Gerontology Nursing Resource Questions

Which of the following therapies would not be beneficial for an older adult client with Parkinson's disease (PD)? A. Range-of-motion (ROM) and balance exercises B. Adaptive equipment for eating and self-care C. Facial exercises and swallowing techniques D. Nonparticipation in activities as a result of slowed movements and tremors

D The expressionless face and slowed movements may give the impression of apathy, and the tremors may produce embarrassing moments. Looking beyond the disease to the person within and providing nursing interventions that enhance hope and promote the highest quality of life despite the disease are important. ROM exercises, walking, and balance work need to begin early in the course of PD. Occupational therapy can assist with adaptive equipment such as weighted utensils, nonslip dinnerware, and other self-care aids. Speech therapy is beneficial for dysarthria and dysphagia, and patients can be taught facial exercises and swallowing techniques.

The best gerontological nursing care is that in which A. nursing is provided in a judgmental manner. B. the goal of comfort is to lessen pain as much as possible. C. undertreatment of pain may be caused by a nurse's own definitions of pain. D. the key person in the assessment of pain is the nurse.

D The nurse is the key person in the assessment of the level of comfort in persons receiving care and is usually the most attuned to the needs of patients. The best care is given in a nonjudgmental manner. The goal of comfort is not to simply lessen pain, but it is also to relieve it and to prevent it from reoccurring. The reasons for undertreating pain include the nurse's own definition of pain and his or her expectations of how his or her own pain is expressed.

Your client has severe hearing loss, and you are finding it increasingly difficult to talk with him. During your visit, you spend time with him to discuss options to assist him with his hearing. Which of the following would not benefit your client? A. Hearing aids B. Personal listening systems C. Alerting devices D. Talking clocks, large print books, or software that converts text into artificial voice output

D These items would be more beneficial for a person with a vision problem. Hearing aids are a personal amplifying system that includes a microphone, an amplifier, and a loudspeaker. Many aids can be programmed to meet the specific needs of the client. Personal listening systems can be used to enhance face-to-face communication and to better understand speech in large rooms such as theaters. Alerting devices, such as vibrating alarm clocks that shake the bed or activate a flashing light, and sound lamps that respond with lights to sounds might be beneficial.

Which of the following statements is FALSE regarding caregivers of older adults? A. Family members provide for the majority of care for older adults. B. A daughter is usually the caregiver of her mother. C. Caregiving is considered a major public health issue. D. The use of paid, formal caregivers for older adults with disabilities has been increasing.

D Whereas the use of paid, formal caregivers for older adults with disabilities has been decreasing, the sole reliance of older adults on family caregivers has been increasing. Family members and other unpaid caregivers provide for the majority of the care for older adults in the United States. The most common caregiver arrangement is that of a daughter providing care to her mother. Middle-aged caregivers, known as the "sandwich generation," often struggle to balance the demands of work and parenting with the caregiving responsibilities for an older family member. Caregiving is considered a major public health issue across the globe, and attention to the physical and mental health of caregivers is receiving increased attention.

The Bill of Rights for long-term residents was created to protect the rights of the residents in nursing homes. Which of the following examples do not protect these rights? (select all that apply) A. Right to voice grievances B. Right to be free from abuse C. Right to have a say in their care and treatment D. Right to information about their health but not about their medications E. Right to be free from restraints F. Right to visitation from others except legal advisors, who must obtain permission from the nursing facility before visiting the older adult

D, F

Normal aging changes that would influence an older client's experience of pain would include all of the following EXCEPT A. decreased tactile sensation. B. delayed reaction time. C. degenerative spine conditions. D. increased sensitivity to pain. E. All of the above are normal aging changes that would influence an older client's experience of pain.

E A normal change with aging is decreased tactile sensation, especially at the periphery such as the fingertips. Delayed reaction time is also another normal aging change that can lead to severe injuries. Degenerative spinal conditions are also another cause of disability and pain in later life. There is an increase in sensitivity to pain that is caused by pressure and must be considered in the protection of skin and muscle

Sexuality and intimacy among older adults still plays an important part of their lives. All of the following demonstrate this EXCEPT A. new relationships. B. hugging. C. coitus. D. kissing. E. sexual disinhibition.

E Sexually inappropriate behaviors are often seen in individuals with dementia or as the result of an underlying physical problem. Older adults may want to have a new relationship to fill their need for love and intimacy. Hugging is a form of intimate expression that often meets the needs of older clients. Coitus is way of meeting intimacy needs in older adults. Kissing is a form of intimate expression.

When taking care of an older adult client, you realize when assessing his pain level that all of the following considerations would apply EXCEPT A. he might not be able to express pain. B. he might be depressed. C. sedation will affect how he expresses his pain. D. you will have to take his culture into consideration. E. because he is older, he does not feel pain as much.

E This statement is definitely not true. An older adult feels pain as much as a younger individual. Some older adults are only able to express pain in terms of "not feeling well." Some clients are controlled, and others are very vocal. Depression might mask expression, and the client might not complain of pain. Sedation affects how clients express their pain. They might not be able to express clearly their level of pain. Individuals respond to pain in a way that reflects their own cultural expectations.

You realize that your client's bladder functions are only slightly altered by the physiological changes of age. If an older person is experiencing urinary incontinence, you might expect A. a shortened warning time between the desire to void and actual micturition B. the first urge to void to occur at the mid bladder volume (250 to 350 mL) C. diarrhea to be the most common gastrointestinal complaint made to the health care provider D. constipation as a symptom of altered bladder function.

A Bladder changes are associated with aging and include a decreased capacity that affects the time between the desire to void and actual micturition, especially for a client with urinary incontinence. The first urge to void in an older adult occurs at a lower bladder volume (150 to 300 mL). Constipation is the most common gastrointestinal complaint made to the health care provider. Constipation is a symptom or reflection of poor habits, postponed passage of stool, and many chronic illnesses. It is

You suspect an older adult client is having trouble hearing what you say. It is important to first check for which one of the following interferences in hearing? A. Cerumen impaction B. Otosclerosis C. Presbycusis D. Tinnitus

A Cerumen impaction is the most common and easily corrected of all interferences in the hearing of older people. When hearing loss is suspected, checking for cerumen impaction as a possible cause is the first important step. Otosclerosis is an abnormal growth of bone of the middle ear that prevents the ossicles from properly working against the oval window, causing a hearing loss. Presbycusis is a form of sensorineural hearing loss that is related to aging. Bilateral and symmetrical sensorineural hearing loss also affects the ability to understand speech. Tinnitus has been caused by possible exposure to loud noises, head and neck trauma, tumors, jaw misalignment, or ototoxicity from medications.

When an older adult client complains of itching and pain and several days later show you a rash, you realize she has... A. herpes zoster B. actinic keratosis C. scabies D. skin cancer.

A Herpes zoster, or shingles, is a viral infection that occurs along a nerve pathway and is preceded by itching, tingling, or pain in the affected dermatome. Actinic keratosis is a precancerous lesion. Characterized by intense itching, particularly at night, scabies is a skin condition that is caused by a tiny burrowing mite. Cancer of the skin is the most common of all cancers with most of them being curable; melanoma is the exception.

An older adult client has a history of chronic obstructive pulmonary disease (COPD). Which of the following would you suggest to your client? A. Annual influenza immunizations B. Annual fecal tests C. Annual prostate-specific antigen (PSA) screening D. Limiting smoking to one pack per day

A Immunizations are recommended every year to help prevent respiratory complications of influenza, especially for those with COPD. Annual fecal tests detect microscopic blood in the feces and do not apply to the respiratory track. An annual PSA is performed to screen men for prostate cancer and would be more appropriate in the genitourinary or reproductive track. For someone with COPD, smoking should be completely eliminated.

During an assessment of an older adult, which of the following would the nurse see as a priority? A. Listening as key to an assessment B. Using the Kleinman and associates model C. Attempting to preserve helpful beliefs and practices D. Providing ongoing assistance to persons who are physically or mentally ill

A Listening is the key to any assessment. Actually hearing what the patient and family says sets a foundation on which to base an assessment. The model developed by Kleinman and associates helps health care professionals obtain basic information needed in a culturally sensitive manner. To do so, one must listen. Beliefs and practices need to be preserved whenever possible, and nurses should not attempt to change them. Listening to the beliefs of others is important to assist nurses when negotiating health, treatment, or prevention options. Ongoing assistance to persons who are physically and mentally ill requires ongoing assessments of which listening is paramount.

An older adult client reports pressure ulcers, anemia, hypotension, and recurrent urinary tract infections (UTIs). You suspect that this client is exhibiting which one of the following? A. Malnutrition B. Obesity C. Vitamin B12 deficiency D. Diverticulosis

A Malnutrition is defined as a state in which a deficiency, an excess, or an imbalance of energy, protein, and other nutrients causes adverse effects on body form, function, and clinical outcome. Malnutrition has serious consequences, including infections, pressure ulcers, anemia, hypotension, impaired cognition, hip fractures, and increased mortality and morbidity. Obesity in older adults is a paradox. For obese older adults who are 70 years of age or older, the mortality risk is lowest with a body mass index classified as overweight. Little evidence suggests that dieting in this age group confers any benefit. Vitamin B

Medicare is a big issue for the adults who depend on this medical insurance to pay for their hospital bills, medications, and rehabilitation. When talking to your older client about what Medicare will pay for and what it will not, you tell her or him that Medicare will not cover the cost of A. custodial care B. skilled care C. hospice care D. a semiprivate room.

A Medicare does not cover the cost of custodial care. Patients usually have to apply for Medicaid or pay out of pocket. Medicare covers skilled care at 100% for up to 20 days. Hospice care is provided by Medicare, provided that the eligibility requirements are met. Medicare only pays for semiprivate rooms.

Which one of the following statements about biological theories in aging is incorrect? A. Most theories can be proved. B. Each theory provides a clue to the aging process. C. Theories are useful as points of reference. D. A theory remains a reasonable explanation until someone finds it to be incorrect.

A Most theories cannot be proved nor disproved. Each theory provides a clue to the aging process in its own right. Theories are useful as points of reference to assist in research or understanding what is happening to clients. A theory is an explanation of some phenomenon that makes sense and thus is a reasonable explanation.

Nursing interventions designed to assist older adults or family members in attaining a healthy adjustment to a loss would include all the following EXCEPT A. rapidly establishing rapport. B. observing for functional disruption. C. assisting in the search for meaning. D. helping with the reorganization of the structure of life.

A Nursing interventions, especially when older adults are in crisis, begin with the gentle establishment of rapport. Nurses can look for functional disruption and offer support and direction. As grievers search for meaning, they may need help finding what they are looking for. As the older adult moves forward in adjusting to the loss, the nurse can help the person reorganize the structure of his or her life.

Which one of the following statements is not true about the dietary needs of older adults? A. Older adults need more calories because of their age and possible loss of weight B. Recommendations may need to be modified for the older adult with illness C. Dietary Approaches to Stop Hypertension (DASH) is a dietary plan designed to assist in the maintenance of weight and in the management of hypertension D. MyPlate for older adults includes icons for regular physical activity.

A Older adults do not need more calories because of their age. They generally require fewer calories because they may not be as active as they were during their younger years, and their metabolic rates have slowed down. Recommendations for nutrients and calories intake may need modification with illness. The DASH plan is an eating plan for those with hypertension. MyPlate is another highly recommended eating plan designed to assist older adults with maintaining optimal weight and managing hypertension.

Older persons with hypertension (HTN) have a higher risk for all the following events EXCEPT A. acute renal insufficiency. B. atrial fibrillation. C. heart failure. D. myocardial infarction (MI).

A Older adults with HTN are at risk for chronic, not acute, renal insufficiency. Atrial fibrillation might occur in people who have HTN. Heart failure, as well as acute cardiovascular and cerebrovascular events, can occur in people with HTN. Cardiovascular events, such as MIs, can occur as a result of HTN.

Loss of bone mineral density and structure describes which one of the following terms? A. Osteopenia B. Crepitus C. Bone mineral density D. Osteophyte

A Osteopenia is the loss of bone mineral density and structure at a mild to moderate level. Crepitus is the sound or feel of bone rubbing on bone. Bone mineral density is a measurement of the mineral content of the bones. Osteophyte is excessive bone growth.

