Gero Exam 3

4. A frail, elderly widow is admitted to the hospital after sustaining a fall. The client lives alone and has no living relatives. After cognitive testing reveals mild cognitive impairment, the interdisciplinary team on the Acute Care for the Elderly Unit recommends long-term care placement and that a durable power of attorney for health care (DPOA-HC) be established. When the client seems confused over what a DPOA-HC's responsibilities are, the nurse responds that: a. "A DPOA-HC is a person you name to make health care decisions for you when you can't make them for yourself." b. "A DPOA-HC is a person you trust to make financial decisions for you and to manage your money." c. "A DPOA-HC is a person appointed by the court to make sure you get good care and to manage your affairs." d. "A DPOA-HC is a person who is appointed by the court to make nursing home placement decisions for your care."

ANS: A A person designated by the individual to make health care decisions when the individual is not able is the definition of durable power of attorney for health care. A power of attorney is a person designated by the individual to make financial decisions when the individual is not able to or at his or her request. The definition of a guardian is a person appointed by the court to have care, custody, and control of a disabled person and to manage personal and/or financial affairs. A guardian is able to make many more decisions than just nursing home placement decisions. DIF: Cognitive Level: Applying REF: pp. 418-419 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

2. An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the: a. slower ability of the pupil to adjust to changes in lighting. b. impact arcus senilis has on visual acuity c. flattening and thinning of the cornea. d. retinal changes that begin to occur with aging.

ANS: A A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting. The changes in the retina do not account for the need for increased light that this patient is reporting. DIF: Cognitive Level: Applying REF: p. 131 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

6. An older woman tearfully tells a nurse, "I must buy my neighbor all of his groceries, or he will not drive me to the store or the doctor." This is an example of which type of elder mistreatment? a. Financial exploitation b. Psychological abuse c. Caregiver neglect d. Abandonment

ANS: A Financial exploitation involves taking advantage of an older person for monetary gain. DIF: Cognitive Level: Applying REF: pp. 420-421 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. When caring for an ill adult client, the nurse is particularly concerned that the client communicates well since: a. assessment, planning of care, and even the therapeutic relationship is based on effective communication. b. it is the social connection that all individuals base interpersonal relationships upon. c. how well an individual communicates is a reflection on both his or her physical and emotional well-being. d. the need to communicate is a basic need of all individuals.

ANS: A Good communication skills are the basis for accurate assessment, care planning, and the development of therapeutic relationships between the nurse and the older person. While the other options are true they do not directly address the concerns of an ailing client. DIF: Cognitive Level: Understanding REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

1. An older client reports to a nurse, "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which of the following? a. Presbycusis b. Otosclerosis c. Tinnitus d. A perforated eardrum

ANS: A Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children's voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present. DIF: Cognitive Level: Analyzing REF: p. 143 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

4. An older man tells a nurse, "The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight." The nurse formulates a response based on the knowledge that: a. the lens of the eye loses elasticity causing a loss of focus for near objects. b. the cornea of the eye becomes thicker and less curved causing an increase in astigmatism. c. the lens of the eye increases in opacity causing a decrease in light refraction. d. the cornea of the eye forms a gray ring at the edges.

ANS: A Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye. All of the other options are normal age-related changes; however, they are not related to presbyopia. DIF: Cognitive Level: Applying REF: p. 132, Table 11-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

5. An older resident in a long-term care facility reports to the nurse that she has been noticing changes in her vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with: a. cataracts. b. glaucoma. c. diabetic retinopathy. d. age-related macular degeneration.

ANS: A Signs of cataracts include the appearance of halos around objects as light is diffused, blurring, decreased perception of light and color giving a yellow tint to most objects, and a sensitivity to glare. DIF: Cognitive Level: Remembering REF: p. 134 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. Which statement made by a nurse regarding a resident of a long-term care facility requires followup by the nurse manager? a. "If he doesn't take his medication, he'll get no dessert tonight." b. "She can't take a walk outdoors today; it's much too cold and snowy." c. "The grandchildren have colds so they should not visit this week." d. "I don't understand why, but she wants a different doctor to see her."

ANS: A The Bill of Rights for Long-Term Care Residents assures the individual the right to be free of any form of abuse. Using a threat to gain the resident's cooperation is a form of verbal/emotional abuse and must be addressed by the nurse manager. The client may indeed request a change in medicine providers, even if the staff is unaware of the reasoning behind the request. The remaining statements related to resident safety, not the denial of their guaranteed rights. DIF: Cognitive Level: Applying REF: p. 437, Box 32-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

3. A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse's response is: a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters. DIF: Cognitive Level: Remembering REF: p. 134 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

5. Which behavior suggests that an older adult who has lost his life partner is successfully managing the exploration stage of the adjustment process? a. He smiles when reminiscing about the trips they took together over the years. b. He explains that he can't make a decision about moving "just yet." c. He agrees to eat some of his "favorite soup" that his daughter has made. d. He is heard saying, "I'll never get over the loss, but my life has a purpose."

ANS: A The exploration stage is characterized by the ability to accept the loss and look back fondly upon it. The reactionary stage would be a time when indecision is typical. During the withdrawal stage, eating is often affected. Integration is successful when the individual again shows satisfaction with his life. DIF: Cognitive Level: Applying REF: pp. 465-466 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

6. Which activity would a couple in the reorientation phase of their retirement engage in? a. Establishing a new budget that will allow them to travel to see the grandchildren b. Reading magazines devoted to making decisions about retirement plans c. Looking for ways to "fill up the days" d. Volunteering at the local animal shelter

ANS: A The reorientation phase is one where the couple is developing a realistic and satisfactory lifestyle that would include the opportunity to travel. The near phase includes both planning and fantasizing about the retirement. The disenchantment phase is where the couple deals with letdown and boredom, while the engagement in meaningful activities such as volunteering occurs in the stability phase. DIF: Cognitive Level: Applying REF: p. 465, Box 34-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

5. An older adult is concerned that if her spouse, who recently suffered a stroke, is placed in a nursing home, "they will take everything in order to pay for his care." What response will the nurse make? a. "A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property" b. "You should consider transferring the assets to your son so that your husband will qualify for Medicaid" c. "Have you considered caring for your husband at home since Medicare will cover custodial care at home?" d. "Are you aware that your children have a legal obligation to provide financial support toward the care of disabled parents?"

