Gero exam 4

15. While discussing sexual behavior at a sex and aging seminar, one older adult states, "No condoms for me, I can't get pregnant!" Which of the following responses is most appropriate? A) "Condoms protect you from sexually transmitted diseases including HIV." B) "How freeing to not have to be concerned about unwanted pregnancies anymore." C) "The youth of society have so much to be concerned with, what with AIDS killing people." D) "Your generation is soon going to have the largest population of HIVinfected persons."

Ans: A Condoms are an important protection for sexually active adults who are sexual with anyone other than a long-term monogamous partner. Condoms protect from many sexually transmitted diseases. Acquired immunodeficiency syndrome is considered a chronic disease. Eleven percent of new human immunodeficiency virus (HIV) infections occur in adults aged 50 years, and by 2015, 50% of HIV-infected individuals will be 50 and older. This is true, but doesn't answer the question.

6. It is July in Atlanta, and 90°F in the shade. An 80-year-old client who lives alone in an apartment is struggling to stay cool. What functional consequence of the aging process increases this client's susceptibility to heat exhaustion and heat stroke? A) Delayed and diminished sweating B) Impaired peripheral blood circulation C) Renal insufficiency D) Changes in endocrine regulation

Ans: A Delayed and diminished sweating are functional consequences of aging that create a risk for health exhaustion and heat stroke among older adults. Endocrine, renal, and circulatory factors have a less significant bearing on this risk

4. A nurse counsels an older adult with chronic insomnia. Which of the following statements should the nurse include in the teaching? A) "Consider making your environment more conducive to sleep." B) "Continuing with the hypnotic medications you've been prescribed should soon provide a solution." C) "Decreased sleep is a normal age-related change that you will need to accommodate." D) "Moderate alcohol consumption will help you fall asleep more quickly."

Ans: A Environmental modification can be a useful intervention in promoting sleep in older adults. While age-related changes do influence sleep in older adults, this does not mean that interventions and strategies are unnecessary in mitigating these changes. Alcohol consumption and the use of hypnotics are not recommended solutions to sleep disturbances

9. A nurse plans care for an older adult with insomnia. The client's medication list includes zolpidem, potassium, and omeprazole. Which of the following diagnoses should the nurse include in the plan of care? A) Risk for falls B) Risk for suicide C) Risk for powerlessness D) Risk for urge urinary incontinence

Ans: A Fractures and falls are a risk of nonbenzodiazepine agents. Powerlessness, incontinence, and suicide are not increased with these medications

4. A nurse completes assessment of an older adult. Which of the following physical assessment findings is within normal limits? A) Kyphosis and increased anteroposterior diameter of the chest B) Increased intensity of lung sounds C) Decreased resonance on percussion D) Decreased adventitious sounds in lower lungs

Ans: A Minor differences in assessment findings for healthy older adults include shortened thorax, chest wall stiffness, increased anteroposterior diameter of the chest, and forward-leaning posture because of kyphosis

14. A nurse plans care for a frail older adult in long-term care. Which of the following interventions should be included in the plan of care to reduce the risk of respiratory infections? A) Oral care B) Oxygen administration C) Pulmonary function testing D) Tracheal suctioning

Ans: A Poor oral care in long-term care residents increases the risk for pneumonia. Tracheal suctioning should be limited to those who are intubated. Neither testing nor oxygen would decrease risk of pneumonia

8. An 82-year-old client walked 2 miles last week to enjoy the spring weather. The client says since that time, "I haven't been doing very much, I'm afraid it will hurt." Which action by the nurse is most appropriate? A) Discuss moderation in activity, encouraging continued movement. B) Obtain a cane for use to improve balance, and reduce the client's fears. C) Encourage the client to walk the 2 miles every day. D) Have the client take ibuprofen (Motrin IB) every morning.

Ans: A Practices that are recommended for self-care of osteoarthritis include using moist heat and analgesics for pain, regular low impact exercise, and balancing weight-bearing activities with rest periods. Walking 2 miles is too far for this client (as evidenced by the severe pain after walking that distance previously). The client does not currently have any balance issues; thus, a cane would not reduce the fear of pain.

6. A nurse in a long-term care facility is aware of the effects of age-related changes to the respiratory system. Which of the following functional consequences most likely results from age-related changes? A) Snoring and mouth breathing B) A persistent, dry cough C) Increased sensitivity to environmental allergens D) Hemoptysis on exertion

Ans: A Snoring and mouth breathing often become more prevalent with age. Hemoptysis and a persistent cough are considered pathologic at any age, and allergies do not typically worsen with age.

4. A nurse notes a 2-mm open shallow ulcer with a red wound bed on the great toe where shoe touched the skin. Which of the following should the nurse document? A) 2-mm stage II pressure ulcer B) Stage III pressure ulcer on great toe C) 2-mm skin tear with red wound bed D) Red ulcer on the great toe 2 mm in size

Ans: A The wound described is a pressure ulcer, and Pressure Ulcer Scale for Healing (PUSH) staging should be used to document all pressure ulcers. Wound documentation should also include size of wound bed. Stage II ulcers are partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough

7. A 66-year-old has been conscientious about health as an adult and is disappointed at having been recently diagnosed with type 2 diabetes. The client had been unwilling to discuss this new diagnosis for the past several weeks but has now begun asking the nurse questions about this disease. Which of the following nursing diagnoses is most appropriate for this client? A) Readiness for enhanced knowledge B) Readiness for enhanced self-care C) Readiness for enhanced power D) Readiness for enhanced comfort

Ans: A An expressed willingness to know more about how a health problem is diagnosed and managed suggests a nursing diagnosis of readiness for enhanced knowledge. This is not synonymous with enhanced self-care, but is a likely precursor. The client's questions are not clearly indicative of enhanced comfort or power

12. A nurse in the emergency department cares for an 82-year-old man. The man was found wandering the streets looking for his dog in a snowstorm. Which of the following conditions is the highest priority for the nurse to monitor? A) Altered mental status B) Fluid volume overload C) Hyperglycemia D) Urinary tract infection

Ans: A As hypothermia progresses, mental functioning becomes clouded. More men than women experience hypothermia. Dehydration exacerbates the effects of hypothermia. Diabetes and hypoglycemia are related to higher risk of hypothermia (not hyper).

9. Which of the following older adult clients is most likely to have physiologic barriers to sexual wellness? A) One who has chronic obstructive pulmonary disease and a recent MI B) One who has early stages of lung cancer and who is being treated for hypothyroidism C) One who had an ostomy created several years ago as treatment for colon cancer D) One who recently recovered from urinary tract infection that progressed to urosepsis

Ans: A Chronic obstructive pulmonary disease and coronary heart disease are associated with sexual dysfunction. The other noted health problems are not associated with physiologic barriers to sexual health and function. Early stages of lung cancer symptoms include cough, which potentially produces bloody sputum, not shortness of air. The ostomy may psychologically impact a client, but not physiologically. Recovered urinary tract infection/urosepsis would not specifically cause a physiologic barrier.

13. A nurse in the postoperative unit monitors for hypothermia. Which of the following older adults' assessment findings indicates the onset of hypothermia? A) Cool skin on buttocks B) Puffy face C) Shallow respirations D) Shivering

Ans: A Cool skin in unexposed areas, such as the abdomen and buttocks, is a distinguishing characteristic of hypothermia. The environmental temperature may be only moderately cool, and the older person will not necessarily shiver or complain of feeling cold. As untreated hypothermia progresses, additional signs may include lethargy, slurred speech, mental changes, impaired gait, puffiness of the face, slowed or irregular pulse, low blood pressure, slowed tendon reflexes, and slow, shallow respirations.

