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A nurse monitors for depression in the older adult population. Which of the following are a risk factor and a functional consequence of depression in the older adult? (Select all that apply.) A) Chronic pain B) Functional impairment C) Hypernatremia D) Nutritional deficiencies E) Renal impairment Ans: A, B, D Which of the following statements by residents of a nursing home should prompt a nurse to assess for depression? A) "Lately I wake up for the day at 4:00 or 5:00 in the morning and can't fall asleep again." B) "I've got these cravings for sugary and salty snacks more than I used to." C) "I've never been too prone to headaches, but these days I always seem to have one." D) "I don't know why this sore on my ankle just won't heal this time." Ans: A An older adult started an antidepressant 1 week ago. The client states, "I don't want to take that pill, it's not doing anything." Which of the following responses by the nurse is most appropriate? A) "That is fine, it is your right to refuse medications." B) "It is too soon to see effects; positive effects may begin around 3 weeks." C) "Let's notify the primary health care provider to try another type of medication." D) "What side effects are you having?" Ans: B A nurse plans activities each month at an assisted living facility. Which of the following

activities is most cognitively stimulating? A)

Book discussions B) Movie night C) Exercise D) Reminiscence therapy Ans: A A nurse in an assisted living facility develops interventions that focus on improving cognitive abilities in the residents. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A) Book club B) Calisthenics C) Christmas caroling D) Letter writing E) Reminiscence therapy F) Shopping trip Ans: A, D A 75-year-old woman who often used to go out to dinner with her friends has stopped from going out because she has been experiencing urinary incontinence and is afraid of having an "accident" in public. When her child asks her why she doesn't go out with her friends anymore, she says, "I'm getting too old for such foolishness." How can the nurse best assist this client? A) Assist the client to view this functional limitation as temporary and treatable. B) Encourage the client to accept this consequence of growing old. C) Rephrase the situation to one of control, and allow the client to make the decisions. D) Teach the client that majority of older adults rate their health as good to excellent. Ans: A A resident of a nursing home has accused several members of the care staff of stealing jewelry from the overbed table despite the fact that the facility's policy requires residents

to keep such valuables in a lock box. The nurse has responded empathically to the accusations and has explained why this is impossible, to no avail. Which of the following conditions is the client experiencing? A) Delusions B) Hallucinations C) Unresolved anger D) Illusions Ans: A

A nurse assesses an older adult's insight regarding the care plan. What question may the nurse ask to gauge the client's insight? A) "Where would you go if you were discharged from the hospital today?" B) "How would you spend $100 if you were given it today?" C) "What are the similarities between a doctor and a nurse?" D) "Why do you think that your doctor admitted you to the hospital?" Ans: D A nurse assesses an older adult using a mini-mental status examination. The client is very slow to respond to the questions. Which of the following conditions may be present and will require follow-up by the nurse? (Select all that apply.) A) Lack of education B) Dementia C) Depression D) Confabulation E) Concrete thinking Ans: B, C A nurse differentiates between dementia and depression in an older adult. Which of the following assessment findings leads the nurse to believe that the client has depression?

A)

The client has socially unacceptable behaviors. B) The client is negativistic. C) The client's mood fluctuates. D) The client's mood is distractible. Ans: B An older adult has developed hallucinations. For which of the following should the nurse assess? (Select all that apply.) A) Digoxin toxicity B) Hyperglycemia C) Infection D) Myocardial infarction E) Stroke Ans: A, C, E

A nurse has observed an increasing number of older Asian Americans in the hospital. Which of the following statements regarding Asian cultures will best assist the nurse to plan nursing care? A) Asian Americans as a group have lower mortality rates. B) Health is often viewed as a state of physical and spiritual harmony. C) Older Asian Americans are more likely than other Americans to live alone. D) Care of elders is commonly provided in institutional environments such as nursing homes. Ans: B The child of an 81-year-old client asks the nurse about vitamins, antioxidants, and age- related macular degeneration. Which of the following theories of aging is most appropriate to this topic? A)

Free radicals theory B) Immunosenescence theory C) Program theory D) Wear-and-tear theory Ans: A

