Older adults Exam 1

a nurse discusses advance medical directives with a group of older adults at the senior citizens' center. Which of the following statements made by a member of the group indicates a need for further teaching about medical directives?

"A durable power of attorney cannot be initiated before a person is incapacitated."

A nurse who works with older adults is teaching a colleague about the similarities and differences between gerontology and geriatrics. Which of the following questions best conveys the focus of gerontology?

"How can we help older adults maintain wellness as they age?"

A home care nurse admits an older adult with macular degeneration. Which of the following assessment questions is most appropriate/

"How do you organize your medications?"

A 93-year-old asks the nurse, "I sure would like to live to get that 100 year birthday card from the president." Which of the following responses by the nurse is best?

"Keeping fit and dealing with stress in a positive way helps your chances of living to be 100."

A nurse is discussing an older adult's recent diagnosis of rheumatoid arthritis with a colleague. Which of the nurse's statements reflects an accurate view of the relationship between aging and wellness?

"We need to teach the older adult how he can keep living a fruitful life in spite of his diagnosis."

a healthy 65 yr old says, "I don't think i will live much past 70." the studies however show that this client should live to 84 yrs of age. Which of the following statements, by the nurse, summarizes the compression of morbidity for this client?

"We should work on postponing chronic illnesses."

a nurse assesses an older adult who has been having a difficult time sleeping throughout the night and incontinence. Which of the following questions by the nurse will best provide clues to these problems?

"What beverages do you drink on a regular basis?"

A wound care nurse is assessing a 76-year-old client. The client has intimated to the nurse that her son sometimes "flies off the handle and gets rough with me." Which response made by the nurse is the best response?

"When you say 'gets rough,' what does that look like?"

A 76-year-old Hispanic woman has been admitted to the hospital. There are no advance directives in the chart. Which of the following questions will best prepare the nurse to begin a dialogue with this client about advance directives?

"With whom do you talk to about your health care decisions?"

a nurse hears a colleague make the statement, "Most older adults have nothing to worry about financially." which of the following responses is most appropriate?

"You have to remember that there's a huge economic disparity among older adults."

A nurse administers medications to a group of older adults in a residential facility. Which of the following clients is most likely to experience adverse effects?

A 77-year-old man with a creatinine of 3.6

An 81-year-old adult suffered an ischemic stroke 6 days ago. The client has failed to regain consciousness since the event. The care team has approached the client's family to obtain their views on inserting a feeding tube. Which of the following documents will allow the family to make a decision on the parent's behalf?

A durable power of attorney for health care

a nurse manager of a nursing care facility reviews potential health and safety interventions and outcomes with the nursing staff. which of the following interventions places emphasis on quality of life with the best possible health and safety outcomes?

Allowing the resident with a history of falls to walk with the help of an assistant

A nurse assesses the risk of the members of the community. Which of the following are most likely to be living at or below the poverty line?

An 83-year-old single woman

A nurse conducts a functional assessment of a client who has moved to the assisted living facility. which of the following statements best describes the functional assessment?

Client's ability to perform self-care tasks with a focus on rehabilitation.

A nurse working in an acute care for elders unit observes that a client on the unit frequently stumbles when ambulating with a walker. Which action by the nurse is best?

Ensure that the woman's mobility is assessed and the appropriate assistive device is provided.

A 74-year-old client has recently begun integrating more fresh fruit and vitamin supplements in an effort to increase the levels of antioxidants. This client's actions indicate an understanding of what theory of aging?

Free radical theory

The children of a resident of a nursing home have approached the nurse because they believe their parent is being manipulated by a person who also lives in the facility. Their parent has a diagnosis of early-stage Alzheimer disease and various comorbidities that affect mobility and function. How should the care team appraise the patient's decision making capacity?

Her decision-making capacity should be determined according to objective criteria.

Which of the following statements best explains the relevance of psychological theories for gerontological nursing?

Human needs theory allows the nurse to determine priorities of nursing care for older adults.

A nurse discusses with an older adult who continues to drive, but is probably unsafe on the road. which statement made by the nurse is most appropriate/

I am concerned about your safety, as well as the safety of others.

A nurse teaches an older adult client about the use of the telehealth equipment to monitor congestive heart failure. Which of the following statements by the client shows understanding?

