Chapter 11: Health Care of the Older Adult

22. As the population of the United States ages, research has shown that this aging will occur across all racial and ethnic groups. A community health nurse is planning an initiative that will focus on the group in which the aging population is expected to rise the fastest. What group should the nurse identify? A) Asian-Americans B) White non-Hispanics C) Hispanics D) African-Americans

C) Hispanics

29. You are caring for an 82-year-old man who was recently admitted to the geriatric medical unit in which you work. Since admission, he has spoken frequently of becoming a burden to his children and staying afloat financially. When planning this patients care, you should recognize his heightened risk of what nursing diagnosis? A) Disturbed thought processes B) Impaired social interaction C) Decisional conflict D) Anxiety

D) Anxiety

4. The nurse is caring for a 65-year-old patient who has previously been diagnosed with hypertension. Which of the following blood pressure readings represents the threshold between high-normal blood pressure and hypertension? A) 140/90 mm Hg B) 145/95 mm Hg C) 150/100 mm Hg D) 160/100 mm Hg

A) 140/90 mm Hg

A nurse is caring for an 86-year-old female patient who has become increasingly frail and unsteady on her feet. During the assessment, the patient indicates that she has fallen three times in the month, though she has not yet suffered an injury. The nurse should take action in the knowledge that this patient is at a high risk for what health problem? A) A hip fracture B) A femoral fracture C) Pelvic dysplasia D) Tearing of a meniscus or bursa

A) A hip fracture

11. A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Of what age-related change should the nurse be aware when planning the appropriate administration of this drug? A) An older patient has less subcutaneous tissue and less muscle mass than a younger patient. B) An older patient has more subcutaneous tissue and less durable skin than a younger patient. C) An older patient has more superficial and tortuous nerve distribution than a younger patient. D) An older patient has a higher risk of bleeding after an IM injection than a younger patient.

A) An older patient has less subcutaneous tissue and less muscle mass than a younger patient.

5. You are the nurse caring for an 85-year-old patient who has been hospitalized for a fractured radius. The patients daughter has accompanied the patient to the hospital and asks you what her father can do for his very dry skin, which has become susceptible to cracking and shearing. What would be your best response? A) He should likely take showers rather than baths, if possible. B) Make sure that he applies sunscreen each morning. C) Dry skin is an age-related change that is largely inevitable. D) Try to help your father increase his intake of dairy products.

A) He should likely take showers rather than baths, if possible.

2. A gerontologic nurse practitioner provides primary care for a large number of older adults who are living with various forms of cardiovascular disease. This nurse is well aware that heart disease is the leading cause of death in the aged. What is an age-related physiological change that contributes to this trend? A) Heart muscle and arteries lose their elasticity. B) Systolic blood pressure decreases. C) Resting heart rate decreases with age. D) Atrial-septal defects develop with age.

A) Heart muscle and arteries lose their elasticity.

The nurse is providing patient teaching to a patient with early stage Alzheimers disease (AD) and her family. The patient has been prescribed donepezil hydrochloride (Aricept). What should the nurse explain to the patient and family about this drug? A) It slows the progression of AD. B) It cures AD in a small minority of patients. C) It removes the patients insight that he or she has AD. D) It limits the physical effects of AD and other dementias.

A) It slows the progression of AD.

12. An elderly patient, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. What information can the nurse give the patient to help allay her concerns? A) Medicare has a copayment for many of the services it covers. This requires the patient to pay a part of the bill. B) Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered. C) Medicare will only pay the cost for acute-care services if the patient has a very low income. D) Medicare will not pay for the cost of acute-care services so the patient will be billed for the services provided.

A) Medicare has a copayment for many of the services it covers. This requires the patient to pay a part of the bill.

38. Falls, which are a major health problem in the elderly population, occur from multifactorial causes. When implementing a comprehensive plan to reduce the incidence of falls on a geriatric unit, what risk factors should nurses identify? Select all that apply. A) Medication effects B) Overdependence on assistive devices C) Poor lighting D) Sensory impairment E) Ineffective use of coping strategies

A) Medication effects C) Poor lighting D) Sensory impairment

34. Based on a patients vague explanations for recurring injuries, the nurse suspects that a community- dwelling older adult may be the victim of abuse. What is the nurses primary responsibility? A) Report the findings to adult protective services. B) Confront the suspected perpetrator. C) Gather evidence to corroborate the abuse. D) Work with the family to promote healthy conflict resolution.

A) Report the findings to adult protective services.

30. For several years, a community health nurse has been working with a 78-year-old man who requires a wheelchair for mobility. The nurse is aware that the interactions between disabilities and aging are not yet clearly understood. This interaction varies, depending on what variable? A) Socioeconomics B) Ethnicity C) Education D) Pharmacotherapy

A) Socioeconomics

15. You are the nurse planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiological changes. What phenomenon would you include in your teaching plan? A) A decrease in cognition, judgment, and memory B) A decrease in muscle mass and bone density C) The disappearance of sexual desire for both men and women D) An increase in sebaceous and sweat gland function in both men and women

B) A decrease in muscle mass and bone density

13. The admissions department at a local hospital is registering an elderly man for an outpatient diagnostic test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this patient? A) Advance directives are not legal documents, so you have nothing to worry about. B) Advance directives are limited only to health care instructions and directives. C) Your finances cannot be managed without an advance directive. D) Advance directives are implemented when you become incapacitated, and then you will use a living will to allow the state to manage your money.

B) Advance directives are limited only to health care instructions and directives.

3. An occupational health nurse overhears an employee talking to his manager about a 65-year-old coworker. What phenomenon would the nurse identify when hearing the employee state, He should just retire and make way for some new blood.? A) Intolerance B) Ageism C) Dependence D) Nonspecific prejudice

B) Ageism

A gerontologic nurse is making an effort to address some of the misconceptions about older adults that exist among health care providers. The nurse has made the point that most people aged 75 years remains functionally independent. The nurse should attribute this trend to what factor? A) Early detection of disease and increased advocacy by older adults B) Application of health-promotion and disease-prevention activities C) Changes in the medical treatment of hypertension and hyperlipidemia D) Genetic changes that have resulted in increased resiliency to acute infection

B) Application of health-promotion and disease-prevention activities

28. A gerontologic nurse has been working hard to change the perceptions of the elderly, many of which are negative, by other segments of the population. What negative perceptions of older people have been identified in the literature? Select all that apply. A) As being the cause of social problems B) As not contributing to society C) As draining economic resources D) As competing with children for resources E) As dominating health care research

B) As not contributing to society C) As draining economic resources D) As competing with children for resources

10. The case manager is working with an 84-year-old patient newly admitted to a rehabilitation facility. When developing a care plan for this older adult, which factors should the nurse identify as positive attributes that benefit coping in this age group? Select all that apply. A) Decreased risk taking B) Effective adaptation skills C) Avoiding participation in untested roles D) Increased life experience E) Resiliency during change

B) Effective adaptation skills D) Increased life experience E) Resiliency during change

20. A 47-year-old patient who has come to the physicians office for his annual physical is being assessed by the office nurse. The nurse who is performing routine health screening for this patient should be aware that one of the first physical signs of aging is what? A) Having more frequent aches and pains B) Failing eyesight, especially close vision C) Increasing loss of muscle tone D) Accepting limitations while developing assets

B) Failing eyesight, especially close vision

31. Gerontologic nursing is a specialty area of nursing that provides care for the elderly in our population. What goal of care should a gerontologic nurse prioritize when working with this population? A) Helping older adults determine how to reduce their use of external resources B) Helping older adults use their strengths to optimize independence C) Helping older adults promote social integration D) Helping older adults identify the weaknesses that most limit them

B) Helping older adults use their strengths to optimize independence

39. Older people have many altered reactions to disease that are based on age-related physiological changes. When the nurse observes physical indicators of illness in the older population, that nurse must remember which of the following principles? A) Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population. B) Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults. C) The same physiological processes that indicate serious health care problems in a younger population indicate mild disease states in the elderly. D) Middle-aged people do not react to disease states the same as a younger population does.

B) Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults.

