Gerontology Exam
An 87-year-old patient is unsure of the purpose of a living will. The nurse describes its purpose best when stating: "It's a legal document that Social Services can help you create." "It designates a family member to make decisions if you become incompetent." "It provides a written description of your wishes in the event you become terminally ill." "It assures you won't be subjected to treatments you don't want."
"It provides a written description of your wishes in the event you become terminally ill."
An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patient's daughter questions the possibility of pneumonia stating, "He isn't coughing or having any difficulty breathing." The nurse responds most appropriately by saying: "We are lucky to determine the problem in its early stage." "Respiratory problems develop only after the infection is well established." "People your dad's age often lack the muscular strength to cough." "Older adults frequently lack the typical signs of a respiratory infection."
"Older adults frequently lack the typical signs of a respiratory infection."
A male patient complains about the digital rectal prostate exam and blood work for prostate-specific antigen (PSA) and asks, "How long am I expected to do this?" What response by the nurse is best? "Every year for the rest of your life." "Until you turn 75 years of age." "You can quit when you turn 80." "There are no guidelines on this."
"Until you turn 75 years of age."
A nurse who cares for older adults recognizes which of the following clinical features associated with dementia? (Select all that apply.) Failing to remember his or her room number Becoming increasingly disoriented at night Working on jigsaw puzzles for hours at a time Often referring to a cup as a canyon Misunderstanding when told "it's raining cats and dogs"
Failing to remember his or her room number Often referring to a cup as a canyon Misunderstanding when told "it's raining cats and dogs"
A nurse is working with a woman who has been reluctant to start a walking program for her osteoporosis. What assessment by the nurse is most important? Fear of falling Lack of time Lack of energy Pain with movement
Fear of falling
A patient has not followed up with recommendations made by the nurse to participate in cardiac rehabilitation after a myocardial infarction. What factors are most important for the nurse to assess in determining the cause of this behavior? (Select all that apply.) Out-of-pocket costs Transportation problems Beliefs about the benefits Location of the clinic Ethnicity of providers
Out-of-pocket costs Transportation problems Beliefs about the benefits Location of the clinic
To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first: asks whether the patient has any questions about the interview. makes sure the interview area is comfortable and private. explains the reason for asking the questions. assures the patient that all answers will be kept confidential.
explains the reason for asking the questions.
To establish a mutually respectful relationship with an older adult patient being admitted to a skilled nursing unit, the nurse first introduces himself and then asks: how the patient would like to be addressed. if the patient has any specific requests to make of the staff. the patient to share a little about his or her personal likes and dislikes. the patient to read the orientation materials that the facility provides.
how the patient would like to be addressed.
A 73-year-old patient has been diagnosed with congested heart failure (CHF). The nurse provides the greatest support for this patient's positive view of self-wellness by presenting information regarding: how to minimize the exacerbation of symptoms. locally available supportive services. the importance of adherence to medical treatment. the need to report symptoms promptly.
how to minimize the exacerbation of symptoms.
To best address the patient's right to self-determination, which of the follow questions does the nurse ask at the time the patient is admitted to a nursing facility? (Select all that apply.) "Do you understand what a living will and durable power of attorney are?" "If you have already prepared an advance care directive, can you provide it now?" "Are you prepared to discuss your end-of-life choices with the nursing staff?" "Have you discussed your end-of-life choices with your family or designated surrogate?" "Would you like help with preparing a living will or a durable power of attorney?"
"Do you understand what a living will and durable power of attorney are?" "If you have already prepared an advance care directive, can you provide it now?" "Have you discussed your end-of-life choices with your family or designated surrogate?" "Would you like help with preparing a living will or a durable power of attorney?"
When assessing the older adult for bowel health, the nurse is most effective in obtaining subjective data when asking: "Would you describe your bowel movements as usually normal?" "Do you have a problem with constipation?" "How often do you usually have a bowel movement?" "Have your bowel movements changed recently?"
"How often do you usually have a bowel movement?"
The nurse caring for an older patient who resides in an assisted living facility is asked to obtain and witness the patient's signature on a living will document. The nurse responds most appropriately when stating: "I will, because such a document is so valuable to the patient's plan of care." "I'll ask the patient's family if they agree that the patient should sign the document." "First I need to discuss the purpose of this document with the patient." "I'm sorry but I cannot ethically do that."
"I'm sorry but I cannot ethically do that."
The nurse is seeing a 68-year old woman for a physical exam in the family practice clinic. The woman complains about having another pelvic exam. What response by the nurse is best? "I know it's uncomfortable, but it's important to do it." "You are past the age where this exam is recommended." "Why don't you want to have your pelvic exam?" "This will be the last time you need this exam."
"You are past the age where this exam is recommended."
The nurse is assessing patients diagnosed with chronic disease processes for the probability of hospitalization because of the exacerbation of related symptoms. The nurse recognizes that the patient with the highest probability is a(n): 72-year-old male with congestive heart failure (CHF). 82-year-old male with type 2 diabetes. 72-year-old female with chronic bronchitis. 82-year-old female with osteoporosis.
72-year-old male with congestive heart failure (CHF).
The nurse wishes to participate in a community secondary prevention activity. Which activity does the nurse choose? Administering blood pressure screening at a mall Dispensing free flu vaccinations at a clinic Fitting impoverished older adults with glasses Teaching about the risks of sun exposure
Administering blood pressure screening at a mall
A nurse wishes to volunteer in a tertiary health care activity. What activity would the nurse choose? Teaching about safer sexual behaviors Greeting women at an emergency pregnancy clinic Assisting women who are having radiation therapy Finding home health safety resources
Assisting women who are having radiation therapy
You are caring for a 90 year old female newly admitted to skilled nursing with multiple chronic diseases. What is your role in promoting health and preventing disease? (Select all that apply) Be aware of the patient's basic needs Disregard the patients culture Be aware of the patient's economic needs Disregard public policies
Be aware of the patient's basic needs Be aware of the patient's economic needs
A home health care nurse is conducting a functional assessment on an older woman who lives alone. What assessment question is likely to get the best information? How do you manage all your medications? Who shops and cleans your house for you? Can you show me how you prepare a meal? What parts of your body can't you wash?
Can you show me how you prepare a meal?
You are conducting a skin assessment on a 89 year old male patient. Based on you knowledge regarding the normal aging process your patient skill will be; (Select all that apply.) Decrease elactisty Fragile Decrease subcutaneous fat Well moisturized
Decrease elactisty Fragile Decrease subcutaneous fat
The nurse using the SPICES model to assess older patients collects data on which topics? (Select all that apply.) Sleep disorders Problems with eating Incontinence Falls Social situations
Sleep disorders Problems with eating Incontinence Falls
A nurse planning primary disease prevention interventions for a 64-year-old patient includes which of the following? (Select all that apply.) Giving an influenza vaccination in early autumn of each year. Suggesting the patient attend "Cooking to Manage Hypertension" classes taught by a registered dietician. Giving a pneumococcal vaccination to celebrate the patient's 65th birthday. Identifying several local smoking cessation support groups. Providing the patient with a take-home occult stool screening kit.
Giving an influenza vaccination in early autumn of each year. Giving a pneumococcal vaccination to celebrate the patient's 65th birthday. Identifying several local smoking cessation support groups.
A graduate nurse learns about the provisions of the Health Insurance Portability and Accountability Act (HIPAA), which include which of the following? Requires employers to offer health care insurance Regulates the amount employers can charge for insurance Mandates that employers provide specific benefits Helps maintain coverage when a person changes jobs
Helps maintain coverage when a person changes jobs
You are a nurse caring for a patient in a long-term care facility. The patient concerned about how often he is up during the night to use the restroom. You will explain; (Select all that apply.) His bladder capacity has reduced Urine frequency is normal with older adults Urgency to urinate is normal with older adults Incontinence is a normal part of aging
His bladder capacity has reduced Urine frequency is normal with older adults Urgency to urinate is normal with older adults
An older adult resident of a long-term care nursing facility has a living well. As the nurse you understand that the living well: Must be signed by the patient's physician. Is the written expression of the patient's wishes regarding the use of medical treatments in the event of a terminal illness or condition. Must be witnessed and signed by a family member. Is required by law to be notarized.
Is the written expression of the patient's wishes regarding the use of medical treatments in the event of a terminal illness or condition.
The nurse understands what about the Americans with Disabilities Act? (Select all that apply.) It outlaws discrimination on the job because of disabilities. It requires state governments to fund disability services. It prohibits discrimination in government services to the disabled. It requires all buildings to be retrofitted to allow access. It provides funding for barrier-free buildings and parks.
It outlaws discrimination on the job because of disabilities. It prohibits discrimination in government services to the disabled.