ANS: A The spouse is permitted to keep a portion of the assets, home, car, and personal property. There is a "look back" period of 36 months to determine whether funds that were transferred would normally have been available to the individual. Medicare does not cover the cost of custodial care; it covers skilled care only. There is no legal obligation of a child to support a parent. DIF: Cognitive Level: Applying REF: p. 414 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

6. What intervention should a nurse implement when an older male diagnosed with dementia is observed masturbating in the unit's dayroom? a. Remove the resident from the dayroom and complete an assessment of his behavior. b. Cover the resident's lap with a blanket and leave him in the dayroom. c. Counsel the resident by telling him that his behavior is inappropriate. d. Distract the resident so that he will stop the behavior.

ANS: A When sexually inappropriate behavior occurs, it should be assessed, like any other behavior, as to cause, precipitating factors, and response to interventions. It is appropriate to remove the resident from the dayroom because the behavior may be distressing to staff and other residents. Covering the resident with a blanket and leaving him in the dayroom does not address the cause of the behavior, and it might be distressing for other residents and staff. The resident has dementia and is not capable of altering his behavior based on the information that it is inappropriate. Distracting the resident will only temporarily interrupt the behavior. DIF: Cognitive Level: Applying REF: p. 456 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. A nurse working in an emergency department is caring for an 89-year-old woman who was brought to the hospital by her daughter for a fracture of the right arm. The woman is wheelchair dependent and lives with her widowed daughter who is the primary caregiver. The daughter states that her mother got up out of the wheelchair unassisted to go to the bathroom and fell. The patient cannot recall the circumstances of the fall. The patient is weeping and cradling her right arm. The patient's history reveals two previous wrist fractures over the course of the past year. The nurse notes several large ecchymotic areas on the right hand and left arm and on the left side of the body and the back. The ecchymoses are in various stages of healing. Upon assessment, the patient is non-weight-bearing (NWB). The nurse suspects physical abuse based on which of the following findings? (Select all that apply.) a. Bruises are in various stages of healing. b. The fracture is inconsistent with the patient's functional ability. c. Caregiver suffering stress from caring for a functionally-dependent individual. d. Patient is crying. e. Patient has a history of previous wrist fractures.

ANS: A, B Specific signs of physical abuse include unexplained bruising or lacerations or those in unusual areas in various stages of healing, and fractures inconsistent with functional ability. This patient has many bruises in different areas all in various stages of healing, which leads one to believe that they were sustained at different times. The patient is NWB, so the daughter's statement that she fell while getting out of the wheelchair to go the bathroom does not match the patient's functional abilities. While there could be caregiver stress in this situation, the scenario does not mention it. While the patient's crying is concerning, it could be due to many other factors, including pain. A previous history of wrist fractures is concerning as well, but there are many other possible reasons for repeated fractures. DIF: Cognitive Level: Analyzing REF: p. 424, Box 31-16 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

3. An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: "Is there anything that I can do to prevent progression of this disease and blindness?" The nurse includes which of the following into the response? (Select all that apply.) a. Strict control of blood glucose levels is important in slowing disease progression b. Laser photocoagulation treatments can stop progression of the disease c. Control of blood pressure and cholesterol levels are important steps slowing disease progression d. Wearing sunglasses to protect the eyes from ultraviolet light can stop disease progression e. Eating a diet high in beta-carotene can stop disease progression

ANS: A, B, C Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease. Laser treatment can reduce vision loss in 50% of patients. Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression. DIF: Cognitive Level: Applying REF: p. 136 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. A nurse is preparing education for a group of older adults and caregivers at a senior center on elder abuse. The nurse is preparing to discuss seniors who are more likely to be abused or neglected. The nurse includes which of the following? (Select all that apply.) a. Individuals with cognitive impairment b. Individuals who abused the caregiver earlier in life c. Individuals who live in an institutional setting d. Individuals who are married and living with a spouse e. Men living alone or in a household with family members

ANS: A, B, C Individuals who are living alone are more likely to be abused. Women who are living alone or in a household with family members are more likely to be abused than are men. DIF: Cognitive Level: Remembering REF: p. 420, Box 31-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

2. A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant. The nurse includes which of the following in the teaching plan? (Select all that apply.) a. Avoid lifting heavy objects after the surgery b. Avoid bending from the waist after the surgery c. Take stool softeners as needed d. Maintain strict control of your blood sugar and blood pressure e. Maintain a dry sterile dressing over the eye for 10 days

ANS: A, B, C Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist. Fall prevention is also very important as is complying with eye drop administration. Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction. There usually is not a dressing over the operative site, and not for 10 days. DIF: Cognitive Level: Applying REF: pp. 134-135 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

1. A nurse practitioner is using the PLISSIT model to guide a discussion of sexuality with an older patient in the geriatric clinic. Which of the following are congruent with the PLISSIT model? (Select all that apply.) a. "What concerns or questions do you have about fulfilling your sexual needs?" b. "Let me tell you about the impact of your cardiac disease on sexual activity." c. "I have a few suggestions on lubricants that might make intercourse more comfortable for you." d. "Most older adults are not comfortable talking about sexuality, but it is important to do so." e. "It is not unusual to have difficulty performing sexually as you age."

ANS: A, B, C The PLISSIT model is a helpful guide for discussion of sexuality with older adults. The steps of the model are Permission: Obtain permission from the client to initiate sexual discussion, Limited Information: Provide the limited information to function sexually, Specific Suggestions: Offer suggestions for dealing with problems, Intensive Therapy: Refer as appropriate for complex problems that require specialist intervention. Option A falls into the permission step, option B falls into the limited information step, and option C falls into the specific suggestion step. Options D and E do not fall into any of the steps of this model. DIF: Cognitive Level: Applying REF: p. 459 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

1. A nurse is providing glaucoma education for a group of older adults in a senior center. The nurse knows that the following groups are most likely to develop glaucoma. (Select all that apply.) a. African Americans b. Mexican Americans c. Individuals with a family history of glaucoma d. Individuals with diabetes e. Asian Americans

