Gerontology Exam 3

A nurse is planning an educational session on osteoporosis to be given at a senior center. Which of the following should be discussed as preventive measures for osteoporosis? A. Following a diet with adequate amounts of calcium and vitamin D B. Increasing the intake of beverages containing phosphorus C. Having a yearly dual-energy X-ray absorptiometry DXA (or DEXA) scan D. Including isometric exercise for at least 30 minutes three times per week

A. Following a diet with adequate amounts of calcium and vitamin D

An older client admitted to the hospital after having sustained a fall at home is diagnosed with a right hip fracture and experienced a surgical reduction of the fracture. At 2:30 AM, she awakens from sleep insisting that her daughter is in the other room and wants to see her. Attempts to reorient her to the surroundings are unsuccessful. In reviewing the client's record, what data would be considered a primary risk factor for the delirium? A. History of dementia B. Death of the client's husband last month C. The client's age D. History of cardiac disease

A. History of dementia

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

A. Individuals with cognitive impairment B. Individuals who abused the caregiver earlier in life C. Individuals who live in an institutional setting

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

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

A nurse is conducting an assessment of an older adult in a geriatric clinic. The patient states that he drinks two to three alcoholic beverages daily. The patient has multiple chronic comorbid conditions and is on five different medications. Which of the following medications is the nurse concerned will interact with the alcohol? (Select all that apply.) A. Naproxen for pain B. Daily multivitamin C. Prozac for depression D. Celebrex for arthritis E. Toprol XL for hypertension

A. Naproxen for pain C. Prozac for depression E. Toprol XL for hypertension

. A nurse is involved in primary prevention activities related to the promotion of respiratory health. The nurse is involved in which of the following activities? (Select all that apply.) A. Organizing an influenza vaccination clinic B. Promoting a smoking cessation program in the community C. Referring individuals with respiratory disease to the pulmonology clinic at the hospital D. Visiting a congressman representative to advocate for legislation on clean air E. Teaching individuals with COPD measures to maximize lung function

A. Organizing an influenza vaccination clinic B. Promoting a smoking cessation program in the community D. Visiting a congressman representative to advocate for legislation on clean air

A patient is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? (Select all that apply.) A. Osteoporosis is common in females after menopause. B. Osteoporosis is a degenerative disease characterized by a decrease in bone density. C. The disease is congenital, caused by poor dietary intake of dairy products. D. Osteoporosis can cause pain and injury. E. Passive range of motion can prevent osteoporosis.

A. Osteoporosis is common in females after menopause. B. Osteoporosis is a degenerative disease characterized by a decrease in bone density. D. Osteoporosis can cause pain and injury.

What intervention should a nurse implement when an older male diagnosed with dementia is observed masturbating in the unit's dayroom? A. Remove the resident from the dayroom and complete an assessment of his behavior. B. Cover the resident's lap with a blanket and leave him in the dayroom. C. Counsel the resident by telling him that his behavior is inappropriate. D. Distract the resident so that he will stop the behavior.

A. Remove the resident from the dayroom and complete an assessment of his behavior.

The nurse is caring for an older client who experienced a hip replacement surgery 10 hours ago. Which intervention will help minimize this client's risk of developing delirium? A. Requesting that staff offer fluids each time they interact with the client B. Medicating the client to best facilitate restorative sleep C. Encouraging the client to remain still and thus minimize pain D. Suggesting that visitors are limited to family members only

A. Requesting that staff offer fluids each time they interact with the client

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

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

A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Rest the joint during the acute gout attack. B. Take acetylsalicylic acid (aspirin, or ASA) to relieve pain. C. Increase fluid intake to 2 L/day. D. Avoid foods high in purine. e. Avoid alcoholic beverages.

A. Rest the joint during the acute gout attack. C. Increase fluid intake to 2 L/day. D. Avoid foods high in purine. e. Avoid alcoholic beverages.

Differences between subacute care and long-term care include which of the following? (Select all that apply.) A. Subacute care is more costly than long-term care. B. Higher levels of professional staffing are generally found in subacute settings. C. Medicare covers the costs of both subacute and long-term care. D. Subacute patients tend to be younger and more cognitively intact. E. Subacute care is usually delivered in a hospital setting and long-term care in a nursing home setting.

