Gero Exam 1

9. An older person who relocated to the United States a few months ago has a limited understanding of English and has no living family members for support. Which action should the nurse take to reduce the amount of cultural marginality that this person experiences? A. Locate a community organization that is the same culture as the person B. Find an interpreter to help with completing the assessment C. Suggest returning to the home country for ongoing care and support D. Provide information on English as a second language classes

A. Locate a community organization that is the same culture as the person Rationale: Feeling disconnected from the one's native culture and not being able to acculturate to the prevailing culture is called cultural marginality, and it can have negative and positive impact on an individual. The most culturally sensitive action for the nurse to take for the older person who is new to the US and has little comprehension of the English language is to locate a community organization that is the same culture as the person. An interpreter will be needed for more than just completing the assessment. Providing information on classes so that the person can learn to speak English is not an appropriate first action to help prevent cultural marginality. Suggesting that the person return to the home country does not take the person's needs into consideration. There must be some reason for the person to be emigrating at this stage in life however the nurse is not taking the time to find out why.

1. The nurse desires to become certified as a gerontological nurse. What credentials does the nurse need prior to taking the certification examination? A. Practiced as an RN for 2 years B. Employed in a skilled nursing facility C. Completed 60 hours of continuing education D. Earned a master's degree in nursing

A. Practiced as an RN for 2 years Rationale: Nurses must have practiced the equivalent of 2 years' full-time as a registered nurse prior to seeking certification as a gerontological nurse. A master's degree is not required. Employment in a skilled-nursing facility is not required. A minimum amount of continuing education hours is not required.

16) The nurse is reviewing secondary prevention actions with an older patient. Which interventions should the nurse encourage the patient to complete? Select all that apply. 1. Yearly depression screening 2. Colonoscopy every 10 years 3. Yearly fecal occult blood test 4. Yearly height and weight check 5. Yearly blood pressure screening

Answer: 1, 2, 3 Explanation: 1. For secondary prevention, a yearly depression screening is recommended. 2. For secondary prevention, a colonoscopy is recommended every 10 years. 3. For secondary prevention, a yearly fecal occult blood test is recommended. 4. A yearly height and weight check is a primary prevention intervention. 5. Yearly blood pressure screening is a primary prevention intervention.

17) The nurse is planning a program about the Immunological Theory of Aging for a group of senior citizens. Which information should the nurse include in this program? Select all that apply. 1. Restrict spending time with others who are ill. 2. A healthy diet supports immune function. 3. An active lifestyle supports immune function in the older person. 4. Immune responses increase with aging. 5. Obtaining an annual influenza vaccination supports immune function.

Answer: 1, 2, 3, 5 Explanation: 1. Limiting exposure to pathogens can support immune function in the older person. 2. A healthy diet can support immune function in the older person. 3. A healthy, active lifestyle supports immune function in the older person. 4. Declines in immune function can affect the outcomes of illness such as urinary tract infections and pneumonia. 5. Preventive health measures such as a yearly influenza vaccination can support immune function in the older person.

8) An older client is experiencing a change in mood. For which medications should the nurse assess as the possible cause of this client's cognitive change? Select all that apply. 1. Dexamethasone 2. Ketorolac 3. Fluconazole 4. Phenobarbital 5. Atenolol

Answer: 1, 2, 4, 5 Explanation: 1. Changes in mood can result from taking steroids. 2. Changes in mood can result from taking nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Changes in mood are not associated with taking antibiotics, except fluoroquinolones like levofloxacin, moxifloxacin, and ciprofloxacin. 4. Changes in mood can result from taking benzodiazepines. 5. Changes in mood can result from taking antihypertensives.

14) The nurse is preparing an educational program regarding adverse drug reactions (ADR). What information should the nurse include? Select all that apply. 1. Older adults are more likely to have adverse drug events. 2. Drug side effects that are serious are considered ADRs. 3. Adverse drug reactions are handled on an outpatient basis. 4. Adverse drug reactions are often due to anticoagulants or antidiabetics. 5. Reactions can occur from drug-drug interactions and polypharmacy.

Answer: 1, 2, 4, 5 Explanation: 1. Older persons have ADRs with increased frequency due to issues such as polypharmacy. 2. Adverse drug reaction is a term that refers to drug side effects that are serious. 3. ADRs lead to hospital admissions and are very expensive for the healthcare system, including events leading to increased mortality. 4. According to one study, nearly 70% of ADR-related admissions are due to warfarin, antiplatelet medication, insulin, or oral hypoglycemics. 5. Older persons are more likely to have ADRs because of an inappropriate drug or dosing regimen, drug-drug interactions, polypharmacy, and non-adherence.

22) The nurse recognizes that clients admitted to the unit are associated with nationwide demographic trends. Which statement supports this observation? 1. Diabetes is most prevalent in the Caucasian community. 2. Hispanic patients have a greater incidence of obesity. 3. African-American patients have a lower incidence of hypertension. 4. Caucasians are more likely than African Americans to have limitations with ADLs when chronically ill.

Answer: 2 Explanation: 1. A growing number of Hispanic and African Americans are reporting diabetes. 2. There is an increasing rate of obesity in the Hispanic population. 3. Nearly 60% of older African Americans report high blood pressure. 4. African Americans are more likely than Caucasians to have limitations in ADLs when chronically ill.

6) The family of an older adult, requiring end of life care, is planning on caring for the client in the home. Which intervention should the nurse implement to meet the cultural needs of the client? 1. Encourage the family to allow a hospice nurse in the home to care for the client. 2. Explore the resources available to the family to meet the client's needs in the home. 3. Ask the client when the family is not present if the client wants to stay in the hospital. 4. Explain to the family the importance of allowing the healthcare team to direct the client's care.

Answer: 2 Explanation: 1. The nurse needs to respect the decisions of the family and the culture even when they are different from the nurse's beliefs. 2. Assisting with the exploration of resources to meet the client's needs supports the traditions and culture of the client and family. 3. The nurse should include the family in discussions about care and respect the client's support systems. 4. The healthcare team is available to provide support to the client and family, not completely direct the clients care.

23) The nurse has identified the diagnosis of Risk for Impaired Verbal Communication for a patient with limited English skills. Which intervention would be appropriate for this diagnosis? 1. Asking a family member to act as an interpreter 2. Writing questions on a clipboard for the patient to read 3. Using an interpreter when communicating with the patient 4. Speaking loudly and slowly when attempting to communicate with the patient

Answer: 3 Explanation: 1. Family members should not be used as interpreters. 2. Writing questions does not help improve communication with the patient. 3. Using a competent interpreter is the most appropriate intervention. 4. Speaking loudly and slowly does not help improve communication with the patient.

7. An older person who recently retired expresses delight in not having to get up and go to work every morning. Which theory of aging does this person's statement demonstrate to the nurse? A. Activity B. Disengagement C. Continuity D. Individualism

C. Continuity Rationale: In the continuity theory, the pace of activities may be slower and for some, the relief from time pressures and deadlines is a bounty of older age. The activity theory proposes that older adults should stay active and engaged if they are to age successfully. In the theory of individualism, the focus shifts away from the external world towards inner experiences as the older person searches for answers to life's riddles and find the essence of the true self. In the disengagement theory, the pattern of behavior in later life is for the older person to withdraw so that social equilibrium is maintained.

1. An organization intends to improve cultural-competent care throughout the healthcare system. Which action indicates that the Transcultural Nursing Society's care standards are being implemented? A. Cultural-assessment forms located on each computer station B. Cultural-minority applicants are encouraged to seek employment at the university hospital C. Non-English-speaking persons referred to a local hospital who employs interpreters D. Continuing-education sessions scheduled every three months for all nursing staff

D. Continuing-education sessions scheduled every three months for all nursing staff Rationale: According to the Transcultural Nursing Society's care standards, nurses should be educationally prepared to provide culturally congruent care. This includes ongoing continuing education for all practicing nurses. Placing cultural assessment forms on computer stations does not guarantee that they will be used or completed. Health care organizations should provide the structure and resources necessary to meet the language needs of the persons. Referring the person to another organization that employs interpreters does not meet this care standard. The health care organization should actively engage in the effort to ensure a multicultural workforce in the setting. Encouraging cultural minority applicants to seek employment elsewhere does not meet this care standard.

10. The nurse directs nursing-assistive personnel to assist an older person requiring assistance with feeding. Which intervention should the nurse explain to improve the person's intake? A. Use an attractive place setting B. Offer sips of fluid between bites C. Add sauce or gravy to foods D. Offer one food at a time

D. Offer one food at a time Rationale: Offering one food at a time prevents food mixing and encourages an adequate intake in the person requiring assistance with feeding. Adding sauces and gravy to foods increases the nutritional density of foods and helps with xerostomia. An attractive place setting enhances the eating environment. Offering sips of fluid between bites helps with xerostomia and ensures hydration.

5) Which assessment data best indicates to the nurse that an older client is experiencing undernutrition? 1. Body mass index (BMI) of 21 2. Unintentional 3% weight loss over a month 3. Client takes no supplements or vitamins 4. Serum albumin is slightly below normal

Answer: 1 Explanation: 1. A BMI less than 22 in the older person is predictive of undernutrition. 2. A 3% unintentional weight loss over a month does not indicate undernutrition. This is dependent on the client's original BMI. An unintentional weight loss is cause for concern, though. 3. Taking a multiple vitamin or other supplement is not directly connected to a diagnosis of undernutrition. If the client eats adequately, supplements are not needed for health and nutrition. 4. Albumin, prealbumin, and transferrin are plasma proteins. A lower serum albumin is less specific to malnutrition because it is affected by other conditions, such as liver disease, kidney conditions, and hydration status.

2) The husband of a female patient of the Islamic culture asks that only a female doctor examine his wife. How should the nurse respond to the husband? 1. A female doctor will be provided. 2. The request is unreasonable and cannot be honored. 3. Both male and female doctors respect the patient's privacy. 4. The patient's body will be covered during any examinations.

Answer: 1 Explanation: 1. A common cultural conflict is misunderstanding a cultural practice of modesty and the need for gender-specific care. The nurse should recognize this as a legitimate request and make every attempt to honor the request. 2. Stating that the request is unreasonable shows insensitivity to the patient's cultural need. 3. Although both male and female staff have professional and ethical responsibilities to respect a patient's privacy, the nurse must still make efforts to meet the request of the patient. 4. The response of covering the patient shows insensitivity to the patient's cultural need.

9. An older person is experiencing severe xerostomia. Which action should the nurse take to increase this person's comfort and enjoyment of food during meals? A. Encourage drinking soda between meals B. Prepare meals with eggs and milk C. Provide foods at high temperature D. Serve fluids with meals

D. Serve fluids with meals Rationale: An intervention to improve xerostomia is to serve fluids with meals. Preparing meals with eggs and milk helps to increase nutrient-dense intake. Hot foods should be avoided for the person with xerostomia. Sugar-free candy, chewing gum, and fluids should be offered instead of regular sodas with sugar.

5. The nurse identifies the diagnosis of Insufficient coping strategies for an older person. What functional health pattern data did the nurse use to determine this diagnosis? A. Community golf course raised the rates for a round of golf B Parish council voted to replace the current pastor C. Alcohol consumption increased since son was incarcerated D. Best friend moving to a senior community in another state

C. Alcohol consumption increased since son was incarcerated Rationale: The functional-health pattern of coping-stress tolerance addresses the behavior patterns of coping with stressful events and level of effectiveness of coping strategies. Ingesting more alcohol since a son was incarcerated indicates the person is having difficulty with this functional-health pattern. Replacing a parish pastor would affect the values-beliefs functional-health pattern. A best friend moving to another state would affect the roles-relationships functional-health pattern. Learning that it costs more to play a round of golf would affect the activity-exercise functional-health pattern.

10. During an activity in the recreation room the nurse notes a resident staring with a puzzled expression after instructions for a group activity are given. What should the nurse do to assist this resident? A. Talk louder in the future B. Lower the room lights C. Repeat the information after making eye contact D. Hold the resident's hand

C. Repeat the information after making eye contact Rationale: A puzzled look may mean the person cannot hear but is ashamed to interrupt. Because of the puzzled look, the nurse should repeat the information about the activity. Talking louder can be disturbing. There is no reason to lower the lighting in the room. The resident is not demonstrating an emotion issue, so holding the hand is not appropriate at this time.

5. The nurse notes that an older female patient refuses care offered by a male nursing assistant. For which outcome should the nurse assess the person as a result of this situation? A. Anxiety B. Anger C. Weight loss D. Dehydration

A. Anxiety Rationale: The situation of gender specific care can cause the person experience fear, withdrawal, or increased anxiety. Anger is an outcome associated with a power struggle between the person and family, or person and nurse. Weight loss and dehydration can occur if dietary situations occur.

2. The nurse notes that an older person is prescribed a dose of digoxin that is lower than the recommended amount. Which age-related change explains the reason for this lower dosage? A. Changes in sensitivity of certain drug receptors B. Increase in body fat C. Decreased gastric acidity D. Dry mouth and secretions

A. Changes in sensitivity of certain drug receptors Rationale: Changes in sensitivity of certain drug receptors increases the effect of any drugs. It is wise to start low and go slow when prescribing medications to an older person. An increase in body fat can possibly increase the toxicity of water-soluble drugs and cause more prolonged and possible increased effects of fat-soluble drugs. Dry mouth and secretions affects the person's ability to swallow medications. Decreased gastric acidity can possibly decrease or delay the absorption of acidic drugs decreasing the peak effect of the medication.

3. An older person is experiencing muscle weakness and a change in balance when walking. Which vitamin should the nurse ensure the person is taking in an adequate amount? A. D B. B12 C. E D. B6

A. D Rationale: Poor vitamin D status is associated with muscular weakness and pain. These symptoms in the older adult with vitamin D deficiency are associated with an increased risk of falls. Because of this risk, the nurse should ensure that the person is taking in an adequate amount of vitamin D. Vitamin B6 is required as a coenzyme in metabolism of protein, fat, and other biochemical reactions. A supplement of B6 is not recommended unless a deficiency is diagnosed as the vitamin is widely available in the diet from meat, fish, poultry, legumes, and whole grains. Vitamin B12 is required in cell division and to maintain the myelin sheaths of the central nervous system. Symptoms of vitamin B12 deficiency include macrocytic anemia and neurologic problems, such as peripheral neuropathy, irritability, depression, and poor memory. High vitamin E intake can interact with anticoagulant therapy as well as potentiate the antiplatelet effects of other supplements, such as ginkgo biloba, ginger, ginseng, and garlic.

3. The nurse suspects that an older person is experiencing a side effect from a prescribed anticholinergic medication. What did the nurse assess to make this clinical determination? A. Elevated temperature B. Productive cough C. Constricted pupils D. Pale skin color

A. Elevated temperature Rationale: Anticholinergic medication causes an elevated temperature because of the absence of sweating. Anticholinergic medication causing flushing because of the absence of sweating. Anticholinergic medications inhibit secretions. A productive cough is not a side effect of this medication. Anticholinergic medications paralyze the ciliary muscle causing pupil dilation and not constriction.

3. The nurse prepares to complete a cultural assessment with an older patient newly admitted to the care area for treatment of an acute illness. Which action should the nurse take first before beginning this assessment? A. Identify the patient's primary language B. Review the patient's current health problem C. Select an appropriate culture-assessment tool D. Determine if family are available to answer questions

A. Identify the patient's primary language Rationale: Before a cultural assessment begins, the nurse must determine what language the person speaks and the degree of fluency in the English language. To complete a cultural assessment, the person's current health problem is not the focus. The nurse should use the tool that is implemented in the employing facility. The person is being assessed; the family is not the focus of the cultural assessment.

10. An older person expresses the desire to get better and return to home. Which aspect of ethnogeriatric care is important to this patient? A. Independence B. Manners C. Respect D. Modesty

A. Independence Rationale: The desire to get well and return home demonstrates independence. The nurse can ask the person additional questions to identify the expectations of older people and independence with aging. Respect addresses the person's expectations on the roles and responsibilities of health care workers and the desire for gender-specific care. Manners addresses the name that the person wants to be called. Modesty refers to the amount or degree of body covering that is associated with the culture.

16) The nurse has provided education for a nursing assistant on culturally competent care. Which statement made by a nursing assistant is the most correct about culturally competent care? 1. "I will respect my client's daily prayer ritual." 2. "I will ask my clients how they would like to be addressed." 3. "I will provide my client uninterrupted time to visit their family." 4. "I will ask my client if they would like to participate in any activities."

Answer: 1 Explanation: 1. A ritual of prayer is associated with many cultures and religions. Respecting the client's prayer ritual contributes to the delivery of culturally competent care. 2. Asking a client how they would like to be addressed demonstrates professionalism and respect to all clients regardless of their cultural communication practices. This statement has more to do with professionalism than culturally competent care. 3. Providing the client with uninterrupted time to visit their family is professional and conveys respect to all clients regardless of their cultural beliefs. This statement corresponds more with respect than culturally competent care. 4. All clients should be asked if they would like to participate in general or special activities. There may be a special activity that is culturally related that the client would like to participate in; however, this would not be the most correct comment about culturally competent care.

15) A patient voices concerns about her body weight despite diligently following a healthy diet. Which age-related change would explain this patient's issue with body weight? 1. Body fat increases until middle age. 2. Body weight increases after middle age. 3. Fat is redistributed to the hips after middle age. 4. Body fat promotes a pear-shaped appearance for aging women.

Answer: 1 Explanation: 1. Body fat typically increases until middle age and then stabilizes until late life, when weight tends to decline. 2. Body weight stabilizes after middle age. 3. With aging, fat is redistributed to the deeper organs. 4. With aging, fat is redistributed to the abdomen rather than to the hips. This promotes an apple shape rather than a pear shape.

8) Which observation made by the nurse most suggests that a client is having difficulty swallowing? 1. Drooling 2. Alternating food with liquid 3. Tongue furrows 4. Coughing after taking a drink

Answer: 1 Explanation: 1. Drooling suggests difficulty swallowing because the client is unable to swallow the saliva produced in the mouth. 2. Alternating bites of food with drinks of liquid does not necessarily indicate difficulty swallowing. The nurse assesses this behavior by asking about feelings of food sticking in chest. 3. Long furrows in the tongue are indicative of dehydration. There are many reasons for dehydration other than the inability to swallow correctly. 4. Coughing after ingestion of food or drink can indicate swallowing difficulties. However, if a drink is particularly cold, for example, it can stimulate a cough as well. The nurse carefully observes for the cough for evidence that swallowing is impaired.

22) What food items should the nurse teach an older client to ingest to increase the dietary intake of vitamin D? 1. Eat beef liver, eggs, or salmon each week. 2. Add a bowl of whole wheat cereal to breakfast. 3. Eat three servings of yogurt or cheese each day. 4. Eat kale or spinach each week with dinner.

Answer: 1 Explanation: 1. Food sources of vitamin D include liver, fatty fish, fish liver oils, egg yolks, and fortified milk. 2. Cereals must be specifically fortified with vitamin D to be a good source. 3. Yogurt or cheese are not mandated to be fortified with vitamin D and are not considered good choices. 4. Some vegetables contain vitamin D; however, these are rich in vitamin K. The nurse would need to ensure the client is not taking any anticoagulants prior to suggesting leafy green vegetables.

10) The nurse is caring for an older adult in a long-term care facility. Which statement made by the client best indicates that the client practices heritage consistency? 1. "I look forward to my family visits every Sunday." 2. "The younger generation does not understand me." 3. "My parents were so happy that my spouse shares our culture." 4. "I was so excited to learn English when I came to this country."

Answer: 1 Explanation: 1. Heritage consistency includes the enjoyment of regular contact with their extended family. 2. A generation difference is a challenge to heritage consistency. 3. Marrying someone from the same culture is not an example of heritage consistency. 4. An older adult demonstrates ties to their ethnicity through dress, language, preferred foods, family celebrations, and holidays.

1) The charge nurse has provided a staff inservice on the cultural triad and nursing care. Which statement, made by a staff nurse, best indicates an understanding of a healthcare team's difficulty with cultural literacy? 1. "Our healthcare team has limited knowledge of each others' backgrounds." 2. "Each of our perspectives of our own heritage interferes with cultural literacy." 3. "A feeling of being disconnected from our own culture has resulted in cultural illiteracy." 4. "The lack of healthcare policies have contributed to the current state of cultural illiteracy."

Answer: 1 Explanation: 1. Limited understanding of ethnic, cultural, religious heritages and life trajectories of each other results in difficulty with cultural literacy. 2. The perspective of a person's heritage reflects the consistency with their own heritage. 3. Feeling disconnected from one's own culture and not being able to acculturate to a prevailing culture is a personal experience known as cultural marginality. 4. There is not specifically a lack of healthcare policies that have contributed to cultural illiteracy. However, nurses should recognize the effect of healthcare policies, delivery systems, and resources on the older adult populations and continue to advocate for their inclusion.

9) The nurse is assessing life trajectory of an older client admitted to the unit. Which of the following would be the best question by the nurse to obtain information about life trajectory? 1. "Tell me about your spouse and children?" 2. "How do you feel about your treatment plan?" 3. "Would you like me to contact a chaplain for you?" 4. "Do you have an advanced directive or living will?"

Answer: 1 Explanation: 1. Nodal key events in a person's life are considered life trajectories. Events in a person's life, school, military service, marriage, divorces, children, moves, major illnesses, surgeries, and deaths of significant others are life trajectories. 2. Asking the client about how they feel about their treatment plan is not directly associated with a life trajectory. 3. Inquiring about the need for a hospital chaplain is not directly associated with a life trajectory. 4. Inquiring about a living will or durable power of attorney is not directly associated with a life trajectory.

7) After completing a medication history, the nurse notes that an older client is prescribed 22 different medications and sees five different healthcare providers. What is the nurse most concerned about for this client? 1. Hospital readmission potential is higher for this client. 2. Medication doses may be missed or not taken regularly. 3. The healthcare providers may not know all the medications the client takes. 4. Cognitive impairment and inability to keep up with the medications prescribed

Answer: 1 Explanation: 1. Polypharmacy is a major factor in hospital readmission rates due to unnecessary adverse events. The nurse teaches ways in which the client can avoid readmission to the hospital, including how to take medications as prescribed. 2. There is not enough information to determine if the client is prone to missing medication doses. The nurse does suggest ways in which the client can keep the medications and doses on a regular schedule, such as using a pill planner. 3. Although the client may have multiple conditions that warrant the medications prescribed, it is the job of each provider to obtain a thorough history. Additionally, pharmacists should alert the client and provider to any interaction potentials. 4. Cognitive impairments do occur when clients are on numerous medications. The nurse ensures the client understands their medication regimen and side effect management.

11) The nurse that lives in a predominantly Spanish-speaking community is learning to speak Spanish. Which describes the best use of learning Spanish? 1. The nurse will be able to communicate better with the clients' families. 2. Speaking a second language will facilitate the professional growth of the nurse. 3. A second language will help when communicating with others in the community. 4. The nurse can gain a great deal of personal accomplishment after learning a second language.

Answer: 1 Explanation: 1. The best use for a nurse learning to speak Spanish is the ability to communicate with their clients and their families effectively. 2. Learning a second language can help facilitate the professional growth of the nurse but will be of best use when communicating with the clients and their families. 3. A second language will help facilitate communication with others in the community but will be of best use for communicating with the clients and their families. 4. The nurse can derive a great deal of personal satisfaction from learning a second language, but the language will be of best use when communicating with the clients and their families.

4) The nurse instructed an older client on the importance of maintaining adequate hydration. Which statement by the client most indicates that additional teaching is needed? 1. "I'll drink water, tea, soda, or juice whenever I feel thirsty." 2. "I can add an extra cup of coffee with breakfast and dinner." 3. "I will set up a schedule to drink water every few hours throughout the day." 4. "If I drink a lot of fluids, I'll get more exercise running to the bathroom."

Answer: 1 Explanation: 1. The client needs additional instructions regarding adequate fluid intake. Because the thirst mechanism becomes blunted with age, the client cannot rely on feeling thirsty as a signal to meet hydration requirements. Also, sweet and caffeinated beverages should be limited. 2. Preferably, the client would add decaffeinated fluids, which are allowed and will not lead to diuresis. However, extra fluid is still a positive step. 3. Use of a schedule to maintain adequate fluid intake is preferred because it provides the client with a continuous stimulus to take fluids. The nurse would like to help the client come up with a more detailed plan, such as drinking an 8 oz glass every two hours. 4. The client can expect to urinate more often with the increased fluid intake. The client should be cautioned to reduce fluid intake closer to bedtime to reduce fall hazards with frequent bathroom trips.

4) An older client admitted with chest pain is prescribed Restoril 15 mg at bedtime. The usual dosage given to adults is 30 mg. What intervention would the nurse use for this client? 1. Administer the drug as ordered. 2. Monitor the client's renal function. 3. Ask the physician to change the dosage to 30 mg. 4. Give the drug and contact the doctor for a second dose if the client does not fall asleep.

Answer: 1 Explanation: 1. The rule of thumb for drug prescriptions in older persons is to "start low, go slow." Drugs, such as sedatives, are given at one half the recommended adult dosage. 2. The client's renal function is important to monitor, but it is not relevant in this situation. 3. Recommending the adult dose may result in excessive sedation. 4. Changing the dosage quickly may result in excessive sedation.

13) The nurse is preparing to admit an elderly patient who is deaf. What should the nurse do to ensure effective communication with the patient? 1. Use the hospital-approved interpreter program. 2. Use the patient's family members to communicate with the patient. 3. Ask the patient to read assessment questions off of the computer screen. 4. Ask if anyone who is currently working could help communicate with the patient.

Answer: 1 Explanation: 1. Using the hospital-approved interpreter program is the intervention of choice when communicating with any patient who is deaf or has limited English proficiency. 2. Using family members can interfere with confidentiality and also does not ensure that the information is being communicated correctly. 3. Asking the patient to read assessment questions off of the computer screen does not ensure that the patient will understand the questions that are being asked. 4. Using other coworkers can interfere with confidentiality and also does not ensure that the information is being communicated correctly.

20) At times, the gerontological nurse functions in the role of consultant when working with older clients. Which activities does the nurse perform while functioning in this role? Select all that apply. 1. Develops clinical pathways 2. Implements evidence-based practices 3. Develops quality assurance standards 4. Provides information about regulations 5. Provides instruction about healthy aging

Answer: 1, 2, 3 Explanation: 1. As a consultant, the gerontological nurse will participate in the development of clinical pathways. 2. As a consultant, the gerontological nurse will participate in the implementation of evidence-based practices. 3. As a consultant, the gerontological nurse will participate in the development of quality assurance standards. 4. As a manager, the gerontological nurse will provide information about regulations. 5. As an educator, the gerontological nurse will provide instruction about healthy aging.

16) What should the nurse instruct an older client to do to support healthy eating habits? Select all that apply. 1. Increase intake of whole fruits. 2. Limit ready-to-eat meals. 3. Choose no-sugar-added desserts. 4. Use nuts or healthy oils on salads. 5. Eat quickly to avoid feeling full.

Answer: 1, 2, 3, 4 Explanation: 1. Increasing fiber intake is a healthy eating tip. Eating whole foods also avoids blood sugar spikes that occur with juices. 2. Reduce sodium intake is a healthy eating tip. These small meals are quick and easy but often contain an entire day's allowance of sodium. 3. Looking for hidden sugar is a healthy eating tip. Canned, boxed, and frozen foods can have hidden sugar. Choosing no-sugar-added foods is a good alternative. 4. Enjoying good fats such as olive oil and walnuts is a healthy eating tip. 5. Slowing down at mealtime is a healthy eating tip. Eating quickly allows the client to ingest too many calories before the body reaches satiety.

12) It has been determined that nonpharmacological approaches will be used to help an older client manage pain. What should the nurse explain as the reasons for using these approaches? Select all that apply. 1. Nonpharmacological approaches can alleviate the pain. 2. Nonpharmacological approaches can delay the need for medication. 3. Nonpharmacological approaches can prevent the need for medication. 4. Nonpharmacological approaches can complement current medication therapy. 5. Nonpharmacological approaches do not cost the client anything to use or implement.

Answer: 1, 2, 3, 4 Explanation: 1. Nonpharmacological treatments can alleviate the health condition. 2. Nonpharmacological approaches can delay the need for medication. 3. Nonpharmacological approaches can prevent the need for medication. 4. Nonpharmacological approaches have been used to complement drug therapy. 5. There is no evidence to suggest that nonpharmacological approaches do not cost the client anything to use or implement.

24) A student nurse is preparing a presentation to explain the steps in developing cultural competency. What questions should the student ask to become more aware of personal ethnocultural heritage? Select all that apply. 1. "Do you value stoic behavior?" 2. "Where were your parents and grandparents born?" 3. "What are examples of your ethnocultural life trajectories?" 4. "What do you see as seminal cultural events of your lifetime?" 5. "Which life experience stands out as an event in your heritage?"

Answer: 1, 2, 3, 4 Explanation: 1. One question to ask when becoming aware of personal ethnocultural heritage is "Do you value stoic behavior?" 2. One question to ask when becoming aware of personal ethnocultural heritage is "Where were your parents and grandparents born?" 3. One question to ask when becoming aware of personal ethnocultural heritage is "What are examples of your ethnocultural life trajectories?" 4. One question to ask when becoming aware of personal ethnocultural heritage is "What do you see as seminal cultural events of your lifetime?" 5. One question that is not asked when becoming aware of personal ethnocultural heritage is "Which life experience stands out as an event in your heritage?" since there must be a cumulative effort to learn from each experience.

24) The nurse is using the DETERMINE nutrition screening tool to assess the nutritional status of an older client. Which findings indicate the nurse needs to assess further for nutritional deficiencies? Select all that apply. 1. The client is diagnosed with emphysema. 2. The client eats a can of green beans for dinner. 3. The client lives alone and does not have a vehicle. 4. The client has newly fitted permanent oral dentures. 5. The client is being treated for multiple conditions.

Answer: 1, 2, 3, 5 Explanation: 1. Disease is a category in the DETERMINE nutrition screening tool. Pulmonary diseases often negatively alter a client's food intake. 2. Eating poorly or skipping meals indicates the need to assess further. The client who eats a can of vegetables for dinner is missing key nutrients and likely taking in too much sodium. 3. Reduced social contact is a category in the DETERMINE nutrition screening tool. 4. Tooth loss, mouth pain, and poorly fitting dentures can decrease nutrition intake. New dentures likely fit and work well. 5. Polypharmacy can cause decreased appetite, taste alterations, drowsiness, and gastrointestinal disturbances.

15) The nurse is concerned that an older client exhibits lethargy and headache. What other assessments does the nurse perform immediately? Select all that apply. 1. Mental status 2. Orthostatic blood pressure 3. Daily weight 4. Long tongue furrows 5. Forearm tenting of the skin

Answer: 1, 2, 4 Explanation: 1. Confusion is a symptom of dehydration in the older adult. While confusion does happen from other causes, this would be an excellent indicator in the presence of existing headache and lethargy. 2. An orthostatic blood pressure is an immediate indication of the client's cardiac output in the presence of dehydration and is an essential initial assessment. 3. Weight loss would occur in a client that is dehydrated. Weight gain is an indication of overhydration. However, weight loss can occur for other reasons and is not an immediate indicator of fluid status but an ongoing indicator. 4. Long tongue furrows are symptoms of dehydration in the older adult. 5. Tenting on the forearm is not an accurate indicator of dehydration because the older client will often have tenting with a normal hydration status as a result of loss of skin elasticity.

18) The nurse is providing a psychotropic medication to an older client. Which findings are most concerning to the nurse? Select all that apply. 1. Intermittent, repetitive muscle movements 2. Frequent crossing and uncrossing of legs 3. Belief that a hooded figure is watching 4. Continual lip smacking and tongue movements 5. Disorganized speech and catatonic behavior

Answer: 1, 2, 4 Explanation: 1. Dystonia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later. 2. Akathisia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later. 3. Delusional disorder is one indication for the use of antipsychotic medication. This is not most concerning but may indicate a need to switch medications or increase the dose. 4. Tardive dyskinesia is recurrent, involuntary movements that may be irreversible and is associated with antipsychotic medication. 5. Schizophreniform disorder is one indication for the use of antipsychotic medication. This is not most concerning but may indicate a need to switch medications or increase the dose.

24) The home care nurse is reviewing the medications that an older client is currently taking. Which guidelines should the nurse follow when conducting this review? Select all that apply. 1. Review the client's allergies. 2. Review the drug for number of refills. 3. Review the drugs for duplicate therapy. 4. Review the client's medical conditions. 5. Review each drug for interactions with other drugs.

Answer: 1, 2, 4, 5 Explanation: 1. When assessing an older client's appropriate use of medications, the nurse should follow the guideline of reviewing the client's allergies. 2. Reviewing the drug for number of refills is not a guideline when assessing an older client's appropriate use of medications. 3. When assessing an older client's appropriate use of medications, the nurse should follow the guideline of reviewing the drugs for duplicate therapy. 4. When assessing an older client's appropriate use of medications, the nurse should follow the guideline of reviewing the client's medical conditions. 5. When assessing an older client's appropriate use of medications, the nurse should follow the guideline of reviewing each drug for interactions with other drugs.

8) The nurse is caring for an older patient who only speaks Spanish. To meet the national standards for culturally and linguistically appropriate services in healthcare, what will the nurse do? Select all that apply. 1. Offer language assistance services to the patient. 2. Post signs in the patient's room written in Spanish. 3. Encourage the patient's family members to serve as interpreters. 4. Explain the cost to employ an interpreter to help the patient with language needs. 5. Provide a written notice in the patient's language informing of the right to receive language assistance services.

Answer: 1, 2, 5 Explanation: 1. To meet the national standards for culturally and linguistically appropriate services, the nurse needs to offer language assistance services to the patient. 2. To meet the national standards for culturally and linguistically appropriate services, the nurse needs to post signage in the patient's native language. 3. Family should not be used to provide interpretive services except upon request by the patient. 4. Healthcare organizations must offer and provide language assistance services at no cost to each patient. 5. To meet the national standards for culturally and linguistically appropriate services, the nurse needs to provide the patient with a written notice in the patient's language, informing the patient of the right to receive language assistance services.

15) The nurse is instructing an older client on ways to prevent esophageal irritation from taking medication. Which information should the nurse include in this teaching? Select all that apply. 1. Drink at least 8 ounces of water with morning medications. 2. Crush any pills to make them easier to swallow. 3. Take several sips of water before taking oral medications. 4. Sit up in a chair for at least 30 minutes after taking oral medications. 5. Coffee can be used as a substitute for water when taking medications.

Answer: 1, 3, 4 Explanation: 1. One intervention to prevent esophageal irritation from taking medication is to drink at least 8 ounces of water with each pill. In cases of polypharmacy, this is not feasible, but a full glass of water should be taken when medications are taken. 2. The client should not divide or break up tablets or capsules without consulting the pharmacist since some drugs may be enteric coated or compounded as a sustained-release preparation; chewing or breaking them apart could result in toxicity as more of the drug becomes immediately available for absorption. 3. One intervention to prevent esophageal irritation from taking medication is to take several sips of water before taking oral medications. 4. One intervention to prevent esophageal irritation from taking medication is to sit up in a chair for at least 30 minutes after taking oral medications. 5. In the client with esophageal irritation, coffee is avoided due to its effects on the lower esophageal sphincter.

21) The nurse is instructing an older client about medication management. What information should the nurse include? Select all that apply. 1. Obtain all of your medications from the same pharmacy. 2. Request that medications be placed in childproof packages and caps. 3. Develop a method for remembering if medications have been taken, such as moving it to a different place. 4. Schedule medications at mealtimes or in conjunction with other specific activities unless contraindicated. 5. Establish a routine for taking medications, such as preparing medication for each day in different containers.

Answer: 1, 3, 4, 5 Explanation: 1. Encouraging clients to obtain all of their medications from the same pharmacy will help the pharmacist to monitor medication use. 2. Childproof packages and caps may be difficult for the older client to open and use. 3. One way to help older clients manage medications is to develop a method with the client for remembering if the medication has been taken, such as moving it to another place. 4. One way to help older clients manage medications is to schedule medications at mealtime or in conjunction with other specific daily activities. 5. One way to help older clients manage medications is to establish a routine for taking medications, such as preparing medications for the day in different containers.

11) During a home visit, the nurse learns that an older client is taking herbal remedies in addition to prescribed medications. What should the nurse instruct the client about this practice? Select all that apply. 1. Some herbal remedies interact with medications. 2. Herbal remedies are natural products and do not harm the body. 3. Talk to the healthcare provider about the use of herbal remedies. 4. The Food and Drug Administration does not regulate herbal remedies. 5. For most herbal remedies, no studies have demonstrated effectiveness.

Answer: 1, 3, 4, 5 Explanation: 1. Herbs can interact with medications. 2. Because the FDA does not regulate herbal medicines, there is no assurance of standardization of their ingredients, purity, dosage, or potency. 3. It is important for the client to discuss the use of herbal remedies with prescribed medications with the healthcare provider. 4. The Food and Drug administration does not regulate herbal medicines, and these medicines may have different ingredients, purity, dosage, or potency. 5. For most herbal remedies, there have not been sufficient clinical trials to demonstrate their effectiveness or appropriate dosage.

12) When planning care, which older client does the nurse identify as being most at risk for malnutrition? Select all that apply. 1. Client with a fever of unknown origin for two weeks 2. Client with dysphagia and a soft diet 3. Client with osteoporosis and a hip fracture 4. Client who chooses a vegetarian diet 5. Client with chronic obstructive pulmonary disease

Answer: 1, 3, 5 Explanation: 1. The client with a fever is at risk for malnutrition as a result of hypermetabolism. 2. The client with dysphagia is at risk for malnutrition because of the inability to eat adequate amounts of foods. As long as the diet is suitable to the client's swallowing abilities, malnutrition should not be a problem. 3. Clients with osteoporosis have experienced a nutritional alteration, but the client with a bone fracture is at increased risk of malnutrition. 4. The client with a well-managed vegetarian diet is not at increased risk of malnutrition. The nurse would ensure the client eats the correct varieties of foods to ensure adequate nutrient intake. 5. The client with chronic obstructive pulmonary disease often is malnourished because of the increased caloric need associated with breathing efforts.

22) The nurse is admitting an older client to the unit. Which of the following should the nurse include in the admission process to provide culturally competent care? 1. Assess the client's level of pain 2. Identify the client's life trajectories 3. Allow the client to see the prescribed plan of care 4. Encourage family involvement in as much of the client's care as possible

Answer: 2 Explanation: 1. Assessing the level of pain in the client does not specifically address culture competency. 2. One step to develop cultural competency is becoming aware of the patients' life trajectories. This supports mutual respect between the patient, caregiver, and nurse. 3. The plan of care should include the input of the client. A missed cue can result in a power struggle if there is a cultural conflict. 4. Permission must be obtained from the client prior to involving family members in the client's care.

24) The nurse is caring for a client with advanced dementia who is refusing to cooperate with the initiation of a blood transfusion. Which action should the nurse take? 1. Consult mental health. 2. Document the treatment as refused. 3. Explain to the client why the blood is necessary. 4. Administer the blood after the client calms down.

Answer: 2 Explanation: 1. Consulting mental health does not mean the client will agree and would not be the best action. The client has the right to refuse treatment. 2. Documenting that the treatment was refused would not be the appropriate action by the nurse. The nurse should advocate for the client to receive the treatment as much as possible before documenting it as refused. 3. The stem states the client has dementia, so explaining why they need the blood would not be appropriate to get the client to agree. The client has the right to refuse. 4. Waiting for the client to calm down does not mean the client will then agree to the treatment. The client still has the right to refuse.

3) An older client without any major health problems is experiencing decreased strength and endurance while performing some activities. What should the nurse explain as the reason for the change in strength and endurance? 1. Depression 2. Decrease in lean muscle mass 3. Lowered absorption of vitamin D 4. Increase in cholecystokinin production

Answer: 2 Explanation: 1. Depression is not a normal part of the aging process. 2. Lean muscle mass diminishes with aging. This can lead to a loss of type II muscle fibers that affect strength and endurance. 3. Diminished vitamin D absorption leads to bone loss. 4. Cholecystokinin production increases with age and can cause early satiety and low hunger.

10) An older client is receiving feedings through a permanent feeding tube. Which nursing intervention will decrease this client's risk of aspiration? 1. Administer formulas that contain fiber. 2. Keep the head of the bed elevated at a 30 to 45 degree angle. 3. The risk of aspiration no longer exists after a permanent feeding tube has been placed. 4. Flush the tube with water before and after each medication administered through the tube.

Answer: 2 Explanation: 1. Formulas that contain fiber help stimulate normal bowel function. 2. The head of the bed of clients receiving tube feedings should be elevated at a 30 to 45 degree angle to decrease the risk of aspiration. 3. The client is receiving a feeding through a permanent feeding tube. The risk of aspiration continues to exist after the placement of the tube. 4. Flushing the tube with medication administration is necessary to prevent clogging of the tube.

18) An older client who is post-cerebral vascular accident is receiving enteral feedings and is experiencing abdominal cramps and liquid stools. Which is the best nursing intervention to reduce the client's cramping and diarrhea? 1. Advocate for reducing the calories in the formula. 2. Ask to change the client's feeding from bolus to continuous drip. 3. Suggest reducing the amount of formula prescribed. 4. Administer additional free water to the client every day.

Answer: 2 Explanation: 1. Formulas with more than 1 cal/mL can result in diarrhea; however, more than the client's diarrhea is considered to make such a change. 2. A continuous drip of enteral nutrition can reduce the client's occurrences of diarrhea stools. There are few contraindications to altering the feeding to a drip. This is also safer for the client who is at risk for aspiration. 3. Reducing the volume of feeding might reduce diarrhea, but there are caloric needs to consider first. This might be an option if the client is also able to take in some amount orally. 4. Often, the nurse can offer more free water without a prescription, and this can help prevent dehydration. Water will not reduce diarrhea, though.

23) The nurse has completed an educational program for residents of a retirement community regarding unsafe medication practices. Which statement made by a resident best indicates effective teaching? 1. "Over-the-counter medications are good for up to two years." 2. "I will buy all of my medication from the same pharmacy." 3. "My roommate and I can share any medications that are the same, if needed." 4. "Medication can be obtained that is inexpensive from an internet pharmacy."

Answer: 2 Explanation: 1. Generally, medications should not be kept longer than a year, but it is important to follow the expiration date on the medication. 2. Clients should be encouraged to obtain all of their medications from the same pharmacy. 3. Clients should not take medication that has been prescribed for someone else. 4. Claims for where the medication was made on internet pharmacy sites are not always true. Medications should only be obtained from pharmacies licensed in the United States. These are listed as Verified Internet Pharmacy Practice Sites.

4) An infant of African origin is being cared for by parents who immigrated to the United States 6 months prior. The mother is using an herbal paste to treat the baby's diaper rash. What should the nurse do to ensure cultural competence? 1. Instruct the mother to stop using the paste. 2. Ask the mother to explain the ingredients in the paste. 3. Provide the mother with another cream to use for the diaper rash. 4. Explain to the mother that herbal ingredients are harmful to the baby.