ANS: A, B, C, D African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among the other high-risk groups. Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups. DIF: Cognitive Level: Remembering REF: p. 133 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. Which intervention demonstrates effective care for an individual who has expressed a wish to "retire sometime soon"? (Select all that apply.) a. Asking about when she plans to retire b. Assessing her ability to handle the stresses of retirement c. Engaging her in a conversation about her interests d. Inquiring about the existence of any chronic illnesses e. Scheduling a full physical examination

ANS: A, B, C, D, E Talking with clients about retirement plans, providing anticipatory guidance about the transition to retirement, identifying those who may be at risk for boredom and health concerns, and referring to appropriate resources for retirement planning and support are important nursing interventions. The client could also take this time to consider prevention and lifestyle changes, which can be identified by scheduling a full physical examination. DIF: Cognitive Level: Applying REF: pp. 464-465 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

4. A nurse is conducting an assessment of an older patient's eyes. The nurse expects to see which of the following normal age-related changes of the external eye? (Select all that apply.) a. The eyelids are less elastic and droopy b. The eyes are very dry c. The eyelids may not close completely d. There is a loss of eyelashes e. The lower lid may be turned outward

ANS: A, B, C, E Normal age-related changes in the external eye include a loss of elasticity causing drooping. Eyes become drier, and the eyelids may not close completely. Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid. Loss of eyelashes is not a normal age-related change. DIF: Cognitive Level: Remembering REF: p. 132, Table 11-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

1. A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.) a. Difficulty placing hearing aid properly in the ear b. Stigma associated with wearing a hearing aid c. Difficulty changing the batteries in the hearing aid d. Ineffectiveness of hearing aids for individuals with age-related hearing loss e. Hearing annoying loud noises

ANS: A, B, C, E Options A, B, C, and E are all factors associated with low use after purchase. Option D is incorrect; most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use. DIF: Cognitive Level: Remembering REF: p. 145 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

5. Differences between subacute care and long term care include which of the following? (Select all that apply.) a. Subacute care is more costly than long term care. b. Patients who receive subacute care have a usual length of stay of 1 month; long term care patients have an indefinite length of stay. c. Medicare covers the costs of both subacute and long term care. d. Subacute patients tend to be younger and more cognitively intact. e. Subacute care is usually delivered in a hospital setting and long term care in a nursing home setting.

ANS: A, B, D 1. The partner of a client comments, "Our sex life will certainly suffer now that he's had a heart attack." Which statement is the basis for the nurse's response? a. The client should no longer have sexual relations because of the demand on his heart. b. The energy expenditure during sex is equivalent to briskly climbing six flights of stairs. c. People with heart disease reduce their sexual activity out of fear of their condition. d. The couple will benefit from attending a cardiac support group. ;;ANS: C Many individuals are not given adequate information regarding the impact of illness on sexual relations and therefore are fearful and reduce sexual activity. Changes might be needed in order to accommodate the illness, but curtailing sexual relations is not necessary. The energy expended during sex is not equivalent to briskly climbing six flights of stairs. And while the couple may benefit from attending a support group, that fact does not address the immediate situation. DIF: Cognitive Level: Applying REF: pp. 453-454 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

1. A nurse manager is providing a novice geriatric nurse with guidelines when encouraging an older client to reminisce about his or her life and past experiences. Which suggestions will be included? (Select all that apply.) a. Don't correct the client even when you suspect the memory is incorrect b. When the focus remains on sad topics, assess the client for possible depression c. Refrain from interjecting personal stories into the reminiscing process d. Expect and respect a degree of repetition e. Use close-ended questions to help focus the reminiscing

ANS: A, B, D Suggestions for encouraging reminiscing include listening without correction or criticism, remembering that it is the client's recollections that are important; being patient with repetition since sometimes people need to tell the same story often to come to terms with the experience, especially if it was very meaningful to them; being attuned to signs of depression in conversation (dwelling on sad topics) or changes in physical status or behavior, and providing appropriate assessment and intervention; and keeping the conversation focused on the person reminiscing, but not hesitating to share some of your own memories that relate to the situation being discussed. Use open-ended questions to encourage reminiscing since they encourage free thought. DIF: Cognitive Level: Applying REF: p. 68, Box 6-3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. An older woman is preparing to move in with her daughter following the death of her spouse of 55 years. The daughter asks a nurse, "I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?" The nurse responds: (Select all that apply.) a. "Have you chosen an area of the house for your mom to live in?" b. "Have you considered scheduling regular visits for your mom with your sister who lives out of state?" c. "You have every right to be nervous; multigenerational households are usually not successful." d. "Have you investigated what activities are available at the senior center near your home?" e. "Since your mom is so computer literate she can stay in touch with her friends when she moves."

ANS: A, B, D, E There are some important modifications that may need to be made when adding an older person to the household, which include arranging semiprivate living quarters if possible, scheduling regular visits to other relatives to give each family time for respite and privacy, and arranging senior activities for the older person to help keep contact with members of his or her own generation. It is important to consider how the older person will feel about giving up familiar surroundings and friends. There are a growing number of intergenerational families. DIF: Cognitive Level: Understanding REF: p. 468, Box 34-5 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. When educating an older adult about Medicare Part D, which information will be included? (Select all that apply.) a. It is an elective prescription drug plan with associated out-of-pocket premiums. b. All persons with either Medicare Part A or B can voluntarily purchase a Medicare Part D prescription drug plan. c. The plan covers all costs of drugs after a deductible is paid. d. The plan is not available for individuals who are receive both Medicaid and Medicare. e. This prescription drug plan requires client co-payments.

ANS: A, B, E An individual with Medicare Part D prescription drug coverage pays a deductible and co-payments. The other options represent inaccurate information regarding Medicare Part D. DIF: Cognitive Level: Understanding REF: p. 413 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

3. Which of the following are examples of elderspeak? (Select all that apply.) a. A nursing assistant refers to one of her patients as "grandma" b. A nurse attempts to medicate a patient and states, "Now come on and be a good girl" c. A nurse explains a procedure to a patient using simple nonmedical terms d. A nurse makes sure that she is directly facing a patient who has hearing loss when she is speaking e. A nursing assistant tells a patient, "It is time for our bath now"

ANS: A, B, E Elderspeak is a form of patronizing speech. Examples include using diminutives or pet names, speaking very slowly, and speaking to older adults as if they were children, or using collective pronouns. Option C is not an example of elderspeak; it is appropriate to explain a procedure using nonmedical terminology. Option D is the correct manner in which to address an individual with hearing loss; facing the patient allows the patient to read lips. DIF: Cognitive Level: Applying REF: p. 66 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

1. Which nursing evaluation supports the fact that the goals of long-term client care have been achieved? (Select all that apply.) a. Resident has participated in bath with minimal assistance from the staff. b. Resident has experienced no falls since admission 3 months ago. c. Resident continues to show loss of strength in upper extremities. d. Resident is not required to dress or feed self since assistance is always available. e. Resident demonstrates improved weight bearing on affected leg; discharge to be considered.

