Gerontological Nursing: Care for Older Adults, Exams of Nursing

Download Gerontological Nursing: Care for Older Adults and more Exams Nursing in PDF only on Docsity! Test Bank Ebersole and Hess’ Gerontological Nursing & Healthy Aging 5th Edition by Theris A. Touhy, and Kathleen F Jet Chapter 1-28. NURSINGTB.COM Chapter 01: Introduction to Healthy Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. A man is terminally ill with end-stage prostate cancer. Which is the best statement about this man’s wellness? a. Wellness can only be achieved with aggressive medical interventions. b. Wellness is not a real option for this client because he is terminally ill. c. Wellness is defined as the absence of disease. d. Nursing interventions can help empower a client to achieve a higher level of wellness. ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness in his or her clients. Wellness is defined by the individual and is multidimensional. It is not just the absence of disease. A wellness perspective is based on the belief that every person has an optimal level of health independent of his or her situation or functional level. Even in the presence of chronic illness or while dying, a movement toward wellness is possible if emphasis of care is placed on the promotion of well-being in a supportive environment. PTS: 1 DIF: Apply REF: p. 7 TOP: Nursing Process: Diagnosis MSC: Health Promotion and Maintenance 2. 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 one’s health is compromised. ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves one’s 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 growth—as basic needs are met, higher level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is possible when one’s health is compromised—even with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible. PTS: 1 DIF: Understand REF: p. 7 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance 3. Which racial or ethnic group has the highest life expectancy in the United States? a. Native Americans b. African Americans c. Hispanic Americans d. Asian and Pacific Island Americans NURSINGTB.COM NURSINGTB.COM PTS: 1 DIF: Apply REF: p. 18-19 TOP: Communication and Documentation MSC: Safe, Effective Care Environment 6. The nurse plans care for an older African American man who is from Jamaica and resides in New York City. Which should the nurse include in planning care? a. Attribute his illness to breaking a voodoo. b. Help him improve social relationships. c. Maintain blood pressure below 120/70 mm Hg. d. Review the principles of the magicoreligious system. ANS: C Because African Americans tend to be at risk for cardiovascular disease and hypertension, the nurse plans to maintain the patient’s blood pressure at or below the current recommendation by the American Heart Association. The nurse can be incorrectly assuming that he practices and believes in the magicoreligious system. The nurse should assess his spiritual beliefs and determine how much they influence his attitudes toward Western health care. The magicoreligious system maintains social relationships in good condition to prevent illness; however, if the older adult does not follow this cultural practice, then this goal can be unsuitable. The older adult may not believe in this system; therefore, the information can be irrelevant. PTS: 1 DIF: Apply REF: p. 18-19 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 7. Which health belief system uses treatments to repair a body part? a. Holistic b. Biomedical c. Personalistic d. Magicoreligious ANS: B Because dysfunction or a structural abnormality is thought to cause disease, the biomedical system believes in repairing the structural abnormality. The holistic system holds that health is attained through balance. The personalistic system uses treatments such as meditation, fasting, and praying. The magicoreligious system is the same as the personalistic system. PTS: 1 DIF: Understand REF: p. 17 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 8. A nurse is caring for a culturally diverse patient who has missed follow-up appointments with the primary care provider three times over the past year. The patient has a chronic illness that requires periodic monitoring of blood test values. The patient tells the nurse: “You don’t understand—in my culture, we don’t do things like that. I cannot be troubled with worrying about appointments in the future; I deal with each day as it comes.” The nurse understands which of the following about the patient’s culture? a. The culture does not value Western medicine. b. The culture has a different orientation to time than Western medicine. c. The culture is an interdependent culture. d. The culture does not believe in preventative care. NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: B Time orientation is a culturally constructed factor. Westernized medical care is future oriented. Conflicts between future oriented Westernized medical care and those with a present or past time orientation may arise. Patients are likely to be labeled as noncompliant for failing to keep appointments. PTS: 1 DIF: Understand REF: p. 15-17 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 9. A paper on culture and illness would be likely to include the statement that a. culture is the same as ethnicity. b. ethnic groups always share common geographic origin and religion. c. ethnicity involves recognized traditions, symbols, and literature. d. most members of an ethnic group exhibit identical cultural traits. ANS: C Ethnicity is a complex phenomenon that includes traditions, symbols, literature, folklore, food preferences, and dress. It is a shared identity. Ethnicity is more than just culture. It is social differentiation based on culture. Even within ethnic groups, there is considerable diversity. PTS: 1 DIF: Remember REF: p. 12 TOP: Teaching and Learning MSC: Psychosocial Integrity 10. A home care nurse is caring for an older patient from a different culture who is bedbound and high risk for development of a pressure ulcer. The nurse discusses the plan of care with the patient’s daughter, emphasizing the importance of turning every 2 hours, and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient’s daughter reports that she turns her mother occasionally. She states, “I am taking very good care of my mother. You just don’t understand—our ways do not involve doing things on schedules.” The best response by the nurse is: a. “You must follow my guidelines and turn her every 2 hours, or I will not be able to take care of her.” b. “I understand that you value your culture, but culture cannot stop you from providing good care to your mother.” c. ‘I understand that you care very much for your mother. Perhaps caring for her is too much for you.” d. “How can we best work together to provide the best care for your mother?” ANS: D In providing cross-cultural care, it is important that the nurse work with the patient and family and listen carefully and find a way to include the values and beliefs of the patient in the plan of care. PTS: 1 DIF: Analyze REF: p. 15 TOP: Communication and Documentation MSC: Psychosocial Integrity 11. An older patient learns that she has metastatic cancer. The patient states: “I must have angered God.” This is an example of which type of belief? a. Biomedical b. Magicoreligious c. Naturalistic NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM d. Ayurvedic ANS: B Magicoreligious beliefs view illness as caused by actions of a higher authority. Biomedical beliefs view disease as a result of abnormalities in structure and function and disease caused by intrusion of pathogens into the body. Naturalistic beliefs are based on the concepts of balance; health is seen as a sign of balance. Ayurvedic beliefs are of the oldest known paradigm in the naturalistic system; illness is seen as an imbalance. PTS: 1 DIF: Remember REF: p. 17 TOP: Communication and Documentation MSC: Psychosocial Integrity 12. The term health disparity is defined as a. the systematic elimination of the culture of another resulting in decreased wellness. b. differences in health outcomes among groups. c. the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. d. the existence of more than one group with differing values and perspective. ANS: B Health disparities are defined as differences in health outcomes among groups. Cultural destructiveness is defined as the systematic elimination of the culture of another. Health inequities are defined as the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. Cultural diversity is defined as the existence of more than one group with differing values and perspective. PTS: 1 DIF: Remember REF: p. 13 TOP: Teaching and Learning MSC: Psychosocial Integrity MULTIPLE RESPONSE 1. The nurse is assessing an older adult from a culture different than the nurse’s by asking questions from the explanatory model for culturally sensitive assessment. Which question(s) should the nurse ask to follow this model? (Select all that apply.) a. How can we negotiate to solve the problem? b. What treatment can improve your condition? c. Should we try my plan first to see if it helps? d. Can we discuss differences in our plans now? e. How long have you experienced the problem? f. Who, other than me, can make you feel better? ANS: B, E, F Asking about potential therapies is a question from the explanatory model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the explanatory model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN model. PTS: 1 DIF: Apply REF: p. 14 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: C As shown in Figure 1.4, Hispanic men and women have the highest life expectancy of all. In 2011, for those of Hispanic origin of any race, the overall life expectancy at 65 years of age was 20.7 more years in 2011 (19.1 years for men and 21.8 years for women). PTS: 1 DIF: Understand REF: p. 6 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 4. Historical influences that have shaped the lives of the majority of the in-between cohort in the United States today include which of the following? a. Influenza epidemic of 1918 b. World War I c. Child rearing in the Depression d. World War II ANS: D Those who are in the in-between cohort in 2016 were born between 1915 and 1945. The men were likely to have fought in World War II. The last of the Holocaust survivors are in this group. A person who survived the influenza epidemic would be at least 98 years old in 2016 and therefore would be considered old-old or a centenarian. Most of those who are of the in-between cohort had not reached childbearing age by the end of the Depression. Individuals in the in-between cohort would not have been old enough to fight in World War II. PTS: 1 DIF: Understand REF: p. 5 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 5. According to researchers, which characteristic do most centenarians share? a. Female b. Hispanic c. Living in rural areas d. Located in the Midwestern states ANS: A Based on the U.S. census report of 2010, centenarians were overwhelmingly white, female, and living in the urban areas of the Southern states. PTS: 1 DIF: Remember REF: p. 5 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 6. 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 NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 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 adult’s 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 adult’s life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in wheelchairs 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, although focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being. PTS: 1 DIF: Understand REF: p. 7 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance 7. An older man who resides in a nursing home has a total cholesterol level 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 adult’s 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 to 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: p. 7 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 8. Which approach requires the nurse to integrate and balance all aspects of an individual’s life into the plan of care? a. Holistic nursing b. Healthy People 2020 c. Maslow’s hierarchy of human needs d. Orem’s self-care requirements ANS: A NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Holistic nursing integrates all aspects of an individual’s life into the plan of care by balancing an individual’s 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. Maslow’s 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 Orem’s 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: 1 DIF: Remember REF: p. 7 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 9. The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b. Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d. Take them to the library for guest speakers. ANS: B The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s and 90s were born between 1920 and 1930 and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events, including incontinence and hearing and vision problems. PTS: 1 DIF: Analyze REF: p. 5 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 10. Which of the following issues in the care of older adults are identified in Healthy People 2020? a. Delineating nursing staffing levels in long term care b. Eradicating pressure ulcers in all care settings c. Identifying minimum levels of training for people who care for older adults d. Instituting mandatory training in identification of elder abuse for all caregivers of older adults ANS: C Identifying minimum training levels for people who care for older adults is one of the issues identified in Healthy People 2020. The rest of the issues are not discussed in Healthy People 2020. PTS: 1 DIF: Remember REF: p. 8 TOP: Teaching and Learning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: A Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age-related disorders. The pacemaker theory, which is also known as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can halt with age. The cross-link theory suggests that aging is a result of the stiffening of proteins caused by cross-linking, leading to stiffer joints, rougher skin, and decreased cellular elasticity. PTS: 1 DIF: Understand REF: p. 22-26 TOP: Nursing Process: Assessment MSC: Physiological Integrity 7. During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a. Exercise with light weights. b. Stand on one foot at a time while supported. c. Train with the use of sit-ups. d. Work out in a swimming pool. ANS: B The loss of balance from a musculoskeletal perspective is usually caused by a loss of core muscle strength; thus, the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance. PTS: 1 DIF: Apply REF: p. 28 TOP: Nursing Process: Implementation MSC: Teaching and Learning 8. Which age-related change contributes to anorexia and weight loss in older adults? a. Excessive saliva b. Fewer taste buds c. Wearing dentures d. Softened tooth enamel ANS: B The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Older adults tend to lose enamel. PTS: 1 DIF: Remember REF: p. 32-33 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 9. A nurse is caring for an older adult who asks the following: “I have heard that it is important to eat a diet that is high in fruits and vegetables to age successfully. Is that correct?” The nurse considers which of the following theories of aging when responding to the older adult’s question? a. Oxidative stress theory b. Immunological theory c. Free radical theory d. Telomere theory ANS: C Although the intake of supplemental antioxidants is deleterious to one’s health, there is evidence that diets inclusive of natural antioxidants, such as those high in fruits and vegetables or a Mediterranean diet rich in red wine and olive oil, are healthful. PTS: 1 DIF: Apply REF: p. 23-26 TOP: Nursing Process: Implementation MSC: Physiological Integrity 10. The family member of a patient asks a nurse if vitamin C will prevent aging. In formulating a response, the nurse considers which of the following theories? a. Free radical theory b. Immunological theory c. Oxidative stress theory d. Telomere theory ANS: A The free radical theory posits that aging is a result of random damage from free radicals. Research is ongoing on the ability of substances with antioxidant effects to counter the actions of free radicals. For many years, it was thought that consumption of supplemental antioxidants, such as vitamin C, could delay of minimize the effects of aging. PTS: 1 DIF: Apply REF: p. 23-26 TOP: Nursing Process: Implementation MSC: Physiological Integrity 11. A community health nurse provides an annual flu prevention workshop at a local senior center. The activities include a lecture on preventing infections, which includes hand washing and limiting exposure to individuals who are ill, as well as an influenza immunization clinic. The nurse is basing her activities on what theory of aging? a. Free radical theory b. Immunologic theory c. Oxidative stress theory d. Telomere theory ANS: B The immunologic theory of aging describes changes in cells of the immune system, which make an older person more susceptible to infection. Prevention of infection is very important in older adults and can be accomplished by education and immunization. PTS: 1 DIF: Apply REF: p. 23-26 TOP: Nursing Process: Implementation MSC: Physiological Integrity NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 12. A nurse is caring for an older patient in the hospital who reports: “I am worried because simple tasks such as balancing my checkbook seem to take me longer. Is there something wrong with me?” The best response by the nurse is: a. “As you age, normal changes in the brain occur that make central processing take longer, so don’t worry.” b. “You have every reason to be concerned. This is an abnormal finding; we need to contact your physician.” c. “As you age, changes in the brain lead to decreased intellectual performance, so don’t worry.” d. “Any changes in function are a cause for worry. You need to be evaluated immediately.” ANS: A As one ages, central processing slows down, which may make performance of tasks slower. This is not an abnormal finding in older adults. Intellectual performance without brain dysfunction remains constant. Many changes in function are part of normal aging. PTS: 1 DIF: Analyze REF: p. 34 TOP: Nursing Process: Implementation MSC: Physiological Integrity 13. An older woman was seen in her physician’s office after falling at home. The patient receives a comprehensive assessment, and it is determined that she has a positive urine culture and is started on antibiotic therapy for a urinary tract infection (UTI). The patient is surprised at the diagnosis. The woman reported that she had experienced some pain on urination the previous day but did not think that she had a UTI because her temperature was only 99°F. One reason why the patient may not have developed a higher temperature is a. the patient’s UTI was not yet serious enough to cause a significant increase in body temperature. b. normal age-related changes to the immune system function affect an older person’s response to illness; a low-grade fever may signify serious illness. c. older adults do not run fevers when they are ill. d. this patient likely has an alteration to her immune system that impacts her response to infection. ANS: B Change in immune function affect an older person’s response to illness consistent with the immunologic theory of aging. Older adults typically have lower core body temperatures. A lack of fever cannot be used to rule out infection. The nurse needs to consider the patient from a holistic perspective. A recent fall is often an atypical presentation of a serious illness or infection. PTS: 1 DIF: Analyze REF: p. 37 TOP: Nursing Process: Implementation MSC: Physiological Integrity MULTIPLE RESPONSE 1. Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply.) a. Fewer T lymphocytes b. Less lean muscle mass NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 11. An older man asks a nurse: “How do you define aging? Do I meet the criteria of a senior citizen?” The nurse understands that one can define aging in many different manners. If the nurse chooses to define aging as “social aging,” the nurse would consider which of the following aspects? a. The man retired from his job as a police officer. b. The man takes six different medications multiple times over the course of the day. c. The man walks with a rolling walker. d. The man celebrated his 65th birthday. ANS: A Social aging is determined by changes in roles. Taking multiple medications multiple times over the course of the day and walking with a rolling walker are functional determinants of aging. Age refers to chronological aging. PTS: 1 DIF: Understand REF: p. 7 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 12. The holistic health movement has impacted health care in which of the following ways? a. It has focused health care on disease prevention. b. It has reshaped how health and health care are perceived. c. It has improved access to health care. d. It has introduced numerous alternative modalities into health care. ANS: B The holistic paradigm has reshaped how health and health care are perceived. Wellness is seen as a state of being which can be defined anywhere along the continuum of health. PTS: 1 DIF: Understand REF: p. 7 TOP: Teaching and Learning MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. According to Healthy People 2020, older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement. (Select all that apply.) a. Diabetes b. Arthritis c. Congestive heart failure d. Dementia e. Cancer f. Pressure ulcers ANS: A, B, C, D In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia. PTS: 1 DIF: Remember REF: p. 8 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 2. Identify the Healthy People 2020 emerging issues in the health of older adults. (Select all that apply.) a. Coordinating care for the older adult population b. Assisting older adults in the management of their own care c. Identifying levels of training for those caring for older adults d. Making community resources available for older adults e. Increase in health disparities for rural older adults ANS: A, B, C According to United States Department of Health and Human Services’ Healthy People 2020, emerging issues in the health of older adults include coordinating care, helping older adults manage their own care, establishing quality measures, identifying minimum levels of training for people who care for older adults, and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults. PTS: 1 DIF: Remember REF: p. 8 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 3. Researchers hypothesize that most super-centenarians survive and are in good health due to which of the following factors? (Select all that apply.) a. They have a different genetic makeup than other older adults have. b. They tend to live in wealthier areas of the world. c. The exact cause of this phenomenon is not known. d. Contributing factors to their good health include quality medical care and improved social conditions. e. They have large extended families to assist in their care. ANS: C, D The exact cause of super-centenarians’ longevity is not known; researchers describe it as attributable to “rare and unpredictable reasons.” Contributing factors include medical care and improved sociopolitical conditions. There is no known difference in biological or sociological factors between super-centenarians and other older adults. Super-centenarians exist all over the world. PTS: 1 DIF: Understand REF: p. 4-5 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 4. The nurse in an assisted living facility (ALF) is preparing a lecture on aging for the residents. The philosophy of the ALF is to approach aging from the viewpoint of health. Based on this philosophy, the nurse includes which of the following topics? (Select all that apply.) a. “The Many Chronic Illnesses of Aging” b. “Channeling Your Inner Strength Toward Wellness” c. “Maximizing Function As You Age” d. “Conserving Your Strength As You Age” e. “Keep Moving, Maintain Your Mobility” ANS: B, C, D A wellness perspective is based on the belief that every person has an optimal level of wellness independent of functional ability. This viewpoint approaches aging with an emphasis on resilience, strength, resources, and capabilities rather than focusing on existing pathological conditions. NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM PTS: 1 DIF: Analyze REF: p. 6-7 TOP: Teaching and Learning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM a. Increased secretion of cholinesterase b. Decreased secretion of neurotransmitters c. Loss of spinal cord and brainstem neurons d. Atrophy of dendrites in the cerebral cortex ANS: D Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmission of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. The spinal cord and the cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord. PTS: 1 DIF: Understand REF: p. 49 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 7. The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a. Verbal fluency b. Logical analysis c. Object naming d. Visuospatial skills ANS: A Allowing residents to read aloud helps improve and maintain verbal fluency because it provides an opportunity to practice these skills. Reading aloud does not usually require analysis. Reading is unlikely to improve object recall unless displaying objects is part of the reading. Visuospatial skills require the ability to perceive the relationship of objects in terms of the space each object occupies; reading is unlikely to improve this skill. PTS: 1 DIF: Understand REF: p. 49 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance 8. Mandatory retirement at age 65 years is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory ANS: B Disengagement theory states that in the natural course of aging, the individual does and should withdraw from society to allow for the transfer of power to younger generations. PTS: 1 DIF: Apply REF: p. 41-42 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 9. An older woman retires after a long career as an elementary school principal and begins to volunteer in the local library reading to children. The older woman is very pleased with her volunteer activities. This is consistent with which theory of aging? a. Role theory NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM b. Disengagement theory c. Age-stratification theory d. Social exchange theory ANS: A Role theory posits that self-identity is believed to be defined by one’s role in society. Successful aging means that as one role is completed, it is replaced by another or comparative value to the individual. PTS: 1 DIF: Apply REF: p. 41 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 10. An older married couple move to a continuing care retirement community. The older woman who was always very social and outgoing quickly joins an exercise group, a book club, and a knitting circle. The older man who was always very solitary adopts a routine of a long daily walk and registers for an online course in creative writing. The behaviors of the older couple are consistent with which theory of aging? a. Activity theory b. Continuity theory c. Social exchange theory d. Disengagement theory ANS: B Continuity theory proposes that individuals develop and maintain a consistent pattern of behavior over a lifetime. Aging, as an extension of earlier life, reflects a continuation of the patterns of roles, responsibilities, and activities. Personality influences the roles and activities chosen and the level of satisfaction drawn from these. Successful aging is associated with one’s ability to maintain and continue previous behaviors and roles. PTS: 1 DIF: Apply REF: p. 41 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 11. A retirement community is divided into different communities with different activities available for the residents of each community. There is one community for individuals ages 65 to 74 years, one for individuals ages 75 to 85 years, and one community for individuals older than age 85 years. This is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory ANS: C Age-stratification theory is based on the belief that aging can be best understood by considering the experiences of individuals as members of cohorts with similarities to others in the same group. PTS: 1 DIF: Apply REF: p. 42 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity MULTIPLE RESPONSE NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 1. Which statements are true about aging and the brain? (Select all that apply.) a. Most areas of the brain do not lose brain cells. b. Memory decline is inevitable as people age. c. Basic intelligence remains unchanged with age. d. The brain does not continue to make new brain cells. e. There are decrements in the ability to process information. ANS: A, C, E Most areas of the brain do not lose brain cells. Although older adults may lose some nerve connections, this can be part of the reshaping of the brain that comes with experience. Basic intelligence remains unchanged with age, and older adults should be provided with opportunities for continued learning. There are decrements in the ability to process information. Many people reach older age and have no memory problems. Having a healthy diet and participation in physical exercise, stimulating mental activity, socialization, and stress management help brain health. PTS: 1 DIF: Understand REF: p. 49-50 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. The nurse is admitting a patient to a long-term care facility. During the admission, the patient verbalizes a concern about getting dementia now that he is in a nursing home. In which activities should the nurse encourage the patient to participate to maintain brain health? (Select all that apply.) a. Physical exercise b. Stimulating mental activity c. Socialization d. Increasing dietary intake e. Crossword puzzles ANS: A, B, C, E Many people reach older age and have no memory problems. Having a healthy diet and participation in physical exercise, stimulating mental activity, socialization, and stress management help brain health. Puzzles are a cognitive stimulating activity. An increase in dietary intake has not been shown to influence brain health. PTS: 1 DIF: Apply REF: p. 50-51 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 3. A nurse in an assisted living facility is planning an educational program on exercise for the residents. The nurse needs to consider which of the following when planning the activity? (Select all that apply.) a. Very simple language must be used so that the residents will understand the material. b. Large size fonts must be used on all written material provided to the residents. c. The educational program should be provided in a quiet area without excessive background noise. d. The material discussed should focus only on the consequences of failure to exercise. e. The material discussed should build on the prior knowledge of the residents. ANS: B, C, E NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Chapter 05: Gerontological Nursing and Promotion of Healthy Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Identify the best statement about gerontological nursing. a. Nurses have only recently become involved in the care of older adults. b. Gerontological care was the second specialty in which the American Nurses Association (ANA) offered a certification program. c. Purposes of gerontological nursing include the promotion of health and support for maximal independence. d. ANA certification is available only for gerontological nurses in research positions. ANS: C Promoting health and fostering independence are purposes of the practice, as reflected, for example, in the ANA Scope and Standards. Nurses have always cared for older patients. The ANA’s gerontological nursing certification program was the organization’s first and includes a variety of positions, such as nurse practitioners, clinical specialists, researchers, and administrators. PTS: 1 DIF: Remember REF: p. 56-57, 60 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 2. Which gerontological nursing organization welcomes nurses from all educational backgrounds? a. The National Gerontological Nursing Association (NGNA) b. The National Conference of Gerontological Nurse Practitioners (NCGNP) c. The National Association of Directors of Nursing Administration in Long-Term Care (NADONA/LTC) d. The American Society on Aging (ASA) ANS: A The NGNA was formed specifically for all levels of nursing personnel: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and certified nursing assistants (CNAs). The NCGNP is, as its name implies, limited to nurse practitioners. The NADONA/LTC is, as its name implies, limited to directors and assistant directors of nursing. The ASA is an interdisciplinary organization not limited to nurses. PTS: 1 DIF: Remember REF: p. 59 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 3. Which is an accurate statement regarding gerontological nursing education? a. Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. b. Undergraduate nursing programs extensively cover gerontological nursing in dedicated courses, comparable with the coverage of psychiatric nursing. c. When content is integrated throughout a curriculum, less than 25% is devoted to geriatric care. d. Accreditation of a nursing program guarantees that appropriate amounts of NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM gerontological nursing content are included in the curriculum. ANS: C When content is integrated throughout the curriculum, less than 25% of the content is devoted to geriatric care. Only recently has gerontological nursing content begun to appear in nursing school curricula. Most nursing schools still do not have such courses. At present, no minimum requirements exist for the coverage of care of older adults. PTS: 1 DIF: Remember REF: p. 58 TOP: Teaching and Learning MSC: Health Promotion and Maintenance 4. Based on current demographic data, which of the following statements identifies a predictive trend regarding the health care needs of society? a. Most nurses will not need to care for older persons. b. More nursing services will be required to serve the needs of the population older than 85 years of age. c. Fewer nurses will be needed to care for older adults. d. Older adults expect their quality of life to be less than that of earlier generations at their ages. ANS: B Projections are that 20% of the American population will be older than 65 years of age by 2050, with those older than 85 years showing the greatest increase in numbers. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be older than the age of 60 years than those younger than the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age. PTS: 1 DIF: Remember REF: p. 56 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 5. A case manager is likely to have how many years of nursing education? a. 1 to 1.5 b. 4 to 6 c. 2 d. 8 or more ANS: C A case manager typically has a bachelor’s or master’s degree. This amount of training is typical for a licensed practical nurse, who typically practices at a nursing home or on a home nursing staff. This amount of training, resulting in an associate’s degree in nursing, is typical for an associate registered, who is typically found on hospital, home, and nursing home staffs. A nurse with 8 or more years of education, as well as a doctorate, is typically involved in research and teaching. PTS: 1 DIF: Remember REF: p. 62 TOP: Teaching and Learning MSC: Safe, Effective Care Environment 6. An older man is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of long-term care? a. Decrease the analgesic dose to prevent sedation. NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM b. Provide a basin and towels for morning self-care. c. Inform family members about strict visiting hours. d. Facilitate family rituals related to death and dying. ANS: D To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to patients regardless of the setting or the nurse’s personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus, to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adult’s needs. PTS: 1 DIF: Apply REF: p. 60, 62 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 7. A nursing home executive interviews registered nurses to fill a full-time position for direct patient care to maintain the standards of eldercare. Which nurse should the nursing home hire? a. Nurse from a certified college b. Nurse with 15 years of experience c. Certified gerontological nurse d. Gerontological nurse practitioner ANS: B A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15 years of experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gerontology, these nurses provide primary care in a nursing home. PTS: 1 DIF: Apply REF: p. 57 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 8. Mezey and Fulmer (2002) justify gerontological nursing research and the work of gerontological advanced practice nurses by concluding the following: a. Other scientists devalue gerontological nursing research. b. The research influences outcomes from nursing care in a positive way. c. Gerontological care is expensive but required in long-term care. d. Gerontological nursing research is well known to practicing nurses. ANS: B NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Advanced practice nurses have demonstrated their skill in improving health outcomes and cost effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams. This role is well established, and positive outcomes include increased patient and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving. PTS: 1 DIF: Remember REF: p. 60 TOP: Nursing Process: Evaluation MSC: Safe, Effective Care Environment 2. The ANA Scope and Standards of Gerontological Nursing (2010) addresses which of the following? (Select all that apply.) a. The skills and knowledge required to address gerontological patient needs b. The levels of gerontological nursing practice c. Requirements for certification as a gerontological nurse d. Standards of gerontological nursing practice e. Continuing education requirements for gerontological nurses ANS: A, B, D The ANA Scope and Standards of Gerontological Nursing (2010) provides a comprehensive overview of the scope of gerontological nursing, the skills and knowledge required to address the full range of needs related to the process of aging, and the specialized care of older adults as a group and as individuals. The document also identifies levels of gerontological nursing practice (basic and advanced) and standards of clinical gerontological nursing care and gerontological nursing performance. Certification requirements and continuing education requirements are not addressed. PTS: 1 DIF: Remember REF: p. 57 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 3. In the document “Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults” developed by the American Association of Colleges of Nursing and the Hartford Institute for Geriatric Nursing, New York University, recommendations include which of the following? (Select all that apply.) a. Provision of a free-standing course in gerontology within the curriculum b. Integration of gerontological content throughout the curriculum c. Requirement of gerontological certification for all students before completion of a BSN program d. Structured clinical experiences with older adults across the continuum of care e. Faculty with expertise in gerontological nursing ANS: A, B, D, E Best practice recommendations for nursing education include provision of a stand-alone course, as well as integration of content throughout the curriculum so that gerontology is valued and viewed as an integral part of nursing care. It is important to provide students with nursing practice experiences caring for elders across the health–wellness continuum. Faculty with expertise in gerontological nursing is an important recommendation. PTS: 1 DIF: Remember REF: p. 58 NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 4. Which of the following organizations have interdisciplinary membership? (Select all that apply.) a. Gerontological Society of America b. National Gerontological Nurses Association c. American Society on Aging d. Association of Gerontology in Higher Education e. National Association Directors of Nursing Administration in Long-Term Care ANS: A, C, D The Gerontological Society of America, American Society on Aging, and Association of Gerontology in Higher Education are all interdisciplinary organizations. The National Gerontological Nurses Association and National Association Directors of Nursing Administration in Long-Term Care are nursing organizations. PTS: 1 DIF: Remember REF: p. 58-59 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 5. Common iatrogenic complications for hospitalized older adults include (Select all that apply.) a. delirium. b. new-onset incontinence. c. acute myocardial infarction. d. hip fracture. e. falls. ANS: A, B, E Common iatrogenic complications include functional decline, pneumonia, delirium, new-onset incontinence, malnutrition, pressure ulcers, medication reactions, and falls. PTS: 1 DIF: Remember REF: p. 61 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Chapter 06: Gerontological Nursing Across the Continuum of Care Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. An older female resident in the residential facility keeps a large collection of personal items and photographs of her late husband on her bedside table, but the nursing assistant and resident frequently argue about this. Why should the nurse intervene between the resident and the nursing assistant? a. The resident is attempting to maintain her sense of personal space. b. The resident needs to accept the reality of her spouse’s death. c. The resident’s argumentative nature can indicate early dementia. d. Clutter from all the personal items is a safety and liability risk. ANS: A A thoughtful nurse respects and supports the resident’s boundaries. Even if the resident needed to accept the reality of her spouse’s death, the resident’s grief process and personal space should be respected. Although the resident’s argumentative nature can indicate early dementia, the resident’s behavior can also be understood as a healthy defense of personal space. Although the rationale of the nurse assistant is probably that the clutter from all the personal items is a safety and liability risk, the assistant should realize that this resident is entitled to the personal use of her personal space. PTS: 1 DIF: Apply REF: p. 74 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 2. Which statement is true about living arrangements for older adults? a. Older adults are more independent in their own homes than in a residential community. b. The increase in real estate values makes home ownership essential to security. c. The Program for All-Inclusive Care for the Elderly (PACE) is a community alternative to nursing home care for frail older adults. d. Florida is an example of a naturally occurring retirement community (NORC). ANS: C PACE is an alternative to nursing home care for frail older people who want to live independently in the community with a high quality of life. Although relief from the burden of home maintenance can free a person for more independent living, this statement can or cannot be accurate, depending on the real estate market at the time. In addition, taxes and maintenance costs have also risen. A NORC is an organization formed by older adults living at home in geographic proximity to each other to provide supportive services for each other. PTS: 1 DIF: Understand REF: p. 67-69 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. Which statement is true about residential living for older adults? a. A residential care facility is the new term for a nursing home. b. An assisted living facility (ALF) must have a registered nurse (RN) on staff. c. Administrators are realizing that their duty is to care for the residents as people. NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM homelike environment. ANS: A Life care communities, also known as CCRCs, provide the full range of residential options, from single-family homes to skilled nursing facilities, all in one location. For married couples in which one spouse needs more care than the other, life care communities allow them to live nearby in a different part of the same community. Choosing to live in a CCRC is a costly endeavor, and individuals with low or even middle incomes and assets usually can’t afford this senior housing option. Adult day programs provide social and some health services to adults who need supervised care in a safe setting during the day. PTS: 1 DIF: Apply REF: p. 67-68 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 9. A nurse in an assisted living facility (ALF) evaluates the application for admission of an elderly woman. The woman is 87 years old, needs assistance with bathing and dressing, and is unable to prepare her own meals or do her own housekeeping. The nurse compares this applicant with the typical residents of an ALF and concludes which of the following? a. This woman is not a typical resident of an ALF and is better suited to a long-term care facility. b. This woman matches the profile of a typical resident in an ALF. c. This woman is not a typical resident of an ALF and is better suited for an adult day care program. d. This woman is not a typical resident of an ALF and is better suited for a Program for All-Inclusive Care for the Elderly (PACE) Program. ANS: B The profile of a resident in an assisted living facility is a woman, approximately 87 years old, who needs assistance with two to three activities of daily living and needs help with meal preparation and managing medications. PTS: 1 DIF: Analyze REF: p. 68-69 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 10. A nurse is considering employment in an assisted living facility (ALF). The nurse understands that which of the following are true about nursing in an ALF? a. A registered nurse (RN) is required to supervise residents 24 hours per day in an ALF in all states in the United States. b. Not all states require an RN in ALFs; however, many do employ RNs. c. An RN is not required to supervise residents in all states in the United States, however, a licensed practice nurse (LPN) is required. d. An RN is required to supervise residents 12 hours per day in an ALF in all states in the United States. ANS: B Not all states in the United States require an RN in an ALF; however, between 47% and 70% employ an RN or an LPN or licensed vocational nurse. PTS: 1 DIF: Remember REF: p. 68-69 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 11. An older patient is being discharged from the hospital to a subacute unit. The patient says to a nurse, “I am not sure I understand the difference between a subacute unit and a nursing home. Can you help me understand?” The nurse considers which of the following in formulating a response? a. Subacute care and nursing home care are identical. b. Subacute care is more intensive than traditional nursing home care. c. Subacute care is reimbursed by either Medicaid or private pay. d. Professional nursing staff levels are the same as those in traditional nursing home settings. ANS: B Subacute care is more intensive than traditional nursing home care and is reimbursed by Medicare. Professional staffing levels tend to be higher than in traditional nursing home settings. PTS: 1 DIF: Remember REF: p. 69-70 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment MULTIPLE RESPONSE 1. A family is touring selected nursing homes in preparation for their mother’s future. Which qualities of a nursing home should the family include if they decide on a person-centered nursing home? (Select all that apply.) a. Staff members cover all nursing units. b. Residents and families have a council. c. Residents choose stimulating activities. d. Staff members respond to residents’ needs. e. Group activities are scheduled on the hour. f. Staff members help residents stay well-groomed. ANS: B, C, D, F A characteristic of a person-centered culture is family and resident councils to discuss resident issues, needs, and solutions. A second characteristic of a person-centered culture is residents choosing their own activities to suit their interests. A third characteristic of a person-centered culture is a responsive staff that promptly meets resident needs. A fourth characteristic of a person-centered culture is assisting residents to maintain their appearance and to stay well-groomed. Consistent nursing assignments are a characteristic of a person-centered culture. Predetermined schedules are characteristic of an institution-centered culture. PTS: 1 DIF: Understand REF: p. 74 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 2. An elder-friendly community includes components that (Select all that apply.) a. address basic needs. b. optimize physical health. c. provide financial assistance. d. maximize independence. e. provide social engagement. ANS: A, B, D, E NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Components of an elder-friendly community include addressing basic needs, optimizing physical health and well-being, maximizing independence for frail and disabled older adults, and providing social and civic engagement. Elder-friendly communities do not provide financial assistance. PTS: 1 DIF: Understand REF: p. 66-67 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. Which home modification interventions are designed to enhance the ability of older adults to remain in their homes? (Select all that apply.) a. A 36-inch-wide doorway b. Entryways with less than two steps c. Electrical outlets at chest level d. A bathroom on the first floor ANS: A, D Many state and local governments are assessing the community and designing interventions to enhance the ability of older people to remain in their homes and familiar environments. Home design features such as 36-inch-wide doorways and hallways, a bathroom on the first floor, an entry with no steps, outlets at wheelchair level, and reinforced walls in bathrooms to support grab bars. PTS: 1 DIF: Understand REF: p. 66-67 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 4. An older patient’s daughter asks a nurse the following: “I have heard about PACE [Program for All-Inclusive Care for the Elderly] programs and think that one might be a good option for my father. Can you tell me more about what the qualifications to be part of a PACE program are?” The nurse includes which of the following in her response to the family member? (Select all that apply.) a. PACE programs provide services to individuals who meet the criteria for nursing home admission. b. PACE programs only provide service to individuals who are age 55 years and over. c. Participants in PACE programs must be eligible for either Medicare or Medicaid. d. Participants in PACE programs must be able to perform their own activities of daily living (ADLs) independently. e. Participants in PACE programs must have been residents in a nursing home before enrollment in the PACE program. ANS: A, B PACE provides community services to people age 55 years and older who meet the criteria for nursing home admission, prefer to remain in the community, and are eligible for Medicare and Medicaid. There are no qualifications that address ADL status. PTS: 1 DIF: Understand REF: p. 67 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 5. Which of the following are true about long-term care? (Select all that apply.) a. The number of older adults needing long-term care services is expected to increase exponentially in the next 25 years. NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: A As with everything else in life, always read the fine print. For example, many plans strictly limit benefits for those with Alzheimer’s disease. The rates may go up with age at application. The best LTCI packages have been obtained by large organizations with considerable negotiating power. LTCI plans do not receive any government support; therefore, the subscriber finances his or her own LTCI. PTS: 1 DIF: Understand REF: p. 87-88 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 4. A health care provider asks the nurse about an older man’s 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 patient’s 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 patient’s cognitive status, the nurse assesses the patient for delirium using the confusion assessment method for the intensive care unit. As the patient’s 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 patient’s cognitive status must be determined. The patient is unable to perform an oral test while he is intubated. PTS: 1 DIF: Apply REF: p. 89 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 5. An older woman is brain dead, and the attorney in fact or surrogate named in her le power of attorney (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. b. Provide consent. c. Refuse to decide. d. Get a second opinion. ANS: B NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM A DPA acts at the pleasure of the designator; can manage the designator’s finances; and functions as the designator’s 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 woman’s 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 adult’s neurologic status but not as a way to avoid the decision concerning organ harvesting. PTS: 1 DIF: Apply REF: p. 89 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 6. An older adult wants to appoint an attorney in fact with le power of attorney (DPA) for a specific period around a forthcoming surgery. Which should the nurse implement? a. Help the patient find a qualified attorney. b. Explain the legal rights and responsibilities of an attorney in fact with a DPA. c. Suggest using a guardian for the surgical period. d. Offer to act as the patient’s guardian during surgery. ANS: A The nurse provides safe, effective, and comprehensive care but should not provide legal advice to an older adult; rather, the nurse should refer the patient to experts in the law and can assist the older adult with finding a suitable attorney. The nurse must avoid participating in the selection of the individual attorney to avoid conflict of interest. The nurse can provide short general explanations about powers of attorney to assist the patient in finding suitable legal counsel, but the nurse should leave explanations about the law surrounding a DPA to an attorney. The nurse should avoid providing legal advice to an older adult and avoid offering to participate in an older adult’s legal affairs to avoid a conflict of interest. PTS: 1 DIF: Apply REF: p. 89-90 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 7. Which is the fundamental difference between Medicare Parts A and B? a. Hospice care b. Health care setting c. Home care services d. Invasive procedures ANS: B The primary difference between Medicare Parts A and B is the care setting. Part A covers acute, inpatient care and some specialized care. Part B covers some costs of outpatient and ambulatory services. Hospice care is not a difference; Part A and Part B coverage is no longer available for a patient in hospice care. Home care services are not included in Part B; therefore, home care cannot be compared with Part A. Invasive procedures are potentially covered by both Parts A and B. PTS: 1 DIF: Understand REF: p. 82-87 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 8. Which of the following statements is true about conservators? NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM a. Whereas a conservatorship entails control over property, a guardianship entails control over the person. b. The most legally restricting way individuals and property can be handled are through conservatorships and guardianships. c. Conservators cannot be members of the conservatee’s (patient’s) family. d. Because a conservatorship is the least restrictive alternative, a court hearing is not required. ANS: B A conservator can be responsible for the conservatee’s property, person, or both. The conservatee is a ward of the conservator or guardian and has no decision-making rights and, in many states, has no legal right to sue to terminate the conservatorship or guardianship. The conservator is the individual appointed by the court; this person can be a family member or someone who has a conflict of interest. Conservatorship is a most restrictive alternative and requires a court hearing. PTS: 1 DIF: Understand REF: p. 89-90 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 9. An older patient with type II diabetes mellitus tells a nurse: “I don’t know how I am going to continue with this blood sugar testing. I know it is important, but the strips are so expensive.” The nurse formulates a response based on the knowledge that a. diabetic testing supplies are covered by Medicare Part A. b. diabetic testing supplies are covered by Medicare Part B. c. diabetic testing supplies are covered by Medicare Part D. d. diabetic testing supplies are not covered by Medicare. ANS: B Diabetic supplies are covered by Medicare Part B. PTS: 1 DIF: Understand REF: p. 82-86 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 10. The principle of substituted judgment is defined as a. a surrogate makes a decision based on the surrogate’s personal choice in a similar situation. b. a surrogate makes a decision based on what he or she believes the person would have made if he or she were able to do so. c. a surrogate finds an alternate individual to make the decision if he or she is uncomfortable with the situation. d. a surrogate refuses to make any decisions that he or she is personally not in agreement with. ANS: B Substituted judgment is defined as making a decision based on what he or she believes the person would have made if he or she were able to do so. The personal beliefs and comfort level of the surrogate are irrelevant. PTS: 1 DIF: Understand REF: p. 89 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. The Affordable Care Act (ACA) of the Obama administration has impacted the health of older adults in which of the following ways? (Select all that apply.) a. Expanded access to preventative care b. Institution of the Medicare annual wellness visit c. Reduced medication costs d. Elimination of all copayments for services e. Provision of hospice services to all Medicare enrollees ANS: A, C The ACA has expanded access to preventative care and reduced medication costs. The Medicare annual wellness visit was in place before the ACS, as was hospice. The ACA did not eliminate all copays. PTS: 1 DIF: Remember REF: p. 79 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 4. The “Welcome to Medicare” exam includes which of the following? (Select all that apply.) a. Height, weight, and blood pressure measurements b. Simple vision testing c. Hearing evaluation d. Functional status assessment e. Calculation of body mass index ANS: A, B, E The “Welcome to Medicare” exam includes height, weight, blood pressure measurements, simple vision testing, calculation of body mass index, and a written preventive health plan along with other evaluations that are individually determined for the patient. PTS: 1 DIF: Remember REF: p. 82 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Chapter 09: Safe Medication Use Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which pharmacokinetic parameter is affected most by decreased intestinal motility related to the aging process? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: A Decreased intestinal motility increases the amount of time a substance remains in contact with the intestinal mucosa of the small intestine, where most absorption takes place. With increased exposure, absorption can be increased and the drug effect enhanced. Many medications taken by older adults can also decrease intestinal motility, thereby complicating the titration of medications or introducing new adverse effects through drug-to-drug interactions. Decreased body water leads to higher serum concentrations of water-soluble drugs, increased body fat increases the longevity of fat-soluble drugs, and decreased serum albumin increases the serum concentration of serum protein–bound drugs. Reduced liver mass and hepatic dysfunction can impair oxidative metabolism, which can lead to an accumulation of toxic levels of a drug. Impaired renal function can impair the excretion of drugs through the kidneys. PTS: 1 DIF: Understand REF: p. 111-113 TOP: Nursing Process: Evaluation MSC: Safe, Effective Care Environment 2. Which process is increased in the early morning? a. Fibrinolytic activity b. Blood plasma c. Asthma symptoms d. Rheumatoid arthritis pain ANS: A Fibrinolytic activity is increased in the early morning. Blood plasma volume falls at night, thus hematocrit increases. Asthma symptoms peak at approximately 4 to 5 AM. Pain from rheumatoid arthritis is most severe in the late afternoon. PTS: 1 DIF: Remember REF: p. 114 TOP: Nursing Process: Assessment MSC: Physiological Integrity 3. In questioning an older adult, which question is likely to elicit the most accurate information about the individual’s adherence to the medication plan? a. “You take digoxin (Lanoxin) at the correct time, don’t you?” b. “Why didn’t you take all of your digoxin (Lanoxin) last month?” c. “How many doses of digoxin (Lanoxin) do you think you missed?” d. “You have never missed a dose of digoxin (Lanoxin), have you?” ANS: C NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM “How many doses of digoxin (Lanoxin) do you think you missed?” is a question that is worded to put the client at ease and to elicit information in a matter-of-fact way. “You take digoxin (Lanoxin) at the correct time, don’t you?” sounds like a challenge to the patient’s personal qualities. In addition, the nurse is leading the patient to the answer. The patient is likely to respond simply, “Oh, yes.” Although the question, “Why didn’t you take all of your digoxin (Lanoxin) last month?” is meant to elicit the reason for nonadherence, it has an accusatory tone that is likely to make the patient defensive. “You have never missed a dose of digoxin (Lanoxin), have you?” is a question that can be interpreted as judgmental. PTS: 1 DIF: Understand REF: p. 119 TOP: Nursing Process: Evaluation MSC: Safe, Effective Care Environment 4. When completing medication reconciliation for an older woman, the nurse notes that the patient is being discharged home on anticoagulant therapy. The nurse also notes that at admission, the patient reported that she uses herbal supplements at home. Which instruction should the nurse include during discharge teaching? a. “You may need to supplement with only ginkgo while on anticoagulant therapy.” b. “You may need to increase the use of garlic supplements while on anticoagulant therapy.” c. “Avoid using Hawthorn supplements while taking an anticoagulant medication.” d. “Avoid using chamomile supplements while on anticoagulant therapy.” ANS: D The nurse’s priority is to stop this older adult’s intake of chamomile supplements at home; they will increase the effectiveness of anticoagulation. The nurse instructs this individual to avoid chamomile while she is taking an anticoagulant because the woman’s blood will be much less able to clot, exposing her to a very high risk of a catastrophic injury in the event of a fall or trauma. The patient does not need to supplement with only ginkgo; the patient should cease taking ginkgo while on anticoagulant therapy, as well as the use of garlic supplements. Both increase the effectiveness of anticoagulation. The use of Hawthorn supplements has not been shown to affect the use of anticoagulant medications. PTS: 1 DIF: Analyze REF: p. 116 TOP: Nursing Process: Planning MSC: Pharmacological and Parenteral Therapies 5. The nurse provides instruction about medication safety to older adults. Which instruction should the nurse provide? a. Nausea and vomiting are common, harmless drug side effects. b. Keep a supply of medications at the bedside for convenience. c. Ask the health care provider to describe the purpose of therapy. d. Take your daily medications on an empty stomach with water. ANS: C NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: C A rare but potentially life-threatening adverse drug reaction to antipsychotics is neuroleptic malignant syndrome (NMS). The most typical symptoms are fever greater than 100.4°F, muscle rigidity, autonomic instability (e.g., labile BP, tachycardia), and altered mental status. The onset is rapid, and unless the patient is treated appropriately, death can occur quickly. The drug most associated with NMS is haloperidol (Haldol), but NMS has also been seen when a person is taking chlorpromazine (Compazine) and promethazine (Phenergan). It occurs most often in the first 2 weeks of the start of treatment but must also be considered whenever a dose is increased. The medical provider must be contacted immediately because this is a medical emergency. PTS: 1 DIF: Analyze REF: p. 123 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which herbal supplements when taken with an anticoagulant increase the effectiveness of the medication and should be avoided during anticoagulant therapy? (Select all that apply.) a. Chamomile b. Garlic c. Ginkgo d. Hawthorn e. Ginseng f. Green tea ANS: A, B, C, E, F The intake of chamomile, garlic, ginkgo, ginseng, and green tea supplements at home should be avoided because each increases the effectiveness of anticoagulation. Individuals should avoid these herbal supplements while taking an anticoagulant because the patient’s blood will be significantly less able to clot, exposing them to the risk of a catastrophic injury in the event of a fall or trauma. The use of Hawthorn supplements has not been shown to affect the use of anticoagulants. PTS: 1 DIF: Remember REF: p. 116 TOP: Nursing Process: Planning MSC: Pharmacological and Parenteral Therapies 2. Through which pathways are drugs and their metabolites eliminated? (Select all that apply.) a. Sweat b. Saliva c. Kidneys d. Spleen ANS: A, B, C Drugs and their metabolites are excreted in sweat, saliva, and other secretions but primarily through the kidneys. Metabolites are not eliminated through the spleen. PTS: 1 DIF: Remember REF: p. 113-114 TOP: Nursing Process: Planning MSC: Pharmacological and Parenteral Therapies 3. A nurse is administering medications to an older patient who has renal insufficiency. The nurse understands which of the following? (Select all that apply.) NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM a. Certain drugs may need to be avoided in this patient. b. Certain drug dosages may need to be adjusted based on this patient’s creatinine clearance. c. Larger doses of most drugs frequently need to be administered in this patient. d. This patient should never be administered acetaminophen (Tylenol). e. Drug effects would in general be diminished in this patient. ANS: A, B Drugs that are metabolized in the kidneys may need to be avoided or dosages adjusted based on the patient’s creatinine clearance. Dosages of drugs usually are decreased in patients with renal insufficiency. Because of renal insufficiency, drug effects would be increased, not decreased. In general, Tylenol is not avoided in older patients; it is just limited to a maximum of 4 g/day. Tylenol is of greatest concern in patients with hepatic issues. PTS: 1 DIF: Analyze REF: p. 113-114 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 4. A nurse is reviewing an older resident’s medication list in a long-term care facility. The nurse notices that two of the medications are on the Beers criteria. The nurse understands that the Beers criteria (Select all that apply.) a. include medications that are not permitted to be administered in long-term care facilities. b. include medications that should be used in caution in older adults. c. include specific drug–drug interactions that are known to cause harm in older adults. d. include medications that need to be dose adjusted in older adults with impaired kidney function. e. include medications that are not reimbursed by Medicare and Medicaid. ANS: B, C, D The Beers criteria include lists of medications that have been demonstrated to cause harm, specific drug–drug interactions known to cause harm, medications that should only be used with caution, and those that require dosage adjustments in the presence of altered kidney function. PTS: 1 DIF: Remember REF: p. 120 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 5. Common side effects of the selective serotonin reuptake inhibitors (SSRIs) include (Select all that apply.) a. decreased appetite. b. dry mouth. c. nausea. d. sexual dysfunction. e. dizziness. ANS: B, C, D, E NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM The SSRIs (e.g., Zoloft, Prozac, Lexapro, Celexa) and serotonin–norepinephrine reuptake inhibitors (e.g., Effexor) have been found to be highly effective, with minimal or manageable side effects, and are the drugs of choice for use in older adults. Most of these cause initial problems with nausea or a dry mouth. Although effective, these drugs must be used with caution especially related to serum sodium levels. The SSRIs should also be used with caution in persons with a history of falls because of the potential to produce ataxia or dizziness. One side effect of the SSRIs that does not resolve with time, if experienced, is sexual dysfunction. PTS: 1 DIF: Remember REF: p. 121 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 6. Common symptoms of digoxin toxicity include which of the following? (Select all that apply.) a. Ataxia b. Blurred vision c. Confusion d. Halo vision e. Orthostatic hypotension ANS: B, C, D Common symptoms of digoxin toxicity include confusion, headache, anorexia, vomiting, arrhythmias, blurred vision or visual changes (halos, frost on objects, color blindness), and paresthesias. PTS: 1 DIF: Remember REF: p. 118-119 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 7. Common causes of polypharmacy in older patients include which of the following? (Select all that apply.) a. Use of multiple different health care providers b. Presence of multiple chronic conditions c. Use of multiple pharmacies to obtain medications d. High cost of medications e. Lack of adequate education on medications ANS: A, B, C, E Polypharmacy is a common problem in older adults. Contributing factors include multiple chronic conditions, multiple health care providers, use of multiple pharmacies, and inadequate education on medications provided to the patient. PTS: 1 DIF: Apply REF: p. 115 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM The nurse is able to assess the risk for aspiration by assessing the adult for pocketing, which is residual accumulations or pockets of food in the mouth that the older adult can aspirate after the meal is complete. If food is found in the mouth, then the nurse removes it and evaluates the current plan of care. The amount of food consumed by an older adult is unrelated to the risk of aspiration; therefore, noting the amount of food that is eaten is unsuitable for detecting the risk for aspiration. An alteration in circulation as evidenced by a change in skin color can be a late indicator of aspiration. Thus, a change in skin color can indicate the presence of aspiration, but an older adult with a change in skin color is not necessarily at risk for aspiration. The nurse monitors for tachypnea as an indicator of aspiration; however, tachypnea does not indicate a risk for aspiration. PTS: 1 DIF: Apply REF: p. 136-137 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 6. The nursing home staff needs assistance to feed properly the residents who need assistance with feeding. Which of the following should the nurse implement to ensure that the residents are properly fed? a. Instruct the feeding assistants to feed four people at a time. b. Draw on the availability of family members who are able to follow instructions. c. Ask some residents to self-feed for part of the mealtime. d. Assign a small group of nursing assistants to do the feeding. ANS: B With adequate training and cooperation, the nurse allows family members to feed residents who need assistance with feeding. While the family is assisting with feeding, the nurse supervises the feeding, offers feedback to family members, if necessary, and evaluates the outcome. The nurse avoids assigning more than three residents to each assistant for feeding; four residents are too many to assist safely. If a resident needs assistance with feeding, then attempting to self-feed can be dangerous, humiliating, and frustrating for a resident. If a small group of assistants performs all of the feeding, then the residents will potentially have to wait for long periods before being fed. Because the time required to implement feeding assistance is 38 minutes, a lengthy delay can result in adverse effects or injury for the resident and increase the risk of errors for the assistants, leading to frustration with the residents. PTS: 1 DIF: Apply REF: p. 137 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 7. A nurse is educating a patient who has been recently diagnosed with osteoporosis on foods high in calcium. The nurse should include which food choice? a. Okra b. Plain yogurt c. Turnip greens d. Whole wheat bread ANS: B Plain yogurt has 452 mg of calcium per 8 oz. Okra has 30 mg of calcium per serving. Turnip greens have 14 mg of calcium per serving. Whole wheat bread has 26 mg of calcium per serving. PTS: 1 DIF: Apply REF: p. 133 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 8. What is the recommended daily intake of fiber for older adults? a. 10 g b. 25 g c. 30 g d. 50 g ANS: B A daily intake of 25 g of fiber is recommended along with adequate amounts of water. PTS: 1 DIF: Remember REF: p. 132 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 9. A nurse is caring for an older client in the community who has a diagnosis of advanced dementia. The client’s caregiver reports that over time, the patient has progressively decreased her oral intake and at present is not swallowing the food put in her mouth. The patient’s caregiver reports that the primary care provider has contacted her and asked her to consider placement of a feeding tube. The caregiver asks the nurse what considerations they should be thinking about in making the decision. The nurse responds based on the knowledge that a. there are significantly better outcomes in older patients with dementia who have feeding tubes. b. careful hand feeding for patients with advanced dementia is recommended instead of feeding tubes. c. there are fewer infections in older patients with dementia who have feeding tubes. d. feeding tubes are relatively low risk in older patients with dementia. ANS: B The American Geriatrics Society recommends careful hand feeding for patients with advanced dementia rather than feeding tube placement. Research demonstrates that there are no better outcomes for patients who have feeding tubes. Feeding tubes are high risk and problem prone particularly in older patients with dementia. PTS: 1 DIF: Understand REF: p. 137-138 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 10. A nurse administers the Mini Nutritional Assessment (MNA) to an older patient. The patient is assessed to have a score of 11. The nurse understands which of the following? a. The next step is for the nurse to administer the assessment section of the tool. b. No further action is required at this time. c. Artificial nutrition should be considered. d. The patient is at very high risk of nutritional deficit and needs immediate referral to a dietitian. ANS: A A score of 12 or less on the MNA indicates that the patient is at nutritional risk and the next action is to complete the assessment portion of the tool. PTS: 1 DIF: Apply REF: p. 139 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 11. A nurse assesses an older woman in an outpatient setting. The patient’s height is measured at 5’1” and her weight is recorded as 100 lb. The patient is surprised by her weight and says to the nurse, “I think I lost some weight since last month.” The nurse checks the medical record, and 1 month ago, the patient’s weight was 106 lb. The next action by the nurse is a. continue to monitor the patient’s weight on a monthly basis. b. do a thorough assessment of the patient; this is a significant weight loss and of concern. c. suggest that the patient begin to take in between meal supplements. d. recommend that the patient have several small meals instead of three large meals daily. ANS: B Five percent or more of body weight loss is significant and a reason for concern. A thorough assessment is warranted. The assessment needs to be completed before a plan of care being developed. Weight loss of this magnitude in an older adult requires action as opposed to waiting and monitoring for another month. PTS: 1 DIF: Analyze REF: p. 140 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 12. A nurse is assessing an older adult’s nutritional status. The nurse understands that which of the following is the most important indicator for a potential nutritional deficit? a. Decreased serum albumin levels b. Decreased vitamin D levels c. Unintentional weight loss d. Anorexia lasting more than 24 hours ANS: C Unintentional weight loss is the most important indicator of nutritional deficit. The relevance of serum albumin levels as a marker of malnutrition is limited. Vitamin D levels are not considered indicators of malnutrition. There are many possible causes for anorexia, hence it is not a marker of malnutrition. PTS: 1 DIF: Understand REF: p. 140 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 13. A resident’s family member is concerned that the resident is not eating adequately and is at risk for malnutrition. The family member says to a nurse, “I heard that there are drugs that can make my mother eat better. Do you think she should be on one?” The best response by the nurse is: a. “Yes, there are some very effective drugs out there. Your mother should be on one of them.” b. “Use of drugs results in minimal improvement in appetite and weight gain and can have some serious side effects.” c. “There are no drugs that impact appetite or weight gain.” d. “These drugs are not permitted to be used in a long-term care facility.” ANS: B Drugs to stimulate appetite and weight gain have demonstrated minimal improvement and can have serious side effects. NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Chapter 11: Hydration and Oral Care Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about dental health in older adults? a. Most people can expect to lose most of their teeth by old age. b. Excessive saliva production is a common problem among older adults. c. Dentures should be cleaned once a day by brushing and soaking in a cleaning solution. d. A little blood on the toothbrush is normal. ANS: C Careful cleaning of dentures is necessary to prevent the buildup of residues that contribute to staining and odor, as well as to infection. Older adults can lose teeth, but more adults are retaining their teeth into older age. Tooth loss is most often a result of periodontal disease. Inadequate saliva production (xerostomia) is a common problem for older persons. Bleeding gums is a sign of periodontal disease. PTS: 1 DIF: Understand REF: p. 150 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 2. An older adult with a gastrostomy tube has difficulty using the dominant hand. Which of the following should the nurse provide to prevent complications of the gastrostomy tube? a. Use foam swabs to brush the teeth. b. Provide oral care every 4 hours. c. Supply a soft tooth brush and floss. d. Position the patient at 90 degrees for tube feedings. ANS: B The nurse provides oral care every 4 hours and brushes the teeth after meals to decrease the microorganism count in the mouth of an older adult with a gastrostomy tube. Foam swabs are ineffective tools to remove plaque, regardless of the toothpaste. Because this older adult has difficulty with the dominant hand, providing oral care supplies can be a waste of time unless the nurse assists the older adult to maintain oral health with the supplies. The nurse positions the older adult at a 30- to 45-degree angle during tube feedings to facilitate gastric emptying. PTS: 1 DIF: Apply REF: p. 152 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 3. Which of the following is a true statement? a. Urine flow gradually decreases in older age. b. Older adults generally need less fluid than younger people because of their lower body water content. c. Urine-specific gravity and skin turgor can be used to diagnose dehydration in older adults and in younger people. d. Multiple physiological changes of aging place older adults at a greater risk of dehydration than middle-aged persons or children. NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: D The loss of water-containing tissues, the loss of concentrating power in the kidneys, and a decreased sense of thirst all increase an older person’s risk for dehydration. Urine flow does not diminish in old age. Specifically, it does not diminish in the presence of dehydration as it does in a younger patient. Lower body water content places an older patient at greater risk of dehydration, not a lower risk. These signs are less reliable in older age because of changes to the tissues. PTS: 1 DIF: Understand REF: p. 145 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 4. Which increases the risk for chronic dehydration in older adults? a. Overuse of diuretic agents b. Poor cognitive function c. Dry mucous membranes d. Fluid loss from vomiting ANS: B Poor cognitive functioning, depending on others for ambulation, living in a residential facility, and having four chronic illnesses are factors that increase the risk of chronic dehydration. An overuse of diuretic agents is more likely to cause acute dehydration. Dry mucous membranes are reliable indicators of chronic dehydration. Fluid loss from vomiting leads to acute dehydration. PTS: 1 DIF: Remember REF: p. 146 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 5. Which of the following is a true statement about fluid intake for older adults? a. Daily total volume should be 1500 to 2000 mL. b. Coffee is a suitable beverage for maintaining hydration. c. Caffeinated beverages are sometimes preferable to water. d. Total daily fluid intake should be approximately 10 mL per kg of body weight. ANS: A Daily total volume of fluid should be 1500 to 2000 mL. Caffeine increases urine production and therefore aggravates dehydration rather than relieving it. Total daily fluid intake should be 30 mL per kg of body weight, not 10 mL. PTS: 1 DIF: Understand REF: p. 145 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 6. The nurse notices that an older adult’s urine is greenish-brown. Which step should the nurse implement next? a. Increase oral fluid intake. b. Review laboratory reports. c. Evaluate the medication list. d. Determine fluid volume status. ANS: D NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM The nurse assesses the older adult’s fluid status to develop a suitable plan of care. The nurse selects the correct nursing interventions, depending on the cause of the problem. Increasing oral fluid intake is implemented after the nurse completes the fluid assessment, if the intervention is determined to be suitable. The nurse reviews pertinent laboratory data as part of the fluid assessment. The nurse evaluates the medication list as part of the fluid assessment to eliminate a medication as the cause of the dark urine. PTS: 1 DIF: Analyze REF: p. 147 TOP: Nursing Process: Implementation MSC: Physiological Integrity 7. An older woman asks a nurse, “You always seem to be telling me that I need to drink more water. How much water do I really need to drink?” The nurse bases her response on the knowledge that: a. older adults should consume at least 1000 mL of fluid per day. b. older adults should consume at least 1500 mL of fluid per day. c. older adults should consume at least 2000 mL of fluid per day. d. older adults should consume at least 2500 mL of fluid per day. ANS: B Older adults, with the exception of those who require a fluid restriction, should consume at least 1500 mL of fluid per day. PTS: 1 DIF: Remember REF: p. 145 TOP: Teaching and Learning MSC: Health Promotion and Maintenance 8. A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose of hypodermoclysis is a. to rehydrate an individual with severe dehydration. b. to quickly administer 4 to 5 L of fluid within a 24-hour period. c. to rehydrate an individual with mild to moderate dehydration. d. as a supplement to intravenous (IV) hydration to expedite rehydration. ANS: C HDC is an infusion of isotonic fluids into the subcutaneous space. It is an alternative to IV administration for individuals with mild-to-moderate dehydration. It cannot be used in individuals with severe dehydration or for any situation requiring more than 3 L over 24 hours. PTS: 1 DIF: Remember REF: p. 147 TOP: Teaching and Learning MSC: Health Promotion and Maintenance 9. Which of the following statements describing oral care for the older population is correct? a. Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods. b. Losing one’s teeth is considered a normal part of the aging process. c. Oral malignancies seldom occur in older adults, so oral examinations are of low priority. d. Preventative dental care is covered under Medicare. ANS: A NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Older adults often present atypically when dehydrated. Skin turgor over the sternum is not a reliable marker in older adults because of the loss of subcutaneous tissue with aging. Lower extremity weakness and sunken eyes may indicate dehydration. A high fever and cough can be associated with many other conditions and are not typically signs of dehydration. PTS: 1 DIF: Apply REF: p. 146 TOP: Teaching and Learning MSC: Health Promotion and Maintenance 4. Which of the following nursing interventions should be implemented to prevent dehydration in hospitalized older adults? (Select all that apply.) a. Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection b. Limiting duration of nothing by mouth (NPO) requirements for diagnostic tests and procedures c. Administering intravenous (IV) fluids to all hospitalized older adults d. Limiting the use of diuretic medications in hospitalized older adults e. Making sure that hospitalized patients have easy access to fluids ANS: A, B, E To prevent dehydration, it is essential to closely monitor hospitalized older adults. Any individual who develops fever, diarrhea, vomiting, or an infection should be monitoring closely by implementing intake and output records and providing additional fluids. NPO requirements for diagnostic tests and procedures should be as short as possible. It is not appropriate to administer IV fluids to all hospitalized older adults. IV fluids are administered when there is a clinical indication. It is not appropriate to limit the use of diuretics. Diuretics are an important treatment for many older patients. Hydration management involves acute and ongoing management of oral intake. Oral hydration is the first line of treatment for dehydration prevention. PTS: 1 DIF: Apply REF: p. 147 TOP: Teaching and Learning MSC: Health Promotion and Maintenance 5. An older adult complains of xerostomia. Which of the following interventions should the nurse implement for this patient? (Select all that apply.) a. Encourage the patient to brush and floss teeth regularly. b. Encourage the patient to have regular dental screenings. c. Provide antiseptic mouth wash (such as Listerine) for the patient. d. Encourage adequate intake of water. e. Provide saliva substitutes. ANS: A, B, D, E Individuals with xerostomia should have regular dental screenings and be encouraged to practice good oral hygiene. Adequate intake of water is important, as if avoidance of alcohol and caffeine. Saliva substitutes may be helpful. Antiseptic mouth washes usually contain alcohol, which can further dry the mouth. PTS: 1 DIF: Apply REF: p. 149 TOP: Teaching and Learning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 6. A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a care plan related to oral care. Which of the following should the nurse consider for this patient? (Select all that apply.) a. Oral care should be provided every 4 hours. b. Teeth should be brushed with a toothbrush after each tube feeding. c. Lemon glycerin swabs should be used in between feedings to keep the mouth moist. d. Foam swabs should be used in place of a toothbrush to clean the teeth after each tube feeding. e. Oral care should be provided only twice daily if the older adult is edentulous. ANS: A, B Tube feeding is associated with significant pathological contamination of the mouth, greater than in individuals who receive oral feeding. Oral care should be provided every 4 hours for patients with gastrostomy tubes and teeth should be brushed with a toothbrush after each feeding to decrease the risk of aspiration pneumonia. Lemon glycerin swabs should never be used for oral care because they dry and inhibit saliva production. Foam swabs do not remove plaque as well as tooth brushes. Oral care is required even if the individual is edentulous. PTS: 1 DIF: Apply REF: p. 152 TOP: Teaching and Learning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Chapter 12: Elimination Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about elimination in older adults? a. Defecation less than once each day is not necessarily constipation. b. Mineral oil is recommended as a laxative for older adults. c. Excessive sleep can be a symptom of constipation. d. Leaking liquid feces should be treated as diarrhea. ANS: A Constipation is present when fewer than three bowel movements occur per week or when the frequency decreases. Mineral oil and saline laxatives can be harmful. Fiber, fruit, and fluids are the first recommendations; stimulant laxatives such as senna and cascara can be used on a short-term basis. Altered cognitive status, increased agitation, and unexplained falls can be symptoms of constipation; these behaviors may be the only clinical symptom of constipation in cognitively impaired older persons. Excessive sleep has not been identified as a symptom. Liquid feces may be leaking around a fecal impaction, and antidiarrheal treatment can aggravate the impaction. PTS: 1 DIF: Remember REF: p. 164 TOP: Nursing Process: Assessment MSC: Physiological Integrity 2. Which action should be included in all bladder-retraining programs? a. Toileting at bedtime b. Using adult incontinence pads c. Toileting every hour d. Providing 1000 mL of fluids daily ANS: A Toileting at bedtime should be incorporated for all patients. This intervention decreases the amount of urine in the bladder during the night. Incontinence pads are not encouraged during the retraining process. Toileting is not automatically scheduled every hour but is based on the individual’s needs. The volume of scheduled fluid intake is also based on the individual’s needs. PTS: 1 DIF: Apply REF: p. 159 TOP: Nursing Process: Planning MSC: Physiological Integrity 3. The nurse understands that stress incontinence occurs a. with a urinary tract infection (UTI). b. because of emotional strain. c. as a result of increased intra-abdominal pressure. d. with a specific amount of urine in the bladder. ANS: C NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Dribbling, hesitancy, and a large residual urine volume characterize overflow incontinence. Both urge incontinence and stress incontinence are associated with a small residual urine volume. Functional incontinence is not associated with residual urine volume. PTS: 1 DIF: Remember REF: p. 157 TOP: Nursing Process: Assessment MSC: Physiological Integrity 10. The nurse wants to begin helping a resident who is overweight and has urinary incontinence with healthy bladder behavior skills. Which intervention should the nurse implement? a. Begin a low-calorie diet for weight management. b. Schedule voiding at 2- to 4-hour intervals. c. Instruct the resident to practice abdominal exercises. d. Reduce the time between an urge to void and voiding. ANS: B Healthy bladder behavior skills include scheduling voiding at 2- to 4-hour intervals for residents either independently or with prompting. Beginning a low-calorie diet can be a reasonable approach to urinary incontinence, but the nurse first applies low-cost behavioral techniques. Pelvic floor exercises will help control urinary incontinence. Bladder training involves increasing the time between the urge to void and voiding. PTS: 1 DIF: Apply REF: p. 158 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 11. An older woman tells the nurse practitioner that she fears her family will place her in a nursing home because she developed stress incontinence. Which recommendation should the nurse implement? a. Tell her to eliminate the use of caffeinated beverages. b. Coordinate a family conference with the older adult. c. Recommend exercises to strengthen the pelvic floor. d. Schedule voiding for every 2 hours around the clock. ANS: C The nurse practitioner recommends pelvic floor exercises to strengthen the pelvic floor and the muscles that surround the urethra, vagina, and rectum to decrease the incidence of stress incontinence. Stress incontinence is usually caused by weakened pelvic floor muscles; therefore, eliminating caffeinated beverages can be an ineffective treatment. Arranging a family conference is premature and potentially embarrassing for older adults. Many therapies are available to decrease this older adult’s incontinence. Scheduled voiding is recommended at 2- to 4-hour intervals during the day and at 4-hour intervals at night. PTS: 1 DIF: Apply REF: p. 159 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 12. A nurse visits an older woman in her home. The woman was recently discharged from a subacute rehabilitation facility where she went after a left hip open reduction and internal fixation. The patient ambulates steadily and slowly with a rolling walker. The patient reports that she has an “embarrassing problem” and states that she doesn’t always make it to the bathroom and often wets herself on the way. She attributes this to the fact that she moves slowly. The patient has no complaints of burning or pain on urination. The nurse suspects which type of urinary incontinence? NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM a. Stress b. Overflow c. Functional d. Urge ANS: C Functional incontinence is related to the inability to get to the bathroom because of mobility or environmental issues. This patient moves slower and therefore cannot get to the bathroom in time. PTS: 1 DIF: Apply REF: p. 157 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 13. An older woman presents to the geriatric clinic for a routine annual wellness visit. Upon assessment, the patient reports that she needs to wear a pad because she loses urine when she coughs and sneezes. She also reports that this happens when she picks up her 2-year-old grandson. The nurse suspects which type of urinary incontinence? a. Stress b. Overflow c. Functional d. Urge ANS: A Stress incontinence is defined as a loss of small amount of urine with activities that increase intra-abdominal pressure (e.g., coughing, sneezing, exercising, lifting, bending). PTS: 1 DIF: Apply REF: p. 157 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Long-term use of external catheters can lead to which complications? (Select all that apply.) a. Fungal skin infections b. Penile skin maceration c. Atrophy d. Edema e. Phimosis ANS: A, B, D, E Long-term use of external catheters can lead to fungal skin infections, penile skin maceration, edema, fissures, contact burns from urea, phimosis, UTIs, and septicemia. The catheter should be removed and replaced daily and the penis cleaned, dried, and aired to prevent irritation, maceration, and the development of pressure ulcers and skin breakdown. If the catheter is not sized appropriately and applied and monitored correctly, then strangulation of the penile shaft can occur. Atrophy has not been identified as a complication. PTS: 1 DIF: Remember REF: p. 162-163 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 2. Continuous indwelling catheter use is indicated for which conditions? (Select all that apply.) a. Urethral obstruction NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM b. Urinary retention c. Stress incontinence d. Severely impaired skin integrity e. Gait impairment ANS: A, B, D Continuous indwelling catheter use is indicated for those with urethral obstruction or urinary retention because these patients are unable to empty their bladders without this device. Stress incontinence is not a condition that warrants a continuous indwelling catheter. Continuous indwelling catheter use is indicated for patients with severely impaired skin integrity to decrease the risk of further deterioration of skin integrity. Immobility is not an evidence-based indication for an indwelling catheter. PTS: 1 DIF: Remember REF: p. 162 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 3. A nurse is conducting education on urinary incontinence at a senior center. The nurse is discussing lifestyle changes that are associated with an improvement in urinary incontinence. The nurse includes which of the following interventions? (Select all that apply.) a. Weight reduction b. Smoking cessation c. Increase in physical activity d. Fluid restriction e. Blood sugar control ANS: A, B, C Several lifestyle factors have been associated with an improvement in urinary incontinence. These include increased fluid intake, smoking cessation, bowel management, physical activity, and weight reduction. Fluid restriction is not an intervention associated with an improvement in urinary incontinence, nor is blood sugar control. PTS: 1 DIF: Remember REF: p. 161 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 4. An older adult with moderate dementia is seen in the geriatric clinic. As the nurse is evaluating the patient, the patient’s wife states that her husband has developed an increasing number of episodes of incontinence. She does not know what is precipitating the episodes and states, “Maybe he just doesn’t remember that he needs to urinate, or maybe it’s me; it takes me a while to walk him to the bathroom.” The nurse develops a plan of care for this patient and includes which of the following interventions to manage the incontinence? (Select all that apply.) a. Use of adult incontinence briefs b. Use of an external catheter c. Development of a toileting schedule d. Use of a commode close by to where the patient spends most of his time e. Bladder diary to be completed by the patient’s wife ANS: C, D, E NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: A Regular exercise can help increase the duration of sleep during the night. Adding a new medication to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Administering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of injury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hostility and combativeness. Excessive napping during the day may be contributing to the problem. PTS: 1 DIF: Apply REF: p. 180 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Exercises are prescribed for older adults as therapy to improve which one of the following qualities? a. Relative intensity b. Muscle strength c. Muscle retraining d. Body sculpting ANS: B Exercises that improve muscle strength are important for balance, strong bones, and metabolic processes. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle definition is a quality valued by bodybuilders, but it is not a therapeutic concern. PTS: 1 DIF: Remember REF: p. 180 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 5. During the night, an older woman complains to the nurse that she has not slept more than 2 hours since admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman’s sleep? a. Inquire about her sleep habits used at home. b. Suggest that she avoid napping during the day. c. Tell her that sleep is fragmented in older people. d. Offer a book to her or suggest watching a movie. ANS: A Hospitalization often disrupts normal sleeping patterns; therefore, reestablishing these patterns is the best first step to improving the quality of sleep in the hospital. Avoiding napping during the day is a reasonable approach to complaints of sleeplessness, but it may not be this woman’s problem. Sleep is increasingly fragmented in older adults; however, understanding that issue may or may not help this woman sleep for longer periods. A book or movie can help some people become drowsy, but becoming drowsy will not usually increase the quality or duration of sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep. PTS: 1 DIF: Apply REF: p. 173 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 6. What is the difference between rest and sleep? a. Sleep occurs with rest. b. Rest is an extension of sleep. c. Rest occurs only in brief periods. d. Sleep is restorative and recuperative. ANS: D Sleep provides an important survival tool to rest, restore, and rejuvenate the body. Rest occurs during sleep. Sleep is an extension of rest. Rest can occur in brief periods and in extended cycles during sleep. PTS: 1 DIF: Remember REF: p. 170 TOP: Nursing Process: Assessment MSC: Physiological Integrity 7. An older woman maintains an active lifestyle playing various games with friends. She reports to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this woman’s sleep? a. Recommend preparation for sleep. b. Suggest trying a cup of warm milk at bedtime. c. Inquire about her nightly sleep rituals. d. Propose volunteer work at a thrift shop. ANS: C The nurse completes an assessment of the woman’s sleeping habits and other pertinent information before planning care and implementing nursing interventions to individualize therapy. Preparing for sleep is a reasonable intervention to propose after completing an assessment. Sipping warm milk is also a reasonable intervention to suggest after completing an assessment. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment. PTS: 1 DIF: Apply REF: p. 173 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 8. The nurse completes an admission assessment on an older adult patient. The nurse identifies which factor that may contribute to sleep problems? a. Exposure to sunlight b. Polypharmacy c. Use of a sleep aid d. Decreased fluid intake ANS: B Polypharmacy contributes to sleep problems as a result of medication side effects and drug interactions. Decreased exposure to sunlight contributes to sleep problems. Sleep aids may assist with sleep issues. Decreased fluid intake may lead to dehydration, which may result in lethargy. PTS: 1 DIF: Understand REF: p. 173 TOP: Nursing Process: Planning MSC: Physiological Integrity NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 9. The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY) tool to plan an exercise program for a female resident who is in good health except that her height has decreased inch. Which exercise safety tip from EASY calls for the nurse to assess the resident before planning care? a. Do not exercise a red, warm, or swollen joint. b. Avoid stretches that cause you to bend at the waist. c. Evaluate your surroundings for outdoor exercising. d. Begin by warming up with low- to moderate-intensity exercises. ANS: B The nurse needs more information because the reason the resident’s height has decreased is not known. Therefore, to obtain the information, the nurse decides to complete a resident assessment before planning an exercise program. The shrinkage can be due to atrophy of intervertebral disks, compression fractures, or changes in the curvature of the spine, any of which can be aggravated by incorrectly exercising. With a complete assessment, however, the nurse can plan a suitable exercise program for the resident. Red, warm, swollen joints are usually caused by gout or rheumatoid arthritis; fortunately, the resident does not have these health problems. However, this is a good recommendation for anyone who exercises. Evaluating an individual’s surroundings when exercising does not alert the nurse who is considering an exercise plan for this resident; however, this is a good, general recommendation for anyone who exercises. Warming up with low- to moderate-intensity exercises is a good recommendation for anyone who exercises. PTS: 1 DIF: Apply REF: p. 179 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 10. A patient who reported “a problem sleeping” shows an understanding of good sleep hygiene when a. doing 10 pushups before bed to encourage a “pleasant tiredness.” b. seldom eating a bedtime snack. c. engaging in computer games as a prebed activity. d. limiting the afternoon nap to just 30 minutes. ANS: D Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while bedtime snack is acceptable if the food is light and so easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine. PTS: 1 DIF: Apply REF: p. 174 TOP: Teaching and Learning MSC: Health Promotion and Maintenance 11. When an older adult patient is diagnosed with restless leg syndrome (RLS), the nurse is confident that patient education on the condition’s contributing factors has been effective when the patient states: a. “A warm bath at night instead of in the morning is my new routine.” b. “Eating a banana at breakfast assures me the potassium I need.” c. “I’ve cut way back on my caffeinated coffee, teas, and sodas.” d. “I elevate my legs on a pillow to improve circulation.” ANS: C NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM MSC: Health Promotion and Maintenance 3. The nurse should encourage which of the following exercises to assist with balance for a patient who is at high risk for falls? (Select all that apply.) a. Tai Chi b. Use of resistance bands c. ROM activities d. Walking heel to toe ANS: A, D Tai Chi and walking heel to toe are considered balance exercises. The use of resistance bands is considered muscle strengthening, and ROM activities are considered stretching exercises. PTS: 1 DIF: Understand REF: p. 180 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 4. An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga b. Tai Chi c. Swimming d. Pilates e. Weight lifting ANS: A, B Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling. Swimming, Pilates, and weight lifting do not do this. PTS: 1 DIF: Remember REF: p. 180 TOP: Teaching and Learning MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Chapter 14: Promoting Healthy Skin Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is an important consideration about the skin of older adults? a. Generous amounts of soap should be used for cleansing. b. Sweat gland activity increases. c. Skin becomes more vulnerable to damage. d. Skin becomes darker in unexposed areas. ANS: C Thin skin–reduced sebaceous protection, vascular insufficiency, and longer periods in stationary positions promote skin damage for older adults. Because moisture is lost more rapidly from the skin of older adults, excessive use of soap tends to dehydrate the skin more severely than it does in younger people. Sweat gland activity does not increase in older age, but moisture is lost more rapidly because the skin is thinner and sebum secretion is reduced. Changes of skin color in areas exposed to the sun are of greater concern than those in unexposed areas. PTS: 1 DIF: Remember REF: p. 186 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 2. A dermatologist should promptly evaluate which one of the following skin lesions? a. Circumscribed, raised area resembling a blob of brown wax b. Multicolored raised lesion with a fuzzy border c. Bright red, glazed area with satellite lesions around it d. Brown spot on the skin with no raised area ANS: B A multicolored raised lesion with a fuzzy border must be promptly evaluated; this lesion is a malignant melanoma. A circumscribed, raised area resembling a blob of brown wax reflects seborrheic keratosis. A bright red, glazed area with satellite lesions around it is a Candida infection. A brown spot on the skin with no raised area, such as a freckle, is lentigo. PTS: 1 DIF: Understand REF: p. 191 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 3. An older patient complains of dry skin and asks for advice. Which advice should the nurse offer for improving dry skin? a. Add oil to the bath water to keep skin soft. b. Use tepid bath water. c. Move to a climate with lower humidity. d. Vigorously dry skin with a rough towel after bathing. ANS: B NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Tepid bath water minimizes moisture loss from skin. Oil added to the bathtub increases the risk of slipping and falling, which can result in a catastrophic injury. Oils should be applied directly to moist skin after bathing. Humidity should be maintained at approximately 60%; the person may not be able to move. Vigorous, rough towel drying increases skin irritation. PTS: 1 DIF: Apply REF: p. 186 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Which of the following is a true statement about impaired skin integrity? a. Stage III pressure ulcer cannot regress to stage II because the subcutaneous tissues regenerate. b. Stasis ulcer is another term for pressure ulcer. c. Muscle and fat cannot regenerate. d. Weight reduction is recommended to help prevent pressure ulcers. ANS: C Because subcutaneous tissues such as muscle and fat are not regenerated but simply replaced by granular tissue, the staging of pressure ulcers is never reversed. Stasis ulcers are the result of the leakage of blood from veins beneath the skin. Pressure ulcers are caused when perfusion to the tissue is impaired by external pressure that causes tissue injury and death. Sufficient nutrition is essential in maintaining skin integrity. PTS: 1 DIF: Remember REF: p. 195 TOP: Nursing Process: Evaluation MSC: Physiological Integrity 5. Which of the following is a true statement about skin care for older adults? a. A licensed practical nurse is qualified to care for the feet of a patient with diabetes. b. Onychomycosis is quickly eradicated with antifungal creams or powders. c. A ram’s-horn nail should be cut to give a smooth, rounded edge. d. Maintaining oral hydration may reduce the incidence of xerosis. ANS: D Oral hydration and lubrication decrease the incidence of xerosis. Only a registered nurse who has special training, a nurse practitioner, or a podiatrist should perform diabetic foot care. The treatment of onychomycosis is difficult because of the limited blood supply to the nails. Oral medications are expensive and toxic. A toenail should be cut flat across. Rounding can lead to ingrown toenails. PTS: 1 DIF: Remember REF: p. 186 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance 6. The nurse plans care to protect the skin covering an older adult’s greater trochanter. Which of the following interventions is the nurse’s priority when the older adult is positioned on the side? a. Implement a turning schedule. b. Place a cushion between the knees. c. Keep the skin clean and dry. d. Use the Sims’ position. ANS: A NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM The ABCD rule is used to assess potential cancerous lesions for asymmetry, border irregularity, color, and diameter. The Braden scale is used for predicting pressure ulcers. Wound staging is used during the assessment of pressure ulcers. The PUSH tool provides a detailed form that covers all aspects of an assessment. PTS: 1 DIF: Apply REF: p. 192 TOP: Nursing Process: Assessment MSC: Physiological Integrity 12. A nurse will be conducting an educational session on preventing skin cancer at a local senior citizen’s center. Which should the nurse include in the session? a. Squamous cell cancer may appear similar to a wart. b. Basal cell carcinoma is more common in women. c. Actinic keratosis begins as a pearly papule. d. Melanoma is characterized by rough, scaly patches. ANS: A Squamous cell lesion may appear like a wart and be hard with defined borders. Basal cell carcinoma is more prevalent in fair-skinned older men and begins as a pearly papule. A multicolored, raised lesion with asymmetrical borders characterizes melanoma. PTS: 1 DIF: Apply REF: p. 190 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 13. Which nursing intervention is most likely to prevent the creation of an environment conducive to fungal growth? a. Provide oral care with soft-bristled brush. b. Apply nystatin powder to reddened tissue. c. Use mild skin cleansing agents and blot dry. d. Apply gauze soaked with antifungal lotion. ANS: C Fungal infections are most likely to begin in moist, dark areas of the body such as under the breasts and at the perineum; thus, the nurse works to keep the skin of these areas, as well as all skin, clean and dry and to prevent tissue irritation from harsh drying. Providing oral care with a soft-bristled brush is ineffective therapy for preventing an oral Candida infection (thrush). Besides, thrush is usually an opportunistic infection caused by immunosuppression. Reddened tissue can be already infected; nonetheless, applying an antifungal agent is an indicated treatment for a fungal infection. Applying antifungal lotion and keeping an area moist can contribute to fungal overgrowth. PTS: 1 DIF: Understand REF: p. 189 TOP: Nursing Process: Assessment MSC: Physiological Integrity 14. An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, “How did I get something like this?” The best response by the nurse is: a. “Scabies is highly contagious and spreads easily through physical contact.” b. “Scabies is commonly seen in older adults due to normal age-related changes in the skin.” c. “Scabies is only seen in older adults who have multiple chronic illnesses.” NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM Chapter 15: Falls and Fall Risk Reduction Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which one of the following is a true statement about mobility and safety for older adults? a. Use of restraints on older patients helps prevent injuries from falls. b. Falls that do not cause physical injury are not significant. c. The Get Up and Go test provides a measure of a patient’s energy and initiative. d. Lowering the bed and fluorescent tapes are interventions to increase safety. ANS: D Adjusting the bed height to match the length of the resident’s lower leg and marking the path from the bed to the toilet with bright fluorescent tape are some of the many possible interventions to improve residents’ safety. Restraints have not been shown to increase safety and may contribute to morbidity and mortality. Even if a fall does not cause injury, it can contribute to the fear of falling, inhibiting activities of daily living. The Get Up and Go test, in which the person rises from a straight-backed chair, walks 10 feet, returns, and sits down, assesses balance and gait. PTS: 1 DIF: Understand REF: p. 210 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 2. Which of the following is a true statement about assistive devices to aid older adults with impaired mobility? a. A walker can be used when climbing stairs. b. Cane tips should be smooth. c. Older adults save money by adapting assistive devices from their friends. d. A cane is most useful for unilateral disabilities but not bilateral problems. ANS: D Canes can relieve stress on arthritic joints on one side. A walker can equally relieve pressure on joints on both sides. Cane tips should be flat on the bottom with a series of rings, not smooth. Older adults are tempted to save money by using assistive devices from nonmedical sources; however, regardless of the source of the assistive device, the device should be fitted to the older adult. An older adult should never try to adapt to the assistive device; an ill-fitted device can contribute to falls and injuries. Using a walker is contraindicated when climbing stairs. Improperly selected or improperly used assistive devices can be risk factors for falling. PTS: 1 DIF: Understand REF: p. 210 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use? a. Two full-length rails b. One -length rail c. No side rails d. Four -length rails NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM ANS: B The use of one -length rail is not considered a restraint; it can be used to assist the patient in getting in and out of bed. Two full-length rails and four -length rails would be considered a restraint. The use of no side rails is not considered a restraint; however, the use of one rail to maneuver in and out of bed may be most beneficial to the patient. PTS: 1 DIF: Apply REF: p. 212 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 4. After assessing an older man in his bed, the nurse determines that he is at high risk for falls. The nurse leaves the room to get a fall risk sign and returns to find him on the floor pleading for help. Which of the following was the most important intervention the nurse should have implemented to prevent this event? a. Call for someone to bring the sign. b. Show the older man how to use the call bell. c. Provide a urinal and drinking water. d. Instruct the patient to call for help. ANS: D The nurse accomplished the most important aspect of fall prevention with the assessment. However, in an attempt to communicate the fall risk to other staff members, the nurse failed to communicate properly to the patient about fall prevention before leaving the room. Calling for someone to bring the sign would have been a reasonable approach to communicating the risk of falls, but it does not take the place of directly instructing the patient about prevention. The needs of an older adult can contribute to the risk of falls as an individual leans and reaches for something; therefore, call bell instructions are a reasonable approach for preventing falls. However, before providing the call bell instructions, the nurse needed to tell him to call for help. A urinal and drinking water are common items that an older man needs, but reaching for them can contribute to falls. PTS: 1 DIF: Analyze REF: p. 204 TOP: Nursing Process: Evaluation MSC: Safe, Effective Care Environment 5. The nurse assesses the quality of which of the following patient characteristics when applying the Get Up and Go test from the Hendrich II Fall Risk Model? a. Stride b. Speed c. Balance d. Flexibility ANS: C Using the Get Up and Go test, the quality of the older adult’s movements is assessed. The nurse instructs the individual to rise from a chair, walk, and return to the chair and be seated. The stride is not specifically assessed in this test, although it is an aspect of gait and can be a factor in balance. The older adult’s speed is not assessed in this test. Flexibility is not specifically assessed in this test, although it can be an important factor in balance. PTS: 1 DIF: Understand REF: p. 205 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM c. Is not verbalizing d. Moves during sleep ANS: A Because this older adult has a potential cognitive impairment and is likely to self-report pain unreliably, the nurse uses additional clinical indicators to detect pain. Muscle rigidity and guarding are clinical indicators of pain for a postoperative older adult, regardless of a cognitive impairment. An individual experiencing pain is unlikely to have stable vital signs. Not verbalizing can indicate a sensory impairment and warrants further investigation by the nurse. Nonetheless, this older adult’s verbalizations are potentially unreliable indicators of pain. Older adults move normally during sleep to adjust their position in bed; moving during sleep is not an indicator of pain unless the movements are agitated or restless in nature. PTS: 1 DIF: Apply REF: p. 240 TOP: Nursing Process: Assessment MSC: Physiological Integrity 4. Which of the following statements is true about analgesic medications for older adults? a. Opioids are less effective in older patients than in younger patients. b. Stool softeners and laxatives should be used with opioids. c. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are generally harmless. d. The dose limit for acetaminophen is difficult to reach for older adults. ANS: B Opioids often cause constipation and necessitate bowel stimulation to prevent constipation. A bowel regimen should be instituted at the same time as opioid treatment. Because of changes in metabolism with aging, opioids have a greater and longer lasting analgesic effect in older patients. NSAIDs can cause gastrointestinal bleeding, kidney and liver damage, and drug interactions with potentially fatal results. The maximum daily dose of acetaminophen is 4000 mg, and the limit is lower for patients with kidney or liver failure and patients who use alcohol. A typical dose is two 500-mg (“extra-strength”) tablets. PTS: 1 DIF: Remember REF: p. 243 TOP: Nursing Process: Assessment MSC: Physiological Integrity 5. Each of the following is a pharmacologic intervention for pain except which one? a. Acupuncture treatments b. Adjuvant therapy c. Lidocaine patch d. Capsaicin ANS: A Acupuncture is a nonpharmacologic treatment that helps reduce the perception of pain. An adjuvant is a medication that has been developed for a different purpose but serves to alter the perception of pain, possibly in combination with a pain medication. Lidocaine patches are a pharmacologic treatment for pain relief. Capsaicin is a pharmacologic means of providing comfort and alleviating pain and distress. PTS: 1 DIF: Remember REF: p. 245 TOP: Nursing Process: Assessment MSC: Physiological Integrity NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 6. An older adult admitted for back surgery asks for opioid pain medication. The nurse knows the patient asks for pain medication 15 minutes before it is due. Which recommendation should the nurse implement? a. Validate the pain with other assessment data. b. Administer the pain medication as requested by the patient. c. Tell the patient that it is too soon for pain medication. d. Teach the patient alternative comfort measures. ANS: B The nurse should administer the opioid pain medication as requested because the patient is asking for the pain medication within the prescription’s time limit. Most institutions allow the nurse to administer opioid medications 15 to 30 minutes before the designated time on the prescription; therefore, the patient is not asking for the medication too early. In addition, the nurse has an obligation to the patient to administer the pain medication; not doing so violates the patient’s rights. The nurse can rely on the patient’s report to determine the need for pain medication. As long as the timing is suitable and the patient is stable, the nurse should administer the medication. The nurse should use assessment data to support withholding pain medication in the presence of oversedation or another assessment that would be potentially aggravated by administering the pain medication. The nurse violates the patient’s rights by stating that it is too soon for the medication and ignores the possibility that the patient’s pain is real. Although the nurse may believe the patient is not having pain and is exhibiting drug-seeking behavior, the nurse must administer the medication. The nurse must administer the pain medication as requested. When patients are experiencing pain, most often, it is not the optimal time to teach patients. However, when the patient’s pain is under control, the nurse should teach alternative comfort measures. Comfort measures can be used to enhance the therapeutic effect of the medication and breakthrough pain. PTS: 1 DIF: Apply REF: p. 244 TOP: Nursing Process: Implementation MSC: Physiological Integrity 7. The nurse administers an opioid analgesic to an older male postoperative patient in the surgical unit. Which is the most important intervention for the nurse to implement before leaving the patient’s room? a. Place all side rails up. b. Position the patient comfortably. c. Offer toileting and a sip of water. d. Instruct him to ask for help before getting up. ANS: D The most important intervention for fall and injury prevention is for the nurse to instruct the older adult to ask for help before getting up after receiving an opioid medication. This intervention is important because the medication can cause sedation and dizziness; therefore, the nurse instructs him to ask for help to prevent a fall or injury. Putting all side rails up is considered a restraint and may place the patient at risk for injury. Comfortable positioning is also a good supplemental intervention after administering pain medication. Offering toileting and hydration is a reasonable intervention to implement after administering pain medication, but it does not offer the same degree of safety as instructing the patient to call for help. PTS: 1 DIF: Analyze REF: p. 244 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank NURSINGTB.COM 8. The older adult is at a higher risk for acute psychological pain than a younger adult because older adults a. have many illnesses. b. possess fewer assets. c. experience more loss. d. live with impairments. ANS: C Older adults are at higher risk for acute psychological pain than younger adults because they experience more loss such as the pain occurring in early bereavement or in a major depressive episode. Older adults tend to have more illnesses than younger adults, and illness can trigger depression. The lack of assets of younger and older adults is unlikely to be related to acute psychological distress unless a sudden loss of a large asset is experienced. Older adults do not necessarily live with impairments. Furthermore, if impairment causes psychological distress, then the acute phase is likely to occur at the onset rather than in day-to-day activities. PTS: 1 DIF: Remember REF: p. 237 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 9. An older Hispanic man states that he is not having pain, but he had knee replacement surgery 2 days ago. Which is the best pain assessment tool as recommended by the Hartford Institute for Geriatric Nursing (HIGN) from “Try This” for the nurse to apply for this man? a. Numeric Rating Scale b. Verbal Descriptor Scale c. Iowa Pain Thermometer d. Faces Pain Scale–revised (FPS-R) ANS: D Hispanic men are less likely to report pain because their culture tells them to deny and withstand pain without complaining. The nurse uses the FPS-R to validate the patient’s report because the postoperative period in knee replacement surgery is very painful; this fact makes the nurse think that the patient is likely to have pain. The HIGN has data that support the claim that Hispanic and African American older adults prefer using the FPS-R for evaluating pain. The Numeric Rating Scale, the Verbal Descriptor Scale, and the Iowa Pain Thermometer are valid and reliable assessment tools, but older Hispanic adults prefer using the FPS-R. PTS: 1 DIF: Apply REF: p. 240 TOP: Nursing Process: Assessment MSC: Physiological Integrity 10. The nurse uses comfort measures to enhance an older adult’s pharmacologic pain management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adult’s pain level? a. Older adult’s self-report b. Older adult’s pain diary c. Faces Pain Scale–revised (FPS-R) d. Pain medication frequency ANS: B NURSINGTB.COM Ebersole and Hess' Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank