G3RO

Which option is an example of elder exploitation? a. A homebound client is left alone for days at a time by the caregiver. b. An older client is smacked if he doesn't eat all of his food. c. A client diagnosed with Alzheimer's disease is bathed only twice a month. d. A homebound client can only get groceries by agreeing to pay for her neighbor's groceries, too.

d. A homebound client can only get groceries by agreeing to pay for her neighbor's groceries, too.

A widowed grandmother is about to assume the role of custodial parent for her 6-year-old grandchild. Which intervention has priority when preparing the grandmother for long-term success in this new role? a. Reviewing the developmental milestones of childhood b. Identifying local sources of child counseling services c. Discussing the common challenges of parenting a 6-year-old d. Teaching stress management and relaxation techniques

d. Teaching stress management and relaxation techniques

When the daughter of a client diagnosed with moderate Alzheimer's disease (AD) asks about the possible benefits of enrolling her mother in art classes, the nurse's response is based on the knowledge that: a. creative activities are not limited to cognitively intact older adults; even individuals with dementia can benefit from creative activities. b. individuals with dementia who have rational language skills can benefit from creative activities. c. cognitively impaired elders cannot benefit from creative activities due to altered brain processes. d. cognitively impaired elders are usually too agitated to participate in creative arts.

A

Which activity assures the nurse that the client's wish to "leave a living legacy" has been accomplished? a. Donating his body to the local teaching hospital for research purposes b. Discussing his experiences as a World War II veteran in Europe to a reporter c. Keeping a journal to be passed on to his great-grandchildren d. Making a pilgrimage to a location with personal religious significance

A

Which description would be most characteristic of a self-actualized individual? a. An economically disadvantaged older black man who regularly checks out books from the local library to read to neighborhood children b. A wealthy white older woman who is constantly searching for a better laxative c. A middle-class white man who was forced into an early retirement and is living in fear of being evicted from his apartment d. The older wife of a famous celebrity who travels the world but starves herself and seeks plastic surgery in her quest to fight the physical signs of aging

A

Which intervention best demonstrates that the nurse understands the spiritual needs of a terminally ill client? a. Arranging care so that the client's prayer time is not interrupted b. Assuming the responsibility of notifying the hospital chaplain of the client's admission c. Providing the client with the schedule of religious services offered in the chapel d. Suggesting that the family attend worship services with the client whenever possible

A

Which statement best demonstrates an older adult's success at achieving self-actualization? a. "My father was an alcoholic, but he did love us." b. "I always feel safe when my son is visiting." c. "My heart problems are better since I had the surgery." d. "I've been elected president of my service organization again."

A

A 77-year-old client recently lost her husband to a chronic progressive neurological disease. She has a history of osteoarthritis and hypertension and was newly diagnosed with metastatic gastric cancer. She sold her home and moved to another state to be closer to her children, but she misses her many close friends. What makes her at risk for spiritual distress? (Select all that apply.) a. Metastatic cancer b. Age (77) c. Moving far away from other family and friends d. Loss of a spouse e. Chronic conditions: hypertension and arthritis

A C D

The nurse managers of the geriatric and pediatric units arrange an intergenerational holiday party. The rationale for arranging such a partnering is based on which principle? (Select all that apply.) a. Intergenerational activities can help all participants establish new relationships. b. Intergenerational activities are required by state and local geriatric regulatory agencies. c. Intergenerational activities provide the units with an opportunity to improve interagency cooperation. d. Intergenerational activities are beneficial for older adults because they can decrease isolation and foster a sense of meaning and purpose. e. Intergenerational activities provide youngsters with an opportunity to interact with older adults.

A D E

When an older adult is considering long term care insurance, what is important for the nurse to encourage the client to consider? A. the older one is when applying, the lower the rates will be B. it is financially better to avoid purchasing LTCI through a group policy C. it is wise to scrutinize all exclusions before enrolling D. all policies cover care at home as well as in a long term care facility

C. it is wise to scrutinize all exclusions before enrolling

2. An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the: a. slower ability of the pupil to adjust to changes in lighting. b. impact arcus senilis has on visual acuity c. flattening and thinning of the cornea. d. retinal changes that begin to occur with aging.

ANS: A A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting. The changes in the retina do not account for the need for increased light that this patient is reporting.

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

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

3. A nurse in a long-term care facility notes that an older resident with Alzheimer's disease awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems? a. Taking the resident outside in the garden for 45 minutes daily b. Limiting fluid intake for the resident c. Educating the resident on the association between Alzheimer's Disease and insomnia d. Administering a mild sedative hypnotic at bedtime

ANS: A Behavioral strategies for persons with dementia include daily walks and exposure to light to enhance sleep. Limiting fluid intake may or may not be effective depending on whether or not the resident has nocturia. Educating the resident about the association between AD and insomnia may be feasible depending on the resident's mental status but will not necessarily ameliorate the problem. Sedative hypnotics are not the first-line treatment for older adults with AD and sleep disturbances.

4. A homecare nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment that provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses due to a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.

ANS: A Older adults are less likely to seek assistance than younger adults in times of disaster. The remaining options are not generally proven to be true for the majority of older adults.

1. An older client reports to a nurse, "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which of the following? a. Presbycusis b. Otosclerosis c. Tinnitus d. A perforated eardrum

ANS: A Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children's voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present.

4. An older man tells a nurse, "The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight." The nurse formulates a response based on the knowledge that: a. the lens of the eye loses elasticity causing a loss of focus for near objects. b. the cornea of the eye becomes thicker and less curved causing an increase in astigmatism. c. the lens of the eye increases in opacity causing a decrease in light refraction. d. the cornea of the eye forms a gray ring at the edges.

ANS: A Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye. All of the other options are normal age-related changes; however, they are not related to presbyopia.

5. An older resident in a long-term care facility reports to the nurse that she has been noticing changes in her vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with: a. cataracts. b. glaucoma. c. diabetic retinopathy. d. age-related macular degeneration.

ANS: A Signs of cataracts include the appearance of halos around objects as light is diffused, blurring, decreased perception of light and color giving a yellow tint to most objects, and a sensitivity to glare.

3. A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse's response is: a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

The nurse suspects that the spouse of a terminally ill client is experiencing anticipatory grief when he : a. dramatically reduces the time he spends attending to the client. b. refuses to leave the client's bedside regardless of the reason. c. sobs inconsolably whenever he visits. d. spends hours recalling details of their life together.

ANS: A Anticipatory grief is the response to a real or perceived loss such as in anticipation of the death of a loved one. Behaviors that may signal anticipatory grief include a sudden change in attitude toward the thing or person to be lost. The other options are characteristics of normal grieving.

9. An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: "Is there anything that I can do to prevent progression of this disease and blindness?" The nurse includes which of the following into the response? (Select all that apply.) a. Strict control of blood glucose levels is important in slowing disease progression b. Laser photocoagulation treatments can stop progression of the disease c. Control of blood pressure and cholesterol levels are important steps slowing disease progression d. Wearing sunglasses to protect the eyes from ultraviolet light can stop disease progression e. Eating a diet high in beta-carotene can stop disease progression

ANS: A, B, C Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease. Laser treatment can reduce vision loss in 50% of patients. Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression.

8. A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant. The nurse includes which of the following in the teaching plan? (Select all that apply.) a. Avoid lifting heavy objects after the surgery b. Avoid bending from the waist after the surgery c. Take stool softeners as needed d. Maintain strict control of your blood sugar and blood pressure e. Maintain a dry sterile dressing over the eye for 10 days

ANS: A, B, C Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist. Fall prevention is also very important as is complying with eye drop administration. Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction. There usually is not a dressing over the operative site, and not for 10 days.

7. A nurse is providing glaucoma education for a group of older adults in a senior center. The nurse knows that the following groups are most likely to develop glaucoma. (Select all that apply.) a. African Americans b. Mexican Americans c. Individuals with a family history of glaucoma d. Individuals with diabetes e. Asian Americans

ANS: A, B, C, D African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among the other high-risk groups. Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups.

A Navy war vet is seeking advice about getting treatment for a chronic respiratory problem at the local veterans' hospital. The nurse's initial response is to ask: A. "Why aren't you considering the local general hospital for the care that you need?" B."Are you willing to travel to a veterans' hospital that offers respiratory diagnostic services?" C. "Have you ever been treated at a veterans' hospital before?" D. "Is the problem related to something that occurred while you were in the Navy?"

D. "Is the problem related to something that occurred while you were in the Navy?"

9. A nurse is caring for a frail older adult in a long-term care facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (Select all that apply.) a. Make sure that the temperature in the resident's room is at least 65 degrees Fahrenheit. b. Cover residents well when in bed and while bathing. c. Provide a head covering for the resident. d. Maintain resident in bed covered with heavy blankets at all times. e. Provide hot, high-protein meals and bedtime snacks.

ANS: A, B, C, E Interventions to prevent hypothermia in frail elders include maintaining an ambient temperature of no lower than 65 degrees Fahrenheit, providing a head covering whenever possible—in bed, out of bed, and particularly out-of-doors, covering patients well when in bed and when bathing, and providing hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. In addition, it is important to get the patient out of bed and provide as much exercise as possible to generate heat from muscle activity.

10. A nurse is conducting an assessment of an older patient's eyes. The nurse expects to see which of the following normal age-related changes of the external eye? (Select all that apply.) a. The eyelids are less elastic and droopy b. The eyes are very dry c. The eyelids may not close completely d. There is a loss of eyelashes e. The lower lid may be turned outward

ANS: A, B, C, E Normal age-related changes in the external eye include a loss of elasticity causing drooping. Eyes become drier, and the eyelids may not close completely. Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid. Loss of eyelashes is not a normal age-related change.

5. A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.) a. Difficulty placing hearing aid properly in the ear b. Stigma associated with wearing a hearing aid c. Difficulty changing the batteries in the hearing aid d. Ineffectiveness of hearing aids for individuals with age-related hearing loss e. Hearing annoying loud noises

ANS: A, B, C, E Options A, B, C, and E are all factors associated with low use after purchase. Option D is incorrect; most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use.

8. An older patient is diagnosed with RLS. Which of the following nonpharmacologic interventions should the nurse include in the plan of care? (Select all that apply.) a. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities. b. Avoid caffeine, alcohol, and tobacco. c. Avoid hot baths. d. Relaxation techniques may be helpful. e. A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful.

ANS: A, B, D Nonpharmacologic therapy includes stretching the lower extremities, mild to moderate physical activity, hot baths, massage, acupressure, relaxation techniques, and avoidance of caffeine, alcohol, and tobacco. The use of diphenhydramine (Benadryl) as a sleeping medication for older adults is not appropriate. There is also no evidence that it will decrease RLS.

6. An older patient asks a nurse, "It seems like all of my friends and I have difficulty sleeping. Is it common among older people?" The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.) a. total sleep time and sleep efficiency are reduced. b. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed. c. sleep requirements for older adults are less than that of younger adults. d. daytime napping is common. e. sleep tends to be deeper in older adults than in younger adults.

ANS: A, B, D Normal age-related changes in older adults include a reduced total sleep time and sleep efficiency and shorter, less intense, and more evenly distributed REM sleep. Older adults tend to nap during the daytime. Sleep requirements do not decrease as one ages. Sleep tends to be objectively and subjectively lighter in older adults.

7. An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (Select all that apply.) a. Go to bed only when sleepy. b. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities. c. Engage in moderate exercise to induce fatigue. d. Do not watch television or work in bed. e. If unable to sleep, engage in enjoyable activities on the computer.

