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Aging and Older Adult Health: Key Concepts and Client Needs, Exams of Nursing

A series of study questions and answers related to the health needs and aging processes of older adults. Topics covered include age-related changes, mental health problems, geriatric syndromes, and other aspects of health care. Students are assessed on their ability to analyze, comprehend, and apply concepts related to the nursing process.

Typology: Exams

2023/2024

Available from 02/24/2024

TUTOR2024
TUTOR2024 🇬🇧

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  1. You are performing an initial assessment on an 80-year-old male patient admitted for an infected right hand. The man tells you that he can no longer do as many things as he used to be able to do. What do recognize as impacting your patient's life? A) An infectious-disease state B) Loss of independence C) Age-related changes D) Loneliness

ANS: C Age-related changes and risk factors may negatively interfere with patient outcomes and actually impair patient activity and quality of life. Though the patient was admitted for an infected hand, there is no place in this scenario that says this infection is long standing or that it could impact the patient's life; similarly, this scenario does not cite that the patient has lost his independence or that he is lonely, so these factors would not be impacting the patient's life.

PTS: 1 DIF: Difficult REF: 202 OBJ: 4 TOP: Overview of Aging KEY: Client Needs: C | Cognitive Level: Analysis | Integrated Process: Nursing Process

  1. A gerontologic nurse practitioner has a large patient population with heart-disease problems. This nurse practitioner is aware that heart disease is the leading cause of death in the aged. What is the cause of this trend? A) Heart muscle and arteries lose their elasticity. B) Systolic blood pressure decreases. C) Resting heart rate decreases with age. D) The aged are less likely to adopt a healthy lifestyle.

ANS: A The leading cause of death for patients over the age of 65 years is cardiovascular disease. Malignant neoplasms are the second leading cause. As a person ages, systolic blood pressure does not decrease, resting heart rate does not decrease, and the aged are not less likely to adopt a healthy lifestyle.

PTS: 1 DIF: Moderate REF: 203 OBJ: 3 TOP: Age-Related Changes KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. An occupational health nurse overhears an employee talking to his manager about a 65- year-old coworker. What would the nurse be concerned about when she hears the employee state, “He should retire and make way for some new blood”?

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A) Intolerance B) Ageism C) Dependence D) Nonspecific prejudice

ANS: B Ageism refers to prejudice against the aged. Intolerance is implied by the employee's statement, but the intolerance is aimed at the coworker's age, making option A an incorrect answer. The employee's statement does not raise concern about dependence. The prejudice exhibited in the statement is very specific.

PTS: 1 DIF: Moderate REF: 209 OBJ: 7 TOP: Age-Related Changes KEY: Client Needs: C | Cognitive Level: Analysis | Integrated Process: Caring

  1. The nurse is caring for a 65-year-old patient diagnosed with hypertension. Which of the following blood pressure readings demonstrates hypertension? A) 140/90 mm Hg B) 132/88 mm Hg C) 129/75 mm Hg D) 120/68 mm Hg

ANS: A Hypertension is the diagnosis given when the diastolic pressure is greater than or equal to 90 mm Hg regardless of the systolic pressure. This makes the other options incorrect.

PTS: 1 DIF: Moderate REF: 204 OBJ: 3 TOP: Age-Related Changes KEY: Client Needs: D-4 | Cognitive Level: Application | Integrated Process: Nursing Process

  1. You are the nurse caring for a 75-year-old patient who has been hospitalized for a fractured radius. The patient's daughter has accompanied the patient to the hospital and asks you what her father can do for his very dry skin. What would be your best response? A) “Bathe one to two times a week.” B) “Use makeup to cover the wrinkles.” C) “Avoid prolonged use of sunscreens.” D) “Drink more milk.”

ANS: A Patients with dry skin should be instructed to use a lubricating cream daily, avoid prolonged exposure to the sun, bathe only one to two times per week, and maintain a safe indoor temperature. The nurse would not suggest using makeup to cover the wrinkles, avoiding prolonged used of sunscreens, or drinking more milk.