7. A nurse is participating in a health fair that is being sponsored by a local seniors' center, discussing healthy skin and aging. Which of the following teaching points should the nurse emphasize? A) "You should limit your sun exposure to a small amount each day and keep your skin protected from direct sunlight for the remainder." B) "Many drugs can have an effect on your skin, so it's important to avoid most over-the-counter medications." C) "The health of your skin is primarily determined by your genes, so all you can do is try to maintain your overall level of health." D) "Even if you find it difficult to do, it's important to bathe once a day."

Ans: A Current recommendations emphasize the importance of a balanced approach that encourages small amounts of sun exposure each day for adequate vitamin D synthesis, but not so much that would lead to increased skin cancer risk. Many medications affect the skin, but it would be inappropriate for the nurse to recommend that older adults refrain from all over-the-counter medications. Genetic factors influence integumentary health, but this does not mean that other risk factors are irrelevant or nonmodifiable. It is unnecessary for most older adults to bathe every day

5. A nurse teaches a nursing student about pharmacologic interventions for the treatment of sleep problems among older adults. Which of the following statements by the student shows understanding of the care of those with sleep disturbances? A) "Behavioral therapies are preferable to the use of drugs." B) "Benzodiazepines are the drug group likely to have the fewest adverse effects." C) "L-Tryptophan and melatonin are chemicals the body produces that can be supplemented to improve sleep." D) "Older adults should not use hypnotics or other pharmacologic aids for sleep."

Ans: A In general, behavioral therapies are preferable to hypnotics and other drugs for the treatment of sleep disorders. Benzodiazepines are the drug category with the greatest risk of adverse effect, and L-tryptophan is found in foods rather than produced by the body. Even though there are risks, there is still a role for pharmacologic interventions in the short-term treatment of sleep problems and they should not be categorically discounted.

2. During assessment of an older adult, the nurse discovers that the individual has been reluctant to divulge recent losses in activities of daily living to his primary care provider. Which of the following factors has been demonstrated to contribute to such reluctance? A) The older adult may fear a loss of independence if problems are disclosed. B) The older adult may realize that age-related changes are normally not treatable. C) The older adult may be experiencing cognitive deficits that influence decision making. D) The older adult may recognize that health care systems are not able to address psychosocial problems.

Ans: A Many older adults have been shown to fear losing their independence or becoming institutionalized if they divulge health problems. It has not been demonstrated that age-related changes and psychosocial problems are not treatable, nor that cognitive changes influence such behaviors.

13. A nurse monitors older adults at an assisted living facility for pressure ulcers. Which of the following older adult is at highest risk for a pressure ulcer? A) The obese older adult with continuous positive airway pressure (CPAP) mask B) The frail older adult with a hearing aid C) The older adult undergoing therapy for a weak hand D) The older adult preparing to walk a half marathon

Ans: A Medical devices that are commonly associated with increased risk for pressure ulcers include masks, orthotics, tubing, immobilizers, stockings or boots, nasogastric tubes, cervical collars or braces, and tracheostomy tubes and ties. People who are unable to move around independently are at high risk for pressure ulcers, not those who move and participate in physical activities

8. A 78-year-old home health client has admitted to his nurse that his level of sexual activity with his wife has declined in recent months and become wholly absent over the past several weeks. The client has implied that this is due to a lack of performance, rather than lack of desire, on his part. What assessment should the nurse prioritize in light of this revelation? A) Client's medication regimen B) Client's musculoskeletal system and active range of motion C) Client's cognitive status and level of consciousness D) Client's cardiovascular status

Ans: A Sexual wellness and sexual performance are affected by multiple factors. However, the effects of medications are highly significant and likely supersede potential changes in strength, cognition, or cardiovascular status

2. A 65-year-old client with a long-standing history of chronic obstructive pulmonary disease (COPD) was placed recently on Coumadin after experiencing atrial fibrillation. Upon discharge from the hospital, which of the following statements by the client indicates a need for further teaching? A) "I will continue to use smokeless tobacco since it's a lot better than smoking." B)"I will avoid using over-the-counter antihistamines since they can dry my mucosal secretions." C)"I will watch my intake of dark green leafy vegetables since they may impact the effects of Coumadin." D)"I will not take any herbal preparations without my health care provider's knowledge."

Ans: A Smokeless tobacco is associated with mouth cancer, gingivitis, and tooth loss and may be carcinogenic to the pancreas. The other noted actions are appropriate to the maintenance of health.

10. The aging process is accompanied by a number of changes in thermoregulation. Which of the following clinical phenomena in older adults is likely to result from these changes? A) Lack of detection of an acute infection B) Impaired protein synthesis during hot weather C) Susceptibility to skin breakdown on bony prominences D) Orthostatic hypotension

Ans: A The fever response in older adults is often muted. Changes in thermoregulation do not contribute directly to skin breakdown, orthostatic hypotension, or impaired protein synthesis

3. A 99-year-old resident has fallen. Which of the following functional consequences of this fall most strongly impacts the plan of care? A) A 99-year-old is at much higher risk of a fracture from a fall than a younger person. B) A 99-year-old is more likely to have limited range of motion, impacting performance of some activities of daily living (ADLs). C) A 99-year-old who has fallen is unlikely to develop fear of falls. D) A 99-year-old will have diminished muscle strength related to muscle mass loss.

Ans: A The functional consequence of the fall is risk for future falls which may include a risk for fractures. Osteoporotic fractures occur with little or no trauma to the older adult, and risk of fractures increases in direct relation to age. While a 99-year-old may have slowed performance of ADLs and decreased muscle mass, the high risk for falls is the most important factor (also note these are not consequences of the fall). Fear of falling is a major concern that impacts many residents of long-term care facilities

5. Which of the following statements by the new nurse best conveys an understanding of diabetes in older adults? A) "A combination of lifestyle factors and age-related changes contributes to high rates of diabetes among older adults." B) "Development of diabetes later in life is considered a normal, age-related change." C) "Health care providers should avoid drawing conclusions about diabetes risk based on ethnicity." D) "The diagnosis of diabetes in older adults is complicated by subtle signs and symptoms."

Ans: A The high prevalence and incidence of diabetes among older adults is attributable to lifestyle, genetic, and age-related factors. Ethnicity is a valid variable that needs to be considered, given that some minority groups have significantly higher rates of diabetes. Some symptoms of hypoglycemia are subtle in the older adult, but diagnosis is based on laboratory data that do not change with aging. While age-related changes contribute to a susceptibility to diabetes, the development of the disease should not be considered a normal, age-related change in and of itself

1. A client is unresponsive, the skin is usually dry, confined to bed, with limited mobility and contractures, and the nutrition is less than adequate. Using the Braden score, which score will be assigned to this client's risk for pressure ulcers? A) 8, very high risk B) 8, at risk C) 18, high risk D) 18, moderate risk

Ans: A The nurse uses the Braden score to determine the plan of care. The lower the Braden score, the greater the risk. Scores of 9 or less are considered to be at very high risk, and additional pressure relieving surface and treatment of nutrition are important for this client

2. A nurse is responsible for the care of group of older adults on an acute medical unit. Which of the following clients should the nurse monitor closely at night for worsening symptomatology? A) A client with a diagnosis of chronic obstructive pulmonary disease (COPD) B) A client with diagnoses of osteoarthritis and failure to thrive C) A client with a diagnosis of foot cellulitis secondary to diabetic neuropathy D) A client with chronic anemia receiving transfusions of packed red blood cells

Ans: A The symptoms of individuals with COPD are often exacerbated during sleep, because of both positioning and decreased oxygen saturation that occurs during sleep. Clients with osteoarthritis, cellulitis, or anemia would not be as likely to have increased symptoms at night

5. Which of the following older adults is most at risk to develop osteoporosis? A) A 65-year-old white woman with chronic obstructive pulmonary disease who takes corticosteroids B) A 65-year-old white man with rheumatoid arthritis C) A 70-year-old African American man with a seizure disorder D) A 68-year-old Hispanic woman who recently had a partial hysterectomy

Ans: A White non-Hispanic women have a higher incidence of osteoporosis. Corticosteroids and antiseizure medications are most frequently associated with secondary osteoporosis. White men and African Americans of both genders have a lower incidence of osteoporosis

15. A nurse plans discharge instructions of a 78-year-old black client with newly diagnosed dilated heart failure. The client states, "Will I be going home on hospice now that my heart is failing?" Which of the following responses is most appropriate by the nurse? A) "Heart failure is a chronic condition that can be controlled with medication." B) "No, but you will have palliative care." C) "You must go to cardiac rehabilitation." D) "You will need to take medications for the rest of your life."

