Mod 1

29. During the homecare nurse's visit, the wife of a 74-year-old post-stroke patient is teary and clearly overwhelmed with the fact that she is the sole caregiver for her husband. To what resource(s) should the nurse direct the wife in order to aid in her husband's functional recovery? A) A social worker and rehabilitation counselor B) The couple's family physician C) A family therapist or psychological counselor D) A public health nurse

Ans: A Feedback: Among the diverse sources of assistance available to facilitated rehabilitation, a rehabilitation counselor and social worker are most likely of greater benefit to the man and his wife than a family doctor, counselor, or public health nurse.

16. The children of an elderly resident at a nursing home are concerned that their parent is alone and lonely. A staff nurse can assure the family that the elderly should be allowed periods of solitude because such times: A) Are essential for reflecting, analyzing, and better understanding the dynamics of life B) Decrease loneliness, insecurity, and self-imposed isolation C) Help the elderly face the misfortunes of growing old D) Affect displays of anxiety, depression, and anorexia

Ans: A Feedback: Being alone and being lonely are not the same thing. Periods of isolation are essential at all ages for the reason listed in choice A.

13. The emergence of today's nuclear family units has changed the roles and functions of family members in many ways. In counseling elders and their families, which of the following beliefs about aging should a nurse be aware as one of these ways? A) Children are expected to provide financial support for their aging parents B) Grandparents are spending more time with their grandchildren than ever before C) Older adults enjoy freedom from responsibility for their adult children's welfare D) Older parents and their children grow apart, seldom developing satisfying adult-to-adult relationships

Ans: C Feedback: Children are no longer expected to provide financially for their aging parents, and grandparentingóalthough important and satisfyingóis a long-distance undertaking in families that live many miles apart. Today's parents do, however, often enjoy satisfying adult-to-adult relationships with their grown children. Today's parents are free from responsibilities for their adult children more than any generation before, and many actively enjoy that freedom in middle age and later life.

20. Ms. E, an 80-year-old, is gradually withdrawing from society and wants society to gradually withdraw from her. She believes that this mutual withdrawal will free her from societal roles and give society the means for transferring power from the old to the young. Ms. E's grown children are concerned and say her belief has no scientific basis. On which of the following theories of aging can Ms. E say she bases her belief? A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory

Ans: C Feedback: Disengagement theory views aging as a process in which society and the individual gradually withdraw, or disengage, from each other, to the mutual satisfaction and benefit of both.

12. Mrs. H and Mrs. J are the same age. While in the doctor's waiting room, they discuss their ailments and their beliefs about aging. Mrs. H argues that Mrs. J must be older because she has more ailments. The nurse settles the argument by stating a cornerstone of all biological theories of aging. Which of the following statements did the nurse most likely make? A) Aging is a predictable cellular process. B) Cells undergo a finite number of divisions. C) No two individuals age identically. D) Body systems decline at the same rate.

Ans: C Feedback: Individual variability is fundamental to all biological theories. Aging is not totally predictable, nor is it necessarily cellular in some biological theories. Body systems are often seen to decline at different rates.

25. The director of a nursing home tries to provide stimulating activities for the residents. Every Friday evening, there are Bingo games for the residents. Most residents enjoy playing Bingo, but a few object that it is a ìwaste of timeî and they refuse to play. How should the director handle the situation? A) Continue the games but offer an alternative activity that provides more mental stimulation. B) Continue the games and insist that all the residents should continue participation. C) Find a new, more stimulating activity for all the residents. D) Continue the games but allow the residents to read or watch television instead of playing.

Ans: A Feedback: Bingo may seem frivolous to some residents, but for some it is as much mental stimulation as they can handle, and many people do seem to enjoy it. Although the games should continue for those who wish to play, no one should be forced to play. Reading is always a good way to spend time, but in a nursing home there are many hours to fill in that way. Most television programs are not mentally challenging. Residents who object to playing Bingo should be asked to suggest ideas for other activities; depending on their interests and abilities, they might enjoy playing chess or bridge, playing board games, or telling jokes and stories.

7. Which of following statements most accurately captures the role of chronic illness in the lives of older adults? A) Chronic illnesses constitute the leading cause of death for older adults. B) More older adults die from acute illnesses than from chronic diseases. C) While chronic diseases used to be the leading cause of death, this is no longer the case. D) While cancer rates have fallen, other chronic diseases remain a common cause of death.

Ans: A Feedback: Chronic illnesses constitute the leading cause of death for older adults, exceeding those attributed to acute illnesses. The presence of heart disease as a cause of death has decreased in recent years, while at the same time cancer has become more prevalent.

6. A hospital clinical educator is espousing the disengagement theory of aging when teaching staff how best to meet the needs of older clients. Which of the nurse's teaching points best captures the disengagement theory of aging? A) Older adults often benefit from a gradual and controlled withdrawal of their own interests from society's interests. B) The disengagement between an older adult's abilities and desires can lead to frustration and, ultimately, to illness. C) The lack of synchronicity between older adults' immune systems and their environments can be the root of many problems. D) It is imperative that we ensure older adults remain engaged with interests and events beyond themselves.

Ans: A Feedback: Disengagement theory postulates that disengagement between the individual and society is beneficial to both parties. It does not propose that this process of withdrawal be prevented nor that it necessarily leads to frustration or illness. The immune system is not a central component of the theory.

3. Elderly people are at risk for becoming frail, which can lead to serious disabilities. Which of the following is the most likely to prevent or postpone frailty? A) Exercises for strengthening muscles B) Reminiscing activities C) A weight-loss diet D) Puzzles and board games

Ans: A Feedback: Frailty refers to physical condition. Although activities like doing puzzles and reminiscing may be helpful for a person's mental condition, they do not directly benefit the person's physical condition. Weight loss may be desirable for some elderly people, but being overweight is not a step toward frailty.

13. As compared with a geriatric nurse, on what does the gerontological nurse place greater emphasis? A) Promotion of wellness and quality of life throughout the life span B) Provision of services to the terminally ill clients in hospice facilities C) Caregiving in a long-term, residential facility or similar situation D) Standards of care and performance set by the American Nurses Association

Ans: A Feedback: Gerontological nursing involves the care of aging people and emphasizes the promotion of the highest possible quality of life and wellness. Geriatric nursing focuses on the care of the sick aged.

10. Which of the following events is noted to have marked the beginning of the nursing profession's interest in the care of the aged? A) Articles on the care of the elderly published in the American Journal of Nursing B) Passage of the Federal Old Age Insurance Law and Medicare Act C) Publication of the first specialty nursing textbook dedicated to gerontology D) Establishment of the specialty group of the American Nurses Association

Ans: A Feedback: In 1904, the American Journal of Nursing printed the first nursing article on the care of the aged, presenting many principles that continue to guide gerontological nursing practice today.

17. Although the immune system is affected by the aging process, the elderly are not the only individuals who have autoimmune disorders. These occur in populations of all ages because autoimmune disorders involve: A) An attack of antibodies on body cells B) An overproduction of T cells in bone marrow C) A decrease in the weight of the thymus gland D) An increase in the amount of lipofuscin in the blood

Ans: A Feedback: In autoimmune disorders, the immune system attacks and destroys the body's own cells (as opposed to those of invading, disease-causing microorganisms). There is no overproduction of T cells. Although the weight of the thymus gland decreases with age and the amount of lipofuscin increases, such changes are not characteristic of autoimmune disorders.

19. A nurse is helping a patient with range-of-motion exercises. Which of the following actions by the nurse is correct? The nurse: A) Offers support above and below the knee being exercised. B) Documents any increase in heart rate or respirations. C) Moves each joint slowly and smoothly past the point of resistance. D) Moves each joint back and forth once.

Ans: A Feedback: In performing range-of-motion exercises correctly, support should be provided above as well as below the joint being exercised. Heart rate and respirations need not be documented for range-of-motion exercises. Joints should not be forced past the point of resistance or pain. Joints should be exercised at least three times.

14. Gerontological nursing is a complex specialty. Which of the following contributes most to this fact? A) Elderly people are generally compromised in their health status B) Care for the elderly costs more than care for younger patients C) Numerous health conditions can overlap in the elderly D) Complications after surgery or illness result in death in most cases

Ans: C Feedback: Most elderly people are well, and their care is no more expensive than that of any other person. Death is not the most frequent outcome of illness or surgery. Multiple health conditions often coexist, making it difficult for health care professionals to sort out cause-and-effect relationships in symptoms, diagnoses, and treatments.

12. Twentieth-century laws regarding health care for the elderly trace their roots back to: A) England's 17th-century Poor Laws B) Child labor laws of the 19th century C) The Biblical commandment ìHonor your father and your motherî D) The tradition of respect for the elderly passed down from ancient Roman law

Ans: A Feedback: Laws enacted in 20th-century America provided some measure of financial security and some level of health care for all persons aged 65 years and older, just as did the Poor Laws of 17th-century England that acted as a ìsafety netî for the elderly and the destitute. The child labor laws protected the young but offered no help to the elderly who were left at the mercy of their families. The Biblical commandment to ìhonorî provides a moral guideline but no practical benefit in terms of financial or health support. Ancient Romans deplored the elderly, and no tradition of respect for the aged was incorporated into the Roman legal code.

