Older adult

7. A nursing home is converting to a person-centered culture from an institution-centered culture. Which nursing intervention will be suitable in the new culture? a. Maintain consistent resident assignments. b. Provide structured activities for the residents. c. Assign nursing assistants to perform bathing. d. Determine mealtime on the basis of staffing levels.

ANS: A As part of a person-centered culture, nurses should have consistent resident assignments to establish rapport with their residents and become familiar with their unique qualities and preferences. Activities structured by the staff are part of the institution-centered culture. Assigning assistants to perform bathing is part of the institution-centered culture because it focuses on tasks. Schedules are determined for the staffs convenience as part of the institution-centered culture.

3. An older female patient is reading a large-print magazine and states that reading is difficult for her in the evening. Which intervention should the nurse implement? a. Put a high-intensity lamp at the head of her bed. b. Explain to her that the gray-yellow ring around her cornea, arcus senilis, is interfering with visual acuity. c. Put more powerful tubes in the fluorescent room lights. d. Examine her retinas for signs of damage.

ANS: A The pupil becomes gradually smaller with age; therefore the eye requires three times as much light. A high-intensity light on the object of interest is more effective than increasing the overall room illumination. The arcus senilis does not affect vision. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment.

10. The gerontological nurse collaborates with the wound care team about an older patient who has an ulcer. How is this nurse demonstrating leadership in the care of older people? a. Assessing older adults effectively b. Facilitating access to elder care programs c. Coordinating members of the health care team d. Empowering older adults to manage chronic illness

ANS: C The nurse demonstrates leadership in the care of older adults by initiating and coordinating collaboration with the wound care team to improve the health of an older adult. Screening and assessing are only indirectly related to collaboration. In this case, the nurses collaborative efforts are unrelated to facilitating access to a program. Thus far, the nurse has not educated or trained this patient in wound care.

1. An older woman has left-sided paralysis from a thrombus formation in the cerebral vasculature. Rank the nursing goals of this womans plan of care in order of importance, starting with the most important goal. (Select all that apply.) A. Instruct her to call for help before moving. B. Maintain her blood pressure below 120/80 mm Hg. C. Reinforce occupational therapy for feeding. D. Use range-of-motion exercises to prevent contractures.

ANS: B, A, D, C Using Maslows Hierarchy of Human Needs, the most important goal for this older woman is to control her blood pressure; hypertension and other factors contributed to the development of the thrombus. Thus to prevent further intimal damage to cerebral and other vessels, the nurse maintains the blood pressure at or below the limit as determined by the health care provider. The second priority goal for the nurse is to maintain safety by instructing the older woman to call for help when moving, which will help prevent accidents and injuries. The next goal in importance is the prevention of contractures; joint flexibility is easier to maintain than it is to restore. In addition, joint flexibility is important for adapting to her physical limitations as she learns to perform activities of daily living. The last goal is using joint flexibility and muscle strength to learn self-feeding. The order of these goals is correct; each goal is dependent on the preceding goal for its success.

14. Which cultural group is more likely to distrust the health care system than other cultural groups in the United States? a. African Americans c. Mexican Americans b. Chinese Americans d. Lebanese Americans

ANS: A Because of a history that includes slavery, social injustice, and abuse of African-American men in medical research, African Americans are more likely to distrust the health care system in the United States. Chinese are less likely to distrust the health care system of the United States than African Americans because of a lack of a history of major health-related injustices. Mexican Americans are less likely to distrust the health care system of the United States because of the many benefits they receive that are unavailable in Mexico. Lebanese Americans are less likely to distrust the health care system of the United States because of a lack of a history of health-related injustices against their culture in the United States

7. According to researchers, which characteristic will most centenarians share in the future? a. Female b. Demented c. Malnourished d. Wheelchair bound

ANS: A Researchers expect women to make up the majority of centenarians in the future. Gerontologists expect dementia to be common among older adults, but they are not predicting most centenarians will have dementia. Malnutrition is common among older adults, but researchers have not predicted that most centenarians will be malnourished. Decreased mobility is common among older adults, but researchers have not predicted that most centenarians will be confined to a wheelchair.

2. Which gerontological nursing organization welcomes nurses from all educational backgrounds? a. The National Gerontological Nursing Association (NGNA) b. The National Conference of Gerontological Nurse Practitioners (NCGNP) c. The National Association of Directors of Nursing Administration in Long-Term Care (NADONA/LTC) d. The American Society on Aging (ASA)

ANS: A The NGNA was formed specifically for all levels of nursing personnel: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and certified nursing assistants (CNAs). The NCGNP is, as its name implies, limited to nurse practitioners. The NADONA/LTC is, as its name implies, limited to directors and assistant directors of nursing. The ASA is an interdisciplinary organization not limited to nurses.

6. Which was the first formal action the ANA took in relation to gerontological nursing? a. Established a national geriatric nursing group b. Defined educational standards for gerontology c. Created the ANA Division of Geriatric Nursing

ANS: A The first formal act of the ANA to promote gerontological nursing was to form a national geriatric nursing group in 1962. In 1973, the ANA defined educational standards for geriatric nursing. The ANA Division of Geriatric Nursing was begun in 1966. In 1979, the ANA formed the Council of Long Term Care Nurses.

1. An older female resident in the residential facility keeps a large collection of personal items and photographs of her late husband on her bedside table, but the nursing assistant and resident frequently argue about this. Why should the nurse intervene between the resident and the nursing assistant? a. Resident is attempting to maintain her sense of personal space. b. Resident needs to accept the reality of her spouses death. c. Residents argumentative nature can indicate early dementia. d. Clutter from all the personal items is a safety and liability risk.

ANS: A A thoughtful nurse respects and supports the residents boundaries. Even if the resident needed to accept the reality of her spouses death, the residents grief process and personal space should be respected. Although the residents argumentative nature can indicate early dementia, the residents behavior can also be understood as a healthy defense of personal space. Although the rationale of the nurse assistant is probably that the clutter from all the personal items is a safety and liability risk, the assistant should realize that this resident is entitled to the personal use of her personal space.

