NURS 306 Final exam sample Q's from discussion board
13. What percentage of COPD is caused by smoking? a) 50-60% b) 20-30% c) 70-80% d) 80-90%
Answer D? Couldn't find in lectures Found in Week 2 Lecture - Physiological Health Guest Speaker: Erin Boyce Slide 44
Which of the following is NOT a factor that influences admission to residential care? a) Cognitive impairment b) Living alone c) Age d) Wandering
ANSWER: C - age. From March 7 class, developed from interprofessional teams and patient engagement, can be found in Wk 5 powerpoint slide 11.
Which of the following is not a type of resilience? a) Cognitive b) Health c) Spiritual d) Emotional
Answer C Week 5 Communication, Resilience and Interdependence Resilience: "Ability to spring back from a physical, emotional, financial or social change" Types: o Health o Psychological o Emotional o Cognitive
Exploitation of older adults involves: a) Lack of provision of basic necessities - food, water, medical care b) Physical and sexual assault c) Abandonment d) Use of older adult's resources without knowledge or consent
Answer D Found in March 21 Lecture - Security and Safety slide 7
Which of the following statements are true related to the older adults and activity? a) Activity is an indication of an individual's health and wellness b) Lack of physical activity increases the risk for many medical conditions c) Benefits of exercise include maintaining functional ability, enhancing self-confidence and self-sufficiency, decreasing depression, improving general lifestyle, maintaining mental functional capacity, and decreasing the risk for medical problems d) An exercise prescription should be included in the assessment of all older adults e) A, B, D. f) B, C. g) A, C. h) A, B, C. i) A, B, C, D.
Answer - I (ABCD) Relates to January 31 content Found in Touhy, T., Jett, K., Boscart, V., & McCleary, L. (2012). Gerontological nursing and healthy aging. (1st Canadian Ed.). Toronto: Elsevier. Chapter 10, p. 164-165.
What are the 4 levels of understanding? a) Preliminary, Comprehensive, Analysis, Synthesis b) Preliminary, Inference, Analysis, Synthesis c) Preliminary, Inference, Analysis, Importance d) Preliminary, Comprehensive, Analysis, Importance
Answer A Found in April 4 Lecture - Evidence-informed Practice and Review slide 15
What are the top 4 health problems? a) Aging or frailty, Cardiovascular Disease, Cancer, Alzheimer's or Dementia b) Obesity, Cardiovascular Disease, Cancer, Alzheimer's or Dementia c) Aging or frailty, Cardiovascular Disease, Ebola, Drug addiction d) Malnutrition, Cardiovascular Disease, Cancer, Alzheimer's or Dementia
Answer A Found in February 14 Lecture - Caring in Relation Slide 10
12. What are the symptom(s) of depression? a) Change in appetite b) Increased concentration c) Decreased anxiety d) Constant sleep patterns e) B, C, and D f) All of the above
Answer A Found in Week 2 Lecture - Physiological Health Guest Speaker: Erin Boyce Slide 30 others include: Change in sleep pattern, Change in activity, Fatigue and/or loss of energy, Guilt and/or feeling of worthlessness, Diminished concentration, Suicidal thoughts
6. What is Standard V (five) of Integrating Gerontological Competencies? a) Health Systems b) Relationship Care c) Physiological Health d) Safety and Security
Answer A Integrating gerontological competencies Found in January 3 Lecture - exploring chronicity and aging slide 24 "Gerontological nurses are aware of economic and political influences by providing or facilitating care that supports access to and benefit from the health care delivery system"
What are the 4 roles of an RN in medication and symptom management? a) Encourage self-management, Advocate for medication review, Interprofessional collaboration, Ongoing assessment b) Encourage assisted management, Advocate for medication review, Interprofessional collaboration, Ongoing assessment c) Encourage self-management, Advocate for medication review, Advocate self-assessments, Ongoing assessment d) Encourage self-management, Advocate for medication review, Interprofessional collaboration, Review previous assessment
Answer A Role of the RN in medication and symptom management Found January 17 Lecture - Pharmacology: Older Adults and Pain Management slide 47
Ways to promote mental health and wellness (select all that apply) a) Spend time with the person b) Leave the person to themselves c) Focus on their strengths d) Relieve symptoms e) Ongoing assessment f) Providing hope and dignity
Answer A, C, D, E, F Reference is from Week 6 Responsive Care Slide 14
Hypoactive delirium may include _______? a) Restlessness (for example, pacing), agitation, rapid mood changes or hallucinations. b) Inactivity or reduced motor activity, sluggishness, abnormal drowsiness or seeming to be in a daze. c) Agitation, sluggishness, hallucinations or abnormal drowsiness. d) None of the above.