15. Holistic gerontological care means helping older individuals achieve a sense of wholeness. How can gerontological nurses best help older individuals achieve this wholeness? A) Guiding them in understanding and finding meaning and purpose in life B) Doing as much for them as possible C) Eliminating many of their chronic diseases and effects of advanced age D) Facilitating harmony of all their body systems

Ans: A Feedback: Many positive outcomes are achieved by allowing older persons to do as much for themselves as possible. Chronic diseases and the effects of advanced age cannot be eliminated. The harmony that holism strives for is a balance of the mind, body, and spirit.

22. In a seminar, Nurse T presents a meta-analysis in support of his position that all citizens over age 50 should be screened for hypertension. Nurse T's presentation uses: A) The compiled results from several research studies B) Tables and graphs prepared using PowerPoint C) A detailed breakdown of costs and projected benefits D) A comparison of communities that provide such screening

Ans: A Feedback: Meta-analysis is a process in which published research studies on a specific topic are analyzed and their results compiled. Nurse T may or may not have included the other elements in his presentation.

26. Which aid to reality orientation can most help elderly patients? A) Conversations B) Calendars and clocks C) Holiday decorations D) Newspapers and television and radio news programs

Ans: A Feedback: Nurses and other staff can enhance a patient's orientation by casually mentioning dates and times while dispensing medicines or doing other tasks, an act that is more effective than the other noted methods.

18. Residents in an assisted-living facility attend a daily exercise class. Their blood pressures and heart rates are monitored before, during, and after exercising. While they are riding stationary bicycles, a nurse notices the signs listed below. Which patient should stop exercising? A) Mr. A's systolic blood pressure has increased by 25 mm Hg. B) Mr. B's heart rate has increased to 90 beats per minute. C) Ms. C's face is flushed. D) Ms. D is breathing rapidly.

Ans: A Feedback: Only Mr. A's condition warrants that he should stop exercising. The others may feel a bit tired, but they are not exhibiting dangerous signs.

21. What are the most important competing forces that influence health policy for the elderly? A) Cost containment versus quality of care B) Acute care versus the burden of chronic disease C) Private insurance payments versus Medicare support D) Long-term care at home versus nursing home services

Ans: A Feedback: Policy discussions most often pit cost containment (reducing expenditures) against quality of care (which may mean increasing expenditures). Seniors require relatively less acute care than younger patients do; their health problems are more often chronic. Because all persons over age 65 are entitled to health coverage through Medicare, insurance considerations are fewer than with younger patients. And whereas one in four seniors requires nursing home care at some time, nursing home residency is not typically long term.

18. Gerontology instructors at City College of Nursing impress upon their students that gerontological nurses should be concerned with the welfare of both the current aged population and future ones. The best way nurses can help young and middle-aged adults prepare for their retirement is to promote: A) Meaningful leisure time activities B) Freedom from family responsibilities C) Achievement in a worthwhile occupation D) Maximal use of community health resources

Ans: A Feedback: Retirement is facilitated by learning how to use, appreciate, and gain satisfaction from leisure time throughout an employed lifetime. Occupational achievement may actually hinder a successful retirement if the work role proves difficult to abandon or replace. Although the use of community health resources and freedom from family responsibilities can contribute to a healthful old age, they are not the major sources of satisfaction to be cultivated earlier in life.

15. A young couple are looking for a new home. They want to move into a neighborhood that has no elderly neighbors. Such ageism carries several consequences. By separating themselves from the elderly, the couple: A) Are less likely to see the similarities between themselves and older adults B) Will lose their insights into aging C) Will not experience the challenges of old age D) May have an easier time minimizing their socioeconomic challenges

Ans: A Feedback: Separation from the elderly means people are less likely to see the similarities between themselves and older adults. This separation leads to lack of understanding of the elderly and reduces the opportunities for the young to gain realistic insights into aging.

3. A nurse who practices in a long-term care facility is providing care for a 101-year-old black female. The nurse's coworker states, ìIt's gratifying that black people in this country are finally reaching the same levels of health that white people are enjoying.î How can the nurse best respond? A) Actually, the difference in life expectancy between black people and white people is growing, not shrinking. B) We've not yet arrived at a place where the life expectancies are equal between black and white people, but the gap is decreasing gradually. C) Black women do tend to live longer than white women, but the overall life expectancies when men are included are not yet equal. D) You're right. Since the 1980s the life expectancies of black and white Americans have remained nearly the same.î

Ans: A Feedback: Since the 1980s, the gap between life expectancies of black Americans and white Americans has been increasing rather than decreasing. Black women do not tend to live longer than white women.

23. In old age, the body's efficiency declines. Which of the following is a typical response to that decline? A) An attempt to push the body to perform physically at the same level as in the past B) A neglect of personal appearance and other hygiene practices C) A failure to restrict lifestyle choices in a health-appropriate way D) An expressed desire to enter a nursing home to receive daily care and assistance

Ans: A Feedback: Some seniors deny age-related changes and push themselves physically. Others invest in expensive beauty treatments that promise to subvert the aging process. Others go to the opposite extreme and overestimate their deficiencies, adopting an unnecessarily restrictive lifestyle. An expressed desire for greater dependency is rare.

15. Which of the following statements underlie both the error theory of aging and the free radical theory of aging? A) Biochemical damage accumulates over time, leading to cell death. B) The rate of cellular death is genetically programmed. C) The aging body produces fewer growth and repair hormones. D) Environmental agents such as radiation and heavy metals damage DNA.

Ans: A Feedback: That the rate of cell death is genetically programmed is a basic tenet of the programmed theory of aging. That the aging body produces fewer growth and repair hormones is a neuroendocrine theory. Although radiation and heavy metals may damage DNA, they are not free radicals, and they need not be the cause of the mutations assumed by the error theory.

21. A state committee is looking to improve the lives of the state's elderly. It wants to recommend that health care facilities that cater to the elderly population be required to base their practices on the activity theory of aging. Which of the following may be one problem with implementing the activity theory of aging? A) The assumption that older people want to maintain their middle-aged lifestyle B) The reluctance of the elderly to give up their occupational roles at retirement age C) The decline in mental acuity that accompanies physical impairment in most cases D) Declining health, loss of roles, and shrinking circle of friends of most elderly

Ans: A Feedback: The activity theory suggests that the elderly should maintain their middle-aged lifestyle to the greatest extent possible, a goal not all elderly persons will embrace. The reluctance of many elderly persons to give up their middle-aged roles is consistent with the theory. Relatively small numbers of the elderly experience a significant decline in mental acuity. Declining health, loss of roles, and a shrinking circle of friends are problems the activity theory seeks to minimize.

1. Which of the following statements most accurately conveys an aspect of the error theory of aging? A) Perpetuation of DNA mutations results in organ and system malfunction. B) Age-related dysfunction of organs, tissues, and body systems results in mutation of body DNA. C) The number of cell divisions is genetically predetermined. D) Errors in the function of various organs contribute to changes in the genetic code of various body cells.

Ans: A Feedback: The error theory of aging proposes that genetic mutations are perpetuated through the aging process, resulting in organ malfunction and eventual decline in body function. Organ malfunction results from, but does not cause, the genetic mutations in question. A genetic predetermination of the number of cell divisions is associated with the programmed theory of aging.

4. Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life? A) Women tend to both live longer than men and marry men older than themselves. B) Men tend to have greater access to care facilities due to higher incomes and savings. C) Men are more likely to live with younger family members following the death of a spouse. D) Social pressures tend to stigmatize older men who live alone.

Ans: A Feedback: The facts that women live longer than men and often marry men older than themselves account for their higher rates of living alone in old age. Men are not noted to have greater access to care facilities, to be more likely to live with younger family members or to face stigma for living alone.

4. An 80-year-old female who enjoys good health explains to her primary care provider that she attributes her health status to her regular intake of berries, fruit juices, and green tea, which she states ìhelp cleanse the damaging molecules out of my body.î Which of the following theories of aging underlies the client's health behaviors? A) Free radical theory B) Biogerontology C) Disposable soma theory D) Cross-linking theory

Ans: A Feedback: The free radical theory of aging attributes damage to the accumulation of free radicals that may be countered by the intake of antioxidants. This is not an explicit component of the disposable soma or cross-linking theory of aging. Biogerontology is the study of the relationship between aging and disease.

13. A new patient is not satisfied with the conditions of the nursing home, takes a highly active role in her health care, and, because of her ability to access information, has as much knowledge as her health care providers on some health issues. This new patient is most likely: A) A young-old female baby boomer who just turned age 65 B) An old woman 75 to 85 years of age C) An old-old woman over age 85 D) An elite old woman older than 100 years

Ans: A Feedback: The patient has the predicted characteristics of a baby boomer entering the senior years.

1. Prior to the beginning of a gerontological nursing course, a nursing student questions why the course is not classified as geriatric nursing. How can the instructor best respond? A) Gerontological nursing implies health promotion activities that can accompany aging, not solely nursing care of the sick. B) Gerontological nursing focuses on issues related to normal aging and excludes the direct care of acutely ill older adults. C) The term 'geriatric nursing' implies that all older adults are ill, and the term is no longer in use. D) There is a stigma associated with the term 'geriatric' so it has been replaced with the term 'gerontological'.

