Nursing Care for Older Adults: Exam Questions and Answers, Exams of Gerontology

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When an older patient is hospitalized, Medicare reimburses for this inpatient care by which of the following mechanisms? A. Medicare B B. Medicare A C. Medicare D D. Medigap - - - correct answer ✅B. Medicare A Gerontological nurses are expected to evaluate research to implement evidence-based practice. Which of the following studies provides the strongest evidence to change practice? A. Randomized control clinical trial B. Qualitative phenomenological study C. In-depth case study D. Cohort study - - - correct answer ✅A. Randomized control clinical trial A randomized clinical trial is considered the "gold standard" and the highest level of research evidence. The randomized design eliminates selection bias, and the control and experimental groups provide evidence that any differences in outcomes at the end of the

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study are due to the study intervention and not chance. phenomenological qualitative study and a case study enable understanding of one person's "lived experience" which may or may not be typical of others. Outcomes from a cohort study may reflect differences in age groups found as a result of historical events and not necessarily changes as a result of research interventions The landmark Institute of Medicine (IOM) report entitled "The Future of Nursing" advances which of the following positions? A. Nursing faculty will be required to pursue postdoctoral training B. Nursing curriculum will require advanced aging content C. Physicians will no longer be allowed to direct care in long-term- care facilities D. Nurses should practice to the full extent of their education and training - - - correct answer ✅D. Nurses should practice to the full extent of their education and training Nurses should be full partners with other professionals when redesigning the healthcare system, nurses should achieve higher levels of education and have opportunities for seamless academic progression, and nurses should participate in effective workforce

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planning and policy-making with a better data collection and information infrastructure The biggest risk factor for developing a cognitive impairment is: A. socioeconomic status B. poor nutrition C. age D. female gender - - - correct answer ✅c. age Cognitive impairments become more common with advanced age across all categories of older people A 76 year old woman presents at an ambulatory clinic. About 2 weeks ago, she had difficulty finding words, felt weak, and noticed her right hand felt numb for several hours. Although she has recovered most of her function, she continues to have difficulty with her short-term memory. The most likely cause of these symptoms A. Alzheimer's disease B. organic delusional syndrome

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C. vascular dementia D. acute depressive syndrome - - - correct answer ✅C. vascular dementia Is associated with sudden acute events, such as transient ischemic attacks or small strokes. Clinically, older patients suffering from vascular events will have sudden-onset presentation of their symptoms rather than slow, insidious onset An 85-year-old woman with advanced cancer asks the nurse, "what is wrong with me? My doctor won't tell me anything. The chemotherapy is making me sick and if I knew it wasn't helping, I would stop taking it." The nurse decides to tell the patient the truth. Which ethical principle is the nurse upholding? A. Fidelity B. Autonomy C. Justice D. Nonmaleficence - - - correct answer ✅B. Autonomy By telling the patient the truth about the cancer diagnosis, the nurse is supporting autonomy by providing information that supports self-determination. Justice involves treating patients fairly,

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nonmaleficence involves doing no harm, and fidelity involves faithful performance of duties and obligation to meet the needs of patients Higher RN staffing levels in long-term-care settings are known to be associated with which of the following factors? A. lower costs to the facility B. higher fall rates C. lower rates of decubitus ulcers D. more medication use - - - correct answer ✅C. lower rates of decubitus ulcers Based on a study published by AARP, long-term-care facilities with higher RN staffing levels have higher quality indicators, including lower rates of decubitus ulcers, indwelling catheter use, and patient mortality The process of gerontological nursing certification by the American Nurses Credentialing Center is best described as a(n)

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A. formal process to validate clinical competence in a speciality area of practice B. formal process to obtain a nursing license C. informal process necessary for those considering graduate study D. requirement only for those working in a long-term care - - - correct answer ✅A. formal process to validate clinical competence in a speciality area of practice Certification is a voluntary process that occurs when a nurse passes an examination developed by experts in the field, assuring the public and other healthcare professionals that the nurse possesses knowledge of speciality content in a given area Mrs. Jones is a 78-year-old female with a history of severe degenerative arthritis of her lower back. She suffers from chronic pain much of time, rated between 4 and 6 on a 1-10 scale. She describes the pain as burning and tingling. Over the past few months, she has been on a variety of analgesics without much effect on her pain. Her current regimen includes tramadol 50 mg twice daily and gabapentin 300 mg at bedtime. She states that she sleeps well and that, for the most part, this regimen works better than previous ones that included hydrocodone. This scenario describes which of the following categories of pain?