Answer B Delirium Types Found in Week 2 Lecture - Physiological Health Guest Speaker: Erin Boyce Slide 19
Which of the following is not a gerontological competency? a) Safety and Security b) Communication Systems c) Health Systems d) Responsive Care
Answer B Week 1 Exploring Chronicity and Aging others include: physiological health, optimizing functional health, and relationship care
17. Meleis' Transition Theory is NOT based on which key concept(s): a) Nature b) Transition conditions c) Patterns of symptoms d) Therapeutic interventions in nursing e) A, B, and C f) A, B, and D g) All of the above
Answer C It is patterns of response - Meleis' Transition Theory Found in March 7 Lecture - Interprofessional Teams and Patient Engagement Slide 24 "A conceptualisation of transition that reveals a holistic understanding of the conditions that influence the transition experience for patients"... contains patterns of response from discharge, but not "symptoms"
What are three useful concepts in Motivational Interviewing? a) Responsiveness, Readiness and Ambivalence b) Readiness, Responsiveness and Resilience c) Ambivalence, Readiness and Resistence d) Ambivalence, Resilience, Responsiveness
Answer C Week 9 Interprofessional Teams and Patient Engagement
What concerns exist for Benzodiazepines administered to Geriatric Patients? a) Sedation, confusion, anticholinergic effects b) Reduced renal clearance can cause serious toxicity c) Confusion, depression, anticholinergic effects d) Confusion, ataxia, slurred speech, diplopia
Answer C Potentially inappropriate medications in geriatrics Found January 17 Lecture - Pharmacology: Older Adults and Pain Management slide 28
Self-management involves individual ability to manage symptoms, treatments, lifestyle changes, and psycho social, cultural, and spiritual consequences of health conditions. What are the four proximal outcomes of self-management? Select all that apply. a) Behaviors b) Cognition c) Biomarkers d) Symptom management e) All of the above f) A, C, D g) A, B, C
Answer E Proximal outcomes: behaviors, cognition, biomarkers, symptom management Distal outcomes: health status, individual outcomes, family outcomes, health care
What is a risk of physical restraints? a) Delirium b) Embarrassment c) Walking dependency d) Death e) None of the above f) All of the above
Answer F Found in March 21 Lecture - Security and Safety slide 15
What are the possible causes of delirium? a) Sleep deprivation or severe emotional distress b) Exposure to a toxin c) Alcohol or drug abuse or withdrawal d) Obesity e) B and C f) A, B and C g) All of the above
Answer F Delirium Cases Found in Week 2 Lecture - Physiological Health Guest Speaker: Erin Boyce Slide 16
What drug(s) are potentially inappropriate medications in geriatrics? a) Antihistamines b) Digoxin (cardiac glycoside) c) NSAIDs d) Phenytoin e) A and C f) All of the above
Answer F Potentially inappropriate medications in geriatrics Found January 17 Lecture - Pharmacology: Older Adults and Pain Management slide 28
RN roles in End-of-Life Care: a) Symptom management b) Coordinating care c) Holistic assessments d) Support e) A and B f) C and D g) All of the above
Answer G Found in February 7 Lecture - Responsive Care Slide 11
The Canadian Health Act Standards include: a) Accessibility b) Portability c) Public administration d) Universality and comprehensiveness e) interprofessional collaboration f) both a, d, e g) a, b, c, d
Answer g From week 10 Health System, slide 4 of 30
An 83-year-old woman gets some lab work done, and results show she has a high level of a specific drug, even though she hasn't taken the drug since yesterday. Which of the pharmacokinetic changes in geriatrics best explains this? Choose the best response. a) Decreased hepatic blood flow b) Increased glomerular filtration rate c) Increased total body water d) All of the above
Answer is A EXPLANATION: Slide 14 from January 17th, 2018. The slide states: "Lower levels of metabolism likely due to reduced hepatic blood flow, therefore any drug metabolized by liver (regardless of specific enzyme) will potentially have longer half-life". Therefore, A is correct. The other 3 answers are incorrect: GFR and total body water decrease with age, thus making b, c, and d incorrect.
Alice is an 80-year-old pleasant female. She is living at home by herself. Every morning she takes the bus to the field house and does six laps. She shares with you that she is frustrated that she doesn't have the same stamina that she used to as she was once able to do 10 laps of the track. She does tell you though that her reduction in stamina is not stopping her from going each morning, she just needs to come home after and have a nap on the couch before watching The Price is Right. You would score Alice with a MAPLe score of: a) Mild client b) High client c) Low client d) Non-scorable because of the lack of information regarding her living conditions
Answer is A Question from March 7th "Week 5 Interprofessional teams and patient engagement" powerpoint. Slide 14 on MAPLe score. • MAPLe (Method for Assigning Priority Levels) score - categories o Differentiates service seekers/clients into five priority levels, based on their risk of adverse outcomes. Highest priority level are nearly nine times more likely to be admitted to a long- term care facility. o The highest priority level is based on presence of: 1. ADL impairment 2. Cognitive impairment 3. Wandering 4. Behavior problems 5. InterRAI nursing home risk CAP
What is the best way to approach to help an older adult deal with abuse? a) Empower the older adult to solve their problem and help them be safe b) Remove the older adult from the abuse c) Allow the older adult to solve the problem on their own d) Ignore the issue and pretend you did not witness anything
Answer is A Safety and security lecture; guest lecture "We can solve the problem for you- NOT true- work with the older person - running into rescue them can cause more harm"
What is the STOPP Tool? a) Screening Tool of Older Persons Potentially Inappropriate Prescriptions b) Screen Tool of Potentially Dangerous Procedures c) Screening Tool of Older Personal Precautions d) Screening Tool of Palliative Persons
Answer is A Screening Tool of Older Persons Potentially Inappropriate Prescriptions Reference from Week 2: Physiology caring for older adult's slide 10
What is an example of non-intentional non-adherence in geriatrics? a) "I can't remember if I took my meds today." b) "My meds don't do anything." c) "I don't like the way the medication is shaped" d) "The smell of the medication reminds me of fish and I hate fish."