Answer: 2 Explanation: 1. Instructing the mother to stop using the paste demonstrates cultural insensitivity by the nurse and should not be done. 2. To recognize cultural practices, the nurse must acknowledge that use of folk and home remedies are part of caregiving practices. Asking the mother what ingredients are in the paste allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner. 3. Providing the mother with another cream to use for the diaper rash demonstrates cultural insensitivity by the nurse and should not be done. 4. Explaining to the mother that herbal ingredients are harmful to the baby demonstrates cultural insensitivity by the nurse and should not be done

6) Which older client is at greatest risk for vitamin D deficiency? 1. The client on steroids for pneumonia 2. The client who is lactose intolerant 3. The client who gardens as a hobby 4. The client on phenytoin while hospitalized

Answer: 2 Explanation: 1. Long-term steroid use is associated with vitamin D loss and bone destruction. Short-term use for an infection does not place the client at risk for deficiency. 2. Older adults at risk for poor vitamin D status include those who do not consume milk or milk products. The nurse must ensure the client is getting vitamin D and calcium from other sources such as liver. 3. Vitamin D is produced endogenously by the action of sunlight on the skin. The nurse would determine how much skin to sun exposure the client really gets each week. If the client works inside, wears thick sunscreen, and wears long coverings to garden, the client may still be at risk of vitamin D deficiency. 4. The client who is on phenytoin short-term is not at increased risk of vitamin D deficiency. Vitamin D is fat soluble and stored in the body. If the client needs phenytoin long-term there is a risk of vitamin D deficiency.

2) The nurse has completed the teaching for an older client with prescribed metformin. Which statement made by the client best indicates that the client understands the teaching? 1. "An appetite decrease will help me lose weight." 2. "I will add vitamin B fortified cereal to my breakfast." 3. "Eating animal products at each meal is needed." 4. "Drinking coffee will offset any tiredness or weakness."

Answer: 2 Explanation: 1. Metformin has an adverse effect of anorexia in the elderly. Though weight loss is helpful in those who are overweight, a decrease in appetite should be addressed early and monitored. The dose should be reduced or the medication changed if this occurs. 2. Metformin is associated with a decreased intake and absorption of vitamin B12. Vitamin B12 in fortified foods like breakfast cereals is not bound to protein and therefore is more bioavailable than in natural food sources. 3. Animal products are a terrific source of vitamin B12, but there are other food sources to obtain this nutrient. 4. Weakness and tiredness can be signs of a developing B12 deficiency and this needs to be addressed with the physician. The client should not try to make up for this with caffeine intake.

25) An older client has an unintentional weight loss of 20 pounds in the last 3 months. What should the nurse teach the client's family to prevent further loss of weight? 1. Provide liquid nutritional supplements with meals. 2. Add nonfat milk powder to scrambled eggs to add more protein. 3. Encourage the client to resume smoking to increase the appetite. 4. There is nothing to change as weight loss is a normal part of aging.

Answer: 2 Explanation: 1. Nutritional supplements should be offered at least an hour before or after a meal. 2. Interventions for clients with undernutrition issues include adding nonfat milk to soups, puddings, scrambled eggs, and other recipes. 3. The client should stop smoking to improve taste perception. 4. Weight loss is not a part of the normal aging process.

3) The nurse learns that a client of the Jewish faith does not eat certain types of foods and fasts on religious holidays. Which intervention would help support the client's cultural practice? 1. Research the client's practices. 2. Obtain a consult with the dietician. 3. Document the client's preferences on the assessment form. 4. Communicate the client's practices to the healthcare team.

Answer: 2 Explanation: 1. Researching the client's practices will help the nurse become culturally competent, but this does not support the client in practicing his or her beliefs. 2. Obtaining a consult with a dietician will assist the client in adhering to religious practices that center around dietary intake. 3. Documenting the client's preferences on a form is important for communication but does not address the actual dietary requirements associated with the clients practiced beliefs. 4. Communicating the client's preferences to the healthcare team is important for communication but does not address the actual dietary requirements associated with the client's practiced beliefs.

25) The nurse is admitting a client to the unit who states, "I am very uncomfortable with males. My religion does not permit me to have physical contact with them." Which statement made by the nurse would be most appropriate? 1. "We have many male assistants on this unit." 2. The nurse should have care arranged by a person of the same sex as much as possible and protect the person's personal privacy at all times. 3. "I can see if we can transfer you to another floor." 4. "I will put a sign on your door so that no males enter your room."

Answer: 2 Explanation: 1. Telling the client this information does not help protect the client's privacy and beliefs. 2. The nurse should have care arranged by a person of the same sex as much as possible and protect the person's personal privacy at all times. 3. Telling the client that they may have to be transferred to another floor may increase their anxiety and instill fear and shame. 4. Placing a sign outside the patient's door is inappropriate. The communication between the healthcare team should take place verbally and be documented. Arrangements should be made to have the care by a person of the same sex and to protect the person's personal privacy at all times.

21) The nurse has instructed an older client on the modified MyPlate and caloric intake. Which client response best indicates that instruction has been effective? 1. "I have to drink six cups of milk every day to get enough vitamin D in my diet." 2. "Eating the lowest daily recommended value provides adequate calories each day." 3. "I will get enough B vitamins as long as I eat the recommended amount of vegetables." 4. "Taking daily protein powder supplements is a good alternative to eating meat."

Answer: 2 Explanation: 1. The client can reach their vitamin D intake this way, but other sources include liver, fortified cereals, fish oil, fatty fishes, and eggs. 2. Following the lowest recommended values for all the food groups will result in approximately 1,600 calories of energy. If the client expends additional energy, calorie intake will need to be increased by increasing the intake of recommended daily values. 3. This is not true; for example, B12 is obtained through meats, fish, poultry, dairy, and fortified foods like cereal. Other B vitamins are also better obtained through grain and meat sources. 4. Supplements are never a good alternative to natural food sources in the healthy client.

17) The nurse is caring for an older client who is receiving phenytoin. Which nutrition-related points does the nurse teach the client? Select all that apply. 1. "Notify the provider for difficulty swallowing." 2. "Sometimes you will not have a good appetite." 3. "Make sure to eat food rich in B vitamins." 4. "Your favorite foods may not taste good anymore." 5. "Get a few minutes of sunshine every day."

Answer: 2, 3, 4, 5 Explanation: 1. Phenytoin does not affect the client's ability to swallow. 2. Phenytoin causes clients to experience reduced oral intake. Altered taste and smell reduce appetite and intake. The client may need to eat even when not hungry to maintain adequate nutrition. 3. Phenytoin affects folate levels in the body. 4. Phenytoin alters a client's taste and smell. 5. Phenytoin affects vitamin D levels in the body. Ten minutes or more of mid-day sunshine can counteract this. A supplement may be required.

7) The nurse is planning care for a client who is 82 years old, male and Hispanic. Which of the following should the nurse identify as potential conflicts when considering the cultural-care triad? Select all that apply. 1. Appropriate introductions between the nurse and client 2. Cultural differences in education among the caregivers 3. Difficulty accessing electronic health information by the client 4. Generational differences among the client, caregiver, and nurse 5. Language barriers between the nurse and the caregiver and client

Answer: 2, 3, 4, 5 Explanation: 1. When meeting a person for the first time, introduce yourself by your full name, and then explain your role. This helps establish a respectful relationship between the nurse, family and client and prevent conflict. 2. Many of the CNAs may be new immigrants and have difficulty speaking and understanding English. Both native and foreign-born CNAs may have limited understanding of the ethnic, cultural, and religious heritages and life trajectories of the older persons and nurses who, in turn, have a limited understanding of the backgrounds of these nursing assistants. This lack of understanding may lead to difficulties with cultural literacy for both older persons and caregivers and negatively impact access to culturally competent nursing care. 3. There is a demarcation in the older adult population's technological savvy where the middle-old (75—84) and oldest-old (85+) may not possess the needed technologic ability and comfort. 4. Worldviews tend to differ greatly between generations. Those who have high heritage consistency tend to have difficulty accepting perspectives of generations different from their own. This can be a source of conflict. 5. There is a significant disparity between the number of foreign-born U.S. residents who need a nurse who speaks their language vs. the number of nurses available who actually speak their language.

14) During an assessment, the nurse determines that an older client takes medication for atrial fibrillation and takes over-the-counter supplements to enhance nutritional status. Which supplements most concern the nurse? Select all that apply. 1. Zinc 2. Garlic 3. Fish oil 4. Ginseng 5. Ginkgo biloba

Answer: 2, 3, 4, 5 Explanation: 1. Zinc is a good supplement for immune health and is not concerning. 2. Garlic has an antiplatelet effect. A client with atrial fibrillation is taking medications to control heart rate and prevent blood clots. "Blood thinners" can interact with antiplatelet supplements and result in bleeding. 3. Fish oil has an antiplatelet effect. A client with atrial fibrillation is taking medications to control heart rate and prevent blood clots. "Blood thinners" can interact with antiplatelet supplements and result in bleeding. 4. A supplement with an antiplatelet effect includes ginseng. A client with atrial fibrillation is taking medications to control heart rate and prevent blood clots. "Blood thinners" can interact with antiplatelet supplements and result in bleeding. 5. Ginkgo biloba is avoided or used with extreme caution in anyone taking prescribed medications.

17) The nurse is assessing a client's ability to speak and understand the English language. Which assessment findings are indicative of a language barrier? Select all that apply. 1. The client answers with a minimal response. 2. The client's family member answers the questions. 3. The client does not make eye contact when spoken to. 4. The client moves away from the nurse when approached. 5. The client nods the head in agreement with everything the nurse says.

Answer: 2, 5 Explanation: 1. Minimally responding to an assessment question does not indicate that the client does not understand what is being asked or cannot communicate using the English language. 2. The client's family member answering the questions is indicative of a language barrier. The nurse's observation may be indicative of a pattern of the family communicating for the client. 3. A lack of eye contact with verbal communication may be cultural, not a language barrier. 4. The client that moves away from the nurse when approached may be modest, prefer minimal touch, or require greater personal space. 5. When a client understands minimal English or none at all and is embarrassed or does not know how to communicate that they cannot speak English, they often just nod and agree while the nurse is speaking.

20) The nurse is instructing an older client on the use of MyPlate to ensure an adequate nutritional intake. Which meal choices require further teaching? Select all that apply. 1. A salad with chicken, walnuts, and an olive-oil-based dressing 2. Cottage cheese with a large bowl of canned peaches 3. Toast with fruit jam and a bowl of oatmeal 4. Sausage and vegetable omelet with raisins in oatmeal 5. Plain cheeseburger with french fries

Answer: 2, 5 Explanation: 1. Oils are to be used sparingly. Olive oil and walnuts are considered to be "good fats" and are important to include in small portions. 2. Fresh fruits should be included for one-half of the plate. This choice is fine for a snack as long as the canned peaches have no sugar added, but it is an imbalanced meal choice. 3. Grains should be included for one-fourth of the plate. This meal is imbalanced. 4. Proteins, fruits, vegetables, and grains should be represented equally in each meal according to MyPlate for older adults. 5. Fresh vegetables should be included for one-half of the plate. Fried potatoes are not as good an option as vegetables due to the amount of oil.

12) The nurse is caring for an older client that has requested time to pray. Which interventions are most appropriate to facilitate the client's ability to perform the ritual? Select all that apply. 1. Request a chaplain 2. Defer scheduled activities 3. Remain with the client during prayer 4. Encourage the client to pray when family are visiting 5. Ask questions about the client's beliefs

Answer: 2, 5 Explanation: 1. The nurse should offer the services instead of requesting a chaplain. Requesting a chaplain is an assumption the client would like their services. 2. The nurse that is practicing cultural competence will defer scheduled activities for the client to pray. 3. The nurse should offer privacy to the client for prayer. 4. Encouraging a client to pray when family are visiting does not address the client's immediate spiritual needs. 5. Show a sincere interest in learning about their culture. When you do not understand a person's actions, politely and respectfully seek information.

21) The nurse is conducting a heritage assessment with an older client and wants to understand the client's beliefs on expectations for healthcare. Which question is most appropriate during the assessment? 1. "What was your prior occupation?" 2. "Do you have an advanced directive?" 3. "Do you have a specific dietary practice?" 4. "Would you like to participate in your morning care?"

Answer: 3 Explanation: 1. Asking a client about a prior occupation has no relation to a heritage assessment. 2. An advanced directive does not specifically address the client's cultural practices of death and dying. It is a legal document that is encouraged for all clients to have. 3. Asking the client about a specific dietary practice addresses the client's cultural and religious practices. 4. Assessing independence from a cultural perspective includes engaging in activities and staying active in their healthcare and living arrangements. The client should be encouraged to independently complete their morning cares and any other activity of daily living.

3) An older client has an elevated blood urea nitrogen (BUN) level, but the creatinine clearance is within normal limits. The nurse notes that the client's appetite has been poor the past few days. What should the nurse do about these laboratory findings? 1. Perform a daily weight and document. 2. Inform the physician of the BUN result. 3. Assess intake, output, and dietary intake of protein. 4. Monitor for increased medication levels.

Answer: 3 Explanation: 1. BUN can elevate in response to muscle breakdown and reduced mass, but a daily weight will not offer immediately useful information about the client's status. 2. Informing the physician is not necessary until further assessment data is collected. 3. The nurse should not rely on BUN levels as an indicator of renal function in the older person. BUN is affected by muscle mass, level of hydration, diagnosis of anemia, and dietary intake of protein. The nurse needs to further assess the client's intake and output and dietary intake of protein. 4. Because the creatinine clearance is within a normal range, it is unlikely that medication excretion will be affected. The nurse would bring this to the attention of the prescriber for consideration of dose changes in the event that other kidney function tests demonstrate declining clearance.

18) The staff development instructor is preparing a presentation on the cultural-care triad. Which information should the instructor include? 1. Life perspective solely impacts the triad. 2. The triad consists of the nurse, patient, and family. 3. The cultural diversity of nursing impacts the accessibility to care. 4. Demographic disparities between the client and the triad minimally impact care. 5. The increased use of technology can negatively impact the client's ability to access health information.

Answer: 3 Explanation: 1. Both life and cultural perspectives affect the triad. 2. The cultural care triad consists of the nurse, caregiver, and patient. 3. Cultural diversity of nursing does impact the accessibility to culturally competent care. 4. Demographic disparities between the client and the triad affect the client's care. 5. There is a demarcation in the older adult population's technological savvy with many of the young-old (55—75 years old) easily utilizing computers and other electronic devices while the middle-old (75—84) and oldest-old (85+) may not possess that technologic ability and comfort. This can affect older adults' access to health information and services.

19) The nurse is preparing an educational program regarding the appropriate use of antipsychotic medications in older clients. What information should the nurse include? 1. Fidgeting is an appropriate indication for the use of antipsychotic medications. 2. Use of antipsychotic medications would never be considered a chemical restraint. 3. People prescribed antipsychotic drugs must have efforts to discontinue these drugs. 4. Impaired memory is an appropriate indication for the use of antipsychotic medications.

Answer: 3 Explanation: 1. Fidgeting is not a sole indication for the use of antipsychotic medications. 2. Antipsychotic medications could be considered as a chemical restraint. 3. There are many federal and state regulations regarding appropriate medication use in long-term care facilities. One such regulation states that residents who use antipsychotic drugs must receive gradual dose reductions, drug holidays, or behavioral programming unless clinically contraindicated, in an effort to discontinue the use of these drugs. 4. Impaired memory is not a sole indication for the use of antipsychotic medications.

23) Which statement about food insecurity would the nurse include in a presentation regarding nutritional issues in the older client? 1. "Food insecurity is demonstrated when a person hoards food." 2. "The death of a spouse often results in food insecurity." 3. "African American persons are at risk for food insecurity." 4. "Food insecurity is concern about eating harmful foods."

Answer: 3 Explanation: 1. Food insecurity is when a client lacks sufficient funds or access to buy food. This can lead to food hoarding. There are other causes of food hoarding, though, and food insecurity does not always lead to hoarding. 2. The loss of a spouse can have a negative impact on diet adequacy and occasionally affect ability to get food. Food insecurity is when a client lacks sufficient funds or access to buy food. It can force an individual to decide between paying bills, buying medications, or buying groceries. 3. African Americans and Hispanic older persons are at a disproportionate risk of food insecurity compared with other households. 4. Concern about eating harmful foods is not a part of food insecurity.

1) An older client being treated for pneumonia is given a sedative to sleep. A few hours afterwards, the client has a respiratory rate of 12 and cannot be aroused. What does this assessment finding indicate to the nurse? 1. The sedative was not absorbed. 2. The sedative has reached a therapeutic blood level. 3. The medication for sleep caused excessive sedation. 4. The client is experiencing complications of pneumonia.

Answer: 3 Explanation: 1. It is not lack of absorption because of the excessive sedative effect. 2. Although sleep is desired, clients should be able to awaken after sedation. This is not a therapeutic effect. 3. Pharmacodynamic changes, which affect how the drug affects the body, can also occur because of the aging process. However, it is not always clear if changes in therapeutic responses are due to the pharmacodynamics or to the altered pharmacokinetics. An increased drug-receptor response can occur with benzodiazepines resulting in increased sedation. 4. Complications of pneumonia would present with labored respirations and other associated symptoms.

22) Which nursing action indicates that medication reconciliation for an older client is most complete? 1. All prescribed medications are accounted for in the medical record. 2. Medications were identified and compared with written orders. 3. Herbal supplements, vitamins, and medication were reviewed. 4. Medication reconciliation occurred prior to client transfer.

Answer: 3 Explanation: 1. Medication reconciliation is a process that involves verification of all medications, including herbal or mineral supplements and vitamins, that a client takes; not just medication prescribed by a physician. 2. Medication reconciliation involves identifying, verifying, and comparing medications with the physician's orders. 3. All medications, including herbal or mineral supplements and vitamins, are to be included in a medication reconciliation. 4. The medication reconciliation process should be used whenever an individual moves from one care setting to another.

13) What should the nurse instruct a caregiver to do to assist a cognitively impaired older client to self-feed? 1. Offer the client a variety of favorite foods. 2. Turn on the television to encourage continual snacking. 3. Serve each food with the proper utensil and cue the client. 4. Explain the location of food in relation to the face of a clock.

Answer: 3 Explanation: 1. Offering the client familiar choices is terrific to enhance appetite, but the foods also need to fit the client's ability to self-feed. For example, a dish that is soupy or slippery may be too difficult to manage. 2. Excess stimulation like watching television may add to the client's confusion, reducing eating behaviors. Playing music is a positive intervention. 3. Limiting the client to one task and food, and cueing the client to use the utensil to eat the specific food, can be effective in promoting self-feeding. 4. Placing the food on the plate and relating the location to a clock is used to assist clients with limited vision.

15) The nurse is caring for an older client. Which assessment finding best indicates that the client is practicing heritage consistency? 1. The client attends secular religious services. 2. The client is very well versed in many cultures. 3. The client plans to visit their childhood neighborhood. 4. The client occasionally contacts extended family members.

Answer: 3 Explanation: 1. The client attending secular religious services has no identification with a specific religion. 2. A client that is well versed in many different cultures is not demonstrating the practice of heritage consistency. 3. A client planning to visit a childhood neighborhood is practicing heritage consistency. 4. A client that occasionally contacts extended family members is not necessarily practicing heritage consistency.

13) A prescribed medication is not producing the expected therapeutic effect in an older client. What should the nurse do in response to this finding? 1. Document that the client has not been taking the medication. 2. Discuss changing the medication with the healthcare provider. 3. Ask the client to describe how they take their medications each day. 4. Review the client's current diet and medication list for potential interactions.

Answer: 3 Explanation: 1. The nurse does not know if the client has not been taking the medication. This is an inappropriate action by the nurse. 2. The nurse needs more information before discussing changing the medication with the healthcare provider. 3. If a medication is not demonstrating the expected therapeutic effect, the nurse should investigate if the client is taking the medication at all. Sometimes clients will stop taking a medication or cut the dose amount or frequency due to cost concerns or unwanted side effects. 4. There is not enough information to support that the lack of therapeutic effect is due to a food-drug interaction.

20) The nurse is completing a heritage assessment with an older patient from a non-English-speaking culture. Which question would not be a part of this assessment? 1. Where was your mother born? 2. Did you live in an extended family? 3. Where did your father go to school? 4. Do you belong to a religious institution?

Answer: 3 Explanation: 1. The question "Where was your mother born?" is a question asked when completing a heritage assessment. 2. The question "Did you live in an extended family?" is a question asked when completing a heritage assessment. 3. The question "Where did your father go to school?" is not a question asked when completing a heritage assessment. 4. The question "Do you belong to a religious institution?" is a question asked when completing a heritage assessment.

22) Prior to transferring a client for a scheduled procedure, the client states to the nurse, "I do not know how well I will do after this procedure." Which question should be a priority for the nurse to ask the client? 1. "Are you concerned about your recovery time?" 2. "Do you have any questions about the procedure?" 3. "Do you understand why they are doing this procedure?" 4. "Are you concerned about experiencing pain after the procedure?"

Answer: 3 Explanation: 1. This would be an appropriate question to ask but not the priority. 2. This question should be asked when the nurse obtains consent for the procedure, but this question would not be the priority after the client's statement in the stem. 3. The priority question is to ascertain if the client understands why the procedure is being done. If the client does not clearly comprehend why the procedure is being done, then the Patient's Self Determination Act is in jeopardy of being violated. 4. The nurse should teach the client about what will be experienced after the procedure and how any pain will be managed as part of the care plan, but this question would not be the priority after the client's statement in the stem.

19) The nurse is planning interventions to reduce an older client's risk of dehydration. Which intervention would result in the client's dehydration? 1. Provide peanut butter and crackers for snack 2. Keep the room warm according to client's preference 3. Administer the prescribed diuretic with the evening meal 4. Offer to bring coffee to the client a few times per day

Answer: 3 Explanation: 1. Though these foods contain sodium, the intake is not likely to result in a fluid imbalance. 2. Keeping the room hot could result in dehydration, but adjusting the temperature to the client's comfort level should not cause insensible fluid loss. 3. Administering prescribed diuretics with the evening meal will encourage nocturia and voluntary restriction of fluids by the client. This will lead to dehydration. 4. By offering liquids to the client when entering the room, the risk for dehydration can be decreased. If the client enjoys coffee, this is included in the total intake even though it can have a mild diuretic effect. Decaffeinated coffee is a great way to boost liquid intake, too.

9) The nurse teaches the client about measures to prevent constipation. What does the nurse teach the client? Select all that apply. 1. Do not take fiber supplements with juice or coffee. 2. Take diphenhydramine doses with a laxative. 3. Take psyllium-seed preparations with a full glass of water. 4. Calcium-carbonate should be taken separate from other medications. 5. Take any narcotic doses with a stool softener or laxative.

Answer: 3, 4 Explanation: 1. This medication should be taken with adequate water or other fluid. There is no information to suggest that fiber supplements cannot be taken with juice or coffee. 2. Diphenhydramine has an anticholinergic effect that can be offset with additional fluid intake, but a laxative is not likely to help. 3. At least one glass of water or other fluid is taken with psyllium so that it does not obstruct the esophagus or intestines. 4. No matter how calcium-carbonate is taken, it will cause constipation. Formulations are available that include magnesium, which offsets this side effect. 5. Clients do not ever become tolerant to constipation as a side effect of narcotics and must always take something to prevent constipation unless the client is otherwise able to maintain soft stools.

17) The nurse is preparing an educational program about the use of over-the-counter (OTC) medications for residents of an assisted living community. What information should the nurse include in this program? Select all that apply. 1. Medications purchased without a prescription can be used with alcohol. 2. Herbal supplements are not considered medications. 3. A person can overdose on medications containing acetaminophen. 4. Health insurance does not pay for medications that are not prescribed. 5. There are increased drug interactions between prescribed and OTC medications.

Answer: 3, 4, 5 Explanation: 1. Alcohol can interact with medications, including OTC medications. It depends on the medication. 2. Herbs cause physiological changes and can interact with OTC and prescribed medications. They are considered medications. 3. A person could inadvertently experience an overdose when taking multiple medications with acetaminophen in them. 4. The use of OTC medications can result in increased out-of-pocket costs since health insurance usually does not pay for OTC medications. 5. The risk of drug interactions or an overdose increases, particularly when OTC drugs are used that have similar indications as prescribed medications.

1) The nurse is discussing proper nutrition with older community members at a senior citizen center. What should the nurse teach as general guidelines for healthy older individuals? Select all that apply. 1. Calcium intake should be 1,000 mg for those over the age of 51 years. 2. Older individuals need to take supplements of vitamins A, C, E, and K. 3. Vitamin D intake should be 600 IU up to age 70 and 800 IU if older than 70. 4. Ingest at least 0.8 grams of protein for each kilogram of body weight each day. 5. Fluid intake each day should be at least 13 cups for men and 9 cups for women.

Answer: 3, 4, 5 Explanation: 1. Calcium intake should be 1,200 mg for those over the age of 51 years. 2. Older individuals need supplements of vitamins D and B12 and calcium, not vitamins A, C, E, and K. 3. Vitamin D intake should be 600 IU up to age 70 and 800 IU if older than 70. 4. Protein intake for older individuals should be 0.8 grams per kilogram of body weight. 5. Fluid intake each day should be at least 13 cups for men and 9 cups for women.

11) Which older client with a feeding tube would the nurse identify as being at the highest risk of dehydration? 1. The client's tube feeding totals 1,500 mL every 24 hours 2. Receiving 60 mL of water every 4 hours 3. Client has infrequent, loose stools 4. Receiving feedings with a formula that is 1.5 calories per mL

Answer: 4 Explanation: 1. 1,500 mL of fluid intake is the minimum, with a 1 kcal/mL concentration, to prevent dehydration. 2. A client who is receiving 360 mL of free water daily could be at risk for dehydration, depending on the amount and type of tube feeding formula being used. 3. Stools are monitored for consistency and frequency. If the client develops diarrhea (frequent, liquid stools), the client can experience dehydration. Infrequent loose or liquid stools are common with tube feeding and can be addressed by offering feeding at room temperature, administering feedings in a drip rather than a bolus, or via other intervention. 4. Tube feeding formulas that are denser than 1 calorie per milliliter are hypertonic and predispose the client to dehydration unless the client also receives free water.

21) The charge nurse is reviewing an incident with a staff nurse in which an older client was injured after a fall. Which statement made by the nurse would require immediate intervention by the charge nurse? 1. "The client fell during shift report." 2. "The client fell after getting up from the chair." 3. "The client was instructed to call if they needed help out of bed." 4. "The client was trying to reach for their walker to get to the bathroom."

Answer: 4 Explanation: 1. A client falling during shift report does not indicate the nurse's performance of care contributed to the client's fall. 2. The client that fell after getting up from a chair does not require the charge nurse to immediately intervene because this is not the fault of the nurse or related to the performance of the nurse. 3. A client that is instructed to call if they needed help getting up out of bed does not indicate the nurse's performance of care contributed to the client's fall. 4. The client that was unable to reach their assistive device necessary to use for safe ambulation indicates that the client's environment was unsafe.

16) An older client has recently been put on high risk for fall precautions after a medication for high blood pressure was started. The client's daughter questions why this precaution was put in place. How should the nurse respond to the daughter? 1. "Every older client is automatically put on fall risk precautions." 2. "The client is attached to IV tubing and sequential compression devices." 3. "The client is on multiple medications that may have an interaction." 4. "The client was recently started on a medication that could cause a fall."

Answer: 4 Explanation: 1. Being older increases the chance of needing fall precautions, but every older client is not automatically put on high fall risk. 2. Being attached to multiple medical devices does not automatically indicate a need for fall precautions. 3. Polypharmacy can increase fall risk, but this is determined for each client after examining their personal medication profile. 4. Medications have been associated with the occurrence of falls and related injuries. Antihypertensives can cause hypotension, which can result in falls. This would indicate a need to place the client on high fall risk.

23) The nurse is caring for an older client that states, "I am not taking this medication anymore, and I am tired of being here." Which is the best action for the nurse to take? 1. Contact the client's family. 2. Discuss the therapeutic action of the medication. 3. Remind the client about their agreement for treatment. 4. Inform the client of their right to leave the facility AMA.

Answer: 4 Explanation: 1. Contacting the client's family is a HIPAA violation. 2. Discussing the therapeutic action of the medication does not address the client's comment and feelings and would not be the best action. 3. The client has the right to refuse treatment. 4. Consent that is given can be withdrawn at any time, and the client has the right to leave the healthcare facility.

6) An older client has taken a nonsteroidal anti-inflammatory drug (NSAID) medication for general muscle aches. Which finding is most concerning? 1. Diarrhea 2. Heartburn 3. Abdominal pain 4. Dark emesis

Answer: 4 Explanation: 1. Gastrointestinal symptoms are common when taking NSAIDS. The client should be advised to reduce or eliminate the use of NSAIDs for gastrointestinal symptoms. 2. Gastrointestinal symptoms are common when taking NSAIDS. The client should be advised to reduce or eliminate the use of NSAIDs for gastrointestinal symptoms. 3. Gastrointestinal symptoms are common when taking NSAIDS. The client should be advised to reduce or eliminate the use of NSAIDs for gastrointestinal symptoms. 4. Dark emesis is carefully evaluated in the person taking NSAIDs. Coffee-ground emesis is the result of gastric bleeding, which can be the result of NSAID use.

25) An older homeless patient is admitted to the hospital. The patient has no known family, is unresponsive, and his condition is considered guarded. What should be done to ensure appropriate healthcare decisions are made for this patient? 1. The homeless shelter will provide direction. 2. The patient will be represented by the hospital social worker. 3. The hospital will make decisions for the patient's healthcare. 4. The hospital will ask a judge to appoint a guardian for the patient.

Answer: 4 Explanation: 1. If an older person lacks decisional capacity and has no predetermined wishes, family, or healthcare proxy, the care facility may seek a court-appointed guardian who is appointed by a judge to act on behalf of the ward or the patient. The homeless shelter will not be consulted in this situation. 2. If an older person lacks decisional capacity and has no predetermined wishes, family, or healthcare proxy, the care facility may seek a court-appointed guardian who is appointed by a judge to act on behalf of the ward or the patient. The hospital social worker will not make decisions for the patient. 3. If an older person lacks decisional capacity and has no predetermined wishes, family, or healthcare proxy, the care facility may seek a court-appointed guardian who is appointed by a judge to act on behalf of the ward or the patient. The hospital will not make decisions for the patient. 4. If an older person lacks decisional capacity and has no predetermined wishes, family, or healthcare proxy, the care facility may seek a court-appointed guardian who is appointed by a judge to act on behalf of the ward or the patient.

5) An older client does not take a prescribed diuretic as planned because of the inconvenience of having to urinate frequently, which interrupts scheduled activities. What action should the nurse take with this client? 1. Insist the drug be taken as prescribed. 2. Contact the physician to order another drug. 3. Advise to take the drug in divided doses, half in the morning and half in the evening. 4. Discuss the daily activity schedule and adjust the drug administration time accordingly.

Answer: 4 Explanation: 1. Insisting the client take the drug without addressing the client's concerns would not improve compliance with the medical plan of care. 2. A new drug may not be indicated if the administration time is changed. 3. Drug dosages should not be modified without consultation with the physician because the therapeutic effect may be altered. 4. The administration of diuretics can be scheduled so that the peak diuretic effect does not interrupt activities important to the client. Assisting the client to understand this and modifying the schedule would provide the best compliance with the medical plan of care.

5) The nurse is developing a plan of care for a client with a language barrier that is recovering from surgery and has not requested any pain medication. Which of the following interventions should the nurse include in the care plan? 1. Assess the client for non-verbal signs of pain and medicate the client if signs are noted. 2. Become familiar with the client's culture and how the culture typically demonstrates signs of pain. 3. Obtain a prescription for the client to have a patient-controlled analgesic pump so the client can be in control of their own pain management. 4. Utilize an interpreter to explain the faces pain scale for assessing and evaluating the client's pain level now and throughout the hospitalization.

Answer: 4 Explanation: 1. Loss of trust occurs when there are missed cues with the client. It may not be culturally acceptable for a client that is in pain to show any indication of it. 2. The nurse should become familiar with the client's culture; however, this does not address how to appropriately assess the client's pain level, and the nurse should not assume the client has pain. 3. This would not help implement culturally competent care and does not help the nurse accurately assess the client's pain level. 4. Using an interpreter to accurately assess the client for pain and explain the use of the faces pain scale to assess the client's pain level in the future would be culturally appropriate.

2) An older client who takes digoxin has not eaten in 2 days. Which finding most concerns the nurse? 1. The client is experiencing nausea and vomiting. 2. A new prescription for an antacid is administered. 3. A recent weight loss of several pounds is documented. 4. The client is exhibiting weakness and visual disturbances.

Answer: 4 Explanation: 1. Nausea and vomiting can occur for many reasons. This could result from digoxin toxicity or cause digoxin toxicity. The nurse is concerned about this finding and monitors closely. However, it is not most concerning. 2. Antacids should be taken 2 hours apart from most prescribed medications, including digoxin. The nurse is not yet concerned but does teach the client. 3. Changes in weight and water percentage are often a reason to alter medication doses. Digoxin is not weight based, but the nurse will observe for toxicity related to alterations in fluid and electrolyte status, paying special attention to potassium levels. 4. Vision changes such as blurred or yellowed vision are serious adverse effects of digoxin. Digoxin toxicity is the most likely cause of this and must be addressed immediately.

1) The nurse supports an older client's desire to discuss advance directives with the client's family. What action is the nurse performing with this client? 1. Facilitating palliative care 2. Educating the family on healthcare services 3. Collaborating with the interdisciplinary team 4. Advocating for client's rights and autonomy

Answer: 4 Explanation: 1. Palliative care alleviates pain and suffering. There is no information to suggest the client is in need of palliative care. 2. Educating the clients on healthcare services is important, but the nurse is not educating in this role, they are supporting a discussion with the family. 3. Collaboration with the interdisciplinary team would include the nurse working with other professionals to provide client care. The nurse is not collaborating with other professionals regarding the client's desire to complete advance directives. 4. The nurse is advocating for the family and client regarding end-of-life decisions. This is included in the knowledge and skills of gerontological nurses.

4) Which action by the gerontological nurse demonstrates the role of manager? 1. Performing blood pressure screenings 2. Performing a skin assessment 3. Researching the latest evidence-based practice on wound care 4. Arranging respite care for a client

Answer: 4 Explanation: 1. Participating in taking blood pressure screening is within the traditional nursing role of clinical practitioner. 2. Participating in skin assessments are within the traditional nursing role of clinical practitioner. 3. The nurse is functioning within the role of researcher when seeking the latest evidence-based practice. 4. The nurse is functioning in the role of manager by connecting a client to community resources and coordinating the transfer of care of the client needing respite care.

1) The nurse is preparing to conduct a health history with an older client. Which action should the nurse take to ensure the accuracy and efficiency of the client's health history? 1. Scheduling one-half hour for the medical history interview. 2. Requesting the client use the bathroom before starting the interview. 3. Ensuring the client has their identification and insurance card with them upon arrival. 4. Conducting the history in an environment with comfortable seating and proper lighting.

Answer: 4 Explanation: 1. Patients should have a minimum of 1-hour appointments scheduled. Shorter appointments will result in a hurried interview with missed information. 2. The reference states to be sure there are bathrooms available during the interview. 3. The ID and insurance card are unrelated to gathering data for a health history. 4. To make the older patient comfortable, adequate lighting and seating should be available.

20) Which statement made by a nurse best indicates an understanding about the nurse's role in medication management for the older adult client? 1. "In the client with new onset constipation, I'll advocate for a daily laxative dose." 2. "When a client has difficulty sleeping, an as-needed dose of a benzodiazepine should be used." 3. "The client with acute pain should get pain medications around the clock and as needed." 4. "I should encourage the person with heartburn to sit up after medications and meals."

Answer: 4 Explanation: 1. Polypharmacy is a problem, and laxative use can lead to falls due to bowel urgency. The nurse first suggests bulk such as a bran muffin and a natural laxative such as prune juice, as well as encouraging activity and fluid intake. 2. Hypnotics, benzodiazepines, or antihistamines can help with sleep. However, a natural remedy should be attempted first such as warm milk, a white-noise machine, and avoiding late-day stimulants such as television or coffee use. 3. The client with acute pain should probably get pain medications as needed. Around the clock dosing is usually reserved for those with chronic pain. Other interventions to try for pain include distraction, imagery, and positioning. 4. Antacids have many side effects, such as decreased nutrient absorption. If the client has heartburn at certain times or in relation to certain foods, the nurse suggests sitting up for 30 minutes to an hour after meals, avoiding substances that create symptoms, and eating smaller meals.

25) An older client who is repeatedly admitted to the hospital tells the nurse it is because of the inability to purchase prescribed medications. What should the nurse respond to the client? 1. "Medical insurance covers these costs. Do you need help getting coverage?" 2. "I'm not surprised that you can't afford them. You are on a lot of medications." 3. "There are ways to reduce the cost of medications, such as using Medicare Part D." 4. "I will contact our social services department for resources to obtain medications."

Answer: 4 Explanation: 1. Social services can help with this if it is an identified need, but this is really not the nurse's role. Additionally, insurance often does not pick up the entire cost. 2. The nurse's opinion about the number of medications the client is prescribed is an inappropriate response for the nurse to make. 3. Medicare Part D prescription drug coverage assists with many drug costs. Even those reduced costs may not be helping the client if the client is stating that they cannot purchase needed prescriptions. 4. The social worker can refer the client to insurance policies or hospital, pharmacy, or corporate-sponsored medication assistance programs.

9) An older client is prescribed diet supplementation to combat unintentional weight loss. How should the nurse provide these supplements to the client? 1. Serve at room temperature 2. Provide with the next meal 3. Provide separate from medications 4. Provide more than an hour before the next meal

Answer: 4 Explanation: 1. Temperature is not a significant issue when providing supplements. 2. Supplements should be given more than 1 hour before meals and not with meals. 3. Liquid supplements may be given with medications as long as there is no interference with the specific medication. 4. Supplements should be given more than 1 hour before meals to minimize satiety and enable the client to still eat at mealtime. Liquid supplements are digested more quickly than solids, thus decreasing the feeling of fullness.

7) A resident in the nursing home is diagnosed with undernutrition and is unable to take in adequate food despite efforts by the multidisciplinary team and family members. Prior to insertion of a permanent feeding tube, which issue needs to be considered? 1. Equipment, care, and time needed to administer the feedings 2. The extent of the surgical intervention, cost and insurance coverage 3. The client's nutritional needs and tolerance of the formula feedings 4. The client's advanced directive and evaluation of risks, benefits, and ethical considerations

Answer: 4 Explanation: 1. The actual placement of a feeding tube is a common, relatively simple procedure that can be performed as an outclient. Staff time may be reduced with the tube feeding than with actually feeding the client. 2. Costs of the equipment and formula are reimbursed by Medicare, Medicaid, or most insurance companies. 3. There are a variety of different formulas available for different client needs. 4. Prior to placement of a permanent feeding tube, it is important to evaluate the individual client's wishes and review the advanced directive. The client and family need accurate information regarding risks, benefits, and ethical considerations associated with placement of the feeding tube.

19) The preceptor taught a new nurse about the concepts of ethnocultural heritage. Which statement made by the new nurse indicates an understanding? 1. "A client that cannot acculturate is displaying ethnocultural heritage." 2. "A person can only value characteristics that are heritage consistent." 3. "As the client becomes Americanized, their cultural beliefs will change." 4. "Feeling disconnected from one's culture is a loss of ethnocultural heritage."

Answer: 4 Explanation: 1. The client that cannot acculturate is not displaying ethnocultural heritage. Acculturation is a blending of the old and new cultures. Ethnocultural heritage is the extent to which a person's lifestyle and belief systems align with the culture of their tribal culture. 2. A person can value characteristics that are both heritage consistent (traditional) and heritage inconsistent (modern). These values exist on a continuum. 3. Ethnocultural heritage is not a loss of culture through the process of becoming Americanized. Ethnocultural heritage is the extent to which a person's lifestyle and belief systems align with the culture of their tribal culture. 4. Feeling disconnected from one's culture is a component of cultural marginality. Cultural marginality occurs when one feels disconnected from their native culture and is unable to acculturate.

10) An older client with dementia has been medicated with sedatives. The healthcare provider now prescribes a lower dose of the sedative and the nursing staff is concerned that the client will resume agitated behavior. What should be explained to the staff about the use of this medication? 1. The client's condition warrants physical restraint only. 2. The client's physical condition does not warrant use of the drug. 3. The client's family members would be upset if they were aware of the use of chemical restraints. 4. The use of psychotropic drugs may be considered excessive and harm the client's health.

Answer: 4 Explanation: 1. The client's physical condition may warrant control of behavior, and drug therapy may still be warranted. 2. The client's physical condition may warrant control of behavior, and drug therapy may still be warranted. 3. The nursing staff must be honest with family regarding use of chemical or physical restraints as a form of treatment for the client. 4. The 1987, Omnibus Budget Reconciliation Act ruled on the appropriate use of medications in institutionalized older persons, especially as their use may constitute a chemical restraint. "Chemical restraints" may only be used to ensure the physical safety of older clients in emergency situations, but these medications have the potential to be used inappropriately to quiet a person or subdue certain behaviors in place of other nonpharmacologic measures. Overuse of psychotropic medications is of concern because of the chance of serious adverse events and syndromes associated with these medications.

14) The nurse overhears a student nurse discussing the three areas of focus of cultural care nursing. Which statement by the student best indicates a lack of understanding of cultural care nursing? 1. "The nurse must understand the client's background." 2. "A nurse must acknowledge the total context of the client's situation. 3. "When caring for clients, the nurse should be familiar with the client's cultural health practices." 4. "Nursing considerations regarding the client's culture should be incorporated into the care plan."

Answer: 4 Explanation: 1. Understanding the client's background is a component of providing culturally appropriate care. 2. Considering the context of a client's situation is a component of providing culturally appropriate care. 3. Familiarization with cultural health practices is reflective of culturally appropriate care. 4. A plan of care should incorporate the assessment findings regarding the client's cultural preferences, not nursing considerations.

7. An older person relates being widowed as a young woman and how it was an expectation to wait at least five years before dating. Which question should the nurse ask to understand this person's cultural-life trajectory? A. "Did you want to date sooner?" B. "Why was it an expectation?" C. "Where did you live during this time?" D. "What did you do for 5 years?"

B. "Why was it an expectation?" Rationale: A key area in the older person's life was being a young widow. Asking why the person had to wait 5 years before dating helps understand the influence of the person's culture on this expectation. Asking what the person did for 5 years does not help understand the cultural expectation to wait 5 years to date. Asking if the person wanted to date sooner does not take the cultural expectation into consideration. Asking where the person lived for 5 years does not help understand the cultural expectation for the person to wait to date after being a widow.

6. The nurse reviews the care needs for assigned patients. Which person should the nurse identify as having the highest heritage consistency? A. 60-year-old who occasionally attends culture-based family gatherings B. 75-year-old who visits the country of origin four times a year C. 70-year-old who reads the daily newspaper D. 65-year-old who swims at the local health facility twice a week

B. 75-year-old who visits the country of origin four times a year Rationale: A high level of heritage consistency is the person who identifies and practices the heritage consistently. The person who visits the country of origin 4 times a year strongly identifies with the cultural heritage. The person who occasionally attends culture-based family gatherings is drifting away from the cultural heritage. The person who reads the newspaper and the one who swims are not demonstrating any specific cultural heritage tendencies. Press enter after select an option to check the answer

2. An adult daughter is concerned because her father has no interest in food and stops eating only after a few bites. Which age-related change has the daughter observed in this older adult? A. Achlorhydria B. Appetite dysregulation C. Atrophic gastritis D. Xerostomia

B. Appetite dysregulation Rationale: With appetite dysregulation, the production of cholecystokinin increases with age and can cause early satiety and low hunger. This contributes to the anorexia of aging. Xerostomia is a reduction in saliva that occurs in aging and can be exacerbated by loss of body fluids. Achlorhydria is a lack of hydrochloric acid production that occurs with aging. Atrophic gastritis is caused by a decrease in the size and number of glands and mucous membranes in the stomach.

8. An older person is concerned about the cost of prescribed medications. What should the nurse suggest? A. Take half of the prescribed dose B. Ask the health care provider for samples C. Consider purchasing the medication from another country D. Take a full dose of the medication every other day

B. Ask the health care provider for samples Rationale: One intervention to help control the cost of the person's medication is to ask if the health care provider has any free samples. Taking half of the prescribed dose or taking a dose every other day are strategies that older persons may use to control the cost however will not provide the therapeutic effects of the medication. Medications from other countries do not necessarily have the same regulations as those manufactured in the United States. Buying from another country should not be recommended to this person.

5. After reviewing the medication list the nurse instructs an older person on the sources of dietary calcium. Which medication caused the nurse to make this clinical determination? A. Digitalis B. Colchicine C. Acetaminophen D. Furosemide

B. Colchicine Rationale: A risk factor for poor calcium nutrition is taking a medication that alters the absorption or metabolism of calcium. Medications that alter calcium absorption or metabolism include colchicine. Digitalis, furosemide, and acetaminophen are not identified as medications that alter the absorption or metabolism of calcium.

7. The nurse believes that an antipsychotic medication prescribed for an older person should be discontinued. Which extrapyramidal symptom did the nurse assess to make this clinical decision? A. Tongue thrusting B. Fidgeting and rocking C. Elevated body temperature D. Sudden onset of muscle rigidity

B. Fidgeting and rocking Rationale: Extrapyramidal symptoms are neurologic side effects that can occur at any time from the first few days of treatment to years later. Fidgeting and rocking is a symptom of the extrapyramidal symptom of akathisia. Tongue thrusting is an indication of tardive dyskinesia. Elevated body temperature is associated with serotonin syndrome. A sudden onset of muscle rigidity is associated with neuroleptic malignant syndrome.

4. The nurse notes that an older person who has lost 5 kg over the last month has a reduction in muscle mass of the arms and legs. Which action should the nurse recommend to improve this person's health status? A. Decrease amount of fluid intake B. Increase amount of caloric intake C. Increase protein intake D. Decrease amount of physical activity

B. Increase amount of caloric intake Rationale: Insufficient calorie intake is responsible for excessive protein breakdown regardless of the adequacy of dietary protein intake, because the body's priority is for calories first. Therefore, the nurse should recommend that the person increase the amount of calories ingested each day. There is no need to increase the amount of protein the person ingests each day. Decreasing fluid will not improve the person's muscle mass or stabilize weight loss. Decreasing the amount of physical activity will enhance the loss of lean muscle mass, making the person's overall health status worse.

1. The nurse suspects that an older patient is experiencing an altered drug response. Which reason does the nurse identify that this response is being caused by the aging process? A. Increased effect of drugs metabolized by the liver B. Increased concentration of water-soluble drugs C. Increased availability of highly protein-bound drugs D. Increased excretion of drugs because of decreased renal function

B. Increased concentration of water-soluble drugs Rationale: With aging, there is a decrease in body water (as much as 15%) and an increase in body fat. This could result in increased concentration of water-soluble drugs and more prolonged effects of fat-soluble drugs. Liver mass and overall metabolic activity decrease with aging but they are not usually clinically significant in relation to drug metabolism. Decreases in serum albumin levels or binding capacity may result in increased serum levels of the "free" or unbound proportion of protein-bound drugs. Renal function generally decreases with age and should always be considered in the choice of a drug, in judging the appropriateness of a dose, and in evaluating adverse drug reactions. Press enter after select an option to check the answer

8. An older person will not eat breakfast or take medication until the parish priest arrives. What action should the nurse take that demonstrates cultural sensitivity for the person's delay in eating this meal? A. Remove the breakfast tray and mark "refused' on the appetite record B. Keep the tray in the room until the parish priest arrives C. Explain that the meal must be eaten before medication can be provided D. Discuss that the priest understands the person is ill and will understand if a meal is eaten

B. Keep the tray in the room until the parish priest arrives Rationale: The nurse should respect others ethnocultural values, beliefs, and practices, even if they differ from the nurse's or the dominant culture. Because the person wants to wait until the parish priest arrives before eating or taking medication, the nurse should respect the person's behavior and keep the try in the room until the priest arrives. Removing the tray and marking refused on the appetite record does not take the person's cultural beliefs or practices into consideration. Explaining that the meal should be eaten before receiving medication and saying that the priest would understand if the person eats does not take the person's ethnocultural values and beliefs into consideration.

8. The nurse completes a focused assessment of an older person with an unintentional weight loss. Which finding suggests that this person's functional status is declining? A. Dry mucous membranes B. New onset of skin rash C. Lower-extremity edema D. Hypoactive bowel sounds

B. New onset of skin rash Rationale: Consequences of an unintentional weight loss and undernutrition is associated with adverse outcomes, such as an altered immune response. A new onset of a skin rash could indicate a change in immune status. Lower-extremity edema could be caused by a cardiovascular problem or inadequate protein intake. Dry mucous membranes indicate a fluid-volume deficit. Hypoactive bowel sounds could be caused by a disease process or immobility.

6. An older person experiences a variety of adverse effects from prescribed medications. Which intervention should the nurse use to help this person achieve a restful sleep? A. Coach in guided imagery B. Provide a cup of warm milk C. Remove cheese from the meal tray D. Schedule small frequent meals

B. Provide a cup of warm milk Rationale: Warm milk contains tryptophan which helps with insomnia. Guided imagery is an intervention to reduce anxiety. Small frequent meals help reduce heartburn. Cheese contributes to constipation.

2. The nurse manager prepares an informational sheet for nursing staff regarding scope of practice. Which category should the manager include when designing this sheet? A. Environment B. Quality C. Teamwork D. Context

B. Quality Rationale: The three elements of the scope of practice consist of quality, evidence, and safety. Context and environment are NLN competencies. Teamwork is a QSEN competency.

9. An older person babysits toddler grandchildren several times a week. What should the nurse suggest to ensure for safety when the children are in the person's home? A. Place medications in a purse when the children are present B. Request the medication have childproof caps C. Order a 30-day supply of the medication instead of a 90-day supply D. Place unused medications in the trash

B. Request the medication have childproof caps Rationale: If older persons request that they receive their prescription medications without childproof caps, they need to take special precautions if young children are present in the home, even for a short duration. Unused medication should be disposed of properly. This may include returning the doses to the pharmacy. Toddlers will be able to get to the person's purse. Medications should not be placed there. Changing the number of doses in a prescription does not affect safety.

4. A resident of an assisted living facility enjoys the new apartment but is disappointed that so many females reside there alone. What does this resident's observation suggest about older men? A. They do not like to live in assisted living facilities B. They do not live as long as women C. They are healthy enough to live in their own homes D. They tend to live with family when they age

B. They do not live as long as women Rationale: The gender differences in life expectancy may be explained by the complex interaction among biological, social, and behavioral factors. Greater male exposure to risk factors, such as tobacco, alcohol, and occupational hazards, might negatively affect male life expectancy. There is no evidence to support that older men tend to live with family when they age, dislike assisted-living facilities, or are healthy enough to live in their own homes.

7. An older person on a fixed income receiving Medicare plans to move into a skilled-nursing facility. How should the nurse respond to a question from the person regarding his/her decision? A. "I'm not sure if you need to go to this type of place since many people are really ill." B. "Now that you are 65, you are automatically qualified for admission." C. "In the long-term, you will need to pay for the room until you qualify to receive Medicaid." D. "That's a good decision since Medicare will cover the cost of your room."

C. "In the long-term, you will need to pay for the room until you qualify to receive Medicaid." Rationale: In a skilled-nursing facility, care is delivered by nurses and others to residents. Subacute care is covered by Medicare for short-stays. For chronic or custodial care or for assistance with activities of daily living, Medicaid or private-pay covers the costs. Facilities that support independence include retirement and residential-care communities. Transitional-care units provide subacute care, rehabilitation, and palliative-care health services to persons who no longer require acute care. Most of these persons are recuperating from major illness or surgery, have complex health-monitoring needs, or require palliative care with pain and symptom control.

6. The nurse notes that a resident of an assisted-living facility has severe kyphoscoliosis and rarely participates on community outings. Which nursing diagnosis should the nurse use to guide this resident's care needs? A. Impaired activity tolerance B. Diminished cognitive status C. Altered body image D. Insufficient coping

C. Altered body image Rationale: A resident with a musculoskeletal structural disorder, such as severe kyphoscoliosis, who does not want to participate in community outings more than likely is experiencing a disturbance in body image. There is no evidence to suggest the resident is unable to cope, has an activity intolerance, or an alteration in cognitive status.

2. A healthcare organization placed posters printed in English and Spanish throughout the organization to direct patients and family to various parts of the facility. Which Culturally and Linguistically Appropriate Services in Health Care (CLAS) standard does this demonstrate? A. Governance, leadership, and workforce B. Principle C. Communication and language assistance D. Engagement, continuous improvement, and accountability

C. Communication and language assistance Rationale: Providing easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area demonstrates adherence to the communication and language assistance CLAS standard. The principle standard focuses on providing care and services responsive to diverse cultural health beliefs and practices and fulfilling communication needs. The governance, leadership and workforce standard focuses on hiring staff that promote the CLAS standards and supports a culturally and linguistically diverse population. The engagement, continuous improvement and accountability standard focuses on establishing culturally and linguistically appropriate goals, policies and management accountability, and infuse them throughout the organizations' planning and operations.

7. A cognitively intact resident of a long-term care facility asks for assistance getting dressed. Shortly thereafter a taxicab driver comes to the desk to pick up the resident as requested. What action should the nurse take? A. Obtain the name, license number, and telephone number of the taxicab service B. Ask the resident to sign an "against medical advice" form before leaving the facility C. Locate the resident for the taxicab driver D. Send the driver away since the resident is not permitted to leave the facility

C. Locate the resident for the taxicab driver Rationale: According to OBRA 87, a resident has the right to leave the facility. Legally, the nurse should locate the resident for the taxicab driver. The resident is permitted to leave the facility; therefore, the driver should not be sent away. Obtaining the name, license number, and telephone number of the taxicab service is not expected according to OBRA 87. The resident is not leaving against medical advice. An against-medical-advice form does not need to be signed. Press enter after select an option to check the answer

3. A school of nursing is experiencing a workforce issue that will impact care provided at local hospitals. Which information best indicates that there is a workforce issue? A. Seven signed agreements for clinical rotations B. Twenty senior nursing students mentoring the freshman class C. Three instructors volunteered to staff the learning lab D. 200 applicants on a waiting list for admission

D. 200 applicants on a waiting list for admission Rationale: Faculty shortages limit the number of students that can be admitted to nursing programs and many schools are unable to accept qualified applicants because of inadequate faculty size. U.S. nursing schools turned away 68,938 qualified applicants to undergraduate and graduate nursing programs in 2014-2015 because of an insufficient number of faculty and clinical preceptors; lack of access to clinical placements and laboratory and classroom sites; and budget constraints. A waiting list of 200 applicants indicates a workforce issue in the school of nursing. Having agreements for clinical rotations, staff volunteering to staff a learning lab, and students serving as mentors to undergraduates does not indicate a workforce issue for this school of nursing.

6. The nurse plans to complete a 24-hour food recall with an older person who has lost 7 kg over the last 6 weeks. Which additional assessment should the nurse complete at this time? A. Food record B. Determine checklist C. Mini nutritional assessment D. Food frequency

D. Food frequency Rationale: A 24-hour dietary recall can be done during an office visit or as part of an admission interview. Since the 24-hour dietary recall is only a snapshot in time and is not always indicative of normal habits, a food-frequency assessment is used to fill in the gaps of missing information that occur with a 1-day snapshot. A food record provides information on eating patterns for 3 days, preferably 2 weekdays and 1 weekend day. This tool does not need to be used as a supplement with the 24-hour food recall. The DETERMINE checklist has not been validated as a nutritional-screening tool. The Mini Nutritional Assessment is a stand-alone assessment and would not need any supplement assessments to gain a clear picture of a person's nutritional status.

4. The nurse instructs an older person on ways to prevent esophageal irritation when taking medication. Which statement indicates that teaching has been effective? A. "An enteric-coated aspirin is less effective than one without the coating." B. "Most medication causes chest or shoulder pain." C. "I should lie down after taking medication." D. "I should take each medication separately with 8-ounces of water."

D. I should take each medication separately with 8-ounces of water." Rationale: To prevent esophageal irritation from drug therapy, the person should swallow medications with at least 8 ounces of liquid and take one medication at a time. The person should remain upright for at least 30 minutes after taking medication. A dull aching pain in the chest or shoulder after taking medication should be reported to the health care provider. A drug causing gastric irritation should be taken as enteric-coated. There is no evidence to support that an enteric-coated aspirin is less effective than one without coating.

10. During a home visit the nurse notes that an older person is not taking a medication as prescribed. Which medication factor may be causing this failure to adhere to the prescribed medication regime? A. Lower cognitive function B. Lack of perceived benefit of medications C. Lack of confidence in the health care provider D. Inability to get the tablet out of the packaging

D. Inability to get the tablet out of the packaging Rationale: Some medications are packaged in strips with paper on one side and plastic on the other. The dose is obtained by pushing on the plastic covering the medication. If the person has poor strength or limited dexterity, it would be difficulty to push the pill through the paper. Lower cognitive function is a person factor affecting medication adherence. Lack of perceived benefit of the medication is a behavior/attitudes/habits factor affecting medication adherence. Lack of confidence in the health care provider is a health care provider factor affecting medication adherence.

3. The nurse completes a comprehensive geriatric assessment on an older person. On which area should the nurse focus when identifying this person's level of independence? A. Functional ability B. Medical diagnoses C. Socioeconomic status D. Living arrangements

A. Functional ability Rationale: Functional abilities should be a central focus of the comprehensive evaluation. Other more-traditional measures of health, such as medical diagnosis, living arrangements, and socioeconomic status, form the basic foundation of the assessment to determine overall health, well-being, and the need for and intensity of social services.

4. A new certified nursing assistant has recently relocated to the United States from an Eastern European country. Which facility practice might cause the assistant to provide less-than-competent cultural care? A. Residents' family members visit once or twice a month B. Residents are scheduled for routine baths or showers C. Staff attend report at the beginning and end of every shift D. Meals are provided in the dining hall or in the residents' rooms

A. Residents' family members visit once or twice a month Rationale: Both native certified and foreign born certified nursing assistants may have limited understanding of the ethnic, cultural, and religious heritages and life trajectories of the older persons. In some cultures, aging members are cared for by the family. Having the older person in a facility and only being visited by family once or twice a month could cause the assistant to provide less than competent cultural care. Routine baths/showers, shift report, and the location where residents have meals would not cause the assistant to provide less than competent cultural care.

7. An older resident in a skilled-nursing facility has lost 10% of total body weight over the last 2 months. Which health problem most likely contributed to this resident's unintentional weight loss? A. Stage 3 pressure ulcer B. Lactose intolerance C. Polypharmacy D. Diverticular disease

A. Stage 3 pressure ulcer Rationale: One reason for an unintentional weight loss would be a hypermetabolic state, such as that which occurs with a pressure ulcer. The metabolic demands required for healing are greater than the calories being taken in, leading to an unintentional weight loss. Although older persons are at risk for polypharmacy, an unintentional weight loss would be more likely caused by adverse effects of medications and not the number of medications being used. And since the person is in a skilled-nursing facility, the likelihood of polypharmacy occurring is reduced. Lactose intolerance could cause gastrointestinal discomfort; however, it is unlikely to cause an unintentional weight loss of this amount. Diverticular disease would not cause an unintentional weight loss of this amount.

5. An older person takes garlic to keep blood pressure under control. For which prescribed medication should the nurse assess for adverse effects because of the herbal supplement? A. Warfarin B. Cyclosporine C. St. John's wort D. Alprazolam

A. Warfarin Rationale: Garlic increases INR if used with warfarin. Kava causes sedation if taken with alprazolam. Echinacea counteracts the effects of immunosuppressive drugs such as cyclosporine. St. John's wort reduces the plasma concentration of digoxin.

4. During a comprehensive geriatric assessment the nurse learns that an older person has not been taking prescribed medications for several months. Which aspect of the assessment should the nurse focus to identify the reason for medication nonadherence? A. Medical diagnoses B. Functional ability C. Nutritional status D. Socioeconomic status

D. Socioeconomic status Rationale: Since the older person has not taken medication for several months, it is likely to be because of a financial/socioeconomic issue. This is the area in which the nurse should focus first to determine the reason for medication nonadherence. The reason why the medications have not been taken for several months is unlikely to be because of functional ability, medical diagnoses, or psychological status.

1. An older person is concerned about loose tissue along the upper arms and thighs. What should the nurse explain about the cause of this concern? A. "It is helpful to increase metabolic rate and calorie expenditure." B. "It is nothing to be concerned about since it doesn't change your health status." C. "It helps to reduce your overall body fat when it occurs." D. "It is caused by a loss of lean muscle mass that occurs with aging."

D. "It is caused by a loss of lean muscle mass that occurs with aging." Rationale: The diminishing of lean muscle mass that occurs with aging is termed sarcopenia. The loss of muscle occurs for many reasons with aging, including less physical activity, decreased anabolic-hormone production, increased cytokine activity from inflammation, or poor diet. A coincidental increase in body fat occurs with sarcopenia primarily because of a decrease in physical activity. Metabolic rate is decreased when lean body mass decreases. Loss of muscle mass can lead to negative changes and functional decline.

10. An older adult without an advance directive requests no interventions should he stop breathing during the night. Which type of order should the nurse discuss with the person and healthcare provider? A. Allow natural death B. Permit to die C. All but cardiopulmonary resuscitation D. No extraordinary measures

A. Allow natural death Rationale: Allow natural death (AND) is a formal designation that can replace the "do not resuscitate" order in some hospitals and other healthcare facilities. AND orders describe the person's instructions for the use of feeding tubes, administration of antibiotics, use of catheters and intravenous fluids, and other methods of prolonging life. Without exception, AND orders emphasize provisions for comfort measures, as needed. Permit to die, no extraordinary measures, and all but cardiopulmonary resuscitation are not identified as appropriate orders to address this person's request.

1. The nurse notes that an older person lives alone and has been losing weight despite the absence of chronic illness that affect metabolism. Which member of the interdisciplinary team should the nurse contact to discuss this person's situation? A. Dentist B. Physical therapist C. Social worker D. Geriatric physician

A. Dentist Rationale: Key members of the interdisciplinary team are the gerontological nurse, the social worker, and the geriatric physician. Since the person lives alone, a starting point would be to consult with the social worker to identify if the weight loss is related to income or other psychosocial needs. Other healthcare professionals can be included in the evaluation or consulted, depending on the needs and problems exhibited by the older person. These professionals include dentist, physical therapist and geriatric physician. Since the person has no chronic illnesses that affect metabolism, the physician would not be consulted for this particular problem. There is no evidence to suggest the need for dental care or care from a physical therapist.

10. An adult daughter is concerned about an her 85-year old mother's disinterest in activities since retiring from a full-time teaching position. Which theory of aging should the nurse use to help explain this older person's behavior? A. Disengagement B. Continuity C. Activity D. Developmental

A. Disengagement Rationale: In the disengagement theory, it is believed that older people and society engage in a mutual and reciprocal withdrawal so that when death occurs, neither parties are harmed and social equilibrium is maintained. In the activity theory, it is proposed that older people stay active and engaged to ensure successful aging. In the continuity theory, it is believed that successful aging involves maintaining or continuing previous values, habits, preferences, family ties, and other connections that have formed the underlying structure of the person's life. In the developmental theory, the task of the older adult is ego integrity versus despair. If the ego is intact, the older person will approach death without regrets. If failures or disappointments have occurred, this stage of development will be difficult to achieve because despair interferes with the acceptance of eventual death.

1. The nurse visits the home of an older person with chronic lung disease. Which observation indicates that the person is engaged in health improvement activities? A. Walks a pet dog twice a day B. Talks with family once a week C. Prepares pasta for dinner D. Sleeps in a recliner in the living room

A. Walks a pet dog twice a day Rationale: One myth of aging is health promotion is wasted on older people. The fact is that it is never too late to begin good lifestyle habits, such as eating a healthy diet and engaging in exercise. Walking the pet dog twice a day indicates that the person is engaged in a health-improvement activity. Pasta is high in carbohydrates which would have an adverse effect on weight and overall health. Talking with family may fill a psychosocial need; however, does not indicate engagement in a health-improvement activity. Sleeping in a recliner in the living room may help respiratory function; however, does not indicate engagement in a health-improvement activity.