I need to step on this scale and use this automatic cuff each day.

A nurse performs a reflective cultural self assessment. Which of the following outcomes should the nurse expect?

Progression from judgmental views of other cultures to recognition of positive attributes

a series of transient ischemic attacks have caused an older adult to become dysphagic. Despite failing a swallowing assessment, the client is opposed to eating a minced and pureed diet and wishes to eat a regular diet. How should the care team respond to this request?

Provide the client's requested diet after ensuring the client understands the risks.

An older adult client with urosepsis has become nonresponsive. The nurse is to identify the appropriate person to sign the consent forms for an invasive medical procedure. Which of the following actions by the nurse is appropriate?

Review the chart for a health care power of attorney.

A nurse in a Medicare- and Medicaid-funded nursing home performs assessments and develops care plans. Which of these statements is true of the functional assessments the nurse is likely to perform?

The nurse will identify changes in the older adult's function over time.

As part of a functional assessment, a nurse is assessing an older adult's ADLs and instrumental activities of daily living (IADLs). What piece of assessment data would most likely be considered an IADL rather than an ADL?

The older adult is able to clean and maintain her own apartment.

An 87-year-old woman has a history of depression and hypothyroidism. She was recently diagnosed as having breast cancer. Her daughter tells her health care provider that her mother cannot participate in decision making about her care because she is too old. Which of the following statements is true about decision-making capacity?

The older adult needs to understand the issues involved in decision making and communicate about them.

a group of community health nurses is using the stages of change model as the foundation of a new health promotion campaign for older adults,. What goal for the participants are the nurses likely to promote when working with older adults in the program?

The replacement of participants' unhealthy behaviors with healthy behaviors

A 79-year-old client has been admitted to a long-term care facility because of the progression of Alzheimer disease from mild to the moderate stage. How should the nurse proceed with functional assessment?

Use an assessment tool that is specifically designed for use with cognitively impaired clients.

A nurse is using the Functional Consequences Theory as a lens for planning client care in a health care facility. Which of the following is a key element of this nursing theory?

Wellness is a concept that is broader than just physiologic functioning.

a nursing care manager monitors admissions into an acute care unit. Which of the following clients would be the most appropriate candidate for in home skilled nursing care?

a client requiring twice daily dressing changes for a coccyx wound

An 84 yr old client has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. which of the following characteristics of the clients current situation is more likely to prompt this move?

a decrease in the client's level of function and activities of daily living (ADLs)

which of the following statements is true about the laws of mandatory abuse reporting?

a registered nurse is mandated to report abuse or neglect if it is suspected.

A nurse assesses a 66 yr old woman who strained a muscle. The client attends the gym daily, and states, "I injured my muscle grouting the floor tile getting ready for the bridge class I teach." which of the following categorizes this client's aging?

active

A gerontological nurse is aware that quality of life is an important consideration when assessing the functioning of older adults. What measure should the nurse use when appraising older adults' quality of life?

active life expectancy

a nurse in the long term facility plans care to improve quality of life. Which of the following actions is most likely to enhance the older adult's connectedness?

advocating for the husband and wife to remain in the same room of a long term care facility, as is their preference.

an older adult has recently begun to display unprecedented lapses in short term memory. The nurse overhears a colleague reassuring the person by saying, "try not to worry; its just a part of growing older." the nurse recognizes that this is an example of what phenomenon?

age attribution

an 89 year old adult is dismayed that his primary care provider referred him for a driving evaluation because he experiences vision problems and slower reaction time. Which of the following concepts is illustrated in this example?

age related changes

an 85 year old client takes meals on wheels around the community. The client states, "all these old people really need me, you know how older people are. They can't get out, and are a burden to their family, and I just wan tot help." Most of the people on the client's delivery route are in their 60s. Which of the following characterizes this scenario?

ageism

A nurse is teaching a colleague about the difference between age related changes and risk factors. which of the following examples should the nurse use when discussing age related changes?

an older adult with decreased bowel motility

A nurse plans the care of older adults in a long-term care setting. Which of the following interventions incorporates the residents' connectedness to society?

