Neurologic Function, Eliopoulos Chapter 36- End of Life Care, Eliopoulos Chapter 35- Family Caregiving, Living in Harmony with Chronic Conditions 8th Ed., 31 Living in Harmony with Chronic Conditions

Mrs. H, aged 80, experienced a severe hemorrhagic stroke 7 days ago, and is not expected to survive the night. Mrs. H's family is gathered at her bedside with a member of her church's clergy. Her son has taken the nurse aside and asked how the family will be able to tell that their mother is about to die. How can the nurse best respond? A) "People usually experience a gradual slowing of their heart rate in the hours before death." B) "A lack of sweating, even though they have a fever, often means that someone is coming to the end." C) "Often as death approaches, the individual's eyes stop responding to light or else respond very slowly." D) "When a person's veins become prominent from the sudden increase in blood pressure, it means the heart is making its final efforts."

"Often as death approaches, the individual's eyes stop responding to light or else respond very slowly."

At the beginning of her shift, a nurse has entered the room of a 78-year-old male patient who is in the late stages of liver failure. The patient's son, who has interacted with the nurse appropriately in the past, states, "If you all wouldn't have botched his treatment when he first had this problem, he wouldn't be lying here dying." The nurse understands that which of the following phenomena may underlie the son's statement? A) The son is exhibiting the effects of depression common in those experiencing a loss. B) A common manifestation of anger about the death of a loved one is to direct it elsewhere. C) The son is reacting inappropriately to his imminent loss. D) Survivors of a dying individual often attempt to bargain for their return to health.

A common manifestation of anger about the death of a loved one is to direct it elsewhere.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 3 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 2 Page and Header: 457, Goals for Chronic Care 3. Mr. W has recently been diagnosed with rheumatoid arthritis, a chronic condition that is having a significant impact on his daily routines and his quality of life. Which one of the nurse's following statements best reflects recognition of the importance of healing rather than curing Mr. W's condition?

A) "A combination of physical therapy and corticosteroid treatment holds a strong chance of mitigating the effects of your arthritis." B) "The best way for us to foster your overall well-being is to eliminate the symptoms that are most affecting your daily routines." C) "There are changes that I can help you make that can help you live a full life in spite of this health problem." D) "There are lifestyle changes, coupled with promising new therapies, that hold out hope for being free from this problem." Ans: C Feedback: Answer C best reflects a focus on living a satisfying life in spite of the presence of the chronic condition. The other answers prioritize treatment aimed at eliminating the chronic condition itself.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 5 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Communication and documentation Objective: 3 Page and Header: 457, Goals for Chronic Care 5. A homecare nurse has begun providing care for an older adult male in the community who has recently been diagnosed with type 2 diabetes. The nurse is responsible for creating a care plan for the client and has consequently identified a number of goals for his care. Which of the following goals of care is most in need of reexamination or modification?

A) "The client will gain the knowledge and skills necessary to manage his diabetes independently and effectively within 3 months." B) "The client will remain free of common complications of diabetes." C) "The client will maintain a high quality of life despite his diabetes." D) "The client will no longer require blood sugar monitoring or oral antihyperglycemic medications within 12 months." Ans: D Feedback: While answers A, B, and C stress the management of the condition, freedoms from complications, and a high quality of life, answer D essentially makes curing the disease the goal.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 19 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 464, Impact of Ongoing Care on the Family 19. The daughter of an 80-year-old female patient with a diagnosis of severe ischemic heart disease has been her mother's sole care provider for over a year. The daughter is tearfully telling the homecare nurse about the onerous burden that she bears by struggling to meet her mother's ever-increasing needs. How can the nurse best respond to the daughter?

A) "There are promising new treatments for heart disease that hold a great potential for your mother." B) "It's very normal for you to feel this way, given how much you do for your mother; perhaps we can explore other living options together." C) "It sound like it is probably time to place your mother into long term care." D) "This must be difficult for you; many others in a circumstance similar to yours find it useful to remind themselves of how much their parents did for them when they were young." Ans: B Feedback: Answer B acknowledges the family members burden and tactfully introduces alternatives in a way that is more respectful than in answer C. Answer A overemphasizes curing rather than the daughter's burden of responsibility and answer D is likely to foster guilt rather than a solution.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 17 Chapter: 34 Client Needs: D2 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 6 Page and Header: 449, Using Complementary and Alternative Therapies 17. A 76-year-old man has had his quality of life significantly affected by chronic obstructive pulmonary disease (COPD), a condition that has brought a steady decline in his activity tolerance, his mobility, and ultimately his independence. In light of the apparent ineffectiveness of conventional treatment, the man is eager to forego conventional treatments and explore alternative and complementary treatment options. How can the man's nurse best direct him?

A) "This is a wise decision, since conventional treatments are motivated by profit and the interests of pharmaceutical companies, not patients." B) "These are good options to explore, but you will need to set aside your physician's advice in the short term in order to get accurate information." C) "Try not to think of your options as choosing either conventional treatment or alternative therapies, but rather choosing the best of both." D) "Your care team is probably ignorant of alternative therapies, so you'll have to go elsewhere for any information you need." Ans: C Feedback: Patients should be able to use the best of both complementary/alternative and conventional health care practices. It would be inaccurate to wholly write off conventional treatments as serving only the interests of pharmaceutical companies and while various information sources are likely necessary, it would be inappropriate to recommend ignoring the advice or potential information from the care team and physicians.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 12 Chapter: 34 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 460, Assessment of Chronic Care Needs 12. Which of the following older adults with chronic conditions is most likely to have the greatest care needs?

A) An 80-year-old woman with varicose veins who has just been diagnosed with osteoarthritis. B) A 74-year-old man with macular degeneration and type 1 diabetes. C) A 77-year-old man who has long-standing hypertension and is displaying early signs of chronic renal failure. D) An 84-year-old woman who lives with severe hearing loss and recurrent hemorrhoids. Ans: B Feedback: Visual impairment is likely to impact significantly the ability to monitor blood glucose levels and administer insulin. These challenges likely supersede those of the other older adults in answers A, C, and D.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 14 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 462, Locating a Support Group 14. Mr. Q has heart disease, and his wife needs to learn about the cooking methods and recipes she can use to help his condition. Which of the following sources is probably her best source of information?

A) Cardiologist B) General practitioner C) Nurse D) Support group Ans: D Feedback: Other caregivers in a support group can probably provide many cooking tips and recipes. The other sources can provide more theoretical information and general guidance.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 4 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 4. Which of the following statements about the goals for persons with chronic illnesses are appropriate? (Select all that apply.)

A) Chronic illnesses can be cured with proper and persistent treatment. B) Healing requires the mobilization of the body, mind, and spirit. C) Appropriate care measures focus on helping patients live in harmony with chronic disease. D) Controlling symptoms, promoting a sense of well-being, and enhancing the quality of life are appropriate goals for persons with chronic illnesses. Ans: B, C, D Feedback: Healing requires the mobilization of the body, mind, and spirit. Appropriate care measures focus on helping patients live in harmony with chronic disease. Controlling symptoms, promoting a sense of well-being, and enhancing the quality of life are appropriate goals for persons with chronic illnesses. Chronic illnesses cannot be cured.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 7 Chapter: 34 Client Needs: D1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals of Chronic Care 7. A nurse is providing care for an 82-year-old woman on the palliative care unit of a hospital. The woman has a long-standing diagnosis of diabetes that has manifested in serious cardiac problems and she is not expected to survive the weekend. How can the nurse best understand this course of events in light of the chronic care that the patient has long received?

A) Death represents the ultimate failure of the provision of care. B) Dying in comfort and dignity is the final component of high-quality chronic care. C) The period of death represents the transition from chronic care to acute care. D) Holistic, chronic care requires that the nurse limit care to psychosocial interventions. Ans: B Feedback: Dying a "good death" is a component of sound chronic care. It does not necessarily represent a failure of care nor does the near-death period mark the end of chronic care. Chronic care includes, but is not limited to, psychosocial interventions. Pain control and comfort care, for example, require pharmacological interventions that are still congruent with chronic care and the focus on healing and quality of life.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 20 Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 464, The Need for Institutional Care 20. Mrs. D, a resident in a nursing home, is considered noncompliant by many of the staff because she refuses to eat some of the food, which is nourishing and has been carefully planned by a dietitian. Most other residents have no objection to the meals. In addition, Mrs. D sometimes skips exercise classes. On the other hand, she takes all her medicines, and she gets along well with the other residents, to whom she tells risqué jokes. In what area is Mrs. D coping successfully?

