or using which one of the following methods? a. Clinical observation of dementia b. Inability to speak with relevance c. Development of neurofibrillary tangles d. Computed axial tomographic (CAT) scan
c - Confirming the development of neurofibrillary tangles is the only accurate method for diagnosing AD. Patients with AD can be observed for dementia and delirium, but these indicators are nonspecific for the disease. The inability to speak with relevance is a feature of dementia; if other causes of dementia are ruled out, then it may be dementia of the Alzheimer type. A CAT scan is the most useful means for diagnosing a stroke.
The nurse recognizes which of the following displays may indicate hyperactive delirium? a. Lethargy b. Withdrawn behavior c. Nonpurposeful repetitive movements d. Decreased psychoactive activity
c - Patients with hyperactive delirium often wander and have nonpurposeful repetitive movements. Lethargy and withdrawn behavior are both indicative of hypoactive delirium. Patients with hyperactive delirium have increased psychoactive activity, not decreased.
*Suicide may be a consequence of the depressed older adult client if adequate care is not obtained. Which older adult group is at the most risk for suicide? a. 60 to 68 years of age b. 69 to 76 years of age c. 77 to 84 years of age d. 85 years of age and older
d
*Which of the following statements is true about the mental health of older adults? a. Nurses should discourage denial and regression so older adults can directly face underlying causes of anxiety. b. Anxiety is easily distinguished from depression, dementia, and the effects of disease or medication. c. Compulsive rituals surrounding toileting and sleep are signs of a serious mental disorder. d. The nurse avoids antianxiety medications without an assessment for factors associated with anxiety.
d
An older female resident lowers her voice and tells the nurse that another female resident is looking at her behind her back and is going to make her move tonight with a male staff member. Which ideas should the nurse include in the response to this individual? a. The staff receives training in ethics. b. Validate the woman's impression. c. Avoid suspicious, paranoid thinking. d. Use the call bell if she becomes frightened.
d
An older man who had radical surgery for oral cancer is refusing to see visitors and is losing weight, despite aggressive nutrition therapy. The nurse assesses this man for ineffective coping, related to dysfunctional grieving. Which of the following patient outcomes of nursing care is the most important to implement in response to his mental health status? a. Is able to discuss how his coping mechanisms are overwhelmed. b. Performs daily self-feedings through a gastrostomy tube. c. Effectively uses nonverbal forms of communication. d. Exhibits self-confidence in regaining a sense of control.
d
Managed care systems are most effective for an older adult who does which of the following? a. Avoids using the system until it is really needed in an emergency. b. Avoids seeing generalists and seeks health care only from specialists. c. Uses high-tech treatments to reduce expenses over the long term. d. Seeks regular primary care and preventive strategies to maintain health.
d
Of all the following malignant skin cancers, which one is the most common? a. Actinic keratosis b. Squamous cell carcinoma c. Melanoma d. Basal cell carcinoma
d
The actions of the family members of an older adult who just died are chaotic, and they are unable to decide on a funeral home. Which recommendation should the nurse implement? a. Help them make a list of the problems. b. Provide a list of preferred funeral homes. c. Allow them privacy to work it out alone. d. Suggest they call someone who can help.
d
The community health nurse delivers a program to middle-aged adults about retirement planning and wants to them to choose the year of their retirement. Which is the most important area on which the participants should focus to ease the transition to retirement? a. Kind of legacy they want to leave behind b. Type of setting for their personal residence c. Location of convenient health care services d. Ability to maintain a stable standard of living
d
The wife of an older man who has diabetes mellitus brings him to primary care. He has severe bilateral infections forming black rings around each ankle. He tells the nurse it is caused by tight shoes. Which intervention should the nurse implement first to investigate this individual's health care regimen? a. Examine his health insurance coverage. b. Question the man without the wife present. c. Consult with social services about neglect. d. Analyze his glycosylated hemoglobin level.
d
What makes nursing support of caregivers so important for health care in the United States? a. Family members providing care in the home are the best caregivers. b. Eighty percent of caregiving takes place in the home of the older adult. c. The health care system reimburses families for caregiving from Medicare. d. Informal caregiving saves the health care system enormous sums of money.
