Nursing for Wellness in Older Adults Miller 8th Edition Test BankISBN-10:1496368282 ISBN-1, Exams of Nursing

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Nursing for Wellness in Older Adults Miller 8th Edition Test Bank ISBN-10:1496368282 ISBN-13:9781496368287 Table of Contents Chapter 1: Seeing Older Adults Through the Eyes of Wellness Chapter 2: Applying a Nursing Model for Promoting Wellness in Older Adults Chapter 3: Theoretical Perspectives on Aging Well Chapter 4: Perspectives on Culture and Diversity of Older Adults Chapter 5: Gerontological Nursing and Health Promotion Chapter 6: Diverse Health Care Settings for Older Adults Chapter 7: Assessment of Health and Functioning Chapter 8: Medications and Other Bioactive Substances Chapter 9: Legal and Ethical Concerns Chapter 10: Elder Abuse and Neglect Chapter 11: Cognitive Function Chapter 12: Psychosocial Function Chapter 13: Psychosocial Assessment Chapter 14: Impaired Cognitive Function: Delirium and Dementia Chapter 15: Impaired Affective Function: Depression Chapter 16: Hearing Chapter 17: Vision Chapter 18: Digestion and Nutrition Chapter 19: Urinary Function Chapter 20: Cardiovascular Function Chapter 21: Respiratory Function Chapter 22: Mobility and Safety Chapter 23: Integument Chapter 24: Sleep and Rest Chapter 25: Thermoregulation Chapter 26: Sexual Function Chapter 27: Caring for Older Adults During Illness Chapter 28: Caring for Older Adults Experiencing Pain Chapter 29: Caring for Older Adults at the End of Life C) Older adults must come to accept a decline in wellness as they age. D) A holistic approach to caring for older adults can foster their well-being at every stage of life. Ans: D Feedback: An integral part of the wellness approach to the health care of older adults is a holistic approach to care that considers mind, body, and spirit. Health problems are an inevitable reality but a decrease in wellness does not necessarily accompany the aging process. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 7 7.A diabetes nurse is providing care for a 73-year-old client who is a regular client of the hospital's out-client diabetes clinic. What assessment question most clearly addresses this client's potential for optimal function? A) "What are some goals that you have for maximizing your level of wellness?" B) "How can we help you to take ownership of your own health?" C) "Is there anything that you're doing that might be exacerbating your diabetes?" D) "How long do you think that you'll be able to live independently?" Ans: A Feedback: Eliciting an older adult's goals for wellness and high functioning can help promote these outcomes. Questions about a client's living situation, disease management, and personal responsibility may or may not promote wellness. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 8 8.A nurse cares for an 81-year-old client whose current hospital admission has been prompted by an exacerbation of chronic renal failure. Which of the following actions by the nurse will best emphasize the goal of client wellness? A) Ask for the client's code status be changed to "do not resuscitate." B) Explore the client's abilities and strengths. C) Show the client others who are more ill. D) Teach the client that health problems do not have to affect daily routines. Ans: B Feedback: A focus on existing strengths and abilities can foster wellness in older adults, even when they are experiencing health challenges. It is inappropriate to actively compare clients with each other, and changing Mr. Say's code status is unlikely to promote wellness, even if this is necessary. It is inaccurate to claim that health problems do not affect daily routines. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 9 9.A nurse administrator is involved in strategic planning for a large long-term care facility that has locations in numerous regions of the country. What trend should the nurse administrator anticipate? A) A decrease in the proportion of older adults who are members of minority groups B) A gradual decline in overall life expectancy C) Average longevity of men exceeding that of women D) Increased use of assisted living facilities by older adults Ans: D Feedback: Assisted living facilities have become a more common option for older adults; this trend is expected to continue. Life expectancy is continuing to increase, with women usually outliving men. An increasing proportion of the older adult population will be members of minority groups. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 10 10.A nurse identifies those who are at risk for familial stress. Which of the following persons exemplifies the sandwich generation? A) A 50-year-old who balances the care of an 82-year-old parent and a 20-year-old child B) A 58-year-old whose elderly parents have been forced to live in separate care facilities C) A 72-year-old who deals with own health problems with the care of a grandchild D) An 83-year-old who is the sole caregiver for the 79-year-old spouse Ans: A Feedback: The increasing numbers of middle-aged adults who simultaneously juggle the demands of caring for older and younger generations are referred to as the sandwich generation. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 11 11.A nurse interviews a centenarian gathering data for a large study. In the interview, the centenarian defines aging as not growing older, but growing wiser. Which of the following is the best response to this definition by the nurse? A) "Aging might make you wiser, but it does lead to eventual death." B) "Healthy maturity is characterized by wisdom." C) "How did you get to live to this old?" D) "I will never make it to be 100 like you." Ans: B Feedback: Healthy maturity is characterized not only by physical decline but also by wisdom. The other responses are not therapeutic. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 12 12.A nurse interviews a centenarian gathering data for a large study. In the interview, the centenarian says, "You're only as old as you feel, some days I feel like 'I'm 50.'" To which definition of aging does this response correspond? A) Chronologic aging B) Functional aging C) Perceived aging D) Subjective aging Ans: D Feedback: Subjective age describes a person's perception of his or her age. While perceived age is other people's estimation of someone's age. Chronologic age is the length of time that has passed since birth, and functional age is associated with whether individuals can contribute to society and experience personal quality of life. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 13 13. An 85-year-old client takes meals on wheels around the community. The client states, "All those old people really need me, you know how older people are. They can't get out, and are a burden to their family, and I just want to help." Most of the people on the client's delivery route are in their 60s. Which of the following characterizes this scenario? A) Ageism B) Aging anxiety C) Aging attribution D) Antiaging Ans: A Feedback: Ageism is a way of pigeonholing people and not allowing them to be individuals with unique ways of living their lives. Older adults between the ages 81 and 98 held more ageist stereotypes and reported more avoidance of older adults than younger older adults. The antiaging movement views aging as a process that can be stopped and the life span as something that can be extended for up to 200 years. Aging anxiety is fears about detrimental effects associated with older adulthood. Age attribution is the tendency to attribute problems to the aging process rather than to pathologic and potentially treatable conditions. Origin: Chapter 1- Seeing Older Adults Through the Eyes of Wellness, 14 14. Which of the following statements, made by a new nurse, are myths and need correcting? (Select all that apply.) A) "Ageism is highly influenced by stereotypes and cultural values." B) "Ageism is more common in industrialized societies." C) "In the United States, 20% of the older adults who need care are in a nursing home." D) "People consider themselves old when they are old enough to apply for Medicare." E) "With increased age, people become more diverse and people become less like their age peers." Ans: C, D Feedback: The realities are that between 4% and 5% of older adults live in a nursing home at any time. Most older adults live independently, have high levels of self-reported health, and 3. A nurse is teaching a colleague about the difference between age-related changes and risk factors. Which of the following examples should the nurse use when discussing age-related changes? A) An older adult with a diagnosis of diabetes mellitus B) An older adult who is obese C) An older adult with obstructive lung disease D) An older adult with decreased bowel motility Ans: D Feedback: Decreased bowel motility is an example of a phenomenon that is a normal consequence of the aging process. Diabetes, obesity, and obstructive lung disease are all phenomena that may constitute or exacerbate health problems for older adults, but they are not age-related changes. 4. A nurse determines risk factors for an 81-year-old client's plan of care. Which of the following characteristics of the client would the nurse consider as a risk factor? (Select all that apply.) A) Chronic bronchitis B) Loss of bone density C) Decreased vital lung capacity D) Delayed gastric emptying E) Digoxin (Lanoxin) toxicity Ans: A, E Feedback: Chronic bronchitis would be considered a pathologic process and risk factor for disease, rather than an expected or inevitable age-related change. Adverse medication effects are also considered risk factors. Loss of bone density, decreased vital lung capacity, and delayed gastric emptying are all examples of normal, age-related changes. 5. A nurse is identifying positive functional consequences as part of the development of an older client's care plan. Which of the following outcomes exemplifies the concept of positive functional consequences for an older adult? (Select all that apply.) A) The older adult with arthritis can walk 1 mile without pain. B) The older adult who is overweight develops a plan to lose 2 lb a month. C) The older adult has constipation from pain medication. D) The older adult schedules cataract surgery. Ans: A, B, D Feedback: Positive functional consequences can result from automatic actions or purposeful interventions. Older adults bring about positive functional consequences (also called wellness outcomes) when they compensate for age-related changes and risk factors, such as cataracts and chronic conditions. Nurses help older adults achieve positive functional consequences by teaching about health promotion interventions to improve functioning and quality of life. 6. A nurse uses the Functional Consequences Theory to assess older adults. Which of the following situations best demonstrates the effect of physical environment on the older adult? A) A resident of a care facility experiences a fall because there are not grab bars outside his bathtub. B) A hospital client develops Clostridium difficile–related diarrhea because a care provider did not perform adequate handwashing. C) An older adult cannot afford a wheeled walker and suffers a fall while trying to ambulate using a cane. D) An assisted living resident requires care for emphysema that resulted from a 70 pack-year history of cigarette smoking. Ans: A Feedback: An adverse health effect that results from the inadequacy of one's surroundings (such as the lack of safety devices) is an example of the domain of environment. Although the use of incorrect equipment, health problems caused by lifestyle factors, and infections that result from caregiver negligence create risk factors for older adults, these problems are not situated within the domain of environment. 7. 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 Feedback: Goals of the Functional Consequences Theory include improving or preventing declines in functioning and addressing quality-of-life concerns. Discussing treatment options, having family members make an older adult's decisions, and placing an individual on a waitlist for a transplant are not direct manifestations of this principle. 8. 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 Feedback: Advocating for a husband and wife to remain in the same room of a long-term care facility, as is their preference fosters connectedness, a component of the older adult's quality of life. Teaching wound care, organizing treatment, and adequately assessing a client are aspects of good care, but none is a direct contributor to connectedness. 9. A nurse plans the care of older adults in a long-term care setting. Which of the following interventions incorporates the residents' connectedness to society? A) Ensuring that there are multiple television sets available to residents of the facility B) Arranging regular visits by schoolchildren to the facility C) Conducting reminiscence therapy D) Allowing residents to have input into the meal planning at the facility Ans: B Feedback: Social connectedness can be fostered by arranging meaningful contact between older adults and other members of society. TV, reminiscence, and input into routines may all have benefits, but none is likely to create a sense of connectedness with society. 10. 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 Feedback: Although age-related changes are inevitable, most problems affecting older adults are related to risk factors. Older adults experience positive or negative functional consequences because of a combination of age-related changes and additional risk factors. Interventions can be directed toward alleviating or modifying the negative functional consequences of risk factors. Origin: Chapter 3- Theoretical Perspectives on Aging Well, 1 1.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 Feedback: Immunity theories focus on immunosenescence. Older adults are more susceptible to cancer, autoimmune disorders, and infections, a phenomenon that is known as immunosenescence. Wearing out is exacerbated by harmful factors, such as stress, disease, smoking, poor diet, and alcohol abuse. Free radicals are waste products of metabolism and they can damage cells. Current studies indicate that the genetic effect on longevity is due to modest effects of many genes interacting, with some genes increasing one's susceptibility to age-related disease and early death and other genes slowing the aging process and leading to a longer life. Origin: Chapter 4- Theoretical Perspectives on Aging Well, 2 2. 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 Feedback: The theory of thriving posits that the older adult thrives when there is concordance between the person and the human and nonhuman environment. Activity theory postulates that older people remain socially and psychologically fit if they remain actively engaged in life such as engaging in full-time work and low-level volunteering. Feminist gerontology theories examine aging from the experiences of older women. Feminist theories address gender inequalities with regard to caregiving roles, diseases, and economic status. Life-course theories address old age within the context of the life cycle. Origin: Chapter 4- Theoretical Perspectives on Aging Well, 3 3. Which of the following statements best explains the relevance of psychological theories for gerontological nursing? A) Human needs theory allows the nurse to determine priorities of nursing care for older adults. B) Life span development theories support the belief that it may be difficult to initiate behavioral changes in older adults. C) Psychological theories explain why nurses should focus their discussion more on the present than on the past when talking with older adults. D) Psychological theories explain why reminiscence groups may not be beneficial for older adults. Ans: A Feedback: Maslow's human needs theory is useful in conceptualizing interventions in the older adult's home and in a health care facility. The attainment of lower-level human needs takes priority over higher-level human needs, such as self-actualization. Life span development theories help nurses identify those areas of personality that are likely to change and those that are more likely to remain stable. Psychological theories imply that older adults should devote some time and energy to life review and self-understanding. Origin: Chapter 4- Theoretical Perspectives on Aging Well, 4 4.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 Feedback: The Functional Consequences Theory for Promoting Wellness in Older Adults provides a framework for a holistic approach that identifies the risk factors and addresses those that are modifiable in older adults. Age stratification theory addresses the interdependencies between age as an element of the social structure and the aging of people and cohorts as a social process. Life-course development is related to old age within the context of the life cycle. The activity theory postulates that older people remain socially and psychologically fit if they remain actively engaged in life. Origin: Chapter 4- Theoretical Perspectives on Aging Well, 5 5.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 Ans: C Feedback: Biologic theories of aging do not address the significant influence of nursing, medical, and psychosocial interventions that can improve a person's functioning and life expectancy. More broadly, they do not address holistic questions surrounding wellness. They are generally able to account for increases in life expectancy and phenomena such as cell division. Origin: Chapter 4- Theoretical Perspectives on Aging Well, 11 11.A nurse assesses a 66-year-old woman who strained a muscle. The client attends the gym daily, and states, "I injured my muscle grouting the floor tile getting ready for the bridge class I teach." Which of the following categorizes this client's aging? A) Healthy B) Active C) Productive D) Successful Ans: B Feedback: The scenario does not show social participation, nor does it address whether or not the client is fully aging well (successful aging). The client does show healthy aging, but active aging better fits the information presented (active physically and mentally). Origin: Chapter 4- Theoretical Perspectives on Aging Well, 12 12.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 Feedback: Compression of morbidity emphasizes that preventive approaches must be directed toward preserving health by postponing the onset of chronic illnesses, but one's life expectancy cannot be extended. Consequently, disease, disability, and functional decline are "compressed" into a period averaging 3 to 5 years before death. Origin: Chapter 4- Theoretical Perspectives on Aging Well, 13 13.A 93-year-old asks the nurse, "I sure would like to live to get that 100 year birthday card from the president." Which of the following responses by the nurse is best? A) "Keeping fit and dealing with stress in a positive way helps your chances of living to be 100." B) "Surviving to 100 is strongly impacted by eating meat, fruits and grains." C) "Those people in your socioeconomic situation have higher chance of living to 100." D) "You have had a cancer and a stroke, so that decreases your chance of surviving to 100." Ans: A Feedback: People who survive to 100 years and older are a heterogeneous group with a wide range of health and socioeconomic characteristics. Most centenarians have escaped the common pathologies, such as stroke, cancer, and myocardial infarction (Andersen, Sebastiani, Dworkis, et al., 2012; Vacante, D'Agata, Motta, et al., 2012). Variables commonly identified as predictors of healthy longevity include nutritional patterns with a high intake of plant-based foods and being resilient in the face of stress (Davinelli, Willcox, & Scapagnini, 2012; Hutnik, Smith, & Koch, 2012). Origin: Chapter 4- Theoretical Perspectives on Aging Well, 14 14.An older adult is sore from "doing too much in the yard yesterday." Which statement by the nurse best promotes healthy aging? A) "It's time to start exercising and eating right." B) "Let's look at how we can improve your health so you can do more." C) "Of course you can't do as much as you did before, you need to pace yourself." D) "You need to act your age, and let others do that work." Ans: B Feedback: The Functional Consequences Theory for Promoting Wellness in Older Adults emphasizes those factors that nurses can address through health promotion interventions. The client self-determines, and the nurse teaches and guides. If health care providers hold the perspective of "what do you expect, you're old, " then reversible disease conditions may go untreated. Origin: Chapter 4- Theoretical Perspectives on Aging Well, 15 15.A client, who retired from work this year, asks the nurse the secret to successful aging. Which of the following responses by the nurse is most helpful? A) "Later life can be a time of engagement, contribution and well-being, you must work to make it so." B) "Life is a bowl of cherries, if you are in the pits, crawl out." C) "Studies show that volunteering and helping others improve satisfaction with life." D) "The body is senescent and you will find you slow down each year." Ans: C Feedback: The most helpful statement that guides the client clearly is that the support for this theory comes from many studies, finding that volunteer activities and altruistic attitudes improve life satisfaction, positive affect, and quality of life for older adults (Cattan, Hogg, & Hardill, 2011; Kahana, Bhatta, Lovegreen, et al., 2013). The other statements have some truth to them, but are unclear, use euphemisms, or don't give information that will help the client make decisions toward successful aging. Origin: Chapter 2- Addressing Diversity of Older Adults, 6 6.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 Feedback: Cultural competence begins with unconscious incompetence as a state of not being aware that one is lacking knowledge about another culture. When the person becomes aware of this knowledge gap, he or she progresses to a state of conscious incompetence and takes actions to learn about the cultural group; this stage is demonstrated by the nurse in this question. A person progresses to a stage of conscious competence by verifying generalizations and incorporating culture-specific interventions in care. The final stage is unconscious competence, when knowledge of the cultural group is fully integrated into one's thinking and approach. Origin: Chapter 2- Addressing Diversity of Older Adults, 7 7.A nurse reads up on some of the more common cultural groups in the local area. How should the nurse interpret the information that is available about cultural groups? A) Characteristics of cultural groups are normally consistent between every member of that group. B) Cultural generalizations can be useful and accurate, but they do not replace individualized assessment and care. C) It is simplistic and problematic to make generalized claims about members of a particular cultural group. D) It is unjust to categorize individual clients as being members of a specific cultural group. Ans: B Feedback: Nurses need to be knowledgeable about different cultural groups, but they need to use this information as a backdrop for exploring the ways in which individuals identify with the characteristics of the various cultural groups to which they belong. Generalized knowledge may be accurate and clinically useful, but it is not replacement for individualized knowledge. Nurses need to recognize that the culture of each individual person is based on his or her membership in many groups and is internalized in a unique and personal way. Origin: Chapter 2- Addressing Diversity of Older Adults, 8 8.Following knee replacement surgery 10 days earlier, a 79-year-old woman has been diagnosed with an infection in the knee. A sample of synovial fluid has been cultured in order to determine the causative microorganism and to select an appropriate antibiotic. This course of events characterizes what major health belief system? A) Magico-religious paradigm B) Holistic paradigm C) Scientific paradigm D) Analytical paradigm Ans: C Feedback: The scientific (biomedical) health paradigm prioritizes cause-and-effect relationships (i.e., microorganisms and infection) along with manipulation of these through pharmacologic interventions and surgery. The holistic paradigm emphasizes the interconnectedness of mind, body, and spirit, and the magico-religious paradigm emphasizes supernatural factors. The "analytical paradigm" is not among the three major health belief systems. Origin: Chapter 2- Addressing Diversity of Older Adults, 9 9.A nurse performs a reflective cultural self-assessment. Which of the following outcomes should the nurse expect? A) An accurate ranking of different cultures according to their specific merits B) Identification of the flaws and weaknesses of the nurse's own culture C) Progression from judgmental views of other cultures to recognition of positive attributes D) The ability to assess clients according to their cultural affiliation rather than individual characteristics Ans: C Feedback: The process of cultural competence is often described as a progression from judgmental attitudes and practices to positive approaches. It does not focus primarily on the deficits of one's own culture and it does not replace individualized assessment and care with cultural generalizations. Culturally competent care does not involve "ranking" different cultures. Origin: Chapter 2- Addressing Diversity of Older Adults, 10 10.A nurse at a long-term care facility has completed the admission assessment of a 79-year- old male resident. The resident has identified himself as gay and has expressed sadness at having to leave his partner of several decades in order to move to the facility. The nurse should recognize that this resident is likely to have a history of: A) Homelessness B) Stigmatization C) Nominal employment or unemployment D) Infectious diseases Ans: B Feedback: Stigma is a common experience among LGBT (lesbian, gay, bisexual, and transgender) older adults, and the likelihood of this is greater than the likelihood of homelessness, unemployment, or infectious diseases. Origin: Chapter 2- Addressing Diversity of Older Adults, 11 11.A nurse plans culturally competent care for a variety of clients. Which of the following cultures is most strongly tied to the low health status? A) Hispanic in race B) Low socioeconomic status C) Member of LGBT society D) Resident of urban community Ans: B Feedback: Lower socioeconomic position is an overriding determinant of health status. Hispanic subgroups vary in rates of disability. While urban older adults and those in the LGBT community have special needs, their health is not significantly worse than others as a whole. Origin: Chapter 2- Addressing Diversity of Older Adults, 12 12.A nurse verifies the health belief system of the Puerto Rican older adult client. Which of the following beliefs is this client most likely to hold? A) Health is a gift or reward given as a sign of God's blessing and goodwill. B) Health is obtainable by reaching a mature age. C) Health is the absence of disease. D) Health is the quality of wholeness associated with healthy functioning. Ans: A Feedback: The magico-religious perspective is common among Latino and Caribbean groups. Those with this perspective believe that health is a gift or reward given as a sign of God's blessing and goodwill. Scientific perspective holds that health is an absence of disease. Holism associates health with healthy functioning and well-being. Origin: Chapter 2- Addressing Diversity of Older Adults, 13 13.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 Feedback: prevented." Ans: B Feedback: Discharge planning is not a core component of health promotion. Health promotion denotes interventions or programs that focus on behavior changes that can improve health and well-being. Teaching older adults how to live with a particular disease, fostering spiritual growth, and promoting good nutrition are all components of health promotion. Origin: Chapter 5- Gerontological Nursing and Health Promotion, 4 4. Which of the following interventions most closely aligns with the practices of health promotion? A) Leading a flexibility and mobility class among older adults B) Providing presurgical teaching to an older adult prior to hip replacement C) Administering an anti-inflammatory and analgesics to an older adult with osteoarthritis D) Teaching an older adult how to administer her inhaled bronchodilators independently Ans: A Feedback: The practice that best characterizes health promotion is facilitating exercise. Presurgical teaching, administering drugs, and teaching independence with medication are useful interventions, but they do not characterize the behavior changes of health promotion as well as an intervention such as an exercise class. Origin: Chapter 5- Gerontological Nursing and Health Promotion, 5 5. Which of the following circumstances would be most likely to render a screening program unnecessary? A) Treatment of the disease is available at low cost. B) The disease follows a predictable course. C) The disease is more common among older adults than among younger and middle- aged adults. D) The symptoms of the disease appear at the same time that it is detectable by screening. Ans: D Feedback: For a screening program to be effective, the test must be able to detect the disease in question earlier than it would be detected without screening. While cost-effectiveness is a consideration in screening programs, low treatment costs would not necessarily mean screening is undesirable. The predictability of the course of a disease is not cited as a reason to forgo screening, nor is the fact that the disease may be more common among older adults. Origin: Chapter 5- Gerontological Nursing and Health Promotion, 6 6.A nurse who works with older adults is teaching a colleague about the similarities and differences between gerontology and geriatrics. Which of the following questions best conveys the focus of gerontology? A) "How can we secure more funding for research and development of drugs specifically for older adults?" B) "How can we teach older adults about the relationship between their lifestyle and their health?" C) "How can we help older adults maintain wellness as they age?" D) "How can we reduce the incidence of falls among older adults who live in care facilities?" Ans: C Feedback: Gerontology is the study of aging and older adults, and the focus of the discipline has shifted in recent decades to an emphasis on wellness and healthy, successful aging. As such, a focus on promoting and maintaining wellness best exemplifies the discipline. Geriatrics is associated with the diseases and disabilities of old people, and geriatric medicine is a subspecialty of internal medicine or family practice that focuses on the medical problems of older people. Origin: Chapter 5- Gerontological Nursing and Health Promotion, 7 7.Despite the fact that older adults are proportionately the highest users of health care services, many nurses harbor misconceptions and deficits in practice related to gerontological nursing. What is the most likely solution to this problem? A) A shift from the treatment of older adults in institutional settings to home care B) Increased nursing education and clinical experience specific to working with older adults C) A focus on early discharge planning for older adults in hospital settings D) Increased use of aggressive pharmacologic interventions in the treatment of acute illnesses in older adults Ans: B Feedback: Individual gerontological nurses as well as national nursing bodies have joined in a call for increased education to better enable nurses to meet the diverse health needs of older adults. Early discharge planning, increased home care, and aggressive drug treatment are measures that may be appropriate in certain contexts, but none is likely to improve nursing care of older adults at a broad level. Origin: Chapter 5- Gerontological Nursing and Health Promotion, 8 8.A 69-year-old cigarette smoker asks the nurse questions about the potential benefits of quitting smoking, a subject avoided in past interactions. The nurse asks the client, "Would you like to quit smoking?," to which the client replies, "I will give it some serious thought.” What stage of the Stages of Change model is the client demonstrating? A) Precontemplation B) Preparation C) Contemplation D) Action Ans: C Feedback: The second stage of the Stages of Change model, contemplation, is characterized by an intention to change in the foreseeable future, based on some acknowledgment of the negative consequences of current behaviors and positive consequences of different behaviors. The person is likely to ask questions and to seek information about the short- and long-term risks and benefits of various behaviors. Precontemplation involves a lack of acknowledgment that there is a problem, and preparation involves specific measure to achieve change. Action is characterized by the actual execution of change. Origin: Chapter 5- Gerontological Nursing and Health Promotion, 9 9.A gerontological nurse who works in a public health setting has limited funding for initiatives. Which of the following prevention and health promotion initiatives is most likely to result in significant benefits for the older adults who participate? A) An awareness program that promotes screening sigmoidoscopy B) Teaching older adults about falls prevention in the home C) A program of bone density screening for older adults D) An exercise program for older adults who live in the community Ans: D Feedback: Sigmoidoscopy, bone density screening, and falls prevention are all valid health promotion and screening measures for older adults, but the promotion of exercise is likely to be of greatest benefit to the largest number of participants because of the multiple health benefits associated with regular exercise. Origin: Chapter 5- Gerontological Nursing and Health Promotion, 10 10.A group of community health nurses is using the Stages of Change model as the foundation of a new health promotion campaign for older adults. What goal for the participants are the nurses likely to promote when working with older adults in the program? A) A recognition of the importance of screening for common health problems B) Increased participation in exercise programs and an awareness of the relationship between exercise and wellness C) The replacement of participants' unhealthy behaviors with healthy behaviors D) An awareness of the differences between life expectancy and active life expectancy Ans: C Feedback: The primary focus of the Stages of Change model is on replacing unhealthy behaviors with healthy behaviors. This may include awareness of screening, exercise, and wellness, but the main priority is health-related behaviors. Origin: Chapter 6: Diverse Health Care Settings for Older Adults, 1 1.A hospital nurse is discussing with an older adult the possibility transfer to a nursing home for skilled care after pneumonia. Which statement by the client indicates an understanding of this possible transfer? A) Old people who go to the nursing home don't get out. B) They will take my home if I go to the nursing home. C) I don't qualify for skilled care, I only had pneumonia. D) I have already used 45 Medicare days this year. Ans: D Feedback: Medicare and other insurance programs will cover all or part of the care for up to 100 days of care. Typical diagnoses associated with skilled care in a nursing home are stroke, fractured hip, congestive heart failure, and rehabilitation after acute illnesses (e.g., pneumonia and myocardial infarction). About 65% of older adults spend some time in a nursing home. Origin: Chapter 6- Health Care Settings for Older Adults, 2 2.A nursing case manager monitors admissions into an acute care unit. Which of the following clients would be the most appropriate candidate for in-home skilled nursing care? A) A client requiring twice-daily dressing changes for a coccyx wound B) A client who has been admitted to the emergency department with a recent stroke C) A client with reoccurring urinary retention of unknown etiology D) A client who is scheduled for hip replacement surgery tomorrow Ans: A Feedback: Skilled home care is most appropriate for older adults who are recovering from an illness or injury and have potential for returning to their previous level of functioning. Following a stroke, a client requires hospitalization. A client with a poorly understood or undiagnosed health problem would not be an ideal candidate for home care, nor would a preoperative client. Origin: Chapter 6- Health Care Settings for Older Adults, 3 3.A nurse is teaching a family of an older adult about the role of adult day centers. Which of the statements by the family member indicates a need for further teaching? A) "The day center can give me respite." B) "The day center can improve our quality of life." C) "The day center can be a useful alternative to medical care." D) "The day center can contribute to an actual improvement in dementia symptoms." Ans: C Feedback: Adult day centers are a community-based resource providing food, supervision, and activity, but are not designed to provide acute medical care. They provide caregiver relief and have been linked to improved quality of life and decreased symptoms of dementia. Origin: Chapter 6- Health Care Settings for Older Adults, 4 4.A nurse is teaching an older adult about possible involvement in Programs of All- inclusive Care for the Elderly (PACE). Which of the following statements by the older adult shows understanding? A) PACE programs provide several social and medical services on a managed care basis. B) PACE programs provide a cost-effective alternative to hospital-based acute care. C) PACE programs are more expensive than fee-for-service models but offer better health outcomes. D) There is pressure for Medicare and Medicaid to begin funding PACE programs. Ans: A Feedback: PACE programs provide a range of services using a capitated managed care model. They are focused on meeting the needs of adults with chronic conditions and are not an alternative to in-hospital treatment of acute illness. They are less expensive than fee-for- service models and presently are receiving funding under both Medicare and Medicaid. The 2010 Affordable Care Act provides incentives for further expansion of PACE programs. Origin: Chapter 6- Health Care Settings for Older Adults, 5 5.A client has recently begun receiving Social Security benefits and is asking the nurse about what services might be included or excluded under Medicare. Which of the following services is most likely to be excluded from Medicare funding? A) Hospital care B) Hospice care C) Rehabilitation care D) Nursing home care Ans: D Feedback: Medicare was established as a means of funding some types of direct client medical care, hospice and rehabilitation care may be covered, but nursing home residence is not. Origin: Chapter 6- Health Care Settings for Older Adults, 6 6.A nurse assists an older adult who is homebound in a rural area. Which community resources might this client best benefit from? A) Skilled home nursing B) Senior center C) Personal emergency response system D) Grocery delivery Ans: C Feedback: The rural client is unlikely to have grocery delivery. And as a homebound rural client, a senior center would not be available. Only some clients qualify for skilled home nursing visits, there are not location limitations on personal emergency response systems, some now come with GPS and cellular capabilities. Origin: Chapter 6- Health Care Settings for Older Adults, 7 7. An 84-year-old client has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. Which of the following characteristics of the client's current situation is most likely to prompt this move? A) The development of a severe, acute health problem B) A decrease in the client's level of function and activities of daily living (ADLs) C) Exacerbation of a chronic health problem that may require medical treatment D) A change in the level of the client's social support Ans: B Feedback: Nursing home settings are becoming increasingly diverse, but a common feature of older adults who are admitted to nursing homes is a decrease in function and ADLs. Acute health problems that require medical treatment necessitate hospital admission, and a change in social support would not necessarily prompt a move from assisted living. Origin: Chapter 6- Health Care Settings for Older Adults, 8 8. Active care management is often necessary in order to maintain wellness among older adults. Which of these older adults is most likely to require care management? A) A 90-year-old man who lives alone and has no living family members B) A 77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier C) An 81-year-old resident of a nursing home whose Alzheimer disease is progressing rapidly D) A 90-year-old man who has recently been transferred from an assisted living facility to an acute care setting Ans: A Feedback: Community-dwelling older adults who may lack family involvement in their care often require independent community-based professional geriatric care management. Individuals who are experiencing acute medical conditions and who are in institutional or acute care settings are not frequent recipients of care management. Origin: Chapter 6- Health Care Settings for Older Adults, 9 9.A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. Which action can the nurse take to potentially minimize these expenses for clients? A) Become familiar with the various funding sources and their eligibility requirements. B) Teach older adults to be astute with their spending and saving patterns. goals." Ans: D Feedback: Medicare and other insurance programs will cover all or part of the care for up to 100 days of care, but only as long as the person continues to require the skilled level of services. The expectation is that the person will be able to progress to a higher level of functioning and show some recovery from the acute episode. Origin: Chapter 6- Health Care Settings for Older Adults, 15 15.Centers for Medicare and Medicaid Services (CMS), the Institute of Medicine, and the Joint Commission have developed standards to address areas of concern for older hospitalized adults. Which of the following situations is of particular concern for an older adult with a hospitalization requiring complex care? A) Transitions in care B) Hospital-acquired respiratory infections C) Need for geriatric care manager D) Placement in an acute care for elders unit Ans: A Feedback: CMS, the Institute of Medicine, and the Joint Commission have placed a high priority on the issue of older adults with complex medical problems who transfer between care settings, because they are particularly vulnerable to experiencing problems. Geriatric care managers and acute care for elders unit assist with this issue. Hospital-acquired urinary tract infections and wounds not respiratory infections are prevalent. Origin: Chapter 7- Assessment of Health and Functioning, 1 1.A nurse is responsible for assessing an older adult in an acute care setting. Which of the following statements most accurately captures the complexity involved in assessing the older adult? A) Older adults manifest fewer symptoms of illness than do younger clients. B) Signs and symptoms of illness are often obscure and less predictable among older adults. C) Care must be taken to avoid assessing normal, age-related changes. D) Older adults experience fewer acute health problems but more chronic illnesses than do younger clients. Ans: B Feedback: The manifestations of illness in older adults can be less clear and less predictable than among younger clients. Older adults often show different, but not necessarily fewer, symptoms than do younger clients. Age-related changes must be recognized and acknowledged, not excluded from the assessment process. Older adults do not experience fewer acute health problems than do younger adults but rather different manifestations of health problems. Origin: Chapter 7- Assessment of Health and Functioning, 2 2.An 82-year-old client is getting advice from a family member on how to drive safely. What piece of advice should the older adult follow? A) "Avoid modifying your vehicle with devices that were not supplied by the manufacturer." B) "Realize that normal, age-related changes should not affect your ability to drive safely." C) "You can consider timing your medications to avoid their interfering with safe driving." D) "You should transition from driving to using public transportation as soon as possible." Ans: C Feedback: Older adults can be taught how to safely time their medications to avoid effects such as drowsiness that can affect driving safely. Modification of vehicles with assistive devices can be a useful tool in promoting safe driving. Age-related changes such as decreased visual acuity are significant factors in driving safely. With compensation and education, many older adults can safely drive and do not necessarily need to give up their licenses early. Origin: Chapter 7- Assessment of Health and Functioning, 3 3.A nurse conducts a functional assessment of a client who has moved to the assisted living facility. Which of the following statements best describes this functional assessment? A) Information on the client's medical diagnoses and health problems. B) Client's ability to perform self-care tasks with a focus on rehabilitation. C) Assessment of the client's activities of daily living (ADLs). D) Prioritization of the client's ability to perform roles in relationships and in society. Ans: B Feedback: Functional assessment is a way of determining an individual's ability to fulfill responsibilities and perform self-care. While it is distinct from a medical diagnosis approach, it does not discount or ignore information on an older adult's diagnoses and health problems. It includes data on ADLs and is not a counterpoint to ADL assessment. The focus is on the fulfillment of responsibilities and self-care more than on performing social and relationship roles. Origin: Chapter 7- Assessment of Health and Functioning, 4 4.As part of a functional assessment, a nurse is assessing an older adult's ADLs and instrumental activities of daily living (IADLs). What piece of assessment data would most likely be considered an IADL rather than an ADL? A) The older adult is able to ambulate to and from the bathroom at home. B) The older adult can feed herself independently. C) The older adult can dress in the morning without assistance. D) The older adult is able to clean and maintain her own apartment. Ans: D Feedback: IADLs refer to tasks higher in complexity than basic ADLs. IADLs include housekeeping and shopping. Toileting, feeding, and dressing are all considered basic ADLs. Origin: Chapter 7- Assessment of Health and Functioning, 5 5.A nurse in a Medicare- and Medicaid-funded nursing home performs assessments and develops care plans. Which of these statements is true of the functional assessments the nurse is likely to perform? A) The nurse will address core ADLs but not more complex IADLs. B) The nurse will identify changes in the older adult's function over time. C) The nurse will utilize various functional assessment models. D) The main goal of functional assessments will be to ensure older adult safety. Ans: B Feedback: Functional assessments consider an older adult's functional status and changes in this status over time. They include both core ADLs and more complex IADLs. The nurse is likely to use the Minimum Data Set for Resident Assessment and Care Screening, as mandated for Medicare- and Medicaid-funded facilities. While safety is a consideration in functional assessment, the main goal is determining the older adult's need for assistance and for planning care. Origin: Chapter 7- Assessment of Health and Functioning, 6 6.A nurse completes the admission assessment of an 84-year-old client to the long-term B) Hyponatremia C) Medication interactions D) Positional pain E) Urinary tract infection Ans: B, C, E Feedback: Sodium level, medications, and urinary tract infections can each lead to confusion and combativeness. While pain and social separation may be associated with confusion, they are unlikely to be the root cause of these new onset issues. Origin: Chapter 7- Assessment of Health and Functioning, 12 12.A nurse assesses a client admitted to the subacute care unit. The client is weak and underweight. Which of the following laboratory abnormalities would be related to undernutrition in this client? (Select all that apply.) A) Low albumin B) High hematocrit hemoglobin ratio C) Low serum iron and ferritin levels D) Decreased platelet count E) Elevated sedimentation rate Ans: A, C Feedback: Serum iron, iron-binding capacity, ferritin, and albumin indicate undernutrition. The other laboratory values do not. Origin: Chapter 7- Assessment of Health and Functioning, 13 13.A nurse assesses older adults in their own home. Which of the following questions are appropriate to include in this assessment of the bathroom? (Select all that apply.) A) Can the person enter and exit the tub safely? B) Does the color of the toilet seat contrast with surrounding colors? C) Does the tub have skid-proof strips or a rubber mat in the bottom? D) Is the height of the toilet seat appropriate? E) Is there a lock for the bathroom door? Ans: A, B, C, D Feedback: Can the person enter and exit the tub safely? Does the color of the toilet seat contrast with surrounding colors? Does the tub have skid-proof strips or a rubber mat in the bottom? and Is the height of the toilet seat appropriate? are all appropriate questions to ask when assessing the safety; the door lock is not helpful. Origin: Chapter 7- Assessment of Health and Functioning, 14 14.A nurse at a long-term care facility completes a minimum data set on each client. Which of the following categories are included in this assessment/plan of care? (Select all that apply.) A) Cognitive patterns B) Communication and hearing patterns C) Family support D) Mood and behavior patterns E) Psychosocial well-being Ans: A, B, D, E Feedback: Cognitive patterns, communication and hearing patterns, mood and behavior patterns, and psychosocial well-being are all categories within Minimum Data Set 3, and family support is not. Origin: Chapter 7- Assessment of Health and Functioning, 15 15.A home care nurse assesses the home environment of an older adult client. Which of the following environmental conditions positively affects the functioning and quality of life for the client? A) The client has thick shag carpeting in the home. B) The client shares a bathroom with a teenager. C) The client's 2-year-old great grandchild plays in the living room. D) The client's home has large south-facing windows with blinds. Ans: D Feedback: Shag carpeting can interfere with ambulation, so can the toys of a 2-year-old. Sharing a bathroom also does not affect the environment positively. South-facing windows with blinds allow sunlight, which is a positive environmental condition. Origin: Chapter 8- Medications and Other Bioactive Substances, 1 1.A nurse assesses the eating habits of a 75-year-old client who takes iron supplements for iron deficiency anemia. Which of the following statements by the client indicates a need for further teaching? A) "I drink orange juice with my iron." B) "I prefer coffee to take my pills." C) "I take all my pills with a glass of warm water." D) "I take my iron in between my meals." Ans: B Feedback: Foods that change the pH of the gastrointestinal (GI) system interfere with the absorption of iron. It is best taken on an empty stomach, but if it causes GI upset, then it can be taken with orange juice, which helps absorption. Caffeine and some foods interfere with iron absorption. The temperature of the water should not impact the medication absorption. Origin: Chapter 8- Medications and Other Bioactive Substances, 2 2.A healthy 70-year-old has been using diphenhydramine (Benadryl) for allergic rhinitis. One week later, the client begins to exhibit signs of confusion and disorientation. The spouse calls the primary care facility to speak with the nurse. Which event should the nurse suspect first? A) The older adult has hyponatremia, leading to delirium. B) The older adult is having transient ischemic attacks. C) The older adult has an overwhelming infection. D) The older adult is experiencing an adverse drug effect. Ans: D Feedback: The older adult has been taking diphenhydramine, which can have an anticholinergic effect. Anticholinergic drugs can lead to medication-induced cognitive impairment. There is no reason to think that the client has hyponatremia. Rhinitis does not generally cause delirium in older adults. The client is more likely to be having adverse reaction than transient ischemic attacks. Origin: Chapter 8- Medications and Other Bioactive Substances, 3 3. An older adult, aged 72, with type 2 diabetes and coronary artery disease is admitted to a long-term care facility. The client takes glipizide (Glucotrol) and isosorbide mononitrate (Imdur). The medical history states that the client drank 4 ounces of whiskey per day for many years. Which of the following actions should be a priority for the admitting nurse? A) Assess and observe for depression. B) Assess for hypoglycemia and hypotension. C) Evaluate the client for renal failure. D) Evaluate blood work for changes in electrolytes. Ans: B Feedback: Origin: Chapter 8- Medications and Other Bioactive Substances, 9 9.A nurse is conducting a medication assessment of an older adult client who will soon be receiving home care. Which of the following questions should the nurse include in this assessment? (Select all that apply.) A) "Are you a smoker?" B) "What is your typical diet?" C) "What over-the-counter drugs do you use?" D) "Do you use any herbs or dietary supplements?" E) "Do you drink alcohol?" Ans: A, C, D, E Feedback: Question relating to smoking, alcohol use, over-the-counter drugs, and herbs and dietary supplements should be included in a medication assessment. A client's diet, however, is not a common focus during a medication assessment. Origin: Chapter 8- Medications and Other Bioactive Substances, 10 10.Having completed a medication assessment and physical assessment of a new client, a home care nurse is now creating nursing diagnoses and choosing interventions appropriate to these diagnoses. What factor should the nurse prioritize in this process? A) The need to maintain the client's autonomy B) The nurse's responsibility to teach the patient and minimize liability C) The importance of the patient's safety D) The importance of fostering patient compliance Ans: C Feedback: When dealing with patients' and clients' medications, as in all areas of nursing practice, patient safety is the priority. This supersedes other matters, even though each may be significant. These include autonomy and patient education. Origin: Chapter 8- Medications and Other Bioactive Substances, 11 11.A nurse administers medications to a group of older adults in a residential facility. Which of the following clients is most likely to experience adverse effects? A) A 77-year-old man with a creatinine of 3.6 B) A 78-year-old man with a body mass index of 35 C) An 84-year-old woman with iron deficiency anemia D) An 82-year-old woman with constipation Ans: A Feedback: Although age-related changes can influence skills related to taking medications, risk factors that commonly occur in older adults exert a stronger influence. A creatinine of 3.6 reflects renal failure, which will lead to increase in serum levels of medications. Iron deficiency anemia, obesity, and constipation do not impact the risk of adverse and altered effects. Origin: Chapter 8- Medications and Other Bioactive Substances, 12 12.A nurse reviews the medication list of an older adult upon transfer from the hospital to an extended care facility. Which of the following methods is most likely to reduce the occurrence of adverse effects? A) Administer medications at the same time every day with meals. B) Compare the list to the Beers criteria list and notify the health care provider of any on the list. C) Request that the client's medications be put on hold and restarted one at a time. D) Stop the administration of GI and narcotic pain medications. Ans: B Feedback: An important theme of the Beers criteria and other guidelines is that medications are determined to be appropriate or inappropriate in relation to the patient's condition. Some medications should be given with meals, while others should not. There is no need to stop all medications at this time; nor should the GI and pain medications be stopped. Origin: Chapter 8- Medications and Other Bioactive Substances, 13 13.A nurse assesses frail older adults prescribed multiple medications. Which of the following pairs of medications are most likely to lead to an adverse drug event causing hospitalization? (Select all that apply.) A) Atorvastatin (Lipitor) and tamsulosin (Flomax) B) Ferrous sulfate (Feratab) and vitamin C (L-ascorbic acid) C) Metformin (Glucophage) and glyburide (Micronase) D) Naproxen (Naprosyn) and glucosamine (Glucosamina) E) Warfarin (Coumadin) and clopidogrel (Plavix) Ans: C, E Feedback: Up to 13% of patients taking two medications experience an adverse drug event. Medications most frequently cited as causes of emergency hospitalizations are warfarin, antiplatelet drugs, and antidiabetic drugs, including insulin and oral hypoglycemics. Origin: Chapter 8- Medications and Other Bioactive Substances, 14 14.A nurse notes that an older adult is unable to process complex thoughts and has difficulty forming sentences. Which of the following actions by the nurse is priority? A) Review medication administration record. B) Place the client on high fall risk precaution. C) Assess muscle strength and deep tendon reflexes. D) Orient the client to environment. Ans: A Feedback: Nurses need to be alert to the possibility that even a simple over-the-counter product is a common cause of mental changes in older adults. An acute confusional state can be precipitated by any medication or by medication interactions. Assessment of deep tendon reflexes will be important to assess fluid and electrolyte imbalances; review the medications first. Orienting the client and high fall risk may be needed (or not). Origin: Chapter 8- Medications and Other Bioactive Substances, 15 15.A home care nurse admits an older adult with macular degeneration. Which of the following assessment questions is most appropriate? A) "Do you have difficulty opening your medication bottles?" B) "How do you organize your medications?" C) "How many medications do you take each day?" D) "What medications do you take each day?" Ans: B Feedback: The client with macular degeneration will have limited sight; therefore, a question about assuring that this client takes the correct medications at the correct time is appropriate. There is no indication that this client would have difficulty opening bottles. Asking how many medications are taken each day is not helpful nor does it use therapeutic communication. The nurse will want to know what medications the client takes; however, this question is limiting. It does not include PRN, herbs, or even medications a client may take weekly. Nurses should ask additional questions about the client's ability to take his or her medications as prescribed based on specific observations. Origin: Chapter 9- Legal and Ethical Concerns, 6 6.A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, "I feel quite well and do not wish to undergo another round of chemotherapy. " The client's children are adamantly opposed to their parent's decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action? A) The client's prognosis B) The client's autonomy C) The family's wishes D) The client's treatment options Ans: B Feedback: Autonomy is highly valued in Western societies, and personal autonomy supersedes family wishes and the medical facts about a client or client's situation. Origin: Chapter 9- Legal and Ethical Concerns, 7 7. The children of a resident of a nursing home have approached the nurse because they believe their parent is being manipulated by a person who also lives in the facility. Their parent has a diagnosis of early-stage Alzheimer disease and various comorbidities that affect mobility and function. How should the care team appraise the parent's decision- making capacity? A) Her decision-making ability is nullified by the presence of a dementia. B) Her decision-making capacity should be determined according to objective criteria. C) She should be asked to demonstrate sound decision making in minor matter before being allowed to make more important decisions. D) A surrogate should be appointed to make her decisions because she has been diagnosed with Alzheimer disease. Ans: B Feedback: The presence of dementia does not necessarily render a person incapable of all decision- making ability. Rather, this ability should be analyzed according to criteria of understanding, reasoning, choice, and expression. Origin: Chapter 9- Legal and Ethical Concerns, 8 8. In which of the following situations would a living will provide clear direction to the care and treatment of the individual involved? A) Mr. Penny, age 81, has been diagnosed with bone cancer, is experiencing severe pain, and has been presented with treatment options. B) Ms. Jelic, age 78, has been brought to the emergency department after falling on an escalator. C) Mrs. Kerr, age 77, has been admitted to hospital with an electrolyte imbalance secondary to an accidental overdose of diuretics. D) Mr. Jimenez, age 84, has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive. Ans: D Feedback: Living wills are legal documents whose purpose is to allow people to specify the type of medical treatment they would want or not want if they become incapacitated as a result of terminal illness. A limitation of living will directives is that they apply only to situations in which the person is considered terminally ill, whereas advance directives apply to a broader range of circumstances. Origin: Chapter 9- Legal and Ethical Concerns, 9 9. An 81-year-old adult suffered an ischemic stroke 6 days ago. The client has failed to regain consciousness since the event. The care team has approached the client's family to obtain their views on inserting a feeding tube. Which of the following documents will allow the family to make a decision on the parent's behalf? A) A do not resuscitate (DNR) order B) A living will C) A durable power of attorney for health care D) A will Ans: C Feedback: A durable power of attorney for health care is an advance directive that takes effect whenever someone cannot, for any reason, provide informed consent for health care treatment decisions. A will, a DNR order, or a living will do not confer this authority on the client's family member. Origin: Chapter 9- Legal and Ethical Concerns, 10 10.A series of transient ischemic attacks have caused an older adult to become dysphagic. Despite failing a swallowing assessment, the client is opposed to eating a minced and pureed diet and wishes to eat a regular diet. How should the care team respond to this request? A) Insert a feeding tube to provide nutrition while eliminating the risk of aspiration. B) Continue providing a minced and pureed diet to the client in order to ensure safety. C) Defer responsibility for feeding to the client's friends and family. D) Provide the client's requested diet after ensuring the client understands the risks. Ans: D Feedback: A common ethical dilemma is a client's or client's family's desire to continue an activity at risk. In general, an individual has the autonomy to choose this unless he or she is declared incompetent. Origin: Chapter 9- Legal and Ethical Concerns, 11 11. An older adult client with urosepsis has become nonresponsive. The nurse is to identify the appropriate person to sign the consent forms for an invasive medical procedure. Which of the following actions by the nurse is appropriate? A) Find the older adult's family member to sign the consent. B) Inform the health care provider that no consent can be obtained. C) Move forward with guardianship as the client is incompetent. D) Review the chart for a health care power of attorney. Ans: D Feedback: The client, at this time, does not have the decision-making capacity to sign consents. Guardianship is a permanent option that is used only when a person has been declared incompetent. When the client does not have the decision-making capacity to sign consents, the durable power of attorney for health care should do so. If there is no power of attorney, the nurse needs to follow the institutional protocol for obtaining consent. Origin: Chapter 9- Legal and Ethical Concerns, 12 12. An older adult with heart failure and mild dementia states the intent to refuse low sodium diet and diuretics, stating: "It's important to me to live free, without restrictions on what I eat." The family is supportive. Which action, by the nurse, should be done first? A) Assure that the client understands the consequences of this decision. B) Discuss this decision with the older adult's family to plan for the future. C) Document the client's wishes in the plan of care. D) Notify the primary health care provider of the client's wishes. Ans: A Feedback: All of these actions should be done; however, the primary concern is that the nurse assess the client's understanding of the consequences. During mild-to-moderate stages of dementia, assessment of decision-making ability is based on the person's ability to describe the importance or implications of the choice on his or her future health. Medical decision making is a complex process in which information is shared between clients and clinicians and among family and others who are affected by the outcomes. Origin: Chapter 9- Legal and Ethical Concerns, 13 13.A nurse in the long-term care facility plans a meeting to assist an older adult and family discuss end-of-life care options. Which of the following interventions is appropriate for the nurse to include in preparation for this event? (Select all that apply.) A) Assist the older adult to his or her wear hearing aid. B) Assure that the older adult is well rested. C) Obtain a private meeting room. D) Premedicate the older adult with Ativan (lorazepam). E) Schedule the meeting after a meal. Ans: A, B, C Feedback: An important role of nurses is to promote optimal decision-making capacity by competency and the ability to make decisions for herself. Origin: Chapter 10- Elder Abuse and Neglect, 4 4.Which of the following statements is true about the laws of mandatory abuse reporting? A) Government agencies, not individual nurses, are responsible for reporting abuse. B) Mandatory reporting laws require reporters to know whether abuse or neglect has occurred, rather than just suspecting it has occurred. C) The use of an abuse reporting protocol replaces individual responsibility for reporting. D) A registered nurse is mandated to report abuse or neglect if it is suspected. Ans: D Feedback: In all states within the United States, individual nurses are responsible for reporting abuse. Mandatory reporters are required to report the suspicion of abuse or neglect. Protocols do not replace individual responsibility. Protocols clarify individual roles and enhance the credibility of the abuse report. Origin: Chapter 10- Elder Abuse and Neglect, 5 5.A 30-year-old grandchild lives with and provides care for the 75-year-old grandparent. The grandparent has congestive heart failure, hypothyroidism, and chronic pain from a compression fracture and osteoporosis. The grandchild supervises the older adult's medications. The home health nurse notes that the older adult has extra diuretic pills and that the pain medications for a month have been used and cannot be refilled for 2 more weeks. The older adult tells the nurse: "Those pain pills don't work, my back is always hurting." The nurse notes that the older adult's ankles are very swollen. Which of the following things should the nurse do first? A) Call adult protective services and ask for an immediate evaluation. B) Assess the grandchild's understanding of her grandmother's needs. C) Take the grandmother to the emergency department immediately. D) Tell the older adult that her grandchild is probably taking her pain medications. Ans: B Feedback: Physical neglect can arise from the caregiver's lack of knowledge. It is important to assess the caregiver's understanding of the dependent person's needs before drawing other conclusions. Origin: Chapter 10- Elder Abuse and Neglect, 6 6.A nurse who works with the older population is aware that elder abuse takes many forms. Which of the following examples most clearly constitutes elder abuse? A) A paid caregiver cleans and assists with shopping for an older adult who lives alone. B) An older adult assists with child care in exchange for room and board at her niece's house. C) A daughter manages her mother's finances after the older adult granted her power of attorney. D) A daughter changes her mother's incontinence brief only after the urine has soaked through all her clothing because she wants to save money. Ans: D Feedback: Allowing an older adult to remain in soiled clothing as a way of preserving financial assets is a form of elder abuse. Power of attorney confers legitimate financial control to an individual and this is not necessarily coercive or abusive. Fair exchanges of services for money or housing do not constitute abusive situations. Origin: Chapter 10- Elder Abuse and Neglect, 7 7.A nurse who provides care in a clinic comes into contact with numerous older adults, many of whom have bruises of various sizes and stages on their body. What pattern of bruising is most suggestive of possible abuse? A) Significant bruising on the shin region of a client's leg B) Bruising on both ears and both sides of the neck C) Bruising on the back of a client's hands D) Bruising on both of a client's elbows Ans: B Feedback: Bruising on the neck and ears is not typically accidental. Conversely, bruising on the backs of the hands, elbows, and shins is more common and less likely to raise the suspicion of abuse. Origin: Chapter 10- Elder Abuse and Neglect, 8 8.An 81-year-old has been living for the past 2 years in a long-term care facility. However, financial pressures have required that the resident move in with the oldest child and spouse. Which of the following statements if made by the child's spouse should signal a potential risk for elder abuse? A) "I sure hope that we'll qualify for some home care because this seems pretty overwhelming." B) "This won't be easy for anyone. I think I might even end up having to juggle my work schedule." C) "He's used to being waited on here, but at our place he's going to have to fend for himself." D) "I'm probably going to even have to get some friends or neighbors to help out from time to time." Ans: C Feedback: It is normal and reasonable to be somewhat overwhelmed with the prospect of providing care for an older adult. However, a suggestion that the older adult may have to go without care is problematic and a potential precursor to elder abuse (neglect). Origin: Chapter 10- Elder Abuse and Neglect, 9 9.A wound care nurse is assessing a 76-year-old client. The client has intimated to the nurse that her son sometimes "flies off the handle and gets rough with me." Which response made by the nurse is the best response? A) "When you say 'gets rough,' what does that look like?" B) "What do you think usually provokes this to happens?" C) "I'm going to have to phone adult protective services right now." D) "Why do you think that there is that response with anger or frustration?" Ans: A Feedback: Safety is the first priority in cases of elder abuse and prompt action is often necessary. However, gathering additional information, detail, and context is appropriate when a threat is not immediate. Speculating about a perpetrator's motives is unnecessary and inappropriate. Origin: Chapter 10- Elder Abuse and Neglect, 10 10.An older adult who appears to be between 85 and 95 has been brought to the emergency department by emergency medical services after being found wandering in the street. The older adult is filthy, confused, and exhibits numerous bruises to the face and neck as well as signs of malnutrition and dehydration. What problem should the nurses prioritize for assessment and intervention? A) Hygiene B) Malnutrition C) Dehydration D) Potential elder abuse Ans: C Feedback: Nursing guidelines emphasize that interventions related to hydration status are higher priority than most other problems, including hygiene, and malnutrition; elder abuse is not an immediate threat when the older adult is in a health care setting. Origin: Chapter 10- Elder Abuse and Neglect, 11 11.A nurse in a hospital setting assesses an older adult and is unsure if the assessment data warrant notification to the authorities for elder abuse. Which action is most appropriate for the nurse at this time? A) Determine if the person has dementia. B) Discuss findings with the family. C) Follow the hospital protocol for reporting. D) Question the visitors. Ans: C Feedback: The nurse is a mandatory reporter for potential elder abuse; the authorities can make the final determination if abuse has occurred or not. Nurses assess all potential contributing Origin: Chapter 11- Cognitive Function, 1 1.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 Feedback: Crystallized intelligence refers to vocabulary skills, information, and verbal comprehension. Fluid intelligence involves a person's inherent abilities, such as memory and recognition, and involves adaptive thinking. Memory involves retrieval and storage of information. Origin: Chapter 11- Cognitive Function, 2 2.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 Feedback: The nursing diagnosis of health-seeking behaviors is defined as "the state in which an individual in stable health actively seeks ways to alter personal health habits and/or the environment in order to move toward a higher level of wellness." The older adult is seeking help from the nurse to remember things better so this is the most appropriate diagnosis. Origin: Chapter 11- Cognitive Function, 3 3.A 70-year-old tells a nurse, "I am worried that I'm losing my mind, I have difficulty remembering names as well as I used to, and I missed two health care appointments in the past month because I forgot about them." The nurse initiates a memory training program, although the nurse has been unable to identify any risk factors that might affect the older adult's cognitive abilities. Which of the following questions is the best approach to evaluating the effectiveness of the memory training program? A) "Have you seen an improvement in your memory?" B) "Are you less worried about your memory now?" C) "How have the memory training techniques helped you?" D) "Are you using the memory training techniques now?" Ans: C Feedback: The question, "How have the memory training techniques helped you?," allows the older adult to tell the nurse how memory training has helped and is more open-ended than the other options. It also communicates positive expectations. The question helps identify the techniques that are most effective for the individual. Origin: Chapter 11- Cognitive Function, 4 4.A nurse assesses a 61-year-old adult who reveals that he can't process as quickly as when younger, and that "all these people talk about multi-tasking, but I can't do that!" Which of the following responses by the nurse is appropriate? A) "Have you had any other symptoms of cognitive impairment?" B) "Slower processing of information is an age-related change, and there are things you can do to help with this." C) "The declines in cognitive skills usually begin around the age or 60." D) "You shouldn't expect to see a decline the cognitive functions that you use all the time." Ans: B Feedback: Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. The earliest cognitive changes are due to decreased perceptual speed. The other distracters do not answer his question. It is important for the nurse to address the client's concerns; in this case, the client is asking if it is expected to already have age-related functional consequences. Age-related declines in some cognitive skills begin around the age of 40, but there are substantial individual variations in these changes. Cognitive functions that depend on experience, accumulated knowledge, and well-practiced tasks (e.g., vocabulary) do not decline in healthy older adults, and may even improve. Origin: Chapter 11- Cognitive Function, 5 5. 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 Feedback: Metacognition means that an individual understands his or her own cognitive process, and this process will impact performance. Health education provides information about techniques to enhance cognitive abilities. Older adults benefit from internal and external memory-enhancing techniques, such as calendars, imagery, and notes. Origin: Chapter 11- Cognitive Function, 6 6. 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 Feedback: Adverse medication effects can have a profound influence on the cognitive functioning of older adults. Genetic, environmental, and occupation factors are potential risk factors, but medications are more commonly implicated. Origin: Chapter 11- Cognitive Function, 7 7.A nurse discusses recent changes with a 74-year-old client. The client is distraught stating, "I forgot an important appointment; and I lost my wallet!" The older adult has always cherished being intelligent, alert, and informed, so even minor lapses in cognition are a source of stress. How should the nurse best interpret these recent deficits in memory? A) The older adult is likely experiencing the early stages of Alzheimer disease. B) The older adult is likely experiencing a temporary state of delirium that will self- resolve. C) The older adult may be experiencing age-related changes in personality. D) The older adult may be experiencing mild cognitive impairment. Ans: D Feedback: Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. Longitudinal studies have identified patterns of cognitive change that are likely to occur even in the absence of any pathologic processes. This does not rule out the possibility of dementia or delirium, but a fundamental change in personality is unlikely. Origin: Chapter 11- Cognitive Function, 8 8.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 Feedback: The cognitive reserve model suggests that cognitive abilities can be improved through participation in creative and intellectually stimulating activities. Reminiscence may provide some social interaction and movies serve as a distraction. Exercise does increase Origin: Chapter 11- Cognitive Function, 14 14.A 90-year-old client discusses her life review with a nurse and shares information about how she has raised five children and had "ups and downs" with all of them, but overall feels satisfied with her life. Based on Cohen's empowering model, which of the following statements is the client likely to make? A) "I would sum it up this way." B) "I really would like to see the Grand Canyon." C) "I hope to learn how to Skype with my grandchildren." D) "I know I've done the best that I can do, and I expect I will continue to help my family." Ans: D Feedback: Cohen's empowering model related that those at the end of their life are more likely to reaffirm major themes in their life. From the 50s till the 70s, persons reevaluate life and feel a new sense of inner liberation as expressed in the distracters by discussion of goals. After the late 70s, older adults restate and reaffirm their major themes, including the desire to live well to the very end and have a positive impact on others. Origin: Chapter 11- Cognitive Function, 15 15.An older adult expresses frustration about limitations of aging. Which of the following statements by the nurse promotes wellness? A) "Do you have some words of wisdom to share about that valuable experience?" B) "How does living in these conditions compare to your youth?" C) "Have you met any of your neighbors, they seem like nice people?" D) "What you are saying is that you are frustrated with how they are not listening to you?" Ans: A Feedback: Instead of asking about current versus historical, the nurse should acknowledge the wisdom of older adults by asking questions such as "Do you have some words of wisdom to share? Asking about neighbors is deflection and not helpful?" Reflection can be appropriate, but at this time positive acknowledgment should be used. Origin: Chapter 12- Psychosocial Function, 1 1.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 Feedback: Older adults may use a passive, emotion-focused coping mechanism and try to simply accept the situation. When older adults view functional decline as an inevitable consequence of aging, they are less likely to seek help for some treatable problems. Origin: Chapter 12- Psychosocial Function, 2 2.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 Feedback: In this case, following the client's wishes is an integral part of routine nursing care, as it helps individualize nursing care to this particular client. The nurse must be nonjudgmental and communicate respect for the client's individuality. Origin: Chapter 12- Psychosocial Function, 3 3.A nurse manager of an extended care facility works to promote psychosocial health. Which of the following interventions should the nurse manager include? A) Adapt the environment to compensate for residents' sensory impairments. B) Dress residents exclusively for ease in going to and from the restroom. C) Plan dining room arrangements according to room and hall assignments. D) Position the residents who are in wheelchairs solely for ease in getting out of the dining area. Ans: A Feedback: Table and room arrangements should be made in a way that promotes social relationships. Older adults should be allowed to choose between at least two alternatives when dressing. Residents in wheelchairs should be positioned to promote social interaction. Origin: Chapter 12- Psychosocial Function, 4 4.A nurse teaches a nursing assistant about the impact of culture on older adults' well- being. Which of the following statements by the nursing assistant indicates a need for further teaching? A) "A cultural background has little influence on individuals' standards for 'normal' or 'abnormal' behavior." B) "Western cultures often have a very rigid distinction between health and illness." C) "Culture may influence mental health and illness in individuals." D) "Culture may determine an individual's expression of symptoms or clinical manifestations." Ans: A Feedback: Cultural background significantly influences how a person defines all aspects of psychosocial function. It is essential to recognize that every society has standards of behavior. Many societies do not have the rigid distinction between health and illness that Western society does. Origin: Chapter 12- Psychosocial Function, 5 5.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 Feedback: Resident meetings allow older adults to address personal preferences and to make choices. Posting the meals and later allowing choices is giving the older residents a limited chance to make a choice. Safety should be an ongoing concern. Origin: Chapter 12- Psychosocial Function, 6 6.A nurse assists adults to prepare for the changes that often occur in late adulthood. Which of the following psychosocial consequences occur because of life events during that period? (Select all that apply.) A) A broadening of social networks B) Adjusting to relocation from home C) Adjustment to a lower income 12.A community health nurse presents a class on "Aging in America: Living the Dream." Which of the following should the nurse stress when discussing retirement? (Select all that apply.) A) Delaying retirement until unable to work can be beneficial. B) Factors such as health, friendship relationships, and resources influence the transition. C) Sometimes the adjustment is more difficult for the partner who has not been employed. D) The adjustment to retirement is best accomplished quickly and with finality. E) A strong work ethic assists in the adjustment to retirement. Ans: B, C Feedback: Factors such as health, family and friendship relationships, and economic and social resources influence the transition. Sometimes the adjustment is more difficult for the partner who has not been employed. Work ethic in society can diminish the retirees' status, delay of full retirement can assist with the transition, and delay in retirement is best done in a gradual manner (changing to part time, becoming self-employed). Origin: Chapter 12- Psychosocial Function, 13 13.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 Feedback: The majority of older adults do rate their health as good, but she doesn't and can't until her issue is reframed to one that she can control. Allowing her to make the decisions is good, but her current decision is to passively and inaccurately accept this treatable condition. Origin: Chapter 12- Psychosocial Function, 14 14.A nurse admits an 81-year-old to the hospital for congestive heart failure. The client is widowed, and has recently moved to an assisted living facility. Which of the following contributed the most to this admission? A) Moving changed her daily habits. B) Her age-related changes and risk factors increased. C) The stress of widowhood and relocation stressed her body. D) The assisted living facility serves food high in saturated fats. Ans: B Feedback: There is a strong connection between chronic stress and health. Studies find that chronic stress increases the risk for onset of major illnesses and exacerbation of chronic illnesses. Origin: Chapter 12- Psychosocial Function, 15 15.A nurse assesses an 85-year-old Hispanic woman. The client states that her husband was punished by God. To which of the following illnesses is the woman most likely referring? A) Alcohol abuse B) Fainting C) Posttraumatic stress disorder (PTSD) D) Voodoo Ans: A Feedback: For some Hispanics, mental illness may be viewed as a punishment by a supreme being for past transgressions; Hispanic older adults define mental health problems as alcohol and other drug abuse. PTSD is relatively common in immigrants. Hallucinations are not especially related to Hispanic culture. Those of Caribbean descent may attribute the cause of mental illness to voodoo. Origin: Chapter 13- Psychosocial Assessment, 1 1.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 Feedback: A psychosocial assessment is one component of the mind–body–spirit nature of holistic nursing care of older adults. It is not a formal psychological examination, nor does it exist to identify specific personality traits or the need for psychiatric intervention. Origin: Chapter 13- Psychosocial Assessment, 2 2.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 Feedback: The nurse demonstrates empathy and respect, while also facilitating further assessment findings around the client's beliefs for recovery through the use of an open-ended question. The nurse should not demonstrate a false reassurance of recovery, nor downplay the client's concerns. The nurse does not use patronizing terms of address (dear, honey, sweetie). Origin: Chapter 13- Psychosocial Assessment, 3 3.A nurse assesses an older adult's abstract thinking ability. Which of the following questions is most appropriate? A) "Do you know why you are in hospital right now?" B) "What do a dog and a cat have in common?" C) "What goals do you have for your treatment and recovery?" D) "What would you do if you found a stamped, addressed letter on the ground?" Ans: B Feedback: Asking what traits two similar, but not identical, objects share is a way of gaining insight into a client's ability to think abstractly. Option A addresses insight, not abstract thinking, while Option C is a useful assessment question, but not one that addresses abstract thinking. Option D could be used to assess the client's judgment. D) Illusions Ans: A Feedback: Delusions are fixed false beliefs that have little or no basis in reality and cannot be corrected by appealing to reason. Hallucinations are sensory experiences that have no basis in an external stimulus. Delusions are not known to be a manifestation of unresolved anger. Illusions are misperceptions of an external stimulus. Origin: Chapter 13- Psychosocial Assessment, 10 10.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 Feedback: Appraising an individual's understanding of why he or she is receiving treatment can help assess insight. Questions about hypothetical responses to situations also assess executive function, but not insight specifically. Origin: Chapter 13- Psychosocial Assessment, 11 11. During an admission interview, a client gives the following response to a question about living arrangements. "I can't stay in my own home. Now that I've fallen and broken my hip, I'm not sure what the doctor will say. My children don't want me." Which response by the nurse is most appropriate? A) "You worry that the doctor will tell you need surgery?" B) "You fell and broke your hip?" C) "Your children don't want…" D) "Where you want to live?" Ans: C Feedback: Reflection about the children gives feedback about what the nurse heard and leads into further questions about underlying feelings. The client has already expressed that they can't live at home, asking where they want to live when they don't have the choice is not therapeutic. We know that this client has a broken hip, and the conversation is not about surgery. Origin: Chapter 13- Psychosocial Assessment, 12 12. During an interview with an older adult, the client moves her chair back. Which of the following responses by the nurse is most appropriate? A) Stop the interview and give her recovery time. B) Move own chair closer. C) Sit upright, leaning back. D) Ask the client if she is okay. Ans: C Feedback: It is important to consider the physical space required for the person to feel at ease when communicating with others. Men usually like to have larger personal space than women. Sit upright and leaning back will give more personal space. The nurse adjusts to cultural needs of clients, including nonverbals. There is no need to stop the interview or ask if she is okay. Origin: Chapter 13- Psychosocial Assessment, 13 13.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 Feedback: The nurse assesses the amount of time and effort expended in answering questions. This is particularly important when trying to differentiate between dementia and depression. Lack of education and concrete thinking would not slow the client in responding to assessment tools such as the mini-mental. Confabulation is when the client creates information. Origin: Chapter 13- Psychosocial Assessment, 14 14.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 Feedback: The affect of depressed people is generally sad and negativistic and is not influenced by external circumstances. By contrast, the affect of people who have dementia fluctuates more and changes in response to distractions. Origin: Chapter 13- Psychosocial Assessment, 15 15.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 Feedback: Infection, digoxin toxicity, and a stroke can all lead to hallucinations. Hyperglycemia and myocardial infarction generally do not. Ans: D Feedback: Nurses can use phrases such as "a person with dementia" or a "person with a dementing illness" to accurately refer to the medical syndrome of impaired cognitive function while avoiding pejorative connotations associated with describing older adults as "demented." The terms "senile" and "organic brain syndrome" are no longer in use. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 7 7.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 Feedback: While the four major types of dementia are not discrete or mutually exclusive, vascular dementia is characterized by pathophysiologic processes including infarctions from occlusion of blood vessels. This pathophysiology is not characteristic of Alzheimer disease, Lewy body dementia, or frontotemporal lobe dementia. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 8 8.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 Feedback: One of the myths associated with dementia is that people with dementia deny their symptoms or have no awareness of their deficits. In recent years, this perception of a high prevalence of so-called denial in people with dementia has diminished, and gerontologists are researching insight and self-awareness through all stages of dementia. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 9 9.A gerontological nurse has been providing ongoing care for an older adult who has a diagnosis of dementia. What goal should the nurse prioritize when conducting ongoing assessment of this client? A) Identifying strategies that can be used to cure the client's dementia B) Identifying genetic or lifestyle factors that may have contributed to the client's dementia C) Determining whether the client has Alzheimer disease, Lewy body dementia, or frontotemporal lobe dementia D) Identifying factors affecting the client's functioning and quality of life Ans: D Feedback: A major goal of ongoing assessment of clients with dementia is to identify factors that interfere with the person's level of functioning or quality of life so that interventions can be initiated to alleviate these contributing factors. Medical diagnosis is not a nursing action and causative factors are not a priority after diagnosis. Dementia is not curable. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 10 10.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 Feedback: Pictures, signs, and color codes can help to orient persons with dementia. Floors and walls do not need to be one color, and glossy floors and total darkness at night are safety hazards for this population. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 11 11.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 Feedback: Cholinesterase inhibitors are standard treatment for mild-to-moderate Alzheimer disease. Anticholinergics, including benzodiazepines, as well as atypical antipsychotics can all lead to delirium. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 12 12.A 74-year-old client is diagnosed with mild Alzheimer disease. He has no other noted health issues. When speaking with the nurse, he expresses concern regarding the progression of his disease. Which statement by the nurse is most appropriate? A) As you have no other health issues, the progression is usually gradual. B) The medications stop the progression of the disease. C) We never know how fast Alzheimer disease will progress. D) Yes, progression is usually fairly fast, you might want to start making plans. Ans: D Feedback: Alzheimer disease is very gradual; it has accelerated decline with concomitant conditions. Medications slow the progression, but don't stop it. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 13 13.A intensive care nurse cares for an 83-year-old with sepsis. The client exhibits illogical thinking and agitation. Which intervention should the nurse implement? (Select all that apply.) A) Administer a benzodiazepine. B) Assess for pain. C) Assure a quiet, dark sleep time. D) Initiate fall prevention program. E) Post pictures of client's family in room. Ans: B, C, D, E Feedback: Older clients with infection and those in the ICU are at great risk for delirium. Sleep, rest, pain control, and familiar items are interventions to minimize delirium. The client is a greater risk for falls so a fall prevention program should be initiated. Benzodiazepines should be avoided. Origin: Chapter 14- Impaired Cognitive Function- Delirium and Dementia, 14 14.A nurse councils a care partner of a client with dementia. The care partner states "He fights me when I try and bath him; he hasn't had a shower in 2 months!" Which response by the nurse is most appropriate? A) "I hear your frustration." B) "He wants to feel he has a choice. How do you get him to shower?" C) "I would just put him in there, he needs to be clean." D) "Whatever worked before should work now." E) "What other ways have you tried to assure he is clean?" Ans: E Feedback: There are multiple ways to stay clean, if showering is a trigger, then avoid it. What has worked in the past does not mean it will work again. Forcing a shower is unsafe. They Origin: Chapter 15- Impaired Affective Function- Depression, 4 4.A nurse educator teaches about theories of late-life depression. Which of the following statements by a student shows that the material is understood? A) "Adverse events impair your ability to evaluate yourself." B) "Depression is caused by decreased activity in the hypothalamic–pituitary–adrenal axis." C) "Older adults with depression and chronic illness have more serious negative functional consequences." D) "Researchers have identified a cause-and-effect relationship between depression and dementia." Ans: C Feedback: Studies consistently find that the co-occurrence of depression with chronic conditions in older adults is associated with more serious negative functional consequences. Cognitive theory says that distorted perceptions, not adverse (unfavorable) events, impair one's ability to appraise oneself and the event constructively. Increased plasma cortisol levels and increased activity of the hypothalamic–pituitary–adrenal axis can lead to depression. Researchers have identified neuropathologic changes but have not identified a specific cause-and-effect relationship between dementia and depression. Origin: Chapter 15- Impaired Affective Function- Depression, 5 5.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 Feedback: Suicide assessment is multilevel, and each level of questions depends on the response the client gives to the previous level's questions. Level 1 questions determine the presence or absence of suicidal thoughts. Level 1 questions are indirect; at level 2, they become more direct. Level 2 determines the presence or absence of thoughts about self-harm. Level 3 questions determine whether the client has a realistic suicide plan. Origin: Chapter 15- Impaired Affective Function- Depression, 6 6.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 Feedback: Alcohol and depression have a synergistic relationship: alcohol causes depression, depression leads to alcohol abuse, which, in turn, exacerbates the depression. Four or five drinks daily is excessive, but abstinence is not necessary for all older adults. Abstinence is not guaranteed to improve symptoms of depression. Origin: Chapter 15- Impaired Affective Function- Depression, 7 7. 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 Feedback: Medications may be risk factors for depression in numerous ways. A functional assessment is necessary, but this is more likely to ascertain the effects, rather than causes, of her depression. Musculoskeletal and cardiovascular assessments are secondary. Origin: Chapter 15- Impaired Affective Function- Depression, 8 8. 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 Feedback: Early morning waking is a sleep disturbance that is characteristic of depression. Headaches and impaired healing may also be linked with depression, but sleep disturbances are more highly associated with the problem. Food cravings are not typical of depression in older adults. Origin: Chapter 15- Impaired Affective Function- Depression, 9 9.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 Feedback: All of these statements may be indicative of depression, but an allusion to suicide always constitutes the priority for further follow-up. Origin: Chapter 15- Impaired Affective Function- Depression, 10 10.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 Feedback: Social engagement and contact of all types has the potential to aid in the treatment of depression. Appointing a “buddy,” however, is likely to be construed as intrusive and is unfair to the other resident. Asking an individual to focus on positives may be seen as simplistic. Teaching about suicide is unlikely to alleviate the signs and symptoms of depression. Origin: Chapter 15- Impaired Affective Function- Depression, 11 11.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 Feedback: White men aged 85 years and older have the highest suicide rate. One of the commonly Origin: Chapter 16- Hearing, 1 1. A 62-year-old who has worked on an assembly line since he was 24 years old began taking aspirin for arthritis 6 months ago. The client presents to the nurse with hearing problems and ringing in the ears. Which of the following problems should the nurse suspect? A) Tinnitus B) Vertigo C) Ototoxicity D) Impacted cerumen Ans: C Feedback: The older adult has symptoms of ototoxicity. Aspirin is a known ototoxic drug. Tinnitus is the persistent sensation of ringing in the ears, which is one of this client's symptoms. Vertigo is a sensation of motion, which is not a reported symptom for this client. Although common, impacted cerumen would not lead to ringing in the ears. Origin: Chapter 16- Hearing, 2 2. A new nursing assistant asks the nurse how best to approach a hearing-impaired older adult. Which of the following approaches should the nurse recommend? A) Raise the volume of your voice. B) Leave the radio on to calm the older adult. C) Lower the tone of your voice. D) Use exaggerated lip movements. Ans: C Feedback: Communication interventions for the hearing impaired should aim at clarity of words. This is accomplished by slowing the rate of speech and eliminating environmental noise and distractions. When communicating, lower the tone while speaking in a moderately loud voice. Origin: Chapter 16- Hearing, 3 3. A nurse is teaching a group of hearing-impaired nursing home residents about hearing aids. Which of the following points should the nurse emphasize? A) It is not necessary to use the hearing aid for one-on-one conversations. B) The hearing aid should be used only in the dining room or social area. C) While inserting the hearing aid, make sure the volume is turned off. D) If whistling is heard, the volume of the hearing aid may need to be increased. Ans: C Feedback: The hearing aid should be inserted with the volume off with the canal portion pointing into the ear. A hearing aid should be used for one-on-one conversation and should not be used in a dining room where there is background noise. If whistling is heard, the volume should be decreased. Origin: Chapter 16- Hearing, 4 4. A nurse notes that a client who has heart failure could hear well during the last home visit, and is having difficulty hearing today. Which of the following laboratory findings is most likely associated with impaired hearing? A) Albumin of 4.1 B) Creatinine of 4.2 C) Potassium of 4.3 D) Sodium of 144 Ans: B Feedback: Older adults with heart failure are at increased risk for hearing loss caused by medications (e.g., diuretics) and decreased renal and cardiac perfusion. Normal levels of albumin, potassium, and sodium are not associated with hearing loss. Origin: Chapter 16- Hearing, 5 5. An 85-year-old woman who lives alone says to the nurse, "There is nothing I can do about my hearing. I am 85 years old, and I am not really interested in listening to television programs anymore." Which of the following would be the nurse's best response? A) "You are lucky you still live alone at 85, and I understand why you don't care about the programs on television." B) "Have you talked with your health care provider about a hearing evaluation? This would determine the problem and possible solutions to it." C) "I know a hearing aid dealer who offers free testing. Have you thought about trying a hearing aid?" D) "Did you know that there are closed-caption television sets that would allow you to enjoy some shows?" Ans: B Feedback: The first step would be to determine what the problem is. Free testing is not comprehensive in its evaluative scope. Telling the client she is lucky to be living alone at 85 years of age is nontherapeutic communication and suggesting that the woman use closed-caption television does not address the hearing issue. Origin: Chapter 16- Hearing, 6 6. A 76-year-old adult expresses frustration to the nurse regarding hearing loss despite a lifetime of being conscientious about avoiding known causes of hearing damage. Which of the following age-related changes may result in hearing loss? A) Degeneration of the inner ear structures B) Decreased viscosity and quantity of cerumen C) Plaque formation and occlusion of the Eustachian tubes D) Hypertrophy of the external ear structures Ans: A Feedback: Age-related changes of the inner ear include loss of hair cells, reduction of blood supply, diminution of endolymph production, decreased basilar membrane flexibility, degeneration of spiral ganglion cells, and loss of neurons in the cochlear nuclei. These inner ear changes result in the degenerative hearing impairment termed presbycusis. Cerumen often becomes more viscous with age, and occlusion of the Eustachian tubes is not a normal, age-related change. Changes to the external ear structures are not implicated in age-related hearing loss. Origin: Chapter 16- Hearing, 7 7. A nurse who regularly visits an adult daycare center has noted evidence of a hearing deficit in a man who has no documented history of hearing loss. Which of the following factors should the nurse consider when attempting to ascertain the etiology of the man's hearing loss? (Select all that apply.) A) Genetic factors B) Environmental conditions C) Fluid and electrolyte imbalances D) Ototoxic medications E) Atherosclerosis or thrombotic events Ans: A, B, D Feedback: Medications, genetic factors, and environmental factors are all among the many potential contributors to hearing loss in older adults. Fluid and electrolyte imbalances, atherosclerosis, and thrombosis are not commonly implicated in hearing loss among older adults.