Gerontological Nursing 10th Edition Eliopoulos Test Bank Chapter 1 The Aging Population, Exams of Nursing

Download Gerontological Nursing 10th Edition Eliopoulos Test Bank Chapter 1 The Aging Population and more Exams Nursing in PDF only on Docsity! Gerontological Nursing 10th Edition E liopoulos Test Bank Chapter 1 The Aging Population Test Bank MULTIPLE CHOICE • The nurse explains that in the late 1960s, health care focus was aimed at the older adult because: • disability was viewed as unavoidable. • complications from disease increased mortality. • older adults needs are similar to those of all adults. • preventive health care practices increased longevity. ANS: D Increased preventive health care practices, disease control, and focus on wellness helped people live longer. DIF: Cognitive Level: Comprehension REF: 2 OBJ: 2 TOP: Aging Trends KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development • The nurse clarifies that in the terminology defining specific age groups, the term aged refers to persons who are: • 55 to 64 years of age. • 65 to 74 years of age. • 75 to 84 years of age. • 85 and older. ANS: C The term aged refers to persons who are 75 to 84 years of age. DIF: Cognitive Level: Comprehension REF: 2, Table 1-1 OBJ: 1 TOP: Age Categories KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development • The nurse cautions that ageism is a mindset that influences persons to: • discriminate against persons solely on the basis of age. • fear aging. • be culturally sensitive to concerns of aging. • focus on resources for the older adult. ANS: A Ageism is a negative belief pattern that influences persons to discriminate against persons solely on the basis of age and can lead to destructive behaviors toward the older adult. DIF: Cognitive Level: Comprehension REF: 5 OBJ: 3 TOP: Ageism KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation • The nurse points out that the most beneficial legislation that has influenced health care for the older adult is: • Medicare and Medicaid. • elimination of the mandatory retirement age. • the Americans with Disabilities Act. • the Drug Benefit Program. ANS: A The broadest sweeping legislation beneficial to the older adult is Medicare and Medicaid. DIF: Cognitive Level: Application REF: 16 OBJ: 6 TOP: Legislation KEY: Nursing Process Step: Implementation have been met. ANS: C Two physicians must agree in writing that the criteria of the living will have been met before the document can go into effect. DIF: Cognitive Level: Application REF: 19 OBJ: 11 TOP: Living Wills KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care • In the 1980s, Medicare initiated a program of diagnosis-related groups (DRGs) to reduce hospital costs by: • classifying various diagnoses as ineligible for hospitalization. • allotting a set amount of hospital days and prospective payment on the basis of the admitting diagnosis. • specifying particular physicians to treat specified diagnoses. • using frequency of a particular diagnosis to set a payment schedule. ANS: B DRGs set up a system of preset hospitalization time and payment on the basis of the admitting diagnosis. DIF: Cognitive Level: Comprehension REF: 16 OBJ: 6 TOP: DRGs KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • When discussing extended care with a patient who has had a hip replacement and needs physical therapy, the nurse would recommend a(n): • basic care facility. • skilled care facility. • subacute care facility. • assisted-living residence. ANS: B Skilled care facilities offer not only basic care but also services from trained licensed professionals such as nurses, physical therapists, speech therapists, and occupational therapists. DIF: Cognitive Level: Application REF: 16 OBJ: 9 TOP: Extended-Care Facilities KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care • The 80-year-old woman who is recovering from a stroke is being sent to an extended- care facility. She is concerned about the expense. The nurse can allay anxiety by explaining that Medicare will cover extended-care facility costs: • for a period of 30 days. • for a period of 45 days for physical therapy. • for a period of 100 days for needed skilled care. • until she is able to be discharged home. ANS: C Medicare will cover extended-care costs for 100 days while skilled care is being applied to the resident. After 100 days, the resident must revert to private pay or ancillary long-term care insurance. DIF: Cognitive Level: Application REF: 16 OBJ: 8 TOP: Extended Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care • The senior citizen political action group that uses volunteers and lobbyists to advance the interests of older adults is the: • American Association of Retired Persons (AARP). • National Council of Senior Citizens (NCSC). • National Alliance of Senior Citizens (NASC). • Gray Panthers. ANS: A The AARP uses volunteers and lobbyists to advance the interests and welfare of older adults. DIF: Cognitive Level: Knowledge REF: 12 OBJ: 7 TOP: Political Action Groups KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • The nurse gives an example of the caregiver who is guilty of elder abuse as the: • daughter who uses her mothers Social Security money to purchase her mothers medication. • son who puts an alarm on the front door to prevent his mother from wandering out of the house. • wife who allows her mentally competent husband to refuse to take a bath for a week. • frail spouse who is unable to bathe or change the clothes of her physically dependent husband. ANS: D Unintentional abuse or neglect can occur when the caregiver lacks the stamina to meet care needs. Even though physically unable, the frail wife is guilty of elder abuse. The wife should seek assistance to prevent neglect. DIF: Cognitive Level: Analysis REF: 22 OBJ: 13 TOP: Elder Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort • The nurse cautions that the most frequent response to elder abuse by the abused older adult is: • anger. • physical retaliation. • notification of authorities. • nothing at all. ANS: D Fear of retaliation or abandonment keeps most abused elders silent. DIF: Cognitive Level: Application REF: 25-26 OBJ: 14 often includes behaviors such as isolating, ignoring, or depersonalizing older adults. Health care workers eating a residents candy without permission is an ignorant behavior that can be depersonalizing. DIF: Cognitive Level: Application REF: 23 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE • The nurse is aware that a persons attitude about aging is influenced mainly by his or her . (Select all that apply.) • life experiences • income level • level of education • current age • occupati on ANS: A, D A persons current age and life experiences are the main influences on his or her attitude relative to aging. DIF: Cognitive Level: Comprehension REF: 4 OBJ: 2 TOP: Attitudes toward Aging KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation • Gerontology encompasses application to . (Select all that apply.) • appropriate housing • health care • public education • business ventures • government-sponsored pensions ANS: A, B, C, D Gerontological concerns extend and influence provision of appropriate housing, health care, public education, business ventures, and political stands relative to the welfare of the older adult. DIF: Cognitive Level: Application REF: 2 OBJ: 1 TOP: Gerontology KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • Medicare Part C allows eligible persons to receive Medicare benefits via the services of private insurance companies through the services of a . (Select all that apply.) • health maintenance organization (HMO) • preferred provider organization (PPO) • provider-sponsored organization (PSO) • private fee for service organization (PFFS) • medical service organization (MSO) ANS: A, B, C, D Medicare Part C allows benefits via the services of managed care organizations. Medical service organization is not one of them. DIF: Cognitive Level: Comprehension REF: 17 OBJ: 6 TOP: Medicare Part C KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • The nurse is aware that a familys emotional response to an aging loved ones attempts to cope with diminishing abilities and increased care needs would include apply.) • grief • anger • frustration • loss • resentment . (Select all that ANS: A, B, C, D As the family witnesses the decline of a loved one and attempts to respond to the increasing care needs, the emotional responses are varied and changing. The responses include grief, anger, frustration, loss, and confusion. DIF: Cognitive Level: Application REF: 21 OBJ: 11 TOP: Impact of Aging on the Family KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation • The nurse outlines the characteristics of the typical caregiver for an aging family member as . (Select all that apply.) • 32 years of age • female • having full-time employment • having a care recipient older than 70 • giving care for an average of 18 years ANS: B, C, D, E The average age of the caregiver is 46. DIF: Cognitive Level: Application REF: 20 OBJ: 11 TOP: Characteristics of Family Caregiver KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development • The nurse reminds a family that indicators of self-neglect in the aging person include . (Select all that apply.) • misbalanced check book • reduced personal hygiene • increased alcohol consumption • irritability evidence. DIF: Cognitive Level: Comprehension REF: 28 OBJ: 1 TOP: Fact vs. Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • The biological theory of aging uses a genetic perspective and suggests that aging is a programmed process in which: • each person will age exactly like those in the previous generation. • a biological clock ticks off a predetermined number of cell divisions. • genetic traits can overcome environmental influences. • age-related physical changes are controlled only by genetic factors. ANS: B The biological theory of programmed process suggests that there is a biologic clock set with a predetermined number of cell divisions that will occur before the introduction of the aging process. DIF: Cognitive Level: Application REF: 28 OBJ: 2 TOP: Biological Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • The Gene Theory of aging proposes that: • the presence of a master gene prolongs youth. • genes interact with each other to resist aging. • specific genes target specific body systems to initiate system deterioration. • the activation of harmful genes initiates the aging process. ANS: D The Gene Theory suggests that there is an activation of harmful genes that initiate the aging process. DIF: Cognitive Level: Application REF: 28 OBJ: 2 TOP: Gene Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • The theory that identifies an unstable molecule as the causative factor in aging is the theory. • free radical • molecular • neuroendocrine • crossli nk ANS: A The free radical theory identifies free radicalsunstable moleculesthat will cause aging after accumulation in the body. DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Free Radical Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A • The nurse assesses that the patient who uses good health maintenance practices believes in the aging theory known as the theory. • wear-and-tear • free radical • neuroendocrine • molecu lar ANS: A The wear-and-tear theory suggests that health maintenance practices will prevent wear and tear on the cells of the body and will delay the aging process. DIF: Cognitive Level: Analysis REF: 29 OBJ: 2 TOP: Wear-and-Tear Theory KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease • The nurse describes the neuroendocrine theory of aging as a complex process of: • relating thyroid function to age-related changes. • the effects of adrenal corticosteroids, which inhibit the aging process. • stimulation and/or inhibition of the hypothalamus, causing age-related changes. • adrenal medulla inhibition of epinephrine, causing age-related changes. ANS: C The neuroendocrine theory proposes that the hypothalamus stimulates or inhibits the pituitary gland to produce hormones that initiate the aging process. DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Neuroendocrine Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease • The nurse explains that psychosocial theories differ from biologic theories in that psychosocial theories: • focus on methods to delay the aging process. • are directed at decreasing depression in the older adult. • are organized to enhance the perception of aging. • attempt to explain responses to the aging process. ANS: D Psychosocial theories attempt to explain the various responses of persons to the aging process. DIF: Cognitive Level: Comprehension REF: 30 OBJ: 3 TOP: Focus of Psychosocial Therapies KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development • The major objection to the disengagement theory is that the theory: • justifies ageism. • addresses the diversity of older adults. • does not clarify the aging process. • diminishes the self-esteem of the older adult. Havighurst proposes that the process of aging is defined by adjusting to the loss of a spouse, establishing a relationship with ones own age group, and establishing a satisfactory living arrangement. DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Havighurst KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease MULTIPLE RESPONSE • The nurses list of age-related illnesses thought to cause the accumulation of free radicals includes . (Select all that apply.) • arthritis • colon cancer • osteoporosis • diabetes • atherosclero sis ANS: A, D, E Cancer and osteoporosis are not considered to be diseases that accumulate free radicals. DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Free Radical Influence KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease • The nurse emphasizes that the relatively new theory that correlates restricted caloric intake to slowing of the aging process would probably extend the life span of the person, provided that the person .(Select all that apply.) • consistently eats high-nutrient, low-calorie foods • maintains a regular exercise program • consumes 2000 to 3000 mL of fluid a day • supports the diet with adequate fat-soluble vitamins • eats only organically grown foods ANS: A, B This new theory encourages high-nutrient, low-calorie foods combined with regular exercise to delay the aging process. DIF: Cognitive Level: Application REF: 30 OBJ: 2 TOP: Calorie Restriction Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease • The nurse points out that the positive outcomes from a life review, according to Erikson, would include . (Select all that apply.) • wisdom and integrated self-image • comparing self with others • understanding self and relationships • seeking anothers opinion of his or her achievement • acceptance of self ANS: A, C, E Acceptance of self and understanding self and relationships with accumulated wisdom is the goal of Erikson. Seeking the opinion of others suggests that the older adult is experiencing doubt and gloom, which are negative outcomes according to Erikson. DIF: Cognitive Level: Application REF: 30 OBJ: 2 TOP: Eriksons Developmental Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development • When a patient asks what can be done to neutralize the free radicals in his system, the nurse responds that antioxidant therapy is thought to inhibit free radicals. Antioxidants include . (Select all that apply.) • fruits • vegetables • organ meat • folic acid • vitamin D ANS: A, B, D Antioxidants can be obtained largely from fruits and vegetables. Organ meat and vitamin D are not antioxidants. Chapter 3 Diversity MULTIPLE CHOICE • A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, I expect Ill need a total hysterectomy because when my sister had this problem thats what she had done. The nurse recognizes that this woman belongs to a cultural subgroup whose health care beliefs are most influenced by the: • biomedical model. • magico-religious model. • balance/harmony model. • personal experience. ANS: A The patient shows a tendency to identify with the biomedical model, which views the body as a functioning machine. When a part gives out or is functioning abnormally, traditional Western medical treatment is sought and expected. The magico-religious models believe that health is a reward from a higher power. The balance/harmony models state that illness is the result of a state of imbalance in body energies. Personal experience influences all of these models. DIF: Understanding (Comprehension) REF: Page 91 OBJ: 5-5 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity • A Hispanic patient explains that the Hispanic culture believes that dietary management would be just as effective in managing her problems as medication, so the patients prescription has not been filled. Which action by the nurse illustrates cultural accommodation? • Asking the patient to give more details regarding this belief • Discussing how to add dietary preferences into the treatment plan been canceled. • having a conversation about her grandchildren while her dressing is changed. ANS: D The interactional patterns of high-context (universalism) patients refer to the characteristics of relationships and behaviors toward others. When a person from a high-context culture interacts with the nurse, a more personal relationship is expected. This is not related to television shows, teaching materials, or appointment cancellations. DIF: Understanding (Comprehension) REF: Page 92 OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity • In an attempt to be sensitive to varying cultural responses to touch, before shaking a patients hand, the nurse will: • offer the patient his or her upturned palm. • wait until the patient extends his or her hand. • establish eye contact with the patient first. • address the patient by his or her full name. ANS: B The best way to show respect and implement the appropriate response is to follow the lead of the patient by waiting for the patient to extend a hand. DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity • A older Asian patient receiving physical therapy after hip surgery has developed a low- grade fever. The patient explains that the fever will lessen if the treatment includes the principles of yin/yang. The nurse expects to support the patient by: • providing privacy when his shaman visits. • arranging for his diet to include cold foods and liquids. • planning his physical therapy so it does not conflict with meditation. • keeping a magical amulet under his pillow. ANS: B The yin/yang theory proposes that health is a result of balance within the body. A principle of this theory is that an illness is either hot or cold and must be treated by elements of the opposite state in order to put the system back into balance. It is not related to shaman visits, meditation, or amulets. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity • The nurse in an assisted living facility is preparing to admit an older adult patient who speaks very little English. The nurse decides that it is most important that an interpreter be present when the patient: • indicates a desire to talk with the physician. • is being oriented to the facility. • is required to sign official documents. • begins crying and is inconsolable. ANS: C The more complex the decision making, the more important it is to have an interpreter present. Although all situations would benefit from an interpreter, the most important time is when the patient is signing official documents that have legal implications. DIF: Applying (Application) REF: N/A OBJ: 5-8 TOP: Communication and Documentation MSC: Psychosocial Integrity • When attempting to provide culturally sensitive care according to the explanatory model, the nurse asks the patient: • Who will be able to help you when you go home? • Do you think the treatment is helping? • When did you first notice the problem? • Has this illness changed your life? ANS: D The gerontologic nurse uses this model to explore the meaning of the health problem from the patients perspective. DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity • The nurse is caring for an older adult patient in need of hospitalization. The nurse is aware this patient is a member of an ethnic group that holds a collectivist perspective on community. The nurse best addresses the patients medical needs by: • calling an interpreter to assure the patient is making an informed decision. • assuring the patient that his spiritual advisor will meet him at the hospital. • arranging for admission to a hospital that is familiar with this patients culture. • offering to phone the patients family and ask them to come in and discuss the hospitalization. ANS: D People with a collectivist perspective derive their identity from affiliation with and participation in a social group such as a family or clan. The needs of the group are more important than those of the individual, and decisions are made with consideration of the effect on the whole. Health care decisions may be made by a group (such as the tribal elders) or a group leader (such as the oldest son). The other options may or may not be needed depending on the specifics of the patients case. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity • The nurse is most effectively using the concept of future time orientation when: • promising to help the patient call his daughter each weekend. • offering to complete the health assessment history after the patient eats dinner. • encouraging an older patient to keep a follow-up clinic appointment. • arranging for a colorectal cancer screen for senior citizens. ANS: D In the concept of future orientation, people accept the idea that what is done now affects future health. This means that health screenings will help detect a problem today for potentially better health at a later time, days, weeks, or years ahead; it means that prevention acknowledging the similarities and differences in both viewpoints, recommending a plan of action, and negotiating a final plan. If the patient and nurse have come to an agreement on a plan of action, this model has been successful. DIF: Evaluating (Evaluation) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity • A new nurse is caring for a patient from Appalachia. The patient seems guarded and secretive, which frustrates the new nurse. What advice from the mentor is most appropriate? • Maybe you should ask to change your assignment. • This is a normal behavior for this patients cultural group. • You could try to apologize for anything you may have done. • Ask the patient why she is acting so strangely around you. ANS: B Patients from the Appalachian culture are typically wary and guarded around strangers and view the hospital as a place to go and die. The nurse explains this to the new nurse. Changing assignments will not help the new nurse become culturally competent. The new nurse could ask the patient if there has been some offense, but this is probably not the case. Why questions put people on the defensive and are not considered examples of therapeutic communication. DIF: Understanding (Comprehension) REF: Page 87 OBJ: 5-6 TOP: Caring MSC: Psychosocial Integrity • A nurse is caring for an Arab American patient in the hospital. The patient has many visitors who seem to be tiring the patient. What action by the nurse is best? • Limit the number of visitors the patient can have. • Only allow family members to visit the patient. • Suggest shorter visits to the patients visitors. • Require visitors to check in at the front desk. ANS: C In Arab American Muslim culture, visiting the sick is a cultural value and expectation. Although the visits may be tiring, they may also be important to the patient. The nurse can suggest shorter visits so the patient can have both the visitors and more rest. Limiting the number of visitors would violate this cultural norm as would limiting visits to family only. Checking in at the front desk serves no useful purpose. DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: Caring MSC: Psychosocial Integrity • A director of nursing works in a hospital that serves many Jehovahs Witness patients. What action by the nurse would best facilitate culturally appropriate health care? • Establish a bloodless surgery program. • Create an immunization clinic for children. • Employ spiritual leaders from this faith. • Allow faith healing ceremonies. ANS: A Jehovahs Witnesses generally are opposed to receiving all blood products. A bloodless surgery program would be a culturally competent way to improve the health care of this population. DIF: Applying (Application) REF: N/A OBJ: 5-5 TOP: Caring MSC: Psychosocial Integrity • An incapacitated older adult with dementia is brought to the emergency department by a rescue squad after falling and breaking an arm. When the patients children arrive, they are adamantly against the patient having any medical care and insist that prayer will heal the broken arm. What action by the nurse is most appropriate? • Allow the family to pray with the patient then escort them to the waiting room. • Call security to keep the family from interfering with medical care. • Check facility policies and contact the hospital social worker. • Call the police who can force the family to accept medical care. ANS: C This family may be Christian Scientists, who do not believe in medical care. Health crises are thought to be errors of the mind that can be altered by prayer. The nurse should check the facility policies for treating vulnerable adults and possibly notify social work, who can assist with ensuring adequate treatment occurs as allowed by policy. Allowing the family to pray with the patient is a caring action, but this complex situation requires more intervention. Calling security or the police will antagonize the family even more and demonstrates an adversarial relationship. DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: Communication and Documentation MSC: Safe Effective Care Environment MULTIPLE RESPONSE • When attempting to reflect about personal cultural awareness, the nurse asks himself or herself which of the following quetions? (Select all that apply.) • What image do I want to project to members of other cultures? • What makes a culture worthy of biased treatment? • Have my life experiences contributed to any biases regarding other cultures? • Am I uncomfortable when interacting with members of other cultures? • Does the patients culture rely on solid science to direct health care? ANS: A, C, D Self-reflection implies thinking that regards how I, the individual, perceives/believes/behaves. Awareness of ones thoughts and feelings about others who are culturally different from oneself is necessary to become culturally aware. No culture is worthy of biased treatment. Solid science is an ethnocentric principle. DIF: Applying (Application) REF: N/A OBJ: 5-4 TOP: Caring MSC: Psychosocial Integrity • What does the nurse working with older adults from many different cultures know about the demographics of culture in the United States? (Select all that apply.) • Hispanics will become the largest minority group by 2030. Older adults tend to feel an obligation to return favors. If someone does something for them, such as helping them to get their food, they want to be able to reciprocate. If they are financially unable to do this, they might withdraw so as not to be put in an embarrassing position. DIF: Applying (Application) REF: N/A OBJ: 7-3 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity • When the traditional roles are blurred as an older married couple begins to experience personal disease and disability, there will most likely be: • a rapid decline in their mental health as well. • a loss of self-esteem and satisfaction with life. • increased martial stress and discord. • increased social isolation. ANS: B When the older adult loses his or her traditional role, self-esteem and satisfaction with life may be affected. The other events may happen, but a frequent outcome is loss of self-esteem and life satisfaction. DIF: Remembering (Knowledge) REF: Page 127 OBJ: 7-1 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity • A 69-year-old patient who has both Medicare and long-term supplemental health care insurance shares with the nurse that he is in need of a visual examination as a follow-up after his cataract surgery. The nurse suggests that such treatment is most likely covered by: • Medicare Part A. • Medicare Part B. • Medicare Part D. • Supplemental policy. ANS: B A vision examination is a service covered by Medicare Part B. DIF: Remembering (Knowledge) REF: Page 126 OBJ: 7- 4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment • The nurse recognizes that health and wellness are better among the educated older adult population because they tend to: • place a high value on health and wellness. • frequently take advantage of health screening options. • have occupations that are less physically demanding. • manage emotional stress in a more productive manner. ANS: B More-educated people often have greater access to wellness programs and preventive health options because they tend to have more financial resources and health insurance coverage. Education may lead to an increased value on health and wellness. Occupations may or may not be physically demanding. Educated older adults may not manage stress more productively. DIF: Remembering (Knowledge) REF: Page 124 OBJ: 7-1 TOP: Teaching-Learning MSC: Health Promotion • Which patient is most likely to be seen at a clinic that services older adults who are at or below the poverty level? • A Hispanic male living with extended family • An African American male living with a spouse • A Hispanic female who lives alone • An African American female who lives with her sister ANS: C The highest rates of poverty are among Hispanic women over the age of 65 who live alone. DIF: Remembering (Knowledge) REF: Page 123 OBJ: 7-3 TOP: Nursing Process: Assessment MSC: Health Promotion • The nurse is addressing a senior citizens group that is composed of members who are 75 years of age and older. The nurse expects that the group will be primarily: • widows who have never worked outside of their homes. • widowers with at least one chronic illness. • females who have part-time jobs. • males with pensions plus Social Security income. ANS: A After age 75, women outnumber men in American society. Most women in this age group did not work outside the home, so their incomes depend on their spouses pensions or Social Security benefits. DIF: Remembering (Knowledge) REF: Page 123 OBJ: 7-1 TOP: Nursing Process: Assessment MSC: Health Promotion • A patient who grew up during the 1930s in an urban community has been prescribed several medications for a variety of chronic health issues. To help ensure medication compliance based on knowledge of this age cohort, the nurse: • provides a detailed explanation about the importance of taking the medications appropriately. • educates the patient about the cost-effectiveness of generic brands of the prescribed medications. • includes family members with the patient in the medication education plan. • offers suggestions on ways to minimize the risk of forgetting to take medication correctly. ANS: B Persons of this cohort (raised during the American depression of the 1930s) are generally frugal and often do not spend money, even if they have it. Suggesting a cost-effective way to purchase the medications will particularly appeal to this patient. DIF: Understanding (Comprehension) REF: Page 121 OBJ: the nurse is best? • Thats a good idea to consider at your age. • Check on what levels of care they provide. • Do you have enough money to afford this? • What does your family think of this idea? ANS: B Retirement communities have differing levels of care; some are only for independent seniors, whereas others offer an array of arrangements. This is the most important factor for the couple to consider, because they may face having to move to a chosen community as their needs change. DIF: Applying (Application) REF: N/A OBJ: 7-8 TOP: Teaching-Learning MSC: Psychosocial Integrity • An older adult is planning to move to an assisted living facility. What advice does the nurse provide to the adult children? • Let your father choose what items to take with him. • Warn your dad there will be little room for personal things. • It is best to pick your dad up one day and move him in. • Be aware your dad may suffer from depression or confusion. ANS: A Individuals who move can suffer from relocation stress, which is a negative consequence of moving. If the patient has input into the facility chosen, can take tours, and can bring cherished personal items with him or her, the chances of relocation stress lessen. Although there might be limited room, it is more important for the family to let the patient take wanted items. Moving precipitously can increase the chance of relocation stress. The family should be warned about the negative reactions to moving that are possible, but this does not give them the ability to lessen the impact. DIF: Application (Applying) REF: N/A OBJ: 7-5 TOP: Teaching-Learning MSC: Psychosocial Integrity • An adult daughter brings a patient to the gerontology clinic and reports that the patient has become increasingly withdrawn and no longer goes out during the day. What response by the nurse is best? • Administer a mini mental state exam. • Ask the patient why this is happening. • Assess if the patient feels safe at home. • Determine if abuse is occurring. ANS: C Patients often withdraw and become isolated when they do not feel safe in their surroundings. The nurse should first assess the patients perception of safety. The other options may or may not be necessary, but why questions should be avoided, as they generally place people on the defensive. DIF: Applying (Application) REF: N/A OBJ: 7-7 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity • An older woman lives alone. What action by the nurse is best to keep the patient from becoming a victim of crime? • Encourage the patient to take self-defense classes. • Tell the patient that it is okay to hang up or not answer the door. • Have the patient install a monitored security system. • Ask if there is a neighbor who can check up on her. ANS: B Older people who are lonely may welcome visits from unscrupulous visitors. They are also less likely to hang up the phone or close the door to avoid appearing impolite. The nurse can best help this patient by telling her such behavior is not only all right, it is important for her safety. The other actions are also possible but can be costly, and the patient may not have a reliable neighbor. DIF: Applying (Application) REF: N/A OBJ: 7-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment • The nurse is presenting an educational workshop at a senior center where most of the patients will be 75 years or older. What does the nurse consider about this population when designing the presentation? • Most of these patients only have a high school diploma. • Many patients will be illiterate so handouts should be simple. • A great number of patients never attained a high school. • A lot of these patients went to college on the GI bill. ANS: A Educational attainment differs with age cohorts. In this age group, the highest number of persons attained a high school diploma. DIF: Remembering (Knowledge) REF: Page 121 OBJ: 7-2 TOP: Teaching-Learning MSC: Health Promotion MULTIPLE RESPONSE • When preparing an educational program focused on chronic illnesses that at least a third of the older adult population is likely to experience, the nurse includes information on which of the following? (Select all that apply.) • The benefit of aquatic exercise • Signs and symptoms of cataracts • Ways to control sodium intake • Latest technologic interventions for hearing loss • The effects of exercise on cardiovascular health ANS: A, C, E The most common chronic problems in 2002 were heart disease, cancer, stroke, chronic because it is the main insulator of the body. DIF: Cognitive Level: Application REF: 36 OBJ: 1 TOP: Sensitivity to Cold KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse reassures the distressed 75-year-old male that the wartlike dark macules with distinct borders are not melanomas, but the skin lesions of: • senile lentigo. • cutaneous papillomas. • seborrheic keratoses. • xerosis. ANS: C Dark, slightly raised macules are seborrheic keratoses, which may be mistaken for melanomas. DIF: Cognitive Level: Comprehension REF: 33 OBJ: 1 TOP: Seborrheic Keratosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse is accompanying a group of older adults on a July 4th outing to monitor heat prostration. Older adults are intolerant of heat because of an age-related reduction of: • melanin. • perspiration. • body temperature. • capillary fragility. ANS: B Reduction in perspiration related to reduced sweat gland function results in possible heat intolerance from an inability to cool the body by evaporation. DIF: Cognitive Level: Analysis REF: 34 OBJ: 2 TOP: Heat Intolerance KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse cautions the CNAs to use care when transferring or handling older adults because their vascular fragility will cause: • altered blood pressure. • pressure ulcers. • pruritus. • senile purpura. ANS: D Increased capillary fragility results in subcutaneous hemorrhage or senile purpura from incautious handling by caregivers. DIF: Cognitive Level: Comprehension REF: 34-35 OBJ: 7 TOP: Senile Purpura KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse assesses a stage I pressure ulcer on an older adults coccyx by the appearance of a: • clear blister. • nonblanchable area of erythema. • scaly abraded area. • painful reddened area. ANS: B A red nonblanchable area is indicative of a stage I pressure ulcer. DIF: Cognitive Level: Analysis REF: 35 OBJ: 5 TOP: Pressure Ulcer KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The CNA caring for an older adult asks if the yellow, waxy, crusty lesions on the patients axilla and groin are contagious. The nurses most helpful response is: • Yes. It is cellulitis caused by bacteria. • No. It is seborrheic dermatitis caused by excessive sebum. • Yes. It is an indication of scabies. • No. It is the lesion seen with basal cell carcinoma. ANS: B Seborrheic dermatitis is a bothersome skin condition resulting from an excess of sebum. DIF: Cognitive Level: Application REF: 36 OBJ: 5 TOP: Seborrheic Dermatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse leads a group of postmenopausal older women on a daily 15-minute walking tour through the long-term care facility to: • improve bone strength. • orient them to their surroundings. • improve their socialization. • increase their appetite. ANS: A Stress to long bones by weight-bearing and walking will increase bone strength. DIF: Cognitive Level: Analysis REF: 36 OBJ: 7 TOP: Bone Strength KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • When the perplexed 70-year-old woman asks, How in the world can my bones be brittle when I eat all the right foods? the nurses most informative reply is: • Calcium loss is expected in the older adult. • Calcium is continuously withdrawn from bone for nerve and muscle function. • Smoking and alcohol consumption speed calcium loss from the bones. TOP: Rheumatoid Arthritis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse explains that emphysema is a chronic obstructive pulmonary disease characterized by the pathophysiology of: • constriction of the bronchial tree, excessive mucus, and nonproductive cough. • calcification of the alveoli and a dry cough. • overinflation of the alveoli, making them ineffective for gas exchange. • inflammation of the trachea and bronchioles, excessive mucus, and productive cough. ANS: C Emphysema causes overinflation of the nonelastic alveoli, which disallows gas exchange in the affected alveoli and results in reduced oxygenation. DIF: Cognitive Level: Comprehension REF: 42 OBJ: 5 TOP: Emphysema KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse explains that the pathophysiology of a myocardial infarct is that: • a portion of the myocardium necroses and scars over. • the coronary vessels are narrowed during the attack. • the ischemic myocardium causes pain during the attack but is able to regenerate. • there is damage to the myocardium but no serious alteration of cardiac output. ANS: A The myocardium necroses and scars and does not regenerate. The degree of heart damage is related to the amount of necrosis. DIF: Cognitive Level: Comprehension REF: 46 OBJ: 6 TOP: Myocardial Infarct KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse is aware that the cardinal signs and symptoms of congestive heart failure are: • dyspnea and edema. • myocardial pain and hypotension. • ventricular arrhythmias and cyanosis. • atrial arrhythmias and polycythemia. ANS: A Dyspnea and generalized edema are the cardinal signs and symptoms of congestive heart failure. DIF: Cognitive Level: Application REF: 47 OBJ: 5 TOP: Congestive Heart Failure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse explains that pernicious anemia is caused by: • an iron deficiency. • a deficiency of vitamin B12. • inadequate nutrition. • blood loss. ANS: B Pernicious anemia results from a deficiency of vitamin B12. DIF: Cognitive Level: Knowledge REF: 50 OBJ: 2 TOP: Pernicious Anemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse alters the nursing care plan for a patient with a hiatal hernia and resultant gastrointestinal reflux to include interventions for: • encouraging the patient to lie down after meals. • drinking two full glasses of liquid after the evening meal. • eating smaller, more frequent meals. • using caffeine drinks to assist with digestion. ANS: C Eating smaller and more frequent meals does not enlarge the stomach. DIF: Cognitive Level: Analysis REF: 53 OBJ: 5 TOP: Hiatal Hernia KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk • The nurse suspects that the pale, edematous, listless diabetic patient who has a blood urea nitrogen (BUN) level of 35 mg/dL and a creatinine level of 4 mg/dL has: • diverticulitis. • congestive heart failure. • chronic renal failure. • benign prostatic hypertrophy. ANS: C The increased BUN and creatinine levels indicate renal failure. DIF: Cognitive Level: Application REF: 56 OBJ: 6 TOP: Renal Failure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The most appropriate intervention added to the nursing care plan for a person with Parkinson disease with a nursing diagnosis of Nutrition, less than body requirements related to difficulty swallowing, would be to: • feed the patient at each meal. • place the patient in a semi-Fowler position for mealtime. • offer a thick, high-nutrition shake as a snack. • encourage the patient to drink a sip of water after each bite of solid food. ANS: C Thick shakes are easier to swallow without aspiration and will also improve • health maintenance • ethnicity • heredity • attitude • environm ent ANS: A, C, E Heredity, environment, and health maintenance affect the timing and magnitude of age-related changes. DIF: Cognitive Level: Comprehension REF: 32 OBJ: 1 TOP: Influences on Age-Related Changes KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse reminds an 82-year-old man with rosacea that he should avoid . (Select all that apply.) • stress • dairy products • sun exposure • spicy foods • alcohol consumption ANS: A, C, D, E The patient who has rosacea should avoid stress, sun exposure, spicy foods, and alcohol consumption. DIF: Cognitive Level: Comprehension REF: 35 OBJ: 5 TOP: Rosacea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk • The nurse is aware that in order for a person to support ossification, he or she must have an adequate intake of vitamin(s) . (Select all that apply.) • A • B6 • C • D • E ANS: A, C, D Vitamins A, C, and D are necessary for bone matrix formation and replenishment. DIF: Cognitive Level: Knowledge REF: 36 OBJ: 7 TOP: Ossification KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease • The nurse uses a chart to outline the risk factors for osteoporosis, which include . (Select all that apply.) • menopause • smoking • white female • excessive high-impact exercise • long-term use of phenytoin (Dilantin) ANS: A, B, C, E Menopausal white women who smoke and have had long-term administration of phenytoin (Dilantin), heparin, or corticosteroids are at risk for osteoporosis. DIF: Cognitive Level: Comprehension REF: 39 OBJ: 5 TOP: Risk Factors for Osteoporosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation • The nurse outlines age-related changes in the respiratory system that put the older adult at risk for infection, which include . (Select all that apply.) • reduced ciliary movement • decrease in alveolar elasticity • pooling of secretions • flattened diaphragm • calcification of costal cartilage ANS: A, B, C The flattening of the diaphragm and the calcification of cartilages decrease respiratory effectiveness but do not support pathogen growth as do ciliary and alveolar changes. DIF: Cognitive Level: Comprehension REF: 42 OBJ: 1 TOP: Age-Related Changes in the Respiratory System KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation COMPLETION • The nurse is aware that children with have the treatment and care needs of persons of advanced age. ANS: progeria A rare condition called progeria causes severe premature aging. When they are only 8 or 9 years of age, children with progeria have the physiology and appearance of 70-year-olds. DIF: Cognitive Level: Knowledge REF: 32 OBJ: 7 TOP: Progeria KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation Wellness is possible even if the client assists in the management of his medical care; an individual must work hard to achieve wellness, similar to a job. Wellness is unfortunately not a real option for this client; however, all persons, regardless of age or life-health situations, can be helped to achieve a higher level of wellness. Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks; biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness. PTS: 1 DIF: Apply REF: 4-5 TOP: Nursing Process: Diagnosis MSC:Health Promotion and Maintenance • In differentiating between health and wellness in health care, which of the following statements is true? a. Health is a broad term encompassing attitudes and behaviors. b.The concept of illness prevention was never considered by previous generations. c. Wellness and self-actualization develop through learning and growth. d.Wellness is impossible when ones health is compromised. ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves ones whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growthas basic needs are met, higher-level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is impossible when ones health is compromisedeven with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible. PTS: 1 DIF: Understand REF: 4 TOP: Nursing Process: Evaluation MSC:Health Promotion and Maintenance • Which cultural group is predicted to have the fastest growing older adult population in the United States between the years 2010 and 2050? a. Native Americans b.African Americans c. Hispanic Americans d.Asian/Pacific Island Americans ANS: C As shown in Figure 1-1, the Hispanic older adult population is projected to be the most rapidly increasing population segment between 2010 and 2050. The older adult populations of all other races, combined, do not rise as rapidly as the Hispanic older adult population between the years 2010 and 2050. The African-American older adult population is expected to have the second-fastest rise between 2010 and 2050. The non- Hispanic white older adult population is projected to decrease between 2010 and 2050. PTS:1DIF:UnderstandREF:Figure 1-1 on page 3. TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment • Historical influences that have shaped the lives of the majority of the middle-old population in the United States today include which of the following? • Influenza epidemic of 1918 b.Immigration from communist Europe c. Child rearing in the Depression d.World War II ANS: D Those who are middle-old in 2005 were in their teens and 20s during World War II; in particular, the men were likely to have fought in it. A person who survived the influenza epidemic would be at least 87 years old in 2005 and therefore would be considered old-old or a centenarian. Those who are middle-old in 2005 were born between 1920 and 1930, before communism swept Europe. Most of those who are middle- old in 2005 had not reached childbearing age by the end of the Depression. PTS:1DIF:UnderstandREF:2-3 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment • The nurse prepares for the arrival of older adults evacuated from a hurricane to a shelter for short-term care. Which of the following is the priority nursing intervention? a. Demonstrate that the staff is prepared to meet their needs. b.Use individual medical records to develop a medication plan. c. Help older adults display family photographs and memorabilia. d.Help older adults teach one another a new skill in the shelter. ANS: B The nurse prepares for short-term care by prioritizing the needs of the older adults, and this intervention helps maintain the therapeutic plan, thereby addressing the need for physiological integrity. Furthermore, the nurse maintains continuity of care by preparing a medication schedule to prevent missed doses of medication. Providing safety and security from the storm is Maslows second most basic need. In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important but not in emergency conditions. A state of emergency is not the time to develop self-esteem; meeting safety, security, and physical needs are more important. PTS:1DIF:AnalyzeREF:5-6 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance • According to researchers, which characteristic will most centenarians share in the future? a. Female b.Dement ed c. Malnourished d.Wheelchair bound ANS: A Researchers expect women to make up the majority of centenarians in the future. Gerontologists expect dementia to be common among older adults, but they are not predicting most centenarians will have dementia. Malnutrition is common among older adults, but researchers have not predicted that most centenarians will be malnourished. Decreased mobility is common among older adults, but researchers have not predicted that most centenarians will be confined to a wheelchair. PTS:1DIF:RememberREF:2 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment • Which statement describes aging in developing countries? d.Uses a wheelchair, has peripheral arterial disease, attends weekly baseball games with three friends ANS: D Despite a serious chronic illness and mobility restrictions, this older man has a social network and planned activities with friends. Further, he overcomes mobility issues to pursue personal interests; thus this person is most likely to experience the best health and well- being because of an optimal functional status. This older adult is not thriving in an assisted-living facility, despite having other people in the facility, as evidenced by television viewing habits and weight, both potential indicators of depression. Various aspects of this persons life are unbalanced, thus inhibiting progress on the path to optimal health and wellness. In addition, the use of herbal remedies can be aggravating or precipitating the problems. After a move to a new region, an older adult, especially one who lives alone and is moved to a new area for the familys convenience, is likely to experience loneliness and isolation until a new social network is established. Although this person has a less acute health problem, the social isolation is likely to create significant disruption on the path to health and wellness. Although this older adults financial resources are plentiful, the existence of a large family does not ensure any type of psychosocial support. Most likely, this person faces a grim prognosis because the prostate cancer has crossed the diaphragm, thus reducing the likelihood of a prolonged life. PTS:1DIF:AnalyzeREF:4-6 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance • Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service. b.Wheels ambulatory adults to exercise when running late. c. Assigns female nurses to older women who are Islamic. d.Allows older adults in a nursing home to eat meals alone. ANS: C The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Interrupting an older adults worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adults life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in a wheelchair to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, while focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being. PTS: 1 DIF: Understand REF: 4 TOP: Nursing Process: Evaluation MSC:Health Promotion and Maintenance • An older man who resides in a nursing home has total cholesterol of 245 mg/dl. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instruct him about increasing dietary fiber. b.Ask the health care provider for a low-fat diet. c. Schedule a consultation for him with the dietitian. d.Review a menu with him to choose suitable foods. ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adults collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with hyperlipidemia achieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input. PTS: 1 DIF: Analyze REF: 4-6 TOP: Nursing Process: Planning MSC:Health Promotion and Maintenance • Which approach requires the nurse to integrate and balance all aspects of an individuals life into the plan of care? a. Holistic nursing b.Healthy People 2020 c. Maslows Hierarchy of Human Needs d.Orems Self-Care Requirements ANS: A Holistic nursing integrates all aspects of an individuals life into the plan of care by balancing an individuals internal and external environment with psychosocial, spiritual, cultural, and physical processes. Healthy People 2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslows Hierarchy of Human Needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orems Self-Care Requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness. PTS:1DIF:RememberREF:4 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment • An older man living in an adult community becomes a widower 1 month after retirement. Two months later, he has not resumed a weekly outing with his fishing club. Which should the nurse implement? a. Ask the older adult why he is not fishing. b.Have club members visit him at home. c. Meet with him to assess his The enjoyment of physical activity is a positive aspect of this man and thus can be included in the nurses plan because he already incorporates an important part of diabetic care into his life and, potentially, enjoys the health benefits of exercise. Practicing effective glucose control demonstrates this mans resilience and capacity to manage effectively the challenges associated with a chronic illness and thus is a strength the nurse can use in a positive approach toward his health and well-being. This man has a social network that helps him to live with diabetes and to prevent the long-term complications of diabetes. This is a definite strength the nurse uses to help him achieve his optimal health and well-being. With limited financial resources, paying for some of his diabetic supplies is a burden to overcome and cannot be used in a positive approach toward health and well-being. Living alone is not ideal for an older adult, especially one with diabetes, because of the potential for loneliness and complications from diabetes such as hypoglycemia. Living alone is a negative aspect of this mans life and one which has to be resolved for his safety and well-being. The nurse cannot include this mans transportation issues into a positive plan; the lack of reliable transportation is a problem to overcome and not a strength on which to capitalize. Chapter 7 Holistic Assessment and Care Planning MULTIPLE CHOICE • The geriatric nurse recognizes that the bodys homeostatic mechanisms may be compromised in the: • 79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily living (ADLs). • 73-year-old with a history of chronic bronchitis who lives with family. • 86-year-old who lost a spouse and is moving into an assisted living facility. • 69-year-old with peripheral vascular disease who is visited by home health care weekly. ANS: C Declining physiologic function and increased prevalence of disease, particularly in the old-old (age 85 or older), are in part a result of a reduction in the bodys ability to respond to stress through all of its homeostatic mechanisms. The important point is that older adults often encounter profound and repeated losses; the time between the occurrences of these losses is often short, resulting in an inadequate period for resolution and return to a baseline state, thus putting them at risk for illness. Although the other patients may have compromised homeostatic mechanisms, the 86-year-old patient is most likely to exhibit this phenomenon. DIF: Analyzing (Analysis) REF: N/A OBJ: 4-2 TOP: Nursing Process: Diagnosis MSC: Physiologic Integrity • To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first: • asks whether the patient has any questions about the interview. • makes sure the interview area is comfortable and private. • explains the reason for asking the questions. • assures the patient that all answers will be kept confidential. ANS: C To ensure a successful interview, the nurse should explain the reason for the interview to the patient followed by a brief overview of the format to be followed. This helps alleviate anxiety and uncertainty, and the patient can then focus on providing the information. The other options are all important actions during the assessment interview, but they will not diminish anxiety as much as an explanation of the purpose. DIF: Applying (Application) REF: N/A OBJ: 4-1 TOP: Nursing Process: Implementation MSC: Emotional Needs Related to Health Problems • An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patients daughter questions the possibility of pneumonia stating, He isnt coughing or having any difficulty breathing. The nurse responds most appropriately by saying: • We are lucky to determine the problem in its early stage. • Respiratory problems develop only after the infection is well established. • People your dads age often lack the muscular strength to cough. • Older adults frequently lack the typical signs of a respiratory infection. ANS: D The characteristic presentation of illness in older adults is more commonly one of blunted or atypical signs and symptoms. Stating, we are lucky to determine the problem does not give any useful information. Respiratory problems are often present early on in younger people. The lack of coughing is not caused by weakness. DIF: Understanding (Comprehension) REF: Page 57 OBJ: 4-2 TOP: Teaching-Learning MSC: Physiologic Integrity • A nurse aide working in the geriatric units dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why shes here. The nurse appropriately directs the nurse aide to: • take the patient back to her room and put her safely in bed. • place a falls risk identification bracelet on the patient and add the status care plan. • immediately take the patients vital signs and report them to her. • reorient the patient to time and place frequently and document the patients response. ANS: C A sudden change in an older adult patients cognitive status is likely a symptom of a physiologic stressor such as an infection. The vital signs will allow the nurse to determine the presence of a fever or other deviation from the patients baseline vitals. The patient may or may not need or wish to go to bed, but this does not provide any data for the nurse to evaluate. An ill patient may need to be on fall precautions, but again this does not provide data. Reorientation may be necessary, but if the patient has an illness, this needs to be taken care of. DIF: Applying (Application) REF: N/A OBJ: 4-2 TOP: Nursing Process: Implementation MSC: Physiologic Integrity • The nurse most effectively implements guided reminiscence during a patient interview by: • reminding the patient to share important memories of the past. • scheduling several short interviews rather than one long one. • controlling the interview by selecting the memories to be discussed. • encouraging the patient to relive his or her memories while maintaining focus. ANS: D Relying on established norms for laboratory values when analyzing the assessment data of older adults could lead to incorrect conclusions. The nurse should try to determine what the patients normal range is after stabilizing the patient. DIF: Understanding (Comprehension) REF: Page 56 OBJ: 4-1 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity • A patient is being admitted after a fall that has caused a painful leg injury. In preparing to interview the patient for a health history, the nurse is initially concerned that: • the family should be present to help answer questions. • a therapeutic nurse-patient relationship should be established. • the patient should be free of hearing and vision barriers. • the patients pain should be effectively managed. ANS: D The acute pain the patient is experiencing will have the greatest impact on the success of the health assessment interview and must be removed as a barrier for the assessment to be successful. The other factors are important too, although depending on the cognitive status of the patient, the family may or may not need to be present. DIF: Application (Apply) REF: N/A OBJ: 4-5 TOP: Nursing Process: Implementation MSC: Physiologic Integrity • The nurse has administered the Apgar screen tool to assess an older patients family function status. Upon determining that the family functions at a 4, the nurse: • prepares to administer a more detailed tool. • prepares to report reasonable suspicion of elder abuse. • asks the patient to identify specific family members to include in care planning sessions. • notifies social services that the family is not likely to be of much support to the patient. ANS: D An Apgar score of 4 to 6 suggests a moderately dysfunctional family, one that should not be depended on to provide physical, financial, or emotional support to the patient. DIF: Analysis (Analyze) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity • The geriatric nurse admitting a patient to an assisted living facility recognizes the importance of tools such as the Katz and the Barthel indexes because of the impact they have on: • planning the amount of help the patient will need with ADLs. • the patients ability to be realistic about achieving independence. • creating an appropriate, patient-specific nursing care plan. • appropriate staffing to ensure the safety needs of the patients are met. ANS: C These assessment tools are designed to assess a patients levels of function, particularly related to ADL. Determination of the degree of functional independence in these areas can identify a patients abilities and limitations, leading to appropriate interventions presented in the patients nursing care plan. It provides more information than just how much help the patient needs, it is not related to being realistic, and it is not designed to be used for staffing purposes. DIF: Analysis (Analyze) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance • An older patient is reluctant to report multiple vague signs and symptoms, including lethargy, incontinence, and weight loss that have persisted for 6 weeks. The nurse recognizes that such symptoms place the patient at great risk for: • viral infection. • disorientation. • malnutrition. • physical frailty. ANS: D Self-reported vague signs and symptoms such as lethargy, incontinence, decreased appetite, and weight loss can be indicators of functional impairment. Ignoring older adults vague symptoms exposes them to an increased risk of physical frailty (impairments in the physical abilities). DIF: Remembering (Knowledge) REF: Page 56 OBJ: 4-7 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance • An older patient is hospitalized after a fall that resulted in a fractured left ankle. By day 4 of the hospitalization, which includes reduction of the fracture and analgesic drug therapy, the patient has become mildly disoriented and is incontinent of urine. The nurse explains to the family that these symptoms reflect the: • relationship between aging and both physical and psychosocial responses to trauma. • response exhibited by many older adults who are hospitalized. • effects of stress-induced perceptual deficits often seen in the hospitalized older adult. • results of the pharmacologic pain control therapy. ANS: A Many serious consequences are the result of the interaction of physical and psychosocial factors in the older patient. Although the other options have some degree of truth to them, the most comprehensive answer is the one that relates aging to response to trauma. DIF: Understanding (Comprehension) REF: Page 56 OBJ: 4-2 TOP: Teaching-Learning MSC: Physiologic Integrity • When unsure about how to address older patients with advanced stage Alzheimer disease, the nurse recognizes that it is best to address the patient by: • a pet name, because the patients are not likely to respond to their given names. • the first name, to foster a friendly, relaxed atmosphere. • the full name, to show respect for the patients as individuals. • a childhood nickname, because long-term memory will likely still be intact. ANS: C Nurses should address all older patients by their full name, including Mr. Mrs., or Miss, to show respect, unless the patient specifically requests being called something else. should use a different tool. DIF: Applying (Application) REF: N/A OBJ: 4-10 TOP: Nursing Process: Assessment MSC: Physiologic Integrity • The nurse has used the Yesavage Geriatric Depression Scale (short form) and scored the patient at a 1. What is the nurses best action? • Refer the patient to a mental health practitioner. • Assess the patient further for depression. • Ask the patient about using antidepressant medications. • Document findings in the patients medical record. ANS: D A score of 5 or more indicates possible depression that should be assessed further. A score of 1 indicates no or little depression risk. The nurse should document the findings. No other action is needed. DIF: Applying (Application) REF: N/A OBJ: 4-10 TOP: Nursing Process: Assessment MSC: Psychologic Integrity • A nurse is conducting an admission interview with an older patient admitted to a long- term care facility. When the nurse asks about the patients former occupation, the patient states, What do you care? I am long retired! What response by the nurse is best? • Your job may have exposed you to some health hazards. • It helps me get to know you and your background better. • We have several clubs here you might be interested in. • No real reason, its just part of our admission interview. ANS: A Previous occupations may have exposed the patient to health hazards that might be important. The question does help the nurse get to know the patient and maybe offer some activities he or she would most likely be interested in, but thats not the main reason for the question. Saying there is no reason to ask the question puts the entire admission interview under suspicion for being irrelevant. DIF: Understanding (Comprehension) REF: Page 66 OBJ: 4- 6 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE • A nurse who cares for older adults recognizes which of the following clinical features associated with dementia? (Select all that apply.) • Failing to remember his or her room number • Becoming increasingly disoriented at night • Working on jigsaw puzzles for hours at a time • Often referring to a cup as a canyon • Misunderstanding when told its raining cats and dogs ANS: A, D, E Clinical features of dementia are associated with cognitive deficiencies such as forgetfulness, lack of inquiry, inability to correctly associate proper words to objects, and concrete thinking. DIF: Remembering (Knowledge) REF: Page 57|Page 59 OBJ: 4-3 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity • The nurse using the SPICES model to assess older patients collects data on which topics? (Select all that apply.) • Sleep disorders • Problems with eating • Incontinence • Falls • Social situations ANS: A, B, C, D SPICES stands for sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown. Chapter 8 Legal Aspects of Gerontological Nursing MULTIPLE CHOICE • A nurse caring for older adult patients shows an understanding of the implementation of standards of care when: • dialing the telephone when the patient wants to call his daughter. • requesting the patients favorite dessert on his birthday. • closing the patients door when he is praying. • reminding the patient to call for assistance before getting out of bed. ANS: D A standard of care is a guideline for nursing practice and establishes an expectation for the nurse to provide safe and appropriate care, such as reminding the patient to call for assistance before getting out of bed. Standards of care may be established on national or regional levels. Dialing the phone for the patient, closing the patients door, and requesting a special dessert are not actions that conform to standards of care. DIF: Applying (Application) REF: N/A OBJ: 3-1 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment • A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patients claim that she has been physically abused. The nurse manager responds most appropriately when stating: • Ill show you where you can find this states reporting requirements. • As a nurse you are considered a mandated reporter of elder abuse. • As long as you are reasonably sure abuse has occurred, report it. • You need to report any such claims directly to me. ANS: A To be responsive to the legal obligation to report reasonably suspicious acts of abuse and because there is great variation among the states, nurses should determine the specific reporting requirements of their jurisdictions, including where reports and complaints are received and in what form they must be made. The statements that the nurse is a mandatory reporter and that abuse should be reported if suspected are true, but they do not help the nurse learn to handle the complaint. The manager may want to know about claims of abuse and it may be facility policy to report up the chain of command, but the nurse is responsible for filing the formal complaint. Resuscitate order in effect. A family member tells the nurse, Ill sue you and every other nurse here if you dont do everything possible to keep her alive. The nurse understands that protection from legal prosecution in this situation is provided by: • legal immunity granted when acting according to the patients expressed wishes. • the legal view that the duty to put into effect the patients wishes falls to the physician. • knowledge of and compliance with facility policies and procedures regarding end-of-life care. • implementing interventions that preserve the patients right to self-determination. ANS: C In this case, immunity applies only to the physician and not to the nurse because the physician is given the legal duty to put into effect the patients wishes. Consequently, the nurse must rely on effective communication with the physician, patient, and family, and on the quality of the facilitys policies and procedures, to be sure that his or her actions are consistent with the legally required steps. DIF: Understanding (Comprehension) REF: Page 42 OBJ: 3-10 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment • The nurse is caring for a terminally ill older patient who has a living will that excludes pulmonary and cardiac resuscitation. The family expresses a concern that the patient may change her mind. The nurse best reassures the family by stating: • The nursing staff will watch her very closely for any indication she has changed her mind. • We will discuss her wishes with her regularly. • She can change her mind about any provision in the document at any time. • Your mother was very clear about her wishes when she signed the document. ANS: A AMD provisions appropriately provide that people can change their minds at any time and by any means. Nurses need to be alert to any indications from a patient. Based on the persons medical condition, subtle signs such as a gesture or a nod of the head may be easily overlooked. The patient may or may not be able to discuss her condition. Stating that the mother was very clear in her wishes does not take into account the fact that patients can change their minds any time. DIF: Applying (Application) REF: N/A OBJ: 3-7 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment • A patient residing in a long-term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients rooms during the night. The nurse views the patients PRN antipsychotic medication order as: • an appropriate intervention to help assure his safety. • an option to be used only when all other nondrug interventions prove ineffective. • inappropriate unless the physician is notified and approves its use. • not an option because it should not be used to manage behaviors of this type. ANS: D Reasons for the use of antipsychotic drugs do not include behaviors such as restlessness, insomnia, yelling or screaming, inability to manage the resident, or wandering. The staff must provide nondrug alternatives to help calm the patient. DIF: Analysis (Analyze) REF: N/A OBJ: 3-7 TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment • An alert but disoriented older patient lives with family members. The home health nurse, being aware of the role of patient advocate, recognizes the obligation to report possible patient abuse based on: • a family member stating, Its hard being a caregiver. • assessment showing bruises in the genital area. • observation of mild changes in orientation. • patients report of always being hungry. ANS: B Even when a patient exhibits disorientation, any report of mistreatment or neglect is to be considered reasonably suspicious and so should be reported. Bruises in the genital area raise suspicions of abuse. The family stating caregiving is hard does not mean they dont have enough support to cope. Mild changes in orientation may be expected in a disoriented patient. The patient who is always hungry should be followed up with a nutrition assessment, and this may or may not be a sign of abuse. DIF: Application (Apply) REF: N/A OBJ: 3-8 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment • An older adult patient has been approached to participate in a research study. The nurse best advocates for the patients right of self-determination by: • evaluating the patients cognitive ability to understand the consequence of the study. • determining what risks to the patient are involved. • discussing the importance of the study with the patient and his family. • encouraging the patient to discuss the decision with trusted family or friends. ANS: A The right to self-determination has its basis in the doctrine of informed consent. Informed consent is the process by which competent individuals are provided with information that enables them to make a reasonable decision about any treatment or intervention that is to be performed on them. The other options do not address autonomy and self-determination. DIF Applying (Application) REF: N/A OBJ: 3-7 TOP: Communication and Documentation MSC: Safe and Effective Care Environment • A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on the: • physicians medical orders. • stated requests of the individual patient. • care that a responsible geriatric nurse would provide. • implementation of the nursing process. ANS: C by the director of nursing is best? • Assess residents for the ability to participate in a bladder training program. • Take all residents to the toilet every 2 hours and after meals. • Ensure all residents wear incontinence briefs, which are changed routinely. • Ask physicians and other providers to prescribe medications for bladder control. ANS: A Urinary incontinence is a common problem that can lead to several complications. The extent to which residents participate in bladder training programs is an area of focus for facility inspectors. Some residents may need routine toileting, wearing briefs, and medications, but they should all be assessed for the ability to participate in bladder training. DIF: Applying (Application) REF: N/A OBJ: 3-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity: Reduction of Risk Potential • The director of nursing at a long-term care facility is getting ready for the annual inspection. What information guides the director? • Visits cannot be unannounced. • The director must be off site during the inspection. • Nurses must answer questions from the inspectors. • Results will be shared only through the mail. ANS: C Nurses present during inspections must answer questions posed by the inspectors. Visits can be unannounced. The director should be present during the survey. Results are shared during a conference, then a report is mailed later. DIF: Remembering (Knowledge) REF: Page 36 OBJ: 3-4 TOP: Communication and Documentation MSC: Safe Effective Care Environment • The nursing student learns about the Patient Self-Determination Act. What is a key provision of this act? • It establishes new rights for patients in medical facilities. • It requires facilities to educate patients on their rights. • It allows families to be approached for organ donation. • It spells out the procedures for creating an advance directive. ANS: B The intent of this law is to ensure that patients are given information about the extent to which their rights are protected under state law. It does not establish new rights, is not related to organ donation, and does not specify procedures for advance directives. DIF: Remembering (Knowledge) REF: Page 42 OBJ: 3-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment MULTIPLE RESPONSE • To best address the patients right to self-determination, which of the follow questions does the nurse ask at the time the patient is admitted to a nursing facility? (Select all that apply.) • Do you understand what a living will and durable power of attorney are? • If you have already prepared an advance care directive, can you provide it now? • Are you prepared to discuss your end-of-life choices with the nursing staff? • Have you discussed your end-of-life choices with your family or designated surrogate? • Would you like help with preparing a living will or a durable power of attorney? ANS: A, B, D, E All the correct options address the patients right to make an informed decision regarding health care issues by using various advance directives. The patient does not need to discuss end-of-life choices with the staff in order to exercise the right to self-determination. DIF: Application (Apply) REF: N/A OBJ: 3-7 TOP: Integrated Process: Teaching- Learning MSC: Safe and Effective Care Environment • What provisions for nursing service are part of the Omnibus Budget Reconciliation Act (OBRA) as it pertains to long-term care facilities? (Select all that apply.) • Resident assessments • Annual screenings • Minimum staffing • Ensuring resident rights • Registered nurse educational requirements ANS: A, B, C, D OBRAs service requirements include resident assessments and screenings, minimum staffing requirements, and ensuring resident rights. Educational requirements for nurses are not part of this mandate. DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-4 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment • The director of nursing at a certified long-term care facility overhauls the nursing assistant training program to include which features? (Select all that apply.) • 12 hours of classroom content • Training in infection control measures • Instruction on resident rights • 6 hours of quarterly in-service education • Education on safety measures ANS: B, C, D, E Requirements for a nursing assistants education includes training in infection control and interpersonal skills, instruction on resident rights and safety procedures, and 6 hours of education through in-services quarterly. Nursing assistants must have classroom training before working with residents, but the amount of time is not specified. DIF: Applying (Application) REF: N/A OBJ: 3-3 TOP: Teaching-Learning MSC: Safe Effective Care Environment • The adult child of a long-term care facility resident receives a phone call from the director • Which of the following statements is true about case management and care management for older adults? a. A case manager works for a health care system to save time and money. b.Care managers are usually paid from public agencies such as the Area Agency on Aging (AAA). c. One nurse can only perform care management. d.The Outcomes-Based Quality Improvement system is designed to evaluate the expected benefit of a procedure. ANS: A A case manager works for a health care system to save time and money. Care managers are rarely paid through the AAA or similar agencies; they are usually paid privately and sometimes through Medicare or Medicaid. The nurse can perform case management and care management. The aspects measured in an Outcomes Based Quality Improvement System are known as efficacy, effectiveness, and efficiency. PTS:1DIF:UnderstandREF:16 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment • Which of the following statements describes one of the standards of case management during hospitalization? a. Begin discharge planning on the first day of hospitalization. b.Keep an older adult in the hospital as long as necessary. c. Accept the hospital discharge planners (HDP) proposal for discharge. d.Assist hospital personnel to focus on the admission complaint. ANS: A Discharge planning begins on the first day of hospitalization. The case manager is responsible for ensuring that quality care is given accordingly in a specific time frame. The case manager facilitates discharge and contacts community-based resources to assist in the continuation of care. Keeping an older adult in the hospital as long as necessary is not required for the patient to receive the care he or she needs. Hospitalization is dangerous to older adults; therefore early discharge is encouraged. The case manager should negotiate with the HDP for the least restrictive level of care. Once the patient is in the hospital, any condition that the patient may have been neglecting should also be assessed and treated. PTS:1DIF:UnderstandREF:16-17 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment • An older woman is resisting her sons help to make her money last longer. He wants to have her declared incapacitated so he can manage her finances. Which nursing assessment can be used by the court to declare incapacitation? a. Prepares very few meals and avoids cleaning the house. b.Ambulates around her local community without difficulty. c. Balances her checkbook weekly and pays her bills on time. d.Resists medical advice to remove a stage I malignant tumor. ANS: D Refusing surgery to remove a malignant tumor at an early stage after receiving medical advice to do so can indicate impaired cognitive functioning; early treatment offers the best chance for a cure. Preparing few meals and avoiding cleaning the house may be potential evidence of not understanding the consequences of her actions and may be potential evidence of impaired capacity to make medical decisions. If the aspects of daily living are not important to her, then ambulating around her local community without difficulty does not reflect impaired capacity. Balancing her checkbook weekly and paying her bills on time, which are indications that she is managing her finances, are evidence of intact capacity; functional status is irrelevant in a capacity hearing. PTS:1DIF:ApplyREF:18-22 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment • A health care provider asks the nurse about an older mans durable power of attorney (DPA) because consent is needed for a medically necessary invasive procedure. The patient has end- stage disease, is intubated, and is on mechanical ventilation. Which steps should the nurse implement? a. Refer to the patients advance directive for a name. b.Assist with obtaining informed consent from the patient. c. Use the oral trail-making test to measure cognitive function. d.Apply the Confusion Assessment Method for critical care. ANS: D The health care provider assumes the intubated older adult lacks the cognitive skill to give consent for treatment. Before the search begins for the DPA and to help determine the patients cognitive status, the nurse assesses the patient for delirium using the Confusion Assessment Method for the intensive care unit. As the patients advocate, the nurse implements this valid and reliable tool because the nurse wants to give the patient every opportunity to participate in the plan of care and make his own determinations. If the patient has an advance directive, then the attorney-in-fact named in the power of attorney should be on that document. However, because the patient has the right to make his own decisions about care, his cognitive status should be established first. Before informed consent can be given, the patients cognitive status must be determined. The patient is unable to perform an oral test while he is intubated. PTS:1DIF:ApplyREF:18-22 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment • An older woman is brain dead, and the attorney-in-fact or surrogate named in her DPA is opposed to organ donation; the law in the state allows a surrogate with a DPA to make end-of- life decisions. Although she failed to document it, her family states that she wanted to donate her organs. Given the law about a DPA, what does the nurse expect the surrogate to do? a. Deny consent. c.Refuse to decide. b.Provide consent.d.Get a second opinion. ANS: B A DPA acts at the pleasure of the designator, can manage the designators finances, and functions as the designators health care surrogate, making judgments for the designator using substituted judgment when the designator is unable to do so. Therefore, in accordance with the law and the womans wishes according to her family, the surrogate should provide consent for organ harvesting. It is against the law and unethical for the DPA for this older adult to deny consent for organ harvesting. Because the attorney-in-fact named in the DPA is her health care surrogate, the attorney-in-fact must make a decision on behalf of the woman and cannot refuse to do so. The attorney-in-fact can get another opinion on the older adults neurological status but not as a way to avoid the decision concerning organ harvesting. PTS: 1 DIF: Apply REF: 18-25 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment • The older adult wants to appoint an attorney-in-fact with DPA for a specific period around a forthcoming surgery. Which should the nurse implement?