Gero GERONTOLOGICAL NURSING & HEALTHY AGING 5TH EDITION TOUHY

The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a.Have them bake cookies twice a week. b.Conduct interviews for specific interests. c.Arrange dog and cat visits from volunteers. d.Take them to the library for guest speakers.

The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s, were born between 1920 and 1930, and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events including incontinence and hearing and vision problems. TOUHY 4TH ED TESTBANK

After noticing an older mans extremities are cool and the cardiac monitor is showing a heart rate of 120 bpm, the nurse determines that these findings warrant further investigation. Rank the patient parameters the nurse should examine to assess cardiac output in order of importance, beginning with the first assessment the nurse should complete. A. Hypoxemia B. Hypotension C. Irregular rhythm D. Low urine output

ANS: A, C, B, D The nurse assesses the SaO2 because airway and breathing are the two most basic human needs on Maslows Hierarchy of Human Needs. Assessing the SaO2 is also the first step for this individual because hypoxemia can explain the cool extremities and tachycardia with an adequate cardiac output. The nurse then examines the hearts rhythm; with adequate oxygenation, the cool extremities and increased heart rate can be explained by a low cardiac output as a result of dysrhythmia; the heart becomes an ineffective pump when it beats too quickly, too slowly, or in an irregular pattern. Next, the nurse examines the blood pressure; hypotension as a result of low cardiac output and with adequate oxygen and a regular heart rhythm can explain the cool extremities and tachycardia as the body tries to compensate by shunting blood to the vital organs and increasing the heart rate. Finally, the nurse examines the urine output to assess renal perfusion. With adequate oxygenation and a regular heart rhythm, urine output will drop with a low cardiac output because it decreases renal perfusion. The kidneys need a minimum systolic blood pressure of 80 mm Hg to produce urine. TOUHY 4TH ED TESTBANK

1. An older woman has left-sided paralysis from a thrombus formation in the cerebral vasculature. Rank the nursing goals of this womans plan of care in order of importance, starting with the most important goal. (Select all that apply.) A. Instruct her to call for help before moving. B. Maintain her blood pressure below 120/80 mm Hg. C. Reinforce occupational therapy for feeding. D. Use range-of-motion exercises to prevent contractures.

ANS: B, A, D, C Using Maslows Hierarchy of Human Needs, the most important goal for this older woman is to control her blood pressure; hypertension and other factors contributed to the development of the thrombus. Thus to prevent further intimal damage to cerebral and other vessels, the nurse maintains the blood pressure at or below the limit as determined by the health care provider. The second priority goal for the nurse is to maintain safety by instructing the older woman to call for help when moving, which will help prevent accidents and injuries. The next goal in importance is the prevention of contractures; joint flexibility is easier to maintain than it is to restore. In addition, joint flexibility is important for adapting to her physical limitations as she learns to perform activities of daily living. The last goal is using joint flexibility and muscle strength to learn self-feeding. The order of these goals is correct; each goal is dependent on the preceding goal for its success. TOUHY 4TH ED TESTBANK

A nurse is providing care for a variety of older adults on a transitional care unit. Using Maslows Hierarchy of Human Needs as a basis for prioritizing care, rank the following actions, starting with the most important. (Select all that apply.) A. Encourage a family member to take part in a teaching session. B. Administer 2 liters of oxygen via nasal cannula. C. Place a call bell in reach after transferring the older adult to bed. D. Ask clients their preferences before beginning care.

ANS: B, C, A, D Using Maslows Hierarchy of Human Needs, the first and most important action to complete is to administer 2 liters of oxygen via nasal cannula, which meets a basic physiological need. According to Maslow, airway, nutrition, and elimination are first-level needs. The second action to complete is placing a call bell in reach after transferring an older adult to bed. A call bell promotes feelings of safety and security, which is addressed in Maslows second level. The third action would be encouraging a family member to take part in a teaching session. This action promotes maintaining support systems and is categorized as love and belonging, the third level of Maslows Hierarchy of Human Needs. The last action would be to ask a client his or her preferences, which would promote self-control and support self-esteem needs, which is Maslows fourth level. TOUHY 4TH ED TESTBANK

An older adult who has Alzheimer disease exhibits new behaviors including shouting in the hallways and hallucinations. Rank the following nursing interventions in order, beginning with the first intervention the nurse should implement in response to the new behavior. A. Review the medication list for potential causes. B. Plan nursing care to promote a trusting relationship. C. Look for the likely causes for psychotic manifestations. D. Consult with her health care provider about medications.

ANS: C, A, B, D The nurses first task is to identify the likely causes of psychotic behaviors to provide a framework for planning suitable nursing interventions. Second, as a potential cause of the new behaviors, the nurse reviews the medication list and looks for new medications, missed or increased doses, polypharmacy, and medications likely to cause psychotic behavior. Third, after identifying possible pharmacological reasons, the nurse consults with the health care provider to consider adjustments to the pharmacotherapy. Finally, to supplement the removal of offending medications, the nurse promotes a trusting relationship with the older adult by expressing respect and concern. TOUHY 4TH ED TESTBANK

The nurse evaluates the urinalysis (UA) of a female patient with an indwelling urinary catheter. The UA report shows gross contamination of the urine. Rank the nursing interventions in order, beginning with the first intervention the nurse should implement. A. Provide perineal hygiene. B. Provide urinary catheter care. C. Check the duration of catheterization. D. Obtain a urine specimen from a sterile port.

ANS: C, B, A, D Gross contamination of a urine specimen is a costly error because contaminated urine is unsuitable for evaluation. The nurse responds to the report of contamination by determining how long the catheter has been in place; increased duration increases the risk of a UTI from fecal contamination and can affect subsequent nursing interventions. The second intervention is providing catheter care. Regardless of the cause of the specimen contamination, catheter care is a suitable nursing intervention because it decreases the colony count on the catheter. Third, the nurse progresses to perineal care. This intervention follows catheter care because of the principle of asepsis regarding working from the least contaminated to the most contaminated area. Finally, the nurse obtains another urine specimen from a sterile port. Although the catheter has been washed, the nurse rubs the port with alcohol and withdraws urine with a sterile needle and syringe to prevent the introduction of contaminants into the specimen. TOUHY 4TH ED TESTBANK

The exercise tolerance of an older adult is impaired after a MI because of a low ejection fraction. Rank the following interventions that the nurse should use to assist this individual to restore baseline functional status in order of importance, beginning with the first intervention. A. Provide a well-balanced diet. B. Assist with range of motion. C. Sit in chair four times daily. D. Keep arterial oxygen saturation (SaO2) above 95%.

ANS: D, A, B, C The nurse first helps the patient maintain myocardial oxygenation by keeping the patients SaO2 above 95%; if it drops below that level, then the arterial blood lacks sufficient oxygen to meet tissue oxygen demands. Second, the nurse provides a well-balanced diet for tissue building and repair. The patient has little hope of resuming baseline functioning without adequate food for fuel and maintaining muscle bulk. Third, to help maintain muscle bulk and joint flexibility, the nurse helps the patient perform range-of-motion exercises in preparation for more strenuous physical activity. Last, before ambulation, the nurse ensures that the patient is able to sit in the chair four times a day as progress toward restoring baseline functioning. TOUHY 4TH ED TESTBANK

The following nursing interventions represent each of the four steps of a nutritional assessment. Rank them in order, beginning with the first step. A. Measure the midpoint of the upper arm. B. Obtain blood for serum transferrin level. C. Examine the lips, gums, and oral cavity. D. Ask for an up-to-date list of medications.

ANS: D, C, A, B The first step in a nutritional assessment is to interview the older adult to obtain a health and nutritional history, including an up-to-date list of medications and an overview of daily food habits and resources for obtaining food. The second part of the assessment includes a physical examination to gather data about the older adults current state of health. The third part of the assessment includes anthropomorphic measurements such as height, weight, midarm circumference, and triceps skinfold thickness. The biochemical examination is the final step and includes the prealbumin, transferrin, hemoglobin, and cholesterol levels. TOUHY 4TH ED TESTBANK

An older female resident in the residential facility keeps a large collection of personal items and photographs of her late husband on her bedside table, but the nursing assistant and resident frequently argue about this. Why should the nurse intervene between the resident and the nursing assistant? a.Resident is attempting to maintain her sense of personal space. b.Resident needs to accept the reality of her spouses death. c.Residents argumentative nature can indicate early dementia. d.Clutter from all the personal items is a safety and liability risk.

ANS: A A thoughtful nurse respects and supports the residents boundaries. Even if the resident needed to accept the reality of her spouses death, the residents grief process and personal space should be respected. Although the residents argumentative nature can indicate early dementia, the residents behavior can also be understood as a healthy defense of personal space. Although the rationale of the nurse assistant is probably that the clutter from all the personal items is a safety and liability risk, the assistant should realize that this resident is entitled to the personal use of her personal space. identified as a future direction for nursing research. TOUHY 4TH ED TESTBANK

An older woman fell at home while trying to get to the bathroom in time to prevent urinary leakage. Rank the following suitable nursing interventions in order according to the ability of each intervention to prevent patient injury at home in the future. Start with the intervention that is most likely to prevent injury in the home. A. Discharge to home while attending an alcohol prevention program. B. Perform home safety inspection to identify modifiable safety hazards. C. Instruct the older woman on pelvic floor exercises and other incontinence strategies. D. Explore depression, alcohol abuse, and physiological contributors to falls.

ANS: D, C, B, A The nurse begins planning for home injury prevention by assessing the older adult for risk factors for alcohol abuse and for contributors to alcohol abuse or falls. Assessment data help identify areas for intervention; falling and incontinence, especially in women, are risk factors for alcohol abuse. Second, the nurse helps this woman improve incontinence by teaching her strategies to use to improve bladder control. Alcohol abuse increases the risk of incontinence by relaxing the bladders muscle tone and by increasing an older adults instability or mobility impairment; therefore the nurse includes plans to control alcohol intake. Next, before discharge, the womans home is inspected for potential safety hazards to prevent future falls and injury and to remove a safety hazard as a contributor to falls. Finally, an alcohol prevention program can be a suitable intervention for this older adult if alcohol abuse is a contributing factor. Depending on the assessment data, the willingness to avoid alcohol can determine whether she has the capacity to live at home or should be in a residential facility to maintain safety. TOUHY 4TH ED TESTBANK

_____________ _____________ is the result of a lesion in the part of the brain adjacent to the primary auditory cortex (Wernicke area).

ANS: Fluent aphasia Fluent aphasia is also known as sensory, posterior, or Wernicke aphasia. The person speaks easily with many long runs of words, but the content does not make sense. He or she has problems finding the correct word and often substitutes an incorrect word. The speech sounds are similar to what is sometimes referred to as jabberwocky, with unrelated words strung together or syllables repeated. TOUHY 4TH ED TESTBANK

The CIT includes eight phases. List the phases in order, beginning with the first phase. A. Crisis B. Unstable C. Downward D. Dying E. Stable F. Acute G. Trajectory onset H. Pretrajectory

ANS: H, G, A, F, E, B, C, D The phases of the CIT are pretrajectory, trajectory onset, crisis, acute, stable, unstable, downward, and dying. TOUHY 4TH ED TESTBANK

Persons with _____________ _______________ usually understand others but speak very slowly and use a minimal number of words.

ANS: Nonfluent aphasia Patients often struggle to articulate a word and seem to have lost the ability to voluntarily control the movements of speech. Difficulties are experienced in communicating orally and in writing. TOUHY 4TH ED TESTBANK

_______________ __________________ is a motor speech disorder that affects the ability to plan and sequence voluntary muscle movements.

ANS: Verbal apraxia The muscles of speech are not paralyzed; rather, a disruption occurs in the brains transmission of signals to the muscles. When thinking about what to say, the person may be unable to speak at all or may struggle to say any words. In contrast, the person may be able to say many words or sentences correctly when not thinking about the words. Apraxia frequently occurs with aphasia. TOUHY 4TH ED TESTBANK

Which of the following statements is true about case management and care management for older adults? a.A case manager works for a health care system to save time and money. b.Care managers are usually paid from public agencies such as the Area Agency on Aging (AAA). c.One nurse can only perform care management. d.The Outcomes-Based Quality Improvement system is designed to evaluate the expected benefit of a procedure.

ANS: A A case manager works for a health care system to save time and money. Care managers are rarely paid through the AAA or similar agencies; they are usually paid privately and sometimes through Medicare or Medicaid. The nurse can perform case management and care management. The aspects measured in an Outcomes Based Quality Improvement System are known as efficacy, effectiveness, and efficiency. TOUHY 4TH ED TESTBANK

An older adult woman complains of foot pain from a corn. After assessing her feet, which intervention should the nurse implement to alleviate her discomfort safely? a.Cut out an oval corn pad to make a U shape. b.Use a corn pad slightly larger than the corn. c.Gently remove the corn with a sterile razor blade. d.Tape her toe with the corn to the other toes.

ANS: A A corn pad altered this way surrounds the corn without adding pressure over it. If an oval corn pad is used without being cut to a U shape, then it aggravates pressure over the corn and can reduce circulation to the covered tissue. For the surgical removal of a corn, the patient should be referred to the podiatrist. Taping the toes replaces pressure from the shoe with pressure from the tape. TOUHY 4TH ED TESTBANK

An older woman who has COPD wants to perform self-care activities. Which instruction should the nurse include in patient teaching to help her achieve this goal? a.Bathe and eat slowly with periodic rest. b.Walk short distances without oxygen. c.Perform all activities of daily living (ADLs) and then rest. d.Bathe right after eating, and then rest.

ANS: A A person with COPD can perform self-care tasks if allowed plenty of time to accomplish them and to take breaks for rest. The patient can potentially benefit more from longer periods of exercise supplemented with oxygen than from short excursions without oxygen. A plan to rest in the future after the self-care task of performing ADLs or bathing after eating is accomplished does not compensate for the deprivation of rest when she needs it. TOUHY 4TH ED TESTBANK

Persons with normal age-related sensory changes are likely to have the most difficulty distinguishing which of the following? a.Spoken pairs of phrases like shes praised and fees raised b.Orange towel hanging on a beige wall c.Go and to in lowercase letters in fine print d.Spoken word pairs like cupful and capful

ANS: A A person with presbycusis has trouble hearing the higher frequencies, where most of the differences between consonant sounds occur. The contrast between a vivid color such as orange and a pale color such as beige can help an older person distinguish objects. The details of the letters may be poorly focused, but their overall shape, relative to the line around them, helps distinguish them. Age-related hearing impairments affect the hearing of consonants more than vowels. A person would have more trouble distinguishing cupful and couple. TOUHY 4TH ED TESTBANK

Each of the following is a nonpharmacological intervention for pain except which one? a.Acupuncture treatments c.Lidocaine patch b.Adjuvant therapy d.Capsaicin

ANS: A Acupuncture is a nonpharmacological treatment that helps reduce the perception of pain. An adjuvant is a medication that has been developed for a different purpose but serves to alter the perception of pain, possibly in combination with a pain medication. Lidocaine patches are a pharmacological treatment for pain relief. Capsaicin is a pharmacological means of providing comfort and alleviating pain and distress. TOUHY 4TH ED TESTBANK

Acute illness is to chronic illness as to which of the following comparisons? a.An emergency department is to a nursing home b.A hospital staff nurse is to a nurse practitioner c.Health insurance is to Medicare for older adults d.Inpatient surgical care is to outpatient medical care

ANS: A Acute illness can be likened to an emergency department because it treats conditions with sudden onset and sudden exacerbations of existing conditions with short-term treatment options, as compared with a nursing home, which cares for individuals with long-term conditions that warrant admission after a decline in health or to individuals with long-term health care needs. The acute-chronic analogy is a comparison of sudden and short-term versus gradual and long-term. The comparison between a nurse and a nurse practitioner is one of the practice settings and the scope of the practice. Medicare is a type of health insurance; however, chronic illness is not a type of acute illness. Inpatient surgical care can be emergent and elective, and outpatient medical care is usually for ongoing health care but can also be applied to emergent conditions. TOUHY 4TH ED TESTBANK

The nurse is feeding an older adult patient with hemiparesis as a result of a stroke. Which intervention by the nurse is most important when feeding this patient? a.Allow time to empty the mouth between bites. b.Provide foods that require chewing. c.Offer small sips of fluids with each bite. d.Serve pureed foods only.

ANS: A Allowing time to empty the mouth between bites decreases food buildup in the mouth and gives the patient time to swallow without being rushed. Providing foods that require chewing may be unsafe; the patient may have a decreased ability to chew foods. Pureed foods may not be necessary. The patient may only need extra time to manage each bite. TOUHY 4TH ED TESTBANK

An older woman has diabetes mellitus. Which patient assessment validates the nurses conclusion that she is in the foreground perspective of the shifting perspectives model of chronic illness? a.Has an amputation of two toes. b.Lives at home with her husband. c.Frequently self-checks her blood sugar. d.Changes the battery in her glucometer.

ANS: A An older adult thinks and acts about diabetes mellitus in the foreground perspective when signs of disease progression occur, which is evidenced by the need for the amputation of two toes, because hyperglycemia damaged the lining of vessels and led to peripheral artery disease. The perfusion to this womans toes deteriorated to the extent that the tissue died; the dead tissue had to be removed to avoid infection. Living at home indicates she has a functional status that is sufficient to maintain independent living. This woman is able to monitor her blood sugar independently and retains enough functional ability to change a battery. TOUHY 4TH ED TESTBANK

The nurse administers an antibiotic and naproxen to an older woman. Which laboratory test result should the nurse monitor to gauge the older adults response to the medication? a. Urine creatinine b. Indirect bilirubin c. Serum creatinine d. Total hemoglobin

ANS: A Antibiotics and nonsteroidal antiinflammatory agents such as naproxen can cause kidney damage from various mechanisms; thus the nurse monitors the urine creatinine because it reflects the systems ability to clear waste products and is especially important for gauging appropriate medication administration. Unconjugated (indirect) bilirubin reflects the livers ability to conjugate serum bilirubin. Serum creatinine, also a reflection of renal function, usually remains stable throughout life. Older adults may have changes in hemoglobin and erythrocyte synthesis caused by changes in iron and vitamin B12 absorption. TOUHY 4TH ED TESTBANK

A nursing home is converting to a person-centered culture from an institution-centered culture. Which nursing intervention will be suitable in the new culture? a. Maintain consistent resident assignments. b. Provide structured activities for the residents. c. Assign nursing assistants to perform bathing. d. Determine mealtime on the basis of staffing levels.

ANS: A As part of a person-centered culture, nurses should have consistent resident assignments to establish rapport with their residents and become familiar with their unique qualities and preferences. Activities structured by the staff are part of the institution-centered culture. Assigning assistants to perform bathing is part of the institution-centered culture because it focuses on tasks. Schedules are determined for the staffs convenience as part of the institution-centered culture. TOUHY 4TH ED TESTBANK

Which of the following statements is true about caregiving? a.Dementia in an older adult can cause grief in the caregiver, comparable with the grief from the older adults death. b.Middle-aged adults and older parents reverse life-long caregiving roles with increasing age. c.Older adults should relocate to the caregivers home when long distances separate the two. d.Increasing numbers of adult children who are developmentally disabled become caregivers for their older parents.

ANS: A As the dementia progresses, the patient may cease to recognize a spouse or child. The parent still remains the parent, and the idea that the parent somehow becomes a child again is demeaning. The older person may have significant support in the community where he or she lives. Older parents often remain the caregivers for disabled children, which is a serious burden. TOUHY 4TH ED TESTBANK

When an older adult is considering long-term care insurance (LTCI), which is an important consideration? a.Carefully scrutinize all exclusions before enrolling. b.Apply at the oldest age possible for lower rates. c.Avoid purchasing LTCI through a group policy. d.Delay application until the government sponsors LTCI.

ANS: A As with everything else in life, always read the fine print. For example, many plans strictly limit benefits for those with Alzheimer disease. The rates may go up with age at application. The best LTCI packages have been obtained by large organizations with considerable negotiating power. LTCI plans do not receive any government support; therefore the subscriber finances his or her own LTCI. TOUHY 4TH ED TESTBANK

The nurse is educating an older woman on foods high in calcium. Which foods should the nurse include? (Select all that apply.) a.Chinese cabbage c.Cheese pizza b.Soy milk d.Whole wheat

ANS: A, B, C Chinese cabbage, soy milk, and cheese pizza have all been identified as foods that are high in calcium. Whole wheat bread contains calcium; however, it is not a high calciumrich food. TOUHY 4TH ED TESTBANK

Which cultural group is more likely to distrust the health care system than other cultural groups in the United States? a. African Americans b. Chinese Americans c. Mexican Americans d. Lebanese Americans

ANS: A Because of a history that includes slavery, social injustice, and abuse of African-American men in medical research, African Americans are more likely to distrust the health care system in the United States. Chinese are less likely to distrust the health care system of the United States than African Americans because of a lack of a history of major health-related injustices. Mexican Americans are less likely to distrust the health care system of the United States because of the many benefits they receive that are unavailable in Mexico. Lebanese Americans are less likely to distrust the health care system of the United States because of a lack of a history of health-related injustices against their culture in the United States. TOUHY 4TH ED TESTBANK

An older woman had hip replacement surgery 1 day ago, and the nurse thinks that the woman also has dementia. Which patient assessment does the nurse use to determine whether this woman is experiencing pain? a.Holds abdomen tightly. b.Has stable vital signs. c.Is not verbalizing. d.Moves during sleep.

ANS: A Because this older adult has a potential cognitive impairment and is likely to self-report pain unreliably, the nurse uses additional clinical indicators to detect pain. Muscle rigidity and guarding are clinical indicators of pain for a postoperative older adult, regardless of a cognitive impairment. An individual experiencing pain is unlikely to have stable vital signs. Not verbalizing can indicate a sensory impairment and warrants further investigation by the nurse. Nonetheless, this older adults verbalizations are potentially unreliable indicators of pain. Older adults move normally during sleep to adjust their position in bed; moving during sleep is not an indicator of pain unless the movements are agitated or restless in nature. TOUHY 4TH ED TESTBANK

Which condition is a COPD? a.Bronchial asthma b.Histoplasmosis c.Bacterial pneumonia d.Mycobacterium tuberculosis

ANS: A COPD includes asthma, chronic bronchitis, and emphysema. Pneumonia, an acute pulmonary infection, is not a chronic obstructive lung disorder. TOUHY 4TH ED TESTBANK

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

ANS: A Constipation is present when fewer than three bowel movements occur per week or when the frequency decreases. Mineral oil and saline laxatives can be harmful. Fiber, fruit, and fluids are the first recommendations; stimulant laxatives such as senna and cascara can be used on a short-term basis. Altered cognitive status, increased agitation, and unexplained falls can be symptoms of constipation; these behaviors may be the only clinical symptom of constipation in cognitively impaired older persons. Excessive sleep has not been identified as a symptom. Liquid feces may be leaking around a fecal impaction, and antidiarrheal treatment can aggravate the impaction. TOUHY 4TH ED TESTBANK

The nurse is aware that cultural competence means having the skills to put cultural knowledge to use in all of the following except: a.Assessment b.Communication c.Intervention d.Collaboration

ANS: A Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. To provide culturally competent care, the nurse gathers data about the culture, the older adult, and the specific cultures impact on the older adult, organizes the data, and applies the information by planning, implementing, and evaluating nursing care. Planning includes supporting cultural patterns. Assessing includes increasing cultural knowledge. Through increased knowledge, nurses can better assess the strengths and weaknesses of the older adult within the context of their culture and know when and how to effectively intervene to support rather than hinder cultural patterns that enhance wellness and coping. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about fluid intake for older adults? a.Daily total volume should be 1500 ml to 2000 ml. b.Coffee is a suitable beverage for maintaining hydration. c.Caffeinated beverages are sometimes preferable to water. d.Total daily fluid intake should be approximately 10 ml per kg of body weight.

ANS: A Daily total volume of fluid should be 1500 ml to 2000 ml. Caffeine increases urine production and therefore aggravates dehydration rather than relieving it. Total daily fluid intake should be 30 ml per kg of body weight, not 10 ml. TOUHY 4TH ED TESTBANK

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

ANS: A Decreased intestinal motility increases the amount of time a substance remains in contact with the intestinal mucosa of the small intestine, where most absorption takes place. With increased exposure, absorption can be increased and the drug effect enhanced. Many medications taken by older adults can also decrease intestinal motility, thereby complicating the titration of medications or introducing new adverse effects through drug-to-drug interactions. Decreased body water leads to higher serum concentrations of water-soluble drugs, increased body fat increases the longevity of fat-soluble drugs, and decreased serum albumin increases the serum concentration of serum proteinbound drugs. Reduced liver mass and hepatic dysfunction can impair oxidative metabolism, which can lead to an accumulation of toxic levels of a drug. Impaired renal function can impair the excretion of drugs through the kidneys. TOUHY 4TH ED TESTBANK

When differentiating the characteristics of depression, delirium, and dementia, the nurse recognized which of the following as an indicator of delirium? a.Sudden onset b.Recent loss c.Insidious d.Life change

ANS: A Delirium can occur suddenly. Recent loss or life changes can precipitate depression. Dementia can be insidious, slow, and occur over the course of several years. TOUHY 4TH ED TESTBANK

An older man who is a non-Hispanic Caucasian has a fasting blood sugar level above 130 mg/dl. Which patient assessment does the nurse use to confirm a high risk for diabetes mellitus in this man? a.68 years of age b.120/80 mm Hg c.Palpable peripheral pulses d.Total cholesterol 198 mg/dl

ANS: A Diabetes is significantly more prevalent among older Americans. This mans blood pressure is normal. Palpable peripheral pulses are a normal finding. A total cholesterol level below 200 mg/dl is normal and highly desirable for a man at risk for diabetes. TOUHY 4TH ED TESTBANK

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

ANS: A Difficult access to facilities within the time available is a factor in bowel incontinence and bladder incontinence. The intake of 1 L of fluid is less than the recommended amount to protect against dehydration and constipation. Realistic expectations and goals should be discussed with the patient. Toileting should occur 20 to 40 minutes after regularly scheduled meals when the gastrocolic reflex is active. TOUHY 4TH ED TESTBANK

Which of the following statements describes one of the standards of case management during hospitalization? a.Begin discharge planning on the first day of hospitalization. b.Keep an older adult in the hospital as long as necessary. c.Accept the hospital discharge planners (HDP) proposal for discharge. d.Assist hospital personnel to focus on the admission complaint.

ANS: A Discharge planning begins on the first day of hospitalization. The case manager is responsible for ensuring that quality care is given accordingly in a specific time frame. The case manager facilitates discharge and contacts community-based resources to assist in the continuation of care. Keeping an older adult in the hospital as long as necessary is not required for the patient to receive the care he or she needs. Hospitalization is dangerous to older adults; therefore early discharge is encouraged. The case manager should negotiate with the HDP for the least restrictive level of care. Once the patient is in the hospital, any condition that the patient may have been neglecting should also be assessed and treated. TOUHY 4TH ED TESTBANK

Which of the following statements is true about dysarthria? a.Does not affect intelligence. b.Stems from severe rheumatoid arthritis. c.Physical therapy can be beneficial. d.Can affect the balance.

ANS: A Dysarthria is a speech disorder caused by a weakness or incoordination of the speech muscles. It occurs as a result of central or peripheral neuromuscular disorders that interfere with the clarity of speech and pronunciation; it does not affect intelligence. It does not stem from rheumatoid arthritis. Occupational therapy can help. Dysarthria does not affect balance. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about Medicare for older adults? a.Eighty percent of Medicares annual expenditures are for individuals with chronic illnesses. b.Medicare enrollees spend under $1500 annually for out-of-pocket expenses related to chronic illnesses. c.Complementary and alternative medicines (CAM) are not covered by Medicare. d.Medicare covers care for those who have trouble with activities of daily living.

ANS: A Eighty percent of Medicares expenditures are spent on care provided to those suffering from chronic illness. On average, Medicare enrollees spend over $3000 annually for out-of-pocket expenses related to chronic conditions. Medicare now covers some CAM therapies. Assistance with activities of daily living is not a covered expense with Medicare. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about documentation? a.Nurses should keep records of patients wishes. b.Patients do not have access to their own medical records. c.The Outcomes and Assessment Information Set (OASIS) is a complete record of the health status of a patient. d.The nurse is responsible for completing all of the Minimum Data Set (MDS).

ANS: A Entering patients expressed wishes in the medical or clinical record helps ensure that the interdisciplinary team respects these wishes. According to regulations after the enactment of the Health Insurance Portability and Accountability Act (HIPAA), the patient has access to his or her own medical records and may designate others to have access. The OASIS is used to measure outcomes for quality improvement purposes; it does not contain all of the necessary information for care, such as vital signs. The MDS should be completed jointly by all members of the interdisciplinary team. TOUHY 4TH ED TESTBANK

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

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

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

ANS: A Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age-related disorders. The pacemaker theory, which is also known as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can halt with age. The cross-link theory suggests that aging is a result of the stiffening of proteins caused by cross-linking, leading to stiffer joints, rougher skin, and decreased cellular elasticity. TOUHY 4TH ED TESTBANK

Which medication administered for delirium under a controlled environment can reduce the duration and severity of delirium for high-risk patients? a.Haloperidol (Haldol) c.Fluphenazine (Prolixin) b.Thioridazine (Mellaril) d.Chlorpromazine (Thorazine)

ANS: A Haloperidol administered in low doses can help reduce the severity and duration of delirium for high-risk patients after hip surgery; however, haloperidol therapy does not reduce the incidence of delirium in this group. In addition, atypical antipsychotic medications can also be effective when administered in low doses under controlled circumstances. Thioridazine is a typical antipsychotic agent and is not indicated in the prevention of delirium. Fluphenazine is a typical antipsychotic medication and is not indicated in the prevention of delirium. Chlorpromazine is a typical antipsychotic agent and is not indicated in the prevention of delirium. TOUHY 4TH ED TESTBANK

A nurse will be conducting an educational session on preventing skin cancer at a local senior citizens center. Which should the nurse include in the session? a.Squamous cell cancer may appear similar to a wart. b.Basal cell carcinoma is more common in women. c.Actinic keratosis begins as a pearly papule. d.Melanoma is characterized by rough, scaly patches.

ANS: A Squamous cell lesion may appear like a wart and be hard with defined borders. Basal cell carcinoma is more prevalent in fair-skinned older men and begins as a pearly papule. A multicolored, raised lesion with asymmetrical borders characterizes melanoma. TOUHY 4TH ED TESTBANK

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

ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves ones whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growthas basic needs are met, higher-level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is impossible when ones health is compromised even with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible. TOUHY 4TH ED TESTBANK

Which are the major factors influencing the experience of aging? a.Health, history, and sex b.Self-care needs and culture c.Self-fulfillment and self-esteem d.Society, culture, and marital status

ANS: A Health, history, and sex are major factors influencing the aging experience and interact to make each cohort distinctive. Culture is a major influence on the experience of aging and contributes to the uniqueness of a cohort; however, self-care needs are basic human needs and contribute to the similarities between cohorts. Self-fulfillment and self-esteem are higher-level human needs on Maslows hierarchy and denote similarities between cohorts. Society and culture are major influences on the aging experience, but marital status is not. TOUHY 4TH ED TESTBANK

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

ANS: A Holistic nursing integrates all aspects of an individuals life into the plan of care by balancing an individuals internal and external environment with psychosocial, spiritual, cultural, and physical processes. Healthy People 2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslows Hierarchy of Human Needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orems Self-Care Requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness. TOUHY 4TH ED TESTBANK

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

ANS: A Hospitalization often disrupts normal sleeping patterns; therefore reestablishing those patterns is the best first step to improving the quality of sleep in the hospital. Avoiding napping during the day is a reasonable approach to complaints of sleeplessness, but it may not be this womans problem. Sleep is increasingly fragmented in older adults; however, understanding that issue may or may not help this woman sleep for longer periods. A book or movie can help some people become drowsy, but becoming drowsy will not usually increase the quality or duration of sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep. TOUHY 4TH ED TESTBANK

Which is the most important medication the nurse administers to a patient with diabetes mellitus to attenuate a metabolic disorder that is closely associated with diabetes mellitus and that accelerates the disease processes are associated with diabetes mellitus? a.Atorvastatin (Lipitor) b.Colchicine (Colsalide) c.Calcium citrate (Citracal) d.Aluminum hydroxide (Amphojel)

ANS: A Hyperlipidemia is a metabolic disorder closely associated with diabetes mellitus, and it can be effectively treated with antilipid agents such as atorvastatin (Lipitor), exercise, and diet. Hyperlipidemia is associated with atherosclerosis. Colchicine (Colsalide) is prophylactic therapy for hyperuricemia, or gout, which is not commonly associated with diabetes mellitus; however, it is associated with coronary artery disease. Calcium citrate (Citracal) is used to treat osteoporosis and hypoparathyroidism and metabolic disorders of the bone and of the parathyroid gland; these metabolic disorders are not commonly associated with diabetes mellitus. Aluminum hydroxide (Amphojel) is given to bind with magnesium in chronic renal failure when the patient has hypermagnesemia. TOUHY 4TH ED TESTBANK

Which co-morbidity commonly associated with type 2 diabetes mellitus enhances the development of the microvascular complications of diabetes mellitus? a.Hyperlipidemia c.Venous insufficiency b.Hypothyroidism d.Chronic constipation

ANS: A Hyperlipidemia, a condition commonly associated with type 2 diabetes mellitus, accelerates the development of microvascular complications of diabetes mellitus because high serum, low-density lipoproteins contribute to the formation of atherosclerotic plaque. The plaque first accumulates in the smallest arteries, causing complications of diabetes mellitus including peripheral arterial disease, retinopathy, and nephropathy. Hypothyroidism, venous insufficiency, and chronic constipation are not associated with type 2 diabetes mellitus. TOUHY 4TH ED TESTBANK

While awaiting the imminent death of her sister, an older woman makes arrangements to bury her sister in the survivors home state because she cannot reach the other family members. Which step should the nurse implement? a.Ask questions, including questions about the location of her sisters family. b.Instruct this woman that this is not her decision to make. c.Try to contact the family to inform them of the decision. d.Question her about holding behaviors that she will want.

ANS: A In a countercoping intervention, the nurse assists the older adult to cope with the loss by collecting information and encouraging her to avoid acting on impulse. The older adult can arrive at a hasty decision when not effectively coping with grief; therefore the nurse acts to help restore some control for the bereaved and helps avoid a decision that might be regretted later. The nurse can ask the older adult if she believes that this is her decision to make but avoids informing her that it is not. The nurse avoids acting without the sisters knowledge; the nurse does not have the right to impose personal feelings on the family or on the patient. At a time when the older adult is acting impulsively, it can be reasonable to have her cool off; however, the woman has made a hasty decision and needs help to resolve that issue. In addition, the nurse can be considered insensitive for asking about this issue before the patient is dead. TOUHY 4TH ED TESTBANK

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

ANS: A In the age-stratification model, historical context is used to understand members of a cohort in terms of similar events, conditions, and circumstances and the effect these have on the group as a whole. A good example of such a cohort is older adults who lived through World War II. Biological context is not important in considering the age-stratification theory. The age-stratification theory is a sociological theory of aging that uses historical context to describe cohorts. Chronological context of a cohort will span a range, but historical context is what describes the cohort. TOUHY 4TH ED TESTBANK

A nurse completing a hospital discharge to home understands that which of the following interventions is most important before discharge. a. Medication reconciliation b. Providing a list of community resources c. Contacting a durable medical equipment facility d. Educating the client on appropriate range-of-motion exercises

ANS: A Medication reconciliation is the most important intervention to complete before discharge. Medication discrepancies are the most prevalent adverse event after hospital discharge and the most challenging component of a successful hospital-to-home transition. Nurses attention to an accurate prehospital medication list, medication reconciliation during hospitalization and at discharge, and patient and family education about medications are required to enhance safety. Educating the client on appropriate range-of-motion exercises, providing a list of community resources, and contacting a durable medical equipment facility are all important and should be completed as well, but medication reconciliation should be the priority. TOUHY 4TH ED TESTBANK

Which pain sensation is associated with nociceptive pain? a.Tissue inflammation b.Postherpetic c.Radiculopathies d.Nerve root irritation

ANS: A Nociceptive pain refers to pain that is related to the skin and tissue. Postherpetic and radiculopathies are both a type of neuropathic pain. Nerve root irritation is classified as a mixed or an unspecific pain. TOUHY 4TH ED TESTBANK

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

ANS: A Often the unknown is very frightening, uses the reflective technique to identify the patients feelings regarding the fear of the unknown. Religious people know that God is a good God, denies the patients feelings. People that have had near death experiences say it is peaceful, focuses on the experience of others. You must feel good about attending church most of your life, ignores the patients concern about death. TOUHY 4TH ED TESTBANK

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

ANS: A Older persons tend to spend less time asleep than younger persons, although they spend more time in bed. This statement is true because sleep takes longer to arrive and is more fragmented. Leg movements during sleep often tend to increase with age. REM sleep becomes more evenly distributed with age. Stage III sleep decreases with age and virtually disappears in older adults. TOUHY 4TH ED TESTBANK

Over 50% of the population, aged 65 years and older, suffers from which one of the following chronic health conditions? a.Hypertension b.Renal failure c.Multiple sclerosis d.Cancer

ANS: A Over 50% of the population, aged 65 years and older, suffers from hypertension and arthritis, followed by heart disease and diabetes. TOUHY 4TH ED TESTBANK

Which assessment parameter should the nurse use to differentiate between delirium and depression in an older adult? a.Orientation b.Activity c.Course over the morning hours d.Psychomotor activity

ANS: A Qualities about the patients orientation are a good method for the nurse to use for distinguishing between delirium and depression; in delirium, orientation is usually impaired, and in depression, orientation is normal. Activity can vary throughout the day and is not a good indicator. Delirium tends to be worse at night, and depression tends to be worse in the morning. The nurse avoids using qualities about the patients psychomotor activities to distinguish between delirium and depression in an older adult; psychomotor activities in both disorders are highly variable and make distinctions difficult. TOUHY 4TH ED TESTBANK

An older man has Alzheimer disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the mans duration of sleep? a.Instruct the wife to increase his daily physical activity. b.Collaborate with the health care provider to administer a hypnotic medication. c.Teach the wife how to apply a vest restraint during sleep. d.Help the wife plan daily periods for napping and activity.