A) Diet B) Assertiveness C) Exercise D) Compliance Ans: B Feedback: The staff may be annoyed by Mrs. D's noncompliant behavior, and her diet and exercising may be imperfect, but she is exhibiting a healthy assertiveness in refusing to eat food she dislikes and to exercise when she doesn't want to.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 10 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 10. Mr. P, a 70-year-old retired engineer, has diabetes and is on dialysis. He is a gourmet who takes pride in cooking delicious meals. His physical condition is quite good, but he is unhappy and bored with the restricted life he must lead. An old friend has invited him to travel across the country to San Francisco and spend a week there. Dialysis treatments can be arranged through a network of dialysis providers. How should Mr. P's charge nurse respond to this situation?

A) Discourage the idea, as he is likely to eat and drink too much on vacation B) Discourage the idea, but provide as much helpful information as possible C) Encourage him to go, and provide as much helpful information as possible D) Encourage him to go, and advise him to relax regarding his condition for a week Ans: C Feedback: A visit to San Francisco, a city known for its many fine restaurants, certainly poses risks for a patient who must follow a restricted diet, and could even shorten Mr. P's life. His unhappiness with his current situation, however, probably makes it desirable for him to take that risk. Even in San Francisco, it may be possible for him to eat sensibly, and in any case he is likely to be much happier than he is now. He needs to decide whether his quality of life will improve enough to risk any dangers. A nurse or social worker should help with setting up the dialysis arrangements ahead of time and with giving him any available information about restaurants, medical centers, and other places he may need to know about.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 16 Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 461, Selecting an Appropriate Physician 16. Mrs. S has a serious chronic condition that requires her seeing a physician several times a year (or more, if she is hospitalized). She is considering four physicians, all of whom are well qualified. Which physician is likely to be her best choice?

A) Dr. A is the top expert in his field and is highly respected at the local hospital. B) Dr. B is a woman with an office in Mrs. S's neighborhood. C) Dr. C is a woman who makes Mrs. S feel comfortable and allows plenty of time for talking. D) Dr. D communicates well with her and is in high demand. Ans: C Feedback: Finding a doctor with whom the patient feels comfortable is of major importance. She will also want a physician who makes her feel comfortable in the office. These considerations are likely to outweigh others, especially when the patient is elderly. A physician in high demand may be less accessible.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 8 Chapter: 34 Client Needs: D3 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/learning Objective: 3 Page and Header: 457, Goals for Chronic Care 8. Mr. E, an elderly man who lives alone, has hypertension and diabetes but seems to manage both conditions quite well. Three times a week he drives to a dialysis center for dialysis. He injects himself with insulin and is in charge of his medications and meals. Because Mr. E is lonely, he often has lunch or dinner in restaurants where he may eat and drink unwisely, but he takes his medicines with him. What could a nurse at the dialysis center suggest that would most help Mr. E in managing his conditions?

A) Eat at home most of the time B) Take a list of approved foods to the restaurants C) Find some social activities that do not involve eating D) Test your blood pressure and blood sugar after returning home Ans: C Feedback: Mr. E's loneliness is leading to dietary problems, and a nurse can use a motivational strategy to help him. Even if Mr. E keeps track of his blood pressure readings and blood sugar levels, unwise eating and drinking will eventually affect his conditions. If he has a social life, he may find it easier to eat at home more often, where it is easier to manage his diet. When he does eat out, taking a list of approved foods and measuring his blood pressure and blood sugar afterward will be helpful.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 2 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 457, Box 34-1 2. A nurse planning a health workshop for senior citizens wants to provide discussion topics that will interest everyone. In a typical group of seniors, which disorder will afflict the greatest number?

A) Hypertension B) Hearing impairment C) Heart condition D) Arthritis Ans: D Feedback: All these disorders are common in elderly people, but arthritis will afflict almost half of them. More than one-third will have hypertension, nearly one-third will have a hearing impairment, and more than one-fourth will have a heart condition. These are the "top four" conditions a nurse in this situation would want to present to the group.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 9 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 457, Goals for Chronic Care 9. An elderly woman had a series of lab tests that indicate she is healthy, but she has had several colds lately and often feels fatigued (although she is not depressed). She eats lightly but has a healthful diet. Which is the best advice a nurse could give her for improving her health?

A) Increase total food intake. B) Take mega-doses of vitamins. C) Exercise more. D) Have psychotherapy. Ans: C Feedback: Eating more is inadvisable; current research indicates that a light but nourishing diet is best for most people. Although a daily vitamin/mineral supplement is a healthful practice, mega-doses of vitamins are seldom needed, and use of them should be supervised by a physician. Psychotherapy does not seem to be indicated; the woman is not depressed, and no other mental problem is mentioned. Exercise should help her general health, making her feel more awake during the day and helping her sleep at night. That, in turn, will increase her resistance to colds.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 13 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 4 Page and Header: 460, Assessment of Chronic Care Needs 13. How can a visiting nurse best ensure proper care for a patient when she is not present but can be reached by a telephone or pager?

A) Instruct that all the family's questions should be filtered through the primary caregiver. B) Provide detailed written instructions for all procedures. C) Train the patient carefully in all procedures. D) Train all caregivers carefully in all procedures. Ans: B Feedback: Patients and caregivers can usually follow instructions well when a nurse is present, but the stress of illness and caregiving can make it easy to forget instructions later, especially if a procedure involves several steps or has changed from a recent procedure. Written instructions make it possible for a patient or caregiver to review procedures; if there is still confusion, the nurse can be called for advice.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 1 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 457, Chronic Conditions and Older Adults 1. A nurse is well aware of the high incidence and prevalence of chronic conditions among older adults. The nurse would recognize which of the following phenomena as currently contributing to this high rate of incidence? (Select all that apply.)

A) Longevity is increasing. B) Many previously fatal diseases are now treatable. C) Increasing numbers of older adults can afford medical care. D) Older adults have increased expectations for treatment. E) New chronic conditions are being identified by medical researchers. Ans: A, B Feedback: The combination of increased lifespan with the availability of treatment options for previously fatal conditions has contributed to the increased incidence of chronic conditions in the elderly. Answers C, D, and E are not noted to contribute to the phenomenon.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 15 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 462, Making Smart Lifestyle Choices 15. A 77-year-old woman has recently been diagnosed with type 2 diabetes. The gerontological nurse who is working with the woman has emphasized the need for the woman to make smart lifestyle choices in the management of her chronic condition. The woman has retorted, "Choices! I didn't choose to get diabetes and there's not much that I can do about it!" Which of the following statements best underlies the response that the nurse will provide?

A) Many of the factors that contribute to increased quality of life are within the woman's direct control. B) The woman has the ability to adopt or reject behaviors that have the potential to cure her disease. C) The woman can identify treatment options in consultation with the physician who is providing her care. D) Lifestyle choices exist only in older adults with strong support networks and sufficient resources. Ans: A Feedback: Lifestyle choices are within the locus of control of most older adults with chronic conditions and they have the potential to increase quality of life, though not cure chronic disease. Lifestyle choices supersede the direction of her physician, and while support and resources may indeed open up more lifestyle options, lifestyle choices are not exclusive to patients with these resources.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 21 Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 463, Defense Mechanisms and Implications 21. Mr. A says that he does not need his medicine for hypertension. He also claims that it makes him feel weak and he suspects that it sometimes makes him impotent. When his wife tries to remind him to take the drug, he becomes enraged. How can a nurse best help in this situation?

