Chapter 19- Urinary Function, Chapter 12- Psychosocial Function, Chapter 26- Sexual Function, Chapter 16- Hearing, Chapter 17- Vision, Chapter 24- Sleep and Rest--- Gero test 3

15. A nurse assesses an 85-year-old Hispanic woman. The client states that her husband was punished by God. To which of the following illnesses is the woman most likely referring? A) Alcohol abuse B) Fainting C) Posttraumatic stress disorder (PTSD) D) Voodoo

Ans: A For some Hispanics, mental illness may be viewed as a punishment by a supreme being for past transgressions; Hispanic older adults define mental health problems as alcohol and other drug abuse. PTSD is relatively common in immigrants. Hallucinations are not especially related to Hispanic culture. Those of Caribbean descent may attribute the cause of mental illness to voodoo.

5. A nurse manager develops policies to promote a sense of control for older adults in the assisted living facility. Which of the following policies should be included? A) Hold resident council meetings twice monthly and invite all residents to attend. B) Post a meal menu every Sunday and tell the residents that they must notify the kitchen in advance if they want a menu change. C) Design all the emergency pull cords so they blend in with the wallpaper and are inconspicuous. D) Teach the nurses' aides to use the passkey to do spot checks on every resident at least twice during the night to ensure that the residents are safe.

Ans: A Resident meetings allow older adults to address personal preferences and to make choices. Posting the meals and later allowing choices is giving the older residents a limited chance to make a choice. Safety should be an ongoing concern.

6. A 76-year-old adult expresses frustration to the nurse regarding hearing loss despite a lifetime of being conscientious about avoiding known causes of hearing damage. Which of the following age-related changes may result in hearing loss? A) Degeneration of the inner ear structures B) Decreased viscosity and quantity of cerumen C) Plaque formation and occlusion of the Eustachian tubes D) Hypertrophy of the external ear structures

Ans: A Age-related changes of the inner ear include loss of hair cells, reduction of blood supply, diminution of endolymph production, decreased basilar membrane flexibility, degeneration of spiral ganglion cells, and loss of neurons in the cochlear nuclei. These inner ear changes result in the degenerative hearing impairment termed presbycusis. Cerumen often becomes more viscous with age, and occlusion of the Eustachian tubes is not a normal, age-related change. Changes to the external ear structures are not implicated in age-related hearing loss

3. A nurse assesses the urinary elimination of older adults. Which of the following actions by the nurse is most appropriate? A) Work to identify terms that the older adult comprehends. B) Wait until the person initiates a discussion of this embarrassing topic. C) Give the interview questions to the client in writing. D) Ask the older adult to keep a urination diary

Ans: A Although nurses usually learn to discuss urinary elimination with relative ease, older adults may feel uncomfortable with the topic, especially if there are gender or age differences between the older person and the nurse. In addition, older adults may be reluctant to discuss urinary problems because they tend to accept urinary leakage as an inevitable consequence of aging and gradually increase their tolerance threshold. Because of varying social contexts, successful interviewing about urinary elimination and incontinence depends on identifying the terms that are least embarrassing and most understandable to the older adult

10. A resident of a nursing home has experienced a progressive loss of vision over the past several months as a consequence of diabetes. How should the nurse accommodate the resident's loss of visual acuity? A) Provide the resident with brightly colored grooming utensils. B) Replace the resident's tube television with a flat-screen TV. C) Remove books from the resident's room to avoid reminding her of her vision loss. D)Have the walls in the resident's room painted a neutral color that matches the color of the flooring

Ans: A Brightly colored utensils and grooming supplies can make it easier for an older adult to identify and use them. Replacing the TV is not an effective intervention, and it is not appropriate to remove books simply because they may remind the resident of her vision loss. Contrasting, not monochromatic, color schemes facilitate vision.

7. A nurse assesses a 70-year-old man who has high blood pressure and chronic obstructive pulmonary disease (COPD). He has been prescribed nicardipine and ipratropium inhaler. This medication combines a calcium-channel blocker and an anticholinergic. For which of the following urinary effects should the nurse teach the client to monitor? A) Nocturia B) Urinary tract infection (UTI) C) Urge incontinence D) Hematuria

Ans: A Calcium-channel blockers decrease bladder contractility and can cause urinary retention, frequency, nocturia, and incontinence. Anticholinergic agents decrease bladder contractility, and relaxed bladder muscle can cause urinary retention, frequency, and incontinence

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

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

8. A nurse assesses risk factors for vision loss in a 71-year-old client. Which question should the nurse include in this assessment? A) "Do you have high blood pressure or diabetes?" B) "Did your parents wear glasses or have cataracts?" C) "How much red meat do you usually eat?" D) "Do you have high cholesterol?"

