Gerontology Tabloski 1, 2, 3, 5, 8, 12

The nurse is administering medications to an elderly African-American patient when the patient states, "My people might not react to this medication as well as other races." Which principle should guide the nurse's reaction to the patient? 1. Different races may react to medications differently. 2. The patient's physician ordered it, so it is safe to administer. 3. Medications will impact all races the same way. 4. The patient is elderly and must be confused.

1. Different races may react to medications differently. Correct Rationale: There are a number of medications that will react differently in different races. All of the other statements guiding practice could result in unsafe practice.

REM (Rapid Eye Movement) sleep in the elderly is which of the following? Choose all that apply. 1. Associated with the greatest amount of dreaming. 2. Accompanied by slowing of the heart rate. 3. Characterized by brief muscle contractions. 4. Necessary for daytime concentration and memory consolidation.

1. Associated with the greatest amount of dreaming. 3. Characterized by brief muscle contractions. 4. Necessary for daytime concentration and memory consolidationRationale: REM sleep is characterized by an increase in heart rate and blood pressure, intense brain activity, and small, brief muscle contractions. It is sometimes referred to as "dream sleep" and is thought necessary for mental and cognitive health.

In planning for the increased number and needs of the elderly in developed countries, nurses should realize which of the following? Choose all that apply. 1. Chronicity and disability will continue to increase. 2. Women outlive and outnumber men. 3. Most older people prefer to move out of their homes and into an extended care facility. 4. Older people, in general, are a major drain on societal resources.

1, 2 Rationale: Chronicity and disability will continue to increase along with the aging of the population, especially the 85+ age group and women who have a higher life expectancy than men. Older people prefer to live independently and in their own homes and they continue to contribute to society in a variety of formal and informal ways.

The absorption of iron in the elderly may be diminished in the presence of: 1. Antacids. 2. Diuretics. 3. Vitamin C. 4. Milk.

1. Antacids. Correct Rationale: Anything that interferes with the production of hydrochloric acid interferes with the absorption of iron and should be avoided when trying to promote iron absorption. Diuretics, vitamin C, and milk do not affect iron absorption.

A nurse is planning programs for a senior center that would meet the goals of Healthy People 2020. Which program would address any of these goals? Choose all that apply. 1. Education for safe driving 2. Testing for genetic diseases 3. Diabetes self-management 4. Developing greater spirituality

1. Education for safe driving 3. Diabetes self-management Rationale: A course on safe driving would meet the Injury and Violence Prevention focus, and self-management of a common chronic disease is, also, a focus area. Testing for genetic diseases is not a focus area of health promotion for an older population, and while spirituality is an important dimension related to overall well-being, it is not a specific national health objective of Healthy People 2020.

A nurse is planning to conduct a health promotion program for senior citizens living at a local assisted living facility. When planning the program, which of the facts should be incorporated into the session? 1. Flu vaccines are recommended annually for senior citizens clients. 2. Flu vaccines should only be taken for immunocompromised older adults. 3. The use of flu vaccines in senior citizens meets the recommended levels. 4. Clients who take a flu vaccine will not need to have the pneumococcal vaccine.

1. Flu vaccines are recommended annually for senior citizens clients. Rationale: The flu will claim more than 40,000 lives of people 65 years and older. Studies illustrate that only 32% of Americans age 65 or older have not had a recent flu vaccine and 37% of them have never received a pneumonia vaccine. By virtue of their age, older adults are considered prime candidates for the flu vaccine. Clients are routinely given both types of vaccines.

One of the most important aspects of health care for the elderly is: 1. Focusing on chronic illness and disability. 2. Ensuring adequate housing. 3. Maintaining family ties. 4. Securing adequate income.

1. Focusing on chronic illness and disability. Correct Rationale: This is a goal from Healthy People 2010. Adequate housing, family ties, and income are desirable, but are not within the direct control of nursing or health care agencies.

What is the advanced practice registered nurse (APRN) who is board certified in gerontology most likely to be able to do? 1. Function as a case manager 2. Be employed as a nurse practitioner 3. Develop and test theories of aging 4. Serve as an administrator of a nursing home

1. Function as a case manager Correct Rationale: Not all APRNs are involved in administration or research and not all of them are nurse practitioners.

Risk factors for vitamin B12 deficiency include which of the following? Select all that apply. 1. History of gastric bypass surgery 2. Use of antacids or acid-lowering surgery 3. Folic acid supplementation 4. History of depression

1. History of gastric bypass surgery 4. History of depression Rationale: B12 is absorbed in the ileum bound to intrinsic factor made in the stomach. Gastric bypass and diminished stomach acidity can reduce the absorption of B12. Folic acid supplementation can reverse macrocytic anemia, which often is used as a diagnostic indicator of B12 deficiency. Depression can be a result of B12 deficiency. Cognition level: Knowledge

An elderly client has been prescribed a loop diuretic to aid in the management of hypertension. The nurse is aware that this may cause a sleep disturbance due to: 1. Nocturia. 2. Decreased REM sleep. 3. Nightmares. 4. Sleep walking.

1. Nocturia. Rationale: Diuretics may cause nocturia if taken any time other than morning. Nocturia causes the elderly to awaken and get out of bed, thereby diminishing quality sleep. Diuretics do not cause decreased REM sleep, nightmares, or sleepwalking.

Mr. Jones, a 90-year-old resident in a local nursing care facility is concerned about his dry skin. He asks the nurse what he can do to help with his dry skin. The nurse would instruct him to do which of the following? Select all that apply. 1. Provide a humidified environment. 2. Use Dial soap to bathe daily. 3. Wear wool sweater to keep warm. 4. Apply emollients daily. 5. Use bath oil when bathing

1. Provide a humidified environment. 4. Apply emollients daily. Rationale: Providing a humidified environment and using daily emollients help keep the skin moist. Using Dial soap to bathe daily, wearing a wool sweater to keep warm, and using bath oil are incorrect because Dial is harsh and drying to older skin, wool is irritating, and bath oil can make the bathtub slippery and cause the older person to fall.

When an elderly person is hospitalized with pneumonia, what would be the best action by the nurse to encourage eating? 1. Provide small, more frequent meals. 2. Secure an order for a daily multivitamin to stimulate appetite. 3. Provide a high calorie snack of the client's choice. 4. Make sure the client is adequately hydrated.

1. Provide small, more frequent meals. Correct Rationale: An elderly person is more likely to eat if portions are small, more frequent, and nutrient dense as opposed to a full meal tray three times a day. A vitamin will not stimulate appetite. Snacks are not necessary if small frequent meals are provided. Hydration is always important but fluids do not provide the nutrients needed for healing.