Answer is A. January 17, Pharmacology and Chronic Pain Management Slide 20
If you are using the WHODAS 2.0 assessment tool, what are you assessing? a) Changes in an older person's mental status to assess for dementia b) Changes in a person's health status over time and the contribution of chronic disease on older adults daily functioning c) The risk for coronary artery disease d) The risk for elder abuse
Answer is B Health system lecture; slide 10
Which of the following is true about pain management in older adults? a) A numerical pain rating scale is ineffective b) It is best to use the same pain rating scale consistently to avoid confusion c) Pain is a normal part of aging and cannot be completely avoided d) The same medication regimen is effective for all geriatric patients
Answer is B Lecture 3, Pharmacology, Slide 37
Which of the following is true about changes in geriatric patients that affect absorption of medications? a) Gastric pH decreases, causing increased absorption of acidic medications b) Gastrointestinal motility slows which increases medication absorption c) Blood flow increases which increases medication absorption d) Passive diffusion is not affected in elderly patients
Answer is B Lecture 3, Pharmacology, Slide 9
Which of the following is NOT a principle of motivational interviewing? a) Express empathy b) Reinforce readiness c) Support self-efficacy d) Develop discrepancy
Answer is B Lecture 9, Interprofessional Teams, slide 27 •4 Principles of MI (practicing MI) o Express Empathy o Roll with resistance o Support self-efficacy o Develop discrepancy
True patient centered care involves... a) the MD/NP making the best decisions for the patient b) the patient and their healthcare team working together towards the patient's desired goals c) the patient and their family making their own decisions alone because they know the patient best d) the latest research to give the patient the most up to date and best care possible
Answer is B Question from ... March 7th "Week 5 Interprofessional teams and patient engagement" powerpoint. Slides three, four, and five.
What is the WHODAS 2.0 assessment tool? a) Targets specific diseases in older adults b) Recognizes a change in health status over time and how that may impact an individual's life c) Measures level of understanding of the individual d) Useful for measuring resources in an area
Answer is B Reference from week 10 Health System, slide 10
Margaret is an 85-year-old lady who presents to your emergency department. She is wheeled in a wheelchair by her neighbour. She presents with bruises to her forehead and tells you "I may have slipped and hit my head on the bedside table". Upon further assessment, you find bruises all over her body. You question her further about how these appeared and she says, "Well they may have appeared from someone in my long-term care facility". You suspect abuse is occurring. What is your first action? a) Leave her room and call the police immediately b) Question her further to acquire more information and work with her to determine your next course of action c) Pull the call bell out of the wall and treat this as a medical emergency d) Call mobile crisis immediately without Grace's consent as you have an obligation to report all suspected adult abuse.
Answer is B Week 6- March 21st, Melanie Grace and Elliot's Guest Lecture on elder Abuse
The Meleis transitional theory is based on which following key concepts (select all that apply) a) science b) nature c) patterns of response d) number of falls in the past year
Answer is B and C Question from March 7th "Week 5 Interprofessional teams and patient engagement" powerpoint. Slide 24 Meleis' Transition Theory
A nurse always finds her hydromorphone in the narcotic drawer of the med cart in all hospitals. This is an example of what component of evidence-informed practice? a) Improve quality b) Access c) Standardization d) Cost-effectiveness e) Sustainability of care
Answer is C EXPLANATION: Slide 5 from Week 6: Evidence-Informed Practice. Standardization is essentially consistency, which is exactly what the question was stating.
An incorrect example of absorption of drugs in aging individuals would be... a) GI motility slows so absorption is increased. b) There is impaired active transport, so absorption is decreased c) Gastric PH levels increase so absorption of acidic drugs increases. d) Gastric PH increases so absorption of basic drugs increases.
Answer is C January 17th, 2018. Related to altered drug absorption in geriatric population. Correct answer can be located on slide 9 of the guest lecture PPT presentation by Courtney Quiring. Drugs absorb differently in older adults. Each aging individual will have a different response even if they are dosed by weight. In acidic mediums, acidic drugs are in a unionized form, which increases its absorption. This is why acidic drugs are usually better absorbed from the stomach. But when the stomach acid becomes more basic (increased PH) with age this changes. If there is a large pH difference between two compartments, then ion trapping is common and more acidic drugs have less absorption.