A) Suggest that Mr. A vent his frustrations B) Insist that Mr. A force himself to take the medicine C) Advise Mr. A's wife to supervise him D) Exhort Mr. A repeatedly that a chronic condition like hypertension requires self-care Ans: A Feedback: Mr. A is in denial about his need for the medicine and is angry about the effects. He needs extra support, not criticism. Venting his frustrations, perhaps by yelling or punching a pillow, may give him some relief.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 18 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 463, Factors Affecting the Course of Chronic Care 18. Mr. Y, who lives with his wife in their home of 50 years, has a diagnosis of osteoarthritis. Which of the following factors is most likely to have the largest impact on Mr. Y's ability to manage his illness?

A) The availability of new treatment options for his condition B) The financial resources available to Mr. Y and his wife C) The course and progression of his condition D) The openness of Mr Y to complementary and alternative medicine (CAM) Ans: C Feedback: The course and progression of Mr. Y's arthritis is likely to affect his ability to manage it more than new treatment options, finances, or his openness to CAM treatments.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 6 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 6. Despite the fact that the patient is now receiving palliative care because of the progression of her congestive heart failure (CHF), a nurse views the care that was provided for the patient as a success. Which of the following aspects of the patient's situation would most likely lead the nurse to this conclusion?

A) The client was able to live independently and care for herself until very late in the progression of her disease. B) The client maintained an acceptable cardiac output for the majority of the time that she lived with CHF. C) The client was able to teach other older adults about the experience of living with CHF and the way it affected her life. D) The client remained largely pain-free from the time of diagnosis until the present. Ans: A Feedback: The fact that the client was able to live independently and perform self-care represents success in a holistic nursing model. A focus on cardiac output and the ability to teach others is less indicative of a healing paradigm. While controlling pain in and of itself is a laudable goal, it is less closely associated with the quality of life that is the true goal.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 11 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 11. A nurse in a cardiac fitness unit is helping an elderly man set health goals for the coming year. The patient has had one heart attack and two coronary artery bypass operations, and can now walk only one city block (1/8 mile) before tiring. Which goal seems most reasonable for him?

A) Walk 10 blocks every day B) Jog 4 blocks every day C) Walk 24 blocks every day D) Continue to walk 1 block every day Ans: A Feedback: Although setting such a goal depends very much on the patient and the course of his recovery, it seems reasonable to set a goal of walking 10 blocks (a little more than a mile) every day within a year. That is not so much as to seem unreachable, or so little as to seem worthless. If the patient tries to make progress toward that goal but fails, the goal can be revised after a few months.

Knowing that she was dying, Mrs. P tried to use her condition to obtain sympathy and special treatment from the staff. Worse, she became angry at the slightest provocation. If a nurse failed to answer a light signal immediately, Mrs. P started cursing loudly. Once, she threw a saucer at a nursing assistant who annoyed her. How can a nurse who feels disturbed by her handle this patient? A) Accept Mrs. P's anger without comment, and forget about it B) Return Mrs. P's anger to let her feel justified in being difficult C) Turn her or his own anger into a joking response to Mrs. P D) Accept Mrs. P's anger without comment, but talk with a colleague about it

Accept Mrs. P's anger without comment, but talk with a colleague about it

Which of the following is the most important nursing action to take during a patient's denial stage of dying? A) Act as a shock absorber for the patient's emotions while the patient confronts reality B) Allow the patient to express the feeling that nothing is right C) Accept the dying patient's reactions and provide an open door for honest dialogue D) Impress upon the patient and his or her family that the inevitable cannot be postponed

Accept the dying patient's reactions and provide an open door for honest dialogue

A 79-year-old woman with a longstanding diagnosis of chronic leukemia experienced a blast crisis one week ago and died overnight. Place the stages of the coping mechanisms that the woman's family will go through in the most likely chronological order. Use all the options. A) Anger B) Denial C) Acceptance D) Bargaining E) Depression

All of the above

An elderly man has relied on one of his sons for his care. Now the son has become very involved with a religion other than the one in which he was raised. As a result, he now refuses to help his father. What can a nurse do to help in this family situation? A) Set up a family conference that includes the son B) Bring in help from other family members or outside C) Insist that the son help, along with other family members D) Ask the family's own spiritual adviser to intervene

Ans: A Feedback: Even though the outlook looks bad, it is slightly possible that the son will abandon his new religion and help his father again. If a nurse gives up on him, he will be further alienated from his family; being forced to help might have the same effect. As he may be rebelling against his family's religion, a spiritual adviser from that religion is unlikely to help. A family conference that includes the son may make him see how his behavior is affecting everyone else and help him act responsibly. If that does not work, other family members or an outside caregiver will be needed.

Haven Nursing Home is in a park-like setting in the hills east of San Francisco. Haven serves a variety of residents, ranging from well-to-do local families to those that are very poor. The home provides a wealth of activities, and the meals are excellent. The overall atmosphere is one of quiet calm. Mr. and Mrs. H had a series of cardiovascular disorders that quickly used up their modest retirement savings, and they now live at Haven, with Medicaid paying the bills. Their children are very loving but have little money of their own. They live in the family house in an area that is becoming industrial and must travel a long distance to visit their parents. They can visit only occasionally. What might a nurse suggest to help the grown children make the most of their limited incomes and time with their parents? A) Help them find nearby spots for picnics or other free outings B) Refer the family to a more appropriate practitioner C) Suggest they take out a second mortgage on the family house D) Encourage the entire family to participate in activities at Haven

Ans: A Feedback: A nurse is not obliged to help, but as a caring worker, he or she will probably want to. As Haven is in a suitable area, the entire family may enjoy picnics. Although the family may also want to participate in activities, a picnic would allow the parents to get out of the facility. As they are confined there most of the time, doing so would benefit them, as well as their children. Taking out a second mortgage might help temporarily to make life easier, but the children may well need the investment in the house when they are elderly themselves.

Which of the following statements most accurately captures an aspect of contemporary family caregiving in the United States? A) Women typically spend more time caring for aging parents than they did for their own children. B) The most common pattern of care involves an older man providing in-home care for his wife. C) The majority of care is now provided by public and private agencies rather than family members. D) A residential or institutional environment is now the most common venue for caregiving.

Ans: A Feedback: Today the average woman will spend more time providing care for her parents than for her children. More women provide care for their husbands than vice versa, and the majority of care is still provided by family members in a non-institutional environment.

The children of a 77-year-old man who has recently moved to an assisted-living facility are adamant that their father's common-law partner of 2 years be barred from participating in his care. The children state that the partner is manipulative and solely interested in their father's money, while the father disagrees and states that they have a healthy and mutually beneficial relationship. How can the nurse best respond to this situation? A) The nurse should accept that the relationship plays a positive role for the man. B)The nurse should organize a family meeting that includes both the children and the man's partner in an effort to facilitate reconciliation. C) The nurse should document the children's concerns and investigate the truth of their claims. D) The nurse should ask the partner to demonstrate that she is not a negative influence on the resident.

Ans: A Roles that may appear negative can in fact play a positive role in the lives of patients. In the absence of any illegal activity, the nurse is obliged to accept the man's characterization of their relationship.

2. The nurse plans the care for the hospice client with end-stage Parkinson's disease. Which of the following symptoms should the nurse expect to incorporate into the nursing care plan? A) Bradykinesia B) Hemiparesis C) Hemiplegia D) Visual impairment

Ans: A Feedback: Bradykinesia (slow movement) must be incorporated in a plan of care for the client with end-stage Parkinson's disease. The others are not common findings with Parkinson's disease.

18. A nurse is evaluating an elderly client's lifestyle to determine the level of risk for neurovascular problems. Which of the following should the nurse identify to the client as the most significant lifestyle risk factor for neurovascular problems such as Parkinson's disease and stroke? A) Cigarette smoking B) Failure to use seat belts C) Sexually transmitted disease D) Alcohol and drug abuse

Ans: A Feedback: Cigarette smoking is a significant risk factor for neurovascular disease; the other choices, although they can lead to neurologic dysfunction, are not the most significant risk factors.

