Gerontological Nursing: Care and Management of Older Adults, Study Guides, Projects, Research of Gerontology

Download Gerontological Nursing: Care and Management of Older Adults and more Study Guides, Projects, Research Gerontology in PDF only on Docsity! Updated And Verified Test Bank for Gero GERONTOLOGICAL NURSING & HEALTHY AGING 5TH EDITION TOUHY Which option refers to the highest level of human functioning according to Maslow? a.Biological and physical integrity b.Safety and security c.Self-esteem d.Self-actualization - correct answer ANS: D According to Maslow, persons whose basic physical needs are met, who feel safe and secure, and who possess self-esteem and self-efficacy can achieve self-actualization, reaching out beyond themselves to make their lives meaningful. Biological and physical integrity is the lowest level in Maslows hierarchy, below safety and security. Safety and security are the second-lowest level, below self-esteem. Self-esteem is the second-highest level, below self-actualization. TOUHY 4TH ED TESTBANK A man is terminally ill with end-stage prostate cancer. Which is the best statement about this mans wellness? a.Wellness is possible in the management of his medical care. b.Wellness is unfortunately not a real option for this client. c.Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks. d.Nursing interventions can help empower a client to achieve a higher level of wellness. - correct answer ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness at all levels of the needs hierarchy. Wellness is possible even if the client assists in the management of his medical care; an individual must work hard to achieve wellness, similar to a job. Wellness is unfortunately not a real option for this client; however, all persons, regardless of age or life-health situations, can be helped to achieve a higher level of wellness. Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks; biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness. TOUHY 4TH ED TESTBANK In differentiating between health and wellness in health care, which of the following statements is true? a.Health is a broad term encompassing attitudes and behaviors. b.The concept of illness prevention was never considered by previous generations. c.Wellness and self-actualization develop through learning and growth. d.Wellness is impossible when ones health is compromised. - correct answer ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves ones whole being. schedule to prevent missed doses of medication. Providing safety and security from the storm is Maslows second most basic need. In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important but not in emergency conditions. A state of emergency is not the time to develop self-esteem; meeting safety, security, and physical needs are more important. TOUHY 4TH ED TESTBANK According to researchers, which characteristic will most centenarians share in the future? a.Female b.Demented c.Malnourished d.Wheelchair bound - correct answer ANS: A Researchers expect women to make up the majority of centenarians in the future. Gerontologists expect dementia to be common among older adults, but they are not predicting most centenarians will have dementia. Malnutrition is common among older adults, but researchers have not predicted that most centenarians will be malnourished. Decreased mobility is common among older adults, but researchers have not predicted that most centenarians will be confined to a wheelchair. TOUHY 4TH ED TESTBANK Which statement describes aging in developing countries? a.Aged dependence is likely to improve from 1:4 to 1:2. b.The biggest problem for older adults will be the lack of food. c.Most older adults are likely to reside in these countries. d.Similar to fertility, life expectancy is increasing, although at a different rate. - correct answer ANS: C Currently, developing countries already contain two thirds of the worlds older adult population. Aged dependence is likely to deteriorate from 1:4 to 1:2. The biggest problem of the worlds oldest adults is most likely to be a lack of regular income. Life expectancy is increasing, but fertility is decreasing worldwide. TOUHY 4TH ED TESTBANK An older woman tells the nurse that she has experienced increasing fatigue and shortness of breath over the last 2 days. Which goal is the nurses priority? a.Promote safety to prevent injury. b.Complete nutritional assessment. c.Balance exercise and rest periods. d.Explore the womans complaints. - correct answer ANS: D Investigating the complaint is the nurses priority; fatigue and shortness of breath can indicate cardiac disease, especially in women. Women with cardiac disease often exhibit atypical symptoms, and because it tends to be treated less aggressively in women, the nurse must be careful not to miss indicators of potential cardiac disease. In addition, in investigating the older womans chief complaint, the nurse investigates all possible causes. Promoting safety and preventing injury are reasonable goals to include for this adult but are not as important as investigating the chief complaint; breathing and circulation are two of the three most important physical needs. Completing the nutritional assessment for this adult is reasonable because the symptoms can be related to nutritional deficiencies; however, this assessment should be a part of the examination of the chief complaint. Balancing rest and exercise is a reasonable approach to a complaint of fatigue and shortness of breath if the adult is deconditioned; however, the nurse must investigate the chief complaint to determine whether deconditioning is a factor. increasing, but fertility is decreasing worldwide. TOUHY 4TH ED TESTBANK The nurse develops a community program to promote exercise for older adults. Which should the nurse include in the exercise program? a.Reinforce the ease of exercising every day. b.Use exercise to relax any dietary restrictions. c.Describe ways to resume exercise after lapses. d.Participate because exercise achieves wellness. - correct answer ANS: C Because the path to wellness includes progression, as well as regression, the nurse shares information to help participants anticipate these events. The nurse encourages participants by telling them to expect periods of regression; he or she emphasizes that progress made up to a point is not lost and explains how to approach resumption in progress toward wellness with exercise. TOUHY 4TH ED TESTBANK An older man who resides in a nursing home has total cholesterol of 245 mg/dl. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a.Instruct him about increasing dietary fiber. b.Ask the health care provider for a low-fat diet. c.Schedule a consultation for him with the dietitian. d.Review a menu with him to choose suitable foods. - correct answer ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adults collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with hyperlipidemia achieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input. TOUHY 4TH ED TESTBANK Which approach requires the nurse to integrate and balance all aspects of an individuals life into the plan of care? a.Holistic nursing b.Healthy People 2020 c.Maslows Hierarchy of Human Needs d.Orems Self-Care Requirements - correct answer ANS: A Holistic nursing integrates all aspects of an individuals life into the plan of care by balancing an individuals internal and external environment with psychosocial, spiritual, cultural, and physical processes. Healthy People 2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslows Hierarchy of Human Needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orems Self-Care Requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness. TOUHY 4TH ED TESTBANK An older man living in an adult community becomes a widower 1 month after retirement. Two months later, he has not resumed a weekly outing with his fishing club. Which should the nurse implement? a.Ask the older adult why he is not fishing. b.Have club members visit him at home. c.Meet with him to assess his interests. d.Enroll him in a weekly card game. - correct answer ANS: C The nurse meets with the older adult to determine how and when to establish new relationships and social activities in light of his wifes death. Although the older man was engaged in fishing before, the nurse respects his wishes and needs as he transitions to a different life. The nurse avoids confronting him, even if done so in a gentle manner. Why questions can be interpreted as confrontational, and the older adult may be unable or unwilling to articulate a reason. The nurse avoids asking club members to visit him because doing so would remove the older adult from the decision making process. Although this effort can be well-meaning, it can also be interpreted as an invasion of privacy. The older adult is more likely to participate in an activity in which he has input. In addition, the nurses action can be interpreted as disrespectful because an adult has the right to control his own life. TOUHY 4TH ED TESTBANK The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a.Have them bake cookies twice a week. b.Conduct interviews for specific interests. c.Arrange dog and cat visits from volunteers. d.Take them to the library for guest speakers. - correct answer The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s, were born between 1920 and 1930, and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging b.Arthritis c.Congestive heart failure d.Dementia e.Cancer f.Pressure ulcers - correct answer ANS: A, B, C, D In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia. TOUHY 4TH ED TESTBANK Identify the Healthy People 2020 emerging issues in the health of older adults. (Select all that apply.) a.Coordinating care for the older adult population b.Assisting older adults in the management of their own care c.Identifying levels of training for