Nursing Care for Older Adults, Exams of Advanced Education

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Fundamentals of Nursing, Chapter 14

1. A nurse is performing a physical examination on an older-adult client in an assisted living facility. On completion of the examination, the nurse compares the results to findings expected for individuals in this age-group. An expected finding for this client is:
2. Increased tactile responsiveness
3. Increased sensitivity to visual glare
4. Increased hearing acuity for higher tones
5. Increased thoracic expansion during ventilation - Increased sensitivity to visual glare
6. A 70-year-old client asks the nurse to explain her hypertension as she is to have her blood pressure checked each shift. An appropriate response by the nurse as to why older clients often experience hypertension is because of:
7. Myocardial muscle damage
8. Reduction in physical activity
9. Ingestion of foods high in sodium
10. Accumulation of plaque on arterial walls - Accumulation of plaque on arterial walls
11. In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older client is true?
12. Delirium is usually easily distinguished from irreversible dementia.
13. Therapeutic drug intoxication is a common cause of senile dementia.
14. Reversible systemic disorders are often implicated as a cause of delirium.
15. Cognitive deterioration is an inevitable outcome of the human aging process. - Reversible systemic disorders are often implicated as a cause of delirium.
16. A client has been recently diagnosed with Alzheimer's disease. When teaching the family about the prognosis, the nurse must explain that:
17. Diet and exercise can slow the process considerably
18. Few clients live more than 3 years after the diagnosis
19. Many individuals can be cured if the diagnosis is made early

4. It usually progresses gradually with a deterioration of function - It usually progresses gradually with a deterioration of function
5. Which of the following statements accurately reflects data that the nurse should use in planning care to meet the needs of the older adult?
6. 50% of older adults have two chronic health problems.
7. Cancer is the most common cause of death among older adults.
8. Nutritional needs for both younger and older adults are essentially the same.
9. Adults older than 65 comprise the greatest users of prescription medications. - Adults older than 65 comprise the greatest users of prescription medications.
10. The nurse is aware that the majority of older adults:
11. Live alone
12. Live in institutional settings
13. Are unable to care for themselves
14. Are actively involved in their community - Are actively involved in their community
15. The nurse works with elderly clients in a wellness screening clinic on a weekly basis. Which of the following statements made by the nurse is the most therapeutic regarding their mobility?
16. "Your shoulder pain is normal for your age."
17. "Continue to exercise your joints regularly to your tolerance level."
18. "Why don't you begin walking 3 to 4 miles a day, and we'll evaluate how you feel next week."
19. "Don't worry about taking that combination of medications since your doctor has prescribed them." - "Continue to exercise your joints regularly to your tolerance level."
20. A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying:
21. "Don't worry about the medication's name if you can identify it by its color and shape."
22. "Unless you have severe side affects, don't worry about the minor changes in the way you feel."
23. "Feel free to ask your physician why you are receiving the medications that are prescribed for you."

4. "Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medications." - "Feel free to ask your physician why you are receiving the medications that are prescribed for you."
5. Which of the following behaviors shows the greatest risk to an older adult as they attempt to minimize the effects of the aging process?
6. Increased cosmetic use
7. Refusing to share their actual ages
8. Spending less time with age-related peers
9. Refusing assistance with certain activities - Refusing assistance with certain activities
10. In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging?
11. Increased perspiration
12. Increased airway resistance
13. Increased salivary secretions
14. Increased pitch discrimination - Increased airway resistance
15. There are factors that influence the musculoskeletal system associated with aging. The nurse recognizes that with age:
16. Men have the greatest incidence of osteoporosis
17. Muscle fibers increase in size and become tighter
18. Weight-bearing exercise reduces the loss of bone mass
19. Muscle strength does not diminish as much as muscle mass - Weight-bearing exercise reduces the loss of bone mass
20. The nurse, preparing to discharge an 81-year-old client from the hospital, recognizes that the majority of older adults:
21. Require institutional care
22. Have no social or family support
23. Are unable to afford any medical treatment