24. The nurse advises the 80-year-old patient not to sleep slumped in the recliner. The nurse explains that proper positioning of the head and neck can help prevent transient ischemic attacks (TIAs) in which of the following ways? A) Preventing impairment of cerebral blood flow B) Increasing neck muscle strength C) Maintaining blood pressure in a normal range D) Decreasing muscle tension

Ans: A Feedback: Hyperextension and flexion of the head can interfere with normal cerebral circulation, which may lead to TIAs; thus, proper positioning of the head and neck is important. Although other benefits are possible, they are not associated with avoiding TIAs.

16. Which of the following patients on a subacute geriatric medicine unit is likely at the highest risk for experiencing a cerebrovascular accident (CVA)? A) Mr. L, age 79, who has poorly controlled hypertension and smokes half a pack of cigarettes daily. B) Mrs. H, a 90-year-old woman, who has a diagnosis of vascular dementia. C) Mr. J, a 77-year-old man, who has experienced an upper GI bleed and required a transfusion of packed red blood cells. D) Mrs. N, age 83, who has had a recent fall resulting in a broken left wrist and hip.

Ans: A Feedback: Hypertension and smoking are significant risk factors for CVA. The other cited health problems are less closely associated with stroke.

4. The nurse monitors a group of older adults exercising at the wellness center. For which of the following new assessment findings should the nurse immediately call first responders? A) Inability to speak and imbalance B) Muscle spasms and pain C) Nausea and lethargy D) Tremor in the hands

Ans: A Feedback: New onset of inability to speak and imbalance strongly suggests a cerebrovascular accident or transient ischemic attack. The other symptoms described are symptoms of Parkinson's disease or diabetes that would not require a 911 call.

9. An 83-year-old resident of a nursing facility worked as a chef until retirement. The resident told the nurse "I am greatly disappointed that food just doesn't taste as good as it used to." Which of the following facts should underlie the response that then nurse chooses? A) The function of the cranial nerves mediating taste declines with age. B) Decreased taste sensitivity is indicative of periodontal disease or thrush. C) While hearing, sight, and smell diminish with the aging process, taste is normally unaffected. D) The neurological components of the sense of taste normally disappear by the ninth decade.

Ans: A Feedback: Some decline in the cranial nerves mediating taste is a normal, age-related change, though complete disappearance of taste would constitute a pathological finding. Some loss of taste acuity is not necessarily indicative of oral disease.

22. The nurse prepares the patient for a test to determine the cause of the cerebrovascular accident (CVA). For which test should the nurse teach the client and family? A) Carotid Doppler studies B) Visual acuity testing C) Arterial blood flow to weakened extremity D) Speech therapy evaluation

Ans: A Feedback: Those with arteriosclerosis are at risk for thrombus formation causing most CVAs. Carotid Doppler studies examine the blood flow to the brain and arteriosclerosis. The other choices evaluate the impact of cerebrovascular attacks.

Mr. E is dying and has a great deal of pain. His oncologist is considering adding some alternative measures, such as hypnosis and acupuncture, to the drugs he already takes. What effect may such alternative measures have? A) They may reduce the required drug dosages or potentiate their effects. B) They may be useful substitutes for the analgesics. C) They may interfere with the effects of the analgesics. D) They may be effective but detract from the nurses' time to care for Mr. E.

Ans: A Alternative measures cannot substitute for drugs but are often useful adjuncts in pain therapy. Such measures are unlikely to interfere with effects of analgesics. The truly time-consuming alternatives will probably be supplied by their practitioners rather than by nurses.

Even if they are hungry, dying patients may find it difficult to eat and keep food down. To help with this problem, which of the following is best for a hospice nurse to give such a patient? A) Small-portioned meals B) Analgesia with meals C) More nutritious meals D) Reduced fluid intake

Ans: A Appealing but small-portioned meals are more likely than larger ones to be successfully kept down. Analgesia would not necessarily promote intake. Reduced fluid intake would most likely result in constipation.

Four patients with terminal cancer are in a hospital ward. A nurse observing them on her rounds realizes that one may be near death. Which patient is it? A) Patient A has a rapid, weak pulse B) Patient B is not perspiring C) Patient C has very red skin D) Patient D's blood pressure has risen suddenly

Ans: A Patient A has one of the many signs that bodily functions are slowing down. Some of the other signs are profuse perspiration, pallor, and decline in blood pressure.

A discharge planning nurse works with a wide variety of families when organizing care for older adults after their discharge from the hospital. Which of the following relationship structures would the nurse consider to be a family? Select all that apply. A) Mr. E and his partner, Mr. S, who live together in an apartment B) Mr. R and his new "lady friend," who began cohabitating 2 months ago C) Mrs. B and her daughter, son-in-law, and widowed sister, all of whom share a house D)Mr. R, who is estranged from his children and has lived with his brother, a bachelor, for several years E) Mrs. U, who considers her roommate to be "closer than a sister"

Ans: A, B, C, D, E Feedback: While not traditional nuclear family structures, all of the given relationships and living arrangements constitute family units.

An elderly couple want very much to maintain their independence and avoid asking their children for help. What can a counselor suggest that will most help the couple maintain independence? A) They can have grab bars, a wheelchair ramp, or other needed modifications made to their home. B) They can hire a part-time worker to do chores and run errands. C) They can have someone telephone every day to make sure they are all right. D) They can order meals on wheels or other prepared foods.

Ans: B Feedback: A part-time helper can be flexible and provide whatever help is most needed. The other suggestions are all helpful, but are less adaptable to specific circumstances.

Which of the following persons is likely at the greatest risk for elder abuse? A) A 73-year-old woman who lives with a son and cannot drive a car B) A 76-year-old woman who lives with a daughter and has no income except for Social Security C) A 78-year-old woman who lives alone and has no income except for Social Security D) A 74-year-old woman who lives alone and has a good income from investments

Ans: B Feedback: Choice B fits four categories of at-risk seniors—gender, age, living with a relative, and financial dependence. The other persons are at less risk.

A 92-year-old woman lives with her 70-year-old daughter, Emily. The daughter has been a sole caregiver for several years, has some health problems of her own, and is becoming depressed by her restricted life. She has no financial worries but believes she is wasting her life. What help is most needed in this situation? A) Emily needs more training in caregiving. B) Emily needs to temporarily leave the situation. C) Emily needs more financial help. D) Emily needs a social life.

Ans: B Feedback: Emily needs at least a respite from caregiving, with time to care for her own health and other needs. That may be enough, or she may need to place her mother in a nursing home.

Mrs. J is 80 years old. Until recently, she lived alone, but after having a stroke she moved into an in-law apartment in the home of her 55-year-old widowed daughter, Mary. Mary loves her mother and wants to be a good caregiver, but she also wants to resume a normal social life and perhaps to remarry. Mrs. J's other daughter, 53-year-old Cynthia, is married and lives in another city. She has a large home and would be happy to have Mrs. J live with her, but she is also a busy teacher. Mrs. J and Mary tend to call Cynthia for financial and legal advice. Mrs. J's son, 45-year-old Frank, is something of a black sheep; he cannot keep a job and often asks family members for financial help. Although no one in the family is poor, no one is wealthy either. An energetic 70-year-old neighbor, Mrs. N, is very helpful; she often shops for Mrs. J. In taking notes about the family, a visiting nurse needs to determine who would be the best primary caregiver and who would be a good backup. What is her best choice? A) Mary as primary caregiver, Cynthia as backup B) Mary as primary caregiver, Mrs. N as backup C) Mary as primary caregiver, Frank as backup D) Cynthia as primary caregiver, Mary as backup

Ans: B Feedback: From the information provided, it seems that Mary is the best choice. Living with Cynthia would mean moving far from home, which would be disruptive for Mrs. J. Frank sounds unreliable. If Mrs. N is willing to provide some respite for Mary occasionally, this arrangement may work out well. The nurse needs to know that a local backup is available, and Cynthia is too far away.

Both members of an elderly couple have some health problems. As a young married couple, they fought often and almost were divorced at one point. They stayed together at first because they had children, and later because they seemed better able to tolerate each other's behavior. A nurse working with them wants to assess their current feelings for each other so that she will know how much help they will give each other. Which assessment is most likely? A) They have grown apart and stay together only because of inertia. B) They feel secure with each other and support each other willingly. C) They have grown to care for each other deeply. D) They tolerate and somewhat unwillingly support each other.

Ans: B Feedback: In later life, marriages tend to settle down. Even couples who did not have happy early marriages become interdependent for safety and security. In some cases, their love deepens too, but this is beyond the domain being assessed.

A 52-year-old woman is preparing to have her father move into her home after his discharge from the hospital. Which of the following subjects should the discharge planning nurse prioritize when preparing the woman for her new caregiving role? A) The availability and scope of community resources B) The importance of her own self-care and techniques for maximizing it C) Assertiveness training to ensure she can set limits D) Management of finances

Ans: B Feedback: It is paramount that family caregivers recognize the importance of caring for themselves, facilitating respite, and ensuring their own health. The other subjects are likely valid teaching points, but the importance of self-care cannot be underestimated.

Ms. O is an 80-year-old nursing home resident who has diabetes. She is taken to a dialysis center three times a week in the home's van. She has no family left, but does have a few friends who visit her when they can. As they are also elderly, they cannot drive and must ride buses to visit her. How might the nursing home's social worker help in this situation? A) The social worker should defer to the nursing staff B) Help her friends find easier transportation C) Tell her to make friends at the dialysis center D) Ask other residents' families to bring her friends with them

Ans: B Feedback: Not having a family, Ms. O must be very lonely, and visits from friends can help her considerably. Although her friends may hesitate to ask for help themselves, a call from the nursing home might elicit help from a volunteer group such as those in some churches and temples. Sometimes, dialysis patients do become friends, but their enforced mobility during treatments makes it impossible to talk with many people. The families of other residents probably have enough problems of their own; if someone volunteers to help, that would be useful, but such volunteers should not be asked to do more than they are already doing. It could even lead them to stay away from their own family members.

Which of the following statements by family caregivers would the nurse consider most indicative of elder abuse? A) "Mom can't handle her own money any more so I've had to take over her banking." B) "When my dad starts wandering around the house I give him sleeping pills until he calms down and falls asleep in his chair." C) "My mother says she wants me to do everything for her, but I think it's better if she keeps on doing everything she's still capable of." D) "I get so frustrated because my father used to be so competent and now he can't even use a toilet."

Ans: B Feedback: The inappropriate use of chemical restraints is considered a form of elder abuse. Taking control of finances may or may not be appropriate depending on the individual circumstances. Answer C reflects a sound philosophy of care that maximizes self-care. Answer D reflects a reasonable frustration with the physical decline of a loved one and does not constitute elder abuse in and of itself.

Mr. K has dementia. Having a good deal of money, he has a private room at Haven Nursing Home. He is a retired industrialist whose children and current wife are already squabbling bitterly over his estate. During visits, they often get into shouting matches that disturb the other residents and Mr. K himself. How should an administrator handle this family? A) Emphasize that they must behave civilly when visiting B) Have them set up separate visiting schedules C) Ask them to stay away D) Close Mr. K's door when they visit

Ans: B Feedback: There is little an administrator can do about this dysfunctional family's behavior, but Mr. K should not be upset by it, and the other residents deserve to be protected from shouting. By setting up separate visiting schedules, the family can continue to provide needed support for their husband and father. If they accidentally visit at the same time, the door can be kept closed until they leave.

A daughter and mother are extremely close emotionally. Years ago, the daughter and her mother made a pact never to put her in a nursing home, but now the physical demands of the daughter's caregiving are becoming too great. Which of the following is the best thing a nurse can do to help the daughter? A) Persuade her to admit her mother to a nursing home B) Aid her in finding help with in-home care C) Praise her success in being a good daughter and keeping her promise D) Point out her mistaken altruism

Ans: B Feedback: There seems to be little use in helping this daughter become more insightful; she will feel very guilty if she puts her mother in a nursing home. If she has enough help to manage her mother's care physically, this is probably the best solution.

21. Relatives brought an elderly relative to the health center because they noticed a new behavior in the elderly person. The nurse practitioner explained that the behavior they noticed was characteristic of Parkinson's disease. Which of the following symptoms was most likely noticed in their relative? A) Forced eyelid closure B) Faint tremor in the hands or feet C) Depression D) Difficulty in swallowing

Ans: B Feedback: A progressive, faint tremor is often an early sign of Parkinson's disease. Forced eyelid closure, dysphagia, and depression are likely later signs.

7. The nurse provides for the care of the client after a cerebrovascular accident with expressive aphasia. Which of the following interventions should be the priority intervention? A) Listen for the intent of the message and do not concentrate on the words. B) Devise a picture chart for the patient to point for requests. C) Encourage the client to speak when no one is around. D) Remind the patient that no improvement is expected.

Ans: B Feedback: Although listening for intent is appropriate, the high priority is to devise a method of communication that allows the patient to express requests or needs. Recovery continues for years and improvement can occur, albeit slowly.

8. During a health promotion seminar, a nurse is teaching a group of older adults at a senior center about some of the normal changes that accompany the aging process. Which of the following statements about the effects of aging on the nervous system is most accurate? A) "It's actually a myth that intellectual performance and verbal skills deteriorate in older adults." B) "Your brain actually becomes smaller as you age and this affects how quickly older adults react." C) "The brain's ability to assimilate new information decreases greatly after age 65." D) "While blood flow through the brain remains consistent across the life span, the electrical activity of the brain declines somewhat later in life."

Ans: B Feedback: Brain atrophy and loss of brain weight are considered normal, age-related changes. It is normal for some loss of verbal and intellectual skills to occur though the brain is still able to assimilate new information. Blood flow in the brain declines with age.

19. An autopsy shows that Lewy bodies were present in a patient's brain. Which of the following characteristics did the living patient probably exhibit? A) Hemiparesis B) Tremor C) Diplopia D) Aphasia

Ans: B Feedback: Lewy bodies are found in patients with Parkinson's disease. Choices A, C, and D are associated more with stroke.

27. Nurses should promote activities that reduce patients' risk of cerebrovascular accident (CVA). Which of the following is the most helpful activity to promote for reducing that risk? A) Maintaining physical activity B) Managing hypertension C) Maintaining adequate hydration D) Getting sufficient nutrition

Ans: B Feedback: Managing hypertension is the most important strategy. The other three choices, though less important, do tend to improve cerebral perfusion levels and general health.

11. During a health promotion class, a group of older adults asks the nurse to teach them measures that they can take to foster neurologic health. What should the nurse tell the group? A) "Neurological illnesses are generally the result of factors beyond your control." B) "Quitting smoking and maintaining a healthy body weight can cut your risk of neurological diseases." C) "The best protective measure for your neurological health is to avoid environmental toxins and eat a healthy diet." D) "The more mentally active you stay by continually reading and learning, the less your chance of developing neurological disease."

Ans: B Feedback: Many, but not all, neurologic illnesses exist for reasons beyond an individual's control. Smoking cessation and preventing obesity have been shown to have a preventative effect. Avoidance of toxins and maintaining mental activity are less significant preventative measures.

5. The nurse assesses the members of a senior center. For which of the following new findings should the nurse require immediate follow-up by the primary care provider? A) Blood pressure of 96/62 mm Hg B) Numbness of hands C) Urinary incontinence D) Opaque sclera

Ans: B Feedback: Numbness and tingling can be a subtle indication or neurologic problems. Blood pressure of 96/62 mm Hg is adequate for perfusion; the other findings can be followed up at a later date.

14. A 77-year-old patient has been brought to the emergency department by the daughter due to recent visual disturbances and unilateral weakness. The diagnostic workup has led the diagnosis of transient ischemic attacks (TIAs). Which of the following patient history most likely contributed to the patient's current health problem? A) The patient was treated for anemia 3 months ago. B) The woman is a smoker and takes antihypertensive medications. C) The woman has a history of recurrent deep vein thromboses. D) The woman was diagnosed with Parkinson's disease early this year.

Ans: B Feedback: Smoking and the use of antihypertensives are associated with TIAs. The other cited health issues are less often contributors to TIAs.

The hospital's nursing staff has become very attached to Rev. M. When he dies, the nurse on duty hugs the son and daughter and cries with them. Which of the following is the best description of the nurse's behavior? A) It is appropriate in any similar situation. B) It is appropriate in this situation. C) It is unprofessional. D) It is inappropriately emotional.

Ans: B A family might not welcome this behavior in some instances, but the nurse has a genuine fondness for Rev. M, and that may help the son and daughter in their own grief. Although nurses must behave with objectivity in making decisions about patient care, warmth and caring are also important aspects of their work.

When a patient is admitted to a hospital, he or she is asked if an advance directive is available in case terminal care is necessary. What does an advance directive do? A) It gives the patient's family control over terminal care. B) It gives the patient control over terminal care. C) It gives the hospital control over terminal care. D) It gives the attending physician control over terminal care.

Ans: B By signing an advance directive, a patient can ensure receiving the terminal care he or she wishes, rather than burdening family members with making those decisions. Without an advance directive, a patient may be resuscitated even if there is no hope of meaningful life returning.

Miss L is dying. She is pale and irritable, and the hospice nurse thinks she may be in pain. What should the nurse do? A) Assume that Miss L must be in pain B) Ask Miss L if she is feeling pain C) Provide Miss L pain relief without asking D) Consult Miss L's chart for her previous presentation of pain

Ans: B Patients react in very different ways to pain and express themselves differently. The nurse should assume nothing, but ask Miss L about pain and have her rate it on a scale of 0 to 10. This self-appraisal should be recorded with other information.

The nursing staff on a palliative care unit are helping an unlicensed care provider, who has had little prior exposure to death, adjust to the unique demands of working in such an environment. Which of the following actions are likely to benefit the care provider? Select all that apply. A) The nurses encourage the care provider to find a confidante outside the hospital in order to avoid showing emotion openly while on duty B) The nurses encourage stepping back from intense situations and examining whether strong reactions are impacting the therapeutic relationship. C) The nurses teach the care provider how to be therapeutic while still maintaining an emotionally detached relationship from patients and families. D) The nurses try to help the care provider verbalize emotions and reactions to death. E) The nurses provide a location on the unit where all staff members can retreat during intense encounters.

Ans: B, D, E

Mrs. J is 80 years old. Until recently, she lived alone, but after having a stroke she moved into an in-law apartment in the home of her 55-year-old widowed daughter, Mary. Mary loves her mother and wants to be a good caregiver, but she also wants to resume a normal social life and perhaps to remarry. Mrs. J's other daughter, 53-year-old Cynthia, is married and lives in another city. She has a large home and would be happy to have Mrs. J live with her, but she is also a busy teacher. Mrs. J and Mary tend to call Cynthia for financial and legal advice. Mrs. J's son, 45-year-old Frank, is something of a black sheep; he cannot keep a job and often asks family members for financial help. Although no one in the family is poor, no one is wealthy either. Which family member is fulfilling the role of decision-maker? A) Mary B) Mrs. J C) Cynthia D) Frank

Ans: C Feedback: Mary may make routine day-to-day decisions, but apparently everyone relies on Cynthia for major decision-making. Mrs. J can probably no longer do so after having a stroke, and Frank is usually out of the picture. A nurse may need to consult Cynthia in case of a crisis.

An elderly couple's son and daughter were pawns in their parents' early battles and became resentful of both their father and their mother. They left home after finishing high school and have seldom visited since then. If the parents need care, how are the siblings likely to respond? A) Probably both children will help B) Probably neither of the children will help C) Probably the daughter will help, but the son will not D) Probably the son will help, but the daughter will not

Ans: C Feedback: Neither the son nor the daughter is likely to be enthusiastic about helping the parents, but daughters in general tend to help their elderly parents unless there has been an irrevocable break. As the daughter apparently has visited at least occasionally, she may help out.

Mrs. J is 80 years old. Until recently, she lived alone, but after having a stroke she moved into an in-law apartment in the home of her 55-year-old widowed daughter, Mary. Mary loves her mother and wants to be a good caregiver, but she also wants to resume a normal social life and perhaps to remarry. Mrs. J's other daughter, 53-year-old Cynthia, is married and lives in another city. She has a large home and would be happy to have Mrs. J live with her, but she is also a busy teacher. Mrs. J and Mary tend to call Cynthia for financial and legal advice. Mrs. J's 45-year-old son, Frank, is something of a black sheep; he cannot keep a job and often asks family members for financial help. Although no one in the family is poor, no one is wealthy either. As children, the three siblings did not get along well at all. When Mrs. J had her stroke, they met in her hospital room. The next day, they got together in Mary's home to discuss the family situation. If this family is typical, how did the siblings' relationships develop from that point on? A) All three temporarily became much closer, but only for a short time. B) All three became much closer for the rest of their lives. C) Mary and Cynthia became much closer for the rest of their lives, but Frank remained distant from them. D) They argued about Mrs. J and remained distant from each other.

Ans: C Feedback: Typical siblings become closer in late adulthood, and Mary and Cynthia are already in their 50s. They also cooperate in financial and legal matters and are likely to be united in wanting the best care for their mother. Frank is younger and has been cut off from the family during his adult life. Although he might become close to his sisters in later years, there is no assurance that will happen.

Mrs. W, aged 82, resides with her son and daughter-in-law who are finding it challenging to provide adequate care while maintaining their careers and home life. During a homecare visit, Mrs. W tells the nurse that, "My children's generation doesn't know how good they've got it; when I was younger we all had to take care of our parents, and for a lot longer than most people do now." Which of the following statements most accurately underlies the response that the nurse will provide to Mrs. W? A) The increasing prevalence of chronic illnesses means that there are indeed fewer old-old adults than there were in earlier generations. B) The increasing acceptance of long-term-care means that the caregiving burden of the son and daughter-in-law's generation is lighter than that of Mrs. W's generation. C) More older people are living longer and receiving care in the community than when Mrs. W was in her middle-adult years. D) The caregiving needs of the old-old are increasing but these needs are more commonly met in institutional settings rather than in the community.

Ans: C People are living longer and receiving more of their care in the community than in years past. Answers A, B, and D do not reflect this reality.

20. The nurse initiates teaching for the client who takes levodopa (Larodopa). Which of the following should the nurse caution the patient to avoid? A) Foods high in vitamin A B) Anticholinergic drugs C) Foods high in vitamin B6 D) Passion flower herbs

Ans: C Feedback: Foods high in vitamin B6 counteract the effects of levodopa. None of the other choices are contraindicated.

17. The son and daughter of an 80-year-old woman have expressed concern to the nurse that their mother has become impatient and irritable since her stroke earlier in the year. How should the nurse best respond to the children's concerns? A) "There is a new generation of medications that can help control outbursts with very few side effects." B) "This could be a sign that your mother is still experiencing transient ischemic attacks, so I will make sure to let her physician know." C) "This is not an uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality." D) "This is likely a temporarily response to the difficult changes that a stroke causes, and these behaviors will likely diminish with time."

Ans: C Feedback: Neurologic illnesses are often accompanied by profound and uncharacteristic behavioral changes, requiring understanding and patience. It would be inappropriate to direct the family toward medications or to tell the family that the changes will resolve. Such changes are not necessarily indicative of transient ischemic attacks.

13. A nurse who provides care in a long-term facility is working with a 78-year-old resident who has a diagnosis of Parkinson's disease. Which of the following aspects of the care the nurse provides should be reconsidered or modified? A) The nurse encourages the resident to continue to participate in the regular exercise programs at the facility. B) The nurse provides assistance with activities of daily living when necessary but encourages the resident to do what can be done independently. C) The nurse phrases questions and directions in a simple and understandable manner applicable to the client's decreased cognition. D) The nurse facilitates active and passive range of motion exercises on a regular basis.

Ans: C Feedback: Older adults with Parkinson's disease should not be assumed to have cognitive impairments. The other interventions are valid.

23. The nurse initiates teaching for the patient and family with newly diagnosed Parkinson's disease. In communicating with the patient and his family, which of the following should the nurse emphasize? A) Speech problems may affect the patient's expressive abilities. B) Emotional stability is maintained as the disease progresses. C) The disease progresses slowly, and therapy can minimize disability. D) Intellectual functioning is eventually impaired by this disease.

Ans: C Feedback: Patients with Parkinson's disease may appear to have intellectual problems because of difficulty with speech and emotion, but they do not lose their mental abilities.

10. During a neurologic evaluation, the nurse practitioner has asked an 83-year-old client to draw the face of the clock and then tell the nurse what time the clock reads. Which of the following assessment findings would be most indicative of expressive aphasia? A) The client appears unable to understand and follow the instruction. B) The client draws a person's face rather than the face of a clock. C) The client draws a clock but is unable to state the time. D) The client draws a clock with four hands rather than two.

Ans: C Feedback: The patient with expressive aphasia will be able to understand commands but will not be able to put symbols together into an intelligent speech form. This phenomenon is best demonstrated by answer C.

An elderly dying woman becomes panicky, convinced that she is suffocating. What is a likely cause of the discomfort she is feeling? A) Dyspnea B) Anxiety C) Dropping levels of blood gases D) Hypokalemia

Ans: C One cause of respiratory distress is deteriorating blood gas levels. The respiratory distress (or dyspnea) she is experiencing is common in dying patients; it results in anxiety and fear. Hypokalemia is a lowered blood level of potassium.

Rev. M, a minister in his early 70s, has pancreatic cancer and is expected to die soon. His son and daughter both visit him often. The son causes trouble for the staff by continually criticizing them for no apparent reason. He also asks repeatedly why his father, a good and loving minister, should have to die at a relatively young age. The daughter talks and prays with their father and brings him his favorite books for comfort. Although she is obviously distressed, she is already making tentative plans to move out of the family house and into an apartment. These preparations seem callous to her brother, who becomes further angered. Which stages of grief are the two exhibiting? A) The son has reached the stage of acceptance; the daughter is in the stage of anger. B) The son has reached the stage of bargaining; the daughter is in the stage of denial. C) The son is in the stage of anger; the daughter has reached the stage of acceptance D) The son is in the stage of denial; the daughter has reached the stage of anger.

Ans: C The son's anger about his father's dying is being directed toward the staff and his sister. The daughter is unhappy but has accepted the situation and will be ready to move on after their father dies. Both have passed through denial that he will die, and neither is trying to bargain with God.

12. A 79-year-old male patient has a number of health problems, including Parkinson's disease. Which of the following signs and symptoms would the nurse attribute to the client's diagnosis of Parkinson's disease? (Select all that apply.) A) The patient's vision is gradually deteriorating. B) The patient experiences frequent, severe headaches. C) The patient moves slowly and has poor balance. D) The client shuffles when walking. E) The patient's face is less expressive than when healthy. F) The patient is emotionally unstable.

Ans: C, D, E, F Feedback: While visual disturbances and headaches are not closely associated with Parkinson's disease, the other cited signs and symptoms are associated with it.

A visiting nurse becomes concerned about a caregiver daughter. Although she does not seem overburdened, she may be drinking too much. The recycling bin contains many wine bottles, and visitors come to the home. What action should the nurse take? A) Direct the daughter to a local Alcoholics Anonymous chapter B) Ignore the signs unless they interfere with caregiving C) Find a new caregiver in the family or outside it D) Assess the daughter's motivation and ability to provide care

Ans: D Feedback: At this point, the nurse is relying only on the evidence in the recycling bin, so the daughter must be filling her caregiver role. She may or may not be an alcoholic; if it seems that she is, telling her about AA later may be useful. In the meantime, the daughter needs to find work or another interest that is absorbing and requires her to stay sober.

During a family meeting that the nurse organized during an older adult's discharge planning from the hospital, there is visible animosity between the son and daughter of the patient. What should the nurse's initial response be to the apparent family dysfunction? A) Teach the patient's children alternative methods of interaction. B) Encourage the family to choose one spokesperson to represent all the children. C) Organize separate meetings with the son and with the daughter. D) Assess the family history and the nature of the son and daughter's relationship.

Ans: D Feedback: The first step in the resolution of family dysfunction is to gather data and identify factors that may contribute to the dysfunctional relationship. This assessment precedes the other listed interventions.

A visiting nurse notices bruises on Mr. B's arms; when she asks him about them, he acts evasive and apprehensive. She suspects that his caregiver has abused him. What should the nurse do? A) Call the authorities to report suspected elder abuse B) Wait until the next visit to see if he is all right C) Confront his caregiver and threaten to report her suspicions D) Continue questioning to assess the degree of abuse, but be reassuring

Ans: D Feedback: The nurse needs to proceed carefully, making sure that abuse has actually occurred, and try to correct the situation rather than immediately reporting it.

Which of the following family interactions would the nurse most likely interpret as being atypical? A) Mr. R states that he and his brother always had a cordial, though somewhat distant, relationship but that they are now quite close. B) Mrs. D describes being a grandparent as "having all the benefits of having children without the headaches and responsibilities." C) Mr. and Mrs. N had a tumultuous relationship for decades but now appear more at ease with one another. D) Mr. A states that his ideal living situation would be himself and his adult son and daughter all under the same roof.

Ans: D Feedback: While marital reconciliation, rekindled relationships with siblings, and satisfaction in the role of grandparent are all common phenomena among older adults, it is less common for parents and children to see cohabitation as an ideal situation or first preference.

During a home visit, a nurse notes that an 80-year-old female patient's blood pressure is 166/99 despite the recent introduction of a diuretic to her medication regimen. The patient admits that her son refuses to give her the diuretic because it has precipitated incontinence episodes and states, "He gets so furious when I soil myself." What action should the nurse prioritize in this potential case of elder abuse? A) Improving or salvaging the family dynamics B) Teaching the son why his actions are inappropriate C) Initiating legal action D) Taking measures to protect the patient's safety

Ans: D Feedback: While the interventions in answers A, B, and C may be warranted, the priority in any case of elder abuse is protecting the safety of the older adult.

A nurse at a rehabilitation center is preparing a care plan for a 71-year-old post-stroke patient who has shown significant improvement in function and who is ready to return to the community. In the nurse's efforts to mobilize family caregiving, which of the following statements provides the most accurate criterion for inclusion in the category of "family"? A) The patient's spouse, biological children, and closest friends B) Any unpaid person who has expressed sincere interest in the patient's condition and provided hands-on care since his admission to the facility C) Anyone who self-identifies as being a member of the patient's family D) Any individual who fulfills the patient's family functions

Ans: D The essential criterion for identifying a patient's family is to determine which individuals perform family functions. This criterion supersedes biological connection, provision of care, and self-identification.

29. A nurse is communicating with a family that includes an elder who has neurologic problems. What should the nurse suggest the family include in the home to lessen the likelihood of injury to the elder? A) Scatter rugs rather than wall-to-wall carpeting B) Soft, restful lighting in all areas C) Kitchen chairs with wheels for easy movement D) Smoke alarms with batteries that are replaced often

Ans: D Feedback: Dim lighting increases the possibility of falls as do loose scatter rugs and furniture with wheels. Smoke alarms are important in every home, but a fire can be especially dangerous to a patient who may respond slowly to danger.

15. A nurse is providing care for an 80-year-old patient who experienced an ischemic cerebrovascular accident (CVA) 3 weeks prior. Which of the following nursing actions is most likely to appropriately address the cognitive changes that have accompanied the patient's stroke? A) Discuss distant past events while avoiding discussions of recent events. B) Emphasize written rather than spoken communication on the part of both the patient and the nurse. C) Increase the volume of spoken communication as much as possible. D) Talk to the patient and give explanations while performing routine care tasks.

Ans: D Feedback: It is beneficial for post-CVA patients to be spoken to and have routine activities explained. While distant memory often remains more intact, it would not be appropriate for the nurse to avoid discussion of current or recent events. It would likely be inappropriate and/or unnecessary to forego spoken communication in favor of written communication. The nurse should speak clearly and distinctly but in not too high a volume.

