older adult exam 2 practice questions

A client is unresponsive, the skin is usually dry, confined to bed, with limited mobility and contractures, and the nutrition is less than adequate. Using the Braden score, which score will be assigned to this client's risk for pressure ulcers? A) 8, very high risk B) 8, at risk C) 18, high risk D) 18, moderate risk

Ans: A The nurse uses the Braden score to determine the plan of care. The lower the Braden score, the greater the risk. Scores of 9 or less are considered to be at very high risk, and additional pressure relieving surface and treatment of nutrition are important for this client.

A nurse performs a psychosocial assessment of an older adult living in the community. Which of the following statements best captures the nature of psychosocial assessment? A) It is a formalized psychological test of the individual's condition and needs. B) It aids in identifying and analyzing personality traits of the individual. C) It helps to identify the individual's need for psychiatric care. D) It is a component of holistic nursing care of older adults.

A psychosocial assessment is one component of the mind-body-spirit nature of holistic nursing care of older adults. It is not a formal psychological examination, nor does it exist to identify specific personality traits or the need for psychiatric intervention.

A nurse notes a 2-mm open shallow ulcer with a red wound bed on the great toe where shoe touched the skin. Which of the following should the nurse document? A) 2-mm stage II pressure ulcer B) Stage III pressure ulcer on great toe C) 2-mm skin tear with red wound bed D) Red ulcer on the great toe 2 mm in size

Ans: A The wound described is a pressure ulcer, and Pressure Ulcer Scale for Healing (PUSH) staging should be used to document all pressure ulcers. Wound documentation should also include size of wound bed. Stage II ulcers are partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.

A nurse administers medications to a group of older adults in a residential facility. Which of the following clients is most likely to experience adverse effects? A) A 77-year-old man with a creatinine of 3.6 B) A 78-year-old man with a body mass index of 35 C) An 84-year-old woman with iron deficiency anemia D) An 82-year-old woman with constipation

Ans: A Although age-related changes can influence skills related to taking medications, risk factors that commonly occur in older adults exert a stronger influence. A creatinine of 3.6 reflects renal failure, which will lead to increase in serum levels of medications. Iron deficiency anemia, obesity, and constipation do not impact the risk of adverse and altered effects.

A nurse is participating in a health fair that is being sponsored by a local seniors' center, discussing healthy skin and aging. Which of the following teaching points should the nurse emphasize? A) "You should limit your sun exposure to a small amount each day and keep your skin protected from direct sunlight for the remainder." B) "Many drugs can have an effect on your skin, so it's important to avoid most over-the-counter medications." C) "The health of your skin is primarily determined by your genes, so all you can do is try to maintain your overall level of health." D) "Even if you find it difficult to do, it's important to bathe once a day."

Ans: A Current recommendations emphasize the importance of a balanced approach that encourages small amounts of sun exposure each day for adequate vitamin D synthesis, but not so much that would lead to increased skin cancer risk. Many medications affect the skin, but it would be inappropriate for the nurse to recommend that older adults refrain from all over-the-counter medications. Genetic factors influence integumentary health, but this does not mean that other risk factors are irrelevant or nonmodifiable. It is unnecessary for most older adults to bathe every day.

A nurse plans activities each month at an assisted living facility. Which of the following activities is most cognitively stimulating? A) Book discussions B) Movie night C) Exercise D) Reminiscence therapy

Ans: A Feedback: The cognitive reserve model suggests that cognitive abilities can be improved through participation in creative and intellectually stimulating activities. Reminiscence may provide some social interaction and movies serve as a distraction. Exercise does increase the blood flow; however, the brain and neural circuits develop in response to environmental stimuli (neuroplasticity).

While a nurse is performing a recently admitted hospital client's morning care, the client states, "I'm pretty sure I'll never see my own apartment again." Which of the following responses by the nurse best demonstrates effective communication? A) "What is it that makes you feel that way?" B) ""I'm sure that's not going to be the case." C) "All in all, you're doing quite fine." D) "There's a lot that we can do, dear, to make sure that you do."

Ans: A Feedback: The nurse demonstrates empathy and respect, while also facilitating further assessment findings around the client's beliefs for recovery through the use of an open-ended question. The nurse should not demonstrate a false reassurance of recovery, nor downplay the client's concerns. The nurse does not use patronizing terms of address (dear, honey, sweetie).

A nurse monitors older adults at an assisted living facility for pressure ulcers. Which of the following older adult is at highest risk for a pressure ulcer? A) The obese older adult with continuous positive airway pressure (CPAP) mask B) The frail older adult with a hearing aid C) The older adult undergoing therapy for a weak hand D) The older adult preparing to walk a half marathon

Ans: A Medical devices that are commonly associated with increased risk for pressure ulcers include masks, orthotics, tubing, immobilizers, stockings or boots, nasogastric tubes, cervical collars or braces, and tracheostomy tubes and ties. People who are unable to move around independently are at high risk for pressure ulcers, not those who move and participate in physical activities.

A nurse notes that an older adult is unable to process complex thoughts and has difficulty forming sentences. Which of the following actions by the nurse is priority? A) Review medication administration record. B) Place the client on high fall risk precaution. C) Assess muscle strength and deep tendon reflexes. D) Orient the client to environment.

Ans: A Nurses need to be alert to the possibility that even a simple over-the-counter product is a common cause of mental changes in older adults. An acute confusional state can be precipitated by any medication or by medication interactions. Assessment of deep tendon reflexes will be important to assess fluid and electrolyte imbalances; review the medications first. Orienting the client and high fall risk may be needed (or not).

An older adult with heart failure and mild dementia states the intent to refuse low sodium diet and diuretics, stating: "It's important to me to live free, without restrictions on what I eat." The family is supportive. Which action, by the nurse, should be done first? A) Assure that the client understands the consequences of this decision. B) Discuss this decision with the older adult's family to plan for the future. C) Document the client's wishes in the plan of care. D) Notify the primary health care provider of the client's wishes.

Ans: A Feedback: All of these actions should be done; however, the primary concern is that the nurse assess the client's understanding of the consequences. During mild-to-moderate stages of dementia, assessment of decision-making ability is based on the person's ability to describe the importance or implications of the choice on his or her future health. Medical decision making is a complex process in which information is shared between clients and clinicians and among family and others who are affected by the outcomes.

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

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

A nurse addresses the social supports available for an older adult client. Which of the following should the nurse include in the plan? A) Ask the client direct questions about the barriers to the use of social supports. B) Decide which of the programs is the highest quality. C) Determine if family or friends could do the work. D) Provide the client information about services that are available.

Ans: A Feedback: Assessing barriers to support services is particularly challenging because direct questions about these issues often are inappropriate and usually are very threatening. Social supports are often erroneously seen as expensive, impersonal, and hard to arrange. Funding is available for such programs, though less than 20% of eligible adults use them. The quality of care is not necessarily lower than that provided by friends or family and an older adult is not disqualified by virtue of having friends or family available.

Centers for Medicare and Medicaid Services (CMS), the Institute of Medicine, and the Joint Commission have developed standards to address areas of concern for older hospitalized adults. Which of the following situations is of particular concern for an older adult with a hospitalization requiring complex care? A) Transitions in care B) Hospital-acquired respiratory infections C) Need for geriatric care manager D) Placement in an acute care for elders uni

Ans: A Feedback: CMS, the Institute of Medicine, and the Joint Commission have placed a high priority on the issue of older adults with complex medical problems who transfer between care settings, because they are particularly vulnerable to experiencing problems. Geriatric care managers and acute care for elders unit assist with this issue. Hospital-acquired urinary tract infections and wounds not respiratory infections are prevalent.

Active care management is often necessary in order to maintain wellness among older adults. Which of these older adults is most likely to require care management? A) A 90-year-old man who lives alone and has no living family members B) A 77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier C) An 81-year-old resident of a nursing home whose Alzheimer disease is progressing rapidly D) A 90-year-old man who has recently been transferred from an assisted living facility to an acute care setting

Ans: A Feedback: Community-dwelling older adults who may lack family involvement in their care often require independent community-based professional geriatric care management. Individuals who are experiencing acute medical conditions and who are in institutional or acute care settings are not frequent recipients of care management.

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

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

A resident of a nursing home has accused several members of the care staff of stealing jewelry from the overbed table despite the fact that the facility's policy requires residents to keep such valuables in a lock box. The nurse has responded empathically to the accusations and has explained why this is impossible, to no avail. Which of the following conditions is the client experiencing? A) Delusions B) Hallucinations C) Unresolved anger D) Illusions

Ans: A Feedback: Delusions are fixed false beliefs that have little or no basis in reality and cannot be corrected by appealing to reason. Hallucinations are sensory experiences that have no basis in an external stimulus. Delusions are not known to be a manifestation of unresolved anger. Illusions are misperceptions of an external stimulus.

A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. Which action can the nurse take to potentially minimize these expenses for clients? A) Become familiar with the various funding sources and their eligibility requirements. B) Teach older adults to be astute with their spending and saving patterns. C) Encourage older adults to make care providers aware of each chronic condition they live with. D) Provide care that is primarily focused on acute, rather than chronic, health problems.

Ans: A Feedback: Despite the complexity and limitations of programs, nurses need to know enough about the most common sources of payment for health services so they can understand and address some of the barriers to and challenges of implementing nursing care plans and discharge plans. Ultimately, this may have the effect of reducing some older adults' out-of-pocket expenses. Teaching about financial management is beyond the scope of the nurse and focusing on acute, rather than chronic, health problems is inappropriate.

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

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

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

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

A nurse is conducting a comprehensive psychosocial assessment of an older adult who has recently moved to the long-term care facility. How should the nurse best assess the client's motor function? A) Observe the client walking into or out of the room. B) Assess the client's deep tendon reflexes using a hammer. C) Perform passive range of motion exercises on the client's arms and legs. D) Position the client supine and ask the client to perform a leg lift with each leg separately.

Ans: A Feedback: In the context of a psychosocial assessment, motor function includes such assessment parameters as posture, movement, and body language. It is not an assessment of reflexes, strength, or range of motion.

. A 76-year-old Hispanic woman has been admitted to the hospital. There are no advance directives in the chart. Which of the following questions will best prepare the nurse to begin a dialogue with this client about advance directives? A) "With whom do you talk to about your health care decisions?" B) "I see that you have no advanced directives on your chart, could you tell me about that?" C) "Is there someone we should call to join us while we discuss your care?" D) "Tell me about your living arrangements; do you live alone or with others?"

Ans: A Feedback: Nurses need to identify patterns of culturally influenced decision making in order to ask questions and obtain relevant information from clients of different cultures. Why there are no advance directives on the chart is not the place to start to open the conversation. Whether or not she lives with someone, inviting family to join reflects an emphasis on family caregiving consistent with the Hispanic culture.

A nurse is teaching an older adult about possible involvement in Programs of All-inclusive Care for the Elderly (PACE). Which of the following statements by the older adult shows understanding? A) PACE programs provide several social and medical services on a managed care basis. B) PACE programs provide a cost-effective alternative to hospital-based acute care. C) PACE programs are more expensive than fee-for-service models but offer better health outcomes. D) There is pressure for Medicare and Medicaid to begin funding PACE programs.

Ans: A Feedback: PACE programs provide a range of services using a capitated managed care model. They are focused on meeting the needs of adults with chronic conditions and are not an alternative to in-hospital treatment of acute illness. They are less expensive than fee-for-service models and presently are receiving funding under both Medicare and Medicaid. The 2010 Affordable Care Act provides incentives for further expansion of PACE programs.

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

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

A nursing case manager monitors admissions into an acute care unit. Which of the following clients would be the most appropriate candidate for in-home skilled nursing care? A) A client requiring twice-daily dressing changes for a coccyx wound B) A client who has been admitted to the emergency department with a recent stroke C) A client with reoccurring urinary retention of unknown etiology D) A client who is scheduled for hip replacement surgery tomorrow

Ans: A Feedback: Skilled home care is most appropriate for older adults who are recovering from an illness or injury and have potential for returning to their previous level of functioning. Following a stroke, a client requires hospitalization. A client with a poorly understood or undiagnosed health problem would not be an ideal candidate for home care, nor would a preoperative client.

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

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

Which of the following points should the nurse emphasize when educating older adults about memory and cognition? A) Long-term memory loss is normal. B) Using calendars, notes, and imagery can help enhance memory. C) Drinking caffeinated beverages for mental stimulation is a good idea. D) Having a diminished capacity for learning is an inevitable part of growing older.

Ans: B Feedback: Metacognition means that an individual understands his or her own cognitive process, and this process will impact performance. Health education provides information about techniques to enhance cognitive abilities. Older adults benefit from internal and external memory-enhancing techniques, such as calendars, imagery, and notes.

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

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

A nurse in the long-term care facility plans a meeting to assist an older adult and family discuss end-of-life care options. Which of the following interventions is appropriate for the nurse to include in preparation for this event? (Select all that apply.) A) Assist the older adult to his or her wear hearing aid. B) Assure that the older adult is well rested. C) Obtain a private meeting room. D) Premedicate the older adult with Ativan (lorazepam). E) Schedule the meeting after a meal.