Ans: A The client with heart failure will need medications and will benefit from cardiac rehabilitation; however, these answers avoid the issue of lack of understanding of the type of disease heart failure is. Palliative care is not appropriate at this time

2. A nurse monitors a group of older adults. Which of the following older adults is a high risk for functional consequences of altered thermoregulation? (Select all that apply.) A) 78-year-old adult with heart failure B) 75-year-old adult with a urinary tract infection C) 80-year-old adult with vascular-type dementia D) 71-year-old participant in a wellness center E) 72-year-old adult with peptic ulcer disease

Ans: A, B, C A healthy older adult in a comfortable environment will experience few, if any, functional consequences of altered thermoregulation. In the presence of any risk factor, however, hypothermia or heat-related illness may develop in an older adult. Even moderately adverse environmental temperatures can precipitate hypothermia or heat-related illness in an older adult, especially in the presence of additional predisposing factors, such as certain medications or pathologic conditions. Age-related changes, which can affect processes involved with heat loss or production, begin during the fifth decade, and their cumulative effects are experienced during the seventh or eighth decade

15. During heat waves, nurses can assist to prevent heat-related illnesses in older adults. Which of the following should be included in the teaching? (Select all that apply.) A) Ensure fluid intake at or above 64 ounces per day. B) Keep air-conditioning at or below 72°F. C) Take a cool shower three times a day. D) Use extra soap when bathing. E) Use ice to cool armpits up to 20 minutes. F) Wear loose-fitting clothing

Ans: A, B, C, E, F Ensure fluid intake at or above 64 ounces per day, keep air-conditioning at or below 72°F, take a cool shower three times a day (not with soap every time), use ice to cool armpits up to 20 minutes, and wear multiple layers of loose weave, loose-fitting clothing

15. A nurse assesses older adults at risk for pressure ulcers. Which of the following assessment tools should the nurse use to identify those who might benefit from interventions? (Select all that apply.) A) Braden Scale B) Norton Scale C) PUSH Scale D) Reverse staging E) Waterloo Scale

Ans: A, B, E Braden Scale has been recommended for identifying older adults who are at risk for the development of pressure ulcers. The Norton and Waterloo scales are also commonly used, with reviews of studies indicating that all three of these scales can help identify clients at risk for pressure ulcers. PUSH is a staging system, which rates current pressure ulcers, and reverse staging is not a recommended practice

12. A nurse presents an overview of sleep to older adults at an activity center. Which of the following risk factors for sleep problems should the nurse include in the presentation? (Select all that apply.) A) Boredom B) Chronic discomfort C) Dehydration D) Exercise E) Lack of light F) RLS

Ans: A, B, F Boredom, chronic discomfort, and RLS are all treatable risk factors that can interfere with sleep patterns. Dehydration, exercise, and lack of light do not decrease sleep

8. One of the functional consequences of age-related changes to the skin is an increased susceptibility to injury. Which of the following factors contributes to this susceptibility? (Select all that apply.) A) Decreased sensation of cutaneous pain and discomfort B) Changes in vitamin D synthesis C) Increased healing time for skin wounds D) Decreased resistance to shearing forces E) Changes in skin pigmentation

Ans: A, C, D A muted pain response, increased healing time, and decreased resistance to shearing all contribute to older adults' susceptibility to injury. Changes in vitamin D may occur with age, but these changes do not constitute a risk for injury. Similarly, changes in pigmentation are not a significant risk factor for injury

10. An older adult with a diagnosis of heart failure has been admitted to the hospital with an exacerbation of this condition. Which of the following are consequences of heart failure for which the nurse must monitor? (Select all that apply.) A) Arrhythmias B) Autoimmune disorders C) Drug interactions D) Hypotension E) Sleep disorders

Ans: A, C, D, E Common consequences of heart failure in older adults include increased likelihood for developing arrhythmias, increased risk for hypotension and falls, increased risk for drug interactions, and high incidence of sleep disorders. Autoimmune disorders do not commonly result directly or indirectly from heart failure

10. A 72-year-old man's diagnostic testing and physical examination have resulted in a diagnosis of COPD. Which symptomatology is unexpected and will require follow-up? (Select all that apply.) A) Hemoptysis and orthostatic hypotension B) Chest pain and shortness of breath C) Cough and dyspnea D) Apneic spells and fatigue E) Wheezing and clubbing

Ans: A, D The most common manifestations of COPD are cough, dyspnea, wheezing, and increased sputum production. Hemoptysis and orthostatic hypotension are unexpected and require follow-up, as do apneic spells and fatigue. Chest pain and shortness of breath signal cardiac dysfunction and require immediate attention

16. A 73-year-old client is admitted to the hospital. A nurse assesses the client for frailty. Which of the following indicate frailty? (Select all that apply.) A) Diminished handgrip strength B) High level of physical activity C) Intentional weight loss D) Self-reported exhaustion E) Slow walking speed

Ans: A, D, E Patients are considered fail when they have three or more of the following conditions: low level of physical activity, slow walking speed, unintentional weight loss (i.e., 10 lb or more during the past year), weakness (measured by diminished handgrip strength), and self-reported exhaustion (Koller & Rockwood, 2013)

6. An 81-year-old client was diagnosed with colon cancer several months ago. Both the patient and the family have been made aware of the potential for metastasis and the poor prognosis associated with this disease. At what point in the client's disease trajectory should the principles of palliative care be implemented? A) After chemotherapy and radiation therapy have been proven unsuccessful B) Early in the course of the client's cancer and before symptoms become unmanageable C) Soon after the client has made a decision to change her code status to "do not resuscitate" D) When the client's care team determines that there is less than 2 months to live

Ans: B The principles and practices of palliative care should not be exclusively reserved for late in a disease trajectory. It is applicable early in the course of an illness and should be offered as needs develop and before they become unmanageable. Palliative care can be provided concurrently with life-prolonging therapies or as a main focus of care.

14. A 64-year-old obese man is admitted to the hospital for treatment of heart failure secondary to alcoholism. For which of the following negative consequences should the nurse assess? A) Chronic pain B) Obstructive sleep apnea C) Parkinson disease D) RLS

Ans: B Factors associated with increased risk for obstructive sleep apnea include obesity, diabetes, stroke, Parkinson disease, congestive heart failure, genetic predisposition, craniofacial anatomic features, and the use of alcohol or medications that depress the respiratory center.