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A. nociceptive B. neuropathic C. visceral D. unspecified - - - correct answer ✅B. neuropathic Mrs. Jones is a typical of the older client with chronic nonmalignant pain from inflammation of one or several spinal nerves. Her pain medication regimen include an anticonvulsant and a nonopiate analgesic An 80-year old man reports to his nurse that he is having trouble initiating the flow of urine, has to void every hour or so, and never feels his bladder is empty. The nurse realizes that these symptoms are most probably the result of which of the following conditions? A. Prostate cancer B. Neurological changes of aging C. Anemia D. benign prostatic hypertrophy - - - correct answer ✅D. benign prostatic hypertrophy

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although the urinary symptoms listed could possibly suggest prostate cancer, benign prostatic hypertrophy is very commonly seen in older men and s more likely to be the cause. Anemia and urologic changes are unlikely to contribute to the symptoms in this question Which virus is spread by the fecal-oral rout, is usually transmitted by contaminated food or water, and has no chronic form? A. Hep A B. Hep B C. Hep C D. Hep D - - - correct answer ✅A. Hep A Hepatitis A is a common viral hepatitis that has no chronic state. The options are viral hepatitides that have chronic states and are transmitted by blood and body fluids A 70-year-old man is admitted to the hospital following a visit to his physician's office. He says that he is recovering from the flu and feels very sick. Initial nursing assessment reveals that his BP is 90/60, temperature is 98, pulse is 108, and respirations are 20/min. His skin and mucous membranes are dry. He is 5 ft 9 in and weights

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160 lbs. He states that he takes a "little white pill" for his heart and another pill for "passing water." His wife reports that his memory is pretty good but he has fallen 3 times in the last 2 days. He has taken his medication, but has had no desire to eat or drink. Based on the data given, what is the most serious problem to be addressed in the nursing care plan? A. malnutrition B. dementia C. anxiety D. dehydration - - - correct answer ✅D. dehydration The patient's imminent problem is dehydration, probably from taking a diuretic for several days without adequate fluid intake. He could have any of the other problems listed, but these would be less critical Who of the following patients is most prone to developing hyperkalemia? A. A 65-year-old woman with a fractured humerus B. A 78-year-old man with a decreased creatinine clearance who takes ibuprofen daily for joint pain

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C. An 85-year-old man with no health problems who eats a banana every day D. An 88-year-old woman who takes amlodipine 5 mg daily for her high blood pressure - - - correct answer ✅B. A 78-year-old man with a decreased creatinine clearance who takes ibuprofen daily for joint pain any patient with a degree of renal failure is at risk for elevated potassium; use of NSAIDs, such as ibuprofen, greatly increases this risk. Bone fracture can predispose a person to high calcium Which of the following health promotion activities is labeled correctly? A. Influenza vaccine: primary prevention B. Blood pressure screening: primary prevention C. Diabetic education: secondary prevention D. Mammography: tertiary prevention - - - correct answer ✅A. Influenza vaccine: primary prevention all vaccination are classified as primary prevention. screening activities such as blood pressure and mammography are secondary, and diabetic education is tertiary

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Retirement at the age of 65 reflects the thinking in which of the following theories of aging? A. Orem's self- care theory B. Activity theory C. Disengagement theory D. Free radical theory - - - correct answer ✅C. Disengagement theory retirement is consistent with disengagement theory, which advances that as people get older, they become more self-centered and it is advantageous for them to withdraw from society. disengagement theory is the opposite of activity theory, which says that to be healthy in old age, it is better to stay active and engaged in society Which of the following older persons should receive the zoster vaccine? A. A 70-year-old man who has had Herpes zoster B. An 80-year-old woman who has not had Herpes zoster

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C. A healthy 65-year-old man D. All of the above - - - correct answer ✅D. All of the above the zoster vaccine is recommended for all people over the age of 50, regardless of their history of disease The general recommendation regarding screening for prostate cancer by prostate-specific antigen (PSA) is that screening may be appropriate in patients 75 years of age and older with at least a ____ year life expectancy A. 10 B. 5 C. 2 D. 1 - - - correct answer ✅A. 10 because of the slow progression of prostate cancer, men with less than a 10 year life expectancy are likely to die of something else before their prostate cancer (if detected) is fatal

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Ms. Jones is a 75-year-old woman with several risk factors for cardiovascular disease. Which of her risk factors can be modified to reduce her risk of a cardiovascular event? A. advancing age B. postmenopausal status C. high blood pressure D. family history - - - correct answer ✅C. high blood pressure the risk factors for cardiovascular disease that can be modified are tobacco use, hypertension, obesity, physical inactivity, and high cholesterol Which ethical principle underlies nursing actions respecting each patient's values and beliefs? A. Autonomy. B. Beneficence. C. Justice. D. Responsibility. - - - correct answer ✅A. Autonomy

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The most common symptoms of benign prostatic hypertrophy are: A. chills, fever, and nausea. B. dysuria, abdominal pain, and urinary retention. C. intermittency, hesitancy, and dribbling. D. nocturia, bladder spasms, and hematuria. - - - correct answer ✅C. intermittency, hesitancy, and dribbling The gerontological nurse is monitoring signs of suspected abuse in an 89-year-old patient who was admitted from home. When planning for the patient's discharge, the nurse's first action is to: A. delay discharge by informing the provider of the suspected abuse. B. enlist the help of family members with transitioning the patient home. C. notify Adult Protective Services of the patient's discharge. D. restrict the family members' access to the patient prior to discharge. - - - correct answer ✅C. notify Adult Protective Services of the patient's discharge.

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A resident in a nursing home requests a new room because he or she does not like the view from the current room. While the resident is away from the home on a provider visit, the staff moves the resident's belongings to another room with a better view. The resident and the resident's family later file a formal complaint regarding the move. Which statement gives the best justification for the resident's complaint? A. The change was made without a provider's order. B. The resident was not included in the decision making. C. The resident's belongings were moved without his or her assistance. D. The resident's family was not included in the decision making. - -

• correct answer ✅B. The resident was not included in the decision making. A recently admitted nursing home resident and the resident's family only speak Spanish. One evening during a visit, the resident and the family begin to wail and sob loudly. The gerontological nurse is unable to determine what is wrong. The nurse's most appropriate action is to: A. ask the supervisor to get an interpreter.

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B. attempt to make the resident and the family comfortable. C. contact the provider for orders. D. find an escort to take the resident and the family to the chapel for privacy. - - - correct answer ✅A. ask the supervisor to get an interpreter. The gerontological nurse manager involves the nursing staff in the utilization of trend data and analysis for quality improvement by: A. encouraging staff to volunteer for The Joint Commission's onsite surveys. B. highlighting the quality improvement work of experts in the specialty area. C. informing how data and outcomes are directly related to the staff's daily work. D. using scatter diagrams to identify the root cause of unresolved concerns - - - correct answer ✅C. informing how data and outcomes are directly related to the staff's daily work. An effective way to adequately provide nourishment to a patient with moderate dementia is:

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A. allowing the patient to choose foods from a varied menu. B. hand feeding the patient's favorite foods. C. routinely reminding the patient about the need for adequate nutrition. D. serving soup in a mug, and offering finger foods - - - correct answer ✅D. serving soup in a mug, and offering finger foods An 82-year-old patient has a painful, vesicular rash that burns over the left abdomen. The patient indicates that he or she has tried multiple creams that have not helped. Which question does the gerontological nurse first ask? A. "Did you have the pain before the rash appeared?" B. "Do you have any food or drug allergies?" C. "Have you been around anyone with a rash?" D. "Have your grandchildren visited recently?" - - - correct answer ✅A. "Did you have the pain before the rash appeared?" Which question does the gerontological nurse prioritize for an 86- year-old patient with abdominal pain, muscle weakness, and leg cramps?

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A. "Do you eat a lot of meat?" B. "Do you have heart problems?" C. "Do you take a diuretic?" D. "Do you walk every day?" - - - correct answer ✅C. "Do you take a diuretic?" When teaching an independent older adult patient how to self- administer insulin, the most productive approach is to: A. facilitate involvement in a small group where the skill is being taught. B. gather information about the patient's family health history. C. provide frequent, competitive skills testing to enhance learning. D. use repeated return demonstrations to promote the patient's retention of the involved tasks. - - - correct answer ✅D. use repeated return demonstrations to promote the patient's retention of the involved tasks. Signs and symptoms of age-related macular degeneration include: A. decreases in depth perception. B. deficits in peripheral vision.

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C. distortion of lines and print. D. reports of flashes of light. - - - correct answer ✅C. distortion of lines and print. A frail 80-year-old patient, who cares for a spouse at home without assistance, requires minor surgery. Lacking any family members residing in the area, the patient expresses concern about the spouse's care while the patient is recovering. The gerontological nurse's recommendation is A. arranging inpatient respite care for the spouse. B. having the patient remain in the hospital during the post operative period. C. hiring around-the-clock help for two weeks. D. hospitalizing the spouse. - - - correct answer ✅A. arranging inpatient respite care for the spouse. An older adult patient currently takes phenytoin (Dilantin) and tolterodine (Detrol). The gerontological nurse reinforces the need for routine dental visits because these two medications decrease: A. calcium levels in the blood.

