exam final

Origin: Chapter 13- Spirituality, 16 Chapter: 13 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 165, Box 13-1 16. The nurse is preparing a list of patients who will need the annual influenza inoculation. Which older adult will most likely refuse this vaccination?

A) A 71-year-old Christian Scientist B) A 68-year-old man who attends a Unitarian church C) A 68-year-old female patient who identifies herself on admission as a Jehovah's Witness D) A 78-year-old who says that she is a member of the Church of Jesus Christ of Latter Day Saints Ans: A Feedback: Christian Science is a religion based on the use of faith for healing. Christian Scientists may decline drugs, psychotherapy, hypnotism, vaccination, and some other treatments. The other religions and beliefs do not specify that vaccinations are to be avoided.

Origin: Chapter 3- Diversity, 7 Chapter: 3 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 7. A nurse is being orientated to his new position in a community adjacent to a large Indian reservation. Which of the nurse's following statements indicates a sound understanding of the Native American population with whom he will work? A) "I suppose that we will see a disproportionately high number of clients with lung and oral cancers." B) "The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area." C) "It's unfortunate that many of the older Native Americans are unlikely to have family members involved their care." D) "The unique skin pigmentation of Native Americans means that I'll have to modify my assessment techniques."

A) "I suppose that we will see a disproportionately high number of clients with lung and oral cancers." B) "The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area." C) "It's unfortunate that many of the older Native Americans are unlikely to have family members involved their care." D) "The unique skin pigmentation of Native Americans means that I'll have to modify my assessment techniques." Ans: B Feedback: Diabetes, hypertension, and CVA are all higher than average in Native American adults. Lung and oral cancers are not noted to have a higher prevalence and family is likely to be involved in the care of these elders. The skin tone of Native Americans is not noted to require particular assessment techniques.

Origin: Chapter 13- Spirituality, 6 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 163, Assessment Guide 13-1 6. An older patient just learning of having a terminal illness begins to cry. Which statement or question should the nurse make to facilitate the patient's spiritual health?

A) "Remember that everything in life, even the bad things, happens for a reason." B) "Is there anything in your spiritual beliefs or practices that might bring you comfort at this time?" C) "It's not appropriate for me to pray with you, but would you like me to arrange a visit from the chaplain?" D) "It's likely best for you to try to focus on what is going right in your life, even though that's likely hard right now." Ans: B Feedback: Asking the patient how spiritual needs can be supported is a recognized component of spiritual assessment and acknowledges the patient's spiritual needs while still letting the patient direct the process. Making off-hand statements such as things happening for a reason and encouraging the patient to focus on the good things in life would be inappropriate at this time. It is not inappropriate for a nurse to pray with a patient when circumstances allow.

Origin: Chapter 13- Spirituality, 10 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 162, Forgiveness 10. An older male patient admits to doing many things in life that he is not proud of and is having a difficult time getting them out of his mind. How should the nurse respond to the patient's statement?

A) "Remember that no one has lived a perfect life." B) "Is there anyone that you might want to ask forgiveness from?" C) "Is there anything I can do to help you focus on more positive things?" D) "Do you think that you were really any worse than most other people?" Ans: B Feedback: Seeking forgiveness can be a powerful tool in attaining spiritual health. Urging comparison to others is inappropriate and attempting to change the patient's focus to more positive subjects is not an appropriate intervention.

Origin: Chapter 3- Diversity, 8 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 8. Which of the following statements by a nurse who provides care in an assisted living facility best conveys cultural sensitivity? A) "We need to ensure that both minorities and Americans have their health needs met." B) "It's important to remember that minority groups do not usually express their pain explicitly." C) "We need to build our knowledge of residents who belong to cultural and ethnic groups that we're not familiar with." D) "We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment."

A) "We need to ensure that both minorities and Americans have their health needs met." B) "It's important to remember that minority groups do not usually express their pain explicitly." C) "We need to build our knowledge of residents who belong to cultural and ethnic groups that we're not familiar with." D) "We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment." Ans: C Feedback: Building a knowledge base around cultural groups is a component of culturally sensitive care. Differentiating between "minorities" and "Americans" is an inaccurate dichotomy and it is inaccurate to generalize that all minorities are reticent to express pain. It would be inappropriate to counter an older adult's perception of the cause of illness when it is culturally rooted.

Origin: Chapter 13- Spirituality, 17 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Caring Objective: 3 Page and Header: 165, Box 13-1 17. For patients from which of the religious groups would an opportunity to fast in the weeks before Easter be most important?

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

Origin: Chapter 3- Diversity, 3 Chapter: 3 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 3. A nurse who works in an inner-city clinic provides care for a large number of the older black clients. Which of the following health promotion activities best reflects the particular health needs of this population? A) A blood sugar and blood pressure monitoring program. B) An education session on the positive health effects of good nutrition. C) A screening mammography campaign for older black women. D) A program that teaches black men the importance of prostate health screening.

A) A blood sugar and blood pressure monitoring program. B) An education session on the positive health effects of good nutrition. C) A screening mammography campaign for older black women. D) A program that teaches black men the importance of prostate health screening. Ans: A Feedback: Diabetes and hypertension are disproportionately prevalent among black American elders. While teaching on nutrition and breast cancer and prostate screening may be beneficial, these are not linked to the particular health needs of this population.

8. The occupational therapist on a geriatric rehabilitation unit of a hospital has integrated a life review into a group therapy session. Which of the following statements best captures the nature of life review among older adults? A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff.

A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff. Ans: B Feedback: A life review can bring to light reflections on older adults' accomplishments but may also reveal profound disappointments and regrets. It should not be seen, however, as a purely negative experience. It is not viewed as a diagnostic tool and does not require special training.

Origin: Chapter 3- Diversity, 9 Chapter: 3 Client Needs: A1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 9. Which of the following contexts would be most appropriate for a screening program for high blood pressure? A) A seniors' group that is based at a Jewish community center in Brooklyn. B) An Indian reservation in rural, Western Oklahoma. C) A predominantly Chinese-American neighborhood in the San Francisco Bay area. D) A minimum security prison serving young, rehabilitating offenders.

A) A seniors' group that is based at a Jewish community center in Brooklyn. B) An Indian reservation in rural, Western Oklahoma. C) A predominantly Chinese-American neighborhood in the San Francisco Bay area. D) A minimum security prison serving young, rehabilitating offenders. Ans: B Feedback: Hypertension is disproportionately high among Native Americans. This is not noted to be the case among Jewish Americans, prisoners, or Americans of Chinese ancestry.

Origin: Chapter 13- Spirituality, 24 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 163, Assessment Guide 13-1; 164, Nursing Diagnosis Highlight: Spiritual Distress 24. The nurse determines that a patient is experiencing spiritual distress. What did the nurse assess in this patient? (Select all that apply.)

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

Origin: Chapter 13- Spirituality, 22 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 164, Honoring Beliefs and Practices 22. A patient is demonstrating signs of spiritual distress but refuses to be visited by clergy or to participate in religious services. What should the nurse do to help the patient?

A) Arrange for a volunteer to read inspirational essays to the patient B) Do not challenge the patient's decision or attempt to change his mind C) Pray that the patient will come to recognize his need for spiritual support D) Talk with the hospital chaplain about looking in on the patient without talking about religion Ans: B Feedback: Although a nurse should assist patients in their spiritual growth, the nurse's first commitment is to respect patients' wishes. A nurse should not challenge a patient's religious beliefs or attempt to change them. The nurse should not have inspirational essays read to the patient or talk with the hospital chaplain. The nurse may or may not want to pray about the patient's needs for spiritual support.

Origin: Chapter 3- Diversity, 15 Chapter: 3 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 15. A government study investigated the incidence of diseases and their probable causes in elderly Native Americans as compared with all elderly Americans. Study results showed that Native American seniors have twice the incidence of which of the following diseases? ) Arthritis B) Cancer C) Heart disease D) Diabetes

A) Arthritis B) Cancer C) Heart disease D) Diabetes Ans: D Feedback: Diabetes, a disease uncommon among American Indians at the start of the 20th century, now affects about one in five older American Indians (compared with one in ten of all elderly Americans).

Origin: Chapter 3- Diversity, 4 Chapter: 3 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 4. Nurse Y works in the emergency department of a large, urban hospital. When assessing the following older black adults who have recently presented to the department, which of the following assessments would the nurse want to modify for this population? A) Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive. B) Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus. C) Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease. D) Assessment of a client's chest pain who has a history of myocardial infarction.

A) Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive. B) Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus. C) Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease. D) Assessment of a client's chest pain who has a history of myocardial infarction. Ans: C Feedback: Assessment of cyanosis can be complicated by the high melanin content of black adults' skin. Musculoskeletal assessment, assessment of sensation, and assessment of chest pain would not necessitate modification.

Origin: Chapter 13- Spirituality, 3 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 162, Meaning and Purpose 3. The nurse is aware of the spiritual dimension in Erikson's conceptualization of the older adult's growth and development. When applying Erikson's theory to the care of older patients, what does the nurse realize as being a spiritual component of Erikson's final development task?

A) Awareness that one is loved by others and has provided unconditional love. B) A confidently held hope that a transcendent and positive afterlife awaits one following death. C) A sense of contribution that one's relationships and endeavors have benefited society and one's family. D) A sense of wholeness rooted in the knowledge that life experiences make sense and have served a purpose. Ans: D Feedback: According to Erikson's description of the final developmental task, healthy psychological aging for the older adult involves achieving a sense of integrity. This integrity, or wholeness, is supported by the belief that life experiences—both good and bad—make sense and have served a purpose. The other choices express needs that older individuals may possess, but these are not components of Erikson's framework.

Origin: Chapter 13- Spirituality, 20 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 165, Box 13-1 20. An older patient tells the nurse that he meditates to seek enlightenment. Because of this, the nurse might inquire if he wishes to have which item eliminated from his daily dietary intake?

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

Origin: Chapter 3- Diversity, 11 Chapter: 3 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 11. According to statistics, Baby J, born to a black American couple, has a life expectancy lower than that of Baby K, born to a white American couple. According to current demographic projections, by the seventh decade of life, Baby J's life expectancy will: A) Begin to equal that of similarly aged white elders B) Exceed that of similarly aged Asian elders C) Drop to less than half that of similarly aged Native American elders D) Rise above that of white elders until age 75 and then drop

A) Begin to equal that of similarly aged white elders B) Exceed that of similarly aged Asian elders C) Drop to less than half that of similarly aged Native American elders D) Rise above that of white elders until age 75 and then drop Ans: A Feedback: After reaching the seventh decade of life, black Americans can hope to enjoy a life expectancy equal to that of their white cohorts.

Origin: Chapter 3- Diversity, 19 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 19. When talking with elderly Native Americans and Asian Americans, it is important for gerontological nurses to recognize that: A) Both cultures are in the process of replacing traditional values with modern medicine B) These clients may be reluctant to express their thoughts and feelings openly C) Ritualistic and spiritual healing methods are preferred over modern medical services D) These clients expect to be treated and cared for by family members exclusively.

A) Both cultures are in the process of replacing traditional values with modern medicine B) These clients may be reluctant to express their thoughts and feelings openly C) Ritualistic and spiritual healing methods are preferred over modern medical services D) These clients expect to be treated and cared for by family members exclusively. Ans: B Feedback: In both cultures, traditional attitudes and values persist, although both are willing to accept mainstream medical services in the United States. Ritualistic and spiritual methods may be employed, but they are not necessarily preferred. Family ties are strong, but home care is not necessarily expected. What these groups share is their reticence to reveal personal information to strangers or to speak openly about their health or family problems.

Origin: Chapter 3- Diversity, 1 Chapter: 3 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 24, Increasing Diversity of the Older Adult Population 1. Which of the following projections of future demographics of older Americans is most accurate? A) By 2020, more than 50% of older Americans will belong to a non-Hispanic white group. B) The percentage of black older adults will decrease slightly due to lower life expectancies. C) The number of Hispanic older adults is projected to grow dramatically. D) Within 40 years, a minority of older Americans will be white related to immigration.

A) By 2020, more than 50% of older Americans will belong to a non-Hispanic white group. B) The percentage of black older adults will decrease slightly due to lower life expectancies. C) The number of Hispanic older adults is projected to grow dramatically. D) Within 40 years, a minority of older Americans will be white related to immigration. Ans: C Feedback: Whereas in 2000, approximately 84% of older Americans were non-Hispanic white, it is projected that this population will decrease to 64% by 2050. During this same period, there will be dramatic growth among Hispanic older adults, who will represent 16% of the older population. Black individuals will grow from 8% to 12% of the older population during this time. By 2020, one-quarter of America's older population will belong to a minority racial or ethnic group.

20. Which of the following statements best captures an aspect of illness in older adults? A) Death from heart disease is increasing in this population. B) Death from cancer is increasing in this population. C) Chronic illnesses are less common than in younger people. D) Several acute illnesses are often present that must be managed simultaneously.

Ans: B Feedback: In the elderly population, the cancer death rate has increased in the past three decades; deaths from heart disease have declined. Several chronic conditions are often present and must be managed simultaneously.

Origin: Chapter 3- Diversity, 5 Chapter: 3 Client Needs: D1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 5. A nurse is assessing an 84-year-old female Chinese American's pain following her left hemiarthroplasty 2 days prior. Which of the following characteristics of Chinese Americans should the nurse be aware of during this assessment? A) Chinese Americans often view pain as a virtue and tend to underreport it. B) Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved. C) Chinese women often overstate their pain in light of health care providers' reluctance to provide analgesia. D) There is often a reluctance to acknowledge pain among older Chinese Americans.

A) Chinese Americans often view pain as a virtue and tend to underreport it. B) Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved. C) Chinese women often overstate their pain in light of health care providers' reluctance to provide analgesia. D) There is often a reluctance to acknowledge pain among older Chinese Americans. Ans: D Feedback: Discomfort is not typically aggressively or openly displayed by Chinese persons. Pain is not noted to be seen as a virtue or in a fatalistic light. Pain is not commonly overstated.