25. Good nursing care of a patient who has had a cerebrovascular accident (CVA) can improve the patient's chance of survival and minimize the limitations that impair a full recovery. In the acute phase, nursing efforts should prioritize which of the following aims? A) Teach compensatory techniques for impaired communication. B) Talk to the patient during routine activities. C) Initiation of rehabilitation. D) Maintain a patent airway.

Ans: D Feedback: Maintaining a patent airway is an aim of nursing efforts for any patient who has had a CVA and would supersede the other noted interventions.

6. The nurse presents at a seminar on neurologic health issues in older adults. Which of the following data should the nurse include in the presentation? A) Neurological health is in the hands of God. B) Older adults are not at risk for sexually transmitted infections (STIs) that impact the neurologic system. C) Head and neck injuries can be avoided with the use of protective gear like seat belts. D) A low body mass index reduces the risk of neurovascular disease.

Ans: D Feedback: Maintaining weight and cholesterol levels within their ideal range, avoiding cigarette smoking, effectively managing stress, driving safely, and controlling infections can prevent some neurologic conditions. While using a seat belt reduces risk, it does not eliminate it. Any person who is sexually active is at risk for STIs, including the aged.

28. Promoting independence in an older patient with neurologic problems may take many forms. What advice to a patient's family would most help the patient achieve maximum levels of independence? A) Attend lectures on self-improvement. B) Prepare for personality changes in the patient. C) Complete tasks for the patient. D) Install self-help devices in the home.

Ans: D Feedback: Self-help devices can extend the time that older patients can live independently in the community and would likely be of greater utility than the other listed activities.

26. A patient recovering from a stroke at home seems to have a pleasant environment. Family members come in to talk with him, and he has his own familiar clothing and books in his room. A calendar shows the current date. A television and a radio are near his bed. No one disturbs him with the details of his condition. However, he seems depressed and anxious. A visiting nurse would most likely recommend which of the following? A) Encouraging reminiscence. B) Giving him antidepressant drugs. C) Redecorating his room. D) Giving him more information.

Ans: D Feedback: The environment should be simplified, consistent, and soothing. The patient needs to know the state of his health and what is being done to him.

3. The home care nurse plans the environment of the client with Parkinson's disease. Which of the following should the environment include? A) Brightly colored throw rugs B) Electric adjustable bed with side rails C) Weight training bench and weights D) Shower with nonslip surface and rails

Ans: D Feedback: Tub rails and nonslip tub surfaces are appropriate for clients with Parkinson's disease. While an adjustable bed may be useful, mobility equipment should be individually decided with input from the occupational and physical therapists.

An elderly man dying of cancer tells a nurse that his pain is becoming much worse and rates it as 9 on a scale of 0 to 10. What pain relief should be provided? A) Codeine B) Meperidine C) Oxycodone D) Morphine or hydromorphone

Ans: D The patient should receive an analgesic immediately to prevent the pain from becoming even more severe. Morphine or hydromorphone is given for severe pain. Codeine and oxycodone are for moderate pain, and meperidine is contraindicated in elderly patients because it causes psychoses and other adverse effects at low dosages.

A nurse is worried about his health because he believes he carries a gene for a fatal disease. What does he need to do for the sake of his own mental health and for that of his seriously ill patients? A) Work with patients who are likely to recover B) Come to grips with his own mortality C) Work in the maternity ward D) Adopt a cheerful demeanor with all patients

Come to grips with his own mortality

The children and wife of a man dying of renal failure are eager to interact with him as much as possible in the days before his death. Consequently, the daughter has questioned the nurse's decision to administer the man's scheduled hydromorphone, stating that he does not appear to be in pain at the present time and that the drug tends to make him drowsy. What is the nurse's most appropriate first action? A) Explain the rationale for preventative pain control to the family B) Document the family's reservations and administer the drug after they have completed their visit C) Administer an analgesic that is less likely to have a sedative effect D) Administer a partial dose of hydromorphone to the patient

Explain the rationale for preventative pain control to the family

Faced with the crushing reality of her imminent death, a 72-year-old female patient with advanced pancreatic cancer has become withdrawn and quiet, with her family stating that they believe she is depressed. Which of the following interventions should the nurse prioritize? A) Create a physical environment with more natural light and privacy B) Emphasize the patient's need for a sustained serotonin reuptake inhibitor (SSRI) to her care team. C) Provide gentle encouragement and assure the patient that the care team will prioritize her pain control. D) Focus on being truly with the patient and using therapeutic touch appropriately.

Focus on being truly with the patient and using therapeutic touch appropriately.

1. The nurse assesses a client with Parkinson's disease. Which of the following symptoms are unexpected, requiring immediate follow-up? A) Drooling B) Hallucinations C) Hypoglycemia D) Tremors

Hypoglycemia

The 45-year-old son of a dying woman is profoundly uncomfortable with discussions of her expected time of death, funeral preparations, and the signs and symptoms that may signal that death is imminent. Which of the following historical phenomena may have contributed to the son's reluctance to acknowledge the reality of death? A) In the past, death was viewed positively as a welcome transition, while it is now often seen as an undesirable evil. B) The declining death rate means that individuals live longer and survive to experience more unsettling symptoms and discomfort than in past generations. C) Many people now die in institutional settings, limiting the amount of previous exposure to death that many individuals have. D) Modern medical technology and increasing vigilance of treatment has brought about a mistrust of the natural dying process.

Many people now die in institutional settings, limiting the amount of previous exposure to death that many individuals have.

Mr. G has been an atheist for many years, although he was raised as a Catholic. In talking with his nurse, he says he wants nothing to do with organized religion. Now he is dying and depressed. What helpful advice might the nurse give his family about dealing with Mr. G's depression? A) Make his physical environment more pleasant B) Bring in a priest to visit with him C) Make an effort to improve his mood D) Stay with him for support

Stay with him for support

Which of the following interventions is likely to be of greatest benefit to the family of an 81-year-old woman who has just died from a sudden myocardial infarction? A) Begin working with the family immediately after the woman's funeral has been completed. B) Negative emotions toward the deceased woman need to be explored before healing can begin. C) Even though few survivors want to speak directly with a counselor or therapist, it is important to present the opportunity. D) Survivors benefit from medical support, not just spiritual and psychosocial support.

Survivors benefit from medical support, not just spiritual and psychosocial support.

Mrs. W, a 70-year-old woman with cancer, has been told she could die at any time. Her illness is more serious than it appears, and her daughter is not sure what to tell the grandchildren, who are aged 10 and 12. Which of the following is the best thing a nurse might tell the grandchildren? A) Tell them that Mrs. W is going to die. B) Tell them nothing until Mrs. W worsens. C) Tell them that Mrs. W is ill and that the nurses are concerned. D) Tell them that Mrs. W is ill but will recover.

Tell them that Mrs. W is ill and that the nurses are concerned

The death of an 86-year-old male hospital patient was overshadowed by the fact that his son and his daughter disagreed vehemently on the type and quantity of medical interventions undertaken near the end of their father's life. The daughter insisted, "Dad would want us to do everything reasonable that we could to save him" while the son countered, "He would want to go with dignity, not with tubes sticking out of him." When should the issue of terminal care and life-sustaining measures have been raised? A) When the patient received a diagnosis from his primary care provider B) When a family meeting could be organized by the care team C) When standard interventions had been exhausted D) When the patient was first admitted to the hospital

When the patient was first admitted to the hospital

The daughter of a 79-year-old man with a diagnosis of small-cell lung cancer has learned that her father has been found to have bone metastases. The daughter has approached the oncologist who is caring for him with information that she has found on the Internet that promises to cause remission of cancer through intensive antioxidant therapy. She is adamant that the physician facilitate the treatment and liaise with the providers who are located overseas. Which of the stages of Kübler-Ross' conceptual framework is the daughter most likely experiencing? A) Depression B) Anger C) Denial D) Bargaining

denial

After an elderly hospital patient had a heart attack, his cardiac and pulmonary functions ceased. How is that criterion of death documented? A) Brain death B) Molecular death C) Somatic death D) Cardiopulmonary death

somatic death