9. The nurse is aware that cultural competence means having the skills to put cultural knowledge to use in all of the following except: a. Assessment c. Intervention b. Communication d. Collaboration

ANS: A Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. To provide culturally competent care, the nurse gathers data about the culture, the older adult, and the specific cultures impact on the older adult, organizes the data, and applies the information by planning, implementing, and evaluating nursing care. Planning includes supporting cultural patterns. Assessing includes increasing cultural knowledge. Through increased knowledge, nurses can better assess the strengths and weaknesses of the older adult within the context of their culture and know when and how to effectively intervene to support rather than hinder cultural patterns that enhance wellness and coping.

17. Which are the major factors influencing the experience of aging? a. Health, history, and sex b. Self-care needs and culture c. Self-fulfillment and self-esteem d. Society, culture, and marital status

ANS: A Health, history, and sex are major factors influencing the aging experience and interact to make each cohort distinctive. Culture is a major influence on the experience of aging and contributes to the uniqueness of a cohort; however, self-care needs are basic human needs and contribute to the similarities between cohorts. Self-fulfillment and self-esteem are higher-level human needs on Maslows hierarchy and denote similarities between cohorts. Society and culture are major influences on the aging experience, but marital status is not.

14. Which approach requires the nurse to integrate and balance all aspects of an individuals life into the plan of care? a. Holistic nursing b. Healthy People 2020 c. Maslows Hierarchy of Human Needs d. Orems Self-Care Requirements

ANS: A Holistic nursing integrates all aspects of an individuals life into the plan of care by balancing an individuals internal and external environment with psychosocial, spiritual, cultural, and physical processes. Healthy People 2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslows Hierarchy of Human Needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orems Self-Care Requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness.

11. A nurse completing a hospital discharge to home understands that which of the following interventions is most important before discharge. a. Medication reconciliation b. Providing a list of community resources c. Contacting a durable medical equipment facility d. Educating the client on appropriate range-of-motion exercises

ANS: A Medication reconciliation is the most important intervention to complete before discharge. Medication discrepancies are the most prevalent adverse event after hospital discharge and the most challenging component of a successful hospital-to-home transition. Nurses attention to an accurate prehospital medication list, medication reconciliation during hospitalization and at discharge, and patient and family education about medications are required to enhance safety. Educating the client on appropriate range-of-motion exercises, providing a list of community resources, and contacting a durable medical equipment facility are all important and should be completed as well, but medication reconciliation should be the priority.

3. Which factor(s) are associated with the provision of culturally competent care? (Select all that apply.) a. Cultural awareness c. Cultural skills b. Cultural knowledge d. Cultural connections

ANS: A, B As nurses move toward cultural competence, they increase their cultural awareness, knowledge, and skills. Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. Cultural connections have not been identified as a factor.]

3. Identify the Healthy People 2020 emerging issues in the health of older adults. (Select all that apply.) a. Coordinating care for the older adult population b. Assisting older adults in the management of their own care c. Identifying levels of training for those caring for older adults d. Making community resources available for older adults e. Increase in health disparities for rural older adults

ANS: A, B, C According to United States Department of Health and Human Services (USDHHS): Healthy People 2020, emerging issues in the health of older adults are the following: coordinating care; helping older adults manage their own care, establishing quality measures; identifying minimum levels of training for people who care for older adults; and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults.

MSC:Health Promotion and Maintenance 2. According to Healthy People 2020, older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement. (Select all that apply.) a. Diabetes b. Arthritis c. Congestive heart failure d. Dementia e. Cancer f. Pressure ulcers

ANS: A, B, C, D In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia. PTS: 1 DIF: Remember REF: 4 TOP: Nursing Process: Planning

2. Identify future directions for gerontological nursing research as suggested by Wykle and Tappen. (Select all that apply.) a. Interdisciplinary practice models b. Intergenerational caregiving c. Health disparities d. Influence of culture on aging e. Long-term care initiatives

ANS: A, B, C, D The following have been identified for future directions for gerontological nursing research according to Wykle and Tappen: interdisciplinary practice models, intergenerational caregiving, health disparities, and the influence of culture on aging. Long-term care initiatives have not been identified as a future direction for nursing research

2. An elder-friendly community includes components that: (Select all that apply.) a. Address basic needs b. Optimize physical health c. Provide financial assistance d. Maximize independence e. Provide social engagement

ANS: A, B, D, E Components of an elder-friendly community include addressing basic needs, optimizing physical health and well being, maximizing independence for the frail and disabled, and providing social and civic engagement. Elder-friendly communities do not provide financial assistance.

1. In which areas have advanced practice nurses demonstrated their skill in improving? (Select all that apply.) a. Health outcomes b. Length of stay c. Cost effectiveness d. Reimbursement measures e. Interprofessional communication

ANS: A, C Advanced practice nurses have demonstrated their skill in improving health outcomes and cost effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams. This role is well established, and positive outcomes include increased patient and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving.

2. A nurse caring for older adults must be aware of which consequences of ageism in language? (Select all that apply.) a. Reduced sense of self c. Lowered self-esteem b. Poor nutritional intake d. Decreased memory performance

ANS: A, C, D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Consequences of ageism have been identified as a reduced sense of self, lowered self-esteem, lowered sense of self-competence, and decreased memory performance. Poor nutritional intake has not been identified as a consequence.

3. Which home modification interventions are designed to enhance the ability of older adults to remain in their homes? (Select all that apply.) a. A 36-inch-wide doorway b. Entryways with less than two steps c. Electrical outlets at chest level d. A bathroom on the first floor

ANS: A, D Many state and local governments are assessing the community and designing interventions to enhance the ability of older people to remain in their homes and familiar environments. Home design features such as 36-inch-wide doorways and hallways, a bathroom on the first floor, an entry with no steps, outlets at wheelchair level, and reinforced walls in bathrooms to support grab bars.