ANS: A Regular exercise can help increase the duration of sleep during the night. Adding a new medication to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Administering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of injury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hostility and combativeness. Excessive napping during the day may be contributing to the problem. TOUHY 4TH ED TESTBANK

According to researchers, which characteristic will most centenarians share in the future? a.Female b.Demented c.Malnourished d.Wheelchair bound

ANS: A Researchers expect women to make up the majority of centenarians in the future. Gerontologists expect dementia to be common among older adults, but they are not predicting most centenarians will have dementia. Malnutrition is common among older adults, but researchers have not predicted that most centenarians will be malnourished. Decreased mobility is common among older adults, but researchers have not predicted that most centenarians will be confined to a wheelchair. TOUHY 4TH ED TESTBANK

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

ANS: A The NGNA was formed specifically for all levels of nursing personnel: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and certified nursing assistants (CNAs). The NCGNP is, as its name implies, limited to nurse practitioners. The NADONA/LTC is, as its name implies, limited to directors and assistant directors of nursing. The ASA is an interdisciplinary organization not limited to nurses. TOUHY 4TH ED TESTBANK

An older adult is in the hospital because of heart failure and has become incontinent of urine. Which evidence-based resource should the nurse use to guide continence care for this patient? a.Nursing Standard Practice Protocol b.The Borun Center training modules c.Toolkit from the American Geriatrics Society d.The Centers for Medicare and Medicaid Services

ANS: A The Nursing Standard Practice Protocol is a resource for urinary incontinence in older adults admitted to acute care. The Borun Center provides training modules suitable for nurses managing incontinence in residents in long-term care facilities. The American Geriatrics Society helps with managing urinary incontinence in primary care settings. The Centers for Medicare and Medicaid Services supply guidelines for managing urinary incontinence in long-term care facilities. TOUHY 4TH ED TESTBANK

Which one of the following is connected with the nursing home reform mandated by a 1987 law? a.Resident Assessment Instrument (RAI) b.HIPAA c.OASIS d.Fulmer SPICES

ANS: A The RAI must be completed for all residents receiving Medicare or Medicaid. The HIPAA was passed in 1996 and mandates privacy practices. The OASIS is an assessment designed for use in the home health care setting. Fulmer SPICES is an overall assessment tool developed in 2007. TOUHY 4TH ED TESTBANK

Which disease has become known as the great imitator? a.Human immunodeficiency virus (HIV) b.Acquired immunodeficiency syndrome (AIDS) c.Alzheimer disease d.Schizophrenia

ANS: A The compromised immune system of an older individual makes him or her more susceptible to HIV or AIDS than a younger person. AIDS in older adults has been called the great imitator; many of the symptoms, such as fatigue, weakness, weight loss, and anorexia, are common to other disease conditions and may be attributed to normal aging. Alzheimer disease and schizophrenia are not known as the great imitator. TOUHY 4TH ED TESTBANK

Which was the first formal action the ANA took in relation to gerontological nursing? a.Established a national geriatric nursing group b.Defined educational standards for gerontology c.Created the ANA Division of Geriatric Nursing d.Formed the Council of Long Term Care Nurses

ANS: A The first formal act of the ANA to promote gerontological nursing was to form a national geriatric nursing group in 1962. In 1973, the ANA defined educational standards for geriatric nursing. The ANA Division of Geriatric Nursing was begun in 1966. In 1979, the ANA formed the Council of Long Term Care Nurses. TOUHY 4TH ED TESTBANK

Which assessment is typical for a patient with OA? a.Narrow joint spaces with crepitus b.Effects in symmetrical joints c.Morning stiffness for at least an hour d.Swelling from excess synovial fluid

ANS: A The joint of an older adult with OA is narrower than a normal joint, and as the disease advances, crepitus is palpable over the joint. The joint narrows as it degenerates, and crepitus occurs as the articulating surfaces of the bone abnormally move against each other. Disease in symmetrical joints is characteristic of RA. Morning stiffness lasting for 1 hour or more is characteristic of polymyalgia rheumatica. Swelling from excessive synovial fluid is characteristic of RA. TOUHY 4TH ED TESTBANK

An older woman has diabetes mellitus and requires hemodialysis for renal failure. She is discharged to home to recover from a sternal wound infection and coronary artery bypass graft surgery (CABG). A home care nurse will provide wound care. Which of the following is the major justification for the complete and accurate documentation of this older adults care? a.Requires complex health care b.Has needs in multiple settings c.Is at risk for iatrogenic problems d.Has significant health care expenses

ANS: A The major reason that documentation of this patients health care must be accurate and complete is that she has complex health care needs in multiple settings and experiences a high risk for iatrogenic problems and high reimbursement expenses. The duration of her care is likely to be lengthy; the sternal wound infection after CABG is serious because of the potential for sternal osteomyelitis. In addition, individuals with diabetes are at high risk for infection and are slow to heal. The complexity of her care includes receiving care in multiple settingsat home, at dialysis, and in primary care for postdischarge follow-up care. For an older adult with diabetes, coronary artery disease, renal failure, and a serious infection, each facet of her health care depends on complete and accurate data on the other aspects of her care to help her achieve optimal health and wellness. This older adult is at risk for iatrogenic problems because of the complexity of her care. Each type of care, each illness or condition, and each setting exposes this older adult to a separate set of risks. In addition, individuals with diabetes can have peripheral neuropathies that increase the risk for falls and injuries. This older adult incurs health care expenses dealing with complex health care requirements including a recent hospital stay for surgery and complicated by an infection, ongoing needs for hemodialysis, and home care. Because much of the care is nurse driven, documentation is the basis for which reimbursement is provided. TOUHY 4TH ED TESTBANK

Which of the following is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults who have HF? a.Control fluid balance. b.Control blood pressure. c.Prevent deconditioning. d.Maintain patient safety.

ANS: A The most important goal for keeping a patient who has HF out of the hospital is to control total body fluid; hypervolemia aggravates HF by increasing the blood volume and making the heart work harder. Controlling total body fluid also helps prevent dyspnea and hypertension, maintain physical activity, improve rest and sleep, and promote nutrition for optimal health and wellness. Controlling the blood pressure is an important part of HF therapy; however, fluid volume status is implicated more often in those hospitalized with HF. Preventing deconditioning is an important yet challenging goal for patients with HF, but it is not frequently implicated in those hospitalized with HF. Maintaining patient safety is an important goal for any patient, but it is not commonly implicated as a cause of hospitalization for those with HF. TOUHY 4TH ED TESTBANK

Alcohol diminishes the effects of what type(s) of medications? (Select all that apply.) a.Oral hypoglycemic b.Anticoagulant c.Anticonvulsants d.Tricyclic antidepressants

ANS: A, B, C Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants. Alcohol increases the effect of tricyclic antidepressants. TOUHY 4TH ED TESTBANK

The nurse plans care to protect the skin covering an older adults greater trochanter. Which of the following interventions is the nurses priority when the older adult is positioned on the side? a.Implement a turning schedule. b.Place a cushion between the knees. c.Keep the skin clean and dry. d.Use the Sims position.

ANS: A The most important nursing intervention when an older adult is positioned on the side is to relieve pressure on the head of the femur and the greater trochanter; the greater trochanter is the most prominent bony projection on the side of a body. By turning the older adult at intervals, the nurse helps maintain tissue perfusion, thus providing oxygenation to tissues and allowing the removal of waste from vulnerable skin. The nurse places a pillow between the knees to help maintain physiological body alignment and to prevent strain on the hips and spine; if positioned properly, the pillow can help maintain tissue integrity of the medial malleolus and ankle by elevating them off the mattress. However, because the nurses priority is to maintain tissue oxygenation, preventing muscle and joint strain is not as important. The nurse keeps the skin clean and dry to help maintain skin integrity, but this intervention is not as important as maintaining tissue oxygenation. The nurse uses the Sims position to supplement turning; when in the Sims position, the patient is on the side but rotated slightly forward, allowing the chest and abdomen to fall forward to relieve some of the pressure on the patients side. TOUHY 4TH ED TESTBANK

The nurse monitors for which clinical indicator when the older adult complains of pruritus? a.Coarse skin b.Brown macule c.Brownish skin d.Regional edema

ANS: A The nurse is alert for rough, dry, flaky skin when an older adult complains of pruritus to be able to prevent linear excoriation leading to skin breaks, excoriation, inflammation, and infection. A brown macule is a freckle or a liver spot, an indication of sun exposure. Brownish skin is a clinical indicator of venous insufficiency. Regional edema is a sign of fluid overload and venous insufficiency; localized edema is a sign of infection. TOUHY 4TH ED TESTBANK

The older adult wants to appoint an attorney-in-fact with DPA for a specific period around a forthcoming surgery. Which should the nurse implement? a.Help the patient find a qualified attorney. b.Explain the legal rights and responsibilities of an attorney-in-fact with a DPA. c.Suggest using a guardian for the surgical period. d.Offer to act as the patients guardian during surgery.

ANS: A The nurse provides safe, effective, and comprehensive care but should not provide legal advice to an older adult; rather, the nurse should refer the patient to experts in the law and can assist the older adult with finding a suitable attorney. The nurse must avoid participating in the selection of the individual attorney to avoid conflict of interest. The nurse can provide short general explanations about powers of attorney to assist the patient in finding suitable legal counsel, but the nurse should leave explanations about the law surrounding a DPA to an attorney. The nurse should avoid providing legal advice to an older adult and avoid offering to participate in an older adults legal affairs to avoid a conflict of interest. TOUHY 4TH ED TESTBANK

The nurse scans an older mans identification band in preparation for medication administration. Which step should the nurse implement next? a.Ask the patient to state his name. b.Check for allergies to the medication. c.Document the medication as given. d.Administer the patients medication.

ANS: A The nurse verifies the patients identify to avoid computer errors before proceeding with administering the medication. Although computers were introduced to reduce documentation errors, verification of computer information is safe, effective nursing care. Checking for allergies is a reasonable nursing action; however, if a computer error misidentified the patient, then checking allergies of the wrong person can result in misidentification and serious adverse effects for this older adult. The nurse avoids documenting the medication as given until after the patient takes or receives the medication. The nurse avoids administering the medication until after verifying the patient identity a second time for safety. Further, regulatory agencies can require multiple forms of patient identification. TOUHY 4TH ED TESTBANK

An older man with diabetes mellitus complains to the nurse that his feet feel like they are burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort? a.Wear well-fitting, leather shoes b.Wear knee-high nylon stockings c.Soak the feet in warm water d.Apply antifungal powder on the feet

ANS: A The older adult is potentially experiencing a peripheral neuropathy from peripheral nerve damage from hyperglycemia. To prevent trauma to the feet, the nurse instructs him to wear comfortable, well-fitting, tie-on shoes with a broad toe space and low heels for protection. Nylon stockings for men tend to have restrictive ends that can inhibit tissue perfusion; because this patient is at risk for peripheral tissue damage, the constricted area can break down. The nurse also instructs him to avoid sitting with one leg crossed over the other or with both legs crossed at the knee; these positions restrict blood flow to the feet. Foot soaks can potentially cause excessive dryness. To maintain skin integrity, feet should be washed daily but not soaked. Irritating chemicals such as antifungal powder and corn or wart preparations should not be used on the feet of individuals with diabetes. TOUHY 4TH ED TESTBANK

Which older adult is most likely to have normal mental health? a.The older adult who grieves over the loss of a spouse for 2 years but is traveling again b.The older adult who exhibits long periods of depression with occasional manic episodes c.The older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt d.The older adult who has been treated for chronic depression and whose brother killed himself 1 year ago

ANS: A The older adult who grieves after suffering a major loss for 2 years, which is a length of time for grief that is within normal limits, is beginning to enjoy life again. This individual is most likely to have normal mental health because he or she has worked through the grief and has had the strength to resume normal activities. The older adult who exhibits long periods of depression with occasional manic episodes has clinical indicators of bipolar disorder. The older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt is unlikely to enjoy normal mental health; this older adults life displays an inability to cope effectively with tragedy, relationships, and personal matters. The older adult who has been treated for chronic depression and whose brother killed himself 1 year ago is at risk for suicide and is unlikely to have normal mental health. TOUHY 4TH ED TESTBANK

Which one of the following older adults has the highest economic risk in retirement at the beginning of retirement? a.Divorced woman who has lived in this country for 3 years b.Male veteran who is an above-the-knee amputee and was a teacher c.Female widow who is a primary care nurse practitioner d.Man who immigrated from China and designs computer software

ANS: A The older divorced woman who has lived in this country for 3 years has three factors associated with economic risk in retirement: (1) female sex, (2) divorced, and (3) immigrant with inadequate time to be eligible for government-sponsored retirement benefits. The older male veteran, an above-the-knee amputee, was a teacher and has one risk factordisability. The older female widow and primary care nurse practitioner has two risk factors: (1) female gender and (2) widowhood. The older man who emigrated from China and designs computer software has one risk factor immigrant. TOUHY 4TH ED TESTBANK

Which of the following statements is the most suitable for establishing goals when teaching an older adult with a chronic illness about potential changes in the health maintenance regimen? a.Management of the patients chronic disease rests on the patient and the caregiver; therefore the goals should be collaboratively set. b.The patient will be able to make needed changes in his or her life if the nurse provides accurate, written instructions. c.Psychological functioning is usually impaired only to a small extent in a patient with a chronic illness. d.The patients values, culture, and beliefs will have little to do with the types of changes he or she will be able to make.

ANS: A The patient must remain involved in the decision making; the patient and the caregiver may have different priorities. Instructions, by themselves, are not sufficient. Psychological functioning may be more impaired than physical functioning. The patients values, cultures, and beliefs profoundly shape the patients response to chronic illness and to therapeutic interventions. TOUHY 4TH ED TESTBANK

An older female patient is reading a large-print magazine and states that reading is difficult for her in the evening. Which intervention should the nurse implement? a. Put a high-intensity lamp at the head of her bed. b. Explain to her that the gray-yellow ring around her cornea, arcus senilis, is interfering with visual acuity. c. Put more powerful tubes in the fluorescent room lights. d. Examine her retinas for signs of damage.

ANS: A The pupil becomes gradually smaller with age; therefore the eye requires three times as much light. A high-intensity light on the object of interest is more effective than increasing the overall room illumination. The arcus senilis does not affect vision. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment. TOUHY 4TH ED TESTBANK

At 10 PM, an older male resident attempts to climb over the bedrails. Which intervention should the nurse implement first? a.Talk to the resident about his behavior. b.Call the physician, and ask for a sedative. c.Apply a vest restraint on the resident. d.Get a companion to keep him in the bed.

ANS: A The resident is expressing a need that the nurse can potentially determine with gentle questioning. Pharmacological intervention can be necessary but should not replace careful evaluation and management of the underlying cause. Simply restraining the patient will not address the underlying problem, and the imposition of restraints can trigger delirium. Applying a restraint is the last resort, and the nurse must consider the problems that accompany the application of restraints before doing so. Placing a companion in the room can be an effective method of keeping the resident safe if the companion can determine and meet the residents needs. TOUHY 4TH ED TESTBANK

Which is a healthy practice recommended for a person at risk for OA? a.Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with spinach covered with melted cheese for dinner; and ice cream for dessert b.Long-term estrogen administration as adjunct therapy c.Alendronate (Fosamax) taken with a snack just before bedtime d.Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog on a high-fiber bun at lunch; cocktails before dinner; steak with brown rice, celery, and red wine for dinner

ANS: A These foods in these quantities supply 1204 mg of calcium. Administering estrogen can increase the risk of cancer and heart disease. Alendronate (Fosamax) must be taken with a full glass of water on an empty stomach after awakening. Afterward, the patient must sit upright and refrain from eating or drinking for 30 minutes. Alcohol and high amounts of protein and salt inhibit calcium uptake, whereas caffeine, excess fiber, and phosphorus (in the cola) promote calcium excretion. TOUHY 4TH ED TESTBANK

An older man is taking aripiprazole (Abilify) for agitation. Which patient assessment is the nurses priority to prevent catastrophic effects of the medication? a.Oral and facial dyskinesia b.Mask facies, shuffling gait c.Muscle spasms of the face d.Repetitive aimless walking

ANS: A This individual is taking an atypical antipsychotic agent to control manic episodes of dementia. Although these agents are less likely to cause tardive dyskinesia (TD), the nurse monitors for the associated abnormal movements of TD including oral and facial dyskinesia, which is an impairment in the ability to execute voluntary facial movement. The nurse immediately reports this effect to stop therapy and to prevent an irreversible condition. Mask facies, having a masklike appearance, and shuffling gait are parkinsonian side effects of antipsychotic agents and can be improved with antiparkinsonian agents. Muscle spasms of the face, tongue, neck, and back are adverse effects of antipsychotic agents usually observed within the first 5 days of therapy. They are potential indicators of acute dystonia and can be improved with antiparkinsonian agents. Motor restlessness is an adverse effect of antipsychotic agents and is characteristic of akathisia. TOUHY 4TH ED TESTBANK

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

ANS: A This older adult is at high risk for developing constipation as a result of being on bed rest and being prescribed an opiate for pain. A decrease in activity, combined with the use of an opiate, often leads to constipation, not diarrhea. Appetite can be poor for the first few days after surgery, but it often returns without incidence. Decreased fluid intake is often supplemented with intravenous fluids for the first few days after surgery. TOUHY 4TH ED TESTBANK

When preparing a patient teaching session on retinopathy, the nurse should include which intervention(s) when discussing treatments for slowing the progression of the disease? (Select all that apply.) a.Glucose control b.Blood pressure control c.Laser therapy d.Cornea transplant

ANS: A, B, C Better control of glucose, blood pressure, and cholesterol can assist in halting the progression of retinopathy. Laser therapy is also a treatment. Cornea transplant is not an option. TOUHY 4TH ED TESTBANK

An older woman has a wound infection 5 days after a below-the-knee amputation brought about by diabetes mellitus. Which of the following is the nurses priority intervention to prevent cognitive dysfunction and postoperative complications in this older adult? a.Remove invasive devices as soon as possible. b.Minimize the administration of opioid analgesics. c.Allow for self-care and independent activities. d.Administer short-acting benzodiazepines as needed.

ANS: A To help prevent cognitive dysfunction, postoperative complications, and an increased risk of morbidity and mortality, the nurse recognizes that the risk factors this older adult has for delirium include stressors, infection, and surgery; therefore to prevent cognitive decline and additional postoperative complications, the nurse promptly removes invasive devices such as intravenous infusions, urinary catheters, and wound drains. Removing these devices not only reduces the risk of infection, thromboembolic events, blood loss, injury, and fluid imbalance, but they also serve to promote mobility, promote a sense of control for the patient, and reduce the types of situations that can frighten the patient or that the patient can misinterpret. Poor pain management can contribute to delirium in older patients. A patient with multiple stressors and risk factors for delirium needs additional nursing care and attention to provide a calming, caring therapeutic environment. The nurse must assess the patients functional status before allowing self-care and independent activities. In addition, this older adult is likely to need extensive physical therapy to maintain mobility. Benzodiazepines are a poor pharmacological choice for older adults for sedation or sleep; they can contribute to delirium, are highly addictive, and can cause rebound insomnia if suddenly withdrawn. TOUHY 4TH ED TESTBANK

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

ANS: A Toileting at bedtime should be incorporated for all patients. This intervention decreases the amount of urine in the bladder during the night. Incontinence pads are not encouraged during the retraining process. Toileting is not automatically scheduled every hour but is based on the individuals needs. The volume of scheduled fluid intake is also based on the individuals needs. TOUHY 4TH ED TESTBANK

To avoid trauma to the mouth from hot food being served to a patient diagnosed with dementia, the nurse should: a.Set hot food aside to allow it to cool slightly. b.Mix the hot food item with a cold food item. c.Touch the food to check the temperature before serving. d.Request a patient menu that includes several cold foods.

ANS: A Waiting for hot foods to cool slightly is the safest method. Foods should not be mixed so that each maintains its individual flavor. Touching contaminates the food that will be ingested by the patient. Patients have the right to choose any type of food, whether it is cold or hot. TOUHY 4TH ED TESTBANK

You are evaluating the plan of care for an older adult who is alcohol-dependent. Which patient documentation indicates the need for follow-up nursing interventions by the nurse? a.Patient states that he intends to decrease his alcohol consumption. b.Patient arrives at his group session on time and well-groomed. c.Patient states, I am an alcoholic because I drink 10 beers a day. d.Patient states that he understands that he needs continued treatment.

ANS: A When a patient states that he or she intends to decrease alcohol consumption, this response indicates that the patient continues to believe that his or her alcohol consumption is under his or her control. If the patient arrives at a group session on time and is well-groomed; taking pride in his or her appearance and participating in a group activity are positive signs. Acknowledging that he or she has a problem is a positive sign; older adults cannot be helped until the problem is acknowledged. Acknowledging the need for continuing treatment is a positive sign. TOUHY 4TH ED TESTBANK

Which factor(s) are associated with the provision of culturally competent care? (Select all that apply.) a. Cultural awareness b. Cultural knowledge c. Cultural skills d. Cultural connections

ANS: A, B As nurses move toward cultural competence, they increase their cultural awareness, knowledge, and skills. Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. Cultural connections have not been identified as a factor. TOUHY 4TH ED TESTBANK

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

ANS: A, B, C According to United States Department of Health and Human Services (USDHHS): Healthy People 2020, emerging issues in the health of older adults are the following: coordinating care; helping older adults manage their own care, establishing quality measures; identifying minimum levels of training for people who care for older adults; and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults. TOUHY 4TH ED TESTBANK

The Healthy People 2020 document identified which goals for immunizations? a. Increase percentage of persons who receive a seasonal influenza immunization; 65 years of age or over and living in the community b. Increase percentage of persons who are vaccinated against herpes zoster, 60 years of age or over c. Increase percentage of persons who are vaccinated against pneumococcal disease; 65 years of age or over and living in the community d. Increase percentage of persons who are vaccinated against human papillomavirus (HPV); 60 years of age or over

ANS: A, B, C According to the Healthy People 2020 document, the goals are to increase the percentage of persons who receive a seasonal influenza immunization; 65 years of age or over and living in the community; to increase the percentage of persons who are vaccinated against herpes zoster, 60 years of age or over; and to increase the percentage of persons who are vaccinated against pneumococcal disease; 65 years of age or over and living in the community. Increasing the percentage of persons vaccinated against HPV, 60 years of age or over, is not a goal. After age 27 years, an immunization for HPV is not recommended. TOUHY 4TH ED TESTBANK

The nurse understands that heart disease risk factors are which of the following? (Select all that apply.) a.Age c.Diabetes b.Hypertension d.Macular degeneration

ANS: A, B, C Age, hypertension, cigarette smoking, obesity, inactivity, dyslipidemia, and diabetes are all risk factors for the development of heart disease. Macular degeneration is a disease. TOUHY 4TH ED TESTBANK

The nurse is caring for a patient diagnosed with hyperthyroidism. Which signs and symptoms indicate hyperthyroidism? (Select all that apply.) a.Atrial fibrillation c.Constipation b.Heart failure d.Heat intolerance

ANS: A, B, C Compared with hypothyroidism, the onset of hyperthyroidism may be quite sudden. The signs and symptoms in the older adult include unexplained atrial fibrillation, heart failure, constipation, anorexia, muscle weakness, and other vague complaints. Symptoms of heart failure or angina may cloud the clinical presentation and prevent the correct diagnosis. The person may be misdiagnosed as being depressed or having dementia. On examination, the person is likely to have tachycardia, tremors, and weight loss. Heat intolerance is attributed to hyperthyroidism. TOUHY 4TH ED TESTBANK

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

ANS: A, B, C Drugs and their metabolites are excreted in sweat, saliva, and other secretions but primarily through the kidneys. Metabolites are not eliminated through the spleen. TOUHY 4TH ED TESTBANK

When planning care for a patient that has a history of alcohol abuse, the nurse recognizes which of the following medication(s) will interact with alcohol? (Select all that apply.) a.Analgesics b.Antibiotics c.Antidepressants d.Antipyretics

ANS: A, B, C Many drugs that older adults use for chronic illnesses cause adverse effects when combined with alcohol. Alcohol interacts with at least 50% of prescription drugs. (Naegle, 2008) Medications that interact with alcohol include analgesics, antibiotics, antidepressants, antipsychotics, benzodiazepines, H2-receptor antagonists, nonsteroidal antiinflammatory drugs (NSAIDs), and herbal medications (e.g., Echinacea, valerian). Acetaminophen taken on a regular basis, when combined with alcohol, may lead to liver failure. Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants. All older people should be given precise instructions regarding the interaction of alcohol with their medications. TOUHY 4TH ED TESTBANK

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

ANS: A, B, C Many people reach older age and have no memory problems. Participation in physical exercise, stimulating mental activity, socialization, health diet, and stress management help brain health. An increase in dietary intake has not been shown to influence brain health. TOUHY 4TH ED TESTBANK

The nurse is caring for an older adult who has dementia. The patient has just returned from recovery after a percutaneous endoscopic gastrostomy (PEG) tube placement. Which intervention(s) should the nurse implement? (Select all that apply.) a.Place IV tubing behind the patient. b.Hang the IV bag behind the patients field of vision. c.Cover the PEG tube with an abdominal binder. d.Use wrist restraints.

ANS: A, B, C Placing the tube behind the patient, hanging the IV bag behind patients field of vision, and covering PEG tube with an abdominal binder decrease the likelihood of the patient accidently pulling out the lines. Soft mitts should be used instead of hand restraints. TOUHY 4TH ED TESTBANK

The OASIS was implemented to provide the format for a comprehensive assessment in the home health care setting. How is this assessment tool used? (Select all that apply.) a.To improve the quality of care b.To improve the communication about the individual c.To serve as a guide for reimbursement d.To evaluate the level of patient disability

ANS: A, B, C The OASIS was implemented to provide the format for a comprehensive assessment, which forms the basis for planning care and measuring patient outcomesbased quality improvement (OBQI) (CMS, 2011). As with all other documentation systems, OASIS is used to improve both the quality of care and the communication about the individual and serve as a guide for reimbursement. The OASIS assessment does not evaluate the level of patient disability; however, a portion of the assessment addresses the functional capabilities of the patient to perform activities of daily living. TOUHY 4TH ED TESTBANK

The nurse should instruct a patient on which of the following modifiable risk factor(s) for essential hypertension? (Select all that apply.) a.Tobacco use c.Stress management b.Alcohol d.Adequate rest

ANS: A, B, C Tobacco use, alcohol, and stress management are modifiable risk factors. Although adequate rest helps with general health and wellness, it has not been identified as a modifiable risk factor for essential hypertension. TOUHY 4TH ED TESTBANK

The nurse will be educating a group of senior citizens on adaptations for safer driving. Which adaptation(s) should the nurse include? (Select all that apply.) a.Wide rear-view mirrors b.Pedal extensions c.Global positioning system (GPS) devices d.Antiroll bars

ANS: A, B, C Wide rear-view mirrors, pedal extensions, and GPS devices are all suggested adaptations. The use of antiroll bars has not been identified as an adaptation. TOUHY 4TH ED TESTBANK

During a walk, an older man suffers a laceration from a broken tree branch. Rank the nurses interventions in order, beginning with the most important intervention. a.Flush and cleanse the wound well. b.Investigate a possible safety hazard. c.Instruct him to keep the wound covered. d.Verify a current tetanus immunization.

ANS: A, B, C, D Flushing and cleansing the wound helps prevent the invasion of potential pathogens from the tree into the mans system. This most basic nursing intervention is the nurses first priority because it helps maintain physiological functioning. Without the wound being clean, the remaining nursing interventions cannot be effective. The second most important task for the nurse is to instruct the patient to keep the wound covered; the inflammatory response can take 48 to 72 hours to begin in an older adult. Covering the wound will help keep the wound clean and prevent contamination. Without the action of the bodys defense mechanisms at the wound in an older adult, inflammatory mediators remain inactive, allowing potential pathogens to remain unchecked, increasing the risk for infection. The third most important task is for the nurse to ensure that the older adult has a current tetanus immunization; tetanus is associated with breaks in the skin. The lowest-priority task for the nurse is to ensure the broken tree branch does not present a safety hazard; therefore the nurse questions the older adult for additional information and takes any necessary action to prevent another accident. TOUHY 4TH ED TESTBANK

According to Healthy People 2020, older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement. (Select all that apply.) a.Diabetes b.Arthritis c.Congestive heart failure d.Dementia e.Cancer f.Pressure ulcers

ANS: A, B, C, D In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia. TOUHY 4TH ED TESTBANK

Which medication(s) affect appetite and nutrition in the older adult? (Select all that apply.) a.Digoxin b.Theophylline c.Iron supplements d.Aspirin e.Phenergan

ANS: A, B, C, D Many medications affect appetite and nutrition, including digoxin, theophylline, nonsteroidal antiinflammatory drugs (NSAIDs), iron supplements, antidepressants, and psychotropic medications. Clinically significant drug-nutrients interactions can result in nutrient loss, and evidence is accumulating that shows the use of nutritional supplements may counteract these possible drug-induced nutrient depletions. A thorough medication review is an essential component of nutritional assessment, and individuals should receive education about the effects of prescription medications, as well as herbals and supplements, on their nutritional status. TOUHY 4TH ED TESTBANK

In a retirement planning program, the community health nurse wants to help participants avoid disappointment in retirement. The nurses program emphasizes which of the following elements that must be adequate to meet postretirement expectations? (Select all that apply.) a.Financial planning b.Company-sponsored benefits c.Company-sponsored health care d.Government-sponsored benefits e.Ability to maintain a personal residence f.Safety and security of a personal residence

ANS: A, B, C, D Overall financial planning is important to provide a stable source of income for retirement if individuals want to fulfill their retirement expectations. Company-sponsored benefits must be sufficient in retirement to avoid large, unplanned expenses. Health care expenses in retirement are more likely to be significant; therefore retirement health care must be adequate to avoid huge, unexpected expenses. If government-sponsored benefits are inadequate for retirement, then the individual must plan to fill the gaps with preretirement planning. The ability to maintain a residence is not essential to fulfill retirement expectations. Safety and security of the personal residence is also not essential to fulfill retirement expectations. TOUHY 4TH ED TESTBANK

Identify future directions for gerontological nursing research as suggested by Wykle and Tappen. (Select all that apply.) a.Interdisciplinary practice models b.Intergenerational caregiving c.Health disparities d.Influence of culture on aging e.Long-term care initiatives

ANS: A, B, C, D The following have been identified for future directions for gerontological nursing research according to Wykle and Tappen: interdisciplinary practice models, intergenerational caregiving, health disparities, and the influence of culture on aging. Long-term care initiatives have not been identified as a future direction for nursing research. TOUHY 4TH ED TESTBANK

The children of an older man believe he is too old to drive a car. Which assessment information about the man warrants further investigation by the nurse to determine his fitness to drive a car safely? (Select all that apply.) a.Increased rate of tripping on curbs b.Increased frequency of getting lost c.Multiple bruises on lower extremities d.Restricts reading to a well-lit sunroom e.Socializes with a partners bridge group f.Cooks gourmet meals for entertainment

ANS: A, B, C, D Tripping on curbs can potentially indicate a vision impairment, but it can also be caused by other problems. Getting lost frequently can potentially indicate a vision impairment, but it can also be caused by other problems. Bruising from bumping into objects can potentially indicate a vision impairment, but it can also be caused by other problems. Reading in a well-lit sunroom exclusively can potentially indicate vision impairment, especially if the patient requires additional lighting for reading. Socializing with a bridge group is likely to indicate adequate visual acuity for reading the cards and keeping score. Gourmet cooking is likely to indicate adequate visual acuity to measure and prepare food. TOUHY 4TH ED TESTBANK

An older woman who takes escitalopram (Lexapro) 10 mg by mouth daily states she does not feel better after 1 week of treatment. Rank the interventions in order, starting with the first intervention the nurse should implement to facilitate patient compliance with therapy. a.Tell her that the beneficial effects can take 4 to 6 weeks to appear. b.Instruct her to take the medication as prescribed without stopping. c.Suggest hard candy, ice chips, and sips of water for a dry mouth. d.Collaborate with the health care provider to provide an increased dose.

ANS: A, B, C, D Usually, older adults are sensitive to the effects of medications, but under normal circumstances, the therapeutic effect of escitalopram and other SSRI antidepressant medications can take up to 4 to 6 weeks to appear. Conversely, if an individual who is taking an antidepressant experiences adverse effects of the medication, then the individual should be instructed to take the medication continually as prescribed for 1 to 2 months before abandoning the therapy; the untoward effects usually diminish or disappear with time. To bolster the initial intervention, the nurse instructs the older adult to continue therapy without stopping because consistent, daily administration is the best method of achieving the full beneficial effects of an antidepressant. A common, early adverse effect of antidepressant therapy is dry mouth; therefore the nurse supplies the individual with strategies for effectively counteracting the anticholinergic effects of this medication. The nurse assists the older adult with strategies to manage antidepressant therapy before asking for an increased dose. Titration of an antidepressant medication for an older adult is a slow process because of increased sensitivity to the effects of the medication. In addition, dosing trial and error is a common strategy for determining an individuals optimal dose. TOUHY 4TH ED TESTBANK

Residents of a nursing home taking which of the following medication(s) are at risk for sleep disturbances as an adverse effect of the medication? (Select all that apply.) a.Celecoxib (Celebrex) b.Diltiazem (Cardizem) c.Venlafaxine (Effexor) d.Ipratropium (Atrovent) e.Oxycodone (Oxycontin) f.Guaifenesin (Robitussin)

ANS: A, B, C, D, E Celecoxib (Celebrex), a cyclooxygenase-2 (COX-2) inhibitor; diltiazem (Cardizem), a calcium-channel blocker; venlafaxine (Effexor), an antidepressant; ipratropium (Atrovent), an anticholinergic bronchodilator; and oxycodone (Oxycontin), an opioid analgesic, can all cause insomnia. Guaifenesin (Robitussin) is not known to cause insomnia. TOUHY 4TH ED TESTBANK

The nurse plans care to prevent a dangerous thermal environment for an older man who lives in a northern climate of the United States. Which patient assessment data does the nurse recognize that can contribute to his risk of hypothermia? (Select all that apply.) a.Has a history of a cerebrovascular accident (CVA) b.Has a history of diabetes mellitus c.Builds miniature cars for a hobby d.Bathes three to four times a week e.Gets heat from a boiler in the cellar f.Becomes diaphoretic on warm days

ANS: A, B, C, E A CVA can impair an older adults thermoregulatory center and potentially diminish the individuals awareness of temperature changes or the ability to respond suitably to a temperature change. In addition, if the older adult is left with a cognitive deficit or aphasia, then the older adults ability to communicate a thermal problem is potentially impaired. A history of diabetes mellitus can contribute to a dangerous thermal environment for the older adult. A complication of diabetes is peripheral neuropathy, which potentially impairs the ability to sense temperature change. In addition, peripheral arterial disease associated with diabetes contributes to the individuals ability to compensate to temperature changes with vasodilation or vasoconstriction. Building miniature cars is a sedentary activity. The associated metabolic activity is low, the older adult generates less heat from metabolic activity, and the individual is at a higher risk for hypothermia when the temperature is cool. Household heat from a boiler in the cellar creates a potential regulatory problem for the older adult living in the building because adjustments to temperature affect the entire household and are only made in the cellar. Thermostats in individual rooms do not exist in such a heating system. If the individual has impaired mobility, then he might be unable to navigate the stairs to the cellar and adjust the temperature. Bathing three to four times a week limits the exposure of bare skin to the cooling effects of evaporation to reduce the risk of hypothermia. Diaphoresis on a warm day is a suitable response to heat.

The nurse plans care to prevent a dangerous thermal environment for an older man who lives in a northern climate of the United States. Which patient assessment data does the nurse recognize that can contribute to his risk of hypothermia? (Select all that apply.) a.Has a history of a cerebrovascular accident (CVA) b.Has a history of diabetes mellitus c.Builds miniature cars for a hobby d.Bathes three to four times a week e.Gets heat from a boiler in the cellar f.Becomes diaphoretic on warm days

ANS: A, B, C, E A CVA can impair an older adults thermoregulatory center and potentially diminish the individuals awareness of temperature changes or the ability to respond suitably to a temperature change. In addition, if the older adult is left with a cognitive deficit or aphasia, then the older adults ability to communicate a thermal problem is potentially impaired. A history of diabetes mellitus can contribute to a dangerous thermal environment for the older adult. A complication of diabetes is peripheral neuropathy, which potentially impairs the ability to sense temperature change. In addition, peripheral arterial disease associated with diabetes contributes to the individuals ability to compensate to temperature changes with vasodilation or vasoconstriction. Building miniature cars is a sedentary activity. The associated metabolic activity is low, the older adult generates less heat from metabolic activity, and the individual is at a higher risk for hypothermia when the temperature is cool. Household heat from a boiler in the cellar creates a potential regulatory problem for the older adult living in the building because adjustments to temperature affect the entire household and are only made in the cellar. Thermostats in individual rooms do not exist in such a heating system. If the individual has impaired mobility, then he might be unable to navigate the stairs to the cellar and adjust the temperature. Bathing three to four times a week limits the exposure of bare skin to the cooling effects of evaporation to reduce the risk of hypothermia. Diaphoresis on a warm day is a suitable response to heat. TOUHY 4TH ED TESTBANK

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

ANS: A, B, C, E, F The intake of chamomile, garlic, ginkgo, ginseng, and green tea supplements at home should be avoided because each increases the effectiveness of anticoagulation. Individuals should avoid these herbal supplements while taking an anticoagulant because the patients blood will be significantly less able to clot, exposing him or her to the risk of a catastrophic injury in the event of a fall or trauma. The use of Hawthorn supplements has not been shown to affect the use of anticoagulants. TOUHY 4TH ED TESTBANK

The nurse recognizes which of the following signs and symptoms as an indication of hypothyroidism? (Select all that apply.) a.Decline in cognitive function b.Decrease in functional status c.Decrease in thyroid-stimulating hormone (TSH) and thyroxine (T4) d.Heat intolerance

ANS: A, B, D A decline in cognitive function, functional status, and heat intolerance are all indicative of hypothyroidism. An elevated TSH and decrease in T4 indicates hypothyroidism. TOUHY 4TH ED TESTBANK

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

ANS: A, B, D Although men have the ability to produce sperm throughout their lives, they also experience changes in the functioning of the reproductive and the urogenital organs in later life. The changes are usually more subtle and noticed only as they accumulate, beginning when men are in their 50s. The testes atrophy and soften. The seminiferous tubules thicken, and obstruction caused by sclerosis and fibrosis can occur. Although sperm count does not decrease, fertility may be reduced because of a higher number of sperm lack motility or have structural abnormalities. Erectile changes are also seen; more stimulation is needed to achieve a full erection, ejaculation is slower and less forceful, and refractory periods are longer. TOUHY 4TH ED TESTBANK

An older man who has hyperuricemia complains of severe pain in the right ankle. Which instructions should the nurse include in patient teaching to enhance the action of the medication the patient takes for his condition? (Select all that apply.) a.Avoid dehydration by drinking water. b.Take aspirin when joints are red and hot. c.Comply with antihypertensive diuretic regimen. d.Avoid game meat, asparagus, and alcohol.

