Gerontology C92 93 96

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A 65-year-old man with a 45-year history of smoking complains of a change in his cough pattern, a nonproductive cough, and an ache in his chest. The man's chest x-ray reveals an infiltrate. The gerontological nurse suspects: 1. a lung tumor. 2. chronic obstructive pulmonary disease. 3. pulmonary edema. 4. tuberculosis.

A 72-year-old man with asthma, chronic obstructive pulmonary disease, and chronic anxiety is admitted to a nursing home. Care plan objectives for this man include: 1. adherence to his medication regimen, inhalation therapy, and instruction about methods of conserving energy. 2. an exercise program to increase the vital capacity of his lungs. 3. instruction in respiratory exercises with emphasis on forced inhalation. 4. oxygen therapy at 3 L/min as needed and deep-breathing exercises for relaxation.

Which is an accurate statement about Medicare? 1. Medicare is a health insurance program with carefully described benefits that may restrict the length of hospital stays. 2. Medicare patients can expect to receive routine household and attendant care under Part A of their Medicare insurance. 3. Medicare pays for the majority of nursing home care for persons who are 65 years of age or older. 4. Persons covered by Medicare must pay once-in-a-lifetime deductibles on both the physician and hospital portions of the program.

Which symptom in older adults is most indicative of a urinary tract infection? 1. Confusion 2. Dysuria 3. Fever 4. Frequency

A nurse is caring for a client admitted to a subacute-care facility. For how long does a client generally undergo treatment in a subacute-care facility? Select one: A. 1-4 years B. 1-4 months C. 1-4 weeks D. 1-4 daysterm-51

1-4 weeks The client generally undergoes treatment in a subacute-care facility for 1 to 4 weeks. A client may be classified as "subacute" for 20 days under Medicare, after which the status is reevaluated. hospital, only 1 to 4 days;

A 78-year-old male resident at a long-term care facility, who is a former business executive, has been smoking and extinguishing cigarettes in a paper cup in areas where smoking is prohibited. He has been informed repeatedly of the designated smoking areas. The resident's behavior indicates an attempt to: 1. express self-transcendence. 2. maintain autonomy by exercising control. 3. maintain his previous professional role. 4. react against the facility's ageism.

A gerontological nurse is creating a staff development program for a unit. To assess the staff's learning needs, the nurse's best approach is to ask staff members: 1. "How do you want to learn new material?" 2. "What do you need to know to do your job better?" 3. "What do you think others need to learn?" 4. "What do you think others want you to learn?"

A gerontological nurse is teaching dressing techniques to a patient with right hemiplegia and a severe speech impairment. An appropriate first step in the nurse's teaching would be to: 1. ask the patient to put on a shirt. 2. demonstrate the proper way to put on a shirt. 3. explain the difficulties in putting on a shirt. 4. give verbal instructions on dressing procedures.

A patient with Stage 2 Alzheimer disease visits the mental health clinic. During the interview, the patient becomes hostile and refuses to answer further questions. The gerontological nurse's best action is to: 1. ask if the questions upset the patient in any way. 2. discontinue the interview. 3. explain that the information is needed to plan the patient's care. 4. ignore the patient's reaction and proceed.

A stage III pressure ulcer is characterized by: 1. blisters, abrasions, or shallow craters. 2. deep craters with or without undermining and full-thickness skin loss involving subcutaneous tissue. 3. full-thickness skin loss with tissue necrosis or damage to muscle or bone. 4. partial-thickness skin loss involving the dermis or epidermis.

An 83-year-old female patient underwent a total hip replacement three days ago. She should not cross her legs because: 1. abduction of the hip can cause dislocation of the prosthesis. 2. adduction of the hip can cause dislocation of the prosthesis. 3. blood clots often result from pressure on arteries in the legs. 4. contracture can be prevented by avoiding acute flexion of the hip.

For an individual with age-related hearing loss, which sound is most difficult to hear: a) A recording of a march played softly b) A young child talking in a cafeteria line c) Hammering during construction of a house next door d) The voice of a man speaking in an elevator

In preparing a presentation for older adults, a gerontological nurse keeps in mind that: 1. older adults are unlikely to participate in educational programs due to lack of interest. 2. older adult learners are heterogeneous due to diverse educational experiences and learning strategies. 3. the ability to acquire knowledge from a verbal presentation decreases with age more than the ability to acquire knowledge through reasoning. 4. the age-related decline in intellectual performance creates obstacles for acquiring new information.

Older adults who take the herbal supplement cascara sagrada are monitored for the presence of: 1. fever. 2. hypokalemia. 3. jaundice. 4. vertigo.

Persons who are taking anticholinergic drugs are at high risk for: 1. cardiac arrhythmias. 2. dry mouth. 3. orthostatic hypotension. 4. slurred speech.

The main reason that older adults with a chronic illness tolerate functional impairments is that they: 1. are afraid to seek medical advice for fear of what they may find. 2. associate their symptoms with aging rather than an illness. 3. believe in home remedies and parental traditions. 4. relate their symptoms to conditions that resolved in the past without treatment.

The most appropriate environment for a person with chronic dementia is one that: 1. changes often to decrease boredom. 2. contains familiar objects. 3. is limited in color and sound. 4. is stimulating so as to challenge thought.

When relocating from a family home to a continuing care community, the most crucial factor in an older person's adjustment is his or her: 1. level of economic independence. 2. perceived control of the move. 3. physical proximity to remaining family. 4. risk-taking ability.

Which assessment tool measures economic resources, mental health, and activities of daily living? 1. Lawton's Physical Self-Maintenance Scale 2. Older Americans Resources and Services Assessment 3. Problem Oriented Medical Record 4. Short Portable Mental Status Questionnaire

Which profession first developed standards of gerontological care and provided a certification mechanism to ensure expertise? 1. Medicine 2. Nursing 3. Physical therapy 4. Social work

Which symptom is exhibited first by an older adult with a urinary tract infection? 1. Anorexia 2. Confusion 3. Fever 4. Restlessness

Which type of fracture has the highest morbidity and mortality in the older adult? 1. Ankle 2. Hip 3. Shoulder 4. Vertebral

maybe you heard a vacuum cleaner." 4. "You live here at the nursing home now, not on the farm."

A nursing home conducts a survey to evaluate nursing care. However, some residents did not express their concerns due to fear of reprisal by the staff. Which aspect of the evaluation is most affected? 1. Generalizability 2. Reliability 3. Statistical significance 4. Validity

The nurse is examining a 76-year-old female with the complaints of fatigue, ankle swelling, and mild shortness of breath over a three-week period. An appropriate nursing diagnosis might include: a. Decreased cardiac output related to altered contractility and elsticity of cardiac muscle b. Activity tolerances due to compensation of oxygen supply c. Increased cardiac output related to an aging heart muscle d. Decreased urinary output due to poor kidney perfusion

The purpose of the Patient Self-Determination Act is: a. To encourage patient to document their choices about life support and advance directives b. To hel polder adults organize their finances c. To help older adults plan for jobs after the age of 65 d. To assist older adults in naming benefactors

To decrease complications of hypercalcemia caused by prolonged immobilization, the most appropriate nursing intervention is to: a) encourage a high fluid intake unless contraindicated b) monitor renal function c) monitor serum calcium and phosphorus levels d) observe the patient for signs of muscle twitching

Veritgo in the older adult is best described as: a. A vestibular disorder producing a rotational sensation b. A dysfunction of sensory signals c. A transient loss of consciousness d. A light-headed feeling

What is one important consideration when dealing with the older population when considering safety and medications? a. The older adult is at risk for falls, leading to an increase in morbidity and death b. A fractured arm is the highest risk for the older adult c. Depression is common in older adults and needs not be treated with medication d. Most older adults are not as fragile as was previously thought

Which age-related psychological change is not the norm? a. An increased ability to multi-task b. Lower scores on tests of creativity c. Thinking of death as a process rather than a moment in time d. Life satisfaction is related to well-being

Which best describes what guides the appropriate nursing care of an aging adult? a. Evidence-based practice developed with ongoing research into the needs and outcomes of older adults b. General nursing care previously practices c. Facility policies and procedures d. Physician orders for patient complaints

Which choice would not be a nursing goal when managing chronic obstructive pulmonary disorder (COPD) in an older adult patient? a. Decreasing exercise b. Preventing and treating complications c. Reducing mortality risks d. Relieving symptoms

Which statement demonstrates normal cognitive function for an aging adult? a) Occasional memory lapses b) Unable to recall the names of their children or siblings c) Unable to recall current address or phone number d) Unable to count to 10 or repeat a series of consecutive numbers

Which statement is true regarding adverse drug reactions (ADRs) in older adults? a) The rate of ADRs in geriatric clients is seven times that of younger adults and poses serious health problems b) Older adults rarely have adverse reactions to prescribed medications becuase they are monitored c) Adverse reactions are minimal in older adults and require no intervention d) Only about 1% of older adults require hospitalization for ADRs

Which statement reflects the state of drug absorption in the geriatric patient? a) The rate of absorption is slowed b) The rate of absorption is faster due to thinning of the mucosa c) The percentage of the medication that is absorbed is decreased d) There is a decrease in gastric pH as we age

Which symptom is the most common with peripheral artery disease (PAD)? a. Intermittent claudication b. Warm extremities c. Pain unrelieved by rest d. Bounding pulses

Which theories on aging were introduced in the early 1900s? a) Wear-and-tear theory and autointoxication theory b) Evolution theory c) Molecular theory d) Cellular theory

Which statement best describes the nurse's understanding of normal expected sexual resonses in aging female clients? a. No changes in sexual responses are noted with aging females b. Aging females experience a quicker arousal phase c. An aging female will most often experience a delayed arousal phase during intercourse d. An increas in vaginal secretions may be noted in the aging female

Which statement best describes the procedure for assessing for the presence of Helicobacter pylori in the older adult patient? a. Colonoscopy b. Prescribing two weeks' worth of antibiotics, and then performing a colonoscopy c. Gastric biopsy, serum blood antibody studies, or stool assay exam d. Fecal occult blood exams

Which statement would be most appropriate to ask when assessing an aging adult for cognitive function? a) What is today's date? b) Can you count to 10 for me? c) Have you noticed anything different about your memory or thinking in the past few months? d) Who is the president of the United States?

Quality improvement (QI) refers to: a. Acute care and inpatient facilities only b. Attention to safety and appropriate care for all c. It has not importance to gerontological nursing d. High-risk older adults only

The Framingham Heart Study examined the effect of blood pressure,cholesterol levels, smoking, exercise, and other variables on the development of coronary artery disease in a cohort of healthy men and women. The subjects were studied at specific intervals over a period of years. The Framingham study is an example of which type of research study? a) Cross-sectional b) Longitudinal c) Predictive d) Retrospective

The cosmetic side of aging poses which effect on many older adults? a. The physical effect of sagging cheeks b. Psychological, affecting self-esteem and causing depression c. No notable effect d. No effect because older adults are mature enough to understand the aging process

The gerontological nurse may prescribe corticosteroids for all but which one of these conditions? a. Arthritis b. Hyperglycemia c. Allergic reactions d. Inflammatory states

The nurse assessing the older population needs to have a basic understanding of which of the following? a) The economic status of the area b) The difference between normal and abnormal for the older age group c) The signs of sexual dysfunction d) The signs of cardiac disease

The nurse caring for the elderly population understands that movement slows with aging. This is most likely due to: a. Cognitive function b. Changes in musculoskeletal and nervous systems c. Laziness and a feeling that life is over d. A recent change in medical condition

The nurse recognizes that cumulative changes in the skin of the elderly are related to environmental factors are termed? a. Sunburned b. Photoaging c. No term exists to describe this d. Mole or blemish

The nurse recognizes the most common eye-related disease affecting the older adult is: a. glaucoma b. cataracts c. near-sighted visual disturbances d. far-sighted visual disturbances

The program designed to supplement Social Security for thsoe who do not qualify for Social Securiety or who are disabled is: a. OAA b. SSI c. Medicare d. Medicaid

What benefit does evidnce-based practice offer clients over the age of 60? a) No actual benefits have been noted when evidence-based practice is the model for geriatric care b) Evidence-based practice offers the client improved health care in all settings c) Evidence-based pracrice is only used as a model in acute care settings d) Minimal changes in geriatric care have arisen from the use of evidnece-baseed practice models

What is the single most cost-effective discovery made in the past 30 years that has influenced the prevention and treatment of cardiovascular events? a. The development of oral hypoglycemic drugs b. Recognizing the need to lower blood pressure in older adults c. Antismoking campaigns d. Zero tolerance for drug and alcohol abuse in older adults

When assessing an aging client's genitourinary system, the gerontological nurse recognizes the importance of screening for: a. Drug addiction b. Bladder malignancy c. Diabetes d. Cognitive abilities

When encouraging adult learners to use the concept of critical reflection, the gerontological clinical specialist: a) emphasizied the "how" and "how to" instead of the "why" b) encourages and engages learners in problem formation and problem-solving activities c) explains the definition of the issue or problem under discussion so the definition is understood by all d) focuses on the present and minimizes discussion regarding learners' past experiences

Which disease or ailment is often under diagnosed and undertreated in the aging population? a) Schizpphrenia b) Depression c) Associative disorders d) Attention deficit disorder

Which of the following statements defines who is appropriate for gerontological nursing care as stated by Orem (1991)? a) Orem (1991) refers to advanced epdistric nursing care b) Any aged client whose self-care demands exceed their ability to meet those demands is appropriate c) Orem (1991) refers to young adult nursing care in preparation for a healthyolder adult life stage d) Any client who needs nursing care for whatever reason at any age is appropriate

Which substance(s) show changes through aging by becoming less pliable and stiffer? a) Lipofuscin b) Collagen and elastin c) Epithelial tissue d) Cytoplasm

The nurse evaluates a 70-year-old remale who has been recording her blood pressures for the last few days. These pressures were 140/90, 146/90, 146/92, 138/88, and 150/89. The nurse recognizes this as the beginning of which stage of hypertension? a. Stage 2 b. High normal blood pressures c. Stage 1 d. Stafe 3

The nurse is doing a follow-up clinic visit for a 75-year-old female post-cerrebrovascular accident (CVA) of two months. The nurse should be prepared to discuss all of these possible complications except: a. Neurogenic bladder b. Depression c. Financial concerns d. Fecal incontinence

The nurse may recommend which of the following for the older client with mild arthritis? a. Complete bedrest b. Rest and ice for the joints affected c. A mild exercise program including walking d. No exercise will improve arthritis

The nurse recognizes that involuntary movements may appear in the elderly patient and be normal. These normal involuntary movements may present as which of the following? a. Seizures b. Tongue protrusions c. Resting tremors d. Eye twitches and spasms

What is the most significant change in vital organs in the aging client? a) No change in organ tissue is noted b) The outer appearance of an organ changes, but the functional component does not change c) Organs show signs of decrease in function during the aging process d) The aging process speeds up the functional capacity of major organs

What is the purpose of Rogers' diffusion of innovation model in relation to evidnece-based practice (EBP)? a) There is no relation to EBP b) It offers an explanation of aging c) It is used to open communication around issues of implementing changes in practice when EBP research has shown that change would improve outcomes d) It is the model that contradicts the EBP theory

When caring for an older adult with pneumonia, the nurse recognizes all of the following are appropriate interventions except: a. Monitoring rate, rhythm, depth, and effort of respirations b. Auscultating breath sounds c. Monitoring blood sugars and reports BS higher than 145 d. Monitoring for increased restlessness or anxiety indicating air hunger

Which factor is NOT a normal part of aging and needs to be addressed to promote nutrition in the older adult client? a) Loss of teeth b) Increase in gastric pH c) Xerostoma or dry mouth d) Decline in basal metabolic rate

Which group of older adults has the highest risk for suicide? a) African-American men b) African-American women c) White men d) White women

Which item would not be a focus of a cognitive-perceptual pattern assessment for the older client? a) Cognition--Have you experienced any changes in your memory? b) Communication--Have you had any difficulty speaking or forming ideas? c) FInancial--Have you had any financial hardships over the past several months? d) Orientation--Do you know what day, month, and year it is?

