Geriatric Care Management for Older Adults, Exams of Nursing

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A hospital nurse is discussing with an older adult the possibility transfer to a nursing home for skilled care after pneumonia. Which statement by the client indicates an understanding of this possible transfer? A)Old people who go to the nursing home don't get out. B)They will take my home if I go to the nursing home. C)I don't qualify for skilled care, I only had pneumonia. D)I have already used 45 Medicare days this year. - correct answer ✅✅ D)I have already used 45 Medicare days this year. Feedback Medicare and other insurance programs will cover all or part of the care for up to 100 days of care. Typical diagnoses associated with skilled care in a nursing home are stroke, fractured hip, congestive heart failure, and rehabilitation after acute illnesses (e.g., pneumonia and myocardial infarction). About 65% of older adults spend some time in a nursing home. A nursing case manager monitors admissions into an acute care unit. Which of the following clients would be the most appropriate candidate for in-home skilled nursing care?

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A)A client requiring twice-daily dressing changes for a coccyx wound B)A client who has been admitted to the emergency department with a recent stroke C)A client with reoccurring urinary retention of unknown etiology D)A client who is scheduled for hip replacement surgery tomorrow - correct answer ✅✅ A)A client requiring twice- daily dressing changes for a coccyx wound Feedback Skilled home care is most appropriate for older adults who are recovering from an illness or injury and have potential for returning to their previous level of functioning. Following a stroke, a client requires hospitalization. A client with a poorly understood or undiagnosed health problem would not be an ideal candidate for home care, nor would a preoperative client. A nurse is teaching a family of an older adult about the role of adult day centers. Which of the statements by the family member indicates a need for further teaching?

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A)"The day center can give me respite." B)"The day center can improve our quality of life." C)"The day center can be a useful alternative to medical care." D)"The day center can contribute to an actual improvement in dementia symptoms." - correct answer ✅✅ C)"The day center can be a useful alternative to medical care." Feedback Adult day centers are a community-based resource providing food, supervision, and activity, but are not designed to provide acute medical care. They provide caregiver relief and have been linked to improved quality of life and decreased symptoms of dementia. A nurse is teaching an older adult about possible involvement in Programs of All-inclusive Care for the Elderly (PACE). Which of the following statements by the older adult shows understanding? A)PACE programs provide several social and medical services on a managed care basis.

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B)PACE programs provide a cost-effective alternative to hospital-based acute care. C)PACE programs are more expensive than fee-for-service models but offer better health outcomes. D)There is pressure for Medicare and Medicaid to begin funding PACE programs. - correct answer ✅✅ A)PACE programs provide several social and medical services on a managed care basis. Feedback PACE programs provide a range of services using a capitated managed care model. They are focused on meeting the needs of adults with chronic conditions and are not an alternative to in-hospital treatment of acute illness. They are less expensive than fee-for-service models and presently are receiving funding under both Medicare and Medicaid. The 2010 Affordable Care Act provides incentives for further expansion of PACE programs. A client has recently begun receiving Social Security benefits and is asking the nurse about what services might be included or excluded under Medicare. Which of the following services is most likely to be excluded from Medicare funding?

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A)Hospital care B)Hospice care C)Rehabilitation care D)Nursing home care - correct answer ✅✅ D)Nursing home care Feedback Medicare was established as a means of funding some types of direct client medical care, hospice and rehabilitation care may be covered, but nursing home residence is not. A nurse assists an older adult who is homebound in a rural area. Which community resources might this client best benefit from? A)Skilled home nursing B)Senior center C)Personal emergency response system D)Grocery delivery - correct answer ✅✅ C)Personal emergency response system

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Feedback The rural client is unlikely to have grocery delivery. And as a homebound rural client, a senior center would not be available. Only some clients qualify for skilled home nursing visits, there are not location limitations on personal emergency response systems, some now come with GPS and cellular capabilities. An 84-year-old client has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. Which of the following characteristics of the client's current situation is most likely to prompt this move? A)The development of a severe, acute health problem B)A decrease in the client's level of function and activities of daily living (ADLs) C)Exacerbation of a chronic health problem that may require medical treatment D)A change in the level of the client's social support - correct answer ✅✅ B)A decrease in the client's level of function and activities of daily living (ADLs) Feedback