arranging regular visits by children to the facility

a 30 year old grandchild lives with and provides care for the 75 year old grandparent. The grandparent has congestive heart failure, hypothyroidism, and chronic pain from a compression fracture and osteoporosis. The grandchild supervises the older adult's medications. The home health nurse notes that the older adult has extra diuretics pills and that the pain medications for a month have been used and cannot be refilled for 2 more weeks. The older adult tells the nurse: "Those pain pills don't work, my back is always hurting. " The nurse notes that the older adult's ankles are very swollen. which of the following things should the nurse do first?

assess the grandchild personal understanding of her grandparent's needs.

an 80 year old is seen in the emergency department for a fall. The client has bruises on the upper arms and appears depressed. The client is accompanied by a grandchild, who is unkempt, glassy eyed, and whose breath smells of alcohol. Which of the following should be a priority with the nurse?

assess whether the older adult is safe in the home environment

a nurse who provides care in a clinic comes into contact with numerous older adults, many of whom have bruises of various sizes and stages on their body. what pattern of bruising is most suggestive of possible abuse?

bruising on both ears and both sides of neck

A nurses colleague states, "older people who live in the country are a lot healthier than city folk." which statement by the nurse is most appropriate?

but chronic conditions are most common among rural adults.

a nurse reviews the medication list of an older adult upon transfer from the hospital to an extended care facility. which of the following methods is most likely to reduce the occurrence of adverse effects?

compare the list to the beers criteria list and notify the health care provider of any on the list

a nurse has recently begun to provide care to older adults in a larger, urban hospital,. Having lived until recently in an ethnically homogenous region, the nurse has begun to recognize the significant differences in priorities and perspectives of clients from other cultural groups and has taken action to learn about these groups. What stage of cultural self assessment is the nurse demonstrating?

consciously incompetent

A 69-year-old cigarette smoker asks the nurse questions about the potential benefits of quitting smoking, a subject avoided in past interactions. The nurse asks the client, "Would you like to quit smoking?," to which the client replies, "I will give it some serious thought." What stage of the Stages of Change model is the client demonstrating?

contemplation

an older woman of Filipino heritage has been having rectal bleeding for several months. Her physician has told the woman and her daughters that she has advanced colon cancer. Her daughters want to obtain hospice services but the client is reluctant and does not want to discuss what she feels is "beyond her control" Which of the following concerns is the client most likely experiencing?

cultural taboo to discuss death

A nurse reviews the medication list of an older adult. Which of the following age-related changes leads to a slower drug clearance?

decreased hepatic flow

An older adult who appears to be between 85 and 95 has been brought to the emergency department by emergency medical services after being found wandering in the street. The older adult is filthy, confused, and exhibits numerous bruises to the face and neck as well as signs of malnutrition and dehydration. What problem should the nurses prioritize for assessment and intervention?

dehydration

Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which of the following problems is most likely to precipitate admission to long-term care?

dementia

a nurse is teaching an older adult about the concept of successful aging. which of the nurse's questions addresses an important contributor to successful aging?

do you feel like you are actively engaging with life?

a nurse plans interventions to promote wellness in older adults. Which of the following interventions is most appropriate to meet this goal?

facilitating early mobilization to prevent muscle wasting and loss of function in an older hospital client.

a nurse in a hospital setting assesses an older adult and is unsure if the assessment data warrant notification to the authorities for elder abuse. Which action is most appropriate for the nurse at this time?

follow the hospital protocol for reporting

A 55-year-old client was recently diagnosed with type 2 diabetes. The client completed a diabetes education class and does water aerobics three times a week. The blood sugar and hemoglobin A1c have improved since losing 20 lb. Which of the following statements best describes this client's actions?

functional consequences theory

an 81 year old has been living for the past 2 years in a long term care facility. However, financial pressures have required that the resident move in with the oldest child and spouse. Which of the following statements made by the child's spouse should signal a potential risk for elder abuse?

he's used to being waited on here, but at our place he is going to have to fend for himself.

a nurse verifies the health belief system of the Puerto Rican older adult client. Which of the following beliefs is this client most likely to hold?

health is a gift or reward given as a sign of God's blessing and goodwill.

a rural community nurse sets up a monthly disease screening service. Local news coverage chooses not to cover this event. Which of the following justifications best support the screenings?

health promotion is essential for older adults because they have complex health care needs

a hospital nurse is discussing with an older adult the possibility of transfer to a nursing home for skilled care after pneumonia. which statement by the client indicates an understanding of this possible transfer?

i have already used 45 Medicare days this year

a nurse addresses the eating habits of a 75 year old client who takes iron supplements for iron deficiency anemia. Which of the following statements by the client indicates a need for further teaching?

i prefer coffee to take my pills.

