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Origin: Chapter 15- Rest and Sleep, 7 Chapter: 15 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 188, Drugs That Affect Sleep 7. An older patient with multiple health problems asks the nurse for advice about recurrent insomnia. Which statement made by the nurse is most accurate?

A) "Caffeine obviously makes it hard for you to sleep, while a moderate amount of alcohol at bedtime is useful." B) "You should try over-the-counter sleep aides for several weeks before you move on to prescription options." C) "It's very normal for the quality of sleep to decrease with age, so this is usually a problem that requires accommodation rather than treatment." D) "A lot of medications have the potential to interfere with sleep, so it would be useful to review your medications with your physician or a pharmacist." Ans: D Feedback: Numerous medications are noted to be detrimental to sleep in older adults. Nonprescription sleep aides carry risks, and alcohol is not a recommended intervention. While sleep quality does decrease with age, this does not mean that measure cannot be taken to address the problem.

Prior to the beginning of a gerontological nursing course, a nursing student questions why the course is not classified as geriatric nursing. How can the instructor best respond?

A) "Gerontological nursing implies health promotion activities that can accompany aging, not solely nursing care of the sick."

Origin: Chapter 14- Nutrition and Hydration, 7 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 6 Page and Header: 178, Promotion of Oral Health 7. After receiving new dentures the nurse provides instruction to an older patient on the use and their care. Which patient statement indicates that teaching about the dentures has been effective?

A) "I do not have to brush and floss my teeth every day." B) "I suppose that I'll have to get these resized and adjusted from time to time." C) "I'll have to change my diet to include only soft and pureed foods now I suppose." D) "I've had to go to the dentist so often over the last few years and it's a relief not to have to anymore." Ans: B Feedback: It is important that older adults realize that dentures still necessitate maintenance and occasional readjustments. Brushing is still necessary, as is visiting the dentist. The diet of adults with dentures is not noted to be restricted to soft and pureed foods.

Origin: Chapter 3- Diversity, 7 Chapter: 3 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 7. A nurse is being orientated to his new position in a community adjacent to a large Indian reservation. Which of the nurse's following statements indicates a sound understanding of the Native American population with whom he will work? A) "I suppose that we will see a disproportionately high number of clients with lung and oral cancers." B) "The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area." C) "It's unfortunate that many of the older Native Americans are unlikely to have family members involved their care." D) "The unique skin pigmentation of Native Americans means that I'll have to modify my assessment techniques."

A) "I suppose that we will see a disproportionately high number of clients with lung and oral cancers." B) "The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area." C) "It's unfortunate that many of the older Native Americans are unlikely to have family members involved their care." D) "The unique skin pigmentation of Native Americans means that I'll have to modify my assessment techniques." Ans: B Feedback: Diabetes, hypertension, and CVA are all higher than average in Native American adults. Lung and oral cancers are not noted to have a higher prevalence and family is likely to be involved in the care of these elders. The skin tone of Native Americans is not noted to require particular assessment techniques.

Origin: Chapter 15- Rest and Sleep, 4 Chapter: 15 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 187, Nocturnal Myoclonus and Restless Leg Syndrome 4. An older patient is experiencing restless legs that are interfering with sleep. What should the nurse respond to this patient's problem?

A) "Some people find that daily exercise helps with this problem." B) "Most often restless legs can be traced to a deficiency in dietary calcium." C) "There are prescription drugs that nearly always provide relief from this problem." D) "There are a number of different medications that can cause this problem or make it worse." Ans: D Feedback: Antidepressants, antihistamines, antipsychotics, alcohol, caffeine, hypoglycemia, and simple and refined carbohydrates can contribute to restless legs syndrome. Exercise and medications are not noted to provide a solution and calcium is not noted to be implicated in the etiology.

Origin: Chapter 14- Nutrition and Hydration, 3 Chapter: 14 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 175, Nutritional Supplements 3. During a home visit, the nurse is asked by an older couple if vitamin and nutritional supplements can compensate for poor food intake. What should the nurse respond to this question?

A) "Supplements can be useful but avoid those that contain calcium." B) "The risks of excess dosages mean that supplements are best avoided entirely." C) "Supplements should be thought of as supplements, not replacements, so it's best not use them." D) "Vitamin and nutrient supplements can be a useful short-term nutritional measure, but only if they don't interact with prescribed medications." Ans: D Feedback: There is a valid role for supplements in meeting the nutritional needs of older adults, but the risk of medication interactions must be taken into account. It would be unnecessary to recommend complete avoidance of all supplements or of those that contain calcium.

Origin: Chapter 14- Nutrition and Hydration, 1 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs Even though a nursing assistant notices that an older patient's oral intake has been poor since being admitted to the care area, the assistant is not concerned since "older people don't need to eat much anyway." How should the nurse respond to this assistant's comment?

A) "That's a myth actually; older adults have increased caloric and nutritional needs." B) "Actually, older adults who are sick require more calories than younger people do during their recovery." C) "You're right, but it's still important that we provide vitamin supplements especially when a patient is recovering from an illness." D) "Even though it is true that older people don't need quite as many calories as younger people, they need as many nutrients as you or I." Ans: D Feedback: While caloric need does decrease with age, nutrient requirements are relatively consistent across the life span. Older adults do not have increased caloric and nutritional needs. Older adults who are sick do not necessarily require more calories since the basal metabolic rate declines 2% for each decade of life. Vitamin and mineral supplements for older adults are undetermined.

Origin: Chapter 14- Nutrition and Hydration, 4 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 176, Special Needs of Women 4. An older woman asks what she can do to reduce the risk of developing osteoporosis. What should the nurse respond to this patient?

A) "The key to preventing osteoporosis is to remain physically active on a regular basis." B) "For women who have complete menopause, vitamin D supplements are the best form of prevention." C) "The best thing that you can do is to maximize your calcium intake by including dairy at most meals and taking supplements as well." D) "You need to make sure you are getting the recommended daily dose of calcium, which may involve taking supplements at each meal." Ans: D Feedback: Postmenopausal women need to ensure a daily intake of calcium of at least 1 g. Supplements may be required. It would be inaccurate to encourage the woman to consume as much calcium as possible given the risks associated with excess calcium intake. Neither vitamin D supplementation nor exercise is the primary preventative measure for the development of osteoporosis.

16. The nurse is preparing a list of patients who will need the annual influenza inoculation. Which older adult will most likely refuse this vaccination? A) A 71-year-old Christian Scientist B) A 68-year-old man who attends a Unitarian church C) A 68-year-old female patient who identifies herself on admission as a Jehovah's Witness D) A 78-year-old who says that she is a member of the Church of Jesus Christ of Latter Day Saints

A) A 71-year-old Christian Scientist Feedback:Christian Science is a religion based on the use of faith for healing. Christian Scientists may decline drugs, psychotherapy, hypnotism, vaccination, and some other treatments. The other religions and beliefs do not specify that vaccinations are to be avoided.

Origin: Chapter 3- Diversity, 8 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 8. Which of the following statements by a nurse who provides care in an assisted living facility best conveys cultural sensitivity? A) "We need to ensure that both minorities and Americans have their health needs met." B) "It's important to remember that minority groups do not usually express their pain explicitly." C) "We need to build our knowledge of residents who belong to cultural and ethnic groups that we're not familiar with." D) "We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment."

A) "We need to ensure that both minorities and Americans have their health needs met." B) "It's important to remember that minority groups do not usually express their pain explicitly." C) "We need to build our knowledge of residents who belong to cultural and ethnic groups that we're not familiar with." D) "We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment." Ans: C Feedback: Building a knowledge base around cultural groups is a component of culturally sensitive care. Differentiating between "minorities" and "Americans" is an inaccurate dichotomy and it is inaccurate to generalize that all minorities are reticent to express pain. It would be inappropriate to counter an older adult's perception of the cause of illness when it is culturally rooted.

Origin: Chapter 14- Nutrition and Hydration, 11 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 11. The nurse is providing a seminar for a group of seniors on changing nutritional needs. What should the nurse instruct the participants about the reduced need for calories?

A) "You should consume at least three servings of fruits and vegetables daily." B) "You should limit your fat intake to less than 50% of total calories consumed." C) "The consumption of a high-carbohydrate diet prevents the release of glucose." D) "As you age, your basal metabolic rate declines, contributing to weight gain even when you consume the same amount of calories as when you were younger." Ans: D Feedback: Basal metabolic rate declines with age, a fact that can contribute to weight gain. Carbohydrates stimulate the release of insulin while fat intake should be below 30% of calories and five servings of fruit and vegetables should be consumed daily.

Origin: Chapter 3- Diversity, 3 Chapter: 3 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 3. A nurse who works in an inner-city clinic provides care for a large number of the older black clients. Which of the following health promotion activities best reflects the particular health needs of this population? A) A blood sugar and blood pressure monitoring program. B) An education session on the positive health effects of good nutrition. C) A screening mammography campaign for older black women. D) A program that teaches black men the importance of prostate health screening.

A) A blood sugar and blood pressure monitoring program. B) An education session on the positive health effects of good nutrition. C) A screening mammography campaign for older black women. D) A program that teaches black men the importance of prostate health screening. Ans: A Feedback: Diabetes and hypertension are disproportionately prevalent among black American elders. While teaching on nutrition and breast cancer and prostate screening may be beneficial, these are not linked to the particular health needs of this population.

Origin: Chapter 14- Nutrition and Hydration, 12 Chapter: 14 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 12. A confused but physically healthy older patient eats a diet very high in cereals and breads, with fruit only once per week and little protein. How does the patient's diet impact her current condition?

A) A lack of vitamin A can affect her night vision. B) A high-calcium diet can lead to problems with kidney stones. C) The lack of fruit in her diet can contribute to complaints of constipation. D) A high-carbohydrate diet can stimulate abnormally high release of insulin, which can add to her confusion. Ans: D Feedback: An abnormally high release of insulin can cause hypoglycemia, which first presents in the elderly as a confused state. The patient's high-carbohydrate diet could increase her confusion. There is not enough information to support that the patient is experiencing problems with night vision because of a lack of vitamin A. There is also not enough information to support that the patient is experiencing constipation or has a high intake of calcium.

8. The occupational therapist on a geriatric rehabilitation unit of a hospital has integrated a life review into a group therapy session. Which of the following statements best captures the nature of life review among older adults? A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff.

A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff. Ans: B Feedback: A life review can bring to light reflections on older adults' accomplishments but may also reveal profound disappointments and regrets. It should not be seen, however, as a purely negative experience. It is not viewed as a diagnostic tool and does not require special training.

Origin: Chapter 3- Diversity, 9 Chapter: 3 Client Needs: A1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 9. Which of the following contexts would be most appropriate for a screening program for high blood pressure? A) A seniors' group that is based at a Jewish community center in Brooklyn. B) An Indian reservation in rural, Western Oklahoma. C) A predominantly Chinese-American neighborhood in the San Francisco Bay area. D) A minimum security prison serving young, rehabilitating offenders.

A) A seniors' group that is based at a Jewish community center in Brooklyn. B) An Indian reservation in rural, Western Oklahoma. C) A predominantly Chinese-American neighborhood in the San Francisco Bay area. D) A minimum security prison serving young, rehabilitating offenders. Ans: B Feedback: Hypertension is disproportionately high among Native Americans. This is not noted to be the case among Jewish Americans, prisoners, or Americans of Chinese ancestry.

Long Term Care - Pop / LOS

Pop: 65 and older, permanent disability - usually become resident of SNF LOS: usually long term , 22 months

Origin: Chapter 15- Rest and Sleep, 1 Chapter: 15 Client Needs: D1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 186, Circadian Sleep-Wake Cycles 1. The nurse is identifying the different sleep patterns of assigned patients on a geriatric care unit. Which patient is demonstrating the typical sleep pattern of a patient who is older?

A) Age 82 patient sleeps a total of more than 12 hours out of 24 B) Age 90 patient describes the quality of sleep as "better than it ever was" C) Age 80 patient falls asleep early in the evening but wakes up before dawn D) Age 79 patient sleeps in until 9 o'clock each morning despite a lifetime of early rising Ans: C Feedback: The patient who falls asleep early in the evening but wakes up before dawn is demonstrating the behavior of phase advance. The other patients are not demonstrating typical sleep patterns of an older person.

Origin: Chapter 14- Nutrition and Hydration, 5 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 177, Hydration Needs of Older Adults 5. An older patient with a history of renal failure is admitted with dehydration and hyponatremia. The nurse identifies which assessment findings as being consistent with the diagnosis of dehydration? (Select all that apply.)

A) Confusion B) Shortness of breath C) Decreased skin elasticity D) Increased blood urea nitrogen (BUN) E) Adventitious lung sounds on auscultation Ans: A, C, D Feedback: Confusion, decreased skin elasticity, and increased BUN are all associated with dehydration. Adventitious lung sounds and shortness of breath are not associated with dehydration but rather with overhydration.

Origin: Chapter 15- Rest and Sleep, 6 Chapter: 15 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 188, Medical Conditions That Affect Sleep 6. Which patient on a geriatric medicine unit would the nurse recognize as being most prone to sleep problems?

A) An obese female patient receiving IV antibiotics for the treatment of a urinary tract infection B) A 74-year-old female receiving transfusions of packed red blood cells for an upper GI bleed C) A 78-year-old male recovering from an ischemic stroke and has skin breakdown on the coccyx D) A male patient admitted for exacerbation of chronic obstructive pulmonary disease (COPD) with a history of angina Ans: D Feedback: COPD and conditions involving cardiac ischemia are often associated with sleep problems. Infections, ischemic stroke, skin breakdown, and GI bleeds are not noted to be specifically associated with sleep difficulties.

24. The nurse determines that a patient is experiencing spiritual distress. What did the nurse assess in this patient? (Select all that apply.) A) Anger B) Smiling C) Complaining D) Poor appetite E) Refusing to make plans

A) Anger C) Complaining D) Poor appetite E) Refusing to make plans Feedback:Signs of spiritual distress include anger, complaining, poor appetite, and refusing to make plans. Smiling would not be a sign of spiritual distress.

Origin: Chapter 15- Rest and Sleep, 8 Chapter: 15 Client Needs: D2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 189, Pharmacologic Measures to Promote Sleep 8. An older resident of a long-term care facility has recently been prescribed a non-barbiturate sedative. For which effect should the nurse assess in this patient?

A) Anticholinergic effects B) Daytime sedation and confusion C) Respiratory depression and sleep apnea D) Changes in blood pressure and heart rate Ans: B Feedback: Patients who are receiving sedation should be monitored for daytime sluggishness and confusion. Heart rate and blood pressure are not noted to be affected by these drugs and they are not associated with anticholinergic effects. Respiratory depression and sleep apnea are not noted to result from non-barbiturate sedatives.

Origin: Chapter 3- Diversity, 15 Chapter: 3 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 15. A government study investigated the incidence of diseases and their probable causes in elderly Native Americans as compared with all elderly Americans. Study results showed that Native American seniors have twice the incidence of which of the following diseases? ) Arthritis B) Cancer C) Heart disease D) Diabetes

A) Arthritis B) Cancer C) Heart disease D) Diabetes Ans: D Feedback: Diabetes, a disease uncommon among American Indians at the start of the 20th century, now affects about one in five older American Indians (compared with one in ten of all elderly Americans).

Which of the following events is noted to have marked the beginning of the nursing profession's interest in the care of the aged?

A) Articles on the care of the elderly published in the American Journal of Nursing

Origin: Chapter 15- Rest and Sleep, 11 Chapter: 15 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 186, Circadian Sleep-Wake Cycles 11. A healthy older patient is experiencing sleep problems. What should the nurse instruct the patient about the influence of aging as it relates to sleep?

A) As people age, most of them require fewer hours of sleep. B) The normal aging process has minimal effect on the quantity of sleep. C) Older adults are no longer bothered by noise and lights during the night. D) Older people sleep more soundly but awaken more often during the night. Ans: B Feedback: Changes to the circadian rhythm occur, so the quantity of sleep does not change but the hours for sleep change. The other choices are not true statements.

Origin: Chapter 3- Diversity, 4 Chapter: 3 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 4. Nurse Y works in the emergency department of a large, urban hospital. When assessing the following older black adults who have recently presented to the department, which of the following assessments would the nurse want to modify for this population? A) Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive. B) Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus. C) Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease. D) Assessment of a client's chest pain who has a history of myocardial infarction.

A) Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive. B) Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus. C) Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease. D) Assessment of a client's chest pain who has a history of myocardial infarction. Ans: C Feedback: Assessment of cyanosis can be complicated by the high melanin content of black adults' skin. Musculoskeletal assessment, assessment of sensation, and assessment of chest pain would not necessitate modification.

Origin: Chapter 15- Rest and Sleep, 15 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 189, Activity and Rest Schedules 15. An older patient asks for natural methods, instead of medications, to help with falling asleep. What can the nurse suggest to this patient?

A) Avoid protein, take a walk every day, and drink a non-caffeinated herbal tea at bedtime B) Avoid carbohydrates, take a walk every day, and drink non-caffeinated herbal tea at bedtime C) Take a walk every day, get exposure to the sun daily, and drink non-caffeinated herbal tea at bedtime D) Minimize the amount of exercise, get exposure to the sun daily, and drink non-caffeinated herbal tea at bedtime Ans: C Feedback: Natural methods to promote sleep include getting daily exercise, being exposed to the sun every day, and drinking non-caffeinated beverages at bedtime. Protein and carbohydrates can promote sleep and exercise should not be avoided.

Subacute care - Pop / LOS

Pop: Usually older adults that can handle IRF- Transferred from other places to here LOS: 3-5 weeks

Outpatient: pop / LOS

Pop: anyone who lived independently LOS: depends on insurance and # of visit allows

20. An older patient tells the nurse that he meditates to seek enlightenment. Because of this, the nurse might inquire if he wishes to have which item eliminated from his daily dietary intake? A) Beef B) Cereal C) Refined sugar D) Leavened bread

A) Beef Feedback:The belief that enlightenment is found in individual meditation is a characteristic of Buddhism. Buddhists often are vegetarians. Cereal, refined sugar, and leavened bread are not specifically identified as being omitted from the diet of a person who practices Buddhism.

Origin: Chapter 3- Diversity, 11 Chapter: 3 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 11. According to statistics, Baby J, born to a black American couple, has a life expectancy lower than that of Baby K, born to a white American couple. According to current demographic projections, by the seventh decade of life, Baby J's life expectancy will: A) Begin to equal that of similarly aged white elders B) Exceed that of similarly aged Asian elders C) Drop to less than half that of similarly aged Native American elders D) Rise above that of white elders until age 75 and then drop

A) Begin to equal that of similarly aged white elders B) Exceed that of similarly aged Asian elders C) Drop to less than half that of similarly aged Native American elders D) Rise above that of white elders until age 75 and then drop Ans: A Feedback: After reaching the seventh decade of life, black Americans can hope to enjoy a life expectancy equal to that of their white cohorts.

Origin: Chapter 3- Diversity, 19 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 19. When talking with elderly Native Americans and Asian Americans, it is important for gerontological nurses to recognize that: A) Both cultures are in the process of replacing traditional values with modern medicine B) These clients may be reluctant to express their thoughts and feelings openly C) Ritualistic and spiritual healing methods are preferred over modern medical services D) These clients expect to be treated and cared for by family members exclusively.

A) Both cultures are in the process of replacing traditional values with modern medicine B) These clients may be reluctant to express their thoughts and feelings openly C) Ritualistic and spiritual healing methods are preferred over modern medical services D) These clients expect to be treated and cared for by family members exclusively. Ans: B Feedback: In both cultures, traditional attitudes and values persist, although both are willing to accept mainstream medical services in the United States. Ritualistic and spiritual methods may be employed, but they are not necessarily preferred. Family ties are strong, but home care is not necessarily expected. What these groups share is their reticence to reveal personal information to strangers or to speak openly about their health or family problems.

Origin: Chapter 3- Diversity, 1 Chapter: 3 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 24, Increasing Diversity of the Older Adult Population 1. Which of the following projections of future demographics of older Americans is most accurate? A) By 2020, more than 50% of older Americans will belong to a non-Hispanic white group. B) The percentage of black older adults will decrease slightly due to lower life expectancies. C) The number of Hispanic older adults is projected to grow dramatically. D) Within 40 years, a minority of older Americans will be white related to immigration.

A) By 2020, more than 50% of older Americans will belong to a non-Hispanic white group. B) The percentage of black older adults will decrease slightly due to lower life expectancies. C) The number of Hispanic older adults is projected to grow dramatically. D) Within 40 years, a minority of older Americans will be white related to immigration. Ans: C Feedback: Whereas in 2000, approximately 84% of older Americans were non-Hispanic white, it is projected that this population will decrease to 64% by 2050. During this same period, there will be dramatic growth among Hispanic older adults, who will represent 16% of the older population. Black individuals will grow from 8% to 12% of the older population during this time. By 2020, one-quarter of America's older population will belong to a minority racial or ethnic group.

Origin: Chapter 14- Nutrition and Hydration, 13 Chapter: 14 Client Needs: B Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 176, Special Needs of Women 13. After a nutritional assessment the nurse learns that a 70-year-old female patient routinely ingests a diet high in fat. The nurse realizes the patient is at an increased risk for developing which health problem?

A) Cancer B) Arthritis C) Osteoporosis D) Heart disease Ans: D Feedback: Heart disease, cancer, and osteoporosis are among the nutrition-related conditions to which older women are susceptible. From ages 64 to 74, the rate of heart disease equals that of men, and reduction of fat intake can be beneficial in reducing this risk.

Origin: Chapter 15- Rest and Sleep, 20 Chapter: 15 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 192, Pain Control 20. An older patient is complaining of not being able to sleep because of leg pain. What is the first thing that the nurse should identify when relieving the patient's pain?

A) Cause of the pain B) Psychological factors C) Sleeping position at night D) Medications that could interfere with sleep Ans: A Feedback: Identifying the cause of the pain is the essential first step to controlling it. Once the cause of the pain is identified, interventions can be implemented to try to control it. Psychological factors, sleeping position, and medications that interfere with sleep would then be analyzed once the cause of the pain is identified.

Origin: Chapter 15- Rest and Sleep, 18 Chapter: 15 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Sleep Apnea 18. The nurse notes that two obese male residents snore loudly throughout the night. The nurse recognizes that snoring usually accompanies which health problem?

A) Central sleep apnea B) Nocturnal sleep apnea C) Obstructive sleep apnea D) A combination of central and obstructive sleep apneas Ans: C Feedback: Snoring usually accompanies obstructive sleep apnea. Sleep apnea is not categorized as "nocturnal." Central sleep apnea is caused by a defect in the central nervous system that affects the diaphragm.

Origin: Chapter 14- Nutrition and Hydration, 8 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 7 Page and Header: 178, Indigestion and Food Intolerance 8. An older patient asks the nurse what he can about nausea that occurs after eating because of delayed gastric emptying. What advice should the nurse provide to the patient?

A) Changing to a vegetarian, organic diet B) Limiting food intake and taking antacids regularly C) Increasing the amount of soluble and insoluble fiber in his diet D) Eating several small meals throughout the day rather than three larger ones Ans: D Feedback: More frequent intake of smaller amounts of food is noted to be useful in the management of slow gastric emptying. A vegetarian diet and increasing fiber intake are not known to be effective management techniques for delayed gastric emptying. Limiting food and using antacids predisposes the patient to other risks.

Origin: Chapter 3- Diversity, 5 Chapter: 3 Client Needs: D1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 5. A nurse is assessing an 84-year-old female Chinese American's pain following her left hemiarthroplasty 2 days prior. Which of the following characteristics of Chinese Americans should the nurse be aware of during this assessment? A) Chinese Americans often view pain as a virtue and tend to underreport it. B) Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved. C) Chinese women often overstate their pain in light of health care providers' reluctance to provide analgesia. D) There is often a reluctance to acknowledge pain among older Chinese Americans.

A) Chinese Americans often view pain as a virtue and tend to underreport it. B) Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved. C) Chinese women often overstate their pain in light of health care providers' reluctance to provide analgesia. D) There is often a reluctance to acknowledge pain among older Chinese Americans. Ans: D Feedback: Discomfort is not typically aggressively or openly displayed by Chinese persons. Pain is not noted to be seen as a virtue or in a fatalistic light. Pain is not commonly overstated.

Hospice: Pop / LOS

Pop: end of life care LOS: months to years

Origin: Chapter 14- Nutrition and Hydration, 21 Chapter: 14 Client Needs: D3 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 175, Nutritional Supplements 21. During a home visit the nurse notes that an older patient has a tray of many types of vitamins, minerals, and herbal supplements on the kitchen counter. The patient was recently discharged from the hospital after having an acute myocardial infarction. What should the nurse instruct the patient about these supplements?

A) Continue taking the supplements but only with meals B) Stop taking the vitamins and other supplements until further notice C) Take the vitamins but do not exceed the recommended daily allowances for older adults D) Check with the health care provider to identify any supplements that may produce adverse interactions with prescribed medication Ans: D Feedback: Caution is necessary when using vitamins, minerals, and herbal supplements in older patients since some can cause adverse effects if taken in high doses and may interact with many medications. The patient should check with the health care provider before continuing to take the supplements with meals. Telling the patient to stop the supplements until further notice could frighten the patient since some of the supplements may be appropriate. It is most important that the patient check with the health care provider for adverse interactions between the supplements and prescribed medication.

Origin: Chapter 3- Diversity, 22 Chapter: 3 Client Needs: B Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 22. Some health conditions are more prevalent in the black population than in the white population. It is important that nurses pay particular attention to identifying those health conditions. Which of the following health assessments and reasons is the most important in working with black patients? A) Control their lifestyle changes because of a lower life expectancy B) Monitor their blood pressure because of a blunted nocturnal response C) Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems D) Monitor for HIV/AIDS as this is a leading cause of death among African Americans

A) Control their lifestyle changes because of a lower life expectancy B) Monitor their blood pressure because of a blunted nocturnal response C) Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems D) Monitor for HIV/AIDS as this is a leading cause of death among African Americans Ans: B Feedback: Hypertension is the most prevalent health problem among black Americans, and a blunted nocturnal response is one factor responsible for this problem. The serious consequences of high blood pressure would supersede the alterations in skin assessment, and highlighting test results and controlling lifestyle changes would be inappropriate actions.

13. A patient with cancer asks the nurse to pray with him but the nurse does not feel comfortable with prayer. What should the nurse do? A) Decline politely and ask a coworker to pray with the patient B) Arrange transportation so that the patient can attend prayer meetings at his church C) Pray with the patient after making sure he understands that the nurse would prefer not to D) Pray with the patient realizing that the patient's needs are more important than the nurse's beliefs

A) Decline politely and ask a coworker to pray with the patient Feedback:People of faith have long understood the value of prayer, and now growing research evidence supports the positive relationship between prayer and health and healing. One need not be an ordained clergy to hold a patient's hand and offer a prayer. Nurses who are not comfortable offering prayers themselves can ask coworkers to pray with and for their patients who so desire.

Origin: Chapter 14- Nutrition and Hydration, 17 Chapter: 14 Client Needs: D2 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 5 Page and Header: 177, Hydration Needs of Older Adults 17. An 80-year-old patient who has just spent 2 days at the beach with his family is demonstrating confusion, dry skin, a dry brown tongue, sunken cheeks, and concentrated urine. What health problem do the patient's symptoms most likely indicate?

A) Dehydration B) Renal failure C) Hyperthermia D) Food poisoning Ans: A Feedback: The nurse has identified the signs of dehydration in older adults. The manifestations of confusion, dry skin, dry brown tongue, sunken cheeks, and concentrated urine may or may not indicate renal failure, hyperthermia, or food poisoning.

Long term acute care - Pop / LOS

Pop: medically complex, primary and secondary diagnosis LOS: long or short, 25+ days

Origin: Chapter 15- Rest and Sleep, 16 Chapter: 15 Client Needs: D3 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 187, Insomnia 16. The nurse is identifying interventions to help older patients with insomnia. What action should the nurse perform first?

A) Educate older patients about how foods and beverages affect sleep B) Identify insomnia as a short-term problem associated with physical or mental illness C) Suggest natural methods to the older patient fall asleep sooner and sleep more soundly D) Recognize insomnia as a symptom and assess for factors that contribute to disrupted sleep Ans: D Feedback: Insomnia is a symptom, and the underlying cause must be investigated. Because of this, a thorough assessment must be completed before implementing any of the other options. Insomnia is not necessarily a short-term problem.

Origin: Chapter 3- Diversity, 21 Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 21. Which of the following is the most direct way for nurses to accommodate ethnic diversity among their clients? A) Explain how scientific research evidence supports medical treatment B) Provide standardized diets that meet patients' nutritional needs C) Listen to the life stories of elderly patients D) Take a foreign language class or travel abroad

A) Explain how scientific research evidence supports medical treatment B) Provide standardized diets that meet patients' nutritional needs C) Listen to the life stories of elderly patients D) Take a foreign language class or travel abroad Ans: C Feedback: Although the research base underlying treatments may be important to some patients, relating it does not help the nurse understand or address ethnic diversity among patients. Standardized diets ignore patients' food choice preferences, which are often culturally related. Although travel and language study may broaden a nurse's appreciation for other cultures, the most direct step is to value and respect the life stories that patients share.

Origin: Chapter 15- Rest and Sleep, 17 Chapter: 15 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Nocturnal Myoclonus and Restless Leg Syndrome 17. The nurse is preparing to document that an older patient is experiencing nocturnal myoclonus. What assessment finding is consistent with this documentation?

A) Five leg jerks or movements per hour of sleep B) Any number of leg jerks related to the use of antidepressants C) Five leg jerks brought on by an epileptic seizure during a night's sleep D) Leg jerks in combination with episodes of breathing cessation during sleep Ans: A Feedback: Nocturnal myoclonus is a condition characterized by at least five leg jerks or movements per hour during sleep. Nocturnal myoclonus is not associated with the use of antidepressants, epileptic seizures, or breathing cessation during sleep.

Origin: Chapter 14- Nutrition and Hydration, 18 Chapter: 14 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 5 Page and Header: 177, Hydration Needs of Older Adults 18. An 80-year-old patient is admitted to the hospital for dehydration related to flu symptoms and receives intravenous fluids. What is a major risk factor for the patient during this hospitalization?

A) Fluid restriction can lead to infection and constipation. B) Fluid restriction can lead to serious electrolyte imbalance. C) Dehydration can lead to decreased ability of the bladder to distend. D) Overhydration can lead to problems when receiving intravenous fluids. Ans: D Feedback: Older patients are more sensitive to overhydration which is a consideration if intravenous fluids are needed. The patient was admitted and treated with intravenous fluids for dehydration. At this point, overhydration would be a concern. The patient is not prescribed a fluid restriction so there is no risk for infection, constipation, or electrolyte imbalance. Dehydration does not lead to changes in the bladder's ability to distend.

Origin: Chapter 15- Rest and Sleep, 22 Chapter: 15 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 191, Stress Management 22. An older patient is demonstrating signs of dress. How does the nurse explain the body's immediate reaction to stress?

A) Formation of ulcers B) Elevation of blood pressure C) Development of heart disease D) Stimulation of the sympathetic nervous system Ans: D Feedback: Elevated blood pressure, ulcers, and heart disease can result from unrelieved chronic stress. Regardless of the source of the stress, the body's immediate reaction is stimulation of the sympathetic nervous system with such changes as dilation of the pupils and increase in heart rate and respirations.

Origin: Chapter 14- Nutrition and Hydration, 26 Chapter: 14 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 175, Nutritional Supplements; 176, Table 14-5 26. An older patient is prescribed a thiazide diuretic as treatment for mild right heart failure. Which herbal supplements should the nurse instruct the patient to avoid while taking this medication? (Select all that apply.)

A) Green tea B) Kava-kava C) White willow D) Cascara sagrada E) Aloe barbadensis Ans: D, E Feedback: Aloe barbadensis or cascara sagrada interacts with thiazide diuretics to cause an increased loss of potassium. Green tea can cause anorexia, diarrhea, insomnia, and vertigo. Kava-kava interacts with central nervous system depressants to cause increased sedation. White willow interacts with salicylates to cause increased antithrombotic effects.

Holistic gerontological care means helping older individuals achieve a sense of wholeness. How can gerontological nurses best help older individuals achieve this wholeness?

A) Guiding them in understanding and finding meaning and purpose in life

Origin: Chapter 15- Rest and Sleep, 2 Chapter: 15 Client Needs: D1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 186, Sleep Stages; 187, Table 15-2 2. An older patient suffering from chronic exhaustion has an EEG that shows little time is spent in REM sleep. After reviewing the patient's history, what does the nurse suspect might be contributing to the patient's sleep problem?

A) Has two or three glasses of wine near bedtime B) Obese and diagnosed with type 2 diabetes 6 years ago C) Takes low-dose aspirin for the prevention of heart disease D) Stressed due to the spouse's new diagnosis of Alzheimer disease Ans: A Feedback: Certain drugs can decrease REM sleep, including alcohol. The use of aspirin has not been associated with decreased REM sleep. Obesity, type 2 diabetes, and stress have not been linked to specifically reducing the amount of REM sleep although these health problems can negatively impact sleep overall.

Origin: Chapter 3- Diversity, 17 Chapter: 3 Client Needs: A1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 17. Mrs C brings her elderly Chinese grandmother to the health clinic. When Grandmother C finds out that all the clinic physicians on duty are males, she appears embarrassed and becomes quiet and withdrawn. All the office staff were schooled in traditional Western medicine. Of the following suggestions, which best describes what the staff can do to put Grandmother C more at ease about receiving health care? A) Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C's medical problem B) Show Grandmother C a picture of the human body and have her point to the area of her problem C) Observe Grandmother C more closely and ask specific questions D) Tell Grandmother C that being s

A) Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C's medical problem B) Show Grandmother C a picture of the human body and have her point to the area of her problem C) Observe Grandmother C more closely and ask specific questions D) Tell Grandmother C that being seen for treatment by a physician of either gender will put her yin and yang back in balance Ans: C Feedback: Chinese women may be embarrassed to receive health care from a man. Nurses should observe more closely and ask specific questions to ensure that the quiet nature of the patient is not misinterpreted to imply that no problems exist. It would be disingenuous to tell her that receiving care would right her yin and yang, and close observation and questioning would be preferable to simply asking her to point to the problematic area on a picture.

Origin: Chapter 14- Nutrition and Hydration, 25 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 180, Malnutrition 25. The nurse is concerned that an older patient with renal failure is developing malnutrition. What did the nurse assess in this patient? (Select all that apply.)

A) Hematocrit level 30% B) Hemoglobin level 7 g/dL C) Serum albumin level 2.5 g/100 mL D) Blood glucose level 110 mg/dL E) Weight loss of 6% over the last month Ans: A, B, C, E Feedback: Clinical signs of malnutrition include a weight loss of greater than 5% over the last month, a serum albumin level lower than 3.5 g/100 mL, hemoglobin level below 12 g/dL, and hematocrit level below 35%. Blood glucose level is not used as a clinical indicator of malnutrition.

Origin: Chapter 3- Diversity, 12 Chapter: 3 Client Needs: B Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 12. Although only 12% of elderly black Americans experience institutional care in their lifetimes, compared with 23% of elderly white Americans, they typically possess more health problems than their white counterparts. This difference in health status is most likely due to: A) High incidence of violent crime and sexually transmitted diseases B) Reliance on family for health care advice and rejection of formal service agencies C) Cultural preference for unconventional medical treatments like spiritual and herbal remedies D) Lower standard of living and less access to health care services

A) High incidence of violent crime and sexually transmitted diseases B) Reliance on family for health care advice and rejection of formal service agencies C) Cultural preference for unconventional medical treatments like spiritual and herbal remedies D) Lower standard of living and less access to health care services Ans: D Feedback: Black elders historically possess many health problems that have accumulated over a lifetime due to a poor standard of living and limited access to health care services. Although the other choices may apply to this population, they are not the major reasons for the diminished health status of many black elders.

Which of the following statements about gerontological nursing is supported by research evidence?

C) Gerontological clinical nurse specialists in acute hospitals decrease the length of stay for elderly patients.

Origin: Chapter 3- Diversity, 20 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 25, Hispanic Americans 20. To receive government money, County Hospital is required to provide demographic statistics on its patient base. In checking off the Ethnic Group boxes on the obligatory forms, office workers must be able to distinguish terminology. Which of the following best defines the term Hispanic? A) Immigrant workers who entered the United States and their descendants B) Puerto Ricans who emigrated from the United States and their descendants C) Any Spanish-speaking people living in the United States D) Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil

A) Immigrant workers who entered the United States and their descendants B) Puerto Ricans who emigrated from the United States and their descendants C) Any Spanish-speaking people living in the United States D) Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil Ans: C Feedback: The term Hispanic encompasses a variety of Spanish-speaking persons in America, including Spaniards, Cubans, Mexicans, and Puerto Ricans. Hispanic people now represent approximately 6% of the older population.

Origin: Chapter 14- Nutrition and Hydration, 2 Chapter: 14 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 2. A health-conscious resident of an assisted living facility is promoting the value of fiber to a fellow resident. Which statement made by the resident about the benefits of fiber is accurate?

A) Improved bowel activity and increased metabolic rate B) Improved bowel activity and decreased serum cholesterol C) Improved gastric emptying and prevention of colon cancer D) Increased nutrient absorption and decreased glucose tolerance Ans: B Feedback: Fiber is noted to lower serum cholesterol and promote good bowel activity. It is not noted to improve nutrient absorption or gastric emptying or to increase overall metabolic rate.

Origin: Chapter 14- Nutrition and Hydration, 10 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 179, Constipation 10. The nurse is planning interventions for an older patient who is prone to developing constipation. Which intervention would be appropriate for the nurse to implement with this patient?