PTS: 1 DIF: Moderate REF: 205 OBJ: 2 TOP: Age-Related Changes

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KEY: Client Needs: D-1 | Cognitive Level: Application | Integrated Process: Teaching/Learning

  1. An elderly patient has come in to the clinic for her yearly physical. The patient tells the nurse that she is having difficulty with bowel movements. What intervention could the nurse suggest? A) Stress reduction B) Increasing caloric intake C) Adequate privacy D) Increasing intake of water

ANS: D Age-related changes, as well as additional risk factors such as disease and the effects of medications, can result in a negative impact on function. Constipation is a common problem in people who are aged. The nurse should assess the patient for frequent laxative and antacid use, which is associated with constipation. The patient should eat high-fiber foods, drink 8 to 10 glasses of water daily, and establish regular bowel habits. Interventions the nurse would not suggest are stress reduction, eating more, or insuring adequate privacy.

PTS: 1 DIF: Moderate REF: 206 OBJ: 6 TOP: Age-Related Changes KEY: Client Needs: B | Cognitive Level: Application | Integrated Process: Nursing Process

  1. An 84-year-old patient has returned from the PACU. The patient is oriented to name only. The patient's family is very upset because before having surgery, the patient knew the family. The patient is diagnosed with delirium. What should the nurse explain to the patient's family? A) There is nothing to worry about. B) Delirium involves a progressive decline in memory loss. C) Delirium usually lasts only a short time. D) Delirium is generally more prevalent in women.

ANS: C Delirium occurs secondary to a number of causes, including physical illness, medication or alcohol toxicity, dehydration, fecal impaction, malnutrition, infection, head trauma, lack of environmental cues, and sensory deprivation or overload. Delirium differs from other types of dementia in that delirium begins with confusion and progresses to disorientation. It affects men and women equally, has symptoms that are reversible with treatment, and, with treatment, is short term in nature. Progressive memory loss is seen in Alzheimer's disease. Delirium in the elderly is a common and life-threatening complication for the hospitalized elderly.

PTS: 1 DIF: Moderate REF: 216 OBJ: 4

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TOP: Mental Health Problems in the Older Adult KEY: Client Needs: D-4 | Cognitive Level: Application | Integrated Process: Communication and Documentation

  1. The nurse is doing patient teaching with a patient with early stage Alzheimer's disease and her family. The patient has been prescribed tacrine hydrochloride. What should the nurse explain to the patient and family about the potential side effect of the drug? A) Liver toxicity B) Dental caries C) Depression D) Sexual impotence

ANS: A Tacrine hydrochloride enhances the body's production of acetylcholine, which can decrease the symptoms of Alzheimer's disease. This medication may cause liver toxicity and, therefore, the patient must be closely monitored.

PTS: 1 DIF: Difficult REF: 218 OBJ: 6 TOP: Mental Health Problems in the Older Adult KEY: Client Needs: D-2 | Cognitive Level: Analysis | Integrated Process: Teaching/Learning

  1. A nurse is caring for an 86-year-old female patient who is very frail and unsteady on her feet. During the assessment, the patient indicates that she has fallen three times in the month. She has not injured herself to date. What is the nurse aware of a high potential for? A) A hip fracture B) A fracture of the mandible C) An increased likelihood of confusion D) Noncompliance with preventive teaching

ANS: A The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition or situation that produced the fall. Falls have been associated with increased institutionalization of elderly patients.

PTS: 1 DIF: Moderate REF: 221 OBJ: 6 TOP: Geriatric Syndromes KEY: Client Needs: D-3 | Cognitive Level: Application | Integrated Process: Nursing Process

  1. You are a case manager working with a patient newly admitted to a rehabilitation facility. When developing a care plan for this older adult, which factors should the nurse consider as being positive in this age group? (Mark all that apply.) A) Decreased risk taking B) Effective coping skills

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C) No participation in untested roles D) A positive self-image E) Resiliency

ANS: B, D, E Because changes in life patterns are inevitable over a lifetime, older people need resiliency and coping skills when confronting stresses and change. A positive self-image enhances risk taking and participation in new, untested roles.

PTS: 1 DIF: Easy REF: 209 OBJ: 5 TOP: Age-Related Changes KEY: Client Needs: B | Cognitive Level: Application | Integrated Process: Nursing Process

  1. The nursing instructor is teaching first-semester nursing students about administering IM injections to an older patient. What does the instructor stress to her students? A) An older patient has less subcutaneous tissue and muscle mass than a younger patient. B) An older patient has more subcutaneous tissue and less muscle mass than a younger patient. C) An older patient has less subcutaneous tissue and more muscle mass than a younger patient. D) An older patient has more subcutaneous tissue and muscle mass than a younger patient.