7. A nurse who oversees the care in a nursing home is aware that the older adults who reside in the facility are vulnerable to impaired thermoregulation. What information source should the nurse prioritize when regulating the temperature in the facility? A) The nurse's perception of heat and cold when dressed similarly to the residents B) Readings from an accurate thermometer C) The input from nursing assistant and unlicensed care providers in the facility D) The suggestions of residents who do not have cognitive impairments

Ans: B A reliable thermometer must be used in order to maintain a temperature as close to 75°F as possible. This objective data source supersedes the subjective perceptions of nurses, care providers, or certain residents, though each should likely be considered

11. A nurse discusses common illnesses at the local health fair. The older adult asks, "Why do all my friends seem to get pneumonia?We never did when we were younger." Which of the following interventions should the nurse include in the teaching? A) Examinations by health care provider B) Hand hygiene C) Jogging/running D) Yearly pneumovax

Ans: B Age-related alterations of the immune functions are a major contributing factor in the prevalence of lung diseases among older adults. Examinations are helpful in early identification of some lung diseases but not preventative regarding communicable diseases such as pneumonia. Pneumovax is not required yearly

9. A community health nurse is to create initiatives to foster the health of older adults in the community. Which of the following health promotion activities has the greatest potential to promote the respiratory health of older adult participants? A) A lung cancer screening program B) A smoking cessation program C) A tuberculosis screening program D) A bronchitis immunization program

Ans: B As with younger adults, smoking cessation confers a multitude of health benefits, especially with regard to respiratory and cardiovascular health. Lung cancer screening and tuberculosis screening are less likely to benefit large numbers of participants. Bronchitis is not a health problem that is amenable to immunization

4. Which of the following nursing interventions should be the priority for a nurse working in a retirement community? A) Using restraints to keep nursing home residents from getting out of chairs unattended B) Establishing a fall-prevention program for residents at risk C) Using cordless phones or emergency call systems for residents in assisted living D) Using a monitoring device for people who live alone in their own home

Ans: B Formal fall-prevention programs are implemented in home care and health care settings. These programs can address multiple risk factors, focusing on those who are at risk for falls and the consistent implementation of preventive measures.

9. A nurse on an acute care unit is disturbed by the increasing incidence of pressure ulcers among older adults. Which of the following measures should the nurses on the unit prioritize in order to prevent the formation of pressure ulcers? A) Apply emollient lotions with baths B) Frequent repositioning of immobilized clients C) High-protein, high-calorie diet D) Massage bony prominences each shift

Ans: B Frequent repositioning is an important measure in prevention. Lotions should be applied; relief of pressure is the highest priority. Nurses should ensure that those at risk for pressure ulcers do receive enough calories, vitamins, and protein. Nurses do not massage bony prominences for concern of damage

3. A 70-year-old client smoked for 30 years and has a history of COPD. The spouse assists with cooking, cleaning, and transportation. The spouse has become ill, and they now receive assistance from a home health nurse. Which of the following interventions should be the priority? A) Assisting the clients to perform instrumental activities of daily living (IADLs) B) Determining a plan for providing meals C) Setting up medications for the clients D) Smoking cessation plan

Ans: B The nurse's role is not to perform the IADLs, but to plan for the IADLs including meals, cleaning, and transportation. There is no indication that the clients need their medications set up, smoking cession is important, but basic needs come first

13. A nurse cares for an older adult in a residential care program. The client has multiple chronic conditions. The client has developed dyspnea and has lost 105 lb of body weight. Which of the following statements by the nurse is most appropriate? A) "Have you ever heard of palliative care?" B) "I want to talk to you about switching our focus from cure to care." C) "We don't think that there is anything we can change to make you better." D) "Your breathing problems concern me."

Ans: B Unintentional weight loss, unstable medical conditions, and frequent hospitalizations indicate a need for discussion of palliative care services. The nurse uses open-ended assertive statements that teach the client. Saying we can't make you better might be helpful for a client who is unable to hear the professional the first time palliative care is introduced. The concern regarding the breathing doesn't introduce the idea of supportive care.

1. A 65-year-old woman is speaking to her nurse at the primary care clinic. She states that it is very painful for her when she has sexual relations. She asks the nurse what she could do to alleviate the pain. Which of the following suggestions could the nurse make to the woman? A) Decrease the incidence of sexual relations. B) Use a water-soluble lubricant or estrogen cream. C) While engaging in intercourse, have your partner thrust his penis upward. D) Use a polyisoprene (non-latex) condom for intercourse

Ans: B With age, there is a thinning of the vaginal mucosa, which creates dryness and predisposes women to irritation and inflammation so using a water-soluble lubricant or estrogen cream may be helpful. The male partner should thrust downward instead of upward during sexual intercourse. Decreasing the incidence of sexual relations may lead to a "use it or lose it" principle. Use of a condom, latex or polyisoprene, will not decrease vaginal wall irritation.

4. Which of the following processes should a nurse address first when assessing sexual function in older adults? A) Identify risk factors that may interfere with the older adult's sexual functioning. B) Assess own personal attitudes toward sexuality and aging. C)Obtain permission from the individual to initiate a discussion on sexual relations. D) Provide detailed information about sexual function to the older adult.

Ans: B A personal attitude assessment about sexuality and aging is a nurse's prerequisite to discussing sexual function with older adults. The next step would be to obtain permission from the individual to initiate discussion about sexual relations

15. An older adult at home uses earplugs to diminish street noise at night. Which of the following statements by the nurse is appropriate? A) "Using earplugs during sleep can damage your hearing." B) "I suggest a smoke alarm with blinking lights." C) "Your neighbors must be really loud." D) "This apartment sounds really unsafe."

Ans: B People who live alone should be cautioned about the danger of blocking out the sound of a smoke alarm; one that has lights increases the safety. Earplugs at night do not damage hearing

14. A nurse assesses residents of the acute care facility for pressure ulcers. Which older adult should the nurse monitor closely for pressure ulcers? A) The Asian with multiple nevi on extremities B) The Ethiopian former store clerk C) The fair-skinned Caucasian woman D) The wrinkled face Hispanic ranch worker

Ans: B Persons with darkly pigmented skin have a higher incidence of serious pressure ulcers. Nevi, sun exposure, and fail skin are related to cancer, not pressure ulcers

2. A nurse is discussing sexual activity with older adults in a wellness clinic. Which of the following statements by an individual indicates a need for further exploration? A) "I know my diabetes can affect my sexual activity." B) "My husband has an enlarged prostate." C) "I use Premarin cream to help with vaginal dryness." D) "I will not use petroleum jelly as a lubricant."

Ans: B The husband's prostate problem can affect his sexual performance and needs further exploration. Premarin cream helps when vaginal dryness occurs because of estrogen withdrawal. Diabetes has an effect on vaginal lubrication. Petroleum jelly increases risk for infection

1. Which of the following statements best captures the typical character of health problems in the lives of older adults? A) Older adults' lives are dominated by the increasing number of acute health problems due to age-related changes. B) Most older adults experience an interplay between a number of chronic conditions and occasional acute health problems. C) Older adults can expect a relatively consistent decline in their health over time as a result of acute health problems. D) Chronic conditions account for the normal downward direction of an older adult's health status

Ans: B The interplay between chronic and occasional acute conditions is typical of the health trajectory of many older adults. The most salient factor is not acute problems alone, nor are health problems necessarily attributable to age-related changes. Changes in health status are rarely consistent and do not exclude chronic conditions or acute problems

7. A nurse in a long-term care facility has noticed that many residents of the facility spend a large amount of time in bed yet frequently complain of fatigue and sleep deprivation. What change in the facility's environment is most conducive with helping residents achieve adequate amounts of restful sleep? A) Keeping the lights at a consistent, low level throughout the day and night B) Allowing residents to awake/sleep according to their own routines C) Maintaining the facility at a temperature of 78°F to 80°F during the night D) Checking on each resident every 2 hours during the night to ensure safety

Ans: B It is important not to schedule the time for awakening clients/residents based on the most efficient use of nursing and dietary time that require clients/residents to adjust their sleep routines accordingly. Lighting should be bright during the day and dark at night in order to foster normal circadian rhythms. A temperature of 78°F to 80°F during the night is likely too warm to promote restful sleep. Safety concerns are not related to the issue of adequate sleep

3. A nurse is teaching new graduates about the nature of palliative care on her unit. Which of the following statements by a new nurse indicates a need for further teaching? A) "I can see how important it is for us to educate patients and their families and friends on the unit." B) "It certainly requires a change in thinking to understand why we don't provide any medical interventions for patients." C) "I can see how comfort and psychosocial well-being take precedence over physical functioning." D) "Purpose in life and quality of life seem to be the overarching goals of palliative care."

Ans: B While the focus of palliative care is not on curing disease, this does not mean that treatments of all kinds are absent. Distressing symptoms are addressed from both a nursing perspective and a medical perspective. Education is a key component of palliative care, and comfort and psychosocial well-being trump physical functioning. Purpose in life and quality of life are similarly emphasized

9. A recent heat wave has resulted in an increase in the number of older adults who are presenting to the emergency department with actual or suspected hyperthermia. What assessment findings are congruent with a diagnosis of hyperthermia in older adult clients? (Select all that apply.) A) Diaphoresis B) Weakness C) Warm, dry skin D) Pallor E) Bradycardia

Ans: B, C Signs and symptoms of hyperthermia include warm, dry skin, and weakness. Skin surfaces are not typically pale and heart rate typically increases, not decreases. Sweating may be minimal or absent

13. A nursing supervisor in the long-term care facility implements changes to improve environmental conditions. Which of the following should be included in these changes? (Select all that apply.) A) Assist residents to bed at 7 PM each day. B) Build partitions between roommates. C) Install low-level night lights in the bathrooms. D) Replace light bulbs with low light energy efficient bulbs. E) Set thermostat at 72 each night.

Ans: B, C, E More time in bed does not mean more time sleeping. Partitions can increase the sleeping privacy of residents; bright lights at night interfere with sleep but are helpful during the day. Temperature that is too hot or too cold interferes with sleep

1. A nurse assesses an 82-year-old client who states, "That waiting room is so cold!" Which of the following systems should the nurse assess to determine the source of the clients sensations? (Select all that apply.) A) Bowel sounds B) Capillary refill time C) Oral temperature D) Respiratory rate E) Skin temperature

Ans: B, C, E The age-related changes that impact the older adult's response to cold include inefficient vasoconstriction, decreased cardiac output, diminished peripheral circulation, and delayed and diminished shivering. There is no indication of respiratory or bowel issues

13. A nurse reviews the medications of a 58-year-old man who has erectile dysfunction. Which of the following prescribed medications can interfere with sexual functioning? (Select all that apply.) A) Acetylsalicylic acid (aspirin) B) Metoprolol (Lopressor) C) Clopidogrel (Plavix) D) Lisinopril (Prinivil) E) Ezetimibe (Zetia)

Ans: B, D Metoprolol and lisinopril interfere with libido and can cause erectile dysfunction in men. Acetylsalicylic acid, clopidogrel, and ezetimibe do not. Of note, these medications indicate cardiovascular disease which is strongly associated with sexual dysfunction

14. A nurse administrator incorporates older adults' sexuality into the policies of a long-term care facility. Which of the following should be included in this plan? (Select all that apply.) A) Allow public masturbation. B) Ask permission to enter a room. C) House spouses separately. D) Knock on door before entering. E) Redirect inappropriate sexual behaviors.

Ans: B, D, E Masturbation is normal, but not appropriate for public places, assuring that the clients' rooms are their own personal space and assuring privacy while in those rooms are important to sexuality. Sexual behaviors that impinge on others' comfort should be redirected. Components of sexuality that are especially important for older adults include kissing, hugging, intimacy, fantasy, masturbation, oral sex, loving words, physical closeness, and expressions of affection

5. A nurse plans interventions in a skilled nursing facility to prevent lower respiratory infections. Which of the following nursing interventions should be included in the plan? (Select all that apply.) A) Encourage annual pneumonia vaccinations. B) Encourage annual influenza vaccinations. C) Encourage annual chest radiographs to detect tuberculosis. D) Encourage influenza vaccinations every 5 years. E) Encourage hand hygiene for residents and staff.

Ans: B, E Influenza vaccinations should be given yearly to older adults. The Centers for Disease Control and Prevention (CDC) recommends a one-time booster dose of the pneumonia vaccination for all people 65 years of age or older if they received an initial pneumonia vaccination 5 or more years earlier or were younger than 65 years of age when they first received the pneumonia vaccine. Chest radiographs will not prevent lower respiratory infections. Hand hygiene is essential in prevention of infections

4. A nurse is teaching an older adult's family about the concept of caregiver burden. Which of the following points is priority for the nurse to communicate to the family? A) "Don't feel guilty about having to hire help. Most older Americans' care is currently provided by professionals and formal services." B) "If you do eventually feel overburdened, moving your loved one to a nursing home will provide you with relief." C) "You'll find it difficult to provide for your loved one's needs if you yourself don't have a strong support system." D) "You'll actually find that for you, the benefits of providing for your loved one outweigh the negative consequences."

Ans: C A strong support system is a prerequisite for anyone who is planning to become a caregiver for a friend or family member. Most care is provided by friends and family, not professionals. It has been shown that moving a loved one to a nursing home does not diminish stress and burden on caregivers. While there are psychosocial benefits to being a caregiver, the negative functional consequences of caregiving outweigh the positive

11. A 52-year-old woman discusses her menstrual cycles with the nurse. The client states that she still has menses, but that she "never knows when they might begin or end." Which of the following is the most appropriate response by the nurse? A) "It sounds like you are frustrated with this change; it is a difficult part of life." B) "Reproduction is no longer possible so that is one thing less to worry about." C) "We can't say how long this perimenopausal phase might last." D) "You are in the postmenopausal cycle and should expect further changes."

Ans: C Perimenopause refers to the several years before menopause when women begin experiencing changes in menstrual cycles. The client doesn't express frustration, nor does she sound like she is "worrying" about reproduction (which still could happen, even with low probability). Menopause typically occurs around the age of 49 to 51 years and postmenopause begins 12 months after last period

12. A nurse evaluates the healing of a full-thickness skin tear on a 92-year-old resident of a longterm care facility. Which of the following would support the continuation of the current treatment plan? A) The wound with redness surrounding at 12 days B) The wound draining serosanguinous drainage at 14 days C) The wound showing 50% healing at 16 days D) Pain at the wound site at 19 days

Ans: C About 50% healing at 16 days is acceptable. Full-thickness skin tears take an average of 21 days to healing in older adults. The treatment plan needs to be changed if there is redness (at 12 days), pain (at 19 days), or draining plasma (at 14 days).

11. A nurse in the long-term care facility assesses an 86-year-old woman who has recently become lethargic and difficult to arouse. Her vital signs are all stable and within normal limits. Her breath sounds are diminished. Which action by the nurse should be the priority? A) Call the family and give them an update. B) Place her on high fall risk precautions. C) Send her to the emergency department. D) Tell the aides to keep an eye on her.

Ans: C Atypical presentation is especially common in those who are older than 85 years. Changes in behavior or functioning and increased fatigue are common atypical presentations of infection (e.g., pneumonia or urinary tract infection). In addition, the expected manifestations of an infection, such as elevated temperature or specific complaints of pain or discomfort, may be absent. While the family should be made aware of the update on the condition, the care of the client is the priority. It is not appropriate to delegate this to the certified nursing assistant (CNA). Placing her on fall prevention does not address the assessment data.