ANS: A, B, E Goals of long-term care include providing a safe and supportive environment for chronically ill and functionally dependent people; restoring and maintaining the highest practicable level of functional independence; and providing coordinated interdisciplinary care to residents who plan to return to home. The remaining options show loss of function that is likely preventable and an environment that does not support autonomy and independence. DIF: Cognitive Level: Applying REF: p. 430, Box 32-3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

4. Factors that are influencing the decrease in nursing home beds in the United States include: (Select all that apply.) a. an increase in the use of residential care facilities. b. a shortage of certified nursing assistants (CNAs). c. increased Medicaid reimbursement for community-based care alternatives. d. a shortage of Registered Nurses who are certified in gerontology. e. the high cost of care in a nursing home.

ANS: A, C The number of nursing home beds is decreasing in the United States as a result of the increased use of residential care facilities and more reimbursement by Medicaid programs for community-based care alternatives. However, in most areas of the country, the supply and use of nursing homes is still greater than those of other long-term care services options. While there is a shortage of certified nursing assistants as well as RNs who are certified in gerontology, this does not account for the decrease in nursing home beds in the United States. The cost of care in a nursing home is high; however, that is not the driving factor in the decrease in the number of nursing home beds in the United States. DIF: Cognitive Level: Understanding REF: p. 434 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

3. An older patient with dementia is referred for adult day services (ADS). The patient's daughter asks the nurse about the benefits of ADS. The nurse considers which of the following in formulating a response? (Select all that apply.) a. ADS are designed to provide social and some health services for older adults. b. ADS are covered under Medicare Part B. c. ADS offer respite services for caregivers from the responsibilities of caregiving. d. ADS often provide educational programs and support groups for caregivers. e. ADS are all staffed with registered nurses.

ANS: A, C, D Adult day services are community-based group programs designed to provide social and some health services to adults who need supervised care in a safe setting during the day. They also offer caregivers respite from the responsibilities of caregiving, and most provide educational programs, support groups, and individual counseling for caregivers. Some ADS are private pay, and others are funded through Medicaid home and community-based waiver programs, state and local funding, and the Veterans Administration. While most ADS do have professional nursing staff, there is no mandate that they do. DIF: Cognitive Level: Understanding REF: p. 432 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

2. An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.) a. Exposure to loud noises b. Use of a hearing aid c. Cerumen buildup d. Side effects of medications e. Age-related changes in the middle and inner ear

ANS: A, C, D Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications. DIF: Cognitive Level: Remembering REF: p. 149 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. Which intervention is therapeutic when facilitating communication with a cognitively impaired older client? (Select all that apply.) a. Explain a task using simple, concise phrasing and one step at a time b. Give instructions to a group whenever possible to provide peer support c. Allow for additional time for the client to respond to questions or directions d. Use nonverbal as well as verbal cues to help get your message across to the client e. Speak loudly to gain and retain the client's attention

ANS: A, C, D Useful strategies for communicating with individuals experiencing cognitive impairment include giving one-step directions, allowing time for the expected response, and giving clues and cues as to what you want the person to do. It is also helpful to interact with one person at a time and to speak slowly rather than loudly. DIF: Cognitive Level: Applying REF: p. 69 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

2. An older man who recently had a myocardial infarction is being discharged home from the hospital. He tells a nurse, "I am really worried about having sex with my wife. I am afraid that I am going to have another heart attack." The best response by the nurse includes which of the following? (Select all that apply.) a. "If you are able to engage in mild to moderate physical activity without symptoms, you can resume sexual activity." b. "You really should not engage in sexual activity until 3 months have passed post heart attack." c. "It is best if you avoid eating a large meal for several hours before you have sexual relations." d. "If you have chest pain while having sex, stop and rest, and take your nitroglycerin." e. "You might want to consider some alternate positions that avoid strain."

ANS: A, C, D, E Individuals who are post MI who are able to engage in mild to moderate physical activity without symptoms can generally resume sexual activity; those with a complicated MI may need to resume sexual activity gradually over a longer period of time. Suggestions include avoiding large meals several hours before sex and suggesting alternative positions to avoid strain. If the individual does experience chest pain, it is important to stop and rest if he or she feels chest pain, take nitroglycerin if prescribed, and seek emergency treatment for sustained chest pain. There is no reason to wait 3 months post MI to resume sexual activity. DIF: Cognitive Level: Applying REF: p. 453, Table 33-2 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. A nurse is discharging an older patient after a hospitalization for a hip fracture. The patient is a participant in a Program for All Inclusive Care for the Elderly (PACE). The nurse understands that a PACE program: (Select all that apply.) a. provides services to older people who would otherwise need a nursing home level of care. b. does not provide services to participants who reside in a nursing home. c. is only available to individuals who have both Medicare and Medicaid. d. provides medications, eyeglasses, and transportation to care. e. provides urgent and preventive care.

ANS: A, D, E This program is a Medicaid and Medicare program that provides community services to people age 55 or older who would otherwise need a nursing home level of care. Participants must meet the criteria for nursing home admission, prefer to remain in the community, and be eligible for Medicare and Medicaid. The majority of PACE participants reside in the community; however, the program will pay for nursing home care. If the individual has Medicaid, he or she will not have to pay a monthly premium for the long-term care portion of the PACE benefit. If the individual does not qualify for Medicaid but has Medicare, there will be a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Part D Medicare drugs. PACE provides a comprehensive continuum of primary care, acute care, home care, adult day health care, nursing home care, and specialty care by an interdisciplinary team. PACE is a capitated system in which the team is provided with a monthly sum to provide all care to the enrollees, including medications, eyeglasses, and transportation to care as well as urgent and preventive care. DIF: Cognitive Level: Understanding REF: p. 432 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. When a cognitively impaired, wealthy, white client is noted to have burns on her upper back, her son states that the patient burned herself when attempting to shower. Which statement by a member of the team reflects a need for further education on elder abuse? (Select all that apply.) a. "She is wealthy; abuse does not happen in people of financial means." b. "Even if we are not sure, we are legally bound to report our suspicions." c. "We need to consider that most abusers are either adult children or spouses." d. "Her cognitive deficiencies put her at risk for elder abuse." e. "The client is white and race places an important role in who is likely to be abused."