ANS: A When administering IM injections, the nurse should remember that in an older patient, subcutaneous fat diminishes, particularly in the extremities, but gradually increases in other areas, such as the abdomen (men) and thighs (women), leading to an overall increase in body fat in older people.

PTS: 1 DIF: Moderate REF: 205 OBJ: 3 TOP: Age-Related Changes KEY: Client Needs: A-2 | Cognitive Level: Application | Integrated Process: Nursing Process

  1. An elderly patient, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. The nurse realizes that the patient is concerned about the financial aspects of this illness. What information can the nurse give the patient to help allay her concerns? A) Medicare has a copayment for many of the services it covers. This requires the

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patient to pay a part of the bill. B) Medicare pays for 100% of the cost for acute-care services so the cost of the visit will be covered. C) Medicare will only pay the cost for acute- care services if the patient is very poor. D) Medicare will not pay for the cost of acute-care services so the patient will be billed for the services provided.

ANS: A The two major programs that finance health in the United States are Medicare and Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing. Options B and D are incorrect; Medicare pays for about 55% of all personal health costs. Option C is incorrect; Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on income.

PTS: 1 DIF: Moderate REF: 223 OBJ: 8 TOP: Other Aspects of Health Care of the Older Adult KEY: Client Needs: A-1 | Cognitive Level: Application | Integrated Process: Nursing Process

  1. The admissions department at a local hospital is registering an elderly man for an outpatient test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advanced directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this patient? A) “Advanced directives are not legal documents, so you have nothing to worry about.” B) “Advanced directives are limited only to health care instructions and directives.” C) “Your finances cannot be managed without an advanced directive.” D) (^) “Advanced directives are implemented when you become incapacitated, and then you will use a living will to allow the state to manage your money.”

ANS: B An advance directive is a formal, legally endorsed document that provides instructions for care (living will) or names a proxy decision maker (durable power of attorney for health care) and covers only issues related specifically to health care, not financial issues. Options A and C are incorrect; advanced directives are legal documents, but they do not address financial issues. Option D is incorrect; advanced directives are implemented

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when a patient becomes incapacitated, but financial issues are addressed with a durable power of attorney for finances, or financial power of attorney.

PTS: 1 DIF: Easy REF: 224 OBJ: 5 TOP: Ethical and Legal Issues Affecting the Older Adult KEY: Client Needs: A-1 | Cognitive Level: Application | Integrated Process: Teaching/Learning

  1. A nurse is planning discharge teaching for an 80-year-old patient with some short-term memory loss. The discharge teaching will include how to do his dressing change. What should the nurse plan to do? A) Set long-term goals with the patient B) Provide some music to aid learning C) Keep visual cues to a minimum D) Keep teaching periods short

ANS: D To assist the elderly patient with short-term memory loss, the nurse should keep teaching periods short, provide glare-free lighting, link new information with familiar information, use visual and auditory cues, and set short-term goals with the patient. Therefore, options A, B, and C are incorrect.

PTS: 1 DIF: Moderate REF: 212 OBJ: 4 TOP: Age-Related Changes KEY: Client Needs: D-1 | Cognitive Level: Application | Integrated Process: Teaching/Learning

  1. You are the nurse planning an educational event on the topic of the normal signs of aging to a group of senior citizens. What would you include in your teaching plan? A) An enhanced sense of smell B) A decrease in muscle mass C) The disappearance of sexual desire for both men and women D) An increase in sebaceous and sweat glands for both men and women

ANS: B Normal signs of aging include a decrease in the sense of smell, a decrease in muscle mass, a decline but not disappearance of sexual desire, and decreased sebaceous and sweat glands for both men and women. Therefore options A, C, and D are incorrect.

PTS: 1 DIF: Difficult REF: 203 OBJ: 4 TOP: Age-Related Changes KEY: Client Needs: D-4 | Cognitive Level: Application | Integrated Process: Teaching/Learning

  1. A home health nurse makes a home visit to a 90-year-old patient who has cardiovascular

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disease. During the visit the patient asks the nurse, “Can you see the little green bugs that have been singing to me?” The patient is also exhibiting signs of confusion and agitation. What should the home health nurse do? A) Have the patient's home care increased B) Have a family member check in on the patient in the evening C) Have the patient see his physician D) Refer the patient to an adult day program

ANS: C In more than half of the cases, sudden confusion and hallucinations are evident in multi- infarct dementia. This condition is also associated with cardiovascular disease. Having the patient's home care increased does not address the problem, neither does having a family member check on the patient in the evening. Referring the patient to an adult day program may be beneficial to the patient, but it does not address the problem the patient is having.

