Gero Practice Questions 1

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

ANS: A Skilled home care is most appropriate for older adults who are recovering from an illness or injury and have potential for returning to their previous level of functioning

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

ANS: A Despite the complexity and limitations of programs, nurses need to know enough about the most common sources of payment for health services so they can understand and address some of the barriers to and challenges of implementing nursing care plans and discharge plans.

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

ANS: A Community-dwelling older adults who may lack family involvement in their care often require independent community-based professional geriatric care management.

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

ANS: A CMS, the Institute of Medicine, and the Joint Commission have placed a high priority on the issue of older adults with complex medical problems who transfer between care settings, because they are particularly vulnerable to experiencing problems.

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

ANS: A PACE programs provide a range of services using a capitated managed care model. They are focused on meeting the needs of adults with chronic conditions and are not an alternative to in-hospital treatment of acute illness.

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

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

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

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

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

ANS: B The manifestations of illness in older adults can be less clear and less predictable than among younger clients. Older adults often show different, but not necessarily fewer, symptoms than do younger clients.

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

ANS: B Functional assessment is a way of determining an individual's ability to fulfill responsibilities and perform self-care. While it is distinct from a medical diagnosis approach, it does not discount or ignore information on an older adult's diagnoses and health problems.

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

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

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

ANS: B Nursing home settings are becoming increasingly diverse, but a common feature of older adults who are admitted to nursing homes is a decrease in function and ADL

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

ANS: B A brief mental status assessment is included on the ADL form. Including mental status in the functional assessment rather than using a separate mental status assessment tool reinforces the fact that cognitive function is an integral component of ADLs.

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

ANS: B Functional assessments consider an older adult's functional status and changes in this status over time. They include both core ADLs and more complex IADLs

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

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

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

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

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

ANS: C The rural client is unlikely to have grocery delivery. And as a homebound rural client, a senior center would not be available

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

ANS: C ADLs include activities such as bathing, dressing, mouth care, hair care, dietary intake, transfer mobility, ambulation, bed mobility, and bladder and bowel elimination.

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

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

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

ANS: D Nurses should be aware of problems with assistive devices and follow up these problems with the appropriate therapists.

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

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

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

ANS: D The presence of cognitive deficits presents a challenge to the assessment of a client's ADLs.

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

ANS: D In contrast to admissions for skilled nursing care that are associated with a hospitalization, admissions to long-term care commonly occur after a period of gradual decline in functioning because of a chronic condition, such as dementia.

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

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

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

ANS: D Medicare and other insurance programs will cover all or part of the care for up to 100 days of care

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

ANS: D Medicare and other insurance programs will cover all or part of the care for up to 100 days of care, but only as long as the person continues to require the skilled level of services.

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

ANS: D Quality assurance and performance improvement programs measure attainment of outcomes. Quality in long-term care focuses on consumer personal choices and quality of life issues, without the overemphasis on safety, uniformity, and medical care.

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

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

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

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

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

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

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

C Feedback: Older adults can be taught how to safely time their medications to avoid effects such as drowsiness that can affect driving safely. Modification of vehicles with assistive devices can be a useful tool in promoting safe driving.