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Nursing home settings are becoming increasingly diverse, but a common feature of older adults who are admitted to nursing homes is a decrease in function and ADLs. Acute health problems that require medical treatment necessitate hospital admission, and a change in social support would not necessarily prompt a move from assisted living. Active care management is often necessary in order to maintain wellness among older adults. Which of these older adults is most likely to require care management? A)A 90-year-old man who lives alone and has no living family members B)A 77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier C)An 81-year-old resident of a nursing home whose Alzheimer disease is progressing rapidly D)A 90-year-old man who has recently been transferred from an assisted living facility to an acute care setting - correct answer ✅✅ A)A 90-year-old man who lives alone and has no living family members Feedback

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Community-dwelling older adults who may lack family involvement in their care often require independent community-based professional geriatric care management. Individuals who are experiencing acute medical conditions and who are in institutional or acute care settings are not frequent recipients of care management. A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. Which action can the nurse take to potentially minimize these expenses for clients? A)Become familiar with the various funding sources and their eligibility requirements. B)Teach older adults to be astute with their spending and saving patterns. C)Encourage older adults to make care providers aware of each chronic condition they live with. D)Provide care that is primarily focused on acute, rather than chronic, health problems. - correct answer ✅✅ A)Become familiar with the various funding sources and their eligibility requirements. Feedback

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Despite the complexity and limitations of programs, nurses need to know enough about the most common sources of payment for health services so they can understand and address some of the barriers to and challenges of implementing nursing care plans and discharge plans. Ultimately, this may have the effect of reducing some older adults' out-of-pocket expenses. Teaching about financial management is beyond the scope of the nurse and focusing on acute, rather than chronic, health problems is inappropriate. Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which of the following problems is most likely to precipitate admission to long-term care? A)Kidney disease B)Traumatic injury C)Chronic obstructive pulmonary disease D)Dementia - correct answer ✅✅ D)Dementia Feedback In contrast to admissions for skilled nursing care that are associated with a hospitalization, admissions to long-term care commonly occur after a period of gradual decline in

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functioning because of a chronic condition, such as dementia. Studies indicate that more severe functional limitations, cognitive impairment, and problematic behaviors in people with dementia are predictors of admission to nursing facilities for long-term care. Which of the following actions exemplifies the nurses' role in home care of an older adult? (Select all that apply.) A)Coordinate a multidisciplinary team. B)Perform ADL care for clients. C)Provide resources to caregivers to reduce caregiver stress. D)Refer available community resources. E)Teach about interventions to provide quality care. - correct answer ✅✅ A)Coordinate a multidisciplinary team. C)Provide resources to caregivers to reduce caregiver stress. D)Refer available community resources. E)Teach about interventions to provide quality care. Feedback

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Nurses who provide skilled home care services typically assume a primary coordinating role with a multidisciplinary team. Nursing responsibilities include referrals for additional services. Nurses direct their interventions toward the caregivers providing teaching about interventions, and they address needs of the caregiver related to information about resources and ways to reduce caregiver stress. A nurse teaches an older adult client about the use of the telehealth equipment to monitor congestive heart failure. Which of the following statements by the client shows understanding? A)"I will call the primary health care office everyday with my weight, and blood pressure." B)"I won't touch this fancy equipment unless you are here." C)"I need to step on this scale and use this automatic cuff each day." D)"I will watch the prescribed television show every afternoon." - correct answer ✅✅ C)"I need to step on this scale and use this automatic cuff each day." Feedback

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Telehealth is used to collect and transmit assessment information. The client does not have to call anyone, they are to use the equipment to collect weight and blood pressure to monitor congestive heart failure, this equipment will transmit the data. Television is not included in telehealth. A nursing administrator of the long-term care facility implements a performance improvement program. Which of the following activities should be included in the program? A)Develop a dementia care unit. B)Decrease the use of intramuscular medications. C)Emphasize safety and medical care. D)Measure outcomes focusing on personal choice. - correct answer ✅✅ D)Measure outcomes focusing on personal choice. Feedback Quality assurance and performance improvement programs measure attainment of outcomes. Quality in long-term care focuses on consumer personal choices and quality of life issues, without the overemphasis on safety, uniformity, and medical care. Developing a dementia unit

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is not always included in quality improvement of long- term care, nor is reduction of IM medications. A client in the skilled nursing facility refuses rehabilitation services 5 out of 7 days. An administrator tells the client that they will be transferred to the intermediate care unit. The client states, "Medicare is paying my bill; you can't transfer me." Which of the following is the best response by the nurse administrator? A)"You are making good progress it's time to move to the intermediate care unit." B)"We don't accept Medicare clients in the skilled unit." C)"Oh, I wasn't aware; you will be staying here." D)"Medicare will only pay as long as you continue to make progress toward your goals." - correct answer ✅✅ D)"Medicare will only pay as long as you continue to make progress toward your goals." Feedback Medicare and other insurance programs will cover all or part of the care for up to 100 days of care, but only as long as the person continues to require the skilled level of services. The expectation is that the person will be able

