Gero Exam 1

6. Based on the census reports of 2010, the typical profile of a centenarian in the United States includes which of the following characteristics? a. A Caucasian woman who lives in an urban area of a Southern state b. An African American woman who lives in a rural area of a Southern state c. A Hispanic man who lives in an urban area of a Midwestern state d. A Caucasian man who lives in a rural area of a Midwestern state

ANS: A Based on the 2010 U.S. Census data, centenarians were overwhelmingly white (82.5%), women (82.8%), and living in urban areas of the Southern states.

2. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching? a. Avoid foods high in purine. b. Encourage the patient to take in 1 L of fluid daily. c. Consume one glass of red wine daily. d. Recommend that the patient eat 12-16 ounces of foods high in protein such as red meat.

ANS: A A person who is having an acute attack of gout should avoid foods that are high in purine, take in 2 L of fluid daily, avoid alcohol, and only have 4-6 ounces of foods high in protein daily.

4. A homecare nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment that provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses due to a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.

ANS: A Older adults are less likely to seek assistance than younger adults in times of disaster. The remaining options are not generally proven to be true for the majority of older adults.

6. A nurse utilizes the SPICES tool (Sleep disorders, Problems with eating, Incontinence, Confusion, Evidence of falls, and Skin breakdown) to assess an older female patient in the hospital. The nurse notes that the patient has new onset urinary incontinence. The first action by the nurse is to: a. conduct a more in-depth focused assessment of the urinary incontinence. b. call the provider and obtain an order for an antibiotic for a suspected urinary tract infection. c. send a urine specimen for culture and sensitivity. d. develop a plan of care with the patient to control episodes of incontinence.

ANS: A SPICES is an assessment tool. Anything that indicates a problem in any of the categories warns the nurse that a more in-depth assessment is needed. The nurse needs to further assess the urinary incontinence prior to implementing any interventions.

2. Which pharmacokinetic/pharmacodynamic parameter does the aging process least affect? a. Absorption b. Distribution c. Metabolism d. Excretion

ANS: A There is no conclusive evidence that the absorptive process is changed appreciably in older adults. Distribution, metabolism, and excretion are all affected significantly by aging.

4. A nurse is planning an education program on wellness in a local senior citizen center. The nurse plans to provide education on the importance of immunizations, annual physical examinations, screening for diabetes, and vision and hearing screening. It is important for the nurse to understand which of the following? a. Approximately 40% of older adults (ages 65 and older) utilize available preventive services b. Preventive strategies are more widely used in the 40-64 age group than in the 65 and over age group c. The research on health promotion strategies in older adults demonstrates that they have low efficacy d. There is an abundance of research specific to health promotion and aging

ANS: A Approximately 40% of individuals, ages 65 and older, utilize the preventive services that are available to them. However, only 24% of those between the ages of 40 and 64 do so. There is a paucity of research specific to health promotion and aging; however, the research that exists demonstrates that health promotion strategies are highly effective.

5. An older woman with breast cancer has completed a course of external radiation and is receiving chemotherapy. After her recent chemotherapy treatment, she complains of severe weakness, dizziness, and lethargy and is admitted to the hospital. Her platelet count is 45,000. Based on this scenario, what nursing intervention is of the highest priority? a. Preventing falls b. Maintaining skin integrity c. Preventing infection d. Replacing fluids

ANS: A Fall prevention is the highest priority. The patient has at least two significant risk factors for falls (unsteady gait and complaints of dizziness). She has a platelet count of 45,000; a platelet count of less than 50,000 makes one at high risk for spontaneous bleeding. The nurse must observe for overt and covert bleeding. If the patient falls, she is very likely to have a significant injury because of the low platelet count. Maintaining skin integrity would be important in this patient because she has received external radiation, which can cause alterations in skin integrity, but this is not as high a priority. Although preventing infection is an important intervention in a patient with cancer who has received radiation and chemotherapy, there is no evidence that this patient has alterations in her laboratory values related to the treatments, so fall prevention is more critical. There are no specific indications that this patient is experiencing a fluid deficit.

5. A nurse is caring for an 85-year-old male client with diabetes in a community setting. The nurse promotes functional wellness by which of the following activities? a. Encouraging the client maintains current levels of physical activity b. Assisting the client to receive all the recommended preventive screenings that are appropriate for his age group c. Teaching the patient how to use a rolling walker so that he can ambulate for longer distances d. Encouraging the client to attend his weekly chess games

ANS: A Maintaining existing levels of physical activity is consistent with functional wellness. Teaching the client how to use a rolling walker enables the client to remain active at the highest level possible, which is an example of promoting functional wellness. Receiving recommended screening is an example of promoting biological wellness. The use of a rolling walker should be based on assessment of physical ability. Encouraging the client to attend weekly chess games is an example of promoting social wellness.

2. A nurse is planning care for a group of super-centenarians in an assisted living facility. The nurse considers which of the following? a. Most super-centenarians are functionally independent or require minimal assistance with activities of daily living b. The majority of super-centenarians have cognitive impairment c. The number of super-centenarians is expected to decrease in coming years as a result of heart disease and stroke d. It is theorized that super-centenarians survived as long as they have due to genetic mutations that made them less susceptible to common diseases

ANS: A Research supports that most super-centenarians are functionally and cognitively intact, requiring minimal assistance with ADLs. The number of super-centenarians is expected to increase in coming years as the number of older adults increases. The reason why individuals survived as long as they have is not known.

4. A nurse is planning an educational session on osteoporosis to be given at a senior center. Which of the following should be discussed as preventive measures for osteoporosis? a. Following a diet with adequate amounts of calcium and vitamin D b. Increasing the intake of beverages containing phosphorus c. Having a yearly dual-energy X-ray absorptiometry DXA (or DEXA) scan d. Including isometric exercise for at least 30 minutes three times per week

ANS: A A diet with adequate amounts of calcium and vitamin D is important in preventing osteoporosis. Phosphorous is not recommended for osteoporosis prevention. The recommendation for DXA/DEXA scan is every 2 years. Exercise recommendations are for weight-bearing exercise.

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

ANS: A A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting. The changes in the retina do not account for the need for increased light that this patient is reporting.

9. When discussing pharmacological considerations, a 68-year-old client asks, "Why do medications seem to act differently than they did when I was younger?" The nurse bases the response on the concept that: a. age-related changes affect the way drugs are metabolized by older adults. b. Over-the-counter (OTC) drugs have standardized dosages that are appropriate for all ages. c. older adults may need larger doses of medication to bring about the desired effects. d. adverse drug reactions occur with similar frequency in older adults as the general population.

ANS: A Age-related pharmacokinetic and pharmacodynamic changes explain why older adults react differently to medications. OTC drugs can result in altered drug outcomes since that relates to the individual's response to the medication. Age-related changes may require smaller doses of medication in older patients than in younger patients. The rule is to "start low and go slow." The older a person is, the more likely he or she is to have an adverse drug reaction.

4. Which of the following nursing actions would help minimize the psychosocial impact of bladder and/or bowel incontinence for individuals experiencing incontinence prior to going to a group dining room? a. Assess for soiled clothing and change, if necessary. b. Toilet the client and then promptly transport to the dining room. c. Provide peri-care and fresh underclothing. d. Ask the client if toileting is needed and assist as necessary.

ANS: A Deviations from normal bowel and bladder toileting can lead to chastisement, ostracism, and social withdrawal. By addressing incontinency issues prior to social interactions, such negative responses can be minimized. While toileting is appropriate, it does not directly address the social impact that may result from soiled and/or odorous clothing. Providing peri-care and clean underclothing is necessary only if incontinency has occurred. Asking to toilet the client is not necessarily an effective intervention when the client is consistently incontinent.

4. A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right thoracic area. The nurse suspects HZ. The patient asks the nurse, "I really don't understand how I got shingles. I don't even know anyone who has this infection." The nurse includes which of the following in formulating a response to the patient? a. HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion b. HZ is caused by the same virus as chickenpox and requires exposure to an individual with active chickenpox c. HZ is caused by the same virus as chickenpox and requires direct contact with an individual with HZ d. HZ is caused by the varicella zoster virus and occurs only in individuals who were never previously exposed to the virus

ANS: A HZ is a viral infection caused by a reactivation of the latent varicella zoster virus (the same virus that causes chickenpox) within the sensory neurons of the dorsal root ganglion, decades after the initial varicella zoster infection is established. HZ is infectious until the lesions are completely crusted over. Individuals do not have to have direct contact with someone who has either chickenpox or HZ in order to have a reactivation; other factors such as illness and stress can cause the reactivation. Individuals who have HZ infection were previously exposed to the varicella zoster virus.

3. Hyperglycemia is harder to detect in older adults due to which of the following? a. There is a higher tolerance for elevated levels of circulating glucose in older adults. b. Older adults tend to metabolize glucose at a faster rate than younger adults. c. Fingerstick glucose monitoring is inaccurate in older adults. d. The classic signs of elevated glucose levels, polyuria, polyphagia, and polydipsia are rarely present in older adults.

ANS: A Hyperglycemia in older adults is harder to detect than in a younger adult. With aging there is a higher tolerance for elevated levels of circulating glucose. It is not unusual to find persons with fasting glucose levels of 200-600 mg/dL or higher. It is not true that older adults metabolize glucose at a faster rate than younger adults or that fingerstick glucose monitoring is inaccurate in older adults. While it is true that older adults usually do not have the classic symptoms of elevated glucose levels, this does not explain why hyperglycemia is harder to detect in older adults.

A nurse is auscultating an older patient's heart and notes a systolic murmur (heard between the S1 and S2 heart sounds. The first action by the nurse is to: a. question the patient about the presence of the murmur. b. note it in the chart as this is always a normal finding for an older adult. c. contact the medical provider as this is an abnormal finding. d. immediately implement emergency interventions.

ANS: A In normal aging, the heart valves separating the chambers thicken and stiffen as a result of lipid deposits and collagen cross-linking. Mild systolic murmurs (between S1 and S2) are expected findings in the older adult. Aortic and mitral valves are those most commonly affected. If the nurse auscultates a systolic murmur in an asymptomatic older adult, he or she should ask about it. Most older adults will reply that they have had it for a while. If this is not the case, the person is referred to a cardiologist. If the new finding is accompanied by any significant signs or symptoms of distress, it is a medical emergency. Diastolic murmurs (heard between S2 and S1) are always indicative of a serious problem in cardiac hemodynamics and these persons are followed closely by a cardiologist.

The son of a nursing home resident asks a nurse: "What is the significance of being certified in gerontology? I see that you are, but not all of the nurses are." The best response by the nurse is which of the following? A. "National certification as a gerontological nurse is a way to demonstrate special knowledge in caring for older adults" B. "National certification in gerontology is required for all nurses who have worked in this setting for 2 or more years" C. "National certification is only available to nurses who have a Baccalaureate degree in nursing" D. "Only advanced practice nurses, like nurse practitioners, are certified in gerontology"

ANS: A National certification is a way to demonstrate special expertise in caring for older adults. It is not required for practice in any setting across the continuum of care, and it is not exclusive to nurses with Baccalaureate degrees. There is both a generalist and a specialist gerontological nursing certification. The generalist functions in a variety of settings providing care to older adults and their families. The specialist has advanced gerontological education at a Masters level.

4. The area in which nurses have the greatest effect on the safe, effective medication therapy of an older client is: a. educating the client to all aspects of the medication. b. assessing for adverse reactions to the medication. c. monitoring overall health of the client as it is affected by the medication. d. evaluating the outcomes resulting from the medication.

ANS: A Nurses have the greatest opportunity to impact medication use and improve treatment outcomes through patient education. Assessing for reactions, monitoring effects, and evaluation of outcomes all depend on the client's understanding and compliance with the medication therapy (i.e., are affected by client education).

1. Factors that affect the pharmacokinetics of lipophilic medications in older adults include: a. greater adipose tissue ratio to body mass. b. decreased total body water. c. increased glomerular filtration rate. d. increased creatinine clearance.

ANS: A Older adults have a higher ratio of adipose (fat) tissue where lipophilic (fat-soluble) medications can be stored thus resulting in a potential for an accumulation of the medication and potentially fatal overdoses. Older adults have a decrease in lean body mass and an increase in fat. An increased body mass would not affect lipophilic medication absorption. Older adults have a decreased glomerular filtration rate, which begins to decline as early as age 25. Older adults have a decrease in overall kidney function.

1. Serious and well-controlled research studies on aging have been available: a. only in the past 60 years. b. since the turn of the 20th century. c. following the Great Depression. d. since the year 2000.

ANS: A Only in the past 60 years have serious and carefully controlled research studies flourished. Before that, anecdotal evidence was used to illustrate issues assumed to be universal, making all the remaining options incorrect.

3. What factor is an important contribution to polypharmacy in older adults? a. Inadequate communication among medical care providers b. Implementation of Medicare Part D prescription drug benefit c. Use of generic medications d. Increasing popularity of dietary and herbal supplements

ANS: A Polypharmacy is often the result of inadequate communication among specialists or between specialists and primary care providers. Medicare Part D prescription drug benefits influence the financing of medication but are not directly related to polypharmacy. Generic medications are a way to keep medication costs down. The use of herbal supplements is an important factor when examining drug interactions or adverse reactions but is not a direct factor related to polypharmacy.

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

ANS: A Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children's voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present.

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

ANS: A Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye. All of the other options are normal age-related changes; however, they are not related to presbyopia.

8. An older woman asks a nurse in the cardiology practice, "What is the ideal number that my cholesterol levels should be? I am confused by all of the different numbers." The nurse formulates her response on the knowledge that: a. recent guidelines from the American Heart Association state that there is no "one size fits all" recommendation and that recommendations must be individualized to each patient. b. recent guidelines from the American Heart Association provide different recommendations for individuals age 65-74, 75-84, and over age 85. c. recent guidelines from the American Heart Association recommend a total serum cholesterol level below 100. d. recent guidelines from the American Heart Association recommend a total serum cholesterol level over 200.

ANS: A Recent guidelines from the American Heart Association state that there is no "one size fits all" recommendation and that recommendations must be individualized to each patient. Multiple factors that must be considered include family history, other risk factors for heart disease, and long-term risk-benefit ratios.

2. An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, "How did I get something like this?" The best response by the nurse is: a. "Scabies is highly contagious and spreads easily through physical contact." b. "Scabies is commonly seen in older adults due to normal age-related changes in the skin." c. "Scabies is only seen in older adults who have multiple chronic illnesses." d. "Certain medications can make you more susceptible to contracting scabies."

ANS: A Scabies is caused by a tiny burrowing mite and is highly contagious and easily passed by an infected person to family members and others in close contact by direct physical content. It is not limited to older adults, and age-related changes in the skin do not cause it or make a person more susceptible. Individuals with multiple chronic conditions are not more likely to develop scabies than other individuals. There is no evidence that medications can make an individual more susceptible.

7. An older adult with gastric cancer with bone metastases is being discharged from the hospital after beginning a regimen of opioid analgesics to control the metastatic pain. What should be included in the discharge teaching plan? a. The development of a plan to prevent constipation b. Benefits of grief counseling c. Increasing calories in the diet d. Preventing pressure ulcers

ANS: A Side effects of opioids are significant to older adults and include constipation. Because constipation is almost universal when opioids are used, the nurse should ensure that an appropriate bowel regimen is taken at the same time as the opioids. The remaining options are not specifically related to the management of the client's pain or the effects of opioid treatment.

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

ANS: A Signs of cataracts include the appearance of halos around objects as light is diffused, blurring, decreased perception of light and color giving a yellow tint to most objects, and a sensitivity to glare.

The FANCAPES assessment tool focuses on the older adult's: a. ability to meet personal needs to identify the amount of assistance needed. b. ability to perform instrumental activities of daily living (IADLs). c. cognitive abilities. d. level of dementia present.

ANS: A The FANCAPES assessment tool focuses on physical functioning and evaluates the individual's ability to meet his/her needs and how much assistance is needed to meet the needs. FANCAPES evaluates physical functioning. IADLs involve more than just physical functioning. FANCAPES does not assess cognitive function, nor does it assess dementia.

3. The major goal of the NICHE (Nurses Improving Care for Health System Elders) program includes which of the following? a. Improve outcomes for hospitalized older adults b. Increase the number of older adults cared for in hospitals c. Increase the number of iatrogenic complications that occur in hospitalized older adults d. Decrease 30-day readmission rates for hospitalized older adults

ANS: A The goal of NICHE is to improve outcomes for hospitalized older adults. Although D is a good outcome for hospitalized older adults, it is not one of the major goals of NICHE, which are broader. Options b and c are not goals that would improve care for older adults, but would be negative outcomes themselves.

1. The most significant etiology for chronic obstructive pulmonary disease (COPD) is: a. tobacco use. b. chronic bronchitis. c. exposure to carcinogens in the workplace. d. emphysema.

ANS: A Tobacco use or exposure is the most significant etiology for COPD and accounts for 80% to 90% of all cases of COPD. Exposure to certain chemicals in the work environment may be a causative factor of COPD but is not as significant as tobacco. COPD includes emphysema and chronic bronchitis.

1. When performing a pain assessment on a client who is aphasic, the nurse should consider: a. reports from the family or staff at the nursing home about changes in functional status. b. that the patient is lying quietly in bed so she is not likely to be experiencing pain. c. that the patient's previous stroke interrupted pain pathways so she does not feel pain. d. that older adults do not tolerate opioid analgesics well and may exhibit side effects.

ANS: A When an individual is not able to verbally communicate complaints of pain, reports from family or caregivers are important. In addition, in older adults, pain is often manifested as changes in functional status. To assume that the patient is not in pain because she is lying quietly in bed is incorrect. One should not assume that she feels no pain due to her stroke. Older adults tolerate opioid analgesics.

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

ANS: A The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

3. An older adult client is being seen for the first time at the outpatient geriatric clinic. As a component of the nursing admission history, the nurse inquires about the use of herbs and other supplements. The basis for this inquiry is that such herbal therapy: a. may interact with prescription medications. b. is hazardous when used by older adults. c. replaces the need for prescription medications. d. causes excessive sedation in older adults.

ANS: A The gerontological nurse has the obligation to ask questions and obtain specific information about the use of herbs and supplements because they may interact with prescription medications. When used cautiously and with knowledge of potential interactions with other medications, herbs and supplements are not hazardous. They do not replace the need for prescription medications. Not all herbs and supplements cause excessive sedation.

3. A nurse implements a nursing care plan for a patient with constipation. Which of the following should the nurse include in the plan? a. Increasing fiber in the diet b. Administering aluminum hydroxide antacids c. Bed rest d. Restricting fluids

ANS: A Fluid intake of at least 1.5 L/day, unless contraindicated, is the cornerstone of constipation therapy, with fluids coming mainly from water. A gradual increase in fiber, either as supplements or incorporated into the diet, is generally recommended. Fiber helps stools become bulkier and softer and move through the body more quickly. Physical activity is important as an intervention to stimulate colon motility and bowel evacuation. Daily walking for 20-30 minutes, if tolerated, is helpful, especially after a meal. Aluminum hydroxide antacids are known to be constipating.

7. Changes in certified nursing facilities in recent years include which of the following? (Select all that apply.) a. Increase in the number of subacute beds b. Decrease in nursing facility length of stay c. Increase in level of acuity of the residents d. Decrease in cost of care in the nursing facility e. Decrease in the number of registered nurses employed in long-term care facilities

ANS: A, B, C Certified nursing facilities have evolved over recent years. Most facilities have subacute care units that resemble hospital units caring for more patients with higher acuity than in the past. Therefore, the average length of stay in a facility has decreased. The cost of care in the facility has increased due to the increased complexity of illnesses treated, and the number of registered nurses has increased in order to care for these complex patients.

2. A nurse organizes a health fair for older adults. The nurse's goal is to focus on the six priority areas identified by the National Prevention Council. Which of the following activities should the nurse include? (Select all that apply.) a. Smoking cessation b. Depression screening c. Recognizing elder abuse d. Cholesterol screening e. Fitness training

ANS: A, B, C The six priority areas of the National Prevention Council include tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being. Smoking cessation, depression screening, and recognizing elder abuse all directly address these areas. While cholesterol screening and fitness training are important for older adults, they do not address these six priority areas.

2. A nurse completes a cultural assessment of an older adult who is being admitted to an assisted living facility. Reasons for completing a cultural assessment include: (Select all that apply.) a. culture guides decision-making about health, illness, and preventive care. b. culture provides direction for individuals on how to interact during health care encounters. c. culture impacts attitudes toward aging. d. all members of a culture react in the same way in similar situations. e. knowledge of culture eliminates health care disparities.

ANS: A, B, C Although knowledge of culture has the potential to optimize care, not all individuals will respond in the same way to a specific situation. Knowledge of an individual's culture will not eliminate health care disparities.

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

ANS: A, B, C Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease. Laser treatment can reduce vision loss in 50% of patients. Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression.

1. A 77-year-old Hispanic Catholic nun (retired) who immigrated to the United States 15 years ago lives alone but in an apartment complex where her biological sister lives as well. She is being discharged home after a hospitalization for congestive heart failure with prescriptions for eight different medications. She is considered at risk for noncompliance due to contributing factors that include: (Select all that apply.) a. language barrier. b. living alone. c. large number of medications. d. ethnic background. e. religious background.

ANS: A, B, C Language barriers, living alone, and a large number of medications are all factors that have been shown to contribute to noncompliance in older adults. There is no evidence that ethnic or religious background contributes to noncompliance.

1. A nurse is developing an educational session for a group of older adults at a senior center. Which of the following would the nurse include in the education? (Select all that apply.) a. Attention span, language, and communication skills typically remain stable with increasing age b. Older brains slow down and take longer to process constantly increasing amounts of information c. In order to preserve brain function, it is important to engage in challenging cognitive activities d. Older adults are not able to develop new cognitive abilities e. Individuals over age 100 have a higher prevalence of dementia than younger individuals

ANS: A, B, C Older adulthood is no longer seen as a period when cognitive development is halted; it is a life stage where unique capacities are developed. Centenarians and super-centenarians have a lower prevalence of dementia then those under age 100.

5. A nurse is educating an older adult with diabetes on glucose self-monitoring. When developing the teaching plan, the nurse includes which of the following goals in the teaching plan? The patient will: (Select all that apply.) a. demonstrate the technique for obtaining a blood sample. b. verbalize actions to take when results indicate an error on the machine. c. state the correct timing of blood glucose monitoring. d. state the signs and symptoms of both hyperglycemia and hypoglycemia. e. demonstrate technique for storing and transporting insulin correctly.

ANS: A, B, C Option D is important for an older person with diabetes; however, it is not directly related to glucose self-monitoring. Option E is important for a person who is taking insulin, however is not directly related to glucose self-monitoring.

1. A nurse is educating a group of older adults on the impact of lifestyle changes on hypertension. The nurse includes which of the following in the education? (Select all that apply.) a. Learning how to read and interpret food labels b. The sodium content of commonly consumed foods c. Techniques to incorporate more physical activity into the daily routine d. The actions of calcium channel blocker medications on hypertension e. The importance of adhering to pharmacological regimens for treatment of hypertension

ANS: A, B, C Options A and B address dietary interventions to control hypertension. Option C addresses physical activity. These all involve lifestyle changes to control hypertension. Options D and E are related to pharmacological treatment of hypertension.

3. The "in-between" generation (individuals born between 1915 and 1945) were subject to which of the following health challenges during their childhood? (Select all that apply.) a. Polio b. Lack of fluoride in the water causing teeth to be soft and cavity prone c. "Pigeon Chest," a malformation of the rib cage due to a lack of vitamin D d. Smallpox e. HIV/AIDS

ANS: A, B, C Polio was a major fear of this group; the polio vaccine was not available in the United States until 1955. In many areas water was not fluoridated. "Pigeon Chest" was common. Smallpox was a concern for the centenarians, not this generation. HIV/AIDS had not been identified in the early years of 1915-1945.

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

ANS: A, B, C Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist. Fall prevention is also very important as is complying with eye drop administration. Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction. There usually is not a dressing over the operative site, and not for 10 days.

2. An older patient complains of pruritus. The nurse suggests which of the following interventions to alleviate the patient's complaint? (Select all that apply.) a. Use only nonperfumed laundry detergent and fabric softeners b. Avoid sudden temperature changes c. Wear loose-fitting clothing d. Apply heat to affected areas e. Exercise vigorously for at least 30 minutes daily

ANS: A, B, C Pruritus is aggravated by heat, sudden temperature changes, sweating, restrictive clothing, fatigue, exercise and anxiety, perfumed detergents, and fabric softeners.

1. A nurse identifies a need to assess a patient's cognitive status. The nurse chooses to use the MMSE. The nurse knows that the patient must have which of the following abilities? (Select all that apply.) a. Number fluency b. Familiarity with analog clocks c. Ability to hear and see d. Ability to sit up for 10 minutes e. Ability to speak English

ANS: A, B, C The MMSE requires number fluency, ability to see and hear and hold a pencil, and experience with analog clocks. The instrument is available in languages other than English. It is a cognitive status exam and does not require that the patient be able to sit up.

5. Which of the following are subscales on the Braden Scale for predicting pressure ulcers? (Select all that apply.) a. Nutrition b. Moisture c. Mobility d. Age e. BMI

ANS: A, B, C The six subscales of the Braden Scale are sensory perception, activity, mobility, moisture, friction and shear, and nutrition.

2. An older adult is seen in the emergency department after falling and sustaining substantial soft tissue bruising. The assessment interview notes a history of arthritic pain in several joints. The client is prescribed 650 mg of acetaminophen (Tylenol) four times per day and 800 mg of ibuprofen (Motrin) four times per day for control of the persistent arthritic pain. When providing discharge teaching, the nurse includes information regarding the signs and symptoms of: (Select all that apply.) a. gastrointestinal bleeding. b. renal impairment. c. medication interactions. d. confusion. e. increased anxiety.

ANS: A, B, C There is no indication that the patient is at risk for mental status changes such as confusion or increased anxiety. The remaining options are directly related to the possible outcomes of long-term pain management with these medications.

3. A nurse is planning education for a group of older adults at a senior center on promoting respiratory health. Which of the following should the nurse include in the education? (Select all that apply.) a. Annual influenza immunization b. Pneumococcal pneumonia immunization c. Smoking cessation d. Weight reduction e. Benefits of low-sodium low-fat diets

ANS: A, B, C Guidelines for good respiratory health include pneumonia immunization, annual influenza immunization, avoiding exposure to smoke and pollutants, smoking cessation, avoiding individuals with respiratory illness, promptly treating respiratory infections, and hand hygiene. Although weight reduction and a low-sodium, low-fat diet are important, neither is directly related to respiratory health.

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

ANS: A, B, C, D African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among the other high-risk groups. Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups.

2. Factors that complicate assessment of older adults include: (Select all that apply.) a. presence of multiple comorbid conditions. b. atypical presentation of illness. c. difficulty in differentiating symptoms of disease from normal age-related changes. d. increase in iatrogenic illness. e. lack of assessment instruments specific for the older adult population.

ANS: A, B, C, D Factors that complicate assessment of older adults include difficulty differentiating disease symptoms from normal age-related changes, the presence of multiple comorbidities, atypical presentations of illness, and the presence of iatrogenic illness. There are many assessment tools that are designed specifically for use in the older adult population.

2. An elderly man is brought to the geriatrics clinic by his wife because of his increasing confusion. As part of his medical workup, the nurse practitioner orders which of the following laboratory tests? (Select all that apply.) a. Basic metabolic panel b. Vitamin D level c. Thyroid stimulating panel d. Vitamin B12 e. Serum albumin level

ANS: A, B, C, D The following laboratory tests are part of a workup for a change in mental status: Basic metabolic panel, vitamin D level, vitamin B12, thyroid stimulating panel. Serum albumin is not part of a dementia workup.

1. The nurse in a clinic setting that provides care for an ethnically diverse population of older clients shows an understanding of the LEARN Model to direct the assessment process when: (Select all that apply.) a. recognizing that the client's hands are clenched as she answers the assessment questions. b. asking the client to describe what he thinks will help him feel better. c. explaining to the client that herbal remedies may not be sufficient treatment for his chest congestion. d. acknowledging that the client has a different view of the appropriate treatment. e. suggesting to the client that it would be beneficial if she would trust her health care provider to prescribe the correct treatment.

ANS: A, B, C, D The LEARN Model implements active listening to both the client's verbal and nonverbal communication as a means of obtaining insight into the client's perspective of his or her medical problem. This model also encourages the nurse to recognize that the perceptions may differ and to explain the differences in perceptions to the client. The model advocates arriving at a mutually agreed upon treatment plan rather than encouraging the client to surrender personal autonomy in the decision-making.

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

ANS: A, B, C, E Options A, B, C, and E are all factors associated with low use after purchase. Option D is incorrect; most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use.

1. A nurse is assessing an older adult's respiratory status. Which of the following are normal age-related changes in the respiratory system? (Select all that apply.) a. Diminished cough reflex b. Stiffening of the chest wall c. Increased resistance to airflow d. Decreased respiratory rate e. Loss of elastic recoil

ANS: A, B, C, E Age-related changes include loss of elastic recoil, stiffening of the chest wall, and increased resistance to airflow leading to more effort required for movement of the diaphragm. A diminished cough reflex is a normal age-related change. A decreased respiratory rate is not a normal age-related change.

4. A nurse is caring for a frail older adult in a long-term care facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (Select all that apply.) a. Make sure that the temperature in the resident's room is at least 65 degrees Fahrenheit. b. Cover residents well when in bed and while bathing. c. Provide a head covering for the resident. d. Maintain resident in bed covered with heavy blankets at all times. e. Provide hot, high-protein meals and bedtime snacks.

ANS: A, B, C, E Interventions to prevent hypothermia in frail elders include maintaining an ambient temperature of no lower than 65 degrees Fahrenheit, providing a head covering whenever possible—in bed, out of bed, and particularly out-of-doors, covering patients well when in bed and when bathing, and providing hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. In addition, it is important to get the patient out of bed and provide as much exercise as possible to generate heat from muscle activity.

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

ANS: A, B, C, E Normal age-related changes in the external eye include a loss of elasticity causing drooping. Eyes become drier, and the eyelids may not close completely. Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid. Loss of eyelashes is not a normal age-related change.

2. An otherwise healthy older adult reports having begun to experience problems "holding my water." The nurse shows an understanding of interventions that may help minimize the problem of urinary incontinence when: (Select all that apply.) a. asking whether the client smokes tobacco. b. assessing the average amount of caffeine the client drinks daily. c. asking if the client has been evaluated for diabetes recently. d. suggesting the client keep a record of the amount of fluids ingested daily. e. reviewing the client's current medication list.

ANS: A, B, C, E Risk factors for urinary incontinence include tobacco use, caffeine consumption, and increased urine resulting from diabetes and certain medications. Keeping record of fluid intake will have little or no impact on urine incontinence.

4. A nurse is assessing a patient's activities of daily living. The nurse will assess which of the following? (Select all that apply.) a. Eating b. Continence c. Toileting d. Self-medication administration e. Bathing

ANS: A, B, C, E The basic activities of daily living include eating, transfer, toileting, bathing, continence, and dressing. Self-medication administration is an independent activity of daily living (IADL).

2. An older client prescribed a transdermal morphine patch for severe chronic pain is being educated on the appropriate administration of the medication. The nurse shows an understanding of essential information regarding this route of drug administration when stating: (Select all that apply.) a. "This is an effective route for delivering small doses of medication over long periods of time." b. "Since you have problems with digestion, this is a good way to take your medication." c. "Please show me how you would apply your patch." d. "Be careful to put the patch only on your chest but change locations with each application." e. "Be sure to avoid placing the patch on injured skin."

ANS: A, B, C, E Aging does increase the risk of developing an allergic reaction due to its effect on the immune system and decreased gastric motility. Transdermal medications bypass the gastrointestinal tract and so do not cause digestion problems, and their effectiveness is not affected by digestive problems. Demonstrating the application process is an excellent way to evaluate the client's understanding and technique. Transdermal patches can be applied to areas other than the chest, such as the arms, backs, legs, and abdomen, but damaged skin should be avoided.

3. Best practice recommendations for undergraduate nursing education in relation to gerontology include which of the following? (Select all that apply.) a. Provision of a "stand-alone" course in gerontological nursing b. Integration of gerontological content throughout the curriculum c. Replacement of acute care pediatric clinical experiences with gerontological clinical experiences d. Recruitment of nurses with Masters and Doctoral degrees and a specialty in gerontology to faculty roles e. Requiring all undergraduate nursing students to obtain gerontological certification as a requirement for graduation

ANS: A, B, D Best practices include providing a stand-alone gerontological nursing course as well as integrating gerontology throughout the curriculum. Recruitment of nurses with a specialty in gerontology and a Masters or Doctoral degree to faculty roles is a critical step in making sure that the next generation of nurses is prepared to care for older adults. Best practices do not recommend removing pediatric clinical experiences and replacing them with gerontological experiences. Nursing certification is only available to practicing nurses who meet specific education and practice requirements. It is not applicable to nursing students.

3. A nurse is caring for an older adult who has metabolic syndrome. The nurse knows that the following conditions are common in persons with metabolic syndrome: (Select all that apply.) a. Glucose levels that are higher than normal b. Increased waist circumference c. Blood pressure that is lower than normal d. Increased blood cholesterol levels e. Decreased triglyceride levels

ANS: A, B, D Metabolic syndrome is characterized by higher than normal glucose levels, increased waist size due to excess abdominal fat, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood.

4. A nurse works in an outpatient diabetes clinic. The nurse knows that the minimum standard of care for a patient with diabetes includes the following at each visit: (Select all that apply.) a. Monitoring weight and BP b. Inspecting the feet c. Obtaining hemoglobin A1C d. Reviewing self-management skills e. Obtaining fasting lipid profile and serum creatinine

ANS: A, B, D Minimum standards of care for an individual with diabetes include the following at each visit: Monitoring weight and BP, inspecting feet, reviewing self-monitoring glucose record, reviewing/adjusting medications as needed, reviewing self-management skills/goals, assessing mood, counseling on tobacco and alcohol use. Obtaining hemoglobin A1C is recommended at quarterly intervals and obtaining fasting lipid profile and serum creatinine is recommended annually.

3. A patient is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? (Select all that apply.) a. Osteoporosis is common in females after menopause. b. Osteoporosis is a degenerative disease characterized by a decrease in bone density. c. The disease is congenital, caused by poor dietary intake of dairy products. d. Osteoporosis can cause pain and injury. e. Passive range of motion can prevent osteoporosis.

ANS: A, B, D Osteoporosis is not a congenital disease. While a low intake of calcium is a factor, there are dietary sources of calcium other than dairy products. Passive range of motion cannot prevent osteoporosis.

5. A nurse is involved in primary prevention activities related to the promotion of respiratory health. The nurse is involved in which of the following activities? (Select all that apply.) a. Organizing an influenza vaccination clinic b. Promoting a smoking cessation program in the community c. Referring individuals with respiratory disease to the pulmonology clinic at the hospital d. Visiting a congressman representative to advocate for legislation on clean air e. Teaching individuals with COPD measures to maximize lung function

ANS: A, B, D Primary prevention includes activities such as promoting or conducting smoking cessation programs and community intervention, including organizational efforts to promote and administer preventive vaccinations such as that for influenza and pneumonia. Primary prevention includes political activism with industry leaders and environmental agencies to push for clean air and water. Referrals to specialists or teaching individuals who already have respiratory illness are not part of primary prevention.

3. An older patient tells a nurse. "The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still don't understand why this happens to me." The nurse responds based on the knowledge that: (Select all that apply.) a. purpura is due to normal age-related changes. b. the incidence of purpura increases with age. c. purpura is a precancerous skin condition. d. individuals who take blood thinners are especially prone to purpura. e. individuals prone to purpura should make sure that affected areas are open to the air.

ANS: A, B, D Purpura is due to normal age-related changes and hence the incidence increases with age. Individuals who take blood thinners are especially prone to purpura. Purpura is not a precancerous condition. Individuals who are prone to purpura are encouraged to wear protective garments such as long sleeves and long pants.

3. The benefits of telehealth include that it: (Select all that apply.) a. promotes self-management of illness in rural and underserved areas. b. facilitates remote physical assessment and monitoring of chronic conditions. c. decreases costs by replacing the role of the nurse with technology. d. decreases costs by reducing hospital readmissions. e. is reimbursed by all health care insurances.

ANS: A, B, D Telehealth promotes self-management of illness and facilitates remote assessment and monitoring in rural and underserved areas. Evidence has demonstrated that it reduces costs by decreasing hospital readmission. Telehealth does not replace the role of the nurse; the technology augments the ability of the nurse to reach clients in remote areas. Unfortunately, not all health care insurers reimburse for telehealth services.

2. Which precaution would be beneficial in minimizing an older adult's risk of being a victim of fraud? (Select all that apply.) a. Do not allow uninvited salespersons into your home. b. Never provide personal information to telephone sales solicitors. c. Rely on the advice of people who only friends have recommended. d. Contact the local Medicare or Medicaid service office for information when needed. e. Keep your bank account and credit card numbers with you at all times.

ANS: A, B, D The correct options provide sound advice, but relying on friends alone for advice may not be prudent while personal information should be kept in a safe place, not necessarily on your person.

4. An older patient with atrial fibrillation is prescribed warfarin for anticoagulation. Which of the following should the nurse include in the teaching plan? (Select all that apply.) a. Frequent blood testing is required to assure that the level of anticoagulation is in the correct range. b. Limit dietary intake of vitamin K. c. Increase dietary intake of vitamin D and calcium. d. Inform the medical provider if any antibiotics are ordered from any other provider. e. Seek medical attention immediately if an injury is sustained.

ANS: A, B, D, E Frequent blood testing is required to check the level of anticoagulation. Vitamin K is an antidote to warfarin, so the patient must limit intake of vitamin K. Warfarin interacts with most antibiotics. Since warfarin is an anticoagulant, the patient needs to seek medical attention if an injury is sustained due to risk of bleeding. Vitamin D and calcium are unrelated to warfarin.

3. When individualizing pain management for a client hospitalized after major surgery, the nurse will: (Select all that apply.) a. titrate the prescribed analgesic medication to provide effective pain management. b. assess the client for cultural beliefs that affect individual expression of pain. c. reassure the client that pain medication is available whenever he or she expresses a need for it. d. anticipate the client's need for pain medications. d. implement nonpharmacological pain management interventions whenever possible.

ANS: A, B, D, E The client will require knowledge about the frequency of the administration of the medication; if the requests are consistently made before the medication can be readministered, the treatment plan should be reevaluated and altered. The other options reflect appropriate interventions for effective pain management.

2. The nurse is preparing discharge teaching for a client diagnosed with chronic obstructive pulmonary disease (COPD). Which nursing statement would be included in this intervention? (Select all that apply.) a. "Are you familiar with pursed-lip breathing?" b. "It will be necessary to demonstrate postural drainage techniques with a caregiver." c. "We will need to discuss alterations in your diet." d. "Can you explain the purpose of the medications you have been prescribed?" e. "There are some things I'd like to discuss about adaptive sexual practices."

ANS: A, B, D, E Topics that will be included in this client's discharge teaching include pursed lip breathing, postural drainage techniques, medication education, and safe sexual activity. Diet is not generally a factor in this disease process.

1. What information should be included in an informational program to be presented on burn prevention to a senior citizens group? (Select all that apply.) a. Do not smoke in bed or when sleepy b. Wear well-fitted clothing when cooking or when grilling outdoors c. Establish a meeting place for all family members outside of the home in case of a fire d. Establish a plan for exiting each room of your home in the case of a fire e. Have a fire extinguisher readily available in the kitchen

ANS: A, B, E Measures to prevent burns include not smoking in bed or when sleepy, not wearing loose-fitting clothing (e.g., bathrobes, nightgowns, pajamas) when cooking or around an open heat source, and installing a portable hand fire extinguisher in the kitchen. The remaining options are related to safely evacuating a home in case of a fire.

4. A nurse hears a colleague state the following: "Can you believe that Mr. Jones' daughter just bought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn to use it." The nurse formulates a response based on research that shows: (Select all that apply.) a. older adults comprise the fastest growing population using computers and the Internet. b. Internet use is less prevalent in individuals over age 75 than those ages 65-74. c. older American men are the fastest growing group of social networking site users. d. older adults use the Internet only for social networking and recreational uses. e. technology has the potential to improve quality of life for older adults.

ANS: A, B, E Older adults are the fastest growing population using computers and the Internet. Internet use does decrease in those over age 75 as compared to older adults less than age 75. Older women are the fastest growing group of individuals using social networking sites. Older adults use technology for a whole host of reasons, both social and to communicate with health care providers and access health information. Technology has a large potential to improve quality of life for older adults.

4. A nurse is educating a group of nursing assistants in long-term care on the prevention of skin tears. Which of the following interventions should the nurse include in the education? (Select all that apply.) a. Lubricate the resident's skin with moisturizers twice daily b. Ensure that the resident has adequate nutrition and hydration c. Bathe the resident in hot soapy water d. Avoid the use of lifting shifts when transferring the resident e. Dress the resident in long sleeves and long pants to protect the extremities

ANS: A, B, E Soapless bathing, tepid water, and moisturizers twice daily are recommended to prevent skin tears. Heavy soaps and hot water dry out the skin increasing the risk of skin tears. Lifting sheets are recommended as are the use of long sleeves and long pants to protect the extremities.

1. The impact of the Patient Protection and Affordable Care Act of 2010 on gerontological nursing includes which of the following? (Select all that apply.) a. Funding to support advanced education in gerontological nursing b. Funding to support education of faculty in gerontology c. Funding to increase the number of direct care workers in hospitals d. Funding to increase nurse-patient ratios in long-term care e. Funding for advanced training of direct care workers in long-term care

ANS: A, B, E The Patient Protection and Affordable Care Act of 2010 provides funding for advanced education in gerontology, education for faculty in gerontology, and advanced training for direct care workers in long-term care. The act does not address nurse-patient ratios or staffing issues in any setting.

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

ANS: A, C, D Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications.

5. A nurse interviews for a job in a hospital that advertises that it is "elderly friendly." The nurse would expect to see which of the following in place? (Select all that apply.) a. An elder-assistance program to help patients remember their appointments and navigate the hospital services. b. A long-term care facility that is affiliated with the hospital c. Rooms furnished with foldout beds for family members/caregivers d. An initiative to provide gerontological education for all nurses e. An initiative to increase the number of patients referred to long-term care facilities upon discharge from the hospital

ANS: A, C, D The guiding principles of an elder friendly facility include treating each patient as a unique individual and accommodating the patient and family's special needs. Other principles include ensuring that the nurses are clinically competent in gerontological nursing. Tailoring the environment to support the implementation of these principles is part of this initiative. Option B is not correct as it does not relate to the concept of an elder friendly hospital. Option E is not correct since this might not be a supportive intervention for all patients.

1. A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patient's plan of care? (Select all that apply.) a. Encourage adequate fluid intake b. Encourage daily baths of at least 20 minutes c. Maintain a humid environment d. Apply water-laden emulsions to skin immediately after bathing e. Use only deodorant soaps when bathing

ANS: A, C, D Xerosis is extremely dry, itchy skin. Adequate intake of water is essential in rehydrating the skin. Long duration baths or showers should be avoided, and daily bathing may not be needed. An environment of 60% humidity is recommended. Water-laden emulsions should be applied immediately after bathing. Deodorant soaps should be avoided except in the axilla and groin.

1. An older aphasic client has severe osteoarthritis, bilateral contractures of the lower extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? (Select all that apply.) a. "Client slept throughout the night." b. "Client winces only when turned and repositioned." c. "Client slept during dressing change." d. "Client cooperative during morning care." e. "Client ate 80% of breakfast, 70% of lunch, and 100% of dinner."

ANS: A, C, D, E A pain cue presented by this client is the wincing when being turned, indicating that this intervention is producing pain. The remaining observations are concurrent with effective pain management.

2. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching? (Select all that apply.) a. Rest the joint during the acute gout attack. b. Take acetylsalicylic acid (aspirin, or ASA) to relieve pain. c. Increase fluid intake to 2 L/day. d. Avoid foods high in purine. e. Avoid alcoholic beverages.

ANS: A, C, D, E Individuals who are having an acute attack of gout should not take salicylates for pain. ASA is a salicylate.

1. The nurse is confident that the client who takes glucosamine sulfate daily is conscientious of the safety issues involved when hearing the client state: (Select all that apply.) a. "I'm always careful to buy the same brand of glucosamine sulfate." b. "If glucosamine sulfate wasn't safe the drug store wouldn't sell it." c. "My pharmacist is so helpful when I have questions about the herbals I take." d. "The liquid form of glucosamine sulfate is what I consistently take." e. "I made sure my physician knew that I was allergic to strawberries."

ANS: A, C, D, E Regarding product safety, there is no standardization among manufacturers, so the amount of active ingredients per dose among brands is inconsistent; herbs and supplements should be purchased from reputable sources; herbs are available in different forms, making accurate dosing difficult; and persons who have allergies to certain plants may have allergies to herbs in the same plant family. There is insufficient research data to confidently make a statement about the safety of such herbal therapy.

2. An older female resident of an assisted living facility says the following to a nurse: "I am very frightened about getting dementia. I have read a lot about brain exercises, but I am not sure what I should be doing." The nurse formulates a response based on knowledge of which of the following? (Select all that apply.) a. Individuals should engage in some type of brain fitness activity a couple of times a week for at least 25 minutes b. Brain fitness activities are only effective if an individual has not experienced any memory problems at all c. Brain fitness activities may include computer-based games, memory training, board games, reading, and engaging in conversation d. Physical activity is important for wellness but is unrelated to brain fitness e. Individuals should choose brain exercise activities that are unfamiliar, challenging, and fun

ANS: A, C, E Brain fitness activities are effective for individuals with normal memory or mild memory problems. Physical activity is important and has an impact on improving reaction time and working memory as well as posture, balance, and socialization.

1. A nurse is educating an older adult with diabetes mellitus on minimizing the risk of cardiovascular disease. The nurse focuses on lipid levels. Which of the following are the recommended goals for lipid levels? (Select all that apply.) a. Cholesterol <200 b. Low-density lipoprotein (LDL) >100 c. High-density lipoprotein (HDL) >40 (men), >50 (women) d. Hb A1C value of ≥6.5% e. Triglycerides <150

ANS: A, C, E Goals for acceptable lipid levels include: Cholesterol <200, LDL <100, HDL >40 (men), >50, (women) and triglycerides <150. Hb A1C levels are not a measure of lipids.

1. Primary prevention strategies for older adults include which of the following? (Select all that apply.) a. An annual influenza immunization clinic b. A smoking cessation program c. A prostate screening program d. A cardiac rehabilitation program e. A meal planning education program for type 2 diabetics

ANS: A,B Primary prevention refers to strategies that are used to prevent an illness before it occurs and maintaining wellness across the continuum of care. Immunizations and smoking cessation are examples of primary prevention. Secondary prevention is the early detection of a disease or a health problem that has already developed. Prostate screening is an example of secondary prevention. Tertiary prevention addresses the needs of individuals who already have their wellness challenged. Cardiac rehabilitation and meal planning for diabetics are examples of tertiary prevention.

3. A nurse completes a functional status assessment of an older person using the Lawton IADL instrument, a self-reported instrument. The nurse knows that limitations of self-reported measures include that: (Select all that apply.) a. individuals tend to overestimate their functional ability. b. self-reports often differ from that of proxy reports. c. self-reports are not indicative of small changes in function. d. self-reports do not provide a valid measurement of function. e. older adults are not able to complete self-reported measurements.

ANS: A,B Individuals tend to overestimate their functional ability and often self-reported measures differ from proxy reports. Self-reported measures are a valid measurement of function, and older adults are able to complete them. The choice of tool and the type of scoring of the tool is the factor that determines if the small changes in function can be detected.

8. Which of the following factors contribute to poor outcomes for older adults during transitions of care? (Select all that apply.) a. Inability to read and understand discharge instructions b. Inadequate financial resources to purchase medications c. Lack of desire to comply with discharge instructions d. Improved medication reconciliation during hospitalization e. High levels of nurse-patient engagement

ANS: A,B Language and literacy levels and socioeconomic factors are major contributors to poor transitions of care for older adults. A high level of nurse-patient engagement contributes to safe and effective transitions. Medication reconciliation during hospitalization, at discharge and after discharge, decreases medication discrepancies, which are the most prevalent adverse event following hospital discharge. There is no evidence that patients lack the desire to comply with discharge instructions.

2. An older patient asks a nurse: "I went to my diabetes doctor and everything was stable. The nurse practitioner spent the entire time teaching me about decreasing my risks of heart disease. It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why?" The nurse formulates a response based on the understanding that: (Select all that apply.) a. promoting cardiovascular health has the potential to minimize the complications of DM. b. there is little evidence that demonstrates that the course of DM can be altered in an older adult. c. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control. d. older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease. e. diabetes is not a common chronic condition in older adults.

ANS: A,C While glycemic control is important, more emphasis is now on the prevention and treatment of cardiovascular diseases. Research has indicated that it may take 8 years of glycemic control before benefits are seen while the benefits of better control of blood pressure and lipids are seen as early as 2-3 years. Promoting cardiovascular health has the potential to be the most efficacious in the minimization of complications in the persons with DM. Education on self-management of diabetes is important for patients of all ages. Diabetes is a common chronic condition in older adults.

1. The nurse interviewing an older adult for a nursing history recognizes that the client is experiencing symptomology inconsistent with normal aging of the urinary tract when the client reports: (Select all that apply.) a. finding it more difficult in the last few months to start voiding. b. having two bladder infections in the last 4 years. c. getting up once or twice each night to urinate. d. occasionally experiencing pain when urinating. e. needing to urinate at least every 2 hours during the day.

ANS: A,D Difficulty and pain are not characteristics of urination normally attributed to aging. In about 10-20% of well older adults, aging of the urinary tract is associated with an increased frequency of involuntary bladder contractions. These changes may lead to frequency, nocturia, urgency, and vulnerability to infection.

5. A 74-year-old woman who is in the hospital for rehabilitation following hip replacement has been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient's bladder function? (Select all that apply.) a. Assess the patient's recent voiding pattern. b. Request an order for an indwelling catheter from the patient's physician. c. Teach the patient how to meet hydration needs while still limiting fluid intake. d. Assist the patient to use the bathroom. e. Request an order for medication to decrease bladder spasms.

ANS: A,D When a patient experiences new onset incontinence, the first step is assessment. Assisting the patient to the bathroom has many beneficial aspects to it and it provides a private setting where the patient is in the most normal physiological position to urinate. Placing an indwelling catheter is not a solution to urinary incontinence. Limiting fluids is not indicated in this patient. There is no indication that this patient is having bladder spasms.

2. An older adult is having difficulty sleeping and asks a nurse, "My neighbor told me that I should take melatonin to help me sleep. What do you think about this?" The nurse responds to the individual's question using the knowledge that: (Select all that apply.) a. in the natural state melatonin is produced by the pineal gland and regulates the sleep-wake cycle. b. melatonin is available in both immediate and extended release forms; however, only the immediate form is effective. c. there are no significant adverse effects to melatonin. d. it must be used with caution in a patient that is taking other medications that have central nervous system depressant effects. e. evidence shows that it is effective at decreasing sleep onset latency, improving quality of sleep, and improving morning wakefulness.

ANS: A,D,E In the natural state, melatonin is endogenously produced by the pineal gland and is an important signal in regulating the sleep-wake cycle. Melatonin must be used with caution in patients who are taking other medications that cause drowsiness or have central nervous system depressant effects. Studies have demonstrated that melatonin is effective at decreasing sleep onset latency, improving quality of sleep, and improving morning wakefulness. Melatonin is available in both an immediate and extended release form, and both forms are effective. There are adverse effects to melatonin, which include dizziness, nausea, and drowsiness.

3. A nurse is planning a fall prevention education refresher session for the residents of a long-term care facility. The individuals are all cognitively intact and range in age from 80 to 100. The previous education on fall prevention was presented 2 months ago. What special considerations should the nurse take in relation to teaching this group of older adults? (Select all that apply.) a. Make sure that all pamphlets are in large readable font (14-16 points) and include upper and lower case lettering b. Start education on falls from the beginning. It is unlikely that anyone remembers previous material c. Present all the information at once in one long session d. Ensure that there is adequate lighting in the room and that the temperature is comfortable e. Provide ongoing positive feedback during the session

ANS: A,D,E When educating older adults it is important that it is pertinent and build upon information that they already possess. It is a myth that all older adults experience memory problems. It is important to provide adequate time for learning and to use self-paced techniques.

3. One reason why many "baby boomers" have multiple chronic conditions such as heart disease, diabetes, and arthritis is that: a. they have less access to medication and other treatment regimens. b. there was a lack of importance placed on healthy living as they were growing up. c. they did not have access to immunizations against communicable disease when they were children. d. they grew up in an era of rampant poverty and malnutrition.

ANS: B The baby boomers, individuals born between 1946 and 1964, post-WWII, have better access to medication and treatment regimens than other cohorts. They have had the benefit of the development of immunizations against communicable diseases. They grew up in an era of prosperity post-WWII. However, there was a lack of importance placed on what we now consider healthy living when they were younger. Smoking, for example, was not condoned, but was considered a symbol of status. Candy in the shape of cigarettes was popular, and there was much secondhand smoke.

1. The nurse is most concerned by observing when assisting with an older client's bath: a. A firm, irregularly-shaped, pink-colored nodule b. A slightly raised multicolor lesion with an asymmetrical, irregular border c. A pearly papule with prominent blood vessels d. Rough, scaly, sandpaper-like patches that are slightly tender

ANS: B A slightly raised multicolor lesion with an asymmetrical irregular border is characteristic of melanoma that accounts for less than 5% of skin cancer cases, but it causes most skin cancer deaths. A firm, irregularly-shaped, pink-colored nodule or persistent red lesion is characteristic of squamous cell carcinoma. A pearly papule with prominent blood vessels is a characteristic of a basal cell carcinoma. A tender, rough, scaly, sandpaper-like patch is a characteristic of actinic keratoses (a precancerous lesion).

6. A nurse assesses the lower extremities of an older adult and notes a small ulcer between the person's great toe and second toe. The ulcer has well-defined edges and there is no bleeding; however, there is a small amount of necrotic tissue present. This wound is most likely a(n): a. venous ulcer. b. arterial ulcer. c. pressure ulcer d. surgical wound.

ANS: B Arterial ulcers are often located between the toes. They usually present with well-defined edges, do not bleed, and have necrotic tissue. These features are not found in venous ulcers. Pressure ulcers develop from unrelieved pressure. There is no indication in the description that there is unrelieved pressure. There is no mention of surgery in the scenario above.

6. A 69-year-old patient in the geriatric clinic has an annual physical examination and a complete blood count and serum electrolytes are drawn. While the physical examination was uneventful, the laboratory results show an elevated blood urea nitrogen (BUN). The nurse will then: a. ask that the test be rerun since the client showed no physical signs of renal failure. b. review the client's medication list since BUN can be affected by many specific medications. c. instruct the client on collecting a 24-hour urine specimen for a more detailed analysis. d. assure the client that an elevated BUN is normal in older adults.