ANS: A, B, D Some interventions to improve sleep include going to bed only when sleepy, matching the number of hours in bed to the actual hours of sleep, and reserving the bed for sleep and sex only. Engaging in exercise immediately before sleep will not assist the person in falling asleep, and use of the computer is also discouraged as it can disturb sleep.

8. The benefits of telehealth include that it: (Select all that apply.) a. promotes self-management of illness in rural and underserved areas. b. facilitates remote physical assessment and monitoring of chronic conditions. c. decreases costs by replacing the role of the nurse with technology. d. decreases costs by reducing hospital readmissions. e. is reimbursed by all health care insurances.

ANS: A, B, D Telehealth promotes self-management of illness and facilitates remote assessment and monitoring in rural and underserved areas. Evidence has demonstrated that it reduces costs by decreasing hospital readmission. Telehealth does not replace the role of the nurse; the technology augments the ability of the nurse to reach clients in remote areas. Unfortunately, not all health care insurers reimburse for telehealth services.

7. Which precaution would be beneficial in minimizing an older adult's risk of being a victim of fraud? (Select all that apply.) a. Do not allow uninvited salespersons into your home. b. Never provide personal information to telephone sales solicitors. c. Rely on the advice of people who only friends have recommended. d. Contact the local Medicare or Medicaid service office for information when needed. e. Keep your bank account and credit card numbers with you at all times.

ANS: A, B, D The correct options provide sound advice, but relying on friends alone for advice may not be prudent while personal information should be kept in a safe place, not necessarily on your person.

6. What information should be included in an informational program to be presented on burn prevention to a senior citizens group? (Select all that apply.) a. Do not smoke in bed or when sleepy b. Wear well-fitted clothing when cooking or when grilling outdoors c. Establish a meeting place for all family members outside of the home in case of a fire d. Establish a plan for exiting each room of your home in the case of a fire e. Have a fire extinguisher readily available in the kitchen

ANS: A, B, E Measures to prevent burns include not smoking in bed or when sleepy, not wearing loose-fitting clothing (e.g., bathrobes, nightgowns, pajamas) when cooking or around an open heat source, and installing a portable hand fire extinguisher in the kitchen. The remaining options are related to safely evacuating a home in case of a fire.

6. An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.) a. Exposure to loud noises b. Use of a hearing aid c. Cerumen buildup d. Side effects of medications e. Age-related changes in the middle and inner ear

ANS: A, C, D Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications.

Which intervention is an example of countercoping for a client who has recently received a terminal diagnosis of cancer? (Select all that apply.) a. Answering the client's questions regarding the trajectory of his or her illness b. Offering to pray with the client and family c. Scheduling a meeting with the client and family to identify alternative end-of-life plans d. Assessing the client frequently for depression and risk of self-harm e. Being available to just listen to the client talk about dying

ANS: A, C, D, E One of the strategies of countercoping includes clarification and control. The nurse helps cope with loss and dying by helping individuals confront the loss by getting or receiving information, considering alternatives, and finding a way to make the grief manageable. The nurse helps persons resume control by encouraging them to avoid acting on impulse. It is not an acceptable practice to initiate such an intervention as asking the client to pray.

A patient tells a nurse that she has prepared a living will (LW). The nurse understands that a living will: (Select all that apply.) a. is an advanced directive that is used in the situation of a person who is unable to speak for herself or himself. b. is a legally binding document in all states and territories of the United States. c. appoints a proxy to uphold the patient's wishes. d. includes the provision that the patient's next of kin have more authority than the appointed proxy. e. can be revoked by the patient at any time in either writing or verbally.

ANS: A, C, E The Patient Self-Determination Act (PSDA) recognized a Living Will (LW) as an advanced directive that is specifically related to a situation in which a person is facing a terminal illness and unable to speak for herself/himself. It is a morally and, in some jurisdictions, legally binding document in which adults could express their wishes regarding end-of-life decisions for some future time when they were unable to do so for themselves. The exact requirements for a living will and the associated laws around it vary from state to state. The patient appoints a proxy to uphold his or her wishes when he or she is no longer able to do so. As the proxy is selected by the individual, the legal assumption is that a designated person has more authority than the next-of-kin. The patient can revoke an LW verbally or in writing at any time for any reason.

The daughter of a patient who has a chronic illness that has reached the terminal phase talks about the palliative care referral that the primary care provider made for her mother. Which of the following statements indicate that the daughter needs additional education about palliative care? (Select all that apply.) a. "I know that palliative care is only available to people who have 6 months or less to live. That is really hard to cope with." b. "My mom still can be actively treated while receiving palliative care." c. "I understand that the palliative care team is made up of health care professionals of all different disciplines, not just doctors and nurses." d. "The goal of palliative care is to prevent or to minimize suffering" e. "My mom will have to be transferred to a special unit in the hospital in order to receive palliative care."

ANS: A, E While many individuals are not referred to palliative care until they are at the end of life, ideally, the earlier they are referred, the better. There is no time frame for referral regarding the point that they are in their illness. Palliative care is offered simultaneously with life-prolonging or stabilizing care for those living with chronic conditions. Palliative care uses an interprofessional model of care. Palliative care can be offered in any setting across the continuum of care and on any unit; it is a philosophy of care.

6. An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. He also states, "Strangely enough my peripheral vision continues to be pretty good." The nurse suspects that the patient has which of the following? a. Glaucoma b. Age related macular degeneration c. Diabetic retinopathy d. Cataracts

ANS: B Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration. The other three eye diseases do not present with these symptoms.

1. The nurse is preparing educational material concerning fire safety in the home. What research data will be included in the material? a. Most fires occur during the daytime hours. b. Fire mortality is highest in adults older than 80 years of age. c. Most people who die in fires are killed by the flames. d. Most fires occur outside the home.

ANS: B Fire-related mortality is three times higher in individuals over age 80. Most deaths in fires are caused by smoke injuries. Most fires occur within the home, and most fires occur at night.

1. You have four rooms to choose from for your older client to be admitted this afternoon. Which room would you choose? a. A brightly lit, blue room with cozy throw rugs b. An orange-carpeted room with soft lighting and yellow walls c. A brightly lit, blue room with an EZ-Glide wax floor d. A fluorescent-lighted room with green walls and a glossy, tiled floor

ANS: B Light colors such as red, orange, and yellow are more easily seen by aging eyes. Softer lighting will help reduce some of the glare and is also easier seen by aging eyes. Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem. Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare.

5. A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement Community (NORC). The nurse understands that NORCs are: a. purpose-built senior housing communities. b. neighborhoods or buildings where a large segment of the residents are older adults. c. communities where volunteers coordinate access to services for older adults. d. intentional collaborative housing where residents participate in the design and operation of the neighborhood.

ANS: B NORCs are neighborhoods or buildings where a large number of the residents are older adults. They were not purposely built as senior housing. The residents in a NORC aged in place. The village model is where volunteers coordinate access to affordable care for seniors. Cohousing is an intentional collaborative model where residents participate in the design and operation of the neighborhood

3. A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90 degrees Fahrenheit outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to: a. cognitive changes that diminish the individual's awareness of temperature changes. b. age-related neurosensory changes that diminish awareness of temperature changes. c. a delirium-related acute illness that is affecting body heat production. d. age-related motor deficiencies that result in self-neglect.

ANS: B Neurosensory changes related to aging tend to delay or diminish the individual's awareness of temperature changes and may impair behavior or thermoregulatory responses to dangerously high or low temperatures. There is no evidence in this scenario that the client has cognitive changes, an acute illness, or is incapable of self-care, and such assumptions should not be routinely made based on age alone.

2. The nurse is recommending that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on "being stuck at home." Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization thus minimizing the effects of social isolation b. Helps with minimizing the loss as a factor in causing depression c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client

ANS: B Participants attending the driving cessation support groups had an improvement in depression scores, were less angry, and were happier. Support groups designed specifically to deal with loss of driving privileges among individuals with dementia may be important in alleviating depressive symptoms and other negative outcomes associated with cessation of driving. The remaining options represent possible outcomes but they do not have the priority that minimizing depression has for this client.

A woman is terminally ill. Although it has never been discussed in the family or stated outright by her physician, she is growing to believe that she will die because of her illness. Upon which concept will the nurse base therapeutic intervention on? a. Closed awareness b. Suspected awareness c. Mutual pretense d. Open awareness

ANS: B In suspected awareness, the patient suspects that she is dying; however, it is never openly discussed. With closed awareness, the patient does not know that she is dying; it is kept secret. With mutual pretense, there is a "let's pretend" atmosphere, where real feelings are kept hidden. Open awareness acknowledges the reality of the approaching death.

When working with a bereaved individual, the goal of nursing interventions is to: a. assist the individual to go through the stages of grief work in the optimal order. b. assist the individual to attain a healthy adjustment to the loss experience. c. encourage the individual to talk about his or her feelings about the deceased individual. d. offer support and advice about how to successfully achieve grief work.

ANS: B The goal of nursing interventions when working with bereaved individuals is to help them adjust in a healthy manner. There is no optimal order in which to experience grief. Not all individuals are able to talk about their feelings, nor is it helpful for everyone. The role of nursing is to offer support, but not advice.

A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, the nurse should: a. explain the family's concern to the client. b. educate the family that this is normal behavior in this situation. c. contact the physician for an order for enteral feeding. d. contact the dietitian for feeding supplements.

ANS: B The nurse should educate the family that this is a normal part of the dying process and should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying. Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on.

10. The daughter of an older patient says to a nurse, "I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?" The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.) a. Report the person to the division of motor vehicles for license suspension. b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. c. Arrange for alternate transportation for the person. d. Confiscate the keys to the car. e. Ask the patient's physician to write a prescription for the person to stop driving.

ANS: B, C Options B and C are examples of the involved type of action strategies for driving cessation. Options A, D, and E are all examples of the imposed type of action strategies for driving cessation.

A nurse is caring for a patient in Portland, Oregon, who has a terminal illness. The patient tells the nurse that she has made a decision "to end it all," that she has suffered enough and is considering asking her physician to prescribe medications to help her die. The nurse knows that the regulations for physician-assisted suicide include which of the following? (Select all that apply.) a. A nurse or physician must be the one to administer the medications. b. The patient must have a prognosis of 6 months or less to live. c. The patient must be informed of all treatments and alternatives. d. The family of the patient must agree in writing to the patient's decision. e. The patient must have received counseling to ensure that she is fully informed of the risks.

ANS: B, C The physician-assisted suicide laws in the states of Oregon and Washington have the following requirements: The individual must be a competent adult who is free of depression and who has a prognosis of less than 6 months to live. The patient must make two requests, both verbal and in writing, repeated in 15 days, and there must be two witnesses to the request; one must not be an heir, related, or employed by the health care facility caring for the patient. The patient must have been informed of alternatives and have received counseling to ensure that the person is fully informed regarding the risks of such actions. Neither physicians nor nurses are permitted to administer the product used.

5. An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include: (Select all that apply.) a. followed a vegetarian diet for last 28 years. b. male gender. c. a smoking history of 1 pack a day for 45 years. d. 30 pounds over ideal weight. e. history of Crohn's disease.

ANS: B, C, D Rest factors for sleep apnea include being male, a smoking habit, and excess weight. There is no current research to support a connection between a vegetarian diet (possible low protein) or Crohn's disease to the development of sleep apnea.