Ans: A, B, C Feedback: An important role of nurses is to promote optimal decision-making capacity by identifying and addressing the factors that influence cognitive functioning and is within the realm of nursing responsibilities (such as wearing hearing aid and being rested). Benzodiazepines and overstimulation (such as after a meal) can interfere with the older adult's capacity.

A nurse assesses older adults at risk for pressure ulcers. Which of the following assessment tools should the nurse use to identify those who might benefit from interventions? (Select all that apply.) A) Braden Scale B) Norton Scale C) PUSH Scale D) Reverse Staging E) Waterloo Staging

Ans: A, B, E Braden Scale has been recommended for identifying older adults who are at risk for the development of pressure ulcers. The Norton and Waterloo scales are also commonly used, with reviews of studies indicating that all three of these scales can help identify clients at risk for pressure ulcers. PUSH is a staging system, which rates current pressure ulcers, and reverse staging is not a recommended practice.

One of the functional consequences of age-related changes to the skin is an increased susceptibility to injury. Which of the following factors contributes to this susceptibility? (Select all that apply.) A) Decreased sensation of cutaneous pain and discomfort B) Changes in vitamin D synthesis C) Increased healing time for skin wounds D) Decreased resistance to shearing forces E) Changes in skin pigmentation

Ans: A, C, D A muted pain response, increased healing time, and decreased resistance to shearing all contribute to older adults' susceptibility to injury. Changes in vitamin D may occur with age, but these changes do not constitute a risk for injury. Similarly, changes in pigmentation are not a significant risk factor for injury.

A nurse is conducting a medication assessment of an older adult client who will soon be receiving home care. Which of the following questions should the nurse include in this assessment? (Select all that apply.) A) "Are you a smoker?" B) "What is your typical diet?" C) "What over-the-counter drugs do you use?" D) "Do you use any herbs or dietary supplements?" E) "Do you drink alcohol?"

Ans: A, C, D, E Question relating to smoking, alcohol use, over-the-counter drugs, and herbs and dietary supplements should be included in a medication assessment. A client's diet, however, is not a common focus during a medication assessment.

Which of the following actions exemplifies the nurses' role in home care of an older adult? (Select all that apply.) A) Coordinate a multidisciplinary team. B) Perform ADL care for clients. C) Provide resources to caregivers to reduce caregiver stress. D) Refer available community resources. E) Teach about interventions to provide quality care.

Ans: A, C, D, E Feedback: Nurses who provide skilled home care services typically assume a primary coordinating role with a multidisciplinary team. Nursing responsibilities include referrals for additional services. Nurses direct their interventions toward the caregivers providing teaching about interventions, and they address needs of the caregiver related to information about resources and ways to reduce caregiver stress.

An older adult has developed hallucinations. For which of the following should the nurse assess? (Select all that apply.) A) Digoxin toxicity B) Hyperglycemia C) Infection D) Myocardial infarction E) Stroke

Ans: A, C, E Feedback: Infection, digoxin toxicity, and a stroke can all lead to hallucinations. Hyperglycemia and myocardial infarction generally do not.

A nurse initiates an acute care for elders unit in a medical facility. Which of the following factors should the nurse include when teaching the nursing staff about delivering medications to the older adults on the unit. A) Drug metabolism shifts from the liver to the kidneys as individuals age. B) Older adults face an increased risk of adverse medication effects. C) Older adults tend to achieve clearance of medication faster than do younger patients. D) Older adults tend to need more frequent doses of a drug to achieve therapeutic effect.

Ans: B Age-related physiologic changes result in an overall increased risk of adverse drug effects. Drug clearance tends to be slower, so lower doses are normally required. There is no change in which organs are responsible for metabolism of drugs in older adults.

A nurse assesses a 61-year-old adult who reveals that he can't process as quickly as when younger, and that "all these people talk about multi-tasking, but I can't do that!" Which of the following responses by the nurse is appropriate? A) "Have you had any other symptoms of cognitive impairment?" B) "Slower processing of information is an age-related change, and there are things you can do to help with this." C) "The declines in cognitive skills usually begin around the age or 60." D) "You shouldn't expect to see a decline the cognitive functions that you use all the time."

Ans: B Feedback: Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. The earliest cognitive changes are due to decreased perceptual speed. The other distracters do not answer his question. It is important for the nurse to address the client's concerns; in this case, the client is asking if it is expected to already have age-related functional consequences. Age-related declines in some cognitive skills begin around the age of 40, but there are substantial individual variations in these changes. Cognitive functions that depend on experience, accumulated knowledge, and well-practiced tasks (e.g., vocabulary) do not decline in healthy older adults, and may even improve.

An older adult, aged 72, with type 2 diabetes and coronary artery disease is admitted to a long-term care facility. The client takes glipizide (Glucotrol) and isosorbide mononitrate (Imdur). The medical history states that the client drank 4 ounces of whiskey per day for many years. Which of the following actions should be a priority for the admitting nurse? A) Assess and observe for depression. B) Assess for hypoglycemia and hypotension. C) Evaluate the client for renal failure. D) Evaluate blood work for changes in electrolytes.

Ans: B Older adults are more susceptible to developing medication-alcohol interactions. Age-related changes in body composition can cause higher levels of alcohol to be absorbed into the bloodstream. Alcohol enhances vasodilation when an individual takes a nitrate, and there is potentiation of oral hypoglycemics by alcohol. CNS depression occurs when alcohol interacts with barbiturates and meprobamate, which this client is not taking. There is no need to evaluate for renal failure or changes in electrolytes; these are not known medication-alcohol interactions.

A nurse reviews the medication list of an older adult upon transfer from the hospital to an extended care facility. Which of the following methods is most likely to reduce the occurrence of adverse effects? A) Administer medications at the same time every day with meals. B) Compare the list to the Beers criteria list and notify the health care provider of any on the list. C) Request that the client's medications be put on hold and restarted one at a time. D) Stop the administration of GI and narcotic pain medications.

Ans: B An important theme of the Beers criteria and other guidelines is that medications are determined to be appropriate or inappropriate in relation to the patient's condition. Some medications should be given with meals, while others should not. There is no need to stop all medications at this time; nor should the GI and pain medications be stopped.

A nurse on an acute care unit is disturbed by the increasing incidence of pressure ulcers among older adults. Which of the following measures should the nurses on the unit prioritize in order to prevent the formation of pressure ulcers? A) Apply emollient lotions with baths B) Frequent repositioning of immobilized clients C) High-protein, high-calorie diet D) Massage bony prominences each shift

Ans: B Frequent repositioning is an important measure in prevention. Lotions should be applied; relief of pressure is the highest priority. Nurses should ensure that those at risk for pressure ulcers do receive enough calories, vitamins, and protein. Nurses do not massage bony prominences for concern of damage.

A nurse assesses residents of the acute care facility for pressure ulcers. Which older adult should the nurse monitor closely for pressure ulcers? A) The Asian with multiple nevi on extremities B) The Ethiopian former store clerk C) The fair-skinned Caucasian woman D) The wrinkled face Hispanic ranch worker

Ans: B Persons with darkly pigmented skin have a higher incidence of serious pressure ulcers. Nevi, sun exposure, and fail skin are related to cancer, not pressure ulcers.

A home care nurse admits an older adult with macular degeneration. Which of the following assessment questions is most appropriate? A) "Do you have difficulty opening your medication bottles?" B) "How do you organize your medications?" C) "How many medications do you take each day?" D) "What medications do you take each day?"

Ans: B The client with macular degeneration will have limited sight; therefore, a question about assuring that this client takes the correct medications at the correct time is appropriate. There is no indication that this client would have difficulty opening bottles. Asking how many medications are taken each day is not helpful nor does it use therapeutic communication. The nurse will want to know what medications the client takes; however, this question is limiting. It does not include PRN, herbs, or even medications a client may take weekly. Nurses should ask additional questions about the client's ability to take his or her medications as prescribed based on specific observations.

A nurse manager of a nursing care facility reviews potential health and safety interventions and outcomes with the nursing staff. Which of the following interventions places emphasis on quality of life with the best possible health and safety outcomes? A) Telling the resident about his or her schedule for the day B) Allowing the resident with a history of falls to walk with the help of an assistant C) Discouraging the resident who states they are tired from participating in activities D) Advising the resident not to attend church because the resident is not Catholic

Ans: B Feedback: Allowing the resident with a history of falls to walk with the help of an assistant places emphasis on quality of life with the best possible health and safety outcomes. Telling the resident about his or her schedule for the day does not address safety or autonomy. It is not quality of life to discourage the resident from participating in activities (even if tired). Advising the resident not to attend church because the resident is not Catholic is unethical.

Even in a high acuity situation, a nurse can assess the spiritual needs of a client. Which of the following questions is appropriate for the older adult admitted to the intensive care unit for sepsis? A) "Do you attend church services?" B) "Is there a spiritual leader we can call for you?" C) "What are your beliefs about death?" D) "What religion are you?"

Ans: B Feedback: Asking about religion is less important than asking about spirituality, and while the nurse in the intensive care unit may not be able to complete a full spirituality assessment, they can obtain support for the client. Asking about death beliefs may be appropriate in a full spiritual assessment, but not for the high acuity client.

A nurse assesses an older adult's abstract thinking ability. Which of the following questions is most appropriate? A) "Do you know why you are in hospital right now?" B) "What do a dog and a cat have in common?" C) "What goals do you have for your treatment and recovery?" D) "What would you do if you found a stamped, addressed letter on the ground?"

Ans: B Feedback: Asking what traits two similar, but not identical, objects share is a way of gaining insight into a client's ability to think abstractly. Option A addresses insight, not abstract thinking, while Option C is a useful assessment question, but not one that addresses abstract thinking. Option D could be used to assess the client's judgment.

A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, "I feel quite well and do not wish to undergo another round of chemotherapy. " The client's children are adamantly opposed to their parent's decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action? A) The client's prognosis B) The client's autonomy C) The family's wishes D) The client's treatment options

Ans: B Feedback: Autonomy is highly valued in Western societies, and personal autonomy supersedes family wishes and the medical facts about a client or client's situation.

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

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

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

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

An 84-year-old client has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. Which of the following characteristics of the client's current situation is most likely to prompt this move? A) The development of a severe, acute health problem B) A decrease in the client's level of function and activities of daily living (ADLs) C) Exacerbation of a chronic health problem that may require medical treatment D) A change in the level of the client's social support

Ans: B Feedback: Nursing home settings are becoming increasingly diverse, but a common feature of older adults who are admitted to nursing homes is a decrease in function and ADLs. Acute health problems that require medical treatment necessitate hospital admission, and a change in social support would not necessarily prompt a move from assisted living

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

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

A nurse differentiates between dementia and depression in an older adult. Which of the following assessment findings leads the nurse to believe that the client has depression? A) The client has socially unacceptable behaviors. B) The client is negativistic. C) The client's mood fluctuates. D) The client's mood is distractible

Ans: B Feedback: The affect of depressed people is generally sad and negativistic and is not influenced by external circumstances. By contrast, the affect of people who have dementia fluctuates more and changes in response to distractions.

The children of a resident of a nursing home have approached the nurse because they believe their parent is being manipulated by a person who also lives in the facility. Their parent has a diagnosis of early-stage Alzheimer disease and various comorbidities that affect mobility and function. How should the care team appraise the parent's decision-making capacity? A) Her decision-making ability is nullified by the presence of a dementia. B) Her decision-making capacity should be determined according to objective criteria. C) She should be asked to demonstrate sound decision making in minor matter before being allowed to make more important decisions. D) A surrogate should be appointed to make her decisions because she has been diagnosed with Alzheimer disease.

Ans: B Feedback: The presence of dementia does not necessarily render a person incapable of all decision-making ability. Rather, this ability should be analyzed according to criteria of understanding, reasoning, choice, and expression.

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

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

A nurse assesses the eating habits of a 75-year-old client who takes iron supplements for iron deficiency anemia. Which of the following statements by the client indicates a need for further teaching? A) "I drink orange juice with my iron." B) "I prefer coffee to take my pills." C) "I take all my pills with a glass of warm water." D) "I take my iron in between my meals."

Ans: B Foods that change the pH of the gastrointestinal (GI) system interfere with the absorption of iron. It is best taken on an empty stomach, but if it causes GI upset, then it can be taken with orange juice, which helps absorption. Caffeine and some foods interfere with iron absorption. The temperature of the water should not impact the medication absorption.

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

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

A nurse assesses an older adult using a mini-mental status examination. The client is very slow to respond to the questions. Which of the following conditions may be present and will require follow-up by the nurse? (Select all that apply.) A) Lack of education B) Dementia C) Depression D) Confabulation E) Concrete thinking

Ans: B, C Feedback: The nurse assesses the amount of time and effort expended in answering questions. This is particularly important when trying to differentiate between dementia and depression. Lack of education and concrete thinking would not slow the client in responding to assessment tools such as the mini-mental. Confabulation is when the client creates information.

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

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

An older adult is admitted to a geriatric unit in the hospital. The nurse in the emergency department states that the client is oriented to one only. Which of the following actions should the admitting nurse perform? (Select all that apply.) A) Have a conversation with the client about challenges to cognitive functioning. B) Orient the client to the room, unit, and plan of care. C) Post a calendar with dates crossed off. D) Reassess orientation status. E) Repeat orientation as needed.

Ans: B, C, D, E Feedback: The nurse understands that the older adult may take time to orient to new surroundings and may need to be given cues to assist them. Temporary memory impairment because of acute medical problems may impact the orientation questions. Asking the client about his or her subjective cognitive challenges may yield meaningful information, but this does not necessarily gauge orientation.

A nurse evaluates the healing of a full-thickness skin tear on a 92-year-old resident of a long-term care facility. Which of the following would support the continuation of the current treatment plan? A) The wound with redness surrounding at 12 days B) The wound draining serosanguinous drainage at 14 days C) The wound showing 50% healing at 16 days D) Pain at the wound site at 19 days

Ans: C About 50% healing at 16 days is acceptable. Full-thickness skin tears take an average of 21 days to healing in older adults. The treatment plan needs to be changed if there is redness (at 12 days), pain (at 19 days), or draining plasma (at 14 days).

An older adult is brought to the community clinic by an adult child with the concern of increasingly frequent lapses in memory. Which assessment question is most likely to identify potential risk factors for impaired cognitive functioning? A) "What did your mother and father die of?" B) "What line of work were you in?" C) "What medications are you currently taking?" D) "Where are you currently living?"

Ans: C Feedback: Adverse medication effects can have a profound influence on the cognitive functioning of older adults. Genetic, environmental, and occupation factors are potential risk factors, but medications are more commonly implicated.

A nurse is leading a word-quiz game with a group of nursing home residents because the nurse knows this activity will assist the residents in maintaining: A) Fluid intelligence B) Adaptive thinking C) Crystallized intelligence D) Psychomotor memory

Ans: C Feedback: Crystallized intelligence refers to vocabulary skills, information, and verbal comprehension. Fluid intelligence involves a person's inherent abilities, such as memory and recognition, and involves adaptive thinking. Memory involves retrieval and storage of information.

A nurse providing care in a long-term care setting is aware that the cognitive function of older adults does not necessarily decline on an inevitable trajectory. Which action has the greatest potential to enhance the cognitive function of residents and prevent cognitive declines? A) Encourage older adults to openly express their emotions and opinions. B) Provide residents with four or five low-fat, high-protein meals during the day. C) Encourage older adults to participate in mentally stimulating activities. D) Present older adults with numerous opportunities to make autonomous decisions.

Ans: C Feedback: Healthy diet, decisional autonomy, and emotional expression are all potentially beneficial, but participation in mentally challenging and stimulating activities has the greatest potential to protect and enhance cognition.

A 69-year-old has recently been diagnosed with mild cognitive impairment and has asked the nurse to help her remember things better. Which of the following nursing diagnoses is appropriate for this older adult? A) Knowledge deficit B) Altered thought processes C) Health-seeking behaviors D) Altered health maintenance

Ans: C Feedback: The nursing diagnosis of health-seeking behaviors is defined as "the state in which an individual in stable health actively seeks ways to alter personal health habits and/or the environment in order to move toward a higher level of wellness." The older adult is seeking help from the nurse to remember things better so this is the most appropriate diagnosis.

A 70-year-old tells a nurse, "I am worried that I'm losing my mind, I have difficulty remembering names as well as I used to, and I missed two health care appointments in the past month because I forgot about them." The nurse initiates a memory training program, although the nurse has been unable to identify any risk factors that might affect the older adult's cognitive abilities. Which of the following questions is the best approach to evaluating the effectiveness of the memory training program? A) "Have you seen an improvement in your memory?" B) "Are you less worried about your memory now?" C) "How have the memory training techniques helped you?" D) "Are you using the memory training techniques now?"

Ans: C Feedback: The question, "How have the memory training techniques helped you?," allows the older adult to tell the nurse how memory training has helped and is more open-ended than the other options. It also communicates positive expectations. The question helps identify the techniques that are most effective for the individual.

A nurse at the dermatology office triages calls. Which of the following clients is the highest priority to follow up? A) A 2 year old with diaper rash B) A 20 year old with red sunburn on the chest and arms C) A 78 year old with a lesion that is black, swollen, and draining liquid D) A 90 year old with flat discolored spots on face

Ans: C In general, the following characteristics of a skin lesion warrant medical evaluation: redness, swelling, dark pigmentation, moisture or drainage, pain or discomfort, raised or irregular edges around a flat center.

A nurse monitors a group of older adults in the long-term care facility's kitchen. Which of the following actions would cause the nurse to intervene? A) Sharing perfumed hand soap B) Using hand lotion after washing dishes C) Using hot water to rinse the dishes D) Using soap to wash the dishes

Ans: C Older adults are more susceptible to scald burns because of their diminished ability to feel dangerously hot water temperatures. Perfumed hand soap, dish washing liquid, and lotion are acceptable.

A nurse in a long-term care facility teaches aides to assist several older adults with bathing each day. Which of the following interventions should the nurse include in the teaching? A) Apply perfumed products after bathing to promote hygiene and self-esteem. B) Cleanse groin with isopropyl alcohol to eliminate potential pathogens. C) Dry skin thoroughly; particularly between the toes and other areas where skin touches. D) Use water that is warm to hot (100°F to 105°F) to prevent hypothermia.

Ans: C Skin need to be dried thoroughly but gently, particularly between the toes and other areas where skin touches. Perfumed products and alcohol should be avoided. Water temperatures for bathing should be about 90°F to 100°F.

The nurse assesses the fluid volume status of a 72-year-old client who takes Lasix (furosemide) and Pacerone (amiodarone). Which of the following is the most reliable method for assessing this client's skin turgor? A) Ask the client to open the mouth and examine the oral mucous membranes for dryness. B) Examine the skin on the lower legs and look for dry, scaly, or rough skin. C) Gently pinch the skin on the abdomen to see how long it takes to return to normal. D) Squeeze the skin on back of hand to see if it remains pinched or is slow to return to normal.

Ans: C Skin turgor should be checked over protected areas, such as the sternum or abdomen. The use of diuretics can exacerbate xerosis that older adults may have. Diuretics and amiodarone increase the risk for photosensitivity.

Having completed a medication assessment and physical assessment of a new client, a home care nurse is now creating nursing diagnoses and choosing interventions appropriate to these diagnoses. What factor should the nurse prioritize in this process? A) The need to maintain the client's autonomy B) The nurse's responsibility to teach the patient and minimize liability C) The importance of the patient's safety D) The importance of fostering patient compliance

Ans: C When dealing with patients' and clients' medications, as in all areas of nursing practice, patient safety is the priority. This supersedes other matters, even though each may be significant. These include autonomy and patient education.

An 81-year-old adult suffered an ischemic stroke 6 days ago. The client has failed to regain consciousness since the event. The care team has approached the client's family to obtain their views on inserting a feeding tube. Which of the following documents will allow the family to make a decision on the parent's behalf? A) A do not resuscitate (DNR) order B) A living will C) A durable power of attorney for health care D) A will

Ans: C Feedback: A durable power of attorney for health care is an advance directive that takes effect whenever someone cannot, for any reason, provide informed consent for health care treatment decisions. A will, a DNR order, or a living will do not confer this authority on the client's family member.

A nurse is teaching a family of an older adult about the role of adult day centers. Which of the statements by the family member indicates a need for further teaching? A) "The day center can give me respite." B) "The day center can improve our quality of life." C) "The day center can be a useful alternative to medical care." D) "The day center can contribute to an actual improvement in dementia symptoms."

Ans: C Feedback: Adult day centers are a community-based resource providing food, supervision, and activity, but are not designed to provide acute medical care. They provide caregiver relief and have been linked to improved quality of life and decreased symptoms of dementia.

An 87-year-old woman has a history of depression and hypothyroidism. She was recently diagnosed as having breast cancer. Her daughter tells her health care provider that her mother cannot participate in decision making about her care because she is too old. Which of the following statements is true about decision-making capacity? A) Determination of decision-making capacity is based on the older adult's diagnosis and chronologic age. B) The older adult has decision-making capacity if she understands most of the risks and benefits of medical treatment. C) The older adult needs to understand the issues involved in decision making and communicate about them. D) Decision-making capacity of older adults is always determined by a mental health judge

Ans: C Feedback: Decision making should not be determined by the diagnosis or the age of the older adult. The older adult needs to understand all of the risks and benefits of medical treatment. Decision-making capacity is determined by the health care practitioner or by the interdisciplinary team assigned to the client.

A nurse plans discharge for an older woman from China who is living with her son. Which of the following should be included in this plan to indicate that the nurse understands cultural influences? A) Include all family members in discharge planning. B) Ensure that the discharge plan does not include any technologic aspects. C) Review the discharge plans with the client and her son. D) Speak only with the client.

Ans: C Feedback: In the Chinese culture, each family has a recognized male head who has great authority and assumes all major responsibilities. Avoidance of technology is not part of this culture.

During an interview with an older adult, the client moves her chair back. Which of the following responses by the nurse is most appropriate? A) Stop the interview and give her recovery time. B) Move own chair closer. C) Sit upright, leaning back. D) Ask the client if she is okay.

Ans: C Feedback: It is important to consider the physical space required for the person to feel at ease when communicating with others. Men usually like to have larger personal space than women. Sit upright and leaning back will give more personal space. The nurse adjusts to cultural needs of clients, including nonverbals. There is no need to stop the interview or ask if she is okay.

A nurse performs a psychosocial assessment on an older adult in the hospital. Which of the following statements may suggest low self-esteem? A) "I don't know who's going to take care of my spouse while I'm in the hospital." B) "I know I have to rely on others for some help to get along in life." C) "When I was younger, I worked around the clock and now I can't even make it to the toilet." D) "I'm worried about what's going to happen once I get out of here."

Ans: C Feedback: Lamenting a loss of activities of daily living and function and an increase in dependence may be suggestive of low self-esteem, especially if this is linked with self-worth. Worrying about the future or the care of a loved one may be accurate and warranted and not necessarily indicative of low self-esteem.

During an admission interview, a client gives the following response to a question about living arrangements. "I can't stay in my own home. Now that I've fallen and broken my hip, I'm not sure what the doctor will say. My children don't want me." Which response by the nurse is most appropriate? A) "You worry that the doctor will tell you need surgery?" B) "You fell and broke your hip?" C) "Your children don't want..." D) "Where you want to live?"

Ans: C Feedback: Reflection about the children gives feedback about what the nurse heard and leads into further questions about underlying feelings. The client has already expressed that they can't live at home, asking where they want to live when they don't have the choice is not therapeutic. We know that this client has a broken hip, and the conversation is not about surgery

A nurse teaches an older adult client about the use of the telehealth equipment to monitor congestive heart failure. Which of the following statements by the client shows understanding? A) "I will call the primary health care office everyday with my weight, and blood pressure." B) "I won't touch this fancy equipment unless you are here." C) "I need to step on this scale and use this automatic cuff each day." D) "I will watch the prescribed television show every afternoon."

Ans: C Feedback: Telehealth is used to collect and transmit assessment information. The client does not have to call anyone, they are to use the equipment to collect weight and blood pressure to monitor congestive heart failure, this equipment will transmit the data. Television is not included in telehealth.

A nurse assists an older adult who is homebound in a rural area. Which community resources might this client best benefit from? A) Skilled home nursing B) Senior center C) Personal emergency response system D) Grocery delivery

Ans: C Feedback: The rural client is unlikely to have grocery delivery. And as a homebound rural client, a senior center would not be available. Only some clients qualify for skilled home nursing visits, there are not location limitations on personal emergency response systems, some now come with GPS and cellular capabilities.

A nurse assesses frail older adults prescribed multiple medications. Which of the following pairs of medications are most likely to lead to an adverse drug event causing hospitalization? (Select all that apply.) A) Atorvastatin (Lipitor) and tamsulosin (Flomax) B) Ferrous sulfate (Feratab) and vitamin C (L-ascorbic acid) C) Metformin (Glucophage) and glyburide (Micronase) D) Naproxen (Naprosyn) and glucosamine (Glucosamina) E) Warfarin (Coumadin) and clopidogrel (Plavix)

Ans: C, E Up to 13% of patients taking two medications experience an adverse drug event. Medications most frequently cited as causes of emergency hospitalizations are warfarin, antiplatelet drugs, and antidiabetic drugs, including insulin and oral hypoglycemics.

A nurse teaches older adults about skin care and aging. Which of the following would be appropriate to include in this teaching? (Select all that apply.) A) Avoid sunscreens with a sun protection factor (SPF) higher than 14. B) Gently apply rubbing alcohol to keratosis growths to remove them. C) Include adequate amounts of fluid and vitamins in the daily diet. D) Use firm rubbing motions when drying your skin. E) Use emollient moisturizing lotions after bathing. F) When bathing or showering, use a mild, unscented soap.

Ans: C, E, F Older adults need an adequate intake of calories, nutrients, and hydration. Older adults should use a gentle, patting motion when drying their skin ensuring dry skin between toes. Older adults need to use a sunscreen with an SPF of 15 or higher even on overcast days and apply the emollient moisturizing lotion after bathing (not oils during bathing).

A nurse assesses an older adult who has been having a difficult time sleeping throughout the night and incontinence. Which of the following questions by the nurse will best provide clues to these problems? A) "How many times a night do you get up to urinate?" B) "What did your health care practitioner tell you about your medications?" C) "What medications do you take when you need to stay asleep?" D) "What beverages do you drink on a regular basis?"

Ans: D Determining what medications the client has used PRN can be helpful, but an increase in caffeine intake might be making it difficult for the older adult to sleep. Sleep problems can be handled by decreasing caffeine intake rather than by giving the older adult a sleeping medication. Incontinence is not nocturia. "What did health care provider tell you" assesses the client's knowledge of medications; it does not address this issue.

A nurse discusses recent changes with a 74-year-old client. The client is distraught stating, "I forgot an important appointment; and I lost my wallet!" The older adult has always cherished being intelligent, alert, and informed, so even minor lapses in cognition are a source of stress. How should the nurse best interpret these recent deficits in memory? A) The older adult is likely experiencing the early stages of Alzheimer disease. B) The older adult is likely experiencing a temporary state of delirium that will self-resolve. C) The older adult may be experiencing age-related changes in personality. D) The older adult may be experiencing mild cognitive impairment.

Ans: D Feedback: Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. Longitudinal studies have identified patterns of cognitive change that are likely to occur even in the absence of any pathologic processes. This does not rule out the possibility of dementia or delirium, but a fundamental change in personality is unlikely.

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

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

A nurse is conducting a medication assessment of an older adult. Which of the statements by the older adult indicates a need for further education? A) "Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy." B) "I've made a reminder system for myself so that I don't miss any of my pills during the day." C) "My family doctor has me on so many different pills now, so I want to talk about whether they're all necessary." D) "I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."

Ans: D It is a common misconception that because herbs are natural, they have no potential for harm; the nurse should teach clients about the potential risks of herbal supplements. It is proactive to act in a manner that will prevent illness. Implementing a reminder system for drugs is prudent. Similarly, wanting to discuss the potential for polypharmacy with a care provider shows appropriate assertiveness and ownership of health.

A gerontological nurse is aware of the changes in the structure and function of the skin and accessory glands that occur with aging. Which of the following changes is a normal accompaniment to the aging process? A) Thickening of collagen in the dermal layers of the skin B) Cessation of eccrine and apocrine sweat gland function C) Increase in the number of melanocytes in the epidermis D) Decrease in the vascular bed of the dermis

Ans: D The dermal vascular bed decreases by about one-third with increased age; this contributes to the atrophy and fibrosis of hair bulbs and sweat and sebaceous glands. However, sweat glands do not wholly stop functioning. Collagen tends to thin rather than thicken, and the number of melanocytes in the epidermis decreases.

A nurse reviews the medication list of an older adult. Which of the following age-related changes leads to a slower drug clearance? A) Increase in sensitivity to bioactive substances B) Elimination half-time is likely to be faster. C) Increase in glomerular filtration rate D) Decrease in hepatic blood flow

Ans: D The older adult is not more sensitive to bioactive substances. Elimination is likely to be slower. There is an age-related decline in hepatic blood flow that impacts pharmacokinetics, as well as the glomerular filtration rate.

Which of the following functional consequences of skin changes will impact the nursing care of older adults? A) Older adults have an increased incidence of moles requiring intervention. B) There is a decreased incidence of skin cancer in older adults because of an increase in melanocytes. C) In older adults, tactile sensitivity increases and there is an intense response to cutaneous stimulation. D) Collagen changes interfere with tensile strength of older adults' skin, causing the skin to be less resilient.

Ans: D There is less tensile strength of the skin because of collagen changes, which predisposes the older adult to abrasive and tearing skin damage. There is a decreased incidence of moles after 40 years of age. There is an increased incidence of skin cancer in older adults, and decreased melanocytes is one factor that impacts this. Tactile stimulation decreases, and there is a less intense response to cutaneous stimulation.

An older adult wants to take ginkgo biloba, valsartan (Diovan), and hydrochlorothiazide for hypertension. He also takes an aspirin daily. Which of the following statements best reflects the advice his nurse should give him? A) "Ginkgo biloba may cause postprandial hypotension in older adults." B) "Ginkgo biloba has the potential to interact with hydrochlorothiazide." C) "Ginkgo biloba can interact with valsartan, reducing its effectiveness." D) "Ginkgo biloba taken with aspirin can potentially cause a drug interaction."

Ans: D Medications that are likely to be affected by herbs are warfarin, insulin, aspirin, digoxin, cyclosporine, and ticlopidine. Ginkgo biloba has the potential to increase blood glucose levels in type 2 diabetes. Its use is contraindicated with monoamine oxidase inhibitors. It is not known to have any interaction with valsartan or hydrochlorothiazide.

A series of transient ischemic attacks have caused an older adult to become dysphagic. Despite failing a swallowing assessment, the client is opposed to eating a minced and pureed diet and wishes to eat a regular diet. How should the care team respond to this request? A) Insert a feeding tube to provide nutrition while eliminating the risk of aspiration. B) Continue providing a minced and pureed diet to the client in order to ensure safety. C) Defer responsibility for feeding to the client's friends and family. D) Provide the client's requested diet after ensuring the client understands the risks.

Ans: D Feedback: A common ethical dilemma is a client's or client's family's desire to continue an activity at risk. In general, an individual has the autonomy to choose this unless he or she is declared incompetent.

A nurse assesses an older adult's insight regarding the care plan. What question may the nurse ask to gauge the client's insight? A) "Where would you go if you were discharged from the hospital today?" B) "How would you spend $100 if you were given it today?" C) "What are the similarities between a doctor and a nurse?" D) "Why do you think that your doctor admitted you to the hospital?"

Ans: D Feedback: Appraising an individual's understanding of why he or she is receiving treatment can help assess insight. Questions about hypothetical responses to situations also assess executive function, but not insight specifically.

Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which of the following problems is most likely to precipitate admission to long-term care? A) Kidney disease B) Traumatic injury C) Chronic obstructive pulmonary disease D) Dementia

Ans: D Feedback: In contrast to admissions for skilled nursing care that are associated with a hospitalization, admissions to long-term care commonly occur after a period of gradual decline in functioning because of a chronic condition, such as dementia. Studies indicate that more severe functional limitations, cognitive impairment, and problematic behaviors in people with dementia are predictors of admission to nursing facilities for long-term care.

A nurse discusses the future with an older adult who has had surgery for a fractured hip and is also diagnosed as having depression. The client wavers between wanting to give up and going to rehabilitation. Which of the following questions should the nurse ask to assist the client toward values clarification? A) Which pain medication works best for you? B) How can we best assist you with your activities of daily living? C) Do you prefer to bath in the morning or in the evening? D) What goals do you have for the next year?

Ans: D Feedback: In holistic nursing ethics, the process of values clarification can be used to guide nurses. Values clarification is an ongoing process in which an individual becomes increasingly aware of what is important and just—and why. The nurse can facilitate this process for clients by listing several health behaviors or values, such as health, happiness, independence, and good relationships, and ask clients to rank them or identify how they incorporate them into their lives why

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

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

In which of the following situations would a living will provide clear direction to the care and treatment of the individual involved? A) Mr. Penny, age 81, has been diagnosed with bone cancer, is experiencing severe pain, and has been presented with treatment options. B) Ms. Jelic, age 78, has been brought to the emergency department after falling on an escalator. C) Mrs. Kerr, age 77, has been admitted to hospital with an electrolyte imbalance secondary to an accidental overdose of diuretics. D) Mr. Jimenez, age 84, has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive.

Ans: D Feedback: Living wills are legal documents whose purpose is to allow people to specify the type of medical treatment they would want or not want if they become incapacitated as a result of terminal illness. A limitation of living will directives is that they apply only to situations in which the person is considered terminally ill, whereas advance directives apply to a broader range of circumstances

A nurse discusses advance medical directives with a group of older adults at the senior citizens' center. Which of the following statements made by a member of the group indicates a need for further teaching about medical directives? A) "Advance directives address the person's right to refuse medical treatment." B) "It is helpful to see an attorney before completing a durable power of attorney." C) "Advance directives provide legal assurances that a person's preferences will be considered." D) "A durable power of attorney cannot be initiated before a person is incapacitated."

Ans: D Feedback: Medical directives focus on the right to refuse treatment and address the person's desires for medical treatment in certain circumstances. The durable power of attorney for health care must be initiated when the person is competent, but it takes effect only when the person is incapacitated. Medical directives cannot guarantee that a medical intervention will be completed, but they give assurances that the person's preferences will be considered.

A client in the skilled nursing facility refuses rehabilitation services 5 out of 7 days. An administrator tells the client that they will be transferred to the intermediate care unit. The client states, "Medicare is paying my bill; you can't transfer me." Which of the following is the best response by the nurse administrator? A) "You are making good progress it's time to move to the intermediate care unit." B) "We don't accept Medicare clients in the skilled unit." C) "Oh, I wasn't aware; you will be staying here." D) "Medicare will only pay as long as you continue to make progress toward your goals."

Ans: D Feedback: Medicare and other insurance programs will cover all or part of the care for up to 100 days of care, but only as long as the person continues to require the skilled level of services. The expectation is that the person will be able to progress to a higher level of functioning and show some recovery from the acute episode.

A hospital nurse is discussing with an older adult the possibility transfer to a nursing home for skilled care after pneumonia. Which statement by the client indicates an understanding of this possible transfer? A) Old people who go to the nursing home don't get out. B) They will take my home if I go to the nursing home. C) I don't qualify for skilled care, I only had pneumonia. D) I have already used 45 Medicare days this year.

Ans: D Feedback: Medicare and other insurance programs will cover all or part of the care for up to 100 days of care. Typical diagnoses associated with skilled care in a nursing home are stroke, fractured hip, congestive heart failure, and rehabilitation after acute illnesses (e.g., pneumonia and myocardial infarction). About 65% of older adults spend some time in a nursing home.

A client has recently begun receiving Social Security benefits and is asking the nurse about what services might be included or excluded under Medicare. Which of the following services is most likely to be excluded from Medicare funding? A) Hospital care B) Hospice care C) Rehabilitation care D) Nursing home care

Ans: D Feedback: Medicare was established as a means of funding some types of direct client medical care, hospice and rehabilitation care may be covered, but nursing home residence is not.

A nursing administrator of the long-term care facility implements a performance improvement program. Which of the following activities should be included in the program? A) Develop a dementia care unit. B) Decrease the use of intramuscular medications. C) Emphasize safety and medical care. D) Measure outcomes focusing on personal choice.

Ans: D Feedback: Quality assurance and performance improvement programs measure attainment of outcomes. Quality in long-term care focuses on consumer personal choices and quality of life issues, without the overemphasis on safety, uniformity, and medical care. Developing a dementia unit is not always included in quality improvement of long-term care, nor is reduction of IM medications.

An older woman of Filipino heritage has been having rectal bleeding for several months. Her physician has told the woman and her daughters that she has advanced colon cancer. Her daughters want to obtain hospice services but the client is reluctant and does not want to discuss what she feels is "beyond her control." Which of the following concerns is this client most likely experiencing? A) Entrenched optimism in health care providers B) Individual autonomy regarding end of life C) Impaired cognition secondary to cancer D) Cultural taboo to discuss death

Ans: D Feedback: Some members of the Filipino culture believe in fatalism and resist any discussion about or planning for events beyond one's control such as illness or death, because it is viewed as tempting fate and will likely bring the potential event into reality.

An older adult client with urosepsis has become nonresponsive. The nurse is to identify the appropriate person to sign the consent forms for an invasive medical procedure. Which of the following actions by the nurse is appropriate? A) Find the older adult's family member to sign the consent. B) Inform the health care provider that no consent can be obtained. C) Move forward with guardianship as the client is incompetent. D) Review the chart for a health care power of attorney.

Ans: D Feedback: The client, at this time, does not have the decision-making capacity to sign consents. Guardianship is a permanent option that is used only when a person has been declared incompetent. When the client does not have the decision-making capacity to sign consents, the durable power of attorney for health care should do so. If there is no power of attorney, the nurse needs to follow the institutional protocol for obtaining consent.

A healthy 70-year-old has been using diphenhydramine (Benadryl) for allergic rhinitis. One week later, the client begins to exhibit signs of confusion and disorientation. The spouse calls the primary care facility to speak with the nurse. Which event should the nurse suspect first? A) The older adult has hyponatremia, leading to delirium. B) The older adult is having transient ischemic attacks. C) The older adult has an overwhelming infection. D) The older adult is experiencing an adverse drug effect.

Ans: D The older adult has been taking diphenhydramine, which can have an anticholinergic effect. Anticholinergic drugs can lead to medication-induced cognitive impairment. There is no reason to think that the client has hyponatremia. Rhinitis does not generally cause delirium in older adults. The client is more likely to be having adverse reaction than transient ischemic attacks.