those caring for older adults d.Making community resources available for older adults e.Increase in health disparities for rural older adults - correct answer ANS: A, B, C According to United States Department of Health and Human Services (USDHHS): Healthy People 2020, emerging issues in the health of older adults are the following: coordinating care; helping older adults manage their own care, establishing quality measures; identifying minimum levels of training for people who care for older adults; and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults. TOUHY 4TH ED TESTBANK 1. An older woman has left-sided paralysis from a thrombus formation in the cerebral vasculature. Rank the nursing goals of this womans plan of care in order of importance, starting with the most important goal. (Select all that apply.) A. Instruct her to call for help before moving. B. Maintain her blood pressure below 120/80 mm Hg. C. Reinforce occupational therapy for feeding. D. Use range-of-motion exercises to prevent contractures. - correct answer ANS: B, A, D, C Using Maslows Hierarchy of Human Needs, the most important goal for this older woman is to control her blood pressure; hypertension and other factors contributed to the development of the thrombus. Thus to prevent further intimal damage to cerebral and other vessels, the nurse maintains the blood pressure at or below the limit as determined by the health care provider. The second priority goal for the nurse is to maintain safety by instructing the older woman to call for help when moving, which will help prevent accidents and injuries. The next goal in importance is the prevention of contractures; joint flexibility is easier to maintain than it is to restore. In addition, joint flexibility is important for adapting to her physical limitations as she learns to perform activities of daily living. The last goal is using joint flexibility and muscle strength to learn self-feeding. The order of these goals is correct; each goal is dependent on the preceding goal for its success. TOUHY 4TH ED TESTBANK A nurse is providing care for a variety of older adults on a transitional care unit. Using Maslows Hierarchy of Human Needs as a basis for prioritizing care, rank the following actions, starting with the most important. (Select all that apply.) A. Encourage a family member to take part in a teaching session. B. Administer 2 liters of oxygen via nasal cannula. C. Place a call bell in reach after transferring the older adult to bed. D. Ask clients their preferences before beginning care. - correct answer ANS: B, C, A, D Using Maslows Hierarchy of Human Needs, the first and most important action to complete is to administer 2 liters of oxygen via nasal cannula, which meets a basic physiological need. According to Maslow, airway, nutrition, and elimination are first-level needs. The second action to complete is placing a call bell in reach after transferring an older adult to bed. A call bell promotes feelings of safety and security, which is addressed in Maslows second level. The third action would be encouraging a family member to take part in a teaching session. This action promotes maintaining support systems and is categorized as love and belonging, the third level of Maslows Hierarchy of Human Needs. The last action would be to ask a client his or her preferences, which would promote self-control and support self-esteem needs, which is Maslows fourth level. TOUHY 4TH ED TESTBANK Identify the best statement about gerontological nursing. a.Nurses have only recently become involved in the care of the older adult. b.More nursing services will be required to serve the needs of the population older than 85 years of age. c.Fewer nurses will be needed to care for older adults. d.Older adults expect their quality of life to be less than that of earlier generations at their ages. - correct answer ANS: B Projections are that 20% of the American population will be older than 65 years of age by 2050, with those older than 85 years showing the greatest increase in numbers. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be over the age of 60 years than those under the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age. TOUHY 4TH ED TESTBANK A case manager is likely to have how many years of nursing education? a. 1 to 1.5 b. 2 c. 4 to 6 d. 8 or more - correct answer ANS: C A case manager typically has a bachelors or masters degree. This amount of training is typical for an LPN, who typically practices at a nursing home or on a home nursing staff. This amount of training, resulting in an Associates Degree in Nursing (ADN), is typical for an associate RN, who is typically found on hospital, home, and nursing home staffs. A nurse with 8 or more years of education, as well as a doctorate, is typically involved in research and teaching. TOUHY 4TH ED TESTBANK Which was the first formal action the ANA took in relation to gerontological nursing? a.Established a national geriatric nursing group b.Defined educational standards for gerontology c.Created the ANA Division of Geriatric Nursing d.Formed the Council of Long Term Care Nurses - correct answer ANS: A The first formal act of the ANA to promote gerontological nursing was to form a national geriatric nursing group in 1962. In 1973, the ANA defined educational standards for geriatric nursing. The ANA Division of Geriatric Nursing was begun in 1966. In 1979, the ANA formed the Council of Long Term Care Nurses. TOUHY 4TH ED TESTBANK A older man is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of long-term care? a.Decrease the analgesic dose to prevent sedation. b.Provide a basin and towels for morning self-care. c.Inform family members about strict visiting hours. d.Facilitate family rituals related to death and dying. - correct answer ANS: D To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to patients, regardless of the setting or the nurses personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adults needs. TOUHY 4TH ED TESTBANK A nursing home executive interviews RNs to fill a full-time position for direct patient care to maintain the standards of elder care. Which nurse should the nursing home hire? a.Nurse from a certified college b.Certified gerontological nurse c.Nurse with 15 years of experience d.Gerontological nurse practitioner - correct answer ANS: B A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15-years experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gerontology, these nurses provide primary care in a nursing home. TOUHY 4TH ED TESTBANK Mezey and Fulmer (2002) justify gerontological nursing research and the work of gerontological advanced practice nurses by concluding the following: a.Other scientists devalue gerontological nursing research. b.The research influences outcomes from nursing care in a positive way. c.Gerontological care is expensive but required in long-term care. d.Gerontological nursing research is well known to practicing nurses. - correct answer ANS: B With the passage of the Social Security Act of 1935, federal monies were provided for old-age insurance and public assistance for needy older people not covered by insurance. To combat the fear of almshouse placement, Congress stipulated that the Social Security funds could not be used to pay for care in almshouses or other public institutions. This move is thought to have been the genesis of commercial nursing homes. During the next 10 years, many almshouses closed, and the number of private boarding homes providing care to older adults increased. Because retired and widowed nurses often converted their homes into such living quarters and gave care when their boarders became ill, they can be considered the first geriatric nurses and their homes to be the first nursing homes. The Hartford Institute has sponsored significant improvements in gerontological nursing practice, research, and education. HMOs have had a significant impact on the management of care but were virtually nonexistent in the 1930s and 1940s. TOUHY 4TH ED TESTBANK Which gerontological organization had a significant influence on the care of older adults? a.American Association of Retired Persons (AARP) b.John Hartford Foundation c.Medicare d.Mutual of Omaha Insurance - correct answer ANS: B The most significant influence in enhancing gerontological nursing has been the work of the Hartford Institute for Geriatric Nursing, funded by the John A. Hartford Foundation. The foundation seeks to shape the quality of the nations health care for older Americans by promoting geriatric nursing excellence to both the nursing profession and the larger health care community. Initiatives in nursing education, nursing practice, nursing research, and nursing policy include enhancing geriatrics in nursing education programs through curricular reform and faculty development and the development of nine Centers of Geriatric Nursing Excellence. AARP is a foundation that helps struggling seniors by being a force for change on the most serious issues they face today. Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees access to health insurance for Americans ages 65 years and older and younger people with disabilities. Mutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska. TOUHY 4TH ED TESTBANK In which areas have advanced practice nurses demonstrated their skill in improving? (Select all that apply.) a.Health outcomes b.Length of stay c.Cost effectiveness d.Reimbursement measures e.Interprofessional communication - correct answer ANS: A, C Advanced practice nurses have demonstrated their skill in improving health outcomes and cost effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams. This role is well established, and positive outcomes include increased patient and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving. TOUHY 4TH ED TESTBANK Identify future directions for gerontological nursing research as suggested by Wykle and Tappen. (Select all that apply.) a.Interdisciplinary practice models b.Intergenerational caregiving c.Health disparities d.Influence of culture on aging e.Long-term care initiatives - correct answer ANS: A, B, C, D The following have been identified for future directions for gerontological nursing research according to Wykle and Tappen: interdisciplinary practice models, intergenerational caregiving, health disparities, and the influence of culture on aging. Long-term care initiatives have not been identified as a future direction for nursing research. TOUHY 4TH ED TESTBANK An older female resident in the residential facility keeps a large collection of personal items and photographs of her late husband on her bedside table, but the nursing assistant and resident frequently argue about this. Why should the nurse intervene between the resident and the nursing assistant? a.Resident is attempting to maintain her sense of personal space. b.Resident needs to accept the reality of her spouses death. c.Residents argumentative nature can indicate early dementia. d.Clutter from all the personal items is a safety and liability risk. - correct answer ANS: A A thoughtful nurse respects and supports the residents boundaries. Even if the resident needed to accept the reality of her spouses death, the residents grief process and personal space should be respected. Although the residents argumentative nature can indicate early dementia, the TOUHY 4TH ED TESTBANK A family that has three small children prepares to move an older female parent into their home knowing that she stays up all night. The nurse helps the family prepare for the change. Which part of planning should the nurse indicate is the familys priority? a.Sharing household responsibilities b.Preparing the house for her arrival c.Helping her use her skills and talents d.Setting limits on nighttime activities - correct answer ANS: B To reduce the risk of injury and falls, the familys priority is to prepare the house for an older adults arrival including preparing the parents private space, removing hazards, providing adequate lighting, installing handrails where necessary, and completing other safety measures. In addition, the parent needs to prepare mentally for the challenges presented when the children create new safety hazards for an older adult, such as spills and leaving toys on the floor. Sharing household responsibilities should be part of the preparation; however, safety concerns are more important. Helping the older adult to use her skills and talents provides meaningful activities; however, safety concerns are more important. Setting limits on her nighttime activities is important preparation to avoid conflicts; however, safety concerns are the priority. TOUHY 4TH ED TESTBANK A resident of a long-term care facility has been asking to have the drain in the bathroom sink repaired for 2 months. The nurse responds by saying that when they move to the new building, the sinks will work very well. Which right of a resident of a long-term care facility has the nurse violated? a.Right to be free of all forms of abuse b.Right to be transferred for appropriate reasons c.Right to voice grievances and have them remedied d.Right to information about conditions and treatments - correct answer ANS: C The nurse has violated the residents right to voice a grievance and to have the problem fixed. If the residents were moving into the new building in a few days, then the nurses response might be suitable; however, without specifying a time limit, the nurse has violated the residents right to voice a grievance and have it remedied. A clogged sink is not abuse. The resident is not going to be transferred; all of the residents are moving to a new facility. A residents condition or treatments are not mentioned by the resident. TOUHY 4TH ED TESTBANK A nursing home is converting to a person-centered culture from an institution-centered culture. Which nursing intervention will be suitable in the new culture? a. Maintain consistent resident assignments. b. Provide structured activities for the residents. c. Assign nursing assistants to perform bathing. d. Determine mealtime on the basis of staffing levels. - correct answer ANS: A As part of a person-centered culture, nurses should have consistent resident assignments to establish rapport with their residents and become familiar with their unique qualities and preferences. Activities structured by the staff are part of the institution-centered culture. Assigning assistants to perform bathing is part of the institution-centered culture because it focuses on tasks. Schedules are determined for the staffs convenience as part of the institution- centered culture. TOUHY 4TH ED TESTBANK The nurse prepares to transfer an older adult to a long-term care facility and calls the facility to give a report. Which nursing actions are the responsibilities of the transferring nurse and the receiving nurse? a.Incorporating patient goals into the plan b.Ensuring the patient is stable for transfer c.Supplying patient documents for planning d.Providing continuity of care during the transfer - correct answer ANS: D A shared responsibility of the sending and the receiving nurses or care team is to regard the transition as a transfer versus a discharge and to provide continuous and consistent nursing care throughout the transfer phase. To accomplish this, the two nurses or groups must have clear, comprehensive communication. The receiving nurse incorporates patient goals into the plan. The sending nurse ensures that the patient is stable for the transfer to prevent decompensation during the trip or shortly after arrival at the new facility. The sending nurse is responsible for providing clear, comprehensive, and complete patient documentation. TOUHY 4TH ED TESTBANK The nurse assesses a resident who was transferred yesterday from an acute care hospital. Which should the nurse assess to determine whether this individual is under stress from the transfer? a.Length of the residents stay in the acute care facility f. Staff members help residents stay well-groomed. - correct answer ANS: B, C, D, F A characteristic of a person-centered culture is family and resident councils to discuss resident issues, needs, and solutions. A second characteristic of a person-centered culture is residents choosing their own activities to suit their interests. A third characteristic of a person-centered culture is a responsive staff that promptly meets resident needs. A fourth characteristic of a person-centered culture is assisting residents to maintain their appearance and to stay well- groomed. Consistent nursing assignments are a characteristic of a person-centered culture. Predetermined schedules are characteristic of an institution-centered culture. TOUHY 4TH ED TESTBANK Which home modification interventions are designed to enhance the ability of older adults to remain in their homes? (Select all that apply.) a. A 36-inch-wide doorway b. Entryways with less than two steps c. Electrical outlets at chest level d. A bathroom on the first floor - correct answer ANS: A, D Many state and local governments are assessing the community and designing interventions to enhance the ability of older people to remain in their homes and familiar environments. Home design features such as 36-inch-wide doorways and hallways, a bathroom on the first floor, an entry with no steps, outlets at wheelchair level, and reinforced walls in bathrooms to support grab bars. TOUHY 4TH ED TESTBANK An elder-friendly community includes components that: (Select all that apply.) a.Address basic needs b.Optimize physical health c.Provide financial assistance d.Maximize independence e.Provide social engagement - correct answer ANS: A, B, D, E Components of an elder-friendly community include addressing basic needs, optimizing physical health and well being, maximizing independence for the frail and disabled, and providing social and civic engagement. Elder-friendly communities do not provide financial assistance. TOUHY 4TH ED TESTBANK Which of the following is a true statement about gerontological nursing for patients of different races and ethnic backgrounds? a.The fact that a nurse is white has no bearing on the nurses ability to care for minority patients or patients of color. b.An encyclopedic accumulation of details of a particular culture is the best preparation for caring for persons from that culture. c.A nurse who works in Illinois does not need to be as concerned about sensitivity to multiple cultures as the nurse who works in California. d.Facial expressions, body language, posture, and touch are important elements of communication between a nurse and a patient from a different ethnicity. - correct answer ANS: D Facial expressions, body language, posture, and touch become more important as language barriers limit the effectiveness of verbal exchanges. They also have different meanings in different cultures. A white person is more likely to have had opportunities and freedoms and take them for granted, whereas a person of color who has never experienced such opportunities and freedoms may regard them as special privileges. Knowledge of cultural details can be useful, but it can also lead to stereotypes that obscure the differences between individual persons. Illinois, along with California, Nevada, Florida, Texas, and New Jersey, is one of the states with the greatest numbers of immigrant older adults. TOUHY 4TH ED TESTBANK Which of the following is a true statement about differing health belief systems? a.Personalistic or magicoreligious beliefs have been superseded in Western minds by biomedical principles. b.In most cultures, older adults are likely to treat themselves using traditional methods before turning to biomedical professionals. c.Ayurvedic medicine is another name for traditional Chinese medicine. d.The