Gerontology Exam Sample Questions
The nurse understands that the goal for treatment of leg ulcers in the elderly client should be to? a. Relieve pain and swelling b. Relieve immobility c. Promote circulation d. Alleviate swelling, eliminate infection, and promote healing
D
The primary risk factor for the development of pressure ulcers in older adult patients is: 1. immobility. 2. impaired circulation. 3. incontinence. 4. malnutrition.
1
The gerontological nurses in a teaching nursing home are informed of a research project to obtain voiding cystometrograms on all residents. The gerontological nurses' responsibility is to ensure that the: 1. non-English speaking residents receive a complete explanation of the study in their native languages. 2. nursing home administration know that the nurses do not support such invasive studies on the residents. 3. research team is well staffed so that the nursing home staff can provide care as usual. 4. residents will be properly medicated in the examining room where the tests will be conducted.
1
The progression of intermittent claudication is measured by the: 1. distance walked before leg pain starts. 2. pedal edema after dangling the legs for 20 minutes. 3. peripheral pulses in the affected leg. 4. skin temperature and color of the feet.
1
Which condition might be indicated by an increase in hemoglobin values? 1. Dehydration 2. Infection 3. Malnutrition 4. Opiate use
1
Which is an accurate statement about Medicare? 1. Medicare is a health insurance program with carefully described benefits that may restrict the length of hospital stays. 2. Medicare patients can expect to receive routine household and attendant care under Part A of their Medicare insurance. 3. Medicare pays for the majority of nursing home care for persons who are 65 years of age or older. 4. Persons covered by Medicare must pay once-in-a-lifetime deductibles on both the physician and hospital portions of the program.
1
Which symptom in older adults is most indicative of a urinary tract infection? 1. Confusion 2. Dysuria 3. Fever 4. Frequency
1
Persons who are taking anticholinergic drugs are at high risk for: 1. cardiac arrhythmias. 2. dry mouth. 3. orthostatic hypotension. 4. slurred speech.
2
All care plans for older adult patients include: 1. a bowel and bladder program. 2. a fall prevention program. 3. discharge planning. 4. reminiscence therapy.
3
To prevent injury, a gerontological nurse advises an older adult who is taking tricyclic antidepressants to: 1. eat a diet high in roughage. 2. get an additional night light. 3. provide lubrication for the oral mucosa. 4. stand up slowly from sitting or lying positions.
4
Which age-related psychological change is not the norm? a. An increased ability to multi-task b. Lower scores on tests of creativity c. Thinking of death as a process rather than a moment in time d. Life satisfaction is related to well-being
A
An 88-year-old patient is reluctant to use the call light for assistance and is often incontinent. The gerontological clinical nurse specialist tells the staff to praise the patient each time the call light is used to request toileting assistance. The clinical nurse specialist's suggestion is based on which theory? a) Behavioral learning b) Cognitive reorganization c) Person-environment fit d) Social cognitive
A
The most reliable measure for assessing hydration in an older adult is: a) Mucous membrane condition b) Skin texture c) Skin turgor d) Urinary frequency
A
In a quality review of pressure ulcers amoung nursing home residents, appropriate outcome criteria include the: a) Availability of supplies for wound care b) Incidence of pressure ulcers correlated with staffing levels c) Percentage of pressure ulcers that demonstrate healing each month d) Rate of nurse compliance with the protocol for treating pressure ulcers
C
Symptoms of hyperthyroid disease may include all of the following except: a. Heat intolerance b. Palpitations c. Tremors d. Diarrhea
D
A gerontological clinical nurse specialist is administering a mental status examination to an 80-year-old patient. The patient answers the more complicated questions by saying "I don't know." Which test is included in a further assessment? a) Barthel Index b) Functional Independence Measure c) Geriatric Depression Scale d) Lawton Life Satisfaction Scale
C
Which statement best describes the nurse's understanding of normal expected sexual resonses in aging female clients? a. No changes in sexual responses are noted with aging females b. Aging females experience a quicker arousal phase c. An aging female will most often experience a delayed arousal phase during intercourse d. An increas in vaginal secretions may be noted in the aging female
C
Which statement would be most appropriate to ask when assessing an aging adult for cognitive function? a) What is today's date? b) Can you count to 10 for me? c) Have you noticed anything different about your memory or thinking in the past few months? d) Who is the president of the United States?
C
Which is the main principal age-related change that causes alteration in drug distribution in older adults? a) A decrease in absorption b) A decrease in total body weight c) An increase in body water d) An increase in the ratio of body fat to lean body mass
D
The Framingham Heart Study examined the effect of blood pressure,cholesterol levels, smoking, exercise, and other variables on the development of coronary artery disease in a cohort of healthy men and women. The subjects were studied at specific intervals over a period of years. The Framingham study is an example of which type of research study? a) Cross-sectional b) Longitudinal c) Predictive d) Retrospective
B
Quality improvement (QI) refers to: a. Acute care and inpatient facilities only b. Attention to safety and appropriate care for all c. It has not importance to gerontological nursing d. High-risk older adults only
B
The nurse evaluates a 70-year-old remale who has been recording her blood pressures for the last few days. These pressures were 140/90, 146/90, 146/92, 138/88, and 150/89. The nurse recognizes this as the beginning of which stage of hypertension? a. Stage 2 b. High normal blood pressures c. Stage 1 d. Stafe 3
C
When caring for an older adult with pneumonia, the nurse recognizes all of the following are appropriate interventions except: a. Monitoring rate, rhythm, depth, and effort of respirations b. Auscultating breath sounds c. Monitoring blood sugars and reports BS higher than 145 d. Monitoring for increased restlessness or anxiety indicating air hunger
C
The nurse shold be aware that the percent of aging adults in a nursing home/long-term care setting experiencing sensory hearing loss is: a. 40% b. 60% c. 30% d. 70 to 80%
D
What is the most noticeable change in tissue as it ages? a) Decrease in lipids b) Increase in subcutaneous tissue c) Decrease in wrinkles d) Accumulation of pigmented material called lipofuscin
D
Which theories on aging were introduced in the early 1900s? a) Wear-and-tear theory and autointoxication theory b) Evolution theory c) Molecular theory d) Cellular theory
A
Older adults who take the herbal supplement cascara sagrada are monitored for the presence of: 1. fever. 2. hypokalemia. 3. jaundice. 4. vertigo.