9. A long term care facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit? (Select all that apply.) a. Ensuring that all residents receive evening care and are in bed by 8:00 PM b. Taking as many residents as possible outside for 30 minutes daily c. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM d. Avoiding waking residents for routine care during the night e. Limiting caffeine and fluids before bedtime

ANS: B, C, D, E Strategies to promote sleep for individuals in long term care and hospitals include allowing the resident to stay out of the bed and the room for as long as possible before bed, and not placing him/her in bed too early. Exposing individuals to sunlight for 30 minutes daily in a comfortable outdoor location is also helpful in promoting sleep. Limiting fluids and caffeine before bedtime is also helpful. Changing institutional routines to avoid waking residents for routine care and providing care when residents wake up are also successful strategies to promote sleep.

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

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

2. An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse? a. Refer the resident for an evaluation for a hearing aid b. Raise her voice when speaking to the resident c. Examine the resident's ears for cerumen impaction d. Teach the resident to read lips

ANS: C When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. Raising one's voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

Which principle regarding grief crisis intervention is the basis for intervention planning? a. The acute phase is the most intense period of the grieving process. b. The intensity of the grief is in proportion to the expected death trajectory. c. Grief work is most effective when addressed during the acute phase of grief. d. Anticipatory grief is an expected barrier to grief work.

ANS: C The acute phase is usually the peak time of stress and anxiety as the life and future of the individual and the family are thrown into disequilibrium. Crisis intervention is most effective here because the individual, family, and caregivers are struggling to come to terms with the knowledge. While the other options are true, they are not as directly related to intervention planning

Which truism will the nurse base spousal grief counseling upon? a. Men are less likely to grieve the loss of a spouse. b. Women carry deeper attachments to their spouses than men do. c. Women are generally more likely to outlive their spouses. d. The male response to grief has been thoroughly studied and documented

ANS: C Three out of four women will be widowed at some point because women tend to live longer than men and frequently marry older men. There is no evidence that men grieve less than women; men and women grieve in different manners. It has not been found to be true that women carry attachments to their spouses that are less deep than men's attachments. Male response to grief has not been studied as thoroughly as that of women; the abundance of literature on this topic deals with women.

3. An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?" The nurse formulates a response based on the knowledge that: a. a cochlear implant is permanent, surgically-implanted hearing aid. b. a cochlear implant speeds up the conduction of sound to the auditory nerve. c. a cochlear implant functions as an artificial auditory nerve. d. a cochlear implant directly stimulates the auditory nerve.

ANS: D A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve.

4. A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse's teaching plan? a. "Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure." b. "With the right hearing aid, you can expect your hearing to be back to normal." c. "Hearing aids are covered by Medicare Part B." d. "Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise."

ANS: D Hearing aids do bring challenges, such as distorted speech and amplified background noise. Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not restore hearing to normal. Medicare does not cover the cost of hearing aids.

1. A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by: a. doing 10 pushups before bed to encourage a "pleasant tiredness." b. seldom eating a bedtime snack. c. engaging in computer games as a pre-bed activity. d. limiting the afternoon nap to just 30 minutes.

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

The nurse sits at the bedside of a comatose, terminally ill older client reading the wishes expressed in the numerous cards the client has received. Which concept of grief work is the nurse addressing with this intervention? a. Everyone needs social interaction. b. The nurse needs to "attend to the patient." c. Hearing is believed to be the last sense to be lost. d. The individual is living until he or she is dead.

ANS: D An individual is living until he or she has died; the nurse works with the older adult and significant others to maintain as high a quality of life as possible before, during, and after the loss or death. While the other options are true they are not directly involved in grief work.

Which behavior is characteristic of grief by a disenfranchised adult child in response to a parent's death following a lengthy, painful illness? a. Crying out loudly while invoking "God's help" to go on with life b. Announcing to family members, "I've already grieved the loss." c. Having difficulty even deciding what to wear to the funeral d. Going on a drinking binge instead of attending the funeral

ANS: D The individual is exhibiting disenfranchised grief since situations have distanced him or her from the family, making grieving openly impossible. Pathological grief begins with a normal grieving process, but obstacles interfere with a normal evolution toward adjustment, causing reactions to be exaggerated. Anticipatory grief is a response to a real or perceived loss before the loss occurs. Acute grief is a crisis; it is a syndrome of physical and psychological symptoms of distress, often accompanied by functional disruption.

7. An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction. c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

ANS: D, E A, B, and C are all associated with conductive hearing loss. Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss.

What is the role of the nurse in assisting older adults with travel interests? a. Suggesting that they travel with a seniors' group b. Addressing arrangements to have medical care, if needed, during their travels c. Providing information regarding pet care services for their beloved dog d. Reassuring the client that their concerns about safety are unfounded

B

When a terminally ill client expresses a need "for something more to help me cope with the pain," the nurse bases the recommendation of meditation on which principle concerning this alternative therapy? a. It is efficient and usually takes less than 5 minutes to implement. b. It has been shown to decrease anxiety and depression. c. It improves cognitive abilities. d. It has been known to eliminate emotional distress.

B

Which statement best demonstrates the primary benefit of intergenerational partnering and the activities that it creates? a. These types of activities can help establish new relationships. b. Intergenerational activities can foster a sense of meaning and purpose. c. Such partnering can increase the self-esteem of the younger people. d. These activities can decrease social isolation in the older people.

B

The cost of nursing home care is significant. The primary payer for nursing home care is: A. medicare B. medicaid and private pay C. long term care insurance D. Medigap insurance

B. medicaid and private pay

The original intent of Social Security was to: A. provide a hospital insurance plan B. minimize the dependency of older members on younger members of society C. provide the blind, older adult, or disabled with adequate financial support D. penalize women financially for numerous zero wage years while raising children.