ANS: A, B, D Because this individual exhibits an acute attack in the ankle from hyperuricemia, the goal of therapy is to prevent another attack. To decrease uric acid production, the prophylactic medication of choice for gouty arthritis is colchicine (Colsalide). To enhance the action of this medication and to further reduce this patients risk of another attack, the nurse instructs the patient to avoid game meat and asparagus, because they contain purine, and to avoid alcohol, because it increases uric acid production. The nurse instructs the patient to drink 2 liters of water daily to facilitate uric acid excretion and to prevent the crystallization of uric acid in the renal tubules. The nurse also instructs this individual to avoid aspirin because it increases the risk of an acute attack and counteracts the benefit of uric acid prophylaxis. Antihypertensive therapy helps reduce the risk of another attack, but when diuretic agents are used for antihypertensive therapy, the potential benefit for gout prophylaxis is blunted because diuretics increase the risk of gouty attacks. TOUHY 4TH ED TESTBANK

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

ANS: A, D Tai chi and walking heel to toe are considered balance exercises. The use of resistance bands is considered muscle strengthening, and ROM activities are considered stretching exercises. TOUHY 4TH ED TESTBANK

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

ANS: A, B, D Continuous indwelling catheter use is indicated for those with urethral obstruction or urinary retention because these patients are unable to empty their bladder without this device. Stress incontinence is not a condition that warrants a continuous indwelling catheter. Continuous indwelling catheter use is indicated for patients with severely impaired skin integrity to decrease the risk of further deterioration of skin integrity. TOUHY 4TH ED TESTBANK

Which population(s) is(are) most at risk for developing HIV? (Select all that apply.) a.Those over the age of 50 years b.Women c.Those who are cognitively impaired d.Those who are sexually active

ANS: A, B, D Older adults who are sexually active are at risk for HIV, AIDS, and other sexually transmitted diseases. People older than 50 years of age are approximately one sixth as likely to use condoms during sex. Older women who are sexually active are at high risk for HIV, AIDS, and other sexually transmitted infections from an infected partner, resulting, in part, from normal age changes of the vaginal tissuea thinner, drier, friable vaginal lining that makes viral entry more efficient. Being cognitively impaired does not put one at high risk. TOUHY 4TH ED TESTBANK

Although intact skin effectively protects an individual, it functions within physiological limits. Which qualities of healthy skin work synergistically within these limits to absorb, cushion against, deflect, or neutralize potentially harmful forces, as well as protect against potentially harmful substances that might impair skin integrity? (Select all that apply.) a.Strength b.Pliability c.Location d.Durability e.Moistness f.Pigmentation

ANS: A, B, D Skin must be strong enough to withstand forces that can impair its integrity. If skin is not supple, then it is unable to withstand directional forces and will tear. Skin must be sturdy enough to act as an effective protective mechanism. All skin must be able to absorb, cushion, and withstand forces. Skin in a moist environment is subject to bacterial and fungal overgrowth. Skin pigmentation is unrelated to its ability to cushion, absorb, and withstand potentially harmful substances and forces. TOUHY 4TH ED TESTBANK

Which factors in the patient care environment should be routinely assessed to decrease the risk of falls? (Select all that apply.) a.Outdoor grounds b.Appropriate footwear c.All four bed rails raised d.Grab bars in place

ANS: A, B, D The outdoor grounds should be checked for uneven areas, such as breaks in the sidewalk and items the patients could trip over. Ensuring that patients have the appropriate footwear in important to decrease the risk for falls. Raised bed rails can be considered a restraint. Grab bars are considered assistive devices and can decrease the risk for falls or injuries. TOUHY 4TH ED TESTBANK

An elder-friendly community includes components that: (Select all that apply.) a.Address basic needs b.Optimize physical health c.Provide financial assistance d.Maximize independence e.Provide social engagement

ANS: A, B, D, E Components of an elder-friendly community include addressing basic needs, optimizing physical health and well being, maximizing independence for the frail and disabled, and providing social and civic engagement. Elder-friendly communities do not provide financial assistance. TOUHY 4TH ED TESTBANK

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

ANS: A, B, D, E Long-term use of external catheters can lead to fungal skin infections, penile skin maceration, edema, fissures, contact burns from urea, phimosis, UTIs, and septicemia. The catheter should be removed and replaced daily and the penis cleaned, dried, and aired to prevent irritation, maceration, and the development of pressure ulcers and skin breakdown. If the catheter is not sized appropriately and applied and monitored correctly, then strangulation of the penile shaft can occur. Atrophy has not been identified as a complication. TOUHY 4TH ED TESTBANK

3. Which of the following is(are) assessed in a fall prevention assessment of an older adult? (Select all that apply.) a.Environment b.Physical status c.Financial status d.Functional status e.Medical history f.Occupational history

ANS: A, B, D, E The nurse uses information about lighting, flooring, apparel, and other issues from the environmental assessment of an older adult to plan individualized fall prevention measures. The nurse examines flexibility, muscle strength, vital signs, and other clinical indicators in the physical assessment of an older adult to plan individualized fall prevention measures. The nurse uses information about gait, balance, and ability to perform activities of daily living in the functional status assessment of an older adult to plan individualized fall prevention measures. The nurse examines medications, previous accidents and falls, co-morbid conditions, and other factors in the historical assessment of an older adult to plan individualized fall prevention measures. Financial issues and occupational history are not directly related to a risk for falls. TOUHY 4TH ED TESTBANK

Which ethnic groups in the United States have higher rates of diabetes mellitus than non-Hispanic white people? (Select all that apply.) a.Pima Indians b.Alaskan Natives c.Cuban Americans d.Native Americans e.African Americans f.Mexican Americans

ANS: A, B, D, E, F Pima Indians who live in southwestern United States have the highest incidence of diabetes mellitus in the world. Alaskan Natives have an incidence of diabetes mellitus of 14.2%. Native Americans have diabetes at a rate of 6% to 29.3%. African Americans are 1.8 times more likely to have diabetes mellitus. Mexican Americans have the highest incidence of diabetes mellitus in the United States. The rate of diabetes mellitus for non-Hispanic whites in the United States was 6.6% in 2007. Cuban Americans have the lowest rates of diabetes mellitus. TOUHY 4TH ED TESTBANK

Which of the following statement(s) is(are) true about pain in older adults? (Select all that apply.) a.Pain is not a normal aging process. b.Pain sensitivity decreases with age. c.If patients do not complain, they do not have pain. d.Opioid analgesics are often the best treatment for persistent pain.

ANS: A, D Pain is not a normal aging process. Something pathological is usually causing the pain. Pain sensitivity does not decrease with age. Some patients have a variety of reactions to pain; many are stoic and refuse to give in to their pain. Opioid analgesics are beneficial for moderate-to-severe persistent pain. TOUHY 4TH ED TESTBANK

An older man with myasthenia gravis lives with his wife. Which patient characteristics should the nurse use to identify areas for nursing care in the disability assessment of this man? (Select all that apply.) a.Successfully manages his finances. b.Lives in an adults-only community. c.Walks around the house for exercise. d.Health care is provided through Medicare. e.Has a history of peptic ulcer disease. f.Wife is in good health but has poor eyesight.

ANS: A, B, D, F An older adult with myasthenia gravis has a chronic, progressive disorder characterized by muscle weakness, especially after exercise. Crises can develop as a myasthenic crisis, characterized by severe, generalized, muscle weakness with life-threatening consequences, or a cholinergic crisis, generally caused by an excessive dose of medication and characterized by excessive salivation and lacrimation, tachycardia, and diarrhea. The nurse recognizes the cognitive function to manage his finances successfully as a potential for self-care of his condition and can use this potential ability to plan care in the disability assessment. Living in an adult community implies independent living and some ability to perform self-care activities. Skilled nursing services in the home must be necessary to have Medicare health coverage; therefore if this patient requires assistance with activities of daily living, then he must depend on his wife or another resource. Living with another adult can be an asset. For this man, his wife identifies an area of a needed self-care resource because, although she can be trained to identify deteriorating muscle strength in this man, her ability to manage a crisis effectively is impaired with poor eyesight. Thus, the nurse uses the gap between his cognitive function and the wifes ability to manage a crisis to plan his nursing care. Walking around the house is not an asset for this man; individuals who have extrapyramidal symptoms from an antipsychotic medication can walk around the house. Walking around the house is probably more indicative of limitations from myasthenia gravis; however, it does not indicate a resource need. The history of peptic ulcer disease is a neutral aspect of this mans disability assessment. TOUHY 4TH ED TESTBANK

The same nursing documentation record is used in every unit of a hospital. Why does a hospital use a standardized form for nursing documentation? (Select all that apply.) a.Helps provide continuity of care b.Standardizes patient care parameters c.Assists in maintaining confidentiality d.Reduces the number of medication errors e.Provides the foundation for staffing levels f.Allows for quality evaluations among units

ANS: A, B, E, F An institution uses the same nursing documentation record because it helps provide continuity of care across various settings by providing organized, pertinent, and thorough health care data on a specific individual. Other units in the hospital and other health care settings have an easier time locating relevant data. Specific health care data are found in one location on a standardized nursing documentation record throughout an institution and provide the basis for standardized patient evaluation across settings. Standardized documents help describe patient acuity levels and thus provide a justification for staffing. Because the same parameters are, or should be, recorded across all units, the standardized documentation record allows for hospital-wide quality evaluations. Nurses must restrict access to a standardized documentation record or any other type of patient record such as laboratory reports, narrative or progress notes, and other documents. A standardized nursing documentation record can reduce a specific type of documentation error but is unlikely to affect the rate of medication errors. TOUHY 4TH ED TESTBANK

Which of the following characteristics are associated with acute grief? (Select all that apply.) a. Preoccupation with the loss of a loved one b.Waves of grief or distressing emotion c.Prolonged inability to sleep after a loss d.Exacerbations of grief on specific dates e.Change in attitude toward the future loss f.Inability to perform simple self-care tasks

ANS: A, B, F In acute grief, the bereaved is preoccupied with the deceased or the loss in a manner similar to daydreaming, combined with a sense of unreality. Specific activities, items, people, or other things can trigger an overwhelming pain in acute grief. The bereaved can be incapacitated by acute grief, making simple tasks such as dressing nearly impossible to complete or taking much longer to complete a task. Chronic grief is characterized by prolonged insomnia and an extended period of inhibited activities and suboptimal performance. Chronic grief is characterized by periods of pain exacerbated on specific dates such as anniversaries, birthdays, and holidays, among others. Anticipatory grief is characterized by a change in attitude toward the individual who is about to die when the death does not occur as planned. TOUHY 4TH ED TESTBANK

In which areas have advanced practice nurses demonstrated their skill in improving? (Select all that apply.) a.Health outcomes b.Length of stay c.Cost effectiveness d.Reimbursement measures e.Interprofessional communication

ANS: A, C Advanced practice nurses have demonstrated their skill in improving health outcomes and cost effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams. This role is well established, and positive outcomes include increased patient and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving. TOUHY 4TH ED TESTBANK

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

ANS: A, C Most areas of the brain do not lose brain cells. Although older adults may lose some nerve connections, it can be part of the reshaping of the brain that comes with experience. Basic intelligence remains unchanged with age, and older adults should be provided with opportunities for continued learning. Many people reach older age and have no memory problems. Participation in physical exercise, stimulating mental activity, socialization, health diet, and stress management help brain health. TOUHY 4TH ED TESTBANK

Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.) a.Carotid stenosis b.Diabetes mellitus c.Renal insufficiency d.Coronary artery disease e.Isolated systolic hypertension f.Familial hypercholesterolemia

ANS: A, C, D Carotid stenosis refers to the occlusion of the carotid artery from atherosclerotic plaque and can be a result of chronic hypertension. Older adults with carotid stenosis are at high risk for strokes because of the risk of a thromboembolic event from the plaque. Renal dysfunction can occur as a result of chronic hypertension; the intimal lining of the renal arteries is damaged over time, which leads to renal artery stenosis and decreased renal perfusion. Coronary artery disease is a common result of chronic hypertension. Diabetes mellitus (DM) is not a result of end-organ damage from chronic hypertension; however, when it accompanies hypertension, DM accelerates the process of end-organ damage and greatly increases the risk of cardiovascular disease. Isolated systolic hypertension is a common consequence of aging but not a result of end-organ damage. Genetic factors determine familial hypercholesterolemia and cannot be caused by end-organ damage. TOUHY 4TH ED TESTBANK

The nurse working in a long-term care facility completes her morning assessment on a new postoperative patient and notes a change in cognitive status from the previous day? The nurse recognizes which of the following as a precipitating factor for delirium? (Select all that apply.) a.Major medical treatment b.Poor sleep habits c.Admission to long-term care d.Pharmacological agents

ANS: A, C, D Major medical treatment, admission to long-term care, and pharmacological agents are all precipitating factors for delirium. Changes in surroundings often precipitate delirium. The development of delirium is a result of complex interactions among multiple causes. Delirium can result from the interaction of predisposing factorsvulnerability on the part of the individual as a result of predisposing conditions, such as cognitive impairment, severe illness, and sensory impairment; delirium can also result from precipitating factors and insultsmedications, procedures, restraints, and iatrogenic events. Although a single factor (e.g., infection) can trigger an episode of delirium, several co-existing factors are also likely to be present. A highly vulnerable older individual requires a lesser amount of precipitating factors to develop delirium. Poor sleep habits is not a contributing factor in of itself. TOUHY 4TH ED TESTBANK

Which factor(s) is(are) modifiable health risk behaviors for chronic illness? (Select all that apply.) a.Physical activity b.Prescription medication use c.Poor nutrition d.Tobacco use

ANS: A, C, D Physical activity is modifiable; patients can begin an exercise program at any time. Nutrition is also a modifiable health risk behavior; patients have the ability to increase or decrease intake, depending on their weight and nutritional status. Tobacco use is also a modifiable behavior; patients can participate in a smoking cessation program or use other assistance to stop smoking. TOUHY 4TH ED TESTBANK

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

ANS: A, C, D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Consequences of ageism have been identified as a reduced sense of self, lowered self-esteem, lowered sense of self-competence, and decreased memory performance. Poor nutritional intake has not been identified as a consequence. TOUHY 4TH ED TESTBANK

An older man who has HF complains of increasing dyspnea over 2 days. Which of the following should the nurse assess to help determine whether the patient has adhered to his therapy? (Select all that apply.) a.Check for peripheral edema. b.Ask about his bowel pattern. c.Auscultate the lungs bilaterally. d.Compare his weight to baseline. e.Determine coughing frequency. f.Assess his diet over last 48 hours.

ANS: A, C, D, F Standard HF therapy includes taking medications as prescribed with a low-sodium diet to control total body fluids. Usually, dyspnea in a patient with HF is due to hypervolemia, which occurs after a lapse in adherence to the standard HF therapy. The nurse checks the patients extremities for edema because peripheral edema is a clinical indicator of hypervolemia. If the patient is nonadherent with therapy, then the nurse is more likely to find peripheral edema than with an adherent patient. Hypervolemia can also be due to worsening HF. The nurse listens to the patients lungs to assess for pulmonary edema as a cause for the patients dyspnea. Pulmonary edema can be caused by hypervolemia from nonadherence to therapy or from worsening HF. The nurse compares the patients weight to his baseline to determine whether the patient has experienced a sudden weight gain, which would be indicative of hypervolemia. Assessing the patients diet over the last 48 hours can provide clues about a potential cause of the patients dyspnea. If the patient increases the dietary sodium by eating pizza, pickles, and processed food, among others, the patient is likely to experience a sudden increase in total body fluid, which can cause the patients dyspnea. Although older adults with HF complain of anorexia, bowel habits are not as likely to be affected by hypervolemia as is the appetite. Coughing is a nonspecific, nonsensitive indicator of pulmonary edema. TOUHY 4TH ED TESTBANK

The nurse identifies which of the following intervention(s) in the treatment of fungal infections? (Select all that apply.) a.Eliminate the conditions that created the problem. b.Lubricate affected area daily with moisturizing lotion. c.Thoroughly clean and dry skin daily. d.Use an antibacterial cleanser daily. e.Apply miconazole (Micatin) as directed.

ANS: A, C, E Eliminating the conditions that created the problem will decrease the occurrences. The skin should be cleaned with a mild soap or cleansing agent daily, and the skin should be thoroughly dried. Lotion should not be used because it traps moisture. Antifungal medications should be used 7 to 14 days or until the fungal infection is completely cleared. TOUHY 4TH ED TESTBANK

Which of the following is(are) the risk factors for vascular dementia (VaD) after a stroke? (Select all that apply.) a.Smoking b.Male sex c.Hypertension d.Advancing age e.Hyperlipidemia f.African American

ANS: A, C, E Smoking, hypertension, and hyperlipidemia are all risk factors for VaD after a stroke. Male sex, advancing age, and African-American ancestry are risk factor for VaD. TOUHY 4TH ED TESTBANK

A nurse will be conducting an education session at the local senior citizens center on the importance of physical activity. Which activities should the nurse include as an example of moderate-intensity aerobic activity? (Select all that apply.) a.Biking b.Range of motion (ROM) c.Weight lifting d.Dancing

ANS: A, D Biking and dancing incorporate large muscle groups and are classified as moderate-intensity aerobic activity. ROM exercises are classified as stretching activities. Weight lifting is considered an exercise that uses body weight and is a muscle-strengthening activity. TOUHY 4TH ED TESTBANK

Which home modification interventions are designed to enhance the ability of older adults to remain in their homes? (Select all that apply.) a. A 36-inch-wide doorway b. Entryways with less than two steps c. Electrical outlets at chest level d. A bathroom on the first floor

ANS: A, D Many state and local governments are assessing the community and designing interventions to enhance the ability of older people to remain in their homes and familiar environments. Home design features such as 36-inch-wide doorways and hallways, a bathroom on the first floor, an entry with no steps, outlets at wheelchair level, and reinforced walls in bathrooms to support grab bars. TOUHY 4TH ED TESTBANK

Which of the following patient(s) does the nurse identify as at risk for developing fungal infections? (Select all that apply.) a.Obesity b.Multiple sclerosis c.Impaired mental status d.Incontinent e.Bedridden

ANS: A, D, E Prevention is prioritized for persons who are obese, bedridden, incontinent, or diaphoretic. Patients with multiple sclerosis may develop skin infections but are not at high risk. Patients with an impaired mental status can often be incontinent, but this condition, in itself, does not predispose the patient to fungal infections. TOUHY 4TH ED TESTBANK

Which types of exercise programs are better for older adults with AD for improving mood and function? (Select all that apply.) a.Balance b.Walking c.Self-paced d.Endurance e.Muscle strength f.Lasting 16 weeks or longer

ANS: A, D, E, F Older adults with AD can benefit from regular exercise as demonstrated by more positive affect and mood, improved function, and less disability. Suitable exercises for older adults with AD include exercises that improve balance. Exercises that improve endurance and exercises for muscle strengthening are also both suitable for the older adult with AD. Research data support the claim that exercise programs lasting 16 weeks can help improve function and mood of older adults with AD. Endurance, strength, and balance exercises help improve patients with AD more than walking. Self-paced exercises are unlikely to be suitable for a patient with AD because of cognitive dysfunction TOUHY 4TH ED TESTBANK

An older woman is brain dead, and the attorney-in-fact or surrogate named in her DPA is opposed to organ donation; the law in the state allows a surrogate with a DPA to make end-of-life decisions. Although she failed to document it, her family states that she wanted to donate her organs. Given the law about a DPA, what does the nurse expect the surrogate to do? a.Deny consent. b.Provide consent. c.Refuse to decide. d.Get a second opinion.

ANS: B A DPA acts at the pleasure of the designator, can manage the designators finances, and functions as the designators health care surrogate, making judgments for the designator using substituted judgment when the designator is unable to do so. Therefore, in accordance with the law and the womans wishes according to her family, the surrogate should provide consent for organ harvesting. It is against the law and unethical for the DPA for this older adult to deny consent for organ harvesting. Because the attorney-in-fact named in the DPA is her health care surrogate, the attorney-in-fact must make a decision on behalf of the woman and cannot refuse to do so. The attorney-in-fact can get another opinion on the older adults neurological status but not as a way to avoid the decision concerning organ harvesting. TOUHY 4TH ED TESTBANK

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

ANS: B A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15-years experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gerontology, these nurses provide primary care in a nursing home. TOUHY 4TH ED TESTBANK

Which of the following describes the nurses role for an older patient with a chronic illness? a.Implement an individualized therapeutic regimen that brings about a cure. b.Provide caring to help the patient live at the optimal level of health and wellness. c.Suggest that the patient accept eventual death to reduce the burdens on the patients family. d.Encourage the patient to minimize the use of services to control costs.

ANS: B A chronic illness cannot be cured, but with caring, the nurse can assist the patient to live without being dominated by the demands of the illness. Chronic illnesses are long-term problems, and cures are not usually available. If a patient has an incurable illness, then the nurse can provide a caring environment to facilitate the implementation of the patient and familys wishes. The nurse can help the patient and family to formulate cost-cutting measures, if so requested; however, because the nurse is the patients advocate, the nurse avoids making recommendations about not using services. TOUHY 4TH ED TESTBANK

The nurse determines that an older adult who has chronic bronchitis is at high risk for falls, but he repeatedly tries to ambulate without assistance. Which alternative measure to restraints is contraindicated for this older adult? a.Inform the staff about his risk for falls. b.Place a concave mattress on the bed. c.Provide frequent walks in the hallway. d.Help him learn to use an assistive device.

ANS: B A concave mattress is a restraint alternative, but it is contraindicated for this patient who has chronic bronchitis because lowering the relative position of his torso in relationship to the head and lower extremities places extra pressure on the diaphragm and restricts chest expansion, which makes the work of breathing significantly more difficult for him and is contraindicated because chronic bronchitis is an obstructive breathing disorder. Communicating the risk for falls is a suitable alternative measure to restraints for him; it employs multiple people to observe, manage, and lower his fall risk. Providing frequent walks can be an effective restraint alternative for this older adult if he is restless or bored. Finally, the nurse can help him learn how to use an assistive device to help avoid the use of restraints. TOUHY 4TH ED TESTBANK

Which of the following statements is true about conservators? a.A conservatorship entails control over property, whereas a guardianship entails control over the person. b.The most legally restricting way individuals and property can be handled are through conservatorships and guardianships. c.Conservators cannot be members of the conservatees (patients) family. d.Because a conservatorship is the least restrictive alternative, a court hearing is not required.

ANS: B A conservator can be responsible for the conservatees property, person, or both. The conservatee is a ward of the conservator or guardian and has no decision-making rights and, in many states, has no legal right to sue to terminate the conservatorship or guardianship. The conservator is the individual appointed by the court; this person can be a family member or someone who has a conflict of interest. Conservatorship is a most restrictive alternative and requires a court hearing. TOUHY 4TH ED TESTBANK

Which of the following statements is true about diabetes mellitus? a.Type 2 diabetes is the result of the failure of the pancreas to produce insulin. b.Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dl. c.Noninsulin-dependent diabetes mellitus is another name for type 1 diabetes. d.The incidence of diabetes mellitus does not increase with age.

ANS: B A fasting plasma glucose reading of over 125 mg/dl is considered diabetes, whereas a level between 110 mg/dl and 125 mg/dl is considered to be impaired fasting glucose (IFG). Type 2 diabetes is present when insulin is produced but does not lower the blood glucose level. Type 1 diabetes was formerly called insulin-dependent diabetes mellitus, whereas type 2 diabetes was formerly called noninsulin-dependent diabetes mellitus. In the United States, approximately 8.7% of all adults have diabetes, whereas 18.3% of persons older than 60 years have diabetes. TOUHY 4TH ED TESTBANK

A dermatologist should promptly evaluate which one of the following skin lesions? a.Circumscribed, raised area resembling a blob of brown wax b.Multicolored raised lesion with a fuzzy border c.Bright red, glazed area with satellite lesions around it d.Brown spot on the skin with no raised area

ANS: B A multicolored raised lesion with a fuzzy border must be promptly evaluated; this lesion is a malignant melanoma. A circumscribed, raised area resembling a blob of brown wax reflects seborrheic keratosis. A bright red, glazed area with satellite lesions around it is a Candida infection. A brown spot on the skin with no raised area is lentigo. TOUHY 4TH ED TESTBANK

Which of the following statements is true about end-of-life care? a.The physician is the ultimate authority in the decision to use or not to use life-sustaining medical treatment. b.The proxy appointed in a living will cannot speak for the testator in health care matters other than terminal illness. c.A patient with dementia cannot be capable of making personal wishes known about life-sustaining treatment. d.The American Nurses Association encourages nurses to participate in assisted suicide.

ANS: B According to the Patient Self-Determination Act, the adult patient has the ultimate authority to accept or forgo treatment. By contrast, the health care advocate designated by a durable power of attorney for health care can speak for the patient in other health care matters. A study showed that up to 30% of patients with dementia understand the issues and can express their preferences. The American Nurses Association calls for nurses not to participate in assisted suicide. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about sleeping in older adults? a.Older adults tend to fall asleep quickly but are awakened throughout the night. b.Sleep disturbances in the older adult can be caused by cardiovascular disease, arthritis, or diabetes. c.Benzodiazepine agents are the medications of choice for sleep disorders. d.Selective serotonin-reuptake inhibitors (SSRIs) can alleviate sleep disturbances caused by depression.

ANS: B All of these physical problems, as well as arthritis, can contribute to sleep disorders. It takes older adults more time to fall asleep, and older adults are awakened throughout the night more frequently than younger people. Benzodiazepines should not be used to induce sleep; these substances are highly addictive, and if their administration is suddenly withdrawn, then rebound insomnia can occur. In addition, older adults who take benzodiazepines for sleeping are more likely to experience a hangover after waking that can increase the risk of accidents and injuries. In addition to alleviating depression that causes sleep disorders, SSRIs can have a stimulating effect that, in itself, interferes with the sleep cycle. TOUHY 4TH ED TESTBANK

Which of the following statements is true about a safe, effective care environment for older adults? a.Cold beer with steak and potatoes is a good meal for an older adult on a hot day. b.Older drivers are more likely to be in a fatal motor vehicle accident than younger drivers. c.Barrier-free buses and low fares make public transit a safe transportation option. d.A nurses perception of temperature is a useful guide for patient thermal needs.

ANS: B Although older adults have safer driving habits (e.g., less night driving, less driving in heavy traffic, shorter distances, less speeding or drunk driving) than younger drivers, the physical and sensory changes of aging contribute to a higher incidence of fatal accidents for older adults. Hot, heavy meals and alcohol should be avoided when ambient temperatures exceed 90 F. The fear of crime often deters older adults from using public transit. The older adults perception of temperature is the important factor. TOUHY 4TH ED TESTBANK

Which option is not a primary reason that documentation is important? a.Documentation enables the team to provide care to meet a residents individual needs. b.Documentation helps defend the nurse in the event of a possible lawsuit. c.Documentation enables a patient to receive consistent care from one shift to the next. d.Documentation is the basis for reimbursement to the facility.

ANS: B Although providing a defense in the event of a possible lawsuit should not be the primary motive for the nurse to keep accurate and thorough documentation, doing so is the best defense in the event of legal action against anyone involved in a patients care. Enabling the team to provide care that meets individual needs is a primary reason; documentation is necessary to ensure that the team has accurate and complete information about the residents specific conditions. Enabling the patient to receive consistent care is a primary reason; documentation enables nurses on later shifts to be aware of conditions that have developed and the actions that have been taken on previous shifts. Providing the basis for reimbursement is a primary reason; the use of standard documentation in applying for reimbursement is a matter of law. TOUHY 4TH ED TESTBANK

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

ANS: B Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease. TOUHY 4TH ED TESTBANK

The nurse is caring for a patient diagnosed with PD. Which tool should the nurse use to gather information from the patients perspective? a.The Geriatric Depression Tool b.The Sickness Impact Profile (SIP) c.The Mini-Mental State Examination2nd edition (MMSE-2) d.The Montreal Cognitive Assessment Tool

ANS: B The SIP is a useful tool that can be used by nurses to determine problems most troublesome from the patients perspective. The Geriatric Depression Tool measures depression, and the MMSE-2 and the Montreal Cognitive Assessment Tool measures cognitive ability. TOUHY 4TH ED TESTBANK

Which of the following interventions should the nurse use when communicating with a hearing impaired older patient. a.Stand beside the patients chair when speaking. b.Always clearly identify yourself and others with you. c.Exaggerate your voice, depending on the cause of the hearing loss. d.Select colors for paint, furniture, and pictures with rich intensity.

ANS: B Always speak promptly, and clearly identify yourself and others who are with you. State when you are leaving to ensure that the person is aware of your departure. Get down to the persons level, and face him or her when speaking. Speak normally but not from a distance; do not raise or lower your voice, and continue to use gestures if doing so is natural to your communication. Selecting colors for paint, furniture, and pictures with rich intensity is for the visually impaired, not those with a hearing impairment. TOUHY 4TH ED TESTBANK

Which is characteristic of relocation stress syndrome in a resident of a long-term care facility? a. Agitation b. Apprehension c. Caring family d. Hallucinations

ANS: B Apprehension is a major defining characteristic of stress relocation syndrome. Agitation is uncharacteristic of stress relocation syndrome. An inadequate support system is characteristic of this syndrome. Hallucinations are uncharacteristic of this syndrome. TOUHY 4TH ED TESTBANK

Which intervention should the nurse use to decrease the risk of burns during mealtime in patients with mental and physical impairments? a.Wait until the drink has cooled. b.Assist patients with warm drinks. c.Use plastic mugs instead of ceramic. d.Serve only cold beverages to patients at risk.

ANS: B Assist patients who have deficits with warm drinks. This intervention prevents oral trauma and burns from possible spills. The use of plastic mugs does not prevent the spilling of hot liquids. All patients have the right to foods and drinks served at different temperatures. Serving only cold drinks violates a patients rights. TOUHY 4TH ED TESTBANK

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

ANS: B Because dysfunction or a structural abnormality is thought to cause disease, the biomedical system believes in repairing the structural abnormality. The holistic system holds that health is attained through balance. The personalistic system uses treatments such as meditation, fasting, and praying. The magicoreligious system is the same as the personalistic system. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about heart disease in older adults? a.Myocardial infarction (MI) has many of the same symptoms in older patients as in middle-aged persons. b.Both excessive urination at night and decreased urination can be signs of heart failure (HF). c.Any exertion on the part of an older adult patient with heart disease can bring on another heart attack. d.A person with HF is likely to have trouble breathing, except when lying down.

ANS: B Because the heart is an ineffective pump in HF, both excessive urination at night and decreased urination can occur when older adults have an MI. Nocturia occurs in HF when the heart is unable to maintain adequate renal blood flow in the performance of daily activities; then, during the night when the patients lower extremities are elevated for sleep, the heart is able to perfuse the kidneys with the assistance of increased venous return owing to the elevated extremities. Inadequate urine production is due to inadequate perfusion from an ineffective pump. The classic presentation of angina pectoris in older patients is often absent in what is known as a silent MI, with only mild discomfort, perhaps even limited to nausea or heartburn as the only symptom. Failure to engage in cardiac rehabilitation exercises is more likely to result in another MI or be an aggravation of HF than ordinary exertion. A person with HF is more likely to have difficulty breathing except when the trunk is upright (orthopnea). TOUHY 4TH ED TESTBANK

Which medication is correctly matched to the condition given of an older adult patient according to current medical knowledge? a. Methylphenidate (Ritalin) for depression at bedtime b. Buspirone (BuSpar) for chronic anxiety states c. Amitriptyline (Elavil) for depression in the morning d. Haloperidol (Haldol) long-term for psychotic behavior

ANS: B Buspirone (BuSpar) is safer for older adults with anxiety than benzodiazepines. Because it can take up to 5 to 7 days for the therapeutic benefit to be realized, it should be used only for chronic anxiety. Stimulants such as methylphenidate (Ritalin) should be administered in low doses in patients with chronic depression. To prevent insomnia, extended-release forms should be administered early in the morning and short-acting forms at the latest in the early afternoon. Tricyclic antidepressants such as amitriptyline (Elavil) are contraindicated for use with older adults because of the risk for anticholinergic and sedative effects. Tricyclic antidepressants have been replaced with selective serotonin reuptake inhibitors (SSRIs), which are more effective at lower doses with fewer side effects. Antipsychotic agents such as haloperidol (Haldol) can cause extrapyramidal effects, especially in older adults. For long-term administration, they should be used only after a thorough psychiatric evaluation. TOUHY 4TH ED TESTBANK

The most detrimental illness or condition that an older adult with deafness that occurred at birth can experience is which one of the following? a.Aphasia b.Cataracts c.Glaucoma d.Osteoarthritis

ANS: B Cataracts can have a potentially devastating impact on the life of an individual with prelingual deafness because sign language is the primary source for communication. Without the ability to read signing or lips accurately, the older adult who has a cloudy lens is unable to receive communication except by Braille. Aphasia has the potential to affect the individuals life; however, with adequate vision, some means of communication can remain viable. Glaucoma would not devastate the individuals ability to read sign language unless blindness occurred. Effective treatment should help maintain the individuals baseline visual acuity. Osteoarthritis can make signing more difficult for an individual with prelingual deafness, but it is not nearly as devastating to the ability to communicate as a cloudy lens from cataracts. TOUHY 4TH ED TESTBANK

An older woman has severe osteoporosis in the long bones, impaired mobility, and chronic pain. Which acute illness or condition is this woman most likely to experience as a result of osteoporosis? a.Peripheral neuropathy b.Chronic stable depression c.Intertrochanteric fracture d.Opioid analgesic addiction

ANS: B Chronic pain is more likely to cause depression than osteoporosis. This woman has no predictive indicators for a peripheral neuropathy. A hip fracture from the greater to the lesser trochanter because of osteoporosis is the most likely acute condition this older adult will face, because osteoporosis commonly attacks long bones and the proximal end of the femur, in particular. As a result, the older woman is more likely to fracture her hip and then fall than she is to fall and then fracture her hip. Research data support the claim that individuals with real pain have a low risk of dependency. TOUHY 4TH ED TESTBANK

Which is a common age-related physical change that may affect digestion and food intake? a.Loss of the majority of taste buds b.Decreased motility in the esophagus c.Decreased cholecystokinin secretion d.Loss of smell

ANS: B Decreased motility in the esophagus is a common age-related change and can affect the ease of swallowing. A loss of the majority of taste buds is not a common age-related physical change. A small number of taste buds are lost beginning around 60 years of age, but it does not affect all flavors equally. Decreased cholecystokinin secretion is not common; however, increased cholecystokinin secretion is. A loss of smell is not a common age-related physical change. TOUHY 4TH ED TESTBANK

The nurse prepares to administer diltiazem (Cardizem LA) to an older adult with ischemic heart disease. When is the optimal time to administer this medication to help prevent complications of heart disease associated with rhythmical variations? a.Midday c.At breakfast b.At bedtime d.Every 4 hours

ANS: B Diltiazem is a calcium-channel blocker used for hypertension, heart rate control, and angina from ischemic heart disease. To take advantage of rhythmical variations in heart disease, the best time to administer long-acting diltiazem (Cardizem LA) is at bedtime; the medication will then be active in the early morning hours when a cardiovascular event is most likely to take place. Midday administration is a less advantageous time for the medication administration because the main period of drug activity will occur in the evening. Morning administration is too late for administration because morning administration misses the critical period around 4 and 5 AM. Administering Cardizem LA every 4 hours is contraindicated because it is a long-acting formulation meant to be administered once daily. TOUHY 4TH ED TESTBANK

Which of the following is most likely to be true about caring for an older African-American patient? a.The patient can expect to find support from his church after discharge. b.During a physical assessment, an examination of the interior of the patients mouth with adequate light is important. c.The patient may follow hot-cold beliefs. d.African Americans may avoid eye contact when interacting with others.

ANS: B During a physical assessment, an examination of the interior of the patients mouth with adequate light is important; this statement is true because skin pigmentation can conceal some clinical signs such as cyanosis, which are more visible in the buccal cavity. Although the church is a source of support for many older African Americans, it should not be assumed at the expense of other forms of support. Traditional Chinese medicine is based on hot-cold beliefs, not African-American beliefs. Avoidance of eye contact has not been identified as a cultural practice for African Americans. TOUHY 4TH ED TESTBANK

To help older adults maintain a healthy mental state, the nurse plans activities at a community center to promote the developmental stages of older adulthood. Which nursing intervention is suitable for the nurses plan? a.Screen for communicable diseases common among older adults. b.Participate at a soup kitchen for other people who are homeless. c.Plan a safety program about falls, fire safety, and home security. d.Have speakers emphasize the need for isolated self-exploration.

ANS: B Eriksons developmental stages for older adulthood include generativity, which is the concern for the establishment and guidance of the next generation. The nurse helps older adults accomplish this task by organizing their participation at a soup kitchen; socially valued work is a method of expressing generativity. This activity is likely to improve an older adults self-concept because it demonstrates that the individual is able to extend the self for the benefit of others. Screening for communicable diseases can help maintain a healthy mental outlook by avoiding major illnesses and the consequences of those illnesses that can lead to depression and anxiety; however, this intervention is unrelated to the tasks associated with Eriksons stages of development. Planning a safety program helps instill peace of mind and prevent injury, but it is also unrelated to the stages of development. Promoting isolated self-exploration is counterintuitive to Eriksons stages of intimacy versus isolation. TOUHY 4TH ED TESTBANK

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

ANS: B Exercises that improve muscle strength are important for balance, strong bones, and metabolic processes. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle definition is a quality valued by bodybuilders, but it is not a therapeutic concern. TOUHY 4TH ED TESTBANK

An older adult who has OA receives a prescription for alendronate (Fosamax). Which instruction should the nurse include in patient teaching? a.Use with a bisphosphonate medication. b.Is available for oral use. c.Take this medication for up to 2 years. d.Consume up to 600 mg of calcium daily.

ANS: B Fosamax is available for oral use. This medication is bisphosphonate therapy. No time limit on administration exists. The nurse instructs the patient to consume 1200 mg of calcium daily. TOUHY 4TH ED TESTBANK

Which of the following statements is true about the role of grandparents? a.The usefulness of grandparents declined with the advent of the industrial age. b.Today, many grandparents are the primary caregivers of their grandchildren. c.The value of grandparents is to provide gifts to younger family members. d.Traditionally, parents are subordinate to the grandparents in caregiving.

ANS: B Grandparents have always had an important role to play and have become more important than ever in recent decades. An increasing number of parents have been unable to provide necessary care for their children as a result of personal problems; often, grandparents fill the gaps. Grandparents provide continuity, family tradition, and accumulated wisdom. Parents are still expected to be the primary caregivers. TOUHY 4TH ED TESTBANK

The nurse wants to begin helping a resident who is overweight and has urinary incontinence with healthy bladder behavior skills. Which intervention should the nurse implement? a.Begin a low-calorie diet for weight management. b.Schedule voiding at 2- to 4-hour intervals. c.Instruct the resident to practice abdominal exercises. d.Reduce the time between an urge to void and voiding.

ANS: B Healthy bladder behavior skills include scheduling voiding at 2- to 4-hour intervals for residents either independently or with prompting. Beginning a low-calorie diet can be a reasonable approach to urinary incontinence, but the nurse first applies low-cost behavioral techniques. Pelvic floor exercises will help control urinary incontinence. Bladder training involves increasing the time between the urge to void and voiding. TOUHY 4TH ED TESTBANK

An older woman recently lost her brother, provides care for her husband who has health needs, and must move to a new location after 35 years in the same home. When she comes to the primary care facility with clinical indicators of influenza, the nurse recognizes which of the following? a.She is exhibiting attention-seeking behaviors. b.Crises and stressors can impair physical health. c.Her greatest need is respite care for her husband. d.Crisis leads to a lower functional status for the victim.

ANS: B Her resistance to disease is likely to be lower as a result of the effects of heavy stresses acting simultaneously. She may be seeking attention, but that does not make the stress and illness any less real. Her greatest need at this moment is to be treated for influenza. Respite care may be necessary, but it is not sufficient. Successful coping with a crisis may lead to a higher level of functioning. TOUHY 4TH ED TESTBANK

The primary difference between the Loss Response Model (LRM) and the Worden model of grief is which of the following? a.In the Worden model, those grieving pass through stages in order. b.The LRM uses a systems approach that acts to uphold stability. c.In the Worden model, the system helps maintain equilibrium. d.In the LRM model, those who are grieving transition through several stages.

ANS: B In the LRM, a systems approach is used to explain grieving wherein the system responds to the loss with chaos at first and then works to restore equilibrium. The Worden model describes grieving as a series of evolving tasks that do not necessarily occur in a distinct order. TOUHY 4TH ED TESTBANK

Which interaction between each prescription and food or nutritional supplement is favorable? a.Warfarin (Coumadin) and ginkgo biloba b.Terazosin (Hytrin) and increased fluids c.Lithium (Eskalith) and low-sodium diet d.Warfarin (Coumadin) and leafy, green vegetables

ANS: B Increased fluids can combat the hypotensive effects of alpha-adrenergic blockers such as terazosin. Ginkgo biloba can amplify the anticoagulant effect of warfarin, leading to an increased risk of bleeding. Reduced sodium intake contributes to the toxicity of lithium. Leafy, green vegetables can diminish the anticoagulant effect of warfarin (Coumadin). TOUHY 4TH ED TESTBANK

Which of the following statements is true about medications taken by individuals with diabetes mellitus? a.Sitagliptin (Januvia) is indicated to treat type 1 diabetes mellitus. b.Nateglinide (Starlix) increases the secretion of insulin. c.Metformin (Glucophage) increases the secretion of insulin. d.Rosiglitazone (Avandia) decreases glucose absorption.

ANS: B Meglitinides, such as nateglinide (Starlix), act by helping the pancreas release insulin. The use of sitagliptin (Januvia), a dipeptidyl-peptidase-4 inhibitor, is indicated for type 2 diabetes mellitus and acts by improving glucose-dependent insulin synthesis, lowering glucagon secretion and slowing gastric emptying. Metformin (Glucophage) acts by decreasing the release of glucose from the liver. Thiazolidinediones, such as rosiglitazone (Avandia), act by enhancing insulin sensitivity with hepatic glucose metabolism and by enhancing insulin-receptor kinase activity and phosphorylation. TOUHY 4TH ED TESTBANK

An older man was oriented and responded appropriately in the hospital, but he is now disoriented and confused in his home after discharge. Which of the following issues is the first that the home nurse should examine to determine whether an environmental issue is contributing to the patients condition at home? a.Complaints of shivering b.Temperature of household c.Types of food preparation d.Presence of radon

ANS: B Older adults are at higher risk of hypothermia in the community because hypothermia is difficult to detect and because, as hypothermia sets in, the older adult can respond to a lower temperature. This man has clinical indicators of hypothermia; therefore the home care nurse first assesses the ambient temperature for a baseline determination because the household temperature should have the most profound impact on his body temperature. Asking about shivering can be ineffective with an older adult who is confused and disoriented; the response can be incorrect. However, to display respect, the nurse should ask the question. The type of food preparation can offer additional clues about the older adults hypothermia and mental status; if he is eating cold foods such as sandwiches and yogurt, then he can be unwittingly contributing to the problem. Presence of radon in the home may lead to lung cancer, not confusion. TOUHY 4TH ED TESTBANK

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

ANS: B Older adults in most cultures usually have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is not uncommon for older adults to pray for cures or wonder what they did to incur an illness as punishment. The Ayurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of a holistic or naturalistic approach. TOUHY 4TH ED TESTBANK

Which one of the following older adults is most likely to need preretirement counseling to avoid significant concerns in retirement? a.African-American woman who is a certified public accountant b.Mexican-American woman who receives cash for cleaning services c.Middle-aged man who has a history of type 1 diabetes mellitus d.Older male clerk who works for the Department of Homeland Security

ANS: B Older adults with the most need for retirement planning are usually the same people who are least likely to receive it. The Mexican-American woman will most likely need preretirement counseling to avoid significant problems in retirement. She has three characteristics indicating a need for retirement planning: (1) her sex is female, (2) her job implies a lack of education or training, and (3) she does not pay into Social Security or federal taxes. Thus she can potentially fail to pay into the federal system for a sufficient length of time to be eligible for Social Security and Medicare benefits in retirement. In addition, her job is unlikely to offer a 401k plan. Although the African-American woman is a member of a minority group, she is a professional and likely to earn a significant income in a finance-related business. Her occupation and education places her well to receive significant retirement planning. The middle-aged man has one factor potentially associated with the need for retirement planningpoor health. The older clerk has one factor potentially associated with the need for retirement planninghe is likely to be a low-level employee. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about nutrition for older adults? a.The older person should be encouraged to practice strict controls on cholesterol intake to ensure protection against heart disease. b.Transportation can be a critical factor in nutritional insufficiency in older adults. c.Soul food is a concern primarily for the African-American culture. d.No government programs promote congregate dining among older adults.

ANS: B Older persons often have difficulty in obtaining adequate transportation to remote supermarkets and may choose light-weight but less nutritious food items rather than heavy fresh fruits and vegetables. Cholesterol phobia, or the excessive concern over cholesterol control, can contribute to malnutrition in older adults. Every culture has some particular foods and ways of preparing food that can bring great comfort for a person raised in that culture. Title VII of the Older Americans Act provides funding for outreach centers that serve social meals open to all older adults, regardless of their ability to pay. TOUHY 4TH ED TESTBANK

An OA-related fall necessitated hip replacement surgery for an older woman who is entering a rehabilitation facility. Which of the following is the nurses priority goal during this womans rehabilitation? a.Incorporate whole grains into her diet. b.Recapture preoperative mobility status. c.Keep the surgical wound clean and dry. d.Tell her to take two steps into the walker.

ANS: B Only 40% of people who have an OA-related fracture recuperate to their prefall mobility status; therefore the most important goal for the nurse is to plan care designed to restore her baseline mobility status. This comprehensive goal encompasses nutrition, exercise, rest, and physical therapy and prevents postoperative complications, such as atelectasis and pneumonia, impaired skin integrity, constipation, and dehydration, which can plague older adults. Increasing dietary fiber and nutrient-dense foods is an intervention to help maintain regular bowel habits and to repair and build tissue; it is integral to postoperative and rehabilitative care for an older adult but is not the highest priority. Preventing infection and promoting skin integrity are integral to postoperative and rehabilitative care for an older adult. Instructing the older adult about properly using a walker is an intervention and part of the primary goal of restoring preoperative mobility. TOUHY 4TH ED TESTBANK

Which of the following statements is true about analgesic medications for older adults? a.Opioids are less effective in older patients than in younger patients. b.Stool softeners and laxatives should be used with opioids. c.Over-the-counter NSAIDs are generally harmless. d.The dose limit for acetaminophen is difficult to reach for older adults.

ANS: B Opioids often cause constipation and necessitate bowel stimulation to prevent constipation. A bowel regimen should be instituted at the same time as opioid treatment. Because of changes in metabolism with aging, opioids have a greater and longer-lasting analgesic effect in older patients. NSAIDs can cause gastrointestinal bleeding, kidney and liver damage, and drug interactions with potentially fatal results. The maximum daily dose of acetaminophen is 4000 mg, and the limit is lower for patients with kidney or liver failure and patients who use alcohol. A typical dose is two 500-mg (extra-strength) tablets. TOUHY 4TH ED TESTBANK

A new nurse in a long-term care facility is caring for a patient with PD. The nurse should note which one of the following actions related to PD that is observed during the assessment? a.Tremors during sleep b.Cogwheel rigidity c.Frequent blinking d.Fast movements

ANS: B Patients with PD display slow movement, infrequent blinking, masked facies, and cogwheel rigidity. Patients with PD exhibit tremors at rest in their hands, arms, legs, feet, and jaw. TOUHY 4TH ED TESTBANK

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

ANS: B Polypharmacy contributes to sleep problems as a result of medication side effects and drug interactions. Decreased exposure to sunlight contributes to sleep problems. Sleep aids may assist with sleep issues. Decreased fluid intake may lead to dehydration, which may result in lethargy. TOUHY 4TH ED TESTBANK

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

ANS: B Poor cognitive functioning, depending on others for ambulation, living in a residential facility, and having four chronic illnesses are factors that increase the risk of chronic dehydration. An overuse of diuretic agents is more likely to cause acute dehydration. Dry mucous membranes are reliable indicators of chronic dehydration. Fluid loss from vomiting leads to acute dehydration. TOUHY 4TH ED TESTBANK

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

ANS: B Projections are that 20% of the American population will be older than 65 years of age by 2050, with those older than 85 years showing the greatest increase in numbers. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be over the age of 60 years than those under the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age. TOUHY 4TH ED TESTBANK

Which of the following should the nurse use to assess a nonverbal older adult for delirium? a.Cranial nerves XI and XII b.Confusion Assessment Method c.MMSE-2 d.Controlled Word Association Test

ANS: B The Confusion Assessment Method is a tool for measuring delirium in patients who are intubated or nonverbal. Assessing the accessory (CN XI) and hypoglossal (CN XII) cranial nerves provides clues about the patients ability to swallow. The nurse uses the Controlled Word Association Test to assess for a neurologic cause of an older adults cognitive dysfunction. This tool is an index of frontal lobe functioning and provides an assessment of executive function, including the patients frontal lobe functioning and his or her ability to refrain from distraction and perseveration. The MMSE-2 is a valid and reliable tool to assess cognitive function; however, it is unable to pinpoint discrete areas of neurologic dysfunction. TOUHY 4TH ED TESTBANK

An older woman is recovering from a bowel resection in the intensive care unit but remains intubated and on a mechanical ventilator. Which of the following should the nurse implement to help prevent delirium in this woman? a.Assess cognition with MMSE-2. b.Provide uninterrupted periods of rest and sleep. c.Maintain adequate sedation and pain management. d.Cover the patients eyes with protective ophthalmic ointment.

ANS: B Providing uninterrupted periods of rest and sleep is a challenge for the nurse in intensive care. Because of the nature of the patients illnesses, nurses administer medications and treatments and perform invasive procedures on a 24-hour basis, leaving patients little time for rest. Many patients become delirious in the intensive care unit because the noise, activity, brightness, and disturbance tend to persist around the clock, which contribute to delirium. Patients lose their sources for maintaining orientation and stability; that is, bright lighting at all times, as well as unfamiliar and abrupt increases in noise, can lead to a disruption in the circadian rhythm. In addition, patients in intensive care are more likely to receive multiple medications, and medications that are potentially harmful can aggravate the patients cognitive difficulties. Because this patient is intubated and on mechanical ventilation, the nurse cannot apply the MMSE-2; the patient is unable to perform adequately. Besides, assessing for dementia is not a prophylactic measure. Sedation and pain management, although often needed in the intensive care unit, can contribute to delirium. Covering the eyes of a patient in intensive care with ointment can be necessary to prevent corneal damage; however, it is likely to contribute to delirium because the patient will be unable to see clearly. TOUHY 4TH ED TESTBANK

As the nurse admits an older woman to a long-term care facility from her home of 50 years, she mistakes the nurse for her daughter. Which diagnosis does the nurse use to plan care for this woman? a.Hypoxia as a result of chronic disease b.Relocation stress syndrome c.Alzheimer disease (AD) d.Attention-seeking behavior

ANS: B Relocation, especially if sudden, causes stress that may lead to altered mental status. Many conditions other than hypoxia can cause altered mental status, including relocation stress. Many conditions other than AD can cause altered mental status, including relocation stress. The nurse has no confirmatory evidence to regard the older womans error as something other than a mistake; in addition, it can be understood as relocation stress syndrome. TOUHY 4TH ED TESTBANK

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

ANS: B Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis. TOUHY 4TH ED TESTBANK

A nursing home resident who has type 1 diabetes mellitus is gradually requiring more and more insulin on an as-needed (PRN) basis to treat hyperglycemia. Which of the following should the nurse assess to plan care for improving this individuals glucose metabolism? a.New-onset urinary tract infection b.Trends over time in activity level c.Sudden increase in caloric intake d.Big change in diabetic medication use

ANS: B Standard diabetic therapy includes diet, hypoglycemic agents, and exercise. If one aspect of the therapy changes, then the other two aspects must be adjusted to avoid hyperglycemia. Improving glucose metabolism is a huge benefit of exercise for the person with diabetes. In all people, exercise helps maintain aerobic conditioning, stabilizes mood, improves the quality of sleep, and is especially important for those with diabetes to promote and maintain collateral circulation. For this resident, a slow decline in physical activity will necessitate a change in the amount of insulin given or the total amount of daily calories to prevent hyperglycemia; however, the best solution for this resident is to increase daily physical activity. A new event is likely to cause an abrupt change in the serum glucose. Although infections are frequently detected in an individual with diabetes, infections are more closely associated with sudden-onset hyperglycemia. A sudden increase in caloric intake is likely to cause a sudden increase in blood glucose. A big change in medication use is likely to cause an abrupt change in the serum glucose. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about joints in older adults? a.OA is an inflammatory joint disorder. b.Surgical joint replacement can cure OA. c.Joint damage in OA is reversed with medication. d.Very old patients should avoid joint replacement surgery.

ANS: B Surgical joint replacement can cure OA and is the only cure for the disease. OA is a degenerative joint disease, whereas rheumatoid arthritis (RA) is an inflammatory process. Medications are used to control the pain of OA. The joint damage cannot be reversed except through joint replacement surgery. Surgical joint replacements are recommended even for those who are very old. TOUHY 4TH ED TESTBANK

An older patient complains of dry skin and asks for advice. Which advice should the nurse offer for improving dry skin? a.Add oil to the bath water to keep skin soft. b.Use tepid bath water. c.Move to a climate with lower humidity. d.Vigorously dry skin with a rough towel after bathing.

ANS: B Tepid bath water minimizes moisture loss from skin. Oil added to the bathtub increases the risk of slipping and falling, which can result in a catastrophic injury. Oils should be applied directly to moist skin after bathing. Humidity should be maintained at approximately 60%; the person may not be able to move. Vigorous, rough towel drying increases skin irritation. TOUHY 4TH ED TESTBANK

The nurse wants to use exercise according to the recommendations of the American Geriatrics Society (AGS) for an older woman who lost her balance and fell. Which nursing intervention is suitable for this older adult according to the AGS? a.Tell her to use an assistive device until her balance improves. b.Provide information on group exercises for balance training. c.Help her to learn how to exercise the core group of muscles. d.Instruct her to enroll in an exercise program for 8 weeks.

ANS: B The AGS states that group exercises can be effective to improve balance as part of a fall prevention program for older adults. Using an assistive device can help prevent falls; however, assistive devices are not part of an exercise program. Although the AGS states that the relationship between exercise and reducing the risk for falls is strong, the recommended type, duration, and intensity of the exercises are not clear. The AGS states that to improve balance with exercise, an older adult must participate in exercise for at least 10 weeks. TOUHY 4TH ED TESTBANK

An older man who is right-handed works as a carpenter, but he has been left with a flaccid right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the plan of care to help this man achieve his optimal state of health and wellness? a.Maintain skin integrity of right arm. b.Collaborate with occupational therapy (OT). c.Promote plaque-reversing strategies. d.Support effective coping mechanisms.

ANS: B The dominant arm, vital to the skill of a carpenter, is useless to this man unless he can adapt to the impairment with adaptive skills. Collaborating with OT is the most important goal for this older adult because adaptation is the greatest factor in establishing wellness, and OT can assist this man with adaptive tools, skills, and abilities to manage living with a flaccid dominant hand and arm. Maintaining skin integrity should be included in this mans plan of care because a flaccid extremity is at risk for skin breakdown, but it is not the first priority. Promoting plaque-reversing strategies, including diet and antilipid medication, should be part of this mans plan of care. However, these strategies are not the most important goal for this man; adaptation is the most important factor in establishing health and wellness. Supporting effective coping mechanisms is a goal that should be included in this mans plan of care; however, given the flaccidity of his dominant arm, the most effective measures toward adaptation are to help him develop the new skills and abilities he will need to cope effectively. Supporting effective coping mechanisms can help enhance the work of OT. TOUHY 4TH ED TESTBANK

An older patient who has end-stage pulmonary disease decides to accept care from the palliative care nurse. This older adult will most likely benefit from the palliative care nurse in which patient needs of Weismans six needs for the dying? a.Closure c.Composure b.Control d.Cohesiveness

ANS: B The dying patient is most likely to benefit from the care of the palliative care nurse by affording the patient as much control as possible, providing effective nursing care for symptom control and by providing continuity of care as the palliative care team directs total patient care. In providing control, the nurse asks the patient to determine activities and how time is spent. Palliative care can indirectly benefit the patient by providing a better quality of life at the end of life, but palliative care does not provide for closure. Nurses use countercoping techniques to help the patient maintain composure. Cohesiveness is not one of the six needs of a patient who is dying. TOUHY 4TH ED TESTBANK

The health care provider believes an older woman has approximately 6 weeks to live. After 2 months, the family remains at the bedside but, in the last few days, are becoming increasingly impatient and irritable. This pattern is least indicative of which of the following statements? a.Family is experiencing anticipatory grief for the older adult. b.Family desires that the patient be relieved of her misery. c.Anticipatory grieving can fail to attenuate acute grief upon death. d.Grievers deal more easily with known losses at known times.

ANS: B The family is not impatient because they want her death to take place and want her to be relieved of her misery; they are impatient because of the emotional fluctuations of waiting. The remaining three statements are true. TOUHY 4TH ED TESTBANK

Which role is most likely to have a significant effect on the type of aging process experienced by the older adult? a.Grandparent b.Spouse c.Friend d.Parent

ANS: B The loss of a spouse is likely to be devastating for an older adult for economic and biopsychosocial reasons. When an older adult loses a spouse, the loss can include economic security, especially for a woman, and societal roles. Alterations in these roles are not usually as challenging as the loss of a spouse. Grandparenting can offer the potential for enhanced social experiences for an older adult; however, adults can age well without them when more basic needs are met. Alterations in these roles are not always as acutely demanding as the loss of a spouse. Alterations in these roles usually call for little or a gradual adjustment. TOUHY 4TH ED TESTBANK

During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a.Exercise with light weights. b.Stand on one foot at a time while supported. c.Train with the use of sit-ups. d.Work out in a swimming pool.

ANS: B The loss of balance from a musculoskeletal perspective is usually due to a loss of core muscle strength, thus the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance. TOUHY 4TH ED TESTBANK

Which of the following statements is true about relationships of older adults? a. Loneliness is evidence of self-centeredness and an unwillingness to love. b. A person may be lonely even when surrounded by other people. c.Hostile behavior indicates that a person prefers to be left alone. d.A pet cannot substitute for human attention.

ANS: B The mere presence of other people, without significant personal exchange, does not prevent or alleviate loneliness. TOUHY 4TH ED TESTBANK

Which is the best goal when planning nursing care for an older patient with diabetes mellitus? a.Stabilize the serum glucose. b.Prevent disease progression. c.Set walking distance goals. d.Plan for consistent exercise.

ANS: B The most important goal for planning nursing care for a patient with diabetes mellitus is to prevent disease progression. Stabilizing the serum glucose, managing hyperlipidemia, controlling the blood pressure, preventing infection, maintaining a normal weight (if applicable), and obtaining regular medical evaluation will accomplish this goal. Stabilizing the serum glucose is a part of preventing disease progression. Setting goals for walking is part of a consistent walking regimen. Planning for consistent exercise is part of stabilizing the serum glucose. TOUHY 4TH ED TESTBANK

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

ANS: C The nurse demonstrates leadership in the care of older adults by initiating and coordinating collaboration with the wound care team to improve the health of an older adult. Screening and assessing are only indirectly related to collaboration. In this case, the nurses collaborative efforts are unrelated to facilitating access to a program. Thus far, the nurse has not educated or trained this patient in wound care. TOUHY 4TH ED TESTBANK

Which gerontological organization had a significant influence on the care of older adults? a.American Association of Retired Persons (AARP) b.John Hartford Foundation c.Medicare d.Mutual of Omaha Insurance

ANS: B The most significant influence in enhancing gerontological nursing has been the work of the Hartford Institute for Geriatric Nursing, funded by the John A. Hartford Foundation. The foundation seeks to shape the quality of the nations health care for older Americans by promoting geriatric nursing excellence to both the nursing profession and the larger health care community. Initiatives in nursing education, nursing practice, nursing research, and nursing policy include enhancing geriatrics in nursing education programs through curricular reform and faculty development and the development of nine Centers of Geriatric Nursing Excellence. AARP is a foundation that helps struggling seniors by being a force for change on the most serious issues they face today. Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees access to health insurance for Americans ages 65 years and older and younger people with disabilities. Mutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska. TOUHY 4TH ED TESTBANK

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

ANS: B The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Older adults tend to lose enamel. TOUHY 4TH ED TESTBANK

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

ANS: B The nurse assesses the older adults mental status. Changes in mental status, character of urine, decreased appetite, abdominal pain, chills, low back pain, urethral discharge in men, new onset of incontinence, or even respiratory distress may signal a possible UTI in older people. An indwelling catheter does not often cause a decrease in activity. TOUHY 4TH ED TESTBANK

An older man who has tinnitus complains to the nurse that it is very annoying. Which should the nurse implement to alleviate the stress he is experiencing from tinnitus? a.Irrigate the bilateral Eustachian tubes. b.Assess for modifiable risk factors. c.Propose a hearing aid and a masker. d.Use white noise to override the tinnitus.

ANS: B The nurse assesses the patient for risk factors potentially contributing to tinnitus that can be altered such as smoking cigarettes, consuming caffeine, drinking alcohol, experiencing fatigue, and taking medications that carry a high risk of causing tinnitus. Removing these potential offenders can help give the patient a sense of control, as well as provide potential relief from tinnitus. The nurse irrigates the external auditory canal for impacted cerumen to decrease the risk of tinnitus.. Although a hearing aid and a masker have the potential to alleviate tinnitus, introducing them can also serve as a potential source of additional stress, depending on the financial and functional status of the individual. Although white noise has the potential to alleviate tinnitus, it can be ineffective or serve as a potential source of additional stress. TOUHY 4TH ED TESTBANK

An African-American 58-year-old man in good health has a blood pressure at 120/73 mm Hg at his annual physical examination. Which of the following is the best goal for the nurse to use to assist him in maintaining his health and wellness into older age? a.Alter modifiable risk factors. b.Prevent cardiovascular disease. c.Recognize disease in early stage. d.Maintain tight glycemic control.

ANS: B The nurse assists this adult in maintaining health and wellness by helping him prevent cardiovascular disease; as an older African-American man, he has a high risk of stroke, hypertension, and diabetes mellitus. Furthermore, he is more likely to die of a stroke or heart attack than other people in the United States. To help him prevent cardiovascular disease, the nurse assists him with lifestyle modifications. Specific recommendations the nurse can make include getting regular exercise; learning the warning signs of heart attack and stroke; maintaining a normal weight; controlling blood pressure; eating a well-balanced, low-fat, no-added-salt diet; and avoiding smoking. Altering modifiable risk factors is a subgoal to preventing cardiovascular disease. Learning the early warning signs of disease is a subgoal to preventing cardiovascular disease. Although he has no clinical indicators of hyperglycemia, he is at risk for developing diabetes mellitus, which is an important subgoal of preventing cardiovascular disease for an African-American man. TOUHY 4TH ED TESTBANK

An older adult who recently had surgery complains of pain at the level of 3 out of 10 and constipation during the postoperative primary care visit. Which intervention should the nurse implement to first facilitate elimination? a.Encourage the use of a laxative. b.Review the medication list. c.Promote fiber in the diet. d.Suggest added fluid intake.

ANS: B The nurse begins by reviewing the medication list to find substances that are likely to cause constipation such as opioid analgesics and antidepressants, among others. If the patient is taking an opioid analgesic and because the patient rates the pain as 3 out of 10, then a change in pain medication can help relieve constipation. The use of a laxative can be contraindicated and is the therapy of last resort for constipation caused by factors other than opioid analgesics. Promoting fiber in the diet is a reasonable intervention but can be made unnecessary by omitting the opioid analgesic. Increasing fluid intake is a reasonable nursing intervention for older adults with and without constipation, but it can be unnecessary for this older adult. TOUHY 4TH ED TESTBANK

A patient loses her husband because of a sudden myocardial infarction, and she blames herself for not recognizing the warning signs. Which patient outcome associated with her loss should the nurse use to plan care? a.Meets her daily responsibilities b.Expresses feelings of guilt, fear, anger, or sadness c.Assesses the causes of the dysfunctional grieving processes d.Identifies problems connected to anticipatory grief

ANS: B The nurse plans care that will help this patient resolve her grief and will work to accomplish this by determining a suitable patient outcomethe ability of the patient to express feelings of guilt, fear, anger, or sadness within 3 months. Being able to express herself in this manner is part of the work of grief. Expecting the patient to meet her daily responsibilities is a nursing intervention suitable for dysfunctional grieving. Assessing the causes of the dysfunctional grieving processes is a nursing intervention suitable for the grieving patient. Identifying problems connected to anticipatory grief is a patient outcome suitable for anticipatory grief. TOUHY 4TH ED TESTBANK

An older man comes to the emergency department after falling at home, and he reports that he cannot walk without losing his balance. Which steps should the nurse implement for this patient? a.Arrange to transfer him immediately to the radiology department. b.Determine symptom onset or when he fell at home. c.Organize the reperfusion tissue plasminogen activator (tPA) infusion. d.Perform a comprehensive neurologic assessment.

ANS: B The nurse determines when the symptoms first appeared or the time of the fall to determine whether sufficient time is left to administer reperfusion tPA; if indicated, tPA must be administered within 3 hours of symptom onset. A patient with clinical indicators of a stroke will need a computed tomographic (CT) scan to differentiate between a thrombotic stroke and a hemorrhagic stroke; the type of stroke will determine the therapeutic course. The time of symptom onset is a vital piece of information that must be determined before the patient is referred to the radiology department because tPA is usually administered in the radiology suite. Administering tPA can be contraindicated for this patient; therefore the preparation of this infusion is delayed until the type of stroke and the plan of care are determined. The nurse will not have enough time to complete a comprehensive assessment and thus will perform a focused assessment in preparation for the trip to radiology. TOUHY 4TH ED TESTBANK

The older adult who has type 2 diabetes mellitus has a sensory impairment and unstable blood sugar levels. Which of the following alterations in sensory function does the nurse address in the plan of care for stabilizing the blood sugar? a.Requires reading glasses at 2.0 strength. b.Has difficulty hearing in crowded rooms. c.Enjoys spicy food more than bland food. d.Awakens with periodic left-foot numbness.

ANS: B The nurse focuses on the hearing impairment to plan care for stabilizing this patients blood glucose level; hearing impairment is a factor that affects blood glucose control in older adults with diabetes mellitus. Reading glasses at 2.0 are medium-strength glasses, and the need for such glasses is common and not considered a visual impairment. A preference for spicy food does not indicate an impaired sense of taste. Although numbness is a sensory impairment, episodic numbness associated with sleeping is more likely to be due to a poorly positioned extremity. TOUHY 4TH ED TESTBANK

The nurse is teaching older adults about maintaining health and wellness. Which recommendation should the nurse include in the teaching to maintain optimal vision? a.Take 50,000 units of vitamin A daily. b.Wear sunglasses that block sun rays. c.Read in good light to avoid eye strain. d.Visit the ophthalmologist every 5 years.

ANS: B The nurse helps older adults preserve their vision by recommending sunglasses that block harmful ultraviolet rays. Although vitamin A intake is encouraged to promote visual health and to relieve dry eyes, 50,000 units is a huge dose with the potential to cause liver damage; this dose is used to treat acne but only for limited periods. Reading in good light is usually easier for older adults; however, reading in poor light does not cause eye damage. An ophthalmologist should check the vision of an older adult every year. TOUHY 4TH ED TESTBANK

The nurse uses comfort measures to enhance an older adults pharmacological pain management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adults pain level? a.Older adults self-report b.Older adults pain diary c.FPS-R d.Pain medication frequency

ANS: B The nurse instructs the older adult to maintain a pain diary to help the individual achieve some control over the pain experience. The diary is then used to identify trends or the timing of pain and the relationships between the patients pain level and the comfort measures, activity, and pain medications. Many older adults report feeling useful and having some control over the pain, or at least the pain management program, through maintaining a pain diary. Self-reporting is one parameter used to evaluate pain, but drawing a relationship between the pain level and other factors is still necessary. The FPS-R is a reliable pain assessment tool, but the task remains to link the pain rating to other factors. The frequency of medication administration provides a clue about the patients pain level. TOUHY 4TH ED TESTBANK

The federal government requires the use of a specific standardized documentation tool for home nursing care. Which information must a home nurse add to the approved documentation tool? a.Activity b.Vital signs c.Functional d.Demographic

ANS: B The nurse must add the vital signs and information about the older adults health care beliefs to the OASIS. The nurse does not need to add information about the older adults activity level. The nurse does not need to add information about the older adults functional status. The nurse does not need to add demographic information about the older adult to the documentation tool. TOUHY 4TH ED TESTBANK

The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY) tool to plan an exercise program for a female resident who is in good health except that her height has decreased inch. Which exercise safety tip from EASY calls for the nurse to assess the resident before planning care? a.Do not exercise a red, warm, or swollen joint. b.Avoid stretches that cause you to bend at the waist. c.Evaluate your surroundings for outdoor exercising. d.Begin by warming up with low-to-moderate exercises.

ANS: B The nurse needs more information because the reason the residents height has decreased is not known. Therefore to obtain the information, the nurse decides to complete a resident assessment before planning an exercise program. The shrinkage can be due to atrophy of intervertebral discs, compression fractures, or changes in the curvature of the spine, any of which can be aggravated by incorrectly exercising. With a complete assessment, however, the nurse can plan a suitable exercise program for the resident. Red, warm, swollen joints are usually due to gout or rheumatoid arthritis; fortunately, the resident does not have these health problems. However, this is a good recommendation for anyone who exercises. Evaluating an individuals surroundings when exercising does not alert the nurse who is considering an exercise plan for this resident; however, this is a good, general recommendation for anyone who exercises. Warming up with low-to-moderate exercises is a good recommendation for anyone who exercises. TOUHY 4TH ED TESTBANK

When teaching a patient about foods that do not increase blood glucose, which should the nurse include? a.White bread b.Baked beans c.Broccoli d.Corn

ANS: C Broccoli does not raise blood glucose levels. White bread quickly breaks down to glucose and therefore tends to cause a rapid, brief rise in the blood sugar level. Whole grains provide a more sustained release of glucose and are a better source of carbohydrates. The blood glucose level increases after eating baked beans, but the rise will occur more slowly, reaching a lower level of hyperglycemia and remaining for a longer period. Corn is a starchy vegetable and will raise the blood glucose level almost as much as sugar itself. TOUHY 4TH ED TESTBANK

The nurse prepares for the arrival of older adults evacuated from a hurricane to a shelter for short-term care. Which of the following is the priority nursing intervention? a.Demonstrate that the staff is prepared to meet their needs. b.Use individual medical records to develop a medication plan. c.Help older adults display family photographs and memorabilia. d.Help older adults teach one another a new skill in the shelter.

ANS: B The nurse prepares for short-term care by prioritizing the needs of the older adults, and this intervention helps maintain the therapeutic plan, thereby addressing the need for physiological integrity. Furthermore, the nurse maintains continuity of care by preparing a medication schedule to prevent missed doses of medication. Providing safety and security from the storm is Maslows second most basic need. In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important but not in emergency conditions. A state of emergency is not the time to develop self-esteem; meeting safety, security, and physical needs are more important. TOUHY 4TH ED TESTBANK

An older adult with a gastrostomy tube has difficulty using the dominant hand. Which of the following should the nurse provide to prevent complications of the gastrostomy tube? a.Use foam swabs to brush the teeth. b.Provide oral care every 4 hours. c.Supply a soft tooth brush and floss. d.Position the patient at 90 degrees for tube feedings.

ANS: B The nurse provides oral care every 4 hours and brushes the teeth after meals to decrease the microorganism count in the mouth of an older adult with a gastrostomy tube. Foam swabs are ineffective tools to remove plaque, regardless of the toothpaste. Because this older adult has difficulty with the dominant hand, providing oral care supplies can be a waste of time, unless the nurse assists the older adult to maintain oral health with the supplies. The nurse positions the older adult at a 30- to 45-degree angle during tube feedings to facilitate gastric emptying. TOUHY 4TH ED TESTBANK

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

ANS: B The nurse provides regular toileting to promote voiding and to prevent incontinence for a resident with a potential cognitive impairment. The nurse avoids limiting oral fluid intake; older adults, especially those living in residential facilities, are at higher risk for dehydration than younger people. Using absorbent undergarments may be unnecessary if the incontinence can be controlled with regular toileting. Nursing research supports the claim that ambulatory residents are less likely to be incontinent. This resident may have dementia, but maintaining mobility will have a greater impact in preventing incontinence. TOUHY 4TH ED TESTBANK

An older adult admitted for back surgery asks for opioid pain medication. The nurse knows the patient asks for pain medication 15 minutes before it is due. Which recommendation should the nurse implement? a.Validate the pain with other assessment data. b.Administer the pain medication as requested by the patient. c.Tell the patient that it is too soon for pain medication. d.Teach the patient alternative comfort measures.

ANS: B The nurse should administer the opioid pain medication as requested because the patient is asking for the pain medication within the prescriptions time limit. Most institutions allow the nurse to administer opioid medications 15 to 30 minutes before the designated time on the prescription; therefore the patient is not asking for the medication too early. In addition, the nurse has an obligation to the patient to administer the pain medication; not doing so violates the patients rights. The nurse can rely on the patients report to determine the need for pain medication. As long as the timing is suitable and the patient is stable, the nurse should administer the medication. The nurse should use assessment data to support withholding pain medication in the presence of oversedation or another assessment that would be potentially aggravated by administering the pain medication. The nurse violates the patients rights by stating that it is too soon for the medication and ignores the possibility that the patients pain is real. Although the nurse may believe the patient is not having pain and is exhibiting drug-seeking behavior, the nurse must administer the medication. The nurse must administer the pain medication as requested. When patients are experiencing pain, most often, it is not the optimal time to teach patients. However, when the patients pain is under control, the nurse should teach alternative comfort measures. Comfort measures can be used to enhance the therapeutic effect of the medication and breakthrough pain. TOUHY 4TH ED TESTBANK

The children of an older woman ask the nurse for advice about helping their mother heal after her husbands (their fathers) death. Which strategy should the nurse share with the family? a.Appoint one family member to take her on outings. b.Coordinate family expressions of care and concern. c.Have each child plan a long trip with her assistance. d.Take her to community events to meet other people.

ANS: B The nurse suggests that the family work together to provide extended expressions of caring and concern for their mother; many small expressions of concern and caring from several sources help the bereaved gain the strength and confidence needed to survive a huge loss. Multiple small gestures are more likely to help build strength and confidence than a few large gestures. One person is unlikely to provide enough support for the bereaved, and this strategy can potentially imply that only one person is concerned. Helping a widow meet new people can be unsuitable; she may be uninterested or unwilling to attend events for meeting new people. In addition, she may feel that the family is trying to find a replacement for the deceased to ease the familys burden. However, the family can offer to accompany her to such events. TOUHY 4TH ED TESTBANK

The health care provider discusses the need for surgery with an older adult and her family. Which information about the older adults culture is important for the nurse to collect before this discussion to facilitate the process of informed consent? a.Attitudes about caregiving b.Process of decision making c.Rituals for death and dying d.Experience with discomfort

ANS: B The nurse uses knowledge of the cultures influence on the older adult in relation to decision making to avoid unnecessary tension and misunderstanding and thus to facilitate the process of informed consent. The nurse uses the information about decision making by sharing the cultural information with the health care provider and by addressing the culturally suitable member of the family for informed consent. Caregiving is unrelated to the process of informed consent. Death and dying, although potentially relevant, is unrelated to informed consent. Relevant to surgical procedures, the older adult and family experiences with pain and discomfort are important to the pain management plan. TOUHY 4TH ED TESTBANK

A home health nurse is completing an admission on a patient who recently experienced a transient ischemic attack (TIA). During the assessment, the patient begins to complain of a severe headache and numbness in his left arm. Which action should the nurse take next? a.Instruct the patient to take Tylenol. b.Ask whether patient suffers from migraine headaches. c.Reschedule the visit. d.Call 9-1-1.

ANS: D The home health nurse should immediately call 9-1-1. Approximately 24% to 29% of those who have a TIA will have a stroke within 5 years after the event (Goldstein, 2011). Tylenol would not be advised. The nurse should not leave the patient until the patient is en route to the emergency department. TOUHY 4TH ED TESTBANK

Although the older man who was forced to retire from law enforcement has multiple physical complaints, the primary care health care provider finds nothing abnormal. After the man tells the nurse that his girlfriend just left him, which of the following is the priority nursing intervention to complete before the older adult leaves? a.Ask him how he plans to cope with his loss. b.Use direct questions about access to firearms. c.Collaborate with his provider for antidepressants. d.Allow him to express himself by intently listening.

ANS: B The nurses priority intervention is to ask him directly about his access to firearms; he has familiarity with guns, and the risk factors for suicide in older adults include male gender, physical complaints of unknown causes, and having suffered a recent loss. Asking him how he plans to cope with his loss is a reasonable intervention for the nurse to include in the plan of care for this older adult in light of his risk factors for suicide. Collaborating with his provider for antidepressants is a reasonable intervention for the nurse to include after a comprehensive assessment of this older adult. Allowing him to express himself by intently listening is a reasonable intervention for the nurse to include because it helps the nurse establish a trusting, caring relationship with this older adult. TOUHY 4TH ED TESTBANK

Which assessment finding of an older adult living in an assisted-living facility indicates the highest risk for suicide? a.Liver failure is due to alcohol abuse; older adult is popular at meals. b.Older adult declines company; is preoccupied with lethal weapons. c.Refuses to allow a large, extended family to help him. d.Older adult had an overdose of acetaminophen 20 years ago; is in a sewing group.

ANS: B The older adult who prefers to be alone and is preoccupied with lethal weapons has two risk factors for suicide. This individual warrants close observation for additional risk factors and verbalization and indicators of future suicide attempts. The nurse should also increase the frequency of observations and account for his whereabouts at all times. The individual who has a serious illness and a history of alcohol abuse has two risk factors for suicide. However, this older adult also relishes social interaction, which is an indication that suicide is less likely to be imminent or even in the individuals thoughts. The older adult who will not accept help from the family exhibits a potential risk factor for suicide or is an exceedingly proud individual who wants to be self-sufficient. History of a suicide attempt is a risk factor for suicide; however, the acetaminophen overdose could have been accidental. TOUHY 4TH ED TESTBANK

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

ANS: B The practices of advanced practice nurses, who base their practice on nursing research, have resulted in positive older adult outcomes and cost effectiveness. The scientific community widely accepts the research. Advanced practice nurses generate positive outcomes and are cost effective in many settings. Mezey and Fulmer believe the goal of gerontological nursing is to disseminate the knowledge from gerontological nursing research to all nurses and to have the knowledge applied to their practices. TOUHY 4TH ED TESTBANK

Which is the fundamental difference between Medicare Part A and Medicare Part B? a.Hospice care b.Health care setting c.Home care services d.Invasive procedures

ANS: B The primary difference between Medicare Part A and Part B is the care setting. Part A covers acute, inpatient care and some specialized care. Part B covers some costs of outpatient and ambulatory services. Hospice care is not a difference; Part A and Part B coverage is no longer available for a patient in hospice care. Home care services are not included in Part B, therefore home care cannot be compared with Part A. Invasive procedures are potentially covered by both Part A and Part B. TOUHY 4TH ED TESTBANK

The nurse can place an older adult into one of four patient rooms. Which is the most suitable room for an older adult? a.Brightly lit, blue room with cozy throw rugs b.Room with orange carpeting and soft lighting c.Brightly lit, blue room with waxed vinyl floors d.Room for television and childrens playtime

ANS: B The soft lighting avoids glare, and the carpet provides better traction than a glossy floor. Lamps should be added to supply more light when desired. Throw rugs easily slip, and older adults can trip on them, resulting in injury. The patients feet should not be able to glide easily across the floor, and when the surface becomes wet, a waxed floor can be very slippery. The patient may stumble over children and toys. TOUHY 4TH ED TESTBANK

The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use? a.Two full-length rails b.One -length rail c.No side rails d.Four -length rails

ANS: B The use of one -length rail is not considered a restraint; it can be used to assist the patient in getting in and out of bed. Two full-length rails and four -length rails would be considered a restraint. The use of no side rails is not considered a restraint; however, the use of one rail to maneuver in and out of bed may be most beneficial to the patient. TOUHY 4TH ED TESTBANK

An older man dislikes the daily meal he receives from his family because it is always cold. He is underweight and has a hemoglobin of 11.2 g/100 ml. Which recommendation should the nurse implement? a.Assess the man for a potential transfer to an assisted living facility. b.Meet with the man and his family to solve the problem. c.Collaborate with a social worker for food stamps. d.Ask the family about providing hot meals for him.

ANS: B This man is underweight and has low hemoglobin and potential signs of malnutrition. The nurse uses education and a problem-solving approach for adults who have nutritional deficiencies and live in the community; thus meeting with the family and the older adult will manage the malnutrition and improve this mans nutritional status. Although assessing the man for transfer to an assisted living facility can be an option, implementing a transfer would be premature before other attempts are made to resolve the problem. Sources for food are not this mans problem unless the family-supplied meal is his only source of food, which is unknown. This can be a part of education and problem solving. The best chance of improving this mans malnutrition is to engage him in the plan; thus the nurse avoids contacting the family except to engage them in problem solving along with the older adult. TOUHY 4TH ED TESTBANK

After the loss and burial of a beloved pet, an older man loses weight because he eats very little. Three months later, he starts to paint pictures of the pet and his appetite slowly improves. Describe this individuals mourning for his pet. a.Weight loss from inadequate intake b.Pets burial and painting pictures of the pet c.Loss of his appetite resulting in weight loss d.Increased food intake after painting begins

ANS: B This older adult mourns and incorporates into his life the loss of his pet by burying the pet and then by memorializing the pet in pictures he created. Weight loss from inadequate intake: grief is displayed by a decreased appetite that results in weight loss; the older adults response is not weight loss, it is anorexia. Loss of his appetite resulting in weight loss: grief is displayed by a decreased appetite that results in weight loss. The transition from the loss through the burial to painting the pictures is how this man mourns his pet; the improved appetite is a result of effective coping and mourning. TOUHY 4TH ED TESTBANK

The nurse assesses a resident who was transferred yesterday from an acute care hospital. Which should the nurse assess to determine whether this individual is under stress from the transfer? a.Length of the residents stay in the acute care facility b.Availability of disposition options before the transfer c.Presence of familiar people throughout the transfer d.Tour of the new facility shortly after transfer

ANS: B To help assess the resident for stress, the nurse reviews the sequence of events that led to the relocation including whether the resident had relocation options and what those options were before relocation. If the resident played an active role in the choice of facilities and had several available options, then the resident is likely to experience less stress upon relocation. The length of stay in the acute care facility is an unreliable index of stress in a resident who has been recently relocated. The presence of familiar people is an unreliable predictor of relocation stress. Touring the new facility is an unreliable predictor of relocation stress; if the tour is conducted too soon or when the resident is in pain, tired, or distracted, then the resident is unlikely to benefit from the tour. TOUHY 4TH ED TESTBANK

A family that has three small children prepares to move an older female parent into their home knowing that she stays up all night. The nurse helps the family prepare for the change. Which part of planning should the nurse indicate is the familys priority? a.Sharing household responsibilities b.Preparing the house for her arrival c.Helping her use her skills and talents d.Setting limits on nighttime activities

ANS: B To reduce the risk of injury and falls, the familys priority is to prepare the house for an older adults arrival including preparing the parents private space, removing hazards, providing adequate lighting, installing handrails where necessary, and completing other safety measures. In addition, the parent needs to prepare mentally for the challenges presented when the children create new safety hazards for an older adult, such as spills and leaving toys on the floor. Sharing household responsibilities should be part of the preparation; however, safety concerns are more important. Helping the older adult to use her skills and talents provides meaningful activities; however, safety concerns are more important. Setting limits on her nighttime activities is important preparation to avoid conflicts; however, safety concerns are the priority. TOUHY 4TH ED TESTBANK

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

ANS: B When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and therefore validates the assessment about the older adults tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable discussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adults discomfort. Instructing the older adult to repeat the nurses instruction ignores the her needs. TOUHY 4TH ED TESTBANK

The nursing home staff needs assistance to feed properly the residents who need assistance with feeding. Which of the following should the nurse implement to ensure that the residents are properly fed? a.Instruct the feeding assistants to feed four people at a time. b.Draw on the availability of family members who are able to follow instructions. c.Ask some residents to self-feed for part of the mealtime. d.Assign a small group of nursing assistants to do the feeding.

ANS: B With adequate training and cooperation, the nurse allows family members to feed residents who need assistance with feeding. While the family is assisting with feeding, the nurse supervises the feeding, offers feedback to family members, if necessary, and evaluates the outcome. The nurse avoids assigning more than three residents to each assistant for feeding; four residents are too many to assist safely. If a resident needs assistance with feeding, then attempting to self-feed can be dangerous, humiliating, and frustrating for a resident. If a small group of assistants performs all of the feeding, then the residents will potentially have to wait for long periods before being fed. Since the time required to implement feeding assistance is 38 minutes, a lengthy delay can result in adverse effects or injury for the resident and increase the risk of errors for the assistants, leading to frustration with the residents. TOUHY 4TH ED TESTBANK

An older man who has osteoarthritis (OA) tells the nurse that he has experienced fatigue for the past 2 weeks. Which nursing intervention should the nurse implement to help him manage his fatigue? a.Recommend an antidepressant. b.Help him plan exercise and rest. c.Plan two or three naps every day. d.Tell him the fatigue is due to his OA.

ANS: B With no clues about the cause of the fatigue, the nurse helps this older adult balance exercise and rest to help alleviate fatigue. The fatigue can be due to decreased physical activity that, in turn, is due to pain from the OA, in which case a balance of exercise and rest should help attenuate the effects of the pain from the OA. This older adult has no indicators of depression except for fatigue. Although a balance of rest and exercise can help relieve depressive symptoms, exercise is not an effective therapy for severe depression. Decreasing physical exercise is likely to contribute to fatigue and deconditioning. Fatigue is an unusual characteristic of OA. TOUHY 4TH ED TESTBANK

Which had a major influence in shifting the care of older adults away from almshouses and public institutions and stimulated the growth of commercial nursing homes? a.Medicare b.Social Security Act c.Hartford Institute for Geriatric Nursing d.Health maintenance organizations (HMOs)

ANS: B With the passage of the Social Security Act of 1935, federal monies were provided for old-age insurance and public assistance for needy older people not covered by insurance. To combat the fear of almshouse placement, Congress stipulated that the Social Security funds could not be used to pay for care in almshouses or other public institutions. This move is thought to have been the genesis of commercial nursing homes. During the next 10 years, many almshouses closed, and the number of private boarding homes providing care to older adults increased. Because retired and widowed nurses often converted their homes into such living quarters and gave care when their boarders became ill, they can be considered the first geriatric nurses and their homes to be the first nursing homes. The Hartford Institute has sponsored significant improvements in gerontological nursing practice, research, and education. HMOs have had a significant impact on the management of care but were virtually nonexistent in the 1930s and 1940s. TOUHY 4TH ED TESTBANK

Which population groups are most at risk for developing macular degeneration? (Select all that apply.) a.African American b.Asian American c.Caucasian d.Hispanic

ANS: B, C Individuals who are Caucasian or Asian American are most at risk for developing macular degeneration than are African Americans or Hispanics. TOUHY 4TH ED TESTBANK

Which of the following are common side effects of PD and the medications used to treat it? (Select all that apply.) a.Skin irritation b.Dyskinesias c.Dystonia d.Nausea

ANS: B, C Medication therapy is complicated and must be closely supervised. Hypotension, dyskinesias (involuntary movements), dystonia (lack of control of movement), hallucinations, sleep disorders, and depression are common side effects of both the disease and the medications used to treat it. Nausea is not a side effect of PD. TOUHY 4TH ED TESTBANK

The nurse understands which of the following indicator(s) describe(s) the profile of an abused older adult? (Select all that apply.) a.Resides in safe housing. b.Is from a lower socioeducational level. c.Is a woman who lives with an abuser and is socially isolated. d.Has nonwhite ethnicity.

ANS: B, C, D A profile of an abused older adult consists of one who is married and comes from a lower socioeducational level. Women who are 80 years of age or older are more often abused; the abused older adult often lives with the abuser and is socially isolated. The abused are often nonwhite, have a mental or physical disability, are dependent on the abuser, and reside in unsafe or inadequate housing. TOUHY 4TH ED TESTBANK

The nurse should suggest which of the following to a spouse of a patient with dementia who has displayed inappropriate sexual behavior to decrease the occurrence? (Select all that apply.) a.Intimate relations c.Kiss b.Hug d.Touch

ANS: B, C, D Inappropriate sexual behavior may be triggered by unmet intimacy needs or may be symptoms of an underlying physical problem, such as a urinary tract or vaginal infection. Encouraging family and friends to touch, hug, kiss, and hold hands when visiting may help meet the patients touch and intimacy needs and decrease inappropriate sexual behavior. TOUHY 4TH ED TESTBANK

Which of the following indicate a person is effectively coping? (Select all that apply.) a.Avoids avoidance b.Confronts realities c.Focuses on solutions d.Redefines problems

ANS: B, C, D People who cope well confront reality and deal with situations. They focus on the solution and redefine the problem. People who cope well avoid avoidance. TOUHY 4TH ED TESTBANK

Which of the following behavior modifications should the nurse instruct a patient to accomplish to help reduce the risk factors for an occurrence of a stroke. (Select all that apply.) a.Increase the intake of green, leafy vegetables. b.Stop smoking. c.Control blood pressure. d.Increase physical activity.

ANS: B, C, D Stopping smoking, keeping blood pressure under control, and incorporating physical activities are all modifiable risk factors. Increasing the intake of green leafy vegetables does not, in itself, decrease the risk of stroke; however, they are part of a healthy diet if the patient is not taking an anticoagulant medication. TOUHY 4TH ED TESTBANK

Which mental status assessment tool(s) would be appropriate for use in long-term care facilities? (Select all that apply.) a.Fulmer SPICES b.Clock Drawing Test c.The Mini-Cog d.Mini-Mental State Examination (MMSE)

ANS: B, C, D The Clock Drawing Test, which has been used since 1992, is a screening tool that helps identify those with a cognitive impairment and is used as a measure of severity. The Mini-Cog was developed as a tool that could establish cognitive status more quickly than the MMSE and the limitations of educational adjustments. It is now the recommended evidenced-based tool and combines one aspect of the MMSE (short-term memory recall) with the test of executive function of the Clock Drawing Test. It has been found to be highly sensitive to diagnosing dementia. The MMSE tool has been used most often and is a 30-item instrument that has been used to screen for cognitive difficulties and is one of the tools often used in determining a diagnosis of dementia or delirium. Fulmer SPICES is an overall assessment tool developed in 2007. TOUHY 4TH ED TESTBANK

The nurse understands which of the following indicator(s) describe(s) the profile of an elder abuser? (Select all that apply.) a.Does not have a history of abuse. b.Has mental health problems. c.Has substance abuse problems. d.Is stressed with the caregiving role.

ANS: B, C, D The abuser often has mental health and substance abuse problems and is stressed or frustrated with the caregiving role. The abuser is often financially dependent on abused and has inadequate financial resources of his or her own. The abuser has had or currently has health problems, and may have a history of abuse and being abused. TOUHY 4TH ED TESTBANK

A health care provider has ordered alendronate (Fosamax) for an older adult who has been admitted for a hip fracture. Which is the best response from the nurse when educating the patient on the new medication? a.You will need to have your calcium checked monthly while on this medication. b.If you miss a dose, you will need to take the medication as soon as you remember. c.Take on an empty stomach. d.Do not take with alcohol.

ANS: C Drug-food interactions may either decrease or increase the amount absorbed. For example, when a bisphosphonate such as Fosamax is taken with food of any kind, the absorption is reduced to only a few milligrams; therefore the drug has no effect on the target organthe bones. If a patient misses a dose, then he or she should not take it as soon as remembered; it should be taken at its next scheduled dose. No current recommendations suggest that calcium levels are to be checked monthly. TOUHY 4TH ED TESTBANK

A family is touring selected nursing homes in preparation for their mothers future. Which qualities of a nursing home should the family include if they decide on a person-centered nursing home? (Select all that apply.) a. Staff members cover all nursing units. b. Residents and families have a council. c. Residents choose stimulating activities. d. Staff members respond to residents needs. e. Group activities are scheduled on the hour. f. Staff members help residents stay well-groomed.

ANS: B, C, D, F A characteristic of a person-centered culture is family and resident councils to discuss resident issues, needs, and solutions. A second characteristic of a person-centered culture is residents choosing their own activities to suit their interests. A third characteristic of a person-centered culture is a responsive staff that promptly meets resident needs. A fourth characteristic of a person-centered culture is assisting residents to maintain their appearance and to stay well-groomed. Consistent nursing assignments are a characteristic of a person-centered culture. Predetermined schedules are characteristic of an institution-centered culture. TOUHY 4TH ED TESTBANK

Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply.) a.Fewer T-lymphocytes b.Less lean muscle mass c.Decreased thyroid function d.Decreased physical activity e.Left ventricular hypertrophy f.Decreased insulin sensitivity

ANS: B, C, D, F Less lean muscle mass means that the body has fewer insulin receptor sites; thus glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metabolic rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, the older adult must increase physical activity and decrease food consumption. Fewer T-lymphocytes are associated with age-related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it. Type 1 diabetes mellitus is considered an autoimmune disorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes. TOUHY 4TH ED TESTBANK

The nurse determines the risk for a pressure ulcer in an older adult who is 6 feet tall and weighs 155 pounds. Which patient information should the nurse use in planning care to reduce this individuals risk for a pressure ulcer? (Select all that apply.) a.Osteoarthritis of neck b.Dry mucous membranes c.Prealbumin level 7 mg/dl d.Fasting glucose 140 mg/dl e.Serum sodium 135 mEq/dl f.Uses food stamps to get food

ANS: B, C, D, F One area of concern the nurse should address is the potential for skin breakdown related to possible pain or immobility due to arthritic changes. The nurse also plans care to address dehydration as a significant risk factor for pressure ulcers because this man is underweight, malnourished, and dehydrated as evidenced by dry mucous membranes. Dehydration increases the risk for pressure ulcers because water is essential for intracellular functioning and cell durability. The nurse plans care based on the assessment of hypoproteinemia because this man is underweight and malnourished, significantly increasing his risk for pressure ulcers. A fasting glucose showing hyperglycemia is a clinical indicator of diabetes mellitus; therefore the nurse plans care to manage the hyperglycemia. Diabetes mellitus increases the risk of pressure ulcers as a result of the greater likelihood of impaired tissue perfusion, impaired wound healing, and a greater occurrence of peripheral neuropathies. In addition, impaired tissue sensation as a result of nerve damage from hyperglycemia increases the risk of injury and infection for individuals with diabetes mellitus. A characteristic of type 1 diabetes mellitus is a low weight-for-height ratio. This man has limited resources for obtaining food, considering that he uses food stamps, and is therefore at risk for malnutrition, which increases the risk for pressure ulcers. Osteoarthritis in the neck is not related to the nursing care planned to reduce the risk for pressure ulcers; it should not impair this older adults mobility or ability to obtain and prepare food. His sodium level is within normal limits. TOUHY 4TH ED TESTBANK

Which of the following types of phases are included in the chronic illness trajectory (CIT)? (Select all that apply.) a.Caring b.Plateau c.Instability d.Bargaining e.Deterioration f.Rehabilitation

ANS: B, C, E The CIT includes a stable (plateau) phase, an unstable (instability) phase, and a downward and dying (deterioration) phase. The CIT does not include a caring phase, a bargaining phase, or a rehabilitation phase. TOUHY 4TH ED TESTBANK

Which factors interfere with the mental health of older adults because of the effect on adaptation? (Select all that apply.) a.Culture b.Life events c.Physical illness d.Substance abuse e.Cognitive impairment f.Developmental transitions

ANS: B, C, E, F A life event can interfere with the mental health of an older adult because the experience can interfere with the older adults ability to adapt to the situation. Physical illness can interfere with the mental health of an older adult because the illness can interfere with the individuals adaptive ability. A cognitive impairment can interfere with the mental health of an older adult because this impairment can destroy the older adults ability to adapt to new situations. Development transitions can interfere with the mental health of an older adult because the individual can lack the suitable skills necessary for adaptation through the transitional period. Culture is likely to influence the mental health of an older adult and influence how the individual adapts but does not necessarily interfere with adaptation. Substance abuse is likely to interfere with the mental health of an older adult but has a variable impact on the ability to of the older adult to adapt. TOUHY 4TH ED TESTBANK

The nurse teaches an older adult who has diabetes mellitus and takes metoprolol (Lopressor) to recognize clinical indicators of hypoglycemia. Which clinical indicators of hypoglycemia does the nurse include in patient teaching as the indicators this man is most likely to detect? (Select all that apply.) a.Shaking b.Dizziness c.Weakness d.Diaphoresis e.Tachycardia f.Impaired vision

ANS: B, C, F Dizziness is a clinical indicator of moderate hypoglycemia. It is unlikely to be masked by the effects of metoprolol, a beta-adrenergic blocker, because beta-blockers effectively mask the early signs of hypoglycemia. Weakness is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Impaired vision is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Shaking is an early clinical indicator of hypoglycemia and likely to be masked by the action of a beta-adrenergic blocker such as metoprolol; beta-blockers oppose the surge of epinephrine in early hypoglycemia. Diaphoresis is an early clinical indicator of hypoglycemia, and it is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol. Increased heart rate is an early clinical indicator of hypoglycemia and is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol. TOUHY 4TH ED TESTBANK

The nurse plans the care for an older man who has Medicare, lives on Social Security and a small pension, and has type 2 diabetes mellitus. Which aspect(s) of this man should the nurse integrate into a positive approach to his health and well-being? (Select all that apply.) a.Pays for some diabetic supplies. b.Enjoys regular physical activity. c.Practices effective glucose control. d.Lives alone in a high-rise apartment. e.Lacks low-cost, reliable transportation. f.Attends weekly dinner club for diabetics.

ANS: B, C, F The enjoyment of physical activity is a positive aspect of this man and thus can be included in the nurses plan because he already incorporates an important part of diabetic care into his life and, potentially, enjoys the health benefits of exercise. Practicing effective glucose control demonstrates this mans resilience and capacity to manage effectively the challenges associated with a chronic illness and thus is a strength the nurse can use in a positive approach toward his health and well-being. This man has a social network that helps him to live with diabetes and to prevent the long-term complications of diabetes. This is a definite strength the nurse uses to help him achieve his optimal health and well-being. With limited financial resources, paying for some of his diabetic supplies is a burden to overcome and cannot be used in a positive approach toward health and well-being. Living alone is not ideal for an older adult, especially one with diabetes, because of the potential for loneliness and complications from diabetes such as hypoglycemia. Living alone is a negative aspect of this mans life and one which has to be resolved for his safety and well-being. The nurse cannot include this mans transportation issues into a positive plan; the lack of reliable transportation is a problem to overcome and not a strength on which to capitalize. TOUHY 4TH ED TESTBANK

Which of the following is(are) true statement(s) about depression or depression therapy? (Select all that apply.) a.An older adult who lived through the depression is unlikely to develop depression. b.Complaining and not complaining can be symptomatic of depression. c.Serotonin-reuptake inhibitors are used to resolve depression in 2 weeks. d.The nurse should avoid trying to bolster a depressed persons mood.

ANS: B, D An older adult can complain because of having no positive feelings, or the older adult may not bother complaining because of having no hope. The nurse should not deny the older adults depressed feelings or grief. Older adults who have endured the horrors of the mid-twentieth century (e.g., the Great Depression, the Holocaust, and World War II) are as prone to depression as other older adults, but they can consider it shameful to acknowledge depressive feelings. Serotonin-reuptake inhibitors, usually the drug of choice for depression, can be unsuitable for a specific individual. Most antidepressant medications take 6 weeks to resolve symptoms completely. TOUHY 4TH ED TESTBANK

Which intervention(s) can be used to improve intake for individuals with dementia? (Select all that apply.) a.Serve soup in a plastic bowl. b.Cut up foods before serving. c.Use clear cups to serve drinks. d.Provide one utensil at a time.

ANS: B, D Cutting food before serving decreases the risk for choking, as well as making it easier for patients to feed themselves. Soups should be served in a mug instead of a bowl to enable patients to hold the cup for ease of consuming. The use of red cups, not clear cups, has been shown to increase food intake. Providing one utensil at a time can often decrease confusion during meal time. TOUHY 4TH ED TESTBANK

The nurse distrusts the male caregiver, the son of an older woman, and collaborates with social services about potential resources for abused older adults. Which characteristics of the caregiver does the nurse report to social services as indicators of potential elder abuse? (Select all that apply.) a.Collects unemployment benefits. b.Finds fault with any nursing care. c.Takes frequent breaks for smoking. d.Lives in the same house as his mother. e.Makes demands on assistive personnel. f.Sits at his mothers bedside for hours daily.

ANS: B, D, E The male caregiverand sonof this woman excessively criticizes the nursing care and demonstrates a lack of appreciation, which are common characteristics of an elder abuser. Because the majority of caregiving occurs in the home and a majority of abuse occurs in the family, this caregiver has the characteristics of a potential abuser. Aggressive, combative, provocative, and overly demanding behavior is also characteristic of an older adult abuser. The lack of employment is not a characteristic of an elder abuser, although this problem can frustrate the individual; however, financial dependency on the abused is a predictor for abuse. Although smoking is an unhealthy habit and exposes the older adult to second-hand unhealthy air, smoking is not a characteristic of an elder abuser. Sitting at the patients bedside for hours, in itself, is not a characteristic of an older adult abuser; concerned, caring family members often keep bedside vigils. TOUHY 4TH ED TESTBANK

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

ANS: B, E, F Asking about potential therapies is a question from the Explanatory Model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the Explanatory Model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN Model. TOUHY 4TH ED TESTBANK

Which conditions are likely to cause an older adult chronic pain? (Select all that apply.) a.Hip replacement b.Bone metastasis c.Hypoproteinemia d.Migraine headache e.Compression fracture f.Postherpetic neuralgia

ANS: B, E, F Bone metastasis is likely to cause an older adult chronic pain because it is extremely difficult to eradicate cancer metastasis from bone. In addition, the invasion of cancer into bone can be very painful as a result of tumor growth pressing on nerves. Compression fractures are likely to cause chronic pain because the compressed vertebra is likely to press on spinal nerves, causing muscle spasms. Postherpetic neuralgia is a result of nerve damage from shingles and is likely to cause chronic pain; it is very difficult to treat effectively. A hip replacement is performed to relieve chronic pain or to repair a fracture and is more likely to cause acute pain. Hypoproteinemia is unlikely to cause chronic pain but is more likely to cause fatigue. A migraine headache is likely to cause acute, intense pain. Although headaches can be recurrent, they are usually time limited. TOUHY 4TH ED TESTBANK

Which recommendations for daily food intake is correct for older adults according to the MyPlate for Older Adults from Tufts University? (Select all that apply.) a.Three 8-ounce glasses of water b.Two servings of deep-colored fruit c.Four or more servings of high-quality protein d.One or two servings of brightly colored vegetables e.Three or more servings of low-fat or nonfat dairy products f.Six or more servings of fortified, enriched, or whole grain foods

ANS: B, E, F The Tufts food pyramid recommends two or more servings of deep-colored fruit, three or more servings of low-fat or nonfat dairy products such as milk and yogurt, and six or more servings of whole, enriched, or fortified grain products such as brown rice and whole grain cereal and bread. The Tufts food pyramid also recommends eight 8-ounce glasses of fluid in the form of water, milk, and soup, among others; two or more servings of protein; and three or more servings of brightly colored vegetables. TOUHY 4TH ED TESTBANK

A case manager is likely to have how many years of nursing education? a. 1 to 1.5 b. 2 c. 4 to 6 d. 8 or more

ANS: C A case manager typically has a bachelors or masters degree. This amount of training is typical for an LPN, who typically practices at a nursing home or on a home nursing staff. This amount of training, resulting in an Associates Degree in Nursing (ADN), is typical for an associate RN, who is typically found on hospital, home, and nursing home staffs. A nurse with 8 or more years of education, as well as a doctorate, is typically involved in research and teaching. TOUHY 4TH ED TESTBANK

Which of the following statements is true about rehabilitation and restorative care for older adults? a.The purpose of rehabilitation and restorative care is to regain specific abilities lost because of a condition. b.Rehabilitation consists primarily of regular physical therapy sessions. c.A person can learn skills and gain abilities that enable functioning. d.The patients capabilities are recognized at the time of admission.

ANS: C A patient with a severe stroke, for example, may not be able to walk again but may recover mobility by learning to drive a motorized wheelchair. The purpose of rehabilitation is to enable the person to regain function but not necessarily specific abilities, which can involve the development of compensating abilities (e.g., motorized chair driving) rather than the recovery of original abilities (e.g., walking). Rehabilitation involves activities involving the entire day, not merely those within an allotted time period. On admission, the patient is in crisis and his or her actual abilities may not be evident. TOUHY 4TH ED TESTBANK

Which of the following should the nurse recommend for a moderate-intensity exercise for older adults who are ambulatory and in good health? a.Walk 4 miles in 60 minutes. b.Work in the garden for 45 minutes. c.Swim laps in the pool for 20 minutes. d.Wash and wax the car for 75 minutes.

ANS: C According to the American Geriatrics Society, the nurse can safely recommend swimming laps for 20 minutes consecutively to older adults. The nurse can safely recommend walking 2 miles in 30 minutes, but walking for 60 minutes is excessive. Older adults should limit gardening to 35 to 40 minutes at a time. The older adult can wash and wax a car for a combined 45 to 60 minutes. TOUHY 4TH ED TESTBANK

As the wife of a university president, an older woman met exciting people and traveled extensively until her husband died. Besides losing an intimate partner, the nurse identifies that this woman is most likely to grieve for the loss of which area of her life? a.Self-confidence b.Economic security c.Status in community d.Intellectual stimulation

ANS: C After the loss of her husband, this older adult will most likely mourn the loss of her status in the community; no longer is she a wife or the wife of a community leader. After her husbands death, the opportunities for university-related travel and social occasions will most likely disappear from her life. After extensive travel and sophisticated social stimulation, this older adult is likely to be self-confident and to have acquired life skills from her experiences. The president of a university is likely to have planned for retirement and is likely to have left his survivors with an adequate estate. This woman will most likely to be able to provide intellectual stimulation in her own life, although the stimulation from the university-related activities will likely decrease. TOUHY 4TH ED TESTBANK

After completing an admission assessment on a patient who recently suffered a stroke, the nurse should choose which of the following nursing diagnoses as a priority? a.Risk for inury c.Altered cerebral perfusion b.Altered thought process d.Decreased mobility

ANS: C Altered cerebral perfusion is the priority diagnosis. Altered cerebral perfusion may be caused by an interruption in blood flow such as occlusive disorder, hemorrhage, cerebral vasospasm, or cerebral edema. It is important for the nurse to monitor cognitive status and vitals for patients experiencing altered cerebral perfusion. The patient is at risk for injury due to the effects of the stroke, however it is not the priority diagnosis. This patient may suffer from altered thought processes due to cerebral damage from the stroke; however, this is not the priority diagnosis. This patient may experience a decrease in mobility such as hemiparesis; however, it is not the priority diagnosis. TOUHY 4TH ED TESTBANK

The nurse prepares to administer vancomycin (Vancocin) to an older adult. Which laboratory test should the nurse review before administering this medication? a.Stool culture b.Serum potassium c.Creatinine clearance d.Alkaline phosphatase

ANS: C Antibiotics, as a group of drugs, are hard on the kidneys; thus the nurse should check the creatinine clearance of this individual. Although approximately 30% of absorbed vancomycin is protein bound, it is cleared by the kidneys, and creatinine clearance is the best index available of renal function. Because approximately 70% of vancomycin circulates in the bloodstream in the active form, the dose must be reduced or the dosing intervals increased to maintain the desired drug level and to prevent toxicity in the older adult who has renal dysfunction. The pathogen is already identified; however, some value can be obtained from subsequent stool cultures to determine whether the infection is eradicated. Serum potassium is a reasonable parameter to check in an older adult; however, if used as a measure of renal function, then the creatinine clearance is a better choice. Alkaline phosphatase is a measure of hepatic function and a reasonable parameter to check when administering medications; hepatic clearance is important in the metabolism of many medications. TOUHY 4TH ED TESTBANK

When the older woman who is close to death asks the family to leave after short visits and acts withdrawn in their presence, the family becomes distraught. Which of the following does the nurse include in family teaching to explain the patients behavior? a.She is preoccupied with her own death. b.She must have unresolved family issues. c.She can be experiencing anticipatory grief. d.Her body prepares for death in this manner.

ANS: C Anticipatory grief occurs before the death and can be experienced by the patient or the potential survivors. When the patient who is dying experiences anticipatory grief, the individual detaches from the environment into a state sometimes described as psychological death. The person is no longer involved in day-to-day activities and enacts a premature death. Preoccupation with death is acute grief, but since the death has not occurred, preoccupation cannot describe this patient. The patient might have unresolved issues with the family, but this behavior is an unusual way to express it. The body prepares for death through the deterioration of organ system functioning; for example, the kidneys stop producing urine, the patient stops drinking and eating, and the extremities become cold, among other functions. TOUHY 4TH ED TESTBANK

Which of the following is important to include in the initial assessment for older adults who are frail and beginning an exercise program? a.Exercise tolerance testing (ETT) b.Financial ability to pay for training sessions c.Medical history and physical examination d.Pulmonary function tests (PFTs)

ANS: C Any aspect of the patients current and past physical and psychological condition can be important in designing the exercise program to suit the patient. Fitness tests such as the ETT are warranted in older adults who are beginning a moderately intense or vigorous exercise program. The ETT is not recommended for the frail older adult. Expensive training programs are not usually needed. Although aerobic capability must be carefully observed, PFTs, specifically, are not necessary unless pulmonary function is a parameter that the therapeutic program is targeting for improvement. TOUHY 4TH ED TESTBANK

The nurse prepares an older man who has OA for discharge. Which instruction does the nurse include in patient teaching to maintain safety for this man? a.Take ibuprofen (Motrin) rather than opioid analgesics. b.Increase rest periods to slow disease progression. c.Report joint instability to the health care provider. d.Avoid stretching the affected joint during exercise.

ANS: C As OA progresses, the joint deteriorates and can become unstable, thereby increasing the risk of falls. The joint stability will not improve without physical therapy or surgery; therefore the patient needs to report instability to the health care provider. Although ibuprofen is much less likely to cause dizziness, hypotension, or sedation, nonsteroidal antiinflammatory agents such as ibuprofen are poor analgesic choices for older adults; they can aggravate hypertension and impair renal blood flow. The nurse avoids recommending increased rest because rest contributes to stiffness. Stretching is an important form of exercise for older adults with OA; it helps maintain joint flexibility and range of motion. TOUHY 4TH ED TESTBANK

Which cultural group is predicted to have the fastest growing older adult population in the United States between the years 2010 and 2050? a.Native Americans b.African Americans c.Hispanic Americans d.Asian/Pacific Island Americans

ANS: C As shown in Figure 1-1, the Hispanic older adult population is projected to be the most rapidly increasing population segment between 2010 and 2050. The older adult populations of all other races, combined, do not rise as rapidly as the Hispanic older adult population between the years 2010 and 2050. The African-American older adult population is expected to have the second-fastest rise between 2010 and 2050. The non-Hispanic white older adult population is projected to decrease between 2010 and 2050. TOUHY 4TH ED TESTBANK

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

ANS: C Because African Americans tend to be at risk for cardiovascular disease and hypertension, the nurse plans to maintain the patients blood pressure at or below the current recommendation by the American Heart Association. The nurse can be incorrectly assuming that he practices and believes in the magicoreligious system. The nurse should assess his spiritual beliefs and determine how much they influence his attitudes toward Western health care. The magicoreligious system maintains social relationships in good condition to prevent illness; however, if the older adult does not follow this cultural practice, then this goal can be unsuitable. The older adult may not believe in this system; therefore the information can be irrelevant. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about impaired skin integrity? a.Stage III pressure ulcer cannot regress to stage II because the subcutaneous tissues regenerate. b.Stasis ulcer is another term for pressure ulcer. c.Muscle and fat cannot regenerate. d.Weight reduction is recommended to help prevent pressure ulcers.

ANS: C Because subcutaneous tissues such as muscle and fat are not regenerated but simply replaced by granular tissue, the staging of pressure ulcers is never reversed. Stasis ulcers are the result of the leakage of blood from veins beneath the skin. Pressure ulcers are caused when perfusion to the tissue is impaired by external pressure that causes tissue injury and death. Sufficient nutrition is essential in maintaining skin integrity. TOUHY 4TH ED TESTBANK

The nurse develops a community program to promote exercise for older adults. Which should the nurse include in the exercise program? a.Reinforce the ease of exercising every day. b.Use exercise to relax any dietary restrictions. c.Describe ways to resume exercise after lapses. d.Participate because exercise achieves wellness.

ANS: C Because the path to wellness includes progression, as well as regression, the nurse shares information to help participants anticipate these events. The nurse encourages participants by telling them to expect periods of regression; he or she emphasizes that progress made up to a point is not lost and explains how to approach resumption in progress toward wellness with exercise. The nurse tells the participants that achieving wellness takes work and regular effort. Rather than offering false hope, the nurse shares practical advice about how to incorporate exercise into everyday life. The nurse avoids suggesting that adults can look forward to relaxing dietary or medical restrictions by using a single method; it is unethical to offer false hope, the plan can be ineffective, and the plan can have adverse effects. The nurse avoids instructing adults to rely on one method of achieving wellness; wellness is achieved by balancing emotional, spiritual, social, cultural, and physical processes. TOUHY 4TH ED TESTBANK

An older man is being abused by his daughter, a single working mother of four children, with whom he lives. The nurse investigates and learns that the abuse is due to situational stress. Which of the following interventions should the nurse implement to address the short-term crisis? a.Immediately remove him from his daughters home. b.Encourage the daughter to work with social services. c.Arrange respite care or day care for the patient. d.Place the patient in a long-term care facility.

ANS: C By relieving the daughter of some responsibilities, respite care is likely to be beneficial for the older adult and his daughter; it can help reduce tension. Unlike children, abused older adults cannot be removed from their situations without their permission. Helping the daughter manage the situational stress would be more effective. Encouraging the daughter to work with social services can help teach her more effective and harmless ways of solving problems, but it does not address the short-term crisis. Placing the patient in a long-term care facility may eventually be necessary, but improving the living situation within the patients family would be better. TOUHY 4TH ED TESTBANK

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

ANS: C Careful cleaning of dentures is necessary to prevent the buildup of residues that contribute to staining and odor, as well as to infection. Older adults can lose teeth, but more adults are retaining their teeth into older age. Tooth loss is most often a result of periodontal disease. Inadequate saliva production (xerostomia) is a common problem for older persons. Bleeding gums is a sign of periodontal disease. TOUHY 4TH ED TESTBANK

An older female patient is diagnosed with a chronic illness. Which of the following principles should the nurse apply when answering her questions? a.The most prevalent form of disease in the United States is acute illness. b.Usually, chronic disease has a negligible impact on the family. c.Chronic illness is unending, and coping can be influenced by the perception of uncertainty. d.Older adults successfully cope with chronic disease by learning about the disease.