Ans: A Diabetes and hypertension are significant risk factors for vision loss. Family history, diet, and high cholesterol are not closely associated with vision loss in older adults

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

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

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

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

13. A nurse teaches an older adult about risks related to ototoxic medications. Which of the following medications should the adult minimize or avoid? A) Nonsteroidal anti-inflammatory agents B) Osmotic stool softeners C) Over-the-counter sleep aids D) Penicillin-type antibiotics

Ans: A Ototoxic medications include (but are not limited to) aminoglycosides, macrolides, quinolones, and some antifungals (not penicillins), aspirin and other salicylates, as well as nonsteroidal anti-inflammatory drugs. Neither sleep aids nor stool softeners have been implicated in ototoxicity

1. A nurse develops a plan of care for an older adult recently diagnosed with Lewy body dementia. Which functional consequence would be most important to monitor in this older adult? A) Development of visual hallucinations B) A visual acuity score of 20/30 C) Improved visual acuity after medications for dementia D) Growth of cataracts

Ans: A Persons with Lewy body dementia are at risk for visual hallucinations. Low vision is 20/70 visual acuity to 20/200 visual acuity. Visual acuity will not improve with dementia medications, as anticholinergics also impair vision. Cataracts are unrelated to Lewy body dementia, although they are common in all older adults

11. A nurse assesses an older adult's color perception. Which of the following colors should the nurse expect the client to have the most difficulty visualizing? A) Blue and violet hues B) Yellow tones C) White and off-white D) Tan and brown wavelengths

Ans: A These age-related changes decrease responsiveness of the lens and increase the diffusion of light rays, resulting in fewer rays reaching the retina. The most detrimental effect occurs with the shorter blue and violet wavelengths

8. An older adult has impaired psychosocial functioning. Which of the following consequences should the nurse monitor? A) Anxiety B) Elevated blood glucose level C) Increased independence D) Resilience

Ans: A Anxiety is a common result of impaired psychosocial function in older adults. It is less likely to result in hyperglycemia and it is not associated with increased independence or resilience, another positive consequence of healthy psychosocial functioning

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

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

4. A nurse teaches a nursing assistant about the impact of culture on older adults' well-being. Which of the following statements by the nursing assistant indicates a need for further teaching? A) "A cultural background has little influence on individuals' standards for 'normal' or 'abnormal' behavior." B) "Western cultures often have a very rigid distinction between health and illness." C) "Culture may influence mental health and illness in individuals." D) "Culture may determine an individual's expression of symptoms or clinical manifestations."

Ans: A Cultural background significantly influences how a person defines all aspects of psychosocial function. It is essential to recognize that every society has standards of behavior. Many societies do not have the rigid distinction between health and illness that Western society does.

10. A nurse leads a "Healthy Aging" class at a community health center. Which question should the nurse use to generate discussion among participants in this setting? A) "How did you adjust to your move from your house to the assisted living facility Irma?" B) "Are you satisfied with the care that you're getting from your family doctor, Elizabeth?" C) "Donald, could you tell us why your grandson is living with you?" D) "Have you had any tests done on your heart since we last met, Marie?"

Ans: A Healthy aging classes are based on the belief that older adults who are beginning to recognize age-related physical and psychosocial changes or who are already dealing with such changes can benefit from sharing their experiences with their peers. Discussion about these adjustments should be the priority in a healthy aging class

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

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

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

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

3. A nurse manager of an extended care facility works to promote psychosocial health. Which of the following interventions should the nurse manager include? A) Adapt the environment to compensate for residents' sensory impairments. B) Dress residents exclusively for ease in going to and from the restroom. C) Plan dining room arrangements according to room and hall assignments. D) Position the residents who are in wheelchairs solely for ease in getting out of the dining area.

Ans: A Table and room arrangements should be made in a way that promotes social relationships. Older adults should be allowed to choose between at least two alternatives when dressing. Residents in wheelchairs should be positioned to promote social interaction

13. A 75-year-old woman who often used to go out to dinner with her friends has stopped from going out because she has been experiencing urinary incontinence and is afraid of having an "accident" in public. When her child asks her why she doesn't go out with her friends anymore, she says, "I'm getting too old for such foolishness." How can the nurse best assist this client? A) Assist the client to view this functional limitation as temporary and treatable. B) Encourage the client to accept this consequence of growing old. C) Rephrase the situation to one of control, and allow the client to make the decisions. D) Teach the client that majority of older adults rate their health as good to excellent.

Ans: A The majority of older adults do rate their health as good, but she doesn't and can't until her issue is reframed to one that she can control. Allowing her to make the decisions is good, but her current decision is to passively and inaccurately accept this treatable condition.

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

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

A nurse performs an assessment on a 93-year-old client. Which of the following assessment findings are age-related changes? (Select all that apply.) A) Ectropion B) Enophthalmos C) Erythematosus D) Eschar E) Exophthalmos

Ans: A, B Enophthalmos is the appearance of sunken eyes and ectropion is when the lower eyelid falls away from conjunctiva, causing decreased lubrication, both of which are age-related changes. Erythematosus refers to the presence of erythema, eschar is the necrotic scab on a wound, and exophthalmos is the protrusion of the eye

15. The nurse assesses an older woman regarding urinary health. Which of the following interview questions are appropriate? (Select all that apply.) A) Do you ever leak urine? B) Do you ever wear pads or protective garments to protect your clothing from wetness? C) Do you have any discomfort or burning when you pass urine? D) How much alcohol do you drink each day? E) When you urinate do you have any difficulty starting the stream or keeping the stream going?

Ans: A, B, C Interviewing older woman for urinary elimination should include the questions about signs and symptoms of infection, leaks, and use of pads. The nurse should ask about how much water and other liquids do you drink during the day? But not assume that this fluid included alcohol. When interviewing men, it is appropriate to ask about starting and maintaining a urine stream

7. A nurse who regularly visits an adult daycare center has noted evidence of a hearing deficit in a man who has no documented history of hearing loss. Which of the following factors should the nurse consider when attempting to ascertain the etiology of the man's hearing loss? (Select all that apply.) A) Genetic factors B) Environmental conditions C) Fluid and electrolyte imbalances D) Ototoxic medications E) Atherosclerosis or thrombotic events

Ans: A, B, D Medications, genetic factors, and environmental factors are all among the many potential contributors to hearing loss in older adults. Fluid and electrolyte imbalances, atherosclerosis, and thrombosis are not commonly implicated in hearing loss among older adults

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

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

3. Which of the following methods can be used to informally assess an older adult's visual skills? (Select all that apply.) A) Ask the person to look out a window and describe certain details. B) Perform a standard confrontation test to assess central vision. C)Place good illumination and ask the person to read printed material with various type sizes. D)Perform a standard vision test, testing each eye separately and allowing the person to cover the other eye with a hand

Ans: A, C Nurses informally assess vision by asking the older adult to read printed material with various type sizes and describing details of a scene at a distance. A standard confrontation test is a gross measurement of peripheral vision fields. With standard vision tests, each eye is tested separately, and one should avoid using the hand as a cover

14. After an older adult has had irrigation for removing impacted cerumen, which of the following interventions would be helpful for preventing a recurrence? (Select all that apply.) A) Ceruminolytic drops as indicated B) Cotton-tipped swabs daily C) Ear candling monthly D) Home oral jet irrigator bimonthly E) Examination by the health care provider every 6 to 12 months

Ans: A, E Prophylactic use of ceruminolytic agents can reduce the risk of impacted cerumen. Those at high risk for impaction should get an examination by qualified health care provider every 6 to 12 months. Teach all older adults to avoid putting anything smaller than their elbow in their ear: this includes candles, oral jets, and swabs. All of these are potentially harmful to the ear

12. A nurse cares for a 92-year-old woman with urinary incontinence. Which of the following agerelated changes is the rationale behind assisting client to the bathroom every 2 hours? A) Decreased estrogen levels B) Degenerative changes in the cerebral cortex C) Demyelination of parasympathetic nerves D) Diminished thirst perception

Ans: B Decreased estrogen levels cause a loss of tone, strength, and collagen support in the urogenital tissues and can predispose the urinary system to leakage problems; but in older adults, degenerative changes in the cerebral cortex may alter both the sensation of bladder fullness and the ability to empty the bladder completely. The degenerative changes in this 91-year-old woman more directly impact the decision to toilet every 2 hours. Younger adults perceive a sensation of fullness when the bladder is about half full, but this occurs at a later point for older adults. Normal aging does not include the demyelination of parasympathetic nerves. Diminished thirst is not impacted by toileting every 2 hours

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

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

13. A nurse assesses a 79-year-old adult noting the presence of a white ring around the iris bilaterally. What is the correct term for this? A) Glaucoma B) Arcus senilis C) Arthritis D) Presbyopia

Ans: B Arcus senilis (also called corneal arcus) is evidenced by the development of yellow or gray-white ring around the iris. Glaucoma is related to pressure changes, not changes to the iris. Arthritis is unrelated to eye health. Presbyopia is an age-related visual acuity change

9. As part of a comprehensive physical assessment of an older adult client, a nurse is performing an otoscopic examination. Which of the following assessment findings most clearly warrants further assessment and possible intervention? A) There is a small amount of cerumen visible in the ear canal. B) The epithelial lining is bright red. C) The tympanic membrane is intact. D) The tympanic membrane is a pearl-gray color