Ans: A Feedback: The term ìgerontological nursingî encompasses the direct care of older adults but supersedes this to include activities related to health promotion and wellness among this population. It does not, however, exclude direct care during illness. The term ìgeriatric nursingî is not obsolete nor is the change to ìgerontological nursingî motivated by stigma associated with ìgeriatric.î

24. Which of the nurse's following questions is most appropriate for providing reality orientation for a patient with stage 5 Alzheimer's disease? A) Are you looking forward to Thanksgiving next week Mr. Hall? B) Could you tell me the month and the year this morning, Mr. Hall? C) Do you know what holiday is coming up soon, Mr. Hall? D) Will your son and daughter-in-law be coming to visit on Thanksgiving, Mr. Hall?

Ans: A Feedback: Answer A clearly but tactfully cues the patient to the fact that Thanksgiving is coming up, while answer D does not orient the patient as clearly to the fact that the holiday is next week. Answers B and C do not orient the patient but rather assess his orientation.

7. Which of the following nursing interventions by practitioner in a long-term care facility are appropriate? Select all that apply. A) The nurse times laxative administration as to not interfere with social interaction. B) The nurse provides diuretics after, not before, recreation sessions. C) The client's need for and dosage of nighttime sedation is weighed in light of activities planned for the following morning. D) Analgesia is provided prior to physical activity but held before social activities.

Ans: A, B, C Feedback: A failure to provide adequate pain control is likely to interfere with older adults' social activity. The nursing actions in answers A, B, and C are all prudent in light of promoting social interaction.

5. Which of the following are reactions that accompany disability for most people? (Select all that apply.) A) Mourning losses B) Denial of disabilities by making unrealistic plans and not complying with their care plans C) Angry outbursts and impatience with those who are trying to help them D) Fluctuations in reactions E) Acceptance of the disability with an absence of periods of regret or resentment

Ans: A, B, C, D Feedback: A person who has a disability may mourn their losses, deny disabilities by making unrealistic plans and not complying with their care plans, have angry outbursts and impatience with those who are trying to help them, and fluctuations in reactions. It is rare that a person can accept a disability without some periods of regret or resentment.

13. Which of the following are typical activities of daily living? (Select all that apply.) A) Eating B) Dressing C) Toileting D) Moving E) Cooking

Ans: A, B, C, D Feedback: Activities of daily living include eating, washing, dressing, toileting, and moving. Instrumental activities of daily living include the skills beyond the basics that enable the individual to function independently in the community.

4. Nurse L works on an acute care for elders (ACE) unit of a county hospital. Which of the following sources should the nurse utilize as standards for practice? Select all that apply. A) The American Nurses Association (ANA) standards B) The Joint Commission C) Hospital-specific standards of practice D) State and federal regulations

Ans: A, B, C, D Feedback: All of the listed sources are valid sources of standards of gerontological nursing practice.

30. Which of the following are professionals who can offer guidance in locating appropriate resources? (Select all that apply.) A) Social workers B) Physical therapists C) Occupational therapists D) Speech and hearing therapists E) Local libraries

Ans: A, B, C, D Feedback: Social workers, physical therapists, occupational therapists, speech and hearing specialists, and rehabilitation and vocational counselors are among the professionals who can offer guidance in locating appropriate resources. Local libraries, health departments, and information and referral services for older people can also provide valuable assistance.

16. Which of the following are reasons that correct body alignment for the elderly rehabilitation client is so important? Correct body alignment: (Select all that apply.) A) Facilitates optimal function of major systems. B) Makes the nurse feel more comfortable. C) Promotes comfort for the patient. D) Prevents complications such as contractures and pressure ulcers.

Ans: A, C, D Feedback: Correct body alignment facilitates the optimal function of major systems, promotes comfort, and prevents complications. It is not important that correct body alignment for the client makes the nurse feel more comfortable.

8. Which of the following tasks are components of Erikson's description of the old age tasks of reconciling ego integrity with despair? Select all that apply. A) An 80-year-old man is struggling to determine his identity apart from his lifelong career as a business leader. B) A 79-year-old woman has established habits that promote her financial independence in spite of a lack of savings. C) An 80-year-old man revels in his large, happy family rather than focusing on his mobility limitations resulting from Parkinson disease. D) A 77-year-old man is trying to determine whether his life has had deep significance and meaning.

Ans: A, C, D Feedback: Deriving satisfaction from oneself rather than occupational roles, finding pleasure in spite of physical limitations, and determining meaning in the life one has lived are all aspects of Erikson's outcome of ego integrity or despair. Financial independence is not a central component of this outcome.

8. Which of the following are principles of rehabilitative nursing in gerontological nursing care? (Select all that apply.) A) Increase self-care capacity. B) If the patient is not returned to his or her pre-illness state, rehabilitative nursing was unsuccessful. C) Eliminate or minimize self-care limitations. D) Act for or do for when the person is unable to take action for himself or herself.

Ans: A, C, D Feedback: The principles guiding gerontological nursing care that are of particular significance in rehabilitation include these actions: increase self-care capacity; eliminate or minimize self-care limitations; act for or do when the person is unable to take action for himself or herself. Rehabilitative nursing can be successful even if the client is not restored to his or her pre-illness state.

8. The board of a large chain of hospitals has commissioned a strategic plan in order to meet the care needs of baby boomers in coming years. Which of the following trends constitute a sound basis for understanding the baby boomer generation and conducting future planning? Select all that apply. A) Baby boomers tend to have fewer children than members of earlier generations. B) Adjusted for inflation, baby boomers have lower incomes than their parents had. C) Due to technology, baby boomers have more leisure time than other adults. D) Baby boomers perform physical exercise more frequently than other adults.

Ans: A, D Feedback: Baby boomers have had fewer children than generations that preceded them and they tend to exercise more often. Their incomes tend to be higher while they enjoy less leisure time.

8. The occupational therapist on a geriatric rehabilitation unit of a hospital has integrated a life review into a group therapy session. Which of the following statements best captures the nature of life review among older adults? A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff.

Ans: B Feedback: A life review can bring to light reflections on older adults' accomplishments but may also reveal profound disappointments and regrets. It should not be seen, however, as a purely negative experience. It is not viewed as a diagnostic tool and does not require special training.

15. Recognizing the high incidence of pressure ulcers in the hospitalized elderly patients, a nurse is in the habit of prompting patients to maintain proper positioning when they are seated in a chair or in a wheelchair that lacks foot pedals. Which of the nurse's following directions is most accurate? A) Make sure that you place your arms flat on your lap with your palms down. B) Try to keep your back straight and your head aligned with your spine. C) Keep your legs uncrossed and your feet directly under your chair. D) Make sure that your feet are raised so that your thighs are not bearing any weight.

Ans: B Feedback: A straight back with the head aligned is associated with sound body positioning. Arms should be supported by armrests and feet flat out in front of the chair.

11. Which of the following residents of an extended care facility is most likely to be characterized as dependent in terms of his or her capacity to perform activities of daily living? A) Ms. Q, who needs to ring the call bell and then be accompanied to the toilet by a care aide. B) Mr. H, a man who needs the assistance of care staff to get off the bedpan after he voids. C) Mr. N, who requires regular prompts to toilet himself. D) Mrs. R, who has a long term, indwelling urinary catheter and needs help in performing the relevant care.

Ans: B Feedback: An individual who is unable to get off of a bedpan or commode independently is likely to be considered dependent. The other older adults display characteristics of partial independence.

23. Which of the following patient histories is most likely for a person older than 65 years of age? A) In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B) Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C) Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D) Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks

Ans: B Feedback: Arthritis and heart conditions are among the most common chronic conditions of the elderly. Daily medications to reduce arthritis pain and decrease blood pressure are common. The other histories are more likely for younger patients.

22. A nursing home resident can walk only with difficulty and has trouble reaching the dining room by mealtime. In walking down the hall, she must frequently use the wall railings for supporting her weight, although her sense of balance is good. The entire nursing home has smooth tiled floors. Which of the following is likely the best mobility aid for the resident? A) Walker with four wheels B) Walker with two or no wheels C) Cane with a broad claw foot D) Wheelchair

Ans: B Feedback: As long as she is able to walk as far as the dining room, she should continue to do so because of the benefits of walking. A wheelchair is unnecessary. As she needs help with support rather than with balance, she needs a walker. In some situations, a walker with four wheels is desirable, but on smooth tiled floors it might move too easily and cause a dangerous fall.

11. Why did facilities that provided residential care for the elderly come to be known as nursing homes? A) Were staffed by gerontological nurses after passage of the Social Security Act B) Were often operated by women who called themselves nurses C) Served mostly sick and disabled patients who required round-the-clock nursing D) Employed mostly elderly nurses who were themselves near retirement age

Ans: B Feedback: Because many of the homes that offered residential care for the elderly were operated by women who called themselves nurses, it is not coincidental that such residences became known as nursing homes.