__ is associated with increased health care costs, functional impairments, and disability. A. Obesity B. Malnutrition C. Dysphagia D. Aspiration

A Overweight and obesity are associated with increased health care costs, functional impairments, disability, chronic disease, and nursing home admission. Overweight and obese individuals are also at risk for malnutrition as a result of chronic illness or diets inadequate in appropriate nutrients. Malnutrition is a recognized geriatric syndrome and a serious challenge for health professionals in all settings. Dysphagia is a serious problem and has negative consequences, including weight loss, malnutrition, dehydration, aspiration pneumonia, and even death. Aspiration (the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract) is common in older adults with dysphagia and can lead to aspiration pneumonia.

An older adult client is talking to you about his Vietnam experiences and shares that he still has flashbacks to that time. While assessing him, you notice that he is jumpy, has startle reactions, and has poor concentration. You realize these are symptoms of which of the following? A. Posttraumatic stress disorder (PTSD) B. Obsessive-compulsive disorder (OCD) C. Delusions D. Hallucinations

A PTSD is a syndrome characterized by the development of symptoms after an extremely traumatic event. Symptoms include helplessness, flashbacks, intrusive thoughts, dreams, images, avoidance of any thoughts or situations that reminds the individual of the traumatic event, poor concentration, irritability, startle reactions, and numbing of emotional responses. OCD is characterized by recurrent and persistent thoughts, impulses, or images that are repetitive and purposeful and intentional urges of ritualistic behaviors that improve the comfort level. Delusions are beliefs that guide an individual's interpretation of events and help make sense out of disorder. Common delusions of older adults are of being poisoned, their children taking their assets, being held prisoner, or being deceived by a spouse or lover. Hallucinations are described as sensory perceptions of a nonexistent object. As an example, older adults with hearing and vision deficits may hear voices or see people who are not actually present.

The overriding goals in caring for older adults with dementia would include all of the following EXCEPT A. limit opportunities for interaction. B. structure the environment. C. maintain function. D. create a therapeutic milieu.

A Providing opportunities for interaction and caring communication, both verbal and nonverbal, are still important. Persons with dementia may understand more than is realized. Structuring the environment and relationships help maintain stability. Maintaining function helps prevent excess disability. Creating a therapeutic milieu nurtures the personhood of the individual and maintains a quality of life.

Your older adult client lost his wife of 65 years and is approaching their 66th wedding anniversary. You anticipate that he will go through "shadow grief," which can be defined as which one of the following? A. Grief that is often exacerbated on special dates B. A crisis C. Grief that cannot be publically acknowledged D. An effective coper

A Shadow grief is a type of lingering grief that resurfaces from time to time but does not persist; it produces temporary grief. Sights, smells, or sounds can trigger shadow grief. Acute grief is a crisis and has a definitive syndrome of somatic and psychological symptoms. Disenfranchised grief is experienced by persons whose losses cannot be openly acknowledged or publicly mourned because they might be socially disallowed or unsupported. Effective copers are those who can acknowledge the loss and try to make sense of it.

Many different sources are used to evaluate older adults. Which one of the following offers a simple and overall assessment tool that provides reliable and valid information when used with persons later in life? A. Fulmer SPICES B. Older Adult Resources Scale (OARS) instrument C. Katz index of independence in activities of daily living (ADLs) D. Barthel index

A The Fulmer SPICES (sleep problems, problems with eating and sleeping, incontinence, confusion, evidence of falling, and skin breakdown) is a simple and overall assessment tool of older adults. This system alerts the nurse of the most common problems that occur in the health and well-being of older adults. The OARS was designed to evaluate ability, disability, and the capacity level at which a person is able to function. It includes five subscales that can be separately used. The Katz index serves as a basic framework for most of the measures of ADLs. The Barthel index is commonly used in rehabilitation settings to measure the amount of physical assistance required when a person can no longer carry out his or her ADLs.

With which one of the following theoretical frameworks is living with a chronic illness viewed as an integral part of their lives rather than an isolated event? A. The chronic illness trajectory model B. The return to wellness perspective model C. The shifting perspectives model of chronic illness D. The dual-kingdom model

A The chronic illness trajectory model states that chronic illness can be viewed from a life course perspective or along a trajectory and can be viewed as an integral part of an individual's life rather than an isolated event. The return to wellness perspective model is part of the shifting perspectives model of chronic illness and calls for a shift from illness to wellness as an active process. The shifting perspectives model of chronic illness views living with chronic illness as an ongoing, continually shifting process during which the person moves between the perspectives of wellness in the foreground or illness in the foreground. The dual-kingdom model is part of the phrase "dual kingdoms of the well and sick" and refers to chronic illnesses that contain elements of both illness and wellness.

As a nurse contemplating a future in gerontological nursing, you might plan on achieving a master's degree and becoming one of the following EXCEPT A. geriatric nurse generalist B. gerontological nurse practitioner (GNP) C. advanced practice registered nurse (APRN) with gerontological certification D. gerontological clinical nurse specialist (GCNS).

A The geriatric nurse generalist functions in a variety of settings, from primary care to the community, and involves the individuals and their families. This certification does not require a master's or bachelor's degree. The GNP has earned a master's degree, performs all the functions of the generalist and has developed advanced clinical expertise. APRNs are educated, certified, and licensed solely within a specialty area, one of which is the adult gerontology nurse practitioner, which includes young adult to older adult. The GCNS focus is skilled nursing facilities that manage complex care of frail older adults.

The concept of balance, chi, and disturbances in balance that result in disharmony and illness are examples that demonstrate what type of health system? A. Naturalistic B. Personalistic C. Western D. Magic oreligious

A The naturalistic or holistic health system is based on the concept of balance with its origin from the ancient civilizations of China, India, and Greece. Health is viewed as a sign of balance. Disturbances in this balance result in disharmony and illness. The personalistic health system believes that actions of the supernatural cause illness. The Western or biomedical health system is believed to be the result of abnormalities in the structure and function of body organs and systems. The magico religious health system is similar to the personalistic system and views health as a blessing or reward from God.

As a nurse, you understand that several specific types of disorders fall under the umbrella of chronic obstructive pulmonary disease (COPD). After assessing an older adult client who has been diagnosed with COPD, you note that his skin color is pink and that he has little sputum production. As a result, you determine that he has which one of the following disorders? A. Emphysema B. Bronchitis C. Asthma D. Pneumonia

A With emphysema, the client has little sputum production, and his skin color appears pink because he is actually able to get enough oxygen. Individuals with bronchitis have chronic sputum production and a frequent cough, and they are pale and somewhat cyanotic. Clients with asthma often have difficulty exhaling, which results in wheezing that can be heard with a stethoscope or audibly. With pneumonia, symptoms include cough, fatigue, and dyspnea. An older adult may also experience falling, mental status changes or signs of confusion, general deterioration, weakness, anorexia, rapid pulse rate, and rapid respirations rate.

As a nurse taking care of an older adult who is facing surgery in the near future, you notice that she is withdrawn and talks about missing her church family and pastor who are in another town. Which of the following nursing actions might you take? (select all that apply) A. Ask her permission to call her pastor to request a visit and to notify her church friends. B. Ask if you could call the hospital's clergy representative to come and visit her. C. Tell her that the physician is the best in his field and that she has nothing to worry about.Spend some time with her, holding her hand, and let her talk about her church family. D. Call her family members and let them know that she is in anguish and would better survive surgery if she were able to see her pastor and some church family members. E. Take her hand and ask her to pray with you.

A, B, C

Healthy People 2020 has identified emerging issues and recommendations for the aging baby boomers and those in between. Which of the following are Healthy People 2020's recommendations? (select all that apply) A. Coordinate care. B. Establish quantity measures. C. Research and analyze appropriate training to equip providers. D. Identify minimum levels of training for people who care for older adults.

A, B, C As individuals age and require more medical and social care, coordination of that care is essential to a healthy lifestyle. Analyzing research into the appropriate care of older adults is an important goal for maintaining their health. Training of individuals taking care of older adults is essential in assisting them to maintain their goal of a healthy lifestyle. One would want to establish quality measurements to establish goals of healthy living.

While taking care of an older adult client, you recognize that he has health behaviors that place him at risk for a chronic disorder. They would include which of the following? (Select all that apply) A. He smokes 1½ pack of cigarettes a day. B. He is overweight. C. His everyday exercise consists of going out to get the mail and newspaper. D. He receives Meals on Wheels 3 days a week. E. He has access to public transportation to his physician's office every month. F. His daughter packs and freezes food low in sugar and fats on a weekly basis.

A, B, C Tobacco use is one of four modifiable health risk factors. Education on the benefits of quitting smoking needs to be instituted. Overeating and being overweight is a chronic condition that can lead to diabetes mellitus, elevated blood pressure, heart disorders, and other chronic illnesses. A lack of physical activity is another health risk behavior to be aware of. Suggestions to walk around the block daily or walk in the mall when it is hot or freezing cold might help postpone and reduce morbidity. Poor nutrition is a modifiable risk factor; however, poor nutrition is minimized with Meals on Wheels delivering a hot noon-day meal and a snack for the next morning. The ability to see his physician on a monthly basis will assist in preventing a chronic disorder. Frozen meals put together by his daughter for the evenings and weekends also demonstrate that his nutritional needs are being met, which will help prevent chronic disorders.

After working with the older adults, you know that which of the following skin problems are common? (Select all that apply) A. Xerosis B. Pruritus C. Seborrheic keratosis D. Pressure ulcers E. Eschar F. Hyperemia

A, B, C Xerosis is extremely dry, cracked, and itchy skin and is the most common skin problem experienced by older adults. Pruritus, or itchy skin, is a consequence of xerosis. It is a symptom, not a diagnosis, of disease. Seborrheic keratosis is a benign growth that appears mainly on the trunk, face, neck, and scalp as single or multiple lesions. Pressure ulcers are an injury to the skin or underlying tissue, resulting from pressure or in combination with shearing, usually over a bony prominence. A pressure ulcer is not a common skin problem and can be prevented. Eschar is black, dried, dead tissue. Again, eschar not a common problem and can be prevented. Hyperemia is redness in a part of the body caused by increased blood flow, such as in an area of infection.

You know your client has reached a state of wellness when (select all that apply) A. as a 91-year-old, he still enjoys going out to dinner and dancing. B. he bowls every week with his friends. C. he still likes to go with his wife to the grocery store, although he has hip pain and uses a walker. D. he continues to eat his green, leafy vegetables while taking Coumadin. E. he says to you, "I have smoked all my life, and I am not going to stop now." F. he says, "I am a devout Christian and believe that my God is with me always. I am not afraid of dying."

A, B, C, D

As a nurse taking care of an older adult with pre-diabetes, you need to teach her which of the following? (select all that apply) A. Smoking cessation B. Keeping the fasting blood sugar (FBS) below 126 mg/dL C. Keeping the low-density lipoprotein (LDL) level below 100 mg/dL D. Maintaining her blood pressure (BP) at 130/80 mm Hg or less E. Keeping the triglyceride level above 150 mg/dL F. Maintaining a cholesterol level above 200 mg/dL

A, B, C, D Cessation of smoking is essential to a healthy individual, regardless of his or her condition. An FBS level less than 126 mg/dL helps keep the risk for diabetes and heart disease low. An LDL level less than 200 mg/dL also helps keep the client healthy. A BP reading equal to or less than 130/80 mm Hg helps prevent cardiac problems. Triglyceride levels need to be kept less than 150 mg/dL. Cholesterol levels should be less than 200 mg/dL.

Across the country, temperatures are in the high 90s to low 100s °F, and your client has no air conditioning. You know that hyperthermia can result because of the elevated temperatures. Which of the following tips to prevent hyperthermia should you tell your elderly client? (select all that apply) A. Drink plenty of fluids B. Avoid alcohol C. Use cool or tepid water D. Minimize exertion. E. Wear cool clothing such as silk or polyester.

A, B, C, D Drink 2 to 3 L of cool fluid daily to maintain hydration. Avoid alcohol to prevent dehydration. Take tepid baths or showers or apply cold wet compresses or immerse the hands and feet in cool water. It will help one cool down. Minimize exertion, especially during the warmest times of the day. This prevents sweating and dehydration. Wear hats and loose clothing made of natural fibers when outside; remove most clothing when indoors. Silks and polyester retain heat.

An older adult client has been admitted to a skilled nursing facility. Which of the following circumstances can be caused by physical restraints? (Select all the apply) A. Death B. Pressure ulcers C. Nosocomial infections D. Agitation E. Halitosis

A, B, C, D Physical restraints may actually exacerbate many of the problems for which they are used and can cause serious injury and death. Individuals in restraints, who do not often move or are not turned as often as they should be, develop pressure ulcers. When in restraints, an older adult is susceptible to pneumonia, which is a nosocomial infection. The client does not move around or turn, and the pulmonary secretions sit and become a breading site for bacteria. Many times when older adult clients are placed in restraints, their anxiety level reaches a new high. They tend to become more agitated and restless. Clients with dementia experience high anxiety levels even more so. Clients in restraints do not have an increase of orientation because of restraints. Therefore, they might become more agitated and hostile, but their orientation levels actually decrease. Halitosis is bad breath and is not an injury; it is simply a sign that the patient is not receiving good oral care by the nursing staff.

Factors that influence the aging experience include (select all that apply) A. Retirement B. Grandchildren C. Chronic Illness D. Lack of medical care E. Quality of life

A, B, C, D, E Retirement could mean a loss of income or influence and either can affect how one lives. Grandchildren usually have a positive effect on the older individual and help to give purpose to the aging experience. Chronic illnesses influence the aging experience with hospitalizations and often homebound situations. Lack of medical care can lead to chronic illnesses, leading to spiraling downward health. The better the lifestyle, the better the aging experience. Having less to worry about and deal with lead to less depression and anxiety.

In visiting with an older adult client in his home, you see that he has more medications left in his bottles than he should have if he were taking them as instructed. You also note that his glasses are on the side table and broken. After calling to have his glasses fixed, you discuss with your client about asking the pharmacy to... (select all that apply) A. use a larger font for the instructions on the front of the bottles to ensure that he can more easily read the instructions with his new glasses. B. use color-coded tops on the medication bottles to assist him in determining what times to take the medications or to help him determine which medications are in each bottle. C. place his medications in a daily and weekly medication pack to make it easier in determining what medications to take at what time. D. use easy-to-open cap tops on his bottles for easy opening E. make a weekly calendar with medication pockets.

A, B, C, E A larger font would make it easier for the client to read the instruction even without glasses. New glasses would also make reading the instructions easier. In addition, pictures of the medications would be beneficial. Color-coded tops on the medication bottles eliminate the need to read the names of the medications on the bottles. However, the client should always be encouraged to read the medication names. Daily and weekly medication packs would reduce the pressure of having to remember what medications to take and when. It would also solve the problem of trying to decipher medication instructions and would give the patient, family members, pharmacist, and nurse a visual on how the client is taking his medications. Weekly calendars with pockets for medications that indicate the day, time, and date can be used. Clear envelopes or sandwich bags containing the medication can be affixed to the dated square on a daily basis. Using easy-to-open cap tops on medication bottles will not necessarily help if the client cannot read the instructions. However, if the client has arthritis, then easy-to-open caps would be necessary.

When assessing your patient who has a history of falls, you should pay particular attention to which of the following? (Select all that apply) A. Orthostatic hypotension B. Vision C. Cognitive disorders D. Preprandial hypotension E. Hearing F. Antibiotics

A, B, C, E Clinically significant orthostatic hypotension is a common clinical finding in frail older adults that can lead to falls. Poor visual acuity, reduced contrast sensitivity, decreased visual field, cataracts, and use of nonmiotic glaucoma medications have all been associated with falls. The presence of neurocognitive disorders, such as dementia and delirium, increases risk for falls Hearing ability is also directly related to fall risk. For someone with only a mild hearing loss, there is a threefold increased chance of having falls. Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide, causing lightheadedness and falls. Medications implicated in increasing fall risk include psychotropics, opioids, antiarrhythmics, digoxin, antihypertensives, and diuretics but not antibiotics.

As a nurse caring for a cognitively impaired older adult client, you need to observe for which of the following? (select all that apply) A. Increased confusion B. Agitation C. Aggression D. Decreased passivity E. Pointing to a grimacing face or crying F. Staring off into space

A, B, C, E For those with dementia who are no longer able to express themselves verbally, communication of pain usually occurs through changes in behavior such as increased confusion. A change in behavior would include agitation. Another change in behavior is aggression. Pointing to a grimacing face or crying are overt signs that a client is in distress. Older adult clients might become more passive, and the signal of pain might go unnoticed. Staring off into space is not a usual occurrence for an older adult. Rather, it could mean overmedication or another neurologic problem.

Hypothermia is a medical emergency defined as a core temperature less than 95°F. Which of the following tips to prevent hypothermia should you tell your elderly client? (Select all that apply) A. Use a head covering B. Eat high-protein meals C. Use absorbent incontinent pads D. Use your comfort level to set the thermostat E. Layer clothing and bed clothes.

A, B, C, E Provide a head covering whenever possible—in bed, out of bed, and particularly outdoors. It helps to hold in the core heat generated by the body. Provide hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. Use absorbent pads for incontinent patients rather than allowing urine to wet large areas of clothing, sheets, and bedcovers, which turn cold within minutes. Layer clothing and bedcovers for best insulation. Be careful not to judge your patient's needs by how you feel and maintain a comfortably warm ambient temperature no lower than 65°F. Many frail older adults require much higher temperatures.

Widowhood is a stage in life that can be anticipated but seldom is. Which of the following statements best defines widowhood? (select all that apply) A. The death of a partner is a loss of self. B. A core part of oneself dies with the partner. C. A widow still misses her or his "other half" even years later. D. Individuals who have been self-confident seem to lose some of their confidence. E. One's identity is confirmed. F. Mourning is also for oneself.

A, B, C, F

Pain can be which of the following? A. Acute B. Idiopathic C. Nociceptive D. Pathologic E. Adjuvant F. Persistent

A, B, C, F Pain is either acute or persistent and is otherwise known as chronic. Acute physical pain is temporary and includes postoperative, procedural, and traumatic pain. Pain is idiopathic. Although a causative factor might not be found, the client can and does still experience pain. Pain is nociceptive and is caused when special nerve endings—called nociceptors—are irritated. Persistent or chronic pain is moderate to severe and present in approximately 50% of those older than 65 years of age. The most common persistent pain is noncancerous and musculoskeletal in nature and is from arthritis and degenerative spinal conditions. Pathologic pain is first classified as that which is related to cancerous or noncancerous conditions. Adjuvant is a drug that has a primary use other than for pain, but it is also used to enhance the effects of traditional pain medication.

A patient care assistant has been assigned to feed your client with dysphagia. Which of the following instructions would you give the assistant? (select all that apply) A. Have the client sit at 90 degrees during all of oral intake B. Alternate solid and liquid boluses C. Avoid rushing the client or force feeding her D. If facial weakness is present, place food on the impaired side of the mouth E. Keep pulse oximeter ready at all times F. Stroke under the chin in a downward motion.

A, B, C, F Sitting at 90 degrees allows clients to swallow their food correctly and helps prevent regurgitation and aspiration. By giving liquid boluses between solid bites, the throat remains moist, making it easier for the client to swallow. Avoid rushing clients; allow them time to chew and savor their food and then to swallow. This allows the oral enzymes to begin the digestive process of the food. Stroking downward under the chin initiates the swallow reflex. If facial weakness if present, place food on the unimpaired side of the mouth. Suction equipment is kept at bedside in case of aspiration. A pulse oximeter will not help remove food particles.

You understand from an older adult client that he experienced a TIA last week. You realize that he would benefit from some education on how to prevent another TIA or stroke. You instruct him in which of the following? (select all that apply) A. Stop smoking. B. Maintain blood pressure at levels equal to or less than 130/85 mm Hg. C. Initiate an exercise program. D. Immediately stop all aspirin. E. Monitor for skin breakdown. F. Maintain control of diabetes.

A, B, C, F Smoking cessation is, first and foremost, the most important strategy to modify the risk factors for a TIA or stroke. Reducing both the systolic and diastolic blood pressure as little as 5 mm Hg reduces the risk of death from a stroke. Regular exercise and weight management programs have been found to be helpful in preventing strokes. Strict control of blood pressure and diabetes is an important factor that both the person and the nurse can influence to reduce the risk for any one person to suffer from a stroke. Aspirin therapy daily is recommended unless contraindicated. Monitoring for skin breakdown is a complication for which nurses should be observant.

When assessing an older client, what are the specific areas to look for that might put your patient at risk for changes in their fluid balance? (Select all that apply) A. Age-related changes B. Medication use C. Nonfunctional impairments D. Emotional illnesses

A, B, D Age-related changes such as arthritis or Parkinson disease possibly hinder older adults from hold a cup for drinking purposes, leading to a lowered fluid intake, which might lead to dehydration. Taking multiple medications causes diuresis, which can cause dehydration. Emotional illnesses might cause clients to forget to drink fluids or think they have already done so. Functional impairments such as using a wheelchair or an inability to get out of bed might lead to an inability to reach a cup with fluid or the sink for water.

Following the chronic illness trajectory, as a nurse, you would (select all that apply) A. assist with advanced care planning. B. assist the client to gain greater control. C. assist the client in making longitudinal lifestyle changes. D. assist the client who is in a downward trajectory.

A, B, D Following the chronic illness trajectory, you would assist with advance care planning to assure the client's wishes are met. You would assist a client who is in an unstable phase to gain greater control over symptoms that are interfering with his or her ability to carry out everyday activities. You would assist a client who is in a downward trajectory to be able to maintain sense of self and receive expert palliative care. Last, you would assist the client in making the attitudinal and lifestyle changes that are needed to promote health and prevent disease.

You are visiting your elderly client in his son's home. You note that he has lost 10 lb since your visit last month. Your client assures you he is eating three meals per day. Concerned about neglect or abuse, you quietly perform a history and physical assessment. Which of the following observations supports your concern? (select all that apply) A. An unusual amount of anxiety B. Missed doctor's appointments C. The elder answers your questions freely even with the caregiver present D. Some unexplained bruising and two lacerations E. A lack of grooming F. The client is dressed appropriately

A, B, D, E Fear or an unusual amount of anxiety related to either routine or necessary examination of the nongenital area is one sign of physical abuse or sexual abuse. Repeated missed appointments without reasonable explanations could be a sign of neglect or abuse. Unexplained bruising or lacerations in unusual areas in various stages of healing usually found hidden under clothing is a sign of physical abuse. Uncharacteristically neglected grooming is common with neglect. A sign of physical abuse is when a caregiver does all of the talking in a situation even though the elder is capable or the caregiver appears angry, frustrated, or indifferent while the elder appears hesitant or frightened. Inappropriate clothing for the situation or weather is sign of abuse and neglect.

An older adult client has been experiencing some problems with urinary incontinence. You suggest that she document which of the following in a "bladder and voiding diary"? (Select all that apply) A. Character of the urine B. Difficulty starting or stopping the urinary stream C. Whether she had a bowel movement at the same time D. Ability to reach a toilet and use it E. Whether she is constipated F. Finger dexterity

A, B, D, F Documentation of the character of the urine should include its color and odor, as well as the presence of sediment, or whether the urine is clear. If the urine has a foul odor or cloudy color or if sediment is present in the urine, then the client might have a urinary tract infection. If the client is experiencing any difficulty starting or stopping the urinary stream, then the difficulty needs to be documented. If the client is unable to reach the toilet and use it, a functional issue that has an easy fix should be documented. Is the client able to manipulate her or his clothing to the bathroom? Are too many buttons or a zipper present that, with the patient's arthritis, reduces her or his finger dexterity? Documentation of a bowel movement will not help establish a bladder pattern or issue. Constipation is a gastrointestinal problem and does not affect the genitourinary system and voiding unless a prolapsed colon exists.

The children of an older adult have petitioned the courts to have their father declared incapacitated, at which time an agency or individuals will be appointed to (select all that apply) A. control and manage his personal affairs B. manage him individually because he is unable to do so C. meet with the client and work out a plan of care. D. act as a proxy to make medical decisions E. control and manage his financial affairs F. act as the judge's assistants in determining competence.

A, B, E A conservator is appointed specifically to control the personal affairs of the older adult. A guardian is appointed to be responsible for the individual person. A conservator is appointed specifically to control the financial affairs of the individual declared to be incompetent. Neither the conservator nor the guardian will probably meet with the client because he has been declared incapacitated and cannot provide care or make decisions for himself. A proxy, or health care surrogate, is chosen by the client, not by the courts. A guardian is appointed by the courts to be responsible for the individual person. The conservator or guardian is appointed by the judge to ensure that the client's best interests are met. Incompetency has already been proven.

An older adult client has been married for 60 years. Considering today's statistics, you realize that (select all that apply) A. women older than the age of 65 years are three times more likely to be widowed than are men. B. marital status is positively related to good health. C. widowed women have multiple opportunities to remarry. D. the needs, tasks, and expectations are the same as those of earlier years. E. families provide the majority of care. F. many grandparents assume parental roles.