A) Increase fluids and encourage activity B) Scheduled administration of oil-based laxatives C) Provide normal saline enemas every 2 to 3 days D) Reduce activity and provide senna each day before bed Ans: A Feedback: Plenty of fluids and activity are advisable to prevent the onset of constipation. Laxatives and enemas would not be appropriate to prevent the onset of constipation. Reducing activity could contribute to the development of constipation.

Origin: Chapter 15- Rest and Sleep, 5 Chapter: 15 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Sleep Apnea 5. An older patient complains of overwhelming daytime fatigue, which the spouse attributes to loud snoring and erratic breathing patterns during the night. Which health problem should the nurse suspect as causing this patient's fatigue?

A) Insomnia B) Central sleep apnea C) Nocturnal myoclonus D) Obstructive sleep apnea Ans: D Feedback: Obstructive sleep apnea is characterized by periods without breathing during sleep and is most often accompanied by snoring. Central sleep apnea is not as frequently marked by snoring and neither insomnia nor nocturnal myoclonus is suggested by the patient's particular signs and symptoms.

Origin: Chapter 14- Nutrition and Hydration, 14 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 175, Nutritional Supplements 14. An older patient reports a significant amount of cheese, milk, and calcium-fortified orange juice in her diet. She also takes a 750 mg calcium supplement at breakfast. What should the nurse instruct the patient about her calcium intake?

A) Keep the intake of calcium to 30% of kilocalories or less B) Take calcium supplement doses totaling not more than 5,000 mg C) Limit the intake of calcium to a total of 2,000 mg or less from all sources D) Follow the RDA listed on the milk products' nutrition labels for calcium intake Ans: C Feedback: If the patient has a daily calcium intake of greater than 2,000 mg, she may be at risk for kidney stones. Patients should check labels of food as well as supplements to ensure that the contents do not add up to excessive calcium consumption; however, the RDA listed on milk products' nutritional labels for calcium intake may be too great for the older patient. Calcium does not contribute to caloric intake. Calcium supplements totaling not more than 5,000 mg is too high an amount for most adults.

Home Health: pop / los

Pop: medically stable enough to be homebound LOS: 2-3 months, or permanent proven progress

Origin: Chapter 3- Diversity, 13 Chapter: 2 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 13. Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because: A) Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B) Black Americans have a higher incidence of cancer and diabetes than white Americans C) Hypertension and heart disease occur at a higher rate in the black population than in the white population D) Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep

A) Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B) Black Americans have a higher incidence of cancer and diabetes than white Americans C) Hypertension and heart disease occur at a higher rate in the black population than in the white population D) Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep Ans: C Feedback: The black population has a higher prevalence of heart disease than the white population, and hypertension occurs at a higher rate. A contributing factor is a blunted nocturnal response, in which only a minor decline occurs during sleep. Even though it is true that black persons have a higher incidence of cancer and diabetes than white persons, blood pressure screening does not address those disorders. Lifestyle modifications can effectively control many causes of morbidity and mortality among all people.

Origin: Chapter 3- Diversity, 14 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 14. Nurse A works with Native American patients at a reservation health care center. She advises a new staff member to be especially observant of these patients and tolerant of their health care requests because Native American patients: A) May demand special rituals during sickness and at death B) Use services from agencies as a last resort because such assistance conflicts with their belief in the Great Creator C) Link the typical nursing assessment process to evil forces or to punishment D) Show their absence of feeling, caring, or discomfort by appearing calm and controlled

A) May demand special rituals during sickness and at death B) Use services from agencies as a last resort because such assistance conflicts with their belief in the Great Creator C) Link the typical nursing assessment process to evil forces or to punishment D) Show their absence of feeling, caring, or discomfort by appearing calm and controlled Ans: A Feedback: Spiritual rituals, medicine men, herbs, homemade drugs, and mechanical interventions can be used by Native American people to treat illness. Treatment does not necessarily conflict with belief in a Great Creator and the nursing assessment process is not linked to punishment. Feeling and care are not absent among Native Americans.

Origin: Chapter 14- Nutrition and Hydration, 6 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 177, Hydration Needs of Older Adults 6. An older patient is demonstrating signs of dehydration. Which action should the nurse initiate first?

A) Minimize food intake and maximize fluid intake B) Advocate for the initiation of intravenous rehydration C) Initiate monitoring and recording of fluid intake and output D) Ask that the physician order blood work to confirm or rule out dehydration Ans: C Feedback: When dehydration is suspected, the nurse should monitor and record fluid intake and output. This would likely precede IV rehydration and blood work, and minimizing food intake would be an inappropriate action.

Post Acute - Population / LOS

Pop: sustained an acute injury or illness, needs further medical help to return to community- INTENSE THERAPY LOS: 1-3 weeks

Origin: Chapter 15- Rest and Sleep, 10 Chapter: 15 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 192, Pain Control 10. What should the nurse keep in mind when determining the relationship between pain and sleep in an older patient?

A) Nonpharmacologic measures to control pain and enhance sleep are preferable to analgesics. B) Analgesic drugs should be administered to older adults to prevent potential episodes of pain. C) Older adults are more sensitive to pain than younger adults, and more at risk of having pain interfere with sleep. D) The availability of alternative forms of pain control such as massage and diversion means that pharmacologic pain medications are inappropriate and unnecessary. Ans: A Feedback: Nonpharmacologic measures to control pain should be attempted whenever possible. If nonpharmacologic means of pain relief are ineffective, it is appropriate to provide the weakest type of analgesic and increase as necessary to control pain. It is not known if older adults are more sensitive to pain and it would inappropriate to administer analgesic medications prophylactically to all older adults.

Origin: Chapter 15- Rest and Sleep, 3 Chapter: 15 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 186, Sleep Efficiency and Quality 3. An older patient hospitalized for pneumonia is having difficulty sleeping and is frustrated with the noises at night. What should the nurse do about this situation?

A) Obtain an order for a benzodiazepine to be taken at bedtime B) Change the temperature of the client's room to be more conducive to sleep C) Provide a form of white noise and plan to minimize noise during caregiving activities D) Teach the client about the normal changes in sleep quality and quantity that accompany aging Ans: C Feedback: Reorganizing care to avoid awakening and providing white noise can facilitate sleep. These actions would be preferable to pharmacologic measures while changing the temperature does not specifically address the patient's concerns. Teaching on sleep changes would be inappropriate given the nature and context of the patient's concerns.

Origin: Chapter 15- Rest and Sleep, 9 Chapter: 15 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 189, Activity and Rest Schedules 9. Because many residents in a long-term care facility are experiencing sleep problems, which routine should the nurse reevaluate?

A) Offering a light snack at bedtime B) Bathing residents in the evening rather than first thing in the morning C) Activities are concentrated in the morning to ensure evenings are free D) Encouraging residents to refrain from going to bed when they first feel drowsy in the evening Ans: C Feedback: It is preferable to intersperse activities throughout the day rather than concentrating them in the morning. A bath and a snack in the evening are both conducive to sleep and going to bed too early is not conducive to sustained sleep.

Origin: Chapter 15- Rest and Sleep, 12 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 186, Sleep Efficiency and Quality 12. An older patient is relocating to the home of her daughter who wants to modify the home environment to suit her mother's needs. What information should the nurse provide to the daughter to address the patient's age-related sleeping needs?

A) Older people are less active during the day and require less sleep at night. B) Older people are not affected by age-related changes but may have some individual needs. C) Older people stay awake very late into the night and as a result usually sleep late in the morning. D) Older people sleep less soundly and may awaken to noises that would not cause the same reaction in younger adults. Ans: D Feedback: The normal aging process has minimal effect on quantity of sleep, but that is not true of quality of sleep. Older people sleep less soundly and are prone to early rising and falling asleep early in the evening. Older individuals are more likely to be awakened by noises that may not cause a reaction in younger adults.

Origin: Chapter 15- Rest and Sleep, 24 Chapter: 15 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 186, Sleep Stages; 187, Table 15-2 24. The nurse determines that an older patient is in stage II of sleep. What did the nurse observe in this patient? (Select all that apply.)

A) Relaxed muscles B) Easily awakened C) Rapid respirations D) Difficult to awaken E) Minor eye movement seen Ans: B, E Feedback: In stage II of sleep the person will be easily awakened and will have some eye movement noted through closed lids. Relaxed muscles occur in stage III of sleep. Difficulty awakening occurs in stages III and IV of sleep. Rapid respirations might occur during REM sleep.

Origin: Chapter 14- Nutrition and Hydration, 19 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 6 Page and Header: 178, Promotion of Oral Health 19. An older female patient will only eat oatmeal and has bad breath. A dental exam reveals that the patient has a few of her own teeth and uses a partial appliance. She also has red, swollen, painful gums, and some teeth are loose at the gumline. The nurse realizes the patient is experiencing which health problem?

A) Periodontal disease B) Endodontic disease C) Gastrointestinal disease D) Lack of adequate nutrition Ans: A Feedback: The patient's signs and symptoms are typical of periodontal disease. These signs and symptoms are consistent with endodontic disease, gastrointestinal disease, or a lack of adequate nutrition.

Origin: Chapter 15- Rest and Sleep, 23 Chapter: 15 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 191, Stress Management 23. An older patient is telling the nurse about life stresses, including a chronically ill spouse and problems with grandchildren. What is the most appropriate information for the nurse to provide to the patient?

A) Pharmacological options B) Ways to prevent chronic stress C) The benefits of natural remedies D) The name and phone number of a geriatric therapist Ans: B Feedback: It is most appropriate to discuss ways to prevent chronic stress, although the patient has ongoing stressors. The patient needs to identify those periods of stress; manage them with healthy responses, relaxation, and so on; and then allow some recovery periods. These actions should come before using pharmacological interventions, natural remedies, or scheduling an appointment with a geriatric therapist.

Origin: Chapter 3- Diversity, 16 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Jewish Americans 16. Rehabilitation Health Facility has a high percentage of Jewish patients recovering from a variety of ailments. Which of the following is important for the facility's staff to know about medical care and the Jewish culture? A) Pork and shellfish but not milk products are recommended as healthful foods in the diet. B) A rabbi must be consulted before any health-related decisions can be made. C) A skullcap and socks must be worn from sundown Friday to sundown Saturday. D) Modern medical care is encouraged but may be opposed during the Sabbath.

A) Pork and shellfish but not milk products are recommended as healthful foods in the diet. B) A rabbi must be consulted before any health-related decisions can be made. C) A skullcap and socks must be worn from sundown Friday to sundown Saturday. D) Modern medical care is encouraged but may be opposed during the Sabbath. Ans: D Feedback: In the Jewish culture, medical care is encouraged but may be opposed during the Sabbath. Exceptions may be made for the seriously ill. The other choices are not true of the Jewish culture.

26. The nurse is planning care to address a patient's spiritual distress. Which interventions would be appropriate to include in this plan of care? (Select all that apply.) A) Pray with the patient upon request as needed and desired B) Find a volunteer to read the Bible to the patient upon request C) Remind the patient that spiritual needs are often addressed last D) Contact the patient's church to have the clergy visit the patient E) Help the patient identify factors contributing to spiritual distress

A) Pray with the patient upon request as needed and desired B) Find a volunteer to read the Bible to the patient upon request D) Contact the patient's church to have the clergy visit the patient E) Help the patient identify factors contributing to spiritual distress Feedback:Interventions to address spiritual distress include praying with the patient upon request and as desired, finding someone to read the Bible to the patient upon request, contacting the patient's church for clergy to visit, and helping the patient identify factors that contribute to spiritual distress. Reminding the patient that spiritual needs are often addressed last will not help with the patient's spiritual needs at this time and would be inappropriate to include in the plan of care.

23. During an assessment an older male patient states that he has not been happy in life because he does not deserve to be loved. The nurse realizes that this patient believes love has been withheld because of which criteria? (Select all that apply.) A) Productivity B) Social position C) Education level D) Physical condition E) Material possessions

A) Productivity B) Social position D) Physical condition E) Material possessions Feedback:Spiritual love is unconditional and people need to feel loved regardless of their physical condition, social position, material possessions, or productivity. Educational level is not identified as a condition for being loved.

Origin: Chapter 15- Rest and Sleep, 13 Chapter: 15 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 189, Pharmacologic Measures to Promote Sleep 13. An older patient who spends most of the time in bed because of impaired mobility is complaining about not getting enough sleep. What would cause the nurse concern if this patient were prescribed sleep sedatives?

A) Promotion of incontinence B) Depression of some vital body functions C) Decreased body movements during sleep D) Decreased susceptibility to adverse reactions Ans: C Feedback: The patient already has compromised body movements. All sedatives may decrease body movements during sleep and predispose the older person to many complications of reduced mobility. It is not known if the sleep sedative would promote incontinence, depress vital body functions, or decrease susceptibility to adverse reactions of the sleep medications.

As compared with a geriatric nurse, on what does the gerontological nurse place greater emphasis?

A) Promotion of wellness and quality of life throughout the life span

Origin: Chapter 15- Rest and Sleep, 21 Chapter: 15 Client Needs: D2 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 192, Pain Control 21. Nonpharmacologic pain relief measures have been ineffective to reduce an older patient's pain to promote sleep. What should the nurse do next?

A) Provide a trial of opioids B) Give the strongest dosage of analgesic and gradually decrease as necessary C) Administer the lowest dosage of analgesic and gradually increase as necessary D) Offer the lowest dosage of analgesic and give only when requested by the patient Ans: C Feedback: When providing pharmacologic pain relief prior to sleep it is advisable to always begin with the weakest type and dosage of analgesic and gradually increase as necessary. Analgesics should be administered regularly to maintain a constant blood level; fear of addiction should not be a factor in appropriately using analgesics to assist patients with pain relief.

Origin: Chapter 14- Nutrition and Hydration, 15 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 7 Page and Header: 182, Assessment Guide 14-1 15. The nurse observes the skin of an older patient and then asks the patient questions about his nutritional status. How did inspection of the patient's skin guide the nurse to complete a nutritional assessment?

A) Purpura may indicate hyperglycemia B) Fungus infections may indicate zinc deficiency C) Poor skin turgor may be an indicator of overhydration D) Persistent "goose bumps" may indicate a vitamin deficiency Ans: D Feedback: Persistent "goose bumps" can be indicative of a deficiency in B vitamins. Purpura does not indicate hyperglycemia. Fungus infections do not indicate a zinc deficiency. Poor skin turgor may be an indication of dehydration and not overhydration.

Origin: Chapter 15- Rest and Sleep, 27 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 191, Stress Management 27. An older patient has identified stress as being the cause for not receiving adequate sleep and wants to "do something" to relax. Which activities should the nurse suggest to the patient? (Select all that apply.)

A) Read B) Take a walk C) Needlework D) Listen to music E) Visit with friends Ans: A, C, D Feedback: Activities to help with relaxation include reading, performing an activity in which to get absorbed such as needlework, and listening to music. Taking a walk and visiting with friends could increase stimulation and may not be relaxing to the patient.

27. A patient is observed sitting on the side of the bed crying. When approached the patient does not say anything but continues to cry and hold the nurse's hand. What should the nurse do to communicate being present with the patient? A) Sit down next to the patient B) Leave the patient alone to cry C) Encourage the patient to stop crying D) Ask the patient to use the call bell if he or she wants to talk

A) Sit down next to the patient Feedback:Nurses need to be available for patients to express their feelings. This means being fully present without being distracted or thinking about other activities. The best action for the nurse to take to communicate being present with the patient is to sit down next to the patient. Leaving the patient alone to cry, encouraging the patient to stop crying, or asking the patient to use the call bell if he or she wants to talk does not communicate being present with the patient.

Origin: Chapter 15- Rest and Sleep, 19 Chapter: 15 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Sleep Apnea 19. An adult male patient who works full time complains of being tired all day even after getting 8 hours of sleep each night. Which condition is most likely the cause of this patient's complaint?

A) Sleep apnea B) Alcohol abuse C) Nocturnal myoclonus D) Age-related changes to sleep Ans: A Feedback: Sleep apnea is the most likely cause. It is two times greater in men than in women, and fatigue in spite of seemingly sufficient quantity of sleep is more characteristic of sleep apnea than of the other cited problems. There is no information to suggest the patient is using alcohol. The patient is not explaining symptoms of nocturnal myoclonus. It is unknown what the patient's age is to assume that the complaint is due to age-related changes.

12. At the conclusion of a health history the nurse conducts a spiritual assessment with the patient. Why is this assessment important? A) Strong spiritual beliefs facilitate health and healing B) A spiritual crisis can trigger a psychosomatic disease C) It is the nurse's job to facilitate communication between the patient and the clergy D) The nurse needs to be careful that therapeutic regimens do not violate a patient's religious beliefs

A) Strong spiritual beliefs facilitate health and healing Feedback:Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is of therapeutic benefit to support patients' spirituality and assist them in fulfilling spiritual needs. The nurse does not complete a spiritual assessment to avoid the onset of a psychosomatic disease or to facilitate communication between the patient and the clergy. This assessment is also not being done to ensure that therapeutic regimens will not violate the patient's religious beliefs.

Origin: Chapter 3- Diversity, 23 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 23. An elderly Chinese patient tells the nurse that blockage of qi in one of her meridians is causing her severe headaches. Her doctor has diagnosed migraines and has prescribed a triptan drug. The nurse's best course of action is to: A) Suggest that the prescribed medicine may stimulate the flow of qi B) Explain the vasoconstrictive and serotonin-moderating action of triptan C) Recommend acupuncture or acupressure treatments as an adjunct to the triptan D) Caution her that her headaches will grow worse if she fails to take her medication

A) Suggest that the prescribed medicine may stimulate the flow of qi B) Explain the vasoconstrictive and serotonin-moderating action of triptan C) Recommend acupuncture or acupressure treatments as an adjunct to the triptan D) Caution her that her headaches will grow worse if she fails to take her medication Ans: A Feedback: Although explaining the scientific principles underlying drug action is often appropriate, the same objective can be achieved through the use of culturally relevant terms and concepts. Recommending additional treatments is unnecessary and may be inappropriate. Threats or predictions of dire consequences may impede the communication process.

Origin: Chapter 3- Diversity, 6 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Jewish Americans 6. Which of the following interventions in the care that preceded the death of a female, Jewish older American was most likely to have warranted special consideration? A) The client required transfusions of packed red blood cells during her care. B) Assessment by a male physician was required. C) An autopsy was ordered due to the client's unique disease etiology. D) A do-not-resuscitate (DNR) order was recommended by the care team when the client's disease progressed.

A) The client required transfusions of packed red blood cells during her care. B) Assessment by a male physician was required. C) An autopsy was ordered due to the client's unique disease etiology. D) A do-not-resuscitate (DNR) order was recommended by the care team when the client's disease progressed. Ans: C Feedback: Autopsy is often opposed in the context of Jewish religious and cultural beliefs. Blood transfusions, assessment by a physician of the opposite sex, and DNR orders are not noted to be particular issues in the context of this culture.

Nurse L works on an acute care for elders (ACE) unit of a county hospital. Which of the following sources should the nurse utilize as standards for practice? Select all that apply.

