Eliopoulos - Gerontological Nursing 8th Ed - The Aging Population CH 1, Eliopoulos - Gerontological Nursing 8th Ed - Diversity CH 3, Eliopoulos - Gerontological Nursing 8th Ed - Theories of Aging CH 2, Eliopoulos - Gerontological Nursing 8th Ed - Com...

Origin: Chapter 12- Sexuality and Intimacy, 5 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/learning Objective: 3 Page and Header: 150, Age-Related Changes and Sexual Response 5. The nurse manager overhears health care providers make inaccurate comments about the sexuality of older patients. Which comment should the nurse correct or follow up with teaching?

A) "Overall, sex takes longer for older men than younger men." B) "Older people are less sexually responsive than young people." C) "Both men and women have orgasms less often than younger people do." D) "Sexual intercourse is usually not physically possible for older women because vaginal lubricant production ceases with menopause." Ans: D Feedback: Though decreased lubrication can result in dyspareunia for older women, lubricant production does not completely cease at menopause and it would be inaccurate to generalize that sex is usually not possible physically. Sex does take longer for older men than younger men. Older people are less sexually responsible than younger people. There is a reduction in orgasm in older people.

Origin: Chapter 13- Spirituality, 6 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 163, Assessment Guide 13-1 6. An older patient just learning of having a terminal illness begins to cry. Which statement or question should the nurse make to facilitate the patient's spiritual health?

A) "Remember that everything in life, even the bad things, happens for a reason." B) "Is there anything in your spiritual beliefs or practices that might bring you comfort at this time?" C) "It's not appropriate for me to pray with you, but would you like me to arrange a visit from the chaplain?" D) "It's likely best for you to try to focus on what is going right in your life, even though that's likely hard right now." Ans: B Feedback: Asking the patient how spiritual needs can be supported is a recognized component of spiritual assessment and acknowledges the patient's spiritual needs while still letting the patient direct the process. Making off-hand statements such as things happening for a reason and encouraging the patient to focus on the good things in life would be inappropriate at this time. It is not inappropriate for a nurse to pray with a patient when circumstances allow.

Origin: Chapter 13- Spirituality, 10 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 162, Forgiveness 10. An older male patient admits to doing many things in life that he is not proud of and is having a difficult time getting them out of his mind. How should the nurse respond to the patient's statement?

A) "Remember that no one has lived a perfect life." B) "Is there anyone that you might want to ask forgiveness from?" C) "Is there anything I can do to help you focus on more positive things?" D) "Do you think that you were really any worse than most other people?" Ans: B Feedback: Seeking forgiveness can be a powerful tool in attaining spiritual health. Urging comparison to others is inappropriate and attempting to change the patient's focus to more positive subjects is not an appropriate intervention.

Origin: Chapter 15- Rest and Sleep, 4 Chapter: 15 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 187, Nocturnal Myoclonus and Restless Leg Syndrome 4. An older patient is experiencing restless legs that are interfering with sleep. What should the nurse respond to this patient's problem?

A) "Some people find that daily exercise helps with this problem." B) "Most often restless legs can be traced to a deficiency in dietary calcium." C) "There are prescription drugs that nearly always provide relief from this problem." D) "There are a number of different medications that can cause this problem or make it worse." Ans: D Feedback: Antidepressants, antihistamines, antipsychotics, alcohol, caffeine, hypoglycemia, and simple and refined carbohydrates can contribute to restless legs syndrome. Exercise and medications are not noted to provide a solution and calcium is not noted to be implicated in the etiology.

Origin: Chapter 14- Nutrition and Hydration, 3 Chapter: 14 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 175, Nutritional Supplements 3. During a home visit, the nurse is asked by an older couple if vitamin and nutritional supplements can compensate for poor food intake. What should the nurse respond to this question?

A) "Supplements can be useful but avoid those that contain calcium." B) "The risks of excess dosages mean that supplements are best avoided entirely." C) "Supplements should be thought of as supplements, not replacements, so it's best not use them." D) "Vitamin and nutrient supplements can be a useful short-term nutritional measure, but only if they don't interact with prescribed medications." Ans: D Feedback: There is a valid role for supplements in meeting the nutritional needs of older adults, but the risk of medication interactions must be taken into account. It would be unnecessary to recommend complete avoidance of all supplements or of those that contain calcium.

Origin: Chapter 14- Nutrition and Hydration, 1 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs Even though a nursing assistant notices that an older patient's oral intake has been poor since being admitted to the care area, the assistant is not concerned since "older people don't need to eat much anyway." How should the nurse respond to this assistant's comment?

A) "That's a myth actually; older adults have increased caloric and nutritional needs." B) "Actually, older adults who are sick require more calories than younger people do during their recovery." C) "You're right, but it's still important that we provide vitamin supplements especially when a patient is recovering from an illness." D) "Even though it is true that older people don't need quite as many calories as younger people, they need as many nutrients as you or I." Ans: D Feedback: While caloric need does decrease with age, nutrient requirements are relatively consistent across the life span. Older adults do not have increased caloric and nutritional needs. Older adults who are sick do not necessarily require more calories since the basal metabolic rate declines 2% for each decade of life. Vitamin and mineral supplements for older adults are undetermined.

Origin: Chapter 36- Acute Care, 6 Chapter: 36 Client Needs: D2 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 2 Page and Header: 485, Preoperative Care Considerations 6. A nurse is conducting a preoperative assessment of a 76-year-old patient who will be having a transurethral prostatic resection later that day. The patient's wife is concerned about maintaining the patient's medication regimen, stating, "He takes a lot of pills and it's important that he gets them while he's in the hospital." How can the nurse best respond to the wife's concern?

A) "The care team will look at his medications and only hold those that can safely be stopped." B) "You're right that it's important, and they'll be continued throughout his stay in the hospital." C) "His medications will have to stop while he's being held without food, but we will restart them as soon as possible." D) "In light of his surgery, your husband probably will not need any of the medications that he used to require." Ans: A Feedback: Some medications need to be continued in spite of a patient's NPO status; these should be identified by the team and continued. Other medications can be temporarily held without significant risk to the patient. It would be inaccurate to assure the wife that all the husband's medications will continue, that they will be unnecessary, or that they will all be held.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 5 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Communication and documentation Objective: 3 Page and Header: 457, Goals for Chronic Care 5. A homecare nurse has begun providing care for an older adult male in the community who has recently been diagnosed with type 2 diabetes. The nurse is responsible for creating a care plan for the client and has consequently identified a number of goals for his care. Which of the following goals of care is most in need of reexamination or modification?

A) "The client will gain the knowledge and skills necessary to manage his diabetes independently and effectively within 3 months." B) "The client will remain free of common complications of diabetes." C) "The client will maintain a high quality of life despite his diabetes." D) "The client will no longer require blood sugar monitoring or oral antihyperglycemic medications within 12 months." Ans: D Feedback: While answers A, B, and C stress the management of the condition, freedoms from complications, and a high quality of life, answer D essentially makes curing the disease the goal.

Origin: Chapter 14- Nutrition and Hydration, 4 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 176, Special Needs of Women 4. An older woman asks what she can do to reduce the risk of developing osteoporosis. What should the nurse respond to this patient?

A) "The key to preventing osteoporosis is to remain physically active on a regular basis." B) "For women who have complete menopause, vitamin D supplements are the best form of prevention." C) "The best thing that you can do is to maximize your calcium intake by including dairy at most meals and taking supplements as well." D) "You need to make sure you are getting the recommended daily dose of calcium, which may involve taking supplements at each meal." Ans: D Feedback: Postmenopausal women need to ensure a daily intake of calcium of at least 1 g. Supplements may be required. It would be inaccurate to encourage the woman to consume as much calcium as possible given the risks associated with excess calcium intake. Neither vitamin D supplementation nor exercise is the primary preventative measure for the development of osteoporosis.

Origin: Chapter 12- Sexuality and Intimacy, 3 Chapter: 12 Client Needs: D3 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/learning Objective: 2 Page and Header: 146, Symptom Management and Patient Education 3. A female patient asks about using hormone replacement therapy (HRT) for menopausal symptoms but is concerned about the risks. How can the health care provider best guide the patient decision to begin or forego HRT?

A) "The significant increases in the risk of heart disease make HRT a risky treatment that is best avoided." B) "You won't likely be increasing your risk of heart disease if you begin HRT, but neither will you be preventing." C) "The overall effectiveness of HRT in alleviating the unwanted changes that following menopause has been disproven." D) "HRT can best be described as a tradeoff, where menopausal symptoms decrease but there is a significantly increased risk of hip fractures and breast cancer." Ans: B Feedback: Although women can feel reassured that they are not increasing their risk for cardiovascular disease by using hormones to treat symptoms as they go through menopause, it is not wise to extrapolate from the data that women should take hormones for the prevention of heart disease. HRT is not noted to increase the risk of breast cancer or hip fractures, while the effectiveness at relieving symptoms of low estrogen is significant. The health care provider would be unlikely to categorically rule out HRT as a treatment option, but would more likely weigh the potential risks and benefits with the client.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 19 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 464, Impact of Ongoing Care on the Family 19. The daughter of an 80-year-old female patient with a diagnosis of severe ischemic heart disease has been her mother's sole care provider for over a year. The daughter is tearfully telling the homecare nurse about the onerous burden that she bears by struggling to meet her mother's ever-increasing needs. How can the nurse best respond to the daughter?

A) "There are promising new treatments for heart disease that hold a great potential for your mother." B) "It's very normal for you to feel this way, given how much you do for your mother; perhaps we can explore other living options together." C) "It sound like it is probably time to place your mother into long term care." D) "This must be difficult for you; many others in a circumstance similar to yours find it useful to remind themselves of how much their parents did for them when they were young." Ans: B Feedback: Answer B acknowledges the family members burden and tactfully introduces alternatives in a way that is more respectful than in answer C. Answer A overemphasizes curing rather than the daughter's burden of responsibility and answer D is likely to foster guilt rather than a solution.

Origin: Chapter 36- Acute Care, 4 Chapter: 36 Client Needs: D1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 485, Figure 36-1 4. Nurse R is providing care for a 71-year-old woman who has been admitted to the surgical unit following her post-anesthetic recovery from a bilateral mastectomy. The patient has been physically stable but disoriented to place and time since admission, but the nurse knows that a history of dementia is noted in the patient's chart. The patient's daughter is distraught, however, because "mom was always just a bit forgetful, but nothing at all like this." What would be the most appropriate response by the nurse?

A) "If your mother already has dementia, her confusion is to be expected." B) "It is nothing for you to worry about, most elderly persons are forgetful." C) "Delirium can also cause an alteration in mental status and can be caused from a new environment, altered level of consciousness, excess stimuli, adverse drug reactions, and physiologic disturbance, all which your mother has likely experienced as a result of her hospitalization and surgery." D) "Are you blaming us for your mother's confusion?" Ans: C Feedback: Answer C is the best response because it informs the patient's daughter about what may be occurring with her mother. The daughter has stated that the mother is usually a bit forgetful but not like she is now. This means that the daughter has noticed a difference, which may be attributable to delirium instead of the dementia that the patient already has. Not all elderly persons are forgetful and this does not address the patient's daughter's concern. Answer D is defensive and the patient's daughter has not made any accusations.

Origin: Chapter 1- The Aging Population, 6 Chapter: 1 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 8, Health Status 6. A care aide employed on a geriatric medicine unit of a hospital expresses frustration that "old people get sick so much more often than young people." What is the nurse's most appropriate response to this statement?

A) "In fact, the prevalence of obesity and accompanying chronic illnesses mean that young people actually have more chronic conditions than older adults." B) "It's actually a myth that older adults require more hospitalization than young people." C) "Actually, older adults experience fewer acute illnesses than younger people, it's just that they tend to take longer to recover from them." D) "With the increase in life expectancies in recent years, most older people actually live free of chronic diseases until very late in life." Ans: C Feedback: The incidence of acute illness is lower among older adults than younger adults, though recovery times tend to be longer. Older adults tend to have a higher incidence of chronic illness and require more frequent and longer hospitalizations.

During a health promotion class a group of older adults ask the nurse to teach them measures that they can take to foster neurologic health. What should the nurse tell the group?

"Quitting smoking and maintaining a healthy body weight can cut your risk of neurological diseases."

The son and daughter of an 80-year-old woman have expressed concern to the nurse that their mother has become impatient and irritable since her stroke earlier in the year. How should the nurse best respond to the children's concerns?

"This is not uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality.

During a health promotion seminar, a nurse is teaching a group of older adults at a senior center about some of the normal changes that accompany the aging process. Which of the following statements about the effects of aging on the nervous system is most accurate?

"Your brain becomes smaller as you age and this affects how quickly older adults react."

A 79-year-old male patient has a number of health problems, including Parkinson's disease. Which of the following signs and symptoms would the nurse attribute to the client's diagnosis of Parkinson's disease? (Select all that apply)

1.The patient moves slowly and has poor balance. 2.The client shuffles when walking. 3.The patient's face is less expressive than when healthy. 4.The patient is emotionally unstable.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 8 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication and documentation Objective: 4 Page and Header: 117, Measures to Help Nurses Make Ethical Decisions 8. Which of the following statements that nurses on a hospital unit made about ethical decision making is most accurate?

A) "Instead of making ethical decisions in isolation we should enlist the help of people like ethics committees and clergy." B) "We should ensure that contributors to our ethical decision making have direct experience with the types of hands-on care we provide." C) "Decisions that we make involve complex realities so we have to avoid specific philosophies of ethics." D) "The need for confidentiality means that we shouldn't be discussing particular ethical issues with anyone other than patients themselves." Ans: A Feedback: Ethical decision making should include individuals apart from the situation, including ethics committees, lawyers, and clergy, many of whom will not have direct health-care experience. Specific philosophies of ethics can provide a useful framework for decision making.

The nurse presents at a seminar on neurologic health issues in older adults. Which of the following data should the nurse include in the presentation?

A low body mass index reduces the risk of neurovascular disease.

18. A statistical analysis of City Health Clinic's patient base shows that few of its patients are elderly Asian Americans. Nurse K, a second-generation Asian American, offers a probable cause for this phenomenon. She knows that Asian American groups, though different from each other: A)Value a strong family network and expect that family members will care for their elders at home B) Subscribe to traditional health practices and reject modern technology C) Do not express their feelings openly or challenge the health professional D) Have preserved many of their homeland traditions and tend to live in isolated pockets

A) Ans: A Feedback: Although differences among various Asian American groups exist, two similarities are strong family networks and the expectation that family members will care for their elders at home. They do not necessarily reject modern technology and neither reluctance to express feelings nor the tendency to preserve traditions would account for the phenomenon noted.

Origin: Chapter 1- The Aging Population, 10 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Teaching/learning Objective: 3 Page and Header: 8, Health Status 10. Which of the following statements by the daughter of an 87-year-old resident of a nursing home would the nurse most likely want to correct or clarify?

A) "It seems like more and more people are living well into their 80s like my mom." B) "My mom has a house worth loads of money but little cash flow, like many older adults." C) "It seems like heart disease is getting more common even though people live longer than they used to." D) "There are more women living to my mother's age than there are men." Ans: C Feedback: The incidence of heart disease as a cause of death is on the decline. More Americans are indeed achieving old age and many older adults have valuable assets but little cash flow. Female longevity continues to exceed that of males.

Origin: Chapter 5- Common Aging Changes, 8 Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 64, Memory 8. A care aide at a long-term care facility has assured the family of a resident that their father's increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide's statement to the family?

A) "It's actually a myth that older people experience changes to their memory." B) "Memory losses are a normal age-related change many people experience." C) "Older adults have less working memory and slower retrieval, but this still requires further assessment." D) "There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia." Ans: C Feedback: Older adults often experience delays in retrieval of memories and working memory. Some changes in memory, even in the absence of delirium or dementia, are to be expected but they should not be discounted and would require further assessment.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 3 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 2 Page and Header: 457, Goals for Chronic Care 3. Mr. W has recently been diagnosed with rheumatoid arthritis, a chronic condition that is having a significant impact on his daily routines and his quality of life. Which one of the nurse's following statements best reflects recognition of the importance of healing rather than curing Mr. W's condition?

A) "A combination of physical therapy and corticosteroid treatment holds a strong chance of mitigating the effects of your arthritis." B) "The best way for us to foster your overall well-being is to eliminate the symptoms that are most affecting your daily routines." C) "There are changes that I can help you make that can help you live a full life in spite of this health problem." D) "There are lifestyle changes, coupled with promising new therapies, that hold out hope for being free from this problem." Ans: C Feedback: Answer C best reflects a focus on living a satisfying life in spite of the presence of the chronic condition. The other answers prioritize treatment aimed at eliminating the chronic condition itself.

Origin: Chapter 5- Common Aging Changes, 3 Chapter: 5 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 54, Cardiovascular System 3. An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns?

A) "It's inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency." B) "It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously." C) "As you age, it's common for your heart rate becomes less regular and this often results in fatigue." D) "The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young." Ans: B Feedback: Cardiac contractility decreases as a part of normal aging. An increase in heart size, irregular heart rate, and increased blood pressure would be considered pathological conditions regardless of age.

Origin: Chapter 12- Sexuality and Intimacy, 6 Chapter: 12 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 153, Psychological Barriers 6. An older male patient has disclosed to the nurse his recent inability to achieve an erection. How should the nurse respond to the patient's statement?

A) "It's not unusual for older men to have the problem occasionally, but we need to make sure that it's not the result of something we can change." B) "This is a very normal part of the aging process. Are there other ways of achieving sexual fulfillment that you and your wife could try?" C) "It's a myth that older men have difficulty gaining and maintaining erections, so a thorough medical investigation is likely the best plan." D) "This is often an unintended result of medications. Try withholding your medications for a few days and see if the problem resolves itself." Ans: A Feedback: Occasional difficulty gaining and maintaining erections is common in older men. However, this does not rule out the presence of a modifiable cause such as medication side effects, and the situation would warrant further assessment. It would be inappropriate for the nurse to discount his concerns as normal and suggest alternative activity or to arbitrarily suggest he withhold his medications.

Origin: Chapter 35- Rehabilitative Care, 15 Chapter: 35 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 4 Page and Header: 472, Figure 35-1 15. Recognizing the high incidence of pressure ulcers in the hospitalized elderly patients, a nurse is in the habit of prompting patients to maintain proper positioning when they are seated in a chair or in a wheelchair that lacks foot pedals. Which of the nurse's following directions is most accurate?

A) "Make sure that you place your arms flat on your lap with your palms down." B) "Try to keep your back straight and your head aligned with your spine." C) "Keep your legs uncrossed and your feet directly under your chair." D) "Make sure that your feet are raised so that your thighs are not bearing any weight." Ans: B Feedback: A straight back with the head aligned is associated with sound body positioning. Arms should be supported by armrests and feet flat out in front of the chair.

Origin: Chapter 16- Comfort and Pain Management, 3 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 196, Pain Perception 3. The family of an older patient is concerned because the patient at times complains of pain but at other times does not. The family does not know what to believe. What can the nurse explain to the family about aging and pain perception?

A) "Older adults become progressively more sensitive to pain." B) "The only pain to be concerned about is pain that lasts longer than 3 months." C) "Older people have been shown to be less sensitive to pain than younger people." D) "It's actually not clear in the research what happens to people's perception of pain as they age." Ans: D Feedback: The role of age in pain perception is unclear. Since research is inconclusive concerning the role of aging on pain perception and tolerance, the nurse must assess and understand each patient's unique pain experience. It is not known if older patients become more sensitive or insensitive to pain. All pain needs to be assessed and addressed and not just pain that lasts longer than 3 months.

Origin: Chapter 36- Acute Care, 25 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 5 Page and Header: 493, Discharge Planning for Older Adults 25. An 81-year-old female patient has just been admitted to the hospital following a stroke. The patient's daughter is upset that nurses are trying to carry out discharge planning early in the admission, characterizing their efforts as evidence that they "just want to get her out the door as soon as possible." How can a nurse best respond to the daughter's concern?

A) "Actually, it's been found that patients who leave the hospital as soon as possible recover better and more quickly than those who stay hospitalized longer." B) "Our goal is not to rush your mother's discharge but rather to have as many supports in place as possible when it does come time for her to go home." C) "Unfortunately, one of the realities of hospital care today is that patients do get discharged earlier than they did in years past." D) "Discharge can often happen with little notice, so we are trying to get as much organized early in her admission as we can." Ans: B Feedback: The goal of early discharge planning is to establish as many aspects of care as possible, maximizing the patient's chances of a healthy recovery. Answers C and D are often true, but these statements are unlikely to be of benefit to the patient's family, nor do they provide the best justification for early discharge planning. Answer A is not necessarily true.

Origin: Chapter 1- The Aging Population, 3 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 4, Population Growth and Increasing Life Expectancy 3. A nurse who practices in a long-term care facility is providing care for a 101-year-old black female. The nurse's coworker states, "It's gratifying that black people in this country are finally reaching the same levels of health that white people are enjoying." How can the nurse best respond?

A) "Actually, the difference in life expectancy between black people and white people is growing, not shrinking." B) "We've not yet arrived at a place where the life expectancies are equal between black and white people, but the gap is decreasing gradually." C) "Black women do tend to live longer than white women, but the overall life expectancies when men are included are not yet equal." D) "You're right. Since the 1980s the life expectancies of black and white Americans have remained nearly the same." Ans: A Feedback: Since the 1980s, the gap between life expectancies of black Americans and white Americans has been increasing rather than decreasing. Black women do not tend to live longer than white women.

Origin: Chapter 2- Theories of Aging, 6 Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 16, Disengagement Theory 6. A hospital clinical educator is espousing the disengagement theory of aging when teaching staff how best to meet the needs of older clients. Which of the nurse's teaching points best captures the disengagement theory of aging?

A) "Older adults often benefit from a gradual and controlled withdrawal of their own interests from society's interests." B) "The disengagement between an older adult's abilities and desires can lead to frustration and, ultimately, to illness." C) "The lack of synchronicity between older adults' immune systems and their environments can be the root of many problems." D) "It is imperative that we ensure older adults remain engaged with interests and events beyond themselves." Ans: A Feedback: Disengagement theory postulates that disengagement between the individual and society is beneficial to both parties. It does not propose that this process of withdrawal be prevented nor that it necessarily leads to frustration or illness. The immune system is not a central component of the theory.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 4 Chapter: 8 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication Objective: 2 Page and Header: 103, Confidentiality 4. A nurse is providing care for an older adult client who has been admitted to the hospital with liver cirrhosis. The client has expressed to the nurse his concerns that the details of his condition and treatment remain confidential, and that written documentation not "get out there." How can the nurse best respond to the client's concerns?

A) "Anything that is discussed between us is confidential and will not be shared with anyone else." B) "The Health Insurance Portability and Accountability Act ensures that your medical records will not leave this hospital." C) "Provided you signed a directive on admission, your records will not be made public." D) "The law protects your right to confidentiality and health information from being released into unintended hands." Ans: D Feedback: The HIPAA aims to protect individuals' right to confidentiality and prevent records from being accessed by individuals for whom it was not intended. It would be inaccurate to assure a client that all assessment findings and interactions will remain between the client and the nurse, and the HIPAA does not necessarily guarantee that records will never leave the institution in question. Preventing health records from public access does not require a signed directive.

Origin: Chapter 35- Rehabilitative Care, 24 Chapter: 35 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 480, Reality Orientation 24. Which of the nurse's following questions is most appropriate for providing reality orientation for a patient with stage 5 Alzheimer's disease?

A) "Are you looking forward to Thanksgiving next week Mr. Hall?" B) "Could you tell me the month and the year this morning, Mr. Hall?" C) "Do you know what holiday is coming up soon, Mr. Hall?" D) "Will your son and daughter-in-law be coming to visit on Thanksgiving, Mr. Hall?" Ans: A Feedback: Answer A clearly but tactfully cues the patient to the fact that Thanksgiving is coming up, while answer D does not orient the patient as clearly to the fact that the holiday is next week. Answers B and C do not orient the patient but rather assess his orientation.

Origin: Chapter 15- Rest and Sleep, 7 Chapter: 15 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 188, Drugs That Affect Sleep 7. An older patient with multiple health problems asks the nurse for advice about recurrent insomnia. Which statement made by the nurse is most accurate?

A) "Caffeine obviously makes it hard for you to sleep, while a moderate amount of alcohol at bedtime is useful." B) "You should try over-the-counter sleep aides for several weeks before you move on to prescription options." C) "It's very normal for the quality of sleep to decrease with age, so this is usually a problem that requires accommodation rather than treatment." D) "A lot of medications have the potential to interfere with sleep, so it would be useful to review your medications with your physician or a pharmacist." Ans: D Feedback: Numerous medications are noted to be detrimental to sleep in older adults. Nonprescription sleep aides carry risks, and alcohol is not a recommended intervention. While sleep quality does decrease with age, this does not mean that measure cannot be taken to address the problem.

Origin: Chapter 2- Theories of Aging, 5 Chapter: 2 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 15, Autoimmune Reactions 5. A nurse is discussing an older adult client's apparent increased susceptibility to infection with his family. Which of the following statements by the nurse would be most congruent with current thought around the autoimmune role in the aging process?

A) "Changes that we call 'mutations' in your father's cells make his organs more vulnerable to chronic illness and germs." B) "Older adults often have more difficulty fighting off infections because of their weaker immune systems, and their bodies can even attack themselves." C) "Diseases such as arthritis, which we term 'autoimmune,' make older people more likely to catch viruses and other bugs." D) "Our bodies seem to have an 'expiry date,' after which we are far more likely to get infections and develop chronic illness." Ans: B Feedback: Decreased immune response coupled with increased autoimmune activity is implicated in many of the effects of the aging process. The salience of mutations is associated with genetic theories of aging and autoimmune activity is not considered the direct cause of the decline in thymus and bone marrow activity. A predetermined cell life span is associated with the programmed theory of aging.

Origin: Chapter 35- Rehabilitative Care, 1 Chapter: 35 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 469, Importance of Attitude and Coping Capacity 1. The mobility, activity tolerance, and overall quality of life of a 79-year-old woman are severely diminished by her angina. The woman now lives with her daughter and son-in-law, both of whom are unsure how best to foster her well-being. Which of the following teaching points of the nurse is most appropriate?

A) "Doing as much as you and your husband can for your mother will allow her to dedicate her energies to recovery." B) "The most beneficial approach for your mother is to treat her exactly as you did before she developed this disability." C) "It will be helpful for you both to occasionally remind your mother about the areas of her health and abilities that remain intact." D) "Try to maximize the amount of self-care that your mother performs and still treat her like a responsible person." Ans: D Feedback: Interacting with the woman as a responsible adult who can still perform some self-care is more beneficial than doing everything for her, denying the reality of her losses or downplaying her disability by reminding her of what she still possesses.

Origin: Chapter 16- Comfort and Pain Management, 8 Chapter: 16 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 4 Page and Header: 200, Dietary Changes 8. What dietary advice should the nurse provide to an older patient who is experiencing pain and inflammation due to rheumatoid arthritis?

A) "Eating fewer calories will minimize inflammation in your joints." B) "A high protein, low-carbohydrate diet has been shown to benefit many arthritis sufferers." C) "A low-cholesterol diet and drinking lots of fluids might help with the pain you're experiencing." D) "Cutting back on your consumption of meat, fatty dairy products and oils might have a positive effect on your pain." Ans: D Feedback: Individuals with inflammatory conditions should consider avoiding animal products, high-fat dairy products, egg yolks, beef fat, safflower, corn, sunflower, soybean, and peanut oils. The other dietary recommendations do not directly relate to the treatment of inflammatory conditions.

Origin: Chapter 21- Digestion and Bowel Elimination, 10 Chapter: 21 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 295, Hiatal Hernia 10. A 76-year-old client has been diagnosed with an axial hiatal hernia following several months of belching and heartburn. What should the nurse teach the client about the management of this health problem?

A) "Even though you would expect them to help, it's important to avoid over-the-counter antacids as much as possible." B) "Losing weight and trying a bland diet might help alleviate some of the symptoms you're experiencing." C) "This problem can be easily corrected with day surgery, which your physician will likely suggest." D) "Try to limit yourself to two larger meals daily in order to minimize the amount of time in a day that food is in your stomach." Ans: B Feedback: Weight loss and a bland diet are noted interventions for the management of hiatal hernias. Antacids are an appropriate measure and medical rather than surgical treatment is the norm. Several small meals are preferred to less frequent larger meals.

Origin: Chapter 21- Digestion and Bowel Elimination, 4 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 293, Dental Problems 4. The nurse discusses dental health with an 81-year-old client. Which of the following statements, when made by the client is identified as true?

A) "Everyone loses their teeth, it's natural." B) "I can't get any cavities any more, only young people get them." C) "Fluoride treatments might help strengthen the enamel on my teeth." D) "There is no treatment for my bad teeth and poor appetite." Ans: C Feedback: Topical fluoride treatments are beneficial to the teeth of older persons. Tooth loss is related to periodontal disease, not aging. Whereas the incidence of caries decreases with age, it is still present.

Origin: Chapter 21- Digestion and Bowel Elimination, 2 Chapter: 21 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 290, Effects of Aging on Gastrointestinal Health 2. Which of the following statements by older adult clients should the nurse interpret as a potential pathological process rather than a normal age-related change?

A) "Food just doesn't seem to have as much taste as it did when I was younger." B) "I feel like it takes so much longer to digest my meals than it used to." C) "Even when I have a bowel movement it often doesn't feel like it's complete." D) "I tend to regurgitate a lot of my food after a meal these days." Ans: D Feedback: Regurgitation is indicative of GERD or a hiatal hernia. Decreased taste sensation, lower gastric motility, and incomplete bowel movements are considered normal, age-related changes.

Origin: Chapter 1- The Aging Population, 1 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 3, Views of Older Adults Through History 1. A nurse who works on a subacute medical unit of a hospital is discussing the increasing population of older adults on the unit with a colleague. Which of the colleague's following statements about older adults is most accurate?

A) "Fortunately, Social Security ensures a sufficient level of income for people over 65." B) "It helps that older people don't have to directly incur any costs for their medical care." C) "Most of the older clients on the unit will have come to us from nursing homes." D) "It's reassuring that people are starting to show more concern for older adults than in decades past." Ans: D Feedback: The formation of the Administration on Aging, enactment of the Older Americans Act, and the introduction of Medicaid and Medicare all occurred in 1965. Since that time, society has demonstrated a growing concern for its older members. Myths about older people include the belief that Social Security ensures them an adequate income, that they do not have to pay for medical care, and that most older adults live in nursing homes.

Origin: Chapter 14- Nutrition and Hydration, 7 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 6 Page and Header: 178, Promotion of Oral Health 7. After receiving new dentures the nurse provides instruction to an older patient on the use and their care. Which patient statement indicates that teaching about the dentures has been effective?

A) "I do not have to brush and floss my teeth every day." B) "I suppose that I'll have to get these resized and adjusted from time to time." C) "I'll have to change my diet to include only soft and pureed foods now I suppose." D) "I've had to go to the dentist so often over the last few years and it's a relief not to have to anymore." Ans: B Feedback: It is important that older adults realize that dentures still necessitate maintenance and occasional readjustments. Brushing is still necessary, as is visiting the dentist. The diet of adults with dentures is not noted to be restricted to soft and pureed foods.

Origin: Chapter 21- Digestion and Bowel Elimination, 29 Chapter: 21 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 301, Biliary Tract Disease 29. The nurse discusses gallbladder disease with a client diagnosed with cholelithiasis. The client indicates understanding of the pathological process when the client states:

A) "I never had any GI infections before this one." B) "I will be undergoing laparoscopic surgery to remove the stones." C) "I hear that the gallbladder gets weak with old age." D) "I'm glad that this issue can be dealt with medication." Ans: B Feedback: The structure of the gallbladder and bile ducts is unchanged with age. Cholelithiasis, the formation or presence of gallstones in the gallbladder, increases with age. Treatment measures include nonsurgical therapies, such as rotary lithotrite treatment and extracorporeal shock wave lithotripsy, as well as standard surgical procedures.

Origin: Chapter 3- Diversity, 7 Chapter: 3 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 7. A nurse is being orientated to his new position in a community adjacent to a large Indian reservation. Which of the nurse's following statements indicates a sound understanding of the Native American population with whom he will work?

A) "I suppose that we will see a disproportionately high number of clients with lung and oral cancers." B) "The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area." C) "It's unfortunate that many of the older Native Americans are unlikely to have family members involved their care." D) "The unique skin pigmentation of Native Americans means that I'll have to modify my assessment techniques." Ans: B Feedback: Diabetes, hypertension, and CVA are all higher than average in Native American adults. Lung and oral cancers are not noted to have a higher prevalence and family is likely to be involved in the care of these elders. The skin tone of Native Americans is not noted to require particular assessment techniques.

Origin: Chapter 21- Digestion and Bowel Elimination, 6 Chapter: 21 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 290, Gastrointestinal Health Promotion 6. The nurse teaches a group of older adults about diet. Which of following recommendations made by the nurse is most likely to result in the promotion of gastrointestinal (GI) health?

A) "If possible, eat organic, whole foods." B) "It's important to emphasize fiber and fluid intake." C) "Try to maximize the amount of unsaturated fats you eat every day." D) "You should try to limit your food and fluid intake." Ans: B Feedback: Adequate fluid and fiber intake are central to GI health in older adults. Organic foods are not noted to have a particular beneficial effect on GI health. Fats may not be well tolerated with the decrease in pancreatic enzymes present. Food and fluids should not be decreased.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 3 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 114, Ethical Principles 3. Despite the wishes of her family and the recommendations of the care team, a 70-year-old client with a diagnosis of congestive heart failure, but who is otherwise healthy, wants to have a no-code order in place. Which of the following statements by the care team most clearly prioritizes the patient's autonomy?

A) "If this is what is best for everyone then we need to go ahead with the order." B) "Provided it can be demonstrated that she has a potentially poor prognosis, we should certainly consider doing this." C) "It's best that social work get involved at this point to reconcile the family's and the patient's wishes." D) "If that's what she wants, then ultimately we're obliged to respect her wishes." Ans: D Feedback: Answer D most clearly prioritizes the patient's individual freedom, preference, and rights in this case, and these considerations would override the family's or the care team's conflicting interests.

Origin: Chapter 14- Nutrition and Hydration, 23 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 23. The nurse is caring for an 85-year-old male patient who weighs 150 lb and is 6 feet 3 inches tall. If using the resting energy expenditure equation, how many calories must the patient consume each day to maintain his current body weight? (Be sure to round your answer to the nearest whole number.)

Ans: 1,378 calories Feedback: The equation for a male patient is 66 + [(6.23 × weight in pounds)] + [(12.7 × height in inches)] - (6.76 × age in years). For this patient, the equation would be: 66 + [(6.23 × 150 lb)] + [(12.7 ×75 inches)] - (6.76 × 85) 66 + 934.5 + 952.5 - 574.6 = 1378.4 calories

19. Bone fractures are a serious risk to the elderly. Which of the following is a contributing factor? A) Diminished calcium absorption B) Shortening of the long bones C) Formation of points and spurs D) Deterioration of cartilage surfaces

Ans: A Feedback: A decrease in calcium absorption in the elderly contributes to the brittleness of the bones, thus increasing the risk of fractures.

3. Which of the following clients of a nurse practitioner is demonstrative of a growing trend in the role of grandparents in contemporary American society? A) A 70-year-old grandmother is raising her two grandchildren because their mother is in prison. B) An 80-year-old client of the nurse is going through a divorce with her husband of several decades. C) A 79-year-old man laments the fact that he is estranged from his son's children. D) A married couple in their seventies who refuse to provide free child care for their grandchildren on a daily basis.

Ans: A Feedback: A growing number of grandparents have primary responsibility for the care of their grandchildren, a fact that can often be attributed to teen pregnancy, incarceration, or substance abuse. Divorce late in life, estrangement from grandchildren, and refusal to provide care are not noted to be phenomena.

11. According to statistics, Baby J, born to a black American couple, has a life expectancy lower than that of Baby K, born to a white American couple. According to current demographic projections, by the seventh decade of life, Baby J's life expectancy will: A) Begin to equal that of similarly aged white elders B) Exceed that of similarly aged Asian elders C) Drop to less than half that of similarly aged Native American elders D) Rise above that of white elders until age 75 and then drop

Ans: A Feedback: After reaching the seventh decade of life, black Americans can hope to enjoy a life expectancy equal to that of their white cohorts.

23. An elderly Chinese patient tells the nurse that blockage of qi in one of her meridians is causing her severe headaches. Her doctor has diagnosed migraines and has prescribed a triptan drug. The nurse's best course of action is to: A) Suggest that the prescribed medicine may stimulate the flow of qi B) Explain the vasoconstrictive and serotonin-moderating action of triptan C) Recommend acupuncture or acupressure treatments as an adjunct to the triptan D) Caution her that her headaches will grow worse if she fails to take her medication

Ans: A Feedback: Although explaining the scientific principles underlying drug action is often appropriate, the same objective can be achieved through the use of culturally relevant terms and concepts. Recommending additional treatments is unnecessary and may be inappropriate. Threats or predictions of dire consequences may impede the communication process.

16. The children of an elderly resident at a nursing home are concerned that their parent is alone and lonely. A staff nurse can assure the family that the elderly should be allowed periods of solitude because such times: A) Are essential for reflecting, analyzing, and better understanding the dynamics of life B) Decrease loneliness, insecurity, and self-imposed isolation C) Help the elderly face the misfortunes of growing old D) Affect displays of anxiety, depression, and anorexia

Ans: A Feedback: Being alone and being lonely are not the same thing. Periods of isolation are essential at all ages for the reason listed in choice A.

7. Which of following statements most accurately captures the role of chronic illness in the lives of older adults? A) Chronic illnesses constitute the leading cause of death for older adults. B) More older adults die from acute illnesses than from chronic diseases. C) While chronic diseases used to be the leading cause of death, this is no longer the case. D) While cancer rates have fallen, other chronic diseases remain a common cause of death.

Ans: A Feedback: Chronic illnesses constitute the leading cause of death for older adults, exceeding those attributed to acute illnesses. The presence of heart disease as a cause of death has decreased in recent years, while at the same time cancer has become more prevalent.

3. A nurse who works in an inner-city clinic provides care for a large number of the older black clients. Which of the following health promotion activities best reflects the particular health needs of this population? A) A blood sugar and blood pressure monitoring program. B) An education session on the positive health effects of good nutrition. C) A screening mammography campaign for older black women. D) A program that teaches black men the importance of prostate health screening.

Ans: A Feedback: Diabetes and hypertension are disproportionately prevalent among black American elders. While teaching on nutrition and breast cancer and prostate screening may be beneficial, these are not linked to the particular health needs of this population.

6. A hospital clinical educator is espousing the disengagement theory of aging when teaching staff how best to meet the needs of older clients. Which of the nurse's teaching points best captures the disengagement theory of aging? A) "Older adults often benefit from a gradual and controlled withdrawal of their own interests from society's interests." B) "The disengagement between an older adult's abilities and desires can lead to frustration and, ultimately, to illness." C) "The lack of synchronicity between older adults' immune systems and their environments can be the root of many problems." D) "It is imperative that we ensure older adults remain engaged with interests and events beyond themselves."

Ans: A Feedback: Disengagement theory postulates that disengagement between the individual and society is beneficial to both parties. It does not propose that this process of withdrawal be prevented nor that it necessarily leads to frustration or illness. The immune system is not a central component of the theory.

17. Although the immune system is affected by the aging process, the elderly are not the only individuals who have autoimmune disorders. These occur in populations of all ages because autoimmune disorders involve: A) An attack of antibodies on body cells B) An overproduction of T cells in bone marrow C) A decrease in the weight of the thymus gland D) An increase in the amount of lipofuscin in the blood

Ans: A Feedback: In autoimmune disorders, the immune system attacks and destroys the body's own cells (as opposed to those of invading, disease-causing microorganisms). There is no overproduction of T cells. Although the weight of the thymus gland decreases with age and the amount of lipofuscin increases, such changes are not characteristic of autoimmune disorders.

12. Twentieth-century laws regarding health care for the elderly trace their roots back to: A) England's 17th-century Poor Laws B) Child labor laws of the 19th century C) The Biblical commandment "Honor your father and your mother" D) The tradition of respect for the elderly passed down from ancient Roman law

Ans: A Feedback: Laws enacted in 20th-century America provided some measure of financial security and some level of health care for all persons aged 65 years and older, just as did the Poor Laws of 17th-century England that acted as a "safety net" for the elderly and the destitute. The child labor laws protected the young but offered no help to the elderly who were left at the mercy of their families. The Biblical commandment to "honor" provides a moral guideline but no practical benefit in terms of financial or health support. Ancient Romans deplored the elderly, and no tradition of respect for the aged was incorporated into the Roman legal code.

9. A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session? A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age. B) Older adults require simplified learning objectives and slower introduction of new directions. C) Simple association is well executed by older adults but complex analysis is normally absent. D) Successful learning late in life requires a multisensory teaching approach.

Ans: A Feedback: Learning ability is not seriously changed with age. It is not likely necessary to simplify learning objectives, and analysis abilities may slightly diminish but are not normally absent. A multisensory teaching approach is not noted to be required.

21. What are the most important competing forces that influence health policy for the elderly? A) Cost containment versus quality of care B) Acute care versus the burden of chronic disease C) Private insurance payments versus Medicare support D) Long-term care at home versus nursing home services

Ans: A Feedback: Policy discussions most often pit cost containment (reducing expenditures) against quality of care (which may mean increasing expenditures). Seniors require relatively less acute care than younger patients do; their health problems are more often chronic. Because all persons over age 65 are entitled to health coverage through Medicare, insurance considerations are fewer than with younger patients. And whereas one in four seniors requires nursing home care at some time, nursing home residency is not typically long term.

10. Which of the following phenomena most likely accounts for the progressive loss of hearing that an 83-year-old man is experiencing? A) Multiple changes in the structures of the inner ear. B) The effect of cognitive changes on the interpretation of auditory stimuli. C) Cellular atrophy of the cells in the outer and middle ear. D) Age-related deterioration of the neural pathways associated with hearing acuity.

Ans: A Feedback: Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph. Cognitive changes, cellular changes in the outer and middle ear, and deterioration of neural pathways are less likely to be implicated.