A, B, E, F Women older than 65 years of age are three times as likely to be widowed than are men of the same age. Marital status is positively related to health, life satisfaction, and well-being. Families provide the majority of care for older adults. Many grandparents assume parental roles for their grandchildren if their own children are unable to care for them. Men who survive their spouses have multiple opportunities to remarry; women are less likely to have an opportunity to remarry in later life. The needs, tasks, and expectations of couples in later life differ from those in earlier years.

You have read that your older adult client has a history of thyroid disease. After assessing him, you realize he has signs of hyperthyroidism and note which of the following symptoms? (select all that apply) A. Atrial fibrillation B. Muscle weakness C. Slowed thinking D. Heat intolerance E. Diarrhea F. Anorexia

A, B, F Atrial fibrillation, or feelings of a fluttering heart rate, is a symptom of hyperthyroidism. Muscle weakness is another sign of hyperthyroidism. Anorexia is also a sign of hyperthyroidism. Slowed thinking is a symptom of hypothyroidism. Heat intolerance is another sign of hypothyroidism. Individuals with hyperthyroidism usually complain of constipation.

An older adult client has chosen his daughter to act as his attorney in fact. You know that she... (select all that apply) A. has the right to make financial decisions in defined circumstances B. has the right and responsibility to make health-related decisions C. was chosen to act on his behalf D. realizes that as long as her father retains his abilities, he can make his own decisions E. has been chosen by the courts and not by her father F. knows that this legal designation is the most restrictive.

A, C, D An attorney in fact usually has the right to make financial decisions and pay bills, among other rights, in defined circumstances, but an attorney in fact cannot to make decisions related to health care. The attorney in fact was chosen by her father to act on his behalf when he becomes unable to do so for himself. The attorney in fact realizes that as long as the older adult retains his abilities, he or she can make his or her own decisions. In this particular case, her father can continue to make his own decisions. Only a durable power of attorney (POA), also known as a health care surrogate or proxy, is able to make health-related decisions for persons when they are unable to do so themselves. A durable POA has been chosen by the client and not the courts. A durable POA is the least restrictive designation and the most likely person to ensure that the wishes of the client are followed.

As the nurse caring for an older adult client, you realize that your documentation is essential for communication from one shift to the other to ensure continuity of care. When providing documentation on your client, what would you include? (select all that apply) A. Mr. H. states that he "has not had a bowel movement in 3 days." B. Dr. M. says that Ms. C. needs digoxin 0.125 mg by mouth every day at 5 PM C. Mrs. C. has a 3-cm laceration on her lateral anterior antecubital space D. Mr. Q. was transported to the x-ray department at 3 PM by stretcher with oxygen via nasal cannula at 2 L/min. The client denies any pain or shortness of breath E. Mr. H. states that he is happy with his care and his physician F. Mr. Q. relates that he does not understand why the pain medication you give him works and the one given by the night nurse does not.

A, C, D Whenever a patient states a problem, it needs to be documented within quotations. Documenting an injury and its site, size, and location is essential for others to know where the injury is and to be able to judge whether the injury is improving (e.g., reduction in size). Whenever clients leave the unit, when they left, how they were transported, where they were going, and what equipment they had with them should be documented. In addition, documenting the condition of the client is a good idea. Dr. M. gave a medication order that goes on the physician's order sheet or in the electronic medication administration record. It does not get written in the nurse's notes. This information should also be passed to the next shift during the shift report. In addition, Dr. M. should write the order himself. Mr. H.'s statement that he is happy is nice to know; however, unless other negative legal issues are at stake, it does not require documentation. This scenario may be evidence of possible drug abuse by a fellow nurse and needs to be reported to the nurse manager. It does not get documented in the nurse's notes.

An older adult client's family has made the difficult decision to place him in a nursing home. You discuss with the family about person-centered care and explain that this care (select all that apply) A. fosters abilities. B. focuses on the disease. C. enhances quality of life. D. offers hope. E. supports limitations. F. maintains quality of life.

A, C, D, E

Typically, when discussing the topic of suicide, the discussion is targeted to younger or middle-aged adults. However, older adults actually account for 20% of the suicide deaths in the United States. When assessing an older adult client, you believe that suicide might be his intent. Which of the following questions should you ask? (Select all that apply) A. "Have you ever thought about killing yourself?" B. "Why do you think you will not be around much longer?" C. "How often have you had these thoughts?" D. "How would you kill yourself if you decided to do it?" E. "Do you have the implement to kill yourself?" F. "Have you thought of those who love you?"

A, C, D, E If the suspicion exists that an older adult is suicidal, then use direct and straightforward questions such as, "Have you ever thought about killing yourself?" Asking how often one has had thoughts of suicide is direct and straightforward and will give you a clear answer. Many times, those who intend to commit suicide have already decided how they are going to kill themselves. Being direct in this line of questioning encourages the client to discuss her or his suicidal intentions with you. Knowing whether the client has the implement to kill him- or herself will give you a good idea of his or her intent of suicide. This question does not directly ask a question about suicide. Attempting to place the client on a guilt trip is not directly addressing the issue of suicide.

As a nurse caring for clients, how do you see yourself advancing the care of older adults, which is so essential now and in the future? (select all that apply) A. Enhancing interest and recruitment B. Combating the consistent sense of apathy concerning the significance of nursing role models of care for older adults C. Being a positive role model D. Demonstrating a deep commitment in caring for the older adult E. Promoting ageism F. Preparing for geriatric nursing in a school setting

A, C, D, F Stimulating the interest in caring for older adults will increase the recruitment of new nurses. Having a positive outlook when caring for older adults will help demonstrate the importance of caring for older adults to both peers and new students. Avoiding negative remarks and ageism maintains positive outlooks and attitudes. Demonstrating a deep commitment to older adults helps encourage the advancement of caring for older adults. Preparing for geriatric nursing in a school setting is imperative in setting a foundation for caring for older individuals. Appreciating the significant contribution of a nursing model of care to the well-being of older adults is often a motivating factor that draws nurses to this specialty. Promoting ageism will have a negative impact and will not advance the care of older adults.

Your client has perceptual disturbances and misinterpretations of reality. When providing care for her, you learn that she does not like bathing. When approached, she screams at you and strikes out. Which of the suggestions below might make her more comfortable? (select all that apply) A. Playing background music B. Using bathing terminology C. Singing to her D. Washing her hair first E. Keeping the room warm and low lit F. Bathing the least sensitive areas first

A, C, E, F The use of music and other sound stimulation can contribute to improved health and well-being. Singing familiar songs has been shown to enhance the expression of positive moods and emotions, increase the mutuality of communication, and reduce aggression and resistive care behaviors. Having the room ready, warm, and well lit and providing a large towel or blanket preserves dignity and keeps the client warm. Begin bathing the least sensitive areas first—the legs and feet first followed by the arms, trunk, perineum area, and face last. Avoid using bathroom and bathing terminology to create a more positive atmosphere. Wash the hair last or at a separate time.

Individuals who are 100 to 109 years of age are known as A. Centenarians B. Supercentenarians C. those in between D. baby boomers

A. Centenarians Centenarians are those who are between the ages of 100 and 109 years of age, with the majority between 100 and 104 years of age. Supercentenarians are the elite who are 110 years of age or older. Those in between are born between 1915 and 1945—between baby boomers and centenarians—usually between 70 and 99 years of age. Baby boomers are the youngest of the "older generation"—born between 1946 and 1964.

When discussing with an older adult client his psychiatric care, he says to you, "When I was growing up, I was taught to accept my lot in life and not to complain. I am proud of the fact that, despite my issues, I can still function independently. I do not want to be just put away." Of the factors that influence mental health care, you realize that this client is demonstrating an example of which one of the following? A. Settings of care B. Attitudes and beliefs C. Cultural and ethnic disparities D. Anxiety disorder

B

You realize your client does not understand her diagnosis of osteoporosis when she makes which one of the following statements? A. "I have removed all the throw rugs in my house so I will not trip and fall." B. "I am going to have to quit smoking sometime." C. "I have signed up at the YMCA to do water exercises twice a week." D. "I have asked my son to put grab bars in my bathtub and handrails in the hallway."

B

You, as a nurse, have been working with an older adult client who is starting a new medication. Over the past 2 to 3 days, you notice that that he has become confused and lethargic, more so than in the past. You suspect that he is experiencing A. polypharmacy B. an adverse drug reaction (ADR) C. chronopharmacology D. misuse of drugs.

B An older adult client is experiencing an unwanted pharmacological effect. ADRs can occur when a client starts taking a drug dose that is inappropriately high or one that necessitates laboratory monitoring.

When established in 1935, what effect did Social Security have by setting the retirement age at 65 years? A. It allowed older persons to work until they made the decision to stop B. It set a time frame to describe someone as being old. C. It made it mandatory for all individuals to retire at 65 years of age. D. It made everyone realize that they could quit work at 65 years of age and live comfortably on the benefits.

B By setting 65 years of age as the time to collect benefits, Social Security set the tone of when one became "old." Older persons have always had the option to work until they decide to stop. Employers decide who is let go and who stays. Although a person can retire and collect Social Security benefits at 65 years of age, one does not have to collect the benefits or stop working. The benefits from Social Security were meant to act as a supplement to retirement accounts and savings. It was not meant to be a sole source of income. One cannot comfortably live on Social Security income only.

To prevent malnutrition in older clients with dementia, all of the following would benefit your client EXCEPT A. optimal social supports B. caloric supplements with the meals C. providing feeding assistance D. making refreshment stations readily available.

B Caloric supplements, if used, should be administered at least 1 hour before meals, or they will interfere with meal intake. Dispensing a small amount of calorically dense oral nutritional supplement (2 calories/mL) during the routine medication pass may have a greater effect on weight gain. Clients with dementia have a tendency to eat more when in a social setting. Cafeteria-style service, home-like dining rooms, music, touch, and kitchens on the unit are a few social avenues. Often clients with dementia get to the point where using utensils is beyond them. Using finger foods or visually appealing pureed foods with texture is beneficial. Easy access to juices, water, and healthy snacks during the day will help with hydration and extra calories.

An older adult client has the following symptoms: disturbances in attention and awareness, changes in cognition, and delusional thoughts and behavior. You have watched these symptoms develop over the past couple of days. Considering what you know about cognitive impairment, you realize your client is experiencing which one of the following conditions? A. Dementia B. Delirium C. Lowered stress threshold D. Normal-pressure hydrocephalus

B Delirium develops over a short period, and symptoms include disturbances in attention and awareness and changes in cognition. Perceptual disturbances are often accompanied by delusional thoughts and behavior. Dementia typically has a gradual onset and a slow, steady pattern of decline without alterations in consciousness. The lowered stress threshold model was one of the first models used to plan and evaluate care for people with neurocognitive disorders in every setting. Normal-pressure hydrocephalus causes a type of dementia that is characterized by an ataxic gait, incontinence, and memory impairment.

Which of the following social determinates does not play a part in influencing levels of chronic illness? A. Education B. Delirium C. Language barriers D. Socially disadvantaged

B Delirium is an acute problem. Clients with dementia often not be able to convey any ongoing symptoms they might be having. Clients with a higher education often have access to better health care, therefore lessening their chances of having chronic illnesses. Language barriers, reduced access to health care, historically low economic status, and differing cultural norms can be major challenges to promoting health in an increasingly diverse older population Vulnerable and socially disadvantaged people of any age get sicker and die sooner as a result of chronic illness than others.

You are taking care of an older adult with severe cognitive impairments. She is unable to tell you when she needs to urinate and, as a result, is often incontinent. You realize that she is experiencing A. stress incontinence B. functional incontinence C. urge incontinence D. postvoid residual.

B Functional incontinence refers to a situation in which the lower urinary tract is intact but the individual is unable to reach the toilet because of environmental barriers, physical limitations, or severe cognitive impairment. Stress incontinence is defined as an involuntary loss of less than 50 mL of urine associated with activities that increase intra-abdominal pressure. Urge incontinence is an involuntary loss of urine that occurs soon after feeling an urgent need to void. Postvoid residual is the amount of urine left in the bladder after the individual has urinated.

As a nursing student who is interested in furthering his or her education in gerontological nursing, which of the following would be beneficial? A. Advancing Care Excellence for Seniors (ACES) B. Hartford Institute for Geriatric Nursing (HIGN) C. Geriatric Nursing Education Consortium (GNEC) D. Hartford Geriatric Nursing Initiative (HGNI)

B HIGN offers predoctoral and postdoctoral scholarships for study and research in geriatric nursing. The ACES is a 3-year grant that fosters gerontological nursing education in prelicensure programs for faculty education. The GNEC is educational curriculum and includes evidenced-based modules for senior level undergraduate level nursing courses. The HGNI prepares professional nurses to play leadership roles in improving the health of older adults. Obtaining a scholarship to attend school would be more beneficial.

Pressure ulcers are defined as an injury to the skin or underlying tissue resulting from pressure or in combination with shear, usually over a bony prominence. To prevent pressure ulcers, you know that you must perform all the following EXCEPT A. turn immobile clients every 2 hours off bony prominences B. keep the skin moist C. use lift or draw sheets to move clients in bed D. ensure that your client maintains a healthy nutritional status.

B Keeping the skin moist causes maceration and promotes skin breakdown. Turning your client every 2 hours, even at a 10- to 30-degree tilt, gets him or her off the bony prominences, thereby reducing the pressure and allowing blood to circulate in that area. Using lift or draw sheets prevents dragging the client over the sheets and shearing the skin. Maintaining a healthy nutritional status ensures healthy skin, which helps prevent skin breakdown.

In assessing an older adult, you question his cognitive skills when you notice that A. his attention span lasts as long as the project he is working on. B. he is constantly checking to see whether what he did is correct C. he is able to hold a conversation with you D. he is able to name objects with which he comes in contact correctly.

B Logical analysis, such as not being able to determine whether he was correct, is a cognitive skill that might decline and require intervention from the physician. Attention span is a cognitive function that remains stable. Communication skills are another cognitive function that does not decline. Object naming is a cognitive skill that does not decline.

Relationships are an important part of the aging process. Which of the following does not support this idea? A. Friendships B. Widowhood C. Fictive kin D. Siblings E. Family members

B Losing a spouse or other life partner is essentially a loss of self. This loss is a stage in the life course that can be anticipated but seldom is considered. Friends are often a significant source of support in late life and can promote health and well-being. Fictive kin are nonblood kin who serve as "genuine fake families," becoming surrogate families. Siblings are often strong sources of support in the lives of never-married older persons, widowed persons, and those without children. Family members form the nucleus of relationships for the majority of older adults.

In reviewing an older adult's insurance history, you find that he is on Medicaid. You know that Medicaid... A. is meant to provide insurance coverage for medical care to the older adult and disabled populations regardless of their financial situations B. is designed to help the states defray the expenses for individuals with low socioeconomic status (SES) C. provides a minimum level of economic support D. provides monetary benefits to American citizens and legal residents to prevent their dependency on their families.

B Medicaid is designed to help the states defray the expenses for people with low SES, including older adults who do not qualify for or cannot afford to purchase Medicare Part B supplemental insurance or to pay the required copayments. Medicare, not Medicaid, provides insurance coverage for medical care to older adults. Supplemental Security Income provides for a minimum level of economic support to older adults. Social Security provides monetary benefits to American citizens and legal residents older than 65 years of age to prevent dependency on their families.

The change in the effectiveness of two or more substances when used in combination refers to which one of the following terms? A. Biotransformation B. Potentiation C. Bioavailability D. Iatrogenic

B Potentiation is the strengthening of the effect of two or more substances (e.g., food, another drug) when used in combination. Biotransformation is a series of chemical alterations of a drug that occur in the body. Bioavailability is the amount of a drug that becomes available to effect changes in the target tissues. Iatrogenic is a result of something that is performed or administered to a person in the context of providing care.

As a nurse, you know that sleep and rest are physiological and mental necessities for survival. Which of the following statements is incorrect about rest and sleep? A. Sleep is a basic need B. Sleep occupies half of our lives C. Rest occurs with sleep D. Deprivation of sleep may adversely affect older adults.

B Sleep occupies approximately one third of our lives and is a vital function and basic need. Sleep is a basic need and is an extension of rest, both of which are physiological and mental necessities for survival. Rest occurs with sleep in sustained unbroken periods. Sleep deprivation and fragmentation of sleep in older adults may adversely affect cognitive, emotional, and physical functioning, as well as the quality of life.

__ is the application of limited knowledge about one person with specific characteristics to other persons with the same characteristics. A. Ethnicity B. Stereotyping C. Ethnocentrism D. Health disparities

B Stereotyping also limits the recognition of the heterogeneity of a group. Ethnicity is belonging to or deriving from the cultural, racial, religious, or linguistic traditions of a people or country. Ethnocentrism is the belief in the inherent superiority of one's ethnic group accompanied by the devaluation of other groups. Health disparities refer to the differences in the state of health and health outcomes among people.

Regular recurrence of certain phenomena linked to the 24-hour day by time cues, defines which one of the following? A. Non-rapid eye movement B. Circadian rhythm C. Obstructive sleep apnea D. Insomnia

B The circadian sleep-wake rhythm, which is the regular recurrence of certain phenomena in cycles of approximately 24 hours, is the most important biorhythm, second only to body temperature, pulse, blood pressure, and hormonal levels. Four stages of non-rapid eye movement and a fifth stage of rapid eye movement occur with sleep. The obstruction of the upper airway causes obstructive sleep apnea and is the most common of the sleep apneas. Insomnia is defined as "a complaint of disturbed sleep in the presence of an adequate opportunity and circumstance for sleep."

As the nurse performing and collecting assessment data, you realize that during the process of interviewing the client that a majority of the information is coming from the client's family members. This approach for collecting assessment data is known as... A. self-report B. report by proxy C. observation D. dual communications.

B The report-by-proxy approach means that the nurse asks another person to report his or her observations. With the self-report approach, the person is expected to respond to the question about his or her health status. With the observation approach, the nurse collects and records the data. Dual communications is communication between two sources with cables (e.g., telephone, computer).

In assessing an older adult client, you notice symptoms that include bradykinesia, a reduction in facial muscle movement, and tremors. You realize that this client possibly has which one the following conditions? A. Alzheimer's disease B. Parkinson's disease C. Festination disorder D. Anomia

B The symptoms of Parkinson's disease are many. Bradykinesia is most often observed and is the most disabling symptom and often overlooked. Fewer overall movements of the body occur, of which a reduction in facial muscle movements is common. When a client has a tremor, it is asymmetrical, pin rolling, regular, and rhythmic. Alzheimer's disease is a progressive neurological disorder of the brain. Festination disorder is characterized by a gait that consists of very short steps and minimal arm movements. Anomia is the difficulty to retrieve words.

You notice that your 85-year-old grandfather is having some trouble with his visual, motor, and cognitive skills. You would recommend the following driving adaptations EXCEPT A. a booster cushion B. tinted windows C. a wider rear-view mirror D. electronic detectors.

B Tinted windows are not a recommended adaptation for safer driving. A booster cushion would allow him to see over the steering wheel easier. A wider rear-view mirror will allow for more vision if the client is unable to turn his head or his peripheral vision is distorted. Electronic detectors in front and back signal when the car is getting too close to other cars, drifting into another lane, or likely to hit center dividers or other highway infrastructures.

The best determination of hydration is the patient's A. blood urea nitrogen (BUN) B. urine color C. serum sodium levels D. urine osmolality.

B Urine color is a very common and easy way to determine hydration, not necessarily dehydration. Although most cases of dehydration have an elevated BUN measurement, there are many other causes of an elevated BUN-to-creatinine ratio. Serum sodium levels measure the sodium in your blood system. Drinking too much fluid decreases the level, and dehydration increases the levels. Urine osmolality is a determination of urine concentration.

A female older adult client is complaining of mild and localized back and shoulder pain and some nausea and heartburn. Your immediate concern might be that she is experiencing which one of the following events? A. Coronary heart disease (CHD) B. Silent myocardial infarction (MI) C. Acute MI D. Heart failure

B With a silent MI, the discomfort may be mild and localized to the back, the abdomen, the shoulders, or either or both arms. Heartburn may be the only symptom. Often, no signs or symptoms are evident, and the silent MI is often not noticed until an electrocardiogram is performed or at the time of death. CHD is caused by a stiffening of the blood vessels, which is referred to as arteriosclerosis, and may reduce the ability of the heart to receive oxygen. CHD can lead to angina or an MI. With an acute MI, the patient will have gripping chest pain, radiating to the shoulder. When in heart failure, an individual might expect fatigue, dyspnea on exertion, waking up at night gasping for air, weight gain, and swelling in the lower extremities.

What type of care is projected to be the fastest growing employment sector in the health care industry? A. Childcare B. Eldercare C. Adulthood D. Adolescent care

B With older adults living longer, the rates of outpatient visits, hospitalizations, home care, and long-term care services are higher, necessitating the use of trained medical providers. The childcare industry is thriving; however, the older adult population is outdistancing the child population. Adulthood does not require the output of health care providers that eldercare does. Individuals in adulthood are usually healthier. Care of adolescents has not required an increase in health care providers.

As the nurse of an older adult, you observe signs of aging skin. You would advise your client to (select all that apply) A. avoid all exposure to ultraviolet light. B. keep his or her skin moist. C. always use sunscreen. D. keep well hydrated E. not worry about smoking. F. not worry about purpura.

B, C, D Keeping the skin moisturized helps prevent drying, cracking, and tearing. Sunscreens help block out ultraviolet rays that might injure the skin. Keeping well hydrated promotes healthy skin and prevents dehydration. Avoiding all exposure to ultraviolet light is impossible 100% of the time. All people need some sunshine each day. Even if an older adult has been smoking 50 years, stopping might extend her or his lifespan and improve lung function and skin health. Smoking causes coarse wrinkles in the skin. Purpura, which are large purple spots, are common but not normal aspects of physical aging. The client may want to discuss this condition with his or her physician.

Current medical and public health care models of care are not meeting the needs of the older adult with chronic illnesses. Several new models and programs help in improving the care for individuals with chronic illnesses and include which of the following? (select all that apply) A. Shifting Perspectives Model of Chronic Illness B. Geriatric Resources for Assessment and Care of Elders Model C. Guided Care Results D. Program of All Inclusive Care for the Elderly E. Chronic Illness Model

B, C, D The Geriatric Resources for Assessment and Care of Elders Model was developed for primary health care provided for low-income seniors by their primary care physicians. The Guided Care Results is a model of comprehensive health care provided by physician-nurse teams for people with several chronic health conditions. The Program of All Inclusive Care for the Elderly provides comprehensive long-term services and supports Medicaid and Medicare enrollees. The Shifting Perspectives Model of Chronic Illness views living with chronic illness as an ongoing, continually shifting process during which the person moves between the perspectives of wellness in the foreground or illness in the foreground. Chronic illnesses are "conditions that last a year or more and require ongoing medical attention and/or limited activities of daily living."

When assessing an older adult client before noon, you smell alcohol on his breath. You suspect he is an alcoholic when you observe which of the following signs? (select all that apply) A. Good nutritional habits B. Excessive mood swings C. Family conflict D. Poor hygiene E. Irritability F. Maintenance of cognition

B, C, D, E Excessive mood swings are a sign that an individual might be an alcoholic. Many alcoholics have been pushed away by their families because of their drinking and habits. Alcoholics tend to forget to bathe, clean their clothes, or even eat correctly. Irritability is often observed in alcoholics and is a definite sign to look for. Alcoholics have poor nutritional habits and often skip meals for alcohol. Older adults who drink to excess are susceptible to cognitive decline.

When caring for an older adult client with a chronic respiratory disorder, you realize that nursing interventions are based on palliative care. Your education would include which of the following? (select all that apply) A. Reducing the cause of exacerbations B. Breathing retraining C. Providing nutritional support D. Dealing with supplemental oxygen therapy E. Promoting minimal functional capacity F. Smoking cessation

B, C, D, F Breathing retraining could include teaching about abdominal breathing or pursed-lip breathing. Nutritional support helps support a healthy body and could include nutritional supplemental drinks, puddings, and a balanced diet. Teaching clients how to work with their oxygen tanks will help them be more ambulatory. Teaching them about small versus large canisters and how they can move more easily will assist them in socialization. Teaching clients how to read the dial to determine oxygen levels left in the tank is essential. Cessation of smoking is essential to health in all perspectives, with respiratory care being the most important. Encouraging a client to stop smoking is important to breathing. Education would not include reducing the risk of exacerbations and hospitalizations. Education would not include promoting maximal functional capacity.

When assessing an older adult client about his sleeping patterns at home, you will ask: (Select all that apply) A. Do you have a bowel movement before going to bed? B. What time do you go to bed? C. Do you have any specific rituals at bedtime? D. What is the room environment? E. Do you experience any leg twitches in the hours before going to bed? F. How many times do you wake up at night?