A) The American Nurses Association (ANA) standards B) The Joint Commission C) Hospital-specific standards of practice D) State and federal regulations All of the listed sources are valid

Origin: Chapter 3- Diversity, 2 Chapter: 3 Client Needs: C Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 25, Hispanic Americans 2. A nurse is providing care for an 81-year-old Hispanic woman in the context of a geriatric medicine unit of a hospital. Which of the following phenomena should the nurse anticipate? A) The client's family is likely to advocate for her placement in a nursing home at an early stage. B) The client is likely to prioritize the role of spirituality in the healing process. C) She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness. D) The woman's family will most likely delegate responsibility for her care to the hospital care team.

A) The client's family is likely to advocate for her placement in a nursing home at an early stage. B) The client is likely to prioritize the role of spirituality in the healing process. C) She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness. D) The woman's family will most likely delegate responsibility for her care to the hospital care team. Ans: B Feedback: Hispanic elders often emphasize the role of spirituality in both the etiology and treatment of disease. Nursing home admissions are proportionately low and while health and illness are often seen as the actions of God, this does not translate into a rejection of treatment. The family is likely to play a central role in care planning and recovery.

Origin: Chapter 14- Nutrition and Hydration, 9 Chapter: 14 Client Needs: A2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 179, Dysphagia 9. The family of an older patient with dysphagia comes to the skilled nursing facility at mealtimes to feed the patient. Which of the family's feeding practices should the nurse follow up with teaching or correction?

A) The family makes sure that the patient does not talk while eating B) The family checks for pocketing of food prior to introducing another bite C) The family places the patient in high Fowler position during and after feeding D) The family introduces large pieces of food to prevent accidental inhalation of small food particles Ans: D Feedback: For patients with dysphagia, small pieces of food are preferable. The other actions by the family are appropriate when feeding a patient with dysphagia.

Origin: Chapter 14- Nutrition and Hydration, 16 Chapter: 14 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 177, Hydration Needs of Older Adults 16. A 75-year-old patient and his 40-year-old daughter both have an intestinal virus with complaints of vomiting and diarrhea. Why is the nurse concerned about the patient being at risk for dehydration?

A) The patient is on a fixed income B) The virus will make changes to the patient's gastrointestinal system C) The vomiting and diarrhea will cause a reduction in intracellular fluids D) The patient does not want to bother a health care professional for a common virus Ans: C Feedback: The patient is at risk because of his age. With age, intracellular fluid is lost, resulting in decreased body fluids. Water makes up 50% or less of body weight in older adults, compared with 60% in younger adults. An increase in water loss could be life-threatening to an older person. The nurse's concern has nothing to do with the patient's income. The virus will not make changes to the patient's gastrointestinal system. There is not enough information to determine that the patient does not want to bother the nurse for a common virus.

Origin: Chapter 14- Nutrition and Hydration, 22 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 7 Page and Header: 179, Dysphagia 22. The nurse is instructing a nursing assistant on how to feed all patients with dysphagia. What information should the nurse include in this instruction?

A) Thicken liquids and cut solids into very small pieces B) Use a spoon to transport even solid food to the patient's mouth C) Listen for bowel sounds to make sure the food has reached the stomach D) Make sure the patient is sitting upright whenever consuming food or fluid Ans: D Feedback: One general measure for all persons with dysphagia is to have the patient sitting upright whenever food or fluid is being consumed. The other feeding measures may not be indicated for every person with dysphagia.

Origin: Chapter 14- Nutrition and Hydration, 24 Chapter: 14 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 180, Box 14-1; 180, Malnutrition 24. An older patient takes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for self-treatment of arthritis. For which nutritional health problems will the nurse include when assessing this patient? (Select all that apply.)

A) Thirst B) Nausea C) Diarrhea D) Vomiting E) Constipation Ans: B, C, D, E Feedback: Nutritional health problem risks associated with taking NSAIDs include nausea, diarrhea, vomiting, and constipation. Thirst is not associated with taking NSAIDs.

Origin: Chapter 3- Diversity, 10 Chapter: 3 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 10. Nursing students attending City College of Nursing are scheduled for clinical experience at facilities in various sections of the city. Their experience will expose them to a wide variety of populations. Which of the following is a major reason why nurses need to understand the general characteristics of various ethnic groups? A) To ensure that clients get the respect customary in their own ethnic group B) To provide individualized and culturally sensitive care C) To ensure that medical treatments comply with cultural expectations D) To increase compliance among minority patients

A) To ensure that clients get the respect customary in their own ethnic group B) To provide individualized and culturally sensitive care C) To ensure that medical treatments comply with cultural expectations D) To increase compliance among minority patients Ans: B Feedback: To understand the uniqueness of each older adult encountered, consideration must be given to the influences of ethnic origin.

8. An older male patient with end-stage renal disease is sad and believes that he will die within a few days. Which interventions should the nurse use to promote hope in the patient? (Select all that apply.) A) Using humor at the bedside B) Facilitating a life review for the client C) Helping the client to find pleasure during current life activities D) Encouraging the client to focus on a time of life that was more pleasant E) Introducing the client to an individual who has a much poorer prognosis and/or health status

A) Using humor at the bedside B) Facilitating a life review for the client C) Helping the client to find pleasure during current life activities Feedback:The tactful use of humor, facilitation of life review, and aiding clients in finding pleasure in activities are noted to instill hope. Encouraging comparison to someone with a worse situation and encouraging focus on a different time of life are not noted to foster the development of hope.

Origin: Chapter 15- Rest and Sleep, 25 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 189, Promoting Rest and Sleep in Older Adults 25. An older patient is being admitted to a long-term care facility. What information will the nurse include when conducting a sleep history with this patient? (Select all that apply.)

A) Usual bedtime routine B) Characteristics of sleep C) Amount of daytime drowsiness D) Food and fluids consumed before sleep E) Number of hours doing housework each day Ans: A, B, C, D Feedback: Parts of a sleep history include the patient's usual bedtime routine, characteristics of sleep, amount of daytime drowsiness, and food and fluids consumed before sleep. The number of hours doing housework each day is not a part of the sleep history.

Origin: Chapter 3- Diversity, 18 Chapter: 3 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 18. A statistical analysis of City Health Clinic's patient base shows that few of its patients are elderly Asian Americans. Nurse K, a second-generation Asian American, offers a probable cause for this phenomenon. She knows that Asian American groups, though different from each other: A) Value a strong family network and expect that family members will care for their elders at home B) Subscribe to traditional health practices and reject modern technology C) Do not express their feelings openly or challenge the health professional D) Have preserved many of their homeland traditions and tend to live in isolated pockets

A) Value a strong family network and expect that family members will care for their elders at home B) Subscribe to traditional health practices and reject modern technology C) Do not express their feelings openly or challenge the health professional D) Have preserved many of their homeland traditions and tend to live in isolated pockets Ans: A Feedback: Although differences among various Asian American groups exist, two similarities are strong family networks and the expectation that family members will care for their elders at home. They do not necessarily reject modern technology and neither reluctance to express feelings nor the tendency to preserve traditions would account for the phenomenon noted.

Origin: Chapter 14- Nutrition and Hydration, 20 Chapter: 14 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 6 Page and Header: 178, Promotion of Oral Health 20. An older patient has dentures and tells the nurse that she has not seen the dentist for years. What is the best advice the nurse should provide the patient?

A) Visit the dentist periodically to replace the dental appliance B) Visit the dentist regularly if she wears his dentures everyday C) Make an emergency dental visit if she notices a problem with the gums D) Schedule regular visits with the dentist to monitor for lesions and fit of the dental appliance Ans: D Feedback: Older adults commonly misunderstand their need for dental care once they have dental appliances. The nurse should correct this misconception and encourage the patient to have routine dental examinations. The dental appliance may or may not need to be replaced. The patient should see the dentist regularly whether or not the dentures are worn every day. If the patient visits the dentist regularly, a problem with the gums could be avoided.

Origin: Chapter 15- Rest and Sleep, 26 Chapter: 15 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 190, Food and Supplements 26. The nurse was considering melatonin supplements for an older patient with a sleep disturbance but realized this action would be contraindicated because of the patient's medications. Which medications interact with melatonin? (Select all that apply.)

A) Warfarin B) Salicylates C) Antipsychotics D) Antidepressants E) Immunosuppressants Ans: A, C, D, E Feedback: Melatonin supplements interact with immunosuppressants, antidepressants, antipsychotics, and warfarin. Salicylates are not documented as interacting with melatonin supplements.

Origin: Chapter 15- Rest and Sleep, 14 Chapter: 15 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 190, Environment 14. An older patient asks the nurse for medication to promote sleep. What is the best alternative to sleep sedatives that the nurse can suggest?

A) Watch television before going to bed B) Drink some wine before going to bed C) Take a warm bath before going to bed D) Avoid eating carbohydrates before going to bed Ans: C Feedback: A warm bath is the best alternative. Television is likely not as relaxing as a bath. Alcohol is a depressant and may help the patient go to sleep but will probably not promote quality of the sleep. A person should eat carbohydrates before sleep because they tend to raise the serotonin level, which could have a sedating effect.

Origin: Chapter 14- Nutrition and Hydration, 23 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 23. The nurse is caring for an 85-year-old male patient who weighs 150 lb and is 6 feet 3 inches tall. If using the resting energy expenditure equation, how many calories must the patient consume each day to maintain his current body weight? (Be sure to round your answer to the nearest whole number.)

Ans: 1,378 calories Feedback: The equation for a male patient is 66 + [(6.23 × weight in pounds)] + [(12.7 × height in inches)] - (6.76 × age in years). For this patient, the equation would be: 66 + [(6.23 × 150 lb)] + [(12.7 ×75 inches)] - (6.76 × 85) 66 + 934.5 + 952.5 - 574.6 = 1378.4 calories

2. The nurse manager of a geriatric medicine unit learns that spiritual care services are underutilized by patients and their families. Which phenomenon explains this finding? A) While spiritual needs are a universal part of the human condition, many people do not acknowledge these needs. B) The high-stress environment of a hospital is incompatible with the solace and quiet necessary for addressing spiritual needs. C) Spiritual needs are less apparent during times of immediate and tangible need, such as acute illness requiring hospital treatment. D) Many older adults who have experienced a lifetime of self-sufficiency and practical resourcefulness do not have spiritual needs.

A) While spiritual needs are a universal part of the human condition, many people do not acknowledge these needs. Feedback:All humans have spiritual needs regardless of whether they realize or acknowledge them. Some of these needs become relevant in late life when the high prevalence of chronic illness and the reality of death are evident. While a hospital does provide a high-stress environment, this is not mutually exclusive with identifying and providing for patients' spiritual needs.

An elderly client with obesity, arthritis, and osteoporosis has a fall with a hip fracture. He is transported via ambulance to the acute hospital. Due to pain and obesity, his recovery is slower than is typical, and his only available caregiver is his frail wife. Which might be his next step on the continuum? a. Subacute facility b. Home c. Outpatient d. LTAC

A. Subacute facility

High to low Acuity

Acute Hospital - LTAC - inpatient rehab - subacute - LTC - HH - Outpaitent

19. Bone fractures are a serious risk to the elderly. Which of the following is a contributing factor? A) Diminished calcium absorption B) Shortening of the long bones C) Formation of points and spurs D) Deterioration of cartilage surfaces

Ans: A Feedback: A decrease in calcium absorption in the elderly contributes to the brittleness of the bones, thus increasing the risk of fractures.

3. Which of the following clients of a nurse practitioner is demonstrative of a growing trend in the role of grandparents in contemporary American society? A) A 70-year-old grandmother is raising her two grandchildren because their mother is in prison. B) An 80-year-old client of the nurse is going through a divorce with her husband of several decades. C) A 79-year-old man laments the fact that he is estranged from his son's children. D) A married couple in their seventies who refuse to provide free child care for their grandchildren on a daily basis.

Ans: A Feedback: A growing number of grandparents have primary responsibility for the care of their grandchildren, a fact that can often be attributed to teen pregnancy, incarceration, or substance abuse. Divorce late in life, estrangement from grandchildren, and refusal to provide care are not noted to be phenomena.

16. The children of an elderly resident at a nursing home are concerned that their parent is alone and lonely. A staff nurse can assure the family that the elderly should be allowed periods of solitude because such times: A) Are essential for reflecting, analyzing, and better understanding the dynamics of life B) Decrease loneliness, insecurity, and self-imposed isolation C) Help the elderly face the misfortunes of growing old D) Affect displays of anxiety, depression, and anorexia

Ans: A Feedback: Being alone and being lonely are not the same thing. Periods of isolation are essential at all ages for the reason listed in choice A.

7. Which of following statements most accurately captures the role of chronic illness in the lives of older adults? A) Chronic illnesses constitute the leading cause of death for older adults. B) More older adults die from acute illnesses than from chronic diseases. C) While chronic diseases used to be the leading cause of death, this is no longer the case. D) While cancer rates have fallen, other chronic diseases remain a common cause of death.

Ans: A Feedback: Chronic illnesses constitute the leading cause of death for older adults, exceeding those attributed to acute illnesses. The presence of heart disease as a cause of death has decreased in recent years, while at the same time cancer has become more prevalent.

6. A hospital clinical educator is espousing the disengagement theory of aging when teaching staff how best to meet the needs of older clients. Which of the nurse's teaching points best captures the disengagement theory of aging? A) "Older adults often benefit from a gradual and controlled withdrawal of their own interests from society's interests." B) "The disengagement between an older adult's abilities and desires can lead to frustration and, ultimately, to illness." C) "The lack of synchronicity between older adults' immune systems and their environments can be the root of many problems." D) "It is imperative that we ensure older adults remain engaged with interests and events beyond themselves."

Ans: A Feedback: Disengagement theory postulates that disengagement between the individual and society is beneficial to both parties. It does not propose that this process of withdrawal be prevented nor that it necessarily leads to frustration or illness. The immune system is not a central component of the theory.

17. Although the immune system is affected by the aging process, the elderly are not the only individuals who have autoimmune disorders. These occur in populations of all ages because autoimmune disorders involve: A) An attack of antibodies on body cells B) An overproduction of T cells in bone marrow C) A decrease in the weight of the thymus gland D) An increase in the amount of lipofuscin in the blood

Ans: A Feedback: In autoimmune disorders, the immune system attacks and destroys the body's own cells (as opposed to those of invading, disease-causing microorganisms). There is no overproduction of T cells. Although the weight of the thymus gland decreases with age and the amount of lipofuscin increases, such changes are not characteristic of autoimmune disorders.

12. Twentieth-century laws regarding health care for the elderly trace their roots back to: A) England's 17th-century Poor Laws B) Child labor laws of the 19th century C) The Biblical commandment "Honor your father and your mother" D) The tradition of respect for the elderly passed down from ancient Roman law

Ans: A Feedback: Laws enacted in 20th-century America provided some measure of financial security and some level of health care for all persons aged 65 years and older, just as did the Poor Laws of 17th-century England that acted as a "safety net" for the elderly and the destitute. The child labor laws protected the young but offered no help to the elderly who were left at the mercy of their families. The Biblical commandment to "honor" provides a moral guideline but no practical benefit in terms of financial or health support. Ancient Romans deplored the elderly, and no tradition of respect for the aged was incorporated into the Roman legal code.

9. A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session? A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age. B) Older adults require simplified learning objectives and slower introduction of new directions. C) Simple association is well executed by older adults but complex analysis is normally absent. D) Successful learning late in life requires a multisensory teaching approach.

Ans: A Feedback: Learning ability is not seriously changed with age. It is not likely necessary to simplify learning objectives, and analysis abilities may slightly diminish but are not normally absent. A multisensory teaching approach is not noted to be required.

21. What are the most important competing forces that influence health policy for the elderly? A) Cost containment versus quality of care B) Acute care versus the burden of chronic disease C) Private insurance payments versus Medicare support D) Long-term care at home versus nursing home services

Ans: A Feedback: Policy discussions most often pit cost containment (reducing expenditures) against quality of care (which may mean increasing expenditures). Seniors require relatively less acute care than younger patients do; their health problems are more often chronic. Because all persons over age 65 are entitled to health coverage through Medicare, insurance considerations are fewer than with younger patients. And whereas one in four seniors requires nursing home care at some time, nursing home residency is not typically long term.

10. Which of the following phenomena most likely accounts for the progressive loss of hearing that an 83-year-old man is experiencing? A) Multiple changes in the structures of the inner ear. B) The effect of cognitive changes on the interpretation of auditory stimuli. C) Cellular atrophy of the cells in the outer and middle ear. D) Age-related deterioration of the neural pathways associated with hearing acuity.

Ans: A Feedback: Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph. Cognitive changes, cellular changes in the outer and middle ear, and deterioration of neural pathways are less likely to be implicated.

18. Gerontology instructors at City College of Nursing impress upon their students that gerontological nurses should be concerned with the welfare of both the current aged population and future ones. The best way nurses can help young and middle-aged adults prepare for their retirement is to promote: A) Meaningful leisure time activities B) Freedom from family responsibilities C) Achievement in a worthwhile occupation D) Maximal use of community health resources

Ans: A Feedback: Retirement is facilitated by learning how to use, appreciate, and gain satisfaction from leisure time throughout an employed lifetime. Occupational achievement may actually hinder a successful retirement if the work role proves difficult to abandon or replace. Although the use of community health resources and freedom from family responsibilities can contribute to a healthful old age, they are not the major sources of satisfaction to be cultivated earlier in life.

15. A young couple are looking for a new home. They want to move into a neighborhood that has no elderly neighbors. Such ageism carries several consequences. By separating themselves from the elderly, the couple: A) Are less likely to see the similarities between themselves and older adults B) Will lose their insights into aging C) Will not experience the challenges of old age D) May have an easier time minimizing their socioeconomic challenges

Ans: A Feedback: Separation from the elderly means people are less likely to see the similarities between themselves and older adults. This separation leads to lack of understanding of the elderly and reduces the opportunities for the young to gain realistic insights into aging.

23. The charge nurse at a nursing home impresses on a visiting class of nursing assistants the importance of hand washing, because older adults have a depressed immune response. One contributor to this depressed immune response in older adults is: A) Decreased serum activity of the thymic hormones B) Inactivation of varicella-zoster infections C) Decreased serum concentrations of IgA and IgG D) High pain sensitivity associated with inflammation

Ans: A Feedback: Serum activity of the thymic hormones is almost undetectable with age. Serum concentrations of IgA and IgG increase with age. Inflammation often causes minimal pain in the elderly.

3. A nurse who practices in a long-term care facility is providing care for a 101-year-old black female. The nurse's coworker states, "It's gratifying that black people in this country are finally reaching the same levels of health that white people are enjoying." How can the nurse best respond? A) "Actually, the difference in life expectancy between black people and white people is growing, not shrinking." B) "We've not yet arrived at a place where the life expectancies are equal between black and white people, but the gap is decreasing gradually." C) "Black women do tend to live longer than white women, but the overall life expectancies when men are included are not yet equal." D) "You're right. Since the 1980s the life expectancies of black and white Americans have remained nearly the same."