4. Are capable of taking charge of their own lives - Are capable of taking charge of their own lives
5. To assist older adults to meet their needs for sexuality, the nurse should recognize that the greatest impact on the sexuality of older adults is:
6. Therapeutic medications may alter sexual function
7. Sexual interest declines and then fades completely with age
8. Physiological changes do not adversely influence sexual activity
9. Prevention of sexually transmitted diseases is no longer an issue - Therapeutic medications may alter sexual function
10. The nurse is presenting an information session on nutritional guidelines at a senior living center. Incorporated into the discussion are the recommendations for nutritional intake for individuals of this age-group, which include a reduction in:
11. Fiber
12. Protein
13. Vitamin A
14. Refined sugars - Refined sugars
15. The nurse is presenting an information session on nutritional guidelines at a senior living center. Which of the following foods meets the recommended nutritional guidelines for older adults?
16. Grilled chicken
17. Hamburger and french fries
18. Hot dog with dill pickle relish
19. Baked potato with cheese and bacon bits - Grilled chicken
20. In the assessment of older-adult clients, it is often difficult to discriminate between delirium and dementia. Delirium is characterized by:
21. A slow progression
22. Lasting months to years
23. A normal state of alertness
24. Occurrences at twilight or darkness - Occurrences at twilight or darkness

17. Which of the following nursing questions is best directed towards the assessment of a normal finding regarding physiological changes in an older-adult client?
18. "Any difficulty driving at night?"
19. "Are you experiencing any loss of libido?"
20. "Do you see yourself as becoming forgetful"
21. "Have you had your cholesterol tested lately?" - "Any difficulty driving at night?"
22. Which of the following responses by an older-adult client is most reflective of a need for further education by the nurse regarding the physiological changes associated with the older adult?
23. "I call a cab if I want to go out after dark."
24. "I can't help worrying about becoming forgetful."
25. "I have my eyes checked regularly. Can't afford to fall."
26. "I really enjoy eating good vanilla ice cream, but I have cut way down." - "I can't help worrying about becoming forgetful."
27. Which of the following statements made by a family member of a client recently diagnosed with Alzheimer's disease is most reflective of an understanding of this disease process?
28. "Dad has always been a fighter; he'll fight this too. He won't give up."
29. "We have an appointment with his care provider to see about medication therapy."
30. "Good thing we found out about this early so steps can be taken to keep it from getting worse."
31. "It usually progresses gradually so we are hoping it will be a while before his memory is gone." - "We have an appointment with his care provider to see about medication therapy."
32. The nurse is planning client education for an older adult being prepared for discharge home after hospitalization for a cardiac problem. Which nursing action addresses the most commonly determined need for this age-group?
33. Suggest that he purchase an emergency in-home alert system.
34. Arrange for the client to receive meals delivered to his home daily.
35. Encourage the client to use a compartmentalized pill storage container for his daily medications.
36. Provide a written document describing the medications the client is currently prescribed. - Encourage the client to use a compartmentalized pill storage container for his daily medications.

21. An assisted living facility has provided its clients with an educational program on safe administration of prescribed medications. Which statement made by an older-adult client reflects the best understanding of safe self-administration of medications?
22. "I don't seem to have problems with side effects, but I'll let my doctor know if something happens."
23. "I'm lucky since my daughter is really good about keeping up with my medications."
24. "I'll be sure to read the inserts and ask the pharmacist if I don't understand something."
25. "It shouldn't be too hard to keep it straight since I don't have any really serious health issues." - "I'll be sure to read the inserts and ask the pharmacist if I don't understand something."
26. Which of the following client statements regarding self-medication administration by an older-adult client requires follow-up teaching by the nurse?
27. "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them."
28. "I have one pill that needs cut in half. I am going to ask the pharmacist to do that for me."
29. "The pharmacist said to keep my pills away from the sunlight, so I put them inside the kitchen cabinet."
30. "My daughter comes over each morning and puts my pills into a container that sorts them by the time they are due." - "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them."
31. Which of the following statements made by an older-adult client poses the greatest concern for the nurse conducting an assessment regarding the client's adjustment to the aging process?
32. "I use to enjoy dancing and jogging so much, but now I have arthritis in my knees so that it's hard to even walk."
33. "I've given my grandchildren money for college so they can live a better life than I had."
34. "Growing old certainly presents all sorts of challenges. I wish I knew then what I know now."
35. "As I age I've found its harder to do the things I love doing, but I guess it will all be over soon enough."