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to progress to a higher level of functioning and show some recovery from the acute episode. Centers for Medicare and Medicaid Services (CMS), the Institute of Medicine, and the Joint Commission have developed standards to address areas of concern for older hospitalized adults. Which of the following situations is of particular concern for an older adult with a hospitalization requiring complex care? A)Transitions in care B)Hospital-acquired respiratory infections C)Need for geriatric care manager D)Placement in an acute care for elders unit - correct answer ✅✅ A)Transitions in care Feedback CMS, the Institute of Medicine, and the Joint Commission have placed a high priority on the issue of older adults with complex medical problems who transfer between care settings, because they are particularly vulnerable to experiencing problems. Geriatric care managers and acute care for elders unit assist with this issue. Hospital- acquired urinary tract infections and wounds not respiratory infections are prevalent.

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1. A 77-year-old client was put on broad-spectrum antibiotics when hospitalized for sepsis. The client has a history of rheumatoid arthritis and a recurring problem with pneumonia. Which of the following theories best explains why the client has had these issues? A) Free radical theory B) Genetic theory C) Immunity theory D) Wear-and-tear theory - correct answer ✅✅ Ans: C Immunity theories focus on immunosenescence. Older adults are more susceptible to cancer, autoimmune disorders, and infections, a phenomenon that is known as immunosenescence. Wearing out is exacerbated by harmful factors, such as stress, disease, smoking, poor diet, and alcohol abuse. Free radicals are waste products of metabolism and they can damage cells. Current studies indicate that the genetic effect on longevity is due to modest effects of many genes interacting, with some genes increasing one's susceptibility to age-related disease and early death and other genes slowing the aging process and leading to a longer life.

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2. Until recently, a 77-year-old client lived alone in her own home. The client fell and fractured an ankle and was placed in a long-term care facility for physical therapy. After the physical therapy was finished, the client tells the nurse, "I want to stay at the facility; I am happy living there and I like the social interaction." Which of the following theories of aging best describes the status of this client? A) Activity theory B) Feminist theory C) Life-course theory D) Theory of thriving - correct answer ✅✅ Ans: D The theory of thriving posits that the older adult thrives when there is concordance between the person and the human and nonhuman environment. Activity theory postulates that older people remain socially and psychologically fit if they remain actively engaged in life such as engaging in full-time work and low-level volunteering. Feminist gerontology theories examine aging from the experiences of older women. Feminist theories address gender inequalities with regard to caregiving roles, diseases, and economic status. Life- course theories address old age within the context of the life cycle.

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3. Which of the following statements best explains the relevance of psychological theories for gerontological nursing? A) Human needs theory allows the nurse to determine priorities of nursing care for older adults. B) Life span development theories support the belief that it may be difficult to initiate behavioral changes in older adults. C) Psychological theories explain why nurses should focus their discussion more on the present than on the past when talking with older adults. D) Psychological theories explain why reminiscence groups may not be beneficial for older adults - correct answer ✅✅ Ans: A Maslow's human needs theory is useful in conceptualizing interventions in the older adult's home and in a health care facility. The attainment of lower-level human needs takes priority over higher-level human needs, such as

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self-actualization. Life span development theories help nurses identify those areas of personality that are likely to change and those that are more likely to remain stable. Psychological theories imply that older adults should devote some time and energy to life review and self- understanding.

4. A 55-year-old client was recently diagnosed with type 2 diabetes. The client completed a diabetes education class and does water aerobics three times a week. The blood sugar and hemoglobin A1c have improved since losing 20 lb. Which of the following statements best describes this client's actions? A) Activity theory B) Age stratification theory C) Functional consequences theory D) Life-course development theory - correct answer ✅✅ Ans: C The Functional Consequences Theory for Promoting Wellness in Older Adults provides a framework for a holistic approach that identifies the risk factors and addresses those that are modifiable in older adults. Age stratification theory addresses the interdependencies

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between age as an element of the social structure and the aging of people and cohorts as a social process. Lifecourse development is related to old age within the context of the life cycle. The activity theory postulates that older people remain socially and psychologically fit if they remain actively engaged in life.

5. The child of an 81-year-old client asks the nurse about vitamins, antioxidants, and age-related macular degeneration. Which of the following theories of aging is most appropriate to this topic? A) Free radicals theory B) Immunosenescence theory C) Program theory D) Wear-and-tear theory - correct answer ✅✅ Ans: A Free radical theory focuses on interventions to modify or prevent the age-related accumulation of free radicals or to diminish the formation of free radicals. Antioxidants, beta-carotene, and vitamins C and E provide defense mechanisms against oxidative damage from free radicals. Immunosenescence (age-related decline of the immune system) theory focuses on the increased susceptibility of older people to diseases, such as cancer and infections.

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The immune system may even attack healthy cells, leading to autoimmune conditions, such as rheumatoid arthritis. Program theory postulates the life span of about 110 years in humans. Abnormal cells, such as cancer cells, are not subject to this predictable program and can proliferate an indefinite number of times. Wear-and-tear theory postulates that the longevity of the human body is affected by the care it receives, as well as by its genetic components.

6. A group of nurses is involved in the planning and implementation of a health promotion campaign aimed at older adults. Which of the following questions is the best guide to such a campaign? A) "How can we help older adults maintain wellness as they age?" B) "What can we do to increase life expectancy in our region?" C) "How can we help older adults avoid age-related changes?"

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D) "What is stopping older adults from living longer lives?" - correct answer ✅✅ Ans: A Nursing practice prioritizes the maintenance of wellness into later life rather than simply increasing chronological life expectancy. It is unrealistic to expect older adults to avoid agerelated physiologic changes

7. A gerontological nurse is aware that quality of life is an important consideration when assessing the functioning of older adults. What measure should the nurse use when appraising older adults' quality of life? A) Active life expectancy B) Gerotranscendence C) Life expectancy D) Rectangularization of the curve - correct answer ✅✅ Ans: A Active life expectancy, which is measured on a continuum ranging from inability to perform activities of daily living to full independent functioning, is an indicator of quality of life during later adulthood. The theory of gerotranscendence addresses the change in perspective

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that often accompanies aging, and life expectancy is a measure of chronologic age. Rectangularization of the curve is attributed to changes in survival caused by various significant factors occurring at different points in time.

8. A 74-year-old client has recently begun integrating more fresh fruit and vitamin supplements in an effort to increase the levels of antioxidants. This client's actions indicate an understanding of what theory of aging? A) Cross-linkage theory B) Program theory of aging C) Immunosenescence D) Free radical theory - correct answer ✅✅ Ans: D Antioxidants, including beta-carotene and vitamins C and E, are one of the major defense mechanisms against oxidative damage from free radicals. The theory of immunosenescence, cross-linkage theory, and the program theory of aging do not directly prioritize a role for antioxidants in maintaining health.

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9. Which of the following characteristics of older adults is explained by the subculture theory? A) Older adults have little control over the biologic effects of the aging process. B) Older adults have a decreased need for social interaction and peer support as they become older. C) Older adults may see their status with their peers in terms of economic achievement. D) Older adults may interact much more with other older adults than with members of other age groups. - correct answer ✅✅ Ans: D The subculture theory maintains that older people are less well integrated into the larger society and interact more among themselves, compared with people from other age groups. The theory does not prioritize economic achievement or the biologic effects of aging. Older adults do not have a diminished need for social interaction.

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10. A nurse is aware that many health care providers prioritize the role of biology in the aging process. What is a weakness of biologic theories of aging as it applies to nursing? A) Biologic theories do not account for the differences in life expectancy between men and women. B) Biologic theories are unable to explain the role of cell division in life expectancy and the aging process. C) Biologic theories of aging do not adequately address issues of wellness and quality of life. D) Biologic theories of aging are unable to explain the significant increases in life expectancy that occurred in the 20th century. - correct answer ✅✅ Ans: C Biologic theories of aging do not address the significant influence of nursing, medical, and psychosocial interventions that can improve a person's functioning and life expectancy. More broadly, they do not address holistic questions surrounding wellness. They are generally able to account for increases in life expectancy and phenomena such as cell division.

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11. A nurse assesses a 66-year-old woman who strained a muscle. The client attends the gym daily, and states, "I injured my muscle grouting the floor tile getting ready for the bridge class I teach." Which of the following categorizes this client's aging? A) Healthy B) Active C) Productive D) Successful - correct answer ✅✅ Ans: B The scenario does not show social participation, nor does it address whether or not the client is fully aging well (successful aging). The client does show healthy aging, but active aging better fits the information presented (active physically and mentally).
12. A healthy 65-year-old says, "I don't think I will live much past 70." The studies however show that this client should live to 84 years of age. Which of the following statements, by the nurse, summarizes the compression of morbidity for this client?