PTS: 1 DIF: Difficult REF: 217 OBJ: 4 TOP: Mental Health Problems in the Older Adult KEY: Client Needs: D-4 | Cognitive Level: Application | Integrated Process: Nursing Process

  1. The home health nurse is making an initial home visit to a 76-year-old male widower. During the assessment, the nurse finds that the patient is taking multiple medications. The patient states that he has also been taking some herbal remedies. What should the nurse be sure to include in the patient's teaching? A) Herbal remedies are holistic. B) Herbal remedies are often cheaper than prescribed medicine. C) The importance of avoiding herbal remedies D) The need to inform his physician and pharmacist about the herbal remedies

ANS: D Herbal remedies combined with prescribed medications can lead to interactions that may be toxic. Patients should notify the physician and pharmacist of any herbal remedies they are using. Option A is incorrect; even though herbal remedies are considered holistic, this is not something that is necessary to include in the patient's teaching. Option B is incorrect; herbal remedies may be cheaper than prescribed medicine, but this is still not something that is necessary to include in the patient's teaching. Option C is incorrect because for most people it is not necessary to avoid herbal remedies.

PTS: 1 DIF: Moderate REF: 212 OBJ: 5 TOP: Age-Related Changes KEY: Client Needs: D-2 | Cognitive Level: Application | Integrated Process: Teaching/Learning

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  1. You are the nurse caring for an elderly patient who is confused and agitated. When the patient's family comes to visit the patient, you ask them how long the patient has been confused. The family states that the patient has been confused for a long time, and the confusion is getting worse. The patient is subsequently diagnosed with dementia. What is the most common cause of dementia in an elderly patient? A) Delirium B) Depression C) Excessive drug use D) Alzheimer's disease

ANS: D Alzheimer's disease is the most common cause of dementia in the elderly. Approximately 10% of people over age 65 have Alzheimer's disease; about 50% of people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and isn't itself a cause of dementia. Depression is common in the elderly but, in many cases, manifests itself in apathy, self-deprecation, or inertia — not dementia. Excessive drug use, commonly stemming from the patient seeing multiple physicians who are unaware of drugs that other physicians have prescribed, can cause dementia. Although it is a problem among the elderly, it is not as common as Alzheimer's disease.

PTS: 1 DIF: Moderate REF: 217 OBJ: 4 TOP: Mental Health Problems in the Older Adult KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. You are caring for a patient with late-stage Alzheimer's disease. The patient's wife tells you that the patient has become very dependent and that she feels guilty if she takes any time for herself because the patient cries out for her. What outcomes would be appropriate for the nurse to develop to assist the patient's wife? A) The caregiver learns to explain to the patient why she needs time for herself. B) The caregiver distinguishes obligations she must fulfill from those that can be controlled or limited. C) The caregiver leaves the patient at home alone for short periods of time to encourage independence. D) The caregiver avoids asking other family members to help for fear of imposing on them.

ANS: B For prolonged periods, it is not uncommon for caregivers to neglect their own emotional and health needs. The caregiver must learn to distinguish obligations that she must fulfill and limit those that aren't necessary. The caregiver can tell the patient when she leaves, but she shouldn't expect that the patient will remember or won't become angry with her

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for leaving. The caregiver should not leave the patient home alone for any length of time because it may compromise the patient's safety. The nurse can provide support to the primary caregiver if she needs to ask other family members for assistance.

PTS: 1 DIF: Difficult REF: 220 OBJ: 7 TOP: Mental Health Problems in the Older Adult KEY: Client Needs: C | Cognitive Level: Analysis | Integrated Process: Nursing Process

  1. A 47-year-old patient who has come to the physician's office for his annual physical is being assessed by the office nurse. The nurse is doing routine screening on this patient. The nurse is aware that one of the first physical signs of aging is what? A) Having more frequent aches and pains B) Failing eyesight, especially close vision C) Increasing loss of muscle tone D) Accepting limitations while developing assets

ANS: B Failing eyesight, especially close vision, is one of the first signs of aging in middle life (between ages 46 and 64). More frequent aches and pains begin in the “early” late years (between ages 65 and 79). Increase in loss of muscle tone occurs in later years (ages 80 and older). Accepting limitations while developing assets is socialization development that occurs in adulthood (between ages 31 and 45).