B, C, D, F Determining the time an older adult goes to bed will assist the nurse to meet the client's needs. Individuals often have specific rituals before they go to bed, which might include a bedtime snack, watching television, listening to music, or reading. All of these rituals are crucial to the individual's ability to fall asleep. The room environment includes temperature, ventilation, and illumination. All play a part in how well a patient can or will sleep. Assessing how many times the client wakes up at night might signify other problems that should be addressed. Asking about a bowel movement before bed might be part of a nighttime ritual; however, it does not affect the client's sleeping pattern. Restless leg syndrome is a disorder characterized by unpleasant leg sensations that disrupt sleep.

When visiting an older adult client in his home, you note that he is unsteady on his feet, and you are concerned about him falling. Which of the following functional issues make him at risk for a traumatic brain injury (TBI)? (Select all that apply) A. He has grab bars in his bathtub and a ramp for his rolling walker B. He has gnarled hands and feet because of a history of rheumatoid arthritis C. Throw rugs are throughout the house to "keep his feet warm and off the cold floor." D. He uses a walker to get around his home, both inside and outside E. He has poor lighting throughout his home.

B, C, E Gnarled hands and feet do not allow the person to hold on to things easily, and gnarled feet might cause him to trip, placing him at risk for a fall, resulting in a TBI. Older adults frequently slip and fall on throw rugs, which leads to the possibility of a TBI. Poor lighting in the home environment is conducive to falls and the possibility of a TBI. Grab bars and a ramp are safety devices to help keep a client from falling. The use of adequate assistive devices will help a client prevent falls and thus prevent TBIs.

A 90-year-old client has early dementia and wants to stay in her home for as long as possible. Which of the following technologies would be appropriate for this client? (select all that apply) A. Telemedicine B. SmartSoles C. Motion sensors D. QuietCare system

B, D SmartSoles, shoe insoles with an embedded GPS device, are being developed and may be an aid to locate individuals with dementia who wander from their homes. The QuietCare 24-hour monitoring system uses an ordinary home security infrastructure to monitor the house and transfers information about the occupant's daily living activities, triggering when a normal routine is broken. Caregivers and family can perform virtual check-ins with their older relative over the Internet. Telemedicine is defined as "the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration." Smart medical homes are being studied as a way to aid in the prevention and early detection of disease through the use of sensors and monitors.

As a nurse performing a functional assessment to help promote healthy aging, which of the following statements from an older client make you realize that he requires assistance? (Select all that apply) A. He tells you that he is able to take a bath on his own B. He tells you that he has bounced a couple of checks lately C. He tells you that he loves to "putter around" in his garden D. He tells you that he is unable to get to the grocery store because he does not have a car E. He tells you that he is not having any problems with the stairs and feels safe at night in his upstairs bedroom F. He tells you that he does not feel like cooking on his gas stove and that he does not feel safe with it anymore.

B, D, F If your client can no longer balance his checkbook, then he might be experiencing some changes that might require outside intervention. The Council on Aging in most cities provides individuals who can help older adults with their finances. Not having a car and the ability to get to the grocery store can result in unhealthy aging as a result of an improper diet. Encouraging the client to ask neighbors or family members for transportation or using community resources to provide transportation is necessary. If your client is no longer cooking, then he is probably not eating a well-balanced diet. A referral to the Council on Aging for Meals on Wheels might be a suggestion you would make. If your client can take a bath and perform his own activities of daily living, he will not need outside assistance. If your client can "putter around" in his garden, he is able to get up and down and get outside in the sunlight and fresh air. This activity will definitely help promote healthy aging. Because your client can walk up and down the stairs without assistance or encountering any problems he is able to function in his home by himself.

Components to a cognitive assessment include all of the following EXCEPT A. differentiating among delirium, dementia, and depression. B. comprehensive assessment. C. a complete blood count (CBC). D. assessing for atypical presentation of illness.

C A CBC would provide an idea of basic cell functions; however, it would not help with diagnosing cognitive dysfunction. Whenever there is a change in cognitive status, it is essential that a comprehensive cognitive assessment be done to identify reversible conditions that may be the cause of an individual's symptoms. An important aspect of this is differentiating among delirium, dementia, and depression. A comprehensive assessment would be performed if an impairment is identified through screening. Older individuals often present with atypical signs or symptoms of illnesses. This can be exaggerated when the client had dementia.

Many reasons explain why an older adult plans on retiring. Which one of the following would not be a reason to retire? A. An older adult has reached "retirement age" and is ready to stop working formally. B. Illness has caused the older adult to reassess his or her retirement. C. An older adult has been terminated from his or her job. D. The nature of the older adult's job has become a burden and is no longer a pleasure.

C Although termination from a job is not planned, it is not necessarily a reason for an older adult to plan on retiring. Many people look at the retirement age of 65 years as the time to stop working formally. They believe that they have put in their time and that it is time to let someone else take over. Poor health and illness might cause an older adult to reassess her or his retirement plans. After working in a job for many years, times change, job duties change, and the job might no longer be what the older adult wants to do. He or she might then decide that it is time to retire and move on.

As a nurse today taking care of an older adult from a different culture, you would have a refined set of skills that would include all of the following EXCEPT A. working with the client, not on the client. B. listening carefully to the older adult for his or her perception of the situation. C. being able to explain your perceptions clearly and nonjudgmentally. D. developing a plan of action that takes both the client's and your perspectives into account and negotiates an outcome.

C As a nurse, you must be able to explain your perceptions clearly and without judgment. Working with clients involves them in their own care, making them a part of the team and showing respect for their opinions. Working on clients is one sided and does not show respect for them. Listening carefully and paying attention to the nonverbal communication and meaning behind the stories give the nurse a full understanding of the older adult. When both perspectives are taken into account and an outcome is negotiated, then both the nurse and the older adult have formed a working team, which is a win-win situation.

Which classification of drugs is on the list of potentially inappropriate medications (PIM) for older adults and should be avoided except in extreme cases? A. Warfarin B. Acetaminophen C. Benzodiazepines D. Narcotic analgesics

C Benzodiazepines are associated with an increased risk for accidental injury and are on the PIM list and not recommended for older adults. Warfarin is prescribed for many older adults who have pacemakers, who have had transient ischemic attacks, or have cardiac issues. Close monitoring of the client's international normalized ratio must be conducted. Acetaminophen is an over-the-counter medication that, if taken as directed, will cause no problems. Narcotic analgesics can be prescribed; however, the older adult's age and condition are considerations.

As a nurse, you will be responsible for teaching self-management skills to an older adult client who has diabetes mellitus. Which one of the following skills would not be something you would teach your client? A. What to do during periods of other illnesses B. How to use a personal glucose monitor C. The importance of eating fats and carbohydrates D. How to take care of his or her feet

C Carbohydrates are restricted to those that are full of grain, and fats are limited to saturated fats. Blood glucose levels have a tendency to rise during other illnesses. Clients should consult their physicians about how to manage their blood sugar level when it rises. Diabetes self-management education includes teaching the client about self-monitoring blood glucose levels, obtaining blood samples, using glucose monitoring equipment, and troubleshooting when error messages appear. Daily foot care and foot examinations should be discussed and demonstrated.

An older adult client is having some vision problems. Which one of the following disorders is caused by oxidative damage to the lens? A. Macular degeneration B. Glaucoma C. Cataracts D. Diabetic retinopathy

C Cataracts are a prevalent disorder among older adults and are caused by oxidative damage to the lens protein and fatty deposits in the ocular lens. Age-related macular degeneration is a degenerative eye disease that affects the macula. Although glaucoma's causes are variable, normally the natural fluids of the eye are blocked by ciliary muscle rigidity, and the buildup of pressure causes damage to the optic nerve. Diabetic retinopathy is a disease of the retinal microvasculature characterized by increased vessel permeability.

The most common gastrointestinal complaint made to a health care provider is A. fecal impaction B. hemorrhoids C. constipation D. diarrhea

C Constipation is the most common gastrointestinal complaint made to health care providers. Constipation is a symptom of and can signal more serious problems. Fecal impaction is a major complication of constipation. Hemorrhoids might be a sign of a fecal impaction. Paradoxically, diarrhea may be caused by leakage of fecal material around a fecal impaction.

To help nurses grow through their own ethnocentrism, nurses must develop all of the following EXCEPT A. knowledge about ethnicity. B. knowledge about cultures. C. full dependence on verbal, facial, and body expressions to get their point across. D. acknowledge about another culture's health belief system.

C Depending fully on verbal, facial, and body expressions is easily misunderstood, especially from cultural and ethnic perspectives. Learning about a new ethnicity is important in the care of today's clients. Accepting ethnic values and respecting them is even more important. Learning about a new culture is just as important as ethnicity. Recognizing and respecting the individual's health belief system will go a long way in providing quality treatment.

With the increase in nuclear families, 15% of the caregivers are long-distance. Issues that need to be identified when initiating long-distance caregiving include all EXCEPT A. reliable individuals or services. B. acceptable facilities. C. unavailable family members. D. legal issues.

C Determining which family member who is closest and is most likely to be free to travel to the older family member if needed is more important than determining who is unavailable. Identifying a local person who will be available quickly in emergency situations and reliable individuals or services that will provide daily monitoring, if necessary will help relieve and emergency situation. Identifying acceptable facilities for assisted living or nursing home care if that becomes necessary should be done in advance in case of emergencies. Being sure that legalities regarding advance directives, a will, and power of attorney have been established will help prevent any guesswork of what the client might desire.

As a nurse, you realize the symptoms that normally occur in younger adults are often absent in older adults. When visiting an older adult client, you note that he has been falling, has some signs of confusion, is anorexic, and has rapid pulse and respirations rates. You realize that immediate treatment must be instituted for which one of the following conditions? A. Congestive heart failure B. HTN C. Pneumonia D. Chronic obstructive pulmonary disease (COPD)

C In older adults, other signs, such as falling, mental status changes or signs of confusion, general deterioration, weakness, anorexia, rapid pulse rate, and rapid respirations rate, may be observed. Congestive heart failure is a disease of the heart muscle in which the muscle is damaged, malfunctions, and can no longer pump enough blood to meet the needs of the body. HTN is diagnosed any time the diastolic blood pressure reading is 90 mm Hg or higher or the systolic blood pressure reading is 140 mm Hg or higher on two separate occasions. COPD is a term used to encompass asthma, bronchitis, and emphysema, none of which would cause this client's symptoms.

As a gerontological nurse, you will know that more older adults live in A. nursing homes B. rehabilitation centers C. their own homes D. hospitals.

C Many older adults live in their own homes, retirement communities, and independent senior housing and attend adult day health programs, primary care clinics, and public health departments. Older adults prefer to age in place. Although it might seem that the majority of older individuals live in nursing homes, such is not the case. Many more live in community-based care settings. The percentage of older adults living in nursing homes is dropping each year. Rehabilitation centers are a step down from the hospital and are designed to prepare the older adult to return home. Hospitals are a temporary and acute care setting with limited days available before discharge.

The following statements are true about Medicare Part B supplemental insurance EXCEPT A. it must be purchased and is a subsidized medical policy B. it covers the costs of outpatient services C. it covers medication costs D. it covers the costs of speech therapy.

C Medicare Part B does not cover medication costs. Medicare Part B must be applied for through the local Social Security Administration office. Medicare Part B is a supplemental policy for Medicare Part A. Medicare Part B covers the costs of outpatient and physician services. Medicare Part B covers the costs of qualified physical, speech, and occupational therapies.

Myxedema can be described as a(n): A. Complication of hyperthyroidism B. Combination of peripheral and central edema C. Serious complication of untreated hypothyroidism in the older adult D. Apathetic thyrotoxicosis

C Myxedema coma is a serious complication of untreated hypothyroidism in an older adult. Myxedema is a result of hypothyroidism and is not related to hyperthyroidism. Peripheral and central edema is a result of circulatory impairment. Apathetic thyrotoxicosis is a condition in which the usual hyperkinetic activity is replaced with slowed movements and depressed affect.

Your family member who is a resident in a nursing home has become dehydrated, and her blood pressure and pulse have dropped significantly enough to require hospitalization. You realize that there has been a lapse in her care and know that you can share the incidence with A. Medicare B. Quality Assurance Performance Improvement (QAPI) C. Omnibus Budget Reconciliation Act (OBRA) D. Center for Medicare and Medicaid Services (CMS).

C OBRA is designed to improve the quality of resident care. Nursing homes are required to post information about OBRA and contact persons in case of a complaint. Medicare is a health insurance program for those older than 65 years of age. QAPI requires all nursing homes to assess quality of care provided to residents and to improve outcomes CMS has activities under way with regard to pay for performance and instituted the skilled nursing facility scorecard.

PACE provides community services to A. people ages 65 and older only B. people who prefer to live in an assisted living facility (ALF) C. people who are eligible for Medicare and Medicaid D. people on disability.

C PACE provides services for those who qualify for Medicare and Medicaid older than 55 years of age. PACE provides services for those older than 55 years of age who qualify for Medicare and Medicaid. PACE does not provide for those living in an ALF, only for those who prefer to remain in the community. PACE does not cover for disabilities unless covered under Medicare or Medicaid.

Examples of interventions to promote wellness include all of the following EXCEPT A. influenza and pneumonia vaccinations. B. breast cancer screenings. C. psychiatric screenings. D. colorectal screenings.

C Psychiatric screenings are not recommended unless symptoms suggest a need. Influenza vaccines are recommended every year. Pneumonia vaccines are recommended at least once annually. Breast cancer screenings continue to be recommended. Self-breast examination should be performed every month, and mammograms are recommended every other year for women older than 65 years of age. Colorectal screenings are recommended. A stool guaiac test should be performed every year and a colonoscopy every 10 years. If the client has a history of polyps, then a colonoscopy is recommended every 5 years.

You realize an older adult woman does not understand how to maintain healthy bones and muscles when she makes which one of the following statements? A. "I participate every morning in my assisted living community's healthy activity programs." B. "I enjoy going to my senior center and participating in its Tai Chi program." C. "My spouse loves to walk every evening and encourages me to go along, but I am just too tired to do so." D. "I use my 2-lb weights every morning while watching my morning news shows."

C Refusing to walk because of being too tired does not help improve muscle strength and prevents the uptake of calcium into the bone, which can possibly lead to osteoporosis. Participating in a community physical exercise program will help in maintaining healthy bones. Participating in the Tai Chi program uses muscles through gentle continuous motions, which helps reduce stress and improves other health conditions. Using light weights daily, whether in the morning or in the evening, helps strengthen muscles and promotes the uptake of calcium into the bone.

What book or journal provides a comprehensive overview of the scope of gerontological nursing for today's geriatric nurse? A. Nursing Research B. American Journal of Nursing C. Scope and Standards of Gerontological Nursing Practice D. Newton and Anderson's first textbook on nursing care of older adults

C Scope and Standards of Gerontological Nursing Practice

A client has been complaining of headaches, poor vision in dim lighting, sensitivity to glare, and impaired peripheral vision, and he has a fixed and dilated pupil. He probably has which one of the following disorders? A. Cataracts B. Diabetic retinopathy C. Glaucoma D. Macular degeneration

C Signs of glaucoma can include headaches, poor vision in dim lighting, increased sensitivity to glare, "tired eyes," impaired peripheral vision, a fixed and dilated pupil, and frequent changes in prescriptions for corrective lenses. Lens opacity reduces visual acuity, halos are seen around objects, vision is blurred, and the perception of light and color is decreased are all symptoms of cataracts. Generally, no symptoms are recognized in the early stages of diabetic retinopathy. Early signs are revealed during eye examinations. Early signs of macular degeneration might include blurred vision, difficulty reading and driving, colors that appear dim or gray, and an awareness of a blurry spot in the middle of vision.

Which one of the following traits is a normal part of aging? A. Depression B. Isolation C. Spirituality D. Gerotranscendence

C Spirituality is a broader concept than religion and encompasses a person's values or beliefs; his or her search for meaning; and his or her relationships with a higher power, with nature, and with other people. Depression is usually the result of another underlying cause that might be treated with medications or counseling. Isolation is not a normal part of aging. The social exchange theory explains that withdrawal or social isolation is the result of an imbalance in the exchanges between older persons and younger members of society. Gerotranscendence is a shift in perspective from the material world to the cosmic world and is evidenced by an increase in life satisfaction.

An older adult client who was a veteran of World War II has just died. His widowed wife did not work and does not have sufficient funds to afford supplemental Medicare insurance. You would recommend which one of the following? A.Medicaid B. Supplemental Security Income C. TRICARE for Life D. Medicare Part D

C TRICARE for Life is the health care insurance program provided by the Department of Defense for eligible beneficiaries. It covers expenses not covered by Medicare, such as copays and the cost of prescription medications. Medicaid is designed to help the states defray the expenses for the very poor, including older adults who do not qualify for or cannot afford to purchase Medicare Part B or to pay the required copayments. However, this widow would qualify for Tricare. Supplemental Security Income provides for a minimum level of economic support to older adults; however, it would offer as much help for this widow because Tricare would. Medicare Part D is an option; however, deductibles and possibly copayments would still be required. Tricare does not require any deductibles or copayments.

You notice that your older adult client frequently knocks his arm or hand against door frames or chair backs and then develops a purpura. You advise your client to do all the following EXCEPT A. wear a long-sleeved shirt B. protect the skin from trauma C. tape a nonadherent dressing over the site of the skin tear D. remind the health care personnel to be gentle when handling the client's skin.

C Tape should be avoided when possible and not applied to the skin of an older adult. Tape usually results in skin tears when trying to remove it. Wearing a long-sleeved shirt will help protect the client's arms from trauma and friction. Protecting the skin is paramount to preventing purpuras or skin tears. Gentle reminders to the health care workers about preventing purpuras and skin tears are important and should be ongoing.

As a home health nurse, you are providing care to a 91-year-old man and his 84-year-old wife who live on their own in an active retirement community. You note that this couple continues to be active in going out to eat with friends, traveling, and playing bridge and other card games. The husband plays bocce ball and volunteers at the library. They are exhibiting which sociological theory of aging? A. Continuity theory B. Modernization theory C. Activity theory D. Social exchange theory

C The activity theory is based on the belief that remaining as active as possible in the pursuits during middle age is the ideal in later life. The continuity theory explains that life satisfaction with engagement or disengagement depends on personality traits. The modernization theory attempts to explain the social changes that have resulted in the devaluation of both the contributions of older adults and the older adults themselves. The social exchange theory explains that withdrawal or social isolation is the result of an imbalance in the exchanges between older persons and younger members of society.

An older adult client has fallen in his yard, resulting in a 4-inch laceration on his forearm. As the home health nurse caring for him, you need to reassure him of all EXCEPT A. if the laceration becomes pink several days after the injury, this is normal as healing has begun. B. if he notices any lack of scabbing, he needs to notify the physician. C. the healing process will begin immediately. D. evidence of a true skin infection in an older adult is the same as that for a younger person.

C The healing process in an older adult does not begin until approximately 48 to 72 hours after an injury, as evidenced by the slight redness they might see. The inflammatory process may not begin to occur for 48 to 72 hours in an older adult; this does not mean the laceration is infected. Scabbing is a normal process, and the client does not need to notify his or her physician when it occurs. If scabbing does not occur, then a call to a physician is necessary. Increasing redness and purulent drainage are signs of a true infection and are the same in both a young adult and an older adult.

Which of the following special abilities would not be needed in performing and assessing an older adult? A. Listening patiently B. Allowing for pauses while the older adult thinks C. Asking questions that are frequently asked D. Understanding that he or she might need to obtain data from all available sources

C The nurse needs to have the ability to ask questions that are not often asked. The nurse needs to have the ability to be patient when listening to older adults. Older adults do not often move, speak, or respond as fast as younger individuals. The nurse, along with being patient, needs to be comfortable enough to allow for pauses while the older adult thinks about the question and his or her answer. The nurse needs to have the ability to look beyond what the patient or family has to offer and use the physician's office notes, data from the hospital, and laboratory and procedure results, to name a few, to perform an assessment.

Your client has a history of arthritis. After assessing her condition and finding stiffness with inactivity, pain relieved by rest, and crepitus, you realize she has which one of the following types of arthritis? A. Rheumatic arthritis (RA) B .Gout C. Osteoarthritis (OA) D. Polymyalgia rheumatica (PMR)

C With OA, the joint space narrows; the bones of the joint rub together, which causes pain relieved by rest; swelling develops; and a loss of motion occurs. In classic OA, stiffness with inactivity develops. With activity, OA might lead to pain. In addition, joint instability and crepitus may develop, and a crunching or popping may be felt or heard. OA is usually found in the larger joints. RA is an autoimmune disease and is characterized by pain and swelling in multiple joints in a symmetrical pattern. It generally affects the small joints. Gout causes exquisite pain in the affected joint and wakes up the client in the middle of the night. The joint is bright purple, red, hot, and too painful to touch. PMR may occur at the same time as OA; however, it has a more acute presentation with pain beginning in the neck and upper arms, pelvic area, and possibly in the pectoral girdles. Fatigue and low-grade fever may also occur.

You realize that an older adult client has had a transient ischemic attack (TIA) when... A. he has had no resolution of his symptoms. B. his right side remains nonfunctional. C. his symptoms begin to resolve within minutes. D. he has developed an expressive aphasia.

C With a TIA, the symptoms begin to resolve within minutes, and all neurologic deficits caused by a TIA resolve within 24 hours. If the symptoms fail to resolve after 24 hours, then the client has not had a TIA; rather, he has sustained a stroke. If his right side remains nonfunctional after 24 hours, he has probably sustained a stroke. Expressive aphasia is a complication of a stroke, not a TIA.

You are taking care of a female older adult client with a loss of height and kyphosis. She is also postmenopausal. Which one of the following diagnostic tools would you order? A. Computed tomography (CT) scan of her bones B. Magnetic resonance image (MRI) of her bones C. Bone scan D. Dual-energy x-ray absorptiometry (DEXA) scan

D A DEXA scan is the correct choice of diagnostic tool and is the preferred tool for measuring mineral density in the bones. A CT scan might assist in a diagnosis of osteoporosis; however, this tool would not be the first to be ordered. An MRI might show a loss of density; however, MRIs are more effective for revealing soft tissue issues. A bone scan is usually used to diagnose cancer in the bones, not necessarily for diagnosing osteoporosis.

The following statements describe a mentally healthy person EXCEPT an individual who A. successfully adapts to life's challenges. B. demonstrates flexibility. C. sustains positive interpersonal relationships. D. maintains minimum resilience.

D A mentally healthy person is one who maintains maximum resilience, flourishing despite adversity. A mentally healthy person is one who successfully adapts to difficult and challenging life experiences, especially those that are highly stressful or traumatic. A mentally healthy person is one who bends rather than breaks during stressful conditions and is able to return to adequate functioning after stress. A mentally healthy person is one who sustains positive relationships with others.

An older adult client has recently been diagnosed with gout. You will need to teach him all of the following EXCEPT A. side effects of medications. B. how to decrease the likelihood of another attack. C. care of the joint. D. reassurance that this is a one-time occurrence.

D After an acute attack, gout may become chronic with periodic acute "attacks." It is not always a one-time occurrence. The nurse will need to teach the older adult about the side effects (e.g., stomachache, headache, nausea, diarrhea, rash, ulcers) of the gout medication. If the client is prescribed colchicine, watching for diarrhea with blood and a reduced white blood cell count is important. Decreasing the likelihood of another attack will involve a change of diet. Reducing the intake of foods that are high in purine and alcohol and drinking enough fluids daily to help flush the uric acid through the kidneys may decrease the likelihood of another attack. Care of the joint includes elevating the foot, placing nothing on the swollen toe, and taking analgesic agents for the pain and an anti-inflammatory medication for the swelling.

When teaching a client about taking his thyroid medication, the nurse needs to ensure that he follows all of the following instructions EXCEPT A. take the medication early in the morning on an empty stomach. B. always take the same brand of medication. C. do not take mineral products (e.g., calcium) at the same time. D. take an extra dose if you feel any fluttering in the chest.

D An extra dose should not be taken. Taking too much thyroid medication can be toxic. Levothyroxine should always be taken early in the morning, on an empty stomach, and at least 30 minutes before a meal. Taking the same brand of the medication ensures that he is taking the same medication and inert ingredients. Clients should not take any mineral products (e.g., calcium) at the same time of the day because they interfere with absorption.

Of all the following malignant skin cancers, which one is the most common? A. Actinic keratosis B. Squamous cell carcinoma C. Melanoma D. Basal cell carcinoma

D Basal cell carcinoma is the most common malignant skin cancer. It is slow growing, and metastasis is rare. It has also been known to ulcerate. Actinic keratosis is a precancerous lesion that may become a squamous cell carcinoma. It is directly related to years of overexposure to ultraviolet light. Squamous cell carcinoma is the second most common skin cancer. Melanoma is a neoplasm of the melanocytes and accounts for 5% of skin cancers, but it causes a majority of skin cancer deaths.