The nurse is caring for elderly clients in a subacute nursing care facility and institutes nursing measures to keep them safe. Which of the following is the leading cause of disability and death in nursing homes? Select one: A. Poisoning B. Fires C. Falls D. Suffocation

Falls Accidents, particularly falls, increase significantly with age and are a leading cause of disability and death after age 65. In addition to falls, the greatest dangers are fire, suffocation, and poisoning.

A nurse is caring for a client with Alzheimer's disease (AD). What finding should the nurse assess for during the mid-stage level of AD? Select one: A. Failing to recognize people B. Forgetting the car keys C. Forgetting familiar words D. Forgetting the phone number

Forgetting the phone number The nurse should assess the client for major gaps in memory, such as difficulty recollecting the client's phone number during the mid-stage level of AD. Concentration, orientation, judgment, and planning abilities are severely affected during the mid-stage of AD. Disregarding or failing to recognize people, forgetting familiar words, and forgetting the car keys are seen during the early stage of AD

The nurse is placing a restraint on an elderly male client who is on bed rest and attempts to get out of bed to go to the bathroom. Which of the following is a guideline when using restraints? Select one: A. Restraints should be used when nursing staff is inadequate to keep clients safe. B. For a client on bed rest, physical restraints are the recommended option. C. Generally, a physician's order is required to apply restraints. D. Use side rails instead of restraints, as appropriate.

Generally, a physician's order is required to apply restraints.

The nurse is performing risk assessment for depression on elderly clients in a long-term healthcare facility. Which of the following is a nursing consideration when assessing the mental health of an older adult? Select one: A. Older adults are more in control when losses occur than are younger adults. B. Clinical depression is often overdiagnosed in older adults C. Many older adults are reluctant to admit that they are depressed. D. Depression is a normal part of aging.

Many older adults are reluctant to admit that they are depressed

The nurse is caring for a client who is recovering from severe burns over two-thirds of his body. The client is stable, but needs specialized wound care. In which of the following facilities would this client most likely be placed? Select one: A. Subacute-care facility B. Long-term care facility C. Medically complex care unit D. Short-term rehabilitation unit

Medically complex care unit A specialized step in the continuum of care is the medically complex nursing unit. This unit cares for clients who require more specialized, high-tech care than is provided in traditional skilled nursing facilities, while still not requiring hospitalization or care in subacute units. The medically complex unit is often a section in the SNF; nursing procedures here include IV therapy, specialized wound care, and some daily nursing care.

The nurse is teaching the family of a client a process that parallels the nursing process to use to make decisions for their loved one. What would be the second step in this process? Select one: A. Restate and clarify the family's perceptions and feelings. B. Assist the family to create solutions for the problems presented. C. Realize the ambiguity of the situation that the adult is now like a child. D. Verify the family's feelings and perceptions to be sure they understand the situation.

Verify the family's feelings and perceptions to be sure they understand the situation.

1) The new LV/LPN is searching for employment options in the extended-care facility (ECF). Which type of facility should the nurse research? Select all that apply. a. Subacute care b. Medically complex care facility c. Hospital emergency department d. Short-term rehabilitation unit e. Skilled nursing facility

a, b, d, e Explanation: Extended-care facilities (ECFs) "extend" or continue care started in the acute care facility. Facilities that are considered ECFs include subacute care or transitional facilities, medically complex care facilities, short-term rehabilitation units; Long-term care (LTC) facilities or skilled nursing facilities (SNF) ("nursing homes"). Hospital Emergency Departments are not considered ECFs.

a nurse is caring for a client with Wernicke Korsakoff syndrome. The nurse might find it difficult to care for the client for which reason? a language problems b impaired long term memory c belligerent behavior patterns d perceptual problem

c RATIONALE: The nurse should be aware that the characteristic belligerent behavior patterns of clients with Wernicke-Korsakoff syndrome make them difficult to care for. These clients may not have language or perceptual problems as are common in AD. Short-term, not long-term, memory is most impaired in clients with Wernicke- Korsakoff syndrome.

a nurse is caring for a client with dementia who is agitatted and refuses to take directions. What measures should the nurse employ to this client? a touch the client gently when talking b try to reason with the client c try to talk with a pleasant tone d go away briefly and com back later

d RATIONALE: When a client balks or refuses to do things, the nurse should go away briefly and come back later with a pleasant tone of voice. This allows the client to calm down. The nurse should avoid touching the agitated client, because any physical contact can be perceived as a threat. Trying to reason with the client may aggravate the aggressive responses. Trying to calm the client with a pleasant tone may not be of any help at the moment.

A nurse is caring for an older adult who is obese. What health risk should the nurse point out as associated with obesity? a hypotension b diabetes insipidus c TB d Myocardial infarction

d RATIONALE: The nurse should educate the client that obesity is associated with a higher risk of myocardial infarction. Other health hazards associated with obesity include hypertension (not hypotension) and diabetes mellitus (not diabetes insipidus). Tuberculosis is an infectious disease and is not associated with increased body weight. It is seen more commonly in clients with a low body weight

The nurse should assist the client's caregivers in the following areas: • Identifying problems and realizing the ambiguity of the situation • Verifying their feelings and perceptions to make sure they correctly understand the situation • Restating and clarifying their perceptions and feelings to clarify how they are feeling

• Assisting the family to create solutions for the problems presented • Testing the solutions • Evaluating by determining whether goals have been met and revising the care plan

The nurse should take the following measures when communicating with a client with dementia: • Identify yourself and do not make the client guess who you are. • Inform the client what you are going to do in simple language. • Approach the client from the front and maintain direct eye contact. • Use a low-pitched voice and speak slowly. • Eliminate background noise. • Use short, simple sentences and give one-step commands

• Avoid using questions. • Label the environment, if the client can read. • Give the client "reassurance cards." • Be aware of nonverbal language; smile and nod your head; use gestures. • Avoid restraining the client.

The nurse should employ the following measures to maintain the client's nutrition and hydration : • Offer small amounts of fluid at each interaction with the client. • Avoid giving plain water every time. • Vary choices by providing gelatin, ices, juices, herbal teas, and soups.

• Avoid very hot liquids. • Limit the variety of foods, to prevent confusion. • Cut meats to appropriate sizes to prevent choking. • Place the client near people he should mimic. • Place the spoon in the client's hand, if he is able to feed himself. • Give finge

The nurse should provide the following information regarding respite care: • Respite care allows caregivers some time to themselves by having others care for clients on a short-term basis. • Many long-term care facilities arrange shortterm stays to provide respite.

• Community alternatives exist, including senior volunteers, home health services, and adult daycare. • Adult daycare programs afford caregivers a break for a portion of the day so that they can work or fulfill other responsibilities

. The following measures should be employed during bladder and bowel management in a client with dementia: • Encourage regular toileting to avoid daytime incontinence episodes. • Label the bathroom, give one-step instructions, and make each step simple.

• Educate the family regarding the use of continence products at home. • Document bowel movements and be alert for constipation or impaction . • Check for lactose intolerance, constipation, or drug reactions if a client develops diarrhea. • Provide a bowel and bladder program for the client.

The brain cell changes that occur in AD include the following: • Neurofibrillary tangles: delicate abnormal fibers or threads of proteins arranged in filaments • Senile (neuritic) plaques: round or ovoid clusters of destroyed synapses, entrenched in a central amyloid core

• Granulovacuolar degeneration: the inside of the brain cell is crowded with fluid-filled vacuoles and granular material

The nurse should employ the following measures to protect the safety of a client with AD: • The client should be allowed to live in separate units that are locked and alarmed. • The elevators in the units should be kept locked. • A picture of the client should be placed on the client's chart for identification issues.

• The client should be provided with a special Wanderguard or Ambularm device, which warns nursing staff if he tries to leave the unit without permission. • A buzzer should be located under the mattress to warn the staff if an unsteady client attempts to get out of bed.

The nurse should employ the following measures when handling an aggressive client: • Use a calm approach. • Avoid confronting or trying to reason with the client. • Remove the client from the group to avoid upsetting others.

• Validate the client's feelings. • Reassure the client. • Allow the client time to calm down by leaving the client alone temporarily when the client strikes out. • Identify factors that cause outbursts and plan to avoid or minimize them.

Which condition might be indicated by an increase in hemoglobin values? 1. Dehydration 2. Infection 3. Malnutrition 4. Opiate use

The major portion of the dermis consists of what substance? a. Sebaceous glands b. Hair follicles c. Collagen d. Blood vessels and nerves

The primary risk factor for the development of pressure ulcers in older adult patients is: 1. immobility. 2. impaired circulation. 3. incontinence. 4. malnutrition.

The most common cause of death from skin cancer in the elderly is: a. Basal cell carcinoma b. Squamous cell carcinoma c. Malignant melanoma d. Actinic keratosis

Unusual symptoms of pneumonia often found in long-term care residents include: 1. anorexia and new behavioral problems. 2. headache and difficulty breathing. 3. muscle aches and fever. 4. nonproductive cough and chest pain.

The progression of intermittent claudication is measured by the: 1. distance walked before leg pain starts. 2. pedal edema after dangling the legs for 20 minutes. 3. peripheral pulses in the affected leg. 4. skin temperature and color of the feet.

A 73-year-old patient is admitted to a rehabilitation facility after sustaining a mild stroke. After three nights in the facility, the patient begins to sleep only four to five hours a night and to awaken frequently during the night. The patient then complains of not feeling rested and begins to nap during the day. Which is the most appropriate nursing action? 1. Completing an assessment of the patient's sleep-wake cycle to determine necessary interventions 2. Doing nothing since this type of sleep pattern is associated with normal aging 3. Inquiring if the patient takes a medication at bedtime and requesting that the physician order it 4. Moving the patient further away from the nurse's station to minimize disturbances

A 78-year-old patient calls a telephone triage nurse and reports several falls after taking over-the-counter medication for a recent cold. Which medication contributed to the falls? 1. Diphenhydramine (Benadryl) 2. Ferrous sulfate 3. Guaifenesin (Robitussin) 4. Loratadine (Claritin)

A 92-year old patient, who recently underwent a below-the-knee leg amputation, is resisting attempts at rehabilitation. The most likely reason for the resistance is that the patient: 1. has goals that differ from the rehabilitation care plan. 2. has too many disabilities to realistically plan for rehabilitation. 3. is too old to undergo rehabilitation. 4. requires a psychiatrist's assistance to deal with the loss.

A common side effect of angiotensin-converting enzyme inhibitors that frequently results in discontinuation of therapy is: 1. a dry, persistent cough. 2. exacerbation of heart failure. 3. sedation. 4. urinary incontinence.

A factor that contributes to hypothermia in older adults is: 1. decreased activity. 2. decreased vulnerability to cold. 3. increased perception of cold. 4. increased subcutaneous fat.

A gerontological charge nurse delegates the administration of a nasogastric tube feeding to a licensed practical nurse (LPN). Which statement about this situation is most accurate? 1. The charge nurse is responsible for delegated care. 2. The charge nurse should implement the care and not delegate the task. 3. The LPN is accountable for his or her own actions. 4. The LPN should respectfully refuse to initiate this care.

A gerontological nurse in a daycare program for older adults observes that the participants have long toenails, corns, calluses, and other problems indicating a need for better foot care. What is the nurse's best action? 1. Developing an educational program on foot health and arranging for podiatry services at the site 2. Establishing a regular foot care plan whereby the participants' toenails would be cut and corns and calluses shaved 3. Instructing competent family members in the proper methods of cutting toenails and using commercial foot care products. 4. Recommending that the participants soak their feet for 10 minutes before cutting their toenails using safe toenail clippers

An 80-year-old patient is in the terminal stage of Alzheimer disease. The treatment team meets with the patient's who are angry and complain about a recent incident in which their parent's dentures were misplaced. The team members realize that: 1. anger at staff is a symptom of grief and needs to be addressed. 2. anxiety about the meeting may have interfered with the children's affect. 3. material items are the focus for the children at this time. 4. the focus of control should shift to the parent.

An accrediting body evaluates a nursing home by monitoring the number of residents who developed pressure ulcers and urinary tract infections. What type of audit is being conducted? 1. Outcomes 2. Process 3. Prospective 4. Structure

Heat stroke is a serious form of hyperthermia that is characterized by: 1. absence of sweating. 2. decrease in body temperature. 3. increase in sweating. 4. nausea and vomiting.

In teaching an older adult client, the gerontological nurse's most appropriate initial strategy is to: 1. assess the client and individualize the teaching methods. 2. set a slow learning pace and begin teaching simple concepts. 3. teach slowly and use repetition. 4. use demonstration and provide ample opportunity for practice.

Members of a family are caring for their father at home. Which statement by a family member indicates a need for teaching and caregiver instruction? 1. "Dad has gotten lazy about his bathroom habits. He blames his arthritis medication for his toileting accidents." 2. "Dad's room is close to the bathroom and we keep a light on for him at night." 3. "It's inconvenient, but we stop other activities to remind Dad to go to the bathroom on a regular schedule." 4. "We try to avoid coffee and tea at night, but Dad really likes a cup of coffee for breakfast."

The adult children of an aging couple ask a gerontological nurse about alternative therapies or nontraditional services to improve their parents' health. The nurse's most appropriate response is to: 1. discuss the benefits, risks, and limitations of various therapies. 2. distinguish between folk and traditional medicine. 3. give a firm warning about alternative therapies. 4. recommend a reputable holistic health therapist.

The gerontological nurses in a teaching nursing home are informed of a research project to obtain voiding cystometrograms on all residents. The gerontological nurses' responsibility is to ensure that the: 1. non-English speaking residents receive a complete explanation of the study in their native languages. 2. nursing home administration know that the nurses do not support such invasive studies on the residents. 3. research team is well staffed so that the nursing home staff can provide care as usual. 4. residents will be properly medicated in the examining room where the tests will be conducted.

The holiday season is approaching and a woman is admitted to a psychiatric unit. She reports that her husband of 45 years passed away four weeks ago. She frequently cries, eats poorly, periodically complains of back and stomach aches, and has begun isolating herself. What type of grief is this woman exhibiting? 1. Acute 2. Anticipatory 3. Disenfranchising 4. Dysfunctional

The most common cause of chronic pain in older adults is: 1. arthritis. 2. fractures. 3. headaches. 4. neuropathy.

The primary function of an ombudsman is to: 1. act as a clearinghouse for complaints and problems. 2. initiate complaints about the facility's operations. 3. question the facility administrator and the director of nursing. 4. welcome and interview patients and their families.

a client with a chronic illness is provided extended care in his own home. What role does a home care assistant play in providng care for this client? a draws blood for tests b helps in bathing and laundry c sets up client's medications d assists with finances

1. Answer: b RATIONALE: Home care assistants may assist clients with activities of daily living, such as bathing and laundry. They may check the client's food/fluid intake, run errands, or just provide companionship. Home care nurses, not home care assistants, assist in drawing blood for tests and set up medications. The client's advocate or a family member, not the home care assistant, assists the client in dealing with finances

A 76-year-old patient with osteoarthritis complains of pain, stiffness, and deformities of the fingers. The gerontological nurse recommends: 1. cold packs. 2. exercise. 3. meditation therapy. 4. vitamin therapy.

Which signs are characteristic of deep vein thrombosis? 1. A cool, non-tender limb 2. Limb numbness with diaphoresis 3. Rapid onset of unilateral leg swelling with dependent edema 4. Vertigo with an abrupt onset of blurred vision

A 63-year-old patient is returning home after being hospitalized for injuries received during a robbery and home invasion. Although neighborhood robberies are rampant, the patient has lived in the same house for 50 years and does not want to move. The patient receives a monthly social security check. The gerontological nurse's most appropriate step is to: 1. advise the patient to arrange for someone to visit regularly or move into the home. 2. advise the patient to have the social security check deposited directly to the bank and to get a dog. 3. assume that the patient is incompetent and initiate commitment proceedings. 4. take no action since the patient has a right to autonomy.

A 68-year-old man calls his daughter every night to talk about his beloved wife who died four weeks ago. During the day, he is sad and goes out frequently to get away from the empty house. The man's most probable state is: 1. depression. 2. mourning. 3. neurosis. 4. prolonged grief.

A 75-year-old patient who sustained a stroke has residual left-sided weakness. From the first day of hospitalization, the patient has been combative and demanding, and has refused to swallow any medication. The most constructive nursing action is to: 1. continue to attempt to follow the physician's orders. 2. determine the patient's premorbid personality. 3. restrain the patient and request a change in the route of medication. 4. wait for the patient to become more cooperative.

she is only 60, and I can't seem to satisfy her as often as I used to." Which is the nurse's most appropriate response? 1. "At your age, sexual activity diminishes because of changes in your circulation. I will explain this to your wife." 2. "Certain body functions, such as erections, slow down with age. Could you tell me more about your sexual relations? For instance, how often do you have intercourse?" 3. "Your problem is probably an emotional one. If you could relax, you would be as sexually active as you were 10 years ago." 4. "Your problem is probably due to a decrease in your sexual hormones. This occurs naturally as people age."

The gerontological nurse facilitates the benefits of life review by: 1. assisting the older adult to accept death as the inevitable last stage. 2. changing the topic when a patient talks about his or her morbid past. 3. encouraging reminiscence, oral histories, and storytelling. 4. helping the older adult explore how spiritual involvement assists with stress relief.

A comprehensive staff development program in a long-term care facility is based on the: 1. availability of educational resources. 2. nursing director's perceptions of staff learning needs. 3. philosophy, goals, and objectives of the organization. 4. recommendations of the ombudsman.

A healthy 80-year-old female patient complains that her skin feels dry and sometimes itchy. The gerontological nurse advises her to: 1. avoid scratching since breaks in the skin increase the risk of infection. 2. drink more liquids and take showers instead of baths. 3. take fewer baths, use soap sparingly, and apply skin cream afterward. 4. wear cotton clothing and try a different brand of soap.

A physician has just informed an older adult patient that test results indicate that the patient has cancer and will require extensive surgery. The patient says, "I know the tests are wrong. I feel fine." The gerontological nurse's most appropriate response is to: 1. acknowledge that the patient looks healthy and encourage seeking a second opinion. 2. advise the patient to join a support group. 3. convey availability to talk to the patient. 4. tell the patient that the tests are reliable and accurate.

Age-related changes in which two organs most affect an older adult's reaction to medication? 1. Heart and lungs 2. Intestines and spleen 3. Liver and kidneys 4. Pancreas and gall bladder

All care plans for older adult patients include: 1. a bowel and bladder program. 2. a fall prevention program. 3. discharge planning. 4. reminiscence therapy.

An 80-year-old resident of a retirement center states that something is wrong with the lighting in the room because colored rings appear around the light bulbs. The resident most likely has: 1. cataracts. 2. delusions. 3. glaucoma. 4. increased intracranial pressure.

Older adults with Parkinson disease exhibit: 1. confusion and depression. 2. dementia and hyperkinesia. 3. rigidity and tremor at rest. 4. weakness and tremor with movement.

Sildenafil citrate (Viagra) is hazardous for patients with: 1. a history of coronary artery bypass graft. 2. a history of shingles. 3. heart failure and borderline hypotension. 4. Paget disease and hypertension.

A 90-year-old patient with multiple medical problems is admitted to the hospital's geriatric care unit. The nursing assessment reveals lethargy, poor capillary perfusion, and urinary incontinence. These findings alert the gerontological nurse to the potential for: 1. aspiration. 2. contractures. 3. dehydration. 4. skin breakdown.

A gerontological nurse is caring for an older adult who has been confined to home for the last 10 weeks due to illness. The patient is anxious, has multiple somatic complaints, and has become unable to follow instructions. The nurse knows that this phenomenon commonly occurs with: 1. environmental overload. 2. protective isolation. 3. selective inattention. 4. sensory deprivation.

An 80-year-old patient complains of sleeping less despite spending more time in bed. The patient does not use alcohol, caffeine, or any medications other than acetaminophen for arthritis pain. The patient goes to bed at 11:00 pm, falls asleep in 15 minutes, awakens several times during the night, and promptly goes back to sleep. The patient feels refreshed in the morning and works five days a week as a volunteer. The gerontological nurse's most appropriate response is to: 1. recommend that the patient eliminate fluid intake after 6:00 pm. 2. recommend that the patient go to bed one hour earlier. 3. suggest that the patient enroll in a sleep study. 4. tell the patient that the sleeping pattern is a normal age-related change.

An 87-year-old man, who has been living independently, is entering a nursing home. To help him adjust, the most effective action is to: 1. involve him in as many activities as possible so he can meet other residents. 2. move him as quickly as possible so that he does not have time to think. 3. restrict family visits for the first two weeks to give him time to adjust. 4. suggest that he bring his favorite things from home to make his room seem familiar.

An alert and oriented 82-year-old woman, who lives with her daughter, has been admitted to the hospital with bruises about the face and head. The daughter reports that her mother fell. Which behavior by the daughter raises the greatest suspicion of elder abuse? 1. Becoming defensive when questions are asked 2. Complaining about care delivered by hospital staff 3. Giving an illogical account of her mother's fall 4. Refusing to leave her mother alone to answer questions

An early sign of alcohol withdrawal is: 1. auditory hallucinations. 2. decreased blood pressure. 3. depression. 4. diaphoresis.

An older adult patient, who is recovering from surgery, has a sodium level of 128 mEq/L and is confused. The physician diagnoses syndrome of inappropriate secretion of antidiuretic hormone. The gerontological nurse's primary goal for this patient is to: 1. decrease edema by restricting free water intake. 2. prevent complications of hyponatremia. 3. reorient the patient to his or her surroundings. 4. restore the patient's fluid and electrolyte balance.

In assessing the lighting for a patient with glaucoma, the gerontological nurse knows that: 1. ceiling lights are best. 2. drapes should be left open during the daylight hours. 3. higher levels of light are needed. 4. lower levels of light are needed.

Nursing facilities that receive federal funds must complete for all residents a: 1. minimum data set and care plan within seven days. 2. resident assessment instrument and care plan on admission. 3. resident assessment instrument and care plan within 14 days. 4. resident assessment instrument within 14 days and a care plan within 21 days.

Pain of gastrointestinal origin is best differentiated from pain of cardiac origin by the presence of: 1. chest pain lasting longer than five minutes. 2. chest pain of rapid onset. 3. left flank pain. 4. substernal chest discomfort.

Reminiscence therapy promotes an older adult's sense of security by: 1. increasing socialization skills. 2. meshing the past with the future. 3. providing praise and recognition. 4. reviewing comforting memories.

The occurrence of tuberculosis in the older adult is significantly increased among individuals who: 1. are physically inactive. 2. are cigarette smokers. 3. have received the Bacile Calmette Guérin (BCG) vaccine. 4. reside in institutions.

The primary reason for establishing quality improvement committees at long-term care facilities is to: 1. facilitate staff participation. 2. initiate changes based on interdisciplinary exchange. 3. monitor and record incidents, accidents, and injuries. 4. provide quality care based on measurable data.

To prevent injury, a gerontological nurse advises an older adult who is taking tricyclic antidepressants to: 1. eat a diet high in roughage. 2. get an additional night light. 3. provide lubrication for the oral mucosa. 4. stand up slowly from sitting or lying positions.

When hospital quality assurance indicators are assigned, the nursing staff strives to: 1. avoid emphasizing performance deficits. 2. decrease patient falls. 3. focus on achieving 100% compliance. 4. identify high-risk, high-volume, or problem-prone areas.

Which is a risk factor for vaginitis in older adult women? 1. Anticoagulation therapy 2. Increased sexual activity 3. Poor nutrition 4. Prolonged antibiotic therapy

All statements are examples of nonpharmacological nursing interventions for a patient experiencing delirium but needing sleep except: a. Providing adequate sleep and awake times b. Encouraging ambulation c. Providing a night light to prevent fears d. Reducing noise levels during periods of sleep

5. An alert, oriented client voided incontinently, soiling clothing. What action by the nurse is a priority? a. Inform the client to use the bathroom next time. b. Provide assistance with washing and changing clothing. c. Tell the client that an adult diaper must be worn. d. Insert an indwelling catheter.

: b Explanation: Incontinence may embarrass adults and can be a source of social isolation because the client is afraid of leaving the security of a ready bathroom. Be sensitive to treating this situation with dignity and discretion. Do not chide or scold anyone for episodes for example by telling them that they must use the bathroom next time. Instead, provide assistance in cleaning the skin and changing clothes, as needed. Evaluate incontinence to identify its cause; some forms can be eliminated with correction of the underlying problem. Catheters are not the treatment of choice for urinary incontinence because they can introduce infection-causing microorganisms into the urinary tract. Offering an adult brief is an option but the client may refuse. The nurse should not "tell" the client that it is mandatory to wear one.

A nurse is providng assisstance to a diabetic elderly client. Whihc is major nursing consideration when providing nail and food care for the client? a wash the pt leg in cold water b cut the overgrown nails of the foot c document any injury to the client's foot d encorgae client to inspect the feet once a week

: c RATIONALE: A nurse providing nail and foot care for a diabetic aging adult should document any injury to the foot and discuss the observation with the client's healthcare provider. This is to prevent spread of any infection and also for the fast healing of the wound. A nurse should wash the client's legs in warm water rather than cold water. A nurse is not allowed to cut the nails of aging clients; a podiatrist should do this, because the nails become thick and hard due to aging. A nurse must encourage the client to inspect his or her feet every day and to inform the nurse about any pain or injury.

a nurse is caring for an aign adult who has been prescribed an enteric-coated medication. The client is not agreeing to swallow the med. What should the nurse do a crush the tablet before administering b hide the tablet in the client's food c tells the client that she must take the med d ask the client to chew the med before swallowing

: c RATIONALE: The nurse should tell the client that she must take the medicine to improve her health. Compliance can be achieved with patience. An enteric-coated tablet should never be crushed or chewed, because it should not be digested in the stomach. Tricking the client by hiding the medicine in the food is illegal and should not be done

A gerontological clinical nurse specialist plans to investigate the relationship between educational levels and adherence to prescribed hypertensive medication, as measured by changes in blood pressure readings. Which research design is most appropriate to study this issue? a) Descriptive correlational b) Nonequivalent control group c) Pretest-posttest d) Quasi-experimental

A male elderly client on long-term auranofin therapy presents with oral ulcers and a pruritic rash and complains of decreased urinary output. The nurse understands that: a. These symptoms can be the adverse effects of gold salt therapy b. These symptoms are unrelated to anything and need a major work-up for diagnosis c. These symptoms represent liver failure d. These symptoms are common when clients are treated for arthritis

An 80-year-old female decides on a do not resuscitate (DNR) status for herself after discussing her medical concerns with her physician. Which statement best describes the reasoning behing this decision? a. This is ethical reasoning based on self-determination and informed consent b. This is not a medical decision c. This discussion would be meaningless because the family members were not involved d. THis is not an ethical decision

An 85-year-old patient has an intestinal viral infection with severe diarrhea. Laboratory studies are ordered. Which result confirms a diagnosis of dehydration? a) Hyperchloremia and hypernatremia b) Hyperglycemia and hyponatremia c) Hyperkelemia and hypercapnia d) Hypermagnesemia and hyponatremia

An 88-year-old patient is reluctant to use the call light for assistance and is often incontinent. The gerontological clinical nurse specialist tells the staff to praise the patient each time the call light is used to request toileting assistance. The clinical nurse specialist's suggestion is based on which theory? a) Behavioral learning b) Cognitive reorganization c) Person-environment fit d) Social cognitive

An older adult on digoxin and furosemide is showing signs of toxicity. The gerontology nurse understands that: a) Digoxin and furosemide are excreted by the kidneys, and the doses may need to be decreased due to impaired kidney function b) Digoxin and furosemide are excreted through the intestinal tract, and dose changes would be ineffective c) An increase in fluid intake will fix the symptoms, and no change in dose is needed d) How a drug is excreted is not a consideration when dosing an older adult

Changes in bone and muscle in the aging population have the greatest effect on? a. Stature, posture, and function b. Appearance c. Immunity d. Pain tolerance

Medications, slower mobility, lack of proper fluid intake, and poor diet can contribute to what common symptom in the elder population? a) Urinary incontinence b) Skin changes c) Mental changes d) Depression

The disease affecting adults over the ages of 55 to 60 where these is excessive resorption and deposition of bone is: a. Paget's disease b. Osteoporosis c. Wright's disease d. Scott's disease

The gerontological clinical nurse specialist is asked to speak to a chronic obstructive pulmonary disease support group about the ethical issues surrounding physician-assisted suicide. At the beginning of the presentation, the clinical nurse specialist asks the group to identify what they fear most about death and dying. This technique is used to achieve objectives in which domain? a) Affective b) Cognitive c) Psychomotor d) Spiritual

The most reliable measure for assessing hydration in an older adult is: a) Mucous membrane condition b) Skin texture c) Skin turgor d) Urinary frequency

The nurse evaluating an elderly male client for urinary complaints understands that the major change in the prostate during the aging process is? a. Hyperplasia b. Renal stones causing obstructions c. Hypolplasia d. Impotence and embarassment

A nurse is caring for a client with Alzheimer's disease in an extended-care facility. What safety measures would be best for the client who attempts to get out of bed? Select one: A. A buzzer located under the mattress B. A special armband alarm device C. A leather restraint tied to the client's arm D. A phone close to the client's bed

A buzzer located under the mattress A buzzer located under the mattress warns the nurse if an unsteady client attempts to get out of bed. Providing a phone close to the client's bed will not warn the nurse of a client who is trying to get out of bed. The client who may wander away from the unit may wear a special armband alarm device, which warns the nursing staff if the person tries to leave the unit without permission. If the client is tied with a leather restraint, the client may feel hemmed in, and this may result in depression.

A 69-year-old female presents with knee pain. The nurse hears a dry crackling or grating sound and the client feels the same sensation on exam. The nurse reconizes this as: a. Nothing abnormal for the age of the client b. Crepitation, the sound of osteoarthritis in the knee joint c. Osteoporosis and a softening of the knee joint d. Fluid-filled spaces in the knee joint

The nurse is caring for clients in a nursing home who have various forms of dementia. Which of the following clients would most likely be a candidate to have Wernicke-Korsakoff syndrome Select one: A. A client who has uncontrolled hypertension B. A client who has AIDS C. A client who abuses cocaine D. A client who is a long-term alcoholic

A client who is a long-term alcoholic Wernicke-Korsakoff syndrome is the most common type of alcohol-related dementia. It is thought to result from direct damage to the brain by alcohol. Hypertension is related to Alzheimer's disease. Crack-related dementia is related to the abuse of cocaine, particularly crack cocaine. The client in the late stages of AIDS may become demented (AIDS dementia).

he nurse is performing toenail care for clients in a long-term care facility. For which of the following clients would this most likely be contraindicated? Select one: A. A client with arthritis B. A client with stomach ulcers C. A client with diabetes D. A client with hypertension

A client with diabetes

In older women, the onset of physical discomfort and bleeding associated with intercourse often indicates: a) a friable cervix with possible cellular abnormalities b) decreased distensibility and mucosal changes of the vaginal vault c) infrequent sexual activity d) thickening of the vaginal mucosa with decreased lubrication

Which client is most likely to develop kyphosis? Select one: A. A client with osteoporosis B. A client with emphysema C. A client with hypertension D. A client with leukemia

A. A client with osteoporosis Osteoporosis is common in the elderly. Radiologic examination may detect loss of bone density, fractures, or loss of vertebral height. Kyphosis (curvature of the spine) can be associated with osteoporosis; this typically causes a humpbacked appearance ("dowager's hump" or "widow's hump").

The nurse is arranging discharge for an elderly client to a skilled nursing facility (SNF). What are characteristics of this type of facility? Select All That Apply Select one or more: A. The facility provides rehabilitation services. B. Physicians are on call and provide supervision to the advance practice nurse. C. Can accommodate for clients with special dietary needs. D. Clients can stay temporarily following a surgery and plan to return to independent living

A. The facility provides rehabilitation services. B. Physicians are on call and provide supervision to the advance practice nurse. C. Can accommodate for clients with special dietary needs. D. Clients can stay temporarily following a surgery and plan to return to independent living In an SNF, physicians are on call and are required to make regular visits to residents, as well as to provide supervision for the advance practice nurse. The SNF provides rehabilitation services, special diets, and access to pharmacy, x-ray, and laboratory services. Occupational, physical, recreational, and speech therapists are usually on staff or serve as consultants. The primary care or "medical oversight" is often provided by an advance practice nurse (nurse practitioner). Some clients may plan to live there indefinitely. Other clients may come to the SNF to recuperate following injury, surgery, or severe debilitating illness, but plan to return to independent living

Kolcaba's (1994) theory of comfort supports which nursing practice standard? a. It supports transcultural nursing practice b. It supports basic nursing care, promoting the comfort of the patient c. It supports the importance of social support to buffer life's stresses d. It supports helping the patient to adapt to chronic illnesses

Persons who have chronic open-angle glaucoma are advised to wear medical alert bracelets because they have the potential for developing acute glaucoma if they are administered: a) angiotensin-converting enzyme (ACE) inhibitors b) anticholinergic agents c) adrenergic blocking agents d) osmotic agents

A nurse is caring for an elderly client who is to undergo a brief mental status examination as part of psychometric testing. What function is lost in the initial stages of Alzheimer's disease (AD)? Select one: A. Ability to complete simple tasks B. Memory of childhood events C. Ability to remember everyday words D. Ability to concentrate

Ability to concentrate A client in the initial stages of AD loses the ability to concentrate. Concentration and orientation are affected initially in a client with AD. Memory of recent events, not long-ago events, are lost first in AD. The client developing AD would first lose the ability to complete complex tasks, not simple tasks. Deteriorating language skills, such as difficulty to remember everyday words, occurs later during the progression of the disease and not initially.

Every client in a long-term care facility has a case manager. What are common functions of this position? Select all that apply. Select one or more: A. Provide direct nursing care for the client B. Act as a client advocate C. Oversee the client's care D. Evaluate the client's money skills E. Disperse funds from the client's monthly chec

Act as a client advocate + Oversee the client's care + Disperse funds from the client's monthly check +, Evaluate the client's money skills Each client in the long-term care system should have a case manager or care manager (CM) who oversees the client's case, regardless of the length of care or whether the client is cared for in a facility or the community. In a short-term stay, the head nurse or nursing director will serve as case manager. The CM is the local advocate for the client and must ensure that the client is receiving appropriate care. The CM often evaluates the client's money management skills, and the CM or a family member may be designated as the client's payee, receiving the client's monthly check and disbursing funds appropriately.

An elderly client diagnosed with dementia manifests an inability to recognize objects or persons via auditory, visual, sensory, or tactile sensations. What is the correct term for this condition? Select one: A. Akinesia B. Apraxia C. Aphagia D. Agnosia

Agnosia Agnosia is the inability to recognize objects or persons via auditory, visual, sensory, or tactile sensations. Akinesia is difficulty moving, which may include complete or partial loss of muscle movement. Aphagia is difficulty with swallowing or an inability to swallow. Apraxia is the inability to perform purposive movements or to use objects properly.

A nurse is caring for a client with delirium. What should the nurse assess for in this client? Select one: A. Inability to eat or swallow B. Inability to use objects properly C. Altered level of consciousness D. Complete loss of muscle control

Altered level of consciousness The nurse should assess for altered level of consciousness in a client with delirium. The client's level of consciousness can vary from extreme drowsiness to hyperactivity. Complete loss of muscle control (akinesia), inability to eat or swallow (dysphagia), and inability to use objects properly (apraxia) are all seen in clients with dementia, not in clients with delirium.

A 70-year-old presents to the clinic stating that his family things he is losing his mind and they want to put him in a home. What would be the intial role of the gerontological nurse? a) Begin the process of finding a qualified nursing home b) Do a complete history,physical, and assessment c) Speak with the family about their concerns d) Make light of the subject until the nurse can evaluate the situation

A gerontological clinical specialist is conducting a study on risk factors for osteoporosis and has developed a questionnaire covering risk-reducing and risk-increasing behaviors of older women. The clinical specialist asks experts in the area of osteoporosis to review the tool to establish: a) concurrent validity b) content validity c) interrater reliability d) test-retest reliability

a nurse is caring for a client with AD who needs asseistance with dressing. Which measure should the nurse employ for this client? a allow the client to choose clean clothes b provide clothing whi Velcro and elastic waistbands c provides alal instructions before the client starts to dress d encourage the client to wear pullovers instead of buttoned clothes

Answer: b RATIONALE: The nurse should encourage the client to wear simple clothing with Velcro and elastic waistbands, because they are easy to wear and to remove. The nurse should lay out clean clothes and remove dirty clothes to prevent confusion. The client should be given one-step instructions to make each step simple, and not given all instructions at once, on how to put on and remove clothing. The client should be encouraged to wear cardigans or button-down shirts instead of pullovers, because covering the head may be frightening

A client states that he was physically abused by another client in a long-term care facility. Which of the following measures should the nurse initiate for the client who stated he was abused? Select one: A. Ask the client to meet the ombudsperson. B. Encourage the client to meet his case manager. C. Arrange for the client to contact social services. D. Refer the client to the nursing director. Most clients in healthcare facilities are protected by law from abuse or neglect due to their vulnerability. Who is responsible for protecting the client rights?

Ask the client to meet the ombudsperson. Most clients in healthcare facilities are designated as vulnerable adults and are protected by law from abuse or neglect. The ombudsperson is responsible for seeing that the client's rights are not violated. Referring the client to the nursing director, the case manager, or social services will not protect the client by law from abuse or neglect.

An aging client has gone into depression and refuses to eat. What measure should the nurse take? Select one: A. Start an IV line to provide parenteral nutrition. B. Ask the family members to feed the client. C. Ask the client what favorite foods may be prepared. D. Provide oral nutraceutical supplements to the client.

Ask the client what favorite foods may be prepared. The nurse should encourage the client to prepare his or her favorite dish. This can stimulate the client into being active and sticking to a regular intake of food. Oral nutraceutical supplements are provided to clients with difficulty in swallowing, not when a client merely refuses to eat because of depression. Parenteral nutrition need not be provided if the client is conscious and has no difficulty swallowing food. If the client is depressed, it may not help to ask family members to feed the client because this may irritate the client further.

The gerontological nurse understands that the purpose for prescribing Ditropan is: a. An underactive kidney function b. Increasing contractions of the sphincter muscles c. Decreasing bladder muscle tone and aiding in urge incontinence d. Improving urogenital symptoms caused by vaginitis

A nurse is caring for an older adult with constipation. What should the nurse encourage the client to increase in the diet? Select one: A. Milk B. Meat C. Bran D. Eggs

Bran Bran is a good source of fiber for the older adult with constipation. It contains insoluble fibers that add bulk to the diet and improve bowel movement. Meat, milk, and eggs should not be taken in large quantities. Although meat, milk, and eggs are good sources of protein, they also contain saturated fats. Milk is also rich in sugar, thus it should be consumed in restricted amounts.

A gerontological clinical nurse specialist is administering a mental status examination to an 80-year-old patient. The patient answers the more complicated questions by saying "I don't know." Which test is included in a further assessment? a) Barthel Index b) Functional Independence Measure c) Geriatric Depression Scale d) Lawton Life Satisfaction Scale

A gerontological clinical nurse specialist is asked to provide consultation on ways to reduce the use of restraints in a nursing home. In the initial meeting with the nursing home administration, the clinical specialist's primary goal is to: a) Complete a written contract for services that covers expected outcomes, time commitments, support systems, and financial arrangements b) Conduct a force field analysis of the variables in the nursing home that includes use of existing data on restraint use and staff strengths and weaknesses c) Discuss the need for consultation, the overall goal of the project, and the working relationship with the staff d) Plan a review of how the use of restraints has been accomplished elsewhere and the models used for education and for changing practice

After presenting a talk on breast health, a gerontological clinical specialist discovers that at least 60% of the women who attend a large urban senior center do not believe in the benefits of mammography, have never had a mammogram, or had a painful experience and refuse to get another one. Which initial approach is most likely to motivate change? a) Administering a survey to assess the exact nature of the women's self-care behaviors before planning the next step b) Arranging for reduced-cost mammograms and free transport to the local hospital c) Planning some small group sessions with these women to allow them to explore their beliefs and feelings d) Presenting another educational session that includes a speech by a physician and then distribute additional literature

An 81-year-old patient has right-sided pleuritic pain with shortness of breath. The patient reports falling during the night, and has a large ecchymosis on the right flank area. Which nursing diagnosis is a priority for this patient? a) Anxiety b) Impaired skin integrity c) Ineffective breathing pattern d) Sleep pattern disturbance

Denmentia and depression are strongly related to: a) Clients over the age of 60 b) Clients over the age of 65 c) A decreased quality of life and functional deficits d) Past economic status and job performance

Describe the order for the nursing process as practiced by the gerontological nurse: a) Diagnose, implement, evaluate b) Assess, identify expected outcomes, implement, evaluate c) Assess, dignose along with the team, identify outcomes, plan, implement, evaluate d) Assess, evaluate, plan, implement, and look at outcomes

Differences between the IQ scores of a group of 20-year-old individuals and a group of 80-year-old individuals suggest: a) Cortical atrophy b) An accumulation of lipofuscin c) Cohort differences d) Vascular changes

Ever since the death of her husband a year ago, an older woman's ability to care for herself has significantly diminished. The older woman expresses increased feelings of inadequacy and decreased satisfaction with life. The daughter had become the primary caregiver for the woman and has become increasingly resentful of this role. The mother and daughter's feelings are best explained in terms of: a) Ego integrity versus despair b) Role theory c) Social exchange theory d) Unresolved grieving

In a quality review of pressure ulcers amoung nursing home residents, appropriate outcome criteria include the: a) Availability of supplies for wound care b) Incidence of pressure ulcers correlated with staffing levels c) Percentage of pressure ulcers that demonstrate healing each month d) Rate of nurse compliance with the protocol for treating pressure ulcers

Quality indicators for health-care research and patient safety appropriate for the older adult would include all of the following except: a. Wound care and decubitus ulcer prevention b. Postoperative hip fracture care c. Obstetric trauma d. Fall risk assessments

Senile purpura significantly increases with age and is most related to? a. The aging process past the age of 60 b. Related to increase in blood vessels c. Related to loss of subcutaneous fat and connective tissue d. Related to medications

Systems theory includes which components about aging? a) Gene regulation ideas b) Nutation accumulation on aging c) Neuroendocrine and immunological ideas d) Free radical ideas

The absorption of medication in the geriatric client is most often affected by: a) A decrease in body fat b) An increase in serun albumin c) A decrease in body water and lean body weight d) An increase in body water

The gerontological nurse understands that nonsteroidal anti-inflammatory drugs (NSAIDS) used for arthritis pain may cause? a. No side effects b. Liver failure in the first 24 hours c. Coagulation impairment and gastric irritation d. Fear or anxiety

A client is to be admitted to an intermediate care facility (ICF). Which of the following should the nurse tell the client about the ICF? Select one: A. Provides physical and occupational therapy B. Ensures assistance with social services C. Provides room, board, and basic care with a nurse on call D. Provides rehabilitation services to clients

C. Provides room, board, and basic care with a nurse on call The nurse should inform the client that the ICF provides basic care to clients with a nurse on call. ICFs provide room, board, and some nursing care. The ICF always employs a licensed nurse on duty and not unlicensed assistive personnel to provide care. The ICF provides fewer services and less extensive care than the skilled nursing facility (SNF); hence, rehabilitation services and social services are provided at an SNF and not at an ICF.

The ombudsperson is explaining to the family of a client how payment for long-term care is devised. Which of the following is true of this payment system? Select one: A. Medicare pays for all long-term care. B. Private insurance may cover all or part of the cost. C. With Medicaid, clients must exhaust private insurance, but not financial resources. D. Coverage with Medicaid is the same from state to state.

Private insurance may cover all or part of the cost.

A nurse is recommending a state-assisted living facility to an elderly client who cannot afford private assisted living. Which of the following is a requirement for this type of housing? Select one: A. One or more chronic illnesses B. Medicaid C. Private insurance D. Certificate of need

Certificate of need Some states have formal statewide assisted-living facilities. These facilities require a certificate of need (CON). Medicaid is a federal program for assistance and having a chronic illness is not a requirement. Residents in facilities based on need would most likely not have private insurance.

A nurse is assessing a client for multi-infarct dementia (MID). What should the nurse assess in this client? Select one: A. Ask the client about a history of alcohol consumption. B. Confirm with the client any crack cocaine abuse. C. Check for hypertension or cardiovascular disease. D. Check if the progress was gradual and continuous.

Check for hypertension or cardiovascular disease.

A nurse is assessing a client with severe Alzheimer's disease (AD). What should the nurse assess? Select one: A. Client is unable to sit upright without support. B. Client keeps talking to himself throughout the day. C. Muscles of the client become flaccid and lose tone. D. Client always tends to sleep in the prone position

Client is unable to sit upright without support. In severe AD, the client is unable to sit upright without support. The client tends to sleep in the fetal position, rather than the prone position. The client's muscles become rigid and not flaccid. The client does talk to himself throughout the day. In severe AD, the client loses the ability to speak

A nurse is caring for an elderly client who is a substance abuser. What information should the nurse provide the client's family when educating them on substance abuse in their loved one? Select one: A. Substance abuse by the client cannot be controlled or cured. B. Alcoholism can be easily detected in the client. C. Client may have a low self-esteem and be a loner. D. Older clients often admit being a substance abuser.

Client may have a low self-esteem and be a loner. The client may have a low self-esteem and be a loner. Older adults believe that substance abuse is a problem in young people. Thus, they tend to deny that they are substance abusers. Among older adults, loneliness is a major contributor. Alcoholism is difficult to detect in elderly clients. The nurse should inform the family that the situation usually gets out of control if the client stays alone or is a loner.

A nurse is caring for an elderly client. The nurse suspects that the client, who lives in a group home setting, is a victim of elder abuse. What warning sign should the nurse watch for when caring for the client? Select one: A. Client misses scheduled visits to the healthcare facility. B. Client does not like spending his own money. C. Client shows signs of recent weight gain. D. Client shows evidence of poor grooming.

Client shows evidence of poor grooming. The nurse should watch out for evidence of poor grooming; it could indicate that the client is a victim of elder abuse. Such a client usually spends or donates large sums of money. Weight loss and malnutrition are common among elders who are abused. Such clients also make frequent visits to the healthcare facility.

Which statement describes the importance of understanding nursing theory when practicing gerontologic nursing? a. Understanding and using tested theories offer a framework on which to base nursing practice interventions b. Nursing theories are vague and do not offer substance in most health-care settings c. Theories are not proven ways onwhich to base nursing practice d. Theory helps identify major concepts in nursing practice and offers a framework for decision making

Which statement give examples of educational programs for the older adult? a. Community programs that focus on lifestyle modifications b. Programs targeting specific age-related problems, such as nutrition, finances, or prevention c. Programs that focus on exercise for the older adult d. All of the above

Which topic should NOT be omitted when assessign the aging client? a) Sexual history b) Caridac history c) History of abuse d) All of the above

A 73-year-old patient reports "dizzy spells" for the past several weeks. The patient describes three similar episodes during which the patient experienced "a swimming in my head," loss of balance without falling, and numbness in the left arm. These episodes lasted 10 to 30 minutes. This patient is experiencing: a) carotid artery stenosis b) Meniere's disease c) postural hypotension d) transient ischemic attacks

A 92-year-old patient with advanced dementia has had three episodes of aspiration pneumonia in five months. The patient has no written advanced directives. The speech therapist recommends feeding tube placement. The patient's son would like a feeding tube placed, the daughter is unsure, and the patient's spouse states that the patient would never want a feeding tube. The gerontological clinical nurse specialist's next action is to: a) bring the case to the attention fo the ethics committee b) emphasize to the family that a feeding tube will decrease recurrent pneumonias c) obtain a surgical consult to schedule feeding tube placement d) organize a family and staff meeting to discuss the risks and benefits and consider the patient's wishes

An 80-year-old female asks the nurse about over-the-counter vitamin supplements. The most appropriate advice would include: a) No vitamin supplements are needed with a balanced diet b) Any multivitamin will do c) Take only a calcium supplement d) Take a multivitamin for those over the age of 50, which should include the recommended vitamins for the aging adult

Examples of health-care reimbrusement or delivery modes include all of the following except: a. Medicaid b. Medicare c. Managed care, telemedicine, and case management d. Anthem for the elderly A/B

Factors that may further decrease lung finction besides aging include all but: a. Smoking b. Obesity c. Immobility d. Exercise

In assessing the aging client, it is importnat for the nurse to recognize: a) The client's ability to perform ADLs b) The financial status of the client c) The job that the client held prior to aging d) All components of well-being, including biological function, psychological function, and social function

In teaching older adults in a group setting, the gerontological clinical specialist minimizes the impact of presbycusis by: a) Increasing the volume of the audio system b) Providing soft background music c) Raising voice pitch and facing the group d) Reducing voice pitch, speaking slowly, and enunciating

Symptoms of hyperthyroid disease may include all of the following except: a. Heat intolerance b. Palpitations c. Tremors d. Diarrhea

The nurse is evaluating a 64-year-old male for coronary artery disease (CAD). Understanding that CAD is the leading cause of mortality, which risk factor would not be related to CAD? a. Hypertension b. Dyslipidemia c. Diabetes d. Sexual orientation

The nurse shold be aware that the percent of aging adults in a nursing home/long-term care setting experiencing sensory hearing loss is: a. 40% b. 60% c. 30% d. 70 to 80%

The nurse understands that the goal for treatment of leg ulcers in the elderly client should be to? a. Relieve pain and swelling b. Relieve immobility c. Promote circulation d. Alleviate swelling, eliminate infection, and promote healing

The role of the gerontology nurse includes all of the following except: a. To facilitate the establishment of social support for the older adults b. To promote independent living as much as possible c. To educate and refer older adults to the appropriate resources d. All of the above

To be an effective consultant in a new setting, the gerontological clinical nurse specialist first explains to the staff members the: a) clinical nurse specialist's ability to plan care b) Clinical nurse specialist's expertise as a consultant c) need for consultation d) rold of the consultant

To ensure the successful implementation of the humanistic model of organizational theory, nursse managers and gerontological clinical nurse specialists prioritize activities that: a) eliminate at least one organizational level to decentralize b) eliminate or minimize the informal "grapevine" c) emphasize informal communication and minimize formal communication d) emphasize job satisfaction to improve productivity

Treatment approaches for an aging adult experiencing overflow incontinence may include all of the following except: a. Toilet schedule b. Positioning and the Crede maneuver c. Clean self-catheterizations d. Kegel exercises

What is the most noticeable change in tissue as it ages? a) Decrease in lipids b) Increase in subcutaneous tissue c) Decrease in wrinkles d) Accumulation of pigmented material called lipofuscin

Which choice best explains the practice setting for the gerontological nurse? a) In the home of the client b) Only in acute care settings c) Clinics and long-term care facilities d) Home of the client, acute care facilities, long-term care settings, and clinics or anywhere clients over the age of 65 seek health care and health education

Which is the main principal age-related change that causes alteration in drug distribution in older adults? a) A decrease in absorption b) A decrease in total body weight c) An increase in body water d) An increase in the ratio of body fat to lean body mass

Which organ is responsible for drug metabolism and must be considered when prescribing medicaiton for an older adult? a) Kidneys b) Pancreas c) Intestines d) Liver

The nurse caring for clients in a nursing home explains to a student nurse that many problems commonly associated with aging processes are disease processes that result from changes related to the normal aging processes. What are normal effects of aging? Select all answers that apply. Select one or more: A. Decreased reaction time B. Increased functioning of organs C. Decreased intellectual ability D. Decreased tactile sensation owing to fragile skin E. Increased emotional, socioeconomic, and physical losses F. Decreased capacity for recovery from wounds, injury, or illness

Decreased tactile sensation owing to fragile skin, Increased emotional, socioeconomic, and physical losses, Decreased capacity for recovery from wounds, injury, or illness, Decreased reaction time decreased functioning of organs, changes in visual and auditory acuity, decreased reaction time, unsteady gait; decreased sense of balance and tactile sensations, stiff joints; increased emotional, socioeconomic, and physical losses; decreased capacity for recovery from wounds, injury, or illness; and combinations of chronic illnesses, poor dietary habits, and lack of exercise Intellectual ability does not decrease because of normal aging.

An 84-year-old patient has returned from the PACU. The patient is oriented to name only. The patient's family is very upset because before having surgery, the patient knew the family. The patient is diagnosed with delirium. What should the nurse explain to the patient's family?

Delirium is usually temporary.

A nurse is caring for a client who has Parkinson's disease. What mental functioning impairment is associated with this disease? Select one: A. Delirium B. Alzheimer's disease C. Dementia D. Confusion

Dementia Progressive dementias are characterized by deterioration of emotional control, intellect, memory, judgment, basic arithmetic abilities, language, and independence. Parkinson's disease is a type of neuromuscular disease that leads to dementia.

The nurse is teaching the family of a client diagnosed with dementia about the disease process. Which of the following teaching points accurately describe this mental alteration? Select one: A. Dementia is not any specific disease or disorder. B. Dementia does not affect level of consciousness. #delirium C. Dementia does not cause personality changes. D. Dementia is a normal part of aging.

Dementia does not affect level of consciousness. Dementia literally means "mind away"; it is not a normal part of aging Dementia is not any specific disease or disorder but, rather, is a group of symptoms that reflect losses in the ability to think, reason, or remember. Dementia causes personality changes, but does not affect level of consciousness.

A nurse is caring for an elderly client with Alzheimer's disease (AD). What should the nurse assess for in this client? Select one: A. History of a series of small strokes B. Crack cocaine abuse C. Elevated blood pressure D. High-dose folate supplementation

Elevated blood pressure elevated blood pressure # hypertension is associated with the development of AD. A low level of the vitamin folate is a risk factor for the development of AD. A series of small strokes is seen in clients with multi-infarct dementia, not AD. Abuse of cocaine, particularly crack cocaine, is associated with crack-related dementia.

A client manifesting the signs of Alzheimer's disease is undergoing testing to rule out other causes of this dementia. What test would be performed to rule out an immune disorder as the cause? Select one: A. Fasting blood sugar B. Erythrocyte sedimentation rate C. Chemistry screening D. Complete blood count

Erythrocyte sedimentation rate Erythrocyte sedimentation rate would be performed to rule out an immune disorder or infection. Alzheimer maybe result of infection Complete blood count could rule out anemia. Chemistry screening would be done to rule out toxicity fasting blood sugar could rule out diabetes mellitus

The nurse is caring for clients in an extended care facility. Which healthcare facilities belong in this category? Select all that apply. Select one or more: A. Subacute-care facilities B. Community healthcare clinics C. Medically complex care facilities D. Hospitals E. Skilled nursing facilities F. Long-term rehabilitation units

Extended-care facilities (ECFs) "extend" or continue care started in the hospital. Facilities that are considered ECFs include subacute-care or transitional facilities, medically complex care facilities, long-term rehabilitation units, and long-term care (LTC) facilities or skilled nursing facilities (SNF) ("nursing homes").

The nurse caring for a client with Alzheimer's disease states the risk factors of the disease to the family members. What are risk factors for this mental functional impairment? Select all that apply. Select one or more: A. History of stroke B. Age <50 years C. Having higher education D. Genetics E. Low levels of vitamin folate F. Hypertension

Genetics, Hypertension, History of stroke, Low levels of vitamin folate factors for AD, including age, genetics, diet, environment, education, and continual use of mental abilities; diseases that affect cerebral blood flow, such as stroke, heart disease, and hypertension; and low levels of the vitamin folate.

A nurse is caring for a client with dementia. What measure should the nurse employ when communicating with the client? Select one: A. Give simple, one-step commands. B. Always verbalize all communications. C. Wear a nametag for identification. D. Use questions to assist reasoning.

Give simple, one-step commands The nurse should use simple, one-step commands because the client's brain cannot process multiple steps. Too many commands add to confusion, frustration, and fear. It may not be possible for the client with dementia to be able to read the nametag and so the nurse should identify himself or herself. Questions should be avoided; the client cannot process or think through questions because those abilities are lost. The nurse need not always verbalize all communications. Nonverbal body language might be the only thing the client can perceive.

Under a Medicare program called "Pay for Performance" (P4P), a facility's reimbursement is based on quality of care provided. What is one quality measure on which great emphasis is being placed? Select one: A. Nosocomial infections B. Fall prevention C. Fire safety D. Hospital readmission

Hospital readmission Although all of the above are concerns, great emphasis is currently being placed on prevention of hospital readmission within 30 days of discharge.

The nurse is speaking to a group of senior citizens at senior center about the benefits of exercise on a person's health. What would be a benefit listed? Select one: A. Increases bone mass to reduce osteoporosis B. Increases fat muscle ratio to maintain metabolism C. Prevents vascular elasticity from causing arteriosclerosis. D. Decreases endurance to ensure mobility and improve posture

Increases bone mass to reduce osteoporosis The benefits of exercise are (1) it increases bone mass to reduce osteoporosis; (2) it maintains vascular elasticity to delay arteriosclerosis; (3) it decreases fat muscle ratio to maintain metabolism; (4) it increases endurance; (5) it retains strength and flexibility to ensure mobility and improve posture.

The nurse is teaching the family of a client with cognitive dysfunction how to make the home environment safe for the client. Which of the following is a recommended guideline to include in the teaching plan? Select one: A. Remove all medications and poisonous substances from the home. B. Allow the client to drive only if supervised. C. Get a pet for the client as a companion. D. Install safety locks and buzzers on doors.

Install safety locks and buzzers on doors. Safety guidelines include the following: Install safety locks and buzzers on doors (in case the person wanders); do not allow the client to drive (remove keys, disable car, revoke license); lock up all medications, over-the-counter remedies, poisons, paints, cleaning solutions; and find a good home for pets, if this person is no longer able to care for a pet safely

A nurse is caring for a client recovering from a stroke at a subacute-care facility. Which of the following interventions is most likely provided to this client? Select one: A. Intravenous therapy B. Physical rehabilitation C. Reminiscence therapy D. Therapeutic recreation

Intravenous therapy he nurse can provide intravenous therapy to a client recovering from a stroke at a subacute-care facility. Nursing functions in subacute-care include IV therapy, cardiac monitoring, ventilator care, tube feeding of nutrients, peritoneal dialysis, and management of severe wounds. Therapeutic recreation, reminiscence therapy, and physical rehabilitation are provided for clients in long-term care facilities and not in subacute-care facilities, because they require care for an extended period of time.

The nurse manager is discussing safety issues with the staff of a nursing home and outlines interventions to keep clients with Alzheimer's disease from getting lost. Which of the following would be a recommended practice for these clients? Select one: A. Keep a recent photo of the client on file. B. Place hospital bands on both wrists and ankles. C. Put at least four phone numbers on the identification band. D. Identify the client as having dementia on the identification band.

Keep a recent photo of the client on file. The family (or the long-term care facility, if the client resides there) should have a recent photo of the person, in case he or she becomes lost and police need to assist in the search. Clients with dementia must wear some sort of identification in case they wander and become lost. They can wear ID bracelets or sewn-on nametags. Hospital identification bands may work well because they cannot be removed easily. Placing bands around ankles rather than wrists is better because the bands are then out of a client's sight. At least two telephone numbers should be on the identification band. The nurse should identify the client as memory impaired.

A nurse is caring for a client with loss of proprioception. He uses a bed with side rails. What measure should the nurse implement to prevent discomfort and support independence for the client when using a bed with side rails? Select one: A. Move side rails when client wants to move off the bed. B. Keep only one side rail of the bed up. C. Set the bed 3 feet above the ground. D. Place a chair to support the client when climbing down.

Keep only one side rail of the bed up. When a client with loss of proprioception uses a bed with side rails, only one side rail of the bed should be up. This will assist the client in moving in and out of the bed When a client with loss of proprioception uses a bed with side rails, only one side rail of the bed should be up. This will assist the client in moving in and out of the bed No supports, such as chairs, should be provided for the client to climb up or down from the bed. This increases the chance of injury due to a fall. Having both the side rails up and moving one down from when the client wants to step off the bed may confuse the elderly client and prevent his or her movement out of bed.

A nurse is caring for a client with dementia. What measure should the nurse take when assisting the client with nutrition and hydration? Select one: A. Keep reminding the client to chew and swallow. B. Encourage the client to sit alone for meals. C. Place the spoon and fork in the client's hand. D. Provide a variety of foods to encourage eating.

Keep reminding the client to chew and swallow. The nurse should remind the client to chew and swallow because clients with dementia often forget to eat and drink. The use of forks and knives should be avoided in clients with dementia, because they may be dangerous. The variety of foods provided at the table should be limited to prevent confusion. The clients should be placed near people they could mimic during meals, not encouraged to sit alone for meals.

The nurse caring for clients with dementia and Alzheimer's disease in a long-term care setting explains to the new nurse how multi-infarct dementia (MID) differs from AD. Which of the following is one of these differences? Select one: A. AD has a faster onset. B. AD does not cause dementia. C. MID usually coexists with other conditions. D. AD progresses in step-wise fashion instead of gradual and continuous.

MID usually coexists with other conditions MID can be distinguished from AD in the following ways: (1) It has a faster onset; (2) it progresses in a stepwise fashion (not gradually and continuously); (3) it usually coexists with other conditions e.g., diabetes, high blood pressure, cardiac disease, previous strokes. Both conditions are forms of dementia.

The nurse is assisting an aging client with nutritional needs. Which fact should the nurse keep in mind when planning meals for this client? Select one: A. Older adults' fat intake should not exceed approximately 10% of total caloric intake. B. Older adults absorb nutrients more quickly. C. Older adults' specific nutrient requirements vary greatly from younger people. D. Older adults have reduced caloric needs.

Older adults have reduced caloric needs. Older adults absorb nutrients more slowly, and their caloric needs are reduced because of the slowing of metabolism. In general, older adults need to consume fewer calories while meeting their specific nutrient requirements, which vary only slightly from those of younger people. The older adult's fat intake should not exceed approximately 35% of total caloric intake.

When planning meals for older adults in a long-term care facility, the nurse keeps in mind the hydration needs of older adults. Which of the following is a nursing consideration related to intake of fluids for these clients? Select one: A. Older adults have larger fluid reserves to protect against dehydration. B. Older adults experience a stronger thirst mechanism than younger adults. C. Older adults should limit fluids if incontinence is a problem. D. Older adults need to be encouraged to drink fluids.

Older adults need to be encouraged to drink fluids. Many older adults do not experience thirst as strongly as do younger people. Sometimes, the older adult avoids drinking fluids because of problems with urinary incontinence, urinary retention, or frequency. Dehydration is a serious and frequently overlooked problem in this age group. The nurse should offer a variety of fluids and provide assistance to clients who are unable to consume fluids independently

Which of the following diseases is characterized by tremor, rigidity, akinesia, and postural problems?

Parkinson's disease

An elderly client wants to move into a congregate housing facility. What information should the nurse provide regarding congregate housing? Select one: A. Clients spend only part of their day in this facility. B. Personnel from the facility will check on each client daily. C. Only clients with disabilities can use this facility. D. Clients at this facility are supervised in all activities.

Personnel from the facility will check on each client daily. The nurse should inform the client that the personnel from the facility check on each client daily. Clients in congregate housing may have no supervision or only minimal supervision and are not supervised in all their activities A medical daycare program, not congregate housing, is a program in which the client spends only part of the day at the facility. Congregate housing facilities are available for older adults as well as individuals with disabilities.

The nurse is arranging discharge for an elderly client to a skilled nursing facility (SNF). Which of the following is a characteristic of this type of facility? Select one: A. Physicians are on call and provide supervision to the advance practice nurse. B. The facility does not provide rehabilitation services. C. The primary care or "medical oversight" is usually provided by a physician. D. Clients in an SNF plan to live there the rest of their lives.

Physicians are on call and provide supervision to the advance practice nurse. In an SNF, physicians are on call and are required to make regular visits to residents, as well as to provide supervision for the advance practice nurse. The SNF provides rehabilitation services, special diets, and access to pharmacy, x-ray, and laboratory services. Occupational, physical, recreational, and speech therapists are usually on staff or serve as consultants. The primary care or "medical oversight" is often provided by an advance practice nurse (nurse practitioner). Some clients may plan to live there indefinitely. Other clients may come to the SNF to recuperate following injury, surgery, or severe debilitating illness, but plan to return to independent living

The nurse is using therapeutic communication techniques when counseling residents of an assisted-living facility. What is a recommended guideline for this process? Select one: A. Place older clients in double rooms to encourage social interaction. B. Do not engage a client with speaking difficulties in a conversation. C. Allow the client to speak without actively participating in the conversation. D. Stand up when speaking to demonstrate interest and respect.

Place older clients in double rooms to encourage social interaction. In a hospital or nursing-home setting, placing older clients in double rooms is usually best, to help prevent isolation and provide more environmental stimulation. Communication is a two-way process. Therapeutic and social communications have different approaches that should be used with all clients, including those with speaking difficulties. The nurse should be aware of the meanings of touch and body language, make appropriate eye contact, and show genuine interest when visiting. The nurse should also listen attentively and sit down when speaking to demonstrate interest and respect.

When bathing a client with dementia, the nurse recognizes which intervention as being effective

Preparing the water and supplies before the client enters the bathroom

An aging adult who has diabetes needs assistance with ADLs. What is the current trend for caring for adults with manageable conditions? Select one: A. Provide care in an assisted living facility. B. Provide care in a nursing home. C. Provide care in the client's own home. D. Provide care in a family member's home.

Provide care in the client's own home. Most aging adults live in their own homes and are able to care for their own needs independently. For aging adults with manageable conditions, the current trend in healthcare is to provide needed care in the client's home. To some degree, measures such as financial aid, Medicaid, food stamps, and rental and fuel assistance, help aging adults to remain in their homes.

A nurse is caring for a 72-year-old client with a fracture in the neck of the femur. What should the nurse keep in mind when preparing a diet chart for the client? Select one: A. Provide unsaturated fats containing essential fatty acids. B. Provide 1 g of protein per kilogram of body weight. C. Provide maximum of 40% of the total calories as fat intake. D. Restrict the client's fluid intake to prevent edema.

Provide unsaturated fats containing essential fatty acids. The nurse should provide unsaturated fats containing essential fats rather than empty-calorie fats such as fried foods and chocolates. In old age, the body's fluid volume is decreased. Hence, fluids should be encouraged, not restricted. The protein intake should not be restricted to only 1 g/kg of body weight. The client needs an increased protein intake to facilitate healing of the fracture. A maximum of 35%, not 40%, of the total calorie intake should be from fat.

A client is to be admitted to an intermediate care facility (ICF). Which of the following should the nurse tell the client about the ICF? Select one: A. Ensures assistance with social services B. Employs unlicensed assistants to provide care C. Provides rehabilitation services to clients D. Provides basic care with a nurse on call

Provides basic care with a nurse on call The nurse should inform the client that the ICF provides basic care to clients with a nurse on call. ICFs provide room, board, and some nursing care. The ICF always employs a licensed nurse on duty and not unlicensed assistive personnel to provide care. The ICF provides fewer services and less extensive care than the skilled nursing facility (SNF); hence, rehabilitation services and social services are provided at an SNF and not at an ICF.

A nurse is informing a client at a long-term care (LTC) facility regarding Centers of Excellence (COE) programs. What information should the nurse provide the client regarding the COE programs? Select one: A. Offers financial support for clients at the LTC facility B. Provides care for clients with specific disorders C. Imparts care only to clients with mental illness D. Assists in improving the quality of care at the LTC facility

Provides care for clients with specific disorders

The nurse is explaining the services provided in a long-term care (LTC) facility to the family of an elderly client being transferred there. Which of the following would the nurse state as a requirement in LTC facilities? Select one: A. Full healthcare clinic B. Chaplain C. Swimming pool/whirlpool D. Recreation program

Recreation program A planned recreation program is a requirement in LTC facilities. The program's complexity is often based on the level of functioning of the facility's residents. In some facilities, particularly those sponsored by a religious organization, a chaplain and formal chapel may be available for regular services, counseling, and individual prayer. In many cases, a swimming pool, whirlpool, or sauna is available Some facilities have a full healthcare center on site, with a complete medical office and pharmacy, staffed with physicians, advance practice nurses, podiatrists, dentists, mental health professionals, pharmacists, and other healthcare professionals.

A 79-year-old woman who is living independently in her home needs help with ADLs following a hip replacement. Home care is not an option because of the level of care she currently needs. Which of the following facilities would be the best option for care? Select one: A. Subacute care facility B. Senior center C. Assisted living facility D. Rehabilitative care facility

Rehabilitative care facility 1 The rehabilitative care facility provides 24-hour care for a few weeks or months, but the client eventually returns home after recovery from a disabling (e.g., cerebrovascular accident) or traumatic (e.g., hip fracture) experience. 2 Senior centers provide social interaction and opportunities for peer group relationships, but do not provide rehabilitation. 3 An assisted living facility provides room and board, laundry, and some personal assistant services, but not the rehabilitation this client needs. This client needs a focus on rehabilitation, not subacute care.

The nurse is using remotivation techniques to treat an elderly client with depression. Which of the following is an example of the use of this technique? Select one: A. Providing physical exercise, such as walking outside B. Providing a pet for companionship C. Doing crossword puzzles or playing cards D. Reminiscing about a patient's past accomplishments

Reminiscing about a patient's past accomplishments Remotivation is an important adjunct to therapy. This reality orientation attempts to focus attention on the present, calling on memories from the client's past (reminiscence). Reminiscence and reality orientation are useful strategies to promote mental stimulation and validation of life's past events. Cognitive and physical therapy encourage thinking exercises and physical exercise, respectively. Pet therapy provides pets to clients to provide companionship, stimulate the sense of touch, facilitate interactions, and encourage a sense of responsibility.

A nurse is caring for a client at the long-term care (LTC) facility. What information should the nurse provide the client about the meal program there? Select one: A. An ombudsperson oversees the client's dietary intake. B. Residents can select the meal program they prefer. C. The case manager selects the client's meal program. D. A nurse practitioner oversees the client's dietary intake.

Residents can select the meal program they prefer. The case manager oversees the client's dietary intake. Neither the ombudsperson nor the nurse practitioner oversees the client's dietary intake. The ombudsperson sees that the client's legal rights are not violated. The nurse practitioner provides primary care or "medical oversight."

The nurse is administering donepezil (Aricept) to a client who is diagnosed with Alzheimer's disease (AD). What is the therapeutic affect of this drug? Select one: A. Treats vascular dementia accompanying AD B. Treats depression of AD C. Treats moderate to severe AD D. Slows memory impairment

Slows memory impairment Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) slow memory impairment. Memantine (Namenda) treats moderate to severe AD. Antidepressants include trazodone (Desyrel) and fluoxetine HCl (Prozac). Antihypertensives are used in prevention of vascular dementias, which can accompany AD.

he daughters of an aging man who lives alone agree to help their father to stay independently in his home by using available community and social services. Which of the following is the biggest disadvantage of home care? Select one: A. Nutritional needs may not be addressed. B. Basic hygiene needs may not be met. C. Independence may not be attained. D. Social needs may not be addressed.

Social needs may not be addressed. Living at home helps the client retain independence. However, the home environment may limit social interaction. Using community resources, such as visiting nurses, meals on wheels, and home care aides, would address the hygiene and nutritional needs.

Each state, U.S. territory, and the District of Columbia must have a quality improvement organization (QIO) contracted with CMS to provide support and oversight to LTC facilities. What are functions of quality improvement organizations? Select all answers that apply. Select one or more: A. Quality improvement for facility manager B. Monitoring techniques and intervention strategies C. Staff development D. Providing advance degree nursing courses E. Informing clients of their rights F. Training nonlicensed personnel

Staff development, Monitoring techniques and intervention strategies, Quality improvement for facility manager, Training nonlicensed personnel Functions of QIOs include the following: providing educational materials and resources to facilities for staff development, guidance for quality improvement for facility managers and staff (to improve care), monitoring techniques and intervention strategies to improve care, and giving recommendations for training and/or certification of nonlicensed personne

The nurse is assisting a frail adult with an impaired swallowing mechanism to eat a nutritious meal. Which of the following nursing interventions would be appropriate for this client? Select one: A. Cut the food into large pieces and allow the client to cut smaller pieces. B. Have the client lie in bed for meals. C. Suggest that the client bend the chin toward the chest. D. Provide larger, less frequent, meals of semisolid foods.

Suggest that the client bend the chin toward the chest. Suggesting that the client bend the chin toward the chest while swallowing can help in preventing aspiration (choking). For meals, the nurse should elevate the head of the bed or, if possible, have the client sit in a chair. Cutting food into small bites will enable the client to chew food easily and helps prevent choking. Clients may better tolerate semisolid foods and thickened liquids and may prefer small, frequent meals to large, less frequent meals.

A client with mild dementia who lives in a board-and-care-home is getting worse and needs more care. Which of the following would be the next level of housing appropriate for this client? Select one: A. Hospice care B. Senior apartment complex C. Supervised group home D. Congregate housing

Supervised group home A person may live in a board-and-care home, which provides room, board, and minimal supervision. Many people with mental illnesses and/or physical disabilities live in board-and-care or adult foster care homes. the next level of housing is the supervised group home. In this facility, clients are supervised regarding medications and are often required to participate in a treatment program or to work or volunteer a specific amount of time weekly Other types of congregate living facilities, such as senior apartment complexes, provide more services for older clients or for those with disabilities. Hospice care or end-of-life care may be provided to individuals in congregate living facilities

1) A client with moderate Alzheimer disease (AD) is prescribed memantine. When explaining to the caregiver how the drug will be beneficial for the client, what information should the nurse provide? a. The drug will prevent aggressive and combative behavior. b. The drug can delay progression of some of the symptoms of AD. c. The drug will arrest any further cognitive impairment. d. The drug will cure AD.

The drug can delay progression of some of the symptoms of AD. Explanation: Memantine (Namenda), an N-methyl D-aspartate (NMDA) antagonist, is a drug used to treat moderate to severe AD. As with cholinesterase inhibitors, the drug memantine can delay progression of some of the symptoms of moderate to severe AD. The drug will not prevent aggressive and combative behavior, arrest any further cognitive impairment, or cure AD.

The nurse should consider the following measures when working with paranoid clients: keep the environment calm and predictable; remove excess stimulation or items that can contribute to misperceptions; reassure the clients that they are safe

The neurologic examination for diagnosis of dementia includes tests of vision, eye movement, muscle tone and strength, reflexes, coordination, and mental status

Nurses care for clients in a variety of healthcare settings. What is the term for the movement clients make between healthcare practitioners and settings as their conditions and care needs change during a course of acute or chronic illness? Select one: A. Transitional care B. Handover care C. SBAR process D. Universal transfer

Transitional care ransitional care "refers to the movement patients make between healthcare practitioners and settings as their conditions and care needs change during a course of acute or chronic illness The term handover or handoff implies transfer of information, as well as the professional responsibility to make sure information is understood by the receiver. A Universal Transfer Form (UTF) is used in several states to improve the handover or transition process The SBAR process presents a method of organizing information in preparation for a handover.

The nurse is caring for a client who is taking haloperidol (Haldol) for dementia. For which of the following conditions related to this drug should the nurse monitor? Select one: A. Urinary retention B. Constipation C. Joint stiffness D. Respiratory distress

Urinary retention Drugs, such as the antipsychotic haloperidol (Haldol), can cause urinary retention. Reducing the haloperidol dose may help prevent overflow incontinence.

A nurse is caring for an older adult who does not comply with the medication program because of forgetfulness. What is the best technique for the nurse to do to help the client in taking her medications? Select one: A. Appoint a volunteer to assist with administration of medication. B. Place a list of medications in the client's wallet. C. Use organizers to place daily medications. D. Provide medications on time every day.

Use organizers to place daily medications. This helps the client to remember & Using organizers encourages self-care by the clients. The nurse or a volunteer need not provide medications to the client every day. A list of prescribed medications is not of much help to the forgetful client. The list must also mention the dose and time when the medications should be taken.

The nurse caring for older adults in a nursing home setting know that most older adults are active and healthy and able to perform typical activities of daily living (ADLs). What are considered instrumental activities of daily living (IADLs)? SATA Select one or more: A. Managing money B. Taking care of household maintenance C. Preparing meals # ADLs D. Using a cell phone E. Using a computer

Using a cell phone, Managing money, Using a computer, Taking care of household maintenance IADLs complex tasks # household maintenance, managing money, or technologies,

The nurse caring for older adults in a long-term care facility compares the residents' current weight with their usual weight. Which of the following would be a significant finding that should be reported to the physician? Select one: A. Weight loss within the past month that is greater than 5% of the total body weight B. A loss of 15% or more of body weight within the past 6 months C. Weight loss within the past month that is greater than 10% of the total body weight D. A loss of 5% or more of body weight within the past 3 months

Weight loss within the past month that is greater than 5% of the total body weight Weight loss within the past month that is greater than 5% of the total body weight, or a loss of 10% or more of body weight within the past 6 months, is significant.

A nurse is caring for a client who has been admitted to the hospital. Which of the following services is a priority for a nurse in the acute hospital setting? Select one: A. Helping clients with rehabilitation after a stroke B. Working to stabilize the client during the acute phase of illness C. Working closely with the client's caregivers D. Helping clients to achieve maximum level of functioning

Working to stabilize the client during the acute phase of illness In a hospital setting, the nurse works to stabilize the person during the acute phase of illness. Hospitals are healthcare facilities that deal almost exclusively with cases of acute injury or illness. Nurses working in extended-care facilities and assisted living services help clients in recovering after an acute illness, work closely with the client's caregivers, and aid clients to achieve a maximum level of functioning.

an elderly client recovering from stroke was dischaged from an extended care facility after 20 days. which facility ws the client admitted to? a continual care facility b medically complex care c skilled nursing gacility d intermediate care facility

a RATIONALE: The client was provided care at a continual care facility, which is an extended-care facility where the client remains for a period of 1 to 4 weeks. Clients who do not require care in continual care facilities are admitted to medically complex care units. Skilled nursing facilities and intermediate care facilities are long-term care facilities that provide rehabilitation services for longer durations.

a nurse is required to assess a client with dementia for signs of paranoid behavior. Which behavior for the client demonstrates paranoia? a client accuses others of stealing her belonging b client has a false perception of hearing voices c client believes that her spouse is trying to kill her d client uses hostile language and makes verbal threats

a RATIONALE: A paranoid client may accuse others of stealing her belongings. A client with the false perception of hearing voices has hallucinations. A client's belief that her spouse is trying to kill her indicates delusion. Verbal abuse, such as using hostile language and making verbal threats, indicates agitation and aggressive behavior.

a nurse is providing care for an elderly client who has diabetes. What nursing measure is the nurse likely to undertake when caring for such a client? a provide bladder retraining b provide a daily bath to the client c cut the client;s fingerneails d shave the client's facial hair

a RATIONALE: Aging adults with diabetes may have frequency of urination and incontinence. The nurse should help the client with bladder retraining. An elderly client need not be bathed daily, because the skin is dry and fragile. However, personal hygiene must be maintained. The nurse is not allowed to cut the fingernails of a diabetic client; the podiatrist does this. The nurse need not shave the client's beard. The client should be allowed to do it himself. The nurse should assist the client only if needed.

the nurse is asked to test a clien's skin turgor. What should the nurse assess for by performing this test? a signs of dehydration b pressure areas c peripheral edema d tactile sensation

a RATIONALE: The nurse should perform skin turgor tests to determine signs of tenting, which indicates whether the client is dehydrated. Pressure areas are not indicated when the skin turgor is tested. Peripheral edema is determined by putting pressure on the area for few seconds and then releasing it to notice the presence of any pitting; A skin turgor test does not indicate sensory functions and therefore will not indicate the tactile sensation of the client

1) The nurse is caring for a client at risk for aspiration. What action should the nurse take when assisting the client with the meal to prevent aspiration? a. Have the client bend the chin toward the chest when swallowing. b. Suction the client frequently during the meal. c. Have the client's food pureed. d. Place the client on the side while eating.

a Have the client bend the chin toward the chest when swallowing Explanation: Suggesting that the client bend the chin toward the chest while swallowing can help in preventing aspiration (choking). A suction apparatus should be present when the client is eating but the client should not be suctioned several times during the meal. This deprives the client of oxygen and may cause gagging with vomiting. It is not necessary to puree the client's food unless the client is edentulous and not able to chew food which is not indicated in the scenario. The client should be sitting in an upright position and not on the side.

A nurse is assessing a client for progressive dementia. Which of he following should the nurse assess for in this client? SATA a difficulty with functional skills b signs of hyperactivity c imapired arithmetic calcualtions d loss of language skills e altherd level of consciousness

a, c, and d RATIONALE: The nurse should assess for impaired functional skills, impaired arithmetic calculations, and loss of language skills in clients with progressive dementia. Progressive dementia is a chronic, irreversible condition that affects cognitive function, which is the ability to think, understand, and interact with the surrounding world. Signs of hyperactivity and altered levels of consciousness are seen typically in clients with delirium, not dementia

aclient with AD is admitted to along term care facility. WHich of the following services do volunteers provide? SATA a take residents on outings b oversee the clien;s dieatary intake c organize fund raising program d help with the client daily care e receive the client monthly check

a, c, and d RATIONALE: Volunteers in a long-term care facility may take residents on outings, organize fundraising programs to help raise money for special programs, and help with the client's daily care. Volunteers provide services that allow more time for nursing staff to provide skilled nursing care. The case manager, not the volunteer, oversees the client's dietary intake; the case manager, not the volunteer, receives the client's monthly check and disburses the funds appropriately.

An elderly client's daughter wants to leave her mother at a senior care center when she goes out to work. What facilities are available at senior care cneters? SATA a educational discusssions b laundry services c recreational games d monitored healthcare c lunchtime meals

a, c, and e RATIONALE: Senior care centers provide temporary respite to caregivers of elderly clients. The services they provide include educational discussions, recreational games, and lunchtime meals. They do not provide laundry services, as provided by retirement communities, nor do they provide monitored healthcare, as provided in long-term care facilities.

an elderly client is admitted to a skilled nursing facility SNF two months after the death of her husband of 60 years. which of the following recreational activites should the nurse invlolve the clientt in? SATA a crafts, cards, and other games b indepentent outings in the community c Wii goft or blowling d monthly theme carnival with games and food for residents and family members e musical programs f cultural evants such as a play

a, c, d, and e RATIONALE: The nurse should involve the client in recreational activities that may include crafts, cards, and other games; supervised outings, not independent outings, in the community; sports activities such as Wii golf or bowling; a monthly theme carnival with games and food for residents and families; and musical programs and cultural events, such as plays.

an elderly client is being cared for at an assisted living facility. which servie is available at an assistant living facilty? a 24 hours care by a licensed nurse b grocery & mediaction delivery c bowel and bladder retraining program d primary healthcare facilities

b RATIONALE: Assisted living facilities provide for grocery and medication delivery to the clients. These facilities give older adults the opportunity to age in their own homes, while maintaining independence, individuality, privacy, and dignity. Assisted living facilities are provided with home care nurses who visit the clients at regular intervals, but they do not provide 24-hour nursing care. Skilled nursing facilities, not assisted living facilities, offer bowel and bladder retraining programs. Assisted living facilities do not provide primary healthcare but help clients remain independent by assisting in activities of daily living

a nurse is assisting the healthare provider to assessing a client for dementia. Which is part of the assessment during psychometric testing a indetifying behavioral problems b determining judgment and planning abilities c assessing for sleep pattern disturbances d testing for ability to communicate

b RATIONALE: Psychometric testing includes testing of judgment and planning abilities. Behavioral problems are identified when conducting a psychological assessment, and assessing for sleep pattern disturbances is done as a part of physical assessments. The ability to communicate is assessed when determining the client's ability to perform ADL.

a nurse is caring for a client with dementia who needs assistance with daily care. What measure should the nurse employ? a keep ready all the clothes to be worn b give pain medication before bathing the client c provide clothes with buttons and zippers d give the client a cup of coffee immediately after the bath

b RATIONALE: The nurse should give pain medications before performing care measures, such as bathing. Instead of keeping all the clothes ready at one time, the nurse should hand over the clothes one at a time in sequence. Clothes with buttons or zippers should be avoided for elderly clients with arthritis, who may have lost finger dexterity. Clients with dementia should not be encouraged to wear pullovers, because covering the head is a frightening experience for such clients. If a button-down shirt is used, the client may need help managing the buttons. The nurse should not give the client a cup of hot coffee because the client may have poor judgment and may be likely to spill the hot coffee and get burned.

An aging adult is being treated for constipation. Which should the nurse make sure is increased in the client's diet? a protein intake b fiber intake c vitamin d fat

b RATIONALE: The nurse should increase the amount of fiber in the client's diet. An increased intake of fiber reduces constipation. Increased protein is given in case of injury to the client. Vitamins are provided in adequate amounts; increased intake may have side effects. Aging adults should not take in high amounts of fats, because they increase the risk of disorders related to obesity

a client has been admitted to a healthcare facility due to elder abuse. What is the most common category of elder abusers? a siblings b childrent c friends d spouses

b RATIONALE: Children are the major group of elder abusers. The relatives and spouses of the clients follow them. Then come the various service providers of the clients. Friends, grandchildren, and siblings are less commonly elder abusers.

An elderly client has difficulty swallowing food. How can a nurse help in such a condition/ SATA a place the pt in a lateral recumbent position b Elevate the head end of the client's bed c Encourage the client to bend his chin toward the chest d cut the food into smaller bites e provide less frequent meals to the client

b, c, and d RATIONALE: The nurse should cut the food into smaller edible bites, elevate the head end of the bed, and encourage the client to bend his chin toward his chest when swallowing. The client should not be placed in a lateral recumbent position when feeding. He should be encouraged to sit in a chair if possible. Instead of heavy, less frequent meals, the client should be provided light, frequent meals.

an elderly client wiith AD is admitted to the ectendedc are facility. which of the following are part of an extended care facility? SATA a intensive care unit b SNF c subacute care d emergency department e nursing home beds

b, c, and e RATIONALE: Extended-care facilities often include areas designated as skilled nursing care, subacute care, and nursing home beds. Many facilities also include areas specifically designated for specific disorders, such as dementia. The intensive care unit and the emergency department are parts of a hospital and not of an extended-care facility.

A nurse is caring for a client ith dementia. Te nurse should removes which of the following items from the client's environments? SATA a electrical razors b mirrors c intercorms d door buzzers e lamps

b, c, and e RATIONALE: The nurse caring for a paranoid client should remove items that lead to excess stimulation or items that can contribute to misperceptions, such as mirrors, intercoms, and lamps. The client's environment should be kept calm and predictable. The nurse should allow the client to use an electric razor, because it is safe to use. Door buzzers are installed to alert caregivers in case the client wanders.

1) A client with Parkinson disease is experiencing subcortical dementia. What early findings does the nurse expect to observe? Select all that apply. a. Language impairment b. Depression c. Clumsiness d. Irritability e Apathy

b, c, d, e Explanation: Early symptoms of subcortical dementia include: depression, clumsiness, irritability, and apathy. As subcortical dementia progresses, symptoms that reflect cortical dementia will appear, that is, problems with memory and judgment. The end stages result in the total breakdown of brain function of both the cortical and subcortical areas. Language impairment is a symptom of cortical dementia.

1) An adult child of a client has a complaint regarding the care the adult child's parent has received at an extended-care facility. To whom should the family member first state the complaint? a. State ombudsperson b. Facility administration c. The state's attorney d. The client's insurance company

b. Facility administration Explanation: Most clients in healthcare facilities are designated as vulnerable adults and are protected by law from abuse or neglect. The ombudsperson is responsible for protecting their rights. Complaints are first referred to the facility's administration. If these complaints cannot be resolved at the local level, the state ombudsperson is consulted.

1) An alert, oriented client voided incontinently, soiling clothing. What action by the nurse is a priority? a. Inform the client to use the bathroom next time. b. Provide assistance with washing and changing clothing. c. Tell the client that an adult diaper must be worn. d. Insert an indwelling catheter.

b. Provide assistance with washing and changing clothing. Explanation: Incontinence may embarrass adults and can be a source of social isolation because the client is afraid of leaving the security of a ready bathroom. Be sensitive to treating this situation with dignity and discretion. Do not chide or scold anyone for episodes for example by telling them that they must use the bathroom next time. Instead, provide assistance in cleaning the skin and changing clothes, as needed. Evaluate incontinence to identify its cause; some forms can be eliminated with correction of the underlying problem. Catheters are not the treatment of choice for urinary incontinence because they can introduce infection-causing microorganisms into the urinary tract. Offering an adult brief is an option but the client may refuse. The nurse should not "tell" the client that it is mandatory to wear one.

1) A new LPN is preparing to administer medication. What action by the LPN requires the charge nurse to intervene? Select all that apply. a. The LPN asks if the client would like to take the medication with water or juice. b. The LPN is crushing an enteric-coated aspirin. c. The LPN is hiding a pill in applesauce when the patient refuses the pill. d. The LPN informs the client what medication is being administered. The LPN has the client swallow each pill individually

b. The LPN is crushing an enteric-coated aspirin. c. The LPN is hiding a pill in applesauce when the patient refuses the pill. Explanation: Intervention is required when the charge nurse observes the LPN crush enteric-coated tablets because they are not meant to be digested in the stomach. Intervention is also required when the LPN is observed "tricking" a person into taking a medication by hiding it in food because that action is illegal. Every person has the right to refuse medications unless a specific court order exists stating otherwise which is not indicated in the scenario. Giving the client the option to take the medicine with juice or water is appropriate as is informing the client about the prescribed medications and allowing the client to take pills individually and not all at once.

an elderly client with dementia is brough to the healthcare facilty by her son, who is unable to care for her during the day because of his job. which program should the client be involved in? a hospice care b nursing home d respite care d transitional care

c RATIONALE: The client should be involved in respite care programs in which the client spends part of the time in a healthcare facility, giving the family some time to themselves. However, caregivers must be available to care for the client before and after the period of respite care. Hospice care is provided for clients who are terminally ill. Nursing homes are long-term care facilities that provide care for clients who require care throughout the day and for long durations. Clients remain in transitional care facilities for periods of only 1 to 4 weeks.

an elderly client with a chronic conditionn is being cared for by unlicensed assitive peronnel UAP at an assisted living gacility. Whihc team member monitors the funcions of the UAP? a care manager b ombudsperson c visiting nurse d helthcare providers on call

c RATIONALE: Visiting nurses may be asked to monitor the functions of UAP. People who regularly receive services from UAP usually live alone or have inadequate support from family or friends. The care manager is the client's local advocate and ensures that the client is receiving appropriate care but does not monitor the functions of UAP. The ombudsperson is responsible for seeing that the client's rights are not violated but does not monitor the UAP. Healthcare providers on call provide supervision for advanced nurse practitioners but do not monitor UAP.

An older adult decides to leve away from his family, but wants to stay in a care center where he can be proveded both care and privacy. Which type of facility should a nurse suggest? a senior care center b assisted living facilities c retirement complexes d rehabilitative care facilities

c RATIONALE: Retirement complexes offer clients the freedom and privacy of living in their own apartment. They may have the option of assisted living in these complexes. An assisted living facility is a category of long-term care facilities. A client may stay for a few days in an assisted living facility and then return home. A rehabilitative care facility is also a category of long-term care facilities. Here too, a client may stay for a few weeks or months after recovering from a disability and eventually return home. Senior care centers provide care for older adults but do not allot separate rooms or apartments to each client.

1) The nurse is talking with a family member of an older adult client with dementia. The family member reports that the client becomes more confused, aggressive, and combative in the evening. What suggestions can the nurse provide to the family member to decrease this behavior? Select all that apply. a. Sedate the client every evening before mealtime. b. Have the client restrained to avoid injury. c Maintain a routine for the client d Limit daytime sleeping. e. Limit sugar and caffeine intake.

c, d, e Explanation: Sundowning, sundown syndrome, or late-day confusion are terms that refer to a state of confusion at the end of the day and into the night. The person's behaviors change from a normal pattern to a state of confusion, anxiety, aggression, or combativeness. The fading light at sunset seems to be a trigger for the problem. Maintain a routine for daily hygiene, meals, activities, and bedtime. Limit daytime sleeping so that the adult is sleepy at nighttime. Limit sugar and caffeine in the afternoons and evenings. Use night-lights. Provide a quiet environment that is free of stimulating activities. Use the same person, whenever possible, to provide care. Sedation is not appropriate and may cause injury if the client attempts to walk around in the evening. The restrained client may become more disoriented and agitated if restrained.

1) A client with dementia at the long-term care facility states to the nurse, "I want to go home." What is the best response by the nurse? a. "You have repeatedly asked me the same question." b. "You can't live at your house anymore, it isn't safe." c. "You are safe here. Let's go eat lunch." d. "No one can take care of you at home anymore."

c. "You are safe here. Let's go eat lunch." Explanation: The person with dementia who resides in a long-term care facility may state, "I want to go home." Do not try to convince the resident that this is the home that has been part of the person's past life. It is not the "home" that the individual remembers. The nurse can make statements, such as "You are staying here. You are safe here." Distracting the person by initiating an activity may also help. The other responses are not therapeutic.

1) The nurse observes that a client with dementia can't remember the name of a grandchild and now requires assistance with picking out clothes to wear. What phase of dementia does the nurse determine the client is experiencing? a. Mild decline b. Moderate decline c. Moderately severe decline d. Severe decline

c. Moderately severe decline Explanation: In moderately severe decline, the individual cannot remember important numbers and names such as birthdays, phone numbers, grandchildren, and friends. They are confused about time of day or day of the week and require assistance with some ADLs, such as picking out clothes to wear. In mild decline there is trouble making plans, with noticeable changes in thinking and reasoning. The client may repeat things a lot and has difficulty remembering recent events. In moderate decline, there are increasing problems making plans and remembering recent events. Traveling and handling money become difficult. Severe decline results in an inability to remember the name of the spouse. ADLs become more difficult and the client needs help eating and getting to the bathroom. Changes are noted in personality and emotions.

1) An older adult frail client in a healthcare facility develops a large sacral pressure wound. What outcome does the nurse anticipate will occur from this incident? a. The facility will be mandated to close. b. Nursing personnel caring for this client will be terminated. c. The facility will not be reimbursed for care. d. The client will have to pay out of pocket expenses.

c. The facility will not be reimbursed for care. Explanation: All healthcare facilities are charged with providing careful and appropriate skin care to clients/residents. The Centers for Medicare/Medicaid Services (CMS) continues to stress the importance of pressure wound prevention, as well as meticulous skin and wound care. In most cases, a facility will not be reimbursed for treatment of pressure wounds originating in the facility. The nursing personnel will not be terminated but the incident should be investigated. The client is not responsible for the lack of preventative care.

which client is a good candidate for an exteded care facility a a client wiht a recent hip fracture b a client admitted for join surgery c a client wiht head trauma after an accident d an elderly client with AD

d RATIONALE: An elderly client with AD is an ideal candidate to be admitted to an extended-care facility. Clients often receive care from extendedcare facilities for chronic conditions such as AD or after the end of an initial crisis period. The hospital stabilizes clients during the acute phase of illness such as a recent hip fracture; performs surgeries such as joint surgery; or cares for clients immediately after an injury as in case of accidents.

An elderly client has been diagnosed with Hirsutism. Which indicates the presence of hirsutism in this client? a impaired vision due to aging b altered sense of equilibrium c involuntary voidng of urine d presense of facial hair

d RATIONALE: Hirsutism is the presence of facial hair seen in postmenopausal women. Impaired vision due to the normal aging process is termed presbyopia. An altered sense of equilibrium is called loss of proprioception. Involuntary voiding of urine is termed incontinence.

A client living at a long term care facility feels that the staff is neglecting him. What measures should he take? a contact the facility's nursing director b use a buzzer to warn the staff members c speak to facility's social servies director d contact the facility' local administration

d RATIONALE: The client should contact the facility's local administration. Most clients in long-term care facilities are designated as vulnerable adults and are protected by law from abuse or neglect. If these problems cannot be resolved at the local administration level, the state ombudsperson may be called in to assist. Contacting the facility's nursing director or using a buzzer does not help in providing sufficient protection to the client. Social services may or may not be available at all longterm care facilities.

a nurse is employed at a long term facility caring for clients with dementia. Which nursing diagnosis should be included on nursing care plans for these clients? a age when changes began b association with medical events c deterorating mental status d ineffective family coping

d RATIONALE: The nursing diagnoses on the nursing care plans for the client with dementia could include ineffective family coping. A number of nursing diagnoses for clients, family members, or caregivers are identifiable from information the nurse gathers. The healthcare provider must perform a mental status evaluation to determine the cause of dementia. The healthcare provider, not the nurse, establishes the age when changes began, the exact functions lost in the client, and whether the dementia is associated with any medical or emotional

1) A client has developed a large pressure wound on the right trochanter. How can the nurse best ensure this client's nutritional needs are met to assist with healing? a. Encourage the client to drink 2 L of fluid per day. b. Increase fat intake to 50% of total caloric intake. c. Give vitamin and mineral supplements. d Increase daily protein requirements

d Increase daily protein requirements Explanation: An adult whose body needs to build and repair tissues after injury (e.g., pressure wound) or illness (e.g., cancer) has greatly increased daily protein requirements. The adult's fat intake should not exceed approximately 35% of total caloric intake. Vitamins and minerals are important; most can and should be obtained through a healthy diet, rather than supplements. Fluid replacement will maintain hydration but will not provide the nutrition required to heal the pressure wound.

1) An older adult client in a long-term care facility, who feels cold all of the time, reports this to the nurse. What is the best response by the nurse? a. "I will find a space heater for you to use to warm you up." b. "Use a heating pad at a higher setting." c. "Take hot baths." d. "Layer clothing to maintain internal warmth."

d. "Layer clothing to maintain internal warmth." Explanation: Keeping warm due to loss of subcutaneous fats is often noted in senior adults and especially common in the eldest adults. Layering of clothing is very beneficial and helps the client maintain internal warmth. Space heaters, hot baths and heating pads can be dangerous to the older adult client because there may be diminished sensation, which may cause burns.

1) A client is injured in a boating accident sustaining a femur fracture. What facility would be the first step in the continuum of care? a. Transitional facility b. Short-term rehabilitation unit c. Skilled nursing facility d. Acute care facility

d. Acute care facility Explanation: The acute care hospital may be the first step in the continuum of care for ill, injured, or disabled persons. The hospital stabilizes the person during acute illness, performs surgery, or cares for the client immediately after an injury. The client then enters another facility or accesses community resources while living at home, to continue toward achieving the maximum possible level of functioning. The transitional facility, short-term rehabilitation unit, or skilled nursing facility are options after the client has emergency care and is stabilized.

1) An older adult client in assisted living after recovering from an illness is having difficulty remembering what medication to take. What would be an appropriate option for this client to avoid complications? a. The client will have to live with a family member. b. The client will need to live in a long-term care facility to obtain medications. c. Request that the pharmacy put all of the medication in a daily pill reminder. d. Have a home health nurse come and set up a daily medication reminder box.

d. Have a home health nurse come and set up a daily medication reminder box. Explanation: Home care nurses may visit to evaluate clients or perform treatments, such as drawing blood for tests or changing dressings. Nurses may set up a daily medication reminder box for clients, to promote medication compliance and help prevent duplicate dosing. Each day's medications are placed into compartments marked for that day and for administration times during the day. The client should not be required to live with a family member or move to a higher level of care. The pharmacy must put the medication in a labeled pill bottle and not a pill reminder box.

1. A client has developed a large pressure wound on the right trochanter. How can the nurse best ensure this client's nutritional needs are met to assist with healing? a. Encourage the client to drink 2 L of fluid per day. b. Increase fat intake to 50% of total caloric intake. c. Give vitamin and mineral supplements. d. Increase daily protein requirements.

d. Increase daily protein requirements.

A nurse is caring for clients who have dementia and are living in a nursing home. Which of the following is a recommended guideline for dealing with behavioral issues? Select one: A. If a person balks, go away briefly and come back later with a pleasant tone of voice. B. Provide extra stimulation in the environment for a client with paranoia. C. If a person displays catastrophic reaction, forcibly remove the client from the activity. D. If a client displays aggression, leave the client and call for security

if a person balks, go away briefly and come back later with a pleasant tone of voice. Balking, which means refusing to do things, often occurs when clients do not understand what is expected. If a client balks, the nurse should go away briefly, and come back later with a pleasant tone of voice. Persons with dementias commonly display catastrophic reactions in which they become overly agitated when confronted with situations that are too overwhelming or difficult for them. The best approach when this occurs is to cease the activity and allow quiet time or time out. The nurse should keep the environment calm and predictable for a person with paranoia and remove excess stimulation or items that can contribute to misperceptions (e.g., mirrors, intercoms, lamps that cast shadows). If a client strikes out aggressively, the nurse should leave temporarily, allow the client time to calm down, and then return.

The nurse is caring for an elderly client who is diagnosed with presbyopia. Which statement describes this condition? Select one: A. A sensorineural hearing problem B. Impaired vision that results from normal aging C. Dry eyes related to the aging process D. The inability to use or understand speech

presbyopia # Impaired vision that results from normal aging Presbyopia is the specific name for impaired vision that results from normal aging. Presbyopia is caused by a loss of elasticity in the lens of the eye. Dry eyes are a common outcome of normal aging; for some individuals, they result from an autoimmune disease called Sjögren's syndrome. Presbyacusia is a sensorineural hearing problem and aphasia is the inability to use or understand speech.

A nurse is caring for an elderly client. During the nursing assessment, what sign of stress should the nurse watch for in the aging client? Select one: A. Attention to minute details B. Bradycardia C. Elevated blood pressure D. Urinary retention

sign of stress 1 Elevated blood pressure 2 frequency of urination or incontinence 3 does not pay attention to minute details, but rather lacks attention to details. 4 Tachycardia or an increase in heart rate

Gerontology C92 93 96

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