Gerontology Exam 1

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

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

An older adult client asks a nurse, "I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me because they are not good for older people. I really don't understand that. Can you help me?" What is the best response by the nurse? a. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep." b. "Prescription sleeping medications have many adverse effects in older people. Why don't you try using an over the counter medication?" c. "Sleeping medications do not provide any improvement in sleep for older people." d. "Sleep problems are common in older people. There really is nothing that you can do to help with that."

ANS: A Adverse effects of sleep medications, including over the counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep problems are common in older adults; however, there are many nonpharmacologic interventions that can be utilized to improve sleep.

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

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

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

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

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

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

Which of the following is a true statement about elimination in older adults? a. Defecation less than once each day is not necessarily constipation. b. Mineral oil is recommended as a laxative for the older adult. c. Excessive sleep can be a symptom of constipation. d. Leaking liquid feces should be treated as diarrhea.

ANS: A Constipation is present when fewer than three bowel movements occur per week or when the frequency decreases. Mineral oil and saline laxatives can be harmful. Fiber, fruit, and fluids are the first recommendations; stimulant laxatives such as senna and cascara can be used on a short-term basis. Altered cognitive status, increased agitation, and unexplained falls can be symptoms of constipation; these behaviors may be the only clinical symptom of constipation in cognitively impaired older persons. Excessive sleep has not been identified as a symptom. Liquid feces may be leaking around a fecal impaction, and antidiarrheal treatment can aggravate the impaction.

Which of the following is a true statement about fluid intake for older adults? a. Daily total volume should be least 1500 mL. b. Coffee is a suitable beverage for maintaining hydration. c. Caffeinated beverages are sometimes preferable to water. d. Total daily fluid intake should be approximately 10 mL per kg of body weight.

ANS: A Daily total volume of fluid should be at least 1500 mL. Caffeine increases urine production and therefore aggravates dehydration rather than relieving it. Total daily fluid intake should be 30 mL per kg of body weight, not 10 mL.

Which pharmacokinetic parameter is affected most by decreased intestinal motility related to the aging process? a. Absorption b. Distribution c. Metabolism d. Excretion

ANS: A Decreased intestinal motility increases the amount of time a substance remains in contact with the intestinal mucosa of the small intestine, where most absorption takes place. With increased exposure, absorption can be increased and the drug effect enhanced. Many medications taken by older adults can also decrease intestinal motility, thereby complicating the titration of medications or introducing new adverse effects through drug-to-drug interactions. Decreased body water leads to higher serum concentrations of water-soluble drugs, increased body fat increases the longevity of fat-soluble drugs, and decreased serum albumin increases the serum concentration of serum protein-bound drugs. Reduced liver mass and hepatic dysfunction can impair oxidative metabolism, which can lead to an accumulation of toxic levels of a drug. Impaired renal function can impair the excretion of drugs through the kidneys.

Which option is part of a program that addresses bowel incontinence in an older adult client? a. Ensuring ready access to a toilet or commode client b. Encouraging the intake of 1 L of water each day c. Expecting a rapid and full recovery d. Toileting the client 10 to 15 minutes after meals

ANS: A Difficult access to facilities within the time available is a factor in bowel incontinence and bladder incontinence. The intake of 1 L of fluid is less than the recommended amount to protect against dehydration and constipation. Realistic expectations and goals should be discussed with the client. Toileting should occur 20 to 40 minutes after regularly scheduled meals when the gastrocolic reflex is active.

Which process is increased in the early morning? a. Fibrinolytic activity b. Blood plasma c. Asthma symptoms d. Rheumatoid arthritis pain

ANS: A Fibrinolytic activity is increased in the early morning. Blood plasma volume falls at night, thus hematocrit increases. Asthma symptoms peak at approximately 4 to 5 AM. Pain from rheumatoid arthritis is more severe in the late afternoon.

The latest trends in medicine encourage health care providers to prescribe nutrient-dense foods and exercise to prevent or delay the shortening of telomeres. On which biological theory of aging are these practices based? a. Genetic research b. Caloric restriction c. Oxidative stress d. Cross-link

ANS: A Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age-related disorders. The pacemaker theory, which is also known as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can halt with age. The cross-link theory suggests that aging is a result of the stiffening of proteins caused by cross-linking, leading to stiffer joints, rougher skin, and decreased cellular elasticity.

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

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

Which approach requires the nurse to integrate and balance all aspects of an individual's life into the plan of care? a. Holistic nursing b. Healthy People 2020 c. Maslow's Hierarchy of Human Needs d. Orem's Self-Care Requirements

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

During the night, an older adult woman complains to the nurse that she has not slept more than 2 hours since admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman's sleep? a. Inquire about her sleep habits used at home. b. Suggest that she avoid napping during the day. c. Tell her that sleep is fragmented in older people. d. Offer a book to her or suggest watching a movie.

ANS: A Hospitalization often disrupts normal sleeping patterns; therefore, reestablishing those patterns is the best first step to improving the quality of sleep in the hospital. Avoiding napping during the day is a reasonable approach to complaints of sleeplessness, but it may not be this woman's problem. Sleep is increasingly fragmented in older adults; however, understanding that issue may or may not help this woman sleep for longer periods. A book or movie can help some people become drowsy but becoming drowsy will not usually increase the quality or duration of sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep.

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

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

A 75-year-old female asks a nurse, "I know I should be moving, but how much is the right amount of exercise for me?" What is the nurse's best response? a. "You need to engage in 150 minutes of moderate intensity exercise over a 7-day period." b. "You need to engage in at least 30 minutes of moderate intensity exercise every day of the week." c. "Since you are 75, the recommendations are 30 minutes of moderate exercise three times a week." d. "There are no specific recommendations for someone of your age, just keep moving."

ANS: A Older adults need at least: 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g., brisk walking, swimming, bicycling) every week and muscle-strengthening activities on 2 or more days that work all major muscle groups (legs, hips, abdomen, chest, shoulders, and arms).

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

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

Which of the following statements describing oral care for the older population is correct? a. Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods. b. Losing one's teeth is considered a normal part of the aging process. c. Oral malignancies seldom occur older adults so oral examinations are of low priority. d. Preventative dental care is covered under Medicare.

ANS: A Regular dental care is essential and can prevent tooth loss. Losing one's teeth is not a normal part of aging, about 1/4 of adults over age 65 are edentulous. Oral cancers occur more often in older individuals. The median age at diagnosis is 61. Oral examinations can assist in early identification and treatment. Medicare does not provide any coverage for oral care services.

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

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

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

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

If the nurse chooses to define aging as "social aging," the nurse would consider which of the following aspects? a. The person retired from their job as a police officer. b. The person takes six different medications multiple times over the course of the day. c. The person walks with a rolling walker. d. The person celebrated his 65th birthday.

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

An older woman presents to the geriatric clinic for a routine annual wellness visit. Upon assessment, the client reports that she needs to wear a pad because she loses urine when she coughs or sneezes. She also reports that this happens when she picks up her 2-year-old grandson. The nurse suspects which type of urinary incontinence? a. Stress b. Overflow c. Functional d. Urge

ANS: A Stress incontinence is defined as a loss of small amount of urine with activities that increase intra-abdominal pressure (coughing, sneezing, exercising, lifting, bending). None of the other options are associated with this scenario.

