Download Care of The Older Adult TEST BANK and more Exams Nursing in PDF only on Docsity! 1 Care of The Older Adult TEST BANK A negative attitude towards aging and the aged is called: A. geriatrics B. racism C. ageism D. ethnocentrism Answer: C Which of the following is not considered a core competency for nurses caring for older adults? A. Analyze the impact of an aging society on the health care system B. Obtain certification in gerontological nursing C. Prevent or reduce common risk factors that contribute to functional decline D. Recognize one's own attitudes about aging Answer: B The nurse wishes to obtain basic certification in the specialty of gerontological nursing. Which of the following is true about this credential? A. there is an experience requirement B. one must pass an exam C. one must have a BSN D. a and b only Answer: D When the nurse reads an article and uses the findings of a study to improve the quality of the patients for whom she cares, she is implementing the role of: A. teacher B. manager C. research consumer D. advocate Answer: C A lawyer wishes to hire a nurse consultant who has advanced education and certification in gerontology. Based on their 2 Care of The Older Adult TEST BANK listed credentials, which of the following nurses best fits his wishes? A. Sally Smith, RN, BSN, BC B. Mary Malloy, RN, MS, GNP C. Andy Jones, LPN, CRRC 5 Care of The Older Adult TEST BANK C. most older persons are cared for by their children D. nearly a half million grandparents are raising their grandchildren Answer: D What best explains the lack of prepared, qualified health professionals to care for the aged? A. a shortage of nursing faculty B. medical programs not including gerontology content C. not enough health professionals choosing gero as a specialty D. the current nursing shortage Answer: C There were approximately 36 million Americans over the age of 65 years in 2000 and this number is expected to grow to 71 million by 2030 A. TRUE B. FALSE Answer: A Over half of women over the age of 85 are widowed A. TRUE B. FALSE Answer: A There are more males in the population than females A. TRUE B. FALSE Answer: B Most centenarians (people over the age of 100 years) are White and female A. TRUE B. FALSE 6 Care of The Older Adult TEST BANK Answer: A Minority elderly groups are growing and thus present unique challenges for nurses today A. TRUE B. FALSE Answer: A The majority of older persons live alone A. TRUE B. FALSE Answer: B Older women who live alone tend to be more from lower income groups than those who are married A. TRUE B. FALSE Answer: A Elderly Hispanics rate their overall health significantly higher than those from other ethnic groups A. TRUE B. FALSE Answer: B Older persons tend to die from acute illnesses more than chronic diseases A. TRUE B. FALSE Answer: B The major causes of death in the older age group are heart disease, AIDS, and tuberculosis 7 Care of The Older Adult TEST BANK A. TRUE B. FALSE Answer: B (It's Heart Disease, Cancer and Strokes) Which ethnic/cultural group has a higher rate of diabetes, hypertension, and chronic renal disease than other ethnic groups? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives Answer: A Which ethnic/cultural group is the most rapidly growing ethnic minority, and less likely to obtain preventive services such as flu vaccines and mammograms? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives Answer: B Which ethnic/cultural group is comprised of many subgroups and generally have a longer life expectancy than white Americans? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives Answer: C Which ethnic/cultural group makes up a small percentage of America's elderly population and have increased morbidity and mortality related to diabetes and renal disease? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives 10 Care of The Older Adult TEST BANK 6) nonstochastic theories F. problems with gland feedback leads to disease 11 Care of The Older Adult TEST BANK 7) theory of thriving G. based on random events that cause cellular damage 8) human needs theory H. genetically programmed events cause cellular damage that lead to aging 9) functional consequences theory I. failure to thrive is from discord in relationships 10) wear and tear theory J. (Miller’s Theory) nurse’s role is risk reduction to enhance safety Answer: 1) continuity theory (A) A. personality and coping patterns remain consistent through life 2) stochastic theories (G) B. remaining active and involved promotes life satisfaction in later year 3) neuroendocrine theory (F) C. transformation towards oneness with the universe 4) activity theory (B) D. cells wear out with age 5) gerotranscendence theory (C) e. five basic needs that motivate behavior 6) nonstochastic theories (H) F. problems with gland feedback leads to disease 7) theory of thriving (I) G. based on random events that cause cellular damage 8) human needs theory (E) H. genetically programmed events cause cellular damage that lead to aging 9) functional consequences theory (J) I. failure to thrive is from discord in relationships 10) wear and tear theory (D) J. (Miller’s Theory) nurse’s role is risk reduction to enhance safety Which of the following visual changes is not usually associated with normal aging? a. presbyopia b. yellowing of the lens c. night blindness d. decreased accommodation Answer: C All of the following are considered IADLs (Instrumental Activities of Daily Living) except: a. toileting b. balancing the checkbook c. using the phone d. shopping Answer: A (this is considered an ADL) Old persons may have difficulty picking up