Ans: B Bright red epithelial lining in the ear is an abnormal finding; the lining should be pinkish white. A small amount of cerumen and an intact, pearl-gray tympanic membrane are expected findings

7. A 69-year-old woman is saddened by her recent diagnosis of type 2 diabetes, which is a stressor that will make numerous demands on her life in the coming years. Which of the following actions demonstrates a problem-focused approach to this stressor? A) Eliciting support and sympathy from her sister and neighbor B) Obtaining diabetic cookbooks and learning to change her cooking habits C) Seeking out a second opinion from another physician D) Deciding to make no lifestyle changes despite her new diagnosis

Ans: B Making tangible changes to address a problem, such as changing lifestyle to accommodate a new diagnosis, demonstrates a problem-focused approach to coping. Seeking support is emotion focused and seeking a second opinion is not necessarily a solution

4. A nurse notes that a client who has heart failure could hear well during the last home visit, and is having difficulty hearing today. Which of the following laboratory findings is most likely associated with impaired hearing? A) Albumin of 4.1 B) Creatinine of 4.2 C) Potassium of 4.3 D) Sodium of 144

Ans: B Older adults with heart failure are at increased risk for hearing loss caused by medications (e.g., diuretics) and decreased renal and cardiac perfusion. Normal levels of albumin, potassium, and sodium are not associated with hearing loss

5. A nurse knows teaching has been effective when the client states the following: A)"If my sensitivity to glare decreases and my contrast sensitivity increases, I will be evaluated for cataracts." B)"I wear sunglasses and a wide-brimmed hat when I am in the sun to protect my eyes and prevent the development of cataracts." C)"Having Alzheimer disease increases one's risk of developing macular degeneration." D)"If I take ototoxic medications, this will increase my risk for developing cataracts."

Ans: B Protecting one's eyes from sunlight is a health promotion intervention for preventing cataracts. Cataract symptoms include increased sensitivity to glare and decreased contrast sensitivity. Individuals with Alzheimer disease may have impaired contrast sensitivity and other visual impairments, but not an increased risk of developing macular degeneration. Ototoxic drugs will damage the auditory nerve; they do not affect the optic nerve or vision

11. A gerontological nurse presents at a local conference regarding recent findings in age-related hearing loss. Which age-related changes indicated in hearing loss and speech perception should the nurse include? A) Changes to the external auditory canal and pinna B) Degenerative changes to the auditory brainstem C) Growth of longer and thicker hair in the ear canal D) Thickening of the tympanic membrane

Ans: B Studies suggest that central auditory structures (e.g., primary auditory cortex and auditory brainstem) account for a significant component of hearing loss in older adults, particularly with regard to speech perception. The external ear changes that occur with normal aging are not directly related to hearing loss (including hair growth in men). The tympanic membrane thins and stiffens with age

5. An 85-year-old woman who lives alone says to the nurse, "There is nothing I can do about my hearing. I am 85 years old, and I am not really interested in listening to television programs anymore." Which of the following would be the nurse's best response? A)"You are lucky you still live alone at 85, and I understand why you don't care about the programs on television." B)"Have you talked with your health care provider about a hearing evaluation? This would determine the problem and possible solutions to it." C)"I know a hearing aid dealer who offers free testing. Have you thought about trying a hearing aid?" D)"Did you know that there are closedcaption television sets that would allow you to enjoy some shows?"

Ans: B The first step would be to determine what the problem is. Free testing is not comprehensive in its evaluative scope. Telling the client she is lucky to be living alone at 85 years of age is nontherapeutic communication and suggesting that the woman use closedcaption television does not address the hearing issue.

7. After a scheduled trip to her optometrist, a 70-year-old has been told that the pressure in her eye is high and she needs to be monitored and treated to prevent damage to the optic nerve. What is this person's diagnosis? A) Cataracts B) Glaucoma C) AMD D) Presbyopia

Ans: B The term glaucoma refers to a group of eye diseases in which the ganglion cells of the optic nerve are damaged by an abnormal buildup of aqueous humor in the eye. Increased intraocular pressure is not implicated in the development of cataracts, AMD, or presbyopia

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

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

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

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

4. A nurse teaches an older adult man to perform pelvic floor muscle exercises (PFME)? Which of the following should be included in a nurse's instructions? A) Interrupt the flow of urine several times each time you urinate. B) Identify the correct muscle by making the base of your penis move up and down. C)Contract your legs and buttocks while contracting the pubococcygeal muscle. D) Perform the exercise while standing over the toilet

Ans: B An important element of teaching about pelvic floor exercises is to identify the pubococcygeal muscle and practice contracting and relaxing this muscle. For men, this can be done by raising the base of the penis. Once the muscles have been identified, do not continue to stop urinary flow. These exercises can be performed sitting, standing, or lying down. Keep legs, buttocks, and abdomen relaxed

11. An 81-year-old is admitted to the hospital for congestive heart failure. The client is widowed, and the medical staff and client are talking about the client moving to an assisted living facility. Which of the following interventions by the nurse best creates a wellness opportunity? A) Ask the client to explain how cares have been accomplished at home. B) Assist the client to discuss the feelings associated with a potential move to assisted living. C) Describe the options for long-term housing with the client. D) Encourage the client to think positively about this move.

Ans: B Nurses promote wellness by asking older adults to talk about the meaning of life events that they have experienced. Asking about how cares have been accomplished does not assist the client. Nurses promote psychosocial wellness by encouraging older adults to express their feelings about decisions (not tell them how to feel) and help them identify effective ways of coping, even when they are not happy about the decision.

1. A 75-year-old woman who often used to go out to dinner with her friends has stopped going out because she has been experiencing urinary incontinence and is afraid of having an "accident" in public. When her child asks her why she doesn't go out with her friends anymore, she says, "I'm getting too old for such foolishness." Her child asks her to go to the doctor for an evaluation, but she refuses to do so. Which of the following is occurring with this older adult? A) She is experiencing learned helplessness and low self-efficacy. B) She sees incontinence as an inevitable consequence of aging. C) She views her incontinence as a negative functional consequence of aging. D) Her doctor is sympathetic; however, the woman and the doctor are unable to find a solution

Ans: B Older adults may use a passive, emotion-focused coping mechanism and try to simply accept the situation. When older adults view functional decline as an inevitable consequence of aging, they are less likely to seek help for some treatable problems.

11. A nurse assesses an older adult 24 hours after a retropubic suspension surgical procedure. The client is confused, exhibits muscle twitching, and states she is nauseated. Which laboratory data should the nurse assess? A) Blood urea nitrogen B) Sodium C) Hemoglobin D) White blood cell count

Ans: B Older adults will more readily develop hyponatremia especially under conditions of physiologic stress (e.g., surgery). The concern is hyponatremia not hemoglobin, or blood urea nitrogen. An UTI increasing the neutrophil count might also impact the sodium level; however, the symptomology exhibited is hyponatremia.

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

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

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

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

14. A nurse admits an 81-year-old to the hospital for congestive heart failure. The client is widowed, and has recently moved to an assisted living facility. Which of the following contributed the most to this admission? A) Moving changed her daily habits. B) Her age-related changes and risk factors increased. C) The stress of widowhood and relocation stressed her body. D) The assisted living facility serves food high in saturated fats

Ans: B There is a strong connection between chronic stress and health. Studies find that chronic stress increases the risk for onset of major illnesses and exacerbation of chronic illnesses.

8. An 89-year-old woman has developed urinary incontinence. The woman states, "When I have to go, I go. I can't make it to the bathroom before it leaks out." For which type of incontinence should the nurse develop a plan of care? A) Functional incontinence B) Urge incontinence C) Mixed incontinence D) Stress incontinence

Ans: B Urge urinary incontinence is characterized by involuntary urinary leakage due to the inability to hold urine long enough to reach a toilet after perceiving the urge to void. Functional incontinence is urination due to inability to reach appropriate toileting facility. There is no indication that she has functional impairment. Stress incontinence is leakage of urine as a result of an activity that increases abdominal pressure. Mixed incontinence is the involuntary leakage of urine with both the sensation of urgency and activities such as coughing, sneezing, and exertion

1. A nurse develops a plan of care for a family with nursing diagnosis of Caregiver Role Strain related to urinary incontinence. Which of the following interventions is the highest priority? A) Administer diphenhydramine at bedtime. B) Assist the client to the bathroom prior to bedtime. C) Limit the fluid intake of the client to 1000 mL each day. D) Monitor bowels for diarrhea and constipation

Ans: B Walking the client to the bathroom encourages voiding prior to bedtime. Urinary incontinence is a major factor that impacts placement in an institution. Fluid intake should be carefully timed and should be about 2,000 mL per day. Diphenhydramine relaxes bladder muscles, which can lead to urinary retention and incontinence

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

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

10. Following a prolonged hospital stay due to an exacerbation of congestive heart failure, an older adult woman has returned to the nursing home where she normally resides. The woman became incontinent of urine during her time in the hospital, a problem that nursing staff wish to now resolve. What action should her caregivers take in performing continence training? A) Limit the woman's fluid intake to 750 mL daily, primarily before suppertime. B) Assist the woman with toileting at timed intervals throughout the day. C) Teach the woman about the functional and psychosocial benefits of restoring continence. D) Perform intermittent catheterization before each meal and before bedtime