Joe, a 75-year-old man, states that he has arterial insufficiency. Education for arterial insufficiency would include which of the following? Select all that apply. 1. Range of motion exercises 2. Sit with legs crossed 3. Wear compression socks 4. Inspect skin daily 5. Lower cholesterol

1. Range of motion exercises 4. Inspect skin daily 5. Lower cholesterol Rationale: Range of motion exercises promote circulation, inspecting the skin daily can promote healthy skin, and lower cholesterol will help prevent arterial insufficiency. Wearing compression socks is good for venous insufficiency, and crossing legs leads to decreased circulation to the extremities.

An 80-year-old client has osteoarthritis and is chairfast. Presently the client has no evidence of skin breakdown. Which of the following nursing diagnoses should the nurse assign to this client? Select all that apply. 1. Risk for impaired tissue integrity related to decreased circulation 2. Ineffective tissue perfusion related to painful joints 3. Activity intolerance related to age 4. Risk for impaired skin integrity related to physical immobility

1. Risk for impaired tissue integrity related to decreased circulation 4. Risk for impaired skin integrity related to physical immobility

Which medication is least likely to be recommended as a sleep aid for an elderly person? 1. Zolpidem (Ambien) 2. Diphenhydramine (Benadryl) 3. Zaleplon (Sonata) 4. Sustained-release melatonin

2. Diphenhydramine (Benadryl) Rationale: Antihistamines such as Benadryl should not be used because of their anticholinergic side effects. Ambien and Sonata can be used safely in low doses and for short periods of time. Melatonin, also, is considered safe for short periods of time, but is recommended in a sustained-release formula for maintaining sleep throughout the night.

When doing a postoperative assessment on an 82-year-old, the nurse identifies an irregular heart beat. This is an example of which key health promotion strategy for older adults? 1. Secondary prevention to slow progression and prevent or limit disability 2. Primary prevention of injury or disease 3. Tertiary prevention to improve function and independence 4. Teaching self-management techniques to reduce the cost of chronic disease

1. Secondary prevention to slow progression and prevent or limit disability Correct Rationale: Detecting an abnormality in its early stages may reduce the potential for disease progression, complications, and disability. Primary prevention must occur before a disease begins. The focus of tertiary prevention is on improving functional capacity after the disease process has occurred. Teaching self-management is desirable, but is not the key focus of secondary prevention.

The nurse is reviewing the laboratory values for a hospitalized 88 year old female patient admitted for treatment of a Stage III pressure ulcer. Which value will decrease the ability of the patient's wound to heal? 1. Serum albumin level of 2.0 g/dl 2. Serum transferring level of 250 mg/dl 3. Hemoglobin 14 mg/dl 4. White blood cell count 8,000

1. Serum albumin level of 2.0 g/dl Correct Rationale: Albumin levels provide an assessment of nutritional status. Protein levels below 2.5 g/dl are indicative of a serious depletion of protein. Inadequate protein will hinder wound healing. The remaining laboratory levels are within normal limits.

Which of the following factors affect skin tolerance and enhance the occurrence of pressure ulcers? Select all that apply. 1. Shearing 2. Increased body weight 3. Decreased serum albumin 4. Dramatic loss of collagen

1. Shearing 2. Increased body weight 4. Dramatic loss of collagen Rationale: Shearing, or the sliding of parallel surfaces against each other occurs most commonly when the client slides down in the bed. Increased body weight and dramatic loss of collagen could also increase the risk of pressure ulcers. An increased serum albumin would not create a skin problem, but a decreased serum albumin would indicate a low level of protein stores and increased risk for impaired skin integrity.

A recently hired nurse in a skilled nursing facility has been reviewing the ANA Standards of Clinical Gerontological Nursing Care. The preceptor asks the newly hired nurse about her understanding of the standards. Which statements by the newly hired nurse indicate the need for further education about the standards? Select all that apply. 1. The elderly client has the charge of identifying desired outcomes. 2. The nurse has the responsibility of developing the plan of care. 3. The gerontological nurse may collaborate with other healthcare providers to develop the plan of care. 4. The plan of care is used to guide the interventions for the geriatric client. 5. The gerontological nurse has advocacy responsibilities for the client only, not the family.

1. The elderly client has the charge of identifying desired outcomes. 5. The gerontological nurse has advocacy responsibilities for the client only, not the family. Rationale: The ANA Standards of Clinical Gerontological Nursing Care are outlined in Box 2-1. The desired outcomes should be established by the interdisciplinary team together with the client. The gerontological nurse has advocacy responsibilities for the client and family. The other statements are correct and would not require further education.

Which of the following may be barriers to sleep in the hospital? Choose all that apply. 1. Too hot or too cold 2. Frequent awakenings by nurses for care and monitoring 3. Sleeping partner or comfort items are missing 4. Excessive noise and bright lights

1. Too hot or too cold 2. Frequent awakenings by nurses for care and monitoring 3. Sleeping partner or comfort items are missing 4. Excessive noise and bright lights Rationale: Inadequate sleep is common in acute care and is a significant detriment to healing and recovery. There are many unfamiliar challenges to sleep (e.g. noise, lights, uncomfortable temperature and bed). Familiar sleep routines are not present, and nurses who do not pay careful attention to clustering care during the night and ensuring adequate sleep contribute to the problem

Services covered during the one-time "Welcome to Medicare" preventative physical exam include which of the following? Choose all that apply. 1. Vision screening 2. Electrocardiogram (EKG) 3. Routine immunizations (as needed) 4. Health promotion education and counseling

1. Vision screening 2. Electrocardiogram (EKG) 3. Routine immunizations (as needed) 4. Health promotion education and counseling Rationale: All of these services are covered in the exam if given within the first 12 months that an older person is enrolled in Part B of Medicare.

The Minimum Data Set (MDS) is: 1. a tool for assessment of clinical problems. 2. a multidimensional view of the patient's functional capacities and is linked to quality. 3. information that the provider can use to determine the patient's nutritional needs. 4. something the physician uses to determine what medications the patient needs.

1. a tool for assessment of clinical problems. Correct Rationale: The MDS is used for validating the need for long-term care, reimbursement, ongoing assessment of clinical problems, and assessment of and need to alter the current plan of care.

Allowing an elderly client who is hospitalized for the management of an electrolyte imbalance and surgical repair of a fractured hip to take medication with a morning glass of juice is an example of: 1. an appropriate nursing intervention. 2. providing culturally acceptable care. 3. nursing practice that is not evidence based. 4. appropriate case management.

1. an appropriate nursing intervention. Correct Rationale: This is an appropriate nursing intervention. The intervention is not based on culturally sensitive care or case management. There is not enough information in the stem to know whether it is evidence based or not

The nurse is preparing to document an unwitnessed fall of an elderly client. The nurse should include all of the following except: 1. how the client fell. 2. what the client said. 3. time of occurrence. 4. outcome of the fall.

1. how the client fell. Correct Rationale: In documenting a fall, the documentation should include the time of day, the outcome of the fall, what the client stated, whether mechanical devices were involved, whether the patient was at risk for fall, and what fall reduction measures were in place. How the patient fell could only be speculated if it was unwitnessed, and that would not belong in the medical record

When obtaining a social history from an elderly patient, the nurse should ask about: 1. living arrangements and family dynamics. 2. problems with memory, judgment, and thought. 3. acute and chronic medical problems. 4. problems with hearing, vision, and speech.

1. living arrangements and family dynamics. Correct Rationale: All of the listed components are important to the patient's history; however, only living arrangements and family dynamics are part of the social history.

The gerontological nurse is admitting a client to a skilled nursing facility. In what order should the nurse perform the interventions? 1. Prioritize problems 2. Complete the client assessment 3. Choose appropriate client desired outcomes 4. Use objective and subjective data to choose appropriate nursing diagnoses 5. Evaluate interventions 6. Implement the plan of care.

2, 4, 1, 3, 6, 5 2 Assess, 4 diagnose, 1 prioritize, 3 outcomes, 6 implement, 5 evaluate Rationale: The order for the nursing process is completing the assessment, choosing the appropriate nursing diagnoses, prioritizing the problems, choosing outcomes, implementing the plan of care, and evaluating the interventions for whether they were effective or not.

The nurse is completing a home assessment of an elderly patient's home due to some cognitive deficiencies. In talking to the patient and family, the nurse is trying to ascertain whether there are adequate resources for the patient to maintain his nutritional needs. Which response by the patient or family should be further investigated? 1. "Dad knows he can call me any time and I will be able to bring him food or take him shopping." 2. "Mom knows how to cook and she really likes to cook, especially on the grill." 3. "We have someone staying with Dad during the day to make sure he eats his meals." 4. "We have taken the knobs off of the stove so Mom can't use it when we are not here."

2. "Mom knows how to cook and she really likes to cook, especially on the grill." Correct Rationale: The nurse should be concerned with the safety of an elderly patient with cognitive deficiencies who is cooking—especially on a grill. Therefore, this would require more questioning. With just this statement, the safety of the patient cannot be determined. The other answers would all be appropriate for assisting the patient in meeting his or her nutritional needs.

A patient discusses with the nurse her fears of having sleep apnea. Which of the following statements made by the patient is suggestive of sleep apnea? Choose all that apply. 1. "My legs jump and feel tingly off and on during the night." 2. "My husband says I've been waking him up with my snoring." 3. "I just seem to be falling asleep too often during the daytime." 4. "I have to sleep on at least three pillows every night."

2. "My husband says I've been waking him up with my snoring." 3. "I just seem to be falling asleep too often during the daytime." Rationale: Sleep apnea is characterized by heavy snoring and delays in breathing, which are often followed by a snort when breathing begins again. Sleep quality is diminished, which often results in excessive daytime sleepiness and difficulty with concentration. Restless leg syndrome often awakens the person with numbness, tingling, and burning of the extremities. The need to sit upright in bed is often seen with heart failure and obstructive respiratory disorders.

Based on the laboratory value sets, which of the following clients should the nurse determine is at greatest risk for pressure ulcer formation and requires immediate nutritional intervention? 1. An 80-year-old client with a serum pre-albumin level of 15 mg/dL and a serum transferrin level of 220 mg/dl 2. A 75-year-old client with a serum pre-albumin level of 5mg/dL and a serum albumin level of 1.0 g/dl 3. A 70-year-old client with a serum transferrin level above 200 mg/dl and a serum albumin level of 4.5 g/dl 4. 78-year-old client with a serum pre-albumin level of 14 mg/dL and a total lymphocyte count of 1,700 mm3

2. A 75-year-old client with a serum pre-albumin level of 5mg/dL and a serum albumin level of 1.0 g/dl Correct Rationale: Serum albumin, pre-albumin, transferrin, and lymphocyte count are useful values that will help to determine nutritional status. Serum albumin levels below 3.5 g/dl, pre-albumin levels less than 15mg/dL, and transferrin levels below 200 mg/dl are indicative of protein deficiency, which increases risk for pressure ulcer formation. A lymphocyte count below 1,500 mm3 indicates loss of energy to skin due to protein deficiencies.

What type of diet will the nurse recommend to most healthy elderly clients? 1. A balanced 1,100-calories per day diet 2. A diet high in complex carbohydrates and fiber 3. A diet low in fat and protein 4. A diet low in fat with a moderate amount of carbohydrates

2. A diet high in complex carbohydrates and fiber Correct Rationale: Complex carbohydrates and fiber provide some protein in addition to necessary vitamins and minerals. They aid digestion and have a lower glycemic load. For an active, healthy elderly person 1,200 calories per day will not be adequate to prevent weight loss. Inadequate protein does not allow for tissue maintenance and repair. High carbohydrate diets do not provide adequate balance to caloric distribution.

Continuous positive airway pressure (CPAP) is which of the following? Choose all that apply. 1. An invasive method used to keep the airway partially open 2. A noninvasive treatment administered through a nasal mask 3. Involves use of an oral airway 4. 100% effective, if used correctly

2. A noninvasive treatment administered through a nasal mask 4. 100% effective, if used correctly Rationale: CPAP is the most common treatment for sleep apnea. The 5-20cm of air delivered under pressure through a mask has been found to be 100% effective in keeping the airway open, if the face mask fits correctly and it is used regularly.

The elderly client who wants to take an herbal supplement for arthritis symptoms should be advised to: 1. Read labels very carefully prior to making a selection because the supplements are usually quite expensive. 2. Consult his or her healthcare provider about possible interactions with current medications. 3. Verify the supplement's effectiveness with friends or family members who have taken it. 4. Reconsider the idea because the supplement may have serious side effects.

2. Consult his or her healthcare provider about possible interactions with current medications. Correct Rationale: Herbal supplements may be of unknown quality and may also interact with medications. Serious side effects are more likely when used with some prescription medications. Family or friends are not the best source of health information.

To be considered capable of providing consent, the elderly patient should have the ability to do which of the following? Select all that apply. 1. Read the consent form 2. Contemplate options 3. Comprehend information 4. Problem solve

2. Contemplate options 3. Comprehend information 4. Problem solve Rationale: To be considered capable of providing consent, the elderly patient should be able to comprehend information (understand), contemplate options (reason), evaluate risks and consequences (problem solve), and communicate that decision (make their decision known).

Typical sleep pattern changes that occur with aging include: 1. Late morning awakening. 2. Diminished time in deep sleep. 3. Longer daytime naps. 4. Decreased sleep latency.

2. Diminished time in deep sleep. Rationale: A normal part of aging is a decreased amount of time at deeper levels of sleep. Diminished deep sleep can lead to increased daytime sleepiness, which causes the elderly to take naps. The elderly frequently awaken early in the morning and have increased sleep latency

An elderly client reports that she no longer likes to attend social functions and has expressed concern over changes in her skin and hair. The nurse assigns which of the following priority nursing diagnoses to this client? 1. Ineffective role performance 2. Disturbed body image 3. Ineffective coping 4. Ineffective denial

2. Disturbed body image Correct Rationale: Changes in the skin (wrinkling) and hair (graying) are part of aging that may lead to changes in sense of self as well as how the person is perceived by others. The nurse should place the highest focus on the client's imposed self-isolation due to her concerns over changes in body image.

An elderly client is being assessed because of a rough, scaly, erythematous papule on the body. Important teaching for this client would include that this is most likely a(an): 1. Acrochordons. 2. Erythematous actinic keratotic lesion. 3. Seborrheic keratoses. 4. Senile lentigines.

2. Erythematous actinic keratotic lesion. Correct Rationale: Erythematous actinic keratotic lesions are the most common type of precancerous lesions. They appear as a painful, rough, scaly, erythematous papule or plaque. The arochordon, seborrheic keratoses, and senile lentigines do not become malignant.

When working with the elderly, the nurse recognizes that the elderly frequently have problems with sleep. Most notably they: 1. Fall asleep more rapidly than any group except young children. 2. Have a significant decline in stage 4 sleep. 3. Require less sleep than middle-aged adults. 4. Find it difficult to become fully alert after sleeping at night.

2. Have a significant decline in stage 4 sleep. Rationale: Stage 4 sleep is characterized by large, slow patterns of brain activity. In the elderly, who awaken frequently, this high-quality sleep is diminished. Many elderly have problems with insomnia. They require the same amount of sleep as all adults and find it no more difficult to become fully alert on awakening than other adults

One of the challenges in meeting the nutritional needs of the elderly is that the elderly: 1. Have decreased need for almost all nutrients. 2. Have decreased caloric needs but constant or increased needs for vitamins and minerals. 3. Often have significant problems with dentition that affect their ability to masticate most food. 4. Lose interest in eating a balanced diet.

2. Have decreased caloric needs but constant or increased needs for vitamins and minerals. Correct Rationale: A decreasing metabolic rate (or resting energy expenditure) means fewer calories are required, but the DRI for most nutrients remains unchanged or may be increased in the elderly thus necessitating careful dietary planning to meet those needs. Loss of interest in food may mean physiologic problems exist. Dental problems for the elderly are not nearly as common today as they were a generation ago

Mrs. Smith, an 86-year-old resident in an assisted living facility, approaches the nurse and asks about changes in her skin. Which of the following changes in skin is not normal in an older person? 1. Thinner and more fragile 2. Increased redness five days after a wound 3. Greater numbers of freckles 4. Loss of leg hair

2. Increased redness five days after a wound Rationale: Increasing redness more than three days after a wound is not a normal finding and could be the beginning of an infection. Thinner and more fragile skin, greater numbers of freckles, and loss of leg hair are normal and expected.

How does the Scope and Standards of Gerontological Nursing Practice (ANA, 2010) guide professional nursing practice? 1. It contains the legal standards for gerontological nursing practice. 2. It defines expectations and guides gerontological nursing practice. 3. It is used to assess nurses' performances when caring for the elderly. 4. It is based on the provisions of the Nurse Practice Act.

2. It defines expectations and guides gerontological nursing practice. Correct Rationale: The Scope and Standards of Gerontological Nursing Practice were established to guide practice and go beyond just defining the legal scope of practice. It is not intended to be used to assess a nurse's performance and was not based on the Nurse Practice Act.

Good dietary sources of vitamin D include which of the following? Select all that apply: 1. Cheeses and yogurt 2. Liver 3. Fortified milk 4. Fish and oils

2. Liver 3. Fortified milk 4. Fish and oils Correct Rationale: While good sources of calcium, cheese and yogurt are not mandated to be fortified with vitamin D. It would take approximately 6 cups of milk per day to meet the daily recommendations for vitamin D (note: The prevalence of lactose intolerance increases in the elderly). Intake of vitamin D is insufficient for many elderly, who will need supplementation to meet minimum requirements of 800 IU if over age 70.

An 84-year-old client's skin is assessed to be wrinkled, thin, and dry. These findings should be interpreted as related to: 1. An increase in elastin and decrease in subcutaneous fat. 2. Loss of elastin and a decrease in subcutaneous fat. 3. Increased numbers of sweat and sebaceous glands. 4. Increased vascularity of the skin.

2. Loss of elastin and a decrease in subcutaneous fat. Correct Rationale: Several factors cause wrinkled, thin, and dry skin. These include gradual loss of elastin and decreased subcutaneous fat, decreased number of epithelial cells providing a barrier causing insensible loss of body fluids from the deeper layers of the skin, a lifetime of environmental trauma to the skin, increasing sedentary lifestyle, and a decrease in mobility.

Mr. West, an 87-year-old man, has been complaining of pain in his right leg. He states he has been unable to get out of bed for several days because the pain is so bad. He is at risk for skin breakdown. Which of the following areas are most at risk for breakdown? Select all that apply. 1. Upper back 2. Sacral area 3. Ears 4. Nose 5. Left lateral leg 6. Great toe

2. Sacral area 3. Ears 5. Left lateral leg 6. Great toe Rationale: Sacral area, ears, left lateral leg, and great toe are areas over bony prominences that could be easily broken down when pressure is applied. The nose and upper back are not as much at risk for pressure.

Mrs. White, an 82-year-old woman, comes to the local clinic complaining of waxy, raised, flesh-colored and brownish areas on her head and trunk. The nurse knows that which of the following best describes this normal aging skin condition? 1. Herpes zoster 2. Seborrheic keratoses 3. Rosacea 4. Psoriasis

2. Seborrheic keratoses Correct Rationale: Seborrheic keratoses are waxy, raised, flesh-colored and brownish areas on the head and trunk. Incorrect: herpes zoster is blisters on skin that follow a nerve ending; psoriasis is a red, raised, and very dry rash; and rosacea is a fine, red rash.

The nurse is assigned to provide care for an elderly client hospitalized for regulation of blood pressure. During the hospitalization, the nurse notices the client is awake often during the night. When questioned, the client reports "I thought I would need more sleep as I got older but I can't sleep more than 3 hours at night." When questioned further, the client reports falling to sleep immediately after getting into bed but waking up repeatedly thereafter. Which of the following statements does the nurse recognize as most correct? 1. Since the client is falling asleep quickly he likely has no significant issues related to sleep. 2. The client is likely demonstrating a manifestation of sleep deprivation. 3. The client has no health implications as a result of his reduced amount of sleep hours. 4. The client is getting adequate sleep each night.

2. The client is likely demonstrating a manifestation of sleep deprivation. Correct Rationale: Individuals who fall asleep immediately upon retiring are often sleep-deprived. Older adults typically need between 6 and 10 hours of sleep each night. Obtaining fewer than 4 hours per night is associated with an increase in mortality rates.

A nurse has been hired to plan for the educational needs of the residents in an assisted living community. When considering factors related to disability and chronic illness, which of the following factors may the nurse use to guide their decisions? Select all that apply. 1. The rates of disability are greater today than in the past. 2. The majority of senior citizens have at least one chronic health condition. 3. Weight reduction is needed for more than half of senior citizens. 4. Programming related to arthritis and respiratory disorders will be useful.

2. The majority of senior citizens have at least one chronic health condition. 4. Programming related to arthritis and respiratory disorders will be useful. Rationale: The rate of disability has dropped in recent years. Approximately 80% of senior citizens have a chronic health condition. Obesity is a concern for 33% of men and 39% of women. Arthritis and respiratory disorders represent common causes of disability for senior citizens.

A baccalaureate prepared nursing student is reviewing career options available after graduation. The student has a longstanding interest in the care of older adults. The nurse is interested in pursuing opportunities related to practitioner roles. Which statements regarding this potential career option are correct? Select all that apply. 1. A baccalaureate prepared nurse may become a gerontological nurse practitioner after working at least two years in an applicable setting. 2. The master's degree is the minimum educational preparation required of a geriatric nurse practitioner. 3. The doctoral degree is the minimum educational preparation required to become a geriatric nurse practitioner. 4. Some advanced practice nurses may have prescriptive authority. 5. Certification in gerontological nursing is the same as geriatric nurse practitioner.

2. The master's degree is the minimum educational preparation required of a geriatric nurse practitioner. 4. Some advanced practice nurses may have prescriptive authority. Rationale: A nurse practitioner is at least master's prepared, and will soon require doctoral preparation. In some states nurse practitioners have prescriptive authority. Being certified is different than being licensed as a nurse practitioner.

The nurse is reviewing the nutritional intake of a recently admitted nursing home 68-year-old resident. The nurse notes the client's records indicate a recent history of weight between 135 and 138 pounds. The admission weight of the resident is 122 pounds. The resident often leaves about 10-15% of the meal uneaten. The resident has a history of bipolar disorder successfully managed by medications. The resident demonstrates moderate involvement in unit social activities. When evaluating these findings which of the following statements is most correct? 1. The resident demonstrates malnutrition. 2. The resident does not demonstrate malnutrition. 3. The resident is at high risk for the development of malnutrition. 4. The resident is currently at moderate risk for malnutrition.

2. The resident does not demonstrate malnutrition. Rationale: A weight loss of 13 to 16 pounds is reflective of a loss of approximately 10%. The weight loss combined with the dietary intake does not meet the criteria of malnutrition. The resident's mental health history do increase the risk of malnutrition but this risk is somewhat negated by the remission of the condition. A weight loss of 25% accompanied by not eating 25% or more of the provided meals is a strong indicator of malnutrition.

Which action by a colleague should the nurse recognize as a breach of confidentiality? 1. Reporting a patient's change of condition to the oncoming shift at change of shift report 2. Throwing unofficial laboratory results and radiology results into the trash can 3. Faxing a patient summary to the nursing home with a coversheet in place 4. Using the telephone to confer a change to status to a physician

2. Throwing unofficial laboratory results and radiology results into the trash can Correct Rationale: The only breach of confidentiality is throwing the results into the trash can. Those results would be protected information and would need to be placed in a confidential shred bin or shredded immediately. All of the remaining answers would be necessary in the normal care of a patient and would not be considered breaches in confidentiality

The nurse is completing a nutritional assessment and asking about her elderly patient's use of vitamins. Which of the following vitamins being taken must be carefully evaluated for risk of toxicity? Select all that apply. 1. Vitamin 12 2. Vitamin A 3. Vitamin D 4. Vitamin E

2. Vitamin A 3. Vitamin D 4. Vitamin E Rationale: Fat-soluble vitamins such as A, D, and E could lead to toxicity. Water-soluble vitamins such as all B vitamins and vitamin C have a low risk of toxicity.

Which nutrient is most likely to be deficient in elderly residents of nursing homes? 1. Phosphorus 2. Vitamin D 3. Protein 4. Vitamin B

2. Vitamin D Rationale: The elderly have greater need for vitamin D due to decreased absorption, decreased dietary intake, and lack of exposure to sunlight. Phosphorus, protein, and vitamin B are more readily obtained through dietary means.

When working with elderly clients who require an increased consumption of complete protein, the nurse recommends: 1. Legumes. 2. Yogurt. 3. Iron fortified cereal. 4. Whole grain bread.

2. Yogurt. Rationale: After eggs and meats, dairy products are the best source of complete protein. Legumes, cereal, and bread have some protein but it is incomplete protein.

In providing care to an elderly patient, which practice might result in malpractice? 1. Obtaining orders for a left hip x-ray upon notifying the physician that an elderly patient has fallen 2. Moving a patient's recliner that the family purchased out of the patient's room to keep the patient from falling 3. Amoxicillin 250 mg IV stat given po because IV administration takes too long to arrive on the unit 4. Beginning cardiopulmonary resuscitation on a terminally ill elderly patient who has collapsed and is unresponsive

3. Amoxicillin 250 mg IV stat given po because IV administration takes too long to arrive on the unit Correct Rationale: Changing the route of a medication is outside the scope of practice for a nurse and therefore could result in a charge of malpractice. All other answers would be in the scope of practice of the nurse and should be done.

The leading cause of death in the elderly is: 1. Infectious disease. 2. Cancer. 3. Cardiovascular disease. 4. Complications from falls.

3. Cardiovascular disease.

The nurse is preparing the plan of care for a newly admitted client who was seriously injured in an automobile accident and now has left hemiparesis. The selected nursing diagnosis is impaired self-management. What should the nurse choose as an applicable goal for this client? 1. Rates pain at 3 on a 10-point scale 2. States willingness to go to long-term care for rehabilitation 3. Communicates need to use the urinal 4. Requests that shaving should be done by his wife

3. Communicates need to use the urinal Correct Rationale: Pain, shaving, and willingness to go to rehabilitation do not address his needs related to self-care. Feeling the need to use the urinal is the only goal that addresses his impaired self-management

Sleep is a problem that should be assessed in the elderly because a major potential complication of sleep deprivation is: 1. Sleepwalking. 2. Unremitting fatigue. 3. Disorientation. 4. Cardiac arrhythmias.

3. Disorientation. Rationale: The elderly who do not get enough quality sleep may become disoriented or suffer from hallucinations. Sleep deprivation is not a cause of sleepwalking or cardiac arrhythmias. Unremitting fatigue may cause one to fall asleep anytime or anyplace.

What part of the functional health assessment is the nurse most concerned with for an elderly female admitted to the hospital with jaundice? 1. Health perception-health maintenance 2. Coping-stress tolerance 3. Elimination 4. Nutritional-metabolic

3. Elimination Correct Rationale: Jaundice is a problem with elimination of waste products according to Gordon's Functional Health Patterns. Please see Table 2-2 for further clarification

In order to prevent shearing injury to a 50-year-old, hospitalized, terminally ill client who is high-risk for skin damage, which of the following measures would be effective? 1. Applying a foam mattress to the bed 2. Turning the client three times during each shift 3. Encouraging the client to use a trapeze bar 4. Keeping the client's skin clean and dry

3. Encouraging the client to use a trapeze bar Correct Rationale: The client at high-risk for skin damage will need frequent position changes and clean, dry skin. A trapeze bar, turning sheet, or transfer board are specific interventions that can be used to prevent shearing injury to the skin.

The nurse is providing care to an elderly client who may require a brief nursing home stay for rehabilitation before returning home. The client is concerned about the placement, and states, "I will never go to a nursing home. I want to die at home." What information will the nurse use to formulate a response? 1. Most elderly clients die in hospitals. 2. Medicare determines who can be admitted to a nursing home. 3. Families provide most of the care for the elderly. 4. Most elderly clients require a nursing home stay.

3. Families provide most of the care for the elderly. Correct Rationale: 64% of elderly clients who require care are cared for by their families. The other three answers are not correct.

Which of the following statements, if made by a dying client, indicates that spiritual needs are most likely being met? The individual states that: 1. Begins soon after injury and continues for up to three weeks. 2. Is responsible for rebuilding damaged tissues. 3. Is characterized by redness, heat, pain, edema, and swelling. 4. Begins within one week after the injury and may last for two weeks.

3. Is characterized by redness, heat, pain, edema, and swelling. Correct Rationale: The inflammatory phase of healing is characterized with the classic symptoms of inflammation such as redness, heat, pain, and edema or swelling. The other answers relate to the different phases of wound development.

The nurse is developing a plan of care for an elderly patient who experienced a fall. Which intervention would not be included in the plan of care? 1. Keep bed in the lowest position 2. Make sure eyeglasses are on before getting up 3. Keep all four side rails up at all times 4. Keep cane within client's reach

3. Keep all four side rails up at all times Correct Rationale: Keeping all four side rails up is considered restraining a patient and should be done only short term, if at all. Less restrictive ways of minimizing the risk for falls include toileting rounds, adequate lighting, safe footwear, wearing glasses, using appropriate assistive devices, keeping the bed in the lowest position, and frequent observation.

Which of the following screening tests is recommended to be done every five years by Medicare? Choose all that apply. 1. Fecal occult blood testing 2. Prostate-specific antigen (males) or PAP smear (women) 3. Lipids, triglycerides, and cholesterol levels 4. Mammograms (women)

3. Lipids, triglycerides, and cholesterol levels Correct Rationale: Lipids, triglycerides, and cholesterol levels are recommended only every five years for those without cardiovascular disease. All of the other responses are recommended to be done annually.

A primary goal of dietary intervention for the elderly is to: 1. Prevent complications from chronic conditions. 2. Improve digestion and metabolism. 3. Maintain quality of life. 4. Treat acute conditions.

3. Maintain quality of life. Rationale: Dietary assessment and early intervention can improve the overall quality of life and possibly prevent disease or illness. Most acute conditions are not treated primarily by dietary intervention. Digestion occurs in the GI tract and metabolism occurs at the cellular level.

Which of the following suggestions might the nurse use for an elderly client who lives alone and has insomnia? 1. A mild hypnotic 2. Ear plugs to decrease ambient noise 3. Melatonin supplement 4. A walk around the block just before bed

3. Melatonin supplement Correct Rationale: Melatonin supplements have been found to significantly improve sleep in the elderly with insomnia and have few side effects. The client should check with the healthcare provider before taking a supplement. Hypnotics are for short-term use only. Insomnia has many causes other than noise so ear plugs may not address the main problem. Activity within a couple hours of bed often leads to inability to release into sleep; therefore, activity should be earlier in the day.

Which nursing action will help maintain safety for the elderly? Select all that apply. 1. Encourage independence 2. Provide for regular ambulation 3. Orient to new surroundings 4. Ensure adequate hydration 5. Encourage socks while ambulating

3. Orient to new surroundings 4. Ensure adequate hydration Rationale: Although regular ambulation and encouraging independence are appropriate interventions for an elderly client, they are not related to promoting safety. Wearing socks would not promote safety as well

An elderly client has been admitted to a nursing home and the nurse completes an assessment. Which finding may lead the nurse to suspect a nutritional alteration? 1. Pale tongue 2. Thinning hair 3. Ridged nails 4. Moist conjunctiva

3. Ridged nails Correct Rationale: Ridged, spoon-shaped nails are signs of long-term nutritional deficiencies. Thinning hair is consistent with aging. Moist conjunctiva are signs of nutritional balance. A pale tongue, in the absence of other pathology, does not signify nutritional inadequacy.