Origin: Chapter 3- Diversity, 22 Chapter: 3 Client Needs: B Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 22. Some health conditions are more prevalent in the black population than in the white population. It is important that nurses pay particular attention to identifying those health conditions. Which of the following health assessments and reasons is the most important in working with black patients? A) Control their lifestyle changes because of a lower life expectancy B) Monitor their blood pressure because of a blunted nocturnal response C) Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems D) Monitor for HIV/AIDS as this is a leading cause of death among African Americans

A) Control their lifestyle changes because of a lower life expectancy B) Monitor their blood pressure because of a blunted nocturnal response C) Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems D) Monitor for HIV/AIDS as this is a leading cause of death among African Americans Ans: B Feedback: Hypertension is the most prevalent health problem among black Americans, and a blunted nocturnal response is one factor responsible for this problem. The serious consequences of high blood pressure would supersede the alterations in skin assessment, and highlighting test results and controlling lifestyle changes would be inappropriate actions.

Origin: Chapter 13- Spirituality, 13 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 168, Praying with and for 13. A patient with cancer asks the nurse to pray with him but the nurse does not feel comfortable with prayer. What should the nurse do?

A) Decline politely and ask a coworker to pray with the patient B) Arrange transportation so that the patient can attend prayer meetings at his church C) Pray with the patient after making sure he understands that the nurse would prefer not to D) Pray with the patient realizing that the patient's needs are more important than the nurse's beliefs Ans: A Feedback: People of faith have long understood the value of prayer, and now growing research evidence supports the positive relationship between prayer and health and healing. One need not be an ordained clergy to hold a patient's hand and offer a prayer. Nurses who are not comfortable offering prayers themselves can ask coworkers to pray with and for their patients who so desire.

Origin: Chapter 3- Diversity, 21 Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 21. Which of the following is the most direct way for nurses to accommodate ethnic diversity among their clients? A) Explain how scientific research evidence supports medical treatment B) Provide standardized diets that meet patients' nutritional needs C) Listen to the life stories of elderly patients D) Take a foreign language class or travel abroad

A) Explain how scientific research evidence supports medical treatment B) Provide standardized diets that meet patients' nutritional needs C) Listen to the life stories of elderly patients D) Take a foreign language class or travel abroad Ans: C Feedback: Although the research base underlying treatments may be important to some patients, relating it does not help the nurse understand or address ethnic diversity among patients. Standardized diets ignore patients' food choice preferences, which are often culturally related. Although travel and language study may broaden a nurse's appreciation for other cultures, the most direct step is to value and respect the life stories that patients share.

Origin: Chapter 13- Spirituality, 9 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 168, Praying with and for 9. An older female patient, experiencing cancer pain and nausea and vomiting from chemotherapy, asks the nurse to pray for her during this difficult time. How should the nurse respond to the patient's request?

A) Facilitate a visit from a chaplain to the client at the bedside. B) First determine whether the client shares a similar religious tradition as the nurse. C) Pray for the client, asking a higher power to intervene and provide peace and relief. D) Explain that praying is beyond the nurse's scope of practice and explore alternative interventions. Ans: C Feedback: Nurses are justified in praying for clients and can simply ask a higher power to intervene. An identical religious tradition is not a prerequisite and praying need not be delegated to a chaplain. Praying is not beyond the nurse's scope of practice.

Origin: Chapter 3- Diversity, 17 Chapter: 3 Client Needs: A1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 17. Mrs C brings her elderly Chinese grandmother to the health clinic. When Grandmother C finds out that all the clinic physicians on duty are males, she appears embarrassed and becomes quiet and withdrawn. All the office staff were schooled in traditional Western medicine. Of the following suggestions, which best describes what the staff can do to put Grandmother C more at ease about receiving health care? A) Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C's medical problem B) Show Grandmother C a picture of the human body and have her point to the area of her problem C) Observe Grandmother C more closely and ask specific questions D) Tell Grandmother C that being seen for treatment by a physician of either gender will put her yin and yang back in balance

A) Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C's medical problem B) Show Grandmother C a picture of the human body and have her point to the area of her problem C) Observe Grandmother C more closely and ask specific questions D) Tell Grandmother C that being seen for treatment by a physician of either gender will put her yin and yang back in balance Ans: C Feedback: Chinese women may be embarrassed to receive health care from a man. Nurses should observe more closely and ask specific questions to ensure that the quiet nature of the patient is not misinterpreted to imply that no problems exist. It would be disingenuous to tell her that receiving care would right her yin and yang, and close observation and questioning would be preferable to simply asking her to point to the problematic area on a picture.

Origin: Chapter 3- Diversity, 12 Chapter: 3 Client Needs: B Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 12. Although only 12% of elderly black Americans experience institutional care in their lifetimes, compared with 23% of elderly white Americans, they typically possess more health problems than their white counterparts. This difference in health status is most likely due to: A) High incidence of violent crime and sexually transmitted diseases B) Reliance on family for health care advice and rejection of formal service agencies C) Cultural preference for unconventional medical treatments like spiritual and herbal remedies D) Lower standard of living and less access to health care services

A) High incidence of violent crime and sexually transmitted diseases B) Reliance on family for health care advice and rejection of formal service agencies C) Cultural preference for unconventional medical treatments like spiritual and herbal remedies D) Lower standard of living and less access to health care services Ans: D Feedback: Black elders historically possess many health problems that have accumulated over a lifetime due to a poor standard of living and limited access to health care services. Although the other choices may apply to this population, they are not the major reasons for the diminished health status of many black elders.

Origin: Chapter 13- Spirituality, 5 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 162, Gratitude 5. The spouse of a patient with dementia remains upbeat and is appreciative of having good health and a loving family. The nurse realizes that the spouse is demonstrating which component of spirituality?

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

Origin: Chapter 3- Diversity, 20 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 25, Hispanic Americans 20. To receive government money, County Hospital is required to provide demographic statistics on its patient base. In checking off the Ethnic Group boxes on the obligatory forms, office workers must be able to distinguish terminology. Which of the following best defines the term Hispanic? A) Immigrant workers who entered the United States and their descendants B) Puerto Ricans who emigrated from the United States and their descendants C) Any Spanish-speaking people living in the United States D) Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil

A) Immigrant workers who entered the United States and their descendants B) Puerto Ricans who emigrated from the United States and their descendants C) Any Spanish-speaking people living in the United States D) Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil Ans: C Feedback: The term Hispanic encompasses a variety of Spanish-speaking persons in America, including Spaniards, Cubans, Mexicans, and Puerto Ricans. Hispanic people now represent approximately 6% of the older population.

Origin: Chapter 3- Diversity, 13 Chapter: 2 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 13. Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because: A) Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B) Black Americans have a higher incidence of cancer and diabetes than white Americans C) Hypertension and heart disease occur at a higher rate in the black population than in the white population D) Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep

A) Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B) Black Americans have a higher incidence of cancer and diabetes than white Americans C) Hypertension and heart disease occur at a higher rate in the black population than in the white population D) Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep Ans: C Feedback: The black population has a higher prevalence of heart disease than the white population, and hypertension occurs at a higher rate. A contributing factor is a blunted nocturnal response, in which only a minor decline occurs during sleep. Even though it is true that black persons have a higher incidence of cancer and diabetes than white persons, blood pressure screening does not address those disorders. Lifestyle modifications can effectively control many causes of morbidity and mortality among all people.

Origin: Chapter 3- Diversity, 14 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 14. Nurse A works with Native American patients at a reservation health care center. She advises a new staff member to be especially observant of these patients and tolerant of their health care requests because Native American patients: A) May demand special rituals during sickness and at death B) Use services from agencies as a last resort because such assistance conflicts with their belief in the Great Creator C) Link the typical nursing assessment process to evil forces or to punishment D) Show their absence of feeling, caring, or discomfort by appearing calm and controlled

A) May demand special rituals during sickness and at death B) Use services from agencies as a last resort because such assistance conflicts with their belief in the Great Creator C) Link the typical nursing assessment process to evil forces or to punishment D) Show their absence of feeling, caring, or discomfort by appearing calm and controlled Ans: A Feedback: Spiritual rituals, medicine men, herbs, homemade drugs, and mechanical interventions can be used by Native American people to treat illness. Treatment does not necessarily conflict with belief in a Great Creator and the nursing assessment process is not linked to punishment. Feeling and care are not absent among Native Americans.

Origin: Chapter 13- Spirituality, 25 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 3 Page and Header: 163, Assessment Guide 13-1; 167, Box 13-2 25. A patient tells the nurse that she has practiced meditation for years since it has helped her with mental clarity. Which type of meditation should the nurse document that the patient practices?

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

Origin: Chapter 13- Spirituality, 4 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 162, Dignity 4. The nurse is caring for older patients in a long-term care facility. When ensuring for these patients' dignity, which statement reflects the role of dignity as it relates to the spiritual needs of the older adult?

A) Older adults who have lived a life of integrity and service have earned dignity. B) An acknowledgment of spiritual needs is necessary for the presence of dignity. C) Older adults may lack many of the attributes that are valued in society, but they can derive a sense of dignity from spirituality. D) Older adults who have moved successfully through Erikson's stages of development can experience dignity in spite of disability. Ans: C Feedback: Despite declines in such areas as productivity and physical appearance, older adults can maintain a sense of their intrinsic worth, or dignity, by connecting with the Divine. Acknowledgment of spiritual needs is not necessarily a prerequisite for dignity, given that dignity is by definition inherent in all persons, nor is progression through Erikson's stages or a life of service necessarily required.

Origin: Chapter 13- Spirituality, 21 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 163, Addressing Spiritual Needs 21. An older female patient tells the nurse that through periods of trial and tribulation, the Bible has been the source of ongoing strength and support. Which statement supports this patient's beliefs by researched evidence?

A) Patients from low socioeconomic levels tend to be more religious. B) Religious commitment has a positive effect on health care outcomes. C) Patients holding strong religious convictions experience great emotional stress during illness. D) Among the elderly, high levels of religiosity correlate with greater levels of physical disability. Ans: B Feedback: Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is therapeutically beneficial to support patients' spirituality and assist them in fulfilling spiritual needs. The other statements are not supported by researched evidence.

Origin: Chapter 13- Spirituality, 18 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 165, Box 13-1 18. The nurse is caring for an older patient who is nearing death and realizes that no professional clergy needs to be contacted. This patient is most likely a member of which faith?

A) Pentecostal B) Unitarianism C) Seventh-Day Adventists D) Church of Jesus Christ of Latter Day Saints Ans: D Feedback: The Church of Jesus Christ of Latter Day Saints (Mormons) is the only faith of those listed that has no professional clergy.

Origin: Chapter 3- Diversity, 16 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Jewish Americans 16. Rehabilitation Health Facility has a high percentage of Jewish patients recovering from a variety of ailments. Which of the following is important for the facility's staff to know about medical care and the Jewish culture? A) Pork and shellfish but not milk products are recommended as healthful foods in the diet. B) A rabbi must be consulted before any health-related decisions can be made. C) A skullcap and socks must be worn from sundown Friday to sundown Saturday. D) Modern medical care is encouraged but may be opposed during the Sabbath.

A) Pork and shellfish but not milk products are recommended as healthful foods in the diet. B) A rabbi must be consulted before any health-related decisions can be made. C) A skullcap and socks must be worn from sundown Friday to sundown Saturday. D) Modern medical care is encouraged but may be opposed during the Sabbath. Ans: D Feedback: In the Jewish culture, medical care is encouraged but may be opposed during the Sabbath. Exceptions may be made for the seriously ill. The other choices are not true of the Jewish culture.

Origin: Chapter 13- Spirituality, 26 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 163, Assessment Guide 13-1 26. The nurse is planning care to address a patient's spiritual distress. Which interventions would be appropriate to include in this plan of care? (Select all that apply.)

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

Origin: Chapter 13- Spirituality, 23 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 162, Love 23. During an assessment an older male patient states that he has not been happy in life because he does not deserve to be loved. The nurse realizes that this patient believes love has been withheld because of which criteria? (Select all that apply.)

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

Origin: Chapter 13- Spirituality, 19 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 165, Box 13-1 19. An older female patient in the resident care facility insists that her hair be kept covered at all times. Of which branch of the Jewish faith is she most likely a member?

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

Origin: Chapter 13- Spirituality, 27 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 164, Being Available 27. A patient is observed sitting on the side of the bed crying. When approached the patient does not say anything but continues to cry and hold the nurse's hand. What should the nurse do to communicate being present with the patient?

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

Origin: Chapter 13- Spirituality, 1 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 161, Introduction 1. An older female patient tells the nurse that even though she believes in a higher power she is not interested in information on the hospital's chaplaincy services since she has never been religious. What does the nurse recognize as the relationship between religion and spirituality?

A) Some people are religious, while others are spiritual. B) Religion is a particular, structured way of expressing spirituality. C) Religion is the essence of our being that connects us with the Divine. D) All human beings have an innate desire for religious structure and spiritual fulfillment. Ans: B Feedback: Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion. Not everyone identifies a need for religion, and religion and spirituality are not mutually exclusive. Spirituality, not religion, is defined as the essence of our being that connects us with the divine.

Origin: Chapter 13- Spirituality, 15 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 167, Providing Opportunities for Solitude 15. Which statement should the nurse use to plan interventions to address the behavior of an older patient sitting quietly alone in a room?

A) Spending a lot of time alone is a sign that an elder is lonely or grieving. B) Uninterrupted periods of solitude and inactivity are therapeutic for the elderly. C) Solitude should be discouraged among elders because it leads to social isolation. D) Occupational therapy should be arranged for an elder often observed doing nothing. Ans: B Feedback: Periods of solitude are therapeutic to the elderly. Unresolved feelings from earlier years may be contemplated and resolved, resulting in personal satisfaction. In reminiscing, evaluating, and understanding the dynamics of life's earlier events and achievements, older persons can find a satisfaction with the quality of their lives that helps compensate for their multiple losses. Spending time alone is not a sign that the patient is lonely or grieving. Solitude does not lead to social isolation. Activities should not be planned for an older patient who is doing nothing.

Origin: Chapter 13- Spirituality, 14 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 162, Spiritual Needs 14. During an interview process as a staff nurse for a geriatric patient care area, the nurse is asked about her philosophy of spirituality. Why is this important when caring for older patients?

A) Spirituality becomes more unconditional as people age B) Spirituality often becomes more important to people as they age C) An individual's spirituality remains stable from youth through old age D) As people age, their spirituality becomes more quantitative than qualitative Ans: B Feedback: All humans have spiritual needs, regardless of whether they realize or acknowledge them. Some of these needs become particularly relevant in late life when the high prevalence of chronic illness and reality of death are evident. Spirituality does not become more unconditional as people age. Spirituality may change throughout the life. There is no evidence to support that spirituality becomes more quantitative than qualitative as people age.

Origin: Chapter 13- Spirituality, 12 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 163, Addressing Spiritual Needs 12. At the conclusion of a health history the nurse conducts a spiritual assessment with the patient. Why is this assessment important?

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

Origin: Chapter 3- Diversity, 23 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 23. An elderly Chinese patient tells the nurse that blockage of qi in one of her meridians is causing her severe headaches. Her doctor has diagnosed migraines and has prescribed a triptan drug. The nurse's best course of action is to: A) Suggest that the prescribed medicine may stimulate the flow of qi B) Explain the vasoconstrictive and serotonin-moderating action of triptan C) Recommend acupuncture or acupressure treatments as an adjunct to the triptan D) Caution her that her headaches will grow worse if she fails to take her medication

A) Suggest that the prescribed medicine may stimulate the flow of qi B) Explain the vasoconstrictive and serotonin-moderating action of triptan C) Recommend acupuncture or acupressure treatments as an adjunct to the triptan D) Caution her that her headaches will grow worse if she fails to take her medication Ans: A Feedback: Although explaining the scientific principles underlying drug action is often appropriate, the same objective can be achieved through the use of culturally relevant terms and concepts. Recommending additional treatments is unnecessary and may be inappropriate. Threats or predictions of dire consequences may impede the communication process.

Origin: Chapter 3- Diversity, 6 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Jewish Americans 6. Which of the following interventions in the care that preceded the death of a female, Jewish older American was most likely to have warranted special consideration? A) The client required transfusions of packed red blood cells during her care. B) Assessment by a male physician was required. C) An autopsy was ordered due to the client's unique disease etiology. D) A do-not-resuscitate (DNR) order was recommended by the care team when the client's disease progressed.

A) The client required transfusions of packed red blood cells during her care. B) Assessment by a male physician was required. C) An autopsy was ordered due to the client's unique disease etiology. D) A do-not-resuscitate (DNR) order was recommended by the care team when the client's disease progressed. Ans: C Feedback: Autopsy is often opposed in the context of Jewish religious and cultural beliefs. Blood transfusions, assessment by a physician of the opposite sex, and DNR orders are not noted to be particular issues in the context of this culture.

Origin: Chapter 3- Diversity, 2 Chapter: 3 Client Needs: C Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 25, Hispanic Americans 2. A nurse is providing care for an 81-year-old Hispanic woman in the context of a geriatric medicine unit of a hospital. Which of the following phenomena should the nurse anticipate? A) The client's family is likely to advocate for her placement in a nursing home at an early stage. B) The client is likely to prioritize the role of spirituality in the healing process. C) She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness. D) The woman's family will most likely delegate responsibility for her care to the hospital care team.

A) The client's family is likely to advocate for her placement in a nursing home at an early stage. B) The client is likely to prioritize the role of spirituality in the healing process. C) She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness. D) The woman's family will most likely delegate responsibility for her care to the hospital care team. Ans: B Feedback: Hispanic elders often emphasize the role of spirituality in both the etiology and treatment of disease. Nursing home admissions are proportionately low and while health and illness are often seen as the actions of God, this does not translate into a rejection of treatment. The family is likely to play a central role in care planning and recovery.

Origin: Chapter 13- Spirituality, 7 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 163, Assessing Spiritual Needs 7. What should the nurse use to help guide interventions to meet the spiritual needs of a patient?

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

Origin: Chapter 13- Spirituality, 11 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 161, Introduction. 11. Two nurses are discussing the relationship between spirituality and religion. Which statement explains this relationship?

A) They are the same. Both connect individuals to the Divine and to other living things. B) They are directly related. The more spiritual the individual, the greater his or her commitment to religion. C) They interact inversely. Heavy involvement in organized religion diminishes spirituality and vice versa. D) They are different. Spirituality is a sense of connection to the Divine; religion is a structure of beliefs, rituals, and rules. Ans: D Feedback: Spirituality is the essence of our being that transcends and connects us to the Divine and other living organisms. It involves relationships and feelings. Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion.

Origin: Chapter 3- Diversity, 10 Chapter: 3 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 10. Nursing students attending City College of Nursing are scheduled for clinical experience at facilities in various sections of the city. Their experience will expose them to a wide variety of populations. Which of the following is a major reason why nurses need to understand the general characteristics of various ethnic groups? A) To ensure that clients get the respect customary in their own ethnic group B) To provide individualized and culturally sensitive care C) To ensure that medical treatments comply with cultural expectations D) To increase compliance among minority patients

A) To ensure that clients get the respect customary in their own ethnic group B) To provide individualized and culturally sensitive care C) To ensure that medical treatments comply with cultural expectations D) To increase compliance among minority patients Ans: B Feedback: To understand the uniqueness of each older adult encountered, consideration must be given to the influences of ethnic origin.

Origin: Chapter 13- Spirituality, 8 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 167, Promoting Hope 8. An older male patient with end-stage renal disease is sad and believes that he will die within a few days. Which interventions should the nurse use to promote hope in the patient? (Select all that apply.)

A) Using humor at the bedside B) Facilitating a life review for the client C) Helping the client to find pleasure during current life activities D) Encouraging the client to focus on a time of life that was more pleasant E) Introducing the client to an individual who has a much poorer prognosis and/or health status Ans: A, B, C Feedback: The tactful use of humor, facilitation of life review, and aiding clients in finding pleasure in activities are noted to instill hope. Encouraging comparison to someone with a worse situation and encouraging focus on a different time of life are not noted to foster the development of hope.

Origin: Chapter 3- Diversity, 18 Chapter: 3 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 18. A statistical analysis of City Health Clinic's patient base shows that few of its patients are elderly Asian Americans. Nurse K, a second-generation Asian American, offers a probable cause for this phenomenon. She knows that Asian American groups, though different from each other: A) Value a strong family network and expect that family members will care for their elders at home B) Subscribe to traditional health practices and reject modern technology C) Do not express their feelings openly or challenge the health professional D) Have preserved many of their homeland traditions and tend to live in isolated pockets

A) Value a strong family network and expect that family members will care for their elders at home B) Subscribe to traditional health practices and reject modern technology C) Do not express their feelings openly or challenge the health professional D) Have preserved many of their homeland traditions and tend to live in isolated pockets Ans: A Feedback: Although differences among various Asian American groups exist, two similarities are strong family networks and the expectation that family members will care for their elders at home. They do not necessarily reject modern technology and neither reluctance to express feelings nor the tendency to preserve traditions would account for the phenomenon noted.

Origin: Chapter 13- Spirituality, 2 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 162, Spiritual Needs 2. The nurse manager of a geriatric medicine unit learns that spiritual care services are underutilized by patients and their families. Which phenomenon explains this finding?