8. A nursing home executive interviews RNs to fill a full-time position for direct patient care to maintain the standards of elder care. Which nurse should the nursing home hire? a. Nurse from a certified college c. Nurse with 15 years of experience b. Certified gerontological nurse d. Gerontological nurse practitioner

ANS: B A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15-years experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gero

5. Which change in the skin is abnormal in an older person? a. Thinner and more fragile skin c. Greater number of freckles b. Red, swollen 3-day-old wound d. Loss of hair on the extremities

ANS: B Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss

5. Which of the following is most likely to be true about caring for an older African-American patient? a. The patient can expect to find support from his church after discharge. b. During a physical assessment, an examination of the interior of the patients mouth with adequate light is important. c. The patient may follow hot-cold beliefs. d. African Americans may avoid eye contact when interacting with others.

ANS: B During a physical assessment, an examination of the interior of the patients mouth with adequate light is important; this statement is true because skin pigmentation can conceal some clinical signs such as cyanosis, which are more visible in the buccal cavity. Although the church is a source of support for many older African Americans, it should not be assumed at the expense of other forms of support. Traditional Chinese medicine is based on hot-cold beliefs, not African-American beliefs. Avoidance of eye contact has not been identified as a cultural practice for African Americans.

3. As the nurse admits an older woman to a long-term care facility from her home of 50 years, she mistakes the nurse for her daughter. Which diagnosis does the nurse use to plan care for this woman? a. Hypoxia as a result of chronic disease b. Relocation stress syndrome c. Alzheimer disease (AD) d. Attention-seeking behavior

ANS: B Relocation, especially if sudden, causes stress that may lead to altered mental status. Many conditions other than hypoxia can cause altered mental status, including relocation stress. Many conditions other than AD can cause altered mental status, including relocation stress. The nurse has no confirmatory evidence to regard the older womans error as something other than a mistake; in addition, it can be understood as relocation stress syndrome.

2. Decreased functioning of which physical structure is likely to result in decreased metabolism in older adults? a. Kidney c. Brain b. Thyroid gland d. Skeleton

ANS: B Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis.

13. Which gerontological organization had a significant influence on the care of older adults? a. American Association of Retired Persons (AARP) b. John Hartford Foundation c. Medicare d. Mutual of Omaha Insurance

ANS: B The most significant influence in enhancing gerontological nursing has been the work of the Hartford Institute for Geriatric Nursing, funded by the John A. Hartford Foundation. The foundation seeks to shape the quality of the nations health care for older Americans by promoting geriatric nursing excellence to both the nursing profession and the larger health care community. Initiatives in nursing education, nursing practice, nursing research, and nursing policy include enhancing geriatrics in nursing education programs through curricular reform and faculty development and the development of nine Centers of Geriatric Nursing Excellence. AARP is a foundation that helps struggling seniors by being a force for change on the most serious issues they face today. Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees access to health insurance for Americans ages 65 years and older and younger people with disabilities. Mutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska.

8. The nurse prepares an older woman, who is Polish, for discharge through an interpreter and notes that she becomes tense during the instructions about elimination. Which intervention should the nurse implement? a. Move onto the discussion about medication. b. Ask the older woman how she feels about this topic. c. Instruct the interpreter to repeat the instructions. d. Have the older woman repeat the instructions for clarity.

ANS: B When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and therefore validates the assessment about the older adults tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable discussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adults discomfort. Instructing the older adult to repeat the nurses instruction ignores the her needs.

10. Which is characteristic of relocation stress syndrome in a resident of a long-term care facility? a. Agitation c. Caring family b. Apprehension d. Hallucinations

ANS: B Apprehension is a major defining characteristic of stress relocation syndrome. Agitation is uncharacteristic of stress relocation syndrome. An inadequate support system is characteristic of this syndrome. Hallucinations are uncharacteristic of this syndrome.

12. Which health belief system uses treatments to repair a body part? a. Holistic c. Personalistic b. Biomedical d. Magicoreligious

ANS: B Because dysfunction or a structural abnormality is thought to cause disease, the biomedical system believes in repairing the structural abnormality. The holistic system holds that health is attained through balance. The personalistic system uses treatments such as meditation, fasting, and praying. The magicoreligious system is the same

2. Which of the following is a true statement about differing health belief systems? a. Personalistic or magicoreligious beliefs have been superseded in Western minds by biomedical principles. b. In most cultures, older adults are likely to treat themselves using traditional methods before turning to biomedical professionals. c. Ayurvedic medicine is another name for traditional Chinese medicine. d. The belief that health depends on maintaining a balance among opposite qualities is characteristic of a magicoreligious belief system.

ANS: B Older adults in most cultures usually have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is not uncommon for older adults to pray for cures or wonder what they did to incur an illness as punishment. The Ayurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of a holistic or naturalistic approach.

4. Based on current demographic data, which of the following statements identifies a predictive trend regarding the health care needs of society? a. Most nurses will not need to care for older persons. b. More nursing services will be required to serve the needs of the population older than 85 years of age. c. Fewer nurses will be needed to care for older adults. d. Older adults expect their quality of life to be less than that of earlier generations at their ages.

ANS: B Projections are that 20% of the American population will be older than 65 years of age by 2050, with those older than 85 years showing the greatest increase in numbers. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be over the age of 60 years than those under the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age.

16. The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b. Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d. Take them to the library for guest speakers.

ANS: B The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s, were born between 1920 and 1930, and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events including incontinence and hearing and vision problems.

6. The nurse prepares for the arrival of older adults evacuated from a hurricane to a shelter for short-term care. Which of the following is the priority nursing intervention? a. Demonstrate that the staff is prepared to meet their needs. b. Use individual medical records to develop a medication plan. c. Help older adults display family photographs and memorabilia. d. Help older adults teach one another a new skill in the shelter.