Ans: A Feedback: Since the 1980s, the gap between life expectancies of black Americans and white Americans has been increasing rather than decreasing. Black women do not tend to live longer than white women.

23. In old age, the body's efficiency declines. Which of the following is a typical response to that decline? A) An attempt to push the body to perform physically at the same level as in the past B) A neglect of personal appearance and other hygiene practices C) A failure to restrict lifestyle choices in a health-appropriate way D) An expressed desire to enter a nursing home to receive daily care and assistance

Ans: A Feedback: Some seniors deny age-related changes and push themselves physically. Others invest in expensive beauty treatments that promise to subvert the aging process. Others go to the opposite extreme and overestimate their deficiencies, adopting an unnecessarily restrictive lifestyle. An expressed desire for greater dependency is rare.

12. With aging the skin becomes thinner and more fragile. The thinning of the skin's subcutaneous fat layer makes older adults more sensitive to: A) Cold B) Heat C) Pain D) Pressure

Ans: A Feedback: Subcutaneous fat serves as an insulator. With less of it, the elderly may be more sensitive to cold temperatures. Older adults are less sensitive to pain and pressure because of decreased sensitivity of nerve endings.

15. Which of the following statements underlie both the error theory of aging and the free radical theory of aging? A) Biochemical damage accumulates over time, leading to cell death. B) The rate of cellular death is genetically programmed. C) The aging body produces fewer growth and repair hormones. D) Environmental agents such as radiation and heavy metals damage DNA.

Ans: A Feedback: That the rate of cell death is genetically programmed is a basic tenet of the programmed theory of aging. That the aging body produces fewer growth and repair hormones is a neuroendocrine theory. Although radiation and heavy metals may damage DNA, they are not free radicals, and they need not be the cause of the mutations assumed by the error theory.

21. A state committee is looking to improve the lives of the state's elderly. It wants to recommend that health care facilities that cater to the elderly population be required to base their practices on the activity theory of aging. Which of the following may be one problem with implementing the activity theory of aging? A) The assumption that older people want to maintain their middle-aged lifestyle B) The reluctance of the elderly to give up their occupational roles at retirement age C) The decline in mental acuity that accompanies physical impairment in most cases D) Declining health, loss of roles, and shrinking circle of friends of most elderly

Ans: A Feedback: The activity theory suggests that the elderly should maintain their middle-aged lifestyle to the greatest extent possible, a goal not all elderly persons will embrace. The reluctance of many elderly persons to give up their middle-aged roles is consistent with the theory. Relatively small numbers of the elderly experience a significant decline in mental acuity. Declining health, loss of roles, and a shrinking circle of friends are problems the activity theory seeks to minimize.

1. Which of the following statements most accurately conveys an aspect of the error theory of aging? A) Perpetuation of DNA mutations results in organ and system malfunction. B) Age-related dysfunction of organs, tissues, and body systems results in mutation of body DNA. C) The number of cell divisions is genetically predetermined. D) Errors in the function of various organs contribute to changes in the genetic code of various body cells.

Ans: A Feedback: The error theory of aging proposes that genetic mutations are perpetuated through the aging process, resulting in organ malfunction and eventual decline in body function. Organ malfunction results from, but does not cause, the genetic mutations in question. A genetic predetermination of the number of cell divisions is associated with the programmed theory of aging.

4. Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life? A) Women tend to both live longer than men and marry men older than themselves. B) Men tend to have greater access to care facilities due to higher incomes and savings. C) Men are more likely to live with younger family members following the death of a spouse. D) Social pressures tend to stigmatize older men who live alone.

Ans: A Feedback: The facts that women live longer than men and often marry men older than themselves account for their higher rates of living alone in old age. Men are not noted to have greater access to care facilities, to be more likely to live with younger family members or to face stigma for living alone.

4. An 80-year-old female who enjoys good health explains to her primary care provider that she attributes her health status to her regular intake of berries, fruit juices, and green tea, which she states "help cleanse the damaging molecules out of my body." Which of the following theories of aging underlies the client's health behaviors? A) Free radical theory B) Biogerontology C) Disposable soma theory D) Cross-linking theory

Ans: A Feedback: The free radical theory of aging attributes damage to the accumulation of free radicals that may be countered by the intake of antioxidants. This is not an explicit component of the disposable soma or cross-linking theory of aging. Biogerontology is the study of the relationship between aging and disease.

13. A new patient is not satisfied with the conditions of the nursing home, takes a highly active role in her health care, and, because of her ability to access information, has as much knowledge as her health care providers on some health issues. This new patient is most likely: A) A young-old female baby boomer who just turned age 65 B) An old woman 75 to 85 years of age C) An old-old woman over age 85 D) An elite old woman older than 100 years

Ans: A Feedback: The patient has the predicted characteristics of a baby boomer entering the senior years.

14. The heart muscle commonly weakens with age. What is a consequence of this fact? A) The heart beats faster but pumps with less force. B) Fatty deposits and other substances clog narrowed coronary vessels. C) Blood pressure lowers because of systemic vasodilation. D) The time required for the heart's diastolic-systolic cycle decreases.

Ans: A Feedback: The statement in choice B is true, but age-weakened heart muscle is not the cause. Blood pressure may actually rise as an effect of choice B. The opposite of the statement in choice D is true.

13. Each of the blood vessel layers is affected differently by the aging process. Which would a nurse suspect is responsible for a patient's fibrosis? A) Tunica intima B) Tunica media C) Tunica adventitia D) Fibrosis is caused by an enlarged heart

Ans: A Feedback: The tunica intima, the innermost layer, experiences the most direct changes, including fibrosis, calcium and lipid accumulation, and cellular proliferation. The middle layer, the tunica media, undergoes a thinning and calcification of elastin fibers and an increase in collagen, which causes a stiffening of the vessels. The outermost layer, the tunica adventitia, is not affected by the aging process. In the absence of heart disease, heart size changes little with age.

A nurse recommends to an older patient's family to place a seat alongside the bathtub to enable the older adult bather to rest while drying off. What is the best explanation for the nurse's recommendation? A) A drop in blood pressure may follow bathing. B) Nonslip surfaces are essential for tubs and shower floors. C) The elderly use the bathroom often and can benefit from the rest. D) Most elderly have an age-related problem discriminating hazards.

Ans: A Feedback: A drop in blood pressure may follow bathing; sitting down after bathing lessens the risk of the elderly bather falling because of low blood pressure. Nonslip surfaces inside tubs and shower stalls are important, but this choice is not a reason for having a seat outside the tub. It is not true that the elderly use the bathroom often and can benefit from the rest. It is also not true that most elderly have an age-related problem with discriminating hazards.

The nurse visiting a patient living in the daughter's home finds the patient in an old hospital bed that has bilateral full-length side rails. What should the nurse do? A) Present alternatives to the family B) Recommend frequent repositioning C) Discuss additional preventive measures D) Commend the family on the use of this type of bed

Ans: A Feedback: Bilateral full-length side rails can be considered a type of physical restraint and should be avoided. The nurse should also discuss alternative, not additional, methods of protecting the patient. Frequent positioning may or may not be needed. The nurse should not commend the family on the use of this type of bed.

The nursing home staff is working on a renovation project for the special care unit. What should be a key element of the plan? A) Paint the bedrooms green B) Paint the dining room violet C) Use wavy-patterned rugs in the hallways D) Use contrasting colors for the doors of the storage closets

Ans: A Feedback: Green is a soothing color; violet suppresses appetite; wavy patterns can be disorienting; and contrasting colors make a door stand out.

Which self-care activity should the nurse instruct an older patient with a history of congestive heart failure, type 2 diabetes, and hypertension? A) Monitoring of radial heart rate and lung sounds B) Starting a course of antibiotics with temperature increases C) Accurate measurement of total daily fluid intake and output D) Adjustment of blood pressure medication dosage based on home blood pressure readings

Ans: A Feedback: Monitoring of heart rate and lung sounds is an appropriate self-care activity for older adults. Changing medication dosages and beginning a course of antibiotics are not safe or appropriate actions, while detailed monitoring of intake and output is unnecessary.

An older patient who lives at home has had several admissions to the hospital for infections and drug reactions over the last 18 months. Which nursing diagnosis would the nurse identify as being appropriate for this patient? A) Risk for Injury B) Risk for Infection C) Risk for Impaired Mobility D) Risk for Violence: Self-Directed

Ans: A Feedback: Persons are considered at risk for injury when their environmental conditions affect their ability to adapt and their defensive resources are altered. Indications that this diagnosis exists can be manifested through a history of falls or accidents, adverse drug reactions, and infections. The risk of infection does not include adverse drug reactions. The patient's risk is more than the risk of impaired mobility. There is no evidence to suggest that the patient is at risk for self-directed violence.

During a home visit the nurse learns that an older patient with macular degeneration restricts the intake of fluids after 6 pm. What would the nurse suspect as a reason for the patient to limit fluids after this time? A) A fear of falling at night B) A lack of thirst perception C) Lack of non-skid footwear D) Problems differentiating shades of the same color

Ans: A Feedback: The patient's poor vision due to macular degeneration and age-related urinary changes can contribute to frequent bathroom trips. The nurse could easily correlate the patient's vision problems with a desire to minimize trips to bathroom and reduce the potential of falling at night. The patient has been avoiding fluids after 6 pm so it is unlikely that the patient has a lack of thirst perception. A lack of non-skid footwear and problems differentiating shades of the same color would not contribute to the patient's plan to limit fluids after 6 pm.

Which of the following lighting schemes should the nurse manager integrate into the plan for a new long-term care facility? A) Placement of multiple diffuse lighting sources B) The use of large banks of windows to maximize direct sunlight C) Placement of large fluorescent lighting panels centered in each room D) Low levels of lighting to reduce glare and accommodate residents with light sensitivity

Ans: A Feedback: The use of multiple diffuse lighting sources is ideal for older adults and would be preferable to direct sunlight, large, single lighting sources, or fluorescent lights.

A group of residents in a skilled nursing facility are sitting outside in the garden enjoying a hot summer day. What primary concern does the nurse recognize for these residents? A) Lack of thirst perception B) Lack of energy and related depression C) Lack of motivation to get out of the sun D) Effects of certain medications on body temperature

Ans: A Feedback: Thirst perception declines with age, and so older persons are less aware of their fluid needs. This can be dangerous in hot weather. Natural sunlight would help with energy and depression. The residents may need assistance to get out of the sun. The effects of medications on body temperature may or may not be a concern since it would depend upon the resident and the medications being taken.

While conducting a home visit the nurse learns that the older patient has developed cataracts. Which statement should the nurse make about this patient's ability to drive? A) "You might want to consider planning to avoid nighttime driving." B) "This is likely a good time for you to consider giving up your license." C) "The myth of older drivers being more dangerous is exactly that: a myth." D) "It's probably best to consider asking your children to drive you around from now on."

Ans: A Feedback: While older adults do get have more driving accidents than younger adults, it is unknown if the patient should cease driving altogether. Restricting driving to daylight hours is a prudent measure that can still afford a degree of mobility and independence for the patient. The nurse should not discuss if older drivers being more dangerous is or is not a myth. It is unknown if the patient has children who are available to drive for the patient.

7. Which of the following nursing interventions by practitioner in a long-term care facility are appropriate? Select all that apply. A) The nurse times laxative administration as to not interfere with social interaction. B) The nurse provides diuretics after, not before, recreation sessions. C) The client's need for and dosage of nighttime sedation is weighed in light of activities planned for the following morning. D) Analgesia is provided prior to physical activity but held before social activities.

Ans: A, B, C Feedback: A failure to provide adequate pain control is likely to interfere with older adults' social activity. The nursing actions in answers A, B, and C are all prudent in light of promoting social interaction.

Acute Setting (Hospital) - Population / LOS

Sudden medical change + Daily monitoring LOS: 1-5 days

1. During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply. A) The woman's overall proportion of body water has decreased. B) The client has experienced a loss of cartilage. C) The woman's thyroid hormone levels have declined since the sixth decade. D) The client's vertebrae have thinned. E) Loss of stature is a consequence of the woman's diet. F) The woman's long bones have decreased in length.

Ans: A, B, D Feedback: Reduced hydration, loss of cartilage, and thinning of vertebrae can all contribute to loss of stature. Decreased levels of TH, shortening of long bones, and diet are not noted to contribute to this phenomenon.

8. Which of the following tasks are components of Erikson's description of the old age tasks of reconciling ego integrity with despair? Select all that apply. A) An 80-year-old man is struggling to determine his identity apart from his lifelong career as a business leader. B) A 79-year-old woman has established habits that promote her financial independence in spite of a lack of savings. C) An 80-year-old man revels in his large, happy family rather than focusing on his mobility limitations resulting from Parkinson disease. D) A 77-year-old man is trying to determine whether his life has had deep significance and meaning.

Ans: A, C, D Feedback: Deriving satisfaction from oneself rather than occupational roles, finding pleasure in spite of physical limitations, and determining meaning in the life one has lived are all aspects of Erikson's outcome of ego integrity or despair. Financial independence is not a central component of this outcome.

The nurse identifies the diagnosis of risk for injury as being appropriate for an older patient. What health problems would increase this patient's risk for injury? (Select all that apply.) A) Hard of hearing B) Weak gag reflex C) Chronic renal failure D) Fatigue and weakness E) Macular degeneration

Ans: A, C, D, E Feedback: Health problems that could increase this patient's risk for injury include being hard of hearing, having renal failure that causes ineffective elimination of wastes from the blood stream, fatigue and weakness leading to poor muscle tone, and poor vision caused by macular degeneration. A weak gag reflex would increase the patient's risk of infection related to aspiration.

The nurse is visiting the home of an older patient with changes in peripheral vision and depth perception. What should the nurse instruct the family to ensure safety for the patient? (Select all that apply.) A) Use contrasting colors on the stairs B) Avoid the use of bright colors on walls C) Arrange furniture so that it is in full view D) Ensure good lighting throughout the home E) Approach the patient directly and not from the side

Ans: A, C, D, E Feedback: To compensate for reduced peripheral vision, arrange furniture so that it is in full view and approach the patient directly and not from the side. To compensate for reduced depth perception, use contrasting colors on the stairs and ensure good lighting throughout the home. Bright colors are recommended and helpful.

8. The board of a large chain of hospitals has commissioned a strategic plan in order to meet the care needs of baby boomers in coming years. Which of the following trends constitute a sound basis for understanding the baby boomer generation and conducting future planning? Select all that apply. A) Baby boomers tend to have fewer children than members of earlier generations. B) Adjusted for inflation, baby boomers have lower incomes than their parents had. C) Due to technology, baby boomers have more leisure time than other adults. D) Baby boomers perform physical exercise more frequently than other adults.

Ans: A, D Feedback: Baby boomers have had fewer children than generations that preceded them and they tend to exercise more often. Their incomes tend to be higher while they enjoy less leisure time.

The staff nurses are discussing ways to reduce safety risks for patients with Alzheimer's disease. Which impairments could cause safety risks for these patients? (Select all that apply.) A) Diabetes B) Dementia C) Depression D) Disorientation E) Memory deficits

Ans: B, C, D, E Feedback: Impairments that could heighten safety risks for the patient with Alzheimer's disease include memory deficits, disorientation, dementia, and depression. Diabetes is not identified as a disorder that heightens safety risks for the patient with Alzheimer's disease.

The home care nurse is conducting a home environment assessment for an older patient with peripheral vascular disease and foot wounds. Which findings should the nurse identify as safety issues for the patient? (Select all that apply.) A) Hot water temperature 124°F B) Fire extinguisher present in the hall closet C) Functioning smoke detector in the kitchen D) Refrigerator stocked with food that is not outdated E) Medication labels absent from prescription containers

Ans: A, E Feedback: The hot water temperature should be less than 110°F. Medication labels should be present on all prescription containers. A fire extinguisher should be present. The smoke detector in the kitchen should be functioning. And food should not be outdated in the refrigerator.

6. A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse's assessment of the client would recognize which of the following factors as most likely contributed to the suspected injury? A) Bone remodeling in long bones ceases in the seventh or eighth decade. B) Bone minerals and mass are reduced as part of the aging process. C) Bone marrow production of cellular components declines with age. D) Thinning disks and shortened vertebrae are common assessment findings in older adults.

Ans: B Feedback: A decrease in bone minerals and mass is common later in life. Bone remodeling does not, however, cease. Neither thinning disks, shortened vertebrae, nor marrow production of blood cellular components is likely to directly contribute to the client's suspected fracture.

22. Which of the following blood chemistries may indicate diabetes among young adults but not among the elderly? A) Low blood glucose level B) High blood glucose level C) Prolonged hypoglycemia D) Insufficient release of insulin

Ans: B Feedback: Although there is a delayed and insufficient release by the -cells of the pancreas in the elderly, what will show up in a blood chemistry report is an apparently high level of glucose in the blood. Low blood glucose and prolonged hypoglycemia are not indicators of diabetes.

23. Which of the following patient histories is most likely for a person older than 65 years of age? A) In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B) Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C) Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D) Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks

Ans: B Feedback: Arthritis and heart conditions are among the most common chronic conditions of the elderly. Daily medications to reduce arthritis pain and decrease blood pressure are common. The other histories are more likely for younger patients.

3. An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns? A) "It's inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency." B) "It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously." C) "As you age, it's common for your heart rate becomes less regular and this often results in fatigue." D) "The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young."

Ans: B Feedback: Cardiac contractility decreases as a part of normal aging. An increase in heart size, irregular heart rate, and increased blood pressure would be considered pathological conditions regardless of age.

16. The nursing staff at a nursing home works closely with the staff in the Endocrinology Department at a local hospital. This relationship is maintained for the welfare of the nursing home residents, because a failing immune system in the elderly might account for: A) A decline in the rate of growth hormone production B) The increased incidence of cancer among the aged C) The oxidative activity of free radicals D) Changes in brain activity and nervous system function

Ans: B Feedback: Compromises in the immune systems of the elderly may lead to a failure to recognize and destroy cancerous cells. The immune system is not involved in the production of growth hormones. The immune system does not determine the action of free radicals, although it may be involved in seeking out and destroying cells damaged by free radical activity. There is no known association between diminished immune activity and changes in the brain or nervous system action.

5. A nurse is discussing an older adult client's apparent increased susceptibility to infection with his family. Which of the following statements by the nurse would be most congruent with current thought around the autoimmune role in the aging process? A) "Changes that we call 'mutations' in your father's cells make his organs more vulnerable to chronic illness and germs." B) "Older adults often have more difficulty fighting off infections because of their weaker immune systems, and their bodies can even attack themselves." C) "Diseases such as arthritis, which we term 'autoimmune,' make older people more likely to catch viruses and other bugs." D) "Our bodies seem to have an 'expiry date,' after which we are far more likely to get infections and develop chronic illness."

Ans: B Feedback: Decreased immune response coupled with increased autoimmune activity is implicated in many of the effects of the aging process. The salience of mutations is associated with genetic theories of aging and autoimmune activity is not considered the direct cause of the decline in thymus and bone marrow activity. A predetermined cell life span is associated with the programmed theory of aging.