You are caring for a palliative patient who has stage 4 colorectal cancer. He has been suffering for many years and the physician has told the family that he is no longer responding to treatment. The patient has signed a DNR and is asking to spend his final weeks in his home. This patient's family is at risk for which type of grief? a) Acute grief b) Disenfranchised grief c) Anticipatory grief d) Complicated grief
Answer is C Lecture 6, Responsive care, slide 8 o anticipatory: feel grief before it happens e.g planning a move to another community
Jerry is an 83 year old man that is admitted to the ER due to a fall. You as the nurse arrive in the room to ask a few questions. You find out that Jerry lives on his own and is on multiple medications for his hypertension, atrial fibrillation, and osteoarthritis. However, Jerry is non-adherent to taking his medication. As the nurse you: a) Remind Jerry that he needs to take his medication as prescribed and send him on his way b) Inquire if Jerry has dementia and help him find a long-term care home c) Ask the patient why he is non-adherent to his medications and help him develop a plan d) Schedule an appointment for another day, this patient is not an emergency department priority
Answer is C Slide 20 and 21 (Adherence in Geriatrics) on powerpoint Pharmacology and Pain Management, lecture January 17th
An 80-year-old female is admitted to your unit with significant orthostatic hypotension, as the nurse you notice she is on 10 medications. You begin reviewing the medications she is takeing, she explains that it all began when she was diagnosed with hypertension and was prescribed metoprolol, after this she began feeling depressed and was prescribed citalopram, an SSRI, after this she began experiencing significant tremors and has been on levodopa for a month now. You understand this series of events as... a) A normal, and a doctor should add additional medication to address the orthostatic hypotension b) A normal process of aging, this patient should be admitted into long term care, as she is a fall risk c) This is a prescribing cascade, a normal process that occurs with aging d) This is a prescribing cascade, an interdisciplinary team should be put together, including you, a physician, pharmacist, and the patient
Answer is D Information found on Jan 4th, slide from Courtney Quiring "process whereby the side effects of drugs are misdiagnosed as symptoms of another problem resulting in further prescriptions and further side effects and unanticipated drug interactions. This may lead to further misdiagnoses and further symptoms."
All of these factors decrease drug absorption except? a) Decreased blood flow b) Impaired gastric diffusion c) Decreased GI motility d) Impaired active transport
Answer is D January 11, Geriatric Syndromes and Chronicity Slide 5
Which of these is not included in the 4 shared risk factors for geriatrics? a) Impaired mobility b) Baseline Functional Impairment c) Older age d) Mental Instability
Answer is D January 11, Geriatric Syndromes and Chronicity Slide 5
A home safety assessment includes: a) Risk assessment for falls b) Risk assessment for fire c) Assessment of the bathroom, bedroom, living room, and telephone placement d) All of the above
Answer is D Lecture 11; Safety and Security, slide 9 o Home assessment should include a fall, injury, fire, and crime risk assessment. Significantly reduces risk of falls.
Which of the following is NOT an appropriate intervention to improve medication adherence? a) Engaging family members to support the patient b) Contacting supportive financial services c) Assessing the patients understanding of each medication they take d) Organizing their medication regimen so they take medications at multiple points in the day
Answer is D Lecture 3, Pharmacology, Slide 21
You're working in long term care and notice that one of your patients is having difficulty swallowing their pills. Which of the following medications can safely be crushed and administered with apple sauce? a) Rabeprazole enteric-coated tablet b) Hydromorphone sustained release tablet c) Gliclazide modified release tablet d) None of the above e) a, b f) b, c g) a, b, c
Answer is D Lecture 3, Pharmacology, Slide 22 •What makes a medication non-crushable? o Enteric-coated (EC) o Extended-release (ER, XR, XL), sustained release (SR), modified release (MR), controlled delivery (CD), long-acting (LA) o Drugs meant for sublingual (SL) or buccal administration o Capsules can often be opened, but contents (spheres, pellets) should not be crushed, if they are opening them we want to make sure they are not chewing them.
Your patient 87-year-old presents with: 1. A pressure ulcer to her left foot, 2. Type 2 diabetes, 3. Depression, and 4. Urinary incontinence Which of these conditions are considered "geriatric syndromes"? a) None b) 1, 2 c) 1, 3, 4 d) 1, 4 e) 1, 2, 3, 4
Answer is D Lecture 4, Geriatric Syndrome, slide 3 •Common geriatric syndromes: 1. Pressure ulcers 2. Urinary incontinence 3. Falls** 4. Functional decline 5. Delirium 6. Frailty
You are caring for a patient receiving end of life care. Which of the following is your role as an RN? a) Symptom management with pain medication, mouth care, bowel care and bladder care b) Assisting with practical arrangements, such as contacting a funeral home c) Supporting family care givers d) All of the above
Answer is D Lecture 6, Responsive care, slide 10
Which is NOT a risk factor for elder abuse? a) Social isolation b) Cognitive disabilities c) Addictions d) Social alcohol use
Answer is D Safety and security lecture; guest lecture
There are three useful concepts related to Motivational Interviewing. These are: a) Resistance, empathy, and readiness b) Coaching, readiness, and ambivalence c) Interviewing, persuasion, and adherence d) Ambivalence, resistance, and readiness
Answer is D Slide 28 Three Useful concepts of motivational interviewing from March. 7th class.
74. All of the following represent Geriatric Syndromes EXCEPT for: a) Pressure ulcers b) Falls c) Urinary incontinence d) Memory loss
Answer is D Slide 3 (Geriatric Syndromes) on the powerpoint of Geriatric Syndromes January 24th.