belief that health depends on maintaining a balance among opposite qualities is characteristic of a magicoreligious belief system. - correct answer ANS: B Older adults in most cultures usually have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is not uncommon for older adults to pray for cures or wonder what they did to incur an illness as punishment. The Ayurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of a holistic or naturalistic approach. TOUHY 4TH ED TESTBANK clinical signs such as cyanosis, which are more visible in the buccal cavity. Although the church is a source of support for many older African Americans, it should not be assumed at the expense of other forms of support. Traditional Chinese medicine is based on hot-cold beliefs, not African-American beliefs. Avoidance of eye contact has not been identified as a cultural practice for African Americans. TOUHY 4TH ED TESTBANK An older adult who is a traditional Chinese man has a blood pressure of 80/54 mm Hg and refuses to remain in the bed. Which intervention should the nurse use to promote and maintain his health? a.Have the health care provider speak to him. b.Use principles of the holistic health system. c.Ask about his perceptions and treatment ideas. d.Consult with a practitioner of Chinese medicine. - correct answer ANS: C Using the LEARN model (Listen with sympathy to the patients perception of the problem; Explain your perception of the problem; Acknowledge the differences and similarities; Recommend treatment; and Negotiate agreement), the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health-related information. Speaking with the health care provider is premature until the assessment is complete. Unless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can also be unsuitable and insulting for this patient. TOUHY 4TH ED TESTBANK Which action should the nurse take when addressing older adults? a.Speak in an exaggerated pitch. b.Use a lower quality of speech. c.Use endearing terms such as Honey. d.Speak clearly. - correct answer ANS: D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Providers should not assume all older adults are hearing or mentally impaired. The most appropriate action when addressing an older adult would be to speak clearly. Examples of unintentional ageism in language are exaggerated pitch, demeaning emotional tone, and a lower quality of speech. TOUHY 4TH ED TESTBANK The nurse prepares an older woman, who is Polish, for discharge through an interpreter and notes that she becomes tense during the instructions about elimination. Which intervention should the nurse implement? a.Move onto the discussion about medication. b.Ask the older woman how she feels about this topic. c.Instruct the interpreter to repeat the instructions. d.Have the older woman repeat the instructions for clarity. - correct answer ANS: B When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and therefore validates the assessment about the older adults tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable discussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adults discomfort. Instructing the older adult to repeat the nurses instruction ignores the her needs. TOUHY 4TH ED TESTBANK The nurse is aware that cultural competence means having the skills to put cultural knowledge to use in all of the following except: a.Assessment b.Communication c.Intervention d.Collaboration - correct answer ANS: A Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. To provide culturally competent care, the nurse gathers data about the culture, the older adult, and the specific cultures impact on the older adult, organizes the data, and applies the information by planning, implementing, and evaluating nursing care. Planning includes supporting cultural patterns. Assessing includes increasing cultural knowledge. Through increased knowledge, nurses can better assess the strengths and weaknesses of the older adult within the context of their culture and know when and how to effectively intervene to support rather than hinder cultural patterns that enhance wellness and coping. TOUHY 4TH ED TESTBANK The health care provider discusses the need for surgery with an older adult and her family. Which information about the older adults culture is important for the nurse to collect before this discussion to facilitate the process of informed consent? a.Attitudes about caregiving An African American is more likely to receive respect than a younger person in the same community because African Americans are more likely to value the wisdom and insight of older adults. Older individuals from a Euro-American culture are less likely to be valued by the community, owing to the effects of the industrial revolution and the need for strong, young laborers. An individual who is an Anglo-Saxon has European ancestry. A German citizen is European. TOUHY 4TH ED TESTBANK Which cultural group is more likely to distrust the health care system than other cultural groups in the United States? a. African Americans b. Chinese Americans c. Mexican Americans d. Lebanese Americans - correct answer ANS: A Because of a history that includes slavery, social injustice, and abuse of African-American men in medical research, African Americans are more likely to distrust the health care system in the United States. Chinese are less likely to distrust the health care system of the United States than African Americans because of a lack of a history of major health-related injustices. Mexican Americans are less likely to distrust the health care system of the United States because of the many benefits they receive that are unavailable in Mexico. Lebanese Americans are less likely to distrust the health care system of the United States because of a lack of a history of health- related injustices against their culture in the United States. TOUHY 4TH ED TESTBANK The nurse is assessing an older adult from a culture different than the nurses by asking questions from the Explanatory Model for Culturally Sensitive Assessment. Which question(s) should the nurse ask to follow this model? (Select all that apply.) a. How can we negotiate to solve the problem? b. What treatment can improve your condition? c. Should we try my plan first to see if it helps? d. Can we discuss differences in our plans now? e. How long have you experienced the problem? f. Who, other than me, can make you feel better? - correct answer ANS: B, E, F Asking about potential therapies is a question from the Explanatory Model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the Explanatory Model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN Model. TOUHY 4TH ED TESTBANK A nurse caring for older adults must be aware of which consequences of ageism in language? (Select all that apply.) a. Reduced sense of self b. Poor nutritional intake c. Lowered self-esteem d. Decreased memory performance - correct answer ANS: A, C, D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Consequences of ageism have been identified as a reduced sense of self, lowered self-esteem, lowered sense of self- competence, and decreased memory performance. Poor nutritional intake has not been identified as a consequence. TOUHY 4TH ED TESTBANK Which factor(s) are associated with the provision of culturally competent care? (Select all that apply.) a. Cultural awareness b. Cultural knowledge c. Cultural skills d. Cultural connections - correct answer ANS: A, B As nurses move toward cultural competence, they increase their cultural awareness, knowledge, and skills. Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. Cultural connections have not been identified as a factor. TOUHY 4TH ED TESTBANK Name the theory of aging that suggests that the adverse physical effects of aging are the result of a gradual loss of control mechanisms in the pituitary and hypothalamus. a.Free-radical theory b.Programmed theory c.Stochastic theory d.Neuroendocrine theory - correct answer ANS: D The neuroendocrine theory attributes aging to gradual changes in or the loss of the mechanisms that control the organs through chemical signals. The free-radical theory attributes aging to the accumulation of destructive products of metabolic oxidation. The programmed theory c.Greater number of freckles d.Loss of hair on the extremities - correct answer ANS: B Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease. TOUHY 4TH ED TESTBANK The nurse designs a group exercise program at a senior center. Which room should the nurse choose for the program? a.Room with a beautiful hardwood floor tastefully appointed with throw rugs b.Spacious room with no windows but with fluorescent lighting and a natural stone floor c.Room with a hardwood floor and large windows overlooking a garden area d.End room with a linoleum floor and a fan for ventilation to compensate for the rooms broken air conditioner - correct answer The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains may be used. Throw rugs can slide underfoot and can lead to a fall, particularly when the sense of balance has declined with age. The fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat-gland response to heat. TOUHY 4TH ED TESTBANK The latest trends in medicine encourage health care providers to prescribe nutrient-dense foods and exercise to prevent or delay the shortening of telomeres. On which biological theory of aging are these practices based? a.Genetic research b.Caloric restriction c.Pacemaker theory d.Cross-link theory - correct answer ANS: A Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age-related disorders. The pacemaker theory, which is also known as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can halt with age. The cross-link theory suggests that aging is a result of the stiffening of proteins caused by cross-linking, leading to stiffer joints, rougher skin, and decreased cellular elasticity. TOUHY 4TH ED TESTBANK During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a.Exercise with light weights. b.Stand on one foot at a time while supported. c.Train with the use of sit-ups. d.Work out in a swimming pool. - correct answer ANS: B The loss of balance from a musculoskeletal perspective is usually due to a loss of core muscle strength, thus the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance. TOUHY 4TH ED TESTBANK The nurse cares for an older adult who has a prealbumin level of 10 mg/dl and an infection in a large wound. Which intervention is the nurses priority? a.Monitor temperature and leukocytes. b.Provide assistance with meal planning. c.Provide high-quality protein in the diet. d.Maintain oxygen saturation above 95%. - correct answer ANS: D The nurses priority is to maintain oxygen saturation above 95% to help provide oxygen that the heart is unable to provide. The heart of this older adult is less able to respond to increased oxygen demands from infection because of age-related changes in the myocardium including ventricular hypertrophy and decreased coronary blood flow and changes in pulmonary function. Further, because this older adult is malnourished and thus likely to have anemia, any capacity to meet increased oxygen demand is stymied. Along with airway, breathing and circulation are two of the three most basic needs. Similarly, the older heart may not be able to respond to other calls for increased cardiac demand such as infection, anemia, pneumonia, cardiac dysrhythmias, surgery, diarrhea, hypoglycemia, malnutrition, and drug-induced and noncardiac illnesses such as renal disease and prostatic obstruction. d.Suggest added fluid intake. - correct answer ANS: B The nurse begins by reviewing the medication list to find substances that are likely to cause constipation such as opioid analgesics and antidepressants, among others. If the patient is taking an opioid analgesic and because the patient rates the pain as 3 out of 10, then a change in pain medication can help relieve constipation. The use of a laxative can be contraindicated and is the therapy of last resort for constipation caused by factors other than opioid analgesics. Promoting fiber in the diet is a reasonable intervention but can be made unnecessary by omitting the opioid analgesic. Increasing fluid intake is a reasonable nursing intervention for older adults with and without constipation, but it can be unnecessary for this older adult. TOUHY 4TH ED TESTBANK Which age-related change contributes to anorexia and weight loss in the older adult? a.Excessive saliva b.Fewer taste buds c.Wearing dentures d.Softened tooth enamel - correct answer ANS: B The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Older adults tend to lose enamel. TOUHY 4TH ED TESTBANK The nurse assigns the diagnosis of Nutrition Imbalance: less than body requirements for an older adult. Which age-associated intestinal problem does the nurse apply to plan goals and interventions to improve this adults nutritional status? a.Less intrinsic factor secretion b.Short, broad small intestinal villi c.Decreased gastric smooth muscle d.Decreased large intestinal motility - correct answer Villi of the small intestine shorten and widen with age and, as a result, become less functional, which contributes to malabsorption of nutrients; despite a healthy diet, nutrients are absorbed primarily in the small intestines. The concept of malabsorption is what the nurse uses to plan care; this nursing diagnosis refers to the inability of the body to absorb nutrients as a result of biological factors. Decreased intrinsic factor secretion leads to pernicious anemia as a result of the inability to absorb vitamin B12 in the stomach. Gastric smooth muscle is not present in the intestines. Decreased large intestine motility is an age-associated problem; however, it should have no impact on absorption in the small intestine. TOUHY 4TH ED TESTBANK Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply.) a.Fewer T-lymphocytes b.Less lean muscle mass c.Decreased thyroid function d.Decreased physical activity e.Left ventricular hypertrophy f.Decreased insulin sensitivity - correct answer ANS: B, C, D, F Less lean muscle mass means that the body has fewer insulin receptor sites; thus glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metabolic rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, the older adult must increase physical activity and decrease food consumption. Fewer T-lymphocytes are associated with age-related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it. Type 1 diabetes mellitus is considered an autoimmune disorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes. TOUHY 4TH ED TESTBANK During a walk, an older man suffers a laceration from a broken tree branch. Rank the nurses interventions in order, beginning with the most important intervention. a.Flush and cleanse the wound well. b.Investigate a possible safety hazard. c.Instruct him to keep the wound covered. d.Verify a current tetanus immunization. - correct answer ANS: A, B, C, D c.The exercise of rights is not a task of aging in Kellys model. d.A person may choose to avoid pursuing inner discovery in older age. - correct answer ANS: D Some persons do not value inner psychological exploration and remain action oriented even in an older age, and others are still subject to the same demands of daily living as they were in middle age. None of these theories is clearly supported by data. Pecks tasks of ego differentiation, body transcendence, and ego transcendence demand a great deal of courage and energy that not everyone possesses. Tasks of aging in Kellys model are accepting reality, fulfilling responsibility, and exercising rights. TOUHY 4TH ED TESTBANK Which of the following is a true statement about neuropsychiatric function in older adults? a.Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging. b.Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting. c.Nerve cells regenerate in the hippocampus. d.Mood does not influence an older person ability to remember verbal instructions. - correct answer ANS: C Nerve cells regenerate in the hippocampus; this is a true statement. Although neurons can regenerate in the hippocampus, regeneration is impeded by stress. Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging; this statement is not true. Neuron loss does not harm overall cognitive ability, although it makes neural processes run more slowly. Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting; this is not a true statement. Neural functions can be retrained, but exercising the brain on a regular basis is necessary. Older adults learn best when new information is relevant to what is already familiar. Mood does not influence whether an older person remembers verbal instructions; this is a not a true statement. Recalling events, including communication, is impaired by a crisis situation or anxiety. TOUHY 4TH ED TESTBANK Which of the following statements is true about social and emotional health of older adults? a.Contemporary society has strong norms for the behavior of adults older than 80 years. b.The transition to old age entails a declining level of contribution to others as one becomes increasingly dependent on them. c.Computers and the Internet have little to contribute to older adults in their need for social support. d.Nurses are often significant sources of social and emotional support for older adults. - correct answer ANS: D Nurses are often important confidants and providers of social support in the lives of older adults. The diversity of cultures and individuals in a society such as the United States means that norms are almost nonexistent for those older than 80 years. Older adults have a great deal to contribute in wisdom and by example. E-mail and online chat rooms are a means of contact and social support for many older adults. TOUHY 4TH ED TESTBANK Which role is most likely to have a significant effect on the type of aging process experienced by the older adult? a.Grandparent b.Spouse c.Friend d.Parent - correct answer ANS: B The loss of a spouse is likely to be devastating for an older adult for economic and biopsychosocial reasons. When an older adult loses a spouse, the loss can include economic security, especially for a woman, and societal roles. Alterations in these roles are not usually as challenging as the loss of a spouse. Grandparenting can offer the potential for enhanced social experiences for an older adult; however, adults can age well without them when more basic needs are met. Alterations in these roles are not always as acutely demanding as the loss of a spouse. Alterations in these roles usually call for little or a gradual adjustment. TOUHY 4TH ED TESTBANK The children in an African-American family attended college because their mother worked two jobs as they were growing up. She never finished high school, the children are grown, and she lives alone in retirement. Which noted weakness of sociological theories on aging explains why the social exchange theory is not applicable to this older adult? a.Gender b.Culture c.Ethnicity d.Opportunity - correct answer ANS: D Social exchange theory ignores the effect that opportunity can have on aging because, according to this theory, the mother should be living with one of the children. They had the opportunities that she never had. Gender is not as relevant to this theory of the value of youth TOUHY 4TH ED TESTBANK 9. The nurse plans care for older adults who are in good health but isolated from their families. If the nurses goal is to move the adults toward gerotranscendence, which intervention should the nurse use in the plan of care? a. Give a daily tea party for the group. b. Call each family to encourage visiting. c. Assist them to resume midlife patterns. d. Help each person with individual activities. - correct answer ANS: D In Tornstams theory, aging offers the potential for gerotranscendence, a culmination of an individuals life, wisdom, and spiritual growth that allows the older adult to live contentedly with and without social activities. An older adult spends more time on meditation and solitude, and less time on materialism and self-consciousness about body image. Individual activities or self- selected activities are satisfactory. Solitude is satisfactory. Midlife patterns are no longer relevant to contentment. TOUHY 4TH ED TESTBANK The nurse observes older female adults learning advanced knitting techniques. The nurse concludes that this learning activity is suitable for these women because it accomplishes which of the following? a. Helps maintain joint flexibility b. Improves the groups cohesiveness c. Provides a needed social opportunity d. Adds to their existing knowledge base - correct answer ANS: D Learning advanced techniques is a suitable activity for older adults because it builds on knowledge they already have; further, this activity is suitable because it is concrete and practical for experienced knitters to develop advanced skills. Joint flexibility is a physical activity and not necessarily a learning activity. The members share enjoyment of knitting; other than being women and older, the group has no special bond on which to build. The need for socializing is not evident. TOUHY 4TH ED TESTBANK The nurse at a nursing home wants to help decrease the risk of Alzheimer disease in the residents. Which should the nurse do to implement this goal? a.Keep the curtains open in their rooms. b.Offer beads for them to string on yarn. c.Show movies that the residents choose. d.Assist residents with ambulation to meals. - correct answer ANS: D Engaging in physical activity and social interaction are associated with a lower risk for Alzheimer disease. Keeping the curtains open can make a residents room more pleasant but is likely to be counterproductive in lowering the risk; brightening the room can entice the resident to stay in the room and decrease social interaction. Stringing beads is a passive and sedentary activity and therefore unlikely to decrease the risk for Alzheimer disease; physical activity is associated with a lower risk for Alzheimer disease. Watching movies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence. TOUHY 4TH ED TESTBANK Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults? a.Increased secretion of cholinesterase b.Decreased secretion of neurotransmitters c.Loss of spinal cord and brainstem neurons d.Atrophy of dendrites in the cerebral cortex - correct answer ANS: D Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmission of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. The spinal cord and the cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord. TOUHY 4TH ED TESTBANK The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a.Verbal fluency b.Logical analysis c.Object naming What is a SOAP note? a.Record of supplies used in patient hygiene b.Record of an event during a patients stay, formatted according to the Simple Object Access Protocol (SOAP), enabling it to be easily transmitted between computers c.Form of bar code d.Record of patient data listing the patients subjective complaint, objective data recorded by the nurse, the nurses assessment of the situation, and the nurses plan of action - correct answer ANS: D SOAP stands for subjective (patient complaint), objective (observed data), assessment, and plan. A SOAP note is a record of an event in which a patient makes a subjective complaint and the nurse observes objective data, makes an assessment on the basis of the complaint and the data, and makes a plan for interventions based on the assessment. A SOAP note is a record in human language describing a problem, its assessment, and planned interventions. TOUHY 4TH ED TESTBANK Which of the following is a true statement about documentation? a.Nurses should keep records of patients wishes. b.Patients do not have access to their own medical records. c.The Outcomes and Assessment Information Set (OASIS) is a complete record of the health status of a patient. d.The nurse is responsible for completing all of the Minimum Data Set (MDS). - correct answer ANS: A Entering patients expressed wishes in the medical or clinical record helps ensure that the interdisciplinary team respects these wishes. According to regulations after the enactment of the Health Insurance Portability and Accountability Act (HIPAA), the patient has access to his or her own medical records and may designate others to have access. The OASIS is used to measure outcomes for quality improvement purposes; it does not contain all of the necessary information for care, such as vital signs. The MDS should be completed jointly by all members of the interdisciplinary team. TOUHY 4TH ED TESTBANK Which one of the following is connected with the nursing home reform mandated by a 1987 law? a.Resident Assessment Instrument (RAI) b.HIPAA c.OASIS d.Fulmer SPICES - correct answer ANS: A The RAI must be completed for all residents receiving Medicare or Medicaid. The HIPAA was passed in 1996 and mandates privacy practices. The OASIS is an assessment designed for use in the home health care setting. Fulmer SPICES is an overall assessment tool developed in 2007. TOUHY 4TH ED TESTBANK An older woman has diabetes mellitus and requires hemodialysis for renal failure. She is discharged to home to recover from a sternal wound infection and coronary artery bypass graft surgery (CABG). A home care nurse will provide wound care. Which of the following is the major justification for the complete and accurate documentation of this older adults care? a.Requires complex health care b.Has needs in multiple settings c.Is at risk for iatrogenic problems d.Has significant health care expenses - correct answer ANS: A The major reason that documentation of this patients health care must be accurate and complete is that she has complex health care needs in multiple settings and experiences a high risk for iatrogenic problems and high reimbursement expenses. The duration of her care is likely to be lengthy; the sternal wound infection after CABG is serious because of the potential for sternal osteomyelitis. In addition, individuals with diabetes are at high risk for infection and are slow to heal. The complexity of her care includes receiving care in multiple settingsat home, at dialysis, and in primary care for postdischarge follow-up care. For an older adult with diabetes, coronary artery disease, renal failure, and a serious infection, each facet of her health care depends on complete and accurate data on the other aspects of her care to help her achieve optimal health and wellness. This older adult is at risk for iatrogenic problems because of the complexity of her care. Each type of care, each illness or condition, and each setting exposes this older adult to a separate set of risks. In addition, individuals with diabetes can have peripheral neuropathies that increase the risk for falls and injuries. This older adult incurs health care expenses dealing with complex health care requirements including a recent hospital stay for surgery and complicated by an infection, ongoing needs for hemodialysis, and home care. Because much of the care is nurse driven, documentation is the basis for which reimbursement is provided. TOUHY 4TH ED TESTBANK The nurse scans an older mans identification band in preparation for medication administration. Which step should the nurse implement next? a.Develop an individualized care plan. b.Assign suitable nursing interventions. c.Use the RAPs. d.Institute agency-approved catheter care. - correct answer ANS: C The nurse uses the RAPs to assess triggers identified from the MDS. To help the resident achieve optimal functional status by determining his strengths, needs, and preferences, RAPs provide an organized framework used by the health care team for additional assessment of the trigger. The nurse develops the care plan after completing the RAPs. The nurse assigns suitable nursing interventions to the plan of care. The nurse uses agency-approved policies to provide care as assigned in the plan of care. TOUHY 4TH ED TESTBANK The federal government requires the use of a specific standardized documentation tool for home nursing care. Which information must a home nurse add to the approved documentation tool? a.Activity b.Vital signs c.Functional d.Demographic - correct answer ANS: B The nurse must add the vital signs and information about the older adults health care beliefs to the OASIS. The nurse does not need to add information about the older adults activity level. The nurse does not need to add information about the older adults functional status. The nurse does not need to add demographic information about the older adult to the documentation tool. TOUHY 4TH ED TESTBANK The nurse must inform an older adult who does not speak English about patient rights. In addition, the nurse must have the adult sign the document about information access. Which intervention should the nurse use to maintain the confidentiality of this older adult? a.Present the patient with a Spanish version of the information access document. b.Have an English-speaking family member explain the document to the patient. c.Explain the document to the patient using an interpreter to ensure understanding. d.Instruct an interpreter to read the information access document to the resident privately. - correct answer ANS: C To ensure patient understanding, the nurse explains a patients rights about information access to the patient with the assistance of an interpreter. The nurse is responsible for patient understanding and thus cannot relinquish this task to another person. When understanding is reached concerning the rights associated with access to information, the patient can then make an informed decision about releasing health care information and thus maintain privacy. The nurse cannot ensure patient understanding without discussing the document with the patient using an interpreter. The nurse cannot delegate a nursing responsibility to a family member; the nurse does not have the right to release the health information to anyone. In private or public, the nurse cannot delegate this task to another person. TOUHY 4TH ED TESTBANK The same nursing documentation record is used in every unit of a hospital. Why does a hospital use a standardized form for nursing documentation? (Select all that apply.) a.Helps provide continuity of care b.Standardizes patient care parameters c.Assists in maintaining confidentiality d.Reduces the number of medication errors e.Provides the foundation for staffing levels f.Allows for quality evaluations among units - correct answer ANS: A, B, E, F An institution uses the same nursing documentation record because it helps provide continuity of care across various settings by providing organized, pertinent, and thorough health care data on a specific individual. Other units in the hospital and other health care settings have an easier time locating relevant data. Specific health care data are found in one location on a standardized nursing documentation record throughout an institution and provide the basis for standardized patient evaluation across settings. Standardized documents help describe patient acuity levels and thus provide a justification for staffing. Because the same parameters are, or should be, recorded across all units, the standardized documentation record allows for hospital-wide quality evaluations. Nurses must restrict access to a standardized documentation record or any other type of patient record such as laboratory reports, narrative or progress notes, and other documents. A standardized nursing documentation record can reduce a specific type of documentation error but is unlikely to affect the rate of medication errors. TOUHY 4TH ED TESTBANK The OASIS was implemented to provide the format for a comprehensive assessment in the home health care setting. How is this assessment tool used? (Select all that apply.) a.To improve the quality of care b.To improve the communication about the individual b.Blood plasma c.Asthma symptoms d.Rheumatoid arthritis pain - correct answer ANS: A Fibrinolytic activity is increased in the early morning. Blood plasma volume falls at night, thus hematocrit increases. Asthma symptoms peak at approximately 4 to 5 AM. Pain from rheumatoid arthritis is more severe in the late afternoon. TOUHY 4TH ED TESTBANK Which interaction between each prescription and food or nutritional supplement is favorable? a.Warfarin (Coumadin) and ginkgo biloba b.Terazosin (Hytrin) and increased fluids c.Lithium (Eskalith) and low-sodium diet d.Warfarin (Coumadin) and leafy, green vegetables - correct answer ANS: B Increased fluids can combat the hypotensive effects of alpha-adrenergic blockers such as terazosin. Ginkgo biloba can amplify the anticoagulant effect of warfarin, leading to an increased risk of bleeding. Reduced sodium intake contributes to the toxicity of lithium. Leafy, green vegetables can diminish the anticoagulant effect of warfarin (Coumadin). TOUHY 4TH ED TESTBANK Which medication is correctly matched to the condition given of an older adult patient according to current medical knowledge? a. Methylphenidate (Ritalin) for depression at bedtime b. Buspirone (BuSpar) for chronic anxiety states c. Amitriptyline (Elavil) for depression in the morning d. Haloperidol (Haldol) long-term for psychotic behavior - correct answer ANS: B Buspirone (BuSpar) is safer for older adults with anxiety than benzodiazepines. Because it can take up to 5 to 7 days for the therapeutic benefit to be realized, it should be used only for chronic anxiety. Stimulants such as methylphenidate (Ritalin) should be administered in low doses in patients with chronic depression. To prevent insomnia, extended-release forms should be administered early in the morning and short-acting forms at the latest in the early afternoon. Tricyclic antidepressants such as amitriptyline (Elavil) are contraindicated for use with older adults because of the risk for anticholinergic and sedative effects. Tricyclic antidepressants have been replaced with selective serotonin reuptake inhibitors (SSRIs), which are more effective at lower doses with fewer side effects. Antipsychotic agents such as haloperidol (Haldol) can cause extrapyramidal effects, especially in older adults. For long-term administration, they should be used only after a thorough psychiatric evaluation. TOUHY 4TH ED TESTBANK In questioning an older adult, which question is likely to elicit the most accurate information about the individuals adherence to the medication plan? a.You take digoxin (Lanoxin) at the correct time, dont you? b.Why didnt you take all of your digoxin (Lanoxin) last month? c.How many doses of digoxin (Lanoxin) do you think you missed? d.You have never missed a dose of digoxin (Lanoxin), have you? - correct answer ANS: C How many doses of digoxin (Lanoxin) do you think you missed? is a question that is worded to put the client at ease and to elicit information in a matter-of-fact way. You take digoxin (Lanoxin) at the correct time, dont you? sounds like a challenge to the patients personal qualities. In addition, the nurse is leading the patient to the answer. The patient is likely to respond simply, Oh, yes. Although the question, Why didnt you take all of your digoxin (Lanoxin) last month? is meant to elicit the reason for nonadherence, it has an accusatory tone that is likely to make the patient defensive. You have never missed a dose of digoxin (Lanoxin), have you? is a question that can be interpreted as judgmental. TOUHY 4TH ED TESTBANK Which of the following is on the list of drugs considered suitable for the older adult? a.Indomethacin (Indocin) b.Reserpine (Reserpine) c.Chlorpheniramine (Chlor-Trimeton) d.Bupropion (Wellbutrin) - correct answer ANS: D Bupropion is a safe antidepressant for an older adult that is also less likely to cause sexual dysfunction than other nonsteroidal SSRIs. Indomethacin is unsuitable for an older adult because it produces the most central nervous system effects of all nonsteroidal antiinflammatory agents. Reserpine is unsuitable for an older adult because it poses a risk of depression, sedation, and orthostatic hypotension. Chlorpheniramine and similar antihistamines are unsuitable for an older adult because of their anticholinergic properties. TOUHY 4TH ED TESTBANK The nurse prepares to administer diltiazem (Cardizem LA) to an older adult with ischemic heart disease. When is the optimal time to administer this medication to help prevent complications of heart disease associated with rhythmical variations? a.Midday c.At breakfast b.At bedtime d.Every 4 hours - correct answer ANS: B Diltiazem is a calcium-channel blocker used for hypertension, heart rate control, and angina from ischemic heart disease. To take advantage of rhythmical variations in heart disease, the best time to administer long-acting diltiazem (Cardizem LA) is at bedtime; the medication will then be active in the early morning hours when a cardiovascular event is most likely to take place. Midday administration is a less advantageous time for the medication administration because the main period of drug activity will occur in the evening. Morning administration is too late for administration because morning administration misses the critical period around 4 and 5 AM. Administering Cardizem LA every 4 hours is contraindicated because it is a long-acting formulation meant to be administered once daily. TOUHY 4TH ED TESTBANK A health care provider has ordered alendronate (Fosamax) for an older adult who has been admitted for a hip fracture. Which is the best response from the nurse when educating the patient on the new medication? a.You will need to have your calcium checked monthly while on this medication. b.If you miss a dose, you will need to take the medication as soon as you remember. c.Take on an empty stomach. d.Do not take with alcohol. - correct answer ANS: C Drug-food interactions may either decrease or increase the amount absorbed. For example, when a bisphosphonate such as Fosamax is taken with food of any kind, the absorption is reduced to only a few milligrams; therefore the drug has no effect on the target organthe bones. If a patient misses a dose, then he or she should not take it as soon as remembered; it should be taken at its next scheduled dose. No current recommendations suggest that calcium levels are to be checked monthly. TOUHY 4TH ED TESTBANK When completing medication reconciliation for an older woman, the nurse notes that the patient is being discharged home on anticoagulant therapy. The nurse also notes that at admission, the patient reported that she uses herbal supplements at home. Which instruction should the nurse include during discharge teaching? a.You may need to supplement with only ginkgo while on anticoagulant therapy. b.You may need to increase the use of garlic supplements while on anticoagulant therapy. c.Avoid using Hawthorn supplements while taking an anticoagulant medication. d.Avoid using chamomile supplements while on anticoagulant therapy. - correct answer ANS: D The nurses priority is to stop this older adults intake of chamomile supplements at home; they will increase the effectiveness of anticoagulation. The nurse instructs this individual to avoid chamomile while she is taking an anticoagulant because the womans blood will be much less able to clot, exposing her to a very high risk of a catastrophic injury in the event of a fall or trauma. The patient does not need to supplement with only ginkgo; the patient should cease taking ginkgo while on anticoagulant therapy, as well as the use of garlic supplements. Both increase the effectiveness of anticoagulation. The use of Hawthorn supplements has not been shown to affect the use of anticoagulant medications. TOUHY 4TH ED TESTBANK The nurse provides instruction about medication safety to older adults. Which instruction should the nurse provide? a.Nausea and vomiting are common, harmless drug side effects. b.Keep a supply of medications at the bedside for convenience. c.Ask the health care provider to describe the purpose of therapy. d.Take your daily medications on an empty stomach with water. - correct answer ANS: C Older adults should ask the health care provider for the purpose of each drug and record the information. Although nausea and vomiting are among the most common adverse effects of pharmacotherapy, they can indicate medication toxicity and should be reported to the health care provider. Keeping a medication at the bedside is dangerous for anyone and can be especially dangerous for older adults who are taking antianxiety agents, hypnotic agents, and opioid analgesics; these and other medications can cause respiratory depression with and without excessive dosing. If sleepy or lethargic, then the older adult can inadvertently take more than the correct dose and suffer serious consequences as a result. Taking a medication on an empty stomach with water is a suitable instruction for many medications; however, many medications that are likely to cause nausea are taken with food. The nurse should instruct older adults to keep a record of the recommended method of administration. TOUHY 4TH ED TESTBANK An older man is taking aripiprazole (Abilify) for agitation. Which patient assessment is the nurses priority to prevent catastrophic effects of the medication? a.Oral and facial dyskinesia b.Mask facies, shuffling gait to the effects of the medication. In addition, dosing trial and error is a common strategy for determining an individuals optimal dose. TOUHY 4TH ED TESTBANK Which herbal supplement(s) when taken with an anticoagulant increases the effectiveness of the medication and should be avoided during anticoagulant therapy? (Select all that apply.) a.Chamomile b.Garlic c.Ginkgo d.Hawthorn e.Ginseng f.Green tea - correct answer ANS: A, B, C, E, F The intake of chamomile, garlic, ginkgo, ginseng, and green tea supplements at home should be avoided because each increases the effectiveness of anticoagulation. Individuals should avoid these herbal supplements while taking an anticoagulant because the patients blood will be significantly less able to clot, exposing him or her to the risk of a catastrophic injury in the event of a fall or trauma. The use of Hawthorn supplements has not been shown to affect the use of anticoagulants. TOUHY 4TH ED TESTBANK Through which pathway(s) are drugs and their metabolites eliminated? (Select all that apply.) a.Sweat b.Saliva c.Kidneys d.Spleen - correct answer ANS: A, B, C Drugs and their metabolites are excreted in sweat, saliva, and other secretions but primarily through the kidneys. Metabolites are not eliminated through the spleen. TOUHY 4TH ED TESTBANK Which combination is suitable for the daily diet of older adults? a.Vitamin B12, 2.4 mcg; and fiber, 15 g b.Three 8-oz glasses of fluid; and 1600 calories c.Vitamin B12, 1.1 mcg; and 40% of daily calories from fat d.Calcium, 1200 mg; and vitamin D, 600 to 800 units - correct answer ANS: D Daily recommendation is 1200 mg of calcium, and 600 to 800 units of vitamin D are needed to enable the body to use the calcium. Daily vitamin B12 intake is correct, but older adults require 20 g to 35 g of fiber. Although 1600 calories per day is correct, fluid intake (preferably water) should be 1500 ml, approximately six to eight 8-oz glasses. Vitamin B12 intake should be 2.4 mcg per day, and calories from fat should be 20% to 25%. TOUHY 4TH ED TESTBANK Which is a common age-related physical change that may affect digestion and food intake? a.Loss of the majority of taste buds b.Decreased motility in the esophagus c.Decreased cholecystokinin secretion d.Loss of smell - correct answer ANS: B Decreased motility in the esophagus is a common age-related change and can affect the ease of swallowing. A loss of the majority of taste buds is not a common age-related physical change. A small number of taste buds are lost beginning around 60 years of age, but it does not affect all flavors equally. Decreased cholecystokinin secretion is not common; however, increased cholecystokinin secretion is. A loss of smell is not a common age-related physical change. TOUHY 4TH ED TESTBANK Which of the following is a true statement about nutrition for older adults? a.The older person should be encouraged to practice strict controls on cholesterol intake to ensure protection against heart disease. b.Transportation can be a critical factor in nutritional insufficiency in older adults. c.Soul food is a concern primarily for the African-American culture. d.No government programs promote congregate dining among older adults. - correct answer ANS: B Older persons often have difficulty in obtaining adequate transportation to remote supermarkets and may choose light-weight but less nutritious food items rather than heavy fresh fruits and vegetables. Cholesterol phobia, or the excessive concern over cholesterol TOUHY 4TH ED TESTBANK The nurse instructs the unlicensed assistive personnel to feed an older adult. If the nurse is unable to observe feeding directly, then which action should the nurse use to assess the older adults risk for aspiration immediately after feeding? a.Note food volume eaten. b.Observe skin color. c.Inspect for pocketing. d.Monitor for bradypnea. - correct answer ANS: C The nurse is able to assess the risk for aspiration by assessing the adult for pocketing, which is residual accumulations or pockets of food in the mouth that the older adult can aspirate after the meal is complete. If food is found in the mouth, then the nurse removes it and evaluates the current plan of care. The amount of food consumed by an older adult is unrelated to the risk of aspiration; therefore noting the amount of food that is eaten is unsuitable for detecting the risk for aspiration. An alteration in circulation as evidenced by a change in skin color can be a late indicator of aspiration. Thus a change in skin color can indicate the presence of aspiration, but the older adult with a change in skin color is not necessarily at risk for aspiration. The nurse monitors for tachypnea as an indicator of aspiration; however, tachypnea does not indicate a risk for aspiration. TOUHY 4TH ED TESTBANK An older adult with a gastrostomy tube has difficulty using the dominant hand. Which of the following should the nurse provide to prevent complications of the gastrostomy tube? a.Use foam swabs to brush the teeth. b.Provide oral care every 4 hours. c.Supply a soft tooth brush and floss. d.Position the patient at 90 degrees for tube feedings. - correct answer ANS: B The nurse provides oral care every 4 hours and brushes the teeth after meals to decrease the microorganism count in the mouth of an older adult with a gastrostomy tube. Foam swabs are ineffective tools to remove plaque, regardless of the toothpaste. Because this older adult has difficulty with the dominant hand, providing oral care supplies can be a waste of time, unless the nurse assists the older adult to maintain oral health with the supplies. The nurse positions the older adult at a 30- to 45-degree angle during tube feedings to facilitate gastric emptying. TOUHY 4TH ED TESTBANK The nursing home staff needs assistance to feed properly the residents who need assistance with feeding. Which of the following should the nurse implement to ensure that the residents are properly fed? a.Instruct the feeding assistants to feed four people at a time. b.Draw on the availability of family members who are able to follow instructions. c.Ask some residents to self-feed for part of the mealtime. d.Assign a small group of nursing assistants to do the feeding. - correct answer ANS: B With adequate training and cooperation, the nurse allows family members to feed residents who need assistance with feeding. While the family is assisting with feeding, the nurse supervises the feeding, offers feedback to family members, if necessary, and evaluates the outcome. The nurse avoids assigning more than three residents to each assistant for feeding; four residents are too many to assist safely. If a resident needs assistance with feeding, then attempting to self-feed can be dangerous, humiliating, and frustrating for a resident. If a small group of assistants performs all of the feeding, then the residents will potentially have to wait for long periods before being fed. Since the time required to implement feeding assistance is 38 minutes, a lengthy delay can result in adverse effects or injury for the resident and increase the risk of errors for the assistants, leading to frustration with the residents. TOUHY 4TH ED TESTBANK The nurse is feeding an older adult patient with hemiparesis as a result of a stroke. Which intervention by the nurse is most important when feeding this patient? a.Allow time to empty the mouth between bites. b.Provide foods that require chewing. c.Offer small sips of fluids with each bite. d.Serve pureed foods only. - correct answer ANS: A Allowing time to empty the mouth between bites decreases food buildup in the mouth and gives the patient time to swallow without being rushed. Providing foods that require chewing may be unsafe; the patient may have a decreased ability to chew foods. Pureed foods may not be necessary. The patient may only need extra time to manage each bite. TOUHY 4TH ED TESTBANK To avoid trauma to the mouth from hot food being served to a patient diagnosed with dementia, the nurse should: a.Set hot food aside to allow it to cool slightly. b.Mix the hot food item with a cold food item.