14. A nurse discusses health promotion with a group of older adult women. The nurse suggests a Pap test every 2 years. One woman states, "I haven't had a Pap since the change, why would I do that now?" Which response by the nurse is best? A) Annual checkup by your primary care provider to examine your ovaries is appropriate. B) Avoidance doesn't help with diagnosis of cancers. C) Risk of death from ovarian cancer is twice as high among women aged 65 and older. D) Women who don't have sex are at higher risk for ovarian cancer

Ans: C Cancers are found more often in older adults, functional consequences of many sequelae. The risk of death from ovarian cancer is twice as high among women aged 65 and older, compared with younger patients. Sexual relations do not cause ovarian cancer

7. A nurse admits an 81-year-old man to the hospital with aspiration pneumonia. Which of the following risk factors should the nurse predict that the client has in his history? A) Cigarette smoking B) Lung cancer C) Dysphagia D) Sleep apnea

Ans: C Dysphagia creates a serious risk for aspiration pneumonia. Smoking, cancer, and sleep apnea do not have a direct correlation with aspiration pneumonia

8. A 78-year-old client has been brought to the emergency department from home with a sudden change in mental status accompanied by significant weakness. For which condition should the health care providers assess? A) Alzheimer disease B) Lung cancer C) Pneumonia D) Tuberculosis

Ans: C In older adults, pneumonia often has a presentation that differs from that of younger adults. Rather than presenting with a cough, chills, dyspnea, elevated temperature, and elevated white blood cell count, older adults are more likely to have subtler and nonspecific disease manifestations such as fatigue and change in mental status. Alzheimer disease has an insidious onset. Lung cancer and tuberculosis are not characterized by cognitive deficits

10. An older adult client states that he has lately been taking up to 2 hours to fall asleep at night, despite avoiding caffeine during the day and going for a brisk walk after lunch each day. Which of the following statements by the nurse is most appropriate? A) "We can request a prescription for a sleeping pill from your primary care provider." B) "I suggest a 'nightcap' before bed, as long as it's not beer or wine." C) "It will benefit you to get up at the same time each morning, even if you are tired." D) "Move your daily walk to the late evening to make yourself tired before bed."

Ans: C Older adults experiencing sleep problems should attempt to awaken, rest, and go to bed at a consistent time each day. Hypnotics should be a temporary measure of last resort, and alcohol and exercise should be avoided around bedtime

15. A nurse admits an older adult from a longterm care facility into the hospital for respiratory infection. Which diagnostic testing should the nurse anticipate? A) Electrocardiogram B) Lung cancer screening C) Mantoux testing D) Pulmonary function testing

Ans: C Residents of long-term care are at risk for tuberculosis. While cancer and cardiac and lung function testing may occur, testing for tuberculosis should be done to screen for this contagious disease to protect others

13. A nurse interviews an older adult with pulmonary disease. The client states, "I worked hard all my life in the shipyard, I provided for my family. I never smoked, why did I get this disease?" Which response by the nurse is best? A) "It is a good thing that you never smoked." B) "Pulmonary disease can happen to anyone." C) "The work in the shipyard put you at risk." D) "You feel like you are being punished..."

Ans: C Shipyard work is a job category that is associated with an increased risk of respiratory disease. Caring responses give information and are directly related to the client's issue (and smoking is not). The client does not directly imply he feels punished

12. A nurse assesses older adults at a pulmonary clinic. Which of the following questions might best assist identify those at risk for pulmonary disorders? A) "Do any of your children smoke?" B) "In what state did you grow up?" C) "What type of job did you have?" D) "Where do you exercise?"

Ans: C Some job categories are associated with an increased risk of respiratory disease. Children who smoke do not imply that secondhand smoke occurs. While location does correlate with the percent of smokers, it is not as helpful in identification of those with pulmonary disorders; nor is where a person exercises.

1. A nurse assesses an older adult's overall respiratory function. Which of the following interview questions would be most appropriate? A) "Would you be interested in finding out more about environmental smoke?" B) "Did either of your parents experience lung diseases?" C)"Have you ever worked in a job where you were exposed to dust, fumes, smoke, or other pollutants?" D) "What do you do to actively maintain your respiratory health?"

Ans: C The effects of air pollution are cumulative over many years. Thus, there is an increased impact on older adults over their lifetimes. Hazards in the workplace were unregulated before 1970. Therefore, there are older adults who have experienced cumulative and long-term effects from toxic substances

1. A nurse presents at a conference about the concept of sleep. Which of the following statements should the nurse include in the teaching? A) "Increased sleep efficiency is considered a normal, age-related change." B) "Sleep efficiency is quite consistent across different age groups." C) "Both pathologic conditions and age-related changes influence sleep efficiency." D) "Older adults often experience increased sleep latency and decreased numbers of awakenings."

Ans: C Age-related changes and pathologic conditions together contribute to the decreased sleep efficiency associated with older age. Sleep efficiency tends to decrease, not increase, with increasing age and is not generally consistent with that of younger people. Older adults tend to experience both increased sleep latency (time required to fall asleep) and increased numbers of awakenings during the night

3. A nurse plans the care for an older adult man who consumes two alcoholic beverages each evening. Which of the following should be included in the plan of care? A) Allow for a later bedtime. B) Encourage the client to cease all alcohol intake. C) Monitor for nocturnal awakenings. D) Watch for an increased rapid eye movement (REM) sleep

Ans: C Alcohol consumption is associated with both initial drowsiness and increased numbers of awakenings during the night, as well as overall decreases in both total sleep time and REM sleep. Individuals who are accustomed to the depressant effect of alcohol are prone to insomnia once they stop consuming it

12. A nurse in the ambulatory clinic assesses a 53-year-old woman who states, "last night all of the sudden I got really sick, got really hot, and started sweating; then I had chills, and my chest was pounding." Which action by the nurse is priority? A) Ask if the client had been exposed to anyone who was ill. B) Check the client's troponin and B-type natriuretic peptide (BNP) labs. C) Discuss the client's menstrual cycle with her. D) Review the client's medication history

Ans: C Asking about "anyone who was ill" is broad and generic. Illness is often spread in the prodromal phase when there are no symptoms. Troponin and BNP are indicators of cardiac functioning; women who have an MI are more likely to experience severe fatigue, not heat and chills. Hot flashes are a vasomotor symptom characterized by the sudden onset of heat, perspiration, and flushing that spreads from the head to the trunk. Symptoms last from 1 to 5 minutes and may be accompanied by chills, nausea, anxiety, palpitations, and clamminess. Medications do not relate to these symptoms

6. A gerontological nurse is aware that the aging process is accompanied by numerous, multifactorial changes that affect sexual wellness in older adults. Among women, which of the following factors is usually the primary cause of changes in sexual functioning? A) Psychosocial factors B) Environmental factors C) Hormonal factors D) Spiritual factors

Ans: C Changes in sexual functioning are influenced by many factors. In women, however, the influence of hormonal factors is often primary. Diminished estrogen levels can directly affect sexual function for older women in several ways

3. A 64-year-old man had a myocardial infarction (MI) 2 months ago. He has recovered to the point that he is able to climb up two flights of stairs, but he and his spouse have not resumed sexual relations. Which of the following responses by the nurse is most appropriate? A) "Is angina interfering with your sexual functioning?" B) "This lack of libido is caused by vasoconstriction in the genital area." C) "You are safe to have sex; you can resume sexual relations when you desire." D) "You may have a problem with retrograde ejaculation."

Ans: C Even when no physiologic basis exists for abstaining from sexual intercourse after an MI, sexual activity is often limited or absent because of fatigue, depression, diminished sexual desire, and fears and anxiety of the person or the sexual partner. Diabetes can cause retrograde ejaculation. An MI does not cause vasoconstriction

16. A nurse at the dermatology office triages calls. Which of the following clients is the highest priority to follow up? A) A 2-year-old with diaper rash B) A 20-year-old with red sunburn on the chest and arms C) A 78-year-old with a lesion that is black, swollen, and draining liquid D) A 90-year-old with flat discolored spots on face

Ans: C In general, the following characteristics of a skin lesion warrant medical evaluation: redness, swelling, dark pigmentation, moisture or drainage, pain or discomfort, raised or irregular edges around a flat center

12. A wellness center nurse teaches a class of older adults about healthy habits. Which of the following interventions will make a difference in the clients' lives and as such be included by the nurse? A) Avoid alcohol consumption. B) Avoid fried foods and red meats. C) Avoid secondhand smoke. D) Avoid sunlight.

Ans: C Nurses must not be influenced by ageist attitudes suggesting that older adults are too old to change behaviors and to benefit from improved health behaviors. Health promotion behaviors include the following: avoid secondhand smoke; limit intake of fats, red meats, and fried foods; avoid excessive exposure to sunlight; and avoid excessive alcohol consumption

11. A nurse monitors a group of older adults in the long-term care facility's kitchen. Which of the following actions would cause the nurse to intervene? A) Sharing perfumed hand soap B) Using hand lotion after washing dishes C) Using hot water to rinse the dishes D) Using soap to wash the dishes

Ans: C Older adults are more susceptible to scald burns because of their diminished ability to feel dangerously hot water temperatures. Perfumed hand soap, dish washing liquid, and lotion are acceptable

11. A nurse discusses sleep patterns with an older adult. The client states, "I feel like all I do is lie in bed awake each night." Which response by the nurse is most appropriate? A) "How long do you lie there each night?" B) "Describe your pillow and mattress to me." C) "Do you have a history of sleep apnea?" D) "What have you tried to get a better nights rest?"

Ans: C Older adults have more diminished sleep efficiency secondary to prolonged sleep latency, and an increased number of awakenings during the night. How long he lies there is not as important as the fact that he feels like it is all night. The nurse assesses for sleep patterns, contributing factors, and alleviating and aggravating factors.

8. An older adult with restless legs syndrome (RLS) has sought advice from the nurse in an effort to ease the problem. Which of the following statements should the nurse include in the plan? A) "There are new, over-the-counter medications that can probably resolve your RLS." B) "RLS can be a sign of a much more serious health problem, so I'd encourage you to visit your primary care provider." C) "I see that your iron level is low, let's add foods high in iron to your diet." D) "Even though it's certainly unpleasant, RLS is a normal part of the aging process."

Ans: C Risk factors for RLS include genetic predisposition, iron deficiency, chronic renal failure, peripheral neuropathy, and adverse effects of certain medications. RLS is considered a neuromuscular disorder, not an age-related change. It is more common with certain health problems, but it is not considered a sign of more serious pathology. Over-the-counter medications are not available for RLS.

3. The nurse assesses the fluid volume status of a 72-year-old client who takes Lasix (furosemide) and Pacerone (amiodarone). Which of the following is the most reliable method for assessing this client's skin turgor? A) Ask the client to open the mouth and examine the oral mucous membranes for dryness. B) Examine the skin on the lower legs and look for dry, scaly, or rough skin. C) Gently pinch the skin on the abdomen to see how long it takes to return to normal. D) Squeeze the skin on back of hand to see if it remains pinched or is slow to return to normal.

Ans: C Skin turgor should be checked over protected areas, such as the sternum or abdomen. The use of diuretics can exacerbate xerosis that older adults may have. Diuretics and amiodarone increase the risk for photosensitivity

8. During a period of cold weather, an older adult has been brought to the emergency department with suspected hypothermia. Which of the following assessments should the nurse prioritize with this client? A) Palpation of the client's extremities to determine temperature B) Assessment of the client's level of consciousness C) Assessment of the client's core body temperature D) Interviewing to determine the client's sensation of cold

Ans: C The most reliable assessment for hypothermia is measurement of core body temperature. Palpation of extremities, interviewing, and assessment of level of consciousness are also relevant assessments, but the measurement of core body temperature is prioritized

1. A nurse is teaching health interventions to an older adult with osteoarthritis. Which of these statements indicates that the individual needs additional teaching? A) "I will avoid high-impact exercises." B) "I will get adequate intake of calcium and vitamin D." C) "I will try to limit my use of walkers and assistive devices." D) "I will lose weight if it turns out that I need to."

Ans: C Walkers and other assistive devices help relieve stress on weight-bearing joints and improve balance. Individuals with osteoarthritis need to participate in supervised, low-impact exercises and avoid high-impact activities. Vitamin D is essential for absorption of calcium. The individual needs to lose weight if appropriate

7. Mr. Thomas and Mrs. Young are residents of a long-term care facility who are both physically frail but cognitively healthy. Last night, the nurse at the facility discovered Mr. Thomas and Mrs. Young in bed together in Mr. Thomas' room and engaging in foreplay. How should care providers best respond to these residents' new sexual relationship? A) Ensure that each resident's family members are aware of this development. B) Teach Mr. Thomas and Mrs. Young about sexual health promotion. C) Accommodate the residents' relationship and provide them with appropriate privacy. D) Have each resident assessed to ensure that the relationship is medically safe and appropriate.

Ans: C Sexual relationships between competent and consenting residents in institutional settings should be accommodated by care providers. It is likely unnecessary to directly involve family members. Education and medical assessment are likely unnecessary and may be inappropriate.

10. A nurse in a long-term care facility teaches aides to assist several older adults with bathing each day. Which of the following interventions should the nurse include in the teaching? A) Apply perfumed products after bathing to promote hygiene and selfesteem. B) Cleanse groin with isopropyl alcohol to eliminate potential pathogens. C) Dry skin thoroughly; particularly between the toes and other areas where skin touches. D) Use water that is warm to hot (100°F to 105°F) to prevent hypothermia.

Ans: C Skin need to be dried thoroughly but gently, particularly between the toes and other areas where skin touches. Perfumed products and alcohol should be avoided. Water temperatures for bathing should be about 90°F to 100°F

7. A nurse was recently assisting an 84-year-old resident of a nursing home with the resident's biweekly bath. While the nurse was helping the resident transfer out of the bathtub, the resident grabbed on to the nurse forcefully, became rigid, and exclaimed, "Help me quick," despite the fact that the nurse was performing a safe and controlled transfer. Why might this resident have exhibited sudden anxiety during the transfer? A) The resident may be developing a cognitive deficit. B) The resident is experiencing age-related changes. C) The resident may have a fear of falling. D) The resident is ensuring safety.

Ans: C The fear of falling, which is the most common reported fear among older adults, has been identified as a public health problem that is of equal importance to falls. This fear goes beyond prudent safety measures and is not a normal, age-related change. The resident's actions do not necessarily indicate a cognitive deficit

2. A nurse teaches older adults about skin care and aging. Which of the following would be appropriate to include in this teaching? (Select all that apply.) A) Avoid sunscreens with a sun protection factor (SPF) higher than 14. B) Gently apply rubbing alcohol to keratosis growths to remove them. C) Include adequate amounts of fluid and vitamins in the daily diet. D) Use firm rubbing motions when drying your skin. E) Use emollient moisturizing lotions after bathing. F) When bathing or showering, use a mild, unscented soap.

Ans: C, E, F Older adults need an adequate intake of calories, nutrients, and hydration. Older adults should use a gentle, patting motion when drying their skin ensuring dry skin between toes. Older adults need to use a sunscreen with an SPF of 15 or higher even on overcast days and apply the emollient moisturizing lotion after bathing (not oils during bathing).

5. A nurse evaluates the teaching done for an older adult with an upper respiratory infection during a heat wave. Which of the following statements indicates a need for further teaching? A) "The air conditioner increases the ventilation in my apartment." B) "I know that having diabetes will impact my body temperature." C) "If I have an alcoholic drink, it will affect my body temperature." D) "I can take an antihistamine; it will not have an effect on my temperature."

Ans: D Antihistamines are a risk for heat-related illness. Alcohol is a risk factor for hyperthermia and hypothermia. Diabetes is a risk factor that affects hyperthermia

9. A palliative care team has taken over primary responsibility for the care of an older adult who has recently experienced a stroke. A visitor asks, "What is palliative care?" Which of the following is the best response by the nurse? A) "Spiritual and psychosocial care that takes place near the end of life" B) "Nursing care and medical treatment that prioritizes the wishes of patients and families" C) "The prioritization of complementary and alternative measures over biomedical interventions" D) "The provision of holistic care to patients experiencing incurable health states"

Ans: D Palliative care is a holistic approach to care that may be applied during complex and/or declining health states. It is not necessarily limited to the end of life and does not involve a rejection of biomedical interventions. The wishes of patients and their families are prioritized, but this is not the defining feature of palliative care. It includes spiritual and psychosocial care, but is not limited to these domains

6. A 79-year-old woman is scheduled to undergo hip replacement surgery after a fracture that was caused by a fall. Which of the following age-related changes may have contributed to the woman's susceptibility to bone fracture? A) Increased protein synthesis B) Infections within the synovial capsules of the knees and ankles C) Loss of neural control of balance D) Increased bone resorption

Ans: D The process of bone resorption accelerates with age, resulting in lower bone density. Changes in various aspects of the nervous system accompany the aging process, but a loss of neural control of balance is not normally among these. Infection is never a normal, age-related change and protein synthesis decreases, not increases, with age

5. Which of the following functional consequences of skin changes will impact the nursing care of older adults? A) Older adults have an increased incidence of moles requiring intervention. B) There is a decreased incidence of skin cancer in older adults because of an increase in melanocytes. C) In older adults, tactile sensitivity increases and there is an intense response to cutaneous stimulation. D) Collagen changes interfere with tensile strength of older adults' skin, causing the skin to be less resilient

Ans: D There is less tensile strength of the skin because of collagen changes, which predisposes the older adult to abrasive and tearing skin damage. There is a decreased incidence of moles after 40 years of age. There is an increased incidence of skin cancer in older adults, and decreased melanocytes is one factor that impacts this. Tactile stimulation decreases, and there is a less intense response to cutaneous stimulation

10. A nurse who provides care in a nursing home occasionally encounters colleagues' prejudices and misperceptions around the sexual wellness of residents. Which of the following statements reflects an appropriate view of sexual health in older adults? A) "I think it's just so cute when residents think that they're dating each other." B) "We need to make sure that residents get the teaching they need before we allow a sexual relationship." C) "Older adults need companionship and comfort much more than they need sex." D) "Let's do all we can to facilitate competent residents' sexual relationships."

Ans: D Among competent older adults, autonomy around sexual relationships should be protected and fostered. It is untrue that older adults have little need for sex and it is inappropriate for a nurse to prohibit a relationship pending education. Referring to older adults' relationships as "cute" is patronizing and inappropriate.

11. A nurse on the cruise ship to Pacific Islands monitors the older adults for heat stroke in the hot weather. Which of the following persons is at greatest risk for developing heat stroke? A) 82-year-old Pacific Islander working the stand B) 80-year-old Canadian who abstains from alcoholic drinks C) 82-year-old woman who has been on the cruise for 4 weeks D) 78-year-old man with Parkinson disease

Ans: D Cardiovascular disease and Parkinson disease can worsen the severity of heat-related illness and decrease the chance of full recovery. More men than women experience heat-related illnesses. When exposed to hot climates for 7 to 14 days, healthy adults are able to acclimatize, and abstaining from alcohol decreases the chance of hot intolerance

14. A nurse in the intensive care unit monitors an older adult admitted with hypothermia. Which of the following assessment findings indicates the need to notify the primary health care provider immediately? A) Shivering B) Slurred speech C) Temperature of 95.5°F (35.3°C) D) Urine output of 25 mL per hour

Ans: D Early signs of hypothermia are subtle; hypothermia is best detected by measuring core body temperature with a thermometer that registers below 95°F (35°C). Signs of moderate hypothermia may include lethargy and slurred speech. However, severe stages of hypothermia are characterized by muscular rigidity and diminished urinary function

2. A nurse is teaching older adults at a senior center how to reduce the incidence of falls. Which of the following statements indicates that the nurse's teaching has been effective? A) "Benadryl is a safe medication to take for sleep." B) "It is safe to have rugs in my kitchen and bathroom." C) "It is safe to take a low dose of Ativan when I am anxious." D) "I understand that over-the-counter medications can cause falls."

Ans: D Numerous prescription and over-the-counter medications are implicated in falls. Benzodiazepines have been studied, and it is suggested that their effect on psychomotor function increases the incidence of falls. Benadryl (diphenhydramine) has been associated with significant adverse effects on psychomotor skills

3. An 83-year-old puts on a sweatshirt and jacket preparing to go outside where it is currently 60°F. What interpretation should the nurse give to these actions? A) The client is experiencing a reaction to a medication. B) The client has decreased circulation due to heart failure. C) The client has a dementia and cannot make decisions. D) The client dresses to maintain an adequate internal temperature

Ans: D Older adults often report feeling cold, even in warm environments, and they generally prefer environmental temperatures that are at least 75°F. This choice of attire seems appropriate for the 60oF

6. A nurse orients a graduate nurse to a gerontology unit. Which of the following statements, if made by the graduate nurse, shows understanding of normal age-related changes of sleep patterns? A) Older adults need for 10% to 20% more sleep than younger adults. B) Older adults have fewer sleep cycles during the night. C) Older adults fall asleep faster and staying asleep longer than younger adults. D) Older adults spend less time in deep sleep.

Ans: D Older adults typically spend less time in deep sleep than do younger adults, though the overall quantity of sleep required remains fairly static throughout the adult life span. Older adults usually experience more sleep cycles during the night and experience longer sleep latency.

5. A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which of the following statements indicates that the nurse's teaching has been successful? A) "I will decrease the amount of time spent in foreplay before engaging in sexual intercourse." B) "I will avoid taking a warm bath before engaging in sexual activity." C) "I will avoid experimenting with different positions during sexual relations." D) "I will use a vibrator since my ability to massage is limited."

Ans: D People with arthritis will want to increase foreplay. Warm baths will decrease stiffness. People with arthritis should experiment with sexual positions for comfort and support. A vibrator may help if the ability to massage is limited for the person with arthritis

8. A 68-year-old client has a long history of poor eating habits and low activity levels. The client now has a diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions should be the priority? A) Adherence to diabetes screen protocols B) Education about the role that his lifestyle has played in his diagnosis C) Maintenance of function and activities of daily livings D) Self-care measures to aid in the management of his disease

Ans: D The care of older adults with diabetes should prioritize self-care measures such as diet, exercise, medications, and glucose monitoring. Screening is not relevant since the client has already been diagnosed with the disease in question. Education about lifestyle factors and maintenance of function are relevant and appropriate, but these are superseded by the importance of facilitating self-care

4. A community care nurse plans care for older adults as the fall season sets in a cooler weather starts. Which of the following clients is at greatest risk for development of hypothermia? A) Client who lives in an apartment building B) Client who sets the thermostat at 76°F year round C) Institutionalized older adult with cancer D) Older adult who has dementia and lives alone

Ans: D The client with dementia has multiple risks for hypothermia including loss of sensation, difficulty with decision, and living alone. Even in environmental temperatures of 68°F (20°C) an older person may become hypothermic, especially if other risk factors are present.

6. A gerontological nurse is aware of the changes in the structure and function of the skin and accessory glands that occur with aging. Which of the following changes is a normal accompaniment to the aging process? A) Thickening of collagen in the dermal layers of the skin B) Cessation of eccrine and apocrine sweat gland function C) Increase in the number of melanocytes in the epidermis D) Decrease in the vascular bed of the dermis

Ans: D The dermal vascular bed decreases by about one-third with increased age; this contributes to the atrophy and fibrosis of hair bulbs and sweat and sebaceous glands. However, sweat glands do not wholly stop functioning. Collagen tends to thin rather than thicken, and the number of melanocytes in the epidermis decreases.