Sociological theories of aging are characterized by what kinds of changes? 1. Intuitive 2. Functional 3. Role 4. Behavioral

3. Role Rationale: Sociological theories tend to focus on adaptive changes in roles and relationships that change. While behaviors and function may change as roles change, they are not the central focus of this theory.

When reviewing an elderly person's medications during a clinic visit, the nurse will recognize which of the following classifications of medications as one that may cause suppression of REM sleep? 1. Decongestants 2. Beta blockers 3. Stimulants 4. Aminoglycosides

3. Stimulants Rationale: Stimulants cause disruption in REM sleep by their effects on the central nervous system, causing a loss of total sleep time and time in REM sleep. Decreased REM sleep can lead to a feeling of increased daytime sleepiness. The other classifications do not affect REM sleep although they may cause sleepiness or insomnia in some individuals.

The loss of lean muscle mass that occurs with aging can be diminished or reversed by: 1. Aerobic exercise. 2. High protein diets. 3. Strength training exercises. 4. Small doses of anabolic hormones.

3. Strength training exercises. Rationale: Resistance exercises, such as lifting weights, have been shown to increase muscle mass in the elderly. Anaerobic exercises, high protein diets, and anabolic steroids are not effective in reducing loss of muscle mass or increasing muscle mass.

Which of the following represents an appropriate generalization about the elderly? 1. Intellectual decline begins at about age 70. 2. Social Security proves an adequate level of income for most elderly. 3. The aging experience is unique to the individual. 4. Psychological changes are unavoidable.

3. The aging experience is unique to the individual. Correct Rationale: Chronological age does not reflect the uniqueness of each individual's physiological and psychological changes. Psychological and intellectual declines are not experienced by many elderly. Social Security often becomes less adequate as people age and need greater resources.

Current demographic trends project a steadily increasing elderly population. A research focus that recognizes that trend includes studies that: 1. examine the safety of soft restraints. 2. demonstrate best timing for introduction of durable power of attorney for healthcare. 3. examine the role strain of caregivers for the elderly. 4. seek methods to reduce the incidence of incontinence.

3. examine the role strain of caregivers for the elderly. Correct Rationale: This is the only option focused only on the elderly population. The other answers are not necessarily just noted in the elderly.

The purpose of the functional assessment is to assess: 1. how many pounds the patient is able to lift. 2. whether the patient can cook his or her own meals. 3. the patient's ability to complete activities of daily living. 4. the ability of the patient to drive to appointments.

3. the patient's ability to complete activities of daily living. Correct Rationale: The functional assessment is used to determine what capability the patient has to complete self-care activities. Although the other answers deal with self-care, they are not as inclusive as the ability to complete activities of daily living.

An elderly man reports some concerns during a routine physical. The client states he has not really changed his eating patterns or activity in the past several years but has noted some "negative" changes in overall physique. When questioned further he reports he has noticed some loss of muscle tissue. He questions the cause and wonders what he can do to improve. What information should be provided to the client? 1. "As the body ages this is a natural change." 2. "You may need to increase your protein intake to promote muscle development." 3. "We should investigate the potential side effects from your medicines to identify a potential relationship." 4. "Aging is associated with a loss of muscle mass and cannot be reversed."

4. "Aging is associated with a loss of muscle mass and cannot be reversed." Correct Rationale: The loss of muscle mass is seen in older adults. It is a natural occurrence. Diet and exercise can prolong the phenomena but not totally arrest it. The client has asked specifically about the cause and possible solutions. The other options do not fully address the client's requests for information.

An elderly client asks the nurse what may have caused her to have excessive wrinkling and sagging skin on her face. Which of the following questions should the nurse ask the client to assess for intrinsic risk factors? 1. "Did you have excessive, unprotected sun exposure while growing up?" 2. "How many packs per year of cigarettes do you smoke?" 3. "Have you had significant exposure to environmental pollutants?" 4. "Have any of your close relatives experienced excessive wrinkling?"

4. "Have any of your close relatives experienced excessive wrinkling?" Correct Rationale: Intrinsic risk factors include genetic makeup and the normal aging process. Extrinsic factors include ultraviolet light exposure, smoking, and environmental pollutants.

A client is at the physician's office for an annual physical examination. During the examination, the client voices resignation about the inevitable changes in his physical condition as a result of his diabetes. Which of the following responses by the nurse is most appropriate? 1. "Unfortunately, the changes you are seeing associated with your diabetes are unavoidable." 2. "What concerns you most?" 3. "Diabetes is a permanent health concern experienced by many of your peers." 4. "Your own behaviors will have the greatest impact on your condition."

4. "Your own behaviors will have the greatest impact on your condition." Correct Rationale: The course of diabetes may be heavily impacted by the behaviors of the client. Potential changes relating to compliance with diet and medication regimen will influence the outcome of this chronic disease. While it is important to investigate the client's concerns this does not exceed the importance of providing accurate information to the client. Diabetes is a health concern for many older adults but it may be easily modified or managed with the correct treatment.

At 0200 the nurse finds an elderly hospitalized client sitting in a chair beside the bed. When the client says she is unable to sleep, the best action on the part of the nurse is to: 1. Call the physician to obtain an order for a hypnotic. 2. Assist the client back to bed. 3. Provide a glass of warm milk and offer a back rub. 4. Ask about strategies the client has used successfully in the past to fall asleep.

4. Ask about strategies the client has used successfully in the past to fall asleep. Rationale: Very often the client can tell the nurse what has been used in the past to fall asleep—things like soft music, a dark room, or warm milk. The nurse can then plan interventions that are acceptable to the client and will aid in sleep. Merely assisting a client back to bed does not address the problem. Hypnotics should only be prescribed for short-term sleep problems, so a prescription does not address what might be a chronic problem.

The cohort that is expected to be the largest consumers of health care in the next three decades is known as the: 1. War generation. 2. Generation X. 3. Sandwich generation. 4. Baby boomers.

4. Baby boomers. Correct Rationale: This is the largest cohort of Americans who were born between 1946 and 1964. The War generation was born early in the 20th century, Generation X was born in the 1970s and the Sandwich generation does not exist.

Which is a common myth of aging? 1. Women comprise the majority of the older population. 2. Fewer than 5% of persons over the age of 65 live in Skilled Nursing Facilities. 3. Older people in the United States are, in general, healthier than in the past. 4. Being old means being sick.