14) Which of the following situations would be a priority for the nurse to intervene? 1. A client's spouse asks the nurse for the results of an HIV test. 2. Copies of the patient's diagnostic test results are found in the regular trash behind the nurse's station. 3. The charge nurse overhears a physician asking another physician not involved in the client's care to look at a test result. 4. A client's medical record is left unattended on a stretcher outside the radiology department while the client receives an x-ray.

Answer: 1 Explanation: 1. A breach in patient privacy is the nurse discussing the client's condition with a relative without the client's permission, and if the nurse gives the results, there is no way to undo that information and to protect the client's privacy. This should be the charge nurse's priority. 2. Copies of patient records must be rendered unreadable before being discarded. This would be a violation of HIPAA but not an immediate threat to the client's privacy, so it would not be the priority. 3. The physician should not be asking another physician to look at records unless a formal consult has been ordered; however, this would not be a priority since all doctors should protect client information, so there is no immediate threat of client information being unprotected. 4. Patient records must be secure, especially when used in departments other than the nursing unit. However, this would not be the priority unless the charge nurse saw that someone without authorization was trying to look at the medical record.

21) The nurse is preparing a care plan for an older African American patient at risk for colon cancer. What should be included in the plan of care? 1. Colonoscopy every 2 years 2. Serum cancer marker testing every year 3. Flexible sigmoidoscopy testing annually 4. Fecal occult blood screening every 2 years

Answer: 1 Explanation: 1. Currently, colonoscopy screening is recommended every 2 years for those at high risk. 2. Serum cancer markers are not a recommended screening test. 3. The flexible sigmoidoscopy is recommended every 4 years. 4. Fecal occult blood screening is recommended annually.

12) A nursing student is preparing a program to review health concerns for seniors. Which statement should the student include in the presentation? 1. "Heart disease is the leading cause of death for senior citizens." 2. "Decreases have been shown in the rate of Alzheimer's disease." 3. "The rate of heart-disease death for senior citizens is steadily increasing." 4. "Cancer is currently steady within the senior citizen population."

Answer: 1 Explanation: 1. Heart disease is the leading cause of death in the senior population, even though it has decreased by 2.4% between 2009 and 2010. 2. The death rate increased significantly from 2009 to 2010 for Alzheimer's disease. 3. The rate of heart disease in the senior population has decreased by 2.4% between 2009 and 2010. 4. Cancer is among the top causes of death but is not the number one cause of death.

17) An older client recently admitted from a homeless shelter experiences cardiac arrest. The client has no resuscitation orders. Which action should the nurse take? 1. Begin chest compressions. 2. Notify the nursing supervisor. 3. Obtain a prescription for DNR. 4. Attempt to contact the client's next of kin.

Answer: 1 Explanation: 1. If resuscitation orders are not present, the nurse should begin chest compressions on the client. 2. The nurse should call for the code team, which would also include the supervisor, but starting chest compressions is the best action. 3. Obtaining a DNR prescription would not be appropriate unless the client requests the nurse to do so. 4. Attempting to contact the client's next of kin delays treatment for the client and is not appropriate.

18) The family of an older client asks the nurse if the client qualifies for Medicaid to help with hospital bills. What information should the nurse provide to the family? 1. Eligibility for Medicaid is based upon annual income level. 2. Medicaid is available to individuals once they have the ability to retire. 3. Medicaid is intended to assist low-income individuals over the age of 65. 4. Eligibility for Medicaid begins when entering a long-term care facility.

Answer: 1 Explanation: 1. Medicaid is for low-income individuals. To qualify for Medicaid, the older person must "spend down" their assets to cover the costs of long-term care. 2. Medicare is a federal program available to older people and those with disabilities and certain chronic diseases. 3. Medicaid eligibility is based upon income level and not age. Medicare and Medicaid are different social programs. 4. Eligibility for Medicaid is based upon income. Those entering a long-term care facility do not become Medicaid eligible, regardless of age.

14) A graduate nurse is nervous about caring for older adult patients because of the personality changes that occur with aging. How should the nurse's preceptor respond to this statement? 1. "Personality tends to stay stable through life, rarely showing signs of change during final years." 2. "The losses many elderly experience understandably will impact their personality." 3. "The personalities of the elderly do undergo some significant changes after the eighth decade of life." 4. "After retirement, feelings of disuse cause many elderly to begin demonstrating personality changes."

Answer: 1 Explanation: 1. Personality is stable throughout adult life and rarely do healthy older people show signs of personality change during their final years. 2. Personality usually does not change radically even as a result of major lifestyle changes such as the death of a loved one. 3. Personality is stable throughout adult life and rarely do healthy older people show signs of personality change during their final years. 4. Personality usually does not change radically even as a result of major lifestyle changes such as retirement.

10) Which of the following actions by the nurse would meet the standard of care? 1. The nurse questioned a physician about a prescription where the dose was higher than the recommended dose. 2. The nurse medicated a client who reported severe chest pain with aspirin and then called the physician to get a prescription. 3. The nurse brings a breakfast tray into the client's room and puts in on the counter away from the client who is vomiting and nauseous. 4. A nurse leaving the facility at the end of the shift witnesses a client fall. The nurse calls for help and tells the other nurse that during the next shift he or she will fill out the incident report.

Answer: 1 Explanation: 1. Questioning a medication dosage outside the normal range is a situation in which a reasonable nurse would pursue a similar action and would be considered the standard of care. 2. Medicating a client with aspirin for severe chest pain without a prescription and then notifying the physician would not be considered standard care. 3. The nurse should have withheld the breakfast tray from a client who is nauseated and vomiting or at least left it outside the client's room so the client would not smell the food and possibly exacerbate the symptoms. 4. Assisting a patient who has fallen is a situation in which a reasonable nurse would pursue a similar action and would be considered the standard of care. The nurse would then need to fill out the incident report at the time of the incident, not on the next shift.

15) An older client with confusion has a prescription to receive a blood transfusion. Which of the following actions should the nurse take to obtain consent? 1. Request the client's family member or next of kin sign the consent. 2. Withhold the blood transfusion until the client's mental status improves. 3. Administer the blood transfusion since a signed consent form is not necessary. 4. Explain the transfusion, help the client sign the consent, and administer the transfusion.

Answer: 1 Explanation: 1. The nurse who finds a patient lacking the capacity to provide consent, as in the case of a confused patient, must still obtain consent from a family member or next of kin, unless it was a life-threatening situation, in which the medical staff can then proceed in the client's best interest, which is considered implied consent. 2. Withholding the transfusion until the client is no longer confused delays the treatment and may result in harm to the client. 3. A blood transfusion is considered a specialized procedure and requires a separate informed consent form be signed. 4. Explaining the treatment to a confused client and then assisting the client to sign the consent does not meet the test of capacity for consent (understanding, reasoning, problem solving, and communicating the decision).

6) The nurse documents values-beliefs in the functional health pattern categories; which of the following is an example of this domain? 1. A client's religious affiliation 2. Daily fluid consumption 3. Sleep and rest patterns 4. Coping strategies

Answer: 1 Explanation: 1. The values-beliefs category of the functional health pattern assessment includes beliefs, values, and perceptions about the meaning of life. A client's participation in a religion would be part of this assessment. 2. Daily fluid consumption is part of the nutrition-metabolic category. 3. Sleep and rest are part of the sleep-rest category. 4. The coping-stress tolerance category of the functional health pattern assessment includes patterns of coping with stressful events and the effectiveness of coping strategies.

13) During a home visit, an older client recovering from cardiac surgery is concerned about weakness and not being able to enjoy dancing with the spouse anymore. What would be an appropriate response for the nurse to make to the client? 1. "In time, your strength will return so you can return to your activities." 2. "Tell me more about not feeling able to do what you want to do." 3. "Dancing is a strenuous activity and may no longer be appropriate for you." 4. "Do you think you are working hard enough to return to that type of activity?"

Answer: 2 Explanation: 1. The nurse does not offer false hope. The client's strength and endurance may not return fully. 2. Open-ended statements will encourage the client to talk. Sentences that ask the client to "tell me more" are helpful. 3. Not all dancing is strenuous, and the client may be able to build up cardiac endurance to return to whatever dancing is desired. 4. This statement is giving the client advice and should be avoided.

18) An older client is diagnosed with an intestinal obstruction and needs immediate surgery. The client's next of kin is a granddaughter who lives in a neighboring community. Which of the following actions should the nurse take? 1. Obtain consent from the client for the surgery. 2. Perform the surgery since it is emergent, consent is not necessary. 3. Delay the surgery until the client's granddaughter can be contacted. 4. Obtain a consult from mental health to ensure the client's competence.

Answer: 1 Explanation: 1. Unless there has been some indication of a loss of competence or a legal document exists that establishes the power of attorney, the client has the responsibility to sign the consent form for the surgery. 2. Even though the surgery is emergent, consent is necessary, unless the client is unconscious and no other family is around to give consent, then the physician can assume implied consent to save the client's life if there is no DNR in place. 3. The surgery should not be delayed if it is emergent. 4. Ensuring a client's competence just because they are old is unnecessary and can be insulting to the client. This is not a routine standard of care, and there is no indication in the stem that the client is not capable of signing a consent form.

16) A 60-year-old patient in good health has asked the nurse about what steps can be taken to build muscle mass. What information should be provided to the patient? 1. Exercise can slow the loss of muscle mass. 2. Increasing protein and fat intake will increase muscle mass. 3. Muscle mass declines by 40% between the ages of 30 and 70. 4. There is little that can be done to reduce the loss of muscle mass associated with aging.

Answer: 1 Explanation: 1. Without exercise muscle mass declines 22% for women and 23% for men between the ages of 30 and 70. Exercise can slow this rate of loss. 2. Calories are burned more slowly during aging, and adding fats can promote fat build-up, not an increase in muscle mass. 3. Without exercise, muscle mass declines 22% for women and 23% for men between the ages of 30 and 70. 4. Without exercise, muscle mass declines 22% for women and 23% for men between the ages of 30 and 70. Exercise can slow this rate of loss.

22) The nurse is planning care for an older client with chronic comorbid conditions. The nurse determines that insufficient health maintenance is the priority nursing diagnosis for this client due to non-adherence to the medication regimen. What are the most important nursing interventions for this client? Select all that apply. 1. Ensure the client has written and verbal medication administration instructions. 2. Ask the client to identify ways in which the medication regimen can best fit the current lifestyle. 3. Have the client teach back any medication skills and knowledge after the learning session. 4. Browsing web resources with the nurse about how to use medications correctly. 5. Emphasize the importance of keeping medications organized with a pill planner.

Answer: 1, 2, 3 Explanation: 1. After formulating nursing diagnoses, nursing interventions will be selected based upon the desired outcome. The nurse must make sure the client understands how to use the medications and that non-adherence is not due to lack of understanding. 2. After formulating nursing diagnoses, nursing interventions will be selected based upon acceptance of the intervention to the client. The nurse addresses issues such as what time medications are taken in relation to any side effects, interference with rest or work, and other common issues that, if addressed, increase compliance. 3. After formulating nursing diagnoses, nursing interventions will be selected based upon assurance that the intervention is appropriate and that the client has the understanding and ability to continue the plan. 4. The nurse can direct the client to reputable websites about conditions and medications, but the nurse should be offering and reviewing institution approved and provided client-teaching materials. 5. The client should do whatever will work for them, and the nurse works with the client to determine what method is best for them to keep up with their medications. Pill planners are not the best solution for everyone.

20) The nurse needs to fax confidential patient information to another office. What actions should the nurse take when faxing this type of information? Select all that apply. 1. Use a cover sheet. 2. Obtain patient permission to fax. 3. Include a confidentiality statement. 4. Verify the fax number before faxing. 5. Print the patient's name on the cover sheet.

Answer: 1, 2, 3, 4 Explanation: 1. Fax machines are the least secure of all technologies. The nurse should use a cover sheet when faxing confidential patient information. 2. Fax machines are the least secure of all technologies. The nurse should obtain the patient's permission before faxing confidential patient information. 3. Fax machines are the least secure of all technologies. The nurse should include a confidentiality statement when faxing confidential patient information. 4. Fax machines are the least secure of all technologies. The nurse should verify the fax number before faxing confidential patient information. 5. Fax machines are the least secure of all technologies. The nurse should not print the patient's name on the cover sheet when faxing confidential patient information.

17) The administrator at a skilled nursing facility is concerned about the rates of aspiration pneumonia. Which long-term facility factors are most likely to lead to increased rates of aspiration pneumonia? Select all that apply. 1. Prolonged nurse position vacancies 2. Reduced staffing levels for second shift 3. Bonus pay offered for working extra shifts 4. High client turnover in the morning 5. Shortage of beverage thickener

Answer: 1, 2, 3, 4 Explanation: 1. Inadequate nurse staffing could lead to pneumonia because of aspiration during mealtimes. Staff is rushed and may feed too quickly; clients may try to feed themselves when they should not. 2. Inadequate nurse staffing could lead to pneumonia because of aspiration during mealtimes. Staff is rushed and may feed too quickly; clients may try to feed themselves when they should not. Dinner time and evening snacks are important to the client's nutritional status. 3. Overworked staff may not provide the care required during mealtimes due to their own fatigue. Bonus pay for extra shifts can temporarily help staffing issues, but it is not a permanent solution. 4. When staff are rushed to admit, transfer, or discharge clients, feeding clients can become rushed, leading to aspiration pneumonia. 5. Foods and liquids can be safely administered to clients at risk of aspiration pneumonia without a thickening agent.

23) The nurse is planning a program for community members to highlight the Healthy People 2020 areas applicable to older people. Which topics would the nurse include in this program? Select all that apply. 1. The importance of performing monthly breast exams 2. How to cook healthy food safely 3. Tobacco and Smoking Cessation techniques 4. Employment and occupational hazards 5. Heart healthy lifestyle choices

Answer: 1, 2, 3, 5 Explanation: 1. Cancer is a focus area in Healthy People 2020 that is applicable to older people. 2. Food safety is a focus area in Healthy People 2020 that is applicable to older people. 3. Tobacco use is a focus area in Healthy People 2020 that is applicable to older people. 4. Employment is not a focus area in Healthy People 2020 that is applicable to older people. 5. Heart disease is a focus area in Healthy People 2020 that is applicable to older people.

25) An older client expresses a desire to stop all care. Which techniques will the nurse use to discuss end-of-life issues with this client? Select all that apply. 1. Sit down in a chair at the client's bedside. 2. Turn off the television in the room. 3. Pause for clarification if client's facial expression changes. 4. Begin by addressing the client by their first name. 5. Inform the client that hospice services can be arranged.

Answer: 1, 2, 3, 5 Explanation: 1. Communication is always best done at eye level. 2. Best practice is to minimize background noise and distractions. Be sure to ask permission first. 3. It is important to be alert to signs that the client is confused or needs a minute to formulate a thought. 4. Ask the client how they would like to be addressed. Using general terms like "sir" or "ma'am" may feel too impersonal, but using the client's first name may be too informal. Ask permission to use the first name. 5. The nurse does not yet know why the client has this wish and has not assessed their needs. Assessment through good communication must occur prior to suggesting a route.

6) The nurse is assessing the function of an older adult. Which of the following actions should the nurse take? Select all that apply. 1. Utilize the SPICES tool. 2. Utilize the PULSES tool. 3. Identify the client's strengths. 4. Interview the client's closest family member. 5. Use an interdisciplinary assessment approach.

Answer: 1, 2, 3, 5 Explanation: 1. SPICES is an overall assessment tool used to plan, promote, and maintain optimal function in older adults. 2. PULSES is a tool that measures general functional performance in mobility and self-care, medical status, and psychosocial factors. 3. Identifying and using the client's strengths to help maximize independence is one role of the nurse when assessing the function of an older adult. 4. Interviewing a family member is not necessary for assessing the older adults' functional status. 5. An interdisciplinary approach should be utilized to consult and evaluate the older adult.

8) An older client with chronic health problems does not want to be admitted to a nursing home for continued care. What can the nurse explain to the client about nursing homes today? Select all that apply. 1. Nursing homes are for short-term stays. 2. Nursing homes help the client with activities of daily living. 3. Nursing homes are being replaced with community-based services. 4. Nurses in nursing homes provide at least 5 hours of care to each client each day. 5. Nursing homes help with bathing, toileting, meals, and medication administration

Answer: 1, 2, 3, 5 Explanation: 1. The number of discharges from nursing homes has increased over the years, which indicate that many long-term care facility residents are short-stay rehabilitation clients. 2. Nursing home residents are assisted with activities of daily living. 3. The decline in nursing home occupancy is attributed to more community-based services, which can delay or prevent nursing home placement in older persons. 4. Surveys indicate that nurse staffing time in nursing homes average 3.5 hours per resident per day. 5. Nursing homes help clients with bathing, dressing, eating, toileting, walking, and medications.

9) The director of nursing at a skilled facility is implementing the Quality and Safety Education for Nurses (QSEN) project to improve the quality of care of the older residents. Which topics will the director include in staff teaching? Select all that apply. 1. Directions on accessing evidence-based practice resources 2. Methods for ensuring effective team collaboration 3. A plan for staff incentives for meeting care goals 4. Examples of respectful team communication 5. Information on the most prevalent cultures in the region

Answer: 1, 2, 4 Explanation: 1. Care must always be based on current evidence. Nurses must be knowledgeable about using informatics to access the best evidence for care provision. 2. Teamwork is a knowledge, skill, or attitude that will improve the quality of care of the facility's residents by fostering open communication, mutual respect, and shared decision making to achieve better quality. 3. Staff incentives are not a knowledge, skill, or attitude that will improve the quality of care of the facility's residents. 4. For a team to function well, respectful communication is an essential skill. 5. QSEN does emphasize valuing everyone's beliefs, values, and needs. The nursing director would include information on how to be respectful of all cultures and individuals, but presenting information specific to the local area does not fully meet this criteria.

20) A patient who is new to Medicare has been reviewing coverage for health screening tests. Which statements indicate the patient understands the recommendations provided by Medicare? Select all that apply. 1. "I can have a Pap smear once a year." 2. "I can have a mammogram once a year." 3. "I can have a colonoscopy every 15 years." 4. "I can have fecal occult blood testing every 2 years." 5. "I can have bone mass screening every 2 years if I'm at risk."

Answer: 1, 2, 5 Explanation: 1. Medicare recommends a Pap smear once a year. 2. Medicare recommends a mammogram once a year. 3. Medicare recommends a colonoscopy every 10 years for those with normal risk levels and every 2 years for those at high risk. 4. Medicare recommends fecal occult blood testing once a year. 5. Medicare recommends bone mass screening every 2 years for those at risk.

9) Jung's theory of individualism focuses on the client's inner psychological state in regards to aging. When assessing an older client, the nurse might find which thoughts? Select all that apply. 1. Signs of sadness and depression 2. Questions about nutrition and vitamins 3. Regrets on not accomplishing more in life 4. A belief that past injuries have altered their abilities 5. Concerns that damaged cells are slowing down their body

Answer: 1, 3 Explanation: 1. Jung's theory of individualism states that with aging the focus is away from the external world and moves toward the inner experience. This is a psychosocial theory of aging and would be applicable to use for a patient experiencing these emotions. 2. The free-radical theory focuses on aging as a result of accumulated damage caused by oxygen radicals causes cells, and eventually organs, to lose function and organ reserve. 3. Jung's theory of individualism states that with aging the focus is away from the external world and moves towards the inner experience. This is a psychosocial theory of aging and would be applicable to use for a patient experiencing these emotions. 4. The wear-and-tear theory focuses on aging as a result of cells and organs wearing out after years of use. Proponents of this theory see the human body as a machine. They believe that a "master clock" controls all organs and that cellular function slows down with time. 5. The programmed longevity theory focuses on aging as a result of changes in gene function which is a biological theory. This patient is demonstrating psychosocial changes with aging.

25) After completing an assessment, the nurse is concerned that a middle-aged patient is at risk for having a chronic illness later in life. What did the nurse assess in this patient? Select all that apply. 1. Has a blood pressure reading of 150/90 2. Goes out with friends for a drink once per week 3. Smokes 1 pack of cigarettes per day for the last 25 years 4. Has a history of lower back pain 5. Works as a laboratory technologist

Answer: 1, 3, 4 Explanation: 1. Atherosclerosis is considered one of the most common causes of disability in the United States. High blood pressure can be caused by atherosclerotic changes in the arteries. 2. Drinking alcohol on a daily/consistent basis can cause chronic illness; once a week is not consistent with chronic illness later in life. 3. Smoking 1 pack per day for 25 years can lead to a lung or respiratory problem, which is considered as being one of the most common causes of chronic illness in the United States. 4. Degenerative joint disease is considered one of the most common causes of disability in the United States. A history of lower back pain could be an indication of degenerative joint disease in the spine. 5. Employment history such as working as a laboratory technician is not considered a contributing factor to chronic illness later in life.

13) The nurse provides care to patients in a long-term care facility that embraces the Continuity Theory of Aging. Which actions will the nurse plan to promote this theory? Select all that apply. 1. Plan rest periods between activities. 2. Introduce patients to a wide variety of new activities. 3. Encourage family members to visit with the patients. 4. Suggest participating only in activities that bring satisfaction. 5. Remind patients that withdrawing from activities is expected.

Answer: 1, 3, 4 Explanation: 1. In the Continuity Theory of Aging, the pace of activities may be slowed, so rest periods between activities would be appropriate. 2. In the Continuity Theory of Aging, older age is not viewed as a time for major life readjustments but rather as a time to continue being the same person. Introducing patients to new activities does not support this theory. 3. In the Continuity Theory of Aging, successful aging involves maintaining family ties. Encouraging family members to visit with the patients would be appropriate. 4. In the Continuity Theory of Aging, activities pursued in life that did not bring satisfaction may be dropped. Suggesting that patients avoid activities that do not bring satisfaction would be appropriate. 5. In the Continuity Theory of Aging, successful aging involves maintaining values, habits, and preferences that formed the basic underlying structure of adult life. Reminding patients that withdrawing from activities is expected supports the Disengagement Theory.

11) What actions will the nurse follow when using restraints for an older client in a long-term care facility? Select all that apply. 1. Use restraints for 2 hours or less. 2. Use restraints for emergency situations only. 3. Utilize waist restraints to prevent client falls. 4. Obtain a physician's order before using restraints. 5. Remove the client's eyeglasses when applying restraints.

Answer: 1, 4 Explanation: 1. Restraints are now limited to short-term use of 2 hours or less. 2. Restraints may be necessary in other situations other than just in emergency situations. 3. Waist restraints are not proven to be the best approach to prevent client falls. Nurses are urged to develop alternatives to physical restraints such as addressing client and environmental factors. 4. Restraints are used only with a physician's order. 5. The nurse should ensure the client is wearing eyeglasses, which would reduce the need to use a restraint.

19) The nurse at an assisted-living facility is planning secondary prevention activities for a group of residents at risk for cardiac problems. Which activities would be appropriate for this level of care? Select all that apply. 1. Blood pressure monitoring 2. Demonstration on the use of walkers and canes 3. Explanation on why the use of alcohol should be avoided 4. Discussion with a dietitian for elevated cholesterol levels 5. Discussion with a physical therapist on weight-bearing activities

Answer: 1, 4, 5 Explanation: 1. Blood pressure monitoring is a secondary prevention intervention and would be appropriate for the residents at risk for cardiac problems. 2. Demonstrating the use of walkers and canes is a tertiary prevention intervention and would not be appropriate for these residents. 3. Explanation on the avoidance of alcohol would be a primary prevention intervention and would not be appropriate for these residents. 4. Discussion with a dietitian for elevated cholesterol levels is a secondary prevention intervention and would be appropriate for these residents. 5. Discussion with a physical therapist on weight-bearing exercises is a secondary prevention intervention and would be appropriate for these residents.

21) A gerontological nurse is planning an educational program to discuss the current and anticipated nursing staffing needs of the future. What should be included in the presentation? Select all that apply. 1. More nurses will be needed to work in assisted living care settings. 2. The number of nursing homes has begun to increase over the last 10 years. 3. The number of nurses employed in hospital settings has increased since 1980. 4. Adding nurses has no impact on the long-term health of nursing home residents. 5. More complex nursing skills are needed to provide care in long-term care and rehabilitative care facilities.

Answer: 1, 5 Explanation: 1. There is an increase in assistive care settings in the United States. More nurses will be needed to work in this care setting. 2. The current nursing home occupancy rate is 86%, and the number of beds and nursing home residents began to decline in 1999. 3. Hospitals remain the major employer of nurses, although the number of nurses employed in other sectors has increased. 4. Adding nurses to provide care will reduce the mortality rate and improve the nutritional status of clients in long-term care facilities. 5. Clients in long-term care and rehabilitation care facilities are more ill because hospital lengths of stays have decreased. The clients are being admitted to long-term care facilities with more health problems.

5) The nurse is completing a functional health pattern assessment with an older client. Which assessment finding reflects the cognitive-perceptual category? 1. Participates in church choir 2. Volunteers for political functions 3. Attends meditation classes weekly 4. Attends self-help seminars

Answer: 2 Explanation: 1. The functional health pattern assessment consists of 11 health patterns. The values-beliefs category includes the client's beliefs, values, and perceptions about the meaning of life. 2. The functional health pattern assessment consists of 11 health patterns. The cognitive-perceptual pattern includes how the client thinks and perceives the world and current events. The client's activities with political functions would be part of this assessment. 3. The functional health pattern assessment consists of 11 health patterns. Coping-stress tolerance includes patterns of coping with stressful events and the level of effectiveness of coping strategies. 4. The functional health pattern assessment consists of 11 health patterns. Self-perception-self-concept identifies patterns of how a person views and values the self.

24) An older client who is still physically active complains of progressive inability to maintain the home. The client wants to research other living options and has significant financial resources. What should the nurse recommend to help meet the client's living needs? 1. Adult day care 2. Retirement community 3. Skilled-nursing facility 4. Residential care facility

Answer: 2 Explanation: 1. Adult day care is an option for people with multiple comorbidities or people who need daytime supervision and activities. This type of setting would not be appropriate for the client. 2. A retirement community is a senior citizen community that ranges in size, scope of services, types of apartments, and different levels of activities. This is the type of facility in which the client would most benefit. 3. A skilled-nursing facility is a place where skilled care is provided to residents by nurses. The care might be subacute or chronic. This setting would not be appropriate for the client. 4. A residential care facility is like a rest home, usually in a large private home that has been converted to provide rooms for residents who can provide most of their own personal care but might need help with laundry, meals, and housekeeping. This type of setting would not be appropriate for the client.

11) An older client begins to cry when talking about the death of a daughter 20 years ago. Which response should the nurse make? 1. Assess the client for depression. 2. Touch the client's arm and listen in silence. 3. Ask the client to describe the details of the death. 4. Leave the client alone so they can cry.

Answer: 2 Explanation: 1. Assessing the client for depression could give the client the impression that the expression of feelings of grief is not normal or healthy. 2. Attentive listening is the key to effective communication, and the most appropriate response is to demonstrate empathy and support for the client in the expression of strong feelings. Crying can be therapeutic to the older client and offers release from persistent feelings of sadness. 3. Asking the client to describe the details of the death would not support the client's needs at this time. 4. Crying is an effective means to express emotions, but leaving them alone would not be a supportive action.

4) The nurse is caring for an older adult with a chronic disease. Which is reflective of a tertiary intervention to help slow down the progression of the client's illness? 1. Assess the client's mobility 2. Integrate physical therapy 3. Discuss injury-prevention measures within the home 4. Obtain a referral for occupational therapy

Answer: 2 Explanation: 1. Assessment of the client's mobility is reflective of secondary prevention. 2. The integration of physical therapy for a client with chronic disease reflects a tertiary intervention to promote restoration and prevent or slow down further debilitation. 3. Discussing injury prevention is health promotion or primary prevention. 4. Obtaining a referral for an occupational therapist reflects a secondary measure of prevention in which there is an early diagnosis and prompt treatment.

5) The nurse is talking with an older client who has a history of multiple hospitalizations and a recent decline in mental status. Which of the following interventions should the nurse implement to improve the client's overall health? 1. Have the client evaluated for long-term care. 2. Obtain a referral for a comprehensive evaluation. 3. Collect an accurate and thorough health history. 4. Provide the appropriate amount of help for normal activities.

Answer: 2 Explanation: 1. Evaluating the client for long-term care would not improve the client's overall health. 2. Research shows that comprehensive geriatric evaluations can help improve mental status and reduce hospital readmissions. 3. Collecting an accurate and thorough health history should always be the standard of care, but this would not help improve the client's overall health status. 4. This action only helps with the client's ADLs.

2) The nurse supports an older client's autonomy; which decision supports this ethical principle? 1. Client wants to see case management for Medicaid resources. 2. Client decides to stop further chemotherapy treatments. 3. Client is given more education regarding medication side effects. 4. Client treatment information is kept from client because of family request.

Answer: 2 Explanation: 1. Justice involves fairness and equal distribution of resources to all in need. 2. Autonomy is the respect for a client's self-determination, freedom, and rights including the right to refuse treatment. 3. Beneficence is the principle of doing "good" and not doing harm to clients. 4. Nondisclosure is an ethical issue when persons who care about a client, such as family, do not want a client to be told the entire facts of a negative prognosis in order to protect the client from anxiety and fear.

7) The family of an older client in a nursing home feels that the client has not been treated fairly and that the client's rights have been violated. Which of the following would be the best action for the family to take? 1. Remove the client from the facility. 2. Call the local ombudsman and report the information. 3. Hire a lawyer to obtain information about the client's care. 4. Request a copy of the client's medical record and determine if appropriate care has been given.

Answer: 2 Explanation: 1. Removing the client from the facility may be unnecessary and can be difficult on the older adult. The client can become more confused and if the client already has established relationships with other residents in the nursing home, removing the client may not be the best action. 2. All states are to operate long-term care ombudsmen programs. These programs provide trained people to investigate complaints made by residents and families about care received in the facility. 3. Since all states are required to provide ombudsmen programs, it would not be in the family's best interest to hire a lawyer first. They should call the ombudsmen first. 4. Unless the family is trained in the medical field, they would not necessarily know what to look for in the medical records to know if appropriate care has been given. This would not be the best choice over calling the ombudsmen.

15) The nurse focuses on effective communication when caring for an older client. Which method does the nurse use? 1. Speak continuously so the client can stay focused on the conversation. 2. Ask for clarification, rephrase, and summarize throughout the interaction. 3. Keep the speaking voice loud and make statements slowly and clearly. 4. Change the subject if the client seems disturbed by the discussion topic.

Answer: 2 Explanation: 1. Silent pauses are beneficial in that they give the client time to think and provide more information. 2. The nurse should avoid misunderstandings by saying, "I'm not sure what you mean," which helps to clarify content. 3. Yelling or speaking loudly to older clients should be avoided because yelling could be disturbing if a hearing aid is being used. Slowing down speech rate is not necessary for the client with adequate hearing and cognition. 4. Changing the subject is a barrier that could disrupt the communication process.

8) Which action should the nurse take to avoid becoming involved in a legal suit with client care? 1. Consistently follow the physician's orders. 2. Document carefully all nursing care provided. 3. Avoid using emails and fax machines to send client information. 4. Always provide friendly and respectful care to the client and families.

Answer: 2 Explanation: 1. The nurse has a duty to advocate for clients and that includes questioning any orders that seem unsafe or inappropriate. The nurse should not just follow the physician's orders without using clinical judgement about the order. 2. Careful documentation of nursing care is the best way for the nurse to defend himself or herself should a legal suit be filed. 3. It is not necessary to avoid using this type of technology to share or transmit client information, but it is the nurse's responsibility to ensure that client confidentiality is upheld when using email or fax. 4. Providing friendly and respectful care should be practiced by every nurse, but this would not prevent the nurse from being involved in a legal suit.

24) The nurse is working on a care area that focuses on tertiary prevention. Which goal is most consistent with this focus? 1. Patients at risk for skin breakdown will be turned every 2 hours. 2. Patients with pressure ulcers will have whirlpool therapy as indicated. 3. Patients will be assessed for factors that place them at risk for skin breakdown. 4. Patients are instructed to change positions in bed every 2 hours to prevent skin breakdown.

Answer: 2 Explanation: 1. Turning a patient at risk for skin breakdown is an example of a primary prevention goal. 2. Treating a pressure ulcer is an example of a tertiary prevention goal. 3. Assessing a patient at risk for skin breakdown is an example of a primary prevention goal. 4. Teaching a patient how to prevent skin breakdown is an example of a primary prevention goal.

10) The nurse creates and implements a client's plan of care. Which client outcomes best demonstrate use of evidence-based practice in planning care for the older client? Select all that apply. 1. The client is placed in physical restraints and does not experience a fall. 2. The nurse reports to the next shift nurse that the malnourished client enjoys milkshakes. 3. The client who is at risk of deep vein thrombosis is assisted to walk three times daily. 4. The nurse requests a laxative and administers it while the client is on a narcotic. 5. The nurse allows the client with pneumonia to rest in bed throughout the shift.

Answer: 2, 3, 4 Explanation: 1. It is a positive outcome that the nurse prevented a fall, but physical and chemical restraints are used cautiously, if at all, and are not considered an acceptable fall prevention technique in the older client. 2. The nurse has evidence that this practice works well to encourage the client to take in more nutrients and calories, improving the client's health and treating the client's lack of nourishment. Though not published research, evidence of this kind is used based on trial and error to improve client outcomes. 3. Evidence states that the client at risk for DVT needs to ambulate when possible to prevent clots from forming, with or without compression socks. If ambulation is not realistic, a sequential compression device is used. 4. The nurse uses established evidence and information about narcotics to prevent the problem of constipation in the client. Constipation is the only narcotic side effect clients do not become tolerant to and older clients are at higher risk of constipation. 5. Clients with pneumonia do need rest but also need to be turned, helped to sit up in the chair, and assisted to walk if able. Resting in the bed all day is not the best intervention for the client.

6) The nurse is assessing an older female patient admitted to the hospital for generalized weakness and a cough. Which assessment findings indicate normal changes of aging? Select all that apply. 1. Blood pressure of 160/90 2. Needing to urinate every 3 hours 3. Needing to wear eye glasses for reading 4. Pulse rate 110 bpm 5. Respiratory rate 22 per minute after walking a short distance

Answer: 2, 3, 5 Explanation: 1. Even though the arteries stiffen with age, an elevation in blood pressure needs to be investigated and not assumed that it is a normal change related to aging. 2. With aging, bladder capacity declines. Needing to urinate every 3 hours would be evidence of reduced bladder capacity. 3. With aging, difficulty focusing up close would necessitate the need for reading glasses. This would be considered a normal change with aging. 4. Even though the heart muscle thickens with age, a pulse rate of 110 needs to be investigated and not assumed that it is a normal change related to aging. 5. Maximum breathing capacity may decline by about 40% between the ages of 40 and 70. A respiratory rate of 22 per minute after walking a short distance can be considered a normal change related to aging.

19) The nurse caring for older clients wants to return to school to become a gerontological nursing specialist. Which criteria would the nurse need to achieve in order to fulfill this career goal? Select all that apply. 1. Been a practicing nurse for at least 2 years, with 2,000 unsupervised clinical practice hours. 2. Complete at least 500 supervised hours of providing care to older clients. 3. Have a gerontological nurse manager recommend the nurse for the credential. 4. Complete a course in advanced pathophysiology and pharmacology. 5. Receive their doctor of nursing practice degree.

Answer: 2, 4 Explanation: 1. To be considered as a gerontological nursing specialist, the nurse would need 500 supervised hours. 2. To be considered as a gerontological nursing specialist, the nurse would need to complete at least 500 supervised hours of providing care to older clients. 3. To be considered as a gerontological nursing specialist, the nurse would not need to have a gerontological nurse manager recommendation. 4. To be considered as a gerontological nursing specialist, the nurse would need to complete a course in advanced pathophysiology and pharmacology. 5. To be considered as a gerontological nursing specialist, the nurse does not need a doctorate degree.

18) Jung's theory focuses on a person's inability to accept past accomplishments and failures. When assessing a client, which statement supports this theory of a patient's belief? 1. "I am having trouble finding the right bowling league since I retired." 2. "I joined a sewing club with my older sister but don't always feel like going." 3. "I lost my husband to a younger, more attractive woman about 4 years ago." 4. "I still get up every morning to go walking, but I miss my dog since she died."

Answer: 3 Explanation: 1. The Continuity Theory of Aging supports the idea that after retirement, activities may slow but are still important to continue for satisfaction and happiness. 2. The Disengagement Theory considers the need of an individual to engage in society and maintain equilibrium. 3. A key focus of Jung's theory is the impact of an inability to accept past accomplishments and failures to promote successful aging. The client is having a hard time regarding the loss of her husband to another person. 4. Despite the loss of a pet/animal, the Continuity Theory of Aging supports that life must go on and routines must continue.

12) The gerontological nurse is planning health promotion actions for an older client. Which of the following information should the nurse focus on when planning these actions? Select all that apply. 1. Client has type 2 diabetes mellitus. 2. Client walks for 30 minutes 3 times a week. 3. Client uses BIPAP machine for sleep apnea. 4. Client attends religious services every Sunday morning. 5. Client lives alone and volunteers at the local library most afternoons.

Answer: 2, 4, 5 Explanation: 1. Health promotion for the older adult is not focused on disease or disability. Type 2 diabetes would not be a focus when planning health promotion. 2. Health promotion for the older adult is focused on individual strengths, abilities, and values. Walking for 30 minutes 3 times a week would be taken into consideration for the patient. 3. Health promotion for the older adult is not focused on disease or disability. Using a BIPAP machine for sleep apnea would not be a focus when planning health promotion. 4. Health promotion for the older adult is focused on individual strengths, abilities, and values. Attending religious services every Sunday would be taken into consideration for the patient. 5. Health promotion for the older adult is focused on individual strengths, abilities, and values. Living alone and volunteering at the local library most afternoons would be taken into consideration for the patient.

2) The nurse is planning to conduct education for older adult clients regarding preventative health screenings. Which type of screening does the nurse anticipate educating this population on? 1. Glaucoma 2. Nutrition 3. An annual mammogram 4. Prostate-specific antigen

Answer: 3 Explanation: 1. A glaucoma screening is recommended annually for those at risk for glaucoma. 2. Nutritional assessment and counseling are encouraged for those with diabetes or renal disease. 3. The nurse will discuss the importance of annual mammograms. Older women are the fastest growing population in the United States. 4. A prostate-specific antigen is recommended yearly for men under the age of 70.

5) The nurse is caring for an older client with heart disease that is experiencing fatigue. Which will the nurse initially implement to enhance the overall quality of life and functional ability of the client? 1. Assess the need for assistive devices 2. Provide education on health screenings 3. Reinforce the importance of rehabilitation 4. Instruct the client on techniques for self-management

Answer: 3 Explanation: 1. Assistive devices may be necessary to increase the independence of the client. The assessment for an assistive device occurs during the rehabilitation time. 2. Education regarding health screenings focuses on prevention of disease. 3. Rehabilitation after a chronic illness can enhance the quality of life and functional ability of the client. Managing chronic fatigue that occurs with heart disease can require rehabilitation. 4. Techniques of self-management can reduce pain and cost of chronic disease by teaching the client to manage their own chronic condition.

19) A nurse has just completed training on the Health Insurance Portability and Accountability Act (HIPAA). Which statement made by the nurse indicates that training has been successful? 1. "Faxing of information is prohibited by HIPAA." 2. "I need to verbally provide the patient with the privacy notice." 3. "I cannot discuss a patient's health history with family members without the patient's permission." 4. "Financial information relating to payment for services is not subject to the HIPAA regulations."

Answer: 3 Explanation: 1. Faxing is permitted only with the permission of the patient. 2. It is mandated that all patients receive a privacy notice, which is a written statement that explains how healthcare information will be used and disclosed. 3. Discussing a patient's health history with family members is not permitted without the patient's permission. 4. Past, present, or future payment for the provision of healthcare is considered confidential and subject to the HIPAA regulations.

3) The nurse is preparing to assess an older client using functional health patterns. How does this approach ensure holistic care will be provided to the client? 1. Focuses on the effects of diseases 2. Predicts the outcome for clients with disabilities 3. Demonstrates the client's interaction with the environment 4. Identifies the potential for rehabilitation early in the process

Answer: 3 Explanation: 1. Functional health patterns are an interrelated group of behavioral areas that provides a view of the whole person and the relationship with the environment. Functional health patterns do not focus on the effects of diseases. 2. Functional health patterns are an interrelated group of behavioral areas that provides a view of the whole person and the relationship with the environment. Functional health patterns do not predict the outcome for clients with disabilities. 3. Functional health patterns are an interrelated group of behavioral areas that provides a view of the whole person and the relationship with the environment. 4. Functional health patterns are an interrelated group of behavioral areas that provides a view of the whole person and the relationship with the environment. Functional health patterns do not identify the potential for rehabilitation early in the process.

1) The nurse is preparing to discharge an older client with instructions on smoking cessation. The nurse states to a colleague, "This client has been smoking for years and isn't going to stop now." Which negative stereotype of aging does the nurse's statement most reflect? 1. Old people are expected to be sick. 2. Old people are set in their ways. 3. Old people do not value health promotion education. 4. Old people are a drain on societal resources.

Answer: 3 Explanation: 1. Many older adults have chronic disease but function well. 2. Often people characterize the elderly in a negative way, believing that after a certain age, things cannot be changed. Older people can learn new things and take up new hobbies they can enjoy and give life meaning and pleasure. 3. Although it may not be possible to reverse all the damage, it is never too late to stop smoking cigarettes. People who quit smoking at an older age enjoy better health outcomes. 4. Older people contribute greatly to society by volunteering, helping with grandchildren, mentoring others, and continue working.

2) Which nursing intervention will ensure that the nurse will provide culturally competent healthcare to an older patient? 1. Speak the patient's primary language. 2. Use standardized assessment instruments in health evaluations. 3. Approach patients of a particular ethnic group in the same manner. 4. Know prevalence, incidence, and risk factors for diseases specific to different ethnic groups.

Answer: 4 Explanation: 1. It is unrealistic to expect that the nurse will speak the patient's primary language if it is not English. 2. Many of the clinical assessment instruments have not been validated for use with ethnic minorities. 3. To avoid stereotypical thinking, the nurse must approach each patient as a unique individual. 4. Knowing the prevalence, incidence, and risk factors for diseases specific to different ethnic groups is a component of cultural competence in healthcare.

10) A 62-year-old former professional football player is in the hospital for a total knee replacement as a result of wear and tear and a medical diagnosis of osteoarthritis. Which biological theory of aging would help explain this patient's current health problem? 1. Cross-link 2. Free radical 3. Wear-and-tear 4. Somatic DNA damage

Answer: 3 Explanation: 1. The cross-link theory is related to the accumulation of cross-linked proteins causing disease. This theory does not explain the damage done to the patient's joint from playing football. 2. The free-radical theory states that cell damage is a result of accumulation of oxygen radicals. This theory does not explain the damage done to the patient's joint from playing football. 3. Osteoarthritis is characteristic of degeneration that results from joint usage. This disease is characteristic of the aspects of the wear-and-tear theory, which states that there is a "master clock" that controls all organs and cellular functions, which becomes less efficient over time. Abusing one organ or bodily system through repeated injury that occurs with contact sports may result in premature aging and diseases such as osteoarthritis. 4. The somatic DNA damage theory states that genetic mutations occur and accumulate with increasing age. This theory does not explain the damage done to the patient's joint from playing football.

8) A patient takes herbal and vitamin supplements in order to "slow down" the aging process. The nurse realizes that the patient believes in the use of antioxidants to slow down cell damage. Which is associated with the biological theory of aging? 1. Cross-link 2. Wear-and-tear 3. Free radical 4. Emerging biological

Answer: 3 Explanation: 1. The cross-link theory states that cross-linked proteins resulting from binding of glucose to proteins causes various problems associated with nutrition. 2. The wear-and-tear theory sees the human body as a machine and cellular function slows down with time. 3. The free-radical theory states that accumulated damage caused by oxygen radicals causes cells, and eventually organs, to lose function and organ reserve. The use of antioxidants and vitamins is believed to slow this damage. 4. The emerging biological theory states that there are specific genes responsible for human aging.

13) Which of the following actions, if observed by the charge nurse, would require the charge nurse to intervene? 1. The nurse looks over the physician's shoulder to see the results of an assigned client's labs. 2. The nurse requires a client to fill out a release of information form when the client requests a copy of his or her medical record. 3. The nurse asks another nurse to quickly look up the results of an x-ray of a client since the other nurse is already signed on the computer. 4. The nurse faxed reports of client tests to a machine that is in the office of the client's primary care physician, and a nurse is expecting the report.

Answer: 3 Explanation: 1. The nurse would not be violating confidentiality if the client and physician are both caring for the client. 2. Clients must sign a release form when they want copies of their medical records. 3. Nurses should never ask another nurse to look up client information if that nurse is not involved in the client's care. This would require the charge nurse to intervene. 4. Faxing client information via fax machine is legal as long as the information is kept private and an authorized person is there to receive the information.

4) The nurse is assessing an older client's health status. Which comments, made by the client, would indicate that the client's health beliefs are based on the perceived importance of taking action to promote health? Select all that apply. 1. "I should get a physical every year so I can stay healthy." 2. "I know that choosing to eat healthy or not will affect my health now and later on." 3. "I know if I go for walks on a regular basis, I am less likely to have a health problem." 4. "I understand if I continue to go to church and spend time with friends, I will feel less lonely." 5. "I understand if I stop drinking alcohol, I will decrease my chance of liver disease and other health issues."

Answer: 3, 4 Explanation: 1. This statement indicates the health belief based on the perceived control of health outcome. 2. This statement is based on the health belief of perceived internal control of action. 3. This statement indicates the client's health beliefs are based on the perceived importance of taking action. 4. This statement indicates the client's health beliefs are based on the perceived importance of taking action. 5. This statement indicates the client's health beliefs are based on the perceived reduction of threat from action.

9) Which of the following would violate client's rights according to the Patient's Bill of Rights? Select all that apply. 1. The client signed out and left the facility for the day to go to a casino. 2. The nurse showed the adult daughter of a client the notice posted about the ombudsman. 3. The nurse gave a prescribed prn sedative to a client who continuously yelled out, "Hello!". 4. The nurse refused to allow clients, who are husband and wife, to have private time with the door closed. 5. The nurse told the client, who is a practicing Jew, that the client had to participate in the facilities Christmas party.

Answer: 3, 4, 5 Explanation: 1. The right to leave the facility and gamble is in the Patient's Bill of Rights. As long as the client signs out, the client is allowed to leave and participate in legal activities. 2. The right to raise grievances and make complaints is in the Patient's Bill of Rights. Every client and family member should be shown where the information is posted about the ombudsmen. 3. The right to be free from chemical and physical restraints is in the Patient's Bill of Rights, and sedating a resident because they are making noise or calling out is not an appropriate use of restraints. 4. The right to privacy and marry is in the Patient's Bill of Rights and clients who are both residents and married have the right to sexual activity or just private time together with the door closed. 5. The right to practice religion is in the Patient's Bill of Rights, and the client should not be forced to participate in an activity that is not part of the client's religious beliefs.

3) The nurse is completing the minimal data set (MDS) for an older patient. What are characteristics of this assessment? Select all that apply. 1. Eliminates listing the patient's prescribed medications 2. Identifies health insurance coverage that is not Medicare or Medicaid 3. Provides a multidimensional view of the patient's functional capacities 4. Used primarily to determine the amount of funding the patient has for long-term care 5. Includes a core set of screening, clinical, and functional measures used in patient assessment

Answer: 3, 5 Explanation: 1. Medication information is needed since this may impact the patient's ability to function. 2. The MDS is a standardized assessment tool that forms the foundation for all residents of long-term care facilities certified to participate in Medicare or Medicaid. 3. The items in the MDS give a multidimensional view of the patient's functional capacities. 4. The MDS is used for validating the need for long-term care, reimbursement, ongoing assessment of clinical problems, and assessment of and need to alter the current plan of care. 5. The MDS includes categories that measure physical, psychological, and psychosocial functioning of the patient.

14) The gerontological nurse is identifying interventions based upon evidence-based practice. What is the best source of evidence-based practice information for the nurse? 1. Progress notes about methods that were previously effective for that client 2. The nurse's practice and experience with successful client interventions 3. The policy and procedures manual of the healthcare facility 4. A publicly available resource website information database

Answer: 4 Explanation: 1. Methods that were previously effective for a client may or may not be evidence-based practice interventions. 2. Interventions that are effective in the nurse's own experience may or may not be based upon evidence-based practice. 3. Policies and procedures may or may not be based upon evidence-based practice. The nurse finds the best resources and uses them to advocate for policy and procedure change where needed. 4. Sites such as the National Guideline Clearinghouse, supported by the Agency for Healthcare Research and Quality is an excellent place for nurses to obtain evidence-based practices to integrate into their practice. Interventions that support evidence-based practice are those that have been tested and have the best chance of establishing a cause-and-effect relationship between the intervention and the desired outcome of care.

12) After an assessment, the nurse determines that the diagnosis of constipation is appropriate for an older client recovering from surgery. What would be a goal for this nursing diagnosis? 1. Decrease the frequency of narcotic pain medication administration. 2. Explain the importance of hydration and activity in regard to constipation. 3. Drink at least 800 ml of non-caffeinated and nonalcoholic beverages each day. 4. Evacuate a formed bowel movement at least every 2 days with minimal distress.

Answer: 4 Explanation: 1. Pain control would be addressed under a separate nursing diagnosis, even though constipation may be improved by decreasing the pain medication, a better intervention is to administer laxatives or enemas if needed. 2. The importance of hydration and activity in regards to constipation is good for the client to understand and explain, but a postoperative client does not have complete control over intake and activity. This also does not help the client reach the goal of having a bowel movement. 3. Oral fluid is often limited after surgery. Additionally, 800 ml is an insufficient amount of daily fluid intake. 4. The goal should be linked to the nursing diagnosis—be measurable, realistic, and achievable—and include a time frame for attainment. The type and frequency of bowel movement is directly connected to the nursing diagnosis. This is an appropriate goal for the nursing diagnosis of constipation.

11) An older patient is refusing to receive the influenza and pneumococcal vaccinations because he believes he is "too old." How should the nurse respond to this patient? 1. "I understand your feelings." 2. "I will report your concerns to the physician." 3. "You are likely to get sick if you do not take the vaccines." 4. "It is never too late in life to begin health promotion activities."

Answer: 4 Explanation: 1. Telling the patient that the nurse understands the patient's feelings does not help the patient understand the importance of health promotion activities. 2. Reporting the concerns to the physician does not help the patient understand the importance of health promotion activities. 3. While the patient has an increased likelihood of developing an illness if the vaccines are not taken, stating this does little to meet the patient's voiced concerns. 4. Receiving vaccinations for communicable diseases is a form of health promotion. The patient should be advised that age should not restrict health-saving activities.

7) A hiring manager is hiring a certified gerontological nurse. Which candidate would be qualified for this position? 1. The nurse has a master's degree in nursing and has worked in a nursing home for 10 years. 2. The nurse has worked in administration at a geriatric psychiatric facility for 5 years. 3. The nurse has worked full time at least 2 years in gerontological nursing and is in a PhD program. 4. The nurse's clinical competence in gerontological nursing has been validated via testing.

Answer: 4 Explanation: 1. The nurse does not need to have a master's degree to be credentialed as a gerontological nurse. 2. Certified nurses can work in administration but also provide direct client care. Working in administration at a facility is not a prerequisite for certification. 3. In order to qualify to take the certification examination, the nurse must have practiced the clinical equivalent of 2 years full time or a minimum of 2,000 hours over the past 3 years. 4. Certification is a formal process by which clinical competence is validated in a specialty area of practice.

23) The nurse is planning care for a client admitted for surgery with the primary nursing diagnosis being knowledge deficit related to pre- and postoperative care. Which goal statement is the most appropriate for this diagnosis? 1. The client will be knowledgeable about the surgery being performed. 2. The client will be given the postoperative plan of care prior to surgery. 3. The client will be afebrile during the intraoperative and postoperative period. 4. The client will verbalize the purpose of preoperative medications prior to surgery.

Answer: 4 Explanation: 1. The statement "The client will be knowledgeable" is not measurable. The client must be able to verbalize the surgery during the consent process. 2. "The client will be given the postoperative plan of care prior to surgery" is a nursing goal, not a client-centered goal, and "plan of care" is not specific. Before surgery, the client must be able to demonstrate use of an incentive spirometer and know how to use a patient-controlled analgesia pump, if applicable. 3. The statement "The client will be afebrile during the postoperative period" does not address the problem of knowledge deficit. 4. The statement "The client will verbalize the purpose of preoperative medications prior to surgery" is specific to the nursing diagnosis, client focused, and measurable.

7) The family of an older male patient asks why the patient needs to be hospitalized for pneumonia when the youngest daughter had the same infection a few months ago and was treated at home. How should the nurse respond to the family? 1. "The patient has chronic illnesses that put him at risk." 2. "I don't think you can compare your grandfather to yourself." 3. "There are some differences between men and women and illness." 4. "Aging decreases the body's ability to restore balance to body systems with an infection."

Answer: 4 Explanation: 1. There is not enough information to determine if the patient has chronic illnesses. 2. This response does not address the issue that body systems return to balance slower after an illness as a part of aging. 3. This response does not address that the patient's age impacts the body's ability to fight an infection and return to homeostasis. 4. The loss of organ reserve that can occur with aging can lead to the concept of homeostenosis or inability of the body to restore homeostasis after even minor environmental challenges, such as trauma or infection. An older person may die from pneumonia, which may have only been a minor illness to a younger person

16) An older client is being discharged to live with adult children who need to work during the day. What referral information would be beneficial for the client and family members? 1. Transitional care unit 2. Retirement community 3. Skilled nursing facility 4. Community nursing care

Answer: 4 Explanation: 1. Transitional care is within an acute care hospital and provides subacute, rehabilitation, and palliative care services. This would not be appropriate for the client who is being discharged to a home environment. 2. A retirement community ranges in size and scope of services. The client would need to live there permanently and not live with family. This would not be appropriate for the client who is being discharged to live with adult children. 3. A skilled nursing facility is a place where clients are admitted for subacute or chronic care. This would not be appropriate for the client who is being discharged to a home environment. 4. Community nursing care, such as visiting nurses, is an option for many older clients requiring skilled care in the home. Visits can be made by nurses, home health aides, or homemakers.

3) While completing an admission assessment, the nurse learns that a female adult patient has smoked a pack of cigarettes daily for 20 years and works at a chemical plant. From this information, what is this patient most at risk for? 1. Decline in muscle mass 2. Nutritional deficiencies 3. Depression and social isolation 4. Occupational hazard shortening life expectancy

Answer: 4 Explanation: 1. While muscle mass does naturally decline in older adults, there is no indication that she is not physically active. 2. In older adults, adequate nutrition can be a concern, yet there is no indication that she is not adequately nourished. 3. In older adults, depression and social isolation are a risk, yet there is no indication that she is not socially active. 4. Exposure to occupational risk factors has been known to affect life expectancy in men and will have the same effect on women given similar circumstances.

2. The nurse schedules an interdisciplinary team meeting for an older person with new pressure injuries on the sacrum and left heel. Which team member should the nurse ensure is present before the meeting begins? A. Social worker B. Geriatric physician C. Physical therapist D. Dietician

B. Geriatric physician Rationale: Key members of the interdisciplinary team are the gerontological nurse, the social worker, and the geriatric physician. Other healthcare professionals can be included in the evaluation or consulted, depending on the needs and problems exhibited by the older person. Sometimes advanced-practice nurses, physical therapists, occupational therapists, clinical pharmacists, psychologists, psychiatrists, podiatrists, dentists, and other professionals are called in to consult and evaluate an older person with complex needs. For this person's new pressure injuries, the geriatric physician should be in attendance. The dietician might be consulted to ensure an adequate protein intake for wound healing, but this is not a priority at this time. There is no specific need for the social worker or physical therapist to be consulted at this time.

6. The nurse plans an educational wellness program for a group of older adults residing in the community. On which topic should the nurse focus the majority of the information? A. Benefits of treating depression with medications B. Managing heart failure symptoms C. Managing Alzheimer's Disease symptoms D. Benefits of remaining socially active

B. Managing heart failure symptoms Rationale: Five chronic diseases—heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes—cause more than two-thirds of all deaths each year. To help reduce the incidence of death from heart disease and stroke, and possible adverse effects from diabetes, the nurse should focus the majority of information on blood pressure control. Although socialization, cognitive activities, and socioeconomic support are useful topics for senior community members, the topic that has the greatest impact on wellness is blood pressure control.

2. The nurse visits the home of an older person recovering from an exacerbation of a chronic illness. Which observation indicates to the nurse that the person has dispelled the myth that older people cannot learn new things? A. Preparing a shopping list B. Researching medications on the internet C. Scheduling an ophthalmologic examination D. Planning to meet friends for lunch

B. Researching medications on the internet Rationale: One common myth about older people is being set in familiar ways and having the inability to learn new things. Researching medications on the internet dispels this myth. Preparing a shopping list demonstrates engagement in everyday-life activities. Meeting friends for lunch indicates interest in socialization. Scheduling a health appointment indicates interest in health-promotion activities.

8. An older person states that "it's just a matter of time" before a knee and hip replacement will be needed. Which theory of aging is this older person describing to the nurse? A. Programmed longevity B. Wear and tear C. Endocrine D. Immunological

B. Wear and tear Rationale: People who subscribe to the wear-and-tear theory believe that the human body is similar to a machine and parts wear out after years of use. In the endocrine theory, the biological clock acts through hormones to control the pace of aging. People who follow this theory would use various natural and synthetic hormones to slow the aging process. In the immunological theory, immune function slowly declines, which increases vulnerability to diseases, aging, and death. People who follow this theory follow a healthy diet and use preventive measures to support immune function. In the programmed-longevity theory, aging occurs because of gene changes. People who follow this theory are interested in genetic theories of aging.

9. An adult daughter says that the parent has been asked repeatedly to complete an advance directive; however, he has neglected to do so. What should the nurse do first to facilitate this person completing an advance directive? A. Determine if an attorney has been identified B. Ascertain the person's religious belief surrounding death and dying C. Assess the older adult's attitudes about advance directives D. Obtain a copy of the person's Last Will and Testament

C. Assess the older adult's attitudes about advance directives Rationale: There are a variety of reasons why an older person may not have an advance directive. The first thing, though, for the nurse to do is to determine if there are any physical reasons why the directive has not been completed. They may have poor eyesight, cognitive impairment, hearing disorder, or challenges with writing. An attorney does not need to be identified for the person to complete an advance directive. The Last Will and Testament is not required for completing an advance directive. Religious beliefs may be hindering the person's completion an advance directive and this could be assessed; however, it would not be assessed first. Physical reasons for not completing the advance directive should be assessed first.

4. During a regulatory-body survey it was determined that a skilled-nursing facility is short-staffed. Which data was used to make this clinical determination? A. Nursing assistive personnel helping residents with meal trays B. Residents transported to the recreation room every afternoon for a movie C. Delivery made of 50 indwelling urinary catheter devices to the care area D. Nursing staff turning and repositioning residents every 2 hours as needed

C. Delivery made of 50 indwelling urinary catheter devices to the care area Rationale: Lower nurse-staffing levels are associated with higher rates of urinary-catheter use. Having 50 urinary-collection devices delivered to the care area indicates that a large number of residents have an indwelling urinary catheter. This high number is associated with a facility with insufficient care providers. Helping residents with meals indicates a sufficient number of staff to ensure for the residents' nutritional needs. Transporting staff to the recreation room indicates an adequate number of staff to ensure residents participate in activities. Having enough staff to turn and reposition residents every 2 hours helps reduce pressure-injury rates.

8. The nurse notes that laboratory data for a person who is not a resident of the skilled facility was accidentally faxed to the care area. What should the nurse do with this information? A. Place it in biohazard trash B. File in the reusable paper pile C. Destroy it with a paper shredder D. Throw it in the trash

C. Destroy it with a paper shredder Rationale: Fax machines should be used only when it is understood that the authorized provider is the only receiver or that the authorized receiver will "stand by" a shared fax machine to receive confidential information. Sending the information to the wrong receiver constitutes a breech in confidentiality. Throwing the data in the trash, biohazard trash, or using it as recycled paper compounds the breech and should not be done. The data should the destroyed with a paper shredder.

9. An older person is seen sitting in a chair, staring out the window and crying. Which approach should the nurse use to comfort this person? A. Suggest watching television as a distraction B. Cheerfully ask the person "what's wrong?" C. Offer a tissue and hold the person's hand D. Leave the person alone to maintain privacy

C. Offer a tissue and hold the person's hand Rationale: If a person cries, the nurse should offer a tissue, hold their hand if appropriate, and wait a few minutes. Crying can be therapeutic and offers release from persistent feelings of sadness. Asking "what's wrong" in a cheerful tone does not take the person's behavior into consideration. Leaving the person alone may exacerbate the feelings of sadness. Watching television is not an appropriate approach to use for a person who is obviously distressed or sad.

3. The nurse prepares an educational program on healthy aging for a community group. Which segment of the population should the nurse explain as being the fastest growing in the United States? A. Middle-age B. Young-old C. Old-old D. Middle-old

C. Old-old Rationale: The old-old (ages 85+) are the fastest growing segment of the population, growing at twice the rate of those ages 65 and over and four times faster than the total U.S. population. This group will triple from the current 5.7 million to over 19 million by 2060. During the next 13 years, the young-old (ages 65-74), 74 million baby boomers will retire. During the next decade, increased life expectancy will add to the number of middle-old (ages 75-84) baby boomers. Middle-age individuals are not identified as being the fastest growing population segment in the United States.

5. The nurse notes that an older person has difficulty removing clothes in preparation for a physical assessment. On which area should the nurse focus when determining this person's ability to perform activities of daily living? A. Housekeeping B. Laundry C. Walking D. Bathing

D. Bathing Rationale: Categories when determining competence in performing activities of daily living include bathing, dressing, toileting, transferring, continence, and feeding. Since the nurse observed the person's difficulty with dressing, additional assessment would focus on the other categories. Laundry and housekeeping are criteria within functional activities of daily living. There is no evidence to suggest that the person has difficulty walking.

8. The nurse plans care for an older patient recovering from an exacerbation of a chronic illness. Which intervention best supports this person's autonomy? A. Encourage to perform active range of motion twice a day B. Assess for pain level every 4 hours C. Ambulate down the hall to have meals in the dining room with other clients D. Coordinate time of day to provide hygienic care with the client

D. Coordinate time of day to provide hygienic care with the client Rationale: The ethical principle of autonomy is to respect people's needs for self-determination, freedom, and rights. Coordinating the time of day to provide hygienic care with the person supports the principle of autonomy. Assessing for pain, encouraging range of motion, and ambulation supports the ethical principles of beneficence and nonmaleficence.

6. The nurse notes that an older person has a blood pressure of 150/90 mm Hg. Which health screening should the nurse recommend? A. Arthritis B. Depression C. Cognitive function D. Diabetes

D. Diabetes Rationale: Diabetes screening is recommended every 3 years in people with a blood pressure greater than 135/80 mm Hg. The blood pressure is not used to identify health screenings for arthritis, depression, or cognitive functioning.

5. The nurse reviews information collected after completing a comprehensive assessment with an older person. For which reason should the nurse recommend lipid disorder screening? A. Over the age of 65 B. Body mass index 28.5 C. Blood pressure 140/90 mm Hg D. Diagnosed with peripheral-artery disease

D. Diagnosed with peripheral-artery disease Rationale: Lipid-disorder screening is recommended every five years or more often in older people with peripheral-artery disease. Bone-mineral density, herpes zoster immunization, pneumonia immunization, tetanus booster, abdominal aortic aneurysm screening, sigmoidoscopy/colonoscopy, and mammography/clinical breast exam are recommended screenings for persons over the age of 65. Height and weight are measured annually to address obesity. Diabetes screening should be recommended every 3 years in people with a blood pressure greater than 135/80 mm Hg.

The nurse learns that an older person takes several vitamin and nutritional supplements every day. Which theory of aging is supported by this older person's behavior? A. Somatic DNA damage B. Wear-and-tea C. Cross-link D. Free radical

D. Free radical Rationale: In the free-radical theory, it is believed that accumulated damage caused by oxygen radicals causes cells, and eventually organs, to lose function and organ reserve. The use of antioxidants and vitamins is believed to slow this damage. In the cross-link theory, it is believed that an accumulation of cross-linked proteins from the binding of glucose to protein causes health problems, such as cataracts, wrinkles, and skin aging. In the wear-and-tear theory, it is believed that parts of cells and organs wear out after years of use. In the somatic DNA theory, it is believed that genetic mutations occur and accumulate with increasing age, which causes cells to deteriorate and malfunction.