A. Subacute care is more costly than long-term care. B. Higher levels of professional staffing are generally found in subacute settings. D. Subacute patients tend to be younger and more cognitively intact.

An older adult with gastric cancer with bone metastases is being discharged from the hospital after beginning a regimen of opioid analgesics to control the metastatic pain. What should be included in the discharge teaching plan? A. The development of a plan to prevent constipation B. Benefits of grief counseling C. Increasing calories in the diet D. Preventing pressure ulcers

A. The development of a plan to prevent constipation

Which intervention to manage a wandering client in a long-term care facility should be implemented? (Select all that apply.) A. Walk with the person, allowing them control within the bounds of safety. B. Redirect the person back toward the facility. C. Call the person by his or her formal name. D. Using physical restraints to prevent wandering to maintain safety. E. Make direct eye contact with the person.

A. Walk with the person, allowing them control within the bounds of safety. B. Redirect the person back toward the facility. C. Call the person by his or her formal name. E. Make direct eye contact with the person.

Factors that are influencing the decrease in nursing home beds in the United States include: (Select all that apply.) A. an increase in the use of residential care facilities. B. a shortage of certified nursing assistants (CNAs). C. increased Medicaid reimbursement for community-based care alternatives. D. a shortage of registered nurses who are certified in gerontology. E. the high cost of care in a nursing home.

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

An older adult is seen in the emergency department after falling and sustaining substantial soft tissue bruising. The assessment interview notes a history of arthritic pain in several joints. The client is prescribed 650 mg of acetaminophen (Tylenol) four times per day and 800 mg of ibuprofen (Motrin) four times per day for control of the persistent arthritic pain. When providing discharge teaching, the nurse includes information regarding the signs and symptoms of: (Select all that apply.) A. gastrointestinal bleeding. B. renal impairment. C. medication interactions. D. confusion. E. increased anxiety.

A. gastrointestinal bleeding. B. renal impairment. C. medication interactions.

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

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

When performing a pain assessment on a client who is aphasic, the nurse should consider: A. reports from the family or staff at the nursing home about changes in functional status. B. that the patient is lying quietly in bed so she is not likely to be experiencing pain. C. that the patient's previous stroke interrupted pain pathways so she does not feel pain. D. that older adults do not tolerate opioid analgesics well and may exhibit side effects

A. reports from the family or staff at the nursing home about changes in functional status.

When assessing an older client for indications of depression, the nurse bases the intervention on the knowledge that: A. the older client's symptoms may be atypical for the disorder. B. depression is a common mental disorder among the older population. C. the older client is generally willing to discuss his or her mental health symptoms. D. depression is not as commonly seen in this population as are anxiety disorders.

A. the older client's symptoms may be atypical for the disorder.

When individualizing pain management for a client hospitalized after major surgery, the nurse will: (Select all that apply.) A. titrate the prescribed analgesic medication to provide effective pain management. B. assess the client for cultural beliefs that affect individual expression of pain. C. reassure the client that pain medication is available whenever he or she expresses a need for it. D. anticipate the client's need for pain medications. E. implement nonpharmacological pain management interventions whenever possible.

A. titrate the prescribed analgesic medication to provide effective pain management. B. assess the client for cultural beliefs that affect individual expression of pain. D. anticipate the client's need for pain medications. E. implement nonpharmacological pain management interventions whenever possible.

The most significant etiology for chronic obstructive pulmonary disease (COPD) is: A. tobacco use. B. chronic bronchitis. C. exposure to carcinogens in the workplace. D. emphysema.

A. tobacco use.

Which question has priority when assessing a client for risk factors related to the use of sildenafil (Viagra)? A. "How old are you?" B. "Are you currently being treated for hypertension?" C. "Do you have a history of respiratory infections?" D. "Have you ever been told you have prostate problems?"