PTS: 1 DIF: Difficult REF: 209 OBJ: 3 TOP: Age-Related Changes KEY: Client Needs: D-4 | Cognitive Level: Analysis | Integrated Process: Nursing Process

  1. The population in the United States is changing. As the elderly population grows, which factor is most dramatically increasing in this age group? A) More families are having to provide care for their aging members. B) Adult children find themselves being “sandwiched” between their own children and their parents. C) There is a growing number of people who live to a very old age. D) Elderly people are having more accidents, increasing the cost of health care.

ANS: C As the older population increases, the number of people who live to a very old age is dramatically increasing. The other options are all correct, but they are not the factor that is most dramatically increasing in this age group.

PTS: 1 DIF: Difficult REF: 201 OBJ: 1

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TOP: Overview of Aging KEY: Client Needs: B | Cognitive Level: Analysis | Integrated Process: Nursing Process

  1. As the population of the United States ages, research has shown that this aging will occur across all racial and ethnic groups. In what population is the rate of growth of the aging population expected to rise the fastest? A) Asian-American B) White non-Hispanic C) Hispanic D) African-American

ANS: C Although the older population will increase in number for all racial and ethnic groups, the rate of growth is projected to be fastest in the Hispanic population, in which it is expected to increase from 6 million in 2004 to an estimated 17.5 million in 2050. The number in the white non-Hispanic population is projected to decrease dramatically. The Asian- American and the African-American populations are not projected to rise faster than the Hispanic elderly population.

PTS: 1 DIF: Moderate REF: 201 OBJ: 1 TOP: Overview of Aging KEY: Client Needs: D-4 | Cognitive Level: Analysis | Integrated Process: Nursing Process

  1. National surveys indicate that as much as 20% of the population 65 years of age or older report what? A) Good health B) Declining faculties C) A chronic disability D) A chronic disease

ANS: C Although the majority of older adults enjoy good health, in national surveys as many as 20% of adults 65 years of age and older report a chronic disability.

PTS: 1 DIF: Easy REF: 201 OBJ: 1 TOP: Overview of Aging KEY: Client Needs: D-1 | Cognitive Level: Knowledge | Integrated Process: Nursing Process

  1. Even with the elderly population increasing, the majority of people aged 75 years of age and over remains functionally independent. What is this trend attributed to? A) Early detection and increasing risk factors B) Health-promotion and disease-prevention activities C) Decrease in treatment of factors like

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hypertension and serum cholesterol levels D) Increase in number of risk factors such as rising numbers of smokers

ANS: B Even among people 75 years of age and over, the majority remains functionally independent, and the proportion of older Americans with limitations in activities is declining. These declines in limitations reflect recent trends in health-promotion and disease-prevention activities, such as improved nutrition, decreased smoking, increased exercise, and early detection and treatment of risk factors such as hypertension and elevated serum cholesterol levels. There is no evidence that there are an increasing number of risk factors that would limit functional independence. Treatment factors for hypertension and serum cholesterol levels have not been decreasing, and there is decreased, not increased, smoking.

PTS: 1 DIF: Moderate REF: 202 OBJ: 2 TOP: Overview of Aging KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. Health promotion and preventive health care are a major focus for the nursing professional. The challenge for nursing is to promote positive lifelong health behaviors in all segments of the population. What is the impact on the population if this challenge is not met? A) Declining longevity B) Increased disabilities C) Chronic disease D) Increased numbers of risk factors

ANS: C Nurses are challenged to promote positive lifelong health behaviors among all populations because the impact of unhealthy behaviors and choices can result in chronic disease. The absence of health promotion and preventive health care will not cause declining longevity, increased disabilities, or an increase in the number of risk factors.

PTS: 1 DIF: Moderate REF: 202 OBJ: 2 TOP: Overview of Aging KEY: Client Needs: B | Cognitive Level: Application | Integrated Process: Teaching/Learning

  1. Approximately 50% of the deaths in the 65 and older age group are caused by heart disease and cancer. However, over the past 50 years, a noticeable decline in overall deaths, especially from heart disease and cancer, has been noted. What has most caused this decline in deaths? A) Health care awareness in the elderly population

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B) Healthier lifestyles in the elderly population C) An increase in exercise and better nutrition among the aging population D) Improvements in the prevention and early detection and treatment of diseases

ANS: D The majority of deaths in the United States occur in people 65 years of age and older, and half of these are caused by heart disease and cancer. However, due to improvements in the prevention and early detection and treatment of diseases, there has been a noticeable impact on the health of people 65 years of age and older. In the past 50 years, there has been a decline in overall deaths and, specifically, deaths from heart disease and, more recently, cancer. Options A, B, and C are all correct answers, but they are not the biggest (strongest) cause in the decline of these deaths.

PTS: 1 DIF: Difficult REF: 201 OBJ: 2 TOP: Overview of Aging KEY: Client Needs: B | Cognitive Level: Analysis | Integrated Process: Teaching/Learning

  1. On which factor does the well-being of older adults depend? (Mark all that apply.) A) Environmental B) Economic C) Mental D) Natural medicine E) Holistic relationships

ANS: A, B, C The well-being of older people depends on physical, psychosocial, mental, social, economic, and environmental factors. The well-being of older people does not depend on natural medicine or holistic relationships.

PTS: 1 DIF: Easy REF: 202 OBJ: 8 TOP: Age-Related Changes KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. The perceptions of the elderly by other segments of the population are sometimes negative. How do some people see older people? (Mark all that apply.) A) As being selfless and self-absorbed B) As not contributing to society C) As draining economic resources D) As competing with children for resources E) As using health care resources they need

ANS: B, C, D

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Retirement and perceived nonproductively are also responsible for negative feelings because a younger working person may falsely see older people as not contributing to society and as draining economic resources. Younger working people may actually feel that older people are in competition with children for resources. The older population is generally not seen as being selfless or as needing the health care resources that they need by those people who look at the elderly in a negative fashion.

PTS: 1 DIF: Moderate REF: 209 OBJ: 8 TOP: Age-Related Changes KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. You are caring for a 72-year-old male patient who was recently admitted to the long-term care facility in which you work. Since admission he has become withdrawn and anxious. You know that anxiety in the elderly can be the result of what? A) Loss of dependence B) Fear of being visited in the hospital C) Mental sharpness D) Economic concerns

ANS: D Older people admitted to the hospital are at high risk for disorientation, confusion, change in level of consciousness, and other symptoms of delirium, as well as anxiety and fear. In addition, economic concerns and fear of becoming a burden to families often lead to high anxiety in older people. Concerns about a loss of dependence or fear of being visited in the hospital or being mentally acute are not factors that cause anxiety in the elderly.

PTS: 1 DIF: Moderate REF: 222 OBJ: 8 TOP: Geriatric Syndromes KEY: Client Needs: C | Cognitive Level: Application | Integrated Process: Nursing Process

  1. The interactions between disabilities and aging are not yet clearly understood. The nurse knows this interaction varies depending on what? A) Socioeconomics B) Nutritional status C) Social situations D) Decade of life

ANS: A There are still large gaps in our understanding of the interaction between disabilities and aging, including how this interaction varies depending on the type and degree of disability and other factors such as socioeconomics and gender. Nutritional status, social situations, and the decade of life of the patient are not factors that vary the interactions between disabilities and aging.

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PTS: 1 DIF: Moderate REF: 224 OBJ: 8 TOP: Other Aspects of Health Care of the Older Adult KEY: Client Needs: D-4 | Cognitive Level: Application | Integrated Process: Nursing Process

  1. Gerontologic nursing is a specialty area of nursing that provides care for the elderly in our population. What goals of care are included in this population? A) Helping older adults determine how to best find their functional status B) Helping older adults use their strengths to achieve optimal independence C) Helping older adults promote independent living D) Helping older adults identify their weaknesses

ANS: B Gerontologic nursing is provided in acute care, skilled and assisted living, community, and home settings. The goals of care include promoting and maintaining functional status and helping older adults identify and use their strengths to achieve optimal independence. Goals of gerontologic nursing do not include helping older adults determine how best to find their functional status, promote independent living, or identify their weaknesses.

PTS: 1 DIF: Moderate REF: 202 OBJ: 7 TOP: Overview of Aging KEY: Client Needs: B | Cognitive Level: Application | Integrated Process: Caring

  1. The use of gerontologic advanced practice nurses (GAPNs) in long-term care has proven beneficial to both the patients and the communities in which they live. Using current knowledge based on evidence-based research conducted on clinical problems specific to the elderly population, what has occurred? A) Research has identified the major health problems of the chronically ill elderly population. B) The elderly are experiencing more long- term health problems. C) Less deterioration in the overall health issues of patients has occurred. D) The elderly are better taken care of in long-term care facilities than at home.

ANS: C The use of gerontologic advanced practice nurses (GAPNs) in long-term care has proved to be very effective; when GAPNs use current scientific knowledge about clinical problems to collaborate with nursing home staff, significantly less deterioration in the overall health issues of patients occurs. The major health problems specific to the elderly population that is chronically ill were identified without the use of evidence-based

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research. The elderly are not experiencing more long-term health problems then they did before the use of GAPNs in long-term care. Research has not shown that the elderly are better cared for in long-term care facilities than they are at home.

PTS: 1 DIF: Moderate REF: 202 OBJ: 4 TOP: Overview of Aging KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. Even with health care programs such as Medicare and Medicaid, the poor and near-poor elderly populations are negatively impacted by out-of-pocket health care expenses. How much of the income of this population is spent on out-of-pocket health care expenses? A) 38% B) 33% C) 28% D) 23%

ANS: C Out-of-pocket health care expenses represent 28% of the income of poor and near-poor elderly people.

PTS: 1 DIF: Moderate REF: 223 OBJ: 8 TOP: Other Aspects of Health Care of the Older Adult KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. The strains of providing care for an elderly family member with a chronic condition can sometimes be more than the family or caregiver can bear. If the nurse suspects that there is a potential problem with abuse of an elderly person, preventive measures should be taken. What might early detection and prevention provide for this potential problem? A) Sufficient resources to decrease risk for patient safety B) Support classes for the elderly patient C) Aging parenting classes for caregivers D) New ways to prevent the abuse of the elderly

ANS: A Nurses should be alert to possible elder abuse and neglect. During the health history, the elderly person should be asked about abuse during a private portion of the interview. Most states require that care providers, including nurses, report suspected abuse. Preventive action should be taken when caregiver strain is evident, before elder abuse occurs. Early detection and intervention may provide sufficient resources to the family or person at risk to ensure patient safety. Early detection and prevention of the abuse of the elderly does not provide support classes for the elderly patient, aging parenting classes for caregivers, or new ways to prevent the abuse of the elderly.

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PTS: 1 DIF: Easy REF: 223 OBJ: 2 TOP: Other Aspects of Health Care of the Older Adult KEY: Client Needs: B | Cognitive Level: Comprehension | Integrated Process: Caring

  1. You are the nurse caring for an elderly patient with cardiovascular disease. The patient comes to the clinic with a suspected respiratory infection and is diagnosed with pneumonia. As the nurse, what do you know about the altered responses of older adults? A) Treatments for older adults need to be rapid and less intense than treatments used in the younger population. B) (^) The altered responses of older adults reinforce the need for the nurse to monitor all body systems to ascertain signs of impending systemic complication. C) The altered responses of older adults define the nursing interactions with the patient. D) Older adults become hypersensitive to antibiotic treatments for infectious-disease states.

ANS: B Older people may be unable to respond effectively to an acute illness, or, if a chronic health condition is present, they may be unable to sustain appropriate responses over a long period. Furthermore, their ability to respond to definitive treatment is impaired. The altered responses of older adults reinforce the need for nurses to monitor all body system functions closely, being alert to signs of impending systemic complication. Treatment for the elderly for acute conditions needs to be given in a timely manner, but they do not need to be less intense than treatments used in the younger population. Altered responses in the older adult do not define the interactions between the nurse and the patient. Older adults do not become hypersensitive to antibiotic treatments for infectious-disease states.

PTS: 1 DIF: Moderate REF: 222 OBJ: 5 TOP: Geriatric Syndromes KEY: Client Needs: D-4 | Cognitive Level: Application | Integrated Process: Nursing Process

  1. You are the nurse caring for patients in the urology clinic. A new patient, 68 years old, presents with complaints of urinary incontinence. An anticholinergic is prescribed. Why might this type of medication be an inappropriate choice in the elderly population? A) Gastrointestinal hypermobility can be an adverse effect of this medication. B) Detrusor instability can be an adverse effect of this medication. C) Confusion can be an adverse effect of this medication.