• "As I age I've found its harder to do the things I love doing, but I guess it will all be over soon enough."

24. Which of the following statements made by a 75-year-old client shows the best understanding of how the aging process affects the musculoskeletal system?
25. "I drink milk and eat cheese to get my calcium."
26. "I walk 1 mile everyday to strengthen my bones."

3. "I wear sensible shoes so I won't sprain an ankle."
4. "At my age I might never fully recover from a hip fracture." - "I walk 1 mile everyday to strengthen my bones."
5. Which statement made by an older adult would reflect the best understanding of the nutritional requirements of individuals at this developmental stage?
6. "An apple a day is my motto; always has been."
7. "I eat everything, but just a little a bit of things like sweets."
8. "Fiber is more important than ever to my digestive system."
9. "I don't need the fat so I've taken to drinking protein shakes." - "I eat everything, but just a little a bit of things like sweets."
10. Which statement made by an older adult would reflect the best understanding of the nutritional guidelines for this age-group?
11. "I can prepare grilled chicken at least 10 different, delicious ways."
12. "When I entertain, I serve healthy foods like veggies and low-fat dip."
13. "I know I need to eat nutritiously, and I have certainly been doing better."
14. "I take seriously the suggestions my health team gives me on healthy eating." - "When I entertain, I serve healthy foods like veggies and low-fat dip."
15. Which of the following statements made by an older adult regarding sexuality would be of greatest concern for the nurse?
16. "Will this new medication affect my libido?"
17. "What can I do to help with vaginal dryness?"
18. "I really miss the intimacy my husband and I shared."
19. "It's so nice not to have to worry about an unwanted pregnancy." - "It's so nice not to have to worry about an unwanted pregnancy."
20. Of the following options, which is the greatest barrier to providing quality health care to the older- adult client?
21. Poor client compliance resulting from generalized diminished capacity
22. Inadequate health insurance coverage for the group as a whole

3. Insufficient research to provide a basis for effective geriatric health care
4. Preconceived assumptions regarding the lifestyles and attitudes of this group - Preconceived assumptions regarding the lifestyles and attitudes of this group
5. The nurse is preparing an educational program for members of the local senior center. Which of the following topics would present the greatest learning challenge for this developmental group?
6. Exercising arthritic joints
7. Tips for living with GERD
8. Importance of the human touch
9. Principles of heart-healthy eating - Importance of the human touch
10. When presenting information to the older adult, the client will be most likely to engage with the nurse in the learning process if:
11. Client feedback is encouraged and valued
12. Physical disabilities are accommodated for
13. The topic or information is valued by the learner
14. New knowledge is connected to knowledge already processed - The topic or information is valued by the learner
15. Of the following client statements made by an older adult client which best reflects an understanding the educational materials on nutrition presented by the nurse?
16. "I'll keep this literature and read it again later."
17. "I love rye bread. It's good to know its high in fiber."
18. "Nutrition and cooking has always been passions of mine."
19. "Now I can see the connection between food and my health." - "I love rye bread. It's good to know its high in fiber."
20. The nurse defines ageism most accurately as:
21. The undervaluing of individuals based on their age.
22. Perception of a person's worth based on productivity
23. Biases directed towards individuals considered aged

4. Discrimination based on an individual's increasing age - Discrimination based on an individual's increasing age
5. Which of the following statements made by a nurse best reflects an understanding of the negative impact of ageism regarding client care?
6. "If I don't value the older client, I will never be able to provide the care they are entitled too."
7. "Everyone, regardless of age or position, always deserves effective, appropriate nursing care."
8. "As a society we lose so much valuable wisdom and knowledge when we devalue our older members."
9. "If older clients do not feel valued, they are less likely to seek the health care they need and deserve."