2
When assessing an aging client's genitourinary system, the gerontological nurse recognizes the importance of screening for: a. Drug addiction b. Bladder malignancy c. Diabetes d. Cognitive abilities
B
A 68-year-old man calls his daughter every night to talk about his beloved wife who died four weeks ago. During the day, he is sad and goes out frequently to get away from the empty house. The man's most probable state is: 1. depression. 2. mourning. 3. neurosis. 4. prolonged grief.
2
Age-related changes in which two organs most affect an older adult's reaction to medication? 1. Heart and lungs 2. Intestines and spleen 3. Liver and kidneys 4. Pancreas and gall bladder
3
A gerontological clinical nurse specialist plans to investigate the relationship between educational levels and adherence to prescribed hypertensive medication, as measured by changes in blood pressure readings. Which research design is most appropriate to study this issue? a) Descriptive correlational b) Nonequivalent control group c) Pretest-posttest d) Quasi-experimental
A
All statements are examples of nonpharmacological nursing interventions for a patient experiencing delirium but needing sleep except: a. Providing adequate sleep and awake times b. Encouraging ambulation c. Providing a night light to prevent fears d. Reducing noise levels during periods of sleep
B
Kolcaba's (1994) theory of comfort supports which nursing practice standard? a. It supports transcultural nursing practice b. It supports basic nursing care, promoting the comfort of the patient c. It supports the importance of social support to buffer life's stresses d. It supports helping the patient to adapt to chronic illnesses
B
A 69-year-old female presents with knee pain. The nurse hears a dry crackling or grating sound and the client feels the same sensation on exam. The nurse reconizes this as: a. Nothing abnormal for the age of the client b. Crepitation, the sound of osteoarthritis in the knee joint c. Osteoporosis and a softening of the knee joint d. Fluid-filled spaces in the knee joint
B
A 70-year-old presents to the clinic stating that his family things he is losing his mind and they want to put him in a home. What would be the intial role of the gerontological nurse? a) Begin the process of finding a qualified nursing home b) Do a complete history,physical, and assessment c) Speak with the family about their concerns d) Make light of the subject until the nurse can evaluate the situation
B
Which symptom is exhibited first by an older adult with a urinary tract infection? 1. Anorexia 2. Confusion 3. Fever 4. Restlessness
2
Which item would not be a focus of a cognitive-perceptual pattern assessment for the older client? a) Cognition--Have you experienced any changes in your memory? b) Communication--Have you had any difficulty speaking or forming ideas? c) FInancial--Have you had any financial hardships over the past several months? d) Orientation--Do you know what day, month, and year it is?
C
Which organ is responsible for drug metabolism and must be considered when prescribing medicaiton for an older adult? a) Kidneys b) Pancreas c) Intestines d) Liver
D
A 72-year-old man with asthma, chronic obstructive pulmonary disease, and chronic anxiety is admitted to a nursing home. Care plan objectives for this man include: 1. adherence to his medication regimen, inhalation therapy, and instruction about methods of conserving energy. 2. an exercise program to increase the vital capacity of his lungs. 3. instruction in respiratory exercises with emphasis on forced inhalation. 4. oxygen therapy at 3 L/min as needed and deep-breathing exercises for relaxation.
1
Which profession first developed standards of gerontological care and provided a certification mechanism to ensure expertise? 1. Medicine 2. Nursing 3. Physical therapy 4. Social work
2
Which choice best explains the practice setting for the gerontological nurse? a) In the home of the client b) Only in acute care settings c) Clinics and long-term care facilities d) Home of the client, acute care facilities, long-term care settings, and clinics or anywhere clients over the age of 65 seek health care and health education
D
A 65-year-old man with a 45-year history of smoking complains of a change in his cough pattern, a nonproductive cough, and an ache in his chest. The man's chest x-ray reveals an infiltrate. The gerontological nurse suspects: 1. a lung tumor. 2. chronic obstructive pulmonary disease. 3. pulmonary edema. 4. tuberculosis.
1
A 73-year-old patient is admitted to a rehabilitation facility after sustaining a mild stroke. After three nights in the facility, the patient begins to sleep only four to five hours a night and to awaken frequently during the night. The patient then complains of not feeling rested and begins to nap during the day. Which is the most appropriate nursing action? 1. Completing an assessment of the patient's sleep-wake cycle to determine necessary interventions 2. Doing nothing since this type of sleep pattern is associated with normal aging 3. Inquiring if the patient takes a medication at bedtime and requesting that the physician order it 4. Moving the patient further away from the nurse's station to minimize disturbances
1
A 78-year-old patient calls a telephone triage nurse and reports several falls after taking over-the-counter medication for a recent cold. Which medication contributed to the falls? 1. Diphenhydramine (Benadryl) 2. Ferrous sulfate 3. Guaifenesin (Robitussin) 4. Loratadine (Claritin)
1
A 92-year old patient, who recently underwent a below-the-knee leg amputation, is resisting attempts at rehabilitation. The most likely reason for the resistance is that the patient: 1. has goals that differ from the rehabilitation care plan. 2. has too many disabilities to realistically plan for rehabilitation. 3. is too old to undergo rehabilitation. 4. requires a psychiatrist's assistance to deal with the loss.
1
A common side effect of angiotensin-converting enzyme inhibitors that frequently results in discontinuation of therapy is: 1. a dry, persistent cough. 2. exacerbation of heart failure. 3. sedation. 4. urinary incontinence.
1
A factor that contributes to hypothermia in older adults is: 1. decreased activity. 2. decreased vulnerability to cold. 3. increased perception of cold. 4. increased subcutaneous fat.
1
A gerontological charge nurse delegates the administration of a nasogastric tube feeding to a licensed practical nurse (LPN). Which statement about this situation is most accurate? 1. The charge nurse is responsible for delegated care. 2. The charge nurse should implement the care and not delegate the task. 3. The LPN is accountable for his or her own actions. 4. The LPN should respectfully refuse to initiate this care.
1
A gerontological nurse in a daycare program for older adults observes that the participants have long toenails, corns, calluses, and other problems indicating a need for better foot care. What is the nurse's best action? 1. Developing an educational program on foot health and arranging for podiatry services at the site 2. Establishing a regular foot care plan whereby the participants' toenails would be cut and corns and calluses shaved 3. Instructing competent family members in the proper methods of cutting toenails and using commercial foot care products. 4. Recommending that the participants soak their feet for 10 minutes before cutting their toenails using safe toenail clippers
1
An 80-year-old patient is in the terminal stage of Alzheimer disease. The treatment team meets with the patient's who are angry and complain about a recent incident in which their parent's dentures were misplaced. The team members realize that: 1. anger at staff is a symptom of grief and needs to be addressed. 2. anxiety about the meeting may have interfered with the children's affect. 3. material items are the focus for the children at this time. 4. the focus of control should shift to the parent.
1
An accrediting body evaluates a nursing home by monitoring the number of residents who developed pressure ulcers and urinary tract infections. What type of audit is being conducted? 1. Outcomes 2. Process 3. Prospective 4. Structure
1
Heat stroke is a serious form of hyperthermia that is characterized by: 1. absence of sweating. 2. decrease in body temperature. 3. increase in sweating. 4. nausea and vomiting.
1
In teaching an older adult client, the gerontological nurse's most appropriate initial strategy is to: 1. assess the client and individualize the teaching methods. 2. set a slow learning pace and begin teaching simple concepts. 3. teach slowly and use repetition. 4. use demonstration and provide ample opportunity for practice.
1
Members of a family are caring for their father at home. Which statement by a family member indicates a need for teaching and caregiver instruction? 1. "Dad has gotten lazy about his bathroom habits. He blames his arthritis medication for his toileting accidents." 2. "Dad's room is close to the bathroom and we keep a light on for him at night." 3. "It's inconvenient, but we stop other activities to remind Dad to go to the bathroom on a regular schedule." 4. "We try to avoid coffee and tea at night, but Dad really likes a cup of coffee for breakfast."
1
The adult children of an aging couple ask a gerontological nurse about alternative therapies or nontraditional services to improve their parents' health. The nurse's most appropriate response is to: 1. discuss the benefits, risks, and limitations of various therapies. 2. distinguish between folk and traditional medicine. 3. give a firm warning about alternative therapies. 4. recommend a reputable holistic health therapist.
1
The holiday season is approaching and a woman is admitted to a psychiatric unit. She reports that her husband of 45 years passed away four weeks ago. She frequently cries, eats poorly, periodically complains of back and stomach aches, and has begun isolating herself. What type of grief is this woman exhibiting? 1. Acute 2. Anticipatory 3. Disenfranchising 4. Dysfunctional
1
The most common cause of chronic pain in older adults is: 1. arthritis. 2. fractures. 3. headaches. 4. neuropathy.
1
The primary function of an ombudsman is to: 1. act as a clearinghouse for complaints and problems. 2. initiate complaints about the facility's operations. 3. question the facility administrator and the director of nursing. 4. welcome and interview patients and their families.
1
Unusual symptoms of pneumonia often found in long-term care residents include: 1. anorexia and new behavioral problems. 2. headache and difficulty breathing. 3. muscle aches and fever. 4. nonproductive cough and chest pain.
1
A 63-year-old patient is returning home after being hospitalized for injuries received during a robbery and home invasion. Although neighborhood robberies are rampant, the patient has lived in the same house for 50 years and does not want to move. The patient receives a monthly social security check. The gerontological nurse's most appropriate step is to: 1. advise the patient to arrange for someone to visit regularly or move into the home. 2. advise the patient to have the social security check deposited directly to the bank and to get a dog. 3. assume that the patient is incompetent and initiate commitment proceedings. 4. take no action since the patient has a right to autonomy.
2
A 75-year-old patient who sustained a stroke has residual left-sided weakness. From the first day of hospitalization, the patient has been combative and demanding, and has refused to swallow any medication. The most constructive nursing action is to: 1. continue to attempt to follow the physician's orders. 2. determine the patient's premorbid personality. 3. restrain the patient and request a change in the route of medication. 4. wait for the patient to become more cooperative.
2
A 76-year-old patient with osteoarthritis complains of pain, stiffness, and deformities of the fingers. The gerontological nurse recommends: 1. cold packs. 2. exercise. 3. meditation therapy. 4. vitamin therapy.
2
A 78-year-old male resident at a long-term care facility, who is a former business executive, has been smoking and extinguishing cigarettes in a paper cup in areas where smoking is prohibited. He has been informed repeatedly of the designated smoking areas. The resident's behavior indicates an attempt to: 1. express self-transcendence. 2. maintain autonomy by exercising control. 3. maintain his previous professional role. 4. react against the facility's ageism.
2
A gerontological nurse at a nursing home conducts a reminiscence therapy group for residents with confusion. A member of the group stands up and says, "I just heard my cow. I have to go and milk her now." The nurse's most therapeutic response is: 1. "All right, you may leave the group now." 2. "Please tell us about your cow." 3. "That wasn't a cow; maybe you heard a vacuum cleaner." 4. "You live here at the nursing home now, not on the farm."
2
A gerontological nurse is creating a staff development program for a unit. To assess the staff's learning needs, the nurse's best approach is to ask staff members: 1. "How do you want to learn new material?" 2. "What do you need to know to do your job better?" 3. "What do you think others need to learn?" 4. "What do you think others want you to learn?"
2
A gerontological nurse is teaching dressing techniques to a patient with right hemiplegia and a severe speech impairment. An appropriate first step in the nurse's teaching would be to: 1. ask the patient to put on a shirt. 2. demonstrate the proper way to put on a shirt. 3. explain the difficulties in putting on a shirt. 4. give verbal instructions on dressing procedures.
2
A patient with Stage 2 Alzheimer disease visits the mental health clinic. During the interview, the patient becomes hostile and refuses to answer further questions. The gerontological nurse's best action is to: 1. ask if the questions upset the patient in any way. 2. discontinue the interview. 3. explain that the information is needed to plan the patient's care. 4. ignore the patient's reaction and proceed.
2
A stage III pressure ulcer is characterized by: 1. blisters, abrasions, or shallow craters. 2. deep craters with or without undermining and full-thickness skin loss involving subcutaneous tissue. 3. full-thickness skin loss with tissue necrosis or damage to muscle or bone. 4. partial-thickness skin loss involving the dermis or epidermis.
2
An 83-year-old female patient underwent a total hip replacement three days ago. She should not cross her legs because: 1. abduction of the hip can cause dislocation of the prosthesis. 2. adduction of the hip can cause dislocation of the prosthesis. 3. blood clots often result from pressure on arteries in the legs. 4. contracture can be prevented by avoiding acute flexion of the hip.
2
For an individual with age-related hearing loss, which sound is most difficult to hear: a) A recording of a march played softly b) A young child talking in a cafeteria line c) Hammering during construction of a house next door d) The voice of a man speaking in an elevator
2
In preparing a presentation for older adults, a gerontological nurse keeps in mind that: 1. older adults are unlikely to participate in educational programs due to lack of interest. 2. older adult learners are heterogeneous due to diverse educational experiences and learning strategies. 3. the ability to acquire knowledge from a verbal presentation decreases with age more than the ability to acquire knowledge through reasoning. 4. the age-related decline in intellectual performance creates obstacles for acquiring new information.
2
The main reason that older adults with a chronic illness tolerate functional impairments is that they: 1. are afraid to seek medical advice for fear of what they may find. 2. associate their symptoms with aging rather than an illness. 3. believe in home remedies and parental traditions. 4. relate their symptoms to conditions that resolved in the past without treatment.
2
The most appropriate environment for a person with chronic dementia is one that: 1. changes often to decrease boredom. 2. contains familiar objects. 3. is limited in color and sound. 4. is stimulating so as to challenge thought.
2
When relocating from a family home to a continuing care community, the most crucial factor in an older person's adjustment is his or her: 1. level of economic independence. 2. perceived control of the move. 3. physical proximity to remaining family. 4. risk-taking ability.
2
When the gerontological nurse in a clinic asks a 70-year-old man about his sexual activity, he begins to cry and says, "I feel so bad for my wife; she is only 60, and I can't seem to satisfy her as often as I used to." Which is the nurse's most appropriate response? 1. "At your age, sexual activity diminishes because of changes in your circulation. I will explain this to your wife." 2. "Certain body functions, such as erections, slow down with age. Could you tell me more about your sexual relations? For instance, how often do you have intercourse?" 3. "Your problem is probably an emotional one. If you could relax, you would be as sexually active as you were 10 years ago." 4. "Your problem is probably due to a decrease in your sexual hormones. This occurs naturally as people age."
2
Which assessment tool measures economic resources, mental health, and activities of daily living? 1. Lawton's Physical Self-Maintenance Scale 2. Older Americans Resources and Services Assessment 3. Problem Oriented Medical Record 4. Short Portable Mental Status Questionnaire
2
Which type of fracture has the highest morbidity and mortality in the older adult? 1. Ankle 2. Hip 3. Shoulder 4. Vertebral
2
A comprehensive staff development program in a long-term care facility is based on the: 1. availability of educational resources. 2. nursing director's perceptions of staff learning needs. 3. philosophy, goals, and objectives of the organization. 4. recommendations of the ombudsman.
3
A healthy 80-year-old female patient complains that her skin feels dry and sometimes itchy. The gerontological nurse advises her to: 1. avoid scratching since breaks in the skin increase the risk of infection. 2. drink more liquids and take showers instead of baths. 3. take fewer baths, use soap sparingly, and apply skin cream afterward. 4. wear cotton clothing and try a different brand of soap.
3
A physician has just informed an older adult patient that test results indicate that the patient has cancer and will require extensive surgery. The patient says, "I know the tests are wrong. I feel fine." The gerontological nurse's most appropriate response is to: 1. acknowledge that the patient looks healthy and encourage seeking a second opinion. 2. advise the patient to join a support group. 3. convey availability to talk to the patient. 4. tell the patient that the tests are reliable and accurate.
3
An 80-year-old resident of a retirement center states that something is wrong with the lighting in the room because colored rings appear around the light bulbs. The resident most likely has: 1. cataracts. 2. delusions. 3. glaucoma. 4. increased intracranial pressure.
3
Older adults with Parkinson disease exhibit: 1. confusion and depression. 2. dementia and hyperkinesia. 3. rigidity and tremor at rest. 4. weakness and tremor with movement.
3
Sildenafil citrate (Viagra) is hazardous for patients with: 1. a history of coronary artery bypass graft. 2. a history of shingles. 3. heart failure and borderline hypotension. 4. Paget disease and hypertension.
3
The gerontological nurse facilitates the benefits of life review by: 1. assisting the older adult to accept death as the inevitable last stage. 2. changing the topic when a patient talks about his or her morbid past. 3. encouraging reminiscence, oral histories, and storytelling. 4. helping the older adult explore how spiritual involvement assists with stress relief.
3
Which signs are characteristic of deep vein thrombosis? 1. A cool, non-tender limb 2. Limb numbness with diaphoresis 3. Rapid onset of unilateral leg swelling with dependent edema 4. Vertigo with an abrupt onset of blurred vision
3
A 90-year-old patient with multiple medical problems is admitted to the hospital's geriatric care unit. The nursing assessment reveals lethargy, poor capillary perfusion, and urinary incontinence. These findings alert the gerontological nurse to the potential for: 1. aspiration. 2. contractures. 3. dehydration. 4. skin breakdown.
4
A gerontological nurse is caring for an older adult who has been confined to home for the last 10 weeks due to illness. The patient is anxious, has multiple somatic complaints, and has become unable to follow instructions. The nurse knows that this phenomenon commonly occurs with: 1. environmental overload. 2. protective isolation. 3. selective inattention. 4. sensory deprivation.
4
A nursing home conducts a survey to evaluate nursing care. However, some residents did not express their concerns due to fear of reprisal by the staff. Which aspect of the evaluation is most affected? 1. Generalizability 2. Reliability 3. Statistical significance 4. Validity
4
An 80-year-old patient complains of sleeping less despite spending more time in bed. The patient does not use alcohol, caffeine, or any medications other than acetaminophen for arthritis pain. The patient goes to bed at 11:00 pm, falls asleep in 15 minutes, awakens several times during the night, and promptly goes back to sleep. The patient feels refreshed in the morning and works five days a week as a volunteer. The gerontological nurse's most appropriate response is to: 1. recommend that the patient eliminate fluid intake after 6:00 pm. 2. recommend that the patient go to bed one hour earlier. 3. suggest that the patient enroll in a sleep study. 4. tell the patient that the sleeping pattern is a normal age-related change.
4
An 87-year-old man, who has been living independently, is entering a nursing home. To help him adjust, the most effective action is to: 1. involve him in as many activities as possible so he can meet other residents. 2. move him as quickly as possible so that he does not have time to think. 3. restrict family visits for the first two weeks to give him time to adjust. 4. suggest that he bring his favorite things from home to make his room seem familiar.
4
An alert and oriented 82-year-old woman, who lives with her daughter, has been admitted to the hospital with bruises about the face and head. The daughter reports that her mother fell. Which behavior by the daughter raises the greatest suspicion of elder abuse? 1. Becoming defensive when questions are asked 2. Complaining about care delivered by hospital staff 3. Giving an illogical account of her mother's fall 4. Refusing to leave her mother alone to answer questions
4
An early sign of alcohol withdrawal is: 1. auditory hallucinations. 2. decreased blood pressure. 3. depression. 4. diaphoresis.
4
An older adult patient, who is recovering from surgery, has a sodium level of 128 mEq/L and is confused. The physician diagnoses syndrome of inappropriate secretion of antidiuretic hormone. The gerontological nurse's primary goal for this patient is to: 1. decrease edema by restricting free water intake. 2. prevent complications of hyponatremia. 3. reorient the patient to his or her surroundings. 4. restore the patient's fluid and electrolyte balance.
4
In assessing the lighting for a patient with glaucoma, the gerontological nurse knows that: 1. ceiling lights are best. 2. drapes should be left open during the daylight hours. 3. higher levels of light are needed. 4. lower levels of light are needed.
4
Nursing facilities that receive federal funds must complete for all residents a: 1. minimum data set and care plan within seven days. 2. resident assessment instrument and care plan on admission. 3. resident assessment instrument and care plan within 14 days. 4. resident assessment instrument within 14 days and a care plan within 21 days.
4
Pain of gastrointestinal origin is best differentiated from pain of cardiac origin by the presence of: 1. chest pain lasting longer than five minutes. 2. chest pain of rapid onset. 3. left flank pain. 4. substernal chest discomfort.
4
Reminiscence therapy promotes an older adult's sense of security by: 1. increasing socialization skills. 2. meshing the past with the future. 3. providing praise and recognition. 4. reviewing comforting memories.
4
The occurrence of tuberculosis in the older adult is significantly increased among individuals who: 1. are physically inactive. 2. are cigarette smokers. 3. have received the Bacile Calmette Guérin (BCG) vaccine. 4. reside in institutions.
4
The primary reason for establishing quality improvement committees at long-term care facilities is to: 1. facilitate staff participation. 2. initiate changes based on interdisciplinary exchange. 3. monitor and record incidents, accidents, and injuries. 4. provide quality care based on measurable data.
4
When hospital quality assurance indicators are assigned, the nursing staff strives to: 1. avoid emphasizing performance deficits. 2. decrease patient falls. 3. focus on achieving 100% compliance. 4. identify high-risk, high-volume, or problem-prone areas.
4
Which is a risk factor for vaginitis in older adult women? 1. Anticoagulation therapy 2. Increased sexual activity 3. Poor nutrition 4. Prolonged antibiotic therapy
4
A male elderly client on long-term auranofin therapy presents with oral ulcers and a pruritic rash and complains of decreased urinary output. The nurse understands that: a. These symptoms can be the adverse effects of gold salt therapy b. These symptoms are unrelated to anything and need a major work-up for diagnosis c. These symptoms represent liver failure d. These symptoms are common when clients are treated for arthritis
A
An 80-year-old female decides on a do not resuscitate (DNR) status for herself after discussing her medical concerns with her physician. Which statement best describes the reasoning behing this decision? a. This is ethical reasoning based on self-determination and informed consent b. This is not a medical decision c. This discussion would be meaningless because the family members were not involved d. THis is not an ethical decision
A
An 85-year-old patient has an intestinal viral infection with severe diarrhea. Laboratory studies are ordered. Which result confirms a diagnosis of dehydration? a) Hyperchloremia and hypernatremia b) Hyperglycemia and hyponatremia c) Hyperkelemia and hypercapnia d) Hypermagnesemia and hyponatremia
A
An older adult on digoxin and furosemide is showing signs of toxicity. The gerontology nurse understands that: a) Digoxin and furosemide are excreted by the kidneys, and the doses may need to be decreased due to impaired kidney function b) Digoxin and furosemide are excreted through the intestinal tract, and dose changes would be ineffective c) An increase in fluid intake will fix the symptoms, and no change in dose is needed d) How a drug is excreted is not a consideration when dosing an older adult
A
Changes in bone and muscle in the aging population have the greatest effect on? a. Stature, posture, and function b. Appearance c. Immunity d. Pain tolerance
A
Medications, slower mobility, lack of proper fluid intake, and poor diet can contribute to what common symptom in the elder population? a) Urinary incontinence b) Skin changes c) Mental changes d) Depression
A
The disease affecting adults over the ages of 55 to 60 where these is excessive resorption and deposition of bone is: a. Paget's disease b. Osteoporosis c. Wright's disease d. Scott's disease
A
The gerontological clinical nurse specialist is asked to speak to a chronic obstructive pulmonary disease support group about the ethical issues surrounding physician-assisted suicide. At the beginning of the presentation, the clinical nurse specialist asks the group to identify what they fear most about death and dying. This technique is used to achieve objectives in which domain? a) Affective b) Cognitive c) Psychomotor d) Spiritual
A
The nurse evaluating an elderly male client for urinary complaints understands that the major change in the prostate during the aging process is? a. Hyperplasia b. Renal stones causing obstructions c. Hypolplasia d. Impotence and embarassment
A
The nurse is examining a 76-year-old female with the complaints of fatigue, ankle swelling, and mild shortness of breath over a three-week period. An appropriate nursing diagnosis might include: a. Decreased cardiac output related to altered contractility and elsticity of cardiac muscle b. Activity tolerances due to compensation of oxygen supply c. Increased cardiac output related to an aging heart muscle d. Decreased urinary output due to poor kidney perfusion
A
The purpose of the Patient Self-Determination Act is: a. To encourage patient to document their choices about life support and advance directives b. To hel polder adults organize their finances c. To help older adults plan for jobs after the age of 65 d. To assist older adults in naming benefactors
A
To decrease complications of hypercalcemia caused by prolonged immobilization, the most appropriate nursing intervention is to: a) encourage a high fluid intake unless contraindicated b) monitor renal function c) monitor serum calcium and phosphorus levels d) observe the patient for signs of muscle twitching
A
Veritgo in the older adult is best described as: a. A vestibular disorder producing a rotational sensation b. A dysfunction of sensory signals c. A transient loss of consciousness d. A light-headed feeling
A
What is one important consideration when dealing with the older population when considering safety and medications? a. The older adult is at risk for falls, leading to an increase in morbidity and death b. A fractured arm is the highest risk for the older adult c. Depression is common in older adults and needs not be treated with medication d. Most older adults are not as fragile as was previously thought
A
Which best describes what guides the appropriate nursing care of an aging adult? a. Evidence-based practice developed with ongoing research into the needs and outcomes of older adults b. General nursing care previously practices c. Facility policies and procedures d. Physician orders for patient complaints
A
Which choice would not be a nursing goal when managing chronic obstructive pulmonary disorder (COPD) in an older adult patient? a. Decreasing exercise b. Preventing and treating complications c. Reducing mortality risks d. Relieving symptoms
A
Which statement demonstrates normal cognitive function for an aging adult? a) Occasional memory lapses b) Unable to recall the names of their children or siblings c) Unable to recall current address or phone number d) Unable to count to 10 or repeat a series of consecutive numbers
A
Which statement is true regarding adverse drug reactions (ADRs) in older adults? a) The rate of ADRs in geriatric clients is seven times that of younger adults and poses serious health problems b) Older adults rarely have adverse reactions to prescribed medications becuase they are monitored c) Adverse reactions are minimal in older adults and require no intervention d) Only about 1% of older adults require hospitalization for ADRs
A
Which statement reflects the state of drug absorption in the geriatric patient? a) The rate of absorption is slowed b) The rate of absorption is faster due to thinning of the mucosa c) The percentage of the medication that is absorbed is decreased d) There is a decrease in gastric pH as we age
A
Which symptom is the most common with peripheral artery disease (PAD)? a. Intermittent claudication b. Warm extremities c. Pain unrelieved by rest d. Bounding pulses
A
A gerontological clinical specialist is conducting a study on risk factors for osteoporosis and has developed a questionnaire covering risk-reducing and risk-increasing behaviors of older women. The clinical specialist asks experts in the area of osteoporosis to review the tool to establish: a) concurrent validity b) content validity c) interrater reliability d) test-retest reliability
B
In older women, the onset of physical discomfort and bleeding associated with intercourse often indicates: a) a friable cervix with possible cellular abnormalities b) decreased distensibility and mucosal changes of the vaginal vault c) infrequent sexual activity d) thickening of the vaginal mucosa with decreased lubrication
B
Persons who have chronic open-angle glaucoma are advised to wear medical alert bracelets because they have the potential for developing acute glaucoma if they are administered: a) angiotensin-converting enzyme (ACE) inhibitors b) anticholinergic agents c) adrenergic blocking agents d) osmotic agents
B
The cosmetic side of aging poses which effect on many older adults? a. The physical effect of sagging cheeks b. Psychological, affecting self-esteem and causing depression c. No notable effect d. No effect because older adults are mature enough to understand the aging process
B
The gerontological nurse may prescribe corticosteroids for all but which one of these conditions? a. Arthritis b. Hyperglycemia c. Allergic reactions d. Inflammatory states
B
The nurse assessing the older population needs to have a basic understanding of which of the following? a) The economic status of the area b) The difference between normal and abnormal for the older age group c) The signs of sexual dysfunction d) The signs of cardiac disease
B
The nurse caring for the elderly population understands that movement slows with aging. This is most likely due to: a. Cognitive function b. Changes in musculoskeletal and nervous systems c. Laziness and a feeling that life is over d. A recent change in medical condition
B
The nurse recognizes that cumulative changes in the skin of the elderly are related to environmental factors are termed? a. Sunburned b. Photoaging c. No term exists to describe this d. Mole or blemish
B
The nurse recognizes the most common eye-related disease affecting the older adult is: a. glaucoma b. cataracts c. near-sighted visual disturbances d. far-sighted visual disturbances
B
The program designed to supplement Social Security for thsoe who do not qualify for Social Securiety or who are disabled is: a. OAA b. SSI c. Medicare d. Medicaid
B
What benefit does evidnce-based practice offer clients over the age of 60? a) No actual benefits have been noted when evidence-based practice is the model for geriatric care b) Evidence-based practice offers the client improved health care in all settings c) Evidence-based pracrice is only used as a model in acute care settings d) Minimal changes in geriatric care have arisen from the use of evidnece-baseed practice models
B
What is the single most cost-effective discovery made in the past 30 years that has influenced the prevention and treatment of cardiovascular events? a. The development of oral hypoglycemic drugs b. Recognizing the need to lower blood pressure in older adults c. Antismoking campaigns d. Zero tolerance for drug and alcohol abuse in older adults
B
When encouraging adult learners to use the concept of critical reflection, the gerontological clinical specialist: a) emphasizied the "how" and "how to" instead of the "why" b) encourages and engages learners in problem formation and problem-solving activities c) explains the definition of the issue or problem under discussion so the definition is understood by all d) focuses on the present and minimizes discussion regarding learners' past experiences
B
Which disease or ailment is often under diagnosed and undertreated in the aging population? a) Schizpphrenia b) Depression c) Associative disorders d) Attention deficit disorder
B
Which of the following statements defines who is appropriate for gerontological nursing care as stated by Orem (1991)? a) Orem (1991) refers to advanced epdistric nursing care b) Any aged client whose self-care demands exceed their ability to meet those demands is appropriate c) Orem (1991) refers to young adult nursing care in preparation for a healthyolder adult life stage d) Any client who needs nursing care for whatever reason at any age is appropriate
B
Which substance(s) show changes through aging by becoming less pliable and stiffer? a) Lipofuscin b) Collagen and elastin c) Epithelial tissue d) Cytoplasm
B
A gerontological clinical nurse specialist is asked to provide consultation on ways to reduce the use of restraints in a nursing home. In the initial meeting with the nursing home administration, the clinical specialist's primary goal is to: a) Complete a written contract for services that covers expected outcomes, time commitments, support systems, and financial arrangements b) Conduct a force field analysis of the variables in the nursing home that includes use of existing data on restraint use and staff strengths and weaknesses c) Discuss the need for consultation, the overall goal of the project, and the working relationship with the staff d) Plan a review of how the use of restraints has been accomplished elsewhere and the models used for education and for changing practice
C
After presenting a talk on breast health, a gerontological clinical specialist discovers that at least 60% of the women who attend a large urban senior center do not believe in the benefits of mammography, have never had a mammogram, or had a painful experience and refuse to get another one. Which initial approach is most likely to motivate change? a) Administering a survey to assess the exact nature of the women's self-care behaviors before planning the next step b) Arranging for reduced-cost mammograms and free transport to the local hospital c) Planning some small group sessions with these women to allow them to explore their beliefs and feelings d) Presenting another educational session that includes a speech by a physician and then distribute additional literature
C
An 81-year-old patient has right-sided pleuritic pain with shortness of breath. The patient reports falling during the night, and has a large ecchymosis on the right flank area. Which nursing diagnosis is a priority for this patient? a) Anxiety b) Impaired skin integrity c) Ineffective breathing pattern d) Sleep pattern disturbance
C
Denmentia and depression are strongly related to: a) Clients over the age of 60 b) Clients over the age of 65 c) A decreased quality of life and functional deficits d) Past economic status and job performance
C
Describe the order for the nursing process as practiced by the gerontological nurse: a) Diagnose, implement, evaluate b) Assess, identify expected outcomes, implement, evaluate c) Assess, dignose along with the team, identify outcomes, plan, implement, evaluate d) Assess, evaluate, plan, implement, and look at outcomes
C
Differences between the IQ scores of a group of 20-year-old individuals and a group of 80-year-old individuals suggest: a) Cortical atrophy b) An accumulation of lipofuscin c) Cohort differences d) Vascular changes
C
Ever since the death of her husband a year ago, an older woman's ability to care for herself has significantly diminished. The older woman expresses increased feelings of inadequacy and decreased satisfaction with life. The daughter had become the primary caregiver for the woman and has become increasingly resentful of this role. The mother and daughter's feelings are best explained in terms of: a) Ego integrity versus despair b) Role theory c) Social exchange theory d) Unresolved grieving
C
Quality indicators for health-care research and patient safety appropriate for the older adult would include all of the following except: a. Wound care and decubitus ulcer prevention b. Postoperative hip fracture care c. Obstetric trauma d. Fall risk assessments
C
Senile purpura significantly increases with age and is most related to? a. The aging process past the age of 60 b. Related to increase in blood vessels c. Related to loss of subcutaneous fat and connective tissue d. Related to medications
C
Systems theory includes which components about aging? a) Gene regulation ideas b) Nutation accumulation on aging c) Neuroendocrine and immunological ideas d) Free radical ideas
C
The absorption of medication in the geriatric client is most often affected by: a) A decrease in body fat b) An increase in serun albumin c) A decrease in body water and lean body weight d) An increase in body water
C
The gerontological nurse understands that nonsteroidal anti-inflammatory drugs (NSAIDS) used for arthritis pain may cause? a. No side effects b. Liver failure in the first 24 hours c. Coagulation impairment and gastric irritation d. Fear or anxiety
C
The gerontological nurse understands that the purpose for prescribing Ditropan is: a. An underactive kidney function b. Increasing contractions of the sphincter muscles c. Decreasing bladder muscle tone and aiding in urge incontinence d. Improving urogenital symptoms caused by vaginitis
C
The major portion of the dermis consists of what substance? a. Sebaceous glands b. Hair follicles c. Collagen d. Blood vessels and nerves
C
The most common cause of death from skin cancer in the elderly is: a. Basal cell carcinoma b. Squamous cell carcinoma c. Malignant melanoma d. Actinic keratosis
C
The nurse is doing a follow-up clinic visit for a 75-year-old female post-cerrebrovascular accident (CVA) of two months. The nurse should be prepared to discuss all of these possible complications except: a. Neurogenic bladder b. Depression c. Financial concerns d. Fecal incontinence
C
The nurse may recommend which of the following for the older client with mild arthritis? a. Complete bedrest b. Rest and ice for the joints affected c. A mild exercise program including walking d. No exercise will improve arthritis
C
The nurse recognizes that involuntary movements may appear in the elderly patient and be normal. These normal involuntary movements may present as which of the following? a. Seizures b. Tongue protrusions c. Resting tremors d. Eye twitches and spasms
C
What is the most significant change in vital organs in the aging client? a) No change in organ tissue is noted b) The outer appearance of an organ changes, but the functional component does not change c) Organs show signs of decrease in function during the aging process d) The aging process speeds up the functional capacity of major organs
C
What is the purpose of Rogers' diffusion of innovation model in relation to evidnece-based practice (EBP)? a) There is no relation to EBP b) It offers an explanation of aging c) It is used to open communication around issues of implementing changes in practice when EBP research has shown that change would improve outcomes d) It is the model that contradicts the EBP theory
C
Which factor is NOT a normal part of aging and needs to be addressed to promote nutrition in the older adult client? a) Loss of teeth b) Increase in gastric pH c) Xerostoma or dry mouth d) Decline in basal metabolic rate
C
Which group of older adults has the highest risk for suicide? a) African-American men b) African-American women c) White men d) White women
C
Which statement best describes the procedure for assessing for the presence of Helicobacter pylori in the older adult patient? a. Colonoscopy b. Prescribing two weeks' worth of antibiotics, and then performing a colonoscopy c. Gastric biopsy, serum blood antibody studies, or stool assay exam d. Fecal occult blood exams
C
A 73-year-old patient reports "dizzy spells" for the past several weeks. The patient describes three similar episodes during which the patient experienced "a swimming in my head," loss of balance without falling, and numbness in the left arm. These episodes lasted 10 to 30 minutes. This patient is experiencing: a) carotid artery stenosis b) Meniere's disease c) postural hypotension d) transient ischemic attacks
D
A 92-year-old patient with advanced dementia has had three episodes of aspiration pneumonia in five months. The patient has no written advanced directives. The speech therapist recommends feeding tube placement. The patient's son would like a feeding tube placed, the daughter is unsure, and the patient's spouse states that the patient would never want a feeding tube. The gerontological clinical nurse specialist's next action is to: a) bring the case to the attention fo the ethics committee b) emphasize to the family that a feeding tube will decrease recurrent pneumonias c) obtain a surgical consult to schedule feeding tube placement d) organize a family and staff meeting to discuss the risks and benefits and consider the patient's wishes
D
An 80-year-old female asks the nurse about over-the-counter vitamin supplements. The most appropriate advice would include: a) No vitamin supplements are needed with a balanced diet b) Any multivitamin will do c) Take only a calcium supplement d) Take a multivitamin for those over the age of 50, which should include the recommended vitamins for the aging adult
D
Examples of health-care reimbrusement or delivery modes include all of the following except: a. Medicaid b. Medicare c. Managed care, telemedicine, and case management d. Anthem for the elderly A/B
D
Factors that may further decrease lung finction besides aging include all but: a. Smoking b. Obesity c. Immobility d. Exercise
D
In assessing the aging client, it is importnat for the nurse to recognize: a) The client's ability to perform ADLs b) The financial status of the client c) The job that the client held prior to aging d) All components of well-being, including biological function, psychological function, and social function
D
In teaching older adults in a group setting, the gerontological clinical specialist minimizes the impact of presbycusis by: a) Increasing the volume of the audio system b) Providing soft background music c) Raising voice pitch and facing the group d) Reducing voice pitch, speaking slowly, and enunciating
D
The nurse is evaluating a 64-year-old male for coronary artery disease (CAD). Understanding that CAD is the leading cause of mortality, which risk factor would not be related to CAD? a. Hypertension b. Dyslipidemia c. Diabetes d. Sexual orientation
D
The role of the gerontology nurse includes all of the following except: a. To facilitate the establishment of social support for the older adults b. To promote independent living as much as possible c. To educate and refer older adults to the appropriate resources d. All of the above
D
To be an effective consultant in a new setting, the gerontological clinical nurse specialist first explains to the staff members the: a) clinical nurse specialist's ability to plan care b) Clinical nurse specialist's expertise as a consultant c) need for consultation d) rold of the consultant
D
To ensure the successful implementation of the humanistic model of organizational theory, nursse managers and gerontological clinical nurse specialists prioritize activities that: a) eliminate at least one organizational level to decentralize b) eliminate or minimize the informal "grapevine" c) emphasize informal communication and minimize formal communication d) emphasize job satisfaction to improve productivity
D
Treatment approaches for an aging adult experiencing overflow incontinence may include all of the following except: a. Toilet schedule b. Positioning and the Crede maneuver c. Clean self-catheterizations d. Kegel exercises
D
Which statement describes the importance of understanding nursing theory when practicing gerontologic nursing? a. Understanding and using tested theories offer a framework on which to base nursing practice interventions b. Nursing theories are vague and do not offer substance in most health-care settings c. Theories are not proven ways onwhich to base nursing practice d. Theory helps identify major concepts in nursing practice and offers a framework for decision making
D
Which statement give examples of educational programs for the older adult? a. Community programs that focus on lifestyle modifications b. Programs targeting specific age-related problems, such as nutrition, finances, or prevention c. Programs that focus on exercise for the older adult d. All of the above
D
Which topic should NOT be omitted when assessign the aging client? a) Sexual history b) Caridac history c) History of abuse d) All of the above
D