Which gerontological nursing organization welcomes nurses from all educational backgrounds? a. The National Gerontological Nursing Association (NGNA) b. The National Conference of Gerontological Nurse Practitioners (NCGNP) c. The National Association of Directors of Nursing Administration in Long-Term Care (NADONA/LTC) d. The American Society on Aging (ASA)

ANS: A The NGNA was formed specifically for all levels of nursing personnel: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and certified nursing assistants (CNAs). The NCGNP is, as its name implies, limited to nurse practitioners. The NADONA/LTC is, as its name implies, limited to directors and assistant directors of nursing. The ASA is an interdisciplinary organization not limited to nurses.

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

ANS: A The free radical theory posits that aging is a result of random damage from free radicals. Research is ongoing on the ability of substances with antioxidant effects to counter the actions of free radicals. For many years it was thought that consumption of supplemental antioxidants, such as vitamin C could delay of minimize the effects of aging. However, it is now known that the intake of supplemental antioxidants is deleterious to one's health. At the same time, diets inclusive of natural antioxidants, such as those high in fruits and vegetables or a Mediterranean diet rich with red wine and olive oil, have been found to be clearly healthful.

An older adult client is reading a large-print magazine and states that reading is difficult especially in the evening. Which intervention should the nurse implement? a. Putting a high-intensity light bulb in the reading lamp b. Explaining how exiting arcus senilis is interfering with visual acuity c. Putting more powerful tubes in the fluorescent room lights d. Examining the client's retinas for signs of damage

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

An older adult who is on bed rest after surgery is prescribed morphine for pain. Which of the following is the nurse's priority for preventive care? a. Constipation b. Diarrhea c. Poor solid food intake d. Poor liquid intake

ANS: A This older adult is at high risk for developing constipation as a result of being on bed rest and being prescribed an opiate for pain. A decrease in activity, combined with the use of an opiate, often leads to constipation, not diarrhea. Appetite can be poor for the first few days after surgery, but it often returns without incidence. Decreased fluid intake is often supplemented with intravenous fluids for the first few days after surgery.

Which action should be included in all bladder-retraining programs? a. Toileting at bedtime b. Using adult incontinence pads c. Toileting every hour d. Providing 1000 mL of fluids daily

ANS: A Toileting at bedtime should be incorporated for all clients. This intervention decreases the amount of urine in the bladder during the night. Incontinence pads are not encouraged during the retraining process. Toileting is not automatically scheduled every hour but is based on the individual's needs. The volume of scheduled fluid intake is also based on the individual's needs.

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

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

A nurse is administering medications to an older client who has renal insufficiency. The nurse understands which of the following? (Select all that apply.) a. Certain drugs may need to be avoided in this client. b. Certain drug dosages may need to be adjusted based on this client's creatinine clearance. c. Larger doses of most drugs frequently need to be administered in this client. d. This client should never be administered acetaminophen (Tylenol). e. Drug effects would in general be diminished in this client.

ANS: A, B Drugs that are metabolized in the kidneys may need to be avoided and/or dosages adjusted based on the client's creatinine clearance. Dosages of drugs usually are decreased in a client with renal insufficiency. Due to renal insufficiency drug effects would be increased, not decreased. In general, Tylenol is not avoided in older clients, it is just limited to a maximum of 4 g/day. Tylenol is of greatest concern in a client with hepatic issues.

A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a care plan related to oral care. Which of the following should the nurse consider for this patient? (Select all that apply.) a. Teeth should be brushed twice daily. b. Toothbrush should ideally be connected to wall suction. c. Lemon glycerin swabs should be used in between feedings to keep the mouth clean. d. Foam swabs should be used in place of a toothbrush to clean the teeth after each tube feeding. e. Oral care with lemon glycerin swabs should be provided daily if the older adult is edentulous.

ANS: A, B Tube feeding is associated with significant pathologic contamination of the mouth, greater than individuals who receive oral feeding. Oral care should be provided twice daily for patients with gastrostomy tubes and teeth should be brushed with a toothbrush attached to wall suction to decrease the risk of aspiration pneumonia. Lemon glycerin swabs should never be used for oral care, as they dry and inhibit saliva production. Foam swabs do not remove plaque as well as toothbrushes.

An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga b. Tai Chi c. Swimming d. Pilates e. Weightlifting

ANS: A, B Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling. Swimming, Pilates, and weightlifting do not do this.

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

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

What are the reasons for completing a cultural assessment? (Select all that apply.) a. Culture guides decision-making about health, illness, and preventive care. b. Culture provides direction for individuals on how to interact during health care encounters. c. Culture impacts attitudes toward aging. d. All members of a culture react in the same way in similar situations. e. Knowledge of culture eliminates health care disparities.

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

Which of the following are age related changes that affect hydration status? (Select all that apply.) a. Decrease in thirst sensation b. Decrease in total body water c. Decrease in ability of kidneys to maximally concentrate urine d. Decrease in bone marrow mass e. Decrease in bladder capacity

ANS: A, B, C As one ages, thirst sensation decreases and is not proportional to metabolic needs in response to dehydrating conditions. There is a decrease in total body water. The kidneys are less able to maximally concentrate urine resulting in a loss of water. While there is a decrease in bone marrow mass, this does not impact hydration status. As one ages, bladder capacity decreases, however this does not directly impact hydration status.

Through which pathway(s) are drugs and their metabolites eliminated? (Select all that apply.) a. Sweat b. Saliva c. Kidneys d. Spleen

ANS: A, B, C Drugs and their metabolites are excreted in sweat, saliva, and other secretions but primarily through the kidneys. Metabolites are not eliminated through the spleen.

A nurse is conducting education on urinary incontinence at a senior center. The nurse is discussing lifestyle changes that are associated with an improvement in urinary incontinence. The nurse includes which of the following interventions? (Select all that apply.) a. Weight reduction b. Smoking cessation c. Increase in physical activity d. Fluid restriction e. Blood sugar control

ANS: A, B, C Several lifestyle factors have been associated with an improvement in UI. These include increased fluid intake, smoking cessation, bowel management, physical activity, and weight reduction. Fluid restriction is not an intervention associated with an improvement in urinary incontinence, nor is blood sugar control.

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

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

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

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

Common causes of polypharmacy in older clients include which of the following? (Select all that apply.) a. Use of multiple different health care providers b. Presence of multiple chronic conditions c. Use of multiple pharmacies to obtain medications d. High cost of medications e. Lack of adequate education on medications

ANS: A, B, C, E Polypharmacy is a common problem in older adults. Contributing factors include multiple chronic conditions, multiple health care providers, use of multiple pharmacies and inadequate education on medications provided to the client.

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

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

Continuous indwelling catheter use is indicated for which condition(s)? (Select all that apply.) a. Urethral obstruction b. Urinary retention c. Stress incontinence d. Severely impaired skin integrity e. Gait impairment

ANS: A, B, D Continuous indwelling catheter use is indicated for those with urethral obstruction or urinary retention because these clients are unable to empty their bladder without this device. Stress incontinence is not a condition that warrants a continuous indwelling catheter. Continuous indwelling catheter use is indicated for clients with severely impaired skin integrity to decrease the risk of further deterioration of skin integrity. Immobility is not an evidence-based indication for an indwelling catheter.

The ANA Scope and Standards of Gerontological Nursing (2010) addresses which of the following? (Select all that apply.) a. The skills and knowledge required to address gerontological client needs b. The levels of gerontological nursing practice c. Requirements for certification as a gerontological nurse d. Standards of gerontological nursing practice e. Continuing education requirements for gerontological nurses

ANS: A, B, D The ANA Scope and Standards of Gerontological Nursing provides a comprehensive overview of the scope of gerontological nursing, the skills and knowledge required to address the full range of needs related to the process of aging, and the specialized care of older adults as a group and as individuals. The document also identifies levels of gerontological nursing practice (basic and advanced) and standards of clinical gerontological nursing care and gerontological nursing performance. Certification requirements and continuing education requirements are not addressed.

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

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

In the document "Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults" developed by AACN and the Hartford Institute for Geriatric Nursing, New York University, recommendations include which of the following? (Select all that apply.) a. Provision of a free-standing course in gerontology within the curriculum b. Integration of gerontological content throughout the curriculum c. Requirement of gerontological certification for all students prior to completion of a BSN program d. Structured clinical experiences with older adults across the continuum of care e. Faculty with expertise in gerontological nursing

ANS: A, B, D, E Best practice recommendations for nursing education include provision of a stand-alone course, as well as integration of content throughout the curriculum so that gerontology is valued and viewed as an integral part of nursing care. It is important to provide students with nursing practice experiences caring for elders across the health-wellness continuum. Faculty with expertise in gerontological nursing is an important recommendation.

According to Healthy People 2020, older adults have been identified as a priority, addressing goals to improve dental health. Identify the correct dental health goals for older adults. (Select all that apply.) a. Reduce the proportion of adults with untreated dental decay. b. Prevent and control oral and craniofacial diseases, conditions, and injuries. c. Reduce the proportion of oral and pharyngeal cancers detected at the earliest stages. d. Improve access to preventive services and dental care. e. Reduce the proportion of older adults with untreated caries. f. Increase the proportion of older adults 65 to 74 years of age who have lost all of their natural teeth.

ANS: A, B, D, E In a push toward wellness, older adults were identified as a priority area for the first time. Good oral hygiene and timely assessment of oral health are essentials of nursing care.

An older adult reports symptoms of xerostomia. Which of the following intervention should the nurse implement for this patient? (Select all that apply.) a. Encourage the patient to brush and floss teeth regularly. b. Encourage the patient to have regular dental screenings. c. Provide antiseptic mouth wash (such as Listerine) for the patient. d. Encourage adequate intake of water. e. Provide saliva substitutes.

ANS: A, B, D, E Individuals with xerostomia should have regular dental screenings and be encouraged to practice good oral hygiene. Adequate intake of water is important, as if avoidance of alcohol and caffeine. Saliva substitutes may be helpful. Antiseptic mouth washes usually contain alcohol which can further dry the mouth.

Long-term use of external catheters can lead to which complication(s)? (Select all that apply.) a. Fungal skin infections b. Penile skin maceration c. Atrophy d. Edema e. Urinary tract infection

ANS: A, B, D, E Long-term use of external catheters can lead to fungal skin infections, penile skin maceration, edema, fissures, contact burns from urea, UTIs, and septicemia. The catheter should be removed and replaced daily, and the penis cleaned, dried, and aired to prevent irritation, maceration, and the development of pressure ulcers and skin breakdown. If the catheter is not sized appropriately and applied and monitored correctly, then strangulation of the penile shaft can occur. Atrophy has not been identified as a complication.

Common iatrogenic complications for hospitalized older adults include (Select all that apply.) a. delirium. b. new onset incontinence. c. acute myocardial infarction. d. hip fracture. e. falls.

ANS: A, B, E Common iatrogenic complications include functional decline, pneumonia, delirium, new-onset incontinence, malnutrition, pressure ulcers, medication reactions, and falls.

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

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

Which of the following nursing interventions should be implemented to prevent dehydration in hospitalized older adults? (Select all that apply.) a. Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection b. Limiting duration of NPO requirements for diagnostic tests and procedures c. Administering IV fluids to all hospitalized older adults d. Limiting the use of diuretic medications in hospitalized older adults e. Making sure that hospitalized patients have easy access to fluids

ANS: A, B, E In order to prevent dehydration, it is essential to closely monitor hospitalized older adults. Any individual who develops fever, diarrhea, vomiting, or an infection should be monitoring closely by implementing intake and output records and providing additional fluids. NPO requirements for diagnostic tests and procedures should be as short as possible. It is not appropriate to administer IV fluids to all hospitalized older adults. IV fluids are administered when there is a clinical indication. It is not appropriate to limit the use of diuretics. Diuretics are an important treatment for many older patients. Hydration management involves acute and ongoing management of oral intake. Oral hydration is the first line of treatment for dehydration prevention.

Which herbal supplement(s) when taken with an anticoagulant increases the effectiveness of the medication and should be avoided during anticoagulant therapy? (Select all that apply.) a. Garlic b. Ginkgo c. Hawthorn d. Ginseng e. Green tea

ANS: A, B, E The intake of garlic, ginkgo, ginseng, and green tea supplements at home should be avoided because each increases the effectiveness of anticoagulation. Individuals should avoid these herbal supplements while taking an anticoagulant because the client's blood will be significantly less able to clot, exposing him or her to the risk of a catastrophic injury in the event of a fall or trauma. The use of Hawthorn supplements has not been shown to affect the use of anticoagulants.

Advanced Practice Nurses have demonstrated the most significant impact in improving which of the following for older adults? (Select all that apply.) a. Health outcomes b. Length of stay c. Cost-effectiveness d. Reimbursement measures e. Interprofessional communication

ANS: A, C Advanced practice nurses have demonstrated their skill in improving health outcomes and cost-effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams. This role is well established, and positive outcomes include increased client and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving.

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

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

Which of the following organizations have interdisciplinary membership? (Select all that apply.) a. Gerontological Society of America b. National Gerontological Nurses Association c. American Society on Aging d. Association of Gerontology in Higher Education e. National Association Directors of Nursing Administration in Long Term Care

ANS: A, C, D Gerontological Society of America, American Society on Aging, and Association of Gerontology in Higher Education are all interdisciplinary organizations. National Gerontological Nurses Association and National Association Directors of Nursing Administration in Long Term Care are nursing organizations.

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

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

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

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

A nurse will be conducting an education session at the local senior citizen's center on the importance of physical activity. Which activities should the nurse include as an example of moderate-intensity aerobic activity? (Select all that apply.) a. Biking b. Range of motion (ROM) c. Weightlifting d. Swimming e. Brisk walking

ANS: A, D, E Biking, swimming, and brisk walking are classified as moderate-intensity aerobic activity. ROM exercises are classified as stretching activities. Weightlifting is considered an exercise that uses body weight and is a muscle-strengthening activity.

The nurse should encourage which of the following exercise(s) to assist with balance for a client who is at high risk for falls? (Select all that apply.) a. Tai chi b. Use of resistance bands c. ROM activities d. Stretching e. Yoga

ANS: A, E Tai chi and Yoga are considered balance exercises. The use of resistance bands is considered muscle strengthening, and ROM and stretching activities are considered stretching exercises.

A nursing home executive interviews RNs to fill a full-time position for direct client care to maintain the standards of elder care. Which nurse should the nursing home hire? a. Nurse from a certified college b. Certified gerontological nurse c. Nurse with 15 years of experience d. Gerontological nurse practitioner

ANS: B A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15 years of experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gerontology, these nurses provide primary care in a nursing home.

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

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

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

ANS: B Aquatic exercises improve muscle strength and are important for improving circulation and endurance and providing socialization and relaxation. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle definition is a quality valued by bodybuilders, but it is not a therapeutic concern.

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

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

An older adult was seen after falling at home. The client receives a comprehensive assessment and it is determined the presence of a positive urine culture. The client is started on antibiotic therapy for a urinary tract infection. The client is surprised at the diagnosis since there was only indication of a low-grade fever. One reason why the client may not have developed a higher temperature is: a. The client's urinary tract infection was not yet serious enough to cause a significant increase in body temperature. b. Normal age-related changes to the immune system function affect an older person's response to illness; a low-grade fever may signify serious illness. c. Older adults do not run fevers when they are ill. d. This client likely has an alteration to her immune system that impacts her response to infection.

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

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

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

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

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

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

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

Based on current demographic data, which of the following statements identifies a predictive trend regarding the health care needs of society? a. Most nurses will not need to care for older persons. b. More nursing services will be required to serve the needs of the population older than 85 years of age. c. Fewer nurses will be needed to care for older adults since the older population is healthier. d. Older adults expect their quality of life to be less than that of earlier generations at their ages.

ANS: B Gerontological nursing will be the most needed specialty in nursing as the number of older adults continues to increase and the need for our specialized knowledge becomes even more critical in every specialty and every health care setting. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be over the age of 60 years than those under the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age.

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

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

Which client teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a. Exercise with light weights. b. The risk may be increased by inner ear issues. c. Train with the use of sit-ups. d. Work out in a swimming pool.

ANS: B Kinesthetic sense, or proprioception (awareness of one's position in space), is altered because of changes in both the peripheral and the central nervous systems. If one is less aware of body position and has less tactile awareness, the risk for falling is dramatically increased and may be exasperated by inner ear issues. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance.

An older client who has a history of atrial fibrillation, s/p MI, and HTN is on Warfarin, Aspirin, and a Beta Blocker, is purchasing lunch in the cafeteria after his outpatient appointment. Which of the following meals is most appropriate for this client? a. Tuna salad on a bed of spinach and a glass of a cup of decaffeinated coffee b. Tuna salad sandwich on whole wheat bread and a cup of decaffeinated coffee c. Tuna and kale salad with a whole wheat role and a cup of decaffeinated coffee d. Large romaine lettuce salad with broccoli, carrots, tomatoes, and grilled chicken and a cup of decaffeinated coffee

ANS: B Leafy green vegetables decrease the anticoagulant effects of warfarin. A tuna salad sandwich on whole wheat bread and a cup of decaffeinated coffee does not include leafy green vegetables.

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

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

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

ANS: B Older adults in most cultures usually have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is not uncommon for older adults to pray for cures or wonder what they did to incur an illness as punishment. The Ayurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of a holistic or naturalistic approach.

An older woman asks a nurse, "You always seem to be telling me that I need to drink more water. How much water do I really need to drink?" The nurse bases her response on the knowledge that a. older adults should consume at least 1000 mL of fluid per day. b. older adults should consume at least 1500 mL of fluid per day. c. older adults should consume at least 2000 mL of fluid per day. d. older adults should consume at least 2500 mL of fluid per day.

ANS: B Older adults with the exception of those who require a fluid restriction should consume at least 1500 mL of fluid per day.

The nurse completes an admission assessment on an older adult client. The nurse identifies which factor that may contribute to sleep problems? a. Exposure to sunlight b. Polypharmacy c. Use of a sleep aid d. Decreased fluid intake

ANS: B Polypharmacy contributes to sleep problems as a result of medication side effects and drug interactions. Decreased exposure to sunlight contributes to sleep problems. Sleep aids may assist with sleep issues. Decreased fluid intake may lead to dehydration, which may result in lethargy.

Which factor increases the risk for chronic dehydration in older adults? a. Overuse of diuretic agents b. Poor cognitive function c. Dry mucous membranes d. Fluid loss from vomiting

ANS: B Poor cognitive functioning, depending on others for ambulation, living in a residential facility, and having four chronic illnesses are factors that increase the risk of chronic dehydration. An overuse of diuretic agents is more likely to cause acute dehydration. Dry mucous membranes are reliable indicators of chronic dehydration. Fluid loss from vomiting leads to acute dehydration.

An older adult with a gastrostomy tube has difficulty using the dominant hand. Which of the following should the nurse provide to prevent complications of the gastrostomy tube? a. Use foam swabs to brush the teeth. b. Provide teeth brushing at least twice a day. c. Supply a soft toothbrush and floss. d. Position the patient at 90 degrees for tube feedings.

ANS: B Recommendations are that individuals receiving tube feeding should have their teeth brushed twice a day to decrease the microorganism count in the mouth of an older adult with a gastrostomy tube. Foam swabs are ineffective tools to remove plaque, regardless of the toothpaste. Because this older adult has difficulty with the dominant hand, providing oral care supplies can be a waste of time, unless the nurse assists the older adult to maintain oral health with the supplies. The nurse positions the older adult at a 30- to 45-degree angle during tube feedings to facilitate gastric emptying.

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

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

Which of the following statements is true about the National Hartford Centers of Gerontological Nursing Excellence initiative? a. It was developed to support the professional development and leadership growth of nurses who provide care to older adults in long-term care. b. It offers a Distinguished Educator in Gerontological Nursing Program. c. It provides predoctoral and postdoctoral scholarships for study and research in geriatric nursing. d. It developed the first certification in gerontological nursing.

ANS: B The National Hartford Center of Gerontological Nursing Excellence offers a Distinguished Educator in Gerontological Nursing Program. Sigma Theta Tau's Center for Nursing Excellence in Long-Term Care sponsors the Geriatric Nursing Leadership Academy (GNLA) and offers a range of products and services to support the professional development and leadership growth of nurses who provide care to older adults in long-term care. The ANA developed the gerontological certification exam.

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

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

A community health nurse provides an annual flu prevention workshop at a local senior center. The activities include a lecture on preventing infections, which includes hand washing and limiting exposure to individuals who are ill, as well as an influenza immunization clinic. The nurse is basing her activities on what theory of aging? a. Free radical theory b. Inflamm-aging c. Oxidative stress theory d. Telomere theory

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

Which organization had the largest role in enhancing the specialty of gerontological nursing? a. American Association of Retired Persons (AARP) b. John Hartford Foundation c. Medicare d. Mutual of Omaha Insurance

ANS: B The most significant influence in enhancing gerontological nursing has been the work of the Hartford Institute for Geriatric Nursing, funded by the John A. Hartford Foundation. The foundation seeks to shape the quality of the nation's health care for older Americans by promoting geriatric nursing excellence to both the nursing profession and the larger health care community. Initiatives in nursing education, nursing practice, nursing research, and nursing policy include enhancing geriatrics in nursing education programs through curricular reform and faculty development and the development of nine Centers of Geriatric Nursing Excellence. AARP is a foundation that helps struggling seniors by being a force for change on the most serious issues they face today. Medicare is a national social insurance program, administered by the US federal government since 1965, that guarantees access to health insurance for Americans ages 65 years and older and younger people with disabilities. Mutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska.

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

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

The nurse is caring for a client who has recently had an indwelling catheter placed. The nurse should assess the client for what outcome? a. An increase in oral fluid intake b. A change in mental status c. Upper back pain d. A decrease in activity

ANS: B The nurse assesses the older adult's mental status. Changes in mental status, character of urine, decreased appetite, abdominal pain, chills, low back pain, urethral discharge in men, new onset of incontinence, or even respiratory distress may signal a possible UTI in older people. An indwelling catheter does not often cause a decrease in activity.

The nurse plans activities for older client born between in 1918 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b. Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d. Take them to the library for guest speakers.

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

The nurse assesses a male resident in a nursing home for urinary incontinence and determines that he is unaware of the problem. Which recommendation should the nurse implement? a. Limit oral fluid intake. b. Provide regular toileting. c. Apply absorbent undergarment. d. Encourage frequent rest periods.

ANS: B The nurse provides regular toileting to promote voiding and to prevent incontinence for a resident with a potential cognitive impairment. The nurse avoids limiting oral fluid intake; older adults, especially those living in residential facilities, are at higher risk for dehydration than younger people. Using absorbent undergarments may be unnecessary if the incontinence can be controlled with regular toileting. Nursing research supports the claim that ambulatory residents are less likely to be incontinent. This resident may have dementia but maintaining mobility will have a greater impact in preventing incontinence.

Mezey and Fulmer (2002) justify gerontological nursing research and the work of gerontological advanced practice nurses by concluding the following: a. Other scientists devalue gerontological nursing research. b. The research influences outcomes from nursing care in a positive way. c. Gerontological care is expensive but required in long-term care. d. Gerontological nursing research is well known to practicing nurses.

ANS: B The practices of advanced practice nurses, who base their practice on nursing research, have resulted in positive older adult outcomes and cost-effectiveness. The scientific community widely accepts the research. Advanced practice nurses generate positive outcomes and are cost effective in many settings. Mezey and Fulmer believe the goal of gerontological nursing is to disseminate the knowledge from gerontological nursing research to all nurses and to have the knowledge applied to their practices.

The nurse wants to begin helping a resident who is overweight and has urinary incontinence develop healthy bladder behavior skills. Which intervention should the nurse implement? a. Begin a low-calorie diet for weight management. b. Schedule voiding on common voiding patterns. c. Instruct the resident to practice abdominal exercises. d. Reduce the time between an urge to void and voiding.

ANS: B The schedule or timing of voiding can be based on common voiding patterns (voiding on arising, before and after meals, midmorning, midafternoon, and bedtime). Beginning a low-calorie diet can be a reasonable approach to urinary incontinence, but the nurse first applies low-cost behavioral techniques. Pelvic floor exercises will help control urinary incontinence. Bladder training involves increasing the time between the urge to void and voiding.

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

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

A nurse is observing a nurse aide perform denture care for a resident in the nursing home. The nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following? a. The nurse aide places a face cloth in the sink and fills the sink half full with water. b. The nurse aide uses toothpaste to clean the dentures. c. The nurse aide utilizes a specially designed denture brush to clean the dentures. d. The nurse aide stores the dentures in a denture cup filled with denture cleansing solution.

ANS: B Toothpaste is not used to clean dentures since it abrades denture surfaces. All of the other options are correct steps in the process to cleanse dentures.

The nurse prepares an older client for discharge through an interpreter and notes that the client becomes tense during the instructions about elimination. Which intervention should the nurse implement? a. Move onto the discussion about medication. b. Ask the client how they feel about this topic. c. Instruct the interpreter to repeat the instructions. d. Have the client repeat the instructions for clarity.

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

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

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

A nurse is reviewing an older resident's medication list in a long-term care facility. The nurse notices that two of the medications are on the Beer's Criteria. The nurse understands what about the Beer's Criteria: (Select all that apply.) a. It lists medications that are not permitted to be administered in a long-term care facility. b. It lists medications that should be used in caution in older adults. c. It lists specific drug-drug interactions that are known to cause harm in older adults. d. It lists medications that need to be dose adjusted in older adults with impaired kidney function. e. It lists medications that are not reimbursed by Medicare and Medicaid.

ANS: B, C, D The Beers Criteria includes lists of medications that have been demonstrated to cause harm; those specific drug-drug interactions known to cause harm, medications that should only be used with caution and those that require dosage adjustments in the presence of altered kidney function.

Common anticholinergic side effects include which of the following? (Select all that apply.) a. Ataxia b. Blurred vision c. Confusion d. Urinary retention e. Hallucinations

ANS: B, C, D, E Common anticholinergic side effects include confusion, blurred vision, hallucinations, and urinary retention.

What are common side effects of selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Decreased appetite b. Dry mouth c. Nausea d. Sexual dysfunction e. Dizziness

ANS: B, C, D, E The SSRIs and SNRIs have been found to be highly effective, with minimal or manageable side effects, and are the drugs of choice for use in older adults. Most of these cause initial problems with nausea or a dry mouth. While effective, these must be used with caution especially related to serum sodium levels. The SSRIs should also be used with caution in persons with a history of falls due to the potential to produce ataxia or dizziness. One side effect of the SSRIs that does not resolve with time, if experienced, is sexual dysfunction.

Which diseases are associated with aging and inflammation noted in older adults? (Select all that apply.) a. Hypertension b. Dementia c. Diabetes Type 2 d. Rheumatoid arthritis e. Sarcopenia f. Chronic skin ulcers

ANS: B, C, D, F Dementia, diabetes type 2, rheumatoid arthritis, and sarcopenia all are triggered to varying degree by age-related inflammation. Hypertension and chronic skin ulcers are associated with an accumulation of aging cells in the body.

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

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

A nurse is performing an admission assessment on an older patient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient's skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (Select all that apply.) a. Poor skin turgor over the sternum b. Lower extremity weakness c. High fever d. Sunken eyes e. Cough

ANS: B, D Older adults often present atypically when dehydrated. Skin turgor over the sternum is not a reliable marker in older adults due to the loss of subcutaneous tissue with aging. Lower extremity weakness and sunken eyes may indicate dehydration. High fever and cough can be associated with many other conditions and are not typically signs of dehydration.

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

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

In assessing an older adult, which question is likely to elicit the most accurate information about the individual's adherence to the medication plan? a. "You take digoxin at the correct time, don't you?" b. "Why didn't you take all of your digoxin last month?" c. "How many doses of digoxin do you think you missed?" d. "You have never missed a dose of digoxin, have you?"

ANS: C "How many doses of digoxin do you think you missed?" is a question that is worded to put the client at ease and to elicit information in a matter-of-fact way. "You take digoxin at the correct time, don't you?" sounds like a challenge to the client's personal qualities. In addition, the nurse is leading the client to the answer. The client is likely to respond simply, "Oh, yes." Although the question, "Why didn't you take all of your digoxin last month?" is meant to elicit the reason for nonadherence, it has an accusatory tone that is likely to make the client defensive. "You have never missed a dose of digoxin, have you?" is a question that can be interpreted as judgmental.

An older client who is receiving haloperidol is noted to have a change in mental status (increasing confusion). Upon assessment the nurse notes that the client has a fever, 102F, 92/60, 118, 24. The client is noted to have rigidity of the upper and lower extremities. The first action of the nurse is to do what? a. Administer acetaminophen for the elevated temperature. b. Place the client on fall precautions due to the rigidity of the lower extremities. c. Contact the medical provider immediately. d. Force fluids to treat the low blood pressure.

ANS: C A rare but potentially life-threatening ADE to antipsychotics is neuroleptic malignant syndrome (NMS). The most typical symptoms are fever greater than 100.4F, muscle rigidity, autonomic instability (e.g., labile BP, tachycardia), and altered mental status. Onset is rapid and unless treated appropriately death can occur quickly. The drug most associated with NMS is haloperidol but has also been seen when a person is taking chlorpromazine and promethazine. It occurs most often in the first 2 weeks of the start of treatment but must also be considered whenever a dose is increased. The medical provider must be contacted immediately as this is a medical emergency.

During a routine physical examination, the client reports, "I have problems falling asleep at night. I regularly engage in vigorous exercise to tire myself every evening." What response by the nurse is indicated? a. "Exercise is recommended and should be done immediately before bedtime to tire you out." b. "Exercise should only be done in the morning; otherwise, it can ruin your sleep." c. "A regular exercise regimen is helpful; it can deepen sleep but should not be done immediately before bedtime." d. "Exercise is helpful, but vigorous exercise can lead to restless leg syndrome which can contribute to insomnia."

ANS: C A regular exercise regimen, for those who are able, can deepen sleep, increase daytime arousal, and decrease depression. It is important, however, to avoid exercise before bedtime but rather implement a relaxing bedtime routine. Vigorous exercise is not a contributor to restless leg syndrome.

Which statement best relates information regarding characteristics of acute care for the elderly (ACE) units? a. They are seldom a part of a hospital facility. b. They facilitate admission to nursing home situations. Association (ANA) offered a certification program. c. They support promotion of health and support for maximal independence. d. Their purpose is to rehabilitate any hospital incurred functional disability.

ANS: C ACE units are distinct areas of a hospital specifically designed to reduce the incidence of functional disability of older adults occurring during hospitalization for acute medical illness by proactively identifying and managing geriatric syndromes to help maintain the patient's function, reducing admission to nursing homes, and lowering the cost of hospitalizations.

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

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

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

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

Which of the following is a true statement about dental health in older adults? a. Most people can expect to lose most of their teeth by old age. b. Excessive saliva production is a common problem among older adults. c. Dentures should be cleaned once a day with a thoroughly brushing. d. A little blood on the toothbrush is normal.

ANS: C Careful cleaning of dentures is necessary to prevent the buildup of residues that contribute to staining and odor, as well as to infection. Older adults can lose teeth, but more adults are retaining their teeth into older age. Tooth loss is most often a result of periodontal disease. Inadequate saliva production (xerostomia) is a common problem for older persons. Bleeding gums is a sign of periodontal disease.

A large residual urine volume characterizes what type of incontinence? a. Urge b. Stress c. Overflow d. Functional

ANS: C Dribbling, hesitancy, and a large residual urine volume characterize overflow incontinence. Both urge incontinence and stress incontinence are associated with a small residual urine volume. Functional incontinence is not associated with residual urine volume

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

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

A home health nurse visits an older woman who was recently been discharged from a sub-acute rehabilitation facility where she went after a Left hip ORIF. The client ambulates steadily and slowly with a rolling walker. The client reports that she has an "embarrassing problem" and states that she doesn't always make it to the bathroom, and often wets herself on the way. She attributes this to the fact that she moves slowly. The client has no complaints of burning or pain on urination. The nurse suspects which type of urinary incontinence? a. Stress b. Overflow c. Functional d. Urge

ANS: C Functional incontinence is related to the inability to get to the bathroom due to mobility or environmental issues. This client moves slower and therefore cannot get to the bathroom in time. None of the other options are associated with this scenario.

A nurse administers hypodermoclysis (HDC) to an older nursing home resident. What is the purpose of hypodermoclysis? a. To rehydrate an individual with severe dehydration b. To quickly administer 4 to 5 L of fluid within a 24-hour period c. To rehydrate an individual with mild to moderate dehydration d. As a supplement to IV hydration to expedite rehydration

ANS: C HDC is an infusion of isotonic fluids into the subcutaneous space. It is an alternative to IV administration for individuals with mild to moderate dehydration. It cannot be used in individuals with severe dehydration or for any situation requiring more than 3 L over 24 hours.

A nurse is preparing to administer medications to an older client. The nurse consults the drug reference book, which provides the half-life of the drug. The nurse understands that half-life is defined as what? a. The amount of time that the drug is stable once prepared. b. The amount of time that it takes for the drug to be excreted by the body. c. The amount of time that the drug remains active in the body. d. The amount of time between drug ingestion and absorption.

ANS: C Half life is defined as the amount of time that the drug remains active in the body.

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

ANS: C Hispanic men and women have the highest life expectancy of all. This information makes all the other options incorrect.

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

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

The nurse should understand that stress incontinence occurs related to what? a. A urinary tract infection (UTI) b. Emotional strain c. Increased intra-abdominal pressure d. Amount of urine in the bladder

ANS: C If intra-abdominal pressure increases, then the client can have dribbling. A UTI causes frequency as a result of irritation in the bladder. Emotional strain can cause frequency. Specific volume of urine in the bladder triggers reflex incontinence.

When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse is confident that client education on the condition's contributing factors has been effective when the client make what statement? a. "A warm bath at night instead of in the morning is my new routine." b. "Eating a banana at breakfast assures me the potassium I need." c. "I've cut way back on my caffeinated coffee, teas, and sodas." d. "I elevate my legs on a pillow so as to improve circulation."

ANS: C Increased caffeine use can be a contributing factor to RLS. There is no research to confirm that a warm bath prior to sleep or elevating the legs will minimize/prevent RLS. A potassium deficiency has not been identified as a contributing factor to RLS.

The nurse provides instruction about medication safety to older adults. Which instruction should the nurse provide? a. Nausea and vomiting are common, harmless drug side effects. b. Keep a supply of medications at the bedside for convenience. c. Provide information to describe the purpose of therapy. d. Take your daily medications on an empty stomach with water.

ANS: C Older adults should be provided information regarding the purpose of each drug and record the information. Although nausea and vomiting are among the most common adverse effects of pharmacotherapy, they can indicate medication toxicity and should be reported to the health care provider. Keeping a medication at the bedside is dangerous for anyone and can be especially dangerous for older adults who are taking antianxiety agents, hypnotic agents, and opioid analgesics; these and other medications can cause respiratory depression with and without excessive dosing. If sleepy or lethargic, then the older adult can inadvertently take more than the correct dose and suffer serious consequences as a result. Taking a medication on an empty stomach with water is a suitable instruction for many medications; however, many medications that are likely to cause nausea are taken with food. The nurse should instruct older adults to keep a record of the recommended method of administration.

A nurse is caring for an older adult in a nursing home. During medication reconciliation, the nurse notes that the client is prescribed two medications that are listed on the Beer's criteria. What is the best action by the nurse? a. Refuse to administer the medications. b. Substitute an alternate medication of the same drug classification. c. Contact the prescriber and to inform the prescriber that the medications are on the list. d. Inform the resident.

ANS: C The Beer's Criteria includes lists of medications that have been demonstrated to cause harm; those specific drug-drug interactions known to cause harm, medications that should only be used with caution and those that require dosage adjustments in the presence of altered kidney function. The best action by the nurse is to contact the prescriber and notify him/her of the fact that the medications are on the Beer's list. The nurse cannot substitute a medication without a prescriber's order, nor should the nurse refuse to administer the medications. Informing the resident is important, but most important is resolving the issue with the prescriber.

What is one of the goals of Nurses Improving Care for Health System Elders-Long Term Care (NICHE-LTC)? a. To insure that all older adults are only cared for by nurses who are certified in gerontological nursing. b. To decrease the cost of care for hospitalized older adults. c. To increase access to care for adults age 64 and older. d. To promote the role of the Geriatric Certified Nursing Assistant.

ANS: D The vision of NICHE is for all clients 65 and over to be given sensitive and exemplary care.

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

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

Which statement accurately describes gerontological nursing education? a. Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. b. Undergraduate nursing programs extensively cover gerontological nursing in dedicated courses, comparable with the coverage of psychiatric nursing. c. The Hartford Foundation has funded significant work regarding the specialty of gerontological nursing. d. Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum.

ANS: C The most significant influence in enhancing the specialty of gerontological nursing has been the work of The Hartford Institute for Geriatric Nursing, established in 1996 and funded by the John A. Hartford Foundation. Only recently has gerontological nursing content begun to appear in nursing school curricula. Most nursing schools still do not have such courses. At present, no minimum requirements exist for the coverage of care of older adults.

An older adult male maintains an active lifestyle playing various games with friends. He reports to the nurse that he experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this client's sleep? a. Recommend preparation for sleep. b. Suggest trying a cup of warm milk at bedtime. c. Inquire about his nightly sleep rituals. d. Propose regular volunteer work.

ANS: C The nurse completes an assessment of the client's sleeping habits and other pertinent information before planning care and implementing nursing interventions to individualize therapy. Preparing for sleep is a reasonable intervention to propose after completing an assessment. Sipping warm milk is also a reasonable intervention to suggest after completing an assessment. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment.

The gerontological nurse collaborates with the wound care team about an older client who has an ulcer. How is this nurse demonstrating leadership in the care of older people? a. Assessing older adults effectively b. Facilitating access to elder care programs c. Coordinating members of the health care team d. Empowering older adults to manage chronic illness

ANS: C The nurse demonstrates leadership in the care of older adults by initiating and coordinating collaboration with the wound care team to improve the health of an older adult. Screening and assessing are only indirectly related to collaboration. In this case, the nurse's collaborative efforts are unrelated to facilitating access to a program. Thus far, the nurse has not educated or trained this client in wound care.

An older woman tells the nurse practitioner that she fears her family will place her in a nursing home because she developed stress incontinence. Which recommendation should the nurse implement? a. Tell her to eliminate the use of caffeinated beverages. b. Coordinate a family conference with the older adult. c. Recommend exercises to strengthen the pelvic floor. d. Schedule voiding for every 2 hours around the clock.

ANS: C The nurse practitioner recommends pelvic floor exercises to strengthen the pelvic floor and the muscles that surround the urethra, vagina, and rectum to decrease the incidence of stress incontinence. Stress incontinence is usually due to weakened pelvic floor muscles; therefore, eliminating caffeinated beverages can be an ineffective treatment. Arranging a family conference is premature and potentially embarrassing for the older adult. Many therapies are available to decrease this older adult's incontinence. Scheduled voiding is recommended at 2- to 4-hour intervals during the day and at 4-hour intervals at night.

Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service b. Wheels ambulatory adults to exercise when running late c. Basing interventions on the client's functional abilities d. Allows older adults in a nursing home to eat meals alone

ANS: C The nurse uses a holistic approach to the care when tailoring care needs to support the client's optimal level of health independent. Interrupting an older adult's worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adult's life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in a wheelchair to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, while focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being.

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

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

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

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

In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include which of the following? a. Speaking to the client sternly and instructing the client to open the mouth and cooperate immediately b. Having another nurse aide assist in holding the client's mouth open with a tongue depressor c. Involving the client in the process of oral hygiene, such as using the hand over hand technique to brush the client's teeth d. Quickly performing oral hygiene without explanation since the client is uncooperative

ANS: C With uncooperative individuals, it is important for the caregiver to be at eye level and explain all actions with step by step instructions. Speaking to the client sternly, having another nurse aide hold the patient's mouth open or performing oral hygiene without an explanation will only serve to agitate the patient. Involving the client and having the client participate to the extent possible is important. Using a hand over hand technique is effective.

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

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

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

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

An older adult diagnosed with moderate dementia is seen in the geriatric clinic. As the nurse is evaluating the client, the client's wife states that her husband has developed an increasing number of episodes of incontinence. She does not know what is precipitating the episodes, and states "maybe he just doesn't remember that he needs to urinate or maybe it's me, it takes me a while to walk him to the bathroom." The nurse develops a plan of care for this client and includes which of the following interventions to manage the incontinence? (Select all that apply.) a. Use of adult incontinence briefs b. Use of an external catheter c. Development of a toileting schedule d. Use of a commode close by to where the client spends most of his time e. Bladder diary to be completed by the client's wife

ANS: C, D, E A bladder diary is a helpful tool used to assess an individual's voiding patterns and to assist in assessment of incontinence. Development of a toileting schedule can be helpful in individuals with dementia who might no longer be aware of the cues to void. A commode may be helpful in this case as the wife indicates that it takes her some time to bring her husband to the toilet. Adult incontinence briefs and external catheters are not first line interventions for this individual.