ANS: B The nurse prepares for short-term care by prioritizing the needs of the older adults, and this intervention helps maintain the therapeutic plan, thereby addressing the need for physiological integrity. Furthermore, the nurse maintains continuity of care by preparing a medication schedule to prevent missed doses of medication. Providing safety and security from the storm is Maslows second most basic need. In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important but not in emergency conditions. A state of emergency is not the time to develop self-esteem; meeting safety, security, and physical needs are more important.

10. The health care provider discusses the need for surgery with an older adult and her family. Which information about the older adults culture is important for the nurse to collect before this discussion to facilitate the process of informed consent? a. Attitudes about caregiving c. Rituals for death and dying b. Process of decision making d. Experience with discomfort

ANS: B The nurse uses knowledge of the cultures influence on the older adult in relation to decision making to avoid unnecessary tension and misunderstanding and thus to facilitate the process of informed consent. The nurse uses the information about decision making by sharing the cultural information with the health care provider and by addressing the culturally suitable member of the family for informed consent. Caregiving is unrelated to the process of informed consent. Death and dying, although potentially relevant, is unrelated to informed consent. Relevant to surgical procedures, the older adult and family experiences with pain and discomfort are important to the pain management plan.

9. Mezey and Fulmer (2002) justify gerontological nursing research and the work of gerontological advanced practice nurses by concluding the following: a. Other scientists devalue gerontological nursing research. b. The research influences outcomes from nursing care in a positive way. c. Gerontological care is expensive but required in long-term care. d. Gerontological nursing research is well known to practicing nurses.

ANS: B The practices of advanced practice nurses, who base their practice on nursing research, have resulted in positive older adult outcomes and cost effectiveness. The scientific community widely accepts the research. Advanced practice nurses generate positive outcomes and are cost effective in many settings. Mezey and Fulmer believe the goal of gerontological nursing is to disseminate the knowledge from gerontological nursing research to all nurses and to have the knowledge applied to their practices.

9. The nurse assesses a resident who was transferred yesterday from an acute care hospital. Which should the nurse assess to determine whether this individual is under stress from the transfer? a. Length of the residents stay in the acute care facility b. Availability of disposition options before the transfer c. Presence of familiar people throughout the transfer d. Tour of the new facility shortly after transfer

ANS: B To help assess the resident for stress, the nurse reviews the sequence of events that led to the relocation including whether the resident had relocation options and what those options were before relocation. If the resident played an active role in the choice of facilities and had several available options, then the resident is likely to experience less stress upon relocation. The length of stay in the acute care facility is an unreliable index of stress in a resident who has been recently relocated. The presence of familiar people is an unreliable predictor of relocation stress. Touring the new facility is an unreliable predictor of relocation stress; if the tour is conducted too soon or when the resident is in pain, tired, or distracted, then the resident is unlikely to benefit from the tour.

12. Which had a major influence in shifting the care of older adults away from almshouses and public institutions and stimulated the growth of commercial nursing homes? a. Medicare b. Social Security Act c. Hartford Institute for Geriatric Nursing d. Health maintenance organizations (HMOs)

ANS: B With the passage of the Social Security Act of 1935, federal monies were provided for old-age insurance and public assistance for needy older people not covered by insurance. To combat the fear of almshouse placement, Congress stipulated that the Social Security funds could not be used to pay for care in almshouses or other public institutions. This move is thought to have been the genesis of commercial nursing homes. During the next 10 years, many almshouses closed, and the number of private boarding homes providing care to older adults increased. Because retired and widowed nurses often converted their homes into such living quarters and gave care when their boarders became ill, they can be considered the first geriatric nurses and their homes to be the first nursing homes. The Hartford Institute has sponsored significant improvements in gerontological nursing practice, research, and education. HMOs have had a significant impact on the management of care but were virtually nonexistent in the 1930s and 1940s.

1. A family is touring selected nursing homes in preparation for their mothers future. Which qualities of a nursing home should the family include if they decide on a person-centered nursing home? (Select all that apply.) a. Staff members cover all nursing units. b. Residents and families have a council. c. Residents choose stimulating activities. d. Staff members respond to residents needs. e. Group activities are scheduled on the hour. f. Staff members help residents stay well-groomed.

ANS: B, C, D, F A characteristic of a person-centered culture is family and resident councils to discuss resident issues, needs, and solutions. A second characteristic of a person-centered culture is residents choosing their own activities to suit their interests. A third characteristic of a person-centered culture is a responsive staff that promptly meets resident needs. A fourth characteristic of a person-centered culture is assisting residents to maintain their appearance and to stay well-groomed. Consistent nursing assignments are a characteristic of a person-centered culture. Predetermined schedules are characteristic of an institution-centered culture.

1. The nurse plans the care for an older man who has Medicare, lives on Social Security and a small pension, and has type 2 diabetes mellitus. Which aspect(s) of this man should the nurse integrate into a positive approach to his health and well-being? (Select all that apply.) a. Pays for some diabetic supplies. b. Enjoys regular physical activity. c. Practices effective glucose control. d. Lives alone in a high-rise apartment. e. Lacks low-cost, reliable transportation. f. Attends weekly dinner club for diabetics.

ANS: B, C, F The enjoyment of physical activity is a positive aspect of this man and thus can be included in the nurses plan because he already incorporates an important part of diabetic care into his life and, potentially, enjoys the health benefits of exercise. Practicing effective glucose control demonstrates this mans resilience and capacity to manage effectively the challenges associated with a chronic illness and thus is a strength the nurse can use in a positive approach toward his health and well-being. This man has a social network that helps him to live with diabetes and to prevent the long-term complications of diabetes. This is a definite strength the nurse uses to help him achieve his optimal health and well-being. With limited financial resources, paying for some of his diabetic supplies is a burden to overcome and cannot be used in a positive approach toward health and well-being. Living alone is not ideal for an older adult, especially one with diabetes, because of the potential for loneliness and complications from diabetes such as hypoglycemia. Living alone is a negative aspect of this mans life and one which has to be resolved for his safety and well-being. The nurse cannot include this mans transportation issues into a positive plan; the lack of reliable transportation is a problem to overcome and not a strength on which to capitalize.

1. The nurse is assessing an older adult from a culture different than the nurses by asking questions from the Explanatory Model for Culturally Sensitive Assessment. Which question(s) should the nurse ask to follow this model? (Select all that apply.) a. How can we negotiate to solve the problem? b. What treatment can improve your condition? c. Should we try my plan first to see if it helps? d. Can we discuss differences in our plans now? e. How long have you experienced the problem? f. Who, other than me, can make you feel better?

ANS: B, E, F Asking about potential therapies is a question from the Explanatory Model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the Explanatory Model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN Model.

The nurse develops a community program to promote exercise for older adults. Which should the nurse include in the exercise program? a. Reinforce the ease of exercising every day. b. Use exercise to relax any dietary restrictions. c. Describe ways to resume exercise after lapses. d. Participate because exercise achieves wellness.

ANS: C Because the path to wellness includes progression, as well as regression, the nurse shares information to help participants anticipate these events. The nurse encourages participants by telling them to expect periods of regression; he or she emphasizes that progress made up to a point is not lost and explains how to approach resumption in progress toward wellness with exercise. The nurse tells the participants that achieving wellness takes work and regular effort. Rather than offering false hope, the nurse shares practical advice about how to incorporate exercise into everyday life. The nurse avoids suggesting that adults can look forward to relaxing dietary or medical restrictions by using a single method; it is unethical to offer false hope, the plan can be ineffective, and the plan can have adverse effects. The nurse avoids instructing adults to rely on one method of achieving wellness; wellness is achieved by balancing emotional, spiritual, social, cultural, and physical processes.

MULTIPLE CHOICE 1. Identify the best statement about gerontological nursing. a. Nurses have only recently become involved in the care of the older adult. b. Gerontological care was the second specialty in which the American Nurses Association (ANA) offered a certification program. c. Purposes of gerontological nursing include the promotion of health and support for maximal independence. d. ANA certification is available only for gerontological nurses in research positions.

ANS: C Promoting health and fostering independence are purposes of the practice, as reflected, for example, in the ANA Scope and Standards. Nurses have always cared for older patients. The ANAs gerontological nursing certification program was the organizations first and includes a variety of positions, such as nurse practitioners, clinical specialists, researchers, and administrators.

6. The nurse designs a group exercise program at a senior center. Which room should the nurse choose for the program? a. Room with a beautiful hardwood floor tastefully appointed with throw rugs b. Spacious room with no windows but with fluorescent lighting and a natural stone floor c. Room with a hardwood floor and large windows overlooking a garden area d. End room with a linoleum floor and a fan for ventilation to compensate for the rooms broken air conditioner

ANS: C The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains may be used. Throw rugs can slide underfoot and can lead to a fall, particularly when the sense of balance has declined with age. The fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat-gland response to heat.

6. A resident of a long-term care facility has been asking to have the drain in the bathroom sink repaired for 2 months. The nurse responds by saying that when they move to the new building, the sinks will work very well. Which right of a resident of a long-term care facility has the nurse violated? a. Right to be free of all forms of abuse b. Right to be transferred for appropriate reasons c. Right to voice grievances and have them remedied d. Right to information about conditions and treatments

ANS: C The nurse has violated the residents right to voice a grievance and to have the problem fixed. If the residents were moving into the new building in a few days, then the nurses response might be suitable; however, without specifying a time limit, the nurse has violated the residents right to voice a grievance and have it remedied. A clogged sink is not abuse. The resident is not going to be transferred; all of the residents are moving to a new facility. A residents condition or treatments are not mentioned by the resident.

6. An older adult who is a traditional Chinese man has a blood pressure of 80/54 mm Hg and refuses to remain in the bed. Which intervention should the nurse use to promote and maintain his health? a. Have the health care provider speak to him. b. Use principles of the holistic health system. c. Ask about his perceptions and treatment ideas. d. Consult with a practitioner of Chinese medicine.

ANS: C Using the LEARN model (Listen with sympathy to the patients perception of the problem; Explain your perception of the problem; Acknowledge the differences and similarities; Recommend treatment; and Negotiate agreement), the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health-related information. Speaking with the health care provider is premature until the assessment is complete. Unless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can also be unsuitable and

11. Several organizations collaborated in 2001 to publish Scope and Standards of Gerontological Nursing Practice by the ANA. What is the significance of the collaborative effort to gerontological nurses? a. Changes the health care delivery to increasing numbers of older adults b. Mandates gerontological certification for nurses who care for older adults c. Standardizes gerontological nursing practice among various organizations d. Ensures minimum gerontological competencies for all graduating students

ANS: C Various gerontological nursing organizations collaborated to define the criteria for gerontological nursing practice, demonstrating an agreement among the various organizations on these standards. The collaboration among multiple organizations potentially improves the quality of gerontological nursing care as the number of older adults grows. This document establishes the criteria for gerontological nursing practice. To improve the health care to older adults, all graduating students should master minimum competencies in gerontological nursing; however, many students continue to receive little specialty training and education in the care of older adults.

5. A case manager is likely to have how many years of nursing education? a. 1 to 1.5 c. 4 to 6 b. 2 d. 8 or more

ANS: C A case manager typically has a bachelors or masters degree. This amount of training is typical for an LPN, who typically practices at a nursing home or on a home nursing staff. This amount of training, resulting in an Associates Degree in Nursing (ADN), is typical for an associate RN, who is typically found on hospital, home, and nursing home staffs. A nurse with 8 or more years of education, as well as a doctorate, is typically involved in research and teaching.

4. Which cultural group is predicted to have the fastest growing older adult population in the United States between the years 2010 and 2050? a. Native Americans b. African Americans c. Hispanic Americans d. Asian/Pacific Island Americans

ANS: C As shown in Figure 1-1, the Hispanic older adult population is projected to be the most rapidly increasing population segment between 2010 and 2050. The older adult populations of all other races, combined, do not rise as rapidly as the Hispanic older adult population between the years 2010 and 2050. The African-American older adult population is expected to have the second-fastest rise between 2010 and 2050. The non-Hispanic white older adult population is projected to decrease between 2010 and 2050.

11. The nurse plans care for an older African American adult who is from Jamaica and resides in New York City. Which should the nurse include in planning care? a. Attribute his illness to breaking a voodoo. b. Help him improve social relationships. c. Maintain blood pressure below 120/70 mm Hg. d. Review the principles of the magicoreligious system.

ANS: C Because African Americans tend to be at risk for cardiovascular disease and hypertension, the nurse plans to maintain the patients blood pressure at or below the current recommendation by the American Heart Association. The nurse can be incorrectly assuming that he practices and believes in the magicoreligious system. The nurse should assess his spiritual beliefs and determine how much they influence his attitudes toward Western health care. The magicoreligious system maintains social relationships in good condition to prevent illness; however, if the older adult does not follow this cultural practice, then this goal can be unsuitable. The older adult may not believe in this system; therefore the information can be irrelevant.

8. Which statement describes aging in developing countries? a. Aged dependence is likely to improve from 1:4 to 1:2. b. The biggest problem for older adults will be the lack of food. c. Most older adults are likely to reside in these countries. d. Similar to fertility, life expectancy is increasing, although at a different rate.

ANS: C Currently, developing countries already contain two thirds of the worlds older adult population. Aged dependence is likely to deteriorate from 1:4 to 1:2. The biggest problem of the worlds oldest adults is most likely to be a lack of regular income. Life expectancy is increasing, but fertility is decreasing worldwide. PTS:1DIF:UnderstandREF:2-5

2. Which statement is true about living arrangements for older adults? a. Older adults are more independent in their own homes than in a residential community. b. The increase in real estate values makes home ownership essential to security. c. Program for All-Inclusive Care for the Elderly (PACE) is a community alternative to nursing home care for frail older adults. d. Florida is an example of a naturally occurring retirement community (NORC).

ANS: C PACE is an alternative to nursing home care for frail older people who want to live independently in the community with a high quality of life. Although relief from the burden of home maintenance can free a person for more independent living, this statement can or cannot be accurate, depending on the real estate market at the time. In addition, taxes and maintenance costs have also risen. A NORC is an organization formed by older adults living at home in geographic proximity to each other to provide supportive services for each other.

4. Which statement is true about residential living for older adults? a. A residential care facility is the new term for a nursing home. b. An assisted living facility (ALF) must have an registered nurse (RN) on staff. c. Administrators are realizing that their duty is to care for the residents as people. d. A granny flat is an apartment in a high-rise building reserved for seniors.

ANS: C The movement is under way from an institution-centered culture to a person-centered one. A residential care facility houses older adults who cannot live independently but do not need the round-the-clock, complex care capabilities of a nursing home. In most states, ALFs are not required to provide skilled nursing. A granny flat is the term used in Australia for a small, prefabricated housing unit where an older adult can live separately from, but close to, family on family property. PTS:1DIF:UnderstandREF:12-13 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 5. A family that has three small children prepares to move an older female parent into their home knowing that she stays up all night. The nurse helps the family prepare for the change. Which part of planning should the nurse indicate is the familys priority? a. Sharing household responsibilities b. Preparing the house for her arrival c. Helping her use her skills and talents d. Setting limits on nighttime activities ANS: B To reduce the risk of injury and falls, the familys priority is to prepare the house for an older adults arrival including preparing the parents private space, removing hazards, providing adequate lighting, installing handrails where necessary, and completing other safety measures. In addition, the parent needs to prepare mentally for the challenges presented when the children create new safety hazards for an older adult, such as spills and leaving toys on the floor. Sharing household responsibilities should be part of the preparation; however, safety concerns are more important. Helping the older adult to use her skills and talents provides meaningful activities; however, safety concerns are more important. Setting limits on her nighttime activities is important preparation to avoid conflicts; however, safety concerns are the priority.

15. An older man living in an adult community becomes a widower 1 month after retirement. Two months later, he has not resumed a weekly outing with his fishing club. Which should the nurse implement? a. Ask the older adult why he is not fishing. b. Have club members visit him at home. c. Meet with him to assess his interests. d. Enroll him in a weekly card game.

ANS: C The nurse meets with the older adult to determine how and when to establish new relationships and social activities in light of his wifes death. Although the older man was engaged in fishing before, the nurse respects his wishes and needs as he transitions to a different life. The nurse avoids confronting him, even if done so in a gentle manner. Why questions can be interpreted as confrontational, and the older adult may be unable or unwilling to articulate a reason. The nurse avoids asking club members to visit him because doing so would remove the older adult from the decision making process. Although this effort can be well-meaning, it can also be interpreted as an invasion of privacy. The older adult is more likely to participate in an activity in which he has input. In addition, the nurses action can be interpreted as disrespectful because an adult has the right to control his own life

12. Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service. b. Wheels ambulatory adults to exercise when running late. c. Assigns female nurses to older women who are Islamic. d. Allows older adults in a nursing home to eat meals alone.

ANS: C The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Interrupting an older adults worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adults life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in a wheelchair to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, while focusing on

3. Which is an accurate statement regarding gerontological nursing education? a. Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. b. Undergraduate nursing programs extensively cover gerontological nursing in dedicated courses, comparable with the coverage of psychiatric nursing. c. When content is integrated throughout a curriculum, less than 25% is devoted to geriatric care. d. Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum.

ANS: C When content is integrated throughout the curriculum, less than 25% of the content is devoted to geriatric care. Only recently has gerontological nursing content begun to appear in nursing school curricula. Most nursing schools still do not have such courses. At present, no minimum requirements exist for the coverage of care of older adults.

8. The nurse prepares to transfer an older adult to a long-term care facility and calls the facility to give a report. Which nursing actions are the responsibilities of the transferring nurse and the receiving nurse? a. Incorporating patient goals into the plan b. Ensuring the patient is stable for transfer c. Supplying patient documents for planning d. Providing continuity of care during the transfer

ANS: D A shared responsibility of the sending and the receiving nurses or care team is to regard the transition as a transfer versus a discharge and to provide continuous and consistent nursing care throughout the transfer phase. To accomplish this, the two nurses or groups must have clear, comprehensive communication. The receiving nurse incorporates patient goals into the plan. The sending nurse ensures that the patient is stable for the transfer to prevent decompensation during the trip or shortly after arrival at the new facility. The sending nurse is responsible for providing clear, comprehensive, and complete patient documentation.

Which option refers to the highest level of human functioning according to Maslow? a. Biological and physical integrity b. Safety and security c. Self-esteem d. Self-actualization

ANS: D According to Maslow, persons whose basic physical needs are met, who feel safe and secure, and who possess self-esteem and self-efficacy can achieve self-actualization, reaching out beyond themselves to make their lives meaningful. Biological and physical integrity is the lowest level in Maslows hierarchy, below safety and security. Safety and security are the second-lowest level, below self-esteem. Self-esteem is the second-highest level, below self-actualization.

13. An older individual from which culture is likely to receive more respect than a younger person in the same community? a. Canadian c. German b. Anglo-Saxon d. African American

ANS: D An African American is more likely to receive respect than a younger person in the same community because African Americans are more likely to value the wisdom and insight of older adults. Older individuals from a Euro-American culture are less likely to be valued by the community, owing to the effects of the industrial revolution and the need for strong, young laborers. An individual who is an Anglo-Saxon has European ancestry. A German citizen is European.

1. Which of the following is a true statement about gerontological nursing for patients of different races and ethnic backgrounds? a. The fact that a nurse is white has no bearing on the nurses ability to care for minority patients or patients of color. b. An encyclopedic accumulation of details of a particular culture is the best preparation for caring for persons from that culture. c. A nurse who works in Illinois does not need to be as concerned about sensitivity to multiple cultures as the nurse who works in California. d. Facial expressions, body language, posture, and touch are important elements of communication between a nurse and a patient from a different ethnicity.

ANS: D Facial expressions, body language, posture, and touch become more important as language barriers limit the effectiveness of verbal exchanges. They also have different meanings in different cultures. A white person is more likely to have had opportunities and freedoms and take them for granted, whereas a person of color who has never experienced such opportunities and freedoms may regard them as special privileges. Knowledge of cultural details can be useful, but it can also lead to stereotypes that obscure the differences between individual persons. Illinois, along with California, Nevada, Florida, Texas, and New Jersey, is one of the states with the greatest numbers of immigrant older adults.

9. An older woman tells the nurse that she has experienced increasing fatigue and shortness of breath over the last 2 days. Which goal is the nurses priority? a. Promote safety to prevent injury. b. Complete nutritional assessment. c. Balance exercise and rest periods. d. Explore the womans complaints.

ANS: D Investigating the complaint is the nurses priority; fatigue and shortness of breath can indicate cardiac disease, especially in women. Women with cardiac disease often exhibit atypical symptoms, and because it tends to be treated less aggressively in women, the nurse must be careful not to miss indicators of potential cardiac disease. In addition, in investigating the older womans chief complaint, the nurse investigates all possible causes. Promoting safety and preventing injury are reasonable goals to include for this adult but are not as important as investigating the chief complaint; breathing and circulation are two of the three most important physical needs. Completing the nutritional assessment for this adult is reasonable because the symptoms can be related to nutritional deficiencies; however, this assessment should be a part of the examination of the chief complaint. Balancing rest and exercise is a reasonable approach to a complaint of fatigue and shortness of breath if the adult is deconditioned; however, the nurse must investigate the chief complaint to determine whether deconditioning is a factor.

4. Aging ordinarily leads to decreases in which of the following? a. Creatinine clearance and insulin secretion b. Blood carbon dioxide and saliva production c. Left ventricle-wall thickness and skin healing time d. Serum triiodothyronine (T3) and gastric pepsin

ANS: D Serum T3 and pepsin secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally remains unchanged. Left ventricle-wall thickness and skin healing time both increase with aging. PTS:1DIF:UnderstandREF:18 TOP: Nursing Process: Assessment MSC: Physiological Integrity

7. Which action should the nurse take when addressing older adults? a. Speak in an exaggerated pitch. b. Use a lower quality of speech. c. Use endearing terms such as Honey. d. Speak clearly.

ANS: D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Providers should not assume all older adults are hearing or mentally impaired. The most appropriate action when addressing an older adult would be to speak clearly. Examples of unintentional ageism in language are exaggerated pitch, demeaning emotional tone, and a lower quality of speech

1. Name the theory of aging that suggests that the adverse physical effects of aging are the result of a gradual loss of control mechanisms in the pituitary and hypothalamus. a. Free-radical theory c. Stochastic theory b. Programmed theory d. Neuroendocrine theory

ANS: D The neuroendocrine theory attributes aging to gradual changes in or the loss of the mechanisms that control the organs through chemical signals. The free-radical theory attributes aging to the accumulation of destructive products of metabolic oxidation. The programmed theory attributes aging to cells exhausting a predetermined number of replications. A stochastic theory attributes aging to the accumulation of random damage to DNA and other molecules.

11. Which describes the older man who is likely to experience the best overall health and well-being? a. Resides in assisted-living facility, watches television alone, uses herbal remedies, is underweight b. Resides alone, was moved to a new city recently by his family members for their convenience, has osteoarthritis c. Has prostate cancer with metastasis to the lungs, is receiving radiation therapy, is wealthy, has a large family d. Uses a wheelchair, has peripheral arterial disease, attends weekly baseball games with three friends

ANS: D Despite a serious chronic illness and mobility restrictions, this older man has a social network and planned activities with friends. Further, he overcomes mobility issues to pursue personal interests; thus this person is most likely to experience the best health and well-being because of an optimal functional status. This older adult is not thriving in an assisted-living facility, despite having other people in the facility, as evidenced by television viewing habits and weight, both potential indicators of depression. Various aspects of this persons life are unbalanced, thus inhibiting progress on the path to optimal health and wellness. In addition, the use of herbal remedies can be aggravating or precipitating the problems. After a move to a new region, an older adult, especially one who lives alone and is moved to a new area for the familys convenience, is likely to experience loneliness and isolation until a new social network is established. Although this person has a less acute health problem, the social isolation is likely to create significant disruption on the path to health and wellness. Although this older adults financial resources are plentiful, the existence of a large family does not ensure any type of psychosocial support. Most likely, this person faces a grim prognosis because the prostate cancer has crossed the diaphragm, thus reducing the likelihood of a prolonged life.

2. A man is terminally ill with end-stage prostate cancer. Which is the best statement about this mans wellness? a. Wellness is possible in the management of his medical care. b. Wellness is unfortunately not a real option for this client. c. Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks. d. Nursing interventions can help empower a client to achieve a higher level of wellness.

ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness at all levels of the needs hierarchy. Wellness is possible even if the client assists in the management of his medical care; an individual must work hard to achieve wellness, similar to a job. Wellness is unfortunately not a real option for this client; however, all persons, regardless of age or life-health situations, can be helped to achieve a higher level of wellness. Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks; biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness. PTS: 1 DIF: Apply REF: 4-5 TOP: Nursing Process: Diagnosis MSC:Health Promotion and Maintenance 3. In differentiating between health and wellness in health care, which of the following statements is true? a. Health is a broad term encompassing attitudes and behaviors. b. The concept of illness prevention was never considered by previous generations. c. Wellness and self-actualization develop through learning and growth. d. Wellness is impossible when ones health is compromised. ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves ones whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growthas basic needs are met, higher-level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is impossible when ones health is compromisedeven with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible.

13. An older man who resides in a nursing home has total cholesterol of 245 mg/dl. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instruct him about increasing dietary fiber. b. Ask the health care provider for a low-fat diet. c. Schedule a consultation for him with the dietitian. d. Review a menu with him to choose suitable foods.

ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adults collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with hyperlipidemia achieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input.

3. Which of the following considerations is most likely to be true when working with an interpreter? a. An interpreter is never needed if the nurse speaks the same language as the patient. b. When working with interpreters, the nurse can use technical terms or metaphors. c. A patients young granddaughter who speaks fluent English would make the best interpreter because she is familiar with and loves the patient. d. The nurse should face the patient rather than the interpreter.

ANS: D The nurse should face the patient rather than the interpreter is a true statement; the intent is to converse with the patient, not with a third party about the patient. Statement A is not true; reasons may prevent the patient from speaking directly to a nurse. Statement B is not true; technical terms and metaphors may be difficult or impossible to translate. Statement C is not true; cultural restrictions may prevent some topics from being spoken of to a grandparent or child.

4. A resident in a nursing home insists that a priest hear his confession. The resident is very anxious, and the nursing home does not have a Roman Catholic chaplain. Which intervention should the nurse implement? a. An Episcopal priest is coming to visit the home this evening. Arrange an appointment with her for the resident. b. Report the residents change in behavior in detail so that the attending physician can appropriately prescribe medication. c. Refer the resident to the staff psychologist to address the underlying cause of the patients anxiety. d. Look in the local telephone book for a Roman Catholic Church, and ask the priest to visit the resident.

ANS: D The nurse should respect the residents beliefs and practices and accommodate them when they are not harmful. Receiving the Sacrament can potentially relieve much of the patients anxiety. Arranging an appointment with an Episcopal priest for the resident is not an appropriate intervention; the two belief systems are not the same, and the resident is unlikely to experience the ministers efforts as satisfactory. Reporting the residents change in behavior to the attending physician is also inappropriate; the residents wish can be understood entirely within the residents belief system and need not reflect a medical problem, particularly if a visit by a priest relieves the residents anxiety. Referring the resident to the staff psychologist to address the underlying cause of the patients anxiety is an approach that attempts to change the residents belief system.

5. Historical influences that have shaped the lives of the majority of the middle-old population in the United States today include which of the following? a. Influenza epidemic of 1918 b. Immigration from communist Europe c. Child rearing in the Depression d. World War II

ANS: D Those who are middle-old in 2005 were in their teens and 20s during World War II; in particular, the men were likely to have fought in it. A person who survived the influenza epidemic would be at least 87 years old in 2005 and therefore would be considered old-old or a centenarian. Those who are middle-old in 2005 were born between 1920 and 1930, before communism swept Europe. Most of those who are middle-old in 2005 had not reached childbearing age by the end of the Depression.

7. A older man is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of long-term care? a. Decrease the analgesic dose to prevent sedation. b. Provide a basin and towels for morning self-care. c. Inform family members about strict visiting hours. d. Facilitate family rituals related to death and dying.

ANS: D To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to patients, regardless of the setting or the nurses personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adults needs.

3. In differentiating between health and wellness in health care, which of the following statements is true? a. Health is a broad term encompassing attitudes and behaviors. b. The concept of illness prevention was never considered by previous generations. c. Wellness and self-actualization develop through learning and growth. d. Wellness is impossible when ones health is compromised.

Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves ones whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growthas basic needs are met, higher-level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is impossible when ones health is compromisedeven with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possiblev