Ans: B With caregiver-directed methods of continence training, the caregiver uses the initial assessment of voiding patterns to establish a schedule for assisting with voiding. The caregiver gradually increases the interval between voidings until the person can maintain continence for 2 to 4 hours. Fluid restriction to 750 mL per day is inadequate to maintain hydration, and intermittent catheterization does not promote continence. Education is a component of continence training, but individuals are not likely to need to be informed of the benefits of continence

12. A community health nurse presents a class on "Aging in America: Living the Dream." Which of the following should the nurse stress when discussing retirement? (Select all that apply.) A) Delaying retirement until unable to work can be beneficial. B) Factors such as health, friendship relationships, and resources influence the transition. C) Sometimes the adjustment is more difficult for the partner who has not been employed. D) The adjustment to retirement is best accomplished quickly and with finality. E) A strong work ethic assists in the adjustment to retirement.

Ans: B, C Factors such as health, family and friendship relationships, and economic and social resources influence the transition. Sometimes the adjustment is more difficult for the partner who has not been employed. Work ethic in society can diminish the retirees' status, delay of full retirement can assist with the transition, and delay in retirement is best done in a gradual manner (changing to part time, becoming self-employed).

4. Which of the following are crucial when assessing visual function in an older adult? (Select all that apply.) A) Asking the older adult to read the fine print on a medicine bottle without a magnifying aid B) Asking the older adult whether he or she can drive without difficulties at night C) Observing the older adult functioning in his or her normal environment D)Observing the older adult while he or she is reading a newspaper without glasses

Ans: B, C The nurse should observe the older adult's usual pattern of activities. These observations are best made in the person's usual environment and address the person's ability to carry out activities. Older adults who report difficulty driving at night may have cataracts or other visual impairments.

6. A nurse instructs a class of older adult women about Kegel exercises. In which of the following urinary conditions would Kegel exercises be effective? (Select all that apply.) A) Functional incontinence B) Pelvic organ prolapse C) Stress incontinence D) Urge incontinence E) Urinary retention

Ans: B, C, D Pelvic floor muscle exercise (PFME) is an evidence-based practice that is effective as a first-line intervention for men and women with stress, urge, and mixed incontinence and in women with pelvic organ prolapse. Functional impairments are a major risk factor for the development of incontinence because they can interfere with the ability to recognize and respond to the urge to void in a timely manner. Because older adults have a shorter interval between the perception of the urge to void and the actual need to empty the bladder, any delay in reaching an appropriate receptacle can result in incontinence

6. A nurse assists adults to prepare for the changes that often occur in late adulthood. Which of the following psychosocial consequences occur because of life events during that period? (Select all that apply.) A) A broadening of social networks B) Adjusting to relocation from home C) Adjustment to a lower income D) Adaptation to chronic illnesses E) Coming to terms with one's mortality

Ans: B, C, D, E The life events of late adulthood have profound psychosocial ramifications, including reduced income, acknowledgment of mortality, relocation from home, and chronic illness. Social networks typically shrink rather than expand

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

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

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

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

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

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

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

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

10. A nurse has been caring for an 83-yearold resident of a nursing home for 2 years and has developed a high level of trust with the resident. Which of the following recent changes in the resident's behavior may signal the possibility of hearing loss? A) The resident's statements occasionally suggest that he is not oriented to time. B)The resident had a recent episode where he became visibly angry at a nursing assistant. C) The resident's attention span is short and he is easily distracted. D) The resident has become increasingly disagreeable and terse in his demeanor

Ans: C Short attention span and easy distractibility are indicators of hearing loss. Aggression and agitation more often suggest alternative etiologies, such as neurologic health problems

1. A 62-year-old who has worked on an assembly line since he was 24 years old began taking aspirin for arthritis 6 months ago. The client presents to the nurse with hearing problems and ringing in the ears. Which of the following problems should the nurse suspect? A) Tinnitus B) Vertigo C) Ototoxicity D) Impacted cerumen

Ans: C The older adult has symptoms of ototoxicity. Aspirin is a known ototoxic drug. Tinnitus is the persistent sensation of ringing in the ears, which is one of this client's symptoms. Vertigo is a sensation of motion, which is not a reported symptom for this client. Although common, impacted cerumen would not lead to ringing in the ears.

2. A new nursing assistant asks the nurse how best to approach a hearingimpaired older adult. Which of the following approaches should the nurse recommend? A) Raise the volume of your voice. B) Leave the radio on to calm the older adult. C) Lower the tone of your voice. D) Use exaggerated lip movements.