ANS: A, E Elder abuse occurs among all races and socioeconomic groups in the United States. All suspected incidences of elder abuse should be reported, even if it is just a suspicion. Most abuse occurs in the home setting, the majority of abusers are spouses or children, and the risk of abuse increases with increased dependency of the elder. DIF: Cognitive Level: Applying REF: p. 420 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. Which statements made by a couple who have recently retired support the nurse's evaluation that the transition to retirement has been a successful one? (Select all that apply.) a. "I'm afraid we can't make it that weekend; we'll be visiting the grandchildren." b. "I'm not accustomed to sharing my kitchen with anyone else." c. "One week I was working 50 hours and the next I didn't have to get up until noon." d. "I often wonder if my buddies from the plant miss me." e. "We have found a few painless ways to reduce our monthly expenses."

ANS: A, E The correct options demonstrate a sense of purpose and adjustment to the realities of retirement and so that the transition has been a successful one. The remaining options suggest that the couple is not adjusting well to having each other around so much and involved in activities they previously used as being theirs alone. Feeling lonely or abandoned is also a sign of ineffective adjustment. A transition into a retirement rather than an abrupt one is also a barrier to a successful adjustment into retirement. DIF: Cognitive Level: Applying REF: p. 464 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

4. An older married couple is considering selling their home and moving into a continuing care retirement community (CCRC). The major benefit of a CCRC is: a. they provide affordable living for older adults. b. they have all levels of care in one location, allowing community members to easily transition between levels. c. they are paid for by Medicare. d. they allow the older adult's family to retain ownership of the property after the owner dies.

ANS: B A major benefit of a CCRC is that it has all levels of care in one location, which allows community members to make the transition between levels without life-disrupting moves. Costs of a CCRC can range greatly from an affordable rate to a very large amount of money. The cost of a CCRC is not covered by Medicare. In the majority of the CCRCs, the property reverts back to the community after the death of the owner. DIF: Cognitive Level: Understanding REF: p. 432 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. Which of the following reactions to the loss of a spouse or long-term partner is a unique example of older adult male bereavement? a. Withdrawing from friends and family b. Remarrying within months of the loss c. Focusing on "doing" rather than "feeling" d. Experiencing moderate to severe depression

ANS: B Bereaved males may be more socially and emotionally vulnerable. Widowers adapt more slowly than widows to the loss of a spouse and often remarry quickly. The remaining options reflect reactions that are typically seen in both grieving men and women. DIF: Cognitive Level: Applying REF: p. 465 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

6. An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. He also states, "Strangely enough my peripheral vision continues to be pretty good." The nurse suspects that the patient has which of the following? a. Glaucoma b. Age related macular degeneration c. Diabetic retinopathy d. Cataracts

ANS: B Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration. The other three eye diseases do not present with these symptoms. DIF: Cognitive Level: Applying REF: pp. 135-136 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. When acting as a fictive kin, in which activity will a paid caregiver engage? a. Being responsible for paying the client's bills b. Organizing the client's birthday celebration c. Accompanying the client to doctor's appointments d. Assuring the client has clean, appropriate clothing available

ANS: B Fictive kin are nonrelatives who become surrogate family members. These individuals take on instrumental and affectional attributes of family such as described in the correct option. The remaining options lack the element of affection and familial concern. DIF: Cognitive Level: Applying REF: p. 471 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. You have four rooms to choose from for your older client to be admitted this afternoon. Which room would you choose? a. A brightly lit, blue room with cozy throw rugs b. An orange-carpeted room with soft lighting and yellow walls c. A brightly lit, blue room with an EZ-Glide wax floor d. A fluorescent-lighted room with green walls and a glossy, tiled floor

ANS: B Light colors such as red, orange, and yellow are more easily seen by aging eyes. Softer lighting will help reduce some of the glare and is also easier seen by aging eyes. Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem. Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare. DIF: Cognitive Level: Applying REF: p. 138 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

5. An older adult is considering residential care/assisted living (RC/AL). The nurse knows that the older adult needs additional teaching when the older adult states which of the following? a. "I read a recent article that stated that almost half of older adults would move to an assisted living community if they could no longer care for themselves." b. "I am happy that Medicare pays for the cost of living in an RC/AL." c. "I will have to check with my long term care insurance company. I heard that it might pay for RC/AL." d. "RC/AL costs significantly less than nursing home care."

ANS: B Medicare does not cover the cost of RC/AL. All of the other statements are true. DIF: Cognitive Level: Understanding REF: p. 433 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

2. Which question will best assess the ability of the LGBT older couple to successfully adjust to the challenges of aging? a. "How long have you been in this relationship?" b. "Have you experienced prejudice and discrimination in your life?" c. "As a couple are you financially secure?" d. "Do you as a couple share similar religious beliefs?"

ANS: B Some research has suggested that this population may adapt more successfully to old age as a result of successful coping over a lifetime with discrimination and prejudice. While the remaining options are positive factors, they do not have the same degree on influence on the development of coping skills that the correct option has. DIF: Cognitive Level: Applying REF: pp. 469-470 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

5. Symptoms of HIV are often under-recognized in older adults because: a. there is a very low incidence of HIV in older adults. b. many of the classic symptoms are also common to other conditions common in older adults. c. presenting symptoms are markedly different from those in younger adults. d. AIDS progresses much slower in older adults so symptoms are not recognized easily.

ANS: B The classic symptoms of weakness, anorexia, and fatigue are common to other conditions common in older adults; additionally, they may also be attributed to normal age-related changes. The incidence of AIDS in older adults is increasing, rising faster among older adults than among younger adults. The symptoms are identical in older and younger populations. AIDS progresses more quickly in older adults than it does in younger adults. DIF: Cognitive Level: Applying REF: p. 457 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. The nurse is providing care to a client diagnosed with dementia. What option is an example of the appropriate use of implied consent by the nurse? a. Preparing to draw blood from a client's arm after asking, "Can I see your arm?" b. Changing the client's dressing when the client asks, "Will you change this bandage now?" c. Using the client's monthly allowance to buy a watch when he continuously asks for the time d. Arranging for a benign mole to be removed after the client states, "I don't like this here."