their pills from a medicine cup because of: a. macular degeneration b. decreased touch sensation that comes with old age c. peripheral neuropathy d. all of the above 12 Care of The Older Adult TEST BANK Answer: D An older adult who complains of a dark spot in the center of the visual field is showing signs of: A. cataracts B. macular degeneration C. acute glaucoma D. diabetic retinopathy Answer: B An older adult who complains of seeing dark shadows around the center of the visual field is showing signs of: A. cataracts B. macular degeneration C. glaucoma D. diabetic retinopathy Answer: C An older adult who complains of blurry vision and has a bluish-white coating that can be seen on the lens is showing signs of: A. cataracts B. macular degeneration C. acute glaucoma D. diabetic retinopathy Answer: A Which of the following factors could contribute to an older person's inability to hear instructions given by the nurse? A. cerumen impaction B. nurse not facing the person when giving directions C. loss of high frequency pitches D. all of the above Answer: D The nurse is trying to take a history from a cooperative but fearful older person with mild dementia. Which of the following would be the most therapeutic strategy to use for this interaction? 15 Care of The Older Adult TEST BANK An older patient has had a stroke that resulted in Broca's aphasia. Which of the following would be most typical of Broca's aphasia? A. fluent speech B. impaired comprehension C. broken speech D. global problems Answer: C Which of the following signs would you consider an abnormal finding for a 75 year old female? A. blood pressure of 110/78 B. Hct (hematocrit) of .41 C. resting pulse of 80 D. urinary incontinence Answer: D A significant result of changes in the respiratory system with advanced age is: A. lower carbon dioxide levels in the bloodstream B. less useful oxygen available with each breath C. more efficient gas exchange at the alveolar level D. the ability to hold one's breath longer Answer: B One of the most significant changes in the reproductive system for older females who are sexually active is: A. decreased vaginal lubrication B. atrophy of uterus C. decreased libido D. lack of male partners Answer: A You are helping care for your 89 year old grandmother who is sick with "the flu". Her temperature is 101.2. What other information would be most useful to better assess your grandmother's condition? A. what her temperature was yesterday B. how long she has felt sick C. what her usual temperature is 16 Care of The Older Adult TEST BANK D. how much she ate today 17 Care of The Older Adult TEST BANK Answer: C Which of the following would be an abnormal finding in assessment of an 80 year old male? A. decreased cardiac output B. decreased stage IV sleep C. loss of hearing of low frequency tones D. age spots on the hands and face Answer: C Which of the following changes in the skeletal system is least characteristic of normal aging? A. decreased range of motion B. loss of height up to 10 cm C. chronic inflammation of joints D. loss of some muscle mass Answer: C All of the following are intrinsic changes in the integumentary system except: A. increased skin temperature B. sagging and wrinkling C. age spots D. increased risk of bruising Answer: A Which of the following is true about normal aging changes in the GI system? A. absorption of nutrients does not change with age B. absorption of certain vitamins does change with age C. small intestine transit rate is relatively unchanged with age D. all of the above Answer: D Which of the following aging changes is most significant to renal efficiency? 20 Care of The Older Adult TEST BANK Answer: C Which of the following is a reason why older females may develop vaginitis? A. lower estrogen levels B. atrophy of the vaginal canal C. decreased lubrication of the vagina D. all of the above Answer: D The nurse wishes to use a tool to help assess the functional status of the older residents in the nursing home where she works. Which of the following would be least appropriate for this purpose? a. Katz index b. MDS c. Barthel Index d. Gibson self-care scale Answer: D Which of the following is the best example of an open-ended question/statement that would promote verbalization from an older person? A. tell me about your major problem today B. do you have any complaints today? C. are you having any major problems? D. do you want to talk about your major complaint? Answer: Name four essential areas to address to promote communication as discussed in this chapter. Answer: Invite-respect, Environment, Understanding, Communication Changes in which of the following body systems are generally most noticeable to the naked eye? A. respiratory B. integumentary 21 Care of The Older Adult TEST BANK C. gastrointestional D. neurological Answer: The nurse working in rehabilitation would most likely see what measure used to evaluate progress of patients in rehabilitation? A. Katz index B. MDS C. FIM D. OASIS Answer: C In assessing IADLs, the nurse will ask questions about all but which of the following patient activities? a. cooking b. shopping C. using the phone D. bathing Answer: D In assessing the circulatory system of an older adult, the nurse would recognize which of the following as abnormal? A. resting pulse rate of 120 B. blood pressure of 118/78 C. respirations of 26 D. a and c Answer: D When assessing the respiratory system of an older person, which of the following is the least essential to ask during history taking? A. use of tobacco products B. feelings of shortness of breath C. exposure to environmental toxins D. all