ANS: B BUN can be elevated as a result of certain medication therapies and so the nurse should assess for this possibility. An elevated BUN is not diagnostic of renal failure alone and will not necessarily be reflected in physical symptoms. A 24-hour urine sample will not generally be done to determine BUN levels. An elevated BUN is not expected as a normal part of aging. Renal functioning decreases substantially with aging, but in most cases the body is able to compensate adequately with only slight increases in laboratory findings.

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

ANS: B Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration. The other three eye diseases do not present with these symptoms.

7. The Beers Criteria is an effective tool for health care professionals prescribing and/or managing the medication therapy of older adults since it identifies medications that for this population: a. are not typically covered by drug benefit plans. b. have a higher than usual risk for injury. c. are likely to be abused. d. generally cause allergic reactions.

ANS: B Drugs on the Beers' list are those that have been identified to have a higher than usual risk when used in older adults. The Beers Criteria have no relation to medication financing. There is no evidence that the drugs are likely to be abused by older adults. There is no greater likelihood of these drugs causing allergic reactions.

4. An older female patient tells a nurse the following: "In my culture, women are the silent partner in the family. Men make all of the decisions. However, when we came to the United States, all that changed. I became an American. I am in charge of my family just like my husband." This is an example of: a. enculturation. b. acculturation. c. ethnicity. d. culture competence.

ANS: B Enculturation is defined as cultural beliefs passed down from one generation to the next. Acculturation is the process by which persons from one culture adapt to another. Ethnicity is defined as the cultural group that one identifies with. Cultural competence involves stepping outside our own biases and understanding that others bring a different set of values.

3. An older resident in a senior community tells a nurse: "I am really worried. I joined an exercise class, and I just learned everyone's name yesterday, and I cannot remember them all today. Am I developing Alzheimer's disease?" The best response by the nurse is: a. "You should be concerned. It is very unusual to forget something that you just learned." b. "There is no reason to be concerned. Short-term memory decreases with age." c. "Don't worry, a decline in both short- and long-term memory is a normal part of getting older." d. "Although it is normal to have some changes in memory, forgetting names is very unusual."

ANS: B Even though some older adults show decrements in the ability to process information, the majority of functioning remains intact. Age-associated memory impairment is used to describe memory loss that is considered normal for one's age and educational level. It may include slowness in processing, storing, and recalling new information and difficulty remembering names and words.

6. The nurse suspects that a client is experiencing tardive dyskinesia when observing that: a. the client can't seem to stop moving. b. the client's facial muscles are twisting involuntarily. c. the client not able to get up out of a chair. d. the client's hand tremors so much that drinking from a cup is difficult.

ANS: B Facial movements and involuntary twisting of the limbs, trunk, neck, and face is the definition of tardive dyskinesia. A compulsion to be in motion is the definition of akathisia. An inability to move is the definition of akinesia. A bilateral tremor and rigidity reflects Parkinsonian symptoms.

The nurse is preparing educational material concerning fire safety in the home. What research data will be included in the material? a. Most fires occur during the daytime hours. b. Fire mortality is highest in adults older than 80 years of age. c. Most people who die in fires are killed by the flames. d. Most fires occur outside the home.

ANS: B Fire-related mortality is three times higher in individuals over age 80. Most deaths in fires are caused by smoke injuries. Most fires occur within the home, and most fires occur at night.

1. Health literacy is defined as: a. the capacity to read basic health information in order to make appropriate health decisions. b. the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions. c. the capacity to read and write in order to access health care. d. the capacity to read and execute health care documents.

ANS: B Health literacy involves more than basic reading and writing skills. It involves the ability to obtain, process, and understand health information in order to make health care decisions.

5. An older adult with type 2 DM who is being treated with insulin wants to increase his activity level and begin a walking program. What recommendations should the nurse provide to this patient? a. A walking program is not recommended for an older adult with diabetes. b. The walking regimen needs to be done on a regularly scheduled basis. c. Regular exercise should not exceed 30 minutes three times a week. d. Insulin can most probably be discontinued if the individual adheres to the walking program.

ANS: B If the person is using insulin, exercise needs to be done on a regular rather than an erratic basis. Exercise is an important part of diabetes self-management. In some cases, exercise in conjunction with an appropriate diet may be sufficient to maintain blood glucose levels within normal levels; however, it is not likely that insulin will be able to be discontinued.

7. A female nurse is caring for an older woman from the Hasidic Jewish community. The woman's son is at the patient's bedside. The nurse notes that when she communicates with the patient and her son, the son does not maintain eye contact with her and also notes that he withdraws when she attempts to shake his hand. The best response by the nurse is to: a. carry on conversation with the patient only, ignoring the son. b. continue conversing with both the patient and the son. c. ask the son to leave since he is not comfortable with her. d. ask the patient why the son will not engage with her.

ANS: B In some cultures, direct eye contact or contact between men and women is seen as a sexual advance. This is true in the Hasidic culture. Options A and C are disrespectful to the patient and her son. Option D may put the son in an uncomfortable position.

10. The nurse's first response when told by a client during an assessment interview that he "can't take furosemide (Lasix)" is to ask: a. "Is your health care provider aware that you are allergic to Lasix?" b. "Can you describe what happened when you took Lasix?" c. "When was the last time you took Lasix?" d. "Have you any questions regarding your reaction to Lasix?"

ANS: B It is important to document the type of allergic reaction, when the patient had it, how long it lasted, and how it was treated. Determining whether the health care provider is aware of the allergic reaction or when the medication was last taken does not have precedence over assessing the client's reaction to the medication since neither has a direct bearing on the management of a similar reaction. Evaluating the client's understanding of the reaction is appropriate but not as an initial response.

4. The nurse is conducting a presurgical interview when it is noted that the older adult patient's medication list includes Tylenol 650 mg four times a day for arthritic pain, gingko 80 mg twice a day, and glucosamine chondroitin 500 mg three times per day. The nurse proceeds to share with the client that in order to minimize the risk for postsurgical complications, there is the need to refrain from taking: a. glucosamine chondroitin for 1-2 weeks due to a potential for excess anesthetic sedation. b. ginkgo for 2 weeks due to the potential for increased bleeding. c. Tylenol for 24-48 hours due to the potential for increased bleeding. d. gingko for 1 week due to the potential for an allergic reaction during surgery.

ANS: B It is recommended that ginkgo be discontinued for 2 weeks preoperatively due to the potential for increased bleeding. There is no evidence that ginkgo is associated with allergic reactions during surgery. There are no recommendations for discontinuation of glucosamine chondroitin, and glucosamine is not associated with a potential for increased sedation from anesthetics. Tylenol is not associated with a potential for increased bleeding.

2. An older client in a long-term care facility is receiving an annual physical examination and is ordered laboratory tests that include a complete blood count, serum electrolytes, and thyroid tests. When the client's son questions why these tests are being ordered by saying, "Dad is 85 why are you bothering him?" the nurse's response is based on an understanding that: a. the health care provider ordering the tests needs to explain the rationale to the son. b. when conducted annually, all of the tests are helpful in promoting maximum health for older adults in the long-term care setting. c. the tests are useful, but only if clinically indicated. d. the complete blood count and serum electrolytes are useful screening tests, but the usefulness of the thyroid test should be questioned.

ANS: B Laboratory tests are a fast and accurate way of assessing key parts of an older person's physical functioning. It is within the nurse's scope of practice to answer the son's question and it does not need to be referred to the health care provider. The laboratory tests are being used as annual screening and therefore do not need to be clinically indicated. Excessive sleepiness is not normal in an 85-year-old and may be a sign of a thyroid disorder.

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

ANS: B Light colors such as red, orange, and yellow are more easily seen by aging eyes. Softer lighting will help reduce some of the glare and is also easier seen by aging eyes. Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem. Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare.

6. An older patient learns that he has metastatic cancer. The patient states: "I must have angered God." This is an example of which type of belief? a. Biomedical b. Magico-religious c. Naturalistic d. Ayurvedic

ANS: B Magico-religious: views illness as caused by actions of a higher authority. Biomedical: views disease as a result of abnormalities in structure and function and disease caused by intrusion of pathogens into the body. Naturalistic: based on the concepts of balance. Health is seen as a sign of balance. Ayurvedic: the oldest known paradigm in the naturalistic system. Illness is seen as an imbalance.

2. The daughter of an older hospitalized patient tells a nurse: "I am worried about my father. His memory is sharper when he is at home. He is forgetful, but is functional. Since he has been hospitalized his memory problems are much worse." The best response by the nurse is: a. "It is common for long-term memory to be more impacted by age-related changes than short-term memory." b. "Memory changes are often worse when an individual is in an unfamiliar or stressful situation." c. "Perhaps you are just noticing your father's memory loss now that he is hospitalized." d. "There is a lot of new information for your father to process here in the hospital; he is overloaded."

ANS: B Memory changes are often worse when the individual is in unfamiliar or stressful situations, such as a hospitalization. Option A is not true, short-term memory is impacted more than long-term memory. Options C and D are true; however, they do not address the issue that the patient's daughter is discussing.

5. A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement Community (NORC). The nurse understands that NORCs are: a. purpose-built senior housing communities. b. neighborhoods or buildings where a large segment of the residents are older adults. c. communities where volunteers coordinate access to services for older adults. d. intentional collaborative housing where residents participate in the design and operation of the neighborhood.

ANS: B NORCs are neighborhoods or buildings where a large number of the residents are older adults. They were not purposely built as senior housing. The residents in a NORC aged in place. The village model is where volunteers coordinate access to affordable care for seniors. Cohousing is an intentional collaborative model where residents participate in the design and operation of the neighborhood.

3. A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90 degrees Fahrenheit outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to: a. cognitive changes that diminish the individual's awareness of temperature changes. b. age-related neurosensory changes that diminish awareness of temperature changes. c. a delirium-related acute illness that is affecting body heat production. d.age-related motor deficiencies that result in self-neglect.

ANS: B Neurosensory changes related to aging tend to delay or diminish the individual's awareness of temperature changes and may impair behavior or thermoregulatory responses to dangerously high or low temperatures. There is no evidence in this scenario that the client has cognitive changes, an acute illness, or is incapable of self-care, and such assumptions should not be routinely made based on age alone.

1. The nurse preparing an educational program focused on herbal supplement targets as a likely interested group: a. Inner-city females who live below the poverty level b. White females who own their own successful businesses c. Male Hispanic Americans who are single, divorced, or widowed d. Men and women from small rural communities who are self-employed farmers

ANS: B Non-Hispanic, white, older, normal-to-underweight women with more education were found to use dietary supplements more than any other racial, ethnic, age, or gender group.

5. A nurse assesses a nursing home resident's pressure ulcer to be a "healing stage III." The primary reason reverse staging is never used is because: a. even though all tissue layers are replaced as a wound heals, the healed skin is not as strong as it originally was. b. not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was. c. reimbursement in nursing homes does not allow for reverse staging to be utilized. d. the collagen layer is not replaced during wound healing.

ANS: B Not all tissue layers are replaced as a wound heals. The wound fills with granulation tissue composed of endothelial cells, fibroblasts, collagen, and extracellular matrix. Muscle, subcutaneous fat, and dermis are not replaced. The healed skin is not as strong as it originally was. Reimbursement in long-term care is not the primary reason for not using reverse staging.

2. The nurse is recommending that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on "being stuck at home." Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization thus minimizing the effects of social isolation b. Helps with minimizing the loss as a factor in causing depression c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client

ANS: B Participants attending the driving cessation support groups had an improvement in depression scores, were less angry, and were happier. Support groups designed specifically to deal with loss of driving privileges among individuals with dementia may be important in alleviating depressive symptoms and other negative outcomes associated with cessation of driving. The remaining options represent possible outcomes but they do not have the priority that minimizing depression has for this client.

7. A 78-year-old female patient was recently diagnosed with atrial fibrillation and started on Coumadin (warfarin) for stroke prophylaxis. A nurse provides extensive education on warfarin including the need for routine blood testing. The woman states the following to a nurse: "I understand all that you have taught me, but I do not know what a good number for the INR test is." The nurse bases her response on the knowledge that the recommended INR is: a. 1.0-2.0. b. 2.0-3.0. c. 3.0-4.0. d. 4.0-5.0.

ANS: B Recommended INR for an individual with atrial fibrillation for stroke prevention in individuals over age 75 is 2.0-3.0.

1. The nurse is reviewing the postsurgical laboratory values of an older adult client. The client's erythrocyte sedimentation rate (ESR) is 20 mm/hr. The nurse initially responds to this data by: a. asking the client if he or she has been diagnosed with any chronic inflammatory diseases. b. recognizing that the value is normal for older adults. c. notifying the client's health care provider immediately. d. requesting that the laboratory rerun the test.

ANS: B The ESR can be slightly elevated (10-20 mm/hr) in healthy older adults, especially those with a chronic disease that results in inflammation. Asking the client if he or she has such a diagnosis is not the initial response. This slight elevation does not warrant immediate notification or rerunning of the test.

2. A limitation of the Katz Index of activities of daily living (ADLs) is that: a. completion of the tool requires the joint efforts of the interdisciplinary team. b. all ADLs are weighted equally. c. it puts a heavier weight on the cognitive abilities necessary to perform ADLs. d. it provides a range of performance for each task.

ANS: B The Katz Index assigns an equal weight to all of the ADLs, and because of that, it cannot be used to identify the particular area of need or change in any one task. Any health care professional can complete the Katz Index, although input from the interdisciplinary team is valuable. The Katz Index does not address the cognitive abilities necessary to perform ADLs. The ADLs are considered in dichotomous terms only, the ability to compete the task independently or the complete inability to do so.

4. When comparing the Older American's Resources and Services (OARS) with the Katz Index of ADLs, what is true? a. The Katz Index and the OARS both measure only ADL performance b. The OARS is a comprehensive assessment tool that measures ability in five areas; the Katz Index measures only ADL performance c. The OARS is used only for older adults in the long-term care setting; the Katz Index is used in all settings d. The OARS is not valid for use in older adults who are cognitively impaired, whereas the Katz Index is

ANS: B The OARS evaluates ability, disability, and capacity at which the person is able to function. Five dimensions are assessed: social resources, economic resources, physical health, mental health, and ADLs. The Katz Index only evaluates ADL ability. Both instruments are used in a variety of care settings and are valid for use with cognitively impaired older adults.

5. A resident of a long-term care facility is assessed by a nurse upon admission to the facility. The assessment includes a comprehensive health, social, and functional profile. The tool that the nurse utilizes is: a. Outcomes and Assessment Information Set (OASIS). b. Resident Assessment Instrument (RAI). c. Older Americans Resources and Services (OARS). d. Comprehensive Geriatric Assessment (CGS). e. Mini Mental Status Examination (MMSE).

ANS: B The OASIS is used in the homecare setting. The RAI is used in the long-term care setting. OARS is a functional status instrument. Comprehensive geriatric assessment is not a specific tool but rather an approach to assessment. The MMSE is a mental status assessment tool.

5. An older person has sudden onset of a severe headache, left-sided facial drooping, and left arm numbness. The person's daughter calls 911 and the person is transported to the emergency department. The first diagnostic test that will likely be performed is a(n): a. electrocardiogram (ECG) to assess for atrial fibrillation b. computed axial tomography (CAT) scan to differentiate hemorrhagic from ischemic stroke. c. international normalized ratio to determine level of anticoagulation. d. lumbar puncture to assess for infection.

ANS: B The first diagnostic test that will be done is a CAT scan to differentiate hemorrhagic from ischemic stroke. If it is an ischemic stroke, tissue plasminogen activator (tPA) can be administered to dissolve the clot but must be done within 3 hours. Depending on the patient's presentation, all of the other diagnostic tests may also be done following the CAT scan.

5. A nurse assesses an older patient's blood gases. The patient is 70 years old. The nurse knows that this patient's maximum PO2 is: a. 69. b. 79. c. 89. d. 99.

ANS: B The maximal PO2 possible at sea level can be estimated by multiplying the person's age by 0.3 and subtracting the product from 100.

4. An older adult who was diagnosed with atrial fibrillation asks a nurse, "I feel fine. I have no symptoms at all with this heart problem, yet I am now on a blood thinner medication, which I understand can by very dangerous. Is this really necessary?" The nurse formulates a response based on the understanding that: a. Atrial fibrillation, while initially asymptomatic, will progress and become symptomatic. b. the risk of stroke is very high for a person with atrial fibrillation. c. untreated atrial fibrillation will likely cause a heart attack. d. atrial fibrillation can cause coronary heart disease.

ANS: B The most serious complication of atrial fibrillation is stroke. Symptoms of atrial fibrillation, if they occur, are usually vague and do not worsen. While untreated atrial fibrillation can cause tachycardia as a compensatory mechanism, which can lead to myocardial ischemia, a heart attack from atrial fibrillation is not a common occurrence. Coronary heart disease can cause atrial fibrillation, not the reverse.

2. A nurse is organizing a support group for older individuals with COPD in the community. The nurse knows that which of the following individuals is most likely to have COPD? a. A 75-year-old Hispanic male who is a retired truck driver and never smoked b. A 72-year-old non-Hispanic white female who never worked outside of the home and is a former smoker c. A 67-year-old African American male who is a retired physician d. A 70-year-old Asian woman who is a retired college professor

ANS: B The profile of individuals most likely to have COPD include: persons 65-75 years of age, non-Hispanic whites, women, those who are unemployed, retired or do not work, have less than a high school education, have lower incomes, are current or former smokers, and have a history of asthma. Option B meets all of the criteria listed above.

3. When asked by an older adult client, "What is the difference between my normal laboratory values and the ones for a 55-year-old?" The nurse responds based on the understanding that there are: a. age-adjusted ranges for older adults for all of the common laboratory findings, similar to those for infants and children. b. no age-adjusted ranges for older adults due to the large variations within the age group and the increasing number of factors that influence the results. c. age-adjusted ranges only for the over-85 age group; there are no expected changes in the 65- to 84-year-old age group. d. age-adjusted ranges only for the hematological tests, which are due mostly to changes in the bone marrow.

ANS: B There are no age-adjusted ranges for laboratory values due to the variation within the group, as well as the many chronic illnesses of older adults. The older one is, the more likely variations are to be seen. Although several age-related hematological changes occur, mainly from changes in the bone marrow, few are clinically significant.

2. A nurse measures an older adult's blood pressure on the right arm and notes a reading of 150/100. The nurse waits 5 minutes and measures the blood pressure again in the right arm and obtains a reading of 152/100. What is the next action by the nurse? a. Immediately contact the medical provider. b. Measure the blood pressure in the left arm. c. Measure the blood pressure in sitting and standing positions. d. Document the findings in the medical record; elevated blood pressures are normal in older adults.

ANS: B When an abnormal blood pressure reading is obtained, it is necessary to do two measurements, five minutes apart, confirmed in the contralateral arm. Doing orthostatic measurements is not indicated in this situation. A blood pressure reading above 140/90 is considered abnormal for an older adult.

7. When a client who routinely takes the herb St. John's Wort (SJW) shares that his or her "hay fever is really bad right now," the nurse initially: a. notifies the primary care provider that the client has been self-medicating for hay fever. b. compares the client's current blood pressure to his/her baseline blood pressure. c. stresses the need to avoid over-the-counter (OTC) medications containing monoamines. d. suggests that the client stop taking the herb until the hay fever has improved.

ANS: B When taking SJW, people should be warned not to take medications containing monoamines, such as medications for nasal decongestants, hay fever, and asthma, because this combination may cause hypertension. The primary care provider should not be notified until the BP monitoring is known. Avoiding specific OTC medications and stopping the herb is information the client should have been given prior.

3. A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education? a. Zostavax should only be given to individuals who have never had an episode of herpes zoster (HZ) b. Zostavax is recommended for all individuals over age 60 that have no contraindications to the vaccine c. Zostavax should not be given to anyone with a chronic cardiac or respiratory condition d. Zostavax will always prevent an individual from developing Herpes Zoster

ANS: B Zostavax is recommended for all persons 60 and older who have no contraindications to the vaccine, including persons with a previous episode of Herpes Zoster (HZ) and those with chronic conditions. The vaccine does not guarantee that an individual will not get HZ; however, individuals who get the vaccine cut their risk in half and if they do get HZ, it is likely that they will get a milder case.

8. An older adult is currently prescribed both aspirin (81 mg) and ibuprofen daily. What instructions are most important for the nurse to provide to assure the expected outcomes for this client? a. The medications should be taken together to ensure the effectiveness of both medications b. Take ibuprofen 30 minutes after the aspirin so as to not interfere with its effectiveness c. The aspirin will negatively affect the analgesic effect of the ibuprofen d. The medications should be taken at least 4 hours apart to minimize risk of gastric irritation

ANS: B In 2006, the Food and Drug Administration in the United States issued a warning regarding the concomitant use of aspirin (81 mg) and ibuprofen. When taken together the aspirin is less cardio-protective; that is, there is less antiplatelet effect increasing the person's risk for a cardiac event. Persons who take immediate release aspirin and take a single dose of ibuprofen 400 mg should take the ibuprofen at least 30 minutes after or 8 hours before the aspirin.

11. An 81-year-old patient is being discharged from the hospital to home. She is on seven different medications, which are to be taken at four different times during the day. What would be most useful in helping this patient manage her medications? a. The package inserts from all of the medications for the client to read b. A pillbox with compartments for each day and each of the doses c. A written list of all the client's medications and administration routine d. A suggestion that the client's daughter administer the medications

ANS: B Providing a pillbox is an effective method to reinforce exactly which medications are to be given at what times. It also serves as an effective method to remind patients when they have missed a dose. Package inserts are often written in language that is not easy for patients to understand. Another consideration is that the size of the print in package inserts may be too small for aging eyes. Although providing a written list of the medications is appropriate, it does not make as much of an impact on the overall management of this patient's medications as other options. There is no indication that this patient cannot self-administer the medications.

3. A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he has been very forgetful lately, and she is concerned that he might be "senile." The advanced practice nurse administers the clock-drawing test and the patient draws a distorted circular shape and places the numbers all on one side of the shape. Based on his performance, the nurse concludes that the patient: a. probably has Alzheimer's disease. b. needs further evaluation. c. probably has delirium. d. needs a functional status assessment.

ANS: B Cognitively intact persons rarely produce errors on the clock-drawing test, such as grossly distorted contour. A low score on the clock-drawing test requires further evaluation. Alzheimer's disease is not a diagnosis using a mental status assessment tool. It is definitively diagnosed with a brain biopsy. The clock-drawing test does not assess for delirium. A low score on the clock-drawing test does not necessarily warrant a functional status assessment.

3. Asthma is often underdiagnosed in older adults because: a. older adults frequently do not have any of the classic signs and symptoms. b. symptoms of asthma are often attributed to normal age-related changes. c. asthma is very uncommon in older adults. d. asthma symptoms are usually very mild in older adults.

ANS: B Asthma is both underdiagnosed and undertreated in older adults. Instead, the symptoms are attributed to normal changes with aging, cardiovascular disease, or are simply labeled "COPD." Older adults do present with the usual signs and symptoms; however, they are often overlooked. Asthma is not uncommon in older adults. Adults over 65 make up a small percentage of those with asthma, and they have the highest associated death rate than any other group. Asthma symptoms in older adults range from mild to very severe.

3. A nurse caring for a cognitively impaired older adult client shows an understanding of the unique clinical symptoms of constipation in this population when: (Select all that apply.) a. checking documentation to determine if the client has had a bowel movement in the last 24-36 hours. b. questioning staff as to whether the client has any unexplained falls in the last few days. c. asking the client to name all of his or her children and grandchildren. d. requesting that the client's temperature be taken now and again in 4 hours. e. reviewing the client's food intake over the last 24-36 hours.

ANS: B, C, D, E It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person. Frequency of defecation is not necessarily an indicator of constipation since it is such a personal characteristic.

6. Significant factors contributing to the growth of community-based care include: (Select all that apply.) a. a decrease in the number of available nursing home beds. b. rapidly escalating health care costs. c. older adults' preferences to "age in place." d. inadequate numbers of nurses with gerontological specialty education. e. decreasing numbers of family caregivers.

ANS: B,C Care will continue to move out of hospitals and long-term care facilities because of rapidly escalating health care costs and individual preferences to "age in place." There has not been a decrease in nursing home beds. Although there are inadequate numbers of nurses with gerontological specialty training, this is not a factor that has impacted the growth of community-based care. There is projected to be a decrease in the number of family caregivers as the caregivers themselves are aging; however, this does not contribute to the growth of community-based care.

1. A nursing student is preparing a presentation on arthritis. The nursing student knows that differences between osteoarthritis (OA) and rheumatoid arthritis (RA) include that: (Select all that apply.) a. both OA and RA have an acute onset in older adults. b. OA is a localized process, whereas RA may be systemic. c. OA usually impacts distal interphalangeal joints; RA impacts proximal interphalangeal joints. d. both OA and RA present with joint stiffness lasting 20-30 minutes after rest. e. initial treatment of both OA and RA is usually non pharmacological using heat or exercise.

ANS: B,C OA has an insidious presentation, and RA has an acute presentation. OA presents with joint stiffness, which resolves in less than 20 minutes, and RA presents with joint stiffness that lasts more than 20-30 minutes. OA is initially treated with nonpharmacological treatments such as heat or exercise, and RA is treated with medications disease-modifying antirheumatic drugs (DMARDs) immediately after diagnosis.

5. The daughter of an older patient says to a nurse, "I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?" The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.) a. Report the person to the division of motor vehicles for license suspension. b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. c. Arrange for alternate transportation for the person. d. Confiscate the keys to the car. e. Ask the patient's physician to write a prescription for the person to stop driving.

ANS: B,C Options B and C are examples of the involved type of action strategies for driving cessation. Options A, D, and E are all examples of the imposed type of action strategies for driving cessation.

4. A nursing student is preparing a presentation on the Wellness-Based Model for Healthy Aging. Which of the following concepts should the student include in the presentation? (Select all that apply.) a. Healthy aging is defined by the absence of physical illness alone b. Healthy aging is individually defined and can change over time c. There are many strategies to promote healthy aging that are believed to be helpful but do not have empirical evidence to support them d. Healthy aging cannot be achieved by only focusing on later life. It is a lifelong process e. According to this model, an individual with a chronic disease would not be considered healthy

ANS: B,C,D Healthy aging is a lifelong process that begins with birth and ends with death. The concept of healthy aging from a wellness perspective is uniquely defined by each individual and can change over time. There are challenges to implementing evidence-based practices on healthy aging because there is a paucity of research on this area. Therefore, there are many strategies that have been used and determined to be effective but do not have research evidence supporting them. The subcomponents with the wellness model are functional independence, self-care management of illness, personal growth, positive outlook, and social contribution and activities that promote one's health.

4. A nurse is caring for an older adult in a hospital who has an indwelling catheter. The nurse assesses the patient based on the knowledge that which of the following are correct indications for an indwelling catheter? (Select all that apply.) a. To assist with incontinence management b. To manage acute urinary retention c. To assist in healing of open sacral or perineal wounds in incontinent patients d. To accurately measure urinary output in critically ill patients e. To prevent falls related to toileting in hospitalized older patients

ANS: B,C,D Indwelling urinary catheters are appropriate in the management of acute urinary retention, to assist in the healing of open sacral or perineal wounds in incontinent patients, and when accurate measurement of urinary output is essential in managing a critically ill patient. Urinary catheters are not an appropriate intervention for the management of incontinence and do not prevent falls related to toileting in hospitalized patients.

3. An antihypertensive medication has been prescribed for an older patient with hypertension. The patient tells a clinic nurse that he would like to take an herbal substance to help lower his blood pressure instead of the prescription medication. Which of the following should the nurse do? (Select all that apply.) a. Tell the patient that herbal substances are less effective than prescription medications b. Encourage the patient to discuss the use of an herbal substance with his primary care provider c. Explore with the patient which herbal substance he is planning on taking d. Educate the patient on possible interactions of the herbal substance with his other medications e. Instruct the patient not to take the herbal substance, as it is dangerous

ANS: B,C,D The popularity of medicinal herbs and supplements continues to rise. A major concern with the use of herbs and supplements is the potential interactions with prescribed medications. It is important that the patient share his or her use of herbs and substances with all providers and that the provider review the herbs and the prescribed medications to ensure compatibility.

4. Goals of the Eldercare Workforce Alliance include which of the following? (Select all that apply.) A. Mandating a minimum of a Baccalaureate degree in nursing in order to care for older adults B. Increasing wages of certified nursing assistants (CNAs) in nursing homes C. Providing loan forgiveness for individuals who assume faculty roles D. Developing a nursing certification specific to long-term care E. Adopting cost-effective care coordination models for older adults across the continuum of care

ANS: B,C,E A, B, and C are all included in the Elder Workforce Alliance goals. Options A and D are not.

4. A nurse is caring for an older adult with cognitive impairment who recently had hip surgery. The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.) a. The client ate all of her meals. b. The client pushes caregivers away when they attempt to change the dressing on her hip. c. The client rocks back and forth repetitively when sitting in a chair. d. The client sleeps soundly throughout the night. e. The client cries out repeatedly when anyone approaches her.

ANS: B,C,E Pain cues in people with communication difficulties involve changes in behavior including restlessness, resistance to care, repetitive movements, and vocalizations. Other cues include sleeplessness and decreased appetite.

3. An older client is diagnosed with venous insufficiency of the lower extremities. The nurse expects the client to display which of the following signs and symptoms? (Select all that apply.) a. Thin, shiny dry skin b. Reddish brown discoloration of the skin of the legs c. Pain when the legs are elevated d. Varicose veins e. Legs are cool to touch

ANS: B,D A reddish brown discoloration of the lower extremities and varicose veins are present with venous insufficiency. The other signs and symptoms are all associated with arterial insufficiency.

4. A nurse practitioner is caring for a 90-year-old adult with asthma who has comorbid dementia and severe osteoarthritis in the hands. The nurse practitioner considers inhaled medications to manage the asthma. Which of the following factors should the nurse take into consideration when developing the medication plan for this patient? (Select all that apply.) a. The patient's ability to swallow safely b. The patient's manual dexterity c. The patient's age d. The patient's cognitive status e. The patient's mobility status

ANS: B,D Inhaled medications may be taken a number of ways. When choosing which method to order, the prescriber needs to consider the manual dexterity of the patient as well as the cognitive ability to follow directions. The patient's age, ability to swallow, and mobility do not directly impact the ordering of inhaled medications.

4. A nurse is teaching a group of 65-year-old patients about reducing the risk of osteoarthritis. Which of the following would the nurse discuss as a modifiable risk factor for osteoarthritis? (Select all that apply.) a. Female sex b. History of joint injuries c. Advancing age d. Drinking one cup of regular coffee a day e. Obesity

ANS: B,E Gender and advancing age are nonmodifiable risk factors for osteoarthritis. There is no evidence that coffee or caffeine has any relationship to the development of osteoarthritis.

1. When asked by new parents what the life expectancy is for their African American newborn, the nurse replies that, "2010 statistics indicate that your son: a. will have a life expectancy of approximately 65 years." b. can realistically expect to live into his late 80s." c. has a good chance of celebrating his 75th birthday." d. is likely to live into his late 90s."

ANS: C In 2010, men in the United States at age 60 can expect to live another 22 years. The life expectancy of African American men is about 4.7 years less than white men. Of the options above, C is the only response that fits into those parameters. The other options are not supported by reliable research.

5. An 89-year-old hospitalized female patient tells a nurse, "I go to the bathroom really often, but I manage this by not drinking too much before I go to bed so I can sleep for the night." The patient has no pain or discomfort with voiding. The nurse considers this finding to be a: a. manifestation of urge incontinence. b. manifestation of a urinary tract infection. c. normal age-related change in an 89-year-old woman. d. manifestation of diabetes.

ANS: C A decreased bladder capacity is a normal age-related change. Urinating frequently with no other symptoms is not a manifestation of infection or diabetes. Urge incontinence is not a correct response as the patient is not experiencing incontinence.

1. After first managing the pain being experienced by the client with gout, the treatment focuses on: a. strengthening the affected joints through a controlled exercise plan. b. minimizing joint disfigurement by using therapeutic splinting. c. preventing systemic involvement by altering the client's diet. d. managing chronic pain by taking regular doses of salicylates.

ANS: C After the acute attack, the goal is to prevent systemic spread of the disease. This may be done by avoiding drugs or foods that are high in purine and alcohol, both of which increase uric acid levels. Exercise and splinting are not effective in achieving the goal and salicylates should be avoided since they will affect the effectiveness of the prescribed medications for gout.

1. A paper on culture and illness would be likely to include the statement that: a. culture is the same as ethnicity. b. ethnic groups always share common geographic origin and religion. c. ethnicity involves recognized traditions, symbols, and literature. d. most members of an ethnic group exhibit identical cultural traits.

ANS: C Ethnicity is a complex phenomenon including traditions, symbols, literature, folklore, food preferences, and dress. It is a shared identity. Ethnicity is more than just culture. It is social differentiation based on culture. Even within ethnic groups, there is considerable diversity.

5. An older adult is being treated for severe pain resulting from a history of osteoarthritis. In her discharge teaching, which information is most important to relay for the successful management of the pain? a. Check for incompatibilities before taking any new medications. b. Arrange to take a dose of analgesic prior to physical activity. c. Take the analgesic around-the-clock as prescribed. d. Be alert for the signs of overdose toxicity.

ANS: C For someone with severe persistent pain it is important to achieve the highest level of pain control; it is helpful to ease the "memory of pain," especially for those whose persistent pain is intense, like that of many chronic illnesses. This means to prevent the pain, not simply relieve it. The most effective way to do this is to provide around-the-clock (ATC) dosing, at the appropriate dosage. The other options are appropriate medication-related instructions but are not as directed toward successful management of chronic pain as is the correct option.

4. The initial step to effect the safe management of mild to moderate acute pain that has not been controlled with over-the-counter medications is to: a. begin acetaminophen (Tylenol) every 4 hours for 24 hours. b. supplement with non pharmacological interventions. c. administer a single low dose of short-acting opioid and monitor for relief. d. titrate dosage of a short-acting opioid upward over 24 hours to achieve relief.

ANS: C If pain continues, consider a single low-dose, short-acting opioid and observe the effect. Acetaminophen is an over-the-counter analgesic and so its effect is already determined to be ineffective. Non pharmacological interventions are only appropriate once pain management has been successfully implemented. Titrating an opioid dose upward is appropriate only after the effects of the initial dose have been determined.

4. The daughter of an older patient with chronic bronchitis says to the nurse, "I don't understand why my father has not been prescribed antibiotics for his bronchitis. The last time I had bronchitis I got antibiotics." The nurse considers the following when formulating a response: a. Antibiotics tend to be less effective in older adults than in younger adults. b. Antibiotics are not prescribed in chronic bronchitis since the cause is usually not bacterial. c. The routine use of antibiotics is controversial because the causal role of bacterial infection is often not clear. d. Normal age-related decreases in immune response delay the presentation of classic symptoms.

ANS: C In chronic bronchitis, the routine use of antibiotics is controversial because the causal role of bacterial infection is often difficult to document. Antibiotics are generally indicated in frail elders when the possibility of pneumonia or an acute exacerbation of bronchitis is suspected. There is no evidence that antibiotics are less effective in older adults or that chronic bronchitis is usually caused by a nonbacterial cause. While it is correct that a normal age-related decreased immune response may delay the presentation of classic symptoms, this does not explain why antibiotics are often not prescribed.

4. A nurse is caring for an older adult who is diagnosed with type 2 Diabetes. The patient is prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first-line therapy? a. Insulin b. Sulfonylureas c. Metformin d. Chlorpropramide

ANS: C Metformin (Glucophage) is commonly prescribed as first-line therapy; it does not cause hypoglycemia or weight gain. Sulfonylureas were used for many years as first-line agents for all persons with type 2 DM. However, they are associated with hypoglycemia and can only be used in persons who can either be aware of the signs themselves or who have a caregiver capable of doing so; therefore, Metformin is considered the first line of therapy. Insulin is used for individuals with type 2 DM; however, it is not first-line therapy. Chlorpropramide is contraindicated due to a long half-life and the fact that it can cause prolonged hypoglycemia.

3. Regarding health care disparities, it is true that older adults of color have: a. equal risk factors for vulnerability as do all older adults. b. equal risk factors for vulnerability as do the young adults of color. c. increased risk factors for vulnerability if they are female. d. an increase in risk factors for vulnerability if care is provided by public facilities.

ANS: C Older females of color have an added risk factor for vulnerability (gender) than do males of the same age and ethnic group. Ethnicity is an added factor for vulnerability. Age is an additional risk factor for vulnerability. Health care disparities are found across a wide range of clinical settings.

9. The nurse is confident that the client who chooses to take red rice yeast daily for dyslipidemia has an understanding of its possible side effects when the client: a. has regular laboratory work to monitor cholesterol levels. b. shows caution by slowly rising from the chair. c. states, "If I start noticing muscle pain, I'll stop taking the pills." d. schedules regular, yearly glaucoma screenings.

ANS: C Persons need to know the potential side effects of red yeast rice, similar to those of lovastatin, such as muscle pain. Regular cholesterol monitoring will not aid in the identification or management of possible side effects. The need to rise slowly from a chair is not directly related to the side effect of muscle pain. There is no current research to support the need for regular glaucoma screens as a precaution when taking red rice yeast.

5. When developing a teaching plan for an older, newly diagnosed diabetic client, the nurse best ensures an understanding of oral hypoglycemic medications when providing: a. the package insert and assessing the client's reading skills. b. the client with the website address for the American Diabetes Association. c. oral explanations and sending the client home with a written copy. d. the information in paragraph form as opposed to numbered line fashion.

ANS: C Providing memory aids, such as written information including charts, is effective in reinforcing teaching. Package inserts are not always written in lay language that is understandable and appropriate to the reading level of the older adult. The font size of the print may be too small for aging eyes. Not all older adults are computer literate or comfortable with the use of the computer. This method may be more effective for younger clients. A more effective manner in which to provide written information to older adults is in the form of lists using a large-size font.

A client is newly diagnosed with type 2 diabetes mellitus. Which diagnostic test will best evaluate the management plan prescribed for this client? a. A yearly funduscopic examination by an ophthalmologist b. Regular foot examinations by a podiatrist c. Quarterly hemoglobin A1C d. Biannual cholesterol testing

ANS: C Quarterly or biannual hemoglobin A1C (Hb A1C) is designed to provide information regarding the averaged glucose levels for a 3-month period of time. The periodic measurement of a glycated hemoglobin test (Hb A1C) is the best measure of ongoing glycemic control. Eye examinations are important, but proper blood sugar control will help prevent the damaging effects of diabetes to the eyes. Proper foot care is important, but good blood sugar control will help prevent the damaging effects of diabetes on the feet. Biannual cholesterol testing is not relevant to the evaluation of type 2 diabetes mellitus.

2. An older adult is admitted to the hospital after a serious fall. When noting that the client has been prescribed meperidine (Demerol) for muscle pain, the nurse: a. administers the medication so as to prevent the client from developing the fear of pain. b. questions the client and family concerning any allergies to analgesic medications. c. calls the physician to question the appropriateness of this medication order. d. conducts a pain assessment and determines the client's need for an analgesic medication.

ANS: C Some medications used in younger adults, for example, meperidine (Demerol), are always contraindicated in the older adult. The metabolites of Demerol can cause confusion, psychotic behavior, and seizure activity. The remaining options would not be inappropriate, except for the fact that they relate to the administration of an inappropriate medication.

A patient tells the nurse, "Every time I laugh or cough, I wet myself." Which type of urinary incontinence is this patient describing? a. Urge b. Functional c. Stress d. Mixed

ANS: C Stress incontinence is defined as the loss of a small amount urine with activities that increase intra abdominal pressure such as coughing, sneezing, exercise, lifting, or bending.

3. A nurse is caring for an older hospitalized patient who recently suffered a myocardial infarction (MI). The patient asks the nurse, "I didn't even know that I had a heart attack. I did not have crushing chest pain like you see on television. Why didn't I?" The best response by the nurse is: a. "Older patients do not feel pain in the same way that younger patients do." b. "Oh, that is just television. Hardly anyone has crushing chest pain when he has a heart attack." c. "Older people often do not have the typical signs and symptoms when they have a heart attack." d. "Older people never have chest pain when they have a heart attack."

ANS: C Symptoms of an MI can be completely atypical in an older person, such as an unexplained fall, acute change in mental status, or extreme fatigue or dyspnea. Some older patients, however, do have the typical signs and symptoms. It is not true that older people do not feel pain.

10. An older client who was recently admitted to the subacute setting after having a knee replacement is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement? a. Share with the patient that it's important to get out of bed and that there is pain medication available if it does hurt. b. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain. c. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed. d. Allow the patient to remain in bed, but share that getting up will be required at least twice a day starting the next morning.

ANS: C The administration of an as-needed analgesic 20 to 30 minutes before an activity may eliminate discomfort and fear of discomfort. It may also enhance the individual's capacity for the activity. It is not true that performing an activity quickly will lessen the pain or that the patient will get used to the pain. A Hoyer lift is only indicated when an individual is completely immobile. Activity is an important part of rehabilitation.

8. When performing the initial assessment on a new client in a geriatric outpatients practice, the most effective method the nurse can implement to elicit an accurate medication assessment is to ask that the client: a. make a list of all her current medications. b. work with a family member to make a list of her medications. c. bring in all of the medications that she is currently taking. d. allow her previous primary care provider to provide a list of medications.

ANS: C The gold standard is to use the "brown bag" approach. The patient is asked to bring all medications including prescription drugs, OTC drugs, and herbal and dietary supplements. The patient may not remember all of the medications that are being taken. As each medication is removed from the bag, necessary information is obtained. A complete medication assessment includes OTC drugs, as well as herbal and dietary supplements, not just prescription medications. Your primary source of information should be the patient if she is able to provide the information; the previous provider may not be able to provide information on supplements or OTC and herbal medications. The nurse needs to include more than just prescription medications. In addition, prescribed medications do not always reflect what is being taken.

2. Which is the most likely reason that type 2 diabetes mellitus is often difficult to diagnose in older adults? a. Presenting symptoms occur very quickly. b. The disease rarely occurs in older adults. c. The classic symptoms may not be present in older adults. d. There are no recognizable symptoms; it is a "silent killer."

ANS: C The symptoms are also often masked by normal aging changes and conditions common in older adults. Polydipsia often does not occur due to the decreased thirst mechanism in older adults, polyphagia is often not recognized due to normal appetite declines associated with aging, and polyuria is often not recognized due to frequent urinary tract infections in older adults. Presenting symptoms usually occur very slowly. Type 2 diabetes mellitus is very common in older adults. There are symptoms of diabetes mellitus in older adults; however, they may be different than those seen in younger adults.

4. An older resident of a long-term care facility diagnosed with dementia has in the last 48 hours become more confused than usual and while usually requiring help with toileting has been incontinent of urine. The client's health care provider orders a complete blood count and serum electrolytes. When the laboratory tests are all within normal limits, the nurse initially: a. attributes the changes in the resident's functioning to advancing dementia. b. suggests that the resident be placed on broad-spectrum antibiotics to prevent infections. c. speaks with the health care provider regarding the changes in the client's function and the possibility of obtaining a urine culture. d. changes the plan of care to include bladder training and implement a 24-hour calorie count.

ANS: C Waiting for usual signs of infection or illness in older adults can be fatal. In older adults, signs of infection may be absent or not seen until the patient is septic or very ill. The nurse needs to be alert to the subtle changes in the patient. A change in mental status may be indicative of an infection. Laboratory values do not always change in older adults, often not until the patient is very ill. Placing a patient on broad-spectrum antibiotics does not prevent infections. This action may in fact cause bacteria to become drug resistant. All evidence points to the changes in functioning being attributable to acute illness. The nurse needs to respond to the acute illness first.

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

ANS: C When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. Raising one's voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

3. Which of the following manifestations would a nurse expect in a 70-year-old patient who has the diagnosis of osteoarthritis? a. Swan neck deformity of the hand b. Subluxation of the fingers c. Heberden's nodes on the distal phalanges d. Enlarged great toe

ANS: C Herbeden's nodes are common in osteoarthritis. As the disease progresses, osteophytes develop in the joints of the fingers. Swan neck deformity and subluxation of the fingers are common in RA. An enlarged great toe is characteristic of gout.

6. A nurse plans for the discharge of a 75-year-old patient who has the diagnosis of osteoporosis. Which of these actions would the nurse consider first? a. Avoid stressful situations. b. Schedule an annual DXA/DEXA scan. c. Remove clutter from the floors of the home. d. Encourage consumption of a high-protein diet.

ANS: C Individuals with osteoporosis are very high risk for falls. The most serious health complication of osteoporosis is the morbidity and mortality associated with a fall. There is no evidence that stress impacts osteoporosis. The recommendation for a DXA/DEXA scan is every 2 years. There is no evidence that a high-protein diet is important for an individual with osteoporosis.

2. A homecare nurse visits an older female adult at home who has peripheral vascular disease to monitor her status. The nurse determines that the client needs additional teaching when the client states which of the following? (Select all that apply.) a. "I need to try and elevate my legs above the level of my heart every time I sit down and all night." b. "I really need to try and avoid sitting in one position for a long period of time." c. "I know that I need to wear these compression stockings 24 hours a day." d. "I will wash my feet and legs with strong antibacterial soap twice daily." e. "I need to examine my feet daily for any cuts, sores, or openings."

ANS: C,D Compression stockings are worn all day but need to be removed at bedtime. It is important to wash the feet and legs with mild soap and water frequently.

3. A nurse in the ambulatory care setting is preparing to do an interview with a non-English-speaking client. The nurse secures an interpreter. In order to have the most effective interview, the nurse should do which of the following? (Select all that apply.) a. Look and speak to the interpreter b. Use technical terminology to ensure accuracy c. Allow more time for the interview d. Watch the client's nonverbal communication e. Have the interpreter check whether the client understands the communication

ANS: C,D For the most effective interview the nurse should look and speak directly to the client, avoid the use of jargon and technical terminology, observe the client's nonverbal communications, and clarify understanding by asking the client to state in his/her own words what he or she understood, facilitated by the interpreter. The interview will take longer.

2. Which of the following are true statements about the current health care workforce? (Select all that apply.) A. Approximately 10% of registered nurses (RNs) are certified in gerontological nursing B. The number of geriatricians is expected to increase about 50% over the next 25 years C. The professions of social work, physical therapy, and psychiatry are demonstrating the same trends as nursing D. Europe and the developing countries are experiencing similar shortages in health care workers with geriatric expertise as in the United States E. It is anticipated that there will be a need for approximately 3 million additional direct care and professional health care workers by the year 2030

ANS: C,D,E Less than 1% of RNs are certified in gerontological nursing. The number of geriatricians is decreasing, not increasing. Responses C, D, and E are all true.

2. Ethnocentrism is defined as: a. an understanding of another's cultural beliefs and practices. b. a conflict that occurs when an individual interacts with another whose beliefs differ from his own. c. application of limited knowledge about one person with characteristics specific to another person. d. a belief that one's ethnic group is superior to that of another.

ANS: D A belief that one's ethnic group is superior to that of another is the definition of ethnocentrism. Ethnocentrism does not involve an understanding of the beliefs of others. A conflict that occurs when an individual interacts with another whose beliefs differ from his own is the definition of cultural conflict. Application of limited knowledge about one person with characteristics specific to another person is the definition of stereotyping.

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

ANS: D A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve.

9. When educating a client on the use of an adjuvant medication, which statement best demonstrates the nurse's understanding of this therapy? a. "These medications are used instead of opioids to decrease the likelihood of addiction." b. "Adjuvant medications are prescribed because they seldom cause any significant side effects." c. "These types of medications are used to eliminate the side effects of opioid medications." d. "These drugs are used in combination with analgesics to increase the effect of the analgesics."

ANS: D Adjuvant medications are not analgesics but are thought to alter the perception of pain and are used with analgesics to potentiate the effect of the analgesics. Adjuvant medications are used with opioids and may have long half-lives in older adults. The nurse must monitor the patient for adverse effects. Adjuvant medications do not eliminate the side effects of opioids.

5. A nurse is interviewing an older woman who is a new patient in an outpatient medical clinic. Which of the following findings by the nurse is considered a risk factor for osteoporosis? a. The woman is obese and has hip pain with ambulation. b. The woman drinks three glasses of skim milk daily. c. The woman eats three to five servings of shrimp and liver per week. d. The woman has been taking corticosteroids for 10 years because of chronic pulmonary disease.

ANS: D Bone loss is rapid in individuals who take steroids for extended periods of time.

2. A 78-year-old patient has a history of osteoarthritis and lives alone in a two-story home. The bathroom is on the first level and the bedroom is on the second level. The patient states, "I am so upset. I have been wetting the bed at night." What type of incontinence does the patient most likely have? a. Mixed incontinence b. Stress incontinence c. Urge incontinence d. Functional incontinence

ANS: D Functional incontinence is defined as incontinence that is due to the individual being unable to get to the toilet as a result of barriers, including environmental barriers.

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

ANS: D Hearing aids do bring challenges, such as distorted speech and amplified background noise. Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not restore hearing to normal. Medicare does not cover the cost of hearing aids.

6. The nurse admitting a client to a same day surgery unit makes the decision to notify the surgical team to cancel the procedure based on the client's statement that: a. "Will I start taking my St. John's wort as soon as I can eat again?" b. "I've haven't taken my ginkgo for exactly 10 days." c. "I didn't want to risk catching a cold so I took my echinacea with just a sip of water." d. "It seemed strange not taking my garlic pill this morning."

ANS: D Herbs that can affect bleeding and clotting time, such as garlic, ginger, ginkgo, and ginseng, should be especially noted and reported to the surgical team. There is no known surgery-related risk involved with the regular self-medication of St. John's Wort or echinacea. Ginkgo should be stopped at least 7 days prior to surgery.

5. A home care nurse is caring for an older patient from a different culture who is bed-bound and high risk for development of a pressure ulcer. The nurse discusses the plan of care with the patient's daughter, emphasizing the importance of turning every 2 hours and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient's daughter reports that she turns her mother occasionally. She states, "I am taking very good care of my mother. You just don't understand; our ways do not involve doing things on schedules." The best response by the nurse is: a. "You must follow my guidelines and turn her every 2 hours, or I will not be able to take care of her." b. "I understand that you value your culture, but culture cannot stop you from providing good care to your mother." c. "I understand that you care very much for your mother. Perhaps caring for her is too much for you." d. "How can we best work together to provide the best care for your mother?"

ANS: D In providing cross-cultural care it is important that the nurse work with the patient and family and listen carefully and find a way to include the values and beliefs of the patient in the plan of care.

5. When a nursing interview identifies that a client is daily taking doses of herbal supplements, the nurse's priority is to: a. evaluate the effectiveness of the herbal supplement self-treatment. b. determine why the client feels the need to take the herbal supplements. c. identify when the herbal supplementation began. d. discuss the client's knowledge regarding the herbal supplements' side effects.

ANS: D The conversation about the client's use of herbal supplements should focus first on the client's understanding of the herbs' uses, side effects, dosage, and safety concerns. Once the therapeutic communication has established a nonjudgmental nature, the nurse can go on to if the client feels the supplements are effective, why the client feels the need to take the supplements, and when the supplements were started.

8. The major focus regarding nursing education for the older adult regarding the use of herbal supplements is the: a. high risk of herbal overdose since the manufacturing process lacks effective controls. b. likelihood that the client will substitute herbals for more expensive prescribed medications. c. expense of the herbal supplements since they are seldom covered by insurance. d. possibility of dangerous interactions between herbals and the client's prescription medications.

ANS: D A major issue in the use of herb and other supplements is the risk for interactions. This is especially a concern due to the number of medications already taken by elders. While the remaining options are all legitimate concerns, they are not unique to the older adult consumer.

3. Compared with acute pain, persistent pain requires the nurse to: a. monitor vital signs more frequently. b. document the character of the pain as burning. c. administer analgesics at least every 4 hours. d. educate the client to the benefit of specific lifestyle changes.

ANS: D Persistent pain can manifest itself as depression, eating and sleeping disturbances, and impaired function, all of which can lead to lifestyle changes. Persistent pain usually does not lead to markedly altered vital signs. Acute or persistent pain can manifest itself as a burning pain. Persistent pain has no time frame; it is continually persistent at varying levels of intensity.

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

ANS: D,E A, B, and C are all associated with conductive hearing loss. Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss.

1. When a client asks, "What could be causing my triglycerides to be so low; I'm really careful about my diet?" the nurse responds by asking the client: (Select all that apply.) a. "Is your type 2 diabetes well managed?" b. "Have you ever been diagnosed with renal failure?" c. "Do you have a history of pancreatitis?" d. "Are you on medication for hyperthyroidism?" e. "Could you tell me how you are careful about your diet?"

ANS: D,E Abnormally low triglyceride levels are suggestive of malnutrition or hyperthyroidism. Reasons for elevated levels include chronic renal failure and poorly controlled diabetes. Severely elevated triglyceride levels (greater than 2000 mg/dL) are a strong risk factor for pancreatitis.

2. During an admission interview, a patient tells the nurse about taking Ginkgo biloba daily. The nurse responds to this information by inquiring whether the client: a. has ever been screened for depression. b. experiences gastrointestinal (GI) upset. c. has concerns regarding impotence. d. has reoccurring bouts of bronchitis.

ANS: B Side effects of Ginkgo biloba include GI upset and should be assessed for by the nurse. Neither depression, nor impotence, nor chronic bronchitis conditions are generally self-treated with Gingko biloba. These conditions are not considered typical side effects of Gingko biloba either.

7. Kyphosis in the older adult can be a result of which of the following? a. Osteoarthritis b. Rheumatoid arthritis c. Osteoporosis d. Gout

ANS: C Kyphosis is a common presentation in osteoporosis. Individuals can lose as much as 3 cm or more in height and develop a "c" shape to the vertebral column.

6. An older client with a history of hypertension and osteoarthritis who has recently fallen and fractured two ribs is prescribed extra strength Tylenol for the pain. What statement by the client requires further evaluation by the nurse? a. "I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep through the whole night." b. "I heard that meditation may help me deal with the pain without taking all that Tylenol." c. "Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours around-the-clock and my pain is gone." d. "I make sure that I take my Tylenol with breakfast when I first get up."

ANS: C The maximum dose for Tylenol is 3 g per 24-hour period; two extra strength Tylenol tablets every 4 hours would mean that the client is taking 6 g and would need further evaluation. Herbal tea may have a relaxing effect and help her sleep. Meditation is one of the alternative modalities that help some patients deal with pain. The practice of taking Tylenol with breakfast upon waking is acceptable.

4. An older patient is prescribed warfarin for stroke prevention. A nurse is providing patient education. Which of the following foods should the patient be taught to avoid? (Select all that apply.) a. Milk b. Whole grains c. Kale d. Spinach e. Red meats

ANS: C,D It is important to avoid "leafy green vegetables" when taking Coumadin.