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D) Increased symptoms of urge incontinence can be an adverse effect of this medication.

ANS: C Although medications such as anticholinergics may decrease some of the symptoms of urge incontinence (detrusor instability), the adverse effects of these medications (dry mouth, slowed gastrointestinal motility, and confusion) may make them inappropriate choices for the elderly.

PTS: 1 DIF: Moderate REF: 221 OBJ: 6 TOP: Geriatric Syndromes KEY: Client Needs: D-2 | Cognitive Level: Application | Integrated Process: Teaching/Learning

  1. The elderly population has not been left out of the HIV/AIDS epidemic. What are common AIDS-indicator disease processes in the elderly population? (Mark all that apply.) A) Wasting syndrome B) Kaposi's sarcoma C) Tuberculosis D) Encephalopathy E) Pneumocystis pneumonia (PCP)

ANS: D The most common AIDS-indicator disease in older people is Pneumocystis pneumonia (PCP). Wasting syndrome and HIV encephalopathy are also common in older people with HIV infection. Kaposi's sarcoma and tuberculosis are not common AIDS-indicator diseases in the older population.

PTS: 1 DIF: Difficult REF: 222 OBJ: 1 TOP: Geriatric Syndromes KEY: Client Needs: D-4 | Cognitive Level: Analysis | Integrated Process: Nursing Process

  1. Falls are a major health problem in the elderly population and occur from multifactorial causes. What is a factor in the rate of falls in the elderly population? (Mark all that apply.) A) Medication effects B) Overdependence on assistive devices C) Poor lighting D) Sensory impairment E) Ineffective use of coping strategies

ANS: A, C, D Causes of falls are multifactorial. Both extrinsic factors, such as changes in the environment or poor lighting, and intrinsic factors, such as physical illness, neurologic

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changes, or sensory impairment, play a role. Mobility difficulties, medication effects, foot problems or unsafe footwear, postural hypotension, visual problems, and tripping hazards are common, treatable causes. Overdependence on assistive devices and ineffective use of coping strategies have not been shown to be factors in the rate of falls in the elderly population.

PTS: 1 DIF: Moderate REF: 221 OBJ: 3 TOP: Geriatric Syndromes KEY: Client Needs: B | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. Older people have many altered reactions to disease that are considered age-related changes. When the nurse observes physical indicators of illness in the older population, that nurse must remember what? A) Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population. B) Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults. C) The same physiologic processes that indicate serious health care problems in a younger population indicate mild disease states in the elderly. D) (^) Middle-aged people do not react to disease states the same as a younger population does.

ANS: B Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for the diagnosis of potential life-threatening problems in older adults. Option A is incorrect because a potentially life-threatening problem in an older person is more serious then it would be in a middle-aged person as the older adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care problems in a young or middle-aged population do not indicate disease states that are considered “mild” in the elderly population. It is true that middle-aged people do not react to disease states the same as a younger population, but this option does not answer the question.

PTS: 1 DIF: Moderate REF: 222 OBJ: 3 TOP: Geriatric Syndromes KEY: Client Needs: D-4 | Cognitive Level: Comprehension | Integrated Process: Nursing Process

  1. You are the nurse caring for a 91-year-old patient admitted to the hospital for a fall. The patient complains of incontinence and tells you he falls when he tries to get to the

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bathroom. You assess the patient as frail and prone to falls. You know that this patient most likely has a diagnosis of what? A) Impaired cognitive functioning B) Environmental hazards C) A geriatric syndrome D) An age-related health deficit

ANS: C A number of problems commonly experienced by the elderly are becoming recognized as geriatric syndromes. These conditions do not fit into discrete disease categories. Examples include frailty, delirium, falls, urinary incontinence, and pressure ulcers. Impaired cognitive functioning, environmental hazards in the home, and an age-related health deficit may all play a part in the episodes in this patient's life that lead to falls, but they are not diagnoses and are, therefore, incorrect.

PTS: 1 DIF: Difficult REF: 220 OBJ: 4 TOP: Geriatric Syndromes KEY: Client Needs: D-4 | Cognitive Level: Analysis | Integrated Process: Nursing Process