are important to ask about 22 Care of The Older Adult TEST BANK Answer: D All of the following may contribute to an older patient complaining of constipation except….. A. decreased thirst mechanism B. changes in peristalsis with age C. lack of fiber in diet D. increased physical activity Answer: D 7) It is important to include sexuality in a comprehensive assessment of older persons because: A. changes occur with normal aging that may impact performance B. older adults still engage in sexual intercourse C. changes in sexual preference in later life often pose conflicts D. a and b Answer: D Neurological assessment of the older person should include: A. history of medications and herbs used B. assessment of swallowing C. checking grip strength D. all of the above Answer: D The Up and Go Test is useful for assessment because it: A. provides a quick measure of physical, especially walking, ability B. gives a precise indication of physical strength C. provide a statistically accurate number associated with grip strength D. gives an idea of cognitive function Answer: A Which of the following new findings would be considered abnormal and requiring immediate attention in the older adult? A. presbyopia B. presbycusis 25 Care of The Older Adult TEST BANK B. older persons are unable to take medications correctly 26 Care of The Older Adult TEST BANK C. older adults are not accustomed to taking multiple medications D. a and c only Answer: A Diphenhyrdramine (Benadryl) is not recommended for use in older adults because of: A. confusion and severe anticholinergic effects B. risk of seizures C. prolonged half life D. dosage problems Answer: A Which of the following questions is least appropriate to ask when taking a medication history? A. use of over the counter medications B. drug allergies C. home remedies used D. all of the above are appropriate Answer: D List five strategies for teaching older adults. Answer: stay active, see doctor regularly, maintain relationships, prevent falls, maintain healthy weight and diet The nurse is preparing a teaching session about diabetes to a group of older adults in assisted living. Which of the following is most essential to consider for this audience? A. whether they are part of the Baby boomer generation B. the accommodations needed for them to participate in the presentation C. literacy level if there are handouts D. b and c Answer: D Which of the following strategies used by the nurse in teaching older adults is a principle of adult learning? 27 Care of The Older Adult TEST BANK A. Adults need a motivation to learn. 30 Care of The Older Adult TEST BANK D. Information about Advance Directives Answer: C In conducting a one-to-one teaching session about the role of nutrition in preventing osteoporosis, the nurse should first: A. establish rapport with the person B. assess readiness to learn C. evaluate outcomes D. provide information Answer: A Which of the following aging changes could pose a barrier to learning? A. hearing loss B. visual impairment C. literacy level D. all of the above Answer: D Which of the following techniques for developing a web page for older adults is least appropriate? A. use large font on the website B. use computer lingo in the text C. create a memorable web address D. make the site user friendly to older adults Answer: A List three activities discussed in this chapter that may prevent the course of frailty. Answer: stay active, see doctor regularly, maintain relationships, prevent falls, maintain healthy weight and diet Which of the following are thought to contribute to healthy aging? A. doing for others and maintaining interests B. engaging in isolated activities 31 Care of The Older Adult TEST BANK C. avoiding connection with religious institutions 32 Care of The Older Adult TEST BANK D. pushing oneself into new situations Answer: A Which of the following is most true of older widowers? A. they may focus more on themselves B. they have an increased self esteem C. they may lose interest in social activities D. they experience a heightened sense of sexuality Answer: C For an older person (living with an adult child) who needs some help and lessinteraction during the day while their family member is at work, which of the following care settings would the nurse most likely recommend? A. hospice B. assisted living C. adult day care D. nursing home Answer: C When an older adult lives with family members, which of the following principles would not be appropriate for the nurse to apply in assisting the family to promote quality of life for their older loved one? A. help them recognize their own needs and limitations B. provide referrals to community resources C. recommend nursing home placement immediately to avoid stress D. respect all family caregivers as an important part of the team Answer: C When an older adult lives with family members, which of the following principles would not be appropriate for the nurse to apply in assisting the family to promote quality of life for their older loved one? A. help them recognize their own needs and limitations B. provide referrals to community resources C. recommend nursing home placement immediately to avoid stress D. respect all family caregivers as an important part of the team 35 Care of The Older Adult TEST BANK Answer: bedtime routine, reduce noise, relaxation, music, daytime sunlight Of the following exercise regimens, which would be most suitable for the nurse to recommend to a 77 year old healthy woman with no restrictions from her physician? A. five miles of bicycling per day on the county roads B. walking for a total of 20 – 30 minutes five days per week C. swimming 50 laps per day in the community swimming pool D. horse back riding in the country alone three times per week Answer: B According to the Merck Institute on Aging and Health, older adults fell short of the Healthy People 2000 goals in all but which of the following area? A. physical activity B. influenza vaccination C. eating fruits and vegetables D. overweight Answer: B The nurse is counseling a patient regarding Medicare prevention efforts. Which of the following is included? A. initial physical examination B. smoking cessation counseling C. nutrition therapy for everyone D. a and b only Answer: D The nurse chooses to use a health contract/calendar as a behavior-changing tool for an older adult client who wants to lose weight. Which of the following principles should the nurse keep in mind when choosing this tool? A. it relies on the self-management capability of a client, after initial assistance is provided by a clinician or health educator B. it relies on the ability and skill of the educator C. it has been shown to be less effective with females who are older and widowed D. it cannot be used in older adults with less than a high school education 36 Care of The Older Adult TEST BANK Answer: A The advantages of using a health contract for behavior change include all of the following except: a. it identifies and enhances motivation b. it assures that change will occur c. it clarifies measurable and modest goals d. it suggests tips to remember new behaviors Answer: B The nurse is instructing a new patient on the benefits of exercise. She would include which of the following in providing the most current recommendations for older adults? a. the emphasis is on being more physically active rather than a narrow adherence to a rigid exercise regimen B. older adults should exercise one solid hour per day to achieve benefits C. research has shown that older adults need to burn more calories than younger adults in order to obtain cardiac benefit from exercise d. all of the above are true Answer: A An older client is discussing his desire to continue walking during the winter months, but expresses fear of being out in the colder weather. The nurse appropriately recommends for him to: a. suspend all walking activities until the weather is favorable b. walk inside at the local shopping mall c. join a health club and walk on the treadmill d. continue to walk outside no matter what the weather Answer: B Nutrition counseling is thought to be important for older adults because of which factors? A. older adults are more vulnerable to obesity than other age groups B. older adults are more vulnerable to malnutrition than other age groups C. eating and drinking habits are linked to several leading causes of death D. all of the above Answer: D Which of the following foods should the nurse encourage the older client to eat 5 – 13 servings of per day? 37 Care of The Older Adult TEST BANK a. grains b. meat/eggs c. dairy d. fruits/vegetables Answer: D Mr. Thin is a 5 foot 8 inch, 79 year old male with a history of hyperlipidemia. Which of the following risk factors does not fit with his diagnosis? A. he drinks four glasses of Jack Daniels per day B. history of hypertension C. smokes 1 pack of cigarettes per day D. weight of 125 pounds Answer: D To help Mr. Thin in the above scenario, which risk factor will the nurse focus on first in teaching lifestyle modifications? A. weight loss B. stress reduction C. smoking cessation D. food restrictions Answer: C Tobacco use is significantly related to all but which of the following cancers in older persons? A. lung B. larynx C. breast D. bladder Answer: C Of the following scales, which is least useful in assessing the cognitive function of an older adult? A. the Kenny Cognitive Scale B. the mini mental state examination (MMSE) C. the CLOX (clock drawing) D. the Controlled Oral Word Association Test 40 Care of The Older Adult TEST BANK B. early diagnosis may have been difficult 41 Care of The Older Adult TEST BANK C. she will exhibit increased urine output, excessive thirst, and hunger D. she is likely to also have hypertension Answer: C What other labs/tests might the nurse least expect to see ordered for this patient? A. Fasting blood sugar B. Glucose tolerance test C. HgBA1C D. MRI Answer: D In teaching this patient about her diabetes, which has lowest priority? A. foot care B. balancing medications, diet, and exercise C. reducing risk of complications D. importance of attending support groups Answer: D A 70 year old male is exhibiting signs of weight loss, heat intolerance, insomnia, sensitivity to light, and heart palpitations. The doctor writes the admitting diagnosis of hypothyroidism on the chart. What is the nurse’s most appropriate reaction to the doctor’s diagnosis? A. discuss the disease process with the patient and family so they know what to expect B. ask the doctor if this was the diagnosis he intended to record on the chart C. do nothing – you have to wait for lab tests D. continue the usual plan of care for a person with hypothyroidism Answer: B Which of the following is true about subclinical hypothyroidism? A. TSH is mildly elevated B. T3 is elevated C. T4 is elevated D. TSH is normal 42 Care of The Older Adult TEST BANK Answer: A An older adult diagnosed with Hashimoto’s disease would probably display which of the following signs/symptoms? A. perspiration and alcoholism B. fatigue and weakness c. weight loss and lack of appetite d. diarrhea and tachycardia Answer: B Which of the following is true of hyperthyroidism? A. there is no ethnic variation B. family