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

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

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

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

The nurse observes that a male client is snoring every night. Which should the nurse assess in this client to diagnose the potential for sleep apnea? (Select all that apply.) a. Change in appetite b. Rituals for sleeping c. Number of daytime naps d. Headaches in the morning e. Irritability during the day f. Awakening during the night

ANS: C, D, E, F The nurse asks the client to evaluate how restorative or refreshing sleeping is for him; awakening unrefreshed is a risk factor for sleep apnea. In addition, morning headaches, daytime irritability and personality changes, and periods of nighttime wakefulness are all risk factors for sleep apnea. Changes in appetite and rituals for sleeping are rarely associated with an increased risk for sleep apnea.

A nurse is caring for an older adult resident in a long-term care facility who has a history of dementia and is becoming agitated. What is the best initial response by the nurse to the client's agitation? a. Call the prescriber and request an order for a psychotropic medication. b. Ignore the behavior since psychoactive medications have potentially dangerous side effects in older clients. c. Utilize only nonpharamacologic interventions to manage the client's behavior. d. Conduct a thorough nursing assessment of the client related to the client's behavior.

ANS: D A client should be prescribed a psychotropic medication only after thorough medical, psychological, and social assessments. Nursing assessment before medication intervention contributes knowledge and baseline information that can optimize the client's medical and psychological improvement. At the same time assessments should be done quickly to enable the client to receive the appropriate treatment as soon as possible. Pharmacological interventions should always be supplemented by nonpharmacological measures such as counseling, changes in the environment, and other actions which promote healthy aging.

What is the primary purpose of geriatric nursing certifications? a. Assuring the basic competency of the geriatric nurse b. Raising the level of professionalism for the geriatric facility c. Addressing the current shortage of specialized geriatric nurses d. Demonstrating commitment to the special needs of the geriatric client

ANS: D Certification assures the public of nurses' commitment to specialized education and qualification for the care of older adults. None of the other options accurately identify the primary purpose of geriatric nursing certification.

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

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

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

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

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

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

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

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

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

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

A client who reported "a problem sleeping" shows an understanding of good sleep hygiene when engaging in what action? a. Doing 10 pushups before bed to encourage a "pleasant tiredness" b. Seldom eating a bedtime snack c. Engaging in computer games as a prebed activity d. Limiting the afternoon nap to just 30 minutes

ANS: D Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while bedtime snack is acceptable if the food is light and so easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.

A man is terminally ill with end-stage prostate cancer. Which statement best describes the nurse's role regarding this man's wellness? a. Providing the client with aggressive medical interventions. b. It is not a real option for this client because he is terminally ill. c. Educating the client that wellness is dependent upon the absence of disease. d. Providing nursing interventions that can help empower a client to achieve his highest level of wellness.

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

Aging ordinarily leads to decreases in which of the following? a. Creatinine clearance and insulin secretion b. Blood carbon dioxide and saliva production c. Left ventricle-wall thickness and skin healing time d. Serum triiodothyronine (T3) and thyroxin (T4)

ANS: D Serum T3 and (T4) secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally remains unchanged. Left ventricle-wall thickness and skin healing time both increase with aging.

What is the difference between rest and sleep? a. Sleep occurs with rest. b. Rest is an extension of sleep. c. Rest occurs only in brief periods. d. Sleep is restorative and recuperative.

ANS: D Sleep provides an important survival tool to rest, restore, and rejuvenate the body. Rest occurs during sleep. Sleep is an extension of rest. Rest can occur in brief periods and in extended cycles during sleep.

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

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

Which of the following is a true statement? a. Urine flow gradually decreases in older age. b. Older adults generally need less fluid than younger people because of their lower body water content. c. Urine-specific gravity and skin turgor can be used to diagnose dehydration in older adults and in younger people. d. Multiple physiological changes of aging place older adults at a greater risk of dehydration.

ANS: D The loss of water-containing tissues, the loss of concentrating power in the kidneys, and a decreased sense of thirst all increase an older person's risk for dehydration. Urine flow does not diminish in old age. Specifically, it does not diminish in the presence of dehydration as it does in a younger patient. Lower body water content places an older patient at greater risk of dehydration, not a lower risk. These signs are less reliable in older age because of changes to the tissues.

The nurse notices that an older adult's urine is concentrated. Which step should the nurse implement next? a. Increase oral fluid intake. b. Review laboratory reports. c. Evaluate the medication list. d. Determine fluid volume status.

ANS: D The nurse assesses the older adult's fluid status to develop a suitable plan of care. The nurse selects the correct nursing interventions, depending on the cause of the problem. Increasing oral fluid intake is implemented after the nurse completes the fluid assessment, if the intervention is determined to be suitable. The nurse reviews pertinent laboratory data as part of the fluid assessment. The nurse evaluates the medication list as part of the fluid assessment to eliminate a medication as the cause of the dark urine.

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

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

What is the most important aspect of care for the nurse to maintain when assisting an older client with urinary incontinence? a. Availability of protective rubber garments b. Using indwelling urinary catheters c. Using smooth muscle relaxants d. Maintaining an attitude that is respectful and positive about resolving the problem

ANS: D The nurse recognizes that incontinence is a sign of an underlying problem and not an inevitable result of aging. In addition, the nurse offers dignity, hope, and understanding by maintaining a positive and respectful manner and by communicating that effective treatments are available. Rubber garments, in particular, are hot and can cause skin irritation. Internal catheters should be used only for a short time and under limited circumstances. Using a smooth muscle relaxant is indicated only for urge incontinence and for an overactive bladder.

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

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

When completing medication reconciliation for an older adult client, the nurse notes that the client is being discharged home on anticoagulant therapy. The nurse also notes that at admission, the client reported the use of herbal supplements at home. Which instruction should the nurse include during discharge teaching? a. "You may need to supplement with only ginkgo while on anticoagulant therapy." b. "You may need to increase the use of garlic supplements while on anticoagulant therapy." c. "Avoid using Hawthorn supplements while taking an anticoagulant medication." d. "Avoid drinking green teas while on anticoagulant therapy."

ANS: D The nurse's priority is to stop this older adult's intake of green teas at home; they will affect the effectiveness of anticoagulation. The client does not need to supplement with only ginkgo; the client should cease taking ginkgo while on anticoagulant therapy, as well as the use of garlic supplements. Both increase the effectiveness of anticoagulation. The use of Hawthorn supplements has not been shown to affect the use of anticoagulant medications.

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

ANS: D Those who are in the in-between cohort were born between 1920 and 1945. The men were likely to have fought in it. The last of the holocaust survivors are in this group. A person who survived the influenza epidemic would be over 100 years old and therefore would be considered old-old or a centenarian. Most of those who are of the in-between cohort had not reached childbearing age by the end of the Depression. Individuals in the in-between cohort would not have been old enough to fight in WWI.

An older adult client is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of hospice? a. Decrease the analgesic dose to prevent sedation. b. Provide a basin and towels for morning self-care. c. Inform family members about strict visiting hours. d. Facilitate family rituals related to death and dying.

ANS: D To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to clients, regardless of the setting or the nurse's personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adult's needs.