d
Which is the most important element for older adults to have for enhancing the transition into retirement? a. Good health c. 401k retirement plan b. Private pension d. Preretirement planning
d
Which of the following interventions is recommended for an older adult in the final stages of dying? a. Apply an electric blanket to keep the patient warm. b. Lower the head of the bed, and turn the head to the side. c. Decrease the number of visitors. d. Support the preservation of energy.
d
Which of the following is a true statement concerning suicide among older adults? a. Older adults and younger adults manifest a suicidal intent in a similar manner. b. Older African-American women have the highest risk of suicide among older adults. c. Ethics require that the nurse respects a person's intent to terminate his or her own life. d. A major crisis experienced by the patient can contribute to the risk of suicide.
d
Which of the following statements is not true of older adult relationships? a. After 50 years of marriage, a couple can face new and severe challenges to their relationship. b. Older adults often hold their families together by arranging get-togethers and documenting the family's history and rituals. c. Losing a brother or sister brings an older adult face-to-face with his or her own death. d. For older adults, friends can never take the place of family.
d
Which of the following statements is true about loss in older adulthood? a. A person experiences each stage of grief once, and then grieving is resolved. b. Antianxiety agents are frequently recommended for reducing the pain of grief. c. The loss response model is concerned with the effect of loss on an individual. d. Referring to the deceased in the past tense can acknowledge the death's reality.
d
Which topical agent is safe to apply? a. Cornstarch to absorb moisture in the groin area b. Betadine to disinfect a healing pressure ulcer c. An over-the-counter preparation to dissolve a corn d. Light mineral oil to moisten skin after bathing
d
Which of the following approaches to hygienic care is beneficial for a patient with dementia? a. Schedule the patient's full shower at 7 AM, three mornings every week. b. Have a team give the bath with each member washing a different body area. c. Wash the perineal region first to remove potentially infectious material. d. Explain each step as you go, and keep the patient covered as much as possible while bathing.
d - A person with dementia can interpret undressing for bathing as an assault. It should be performed in a way that minimizes the intrusive and exposing aspects and maintains trust between the person and only one caregiver. From the point of view of the well-being of the patient, bathing is rarely an emergency that it must be performed at a time when the patient is not receptive. Stimulation should be kept simple and focused, and alarming the patient should be avoided. The most sensitive and intimate areas should be washed last, after trust has been established between the patient and the nurse, which may have to be done anew at every encounter. From an infection-control standpoint, washing occurs from clean to dirty areas.
1. Which of the following statements is true about cognitive impairments in older adults? a. Loss or interruption of sleep can lead to delirium. b. Confusion is a normal and unavoidable consequence of aging. c. Older patients who are agitated often have a lower cognitive status than those who are quietly sitting. d. The Mini-Mental State Examination-2nd edition (MMSE-2) should be administered on admission to detect delirium
d - The MMSE-2 or a similar instrument should be administered to a patient at admission to ascertain the patient's baseline cognitive status. The loss or interruption of sleep, in of itself, does not often lead to delirium. It can potentiate delirium in the presence of other factors. Confusion or delirium is not a normal consequence of aging but an indicator of a potentially underlying problem. The hypoactive subtype of delirium can be associated with a worse prognosis than with the hyperactive subtype; it is easily overlooked.
A man who is 60 years of age and lives in the British Isles develops dementia. Which qualities of dementia does the nurse assess to prevent patient injury related to the type of dementia this man most likely has? a. Visual hallucinations b. Unilateral tremors c. Visuospatial problems d. Clumsy movements
d - The nurse assesses the patient for failing memory and incoordination, which are characteristic of Creutzfeldt-Jakob disease (CJD) or bovine spongiform encephalopathy (also known as mad cow disease). This type of dementia began appearing in adults living in the British Isles who reported eating beef from local breeders. The nurse assesses for these qualities because the age of onset is usually around 60 years. This form of dementia progresses rapidly to death; therefore the nurse anticipates that this man will rapidly deteriorate and must be prepared to anticipate changes in motor activities and memory to maintain his safety and to prevent injury. Visual hallucinations are characteristic of Lewy body dementia. Visuospatial problems are characteristic of Parkinson disease dementia. Visuospatial problems are characteristic of frontotemporal lobe dementia.