The nursing student learns about the Patient Self-Determination Act. What is a key provision of this act? It establishes new rights for patients in medical facilities. It requires facilities to educate patients on their rights. It allows families to be approached for organ donation. It spells out the procedures for creating an advance directive.
It requires facilities to educate patients on their rights
The student learns the Medicare guidelines for preventive health and reimbursement policies. Which statement follows the guidelines? (Select all that apply.) Medicare pays for an annual pneumococcal vaccination. Medicare covers annual influenza vaccinations. Pap smears and pelvic exams are covered once every 2 years. Annual fecal occult blood tests are covered for those who are from 50 to 85 years of age. A bone density scan is covered every 2 years (a co-payment is required).
Medicare covers annual influenza vaccinations. Annual fecal occult blood tests are covered for those who are from 50 to 85 years of age. A bone density scan is covered every 2 years (a co-payment is required).
The adult child of a long-term care facility resident receives a phone call from the director of nursing stating that her parent has 30 days to move out of the home. Under what conditions can a facility require a resident to move? (Select all that apply.) Nonpayment for services received Needs exceeding what the facility can provide Stay is no longer required based on the resident's medical condition Facility is going out of business Frequent disruptive behavior during the night
Nonpayment for services received Needs exceeding what the facility can provide Stay is no longer required based on the resident's medical condition Facility is going out of business
The director of nursing at a long-term care facility is getting ready for the annual inspection. What information guides the director? Visits cannot be unannounced. The director must be off site during the inspection. Nurses must answer questions from the inspectors. Results will be shared only through the mail.
Nurses must answer questions from the inspectors.
Omnibus Budget Reconciliation Act thee major parts include: (select all that apply) Nursing services Physical therapy Survey and Certification process Enforcement and sanctions
Nursing services Survey and Certification process Enforcement and sanctions
An older patient has been admitted to the nursing unit after a car crash and surgery. When does the nurse begin planning for rehabilitation? On admission When the patient is awake When the patient is stable When the family requests it
On admission
The student learning about chronic disease and illness in the older population learns which facts about this situation? (Select all that apply.) One in two adults, or more than 133,000 Americans, has a chronic condition. Chronic disease is the leading cause of death in those over 65. About 75% of medical costs each year are spent on managing chronic disease. Formerly acute conditions are now manageable chronic diseases.. The focus of America's health care services is now on chronic illness
One in two adults, or more than 133,000 Americans, has a chronic condition. Chronic disease is the leading cause of death in those over 65. About 75% of medical costs each year are spent on managing chronic disease. Formerly acute conditions are now manageable chronic diseases..
As your patient adapts to aging and with chronic illness you understand they will have the following psychosocial needs: (Select all that apply) Pain and need for the nurse to help with pain management Fatigue and allow the older adult to rest conserving their energy Immobility which can lead additional functional loss Prevent sexual activity
Pain and need for the nurse to help with pain management Fatigue and allow the older adult to rest conserving their energy Immobility which can lead additional functional loss
Your are conducting a community education class for olders adults and are discussion end-of-life options. Of the following end-of- life documents which one requires a physician's signature? Advance Health Care Directive Living Will Durable Power of Attorney Physician Oders for Life Sustaining Treatment (POLST)
Physician Oders for Life Sustaining Treatment (POLST)
A nurse assesses a newly admitted patient to a nursing home using the Functional Independence Measure (FIM) and rates the patient at 20. What action by the nurse is best? Arrange admission to a rehabilitation center. Plan care for a nearly dependent person. Plan care for a nearly independent person. Tells the family the patient is cognitively impaired.
Plan care for a nearly dependent person.