• "If I don't value the older client, I will never be able to provide the care they are entitled too."

34. Which of the following statements made by a nurse best reflects an understanding of the adaptation required of nursing to assure quality nursing care for the older adult client?
35. "Remember to ask the client when she prefers to have her bath."
36. "I hope that I am that alert and interested in life when I'm her age."
37. "My client is in her 90s, so I don't expect her to respond to the therapy like a 50-year-old does."
38. "I just finished reading a great article on caring for the client newly diagnosed with Alzheimer's disease." - "My client is in her 90s, so I don't expect her to respond to the therapy like a 50-year-old does."
39. Which of the following statements made by an older adult client best reflects a healthy adjustment to the aging process and its physical limitations?
40. "I use to run in marathons, but now I truly enjoy a 1 mile walk around the park."
41. "I see friends my age just rocking on the porch. Not me; I want to stay physically active."
42. "When I can't get around like I do now, I'll watch TV and catch up on my favorite programs."
43. "I'll miss working in my garden when the arthritis gets bad, but I'll find something else to keep me busy." - "I use to run in marathons, but now I truly enjoy a 1 mile walk around the park."
44. Which of the following statements, made by the daughter of an older adult client concerning bring her mother home to live with her family, presents the greatest concern for the nurse?
45. "If this doesn't work out, she can always go to live with my sister."

2. "I don't think she will react very well to me making decisions for her."
3. "I'm afraid that mom will be depressed and really miss her home terribly."
4. "My children will just have to adjust to having their grandmother with us." - "I don't think she will react very well to me making decisions for her."
5. A nurse is caring for an older adult client preparing for discharge to a nursing center after having hip surgery. Which of the following nursing responses is most therapeutic when dealing with the client's concern that she, "will never go back home"?
6. "What makes you think that this transfer to the nursing center will be permanent?"
7. "The reason for this transfer is only to support you while you continue to recuperate."
8. "The decision to stay in the nursing center is yours to make. When you want to leave no one will stop you."
9. "The nursing center is a lovely place with a wonderful staff of caring people. Just give it a chance. You may like it." - "What makes you think that this transfer to the nursing center will be permanent?"
10. A nurse caring for older adults in an assistive living facility recognizes that a client's quality of life needs are best determined by:
11. Excellent physical, social, and emotional nursing assessments
12. A working knowledge of this age-group's developmental needs
13. A therapeutic nurse-client relationship that facilitates communication
14. The client's ever-changing physical, emotional, and cognitive abilities - A therapeutic nurse-client relationship that facilitates communication
15. A nurse is preparing to perform an assessment on an older adult client newly admitted to a nursing center. Which of the following statements made by the nurse best reflects the unique needs of this client regarding the assessment process?
16. "I will be back after you are settled in and we can devote enough time to this assessment process."
17. "We will need to move you to the examination room so that you will be comfortable during the assessment."
18. "I have to perform an assessment as part of the admission process, is this a good time for you to help me with it?"

4. "Since this move has been both physical and emotionally stressful, I will make this assessment as concise and brief as possible." - "I will be back after you are settled in and we can devote enough time to this assessment process."
5. The nurse is preparing to present an educational program to residences of an assisted-living facility. Which teaching strategies would be most appropriate for the learning needs of this age-group? (Select all that apply.)
6. Speak in a slow but well-articulated manner.
7. Present a variety of ideas so as to have broad appeal.
8. Speak in soft, low voice so as to help the audience focus.
9. Small groups allow for more speaker-listener interaction.
10. End the program if there are signs of poor concentration or fatigue.
11. Present the material in a fast-paced manner to keep hold their attention. - 1. Speak in a slow but well- articulated manner.
12. Small groups allow for more speaker-listener interaction.
13. End the program if there are signs of poor concentration or fatigue.