1. You are providing care for an 82-year-old man whose signs and symptoms of Parkinson disease have become more severe over the past several months. The man tells you that he can no longer do as many things for himself as he used to be able to do. What factor should you recognize as impacting your patients life most significantly? A) Neurologic deficits B) Loss of independence C) Age-related changes D) Tremors and decreased mobility

B) Loss of independence

27. Mrs. Harris is an 83-year-old woman who has returned to the community following knee replacement surgery. The community health nurse recognizes that Mrs. Harris has prescriptions for nine different medications for the treatment of varied health problems. In addition, she has experienced occasional episodes of dizziness and lightheadedness since her discharge. The nurse should identify which of the following nursing diagnoses? A) Risk for infection related to polypharmacy and hypotension B) Risk for falls related to polypharmacy and impaired balance C) Adult failure to thrive related to chronic disease and circulatory disturbance D) Disturbed thought processes related to adverse drug effects and hypotension

B) Risk for falls related to polypharmacy and impaired balance

35. You are the nurse caring for an elderly patient with cardiovascular disease. The patient comes to the clinic with a suspected respiratory infection and is diagnosed with pneumonia. As the nurse, what do you know about the altered responses of older adults? A) Treatments for older adults need to be more holistic than treatments used in the younger population. B) The altered responses of older adults reinforce the need for the nurse to monitor all body systems to identify possible systemic complications. C) The altered responses of older adults define the nursing interactions with the patient. D) Older adults become hypersensitive to antibiotic treatments for infectious disease states.

B) The altered responses of older adults reinforce the need for the nurse to monitor all body systems to identify possible systemic complications.

19. You are caring for a patient with late-stage Alzheimers disease. The patients wife tells you that the patient has now become completely dependent and that she feels guilty if she takes any time for herself. What outcomes would be appropriate for the nurse to develop to assist the patients wife? A) The caregiver learns to explain to the patient why she needs time for herself. B) The caregiver distinguishes essential obligations from those that can be controlled or limited. C) The caregiver leaves the patient at home alone for short periods of time to encourage independence. D) The caregiver prioritizes her own health over that of the patient.

B) The caregiver distinguishes essential obligations from those that can be controlled or limited.

40. You are the nurse caring for a 91-year-old patient admitted to the hospital for a fall. The patient complains of urge incontinence and tells you he most often falls when he tries to get to the bathroom in his home. You identify the nursing diagnosis of risk for falls related to impaired mobility and urinary incontinence. The older adults risk for falls is considered to be which of the following? A) The result of impaired cognitive functioning B) The accumulation of environmental hazards C) A geriatric syndrome D) An age-related health deficit

C) A geriatric syndrome

21. A gerontologic nurse is aware of the demographic changes that are occurring in the United States, and this affects the way that the nurse plans and provides care. Which of the following phenomena is currently undergoing the most rapid and profound change? A) More families are having to provide care for their aging members. B) Adult children find themselves participating in chronic disease management. C) A growing number of people live to a very old age. D) Elderly people are having more accidents, increasing the costs of health care.

C) A growing number of people live to a very old age.

16. A home health nurse makes a home visit to a 90-year-old patient who has cardiovascular disease. During the visit the nurse observes that the patient has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do? A) Increase the frequency of the patients home care. B) Have a family member check in on the patient in the evening. C) Arrange for the patient to see his primary care physician. D) Refer the patient to an adult day program.

C) Arrange for the patient to see his primary care physician.

36. You are the nurse caring for patients in the urology clinic. A new patient, 78 years old, presents with complaints of urinary incontinence. An anticholinergic is prescribed. Why might this type of medication be an inappropriate choice in the elderly population? A) Gastrointestinal hypermotility can be an adverse effect of this medication. B) Detrusor instability can be an adverse effect of this medication. C) Confusion can be an adverse effect of this medication. D) Increased symptoms of urge incontinence can be an adverse effect of this medication.

C) Confusion can be an adverse effect of this medication.

An 84-year-old patient has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The patient is oriented to name only. The patient's family is very upset because, before having surgery, the patient had no cognitive deficits. The patient is subsequently diagnosed with postoperative delirium. What should the nurse explain to the patient's family? A) This problem is self-limiting and there is nothing to worry about. B) Delirium involves a progressive decline in memory loss and overall cognitive function. C) Delirium of this type is treatable and her cognition will return to previous levels. D) This problem can be resolved by administering antidotes to the anesthetic that was used in surgery.

C) Delirium of this type is treatable and her cognition will return to previous levels.

32. The presence of a gerontologic advanced practice nurse in a long-term care facility has proved beneficial to both the patients and the larger community in which they live. Nurses in this advanced practice role have been shown to cause what outcome? A) Greater interaction between younger adults and older adults occurs. B) The elderly recover more quickly from acute illnesses. C) Less deterioration takes place in the overall health of patients. D) The elderly are happier in long-term care facilities than at home.

C) Less deterioration takes place in the overall health of patients.

An 83-year-old woman was diagnosed with Alzheimers disease 2 years ago and the disease has progressed at an increasing pace in recent months. The patient has lost 16 pounds over the past 3 months, leading to a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements. What intervention should the nurse include in this patients plan of care? A) Offer the patient rewards for finishing all the food on her tray. B) Offer the patient bland, low-salt foods to limit offensiveness. C) Offer the patient only one food item at a time to promote focused eating. D) Arrange for insertion of a gastrostomy tube and initiate enteral feeding.

C) Offer the patient only one food item at a time to promote focused eating.

After a sudden decline in cognition, a 77-year-old man who has been diagnosed with vascular dementia is receiving care in his home. To reduce this mans risk of future infarcts, what action should the nurse most strongly encourage? A) Activity limitation and falls reduction efforts B) Adequate nutrition and fluid intake C) Rigorous control of the patients blood pressure and serum lipid levels D) Use of mobility aids to promote independence

C) Rigorous control of the patients blood pressure and serum lipid levels

18. You are the nurse caring for an elderly patient who is being treated for community-acquired pneumonia. Since the time of admission, the patient has been disoriented and agitated to varying degrees. Appropriate referrals were made and the patient was subsequently diagnosed with dementia. What nursing diagnosis should the nurse prioritize when planning this patients care? A) Social isolation related to dementia B) Hopelessness related to dementia C) Risk for infection related to dementia D) Acute confusion related to dementia

D) Acute confusion related to dementia

Nurses and members of other health disciplines at a states public health division are planning programs for the next 5 years. The group has made the decision to focus on diseases that are experiencing the sharpest increases in their contributions to the overall death rate in the state. This team should plan health promotion and disease prevention activities to address what health problem? A) Stroke B) Cancer C) Respiratory infections D) Alzheimers disease

D) Alzheimers disease

33. A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Millers Functional Consequences Theory. To actualize this theory of aging, the nurse should prioritize what task? A) Attempting to control age-related physiological changes B) Lowering expectations for recovery from acute and chronic illnesses C) Helping older adults accept the inevitability of death D) Differentiating between age-related changes and modifiable risk factors

D) Differentiating between age-related changes and modifiable risk factors

37. A gerontologic nurse is overseeing the care that is provided in a large, long-term care facility. The nurse is educating staff about the significant threat posed by influenza in older, frail adults. What action should the nurse prioritize to reduce the incidence and prevalence of influenza in the facility? A) Teach staff how to administer prophylactic antiviral medications effectively. B) Ensure that residents receive a high-calorie, high-protein diet during the winter. C) Make arrangements for residents to limit social interaction during winter months. D) Ensure that residents receive influenza vaccinations in the fall of each year.

D) Ensure that residents receive influenza vaccinations in the fall of each year.

An elderly patient has come in to the clinic for her twice-yearly physical. The patient tells the nurse that she is generally enjoying good health, but that she has been having occasional episodes of constipation over the past 6 months. What intervention should the nurse first suggest? A) Reduce the amount of stress she currently experiences. B) Increase carbohydrate intake and reduce protein intake. C) Take herbal laxatives, such as senna, each night at bedtime. D) Increase daily intake of water.

D) Increase daily intake of water.

14. A nurse is planning discharge teaching for an 80-year-old patient with mild short-term memory loss. The discharge teaching will include how to perform basic wound care for the venous ulcer on his lower leg. When planning the necessary health education for this patient, what should the nurse plan to do? A) Set long-term goals with the patient. B) Provide a list of useful Web sites to supplement learning. C) Keep visual cues to a minimum to enhance the patients focus. D) Keep teaching periods short.

D) Keep teaching periods short.

17. The home health nurse is making an initial home visit to a 76-year-old widower. The patient takes multiple medications for the treatment of varied chronic health problems. The patient states that he has also begun taking some herbal remedies. What should the nurse be sure to include in the patients teaching? A) Herbal remedies are consistent with holistic health care. B) Herbal remedies are often cheaper than prescribed medication. C) It is safest to avoid the use of herbal remedies. D) There is a need to inform his physician and pharmacist about the herbal remedies.

D) There is a need to inform his physician and pharmacist about the herbal remedies.