B. minimize the dependency of older members on younger members of society

An elder is experiencing severe chronic pain resulting from a terminal illness. Which intervention by the nurse would be most appropriate when he verbalizes a desire to find "some sort of meaning to all of this"? a. Introduce a sensory distraction, such as television b. Reassure him that this is normal phase that everyone experiences c. Listen and help him express his feelings about life and death d. Ask the doctor to order a psychiatric consult for possible depression

C

A frail, elderly widow is admitted to the hospital after sustaining a fall. The client lives alone and has no living relatives. After cognitive testing reveals mild cognitive impairment, the interdisciplinary team on the Acute Care for the Elderly Unit recommends long-term care placement and that a durable power of attorney for health care (DPOA-HC) be established. When the client seems confused over what a DPOA-HC's responsibilities are, the nurse responds that: a. "A DPOA-HC is a person you name to make health care decisions for you when you can't make them for yourself." b. "A DPOA-HC is a person you trust to make financial decisions for you and to manage your money." c. "A DPOA-HC is a person appointed by the court to make sure you get good care and to manage your affairs." d. "A DPOA-HC is a person who is appointed by the court to make nursing home placement decisions for your care."

a. "A DPOA-HC is a person you name to make health care decisions for you when you can't make them for yourself."

An older adult is concerned that if her spouse, who recently suffered a stroke, is placed in a nursing home, "they will take everything in order to pay for his care." What response will the nurse make? a. "A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property" b. "You should consider transferring the assets to your son so that your husband will qualify for Medicaid" c. "Have you considered caring for your husband at home since Medicare will cover custodial care at home?" d. "Are you aware that your children have a legal obligation to provide financial support toward the care of disabled parents?"

a. "A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property"

An older woman is preparing to move in with her daughter following the death of her spouse of 55 years. The daughter asks a nurse, "I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?" The nurse responds: (Select all that apply.) a. "Have you chosen an area of the house for your mom to live in?" b. "Have you considered scheduling regular visits for your mom with your sister who lives out of state?" c. "You have every right to be nervous; multigenerational households are usually not successful." d. "Have you investigated what activities are available at the senior center near your home?" e. "Since your mom is so computer literate she can stay in touch with her friends when she moves."

a. "Have you chosen an area of the house for your mom to live in?" b. "Have you considered scheduling regular visits for your mom with your sister who lives out of state?" d. "Have you investigated what activities are available at the senior center near your home?" e. "Since your mom is so computer literate she can stay in touch with her friends when she moves."

Which statements made by a couple who have recently retired support the nurse's evaluation that the transition to retirement has been a successful one? (Select all that apply.) a. "I'm afraid we can't make it that weekend; we'll be visiting the grandchildren." b. "I'm not accustomed to sharing my kitchen with anyone else." c. "One week I was working 50 hours and the next I didn't have to get up until noon." d. "I often wonder if my buddies from the plant miss me." e. "We have found a few painless ways to reduce our monthly expenses."

a. "I'm afraid we can't make it that weekend; we'll be visiting the grandchildren." e. "We have found a few painless ways to reduce our monthly expenses."

Which statement made by a nurse regarding a resident of a long-term care facility requires followup by the nurse manager? a. "If he doesn't take his medication, he'll get no dessert tonight." b. "She can't take a walk outdoors today; it's much too cold and snowy." c. "The grandchildren have colds so they should not visit this week." d. "I don't understand why, but she wants a different doctor to see her."

a. "If he doesn't take his medication, he'll get no dessert tonight."

When a cognitively impaired, wealthy, white client is noted to have burns on her upper back, her son states that the patient burned herself when attempting to shower. Which statement by a member of the team reflects a need for further education on elder abuse? (Select all that apply.) a. "She is wealthy; abuse does not happen in people of financial means." b. "Even if we are not sure, we are legally bound to report our suspicions." c. "We need to consider that most abusers are either adult children or spouses." d. "Her cognitive deficiencies put her at risk for elder abuse." e. "The client is white and race places an important role in who is likely to be abused."

a. "She is wealthy; abuse does not happen in people of financial means." e. "The client is white and race places an important role in who is likely to be abused."

An older patient with dementia is referred for adult day services (ADS). The patient's daughter asks the nurse about the benefits of ADS. The nurse considers which of the following in formulating a response? (Select all that apply.) a. ADS are designed to provide social and some health services for older adults. b. ADS are covered under Medicare Part B. c. ADS offer respite services for caregivers from the responsibilities of caregiving. d. ADS often provide educational programs and support groups for caregivers. e. ADS are all staffed with registered nurses.

a. ADS are designed to provide social and some health services for older adults. c. ADS offer respite services for caregivers from the responsibilities of caregiving. d. ADS often provide educational programs and support groups for caregivers.

Which intervention demonstrates effective care for an individual who has expressed a wish to "retire sometime soon"? (Select all that apply.) a. Asking about when she plans to retire b. Assessing her ability to handle the stresses of retirement c. Engaging her in a conversation about her interests d. Inquiring about the existence of any chronic illnesses e. Scheduling a full physical examination

a. Asking about when she plans to retire b. Assessing her ability to handle the stresses of retirement c. Engaging her in a conversation about her interests d. Inquiring about the existence of any chronic illnesses e. Scheduling a full physical examination

A nurse working in an emergency department is caring for an 89-year-old woman who was brought to the hospital by her daughter for a fracture of the right arm. The woman is wheelchair dependent and lives with her widowed daughter who is the primary caregiver. The daughter states that her mother got up out of the wheelchair unassisted to go to the bathroom and fell. The patient cannot recall the circumstances of the fall. The patient is weeping and cradling her right arm. The patient's history reveals two previous wrist fractures over the course of the past year. The nurse notes several large ecchymotic areas on the right hand and left arm and on the left side of the body and the back. The ecchymoses are in various stages of healing. Upon assessment, the patient is non-weight-bearing (NWB). The nurse suspects physical abuse based on which of the following findings? (Select all that apply.) a. Bruises are in various stages of healing. b. The fracture is inconsistent with the patient's functional ability. c. Caregiver suffering stress from caring for a functionally-dependent individual. d. Patient is crying. e. Patient has a history of previous wrist fractures.

a. Bruises are in various stages of healing. b. The fracture is inconsistent with the patient's functional ability.

Which activity would a couple in the reorientation phase of their retirement engage in? a. Establishing a new budget that will allow them to travel to see the grandchildren b. Reading magazines devoted to making decisions about retirement plans c. Looking for ways to "fill up the days" d. Volunteering at the local animal shelter

a. Establishing a new budget that will allow them to travel to see the grandchildren

An older woman tearfully tells a nurse, "I must buy my neighbor all of his groceries, or he will not drive me to the store or the doctor." This is an example of which type of elder mistreatment? a. Financial exploitation b. Psychological abuse c. Caregiver neglect d. Abandonment

a. Financial exploitation

Which behavior suggests that an older adult who has lost his life partner is successfully managing the exploration stage of the adjustment process? a. He smiles when reminiscing about the trips they took together over the years. b. He explains that he can't make a decision about moving "just yet." c. He agrees to eat some of his "favorite soup" that his daughter has made. d. He is heard saying, "I'll never get over the loss, but my life has a purpose."

a. He smiles when reminiscing about the trips they took together over the years.

A nurse is preparing education for a group of older adults and caregivers at a senior center on elder abuse. The nurse is preparing to discuss seniors who are more likely to be abused or neglected. The nurse includes which of the following? (Select all that apply.) a. Individuals with cognitive impairment b. Individuals who abused the caregiver earlier in life c. Individuals who live in an institutional setting d. Individuals who are married and living with a spouse e. Men living alone or in a household with family members

a. Individuals with cognitive impairment b. Individuals who abused the caregiver earlier in life c. Individuals who live in an institutional setting

1. When educating an older adult about Medicare Part D, which information will be included? (Select all that apply.) a. It is an elective prescription drug plan with associated out-of-pocket premiums. b. All persons with either Medicare Part A or B can voluntarily purchase a Medicare Part D prescription drug plan. c. The plan covers all costs of drugs after a deductible is paid. d. The plan is not available for individuals who are receive both Medicaid and Medicare. e. This prescription drug plan requires client co-payments.

a. It is an elective prescription drug plan with associated out-of-pocket premiums. b. All persons with either Medicare Part A or B can voluntarily purchase a Medicare Part D prescription drug plan. e. This prescription drug plan requires client co-payments.

Which nursing evaluation supports the fact that the goals of long-term client care have been achieved? (Select all that apply.) a. Resident has participated in bath with minimal assistance from the staff. b. Resident has experienced no falls since admission 3 months ago. c. Resident continues to show loss of strength in upper extremities. d. Resident is not required to dress or feed self since assistance is always available. e. Resident demonstrates improved weight bearing on affected leg; discharge to be considered.

a. Resident has participated in bath with minimal assistance from the staff. b. Resident has experienced no falls since admission 3 months ago. e. Resident demonstrates improved weight bearing on affected leg; discharge to be considered.

Differences between subacute care and long term care include which of the following? (Select all that apply.) a. Subacute care is more costly than long term care. b. Patients who receive subacute care have a usual length of stay of 1 month; long term care patients have an indefinite length of stay. c. Medicare covers the costs of both subacute and long term care. d. Subacute patients tend to be younger and more cognitively intact. e. Subacute care is usually delivered in a hospital setting and long term care in a nursing home setting.

a. Subacute care is more costly than long term care. b. Patients who receive subacute care have a usual length of stay of 1 month; long term care patients have an indefinite length of stay. d. Subacute patients tend to be younger and more cognitively intact.

Factors that are influencing the decrease in nursing home beds in the United States include: (Select all that apply.) a. an increase in the use of residential care facilities. b. a shortage of certified nursing assistants (CNAs). c. increased Medicaid reimbursement for community-based care alternatives. d. a shortage of Registered Nurses who are certified in gerontology. e. the high cost of care in a nursing home.

a. an increase in the use of residential care facilities. c. increased Medicaid reimbursement for community-based care alternatives.

A nurse is discharging an older patient after a hospitalization for a hip fracture. The patient is a participant in a Program for All Inclusive Care for the Elderly (PACE). The nurse understands that a PACE program: (Select all that apply.) a. provides services to older people who would otherwise need a nursing home level of care. b. does not provide services to participants who reside in a nursing home. c. is only available to individuals who have both Medicare and Medicaid. d. provides medications, eyeglasses, and transportation to care. e. provides urgent and preventive care.

a. provides services to older people who would otherwise need a nursing home level of care. d. provides medications, eyeglasses, and transportation to care. e. provides urgent and preventive care.

Which question will best assess the ability of the LGBT older couple to successfully adjust to the challenges of aging? a. "How long have you been in this relationship?" b. "Have you experienced prejudice and discrimination in your life?" c. "As a couple are you financially secure?" d. "Do you as a couple share similar religious beliefs?"

b. "Have you experienced prejudice and discrimination in your life?"

An older adult is considering residential care/assisted living (RC/AL). The nurse knows that the older adult needs additional teaching when the older adult states which of the following? a. "I read a recent article that stated that almost half of older adults would move to an assisted living community if they could no longer care for themselves." b. "I am happy that Medicare pays for the cost of living in an RC/AL." c. "I will have to check with my long term care insurance company. I heard that it might pay for RC/AL." d. "RC/AL costs significantly less than nursing home care."

b. "I am happy that Medicare pays for the cost of living in an RC/AL."

A 70-year-old diabetic patient has just received instruction from a nurse on glucose self-monitoring. He tells the nurse: "I hear that those test strips cost a lot. I am not sure that I can afford anything else. The only health insurance I have is Medicare Parts A and B." The best response by the nurse is: a. "I am sorry, but Medicaid is the only insurance that covers the cost of diabetic testing supplies." b. "Medicare Part A will cover the cost of the supplies to manage your diabetes." c. "Medicare Part B will cover the cost of the supplies to manage your diabetes." d. "I am sorry, but Medigap insurance is the only insurance that covers the cost of diabetic testing supplies."

b. "Medicare Part A will cover the cost of the supplies to manage your diabetes."

A 70-year-old person who has Medicare Part A only is discussing the cost of health care with a nurse. The nurse understands that Medicare Part A covers the cost of which of the following? (Select all that apply.) a. Diabetic testing supplies b. Acute hospitalization semiprivate rooms c. Intensive care unit hospitalization d. Skilled rehabilitative nursing care in a health care facility e. Prescription medications

b. Acute hospitalization semiprivate rooms c. Intensive care unit hospitalization d. Skilled rehabilitative nursing care in a health care facility

A nurse suspects elder mistreatment in which of the following patients seen in the emergency department? (Select all that apply.) a. An 85-year-old male with cardiac disease who is taking blood thinners and has multiple bruises on his arms and hands b. An 86-year-old female nursing home resident admitted to the hospital with vaginal bleeding and three large bruises on her inner thigh c. A 77-year-old woman who fell at home and broke her arm after tripping over her cat d. A 73-year-old man with a history of gastric ulcers who is vomiting blood and found to be anemic and has a low BMI e. A 69-year-old man with a history of diabetes who is admitted for diabetic foot ulcers wearing dirty clothing and smells like urine

b. An 86-year-old female nursing home resident admitted to the hospital with vaginal bleeding and three large bruises on her inner thigh e. A 69-year-old man with a history of diabetes who is admitted for diabetic foot ulcers wearing dirty clothing and smells like urine

The nurse is providing care to a client diagnosed with dementia. What option is an example of the appropriate use of implied consent by the nurse? a. Preparing to draw blood from a client's arm after asking, "Can I see your arm?" b. Changing the client's dressing when the client asks, "Will you change this bandage now?" c. Using the client's monthly allowance to buy a watch when he continuously asks for the time d. Arranging for a benign mole to be removed after the client states, "I don't like this here."

b. Changing the client's dressing when the client asks, "Will you change this bandage now?"

An older adult asks a nurse, "I saw an advertisement and went to a free breakfast to hear about Medicare Advantage Plans. They sound really good, but I am not sure. Are there benefits to joining one?" The nurse relies on which of the following information when formulating a response? (Select all that apply.) a. All Medicare advantage plans have prescription drug coverage. b. Medicare advantage plans must cover all services traditionally covered by Medicare Parts A and B. c. There are no deductibles in Medicare Advantage plans. d. Medicare advantage plans may provide a cost savings to the member. e. Members must obtain a referral to see a specialist from an assigned primary care provider.

b. Medicare advantage plans must cover all services traditionally covered by Medicare Parts A and B. d. Medicare advantage plans may provide a cost savings to the member. e. Members must obtain a referral to see a specialist from an assigned primary care provider.

When acting as a fictive kin, in which activity will a paid caregiver engage? a. Being responsible for paying the client's bills b. Organizing the client's birthday celebration c. Accompanying the client to doctor's appointments d. Assuring the client has clean, appropriate clothing available

b. Organizing the client's birthday celebration

Which of the following reactions to the loss of a spouse or long-term partner is a unique example of older adult male bereavement? a. Withdrawing from friends and family b. Remarrying within months of the loss c. Focusing on "doing" rather than "feeling" d. Experiencing moderate to severe depression

b. Remarrying within months of the loss

An older married couple is considering selling their home and moving into a continuing care retirement community (CCRC). The major benefit of a CCRC is: a. they provide affordable living for older adults. b. they have all levels of care in one location, allowing community members to easily transition between levels. c. they are paid for by Medicare. d. they allow the older adult's family to retain ownership of the property after the owner dies.

b. they have all levels of care in one location, allowing community members to easily transition between levels.

Which statement made by the resident of a long-term care facility is evidence that the facility is providing care in accordance with the Bill of Rights for Long-Term Care Residents? a. "It's so nice to have my hometown newspaper available here." b. "Going out to the theater with the other residents is a nice social activity." c. "I was told that if I didn't want to change rooms, I didn't have to." d. "The whole place was decorated so beautifully for the holidays

c. "I was told that if I didn't want to change rooms, I didn't have to."

Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse? a. "I get so frustrated because my father used to be so competent and now cannot even feed himself." b. "Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills." c. "My dad wanders at night and I can't be bothered with him. I mix sleeping pills in his dinner so that he will fall asleep." d. "Mom asks me to do everything for her, but I think it is better if she keeps on doing as much as she is capable of."

c. "My dad wanders at night and I can't be bothered with him. I mix sleeping pills in his dinner so that he will fall asleep."

A nurse suspects that her next-door neighbor, an older woman, is a victim of elder abuse by her daughter. What is the appropriate action for the nurse to do in this situation? a. Because the neighbor is not a patient, the nurse should not get involved. b. Visit the neighbor frequently to confirm the suspicions. c. Complete a confidential report with the adult protective services in the area. d. Ask the neighbor herself if she is being abused.

c. Complete a confidential report with the adult protective services in the area.

Which intervention addresses a right guaranteed a long-term care facility resident? a. Ethnic foods are made available to culturally diverse residents who would like them. b. Each resident has access to a telephone in his or her room. c. Family members are welcome at any time. d. A professional hairdresser is available 3 days a week.

c. Family members are welcome at any time.

Which nursing intervention best addresses the need for social support demonstrated by an older adult couple who will be assuming responsibility for the raising of two grandchildren? a. Facilitating a support group for children being raised by grandparents b. Helping the grandparents express their feeling regarding this unexpected role change c. Offering a monthly parenting class for this cohort of grandparents d. Suggesting couple's therapy to assist in managing any new stress on their marriage

c. Offering a monthly parenting class for this cohort of grandparents