A nurse is explaining to a new colleague the similarities and differences between gerontology and geriatrics. Which of the following situations would most likely be addressed by a geriatrician rather than a gerontologist?

identifying and treating a client's vascular dementia

a home health nurse performs an admission assessment on a 90 year old who has a small dog. The client states that the most important problem is urinary incontinence. The client's blood pressure is 135/90 mm Hg, with last bowel movement 3 days ago. Which of the following areas addresses the person's goals/

incontinence

despite the fact that older adults are proportionately the highest users of health care services, many nurses harbor misconceptions and deficits in practice related to gerontological nursing. what is most likely the solution to this problem?

increased nursing education and clinical experience specific to working with older adults

a nurse speaks at a staff development in service. Which of the following statements by a nurse participant shoes the need for education?

it is inaccurate to link the prevalence of particular diseases with particular minority groups.

which of the following interventions most closely aligns with the practices of health promotion?

leading a flexibility and mobility class among older adults

A clinic nurse assesses a client who has limited English-speaking ability. The child interprets for the client. Which action by the nurse is most appropriate?

obtain a professional interpreter

a nurse initiates an acute care for elders unit in a medical facility. Which of the following factors should the nurse include when teaching the nursing staff about delivering medications to the older adults on the unit?

older adults face an increased risk of adverse medication effects.

A nurse assists an older adult who is homebound in a rural area. Which community resources might this client best benefit from?

personal emergency response system

an nurse plans discharge for an older woman from China who is living with her son. Which of the following should be included in the plan to indicate that the nurse understands cultural influences?

review the discharge plans with the client and her son

A nurse works with a program that performs interviews, blood work, and digital rectal examinations aimed at identifying older men with benign prostatic hyperplasia (BPH). The program also facilitates bathroom alterations in older adults' homes to ensure men with BPH have easy access to a toilet. Which of the following components of health promotion has yet to be implemented in the program?

risk reduction interventions

a nurse is responsible for assessing an older adult in an acute care setting. which of the following statements most accurately captures the complexity involved in assessing the older adult/

signs and symptoms of illness are often obscure and less predictable among older adults

a nurse in a community setting plans wellness outcomes with a 68 year old female client who desires to participate in a half marathon run. Which of the following outcomes should the nurse document?

the client will participate in the half marathon that is scheduled in 6 months

A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, "I feel quite well and do not wish to undergo another round of chemotherapy. " The client's children are adamantly opposed to their parent's decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action?

the client's autonomy

a neighbor notices an 81 yr old getting water from someones outside faucet. The neighbor notices that this persons ankles are very swollen and there is an open wound on her leg. The older adults says... which of the following interventions is priority when the nurse visits for an evaluation and does not find any danger?

the competency of the older adult in making decisions, to be determined

having completed a medication assessment and physical assessment of a new client, a home care nurse is now creating nursing diagnoses and choosing interventions appropriate to these diagnoses. What factor should the nurse prioritize in this process/

the importance of the patient's safety

Until recently, a 77-year-old client lived alone in her own home. The client fell and fractured an ankle and was placed in a long-term care facility for physical therapy. After the physical therapy was finished, the client tells the nurse, "I want to stay at the facility; I am happy living there and I like the social interaction." Which of the following theories of aging best describes the status of this client?

theory of thriving

Centers for Medicare and Medicaid Services (CMS), the Institute of Medicine, and the Joint Commission have developed standards to address areas of concern for older hospitalized adults. Which of the following situations is of particular concern for an older adult with a hospitalization requiring complex care?

transitions to care

a diabetes nurse is providing care for a 73 year old client who is a regular client of the hospital's out client diabetes clinic. What assessment question most clearly addresses this client's potential for optimal function?

what are some goals that you have for maximizing your level of wellness?

A nurse discusses the future with an older adult who has had surgery for a fractured hip and is also diagnoses as having depression. The client wavers between wanting to give up and going to rehabilitation. Which of the following questions should the nurse ask to assist the client toward values clarification?

what goals do you have for the next year?