Which of the following characteristics of older adults is explained by the subculture theory? A) Older adults have little control over the biologic effects of the aging process. B) Older adults have a decreased need for social interaction and peer support as they become older. C) Older adults may see their status with their peers in terms of economic achievement. D) Older adults may interact much more with other older adults than with members of other age groups. Ans: D A 75-year-old woman who often used to go out to dinner with her friends has stopped going out because she has been experiencing urinary incontinence and is afraid of having an "accident" in public. When her child asks her why she doesn't go out with her friends anymore, she says, "I'm getting too old for such foolishness." Her child asks her to go to the doctor for an evaluation, but she refuses to do so. Which of the following is occurring with this older adult? A) She is experiencing learned helplessness and low self-efficacy. B) She sees incontinence as an inevitable consequence of aging. C) She views her incontinence as a negative functional consequence of aging. D) Her doctor is sympathetic; however, the woman and the doctor are unable to find a solution. Ans: B An older woman returns to her hospital room after abdominal surgery. As the nurse completes her assessment, the client asks the nurse to pin her "prayer cloth" to her pillow.

Which of the following interventions is priority? A) Say, "I will pin it on your pillow in a couple of hours after you are stable." B) Ask, "What is the purpose of a prayer cloth? Did you make it?" C) Ask, "What religion do you practice? Did your minister give the prayer cloth to you?" D) Pin the prayer cloth to her pillow since it is an essential part of her spiritual health. Ans: D A nurse manager develops policies to promote a sense of control for older adults in the assisted living facility. Which of the following policies should be included? A) Hold resident council meetings twice monthly and invite all residents to attend. B) Post a meal menu every Sunday and tell the residents that they must notify the kitchen in advance if they want a menu change. C) Design all the emergency pull cords so they blend in with the wallpaper and are inconspicuous. D) Teach the nurses' aides to use the passkey to do spot checks on every resident at least twice during the night to ensure that the residents are safe. Ans: A A 69-year-old woman is saddened by her recent diagnosis of type 2 diabetes, which is a stressor that will make numerous demands on her life in the coming years. Which of the following actions demonstrates a problem-focused approach to this stressor? A) Eliciting support and sympathy from her sister and neighbor B) Obtaining diabetic cookbooks and learning to change her cooking habits C) Seeking out a second opinion from another physician D) Deciding to make no lifestyle changes despite her new diagnosis Ans: B An older adult has impaired psychosocial functioning. Which of the following consequences should the nurse monitor? A) Anxiety

B)

Elevated blood glucose level C) Increased independence D) Resilience Ans: A A nurse leads a "Healthy Aging" class at a community health center. Which question should the nurse use to generate discussion among participants in this setting? A) "How did you adjust to your move from your house to the assisted living facility Irma?" B) "Are you satisfied with the care that you're getting from your family doctor, Elizabeth?" C) "Donald, could you tell us why your grandson is living with you?" D) "Have you had any tests done on your heart since we last met, Marie?" Ans: A A 75-year-old woman who often used to go out to dinner with her friends has stopped from going out because she has been experiencing urinary incontinence and is afraid of having an "accident" in public. When her child asks her why she doesn't go out with her friends anymore, she says, "I'm getting too old for such foolishness." How can the nurse best assist this client? A) Assist the client to view this functional limitation as temporary and treatable. B) Encourage the client to accept this consequence of growing old. C) Rephrase the situation to one of control, and allow the client to make the decisions. D) Teach the client that majority of older adults rate their health as good to excellent. Ans: A A nurse performs a psychosocial assessment of an older adult living in the community. Which of the following statements best captures the nature of psychosocial assessment? A) It is a formalized psychological test of the individual's condition and needs. B) It aids in identifying and analyzing personality traits of the individual. C) It helps to identify the individual's need for psychiatric care.