20. Which of the following statements best captures an aspect of illness in older adults? A) Death from heart disease is increasing in this population. B) Death from cancer is increasing in this population. C) Chronic illnesses are less common than in younger people. D) Several acute illnesses are often present that must be managed simultaneously.

Ans: B Feedback: In the elderly population, the cancer death rate has increased in the past three decades; deaths from heart disease have declined. Several chronic conditions are often present and must be managed simultaneously.

24. Hospital management is reviewing departmental statistics. Which of the following departments most likely has the highest death rate of patients over age 65, and why? A) Oncology, because the elderly have been exposed to more carcinogens in their long lifetimes B) Cardiology, because, despite a decline in recent years, heart disease remains the number one cause of death among the elderly C) Endocrinology, because the elderly already have compromised immune systems D) Neurology, because stroke and Alzheimer's disease together cause more deaths of the elderly than any other conditions

Ans: B Feedback: Heart disease is the leading cause of death among persons 65 years of age and older.

15. Which of the following factors should a nurse prioritize when planning the care of older adults? A) The high prevalence of mental impairment among the elderly B) The diversity of the older adult population C) The fact that most older people live below the poverty line D) The lack of family support that is the norm among the elderly

Ans: B Feedback: Individuals aged 65 years and older vary widely in their health status, interest, cultural backgrounds, and health care needs. The population is not generally impaired mentally. Also, only 15% live below the poverty level. The majority live in a household with a spouse or other family member.

22. What is the best action a busy nurse can take to help with the desire of elderly clients to reminisce about their past lives? A) Refer clients to senior centers, where they can share their stories with others of their own age group B) Encourage the recording of stories through diaries and scrapbooks to be shared with younger family members C) Introduce older clients to members of local historical societies who can record their stories for posterity D) Look for ways to steer discussion toward health-promoting habits such as good exercise and adequate nutrition

Ans: B Feedback: It is always important to listen to the stories of seniors and to honor their life histories. Changing the subject is seldom appropriate, and although referrals to senior centers and historical societies may be beneficial in some cases, encouraging elders to record and share their stories with the younger generation is always a good idea.

18. It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people? A) Own their own homes and have sufficient monthly income B) Get more than half their income from Social Security and live above the poverty level C) Are an increasing percentage of the labor force but are "cash poor" D) Are retiring at earlier ages and so live below the poverty level

Ans: B Feedback: Less than 15% of older people live below the poverty level. Social Security is the main source of income for more than half of all older adults.

17. Most older women become widows. Widows must adjust to the significant loss of loved ones and the new task of living alone. Studies show that most widows: A) Require short-term treatment for depression B) Adjust well, finding new friends, interests, and activities C) Turn to their still-married female friends for advice and support D) Move in with their adult children for a period of time

Ans: B Feedback: Most widows adjust well. The friendships of the past between married couples become less important, and friendships with other widows develop. Most widows successfully live alone, and relatively few require treatment for depression.

16. As a person ages, muscle tone decreases throughout the digestive system, causing a slowing movement of food through the esophagus. Delayed esophageal emptying in the elderly increases the risk of: A) Gastric irritation B) Aspiration C) Irritable bowel syndrome D) Constipation

Ans: B Feedback: Normal aging does not interfere with mobility through the bowel or bowel action. Gastric irritation results from a higher pH of stomach fluids. Aspiration is a risk associated with a weakened gag reflex, relaxation of the lower esophageal sphincter, and delayed esophageal emptying.

5. A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client's prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest: A) Prostate cancer B) A risk of malignancy that should be followed up C) A normal age-related change unlikely to have consequences D) A urinary tract infection

Ans: B Feedback: Prostatic enlargement is exceedingly common among older men, but represents a risk of malignancy that necessitates further assessment and follow-up. It is not a definitive sign of prostate cancer and is not indicative of a urinary tract infection.

18. Which of the following is a normal reflex profile for an elderly patient? A) Knee: normal; arm: absent; abdomen: absent B) Knee: normal; arm: reduced; abdomen: absent C) Knee: reduced; arm: normal; abdomen: reduced D) Knee: reduced; arm: reduced; abdomen: absent

Ans: B Feedback: Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee.

19. Mr. B, age 72, has a history of heart disease. He insists that his high-fat diet is permissible, however, because he takes a daily supplement of gugulipid, an herb purported to reduce blood cholesterol levels. In talking with the patient, what should Mr. B's nurse do first? A) Suggest that Mr. B ask his doctor for a prescription medication to reduce cholesterol levels B) Review with Mr. B the benefits associated with limiting dietary fat C) Introduce Mr. B to the additional benefits associated with fish oil supplements D) Advise Mr. B to stop using gugulipid, as herbal supplements are not regulated by the FDA

Ans: B Feedback: The first duty of Mr. B's nurse is to promote positive health behaviors, which means encouraging the patient to limit his fat intake. Herbal supplements are unregulated, and their health benefits may be questionable. Whether fish oil supplements or prescription medications are advisable in this case merits further investigation.

25. Decreased renal mass and reduced glomerular filtration make it especially important that nurses: A) Assist elderly patients with frequent toileting B) Ensure that age-adjusted drug dosages are prescribed C) Look for signs of urinary tract infections D) Frequently check urine for glucose

Ans: B Feedback: The need for frequent toileting is a result of decreased bladder capacity. Weaker bladder muscles increase the risk of urinary tract infections. Tests for glucose in the urine are needed on a case-by-case basis. The need most associated with decreased renal mass and reduced glomerular filtration is age-adjusted drug dosage.

9. Which of the following actions by a nurse who works with older adult clients in an assisted living facility is most likely to inhibit healthy aging? A) Discussing current events with clients who read and watch television. B) Placing a bib on each client during meal times to ensure clients maintain a clean appearance. C) Challenging clients to learn new skills and develop preexisting talents. D) Facilitating introductions between new and existing clients

Ans: B Feedback: While the nurse's action may have a laudable rationale, using a bib and feeding clients who may not require either action is incongruent with promoting function and preventing helplessness. Discussing current events and facilitating new skills and relationships promote well-being.

The nurse is on a task force to reduce the incidence of falls among residents of a long-term care facility. Which measure should the nurse recommend to prevent the most falls? A) The use of diffuse, natural lighting on the unit B) A fall history and fall risk assessment of each patient on admission C) Psychosocial interventions aimed at reducing individuals' fear of falling D) Use of physical restraints on new patients who have delirium or dementia.

Ans: B Feedback: A thorough history and fall risk assessment is central to any fall reduction initiative. This would supersede the use of diffuse lighting, though this type of lighting is appropriate. Interventions aimed at reducing the fear of falling will not necessarily reduce falls, and the liberal use of restraints is inappropriate.

Which characteristic of a resident's room in a nursing home demonstrates Maslow's need of security? A) Large airy windows B) Personal drawers and closets C) Consistent placement of the furniture D) Comfortable couches and rocking chairs

Ans: B Feedback: Personal drawers and closets permit residents to take care of their own possessions, thus allowing them to feel secure. This demonstrates the basic need of security on Maslow's hierarchy of needs. Large airy windows do not demonstrate any of the basic needs. Consistent placement of furniture demonstrates the basic need of trust. Comfortable couches and rocking chairs demonstrate the basic need of love.

In planning the budget for next year, the nurse manager in a special care unit includes line items for a toaster, flowering plants, and a birdfeeder. How should the manager justify these costs to administration? A) Personal items for patients B) Items for residents' sensory stimulation C) Suggested requirements to meet labor contract D) Important tools for maintaining staff satisfaction

Ans: B Feedback: These are elements of a program for sensory stimulation. The program allows patients to smell bread toasting and the sweet aroma of flowers, as well as the sound of birds singing. These are not personal items for patients or tools to maintain staff satisfaction. These are not requirements to meet labor contracts.

5. A primary care nurse has a long-standing relationship with a 63-year-old male client who is poised to retire. Place the following phases of the client's likely transition in the correct chronological order. Use all the options. A) A euphoric period involving testing of fantasies around retirement. B) Near phase, often accompanied by fantasy regarding the retirement role. C) Disenchantment phase D) Establishment of a stable and sustainable retirement role. E) Establishment of realistic and alternative sources of satisfaction during retirement.

Ans: B, A, C, E, D Feedback: The near phase of preretirement and the accompanying fantasy is often followed by a euphoric honeymoon phase. This can be followed by a disenchanting letdown, and a subsequent reorientation that results in eventual stability.

An older male patient is upset by having to be admitted to a skilled nursing facility for extended care and renal dialysis treatments. What can the staff do to minimize this patient's anger? (Select all that apply.) A) Recommend counseling for anger issues B) Respect the patient's private possessions C) Offer to assist with basic needs and desires D) Ask the patient to explain preferences for activities E) Provide the patient with areas for privacy or solitude

Ans: B, C, D, E Feedback: Nursing homes are not like home environments. If a patient does not want to be in such a facility, anger can occur due to loss of control and freedom. To help the patient adjust to the new environment the staff can respect the patient's private possessions, offer to assist with basic needs and desires, ask the patient to explain preferences for activities, and provide the patient with areas for privacy or solitude. The patient does not need counseling for anger issues. The patient's reaction to the new undesired environment is not unusual.

The home care nurse is concerned that an older patient is at risk for a kitchen fire. What actions can the nurse recommend to reduce the risk of this occurring? (Select all that apply.) A) Avoid placing electrical items near a water source B) Instruct the patient to stay in the kitchen while cooking C) Encourage the use of meal delivery services to reduce cooking D) Recommend the use of a timer to check the food on the stove E) Suggest a microwave be used to heat liquids and not the stove

Ans: B, D, E Feedback: Kitchen fires can result when unattended pots with boiling liquids become dry because the person has forgotten them. Kitchen fires can be prevented by staying in the kitchen while cooking, setting a timer to remind them to check the pot, or using a microwave to heat liquids. Avoiding electrical items near a water source will not reduce the risk of a kitchen fire but will reduce the risk of electrocution. Encouraging the use of a meal delivery service to reduce cooking would not support the patient's need to maintain independence.

The nurse, planning care for older patients on a geriatric unit, realizes which of the following health problems as occurring more frequently among older adults than in younger adults? (Select all that apply.) A) Cellulitis B) Pneumonia C) HIV/AIDS D) Diverticulitis E) Endocarditis

Ans: B, D, E Feedback: The incidence of endocarditis, pneumonia, and diverticulitis is higher among older adults. This is not the case with HIV and cellulitis.

1. A nurse manager at a long-term care facility is engaged in efforts to change many staff members' inaccurate and negative views of older adults. Which of the following statements made by staff is most clearly indicative of ageism? A) "Older people seem to have so many more chronic health problems than younger people." B) "Older adults' motor skills get progressively slower as they age." C) "It's normal to expect a gradual loss of memory and intelligence with age." D) "A lot of the physical changes that accompany aging are inevitable."

Ans: C Feedback: A common ageist misconception is that senility and loss of intelligence inevitably, and normally, accompany the aging process. Older adults do have more chronic conditions than younger adults, and motor skills become slower. Many of the physical changes that accompany aging are considered normal and largely inevitable.

20. A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is: A) Decline in brain weight B) Reduction of blood flow to the brain C) Flawed response to changes in balance D) Slowed nerve conduction velocity

Ans: C Feedback: Although all the statements are true, the major factor increasing the risk of falls is a flawed response to changes in balance.

6. Nurse M is employed in an assisted living facility and is privy to many of the changes that accompany the aging process. An older female resident of the facility has expressed a fear that her decreased mobility will make her increasingly dependent on her daughter. How can the nurse best respond to the resident's concerns? A) "There are treatments and drugs that we can explore which might prevent this from happening." B) "This is a normal part of the aging process and you don't necessarily need to fear it." C) "Many older adults have similar concerns. We can work together to keep you independent as long as possible." D) "I'm sure this is very stressful for you, but it's fortunate that you are not experiencing severe pain or illness."

Ans: C Feedback: Answer C validates the client's concerns and expresses the possibility of addressing the issue without downplaying it or providing unrealistic promises. Answer A provides an unrealistic promise of prevention, while answers B and D downplay the severity and significance of the client's concerns.

11. In ancient times, the relationship between age and the value afforded to individuals was generally: A) Positive: with advanced age came increased value B) Negative: respect declined as age increased C) Variable: respect was different in different cultures D) Cyclic: respect moved back and forth between positive and negative

Ans: C Feedback: Attitudes toward the aging varied among cultures. The ancient Chinese, for example, believed that the elderly deserved honor and respect, whereas the ancient Romans had little respect for the elderly, customarily killing them first in the nations Rome conquered.

2. A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future? A) While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. B) By 2020, it is expected that over one-third of Americans will be over the age of 65. C) Both life expectancy and the percentage of people over 65 in the population will increase in coming decades. D) Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020.

Ans: C Feedback: Both life expectancy and the percentage of individuals over age 65 are expected to increase in coming years. About 17% of the population is expected to be over 65 by 2020.

14. Which of the following statements form components of both the error theory of aging and the cross-linking theory of aging? A) Free radicals cause mutations in cells. B) Senescence is environmentally controlled at the cellular level. C) Changes in DNA lead to organ malfunctions. D) Genetic programming determines life expectancy.

Ans: C Feedback: Both the error theory and the cross-linking theory assert some change in DNA that interferes with normal cell functioning. Such changes may be caused by free radicals or any of many other mutagens. Although the aging of cells may be environmentally influenced, it is not thought to be externally controlled. That genetic programming determines life expectancy is a basic tenet of the programmed theory of aging.

13. The emergence of today's nuclear family units has changed the roles and functions of family members in many ways. In counseling elders and their families, which of the following beliefs about aging should a nurse be aware as one of these ways? A) Children are expected to provide financial support for their aging parents B) Grandparents are spending more time with their grandchildren than ever before C) Older adults enjoy freedom from responsibility for their adult children's welfare D) Older parents and their children grow apart, seldom developing satisfying adult-to-adult relationships

Ans: C Feedback: Children are no longer expected to provide financially for their aging parents, and grandparenting—although important and satisfying—is a long-distance undertaking in families that live many miles apart. Today's parents do, however, often enjoy satisfying adult-to-adult relationships with their grown children. Today's parents are free from responsibilities for their adult children more than any generation before, and many actively enjoy that freedom in middle age and later life.

20. Ms. E, an 80-year-old, is gradually withdrawing from society and wants society to gradually withdraw from her. She believes that this mutual withdrawal will free her from societal roles and give society the means for transferring power from the old to the young. Ms. E's grown children are concerned and say her belief has no scientific basis. On which of the following theories of aging can Ms. E say she bases her belief? A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory

Ans: C Feedback: Disengagement theory views aging as a process in which society and the individual gradually withdraw, or disengage, from each other, to the mutual satisfaction and benefit of both.

15. Older adults in good physical condition have cardiac function comparable to younger persons in poor condition. What is the most likely cause of a rise in systolic blood pressure in the elderly? A) Postural and postprandial hypotension B) Atherosclerosis in the innermost layer of the blood vessels C) Impaired baroreceptor function and increased peripheral resistance D) Cellular proliferation in the tunica intima

Ans: C Feedback: In the middle layer of blood vessels, impaired baroreceptor function and increased peripheral resistance lead to a rise in systolic blood pressure. Reduced sensitivity of the blood pressure regulation with baroreceptors increases problems with postural hypotension and postprandial hypotension; thus, they are an effect, not a cause. Cells proliferate in the innermost layer of vessels and atherosclerosis develops, but these are not the direct causes of increased systolic pressure.

12. Mrs. H and Mrs. J are the same age. While in the doctor's waiting room, they discuss their ailments and their beliefs about aging. Mrs. H argues that Mrs. J must be older because she has more ailments. The nurse settles the argument by stating a cornerstone of all biological theories of aging. Which of the following statements did the nurse most likely make? A) Aging is a predictable cellular process. B) Cells undergo a finite number of divisions. C) No two individuals age identically. D) Body systems decline at the same rate.

Ans: C Feedback: Individual variability is fundamental to all biological theories. Aging is not totally predictable, nor is it necessarily cellular in some biological theories. Body systems are often seen to decline at different rates.

19. After an initial period of enthusiasm, Mr J feels disappointed with his retirement. He cannot afford to travel as much as he had dreamed, and arthritis limits his mobility. Mr J's nurse can help him most by assisting him in entering which phase of retirement? A) Stability, in which he accepts his limitations B) Termination, in which he resumes a productive work role C) Reorientation, in which he assesses alternative sources of satisfaction D) Disenchantment, in which his hidden depression can be openly diagnosed and treated

Ans: C Feedback: Mr J has passed through the honeymoon phase of his retirement and has entered the disenchantment phase. In this phase, the retiree feels let down, and depression may or may not be experienced. Mr J's nurse can help him take the next step into the reorientation phase, in which he develops a lifestyle that gives him satisfaction based on realistic choices. The stability phase may follow, although some retirees never achieve it. Termination is the end of retirement brought about by illness, disability, or a return to work.

18. A magazine geared toward elderly women contains an advertisement for an anti-wrinkle cream purported to remove wrinkles caused by the drying effects of years of soap use. Knowledgeable nurses can keep their elderly female clients from being duped by this advertisement by explaining that the wrinkling of facial skin in old age results primarily from: A) Changes in the endocrine glands B) Cellular mutations arising from toxic chemicals C) Repeated exposure to ultraviolet light D) A diet high in fats and refined sugars

Ans: C Feedback: Repeated exposure to ultraviolet light causes solar elastosis, the wrinkling that results from the replacement of collagen by elastin. Toxic chemicals, nutrition, and endocrine changes are not known to produce the wrinkling of the skin seen in old age.

8. A care aide at a long-term care facility has assured the family of a resident that their father's increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide's statement to the family? A) "It's actually a myth that older people experience changes to their memory." B) "Memory losses are a normal age-related change many people experience." C) "Older adults have less working memory and slower retrieval, but this still requires further assessment." D) "There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia."

Ans: C Feedback: Older adults often experience delays in retrieval of memories and working memory. Some changes in memory, even in the absence of delirium or dementia, are to be expected but they should not be discounted and would require further assessment.

24. Older adults may appear rigid in their attitudes because of: A) Changes in personality that accompany aging B) Diminished ability to learn new information C) Physical or mental limitations D) Decline in morale and self-esteem

Ans: C Feedback: Personality, learning ability, and morale/self-esteem do not change with age. Seniors may resist change because of their physical or mental limitations—for example, rearranging the furniture when eyesight or mobility is limited.

10. A nurse notes that a 90-year-old male client on a geriatric medical unit of the hospital has been talking about death frequently. Given that the nurse has good rapport with client, what is the nurse's most appropriate response? A) "Try to focus more on the positive benefits of healing rather than what might happen." B) "Remember that in this day and age many people can live far beyond 90 years of age." C) "I've noticed you've brought up the issue of dying a lot. How do you feel about that?" D) "You'll find that aiming for health rather than thinking about death will have positive results."

Ans: C Feedback: Preparing for death has been identified as a developmental task for later life and would be an appropriate topic for discussion given the partnership that exists between the nurse and the client and the client's desire to broach the subject.