18. Gerontology instructors at City College of Nursing impress upon their students that gerontological nurses should be concerned with the welfare of both the current aged population and future ones. The best way nurses can help young and middle-aged adults prepare for their retirement is to promote: A) Meaningful leisure time activities B) Freedom from family responsibilities C) Achievement in a worthwhile occupation D) Maximal use of community health resources

Ans: A Feedback: Retirement is facilitated by learning how to use, appreciate, and gain satisfaction from leisure time throughout an employed lifetime. Occupational achievement may actually hinder a successful retirement if the work role proves difficult to abandon or replace. Although the use of community health resources and freedom from family responsibilities can contribute to a healthful old age, they are not the major sources of satisfaction to be cultivated earlier in life.

15. A young couple are looking for a new home. They want to move into a neighborhood that has no elderly neighbors. Such ageism carries several consequences. By separating themselves from the elderly, the couple: A) Are less likely to see the similarities between themselves and older adults B) Will lose their insights into aging C) Will not experience the challenges of old age D) May have an easier time minimizing their socioeconomic challenges

Ans: A Feedback: Separation from the elderly means people are less likely to see the similarities between themselves and older adults. This separation leads to lack of understanding of the elderly and reduces the opportunities for the young to gain realistic insights into aging.

23. The charge nurse at a nursing home impresses on a visiting class of nursing assistants the importance of hand washing, because older adults have a depressed immune response. One contributor to this depressed immune response in older adults is: A) Decreased serum activity of the thymic hormones B) Inactivation of varicella-zoster infections C) Decreased serum concentrations of IgA and IgG D) High pain sensitivity associated with inflammation

Ans: A Feedback: Serum activity of the thymic hormones is almost undetectable with age. Serum concentrations of IgA and IgG increase with age. Inflammation often causes minimal pain in the elderly.

3. A nurse who practices in a long-term care facility is providing care for a 101-year-old black female. The nurse's coworker states, "It's gratifying that black people in this country are finally reaching the same levels of health that white people are enjoying." How can the nurse best respond? A) "Actually, the difference in life expectancy between black people and white people is growing, not shrinking." B) "We've not yet arrived at a place where the life expectancies are equal between black and white people, but the gap is decreasing gradually." C) "Black women do tend to live longer than white women, but the overall life expectancies when men are included are not yet equal." D) "You're right. Since the 1980s the life expectancies of black and white Americans have remained nearly the same."

Ans: A Feedback: Since the 1980s, the gap between life expectancies of black Americans and white Americans has been increasing rather than decreasing. Black women do not tend to live longer than white women.

23. In old age, the body's efficiency declines. Which of the following is a typical response to that decline? A) An attempt to push the body to perform physically at the same level as in the past B) A neglect of personal appearance and other hygiene practices C) A failure to restrict lifestyle choices in a health-appropriate way D) An expressed desire to enter a nursing home to receive daily care and assistance

Ans: A Feedback: Some seniors deny age-related changes and push themselves physically. Others invest in expensive beauty treatments that promise to subvert the aging process. Others go to the opposite extreme and overestimate their deficiencies, adopting an unnecessarily restrictive lifestyle. An expressed desire for greater dependency is rare.

12. With aging the skin becomes thinner and more fragile. The thinning of the skin's subcutaneous fat layer makes older adults more sensitive to: A) Cold B) Heat C) Pain D) Pressure

Ans: A Feedback: Subcutaneous fat serves as an insulator. With less of it, the elderly may be more sensitive to cold temperatures. Older adults are less sensitive to pain and pressure because of decreased sensitivity of nerve endings.

15. Which of the following statements underlie both the error theory of aging and the free radical theory of aging? A) Biochemical damage accumulates over time, leading to cell death. B) The rate of cellular death is genetically programmed. C) The aging body produces fewer growth and repair hormones. D) Environmental agents such as radiation and heavy metals damage DNA.

Ans: A Feedback: That the rate of cell death is genetically programmed is a basic tenet of the programmed theory of aging. That the aging body produces fewer growth and repair hormones is a neuroendocrine theory. Although radiation and heavy metals may damage DNA, they are not free radicals, and they need not be the cause of the mutations assumed by the error theory.

21. A state committee is looking to improve the lives of the state's elderly. It wants to recommend that health care facilities that cater to the elderly population be required to base their practices on the activity theory of aging. Which of the following may be one problem with implementing the activity theory of aging? A) The assumption that older people want to maintain their middle-aged lifestyle B) The reluctance of the elderly to give up their occupational roles at retirement age C) The decline in mental acuity that accompanies physical impairment in most cases D) Declining health, loss of roles, and shrinking circle of friends of most elderly

Ans: A Feedback: The activity theory suggests that the elderly should maintain their middle-aged lifestyle to the greatest extent possible, a goal not all elderly persons will embrace. The reluctance of many elderly persons to give up their middle-aged roles is consistent with the theory. Relatively small numbers of the elderly experience a significant decline in mental acuity. Declining health, loss of roles, and a shrinking circle of friends are problems the activity theory seeks to minimize.

1. Which of the following statements most accurately conveys an aspect of the error theory of aging? A) Perpetuation of DNA mutations results in organ and system malfunction. B) Age-related dysfunction of organs, tissues, and body systems results in mutation of body DNA. C) The number of cell divisions is genetically predetermined. D) Errors in the function of various organs contribute to changes in the genetic code of various body cells.

Ans: A Feedback: The error theory of aging proposes that genetic mutations are perpetuated through the aging process, resulting in organ malfunction and eventual decline in body function. Organ malfunction results from, but does not cause, the genetic mutations in question. A genetic predetermination of the number of cell divisions is associated with the programmed theory of aging.

4. Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life? A) Women tend to both live longer than men and marry men older than themselves. B) Men tend to have greater access to care facilities due to higher incomes and savings. C) Men are more likely to live with younger family members following the death of a spouse. D) Social pressures tend to stigmatize older men who live alone.

Ans: A Feedback: The facts that women live longer than men and often marry men older than themselves account for their higher rates of living alone in old age. Men are not noted to have greater access to care facilities, to be more likely to live with younger family members or to face stigma for living alone.

4. An 80-year-old female who enjoys good health explains to her primary care provider that she attributes her health status to her regular intake of berries, fruit juices, and green tea, which she states "help cleanse the damaging molecules out of my body." Which of the following theories of aging underlies the client's health behaviors? A) Free radical theory B) Biogerontology C) Disposable soma theory D) Cross-linking theory

Ans: A Feedback: The free radical theory of aging attributes damage to the accumulation of free radicals that may be countered by the intake of antioxidants. This is not an explicit component of the disposable soma or cross-linking theory of aging. Biogerontology is the study of the relationship between aging and disease.

13. A new patient is not satisfied with the conditions of the nursing home, takes a highly active role in her health care, and, because of her ability to access information, has as much knowledge as her health care providers on some health issues. This new patient is most likely: A) A young-old female baby boomer who just turned age 65 B) An old woman 75 to 85 years of age C) An old-old woman over age 85 D) An elite old woman older than 100 years

Ans: A Feedback: The patient has the predicted characteristics of a baby boomer entering the senior years.

14. The heart muscle commonly weakens with age. What is a consequence of this fact? A) The heart beats faster but pumps with less force. B) Fatty deposits and other substances clog narrowed coronary vessels. C) Blood pressure lowers because of systemic vasodilation. D) The time required for the heart's diastolic-systolic cycle decreases.

Ans: A Feedback: The statement in choice B is true, but age-weakened heart muscle is not the cause. Blood pressure may actually rise as an effect of choice B. The opposite of the statement in choice D is true.

13. Each of the blood vessel layers is affected differently by the aging process. Which would a nurse suspect is responsible for a patient's fibrosis? A) Tunica intima B) Tunica media C) Tunica adventitia D) Fibrosis is caused by an enlarged heart

Ans: A Feedback: The tunica intima, the innermost layer, experiences the most direct changes, including fibrosis, calcium and lipid accumulation, and cellular proliferation. The middle layer, the tunica media, undergoes a thinning and calcification of elastin fibers and an increase in collagen, which causes a stiffening of the vessels. The outermost layer, the tunica adventitia, is not affected by the aging process. In the absence of heart disease, heart size changes little with age.

7. Which of the following nursing interventions by practitioner in a long-term care facility are appropriate? Select all that apply. A) The nurse times laxative administration as to not interfere with social interaction. B) The nurse provides diuretics after, not before, recreation sessions. C) The client's need for and dosage of nighttime sedation is weighed in light of activities planned for the following morning. D) Analgesia is provided prior to physical activity but held before social activities.

Ans: A, B, C Feedback: A failure to provide adequate pain control is likely to interfere with older adults' social activity. The nursing actions in answers A, B, and C are all prudent in light of promoting social interaction.

1. During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply. A) The woman's overall proportion of body water has decreased. B) The client has experienced a loss of cartilage. C) The woman's thyroid hormone levels have declined since the sixth decade. D) The client's vertebrae have thinned. E) Loss of stature is a consequence of the woman's diet. F) The woman's long bones have decreased in length.

Ans: A, B, D Feedback: Reduced hydration, loss of cartilage, and thinning of vertebrae can all contribute to loss of stature. Decreased levels of TH, shortening of long bones, and diet are not noted to contribute to this phenomenon.

8. Which of the following tasks are components of Erikson's description of the old age tasks of reconciling ego integrity with despair? Select all that apply. A) An 80-year-old man is struggling to determine his identity apart from his lifelong career as a business leader. B) A 79-year-old woman has established habits that promote her financial independence in spite of a lack of savings. C) An 80-year-old man revels in his large, happy family rather than focusing on his mobility limitations resulting from Parkinson disease. D) A 77-year-old man is trying to determine whether his life has had deep significance and meaning.

Ans: A, C, D Feedback: Deriving satisfaction from oneself rather than occupational roles, finding pleasure in spite of physical limitations, and determining meaning in the life one has lived are all aspects of Erikson's outcome of ego integrity or despair. Financial independence is not a central component of this outcome.

8. The board of a large chain of hospitals has commissioned a strategic plan in order to meet the care needs of baby boomers in coming years. Which of the following trends constitute a sound basis for understanding the baby boomer generation and conducting future planning? Select all that apply. A) Baby boomers tend to have fewer children than members of earlier generations. B) Adjusted for inflation, baby boomers have lower incomes than their parents had. C) Due to technology, baby boomers have more leisure time than other adults. D) Baby boomers perform physical exercise more frequently than other adults.

Ans: A, D Feedback: Baby boomers have had fewer children than generations that preceded them and they tend to exercise more often. Their incomes tend to be higher while they enjoy less leisure time.

6. A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse's assessment of the client would recognize which of the following factors as most likely contributed to the suspected injury? A) Bone remodeling in long bones ceases in the seventh or eighth decade. B) Bone minerals and mass are reduced as part of the aging process. C) Bone marrow production of cellular components declines with age. D) Thinning disks and shortened vertebrae are common assessment findings in older adults.

Ans: B Feedback: A decrease in bone minerals and mass is common later in life. Bone remodeling does not, however, cease. Neither thinning disks, shortened vertebrae, nor marrow production of blood cellular components is likely to directly contribute to the client's suspected fracture.

22. Which of the following blood chemistries may indicate diabetes among young adults but not among the elderly? A) Low blood glucose level B) High blood glucose level C) Prolonged hypoglycemia D) Insufficient release of insulin

Ans: B Feedback: Although there is a delayed and insufficient release by the -cells of the pancreas in the elderly, what will show up in a blood chemistry report is an apparently high level of glucose in the blood. Low blood glucose and prolonged hypoglycemia are not indicators of diabetes.

23. Which of the following patient histories is most likely for a person older than 65 years of age? A) In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B) Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C) Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D) Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks

Ans: B Feedback: Arthritis and heart conditions are among the most common chronic conditions of the elderly. Daily medications to reduce arthritis pain and decrease blood pressure are common. The other histories are more likely for younger patients.

3. An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns? A) "It's inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency." B) "It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously." C) "As you age, it's common for your heart rate becomes less regular and this often results in fatigue." D) "The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young."

Ans: B Feedback: Cardiac contractility decreases as a part of normal aging. An increase in heart size, irregular heart rate, and increased blood pressure would be considered pathological conditions regardless of age.

16. The nursing staff at a nursing home works closely with the staff in the Endocrinology Department at a local hospital. This relationship is maintained for the welfare of the nursing home residents, because a failing immune system in the elderly might account for: A) A decline in the rate of growth hormone production B) The increased incidence of cancer among the aged C) The oxidative activity of free radicals D) Changes in brain activity and nervous system function

Ans: B Feedback: Compromises in the immune systems of the elderly may lead to a failure to recognize and destroy cancerous cells. The immune system is not involved in the production of growth hormones. The immune system does not determine the action of free radicals, although it may be involved in seeking out and destroying cells damaged by free radical activity. There is no known association between diminished immune activity and changes in the brain or nervous system action.

5. A nurse is discussing an older adult client's apparent increased susceptibility to infection with his family. Which of the following statements by the nurse would be most congruent with current thought around the autoimmune role in the aging process? A) "Changes that we call 'mutations' in your father's cells make his organs more vulnerable to chronic illness and germs." B) "Older adults often have more difficulty fighting off infections because of their weaker immune systems, and their bodies can even attack themselves." C) "Diseases such as arthritis, which we term 'autoimmune,' make older people more likely to catch viruses and other bugs." D) "Our bodies seem to have an 'expiry date,' after which we are far more likely to get infections and develop chronic illness."

Ans: B Feedback: Decreased immune response coupled with increased autoimmune activity is implicated in many of the effects of the aging process. The salience of mutations is associated with genetic theories of aging and autoimmune activity is not considered the direct cause of the decline in thymus and bone marrow activity. A predetermined cell life span is associated with the programmed theory of aging.

24. Hospital management is reviewing departmental statistics. Which of the following departments most likely has the highest death rate of patients over age 65, and why? A) Oncology, because the elderly have been exposed to more carcinogens in their long lifetimes B) Cardiology, because, despite a decline in recent years, heart disease remains the number one cause of death among the elderly C) Endocrinology, because the elderly already have compromised immune systems D) Neurology, because stroke and Alzheimer's disease together cause more deaths of the elderly than any other conditions

Ans: B Feedback: Heart disease is the leading cause of death among persons 65 years of age and older.

2. A nurse is providing care for an 81-year-old Hispanic woman in the context of a geriatric medicine unit of a hospital. Which of the following phenomena should the nurse anticipate? A) The client's family is likely to advocate for her placement in a nursing home at an early stage. B) The client is likely to prioritize the role of spirituality in the healing process. C) She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness. D) The woman's family will most likely delegate responsibility for her care to the hospital care team.

Ans: B Feedback: Hispanic elders often emphasize the role of spirituality in both the etiology and treatment of disease. Nursing home admissions are proportionately low and while health and illness are often seen as the actions of God, this does not translate into a rejection of treatment. The family is likely to play a central role in care planning and recovery.

22. Some health conditions are more prevalent in the black population than in the white population. It is important that nurses pay particular attention to identifying those health conditions. Which of the following health assessments and reasons is the most important in working with black patients? A) Control their lifestyle changes because of a lower life expectancy B) Monitor their blood pressure because of a blunted nocturnal response C) Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems D) Monitor for HIV/AIDS as this is a leading cause of death among African Americans

Ans: B Feedback: Hypertension is the most prevalent health problem among black Americans, and a blunted nocturnal response is one factor responsible for this problem. The serious consequences of high blood pressure would supersede the alterations in skin assessment, and highlighting test results and controlling lifestyle changes would be inappropriate actions.

20. Which of the following statements best captures an aspect of illness in older adults? A) Death from heart disease is increasing in this population. B) Death from cancer is increasing in this population. C) Chronic illnesses are less common than in younger people. D) Several acute illnesses are often present that must be managed simultaneously.

Ans: B Feedback: In the elderly population, the cancer death rate has increased in the past three decades; deaths from heart disease have declined. Several chronic conditions are often present and must be managed simultaneously.

15. Which of the following factors should a nurse prioritize when planning the care of older adults? A) The high prevalence of mental impairment among the elderly B) The diversity of the older adult population C) The fact that most older people live below the poverty line D) The lack of family support that is the norm among the elderly

Ans: B Feedback: Individuals aged 65 years and older vary widely in their health status, interest, cultural backgrounds, and health care needs. The population is not generally impaired mentally. Also, only 15% live below the poverty level. The majority live in a household with a spouse or other family member.

22. What is the best action a busy nurse can take to help with the desire of elderly clients to reminisce about their past lives? A) Refer clients to senior centers, where they can share their stories with others of their own age group B) Encourage the recording of stories through diaries and scrapbooks to be shared with younger family members C) Introduce older clients to members of local historical societies who can record their stories for posterity D) Look for ways to steer discussion toward health-promoting habits such as good exercise and adequate nutrition

Ans: B Feedback: It is always important to listen to the stories of seniors and to honor their life histories. Changing the subject is seldom appropriate, and although referrals to senior centers and historical societies may be beneficial in some cases, encouraging elders to record and share their stories with the younger generation is always a good idea.

18. It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people? A) Own their own homes and have sufficient monthly income B) Get more than half their income from Social Security and live above the poverty level C) Are an increasing percentage of the labor force but are "cash poor" D) Are retiring at earlier ages and so live below the poverty level

Ans: B Feedback: Less than 15% of older people live below the poverty level. Social Security is the main source of income for more than half of all older adults.

17. Most older women become widows. Widows must adjust to the significant loss of loved ones and the new task of living alone. Studies show that most widows: A) Require short-term treatment for depression B) Adjust well, finding new friends, interests, and activities C) Turn to their still-married female friends for advice and support D) Move in with their adult children for a period of time

Ans: B Feedback: Most widows adjust well. The friendships of the past between married couples become less important, and friendships with other widows develop. Most widows successfully live alone, and relatively few require treatment for depression.

16. As a person ages, muscle tone decreases throughout the digestive system, causing a slowing movement of food through the esophagus. Delayed esophageal emptying in the elderly increases the risk of: A) Gastric irritation B) Aspiration C) Irritable bowel syndrome D) Constipation

Ans: B Feedback: Normal aging does not interfere with mobility through the bowel or bowel action. Gastric irritation results from a higher pH of stomach fluids. Aspiration is a risk associated with a weakened gag reflex, relaxation of the lower esophageal sphincter, and delayed esophageal emptying.

5. A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client's prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest: A) Prostate cancer B) A risk of malignancy that should be followed up C) A normal age-related change unlikely to have consequences D) A urinary tract infection

Ans: B Feedback: Prostatic enlargement is exceedingly common among older men, but represents a risk of malignancy that necessitates further assessment and follow-up. It is not a definitive sign of prostate cancer and is not indicative of a urinary tract infection.

18. Which of the following is a normal reflex profile for an elderly patient? A) Knee: normal; arm: absent; abdomen: absent B) Knee: normal; arm: reduced; abdomen: absent C) Knee: reduced; arm: normal; abdomen: reduced D) Knee: reduced; arm: reduced; abdomen: absent

Ans: B Feedback: Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee.

19. Mr. B, age 72, has a history of heart disease. He insists that his high-fat diet is permissible, however, because he takes a daily supplement of gugulipid, an herb purported to reduce blood cholesterol levels. In talking with the patient, what should Mr. B's nurse do first? A) Suggest that Mr. B ask his doctor for a prescription medication to reduce cholesterol levels B) Review with Mr. B the benefits associated with limiting dietary fat C) Introduce Mr. B to the additional benefits associated with fish oil supplements D) Advise Mr. B to stop using gugulipid, as herbal supplements are not regulated by the FDA

Ans: B Feedback: The first duty of Mr. B's nurse is to promote positive health behaviors, which means encouraging the patient to limit his fat intake. Herbal supplements are unregulated, and their health benefits may be questionable. Whether fish oil supplements or prescription medications are advisable in this case merits further investigation.

25. Decreased renal mass and reduced glomerular filtration make it especially important that nurses: A) Assist elderly patients with frequent toileting B) Ensure that age-adjusted drug dosages are prescribed C) Look for signs of urinary tract infections D) Frequently check urine for glucose

Ans: B Feedback: The need for frequent toileting is a result of decreased bladder capacity. Weaker bladder muscles increase the risk of urinary tract infections. Tests for glucose in the urine are needed on a case-by-case basis. The need most associated with decreased renal mass and reduced glomerular filtration is age-adjusted drug dosage.

10. Nursing students attending City College of Nursing are scheduled for clinical experience at facilities in various sections of the city. Their experience will expose them to a wide variety of populations. Which of the following is a major reason why nurses need to understand the general characteristics of various ethnic groups? A) To ensure that clients get the respect customary in their own ethnic group B) To provide individualized and culturally sensitive care C) To ensure that medical treatments comply with cultural expectations D) To increase compliance among minority patients

Ans: B Feedback: To understand the uniqueness of each older adult encountered, consideration must be given to the influences of ethnic origin.

9. Which of the following actions by a nurse who works with older adult clients in an assisted living facility is most likely to inhibit healthy aging? A) Discussing current events with clients who read and watch television. B) Placing a bib on each client during meal times to ensure clients maintain a clean appearance. C) Challenging clients to learn new skills and develop preexisting talents. D) Facilitating introductions between new and existing clients

Ans: B Feedback: While the nurse's action may have a laudable rationale, using a bib and feeding clients who may not require either action is incongruent with promoting function and preventing helplessness. Discussing current events and facilitating new skills and relationships promote well-being.

5. A primary care nurse has a long-standing relationship with a 63-year-old male client who is poised to retire. Place the following phases of the client's likely transition in the correct chronological order. Use all the options. A) A euphoric period involving testing of fantasies around retirement. B) Near phase, often accompanied by fantasy regarding the retirement role. C) Disenchantment phase D) Establishment of a stable and sustainable retirement role. E) Establishment of realistic and alternative sources of satisfaction during retirement.

Ans: B, A, C, E, D Feedback: The near phase of preretirement and the accompanying fantasy is often followed by a euphoric honeymoon phase. This can be followed by a disenchanting letdown, and a subsequent reorientation that results in eventual stability.

1. A nurse manager at a long-term care facility is engaged in efforts to change many staff members' inaccurate and negative views of older adults. Which of the following statements made by staff is most clearly indicative of ageism? A) "Older people seem to have so many more chronic health problems than younger people." B) "Older adults' motor skills get progressively slower as they age." C) "It's normal to expect a gradual loss of memory and intelligence with age." D) "A lot of the physical changes that accompany aging are inevitable."

Ans: C Feedback: A common ageist misconception is that senility and loss of intelligence inevitably, and normally, accompany the aging process. Older adults do have more chronic conditions than younger adults, and motor skills become slower. Many of the physical changes that accompany aging are considered normal and largely inevitable.

20. A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is: A) Decline in brain weight B) Reduction of blood flow to the brain C) Flawed response to changes in balance D) Slowed nerve conduction velocity

Ans: C Feedback: Although all the statements are true, the major factor increasing the risk of falls is a flawed response to changes in balance.

21. Which of the following is the most direct way for nurses to accommodate ethnic diversity among their clients? A) Explain how scientific research evidence supports medical treatment B) Provide standardized diets that meet patients' nutritional needs C) Listen to the life stories of elderly patients D) Take a foreign language class or travel abroad

Ans: C Feedback: Although the research base underlying treatments may be important to some patients, relating it does not help the nurse understand or address ethnic diversity among patients. Standardized diets ignore patients' food choice preferences, which are often culturally related. Although travel and language study may broaden a nurse's appreciation for other cultures, the most direct step is to value and respect the life stories that patients share.

6. Nurse M is employed in an assisted living facility and is privy to many of the changes that accompany the aging process. An older female resident of the facility has expressed a fear that her decreased mobility will make her increasingly dependent on her daughter. How can the nurse best respond to the resident's concerns? A) "There are treatments and drugs that we can explore which might prevent this from happening." B) "This is a normal part of the aging process and you don't necessarily need to fear it." C) "Many older adults have similar concerns. We can work together to keep you independent as long as possible." D) "I'm sure this is very stressful for you, but it's fortunate that you are not experiencing severe pain or illness."

Ans: C Feedback: Answer C validates the client's concerns and expresses the possibility of addressing the issue without downplaying it or providing unrealistic promises. Answer A provides an unrealistic promise of prevention, while answers B and D downplay the severity and significance of the client's concerns.

4. Nurse Y works in the emergency department of a large, urban hospital. When assessing the following older black adults who have recently presented to the department, which of the following assessments would the nurse want to modify for this population? A) Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive. B) Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus. C) Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease. D) Assessment of a client's chest pain who has a history of myocardial infarction.

Ans: C Feedback: Assessment of cyanosis can be complicated by the high melanin content of black adults' skin. Musculoskeletal assessment, assessment of sensation, and assessment of chest pain would not necessitate modification.

11. In ancient times, the relationship between age and the value afforded to individuals was generally: A) Positive: with advanced age came increased value B) Negative: respect declined as age increased C) Variable: respect was different in different cultures D) Cyclic: respect moved back and forth between positive and negative

Ans: C Feedback: Attitudes toward the aging varied among cultures. The ancient Chinese, for example, believed that the elderly deserved honor and respect, whereas the ancient Romans had little respect for the elderly, customarily killing them first in the nations Rome conquered.

6. Which of the following interventions in the care that preceded the death of a female, Jewish older American was most likely to have warranted special consideration? A) The client required transfusions of packed red blood cells during her care. B) Assessment by a male physician was required. C) An autopsy was ordered due to the client's unique disease etiology. D) A do-not-resuscitate (DNR) order was recommended by the care team when the client's disease progressed.

Ans: C Feedback: Autopsy is often opposed in the context of Jewish religious and cultural beliefs. Blood transfusions, assessment by a physician of the opposite sex, and DNR orders are not noted to be particular issues in the context of this culture.

2. A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future? A) While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. B) By 2020, it is expected that over one-third of Americans will be over the age of 65. C) Both life expectancy and the percentage of people over 65 in the population will increase in coming decades. D) Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020.

Ans: C Feedback: Both life expectancy and the percentage of individuals over age 65 are expected to increase in coming years. About 17% of the population is expected to be over 65 by 2020.

14. Which of the following statements form components of both the error theory of aging and the cross-linking theory of aging? A) Free radicals cause mutations in cells. B) Senescence is environmentally controlled at the cellular level. C) Changes in DNA lead to organ malfunctions. D) Genetic programming determines life expectancy.

Ans: C Feedback: Both the error theory and the cross-linking theory assert some change in DNA that interferes with normal cell functioning. Such changes may be caused by free radicals or any of many other mutagens. Although the aging of cells may be environmentally influenced, it is not thought to be externally controlled. That genetic programming determines life expectancy is a basic tenet of the programmed theory of aging.

8. Which of the following statements by a nurse who provides care in an assisted living facility best conveys cultural sensitivity? A) "We need to ensure that both minorities and Americans have their health needs met." B) "It's important to remember that minority groups do not usually express their pain explicitly." C) "We need to build our knowledge of residents who belong to cultural and ethnic groups that we're not familiar with." D) "We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment."

Ans: C Feedback: Building a knowledge base around cultural groups is a component of culturally sensitive care. Differentiating between "minorities" and "Americans" is an inaccurate dichotomy and it is inaccurate to generalize that all minorities are reticent to express pain. It would be inappropriate to counter an older adult's perception of the cause of illness when it is culturally rooted.

13. The emergence of today's nuclear family units has changed the roles and functions of family members in many ways. In counseling elders and their families, which of the following beliefs about aging should a nurse be aware as one of these ways? A) Children are expected to provide financial support for their aging parents B) Grandparents are spending more time with their grandchildren than ever before C) Older adults enjoy freedom from responsibility for their adult children's welfare D) Older parents and their children grow apart, seldom developing satisfying adult-to-adult relationships

Ans: C Feedback: Children are no longer expected to provide financially for their aging parents, and grandparenting—although important and satisfying—is a long-distance undertaking in families that live many miles apart. Today's parents do, however, often enjoy satisfying adult-to-adult relationships with their grown children. Today's parents are free from responsibilities for their adult children more than any generation before, and many actively enjoy that freedom in middle age and later life.

17. Mrs C brings her elderly Chinese grandmother to the health clinic. When Grandmother C finds out that all the clinic physicians on duty are males, she appears embarrassed and becomes quiet and withdrawn. All the office staff were schooled in traditional Western medicine. Of the following suggestions, which best describes what the staff can do to put Grandmother C more at ease about receiving health care? A) Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C's medical problem B) Show Grandmother C a picture of the human body and have her point to the area of her problem C) Observe Grandmother C more closely and ask specific questions D) Tell Grandmother C that being seen for treatment by a physician of either gender will put her yin and yang back in balance

Ans: C Feedback: Chinese women may be embarrassed to receive health care from a man. Nurses should observe more closely and ask specific questions to ensure that the quiet nature of the patient is not misinterpreted to imply that no problems exist. It would be disingenuous to tell her that receiving care would right her yin and yang, and close observation and questioning would be preferable to simply asking her to point to the problematic area on a picture.

20. Ms. E, an 80-year-old, is gradually withdrawing from society and wants society to gradually withdraw from her. She believes that this mutual withdrawal will free her from societal roles and give society the means for transferring power from the old to the young. Ms. E's grown children are concerned and say her belief has no scientific basis. On which of the following theories of aging can Ms. E say she bases her belief? A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory

Ans: C Feedback: Disengagement theory views aging as a process in which society and the individual gradually withdraw, or disengage, from each other, to the mutual satisfaction and benefit of both.

15. Older adults in good physical condition have cardiac function comparable to younger persons in poor condition. What is the most likely cause of a rise in systolic blood pressure in the elderly? A) Postural and postprandial hypotension B) Atherosclerosis in the innermost layer of the blood vessels C) Impaired baroreceptor function and increased peripheral resistance D) Cellular proliferation in the tunica intima

Ans: C Feedback: In the middle layer of blood vessels, impaired baroreceptor function and increased peripheral resistance lead to a rise in systolic blood pressure. Reduced sensitivity of the blood pressure regulation with baroreceptors increases problems with postural hypotension and postprandial hypotension; thus, they are an effect, not a cause. Cells proliferate in the innermost layer of vessels and atherosclerosis develops, but these are not the direct causes of increased systolic pressure.

12. Mrs. H and Mrs. J are the same age. While in the doctor's waiting room, they discuss their ailments and their beliefs about aging. Mrs. H argues that Mrs. J must be older because she has more ailments. The nurse settles the argument by stating a cornerstone of all biological theories of aging. Which of the following statements did the nurse most likely make? A) Aging is a predictable cellular process. B) Cells undergo a finite number of divisions. C) No two individuals age identically. D) Body systems decline at the same rate.

Ans: C Feedback: Individual variability is fundamental to all biological theories. Aging is not totally predictable, nor is it necessarily cellular in some biological theories. Body systems are often seen to decline at different rates.

19. After an initial period of enthusiasm, Mr J feels disappointed with his retirement. He cannot afford to travel as much as he had dreamed, and arthritis limits his mobility. Mr J's nurse can help him most by assisting him in entering which phase of retirement? A) Stability, in which he accepts his limitations B) Termination, in which he resumes a productive work role C) Reorientation, in which he assesses alternative sources of satisfaction D) Disenchantment, in which his hidden depression can be openly diagnosed and treated

Ans: C Feedback: Mr J has passed through the honeymoon phase of his retirement and has entered the disenchantment phase. In this phase, the retiree feels let down, and depression may or may not be experienced. Mr J's nurse can help him take the next step into the reorientation phase, in which he develops a lifestyle that gives him satisfaction based on realistic choices. The stability phase may follow, although some retirees never achieve it. Termination is the end of retirement brought about by illness, disability, or a return to work.

8. A care aide at a long-term care facility has assured the family of a resident that their father's increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide's statement to the family? A) "It's actually a myth that older people experience changes to their memory." B) "Memory losses are a normal age-related change many people experience." C) "Older adults have less working memory and slower retrieval, but this still requires further assessment." D) "There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia."

Ans: C Feedback: Older adults often experience delays in retrieval of memories and working memory. Some changes in memory, even in the absence of delirium or dementia, are to be expected but they should not be discounted and would require further assessment.

24. Older adults may appear rigid in their attitudes because of: A) Changes in personality that accompany aging B) Diminished ability to learn new information C) Physical or mental limitations D) Decline in morale and self-esteem

Ans: C Feedback: Personality, learning ability, and morale/self-esteem do not change with age. Seniors may resist change because of their physical or mental limitations—for example, rearranging the furniture when eyesight or mobility is limited.

10. A nurse notes that a 90-year-old male client on a geriatric medical unit of the hospital has been talking about death frequently. Given that the nurse has good rapport with client, what is the nurse's most appropriate response? A) "Try to focus more on the positive benefits of healing rather than what might happen." B) "Remember that in this day and age many people can live far beyond 90 years of age." C) "I've noticed you've brought up the issue of dying a lot. How do you feel about that?" D) "You'll find that aiming for health rather than thinking about death will have positive results."

Ans: C Feedback: Preparing for death has been identified as a developmental task for later life and would be an appropriate topic for discussion given the partnership that exists between the nurse and the client and the client's desire to broach the subject.

18. A magazine geared toward elderly women contains an advertisement for an anti-wrinkle cream purported to remove wrinkles caused by the drying effects of years of soap use. Knowledgeable nurses can keep their elderly female clients from being duped by this advertisement by explaining that the wrinkling of facial skin in old age results primarily from: A) Changes in the endocrine glands B) Cellular mutations arising from toxic chemicals C) Repeated exposure to ultraviolet light D) A diet high in fats and refined sugars

Ans: C Feedback: Repeated exposure to ultraviolet light causes solar elastosis, the wrinkling that results from the replacement of collagen by elastin. Toxic chemicals, nutrition, and endocrine changes are not known to produce the wrinkling of the skin seen in old age.

9. Which of the following teaching points around the use of self-reflection with older adults is most accurate? A) Self-reflection is easier for older adults than for younger adults. B) Self-reflection is less effective for male elders than for females. C) Self-reflection often involves learning a process and is difficult for many people. D) Self-reflection is not normally possible with individuals who have cognitive deficits.

Ans: C Feedback: Self-reflection is a valuable tool for many older adults, but it does not occur easily or naturally for many people and is likely to require some teaching and guidance. It is not necessarily easier for older people or for women, and cognitive deficits do not preclude it.

13. Which of the following statements is evidence that supports the programmed theory of aging? A) The life spans attained by parents and their offspring are negatively correlated. B) Mutations perpetuate themselves through each cycle of cell division. C) In cultures, cells go through a finite number of cell divisions before dying. D) In cultures, cells from older donors divide faster than those from younger donors.

Ans: C Feedback: Studies of in vitro cell proliferation have demonstrated that various species have a finite number of cell divisions. Life spans of parents and offspring are positively correlated. Mutation perpetration is a tenet of the error theory, not the programmed theory, of aging. Although longer life spans correlate positively with numbers of cell divisions in vitro, the rate of cell division is not affected.

22. When compared with elderly populations of the past, persons entering their senior years between 2015 and 2030 will have: A) Fewer chronic diseases but more acute illnesses B) Greater support from their children and spouses C) Better education and greater wealth D) Fewer needs for hospital or nursing home care

Ans: C Feedback: The baby boomer cohort attained higher levels of education and economic status than past generations. They have, however, fewer children and the same (or greater) burdens of chronic disease and needs for health care as their parents did.

13. Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because: A) Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B) Black Americans have a higher incidence of cancer and diabetes than white Americans C) Hypertension and heart disease occur at a higher rate in the black population than in the white population D) Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep

Ans: C Feedback: The black population has a higher prevalence of heart disease than the white population, and hypertension occurs at a higher rate. A contributing factor is a blunted nocturnal response, in which only a minor decline occurs during sleep. Even though it is true that black persons have a higher incidence of cancer and diabetes than white persons, blood pressure screening does not address those disorders. Lifestyle modifications can effectively control many causes of morbidity and mortality among all people.

16. From the late 1980s to the present, the gap in life expectancy between individuals in the Caucasian and African American communities has widened. Which of the following most clearly accounts for this trend? A) Acute illness in the black population has increased B) Infant mortality and complications of childbirth in the white population have declined C) The life expectancy of African Americans has not increased at the same rate as that of the white population D) Deaths from homicide in the white population have increased

Ans: C Feedback: The gap in life expectancy between white individuals and African Americans has widened because the life expectancy of African Americans has not increased at the same pace as that of Caucasians. The U.S. Department of Health and Human Services attributes this decline to an increase in deaths from homicide and AIDS.

6. A care aide employed on a geriatric medicine unit of a hospital expresses frustration that "old people get sick so much more often than young people." What is the nurse's most appropriate response to this statement? A) "In fact, the prevalence of obesity and accompanying chronic illnesses mean that young people actually have more chronic conditions than older adults." B) "It's actually a myth that older adults require more hospitalization than young people." C) "Actually, older adults experience fewer acute illnesses than younger people, it's just that they tend to take longer to recover from them." D) "With the increase in life expectancies in recent years, most older people actually live free of chronic diseases until very late in life."

Ans: C Feedback: The incidence of acute illness is lower among older adults than younger adults, though recovery times tend to be longer. Older adults tend to have a higher incidence of chronic illness and require more frequent and longer hospitalizations.

10. Which of the following statements by the daughter of an 87-year-old resident of a nursing home would the nurse most likely want to correct or clarify? A) "It seems like more and more people are living well into their 80s like my mom." B) "My mom has a house worth loads of money but little cash flow, like many older adults." C) "It seems like heart disease is getting more common even though people live longer than they used to." D) "There are more women living to my mother's age than there are men."

Ans: C Feedback: The incidence of heart disease as a cause of death is on the decline. More Americans are indeed achieving old age and many older adults have valuable assets but little cash flow. Female longevity continues to exceed that of males.

5. Which of the following statements most accurately captures the financial status of older adults in the United States? A) The percentage of older people living below the poverty level has been increasing. B) The financial needs of most older adults are well met by Social Security income alone. C) The recent decline in housing prices has made many older adults "asset rich and cash poor." D) Women 65 years of age and older is the fastest growing group of employment.

Ans: C Feedback: The percentage of older people living below the poverty level has been declining, with about 10% now falling into this category. Most older people depend on Social Security for more than half of their income. Although the median net worth of older households is nearly twice the national average because of the high prevalence of home ownership by elders, many older adults are "asset rich and cash poor." The recent decline in housing prices, however, has made that asset a less valuable one for many older adults. There has been a significant rise in the percentage of middle-aged women who are employed, although there has been little change in the labor force participation of women 65 years of age and older.

20. To receive government money, County Hospital is required to provide demographic statistics on its patient base. In checking off the Ethnic Group boxes on the obligatory forms, office workers must be able to distinguish terminology. Which of the following best defines the term Hispanic? A) Immigrant workers who entered the United States and their descendants B) Puerto Ricans who emigrated from the United States and their descendants C) Any Spanish-speaking people living in the United States D) Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil

Ans: C Feedback: The term Hispanic encompasses a variety of Spanish-speaking persons in America, including Spaniards, Cubans, Mexicans, and Puerto Ricans. Hispanic people now represent approximately 6% of the older population.

24. The bodily changes that occur during the aging process can affect an older person's body image and self-concept. The nurse can gain insight into the emotional well-being and self-concept of older persons by: A) Uncovering any unresolved guilt and perceived failures B) Reviewing how they interpret and refine their past experiences C) Examining what roles they accept and what roles they reject D) Determining which work roles they forfeit

Ans: C Feedback: The way persons perceive themselves and function can determine the roles they play. And the roles they accept and reject are important indicators of their self-concepts.

21. Younger individuals know that they will not live forever, but their behaviors may indicate that they deny their mortality. One major indication of this denial is their failure to: A) Establish a financial plan for retirement B) Provide adequately for their family's health care needs C) Make a will and set up a burial plan D) Form strong relationships with family and friends

Ans: C Feedback: Those who deny old age fail to establish retirement plans. People fail to provide for health care needs for many reasons, and acceptance of mortality may or may not influence personal relationships. The major sign of denial of mortality is failure to make a will and make plans for death.

12. Mrs S is recently widowed. She worked at home as a full-time wife and mother throughout her adult life. She is now most likely to experience: A) A desire to obtain employment outside the home B) Relief at being freed from the responsibilities of childrearing C) A sense of loss of her established social roles D) An interest in meeting men her own age and remarrying

Ans: C Feedback: Unlike many of today's younger women, who may value employment and motherhood equally, the elderly women of today centered their lives on their families, from which they derived their sense of fulfillment. Having developed few roles from which to achieve satisfaction other than that of wife and mother, many of these women feel a void when their children are gone and their husbands die.

1. Which of the following projections of future demographics of older Americans is most accurate? A) By 2020, more than 50% of older Americans will belong to a non-Hispanic white group. B) The percentage of black older adults will decrease slightly due to lower life expectancies. C) The number of Hispanic older adults is projected to grow dramatically. D) Within 40 years, a minority of older Americans will be white related to immigration.

Ans: C Feedback: Whereas in 2000, approximately 84% of older Americans were non-Hispanic white, it is projected that this population will decrease to 64% by 2050. During this same period, there will be dramatic growth among Hispanic older adults, who will represent 16% of the older population. Black individuals will grow from 8% to 12% of the older population during this time. By 2020, one-quarter of America's older population will belong to a minority racial or ethnic group.

2. A 78-year-old man has received a recent diagnosis of community-acquired pneumonia. Potential pathological findings on a recent chest x-ray have prompted his physician to order a bronchoscopy and lung function tests. Which of the following findings would be most likely suggestive of pathological processes rather than normal, age-related respiratory changes? A) The client has fewer cilia than would be found in a younger client. B) Lung function tests reveal that both maximum breathing and vital capacity are diminished since his last test. C) There is an accumulation of serous fluid between the lungs and the pleural membrane. D) The lungs are smaller than younger adults' and there are fewer alveoli.

Ans: C Feedback: While decreases in the number of cilia, alveoli, lung size, and lung capacities are commonly associated with aging, an accumulation of serous fluid would not be considered a normal consequence of the aging process.

4. A nurse who works on a palliative care unit has developed a strong partnership with the 77-year-old wife of a client who has recently died of lung cancer. The woman has expressed her fears around being a widow to the nurse. How can the nurse best respond? A) "You will likely find that once you are remarried the grief will subside and you will move on." B) "It's very normal to have these fears, but antidepressant medications can help immeasurably with this difficult transition." C) "Though it might not feel like it now, many women eventually find joy in new friendships and freedom after the death of a spouse." D) "It will be important, and healthy, for you to maintain roles and routines similar to before your spouse died."

Ans: C Feedback: Widows often find positive consequences of their status in time, often in the form of new relationships. Suggesting that the grief will subside after remarriage and encouraging the woman not to change would be inappropriate, as would specific recommendations for medication.

2. The error theory of aging proposes a cause-and-effect relationship between the genetic activity of body cells and the effects of aging. Place the following steps in the error theory of aging in the correct chronological order. Use all the options. A) Organ, tissue, and system malfunction B) Perpetuation of mutation during cell divisions C) DNA mutation D) Overall decline in body functions E) Decline in body functions

Ans: C, B, E, A, D Feedback: The error theory of aging proposes that DNA mutations occur on a single-cell level and are perpetuated in subsequent cell divisions. The overall number of mutant cells in the body increases and causes deleterious effects on tissues and systems and eventual decline in body function.

2. According to Erikson, the final stage of the life cycle is centered on achieving integrity versus despair. Which of the following situations would signal to the nurse that the client in question is at risk for disappointment and despair as characterized by Erikson? A) An 81-year-old woman has needed to adopt a minced diet following a recent stroke. B) A 78-year-old man has had a pacemaker implanted to address his atrial fibrillation. C) A 90-year-old woman is grieving the recent death of her husband to whom she was married for 66 years. D) An 80-year-old man describes himself as "useless" since he can no longer help his adult children with their yard and garden work.

Ans: D Feedback: A perceived loss of useful function often constitutes a crisis for older men and can be associated with despair rather than integrity in Erikson's typology of the life cycle. A change in diet, a medical intervention, and grief at the loss of a spouse are less closely associated with this conflict.

11. It is important to measure and record fluid input and output accurately because this information is used in evaluating a patient's fluid balance and in planning care and treatment. Dehydration is a significant risk for the elderly because: A) The number of body cells is less, and fewer cells are functioning in the body. B) Total body fat as a proportion of the body's composition increases with age. C) Cellular solids and bone mass decrease with age affecting the ability to balance. D) Extracellular fluid remains constant, but intracellular fluid decreases with age.

Ans: D Feedback: Although all the statements are true, only the loss of intracellular fluid is a cause of increased risk of dehydration.

17. Which of the following is the most common urinary problem among men aged 65 years and older? A) High urinary volume B) Glucose in the urine C) Stress incontinence D) Frequent urination

Ans: D Feedback: Although all these conditions may occur or coexist, most common is the need for frequent urination associated with enlargement of the prostate gland. This enlargement occurs to some degree in three-fourths of men aged 65 years and older.

3. A nurse is explaining to an older adult client that many of the changes in his body that are currently causing him frustration may have their origins in genetic changes that may have in fact benefited him during his younger years. Which of the following theories of aging underlies the nurse's explanation? A) Disposable soma theory B) Free radical theory C) Mutation accumulation theory D) Antagonistic pleiotropy theory

Ans: D Feedback: Antagonistic pleiotropy theory proposes that genetic mutations that are problematic in later life may be rooted in mutation that played a beneficial role earlier in life. This perspective is not a component of the disposable soma theory, free radical theory, or mutation accumulation theory.

12. Although only 12% of elderly black Americans experience institutional care in their lifetimes, compared with 23% of elderly white Americans, they typically possess more health problems than their white counterparts. This difference in health status is most likely due to: A) High incidence of violent crime and sexually transmitted diseases B) Reliance on family for health care advice and rejection of formal service agencies C) Cultural preference for unconventional medical treatments like spiritual and herbal remedies D) Lower standard of living and less access to health care services

Ans: D Feedback: Black elders historically possess many health problems that have accumulated over a lifetime due to a poor standard of living and limited access to health care services. Although the other choices may apply to this population, they are not the major reasons for the diminished health status of many black elders.

19. What is the most important factor contributing to limitations in self-care and independent living among the elderly? A) Lack of family support B) Low financial assets C) Acute illness and injury D) Chronic illness

Ans: D Feedback: Chronic illnesses are noted to have a significant impact on the quality of life of older adults. These illnesses are more prevalent than acute illnesses and supersede deficits in family and financial support.

5. A nurse is assessing an 84-year-old female Chinese American's pain following her left hemiarthroplasty 2 days prior. Which of the following characteristics of Chinese Americans should the nurse be aware of during this assessment? A) Chinese Americans often view pain as a virtue and tend to underreport it. B) Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved. C) Chinese women often overstate their pain in light of health care providers' reluctance to provide analgesia. D) There is often a reluctance to acknowledge pain among older Chinese Americans.

Ans: D Feedback: Discomfort is not typically aggressively or openly displayed by Chinese persons. Pain is not noted to be seen as a virtue or in a fatalistic light. Pain is not commonly overstated.

16. Rehabilitation Health Facility has a high percentage of Jewish patients recovering from a variety of ailments. Which of the following is important for the facility's staff to know about medical care and the Jewish culture? A) Pork and shellfish but not milk products are recommended as healthful foods in the diet. B) A rabbi must be consulted before any health-related decisions can be made. C) A skullcap and socks must be worn from sundown Friday to sundown Saturday. D) Modern medical care is encouraged but may be opposed during the Sabbath.

Ans: D Feedback: In the Jewish culture, medical care is encouraged but may be opposed during the Sabbath. Exceptions may be made for the seriously ill. The other choices are not true of the Jewish culture.

23. Nurse Z takes ample time to explain all medical options to her elderly patients and to ensure they have the information they need to make informed decisions about their care. What is Nurse Z's best reason for taking these actions? A) Full disclosure deters malpractice suits and negligence claims B) The activity theory of aging requires maintenance of lifestyle C) Information is an effective strategy for stress management D) Empowerment has a positive effect on health status

Ans: D Feedback: Maximum control and decision making can have a positive effect on morbidity and mortality, although they do not necessarily reduce stress and are not inherent in the activity theory of aging. Even though legal considerations apply, the health of the patient is the first priority for nurses.

14. Gerontological nursing will become an increasingly important profession, compared with in the past, because: A) More people will be presenting with the same health care challenges B) More elderly are living in increasingly squalid living conditions C) A greater number of people are surviving the previously hazardous period of infancy D) More people are spending a longer time span in old age

Ans: D Feedback: More people are achieving and spending longer periods of time in old age than ever before in history. Declines in living conditions, increased prevalence and incidence of the same health problems, and higher survival rates during infancy do not account for the increased importance of gerontological nursing.

11. Various changes during the aging process demand multiple complex adjustments that require stamina, ability, and flexibility. In which stage of life do individuals experience the greatest number of simultaneous changes? A) Adolescence B) Young adulthood C) Middle age D) Old age

Ans: D Feedback: More simultaneous changes are experienced in old age than during any other period of life.

9. The family of an 85-year-old man who has been admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults? A) The high value of assets owned by older adults makes the financial burden of care minimal for most older adults. B) Payment for long-term care of adults is most often covered by private insurers. C) Most older adults have their basic care needs provided in a long-term facility. D) Overall, federal money pays for more care than do older adults themselves or private insurers.

Ans: D Feedback: Most money for the care of older adults comes from federally funded programs. The burden of payment is still significant for most older adults and a minority of older adults receive care in an institutional living environment.

14. A group of young student nursing assistants is getting clinical experience at a nursing home. In her introductory meeting with this group, the supervising nurse determines that the students harbor some misconceptions about the elderly. Four of the students' comments are listed below. Three of them are misconceptions about the elderly. Which comment is true? A) Most old people are sick or disabled B) Most seniors have a private pension plan C) Senility comes with old age D) Old people are still interested in sex

Ans: D Feedback: Most old people are well, only a small minority are senile, and only a minority have income from a private pension plan. Many retain a healthy interest in sex.

25. A state health investigator surveyed the residents of a retirement housing complex to determine how their financial resources affected their lives and influenced their choices. Which of the following did the investigator most likely find to be true of most of the retired residents? A) Most older people depend on their life savings through their retirement years B) Inflation in the past decades increased retirement benefits for today's seniors C) Nearly three-quarters of all seniors are financially comfortable D) More than half of all seniors retire with only Social Security benefits

Ans: D Feedback: Only a minority of the older population has an income from a private pension plan. Few have significant savings, and inflation has decreased the value of their retirement funds. Of the workers who are currently active in the labor force, more than half will not have pension plans when they retire.

10. Nurse S encourages older adult clients to engage in spiritual beliefs and practices that they are familiar with. How can this activity be best characterized? A) Spiritual concerns are less relevant than immediate physical and financial issues. B) Older adults raised in more religious times are more likely to spontaneously express their spirituality. C) Addressing clients' expressions of spirituality is beyond the scope of appropriate nursing. D) Spiritual expression can be useful in facilitating hope in older adults.

Ans: D Feedback: Spiritual expression is useful in fostering hope and is within the scope of nursing practice. Older adults are not necessarily more spontaneously spiritual nor is spirituality secondary to finances and physical health.

7. Which of the following directives by the head nurse at a long-term care facility is most reflective of the activity theory of aging? A) "We need to facilitate older adults' desire to step back from the responsibilities and roles they had in earlier years." B) "It's hard to overestimate the importance of regular, physical exercise in maintaining health and healthy aging." C) "We need to remember that the psychological roles and characters of our residents change profoundly in later years of life." D) "We have to treat our residents like younger people and keep them engaged in meaningful acts."

Ans: D Feedback: The activity theory asserts that an older person should continue a middle-aged lifestyle, denying the existence of old age as long as possible, and that society should apply the same norms to old age as it does to middle age and not advocate diminishing activity, interest, and involvement as its members grow old. Stepping back from roles is associated with disengagement theory, and psychological roles and character are not thought to change radically in later life. Physical exercise is not a central component of activity theory.

22. Mr. D was friendly and active as a young adult. Now, as a 75-year-old, he enjoys visiting with his neighbors and attending a variety of sporting and cultural events. Mr. D's behavior is most consistent with which theory of aging? A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory

Ans: D Feedback: The continuity theory suggests that personality and basic patterns of behavior remain unchanged as an individual ages. This is not a central component of the other noted theories.

20. Mr B, age 73, has a terminal illness. He has entered a nursing home, where he will reside until his death. Until age 70, he worked as a successful bank president and was an active community leader. His nurse should be alert for signs that he most resents his: A) Mortality B) Unemployment C) Family D) Dependency

Ans: D Feedback: The elderly often fear that their illness or disability may cause them to lose their independence. Becoming a burden to their families, being unable to meet the demands of daily living, and having to enter a nursing home are some of the fears associated with dependency. Physical pain from an illness may not be as intolerable as the dependency it causes. In Mr B's case, his rapid change from great independence to near total dependence may distress him more than family relationships, the loss of his work role, or his impending death.

1. A nurse who works on a subacute medical unit of a hospital is discussing the increasing population of older adults on the unit with a colleague. Which of the colleague's following statements about older adults is most accurate? A) "Fortunately, Social Security ensures a sufficient level of income for people over 65." B) "It helps that older people don't have to directly incur any costs for their medical care." C) "Most of the older clients on the unit will have come to us from nursing homes." D) "It's reassuring that people are starting to show more concern for older adults than in decades past."

Ans: D Feedback: The formation of the Administration on Aging, enactment of the Older Americans Act, and the introduction of Medicaid and Medicare all occurred in 1965. Since that time, society has demonstrated a growing concern for its older members. Myths about older people include the belief that Social Security ensures them an adequate income, that they do not have to pay for medical care, and that most older adults live in nursing homes.

11. Nurses need to understand the aging process in order to help their patients: A) Live longer with their long-term disabilities B) Maintain youth and delay the onset of old age C) Accept the limitations imposed by genetic tendencies toward cellular degeneration D) Postpone the negative consequences of the aging process

Ans: D Feedback: The promotion of positive health practices increases the chances that an individual can delay or deter the impairments and declines that frequently accompany the aging process. Living long in a disabled state is not the most desirable objective. Maintaining youth is not an achievable goal. Accepting limitations is not necessary for many seniors and not life enhancing for many others.

17. Two related and important trends in the elderly population are: A) The growing gap in life expectancy between males and females and the number of women living alone B) The increase in life expectancy of white and black people. C) The continued burden of acute disease and the low levels of education among the elderly D) The increased burden of chronic illness and the shifting causes of death with advancing age

Ans: D Feedback: The role of chronic illness in death rates is both significant and represents a shift from the past. The gap in life expectancy between men and women is narrowing. The life expectancy of black people has been recently declining. The generation now entering the senior years is better educated than generations past.

4. Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? A) An 81-year-old woman's glomerular filtration rate (GFR) is low. B) A 78-year-old male's stomach pH is increased. C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy. D) A 78-year-old man has recently developed urinary incontinence.

Ans: D Feedback: While a decrease in GFR, increase in stomach pH, and slight left ventricular hypertrophy are considered normal accompaniments to aging, urinary incontinence should be considered a pathological finding that necessitates further assessment.

7. A hospital client, aged 82 years, is presently undergoing an endocrine diagnostic workup in an effort to diagnose his increasing fatigue of unknown etiology. Which of the following findings would his care team recognize as potentially pathological? A) Apparent decreased thyroid gland activity. B) Decreased somatotropic growth hormone (GH) levels. C) Delayed and insufficient release of insulin by the -cells. D) Decreased erythropoietin production by the kidneys.

Ans: D Feedback: While decreases in thyroid gland activity, GH, and insulin are often associated with aging, a decrease in erythropoietin production would be considered problematic and pathological.

21. A nurse is reviewing thyroid test results of her clients. Which of the following is the most likely thyroid test result for a healthy elderly patient? A) T4: low; T3: low; thyroid function: low B) T4: high; T3: normal; thyroid function: high C) T4: high; T3: normal; thyroid function: low D) T4: normal; T3: low; thyroid function: normal

Ans: D Feedback: With normal aging, secretion of thyroid-stimulating hormones (TSH) and the serum concentration of thyroxine (T4) do not change, although there is a significant reduction in triiodothyronine (T3), which is believed to be a result of the reduced conversion of T4 to T3. Overall, thyroid function remains adequate.

The nurse plans the care for the hospice client with end-stage Parkinson's disease. Which of the following symptoms should the nurse expect to incorporate into the nursing care plan?

Bradykinesia.

The nurse prepares the patient for a test to determine the cause of the cerebrovascular accident (CVA). For which test should the nurse teach the client and family?

Carotid Doppler studies.

A nurse is evaluating an elderly client's lifestyle to determine the level of risk for neurovascular problems. Which of the following should the nurse identify to the client as the most significant lifestyle risk factor for neurovascular problems such as Parkinson's disease and stroke?

Cigarette smoking.

The nurse provides for the care of the client after a cerebrovascular accident with expressive aphasia. Which of the following interventions should be the priority intervention?

Devise a picture chart for the patient to point for requests.

Relatives brought an elderly relative to the health center because they noticed a new behavior in the elderly person. The nurse practitioner explained that the behavior they noticed was characteristic of Parkinson's disease. Which of the following symptoms was most likely noticed in their relative?

Faint tremor in the hands or feet.

The nurse initiates teaching for the client who takes levodopa (Larodopa). Which of the following should the nurse caution the patient to avoid?

Foods high in vitamin B6.

A patient recovering from a stroke at home seems to have a pleasant environment. Family members come in to talk with him, and he has his own familiar clothing and books in his room. A calendar shows the current date. A television and radio are near his bed. No one disturbs him with details of his condition. However, he seems depressed and anxious. A visiting nurse would most likely recommend which of the following?

Giving him more information.

The nurse assesses a client with Parkinson's disease. Which of the following symptoms are unexpected, requiring immediate follow-up?

Hypoglycemia.

The nurse monitors a group of older adults exercising at the wellness center. For which of the following new assessment findings should the nurse immediately call first responders?

Inability to speak and imbalance.

Promoting independence in an older patient with neurologic problems may take many forms. What advice to a patient's family would most help the patient achieve maximum levels of independence?

Install self-help devices in the home.

Good nursing care of a patient who has had a cerebrovascular accident (CVA) can improve the patient's chance of survival and minimize the limitations that impair a full recovery. In the acute phase, nursing efforts should prioritize which of the following aims?

Maintain a patent airway.

Nurses should promote activities that reduce patient's risk of cerebrovascular accident (CVA). Which of the following is the most helpful activity to promote for reducing that risk?

Managing hypertension.

Which of the following patients on a subacute geriatric medicine unit is likely at the highest risk for experiencing a cerebrovascular accident (CVA)?

Mr. L age 79, who has poorly controlled hypertension and smokes half a pack of cigarettes daily.

The nurse assesses the members of a senior center. For which of the following new findings should the nurse require immediate follow-up by the primary care provider?

Numbness of hands.

The nurse advises the 80-year-old patient not to sleep slumped in the recliner. The nurse explains that proper positioning of the head and neck can help prevent transient ischemic attacks (TIAs) in which of the following ways?

Preventing impairment of cerebral blood flow.

The home care nurse plans the environment of the client with Parkinson's disease. Which of the following should the environment include?

Shower with nonslip surface and rails.

A nurse is communicating with a family that includes an elder who has neurologic problems. What should the nurse suggest the family include in the home to lessen the likelihood of injury to the elder?

Smoke alarms with batteries that are replaced often.

A nurse is providing care for an 80-year-old patient who has experienced an ischemic cerebrovascular accident (CVA) 3 weeks prior. Which of the following nursing actions is most likely to appropriately address the cognitive changes that have accompanied the patient's stroke?

Talk to the patient and give explanations while performing routine care tasks.

During a neurologic evaluation, the nurse practitioner has asked an 83-year-old client to draw the face of the clock and then tell the nurse what time the clock reads. Which of the following assessment findings would be most indicative of expressive aphasia?

The client draws a clock but is unable to state the time.

The nurse initiates teaching for the patient and family with newly diagnosed Parkinson's disease. In communicating with the patient and his family, which of the following should the nurse emphasize?

The disease progresses slowly, and therapy can minimize disability.

An 83-year-old resident of a nursing facility worked as a chef until retirement. The resident told the nurse "I am greatly disappointed that food just doesn't taste as good as it used to." Which of the following facts should underlie the response that the nurse chooses?

The function of the cranial nerves mediating taste declines with age.

A nurse who provides care in a long-term facility is working with a 78-year-old resident who has a diagnosis of Parkinson's disease. Which of the following aspects of the care the nurse provides should be reconsidered or modified?

The nurse phrases questions and directions in a simple and understandable manner applicable to the client's decreased cognition.

A 77-year-old patient has been brought to the emergency department by the daughter due to recent visual disturbances and unilateral weakness. The diagnostic workup has led the diagnosis of transient ischemic attacks (TIAs). Which of the following patient history most likely contributed to the patient's current health problem?

The woman is a smoker and takes antihypertensive medications.

An autopsy shows that Lewy bodies were present in a patient's brain. Which of the following characteristics did the living patient probably exhibit?

Tremor.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 17 Chapter: 34 Client Needs: D2 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 6 Page and Header: 449, Using Complementary and Alternative Therapies 17. A 76-year-old man has had his quality of life significantly affected by chronic obstructive pulmonary disease (COPD), a condition that has brought a steady decline in his activity tolerance, his mobility, and ultimately his independence. In light of the apparent ineffectiveness of conventional treatment, the man is eager to forego conventional treatments and explore alternative and complementary treatment options. How can the man's nurse best direct him?

A) "This is a wise decision, since conventional treatments are motivated by profit and the interests of pharmaceutical companies, not patients." B) "These are good options to explore, but you will need to set aside your physician's advice in the short term in order to get accurate information." C) "Try not to think of your options as choosing either conventional treatment or alternative therapies, but rather choosing the best of both." D) "Your care team is probably ignorant of alternative therapies, so you'll have to go elsewhere for any information you need." Ans: C Feedback: Patients should be able to use the best of both complementary/alternative and conventional health care practices. It would be inaccurate to wholly write off conventional treatments as serving only the interests of pharmaceutical companies and while various information sources are likely necessary, it would be inappropriate to recommend ignoring the advice or potential information from the care team and physicians.

Origin: Chapter 21- Digestion and Bowel Elimination, 12 Chapter: 21 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 297, Diverticular Disease 12. At a health promotion class at a senior's center, a 67-year-old client asks the nurse, "What can be done to help manage my spouse's diverticular disease?" What is the nurse's most appropriate response to this client's query?

A) "Try to encourage your spouse to drink at least 8 glasses of water each day." B) "You and your spouse might want to try eating 4 or 5 small meals rather than 3 larger ones each day." C) "I'd encourage you and your spouse to integrate more exercise into your daily routine." D) "Try to increase the amount of fiber that you include in the meals you cook." Ans: D Feedback: The importance of fiber intake supersedes fluid intake, meal spacing, and physical activity in the management of diverticular disease.

Origin: Chapter 2- Theories of Aging, 10 Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 18, Developmental Tasks 10. A nurse notes that a 90-year-old male client on a geriatric medical unit of the hospital has been talking about death frequently. Given that the nurse has good rapport with client, what is the nurse's most appropriate response?

A) "Try to focus more on the positive benefits of healing rather than what might happen." B) "Remember that in this day and age many people can live far beyond 90 years of age." C) "I've noticed you've brought up the issue of dying a lot. How do you feel about that?" D) "You'll find that aiming for health rather than thinking about death will have positive results." Ans: C Feedback: Preparing for death has been identified as a developmental task for later life and would be an appropriate topic for discussion given the partnership that exists between the nurse and the client and the client's desire to broach the subject.

Origin: Chapter 3- Diversity, 8 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 8. Which of the following statements by a nurse who provides care in an assisted living facility best conveys cultural sensitivity?

A) "We need to ensure that both minorities and Americans have their health needs met." B) "It's important to remember that minority groups do not usually express their pain explicitly." C) "We need to build our knowledge of residents who belong to cultural and ethnic groups that we're not familiar with." D) "We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment." Ans: C Feedback: Building a knowledge base around cultural groups is a component of culturally sensitive care. Differentiating between "minorities" and "Americans" is an inaccurate dichotomy and it is inaccurate to generalize that all minorities are reticent to express pain. It would be inappropriate to counter an older adult's perception of the cause of illness when it is culturally rooted.

Origin: Chapter 2- Theories of Aging, 7 Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 17, Activity Theory 7. Which of the following directives by the head nurse at a long-term care facility is most reflective of the activity theory of aging?

A) "We need to facilitate older adults' desire to step back from the responsibilities and roles they had in earlier years." B) "It's hard to overestimate the importance of regular, physical exercise in maintaining health and healthy aging." C) "We need to remember that the psychological roles and characters of our residents change profoundly in later years of life." D) "We have to treat our residents like younger people and keep them engaged in meaningful acts." Ans: D Feedback: The activity theory asserts that an older person should continue a middle-aged lifestyle, denying the existence of old age as long as possible, and that society should apply the same norms to old age as it does to middle age and not advocate diminishing activity, interest, and involvement as its members grow old. Stepping back from roles is associated with disengagement theory, and psychological roles and character are not thought to change radically in later life. Physical exercise is not a central component of activity theory.

Origin: Chapter 14- Nutrition and Hydration, 11 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/learning Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 11. The nurse is providing a seminar for a group of seniors on changing nutritional needs. What should the nurse instruct the participants about the reduced need for calories?

A) "You should consume at least three servings of fruits and vegetables daily." B) "You should limit your fat intake to less than 50% of total calories consumed." C) "The consumption of a high-carbohydrate diet prevents the release of glucose." D) "As you age, your basal metabolic rate declines, contributing to weight gain even when you consume the same amount of calories as when you were younger." Ans: D Feedback: Basal metabolic rate declines with age, a fact that can contribute to weight gain. Carbohydrates stimulate the release of insulin while fat intake should be below 30% of calories and five servings of fruit and vegetables should be consumed daily.

Origin: Chapter 36- Acute Care, 7 Chapter: 36 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 485, Surgical Care 7. Upon further questioning, an elderly man who expressed apprehension about his upcoming coronary artery bypass surgery admitted that he had a friend who had coronary artery bypass surgery a few years ago and had many complications postoperatively. Which of the responses by a nurse would be the best?

A) "You will feel better immediately." B) "This surgery is always successful at our hospital." C) "Bypass surgery has improved over the past 20 years." D) "You can recover as easily as a young person can." Ans: C Feedback: Although this surgery has become almost routine in large hospitals, it still poses some dangers. The chances of recovery are good, but they are not as good for elderly persons as for younger ones.

Origin: Chapter 21- Digestion and Bowel Elimination, 5 Chapter: 21 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 290, Effects of Aging on Gastrointestinal Health 5. The nurse assists the aging client to create a menu. Which of the following foods, if requested by the client will require further teaching as it should not be included on this list?

A) 2% milk B) Canned tuna C) Fried chicken D) Squash Ans: C Feedback: The pancreas experiences fibrosis, atrophy, and fatty acid deposits, along with a reduction in pancreatic secretions; this can affect the digestion of fats and contribute to intolerance for fatty foods. The decrease in hydrochloric acid can interfere with the absorption of calcium, iron, folic acid, and vitamin B12. There are fewer cells on the absorbing surface of the intestinal walls affecting the absorption of dextrose, xylose, calcium, iron, and vitamins B, B12, and D.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 23 Chapter: 8 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 107, Do Not Resuscitate Orders 23. Which of the following is required in order for a nurse to be legally justified in not attempting to save a client's life?

A) A "Do Not Resuscitate" (DNR) statement on the patient's care plan B) A "No-Code" sign or symbol placed at the patient's bedside C) A "No-Code" order written and signed on the physician's order sheet D) The next of kin's request for DNR orally or in writing Ans: C Feedback: Unless an order specifically states that the patient should not be resuscitated, failure to attempt to save that person's life can be viewed as negligence. To be valid, DNR orders must be written and signed on the physician's order sheet. DNR on the care plan or a symbol at the bedside is not legal without the medical order. A request from a family member is no substitute for a signed order.

Origin: Chapter 13- Spirituality, 16 Chapter: 13 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 165, Box 13-1 16. The nurse is preparing a list of patients who will need the annual influenza inoculation. Which older adult will most likely refuse this vaccination?

A) A 71-year-old Christian Scientist B) A 68-year-old man who attends a Unitarian church C) A 68-year-old female patient who identifies herself on admission as a Jehovah's Witness D) A 78-year-old who says that she is a member of the Church of Jesus Christ of Latter Day Saints Ans: A Feedback: Christian Science is a religion based on the use of faith for healing. Christian Scientists may decline drugs, psychotherapy, hypnotism, vaccination, and some other treatments. The other religions and beliefs do not specify that vaccinations are to be avoided.

Origin: Chapter 21- Digestion and Bowel Elimination, 11 Chapter: 21 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 297, Esophageal Cancer 11. Which of the following older adults is likely at the highest risk for developing esophageal cancer?

A) A 74-year-old with alcoholism who has chewed tobacco for many decades. B) A 66-year-old who has experienced significant dysphagia since her CVA 3 years prior. C) An 80-year-old who has a history of sepsis that was attributed to periodontal disease. D) An obese, 72-year-old who has a history of a hiatal hernia. Ans: A Feedback: Alcohol, smokeless tobacco use, and poor oral hygiene are associated with an increased incidence of esophageal cancer. Dysphagia is a symptom rather than a causative agent of esophageal cancer. Obesity is not related to it. While hiatal hernias are not directly related, Barrett's esophagus is.

Origin: Chapter 12- Sexuality and Intimacy, 7 Chapter: 12 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 155, Medication Adverse Effects 7. Which older adult client would the nurse identify as being susceptible to decreased libido or sexual function as a result of the medication regimen?

A) A 78-year-old woman who takes an antiplatelet aggregator for the prevention of ischemic heart disease. B) An 80-year-old male client with osteoporosis who is taking vitamin D and calcium supplements. C) A 77-year-old man who takes a diuretic and a -adrenergic receptor blocker for the treatment of hypertension. D) An 81-year-old woman who takes HRT and nebulized bronchodilators for her chronic obstructive pulmonary disease. Ans: C Feedback: Diuretics are noted to diminish sexual function. The other noted medications are not included in the list of medications with this effect.

Origin: Chapter 3- Diversity, 3 Chapter: 3 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 3. A nurse who works in an inner-city clinic provides care for a large number of the older black clients. Which of the following health promotion activities best reflects the particular health needs of this population?

A) A blood sugar and blood pressure monitoring program. B) An education session on the positive health effects of good nutrition. C) A screening mammography campaign for older black women. D) A program that teaches black men the importance of prostate health screening. Ans: A Feedback: Diabetes and hypertension are disproportionately prevalent among black American elders. While teaching on nutrition and breast cancer and prostate screening may be beneficial, these are not linked to the particular health needs of this population.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 8 Chapter: 8 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 107, Do Not Resuscitate Orders 8. Nurse R works on the geriatric medicine unit of the university hospital and provides care for numerous older adult clients nearing the end of life, many of whom have Do Not Resuscitate (DNR) orders. Which of the following situations is incompatible with the legal requirements for a DNR order?

A) A client who is mentally competent has declared his wish to have a DNR order despite the availability of treatment options for his condition. B) A client has expressed her desire to have a DNR order but her daughter is adamantly opposed to it. C) A client clearly told the nurse her desire to have a DNR order, which the nurse documented and noted at the bedside. D) A client has been in a coma and the family has decided to put in place a DNR order. Ans: C Feedback: DNR orders require a written and signed order on the part of the physician. The possibility of positive health outcomes and opposition by family do not negate the wishes of a competent client, and incompetent clients may have the decision made by family.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 3 Chapter: 8 Client Needs: A2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 102, Malpractice 3. An investigation into reports of substandard care on the subacute geriatric unit of a hospital has been undertaken. Which of the following events are representative of malpractice on the part of the nursing staff? Select all that apply.

A) A client with a documented history of seizures was left with his bed raised and with bedrails not in place, resulting in a fall and head injury. B) A client was sent for a colonoscopy, after which it was learned that the client had never given written consent for the procedure. C) A client with a diagnosis of vascular dementia was found wandering in the hall outside the unit. D) An immobile client was not turned over the course of a night shift and developed a pressure ulcer on her coccyx. E) A client admitted with a diagnosis of pneumonia contracted an antibiotic-resistant organism during her stay. Ans: A, D Feedback: Answers A and D include all of the components of malpractice: duty, negligence, and injury. Answer B involves an abdication of duty on the part of the physician, not the nurse, while answer C lacks a resultant injury. Answer E does not necessarily suggest negligence on the part of care providers.

Origin: Chapter 2- Theories of Aging, 16 Chapter: 2 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 15, Autoimmune Reactions 16. The nursing staff at a nursing home works closely with the staff in the Endocrinology Department at a local hospital. This relationship is maintained for the welfare of the nursing home residents, because a failing immune system in the elderly might account for:

A) A decline in the rate of growth hormone production B) The increased incidence of cancer among the aged C) The oxidative activity of free radicals D) Changes in brain activity and nervous system function Ans: B Feedback: Compromises in the immune systems of the elderly may lead to a failure to recognize and destroy cancerous cells. The immune system is not involved in the production of growth hormones. The immune system does not determine the action of free radicals, although it may be involved in seeking out and destroying cells damaged by free radical activity. There is no known association between diminished immune activity and changes in the brain or nervous system action.

Origin: Chapter 14- Nutrition and Hydration, 12 Chapter: 14 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 12. A confused but physically healthy older patient eats a diet very high in cereals and breads, with fruit only once per week and little protein. How does the patient's diet impact her current condition?

A) A lack of vitamin A can affect her night vision. B) A high-calcium diet can lead to problems with kidney stones. C) The lack of fruit in her diet can contribute to complaints of constipation. D) A high-carbohydrate diet can stimulate abnormally high release of insulin, which can add to her confusion. Ans: D Feedback: An abnormally high release of insulin can cause hypoglycemia, which first presents in the elderly as a confused state. The patient's high-carbohydrate diet could increase her confusion. There is not enough information to support that the patient is experiencing problems with night vision because of a lack of vitamin A. There is also not enough information to support that the patient is experiencing constipation or has a high intake of calcium.

8. The occupational therapist on a geriatric rehabilitation unit of a hospital has integrated a life review into a group therapy session. Which of the following statements best captures the nature of life review among older adults? A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff.

A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff. Ans: B Feedback: A life review can bring to light reflections on older adults' accomplishments but may also reveal profound disappointments and regrets. It should not be seen, however, as a purely negative experience. It is not viewed as a diagnostic tool and does not require special training.

Origin: Chapter 36- Acute Care, 10 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 487, Operative and Postoperative Care Considerations 10. As she began to wake after surgery, Mrs. P became extremely restless. Which of the following should the recovery room nurse likely administer first?

A) A narcotic to ease the pain B) Antibiotics to prevent an infection C) Electrolytes to correct an imbalance D) Oxygen to correct hypoxia Ans: D Feedback: Restlessness after surgery may appear to be caused by pain, but is a symptom of hypoxia. Oxygen may even be given prophylactically, but narcotics may worsen the hypoxia. Antibiotics should never be given unless needed, and there is no indication that Mrs. P needs electrolytes.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 13 Chapter: 8 Client Needs: A2 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 102, Malpractice 13. Which of the following is the BEST description for a standard of care?

A) A relationship in which a nurse has assumed responsibility for the care of a patient B) A policy or procedure established by a health care agency or professional association C) The norm for what a reasonable individual would do in a similar circumstance D) A public law that, if violated, can result in liability for the nurse Ans: C Feedback: By definition, a standard of care is the norm for what a reasonable individual in a similar circumstance would do.

Origin: Chapter 3- Diversity, 9 Chapter: 3 Client Needs: A1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 9. Which of the following contexts would be most appropriate for a screening program for high blood pressure?

A) A seniors' group that is based at a Jewish community center in Brooklyn. B) An Indian reservation in rural, Western Oklahoma. C) A predominantly Chinese-American neighborhood in the San Francisco Bay area. D) A minimum security prison serving young, rehabilitating offenders. Ans: B Feedback: Hypertension is disproportionately high among Native Americans. This is not noted to be the case among Jewish Americans, prisoners, or Americans of Chinese ancestry.

Origin: Chapter 35- Rehabilitative Care, 29 Chapter: 35 Client Needs: B Cognitive Level: Application Difficulty: Easy Integrated Process: Teaching/learning Objective: 8 Page and Header: 480, Using Community Resources 29. During the homecare nurse's visit, the wife of a 74-year-old post-stroke patient is teary and clearly overwhelmed with the fact that she is the sole caregiver for her husband. To what resource(s) should the nurse direct the wife in order to aid in her husband's functional recovery?

A) A social worker and rehabilitation counselor B) The couple's family physician C) A family therapist or psychological counselor D) A public health nurse Ans: A Feedback: Among the diverse sources of assistance available to facilitated rehabilitation, a rehabilitation counselor and social worker are most likely of greater benefit to the man and his wife than a family doctor, counselor, or public health nurse.

Origin: Chapter 16- Comfort and Pain Management, 2 Chapter: 16 Client Needs: D1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 194, Comfort 2. The nurse wants to ensure that assigned patients are comfortable. What will the nurse use as a measurement of comfort?

A) A state of physical, emotional, and spiritual well-being B) An absence of reports, signs, or symptoms of physical pain C) A transcendent emotional and spiritual state that exists regardless of the presence or absence of pain D) A condition of maintaining a patient's self-report of pain being below a self-reported threshold of 1 out of 10 Ans: A Feedback: Comfort is defined as a sense of physical, emotional, social, and spiritual peace and well-being. This may include, but is not limited to, considerations of patient reports of pain. It does not exclude consideration of physical pain. It is debatable if pain is a transcendent emotion and spiritual state.

Origin: Chapter 1- The Aging Population, 13 Chapter: 1 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 9, Impact of the Baby Boomers 13. A new patient is not satisfied with the conditions of the nursing home, takes a highly active role in her health care, and, because of her ability to access information, has as much knowledge as her health care providers on some health issues. This new patient is most likely:

A) A young-old female baby boomer who just turned age 65 B) An old woman 75 to 85 years of age C) An old-old woman over age 85 D) An elite old woman older than 100 years Ans: A Feedback: The patient has the predicted characteristics of a baby boomer entering the senior years.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 2 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Communication and documentation Objective: 1 Page and Header: 113, Philosophies Guiding Ethical Thinking 2. Due to a bed shortage in the area, the head nurse on a busy geriatric medicine unit is under significant pressure to minimize client lengths of stay and speed up discharge planning. An older adult client who is convalescing after recent falls is adamant that he is not ready for discharge, and tells the nurse, "It doesn't matter who or how many people are waiting in the emergency department for this bed; I'm simply not healthy enough to go home yet." Of which philosophy of ethics is the patient's statement most indicative?

A) Absolutism B) Relativism C) Egoism D) Beneficence Ans: C Feedback: An emphasis on one's personal interests is characteristic of egoism.

Origin: Chapter 35- Rehabilitative Care, 20 Chapter: 35 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 5 Page and Header: 472, Assisting With Range-of-Motion Exercises 20. The nurse is providing range-of-motion exercises to a patient who is comatose. Which type of range-of-motion is the nurse providing?

A) Active range of motion B) Active assistive range of motion C) Resistive range of motion D) Passive range of motion Ans: D Feedback: Passive range of motion is that in which there is no active involvement of the patient. Active range of motion is performed independently by patients. Active assistive range of motion is with assistance to the patient. There is no such thing as resistive range of motion.

Origin: Chapter 2- Theories of Aging, 20 Chapter: 2 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 16, Disengagement Theory 20. Ms. E, an 80-year-old, is gradually withdrawing from society and wants society to gradually withdraw from her. She believes that this mutual withdrawal will free her from societal roles and give society the means for transferring power from the old to the young. Ms. E's grown children are concerned and say her belief has no scientific basis. On which of the following theories of aging can Ms. E say she bases her belief?

A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory Ans: C Feedback: Disengagement theory views aging as a process in which society and the individual gradually withdraw, or disengage, from each other, to the mutual satisfaction and benefit of both.

Origin: Chapter 2- Theories of Aging, 22 Chapter: 2 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 17, Continuity Theory 22. Mr. D was friendly and active as a young adult. Now, as a 75-year-old, he enjoys visiting with his neighbors and attending a variety of sporting and cultural events. Mr. D's behavior is most consistent with which theory of aging?

A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory Ans: D Feedback: The continuity theory suggests that personality and basic patterns of behavior remain unchanged as an individual ages. This is not a central component of the other noted theories.

Origin: Chapter 1- The Aging Population, 16 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 4, Population Growth and Increased Life Expectancy; 5, Table 1-1 16. From the late 1980s to the present, the gap in life expectancy between individuals in the Caucasian and African American communities has widened. Which of the following most clearly accounts for this trend?

A) Acute illness in the black population has increased B) Infant mortality and complications of childbirth in the white population have declined C) The life expectancy of African Americans has not increased at the same rate as that of the white population D) Deaths from homicide in the white population have increased Ans: C Feedback: The gap in life expectancy between white individuals and African Americans has widened because the life expectancy of African Americans has not increased at the same pace as that of Caucasians. The U.S. Department of Health and Human Services attributes this decline to an increase in deaths from homicide and AIDS.

Origin: Chapter 21- Digestion and Bowel Elimination, 26 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 290, Gastrointestinal Health Promotion 26. The nurse teaches a 65-year-old client with a chronic constipation problem. In reviewing her dietary habits, the nurse finds that the client's diet is low in fiber. Which of the following points should the nurse prioritize when teaching about increasing fiber intake?

A) Add 20 g of fiber to other foods (such as wheat bran to ground beef or muffins). B) Attempt a bowel movement following breakfast. C) Use a suppository to stimulate elimination. D) Add fiber gradually to minimize symptoms of gas or bloating. Ans: D Feedback: If a diet contains less than 20 to 35 g of fiber per day, it is wise to gradually increase intake so that the person remains compliant to dietary changes. The symptoms of gas, bloating, and diarrhea that accompany a sudden increase in fiber intake may inhibit patient adherence to any dietary changes.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 23 Chapter: 9 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Communication and documentation Objective: 4 Page and Header: 114, Box 9-1 23. Which of the following responsibilities is included in the "Code of Ethics for Nurses" of the American Nurses Association?

A) Advancing nursing research B) Meeting continuing education requirements C) Shaping social policy D) Defending colleagues accused of ethical violations Ans: C Feedback: Nurses are expected to articulate nursing values, maintain the integrity of the profession and its practice, and shape social policy.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 21 Chapter: 9 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 4 Page and Header: 114, Box 9-1 21. A patient with a terminal illness confides in his nurse that he plans to commit suicide. The nurse struggles with whether to report his intent. In the "Code of Ethics for Nurses" of the American Nurses Association, the nurse reads the following statement: "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient." In this case, the nurse perceives the greatest ethical conflict between:

A) Advocacy and protection B) Safety and patient rights C) Health and terminal illness D) The patient and the nurse Ans: B Feedback: In this case, the right of the patient (patient rights) to confidentiality and the nurse's commitment to sustaining his life (safety) are in direct conflict.

Origin: Chapter 12- Sexuality and Intimacy, 11 Chapter: 12 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 5 Page and Header: 152, Assessment Guide 12-1 11. At which point should the nurse assess a senior patient's sexual health?

A) After gaining the elder's permission B) Before receiving approval from a physician C) After reviewing the results of the elder's physical exam D) Before checking the patient's prescription and over-the-counter drug use Ans: A Feedback: The nurse should begin a sexual assessment after asking for the senior patient's permission to ask the questions. The nurse does not need to receive approval from the physician before assessing a senior patient's sexual health. The nurse does not need to review the results of the physician exam or check medication use before conducting a sexual history with a senior patient.

Origin: Chapter 16- Comfort and Pain Management, 24 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 195, Pain: A Complex Phenomenon; 196, Pain Assessment 24. The nurse is planning care for several older patients in a long-term care facility. At which points in time will the nurse assess the patients for pain? (Select all that apply.)

A) After helping with morning care B) When the patients complain of pain C) Prior to providing a patient with a meal D) When assessing the patients' vital signs E) When a patient asks for pain medication Ans: B, D, E Feedback: Pain is referred to as the fifth vital sign because it is an important indicator of an individual's health status. Pain should be assessed with vital signs, when the patient complains of pain, and when a patient asks for pain medication. Pain does not need to be assessed prior to providing a patient with a meal or after helping a patient with morning care.

Origin: Chapter 15- Rest and Sleep, 1 Chapter: 15 Client Needs: D1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 186, Circadian Sleep-Wake Cycles 1. The nurse is identifying the different sleep patterns of assigned patients on a geriatric care unit. Which patient is demonstrating the typical sleep pattern of a patient who is older?

A) Age 82 patient sleeps a total of more than 12 hours out of 24 B) Age 90 patient describes the quality of sleep as "better than it ever was" C) Age 80 patient falls asleep early in the evening but wakes up before dawn D) Age 79 patient sleeps in until 9 o'clock each morning despite a lifetime of early rising Ans: C Feedback: The patient who falls asleep early in the evening but wakes up before dawn is demonstrating the behavior of phase advance. The other patients are not demonstrating typical sleep patterns of an older person.

Origin: Chapter 36- Acute Care, 1 Chapter: 36 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 484, Table 36-1 1. The husband of a 78-year-old postsurgical patient has approached the nurse, upset that his wife has become incontinent of urine during her hospital stay. The husband states that this is without precedent and he is adamant that the matter be looked into further. The nurse would recognize that which of the following factors may have contributed to this course of events?

A) Age-related changes to genitourinary function B) Sensory deprivation C) Changes in diet since admission to the hospital D) Sedative effects of medications Ans: D Feedback: Sedation can cause incontinence in the hospitalized elderly. The sudden onset makes it unlikely that the wife's incontinence is a result of age-related changes and a change in diet is unlikely to cause incontinence. Sensory deprivation would be less likely to result in incontinence.

Origin: Chapter 2- Theories of Aging, 12 Chapter: 2 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 13, Biological Theories of Aging 12. Mrs. H and Mrs. J are the same age. While in the doctor's waiting room, they discuss their ailments and their beliefs about aging. Mrs. H argues that Mrs. J must be older because she has more ailments. The nurse settles the argument by stating a cornerstone of all biological theories of aging. Which of the following statements did the nurse most likely make?

A) Aging is a predictable cellular process. B) Cells undergo a finite number of divisions. C) No two individuals age identically. D) Body systems decline at the same rate. Ans: C Feedback: Individual variability is fundamental to all biological theories. Aging is not totally predictable, nor is it necessarily cellular in some biological theories. Body systems are often seen to decline at different rates.

Origin: Chapter 16- Comfort and Pain Management, 28 Chapter: 16 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 196, Pain Assessment; 197, Box 16-1 28. While providing care the nurse suspects an older patient recovering from a stroke is experiencing pain. What did the nurse assess in the patient? (Select all that apply.)

A) Agitation B) Perspiration C) Poor appetite D) Increased focus E) Increased blood pressure Ans: A, B, C, E Feedback: Signs that the patient with cognitive impairment could be experiencing pain include agitation, perspiration, poor appetite, and increased vital signs. Increased focus is not an indication of pain in the cognitively impaired patient.

Origin: Chapter 35- Rehabilitative Care, 4 Chapter: 35 Client Needs: A1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 469, Importance of Attitude and Coping Capacity 4. Albert, Bob, Charlie, and David have all had below-the-knee amputations and are leaving the hospital. Albert's family members are excited about having him come home and have had the house completely remodeled with grab bars, a wheelchair ramp, and every other aid they know of. Someone will always be available to help him. Bob's family members mean well, but they are not reliable. They have made some preparations for his homecoming, but others have not been finished. He will have willing help at times. Charlie's family members have finished some essential preparations, such as a wheelchair ramp; others have not been finished but have been planned. Other family members work and will be able to help him only occasionally; however, he can always rely on their showing up at scheduled times. David's family members have done nothing, saying they will rehab the house when he comes home and then see what is needed. Other family members work and can make no promises about helping him. Whose family situation seems most promising?

A) Albert's B) Bob's C) Charlie's D) David's Ans: C Feedback: Charlie is probably going home to the best family support. Albert's family may smother him with helpfulness, interfering with his own need to be active and independent. Bob's family members cannot be relied on to help him when he may need them, despite their good intentions. David's family may be of no help at all. Although Charlie may have some difficulty in getting help at all times, he knows that his family can be relied on and that some planning and scheduling will take care of most problems.

Origin: Chapter 36- Acute Care, 22 Chapter: 36 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 492, Infections 22. Albert, Bob, Charlie, and David wandered into a health food store when they were mall-walking one morning. They decided to try various remedies that might boost their resistance to infection. According to claims made about the following remedies, which man is most likely to increase his immunity?

A) Albert, who substituted soy for dairy foods. B) Bob, who began taking vitamins C and A everyday. C) Charlie, who began eating large quantities of onions. D) David, who increased his intake of sugar and began taking Siberian ginseng. Ans: B Feedback: Vitamin C and A supplements have been recommended for promoting the prevention and management of infections. Soy is a useful substitute when a person is lactose-intolerant, but it has not been claimed to boost immunity. Consumption of onions has not proved to be helpful in promoting immunity. Although taking Siberian ginseng may help increase immunity, including more refined sugar in the diet does not.

Origin: Chapter 36- Acute Care, 20 Chapter: 36 Client Needs: A2 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 493, Box 36-2 20. Despite the nurses' high-quality care and conscientious application of the principles of asepsis, a 78-year-old post-coronary bypass patient has developed an infection in his leg incision. Which of the following factors may have contributed to the man's infection?

A) Altered antigen-antibody response B) Decreased intracellular fluid volume C) Decreased cardiac output D) An adverse drug reaction Ans: A Feedback: Changes in the antigen-antibody response make older adults more susceptible to infection. Hydration, cardiac output, and adverse drug reactions may have other unwanted effects but are less likely to contribute to infection.

Origin: Chapter 2- Theories of Aging, 8 Chapter: 2 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 18, Developmental Tasks 8. Which of the following tasks are components of Erikson's description of the old age tasks of reconciling ego integrity with despair? Select all that apply.

A) An 80-year-old man is struggling to determine his identity apart from his lifelong career as a business leader. B) A 79-year-old woman has established habits that promote her financial independence in spite of a lack of savings. C) An 80-year-old man revels in his large, happy family rather than focusing on his mobility limitations resulting from Parkinson disease. D) A 77-year-old man is trying to determine whether his life has had deep significance and meaning. Ans: A, C, D Feedback: Deriving satisfaction from oneself rather than occupational roles, finding pleasure in spite of physical limitations, and determining meaning in the life one has lived are all aspects of Erikson's outcome of ego integrity or despair. Financial independence is not a central component of this outcome.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 12 Chapter: 34 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 460, Assessment of Chronic Care Needs 12. Which of the following older adults with chronic conditions is most likely to have the greatest care needs?

A) An 80-year-old woman with varicose veins who has just been diagnosed with osteoarthritis. B) A 74-year-old man with macular degeneration and type 1 diabetes. C) A 77-year-old man who has long-standing hypertension and is displaying early signs of chronic renal failure. D) An 84-year-old woman who lives with severe hearing loss and recurrent hemorrhoids. Ans: B Feedback: Visual impairment is likely to impact significantly the ability to monitor blood glucose levels and administer insulin. These challenges likely supersede those of the other older adults in answers A, C, and D.

Origin: Chapter 5- Common Aging Changes, 4 Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 57, Urinary System 4. Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation?

A) An 81-year-old woman's glomerular filtration rate (GFR) is low. B) A 78-year-old male's stomach pH is increased. C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy. D) A 78-year-old man has recently developed urinary incontinence. Ans: D Feedback: While a decrease in GFR, increase in stomach pH, and slight left ventricular hypertrophy are considered normal accompaniments to aging, urinary incontinence should be considered a pathological finding that necessitates further assessment.

Origin: Chapter 2- Theories of Aging, 17 Chapter: 2 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 15, Autoimmune Reactions 17. Although the immune system is affected by the aging process, the elderly are not the only individuals who have autoimmune disorders. These occur in populations of all ages because autoimmune disorders involve:

A) An attack of antibodies on body cells B) An overproduction of T cells in bone marrow C) A decrease in the weight of the thymus gland D) An increase in the amount of lipofuscin in the blood Ans: A Feedback: In autoimmune disorders, the immune system attacks and destroys the body's own cells (as opposed to those of invading, disease-causing microorganisms). There is no overproduction of T cells. Although the weight of the thymus gland decreases with age and the amount of lipofuscin increases, such changes are not characteristic of autoimmune disorders.

Origin: Chapter 15- Rest and Sleep, 6 Chapter: 15 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 188, Medical Conditions That Affect Sleep 6. Which patient on a geriatric medicine unit would the nurse recognize as being most prone to sleep problems?

A) An obese female patient receiving IV antibiotics for the treatment of a urinary tract infection B) A 74-year-old female receiving transfusions of packed red blood cells for an upper GI bleed C) A 78-year-old male recovering from an ischemic stroke and has skin breakdown on the coccyx D) A male patient admitted for exacerbation of chronic obstructive pulmonary disease (COPD) with a history of angina Ans: D Feedback: COPD and conditions involving cardiac ischemia are often associated with sleep problems. Infections, ischemic stroke, skin breakdown, and GI bleeds are not noted to be specifically associated with sleep difficulties.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 15 Chapter: 9 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 113, Philosophies Guiding Ethical Thinking 15. Which of the following actions is viewed as ethically acceptable under the philosophy of relativism?

A) An older adult's children propose that she split her life savings between them before she needs care. B) A lottery winner donates money to a hospital only if the hospital's new wing is named after him. C) A millionaire finds a wallet in her physician's waiting room and keeps the money inside. D) A poor man steals medicine and diabetic supplies from a pharmacy to help his ill child. Ans: D Feedback: The act of stealing is ethically wrong in some philosophies, but condoned under the philosophy of relativism, or situational ethics, because of the circumstances—in this case, need. Choice A exemplifies utilitarianism; B and C, egoism.

Origin: Chapter 12- Sexuality and Intimacy, 21 Chapter: 12 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 147, Box 12-1 21. A female patient believes she is experiencing menopausal symptoms but the health care provider wants to perform additional testing. What manifestations did the patient most likely demonstrate?

A) An onset of migraine headaches B) Rising to urinate several times each night C) Moodiness, depression, and forgetfulness D) Occasional weakness and numbness on her right side Ans: D Feedback: A new onset of migraine headaches, nighttime voiding, moodiness, depression, and forgetfulness are symptoms associated with menopause. Weakness and numbness are not typical symptoms of menopause; they are symptoms of a possible stroke.

Origin: Chapter 16- Comfort and Pain Management, 4 Chapter: 16 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 196, Effects of Unrelieved Pain 4. An older patient is experiencing nociceptive pain in the shoulder. For which potential consequences of debilitating pain should the nurse assess in the patient? (Select all that apply.)

A) Anemia B) Dementia C) Depression D) Decreased oral intake E) Immobility resulting in skin breakdown Ans: C, D, E Feedback: Unresolved pain can result in malnutrition, depression, or a decrease in mobility that can precipitate skin breakdown. It is not noted to play a direct role in anemia or dementia.

Origin: Chapter 13- Spirituality, 24 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 163, Assessment Guide 13-1; 164, Nursing Diagnosis Highlight: Spiritual Distress 24. The nurse determines that a patient is experiencing spiritual distress. What did the nurse assess in this patient? (Select all that apply.)

A) Anger B) Smiling C) Complaining D) Poor appetite E) Refusing to make plans Ans: A, C, D, E Feedback: Signs of spiritual distress include anger, complaining, poor appetite, and refusing to make plans. Smiling would not be a sign of spiritual distress.

Origin: Chapter 15- Rest and Sleep, 8 Chapter: 15 Client Needs: D2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 189, Pharmacologic Measures to Promote Sleep 8. An older resident of a long-term care facility has recently been prescribed a non-barbiturate sedative. For which effect should the nurse assess in this patient?

A) Anticholinergic effects B) Daytime sedation and confusion C) Respiratory depression and sleep apnea D) Changes in blood pressure and heart rate Ans: B Feedback: Patients who are receiving sedation should be monitored for daytime sluggishness and confusion. Heart rate and blood pressure are not noted to be affected by these drugs and they are not associated with anticholinergic effects. Respiratory depression and sleep apnea are not noted to result from non-barbiturate sedatives.

Origin: Chapter 12- Sexuality and Intimacy, 19 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 150, Intimacy 19. The nurse is planning a presentation for nursing staff on supporting the sexual needs of the long-term care residents. Which statement would the nurse include that best defines sexuality?

A) Any behavior involving the genital organs B) Identification with a socialized gender role C) Any physical interaction between two people D) Any behavior undertaken to attract a member of the opposite sex Ans: B Feedback: Sexuality encompasses more than a physical act. It includes love, warmth, caring, and sharing between individuals and identification with a sexual role. Sexuality may or may not include behavior involving the genital organs. Any physical interaction between two people is not a definition of sexuality. Behavior taken to attract a member of the opposite sex is not a definition of sexuality.

Origin: Chapter 5- Common Aging Changes, 7 Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 62, Endocrine System 7. A hospital client, aged 82 years, is presently undergoing an endocrine diagnostic workup in an effort to diagnose his increasing fatigue of unknown etiology. Which of the following findings would his care team recognize as potentially pathological?

A) Apparent decreased thyroid gland activity. B) Decreased somatotropic growth hormone (GH) levels. C) Delayed and insufficient release of insulin by the -cells. D) Decreased erythropoietin production by the kidneys. Ans: D Feedback: While decreases in thyroid gland activity, GH, and insulin are often associated with aging, a decrease in erythropoietin production would be considered problematic and pathological.

Origin: Chapter 36- Acute Care, 23 Chapter: 36 Client Needs: A2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 4 Page and Header: 492, Infections 23. An elderly woman suffering from abdominal pain, nausea, urinary incontinence, fever, and vomiting is brought to the emergency department. What is the most likely preliminary diagnosis?

A) Appendicitis B) Aneurysm C) Urinary tract infection D) Colon cancer Ans: C Feedback: The fever makes an infection more likely than an aneurysm or cancer. In an elderly person, a urinary tract infection is the most common type of infection, and many elderly people have already lost their appendixes.

Origin: Chapter 13- Spirituality, 22 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 164, Honoring Beliefs and Practices 22. A patient is demonstrating signs of spiritual distress but refuses to be visited by clergy or to participate in religious services. What should the nurse do to help the patient?

A) Arrange for a volunteer to read inspirational essays to the patient B) Do not challenge the patient's decision or attempt to change his mind C) Pray that the patient will come to recognize his need for spiritual support D) Talk with the hospital chaplain about looking in on the patient without talking about religion Ans: B Feedback: Although a nurse should assist patients in their spiritual growth, the nurse's first commitment is to respect patients' wishes. A nurse should not challenge a patient's religious beliefs or attempt to change them. The nurse should not have inspirational essays read to the patient or talk with the hospital chaplain. The nurse may or may not want to pray about the patient's needs for spiritual support.

Origin: Chapter 3- Diversity, 15 Chapter: 3 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 15. A government study investigated the incidence of diseases and their probable causes in elderly Native Americans as compared with all elderly Americans. Study results showed that Native American seniors have twice the incidence of which of the following diseases?

A) Arthritis B) Cancer C) Heart disease D) Diabetes Ans: D Feedback: Diabetes, a disease uncommon among American Indians at the start of the 20th century, now affects about one in five older American Indians (compared with one in ten of all elderly Americans).

Origin: Chapter 15- Rest and Sleep, 11 Chapter: 15 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 186, Circadian Sleep-Wake Cycles 11. A healthy older patient is experiencing sleep problems. What should the nurse instruct the patient about the influence of aging as it relates to sleep?

A) As people age, most of them require fewer hours of sleep. B) The normal aging process has minimal effect on the quantity of sleep. C) Older adults are no longer bothered by noise and lights during the night. D) Older people sleep more soundly but awaken more often during the night. Ans: B Feedback: Changes to the circadian rhythm occur, so the quantity of sleep does not change but the hours for sleep change. The other choices are not true statements.

Origin: Chapter 16- Comfort and Pain Management, 5 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 196, Pain Assessment 5. A patient who is cognitively impaired is demonstrating signs of being in pain. How should the nurse assess this patient's pain level?

A) Ask the patient to numerically rate the pain B) Observe the patient often over the next several hours C) Provide the patient with a visual analog scale to gauge pain D) Go through the McGill Pain Questionnaire with the patient Ans: C Feedback: Given the patient's cognitive impairment, the McGill Questionnaire and numeric rating are likely to be less accurate than a visual analog scale. Simple observation would need to be supplemented with an attempt at active assessment.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 22 Chapter: 8 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 107, Telephone Orders 22. To minimize liability, what action should nurses take when accepting telephone orders from physicians?

A) Ask the physician to follow up with a faxed, written order B) Clearly communicate the most likely diagnosis to the physician C) Have another staff member talk with the physician and audiotape the conversation D) Accept only written orders or those communicated orally, in person Ans: A Feedback: It is acceptable practice to accept telephone orders, but third parties should not be involved, and legal and practical problems are associated with audiotaping. Nurses should not offer diagnoses; diagnosis is the physician's prerogative. The best action is to ask for and receive a written, faxed order and to make sure it is signed within 24 hours.

Origin: Chapter 36- Acute Care, 16 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 491, Box 36-1 16. An elderly woman falls in her home. Paramedics are called to help her get up and take her to a nearby hospital. What action is the paramedics' priority?

A) Assess her vital signs B) Teach the woman how to fall safely C) Assess the factors that led to her fall D) Request that an X-ray be done at the hospital Ans: A Feedback: Assessing her condition immediately is most important; she may need to have an EEG or other medical test or treatment at the hospital. If a fracture seems possible, then an X-ray should be requested. The other choices, though important for her future safety, are less important.

Origin: Chapter 3- Diversity, 4 Chapter: 3 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 4. Nurse Y works in the emergency department of a large, urban hospital. When assessing the following older black adults who have recently presented to the department, which of the following assessments would the nurse want to modify for this population?

A) Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive. B) Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus. C) Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease. D) Assessment of a client's chest pain who has a history of myocardial infarction. Ans: C Feedback: Assessment of cyanosis can be complicated by the high melanin content of black adults' skin. Musculoskeletal assessment, assessment of sensation, and assessment of chest pain would not necessitate modification.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 23 Chapter: 34 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 7 Page and Header: 462, Box 34-4 23. What is one of the steps in the COACHING acronym?

A) Assist B) Help C) Caution D) Instill Ans: B Feedback: The letters in COACHING: C, Contact; O, Observe; A, Affirm; C, Clarify; H, Help; I, Inspire; N, Nurture; and G, Guide.

Origin: Chapter 5- Common Aging Changes, 25 Chapter: 5 Client Needs: D2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 57, Urinary System 25. Decreased renal mass and reduced glomerular filtration make it especially important that nurses:

A) Assist elderly patients with frequent toileting B) Ensure that age-adjusted drug dosages are prescribed C) Look for signs of urinary tract infections D) Frequently check urine for glucose Ans: B Feedback: The need for frequent toileting is a result of decreased bladder capacity. Weaker bladder muscles increase the risk of urinary tract infections. Tests for glucose in the urine are needed on a case-by-case basis. The need most associated with decreased renal mass and reduced glomerular filtration is age-adjusted drug dosage.

Origin: Chapter 21- Digestion and Bowel Elimination, 1 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 290, Gastrointestinal Health Promotion 1. The nurse teaches an 87-year-old inactive client about avoiding constipation. Which of the following fluid and diet choices should the nurse include in the teaching?

A) Avoid beverages with caffeine B) Drink iced liquids C) Encourage low-residue foods D) Increase intake of fruit juices Ans: D Feedback: It is important for older adults to incorporate good fluid intake, a diet rich in fruits and vegetables to promote bowel health.

Origin: Chapter 15- Rest and Sleep, 15 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 189, Activity and Rest Schedules 15. An older patient asks for natural methods, instead of medications, to help with falling asleep. What can the nurse suggest to this patient?

A) Avoid protein, take a walk every day, and drink a non-caffeinated herbal tea at bedtime B) Avoid carbohydrates, take a walk every day, and drink non-caffeinated herbal tea at bedtime C) Take a walk every day, get exposure to the sun daily, and drink non-caffeinated herbal tea at bedtime D) Minimize the amount of exercise, get exposure to the sun daily, and drink non-caffeinated herbal tea at bedtime Ans: C Feedback: Natural methods to promote sleep include getting daily exercise, being exposed to the sun every day, and drinking non-caffeinated beverages at bedtime. Protein and carbohydrates can promote sleep and exercise should not be avoided.

Origin: Chapter 13- Spirituality, 3 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 162, Meaning and Purpose 3. The nurse is aware of the spiritual dimension in Erikson's conceptualization of the older adult's growth and development. When applying Erikson's theory to the care of older patients, what does the nurse realize as being a spiritual component of Erikson's final development task?

A) Awareness that one is loved by others and has provided unconditional love. B) A confidently held hope that a transcendent and positive afterlife awaits one following death. C) A sense of contribution that one's relationships and endeavors have benefited society and one's family. D) A sense of wholeness rooted in the knowledge that life experiences make sense and have served a purpose. Ans: D Feedback: According to Erikson's description of the final developmental task, healthy psychological aging for the older adult involves achieving a sense of integrity. This integrity, or wholeness, is supported by the belief that life experiences—both good and bad—make sense and have served a purpose. The other choices express needs that older individuals may possess, but these are not components of Erikson's framework.

Origin: Chapter 1- The Aging Population, 8 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 9, Impact of the Baby Boomers 8. The board of a large chain of hospitals has commissioned a strategic plan in order to meet the care needs of baby boomers in coming years. Which of the following trends constitute a sound basis for understanding the baby boomer generation and conducting future planning? Select all that apply.

A) Baby boomers tend to have fewer children than members of earlier generations. B) Adjusted for inflation, baby boomers have lower incomes than their parents had. C) Due to technology, baby boomers have more leisure time than other adults. D) Baby boomers perform physical exercise more frequently than other adults. Ans: A, D Feedback: Baby boomers have had fewer children than generations that preceded them and they tend to exercise more often. Their incomes tend to be higher while they enjoy less leisure time.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 6 Chapter: 9 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 114, Ethical Principles 6. Mr. L's health insurance has just expired though he is still in the recovery stages of a serious exacerbation of his chronic obstructive pulmonary disease. Backdating the paperwork by only 2 days will spare Mr. L the out-of-pocket expense of home oxygen therapy. The nurse who is organizing Mr. L's care on discharge has chosen a course of action that prioritizes the principle of veracity. Which of the following courses of action best exemplifies this principle?

A) Backdating the paperwork to ensure that Mr. L does not sustain harm from having to pay or having to go without oxygen therapy. B) Backdating the paperwork because it will clearly maximize Mr. L's well-being at a nominal cost to the insurer. C) Refusing to backdate the paperwork because to do so would be untruthful. D) Refusing to backdate the paperwork because to do so would be an unjust act toward the insurance company. Ans: C Feedback: The principle of veracity emphasizes truthfulness, and the nurse's refusal to lie on the insurance documentation is indicative of this principle. Consideration for the consequences to either the patient or the insurance company would be secondary.

Origin: Chapter 13- Spirituality, 20 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 165, Box 13-1 20. An older patient tells the nurse that he meditates to seek enlightenment. Because of this, the nurse might inquire if he wishes to have which item eliminated from his daily dietary intake?

A) Beef B) Cereal C) Refined sugar D) Leavened bread Ans: A Feedback: The belief that enlightenment is found in individual meditation is a characteristic of Buddhism. Buddhists often are vegetarians. Cereal, refined sugar, and leavened bread are not specifically identified as being omitted from the diet of a person who practices Buddhism.

Origin: Chapter 3- Diversity, 11 Chapter: 3 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 11. According to statistics, Baby J, born to a black American couple, has a life expectancy lower than that of Baby K, born to a white American couple. According to current demographic projections, by the seventh decade of life, Baby J's life expectancy will:

A) Begin to equal that of similarly aged white elders B) Exceed that of similarly aged Asian elders C) Drop to less than half that of similarly aged Native American elders D) Rise above that of white elders until age 75 and then drop Ans: A Feedback: After reaching the seventh decade of life, black Americans can hope to enjoy a life expectancy equal to that of their white cohorts.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 5 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication and documentation Objective: 2 Page and Header: 114, Ethical Principles 5. Nurse T promised an 81-year-old female client that he would liaise with the physiotherapy team and ensure that her rehabilitation would commence soon, since it was apparent that she was being overlooked. Due to a busy shift during which another patient declined rapidly, the nurse did not follow up. Which ethical principle has Nurse T most clearly violated?

A) Beneficence B) Fidelity C) Veracity D) Justice Ans: B Feedback: Central to the principle of fidelity is respecting words and duties to patients, such as following up when promised. The nurse's actions are less indicative of deficits in beneficence, veracity (since he did not overtly lie to the patient), or justice.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 10 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 114, Ethical Principles 10. The ethics committee of a hospital has decided that it is unethical to prioritize patients who possess more comprehensive insurance plans than those with minimal or no insurance. Which of the following principles most clearly underlies this decision?

A) Beneficence B) Justice C) Fidelity D) Veracity Ans: B Feedback: The principle of justice includes treating individuals fairly and giving patients the service they need, emphasizing service based on need rather than the ability to pay. This perspective is not central to the principles of beneficence, fidelity, or veracity.

Origin: Chapter 2- Theories of Aging, 15 Chapter: 2 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 14, Free Radicals and Lipofuscin Theory 15. Which of the following statements underlie both the error theory of aging and the free radical theory of aging?

A) Biochemical damage accumulates over time, leading to cell death. B) The rate of cellular death is genetically programmed. C) The aging body produces fewer growth and repair hormones. D) Environmental agents such as radiation and heavy metals damage DNA. Ans: A Feedback: That the rate of cell death is genetically programmed is a basic tenet of the programmed theory of aging. That the aging body produces fewer growth and repair hormones is a neuroendocrine theory. Although radiation and heavy metals may damage DNA, they are not free radicals, and they need not be the cause of the mutations assumed by the error theory.

Origin: Chapter 21- Digestion and Bowel Elimination, 22 Chapter: 21 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 292, Assessment Guide 21-1 22. During a physical exam, the nurse notes that the patient has a smooth red tongue. Which of the following diagnostic tests is an expected follow-up?

A) Biopsy any lesions. B) Scrape the tongue for syphilis. C) Screen for lead poisoning. D) Complete a nutrition screening. Ans: D Feedback: A smooth red tongue can be an indication of an iron, vitamin B12, or niacin deficiency.

Origin: Chapter 21- Digestion and Bowel Elimination, 20 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 293, Dental Problems 20. A dentist examines an 80-year-old man with a history of pipe smoking. The dentist notes white patches in the patient's mouth. What action should be the dentist's priority?

A) Biopsy the lesion B) Refer the patient for periodontal care C) Refer or treat the patient for moniliasis D) Discuss with the man the reasons why he should quit smoking Ans: A Feedback: Cancer of the oral cavity increases with age, particularly in men, and is highest in men with a history of smoking. The importance of ruling out this possibility would supersede the other actions.

Origin: Chapter 5- Common Aging Changes, 6 Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 58, Musculoskeletal System 6. A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse's assessment of the client would recognize which of the following factors as most likely contributed to the suspected injury?

A) Bone remodeling in long bones ceases in the seventh or eighth decade. B) Bone minerals and mass are reduced as part of the aging process. C) Bone marrow production of cellular components declines with age. D) Thinning disks and shortened vertebrae are common assessment findings in older adults. Ans: B Feedback: A decrease in bone minerals and mass is common later in life. Bone remodeling does not, however, cease. Neither thinning disks, shortened vertebrae, nor marrow production of blood cellular components is likely to directly contribute to the client's suspected fracture.

Origin: Chapter 3- Diversity, 19 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 19. When talking with elderly Native Americans and Asian Americans, it is important for gerontological nurses to recognize that:

A) Both cultures are in the process of replacing traditional values with modern medicine B) These clients may be reluctant to express their thoughts and feelings openly C) Ritualistic and spiritual healing methods are preferred over modern medical services D) These clients expect to be treated and cared for by family members exclusively. Ans: B Feedback: In both cultures, traditional attitudes and values persist, although both are willing to accept mainstream medical services in the United States. Ritualistic and spiritual methods may be employed, but they are not necessarily preferred. Family ties are strong, but home care is not necessarily expected. What these groups share is their reticence to reveal personal information to strangers or to speak openly about their health or family problems.

Origin: Chapter 12- Sexuality and Intimacy, 24 Chapter: 12 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 148, Andropause 24. During an assessment the nurse suspects an older male patient is experiencing andropause. What did the nurse assess in this patient? (Select all that apply.)

A) Breast enlargement B) Testicular shrinking C) Dark spots on the skin D) Reduced muscle mass E) Bruising and petechiae Ans: A, B, D Feedback: Andropause is a decline in testosterone levels. Characteristics of low testosterone levels in men include breast enlargement, testicular shrinking, and reduced muscle mass. Dark spots on the skin and bruising and petechiae are not manifestations of andropause.

Origin: Chapter 3- Diversity, 1 Chapter: 3 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 24, Increasing Diversity of the Older Adult Population 1. Which of the following projections of future demographics of older Americans is most accurate?

A) By 2020, more than 50% of older Americans will belong to a non-Hispanic white group. B) The percentage of black older adults will decrease slightly due to lower life expectancies. C) The number of Hispanic older adults is projected to grow dramatically. D) Within 40 years, a minority of older Americans will be white related to immigration. Ans: C Feedback: Whereas in 2000, approximately 84% of older Americans were non-Hispanic white, it is projected that this population will decrease to 64% by 2050. During this same period, there will be dramatic growth among Hispanic older adults, who will represent 16% of the older population. Black individuals will grow from 8% to 12% of the older population during this time. By 2020, one-quarter of America's older population will belong to a minority racial or ethnic group.

Origin: Chapter 14- Nutrition and Hydration, 13 Chapter: 14 Client Needs: B Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 176, Special Needs of Women 13. After a nutritional assessment the nurse learns that a 70-year-old female patient routinely ingests a diet high in fat. The nurse realizes the patient is at an increased risk for developing which health problem?

A) Cancer B) Arthritis C) Osteoporosis D) Heart disease Ans: D Feedback: Heart disease, cancer, and osteoporosis are among the nutrition-related conditions to which older women are susceptible. From ages 64 to 74, the rate of heart disease equals that of men, and reduction of fat intake can be beneficial in reducing this risk.

Origin: Chapter 36- Acute Care, 8 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 485, Preoperative Care Considerations 8. An obese elderly patient is scheduled for surgery. The following diagnostic tests were performed: a chest X-ray, an ECG, a complete analysis of blood samples, a nutritional assessment, and a mental assessment. What test is missing?

A) Cardiac enzymes test B) Pulmonary function test C) Transferrin test D) Hemoglobin test Ans: B Feedback: A pulmonary function test is needed if a patient is obese or a smoker. The other choices are all blood tests that were done as part of the complete analysis of blood samples.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 14 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 462, Locating a Support Group 14. Mr. Q has heart disease, and his wife needs to learn about the cooking methods and recipes she can use to help his condition. Which of the following sources is probably her best source of information?

A) Cardiologist B) General practitioner C) Nurse D) Support group Ans: D Feedback: Other caregivers in a support group can probably provide many cooking tips and recipes. The other sources can provide more theoretical information and general guidance.

Origin: Chapter 15- Rest and Sleep, 20 Chapter: 15 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 192, Pain Control 20. An older patient is complaining of not being able to sleep because of leg pain. What is the first thing that the nurse should identify when relieving the patient's pain?

A) Cause of the pain B) Psychological factors C) Sleeping position at night D) Medications that could interfere with sleep Ans: A Feedback: Identifying the cause of the pain is the essential first step to controlling it. Once the cause of the pain is identified, interventions can be implemented to try to control it. Psychological factors, sleeping position, and medications that interfere with sleep would then be analyzed once the cause of the pain is identified.

Origin: Chapter 15- Rest and Sleep, 18 Chapter: 15 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Sleep Apnea 18. The nurse notes that two obese male residents snore loudly throughout the night. The nurse recognizes that snoring usually accompanies which health problem?

A) Central sleep apnea B) Nocturnal sleep apnea C) Obstructive sleep apnea D) A combination of central and obstructive sleep apneas Ans: C Feedback: Snoring usually accompanies obstructive sleep apnea. Sleep apnea is not categorized as "nocturnal." Central sleep apnea is caused by a defect in the central nervous system that affects the diaphragm.

Origin: Chapter 5- Common Aging Changes, 24 Chapter: 5 Client Needs: C2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication Objective: 2 Page and Header: 64, Personality 24. Older adults may appear rigid in their attitudes because of:

A) Changes in personality that accompany aging B) Diminished ability to learn new information C) Physical or mental limitations D) Decline in morale and self-esteem Ans: C Feedback: Personality, learning ability, and morale/self-esteem do not change with age. Seniors may resist change because of their physical or mental limitations—for example, rearranging the furniture when eyesight or mobility is limited.

Origin: Chapter 2- Theories of Aging, 18 Chapter: 2 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Teaching/learning Objective: 2 Page and Header: 16, Radiation Theories 18. A magazine geared toward elderly women contains an advertisement for an anti-wrinkle cream purported to remove wrinkles caused by the drying effects of years of soap use. Knowledgeable nurses can keep their elderly female clients from being duped by this advertisement by explaining that the wrinkling of facial skin in old age results primarily from:

A) Changes in the endocrine glands B) Cellular mutations arising from toxic chemicals C) Repeated exposure to ultraviolet light D) A diet high in fats and refined sugars Ans: C Feedback: Repeated exposure to ultraviolet light causes solar elastosis, the wrinkling that results from the replacement of collagen by elastin. Toxic chemicals, nutrition, and endocrine changes are not known to produce the wrinkling of the skin seen in old age.

Origin: Chapter 14- Nutrition and Hydration, 8 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 7 Page and Header: 178, Indigestion and Food Intolerance 8. An older patient asks the nurse what he can about nausea that occurs after eating because of delayed gastric emptying. What advice should the nurse provide to the patient?

A) Changing to a vegetarian, organic diet B) Limiting food intake and taking antacids regularly C) Increasing the amount of soluble and insoluble fiber in his diet D) Eating several small meals throughout the day rather than three larger ones Ans: D Feedback: More frequent intake of smaller amounts of food is noted to be useful in the management of slow gastric emptying. A vegetarian diet and increasing fiber intake are not known to be effective management techniques for delayed gastric emptying. Limiting food and using antacids predisposes the patient to other risks.

Origin: Chapter 3- Diversity, 5 Chapter: 3 Client Needs: D1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 5. A nurse is assessing an 84-year-old female Chinese American's pain following her left hemiarthroplasty 2 days prior. Which of the following characteristics of Chinese Americans should the nurse be aware of during this assessment?

A) Chinese Americans often view pain as a virtue and tend to underreport it. B) Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved. C) Chinese women often overstate their pain in light of health care providers' reluctance to provide analgesia. D) There is often a reluctance to acknowledge pain among older Chinese Americans. Ans: D Feedback: Discomfort is not typically aggressively or openly displayed by Chinese persons. Pain is not noted to be seen as a virtue or in a fatalistic light. Pain is not commonly overstated.

Origin: Chapter 16- Comfort and Pain Management, 1 Chapter: 16 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 195, Types of Pain 1. A patient with a diagnosis of lung cancer has recently developed metastases to the bone which is causing severe pain. The nurse would characterize this patient's pain as being which type?

A) Chronic B) Neuropathic C) Somatic nociceptive D) Visceral nociceptive Ans: C Feedback: Pain that originates from the bones is classified as somatic nociceptive. Chronic pain has been present for 3 months or longer. Neuropathic pain occurs from abnormal processing of sensory stimuli. Visceral pain is another term for referred pain and is deep and aching.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 4 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 4. Which of the following statements about the goals for persons with chronic illnesses are appropriate? (Select all that apply.)

A) Chronic illnesses can be cured with proper and persistent treatment. B) Healing requires the mobilization of the body, mind, and spirit. C) Appropriate care measures focus on helping patients live in harmony with chronic disease. D) Controlling symptoms, promoting a sense of well-being, and enhancing the quality of life are appropriate goals for persons with chronic illnesses. Ans: B, C, D Feedback: Healing requires the mobilization of the body, mind, and spirit. Appropriate care measures focus on helping patients live in harmony with chronic disease. Controlling symptoms, promoting a sense of well-being, and enhancing the quality of life are appropriate goals for persons with chronic illnesses. Chronic illnesses cannot be cured.

Origin: Chapter 1- The Aging Population, 7 Chapter: 1 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 8, Health Status 7. Which of following statements most accurately captures the role of chronic illness in the lives of older adults?

A) Chronic illnesses constitute the leading cause of death for older adults. B) More older adults die from acute illnesses than from chronic diseases. C) While chronic diseases used to be the leading cause of death, this is no longer the case. D) While cancer rates have fallen, other chronic diseases remain a common cause of death. Ans: A Feedback: Chronic illnesses constitute the leading cause of death for older adults, exceeding those attributed to acute illnesses. The presence of heart disease as a cause of death has decreased in recent years, while at the same time cancer has become more prevalent.

Origin: Chapter 21- Digestion and Bowel Elimination, 9 Chapter: 21 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 293, Dental Problems 9. Which of the following statements most accurately captures an aspect of dental health among older adults?

A) Clients who wear dentures do not normally require visits to the dentist. B) The incidence of dental caries increases significantly with age. C) Periodontal disease is less common in older adults than in younger clients. D) The presence of dental problems can be indicative of a variety of other diseases. Ans: D Feedback: Clients with dentures still require visits to the dentist. Dental caries are less common among older adults than younger adults, while the opposite is true of periodontal disease. Numerous health problems can underlie dental health problems.

Origin: Chapter 16- Comfort and Pain Management, 15 Chapter: 16 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 201, Medication 15. An older patient has been treated with acetaminophen for chronic pain, and it is no longer effective. What would be the next drug of choice for this patient?

A) Codeine B) Ibuprofen C) Oxycodone D) Morphine patch Ans: B Feedback: NSAIDs are the next drug of choice when treating pain in the elderly. If the first NSAID is not effective, a different NSAID should be used prior to administering an opioid.

Origin: Chapter 5- Common Aging Changes, 12 Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 64, Thermoregulation 12. With aging the skin becomes thinner and more fragile. The thinning of the skin's subcutaneous fat layer makes older adults more sensitive to:

A) Cold B) Heat C) Pain D) Pressure Ans: A Feedback: Subcutaneous fat serves as an insulator. With less of it, the elderly may be more sensitive to cold temperatures. Older adults are less sensitive to pain and pressure because of decreased sensitivity of nerve endings.

Origin: Chapter 16- Comfort and Pain Management, 7 Chapter: 16 Client Needs: D2 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 4 Page and Header: 198, Complementary Therapies 7. A patient experiencing chronic pain asks the nurse if there is "anything else" that can be done to help with the pain. Which response should the nurse make to address complementary therapies with the patient?

A) Complementary therapies provide added options for treating pain. B) Complementary therapies can be explored when medication has failed to relieve pain. C) Complementary therapies are preferable to medications in light of their more holistic nature. D) Complementary therapies often have unproven effectiveness but bring emotional comfort to patients. Ans: A Feedback: Complementary therapies provide useful additional options for the treatment of pain. Medication need not have failed for alternative therapies to be considered and their effectiveness has been demonstrated. These therapies are not necessarily preferable to medications, but rather should be implemented in addition to medications. Complementary therapies may or may not prove to be effective and are not necessarily preferable to medications.

Origin: Chapter 14- Nutrition and Hydration, 5 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 177, Hydration Needs of Older Adults 5. An older patient with a history of renal failure is admitted with dehydration and hyponatremia. The nurse identifies which assessment findings as being consistent with the diagnosis of dehydration? (Select all that apply.)

A) Confusion B) Shortness of breath C) Decreased skin elasticity D) Increased blood urea nitrogen (BUN) E) Adventitious lung sounds on auscultation Ans: A, C, D Feedback: Confusion, decreased skin elasticity, and increased BUN are all associated with dehydration. Adventitious lung sounds and shortness of breath are not associated with dehydration but rather with overhydration.

Origin: Chapter 12- Sexuality and Intimacy, 23 Chapter: 12 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 148, Box 12-2 23. A female patient is experiencing hot flashes and anxiety since beginning menopause. What should the nurse teach the patient about managing these symptoms? (Select all that apply.)

A) Consider meditation B) Cut down on exercise C) Take rhapontic rhubarb D) T'ai chi can help with stress E) Reduce sleep to 6 hours a night Ans: A, C, D Feedback: Herbs such as standardized extract of rhapontic rhubarb have been shown to reduce hot flashes and other symptoms of menopause. Meditation and t'ai chi are considered complementary and alternative approaches to help control menopausal symptoms. Exercise and regular adequate sleep are recommended to control menopausal symptoms. Exercise and sleep should not be reduced.

Origin: Chapter 36- Acute Care, 17 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 491, Box 36-1 17. Mr. S, a 92-year-old patient in a geriatric medicine unit, has become acutely confused. The development is of great concern to the care team since Mr. S has no history of cognitive deficits. What action should the nurse prioritize?

A) Contacting Mr. S's family B) Assessing Mr. S's vital signs and obtaining blood samples C) Moving Mr. S to a bed that is visible from the nursing station D) Supervising Mr. S during transfers Ans: B Feedback: Assessing vital signs and obtaining blood samples would be prioritized over the other noted interventions. Despite their validity, they are not as time dependent.

Origin: Chapter 14- Nutrition and Hydration, 21 Chapter: 14 Client Needs: D3 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 175, Nutritional Supplements 21. During a home visit the nurse notes that an older patient has a tray of many types of vitamins, minerals, and herbal supplements on the kitchen counter. The patient was recently discharged from the hospital after having an acute myocardial infarction. What should the nurse instruct the patient about these supplements?

A) Continue taking the supplements but only with meals B) Stop taking the vitamins and other supplements until further notice C) Take the vitamins but do not exceed the recommended daily allowances for older adults D) Check with the health care provider to identify any supplements that may produce adverse interactions with prescribed medication Ans: D Feedback: Caution is necessary when using vitamins, minerals, and herbal supplements in older patients since some can cause adverse effects if taken in high doses and may interact with many medications. The patient should check with the health care provider before continuing to take the supplements with meals. Telling the patient to stop the supplements until further notice could frighten the patient since some of the supplements may be appropriate. It is most important that the patient check with the health care provider for adverse interactions between the supplements and prescribed medication.

Origin: Chapter 35- Rehabilitative Care, 25 Chapter: 35 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 479, Maintaining and Promoting Mental Function 25. The director of a nursing home tries to provide stimulating activities for the residents. Every Friday evening, there are Bingo games for the residents. Most residents enjoy playing Bingo, but a few object that it is a "waste of time" and they refuse to play. How should the director handle the situation?

A) Continue the games but offer an alternative activity that provides more mental stimulation. B) Continue the games and insist that all the residents should continue participation. C) Find a new, more stimulating activity for all the residents. D) Continue the games but allow the residents to read or watch television instead of playing. Ans: A Feedback: Bingo may seem frivolous to some residents, but for some it is as much mental stimulation as they can handle, and many people do seem to enjoy it. Although the games should continue for those who wish to play, no one should be forced to play. Reading is always a good way to spend time, but in a nursing home there are many hours to fill in that way. Most television programs are not mentally challenging. Residents who object to playing Bingo should be asked to suggest ideas for other activities; depending on their interests and abilities, they might enjoy playing chess or bridge, playing board games, or telling jokes and stories.

Origin: Chapter 3- Diversity, 22 Chapter: 3 Client Needs: B Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 22. Some health conditions are more prevalent in the black population than in the white population. It is important that nurses pay particular attention to identifying those health conditions. Which of the following health assessments and reasons is the most important in working with black patients?

A) Control their lifestyle changes because of a lower life expectancy B) Monitor their blood pressure because of a blunted nocturnal response C) Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems D) Monitor for HIV/AIDS as this is a leading cause of death among African Americans Ans: B Feedback: Hypertension is the most prevalent health problem among black Americans, and a blunted nocturnal response is one factor responsible for this problem. The serious consequences of high blood pressure would supersede the alterations in skin assessment, and highlighting test results and controlling lifestyle changes would be inappropriate actions.

Origin: Chapter 35- Rehabilitative Care, 26 Chapter: 35 Client Needs: D1 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 7 Page and Header: 480, Reality Orientation 26. Which aid to reality orientation can most help elderly patients?

A) Conversations B) Calendars and clocks C) Holiday decorations D) Newspapers and television and radio news programs Ans: A Feedback: Nurses and other staff can enhance a patient's orientation by casually mentioning dates and times while dispensing medicines or doing other tasks, an act that is more effective than the other noted methods.

Origin: Chapter 12- Sexuality and Intimacy, 20 Chapter: 12 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 146, Symptom Management and Patient Education 20. A female patient in menopause asks why estrogen levels change during and after menopause. What should the nurse explain about estrogen in a postmenopausal woman?

A) Conversion of androstenedione to estrone occurs in the skin and fatty tissue B) Secretion of estradiol and complementary progesterone from the adrenal glands C) Synthesis by the ovarian follicles in response to gonadotropic hormone stimulation D) Coenzyme action in the parathyroid gland prompted by stimulation from the thyroid Ans: A Feedback: When the ovaries decline in function, most estrogen is obtained through the conversion of androstenedione to estrone in the skin and adipose tissue. The other choices do not explain the hormone estrogen in the postmenopausal patient.

Origin: Chapter 1- The Aging Population, 21 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 9, Provision of and Payment for Services 21. What are the most important competing forces that influence health policy for the elderly?

A) Cost containment versus quality of care B) Acute care versus the burden of chronic disease C) Private insurance payments versus Medicare support D) Long-term care at home versus nursing home services Ans: A Feedback: Policy discussions most often pit cost containment (reducing expenditures) against quality of care (which may mean increasing expenditures). Seniors require relatively less acute care than younger patients do; their health problems are more often chronic. Because all persons over age 65 are entitled to health coverage through Medicare, insurance considerations are fewer than with younger patients. And whereas one in four seniors requires nursing home care at some time, nursing home residency is not typically long term.

Origin: Chapter 1- The Aging Population, 20 Chapter: 1 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 8, Health Status 20. Which of the following statements best captures an aspect of illness in older adults?

A) Death from heart disease is increasing in this population. B) Death from cancer is increasing in this population. C) Chronic illnesses are less common than in younger people. D) Several acute illnesses are often present that must be managed simultaneously. Ans: B Feedback: In the elderly population, the cancer death rate has increased in the past three decades; deaths from heart disease have declined. Several chronic conditions are often present and must be managed simultaneously.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 7 Chapter: 34 Client Needs: D1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals of Chronic Care 7. A nurse is providing care for an 82-year-old woman on the palliative care unit of a hospital. The woman has a long-standing diagnosis of diabetes that has manifested in serious cardiac problems and she is not expected to survive the weekend. How can the nurse best understand this course of events in light of the chronic care that the patient has long received?

A) Death represents the ultimate failure of the provision of care. B) Dying in comfort and dignity is the final component of high-quality chronic care. C) The period of death represents the transition from chronic care to acute care. D) Holistic, chronic care requires that the nurse limit care to psychosocial interventions. Ans: B Feedback: Dying a "good death" is a component of sound chronic care. It does not necessarily represent a failure of care nor does the near-death period mark the end of chronic care. Chronic care includes, but is not limited to, psychosocial interventions. Pain control and comfort care, for example, require pharmacological interventions that are still congruent with chronic care and the focus on healing and quality of life.

Origin: Chapter 5- Common Aging Changes, 20 Chapter: 5 Client Needs: D3 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 60, Nervous System 20. A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is:

A) Decline in brain weight B) Reduction of blood flow to the brain C) Flawed response to changes in balance D) Slowed nerve conduction velocity Ans: C Feedback: Although all the statements are true, the major factor increasing the risk of falls is a flawed response to changes in balance.

Origin: Chapter 13- Spirituality, 13 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 168, Praying with and for 13. A patient with cancer asks the nurse to pray with him but the nurse does not feel comfortable with prayer. What should the nurse do?

A) Decline politely and ask a coworker to pray with the patient B) Arrange transportation so that the patient can attend prayer meetings at his church C) Pray with the patient after making sure he understands that the nurse would prefer not to D) Pray with the patient realizing that the patient's needs are more important than the nurse's beliefs Ans: A Feedback: People of faith have long understood the value of prayer, and now growing research evidence supports the positive relationship between prayer and health and healing. One need not be an ordained clergy to hold a patient's hand and offer a prayer. Nurses who are not comfortable offering prayers themselves can ask coworkers to pray with and for their patients who so desire.

Origin: Chapter 21- Digestion and Bowel Elimination, 3 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 290, Effects of Aging on Gastrointestinal Health 3. The nurse discusses nutritional health with an 89-year-old client whose total protein level is 5 (abnormally low). Which of the following physiological changes should the nurse interpret as a potential pathological process rather than a normal age-related change?

A) Decreased amounts of pepsinogen released in the stomach B) Decreased peristalsis of the esophagus and stomach C) Decreased taste sensations, decreasing food intake D) Decreased teeth and chewing ability Ans: D Feedback: Tooth loss is not a normal aging change. Esophageal motility and stomach motility decrease with advanced age causing presbyesophagus. The stomach has a higher pH as a result of the declines in hydrochloric acid and pepsin (converted pepsinogen), which can interfere with the absorption of proteins. The tongue atrophies, affecting the taste buds and decreasing taste sensations.

Origin: Chapter 5- Common Aging Changes, 23 Chapter: 5 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 63, Immune System 23. The charge nurse at a nursing home impresses on a visiting class of nursing assistants the importance of hand washing, because older adults have a depressed immune response. One contributor to this depressed immune response in older adults is:

A) Decreased serum activity of the thymic hormones B) Inactivation of varicella-zoster infections C) Decreased serum concentrations of IgA and IgG D) High pain sensitivity associated with inflammation Ans: A Feedback: Serum activity of the thymic hormones is almost undetectable with age. Serum concentrations of IgA and IgG increase with age. Inflammation often causes minimal pain in the elderly.

Origin: Chapter 14- Nutrition and Hydration, 17 Chapter: 14 Client Needs: D2 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 5 Page and Header: 177, Hydration Needs of Older Adults 17. An 80-year-old patient who has just spent 2 days at the beach with his family is demonstrating confusion, dry skin, a dry brown tongue, sunken cheeks, and concentrated urine. What health problem do the patient's symptoms most likely indicate?

A) Dehydration B) Renal failure C) Hyperthermia D) Food poisoning Ans: A Feedback: The nurse has identified the signs of dehydration in older adults. The manifestations of confusion, dry skin, dry brown tongue, sunken cheeks, and concentrated urine may or may not indicate renal failure, hyperthermia, or food poisoning.

Origin: Chapter 16- Comfort and Pain Management, 27 Chapter: 16 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 2 Page and Header: 196, Effects of Unrelieved Pain 27. An older patient consistently rates pain as being a 6 on a scale from 0 to 10 even after receiving pain medication every 6 hours. What should the nurse realize the patient is at risk for developing? (Select all that apply.)

A) Depression B) Heart disease C) Hopelessness D) Kidney stones E) Spiritual distress Ans: A, C, E Feedback: The experience of chronic or unrelenting pain can cause a person to become depressed, hopeless, and spiritually distressed. Heart disease and kidney stones are not associated with chronic pain.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 9 Chapter: 8 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 109, Elder Abuse 9. An 81-year-old female client has presented to the emergency department accompanied by her daughter with whom she lives. The daughter states that her mother has experienced a recent series of falls, which have resulted in her facial and arm bruises. The client smells of urine and is noticeably emaciated, unkempt, and is anxious while the daughter berates her during the nurse's assessment. What is the nurse's responsibility in this situation?

A) Determine the daughter's legal status with regard to her mother's financial affairs. B) Report suspected elder abuse to the Adult Protective Services Department. C) Establish whether the client has a durable power of attorney in place. D) Obtain medical records regarding prior admissions for similar problems. Ans: B Feedback: In cases of suspected elder abuse, the nurse is responsible for reporting his or her suspicions to the relevant authorities. Neither the legal status of the mother and daughter's relationship nor past medical records are primary concerns.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 20 Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 464, The Need for Institutional Care 20. Mrs. D, a resident in a nursing home, is considered noncompliant by many of the staff because she refuses to eat some of the food, which is nourishing and has been carefully planned by a dietitian. Most other residents have no objection to the meals. In addition, Mrs. D sometimes skips exercise classes. On the other hand, she takes all her medicines, and she gets along well with the other residents, to whom she tells risqué jokes. In what area is Mrs. D coping successfully?

A) Diet B) Assertiveness C) Exercise D) Compliance Ans: B Feedback: The staff may be annoyed by Mrs. D's noncompliant behavior, and her diet and exercising may be imperfect, but she is exhibiting a healthy assertiveness in refusing to eat food she dislikes and to exercise when she doesn't want to.

Origin: Chapter 5- Common Aging Changes, 19 Chapter: 5 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 58, Musculoskeletal System 19. Bone fractures are a serious risk to the elderly. Which of the following is a contributing factor?

A) Diminished calcium absorption B) Shortening of the long bones C) Formation of points and spurs D) Deterioration of cartilage surfaces Ans: A Feedback: A decrease in calcium absorption in the elderly contributes to the brittleness of the bones, thus increasing the risk of fractures.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 10 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 10. Mr. P, a 70-year-old retired engineer, has diabetes and is on dialysis. He is a gourmet who takes pride in cooking delicious meals. His physical condition is quite good, but he is unhappy and bored with the restricted life he must lead. An old friend has invited him to travel across the country to San Francisco and spend a week there. Dialysis treatments can be arranged through a network of dialysis providers. How should Mr. P's charge nurse respond to this situation?

A) Discourage the idea, as he is likely to eat and drink too much on vacation B) Discourage the idea, but provide as much helpful information as possible C) Encourage him to go, and provide as much helpful information as possible D) Encourage him to go, and advise him to relax regarding his condition for a week Ans: C Feedback: A visit to San Francisco, a city known for its many fine restaurants, certainly poses risks for a patient who must follow a restricted diet, and could even shorten Mr. P's life. His unhappiness with his current situation, however, probably makes it desirable for him to take that risk. Even in San Francisco, it may be possible for him to eat sensibly, and in any case he is likely to be much happier than he is now. He needs to decide whether his quality of life will improve enough to risk any dangers. A nurse or social worker should help with setting up the dialysis arrangements ahead of time and with giving him any available information about restaurants, medical centers, and other places he may need to know about.

Origin: Chapter 16- Comfort and Pain Management, 14 Chapter: 16 Client Needs: D4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 4 Page and Header: 198, An Integrative Approach to Pain Management 14. An older patient being treated for intermittent pain is complaining of increased pain despite being started on a new pain management plan. What should the nurse do to help this patient?

A) Discussing alternative methods of pain management B) Identifying underlying factors that could be interfering with the current plan C) Reevaluating and setting realistic, specific goals for the pain management plan D) Discussing with the pain management team about increasing the dosage of the medication Ans: B Feedback: New or worsened pain can be caused by medical problems, poor positioning or posture, inactivity, emotional issues, and adverse drug reactions. Identifying and improving these underlying factors is the first step in pain management. Discussing alternative methods of pain management, setting new pain management goals, and increasing the dosage of medication would all be appropriate after the underlying factors have been identified.

Origin: Chapter 2- Theories of Aging, 9 Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 20, Box 2-2 9. Which of the following actions by a nurse who works with older adult clients in an assisted living facility is most likely to inhibit healthy aging?

A) Discussing current events with clients who read and watch television. B) Placing a bib on each client during meal times to ensure clients maintain a clean appearance. C) Challenging clients to learn new skills and develop preexisting talents. D) Facilitating introductions between new and existing clients. Ans: B Feedback: While the nurse's action may have a laudable rationale, using a bib and feeding clients who may not require either action is incongruent with promoting function and preventing helplessness. Discussing current events and facilitating new skills and relationships promote well-being.

Origin: Chapter 2- Theories of Aging, 3 Chapter: 2 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Difficult Integrated Process: Teaching/learning Objective: 2 Page and Header: 14, Evolutionary Theories 3. A nurse is explaining to an older adult client that many of the changes in his body that are currently causing him frustration may have their origins in genetic changes that may have in fact benefited him during his younger years. Which of the following theories of aging underlies the nurse's explanation?

A) Disposable soma theory B) Free radical theory C) Mutation accumulation theory D) Antagonistic pleiotropy theory Ans: D Feedback: Antagonistic pleiotropy theory proposes that genetic mutations that are problematic in later life may be rooted in mutation that played a beneficial role earlier in life. This perspective is not a component of the disposable soma theory, free radical theory, or mutation accumulation theory.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 24 Chapter: 9 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 113, External and Internal Ethical Standards 24. Mrs. J's insurance company reimburses for a maximum of four physical therapy sessions annually. At age 62, Mrs. J is recovering slowly from hip surgery, and her nurse believes that additional sessions would enhance Mrs. J's self-care capacity. Mrs. J cannot afford to pay for additional sessions. Which of the following is the nurse's major ethical concern?

A) Do I increase financial risks for health care institutions by insisting that nonreimbursed therapy be provided? B) Is the insurance company reimbursing in a manner that threatens my patient's well-being? C) Have meta-analyses shown that additional therapy sessions are cost-effective? D) Am I in compliance with the integrity requirement of the "Code of Ethics for Nurses" of the American Nurses Association? Ans: B Feedback: The nurse's first priority is quality care for the patient. If an insurance company is reimbursing in a manner that threatens a patient's well-being, the nurse faces a difficult ethical conflict.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 16 Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 461, Selecting an Appropriate Physician 16. Mrs. S has a serious chronic condition that requires her seeing a physician several times a year (or more, if she is hospitalized). She is considering four physicians, all of whom are well qualified. Which physician is likely to be her best choice?

A) Dr. A is the top expert in his field and is highly respected at the local hospital. B) Dr. B is a woman with an office in Mrs. S's neighborhood. C) Dr. C is a woman who makes Mrs. S feel comfortable and allows plenty of time for talking. D) Dr. D communicates well with her and is in high demand. Ans: C Feedback: Finding a doctor with whom the patient feels comfortable is of major importance. She will also want a physician who makes her feel comfortable in the office. These considerations are likely to outweigh others, especially when the patient is elderly. A physician in high demand may be less accessible.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 8 Chapter: 34 Client Needs: D3 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/learning Objective: 3 Page and Header: 457, Goals for Chronic Care 8. Mr. E, an elderly man who lives alone, has hypertension and diabetes but seems to manage both conditions quite well. Three times a week he drives to a dialysis center for dialysis. He injects himself with insulin and is in charge of his medications and meals. Because Mr. E is lonely, he often has lunch or dinner in restaurants where he may eat and drink unwisely, but he takes his medicines with him. What could a nurse at the dialysis center suggest that would most help Mr. E in managing his conditions?

A) Eat at home most of the time B) Take a list of approved foods to the restaurants C) Find some social activities that do not involve eating D) Test your blood pressure and blood sugar after returning home Ans: C Feedback: Mr. E's loneliness is leading to dietary problems, and a nurse can use a motivational strategy to help him. Even if Mr. E keeps track of his blood pressure readings and blood sugar levels, unwise eating and drinking will eventually affect his conditions. If he has a social life, he may find it easier to eat at home more often, where it is easier to manage his diet. When he does eat out, taking a list of approved foods and measuring his blood pressure and blood sugar afterward will be helpful.

Origin: Chapter 12- Sexuality and Intimacy, 22 Chapter: 12 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 148, Box 12-2 22. A patient experiencing menopausal symptoms asks what dietary changes can be made to reduce the manifestations of menopause. What should the nurse instruct the patient?

A) Eat meats and dairy products rich in animal estrogens B) Eat whole grains, nuts, and soybeans rich in plant estrogens C) Eat fruits and vegetables rich in vitamin C to increase estrogen retention D) Drink coffee and caffeinated sodas to stimulate estrogen release from the adrenal glands Ans: B Feedback: Foods rich in plant estrogens may offer some relief from menopausal symptoms. Caffeine should be avoided. Fruits and vegetables, high in boron, not vitamin C, promote estrogen retention.

Origin: Chapter 35- Rehabilitative Care, 13 Chapter: 35 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 470, Functional Assessment 13. Which of the following are typical activities of daily living? (Select all that apply.)

A) Eating B) Dressing C) Toileting D) Moving E) Cooking Ans: A, B, C, D Feedback: Activities of daily living include eating, washing, dressing, toileting, and moving. Instrumental activities of daily living include the skills beyond the basics that enable the individual to function independently in the community.

Origin: Chapter 35- Rehabilitative Care, 14 Chapter: 35 Client Needs: D1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 470, Functional Assessment 14. Which of the following are instrumental activities of daily living related to nutritional status? (Select all that apply.)

A) Eating B) Shopping C) Cooking D) Cleaning kitchen after cooking Ans: B, C, D Feedback: Eating is an activity of daily living. Shopping, cooking, and cleaning the kitchen after cooking are instrumental activities of daily living.

Origin: Chapter 15- Rest and Sleep, 16 Chapter: 15 Client Needs: D3 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 187, Insomnia 16. The nurse is identifying interventions to help older patients with insomnia. What action should the nurse perform first?

A) Educate older patients about how foods and beverages affect sleep B) Identify insomnia as a short-term problem associated with physical or mental illness C) Suggest natural methods to the older patient fall asleep sooner and sleep more soundly D) Recognize insomnia as a symptom and assess for factors that contribute to disrupted sleep Ans: D Feedback: Insomnia is a symptom, and the underlying cause must be investigated. Because of this, a thorough assessment must be completed before implementing any of the other options. Insomnia is not necessarily a short-term problem.

Origin: Chapter 35- Rehabilitative Care, 6 Chapter: 35 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 468, The Need for Rehabilitation 6. After a fall in the supermarket near his home, Mr. G has experienced a slow recovery in hospital from hip replacement surgery 9 weeks prior, enduring a postoperative infection and a slow resumption of mobility. Consequently, the care team has recommended that Mr. G be moved to a facility better able to meet his rehabilitative needs. Which of the following goals should be prioritized during his rehabilitation?

A) Effective pain management B) A return to pre-fall levels of mobility C) Improvement in functional capacity D) Freedom from infection Ans: C Feedback: A priority in rehabilitation is the improvement in functional capacity. The other cited goals may be components of this, but none of them would supersede it in importance.

Origin: Chapter 12- Sexuality and Intimacy, 25 Chapter: 12 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 5 Page and Header: 156, Table 12-3 25. A male patient who experienced a heart attack 6 months ago tells the nurse that he did not realize that his sexual life would be over so early in life. What information would be appropriate for the nurse to share with this patient? (Select all that apply.)

A) Encourage to cultivate hobbies B) Teach about alternative positions to avoid strain C) Instruct to avoid large meals for several hours before sex D) Plan to take medications for peak effectiveness during sex E) Explain that everyone experiences an end to sexual experiences Ans: B, C, D Feedback: Heart disease can interfere with sexual functioning. The nurse should teach the patient about alternative positions to avoid strain, avoiding large meals for several hours before sex to reduce the strain on the heart, and taking medications for peak effectiveness during sex. The nurse should not support the patient's belief that his sex life is over by encouraging him to cultivate hobbies and explaining that everyone experiences an end to sexual experiences because this is not true.

Origin: Chapter 35- Rehabilitative Care, 28 Chapter: 35 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 479, Reminiscence 28. What is the most important skill for nurses to use in reminiscing activities?

A) Encouraging B) Listening C) Guiding D) Redirecting Ans: B Feedback: Perhaps the most important skill for nurses to use in reminiscing activities is listening. Little encouragement or guidance is often needed for elderly people to reminisce, and redirecting is only important if the patient starts to ramble aimlessly.

Origin: Chapter 1- The Aging Population, 12 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 3, Views of Older Adults Through History 12. Twentieth-century laws regarding health care for the elderly trace their roots back to:

A) England's 17th-century Poor Laws B) Child labor laws of the 19th century C) The Biblical commandment "Honor your father and your mother" D) The tradition of respect for the elderly passed down from ancient Roman law Ans: A Feedback: Laws enacted in 20th-century America provided some measure of financial security and some level of health care for all persons aged 65 years and older, just as did the Poor Laws of 17th-century England that acted as a "safety net" for the elderly and the destitute. The child labor laws protected the young but offered no help to the elderly who were left at the mercy of their families. The Biblical commandment to "honor" provides a moral guideline but no practical benefit in terms of financial or health support. Ancient Romans deplored the elderly, and no tradition of respect for the aged was incorporated into the Roman legal code.

Origin: Chapter 36- Acute Care, 24 Chapter: 36 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 492, Infections 24. Which of the following measures would be particularly important for preventing infections of elderly persons who are being cared for in a health-care institution? (Select all that apply.)

A) Ensuring that the older adult has had all childhood immunizations. B) Ensuring that pneumococcal and influenza immunizations have been administered (unless contraindicated). C) Adhering to infection-control practices. D) Restricting contact with persons who have infections or suspected infections. Ans: B, C, D Feedback: Measures that assist in preventing infections in older adults who are being cared for in a health-care institution include the following: ensuring that pneumococcal and influenza immunizations have been administered (unless contraindicated); adhering to infection-control practices; and restricting contact with persons who have infections or suspected infections. It is not important to ensure that the older adult has had all childhood immunizations.

Origin: Chapter 12- Sexuality and Intimacy, 4 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 149, Sexual Behavior and Roles 4. The nurse wants to acknowledge and accommodate the sexual needs of older residents in a long-term care facility. Which statement provides the most accurate guide for the nurse's practice?

A) Erectile dysfunction drugs can be used to significantly enhance older adults' lack of interest in sex. B) The nurse should gently and creatively seek to liberate older adults from the rigid gender roles of their youth. C) The nurse should remember that the general pattern and character of sexual behavior and identity is consistent throughout the life. D) The nurse should recognize that older adults experience an increased desire for emotional comfort and intimacy along with an accompanying decrease in desire for physical, sexual activity. Ans: C Feedback: Sexual interest and identity is generally consistent throughout the life span. It is not the nurse's role to deliberately seek to change residents' gender identities, and interest in physical sexual activity does not necessarily wane. It would be inappropriate and ineffective to attempt to create sexual interest through the use of erectile dysfunction drugs.

Origin: Chapter 12- Sexuality and Intimacy, 14 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 153, Psychological Barriers 14. The nurse recognizes that older men may decide they are too old for sex because of a cycle involving which of the following?

A) Erection and flaccidity B) Impotence and anxiety C) Masturbation and impotence D) Climax and a failure to ejaculate Ans: B Feedback: An episode of erectile dysfunction can trigger a cycle wherein anxiety over the potential loss of sexual function interferes with the ability to become erect, which in turn further heightens anxiety. The other choices do not describe cycles that cause older men to decide they are too old for sex.

Origin: Chapter 35- Rehabilitative Care, 3 Chapter: 35 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 468, The Need for Rehabilitation 3. Elderly people are at risk for becoming frail, which can lead to serious disabilities. Which of the following is the most likely to prevent or postpone frailty?

A) Exercises for strengthening muscles B) Reminiscing activities C) A weight-loss diet D) Puzzles and board games Ans: A Feedback: Frailty refers to physical condition. Although activities like doing puzzles and reminiscing may be helpful for a person's mental condition, they do not directly benefit the person's physical condition. Weight loss may be desirable for some elderly people, but being overweight is not a step toward frailty.

Origin: Chapter 3- Diversity, 21 Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 21. Which of the following is the most direct way for nurses to accommodate ethnic diversity among their clients?

A) Explain how scientific research evidence supports medical treatment B) Provide standardized diets that meet patients' nutritional needs C) Listen to the life stories of elderly patients D) Take a foreign language class or travel abroad Ans: C Feedback: Although the research base underlying treatments may be important to some patients, relating it does not help the nurse understand or address ethnic diversity among patients. Standardized diets ignore patients' food choice preferences, which are often culturally related. Although travel and language study may broaden a nurse's appreciation for other cultures, the most direct step is to value and respect the life stories that patients share.

Origin: Chapter 12- Sexuality and Intimacy, 10 Chapter: 12 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 5 Page and Header: 157, Promoting Healthy Sexual Function 10. Two residents of a long-term care facility have been married for over 50 years and lived in the same house until health problems caused them to be admitted to the facility. They are currently assigned to different rooms. How can the nursing staff best facilitate the couple's sexuality?

A) Facilitate a move into the same room if possible B) Locate a place in the facility where they can spend time alone C) Regularly assess and document their feelings and issues around sexuality D) Educate the couple on the ways that they can expect their situation to affect their sexuality Ans: A Feedback: The ideal situation for these residents would be to remain in the same room if possible. The other cited interventions and assessments are valid, but would not supersede the couple's need to stay together at this stage of life.

Origin: Chapter 13- Spirituality, 9 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 168, Praying with and for 9. An older female patient, experiencing cancer pain and nausea and vomiting from chemotherapy, asks the nurse to pray for her during this difficult time. How should the nurse respond to the patient's request?

A) Facilitate a visit from a chaplain to the client at the bedside. B) First determine whether the client shares a similar religious tradition as the nurse. C) Pray for the client, asking a higher power to intervene and provide peace and relief. D) Explain that praying is beyond the nurse's scope of practice and explore alternative interventions. Ans: C Feedback: Nurses are justified in praying for clients and can simply ask a higher power to intervene. An identical religious tradition is not a prerequisite and praying need not be delegated to a chaplain. Praying is not beyond the nurse's scope of practice.

Origin: Chapter 35- Rehabilitative Care, 16 Chapter: 35 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 472, Facilitating Proper Positioning 16. Which of the following are reasons that correct body alignment for the elderly rehabilitation client is so important? Correct body alignment: (Select all that apply.)

A) Facilitates optimal function of major systems. B) Makes the nurse feel more comfortable. C) Promotes comfort for the patient. D) Prevents complications such as contractures and pressure ulcers. Ans: A, C, D Feedback: Correct body alignment facilitates the optimal function of major systems, promotes comfort, and prevents complications. It is not important that correct body alignment for the client makes the nurse feel more comfortable.

Origin: Chapter 21- Digestion and Bowel Elimination, 13 Chapter: 21 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 301, Fecal Impaction 13. A 77-year-old post-surgical patient has been complaining of abdominal pain throughout the nurse's shift. In addition, the patient has a temperature of 101.5°F (38.5°C) and has had small, frequent, loose bowel movements four times since the morning. Which of the following health problems would the nurse suspect?

A) Fecal impaction B) Colon cancer C) Appendicitis D) Biliary tract disease Ans: A Feedback: Fecal impaction often results in fever and fecal oozing that can be mistaken for diarrhea and is associated with abdominal pain. Colon cancer is less likely to precipitate a fever, and appendicitis and biliary tract disease are unlikely to cause frequent bowel movements.

Origin: Chapter 1- The Aging Population, 22 Chapter: 1 Client Needs: C2 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 9, Impact of the Baby Boomers 22. When compared with elderly populations of the past, persons entering their senior years between 2015 and 2030 will have:

A) Fewer chronic diseases but more acute illnesses B) Greater support from their children and spouses C) Better education and greater wealth D) Fewer needs for hospital or nursing home care Ans: C Feedback: The baby boomer cohort attained higher levels of education and economic status than past generations. They have, however, fewer children and the same (or greater) burdens of chronic disease and needs for health care as their parents did.

Origin: Chapter 15- Rest and Sleep, 17 Chapter: 15 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Nocturnal Myoclonus and Restless Leg Syndrome 17. The nurse is preparing to document that an older patient is experiencing nocturnal myoclonus. What assessment finding is consistent with this documentation?

A) Five leg jerks or movements per hour of sleep B) Any number of leg jerks related to the use of antidepressants C) Five leg jerks brought on by an epileptic seizure during a night's sleep D) Leg jerks in combination with episodes of breathing cessation during sleep Ans: A Feedback: Nocturnal myoclonus is a condition characterized by at least five leg jerks or movements per hour during sleep. Nocturnal myoclonus is not associated with the use of antidepressants, epileptic seizures, or breathing cessation during sleep.

Origin: Chapter 14- Nutrition and Hydration, 18 Chapter: 14 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 5 Page and Header: 177, Hydration Needs of Older Adults 18. An 80-year-old patient is admitted to the hospital for dehydration related to flu symptoms and receives intravenous fluids. What is a major risk factor for the patient during this hospitalization?

A) Fluid restriction can lead to infection and constipation. B) Fluid restriction can lead to serious electrolyte imbalance. C) Dehydration can lead to decreased ability of the bladder to distend. D) Overhydration can lead to problems when receiving intravenous fluids. Ans: D Feedback: Older patients are more sensitive to overhydration which is a consideration if intravenous fluids are needed. The patient was admitted and treated with intravenous fluids for dehydration. At this point, overhydration would be a concern. The patient is not prescribed a fluid restriction so there is no risk for infection, constipation, or electrolyte imbalance. Dehydration does not lead to changes in the bladder's ability to distend.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 12 Chapter: 9 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 116, Medical Technology 12. Artificial organs, genetic screening, ultrasound, and other innovations today save lives that once would have been given no hope. These advances have raised ethical questions related to which of the following issues?

A) For whom and when technology should be used B) How procedures should be monitored and outcomes measured C) How judgments about patients' health status can be kept objective D) The limits of medical practice in diagnosing and treating disease Ans: A Feedback: Although all the choices listed may be of concern, the greatest ethical conflict lies in deciding who can have access to a limited resource.

Origin: Chapter 15- Rest and Sleep, 22 Chapter: 15 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 191, Stress Management 22. An older patient is demonstrating signs of dress. How does the nurse explain the body's immediate reaction to stress?

A) Formation of ulcers B) Elevation of blood pressure C) Development of heart disease D) Stimulation of the sympathetic nervous system Ans: D Feedback: Elevated blood pressure, ulcers, and heart disease can result from unrelieved chronic stress. Regardless of the source of the stress, the body's immediate reaction is stimulation of the sympathetic nervous system with such changes as dilation of the pupils and increase in heart rate and respirations.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 14 Chapter: 8 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 2 Page and Header: 104, Patient Consent 14. Nurse M obtains a signature on an informed consent form from Mr. Y, who is later shown to have a fluctuating level of mental competency. In this case, what is Nurse M's most likely legal position?

A) Free from liability because Mr. Y signed the form B) May be held liable for a violation of Mr. Y's rights C) Liable unless a malpractice insurance policy is in effect D) Not liable because no family member had a durable power of attorney Ans: B Feedback: An informed consent may be considered invalid if the patient does not fully understand what he or she is signing. Patients with a fluctuating level of mental function are incapable of granting legally sound consent. The presence of an insurance policy and the legal status of family members are irrelevant.

Origin: Chapter 2- Theories of Aging, 4 Chapter: 2 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 14, Free Radicals and Lipofuscin Theories 4. An 80-year-old female who enjoys good health explains to her primary care provider that she attributes her health status to her regular intake of berries, fruit juices, and green tea, which she states "help cleanse the damaging molecules out of my body." Which of the following theories of aging underlies the client's health behaviors?

A) Free radical theory B) Biogerontology C) Disposable soma theory D) Cross-linking theory Ans: A Feedback: The free radical theory of aging attributes damage to the accumulation of free radicals that may be countered by the intake of antioxidants. This is not an explicit component of the disposable soma or cross-linking theory of aging. Biogerontology is the study of the relationship between aging and disease.

Origin: Chapter 2- Theories of Aging, 14 Chapter: 2 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 14, Cross-Linking Theory 14. Which of the following statements form components of both the error theory of aging and the cross-linking theory of aging?

A) Free radicals cause mutations in cells. B) Senescence is environmentally controlled at the cellular level. C) Changes in DNA lead to organ malfunctions. D) Genetic programming determines life expectancy. Ans: C Feedback: Both the error theory and the cross-linking theory assert some change in DNA that interferes with normal cell functioning. Such changes may be caused by free radicals or any of many other mutagens. Although the aging of cells may be environmentally influenced, it is not thought to be externally controlled. That genetic programming determines life expectancy is a basic tenet of the programmed theory of aging.

Origin: Chapter 2- Theories of Aging, 23 Chapter: 2 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/learning Objective: 4 Page and Header: 20, Box 2-2 23. Nurse Z takes ample time to explain all medical options to her elderly patients and to ensure they have the information they need to make informed decisions about their care. What is Nurse Z's best reason for taking these actions?

A) Full disclosure deters malpractice suits and negligence claims B) The activity theory of aging requires maintenance of lifestyle C) Information is an effective strategy for stress management D) Empowerment has a positive effect on health status Ans: D Feedback: Maximum control and decision making can have a positive effect on morbidity and mortality, although they do not necessarily reduce stress and are not inherent in the activity theory of aging. Even though legal considerations apply, the health of the patient is the first priority for nurses.

Origin: Chapter 5- Common Aging Changes, 16 Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 55, Gastrointestinal System 16. As a person ages, muscle tone decreases throughout the digestive system, causing a slowing movement of food through the esophagus. Delayed esophageal emptying in the elderly increases the risk of:

A) Gastric irritation B) Aspiration C) Irritable bowel syndrome D) Constipation Ans: B Feedback: Normal aging does not interfere with mobility through the bowel or bowel action. Gastric irritation results from a higher pH of stomach fluids. Aspiration is a risk associated with a weakened gag reflex, relaxation of the lower esophageal sphincter, and delayed esophageal emptying.

Origin: Chapter 16- Comfort and Pain Management, 21 Chapter: 16 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 198, Complementary Therapies; 199, Box 16-2 21. An older patient recovering from a stomach virus is experiencing pain and nausea. Since the patient does not have any other complicating illnesses, which herb could the nurse suggest for the symptoms?

A) Ginger B) Valerian C) Devil's claw D) White willow Ans: A Feedback: Ginger can be used to reduce inflammation and nausea. Valerian relaxes muscles. Devil's claw is used for inflammatory-related pain. White willow relieves inflammation and general pain.

Origin: Chapter 21- Digestion and Bowel Elimination, 18 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 290, Gastrointestinal Health Promotion 18. The nurse in the office advises a client with ongoing issues with constipation to keep a food journal. During a typical 24-hour period, the client has a bagel and coffee for breakfast, macaroni and cheese for lunch, and soup and salad for supper. What dietary changes should the nurse recommend to this client?

A) Gradually increase the amount of fiber in the daily diet B) Eat several small meals each day C) Immediately increase the amount of fiber in the diet to 7 to 10 servings per day D) Increase the amount of soups and cheeses in the menu Ans: A Feedback: Gradually increasing fiber in the daily diet is suggested to minimize any discomfort that could be caused by an immediate, substantial increase in fiber intake. Eating smaller meals is less likely to improve the bowel function.

Origin: Chapter 16- Comfort and Pain Management, 26 Chapter: 16 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 4 Page and Header: 200, Dietary Changes 26. During an assessment the nurse learns that an older patient uses flavonoids to help reduce joint inflammation caused by osteoarthritis. Which dietary items should the nurse ensure the patient receives to maintain this patient's practice? (Select all that apply.)

A) Green tea B) Chocolate C) Grapefruit D) Blueberries E) Raspberries Ans: A, B, D, E Feedback: Flavonoids inhibit enzymes that synthesize eicosanoids and interfere with the inflammatory process. Sources of flavonoids include red, purple, and blue fruits such as berries and their juices, green tea, and chocolate. Grapefruit is not considered a flavonoid.

Origin: Chapter 14- Nutrition and Hydration, 26 Chapter: 14 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 175, Nutritional Supplements; 176, Table 14-5 26. An older patient is prescribed a thiazide diuretic as treatment for mild right heart failure. Which herbal supplements should the nurse instruct the patient to avoid while taking this medication? (Select all that apply.)

A) Green tea B) Kava-kava C) White willow D) Cascara sagrada E) Aloe barbadensis Ans: D, E Feedback: Aloe barbadensis or cascara sagrada interacts with thiazide diuretics to cause an increased loss of potassium. Green tea can cause anorexia, diarrhea, insomnia, and vertigo. Kava-kava interacts with central nervous system depressants to cause increased sedation. White willow interacts with salicylates to cause increased antithrombotic effects.

Origin: Chapter 15- Rest and Sleep, 2 Chapter: 15 Client Needs: D1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 186, Sleep Stages; 187, Table 15-2 2. An older patient suffering from chronic exhaustion has an EEG that shows little time is spent in REM sleep. After reviewing the patient's history, what does the nurse suspect might be contributing to the patient's sleep problem?

A) Has two or three glasses of wine near bedtime B) Obese and diagnosed with type 2 diabetes 6 years ago C) Takes low-dose aspirin for the prevention of heart disease D) Stressed due to the spouse's new diagnosis of Alzheimer disease Ans: A Feedback: Certain drugs can decrease REM sleep, including alcohol. The use of aspirin has not been associated with decreased REM sleep. Obesity, type 2 diabetes, and stress have not been linked to specifically reducing the amount of REM sleep although these health problems can negatively impact sleep overall.

Origin: Chapter 3- Diversity, 17 Chapter: 3 Client Needs: A1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 17. Mrs C brings her elderly Chinese grandmother to the health clinic. When Grandmother C finds out that all the clinic physicians on duty are males, she appears embarrassed and becomes quiet and withdrawn. All the office staff were schooled in traditional Western medicine. Of the following suggestions, which best describes what the staff can do to put Grandmother C more at ease about receiving health care?

A) Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C's medical problem B) Show Grandmother C a picture of the human body and have her point to the area of her problem C) Observe Grandmother C more closely and ask specific questions D) Tell Grandmother C that being seen for treatment by a physician of either gender will put her yin and yang back in balance Ans: C Feedback: Chinese women may be embarrassed to receive health care from a man. Nurses should observe more closely and ask specific questions to ensure that the quiet nature of the patient is not misinterpreted to imply that no problems exist. It would be disingenuous to tell her that receiving care would right her yin and yang, and close observation and questioning would be preferable to simply asking her to point to the problematic area on a picture.

Origin: Chapter 14- Nutrition and Hydration, 25 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 180, Malnutrition 25. The nurse is concerned that an older patient with renal failure is developing malnutrition. What did the nurse assess in this patient? (Select all that apply.)

A) Hematocrit level 30% B) Hemoglobin level 7 g/dL C) Serum albumin level 2.5 g/100 mL D) Blood glucose level 110 mg/dL E) Weight loss of 6% over the last month Ans: A, B, C, E Feedback: Clinical signs of malnutrition include a weight loss of greater than 5% over the last month, a serum albumin level lower than 3.5 g/100 mL, hemoglobin level below 12 g/dL, and hematocrit level below 35%. Blood glucose level is not used as a clinical indicator of malnutrition.

Origin: Chapter 3- Diversity, 12 Chapter: 3 Client Needs: B Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 26, Black Americans 12. Although only 12% of elderly black Americans experience institutional care in their lifetimes, compared with 23% of elderly white Americans, they typically possess more health problems than their white counterparts. This difference in health status is most likely due to:

A) High incidence of violent crime and sexually transmitted diseases B) Reliance on family for health care advice and rejection of formal service agencies C) Cultural preference for unconventional medical treatments like spiritual and herbal remedies D) Lower standard of living and less access to health care services Ans: D Feedback: Black elders historically possess many health problems that have accumulated over a lifetime due to a poor standard of living and limited access to health care services. Although the other choices may apply to this population, they are not the major reasons for the diminished health status of many black elders.

Origin: Chapter 5- Common Aging Changes, 17 Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 57, Urinary System 17. Which of the following is the most common urinary problem among men aged 65 years and older?

A) High urinary volume B) Glucose in the urine C) Stress incontinence D) Frequent urination Ans: D Feedback: Although all these conditions may occur or coexist, most common is the need for frequent urination associated with enlargement of the prostate gland. This enlargement occurs to some degree in three-fourths of men aged 65 years and older.

Origin: Chapter 12- Sexuality and Intimacy, 12 Chapter: 12 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 155, Medication Adverse Effects 12. What is the first thing the nurse should check when an elderly widower reports a sudden onset of erectile dysfunction?

A) His mental health history B) His heart rate and blood pressure C) What drugs he has started taking D) His attitudes toward sex outside marriage Ans: C Feedback: Frequently, medications prescribed to the elderly affect potency, libido, orgasm, and ejaculation. Drugs should be reviewed when new sexual dysfunction occurs. A sudden onset of erectile dysfunction is not typically associated with mental health problems in the older patient. Heart rate, blood pressure, and attitudes toward sex outside of the marriage would not be the first thing that the nurse would check in the older patient with a new onset of erectile dysfunction. These areas can be assessed later in the process.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 16 Chapter: 9 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 114, Ethical Principles 16. When advocating the rights of patients to receive health care regardless of ability to pay, a nurse is applying which of the following ethical principles?

A) Holistics B) Justice C) Fidelity D) Autonomy Ans: B Feedback: Justice argues that people should be treated equally regardless of their circumstances. Thus, medical treatments available to the rich should also be available to the poor. The other choices are not directly related to the situation.

Origin: Chapter 13- Spirituality, 5 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 162, Gratitude 5. The spouse of a patient with dementia remains upbeat and is appreciative of having good health and a loving family. The nurse realizes that the spouse is demonstrating which component of spirituality?

A) Hope B) Fatalism C) Gratitude D) Transcendence Ans: C Feedback: Gratitude is characterized by a sense of thankfulness and positivity, as exemplified by the woman's focus on what she has rather that what she lacks. Transcendence involves an awareness of a reality beyond oneself and hope is an expectation that looks to the future. Fatalism is a resignation to the inevitability of life events.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 2 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 457, Box 34-1 2. A nurse planning a health workshop for senior citizens wants to provide discussion topics that will interest everyone. In a typical group of seniors, which disorder will afflict the greatest number?

A) Hypertension B) Hearing impairment C) Heart condition D) Arthritis Ans: D Feedback: All these disorders are common in elderly people, but arthritis will afflict almost half of them. More than one-third will have hypertension, nearly one-third will have a hearing impairment, and more than one-fourth will have a heart condition. These are the "top four" conditions a nurse in this situation would want to present to the group.

Origin: Chapter 16- Comfort and Pain Management, 16 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 4 Page and Header: 201, Comforting 16. The nurse finds a patient sitting in bed, crying. What should the nurse do when the patient says that nothing is wrong?

A) Ignore the problem because the patient obviously does not wish to talk. B) Document the patient crying and go back to see the patient later in the shift. C) Sit in the chair beside the patient's bed, and maintaining eye contact, ask a few questions about the day. D) Fill the patient's water pitcher and move around the room, doing some small things to make the patient more comfortable. Ans: C Feedback: Sitting by the patient's bed demonstrates interest and indicates that the nurse is truly open to listening to the patient's problems and concerns. Ignoring the problem, seeing the patient later in the shift, and doing mindless tasks does not convey "being" with the patient.

Origin: Chapter 3- Diversity, 20 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 25, Hispanic Americans 20. To receive government money, County Hospital is required to provide demographic statistics on its patient base. In checking off the Ethnic Group boxes on the obligatory forms, office workers must be able to distinguish terminology. Which of the following best defines the term Hispanic?

A) Immigrant workers who entered the United States and their descendants B) Puerto Ricans who emigrated from the United States and their descendants C) Any Spanish-speaking people living in the United States D) Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil Ans: C Feedback: The term Hispanic encompasses a variety of Spanish-speaking persons in America, including Spaniards, Cubans, Mexicans, and Puerto Ricans. Hispanic people now represent approximately 6% of the older population.

Origin: Chapter 14- Nutrition and Hydration, 2 Chapter: 14 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 173, Quantity and Quality of Caloric Needs 2. A health-conscious resident of an assisted living facility is promoting the value of fiber to a fellow resident. Which statement made by the resident about the benefits of fiber is accurate?

A) Improved bowel activity and increased metabolic rate B) Improved bowel activity and decreased serum cholesterol C) Improved gastric emptying and prevention of colon cancer D) Increased nutrient absorption and decreased glucose tolerance Ans: B Feedback: Fiber is noted to lower serum cholesterol and promote good bowel activity. It is not noted to improve nutrient absorption or gastric emptying or to increase overall metabolic rate.

Origin: Chapter 1- The Aging Population, 23 Chapter: 1 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 8, Box 1-3 23. Which of the following patient histories is most likely for a person older than 65 years of age?

A) In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B) Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C) Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D) Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks Ans: B Feedback: Arthritis and heart conditions are among the most common chronic conditions of the elderly. Daily medications to reduce arthritis pain and decrease blood pressure are common. The other histories are more likely for younger patients.

Origin: Chapter 35- Rehabilitative Care, 12 Chapter: 35 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 470, Functional Assessment 12. Which is most likely to keep a person from functioning independently and living alone?

A) Inability to prepare meals B) Difficulty in eating C) Illiteracy D) Inability to use a telephone Ans: B Feedback: Difficulty in eating is a problem with one of the basic activities of daily living (ADLs); the others are instrumental activities of daily living (IADLs). The person would need thrice-daily help with eating meals. In comparison, it would be easier to obtain help with meal preparation, reading, or using a telephone.

Origin: Chapter 21- Digestion and Bowel Elimination, 28 Chapter: 21 Client Needs: D4 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 290, Effects of Aging on Gastrointestinal Health 28. The client is a healthy, active 85-year-old with constipation. Which of the following age-related changes may contribute to this complaint?

A) Inactivity B) Reduced food and fluid intake C) Slower peristalsis D) Decreased sensory perception Ans: C Feedback: The client is healthy and active with no sensory perception difficulties. Slower peristalsis is the only age-related change.

Origin: Chapter 14- Nutrition and Hydration, 10 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 179, Constipation 10. The nurse is planning interventions for an older patient who is prone to developing constipation. Which intervention would be appropriate for the nurse to implement with this patient?

A) Increase fluids and encourage activity B) Scheduled administration of oil-based laxatives C) Provide normal saline enemas every 2 to 3 days D) Reduce activity and provide senna each day before bed Ans: A Feedback: Plenty of fluids and activity are advisable to prevent the onset of constipation. Laxatives and enemas would not be appropriate to prevent the onset of constipation. Reducing activity could contribute to the development of constipation.

Origin: Chapter 35- Rehabilitative Care, 8 Chapter: 35 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 470, Principles of Rehabilitative Nursing 8. Which of the following are principles of rehabilitative nursing in gerontological nursing care? (Select all that apply.)

A) Increase self-care capacity. B) If the patient is not returned to his or her pre-illness state, rehabilitative nursing was unsuccessful. C) Eliminate or minimize self-care limitations. D) Act for or do for when the person is unable to take action for himself or herself. Ans: A, C, D Feedback: The principles guiding gerontological nursing care that are of particular significance in rehabilitation include these actions: increase self-care capacity; eliminate or minimize self-care limitations; act for or do when the person is unable to take action for himself or herself. Rehabilitative nursing can be successful even if the client is not restored to his or her pre-illness state.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 9 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 457, Goals for Chronic Care 9. An elderly woman had a series of lab tests that indicate she is healthy, but she has had several colds lately and often feels fatigued (although she is not depressed). She eats lightly but has a healthful diet. Which is the best advice a nurse could give her for improving her health?

A) Increase total food intake. B) Take mega-doses of vitamins. C) Exercise more. D) Have psychotherapy. Ans: C Feedback: Eating more is inadvisable; current research indicates that a light but nourishing diet is best for most people. Although a daily vitamin/mineral supplement is a healthful practice, mega-doses of vitamins are seldom needed, and use of them should be supervised by a physician. Psychotherapy does not seem to be indicated; the woman is not depressed, and no other mental problem is mentioned. Exercise should help her general health, making her feel more awake during the day and helping her sleep at night. That, in turn, will increase her resistance to colds.

Origin: Chapter 21- Digestion and Bowel Elimination, 23 Chapter: 21 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 295, Hiatal Hernia 23. The nurse teaches the client who recently had hiatal hernia diagnosed. To keep the patient free from pain, what should the nurse recommend?

A) Increased fiber intake B) Taking a nap after each meal C) Ensuring not to skip meals D) Remain upright for 1 hour after eating Ans: D Feedback: It is important for individuals with hiatal hernias to remain upright for at least 1 hour following meals. Increasing fiber intake and making sure not to miss meals are measures less likely to prevent symptoms of the problem.

Origin: Chapter 36- Acute Care, 14 Chapter: 36 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 491, Box 36-1 14. Nurse R has just entered the hospital room of an 84-year-old female patient after hearing a crash and has found the patient lying on the floor of the room beside her overturned commode. How should the nurse best respond to this situation?

A) Initiate a code. B) Assist the patient to a sitting position for an assessment. C) Leave the patient on the floor until her status is determined. D) Position a sling for a mechanical lift under the patient. Ans: C Feedback: Patients who have fallen should be left in place until their health status can be determined. A fall in and of itself does not constitute a need for a code, though the patient's cardiac or respiratory status may require it.

Origin: Chapter 15- Rest and Sleep, 5 Chapter: 15 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Sleep Apnea 5. An older patient complains of overwhelming daytime fatigue, which the spouse attributes to loud snoring and erratic breathing patterns during the night. Which health problem should the nurse suspect as causing this patient's fatigue?

A) Insomnia B) Central sleep apnea C) Nocturnal myoclonus D) Obstructive sleep apnea Ans: D Feedback: Obstructive sleep apnea is characterized by periods without breathing during sleep and is most often accompanied by snoring. Central sleep apnea is not as frequently marked by snoring and neither insomnia nor nocturnal myoclonus is suggested by the patient's particular signs and symptoms.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 13 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 4 Page and Header: 460, Assessment of Chronic Care Needs 13. How can a visiting nurse best ensure proper care for a patient when she is not present but can be reached by a telephone or pager?

A) Instruct that all the family's questions should be filtered through the primary caregiver. B) Provide detailed written instructions for all procedures. C) Train the patient carefully in all procedures. D) Train all caregivers carefully in all procedures. Ans: B Feedback: Patients and caregivers can usually follow instructions well when a nurse is present, but the stress of illness and caregiving can make it easy to forget instructions later, especially if a procedure involves several steps or has changed from a recent procedure. Written instructions make it possible for a patient or caregiver to review procedures; if there is still confusion, the nurse can be called for advice.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 10 Chapter: 8 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 110, Legal Safeguards for Nurses 10. Following a recent lawsuit that implicated one of their colleagues, the nursing staff at an assisted living facility are especially aware of the need to safeguard themselves legally. Which of the following measures should the nurses take? Select all that apply.

A) Investigate whether their liability insurance is sufficient B) Ensure that work performed by unlicensed care staff under their supervision is performed adequately C) Avoid admitting residents who have living wills or advance directives. D) Assess the competence of employees under their supervision Ans: A, B, D Feedback: Answers A, B, and D are all measures that can help to protect gerontological nurses from legal liability. It is unnecessary, and likely unacceptable, to deny residence to individuals with living wills or advance directives.

Origin: Chapter 35- Rehabilitative Care, 27 Chapter: 35 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 7 Page and Header: 479, Reminiscence 27. What are the therapeutic effects of reminiscence? (Select all that apply.)

A) It is entertaining. B) It is a means of validating existence. C) It is a means of resolving past conflicts. D) It is a means of finding meaning in remaining life. Ans: B, C, D Feedback: The therapeutic effect of reminiscence is that it is a means of validating existence, resolving past conflicts, and finding meaning in remaining life.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 18 Chapter: 8 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication Objective: 2 Page and Header: 105, Patient Competency 18. A durable power of attorney differs from a power of attorney in what way?

A) It is granted by the court on behalf of an incompetent individual B) It stays in effect if the individual granting it becomes incompetent C) It goes into effect only after an individual becomes incompetent D) It includes responsibility for managing an individual's financial assets Ans: B Feedback: A durable power of attorney allows competent individuals to appoint someone else to make decisions on their behalf in the event they become incompetent. A power of attorney is a mechanism used by competent individuals to appoint someone else to make decisions for them. Usually, a power of attorney becomes invalid if the individual granting it becomes incompetent.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 9 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 4 Page and Header: 117, Measures to Help Nurses Make Ethical Decisions 9. Which of the following statements most accurately captures an aspect of the use of ethics committees in the ethical decision-making process?

A) It is important that lawyers be excluded from ethics committees. B) Ethics committees should originate within academic and religious contexts rather than health care organizations themselves. C) Multiple ethics committees are often necessary in order to gain a holistic and balanced perspective on issues. D) Evaluation by ethics committees of decisions that have been made can lead to the development of policies and better decision making in the future. Ans: D Feedback: The outcomes of ethical decision making should be assessed, a process that can result in the development of improved policies and procedures. Lawyers are valid members of ethics committees and while they should draw from various professions and perspectives, ethics committees can justifiably exist in health care contexts. It is not necessary to have multiple, coexisting ethics committees, but rather to ensure that any given committee have a variety of perspectives and backgrounds.

Origin: Chapter 13- Spirituality, 17 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Caring Objective: 3 Page and Header: 165, Box 13-1 17. For patients from which of the religious groups would an opportunity to fast in the weeks before Easter be most important?

A) Jewish B) Eastern Orthodox C) Seventh-Day Adventist D) Episcopalian (Anglican) Ans: B Feedback: Fasting during Lent is practiced by members of the Roman Catholic and Eastern Orthodox churches. Fasting is not typically done prior to Easter by those of the Jewish, Seventh-Day Adventist, or Anglican Episcopalian faiths.

Origin: Chapter 14- Nutrition and Hydration, 14 Chapter: 14 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 175, Nutritional Supplements 14. An older patient reports a significant amount of cheese, milk, and calcium-fortified orange juice in her diet. She also takes a 750 mg calcium supplement at breakfast. What should the nurse instruct the patient about her calcium intake?

A) Keep the intake of calcium to 30% of kilocalories or less B) Take calcium supplement doses totaling not more than 5,000 mg C) Limit the intake of calcium to a total of 2,000 mg or less from all sources D) Follow the RDA listed on the milk products' nutrition labels for calcium intake Ans: C Feedback: If the patient has a daily calcium intake of greater than 2,000 mg, she may be at risk for kidney stones. Patients should check labels of food as well as supplements to ensure that the contents do not add up to excessive calcium consumption; however, the RDA listed on milk products' nutritional labels for calcium intake may be too great for the older patient. Calcium does not contribute to caloric intake. Calcium supplements totaling not more than 5,000 mg is too high an amount for most adults.

Origin: Chapter 36- Acute Care, 3 Chapter: 36 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 485, Special Risks for Older Adults 3. Elderly hospital patients need special care in some respects. What is one thing a nurse can do to ensure that they leave the hospital in good condition and can return to a normal life?

A) Keep the patients in bed as much as possible to help them rest. B) Keep the room temperature between 65°F and 70°F. C) Wash hands between patients and use other infection control practices. D) Use a urinary catheter on a patient who has stress incontinence. Ans: C Feedback: As soon as patients are able to get out of bed, they should do so. This will help restore normal physiological functioning and make it easier for them to resume their usual activities at home. Most elderly patients are more comfortable when the temperature is 75°F than when it is 70°F. Urinary catheters should be avoided unless absolutely necessary. Many patients acquire infections in the hospital, and it is sometimes a result of staff carelessness about hand washing or other sources of contagion.

Origin: Chapter 36- Acute Care, 5 Chapter: 36 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 485, Preoperative Care Considerations 5. An operating room nurse is assisting with the positioning of a 78-year-old female patient on the operating table prior to the patient's abdominal surgery. Which of the following actions should the nurse prioritize?

A) Keeping the patient cool to prevent operative hyperthermia B) Supporting the neck and head to prevent postoperative neck pain C) Placing the patient supine to maximize respiratory status D) Protecting the patient's skin integrity by padding bony prominences Ans: D Feedback: Older adults require special measures to preserve their skin integrity during surgery. This would supersede supporting the neck and head. Answers A and C do not reflect actual realities of the surgical experience.

Origin: Chapter 5- Common Aging Changes, 18 Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 58, Musculoskeletal System 18. Which of the following is a normal reflex profile for an elderly patient?

A) Knee: normal; arm: absent; abdomen: absent B) Knee: normal; arm: reduced; abdomen: absent C) Knee: reduced; arm: normal; abdomen: reduced D) Knee: reduced; arm: reduced; abdomen: absent Ans: B Feedback: Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee.

Origin: Chapter 1- The Aging Population, 19 Chapter: 1 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 8, Health Status 19. What is the most important factor contributing to limitations in self-care and independent living among the elderly?

A) Lack of family support B) Low financial assets C) Acute illness and injury D) Chronic illness Ans: D Feedback: Chronic illnesses are noted to have a significant impact on the quality of life of older adults. These illnesses are more prevalent than acute illnesses and supersede deficits in family and financial support.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 2 Chapter: 8 Client Needs: A2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 104, Box 8-2 2. A nurse has been providing care for a 69-year-old female client who has recently had her right foot amputated as a result of a chronic diabetic foot ulcer. The nurse undertook to perform debridement of the wound despite lacking the relevant education and experience. The client experienced permanent nerve damage as a result of the nurse's misguided efforts. Which category of legal liability is most likely relevant in this case?

A) Larceny B) Assault C) Invasion of privacy D) Negligence Ans: D Feedback: Negligence involves the commission of an improper act, as exemplified by the nurse's actions. Larceny is tantamount to theft, while assault involves a deliberate threat to harm. The situation would not be categorized as an invasion of privacy.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 19 Chapter: 8 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 105, Staff Supervision 19. What implications does the doctrine of respondent superior have for nurses? Nurses are held

A) Liable for injury deriving from advice given to a member of a patient's family B) Responsible for double-checking the doses of medication ordered by a physician C) Responsible for the actions of the staff they supervise D) Obligated to obtain informed consent for any diagnostic procedure Ans: C Feedback: The doctrine of respondent superior is derived from the old master-servant rule. It means that supervisors are responsible not only for their own actions but also for the actions of the staff they supervise.

Origin: Chapter 16- Comfort and Pain Management, 20 Chapter: 16 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 200, Dietary Changes 20. Which foods should the nurse recommend to a patient who appears to be deficient in the B-complex vitamins?

A) Limes B) Prunes C) Yellow vegetables D) Leafy green vegetables Ans: D Feedback: Of the four foods listed, leafy green vegetables are the best source of the B-complex vitamins. Limes are a good source of vitamin C. Yellow vegetables are a good source of vitamin A. Prunes contain potassium, which is necessary for healthy nerves, but it is not a B-complex vitamin.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 12 Chapter: 8 Client Needs: A2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 101, Legal Risks in Gerontological Nursing 12. Nurse B arrives for his regular night shift at a care facility for the aged. Because of a family emergency, he has slept only 3 hours since his last shift. One of Nurse B's aides calls in sick, and there is no one to replace the aide that night. With no help available, Nurse B lifts an obese patient from a wheelchair into a bed on his own. Short on time and help, Nurse B decides to skip the patient's evening bath. Legally, what does Nurse B most likely face?

A) Little risk of liability because he is doing his best under difficult circumstances B) Immediate discipline or dismissal for dereliction of duty C) Liability if a pattern of negligence is part of his performance evaluation D) A high risk of liability for his actions Ans: D Feedback: Situations that increase the risk of liability include working with insufficient resources, failing to follow policies and procedures, taking shortcuts, and working when feeling highly stressed. All those factors are present in the case study.

Origin: Chapter 2- Theories of Aging, 11 Chapter: 2 Client Needs: B Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 19, Applying Theories of Aging to Nursing Practice 11. Nurses need to understand the aging process in order to help their patients:

A) Live longer with their long-term disabilities B) Maintain youth and delay the onset of old age C) Accept the limitations imposed by genetic tendencies toward cellular degeneration D) Postpone the negative consequences of the aging process Ans: D Feedback: The promotion of positive health practices increases the chances that an individual can delay or deter the impairments and declines that frequently accompany the aging process. Living long in a disabled state is not the most desirable objective. Maintaining youth is not an achievable goal. Accepting limitations is not necessary for many seniors and not life enhancing for many others.

Origin: Chapter 36- Acute Care, 9 Chapter: 36 Client Needs: D2 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 487, Operative and Postoperative Care Considerations 9. What is one way of improving the chances for successful anesthesia of an elderly patient?

A) Long, careful surgery B) Frequent turning of tissue during surgery C) Particularly close monitoring during surgery D) Use of inhaled agents during surgery Ans: C Feedback: For an elderly patient, surgery should not be prolonged, and the tissue should not be handled more than necessary. Inhaled agents are eliminated slowly and may prolong anesthesia. Close monitoring during surgery can catch any problems as they develop.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 1 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 457, Chronic Conditions and Older Adults 1. A nurse is well aware of the high incidence and prevalence of chronic conditions among older adults. The nurse would recognize which of the following phenomena as currently contributing to this high rate of incidence? (Select all that apply.)

A) Longevity is increasing. B) Many previously fatal diseases are now treatable. C) Increasing numbers of older adults can afford medical care. D) Older adults have increased expectations for treatment. E) New chronic conditions are being identified by medical researchers. Ans: A, B Feedback: The combination of increased lifespan with the availability of treatment options for previously fatal conditions has contributed to the increased incidence of chronic conditions in the elderly. Answers C, D, and E are not noted to contribute to the phenomenon.

Origin: Chapter 5- Common Aging Changes, 22 Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 62, Endocrine System 22. Which of the following blood chemistries may indicate diabetes among young adults but not among the elderly?

A) Low blood glucose level B) High blood glucose level C) Prolonged hypoglycemia D) Insufficient release of insulin Ans: B Feedback: Although there is a delayed and insufficient release by the -cells of the pancreas in the elderly, what will show up in a blood chemistry report is an apparently high level of glucose in the blood. Low blood glucose and prolonged hypoglycemia are not indicators of diabetes.

Origin: Chapter 21- Digestion and Bowel Elimination, 24 Chapter: 21 Client Needs: D1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 301, Fecal Impaction 24. An 81-year-old client has developed a fecal impaction while convalescing at home after hip surgery. Which of the following corrective actions should the nurse undertake?

A) Manually remove the feces with a gloved finger. B) Assist the client to sit on the commode to facilitate stool passage. C) Break up the impaction with external abdominal massage. D) Insert a flatus bag to prevent entrance of air into the rectum Ans: A Feedback: An oil retention enema may be prescribed to assist with an impaction. The stool must be removed (gently) as impaction must be removed for the client to be able to vacate their bowels. Internal massage may stimulate a movement; a bag will not assist with the evacuation of the bowel.

Origin: Chapter 3- Diversity, 13 Chapter: 2 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 26, Black Americans 13. Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because:

A) Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B) Black Americans have a higher incidence of cancer and diabetes than white Americans C) Hypertension and heart disease occur at a higher rate in the black population than in the white population D) Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep Ans: C Feedback: The black population has a higher prevalence of heart disease than the white population, and hypertension occurs at a higher rate. A contributing factor is a blunted nocturnal response, in which only a minor decline occurs during sleep. Even though it is true that black persons have a higher incidence of cancer and diabetes than white persons, blood pressure screening does not address those disorders. Lifestyle modifications can effectively control many causes of morbidity and mortality among all people.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 15 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 462, Making Smart Lifestyle Choices 15. A 77-year-old woman has recently been diagnosed with type 2 diabetes. The gerontological nurse who is working with the woman has emphasized the need for the woman to make smart lifestyle choices in the management of her chronic condition. The woman has retorted, "Choices! I didn't choose to get diabetes and there's not much that I can do about it!" Which of the following statements best underlies the response that the nurse will provide?

A) Many of the factors that contribute to increased quality of life are within the woman's direct control. B) The woman has the ability to adopt or reject behaviors that have the potential to cure her disease. C) The woman can identify treatment options in consultation with the physician who is providing her care. D) Lifestyle choices exist only in older adults with strong support networks and sufficient resources. Ans: A Feedback: Lifestyle choices are within the locus of control of most older adults with chronic conditions and they have the potential to increase quality of life, though not cure chronic disease. Lifestyle choices supersede the direction of her physician, and while support and resources may indeed open up more lifestyle options, lifestyle choices are not exclusive to patients with these resources.

Origin: Chapter 3- Diversity, 14 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Native Americans 14. Nurse A works with Native American patients at a reservation health care center. She advises a new staff member to be especially observant of these patients and tolerant of their health care requests because Native American patients:

A) May demand special rituals during sickness and at death B) Use services from agencies as a last resort because such assistance conflicts with their belief in the Great Creator C) Link the typical nursing assessment process to evil forces or to punishment D) Show their absence of feeling, caring, or discomfort by appearing calm and controlled Ans: A Feedback: Spiritual rituals, medicine men, herbs, homemade drugs, and mechanical interventions can be used by Native American people to treat illness. Treatment does not necessarily conflict with belief in a Great Creator and the nursing assessment process is not linked to punishment. Feeling and care are not absent among Native Americans.

Origin: Chapter 21- Digestion and Bowel Elimination, 25 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 301, Fecal Impaction 25. The nurse assesses a client with abdominal and rectal discomfort, diarrhea, and fever. What initial data source should the nurse use to determine a possible cause of his symptoms?

A) Medical history, for prostatic hypertrophy B) Nutritional record, for the amount of dietary fiber C) Defecation record, for frequency and character of bowel movements D) Medication record, for use of anticholinergic medications Ans: C Feedback: The client has at least three indications of a fecal impaction, so it is important to review his defecation record for the date of his last formed stool. This information would supersede the other noted areas of assessment.

Origin: Chapter 13- Spirituality, 25 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 3 Page and Header: 163, Assessment Guide 13-1; 167, Box 13-2 25. A patient tells the nurse that she has practiced meditation for years since it has helped her with mental clarity. Which type of meditation should the nurse document that the patient practices?

A) Mindfulness B) Concentrative C) Transcendental D) Trans-mutational Ans: B Feedback: Concentrative meditation calms the person and promotes mental clarity and acuity. Mindfulness meditation promotes a calm nonreactive mental state. Transcendental meditation relaxes the body while keeping the mind alert. Trans-mutational is not a type of meditation.

Origin: Chapter 14- Nutrition and Hydration, 6 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 177, Hydration Needs of Older Adults 6. An older patient is demonstrating signs of dehydration. Which action should the nurse initiate first?

A) Minimize food intake and maximize fluid intake B) Advocate for the initiation of intravenous rehydration C) Initiate monitoring and recording of fluid intake and output D) Ask that the physician order blood work to confirm or rule out dehydration Ans: C Feedback: When dehydration is suspected, the nurse should monitor and record fluid intake and output. This would likely precede IV rehydration and blood work, and minimizing food intake would be an inappropriate action.

Origin: Chapter 21- Digestion and Bowel Elimination, 15 Chapter: 21 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 298, Colorectal Cancer 15. As part of the treatment regimen for the diagnosis of colon cancer, a 73-year-old client has recently received a colostomy. What should the nurse prioritize during discussions in the early stages of patient teaching?

A) Modifications in food and fluid intake that the device necessitates B) The lifestyle adjustments and effect on self-concept that often accompany colostomies C) Further treatment options that exist for colon cancer D) The importance of monitoring for signs of infection at the colostomy site Ans: B Feedback: Colostomies often constitute a threat to patients' routines, self-concept, and social life, and these matters would require patient teaching and empathic discussions. It would likely be inappropriate to initiate discussion about other treatment options with the patient and changes to diet and the potential for infection are not noted to be areas for emphasis.

Origin: Chapter 21- Digestion and Bowel Elimination, 17 Chapter: 21 Client Needs: A2 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 299, Chronic Constipation 17. A 70-year-old patient with lung cancer is receiving transdermal doses of a narcotic analgesic. Which of the following nursing interventions can minimize any gastrointestinal (GI) issues?

A) Monitor the patient's respirations B) Monitor the drug's sedative effects C) Start at the lowest dosage of medication D) Start the patient on a bowel regimen Ans: D Feedback: One of the most common side effects of opioid administration is constipation, which could be prevented by implementing a bowel protocol. Although monitoring respirations and sedative effects as well as starting at the lowest dose are important, these actions do not minimize GI issues.

Origin: Chapter 1- The Aging Population, 14 Chapter: 1 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 4, Population Growth and Increasing Life Expectancy 14. Gerontological nursing will become an increasingly important profession, compared with in the past, because:

A) More people will be presenting with the same health care challenges B) More elderly are living in increasingly squalid living conditions C) A greater number of people are surviving the previously hazardous period of infancy D) More people are spending a longer time span in old age Ans: D Feedback: More people are achieving and spending longer periods of time in old age than ever before in history. Declines in living conditions, increased prevalence and incidence of the same health problems, and higher survival rates during infancy do not account for the increased importance of gerontological nursing.

Origin: Chapter 12- Sexuality and Intimacy, 17 Chapter: 12 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 153, Unavailability of a Partner 17. The nurse is helping an older female patient understand the difficulty of finding a sexual partner at this time in her life. What is generally true of the elderly population?

A) Most men and most women are still married B) Most men are married and most women are widowed C) Most men are widowers and most women are married D) Most men are widowers and most women are widows Ans: B Feedback: A practical interference with sexual function in later life is the lack of a partner, particularly for older women. By 65 years of age, there are only 7 men to every 10 women; by 85 years of age, the ratio becomes 1 to 5. Furthermore, there is a tendency for men to marry women younger than themselves; one-third of men older than 65 years of age have wives younger than 65 years of age; therefore, most older men are married and most older women are widowed.

Origin: Chapter 12- Sexuality and Intimacy, 8 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 153, Unavailability of a Partner 8. Which statements does the nurse identify as reasons for many older adults being unable to find a sex partner? (Select all that apply.)

A) Most men are married to older women. B) There are many more men over age 65 than women. C) Most older men are married while older women are widowed. D) The number of older women far exceeds the number of older men. E) Most women marry men who are significantly older than themselves. Ans: C, D, E Feedback: Most older men are married while older women are widowed. The number of older women exceeds the number of older men. And most women marry men who are significantly older than themselves. Most men are not married to older women. And there are not many more men over age 65 than women.

Origin: Chapter 35- Rehabilitative Care, 5 Chapter: 35 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 469, Losses Accompanying Disability 5. Which of the following are reactions that accompany disability for most people? (Select all that apply.)

A) Mourning losses B) Denial of disabilities by making unrealistic plans and not complying with their care plans C) Angry outbursts and impatience with those who are trying to help them D) Fluctuations in reactions E) Acceptance of the disability with an absence of periods of regret or resentment Ans: A, B, C, D Feedback: A person who has a disability may mourn their losses, deny disabilities by making unrealistic plans and not complying with their care plans, have angry outbursts and impatience with those who are trying to help them, and fluctuations in reactions. It is rare that a person can accept a disability without some periods of regret or resentment.

Origin: Chapter 35- Rehabilitative Care, 18 Chapter: 35 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 5 Page and Header: 472, Assisting With Range-of-Motion Exercises 18. Residents in an assisted-living facility attend a daily exercise class. Their blood pressures and heart rates are monitored before, during, and after exercising. While they are riding stationary bicycles, a nurse notices the signs listed below. Which patient should stop exercising?

A) Mr. A's systolic blood pressure has increased by 25 mm Hg. B) Mr. B's heart rate has increased to 90 beats per minute. C) Ms. C's face is flushed. D) Ms. D is breathing rapidly. Ans: A Feedback: Only Mr. A's condition warrants that he should stop exercising. The others may feel a bit tired, but they are not exhibiting dangerous signs.

Origin: Chapter 35- Rehabilitative Care, 21 Chapter: 35 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 6 Page and Header: 476, Assisting With Mobility Aids and Assistive Technology 21. Which of the following older adults is using his or her mobility device most appropriately?

A) Mr. B, who says that his cane helps him stay more balanced and stable when he walks. B) Mrs. A, who has begun using a walker in order to prevent further deterioration of her mobility. C) Mrs. D, who uses a wheelchair to get around her care facility because she is unable to walk quickly. D) Mrs. L. who uses an adjustable cane to help support her weaker side during transfers. Ans: A Feedback: A cane is appropriate for broadening the base of support, not for bearing weight. It would be inappropriate to use a walker as a preventative measure against loss of mobility and a wheelchair should not be used simply to speed up mobility.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 7 Chapter: 8 Client Needs: A2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 106, Restraints 7. In which of the following situations would the use of physical restraints most likely be justified?

A) Mr. Y is agitated and aggressive while he is experiencing severe withdrawal from alcohol and is not responding to chemical sedation. B) Mrs. U, who has a diagnosis of dementia, was found wandering outside the hospital and nurses have been unable to redirect her to stay on the unit. C) Mr. I is delirious during the acute stage of his urinary tract infection and is ringing the call bell nearly continuously. D) Mrs. T is frequently entering other patients' rooms and attempting to crawl into others' beds. Ans: A Feedback: Answer A best characterizes a situation where the client poses a risk and where restraints are a necessary last resort. In each of the other situations, alternative strategies should be implemented to address the problem in question.

Origin: Chapter 35- Rehabilitative Care, 2 Chapter: 35 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 1 Page and Header: 468, The Need for Rehabilitation 2. Part of the job responsibility of a nurse who works for a team of physicians is to provide documentation about elderly patients who may need nursing home care. Which of the following patients meets the criteria for being classified as frail?

A) Mrs. A is inactive, walks slowly, and has many colds. B) Mrs. B has many colds, tires easily, and has lost 15 pounds in the past year. C) Mr. C has lost 20 pounds in the past year, cannot grip utensils, and is inactive. D) Mr. D has lost 20 pounds in the past year, is inactive, and has many colds. Ans: C Feedback: Only Mr. C meets three of the criteria for frailty. The others meet only two; having many colds is not a criterion for frailty.

Origin: Chapter 35- Rehabilitative Care, 11 Chapter: 35 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 471, Table 35-2 11. Which of the following residents of an extended care facility is most likely to be characterized as dependent in terms of his or her capacity to perform activities of daily living?

A) Ms. Q, who needs to ring the call bell and then be accompanied to the toilet by a care aide. B) Mr. H, a man who needs the assistance of care staff to get off the bedpan after he voids. C) Mr. N, who requires regular prompts to toilet himself. D) Mrs. R, who has a long term, indwelling urinary catheter and needs help in performing the relevant care. Ans: B Feedback: An individual who is unable to get off of a bedpan or commode independently is likely to be considered dependent. The other older adults display characteristics of partial independence.

Origin: Chapter 5- Common Aging Changes, 10 Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 62, Hearing 10. Which of the following phenomena most likely accounts for the progressive loss of hearing that an 83-year-old man is experiencing?

A) Multiple changes in the structures of the inner ear. B) The effect of cognitive changes on the interpretation of auditory stimuli. C) Cellular atrophy of the cells in the outer and middle ear. D) Age-related deterioration of the neural pathways associated with hearing acuity. Ans: A Feedback: Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph. Cognitive changes, cellular changes in the outer and middle ear, and deterioration of neural pathways are less likely to be implicated.

Origin: Chapter 16- Comfort and Pain Management, 23 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 198, Complementary Therapies 23. A female patient is anxious after having a mastectomy for breast cancer. As part of her pain management program, what alternative therapy should the nurse recommend as the most beneficial?

A) Naturopathy B) Biofeedback C) Nutritional therapy D) Meditation and prayer Ans: D Feedback: Meditation and prayer would help calm the patient and enhance the other traditional therapies she is currently undergoing. Anxiety reduction is less closely associated with naturopathy, biofeedback, or nutritional therapy.

Origin: Chapter 21- Digestion and Bowel Elimination, 27 Chapter: 21 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 299, Chronic Constipation 27. The history of a 70-year-old female indicates that she has been taking laxatives daily for years. Which of her following complaints may be a result of this laxative abuse?

A) Nausea B) Peptic ulcers C) Anorexia D) Dehydration Ans: D Feedback: The safe use of laxatives should be emphasized to prevent laxative abuse. The patient should be aware that diarrhea resulting from laxative abuse may cause dehydration, a serious threat to life. Nausea, ulcers, and anorexia are not noted to be as closely associated with laxative abuse.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 1 Chapter: 9 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 113, Philosophies Guiding Ethical Thinking 1. A nurse manager who provides leadership in a long-term care facility prioritizes the need for residents to have current and relevant immunizations, stating, "it's inconvenient and costly, but it provides protection not only to the person getting the vaccine but to all those that they're in contact with." Which of the following ethical philosophies most likely underlies the nurse's statement?

A) Nonmaleficence B) Absolutism C) Utilitarianism D) Relativism Ans: C Feedback: The nurse's emphasis on providing a perceived good to a maximum number of individuals is typical of a utilitarian outlook.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 4 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 114, Ethical Principles 4. Nurse H is providing care in the hospital for a 71-year-old male patient who is in the late stages of cancer and who has painful bone metastases. The client is non-responsive but groans and grimaces intermittently. Nurse H is drawing up a breakthrough dose of morphine for the patient, but Nurse R cautions that, "sure, that will address his pain, but it could depress his respiratory drive and actually kill him at this stage." Which of the following ethical principles is Nurse R prioritizing?

A) Nonmaleficence B) Justice C) Beneficence D) Fidelity Ans: A Feedback: Nurse R's emphasis on preventing harm to the patient, even during an act that may be motivated by altruism, is characteristic of the principle of nonmaleficence.

Origin: Chapter 15- Rest and Sleep, 10 Chapter: 15 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 192, Pain Control 10. What should the nurse keep in mind when determining the relationship between pain and sleep in an older patient?

A) Nonpharmacologic measures to control pain and enhance sleep are preferable to analgesics. B) Analgesic drugs should be administered to older adults to prevent potential episodes of pain. C) Older adults are more sensitive to pain than younger adults, and more at risk of having pain interfere with sleep. D) The availability of alternative forms of pain control such as massage and diversion means that pharmacologic pain medications are inappropriate and unnecessary. Ans: A Feedback: Nonpharmacologic measures to control pain should be attempted whenever possible. If nonpharmacologic means of pain relief are ineffective, it is appropriate to provide the weakest type of analgesic and increase as necessary to control pain. It is not known if older adults are more sensitive to pain and it would inappropriate to administer analgesic medications prophylactically to all older adults.

Origin: Chapter 12- Sexuality and Intimacy, 18 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 157, Promoting Healthy Sexual Function 18. The nurse learns about an older male and older female resident in a long-term care facility who spend time together in a locked room. What should the nurse do about this situation?

A) Nothing. The residents have a right to privacy B) Talk to the residents' adult children about the situation C) Initiate a meeting with the residents to discuss the situation D) Institute a "no locked doors" policy and make sure all residents know about it Ans: A Feedback: Elders have a right to privacy and a right to sexual expression. Their sexuality should not be sanctioned, screened, or severed by anyone, even in an institutional setting. The older residents have a right to privacy and should be able to close and lock a door. The adult children of the residents should not be consulted about the situation. It is really none of their business.

Origin: Chapter 16- Comfort and Pain Management, 18 Chapter: 16 Client Needs: D1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 196, Pain Assessment 18. An older resident with dementia has been pacing and holding his right arm up against his chest. What should the nurse do first to help this patient?

A) Notify the physician and get an order for an x-ray B) Document the behavior and report it to the next shift C) Check the resident's record for the history of this resident's behavior D) Medicate the resident with acetaminophen that is available PRN in his record Ans: C Feedback: A resident with cognitive impairment is not able to communicate pain in the most common way—verbally. It is important that caregivers document normal daily behavior so that any change can help staff-assess pain effectively. The nurse should not request an x-ray, document the behavior, or medicate the resident until pain has been assessed. The best way to do this is to check the record for the resident's behavior regarding pain.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 16 Chapter: 8 Client Needs: A2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 104, Patient Consent 16. Which is the major reason why nurses should not act in place of a physician in obtaining informed consent from patients?

A) Nurses may be tempted to influence the patient's decision in subtle ways B) Nurses may not be able to answer some of the medical questions the patient asks C) A signature obtained by anyone other than a physician will not stand up in court D) Under the law, nurses are only allowed to act as witnesses to informed consent signatures Ans: B Feedback: Nurses are no more likely than physicians to attempt to influence a patient's decision, but they may not be able to answer all medical questions. A signature obtained by a nurse is legal, and no law restricts nurses from acting as witnesses, although care should be exercised to avoid conflict of interest in some cases.

Origin: Chapter 16- Comfort and Pain Management, 19 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 196, Pain Assessment 19. An older patient who resides in an assisted living facility is experiencing chronic pain. The physical exam reveals joint swelling and a medical history of osteoarthritis. Which approach should be used to ensure effective pain management?

A) Observation of gait B) Radiological studies to pinpoint pain C) Qualitative and quantitative assessment of symptoms D) Documentation of the body language indicative of pain Ans: C Feedback: Effective pain management begins with qualitative and quantitative assessment of the pain, including where the pain is, what it feels like, and how frequently it occurs. This assessment would supersede additional radiographs, documentation, or observation of gait.

Origin: Chapter 15- Rest and Sleep, 3 Chapter: 15 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 186, Sleep Efficiency and Quality 3. An older patient hospitalized for pneumonia is having difficulty sleeping and is frustrated with the noises at night. What should the nurse do about this situation?

A) Obtain an order for a benzodiazepine to be taken at bedtime B) Change the temperature of the client's room to be more conducive to sleep C) Provide a form of white noise and plan to minimize noise during caregiving activities D) Teach the client about the normal changes in sleep quality and quantity that accompany aging Ans: C Feedback: Reorganizing care to avoid awakening and providing white noise can facilitate sleep. These actions would be preferable to pharmacologic measures while changing the temperature does not specifically address the patient's concerns. Teaching on sleep changes would be inappropriate given the nature and context of the patient's concerns.

Origin: Chapter 15- Rest and Sleep, 9 Chapter: 15 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 189, Activity and Rest Schedules 9. Because many residents in a long-term care facility are experiencing sleep problems, which routine should the nurse reevaluate?

A) Offering a light snack at bedtime B) Bathing residents in the evening rather than first thing in the morning C) Activities are concentrated in the morning to ensure evenings are free D) Encouraging residents to refrain from going to bed when they first feel drowsy in the evening Ans: C Feedback: It is preferable to intersperse activities throughout the day rather than concentrating them in the morning. A bath and a snack in the evening are both conducive to sleep and going to bed too early is not conducive to sustained sleep.

Origin: Chapter 35- Rehabilitative Care, 19 Chapter: 35 Client Needs: D1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 5 Page and Header: 472, Assisting With Range-of-Motion Exercises 19. A nurse is helping a patient with range-of-motion exercises. Which of the following actions by the nurse is correct? The nurse:

A) Offers support above and below the knee being exercised. B) Documents any increase in heart rate or respirations. C) Moves each joint slowly and smoothly past the point of resistance. D) Moves each joint back and forth once. Ans: A Feedback: In performing range-of-motion exercises correctly, support should be provided above as well as below the joint being exercised. Heart rate and respirations need not be documented for range-of-motion exercises. Joints should not be forced past the point of resistance or pain. Joints should be exercised at least three times.

Origin: Chapter 36- Acute Care, 15 Chapter: 36 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 491, Box 36-1 15. Mr. A, aged 89, is displaying a furrowed tongue, dry lips, and a thready pulse of 105, causing the care team to strongly suspect that he is dehydrated. Which of the following principles provides the best guide for managing Mr. A's immediate care?

A) Older adults cannot tolerate a rapid intake of oral fluids. B) Older adults are more able to tolerate dehydration than younger people, owing to their lower volume of intracellular fluid. C) Fluids should be replaced intravenously rather than orally in older adults. D) Most older adults require between 2 and 3 L of fluid daily. Ans: D Feedback: Unless otherwise indicated, fluid intake for older adults should range from 2000 to 3000 mL. While some older adults may not be able to tolerate rapid fluid intake, this is not categorically true of all elders. IV administration is not necessarily preferable to oral intake and older adults are more, not less, susceptible to the deleterious effects of dehydration.

Origin: Chapter 13- Spirituality, 4 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 162, Dignity 4. The nurse is caring for older patients in a long-term care facility. When ensuring for these patients' dignity, which statement reflects the role of dignity as it relates to the spiritual needs of the older adult?

A) Older adults who have lived a life of integrity and service have earned dignity. B) An acknowledgment of spiritual needs is necessary for the presence of dignity. C) Older adults may lack many of the attributes that are valued in society, but they can derive a sense of dignity from spirituality. D) Older adults who have moved successfully through Erikson's stages of development can experience dignity in spite of disability. Ans: C Feedback: Despite declines in such areas as productivity and physical appearance, older adults can maintain a sense of their intrinsic worth, or dignity, by connecting with the Divine. Acknowledgment of spiritual needs is not necessarily a prerequisite for dignity, given that dignity is by definition inherent in all persons, nor is progression through Erikson's stages or a life of service necessarily required.

Origin: Chapter 15- Rest and Sleep, 12 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 186, Sleep Efficiency and Quality 12. An older patient is relocating to the home of her daughter who wants to modify the home environment to suit her mother's needs. What information should the nurse provide to the daughter to address the patient's age-related sleeping needs?

A) Older people are less active during the day and require less sleep at night. B) Older people are not affected by age-related changes but may have some individual needs. C) Older people stay awake very late into the night and as a result usually sleep late in the morning. D) Older people sleep less soundly and may awaken to noises that would not cause the same reaction in younger adults. Ans: D Feedback: The normal aging process has minimal effect on quantity of sleep, but that is not true of quality of sleep. Older people sleep less soundly and are prone to early rising and falling asleep early in the evening. Older individuals are more likely to be awakened by noises that may not cause a reaction in younger adults.

Origin: Chapter 1- The Aging Population, 24 Chapter: 1 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 10, Table 1-4 24. Hospital management is reviewing departmental statistics. Which of the following departments most likely has the highest death rate of patients over age 65, and why?

A) Oncology, because the elderly have been exposed to more carcinogens in their long lifetimes B) Cardiology, because, despite a decline in recent years, heart disease remains the number one cause of death among the elderly C) Endocrinology, because the elderly already have compromised immune systems D) Neurology, because stroke and Alzheimer's disease together cause more deaths of the elderly than any other conditions Ans: B Feedback: Heart disease is the leading cause of death among persons 65 years of age and older.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 15 Chapter: 8 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 104, Patient Consent 15. A nurse is caring for a group of clients and will perform each of the following during the next shift. For which of the following is informed consent required?

A) Ordering a liquid diet for a post-surgical patient B) Listening to a patient reveal his or her private, personal secrets C) Giving a patient saline solution to relieve dry nasal passages D) Asking a patient to complete a questionnaire for a research study on hospital practices Ans: D Feedback: Consent need not be obtained for basic, routine care measures, such as ordering a liquid diet, relieving dry nasal passages, or listening with a sympathetic ear. Consent should be sought for any type of research participation, even if noninvasive.

Origin: Chapter 2- Theories of Aging, 2 Chapter: 2 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 15, Genetic Theories 2. The error theory of aging proposes a cause-and-effect relationship between the genetic activity of body cells and the effects of aging. Place the following steps in the error theory of aging in the correct chronological order. Use all the options.

A) Organ, tissue, and system malfunction B) Perpetuation of mutation during cell divisions C) DNA mutation D) Overall decline in body functions E) Decline in body functions Ans: C, B, E, A, D Feedback: The error theory of aging proposes that DNA mutations occur on a single-cell level and are perpetuated in subsequent cell divisions. The overall number of mutant cells in the body increases and causes deleterious effects on tissues and systems and eventual decline in body function.

Origin: Chapter 12- Sexuality and Intimacy, 16 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 150, Age-Related Changes and Sexual Response 16. An older female patient is providing information about her sexual history with the nurse. What does the nurse realize as being true about the sexual response in older women?

A) Orgasm is more easily achieved B) Sexual interest and receptivity decline after age 60 C) Intercourse may be painful as a result of reduced lubrication D) Poor muscle tone in the vaginal wall makes penetration difficult Ans: C Feedback: Older women may experience dyspareunia (painful intercourse) as a result of less lubrication, decreased distensibility, and thinning of the vaginal walls. Orgasm is not more easily achieved in older women. Sexual interest and receptivity do not decline after age 60. Poor muscle tone in the vaginal wall does not make penetration difficult.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 11 Chapter: 9 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 117, Greater Numbers of Older Adults 11. Which of the following social changes is increasing the number and complexity of ethical dilemmas that nurses face?

A) Outdated medical technologies B) Diminished fiscal constraints C) Greater numbers of older adults D) Expansion of the hospice movement Ans: C Feedback: Nurses face more ethical dilemmas as a result of new medical technologies and increased fiscal constraints. The complexity is increased by larger numbers of older adults to serve. The expansion of hospice care helps nurses deal with ethical dilemmas.

Origin: Chapter 1- The Aging Population, 18 Chapter: 1 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 6, Income and Employment 18. It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people?

A) Own their own homes and have sufficient monthly income B) Get more than half their income from Social Security and live above the poverty level C) Are an increasing percentage of the labor force but are "cash poor" D) Are retiring at earlier ages and so live below the poverty level Ans: B Feedback: Less than 15% of older people live below the poverty level. Social Security is the main source of income for more than half of all older adults.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 17 Chapter: 9 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 114, Ethical Principles 17. Patient P refuses a blood test that Nurse N believes P desperately needs. Nurse N ignores the patient's wishes and sends a blood sample to the lab without P's knowledge. The ethical conflict between Patient P and Nurse N involves:

A) P: nonmaleficence; N: veracity B) P: beneficence; N: relativism C) P: egoism; N: utilitarianism D) P: autonomy; N: paternalism Ans: D Feedback: P is asserting his autonomy, but N is ignoring his wishes and acting "for P's own good" as Nurse N perceives it.

Origin: Chapter 16- Comfort and Pain Management, 11 Chapter: 16 Client Needs: D4 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 195, Prevalence of Pain in Older Adults 11. The daughter of an older patient is concerned because the patient continues to experience lower back pain even though all exams, labs, and radiology studies have been negative. What should the nurse discuss with the patient's daughter?

A) Pain is a normal part of being old. B) The pain is phantom pain, and nothing else can be done. C) The patient's complaint does not fall into the true definition of pain. D) The patient's team needs to explore all possible valid reasons for her mother's pain, including physical causes. Ans: D Feedback: It is difficult to determine the accuracy of pain in the elderly because some overreport as a means of getting attention; others underreport pain. It is important to explore every possible cause for pain, including physical, emotional, socioeconomic, and spiritual factors. It would be inappropriate to discount the patient's pain or to characterize it as phantom pain of a normal part of aging.

Origin: Chapter 35- Rehabilitative Care, 17 Chapter: 35 Client Needs: A2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 5 Page and Header: 472, Assisting With Range-of-Motion Exercises 17. A nurse who provides care on a rehabilitative medicine unit of a hospital works with numerous geriatric patients. Which of the following principles most accurately guides the nurse's efforts to integrate range-of-motion exercises into patient care?

A) Passive range-of-motion exercises should be delegated to physiotherapists in order to reduce the chance of injury. B) Patients should be encouraged to put all of their joints through a range of motion at least once daily. C) Performing range-of-motion exercises as slowly as possible maximizes their benefit. D) Range-of-motion exercises are contraindicated in patients with existing cardiac conditions. Ans: B Feedback: Ideally, patients should put each joint through its range of motion at least once per day. Passive range of motion can be performed by nurses and exercises should be performed slowly and steadily, but not as slowly as possible. Heart disease does not categorically contraindicate the performance of range-of-motion exercises.

Origin: Chapter 12- Sexuality and Intimacy, 9 Chapter: 12 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 155, Erectile Dysfunction 9. The nurse identifies which patient as having the highest risk of erectile dysfunction?

A) Patient who is obese and has poorly controlled type 2 diabetes B) Patient who is 80 years old and has a colostomy following colon cancer 7 years prior C) Patient who is 71 years old and was recently diagnosed with Parkinson disease D) Patient who has a diagnosis of lung cancer following a work history that included asbestos exposure Ans: A Feedback: Diabetes is a noted, direct cause of erectile dysfunction. The other cited pathologies are not noted to be directly causative of erectile dysfunction.

Origin: Chapter 36- Acute Care, 2 Chapter: 36 Client Needs: A2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 492, Box 36-2 2. Which of the following nursing practices commonly performed in the geriatric medical unit of a hospital is most in need of modification or correction?

A) Patients are regularly prompted to practice deep-breathing and coughing exercises in order to mobilize secretions and prevent atelectasis. B) Patients at risk for urinary incontinence are catheterized in order to reduce the risk of urinary tract infections. C) Reality orientation is provided to patients who exhibit cognitive deficits. D) The discharge planning process is begun immediately following admission. Ans: B Feedback: Urinary catheterization should be minimized and is not an appropriate intervention for the prevention of urinary incontinence. Promotion of deep breathing and coughing, reality orientation, and early discharge planning can help minimize the risks faced by older adults who are hospitalized.

Origin: Chapter 13- Spirituality, 21 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 163, Addressing Spiritual Needs 21. An older female patient tells the nurse that through periods of trial and tribulation, the Bible has been the source of ongoing strength and support. Which statement supports this patient's beliefs by researched evidence?

A) Patients from low socioeconomic levels tend to be more religious. B) Religious commitment has a positive effect on health care outcomes. C) Patients holding strong religious convictions experience great emotional stress during illness. D) Among the elderly, high levels of religiosity correlate with greater levels of physical disability. Ans: B Feedback: Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is therapeutically beneficial to support patients' spirituality and assist them in fulfilling spiritual needs. The other statements are not supported by researched evidence.

Origin: Chapter 13- Spirituality, 18 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 165, Box 13-1 18. The nurse is caring for an older patient who is nearing death and realizes that no professional clergy needs to be contacted. This patient is most likely a member of which faith?

A) Pentecostal B) Unitarianism C) Seventh-Day Adventists D) Church of Jesus Christ of Latter Day Saints Ans: D Feedback: The Church of Jesus Christ of Latter Day Saints (Mormons) is the only faith of those listed that has no professional clergy.

Origin: Chapter 14- Nutrition and Hydration, 19 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 6 Page and Header: 178, Promotion of Oral Health 19. An older female patient will only eat oatmeal and has bad breath. A dental exam reveals that the patient has a few of her own teeth and uses a partial appliance. She also has red, swollen, painful gums, and some teeth are loose at the gumline. The nurse realizes the patient is experiencing which health problem?

A) Periodontal disease B) Endodontic disease C) Gastrointestinal disease D) Lack of adequate nutrition Ans: A Feedback: The patient's signs and symptoms are typical of periodontal disease. These signs and symptoms are consistent with endodontic disease, gastrointestinal disease, or a lack of adequate nutrition.

Origin: Chapter 2- Theories of Aging, 1 Chapter: 2 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 15, Genetic Theories 1. Which of the following statements most accurately conveys an aspect of the error theory of aging?

A) Perpetuation of DNA mutations results in organ and system malfunction. B) Age-related dysfunction of organs, tissues, and body systems results in mutation of body DNA. C) The number of cell divisions is genetically predetermined. D) Errors in the function of various organs contribute to changes in the genetic code of various body cells. Ans: A Feedback: The error theory of aging proposes that genetic mutations are perpetuated through the aging process, resulting in organ malfunction and eventual decline in body function. Organ malfunction results from, but does not cause, the genetic mutations in question. A genetic predetermination of the number of cell divisions is associated with the programmed theory of aging.

Origin: Chapter 15- Rest and Sleep, 23 Chapter: 15 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 191, Stress Management 23. An older patient is telling the nurse about life stresses, including a chronically ill spouse and problems with grandchildren. What is the most appropriate information for the nurse to provide to the patient?

A) Pharmacological options B) Ways to prevent chronic stress C) The benefits of natural remedies D) The name and phone number of a geriatric therapist Ans: B Feedback: It is most appropriate to discuss ways to prevent chronic stress, although the patient has ongoing stressors. The patient needs to identify those periods of stress; manage them with healthy responses, relaxation, and so on; and then allow some recovery periods. These actions should come before using pharmacological interventions, natural remedies, or scheduling an appointment with a geriatric therapist.

Origin: Chapter 21- Digestion and Bowel Elimination, 16 Chapter: 21 Client Needs: A2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 293, Dental Problems 16. The nurse prepares to give a presentation on the pathology of caries to a group of seniors. Which of the following rationales is correct when understanding why today's elders had a greater risk of caries when they were young than today's children and young adults?

A) Poor diet B) Age-related changes C) Lack of fluoride in the water D) Lack of knowledge regarding oral hygiene Ans: C Feedback: Fluoride in the water, combined with good dental hygiene, has greatly affected the younger generation. Each generation is at risk for poor diet, or lack of knowledge, the older adults no more than today's children and young adults. Age-related changes do not predispose older people to caries.

Origin: Chapter 3- Diversity, 16 Chapter: 3 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 29, Jewish Americans 16. Rehabilitation Health Facility has a high percentage of Jewish patients recovering from a variety of ailments. Which of the following is important for the facility's staff to know about medical care and the Jewish culture?

A) Pork and shellfish but not milk products are recommended as healthful foods in the diet. B) A rabbi must be consulted before any health-related decisions can be made. C) A skullcap and socks must be worn from sundown Friday to sundown Saturday. D) Modern medical care is encouraged but may be opposed during the Sabbath. Ans: D Feedback: In the Jewish culture, medical care is encouraged but may be opposed during the Sabbath. Exceptions may be made for the seriously ill. The other choices are not true of the Jewish culture.

Origin: Chapter 1- The Aging Population, 11 Chapter: 1 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 3, Views of Older Adults Through History 11. In ancient times, the relationship between age and the value afforded to individuals was generally:

A) Positive: with advanced age came increased value B) Negative: respect declined as age increased C) Variable: respect was different in different cultures D) Cyclic: respect moved back and forth between positive and negative Ans: C Feedback: Attitudes toward the aging varied among cultures. The ancient Chinese, for example, believed that the elderly deserved honor and respect, whereas the ancient Romans had little respect for the elderly, customarily killing them first in the nations Rome conquered.

Origin: Chapter 5- Common Aging Changes, 15 Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 54, Cardiovascular System 15. Older adults in good physical condition have cardiac function comparable to younger persons in poor condition. What is the most likely cause of a rise in systolic blood pressure in the elderly?

A) Postural and postprandial hypotension B) Atherosclerosis in the innermost layer of the blood vessels C) Impaired baroreceptor function and increased peripheral resistance D) Cellular proliferation in the tunica intima Ans: C Feedback: In the middle layer of blood vessels, impaired baroreceptor function and increased peripheral resistance lead to a rise in systolic blood pressure. Reduced sensitivity of the blood pressure regulation with baroreceptors increases problems with postural hypotension and postprandial hypotension; thus, they are an effect, not a cause. Cells proliferate in the innermost layer of vessels and atherosclerosis develops, but these are not the direct causes of increased systolic pressure.

Origin: Chapter 13- Spirituality, 26 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 163, Assessment Guide 13-1 26. The nurse is planning care to address a patient's spiritual distress. Which interventions would be appropriate to include in this plan of care? (Select all that apply.)

A) Pray with the patient upon request as needed and desired B) Find a volunteer to read the Bible to the patient upon request C) Remind the patient that spiritual needs are often addressed last D) Contact the patient's church to have the clergy visit the patient E) Help the patient identify factors contributing to spiritual distress Ans: A, B, D, E Feedback: Interventions to address spiritual distress include praying with the patient upon request and as desired, finding someone to read the Bible to the patient upon request, contacting the patient's church for clergy to visit, and helping the patient identify factors that contribute to spiritual distress. Reminding the patient that spiritual needs are often addressed last will not help with the patient's spiritual needs at this time and would be inappropriate to include in the plan of care.

Origin: Chapter 12- Sexuality and Intimacy, 27 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 155, Medication Adverse Effects 27. A patient explains a lack of interest in sex since her spouse passed away 3 years ago. After completing the health history what would the nurse suspect as contributing to the patient's lack of interest in sex?

A) Prescribed antidepressants for sadness B) Change in the patient's Medicare benefits C) Participating in arthritis swimming classes D) Reduced intake of red meat and carbohydrates Ans: A Feedback: Medications prescribed to older people can affect libido. One classification of drugs that have adverse sexual effects is antidepressants. The other assessment findings would not directly affect the patient's interest in sexual activity.

Origin: Chapter 35- Rehabilitative Care, 10 Chapter: 35 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 470, Principles of Rehabilitative Nursing 10. If a nurse infantilizes the client, the nurse is not adhering to which of the following guidelines for rehabilitative nursing?

A) Prevent complications. B) Do not equate physical disability with mental disability. C) Provide time and flexibility. D) Recognize and praise accomplishments. Ans: B Feedback: Infantilizing the client is equating physical disability with mental disability, which may not be the case. It is important to treat disabled persons as mature, intelligent adults.

Origin: Chapter 13- Spirituality, 23 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 162, Love 23. During an assessment an older male patient states that he has not been happy in life because he does not deserve to be loved. The nurse realizes that this patient believes love has been withheld because of which criteria? (Select all that apply.)

A) Productivity B) Social position C) Education level D) Physical condition E) Material possessions Ans: A, B, D, E Feedback: Spiritual love is unconditional and people need to feel loved regardless of their physical condition, social position, material possessions, or productivity. Educational level is not identified as a condition for being loved.

Origin: Chapter 15- Rest and Sleep, 13 Chapter: 15 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 189, Pharmacologic Measures to Promote Sleep 13. An older patient who spends most of the time in bed because of impaired mobility is complaining about not getting enough sleep. What would cause the nurse concern if this patient were prescribed sleep sedatives?

A) Promotion of incontinence B) Depression of some vital body functions C) Decreased body movements during sleep D) Decreased susceptibility to adverse reactions Ans: C Feedback: The patient already has compromised body movements. All sedatives may decrease body movements during sleep and predispose the older person to many complications of reduced mobility. It is not known if the sleep sedative would promote incontinence, depress vital body functions, or decrease susceptibility to adverse reactions of the sleep medications.

Origin: Chapter 5- Common Aging Changes, 5 Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 57, Reproductive System 5. A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client's prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest:

A) Prostate cancer B) A risk of malignancy that should be followed up C) A normal age-related change unlikely to have consequences D) A urinary tract infection Ans: B Feedback: Prostatic enlargement is exceedingly common among older men, but represents a risk of malignancy that necessitates further assessment and follow-up. It is not a definitive sign of prostate cancer and is not indicative of a urinary tract infection.

Origin: Chapter 15- Rest and Sleep, 21 Chapter: 15 Client Needs: D2 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 192, Pain Control 21. Nonpharmacologic pain relief measures have been ineffective to reduce an older patient's pain to promote sleep. What should the nurse do next?

A) Provide a trial of opioids B) Give the strongest dosage of analgesic and gradually decrease as necessary C) Administer the lowest dosage of analgesic and gradually increase as necessary D) Offer the lowest dosage of analgesic and give only when requested by the patient Ans: C Feedback: When providing pharmacologic pain relief prior to sleep it is advisable to always begin with the weakest type and dosage of analgesic and gradually increase as necessary. Analgesics should be administered regularly to maintain a constant blood level; fear of addiction should not be a factor in appropriately using analgesics to assist patients with pain relief.

Origin: Chapter 35- Rehabilitative Care, 9 Chapter: 35 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 470, Principles of Rehabilitative Nursing 9. When the rehabilitative nurse is working with a gerontologic client and focuses on the many obstacles that the client has already successfully overcome, the nurse is exhibiting which of the following guidelines for rehabilitative care?

A) Provide time and flexibility. B) Recognize and praise accomplishments. C) Prevent complications. D) Emphasize function rather than dysfunction. Ans: D Feedback: When the nurse focuses on the many obstacles that the client has already successfully overcome, the nurse is emphasizing function rather than dysfunction. Providing time and flexibility, recognizing and praising accomplishments, and preventing complications are not related to the obstacles that the client has already successfully overcome.

Origin: Chapter 14- Nutrition and Hydration, 15 Chapter: 14 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 7 Page and Header: 182, Assessment Guide 14-1 15. The nurse observes the skin of an older patient and then asks the patient questions about his nutritional status. How did inspection of the patient's skin guide the nurse to complete a nutritional assessment?

A) Purpura may indicate hyperglycemia B) Fungus infections may indicate zinc deficiency C) Poor skin turgor may be an indicator of overhydration D) Persistent "goose bumps" may indicate a vitamin deficiency Ans: D Feedback: Persistent "goose bumps" can be indicative of a deficiency in B vitamins. Purpura does not indicate hyperglycemia. Fungus infections do not indicate a zinc deficiency. Poor skin turgor may be an indication of dehydration and not overhydration.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 20 Chapter: 8 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 105, Staff Supervision 20. Which of the following actions can a nurse safely take without risk of liability?

A) Questioning a doctor's written orders for medication B) Permitting a volunteer to move a patient C) Using a blood pressure cuff that is sometimes sticking D) Asking a family member to deliver routine medication to a patient's room Ans: A Feedback: Under the doctrine of respondent superior, various types of actions can create risks of liability for supervising nurses, including allowing incompetent persons to deliver care, using improperly functioning equipment, or assigning tasks to unqualified staff members. Questioning orders for medication, however, may be appropriate if the nurse has any doubts or questions about accuracy or advisability of the order.

Origin: Chapter 15- Rest and Sleep, 27 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 191, Stress Management 27. An older patient has identified stress as being the cause for not receiving adequate sleep and wants to "do something" to relax. Which activities should the nurse suggest to the patient? (Select all that apply.)

A) Read B) Take a walk C) Needlework D) Listen to music E) Visit with friends Ans: A, C, D Feedback: Activities to help with relaxation include reading, performing an activity in which to get absorbed such as needlework, and listening to music. Taking a walk and visiting with friends could increase stimulation and may not be relaxing to the patient.

Origin: Chapter 36- Acute Care, 11 Chapter: 36 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 487, Operative and Postoperative Care Considerations 11. Older patients are particularly subject to several postoperative complications. Which of the following arrays of symptoms is indicative of respiratory complications?

A) Reduced activity and lowered resistance B) Fever and dehydration C) Negative chest X-ray thoracic distention D) Decreased lung sounds and a low-grade fever Ans: D Feedback: Respiratory complications include pneumonia, pulmonary emboli, and atelectasis; with atelectasis there may be decreased lung sounds and low-grade fever, although a chest X-ray may not show the condition. Atelectasis increases the risk of the development of pneumonia.

Origin: Chapter 35- Rehabilitative Care, 7 Chapter: 35 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 470, Principles of Rehabilitative Nursing 7. Mrs. Y lives with hemiplegia following an ischemic stroke 8 weeks ago, a disability that has impaired her ability to independently check her blood sugars using a glucometer. What action should the nurse choose to address Mrs. Y's challenge?

A) Reevaluate Mrs. Y's goals for diabetes treatment and the need for random blood glucose monitoring. B) Enlist the help of Mrs. Y's family and friends in performing the glucose monitoring. C) Teach Mrs. Y a method of using a glucometer that can be performed using her unaffected hand. D) Substitute scheduled hemoglobin A1c testing at a medical lab for random blood glucose testing. Ans: C Feedback: Mrs. Y's independence and self-care would be best served by teaching her to perform her blood sugar monitoring independently in a way that accommodates her disability. This would be preferable to having others do it or changing her monitoring regimen.

Origin: Chapter 13- Spirituality, 19 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 165, Box 13-1 19. An older female patient in the resident care facility insists that her hair be kept covered at all times. Of which branch of the Jewish faith is she most likely a member?

A) Reform B) Orthodox C) Rabbinical D) Conservative Ans: B Feedback: The covering of the hair of married women is a practice of Orthodox (observant) Judaism. Those who practice Conservative Judaism cover the head during worship and prayer. Those who practice Reform Judaism do not follow laws for covering the head. There is no branch of Rabbinical Judaism.

Origin: Chapter 15- Rest and Sleep, 24 Chapter: 15 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 186, Sleep Stages; 187, Table 15-2 24. The nurse determines that an older patient is in stage II of sleep. What did the nurse observe in this patient? (Select all that apply.)

A) Relaxed muscles B) Easily awakened C) Rapid respirations D) Difficult to awaken E) Minor eye movement seen Ans: B, E Feedback: In stage II of sleep the person will be easily awakened and will have some eye movement noted through closed lids. Relaxed muscles occur in stage III of sleep. Difficulty awakening occurs in stages III and IV of sleep. Rapid respirations might occur during REM sleep.

Origin: Chapter 16- Comfort and Pain Management, 10 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 201, Comforting 10. The nurse observes an older patient crying, tensed, and lying rigidly in bed. What action should the nurse take first?

A) Reposition the patient in bed B) Perform a systematic pain assessment C) Ask the patient if she is experiencing a problem D) Prepare a dose of breakthrough medication for the patient. Ans: C Feedback: Part of comforting is the perception of patients' problems. The nurse should ask the patient to describe any problems she is currently experiencing. It would be premature to draw up breakthrough analgesia or to reposition the patient before further assessment, while a pain assessment may be inappropriate given the multiple potential causes of the patient's affect.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 21 Chapter: 8 Client Needs: A2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 106, Restraints 21. When in doubt about using restraints on an agitated patient, it is prudent for nurses to:

A) Restrain the patient for his or her own safety B) Use such minor restraints as a bedside rail or a tray on a wheelchair C) Use alternatives such as a bed alarm with increased staff supervision D) Avoid any device or procedure to limit liability Ans: C Feedback: The Omnibus Budget Reconciliation Act (OBRA) imposed strict standards on the use of restraints in long-term care facilities. Anything that restricts a patient's movement can be considered a restraint and can result in litigation for false imprisonment and neglect. Thus, it is best to avoid restraints if possible. Bed alarm and staff supervision are effective and nonrestrictive for an agitated patient.

Origin: Chapter 21- Digestion and Bowel Elimination, 8 Chapter: 21 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 293, Dental Problems 8. The nurse discusses dental health with an aging client. Which of the following physiological changes should the nurse interpret as a potential pathological process rather than a normal age-related change?

A) Retraction of the gum's pulp B) Diminished saliva C) Hardened brittle tooth enamel D) Periodontal disease causing tooth loss Ans: D Feedback: While periodontal disease is more frequent in the elderly, it cannot be considered normal aging. With age, teeth experience wear on the surfaces, a decrease in the size and volume of pulp, an increase in brittleness, varying degrees of root absorption, and a loss of enamel.

Origin: Chapter 21- Digestion and Bowel Elimination, 14 Chapter: 21 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 301, Fecal Incontinence 14. An 84-year-old man who resides in a long-term care facility has recently become incontinent of bowel, a situation that is without precedent. What is the nurse's priority for assessment?

A) Review of the man's medication regimen B) Assessment for the presence of fecal impaction C) Assessment for changes to the man's cognitive status D) Examination of the man's stool for frank and occult blood Ans: B Feedback: The priority for assessment of a client with bowel incontinence is assessment for the presence of an impaction. This would supersede the immediacy of reviewing his medications, assessing his cognition, and examining stool for blood.

Origin: Chapter 16- Comfort and Pain Management, 25 Chapter: 16 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 4 Page and Header: 198, Complementary Therapies; 200, Box 16-3 25. The gerontological nurse enrolls in a program to learn healing touch. How does this technique differ from therapeutic touch? (Select all that apply.)

A) Seals energy leaks B) Manipulates soft tissues C) Rebalances energy fields D) Applies pressure to body areas E) Incorporates opening energy blockages Ans: A, C, E Feedback: Healing touch incorporates the techniques of therapeutic touch and adds the approaches to open energy blockages, seal energy leaks, and rebalance energy fields. Manipulation of soft tissues is done through massage. Applying pressure to body areas is done with acupressure.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 22 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 464, Impact of Ongoing Care on the Family 22. An elderly woman has lived with her son and his family for about 10 years. When she came to live with them, she was independent and healthy, but now she has rheumatoid arthritis and is nearly blind. To take care of her, her daughter-in-law took early retirement from a job she enjoyed. Although the daughter-in-law did so voluntarily, she now feels resentful about staying home, and the family's income has lessened. Recently, the family hired a part-time home care worker to help out. This gives the daughter-in-law more freedom but adds to the financial burden. The marriage is beginning to suffer. What might a marriage counselor tell the couple?

A) Set firmer boundaries with the mother B) Arrange for additional in-home care C) Consider finding an assisted-living facility for the mother D) Make their own decisions without outside input Ans: C Feedback: This couple is trying hard to provide good care for the mother, but it has become too much of a burden for them. The counselor must tread lightly to avoid making them feel guilty, but needs to suggest an assisted-living arrangement so that the daughter-in-law can work. More in-home care would add to their current expense and would not allow the daughter-in-law to return to full-time work.

Origin: Chapter 12- Sexuality and Intimacy, 26 Chapter: 12 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 153, Psychological Barriers 26. While completing an assessment the nurse learns that an older female patient has many misconceptions about having sex at this time in her life. What did the patient say for the nurse to come to this conclusion?

A) Sex can refracture a broken hip. B) Some medications can reduce the desire for sex. C) Menopause changes the amount of estrogen in the body. D) Different positions can be used to help with the limits of arthritis. Ans: A Feedback: One common misconception about having a fulfilling sex life in old age is that sex can refracture a broken hip. The other statements are not misconceptions about sex in old age.

Origin: Chapter 12- Sexuality and Intimacy, 15 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 150, Age-Related Changes and Sexual Response 15. Which statement does the nurse recognize as being a myth about sex and the elderly?

A) Sexual responsiveness diminishes in old age. B) Most women lose interest in sex after menopause. C) Most men in their eighties achieve erections and are capable of intercourse. D) An individual's sexual preferences and behaviors are the same in old age as in midlife. Ans: B Feedback: Sexual behaviors and preferences remain stable into old age, and elderly men are capable of intercourse. Although sexual responsiveness typically declines, many postmenopausal women gain a new interest in sex, possibly because they no longer have to fear an unwanted pregnancy or because they have more time and privacy with their children grown and gone.

Origin: Chapter 12- Sexuality and Intimacy, 1 Chapter: 12 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 144, Attitudes Toward Sex and Older Adults 1. Which statement best captures the predominant societal view of sexuality in general and sexuality in older adults?

A) Sexuality has recently become valued and normalized in both older and younger adults. B) There is an acknowledgment that sexual interest and activity do not necessarily decline with age. C) There is societal recognition that the overall importance of sexuality remains high across the life span. D) Stigma and prejudice around sexuality in older adults persists despite changes in the societal view of sexuality in general. Ans: D Feedback: Inaccuracies and misconceptions around sexuality and older adults persist, despite profound changes in the societal views of the topic of sexuality in general. Sexuality is not commonly valued or recognized by society, and interest and activity are presumed to decline and even disappear in older age.

Origin: Chapter 36- Acute Care, 12 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 487, Operative and Postoperative Care Considerations 12. An elderly woman had cardiac surgery that was completed quickly and seemed successful, but she developed an infection and was given cephalosporins and ampicillin. After that, she developed paralytic ileus with a low-grade fever. A chest X-ray appeared normal. Next, her kidneys failed. How might the kidney failure have been prevented in this patient?

A) She should have been on a low-protein diet. B) She should have been given different antibiotics. C) Her ileus should have been treated. D) The surgery should have taken longer. Ans: B Feedback: Kidney failure may occur after certain antibiotics, including cephalosporins and ampicillin, are taken. There is no reason to think the other choices would have helped prevent kidney failure.

Origin: Chapter 21- Digestion and Bowel Elimination, 19 Chapter: 21 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 293, Dry Mouth (Xerostomia) 19. After complaining about severe depression following the death of a daughter, a 77-year-old client is prescribed an antidepressant. Recently, the client was diagnosed with an oral fungal infection. What should the nurse suggest to the client?

A) Sip water to promote saliva B) Stop taking the antidepressant C) Explore complementary therapies D) Eat yogurt to combat the risk of fungus Ans: A Feedback: Reduced saliva is a side effect of antidepressants, and this can increase risk of bacterial or fungal oral infections. Medications should not be stopped without conferring with the primary health care provider. While complementary therapies may be assistive, sipping water can promote saliva and is effective for many individuals. Oral fungal infections are not impacted by ingestion of yogurt.

Origin: Chapter 13- Spirituality, 27 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 164, Being Available 27. A patient is observed sitting on the side of the bed crying. When approached the patient does not say anything but continues to cry and hold the nurse's hand. What should the nurse do to communicate being present with the patient?

A) Sit down next to the patient B) Leave the patient alone to cry C) Encourage the patient to stop crying D) Ask the patient to use the call bell if he or she wants to talk Ans: A Feedback: Nurses need to be available for patients to express their feelings. This means being fully present without being distracted or thinking about other activities. The best action for the nurse to take to communicate being present with the patient is to sit down next to the patient. Leaving the patient alone to cry, encouraging the patient to stop crying, or asking the patient to use the call bell if he or she wants to talk does not communicate being present with the patient.

Origin: Chapter 15- Rest and Sleep, 19 Chapter: 15 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 187, Sleep Apnea 19. An adult male patient who works full time complains of being tired all day even after getting 8 hours of sleep each night. Which condition is most likely the cause of this patient's complaint?

A) Sleep apnea B) Alcohol abuse C) Nocturnal myoclonus D) Age-related changes to sleep Ans: A Feedback: Sleep apnea is the most likely cause. It is two times greater in men than in women, and fatigue in spite of seemingly sufficient quantity of sleep is more characteristic of sleep apnea than of the other cited problems. There is no information to suggest the patient is using alcohol. The patient is not explaining symptoms of nocturnal myoclonus. It is unknown what the patient's age is to assume that the complaint is due to age-related changes.

Origin: Chapter 35- Rehabilitative Care, 23 Chapter: 35 Client Needs: D4 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 6 Page and Header: 476, Assisting With Mobility Aids and Assistive Technology 23. The nurse should keep abreast of current assistive technology for which of the following reasons? (Select all that apply.)

A) So that the nurse can become an entrepreneur in marketing these devices. B) These devices will enable older adults to care for themselves. C) These devices will enable older adults to function within the community. D) These devices will also afford older adults the opportunity to remain in the workforce as long as possible, despite having a disability. Ans: B, C, D Feedback: The nurse should keep abreast of current assistive technology to enable older adults to care for themselves; to function within the community; and to allow them the opportunity to remain in the workforce as long as possible, despite having a disability. If the technology exists and the nurse is aware of it, it is not likely that the nurse can become an entrepreneur in marketing these devices.

Origin: Chapter 35- Rehabilitative Care, 30 Chapter: 35 Client Needs: A1 Cognitive Level: Application Difficulty: Easy Integrated Process: Caring Objective: 8 Page and Header: 480, Using Community Resources 30. Which of the following are professionals who can offer guidance in locating appropriate resources? (Select all that apply.)

A) Social workers B) Physical therapists C) Occupational therapists D) Speech and hearing therapists E) Local libraries Ans: A, B, C, D Feedback: Social workers, physical therapists, occupational therapists, speech and hearing specialists, and rehabilitation and vocational counselors are among the professionals who can offer guidance in locating appropriate resources. Local libraries, health departments, and information and referral services for older people can also provide valuable assistance.

Origin: Chapter 16- Comfort and Pain Management, 17 Chapter: 16 Client Needs: D1 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 195, Types of Pain 17. An older patient with a diagnosis of osteoarthritis complains of stiffness in the joints, tenderness, and pain. Which type of pain is this patient most likely experiencing?

A) Somatic pain B) Visceral pain C) Nociceptive pain D) Neuropathic pain Ans: A Feedback: Somatic pain is pain in the bone and soft tissue. Visceral pain is generalized, referred, and described as deep and aching. Nociceptive pain arises from mechanical, thermal, or chemical noxious stimuli. Neuropathic pain occurs from abnormal processing of sensory stimuli by the central or peripheral nervous system.

Origin: Chapter 16- Comfort and Pain Management, 12 Chapter: 16 Client Needs: D4 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 195, Types of Pain 12. An older patient with type 2 diabetes mellitus is complaining of burning feet. The nurse determines that the patient is most likely experiencing which type of pain?

A) Somatic pain B) Visceral pain C) Nociceptive pain D) Neuropathic pain Ans: D Feedback: Neuropathic pain occurs from an abnormal processing of sensory stimuli by the central or peripheral nervous system and is associated with diabetic neuropathies. Somatic pain is in the bone and soft tissue. Visceral pain is generalized, referred, and described as deep and aching. Nociceptive pain arises from mechanical, thermal, or chemical noxious stimuli.

Origin: Chapter 13- Spirituality, 1 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 161, Introduction 1. An older female patient tells the nurse that even though she believes in a higher power she is not interested in information on the hospital's chaplaincy services since she has never been religious. What does the nurse recognize as the relationship between religion and spirituality?

A) Some people are religious, while others are spiritual. B) Religion is a particular, structured way of expressing spirituality. C) Religion is the essence of our being that connects us with the Divine. D) All human beings have an innate desire for religious structure and spiritual fulfillment. Ans: B Feedback: Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion. Not everyone identifies a need for religion, and religion and spirituality are not mutually exclusive. Spirituality, not religion, is defined as the essence of our being that connects us with the divine.

Origin: Chapter 13- Spirituality, 15 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 167, Providing Opportunities for Solitude 15. Which statement should the nurse use to plan interventions to address the behavior of an older patient sitting quietly alone in a room?

A) Spending a lot of time alone is a sign that an elder is lonely or grieving. B) Uninterrupted periods of solitude and inactivity are therapeutic for the elderly. C) Solitude should be discouraged among elders because it leads to social isolation. D) Occupational therapy should be arranged for an elder often observed doing nothing. Ans: B Feedback: Periods of solitude are therapeutic to the elderly. Unresolved feelings from earlier years may be contemplated and resolved, resulting in personal satisfaction. In reminiscing, evaluating, and understanding the dynamics of life's earlier events and achievements, older persons can find a satisfaction with the quality of their lives that helps compensate for their multiple losses. Spending time alone is not a sign that the patient is lonely or grieving. Solitude does not lead to social isolation. Activities should not be planned for an older patient who is doing nothing.

Origin: Chapter 13- Spirituality, 14 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 162, Spiritual Needs 14. During an interview process as a staff nurse for a geriatric patient care area, the nurse is asked about her philosophy of spirituality. Why is this important when caring for older patients?

A) Spirituality becomes more unconditional as people age B) Spirituality often becomes more important to people as they age C) An individual's spirituality remains stable from youth through old age D) As people age, their spirituality becomes more quantitative than qualitative Ans: B Feedback: All humans have spiritual needs, regardless of whether they realize or acknowledge them. Some of these needs become particularly relevant in late life when the high prevalence of chronic illness and reality of death are evident. Spirituality does not become more unconditional as people age. Spirituality may change throughout the life. There is no evidence to support that spirituality becomes more quantitative than qualitative as people age.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 24 Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 457, Goals for Chronic Care 24. An elderly man is dying of cancer, and a hospice nurse comes to his home every day to oversee his care and comfort. What is the most important thing the nurse can provide?

A) Stress management B) Help with tasks that may sap the patient's energy C) Assurance of support D) Help with basic needs such as eating and bathing Ans: C Feedback: All these tasks are important for a hospice nurse, but the most important is instilling in a dying patient a feeling that the nurse can be depended on for support through this period.

Origin: Chapter 13- Spirituality, 12 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 163, Addressing Spiritual Needs 12. At the conclusion of a health history the nurse conducts a spiritual assessment with the patient. Why is this assessment important?

A) Strong spiritual beliefs facilitate health and healing B) A spiritual crisis can trigger a psychosomatic disease C) It is the nurse's job to facilitate communication between the patient and the clergy D) The nurse needs to be careful that therapeutic regimens do not violate a patient's religious beliefs Ans: A Feedback: Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is of therapeutic benefit to support patients' spirituality and assist them in fulfilling spiritual needs. The nurse does not complete a spiritual assessment to avoid the onset of a psychosomatic disease or to facilitate communication between the patient and the clergy. This assessment is also not being done to ensure that therapeutic regimens will not violate the patient's religious beliefs.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 24 Chapter: 8 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 108, Advance Directives and Issues Related to Death and Dying 24. What is the most important advantage of an advance directive?

A) Such a will indicates how property is to be passed on after death and avoids probate for inheritors B) It spares the family the burden of making significant decisions for a patient regarding terminal care C) It settles the issue of guardianship without the expense of going to court for each incident D) It frees health professionals from any liability derived from Do Not Resuscitate orders Ans: B Feedback: An advance directive, or living will, expresses the desire of competent adults regarding terminal care, life-sustaining measures, and other issues pertaining to their death and dying. It has nothing to do with material inheritance, and it may not free staff from liability, depending on state laws. It does, however, spare the family the burden of making significant decisions for a patient at a very difficult time.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 21 Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 463, Defense Mechanisms and Implications 21. Mr. A says that he does not need his medicine for hypertension. He also claims that it makes him feel weak and he suspects that it sometimes makes him impotent. When his wife tries to remind him to take the drug, he becomes enraged. How can a nurse best help in this situation?

A) Suggest that Mr. A vent his frustrations B) Insist that Mr. A force himself to take the medicine C) Advise Mr. A's wife to supervise him D) Exhort Mr. A repeatedly that a chronic condition like hypertension requires self-care Ans: A Feedback: Mr. A is in denial about his need for the medicine and is angry about the effects. He needs extra support, not criticism. Venting his frustrations, perhaps by yelling or punching a pillow, may give him some relief.

Origin: Chapter 2- Theories of Aging, 19 Chapter: 2 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 16, Nutrition Theories 19. Mr. B, age 72, has a history of heart disease. He insists that his high-fat diet is permissible, however, because he takes a daily supplement of gugulipid, an herb purported to reduce blood cholesterol levels. In talking with the patient, what should Mr. B's nurse do first?

A) Suggest that Mr. B ask his doctor for a prescription medication to reduce cholesterol levels B) Review with Mr. B the benefits associated with limiting dietary fat C) Introduce Mr. B to the additional benefits associated with fish oil supplements D) Advise Mr. B to stop using gugulipid, as herbal supplements are not regulated by the FDA Ans: B Feedback: The first duty of Mr. B's nurse is to promote positive health behaviors, which means encouraging the patient to limit his fat intake. Herbal supplements are unregulated, and their health benefits may be questionable. Whether fish oil supplements or prescription medications are advisable in this case merits further investigation.

Origin: Chapter 12- Sexuality and Intimacy, 13 Chapter: 12 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 155, Erectile Dysfunction 13. A 70-year-old male patient has erectile dysfunction, but he tells the nurse that he is no longer interested in sexual activity. What is the best advice the nurse can give to the patient?

A) Suggest that he ask his physician for Viagra in case he changes his mind B) Encourage the patient to have a medical exam to find the cause of his erectile dysfunction C) Recommend counseling, because most erectile dysfunction is psychological in origin D) Point out that erectile dysfunction affects one in four elderly men and is no reason for concern Ans: B Feedback: Erectile dysfunction can have multiple causes, including atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medications, and psychological factors. Given the range and complexity of potential causes, a thorough physical examination is essential. Even if the patient is not interested in being sexually active, he should be encouraged to have this dysfunction evaluated to identify underlying conditions that warrant medical attention.

Origin: Chapter 3- Diversity, 23 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 23. An elderly Chinese patient tells the nurse that blockage of qi in one of her meridians is causing her severe headaches. Her doctor has diagnosed migraines and has prescribed a triptan drug. The nurse's best course of action is to:

A) Suggest that the prescribed medicine may stimulate the flow of qi B) Explain the vasoconstrictive and serotonin-moderating action of triptan C) Recommend acupuncture or acupressure treatments as an adjunct to the triptan D) Caution her that her headaches will grow worse if she fails to take her medication Ans: A Feedback: Although explaining the scientific principles underlying drug action is often appropriate, the same objective can be achieved through the use of culturally relevant terms and concepts. Recommending additional treatments is unnecessary and may be inappropriate. Threats or predictions of dire consequences may impede the communication process.

Origin: Chapter 12- Sexuality and Intimacy, 2 Chapter: 12 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 144, Attitudes Toward Sex and Older Adults 2. The nurse who cares for patients at an assisted living facility is planning a program to address safer sex in older adults. Why would this program be important? (Select all that apply.)

A) Susceptibility to sexually transmitted infections (STIs) increases with age. B) HIV/AIDS is spreading more quickly among older adults than among younger adults. C) Older adults frequently forego condom use because the risk of pregnancy does not exist. D) Many older adults assume that STIs are problems of younger adults only. E) Because of the hormonal changes that accompany menopause, older women are in fact more prone to sexually transmitted diseases than younger adults. Ans: B, C, D Feedback: Older adults often forego condom use and assume STIs are not a problem, despite the increasing incidence of HIV/AIDS in older adults. Susceptibility to STIs does not necessarily increase in older adults in general or in older women specifically. In the older population, the use of condoms is often avoided because the risk of pregnancy does not exist. Hormonal changes in menopause do not increase an older woman's susceptibility to sexually transmitted diseases.

Origin: Chapter 5- Common Aging Changes, 21 Chapter: 5 Client Needs: B Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 62, Endocrine System 21. A nurse is reviewing thyroid test results of her clients. Which of the following is the most likely thyroid test result for a healthy elderly patient?

A) T4: low; T3: low; thyroid function: low B) T4: high; T3: normal; thyroid function: high C) T4: high; T3: normal; thyroid function: low D) T4: normal; T3: low; thyroid function: normal Ans: D Feedback: With normal aging, secretion of thyroid-stimulating hormones (TSH) and the serum concentration of thyroxine (T4) do not change, although there is a significant reduction in triiodothyronine (T3), which is believed to be a result of the reduced conversion of T4 to T3. Overall, thyroid function remains adequate.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 19 Chapter: 9 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 117, Measures to Help Nurses Make Ethical Decisions 19. Which of the following is the best way for nurses to minimize their struggles in making ethical decisions?

A) Take no action unless an advance directive, will, and other legally binding documents are in effect B) Act on the recommendations of a patient's healthcare provider, friends, and family members C) Consult the guidelines of the American Nurses Association and the institution's ethics committee D) Maintain nursing's traditional focus on following physicians' orders and providing care and comfort for the patient Ans: C Feedback: Although legal documents and the views of family members should be taken into account, a nurse may be called on to make ethical decisions without them or occasionally in opposition to them. Retreating into a "care-only' mode does not resolve ethical dilemmas. The best choice among those listed is to seek guidance from professional organizations and committees charged with establishing ethical guidelines for institutions.

Origin: Chapter 2- Theories of Aging, 21 Chapter: 2 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 17, Activity Theory 21. A state committee is looking to improve the lives of the state's elderly. It wants to recommend that health care facilities that cater to the elderly population be required to base their practices on the activity theory of aging. Which of the following may be one problem with implementing the activity theory of aging?

A) The assumption that older people want to maintain their middle-aged lifestyle B) The reluctance of the elderly to give up their occupational roles at retirement age C) The decline in mental acuity that accompanies physical impairment in most cases D) Declining health, loss of roles, and shrinking circle of friends of most elderly Ans: A Feedback: The activity theory suggests that the elderly should maintain their middle-aged lifestyle to the greatest extent possible, a goal not all elderly persons will embrace. The reluctance of many elderly persons to give up their middle-aged roles is consistent with the theory. Relatively small numbers of the elderly experience a significant decline in mental acuity. Declining health, loss of roles, and a shrinking circle of friends are problems the activity theory seeks to minimize.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 18 Chapter: 34 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 463, Factors Affecting the Course of Chronic Care 18. Mr. Y, who lives with his wife in their home of 50 years, has a diagnosis of osteoarthritis. Which of the following factors is most likely to have the largest impact on Mr. Y's ability to manage his illness?

A) The availability of new treatment options for his condition B) The financial resources available to Mr. Y and his wife C) The course and progression of his condition D) The openness of Mr Y to complementary and alternative medicine (CAM) Ans: C Feedback: The course and progression of Mr. Y's arthritis is likely to affect his ability to manage it more than new treatment options, finances, or his openness to CAM treatments.

Origin: Chapter 5- Common Aging Changes, 2 Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 52, Respiratory System 2. A 78-year-old man has received a recent diagnosis of community-acquired pneumonia. Potential pathological findings on a recent chest x-ray have prompted his physician to order a bronchoscopy and lung function tests. Which of the following findings would be most likely suggestive of pathological processes rather than normal, age-related respiratory changes?

A) The client has fewer cilia than would be found in a younger client. B) Lung function tests reveal that both maximum breathing and vital capacity are diminished since his last test. C) There is an accumulation of serous fluid between the lungs and the pleural membrane. D) The lungs are smaller than younger adults' and there are fewer alveoli. Ans: C Feedback: While decreases in the number of cilia, alveoli, lung size, and lung capacities are commonly associated with aging, an accumulation of serous fluid would not be considered a normal consequence of the aging process.

Origin: Chapter 3- Diversity, 6 Chapter: 3 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 29, Jewish Americans 6. Which of the following interventions in the care that preceded the death of a female, Jewish older American was most likely to have warranted special consideration?

A) The client required transfusions of packed red blood cells during her care. B) Assessment by a male physician was required. C) An autopsy was ordered due to the client's unique disease etiology. D) A do-not-resuscitate (DNR) order was recommended by the care team when the client's disease progressed. Ans: C Feedback: Autopsy is often opposed in the context of Jewish religious and cultural beliefs. Blood transfusions, assessment by a physician of the opposite sex, and DNR orders are not noted to be particular issues in the context of this culture.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 6 Chapter: 34 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 6. Despite the fact that the patient is now receiving palliative care because of the progression of her congestive heart failure (CHF), a nurse views the care that was provided for the patient as a success. Which of the following aspects of the patient's situation would most likely lead the nurse to this conclusion?

A) The client was able to live independently and care for herself until very late in the progression of her disease. B) The client maintained an acceptable cardiac output for the majority of the time that she lived with CHF. C) The client was able to teach other older adults about the experience of living with CHF and the way it affected her life. D) The client remained largely pain-free from the time of diagnosis until the present. Ans: A Feedback: The fact that the client was able to live independently and perform self-care represents success in a holistic nursing model. A focus on cardiac output and the ability to teach others is less indicative of a healing paradigm. While controlling pain in and of itself is a laudable goal, it is less closely associated with the quality of life that is the true goal.

Origin: Chapter 3- Diversity, 2 Chapter: 3 Client Needs: C Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 25, Hispanic Americans 2. A nurse is providing care for an 81-year-old Hispanic woman in the context of a geriatric medicine unit of a hospital. Which of the following phenomena should the nurse anticipate?

A) The client's family is likely to advocate for her placement in a nursing home at an early stage. B) The client is likely to prioritize the role of spirituality in the healing process. C) She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness. D) The woman's family will most likely delegate responsibility for her care to the hospital care team. Ans: B Feedback: Hispanic elders often emphasize the role of spirituality in both the etiology and treatment of disease. Nursing home admissions are proportionately low and while health and illness are often seen as the actions of God, this does not translate into a rejection of treatment. The family is likely to play a central role in care planning and recovery.

Origin: Chapter 13- Spirituality, 7 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 163, Assessing Spiritual Needs 7. What should the nurse use to help guide interventions to meet the spiritual needs of a patient?

A) The client's prognosis for recovery B) The nurse's own religious tradition C) The denominational affiliation of the chaplain D) The presence of icons and religious books at the bedside Ans: D Feedback: The presence and identity of a patient's religious books and symbols can be useful insights into a patient's spiritual belief system. This information would supersede the religious affiliation or tradition of the nurse or chaplain as well as the patient's objective prognosis for recovery.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 17 Chapter: 8 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication and documentation Objective: 2 Page and Header: 105, Patient Competency 17. How does guardianship differ from power of attorney?

A) The court appoints a guardian. An individual grants a power of attorney to someone else to make decisions on his or her behalf B) Guardianship is legally binding whether or not an individual is competent. Power of attorney applies only to the incompetent C) Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of "reasonable prudence" are met D) Guardianship stays in effect for one calendar year and must be renewed annually. Power of attorney stays in effect until one or both parties choose to revoke it Ans: A Feedback: The appointment of a guardian to grant consent for an incompetent individual is the responsibility of the court. When a patient's competency is questionable, staff should encourage family members to seek legal guardianship. Power of attorney is a mechanism used by competent individuals to appoint someone else to make decisions for them.

Origin: Chapter 14- Nutrition and Hydration, 9 Chapter: 14 Client Needs: A2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 179, Dysphagia 9. The family of an older patient with dysphagia comes to the skilled nursing facility at mealtimes to feed the patient. Which of the family's feeding practices should the nurse follow up with teaching or correction?

A) The family makes sure that the patient does not talk while eating B) The family checks for pocketing of food prior to introducing another bite C) The family places the patient in high Fowler position during and after feeding D) The family introduces large pieces of food to prevent accidental inhalation of small food particles Ans: D Feedback: For patients with dysphagia, small pieces of food are preferable. The other actions by the family are appropriate when feeding a patient with dysphagia.

Origin: Chapter 1- The Aging Population, 17 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 2 Page and Header: 8, Health Status 17. Two related and important trends in the elderly population are:

A) The growing gap in life expectancy between males and females and the number of women living alone B) The increase in life expectancy of white and black people. C) The continued burden of acute disease and the low levels of education among the elderly D) The increased burden of chronic illness and the shifting causes of death with advancing age Ans: D Feedback: The role of chronic illness in death rates is both significant and represents a shift from the past. The gap in life expectancy between men and women is narrowing. The life expectancy of black people has been recently declining. The generation now entering the senior years is better educated than generations past.

Origin: Chapter 5- Common Aging Changes, 14 Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 54, Cardiovascular System 14. The heart muscle commonly weakens with age. What is a consequence of this fact?

A) The heart beats faster but pumps with less force. B) Fatty deposits and other substances clog narrowed coronary vessels. C) Blood pressure lowers because of systemic vasodilation. D) The time required for the heart's diastolic-systolic cycle decreases. Ans: A Feedback: The statement in choice B is true, but age-weakened heart muscle is not the cause. Blood pressure may actually rise as an effect of choice B. The opposite of the statement in choice D is true.

Origin: Chapter 1- The Aging Population, 15 Chapter: 1 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 4, Characteristics of the Older Adult Population 15. Which of the following factors should a nurse prioritize when planning the care of older adults?

A) The high prevalence of mental impairment among the elderly B) The diversity of the older adult population C) The fact that most older people live below the poverty line D) The lack of family support that is the norm among the elderly Ans: B Feedback: Individuals aged 65 years and older vary widely in their health status, interest, cultural backgrounds, and health care needs. The population is not generally impaired mentally. Also, only 15% live below the poverty level. The majority live in a household with a spouse or other family member.

Origin: Chapter 1- The Aging Population, 9 Chapter: 1 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 9, Provision of and Payment for Services 9. The family of an 85-year-old man who has been admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults?

A) The high value of assets owned by older adults makes the financial burden of care minimal for most older adults. B) Payment for long-term care of adults is most often covered by private insurers. C) Most older adults have their basic care needs provided in a long-term facility. D) Overall, federal money pays for more care than do older adults themselves or private insurers. Ans: D Feedback: Most money for the care of older adults comes from federally funded programs. The burden of payment is still significant for most older adults and a minority of older adults receive care in an institutional living environment.

Origin: Chapter 2- Theories of Aging, 13 Chapter: 2 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 15, Genetic Theories 13. Which of the following statements is evidence that supports the programmed theory of aging?

A) The life spans attained by parents and their offspring are negatively correlated. B) Mutations perpetuate themselves through each cycle of cell division. C) In cultures, cells go through a finite number of cell divisions before dying. D) In cultures, cells from older donors divide faster than those from younger donors. Ans: C Feedback: Studies of in vitro cell proliferation have demonstrated that various species have a finite number of cell divisions. Life spans of parents and offspring are positively correlated. Mutation perpetration is a tenet of the error theory, not the programmed theory, of aging. Although longer life spans correlate positively with numbers of cell divisions in vitro, the rate of cell division is not affected.

Origin: Chapter 21- Digestion and Bowel Elimination, 7 Chapter: 21 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 299, Chronic Constipation 7. The nurse develops a plan of care for a 75-year-old male patient who has had a myocardial infarction (MI). Which of following characteristics of the man's history and present conditions predispose him to constipation? (Select all that apply.)

A) The man has a history of GERD. B) The man takes a -blocker for the treatment of hypertension. C) The man's activity level is significantly reduced as a result of his MI. D) The man has received several doses of morphine since admission. E) The man's fluid intake has been minimal since admission. Ans: C, D, E Feedback: Decreased activity, low fluid intake, and opioid use are implicated in the development of constipation. A history of GERD and the use of antihypertensive medications are not.

Origin: Chapter 36- Acute Care, 13 Chapter: 36 Client Needs: A2 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 487, Operative and Postoperative Care Considerations 13. What factors are most likely to contribute to the problem of hypothermia that older adults may face intraoperatively and postoperatively? (Select all that apply.)

A) The normal body temperature of older adults that is often lower B) The cool temperature of the operating rooms C) The use of medications that slow metabolism D) Fever from infection Ans: A, B, C Feedback: Factors that contribute to the problem of hypothermia include the lower normal body temperatures of many older persons, the cool temperature of operating rooms, and the use of medications that slow metabolism. Fever does not cause hypothermia.

Origin: Chapter 5- Common Aging Changes, 11 Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 52, Cells 11. It is important to measure and record fluid input and output accurately because this information is used in evaluating a patient's fluid balance and in planning care and treatment. Dehydration is a significant risk for the elderly because:

A) The number of body cells is less, and fewer cells are functioning in the body. B) Total body fat as a proportion of the body's composition increases with age. C) Cellular solids and bone mass decrease with age affecting the ability to balance. D) Extracellular fluid remains constant, but intracellular fluid decreases with age. Ans: D Feedback: Although all the statements are true, only the loss of intracellular fluid is a cause of increased risk of dehydration.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 22 Chapter: 9 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 114, Box 9-1 22. Nurse G is a practicing alcoholic, but continues in the job without seeking treatment. Nurse G is most in violation of which provision of the American Nurses Association "Code of Ethics for Nurses"?

A) The nurse practices with respect for the inherent dignity of every individual B) The nurse is responsible and accountable for determining the appropriate delegation of tasks C) The nurse owes the same duties to self as to others, including the responsibility to preserve integrity D) The nurse participates in maintaining conditions of employment conducive to the provision of quality care Ans: C Feedback: A nurse who is a practicing alcoholic is attempting to perform with his or her integrity compromised. Nurse G is violating duties to self and to patients.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 14 Chapter: 9 Client Needs: A1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Caring Objective: 2 Page and Header: 114, Ethical Principles 14. Which of the following is the best example of the ethical principle of beneficence?

A) The nurses at City Hospital answer patients' call buttons "with all deliberate speed" B) The nursing supervisor fires an incompetent part-time nursing assistant, leaving a less than full complement of staff C) At a nursing home, the staff closes residents' doors before the body of a deceased resident is wheeled out D) The charge nurse documents all reported incidents at the end of the shift Ans: A Feedback: Beneficence means to do good for patients. Of the examples given, A is the best demonstration of this principle.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 5 Chapter: 8 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 105, Patient Competency 5. An 81-year-old female client was diagnosed 1 year ago with Alzheimer's disease following a noticeable increase in confusion. She now possesses a durable power of attorney. Which of the following statements most accurately conveys an aspect of this legal arrangement?

A) The parameters of the arrangement must be revisited if the client's condition declines. B) The arrangement was most likely initiated by court order for a government conservator. C) The client appointed someone to take care of her affairs in the event that she becomes incompetent. D) The family has control of logistical arrangements for the client but must gain court permission around financial affairs. Ans: C Feedback: Usually, a power of attorney becomes invalid if the individual granting it becomes incompetent, except in the case of a durable power of attorney. A durable power of attorney allows competent individuals to appoint someone to make decisions on their behalf in the event that they become incompetent; this is a recommended procedure for individuals with dementias and other disorders in which competency can be anticipated to decline. It would not have been initiated by the court and it encompasses both logistical and financial issues.

Origin: Chapter 36- Acute Care, 21 Chapter: 36 Client Needs: A2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 492, Infections 21. Infections are common acute conditions that demand prompt attention. A variety of factors can be responsible for the high risk of infection in the elderly. Gerontological nurses should suspect an infection when which of the following phenomena occurs?

A) The patient displays reduced activity and lowered resistance. B) Embolus and thrombus are diagnosed. C) A lower body temperature causes atypical fever. D) Any abrupt, unexplained change in physical or mental function is detected. Ans: D Feedback: Not only do infections develop more easily in the elderly, but they also are more difficult to identify early because of altered symptomatology. That is, the atypical presentation of symptoms can complicate early identification and correction. Infection should be suspected whenever any abrupt, unexplained change in physical or mental function is detected in the elderly patient.

Origin: Chapter 14- Nutrition and Hydration, 16 Chapter: 14 Client Needs: D2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 177, Hydration Needs of Older Adults 16. A 75-year-old patient and his 40-year-old daughter both have an intestinal virus with complaints of vomiting and diarrhea. Why is the nurse concerned about the patient being at risk for dehydration?

A) The patient is on a fixed income B) The virus will make changes to the patient's gastrointestinal system C) The vomiting and diarrhea will cause a reduction in intracellular fluids D) The patient does not want to bother a health care professional for a common virus Ans: C Feedback: The patient is at risk because of his age. With age, intracellular fluid is lost, resulting in decreased body fluids. Water makes up 50% or less of body weight in older adults, compared with 60% in younger adults. An increase in water loss could be life-threatening to an older person. The nurse's concern has nothing to do with the patient's income. The virus will not make changes to the patient's gastrointestinal system. There is not enough information to determine that the patient does not want to bother the nurse for a common virus.

Origin: Chapter 16- Comfort and Pain Management, 6 Chapter: 16 Client Needs: D1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 198, An Integrative Approach to Pain Management 6. The nurse is caring for an older patient with a fractured hip. Which pain control goal would be the most realistic for the patient?

A) The patient will experience relief from pain. B) The patient will state that being in a state of comfort. C) Scheduled and breakthrough analgesia will be administered as needed. D) The patient's self-report of pain will remain below 5 out of 10 while hospitalized. Ans: D Feedback: The goal that the patient's self-report of pain will remain below 5 out of 10 while hospitalized is realistic, specific, and achievable. The patient experiencing relief from pain is not specific. The goal that the patient will state being in a state of comfort is neither realistic nor measurable. Providing analgesia is a nursing goal.

Origin: Chapter 1- The Aging Population, 5 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 6, Income and Employment 5. Which of the following statements most accurately captures the financial status of older adults in the United States?

A) The percentage of older people living below the poverty level has been increasing. B) The financial needs of most older adults are well met by Social Security income alone. C) The recent decline in housing prices has made many older adults "asset rich and cash poor." D) Women 65 years of age and older is the fastest growing group of employment. Ans: C Feedback: The percentage of older people living below the poverty level has been declining, with about 10% now falling into this category. Most older people depend on Social Security for more than half of their income. Although the median net worth of older households is nearly twice the national average because of the high prevalence of home ownership by elders, many older adults are "asset rich and cash poor." The recent decline in housing prices, however, has made that asset a less valuable one for many older adults. There has been a significant rise in the percentage of middle-aged women who are employed, although there has been little change in the labor force participation of women 65 years of age and older.

Origin: Chapter 36- Acute Care, 27 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 6 Page and Header: 493, Discharge Planning for Older Adults 27. The family of a 90-year-old female hospital patient is worried about her chances of making a full recovery from her recent fall once she returns home. Which of the following factors are likely to have a positive effect on the woman's post-discharge health outcomes? (Select all that apply.)

A) The presence of a reliable and an adequate social support network. B) The patient's understanding of her health and her prognosis. C) The presence or absence of other health problems. D) The self-care habits that the woman had prior to her fall. E) Beginning the discharge planning at the time that the woman is being discharged. Ans: A, B, C, D Feedback: The factors that would have a positive effect on the woman's post-discharge health outcomes include the presence of a reliable and an adequate social support network; the patient's understanding of her health and prognosis; the presence or absence of other health problems; and the self-care habits that the woman had prior to her fall. Beginning the discharge planning at the time that the woman is being discharged is likely to have a negative effect on the woman's post-discharge health outcomes—it should be started upon admission to the hospital.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 1 Chapter: 8 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 101, Laws Governing Gerontological Nursing Practice 1. Which of the following aspects of gerontological nursing would be most likely classified under private law?

A) The regulation of who may call himself or herself a "nurse" B) The contract between an older adult resident and the owners of the facility C) The legal criteria for declaring an individual mentally incompetent D) The criminal consequences for instances of elder abuse Ans: B Feedback: Private law involves relationships between individuals and organizations, such as the contract between an individual and the care facility in question. The other cited examples would fall under the umbrella of public law.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 13 Chapter: 9 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 117, Greater Numbers of Older Adults 13. Which of the following factors most contributes to the fact that society is experiencing an increased burden for entitlement programs for the elderly?

A) The rights of older citizens to receive health services unavailable to other age groups B) The increasing ratio of dependent elderly to productive workers C) Growing public attention to policy and reimbursement decisions that are not in the best interest of elders D) The widening scope and increased accountability of gerontological nurses Ans: B Feedback: The impact of entitlement programs and services for older adults was felt less severely when only a small portion of the population was old; but with growing numbers of people spending more time in old age and the ratio of dependent individuals to productive workers increasing, society is beginning to feel burdened.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 7 Chapter: 9 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 115, Changes Increasing Ethical Dilemmas for Nurses 7. Which of the following phenomena have contributed to recent increases in the number and complexity of ethical dilemmas for gerontological nurses? Select all that apply.

A) The scope of practice goes beyond simply following doctors' orders. B) Nurses' levels of responsibility are higher than in past years. C) Medical technology has made significant advances. D) The Internet has made patients and their families more informed about health. E) Deaths from heart disease are declining while deaths from cancer are increasing. F) Conflicts between cost effectiveness and quality of care Ans: A, B, C, F Feedback: The increasing scope and responsibility that nurses bring to practice contribute to ethical dilemmas, while advances in medical technology and fiscal constraints bring a new series of issues to care. Increasingly informed patients and changes in causes of death do not directly increase the number of ethical dilemmas faced by nurses.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 20 Chapter: 9 Client Needs: A1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 117, New Fiscal Constraints 20. In which of the following cases is the ethical conflict between cost containment and quality care most obvious?

A) The termination of an incompetent aide who is the sole support of his family B) The conversion of a community playground into a senior citizen center C) An insurance company that denies reimbursement for dialysis of patients older than age 70 D) The decision to remove the feeding tube from a comatose patient Ans: C Feedback: Although all choices involve ethical dilemmas, the most direct opposition between cost containment and quality care arises in the denial of expensive treatments to elderly patients.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 6 Chapter: 8 Client Needs: A2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 105, Staff Supervision 6. During a busy shift, a registered nurse directed an unlicensed care provider to change the dressing and perform wound care on an older adult client's surgical incision, an act that exists outside of the scope of the unlicensed care provider's scope of practice. Which of the following statements best captures the legal context of this event?

A) The unlicensed care provider is solely responsible for the inappropriate practice. B) The nurse can be held liable for the actions of the unlicensed care provider. C) Liability rests with the company that owns the healthcare facility. D) In the absence of documented harm to the client, the action is legally permissible. Ans: B Feedback: Under the doctrine of respondent superior, nurses can be held liable for the actions of persons under their supervision. Responsibility would not necessarily rest with the nurse manager, while the lack of harm to the client does not render the action permissible.

Origin: Chapter 5- Common Aging Changes, 1 Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 52, Physical Appearance 1. During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply.

A) The woman's overall proportion of body water has decreased. B) The client has experienced a loss of cartilage. C) The woman's thyroid hormone levels have declined since the sixth decade. D) The client's vertebrae have thinned. E) Loss of stature is a consequence of the woman's diet. F) The woman's long bones have decreased in length. Ans: A, B, D Feedback: Reduced hydration, loss of cartilage, and thinning of vertebrae can all contribute to loss of stature. Decreased levels of TH, shortening of long bones, and diet are not noted to contribute to this phenomenon.

Origin: Chapter 13- Spirituality, 11 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 161, Introduction. 11. Two nurses are discussing the relationship between spirituality and religion. Which statement explains this relationship?

A) They are the same. Both connect individuals to the Divine and to other living things. B) They are directly related. The more spiritual the individual, the greater his or her commitment to religion. C) They interact inversely. Heavy involvement in organized religion diminishes spirituality and vice versa. D) They are different. Spirituality is a sense of connection to the Divine; religion is a structure of beliefs, rituals, and rules. Ans: D Feedback: Spirituality is the essence of our being that transcends and connects us to the Divine and other living organisms. It involves relationships and feelings. Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion.

Origin: Chapter 36- Acute Care, 19 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 488, Emergency Care 19. For which of the following reasons are emergencies in older persons particularly problematic? (Select all that apply.)

A) They occur frequently because of the age-related changes that lower resistance and make the body more susceptible to injury and illness. B) They are not as urgent as it is expected that elderly people will die. C) They often present an atypical picture that complicates diagnosis. D) They can be more difficult to treat or stabilize because of older persons' altered response to treatment. E) They carry a greater risk of causing serious complications and death. Ans: A, C, D, E Feedback: Emergencies in elderly persons are particularly problematic for the following reasons: they occur frequently, they often present an atypical picture, they can be more difficult to treat or stabilize, and they carry a greater risk of causing serious complications and death.

Origin: Chapter 14- Nutrition and Hydration, 22 Chapter: 14 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 7 Page and Header: 179, Dysphagia 22. The nurse is instructing a nursing assistant on how to feed all patients with dysphagia. What information should the nurse include in this instruction?

A) Thicken liquids and cut solids into very small pieces B) Use a spoon to transport even solid food to the patient's mouth C) Listen for bowel sounds to make sure the food has reached the stomach D) Make sure the patient is sitting upright whenever consuming food or fluid Ans: D Feedback: One general measure for all persons with dysphagia is to have the patient sitting upright whenever food or fluid is being consumed. The other feeding measures may not be indicated for every person with dysphagia.

Origin: Chapter 21- Digestion and Bowel Elimination, 21 Chapter: 21 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 295, Dysphagia 21. The nurse plans the care of the older adult with dysphagia. Which of the following is the priority initial nursing intervention?

A) Thicken the liquids B) Weigh the patient daily C) Observe the patient's food intake D) Offer the patient verbal cues when eating Ans: C Feedback: Assessment and observation assist in diagnosing nature of the dysphagia. The other cited actions are appropriate but would be secondary to assessment through observation of the related symptoms, types of foods, and timing.

Origin: Chapter 16- Comfort and Pain Management, 22 Chapter: 16 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 201, Medication 22. An older patient is receiving oxycodone for cancer pain. For which side effect should the nurse assess the patient?

A) Thirst B) Delirium C) Addiction D) Muscle weakness Ans: B Feedback: Narcotics should be used discriminately in older patients because of the high risk of delirium, falls, decreased respirations, and other side effects. Thirst and muscle weakness may or may not be a side effect of narcotics in the older patient. Addiction should not be considered a side effect to treat this patient's pain.

Origin: Chapter 14- Nutrition and Hydration, 24 Chapter: 14 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 7 Page and Header: 180, Box 14-1; 180, Malnutrition 24. An older patient takes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for self-treatment of arthritis. For which nutritional health problems will the nurse include when assessing this patient? (Select all that apply.)

A) Thirst B) Nausea C) Diarrhea D) Vomiting E) Constipation Ans: B, C, D, E Feedback: Nutritional health problem risks associated with taking NSAIDs include nausea, diarrhea, vomiting, and constipation. Thirst is not associated with taking NSAIDs.

Origin: Chapter 36- Acute Care, 18 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 3 Page and Header: 491, Box 36-1 18. Which of the following are goals that a nurse may have in the case of a myocardial infarction in an elderly person? (Select all that apply.)

A) To aid in prompt diagnosis B) To reduce cardiovascular stress C) To minimize or eliminate causative factors D) To prevent and promptly identify complications Ans: A, B, D Feedback: The goals that a nurse may have in the case of a myocardial infarction in an elderly person include the following: to aid in prompt diagnosis, to reduce cardiovascular stress, and to prevent and promptly identify complications. It would not be appropriate to minimize causative factors as the causative factors for myocardial infarction have already occurred.

Origin: Chapter 3- Diversity, 10 Chapter: 3 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 31, Nursing Considerations for Culturally Sensitive Care of Older Adults 10. Nursing students attending City College of Nursing are scheduled for clinical experience at facilities in various sections of the city. Their experience will expose them to a wide variety of populations. Which of the following is a major reason why nurses need to understand the general characteristics of various ethnic groups?

A) To ensure that clients get the respect customary in their own ethnic group B) To provide individualized and culturally sensitive care C) To ensure that medical treatments comply with cultural expectations D) To increase compliance among minority patients Ans: B Feedback: To understand the uniqueness of each older adult encountered, consideration must be given to the influences of ethnic origin.

Origin: Chapter 36- Acute Care, 26 Chapter: 36 Client Needs: A1 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 5 Page and Header: 493, Discharge Planning for Older Adults 26. Which of the following are reasons that hospitalized older adults require early and competent discharge planning? (Select all that apply.)

A) To prevent complications B) To reduce the risk of rehospitalization C) To minimize stress to themselves and their caregivers D) So that they can leave the hospital in a sicker, more debilitated state Ans: A, B, C Feedback: Hospitalized older adults require early and competent discharge planning to prevent complications, reduce the risk of rehospitalization, and minimize stress to themselves and their caregivers. It is not a goal of early and competent discharge planning to cause patients to leave the hospital sicker and in a more debilitated state that is a consequence of payers wishing to avoid paying for extended hospital stays.

Origin: Chapter 16- Comfort and Pain Management, 9 Chapter: 16 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 4 Page and Header: 201, Medication 9. Which approach should the nurse use when considering pain management of an older patient recovering from injuries from a motor vehicle crash?

A) Try non-opioids and adjuvant drugs before providing opioid analgesia. B) Implement opioids if complementary therapies have proven to be ineffective. C) Begin with a moderate dose of opioid analgesia and taper down to the lowest effective dose. D) Restrict analgesia options to NSAIDs and adjuvant medications due to the risk of unwanted effects. Ans: A Feedback: Due to the risk of side effects in older adults, it is best to try non-opioids and adjuvant drugs prior to using opioids. It would be inappropriate to withhold analgesia entirely or until complementary therapies have been proven ineffective, and beginning with a high dose and tapering down is the opposite or the correct approach.

Origin: Chapter 5- Common Aging Changes, 13 Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 54, Cardiovascular System 13. Each of the blood vessel layers is affected differently by the aging process. Which would a nurse suspect is responsible for a patient's fibrosis?

A) Tunica intima B) Tunica media C) Tunica adventitia D) Fibrosis is caused by an enlarged heart Ans: A Feedback: The tunica intima, the innermost layer, experiences the most direct changes, including fibrosis, calcium and lipid accumulation, and cellular proliferation. The middle layer, the tunica media, undergoes a thinning and calcification of elastin fibers and an increase in collagen, which causes a stiffening of the vessels. The outermost layer, the tunica adventitia, is not affected by the aging process. In the absence of heart disease, heart size changes little with age.

Origin: Chapter 13- Spirituality, 8 Chapter: 13 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 167, Promoting Hope 8. An older male patient with end-stage renal disease is sad and believes that he will die within a few days. Which interventions should the nurse use to promote hope in the patient? (Select all that apply.)

A) Using humor at the bedside B) Facilitating a life review for the client C) Helping the client to find pleasure during current life activities D) Encouraging the client to focus on a time of life that was more pleasant E) Introducing the client to an individual who has a much poorer prognosis and/or health status Ans: A, B, C Feedback: The tactful use of humor, facilitation of life review, and aiding clients in finding pleasure in activities are noted to instill hope. Encouraging comparison to someone with a worse situation and encouraging focus on a different time of life are not noted to foster the development of hope.

Origin: Chapter 15- Rest and Sleep, 25 Chapter: 15 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 189, Promoting Rest and Sleep in Older Adults 25. An older patient is being admitted to a long-term care facility. What information will the nurse include when conducting a sleep history with this patient? (Select all that apply.)

A) Usual bedtime routine B) Characteristics of sleep C) Amount of daytime drowsiness D) Food and fluids consumed before sleep E) Number of hours doing housework each day Ans: A, B, C, D Feedback: Parts of a sleep history include the patient's usual bedtime routine, characteristics of sleep, amount of daytime drowsiness, and food and fluids consumed before sleep. The number of hours doing housework each day is not a part of the sleep history.

Origin: Chapter 3- Diversity, 18 Chapter: 3 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 27, Chinese Americans 18. A statistical analysis of City Health Clinic's patient base shows that few of its patients are elderly Asian Americans. Nurse K, a second-generation Asian American, offers a probable cause for this phenomenon. She knows that Asian American groups, though different from each other:

A) Value a strong family network and expect that family members will care for their elders at home B) Subscribe to traditional health practices and reject modern technology C) Do not express their feelings openly or challenge the health professional D) Have preserved many of their homeland traditions and tend to live in isolated pockets Ans: A Feedback: Although differences among various Asian American groups exist, two similarities are strong family networks and the expectation that family members will care for their elders at home. They do not necessarily reject modern technology and neither reluctance to express feelings nor the tendency to preserve traditions would account for the phenomenon noted.

Origin: Chapter 9- Ethical Aspects of Gerontological Nursing, 18 Chapter: 9 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 114, Ethical Principles 18. Patient R is seriously injured in an automobile accident, and his chances of survival are slim. During his diagnostic workup, lab tests reveal that he is HIV positive. The health care professional who decides to withhold the test results from R is violating the ethical principle of:

A) Veracity B) Nonmaleficence C) Beneficence D) Autonomy Ans: A Feedback: This principle is central to all nurse-patient interactions because the quality of this relationship depends on trust and integrity. Veracity is truthfulness; withholding information violates it.

Origin: Chapter 14- Nutrition and Hydration, 20 Chapter: 14 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 6 Page and Header: 178, Promotion of Oral Health 20. An older patient has dentures and tells the nurse that she has not seen the dentist for years. What is the best advice the nurse should provide the patient?

A) Visit the dentist periodically to replace the dental appliance B) Visit the dentist regularly if she wears his dentures everyday C) Make an emergency dental visit if she notices a problem with the gums D) Schedule regular visits with the dentist to monitor for lesions and fit of the dental appliance Ans: D Feedback: Older adults commonly misunderstand their need for dental care once they have dental appliances. The nurse should correct this misconception and encourage the patient to have routine dental examinations. The dental appliance may or may not need to be replaced. The patient should see the dentist regularly whether or not the dentures are worn every day. If the patient visits the dentist regularly, a problem with the gums could be avoided.

Origin: Chapter 34- Living in Harmony With Chronic Conditions, 11 Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 457, Goals for Chronic Care 11. A nurse in a cardiac fitness unit is helping an elderly man set health goals for the coming year. The patient has had one heart attack and two coronary artery bypass operations, and can now walk only one city block (1/8 mile) before tiring. Which goal seems most reasonable for him?

A) Walk 10 blocks every day B) Jog 4 blocks every day C) Walk 24 blocks every day D) Continue to walk 1 block every day Ans: A Feedback: Although setting such a goal depends very much on the patient and the course of his recovery, it seems reasonable to set a goal of walking 10 blocks (a little more than a mile) every day within a year. That is not so much as to seem unreachable, or so little as to seem worthless. If the patient tries to make progress toward that goal but fails, the goal can be revised after a few months.

Origin: Chapter 35- Rehabilitative Care, 22 Chapter: 35 Client Needs: D3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 6 Page and Header: 476, Assisting With Mobility Aids and Assistive Technology 22. A nursing home resident can walk only with difficulty and has trouble reaching the dining room by mealtime. In walking down the hall, she must frequently use the wall railings for supporting her weight, although her sense of balance is good. The entire nursing home has smooth tiled floors. Which of the following is likely the best mobility aid for the resident?

A) Walker with four wheels B) Walker with two or no wheels C) Cane with a broad claw foot D) Wheelchair Ans: B Feedback: As long as she is able to walk as far as the dining room, she should continue to do so because of the benefits of walking. A wheelchair is unnecessary. As she needs help with support rather than with balance, she needs a walker. In some situations, a walker with four wheels is desirable, but on smooth tiled floors it might move too easily and cause a dangerous fall.

Origin: Chapter 15- Rest and Sleep, 26 Chapter: 15 Client Needs: D3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 190, Food and Supplements 26. The nurse was considering melatonin supplements for an older patient with a sleep disturbance but realized this action would be contraindicated because of the patient's medications. Which medications interact with melatonin? (Select all that apply.)

A) Warfarin B) Salicylates C) Antipsychotics D) Antidepressants E) Immunosuppressants Ans: A, C, D, E Feedback: Melatonin supplements interact with immunosuppressants, antidepressants, antipsychotics, and warfarin. Salicylates are not documented as interacting with melatonin supplements.

Origin: Chapter 15- Rest and Sleep, 14 Chapter: 15 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 190, Environment 14. An older patient asks the nurse for medication to promote sleep. What is the best alternative to sleep sedatives that the nurse can suggest?

A) Watch television before going to bed B) Drink some wine before going to bed C) Take a warm bath before going to bed D) Avoid eating carbohydrates before going to bed Ans: C Feedback: A warm bath is the best alternative. Television is likely not as relaxing as a bath. Alcohol is a depressant and may help the patient go to sleep but will probably not promote quality of the sleep. A person should eat carbohydrates before sleep because they tend to raise the serotonin level, which could have a sedating effect.

Origin: Chapter 1- The Aging Population, 2 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 4, Population Growth and Increasing Life Expectancy 2. A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future?

A) While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. B) By 2020, it is expected that over one-third of Americans will be over the age of 65. C) Both life expectancy and the percentage of people over 65 in the population will increase in coming decades. D) Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020. Ans: C Feedback: Both life expectancy and the percentage of individuals over age 65 are expected to increase in coming years. About 17% of the population is expected to be over 65 by 2020.

Origin: Chapter 5- Common Aging Changes, 9 Chapter: 5 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 65, Learning 9. A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session?

A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age. B) Older adults require simplified learning objectives and slower introduction of new directions. C) Simple association is well executed by older adults but complex analysis is normally absent. D) Successful learning late in life requires a multisensory teaching approach. Ans: A Feedback: Learning ability is not seriously changed with age. It is not likely necessary to simplify learning objectives, and analysis abilities may slightly diminish but are not normally absent. A multisensory teaching approach is not noted to be required.

Origin: Chapter 13- Spirituality, 2 Chapter: 13 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 162, Spiritual Needs 2. The nurse manager of a geriatric medicine unit learns that spiritual care services are underutilized by patients and their families. Which phenomenon explains this finding?

A) While spiritual needs are a universal part of the human condition, many people do not acknowledge these needs. B) The high-stress environment of a hospital is incompatible with the solace and quiet necessary for addressing spiritual needs. C) Spiritual needs are less apparent during times of immediate and tangible need, such as acute illness requiring hospital treatment. D) Many older adults who have experienced a lifetime of self-sufficiency and practical resourcefulness do not have spiritual needs. Ans: A Feedback: All humans have spiritual needs regardless of whether they realize or acknowledge them. Some of these needs become relevant in late life when the high prevalence of chronic illness and the reality of death are evident. While a hospital does provide a high-stress environment, this is not mutually exclusive with identifying and providing for patients' spiritual needs.

Origin: Chapter 16- Comfort and Pain Management, 13 Chapter: 16 Client Needs: D1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 3 Page and Header: 196, Pain Assessment 13. The nurse is planning to assess the pain level of an older patient who is hearing impaired. Which assessment technique would be the most appropriate for the nurse to use?

A) Withhold analgesia until the patient requests it. B) Ask the patient to rate pain on a scale of 1 to 10. C) Show the patient a scale with 0 being a smile and 6 being a crying grimace. D) Show the patient a picture of the body with a pain intensity scale, and use keywords to ask about her pain. Ans: C Feedback: Because the patient is hearing impaired, asking the patient to rate pain on a scale of 1 to 10 or using a body with keywords would be inappropriate. Using the scale with faces and numbers would be the most appropriate way to assess the patient's pain. Withholding pain medication until the patient requests it is inappropriate patient care.

Origin: Chapter 1- The Aging Population, 4 Chapter: 1 Client Needs: A1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 5, Marital Status and Living Arrangements 4. Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life?

A) Women tend to both live longer than men and marry men older than themselves. B) Men tend to have greater access to care facilities due to higher incomes and savings. C) Men are more likely to live with younger family members following the death of a spouse. D) Social pressures tend to stigmatize older men who live alone. Ans: A Feedback: The facts that women live longer than men and often marry men older than themselves account for their higher rates of living alone in old age. Men are not noted to have greater access to care facilities, to be more likely to live with younger family members or to face stigma for living alone.

Origin: Chapter 8- Legal Aspects of Gerontological Nursing, 11 Chapter: 8 Client Needs: A1 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 101, Laws Governing Gerontological Nursing Practice 11. Which of the following is a matter of public, not private, law?

A) Wrongful acts against another party B) Invasion of a patient's privacy C) Assault and battery on a patient D) Licensing of a home health agency Ans: D Feedback: Public law governs relationships between private parties and the government; it includes the requirements for being licensed as a home health agency. Private law governs relationships between individuals and organizations and includes such wrongful acts against another party as invasion of privacy and assault and battery.