Which of the following indicates that the nurse is following the least restraint policy for a patient known to fall when getting out of their chair? a) Using a seatbelt to secure the patient to the chair b) Check in with patient every 20 minutes to ask the patient if they need to use the washroom c) Ensure the patient's call bell is within reach d) Consider the use of antipsychotic or sedative medications so the patient is less agitated e) b, c g) c, d
Answer is E Lecture 11, Safety and Security, Slide 17
Which of the following shows that you as a nurse are incorporating the CGNA standard of responsive care into your practice? a) Understanding and considering normal physiological changes that occur as people age that could affect care b) Assessing for barriers, such as drug interactions or dementia, that could impact the client's understanding of information you are providing them with c) Addressing health-related learning needs and developing, implementing and evaluating learning plans to accommodate changing cognitive and sensory abilities d) Assisting family caregivers to reduce their stress levels and maintain their own mental and physical health e) a, b, c f) b, c g) c, d
Answer is F CGNA Standards of Practice oStandard 3: Responsive Care- Gerontological nurses provide responsive care that facilitates and empowers clients' independence through life courses changes. A responsive care approach recognized that certain behaviors are onto necessarily related solely to pathology but instead may be related to circumstance within the physical or social environment surrounding well older persons and those with dementia.
Reduction of the number of medications in older adults is linked to better health outcomes a) True b) False
Answer is False Reference from Week 3 Pharmacology and Pain Management Slide 5 o A reduction in # of medications is NOT associated with better health outcomes
You are a homecare nurse visiting with Sally, your 77-year-old patient with COPD. She lives her daughter, Emily. During your home care visit, what consequences of family caregiving should you be assessing Emily for? a) Caregiver strain b) Financial distress c) Malnutrition d) Disruption of family relationships e) a, b f) a, b, c g) a, b, d
Answer is G Lecture 7, Care in Relationships, slide 14
The Meleis' Transition Theory is subdivided into different transitions types. Select all that apply. a) Organizational b) Situational c) Readiness d) Health/illness e) Developmental f) A and C g) B, C, D, E h) B, D, E i) A, B, D, E
Answer is I Slide 24 Meleis' Transition theory from March. 7.
What does the LI represent in BLISS communication model? a) Listen to the individual experience b) listen to the family's experience c) look into individual experiences d) none of above
Answer: A February 14 Lecture-Caring in Relation o B: Bring up the topic in an appropriate way o LI: Listen to the individual experience o S: Support the individual and partner o S: Stimulate communication between the partners o S: Supply personalized advice and information; where necessary, refer in an appropriate way
Leonard is a 78-year-old gay man. Since moving to his assisted living home five years ago, he has had a secret relationship with Harold. The two did not tell anyone about the relationship due to fear of judgement and isolation. Harold recently passed away from cancer 6 months ago. What type of grief may Leonard be experiencing? a) Disenfranchised Grief b) Persistent Grief c) Acute Grief d) Anticipatory Grief
Answer: A Disenfranchised grief refers to grief that is not acknowledged by society. No one knows about it, so you can't put it out there and share. February 7, 2018: Lecture: Responsive Care - Slide 9
What statement by the frail older adult with a chronic disease indicates that they may need further education? a) My last A1C level was 8.4%... this means I need to think of other strategies to keep my blood sugar lower so my next A1C will be less than 7%. b) I know that I can never cure my COPD, but I can manage my symptoms if I quit smoking, and use my albuterol as needed. c) I know that my blood pressure does not need to be 120/80... my normal is 163/94 and this is ok. d) My Fosamax (a bisphosphonate) for my osteoporosis makes my stomach really upset so I make sure to stay sitting for 30 minutes after I take it.
Answer: A An A1C between 7.1% and 8.5% is standard for older adults (we would rather not drop their blood glucose too low). Slide 56 Week 2 Week 2 slideshow, slide 53 If BP drops too low it can increase risk for falls via hypotension (thats what google says)
For the older adult diagnosed with diabetes, what recommended monitoring tests will you plan to discuss with the patient. Select all that apply: a) Urine tests for microalbumin b) Serum lipid levels c) Blood pressure d) Annual dilated eye exam
Answer: A, B, C, D Rationale: Basic understanding of DM on retinopathy, neuropathy, nephropathy, and correlation with hypertension. Slide 53 from Week 3
You are a home care nurse going to see a 85 year old patient in her home. Upon arrival, you notice her hair is not brushed, her skin is dry and scaly, and she appears very tired. You see there is no food in the fridge and she states her daughter has not been back in 4 days with her medication. This is an example of what? a) sexual abuse b) neglect c) exploitation d) emotional abuse
Answer: B Found in the March 21 lecture - safety and security slide 6. This example shows signs of poor hygiene, malnutrition and dehydration. She was left by her daughter with lack of basic needs (food) and without her medication. These are all signs of neglect.
While attaining health information, it is important that it is: a) Always from a doctor's perspective. b) Available and accessible for all patients. c) Valid and supports clinical decision making d) Only from a web source e) b & c
Answer: B & C Answer is from March 28th power point (Future of growing older) slide 24.
Which of the following actions determines the greatest resiliency in the individuals? a) Taking a bath b) Getting dressed c) Managing finances d) Brushing teeth
Answer: C Rationale is found in the January 31 ppt, slide 10 discussing independence. Resiliency is shown in our ability to complete iADLs.
Which of the following is a pull factor for older adults in deciding to move? a) independence loss b) loss of spouse c) environmental amenities d) environmental stress
Answer: C Found in the March 28 lecture - future of growing older slide 19. The other choices are all examples of push factors for deciding to move. Push: Independence loss Loss of spouse Environmental stress Pull: Retirement amenities Relocated friendship and/or kinship networks 'successful' relocation by friend(s) Environmental amenities
Which is not a standard of Canada Health Act? a) comprehensiveness b) accessibility c) universality d) completeness
Answer: D March 14 Lecture-Health Systems
Lorna is a 75-year-old woman. 9 months ago, Lorna suffered a hip fracture after slipping on ice outside of her home. Since the fall, Lorna has done physiotherapy daily. With the help of her family, in the 9 months following her fall she has moved back to her home and begun to live independently again. Lorna displays which type of resilience: a) Psychological Resilience b) Emotional Resilience c) Cognitive Resilience d) Health Resilience
Answer: D Health Resilience. Health resilience refers to maintaining functional independence. January 31, 2018: Communication, Resilience, and Interdependence - Slide 5
A 85-year-old man is admitted to your unit. The physician prescribes the patient the default dose for morphine because the 85-year-old man is in pain. What is the most appropriate nursing action? a) Assess the man's RR, then give him half of the dose and the other half when the pain returns. b) Give the patient the full dose as you would for any adult. c) Assess the patient for possible substance abuse and withhold the medication at any signs of substance abuse. d) Give the patient the full dose and monitor the patient for falls. e) Advocate for a new default dose for morphine for adults who are 65 years and older, to reduce the risk of falls. f) d & e
Answer: F According to the week three required reading "High Risk Medications in Hospitalized Elderly Adults: Are We Making it Easy to do the Wrong Thing?" by Blachman et al., elderly adults are at high risk for falls due to health care providers providing default doses of high risk medications. These medications include: opiates, benzodiazepines, benzodiazepine-receptor agonists, sleep medications, muscle relaxants, and anti-psychotics. The article suggests that default doses should be decreased for adults who are 65 years and older. o Result of giving an "average dose" can produce a different response in an older adult, even if dosed by weight (mg/kg)
Your colleague is talking to you about their grandmother. They state that she has no resiliency and is unable to perform ADLs independently. However, the grandmother can shift out of negative emotions and is able to uplift her spirits following negative events. What would you say? a) Tell the colleague that it's normal for older adults to become dependent on others and that they shouldn't dwell on it too long. b) Tell your colleague that resiliency exists in many forms, and their grandmother seems to have psychological and emotional resiliency. c) Provide the definition of health resiliency and agree with the colleague, the grandmother is not resilient. d) Advocate for the grandmother to be placed in a LTC facility of her choosing.
Answer: b From week 5, communication, resilience, and interdependence powerpoint. Resiliency needs to be acknowledge and encouraged in older adults. Resiliency comes in many forms; the grandmother is exhibiting psychological and emotional resiliency. It would be wrong to agree with the colleague and determine that this elderly lady has no resiliency at all.
The older adult population is not homogeneous. Within the population exists multiple generations, which of these statements is correct? a) The first generation is adults from age 60-75 and it is the fastest growing group b) The third generation is adults who are age 85+ and it is the fastest growing group. c) The first generation is adults from age 60-80 and it is the fastest growing group d) The second generation is adults who are age 80+ and it is the fastest growing group
Answer: b This is from the March 28th guest lecture about the SCOA, this was from the information provided by the guest lecture.
The World Health Organization's Age-friendly City Model addresses: (select all that apply) a) Community-based clinics so that older adults can receive treatment for chronic illnesses such as diabetes, kidney disease, and hypertension. b) Issues such as housing, transportation, and social inclusion. c) The necessity of community-based clinics that specialize in physical health and require their staff to take courses specific to the unique profile of older adults. d) The need for a walking club to promote better cardiac health. e) The design of outdoor spaces and buildings that are age-friendly.
Answer: b & e The model provided by the WHO does not emphasize physical health. It emphasizes the infrastructure within the city, and how it can be adapted to the aging population. This comes from the March 28th guest lecture about the SCOA.
A 67-year-old woman is asking for palliative care. She is currently living with chronic kidney disease and is at the end-stage. She is on dialysis and is experiencing negative side effects. What should the nurse do? a) Discuss the meaning of death with the patient b) Explain to the patient that palliative care is only offered during the last 2-3 weeks of life because of the high demand c) Assess what kind of symptoms the patient wants to manage and collaborate with her to create the best management plan. d) Ask the patient if she wants her EOL care in the hospital or at home.
Answer: c Is the correct answer; all the other answers are talking about EOL care and they are not an appropriate nursing action currently. EOL care and palliative care are two different things and should be treated as such. C includes collaboration, and this is vital for care of any patient. This is from Week 6 class discussion about EOL care.
The elderly patient you are caring for is living with cognitive and sensory changes. How would you meet their individual learning needs? (Choose the incorrect statement) a) Keep sessions short, brief, and simple b) Plan teaching sessions around their schedule, not your own schedule. c) Use videos that are simple and easy to understand. d) Provide information and record yourself. Once you are done recording yourself, leave the audio file with the older adult so they can listen to it when they need. e) Follow up with the patient, schedule another visit to ensure that the information was passed on correctly and accurately.
Answer: d D is incorrect. It is incorrect because this does not allow the patient to ask any questions. You have not assessed if the patient has an audio player. All of the other answers are correct and are from Week 6 class discussion about health literacy.
What is the gold standard for pain assessment? a) The most objective way to assess your patient's pain is to measure the patient's brain waves. The brain waves measure the intensity of pain. b) Ask the patient's family or friends if they've noticed the patient to be having any pain. c) Older adults develop chronic pain due to frailty, so baseline pain medication should be initiated to improve quality of life. d) With non-verbal and verbal patients, self-report is desirable.
Answer: d Even with non-verbal patients, self-report is the gold standard. No one will understand a patient's better than the patient does. If able, the nurse should always go directly to the patient for their pain assessment. Although there is brain activity that occurs when someone is experiencing pain, this would be time-consuming and not within the practice scope of the nurse. January 17th. This comes from "Pain Assessment in Older Adults" Horgas A. Week 3 required reading.
You are at the public library, and you see an elderly gentleman struggling to find a book. He is attempting to use the library's search engine to find the book's location. Using your nursing knowledge about growing older, what would you do to help? a) Ask the gentleman what book he's looking for and find it for him. b) Offer to navigate the library's search engine to find his book for him. c) Go to the front desk and tell the librarian that the gentleman is struggling, and probably needs help. d) Pull-up a chair, offer your assistance, and teach him how to use the search engine step-by-step, and allow him to click on buttons himself.
Answer: d From week 5, communication, resilience, and interdependence power point. As nurses, we understand that resiliency is something that is developed as one ages and overcomes obstacles. Resiliency needs to be acknowledged and encouraged with the older adult. After all, the elderly gentleman did find his own way to the library, so he is capable. When we take away an older adult's skills or inhibit them from developing new skills, we are not fostering resilience. D is the best answer, when using nursing knowledge.
A frustrated woman brings in her 73-year-old mother to the hospital. The woman is frustrated that her mother refuses to participate in the yoga, tai chi, and the walking club that she has signed her mother up for. The woman feels as though her mother is not motivated in maintaining her health. What is the best nursing action? a) Interview the woman and her mother separately and ask them how their relationship is going. b) Confront the woman and tell her that she needs to be considerate of her mother's needs and opinions. c) Interview the mother separately and ask her how she feels about the classes she has been signed up for. d) Reassure the mother that it is completely normal to feel unmotivated in old age. e) Ask the mother what kind of activities she has enjoyed in the past and collaborate with the woman and her mother to find new activities that the mother will enjoy. f) c, d & e
Answer: e This is from Geriatric Syndromes and Chronicity power point Jan 24. Interventions that promote mobility should also be patient-centered. When the patient is involved in planning mobility interventions and feel as though their needs are being met, they are more likely to participate.
Robert, an 86-year-old man comes into the emergency department with his adult son. His adult son explains that he was visiting his father and found him lying on the kitchen floor. Which one of these nursing actions avoids the adoption of ageist institutional policies? (select all that apply) a) Ask the patient how many times he has fallen in the past b) Suggest the patient uses a walker at home and hires homecare c) Ask the son if he would be able to move in with his father, if not an immediate LTC referral is needed d) Do an emergency falls risks assessment e) Do a head-to-toe assessment, as well as a thorough neurological assessment f) Ask the patient to explain what happened, then talk to the patient about the success he has in performing ADLs
Answer: e & f E is correct because this is what you would do for any patient. The older population deserves to have the standard of care. F is correct because what if this was the first time he had a fall? We cannot assume he has had falls before, or that he is at risk for falling. Young people fall occasionally as well, but they are not stigmatized by it. Doing a more thorough assessment of the event and inquiring about the patient's daily life will give the nurse a bigger picture of what is really going on. This comes from the March 28th guest lecture about the SCOA.
Mary, a 76-year-old lady is in the hospital for a recent hip injury. Her daughter has just shown up and is currently visiting with her. While you, the student nurse is in the room you notice that Mary' daughter is mocking and humiliating her mother in front of you. What form of abuse would this be considered? a) Physical b) Neglect c) Violation of rights and freedom e) Emotional d) e & b
Answer: e) Emotional. It is emotional abuse if somebody threatens, insults, intimidates, or humiliates an older adult, treats the person like a child, or does not allow them to see their family and friends. Emotional abuse can devastate a person's sense of identity, dignity, or self-worth.
A patient who has complex health problems, physical disability and cognitive impairment could be categorized under which MAPLe Score? a) Low clients b) Mild Clients c) Moderate Clients d) High Clients e) Very High Clients
Answer: is moderate clients - C This question was derived from the blank slide on the March 7th Lecture. This slide was titled "MAPLe Scores." • MAPLe (Method for Assigning Priority Levels) score - categories o Differentiates service seekers/clients into five priority levels, based on their risk of adverse outcomes. Highest priority level are nearly nine times more likely to be admitted to a long- term care facility. o The highest priority level is based on presence of: 1. ADL impairment 2. Cognitive impairment 3. Wandering 4. Behavior problems 5. InterRAI nursing home risk CAP
Which of the following factors contribute to global population aging? Select all that apply: a) Longevity Revolution b) Great Depression c) Baby Bust d) Baby Boom
Answers: A, C, D B: this is not correct as this actually dramatically reduced birth rates before the baby boomer generation. From the video showed March 28th in class Longevity Revolution: life expectancy is increasing due to vaccinations, public health programs. Increased from 48 to 77 years' old Baby boom (1946- 64'): factors that decided how many children families would have in the 30's and 40's in the great depression; when the war ended soldiers came home and lots of babies were made! Baby bust: young families having fewer children
Which RN's actions do not reflect the CGNA's (2010) Standard 5: Health System? a) Max identifies that the Live Well Program monthly meeting targeted for older adults with chronic kidney disease is not very accessible as it is located in on the second floor of a building which does not have an elevator. b) Nora uses a low stimulation environment for older adults with dementia in a nursing home rather than sedative medications to address 'sun-downing' behaviour. c) Ada listens to patients' verbalized preferences for care and advocates for these changes at the next staff meeting. d) Lee encourages patients to report the use of prescription medications, OTC (over-the-counter) medications, and herbal remedies. e) all of the above f) B and C g) B and D h) A, B, and C
Correct Answer: F Rationale: A - Standard 5: "Analyzing the effectiveness of community resources in assisting older adults and their families to retain personal goals, maximize function, maintain independence, and live in the least restrictive environment." and "Identifying and evaluating the accessibility, availability, and affordability of health care for older adults to promote their goals; maximizing function, desired level of autonomy and independence and their living in the least restrictive environment" B - Standard 6: Safety and security: "Intervening to eliminate or minimize the use of physical, chemical, and environmental restraints (e.g. alternate strategies to prevent falls, to prevent treatment interference, and to manage agitated and/or combative behavior)." C - Standard 5: "Representing the older adult as requested and when the older adult is not able to advocate for self in discussions of care, preferences for care and decisions related to care within the healthcare team and the organization" D - Standard 1: Physiological Health: "Identifying older adults' use of prescription medications, over-the-counter medications, herbal remedies and complementary and alternative therapy; and using established criteria for assessment and management of polypharmacy" Information located from week 1 CGNA (2010) Gerontological Nursing Competencies and Standards of Practice 2010 (introduced in the slideshow, 4th last slide)
What does the communication model BLISS stand for? a) Bargaining, Listening, Individualize, Support, Structure, Sympathize b) Believing in the individual, Listening, incorporate past experiences, Supply advice, Sympathize, Strengths c) Bring up the topic, listen to individual, Support, Stimulate communication, Supply advice and information d) None of the above
Correct answer is C Rationale is found on February 14, 2018 PowerPoint presentation, slide 19 of week 4; Care in Relation. The LI component of BLISS is in one point within the Listen to the individual.
What are the most common health problems related to old age? Select all that apply. a) Aging or frailty b) Cardiovascular disease and cancer c) Alzheimer's or dementia d) Chronic fatigue and poor digestion e) All of the above
Correct answers are a, b, and c Rationale is found on February 14, 2018 PowerPoint presentation, slide 10 of week 4; Care in Relation.
Which is not part of the recommendations to the federal governments when discussing chronic disease related to aging: a) Lead a healthy aging strategy for seniors that emphasizes chronic disease prevention and management. b) Give seniors more funding after retirement to be able to afford health care services c) Support primary health care reform by focusing on community based interprofessional teams d) Redirect funding to preventative health care services and programs
The answer is B Iit is not a part of the 3 recommendations toward the federal government to help with chronic disease related to aging. This can be found on slide 7 on the March 14th lecture
Which option is not a cause of Delirium? a) Certain medications or drug toxicity b) Malnutrition or dehydration c) Old age d) Pain
The answer is C Answer is on slide 16, as all others except pain are on the list of causes of delirium. The date of the class was January 10th, when talking and physiological health and delirium slide 16.
What does the Acute Care for Elders (ACE) strategy provide? a) Long term care for seniors b) Home care nursing support c) Outreach to give seniors food, transportation and caregivers d) Better coordination of health services in the senior community
The answer is C The other ones are too specific and not the best answer to the reason for this Acute Care for Elders strategy. This can be found on slide 12 of the March 14th lecture.
Which aspect is not part of the 3 stages included in the provision of MAID? a) Seeking medical assistance in dying b) Assessment of eligibility c) Assessment of readiness for end of life d) Administering medical assistance in dying
The answer is C - all the other ones are included in the stages of MAID however the patient's readiness to for end of life is not part of this assessment. This can be found on slide 4 of the February 14th lecture.
What is the difference between a chronic illness and an acute illness? a) Acute illness is progressive and life long b) Chronic illnesses come on suddenly c) Chronic Illness is ongoing d) Acute illness has a sudden onset e) Both A and B f) Both C and D
The answer is F Both C&D as an acute illness has a sudden onset and a chronic illness is ongoing. The reference is from Week 2: Physiology caring for older adult's slide 6
Which of the following are considered geriatric syndromes? a) Frailty b) Alzheimer's c) Pressure ulcers d) Functional decline e) a, b, d f) a, c, d g) a, b, c, d
The answer is F Alzheimer's is not considered a geriatric syndrome but all the rest are. This can be found on slide 3 of the January 23rd lecture.