B. "Are you currently being treated for hypertension?"

A nurse in a long-term care facility is approached by an older resident who is crying and states: "You need to help me. The mean little men are in my room again. They are watching me from the corner and they are laughing at me. Make them go away." The nurse accompanies the resident to the room and there is no one in the corner of the room. What is the best response by the nurse? (Select all that apply.) A. "Yup, I see them. Let me call security to haul the men away." B. "Can you tell me what you are so frightened of?" C. "I will do my best to keep you safe." D. "I understand that you are very frightened and upset." E. "You know that there is no one there. Stop carrying on like this."

B. "Can you tell me what you are so frightened of?" C. "I will do my best to keep you safe." D. "I understand that you are very frightened and upset."

How should the nurse reply when an older adult asks, "How much alcohol is good for you?" A. "Alcohol isn't good for you so avoid it as a general rule." B. "Experts in the field recommend only one regular sized drink a day." C. "It's been said that red wine has health benefits, but that doesn't mean drink a whole bottle." D. "If you are only drinking on special occasions, limit yourself to two drinks."

B. "Experts in the field recommend only one regular sized drink a day."

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

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

An older client diagnosed with dementia resides with his daughter. When the homecare nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, "I don't know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him." How will the nurse respond to the client's daughter? A. "Let's think about what you may have done to anger your father?" B. "Let's try to figure out what your father was trying to say with his behavior." C. "Scratching is usually a sign of untreated pain. Do you think your father is in pain?" D. "Maybe you should consider having a home health care provider take over responsibility for your father's physical care."

B. "Let's try to figure out what your father was trying to say with his behavior."

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

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

An older client in an adult day care program tells the nurse, "I'm very stressed because another neighbor passed away." The most therapeutic response by the nurse is: A. "You are experiencing grief, not stress." B. "Tell me what you did when your other neighbor passed away." C. "Are you worrying about your own death?" D. "Let's get involved in some activities and not think about sad things."

B. "Tell me what you did when your other neighbor passed away."

A nurse is organizing a support group for older individuals with COPD in the community. The nurse knows that which of the following individuals is most likely to have COPD? A. A 75-year-old Hispanic male who is a retired truck driver and never smoked. B. A 72-year-old non-Hispanic white female who never worked outside of the home and has a history of asthma. C. A 67-year-old divorced African American male who is a retired physician. D. A 70-year-old widowed Asian woman who is a retired college professor.

B. A 72-year-old non-Hispanic white female who never worked outside of the home

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

B. Acute hospitalization semiprivate rooms C. Intensive care unit hospitalization D. Skilled rehabilitative nursing care in a health care facility

A nursing student is preparing a presentation on arthritis. The nursing student knows that differences between osteoarthritis (OA) and rheumatoid arthritis (RA) include that: (Select all that apply.) A. both OA and RA have an acute onset in older adults. B. OA is a localized process, whereas RA may be systemic. C. OA usually impacts distal interphalangeal joints; RA impacts proximal interphalangeal joints. D. both OA and RA present with joint stiffness lasting 20-30 minutes after rest. E. initial treatment of both OA and RA is usually nonpharmacological using heat or exercise.

B. OA is a localized process, whereas RA may be systemic. C. OA usually impacts distal interphalangeal joints; RA impacts proximal interphalangeal joints.

Two older residents of a long-term care facility are engaged in a romantic relationship. The residents are both cognitively intact. A nurse finds the two residents engaging in sexual activity. The response of the nurse includes which of the following? (Select all that apply.) A. Inform the residents that they cannot engage in a sexual relationship while they are residents of the facility. B. Provide a safe private area where the residents can engage in sexual activity. C. Ignore the residents' activity. D. Provide education for the residents using the PLISSIT model. E. Contact the family members of the residents in order to get consent from them.

B. Provide a safe private area where the residents can engage in sexual activity. D. Provide education for the residents using the PLISSIT model.

A nurse is caring for an older adult with cognitive impairment who recently had hip surgery. The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.) A. The client ate all of her meals. B. The client pushes caregivers away when they attempt to change the dressing on her hip. C. The client rocks back and forth repetitively when sitting in a chair. D. The client sleeps soundly throughout the night. E. The client cries out repeatedly when anyone approaches her.

B. The client pushes caregivers away when they attempt to change the dressing on her hip. C. The client rocks back and forth repetitively when sitting in a chair. E. The client cries out repeatedly when anyone approaches her.

A nurse practitioner is caring for a 90-year-old adult with asthma who has comorbid dementia and severe osteoarthritis in the hands. The nurse practitioner considers inhaled medications to manage the asthma. Which of the following factors should the nurse take into consideration when developing the medication plan for this patient? (Select all that apply.) A. The patient's ability to swallow safely B. The patient's manual dexterity C. The patient's age D. The patient's cognitive status E. The patient's mobility status

B. The patient's manual dexterity D. The patient's cognitive status

A nurse administers the Short Michigan Alcohol Screening Test Geriatric Version (S-MAST-G) to an older adult. The older adult receives a score of "2." The nurse knows that this score is indicative of: A. no problem with alcohol. B. a problem with alcohol. C. a mild problem with alcohol. D. a severe problem with alcohol.

B. a problem with alcohol.

The nurse preparing educational information on the most common mental health disorder among the older adult population should include: A. methods for reducing anxiety. B. a written depression screening tool. C. local schizophrenia support groups D. signs and symptoms of alcoholism

B. a written depression screening tool.

A nurse assesses an older patient for asthma. The nurse knows is the strongest risk factor for asthma is: A. positive family history of asthma. B. airway inflammation caused by allergic reaction to inhaled substances. C. genetic predisposition to severe allergies. D. history of smoking.

B. airway inflammation caused by allergic reaction to inhaled substances.

An older adult has recently experienced a number of stressful life events. The client comes to the ambulatory clinic and tells the nurse that, "On top of all I've had to endure, now I've got this flu!" In rendering care for this client, the nurse recognizes that: A. the client is exhibiting attention-seeking behaviors to substitute for poor coping skills. B. crisis and stressful situations may produce emotions that erode the health of the older people. C. the client is exhibiting learned helplessness as a result of the recent stressors. D. a period of crisis will ultimately lead to a lower level of physical and mental functioning.

B. crisis and stressful situations may produce emotions that erode the health of the older people.

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

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

An older adult says to the nurse, "I don't know why I can't handle booze like I used to when I was younger." The nurse's response is based on the knowledge that: A. older adults develop higher blood alcohol levels due to age-related changes in the neurological system. B. older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol. C. older adults develop higher blood alcohol levels due to slowed reaction times. D. older adults develop higher blood alcohol levels due to cognitive changes.

B. older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol.

An older widow who is a newly admitted resident of a long-term care facility develops a romantic relationship with a male resident. When the resident's daughter demands that the staff "put a stop to this sexual behavior right now," the nurse's response is based on the understanding that: A. such activity in a long-term care facility is inappropriate. B. older adults need to express love and intimacy. C. sexual desire is usually absent in older adults. D. sexual activity can be dangerous for older adults with chronic illnesses.

B. older adults need to express love and intimacy.

The initial step to effect the safe management of mild to moderate acute pain that has not been controlled with over-the-counter medications is to: A. begin acetaminophen (Tylenol) every 4 hours for 24 hours. B. supplement with nonpharmacological interventions. C. administer a single low dose of short-acting opioid and monitor for relief. D. titrate dosage of a short-acting opioid upward over 24 hours to achieve relief.

B. supplement with nonpharmacological interventions.

Asthma is often underdiagnosed in older adults because: A. older adults frequently do not have any of the classic signs and symptoms. B. symptoms of asthma are often attributed to normal age-related changes. C. asthma is very uncommon in older adults. D. asthma symptoms are usually very mild in older adults.

B. symptoms of asthma are often attributed to normal age-related changes.

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

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

In order to focus on the older population with the greatest risk for suicide, the nurse would conduct a depression screening that targets: A. African American men. B. white men. C. white women. D. African American women.

B. white men.

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

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

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

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

The daughter of an older patient with chronic bronchitis says to the nurse, "I don't understand why my father has not been prescribed antibiotics for his bronchitis. The last time I had bronchitis I got antibiotics." The nurse considers the following when formulating a response: A. Antibiotics tend to be less effective in older adults than in younger adults. B. Antibiotics are not prescribed in chronic bronchitis since the cause is usually not bacterial. C. Antibiotics are usually indicated in frail older adults when the strong possibility of pneumonia or an acute exacerbation of bronchitis is suspected. D. Normal age-related decreases in immune response delay the presentation of classic symptoms.

C. Antibiotics are usually indicated in frail older adults when the strong possibility of pneumonia or an acute exacerbation of bronchitis is suspected.

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

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

Which intervention has priority before touching a client's consent zone? A. Draping the area to minimize exposure B. Having another nurse present C. Explaining why the area will be touched while asking permission D. Assuring the client that the touch is absolutely necessary

C. Explaining why the area will be touched while asking permission

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

C. Family members are welcome at any time.

Which of the following manifestations would a nurse expect in a 70-year-old patient who has advanced osteoarthritis? A. Swan neck deformity of the hand B. Morning stiffness lasting >30 minutes C. Heberden's nodes on the distal phalanges D. Enlarged great toe

C. Heberden's nodes on the distal phalanges

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

C. It is wise to scrutinize all exclusions before enrolling

An older client who was recently admitted to the subacute setting after having a knee replacement is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement? A. Share with the patient that it's important to get out of bed and that there is pain medication available if it does hurt. B. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain. C. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed. D. Allow the patient to remain in bed, but share that getting up will be required at least twice a day starting the next morning.

C. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed.

Kyphosis in the older adult can be a result of which of the following? A. Osteoarthritis B. Rheumatoid arthritis C. Osteoporosis D. Gout

C. Osteoporosis

The partner of a client comments, "Our sex life will certainly suffer now that he's had a heart attack." Which statement is the basis for the nurse's response? A. The client should no longer have sexual relations because of the demand on his heart. B. The energy expenditure during sex is equivalent to briskly climbing six flights of stairs. C. People with heart disease may reduce their sexual activity out of fear of their condition. D. The couple will benefit from attending a cardiac support group.

C. People with heart disease may reduce their sexual activity out of fear of their condition.

A nurse plans for the discharge of a 75-year-old patient who has the diagnosis of osteoporosis. Which of these actions would the nurse consider first? A. Avoid stressful situations. B. Schedule an annual DXA/DEXA scan. C. Remove clutter from the floors of the home. D. Encourage consumption of a high-protein diet.

C. Remove clutter from the floors of the home.

An older adult is being treated for severe pain resultsing from a history of osteoarthritis. In her discharge teaching, which information is most important to relay for the successful management of the pain? A. Check for incompatibilities before taking any new medications. B. Arrange to take a dose of analgesic prior to physical activity. C. Take the analgesic around-the-clock as prescribed. D. Be alert for the signs of overdose toxicity.

C. Take the analgesic around-the-clock as prescribed.

An older adult is admitted to the hospital after a serious fall. When noting that the client has been prescribed meperidine (Demerol) for muscle pain, the nurse: A. Administer the medication so as to prevent the client from developing the fear of pain B. questions the client and family concerning any allergies to analgesic medications. C. calls the physician to question the appropriateness of this medication order. D. conducts a pain assessment and determines the client's need for an analgesic medication.

C. calls the physician to question the appropriateness of this medication order.

After first managing the pain being experienced by the client with gout, the treatment focuses on: A. strengthening the affected joints through a controlled exercise plan. B. minimizing joint disfigurement by using therapeutic splinting. C. preventing systemic involvement by altering the client's diet. D. managing chronic pain by taking regular doses of salicylates

C. preventing systemic involvement by altering the client's diet.

When an older adult reports experiencing several different stressors over the last 6 months, the nurse demonstrates an understanding of the physiological effects of stress on the body by: (Select all that apply.) A. assessing the client using the Geriatric Depression Scale (GDS). B. testing the client's urine for red blood cells. C. screening the client for abnormally high serum glucose levels. D. inquiring as to whether the client has experienced weight changes.

C. screening the client for abnormally high serum glucose levels. D. inquiring as to whether the client has experienced weight changes.

A nurse who is caring for an older patient with bipolar disorder knows that the patient needs additional education when the patient states: A. "Bipolar disorder often results in 'a leveling out' of symptoms as one ages." B. "Relapses in bipolar disorder tend to be precipitated by medical problems." C. "The length of the phases of depression and mania varies." D. "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults."

D. "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults."

An older client with a history of hypertension and osteoarthritis who has recently fallen and fractured two ribs is prescribed extra strength Tylenol for the pain. What statement by the client requires further evaluation by the nurse? A. "I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep through the whole night." B. "I heard that meditation may help me deal with the pain without taking all that Tylenol." C. "Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours around-the-clock and my pain is gone." D. "I make sure that I take my Tylenol with breakfast when I first get up."

D. "I make sure that I take my Tylenol with breakfast when I first get up."

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

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

When educating a client on the use of an adjuvant medication, which statement best demonstrates the nurse's understanding of this therapy? A. "These medications are used instead of opioids to decrease the likelihood of addiction." B. "Adjuvant medications are prescribed because they seldom cause any significant side effects." C. "These types of medications are used to eliminate the side effects of opioid medications." D. "These drugs are intended for another purpose but have been found to be effective to treat pain."

D. "These drugs are intended for another purpose but have been found to be effective to treat pain."

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

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

Which statement regarding touch and touch zones is most accurate? A. People between the ages 66 and 100 are the most often touched. B. Newly graduated nurses tend to touch clients less often than do nursing students. C. When performing pericare, the nurse is working within the zone of intimacy. D. Illness, confinement, and dependency are stresses on the intimate zone of touch.

D. Illness, confinement, and dependency are stresses on the intimate zone of touch.

Which outcome regarding the effects of therapeutic touch on the skin is inaccurate? A. Brings about sensory stimulation. B. Helps relieve physical and psychosocial pain. C. Is known to reduce anxiety and tension. D. Improves skin integrity.

D. Improves skin integrity.

A nurse is interviewing an older woman who is a new patient in an outpatient medical clinic. Which of the following findings by the nurse is considered a risk factor for osteoporosis? A. The woman is obese and has hip pain with ambulation. B. The woman drinks three glasses of skim milk daily. . C. The woman eats three to five servings of shrimp and liver per week. D. The woman has an estrogen deficiency

D. The woman has an estrogen deficiency

Compared with acute pain, persistent pain requires the nurse to: A. monitor vital signs more frequently. B. document the character of the pain as burning. C. administer analgesics at least every 4 hours. D. educate the client to the benefit of specific lifestyle changes.

D. educate the client to the benefit of specific lifestyle changes.

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

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

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

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

The nurse is preparing discharge teaching for a client diagnosed with chronic obstructive pulmonary disease (COPD). Which nursing statement would be included in this intervention? (Select all that apply.) A. "Are you familiar with pursed-lip breathing?" B. "It will be necessary to demonstrate postural drainage techniques with a caregiver." C. "We will need to discuss alterations in your diet." D. "Can you explain the purpose of the medications you have been prescribed? E. "There are some things I'd like to discuss about adaptive sexual practices."

A. "Are you familiar with pursed-lip breathing?" B. "It will be necessary to demonstrate postural drainage techniques with a caregiver." D. "Can you explain the purpose of the medications you have been prescribed? E. "There are some things I'd like to discuss about adaptive sexual practices."

An older aphasic client has severe osteoarthritis, bilateral contractures of the lower extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? (Select all that apply.) A. "Client slept throughout the night." B. "Client winces only when turned and repositioned." C. "Client slept during dressing change." D. "Client cooperative during morning care." E. "Client ate 80% of breakfast, 70% of lunch, and 100% of dinner."

A. "Client slept throughout the night." C. "Client slept during dressing change." D. "Client cooperative during morning care." E. "Client ate 80% of breakfast, 70% of lunch, and 100% of dinner."

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

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

An older man who recently had a myocardial infarction is being discharged home from the hospital. He tells a nurse, "I am really worried about having sex with my wife. I am afraid that I am going to have another heart attack." The best response by the nurse includes which of the following? (Select all that apply.) A. "If you are able to engage in mild to moderate physical activity without symptoms, you can resume sexual activity." B. "You really should not engage in sexual activity until 3 months have passed post heart attack." C. "It is best if you avoid eating a large meal for several hours before you have sexual relations." D. "If you have chest pain while having sex, stop and rest, and take your nitroglycerin." E. "You might want to consider some alternate positions that avoid strain."

A. "If you are able to engage in mild to moderate physical activity without symptoms, you can resume sexual activity." C. "It is best if you avoid eating a large meal for several hours before you have sexual relations." D. "If you have chest pain while having sex, stop and rest, and take your nitroglycerin." E. "You might want to consider some alternate positions that avoid strain."

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

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

When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult and his family, which statement will the nurse use to support this intervention? (Select all that apply.) A. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications." B. "ECT is contraindicated in frail adults with multiple comorbidities." C. "ECT is a safe intervention for those with psychotic ideation." D. "ECT is the most effective treatment for older adults with major depression." E. "ECT results in a more immediate reduction in depressive symptoms."

A. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications." D. "ECT is the most effective treatment for older adults with major depression." E. "ECT results in a more immediate reduction in depressive symptoms."

A nurse practitioner is using the PLISSIT model to guide a discussion of sexuality with an older patient in the geriatric clinic. Which of the following are congruent with the PLISSIT model? (Select all that apply.) A. "What concerns or questions do you have about fulfilling your sexual needs?" B. "Let me tell you about the impact of your cardiac disease on sexual activity." C. "I have a few suggestions on lubricants that might make intercourse more comfortable for you." D. "Most older adults are not comfortable talking about sexuality, but it is important to do so." E. "It is not unusual to have difficulty performing sexually as you age."

A. "What concerns or questions do you have about fulfilling your sexual needs?" B. "Let me tell you about the impact of your cardiac disease on sexual activity." C. "I have a few suggestions on lubricants that might make intercourse more comfortable for you."

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

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

A nurse is assessing an older patient with new onset confusion. The nurse understands that in order to have a diagnosis of delirium, the patient must exhibit which of the following? (Select all that apply.) A. Acute onset of symptoms or fluctuating course a B. Inattention C. Disorganized thinking D. Altered level of consciousness E. Flat affect

A. Acute onset of symptoms or fluctuating course a B. Inattention C. Disorganized thinking D. Altered level of consciousness

A nurse is caring for a 92-year-old female patient who was admitted to the hospital 1 day after she had outpatient cataract surgery. The patient who lives in an assisted living facility became very confused and agitated and was found wandering in the lobby of the building in her nightgown. She refused to return to her room and stated that there were "bad men" in her room. The patient has a history of dementia, diabetes, heart failure, and is on seven different medications. She was widowed 1 year ago. The nurse suspects that she has delirium. What are the patient's risk factors for delirium? (Select all that apply.) A. Age of 92 B. Residing in an assisted living facility C. History of dementia D. Female gender E. Recent cataract surgery

A. Age of 92 C. History of dementia E. Recent cataract surgery

A nurse is planning education for a group of older adults at a senior center on promoting respiratory health. Which of the following should the nurse include in the education? (Select all that apply.) A. Annual influenza immunization B. Pneumococcal pneumonia immunization C. Smoking cessation D. Weight reduction E. Benefits of low-sodium low-fat diets

A. Annual influenza immunization B. Pneumococcal pneumonia immunization C. Smoking cessation

An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging? A. Assessing the client for both depression and anxiety B. Discussing the poor prognosis of this disorder with the client C. Explaining the need for proper nutrition to minimize the effects of alcoholism D. Identifying the effects of chronic alcoholism on the human body

A. Assessing the client for both depression and anxiety

A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching? A. Avoid foods high in purine. B. Encourage the patient to take in 1 L of fluid daily C. Consume one glass of red wine daily. D. Recommend that the patient eat 12-16 oz of foods high in protein such as red meat.

A. Avoid foods high in purine.

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

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

A nurse is assessing an older adult's respiratory status. Which of the following are normal age-related changes in the respiratory system? (Select all that apply.) A. Diminished cough reflex B. Stiffening of the chest wall C. Increased resistance to airflow D. Decreased respiratory rate E. Loss of elastic recoil

A. Diminished cough reflex B. Stiffening of the chest wall C. Increased resistance to airflow E. Loss of elastic recoil

A nurse is assisting an older adult to cope with depression after the loss of a spouse. Which of the following actions should the nurse take? (Select all that apply.) A. Encourage the person to develop a daily activity schedule that includes pleasant activities. B. Validate depressed feelings as aiding recovery. C. Discourage angry outbursts. D. Suggest that the person not make any decisions until the depression has passed. E. Involve the family in teaching about depression.

A. Encourage the person to develop a daily activity schedule that includes pleasant activities. B. Validate depressed feelings as aiding recovery. E. Involve the family in teaching about depression.

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

A. Financial exploitation

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

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

A nurse in a long-term care facility is concerned that a 94-year-old resident with dementia is losing weight. Upon assessment, the nurse notes that the resident, who is able to feed herself independently, consumes less than 50% of each of her meal trays. Which of the following strategies can the nurse utilize to improve this resident's intake? (Select all that apply.) A. Assign a nursing assistant to feed the resident. B. Assign a nursing assistant to sit with the resident as the resident eats. C. Serve the resident finger foods. D. Serve the resident one dish at a time. E. Alter the dining ambience to reduce distractions.

B. Assign a nursing assistant to sit with the resident as the resident eats. C. Serve the resident finger foods. D. Serve the resident one dish at a time. E. Alter the dining ambience to reduce distractions.

Which intervention best addresses the principle that is the basis for communicating with a client experiencing postsurgical delirium? A. Reminding the client that delirium is generally acute and reversible B. Assuming that the client's statements are an attempt to express needs C. Allowing the client sufficient time to formulate an answer to questions D. Using nonverbal communication techniques to communicate with the client

B. Assuming that the client's statements are an attempt to express needs

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

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

An older adult with rheumatoid arthritis is taking ibuprofen (Advil) daily. What instructions are most important for the nurse to provide to assure the expected outcomes for this client? A. Ibuprofen (Advil) should be taken twice a day to ensure maximum pain relief. B. Consider the use of other OTC NSAIDS such as Naprosyn to reduce the risk of GI toxicity. C. Ibuprofen should always be taken on an empty stomach. D. Ibuprofen is contraindicated in persons with rheumatoid arthritis.

B. Consider the use of other OTC NSAIDS such as Naprosyn to reduce the risk of GI

Which information will the nurse manager include when discussing the major differentiation between delirium and dementia with novice nurses? (Select all that apply.) A. The delirious client learns to make up answers to hide his or her confusion. B. Delirium requires increased monitoring at night. C. The client diagnosed with dementia generally looks frightened. D. Dementia results in a steady decline in cognitive abilities. E. Delirium is characterized by functions in alterness

B. Delirium requires increased monitoring at night. D. Dementia results in a steady decline in cognitive abilities. E. Delirium is characterized by functions in alterness

A nurse is caring for a patient with a diagnosis of delirium. Which of the following is an expected assessment finding for this patient? A. Normal attention span B. Fluctuation in symptoms C. Normal sleep cycle D. Increased appetite

B. Fluctuation in symptoms

A nurse is teaching a group of 65-year-old patients about reducing the risk of osteoarthritis. Which of the following would the nurse discuss as a modifiable risk factor for osteoarthritis? (Select all that apply.) A. Female sex B. History of joint injuries C. Advancing age D. Drinking one cup of regular coffee a day E. Obesity

B. History of joint injuries E. Obesity

Symptoms of HIV are often under-recognized in older adults because: A. there is a very low incidence of HIV in older adults. B. Many of the classic symptoms are also common to other conditions common in older adults. C. presenting symptoms are markedly different from those in younger adults. D. AIDS progresses much slower in older adults so symptoms are not recognized easily.

B. Many of the classic symptoms are also common to other conditions common in older adults.

The cost of nursing home care is significant. The primary payer for nursing home care is: A. Medicare. B. Medicaid. C. Long-term care insurance. D. Medigap insurance.

B. Medicaid.

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

B. Medicare Advantage Plans must cover all services traditionally covered by Medicare Parts A and B. D. Medicare Advantage Plans may provide a cost savings to the member. E. Members must obtain a referral to see a specialist from an assigned primary care provider.