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B. innervations of the trigeminal nerve. C. the muscle strength of the tongue. D. the production of saliva. - - - correct answer ✅D. the production of saliva. A 90-year-old patient comes to the clinic with a family member. During the health history, the patient is unable to respond to questions in a logical manner. The gerontological nurse's action is to: A. ask the family member to answer the questions. B. ask the same questions in a louder and lower voice. C. determine if the patient knows the name of the current president. D. rephrase the questions slightly, and slowly repeat them in a lower voice. - - - correct answer ✅D. rephrase the questions slightly, and slowly repeat them in a lower voice. The American Nurses Association's Gerontological Nursing: Scope and Standards of Practice emphasizes:

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A. that abnormal responses to the aging process determine the appropriate nursing diagnoses. B. that the health status data of older adult patients be documented in a retrievable form. C. the role of the older adult patient as the sole decision maker in planning his or her care. D. the unchanging nature of the goals and plans of care for older adult patients. - - - correct answer ✅B. that the health status data of older adult patients be documented in a retrievable form. A state ombudsman initiates an investigation after a complaint about the care of a nursing home resident. Which statement about the investigation process is true? A. The ombudsman may proceed with the investigation without identifying the individual who made the complaint, and without obtaining a court order or written consent. B. The ombudsman must identify the individual who made the complaint. C. The ombudsman must obtain a court order to review documentation, if the resident described in the complaint does not give written permission.

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D. The ombudsman must obtain the written permission of the resident who is described in the complaint. - - - correct answer ✅A. The ombudsman may proceed with the investigation without identifying the individual who made the complaint, and without obtaining a court order or written consent. Which patient is at greatest risk for developing arteriosclerotic heart disease? A. A 60-year-old female patient with a triglyceride level of 135 mg/dL, and a high-density lipoprotein level of 68 mg/dL. B. A 70-year old male patient with a total cholesterol level of 181 mg/dL, and a low-density lipoprotein level of 90 mg/dL. C. A 75-year old female patient with a triglyceride level of 189 mg/dL, and a low-density lipoprotein level of 149 mg/dL. D. An 86-year-old male patient with a low-density lipoprotein level of 100 mg/dL, and a high-density lipoprotein level of 50 mg/dL. - - - correct answer ✅C. A 75-year old female patient with a triglyceride level of 189 mg/dL, and a low-density lipoprotein level of 149 mg/dL. A 65-year-old patient exhibits symptoms of hemianopsia. The most appropriate nursing intervention is to:

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A. arrange the patient's meal tray so that all the food is in the patient's field of vision. B. explain all tasks thoroughly to help allay the patient's fears. C. look directly at the patient when speaking to maximize comprehension. D. minimize the operating stimuli to reduce distractions to the patient. - - - correct answer ✅A. arrange the patient's meal tray so that all the food is in the patient's field of vision. An 80-year-old patient, who lives at home with a spouse, is instructed to follow a 2 g sodium diet. The patient states, "I've always eaten the same way all my life, and I'm not going to change now." To promote optimal dietary adherence, the gerontological nurse's initial approach is to: A. inform the patient about the need to follow the diet. B. inquire about the patient's current food preferences and eating habits. C. list the variety of foods that are allowed on the diet. D. provide dietary instruction to the patient's spouse, who prepares the meals. - - - correct answer ✅B. inquire about the patient's current food preferences and eating habits.

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For older adult patients who are taking neuroleptic medication, the primary concern is the development of: A. lethargy. B. nausea. C. poor appetite. D. tardive dyskinesia. - - - correct answer ✅D. tardive dyskinesia. The gerontological nurse works with patients with non-insulin dependent diabetes at a senior center in a predominantly Hispanic neighborhood. The nurse demonstrates competency in collaboration by: A. assisting and educating patients on diet restrictions. B. delivering care by preserving and protecting patient autonomy. C. providing written education materials in Spanish. D. working with Hispanic groups in the community. - - - correct answer ✅D. working with Hispanic groups in the community.

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An older adult patient, who has end-stage multiple myeloma, is receiving hospice care. Which situation illustrates that the principles of hospice care are being met? A. The caregiver asks if hospice includes weekend care. B. The caregiver has been calling the provider on his or her own. C. The patient reports enjoying daily excursions. D. The patient reports no breakthrough pain medications are needed. - - - correct answer ✅D. The patient reports no breakthrough pain medications are needed. A 79-year-old retired actor, who continues to pursue lifelong interests in swimming and singing, exemplifies which theory of aging? A. Continuity. B. Developmental. C. Disengagement. D. Physical. - - - correct answer ✅A. Continuity. A 75-year-old patient, whose marriage ended in divorce after two years, has lived alone for the past 50 years. Feeling as if life has had