Ans: C Communication interventions for the hearing impaired should aim at clarity of words. This is accomplished by slowing the rate of speech and eliminating environmental noise and distractions. When communicating, lower the tone while speaking in a moderately loud voice

9. A 78-year-old client states, "I often have dry eyes, it is bothersome and irritating." What intervention should the nurse recommend? A) Daily rinses with tap water B) A medication vacation to determine if medications are the cause C) Use of over-the-counter artificial tears D) Keeping eyes closed for 3 to 5 minutes each hour

Ans: C For most older adults with dry eyes, the use of over-the-counter artificial tears or ocular lubricants usually will relieve symptoms. It would be inappropriate for the nurse to independently recommend a cessation of medication. Rinsing with tap water and keeping the eyes closed are not recommended interventions

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

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

12. The Functional Consequences Theory approach to hearing loss identifies health promotion interventions for promoting hearing wellness. Which of the following interventions will most directly affect auditory health of the older adult? A) Avoidance of medications B) Regular colonics C) Smoking cessation D) Ear muff use in winter

Ans: C Reviews of studies identified the following risk factors for hearing impairment: male gender, increased age, genetic predisposition, exposure to noise, impacted cerumen, smoking, exposure to secondhand smoke, use of ototoxic medications, education level less than or equal to high school diploma, and certain medical conditions. Colonic use and ear coverage for warmth have not been identified as risk factors to hearing loss

3. A nurse is teaching a group of hearingimpaired nursing home residents about hearing aids. Which of the following points should the nurse emphasize? A) It is not necessary to use the hearing aid for one-on-one conversations. B) The hearing aid should be used only in the dining room or social area. C) While inserting the hearing aid, make sure the volume is turned off. D) If whistling is heard, the volume of the hearing aid may need to be increased

Ans: C The hearing aid should be inserted with the volume off with the canal portion pointing into the ear. A hearing aid should be used for one-on-one conversation and should not be used in a dining room where there is background noise. If whistling is heard, the volume should be decreased

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

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

2. A nurse presents at a conference regarding functional consequences related to urinary elimination. Which of the following statements should the nurse include? A) "Most older women will develop urinary incontinence by the age of 85." B) "Most older adults will experience hypertrophy and relaxation of muscles in the urinary tract and pelvic floor." C) "Excretion of penicillin and cimetidine are decreased in older adults." D) "Healthy older adults experience an increase in glomerular filtration rate."

Ans: C Age-related changes in kidney function can impact water-soluble medications that are highly dependent on the glomerular filtration rate. This would include digoxin, penicillin, aminoglycosides, and cimetidine

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

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

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

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

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

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

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

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

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

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

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

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

13. A nurse administers medications to older adults in a long-term care facility. Which of the following actions is most appropriate when the client with dementia is newly prescribed an antimuscarinic agent for urge urinary incontinence? A) Administer with a full glass of water B) Assess the client for drooling and diarrhea C) Monitor the client closely for worsening cognitive impairment D) Toilet the client before administering the medication

Ans: C Antimuscarinic agents are used for urge urinary incontinence. Oxybutynin is the medication most commonly associated with cognitive impairment, but all antimuscarinic agents need to be used with caution in older adults with preexisting dementia. These medications have the same adverse effect profile as other anticholinergics, such as dry mouth, constipation, blurred vision, and mental changes. There is no need to toilet before, water is important, but cognition is the priority

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

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

6. A nurse has noted that most of the residents who live at the long-term care facility require corrective lenses of some type. Which of the following age-related changes contributes to the loss of visual acuity? A) Decreased size and density of the lens B) Increased intraocular pressure C) Presence of floaters in the vitreous D) Decreased responsiveness of the ciliary body

Ans: D Because of age-related changes, the ciliary body gradually becomes smaller, stiffer, and less functional. Although floaters may occur, they do not affect visual acuity. Increased intraocular pressure is a pathologic process in individuals of any age. The lenses increase, not decrease, in mass.

15. A home care nurse teaches a caregiver about the care of hearing aids. Which of the following statements, if made by the caregiver, indicates that further teaching is required? A) "I lay a towel over the table while working on them." B) "I turn off the aid before I change the battery." C) "I wash the earmold with warm soapy water each week." D) "I have purchased enough batteries to last a year."

Ans: D Care of hearing aids includes to keep a fresh battery available but to not purchase batteries more than 1 month in advance. Turn off the hearing aid before changing the battery. Clean the aid weekly, using warm, soapy water for the earmold. And avoid dropping the aid on a hard surface; when handling it, keep it over a soft or padded surface

8. The incidence of hearing loss in a longterm care facility is high, especially among white men. What strategy should care providers adopt when communicating with older adults who have hearing loss? A)Use less complex concepts when communicating with hearing-impaired older adults. B) Use a high, consistent tone and pitch when speaking to adults with hearing loss. C)Speak at a high volume directly into the less affected ear when talking to an older adult with a hearing deficit. D)Make eye contact before and during a conversation with hearing-impaired adults.

Ans: D Eye contact helps facilitate communication with individuals who have hearing loss. It is unnecessary, and likely inappropriate, to simplify the content of conversations, and a low tone is more beneficial than a high tone. It is not normally necessary to speak directly into the ear of the older adult

2. A nurse is providing an educational program about age-related macular degeneration (AMD) to a group of older adults. Which of the following statements by an older adult indicates the need for further teaching? A) "Smoking is a risk factor for AMD." B) "Macular degeneration causes a loss of central vision." C)"People with macular degeneration should have any sudden changes evaluated." D) "The dry type of macular degeneration occurs rapidly."

Ans: D The dry type of AMD progresses slowly and does not cause total blindness. The wet type of macular degeneration develops rapidly and causes visual loss. Smoking is a risk factor for macular degeneration. As AMD progresses, it affects central vision. People with AMD should have any sudden changes evaluated

5. A nurse administers medications to an older man. Which of the following statements if made by the client indicates understanding of the use of tamsulosin? A) "I am so happy that this medication is working to decrease my urinary incontinence." B) "I now have had much less bladder pain and cramping." C) "My blood pressure has been higher since taking this medication." D) "My urine flow starts much faster now."

Ans: D Alpha-blockers or 5-alpha reductase inhibitors are used for prostate enlargement and bladder outlet obstruction: alfuzosin, doxazosin, dutasteride, finasteride, tamsulosin, and terazosin. Alpha-blockers decrease blood pressure, do not impact bladder pain, and are not generally used to treat urinary incontinence.

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

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

14.A home care nurse evaluated the plan care for the older woman with urge incontinence. Which of the following statements by the client indicates the need for further teaching? A) "I drink enough water, but do it early in the day." B) "I make certain I don't get constipated." C) "I purchased a fancy commode for my bedroom." D) "I still have to get up two times each night to urinate."

Ans: D Feedback: It is normal for older adults to urinate once or twice during the night. Water should be consumed hours before bedtime, a commode can reduce the time from sensation to void, and constipation can increase incontinence

9. A nurse in a long-term care facility organizes a "Healthy Aging" class for residents. Which activity should be prioritized during these classes? A) Present tools that residents can use to develop better psychosocial health. B) Role-play responses to life events that may occur in their near future. C) Assess group members' strategies used to deal with life events. D) Discuss coping strategies helpful in adjusting to challenges of aging.

Ans: D Healthy aging classes are based on the belief that older adults who are beginning to recognize age-related physical and psychosocial changes or who are already dealing with such changes can benefit from sharing their experiences with their peers. Such classes are not primarily a venue for assessment or for role-play. Teaching is best performed by having the members share

2. An older woman returns to her hospital room after abdominal surgery. As the nurse completes her assessment, the client asks the nurse to pin her "prayer cloth" to her pillow. Which of the following interventions is priority? A) Say, "I will pin it on your pillow in a couple of hours after you are stable." B) Ask, "What is the purpose of a prayer cloth? Did you make it?" C) Ask, "What religion do you practice? Did your minister give the prayer cloth to you?" D) Pin the prayer cloth to her pillow since it is an essential part of her spiritual health.

Ans: D In this case, following the client's wishes is an integral part of routine nursing care, as it helps individualize nursing care to this particular client. The nurse must be nonjudgmental and communicate respect for the client's individuality.

9. A 79-year-old man was admitted to the hospital for knee arthroplasty (replacement) due to osteoarthritis. During recovery, he developed postoperative pneumonia and became incontinent of urine while recovering from this serious infection. While being treated on the acute medicine unit, he remained in bed for several days. This client's urinary incontinence and other health challenges are most likely to result in what nursing diagnosis? A) Social isolation B) Disturbed body image C) Anxiety D) Impaired skin integrity

Ans: D Limited mobility coupled with urinary incontinence creates a risk for skin breakdown, especially among older adults. Social isolation, disturbed body image, and anxiety are also realistic possibilities, but these are less likely in an acute care setting.

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

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

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

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

A nurse gives a presentation regarding eye health at a wellness clinic. Which of the following interventions should the nurse include in the teaching? A) Avoid reading under halogen lights B) Cardiovascular exercise three times a week C) Get 8 to 10 hours of sleep each night D) Wearing sunglasses with UV-absorbing lenses

Ans: D Poor nutrition, cigarette smoking, and exposure to sunlight are associated with the development of eye diseases. Poor lighting and exposure to sunlight are risk factors that can readily be addressed through simple self-care practices