history is not a risk factor C. medications will cure the problem D. beta-blockers are given to decrease the production of thyroid hormone Answer: A What is the best explanation for cancer being associated with old age? A. mutant cells attach themselves and surface as cancer B. the immune system stops working around age 80 C. decreased ability to resist disease and prolonged exposure to carcinogens D. rate of smoking among older adults has increased in the past decades Answer: C The primary sign of bladder cancer is: A. painful hematuria B. painless hematuria C. painful hemorrhoids D. frequent urination Answer: A 45 Care of The Older Adult TEST BANK D. violent behavior after sundown Answer: C If the nurse suspects that a patient has delirium, which of the following factors should be further investigated? A. UTI b. medications c. oxygen saturation d. all of the above Answer: D Recent research suggests that most incontinence among the elderly is due to: A. stress B. overactive bladder C. lack of Kegel exercises D. multiple pregnancies Answer: B Which of the following best describes a characteristic of the earliest phase of Alzheimer’s disease? A. impaired speech B. personality changes C. total dependence upon others for care D. progressive forgetfulness Answer: D The nurse is asked to assist a family with finding help to care for their terminally ill grandfather who was just diagnosed with inoperable brain cancer. To which of the following programs would the nurse refer the family? A. the hospital B. respite care C. hospice D. visiting nurse association 46 Care of The Older Adult TEST BANK Answer: C Which of the following is least likely a risk factor associated with those who abuse the elderly? A. history of mental illness B. overwhelmed C. poor self-image D. female Answer: D A 60 year old African American male with known hypertension comes to the emergency room with complaints of bad indigestion that has continued all night and a little bit of numbness in his left arm. What action should the admitting nurse take? A. have the patient sit in the waiting room to be seen in order B. treat him as if it he could be having a heart attack C. give him some antacids immediately after checking with the physician D. call 911 and let the paramedics decide what to do Answer: B One of the most significant changes in the reproductive system for older females that are sexually active is: A. decreased vaginal lubrication B. atrophy of uterus C. decreased libido D. lack of male partners Answer: A The nurse is helping an older patient with a history of angina ambulate in the hallway after minor surgery. The patient complains of chest tightness. What should the nurse do first? A. administer nitroglycerin sublingually B. call for help C. have the patient sit and rest D. take the vital signs Answer: C 47 Care of The Older Adult TEST BANK If the nurse wishes to know about the patient’s overall nutritional health, what is the best lab value to look at? A. triglycerides B. iron C. serum albumin D. red blood cells Answer: C An older person with GERD should avoid which of the following? A. laying flat after meals B. caffeine C. chocolate D. all of the above Answer: D The physician is discussing an older person who has just had a stroke. He says that he will try to give t-PA to minimize the ischemic penumbra. What does this tell you? A. he believes the person will die B. he believes the person has had a hemorrhagic stroke that can be helped by medication C. he believes the person has had a stroke from a clot which, if eliminated, may result in less damage D. he doesn’t know what he is talking about Answer: C Which of the following signs exhibited by an older female at home is one that would cause you to call 911? A. a bad headache B. sudden coughing C. forgetting where her car keys are D. sudden numbness of her right arm Answer: D Match the type of incontinence with the associated symptoms. 1. sudden, unexpected need to void A. stress incontinence 2. frequent or continual incontinence of small to moderate amounts B. urge incontinence 3. inability to get to bathroom facilities C. overflow incontinence 4. triggered by laughing, coughing, sneezing D. reflex incontinence 50 Care of The Older Adult TEST BANK B. provide reassurance and emotional support C. provide essential information, but avoid teaching at this stage D. provide direct care, ensure safety, and involve the family Answer: A Which of the following would be the most appropriate bowel program for an older person with constipation who is recovering from a stroke? A. daily soap suds enema B. increase fiber, fluids, and activity C. Colace four times per day D. digital stimulation every morning after a suppository Answer: B Which of the following signs is most indicative of prostate cancer in a 75 year old male? A. PSA of 12 ng/ml B. hard, nodular lump on physical palpation through rectal exam C. blood in the urine D. all of the above may be signs of prostate cancer Answer: D Side effects of Viagra reported by an older person that would require immediate attention include: A. headache B. nasal congestion C. visual problems D. flushing Answer: C A patient newly diagnosed with Parkinson’s disease wishes some information. Which of the following would not be accurate for the nurse to teach the patient? A. the cardinal signs include bradykinesia, tremor, and rigidity B. the disease is chronic and progressive C. there is no known cure D. a surgery called pallidotomy can cure severe tremors in 80% of cases 51 Care of The Older Adult TEST BANK Answer: D A patient with BPPV complains of dizziness because: A. he has Meniere’s disease B. he has a history of stroke C. he has otoconia that are dislodged D. the Epley maneuver is working Answer: C Which of the following best represents the percentage of elderly persons with co-morbid conditions who suffer from depression. A. 15% B. 25% C. 37% D. 50% Answer: C Which of the following is true about depression? A. it does not affect community dwelling elders B. some symptoms can mimic dementia C. usually occurs in early stages of dementia D. leads to suicide in 50% of older males Answer: B Which of the following is true about elderly suicide? A. rates are highest among elderly Black females B. 10% of all suicides are elderly persons C. older women tend to use more lethal means than men D. older men tend to use more lethal means than women Answer: D Common causes for urinary incontinence that the nurse should always check in the elderly include: A. lack of mobility and no toilet facilities 52 Care of The Older Adult TEST BANK B. urinary tract infections and electrolyte imbalances C. stress and multiple pregnancies D. birth defects and prior surgeries Answer: B Kegel exercises may help many forms of incontinence because they: A. decrease bladder contractions B. increase outlet resistance C. strengthen the pelvic floor muscles D. counteract the effects of multiple pregnancies Answer: C Of the following sleep disorders in the elderly, which is the most common? A. restless legs syndrome B. insomnia C. muscle cramps D. nightmares Answer: B A score of 12 on the MMSE would indicate: A. situational depression B. cognitive impairment, probably dementia C. delirium D. a normal result Answer: B If a person is suffering from dementia, what could have caused this? A. Creutzfeld-Jacob disease B. Lewy body disorder C. Alzheimer’s disease D. All of the above 55 Care of The Older Adult TEST BANK B. physical restraints C. strengthening exercises D. walking Answer: B An older person presents in the emergency with symptoms such as tachycardia, shortness of breath, light-headedness, and trembling. Having ruled out any physical causes, what might be the most likely discharge diagnosis seen on the chart? A. generalized anxiety disorder B. panic attack/panic disorder C. delirium D. depression Answer: B Drugs that can cause or worsen anxiety include all the following except: A. baclofen B. theophylline C. acetaminophen D. caffeine Answer: C In providing nursing care for the older adult with anxiety, which of the following interventions is least appropriate? A. increase environmental stimuli B. stay with the patient. C. speak slowly in a soft, calm voice. D. avoid reciprocal anxiety Answer: A The nurse is instructing a group of older women living in the community about ways to minimize the risk of UI. Which of the following is least appropriate to include in the discussion? A. limit fluids B. avoid bladder irritants C. avoid constipation 56 Care of The Older Adult TEST BANK D. strengthen and tone the pelvic floor muscles 57 Care of The Older Adult TEST BANK Answer: A Nursing interventions to prevent pressure ulcers include all of the following except: A. use lift devices for transferring or moving patient in bed B. assess each patient for risk C. turn all patients every two hours D. use pressure relieving devices for patients at risk Answer: C In charting on a 70-year old man with a wound that appears as a shallow crater, the nurse would stage this as a: A. stage I B. stage II C. stage III D. stage IV Answer: B Poor nutrition and subsequent skin breakdown is associated with which of the following lab results? A. Serum albumin of 3.0 B. Serum transferrin of 250 C. Cholesterol of 200 D. none of the above Answer: A Aspiration can occur at which point(s)? A. before the swallow B. after the swallow C. during the swallow D. all of the above Answer: D 60 Care of The Older Adult TEST BANK D. b and c only Answer: D A patient presents to the clinic with confusion and provides a list of medications to the nurse. Which of the following medications could be a source of this problem? A. meperidine B. aspirin C. benzodiazapines D. a and c Answer: D An older adult who presents with complaints of insomnia, loss of energy, impaired concentration and diminished pleasure in activities she once enjoyed is showing signs of: a. delirium B. dementia C. depression D. confusion Answer: C In educating patients and families about depression, the gerontological nurse recognizes that depression is: A. a prevalent condition B. often undertreated c. common cause of excess disability D. all of the above Answer: D Environmental interventions for patients with dementia include all of the following except: A. a cool room temperature B. alarms on exits C. disguising exits D. areas for safe wandering 61 Care of The Older Adult TEST BANK Answer: A If an older adult wishes to have another person make health care decisions in his behalf should he become unable to do so himself, he should appoint: A. a living will B. a health care representative C. a durable power of attorney for healthcare D. b or c Answer: D A family member asks the nurse to witness the signing of a Living Will at the bedside of a mentally competent, alert, adult patient. In signing as a witness, the nurse is stating: A. the signature of this person was valid and not coerced B. the person was mentally competent to sign C. the person is terminally ill at the time D. a and b only Answer: D If an older person wishes to have a DNR status on himself, which of the following is true? A. he needs to have the physician sign a form that states this B. he will receive less quality care than those who are not DNR status C. he should place a copy on his refrigerator at home D. a and c only Answer: D The nurse is caring for a healthy older patient who tells her that he is going to die and wishes no heroic measures to be taken. There are no advance directives on the chart. The nurse leaves the room and returns minutes later to find the patient with no pulse and not breathing. What should the nurse do? A. call a code or 911 and begin CPR B. quickly write and sign advance directives C. leave the room and close the door D. call the doctor before beginning CPR Answer: A 62 Care of The Older Adult TEST BANK The principle of distributive justice is best described as: 65 Care of The Older Adult TEST BANK C. if a person does not state they have pain, they must not be in pain D. all of the above Answer: D Which of the following screenings would the nurse not routinely recommend to an older adult? A. mammogram every 1 - 2 years for females B. annual physical C. dementia D. flexible sigmoidoscopy and FOBT Answer: C An older person with a spinal cord injury wishes to be taken off of life support three months after his injury occurred. The physician will not allow this or sign the order for it. What two principles are in conflict in this situation? A. autonomy versus paternalism B. autonomy versus justice C. nonmaleficence versus beneficence D. veracity versus fidelity Answer: A When a nurse tells a patient the truth about his terminal condition, she is engaging in: A. beneficence B. autonomy C. veracity D. fidelity Answer: C One nursing strategy to use when striving to make persons comfortable in the hospital setting in relation to their dietary habits is: A. assure them that the hospital food is nutritious B. insist that they eat at least 80% of all meals C. provide nutritious snacks D. provide foods that are culturally familiar 66 Care of The Older Adult TEST BANK Answer: D The nurse is caring for an older person from a different culture than her own. What is her best approach to providing holistic care to this patient? A. provide care as she would to all other patients B. learn more about the person’s culture C. talk to family members about the person’s medical condition D. ask other nurses what they do to care for this person Answer: B The nurse is assigned to a patient in home care who is an 89 year old African American woman widowed and living alone. Before even making the first visit, which of the following might the nurse expect, based on her knowledge? A. the patient will be cared for by relatives in a middle class neighborhood B. the patient may have fewer financial resources and have a number of health problems C. the patient is likely to be healthy and financially secure D. the patient is most likely able to pay for all her medications without difficulty Answer: B Which of the following should the nurse include in his teaching about hypertension to a group of African American seniors at the community wellness center? A. hypertension is less prevalent among people of color B. vitamin D deficiency is thought to be a factor in hypertension C. hypertension may be caused by overexposure to the sun D. persons with hypertension are at lower risk for heart attack and stroke Answer: A Nancy is a nurse of Hispanic background who is working with a population of older white males on an Alzheimer’s unit at the Veteran’s Hospital. One of the patients makes an angry racist comment to Nancy about all Latinos being lazy. What is Nancy’s best response? A. consider his disease process and excuse the behavior B. report the incident to the nurse manager C. correct the patient by saying, “I am not lazy” D. ask to be removed from caring for that patient 67 Care of The Older Adult TEST BANK Answer: B Which of the following is important for nurses to remember when providing spiritually competent care to older adults? A. older adults tend to avoid religion B. prayer and faith are commonly used coping strategies by religious elders C. participation in an organized religion has no effect on depression or coping D. religion and spirituality are the same terms Answer: B In addressing the sexual needs of an older couple, the nurse should remember that all of the following may be recognized as common problems the nurse may intervene with except: A. dyspareunia B. utertine prolapse C. incontinence D. vaginal dryness Answer: B The nurse is caring for a 70 year old male in the emergency room who is admitted after a car accident. What is the best question for her to ask the patient when trying to contact a loved one? A. should I call your wife? B. do you have a wife? C. who should I call? D. do your children live around here? Answer: C The nurse is giving an educational program about HIV to a group of seniors living in a retirement community in Florida. Many of the attendees are widows and widowers. Which of the following information is appropriate for the nurse to include in her discussion? A. Persons over 50 comprise approximately 10% of HIV cases. B. There is an increase in heterosexual transmission of HIV in older adults. C. African American and Hispanic women report higher levels of risk taking behaviors. D. all of the above Answer: A 70 Care of The Older Adult TEST BANK List the five behavioral determinants of healthy aging as described in this chapter. Answer: Smoking, activity, nutrition, alcohol, medication adherence Name three options that a nurse could teach an older person about regarding smoking cessation. Answer: personal counseling, smoking cessation groups, smoke free organization(s) Strength building is the primary intervention for preventing what medical condition, the gradual loss of muscle mass with age? A. Osteopenia B. Osteoporosis C. Osteosarcoma D. Sarcopenia Answer: D RATIONALE: The first 3 answers relate to bone (osteo). The correct answer is different and relates to muscle, which is what the question is asking. Among military personnel, what medical condition can be a result of retirement and having more time to dwell on war experiences or other common changes occurring with age? A. Alzheimer’s disease B. Huntington’s disease C. Post Traumatic Stress Disorder (PTSD) D. Late Onset Stress Symptomology (LOSS) Answer: D 71 Care of The Older Adult TEST BANK Even if you do not know the correct answer, it sometimes helps to match up key words in the “stem” of the question to key words in the answer. The purpose of which of the following is to identify drugs to avoid in older adults and improve medication selection for older adults? Select All That Apply: A. Beers Criteria B. START criteria C. STOPP criteria D. Black box warning Answer: A, B, C What is the most important discussion of the interdisciplinary team at regularly scheduled meetings? A. Standardized testing results B. Risk reduction assessments C. Compliance issues D. Care access issues Answer: B RATIONALE: All of these topics might be appropriate for discussion in an interdisciplinary meeting, but “B” is best because it is most patient-focused. A vigorous recent widower visited his primary care team and stated he was lonely. Which recommendation should the team make for this patient? A. Take a sleeping pill B. Take an antidepressant C. Move in with his children D. Find a new relationship 72 Care of The Older Adult TEST BANK Answer: B RATIONALE: Options A & B do not help with loneliness. DO NOT ASSUME ANYTHING…..Option C cannot be correct because we are not given the information that he has children. Option D is best for loneliness…..do not assume this means a “romantic” relationship! At which activity would it be important to protect the client who is on phenothiazines from the side effects of this drug? A. Sunday church services. B. A twilight concert.1 C. A midday movie in the theater. D. A luncheon picnic on the hospital grounds. Answer: D Choices A, B, and C all involve indoor activities. Choice 4 involves outdoor exposure during the height of the sun’s rays. Clients need to be protected against photosensitivity and burns when on phenothiazines. Two hours after a liver biopsy, the nurse finds the client lying on the left side. What is the best nursing action at this time? A. Check for bleeding. B. Turn the client onto the right side. Answer: B 75 Care of The Older Adult TEST BANK A. “You should not rearrange furniture in your home.” B. “You should not install burglar alarms in your home.” C. “You should install blinking lights synced with your doorbell in your home.” D. “You should install an air conditioner in your home.” Answer: C Presbycusis is the process of hearing loss due to aging. Blinking lights can alert the client to an incoming call or a doorbell. The nurse is teaching a client about measures to follow while taking and storing medications at home. Which action of the client indicates the need for further teaching? A. Keeping the medications above the television, in bottles with child safety caps B. Avoiding taking the medication in front of the child C. Storing the medications in a locked cabinet D. Avoiding referring to the medication as candy Answer: A. Child safety caps are not the primary prevention for accidental ingestion of medication. Therefore, the client should not keep the medications within the reach of children. The nurse is preparing to discharge a client with a femur fracture. Which nursing intervention helps to promote the client’s safety at home? A. Identifying a client’s anxiety B. Teaching the client about care guidelines C. Assessing for risk of falls D. Referring the client to a support group 76 Care of The Older Adult TEST BANK Answer: B During client teaching, the nurse instructs precautions and care guidelines that help prevent further damage to the client’s femur. Therefore, the client teaching helps to promote the client’s safety at home. Clients with gustatory deficit should have the following home care; serving the food on a well-garnished plate, not serving overcooked food to the client, and using spices liberally while cooking the client’s food. True False Answer: True. Clients with gustatory deficit lack an appetite and sense of taste. Therefore, the meal experience for these clients may be improved by focusing on the visual appeal of the meal. Thus, the caregiver should serve the food to the client on a well-garnished plate. Also, overcooked food may create an unpleasant meal experience for the client. Therefore, overcooked food should be avoided. Lastly, spices enhance the taste of food. Therefore, the caregiver should add more spices to the client’s food. The nurse is caring for a client who just returned from a hip replacement. What type of evidence-based protocol will the nurse use to ensure high-quality care, but also to limit the cost of care? A. Quality indicator B. Clinical pathway for hip replacement C. Root cause analysis D. Individualized care plan Answer: B. A clinical pathway is an outgrowth of a care plan and was developed to manage clients with similar disorders. After research was reviewed, determinations were made as to when certain things should occur (removal of a Foley catheter and IV) to ensure the client receives optimal but efficient care. Clinical pathways are used for hip and knee replacements, congestive heart failure, and community-acquired pneumonia.