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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
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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
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
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
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
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
KEY: Client Needs: D-1 | Cognitive Level: Application | Integrated Process: Teaching/Learning
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
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
TOP: Mental Health Problems in the Older Adult KEY: Client Needs: D-4 | Cognitive Level: Application | Integrated Process: Communication and Documentation
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
TOP: Overview of Aging KEY: Client Needs: B | Cognitive Level: Analysis | Integrated Process: Nursing Process
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
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
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
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
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
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
ANS: B, C, D
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
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
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.
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
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
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
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
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
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.
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
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
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
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
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
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
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
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