9. Which of the following teaching points around the use of self-reflection with older adults is most accurate? A) Self-reflection is easier for older adults than for younger adults. B) Self-reflection is less effective for male elders than for females. C) Self-reflection often involves learning a process and is difficult for many people. D) Self-reflection is not normally possible with individuals who have cognitive deficits.

Ans: C Feedback: Self-reflection is a valuable tool for many older adults, but it does not occur easily or naturally for many people and is likely to require some teaching and guidance. It is not necessarily easier for older people or for women, and cognitive deficits do not preclude it.

13. Which of the following statements is evidence that supports the programmed theory of aging? A) The life spans attained by parents and their offspring are negatively correlated. B) Mutations perpetuate themselves through each cycle of cell division. C) In cultures, cells go through a finite number of cell divisions before dying. D) In cultures, cells from older donors divide faster than those from younger donors.

Ans: C Feedback: Studies of in vitro cell proliferation have demonstrated that various species have a finite number of cell divisions. Life spans of parents and offspring are positively correlated. Mutation perpetration is a tenet of the error theory, not the programmed theory, of aging. Although longer life spans correlate positively with numbers of cell divisions in vitro, the rate of cell division is not affected.

22. When compared with elderly populations of the past, persons entering their senior years between 2015 and 2030 will have: A) Fewer chronic diseases but more acute illnesses B) Greater support from their children and spouses C) Better education and greater wealth D) Fewer needs for hospital or nursing home care

Ans: C Feedback: The baby boomer cohort attained higher levels of education and economic status than past generations. They have, however, fewer children and the same (or greater) burdens of chronic disease and needs for health care as their parents did.

16. From the late 1980s to the present, the gap in life expectancy between individuals in the Caucasian and African American communities has widened. Which of the following most clearly accounts for this trend? A) Acute illness in the black population has increased B) Infant mortality and complications of childbirth in the white population have declined C) The life expectancy of African Americans has not increased at the same rate as that of the white population D) Deaths from homicide in the white population have increased

Ans: C Feedback: The gap in life expectancy between white individuals and African Americans has widened because the life expectancy of African Americans has not increased at the same pace as that of Caucasians. The U.S. Department of Health and Human Services attributes this decline to an increase in deaths from homicide and AIDS.

6. A care aide employed on a geriatric medicine unit of a hospital expresses frustration that "old people get sick so much more often than young people." What is the nurse's most appropriate response to this statement? A) "In fact, the prevalence of obesity and accompanying chronic illnesses mean that young people actually have more chronic conditions than older adults." B) "It's actually a myth that older adults require more hospitalization than young people." C) "Actually, older adults experience fewer acute illnesses than younger people, it's just that they tend to take longer to recover from them." D) "With the increase in life expectancies in recent years, most older people actually live free of chronic diseases until very late in life."

Ans: C Feedback: The incidence of acute illness is lower among older adults than younger adults, though recovery times tend to be longer. Older adults tend to have a higher incidence of chronic illness and require more frequent and longer hospitalizations.

10. Which of the following statements by the daughter of an 87-year-old resident of a nursing home would the nurse most likely want to correct or clarify? A) "It seems like more and more people are living well into their 80s like my mom." B) "My mom has a house worth loads of money but little cash flow, like many older adults." C) "It seems like heart disease is getting more common even though people live longer than they used to." D) "There are more women living to my mother's age than there are men."

Ans: C Feedback: The incidence of heart disease as a cause of death is on the decline. More Americans are indeed achieving old age and many older adults have valuable assets but little cash flow. Female longevity continues to exceed that of males.

5. Which of the following statements most accurately captures the financial status of older adults in the United States? A) The percentage of older people living below the poverty level has been increasing. B) The financial needs of most older adults are well met by Social Security income alone. C) The recent decline in housing prices has made many older adults "asset rich and cash poor." D) Women 65 years of age and older is the fastest growing group of employment.

Ans: C Feedback: The percentage of older people living below the poverty level has been declining, with about 10% now falling into this category. Most older people depend on Social Security for more than half of their income. Although the median net worth of older households is nearly twice the national average because of the high prevalence of home ownership by elders, many older adults are "asset rich and cash poor." The recent decline in housing prices, however, has made that asset a less valuable one for many older adults. There has been a significant rise in the percentage of middle-aged women who are employed, although there has been little change in the labor force participation of women 65 years of age and older.

24. The bodily changes that occur during the aging process can affect an older person's body image and self-concept. The nurse can gain insight into the emotional well-being and self-concept of older persons by: A) Uncovering any unresolved guilt and perceived failures B) Reviewing how they interpret and refine their past experiences C) Examining what roles they accept and what roles they reject D) Determining which work roles they forfeit

Ans: C Feedback: The way persons perceive themselves and function can determine the roles they play. And the roles they accept and reject are important indicators of their self-concepts.

21. Younger individuals know that they will not live forever, but their behaviors may indicate that they deny their mortality. One major indication of this denial is their failure to: A) Establish a financial plan for retirement B) Provide adequately for their family's health care needs C) Make a will and set up a burial plan D) Form strong relationships with family and friends

Ans: C Feedback: Those who deny old age fail to establish retirement plans. People fail to provide for health care needs for many reasons, and acceptance of mortality may or may not influence personal relationships. The major sign of denial of mortality is failure to make a will and make plans for death.

12. Mrs S is recently widowed. She worked at home as a full-time wife and mother throughout her adult life. She is now most likely to experience: A) A desire to obtain employment outside the home B) Relief at being freed from the responsibilities of childrearing C) A sense of loss of her established social roles D) An interest in meeting men her own age and remarrying

Ans: C Feedback: Unlike many of today's younger women, who may value employment and motherhood equally, the elderly women of today centered their lives on their families, from which they derived their sense of fulfillment. Having developed few roles from which to achieve satisfaction other than that of wife and mother, many of these women feel a void when their children are gone and their husbands die.

2. A 78-year-old man has received a recent diagnosis of community-acquired pneumonia. Potential pathological findings on a recent chest x-ray have prompted his physician to order a bronchoscopy and lung function tests. Which of the following findings would be most likely suggestive of pathological processes rather than normal, age-related respiratory changes? A) The client has fewer cilia than would be found in a younger client. B) Lung function tests reveal that both maximum breathing and vital capacity are diminished since his last test. C) There is an accumulation of serous fluid between the lungs and the pleural membrane. D) The lungs are smaller than younger adults' and there are fewer alveoli.

Ans: C Feedback: While decreases in the number of cilia, alveoli, lung size, and lung capacities are commonly associated with aging, an accumulation of serous fluid would not be considered a normal consequence of the aging process.

4. A nurse who works on a palliative care unit has developed a strong partnership with the 77-year-old wife of a client who has recently died of lung cancer. The woman has expressed her fears around being a widow to the nurse. How can the nurse best respond? A) "You will likely find that once you are remarried the grief will subside and you will move on." B) "It's very normal to have these fears, but antidepressant medications can help immeasurably with this difficult transition." C) "Though it might not feel like it now, many women eventually find joy in new friendships and freedom after the death of a spouse." D) "It will be important, and healthy, for you to maintain roles and routines similar to before your spouse died."

Ans: C Feedback: Widows often find positive consequences of their status in time, often in the form of new relationships. Suggesting that the grief will subside after remarriage and encouraging the woman not to change would be inappropriate, as would specific recommendations for medication.

A design firm is contracted to remodel a care facility. Which bathroom design component is most conducive to safety and quality of life for the older adult residents who will use them? A) Throw rugs will be placed on the tile floors B) Bathrooms will include bathtubs rather than showers C) A small independent light to remain lit in the bathroom at all times D) A single, rotating faucet installed at the sink to control water flow and temperature

Ans: C Feedback: A small light that remains lit in a bathroom promotes safety. It is not necessary to exclude showers from all residents' rooms and clearly marked, separate hot and cold faucets should be used. Throw rugs constitute a fall risk.

An older individual is touring an assisted living facility with his family in order to find a place to live after the death of his spouse and issues with mobility. Which characteristic of the facility is most in need of modification? A) The temperature of common areas is kept between 75°F and 77°F B) Aromatherapy is used in the facility to provide a pleasant scent environment C) Area rugs are placed in front of each sink in residents' washrooms to ensure warmth D) There is more tile than carpet throughout the facility and carpets are glued to the floor

Ans: C Feedback: Area rugs constitute a fall risk and should not be used. The temperature, the use of aromatherapy, and the prioritization of tile over carpet are all conducive to a safe and pleasant environment.

The staff on a unit that provides care to patients with dementia wants to make changes to the patients' environment. What would be the recommended change to lighting? A) Remove all incidental lamps from the rooms B) Keep a bedside light on in the rooms all night C) Avoid using the fluorescent light over the beds at night D) Close the curtains during the day to minimize the effect of sunlight

Ans: C Feedback: Bright lights can disorient people; soft lighting can make them more sedate. Staff should avoid using the glare of the fluorescent light and turn on one or more of the incidental lamps that can offer comfort and support work activities. Incidental lamps should not be removed from the rooms. Keeping a bedside light on in the rooms all night could interrupt the patients' sleep. The patients need to be exposed to natural light, so the curtains should not be closed during the day.

The daughter of an older patient believes that fresh air kills germs and keeps her father's bedroom window open at night. Because her father wears pajamas, she insists that he is comfortable. What recommendation should the nurse make? A) The patient should wear flannel pajamas. B) Place one quilt and two blankets on the patient's bed C) Keep the temperature in the patient's room not lower than 75°F D) Ensure that the window in the patient's room has permanent screening

Ans: C Feedback: The recommended room temperature for an older person should not be lower than 75°F (24°C). The older the person is, the narrower the range of temperature tolerated without adverse reactions. Room temperatures less than 70°F (21°C) can lead to hypothermia in the elderly. Wearing flannel pajamas and using quilts and blankets on the bed will not replace the need to have a sufficient air temperature. Using a screen in the patient's window will not affect the temperature of the room.

2. The error theory of aging proposes a cause-and-effect relationship between the genetic activity of body cells and the effects of aging. Place the following steps in the error theory of aging in the correct chronological order. Use all the options. A) Organ, tissue, and system malfunction B) Perpetuation of mutation during cell divisions C) DNA mutation D) Overall decline in body functions E) Decline in body functions

Ans: C, B, E, A, D Feedback: The error theory of aging proposes that DNA mutations occur on a single-cell level and are perpetuated in subsequent cell divisions. The overall number of mutant cells in the body increases and causes deleterious effects on tissues and systems and eventual decline in body function.

2. According to Erikson, the final stage of the life cycle is centered on achieving integrity versus despair. Which of the following situations would signal to the nurse that the client in question is at risk for disappointment and despair as characterized by Erikson? A) An 81-year-old woman has needed to adopt a minced diet following a recent stroke. B) A 78-year-old man has had a pacemaker implanted to address his atrial fibrillation. C) A 90-year-old woman is grieving the recent death of her husband to whom she was married for 66 years. D) An 80-year-old man describes himself as "useless" since he can no longer help his adult children with their yard and garden work.

Ans: D Feedback: A perceived loss of useful function often constitutes a crisis for older men and can be associated with despair rather than integrity in Erikson's typology of the life cycle. A change in diet, a medical intervention, and grief at the loss of a spouse are less closely associated with this conflict.

11. It is important to measure and record fluid input and output accurately because this information is used in evaluating a patient's fluid balance and in planning care and treatment. Dehydration is a significant risk for the elderly because: A) The number of body cells is less, and fewer cells are functioning in the body. B) Total body fat as a proportion of the body's composition increases with age. C) Cellular solids and bone mass decrease with age affecting the ability to balance. D) Extracellular fluid remains constant, but intracellular fluid decreases with age.

Ans: D Feedback: Although all the statements are true, only the loss of intracellular fluid is a cause of increased risk of dehydration.

17. Which of the following is the most common urinary problem among men aged 65 years and older? A) High urinary volume B) Glucose in the urine C) Stress incontinence D) Frequent urination

Ans: D Feedback: Although all these conditions may occur or coexist, most common is the need for frequent urination associated with enlargement of the prostate gland. This enlargement occurs to some degree in three-fourths of men aged 65 years and older.

3. A nurse is explaining to an older adult client that many of the changes in his body that are currently causing him frustration may have their origins in genetic changes that may have in fact benefited him during his younger years. Which of the following theories of aging underlies the nurse's explanation? A) Disposable soma theory B) Free radical theory C) Mutation accumulation theory D) Antagonistic pleiotropy theory

Ans: D Feedback: Antagonistic pleiotropy theory proposes that genetic mutations that are problematic in later life may be rooted in mutation that played a beneficial role earlier in life. This perspective is not a component of the disposable soma theory, free radical theory, or mutation accumulation theory.

19. What is the most important factor contributing to limitations in self-care and independent living among the elderly? A) Lack of family support B) Low financial assets C) Acute illness and injury D) Chronic illness

Ans: D Feedback: Chronic illnesses are noted to have a significant impact on the quality of life of older adults. These illnesses are more prevalent than acute illnesses and supersede deficits in family and financial support.

23. Nurse Z takes ample time to explain all medical options to her elderly patients and to ensure they have the information they need to make informed decisions about their care. What is Nurse Z's best reason for taking these actions? A) Full disclosure deters malpractice suits and negligence claims B) The activity theory of aging requires maintenance of lifestyle C) Information is an effective strategy for stress management D) Empowerment has a positive effect on health status

Ans: D Feedback: Maximum control and decision making can have a positive effect on morbidity and mortality, although they do not necessarily reduce stress and are not inherent in the activity theory of aging. Even though legal considerations apply, the health of the patient is the first priority for nurses.

14. Gerontological nursing will become an increasingly important profession, compared with in the past, because: A) More people will be presenting with the same health care challenges B) More elderly are living in increasingly squalid living conditions C) A greater number of people are surviving the previously hazardous period of infancy D) More people are spending a longer time span in old age

Ans: D Feedback: More people are achieving and spending longer periods of time in old age than ever before in history. Declines in living conditions, increased prevalence and incidence of the same health problems, and higher survival rates during infancy do not account for the increased importance of gerontological nursing.

11. Various changes during the aging process demand multiple complex adjustments that require stamina, ability, and flexibility. In which stage of life do individuals experience the greatest number of simultaneous changes? A) Adolescence B) Young adulthood C) Middle age D) Old age

Ans: D Feedback: More simultaneous changes are experienced in old age than during any other period of life.

9. The family of an 85-year-old man who has been admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults? A) The high value of assets owned by older adults makes the financial burden of care minimal for most older adults. B) Payment for long-term care of adults is most often covered by private insurers. C) Most older adults have their basic care needs provided in a long-term facility. D) Overall, federal money pays for more care than do older adults themselves or private insurers.

Ans: D Feedback: Most money for the care of older adults comes from federally funded programs. The burden of payment is still significant for most older adults and a minority of older adults receive care in an institutional living environment.

14. A group of young student nursing assistants is getting clinical experience at a nursing home. In her introductory meeting with this group, the supervising nurse determines that the students harbor some misconceptions about the elderly. Four of the students' comments are listed below. Three of them are misconceptions about the elderly. Which comment is true? A) Most old people are sick or disabled B) Most seniors have a private pension plan C) Senility comes with old age D) Old people are still interested in sex

Ans: D Feedback: Most old people are well, only a small minority are senile, and only a minority have income from a private pension plan. Many retain a healthy interest in sex.

25. A state health investigator surveyed the residents of a retirement housing complex to determine how their financial resources affected their lives and influenced their choices. Which of the following did the investigator most likely find to be true of most of the retired residents? A) Most older people depend on their life savings through their retirement years B) Inflation in the past decades increased retirement benefits for today's seniors C) Nearly three-quarters of all seniors are financially comfortable D) More than half of all seniors retire with only Social Security benefits

Ans: D Feedback: Only a minority of the older population has an income from a private pension plan. Few have significant savings, and inflation has decreased the value of their retirement funds. Of the workers who are currently active in the labor force, more than half will not have pension plans when they retire.

10. Nurse S encourages older adult clients to engage in spiritual beliefs and practices that they are familiar with. How can this activity be best characterized? A) Spiritual concerns are less relevant than immediate physical and financial issues. B) Older adults raised in more religious times are more likely to spontaneously express their spirituality. C) Addressing clients' expressions of spirituality is beyond the scope of appropriate nursing. D) Spiritual expression can be useful in facilitating hope in older adults.

Ans: D Feedback: Spiritual expression is useful in fostering hope and is within the scope of nursing practice. Older adults are not necessarily more spontaneously spiritual nor is spirituality secondary to finances and physical health.

Long Term Care - Treatment / Goal

Treatment: ADL, increase endurance and strength, cognition strengthening Goal: Maintain prior level of function - move from toilet transfer to toilet with supervision

7. Which of the following directives by the head nurse at a long-term care facility is most reflective of the activity theory of aging? A) "We need to facilitate older adults' desire to step back from the responsibilities and roles they had in earlier years." B) "It's hard to overestimate the importance of regular, physical exercise in maintaining health and healthy aging." C) "We need to remember that the psychological roles and characters of our residents change profoundly in later years of life." D) "We have to treat our residents like younger people and keep them engaged in meaningful acts."

Ans: D Feedback: The activity theory asserts that an older person should continue a middle-aged lifestyle, denying the existence of old age as long as possible, and that society should apply the same norms to old age as it does to middle age and not advocate diminishing activity, interest, and involvement as its members grow old. Stepping back from roles is associated with disengagement theory, and psychological roles and character are not thought to change radically in later life. Physical exercise is not a central component of activity theory.

22. Mr. D was friendly and active as a young adult. Now, as a 75-year-old, he enjoys visiting with his neighbors and attending a variety of sporting and cultural events. Mr. D's behavior is most consistent with which theory of aging? A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory

Ans: D Feedback: The continuity theory suggests that personality and basic patterns of behavior remain unchanged as an individual ages. This is not a central component of the other noted theories.

20. Mr B, age 73, has a terminal illness. He has entered a nursing home, where he will reside until his death. Until age 70, he worked as a successful bank president and was an active community leader. His nurse should be alert for signs that he most resents his: A) Mortality B) Unemployment C) Family D) Dependency

Ans: D Feedback: The elderly often fear that their illness or disability may cause them to lose their independence. Becoming a burden to their families, being unable to meet the demands of daily living, and having to enter a nursing home are some of the fears associated with dependency. Physical pain from an illness may not be as intolerable as the dependency it causes. In Mr B's case, his rapid change from great independence to near total dependence may distress him more than family relationships, the loss of his work role, or his impending death.

1. A nurse who works on a subacute medical unit of a hospital is discussing the increasing population of older adults on the unit with a colleague. Which of the colleague's following statements about older adults is most accurate? A) "Fortunately, Social Security ensures a sufficient level of income for people over 65." B) "It helps that older people don't have to directly incur any costs for their medical care." C) "Most of the older clients on the unit will have come to us from nursing homes." D) "It's reassuring that people are starting to show more concern for older adults than in decades past."

Ans: D Feedback: The formation of the Administration on Aging, enactment of the Older Americans Act, and the introduction of Medicaid and Medicare all occurred in 1965. Since that time, society has demonstrated a growing concern for its older members. Myths about older people include the belief that Social Security ensures them an adequate income, that they do not have to pay for medical care, and that most older adults live in nursing homes.

Hospice: Treatment / Goals

Treatment: Family education, pain management, positioning Goals: comfort, care, support, meaningful activities

Home Health: Treatment / goal

Treatment: adaptions for safety, education Goal: return to adl in natural context

11. Nurses need to understand the aging process in order to help their patients: A) Live longer with their long-term disabilities B) Maintain youth and delay the onset of old age C) Accept the limitations imposed by genetic tendencies toward cellular degeneration D) Postpone the negative consequences of the aging process

Ans: D Feedback: The promotion of positive health practices increases the chances that an individual can delay or deter the impairments and declines that frequently accompany the aging process. Living long in a disabled state is not the most desirable objective. Maintaining youth is not an achievable goal. Accepting limitations is not necessary for many seniors and not life enhancing for many others.

5. The spouse of a patient with dementia remains upbeat and is appreciative of having good health and a loving family. The nurse realizes that the spouse is demonstrating which component of spirituality? A) Hope B) Fatalism C) Gratitude D) Transcendence

C) Gratitude Feedback:Gratitude is characterized by a sense of thankfulness and positivity, as exemplified by the woman's focus on what she has rather that what she lacks. Transcendence involves an awareness of a reality beyond oneself and hope is an expectation that looks to the future. Fatalism is a resignation to the inevitability of life events.

17. Two related and important trends in the elderly population are: A) The growing gap in life expectancy between males and females and the number of women living alone B) The increase in life expectancy of white and black people. C) The continued burden of acute disease and the low levels of education among the elderly D) The increased burden of chronic illness and the shifting causes of death with advancing age

Ans: D Feedback: The role of chronic illness in death rates is both significant and represents a shift from the past. The gap in life expectancy between men and women is narrowing. The life expectancy of black people has been recently declining. The generation now entering the senior years is better educated than generations past.

4. Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? A) An 81-year-old woman's glomerular filtration rate (GFR) is low. B) A 78-year-old male's stomach pH is increased. C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy. D) A 78-year-old man has recently developed urinary incontinence.

Ans: D Feedback: While a decrease in GFR, increase in stomach pH, and slight left ventricular hypertrophy are considered normal accompaniments to aging, urinary incontinence should be considered a pathological finding that necessitates further assessment.

7. A hospital client, aged 82 years, is presently undergoing an endocrine diagnostic workup in an effort to diagnose his increasing fatigue of unknown etiology. Which of the following findings would his care team recognize as potentially pathological? A) Apparent decreased thyroid gland activity. B) Decreased somatotropic growth hormone (GH) levels. C) Delayed and insufficient release of insulin by the -cells. D) Decreased erythropoietin production by the kidneys.

Ans: D Feedback: While decreases in thyroid gland activity, GH, and insulin are often associated with aging, a decrease in erythropoietin production would be considered problematic and pathological.

21. A nurse is reviewing thyroid test results of her clients. Which of the following is the most likely thyroid test result for a healthy elderly patient? A) T4: low; T3: low; thyroid function: low B) T4: high; T3: normal; thyroid function: high C) T4: high; T3: normal; thyroid function: low D) T4: normal; T3: low; thyroid function: normal

Ans: D Feedback: With normal aging, secretion of thyroid-stimulating hormones (TSH) and the serum concentration of thyroxine (T4) do not change, although there is a significant reduction in triiodothyronine (T3), which is believed to be a result of the reduced conversion of T4 to T3. Overall, thyroid function remains adequate.

Which aspect of the microenvironment is a 79-year-old widow most likely to focus on first? A) The decor of the house is several decades out of date. B) The home was recently burglarized and the television stolen. C) The front steps of the house are decaying and pose a safety risk. D) The home is unbearably hot in the summer and has cockroaches.

Ans: D Feedback: According to Maslow's hierarchy of needs, considerations related to basic comfort and freedom from pests are foundational, and supersede safety risks and aesthetics. The patient is most likely going to focus on home temperature and rodents before decorating, improving the steps, or purchasing a new television.

Maslow's hierarchy of six basic human needs includes love. Which characteristic of an older person's home environment demonstrates that the need for love has been fulfilled? A) Large airy windows B) New, stylish furniture C) Adjustable track lighting D) Furniture acquired as a newlywed

Ans: D Feedback: Environmental needs to satisfy the basic human need for love because this is a place where one derives pleasure from familiar and comfortable furniture and favorite objects. Large airy windows do not demonstrate any of the basic needs. New stylish furniture demonstrates the basic need of self-esteem. Adjustable track lighting demonstrates the basic need of security.

Which statement should be incorporated into the restraint policy for residents of a long-term care facility? A) Restraints should never be used. B) Physical restraints should only be used with verifiably agitated patients. C) Restraints should only be used when one-to-one staff supervision is not possible. D) Alternatives should be explored before chemical and physical restraints are utilized.

Ans: D Feedback: While it is not realistic to categorically prohibit the use of restraints, it is important to first explore and exhaust all other options. Restraints exacerbate agitation and the decision to use restraints should not be driven by staffing considerations.

During a morning assessment the nurse notes that the oral temperature of an older patient is 96°F (35.6°C). What guide will the nurse use to make decisions about this assessment finding? A) Older adults are at increased risk for hyperthermia B) Low temperature constitutes a risk to cardiac health C) Older adults often lose body heat in response to infection D) The normal body temperature of older adults is often lower than that of younger people

Ans: D Feedback: While it is true that older adults are often at risk from temperature fluctuations in general and hyperthermia in particular, this should not guide the nurse's interpretation of the assessment as much as the fact that older adults often have lower core temperatures. Fever constitutes a cardiac risk, and while older adults may fail to become febrile during an infection, they are not noted to develop hypothermia as a result.

Subacute care - Treatment / Goal

Treatment: improve ADLs and performance skills Balance to pull up pants, endurance to bathe Goal: restore functional independent and return to community

Outpatient: Treatment / Goal

Treatment: modalities, wheelchair fittings, compensation and education Goal: restore function, independence, reinforce what was learned in previous settings

10. An older male patient admits to doing many things in life that he is not proud of and is having a difficult time getting them out of his mind. How should the nurse respond to the patient's statement? A) "Remember that no one has lived a perfect life." B) "Is there anyone that you might want to ask forgiveness from?" C) "Is there anything I can do to help you focus on more positive things?" D) "Do you think that you were really any worse than most other people?"

B) "Is there anyone that you might want to ask forgiveness from?" Feedback:Seeking forgiveness can be a powerful tool in attaining spiritual health. Urging comparison to others is inappropriate and attempting to change the patient's focus to more positive subjects is not an appropriate intervention.

6. An older patient just learning of having a terminal illness begins to cry. Which statement or question should the nurse make to facilitate the patient's spiritual health? A) "Remember that everything in life, even the bad things, happens for a reason." B) "Is there anything in your spiritual beliefs or practices that might bring you comfort at this time?" C) "It's not appropriate for me to pray with you, but would you like me to arrange a visit from the chaplain?" D) "It's likely best for you to try to focus on what is going right in your life, even though that's likely hard right now."

B) "Is there anything in your spiritual beliefs or practices that might bring you comfort at this time?" Feedback:Asking the patient how spiritual needs can be supported is a recognized component of spiritual assessment and acknowledges the patient's spiritual needs while still letting the patient direct the process. Making off-hand statements such as things happening for a reason and encouraging the patient to focus on the good things in life would be inappropriate at this time. It is not inappropriate for a nurse to pray with a patient when circumstances allow.

Nurse B talks with Patient G about effective methods of managing stress incontinence. What role of the gerontological nurse is being enacted in this exchange?

B) Caregiver

Which of the following is the primary role of the gerontological nurse, and for what reason?

B) Caregiver, because the nurse uses gerontological theory in the conscientious application of the nursing process to the care of elders

25. A patient tells the nurse that she has practiced meditation for years since it has helped her with mental clarity. Which type of meditation should the nurse document that the patient practices? A) Mindfulness B) Concentrative C) Transcendental D) Trans-mutational

B) Concentrative Feedback:Concentrative meditation calms the person and promotes mental clarity and acuity. Mindfulness meditation promotes a calm nonreactive mental state. Transcendental meditation relaxes the body while keeping the mind alert. Trans-mutational is not a type of meditation.

22. A patient is demonstrating signs of spiritual distress but refuses to be visited by clergy or to participate in religious services. What should the nurse do to help the patient? A) Arrange for a volunteer to read inspirational essays to the patient B) Do not challenge the patient's decision or attempt to change his mind C) Pray that the patient will come to recognize his need for spiritual support D) Talk with the hospital chaplain about looking in on the patient without talking about religion

B) Do not challenge the patient's decision or attempt to change his mind Feedback:Although a nurse should assist patients in their spiritual growth, the nurse's first commitment is to respect patients' wishes. A nurse should not challenge a patient's religious beliefs or attempt to change them. The nurse should not have inspirational essays read to the patient or talk with the hospital chaplain. The nurse may or may not want to pray about the patient's needs for spiritual support.

17. For patients from which of the religious groups would an opportunity to fast in the weeks before Easter be most important? A) Jewish B) Eastern Orthodox C) Seventh-Day Adventist D) Episcopalian (Anglican)

B) Eastern Orthodox Feedback:Fasting during Lent is practiced by members of the Roman Catholic and Eastern Orthodox churches. Fasting is not typically done prior to Easter by those of the Jewish, Seventh-Day Adventist, or Anglican Episcopalian faiths.

To effectively care for the clinical complexities of older adults, nurses need preparation in the unique principles and best practices of geriatric care. On what are the best practices built?

B) Evidence-based practice and the expertise of the nurse

Which of the following sources is the most justifiable foundation for the future of gerontological nursing?

B) Gerontological nursing research

Which of the following facts best accounts for the complexity of gerontological nursing?

B) Multiple health conditions often coexist in older adults and symptoms are often atypical.

19. An older female patient in the resident care facility insists that her hair be kept covered at all times. Of which branch of the Jewish faith is she most likely a member? A) Reform B) Orthodox C) Rabbinical D) Conservative

B) Orthodox Feedback:The covering of the hair of married women is a practice of Orthodox (observant) Judaism. Those who practice Conservative Judaism cover the head during worship and prayer. Those who practice Reform Judaism do not follow laws for covering the head. There is no branch of Rabbinical Judaism.

1. An older female patient tells the nurse that even though she believes in a higher power she is not interested in information on the hospital's chaplaincy services since she has never been religious. What does the nurse recognize as the relationship between religion and spirituality? A) Some people are religious, while others are spiritual. B) Religion is a particular, structured way of expressing spirituality. C) Religion is the essence of our being that connects us with the Divine. D) All human beings have an innate desire for religious structure and spiritual fulfillment.

B) Religion is a particular, structured way of expressing spirituality. Feedback:Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion. Not everyone identifies a need for religion, and religion and spirituality are not mutually exclusive. Spirituality, not religion, is defined as the essence of our being that connects us with the divine.

21. An older female patient tells the nurse that through periods of trial and tribulation, the Bible has been the source of ongoing strength and support. Which statement supports this patient's beliefs by researched evidence? A) Patients from low socioeconomic levels tend to be more religious. B) Religious commitment has a positive effect on health care outcomes. C) Patients holding strong religious convictions experience great emotional stress during illness. D) Among the elderly, high levels of religiosity correlate with greater levels of physical disability.

B) Religious commitment has a positive effect on health care outcomes. Feedback:Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is therapeutically beneficial to support patients' spirituality and assist them in fulfilling spiritual needs. The other statements are not supported by researched evidence.

14. During an interview process as a staff nurse for a geriatric patient care area, the nurse is asked about her philosophy of spirituality. Why is this important when caring for older patients? A) Spirituality becomes more unconditional as people age B) Spirituality often becomes more important to people as they age C) An individual's spirituality remains stable from youth through old age D) As people age, their spirituality becomes more quantitative than qualitative

B) Spirituality often becomes more important to people as they age Feedback:All humans have spiritual needs, regardless of whether they realize or acknowledge them. Some of these needs become particularly relevant in late life when the high prevalence of chronic illness and reality of death are evident. Spirituality does not become more unconditional as people age. Spirituality may change throughout the life. There is no evidence to support that spirituality becomes more quantitative than qualitative as people age.

15. Which statement should the nurse use to plan interventions to address the behavior of an older patient sitting quietly alone in a room? A) Spending a lot of time alone is a sign that an elder is lonely or grieving. B) Uninterrupted periods of solitude and inactivity are therapeutic for the elderly. C) Solitude should be discouraged among elders because it leads to social isolation. D) Occupational therapy should be arranged for an elder often observed doing nothing.

B) Uninterrupted periods of solitude and inactivity are therapeutic for the elderly. Feedback:Periods of solitude are therapeutic to the elderly. Unresolved feelings from earlier years may be contemplated and resolved, resulting in personal satisfaction. In reminiscing, evaluating, and understanding the dynamics of life's earlier events and achievements, older persons can find a satisfaction with the quality of their lives that helps compensate for their multiple losses. Spending time alone is not a sign that the patient is lonely or grieving. Solitude does not lead to social isolation. Activities should not be planned for an older patient who is doing nothing.

Post Acute - Goal / Treatment

Goal: Maximize level of function and independence - INTENSE THERAPY Treatment: ADL, previous occupations, client + caregiver education

Acute Setting- Goal / Treatment

Goal: Stabilize and discharge Treatment: Early mobilization (sitting on edge of bed), restoring function, preventing decline, education

Long term acute care - Goal / Treatment

Goal: Transfer to lower level of care, achieve medical stability, improve functional potential Treatment: improving activity tolerance (brushing hair for diff period of time), gradually increasing participations in ADL

Skilled Nursing Facility - Goals / LOS

Goals: self care, ADL, adaptive equipment, compensary techniques, behavior LOS: sort term to permanent

Transitional Care unit

Bridge between hospital and home to regain independce LOS: 30 days

4. The nurse is caring for older patients in a long-term care facility. When ensuring for these patients' dignity, which statement reflects the role of dignity as it relates to the spiritual needs of the older adult? A) Older adults who have lived a life of integrity and service have earned dignity. B) An acknowledgment of spiritual needs is necessary for the presence of dignity. C) Older adults may lack many of the attributes that are valued in society, but they can derive a sense of dignity from spirituality. D) Older adults who have moved successfully through Erikson's stages of development can experience dignity in spite of disability.

C) Older adults may lack many of the attributes that are valued in society, but they can derive a sense of dignity from spirituality. Feedback:Despite declines in such areas as productivity and physical appearance, older adults can maintain a sense of their intrinsic worth, or dignity, by connecting with the Divine. Acknowledgment of spiritual needs is not necessarily a prerequisite for dignity, given that dignity is by definition inherent in all persons, nor is progression through Erikson's stages or a life of service necessarily required.

9. An older female patient, experiencing cancer pain and nausea and vomiting from chemotherapy, asks the nurse to pray for her during this difficult time. How should the nurse respond to the patient's request? A) Facilitate a visit from a chaplain to the client at the bedside. B) First determine whether the client shares a similar religious tradition as the nurse. C) Pray for the client, asking a higher power to intervene and provide peace and relief. D) Explain that praying is beyond the nurse's scope of practice and explore alternative interventions.

C) Pray for the client, asking a higher power to intervene and provide peace and relief. Feedback:Nurses are justified in praying for clients and can simply ask a higher power to intervene. An identical religious tradition is not a prerequisite and praying need not be delegated to a chaplain. Praying is not beyond the nurse's scope of practice.

Nursing standards arise from a variety of sources. Which of the following is the best source of standards for gerontological nursing?

C) The Joint Commission on Accreditation of Healthcare Organizations

The scope of nursing includes more than following a medical order or performing an isolated task. Which of the following statements best describes the scope of nursing?

C) The nursing process involves a holistic approach to individuals and the care they require.

All of the following are characteristics of the continuum of care EXPECT...? A. The more medically fragile patient , the more the OT is needed to return client to his or her PLOF B. The continuum of care is compressive C. The clients needs remain the same throughout the continuum D. The acuity level changes throughout the continuum

C. The clients needs remain the same throughout the continuum

3. The nurse is aware of the spiritual dimension in Erikson's conceptualization of the older adult's growth and development. When applying Erikson's theory to the care of older patients, what does the nurse realize as being a spiritual component of Erikson's final development task? A) Awareness that one is loved by others and has provided unconditional love. B) A confidently held hope that a transcendent and positive afterlife awaits one following death. C) A sense of contribution that one's relationships and endeavors have benefited society and one's family. D) A sense of wholeness rooted in the knowledge that life experiences make sense and have served a purpose.

D) A sense of wholeness rooted in the knowledge that life experiences make sense and have served a purpose. Feedback:According to Erikson's description of the final developmental task, healthy psychological aging for the older adult involves achieving a sense of integrity. This integrity, or wholeness, is supported by the belief that life experiences—both good and bad—make sense and have served a purpose. The other choices express needs that older individuals may possess, but these are not components of Erikson's framework.

18. The nurse is caring for an older patient who is nearing death and realizes that no professional clergy needs to be contacted. This patient is most likely a member of which faith? A) Pentecostal B) Unitarianism C) Seventh-Day Adventists D) Church of Jesus Christ of Latter Day Saints

D) Church of Jesus Christ of Latter Day Saints Feedback:The Church of Jesus Christ of Latter Day Saints (Mormons) is the only faith of those listed that has no professional clergy.

Which of these nursing actions is most likely to be effective in reconciling the costs of care with the need for quality care?

D) Enlisting the help of family, friends, and neighbors in the care of older adults.

Which of the following nursing actions by a gerontological nurse best exemplifies the role of "advocate"?

D) Teaching an older adult how to best deal with a daughter who is attempting to gain power of attorney prematurely.

7. What should the nurse use to help guide interventions to meet the spiritual needs of a patient? A) The client's prognosis for recovery B) The nurse's own religious tradition C) The denominational affiliation of the chaplain D) The presence of icons and religious books at the bedside

D) The presence of icons and religious books at the bedside Feedback:The presence and identity of a patient's religious books and symbols can be useful insights into a patient's spiritual belief system. This information would supersede the religious affiliation or tradition of the nurse or chaplain as well as the patient's objective prognosis for recovery.

11. Two nurses are discussing the relationship between spirituality and religion. Which statement explains this relationship? A) They are the same. Both connect individuals to the Divine and to other living things. B) They are directly related. The more spiritual the individual, the greater his or her commitment to religion. C) They interact inversely. Heavy involvement in organized religion diminishes spirituality and vice versa. D) They are different. Spirituality is a sense of connection to the Divine; religion is a structure of beliefs, rituals, and rules.

D) They are different. Spirituality is a sense of connection to the Divine; religion is a structure of beliefs, rituals, and rules. Feedback:Spirituality is the essence of our being that transcends and connects us to the Divine and other living organisms. It involves relationships and feelings. Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion.