Gerontology Final Exam

2. Which of the following statements by an older adult indicates the need for further teaching related to cholesterol reduction? A) "I will decrease my intake of food high in polyunsaturated fatty acids." B) "I will increase my intake of soybeans, walnuts, and canola oil." C) "I will eat fish four times a week." D) "I will limit my intake of trans fatty acids and saturated fat."

Ans: A Nutritional interventions for cholesterol reduction limit foods containing saturated fats and trans fatty acids and increase foods that are high in polyunsaturated fatty acids

14. A 64-year-old obese man is admitted to the hospital for treatment of heart failure secondary to alcoholism. For which of the following negative consequences should the nurse assess? A) Chronic pain B) Obstructive sleep apnea C) Parkinson disease D) RLS

Ans: B Factors associated with increased risk for obstructive sleep apnea include obesity, diabetes, stroke, Parkinson disease, congestive heart failure, genetic predisposition, craniofacial anatomic features, and the use of alcohol or medications that depress the respiratory center.

15. An older adult at home uses earplugs to diminish street noise at night. Which of the following statements by the nurse is appropriate? A) "Using earplugs during sleep can damage your hearing." B) "I suggest a smoke alarm with blinking lights." C) "Your neighbors must be really loud." D) "This apartment sounds really unsafe."

Ans: B People who live alone should be cautioned about the danger of blocking out the sound of a smoke alarm; one that has lights increases the safety. Earplugs at night do not damage hearing

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

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

10. A hospice nurse admits an older adult after the metastasis of malignant melanoma. Which of the following health problems should the nurse anticipate? A) Necrosis of extremities B) Hemoptysis C) Hyperglycemia D) Dyspnea

Ans D Dyspnea is a common accompaniment to the dying process. Hyperglycemia, hemoptysis, and tissue necrosis are less common.

14. A nurse assesses residents of the acute care facility for pressure ulcers. Which older adult should the nurse monitor closely for pressure ulcers? A) The Asian with multiple nevi on extremities B) The Ethiopian former store clerk C) The fair-skinned Caucasian woman D) The wrinkled face Hispanic ranch worker

Ans: B Persons with darkly pigmented skin have a higher incidence of serious pressure ulcers. Nevi, sun exposure, and fail skin are related to cancer, not pressure ulcers

15. An older adult reflects, "Why should I go to the gym, I'm going to get fat anyway." Which response by the nurse is most appropriate? A) "Age-related changes are inevitable; however, most problems affecting older adults are related to risk factors, so it's important to do what you can to maintain a high level of functioning." B) "Older adults experience positive or negative functional consequences because of age-related changes." C) "Risk factors do impact consequences, but you can override them." D) "Many problems affecting older adults are based on genetics."

Ans: A Although age-related changes are inevitable, most problems affecting older adults are related to risk factors. Older adults experience positive or negative functional consequences because of a combination of age-related changes and additional risk factors. Interventions can be directed toward alleviating or modifying the negative functional consequences of risk factors.

1. A nurse assesses an older adult following the repair of an abdominal hernia. The older adult client states, "I really hate to take pain medication." Which response by the nurse is best? A) "Early treatment of pain helps now and can reduce the incidence of chronic pain." B) "Pain medication today doesn't really have any side effects." C) "Tell me about your fears regarding pain medication." D) "This pain you are having is normal, and as you heal, the pain level will decrease."

Ans: A Recent studies have focused on the complex mechanisms involved with the development of persistent postsurgical pain, finding that its incidence can be reduced with the use of aggressive and early analgesic therapy. The client does not express that they have "fear." Medications have side effects. The pain level may decrease with time. But if not treated, it is unlikely to and more likely to develop into persistent pain

4. A nurse hears a colleague make the statement, "Most older adults have nothing to worry about financially." Which of the following responses is most appropriate? A) "You have to remember that there's a huge economic disparity among older adults." B) "Actually, the number of older people living below the poverty line has been increasing, not decreasing." C) "This isn't really true now, but it is true that the gaps that disadvantaged groups live with are expected to shrink." D) "This is true for some groups, but not for minorities who are less likely to be living with their relatives."

Ans: A An important consideration with regard to economic conditions of older adults is the tremendous range in financial status, which varies significantly according to race, gender, and living arrangements. The number of adults living below the poverty line, however, has decreased in recent years. The disparities that separate disadvantaged groups from more economically secure older adults are predicted to persist. Minorities are more likely, not less likely, to be living with their relatives.

8. Active care management is often necessary in order to maintain wellness among older adults. Which of these older adults is most likely to require care management? A) A 90-year-old man who lives alone and has no living family members B) A 77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier C) An 81-year-old resident of a nursing home whose Alzheimer disease is progressing rapidly D) A 90-year-old man who has recently been transferred from an assisted living facility to an acute care setting

Ans: A Community-dwelling older adults who may lack family involvement in their care often require independent community-based professional geriatric care management. Individuals who are experiencing acute medical conditions and who are in institutional or acute care settings are not frequent recipients of care management.

9. A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. Which action can the nurse take to potentially minimize these expenses for clients? A) Become familiar with the various funding sources and their eligibility requirements. B) Teach older adults to be astute with their spending and saving patterns. C) Encourage older adults to make care providers aware of each chronic condition they live with. D) Provide care that is primarily focused on acute, rather than chronic, health problems.

Ans: A Despite the complexity and limitations of programs, nurses need to know enough about the most common sources of payment for health services so they can understand and address some of the barriers to and challenges of implementing nursing care plans and discharge plans. Ultimately, this may have the effect of reducing some older adults' out-of-pocket expenses. Teaching about financial management is beyond the scope of the nurse and focusing on acute, rather than chronic, health problems is inappropriate.

7. A diabetes nurse is providing care for a 73-year-old client who is a regular client of the hospital's out-client diabetes clinic. What assessment question most clearly addresses this client's potential for optimal function? A) "What are some goals that you have for maximizing your level of wellness?" B) "How can we help you to take ownership of your own health?" C) "Is there anything that you're doing that might be exacerbating your diabetes?" D) "How long do you think that you'll be able to live independently?"

Ans: A Eliciting an older adult's goals for wellness and high functioning can help promote these outcomes. Questions about a client's living situation, disease management, and personal responsibility may or may not promote wellness.

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

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

6. A group of nurses is involved in the planning and implementation of a health promotion campaign aimed at older adults. Which of the following questions is the best guide to such a campaign? A) "How can we help older adults maintain wellness as they age?" B) "What can we do to increase life expectancy in our region?" C) "How can we help older adults avoid age-related changes?" D) "What is stopping older adults from living longer lives?"

Ans: A Nursing practice prioritizes the maintenance of wellness into later life rather than simply increasing chronological life expectancy. It is unrealistic to expect older adults to avoid agerelated physiologic changes

12. A nurse verifies the health belief system of the Puerto Rican older adult client. Which of the following beliefs is this client most likely to hold? A) Health is a gift or reward given as a sign of God's blessing and goodwill. B) Health is obtainable by reaching a mature age. C) Health is the absence of disease. D) Health is the quality of wholeness associated with healthy functioning.

Ans: A The magico-religious perspective is common among Latino and Caribbean groups. Those with this perspective believe that health is a gift or reward given as a sign of God's blessing and goodwill. Scientific perspective holds that health is an absence of disease. Holism associates health with healthy functioning and well-being.

13. An 85-year-old client takes meals on wheels around the community. The client states, "All those old people really need me, you know how older people are. They can't get out, and are a burden to their family, and I just want to help." Most of the people on the client's delivery route are in their 60s. Which of the following characterizes this scenario? A) Ageism B) Aging anxiety C) Aging attribution D) Antiaging

Ans: A Ageism is a way of pigeonholing people and not allowing them to be individuals with unique ways of living their lives. Older adults between the ages 81 and 98 held more ageist stereotypes and reported more avoidance of older adults than younger older adults. The antiaging movement views aging as a process that can be stopped and the life span as something that can be extended for up to 200 years. Aging anxiety is fears about detrimental effects associated with older adulthood. Age attribution is the tendency to attribute problems to the aging process rather than to pathologic and potentially treatable conditions.

10. A nurse identifies those who are at risk for familial stress. Which of the following persons exemplifies the sandwich generation? A) A 50-year-old who balances the care of an 82-year-old parent and a 20-year-old child B) A 58-year-old whose elderly parents have been forced to live in separate care facilities C) A 72-year-old who deals with own health problems with the care of a grandchild D) An 83-year-old who is the sole caregiver for the 79-year-old spouse

Ans: A The increasing numbers of middle-aged adults who simultaneously juggle the demands of caring for older and younger generations are referred to as the sandwich generation.

16. A nurse assesses the risk of the members of the community. Which of the following are most likely to be living at or below the poverty line? A) An 83-year-old single woman B) A couple who are both 72 years old C) A white 73-year-old man D) A Hispanic couple in their 60s

Ans: A Women and those over the age of 75 are more likely to live in poverty. Couples and those 65 to 74 are less likely. Five percent of older white men live in poverty.

6. A nurse uses the Functional Consequences Theory to assess older adults. Which of the following situations best demonstrates the effect of physical environment on the older adult? A) A resident of a care facility experiences a fall because there are not grab bars outside his bathtub. B) A hospital client develops Clostridium difficile- related diarrhea because a care provider did not perform adequate handwashing. C) An older adult cannot afford a wheeled walker and suffers a fall while trying to ambulate using a cane. D) An assisted living resident requires care for emphysema that resulted from a 70 pack-year history of cigarette smoking.

Ans: A An adverse health effect that results from the inadequacy of one's surroundings (such as the lack of safety devices) is an example of the domain of environment. Although the use of incorrect equipment, health problems caused by lifestyle factors, and infections that result from caregiver negligence create risk factors for older adults, these problems are not situated within the domain of environment.

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

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

14. A nurse at a rehabilitation unit assesses an 86-year-old woman with a BMI of 30 and a history of heart failure, whose oral intake is declining. Which of the following risk factors is related to this older adult's decline in appetite? A) Diuretics B) Exercise C) Female gender D) Obesity

Ans: A Diuretics decrease saliva, olfactory function, and gustatory functioning. Women have better olfactory and gustatory function than men; exercise increases appetite. Obesity is unrelated

13. A community nurse develops wellness outcomes for those at highest risk for poor management of cardiovascular disease. Which of the following populations should the nurse target? A) African American woman B) Hindu men C) Immigrant Indian population D) Mentally ill persons

Ans: A Poor people, women, and African Americans have more health disparities based on risk factors and poor health management. American Indians and Alaskan natives have the highest prevalence by population. Religion is not a diversity factor, nor is mental illness.

11. A nurse administers medications to a group of older adults in a residential facility. Which of the following clients is most likely to experience adverse effects? A) A 77-year-old man with a creatinine of 3.6 B) A 78-year-old man with a body mass index of 35 C) An 84-year-old woman with iron deficiency anemia D) An 82-year-old woman with constipation

Ans: A Although age-related changes can influence skills related to taking medications, risk factors that commonly occur in older adults exert a stronger influence. A creatinine of 3.6 reflects renal failure, which will lead to increase in serum levels of medications. Iron deficiency anemia, obesity, and constipation do not impact the risk of adverse and altered effects.

3. A nurse assesses the urinary elimination of older adults. Which of the following actions by the nurse is most appropriate? A) Work to identify terms that the older adult comprehends. B) Wait until the person initiates a discussion of this embarrassing topic. C) Give the interview questions to the client in writing. D) Ask the older adult to keep a urination diary

Ans: A Although nurses usually learn to discuss urinary elimination with relative ease, older adults may feel uncomfortable with the topic, especially if there are gender or age differences between the older person and the nurse. In addition, older adults may be reluctant to discuss urinary problems because they tend to accept urinary leakage as an inevitable consequence of aging and gradually increase their tolerance threshold. Because of varying social contexts, successful interviewing about urinary elimination and incontinence depends on identifying the terms that are least embarrassing and most understandable to the older adult

10. A nurse admits a 90-year-old client to the hospital with a diagnosis of failure to thrive. Which of the following laboratory data should the nurse expect? A) Low albumin and red blood cells B) Elevated white blood cells (WBCs) and low potassium C) Low platelets and low prothrombin time (PT) D) Elevated calcium and magnesium

Ans: A Anemia and low serum albumin levels are consistent with malnutrition. Elevated WBCs, calcium, and magnesium and low platelets and PT are not characteristic of malnutrition

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

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

3. A neighbor notices an 81-year-old getting water from someone's outside faucet. The neighbor notices that this person's ankles are very swollen and there is an open wound on her left leg. The older adult says, "I stopped taking my pills because the water department turned off my water and I can't use the bathroom. My daughter did not pay the water bill, and she never has time to take me to the doctor so my legs can be checked." The neighbor calls adult protective services. Which of the following interventions is the priority when the nurse visits for an evaluation and does not find any immediate danger? A) The competency of the older adult in making decisions needs to be determined. B) The daughter needs to be picked up by the police on a neglect charge. C) The older adult needs to be involuntarily committed to a long-term care facility. D) An involuntary legal intervention needs to be initiated immediately.

Ans: A Because the older adult is not in immediate danger, the first step is to determine her competency and the ability to make decisions for herself

7. A nurse assesses a 70-year-old man who has high blood pressure and chronic obstructive pulmonary disease (COPD). He has been prescribed nicardipine and ipratropium inhaler. This medication combines a calcium-channel blocker and an anticholinergic. For which of the following urinary effects should the nurse teach the client to monitor? A) Nocturia B) Urinary tract infection (UTI) C) Urge incontinence D) Hematuria

Ans: A Calcium-channel blockers decrease bladder contractility and can cause urinary retention, frequency, nocturia, and incontinence. Anticholinergic agents decrease bladder contractility, and relaxed bladder muscle can cause urinary retention, frequency, and incontinence

15. While discussing sexual behavior at a sex and aging seminar, one older adult states, "No condoms for me, I can't get pregnant!" Which of the following responses is most appropriate? A) "Condoms protect you from sexually transmitted diseases including HIV." B) "How freeing to not have to be concerned about unwanted pregnancies anymore." C) "The youth of society have so much to be concerned with, what with AIDS killing people." D) "Your generation is soon going to have the largest population of HIVinfected persons."

Ans: A Condoms are an important protection for sexually active adults who are sexual with anyone other than a long-term monogamous partner. Condoms protect from many sexually transmitted diseases. Acquired immunodeficiency syndrome is considered a chronic disease. Eleven percent of new human immunodeficiency virus (HIV) infections occur in adults aged 50 years, and by 2015, 50% of HIV-infected individuals will be 50 and older. This is true, but doesn't answer the question.

6. It is July in Atlanta, and 90°F in the shade. An 80-year-old client who lives alone in an apartment is struggling to stay cool. What functional consequence of the aging process increases this client's susceptibility to heat exhaustion and heat stroke? A) Delayed and diminished sweating B) Impaired peripheral blood circulation C) Renal insufficiency D) Changes in endocrine regulation

Ans: A Delayed and diminished sweating are functional consequences of aging that create a risk for health exhaustion and heat stroke among older adults. Endocrine, renal, and circulatory factors have a less significant bearing on this risk

4. A nurse counsels an older adult with chronic insomnia. Which of the following statements should the nurse include in the teaching? A) "Consider making your environment more conducive to sleep." B) "Continuing with the hypnotic medications you've been prescribed should soon provide a solution." C) "Decreased sleep is a normal age-related change that you will need to accommodate." D) "Moderate alcohol consumption will help you fall asleep more quickly."

Ans: A Environmental modification can be a useful intervention in promoting sleep in older adults. While age-related changes do influence sleep in older adults, this does not mean that interventions and strategies are unnecessary in mitigating these changes. Alcohol consumption and the use of hypnotics are not recommended solutions to sleep disturbances

9. A nurse plans care for an older adult with insomnia. The client's medication list includes zolpidem, potassium, and omeprazole. Which of the following diagnoses should the nurse include in the plan of care? A) Risk for falls B) Risk for suicide C) Risk for powerlessness D) Risk for urge urinary incontinence

Ans: A Fractures and falls are a risk of nonbenzodiazepine agents. Powerlessness, incontinence, and suicide are not increased with these medications

14. A nurse assesses an older adult for dietary habits. Which of the following statements by the client should the nurse identify as a positive dietary habit for cardiovascular functioning? A) "I avoid meat, and eat nuts instead." B) "I don't eat vegetables." C) "I drink 4 glasses of wine a day." D) "I limit my salt to 3,500 grams per day."

Ans: A Heart-healthy diets include high intake of nuts, fish, fruits, vegetables, and fiber-rich whole grains, less than 1,500 mg of sodium a day, and fruits and vegetables that are rich in essential nutrients, including antioxidants. Excessive use of alcoholic beverages increases the risk

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

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

4. A nurse completes assessment of an older adult. Which of the following physical assessment findings is within normal limits? A) Kyphosis and increased anteroposterior diameter of the chest B) Increased intensity of lung sounds C) Decreased resonance on percussion D) Decreased adventitious sounds in lower lungs

Ans: A Minor differences in assessment findings for healthy older adults include shortened thorax, chest wall stiffness, increased anteroposterior diameter of the chest, and forward-leaning posture because of kyphosis

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

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

14. A nurse notes that an older adult is unable to process complex thoughts and has difficulty forming sentences. Which of the following actions by the nurse is priority? A) Review medication administration record. B) Place the client on high fall risk precaution. C) Assess muscle strength and deep tendon reflexes. D) Orient the client to environment.

Ans: A Nurses need to be alert to the possibility that even a simple overthe-counter product is a common cause of mental changes in older adults. An acute confusional state can be precipitated by any medication or by medication interactions. Assessment of deep tendon reflexes will be important to assess fluid and electrolyte imbalances; review the medications first. Orienting the client and high fall risk may be needed (or not).

1. A nurse teaches an older adult about changes to nutritional requirements. Which of the following meal choices would give evidence that the older adult understands the teaching? A) Baked chicken, carrots, and angel food cake B) Green salad, mashed potatoes, and an oatmeal cookie C) Vegetable beef soup, crackers, and Jell-O D) Baked pork chop, green beans, and sherbet

Ans: A Older adults need increased intake of foods with a high nutritional value and a concomitant decrease in the intake of foods containing little or no nutrients.

4. A nurse is teaching an older adult about possible involvement in Programs of All-inclusive Care for the Elderly (PACE). Which of the following statements by the older adult shows understanding? A) PACE programs provide several social and medical services on a managed care basis. B)PACE programs provide a cost-effective alternative to hospitalbased acute care. C) PACE programs are more expensive than fee-for-service models but offer better health outcomes. D) There is pressure for Medicare and Medicaid to begin funding PACE programs.

Ans: A PACE programs provide a range of services using a capitated managed care model. They are focused on meeting the needs of adults with chronic conditions and are not an alternative to inhospital treatment of acute illness. They are less expensive than fee-for-service models and presently are receiving funding under both Medicare and Medicaid. The 2010 Affordable Care Act provides incentives for further expansion of PACE programs.

14. A nurse plans care for a frail older adult in long-term care. Which of the following interventions should be included in the plan of care to reduce the risk of respiratory infections? A) Oral care B) Oxygen administration C) Pulmonary function testing D) Tracheal suctioning

Ans: A Poor oral care in long-term care residents increases the risk for pneumonia. Tracheal suctioning should be limited to those who are intubated. Neither testing nor oxygen would decrease risk of pneumonia

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

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

5. Which of the following is the most important remediable risk factor for cardiovascular disease in older adults? A) Smoking B) Stress C) Sedentary lifestyle D) Aggressive personality

Ans: A Smoking is a major risk factor for cardiovascular disease. Benefits of smoking cessation as a secondary prevention intervention begin immediately and are as effective in older adults as they are in younger people. Additional lifestyle interventions that are effective for preventing cardiovascular disease include remaining physically active, managing stress, and maintaining ideal body weight

6. A nurse in a long-term care facility is aware of the effects of age-related changes to the respiratory system. Which of the following functional consequences most likely results from age-related changes? A) Snoring and mouth breathing B) A persistent, dry cough C) Increased sensitivity to environmental allergens D) Hemoptysis on exertion

Ans: A Snoring and mouth breathing often become more prevalent with age. Hemoptysis and a persistent cough are considered pathologic at any age, and allergies do not typically worsen with age.

4. A nurse notes a 2-mm open shallow ulcer with a red wound bed on the great toe where shoe touched the skin. Which of the following should the nurse document? A) 2-mm stage II pressure ulcer B) Stage III pressure ulcer on great toe C) 2-mm skin tear with red wound bed D) Red ulcer on the great toe 2 mm in size

Ans: A The wound described is a pressure ulcer, and Pressure Ulcer Scale for Healing (PUSH) staging should be used to document all pressure ulcers. Wound documentation should also include size of wound bed. Stage II ulcers are partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough

13. A clinic nurse assesses a client who has limited English-speaking ability. The child interprets for the client. Which action by the nurse is most appropriate? A) Obtain a professional interpreter. B) Talk directly to the interpreter. C) Teach the family member the appropriate medical terminology. D) Use the family member as a source for improving cultural competence.

Ans: A A professional medical interpreter is preferred. The use of a child can influence the client's answers to questions. When using an interpreter, speak directly to the client.

7. A gerontological nurse is aware that quality of life is an important consideration when assessing the functioning of older adults. What measure should the nurse use when appraising older adults' quality of life? A) Active life expectancy B) Gerotranscendence C) Life expectancy D) Rectangularization of the curve

Ans: A Active life expectancy, which is measured on a continuum ranging from inability to perform activities of daily living to full independent functioning, is an indicator of quality of life during later adulthood. The theory of gerotranscendence addresses the change in perspective that often accompanies aging, and life expectancy is a measure of chronologic age. Rectangularization of the curve is attributed to changes in survival caused by various significant factors occurring at different points in time.

7. A 66-year-old has been conscientious about health as an adult and is disappointed at having been recently diagnosed with type 2 diabetes. The client had been unwilling to discuss this new diagnosis for the past several weeks but has now begun asking the nurse questions about this disease. Which of the following nursing diagnoses is most appropriate for this client? A) Readiness for enhanced knowledge B) Readiness for enhanced self-care C) Readiness for enhanced power D) Readiness for enhanced comfort

Ans: A An expressed willingness to know more about how a health problem is diagnosed and managed suggests a nursing diagnosis of readiness for enhanced knowledge. This is not synonymous with enhanced self-care, but is a likely precursor. The client's questions are not clearly indicative of enhanced comfort or power

12. A nurse in the emergency department cares for an 82-year-old man. The man was found wandering the streets looking for his dog in a snowstorm. Which of the following conditions is the highest priority for the nurse to monitor? A) Altered mental status B) Fluid volume overload C) Hyperglycemia D) Urinary tract infection

Ans: A As hypothermia progresses, mental functioning becomes clouded. More men than women experience hypothermia. Dehydration exacerbates the effects of hypothermia. Diabetes and hypoglycemia are related to higher risk of hypothermia (not hyper).

15. Centers for Medicare and Medicaid Services (CMS), the Institute of Medicine, and the Joint Commission have developed standards to address areas of concern for older hospitalized adults. Which of the following situations is of particular concern for an older adult with a hospitalization requiring complex care? A) Transitions in care B) Hospital-acquired respiratory infections C) Need for geriatric care manager D) Placement in an acute care for elders unit

Ans: A CMS, the Institute of Medicine, and the Joint Commission have placed a high priority on the issue of older adults with complex medical problems who transfer between care settings, because they are particularly vulnerable to experiencing problems. Geriatric care managers and acute care for elders unit assist with this issue. Hospital-acquired urinary tract infections and wounds not respiratory infections are prevalent.

8. A 78-year-old home health client has admitted to his nurse that his level of sexual activity with his wife has declined in recent months and become wholly absent over the past several weeks. The client has implied that this is due to a lack of performance, rather than lack of desire, on his part. What assessment should the nurse prioritize in light of this revelation? A) Client's medication regimen B) Client's musculoskeletal system and active range of motion C) Client's cognitive status and level of consciousness D) Client's cardiovascular status

Ans: A Sexual wellness and sexual performance are affected by multiple factors. However, the effects of medications are highly significant and likely supersede potential changes in strength, cognition, or cardiovascular status

9. Which of the following older adult clients is most likely to have physiologic barriers to sexual wellness? A) One who has chronic obstructive pulmonary disease and a recent MI B) One who has early stages of lung cancer and who is being treated for hypothyroidism C) One who had an ostomy created several years ago as treatment for colon cancer D) One who recently recovered from urinary tract infection that progressed to urosepsis

Ans: A Chronic obstructive pulmonary disease and coronary heart disease are associated with sexual dysfunction. The other noted health problems are not associated with physiologic barriers to sexual health and function. Early stages of lung cancer symptoms include cough, which potentially produces bloody sputum, not shortness of air. The ostomy may psychologically impact a client, but not physiologically. Recovered urinary tract infection/urosepsis would not specifically cause a physiologic barrier.

13. A nurse in the postoperative unit monitors for hypothermia. Which of the following older adults' assessment findings indicates the onset of hypothermia? A) Cool skin on buttocks B) Puffy face C) Shallow respirations D) Shivering

Ans: A Cool skin in unexposed areas, such as the abdomen and buttocks, is a distinguishing characteristic of hypothermia. The environmental temperature may be only moderately cool, and the older person will not necessarily shiver or complain of feeling cold. As untreated hypothermia progresses, additional signs may include lethargy, slurred speech, mental changes, impaired gait, puffiness of the face, slowed or irregular pulse, low blood pressure, slowed tendon reflexes, and slow, shallow respirations.

7. A nurse is participating in a health fair that is being sponsored by a local seniors' center, discussing healthy skin and aging. Which of the following teaching points should the nurse emphasize? A) "You should limit your sun exposure to a small amount each day and keep your skin protected from direct sunlight for the remainder." B) "Many drugs can have an effect on your skin, so it's important to avoid most over-the-counter medications." C) "The health of your skin is primarily determined by your genes, so all you can do is try to maintain your overall level of health." D) "Even if you find it difficult to do, it's important to bathe once a day."

Ans: A Current recommendations emphasize the importance of a balanced approach that encourages small amounts of sun exposure each day for adequate vitamin D synthesis, but not so much that would lead to increased skin cancer risk. Many medications affect the skin, but it would be inappropriate for the nurse to recommend that older adults refrain from all over-the-counter medications. Genetic factors influence integumentary health, but this does not mean that other risk factors are irrelevant or nonmodifiable. It is unnecessary for most older adults to bathe every day

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

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

14. A rural community nurse sets up a monthly disease screening service. Local news coverage chooses not to cover this event. Which of the following justifications best supports the screenings? A) Health promotion is essential for older adults because they have complex health care needs. B) Older adults are less responsive to health promotion interventions. C) Older adults as a group receive fewer prevention and screening services than other populations. D) Preventive services are less effective after the onset of chronic illness.

Ans: A Even though health promotion interventions are cost-effective ways of preventing disease and disability and improving functioning and quality of life for older adults, older adults as a group receive fewer prevention and screening services than other populations. This is due to misperceptions, such as (1) older adults are less responsive to health promotion interventions, and (2) preventive services are less effective after the onset of chronic illness. In reality, health promotion is essential for older adults precisely because they have more chronic conditions, have complex health care needs, and use considerably more health care services than younger adults.

5. The child of an 81-year-old client asks the nurse about vitamins, antioxidants, and age-related macular degeneration. Which of the following theories of aging is most appropriate to this topic? A) Free radicals theory B) Immunosenescence theory C) Program theory D) Wear-and-tear theory

Ans: A Free radical theory focuses on interventions to modify or prevent the age-related accumulation of free radicals or to diminish the formation of free radicals. Antioxidants, beta-carotene, and vitamins C and E provide defense mechanisms against oxidative damage from free radicals. Immunosenescence (age-related decline of the immune system) theory focuses on the increased susceptibility of older people to diseases, such as cancer and infections. The immune system may even attack healthy cells, leading to autoimmune conditions, such as rheumatoid arthritis. Program theory postulates the life span of about 110 years in humans. Abnormal cells, such as cancer cells, are not subject to this predictable program and can proliferate an indefinite number of times. Wear-and-tear theory postulates that the longevity of the human body is affected by the care it receives, as well as by its genetic components.

5. A nurse teaches a nursing student about pharmacologic interventions for the treatment of sleep problems among older adults. Which of the following statements by the student shows understanding of the care of those with sleep disturbances? A) "Behavioral therapies are preferable to the use of drugs." B) "Benzodiazepines are the drug group likely to have the fewest adverse effects." C) "L-Tryptophan and melatonin are chemicals the body produces that can be supplemented to improve sleep." D) "Older adults should not use hypnotics or other pharmacologic aids for sleep."

Ans: A In general, behavioral therapies are preferable to hypnotics and other drugs for the treatment of sleep disorders. Benzodiazepines are the drug category with the greatest risk of adverse effect, and L-tryptophan is found in foods rather than produced by the body. Even though there are risks, there is still a role for pharmacologic interventions in the short-term treatment of sleep problems and they should not be categorically discounted.

2. During assessment of an older adult, the nurse discovers that the individual has been reluctant to divulge recent losses in activities of daily living to his primary care provider. Which of the following factors has been demonstrated to contribute to such reluctance? A) The older adult may fear a loss of independence if problems are disclosed. B) The older adult may realize that age-related changes are normally not treatable. C) The older adult may be experiencing cognitive deficits that influence decision making. D) The older adult may recognize that health care systems are not able to address psychosocial problems.

Ans: A Many older adults have been shown to fear losing their independence or becoming institutionalized if they divulge health problems. It has not been demonstrated that age-related changes and psychosocial problems are not treatable, nor that cognitive changes influence such behaviors.

13. A nurse monitors older adults at an assisted living facility for pressure ulcers. Which of the following older adult is at highest risk for a pressure ulcer? A) The obese older adult with continuous positive airway pressure (CPAP) mask B) The frail older adult with a hearing aid C) The older adult undergoing therapy for a weak hand D) The older adult preparing to walk a half marathon

Ans: A Medical devices that are commonly associated with increased risk for pressure ulcers include masks, orthotics, tubing, immobilizers, stockings or boots, nasogastric tubes, cervical collars or braces, and tracheostomy tubes and ties. People who are unable to move around independently are at high risk for pressure ulcers, not those who move and participate in physical activities

4. A nurse cares for an older adult who is nonresponsive and surrounded by family. Which of the following statements by the nurse is most appropriate? A) "I am here for you, how can I be helpful?" B) "I know just how you feel, my mother died last month." C) "I'll leave you alone so that you can grieve in private." D) "She was a really nice lady; she did a good job raising you."

Ans: A Nurses can help people who are dying and their caregivers express their needs by using open, honest, direct, and empathetic communication. Nurses use ongoing assessment to meet the needs of their clients. The statements by the nurse should center on the client and not the nurse. Presence is an appropriate intervention; the nurse should not assume that they desire to be alone

1. A 76-year-old Hispanic woman has been admitted to the hospital. There are no advance directives in the chart. Which of the following questions will best prepare the nurse to begin a dialogue with this client about advance directives? A) "With whom do you talk to about your health care decisions?" B) "I see that you have no advanced directives on your chart, could you tell me about that?" C) "Is there someone we should call to join us while we discuss your care?" D) "Tell me about your living arrangements; do you live alone or with others?"

Ans: A Nurses need to identify patterns of culturally influenced decision making in order to ask questions and obtain relevant information from clients of different cultures. Why there are no advance directives on the chart is not the place to start to open the conversation. Whether or not she lives with someone, inviting family to join reflects an emphasis on family caregiving consistent with the Hispanic culture.

13. A 93-year-old asks the nurse, "I sure would like to live to get that 100 year birthday card from the president." Which of the following responses by the nurse is best? A) "Keeping fit and dealing with stress in a positive way helps your chances of living to be 100." B) "Surviving to 100 is strongly impacted by eating meat, fruits and grains." C) "Those people in your socioeconomic situation have higher chance of living to 100." D) "You have had a cancer and a stroke, so that decreases your chance of surviving to 100."

Ans: A People who survive to 100 years and older are a heterogeneous group with a wide range of health and socioeconomic characteristics. Most centenarians have escaped the common pathologies, such as stroke, cancer, and myocardial infarction (Andersen, Sebastiani, Dworkis, et al., 2012; Vacante, D'Agata, Motta, et al., 2012). Variables commonly identified as predictors of healthy longevity include nutritional patterns with a high intake of plant-based foods and being resilient in the face of stress (Davinelli, Willcox, & Scapagnini, 2012; Hutnik, Smith, & Koch, 2012).

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

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

11. An emergency room nurse cares for the family of a 70-year-old African American woman who died unexpectedly. In the waiting room, upon hearing of the death, two family members kneel to the floor moaning and do not respond. Which intervention by the nurse is most appropriate at this time? A) Allow the family to grieve in this manner directing others away. B) Assess these family members' vital signs and neurologic status. C) Bring these family members to the body of their loved one. D) Call an emergency response team to care for these family members.

Ans: A Recognize that this "falling out" is a culturally based response and not an emergency medical condition; provide support. There is no need to assess these clients for emergency assistance. Bringing all of the family members is appropriate when the family is ready (note: family members may also "fall out" then too)

9. A wound care nurse is assessing a 76-year-old client. The client has intimated to the nurse that her son sometimes "flies off the handle and gets rough with me." Which response made by the nurse is the best response? A) "When you say 'gets rough,' what does that look like?" B) "What do you think usually provokes this to happens?" C) "I'm going to have to phone adult protective services right now." D) "Why do you think that there is that response with anger or frustration?"

Ans: A Safety is the first priority in cases of elder abuse and prompt action is often necessary. However, gathering additional information, detail, and context is appropriate when a threat is not immediate. Speculating about a perpetrator's motives is unnecessary and inappropriate.

2. A nursing case manager monitors admissions into an acute care unit. Which of the following clients would be the most appropriate candidate for in-home skilled nursing care? A) A client requiring twice-daily dressing changes for a coccyx wound B) A client who has been admitted to the emergency department with a recent stroke C) A client with reoccurring urinary retention of unknown etiology D) A client who is scheduled for hip replacement surgery tomorrow

Ans: A Skilled home care is most appropriate for older adults who are recovering from an illness or injury and have potential for returning to their previous level of functioning. Following a stroke, a client requires hospitalization. A client with a poorly understood or undiagnosed health problem would not be an ideal candidate for home care, nor would a preoperative client.

2. A 65-year-old client with a long-standing history of chronic obstructive pulmonary disease (COPD) was placed recently on Coumadin after experiencing atrial fibrillation. Upon discharge from the hospital, which of the following statements by the client indicates a need for further teaching? A) "I will continue to use smokeless tobacco since it's a lot better than smoking." B)"I will avoid using over-the-counter antihistamines since they can dry my mucosal secretions." C)"I will watch my intake of dark green leafy vegetables since they may impact the effects of Coumadin." D)"I will not take any herbal preparations without my health care provider's knowledge."

Ans: A Smokeless tobacco is associated with mouth cancer, gingivitis, and tooth loss and may be carcinogenic to the pancreas. The other noted actions are appropriate to the maintenance of health.

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

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

10. The aging process is accompanied by a number of changes in thermoregulation. Which of the following clinical phenomena in older adults is likely to result from these changes? A) Lack of detection of an acute infection B) Impaired protein synthesis during hot weather C) Susceptibility to skin breakdown on bony prominences D) Orthostatic hypotension

Ans: A The fever response in older adults is often muted. Changes in thermoregulation do not contribute directly to skin breakdown, orthostatic hypotension, or impaired protein synthesis

1. An 80-year-old is seen in the emergency department for a fall. The client has bruises on the upper arms and appears depressed. The client is accompanied by a grandchild, who is unkempt, glassy-eyed, and whose breath smells of alcohol. Which of the following should be a priority with the nurse? A) Assess whether the older adult is safe in the home environment. B) Determine whether legal interventions are appropriate. C) Assess the client's degree of frailty and chronic health problems. D) Determine the mental capacity of the older adult.

Ans: A The first priority should be to see whether the older adult is safe and then determine his competency. Legal intervention can be pursued after safety and competency are determined. The degree of frailty and chronic health problems is assessed with safety issues and determination of competency.

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

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

5. Which of the following statements by the new nurse best conveys an understanding of diabetes in older adults? A) "A combination of lifestyle factors and age-related changes contributes to high rates of diabetes among older adults." B) "Development of diabetes later in life is considered a normal, age-related change." C) "Health care providers should avoid drawing conclusions about diabetes risk based on ethnicity." D) "The diagnosis of diabetes in older adults is complicated by subtle signs and symptoms."

Ans: A The high prevalence and incidence of diabetes among older adults is attributable to lifestyle, genetic, and age-related factors. Ethnicity is a valid variable that needs to be considered, given that some minority groups have significantly higher rates of diabetes. Some symptoms of hypoglycemia are subtle in the older adult, but diagnosis is based on laboratory data that do not change with aging. While age-related changes contribute to a susceptibility to diabetes, the development of the disease should not be considered a normal, age-related change in and of itself

1. A client is unresponsive, the skin is usually dry, confined to bed, with limited mobility and contractures, and the nutrition is less than adequate. Using the Braden score, which score will be assigned to this client's risk for pressure ulcers? A) 8, very high risk B) 8, at risk C) 18, high risk D) 18, moderate risk

Ans: A The nurse uses the Braden score to determine the plan of care. The lower the Braden score, the greater the risk. Scores of 9 or less are considered to be at very high risk, and additional pressure relieving surface and treatment of nutrition are important for this client

4. Which of the following interventions most closely aligns with the practices of health promotion? A) Leading a flexibility and mobility class among older adults B) Providing presurgical teaching to an older adult prior to hip replacement C) Administering an anti-inflammatory and analgesics to an older adult with osteoarthritis D) Teaching an older adult how to administer her inhaled bronchodilators independently

Ans: A The practice that best characterizes health promotion is facilitating exercise. Presurgical teaching, administering drugs, and teaching independence with medication are useful interventions, but they do not characterize the behavior changes of health promotion as well as an intervention such as an exercise class.

6. A nurse in a postoperative unit educates peers to overcome myths about pain in older adults. Which of the following statements by a peer most clearly warrants further teaching? A) "We have to be more conservative in the treatment of the older adults' pain than the younger clients." B) "Older adults have more health problems than younger people and this puts them at risk of experiencing pain." C) "The acute can turn into persistent pain if not treated thoroughly." D) "Older adults', even those with dementia, sense of pain is as strong as a younger person."

Ans: A The statement that warrants more teaching is that their pain should be treated more conservatively than younger clients. Studies have found no age-related difference in appropriate doses of postoperative morphine. Multimorbidities and chronic health problems are associated with pain. Recent studies focused on the development of persistent postoperative pain, finding that its incidence can be reduced with the use of aggressive and early analgesic therapy. It is true that older adults have no age-related change in the sensation of pain

2. A nurse is responsible for the care of group of older adults on an acute medical unit. Which of the following clients should the nurse monitor closely at night for worsening symptomatology? A) A client with a diagnosis of chronic obstructive pulmonary disease (COPD) B) A client with diagnoses of osteoarthritis and failure to thrive C) A client with a diagnosis of foot cellulitis secondary to diabetic neuropathy D) A client with chronic anemia receiving transfusions of packed red blood cells

Ans: A The symptoms of individuals with COPD are often exacerbated during sleep, because of both positioning and decreased oxygen saturation that occurs during sleep. Clients with osteoarthritis, cellulitis, or anemia would not be as likely to have increased symptoms at night

14. A home care nurse notes in the assessment that an older adult expresses anxiety and fatigue. The client sleeps 3 hours at a time at maximum and has had a 10 lb weight loss. Which of the following interventions is priority? A) Assess the client's level and intensity of pain. B) Interview the family. C) Perform an assessment of vital signs. D) Weigh the client

Ans: A The symptoms represented reflect functional consequences commonly experienced by older adults. The other assessments are not the priority reflected by these symptoms

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

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

7. A nurse in an intensive care unit prepares to perform postmortem care on an older Jewish client. Family members are at his bedside. Which of the following actions by the nurse is appropriate? A) Allow the family to remain with the client. B) Liaise with the hospital chaplain to visit the family in the chapel. C) Address the man's oldest son when discussing the client's cares. D) Determine which family member(s) will be staying at the bedside during the cares

Ans: A With the Jewish faith, the dying person should not be left alone. Ask the closest relative specifically about postmortem practices. The other noted interventions are not particular to the Jewish culture

12. An older adult with heart failure and mild dementia states the intent to refuse low sodium diet and diuretics, stating: "It's important to me to live free, without restrictions on what I eat." The family is supportive. Which action, by the nurse, should be done first? A) Assure that the client understands the consequences of this decision. B) Discuss this decision with the older adult's family to plan for the future. C) Document the client's wishes in the plan of care. D) Notify the primary health care provider of the client's wishes.

Ans: A All of these actions should be done; however, the primary concern is that the nurse assess the client's understanding of the consequences. During mild-to-moderate stages of dementia, assessment of decision-making ability is based on the person's ability to describe the importance or implications of the choice on his or her future health. Medical decision making is a complex process in which information is shared between clients and clinicians and among family and others who are affected by the outcomes.

3. Which of the following statements best explains the relevance of psychological theories for gerontological nursing? A) Human needs theory allows the nurse to determine priorities of nursing care for older adults. B) Life span development theories support the belief that it may be difficult to initiate behavioral changes in older adults. C) Psychological theories explain why nurses should focus their discussion more on the present than on the past when talking with older adults. D) Psychological theories explain why reminiscence groups may not be beneficial for older adults

Ans: A Maslow's human needs theory is useful in conceptualizing interventions in the older adult's home and in a health care facility. The attainment of lower-level human needs takes priority over higher-level human needs, such as self-actualization. Life span development theories help nurses identify those areas of personality that are likely to change and those that are more likely to remain stable. Psychological theories imply that older adults should devote some time and energy to life review and self-understanding.

15. A nurse plans discharge instructions of a 78-year-old black client with newly diagnosed dilated heart failure. The client states, "Will I be going home on hospice now that my heart is failing?" Which of the following responses is most appropriate by the nurse? A) "Heart failure is a chronic condition that can be controlled with medication." B) "No, but you will have palliative care." C) "You must go to cardiac rehabilitation." D) "You will need to take medications for the rest of your life."

Ans: A The client with heart failure will need medications and will benefit from cardiac rehabilitation; however, these answers avoid the issue of lack of understanding of the type of disease heart failure is. Palliative care is not appropriate at this time

2. A nurse monitors a group of older adults. Which of the following older adults is a high risk for functional consequences of altered thermoregulation? (Select all that apply.) A) 78-year-old adult with heart failure B) 75-year-old adult with a urinary tract infection C) 80-year-old adult with vascular-type dementia D) 71-year-old participant in a wellness center E) 72-year-old adult with peptic ulcer disease

Ans: A, B, C A healthy older adult in a comfortable environment will experience few, if any, functional consequences of altered thermoregulation. In the presence of any risk factor, however, hypothermia or heat-related illness may develop in an older adult. Even moderately adverse environmental temperatures can precipitate hypothermia or heat-related illness in an older adult, especially in the presence of additional predisposing factors, such as certain medications or pathologic conditions. Age-related changes, which can affect processes involved with heat loss or production, begin during the fifth decade, and their cumulative effects are experienced during the seventh or eighth decade

13. A nurse in the long-term care facility plans a meeting to assist an older adult and family discuss end-of-life care options. Which of the following interventions is appropriate for the nurse to include in preparation for this event? (Select all that apply.) A) Assist the older adult to his or her wear hearing aid. B) Assure that the older adult is well rested. C) Obtain a private meeting room. D) Premedicate the older adult with Ativan (lorazepam). E) Schedule the meeting after a meal.

Ans: A, B, C An important role of nurses is to promote optimal decision-making capacity by identifying and addressing the factors that influence cognitive functioning and is within the realm of nursing responsibilities (such as wearing hearing aid and being rested). Benzodiazepines and overstimulation (such as after a meal) can interfere with the older adult's capacity

15. The nurse assesses an older woman regarding urinary health. Which of the following interview questions are appropriate? (Select all that apply.) A) Do you ever leak urine? B) Do you ever wear pads or protective garments to protect your clothing from wetness? C) Do you have any discomfort or burning when you pass urine? D) How much alcohol do you drink each day? E) When you urinate do you have any difficulty starting the stream or keeping the stream going?

Ans: A, B, C Interviewing older woman for urinary elimination should include the questions about signs and symptoms of infection, leaks, and use of pads. The nurse should ask about how much water and other liquids do you drink during the day? But not assume that this fluid included alcohol. When interviewing men, it is appropriate to ask about starting and maintaining a urine stream

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

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

13. A nurse assesses older adults in their own home. Which of the following questions are appropriate to include in this assessment of the bathroom? (Select all that apply.) A) Can the person enter and exit the tub safely? B) Does the color of the toilet seat contrast with surrounding colors? C) Does the tub have skid-proof strips or a rubber mat in the bottom? D) Is the height of the toilet seat appropriate? E) Is there a lock for the bathroom door?

Ans: A, B, C, D Can the person enter and exit the tub safely? Does the color of the toilet seat contrast with surrounding colors? Does the tub have skid-proof strips or a rubber mat in the bottom? and Is the height of the toilet seat appropriate? are all appropriate questions to ask when assessing the safety; the door lock is not helpful.

6. A nurse cares for a 100-year-old man in hospice. The client contemplates his perspectives regarding end-of-life care. Which of the following historical perspectives most likely represent how this client's life experiences have had a formative influence on his views on death and dying? (Select all that apply.) A) I never thought that I would be this old. B) My brother died in a work-related accident. C) I outlived my children and my two wives. D) My family shouldn't have to take care of me. E) I lost an infant to small pox.

Ans: A, B, C, E Concepts related to death, dying, and end of life have changed since the early 1900s. At that time, death was a common occurrence in infants, children, youth, and young adults. Communicable diseases were common. Families provided care. Accidental deaths were common, and death was accepted as an inevitable and normal part of life

15. During heat waves, nurses can assist to prevent heat-related illnesses in older adults. Which of the following should be included in the teaching? (Select all that apply.) A) Ensure fluid intake at or above 64 ounces per day. B) Keep air-conditioning at or below 72°F. C) Take a cool shower three times a day. D) Use extra soap when bathing. E) Use ice to cool armpits up to 20 minutes. F) Wear loose-fitting clothing

Ans: A, B, C, E, F Ensure fluid intake at or above 64 ounces per day, keep air-conditioning at or below 72°F, take a cool shower three times a day (not with soap every time), use ice to cool armpits up to 20 minutes, and wear multiple layers of loose weave, loose-fitting clothing

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

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

5. A nurse is identifying positive functional consequences as part of the development of an older client's care plan. Which of the following outcomes exemplifies the concept of positive functional consequences for an older adult? (Select all that apply.) A) The older adult with arthritis can walk 1 mile without pain. B) The older adult who is overweight develops a plan to lose 2 lb a month. C) The older adult has constipation from pain medication. D) The older adult schedules cataract surgery.

Ans: A, B, D Positive functional consequences can result from automatic actions or purposeful interventions. Older adults bring about positive functional consequences (also called wellness outcomes) when they compensate for age-related changes and risk factors, such as cataracts and chronic conditions. Nurses help older adults achieve positive functional consequences by teaching about health promotion interventions to improve functioning and quality of life.

14. A nurse at a long-term care facility completes a minimum data set on each client. Which of the following categories are included in this assessment/plan of care? (Select all that apply.) A) Cognitive patterns B) Communication and hearing patterns C) Family support D) Mood and behavior patterns E) Psychosocial well-being

Ans: A, B, D, E Cognitive patterns, communication and hearing patterns, mood and behavior patterns, and psychosocial well-being are all categories within Minimum Data Set 3, and family support is not.

15. A nurse provides education to an 82-year-old woman with postprandial hypotension. Which of the following interventions should be included? (Select all that apply.) A) Avoid sitting still for prolonged periods. B) Drink eight glasses of non-caffeinated beverages daily. C) Eat regularly scheduled meals with breakfast as the largest. D) Engage in regular, but not excessive, exercise. E) Limit alcohol consumption to one drink per evening.

Ans: A, B, D, E Health promotion measures specific to postprandial hypotension include the following: minimize the risk for postprandial hypotension by taking antihypertensive medications (if prescribed) 1 hour after meals rather than before meals; eat small, low-carbohydrate meals; avoid alcohol consumption; and avoid strenuous exercise, especially for 2 hours after meals

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

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

15. A nurse assesses older adults at risk for pressure ulcers. Which of the following assessment tools should the nurse use to identify those who might benefit from interventions? (Select all that apply.) A) Braden Scale B) Norton Scale C) PUSH Scale D) Reverse staging E) Waterloo Scale

Ans: A, B, E Braden Scale has been recommended for identifying older adults who are at risk for the development of pressure ulcers. The Norton and Waterloo scales are also commonly used, with reviews of studies indicating that all three of these scales can help identify clients at risk for pressure ulcers. PUSH is a staging system, which rates current pressure ulcers, and reverse staging is not a recommended practice

2. A nurse is beginning a new job in an area with a large African American population. Which of the following statements will assist the nurse to understand this ethnic/race culture to better plan nursing care? (Select all that apply.) A) African Americans as a group have a wide range of socioeconomic conditions. B) Female-headed households are common among African Americans. C) Lifestyle and risk factors account for the health disparities with older African Americans. D) Older African Americans are more likely than other older Americans to live alone. E) Older African Americans are more likely to be caring for their grandchildren.

Ans: A, B, E Female-headed homes are a common family structure among African Americans. The differences in health outcomes between African Americans and other groups are attributed mostly to disparities in health care provision. Older African Americans are more likely to live with family. Half of those older African Americans who live with their grandchildren are the primary care provider to those children.

12. A nurse presents an overview of sleep to older adults at an activity center. Which of the following risk factors for sleep problems should the nurse include in the presentation? (Select all that apply.) A) Boredom B) Chronic discomfort C) Dehydration D) Exercise E) Lack of light F) RLS

Ans: A, B, F Boredom, chronic discomfort, and RLS are all treatable risk factors that can interfere with sleep patterns. Dehydration, exercise, and lack of light do not decrease sleep

12. A nurse assesses a client admitted to the subacute care unit. The client is weak and underweight. Which of the following laboratory abnormalities would be related to undernutrition in this client? (Select all that apply.) A) Low albumin B) High hematocrit hemoglobin ratio C) Low serum iron and ferritin levels D) Decreased platelet count E) Elevated sedimentation rate

Ans: A, C Serum iron, iron-binding capacity, ferritin, and albumin indicate undernutrition. The other laboratory values do not.

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

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

8. One of the functional consequences of age-related changes to the skin is an increased susceptibility to injury. Which of the following factors contributes to this susceptibility? (Select all that apply.) A) Decreased sensation of cutaneous pain and discomfort B) Changes in vitamin D synthesis C) Increased healing time for skin wounds D) Decreased resistance to shearing forces E) Changes in skin pigmentation

Ans: A, C, D A muted pain response, increased healing time, and decreased resistance to shearing all contribute to older adults' susceptibility to injury. Changes in vitamin D may occur with age, but these changes do not constitute a risk for injury. Similarly, changes in pigmentation are not a significant risk factor for injury

10. An older adult with a diagnosis of heart failure has been admitted to the hospital with an exacerbation of this condition. Which of the following are consequences of heart failure for which the nurse must monitor? (Select all that apply.) A) Arrhythmias B) Autoimmune disorders C) Drug interactions D) Hypotension E) Sleep disorders

Ans: A, C, D, E Common consequences of heart failure in older adults include increased likelihood for developing arrhythmias, increased risk for hypotension and falls, increased risk for drug interactions, and high incidence of sleep disorders. Autoimmune disorders do not commonly result directly or indirectly from heart failure

11. Which of the following actions exemplifies the nurses' role in home care of an older adult? (Select all that apply.) A) Coordinate a multidisciplinary team. B) Perform ADL care for clients. C) Provide resources to caregivers to reduce caregiver stress. D) Refer available community resources. E) Teach about interventions to provide quality care.

Ans: A, C, D, E Nurses who provide skilled home care services typically assume a primary coordinating role with a multidisciplinary team. Nursing responsibilities include referrals for additional services. Nurses direct their interventions toward the caregivers providing teaching about interventions, and they address needs of the caregiver related to information about resources and ways to reduce caregiver stress.

9. A nurse is conducting a medication assessment of an older adult client who will soon be receiving home care. Which of the following questions should the nurse include in this assessment? (Select all that apply.) A) "Are you a smoker?" B) "What is your typical diet?" C) "What over-the-counter drugs do you use?" D) "Do you use any herbs or dietary supplements?" E) "Do you drink alcohol?"

Ans: A, C, D, E Question relating to smoking, alcohol use, over-the-counter drugs, and herbs and dietary supplements should be included in a medication assessment. A client's diet, however, is not a common focus during a medication assessment.

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

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

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

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

10. A 72-year-old man's diagnostic testing and physical examination have resulted in a diagnosis of COPD. Which symptomatology is unexpected and will require follow-up? (Select all that apply.) A) Hemoptysis and orthostatic hypotension B) Chest pain and shortness of breath C) Cough and dyspnea D) Apneic spells and fatigue E) Wheezing and clubbing

Ans: A, D The most common manifestations of COPD are cough, dyspnea, wheezing, and increased sputum production. Hemoptysis and orthostatic hypotension are unexpected and require follow-up, as do apneic spells and fatigue. Chest pain and shortness of breath signal cardiac dysfunction and require immediate attention

14. A nurse cares for an older adult at risk for a venous stasis ulcer. Which interventions should the nurse include in the teaching with this older adult? (Select all that apply.) A) Health promotion interventions B) Functional consequences C) Wellness outcomes D) Environmental modifications

Ans: A, D The nurse should include health promotion interventions and environmental modifications to create wellness outcomes for this client. Functional consequences and wellness outcomes are not interventions.

13. A nurse plans care for a client who states that food is no longer appealing. The nurse notes a dry mouth and teeth in poor condition. Which interventions should the nurse include in the plan of care? (Select all that apply.) A) Eight-ounce bottle of water between each meal B) Hard toothbrush C) Ice cold water at bedside D) Meals in the common room E) Oral care before each meal

Ans: A, D, E Social isolation can lead to lack of appetite. Saliva-producing activities before each meal and 60 to 80 ounces of water a day are recommended to treat dry mouth. Iced drinks are less palatable to the older adult with poor oral condition. A soft electric toothbrush is recommended

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

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

16. A 73-year-old client is admitted to the hospital. A nurse assesses the client for frailty. Which of the following indicate frailty? (Select all that apply.) A) Diminished handgrip strength B) High level of physical activity C) Intentional weight loss D) Self-reported exhaustion E) Slow walking speed

Ans: A, D, E Patients are considered fail when they have three or more of the following conditions: low level of physical activity, slow walking speed, unintentional weight loss (i.e., 10 lb or more during the past year), weakness (measured by diminished handgrip strength), and self-reported exhaustion (Koller & Rockwood, 2013)

4. A nurse determines risk factors for an 81-year-old client's plan of care. Which of the following characteristics of the client would the nurse consider as a risk factor? (Select all that apply.) A) Chronic bronchitis B) Loss of bone density C) Decreased vital lung capacity D) Delayed gastric emptying E) Digoxin (Lanoxin) toxicity

Ans: A, E Chronic bronchitis would be considered a pathologic process and risk factor for disease, rather than an expected or inevitable age-related change. Adverse medication effects are also considered risk factors. Loss of bone density, decreased vital lung capacity, and delayed gastric emptying are all examples of normal, age-related changes

6. A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, "I feel quite well and do not wish to undergo another round of chemotherapy. " The client's children are adamantly opposed to their parent's decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action? A) The client's prognosis B) The client's autonomy C) The family's wishes D) The client's treatment options

Ans: B Autonomy is highly valued in Western societies, and personal autonomy supersedes family wishes and the medical facts about a client or client's situation.

12. A nurse cares for a 92-year-old woman with urinary incontinence. Which of the following agerelated changes is the rationale behind assisting client to the bathroom every 2 hours? A) Decreased estrogen levels B) Degenerative changes in the cerebral cortex C) Demyelination of parasympathetic nerves D) Diminished thirst perception

Ans: B Decreased estrogen levels cause a loss of tone, strength, and collagen support in the urogenital tissues and can predispose the urinary system to leakage problems; but in older adults, degenerative changes in the cerebral cortex may alter both the sensation of bladder fullness and the ability to empty the bladder completely. The degenerative changes in this 91-year-old woman more directly impact the decision to toilet every 2 hours. Younger adults perceive a sensation of fullness when the bladder is about half full, but this occurs at a later point for older adults. Normal aging does not include the demyelination of parasympathetic nerves. Diminished thirst is not impacted by toileting every 2 hours

1. A nurse assesses the eating habits of a 75-year-old client who takes iron supplements for iron deficiency anemia. Which of the following statements by the client indicates a need for further teaching? A) "I drink orange juice with my iron." B) "I prefer coffee to take my pills." C) "I take all my pills with a glass of warm water." D) "I take my iron in between my meals.

Ans: B Foods that change the pH of the gastrointestinal (GI) system interfere with the absorption of iron. It is best taken on an empty stomach, but if it causes GI upset, then it can be taken with orange juice, which helps absorption. Caffeine and some foods interfere with iron absorption. The temperature of the water should not impact the medication absorption.

12. A nurse manager of an intensive care unit develops plans to improve end-of-life care for clients in the unit. Which of the following actions is the priority? A) Create a script for nurses to use when discussing hospice and palliative care. B) Guide staff to improve communication with families about end-of-life decision making. C) Increase communication between professionals about end-oflife decision making. D) Survey clients and families about their end-of-life needs.

Ans: B In recent years, nurses and other health care professionals raised concerns about the need to improve end-of-life care in hospitals. Much of this concern is associated with poor communication between professionals and families about end-of-life decision making. Creating a script can help with that specific need, but the clients continue to experience pain, indignity, social isolation, and uncomfortable symptoms related to ineffective and unwanted life-sustaining treatments, particularly in intensive care units. Interprofessional communication will also help; the priority is between staff and families.

15. A nurse assesses a community of older adults. Which of the following persons is at highest risk for a shortened life expectancy? A) A college professor born in 1956 B) A homemaker born in 1957 C) A nuclear engineer born in 1958 D) A nurse born in 1959

Ans: B Socioeconomic characteristics that are most strongly correlated with healthy aging are poverty and lower educational level. Limited English proficiency and poor health literacy skills are two variables that have a negative impact on health and functioning. The college professor, engineer, and nurse positions require more education.

15. A home care nurse admits an older adult with macular degeneration. Which of the following assessment questions is most appropriate? A) "Do you have difficulty opening your medication bottles?" B) "How do you organize your medications?" C) "How many medications do you take each day?" D) "What medications do you take each day?"

Ans: B The client with macular degeneration will have limited sight; therefore, a question about assuring that this client takes the correct medications at the correct time is appropriate. There is no indication that this client would have difficulty opening bottles. Asking how many medications are taken each day is not helpful nor does it use therapeutic communication. The nurse will want to know what medications the client takes; however, this question is limiting. It does not include PRN, herbs, or even medications a client may take weekly. Nurses should ask additional questions about the client's ability to take his or her medications as prescribed based on specific observations.

3. A nurse has observed an increasing number of older Asian Americans in the hospital. Which of the following statements regarding Asian cultures will best assist the nurse to plan nursing care? A) Asian Americans as a group have lower mortality rates. B) Health is often viewed as a state of physical and spiritual harmony. C) Older Asian Americans are more likely than other Americans to live alone. D) Care of elders is commonly provided in institutional environments such as nursing homes.

Ans: B While it is true that Asian Americans as a group have lower mortality rates at all ages, the statement that best assists the nurse to plan care of the Asian client is that a common view of health from the Asian perspective is that of harmony in the spiritual and physical contexts. Asian Americans are less likely to live alone. It is more common for older Asian Americans to live with family than in nursing homes.

1. A nurse is discussing an older adult's recent diagnosis of rheumatoid arthritis with a colleague. Which of the nurse's statements reflects an accurate view of the relationship between aging and wellness? A. "It's important that the individual knows this is an expected part of growing older." B. We need to teach the older adult how he can keep living a fruitful life in spite of his diagnosis." C) "We need to make sure our teaching is not too detailed for someone of his age." D) "We need to ensure his expectations of continuing to live alone are realistic."

Ans: B Answer B reflects a desire to foster a fulfilling and productive life for the older adult despite his diagnosis, and reflects an understanding of wellness and aging. Option A implies that illness is an inevitability of aging. Option C suggests that older adults have a limited capacity to learn by virtue of their age, and option D implies pessimism about the health and functioning of the older adult.

13. A nurse plans care for an older adult with advanced dementia. Which of the following plans is most appropriate regarding the pain treatment plan? A) Monitor assessment findings including vital signs for indications of pain. B) Treat pain that is implied by contractures and diagnoses of arthritis. C) Understand that persons with dementia do not experience pain. D) When the client begins wandering treat the client for pain.

Ans: B Dementia does not directly affect one's experience of pain but it does alter the ability to express pain, as well as other needs. Disruptive behaviors that do not involve locomotion were more strongly correlated with pain in comparison to behaviors (e.g., wandering) that involved locomotion. Compare current assessment findings with the person's baseline function, but recognize that the person's usual level of functioning may be affected by undiagnosed and undertreated pain. Assess for indicators of underlying causes of pain, such as chronic conditions, and treat this potential pain

3. A nurse is teaching nursing students about the importance of health promotion among older adults. Which of the following statements by a student indicates a need for further teaching? A) "Teaching older adults how to live with diabetes would be a useful health promotion initiative." B) "I can see why we would want to promote timely discharge back to the community following hospitalization." C) "I think that attending to spiritual growth could likely be a part of health promotion." D) "If we could promote healthy, simple diets, then some diseases could likely be prevented."

Ans: B Discharge planning is not a core component of health promotion. Health promotion denotes interventions or programs that focus on behavior changes that can improve health and wellbeing. Teaching older adults how to live with a particular disease, fostering spiritual growth, and promoting good nutrition are all components of health promotion.

9. A nurse discusses driving with an older adult who continues to drive, but is probably unsafe on the road. Which statement made by the nurse is most appropriate? A) I am calling your child to take your keys. B) I am concerned about your safety, as well as the safety of others. C) We just don't want you to crash when you drive across the state. D) You shouldn't drive anymore.

Ans: B Nurses can sensitively address issues about driving by expressing compassionate concern not only for the individual older adult but also for the safety of others.

2. A nurse is working with a 79-year-old client newly diagnosed with osteoporosis. Which of the following interactions promotes achievement of wellness outcomes? A) The nurse performs strength and mobility training appropriate to the client's age and diagnosis. B) The nurse teaches the client about bone density in older women and the role of vitamin D and calcium intake. C) The nurse plans interventions in light of the body- mind-spirit interconnectedness of the client. D) The nurse teaches the client about how her risk factors are a consequence of age.

Ans: B Teaching about bone density and the role of vitamin D reflects an acknowledgment that the client's diagnosis is attributable to both the client's age-related changes and risk factors such as inadequate nutrient and mineral intake. Strength and mobility training may well be an appropriate intervention, but it does not necessarily acknowledge the interplay of risk factors and age in the client's diagnosis. The body-mind-spirit interconnectedness is a component of the Functional Consequences Theory, but it does not address the relationship between risk factors and age per se. Teaching about risk factors as a consequence of age implies that these factors are an inevitable consequence of age, which is not the case.

6. An 81-year-old client was diagnosed with colon cancer several months ago. Both the patient and the family have been made aware of the potential for metastasis and the poor prognosis associated with this disease. At what point in the client's disease trajectory should the principles of palliative care be implemented? A) After chemotherapy and radiation therapy have been proven unsuccessful B) Early in the course of the client's cancer and before symptoms become unmanageable C) Soon after the client has made a decision to change her code status to "do not resuscitate" D) When the client's care team determines that there is less than 2 months to live

Ans: B The principles and practices of palliative care should not be exclusively reserved for late in a disease trajectory. It is applicable early in the course of an illness and should be offered as needs develop and before they become unmanageable. Palliative care can be provided concurrently with life-prolonging therapies or as a main focus of care.

14. A home health nurse visits a client who has a history of alcoholism and dementia. The client's words are incoherent, and the client's clothes are filthy. The client is unsteady and leaning to the right, and the room in the rooming house is in disarray. The only word that the nurse can clearly identify is "no." Which action by the nurse is most appropriate at this time? A) Ask the neighbors what has been happening. B) Call emergency services for transport to a hospital. C) Leave and return later. D) Search the room for empty bottles.

Ans: B Victims of self-neglect are likely to have the following characteristics: older age; chronic illness; functional limitations; solo living arrangements; social isolation; inadequate economic resources; and dementia, mental illness, substance abuse, or hoarding behaviors. If the elder is incapable of deciding whether to accept or reject emergency services, then these services should be provided.

8. A nurse cares for an 81-year-old client whose current hospital admission has been prompted by an exacerbation of chronic renal failure. Which of the following actions by the nurse will best emphasize the goal of client wellness? A) Ask for the client's code status be changed to "do not resuscitate." B) Explore the client's abilities and strengths. C) Show the client others who are more ill. D) Teach the client that health problems do not have to affect daily routines.

Ans: B A focus on existing strengths and abilities can foster wellness in older adults, even when they are experiencing health challenges. It is inappropriate to actively compare clients with each other, and changing Mr. Say's code status is unlikely to promote wellness, even if this is necessary. It is inaccurate to claim that health problems do not affect daily routines.

11. A nurse interviews a centenarian gathering data for a large study. In the interview, the centenarian defines aging as not growing older, but growing wiser. Which of the following is the best response to this definition by the nurse? A) "Aging might make you wiser, but it does lead to eventual death." B) "Healthy maturity is characterized by wisdom." C) "How did you get to live to this old?" D) "I will never make it to be 100 like you."

Ans: B Healthy maturity is characterized not only by physical decline but also by wisdom. The other responses are not therapeutic.

7. An 84-year-old client has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. Which of the following characteristics of the client's current situation is most likely to prompt this move? A) The development of a severe, acute health problem B) A decrease in the client's level of function and activities of daily living (ADLs) C) Exacerbation of a chronic health problem that may require medical treatment D) A change in the level of the client's social support

Ans: B Nursing home settings are becoming increasingly diverse, but a common feature of older adults who are admitted to nursing homes is a decrease in function and ADLs. Acute health problems that require medical treatment necessitate hospital admission, and a change in social support would not necessarily prompt a move from assisted living.

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

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

7. A nurse who oversees the care in a nursing home is aware that the older adults who reside in the facility are vulnerable to impaired thermoregulation. What information source should the nurse prioritize when regulating the temperature in the facility? A) The nurse's perception of heat and cold when dressed similarly to the residents B) Readings from an accurate thermometer C) The input from nursing assistant and unlicensed care providers in the facility D) The suggestions of residents who do not have cognitive impairments

Ans: B A reliable thermometer must be used in order to maintain a temperature as close to 75°F as possible. This objective data source supersedes the subjective perceptions of nurses, care providers, or certain residents, though each should likely be considered

5. An older adult client on a palliative care unit divulges to his nurse that he fears being in pain during the dying process. How can the nurse best respond to the client's admission? A) "It sounds like you're understandably anxious about this. How can I help you to relax?" B) "A lot of clients do have pain at the end, and we will do all we can to control it for you." C) "We will do all we can to address it, and you'll be able to have a peaceful passing." D) "Pain during the dying process actually is not nearly as common as many people believe."

Ans: B Acknowledging that a lot of clients do have pain at the end and that staff will do all they can to control it both acknowledges the client's specific concern and provides a realistic response that the pain will be treated as effectively as possible, but does not guarantee a pain-free dying process. Acknowledging the anxiety and offering relaxation assistance do not address the specific concern about pain. Stating that the client will have a peaceful passing makes a promise that is not possible to guarantee. Pain is a common accompaniment to the dying process

11. A nurse discusses common illnesses at the local health fair. The older adult asks, "Why do all my friends seem to get pneumonia?We never did when we were younger." Which of the following interventions should the nurse include in the teaching? A) Examinations by health care provider B) Hand hygiene C) Jogging/running D) Yearly pneumovax

Ans: B Age-related alterations of the immune functions are a major contributing factor in the prevalence of lung diseases among older adults. Examinations are helpful in early identification of some lung diseases but not preventative regarding communicable diseases such as pneumonia. Pneumovax is not required yearly

6. A nurse initiates an acute care for elders unit in a medical facility. Which of the following factors should the nurse include when teaching the nursing staff about delivering medications to the older adults on the unit? A) Drug metabolism shifts from the liver to the kidneys as individuals age. B) Older adults face an increased risk of adverse medication effects. C) Older adults tend to achieve clearance of medication faster than do younger patients. D) Older adults tend to need more frequent doses of a drug to achieve therapeutic effect.

Ans: B Age-related physiologic changes result in an overall increased risk of adverse drug effects. Drug clearance tends to be slower, so lower doses are normally required. There is no change in which organs are responsible for metabolism of drugs in older adults.

12. A nurse reviews the medication list of an older adult upon transfer from the hospital to an extended care facility. Which of the following methods is most likely to reduce the occurrence of adverse effects? A) Administer medications at the same time every day with meals. B) Compare the list to the Beers criteria list and notify the health care provider of any on the list. C) Request that the client's medications be put on hold and restarted one at a time. D) Stop the administration of GI and narcotic pain medications.

Ans: B An important theme of the Beers criteria and other guidelines is that medications are determined to be appropriate or inappropriate in relation to the patient's condition. Some medications should be given with meals, while others should not. There is no need to stop all medication

9. A community health nurse is to create initiatives to foster the health of older adults in the community. Which of the following health promotion activities has the greatest potential to promote the respiratory health of older adult participants? A) A lung cancer screening program B) A smoking cessation program C) A tuberculosis screening program D) A bronchitis immunization program

Ans: B As with younger adults, smoking cessation confers a multitude of health benefits, especially with regard to respiratory and cardiovascular health. Lung cancer screening and tuberculosis screening are less likely to benefit large numbers of participants. Bronchitis is not a health problem that is amenable to immunization

4. A nurse plans the diet for an older adult with congestive heart failure. Which of these nursing interventions would be most successful to encourage optimal nutrition? A) Encourage calorie supplements. B) Provide 55% of calories from complex carbohydrates. C) Teach older adults to sit upright for 2 hours after a meal. D) Use moderate to large amounts of flavor enhancers

Ans: B Dietary guidelines for older adults recommend a daily intake of five to nine servings of fruits and vegetables; 55% of calories need to come from complex carbohydrates. Older adults need fewer calories with increased quality of nutrients in their nutritional requirements. Older adults with presbyesophagus must sit upright for 30 minutes to 1 hour after eating. Flavor enhancers (except lemon) contain sodium and need to be used in small amounts for older adults who have a diminished sense of taste.

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

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

9. A nurse on an acute care unit is disturbed by the increasing incidence of pressure ulcers among older adults. Which of the following measures should the nurses on the unit prioritize in order to prevent the formation of pressure ulcers? A) Apply emollient lotions with baths B) Frequent repositioning of immobilized clients C) High-protein, high-calorie diet D) Massage bony prominences each shift

Ans: B Frequent repositioning is an important measure in prevention. Lotions should be applied; relief of pressure is the highest priority. Nurses should ensure that those at risk for pressure ulcers do receive enough calories, vitamins, and protein. Nurses do not massage bony prominences for concern of damage

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

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

7. The nurses who provide care in a long-term care setting are aware of the high prevalence and risks of cardiovascular disease among the older adults who live at the facility. Which of the following measures is most likely to prevent heart disease among older adults? A) Advocating for organic dietary choices for residents B) Establishing an exercise program C) Teaching about the relationships between family history and heart disease D) Teaching residents to reduce their stress levels

Ans: B Inactivity is among the most salient risk factors for heart disease, exceeding the effects of stress. Knowledge about the role of family history is unlikely to lower individuals' risks of heart disease. An organic diet is not necessary to prevent heart disease

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

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

3. An older adult, aged 72, with type 2 diabetes and coronary artery disease is admitted to a long-term care facility. The client takes glipizide (Glucotrol) and isosorbide mononitrate (Imdur). The medical history states that the client drank 4 ounces of whiskey per day for many years. Which of the following actions should be a priority for the admitting nurse? A) Assess and observe for depression. B) Assess for hypoglycemia and hypotension. C) Evaluate the client for renal failure. D) Evaluate blood work for changes in electrolytes

Ans: B Older adults are more susceptible to developing medication- alcohol interactions. Age-related changes in body composition can cause higher levels of alcohol to be absorbed into the bloodstream. Alcohol enhances vasodilation when an individual takes a nitrate, and there is potentiation of oral hypoglycemics by alcohol. CNS depression occurs when alcohol interacts with barbiturates and meprobamate, which this client is not taking. There is no need to evaluate for renal failure or changes in electrolytes; these are not known medication-alcohol interactions.

1. Which of the following individuals is likely at the highest risk for orthostatic hypotension? A) A 75-year-old woman who uses a walker B) An 80-year-old man who strains to void when using the bedside commode C) A 60-year-old who has a long leg cast on his right leg D) An 80-year-old woman who is taking Premarin

Ans: B Orthostatic hypotension rises significantly after the age of 75. A risk factor for orthostatic hypotension is doing a Valsalva maneuver while voiding.

6. Older adults experience a number of changes in the structure or function of their cardiovascular system. Which of the following changes is considered to be a normal, age-related change? A) Veins become thinner and more elastic. B) Regulation of blood pressure and heart rate becomes less efficient. C) Heart valves become atrophied and regurgitation occurs. D) Heart rate becomes slower and ejection fraction increases

Ans: B Overall regulation of blood pressure and heart rate becomes less responsive and less efficient with age. Veins become thicker and stiffer. Heart rate does not typically slow with age and valvular regurgitation is considered a pathologic condition at any age

15. A nurse helps older adults increase healthy behaviors by restructuring. Which of the following communication techniques should the nurse use to help the older adult overcome barriers? A) "Could you walk with your friend for a half-hour after you both come back from the lunch program at the senior center?" B) "I know it's hard to get outside in the winter, so let's try to identify some ways of getting more exercise indoors during your usual activities." C) "Let's talk about the benefits of exercise. When you walk regularly you reduce constipation and muscle pain." D) "Your activity has been decreasing during the last 3 years and it is at the point that you are at an increased risk for heart disease."

Ans: B Restructuring assists the client to use positive thinking to focus on ways of overcoming barriers (e.g., getting outside in winter). Giving suggestions about when and where to walk might be helpful, but it is best if the client develops the plan of action. Talking about the benefits of exercise reinforces rewards. Discussing consequences of inactivity raises the consciousness of the older adult.

3. A 70-year-old client with urosepsis is admitted to a nursing unit. The labs include elevated sodium, blood urea nitrogen, hematocrit, and albumin. Which of the following nursing diagnoses is priority for this client? A) Constipation B) Fluid volume deficit C) Imbalanced nutrition: less than body requirements D) Impaired tissue perfusion

Ans: B The appropriate nursing diagnosis is fluid volume deficit. Blood values that may be altered in dehydration include elevations in sodium, hematocrit, creatinine, osmolality, and blood urea nitrogen. While the client may develop constipation, it is not the priority at this time. Albumin will be decreased with poor nutrition but increased with dehydration. An elevation in these labs does not implicate impaired tissue perfusion

9. A nurse who provides care in a large, inner-city hospital comes into contact with older adults from a wide variety of cultural groups. How is culture most likely to influence the assessment and management of pain? A) Cultural differences affect the intensity of pain. B) Culture can dictate the appropriate expression of pain. C) Culture should determine the choice of analgesia when treating pain. D) Culture is unrelated to pain because pain is a physiological, rather than psychosocial, phenomenon.

Ans: B The most salient effect of culture on pain management involves the expression of pain. Culture can be a relevant influence on the subjective sensation of pain and clinicians' choice of analgesia, but this is typically less pronounced than the effect of culture on the expression of pain

11. A nurse assesses older adults at a senior center. One older adult, age 78, has a body mass index (BMI) of 15. Which response by the nurse is appropriate? A) "You are too skinny." B) "Have you been losing weight?" C) "Have you tried to lose this extra weight?" D) "Congratulations your BMI is great."

Ans: B The nurse uses therapeutic communication to assess the weight loss. Unintentional weight loss is considered a significant indicator of poor nutrition. Healthy adult BMI is between 18 and 25 and may extend to 30 for older adults

3. A 70-year-old client smoked for 30 years and has a history of COPD. The spouse assists with cooking, cleaning, and transportation. The spouse has become ill, and they now receive assistance from a home health nurse. Which of the following interventions should be the priority? A) Assisting the clients to perform instrumental activities of daily living (IADLs) B) Determining a plan for providing meals C) Setting up medications for the clients D) Smoking cessation plan

Ans: B The nurse's role is not to perform the IADLs, but to plan for the IADLs including meals, cleaning, and transportation. There is no indication that the clients need their medications set up, smoking cession is important, but basic needs come first

13. A nurse cares for an older adult in a residential care program. The client has multiple chronic conditions. The client has developed dyspnea and has lost 105 lb of body weight. Which of the following statements by the nurse is most appropriate? A) "Have you ever heard of palliative care?" B) "I want to talk to you about switching our focus from cure to care." C) "We don't think that there is anything we can change to make you better." D) "Your breathing problems concern me."

Ans: B Unintentional weight loss, unstable medical conditions, and frequent hospitalizations indicate a need for discussion of palliative care services. The nurse uses open-ended assertive statements that teach the client. Saying we can't make you better might be helpful for a client who is unable to hear the professional the first time palliative care is introduced. The concern regarding the breathing doesn't introduce the idea of supportive care.

1. A 65-year-old woman is speaking to her nurse at the primary care clinic. She states that it is very painful for her when she has sexual relations. She asks the nurse what she could do to alleviate the pain. Which of the following suggestions could the nurse make to the woman? A) Decrease the incidence of sexual relations. B) Use a water-soluble lubricant or estrogen cream. C) While engaging in intercourse, have your partner thrust his penis upward. D) Use a polyisoprene (non-latex) condom for intercourse

Ans: B With age, there is a thinning of the vaginal mucosa, which creates dryness and predisposes women to irritation and inflammation so using a water-soluble lubricant or estrogen cream may be helpful. The male partner should thrust downward instead of upward during sexual intercourse. Decreasing the incidence of sexual relations may lead to a "use it or lose it" principle. Use of a condom, latex or polyisoprene, will not decrease vaginal wall irritation.

10. Assessment of an older adult's ADLs addresses parameters such as mobility, dressing, and elimination. In addition to these, which of the following categories should the functional assessment also include? A) Pain B) Mental status C) Previous medical history D) Integumentary assessment

Ans: B A brief mental status assessment is included on the ADL form. Including mental status in the functional assessment rather than using a separate mental status assessment tool reinforces the fact that cognitive function is an integral component of ADLs. In addition, it helps to determine whether ADL impairments are attributable, at least in part, to cognitive impairments, rather than primarily to physical limitations. Pain, medical history, and integument are all relevant assessment parameters, but none is explicitly included in a functional assessment.

4. Which of the following processes should a nurse address first when assessing sexual function in older adults? A) Identify risk factors that may interfere with the older adult's sexual functioning. B) Assess own personal attitudes toward sexuality and aging. C)Obtain permission from the individual to initiate a discussion on sexual relations. D) Provide detailed information about sexual function to the older adult.

Ans: B A personal attitude assessment about sexuality and aging is a nurse's prerequisite to discussing sexual function with older adults. The next step would be to obtain permission from the individual to initiate discussion about sexual relations

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

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

5. A nurse manager of a nursing care facility reviews potential health and safety interventions and outcomes with the nursing staff. Which of the following interventions places emphasis on quality of life with the best possible health and safety outcomes? A) Telling the resident about his or her schedule for the day B) Allowing the resident with a history of falls to walk with the help of an assistant C) Discouraging the resident who states they are tired from participating in activities D) Advising the resident not to attend church because the resident is not Catholic

Ans: B Allowing the resident with a history of falls to walk with the help of an assistant places emphasis on quality of life with the best possible health and safety outcomes. Telling the resident about his or her schedule for the day does not address safety or autonomy. It is not quality of life to discourage the resident from participating in activities (even if tired). Advising the resident not to attend church because the resident is not Catholic is unethical.

13. A home health nurse performs an admission on a 90-year-old client who has a small dog. The client states that the most important problem is urinary incontinence. The client's blood pressure is 135/90 mm Hg, with last bowel movement 3 days ago. Which of the following areas addresses the person's goals? A) Safety B) Incontinence C) Blood pressure D) Constipation

Ans: B Although nurses address safety, blood pressure, and constipation as part of a comprehensive care plan, it is imperative to begin by addressing the older adult's priority.

4. A nurse teaches an older adult man to perform pelvic floor muscle exercises (PFME)? Which of the following should be included in a nurse's instructions? A) Interrupt the flow of urine several times each time you urinate. B) Identify the correct muscle by making the base of your penis move up and down. C)Contract your legs and buttocks while contracting the pubococcygeal muscle. D) Perform the exercise while standing over the toilet

Ans: B An important element of teaching about pelvic floor exercises is to identify the pubococcygeal muscle and practice contracting and relaxing this muscle. For men, this can be done by raising the base of the penis. Once the muscles have been identified, do not continue to stop urinary flow. These exercises can be performed sitting, standing, or lying down. Keep legs, buttocks, and abdomen relaxed

7. A nurse who provides care in a clinic comes into contact with numerous older adults, many of whom have bruises of various sizes and stages on their body. What pattern of bruising is most suggestive of possible abuse? A) Significant bruising on the shin region of a client's leg B) Bruising on both ears and both sides of the neck C) Bruising on the back of a client's hands D) Bruising on both of a client's elbows

Ans: B Bruising on the neck and ears is not typically accidental. Conversely, bruising on the backs of the hands, elbows, and shins is more common and less likely to raise the suspicion of abuse

10. An 89-year-old adult is dismayed that his primary care provider referred him for a driving evaluation because he experiences vision problems and slower reaction time. Which of the following concepts is illustrated in this example? A) Risk factors B) Age-related changes C) Positive functional consequences D) Wellness outcomes

Ans: B Changes in vision and response time are considered to be age-related changes. These are not necessarily risk factors and they would not be considered positive functional consequences or wellness outcomes.

4. A nurse's colleague states, "Older people who live in the country are a lot healthier than city folk." Which statement by the nurse is most appropriate? A) "The differences aren't large, but rural adults do have better health outcomes than do city dwellers." B) "But chronic conditions are more common among rural adults." C) "Overall, yes. Higher levels of family support translate into longer average life spans for rural adults." D) "Unfortunately, no. And this is mostly attributable to the problem of homelessness."

Ans: B Chronic conditions are overrepresented among rural adults. Overall, rural adults have worse health outcomes than do urban dwellers. While family support levels are generally high, this does not mean that rural adults live longer lives on average. Lack of access and other factors, rather than homelessness, are cited as reasons for the differences in health outcomes between rural and urban adults.

6. A nurse has recently begun to provide care to older adults in a large, urban hospital. Having lived until recently in an ethnically homogeneous region, the nurse has begun to recognize the significant differences in priorities and perspectives of clients from other cultural groups and has taken action to learn about these groups. What stage of cultural self-assessment is this nurse demonstrating? A) Unconsciously incompetent B) Consciously incompetent C) Consciously competent D) Unconsciously competent

Ans: B Cultural competence begins with unconscious incompetence as a state of not being aware that one is lacking knowledge about another culture. When the person becomes aware of this knowledge gap, he or she progresses to a state of conscious incompetence and takes actions to learn about the cultural group; this stage is demonstrated by the nurse in this question. A person progresses to a stage of conscious competence by verifying generalizations and incorporating culture-specific interventions in care. The final stage is unconscious competence, when knowledge of the cultural group is fully integrated into one's thinking and approach

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

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

5. A nurse in a Medicare- and Medicaid-funded nursing home performs assessments and develops care plans. Which of these statements is true of the functional assessments the nurse is likely to perform? A) The nurse will address core ADLs but not more complex IADLs. B) The nurse will identify changes in the older adult's function over time. C) The nurse will utilize various functional assessment models. D) The main goal of functional assessments will be to ensure older adult safety.

Ans: B Functional assessments consider an older adult's functional status and changes in this status over time. They include both core ADLs and more complex IADLs. The nurse is likely to use the Minimum Data Set for Resident Assessment and Care Screening, as mandated for Medicare- and Medicaid-funded facilities. While safety is a consideration in functional assessment, the

7. A nurse plans interventions to promote wellness in older adults. Which of the following interventions is most appropriate to meet this goal? A) Talking with the physician about available treatment options for an older adult with an acute illness B) Facilitating early mobilization to prevent muscle wasting and loss of function in an older hospital client C) Deferring the final decision regarding an older adult's choice of assisted living facility to the person's son and daughter D) Placing a 76-year-old on the waitlist for a kidney transplant

Ans: B Goals of the Functional Consequences Theory include improving or preventing declines in functioning and addressing quality-of-life concerns. Discussing treatment options, having family members make an older adult's decisions, and placing an individual on a waitlist for a transplant are not direct manifestations of this principle.

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

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

7. Despite the fact that older adults are proportionately the highest users of health care services, many nurses harbor misconceptions and deficits in practice related to gerontological nursing. What is the most likely solution to this problem? A) A shift from the treatment of older adults in institutional settings to home care B) Increased nursing education and clinical experience specific to working with older adults C) A focus on early discharge planning for older adults in hospital settings D) Increased use of aggressive pharmacologic interventions in the treatment of acute illnesses in older adults

Ans: B Individual gerontological nurses as well as national nursing bodies have joined in a call for increased education to better enable nurses to meet the diverse health needs of older adults. Early discharge planning, increased home care, and aggressive drug treatment are measures that may be appropriate in certain contexts, but none is likely to improve nursing care of older adults at a broad level.

11. A nurse plans culturally competent care for a variety of clients. Which of the following cultures is most strongly tied to the low health status? A) Hispanic in race B) Low socioeconomic status C) Member of LGBT society D) Resident of urban community

Ans: B Lower socioeconomic position is an overriding determinant of health status. Hispanic subgroups vary in rates of disability. While urban older adults and those in the LGBT community have special needs, their health is not significantly worse than others as a whole.

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

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

7. A nurse reads up on some of the more common cultural groups in the local area. How should the nurse interpret the information that is available about cultural groups? A) Characteristics of cultural groups are normally consistent between every member of that group. B) Cultural generalizations can be useful and accurate, but they do not replace individualized assessment and care. C) It is simplistic and problematic to make generalized claims about members of a particular cultural group. D) It is unjust to categorize individual clients as being members of a specific cultural group.

Ans: B Nurses need to be knowledgeable about different cultural groups, but they need to use this information as a backdrop for exploring the ways in which individuals identify with the characteristics of the various cultural groups to which they belong. Generalized knowledge may be accurate and clinically useful, but it is not replacement for individualized knowledge. Nurses need to recognize that the culture of each individual person is based on his or her membership in many groups and is internalized in a unique and personal way.

11. A nurse assesses an older adult 24 hours after a retropubic suspension surgical procedure. The client is confused, exhibits muscle twitching, and states she is nauseated. Which laboratory data should the nurse assess? A) Blood urea nitrogen B) Sodium C) Hemoglobin D) White blood cell count

Ans: B Older adults will more readily develop hyponatremia especially under conditions of physiologic stress (e.g., surgery). The concern is hyponatremia not hemoglobin, or blood urea nitrogen. An UTI increasing the neutrophil count might also impact the sodium level; however, the symptomology exhibited is hyponatremia.

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

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

5. A 30-year-old grandchild lives with and provides care for the 75-year-old grandparent. The grandparent has congestive heart failure, hypothyroidism, and chronic pain from a compression fracture and osteoporosis. The grandchild supervises the older adult's medications. The home health nurse notes that the older adult has extra diuretic pills and that the pain medications for a month have been used and cannot be refilled for 2 more weeks. The older adult tells the nurse: "Those pain pills don't work, my back is always hurting." The nurse notes that the older adult's ankles are very swollen. Which of the following things should the nurse do first? A) Call adult protective services and ask for an immediate evaluation. B) Assess the grandchild's understanding of her grandmother's needs. C) Take the grandmother to the emergency department immediately. D) Tell the older adult that her grandchild is probably taking her pain medications.

Ans: B Physical neglect can arise from the caregiver's lack of knowledge. It is important to assess the caregiver's understanding of the dependent person's needs before drawing other conclusions

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

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

9. A nurse plans the care of older adults in a long-term care setting. Which of the following interventions incorporates the residents' connectedness to society? A) Ensuring that there are multiple television sets available to residents of the facility B) Arranging regular visits by schoolchildren to the facility C) Conducting reminiscence therapy D) Allowing residents to have input into the meal planning at the facility

Ans: B Social connectedness can be fostered by arranging meaningful contact between older adults and other members of society. TV, reminiscence, and input into routines may all have benefits, but none is likely to create a sense of connectedness with society.

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

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

2. A nurse cares for an 87-year-old client from India who has noted Hinduism as religious preference on admission records. This client is transferred to the hospice unit. Which of the following actions by the nurse best shows caring? A) Ask the family to tell you about Hinduism. B) Assess the client's spiritual needs. C) Notify the family's pastor. D) Pray with the client and family.

Ans: B Spiritual assessment should take place on admission and throughout the client's time in palliative care. Spiritual care is within the scope of nursing, and prayer would be appropriate if it were chosen based on a sound assessment of the client's needs and belief system. Nurses should be prepared to refer to whatever spiritual leader the client expresses a desire to speak with. Now is not the time to query, it is the time to listen.

10. A nurse at a long-term care facility has completed the admission assessment of a 79-year-old male resident. The resident has identified himself as gay and has expressed sadness at having to leave his partner of several decades in order to move to the facility. The nurse should recognize that this resident is likely to have a history of: A) Homelessness B) Stigmatization C) Nominal employment or unemployment D) Infectious diseases

Ans: B Stigma is a common experience among LGBT (lesbian, gay, bisexual, and transgender) older adults, and the likelihood of this is greater than the likelihood of homelessness, unemployment, or infectious diseases.

14. An older adult is sore from "doing too much in the yard yesterday." Which statement by the nurse best promotes healthy aging? A) "It's time to start exercising and eating right." B) "Let's look at how we can improve your health so you can do more." C) "Of course you can't do as much as you did before, you need to pace yourself." D) "You need to act your age, and let others do that work."

Ans: B The Functional Consequences Theory for Promoting Wellness in Older Adults emphasizes those factors that nurses can address through health promotion interventions. The client selfdetermines, and the nurse teaches and guides. If health care providers hold the perspective of "what do you expect, you're old, " then reversible disease conditions may go untreated

3. A nurse explores resources available to assist a client. Which of the following older adults meets the eligibility requirements for hospice care? A) A client who is immobilized and unable to afford specialized nursing care B) A client who has experienced a stroke and been given 3 months to live C) A client with cancer who is living with uncontrolled persistent pain D) A client with acquired immunodeficiency syndrome who lacks family support to provide needed care

Ans: B The eligibility requirements for hospice care include physician referral and a life expectancy of less than 6 months. Financial need, high pain levels, and lack of family support are not explicit qualifiers for hospice care

2. A nurse is discussing sexual activity with older adults in a wellness clinic. Which of the following statements by an individual indicates a need for further exploration? A) "I know my diabetes can affect my sexual activity." B) "My husband has an enlarged prostate." C) "I use Premarin cream to help with vaginal dryness." D) "I will not use petroleum jelly as a lubricant."

Ans: B The husband's prostate problem can affect his sexual performance and needs further exploration. Premarin cream helps when vaginal dryness occurs because of estrogen withdrawal. Diabetes has an effect on vaginal lubrication. Petroleum jelly increases risk for infection

1. Which of the following statements best captures the typical character of health problems in the lives of older adults? A) Older adults' lives are dominated by the increasing number of acute health problems due to age-related changes. B) Most older adults experience an interplay between a number of chronic conditions and occasional acute health problems. C) Older adults can expect a relatively consistent decline in their health over time as a result of acute health problems. D) Chronic conditions account for the normal downward direction of an older adult's health status

Ans: B The interplay between chronic and occasional acute conditions is typical of the health trajectory of many older adults. The most salient factor is not acute problems alone, nor are health problems necessarily attributable to age-related changes. Changes in health status are rarely consistent and do not exclude chronic conditions or acute problems

1. A nurse is responsible for assessing an older adult in an acute care setting. Which of the following statements most accurately captures the complexity involved in assessing the older adult? A) Older adults manifest fewer symptoms of illness than do younger clients. B) Signs and symptoms of illness are often obscure and less predictable among older adults. C) Care must be taken to avoid assessing normal, age-related changes. D) Older adults experience fewer acute health problems but more chronic illnesses than do younger clients

Ans: B The manifestations of illness in older adults can be less clear and less predictable than among younger clients. Older adults often show different, but not necessarily fewer, symptoms than do younger clients. Age-related changes must be recognized and acknowledged, not excluded from the assessment process. Older adults do not experience fewer acute health problems than do younger adults but rather different manifestations of health problems

7. The children of a resident of a nursing home have approached the nurse because they believe their parent is being manipulated by a person who also lives in the facility. Their parent has a diagnosis of early-stage Alzheimer disease and various comorbidities that affect mobility and function. How should the care team appraise the parent's decision-making capacity? A) Her decision-making ability is nullified by the presence of a dementia. B) Her decision-making capacity should be determined according to objective criteria. C) She should be asked to demonstrate sound decision making in minor matter before being allowed to make more important decisions. D) A surrogate should be appointed to make her decisions because she has been diagnosed with Alzheimer disease.

Ans: B The presence of dementia does not necessarily render a person incapable of all decision-making ability. Rather, this ability should be analyzed according to criteria of understanding, reasoning, choice, and expression.

11. A nurse assesses a 66-year-old woman who strained a muscle. The client attends the gym daily, and states, "I injured my muscle grouting the floor tile getting ready for the bridge class I teach." Which of the following categorizes this client's aging? A) Healthy B) Active C) Productive D) Successful

Ans: B The scenario does not show social participation, nor does it address whether or not the client is fully aging well (successful aging). The client does show healthy aging, but active aging better fits the information presented (active physically and mentally).

8. An 89-year-old woman has developed urinary incontinence. The woman states, "When I have to go, I go. I can't make it to the bathroom before it leaks out." For which type of incontinence should the nurse develop a plan of care? A) Functional incontinence B) Urge incontinence C) Mixed incontinence D) Stress incontinence

Ans: B Urge urinary incontinence is characterized by involuntary urinary leakage due to the inability to hold urine long enough to reach a toilet after perceiving the urge to void. Functional incontinence is urination due to inability to reach appropriate toileting facility. There is no indication that she has functional impairment. Stress incontinence is leakage of urine as a result of an activity that increases abdominal pressure. Mixed incontinence is the involuntary leakage of urine with both the sensation of urgency and activities such as coughing, sneezing, and exertion

1. A nurse develops a plan of care for a family with nursing diagnosis of Caregiver Role Strain related to urinary incontinence. Which of the following interventions is the highest priority? A) Administer diphenhydramine at bedtime. B) Assist the client to the bathroom prior to bedtime. C) Limit the fluid intake of the client to 1000 mL each day. D) Monitor bowels for diarrhea and constipation

Ans: B Walking the client to the bathroom encourages voiding prior to bedtime. Urinary incontinence is a major factor that impacts placement in an institution. Fluid intake should be carefully timed and should be about 2,000 mL per day. Diphenhydramine relaxes bladder muscles, which can lead to urinary retention and incontinence

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

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

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

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

3. A nurse conducts a functional assessment of a client who has moved to the assisted living facility. Which of the following statements best describes this functional assessment? A) Information on the client's medical diagnoses and health problems. B) Client's ability to perform self-care tasks with a focus on rehabilitation. C) Assessment of the client's activities of daily living (ADLs). D) Prioritization of the client's ability to perform roles in relationships and in society.

Ans: B Functional assessment is a way of determining an individual's ability to fulfill responsibilities and perform self-care. While it is distinct from a medical diagnosis approach, it does not discount or ignore information on an older adult's diagnoses and health problems. It includes data on ADLs and is not a counterpoint to ADL assessment. The focus is on the fulfillment of responsibilities and self-care more than on performing social and relationship roles.

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

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

7. A nurse in a long-term care facility has noticed that many residents of the facility spend a large amount of time in bed yet frequently complain of fatigue and sleep deprivation. What change in the facility's environment is most conducive with helping residents achieve adequate amounts of restful sleep? A) Keeping the lights at a consistent, low level throughout the day and night B) Allowing residents to awake/sleep according to their own routines C) Maintaining the facility at a temperature of 78°F to 80°F during the night D) Checking on each resident every 2 hours during the night to ensure safety

Ans: B It is important not to schedule the time for awakening clients/residents based on the most efficient use of nursing and dietary time that require clients/residents to adjust their sleep routines accordingly. Lighting should be bright during the day and dark at night in order to foster normal circadian rhythms. A temperature of 78°F to 80°F during the night is likely too warm to promote restful sleep. Safety concerns are not related to the issue of adequate sleep

3. A nurse is teaching new graduates about the nature of palliative care on her unit. Which of the following statements by a new nurse indicates a need for further teaching? A) "I can see how important it is for us to educate patients and their families and friends on the unit." B) "It certainly requires a change in thinking to understand why we don't provide any medical interventions for patients." C) "I can see how comfort and psychosocial well-being take precedence over physical functioning." D) "Purpose in life and quality of life seem to be the overarching goals of palliative care."

Ans: B While the focus of palliative care is not on curing disease, this does not mean that treatments of all kinds are absent. Distressing symptoms are addressed from both a nursing perspective and a medical perspective. Education is a key component of palliative care, and comfort and psychosocial well-being trump physical functioning. Purpose in life and quality of life are similarly emphasized

10. Following a prolonged hospital stay due to an exacerbation of congestive heart failure, an older adult woman has returned to the nursing home where she normally resides. The woman became incontinent of urine during her time in the hospital, a problem that nursing staff wish to now resolve. What action should her caregivers take in performing continence training? A) Limit the woman's fluid intake to 750 mL daily, primarily before suppertime. B) Assist the woman with toileting at timed intervals throughout the day. C) Teach the woman about the functional and psychosocial benefits of restoring continence. D) Perform intermittent catheterization before each meal and before bedtime

Ans: B With caregiver-directed methods of continence training, the caregiver uses the initial assessment of voiding patterns to establish a schedule for assisting with voiding. The caregiver gradually increases the interval between voidings until the person can maintain continence for 2 to 4 hours. Fluid restriction to 750 mL per day is inadequate to maintain hydration, and intermittent catheterization does not promote continence. Education is a component of continence training, but individuals are not likely to need to be informed of the benefits of continence

12. A graduate nurse expresses an interest in focusing future study to healthy aging. Toward which of the following fields should the experienced nurse steer the graduate nurse? A) Palliative care B) Gerontological nursing C) Nursing home administration D) Social work

Ans: B Gerontological nurses are the health care professionals consistently responsible for the 24-hour care of older adults in all clinical settings.

9. A recent heat wave has resulted in an increase in the number of older adults who are presenting to the emergency department with actual or suspected hyperthermia. What assessment findings are congruent with a diagnosis of hyperthermia in older adult clients? (Select all that apply.) A) Diaphoresis B) Weakness C) Warm, dry skin D) Pallor E) Bradycardia

Ans: B, C Signs and symptoms of hyperthermia include warm, dry skin, and weakness. Skin surfaces are not typically pale and heart rate typically increases, not decreases. Sweating may be minimal or absent

14. Which of the following sources might nurses use to improve their cultural competence? (Select all that apply.) A) Discuss cultural norms with clients' families. B) Explore the resources in Online Learning Activities. C) Read journals and other references. D) Utilize organizations listed at the end of chapters. E) Write teaching materials in prominent local languages.

Ans: B, C, D Professional sources are suggested to improve nurses' cultural competence. Nurses are encouraged to read journals and other references and by exploring the resources in Online Learning Activities in this chapter. Health care professionals are encouraged to contact local organizations to obtain culturally specific information about groups that reside in their locale. Clients' families should not be the primary source of data regarding cultural norms; nurses should be knowledgeable about cultural groups. Nurses should remain open to families input to their loved ones.

12. A nurse educates an older adult recently diagnosed with hypertension. Which of the following teaching points should the nurse include? (Select all that apply.) A) Avoid home blood pressure monitoring. B) Increase the daily intake of grains to 8 ounces per day. C) Read labels and limit sodium to 1,500 g/day. D) Walk daily for 30 minutes a day 5 of the 7 days. E) If your blood pressure is higher than 130/80 notify the primary health care provider.

Ans: B, C, D About 30 to 45 minutes of exercise, such as brisk walking, at least five times weekly is recommended for all people with hypertension. The following nutritional interventions are recommended for all people with hypertension: sodium intake limited to 1.5 g daily; avoidance of processed foods; daily intake of 7 to 8 servings of grains and grain products and 8 to 10 servings of fruits and vegetables. A person's blood pressure should be measured at least three times before making any decisions about treatment with a goal of systolic blood pressure of <130/80 mm Hg. Home blood pressure monitoring is recommended for initial and ongoing assessment.

6. A nurse instructs a class of older adult women about Kegel exercises. In which of the following urinary conditions would Kegel exercises be effective? (Select all that apply.) A) Functional incontinence B) Pelvic organ prolapse C) Stress incontinence D) Urge incontinence E) Urinary retention

Ans: B, C, D Pelvic floor muscle exercise (PFME) is an evidence-based practice that is effective as a first-line intervention for men and women with stress, urge, and mixed incontinence and in women with pelvic organ prolapse. Functional impairments are a major risk factor for the development of incontinence because they can interfere with the ability to recognize and respond to the urge to void in a timely manner. Because older adults have a shorter interval between the perception of the urge to void and the actual need to empty the bladder, any delay in reaching an appropriate receptacle can result in incontinence

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

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

15. A nurse works to protect vulnerable populations and reduce health disparities. Which of the following nursing actions work toward that goal? (Select all that apply.) A) The nurse acknowledges that the clients in subgroups will not change beliefs or actions. B) The nurse communicates a nonjudgmental attitude toward health system beliefs. C) The nurse incorporates clients' belief systems into the plan of care. D) The nurse asks the client how the care system can incorporate the clients' health beliefs. E) The nurse teaches each client about preventive care.

Ans: B, C, D, E Health promotion interventions, such as teaching about prevention and early detection of certain conditions, are particularly important when caring for older adults who are members of a minority group. Nurses communicate nonjudgmental attitudes and asking open-ended questions to elicit information about each person's life experiences and cultural influences. Nurses need to be aware of the health beliefs that influence their clients, so they can adapt their interventions accordingly.

12. A nurse assesses a 71-year-old person who has smoked for 43 years. Which of the following is a negative functional consequence of smoking for this person? (Select all that apply.) A) Children are exposed to secondhand smoke B) Low oxygen-carrying capacity C) Abnormal breath sounds D) The ability to run a 5-K race E) Pulmonary disease

Ans: B, C, E Functional consequences are the observable effects of actions, risk factors, and age-related changes that influence the quality of life or day-to-day activities of older adults. Low oxygencarrying capacity, abnormal breath sounds, and pulmonary disease are negative functional consequences of smoking. The ability to run a 5-K race is lost with smoking. Children may be exposed to secondhand smoke. These are not functional consequences of smoking for this person.

13. A nursing supervisor in the long-term care facility implements changes to improve environmental conditions. Which of the following should be included in these changes? (Select all that apply.) A) Assist residents to bed at 7 PM each day. B) Build partitions between roommates. C) Install low-level night lights in the bathrooms. D) Replace light bulbs with low light energy efficient bulbs. E) Set thermostat at 72 each night.

Ans: B, C, E More time in bed does not mean more time sleeping. Partitions can increase the sleeping privacy of residents; bright lights at night interfere with sleep but are helpful during the day. Temperature that is too hot or too cold interferes with sleep

11. A nurse assesses a 91-year-old client in long-term care healing from bilateral broken legs caused in a fall. Today, the client developed new onset confusion and combativeness. Which of the factors must the nurse investigate as a source of this mental status state? (Select all that apply.) A) Social separation B) Hyponatremia C) Medication interactions D) Positional pain E) Urinary tract infection

Ans: B, C, E Sodium level, medications, and urinary tract infections can each lead to confusion and combativeness. While pain and social separation may be associated with confusion, they are unlikely to be the root cause of these new onset issues

1. A nurse assesses an 82-year-old client who states, "That waiting room is so cold!" Which of the following systems should the nurse assess to determine the source of the clients sensations? (Select all that apply.) A) Bowel sounds B) Capillary refill time C) Oral temperature D) Respiratory rate E) Skin temperature

Ans: B, C, E The age-related changes that impact the older adult's response to cold include inefficient vasoconstriction, decreased cardiac output, diminished peripheral circulation, and delayed and diminished shivering. There is no indication of respiratory or bowel issues

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

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

13. A nurse reviews the medications of a 58-year-old man who has erectile dysfunction. Which of the following prescribed medications can interfere with sexual functioning? (Select all that apply.) A) Acetylsalicylic acid (aspirin) B) Metoprolol (Lopressor) C) Clopidogrel (Plavix) D) Lisinopril (Prinivil) E) Ezetimibe (Zetia)

Ans: B, D Metoprolol and lisinopril interfere with libido and can cause erectile dysfunction in men. Acetylsalicylic acid, clopidogrel, and ezetimibe do not. Of note, these medications indicate cardiovascular disease which is strongly associated with sexual dysfunction

14. A nurse administrator incorporates older adults' sexuality into the policies of a long-term care facility. Which of the following should be included in this plan? (Select all that apply.) A) Allow public masturbation. B) Ask permission to enter a room. C) House spouses separately. D) Knock on door before entering. E) Redirect inappropriate sexual behaviors.

Ans: B, D, E Masturbation is normal, but not appropriate for public places, assuring that the clients' rooms are their own personal space and assuring privacy while in those rooms are important to sexuality. Sexual behaviors that impinge on others' comfort should be redirected. Components of sexuality that are especially important for older adults include kissing, hugging, intimacy, fantasy, masturbation, oral sex, loving words, physical closeness, and expressions of affection

12. A nurse prepares a presentation regarding elder abuse and neglect. Which of the following types of abuse should the nurse include? (Select all that apply.) A) Alcohol (substance) B) Financial C) Mandatory D) Physical E) Psychological F) Sexual

Ans: B, D, E, F The National Center on Elder Abuse (2013a) recognizes seven major types of abuse: physical, sexual, emotional or psychological, neglect, abandonment, financial or material exploitation, and self-neglect

5. A nurse plans interventions in a skilled nursing facility to prevent lower respiratory infections. Which of the following nursing interventions should be included in the plan? (Select all that apply.) A) Encourage annual pneumonia vaccinations. B) Encourage annual influenza vaccinations. C) Encourage annual chest radiographs to detect tuberculosis. D) Encourage influenza vaccinations every 5 years. E) Encourage hand hygiene for residents and staff.

Ans: B, E Influenza vaccinations should be given yearly to older adults. The Centers for Disease Control and Prevention (CDC) recommends a one-time booster dose of the pneumonia vaccination for all people 65 years of age or older if they received an initial pneumonia vaccination 5 or more years earlier or were younger than 65 years of age when they first received the pneumonia vaccine. Chest radiographs will not prevent lower respiratory infections. Hand hygiene is essential in prevention of infections

4. A nurse is teaching an older adult's family about the concept of caregiver burden. Which of the following points is priority for the nurse to communicate to the family? A) "Don't feel guilty about having to hire help. Most older Americans' care is currently provided by professionals and formal services." B) "If you do eventually feel overburdened, moving your loved one to a nursing home will provide you with relief." C) "You'll find it difficult to provide for your loved one's needs if you yourself don't have a strong support system." D) "You'll actually find that for you, the benefits of providing for your loved one outweigh the negative consequences."

Ans: C A strong support system is a prerequisite for anyone who is planning to become a caregiver for a friend or family member. Most care is provided by friends and family, not professionals. It has been shown that moving a loved one to a nursing home does not diminish stress and burden on caregivers. While there are psychosocial benefits to being a caregiver, the negative functional consequences of caregiving outweigh the positive

5. A client has recently begun receiving Social Security benefits and is asking the nurse about what services might be included or excluded under Medicare. Which of the following services is most likely to be excluded from Medicare funding? A) Hospital care B) Hospice care C) Rehabilitation care D) Nursing home care

Ans: D Medicare was established as a means of funding some types of direct client medical care, hospice and rehabilitation care may be covered, but nursing home residence is not.

11. A 52-year-old woman discusses her menstrual cycles with the nurse. The client states that she still has menses, but that she "never knows when they might begin or end." Which of the following is the most appropriate response by the nurse? A) "It sounds like you are frustrated with this change; it is a difficult part of life." B) "Reproduction is no longer possible so that is one thing less to worry about." C) "We can't say how long this perimenopausal phase might last." D) "You are in the postmenopausal cycle and should expect further changes."

Ans: C Perimenopause refers to the several years before menopause when women begin experiencing changes in menstrual cycles. The client doesn't express frustration, nor does she sound like she is "worrying" about reproduction (which still could happen, even with low probability). Menopause typically occurs around the age of 49 to 51 years and postmenopause begins 12 months after last period

15. A client, who retired from work this year, asks the nurse the secret to successful aging. Which of the following responses by the nurse is most helpful? A) "Later life can be a time of engagement, contribution and wellbeing, you must work to make it so." B) "Life is a bowl of cherries, if you are in the pits, crawl out." C) "Studies show that volunteering and helping others improve satisfaction with life." D) "The body is senescent and you will find you slow down each year."

Ans: C The most helpful statement that guides the client clearly is that the support for this theory comes from many studies, finding that volunteer activities and altruistic attitudes improve life satisfaction, positive affect, and quality of life for older adults (Cattan, Hogg, & Hardill, 2011; Kahana, Bhatta, Lovegreen, et al., 2013). The other statements have some truth to them, but are unclear, use euphemisms, or don't give information that will help the client make decisions toward successful aging

11. A nurse in a hospital setting assesses an older adult and is unsure if the assessment data warrant notification to the authorities for elder abuse. Which action is most appropriate for the nurse at this time? A) Determine if the person has dementia. B) Discuss findings with the family. C) Follow the hospital protocol for reporting. D) Question the visitors.

Ans: C The nurse is a mandatory reporter for potential elder abuse; the authorities can make the final determination if abuse has occurred or not. Nurses assess all potential contributing conditions but the immediate responsibility is to follow the protocol for reporting. Determining whether the person has dementia is not within the scope of nursing

10. Having completed a medication assessment and physical assessment of a new client, a home care nurse is now creating nursing diagnoses and choosing interventions appropriate to these diagnoses. What factor should the nurse prioritize in this process? A) The need to maintain the client's autonomy B) The nurse's responsibility to teach the patient and minimize liability C) The importance of the patient's safety D) The importance of fostering patient compliance

Ans: C When dealing with patients' and clients' medications, as in all areas of nursing practice, patient safety is the priority. This supersedes other matters, even though each may be significant. These include autonomy and patient education.

3. An older adult has recently begun to display unprecedented lapses in short-term memory. The nurse overhears a colleague reassuring the person by saying, "Try not to worry; it's just a part of growing older." The nurse recognizes that this is an example of what phenomenon? A) Multiple jeopardy B) Gerontophobia C) Age attribution D) Implicit ageism

Ans: C Age attribution is the act of attributing a problem to age rather than to a pathology, as in the colleague's statement. Multiple jeopardy is the compounding of discrimination based on factors such as race and gender, while gerontophobia is the fear or hatred of older people. Implicit ageism is the unrecognized, negative perception of older people.

5. A nurse is conducting a study on the needs and living situations of older adults in the community. Which of the following statements should the nurse take into account? A) A majority of older Americans will live in a nursing home at some point. B) More older men live alone than older women. C) Assisted living arrangements have become increasingly common. D) Most older Americans reside in some form of institutional arrangement.

Ans: C Assisted living arrangements have become an increasingly common alternative to nursing homes. The number of Americans living in nursing homes has recently decreased, not increased, and more older women live alone than do older men. Ninety percent of older Americans live in an apartment or house, rather than in an institutional arrangement.

10. An older adult with pain is to be discharged home with a prescription for oral morphine (MSContin) daily for persistent pain. The client historically took an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) for pain. Which statement by the patient shows the nurse that the client understands the plan? A) "I will be careful to take an antacid with the morphine pill." B)"I will only take this morphine when the NSAID doesn't work." C) "I will take MiraLAX and a stool softener to reduce my constipation." D) "NSAID side effects are not as bad as a morphine pill."

Ans: C Long-term use of NSAIDs is associated with more severe and life-threatening adverse effects, whereas the most common adverse effect of opioids is constipation, which can be addressed by using laxatives (MiraLAX), stool softeners, fluid, and activity. While the client historically took an NSAID, the MSContin is an extended-release medication that should be taken daily.

2. A nurse is teaching an older person about the concept of successful aging. Which of the nurse's questions addresses an important contributor to successful aging? A) "Are you largely free of acute or chronic illnesses?" B) "Do you feel financially secure?" C) "Do you feel like you actively engage with life?" D) "Do you have a reliable support network?"

Ans: C Research has indicated that an active engagement with life is central to successful and healthy aging. Absence of illness, financial security, and the nature of a person's support network are not identified components of successful aging.

6. A nurse assists an older adult who is homebound in a rural area. Which community resources might this client best benefit from? A) Skilled home nursing B) Senior center C) Personal emergency response system D) Grocery delivery

Ans: C The rural client is unlikely to have grocery delivery. And as a homebound rural client, a senior center would not be available. Only some clients qualify for skilled home nursing visits, there are not location limitations on personal emergency response systems, some now come with GPS and cellular capabilities.

1. A nurse is using the Functional Consequences Theory as a lens for planning client care in a health care facility. Which of the following is a key element of this nursing theory? A) Most problems affecting older adults may be attributed to age-related changes. B) Most functional consequences cannot be addressed through nursing interventions. C) Wellness is a concept that is broader than just physiologic functioning. D) The Functional Consequences Theory is an alternative to holistic nursing care.

Ans: C Within the Functional Consequences Theory, wellness is a central concept that encompasses more than the older adult's level of physiologic function. Most problems affecting older adults are attributable to risk factors, even though age-related changes are indeed relevant and inevitable. Functional consequences can usually be addressed by nursing interventions, and holistic care is not an alternative to Functional Consequences Theory, but rather a component of the theory.

3. An 87-year-old woman has a history of depression and hypothyroidism. She was recently diagnosed as having breast cancer. Her daughter tells her health care provider that her mother cannot participate in decision making about her care because she is too old. Which of the following statements is true about decision-making capacity? A) Determination of decision-making capacity is based on the older adult's diagnosis and chronologic age. B) The older adult has decision-making capacity if she understands most of the risks and benefits of medical treatment. C) The older adult needs to understand the issues involved in decision making and communicate about them. D) Decision-making capacity of older adults is always determined by a mental health judge.

Ans: C Decision making should not be determined by the diagnosis or the age of the older adult. The older adult needs to understand all of the risks and benefits of medical treatment. Decisionmaking capacity is determined by the health care practitioner or by the interdisciplinary team assigned to the client.

11. A nurse monitors a group of older adults in the long-term care facility's kitchen. Which of the following actions would cause the nurse to intervene? A) Sharing perfumed hand soap B) Using hand lotion after washing dishes C) Using hot water to rinse the dishes D) Using soap to wash the dishes

Ans: C Older adults are more susceptible to scald burns because of their diminished ability to feel dangerously hot water temperatures. Perfumed hand soap, dish washing liquid, and lotion are acceptable

6. A nurse completes the admission assessment of an 84-year-old client to the long-term care facility. Which assessment finding would direct the nurse to document a deficit in the client's ADLs? A) The client experiences chronic pain as a result of rheumatoid arthritis. B) The client is able to ambulate with a wheeled walker for 60 ft but then requires a rest break. C) The client is able to wash self but requires assistance entering and leaving the bathtub. D) The client is unable to explain the rationale for each of the prescribed medications.

Ans: C ADLs include activities such as bathing, dressing, mouth care, hair care, dietary intake, transfer mobility, ambulation, bed mobility, and bladder and bowel elimination. Ambulation using an assistive device does not normally constitute a deficit in mobility. Chronic pain and unfamiliarity with one's medication regimen are significant assessment findings, but neither constitutes an ADL deficit.

12. A nurse evaluates the healing of a full-thickness skin tear on a 92-year-old resident of a longterm care facility. Which of the following would support the continuation of the current treatment plan? A) The wound with redness surrounding at 12 days B) The wound draining serosanguinous drainage at 14 days C) The wound showing 50% healing at 16 days D) Pain at the wound site at 19 days

Ans: C About 50% healing at 16 days is acceptable. Full-thickness skin tears take an average of 21 days to healing in older adults. The treatment plan needs to be changed if there is redness (at 12 days), pain (at 19 days), or draining plasma (at 14 days).

8. A nurse manager of the long-term care facility develops plans to reduce nutritional deficits. Which of the following interventions is appropriate to include in the plan? A) Encourage residents to eat in their rooms to minimize distractions. B) Offer four to five small meals a day rather than three larger meals. C) Promote oral care for residents multiple times each day. D) Provide incentives for residents to eat all the food on their trays.

Ans: C Adequate oral care is important in the promotion of adequate food intake, because it enhances chewing, eating, and swallowing. Eating alone is associated with lower caloric intake. Offering incentives may be construed as coercive or patronizing. Frequent, small meals may be necessitated by certain medical conditions, but this is not a recognized strategy for the promotion of nutrition among a larger group of older adults

11. A nurse in the long-term care facility assesses an 86-year-old woman who has recently become lethargic and difficult to arouse. Her vital signs are all stable and within normal limits. Her breath sounds are diminished. Which action by the nurse should be the priority? A) Call the family and give them an update. B) Place her on high fall risk precautions. C) Send her to the emergency department. D) Tell the aides to keep an eye on her.

Ans: C Atypical presentation is especially common in those who are older than 85 years. Changes in behavior or functioning and increased fatigue are common atypical presentations of infection (e.g., pneumonia or urinary tract infection). In addition, the expected manifestations of an infection, such as elevated temperature or specific complaints of pain or discomfort, may be absent. While the family should be made aware of the update on the condition, the care of the client is the priority. It is not appropriate to delegate this to the certified nursing assistant (CNA). Placing her on fall prevention does not address the assessment data.

11. An emergency department triage nurse receives a phone call from an older adult who states, "I am experiencing pain across my left side. It is tingling, and really hurts when it gets touched." Which of the following response by the nurse is most appropriate? A) "Do you have the pain right now?" B) "Have you taken any medications?" C) "Notify your primary health care provider today." D) "When did this pain start?"

Ans: C Burning, shooting, knife-like, tingling, and pins and needles are common symptoms of neuropathic pain (in this case shingles). Over half of the cases of shingles occur in older adults. Peripheral neuropathy results in pain along the distribution of peripheral nerves. The other questions are not the priority at this time

7. A nurse counsels an older adult regarding nutritional requirements. Which of the following teaching points is priority when discussing age-related changes in nutritional requirements? A) "If possible, try to eliminate animal fats from your diet." B) "You should try to eat less meat and proteins than you did when you were younger." C) "Overall, you don't need to take in as many calories as you used to." D) "As an older adult, you don't need to eat as many starches and complex carbohydrates."

Ans: C Caloric requirements for older adults are significantly less than those for younger adults. It is unnecessary to wholly eliminate animal fats from the diet, and protein intake should remain same as for younger adults. Complex carbohydrates should constitute the majority of caloric intake

14. A nurse discusses health promotion with a group of older adult women. The nurse suggests a Pap test every 2 years. One woman states, "I haven't had a Pap since the change, why would I do that now?" Which response by the nurse is best? A) Annual checkup by your primary care provider to examine your ovaries is appropriate. B) Avoidance doesn't help with diagnosis of cancers. C) Risk of death from ovarian cancer is twice as high among women aged 65 and older. D) Women who don't have sex are at higher risk for ovarian cancer

Ans: C Cancers are found more often in older adults, functional consequences of many sequelae. The risk of death from ovarian cancer is twice as high among women aged 65 and older, compared with younger patients. Sexual relations do not cause ovarian cancer

7. A nurse admits an 81-year-old man to the hospital with aspiration pneumonia. Which of the following risk factors should the nurse predict that the client has in his history? A) Cigarette smoking B) Lung cancer C) Dysphagia D) Sleep apnea

Ans: C Dysphagia creates a serious risk for aspiration pneumonia. Smoking, cancer, and sleep apnea do not have a direct correlation with aspiration pneumonia

8. A 78-year-old client has been brought to the emergency department from home with a sudden change in mental status accompanied by significant weakness. For which condition should the health care providers assess? A) Alzheimer disease B) Lung cancer C) Pneumonia D) Tuberculosis

Ans: C In older adults, pneumonia often has a presentation that differs from that of younger adults. Rather than presenting with a cough, chills, dyspnea, elevated temperature, and elevated white blood cell count, older adults are more likely to have subtler and nonspecific disease manifestations such as fatigue and change in mental status. Alzheimer disease has an insidious onset. Lung cancer and tuberculosis are not characterized by cognitive deficits

11. A nurse identifies clients who are at risk for modifiable risk factors for cardiovascular disease. Which of the following clients should the nurse prioritize as having modifiable cardiovascular functional consequences? A) A 54-year-old admitted to the hospital with hepatitis A B) A 72-year-old after her second myocardial infarction. C) A 86-year-old obese woman who has type 2 diabetes D) A 94-year-old with a strong family history of myocardial infarctions at an early age

Ans: C Modifiable risk factors include obesity, and control of blood glucose levels. Hepatitis A is not a risk factor. Prior myocardial infarction and strong family history are not modifiable. However, those clients are at risk and other risk factors in their life may need to be modified.

4. Which of the following considerations should a nurse prioritize when assessing an older adult who has arrhythmias? A) Assess the client for adverse medication reactions. B) Check the client's electrolytes immediately. C) Make an assessment in relation to the client's medical history. D) Perform auscultation before collecting the client's history

Ans: C Murmurs and arrhythmias may be caused by cardiac diseases, electrolyte imbalances, or adverse medication effects. It is important to make an assessment of underlying causes in relation to the client's medical history

10. An older adult client states that he has lately been taking up to 2 hours to fall asleep at night, despite avoiding caffeine during the day and going for a brisk walk after lunch each day. Which of the following statements by the nurse is most appropriate? A) "We can request a prescription for a sleeping pill from your primary care provider." B) "I suggest a 'nightcap' before bed, as long as it's not beer or wine." C) "It will benefit you to get up at the same time each morning, even if you are tired." D) "Move your daily walk to the late evening to make yourself tired before bed."

Ans: C Older adults experiencing sleep problems should attempt to awaken, rest, and go to bed at a consistent time each day. Hypnotics should be a temporary measure of last resort, and alcohol and exercise should be avoided around bedtime

9. A nurse evaluates the plan of care for a client who experienced an ischemic stroke. Which of the following assessment findings should signal the nurse to the possibility that the client has developed dysphagia? A) The client complains of being excessively hungry. B) The client drinks large amounts of water with meals. C) The client pockets food in the affected cheek during meals. D) The client prefers to sit in a high Fowler's position after eating.

Ans: C Pocketed food suggests dysphagia. Sitting upright after meals prevents, rather than indicates, dysphagia and neither hunger nor high fluid intake is indicative of dysphagia

15. A nurse admits an older adult from a longterm care facility into the hospital for respiratory infection. Which diagnostic testing should the nurse anticipate? A) Electrocardiogram B) Lung cancer screening C) Mantoux testing D) Pulmonary function testing

Ans: C Residents of long-term care are at risk for tuberculosis. While cancer and cardiac and lung function testing may occur, testing for tuberculosis should be done to screen for this contagious disease to protect others

13. A nurse interviews an older adult with pulmonary disease. The client states, "I worked hard all my life in the shipyard, I provided for my family. I never smoked, why did I get this disease?" Which response by the nurse is best? A) "It is a good thing that you never smoked." B) "Pulmonary disease can happen to anyone." C) "The work in the shipyard put you at risk." D) "You feel like you are being punished..."

Ans: C Shipyard work is a job category that is associated with an increased risk of respiratory disease. Caring responses give information and are directly related to the client's issue (and smoking is not). The client does not directly imply he feels punished

9. A nurse who works on a geriatric long-term care unit is aware that many of the older adult clients on the unit have a documented history of orthostatic hypotension. What measure should the nurse prioritize in order to ensure the safety of such clients? A) Mobilize clients within 2 hours of eating a meal. B) Have clients take several deep breaths before standing to their feet. C) Have clients sit on the edge of their beds for a minute or two before ambulating. D)Encourage clients to use a bedpan or incontinence brief to prevent falls while ambulating to the bathroom.

Ans: C Sitting at the edge of the bed before standing can significantly reduce the risk of falls in individuals with orthostatic hypotension. It is inappropriate to have clients use bedpans or briefs for the sole reason of preventing falls. Mobilizing after meals and deep breathing do not appreciably address orthostatic hypotension

15. An older adult states, "I just feel so full so fast, I can't eat any more." Which of the following responses is most appropriate? A) "All of us feel that way after a meal." B) "Make an appointment with your health care provider." C) "Slower emptying of your stomach may be the cause." D) "This happens when you have gall stones."

Ans: C Slight slowing of gastric emptying in older adults after ingestion of large meals leads to early sensations of fullness. Gallstone symptoms include pain, not fullness. An emergent visit to the health care provider is not indicated

12. A nurse assesses older adults at a pulmonary clinic. Which of the following questions might best assist identify those at risk for pulmonary disorders? A) "Do any of your children smoke?" B) "In what state did you grow up?" C) "What type of job did you have?" D) "Where do you exercise?"

Ans: C Some job categories are associated with an increased risk of respiratory disease. Children who smoke do not imply that secondhand smoke occurs. While location does correlate with the percent of smokers, it is not as helpful in identification of those with pulmonary disorders; nor is where a person exercises.

1. A nurse assesses an older adult's overall respiratory function. Which of the following interview questions would be most appropriate? A) "Would you be interested in finding out more about environmental smoke?" B) "Did either of your parents experience lung diseases?" C)"Have you ever worked in a job where you were exposed to dust, fumes, smoke, or other pollutants?" D) "What do you do to actively maintain your respiratory health?"

Ans: C The effects of air pollution are cumulative over many years. Thus, there is an increased impact on older adults over their lifetimes. Hazards in the workplace were unregulated before 1970. Therefore, there are older adults who have experienced cumulative and long-term effects from toxic substances

10. A group of community health nurses is using the Stages of Change model as the foundation of a new health promotion campaign for older adults. What goal for the participants are the nurses likely to promote when working with older adults in the program? A) A recognition of the importance of screening for common health problems B) Increased participation in exercise programs and an awareness of the relationship between exercise and wellness C) The replacement of participants' unhealthy behaviors with healthy behaviors D) An awareness of the differences between life expectancy and active life expectancy

Ans: C The primary focus of the Stages of Change model is on replacing unhealthy behaviors with healthy behaviors. This may include awareness of screening, exercise, and wellness, but the main priority is health-related behaviors.

12. A nurse teaches an older adult client about the use of the telehealth equipment to monitor congestive heart failure. Which of the following statements by the client shows understanding? A) "I will call the primary health care office everyday with my weight, and blood pressure." B) "I won't touch this fancy equipment unless you are here." C) "I need to step on this scale and use this automatic cuff each day." D) "I will watch the prescribed television show every afternoon."

Ans: C Telehealth is used to collect and transmit assessment information. The client does not have to call anyone, they are to use the equipment to collect weight and blood pressure to monitor congestive heart failure, this equipment will transmit the data. Television is not included in telehealth

8. A 69-year-old cigarette smoker asks the nurse questions about the potential benefits of quitting smoking, a subject avoided in past interactions. The nurse asks the client, "Would you like to quit smoking?," to which the client replies, "I will give it some serious thought." What stage of the Stages of Change model is the client demonstrating? A) Precontemplation B) Preparation C) Contemplation D) Action

Ans: C The second stage of the Stages of Change model, contemplation, is characterized by an intention to change in the foreseeable future, based on some acknowledgment of the negative consequences of current behaviors and positive consequences of different behaviors. The person is likely to ask questions and to seek information about the short- and long-term risks and benefits of various behaviors. Precontemplation involves a lack of acknowledgment that there is a problem, and preparation involves specific measure to achieve change. Action is characterized by the actual execution of change.

8. A nurse who works in a palliative setting is aware of the need to facilitate a "good death" for as many clients as possible. Which of the following interventions should be included? A) Discuss openly and explicitly the client's strengths and weaknesses. B) Ensure that a minimum of nursing interventions are performed. C) Empower the client and family to maintain as much control as possible. D) Emphasize spiritual needs rather than physical comfort and medical needs

Ans: C A "good death" is fostered by enabling a sense of control for the client and his or her family over a challenging situation. Nursing interventions are chosen carefully, but not necessarily minimized. A discussion of the client's strengths and weaknesses is inappropriate and spiritual needs are not mutually exclusive of comfort and appropriate biomedical interventions

3. A nurse is teaching a family of an older adult about the role of adult day centers. Which of the statements by the family member indicates a need for further teaching? A) "The day center can give me respite." B) "The day center can improve our quality of life." C) "The day center can be a useful alternative to medical care." D) "The day center can contribute to an actual improvement in dementia symptoms."

Ans: C Adult day centers are a community-based resource providing food, supervision, and activity, but are not designed to provide acute medical care. They provide caregiver relief and have been linked to improved quality of life and decreased symptoms of dementia

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

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

1. A nurse presents at a conference about the concept of sleep. Which of the following statements should the nurse include in the teaching? A) "Increased sleep efficiency is considered a normal, age-related change." B) "Sleep efficiency is quite consistent across different age groups." C) "Both pathologic conditions and age-related changes influence sleep efficiency." D) "Older adults often experience increased sleep latency and decreased numbers of awakenings."

Ans: C Age-related changes and pathologic conditions together contribute to the decreased sleep efficiency associated with older age. Sleep efficiency tends to decrease, not increase, with increasing age and is not generally consistent with that of younger people. Older adults tend to experience both increased sleep latency (time required to fall asleep) and increased numbers of awakenings during the night

2. A nurse presents at a conference regarding functional consequences related to urinary elimination. Which of the following statements should the nurse include? A) "Most older women will develop urinary incontinence by the age of 85." B) "Most older adults will experience hypertrophy and relaxation of muscles in the urinary tract and pelvic floor." C) "Excretion of penicillin and cimetidine are decreased in older adults." D) "Healthy older adults experience an increase in glomerular filtration rate."

Ans: C Age-related changes in kidney function can impact water-soluble medications that are highly dependent on the glomerular filtration rate. This would include digoxin, penicillin, aminoglycosides, and cimetidine

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

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

3. A nurse plans the care for an older adult man who consumes two alcoholic beverages each evening. Which of the following should be included in the plan of care? A) Allow for a later bedtime. B) Encourage the client to cease all alcohol intake. C) Monitor for nocturnal awakenings. D) Watch for an increased rapid eye movement (REM) sleep

Ans: C Alcohol consumption is associated with both initial drowsiness and increased numbers of awakenings during the night, as well as overall decreases in both total sleep time and REM sleep. Individuals who are accustomed to the depressant effect of alcohol are prone to insomnia once they stop consuming it

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

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

12. A nurse in the ambulatory clinic assesses a 53-year-old woman who states, "last night all of the sudden I got really sick, got really hot, and started sweating; then I had chills, and my chest was pounding." Which action by the nurse is priority? A) Ask if the client had been exposed to anyone who was ill. B) Check the client's troponin and B-type natriuretic peptide (BNP) labs. C) Discuss the client's menstrual cycle with her. D) Review the client's medication history

Ans: C Asking about "anyone who was ill" is broad and generic. Illness is often spread in the prodromal phase when there are no symptoms. Troponin and BNP are indicators of cardiac functioning; women who have an MI are more likely to experience severe fatigue, not heat and chills. Hot flashes are a vasomotor symptom characterized by the sudden onset of heat, perspiration, and flushing that spreads from the head to the trunk. Symptoms last from 1 to 5 minutes and may be accompanied by chills, nausea, anxiety, palpitations, and clamminess. Medications do not relate to these symptoms

10. A nurse is aware that many health care providers prioritize the role of biology in the aging process. What is a weakness of biologic theories of aging as it applies to nursing? A) Biologic theories do not account for the differences in life expectancy between men and women. B) Biologic theories are unable to explain the role of cell division in life expectancy and the aging process. C) Biologic theories of aging do not adequately address issues of wellness and quality of life. D) Biologic theories of aging are unable to explain the significant increases in life expectancy that occurred in the 20th century.

Ans: C Biologic theories of aging do not address the significant influence of nursing, medical, and psychosocial interventions that can improve a person's functioning and life expectancy. More broadly, they do not address holistic questions surrounding wellness. They are generally able to account for increases in life expectancy and phenomena such as cell division.

6. A gerontological nurse is aware that the aging process is accompanied by numerous, multifactorial changes that affect sexual wellness in older adults. Among women, which of the following factors is usually the primary cause of changes in sexual functioning? A) Psychosocial factors B) Environmental factors C) Hormonal factors D) Spiritual factors

Ans: C Changes in sexual functioning are influenced by many factors. In women, however, the influence of hormonal factors is often primary. Diminished estrogen levels can directly affect sexual function for older women in several ways

12. A healthy 65-year-old says, "I don't think I will live much past 70." The studies however show that this client should live to 84 years of age. Which of the following statements, by the nurse, summarizes the compression of morbidity for this client? A) "Let's work on extending your life expectancy." B) "The goal is to live better, not longer." C) "We should work on postponing chronic illnesses." D) "You are lucky that you are healthy."

Ans: C Compression of morbidity emphasizes that preventive approaches must be directed toward preserving health by postponing the onset of chronic illnesses, but one's life expectancy cannot be extended. Consequently, disease, disability, and functional decline are "compressed" into a period averaging 3 to 5 years before death.

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

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

13. A graduate nurse expresses an interest in focusing future study to healthy aging. Toward which of the following resources should the experienced nurse steer the graduate nurse? A) American Heart Association B) Healthy Brain Initiative C) Healthy People 2020 D) Springer Publishing Company

Ans: C Each of these is a possible source of data, but the Healthy People initiative is a well-known program that is a major source of recommendations for evidence-based health promotion interventions.

3. A 64-year-old man had a myocardial infarction (MI) 2 months ago. He has recovered to the point that he is able to climb up two flights of stairs, but he and his spouse have not resumed sexual relations. Which of the following responses by the nurse is most appropriate? A) "Is angina interfering with your sexual functioning?" B) "This lack of libido is caused by vasoconstriction in the genital area." C) "You are safe to have sex; you can resume sexual relations when you desire." D) "You may have a problem with retrograde ejaculation."

Ans: C Even when no physiologic basis exists for abstaining from sexual intercourse after an MI, sexual activity is often limited or absent because of fatigue, depression, diminished sexual desire, and fears and anxiety of the person or the sexual partner. Diabetes can cause retrograde ejaculation. An MI does not cause vasoconstriction

9. An 81-year-old adult suffered an ischemic stroke 6 days ago. The client has failed to regain consciousness since the event. The care team has approached the client's family to obtain their views on inserting a feeding tube. Which of the following documents will allow the family to make a decision on the parent's behalf? A) A do not resuscitate (DNR) order B) A living will C) A durable power of attorney for health care D) A will

Ans: C Feedback: A durable power of attorney for health care is an advance directive that takes effect whenever someone cannot, for any reason, provide informed consent for health care treatment decisions. A will, a DNR order, or a living will do not confer this authority on the client's family member.

1. A nurse is explaining to a new colleague the similarities and differences between gerontology and geriatrics. Which of the following situations would most likely be addressed by a geriatrician rather than a gerontologist? A) Teaching older adults techniques to identify and deal with age-related changes B) Organizing and leading exercise classes to facilitate mobility C) Identifying and treating a client's vascular dementia D) Rearranging an older adult's apartment to minimize the risk of falls

Ans: C Geriatricians are medical specialists concerned with the treatment of diseases and disabilities common among older adults. The focus of gerontologists is a multidisciplinary approach aimed at emphasizing healthy and successful aging. Options A, B, and D fall under the auspices of gerontology.

6. A nurse who works with older adults is teaching a colleague about the similarities and differences between gerontology and geriatrics. Which of the following questions best conveys the focus of gerontology? A) "How can we secure more funding for research and development of drugs specifically for older adults?" B) "How can we teach older adults about the relationship between their lifestyle and their health?" C) "How can we help older adults maintain wellness as they age?" D) "How can we reduce the incidence of falls among older adults who live in care facilities?"

Ans: C Gerontology is the study of aging and older adults, and the focus of the discipline has shifted in recent decades to an emphasis on wellness and healthy, successful aging. As such, a focus on promoting and maintaining wellness best exemplifies the discipline. Geriatrics is associated with the diseases and disabilities of old people, and geriatric medicine is a subspecialty of internal medicine or family practice that focuses on the medical problems of older people.

11. A nurse at the aging center organizes exercise classes including tai chi. Which of the following principles is the nurse incorporating? A) Disease prevention B) Environmental modification C) Health promotion D) Spiritual awakening

Ans: C Health promotion also emphasizes personal responsibility for health and self-care actions to achieve high-level wellness. Health is defined as the ability to function at the highest capacity despite the presence of age-related changes and risk factors. Environmental modifications are health promotion activities when they reduce risks or improve a person's level of functioning. Health promotion programs currently include both the traditional focus on disease prevention and health maintenance and on personal responsibility for health self-care actions to achieve highlevel wellness.

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

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

1. A 77-year-old client was put on broad-spectrum antibiotics when hospitalized for sepsis. The client has a history of rheumatoid arthritis and a recurring problem with pneumonia. Which of the following theories best explains why the client has had these issues? A) Free radical theory B) Genetic theory C) Immunity theory D) Wear-and-tear theory

Ans: C Immunity theories focus on immunosenescence. Older adults are more susceptible to cancer, autoimmune disorders, and infections, a phenomenon that is known as immunosenescence. Wearing out is exacerbated by harmful factors, such as stress, disease, smoking, poor diet, and alcohol abuse. Free radicals are waste products of metabolism and they can damage cells. Current studies indicate that the genetic effect on longevity is due to modest effects of many genes interacting, with some genes increasing one's susceptibility to age-related disease and early death and other genes slowing the aging process and leading to a longer life.

16. A nurse at the dermatology office triages calls. Which of the following clients is the highest priority to follow up? A) A 2-year-old with diaper rash B) A 20-year-old with red sunburn on the chest and arms C) A 78-year-old with a lesion that is black, swollen, and draining liquid D) A 90-year-old with flat discolored spots on face

Ans: C In general, the following characteristics of a skin lesion warrant medical evaluation: redness, swelling, dark pigmentation, moisture or drainage, pain or discomfort, raised or irregular edges around a flat center

15. A nurse plans discharge for an older woman from China who is living with her son. Which of the following should be included in this plan to indicate that the nurse understands cultural influences? A) Include all family members in discharge planning. B) Ensure that the discharge plan does not include any technologic aspects. C) Review the discharge plans with the client and her son. D) Speak only with the client.

Ans: C In the Chinese culture, each family has a recognized male head who has great authority and assumes all major responsibilities. Avoidance of technology is not part of this culture.

8. An 81-year-old has been living for the past 2 years in a long-term care facility. However, financial pressures have required that the resident move in with the oldest child and spouse. Which of the following statements if made by the child's spouse should signal a potential risk for elder abuse? A) "I sure hope that we'll qualify for some home care because this seems pretty overwhelming." B) "This won't be easy for anyone. I think I might even end up having to juggle my work schedule." C) "He's used to being waited on here, but at our place he's going to have to fend for himself." D) "I'm probably going to even have to get some friends or neighbors to help out from time to time."

Ans: C It is normal and reasonable to be somewhat overwhelmed with the prospect of providing care for an older adult. However, a suggestion that the older adult may have to go without care is problematic and a potential precursor to elder abuse (neglect).

12. A wellness center nurse teaches a class of older adults about healthy habits. Which of the following interventions will make a difference in the clients' lives and as such be included by the nurse? A) Avoid alcohol consumption. B) Avoid fried foods and red meats. C) Avoid secondhand smoke. D) Avoid sunlight.

Ans: C Nurses must not be influenced by ageist attitudes suggesting that older adults are too old to change behaviors and to benefit from improved health behaviors. Health promotion behaviors include the following: avoid secondhand smoke; limit intake of fats, red meats, and fried foods; avoid excessive exposure to sunlight; and avoid excessive alcohol consumption

10. An older adult who appears to be between 85 and 95 has been brought to the emergency department by emergency medical services after being found wandering in the street. The older adult is filthy, confused, and exhibits numerous bruises to the face and neck as well as signs of malnutrition and dehydration. What problem should the nurses prioritize for assessment and intervention? A) Hygiene B) Malnutrition C) Dehydration D) Potential elder abuse

Ans: C Nursing guidelines emphasize that interventions related to hydration status are higher priority than most other problems, including hygiene, and malnutrition; elder abuse is not an immediate threat when the older adult is in a health care setting

2. An 82-year-old client is getting advice from a family member on how to drive safely. What piece of advice should the older adult follow? A) "Avoid modifying your vehicle with devices that were not supplied by the manufacturer." B) "Realize that normal, age-related changes should not affect your ability to drive safely." C) "You can consider timing your medications to avoid their interfering with safe driving." D) "You should transition from driving to using public transportation as soon as possible."

Ans: C Older adults can be taught how to safely time their medications to avoid effects such as drowsiness that can affect driving safely. Modification of vehicles with assistive devices can be a useful tool in promoting safe driving. Age-related changes such as decreased visual acuity are significant factors in driving safely. With compensation and education, many older adults can safely drive and do not necessarily need to give up their licenses early.

11. A nurse discusses sleep patterns with an older adult. The client states, "I feel like all I do is lie in bed awake each night." Which response by the nurse is most appropriate? A) "How long do you lie there each night?" B) "Describe your pillow and mattress to me." C) "Do you have a history of sleep apnea?" D) "What have you tried to get a better nights rest?"

Ans: C Older adults have more diminished sleep efficiency secondary to prolonged sleep latency, and an increased number of awakenings during the night. How long he lies there is not as important as the fact that he feels like it is all night. The nurse assesses for sleep patterns, contributing factors, and alleviating and aggravating factors.

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

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

8. An older adult with restless legs syndrome (RLS) has sought advice from the nurse in an effort to ease the problem. Which of the following statements should the nurse include in the plan? A) "There are new, over-the-counter medications that can probably resolve your RLS." B) "RLS can be a sign of a much more serious health problem, so I'd encourage you to visit your primary care provider." C) "I see that your iron level is low, let's add foods high in iron to your diet." D) "Even though it's certainly unpleasant, RLS is a normal part of the aging process."

Ans: C Risk factors for RLS include genetic predisposition, iron deficiency, chronic renal failure, peripheral neuropathy, and adverse effects of certain medications. RLS is considered a neuromuscular disorder, not an age-related change. It is more common with certain health problems, but it is not considered a sign of more serious pathology. Over-the-counter medications are not available for RLS.

8. A 79-year-old client recently experienced a syncopal (fainting) episode after standing up quickly while gardening. Which assessment is the nurse's priority? A) "Did you experience any fatigue or blurred vision?" B) "What did you doctor say about this?" C) "What medications do you take?" D) "When did you last eat a meal?"

Ans: C Risks for orthostatic hypotension include multiple medications. Orthostatic hypotension can be accompanied by symptoms such as fatigue, lightheadedness, blurred vision, and syncope upon standing or not. Whether orthostatic hypotension is symptomatic or asymptomatic, it can lead to negative functional consequences. Postprandial hypotension is not represented by this scenario. Asking what the primary health care provider said is passing the buck.

3. The nurse assesses the fluid volume status of a 72-year-old client who takes Lasix (furosemide) and Pacerone (amiodarone). Which of the following is the most reliable method for assessing this client's skin turgor? A) Ask the client to open the mouth and examine the oral mucous membranes for dryness. B) Examine the skin on the lower legs and look for dry, scaly, or rough skin. C) Gently pinch the skin on the abdomen to see how long it takes to return to normal. D) Squeeze the skin on back of hand to see if it remains pinched or is slow to return to normal.

Ans: C Skin turgor should be checked over protected areas, such as the sternum or abdomen. The use of diuretics can exacerbate xerosis that older adults may have. Diuretics and amiodarone increase the risk for photosensitivity

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

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

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

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

4. A 55-year-old client was recently diagnosed with type 2 diabetes. The client completed a diabetes education class and does water aerobics three times a week. The blood sugar and hemoglobin A1c have improved since losing 20 lb. Which of the following statements best describes this client's actions? A) Activity theory B) Age stratification theory C) Functional consequences theory D) Life-course development theory

Ans: C The Functional Consequences Theory for Promoting Wellness in Older Adults provides a framework for a holistic approach that identifies the risk factors and addresses those that are modifiable in older adults. Age stratification theory addresses the interdependencies between age as an element of the social structure and the aging of people and cohorts as a social process. Lifecourse development is related to old age within the context of the life cycle. The activity theory postulates that older people remain socially and psychologically fit if they remain actively engaged in life.

8. During a period of cold weather, an older adult has been brought to the emergency department with suspected hypothermia. Which of the following assessments should the nurse prioritize with this client? A) Palpation of the client's extremities to determine temperature B) Assessment of the client's level of consciousness C) Assessment of the client's core body temperature D) Interviewing to determine the client's sensation of cold

Ans: C The most reliable assessment for hypothermia is measurement of core body temperature. Palpation of extremities, interviewing, and assessment of level of consciousness are also relevant assessments, but the measurement of core body temperature is prioritized

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

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

9. A nurse performs a reflective cultural self-assessment. Which of the following outcomes should the nurse expect? A) An accurate ranking of different cultures according to their specific merits B) Identification of the flaws and weaknesses of the nurse's own culture C) Progression from judgmental views of other cultures to recognition of positive attributes D) The ability to assess clients according to their cultural affiliation rather than individual characteristics

Ans: C The process of cultural competence is often described as a progression from judgmental attitudes and practices to positive approaches. It does not focus primarily on the deficits of one's own culture and it does not replace individualized assessment and care with cultural generalizations. Culturally competent care does not involve "ranking" different cultures.

1. A nurse manager justifies the budget for education regarding cultural competency for the staff. Which of the following justifications will best support the need for this education? A) Life expectancies among minorities are expected to increase while those among non-Hispanic whites are expected to decrease. B) Government and health care organizations support the need for culturally competent care. C) The proportion of health care consumers who are minorities continues to increase. D) Nurses have a moral obligation to achieve cultural competency with all cultural groups.

Ans: C The proportion of health care consumers who are minorities is increasing and is predicted to continue increasing. Life expectancies of all groups, not only minorities, are predicted to increase. Government and health groups have called for culturally appropriate care, but this argument gives less support to administration than the power of money. Nurses have an obligation to achieve cultural competency with the groups they work with, but not with all cultural groups.

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

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

8. Following knee replacement surgery 10 days earlier, a 79-year-old woman has been diagnosed with an infection in the knee. A sample of synovial fluid has been cultured in order to determine the causative microorganism and to select an appropriate antibiotic. This course of events characterizes what major health belief system? A) Magico-religious paradigm B) Holistic paradigm C) Scientific paradigm D) Analytical paradigm

Ans: C The scientific (biomedical) health paradigm prioritizes cause-and-effect relationships (i.e., microorganisms and infection) along with manipulation of these through pharmacologic interventions and surgery. The holistic paradigm emphasizes the interconnectedness of mind, body, and spirit, and the magico-religious paradigm emphasizes supernatural factors. The "analytical paradigm" is not among the three major health belief systems.

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

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

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

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

13. A nurse administers medications to older adults in a long-term care facility. Which of the following actions is most appropriate when the client with dementia is newly prescribed an antimuscarinic agent for urge urinary incontinence? A) Administer with a full glass of water B) Assess the client for drooling and diarrhea C) Monitor the client closely for worsening cognitive impairment D) Toilet the client before administering the medication

Ans: C Antimuscarinic agents are used for urge urinary incontinence. Oxybutynin is the medication most commonly associated with cognitive impairment, but all antimuscarinic agents need to be used with caution in older adults with preexisting dementia. These medications have the same adverse effect profile as other anticholinergics, such as dry mouth, constipation, blurred vision, and mental changes. There is no need to toilet before, water is important, but cognition is the priority

7. Mr. Thomas and Mrs. Young are residents of a long-term care facility who are both physically frail but cognitively healthy. Last night, the nurse at the facility discovered Mr. Thomas and Mrs. Young in bed together in Mr. Thomas' room and engaging in foreplay. How should care providers best respond to these residents' new sexual relationship? A) Ensure that each resident's family members are aware of this development. B) Teach Mr. Thomas and Mrs. Young about sexual health promotion. C) Accommodate the residents' relationship and provide them with appropriate privacy. D) Have each resident assessed to ensure that the relationship is medically safe and appropriate.

Ans: C Sexual relationships between competent and consenting residents in institutional settings should be accommodated by care providers. It is likely unnecessary to directly involve family members. Education and medical assessment are likely unnecessary and may be inappropriate.

10. A nurse in a long-term care facility teaches aides to assist several older adults with bathing each day. Which of the following interventions should the nurse include in the teaching? A) Apply perfumed products after bathing to promote hygiene and selfesteem. B) Cleanse groin with isopropyl alcohol to eliminate potential pathogens. C) Dry skin thoroughly; particularly between the toes and other areas where skin touches. D) Use water that is warm to hot (100°F to 105°F) to prevent hypothermia.

Ans: C Skin need to be dried thoroughly but gently, particularly between the toes and other areas where skin touches. Perfumed products and alcohol should be avoided. Water temperatures for bathing should be about 90°F to 100°F

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

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

14. Which of the following statements, made by a new nurse, are myths and need correcting? (Select all that apply.) A) "Ageism is highly influenced by stereotypes and cultural values." B) "Ageism is more common in industrialized societies." C) "In the United States, 20% of the older adults who need care are in a nursing home." D) "People consider themselves old when they are old enough to apply for Medicare." E) "With increased age, people become more diverse and people become less like their age peers."

Ans: C, D The realities are that between 4% and 5% of older adults live in a nursing home at any time. Most older adults live independently, have high levels of self-reported health, and are aging successfully. People usually feel old based on their health and function, rather than on their chronologic age. They are diverse, even though ageism is rampant in the United States and is influenced by cultural values.

15. The process of nociception is important in determining the most appropriate analgesic. Place the processes in order: A) Modulation B) Perception C) Transduction D) Transmission

Ans: C, D, B, A Nociception includes transduction, transmission, followed by perception, and finally modulation

13. A nurse assesses frail older adults prescribed multiple medications. Which of the following pairs of medications are most likely to lead to an adverse drug event causing hospitalization? (Select all that apply.) A) Atorvastatin (Lipitor) and tamsulosin (Flomax) B) Ferrous sulfate (Feratab) and vitamin C (L-ascorbic acid) C) Metformin (Glucophage) and glyburide (Micronase) D) Naproxen (Naprosyn) and glucosamine (Glucosamina) E) Warfarin (Coumadin) and clopidogrel (Plavix)

Ans: C, E Up to 13% of patients taking two medications experience an adverse drug event. Medications most frequently cited as causes of emergency hospitalizations are warfarin, antiplatelet drugs, and antidiabetic drugs, including insulin and oral hypoglycemics.

2. A nurse teaches older adults about skin care and aging. Which of the following would be appropriate to include in this teaching? (Select all that apply.) A) Avoid sunscreens with a sun protection factor (SPF) higher than 14. B) Gently apply rubbing alcohol to keratosis growths to remove them. C) Include adequate amounts of fluid and vitamins in the daily diet. D) Use firm rubbing motions when drying your skin. E) Use emollient moisturizing lotions after bathing. F) When bathing or showering, use a mild, unscented soap.

Ans: C, E, F Older adults need an adequate intake of calories, nutrients, and hydration. Older adults should use a gentle, patting motion when drying their skin ensuring dry skin between toes. Older adults need to use a sunscreen with an SPF of 15 or higher even on overcast days and apply the emollient moisturizing lotion after bathing (not oils during bathing).

6. A nurse who works with the older population is aware that elder abuse takes many forms. Which of the following examples most clearly constitutes elder abuse? A) A paid caregiver cleans and assists with shopping for an older adult who lives alone. B) An older adult assists with child care in exchange for room and board at her niece's house. C) A daughter manages her mother's finances after the older adult granted her power of attorney. D) A daughter changes her mother's incontinence brief only after the urine has soaked through all her clothing because she wants to save money

Ans: D Allowing an older adult to remain in soiled clothing as a way of preserving financial assets is a form of elder abuse. Power of attorney confers legitimate financial control to an individual and this is not necessarily coercive or abusive. Fair exchanges of services for money or housing do not constitute abusive situations.

4. An older adult wants to take ginkgo biloba, valsartan (Diovan), and hydrochlorothiazide for hypertension. He also takes an aspirin daily. Which of the following statements best reflects the advice his nurse should give him? A) "Ginkgo biloba may cause postprandial hypotension in older adults." B) "Ginkgo biloba has the potential to interact with hydrochlorothiazide." C) "Ginkgo biloba can interact with valsartan, reducing its effectiveness." D) "Ginkgo biloba taken with aspirin can potentially cause a drug interaction."

Ans: D Medications that are likely to be affected by herbs are warfarin, insulin, aspirin, digoxin, cyclosporine, and ticlopidine. Ginkgo biloba has the potential to increase blood glucose levels in type 2 diabetes. Its use is contraindicated with monoamine oxidase inhibitors. It is not known to have any interaction with valsartan or hydrochlorothiazide.

6. A nurse who provides care to many older adults recognizes the importance of implementing a wellness approach to care. What principle underlies this approach to the health care of older adults? A) Older adults have decreasing expectations for wellness as they move through the aging process. B) Health problems are a Western cultural construct that has no objective, physiologic basis. C) Older adults must come to accept a decline in wellness as they age. D) A holistic approach to caring for older adults can foster their well-being at every stage of life.

Ans: D An integral part of the wellness approach to the health care of older adults is a holistic approach to care that considers mind, body, and spirit. Health problems are an inevitable reality but a decrease in wellness does not necessarily accompany the aging process.

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

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

7. A nurse is conducting a medication assessment of an older adult. Which of the statements by the older adult indicates a need for further education? A) "Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy." B) "I've made a reminder system for myself so that I don't miss any of my pills during the day." C) "My family doctor has me on so many different pills now, so I want to talk about whether they're all necessary." D) "I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."

Ans: D It is a common misconception that because herbs are natural, they have no potential for harm; the nurse should teach clients about the potential risks of herbal supplements. It is proactive to act in a manner that will prevent illness. Implementing a reminder system for drugs is prudent. Similarly, wanting to discuss the potential for polypharmacy with a care provider shows appropriate assertiveness and ownership of health.

2. A nurse works with a program that performs interviews, blood work, and digital rectal examinations aimed at identifying older men with benign prostatic hyperplasia (BPH). The program also facilitates bathroom alterations in older adults' homes to ensure men with BPH have easy access to a toilet. Which of the following components of health promotion has yet to be implemented in the program? A) Screening B) Risk assessment C) Environmental modification D) Risk-reduction interventions

Ans: D Risk-reduction interventions are actions that have a direct bearing on preventing an older adult from acquiring a health problem in the future; none of the components of the program have this effect. Screening and risk assessment are accomplished through interviewing older adults and performing blood work and digital rectal examinations. Bathroom alterations are an example of environmental modification.

9. A gerontological nurse who works in a public health setting has limited funding for initiatives. Which of the following prevention and health promotion initiatives is most likely to result in significant benefits for the older adults who participate? A) An awareness program that promotes screening sigmoidoscopy B) Teaching older adults about falls prevention in the home C) A program of bone density screening for older adults D) An exercise program for older adults who live in the community

Ans: D Sigmoidoscopy, bone density screening, and falls prevention are all valid health promotion and screening measures for older adults, but the promotion of exercise is likely to be of greatest benefit to the largest number of participants because of the multiple health benefits associated with regular exercise.

5. A nurse speaks at a staff development in-service. Which of the following statements by a nurse participant shows the need for education? A) "I know that the consequences of racism are still present and they're linked to health disparities." B) "I'm sure the percentage of client-care hours that we spend working with minority clients is bound to increase." C) "There's a huge amount of diversity within the group that's labeled 'Asians and Pacific Islanders.'" D) "It's inaccurate to link the prevalence of particular diseases with particular minority groups."

Ans: D The prevalence of some pathologies varies between different ethnic groups. The effects of racism are indeed linked to health disparities, and nurses are predicted to spend a higher percentage of client-care hours with members of minority groups in the future. As with most groups, there is vast diversity within the group "Asians and Pacific Islanders."

2. Which of the following is true about cognitive impairment and abuse of older adults? A) Older adults who live alone are always willing to acknowledge their impairments. B) Cognitively impaired older adults are usually able to meet minimum standards of care. C) When the older adult denies cognitive impairment, the risk for abuse declines. D) Older adults become more vulnerable to abuse because of cognitive impairment.

Ans: D When the older adult denies cognitive impairment, the risk for abuse increases. Older adults who are cognitively impaired are not able to meet minimal standards of care. Older adults who live alone may be afraid to acknowledge their impairments

9. A nurse administrator is involved in strategic planning for a large long-term care facility that has locations in numerous regions of the country. What trend should the nurse administrator anticipate? A) A decrease in the proportion of older adults who are members of minority groups B) A gradual decline in overall life expectancy C) Average longevity of men exceeding that of women D) Increased use of assisted living facilities by older adults

Ans: D Assisted living facilities have become a more common option for older adults; this trend is expected to continue. Life expectancy is continuing to increase, with women usually outliving men. An increasing proportion of the older adult population will be members of minority groups.

12. A nurse interviews a centenarian gathering data for a large study. In the interview, the centenarian says, "You're only as old as you feel, some days I feel like 'I'm 50.'" To which definition of aging does this response correspond? A) Chronologic aging B) Functional aging C) Perceived aging D) Subjective aging

Ans: D Subjective age describes a person's perception of his or her age. While perceived age is other people's estimation of someone's age. Chronologic age is the length of time that has passed since birth, and functional age is associated with whether individuals can contribute to society and experience personal quality of life.

9. Which of the following characteristics of older adults is explained by the subculture theory? A) Older adults have little control over the biologic effects of the aging process. B) Older adults have a decreased need for social interaction and peer support as they become older. C) Older adults may see their status with their peers in terms of economic achievement. D) Older adults may interact much more with other older adults than with members of other age groups.

Ans: D The subculture theory maintains that older people are less well integrated into the larger society and interact more among themselves, compared with people from other age groups. The theory does not prioritize economic achievement or the biologic effects of aging. Older adults do not have a diminished need for social interaction.

5. A nurse teaches a health education class for older adults about constipation. Which of the following points should the nurse stress? A) Older adults who do not have a daily bowel movement should use a laxative. B)Older adults should limit their intake of highfiber foods because of a risk of lactose intolerance. C)If older adults need a medication to promote bowel regularity, a laxative or enema should be given. D)If older adults need a medication to promote bowel regularity, a bulk-forming agent is needed daily

Ans: D A bulk-forming agent is least likely to have detrimental effects; providing fluid intake is adequate, if a medication is needed to promote regular bowel elimination. If at all possible, older adults should avoid laxatives. Older adults should include several portions of high-fiber foods in their daily diet

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

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

16. An older adult develops diarrhea. Which of the following is the priority intervention for the nurse? A) Assess for pancreatitis. B) Determine the last bowel movement. C) Review meal preparation techniques with the client. D) Review the client's medication list.

Ans: D A number of medications can cause diarrhea in the older adult (e.g., Cimetidine, laxatives, antibiotics, cardiovascular drugs, and cholinesterase inhibitors). Additionally, Clostridium difficile and its related diarrhea are related to antibiotic usage

5. A nurse evaluates the teaching done for an older adult with an upper respiratory infection during a heat wave. Which of the following statements indicates a need for further teaching? A) "The air conditioner increases the ventilation in my apartment." B) "I know that having diabetes will impact my body temperature." C) "If I have an alcoholic drink, it will affect my body temperature." D) "I can take an antihistamine; it will not have an effect on my temperature."

Ans: D Antihistamines are a risk for heat-related illness. Alcohol is a risk factor for hyperthermia and hypothermia. Diabetes is a risk factor that affects hyperthermia

10. A 70-year-old client has been a regular cigarette smoker since late teens and has made several attempts to quit over the years. When the nurse encourages the client to again try to quit, the client responds, "At this point in my life, I think it's probably too late." How should the nurse best respond to the client's statement? A) "You'll be able to avoid having a future heart attack if you quit smoking now." B) "Three months after your quit, you'll have the same risk of heart disease as a lifetime nonsmoker." C) "In a way that's true, but you would feel much better about yourself if you managed to quit." D) "Actually, you'll start to enjoy some health benefits almost as soon as you quit."

Ans: D Benefits of smoking cessation exist at any age. Complete elimination of smoking-related health threats does not disappear after only 3 months, however. Smoking cessation is not a guarantee against future MI

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

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

3. An older adult is admitted to the emergency department with dyspnea and a sudden change in level of consciousness. The nurse should assess first for which of the following disorders? A) Myocarditis B) Aortic aneurysm C) Cor pulmonale D) Myocardial infarction

Ans: D Compared with younger adults, older adults experiencing a myocardial infarction are more likely to have dyspnea or neurologic symptoms, rather than chest discomfort. Older adults with angina and acute myocardial infarction are more likely to have subtle and unusual manifestations

3. A nurse is teaching a colleague about the difference between age-related changes and risk factors. Which of the following examples should the nurse use when discussing age-related changes? A) An older adult with a diagnosis of diabetes mellitus B) An older adult who is obese C) An older adult with obstructive lung disease D) An older adult with decreased bowel motility

Ans: D Decreased bowel motility is an example of a phenomenon that is a normal consequence of the aging process. Diabetes, obesity, and obstructive lung disease are all phenomena that may constitute or exacerbate health problems for older adults, but they are not age-related changes.

5. A nurse assesses an older adult who has been having a difficult time sleeping throughout the night and incontinence. Which of the following questions by the nurse will best provide clues to these problems? A) "How many times a night do you get up to urinate?" B) "What did your health care practitioner tell you about your medications?" C) "What medications do you take when you need to stay asleep?" D) "What beverages do you drink on a regular basis?"

Ans: D Determining what medications the client has used PRN can be helpful, but an increase in caffeine intake might be making it difficult for the older adult to sleep. Sleep problems can be handled by decreasing caffeine intake rather than by giving the older adult a sleeping medication. Incontinence is not nocturia. "What did health care provider tell you" assesses the client's knowledge of medications; it does not address this issue.

3. A nurse assesses the pain of an older adult. Which of the following findings indicates the presence of persistent pain? A) The client's vital signs are unchanged. B) The client is asleep in the chair. C) The client has not reported pain to the nurse. D) The client rubs hands together.

Ans: D Essential assessment information is also obtained by observing for nonverbal indicators of pain, such as grimacing, muscle tension, rubbing, and protecting body parts. Relying on vital signs, presuming that sleeping clients are not experiencing pain, and relying on the absence of reporting of pain are all flawed pain assessment techniques

12. A nurse working for human services visits a long-term care facility. Which resident assessment finding indicates poor quality care? A) BMI of 29 B) Indentured mouth C) Serum albumin of 3.5 D) Unintentional weight loss

Ans: D Healthy adult BMI is between 18 and 25 and may extend to 30 for older adults. Dentures are a common finding in older adults. Normal serum albumin is 3.5 to 5; unintentional weight loss is an indicator of quality of care provided by the facility

9. A 79-year-old experienced a severe stroke several days ago. The client's spouse has been told by the care team that he is unlikely to survive more than a few days and that aggressive treatment would likely be futile. The nurse has just entered the client's room to find the spouse softly crying at the bedside, and makes no attempt to acknowledge the nurse's presence. What is the nurse's most therapeutic response to the client's wife? A) "Do you feel like he was able to live a full life?" B) "Did you feel like you were able to discuss his treatment options thoroughly?" C) "What is it that makes you the saddest about your husband's situation?" D) "I am here; should I leave you alone for now?"

Ans: D In light of the fact that the wife is grieving quietly and has not acknowledged the nurse's presence, it is likely appropriate to offer to leave her alone. Alluding to treatment options, a "full life," or particularly sad aspects of the situation is inappropriate

8. A 74-year-old client with a history of osteoarthritis is being treated in the hospital for pneumonia and malnutrition. The nurse administered 650 mg of acetaminophen 90 minutes ago and the client is now requesting another dose. The medication administration record has the following choices; which choice by the nurse is most appropriate? A) Normal saline 5 ml IV B) Acetaminophen 1,000 mg PO C) Morphine 5 mg IV D) Oxycodone 5 mg PO

Ans: D Limit the amount of acetaminophen to 3,000 mg per day in the client with malnutrition to avoid hepatotoxicity. Pain medication, not normal saline, should be administered. While alternative approaches to pain relief may be warranted, this does not necessarily mean that a pain-controlled analgesia (PCA) was the ideal delivery method. Step 2 of the World Health Organization pain relief ladder suggests adding an opioid. The use of stronger opioids is Step 3

2. A nurse teaches older adults about nutrition. Which of the following statements shows the nurse that the older adult requires further teaching? A) "Alcohol intake will interfere with absorption of B-complex vitamins and vitamin C." B) "Certain 'fluid' pills can decrease the potassium level in my blood." C) "Anticholinergic medications can cause my intestines to work slower." D) "My over-the-counter beta-carotene pill is appropriate for long-term use."

Ans: D Long-term beta-carotene use can cause vitamin E deficiency. Paralytic ileus can occur with anticholinergic medication. Nutritional supplements and herbal preparations can affect nutrients. Alcohol interferes with the absorption of B-complex vitamins and vitamin C

9. A palliative care team has taken over primary responsibility for the care of an older adult who has recently experienced a stroke. A visitor asks, "What is palliative care?" Which of the following is the best response by the nurse? A) "Spiritual and psychosocial care that takes place near the end of life" B) "Nursing care and medical treatment that prioritizes the wishes of patients and families" C) "The prioritization of complementary and alternative measures over biomedical interventions" D) "The provision of holistic care to patients experiencing incurable health states"

Ans: D Palliative care is a holistic approach to care that may be applied during complex and/or declining health states. It is not necessarily limited to the end of life and does not involve a rejection of biomedical interventions. The wishes of patients and their families are prioritized, but this is not the defining feature of palliative care. It includes spiritual and psychosocial care, but is not limited to these domains

6. A nurse assesses an older adult in the assisted living facility who has presbyphagia. Which of the following systems should the nurse auscultate? A) Abdomen for bruit B) Bowel sounds C) Heart tones D) Lung sounds

Ans: D Swallowing difficulties create a risk of aspiration. Presbyphagia is unlikely to result in assessment changes to the abdomen or heart

7. A 79-year-old woman had a total knee replacement yesterday; she has rung her call light to report pain. What consideration should the nurse prioritize when choosing an appropriate intervention? A) The fact that the woman has a documented history of persistent pain that precedes her surgery B) The need to ensure that the woman does not develop addiction during her course of treatment C) The fact that women consistently report a higher prevalence of persistent pain than men D) The need to provide prompt, adequate relief of the woman's pain

Ans: D The need for adequate pain control is paramount in the care of older adults. The fact that the woman has a history of persistent pain has little bearing on her present complaint and the need for relief. Addiction to analgesics is a rare development. Women do report a higher prevalence of persistent pain than men and are also undertreated for pain.

13. A nurse assesses an 85-year-old client and finds bruises on the arms and shins and a skin tear on the right hand. Which action is the priority for further nursing assessment? A) Consider the family as a reliable source of information. B) Determine if the person is depressed. C) Follow the protocol for reporting elder abuse. D) Review the client's medications and medical diagnoses

Ans: D The nurse has not yet gathered enough data to determine whether elder abuse is a potential factor. The client/family may not know the source of the bruises, and in fact may provide inaccurate information if they contribute to an abusive situation. It is important to consider adverse medication effects and some medical conditions as potential causes of bruising.

2. A healthy 70-year-old has been using diphenhydramine (Benadryl) for allergic rhinitis. One week later, the client begins to exhibit signs of confusion and disorientation. The spouse calls the primary care facility to speak with the nurse. Which event should the nurse suspect first? A) The older adult has hyponatremia, leading to delirium. B) The older adult is having transient ischemic attacks. C) The older adult has an overwhelming infection. D) The older adult is experiencing an adverse drug effect

Ans: D The older adult has been taking diphenhydramine, which can have an anticholinergic effect. Anticholinergic drugs can lead to medication-induced cognitive impairment. There is no reason to think that the client has hyponatremia. Rhinitis does not generally cause delirium in older adults. The client is more likely to be having adverse reaction than transient ischemic attacks.

8. A nurse reviews the medication list of an older adult. Which of the following age-related changes leads to a slower drug clearance? A) Increase in sensitivity to bioactive substances B) Elimination half-time is likely to be faster. C) Increase in glomerular filtration rate D) Decrease in hepatic blood flow

Ans: D The older adult is not more sensitive to bioactive substances. Elimination is likely to be slower. There is an age-related decline in hepatic blood flow that impacts pharmacokinetics, as well as the glomerular filtration rate.

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

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

5. Which of the following functional consequences of skin changes will impact the nursing care of older adults? A) Older adults have an increased incidence of moles requiring intervention. B) There is a decreased incidence of skin cancer in older adults because of an increase in melanocytes. C) In older adults, tactile sensitivity increases and there is an intense response to cutaneous stimulation. D) Collagen changes interfere with tensile strength of older adults' skin, causing the skin to be less resilient

Ans: D There is less tensile strength of the skin because of collagen changes, which predisposes the older adult to abrasive and tearing skin damage. There is a decreased incidence of moles after 40 years of age. There is an increased incidence of skin cancer in older adults, and decreased melanocytes is one factor that impacts this. Tactile stimulation decreases, and there is a less intense response to cutaneous stimulation

5. A nurse is teaching an older adult about some of the risks associated with using opioid analgesics. Which of the following statements best demonstrates the individual has gained a sound knowledge base? A) "I know that if I become dependent on the drug, my doctor and I will come up with a plan to discontinue it." B) "I'll need to be careful that I don't become addicted to the drug over time." C) "If I do develop a tolerance to the drug, I can expect some withdrawal symptoms." D) "It sounds like I might have my dosages increased over time because of tolerance."

Ans: D Tolerance denotes a decreased response to a drug over time, a fact that may necessitate an increase in drug dosage. Dependence on a drug's effects is not an indication that the drug necessarily needs to be discontinued, but rather that the drug is needed for living and that withdrawal symptoms would accompany cessation. Addiction is not a common result of opioid use, and clients should be made aware of that fact. Withdrawal symptoms are associated with dependence, not drug tolerance.

10. A series of transient ischemic attacks have caused an older adult to become dysphagic. Despite failing a swallowing assessment, the client is opposed to eating a minced and pureed diet and wishes to eat a regular diet. How should the care team respond to this request? A) Insert a feeding tube to provide nutrition while eliminating the risk of aspiration. B) Continue providing a minced and pureed diet to the client in order to ensure safety. C) Defer responsibility for feeding to the client's friends and family. D) Provide the client's requested diet after ensuring the client understands the risks.

Ans: D A common ethical dilemma is a client's or client's family's desire to continue an activity at risk. In general, an individual has the autonomy to choose this unless he or she is declared incompetent.

8. A nurse in the long-term care facility plans care to improve quality of life. Which of the following actions is most likely to enhance the older adult's connectedness? A) Teaching a client who has had a below-the-knee amputation how to care for his stump B) Organizing a client's intravenous antibiotic therapy on an outpatient basis C) Performing a focused respiratory assessment on a client who has a diagnosis of lung cancer D) Advocating for a husband and wife to remain in the same room of a long-term care facility, as is their preference

Ans: D Advocating for a husband and wife to remain in the same room of a long-term care facility, as is their preference fosters connectedness, a component of the older adult's quality of life. Teaching wound care, organizing treatment, and adequately assessing a client are aspects of good care, but none is a direct contributor to connectedness.

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

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

5. A nurse administers medications to an older man. Which of the following statements if made by the client indicates understanding of the use of tamsulosin? A) "I am so happy that this medication is working to decrease my urinary incontinence." B) "I now have had much less bladder pain and cramping." C) "My blood pressure has been higher since taking this medication." D) "My urine flow starts much faster now."

Ans: D Alpha-blockers or 5-alpha reductase inhibitors are used for prostate enlargement and bladder outlet obstruction: alfuzosin, doxazosin, dutasteride, finasteride, tamsulosin, and terazosin. Alpha-blockers decrease blood pressure, do not impact bladder pain, and are not generally used to treat urinary incontinence.

10. A nurse who provides care in a nursing home occasionally encounters colleagues' prejudices and misperceptions around the sexual wellness of residents. Which of the following statements reflects an appropriate view of sexual health in older adults? A) "I think it's just so cute when residents think that they're dating each other." B) "We need to make sure that residents get the teaching they need before we allow a sexual relationship." C) "Older adults need companionship and comfort much more than they need sex." D) "Let's do all we can to facilitate competent residents' sexual relationships."

Ans: D Among competent older adults, autonomy around sexual relationships should be protected and fostered. It is untrue that older adults have little need for sex and it is inappropriate for a nurse to prohibit a relationship pending education. Referring to older adults' relationships as "cute" is patronizing and inappropriate.

8. A 74-year-old client has recently begun integrating more fresh fruit and vitamin supplements in an effort to increase the levels of antioxidants. This client's actions indicate an understanding of what theory of aging? A) Cross-linkage theory B) Program theory of aging C) Immunosenescence D) Free radical theory

Ans: D Antioxidants, including beta-carotene and vitamins C and E, are one of the major defense mechanisms against oxidative damage from free radicals. The theory of immunosenescence, cross-linkage theory, and the program theory of aging do not directly prioritize a role for antioxidants in maintaining health.

11. A nurse on the cruise ship to Pacific Islands monitors the older adults for heat stroke in the hot weather. Which of the following persons is at greatest risk for developing heat stroke? A) 82-year-old Pacific Islander working the stand B) 80-year-old Canadian who abstains from alcoholic drinks C) 82-year-old woman who has been on the cruise for 4 weeks D) 78-year-old man with Parkinson disease

Ans: D Cardiovascular disease and Parkinson disease can worsen the severity of heat-related illness and decrease the chance of full recovery. More men than women experience heat-related illnesses. When exposed to hot climates for 7 to 14 days, healthy adults are able to acclimatize, and abstaining from alcohol decreases the chance of hot intolerance

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

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

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

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

14. A nurse in the intensive care unit monitors an older adult admitted with hypothermia. Which of the following assessment findings indicates the need to notify the primary health care provider immediately? A) Shivering B) Slurred speech C) Temperature of 95.5°F (35.3°C) D) Urine output of 25 mL per hour

Ans: D Early signs of hypothermia are subtle; hypothermia is best detected by measuring core body temperature with a thermometer that registers below 95°F (35°C). Signs of moderate hypothermia may include lethargy and slurred speech. However, severe stages of hypothermia are characterized by muscular rigidity and diminished urinary function

14.A home care nurse evaluated the plan care for the older woman with urge incontinence. Which of the following statements by the client indicates the need for further teaching? A) "I drink enough water, but do it early in the day." B) "I make certain I don't get constipated." C) "I purchased a fancy commode for my bedroom." D) "I still have to get up two times each night to urinate."

Ans: D Feedback: It is normal for older adults to urinate once or twice during the night. Water should be consumed hours before bedtime, a commode can reduce the time from sensation to void, and constipation can increase incontinence

5. Which of the following circumstances would be most likely to render a screening program unnecessary? A) Treatment of the disease is available at low cost. B) The disease follows a predictable course. C) The disease is more common among older adults than among younger and middle-aged adults. D) The symptoms of the disease appear at the same time that it is detectable by screening.

Ans: D For a screening program to be effective, the test must be able to detect the disease in question earlier than it would be detected without screening. While cost-effectiveness is a consideration in screening programs, low treatment costs would not necessarily mean screening is undesirable. The predictability of the course of a disease is not cited as a reason to forgo screening, nor is the fact that the disease may be more common among older adults.

11. A nurse in a community setting plans wellness outcomes with a 68-year-old female client who desires to participate in a half-marathon run. Which of the following outcomes should the nurse document? A) The client will remain free of disease. B) The client will participate in daily aerobic activity class without falls. C) The client will increase activity until able to run 30 minutes. D) The client will participate in the half marathon that is scheduled in 6 months.

Ans: D Health is individually determined, based on the functional capacities that are perceived as important by that person, in this case, participating in a half marathon. Remaining free from disease and expecting the older adult to participate in daily aerobic activity class may not be pertinent to this client. Increasing activity by only 30 minutes at time minimizes the client's goal.

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

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

4. As part of a functional assessment, a nurse is assessing an older adult's ADLs and instrumental activities of daily living (IADLs). What piece of assessment data would most likely be considered an IADL rather than an ADL? A) The older adult is able to ambulate to and from the bathroom at home. B) The older adult can feed herself independently. C) The older adult can dress in the morning without assistance. D) The older adult is able to clean and maintain her own apartment.

Ans: D IADLs refer to tasks higher in complexity than basic ADLs. IADLs include housekeeping and shopping. Toileting, feeding, and dressing are all considered basic ADLs.

12. A nurse administers IV pain medication to an older adult in the hospital. Which of the following actions by the nurse is the priority? A) Encourage the family to leave. B) Identify the client's expectations for relief. C) Reassess the pain level. D) Reposition the client

Ans: D In acute care settings, effectiveness of analgesics should be assessed 30 to 60 minutes after administration. Pain assessment should include open-ended questions to identify the person's expectations for relief before administering medication. Family is not encouraged to leave. Nonpharmacologic interventions are an integral part of pain management: Physical strategies include massage, reflexology, heat and cold, mild exercise, and physical therapy (this would include repositioning the client)

4. Which of the following statements is true about the laws of mandatory abuse reporting? A) Government agencies, not individual nurses, are responsible for reporting abuse. B) Mandatory reporting laws require reporters to know whether abuse or neglect has occurred, rather than just suspecting it has occurred. C) The use of an abuse reporting protocol replaces individual responsibility for reporting. D) A registered nurse is mandated to report abuse or neglect if it is suspected.

Ans: D In all states within the United States, individual nurses are responsible for reporting abuse. Mandatory reporters are required to report the suspicion of abuse or neglect. Protocols do not replace individual responsibility. Protocols clarify individual roles and enhance the credibility of the abuse report.

10. Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which of the following problems is most likely to precipitate admission to long-term care? A) Kidney disease B) Traumatic injury C) Chronic obstructive pulmonary disease D) Dementia

Ans: D In contrast to admissions for skilled nursing care that are associated with a hospitalization, admissions to long-term care commonly occur after a period of gradual decline in functioning because of a chronic condition, such as dementia. Studies indicate that more severe functional limitations, cognitive impairment, and problematic behaviors in people with dementia are predictors of admission to nursing facilities for long-term care.

14. A nurse discusses the future with an older adult who has had surgery for a fractured hip and is also diagnosed as having depression. The client wavers between wanting to give up and going to rehabilitation. Which of the following questions should the nurse ask to assist the client toward values clarification? A) Which pain medication works best for you? B) How can we best assist you with your activities of daily living? C) Do you prefer to bath in the morning or in the evening? D) What goals do you have for the next year?

Ans: D In holistic nursing ethics, the process of values clarification can be used to guide nurses. Values clarification is an ongoing process in which an individual becomes increasingly aware of what is important and just—and why. The nurse can facilitate this process for clients by listing several health behaviors or values, such as health, happiness, independence, and good relationships, and ask clients to rank them or identify how they incorporate them into their lives why.

9. A 79-year-old man was admitted to the hospital for knee arthroplasty (replacement) due to osteoarthritis. During recovery, he developed postoperative pneumonia and became incontinent of urine while recovering from this serious infection. While being treated on the acute medicine unit, he remained in bed for several days. This client's urinary incontinence and other health challenges are most likely to result in what nursing diagnosis? A) Social isolation B) Disturbed body image C) Anxiety D) Impaired skin integrity

Ans: D Limited mobility coupled with urinary incontinence creates a risk for skin breakdown, especially among older adults. Social isolation, disturbed body image, and anxiety are also realistic possibilities, but these are less likely in an acute care setting.

8. In which of the following situations would a living will provide clear direction to the care and treatment of the individual involved? A) Mr. Penny, age 81, has been diagnosed with bone cancer, is experiencing severe pain, and has been presented with treatment options. B) Ms. Jelic, age 78, has been brought to the emergency department after falling on an escalator. C) Mrs. Kerr, age 77, has been admitted to hospital with an electrolyte imbalance secondary to an accidental overdose of diuretics. D) Mr. Jimenez, age 84, has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive.

Ans: D Living wills are legal documents whose purpose is to allow people to specify the type of medical treatment they would want or not want if they become incapacitated as a result of terminal illness. A limitation of living will directives is that they apply only to situations in which the person is considered terminally ill, whereas advance directives apply to a broader range of circumstances.

2. A nurse discusses advance medical directives with a group of older adults at the senior citizens' center. Which of the following statements made by a member of the group indicates a need for further teaching about medical directives? A) "Advance directives address the person's right to refuse medical treatment." B) "It is helpful to see an attorney before completing a durable power of attorney." C) "Advance directives provide legal assurances that a person's preferences will be considered." D) "A durable power of attorney cannot be initiated before a person is incapacitated."

Ans: D Medical directives focus on the right to refuse treatment and address the person's desires for medical treatment in certain circumstances. The durable power of attorney for health care must be initiated when the person is competent, but it takes effect only when the person is incapacitated. Medical directives cannot guarantee that a medical intervention will be completed, but they give assurances that the person's preferences will be considered

14. A client in the skilled nursing facility refuses rehabilitation services 5 out of 7 days. An administrator tells the client that they will be transferred to the intermediate care unit. The client states, "Medicare is paying my bill; you can't transfer me." Which of the following is the best response by the nurse administrator? A) "You are making good progress it's time to move to the intermediate care unit." B) "We don't accept Medicare clients in the skilled unit." C) "Oh, I wasn't aware; you will be staying here." D) "Medicare will only pay as long as you continue to make progress toward your goals."

Ans: D Medicare and other insurance programs will cover all or part of the care for up to 100 days of care, but only as long as the person continues to require the skilled level of services. The expectation is that the person will be able to progress to a higher level of functioning and show some recovery from the acute episode.

1. A hospital nurse is discussing with an older adult the possibility transfer to a nursing home for skilled care after pneumonia. Which statement by the client indicates an understanding of this possible transfer? A) Old people who go to the nursing home don't get out. B) They will take my home if I go to the nursing home. C) I don't qualify for skilled care, I only had pneumonia. D) I have already used 45 Medicare days this year.

Ans: D Medicare and other insurance programs will cover all or part of the care for up to 100 days of care. Typical diagnoses associated with skilled care in a nursing home are stroke, fractured hip, congestive heart failure, and rehabilitation after acute illnesses (e.g., pneumonia and myocardial infarction). About 65% of older adults spend some time in a nursing home.

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

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

8. A nurse working in an acute care for elders unit observes that a client on the unit frequently stumbles when ambulating with a walker. Which action by the nurse is best? A) Provide a wheelchair for the client to use for the duration of the hospital stay. B) Ask the client to remain in bed as much as possible and teach the client about falls risks. C) Place a chair in the hallway so the client can take a rest break when feeling unsteady. D) Ensure that the woman's mobility is assessed and the appropriate assistive device is provided.

Ans: D Nurses should be aware of problems with assistive devices and follow up these problems with the appropriate therapists. It would be inappropriate to confine the client to bed or to independently replace her walker with a wheelchair. Providing a chair for rest breaks does not address the central problem that she may be using the wrong device.

3. An 83-year-old puts on a sweatshirt and jacket preparing to go outside where it is currently 60°F. What interpretation should the nurse give to these actions? A) The client is experiencing a reaction to a medication. B) The client has decreased circulation due to heart failure. C) The client has a dementia and cannot make decisions. D) The client dresses to maintain an adequate internal temperature

Ans: D Older adults often report feeling cold, even in warm environments, and they generally prefer environmental temperatures that are at least 75°F. This choice of attire seems appropriate for the 60oF

6. A nurse orients a graduate nurse to a gerontology unit. Which of the following statements, if made by the graduate nurse, shows understanding of normal age-related changes of sleep patterns? A) Older adults need for 10% to 20% more sleep than younger adults. B) Older adults have fewer sleep cycles during the night. C) Older adults fall asleep faster and staying asleep longer than younger adults. D) Older adults spend less time in deep sleep.

Ans: D Older adults typically spend less time in deep sleep than do younger adults, though the overall quantity of sleep required remains fairly static throughout the adult life span. Older adults usually experience more sleep cycles during the night and experience longer sleep latency.

5. A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which of the following statements indicates that the nurse's teaching has been successful? A) "I will decrease the amount of time spent in foreplay before engaging in sexual intercourse." B) "I will avoid taking a warm bath before engaging in sexual activity." C) "I will avoid experimenting with different positions during sexual relations." D) "I will use a vibrator since my ability to massage is limited."

Ans: D People with arthritis will want to increase foreplay. Warm baths will decrease stiffness. People with arthritis should experiment with sexual positions for comfort and support. A vibrator may help if the ability to massage is limited for the person with arthritis

13. A nursing administrator of the long-term care facility implements a performance improvement program. Which of the following activities should be included in the program? A) Develop a dementia care unit. B) Decrease the use of intramuscular medications. C) Emphasize safety and medical care. D) Measure outcomes focusing on personal choice.

Ans: D Quality assurance and performance improvement programs measure attainment of outcomes. Quality in long-term care focuses on consumer personal choices and quality of life issues, without the overemphasis on safety, uniformity, and medical care. Developing a dementia unit is not always included in quality improvement of long-term care, nor is reduction of IM medications.

2. An 80-year-old black woman minimizes her pain in the joints and back as "normal aging." Which of the following actions by the nurse is most appropriate? A) Address the client's concerns regarding addiction. B) Allow the client to choose to minimize the pain. C) Encourage opioid use for pain relief. D) Offer warm packs for joints.

Ans: D Racial and ethnic minorities and women are at high risk for receiving inadequate pain relief. The nurse must discuss nonpharmacologic interventions as well as dispelling myths regarding the functional consequences of aging and pain treatment. This client does not express concerns regarding addiction. Older adults commonly fear negative consequences of analgesics

15. A home care nurse assesses the home environment of an older adult client. Which of the following environmental conditions positively affects the functioning and quality of life for the client? A) The client has thick shag carpeting in the home. B) The client shares a bathroom with a teenager. C) The client's 2-year-old great grandchild plays in the living room. D) The client's home has large south-facing windows with blinds.

Ans: D Shag carpeting can interfere with ambulation, so can the toys of a 2-year-old. Sharing a bathroom also does not affect the environment positively. South-facing windows with blinds allow sunlight, which is a positive environmental condition.

14. A quality care nurse assesses the care given by a hospice. Which of the following statements by the client best reflects dignified end-of-life care? A) "I'm glad that my family is making all the decisions; it's too much for me." B) "I'm not ready to die yet; I've got a few more in me." C) "It is fine sharing a room; I like the company." D) "They listened to me and stopped the therapy."

Ans: D Some characteristics of dignified care include being involved in decision making, having privacy and a safe environment, being listened to and having needs and wishes respected, and feeling peaceful and ready to die

4. An older woman of Filipino heritage has been having rectal bleeding for several months. Her physician has told the woman and her daughters that she has advanced colon cancer. Her daughters want to obtain hospice services but the client is reluctant and does not want to discuss what she feels is "beyond her control." Which of the following concerns is this client most likely experiencing? A) Entrenched optimism in health care providers B) Individual autonomy regarding end of life C) Impaired cognition secondary to cancer D) Cultural taboo to discuss death

Ans: D Some members of the Filipino culture believe in fatalism and resist any discussion about or planning for events beyond one's control such as illness or death, because it is viewed as tempting fate and will likely bring the potential event into reality.

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

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

8. A 68-year-old client has a long history of poor eating habits and low activity levels. The client now has a diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions should be the priority? A) Adherence to diabetes screen protocols B) Education about the role that his lifestyle has played in his diagnosis C) Maintenance of function and activities of daily livings D) Self-care measures to aid in the management of his disease

Ans: D The care of older adults with diabetes should prioritize self-care measures such as diet, exercise, medications, and glucose monitoring. Screening is not relevant since the client has already been diagnosed with the disease in question. Education about lifestyle factors and maintenance of function are relevant and appropriate, but these are superseded by the importance of facilitating self-care

4. A community care nurse plans care for older adults as the fall season sets in a cooler weather starts. Which of the following clients is at greatest risk for development of hypothermia? A) Client who lives in an apartment building B) Client who sets the thermostat at 76°F year round C) Institutionalized older adult with cancer D) Older adult who has dementia and lives alone

Ans: D The client with dementia has multiple risks for hypothermia including loss of sensation, difficulty with decision, and living alone. Even in environmental temperatures of 68°F (20°C) an older person may become hypothermic, especially if other risk factors are present.

4. A nurse assesses an older adult client with confusion related to hyponatremia who reports pain. Which of the following data should the nurse use as a guide for choosing interventions? A) Symptoms of hyponatremia do not include pain. B) The client does not manifest any outward signs of pain. C) The client is confused from the pain. D) The client rates the pain at 8 out of 10

Ans: D The client's subjective self-report of pain is the priority assessment finding and reflects the adage that pain is what the client says it is. The nurse should not discount the reports of clients based on medical diagnoses and expected findings, because the client has a history of cognitive deficits, or because the client does not appear to be in pain

11. An older adult client with urosepsis has become nonresponsive. The nurse is to identify the appropriate person to sign the consent forms for an invasive medical procedure. Which of the following actions by the nurse is appropriate? A) Find the older adult's family member to sign the consent. B) Inform the health care provider that no consent can be obtained. C) Move forward with guardianship as the client is incompetent. D) Review the chart for a health care power of attorney.

Ans: D The client, at this time, does not have the decision-making capacity to sign consents. Guardianship is a permanent option that is used only when a person has been declared incompetent. When the client does not have the decision-making capacity to sign consents, the durable power of attorney for health care should do so. If there is no power of attorney, the nurse needs to follow the institutional protocol for obtaining consent.

6. A gerontological nurse is aware of the changes in the structure and function of the skin and accessory glands that occur with aging. Which of the following changes is a normal accompaniment to the aging process? A) Thickening of collagen in the dermal layers of the skin B) Cessation of eccrine and apocrine sweat gland function C) Increase in the number of melanocytes in the epidermis D) Decrease in the vascular bed of the dermis

Ans: D The dermal vascular bed decreases by about one-third with increased age; this contributes to the atrophy and fibrosis of hair bulbs and sweat and sebaceous glands. However, sweat glands do not wholly stop functioning. Collagen tends to thin rather than thicken, and the number of melanocytes in the epidermis decreases.

1. A nurse on a geriatric medical care unit consults hospice for a client. Which of the following nursing interventions should the nurse anticipate after the client begins hospice care? A) Administering chemotherapy to a client with a diagnosis of pancreatic cancer B) Assessing the deep tendon reflexes of a client with neurologic impairment C) Infusing total parenteral nutrition to a client with dysphagia D) Providing an opioid analgesic to a client with bone metastases

Ans: D The focus of hospice care is on the relief of suffering rather than cure of disease. Relief of suffering often encompasses providing pain relief to clients. Active curative treatments, such as chemotherapy, and parenteral feeding often are forgone. Health assessments that do not assess the client's comfort, such as the assessment of deep tendon reflexes, are not the priority of palliative/hospice care

7. A 79-year-old client has been admitted to a long-term care facility because of the progression of Alzheimer disease from mild to the moderate stage. How should the nurse proceed with functional assessment? A) Document the fact that it is not possible to accurately gauge the woman's ADLs. B) Obtain assessment data from the woman's family members and friends. C) Perform assessment passively by observing and recording the woman's behavior and actions over the next several days. D) Use an assessment tool that is specifically designed for use with cognitively impaired clients.

Ans: D The presence of cognitive deficits presents a challenge to the assessment of a client's ADLs. However, there are assessment instruments that are designed for this explicit purpose and these should be utilized. The nurse should not forgo functional assessment. Observation and input from family should be included in assessment, but these do not replace a formal, functional assessment

2. Until recently, a 77-year-old client lived alone in her own home. The client fell and fractured an ankle and was placed in a long-term care facility for physical therapy. After the physical therapy was finished, the client tells the nurse, "I want to stay at the facility; I am happy living there and I like the social interaction." Which of the following theories of aging best describes the status of this client? A) Activity theory B) Feminist theory C) Life-course theory D) Theory of thriving

Ans: D The theory of thriving posits that the older adult thrives when there is concordance between the person and the human and nonhuman environment. Activity theory postulates that older people remain socially and psychologically fit if they remain actively engaged in life such as engaging in full-time work and low-level volunteering. Feminist gerontology theories examine aging from the experiences of older women. Feminist theories address gender inequalities with regard to caregiving roles, diseases, and economic status. Life-course theories address old age within the context of the life cycle.

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

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

13. A quality control nurse for a large group of long-term care facilities assesses the quality of care at the end of life for the residents. Which of the following measures indicate quality care? (Select all that apply.) A) Increase in the number of deaths in the hospital B) Increase in the number of residents who refuse treatments at the end of life C) Increase in the percent of residents with advanced dementia D) Increase in the use of hospice services E) Increasing number of staff trained in palliative care

Ans: D, E Studies confirm the need for staff education related to symptom management and other aspects of palliative care. Two measures of quality care at the end of life for nursing home residents are use of hospice services and avoiding death in the hospital. There are a large number of residents with advanced dementia (the desire is that more of these become clients of hospice)

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

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