A) While spiritual needs are a universal part of the human condition, many people do not acknowledge these needs. B) The high-stress environment of a hospital is incompatible with the solace and quiet necessary for addressing spiritual needs. C) Spiritual needs are less apparent during times of immediate and tangible need, such as acute illness requiring hospital treatment. D) Many older adults who have experienced a lifetime of self-sufficiency and practical resourcefulness do not have spiritual needs. Ans: A Feedback: All humans have spiritual needs regardless of whether they realize or acknowledge them. Some of these needs become relevant in late life when the high prevalence of chronic illness and the reality of death are evident. While a hospital does provide a high-stress environment, this is not mutually exclusive with identifying and providing for patients' spiritual needs.

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

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

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

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

16. The children of an elderly resident at a nursing home are concerned that their parent is alone and lonely. A staff nurse can assure the family that the elderly should be allowed periods of solitude because such times: A) Are essential for reflecting, analyzing, and better understanding the dynamics of life B) Decrease loneliness, insecurity, and self-imposed isolation C) Help the elderly face the misfortunes of growing old D) Affect displays of anxiety, depression, and anorexia

Ans: A Feedback: Being alone and being lonely are not the same thing. Periods of isolation are essential at all ages for the reason listed in choice A.

12. Twentieth-century laws regarding health care for the elderly trace their roots back to: A) England's 17th-century Poor Laws B) Child labor laws of the 19th century C) The Biblical commandment "Honor your father and your mother" D) The tradition of respect for the elderly passed down from ancient Roman law

Ans: A Feedback: Laws enacted in 20th-century America provided some measure of financial security and some level of health care for all persons aged 65 years and older, just as did the Poor Laws of 17th-century England that acted as a "safety net" for the elderly and the destitute. The child labor laws protected the young but offered no help to the elderly who were left at the mercy of their families. The Biblical commandment to "honor" provides a moral guideline but no practical benefit in terms of financial or health support. Ancient Romans deplored the elderly, and no tradition of respect for the aged was incorporated into the Roman legal code.

21. What are the most important competing forces that influence health policy for the elderly? A) Cost containment versus quality of care B) Acute care versus the burden of chronic disease C) Private insurance payments versus Medicare support D) Long-term care at home versus nursing home services

Ans: A Feedback: Policy discussions most often pit cost containment (reducing expenditures) against quality of care (which may mean increasing expenditures). Seniors require relatively less acute care than younger patients do; their health problems are more often chronic. Because all persons over age 65 are entitled to health coverage through Medicare, insurance considerations are fewer than with younger patients. And whereas one in four seniors requires nursing home care at some time, nursing home residency is not typically long term.

18. Gerontology instructors at City College of Nursing impress upon their students that gerontological nurses should be concerned with the welfare of both the current aged population and future ones. The best way nurses can help young and middle-aged adults prepare for their retirement is to promote: A) Meaningful leisure time activities B) Freedom from family responsibilities C) Achievement in a worthwhile occupation D) Maximal use of community health resources

Ans: A Feedback: Retirement is facilitated by learning how to use, appreciate, and gain satisfaction from leisure time throughout an employed lifetime. Occupational achievement may actually hinder a successful retirement if the work role proves difficult to abandon or replace. Although the use of community health resources and freedom from family responsibilities can contribute to a healthful old age, they are not the major sources of satisfaction to be cultivated earlier in life.

15. A young couple are looking for a new home. They want to move into a neighborhood that has no elderly neighbors. Such ageism carries several consequences. By separating themselves from the elderly, the couple: A) Are less likely to see the similarities between themselves and older adults B) Will lose their insights into aging C) Will not experience the challenges of old age D) May have an easier time minimizing their socioeconomic challenges

Ans: A Feedback: Separation from the elderly means people are less likely to see the similarities between themselves and older adults. This separation leads to lack of understanding of the elderly and reduces the opportunities for the young to gain realistic insights into aging.

3. A nurse who practices in a long-term care facility is providing care for a 101-year-old black female. The nurse's coworker states, "It's gratifying that black people in this country are finally reaching the same levels of health that white people are enjoying." How can the nurse best respond? A) "Actually, the difference in life expectancy between black people and white people is growing, not shrinking." B) "We've not yet arrived at a place where the life expectancies are equal between black and white people, but the gap is decreasing gradually." C) "Black women do tend to live longer than white women, but the overall life expectancies when men are included are not yet equal." D) "You're right. Since the 1980s the life expectancies of black and white Americans have remained nearly the same."

Ans: A Feedback: Since the 1980s, the gap between life expectancies of black Americans and white Americans has been increasing rather than decreasing. Black women do not tend to live longer than white women.

23. In old age, the body's efficiency declines. Which of the following is a typical response to that decline? A) An attempt to push the body to perform physically at the same level as in the past B) A neglect of personal appearance and other hygiene practices C) A failure to restrict lifestyle choices in a health-appropriate way D) An expressed desire to enter a nursing home to receive daily care and assistance

Ans: A Feedback: Some seniors deny age-related changes and push themselves physically. Others invest in expensive beauty treatments that promise to subvert the aging process. Others go to the opposite extreme and overestimate their deficiencies, adopting an unnecessarily restrictive lifestyle. An expressed desire for greater dependency is rare.

4. Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life? A) Women tend to both live longer than men and marry men older than themselves. B) Men tend to have greater access to care facilities due to higher incomes and savings. C) Men are more likely to live with younger family members following the death of a spouse. D) Social pressures tend to stigmatize older men who live alone.

Ans: A Feedback: The facts that women live longer than men and often marry men older than themselves account for their higher rates of living alone in old age. Men are not noted to have greater access to care facilities, to be more likely to live with younger family members or to face stigma for living alone.

13. A new patient is not satisfied with the conditions of the nursing home, takes a highly active role in her health care, and, because of her ability to access information, has as much knowledge as her health care providers on some health issues. This new patient is most likely: A) A young-old female baby boomer who just turned age 65 B) An old woman 75 to 85 years of age C) An old-old woman over age 85 D) An elite old woman older than 100 years

Ans: A Feedback: The patient has the predicted characteristics of a baby boomer entering the senior years.

7. Which of the following nursing interventions by practitioner in a long-term care facility are appropriate? Select all that apply. A) The nurse times laxative administration as to not interfere with social interaction. B) The nurse provides diuretics after, not before, recreation sessions. C) The client's need for and dosage of nighttime sedation is weighed in light of activities planned for the following morning. D) Analgesia is provided prior to physical activity but held before social activities.

Ans: A, B, C Feedback: A failure to provide adequate pain control is likely to interfere with older adults' social activity. The nursing actions in answers A, B, and C are all prudent in light of promoting social interaction.

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

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

23. Which of the following patient histories is most likely for a person older than 65 years of age? A) In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B) Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C) Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D) Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks

Ans: B Feedback: Arthritis and heart conditions are among the most common chronic conditions of the elderly. Daily medications to reduce arthritis pain and decrease blood pressure are common. The other histories are more likely for younger patients.

24. Hospital management is reviewing departmental statistics. Which of the following departments most likely has the highest death rate of patients over age 65, and why? A) Oncology, because the elderly have been exposed to more carcinogens in their long lifetimes B) Cardiology, because, despite a decline in recent years, heart disease remains the number one cause of death among the elderly C) Endocrinology, because the elderly already have compromised immune systems D) Neurology, because stroke and Alzheimer's disease together cause more deaths of the elderly than any other conditions

Ans: B Feedback: Heart disease is the leading cause of death among persons 65 years of age and older.

15. Which of the following factors should a nurse prioritize when planning the care of older adults? A) The high prevalence of mental impairment among the elderly B) The diversity of the older adult population C) The fact that most older people live below the poverty line D) The lack of family support that is the norm among the elderly

Ans: B Feedback: Individuals aged 65 years and older vary widely in their health status, interest, cultural backgrounds, and health care needs. The population is not generally impaired mentally. Also, only 15% live below the poverty level. The majority live in a household with a spouse or other family member.

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

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

18. It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people? A) Own their own homes and have sufficient monthly income B) Get more than half their income from Social Security and live above the poverty level C) Are an increasing percentage of the labor force but are "cash poor" D) Are retiring at earlier ages and so live below the poverty level

Ans: B Feedback: Less than 15% of older people live below the poverty level. Social Security is the main source of income for more than half of all older adults.

17. Most older women become widows. Widows must adjust to the significant loss of loved ones and the new task of living alone. Studies show that most widows: A) Require short-term treatment for depression B) Adjust well, finding new friends, interests, and activities C) Turn to their still-married female friends for advice and support D) Move in with their adult children for a period of time

Ans: B Feedback: Most widows adjust well. The friendships of the past between married couples become less important, and friendships with other widows develop. Most widows successfully live alone, and relatively few require treatment for depression.

5. A primary care nurse has a long-standing relationship with a 63-year-old male client who is poised to retire. Place the following phases of the client's likely transition in the correct chronological order. Use all the options. A) A euphoric period involving testing of fantasies around retirement. B) Near phase, often accompanied by fantasy regarding the retirement role. C) Disenchantment phase D) Establishment of a stable and sustainable retirement role. E) Establishment of realistic and alternative sources of satisfaction during retirement.

Ans: B, A, C, E, D Feedback: The near phase of preretirement and the accompanying fantasy is often followed by a euphoric honeymoon phase. This can be followed by a disenchanting letdown, and a subsequent reorientation that results in eventual stability.

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

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

6. Nurse M is employed in an assisted living facility and is privy to many of the changes that accompany the aging process. An older female resident of the facility has expressed a fear that her decreased mobility will make her increasingly dependent on her daughter. How can the nurse best respond to the resident's concerns? A) "There are treatments and drugs that we can explore which might prevent this from happening." B) "This is a normal part of the aging process and you don't necessarily need to fear it." C) "Many older adults have similar concerns. We can work together to keep you independent as long as possible." D) "I'm sure this is very stressful for you, but it's fortunate that you are not experiencing severe pain or illness."

Ans: C Feedback: Answer C validates the client's concerns and expresses the possibility of addressing the issue without downplaying it or providing unrealistic promises. Answer A provides an unrealistic promise of prevention, while answers B and D downplay the severity and significance of the client's concerns.

11. In ancient times, the relationship between age and the value afforded to individuals was generally: A) Positive: with advanced age came increased value B) Negative: respect declined as age increased C) Variable: respect was different in different cultures D) Cyclic: respect moved back and forth between positive and negative

Ans: C Feedback: Attitudes toward the aging varied among cultures. The ancient Chinese, for example, believed that the elderly deserved honor and respect, whereas the ancient Romans had little respect for the elderly, customarily killing them first in the nations Rome conquered.

2. A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future? A) While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. B) By 2020, it is expected that over one-third of Americans will be over the age of 65. C) Both life expectancy and the percentage of people over 65 in the population will increase in coming decades. D) Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020.

Ans: C Feedback: Both life expectancy and the percentage of individuals over age 65 are expected to increase in coming years. About 17% of the population is expected to be over 65 by 2020.

13. The emergence of today's nuclear family units has changed the roles and functions of family members in many ways. In counseling elders and their families, which of the following beliefs about aging should a nurse be aware as one of these ways? A) Children are expected to provide financial support for their aging parents B) Grandparents are spending more time with their grandchildren than ever before C) Older adults enjoy freedom from responsibility for their adult children's welfare D) Older parents and their children grow apart, seldom developing satisfying adult-to-adult relationships

Ans: C Feedback: Children are no longer expected to provide financially for their aging parents, and grandparenting—although important and satisfying—is a long-distance undertaking in families that live many miles apart. Today's parents do, however, often enjoy satisfying adult-to-adult relationships with their grown children. Today's parents are free from responsibilities for their adult children more than any generation before, and many actively enjoy that freedom in middle age and later life.

19. After an initial period of enthusiasm, Mr J feels disappointed with his retirement. He cannot afford to travel as much as he had dreamed, and arthritis limits his mobility. Mr J's nurse can help him most by assisting him in entering which phase of retirement? A) Stability, in which he accepts his limitations B) Termination, in which he resumes a productive work role C) Reorientation, in which he assesses alternative sources of satisfaction D) Disenchantment, in which his hidden depression can be openly diagnosed and treated

Ans: C Feedback: Mr J has passed through the honeymoon phase of his retirement and has entered the disenchantment phase. In this phase, the retiree feels let down, and depression may or may not be experienced. Mr J's nurse can help him take the next step into the reorientation phase, in which he develops a lifestyle that gives him satisfaction based on realistic choices. The stability phase may follow, although some retirees never achieve it. Termination is the end of retirement brought about by illness, disability, or a return to work.

9. Which of the following teaching points around the use of self-reflection with older adults is most accurate? A) Self-reflection is easier for older adults than for younger adults. B) Self-reflection is less effective for male elders than for females. C) Self-reflection often involves learning a process and is difficult for many people. D) Self-reflection is not normally possible with individuals who have cognitive deficits.

Ans: C Feedback: Self-reflection is a valuable tool for many older adults, but it does not occur easily or naturally for many people and is likely to require some teaching and guidance. It is not necessarily easier for older people or for women, and cognitive deficits do not preclude it.

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

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

16. From the late 1980s to the present, the gap in life expectancy between individuals in the Caucasian and African American communities has widened. Which of the following most clearly accounts for this trend? A) Acute illness in the black population has increased B) Infant mortality and complications of childbirth in the white population have declined C) The life expectancy of African Americans has not increased at the same rate as that of the white population D) Deaths from homicide in the white population have increased

Ans: C Feedback: The gap in life expectancy between white individuals and African Americans has widened because the life expectancy of African Americans has not increased at the same pace as that of Caucasians. The U.S. Department of Health and Human Services attributes this decline to an increase in deaths from homicide and AIDS.

6. A care aide employed on a geriatric medicine unit of a hospital expresses frustration that "old people get sick so much more often than young people." What is the nurse's most appropriate response to this statement? A) "In fact, the prevalence of obesity and accompanying chronic illnesses mean that young people actually have more chronic conditions than older adults." B) "It's actually a myth that older adults require more hospitalization than young people." C) "Actually, older adults experience fewer acute illnesses than younger people, it's just that they tend to take longer to recover from them." D) "With the increase in life expectancies in recent years, most older people actually live free of chronic diseases until very late in life."

Ans: C Feedback: The incidence of acute illness is lower among older adults than younger adults, though recovery times tend to be longer. Older adults tend to have a higher incidence of chronic illness and require more frequent and longer hospitalizations.

10. Which of the following statements by the daughter of an 87-year-old resident of a nursing home would the nurse most likely want to correct or clarify? A) "It seems like more and more people are living well into their 80s like my mom." B) "My mom has a house worth loads of money but little cash flow, like many older adults." C) "It seems like heart disease is getting more common even though people live longer than they used to." D) "There are more women living to my mother's age than there are men."

Ans: C Feedback: The incidence of heart disease as a cause of death is on the decline. More Americans are indeed achieving old age and many older adults have valuable assets but little cash flow. Female longevity continues to exceed that of males.

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

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

24. The bodily changes that occur during the aging process can affect an older person's body image and self-concept. The nurse can gain insight into the emotional well-being and self-concept of older persons by: A) Uncovering any unresolved guilt and perceived failures B) Reviewing how they interpret and refine their past experiences C) Examining what roles they accept and what roles they reject D) Determining which work roles they forfeit

Ans: C Feedback: The way persons perceive themselves and function can determine the roles they play. And the roles they accept and reject are important indicators of their self-concepts.

21. Younger individuals know that they will not live forever, but their behaviors may indicate that they deny their mortality. One major indication of this denial is their failure to: A) Establish a financial plan for retirement B) Provide adequately for their family's health care needs C) Make a will and set up a burial plan D) Form strong relationships with family and friends

Ans: C Feedback: Those who deny old age fail to establish retirement plans. People fail to provide for health care needs for many reasons, and acceptance of mortality may or may not influence personal relationships. The major sign of denial of mortality is failure to make a will and make plans for death.

12. Mrs S is recently widowed. She worked at home as a full-time wife and mother throughout her adult life. She is now most likely to experience: A) A desire to obtain employment outside the home B) Relief at being freed from the responsibilities of childrearing C) A sense of loss of her established social roles D) An interest in meeting men her own age and remarrying

Ans: C Feedback: Unlike many of today's younger women, who may value employment and motherhood equally, the elderly women of today centered their lives on their families, from which they derived their sense of fulfillment. Having developed few roles from which to achieve satisfaction other than that of wife and mother, many of these women feel a void when their children are gone and their husbands die.

4. A nurse who works on a palliative care unit has developed a strong partnership with the 77-year-old wife of a client who has recently died of lung cancer. The woman has expressed her fears around being a widow to the nurse. How can the nurse best respond? A) "You will likely find that once you are remarried the grief will subside and you will move on." B) "It's very normal to have these fears, but antidepressant medications can help immeasurably with this difficult transition." C) "Though it might not feel like it now, many women eventually find joy in new friendships and freedom after the death of a spouse." D) "It will be important, and healthy, for you to maintain roles and routines similar to before your spouse died."

Ans: C Feedback: Widows often find positive consequences of their status in time, often in the form of new relationships. Suggesting that the grief will subside after remarriage and encouraging the woman not to change would be inappropriate, as would specific recommendations for medication.

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

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

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

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

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

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

11. Various changes during the aging process demand multiple complex adjustments that require stamina, ability, and flexibility. In which stage of life do individuals experience the greatest number of simultaneous changes? A) Adolescence B) Young adulthood C) Middle age D) Old age

Ans: D Feedback: More simultaneous changes are experienced in old age than during any other period of life.

9. The family of an 85-year-old man who has been admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults? A) The high value of assets owned by older adults makes the financial burden of care minimal for most older adults. B) Payment for long-term care of adults is most often covered by private insurers. C) Most older adults have their basic care needs provided in a long-term facility. D) Overall, federal money pays for more care than do older adults themselves or private insurers.

Ans: D Feedback: Most money for the care of older adults comes from federally funded programs. The burden of payment is still significant for most older adults and a minority of older adults receive care in an institutional living environment.

14. A group of young student nursing assistants is getting clinical experience at a nursing home. In her introductory meeting with this group, the supervising nurse determines that the students harbor some misconceptions about the elderly. Four of the students' comments are listed below. Three of them are misconceptions about the elderly. Which comment is true? A) Most old people are sick or disabled B) Most seniors have a private pension plan C) Senility comes with old age D) Old people are still interested in sex

Ans: D Feedback: Most old people are well, only a small minority are senile, and only a minority have income from a private pension plan. Many retain a healthy interest in sex.

25. A state health investigator surveyed the residents of a retirement housing complex to determine how their financial resources affected their lives and influenced their choices. Which of the following did the investigator most likely find to be true of most of the retired residents? A) Most older people depend on their life savings through their retirement years B) Inflation in the past decades increased retirement benefits for today's seniors C) Nearly three-quarters of all seniors are financially comfortable D) More than half of all seniors retire with only Social Security benefits

Ans: D Feedback: Only a minority of the older population has an income from a private pension plan. Few have significant savings, and inflation has decreased the value of their retirement funds. Of the workers who are currently active in the labor force, more than half will not have pension plans when they retire.

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

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

20. Mr B, age 73, has a terminal illness. He has entered a nursing home, where he will reside until his death. Until age 70, he worked as a successful bank president and was an active community leader. His nurse should be alert for signs that he most resents his: A) Mortality B) Unemployment C) Family D) Dependency

Ans: D Feedback: The elderly often fear that their illness or disability may cause them to lose their independence. Becoming a burden to their families, being unable to meet the demands of daily living, and having to enter a nursing home are some of the fears associated with dependency. Physical pain from an illness may not be as intolerable as the dependency it causes. In Mr B's case, his rapid change from great independence to near total dependence may distress him more than family relationships, the loss of his work role, or his impending death.

1. A nurse who works on a subacute medical unit of a hospital is discussing the increasing population of older adults on the unit with a colleague. Which of the colleague's following statements about older adults is most accurate? A) "Fortunately, Social Security ensures a sufficient level of income for people over 65." B) "It helps that older people don't have to directly incur any costs for their medical care." C) "Most of the older clients on the unit will have come to us from nursing homes." D) "It's reassuring that people are starting to show more concern for older adults than in decades past."

Ans: D Feedback: The formation of the Administration on Aging, enactment of the Older Americans Act, and the introduction of Medicaid and Medicare all occurred in 1965. Since that time, society has demonstrated a growing concern for its older members. Myths about older people include the belief that Social Security ensures them an adequate income, that they do not have to pay for medical care, and that most older adults live in nursing homes.

17. Two related and important trends in the elderly population are: A) The growing gap in life expectancy between males and females and the number of women living alone B) The increase in life expectancy of white and black people. C) The continued burden of acute disease and the low levels of education among the elderly D) The increased burden of chronic illness and the shifting causes of death with advancing age

Ans: D Feedback: The role of chronic illness in death rates is both significant and represents a shift from the past. The gap in life expectancy between men and women is narrowing. The life expectancy of black people has been recently declining. The generation now entering the senior years is better educated than generations past.