16. The nursing staff at a nursing home works closely with the staff in the Endocrinology Department at a local hospital. This relationship is maintained for the welfare of the nursing home residents, because a failing immune system in the elderly might account for: A) A decline in the rate of growth hormone production B) The increased incidence of cancer among the aged C) The oxidative activity of free radicals D) Changes in brain activity and nervous system function

Ans: B Feedback: Compromises in the immune systems of the elderly may lead to a failure to recognize and destroy cancerous cells. The immune system is not involved in the production of growth hormones. The immune system does not determine the action of free radicals, although it may be involved in seeking out and destroying cells damaged by free radical activity. There is no known association between diminished immune activity and changes in the brain or nervous system action.

5. A nurse is discussing an older adult client's apparent increased susceptibility to infection with his family. Which of the following statements by the nurse would be most congruent with current thought around the autoimmune role in the aging process? A) Changes that we call 'mutations' in your father's cells make his organs more vulnerable to chronic illness and germs. B) Older adults often have more difficulty fighting off infections because of their weaker immune systems, and their bodies can even attack themselves. C) Diseases such as arthritis, which we term 'autoimmune,' make older people more likely to catch viruses and other bugs. D) Our bodies seem to have an 'expiry date,' after which we are far more likely to get infections and develop chronic illness.

Ans: B Feedback: Decreased immune response coupled with increased autoimmune activity is implicated in many of the effects of the aging process. The salience of mutations is associated with genetic theories of aging and autoimmune activity is not considered the direct cause of the decline in thymus and bone marrow activity. A predetermined cell life span is associated with the programmed theory of aging.

12. Which is most likely to keep a person from functioning independently and living alone? A) Inability to prepare meals B) Difficulty in eating C) Illiteracy D) Inability to use a telephone

Ans: B Feedback: Difficulty in eating is a problem with one of the basic activities of daily living (ADLs); the others are instrumental activities of daily living (IADLs). The person would need thrice-daily help with eating meals. In comparison, it would be easier to obtain help with meal preparation, reading, or using a telephone.

17. A nurse who provides care on a rehabilitative medicine unit of a hospital works with numerous geriatric patients. Which of the following principles most accurately guides the nurse's efforts to integrate range-of-motion exercises into patient care? A) Passive range-of-motion exercises should be delegated to physiotherapists in order to reduce the chance of injury. B) Patients should be encouraged to put all of their joints through a range of motion at least once daily. C) Performing range-of-motion exercises as slowly as possible maximizes their benefit. D) Range-of-motion exercises are contraindicated in patients with existing cardiac conditions.

Ans: B Feedback: Ideally, patients should put each joint through its range of motion at least once per day. Passive range of motion can be performed by nurses and exercises should be performed slowly and steadily, but not as slowly as possible. Heart disease does not categorically contraindicate the performance of range-of-motion exercises.

20. Which of the following statements best captures an aspect of illness in older adults? A) Death from heart disease is increasing in this population. B) Death from cancer is increasing in this population. C) Chronic illnesses are less common than in younger people. D) Several acute illnesses are often present that must be managed simultaneously.

Ans: B Feedback: In the elderly population, the cancer death rate has increased in the past three decades; deaths from heart disease have declined. Several chronic conditions are often present and must be managed simultaneously.

15. Which of the following factors should a nurse prioritize when planning the care of older adults? A) The high prevalence of mental impairment among the elderly B) The diversity of the older adult population C) The fact that most older people live below the poverty line D) The lack of family support that is the norm among the elderly

Ans: B Feedback: Individuals aged 65 years and older vary widely in their health status, interest, cultural backgrounds, and health care needs. The population is not generally impaired mentally. Also, only 15% live below the poverty level. The majority live in a household with a spouse or other family member.

10. If a nurse infantilizes the client, the nurse is not adhering to which of the following guidelines for rehabilitative nursing? A) Prevent complications. B) Do not equate physical disability with mental disability. C) Provide time and flexibility. D) Recognize and praise accomplishments.

Ans: B Feedback: Infantilizing the client is equating physical disability with mental disability, which may not be the case. It is important to treat disabled persons as mature, intelligent adults.

22. What is the best action a busy nurse can take to help with the desire of elderly clients to reminisce about their past lives? A) Refer clients to senior centers, where they can share their stories with others of their own age group B) Encourage the recording of stories through diaries and scrapbooks to be shared with younger family members C) Introduce older clients to members of local historical societies who can record their stories for posterity D) Look for ways to steer discussion toward health-promoting habits such as good exercise and adequate nutrition

Ans: B Feedback: It is always important to listen to the stories of seniors and to honor their life histories. Changing the subject is seldom appropriate, and although referrals to senior centers and historical societies may be beneficial in some cases, encouraging elders to record and share their stories with the younger generation is always a good idea.

18. It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people? A) Own their own homes and have sufficient monthly income B) Get more than half their income from Social Security and live above the poverty level C) Are an increasing percentage of the labor force but are ìcash poorî D) Are retiring at earlier ages and so live below the poverty level

Ans: B Feedback: Less than 15% of older people live below the poverty level. Social Security is the main source of income for more than half of all older adults.

17. Most older women become widows. Widows must adjust to the significant loss of loved ones and the new task of living alone. Studies show that most widows: A) Require short-term treatment for depression B) Adjust well, finding new friends, interests, and activities C) Turn to their still-married female friends for advice and support D) Move in with their adult children for a period of time

Ans: B Feedback: Most widows adjust well. The friendships of the past between married couples become less important, and friendships with other widows develop. Most widows successfully live alone, and relatively few require treatment for depression.

2. Which of the following facts best accounts for the complexity of gerontological nursing? A) Assessment of older adults is often complicated by the presence of cognitive deficits. B) Multiple health conditions often coexist in older adults and symptoms are often atypical. C) Older adults are expected to have poorer health outcomes than younger clients. D) Evidence-based practice with older adults is more difficult due to the relative lack of research into their unique health needs.

Ans: B Feedback: Older adults frequently experience multiple, overlapping health problems coupled with atypical symptom presentation. While cognitive deficits may exist, this phenomenon is not as pervasive as answer B, and assessment is still possible nonetheless. Expectation of poor health outcomes, a questionable assumption in itself, does not necessarily add to the complexity of care for older adults. There is a significant body of research that addresses elders' health needs.

28. What is the most important skill for nurses to use in reminiscing activities? A) Encouraging B) Listening C) Guiding D) Redirecting

Ans: B Feedback: Perhaps the most important skill for nurses to use in reminiscing activities is listening. Little encouragement or guidance is often needed for elderly people to reminisce, and redirecting is only important if the patient starts to ramble aimlessly.

20. To effectively care for the clinical complexities of older adults, nurses need preparation in the unique principles and best practices of geriatric care. On what are the best practices built? A) The ANA Standards of the Gerontological Nurse and the Principles of Gerontological Nursing Practice B) Evidence-based practice and the expertise of the nurse C) Scientific data regarding theories, life adjustments, and pathophysiology of aging D) A large pool of knowledgeable colleagues and advanced practice

Ans: B Feedback: The best practices of geriatric care are built on the nurse's broad knowledge base and ability to use sound, existing research in solving complex clinical problems.

18. Nurse B talks with Patient G about effective methods of managing stress incontinence. What role of the gerontological nurse is being enacted in this exchange? A) Innovator B) Caregiver C) Educator D) Advocate

Ans: B Feedback: The educator role is a broader communicative function, involving sharing knowledge and skills with other professionals and the general public. Caregiving includes encouraging the active participation of older adults in self-care. Advocacy and innovation are social and professional roles.

19. Mr. B, age 72, has a history of heart disease. He insists that his high-fat diet is permissible, however, because he takes a daily supplement of gugulipid, an herb purported to reduce blood cholesterol levels. In talking with the patient, what should Mr. B's nurse do first? A) Suggest that Mr. B ask his doctor for a prescription medication to reduce cholesterol levels B) Review with Mr. B the benefits associated with limiting dietary fat C) Introduce Mr. B to the additional benefits associated with fish oil supplements D) Advise Mr. B to stop using gugulipid, as herbal supplements are not regulated by the FDA

Ans: B Feedback: The first duty of Mr. B's nurse is to promote positive health behaviors, which means encouraging the patient to limit his fat intake. Herbal supplements are unregulated, and their health benefits may be questionable. Whether fish oil supplements or prescription medications are advisable in this case merits further investigation.

17. Which of the following is the primary role of the gerontological nurse, and for what reason? A) Innovator, because gerontological nursing continues to be an evolving specialty B) Caregiver, because the nurse uses gerontological theory in the conscientious application of the nursing process to the care of elders C) Educator, because the nurse shares knowledge and skills related to the care of older adults with the general public D) Advocate, because the nurse aids older adults in asserting their rights and obtaining required services

Ans: B Feedback: The major role of nurses is that of caregiver for the reason stated. The other roles are important, but they are less frequently called for or exercised.

6. Which of the following sources is the most justifiable foundation for the future of gerontological nursing? A) Systematic trial and error B) Gerontological nursing research C) Financial realities of nursing care D) Institutional policies and procedures

Ans: B Feedback: The most reliable basis for present and future gerontological nursing practice is advanced nursing research. This would supersede trial and error, financial realities, and institution-specific policies and procedures.

9. Which of the following actions by a nurse who works with older adult clients in an assisted living facility is most likely to inhibit healthy aging? A) Discussing current events with clients who read and watch television. B) Placing a bib on each client during meal times to ensure clients maintain a clean appearance. C) Challenging clients to learn new skills and develop preexisting talents. D) Facilitating introductions between new and existing clients.

Ans: B Feedback: While the nurse's action may have a laudable rationale, using a bib and feeding clients who may not require either action is incongruent with promoting function and preventing helplessness. Discussing current events and facilitating new skills and relationships promote well-being.

24. Hospital management is reviewing departmental statistics. Which of the following departments most likely has the highest death rate of patients over age 65, and why? A) Oncology, because the elderly have been exposed to more carcinogens in their long lifetimes B) Cardiology, because, despite a decline in recent years, heart disease remains the number one cause of death among the elderly C) Endocrinology, because the elderly already have compromised immune systems D) Neurology, because stroke and Alzheimer's disease together cause more deaths of the elderly than any other conditions

Ans: B Feedback: Heart disease is the leading cause of death among persons 65 years of age and older.

5. A primary care nurse has a long-standing relationship with a 63-year-old male client who is poised to retire. Place the following phases of the client's likely transition in the correct chronological order. Use all the options. A) A euphoric period involving testing of fantasies around retirement. B) Near phase, often accompanied by fantasy regarding the retirement role. C) Disenchantment phase D) Establishment of a stable and sustainable retirement role. E) Establishment of realistic and alternative sources of satisfaction during retirement.

Ans: B, A, C, E, D Feedback: The near phase of preretirement and the accompanying fantasy is often followed by a euphoric honeymoon phase. This can be followed by a disenchanting letdown, and a subsequent reorientation that results in eventual stability.

14. Which of the following are instrumental activities of daily living related to nutritional status? (Select all that apply.) A) Eating B) Shopping C) Cooking D) Cleaning kitchen after cooking

Ans: B, C, D Feedback: Eating is an activity of daily living. Shopping, cooking, and cleaning the kitchen after cooking are instrumental activities of daily living.

23. The nurse should keep abreast of current assistive technology for which of the following reasons? (Select all that apply.) A) So that the nurse can become an entrepreneur in marketing these devices. B) These devices will enable older adults to care for themselves. C) These devices will enable older adults to function within the community. D) These devices will also afford older adults the opportunity to remain in the workforce as long as possible, despite having a disability.

Ans: B, C, D Feedback: The nurse should keep abreast of current assistive technology to enable older adults to care for themselves; to function within the community; and to allow them the opportunity to remain in the workforce as long as possible, despite having a disability. If the technology exists and the nurse is aware of it, it is not likely that the nurse can become an entrepreneur in marketing these devices.

27. What are the therapeutic effects of reminiscence? (Select all that apply.) A) It is entertaining. B) It is a means of validating existence. C) It is a means of resolving past conflicts. D) It is a means of finding meaning in remaining life.

Ans: B, C, D Feedback: The therapeutic effect of reminiscence is that it is a means of validating existence, resolving past conflicts, and finding meaning in remaining life.

1. A nurse manager at a long-term care facility is engaged in efforts to change many staff members' inaccurate and negative views of older adults. Which of the following statements made by staff is most clearly indicative of ageism? A) Older people seem to have so many more chronic health problems than younger people. B) Older adults' motor skills get progressively slower as they age. C) It's normal to expect a gradual loss of memory and intelligence with age. D) A lot of the physical changes that accompany aging are inevitable.

Ans: C Feedback: A common ageist misconception is that senility and loss of intelligence inevitably, and normally, accompany the aging process. Older adults do have more chronic conditions than younger adults, and motor skills become slower. Many of the physical changes that accompany aging are considered normal and largely inevitable.

6. After a fall in the supermarket near his home, Mr. G has experienced a slow recovery in hospital from hip replacement surgery 9 weeks prior, enduring a postoperative infection and a slow resumption of mobility. Consequently, the care team has recommended that Mr. G be moved to a facility better able to meet his rehabilitative needs. Which of the following goals should be prioritized during his rehabilitation? A) Effective pain management B) A return to pre-fall levels of mobility C) Improvement in functional capacity D) Freedom from infection

Ans: C Feedback: A priority in rehabilitation is the improvement in functional capacity. The other cited goals may be components of this, but none of them would supersede it in importance.

6. Nurse M is employed in an assisted living facility and is privy to many of the changes that accompany the aging process. An older female resident of the facility has expressed a fear that her decreased mobility will make her increasingly dependent on her daughter. How can the nurse best respond to the resident's concerns? A) There are treatments and drugs that we can explore which might prevent this from happening. B) This is a normal part of the aging process and you don't necessarily need to fear it. C) Many older adults have similar concerns. We can work together to keep you independent as long as possible. D) I'm sure this is very stressful for you, but it's fortunate that you are not experiencing severe pain or illness.

Ans: C Feedback: Answer C validates the client's concerns and expresses the possibility of addressing the issue without downplaying it or providing unrealistic promises. Answer A provides an unrealistic promise of prevention, while answers B and D downplay the severity and significance of the client's concerns.

11. In ancient times, the relationship between age and the value afforded to individuals was generally: A) Positive: with advanced age came increased value B) Negative: respect declined as age increased C) Variable: respect was different in different cultures D) Cyclic: respect moved back and forth between positive and negative

Ans: C Feedback: Attitudes toward the aging varied among cultures. The ancient Chinese, for example, believed that the elderly deserved honor and respect, whereas the ancient Romans had little respect for the elderly, customarily killing them first in the nations Rome conquered.

2. A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future? A) While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. B) By 2020, it is expected that over one-third of Americans will be over the age of 65. C) Both life expectancy and the percentage of people over 65 in the population will increase in coming decades. D) Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020.

Ans: C Feedback: Both life expectancy and the percentage of individuals over age 65 are expected to increase in coming years. About 17% of the population is expected to be over 65 by 2020.

14. Which of the following statements form components of both the error theory of aging and the cross-linking theory of aging? A) Free radicals cause mutations in cells. B) Senescence is environmentally controlled at the cellular level. C) Changes in DNA lead to organ malfunctions. D) Genetic programming determines life expectancy.

Ans: C Feedback: Both the error theory and the cross-linking theory assert some change in DNA that interferes with normal cell functioning. Such changes may be caused by free radicals or any of many other mutagens. Although the aging of cells may be environmentally influenced, it is not thought to be externally controlled. That genetic programming determines life expectancy is a basic tenet of the programmed theory of aging.

21. Which of the following older adults is using his or her mobility device most appropriately? A) Mr. B, who says that his cane helps him stay more balanced and stable when he walks. B) Mrs. A, who has begun using a walker in order to prevent further deterioration of her mobility. C) Mrs. D, who uses a wheelchair to get around her care facility because she is unable to walk quickly. D) Mrs. L. who uses an adjustable cane to help support her weaker side during transfers.

Ans: A Feedback: A cane is appropriate for broadening the base of support, not for bearing weight. It would be inappropriate to use a walker as a preventative measure against loss of mobility and a wheelchair should not be used simply to speed up mobility.

3. Which of the following clients of a nurse practitioner is demonstrative of a growing trend in the role of grandparents in contemporary American society? A) A 70-year-old grandmother is raising her two grandchildren because their mother is in prison. B) An 80-year-old client of the nurse is going through a divorce with her husband of several decades. C) A 79-year-old man laments the fact that he is estranged from his son's children. D) A married couple in their seventies who refuse to provide free child care for their grandchildren on a daily basis.

Ans: A Feedback: A growing number of grandparents have primary responsibility for the care of their grandchildren, a fact that can often be attributed to teen pregnancy, incarceration, or substance abuse. Divorce late in life, estrangement from grandchildren, and refusal to provide care are not noted to be phenomena.

23. Nurse Z takes ample time to explain all medical options to her elderly patients and to ensure they have the information they need to make informed decisions about their care. What is Nurse Z's best reason for taking these actions? A) Full disclosure deters malpractice suits and negligence claims B) The activity theory of aging requires maintenance of lifestyle C) Information is an effective strategy for stress management D) Empowerment has a positive effect on health status

Ans: D Feedback: Maximum control and decision making can have a positive effect on morbidity and mortality, although they do not necessarily reduce stress and are not inherent in the activity theory of aging. Even though legal considerations apply, the health of the patient is the first priority for nurses.

14. Gerontological nursing will become an increasingly important profession, compared with in the past, because: A) More people will be presenting with the same health care challenges B) More elderly are living in increasingly squalid living conditions C) A greater number of people are surviving the previously hazardous period of infancy D) More people are spending a longer time span in old age

Ans: D Feedback: More people are achieving and spending longer periods of time in old age than ever before in history. Declines in living conditions, increased prevalence and incidence of the same health problems, and higher survival rates during infancy do not account for the increased importance of gerontological nursing.

9. The family of an 85-year-old man who has been admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults? A) The high value of assets owned by older adults makes the financial burden of care minimal for most older adults. B) Payment for long-term care of adults is most often covered by private insurers. C) Most older adults have their basic care needs provided in a long-term facility. D) Overall, federal money pays for more care than do older adults themselves or private insurers.

Ans: D Feedback: Most money for the care of older adults comes from federally funded programs. The burden of payment is still significant for most older adults and a minority of older adults receive care in an institutional living environment.

14. A group of young student nursing assistants is getting clinical experience at a nursing home. In her introductory meeting with this group, the supervising nurse determines that the students harbor some misconceptions about the elderly. Four of the students' comments are listed below. Three of them are misconceptions about the elderly. Which comment is true? A) Most old people are sick or disabled B) Most seniors have a private pension plan C) Senility comes with old age D) Old people are still interested in sex

Ans: D Feedback: Most old people are well, only a small minority are senile, and only a minority have income from a private pension plan. Many retain a healthy interest in sex.

25. A state health investigator surveyed the residents of a retirement housing complex to determine how their financial resources affected their lives and influenced their choices. Which of the following did the investigator most likely find to be true of most of the retired residents? A) Most older people depend on their life savings through their retirement years B) Inflation in the past decades increased retirement benefits for today's seniors C) Nearly three-quarters of all seniors are financially comfortable D) More than half of all seniors retire with only Social Security benefits

Ans: D Feedback: Only a minority of the older population has an income from a private pension plan. Few have significant savings, and inflation has decreased the value of their retirement funds. Of the workers who are currently active in the labor force, more than half will not have pension plans when they retire.

20. The nurse is providing range-of-motion exercises to a patient who is comatose. Which type of range-of-motion is the nurse providing? A) Active range of motion B) Active assistive range of motion C) Resistive range of motion D) Passive range of motion

Ans: D Feedback: Passive range of motion is that in which there is no active involvement of the patient. Active range of motion is performed independently by patients. Active assistive range of motion is with assistance to the patient. There is no such thing as resistive range of motion.

10. Nurse S encourages older adult clients to engage in spiritual beliefs and practices that they are familiar with. How can this activity be best characterized? A) Spiritual concerns are less relevant than immediate physical and financial issues. B) Older adults raised in more religious times are more likely to spontaneously express their spirituality. C) Addressing clients' expressions of spirituality is beyond the scope of appropriate nursing. D) Spiritual expression can be useful in facilitating hope in older adults.

Ans: D Feedback: Spiritual expression is useful in fostering hope and is within the scope of nursing practice. Older adults are not necessarily more spontaneously spiritual nor is spirituality secondary to finances and physical health.

7. Which of the following directives by the head nurse at a long-term care facility is most reflective of the activity theory of aging? A) We need to facilitate older adults' desire to step back from the responsibilities and roles they had in earlier years. B) It's hard to overestimate the importance of regular, physical exercise in maintaining health and healthy aging. C) We need to remember that the psychological roles and characters of our residents change profoundly in later years of life. D) We have to treat our residents like younger people and keep them engaged in meaningful acts.

Ans: D Feedback: The activity theory asserts that an older person should continue a middle-aged lifestyle, denying the existence of old age as long as possible, and that society should apply the same norms to old age as it does to middle age and not advocate diminishing activity, interest, and involvement as its members grow old. Stepping back from roles is associated with disengagement theory, and psychological roles and character are not thought to change radically in later life. Physical exercise is not a central component of activity theory.

22. Mr. D was friendly and active as a young adult. Now, as a 75-year-old, he enjoys visiting with his neighbors and attending a variety of sporting and cultural events. Mr. D's behavior is most consistent with which theory of aging? A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory

Ans: D Feedback: The continuity theory suggests that personality and basic patterns of behavior remain unchanged as an individual ages. This is not a central component of the other noted theories.

20. Mr B, age 73, has a terminal illness. He has entered a nursing home, where he will reside until his death. Until age 70, he worked as a successful bank president and was an active community leader. His nurse should be alert for signs that he most resents his: A) Mortality B) Unemployment C) Family D) Dependency

Ans: D Feedback: The elderly often fear that their illness or disability may cause them to lose their independence. Becoming a burden to their families, being unable to meet the demands of daily living, and having to enter a nursing home are some of the fears associated with dependency. Physical pain from an illness may not be as intolerable as the dependency it causes. In Mr B's case, his rapid change from great independence to near total dependence may distress him more than family relationships, the loss of his work role, or his impending death.

1. A nurse who works on a subacute medical unit of a hospital is discussing the increasing population of older adults on the unit with a colleague. Which of the colleague's following statements about older adults is most accurate? A) Fortunately, Social Security ensures a sufficient level of income for people over 65. B) It helps that older people don't have to directly incur any costs for their medical care. C) Most of the older clients on the unit will have come to us from nursing homes. D) It's reassuring that people are starting to show more concern for older adults than in decades past.

Ans: D Feedback: The formation of the Administration on Aging, enactment of the Older Americans Act, and the introduction of Medicaid and Medicare all occurred in 1965. Since that time, society has demonstrated a growing concern for its older members. Myths about older people include the belief that Social Security ensures them an adequate income, that they do not have to pay for medical care, and that most older adults live in nursing homes.

5. Which of the following nursing actions by a gerontological nurse best exemplifies the role of ìadvocateî? A) Teaching licensed care staff to perform appropriate assessment of lower limb circulation. B) Providing an environment in which the restoration of a client's mobility post-stroke can be realized. C) Developing new techniques for the wound care of venous ulcers. D) Teaching an older adult how to best deal with a daughter who is attempting to gain power of attorney prematurely.

Ans: D Feedback: The gerontological nurse can function as an advocate in several ways. First and foremost, advocacy for individual clients is essential and can include aiding older adults in asserting their rights, such as the best way to deal with an individual who is attempting to gain control of his or her affairs. Answer A exemplifies the role of educator, while answer B relates to the role of healer. Answer C is indicative of innovation.

11. Nurses need to understand the aging process in order to help their patients: A) Live longer with their long-term disabilities B) Maintain youth and delay the onset of old age C) Accept the limitations imposed by genetic tendencies toward cellular degeneration D) Postpone the negative consequences of the aging process

Ans: D Feedback: The promotion of positive health practices increases the chances that an individual can delay or deter the impairments and declines that frequently accompany the aging process. Living long in a disabled state is not the most desirable objective. Maintaining youth is not an achievable goal. Accepting limitations is not necessary for many seniors and not life enhancing for many others.

17. Two related and important trends in the elderly population are: A) The growing gap in life expectancy between males and females and the number of women living alone B) The increase in life expectancy of white and black people. C) The continued burden of acute disease and the low levels of education among the elderly D) The increased burden of chronic illness and the shifting causes of death with advancing age

Ans: D Feedback: The role of chronic illness in death rates is both significant and represents a shift from the past. The gap in life expectancy between men and women is narrowing. The life expectancy of black people has been recently declining. The generation now entering the senior years is better educated than generations past.

8. Which of these nursing actions is most likely to be effective in reconciling the costs of care with the need for quality care? A) Ensuring that older adults who are hospitalized are discharged as early as possible. B) Maximizing the role of unlicensed caregivers within their scope of practice. C) Standardizing nursing care plans for hospital and care facility clients. D) Enlisting the help of family, friends, and neighbors in the care of older adults.

Ans: D Feedback: The use of lay caregivers has been identified as a sound strategy in the provision of quality care in the context of financial challenges. Early discharge, standardizing care, and maximizing the use of unlicensed care providers are likely to lower costs but may or may not be congruent with good care.

12. Why was the term geriatric nurse replaced with the preferred term gerontological nurse? A) To avoid misinterpretation because geriatric nurse means ìold nurseî B) To define the field as an academic discipline (the suffix -ology means ìto studyî) C) To emphasize the distinction between care of the elderly and other nursing specialties D) To reflect a scope broader than the care of the ill aged

Ans: D Feedback: Throughout the 1970s, nurses became increasingly aware of their role in promoting a healthy aging experience for all individuals and ensuring the wellness of older adults. As a result, the name of the specialty was changed from geriatric to gerontological nursing to reflect a broader scope than the care of the ill aged.

9. When the rehabilitative nurse is working with a gerontologic client and focuses on the many obstacles that the client has already successfully overcome, the nurse is exhibiting which of the following guidelines for rehabilitative care? A) Provide time and flexibility. B) Recognize and praise accomplishments. C) Prevent complications. D) Emphasize function rather than dysfunction.

Ans: D Feedback: When the nurse focuses on the many obstacles that the client has already successfully overcome, the nurse is emphasizing function rather than dysfunction. Providing time and flexibility, recognizing and praising accomplishments, and preventing complications are not related to the obstacles that the client has already successfully overcome.

11. Various changes during the aging process demand multiple complex adjustments that require stamina, ability, and flexibility. In which stage of life do individuals experience the greatest number of simultaneous changes? A) Adolescence B) Young adulthood C) Middle age D) Old age

Ans: D Feedback: More simultaneous changes are experienced in old age than during any other period of life.

19. After an initial period of enthusiasm, Mr J feels disappointed with his retirement. He cannot afford to travel as much as he had dreamed, and arthritis limits his mobility. Mr J's nurse can help him most by assisting him in entering which phase of retirement? A) Stability, in which he accepts his limitations B) Termination, in which he resumes a productive work role C) Reorientation, in which he assesses alternative sources of satisfaction D) Disenchantment, in which his hidden depression can be openly diagnosed and treated

Ans: C Feedback: Mr J has passed through the honeymoon phase of his retirement and has entered the disenchantment phase. In this phase, the retiree feels let down, and depression may or may not be experienced. Mr J's nurse can help him take the next step into the reorientation phase, in which he develops a lifestyle that gives him satisfaction based on realistic choices. The stability phase may follow, although some retirees never achieve it. Termination is the end of retirement brought about by illness, disability, or a return to work.

7. Mrs. Y lives with hemiplegia following an ischemic stroke 8 weeks ago, a disability that has impaired her ability to independently check her blood sugars using a glucometer. What action should the nurse choose to address Mrs. Y's challenge? A) Reevaluate Mrs. Y's goals for diabetes treatment and the need for random blood glucose monitoring. B) Enlist the help of Mrs. Y's family and friends in performing the glucose monitoring. C) Teach Mrs. Y a method of using a glucometer that can be performed using her unaffected hand. D) Substitute scheduled hemoglobin A1c testing at a medical lab for random blood glucose testing.

Ans: C Feedback: Mrs. Y's independence and self-care would be best served by teaching her to perform her blood sugar monitoring independently in a way that accommodates her disability. This would be preferable to having others do it or changing her monitoring regimen.

2. Part of the job responsibility of a nurse who works for a team of physicians is to provide documentation about elderly patients who may need nursing home care. Which of the following patients meets the criteria for being classified as frail? A) Mrs. A is inactive, walks slowly, and has many colds. B) Mrs. B has many colds, tires easily, and has lost 15 pounds in the past year. C) Mr. C has lost 20 pounds in the past year, cannot grip utensils, and is inactive. D) Mr. D has lost 20 pounds in the past year, is inactive, and has many colds.

Ans: C Feedback: Only Mr. C meets three of the criteria for frailty. The others meet only two; having many colds is not a criterion for frailty.

10. A nurse notes that a 90-year-old male client on a geriatric medical unit of the hospital has been talking about death frequently. Given that the nurse has good rapport with client, what is the nurse's most appropriate response? A) Try to focus more on the positive benefits of healing rather than what might happen. B) Remember that in this day and age many people can live far beyond 90 years of age. C) I've noticed you've brought up the issue of dying a lot. How do you feel about that? D) You'll find that aiming for health rather than thinking about death will have positive results.

Ans: C Feedback: Preparing for death has been identified as a developmental task for later life and would be an appropriate topic for discussion given the partnership that exists between the nurse and the client and the client's desire to broach the subject.

18. A magazine geared toward elderly women contains an advertisement for an anti-wrinkle cream purported to remove wrinkles caused by the drying effects of years of soap use. Knowledgeable nurses can keep their elderly female clients from being duped by this advertisement by explaining that the wrinkling of facial skin in old age results primarily from: A) Changes in the endocrine glands B) Cellular mutations arising from toxic chemicals C) Repeated exposure to ultraviolet light D) A diet high in fats and refined sugars

Ans: C Feedback: Repeated exposure to ultraviolet light causes solar elastosis, the wrinkling that results from the replacement of collagen by elastin. Toxic chemicals, nutrition, and endocrine changes are not known to produce the wrinkling of the skin seen in old age.

9. Which of the following teaching points around the use of self-reflection with older adults is most accurate? A) Self-reflection is easier for older adults than for younger adults. B) Self-reflection is less effective for male elders than for females. C) Self-reflection often involves learning a process and is difficult for many people. D) Self-reflection is not normally possible with individuals who have cognitive deficits.

Ans: C Feedback: Self-reflection is a valuable tool for many older adults, but it does not occur easily or naturally for many people and is likely to require some teaching and guidance. It is not necessarily easier for older people or for women, and cognitive deficits do not preclude it.

13. Which of the following statements is evidence that supports the programmed theory of aging? A) The life spans attained by parents and their offspring are negatively correlated. B) Mutations perpetuate themselves through each cycle of cell division. C) In cultures, cells go through a finite number of cell divisions before dying. D) In cultures, cells from older donors divide faster than those from younger donors.

Ans: C Feedback: Studies of in vitro cell proliferation have demonstrated that various species have a finite number of cell divisions. Life spans of parents and offspring are positively correlated. Mutation perpetration is a tenet of the error theory, not the programmed theory, of aging. Although longer life spans correlate positively with numbers of cell divisions in vitro, the rate of cell division is not affected.

21. Nursing standards arise from a variety of sources. Which of the following is the best source of standards for gerontological nursing? A) Each state's nurses association and practice act B) The American Association of Retired Persons (AARP) C) The Joint Commission on Accreditation of Healthcare Organizations D) The National Committee on Vital and Health Statistics (NCVHS)

Ans: C Feedback: The Joint Commission has developed standards for various clinical settings that strive to describe the maximum attainable performance levels. None of the other organizations contribute to nursing standards.

22. When compared with elderly populations of the past, persons entering their senior years between 2015 and 2030 will have: A) Fewer chronic diseases but more acute illnesses B) Greater support from their children and spouses C) Better education and greater wealth D) Fewer needs for hospital or nursing home care

Ans: C Feedback: The baby boomer cohort attained higher levels of education and economic status than past generations. They have, however, fewer children and the same (or greater) burdens of chronic disease and needs for health care as their parents did.

16. From the late 1980s to the present, the gap in life expectancy between individuals in the Caucasian and African American communities has widened. Which of the following most clearly accounts for this trend? A) Acute illness in the black population has increased B) Infant mortality and complications of childbirth in the white population have declined C) The life expectancy of African Americans has not increased at the same rate as that of the white population D) Deaths from homicide in the white population have increased

Ans: C Feedback: The gap in life expectancy between white individuals and African Americans has widened because the life expectancy of African Americans has not increased at the same pace as that of Caucasians. The U.S. Department of Health and Human Services attributes this decline to an increase in deaths from homicide and AIDS.

6. A care aide employed on a geriatric medicine unit of a hospital expresses frustration that ìold people get sick so much more often than young people.î What is the nurse's most appropriate response to this statement? A) In fact, the prevalence of obesity and accompanying chronic illnesses mean that young people actually have more chronic conditions than older adults. B) It's actually a myth that older adults require more hospitalization than young people. C) Actually, older adults experience fewer acute illnesses than younger people, it's just that they tend to take longer to recover from them. D) With the increase in life expectancies in recent years, most older people actually live free of chronic diseases until very late in life.

Ans: C Feedback: The incidence of acute illness is lower among older adults than younger adults, though recovery times tend to be longer. Older adults tend to have a higher incidence of chronic illness and require more frequent and longer hospitalizations.

10. Which of the following statements by the daughter of an 87-year-old resident of a nursing home would the nurse most likely want to correct or clarify? A) It seems like more and more people are living well into their 80s like my mom. B) My mom has a house worth loads of money but little cash flow, like many older adults. C) It seems like heart disease is getting more common even though people live longer than they used to. D) There are more women living to my mother's age than there are men.

Ans: C Feedback: The incidence of heart disease as a cause of death is on the decline. More Americans are indeed achieving old age and many older adults have valuable assets but little cash flow. Female longevity continues to exceed that of males.

23. The scope of nursing includes more than following a medical order or performing an isolated task. Which of the following statements best describes the scope of nursing? A) Nursing involves the care of aging, ill people and emphasizes the promotion of their highest possible quality of life and wellness. B) The needs of the client for self-care drive the nursing process. C) The nursing process involves a holistic approach to individuals and the care they require. D) The nursing role is to focus on the sick, rather than the well, who are more representative of the older population.

Ans: C Feedback: The other choices are not applicable. Choice A describes the role of gerontological nursing, though while denoting older adults as ìill.î Choice B does not describe a scope. Choice D describes the negativism in education programs of the past.

5. Which of the following statements most accurately captures the financial status of older adults in the United States? A) The percentage of older people living below the poverty level has been increasing. B) The financial needs of most older adults are well met by Social Security income alone. C) The recent decline in housing prices has made many older adults ìasset rich and cash poor.î D) Women 65 years of age and older is the fastest growing group of employment.

Ans: C Feedback: The percentage of older people living below the poverty level has been declining, with about 10% now falling into this category. Most older people depend on Social Security for more than half of their income. Although the median net worth of older households is nearly twice the national average because of the high prevalence of home ownership by elders, many older adults are ìasset rich and cash poor.î The recent decline in housing prices, however, has made that asset a less valuable one for many older adults. There has been a significant rise in the percentage of middle-aged women who are employed, although there has been little change in the labor force participation of women 65 years of age and older.

24. The bodily changes that occur during the aging process can affect an older person's body image and self-concept. The nurse can gain insight into the emotional well-being and self-concept of older persons by: A) Uncovering any unresolved guilt and perceived failures B) Reviewing how they interpret and refine their past experiences C) Examining what roles they accept and what roles they reject D) Determining which work roles they forfeit

Ans: C Feedback: The way persons perceive themselves and function can determine the roles they play. And the roles they accept and reject are important indicators of their self-concepts.

19. Which of the following statements about gerontological nursing is supported by research evidence? A) Geriatric nurse practitioners increase the cost of care for elderly patients in hospitals. B) Whether geriatric nurse practitioners are employed has no effect on the quality of care for older adults in ambulatory care settings. C) Gerontological clinical nurse specialists in acute hospitals decrease the length of stay for elderly patients. D) In acute hospitals, readmission rates post-discharge are higher when gerontological nurse specialists are employed.

Ans: C Feedback: The work of gerontological clinical nurse specialists in acute hospitals has been shown to shorten the stay of elderly patients. Geriatric nurse practitioners decrease the cost of care for elderly patients in hospitals and improve the quality of care for elderly patients in ambulatory care settings. In acute hospitals, readmission rates post-discharge are lower when gerontological nurse specialists are employed.

21. Younger individuals know that they will not live forever, but their behaviors may indicate that they deny their mortality. One major indication of this denial is their failure to: A) Establish a financial plan for retirement B) Provide adequately for their family's health care needs C) Make a will and set up a burial plan D) Form strong relationships with family and friends

Ans: C Feedback: Those who deny old age fail to establish retirement plans. People fail to provide for health care needs for many reasons, and acceptance of mortality may or may not influence personal relationships. The major sign of denial of mortality is failure to make a will and make plans for death.

12. Mrs S is recently widowed. She worked at home as a full-time wife and mother throughout her adult life. She is now most likely to experience: A) A desire to obtain employment outside the home B) Relief at being freed from the responsibilities of childrearing C) A sense of loss of her established social roles D) An interest in meeting men her own age and remarrying

Ans: C Feedback: Unlike many of today's younger women, who may value employment and motherhood equally, the elderly women of today centered their lives on their families, from which they derived their sense of fulfillment. Having developed few roles from which to achieve satisfaction other than that of wife and mother, many of these women feel a void when their children are gone and their husbands die.

4. A nurse who works on a palliative care unit has developed a strong partnership with the 77-year-old wife of a client who has recently died of lung cancer. The woman has expressed her fears around being a widow to the nurse. How can the nurse best respond? A) You will likely find that once you are remarried the grief will subside and you will move on. B) It's very normal to have these fears, but antidepressant medications can help immeasurably with this difficult transition. C) Though it might not feel like it now, many women eventually find joy in new friendships and freedom after the death of a spouse. D) It will be important, and healthy, for you to maintain roles and routines similar to before your spouse died.

Ans: C Feedback: Widows often find positive consequences of their status in time, often in the form of new relationships. Suggesting that the grief will subside after remarriage and encouraging the woman not to change would be inappropriate, as would specific recommendations for medication.

4. Albert, Bob, Charlie, and David have all had below-the-knee amputations and are leaving the hospital. Albert's family members are excited about having him come home and have had the house completely remodeled with grab bars, a wheelchair ramp, and every other aid they know of. Someone will always be available to help him. Bob's family members mean well, but they are not reliable. They have made some preparations for his homecoming, but others have not been finished. He will have willing help at times. Charlie's family members have finished some essential preparations, such as a wheelchair ramp; others have not been finished but have been planned. Other family members work and will be able to help him only occasionally; however, he can always rely on their showing up at scheduled times. David's family members have done nothing, saying they will rehab the house when he comes home and then see what is needed. Other family members work and can make no promises about helping him. Whose family situation seems most promising? A) Albert's B) Bob's C) Charlie's D) David's

Ans: C Feedback: Charlie is probably going home to the best family support. Albert's family may smother him with helpfulness, interfering with his own need to be active and independent. Bob's family members cannot be relied on to help him when he may need them, despite their good intentions. David's family may be of no help at all. Although Charlie may have some difficulty in getting help at all times, he knows that his family can be relied on and that some planning and scheduling will take care of most problems.

2. The error theory of aging proposes a cause-and-effect relationship between the genetic activity of body cells and the effects of aging. Place the following steps in the error theory of aging in the correct chronological order. Use all the options. A) Organ, tissue, and system malfunction B) Perpetuation of mutation during cell divisions C) DNA mutation D) Overall decline in body functions E) Decline in body functions

Ans: C, B, E, A, D Feedback: The error theory of aging proposes that DNA mutations occur on a single-cell level and are perpetuated in subsequent cell divisions. The overall number of mutant cells in the body increases and causes deleterious effects on tissues and systems and eventual decline in body function.

2. According to Erikson, the final stage of the life cycle is centered on achieving integrity versus despair. Which of the following situations would signal to the nurse that the client in question is at risk for disappointment and despair as characterized by Erikson? A) An 81-year-old woman has needed to adopt a minced diet following a recent stroke. B) A 78-year-old man has had a pacemaker implanted to address his atrial fibrillation. C) A 90-year-old woman is grieving the recent death of her husband to whom she was married for 66 years. D) An 80-year-old man describes himself as ìuselessî since he can no longer help his adult children with their yard and garden work.

Ans: D Feedback: A perceived loss of useful function often constitutes a crisis for older men and can be associated with despair rather than integrity in Erikson's typology of the life cycle. A change in diet, a medical intervention, and grief at the loss of a spouse are less closely associated with this conflict.

3. Which of the following principles that underlie a gerontological nurse's practice is most in need of reexamination and modification? A) Nursing older adults requires a unique data and knowledge set. B) Aiming for wholeness in physical, social, spiritual, and psychological health is a realistic goal. C) The aging process is a natural and unavoidable part of human life. D) Health outcomes among older adults can be equal to those of younger populations.

Ans: D Feedback: Answers A, B, and C are all identified principles of gerontological nursing. In light of the nature and inevitability of the aging process, however, answer D is neither accurate nor realistic.

3. A nurse is explaining to an older adult client that many of the changes in his body that are currently causing him frustration may have their origins in genetic changes that may have in fact benefited him during his younger years. Which of the following theories of aging underlies the nurse's explanation? A) Disposable soma theory B) Free radical theory C) Mutation accumulation theory D) Antagonistic pleiotropy theory

Ans: D Feedback: Antagonistic pleiotropy theory proposes that genetic mutations that are problematic in later life may be rooted in mutation that played a beneficial role earlier in life. This perspective is not a component of the disposable soma theory, free radical theory, or mutation accumulation theory.

19. What is the most important factor contributing to limitations in self-care and independent living among the elderly? A) Lack of family support B) Low financial assets C) Acute illness and injury D) Chronic illness

Ans: D Feedback: Chronic illnesses are noted to have a significant impact on the quality of life of older adults. These illnesses are more prevalent than acute illnesses and supersede deficits in family and financial support.

9. Which of the following practices at a long-term care facility is most congruent with the provision of quality care at a reasonable cost? A) Ensuring that all medications in a care facility are administered by nurses. B) Maintaining a schedule for bathing that is standardized for all residents. C) Beginning each day with a set of vital signs for each resident. D) Encouraging residents' family members to assist with feeding and dressing when appropriate.

Ans: D Feedback: Delegating care responsibilities to friends and family when appropriate can lessen the costs of care while still maintaining quality. Residents who are able to safely self-administer medications should be permitted to do so. Fixed schedules for activities such as bathing and vital signs are likely to be inefficient.

16. The concept of the ìwounded healerî was suggested by Henri Nouwen. How can the gerontological nurse best put this concept into practice? A) By recognizing that ageism and prejudice can negatively affect health care for the elderly B) By emphasizing coping with disease, restoring function, and finding meaning in life C) By employing medical equipment with caution to avoid injury to self and others D) By using her or his own life experiences to assist the recovery of others

Ans: D Feedback: Henri Nouwen spoke of the ìwounded healerî who uses her or his own life experiences or ìwoundsî as a means to assist in the healing of others. The concept of the wounded healer suggests that by recognizing the wounds of all human beings, including themselves, nurses can provide services within a loving, compassionate framework.

7. Which of the following nursing activities involving older adults best exemplifies holistic care? A) A nurse administers a client's IV antibiotics and teaches him and his wife why he is receiving them. B) A nurse encourages a client with chronic obstructive pulmonary disease to independently perform regular deep breathing exercises. C) A nurse encourages a client who has received a preliminary diagnosis of liver cancer to seek a second opinion. D) A nurse provides wound care to a diabetic client's new foot amputation and explores the client's feelings around the loss.

Ans: D Feedback: Holistic care involves addressing both physical aspects, such as wound care, and emotional and spiritual aspects, such as discussing loss. This is less evident in the nursing actions in answers A, B, and C.

1. The mobility, activity tolerance, and overall quality of life of a 79-year-old woman are severely diminished by her angina. The woman now lives with her daughter and son-in-law, both of whom are unsure how best to foster her well-being. Which of the following teaching points of the nurse is most appropriate? A) Doing as much as you and your husband can for your mother will allow her to dedicate her energies to recovery. B) The most beneficial approach for your mother is to treat her exactly as you did before she developed this disability. C) It will be helpful for you both to occasionally remind your mother about the areas of her health and abilities that remain intact. D) Try to maximize the amount of self-care that your mother performs and still treat her like a responsible person.

Ans: D Feedback: Interacting with the woman as a responsible adult who can still perform some self-care is more beneficial than doing everything for her, denying the reality of her losses or downplaying her disability by reminding her of what she still possesses.