Your clients are interested in a facility that will allow them full care and services for the rest of their lives. Which one of the following would you suggest? A. Assisted living facility (ALF) B. Adult day services (ADS) C. Residential care facility (RCF) D. Continuing care retirement community (CCRC)

D CCRCs provide the full range of residential options from single-family homes to skilled nursing facilities, all in one location. Most provide access to these levels of care for a community member's entire remaining lifetime. ALF is a long-term care residential setting for those able to care for themselves. When an older adult has needs that are greater than the facility can provide, she or he might have to move to another facility. ADS are programs that provide social and some health-related services to adults who need supervised care in a safe setting during the day but who return to their homes at night. An RCF is a nonmedical, community-based residential setting that houses two or more unrelated adults and provides basic services.

Which of the following describes a time of transition that requires a restructuring of one's goals, behaviors, and responsibilities and is a source of both joy and stress? A. Caregiver stress B. Caregiver burden C. Caregiver role strain D. Caregiving

D Caregiving is a very complex issue, and assuming a caregiving role is a time of transition that requires a restructuring of one's goals, behaviors, and responsibilities. Caregiver stress is caused by the emotional and physical strain of caregiving. Unrelieved caregiver stress increases the potential for abuse and neglect. Caregiver burden is defined as the negative psychological, economic, and physical effects of caring for a person who is impaired. Caregiver role strain, a nursing diagnosis accepted by the North American Nursing Diagnosis Association, is defined as difficulty performing the caregiver role.

Which of the following is an unreliable assessment in the older adult? A. Orthostasis B. Decreased urine output C. Sunken eyes D. Skin turgor at the sternum

D Checking the skin turgor at the sternum is unreliable because of the loss of subcutaneous tissue. Orthostasis or orthostatic hypotension is a cause of dehydration, which causes a lower pressure of blood against the arterial walls Decreased urine output is a result of dehydration caused by not drinking enough fluids or a loss of fluids caused by diarrhea or vomiting. Sunken eyes are the result of the skin losing its elasticity because of dehydration.

Some things that you, as the nurse, might teach your client to help control urinary incontinence might be all the following EXCEPT A. scheduled voiding B. pelvic floor muscle exercises C. prompted voiding D. continuous indwelling catheterization.

D Continuous indwelling catheter use is indicated for urethral obstruction or urinary retention and is not necessary for treatable urinary incontinence. Scheduled voiding is used to treat urge and functional urinary incontinence in both cognitively intact and cognitively impaired older adults. Pelvic floor muscle exercises, also called Kegel exercises, involve repeated voluntary pelvic floor muscle contraction. The goal is to strengthen the muscle and therefore decrease urinary incontinence episodes. Prompt voiding combines scheduled voiding with monitoring, prompting, and verbal reinforcement.

Which one of the following does NOT describe a need of the dying? A. Composure enables the person to modulate emotional extremes. B. Closure is an opportunity for reconciliation and transcendence. C. Expert management of symptoms and support are a part of care. D. Closed awareness is the need to remain in a collaborative role. E. Needed information is communicated.

D Control is the need to remain in a collaborative role relating to one's own living and dying and as active participant in one's care as desired. Composure is the need that enables the person to modulate emotional extremes as is appropriate within cultural norms. Closure is the need that corresponds to the opportunity for reconciliation and transcendence. Persons who are dying should have the best care possible, which includes the expert management of symptoms and support at all times. Communication begins with the need for information to make decisions and includes the need to share information.

An older adult client who has had several urinary tract infections (UTIs) complains of constipation. You realize he might have which of the following conditions? A. Malnutrition B. Vitamin B12 deficiency C. Issues related to the digestive system D. Dehydration

D Dehydration is a significant risk factor for delirium, thromboembolic complications, infections, kidney stones, constipation, medication toxicity, and delayed wound healing. Malnutrition is a state in which a deficiency, an excess, or an imbalance of energy, protein, or other nutrients causes adverse effects on body form, function, and clinical outcome. Malnutrition does not necessarily cause constipation but could be a factor in infections. A deficiency in vitamin B

Ageism is a term used to describe the discrimination and negative stereotypes that are based solely on age. From the following list, which statement does not reflect ageism? A. Anti-aging products B. Graphic portrayals mocking the ability of older adults C. Mandatory retirement policies D. Demonstrations of respect for the older adult

D Demonstrations of respect for the older adult do not reflect ageism. Respect is a fundamental right of all individuals. Anti-aging products are a multibillion dollar industry that encourages everyone to remain young. Graphic portrayals that mock older adults are observed in cards, on billboards, and on television. Mandatory retirement policies implicate that older adults cannot handle having jobs.

The infliction of actual harm or a risk for harm to vulnerable older persons through action or behavior of others defines which term below? A. Elder abuse B. Elder neglect C. Self-neglect D. Elder mistreatment

D Elder mistreatment is a complex phenomenon that includes elder abuse and neglect. It is the infliction of actual harm, or a risk for harm, to vulnerable older persons through the action or behavior of others. Abuse is intentional and may be physical, psychological, medical, financial, or sexual. Many states have reporting statutes that require certain persons, including nurses, who become aware of abuse, neglect, or exploitation to report it to the appropriate authorities. Neglect is a form of mistreatment resulting from the failure of action by a caregiver or through one's own behavior or choices. Self-neglect is a behavior in which people fail to meet their own basic needs in the manner that the average person would in similar circumstances.

You are visiting your client a few days before a blizzard is expected to hit your town, and you notice that her heater is not working. As a public health nurse, you know that all of the following require early assessment EXCEPT1. environmental temperatures.2. economic conditions.3. medication effects.4. changes in thermoregulatory responses. A. 1, 3, and 4 B. 2 and 3 C. 1, 2, and 3 D. All of the above

D Environmental temperature extremes impose a serious risk to older persons with declining physical health. Preventive measures require attentiveness to impending climate changes, as well as protective alternatives. Economic conditions often play a role in determining whether an older person living in the community can afford air conditioning or adequate heating. Many drugs affect thermoregulation by affecting the ability to vasoconstrict or vasodilate, both of which are thermoregulatory mechanisms. Neurosensory changes in thermoregulation delay or diminish the individual's awareness of temperature changes and may impair behavioral and thermoregulatory responses to dangerously high or low environmental temperatures.

An older adult client is active and attends college on a part-time basis. He also has a computer and researches his medications and disorders, which enables him to share his ideas with his physician and to come to a collaborative decision of care. These characteristics are an example of A. geragogy B. cognitive health C.fluid intelligence D. health literacy.

D Health literacy is defined as the degree to which an individual has the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Geragogy is the application of the principles of adult learning theory to teaching interventions for older adults. Cognitive health is "the development and preservation of the multidimensional cognitive structure that allows the older adult to maintain social connectedness and an ongoing sense of purpose." Fluid intelligence consists of skills that are biologically determined and independent of experience or learning.

Diabetes, dementia, Parkinson's disease, stroke, and vitamin B deficiencies may cause neurologic damage, leading to... A. postprandial hypotension B. traumatic brain injury (TBI) C. fallophobia D. gait disturbances.

D Neurologic damage may result in gait disturbances. Postprandial hypotension occurs after ingesting a carbohydrate meal and may be related to the release of a vasodilatory peptide. A TBI is caused by a bump, blow, or jolt to the head or by a penetrating head injury that disrupts the normal function of the brain. Fallophobia, or fear of falling, is an important predictor of general functional decline and a risk factor for future falls.

Palliative care can be described as all of the following EXCEPT that which focuses on A. comfort. B. disease treatment. C. symptoms. D. quality of life.

D Palliative care does

During an assessment, an older adult client reports that he fell the night before. You should follow up with all the following EXCEPT A. ask about the history or frequency of falls B. ask about the circumstances behind the fall(s) C. evaluate the client for gait and balance D. perform a complete head-to-toe assessment.

D Performing a head-to-toe assessment is a good idea; however, it will not give you the information you need about the reported fall and can be performed after the initial assessment of the fall. Asking about the frequency of falls will determine whether a fall was an isolated incidence or whether a pattern is developing. The circumstances behind the fall will give the nurse an idea of what to look for in the house, nursing home, or hospital. Some circumstances could possibly be changed to help ensure that a fall does not reoccur. Evaluations for gait and balance will show whether a neurologic issue needs to be addressed.

You realize your client has suffered a hemorrhagic stroke because he: A. is not experiencing any arrhythmias. B. has no coagulation disorders. C. is not dehydrated or hypotensive. D. experiences seizures and has a depressed level of consciousness.

D Persons with a hemorrhage have more specific neurologic changes, including seizures and more depressed level of consciousness, than those with an ischemic stroke. Cardioembolism strokes include those caused by an arrhythmia such as atrial fibrillation, which can cause stasis of blood in the lower extremities from which a clot can break. Hematologic disorders include coagulation disorders and hyperviscosity syndromes. Hypofusion leading to a stroke can occur as a result of dehydration, hypotension, cardiac arrest, or syncope.

__ is the use of multiple medications that can increase the risk for drug interactions and increase the risk for an adverse event. A. Pharmacokinetics B. Chronopharmacology C. Pharmacodynamics D. Polypharmacy

D Polypharmacy is the use of approximately five or more medications or the use of multiple medications for the same problem, which can lead to an increase risk for drug interactions and increase the risk of adverse events. Pharmacokinetics refers to the movement of a drug in the body from the point of administration to excretion. Chronopharmacology is the relationship between the biological rhythms of the body and variations pharmacokinetics and pharmacodynamics. Pharmacodynamics refers to the interaction between a drug and the body.

Which statement is not true about the Patient Self-Determination Act (PSDA)? A. Hospitals are responsible for providing written information about a client's self-determination rights. B. Health maintenance organizations (HMOs) are required to provide written information about self-determination rights. C. Hospices are obliged to inform clients of their self-determination rights. D. Providers are under obligation to provide the same information.

D Providers (physicians and nurse practitioners) are encouraged but are under no obligation to provide information about self-determination rights to their clients. Hospitals and long-term care facilities are responsible for providing written information at the time of admission about the individual's rights under law to refuse both medical and surgical care and to provide this decision in writing in advance. HMOs are required to do the same as hospitals at the time of member enrollment. Hospices are obliged to inform clients of their self-determination rights on the initial visit.

For an older adult client who is having trouble sleeping at night, you would implement all the following EXCEPT A. sleep restriction therapy B. relaxation therapy C. soft music D. administration of a sedative.

D Sedatives and hypnotics should be avoided. Restriction of sleep during the day will assist the client in sleeping at night because he or she will be tired. Relaxation therapy might calm a client enough to enable him or her to sleep. Soft music is a type of relaxation therapy that might help sooth a client.

You want to encourage your older adult client to exercise and recommend all the following EXCEPT A. one hour a day of moderate intensity aerobic activity B. muscle strengthening activities C. stretching and balance exercises D. playing with the Wii game.

A Approximately 2 hours and 30 minutes of moderate intensity aerobic activity is recommended, not 5 to 7 hours. Muscle strengthening activities on 2 or more days that work all major muscle groups is recommended each week. Stretching and balance exercises, particularly for older people who are at risk of falling, are recommended. The Wii game system offers other possibilities for exercise at all levels and is increasingly being used in nursing homes and assisted living facilities.

Diminished tear production that occurs with age is the definition for which of the following terms? A. Keratoconjunctivitis sicca B. Funduscopy C. Cryopexy D. Drusen

A Keratoconjunctivitis sicca is diminished tear production that normally occurs with age. Funduscopy is an ophthalmoscopic examination of the fundus of the eye. Cryopexy is laser surgery or a freeze treatment to repair small holes or tears in the retina. Drusen describes yellow deposits under the retina and is often found in people older than the age of 60 years.

Older adults should consume how much fluid per day? A. 1920 mL/day B. 1500 mL/day C. 2400 mL/day D. 3000 mL/day

B All older adults should have an individualized fluid goal determined by a documented standard for daily fluid intake. At least 1500 mL of fluid/day should be provided. Those in between and baby boomers should consume 1920 mL/day, which amounts to the 8 by 8 "rule": 8 cups each of 8 oz fluid per day. 2400 mL/day is the rule of thumb for pregnant women, or 10 8-oz cups/day. Healthy men require 3000 mL/day of fluids.

The promotion of an adequate fluid balance which prevents medical complication defines which of the following terms? A. Dehydration B. Overhydration C. Hydration D. Hypernatremia

C Hydration is defined