4. Being old means being sick. Rationale: While chronicity and disability increase with aging, many elderly remain healthy into advanced age

A client develops severe inflammation of the lower extremity. Which of the following foods should be included in the diet for this client? 1. Leafy, green vegetables and fluids 2. Carrots and other yellow vegetables 3. Grains, breads, and fluids 4. Citrus fruits, protein, and fluids

4. Citrus fruits, protein, and fluids Correct Rationale: The diet of the client with inflammation should be high in vitamin C to aid in the synthesis of collagen, protein to aid in the formation of blood cells and tissue, and fluids to remove metabolic waste and rehydrate the client.

A moderately overweight client reports to the clinic for a routine physical examination. During the examination, the client reports recent attempts to lose weight in order to improve overall health. While talking the client states he feels he "eats pretty well" but still does not seem to lose the weight desired. Which of the following assessment tools should the nurse encourage to assist the client in attaining his goal? 1. Completion of a diet diary for a 7 day period 2. Completion of a diet diary for a 2 day weekend period 3. Completion of a diet diary for 5 consecutive days beginning on a Monday 4. Completion of a diet diary for 2 weekdays and 1 weekend day

4. Completion of a diet diary for 2 weekdays and 1 weekend day Correct Rationale: The diet diary will provide a tool to review the dietary intake. This will allow the client the ability to review an accurate accounting of the dietary intake. Recording the dietary intake for more than 3 days is not recommended as it is cumbersome. The recommended time length is 2 weekdays and 1 weekend day.

Nutritionists who advocate low-carbohydrate diets as a way to slow the aging process are subscribing to which theory of aging? 1. Endocrine Theory 2. Wear-and-Tear Theory 3. Programmed Longevity 4. Cross-Link Theory

4. Cross-Link Theory Rationale: According to the Cross-Link Theory, binding of sugars to proteins damages proteins, which, over time, causes problems in various tissues. The Endocrine Theory focuses on the decline of hormones in aging. Wear-and-Tear Theory proponents focus on environmental assaults, such as alcohol abuse or smoking, as a contributor to aging, and the genome as the master programmer for defining senescence of the human body is the focus of the Programmed Longevity Theory.

What preventive measures might the nurse teach the elderly to prevent constipation? 1. Use a stool softener once a week. 2. Chew food thoroughly before swallowing. 3. Drink coffee or tea only in the morning. 4. Drink a glass of water several times a day.

4. Drink a glass of water several times a day. Correct Rationale: Adequate fluid intake, along with adequate fiber, is the best dietary measures to prevent constipation. Daily stool softeners can lead to dependency on them for bowel movements. Chewing is important but will not prevent or control constipation. Coffee or tea taken only once per day will not supply enough fluid to prevent constipation.

An elderly person who is experiencing sleep deprivation may exhibit: 1. Increased deep tendon reflexes. 2. Blurred vision. 3. Incontinence. 4. Emotional instability.

4. Emotional instability. Rationale: A sleep deficit accumulates and results in a loss of daytime functions. The person may show signs of memory lapse, loss of initiative, and emotional instability. The other symptoms listed are not related to sleep deprivation.

Persons with sleep apnea: 1. Experience excessive deep sleep. 2. Are often slim and underweight. 3. Experience excessive tension in the muscles of the throat and palate. 4. Have an increased risk for sudden death and stroke.

4. Have an increased risk for sudden death and stroke. Rationale: Obesity and a large neck size are risk factors for sleep apnea, which is caused by relaxation of the muscles in the throat, soft palate, and tongue during sleep. It will result in less deep sleep and REM sleep. Older people who repeatedly suffer hypoxic events during sleep apnea may be more prone to sudden death, stroke, angina, and worsening hypertension.

The family of a hospitalized client has contacted the case management department. They are concerned about the care of their loved one after discharge. They report that the client has been demonstrating increasingly severe episodes of dementia and is dependent on others for care. Which facility best meets the needs of the client after discharge? 1. Transitional care unit 2. Retirement care community 3. Residential care facility 4. Skilled nursing facility

4. Skilled nursing facility Correct Rationale: The correct answer is d. Skilled nursing facilities are for clients requiring custodial care and assistance with activities of daily living. The other answers do not meet this client's needs.

Which of the following is considered a major sleep disorder of the elderly? 1. Insomnia 2. Hyposomnia 3. Restless leg syndrome 4. Sleep apnea

4. Sleep apnea Correct Rationale: Cessation of breathing that occurs during sleep apnea causes poor quality sleep and, in the presence of other medical conditions, may result in exacerbation of those conditions. The other conditions listed may be frustrating for the individual but are not considered major sleep disorders.

An appropriate dietary intervention for an elderly client with dysphagia is to: 1. Serve smaller, more frequent meals. 2. Serve foods at room temperature. 3. Provide a full liquid diet. 4. Thicken thin liquids.

4. Thicken thin liquids. Rationale: Dysphagia means difficulty with swallowing. Liquids that are thickened are easier to swallow and less likely to cause the client to choke or gag. The frequency or temperature of foods does not affect the ability to swallow.

A major predictor of morbidity and mortality in the elderly is: 1. Social isolation. 2. Polypharmacy. 3. Impaired dentition. 4. Unintentional weight loss.

4. Unintentional weight loss. Correct Rationale: Weight loss that is unplanned and not due to a known cause often signifies an undiagnosed health problem or depression that needs treatment. Isolation, multiple medications, or impaired dentition may contribute to weight loss. However, unintentional weight loss should always be investigated.

When an elderly client refuses to take the usual morning medications or get out of bed, the nurse must deal with ethical issues related to: 1. beneficence. 2. justice. 3. veracity. 4. autonomy

4. autonomy. Correct Rationale: Autonomy deals with the client's self-determination and right to refuse treatment. Beneficence means to do good, and is not the correct answer. Justice is to provide equal care to all involved, and is not the correct answer. Veracity is adherence to the truth and is not the correct answer

An elderly client has Alzheimer's disease and frequently gets up during the night and wanders around the house. Which of the following suggestions is most appropriate to give the spouse? 1. Contact the physician to obtain an order for a mild hypnotic or sedative. 2. Try using a soft restraint jacket at night. 3. Make sure the client takes a brief nap during the afternoon. 4. Increase daily activity by going for frequent short walks.

Increase daily activity by going for frequent short walks. Correct Rationale: Activity helps the client remain awake during the day; daytime naps interfere with nighttime sleep. The bed should only be used for sleeping at night. Hypnotics or sedatives are for short-term use only. Restraints only increase agitation.