D)

It is a component of holistic nursing care of older adults. Ans: D While a nurse is performing a recently admitted hospital client's morning care, the client states, "I'm pretty sure I'll never see my own apartment again." Which of the following responses by the nurse best demonstrates effective communication? A) "What is it that makes you feel that way?" B) "“I'm sure that's not going to be the case." C) "All in all, you're doing quite fine." D) "There's a lot that we can do, dear, to make sure that you do." Ans: A A nurse addresses the social supports available for an older adult client. Which of the following should the nurse include in the plan? A) Ask the client direct questions about the barriers to the use of social supports. B) Decide which of the programs is the highest quality. C) Determine if family or friends could do the work. D) Provide the client information about services that are available. Ans: A A nurse is conducting a comprehensive psychosocial assessment of an older adult who has recently moved to the long-term care facility. How should the nurse best assess the client's motor function? A) Observe the client walking into or out of the room. B) Assess the client's deep tendon reflexes using a hammer. C) Perform passive range of motion exercises on the client's arms and legs. D) Position the client supine and ask the client to perform a leg lift with each leg separately. Ans: A

A resident of a nursing home has accused several members of the care staff of stealing jewelry from the overbed table despite the fact that the facility's policy requires residents to keep such valuables in a lock box. The nurse has responded empathically to the accusations and has explained why this is impossible, to no avail. Which of the following conditions is the client experiencing? A) Delusions B) Hallucinations C) Unresolved anger D) Illusions Ans: A A nurse assesses an older adult's insight regarding the care plan. What question may the nurse ask to gauge the client's insight? A) "Where would you go if you were discharged from the hospital today?" B) "How would you spend $100 if you were given it today?" C) "What are the similarities between a doctor and a nurse?" D) "Why do you think that your doctor admitted you to the hospital?" Ans: D A nurse assesses an older adult using a mini-mental status examination. The client is very slow to respond to the questions. Which of the following conditions may be present and will require follow-up by the nurse? (Select all that apply.) A) Lack of education B) Dementia C) Depression D) Confabulation E) Concrete thinking Ans: B, C An older adult has developed hallucinations. For which of the following should the nurse

assess? (Select all that apply.) A) Digoxin toxicity B) Hyperglycemia C) Infection D) Myocardial infarction E) Stroke Ans: A, C, E The proportion of health care consumers who are minorities continues to increase. A nurse is beginning a new job in an area with a large African American population. Which of the following statements will assist the nurse to understand this ethnic/race culture to better plan nursing care? (Select all that apply.) A) African Americans as a group have a wide range of socioeconomic conditions. B) Female-headed households are common among African Americans. C) Lifestyle and risk factors account for the health disparities with older African Americans. D) Older African Americans are more likely than other older Americans to live alone. E) Older African Americans are more likely to be caring for their grandchildren. Ans: A, B, E A nurse has observed an increasing number of older Asian Americans in the hospital. Which of the following statements regarding Asian cultures will best assist the nurse to plan nursing care? A) Asian Americans as a group have lower mortality rates. B) Health is often viewed as a state of physical and spiritual harmony. C) Older Asian Americans are more likely than other Americans to live alone. D) Care of elders is commonly provided in institutional environments such as nursing homes. Ans: B

A nurse has recently begun to provide care to older adults in a large, urban hospital. Having lived until recently in an ethnically homogeneous region, the nurse has begun to recognize the significant differences in priorities and perspectives of clients from other cultural groups and has taken action to learn about these groups. What stage of cultural self-assessment is this nurse demonstrating? A) Unconsciously incompetent B) Consciously incompetent C) Consciously competent D) Unconsciously competent Ans: B A clinic nurse assesses a client who has limited English-speaking ability. The child interprets for the client. Which action by the nurse is most appropriate? A) Obtain a professional interpreter. B) Talk directly to the interpreter. C) Teach the family member the appropriate medical terminology. D) Use the family member as a source for improving cultural competence. Ans: A A nurse is using the Functional Consequences Theory as a lens for planning client care in a health care facility. Which of the following is a key element of this nursing theory? A) Most problems affecting older adults may be attributed to age-related changes. B) Most functional consequences cannot be addressed through nursing interventions. C) Wellness is a concept that is broader than just physiologic functioning. D) The Functional Consequences Theory is an alternative to holistic nursing care. Ans: C A nurse plans interventions to promote wellness in older adults. Which of the following interventions is most appropriate to meet this goal?

A)

Talking with the physician about available treatment options for an older adult with an acute illness B) Facilitating early mobilization to prevent muscle wasting and loss of function in an older hospital client C) Deferring the final decision regarding an older adult's choice of assisted living facility to the person's son and daughter D) Placing a 76-year-old on the waitlist for a kidney transplant Ans: B A nurse in the long-term care facility plans care to improve quality of life. Which of the following actions is most likely to enhance the older adult's connectedness? A) Teaching a client who has had a below-the-knee amputation how to care for his stump B) Organizing a client's intravenous antibiotic therapy on an outpatient basis C) Performing a focused respiratory assessment on a client who has a diagnosis of lung cancer D) Advocating for a husband and wife to remain in the same room of a long-term care facility, as is their preference Ans: D An 89-year-old adult is dismayed that his primary care provider referred him for a driving evaluation because he experiences vision problems and slower reaction time. Which of the following concepts is illustrated in this example? A) Risk factors B) Age-related changes C) Positive functional consequences D) Wellness outcomes Ans: B An older adult reflects, "Why should I go to the gym, I'm going to get fat anyway." Which response by the nurse is most appropriate? A)

"Age-related changes are inevitable; however, most problems affecting older adults are related to risk factors, so it's important to do what you can to maintain a high level of functioning." B) "Older adults experience positive or negative functional consequences because of age- related changes." C) "Risk factors do impact consequences, but you can override them." D) "Many problems affecting older adults are based on genetics." Ans: A A 77-year-old client was put on broad-spectrum antibiotics when hospitalized for sepsis. The client has a history of rheumatoid arthritis and a recurring problem with pneumonia. Which of the following theories best explains why the client has had these issues? A) Free radical theory B) Genetic theory C) Immunity theory D) Wear-and-tear theory Ans: C Until recently, a 77-year-old client lived alone in her own home. The client fell and fractured an ankle and was placed in a long-term care facility for physical therapy. After the physical therapy was finished, the client tells the nurse, "I want to stay at the facility; I am happy living there and I like the social interaction." Which of the following theories of aging best describes the status of this client? A) Activity theory B) Feminist theory C) Life-course theory D) Theory of thriving Ans: D A 55-year-old client was recently diagnosed with type 2 diabetes. The client completed a diabetes education class and does water aerobics three times a week. The blood sugar and hemoglobin A1c have improved since losing 20 lb. Which of the following statements best

describes this client's actions? A) Activity theory B) Age stratification theory C) Functional consequences theory D) Life-course development theory Ans: C The child of an 81-year-old client asks the nurse about vitamins, antioxidants, and age- related macular degeneration. Which of the following theories of aging is most appropriate to this topic? A) Free radicals theory B) Immunosenescence theory C) Program theory D) Wear-and-tear theory Ans: A Which of the following characteristics of older adults is explained by the subculture theory? A) Older adults have little control over the biologic effects of the aging process. B) Older adults have a decreased need for social interaction and peer support as they become older. C) Older adults may see their status with their peers in terms of economic achievement. D) Older adults may interact much more with other older adults than with members of other age groups. Ans: D A healthy 65-year-old says, "I don't think I will live much past 70." The studies however show that this client should live to 84 years of age. Which of the following statements, by the nurse, summarizes the compression of morbidity for this client? A) "Let's work on extending your life expectancy."

B)

"The goal is to live better, not longer." C) "We should work on postponing chronic illnesses." D) "You are lucky that you are healthy." Ans: C Which of the following are examples of appropriate communication techniques for dealing effectively with people with dementia? A) Ask open-ended questions so the person feels he or she can make choices. B) For people in the later stages of Alzheimer disease, talk as you would to a child. C) Maintain good eye contact and use a relaxed and smiling approach. D) When the person forgets something, remind him or her not to forget next time. Ans: C An 80-year-old client was referred to a neurologist after several months of worsening cognitive deficits and has subsequently been diagnosed with Alzheimer disease. Which statement by the nurse to the client's family demonstrates appropriate use of terminology? A) "It's very difficult and stressful when a loved one becomes senile." B) "Even though your parent is demented, we will do all we can to promote his quality of life." C) "This form of organic brain syndrome is a common health problem in the ninth decade of life." D) "We always try our best to foster wellness in persons who have dementia." Ans: D A client was diagnosed 3 years ago with a cognitive impairment, a condition that worsened over the next several months and which culminated in his recent death. An autopsy revealed numerous infarcted brain regions resulting from vessel occlusions. This client most likely suffered from which type of dementia? A) Alzheimer disease B) Vascular dementia

C)

Lewy body dementia D) Frontotemporal degeneration Ans: B A long-time resident of an assisted living facility has just been diagnosed with Alzheimer disease. A nurse who provides care at the facility has remarked to a colleague, "It's a real shame, but at least she'll never know what's happening to her." What fact should underlie the colleague's response? A) Older adults with Alzheimer disease and other dementias rarely have insight into their cognitive deficits. B) Many persons with dementia are acutely aware of the fact that they are experiencing a cognitive deficit. C) Certain types of dementia are occasionally marked by older adults' awareness of their disease. D) An awareness of dementia is an indication that the condition is either latent or resolving. Ans: B A nursing home is in the planning stages of building a new wing that will be specifically designed for the needs of older adults who have dementia. What design characteristic should be included in this new facility? A) Monochromatic walls and floors that are a neutral color B) Pictures, signs, and color codes for identifying places C) Bright, glossy floors that can provide sensory stimulation D) Bright lighting during the day and total darkness at night Ans: B A nurse prepares to administer scheduled medications to a new resident with mild non- Alzheimer-type dementia. Which of the following type of medication should the nurse administer without concern of worsening delirium? A) An anticholinergic B) An atypical antipsychotic

C)

A benzodiazepine D) A cholinesterase inhibitor Ans: A A nurse monitors older adults in a long-term care facility. Which of the following symptoms would require follow-up by the nurse to assess for depression in the older adult? A) Anorexia B) Weakness C) Labile affect D) Impaired perceptions Ans: A A nurse monitors for depression in the older adult population. Which of the following are a risk factor and a functional consequence of depression in the older adult? (Select all that apply.) A) Chronic pain B) Functional impairment C) Hypernatremia D) Nutritional deficiencies E) Renal impairment Ans: A, B, D When risk factors to potential suicide have been identified, a nurse must further assess the actual risk for a suicide attempt. Which of the following questions would be appropriate for initial assessment to determine the presence or absence of suicidal thoughts in an older adult with risk factors? A) "Under what circumstances would you take your life? Have you ever started to act on a plan to harm yourself?" B) "Do you have a plan for taking your life? What action would you take if you were to

harm yourself?" C) "Does your life feel worthless? Do you ever think about escaping from your problems?" D) "Do you think about harming yourself? Do you ever think about committing suicide?" Ans: C A gerontological nurse conducts an assessment of an older adult who has a history of depression. Assessment reveals that the client has been drinking up to two bottles of wine each day for the last several months. What should the nurse teach the client about alcohol use and depression? A) "If you choose to use alcohol to address your depression, it's best to limit it to four to five drinks each day." B) "We recommend that everyone over the age of 70 abstain from drinking alcohol." C) "Alcohol has been shown to contribute to depression and vice versa." D) "If you quit drinking, your depression will likely improve." Ans: C An older adult has been accompanied by an adult child to visit a primary care provider. The child has expressed concern about the client's increasing apathy, isolation, and apparent sadness over the past several months; and the client acknowledges many of the symptoms of depression. Which of the following assessments should the nurse prioritize? A) Functional assessment B) Medication assessment C) Musculoskeletal assessment D) Cardiovascular assessment Ans: B Which of the following statements by residents of a nursing home should prompt a nurse to assess for depression? A) "Lately I wake up for the day at 4:00 or 5:00 in the morning and can't fall asleep again." B) "I've got these cravings for sugary and salty snacks more than I used to." C)

"I've never been too prone to headaches, but these days I always seem to have one." D) "I don't know why this sore on my ankle just won't heal this time." Ans: A A nurse on an acute care for elders (ACE) unit monitors clients for functional consequences of depression. Which of the following statements by a client is of highest priority for follow-up? A) "I can't shake this feeling that I've got a cloud hanging over me these days." B) "I feel like I've got no appetite these days and it takes everything in me just to eat a little meal." C) "I used to be a powerhouse of energy when I was younger, and now all I can do is sit in a chair." D) "I think it would be better for everyone if I wasn't here anymore." Ans: D An older adult was diagnosed with depression shortly after relocating to the nursing home 6 weeks ago. What intervention should the nurse implement to address the depression? A) Teach the client about the problem of suicide in older adults. B) Provide opportunities for the client to engage with other residents. C) Direct the client to list all the positive aspects of her present circumstances. D) Appoint another resident as a “buddy” to accompany the client during the day. Ans: B Which of the following clients is at highest risk for suicide? A) An 18-year-old who has made an appointment with his primary health care provider B) A 60-year-old with kidney stones C) A 75-year-old woman living with her child and grandchildren D) An 85-year-old man whose spouse died 1 year ago Ans:

D

A nurse recognizes that depression has functional consequences. Which of the following are functional consequences of late-life depression? (Select all that apply.) A) Decreased functioning B) Dementia C) Higher incidence of a stroke D) Higher level of pain E) Increased risk for suicide Ans: A, D, E A nurse teaches an older adult about the antidepressant medication recently prescribed. Which of the following should the nurse include in the teaching? (Select all that apply.) A) Antidepressants can interact with alcohol and over-the-counter medications. B) Depression is uncommon in the older adult population. C) Expect adverse effects of the medicine; stop medication if they occur. D) Don't expect immediate improvement; a fair trial may take up to 12 weeks. E) The medication is to be taken only as needed. Ans: A, D A nurse is leading a word-quiz game with a group of nursing home residents because the nurse knows this activity will assist the residents in maintaining: A) Fluid intelligence B) Adaptive thinking C) Crystallized intelligence D) Psychomotor memory Ans: C A 69-year-old has recently been diagnosed with mild cognitive impairment and has asked the nurse to help her remember things better. Which of the following nursing diagnoses is

appropriate for this older adult? A) Knowledge deficit B) Altered thought processes C) Health-seeking behaviors D) Altered health maintenance Ans: C Which of the following points should the nurse emphasize when educating older adults about memory and cognition? A) Long-term memory loss is normal. B) Using calendars, notes, and imagery can help enhance memory. C) Drinking caffeinated beverages for mental stimulation is a good idea. D) Having a diminished capacity for learning is an inevitable part of growing older. Ans: B An older adult is brought to the community clinic by an adult child with the concern of increasingly frequent lapses in memory. Which assessment question is most likely to identify potential risk factors for impaired cognitive functioning? A) "What did your mother and father die of?" B) "What line of work were you in?" C) "What medications are you currently taking?" D) "Where are you currently living?" Ans: C A nurse plans activities each month at an assisted living facility. Which of the following activities is most cognitively stimulating? A) Book discussions B) Movie night C)

Exercise D) Reminiscence therapy Ans: A A nurse in an assisted living facility develops interventions that focus on improving cognitive abilities in the residents. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A) Book club B) Calisthenics C) Christmas caroling D) Letter writing E) Reminiscence therapy F) Shopping trip Ans: A, D A nurse assesses an 82-year-old client who has a history of coronary artery bypass surgery and heart failure. In the interview, the family expresses concern because the client's "ability to figure out what is going on" has deteriorated. However, the client remains wise and continues to give solid life advice. Which theory explains this phenomenon? A) Crystallized intelligence declines with age. B) Cognitive skills of older adults are better than younger adults under some conditions. C) Mild cognitive impairment begins with cognitive dissidence. D) Cognitive abilities may be impaired by the client's cardiovascular disease. Ans: D A nurse determines that a client does not remember current events and has difficulty using technology. The nurse should consider that the client may have difficulty with which of the following? A) Participating in reminiscence group B) Digitally recording blood glucose monitor

C)

Remembering to weigh daily D) Understanding when to notify health care provider Ans: B