ANS: C Chronic illnesses are enduring and necessitate lifetime adaptations. Uncertainty exacerbates the impact of a chronic disease. At this time, the prevalent form of disease is chronic illness. The effect on the family, as on the patient, can be profound. There are no guarantees. Knowledge requires effort on the part of all concerned to apply it. TOUHY 4TH ED TESTBANK

Which of the following nursing interventions are suitable for a patient who has gout? a.Nonsteroidal antiinflammatory drugs (NSAIDs) b.Liquid paraffin hand baths c.Colchicine (Colsalide) by mouth d.Hyaluronic acid injections

ANS: C Colchicine is indicated in the treatment of an acute gout attack. NSAIDs can be used in pain management in all forms of arthritis. Liquid paraffin hand baths can be used to relieve pain in OA and RA. Hyaluronic acid injections are used by some to relieve the pain of OA in the knee. Salicylates should not be used in gout because they can exacerbate an attack. TOUHY 4TH ED TESTBANK

A definitive diagnosis of Alzheimer disease (AD) can be made by detecting or using which one of the following methods? a.Clinical observation of dementia b.Inability to speak with relevance c.Development of neurofibrillary tangles d.Computed axial tomographic (CAT) scan

ANS: C Confirming the development of neurofibrillary tangles is the only accurate method for diagnosing AD. Patients with AD can be observed for dementia and delirium, but these indicators are nonspecific for the disease. The inability to speak with relevance is a feature of dementia; if other causes of dementia are ruled out, then it may be dementia of the Alzheimer type. A CAT scan is the most useful means for diagnosing a stroke. TOUHY 4TH ED TESTBANK

Which statement describes aging in developing countries? a.Aged dependence is likely to improve from 1:4 to 1:2. b.The biggest problem for older adults will be the lack of food. c.Most older adults are likely to reside in these countries. d.Similar to fertility, life expectancy is increasing, although at a different rate.

ANS: C Currently, developing countries already contain two thirds of the worlds older adult population. Aged dependence is likely to deteriorate from 1:4 to 1:2. The biggest problem of the worlds oldest adults is most likely to be a lack of regular income. Life expectancy is increasing, but fertility is decreasing worldwide. TOUHY 4TH ED TESTBANK

The nurse assists an older man who has type 2 diabetes mellitus to improve his glucose control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in one day? a.Omit antidiabetic medication. b.Wear sturdy open-toed shoes. c.Supplement caloric intake. d.Prepare to administer insulin.

ANS: C Diabetes mellitus is controlled by balancing exercise, calories, and hypoglycemic medication; if one element of therapy is altered, then one or both of the remaining elements must be adjusted. When the patients activity is going to metabolize more calories, the medication has to be reduced or the calories have to increase. For a patient with type 2 diabetes mellitus, adjusting the medication can be difficult; therefore the nurse instructs this older adult to supplement his caloric intake, which can be accomplished by eating snacks during the walk or by increasing the glycemic load before walking. The patient ensures glucose control during these activities by testing his blood sugar levels. The nurse cannot tell the patient to omit medication because doing so is not within a nurses scope of practice. The nurse instructs the older adult to wear closed, well-fitting leather shoes to protect the feet from trauma. Although many individuals with type 2 diabetes mellitus periodically take insulin, insulin is administered to induce hypoglycemia. Because the individual plans to walk more than usual, more calories are needed to prevent hypoglycemia. TOUHY 4TH ED TESTBANK

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

ANS: C Dribbling, hesitancy, and a large residual urine volume characterize overflow incontinence. Both urge incontinence and stress incontinence are associated with a small residual urine volume. Functional incontinence is not associated with residual urine volume. TOUHY 4TH ED TESTBANK

An older man in a cardiac rehabilitation exercise class refuses to participate in the cool-down phase of the activity; consequently, 2 minutes later, he passes out but quickly regains consciousness. Which instruction does the nurse include in patient teaching to reinforce the importance of cooling down after exercising to this man? a.Cardiac output diminishes with age. b.Mobility capacity decreases with age. c.Baroreceptor function diminishes with age. d.Sensory perception diminishes with age.

ANS: C During exercise, the body shunts blood to the skeletal muscles to supply enough oxygen to meet the increased metabolic demands of the muscles. If the exercise is suddenly withdrawn, however, the blood temporarily pools in the skeletal muscles, and the older adult loses consciousness from transient hypotension. Baroreceptor responsiveness declines with age; therefore the body does not respond as readily to the need for changes in blood pressure. The cool-down period compensates for this effect. An acute problem such as losing consciousness as a result of decreased cardiac output should appear during the real exercise. The man is mobile enough to participate in the exercise program. Gradual sensory alteration does not account for the acute episode. TOUHY 4TH ED TESTBANK

Which nursing intervention is most likely to prevent the creation of an environment conducive to fungal growth? a.Provide oral care with soft-bristled brush. b.Apply nystatin powder to reddened tissue. c.Use mild skin cleansing agents and blot dry. d.Apply gauze soaked with antifungal lotion.

ANS: C Fungal infections are most likely to begin in moist, dark areas of the body such as under the breasts and at the perineum; thus the nurse works to keep the skin of these areas, as well as all skin, clean and dry and to prevent tissue irritation from harsh drying. Providing oral care with a soft-bristled brush is ineffective therapy for preventing an oral Candida infection (thrush). Besides, thrush is usually an opportunistic infection caused by immunosuppression. Reddened tissue can be already infected; nonetheless, applying an antifungal agent is an indicated treatment for a fungal infection. Applying antifungal lotion and keeping an area moist can contribute to fungal overgrowth. TOUHY 4TH ED TESTBANK

Which classic sign of an acute myocardial infarction (AMI) can be absent in an older man with an AMI? a.Vague complaints b.Epigastric burning c.Crushing chest pain d.Dyspnea and fatigue

ANS: C Gripping chest pain, radiating to the shoulder is typically seen in younger adults, but not always in older adults. Instead, an older adult may be experiencing a silent MI. Older adults with an AMI express vague complaints such as fatigue, weakness, and dyspnea. Older adults with an AMI are seen with atypical complaints such as epigastric burning or pain. TOUHY 4TH ED TESTBANK

In questioning an older adult, which question is likely to elicit the most accurate information about the individuals adherence to the medication plan? a.You take digoxin (Lanoxin) at the correct time, dont you? b.Why didnt you take all of your digoxin (Lanoxin) last month? c.How many doses of digoxin (Lanoxin) do you think you missed? d.You have never missed a dose of digoxin (Lanoxin), have you?

ANS: C How many doses of digoxin (Lanoxin) do you think you missed? is a question that is worded to put the client at ease and to elicit information in a matter-of-fact way. You take digoxin (Lanoxin) at the correct time, dont you? sounds like a challenge to the patients personal qualities. In addition, the nurse is leading the patient to the answer. The patient is likely to respond simply, Oh, yes. Although the question, Why didnt you take all of your digoxin (Lanoxin) last month? is meant to elicit the reason for nonadherence, it has an accusatory tone that is likely to make the patient defensive. You have never missed a dose of digoxin (Lanoxin), have you? is a question that can be interpreted as judgmental. TOUHY 4TH ED TESTBANK

Which of the following statements is true about health care costs for older adults in the United States? a.Older adults become eligible for full Social Security benefits upon reaching the age of 65 years. b.Medicare, Part A, covers physician visits, whereas Part B covers prescription drugs. c.Health maintenance organizations (HMOs) can obtain an exemption from Medicares per capita spending limit. d.Older adults pay a fixed premium and low out-of-pocket costs in a preferred provider organization (PPO).

ANS: C If an HMO is granted a per capita waiver, it cannot refuse an applicant on the basis of a preexisting condition. The eligibility age for full Social Security benefits is 66 years of age for persons born after 1937 and 67 years of age for those born in 1960 or later. Medicare, Part A, covers hospitalizations and other inpatient care. Medicare, Part B, which is optional insurance purchased by the beneficiary, covers outpatient services, physician visits, some therapy sessions, and some home health care. Older adults that pay a fixed premium and low out-of-pocket costs is a description of an HMO rather than a PPO. TOUHY 4TH ED TESTBANK

The nurse understands that stress incontinence occurs: a.With a urinary tract infection (UTI) b.Because of emotional strain c.As a result of increased intraabdominal pressure d.With a specific amount of urine in the bladder

ANS: C If intraabdominal pressure increases, then the patient can have dribbling. A UTI causes frequency as a result of irritation in the bladder. Emotional strain can cause frequency. Specific volume of urine in the bladder triggers reflex incontinence. TOUHY 4TH ED TESTBANK

Which of the following is used to treat the most common cause of impairment to an older persons hearing? a.Hearing aids b.Cochlear implants c.Ear canal irrigation d.Sign language

ANS: C Irrigation is used to dissolve and remove impacted cerumen, the most common cause of impaired hearing in older adults. Hearing aids are useful for sensorineural hearing loss, but the most common cause impairing the hearing of older persons is cerumen impaction. Cochlear implants are useful for profound sensorineural deafness, but the most common cause impairing the hearing of older persons is cerumen impaction. Sign language has been used primarily by those who become deaf in childhood or at birth, but it is not considered a treatment. TOUHY 4TH ED TESTBANK

The nurse in a rehabilitation center is caring for a patient who has new-onset stroke with right-side hemiparesis. Which intervention should the nurse implement when caring for this patient? a.Orders a two-person assist with a transfer. b.May need to incorporate repetition. c.Gives the patient a dry erase board. d.Raises all four side rails.

ANS: C Right-side hemiparesis involves a left-side brain injury. The left side of the brain controls speaking and language. By giving the patient a dry erase board, he or she can communicate easier initially after the stroke. People who have this type of hemiparesis experience difficulty talking. With only one side affected; the nurse should be able to transfer the patient alone. Patients with left-side hemiparesis have with short term memory, often repetition must be incorporated into patient care. The raising of all four side rails up would be considered a restraint. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about loss, dying, and death for older adults? a.Men and women tend to respond similarly to the loss of a spouse. b.Visions on the part of a person who has lost a spouse are not normal grief reactions and should be regarded as signs of underlying defects. c.The grieving process is not rigidly structured. d.Bereaved persons regain their normal capability approximately 6 months after loss, and regressive behavior after that time should be discouraged.

ANS: C Men and women do not always respond similarly to the loss of a spouse. The grieving process is not rigidly structured and is not always predictable. Visions, hallucinations, and an inability to communicate in a logical, sustained manner on the part of a person who has lost a spouse are not normal grief reactions and should be regarded as signs of underlying defects; all these reactions are common in the first several months of bereavement. A bereaved person ordinarily begins to recover personal control and capabilities after approximately 6 months; at first, recovery is sporadic and interspersed with periods of depression. TOUHY 4TH ED TESTBANK

The safest opioid analgesic choice for an older patient who has severe acute pain is which of the following? a.Meperidine (Demerol) c.Morphine sulfate (Morphine) b.Pentazocine (Talwin) d.Safe opioids do not exist.

ANS: C Morphine sulfate (Morphine), oxycodone (Oxycontin), hydrocodone (Hycodan), hydromorphone (Dilaudid), and fentanyl (Sublimaze) are opioids that can be safely used with older patients. Meperidine and pentazocine are both contraindicated for older adults because their metabolites can produce confusion, psychotic behavior, and seizures. Used properly, opioids have a lower risk of certain side effects than nonsteroidal antiinflammatory agents (NSAIDs). TOUHY 4TH ED TESTBANK

Which of the following does the nurse use to categorize the desired end result of nursing care delivered to a patient when using problem-oriented nurses notes? a.North American Nursing Diagnosis Association (NANDA) nursing diagnosis b.Nursing Goals Classification c.Nursing Outcomes Classification (NOC) d.Nursing Interventions Classification (NIC)

ANS: C NOC helps the nurse categorize the desired end-result of nursing care with specific, measurable, patient-oriented, and time-sensitive endpoints for the patient to achieve. A nursing diagnosis from NANDA identifies the patient problem and the associated nursing interventions and outcomes for the problem. Nursing goals classification does not exist. NIC is a set of nursing interventions whose basis is found in evidence-based nursing and is associated with a specific nursing diagnosis. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about neuropsychiatric function in older adults? a.Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging. b.Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting. c.Nerve cells regenerate in the hippocampus. d.Mood does not influence an older person ability to remember verbal instructions.

ANS: C Nerve cells regenerate in the hippocampus; this is a true statement. Although neurons can regenerate in the hippocampus, regeneration is impeded by stress. Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging; this statement is not true. Neuron loss does not harm overall cognitive ability, although it makes neural processes run more slowly. Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting; this is not a true statement. Neural functions can be retrained, but exercising the brain on a regular basis is necessary. Older adults learn best when new information is relevant to what is already familiar. Mood does not influence whether an older person remembers verbal instructions; this is a not a true statement. Recalling events, including communication, is impaired by a crisis situation or anxiety. TOUHY 4TH ED TESTBANK

An older woman with dementia exhibits new behaviors including crying and repeatedly verbalizing the same phrase; further, the behavior has increased over 2 days. Which intervention should the nurse implement in response to this behavior? a.Tell her you will remember what she says if she stops crying. b.Attribute these findings to a deterioration in cognitive function. c.Check the medication administration record for missed doses. d.Present probing questions to the patient about her behavior.

ANS: C New behaviors with increasing frequency warrant further investigation by the nurse to ensure that effective nursing care can be planned and implemented. Crying and repeated verbalizations from a patient with dementia can indicate anxiety, but the cognitive disorder makes anxiety difficult to detect. In addition to checking for missed doses, the nurse checks the medication record for medications that are likely to cause anxiety, such as beta-adrenergic agonists, which are used to reverse bronchoconstriction. The nurse should also check for risk factors for anxiety and perform a comprehensive assessment to identify potential causes. The nurse should avoid making a veiled threat to the patient. Giving the patient the incentive to stop crying can be suitable; however, the incentive should never be attention; the duty of the nurse is to pay close attention to the patient. The new behavior can be deteriorating cognitive function, but the nurse must first assess the patient further before making that determination. One aspect of the assessment is to question the patient. Depending on the stage of dementia, the patient can be an unreliable source of information about herself. TOUHY 4TH ED TESTBANK

The older adult is at a higher risk for acute psychological pain than a younger adult because older adults: a.Have many illnesses. b.Possess fewer assets. c.Experience more loss. d.Live with impairments.

ANS: C Older adults are at higher risk for acute psychological pain than younger adults because they experience more loss such as the pain occurring in early bereavement or in a major depressive episode. Older adults tend to have more illnesses than younger adults, and illness can trigger depression. The lack of assets of younger and older adults is unlikely to be related to acute psychological distress unless a sudden loss of a large asset is experienced. Older adults do not necessarily live with impairments. Further, if impairment causes psychological distress, then the acute phase is likely to occur at the onset rather than in day-to-day activities. TOUHY 4TH ED TESTBANK

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

ANS: C Older adults should ask the health care provider for the purpose of each drug and record the information. Although nausea and vomiting are among the most common adverse effects of pharmacotherapy, they can indicate medication toxicity and should be reported to the health care provider. Keeping a medication at the bedside is dangerous for anyone and can be especially dangerous for older adults who are taking antianxiety agents, hypnotic agents, and opioid analgesics; these and other medications can cause respiratory depression with and without excessive dosing. If sleepy or lethargic, then the older adult can inadvertently take more than the correct dose and suffer serious consequences as a result. Taking a medication on an empty stomach with water is a suitable instruction for many medications; however, many medications that are likely to cause nausea are taken with food. The nurse should instruct older adults to keep a record of the recommended method of administration. TOUHY 4TH ED TESTBANK

The nurse is trying to improve the nutritional status of residents in the nursing home. Which recommendations should the nurse implement? a.Develop a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery. b.Replace the fluorescent lighting with candles at every table to create a cozy, restaurant-like atmosphere. c.Provide nutritious food according to the residents expressed food preferences with a liberal use of seasonings that do not exceed any sodium restrictions. d.Distribute med-pass nutritional supplements.

ANS: C Only nutritious food that is actually eaten can enhance a persons nutritional status. Older adults are more likely to eat food they like, and seasonings can make food more palatable. Developing a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery is not for the benefit of the residents but is an action for the benefit of management and degrades the dignity of the residents. Older adults require greater amounts of light to see; candlelight can be too dim to see adequately. Distributing med-pass nutritional supplements are costly and often are not dispensed or are not consumed as ordered. TOUHY 4TH ED TESTBANK

An older adult is vitamin deficient. Which of the following does the nurse offer to the older adult to provide the important missing vitamin for maintaining healthy skin and enhancing tissue repair? a.Carrot sticks b.Nonfat milk c.Orange slices d.Unsalted nuts

ANS: C Orange slices provide vitamin C, which is important for healthy tissues and gums, tissue repair and healing, and the maintenance of blood vessels. Although carrots sticks are a good source of beta carotene, fiber, and vitamin A and important in the formation of epithelial tissue and although milk provides calcium for bone strength and protein for tissue repair, neither carrots nor milk address vitamin deficiency. Unsalted nuts provide healthy fats, fiber, and other nutrients but not vitamin C. TOUHY 4TH ED TESTBANK

Which statement is true about living arrangements for older adults? a.Older adults are more independent in their own homes than in a residential community. b.The increase in real estate values makes home ownership essential to security. c.Program for All-Inclusive Care for the Elderly (PACE) is a community alternative to nursing home care for frail older adults. d.Florida is an example of a naturally occurring retirement community (NORC).

ANS: C PACE is an alternative to nursing home care for frail older people who want to live independently in the community with a high quality of life. Although relief from the burden of home maintenance can free a person for more independent living, this statement can or cannot be accurate, depending on the real estate market at the time. In addition, taxes and maintenance costs have also risen. A NORC is an organization formed by older adults living at home in geographic proximity to each other to provide supportive services for each other. TOUHY 4TH ED TESTBANK

The nurse recognizes which of the following displays may indicate hyperactive delirium? a.Lethargy b.Withdrawn behavior c.Nonpurposeful repetitive movements d.Decreased psychoactive activity

ANS: C Patients with hyperactive delirium often wander and have nonpurposeful repetitive movements. Lethargy and withdrawn behavior are both indicative of hypoactive delirium. Patients with hyperactive delirium have increased psychoactive activity, not decreased. TOUHY 4TH ED TESTBANK

Identify the best statement about gerontological nursing. a.Nurses have only recently become involved in the care of the older adult. b.Gerontological care was the second specialty in which the American Nurses Association (ANA) offered a certification program. c.Purposes of gerontological nursing include the promotion of health and support for maximal independence. d.ANA certification is available only for gerontological nurses in research positions.

ANS: C Promoting health and fostering independence are purposes of the practice, as reflected, for example, in the ANA Scope and Standards. Nurses have always cared for older patients. The ANAs gerontological nursing certification program was the organizations first and includes a variety of positions, such as nurse practitioners, clinical specialists, researchers, and administrators. TOUHY 4TH ED TESTBANK

Which of the following statements is true about RA? a.Strikes unilaterally. b.Affects more men than women. c.Can affect body systems other than the joints. d.Glucosamine can be helpful for patients in the first 2 years of RA.

ANS: C RA can affect body systems other than joints; this statement is true. Women are affected more often than men. RA strikes the same parts of the body on both sides and affects joints in a symmetrical pattern. Patients with RA can have remissions and exacerbations. Unlike OA, however, RA has a highly variable course, which may include remissions, as well as exacerbations. RA can affect body systems other than joints and can cause general fatigue and malaise and attack systems other than joints. Glucosamine can be helpful for patients in the first 2 years of RA. Conventional therapy for RA includes a complex regimen of medications. Glucosamine has not been proven to offer significant relief from RA. TOUHY 4TH ED TESTBANK

The nurse prepares to discharge an older man who has heart failure and is in stable condition, when his wife states that she will avoid sexual activities with him because of his heart disease. Which of the following factors should the nurse use in patient teaching about sexual activity for an older adult with heart failure? a.An older adult with heart failure should avoid sexual relations because of the demand it places on the heart. b.Sexual relations and climbing six flights of stairs expend the same amount of energy. c.Fear and lack of knowledge can cause older people to reduce their sexual activity unnecessarily. d.Sexuality is a private matter between the older man and his wife.

ANS: C Sex is not restricted to young and healthy individuals; therefore the nurse provides the patient and his wife with information about safely resuming sexual intimacy. With appropriate cardiac rehabilitation, much of his capacity for exertion, such as sexual activity, can be restored. The energy expenditure for sexual activity varies; but, typically, it takes less energy than climbing six flights of stairs. The nurse must be prepared to discuss sexual issues with patients and seeks opportunities for discussion about sexual health. TOUHY 4TH ED TESTBANK

The nurse notices that an older female nursing home resident is not eating and that her heart rate is faster than usual. Which should the nurse do to determine if pneumonia is a potential cause of the change in her status? a.Obtain a specimen for aerobic blood cultures. b.Promptly send the resident for a chest x-ray examination. c.Analyze sputum for color, texture, and volume. d.Compare tympanic temperature to the baseline.

ANS: C Sputum cultures are indicated to assess a resident for pneumonia. Sputum is a sensitive and specific clinical indicator of pneumonia for older adults in nursing homes. If pneumonia is causing this residents anorexia and tachycardia, then her sputum should be cloudy, colored, and thick, especially if the resident is dehydrated, which indicates an infection. Blood cultures are likely to show no growth unless the resident has severe sepsis. A chest x-ray study is a nonsensitive, nonspecific diagnostic tool for determining the presence of pneumonia in an older adult. Fever can be a late indicator of infection for an older adult. TOUHY 4TH ED TESTBANK

The nurse is conducting an admission assessment on an older adult and notes a small lesion with a multicolor appearance. Which assessment approach should the nurse use? a.Braden Scale b.Wound staging c.ABCD (asymmetry, border, color, diameter) rule d.Pressure ulcer scale for healing (PUSH) tool

ANS: C The ABCD rule is used to assess potential cancerous lesions for asymmetry, border irregularity, color, and diameter. The Braden Scale is used for predicting pressure ulcers. Wound staging is used during the assessment of pressure ulcers. The PUSH tool provides a detailed form that covers all aspects of an assessment. TOUHY 4TH ED TESTBANK

The nurse plans the care of an older female resident of a nursing home who has experienced a sudden deterioration in visual acuity. Which intervention should the nurse complete first? a.Prevent behavioral and social decline. b.Tell her to hold onto the rails during ambulation. c.Examine her mood and functional status. d.Use problem solving involving the resident.

ANS: C The most important intervention for the nurse to complete first is to assess the impact of the visual impairment on the residents quality of life, mood, and functional ability. The resulting assessment data will provide the basis for solving new problems caused by the loss of vision and finding compensatory mechanisms for the resident. Preventing decline can be a goal in the overall plan of care for this resident, but that cannot be determined until the assessment is complete. Telling her to hold onto rails during ambulation is a potential nursing intervention for patient teaching; however, in problem solving, a different compensatory solution can be developed, based on the assessment. Problem solving takes place after a complete assessment. TOUHY 4TH ED TESTBANK

Which statement is true about residential living for older adults? a.A residential care facility is the new term for a nursing home. b.An assisted living facility (ALF) must have an registered nurse (RN) on staff. c.Administrators are realizing that their duty is to care for the residents as people. d.A granny flat is an apartment in a high-rise building reserved for seniors.

ANS: C The movement is under way from an institution-centered culture to a person-centered one. A residential care facility houses older adults who cannot live independently but do not need the round-the-clock, complex care capabilities of a nursing home. In most states, ALFs are not required to provide skilled nursing. A granny flat is the term used in Australia for a small, prefabricated housing unit where an older adult can live separately from, but close to, family on family property. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about psychotic behavior in older adults? a.Usually, hallucinations in older patients are the result of psychological conflicts. b.Illusion, delusion, and hallucination are different terms for the same phenomenon. c.An older adult with psychotic behavior should be assessed for a variety of causes. d.Regardless of the cause, dissimilar hallucinations are treated with similar therapies.

ANS: C The nurse assesses an older adult who is exhibiting psychotic behavior by searching for a reason from a wide variety of potential causes for the behavior. For example, neuroleptic medications can cause extrapyramidal side effects, which can result in movement disorders that are similar to psychotic behavior. Hallucinations in older patients are usually the result of physical disorders, dementias, or sensory function loss. A delusion is a belief that is maintained, although facts can prove that it is incorrect. A hallucination or illusion is the sensory perception of a stimulus that does not exist in the external world. Treatments for hallucinatory states vary according to the cause. TOUHY 4TH ED TESTBANK

An older woman maintains an active lifestyle playing various games with friends. She reports to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this womans sleep? a.Recommend preparation for sleep. b.Suggest trying a cup of warm milk at bedtime. c.Inquire about her nightly sleep rituals. d.Propose volunteer work at a thrift shop.

ANS: C The nurse completes an assessment of the womans sleeping habits and other pertinent information before planning care and implementing nursing interventions to individualize therapy. Preparing for sleep is a reasonable intervention to propose after completing an assessment. Sipping warm milk is also a reasonable intervention to suggest after completing an assessment. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment. TOUHY 4TH ED TESTBANK

A resident of a long-term care facility has been asking to have the drain in the bathroom sink repaired for 2 months. The nurse responds by saying that when they move to the new building, the sinks will work very well. Which right of a resident of a long-term care facility has the nurse violated? a.Right to be free of all forms of abuse b.Right to be transferred for appropriate reasons c.Right to voice grievances and have them remedied d.Right to information about conditions and treatments

ANS: C The nurse has violated the residents right to voice a grievance and to have the problem fixed. If the residents were moving into the new building in a few days, then the nurses response might be suitable; however, without specifying a time limit, the nurse has violated the residents right to voice a grievance and have it remedied. A clogged sink is not abuse. The resident is not going to be transferred; all of the residents are moving to a new facility. A residents condition or treatments are not mentioned by the resident. TOUHY 4TH ED TESTBANK

After an acute exacerbation of COPD, the nurse prepares an older adult for discharge to home. Which is the most important patient teaching for the nurse to include for the prevention of hospitalizations for exacerbations of COPD? a.Ease breathing by sitting upright. b.Use low-flow oxygen for dyspnea. c.Avoid sick people and wash hands. d.Eat nutrient- and calorie-dense foods.

ANS: C The nurse helps the patient with COPD maintain health and wellness by preventing infection. To accomplish this, the nurse instructs the patient to avoid people with contagious illnesses to reduce exposure to communicable diseases and to wash hands frequently to reduce exposure to microorganisms as potential pathogens. Following these instructions will help the patient avoid hospitalizations for COPD; a pulmonary infection can have a devastating impact on a patient who has compromised pulmonary reserves. Fluid and exudates accumulate in the lungs to decrease oxygenation and ventilation, and the patient with COPD is less able to cough and expel sputum. The nurse teaches the patient to sit upright to ease breathing for transient dyspnea that occurs after exertion or while eating. This technique, however, is unlikely to prevent a hospitalization for the patient with an exacerbation of COPD. The patient with COPD regularly uses oxygen for dyspnea as prescribed. Oxygen provides symptomatic relief of dyspnea but does not prevent hospitalizations for exacerbated COPD. Eating nutrient- and calorie-dense food is also important. Patients with COPD work very hard at breathing; therefore the patient needs the calories and nutrition to supply fuel for the work of breathing. In addition, patients with COPD should eat these foods because eating them in sufficient quantities to meet their needs is often difficult; therefore the food they do eat must contain many calories and nutrients. Nutritional issues are not the most important aspect of preventative therapy for patients with COPD; an infection is more likely to cause a more devastating problem. TOUHY 4TH ED TESTBANK

An older man who paints houses for a living has had a myocardial infarction (MI). Which intervention should the nurse implement to prevent adverse health effects from his occupational history? a.Provide low-cholesterol diet meals. b.Avoid substances that are hepatotoxic. c.Promote coughing and deep breathing. d.Analyze the electrocardiograms rhythm.

ANS: C The nurse implements coughing and deep breathing because of the older mans history of exposure to environmental toxins from the paint vapor. Therefore to promote oxygenation and ventilation and to prevent atelectasis and pneumonia, the nurse instructs him to cough and deep breathe at regular intervals. Hypercholesterolemia is a common co-morbidity with coronary artery disease; if his total cholesterol is greater than 200 mg/dl, then the nurse should provide a low-cholesterol diet. Inhalation of paint vapor over a long period has adverse effects primarily on the lungs. However, some hepatotoxic substances are used in health care, such as immunosuppressants and aminoglycoside antibiotics, and must be given to this individual with caution. Because he had a MI, the nurse closely monitors the hearts rhythm to detect ventricular dysrhythmias, tachycardia, and other potentially harmful rhythms, but such abnormal rhythms are unlikely to be directly related to his occupational history. TOUHY 4TH ED TESTBANK

The nurse instructs the unlicensed assistive personnel to feed an older adult. If the nurse is unable to observe feeding directly, then which action should the nurse use to assess the older adults risk for aspiration immediately after feeding? a.Note food volume eaten. b.Observe skin color. c.Inspect for pocketing. d.Monitor for bradypnea.

ANS: C The nurse is able to assess the risk for aspiration by assessing the adult for pocketing, which is residual accumulations or pockets of food in the mouth that the older adult can aspirate after the meal is complete. If food is found in the mouth, then the nurse removes it and evaluates the current plan of care. The amount of food consumed by an older adult is unrelated to the risk of aspiration; therefore noting the amount of food that is eaten is unsuitable for detecting the risk for aspiration. An alteration in circulation as evidenced by a change in skin color can be a late indicator of aspiration. Thus a change in skin color can indicate the presence of aspiration, but the older adult with a change in skin color is not necessarily at risk for aspiration. The nurse monitors for tachypnea as an indicator of aspiration; however, tachypnea does not indicate a risk for aspiration. TOUHY 4TH ED TESTBANK

An older man living in an adult community becomes a widower 1 month after retirement. Two months later, he has not resumed a weekly outing with his fishing club. Which should the nurse implement? a.Ask the older adult why he is not fishing. b.Have club members visit him at home. c.Meet with him to assess his interests. d.Enroll him in a weekly card game.

ANS: C The nurse meets with the older adult to determine how and when to establish new relationships and social activities in light of his wifes death. Although the older man was engaged in fishing before, the nurse respects his wishes and needs as he transitions to a different life. The nurse avoids confronting him, even if done so in a gentle manner. Why questions can be interpreted as confrontational, and the older adult may be unable or unwilling to articulate a reason. The nurse avoids asking club members to visit him because doing so would remove the older adult from the decision making process. Although this effort can be well-meaning, it can also be interpreted as an invasion of privacy. The older adult is more likely to participate in an activity in which he has input. In addition, the nurses action can be interpreted as disrespectful because an adult has the right to control his own life. TOUHY 4TH ED TESTBANK

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

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

An older man who had a gastric resection states that he wants to ambulate but the osteoarthritis (OA) in his knees causes too much pain. Which intervention should the nurse implement to increase the amount of walking this man can perform? a.Encourage the patient to keep his leg elevated. b.Instruct him to rest until the pain disappears. c.Suggest taking pain medication before walking. d.Collaborate with the health care provider to make a walker available.

ANS: C The nurse suggests taking the pain medication before walking to provide relief during the time when the pain occurs. In addition, if the patient premedicates, then the analgesic effect is likely to last long enough to benefit the patient for any pain after walking. Elevating leg will provide comfort and decrease in edema after exercise; however inactivity may exacerbate the pain. Inactivity tends to exacerbate the pain of OA. Instead, the nurse recommends a balance of rest and exercise. A walker is not indicated and will not alleviate any pain in the knees; it is intended to provide stability for ambulation. TOUHY 4TH ED TESTBANK

Which nursing intervention is a holistic approach to an older adult? a.Performs glucose testing during the weekly worship service. b.Wheels ambulatory adults to exercise when running late. c.Assigns female nurses to older women who are Islamic. d.Allows older adults in a nursing home to eat meals alone.

ANS: C The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Interrupting an older adults worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adults life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in a wheelchair to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, while focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being. TOUHY 4TH ED TESTBANK

Using the RAI, the nurse identifies a trigger for a male nursing home resident who requires an indwelling urinary catheter from the MDS. Which should the nurse do next? a.Develop an individualized care plan. b.Assign suitable nursing interventions. c.Use the RAPs. d.Institute agency-approved catheter care.

ANS: C The nurse uses the RAPs to assess triggers identified from the MDS. To help the resident achieve optimal functional status by determining his strengths, needs, and preferences, RAPs provide an organized framework used by the health care team for additional assessment of the trigger. The nurse develops the care plan after completing the RAPs. The nurse assigns suitable nursing interventions to the plan of care. The nurse uses agency-approved policies to provide care as assigned in the plan of care. TOUHY 4TH ED TESTBANK

The nurse sees an older woman with OA and a low-grade fever. The patient tells the nurse that her pain is changing; it is worse at night and in her shoulder muscles. Which of the following does the nurse perform to prevent complications of this patients condition? a.Assess her joints for swelling and redness. b.Obtain blood specimens for blood cultures. c.Direct her to report temporal or scalp pain. d.Tell her to apply moist heat for 20 minutes.

ANS: C The older adult exhibits clinical indicators of polymyalgia rheumatica (PMR), and a serious complication of PMR is giant cell arteritis (GCA). The nurse instructs the patient to report scalp and temporal pain because they are early indicators of GCA. As a complication of PMR, the patient exhibits clinical indicators of PMR that include severe pain and stiffness of muscles, including the back, buttocks, and thighs. PMR is not a disease that affects the joints. Blood cultures are not indicated for PMR because it is not an infection. Because PMR is an autoimmune, inflammatory disorder, applying heat is more likely to aggravate the patients condition. Effective treatment for PMR includes low-dose steroids. However, low-dose steroids are unrelated to preventing complications of PMR. TOUHY 4TH ED TESTBANK

The nurse expresses concern about a female nursing home resident in the team meeting. Which resident information determines the teams priority in planning her care? a.Experiences several interruptions with sleep b.Has had coronary bypass graft surgery during the last year c.Needs increasing help with personal hygiene d.Eats insufficient calories to maintain her weight

ANS: C The residents ability for self-care is deteriorating, and needing help with personal hygiene is an indicator of declining health because the level of activity is an indicator of an individuals health and wellness. Thus declining health is the nurses priority in planning care. Assessing and addressing medical problems, such as heart disease and nutrition, and improving sleep are among the aspects of care to restore health and well-being for which the nurse will plan. Improving sleep patterns is part of the overall plan to restore her health and wellness. A history of coronary artery disease is important information to use to plan care; however, it is part of the plan to improve the womans overall health. Improving nutrition is part of the overall plan to restore her health and wellness. TOUHY 4TH ED TESTBANK

Which of the following is an important consideration about the skin of an older adult person? a.Generous amounts of soap should be used for cleansing. b.Sweat gland activity increases. c.Skin becomes more vulnerable to damage. d.Skin becomes darker in unexposed areas.

ANS: C Thin skinreduced sebaceous protection, vascular insufficiency, and longer periods in stationary positions promote skin damage for older adults. Because moisture is lost more rapidly from the skin of an older adult, excessive use of soap tends to dehydrate the skin more severely than it does in a younger person. Sweat gland activity does not increase in older age, but moisture is lost more rapidly because the skin is thinner and sebum secretion is reduced. Changes of skin color in areas exposed to the sun are of greater concern than those in unexposed areas. TOUHY 4TH ED TESTBANK

Which of the following diseases affects the eyesight of an older adult by damaging the central part of the retina? a.Glaucoma b.Presbyopia c.Cataract d.Macular degeneration

ANS: D Macular degeneration is a disease characterized by damage to the central part of the retina that leaves the outer edges of the visual field intact. Presbyopia, a gradual decline in the flexibility of the lens, makes close-up focusing more difficult and is a common age-related change but not a disease. Glaucoma, a disease marked by increased pressure within the eye that potentially leads to optic nerve damage, is the most common cause of blindness in those 65 years of age and older. A cataract is a disease marked by clouding and blurring of the lens. TOUHY 4TH ED TESTBANK

The son of an older adult couple ends his life suddenly and violently. The husband proceeds with living as usual. After 1 year, the wife remains in seclusion and is hospitalized for dehydration. Which steps should the nurse implement to help improve the wifes mental health and wellness? a.Encourage additional fluids and social activity. b.Instruct the husband to display empathy for her. c.Establish a trusting, caring relationship with her. d.Ask social services for a survivors support group.

ANS: C This couple is at high risk for chronic grief because of the nature of their sons death. The nurse can help this older woman work toward better mental health by establishing a trusting and caring relationship with her to encourage expressions about her son. Afterward, the nurse can pose probing questions to determine the best plan of care to help this older adult resolve or reframe enough grief to allow improved functioning. Encouraging fluids can be a reasonable nursing intervention for this woman; however, encouraging social activity without a complete assessment and without being in the environment of a trusting relationship is unlikely to help improve functioning. The husband can be displaying disenfranchised grief and be unable to help until his grief is managed. A survivors support group can be helpful to survivors of a loved ones suicide; however, expecting this older adult to attend such a group is unrealistic until the nurse establishes a trusting relationship with her. TOUHY 4TH ED TESTBANK

An older man, who has activity intolerance as a result pulmonary fibrosis, barks orders and commands at the nursing staff when he cannot help himself. Which of the following is the nurses first priority patient outcome for planning care to resolve this problem? a.Verbalizes requests in a calm, respectful, and appreciative manner. b.Identifies potential triggers of anger, and positively redirects energy. c.Expresses an understanding of the need to balance rest and exercise. d.Resolves the pulmonary fibrosis to restore baseline activity tolerance.

ANS: C This individual becomes frustrated and angry when activity intolerance limits his independence and ability to perform activities of daily living. Although pulmonary fibrosis cannot be cured, expressing an understanding of the need to balance rest and exercise and helping this older adult manage his physiological limitations by balancing rest and exercise, along with other strategies, is the nurses priority patient outcome. Potential behavioral disorders cannot be effectively managed until the physiological needs of the patient are met according to Maslows Hierarchy of Human Needs. Verbalizing requests in a calm, respectful, and appreciative manner is not the nurses priority patient outcome; the physiological need is more important to resolve; lower basic human needs must be met before higher level needs can be effectively managed. Identifying potential triggers of anger and positively redirecting energy is not the nurses priority; physiological needs must be met first. Pulmonary fibrosis is not curable; therefore the patient will have pulmonary fibrosis until death. TOUHY 4TH ED TESTBANK

An older adult who is on bed rest has tachycardia and dry mucous membranes after surgery. Which of the following is the nurses priority for preventive care because of the patients fluid volume status? a.Bowel obstruction b.Delirious behavior c.Thromboembolic events d.Delayed wound healing

ANS: C This older adult is at high risk for a thromboembolic event as a result of bed rest and dehydration. Because it is a potentially life-threatening situation, the nurses priority is to prevent a thromboembolic event, including deep venous thrombosis and pulmonary embolism. The patient is likely to have low circulating blood volume as evidenced by tachycardia, which is a compensatory mechanism when the tissues receive inadequate oxygenation. In addition, compensatory mechanisms that help restore fluid balance are limited in the older adult. This limitation results in poorer tissue perfusion and an increased risk for thrombus formation for a patient who is on bed rest; a lack of skeletal muscle action promotes pooling of blood in the extremities. Dehydration can lead to constipation and, in extreme cases, a bowel obstruction; however, this potential gastrointestinal issue is not the nurses priority because circulation issues take precedence. Dehydration increases the risk of delirium, especially in a patient who is hospitalized, but dehydration has a lower priority than the circulation issue. Dehydration increases the risk of delayed wound healing; optimal wound healing occurs in a moist environment. However, delayed wound healing is a secondary concern until the nurse manages the circulation issue. TOUHY 4TH ED TESTBANK

The nurse must inform an older adult who does not speak English about patient rights. In addition, the nurse must have the adult sign the document about information access. Which intervention should the nurse use to maintain the confidentiality of this older adult? a.Present the patient with a Spanish version of the information access document. b.Have an English-speaking family member explain the document to the patient. c.Explain the document to the patient using an interpreter to ensure understanding. d.Instruct an interpreter to read the information access document to the resident privately.

ANS: C To ensure patient understanding, the nurse explains a patients rights about information access to the patient with the assistance of an interpreter. The nurse is responsible for patient understanding and thus cannot relinquish this task to another person. When understanding is reached concerning the rights associated with access to information, the patient can then make an informed decision about releasing health care information and thus maintain privacy. The nurse cannot ensure patient understanding without discussing the document with the patient using an interpreter. The nurse cannot delegate a nursing responsibility to a family member; the nurse does not have the right to release the health information to anyone. In private or public, the nurse cannot delegate this task to another person. TOUHY 4TH ED TESTBANK

Which laboratory results are goals for reducing a persons risk for diabetes and heart disease? a.Triglycerides over 150 mg/dl b.Cholesterol 250 mg/dl c.High-density lipoprotein (HDL) over 40 mg/d d.Fasting blood glucose under 150 mg/dl

ANS: C To reduce the risk for diabetes and heart disease, the serum triglycerides value should be under 150 mg/dl. The cholesterol value should be under 200 mg/dl to reduce the risk for heart disease and diabetes. The HDL level should be over 40 mg/dl to reduce the risk for heart disease and diabetes. Fasting blood glucose value should be under 126 mg/dl. TOUHY 4TH ED TESTBANK

Which of the following characteristics of RA are unlike those of OA? a.Myalgia and stiffness b.Joint pain that is curable c.Crepitus and instability d.Systemic and symmetrical

ANS: D OA is not a systemic disease, nor does it affect joints symmetrically. Myalgia and stiffness are characteristics of PMR; however, myalgia is uncharacteristic of RA and OA. Joint pain is characteristic of both RA and OA, but only OA is curable through joint replacement. RA is a systemic disease and affects joints symmetrically; therefore these are clinical indicators of OA, not RA. TOUHY 4TH ED TESTBANK

The overall temperature in your gerontological unit is 62 F during the evening shift. In documenting this concern to the administration, which factor is the most important for the health and well-being of older adults? a.It is not fair for older adults to have to deal with an uncomfortable environment. b.Some of the residents are wearing blankets around their shoulders to keep warm. c.An ambient temperature of 62 F is unsuitable for older people because they have impaired thermoregulation. d.It feels much warmer in the administration wing than out in the patient care areas.

ANS: C Under no circumstances should the temperature drop below 65 F because older adults are at risk for hypothermia. Furthermore, frail older adults need the temperature to be considerably higher. The issue is not one of fairness but a more fundamental issue of patient safety. Some of the residents wearing blankets may represent individual temperature preferences. The purpose is to make the point that the patients are vulnerable to low temperatures, not to make veiled accusations against the administrators. TOUHY 4TH ED TESTBANK

The nurse assesses the quality of which of the following patient characteristics when applying the Get-Up-and-Go test from the Hendrich II Fall Risk Model? a.Stride b.Speed c.Balance d.Flexibility

ANS: C Using the Get-Up-and-Go test, the quality of the older adults movements is assessed. The nurse instructs the individual to rise from a chair, walk, and return to the chair and be seated. The stride is not specifically assessed in this test, although it is an aspect of gait and can be a factor in balance. The older adults speed is not assessed in this test. Flexibility is not specifically assessed in this test, although it can be an important factor in balance. TOUHY 4TH ED TESTBANK

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

ANS: C Using the LEARN model (Listen with sympathy to the patients perception of the problem; Explain your perception of the problem; Acknowledge the differences and similarities; Recommend treatment; and Negotiate agreement), the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health-related information. Speaking with the health care provider is premature until the assessment is complete. Unless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can also be unsuitable and insulting for this patient. TOUHY 4TH ED TESTBANK

Several organizations collaborated in 2001 to publish Scope and Standards of Gerontological Nursing Practice by the ANA. What is the significance of the collaborative effort to gerontological nurses? a.Changes the health care delivery to increasing numbers of older adults b.Mandates gerontological certification for nurses who care for older adults c.Standardizes gerontological nursing practice among various organizations d.Ensures minimum gerontological competencies for all graduating students

ANS: C Various gerontological nursing organizations collaborated to define the criteria for gerontological nursing practice, demonstrating an agreement among the various organizations on these standards. The collaboration among multiple organizations potentially improves the quality of gerontological nursing care as the number of older adults grows. This document establishes the criteria for gerontological nursing practice. To improve the health care to older adults, all graduating students should master minimum competencies in gerontological nursing; however, many students continue to receive little specialty training and education in the care of older adults. TOUHY 4TH ED TESTBANK

After the older adult dies, the brother who has a history of alcohol abuse upsets the family by going on a drinking binge instead of attending the funeral. Which of the following is the best description of the brothers behavior? a.Personality disorder c.Disenfranchised grief b.Disrespectful attitude d.Chronic grief

ANS: C When a family is in discord, a grieving member can be unable to or consider him or herself permitted to express grief by socially acceptable means. The brothers behavior is most likely a grief reaction, although it could be indicative of a personality disorder. The brother can feel that the most respectful thing he can do for the family members is to stay out of their way. The brother has suffered an acute loss. TOUHY 4TH ED TESTBANK

Which is an accurate statement regarding gerontological nursing education? a.Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. b.Undergraduate nursing programs extensively cover gerontological nursing in dedicated courses, comparable with the coverage of psychiatric nursing. c.When content is integrated throughout a curriculum, less than 25% is devoted to geriatric care. d.Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum.

ANS: C When content is integrated throughout the curriculum, less than 25% of the content is devoted to geriatric care. Only recently has gerontological nursing content begun to appear in nursing school curricula. Most nursing schools still do not have such courses. At present, no minimum requirements exist for the coverage of care of older adults. TOUHY 4TH ED TESTBANK

The nurse identifies which risk factor(s) for OA? (Select all that apply.) a.Men b.African Americans c.Old age d.Steroid use

ANS: C, D Older adults and steroid use have been identified as risk factors for the development of OA. Women are more prone. Caucasians and Asian Americans are more at risk. TOUHY 4TH ED TESTBANK

The nurse recognized which of the following as symptoms of wet age-related macular degeneration (AMD)? (Select all that apply.) a.Rarely causes severe visual impairment b.Yellow deposits under the retina c.Decrease in central vision d.Visual distortion

ANS: C, D Patients suffering from wet AMD experience a decrease in central vision and visual distortion. Wet AMD leads to blindness. With distortion, edges or lines become wavy. Dry AMD rarely causes severe visual impairment, and yellow deposits under retina are a classic sign. TOUHY 4TH ED TESTBANK

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

ANS: D Sleep provides an important survival tool to rest, restore, and rejuvenate the body. Rest occurs during sleep. Sleep is an extension of rest. Rest can occur in brief periods and in extended cycles during sleep. TOUHY 4TH ED TESTBANK

The community health nurse is preparing for an educational session on AD for a group of seniors. Which modifiable risk factors should the nurse include? (Select all that apply.) a.Family history c.Smoking b.Sex d.Obesity

ANS: C, D Smoking cessation and obesity are both modifiable risk factors. The focus of research on AD is on the interaction between risk-factor genes and lifestyle or environmental factors. Increasing evidence strongly points to the potential risk roles of vascular risk factors (VRFs) and disorders (e.g., midlife obesity, dyslipidemia, hypertension, cigarette smoking, obstructive sleep apnea, diabetes, cerebrovascular lesions) and the potential protective roles of psychosocial factors (e.g., higher education, regular exercise, healthy diet, intellectually challenging leisure activities, socially active and integrated lifestyle) in the pathogenesis and clinical manifestations of dementia (especially AD and vascular cognitive impairment). Family history and sex are not modifiable. TOUHY 4TH ED TESTBANK

Those who cope less effectively may exhibit which of the following? (Select all that apply.) a.Avoids avoidance b.Confronts reality c.Is demanding d.Is rigid

ANS: C, D Those who cope less effectively have few if any of these abilities listed by Weisman. They tend to be more rigid and pessimistic, are demanding, and are given to emotional extremes. Those who cope well avoid avoidance and confront reality. TOUHY 4TH ED TESTBANK

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

ANS: C, D, E, F The nurse asks the patient to evaluate how restorative or refreshing sleeping is for him; awakening unrefreshed is a risk factor for sleep apnea. In addition, morning headaches, daytime irritability and personality changes, and periods of nighttime wakefulness are all risk factors for sleep apnea. Changes in appetite and rituals for sleeping are rarely associated with an increased risk for sleep apnea. TOUHY 4TH ED TESTBANK

An older man who has chronic obstructive lung disease has muscle wasting and poor skin integrity as a result of a long-term therapeutic regimen. Which patient teaching should the nurse use to help reduce his risk of falls? (Select all that apply.) a.Take calcium carbonate (Caltrate) 600 mg with meals. b.Take omeprazole (Prilosec) before breakfast. c.Participate in a progressive regular exercise program. d.Avoid crowds and people with contagious illnesses. e.Consume a well-balanced diet that is high in calories. f.Perform gentle skin cleansing with an emollient lotion.

ANS: C, E Participating in a regular exercise program is an important nursing intervention to help prevent the risk of falls for this older adult who has clinical indicators of complications from steroid therapy. Steroids are a common therapeutic regimen used during exacerbations of chronic obstructive pulmonary disease (COPD). When needed on a long-term basis, steroids can ravage the skin and the musculoskeletal system of the patient, causing muscle wasting and OA. Thus this man is likely to have below-normal bone density; therefore the nurse instructs him to participate in regular, progressive exercises and pulmonary rehabilitation to build cardiopulmonary reserve, muscle bulk, and bone density to help reduce the risk of falls. The nurse also instructs the patient to eat a high-calorie, well-balanced diet to provide the body with substrate for tissue building and repair. A higher amount of calories than usual are required because patients with COPD work hard to breathe, and this work requires more calories to prevent tissue atrophy. A well-balanced diet helps prevent the risk of falls by supplying the body with sufficient fuel to sustain activity and by increasing bone and muscle density to maintain balance and coordinated movement. Although this man is at risk for below-normal bone density, the nurse instructs the patient to take up to 500 mg of calcium because the system cannot absorb more than 500 mg at a time. To protect the gastrointestinal tract, administering a proton-pump inhibitor is a reasonable nursing intervention for a patient with a history of taking steroids; however, this intervention is not directly related to reducing the risk of falls. Avoiding sick people is a reasonable nursing intervention to prevent the risk of infection for an individual with COPD. The nurse instructs this older adult to cleanse the skin gently and to apply an emollient lotion to maintain skin integrity. TOUHY 4TH ED TESTBANK

An older woman has severe ischemic heart disease, hypertension, and low cardiac output. Which medication does the nurse administer to counteract the neurohormonal activation of this patients cardiovascular status? a.Loop diuretic b.Nitroglycerin c.Cardiac glycoside d.Beta-adrenergic blocker

ANS: D A beta-adrenergic blocker is an important part of the standard therapy for patients with HF and is the drug of choice to break the neurohormonal cycle that aggravates HF. Beta-blockers inhibit the action of epinephrine (EPI) and norepinephrine (NE) to decrease myocardial workload and lower the oxygen demands of the myocardial tissue. This womans heart is an ineffective pump because it is ischemic and unable to meet the bodys metabolic demands. An ischemic heart has difficulty obtaining the supply of oxygen it needs to maintain cardiac output. As a result, the hypoxic myocardium stimulates the sympathetic nervous system to release EPI and NE for shunting blood from the periphery to vital organsthe fight-or-flight mechanism. The release of EPI and NE causes vasoconstriction and subsequent hypertension. Both make the work of the heart more difficult because the heart must work harder to pump blood out of the left ventricle against a higher afterload. This extra work increases the oxygen demands of the myocardial tissue and augments the cycle started by the ischemic heart. A diuretic is a part of the standard therapy for HF for controlling fluid balance, but it does not interrupt neurohormonal activation from HF. Nitroglycerin is a common therapy for an ischemic myocardium to increase myocardial oxygenation, but it does not interrupt the neurohormonal activation from HF. Digoxin, a cardiac glycoside, is a part of the standard HF therapy and acts as an inotropic agent to increase the force of myocardial contractions; however, it does not interrupt neurohormonal activation from HF. TOUHY 4TH ED TESTBANK

The actions of the family members of an older adult who just died are chaotic, and they are unable to decide on a funeral home. Which recommendation should the nurse implement? a.Help them make a list of the problems. b.Provide a list of preferred funeral homes. c.Allow them privacy to work it out alone. d.Suggest they call someone who can help.

ANS: D A characteristic of a good coper is one who has good communication with others; however, immediately after the older adults death, this family is ineffectively coping with the loss. To facilitate the family with decision making, the nurse asks one family member to consider calling another person who will likely help the family face the reality of the death. After making the suggestion, the nurse ensures that the family has enough time for holding behaviors, to prepare the body if they wish, and to express their grief in privacy and in their own way. Effective coping includes a focus on the solutions rather than on the problems. The nurse avoids recommending funeral homes, which could be a potential conflict of interest. The family can be unable to solve the problem alone because of ineffective coping in the immediate mourning period. TOUHY 4TH ED TESTBANK

Which of the following approaches to hygienic care is beneficial for a patient with dementia? a.Schedule the patients full shower at 7 AM, three mornings every week. b.Have a team give the bath with each member washing a different body area. c.Wash the perineal region first to remove potentially infectious material. d.Explain each step as you go, and keep the patient covered as much as possible while bathing.

ANS: D A person with dementia can interpret undressing for bathing as an assault. It should be performed in a way that minimizes the intrusive and exposing aspects and maintains trust between the person and only one caregiver. From the point of view of the well-being of the patient, bathing is rarely an emergency that it must be performed at a time when the patient is not receptive. Stimulation should be kept simple and focused, and alarming the patient should be avoided. The most sensitive and intimate areas should be washed last, after trust has been established between the patient and the nurse, which may have to be done anew at every encounter. From an infection-control standpoint, washing occurs from clean to dirty areas. TOUHY 4TH ED TESTBANK

The nurse prepares to transfer an older adult to a long-term care facility and calls the facility to give a report. Which nursing actions are the responsibilities of the transferring nurse and the receiving nurse? a.Incorporating patient goals into the plan b.Ensuring the patient is stable for transfer c.Supplying patient documents for planning d.Providing continuity of care during the transfer

ANS: D A shared responsibility of the sending and the receiving nurses or care team is to regard the transition as a transfer versus a discharge and to provide continuous and consistent nursing care throughout the transfer phase. To accomplish this, the two nurses or groups must have clear, comprehensive communication. The receiving nurse incorporates patient goals into the plan. The sending nurse ensures that the patient is stable for the transfer to prevent decompensation during the trip or shortly after arrival at the new facility. The sending nurse is responsible for providing clear, comprehensive, and complete patient documentation. TOUHY 4TH ED TESTBANK

Which option refers to the highest level of human functioning according to Maslow? a.Biological and physical integrity b.Safety and security c.Self-esteem d.Self-actualization

ANS: D According to Maslow, persons whose basic physical needs are met, who feel safe and secure, and who possess self-esteem and self-efficacy can achieve self-actualization, reaching out beyond themselves to make their lives meaningful. Biological and physical integrity is the lowest level in Maslows hierarchy, below safety and security. Safety and security are the second-lowest level, below self-esteem. Self-esteem is the second-highest level, below self-actualization. TOUHY 4TH ED TESTBANK

Which one of the following is a true statement about mobility and safety for older adults? a.Use of restraints on older patients helps prevent injuries from falls. b.Falls that do not cause physical injury are not significant. c.The get-up-and-go test provides a measure of a patients energy and initiative. d.Lowering the bed and fluorescent tapes are interventions to increase safety.

ANS: D Adjusting the bed height to match the length of the residents lower leg and marking the path from the bed to the toilet with bright fluorescent tape are some of the many possible interventions to improve residents safety. Restraints have not been shown to increase safety and may contribute to morbidity and mortality. Even if a fall does not cause injury, it can contribute to the fear of falling, inhibiting activities of daily living. The Get-Up-and-Go test, in which the person rises from a straight-backed chair, walks 10 feet, returns, and sits down, assesses balance and gait. TOUHY 4TH ED TESTBANK

Which of the following qualities does the nurse need to provide caring? a.Sensitivity to the needs of other nurses b.Longing to help others live a healthy life c.Desire to have a stable career and income d.Ability to create a trusting environment

ANS: D Along with competence, compassion, conscience, and a commitment to provide caring, the nurse must be able to inspire confidence in the nursing care. The nurse with compassion has sensitivity to the needs of others in general. The desire to help others lead a healthy life is admirable; however, to provide caring, the nurse should not impose personal beliefs on patients. Nurses can provide caring by dedicating themselves to nursing as a lifelong commitment and not solely as a means to provide a living. TOUHY 4TH ED TESTBANK

An older individual from which culture is likely to receive more respect than a younger person in the same community? a. Canadian b. Anglo-Saxon c. German d. African American

ANS: D An African American is more likely to receive respect than a younger person in the same community because African Americans are more likely to value the wisdom and insight of older adults. Older individuals from a Euro-American culture are less likely to be valued by the community, owing to the effects of the industrial revolution and the need for strong, young laborers. An individual who is an Anglo-Saxon has European ancestry. A German citizen is European. TOUHY 4TH ED TESTBANK

Which of the following statements is true about cardiopulmonary disease in older adults? a.COPD can be reversed with proper treatment. b.Chest radiographic studies are a reliable indicator of whether pneumonia is present in an older patient. c.Persons older than 65 years should receive Pneumovax annually. d.Mouth hygiene is essential to prevent and treat pneumonia.

ANS: D Bacteria from the mouth can migrate into the lower respiratory tract and cause infection. COPD cannot be reversed. For a debilitated person at the beginning of the course of infection or in dehydration, the chest x-ray study is often falsely negative. Pneumovax is a one-time vaccine against the pneumococcus bacterium. TOUHY 4TH ED TESTBANK

Which of the following is on the list of drugs considered suitable for the older adult? a.Indomethacin (Indocin) b.Reserpine (Reserpine) c.Chlorpheniramine (Chlor-Trimeton) d.Bupropion (Wellbutrin)

ANS: D Bupropion is a safe antidepressant for an older adult that is also less likely to cause sexual dysfunction than other nonsteroidal SSRIs. Indomethacin is unsuitable for an older adult because it produces the most central nervous system effects of all nonsteroidal antiinflammatory agents. Reserpine is unsuitable for an older adult because it poses a risk of depression, sedation, and orthostatic hypotension. Chlorpheniramine and similar antihistamines are unsuitable for an older adult because of their anticholinergic properties. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about assistive devices to aid older adults with impaired mobility? a.A walker can be used when climbing stairs. b.Cane tips should be smooth. c.Older adults save money by adapting assistive devices from their friends. d.A cane is most useful for unilateral disabilities but not bilateral problems.

ANS: D Canes can relieve stress on arthritic joints on one side. A walker can equally relieve pressure on joints on both sides. Cane tips should be flat on the bottom with a series of rings, not smooth. Older adults are tempted to save money by using assistive devices from nonmedical sources; however, regardless of the source of the assistive device, the device should be fitted to the older adult. An older adult should never try to adapt to the assistive device; an ill-fitted device can contribute to falls and injuries. Using a walker is contraindicated when climbing stairs. Improperly selected or improperly used assistive devices can be risk factors for falling. TOUHY 4TH ED TESTBANK

The nurse is caring for a patient who has had a stroke. The nurse is concerned the patient will develop contractures. Which intervention should the nurse implement? a.Use tennis shoes while in bed. b.Turn the patient onto the affected side, resting on the shoulder. c.Use paraffin wax for hand soaks. d.Conduct passive range-of-motion movements to the affected extremities.

ANS: D Conducting passive range-of-motion movements will help decrease the risk of contractures. Using tennis shoes in bed helps decrease foot drop. Turning the patient on the affected side, resting on the shoulder, can cause pain. Paraffin wax soaks are often used for sufferers of arthritis. TOUHY 4TH ED TESTBANK

Which of the following interventions is recommended for an older adult in the final stages of dying? a.Apply an electric blanket to keep the patient warm. b.Lower the head of the bed, and turn the head to the side. c.Decrease the number of visitors. d.Support the preservation of energy.

ANS: D Conserving energy should be a focus in the care of a patient in the final stage of dying. Completing only the necessary activities of daily living (ADLs) would be an example. An electric blanket should not be used; it can increase the patients distress by overheating. Elevating the head of the bed and turning the patients head to the side is a recommended intervention to help clear uncomfortable respiratory congestion. Nurses should not withhold visitors; the patient needs to have closure, as well as the family. TOUHY 4TH ED TESTBANK

Which combination is suitable for the daily diet of older adults? a.Vitamin B12, 2.4 mcg; and fiber, 15 g b.Three 8-oz glasses of fluid; and 1600 calories c.Vitamin B12, 1.1 mcg; and 40% of daily calories from fat d.Calcium, 1200 mg; and vitamin D, 600 to 800 units

ANS: D Daily recommendation is 1200 mg of calcium, and 600 to 800 units of vitamin D are needed to enable the body to use the calcium. Daily vitamin B12 intake is correct, but older adults require 20 g to 35 g of fiber. Although 1600 calories per day is correct, fluid intake (preferably water) should be 1500 ml, approximately six to eight 8-oz glasses. Vitamin B12 intake should be 2.4 mcg per day, and calories from fat should be 20% to 25%. TOUHY 4TH ED TESTBANK

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

ANS: D Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmission of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. The spinal cord and the cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord. TOUHY 4TH ED TESTBANK

Which describes the older man who is likely to experience the best overall health and well-being? a.Resides in assisted-living facility, watches television alone, uses herbal remedies, is underweight b.Resides alone, was moved to a new city recently by his family members for their convenience, has osteoarthritis c.Has prostate cancer with metastasis to the lungs, is receiving radiation therapy, is wealthy, has a large family d.Uses a wheelchair, has peripheral arterial disease, attends weekly baseball games with three friends

ANS: D Despite a serious chronic illness and mobility restrictions, this older man has a social network and planned activities with friends. Further, he overcomes mobility issues to pursue personal interests; thus this person is most likely to experience the best health and well-being because of an optimal functional status. This older adult is not thriving in an assisted-living facility, despite having other people in the facility, as evidenced by television viewing habits and weight, both potential indicators of depression. Various aspects of this persons life are unbalanced, thus inhibiting progress on the path to optimal health and wellness. In addition, the use of herbal remedies can be aggravating or precipitating the problems. After a move to a new region, an older adult, especially one who lives alone and is moved to a new area for the familys convenience, is likely to experience loneliness and isolation until a new social network is established. Although this person has a less acute health problem, the social isolation is likely to create significant disruption on the path to health and wellness. Although this older adults financial resources are plentiful, the existence of a large family does not ensure any type of psychosocial support. Most likely, this person faces a grim prognosis because the prostate cancer has crossed the diaphragm, thus reducing the likelihood of a prolonged life. TOUHY 4TH ED TESTBANK

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

ANS: D Engaging in physical activity and social interaction are associated with a lower risk for Alzheimer disease. Keeping the curtains open can make a residents room more pleasant but is likely to be counterproductive in lowering the risk; brightening the room can entice the resident to stay in the room and decrease social interaction. Stringing beads is a passive and sedentary activity and therefore unlikely to decrease the risk for Alzheimer disease; physical activity is associated with a lower risk for Alzheimer disease. Watching movies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about gerontological nursing for patients of different races and ethnic backgrounds? a.The fact that a nurse is white has no bearing on the nurses ability to care for minority patients or patients of color. b.An encyclopedic accumulation of details of a particular culture is the best preparation for caring for persons from that culture. c.A nurse who works in Illinois does not need to be as concerned about sensitivity to multiple cultures as the nurse who works in California. d.Facial expressions, body language, posture, and touch are important elements of communication between a nurse and a patient from a different ethnicity.

ANS: D Facial expressions, body language, posture, and touch become more important as language barriers limit the effectiveness of verbal exchanges. They also have different meanings in different cultures. A white person is more likely to have had opportunities and freedoms and take them for granted, whereas a person of color who has never experienced such opportunities and freedoms may regard them as special privileges. Knowledge of cultural details can be useful, but it can also lead to stereotypes that obscure the differences between individual persons. Illinois, along with California, Nevada, Florida, Texas, and New Jersey, is one of the states with the greatest numbers of immigrant older adults. TOUHY 4TH ED TESTBANK

Which of the following statements is not true of older adult relationships? a.After 50 years of marriage, a couple can face new and severe challenges to their relationship. b.Older adults often hold their families together by arranging get-togethers and documenting the familys history and rituals. c.Losing a brother or sister brings an older adult face-to-face with his or her own death. d.For older adults, friends can never take the place of family.

ANS: D Friendships can provide the commitment and support that is sometimes lacking in family relationships. Physical and psychosocial changes related to aging, such as declining health, reduced income, and mismatched needs, may cause a severe strain even for a couple who has been together for 50 years or more. A person who holds his or her family together by arranging get-togethers and documenting the familys history and rituals is known as a kin-keeper. The impact of the loss of a brother or sister, not only at the time of the death but also when a younger survivor reaches the age at which the lost sibling died, can be quite disruptive. TOUHY 4TH ED TESTBANK

Which is the most important element for older adults to have for enhancing the transition into retirement? a.Good health c.401k retirement plan b.Private pension d.Preretirement planning

ANS: D Good health is always a desirable state; however, if an older adult in poor health plans for retirement, then the transition to the changes of retirement can be smoother if the planning accounts for health challenges. With preretirement planning, private pensions are not obligatory. With preretirement planning, 401k retirement plans are not obligatory; however, these plans are effective saving plans for retirement; they allow employees to save pretax dollars. Preretirement planning is the most important aspect of a smooth transition into retirement because it affords the individual a chance to prepare for losses associated with retirement such as income, interpersonal communication, health insurance, status, influence, and other issues. Health, social, and financial planning help the older adult adapt to expected or sudden retirement. TOUHY 4TH ED TESTBANK

A patient receives heparin daily. The nurse should assess for which clinical response that indicates the need to discontinue heparin therapy? a.International normalized ratio (INR) of 2.5 b.Platelet count of 150,000/mm3 c.Reflux d.Hematuria

ANS: D Hematuria is a serious side effect and requires temporary discontinuation of heparin therapy. A low platelet count can occur in a small percentage of patients who are receiving heparin therapy, which often resolves without intervention. The INR value is obtained to assess the effectiveness of warfarin therapy, not heparin. Heparin is administered parenterally, not by mouth, thus decreasing the risk for irritation. TOUHY 4TH ED TESTBANK

An older adult arrives at the emergency department with a probable diagnosis of a hemorrhagic stroke. The nurse understands, based on the patients age, that the most likely cause is which one of the following? a.Intracranial hemorrhage b.Decreased cardiac output c.Thrombosis d.Uncontrolled hypertension

ANS: D Hemorrhagic strokes are primarily caused by uncontrolled hypertension and less often by malformations of the blood vessels (e.g., aneurysms). Although the exact mechanism is not fully understood, it appears that chronic hypertension causes a thickening of the vessel wall, microaneurysms, and necrosis. When enough damage to the vessel accumulates, it is at risk for rupture. The spontaneous rupture may be large and acute or small with a slow leak of blood into the adjacent brain tissue. In many cases, blood ruptures or seeps into the ventricular system of the brain with damage to the affected tissue through necrosis or death of brain tissue. Hemorrhagic strokes are more life threatening but occur less frequently than ischemic strokes. Decreased cardiac output does not cause this type of hemorrhage. A thrombosis is not related to this type of hemorrhage. TOUHY 4TH ED TESTBANK

Which infection-control practice should the nurse implement when caring for an older adult who has active herpes zoster? a.Wear a face shield and gown for all patient contact. b.Instruct the staff and visitors to wear a type of respirator mask. c.Use a hospital room that has negative airflow circulation. d.Cover ruptured skin lesions with a nonabsorbent dressing.

ANS: D Herpes zoster in an adult is spread through contact; therefore the nurse applies the principles of contact precautions when caring for an older adult with active herpes zoster. To reduce the transmission of the virus through contact, the nurse keeps the ruptured lesions covered. A face shield is not necessary when caring for an adult with herpes zoster; however, a gown can be necessary during dressing changes or any time that splashing can occur. Airborne precautions and a respirator-type mask are indicated for infections transmitted through the air. Because active herpes zoster in an older adult is transmitted through contact, negative airflow is not indicated. TOUHY 4TH ED TESTBANK

An older Hispanic man states that he is not having pain, but he had knee replacement surgery 2 days ago. Which is the best pain assessment tool as recommended by the Hartford Institute for Geriatric Nursing (HIGN) from Try This for the nurse to apply for this man? a.Numeric Rating Scale b.Verbal Descriptor Scale c.Iowa Pain Thermometer d.Faces Pain Scalerevised (FPS-R)

ANS: D Hispanic men are less likely to report pain because their culture tells them to deny and withstand pain without complaining. The nurse uses the FPS-R to validate the patients report because the postoperative period in knee replacement surgery is very painful; this fact makes the nurse think that the patient is likely to have pain. The HIGN has data that support the claim that Hispanic and African-American older adults prefer using the FPS-R for evaluating pain. The Numeric Rating Scale, the Verbal Descriptor Scale, and the Iowa Pain Thermometer are valid and reliable assessment tools, but older Hispanic adults prefer using the FPS-R. TOUHY 4TH ED TESTBANK

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

ANS: D In Tornstams theory, aging offers the potential for gerotranscendence, a culmination of an individuals life, wisdom, and spiritual growth that allows the older adult to live contentedly with and without social activities. An older adult spends more time on meditation and solitude, and less time on materialism and self-consciousness about body image. Individual activities or self-selected activities are satisfactory. Solitude is satisfactory. Midlife patterns are no longer relevant to contentment. TOUHY 4TH ED TESTBANK

An older woman seeks advice from the nurse about preventing further bone loss after being diagnosed with osteopenia. To achieve the womans goal, which of the following patient teachings should the nurse provide to enhance the activity of the osteoblasts? a.Limit sodium intake. b.Refrain from alcohol use. c.Eat high-fiber foods. d.Exercise with weights.

ANS: D In osteopenia, bone metabolism is unbalanced because the action of osteoclasts is greater than the action of osteoblasts. To treat osteopenia effectively, the balance between the activities of the bone cells must be shifted to more osteoblast (bone-building) activity; increasing osteoblast activity helps reduce bone loss and, at the same time, helps gain bone density. Lifting weights stimulates osteoblasts to build bone through the application of opposing forces on the bone and helps achieve the womans goal by increasing physical activity (to stem bone loss) and by generating more bone (to gain bone density). Sodium impairs calcium absorption; therefore the nurse instructs her to limit sodium intake to reduce bone loss. Alcohol impairs calcium absorption; therefore the nurse instructs her to avoid alcoholic beverages. Fiber inhibits calcium absorption. TOUHY 4TH ED TESTBANK

The wife of an older man who has diabetes mellitus brings him to primary care. He has severe bilateral infections forming black rings around each ankle. He tells the nurse it is caused by tight shoes. Which intervention should the nurse implement first to investigate this individuals health care regimen? a.Examine his health insurance coverage. b.Question the man without the wife present. c.Consult with social services about neglect. d.Analyze his glycosylated hemoglobin level.

ANS: D Infected, black rings around both ankles of an individual who has diabetes is a potential clinical indicator of prolonged hyperglycemia because of nonadherence, neglect, or abuse. To begin the assessment of his health care regimen, the nurse checks his glycosylated hemoglobin to quantify his exposure to hyperglycemia. This is the best intervention because the nurse fulfills the duty owed to the patient by implementing a patient-focused action. Although the nurse might be suspicious of potential abuse or neglect and because it is doubtful that tight shoes have caused the rings, the nurses priority is the older adult. Information about his health insurance can provide clues about nonadherence to therapy if the insurance provider denies coverage for diabetic supplies or other necessary health care services. Questioning the man without the wife present is a low priority for the nurse who is faced with a patient who has such a serious health problem. Although the nurse can gather clues concerning the origin of the patients infection by questioning him without the wife present, talking to him in privacy does not guarantee that he will be forthcoming with information or will be a reliable source of information. Consulting with social services about neglect is secondary to his physical needs and a premature intervention because the nurse has not completed an assessment. However, when the nurse completes the patient assessment and gathers evidence supporting a claim of abuse or neglect, social services is a valuable resource for connecting the older adult to community services. The nurse should follow agency policy regarding abuse and neglect. TOUHY 4TH ED TESTBANK

An older woman tells the nurse that she has experienced increasing fatigue and shortness of breath over the last 2 days. Which goal is the nurses priority? a.Promote safety to prevent injury. b.Complete nutritional assessment. c.Balance exercise and rest periods. d.Explore the womans complaints.

ANS: D Investigating the complaint is the nurses priority; fatigue and shortness of breath can indicate cardiac disease, especially in women. Women with cardiac disease often exhibit atypical symptoms, and because it tends to be treated less aggressively in women, the nurse must be careful not to miss indicators of potential cardiac disease. In addition, in investigating the older womans chief complaint, the nurse investigates all possible causes. Promoting safety and preventing injury are reasonable goals to include for this adult but are not as important as investigating the chief complaint; breathing and circulation are two of the three most important physical needs. Completing the nutritional assessment for this adult is reasonable because the symptoms can be related to nutritional deficiencies; however, this assessment should be a part of the examination of the chief complaint. Balancing rest and exercise is a reasonable approach to a complaint of fatigue and shortness of breath if the adult is deconditioned; however, the nurse must investigate the chief complaint to determine whether deconditioning is a factor. increasing, but fertility is decreasing worldwide. TOUHY 4TH ED TESTBANK

8. An older man with severe knee pain tells the nurse how he lost his job and his home after starting a new business when he was 48 years old. Now he lives alone and relies on Social Security. Using Jungs theory, what in this individuals life is the most pivotal in his personality development? a. Living alone b. Meager income c. Severe knee pain d. Job and home loss

ANS: D Jungs theorizes that the personality forms, in part, after a crisis, as an individual moves from extroversion to introversion in aging. Living alone is a situation that is the result of many factors coalescing in an individuals life. A meager income can be a result of the individuals life work and other individual choices and events. His personality can affect how an individual deals with pain, and the pain can affect an individuals personality. However, whether the pain is old or new is not known; thus a determination cannot be made. TOUHY 4TH ED TESTBANK

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

ANS: D Learning advanced techniques is a suitable activity for older adults because it builds on knowledge they already have; further, this activity is suitable because it is concrete and practical for experienced knitters to develop advanced skills. Joint flexibility is a physical activity and not necessarily a learning activity. The members share enjoyment of knitting; other than being women and older, the group has no special bond on which to build. The need for socializing is not evident. TOUHY 4TH ED TESTBANK

Which topical agent is safe to apply? a.Cornstarch to absorb moisture in the groin area b.Betadine to disinfect a healing pressure ulcer c.An over-the-counter preparation to dissolve a corn d.Light mineral oil to moisten skin after bathing

ANS: D Light mineral oil to moisten skin after bathing helps replace the sebum layer and retain the moisture in the skin. Cornstarch is a substance that promotes fungal growth. Betadine, hydrogen peroxide, alcohol, and some soaps are damaging to newly formed skin. Corn preparations dissolve healthy tissue along with the corn. TOUHY 4TH ED TESTBANK

Which of the following is a true statement concerning suicide among older adults? a.Older adults and younger adults manifest a suicidal intent in a similar manner. b.Older African-American women have the highest risk of suicide among older adults. c.Ethics require that the nurse respects a persons intent to terminate his or her own life. d.A major crisis experienced by the patient can contribute to the risk of suicide.

ANS: D Major crises or transitions, such as retirement or relocation to an assisted living or nursing facility, can contribute to the risk of suicide. Putting personal affairs in order, distributing possessions, making a will, or saying something similar to, I wont be around much longer, can indicate a risk for suicide in a young person but can be a rational and mature act in older age. Men in all countries have a higher suicide rate, and white men are more likely to evaluate their worth solely in terms of their present economic productivity. Health care professionals are obligated to prevent the destruction of life as a permanent solution to what may be a temporary problem. TOUHY 4TH ED TESTBANK

Managed care systems are most effective for an older adult who does which of the following? a.Avoids using the system until it is really needed in an emergency. b.Avoids seeing generalists and seeks health care only from specialists. c.Uses high-tech treatments to reduce expenses over the long term. d.Seeks regular primary care and preventive strategies to maintain health.

ANS: D Managed care is most effective for individuals who, over a long period of enrollment, use primary care and preventive behavior to avoid the need for intensive treatment. Avoiding using the system until it is needed in an emergency is both costly and detrimental to the clients health. Managed care systems limit access to specialists and encourage the use of primary care. Managed care systems favor ongoing subacute care and prevention to avoid the need for high-tech, acute treatments. TOUHY 4TH ED TESTBANK

Which documentation tool does the nurse use to achieve optimal functional status for a nursing home resident? a.Narrative patient progress notes b.Problem-oriented documentation c.Resource Utilization Group (RUG) d.Resident Assessment Instrument (RAI)

ANS: D Mandated by the federal government to improve the quality of care for nursing home residents, the nurse uses the RAI to help residents in nursing homes achieve optimal functional status. The RAI includes identification of issues with the MDS, a comprehensive assessment from Resident Assessment Protocols (RAPs), and the foundation for reimbursement using the RUG. Narrative progress notes are used in nursing homes to describe events that are unsuitable for other forms of documentation in the medical record. Problem-oriented documentation identifies resident problems, the plan of care to resolve the problem, and the outcome of the problem or response to treatment. The RUG is the reimbursement tool in the RAI. TOUHY 4TH ED TESTBANK

An older adult complains about experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the patients complaint? a.Vitamin B deficiency b.Use of humidifier at home c.History of diabetes mellitus d.Prescription antihistamine use

ANS: D Medications can cause dry eye, especially antihistamines, diuretic agents, beta-blockers, and some sleeping pills. Vitamin A deficiency is a risk factor, not Vitamin B deficiency. The use of a humidifier should help with dry eyes, not cause it. Diabetes mellitus is an endocrine disorder, and dry eyes are an exocrine disorder. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about tuberculosis (TB) in older adults? a.The principal threat from TB is its highly contagious nature. b.The tuberculin purified protein derivative (PPD) is a conclusive test for TB. c.Antimicrobial drugs have made TB an infection of the past. d.Older persons, particularly those in nursing homes, are at risk for TB.

ANS: D Most reported cases of TB among older adults are from nursing homes. TB is not as contagious as formerly suggested, but drug-resistant forms exist and are a serious risk for older adults who are immunocompromised. A PPD test has a false-negative rate of approximately 30%. When the result is positive, the patient receives a sputum culture and a chest x-ray examination. A positive sputum culture is necessary to confirm the diagnosis. Although medications such as isoniazid (INH) were thought to have eliminated TB, the organism is still present in multidrug-resistant forms. Older adults who contracted TB before the 1940s may suffer reactivation of the bacterium. TOUHY 4TH ED TESTBANK

Which of the following pain sensation(s) is(are) associated with neuropathic pain? (Select all that apply.) a.Infection b.Obstruction c.Inflammation d.Postamputation

ANS: D Neuropathic involves a pathophysiological process of peripheral or central nervous system. Infection, obstruction, and inflammation are considered nociceptive pain sensations that are associated with injury to skin, mucosa, muscle, or bone. TOUHY 4TH ED TESTBANK

Which of the following statements is true about social and emotional health of older adults? a.Contemporary society has strong norms for the behavior of adults older than 80 years. b.The transition to old age entails a declining level of contribution to others as one becomes increasingly dependent on them. c.Computers and the Internet have little to contribute to older adults in their need for social support. d.Nurses are often significant sources of social and emotional support for older adults.

ANS: D Nurses are often important confidants and providers of social support in the lives of older adults. The diversity of cultures and individuals in a society such as the United States means that norms are almost nonexistent for those older than 80 years. Older adults have a great deal to contribute in wisdom and by example. E-mail and online chat rooms are a means of contact and social support for many older adults. TOUHY 4TH ED TESTBANK

A man is terminally ill with end-stage prostate cancer. Which is the best statement about this mans wellness? a.Wellness is possible in the management of his medical care. b.Wellness is unfortunately not a real option for this client. c.Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks. d.Nursing interventions can help empower a client to achieve a higher level of wellness.

ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness at all levels of the needs hierarchy. Wellness is possible even if the client assists in the management of his medical care; an individual must work hard to achieve wellness, similar to a job. Wellness is unfortunately not a real option for this client; however, all persons, regardless of age or life-health situations, can be helped to achieve a higher level of wellness. Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks; biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness. TOUHY 4TH ED TESTBANK

Which of the following statements is true about Parkinson disease (PD)? a.Drinking large amounts of alcohol can relieve symptoms of essential tremor. b.Motor tremors and slow movement accompany severe cognitive impairment. c.Lewy body dementia (LBD) is the most common form of dementia. d.Older adults taking rasagiline (Azilect) must avoid eating foods containing tyramine.

ANS: D Older adults taking rasagiline (Azilect) must avoid eating foods containing tyramine; interactions of rasagiline with tyramine can cause sudden, severe hypertension. Drinking small amounts of alcohol can relieve symptoms of essential tremor, although heavy drinking should be avoided. The majority of persons with PD remain alert and intelligent, but motor difficulties in facial expression and speech can give a false impression of cognitive impairment. LBD, which can occur in some patients with PD symptoms, is the second most common form of dementia. It accounts for 15% to 20% of all dementias. TOUHY 4TH ED TESTBANK

A geriatric nurse practitioner prescribes an antidepressant for a patient. The patient asks, How long will I have to be on this medication before I feel like my old self? The nurse recalls that a therapeutic response to an antidepressant medication most often takes which one of the following? a.24 hours b.2 days c.2 weeks d.2 months

ANS: D One to 2 months may be necessary to achieve a maximal response to therapy. Both 24 hours and 2 days are too short of timeframes to have a response to therapy. Patients often have an initial response to therapy 1 to 3 weeks after starting the medication. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about osteoporosis (OA)? a.OA is indicative of an underlying health problem. b.The most common site for OA fractures is in long bones. c.African-American women have the highest risk for OA. d.A high risk of death follows an OA-related fracture.

ANS: D One-third of all persons who have an OA-related fracture die within 1 year. OA can be a natural-occurring consequence of aging. The vertebrae, pelvis, and wrist are the most frequent sites for OA fractures. The risk of OA is much lower for African-American women than it is for those of other races. Thin women of northern European descent are at the highest risk. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about skin care for older adults? a.A licensed practical nurse is qualified to care for the feet of a patient with diabetes. b.Onychomycosis is quickly eradicated with antifungal creams or powders. c.A rams-horn nail should be cut to give a smooth, rounded edge. d.Maintaining oral hydration may reduce the incidence of xerosis.

ANS: D Oral hydration and lubrication will decrease the incidence of xerosis. Only a registered nurse who has special training, a nurse practitioner, or a podiatrist should perform diabetic foot care. The treatment of onychomycosis is difficult because of the limited blood supply to the nails. Oral medications are expensive and toxic. A toenail should be cut flat across. Rounding can lead to ingrown toenails. TOUHY 4TH ED TESTBANK

Compared with acute pain, which of the following statements is true of persistent pain? a.Leads to significantly altered vital signs. b.Is usually described as a burning pain. c.Is generally gone within 4 months. d.Can bring about long term changes in lifestyle.

ANS: D Persistent pain affects the patients experience on a continuing basis. Both acute pain and persistent pain can affect the vital signs. Persistent pain may be described in many possible ways. Persistent pain is unrelenting. TOUHY 4TH ED TESTBANK

Which type of pain tends to occur persistently along a well-defined path in a region of the body? a.Unrelenting pain c.Postoperative pain b.Osteoarthritic pain d.Postherpetic pain

ANS: D Postherpetic neuralgia tends to persist in the dermatome of a spinal nerve. For example, postherpetic neuralgia of C8 (the 8th cervical spinal nerve) should cause burning, itching, or stinging pain along the back of one arm, through the elbow, and down to the smallest finger on the side of the same hand. Persistent pain does not occur along a well-defined path. Osteoarthritic pain is usually persistent but seldom occurs along a well-defined path; the pain is usually localized. Postoperative pain is acute pain that occurs in the area of the surgical procedure and incision. TOUHY 4TH ED TESTBANK

An older woman is resisting her sons help to make her money last longer. He wants to have her declared incapacitated so he can manage her finances. Which nursing assessment can be used by the court to declare incapacitation? a.Prepares very few meals and avoids cleaning the house. b.Ambulates around her local community without difficulty. c.Balances her checkbook weekly and pays her bills on time. d.Resists medical advice to remove a stage I malignant tumor.

ANS: D Refusing surgery to remove a malignant tumor at an early stage after receiving medical advice to do so can indicate impaired cognitive functioning; early treatment offers the best chance for a cure. Preparing few meals and avoiding cleaning the house may be potential evidence of not understanding the consequences of her actions and may be potential evidence of impaired capacity to make medical decisions. If the aspects of daily living are not important to her, then ambulating around her local community without difficulty does not reflect impaired capacity. Balancing her checkbook weekly and paying her bills on time, which are indications that she is managing her finances, are evidence of intact capacity; functional status is irrelevant in a capacity hearing. TOUHY 4TH ED TESTBANK

What is a SOAP note? a.Record of supplies used in patient hygiene b.Record of an event during a patients stay, formatted according to the Simple Object Access Protocol (SOAP), enabling it to be easily transmitted between computers c.Form of bar code d.Record of patient data listing the patients subjective complaint, objective data recorded by the nurse, the nurses assessment of the situation, and the nurses plan of action

ANS: D SOAP stands for subjective (patient complaint), objective (observed data), assessment, and plan. A SOAP note is a record of an event in which a patient makes a subjective complaint and the nurse observes objective data, makes an assessment on the basis of the complaint and the data, and makes a plan for interventions based on the assessment. A SOAP note is a record in human language describing a problem, its assessment, and planned interventions. TOUHY 4TH ED TESTBANK

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

ANS: D Serum T3 and pepsin secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally remains unchanged. Left ventricle-wall thickness and skin healing time both increase with aging. TOUHY 4TH ED TESTBANK

The children in an African-American family attended college because their mother worked two jobs as they were growing up. She never finished high school, the children are grown, and she lives alone in retirement. Which noted weakness of sociological theories on aging explains why the social exchange theory is not applicable to this older adult? a.Gender b.Culture c.Ethnicity d.Opportunity

ANS: D Social exchange theory ignores the effect that opportunity can have on aging because, according to this theory, the mother should be living with one of the children. They had the opportunities that she never had. Gender is not as relevant to this theory of the value of youth as being a period where social credits are earned for old age. Culture is not as relevant to this theory as the value of youth. Ethnicity is not as relevant to this theory as the value of youth. TOUHY 4TH ED TESTBANK

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

ANS: D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Providers should not assume all older adults are hearing or mentally impaired. The most appropriate action when addressing an older adult would be to speak clearly. Examples of unintentional ageism in language are exaggerated pitch, demeaning emotional tone, and a lower quality of speech. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about the theories of aging? a.Research data support the disengagement theory, activity theory, and continuity theory. b.Everyone should be able to achieve the three tasks of Pecks model of integrity. c.The exercise of rights is not a task of aging in Kellys model. d.A person may choose to avoid pursuing inner discovery in older age.

ANS: D Some persons do not value inner psychological exploration and remain action oriented even in an older age, and others are still subject to the same demands of daily living as they were in middle age. None of these theories is clearly supported by data. Pecks tasks of ego differentiation, body transcendence, and ego transcendence demand a great deal of courage and energy that not everyone possesses. Tasks of aging in Kellys model are accepting reality, fulfilling responsibility, and exercising rights. TOUHY 4TH ED TESTBANK

An older female resident lowers her voice and tells the nurse that another female resident is looking at her behind her back and is going to make her move tonight with a male staff member. Which ideas should the nurse include in the response to this individual? a.The staff receives training in ethics. b.Validate the womans impression. c.Avoid suspicious, paranoid thinking. d.Use the call bell if she becomes frightened.

ANS: D Telling the resident to use the call bell if she becomes frightened offers assurances to the patient that she will be protected, but it neither confirms her suspicions nor makes a promise that cannot be kept. Replying that the staff receives training in ethics sounds as if the nurse is arguing in defense of the male staff member and does not help alleviate the residents fear, which can lead her to suspect that the nurse is also a part of the plot. Validating the womans impression contributes to the residents suspicions; in addition, the nurse increases professional liability risks by speaking about another resident in a negative manner. Telling the resident to avoid suspicious, paranoid thinking only aggravates the struggle for control. TOUHY 4TH ED TESTBANK

An older man comes to a primary care setting, and his reason for seeking health care is to get a prescription for sildenafil (Viagra). Which of the following laboratory reports can help explain why this individual needs sildenafil? a.Serum potassium 4.5 mEq/L b.Prothrombin time 13 seconds c.Alanine transferase (ALT) 50 units/L d.Glycosylated hemoglobin (Hgb A1c) over 8%

ANS: D The Hgb A1c is an indicator of serum glucose control over the last 90 days. A Hgb A1c level over 8% indicates that this older adult had poor glucose control in that time frame. As a reliable indicator of hyperglycemia, it can indicate the reason this man experiences erectile dysfunction; hyperglycemia is associated with peripheral arterial disease. An erection occurs as the penile shaft becomes engorged with blood. This process can be impaired if the vessels are damaged from hyperglycemia because hyperglycemia damages the lining of blood vessels and leads to progressive occlusion of the damaged vessels. Many of the vessels involved in causing an erection are fine vessels and are among the first vessels occluded in arterial disease. The potassium level, the prothrombin time, and the ALT are all within normal limits. TOUHY 4TH ED TESTBANK

Which of the following statements is true about cognitive impairments in older adults? a.Loss or interruption of sleep can lead to delirium. b.Confusion is a normal and unavoidable consequence of aging. c.Older patients who are agitated often have a lower cognitive status than those who are quietly sitting. d.The Mini-Mental State Examination2nd edition (MMSE-2) should be administered on admission to detect delirium.

ANS: D The MMSE-2 or a similar instrument should be administered to a patient at admission to ascertain the patients baseline cognitive status. The loss or interruption of sleep, in of itself, does not often lead to delirium. It can potentiate delirium in the presence of other factors. Confusion or delirium is not a normal consequence of aging but an indicator of a potentially underlying problem. The hypoactive subtype of delirium can be associated with a worse prognosis than with the hyperactive subtype; it is easily overlooked. TOUHY 4TH ED TESTBANK

A health care provider asks the nurse about an older mans durable power of attorney (DPA) because consent is needed for a medically necessary invasive procedure. The patient has end-stage disease, is intubated, and is on mechanical ventilation. Which steps should the nurse implement? a.Refer to the patients advance directive for a name. b.Assist with obtaining informed consent from the patient. c.Use the oral trail-making test to measure cognitive function. d.Apply the Confusion Assessment Method for critical care.

ANS: D The health care provider assumes the intubated older adult lacks the cognitive skill to give consent for treatment. Before the search begins for the DPA and to help determine the patients cognitive status, the nurse assesses the patient for delirium using the Confusion Assessment Method for the intensive care unit. As the patients advocate, the nurse implements this valid and reliable tool because the nurse wants to give the patient every opportunity to participate in the plan of care and make his own determinations. If the patient has an advance directive, then the attorney-in-fact named in the power of attorney should be on that document. However, because the patient has the right to make his own decisions about care, his cognitive status should be established first. Before informed consent can be given, the patients cognitive status must be determined. The patient is unable to perform an oral test while he is intubated. TOUHY 4TH ED TESTBANK

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

ANS: D The loss of water-containing tissues, the loss of concentrating power in the kidneys, and a decreased sense of thirst all increase an older persons risk for dehydration. Urine flow does not diminish in old age. Specifically, it does not diminish in the presence of dehydration as it does in a younger patient. Lower body water content places an older patient at greater risk of dehydration, not a lower risk. These signs are less reliable in older age because of changes to the tissues. TOUHY 4TH ED TESTBANK

An older man who had radical surgery for oral cancer is refusing to see visitors and is losing weight, despite aggressive nutrition therapy. The nurse assesses this man for ineffective coping, related to dysfunctional grieving. Which of the following patient outcomes of nursing care is the most important to implement in response to his mental health status? a.Is able to discuss how his coping mechanisms are overwhelmed. b.Performs daily self-feedings through a gastrostomy tube. c.Effectively uses nonverbal forms of communication. d.Exhibits self-confidence in regaining a sense of control.

ANS: D The most important element of the nursing plan of care for this older adult is to create and strengthen self-confidence to improve his sense of control; doing so is likely to help him effectively manage the other aspects of his health care. The nurse helps create and improve this self-confidence by observing for strengths and integrating them into his daily care and by responding with empathy and encouragement to his expressions of fears, emotions, and desirable goals. Helping this patient gain self-confidence is the most important outcome because this man has clinical indicators for depressionsocial isolation and weight loss. Before this patient can benefit from discussing his stressors or from patient teaching, the nurse must establish a trusting, caring relationship and build some self-confidence because, at this point, this individual feels hopeless and believes that he has no control. The patient displays a lack of readiness for expressions about emotions, coping, or his stressors; by enhancing his self-confidence, the nurse prepares him to discuss coping mechanisms and stressors. This patient also displays a lack of readiness for learning a new psychomotor activity. Performing daily self-feeding is an outcome that gains importance as the day for discharge approaches. Effectively using nonverbal forms of communication is important for basic communication; however, he displays a lack of readiness for receiving help to achieve this outcome. TOUHY 4TH ED TESTBANK

The nurse administers an opioid analgesic to an older male postoperative patient in the surgical unit. Which is the most important intervention for the nurse to implement before leaving the patients room? a.Place side rails up x 4. b.Position the patient comfortably. c.Offer toileting and a sip of water. d.Instruct him to ask for help before getting up.

ANS: D The most important intervention for fall and injury prevention is for the nurse to instruct the older adult to ask for help before getting up after receiving an opioid medication. This intervention is important because the medication can cause sedation and dizziness; therefore the nurse instructs him to ask for help to prevent a fall or injury. Side rails up x 4 is considered a restraint and may place the patient at risk for injury. Comfortable positioning is also a good supplemental intervention after administering pain medication. Offering toileting and hydration is a reasonable intervention to implement after administering pain medication, but it does not offer the same degree of safety as instructing the patient to call for help. TOUHY 4TH ED TESTBANK

The community health nurse delivers a program to middle-aged adults about retirement planning and wants to them to choose the year of their retirement. Which is the most important area on which the participants should focus to ease the transition to retirement? a.Kind of legacy they want to leave behind b.Type of setting for their personal residence c.Location of convenient health care services d.Ability to maintain a stable standard of living

ANS: D The most significant factors contributing to a smooth transition into retirement are health, income, and social involvement; therefore the nurse helps the participants focus on financial issues to begin retirement planning, thereby establishing the future retirees ability to maintain health, income, and social involvement. By choosing a year for retirement, individuals can estimate their retirement income and consult specialists in retirement planning, such as the employees human resources department, to determine retirement benefits. Defining the kind of legacy is a secondary factor and less likely to contribute to a smooth transition into retirement. The location of retirement and the location of health care services are also less likely to contribute to a smooth transition into retirement. TOUHY 4TH ED TESTBANK

Name the theory of aging that suggests that the adverse physical effects of aging are the result of a gradual loss of control mechanisms in the pituitary and hypothalamus. a.Free-radical theory b.Programmed theory c.Stochastic theory d.Neuroendocrine theory

ANS: D The neuroendocrine theory attributes aging to gradual changes in or the loss of the mechanisms that control the organs through chemical signals. The free-radical theory attributes aging to the accumulation of destructive products of metabolic oxidation. The programmed theory attributes aging to cells exhausting a predetermined number of replications. A stochastic theory attributes aging to the accumulation of random damage to DNA and other molecules. TOUHY 4TH ED TESTBANK

After assessing the older man in his bed, the nurse determines that he is at high risk for falls. The nurse leaves the room to get a fall risk sign and returns to find him on the floor pleading for help. Which of the following was the most important intervention the nurse should have implemented to prevent this event? a.Call for someone to bring the sign. b.Show the older man how to use the call bell. c.Provide a urinal and drinking water. d.Instruct the patient to call for help.

ANS: D The nurse accomplished the most important aspect of fall prevention with the assessment. However, in an attempt to communicate the fall risk to other staff members, the nurse failed to communicate properly to the patient about fall prevention before leaving the room. Calling for someone to bring the sign would have been a reasonable approach to communicating the risk of falls, but it does not take the place of directly instructing the patient about prevention. The needs of an older adult can contribute to the risk of falls as an individual leans and reaches for something; therefore call bell instructions are a reasonable approach for preventing falls. However, before providing the call bell instructions, the nurse needed to tell him to call for help. A urinal and drinking water are common items that an older man needs, but reaching for them can contribute to falls. TOUHY 4TH ED TESTBANK

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

ANS: D The nurse assesses the older adults fluid status to develop a suitable plan of care. The nurse selects the correct nursing interventions, depending on the cause of the problem. Increasing oral fluid intake is implemented after the nurse completes the fluid assessment, if the intervention is determined to be suitable. The nurse reviews pertinent laboratory data as part of the fluid assessment. The nurse evaluates the medication list as part of the fluid assessment to eliminate a medication as the cause of the dark urine. TOUHY 4TH ED TESTBANK

A man who is 60 years of age and lives in the British Isles develops dementia. Which qualities of dementia does the nurse assess to prevent patient injury related to the type of dementia this man most likely has? a.Visual hallucinations b.Unilateral tremors c.Visuospatial problems d.Clumsy movements

ANS: D The nurse assesses the patient for failing memory and incoordination, which are characteristic of Creutzfeldt-Jakob disease (CJD) or bovine spongiform encephalopathy (also known as mad cow disease). This type of dementia began appearing in adults living in the British Isles who reported eating beef from local breeders. The nurse assesses for these qualities because the age of onset is usually around 60 years. This form of dementia progresses rapidly to death; therefore the nurse anticipates that this man will rapidly deteriorate and must be prepared to anticipate changes in motor activities and memory to maintain his safety and to prevent injury. Visual hallucinations are characteristic of Lewy body dementia. Visuospatial problems are characteristic of Parkinson disease dementia. Visuospatial problems are characteristic of frontotemporal lobe dementia. TOUHY 4TH ED TESTBANK

The nurse cares for an older man who has a malignant melanoma. Which intervention should the nurse implement for this man to prevent a recurrence or advancement of this condition in the future? a.Place posters about sunscreen in the halls of his apartment building. b.Promote the application of a sunscreen at his neighborhood health fair. c.Tell him to schedule all outdoor activities after 4 PM daily. d.Instruct him to wear sun-protective clothing and a hat at all times.

ANS: D The nurse caring for an older adult in acute care instructs him to wear sun-protective garments at all times to help prevent additional skin cancers, as well as apply an effective sunscreen to protect his skin against ultraviolet light. Placing posters and promoting sunscreen at a health fair are interventions for a community nurse. Scheduling activities after a specific time can be impractical or impossible. TOUHY 4TH ED TESTBANK

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

ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adults collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with hyperlipidemia achieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input. TOUHY 4TH ED TESTBANK

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

ANS: D The nurse recognizes that incontinence is a sign of an underlying problem and not an inevitable result of aging. In addition, the nurse offers dignity, hope, and understanding by maintaining a positive and respectful manner and by communicating that effective treatments are available. Rubber garments, in particular, are hot and can cause skin irritation. Internal catheters should be used only for a short time and under limited circumstances. Using a smooth muscle relaxant is indicated only for urge incontinence and for an overactive bladder. TOUHY 4TH ED TESTBANK

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

ANS: D The nurse should face the patient rather than the interpreter is a true statement; the intent is to converse with the patient, not with a third party about the patient. Statement A is not true; reasons may prevent the patient from speaking directly to a nurse. Statement B is not true; technical terms and metaphors may be difficult or impossible to translate. Statement C is not true; cultural restrictions may prevent some topics from being spoken of to a grandparent or child. TOUHY 4TH ED TESTBANK

The older adult residents of an assisted-living facility are preparing for a 14-day trip to Europe. Which is the most important exercise for the nurse to recommend for the group? a.Practice standing on one foot for 30 seconds. b.Move light weights in a rowing motion eight times. c.Stretch the hips by pulling the knee to the chest. d.Swim laps in the pool for 10 minutes continuously.

ANS: D The nurse should recommend endurance exercises for the group to improve cardiovascular and respiratory conditioning. Endurance training is suitable to prepare the residents to withstand the rigors of travel. Standing on one foot for 30 seconds is a reasonable exercise to recommend because balance tends to decrease with age; however, the cornerstone of the groups exercise must be endurance. Moving light weights is also a reasonable exercise to recommend because muscle bulk tends to decrease with age; however, the cornerstone of the groups exercise must be endurance. Stretching the hips is a reasonable exercise to recommend because joint flexibility tends to decrease with age; however, the cornerstone of the groups exercise must be endurance. TOUHY 4TH ED TESTBANK

A resident in a nursing home insists that a priest hear his confession. The resident is very anxious, and the nursing home does not have a Roman Catholic chaplain. Which intervention should the nurse implement? a.An Episcopal priest is coming to visit the home this evening. Arrange an appointment with her for the resident. b.Report the residents change in behavior in detail so that the attending physician can appropriately prescribe medication. c.Refer the resident to the staff psychologist to address the underlying cause of the patients anxiety. d.Look in the local telephone book for a Roman Catholic Church, and ask the priest to visit the resident.

ANS: D The nurse should respect the residents beliefs and practices and accommodate them when they are not harmful. Receiving the Sacrament can potentially relieve much of the patients anxiety. Arranging an appointment with an Episcopal priest for the resident is not an appropriate intervention; the two belief systems are not the same, and the resident is unlikely to experience the ministers efforts as satisfactory. Reporting the residents change in behavior to the attending physician is also inappropriate; the residents wish can be understood entirely within the residents belief system and need not reflect a medical problem, particularly if a visit by a priest relieves the residents anxiety. Referring the resident to the staff psychologist to address the underlying cause of the patients anxiety is an approach that attempts to change the residents belief system. TOUHY 4TH ED TESTBANK

The nurse cares for an older adult who has a prealbumin level of 10 mg/dl and an infection in a large wound. Which intervention is the nurses priority? a.Monitor temperature and leukocytes. b.Provide assistance with meal planning. c.Provide high-quality protein in the diet. d.Maintain oxygen saturation above 95%.

ANS: D The nurses priority is to maintain oxygen saturation above 95% to help provide oxygen that the heart is unable to provide. The heart of this older adult is less able to respond to increased oxygen demands from infection because of age-related changes in the myocardium including ventricular hypertrophy and decreased coronary blood flow and changes in pulmonary function. Further, because this older adult is malnourished and thus likely to have anemia, any capacity to meet increased oxygen demand is stymied. Along with airway, breathing and circulation are two of the three most basic needs. Similarly, the older heart may not be able to respond to other calls for increased cardiac demand such as infection, anemia, pneumonia, cardiac dysrhythmias, surgery, diarrhea, hypoglycemia, malnutrition, and drug-induced and noncardiac illnesses such as renal disease and prostatic obstruction. Monitoring temperature and leukocytes is important to implement for anyone with an infection, but it is not as important as breathing and circulation. Besides, fever is an unreliable indicator of infection in an older adult. Providing assistance with meal planning is a reasonable nursing intervention, but it is not as important as breathing and circulation. The nurse provides high-quality protein in this individuals diet because of malnutrition, but this teaching is not as important as breathing and circulation. TOUHY 4TH ED TESTBANK

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

ANS: D The nurses priority is to stop this older adults intake of chamomile supplements at home; they will increase the effectiveness of anticoagulation. The nurse instructs this individual to avoid chamomile while she is taking an anticoagulant because the womans blood will be much less able to clot, exposing her to a very high risk of a catastrophic injury in the event of a fall or trauma. The patient does not need to supplement with only ginkgo; the patient should cease taking ginkgo while on anticoagulant therapy, as well as the use of garlic supplements. Both increase the effectiveness of anticoagulation. The use of Hawthorn supplements has not been shown to affect the use of anticoagulant medications. TOUHY 4TH ED TESTBANK

The nurse is discharging an older woman who uses a walker from rehabilitative care. Which observation does the nurse use to determine whether the patient is prepared for discharge? a.She holds the front of the walker. b.She has a walker with four wheels. c.She takes four steps into the walker. d.She takes the walker to the elevator.

ANS: D The older adult uses the elevator to travel between floors of a building, demonstrating that she knows not to use a walker on the stairs and is thus safe to discharge. Older adults should use the arms of a walker for stability. A walker with four wheels can be easy to move; however, such ease of movement does not provide enough stability to be suitable as an assistive device. To use a walker correctly, she should take two steps at a time into the walker. TOUHY 4TH ED TESTBANK

The nurse admits an older man who had abdominal surgery. Admission vital signs are heart rate (pulse) (P), 73 beats per minute (bpm); respiration rate (R), 20 breaths per minute; blood pressure (BP), 136/84 mm Hg. He is receiving intravenous (IV) fluids but has not requested pain medication since surgery. Seven hours later, his vital signs are P, 98 bpm; R, 26 breaths per minute; and BP, 164/90 mm Hg; and he denies pain. Which intervention should the nurse implement? a.Administer an opioid medication by IV route. b.Check the surgical dressing for bleeding. c.Report the vital signs to the health care provider. d.Ask if he has about discomfort at the surgical site or any other location.

ANS: D The patients P, R, and BP increased significantly since his admitting vital signs and indicate the potential for pain or discomfort from the surgical incision. The older adult patient may also be experiencing pain unrelated to the surgery due to arthritic changes, neuropathies, etc. The patient can be misunderstanding the nurses question or be barred from saying, yes, by cultural patterns. Such miscommunication is common; therefore the nurse rewords the question using another term for pain such as discomfort, burning, or pressure. Administering an opioid medication by IV route is unethical without the patients request. When checking the surgical dressing for bleeding, the patient may show signs of pain rather than blood loss. Reporting the vital signs to the health care provider would be premature; the patients pain assessment is not complete. TOUHY 4TH ED TESTBANK

What makes nursing support of caregivers so important for health care in the United States? a.Family members providing care in the home are the best caregivers. b.Eighty percent of caregiving takes place in the home of the older adult. c.The health care system reimburses families for caregiving from Medicare. d.Informal caregiving saves the health care system enormous sums of money.

ANS: D The value of caregiving is estimated at $257 billion; therefore informal caregiving is a huge savings for the health care system that it might potentially be unable to provide in the event that it was called to do so. Although family members can be the most convenient and are the least expensive, they do not necessarily make the best caregivers. Family members provide 80% of the caregiving for older adults. Caregiving is not an expense for which Medicare reimburses the family. TOUHY 4TH ED TESTBANK

Which of the following statements is true about loss in older adulthood? a.A person experiences each stage of grief once, and then grieving is resolved. b.Antianxiety agents are frequently recommended for reducing the pain of grief. c.The loss response model is concerned with the effect of loss on an individual. d.Referring to the deceased in the past tense can acknowledge the deaths reality.

ANS: D The widow may say, for example, that her husband just loved to garden rather than just loves to garden. Although the bereaved person passes through the stages according to the Bowlby model, the person may experience the cycle more than once as different aspects of the loss are encountered. Such medications do not reduce the pain of grief; they only deaden it for a time. The loss response model considers the effect of the loss on the family as a system. TOUHY 4TH ED TESTBANK

Historical influences that have shaped the lives of the majority of the middle-old population in the United States today include which of the following? a.Influenza epidemic of 1918 b.Immigration from communist Europe c.Child rearing in the Depression d.World War II

ANS: D Those who are middle-old in 2005 were in their teens and 20s during World War II; in particular, the men were likely to have fought in it. A person who survived the influenza epidemic would be at least 87 years old in 2005 and therefore would be considered old-old or a centenarian. Those who are middle-old in 2005 were born between 1920 and 1930, before communism swept Europe. Most of those who are middle-old in 2005 had not reached childbearing age by the end of the Depression. TOUHY 4TH ED TESTBANK

An older woman who receives intravenous (IV) fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially? a.Apply bilateral upper extremity restraints. b.Administer haloperidol (Haldol) for agitation. c.Close the door to her room to reduce the noise. d.Determine the patients needs.

ANS: D To help maintain her independence and permit the administration of IV fluids yet provide safe, effective care, the nurse should determine what the patient is attempting to convey and then address those needs. Restraining one side creates a potential threat from the other arm to the integrity of the IV, but bilateral restraints can be justified for the protection of the IV site. However, as a first step, the nurse should determine if the patient has a need that has not been met before moving to a restraint. Administering an antipsychotic agent can be justified for agitation but not in this patient. Less intrusive measures are available for initial protective measures. Although nurses tend to keep the doors of patients and residents rooms slightly ajar to maintain privacy, closing this womans door is contraindicated to control noise because it can contribute to the risk of falls and injury and does nothing to maintain the integrity of the IV. TOUHY 4TH ED TESTBANK

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

ANS: D To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to patients, regardless of the setting or the nurses personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adults needs. TOUHY 4TH ED TESTBANK

An older woman who has diabetes mellitus takes glipizide (Glucotrol) and tells the nurse that her blood sugar levels have been higher than normal since she began using a vaginal cream for hot flashes. Which one of the following interventions is the best for the nurse to implement? a.Ask the patient if she has had a fever or infection recently. b.Verify the expiration date of the medication. c.Review her diet for increased carbohydrates. d.Ascertain whether the vaginal cream contains estrogen.

ANS: D Vaginal cream prescribed for hot flashes potentially contains estrogen as an active ingredient; estrogen is effective therapy to reduce hot flashes. Unfortunately, estrogen impairs the hypoglycemic effect of sulfonylurea hypoglycemic medications. If the estrogen therapy continues, then the nurse should assist this individual in adjusting her diet and exercise regimen in coordination with her antidiabetic medication to maintain stable blood sugar levels. Asking whether she has had a fever or infection recently is a reasonable question because infection increases the blood sugar of an individual with diabetes mellitus; however, because the hyperglycemia is associated with the vaginal cream, the most likely contributor to the problem is the vaginal cream, which is a good place to start the investigation. Verifying the expiration date of the medication is a reasonable task to implement; however, ineffective medication would not have the desired hypoglycemic effect. Reviewing her diet for increased carbohydrates is a reasonable task to implement because a glucose load will increase blood sugar levels. TOUHY 4TH ED TESTBANK

A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of his forehead. The man is being tested for which of the following? a.Sensorineural hearing loss b.Presbycusis c.Tinnitus d.Unilateral conductive hearing loss

ANS: D Webers test, in which a vibrating tuning fork is placed on the center of the forehead, detects the differences in hearing between one ear and the other caused by poor sound conduction. During testing, the patient is asked to describe the sensation felt when the tuning fork is activated and then placed on the forehead. If the patients hearing by conduction is intact, then he or she will feel vibrations conducted through the bones of the skull from the tuning fork. Webers test with the tuning fork is used to detect conductive hearing loss. Presbycusis affects both ears and has a sensorineural origin. The tuning fork test is used to detect conductive hearing loss in one ear. Tinnitus is a hearing sensation not caused by an actual sound. The tuning fork test is used to detect hearing loss caused by poor sound conduction. TOUHY 4TH ED TESTBANK

Which of the following statements is true about the mental health of older adults? a.Nurses should discourage denial and regression so older adults can directly face underlying causes of anxiety. b.Anxiety is easily distinguished from depression, dementia, and the effects of disease or medication. c.Compulsive rituals surrounding toileting and sleep are signs of a serious mental disorder. d.The nurse avoids antianxiety medications without an assessment for factors associated with anxiety.

ANS: D Without an adequate assessment, medications can exacerbate a problem. Denial and regression may be necessary to enable an older person to cope with underlying stressors. Depression, dementia, disease, and medications can produce anxious behavior, and the resultant anxiety can be manifested in a similar manner, regardless of the cause. Compulsive rituals can be a way of coping with challenges leading to anxiety. TOUHY 4TH ED TESTBANK

Which of the following is a true statement about heart disease in older men and women? a.More women than men die from MIs. b.Cardiac care for men and women is equally aggressive. c.Cardiac medications have been tested on men and women equally. d.Women generally receive less aggressive treatment than men do.

ANS: D Women generally receive less aggressive treatment than men; this stereotype has led to a relative neglect of womens cardiac problems. Men usually receive more aggressive treatment. Testing in the past has focused on male patients. Women receive less aggressive treatment and less effective instruction for cardiac disease, which is potentially due to the atypical presentations women have for cardiac disease and MIs. TOUHY 4TH ED TESTBANK

Which signs and symptoms are characteristic of a urinary tract infection (UTI) in an older adult? (Select all that apply.) a.Fever b.Uremia c.Dysuria d.Anorexia e.Flank pain f.Turbid urine

ANS: D, F Anorexia is a more reliable indicator of a UTI in an older adult. In addition, individuals, including older adults, are likely to void cloudy urine when a UTI is present. Fever, uremia, dysuria, and flank pain are all unreliable indicators of a UTI in the older adult. TOUHY 4TH ED TESTBANK

After living with OA for 2 years, an older womans bone density scan shows no improvement, despite consistent bisphosphonate therapy. Which intervention should the nurse implement to reduce bone loss for this older adult? a.Add tai chi or yoga exercises. b.Instruct her to drink fortified milk. c.Increase weight-bearing exercises. d.Review her daily nutritional habits.

After living with OA for 2 years, an older womans bone density scan shows no improvement, despite consistent bisphosphonate therapy. Which intervention should the nurse implement to reduce bone loss for this older adult? a.Add tai chi or yoga exercises. b.Instruct her to drink fortified milk. c.Increase weight-bearing exercises. d.Review her daily nutritional habits. TOUHY 4TH ED TESTBANK

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

Allowing residents to read aloud helps improve and maintain verbal fluency because it provides an opportunity to practice these skills. Reading aloud does not usually require analysis. Reading is unlikely to improve object recall unless displaying objects is part of the reading. Visuospatial skills require the ability to perceive the relationship of objects in terms of the space each object occupies; reading is unlikely to improve this skill. TOUHY 4TH ED TESTBANK

An older man is taking chlorpromazine (Thorazine), and the nurse helps him choose menu items. To prevent an exacerbation of potential adverse effects of therapy, which menu item does the nurse instruct the man to avoid? a.Biscuits and gravy c.Whole grain bread b.Coffee with cream d.Mixed green salad

Because antipsychotic medications potentially impair the bodys thermoregulatory ability, the nurse instructs an older adult who takes an antipsychotic agent such as chlorpromazine to avoid caffeinated beverages because they contribute to dehydration. This man is at high risk for organ damage as a result of hyperthermia from mild elevations in the environmental temperature; therefore he must avoid dehydration, stay in cool temperatures, keep out of direct sunlight, and alert people around him and caregivers to monitor his temperature carefully and to be prepared to provide cooling sponge baths, cool liquids, and other measures to reduce his temperature quickly. The nurse instructs all older adults to avoid eating biscuits and gravy because these items have an excessively high fat content. Whole grain bread is a healthy food item to choose. Mixed green salad is a healthy food item to choose. TOUHY 4TH ED TESTBANK

A nurse is educating a patient who has been recently diagnosed with osteoporosis on foods high in calcium. The nurse should include which food choice? a.Okra b.Plain yogurt c.Turnip greens d.Whole wheat bread

Plain yogurt has 452 mg of calcium per 8 ounces. Okra has 30 mg of calcium per serving. Turnip greens have 14 mg of calcium per serving. Whole wheat bread has 26 mg of calcium per serving. TOUHY 4TH ED TESTBANK

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

The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains may be used. Throw rugs can slide underfoot and can lead to a fall, particularly when the sense of balance has declined with age. The fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat-gland response to heat. TOUHY 4TH ED TESTBANK

The nurse assigns the diagnosis of Nutrition Imbalance: less than body requirements for an older adult. Which age-associated intestinal problem does the nurse apply to plan goals and interventions to improve this adults nutritional status? a.Less intrinsic factor secretion b.Short, broad small intestinal villi c.Decreased gastric smooth muscle d.Decreased large intestinal motility

Villi of the small intestine shorten and widen with age and, as a result, become less functional, which contributes to malabsorption of nutrients; despite a healthy diet, nutrients are absorbed primarily in the small intestines. The concept of malabsorption is what the nurse uses to plan care; this nursing diagnosis refers to the inability of the body to absorb nutrients as a result of biological factors. Decreased intrinsic factor secretion leads to pernicious anemia as a result of the inability to absorb vitamin B12 in the stomach. Gastric smooth muscle is not present in the intestines. Decreased large intestine motility is an age-associated problem; however, it should have no impact on absorption in the small intestine. TOUHY 4TH ED TESTBANK