Adherence to prescribed health care treatments by a patient with a chronic disease is best facilitated when the nurse does which of the following? (Select all that apply.) Provides the patient with information regarding his disease Assesses the patient's ability to understand his disease Defines "health and wellness" for the patient Helps the patient identify barriers to his personal wellness Coordinates support services to facilitate the patient's discharge
Provides the patient with information regarding his disease Assesses the patient's ability to understand his disease ';lkiuqHelps the patient identify barriers to his personal wellness Coordinates support services to facilitate the patient's discharge
You are teaching an older adult who has just recently been diagnosed with gastroesophageal reflux disease (GERD) how to manage the disease, you will include the following; (Select all that apply.) Sit upright for 60 minutes after eating Take medication as prescribed If possible avoid ascorbic acid Elderly people usually do not suffer from GERD
Sit upright for 60 minutes after eating Take medication as prescribed If possible avoid ascorbic acid
What provisions for nursing service are part of the Omnibus Budget Reconciliation Act (OBRA) as it pertains to long-term care facilities? (Select all that apply.) Resident assessments Annual screenings Minimum staffing Ensuring resident rights Registered nurse educational requirements
Resident assessments Annual screenings Minimum staffing Ensuring resident rights
The staff members in a long-term care facility have noted a decline in cognitive function in one of the residents; however, each time the resident is given the Short Portable Mental Status Questionnaire (SPMSQ), the score does not change. What action by the nursing manager is best? Provide in-service education on using this tool. Conduct the assessment him- or herself Switch to a different screening tool Determine that no changes have occurred.
Switch to a different screening tool
A nurse routinely assesses patients for alcohol use. What principle guides this assessment? The older adult must balance risks to benefits of use. Alcohol causes older adults to fall and should not be consumed. There are no data on risks or benefits after the age of 75. Alcohol-related diseases are more severe in older people.
The older adult must balance risks to benefits of use.
During the state inspection of a skilled nursing facility, a surveyor notes suspicion that a particular nurse may not be providing the proper standard of care. The nurse manager informs the nurse to expect: a review of the situation by the state board of nursing. termination of employment from the facility. mandatory remediation related to the suspect care issues. unannounced reevaluation of performance within the next 3 months.
a review of the situation by the state board of nursing.
The primary focus of the health belief model of health promotion is addressed when the nurse: accompanies the assisted living residents on a walk before dinner. asks a senior citizens' group what health screening they want to have. plans a program on cooking diabetic-friendly meals in cooperation with a dietician. asks the patient if he believes smoking puts him at risk for lung cancer.
asks the patient if he believes smoking puts him at risk for lung cancer.
An alert but disoriented older patient lives with family members. The home health nurse, being aware of the role of patient advocate, recognizes the obligation to report possible patient abuse based on: a family member stating, "It's hard being a caregiver." assessment showing bruises in the genital area. observation of mild changes in orientation. patient's report of always being hungry.
assessment showing bruises in the genital area.
A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on the: physician's medical orders. stated requests of the individual patient. care that a responsible geriatric nurse would provide. implementation of the nursing process.
care that a responsible geriatric nurse would provide.
The nurse impacts the trajectory of a patient's type 2 insulin-dependent diabetes best by: evaluating the patient's ability to administer insulin appropriately. providing the patient with a written copy of the treatment plan. explaining to the patient the importance of serum glucose control. providing the patient with research-based nursing care.
evaluating the patient's ability to administer insulin appropriately.
The nurse most effectively implements guided reminiscence during a patient interview by: reminding the patient to share important memories of the past. scheduling several short interviews rather than one long one. controlling the interview by selecting the memories to be discussed. encouraging the patient to relive his or her memories while maintaining focus.
encouraging the patient to relive his or her memories while maintaining focus.
To engage the older adults who frequently attend a senior citizens' center in primary disease prevention, the nurse: immunizes those attending a weekly luncheon against the H1N1 virus. arranges for a colorectal cancer screening at the center. schedules a speaker to discuss cooking for diabetic patients. surveys the members to identify health issues of interest to them.
immunizes those attending a weekly luncheon against the H1N1 virus.
A patient residing in a long-term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients' rooms during the night. The nurse views the patient's PRN antipsychotic medication order as: an appropriate intervention to help assure his safety. an option to be used only when all other nondrug interventions prove ineffective. inappropriate unless the physician is notified and approves its use. not an option because it should not be used to manage behaviors of this type.
not an option because it should not be used to manage behaviors of this type.
The nurse has administered the Apgar screen tool to assess an older patient's family function status. Upon determining that the family functions at a 4, the nurse: prepares to administer a more detailed tool. prepares to report reasonable suspicion of elder abuse. asks the patient to identify specific family members to include in care planning sessions. notifies social services that the family is not likely to be of much support to the patient.
notifies social services that the family is not likely to be of much support to the patient.
A nurse caring for older adult patients shows an understanding of the implementation of standards of care when: dialing the telephone when the patient wants to call his daughter. requesting the patient's favorite dessert on his birthday. closing the patient's door when he is praying. reminding the patient to call for assistance before getting out of bed.
reminding the patient to call for assistance before getting out of bed.