ANS: B The correct option demonstrates the client's willing to have a low-risk procedure completed. The remaining options, especially the one dealing with a surgical procedure, lack the element of client cooperation and/or understanding in the decision-making process. DIF: Cognitive Level: Applying REF: p. 423 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

7. An older widow who is a newly admitted resident of a long-term care facility develops a romantic relationship with a male resident. When the resident's daughter demands that the staff "put a stop to this sexual behavior right now," the nurse's response is based on the understanding that: a. such activity in a long-term care facility is inappropriate. b. older adults need to express love and intimacy. c. sexual desire is usually absent in older adults. d. sexual activity can be dangerous for older adults with chronic illnesses.

ANS: B The needs of older adults for love and intimacy remain the same regardless of whether the individuals are institutionalized. Meeting the needs of the residents for sexuality and intimacy is as important as the need for food and hydration. Sexual desire is present in older adults. Sexual activity is not dangerous for older adults. Some accommodations for chronic conditions might be required. DIF: Cognitive Level: Applying REF: p. 455 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

1. The original intent of Social Security was to: a. provide a hospital insurance plan. b. minimize the dependency of older members on younger members of society. c. provide the blind, older adult, or disabled with adequate financial support. d. penalize women financially for numerous zero wage years while raising children.

ANS: B The original intent of Social Security was to minimize the dependency of older members of society on younger members. Social Security is not a health insurance plan. It was designed to provide monetary support to persons at a certain age or when blind or disabled. It was not intended to meet all financial needs of the individual. Benefits are provided to individuals who worked or are married to someone who worked the number of years required. DIF: Cognitive Level: Understanding REF: p. 407 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

3. The cost of nursing home care is significant. The primary payer for nursing home care is: a. Medicare. b. Medicaid and private pay. c. Long-term care insurance. d. Medigap insurance.

ANS: B The primary payers for nursing home care are Medicaid and private pay. Because of the potentially high co-payments associated with Medicare, persons who are able to do so often purchase supplemental insurance plans. These feature standard benefits and generally several different policies are available from which to select in each state. Plans referred to as Medigap cover only the deductibles and part of the coinsurance amounts based on Medicare-approved amounts contracted with providers. Long term care insurance does pay for nursing home, but the primary payers are Medicaid and private pay. DIF: Cognitive Level: Remembering REF: p. 414 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

4. Which question has priority when assessing a client for risk factors related to the use of sildenafil (Viagra)? a. "How old are you?" b. "Are you currently being treated for hypertension?" c. "Do you have a history of respiratory infections?" d. "Have you ever been told you have prostate problems?"

ANS: B The use of phosphodiesterase inhibitors (PE5s) such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) might be contraindicated when a client is taking certain antihypertensive medications. DIF: Cognitive Level: Applying REF: p. 451 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. A 70-year-old person who has Medicare Part A only is discussing the cost of health care with a nurse. The nurse understands that Medicare Part A covers the cost of which of the following? (Select all that apply.) a. Diabetic testing supplies b. Acute hospitalization semiprivate rooms c. Intensive care unit hospitalization d. Skilled rehabilitative nursing care in a health care facility e. Prescription medications

ANS: B, C, D Medicare Part A covers the cost of acute hospitalization semiprivate rooms and any necessary medical services and supplies, which include intensive care unit costs. It covers the costs of skilled rehabilitative nursing care in a health care facility. The first 20 days are covered at 100%, days 21 to 100 with a daily co-pay of over $10, and there is no coverage after 100 days. Diabetic testing supplies are covered under Medicare Part B and prescription medications are covered under Medicare Part D. DIF: Cognitive Level: Understanding REF: p. 412, Box 30-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

3. An older adult asks a nurse, "I saw an advertisement and went to a free breakfast to hear about Medicare Advantage Plans. They sound really good, but I am not sure. Are there benefits to joining one?" The nurse relies on which of the following information when formulating a response? (Select all that apply.) a. All Medicare advantage plans have prescription drug coverage. b. Medicare advantage plans must cover all services traditionally covered by Medicare Parts A and B. c. There are no deductibles in Medicare Advantage plans. d. Medicare advantage plans may provide a cost savings to the member. e. Members must obtain a referral to see a specialist from an assigned primary care provider.

ANS: B, D, E Medicare Advantage Plans (MAPs), or Medicare Part C, use a prospective payment system and includes traditional health maintenance organizations (HMOs) and other managed care plans. All traditional services covered by Medicare Parts A and B must be provided, and additional services, co-pays, and deductibles are predetermined. Medicare Advantage Plans may or may not provide prescription drug benefits. MAPs may provide a cost savings to the member as well as extra benefits. However, special rules must be followed, including the requirement that no care is obtained without a referral from an assigned primary care provider. DIF: Cognitive Level: Understanding REF: p. 412 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

4. A nurse suspects elder mistreatment in which of the following patients seen in the emergency department? (Select all that apply.) a. An 85-year-old male with cardiac disease who is taking blood thinners and has multiple bruises on his arms and hands b. An 86-year-old female nursing home resident admitted to the hospital with vaginal bleeding and three large bruises on her inner thigh c. A 77-year-old woman who fell at home and broke her arm after tripping over her cat d. A 73-year-old man with a history of gastric ulcers who is vomiting blood and found to be anemic and has a low BMI e. A 69-year-old man with a history of diabetes who is admitted for diabetic foot ulcers wearing dirty clothing and smells like urine

ANS: B, E An 86-year-old female nursing home resident admitted to the hospital with vaginal bleeding and three large bruises on her inner thigh has the signs of sexual abuse. The 69-year-old man with a history of diabetes who is admitted for diabetic foot ulcers and is wearing dirty clothing and smells like urine has the signs of neglect (either self or caregiver). The remaining patients do not exhibit the signs of elder mistreatment. DIF: Cognitive Level: Applying REF: p. 424 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

5. Which nursing statement shows a true appreciation for an older client's willingness to tell his personal stories about "the war"? a. "It's so nice to see them excited and engaged as they tell the stories." b. "It helps their memory so much to retell their stories." c. "I learn so much about clients when they share their life story with me." d. "They are so proud of the things they have accomplished in their life."

ANS: C A memory is an incredible gift given to the nurse, a sharing of a part of oneself when one may have little else to give, and it provides insight into who the person really is telling the story. DIF: Cognitive Level: Applying REF: p. 67 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. Which statement by the nurse is the strongest example of ageism by professional nurses? a. "It takes a special nurse to provide good care to the older population of clients." b. "It's difficult for a nurse to develop an effective relationship with an older client because of the barriers their age creates." c. "It is so difficult to find nurses who are truly effective geriatric nurses." d. "With the older population increasing so dramatically in numbers, nursing will have a difficult time meeting their needs."

ANS: C Ageism affects health professionals as well as the general public and this attitude is reflected in the lack of nurses who choose to work in the field of geriatrics. The characteristics of a "good geriatric nurse" are no different than those of any effective nurse. Assuming that age produces barriers to an effective nurse-client relationship is an example of ageism. The growing number of older adults is not an example of ageism. DIF: Cognitive Level: Understanding REF: p. 66 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. When an older adult is considering long-term care insurance (LTCI), what is important for the nurse to encourage the client to consider? a. The older one is when applying, the lower the rates will be b. It is financially better to avoid purchasing LTCI through a group policy c. It is wise to scrutinize all exclusions before enrolling d. All policies cover care at home as well as in a long-term care facility

ANS: C LTCI policies vary, and many have exclusions for specific diseases, for example, Alzheimer's disease. It is prudent to examine the policy before purchasing. Costs increase as one ages. The best plans are those that are negotiated by a large group such as an employer, state organization, or association. Although policies are becoming more creative, they are traditionally limited to care in a long-term care facility and frequently do not cover care in the home. DIF: Cognitive Level: Applying REF: p. 415 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

6. A 70-year-old diabetic patient has just received instruction from a nurse on glucose self-monitoring. He tells the nurse: "I hear that those test strips cost a lot. I am not sure that I can afford anything else. The only health insurance I have is Medicare Parts A and B." The best response by the nurse is: a. "I am sorry, but Medicaid is the only insurance that covers the cost of diabetic testing supplies." b. "Medicare Part A will cover the cost of the supplies to manage your diabetes." c. "Medicare Part B will cover the cost of the supplies to manage your diabetes." d. "I am sorry, but Medigap insurance is the only insurance that covers the cost of diabetic testing supplies."

ANS: C Medicare Part B covers the cost of diabetic testing supplies. DIF: Cognitive Level: Remembering REF: p. 412 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

5. Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse? a. "I get so frustrated because my father used to be so competent and now cannot even feed himself." b. "Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills." c. "My dad wanders at night and I can't be bothered with him. I mix sleeping pills in his dinner so that he will fall asleep." d. "Mom asks me to do everything for her, but I think it is better if she keeps on doing as much as she is capable of."

ANS: C Option c is an example of elder mistreatment. While wandering is a serious concern, surreptitiously administering sleeping pills is not the best response to this situation and is indicative of elder mistreatment. All of the other situations described are difficult; however, there is no indication of abuse. DIF: Cognitive Level: Analyzing REF: pp. 419-420 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

7. Which nursing intervention best addresses the need for social support demonstrated by an older adult couple who will be assuming responsibility for the raising of two grandchildren? a. Facilitating a support group for children being raised by grandparents b. Helping the grandparents express their feeling regarding this unexpected role change c. Offering a monthly parenting class for this cohort of grandparents d. Suggesting couple's therapy to assist in managing any new stress on their marriage

ANS: C Primary care grandparents with a network of social support seem to experience fewer negative consequences, but instrumental supports such as assistance with child rearing are often lacking. Education and training programs and support groups are valuable resources, and nurses can be instrumental in developing and conducting these types of interventions. While the remaining options are appropriate, they do not focus on the needs that are identified as currently unaddressed. DIF: Cognitive Level: Applying REF: pp. 475-476 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

2. Which statement made by the resident of a long-term care facility is evidence that the facility is providing care in accordance with the Bill of Rights for Long-Term Care Residents? a. "It's so nice to have my hometown newspaper available here." b. "Going out to the theater with the other residents is a nice social activity." c. "I was told that if I didn't want to change rooms, I didn't have to." d. "The whole place was decorated so beautifully for the holidays."

ANS: C The Bill of Rights for Long-Term Care Residents assures the individual the right to be transferred only for appropriate reasons as indicated by the correct option. While positive in nature, the remaining statements are not directly related to any of the guaranteed rights. DIF: Cognitive Level: Applying REF: p. 437, Box 32-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. Which intervention addresses a right guaranteed a long-term care facility resident? a. Ethnic foods are made available to culturally diverse residents who would like them. b. Each resident has access to a telephone in his or her room. c. Family members are welcome at any time. d. A professional hairdresser is available 3 days a week.

ANS: C The Bill of Rights for Long-Term Care Residents includes the right to immediate visitation and access at any time for family, health care providers, and legal advisors and the right to reasonable visitation and access for others. While generally provided, the remaining interventions are not directly related to the guaranteed rights. DIF: Cognitive Level: Applying REF: p. 437, Box 32-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

1. A nurse suspects that her next-door neighbor, an older woman, is a victim of elder abuse by her daughter. What is the appropriate action for the nurse to do in this situation? a. Because the neighbor is not a patient, the nurse should not get involved. b. Visit the neighbor frequently to confirm the suspicions. c. Complete a confidential report with the adult protective services in the area. d. Ask the neighbor herself if she is being abused.

ANS: C The best action is to make a confidential report with the local adult protective agency. Suspected cases should be reported at once to the agency, which will send a trained investigator to determine whether an abusive or imminently dangerous situation exists and will be able to offer safety to the victim and resources to the relatives and family members. In some states with mandatory reporting, failure to report suspicions may result in civil and/or criminal penalties. Also in states with mandatory reporting, the nurse can be held liable for civil and criminal penalties for failure to report suspected cases of abuse. In states without mandatory reporting, it becomes an ethical issue if the nurse is aware of suspected abuse and does not report it. Making a personal investigation will not obtain a safe environment for the neighbor in a timely manner. Asking the neighbor about abuse will not quickly obtain a safe environment or help if needed. DIF: Cognitive Level: Applying REF: p. 424 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

8. Which intervention has priority before touching a client's consent zone? a. Draping the area to minimize exposure b. Having another nurse present c. Explaining why the area will be touched while asking permission d. Assuring the client that the touch is absolutely necessary

ANS: C The consent zone requires the nurse to seek out or ask permission to touch or initiate procedures to these areas. The touch should not occur unless it is absolutely necessary. Draping is appropriate but doesn't occur until permission is granted. Having another nurse present is not always necessary unless the touch is by a male nurse upon a female client. DIF: Cognitive Level: Applying REF: p. 446 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

4. Which technique is most effective when communicating with a client who is positioned in bed? a. Sitting in a chair at the foot of the bed b. Standing near the client's head on his or her dominant side c. Sitting in a chair at the bedside facing the client d. Standing at the foot of the bed

ANS: C When communicating with individuals in a bed or wheelchair, position yourself at their level and directly face them rather than talking over a side rail or standing above them. DIF: Cognitive Level: Applying REF: p. 67 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

2. An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse? a. Refer the resident for an evaluation for a hearing aid b. Raise her voice when speaking to the resident c. Examine the resident's ears for cerumen impaction d. Teach the resident to read lips

ANS: C When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. Raising one's voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is. DIF: Cognitive Level: Analyzing REF: p. 144 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?" The nurse formulates a response based on the knowledge that: a. a cochlear implant is permanent, surgically-implanted hearing aid. b. a cochlear implant speeds up the conduction of sound to the auditory nerve. c. a cochlear implant functions as an artificial auditory nerve. d. a cochlear implant directly stimulates the auditory nerve.

ANS: D A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve. DIF: Cognitive Level: Analyzing REF: p. 146 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. When conducting an admissions interview with an older client, the nurse observes that the client pauses for a period of time before responding to the questions. The nurse responds to this client based on the assumption that the client is: a. exhibiting signs of mild cognitive impairment. b. nervous and having difficulty concentrating on the questions. c. reluctant to share information with someone with whom he or she has no relationship. d. sorting through his or her vast life experiences in order to answer appropriately.

ANS: D Basically, elders may need more time to give information or answer questions simply because they have a larger life experience to draw from. Sorting through thoughts requires intervals of silence, and therefore listening carefully without rushing the elder is very important. It is an unfounded assumption to assume that the client's response is due to senility based exclusively on his or her age. The remaining options would not be unique to an older client but might be experienced at any age. DIF: Cognitive Level: Applying REF: p. 67 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

4. A widowed grandmother is about to assume the role of custodial parent for her 6-year-old grandchild. Which intervention has priority when preparing the grandmother for long-term success in this new role? a. Reviewing the developmental milestones of childhood b. Identifying local sources of child counseling services c. Discussing the common challenges of parenting a 6-year-old d. Teaching stress management and relaxation techniques

ANS: D Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning with the stress increasing over time. The introduction of the skills identified in the correct option will serve to improve and maintain the family's quality of life. While the remaining options are appropriate, they lack attention to the long-term, fundamental barrier to a successful transition into this new role. DIF: Cognitive Level: Applying REF: p. 476 | p. 478 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

4. A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse's teaching plan? a. "Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure." b. "With the right hearing aid, you can expect your hearing to be back to normal." c. "Hearing aids are covered by Medicare Part B." d. "Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise."

ANS: D Hearing aids do bring challenges, such as distorted speech and amplified background noise. Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not restore hearing to normal. Medicare does not cover the cost of hearing aids. DIF: Cognitive Level: Analyzing REF: p. 145 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. Which option is an example of elder exploitation? a. A homebound client is left alone for days at a time by the caregiver. b. An older client is smacked if he doesn't eat all of his food. c. A client diagnosed with Alzheimer's disease is bathed only twice a month. d. A homebound client can only get groceries by agreeing to pay for her neighbor's groceries, too.

ANS: D In elder mistreatment by exploitation, the abuser takes advantage of the older person for monetary or personal benefit. In this case, the client is being coerced to buy her neighbor's groceries. Abandonment is defined as the desertion or willful forsaking of an older person. Abuse is any action or inaction harming or endangering the welfare of an older adult. The definition of neglect involves failure to provide adequate care or services for an older adult. DIF: Cognitive Level: Applying REF: pp. 419-421 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

4. A Navy war veteran is seeking advice about getting treatment for a chronic respiratory problem at the local veterans' hospital. The nurse's initial response is to ask: a. "Why aren't you considering the local general hospital for the care that you need?" b. "Are you willing to travel to a veterans' hospital that offers respiratory diagnostic services?" c. "Have you ever been treated at a veterans' hospital before?" d. "Is the problem related to something that occurred while you were in the Navy?"

ANS: D Instead of coverage of any health problems, priorities were set for those problems that were in some way deemed "service connected"; in other words, the health care problem had to be linked to the time the person was on active duty. While the other questions are not inappropriate, they do not address the issue of whether the client is illegible for care at a veterans' hospital. DIF: Cognitive Level: Applying REF: p. 415 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

2. Based on recent studies, which statement regarding touch and touch zones is most accurate? a. People between the ages 66 and 100 are the most often touched. b. Newly graduated nurses tend to touch clients less often than do nursing students. c. When performing peri-care, the nurse is working within the zone of intimacy. d. The comfort of touch depends on place, situation, social status, and age.

ANS: D The comfort of touch depends on the location, situation, social status, and age. Older adults are frequently isolated and are not touched. There is no evidence to support the statement that graduate nurses touch patients less than nursing students. The zone of intimacy is within an arm's length of the individual, and it is the space used for comforting, protecting, and lovemaking. DIF: Cognitive Level: Applying REF: pp. 445-447 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. Which outcome regarding the effects of touch on the skin is not supported by current research? a. Brings about sensory stimulation b. Helps relieves physical and psychosocial pain c. Is known to reduce anxiety and tension d. Improves skin integrity

ANS: D There is no evidence that therapeutic touch improves skin integrity. There is research to support the remaining options. DIF: Cognitive Level: Understanding REF: p. 447 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction. c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

ANS: D, E A, B, and C are all associated with conductive hearing loss. Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss. DIF: Cognitive Level: Remembering REF: p. 144 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance