TEST BANK for Miller's Nursing for Wellness in Older Adults, Canadian Edition Sandra P. Hirst

TEST BANK

1. A nurse is discussing an older adult's recent diagnosis of rheumatoid arthritis with a colleague. Which of the nurse's statements reflects an accurate view of the relationship between aging and wellness?

A) “It's important that the individual knows this is an expected part of growing older.”

B) “We need to teach the older adult how he can keep living a fruitful life in spite of his diagnosis.”

C) “We need to make sure our teaching is not too detailed for someone of his age.”

D) “We need to ensure his expectations of continuing to live alone are realistic.”

2. A nurse is teaching an older person about the concept of successful aging. Which of the nurse's questions addresses an important contributor to successful aging?

A) “Are you largely free of acute or chronic illnesses?”

B) “Do you feel financially secure?”

C) “Do you feel like you actively engage with life?”

D) “Do you have a reliable support network?”

3. An older adult has recently begun to display unprecedented lapses in short-term memory. The nurse overhears a colleague reassuring the person by saying, “Try not to worry; it's just a part of growing older.” The nurse recognizes that this is an example of what phenomenon?

A) Multiple jeopardy B) Gerontophobia C) Age attribution D) Implicit ageism 4. A nurse hears a colleague make the statement, “Most older adults have nothing to worry about financially.” Which response is most appropriate?

A) “You have to remember that there's a huge economic disparity among older adults.”

B) “Actually, the number of older people living below the poverty line has been increasing, not decreasing.”

C) “This isn't really true now, but it is true that the gaps that disadvantaged groups live with are expected to shrink.”

D) “This is true for some groups, but not for minorities who are less likely to be living with their relatives.”

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5. A nurse is conducting a study on the needs and living situations of older adults in the community. Which statement should the nurse take into account?

A) A majority of older adults will live in a nursing home at some point.

B) More older men live alone than do older women.

C) Assisted living arrangements have become increasingly common.

D) Most older adults reside in some form of institutional arrangement.

6. A nurse who provides care to many older adults recognizes the importance of implementing a wellness approach to care. What principle underlies this approach to the health care of older adults?

A) Older adults have decreasing expectations for wellness as they move through the aging process.

B) Health problems are a Western cultural construct that has no objective, physiologic basis.

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.

7. A diabetes nurse is providing care for a 73-year-old client who is a regular client of the hospital's out-patient 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?”

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 action 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.

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

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10. A nurse identifies those who are at risk for familial stress. Who exemplifies the sandwich generation?

A) 50-year-old who balances the care of an 82-year-old parent and a 20-year-old child B) 58-year-old whose elderly parents have been forced to live in separate care facilities C) 72-year-old who deals with own health problems with the care of a grandchild D) 83-year-old who is the sole caregiver for the 79-year-old spouse

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 represents the nurse's best response to this definition?

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.”

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

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 characterizes this scenario?

A) Ageism B) Aging anxiety C) Aging attribution D) Antiaging

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14. Which 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 Canada, 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 Old Age Pension.”

E) “With increased age, people become more diverse and people become less like their age peers.”

15. A nurse assesses a community of older adults. Who is at highest risk for a shortened life expectancy?

A) College professor born in 1956 B) Homemaker born in 1957 C) Nuclear engineer born in 1958 D) Nurse born in 1959

16. A nurse assesses the risk of the members of the community. Who is most likely to be living at or below the poverty line?

A) 83-year-old single woman B) Couple who are both 72 years old C) Caucasian 73-year-old man D) Caucasian couple in their 60s

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Answer Key 1. B 2. C 3. C 4. A 5. C 6. D 7. A 8. B 9. D 10. A 11. B 12. D 13. A 14. C, D 15. B 16. A

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1. A nurse manager justifies the budget for education regarding cultural competency for the staff. Which justification will best support the need for this education?

A) Life expectancies among minorities are expected to increase.

B) Government and health care organizations support the need for culturally competent care.

C) Every nurse–client encounter involves some degree of cultural differences.

D) Nurses have a moral obligation to achieve cultural competency with all cultural groups.

2. A nurse is beginning a new job in an area with a Canadian Aboriginal population.

Which statements will assist the nurse to understand this ethnic/race culture to better plan nursing care? (Select all that apply.)

A) Canadian Aboriginals include First Nations, Metis and Inuits.

B) The Aboriginal population is growing much faster than the general population in Canada.

C) Lifestyle and risk factors account for the health disparities with the Aboriginal Canadian population.

D) Older Aboriginal Canadians are more likely than other older Canadians to live alone.

E) Many older Aboriginal Canadians experienced trauma at government-run residential schools.

3. A nurse has observed an increasing number of older South Asian Canadians in the hospital. Which statement regarding the South Asian Canadian culture will best assist the nurse to plan nursing care?

A) South Asian Canadians experience more cardiovascular problems than do other ethnic groups.

B) South Asian Canadians are able to access health services to follow through with treatment regimens.

C) Older South Asian Canadians are more likely than other older Canadians to live alone.

D) South Asian Canadians do not comply with western treatments.

4. A nurse's colleague states, “Older people who live in the country are a lot healthier than city folk.” Which statement by the nurse is most appropriate?

A) “The differences aren't large, but rural adults do have better health outcomes than do city dwellers.”

B) “Older adults living in rural areas tend to be more disadvantaged.”

C) “Overall, yes. Higher levels of family support translate into longer average life spans for rural adults.”

D) “Unfortunately, no. And this is mostly attributable to the problem of homelessness.”

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5. A nurse speaks at a staff development in-service. Which statement by a nurse participant shows the need for education?

A) “I know that the consequences of discrimination are still present and they're linked to health disparities.”

B) “I'm sure the percentage of client-care hours that we spend working with minority clients is bound to increase.”

C) “Some may erroneously assume that there are few health disparities because Canada has a universal health care system.”

D) “It's inaccurate to link the prevalence of particular diseases with particular minority groups.”

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

7. A nurse reviews 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.

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

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9. A nurse performs a reflective cultural self-assessment. Which outcome 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

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

11. A nurse plans culturally competent care for a variety of clients. Which culture is most strongly tied to the low health status?

A) Chinese Canadian Race B) Low socioeconomic status C) Member of LGBT society D) Resident of urban community

12. A nurse verifies the health belief system of the Black Canadian older adult client. Which belief 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.

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.

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14. Which sources might nurses use to improve their cultural competence? (Select all that apply.)

A) Discuss cultural norms with clients' families.

B) Explore the resources in Online Learning Activities.

C) Read journals and other references.

D) Utilize organizations listed at the end of chapters.

E) Write teaching materials in prominent local languages.

15. A nurse works to protect vulnerable populations and reduce health disparities. Which nursing actions work toward that goal? (Select all that apply.)

A) The nurse acknowledges that the clients in subgroups will not change beliefs or actions.

B) The nurse communicates a nonjudgmental attitude toward health system beliefs.

C) The nurse incorporates clients' belief systems into the plan of care.

D) The nurse asks the client how the care system can incorporate the clients' health beliefs.

E) The nurse teaches each client about preventive care.

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Answer Key 1. C 2. A, B, C, E 3. A 4. B 5. D 6. B 7. B 8. C 9. C 10. B 11. B 12. A 13. A 14. B, C, D 15. B, C, D, E

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1. A nurse is using the Functional Consequences Theory as a lens for planning client care in a health care facility. Which represents a key element of this nursing theory?

A) Most problems affecting older adults may be attributed to age-related changes.

B) Most functional consequences cannot be addressed through nursing interventions.

C) Wellness is a concept that is broader than just physiologic functioning.

D) The Functional Consequences Theory is an alternative to holistic nursing care.

2. A nurse is working with a 79-year-old client newly diagnosed with osteoporosis. Which interaction promotes achievement of wellness outcomes?

A) The nurse performs strength and mobility training appropriate to the client's age and diagnosis.

B) The nurse teaches the client about bone density in older women and the role of vitamin D and calcium intake.

C) The nurse plans interventions in light of the body–mind–spirit interconnectedness of the client.

D) The nurse teaches the client about how her risk factors are a consequence of age.

3. A nurse is teaching a colleague about the difference between age-related changes and risk factors. Which example 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

4. A nurse determines risk factors for an 81-year-old client's plan of care. Which 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

5. A nurse is identifying positive functional consequences as part of the development of an older client's care plan. Which outcomes exemplify the concept of positive functional consequences for an older adult? (Select all that apply.)

A) The older adult with arthritis can walk 1.6 km without pain.

B) The older adult who is overweight develops a plan to lose 4.4 kg a month.

C) The older adult has constipation from pain medication.

D) The older adult schedules cataract surgery.

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6. A nurse uses the Functional Consequences Theory to assess older adults. Which situation best demonstrates the effect of physical environment on the older adult?

A) A resident of a care facility experiences a fall because there are no 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.

7. A nurse in long-term care plans interventions to promote wellness in older adults.

Which intervention 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 a hospitalized older adult 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

8. A nurse in the long-term care facility plans care to improve quality of life. Which action 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

9. A nurse plans the care of older adults in a long-term care setting. Which intervention 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

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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 concept is illustrated in this example?

A) Risk factors B) Age-related changes C) Positive functional consequences D) Wellness outcomes

11. A nurse in a community setting plans wellness outcomes with a 68-year-old female client who desires to participate in a half-marathon run. Which outcome should the nurse document?

A) The client will remain free of disease.

B) The client will participate in daily aerobic activity class without falls.

C) The client will increase activity until able to run 30 minutes.

D) The client will participate in the half marathon that is scheduled in 6 months.

12. A nurse assesses a 71-year-old person who has smoked for 43 years. Which represent a negative functional consequence of smoking for this person? (Select all that apply.)

A) Children are exposed to secondhand smoke B) Low oxygen-carrying capacity C) Abnormal breath sounds D) The ability to run a 5-K race E) Pulmonary disease

13. A home health nurse performs an admission on a 90-year-old client who has a small dog. The client states that the most important problem is urinary incontinence. The client's blood pressure is 135/90 mm Hg, with last bowel movement 3 days ago. Which area addresses the person's goals?

A) Safety B) Incontinence C) Blood pressure D) Constipation

14. A nurse cares for an older adult at risk for a venous stasis ulcer. Which interventions should the nurse include in the teaching with this older adult? (Select all that apply.)

A) Health promotion interventions B) Functional consequences C) Wellness outcomes D) Environmental modifications

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15. An older adult reflects, “Why should I go to the gym, I'm going to get fat anyway.”

Which response by the nurse is most appropriate?

A) “Age-related changes are inevitable; however, most problems affecting older adults are related to risk factors, so it's important to do what you can to maintain a high level of functioning.”

B) “Older adults experience positive or negative functional consequences because of age-related changes.”

C) “Risk factors do impact consequences, but you can override them.”

D) “Many problems affecting older adults are based on genetics.”

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Answer Key 1. C 2. B 3. D 4. A, E 5. A, B, D 6. A 7. B 8. D 9. B 10. B 11. D 12. B 13. B 14. A, D 15. A

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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 theory best explains why the client has had these issues?

A) Free radical B) Program C) Immunosenescence D) Wear-and-tear

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 theory of aging best describes the status of this client?

A) Activity B) Feminist C) Life-course D) Subculture

3. Which statement best explains the relevance of psychological theories for gerontologic 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 behavioural 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.

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 44 kg. Which theory best describes this client's actions?

A) Activity B) Age stratification C) Functional consequences D) Life-course development

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5. The child of an 81-year-old client asks the nurse about vitamins, antioxidants and age-related macular degeneration. Which theory of aging is most appropriate to this topic?

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

6. A group of nurses is involved in the planning and implementation of a health promotion campaign aimed at older adults. Which question is the best guide to such a campaign?

A) “How can we help older adults maintain wellness as they age?”

B) “What can we do to increase life expectancy in our region?”

C) “How can we help older adults avoid age-related changes?”

D) “What is stopping older adults from living longer lives?”

7. A gerontologic nurse is aware that quality of life is an important consideration when assessing the functioning of older adults. What measure should the nurse use when appraising older adults' quality of life?

A) Active life expectancy B) Gerotranscendence C) Life expectancy D) Rectangularization of the curve

8. A 74-year-old client has recently begun integrating more fresh fruit and vitamin supplements in an effort to increase the levels of antioxidants. This client's actions indicate an understanding of what theory of aging?

A) Cross-linkage B) Program C) Immunosenescence D) Free radical

9. Which characteristic of older adults is explained by the subculture theory?

A) Older adults have little control over the biologic effects of the aging process.

B) Older adults have a decreased need for social interaction and peer support as they become older.

C) Older adults may see their status with their peers in terms of economic achievement.

D) Older adults may interact much more with other older adults than with members of other age groups.

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10. A nurse is aware that many health care providers prioritize the role of biology in the aging process. What is a weakness of biologic theories of aging as it applies to nursing?

A) Do not account for the differences in life expectancy between men and women B) Unable to explain the role of cell division in life expectancy and the aging process C) Do not address the influence of nursing, medical and psychosocial interventions that can improve quality of life D) Unable to explain the significant increases in life expectancy that occurred in the 20th century

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 categorizes this client's aging?

A) Healthy aging B) Active aging C) Productive aging D) Successful aging 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 statement, 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.”

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 response 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.”

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.”

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15. A client, who retired from work this year, asks the nurse the secret to successful aging.

Which response 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.”

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Answer Key 1. C 2. D 3. A 4. C 5. A 6. A 7. A 8. D 9. D 10. C 11. B 12. C 13. A 14. B 15. C

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1. A nurse is explaining to a new colleague the similarities and differences between gerontology and geriatrics. Which situation would most likely be addressed by a geriatrician rather than a gerontologist?

A) Teaching older adults techniques to identify and deal with age-related changes B) Organizing and leading exercise classes to facilitate mobility C) Identifying and treating a client's vascular dementia D) Rearranging an older adult's apartment to minimize the risk of falls

2. A nurse works with a program that performs interviews, blood work and digital rectal examinations aimed at identifying older men with benign prostatic hyperplasia (BPH).

The program also facilitates bathroom alterations in older adults' homes to ensure men with BPH have easy access to a toilet. Which component of health promotion has yet to be implemented in the program?

A) Screening B) Risk assessment C) Environmental modification D) Risk-reduction interventions

3. A nurse is teaching nursing students about the importance of health promotion among older adults. Which statement by a student indicates a need for further teaching?

A) “Teaching older adults how to live with diabetes would be a useful health promotion initiative.”

B) “I can see why we would want to promote timely discharge back to the community following hospitalization.”

C) “I think that attending to spiritual growth could likely be a part of health promotion.”

D) “If we could promote healthy, simple diets, then some diseases could likely be prevented.”

4. Which intervention 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

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5. Which circumstance 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.

6. A nurse who works with older adults is teaching a colleague about the similarities and differences between gerontology and geriatrics. Which question 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?”

7. Despite the fact that older adults are proportionately the highest users of health care services, many nurses harbour 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

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

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9. A gerontological nurse who works in a public health setting has limited funding for initiatives. Which prevention and health promotion initiative 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

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 behaviours with healthy behaviours D) An awareness of the differences between life expectancy and active life expectancy

11. A nurse at the aging center organizes exercise classes including tai chi. Which principle is the nurse incorporating?

A) Disease prevention B) Environmental modification C) Health promotion D) Spiritual awakening

12. A graduate nurse expresses an interest in focusing future study to healthy aging. Toward which of the following fields should the experienced nurse steer the graduate nurse?

A) Palliative care B) Gerontological nursing C) Nursing home administration D) Social work

13. A graduate nurse expresses an interest in focusing future study toward health promotion activities in the older adult. Toward which resource should the experienced nurse steer the graduate nurse?

A) Canadian Heart and Stroke Foundation B) Canadian Hospice Palliative Care Association C) Public Health Agency of Canada D) Springer Publishing Company

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14. A rural community nurse sets up a monthly disease screening service. Local news coverage chooses not to cover this event. Which justification best supports the screenings?

A) Health promotion is essential for older adults because they have complex health care needs.

B) Older adults are less responsive to health promotion interventions.

C) Older adults as a group receive fewer prevention and screening services than other populations.

D) Preventive services are less effective after the onset of chronic illness.

15. A nurse helps older adults increase healthy behaviours by restructuring. Which communication technique should the nurse use to help the older adult overcome barriers?

A) “Could you walk with your friend for a half-hour after you both come back from the lunch program at the senior center?”

B) “I know it's hard to get outside in the winter, so let's try to identify some ways of getting more exercise indoors during your usual activities.”

C) “Let's talk about the benefits of exercise. When you walk regularly you reduce constipation and muscle pain.”

D) “Your activity has been decreasing during the last 3 years, and it is at the point that you are at an increased risk for heart disease.”

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Answer Key 1. C 2. D 3. B 4. A 5. D 6. C 7. B 8. C 9. D 10. C 11. C 12. B 13. C 14. A 15. B

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1. A hospital nurse is discussing with an older adult the possibility of 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) My pneumonia enables me to qualify for skilled care in a nursing home.

2. A nursing care manager monitors admissions into an acute care unit. Who 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

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.”

4. A nurse is teaching an older adult about possible involvement in skilled home care programs. Which statement by the older adult shows understanding?

A) Skilled home care programs can be funded by the provincial/territorial government–supported initiatives.

B) Skilled home care programs provide a cost-effective alternative to hospital-based acute care.

C) Skilled home care 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 skilled home care programs.

5. A client has recently begun receiving Old Age Security benefits and is asking the nurse about what services might be included or excluded under Medicare. Which service is most likely to be excluded from Medicare funding?

A) Hospital care B) Hospice care C) Rehabilitation care D) Retirement homes

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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

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

8. Active care management is often necessary in order to maintain wellness among older adults. Which older adult is most likely to require care management?

A) 90-year-old man who lives alone and has no living family members B) 77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier C) 81-year-old resident of a nursing home whose Alzheimer disease is progressing rapidly D) 90-year-old man who has recently been transferred from an assisted living facility to an acute care setting

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.

C) Encourage older adults to make care providers aware of each chronic condition they live with.

D) Provide care that is primarily focused on acute, rather than chronic, health problems.

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10. Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which problem is most likely to precipitate admission to long-term care?

A) Kidney disease B) Traumatic injury C) Chronic obstructive pulmonary disease D) Dementia

11. Which actions exemplify the nurses' role in home care of an older adult? (Select all that apply.)

A) Coordinate a multidisciplinary team.

B) Perform ADL care for clients.

C) Provide resources to caregivers to reduce caregiver stress.

D) Refer available community resources.

E) Teach about interventions to provide quality care.

12. A nurse teaches an older adult client about the use of the telehealth equipment to monitor congestive heart failure. Which statement by the client shows understanding?

A) “I will call the primary health care office everyday with my weight and blood pressure.”

B) “I won't touch this fancy equipment unless you are here.”

C) “I need to step on this scale and use this automatic cuff each day.”

D) “I will watch the prescribed television show every afternoon.”

13. A nursing administrator of the long-term care facility implements a performance improvement program. Which activity should be included in the program?

A) Develop a dementia care unit.

B) Decrease the use of intramuscular medications.

C) Emphasize safety and medical care.

D) Assess personal choices and quality of life.

14. A client in the skilled nursing facility refuses rehabilitation services 5 out of 7 days. An administrator tells the client that they will be transferred to the intermediate care unit.

The client states, “Medicare is paying my bill; you can't transfer me.” Which is the best response by the nurse administrator?

A) “You are making good progress; it's time to move to the intermediate care unit.”

B) “We don't accept Medicare clients in the skilled unit.”

C) “Oh, I wasn't aware; you will be staying here.”

D) “You qualify for skilled home care services, but they are meant to be short-term as you continue meeting your goals.”

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15. Older adults with complex medical problems are vulnerable to experiencing problems as they transition between care settings. Several factors have been identified that compromise client safety. Identify those factors. (Select all that apply.)

A) Communication gaps B) Ineffective medication reconciliation procedures C) Poor coordination of services D) Client characteristics E) Client age

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Answer Key 1. D 2. A 3. C 4. A 5. D 6. C 7. B 8. A 9. A 10. D 11. A, C, D, E 12. C 13. D 14. D 15. A, B, C, D

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1. A nurse is responsible for assessing an older adult in an acute care setting. Which statement 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.

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.”

3. A nurse conducts a functional assessment of a client who has moved to the assisted living facility. Which statement 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.

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.

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5. A nurse in a Medicare-funded nursing home performs assessments and develops care plans. Which statement 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.

6. A nurse completes the admission assessment of an 84-year-old client to the long-term care facility. Which assessment finding would direct the nurse to document a deficit in the client's ADLs? A) The client experiences chronic pain as a result of rheumatoid arthritis.

B) The client is able to ambulate with a wheeled walker for 18 meters but then requires a rest break.

C) The client is able to wash self but requires assistance entering and leaving the bathtub.

D) The client is unable to explain the rationale for each of the prescribed medications.

7. A 79-year-old client has been admitted to a long-term care facility because of the progression of Alzheimer disease from mild to the moderate stage. How should the nurse proceed with functional assessment?

A) Document the fact that it is not possible to accurately gauge the woman's ADLs. B) Obtain assessment data from the woman's family members and friends.

C) Perform assessment passively by observing and recording the woman's behaviour and actions over the next several days.

D) Use an assessment tool that is specifically designed for use with cognitively impaired clients.

8. A nurse working in an acute care for elders unit observes that a client on the unit frequently stumbles when ambulating with a walker. Which action by the nurse is best?

A) Provide a wheelchair for the client to use for the duration of the hospital stay.

B) Ask the client to remain in bed as much as possible and teach the client about falls risks.

C) Place a chair in the hallway so the client can take a rest break when feeling unsteady.

D) Ensure that the woman's mobility is assessed and the appropriate assistive device is provided.

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9. A nurse discusses driving with an older adult who continues to drive, but is probably unsafe on the road. Which statement made by the nurse is most appropriate?

A) I am calling your child to take your keys.

B) I am concerned about your safety, as well as the safety of others.

C) We just don't want you to crash when you drive across the state.

D) You shouldn't drive anymore.

10. Assessment of an older adult's ADLs addresses parameters such as mobility, dressing and elimination. In addition to these, which category should the functional assessment also include?

A) Pain B) Mental status C) Previous medical history D) Integumentary assessment

11. A nurse assesses a 91-year-old client in long-term care healing from bilateral broken legs caused in a fall. Today, the client developed new onset confusion and combativeness. Which factor must the nurse investigate as a source of this mental status state? (Select all that apply.)

A) Social separation B) Hyponatremia C) Medication interactions D) Positional pain E) Urinary tract infection

12. A nurse assesses older adults in their own home. Which 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?

13. A nurse at a long-term care facility completes a minimum data set on each client. Which 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 behaviour patterns E) Psychosocial well-being

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14. A home care nurse assesses the home environment of an older adult client. Which environmental condition 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.

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Answer Key 1. B 2. C 3. B 4. D 5. B 6. C 7. D 8. D 9. B 10. B 11. B, C, E 12. A, B, C, D 13. A, B, D, E 14. D

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1. A nurse assesses the eating habits of a 75-year-old client who takes iron supplements for iron-deficiency anemia. Which statement 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.”

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.

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 action 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.

4. An older adult wants to take ginkgo biloba, valsartan (Diovan) and hydrochlorothiazide for hypertension. He also takes an aspirin daily. Which statement best reflects the advice his nurse should give him?

A) “Ginkgo biloba may cause postprandial hypotension in older adults.”

B) “Ginkgo biloba has the potential to interact with hydrochlorothiazide.”

C) “Ginkgo biloba can interact with valsartan, reducing its effectiveness.”

D) “Ginkgo biloba taken with aspirin can potentially cause a drug interaction.”

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5. A nurse assesses an older adult who has been having a difficult time sleeping throughout the night and incontinence. Which question by the nurse will best provide clues to these problems?

A) “How many times a night do you get up to urinate?”

B) “What did your health care practitioner tell you about your medications?”

C) “What medications do you take when you need to stay asleep?”

D) “What beverages do you drink on a regular basis?”

6. A nurse initiates an acute care for elders unit in a medical facility. Which factor should the nurse include when teaching the nursing staff about delivering medications to the older adults on the unit?

A) Drug metabolism shifts from the liver to the kidneys as individuals age.

B) Older adults face an increased risk of adverse medication effects.

C) Older adults tend to achieve clearance of medication faster than do younger clients.

D) Older adults tend to need more frequent doses of a drug to achieve therapeutic effect.

7. A nurse is conducting a medication assessment of an older adult. Which statement by the older adult indicates a need for further education?

A) “Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy.”

B) “I've made a reminder system for myself so that I don't miss any of my pills during the day.”

C) “My family doctor has me on so many different pills now, so I want to talk about whether they're all necessary.”

D) “I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural.”

8. A nurse reviews the medication list of an older adult. Which age-related change leads to a slower drug clearance?

A) Increase in sensitivity to bioactive substances B) Elimination half-time is likely to be faster.

C) Increase in glomerular filtration rate D) Decrease in hepatic blood flow

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9. A nurse is conducting a medication assessment of an older adult client who will soon be receiving home care. Which 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?”

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 client and minimize liability C) The importance of the client's safety D) The importance of fostering client compliance

11. A nurse administers medications to a group of older adults in a residential facility. Who is most likely to experience adverse effects?

A) 77-year-old man with a creatinine of 3.6 B) 78-year-old man with a body mass index of 35 C) 84-year-old woman with iron-deficiency anemia D) 82-year-old woman with constipation

12. A nurse reviews the medication list of an older adult upon transfer from the hospital to an extended care facility. Which method 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.

13. A nurse assesses frail older adults prescribed multiple medications. Which 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)

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14. A nurse notes that an older adult is unable to process complex thoughts and has difficulty forming sentences. Which action 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.

15. A home care nurse admits an older adult with macular degeneration. Which assessment question 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?”

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Answer Key 1. B 2. D 3. B 4. D 5. D 6. B 7. D 8. D 9. A, C, D, E 10. C 11. A 12. B 13. C, E 14. A 15. B

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1. A 76-year-old Asian woman has been admitted to the hospital. There are no advance directives in the chart. Which question will best prepare the nurse to begin a dialogue with this client about advance directives?

A) “Who do you talk to about your health care decisions?”

B) “I see that you have no advanced directives on your chart, could you tell me about that?”

C) “Is there someone we should call to join us while we discuss your care?”

D) “Tell me about your living arrangements; do you live alone or with others?”

2. A nurse discusses advance medical directives with a group of older adults at the senior citizens' center. Which statement made by a member of the group best indicates a need for further teaching about medical directives?

A) “Advance directives address the person's right to refuse medical treatment.”

B) “It is helpful to see an attorney before completing a durable power of attorney.”

C) “Advance directives provide legal assurances that a person's preferences will be considered.”

D) “A Power of Attorney for Personal Care cannot be initiated before a person is incapacitated.”

3. An 87-year-old woman has a history of depression and hypothyroidism. She was recently diagnosed as having breast cancer. Her daughter tells her health care provider that her mother cannot participate in decision making about her care because she is too old. Which statement is true about decision-making capacity?

A) Determination of decision-making capacity is based on the older adult's diagnosis and chronologic age.

B) The older adult has decision-making capacity if she understands most of the risks and benefits of medical treatment.

C) The older adult needs to understand the issues involved in decision making and communicate about them.

D) Decision-making capacity of older adults is always determined by a mental health judge.

4. An older woman of Filipino heritage has been having rectal bleeding for several months.

Her physician has told the woman and her daughters that she has advanced colon cancer. Her daughters want to obtain hospice services but the client is reluctant and does not want to discuss what she feels is “beyond her control.” Which concern is this client most likely experiencing?

A) Entrenched optimism in health care providers B) Individual autonomy regarding end of life C) Impaired cognition secondary to cancer D) Cultural taboo to discuss death

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5. A nurse manager of a nursing care facility reviews potential health and safety interventions and outcomes with the nursing staff. Which interventions place emphasis on quality of life with the best possible health and safety outcomes?

A) Telling the resident about his or her schedule for the day B) Allowing the resident with a history of falls to walk with the help of an assistant C) Discouraging the resident who states he or she is tired from participating in activities D) Advising the resident not to attend church because the resident is not Catholic

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

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.

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8. In which situation would a living will provide clear direction to the care and treatment of the individual involved?

A) 81-year-old male client diagnosed with bone cancer is experiencing severe pain and has been presented with treatment options.

B) 78-year-old female client has been brought to the emergency department after falling on an escalator.

C) 77-year-old female client has been admitted to hospital with an electrolyte imbalance secondary to an accidental overdose of diuretics.

D) 84-year-old male client has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive.

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 its views on inserting a feeding tube. Which document 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 power of attorney for personal health care D) A will

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.

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 action 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.

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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.

13. A nurse in the long-term care facility plans a meeting to assist an older adult and family and to discuss end-of-life care options. Which interventions are appropriate for the nurse to include in preparation for this event? (Select all that apply.)

A) Assist the older adult to wear his or her 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.

14. A nurse discusses the future with an older adult who has had surgery for a fractured hip and is also diagnosed as having depression. The client wavers between wanting to give up and going to rehabilitation. Which question should the nurse ask to assist the client toward values clarification?

A) Which pain medication works best for you?

B) How can we best assist you with your activities of daily living?

C) Do you prefer to bath in the morning or in the evening?

D) What goals do you have for the next year?

15. A nurse plans discharge for an older woman from China who is living with her son.

Which action should be included in this plan to indicate that the nurse understands cultural influences?

A) Include all family members in discharge planning.

B) Ensure that the discharge plan does not include any technologic aspects.

C) Review the discharge plans with the client and her son.

D) Speak only with the client.

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Answer Key 1. A 2. D 3. C 4. D 5. B 6. B 7. B 8. D 9. C 10. D 11. D 12. A 13. A, B, C 14. D 15. C

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1. An 80-year-old is seen in the emergency department for a fall. The client has bruises on the upper arms and appears depressed. The client is accompanied by a grandchild, who is unkempt, glassy-eyed and whose breath smells of alcohol. Which nursing action should be the priority?

A) Assess whether the older adult is safe in the home environment.

B) Determine whether legal interventions are appropriate.

C) Assess the client's degree of frailty and chronic health problems.

D) Determine the mental capacity of the older adult.

2. Which is true about cognitive impairment and abuse of older adults?

A) Older adults who live alone are always willing to acknowledge their impairments.

B) Cognitively impaired older adults are usually able to meet minimum standards of care.

C) When the older adult denies cognitive impairment, the risk for abuse declines.

D) Older adults become more vulnerable to abuse because of cognitive impairment.

3. A neighbor notices an 81-year-old getting water from someone's outside faucet. The neighbor notices that this person's ankles are very swollen and there is an open wound on her left leg. The older adult says, “I stopped taking my pills because the water department turned off my water and I can't use the bathroom. My daughter did not pay the water bill, and she never has time to take me to the doctor so my legs can be checked.” The neighbor calls adult protective services. Which of the following interventions is the priority when the nurse visits for an evaluation and does not find any immediate danger?

A) The competency of the older adult in making decisions needs to be determined.

B) The daughter needs to be picked up by the police on a neglect charge.

C) The older adult needs to be involuntarily committed to a long-term care facility.

D) An involuntary legal intervention needs to be initiated immediately.

4. Which statement 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.

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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 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.

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.

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

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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 statement, 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.”

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?”

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 and 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

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.

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12. A nurse prepares a presentation regarding elder abuse and neglect. Which types of abuse should the nurse include? (Select all that apply.)

A) Alcohol (substance) B) Financial C) Mandatory D) Physical E) Psychological F) Sexual

13. A nurse assesses an 85-year-old client and finds bruises on the arms and shins and a skin tear on the right hand. Which action is the priority for further nursing assessment?

A) Consider the family as a reliable source of information.

B) Determine if the person is depressed.

C) Follow the protocol for reporting elder abuse.

D) Review the client's medications and medical diagnoses.

14. A home health nurse visits a client who has a history of alcoholism and dementia. The client's words are incoherent, and the client's clothes are filthy. The client is unsteady and leaning to the right, and the room in the rooming house is in disarray. The only word that the nurse can clearly identify is “no.” Which action by the nurse is most appropriate at this time?

A) Ask the neighbors what has been happening.

B) Call emergency services for transport to a hospital.

C) Leave and return later.

D) Search the room for empty bottles.

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Answer Key 1. A 2. D 3. A 4. D 5. B 6. D 7. B 8. C 9. A 10. C 11. C 12. B, D, E, F 13. D 14. B

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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

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 nursing diagnosis is appropriate for this older adult?

A) Knowledge deficit B) Altered thought processes C) Health-seeking behaviours D) Altered health maintenance

3. A 70-year-old client reports that he cannot remember things like he used to. The nurse initiates a memory training program. Which question 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?”

4. A nurse assesses a 61-year-old adult who reveals that he can't process as quickly as when he was younger and that “all these people talk about multi-tasking, but I can't do that!” Which response 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 in the cognitive functions that you use all the time.”

5. Which point 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.

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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?”

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.

8. A nurse plans activities each month at an assisted living facility. Which activity is most cognitively stimulating?

A) Book discussions B) Movie night C) Exercise D) Reminiscence therapy

9. A nurse providing care in a long-term care setting is aware that the cognitive function of older adults does not necessarily decline on an inevitable trajectory. Which action has the greatest potential to enhance the cognitive function of residents and prevent cognitive declines?

A) Encourage older adults to openly express their emotions and opinions.

B) Provide residents with four or five low-fat, high-protein meals during the day.

C) Encourage older adults to participate in mentally stimulating activities.

D) Present older adults with numerous opportunities to make autonomous decisions.

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10. A nurse interviews a client who is 82 years old and has several chronic conditions, including type 2 diabetes and heart failure. The client expresses feelings of more satisfaction with life now than when she was younger. Which phenomenon is the client expressing?

A) Metamemory B) Paradox of well-being C) Crystallized intelligence D) Neuroplasticity

11. A nurse in an assisted living facility develops interventions that focus on improving cognitive abilities in the residents. Which interventions should the nurse include in the plan? (Select all that apply.)

A) Book club B) Calisthenics C) Christmas caroling D) Letter writing E) Reminiscence therapy F) Shopping trip

12. A nurse assesses an 82-year-old client who has a history of coronary artery bypass surgery and heart failure. In the interview, the family expresses concern because the client's “ability to figure out what is going on” has deteriorated. However, the client remains wise and continues to give solid life advice. Which theory explains this phenomenon?

A) Crystallized intelligence declines with age.

B) Cognitive skills of older adults are better than younger adults under some conditions.

C) Mild cognitive impairment begins with cognitive dissidence.

D) Cognitive abilities may be impaired by the client's cardiovascular disease.

13. A nurse determines that a client does not remember current events and has difficulty using technology. The nurse should consider that the client may have difficulty: A) participating in reminiscence group B) digitally recording blood glucose monitor C) remembering to weigh daily D) understanding when to notify health care provider

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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 statement 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.”

15. An older adult expresses frustration about limitations of aging. Which statement 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?”

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Answer Key 1. C 2. C 3. C 4. B 5. B 6. C 7. D 8. A 9. C 10. B 11. A, D 12. D 13. B 14. D 15. A

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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 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.

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 intervention 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.

3. A nurse manager of an extended care facility works to promote psychosocial health.

Which intervention 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.

4. A nurse teaches a nursing assistant about the impact of culture on older adults' well-being. Which statement by the nursing assistant indicates a need for further teaching?

A) “A cultural background has little influence on individuals' standards for 'normal' or 'abnormal' behaviour.”

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.”

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5. A nurse manager develops policies to promote a sense of control for older adults in the assisted living facility. Which policy 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.

6. A nurse assists adults to prepare for the changes that often occur in late adulthood.

Which 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 D) Adaptation to chronic illnesses E) Coming to terms with one's mortality

7. A 69-year-old woman is saddened by her recent diagnosis of type 2 diabetes, which is a stressor that will make numerous demands on her life in the coming years. Which action demonstrates a problem-focused approach to this stressor?

A) Eliciting support and sympathy from her sister and neighbor B) Obtaining diabetic cookbooks and learning to change her cooking habits C) Seeking out a second opinion from another physician D) Deciding to make no lifestyle changes despite her new diagnosis

8. An older adult has impaired psychosocial functioning. Which consequence should the nurse monitor?

A) Anxiety B) Elevated blood glucose level C) Increased independence D) Resilience 9. A nurse in a long-term care facility organizes a “healthy aging” class for residents.

Which activity should be prioritized during these classes?

A) Present tools that residents can use to develop better psychosocial health.

B) Role-play responses to life events that may occur in their near future.

C) Assess group members' strategies used to deal with life events.

D) Discuss coping strategies helpful in adjusting to challenges of aging.

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10. A nurse leads a “healthy aging” class at a community health center. Which question should the nurse use to generate discussion among participants in this setting?

A) “How did you adjust to your move from your house to the assisted living facility Irma?”

B) “Are you satisfied with the care that you're getting from your family doctor, Elizabeth?”

C) “Donald, could you tell us why your grandson is living with you?”

D) “Have you had any tests done on your heart since we last met, Marie?”

11. An 81-year-old is admitted to the hospital for congestive heart failure. The client is widowed, and the medical staff and client are talking about the client moving to an assisted living facility. Which intervention by the nurse best creates a wellness opportunity?

A) Ask the client to explain how cares have been accomplished at home.

B) Assist the client to discuss the feelings associated with a potential move to assisted living.

C) Describe the options for long-term housing with the client.

D) Encourage the client to think positively about this move.

12. A community health nurse presents a class on “Aging in America: Living the Dream.”

Which information 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.

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.

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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 event 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.

15. A nurse assesses an 85-year-old Filipino woman. The client states that her husband is very forgetful and angry most of the time. To which illness is the woman most likely referring?

A) Mental illness B) Fainting C) Posttraumatic stress disorder (PTSD) D) Suicide

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Answer Key 1. B 2. D 3. A 4. A 5. A 6. B, C, D, E 7. B 8. A 9. D 10. A 11. B 12. B, C 13. A 14. B 15. A

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1. A nurse performs a psychosocial assessment of an older adult living in the community.

Which statement 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.

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 response 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.”

3. A nurse assesses an older adult's abstract thinking ability. Which question 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?”

4. A nurse addresses the social supports available for an older adult client. Which nursing action should be included in the planning?

A) Ask the client direct questions about the barriers to the use of social supports.

B) Decide which of the programs is the highest quality.

C) Determine if family or friends could do the work.

D) Provide the client information about services that are available.

5. Even in a high-acuity situation, a nurse can assess the spiritual needs of a client. Which question is appropriate for the older adult admitted to the intensive care unit for sepsis?

A) “Do you attend church services?”

B) “Is there a spiritual leader we can call for you?”

C) “What are your beliefs about death?”

D) “What religion are you?”

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6. A nurse is conducting a comprehensive psychosocial assessment of an older adult who has recently moved to the long-term care facility. How should the nurse best assess the client's motor function?

A) Observe the client walking into or out of the room.

B) Assess the client's deep tendon reflexes using a hammer.

C) Perform passive range of motion exercises on the client's arms and legs.

D) Position the client supine and ask the client to perform a leg lift with each leg separately.

7. An older adult is admitted to a geriatric unit in the hospital. The nurse in the emergency department states that the client is oriented to one only. Which actions should the admitting nurse perform? (Select all that apply.)

A) Have a conversation with the client about challenges to cognitive functioning.

B) Orient the client to the room, unit and plan of care.

C) Post a calendar with dates crossed off.

D) Reassess orientation status.

E) Repeat orientation as needed.

8. A nurse performs a psychosocial assessment on an older adult in the hospital. Which statement may suggest low self-esteem?

A) “I don't know who's going to take care of my spouse while I'm in the hospital.”

B) “I know I have to rely on others for some help to get along in life.”

C) “When I was younger, I worked around the clock and now I can't even make it to the toilet.”

D) “I'm worried about what's going to happen once I get out of here.”

9. A resident of a nursing home has accused several members of the care staff of stealing jewelry from the overbed table despite the fact that the facility's policy requires residents to keep such valuables in a lock box. The nurse has responded empathically to the accusations and has explained why this is impossible to no avail. Which condition is the client experiencing?

A) Delusions B) Hallucinations C) Unresolved anger D) Illusions

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10. A nurse assesses an older adult's insight regarding the care plan. Which question should 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?”

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?”

12. During an interview with an older adult of British decent, the client moves her chair back. Which response 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.

13. A nurse assesses an older adult using a mini-mental status examination. The client is very slow to respond to the questions. Which 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

14. A nurse differentiates between dementia and depression in an older adult. Which assessment finding leads the nurse to believe that the client has depression?

A) The client has socially unacceptable behaviours.

B) The client is negativistic.

C) The client's mood fluctuates.

D) The client's mood is distractible.

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15. An older adult has developed hallucinations. For which condition should the nurse assess? (Select all that apply.)

A) Digoxin toxicity B) Hyperglycemia C) Infection D) Myocardial infarction E) Stroke

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Answer Key 1. D 2. A 3. B 4. A 5. B 6. A 7. B, C, D, E 8. C 9. A 10. D 11. C 12. C 13. B, C 14. B 15. A, C, E

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1. Which nursing interventions is priority for the management of delirium?

A) Giving the client low-dose oxygenation and maintaining his or her fluid and electrolyte balance B) Reducing noise and placing familiar objects in the client's environment C) Giving the client a clock, a watch and calendars to provide the client with temporal orientation D) Providing psychological support through cognitive and social stimulation

2. A nurse is conducting a class at a senior citizens' center on factors that protect against dementia. Which statement by an older adult in the class indicates a need for further teaching by the nurse?

A) “No healthy lifestyle is going to ward off dementia.”

B) “Eating food high in omega-3 fatty acids will help preserve my thinking processes.”

C) “Engaging in social activities will help prevent dementia.”

D) “Engaging in an organized exercise program will help prevent symptoms of dementia.”

3. A nurse teaches a client and care partner about cholinesterase inhibitors. Which statement should the nurse include in the teaching?

A) “Rivastigmine has a high chance of interacting with other medications.”

B) “Nausea, vomiting, diarrhea and loss of appetite can be prevented or reduced by starting with a low dose.”

C) “Rivastigmine is only for treatment of mild Alzheimer disease and will be discontinued as the disease progresses.”

D) “You should have a 'drug holiday' monthly to improve the medication's functioning.”

4. Which exemplify appropriate communication techniques for dealing effectively with people with dementia?

A) Ask open-ended questions so the person feels he or she can make choices.

B) For people in the later stages of Alzheimer disease, talk as you would to a child.

C) Maintain good eye contact and use a relaxed and smiling approach.

D) When the person forgets something, remind him or her not to forget next time.

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5. A nurse develops a plan to addressing dementia-related behaviours in an older adult with dementia. Which interventions should be included in this plan? (Select all that apply.)

A) Maintain a clutter-free environment.

B) Implement regular rest periods.

C) Place pictures of familiar people in every visible places.

D) Lay out clothing in the order in which the items are to be donned.

E) Test the client's memory with each conversation.

6. An 80-year-old client was referred to a neurologist after several months of worsening cognitive deficits and has subsequently been diagnosed with Alzheimer disease. Which statement by the nurse to the client's family demonstrates appropriate use of terminology?

A) “It's very difficult and stressful when a loved one becomes senile.”

B) “Even though your parent is demented, we will do all we can to promote his quality of life.”

C) “This form of organic brain syndrome is a common health problem in the ninth decade of life.”

D) “We always try our best to foster wellness in persons who have dementia.”

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

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.”

Which 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.

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9. A gerontological nurse has been providing ongoing care for an older adult who has a diagnosis of dementia. Which 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

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. Which design characteristic should be included in this new facility?

A) Monochromatic walls and floors that are a neutral colour B) Pictures, signs and colour codes for identifying places C) Bright, glossy floors that can provide sensory stimulation D) Bright lighting during the day and total darkness at night

11. A nurse prepares to administer scheduled medications to a new resident with mild non-Alzheimer–type dementia. Which type of medication should the nurse administer without concern of worsening delirium?

A) Anticholinergic B) Atypical antipsychotic C) Benzodiazepine D) Cholinesterase inhibitor

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.

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13. An intensive care nurse cares for an 83-year-old with sepsis. The client exhibits illogical thinking and agitation. Which interventions 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.

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?”

15. A nurse observes an aide asking a client what he wants for breakfast, lunch and dinner while assisting him to toilet. Which action by the nurse is most appropriate?

A) Direct the aide to present only one idea at a time.

B) Encourage this small talk.

C) No action is required.

D) Tell the aide to avoid conversations while the client is toileting.

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Answer Key 1. A 2. A 3. B 4. C 5. A, B, C, D 6. D 7. B 8. B 9. D 10. B 11. A 12. D 13. B, C, D, E 14. E 15. A

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1. A nurse monitors older adults in a long-term care facility. Which symptom would require follow-up by the nurse to assess for depression in the older adult?

A) Anorexia B) Weakness C) Labile affect D) Impaired perceptions

2. A nurse is reviewing the side effects of antidepressants with a group of older adults.

Which statement by a member of the group indicates that the nurse's teaching has been effective?

A) “I will start on the dose that I will take for life.”

B) “Hydrochloride should be given in the evening because it may help me sleep.”

C) “I need to maintain my fluid intake while on antidepressant medication.”

D) “The length of antidepressant treatment is usually 3 months for a first-time depression.”

3. A nurse monitors for depression in the older adult population. Which findings are both risk factors for and functional consequences of depression in the older adult? (Select all that apply.)

A) Chronic pain B) Functional impairment C) Hypernatremia D) Nutritional deficiencies E) Renal impairment

4. A nurse educator teaches about theories of late-life depression. Which statement 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.”

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5. When risk factors to potential suicide have been identified, a nurse must further assess the actual risk for a suicide attempt. Which question 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?”

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.”

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 type of assessment should the nurse prioritize?

A) Functional B) Medication C) Musculoskeletal D) Cardiovascular

8. Which statement 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.”

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9. A nurse on an acute care for elders (ACE) unit monitors clients for functional consequences of depression. Which statement 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.”

10. An older adult was diagnosed with depression shortly after relocating to the nursing home 6 weeks ago. Which 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.

11. Who is at highest risk for suicide?

A) 18-year-old who has made an appointment with his primary health care provider B) 60-year-old with kidney stones C) 75-year-old woman living with her child and grandchildren D) 85-year-old man whose spouse died 1 year ago

12. A nurse recognizes that depression has functional consequences. Late-life depression may lead to which functional consequences? (Select all that apply.)

A) Decreased functioning B) Dementia C) Higher incidence of a stroke D) Higher level of pain E) Increased risk for suicide

13. An older adult is admitted to the hospital with weight loss and cognitive impairment. To assist in the diagnosis of major depressive disorder, for which finding should the nurse assess? (Select all that apply.)

A) Decreased deep tendon reflexes B) Loss of interest or pleasure C) Psychomotor agitation D) Respiratory difficulty E) Sleep disturbances

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14. An older adult started an antidepressant 1 week ago. The client states, “I don't want to take that pill, it's not doing anything.” Which response by the nurse is most appropriate?

A) “That is fine, it is your right to refuse medications.”

B) “It is too soon to see effects; positive effects may begin around 3 weeks.”

C) “Let's notify the primary health care provider to try another type of medication.”

D) “What side effects are you having?”

15. A nurse teaches an older adult about the antidepressant medication recently prescribed.

Which information should the nurse include in the teaching? (Select all that apply.)

A) Antidepressants can interact with alcohol and over-the-counter medications.

B) Depression is uncommon in the older adult population.

C) Expect adverse effects of the medicine; stop medication if they occur.

D) Don't expect immediate improvement; a fair trial may take up to 12 weeks.

E) The medication is to be taken only as needed.

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Answer Key 1. A 2. C 3. A, B, D 4. C 5. C 6. C 7. B 8. A 9. D 10. B 11. D 12. A, D, E 13. B, C, E 14. B 15. A, D

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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 condition should the nurse suspect?

A) Tinnitus B) Vertigo C) Ototoxicity D) Impacted cerumen

2. A new nursing assistant asks the nurse how best to approach a hearing-impaired older adult. Which approach 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.

3. A nurse notes that a client who has heart failure could hear well during the last home visit, but is having difficulty hearing today. Which laboratory finding 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 4. 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 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?”

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5. 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 age-related change 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

6. 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 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

7. What strategy should care providers adopt when communicating with older adults who have hearing loss?

A) Use less complex concepts when communicating with hearing-impaired older adults.

B) Use a high, consistent tone and pitch when speaking to adults with hearing loss.

C) Speak at a high volume directly into the less affected ear when talking to an older adult with a hearing deficit.

D) Make eye contact before and during a conversation with hearing-impaired adults.

8. As part of a comprehensive physical assessment of an older adult client, a nurse is performing an otoscopic examination. Which assessment finding most clearly warrants further assessment and possible intervention?

A) There is a small amount of cerumen visible in the ear canal.

B) The epithelial lining is bright red.

C) The tympanic membrane is intact.

D) The tympanic membrane is a pearl-gray colour.

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9. A nurse has been caring for an 83-year-old resident of a nursing home for 2 years and has developed a high level of trust with the resident. Which recent change in the resident's behaviour may signal the possibility of hearing loss?

A) The resident's statements occasionally suggest that he is not oriented to time.

B) The resident had a recent episode where he became visibly angry at a nursing assistant.

C) The resident's attention span is short and he is easily distracted.

D) The resident has become increasingly disagreeable and terse in his demeanour.

10. A gerontological nurse presents at a local conference regarding recent findings in age-related hearing loss. Which age-related changes indicated in hearing loss and speech perception should the nurse include?

A) Changes to the external auditory canal and pinna B) Degenerative changes to the auditory brainstem C) Growth of longer and thicker hair in the ear canal D) Thickening of the tympanic membrane

11. The Functional Consequences Theory approach to hearing loss identifies health promotion interventions for promoting hearing wellness. Which intervention will most directly affect auditory health of the older adult?

A) Avoidance of medications B) Regular colonics C) Smoking cessation D) Ear muff use in winter

12. A nurse teaches an older adult about risks related to ototoxic medications. Which medication should the adult minimize or avoid?

A) Nonsteroidal anti-inflammatory agents B) Osmotic stool softeners C) Over-the-counter sleep aids D) Penicillin-type antibiotics

13. After an older adult has had irrigation for removing impacted cerumen, which interventions would be helpful for preventing a recurrence? (Select all that apply.)

A) Ceruminolytic drops as indicated B) Cotton-tipped swabs daily C) Ear candling monthly D) Home oral jet irrigator bimonthly E) Examination by the health care provider every 6 to 12 months

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14. A home care nurse teaches a caregiver about the care of hearing aids. Which statement, if made by the caregiver, indicates that further teaching is required?

A) “I lay a towel over the table while working on them.”

B) “I turn off the aid before I change the battery.”

C) “I wash the earmold with warm soapy water each week.”

D) “I have purchased enough batteries to last a year.”

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Answer Key 1. C 2. C 3. B 4. B 5. A 6. A, B, D 7. D 8. B 9. C 10. B 11. C 12. A 13. A, E 14. D

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1. A nurse develops a plan of care for an older adult recently diagnosed with Lewy body dementia. Which functional consequence would be most important to monitor in this older adult?

A) Development of visual hallucinations B) A visual acuity score of 20/30 C) Improved visual acuity after medications for dementia D) Growth of cataracts

2. A nurse is providing an educational program about age-related macular degeneration (AMD) to a group of older adults. Which statement by an older adult indicates the need for further teaching?

A) “Smoking is a risk factor for AMD.” B) “Macular degeneration causes a loss of central vision.”

C) “People with macular degeneration should have any sudden changes evaluated.”

D) “The dry type of macular degeneration occurs rapidly.”

3. Which methods can be used to informally assess an older adult's visual skills? (Select all that apply.)

A) Ask the person to look out a window and describe certain details.

B) Perform a standard confrontation test to assess central vision.

C) Place good illumination and ask the person to read printed material with various type sizes.

D) Perform a standard vision test, testing each eye separately and allowing the person to cover the other eye with a hand.

4. Which actions are crucial when assessing visual function in an older adult? (Select all that apply.)

A) Asking the older adult to read the fine print on a medicine bottle without a magnifying aid B) Asking the older adult whether he or she can drive without difficulties at night C) Observing the older adult functioning in his or her normal environment D) Observing the older adult while he or she is reading a newspaper without glasses

5. A nurse knows teaching has been effective when the client states: A) “If my sensitivity to glare decreases and my contrast sensitivity increases, I will be evaluated for cataracts.”

B) “I wear sunglasses and a wide-brimmed hat when I am in the sun to protect my eyes and prevent the development of cataracts.”

C) “Having Alzheimer disease increases one's risk of developing macular degeneration.”

D) “If I take ototoxic medications, this will increase my risk for developing cataracts.”

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6. A nurse has noted that most of the residents who live at the long-term care facility require corrective lenses of some type. Which age-related change contributes to the loss of visual acuity?

A) Decreased size and density of the lens B) Increased intraocular pressure C) Presence of floaters in the vitreous D) Decreased responsiveness of the ciliary body

7. After a scheduled trip to her optometrist, a 70-year-old has been told that the pressure in her eye is high and she needs to be monitored and treated to prevent damage to the optic nerve. Which is likely to be her diagnosis?

A) Cataracts B) Glaucoma C) AMD D) Presbyopia

8. A nurse assesses risk factors for vision loss in a 71-year-old client. Which question should the nurse include in this assessment?

A) “Do you have high blood pressure or diabetes?”

B) “Did your parents wear glasses or have cataracts?”

C) “How much red meat do you usually eat?”

D) “Do you have high cholesterol?”

9. A 78-year-old client states, “I often have dry eyes, it is bothersome and irritating.”

Which intervention should the nurse recommend?

A) Daily rinses with tap water B) A medication vacation to determine if medications are the cause C) Use of over-the-counter artificial tears D) Keeping eyes closed for 3 to 5 minutes each hour

10. A resident of a nursing home has experienced a progressive loss of vision over the past several months as a consequence of diabetes. How should the nurse accommodate the resident's loss of visual acuity?

A) Provide the resident with brightly coloured grooming utensils.

B) Replace the resident's tube television with a flat-screen TV. C) Remove books from the resident's room to avoid reminding her of her vision loss.

D) Have the walls in the resident's room painted a neutral colour that matches the colour of the flooring.

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11. A nurse assesses an older adult's colour perception. Which colours should the nurse expect the client to have the most difficulty visualizing?

A) Blue and violet hues B) Yellow tones C) White and off-white tones D) Tan and brown hues

12. A nurse gives a presentation regarding eye health at a wellness clinic. Which intervention should the nurse include in the teaching?

A) Avoid reading under halogen lights B) Cardiovascular exercise three times a week C) Get 8 to 10 hours of sleep each night D) Wearing sunglasses with UV-absorbing lenses

13. A nurse assesses a 79-year-old adult noting the presence of a white ring around the iris bilaterally. The nurse should document this finding as: A) Glaucoma B) Arcus senilis C) Arthritis D) Presbyopia

14. A nurse performs an assessment on a 93-year-old client. Which assessment findings are age-related changes? (Select all that apply.)

A) Ectropion B) Enophthalmos C) Erythematosus D) Eschar E) Exophthalmos

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Answer Key 1. A 2. D 3. A, C 4. B, C 5. B 6. D 7. B 8. A 9. C 10. A 11. A 12. D 13. B 14. A, B

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1. A nurse teaches an older adult about changes to nutritional requirements. Which meal choice would give evidence that the older adult understands the teaching?

A) Baked chicken, carrots and angel food cake B) Green salad, mashed potatoes and an oatmeal cookie C) Vegetable beef soup, crackers and Jell-O D) Baked pork chop, green beans and sherbet

2. A nurse teaches older adults about nutrition. Which statement shows the nurse that the older adult requires further teaching?

A) “Alcohol intake will interfere with absorption of B-complex vitamins and vitamin C.” B) “Certain 'fluid' pills can decrease the potassium level in my blood.”

C) “Anticholinergic medications can cause my intestines to work slower.”

D) “My over-the-counter beta-carotene pill is appropriate for long-term use.”

3. A 70-year-old client with urosepsis is admitted to a nursing unit. The labs include elevated sodium, blood urea nitrogen, hematocrit and albumin. Which nursing diagnosis is the priority for this client?

A) Constipation B) Fluid volume deficit C) Imbalanced nutrition: less than body requirements D) Impaired tissue perfusion

4. A nurse plans the diet for an older adult with congestive heart failure. Which nursing intervention would be most successful to encourage optimal nutrition?

A) Encourage calorie supplements.

B) Provide 55% of calories from complex carbohydrates.

C) Teach older adults to sit upright for 2 hours after a meal.

D) Use moderate to large amounts of flavour enhancers.

5. A nurse teaches a health education class for older adults about constipation. Which point should the nurse stress?

A) Older adults who do not have a daily bowel movement should use a laxative.

B) Older adults should limit their intake of high-fiber foods because of a risk of lactose intolerance.

C) If older adults need a medication to promote bowel regularity, a laxative or enema should be given.

D) If older adults need a medication to promote bowel regularity, a bulk-forming agent is needed daily.

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6. A nurse assesses an older adult who lives in an assisted living facility and has presbyphagia. Which system should the nurse auscultate?

A) Abdomen for bruit B) Bowel sounds C) Heart tones D) Lung sounds

7. A nurse counsels an older adult regarding nutritional requirements. Which teaching point is priority when discussing age-related changes in nutritional requirements?

A) “If possible, try to eliminate animal fats from your diet.”

B) “You should try to eat less meat and proteins than you did when you were younger.”

C) “Overall, you don't need to take in as many calories as you used to.”

D) “As an older adult, you don't need to eat as many starches and complex carbohydrates.”

8. A nurse manager of the long-term care facility develops plans to reduce nutritional deficits. Which intervention is appropriate to include in the plan?

A) Encourage residents to eat in their rooms to minimize distractions.

B) Offer four to five small meals a day rather than three larger meals.

C) Promote oral care for residents multiple times each day.

D) Provide incentives for residents to eat all the food on their trays.

9. A nurse evaluates the plan of care for a client who experienced an ischemic stroke.

Which assessment finding should signal the nurse to the possibility that the client has developed dysphagia?

A) Reports being excessively hungry B) Drinks large amounts of water with meals C) Pockets food in the affected cheek during meals D) Prefers to sit in a high Fowler's position after eating

10. A nurse admits a 90-year-old client to the hospital with a diagnosis of failure to thrive.

Which laboratory data should the nurse expect?

A) Low albumin and red blood cells B) Elevated white blood cells (WBCs) and low potassium C) Low platelets and low prothrombin time (PT) D) Elevated calcium and magnesium

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11. A nurse assesses older adults at a senior center. One older adult, age 78, has a body mass index (BMI) of 15. Which response by the nurse is appropriate?

A) “You are too skinny.”

B) “Have you been losing weight?”

C) “Have you tried to lose this extra weight?”

D) “Congratulations your BMI is great.”

12. A nurse working for human services visits a long-term care facility. Which resident assessment finding indicates poor quality care?

A) BMI of 29 B) Indentured mouth C) Serum albumin of 3.5 D) Unintentional weight loss

13. A nurse plans care for a client who states that food is no longer appealing. The nurse notes a dry mouth and teeth in poor condition. Which interventions should the nurse include in the plan of care? (Select all that apply.)

A) Eight-ounce bottle of water between each meal B) Hard toothbrush C) Ice-cold water at bedside D) Meals in the common room E) Oral care before each meal

14. A nurse at a rehabilitation unit assesses an 86-year-old woman with a BMI of 30 and a history of heart failure, whose oral intake is declining. Which risk factor is related to this older adult's decline in appetite?

A) Diuretics B) Exercise C) Female gender D) Obesity 15. An older adult states, “I just feel so full so fast, I can't eat any more.” Which response is most appropriate?

A) “All of us feel that way after a meal.”

B) “Make an appointment with your health care provider.”

C) “Slower emptying of your stomach may be the cause.”

D) “This happens when you have gall stones.”

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16. An older adult develops diarrhea. Which intervention should be the priority for the nurse?

A) Assess for pancreatitis.

B) Determine the last bowel movement.

C) Review meal preparation techniques with the client.

D) Review the client's medication list.

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Answer Key 1. A 2. D 3. B 4. B 5. D 6. D 7. C 8. C 9. C 10. A 11. B 12. D 13. A 14. A 15. C 16. D

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1. A nurse presents at a conference regarding functional consequences related to urinary elimination. Which statement should the nurse include?

A) “Most older women will develop urinary incontinence by the age of 85.”

B) “Most older adults will experience hypertrophy and relaxation of muscles in the urinary tract and pelvic floor.”

C) “Excretion of penicillin and cimetidine are decreased in older adults.”

D) “Healthy older adults experience an increase in glomerular filtration rate.”

2. A nurse assesses the urinary elimination of older adults. Which action by the nurse is most appropriate?

A) Work to identify terms that the older adult comprehends.

B) Wait until the person initiates a discussion of this embarrassing topic.

C) Give the interview questions to the client in writing.

D) Ask the older adult to keep an urination diary.

3. A nurse teaches an older adult man to perform pelvic floor muscle exercises (PFME)?

Which should be included in a nurse's instructions?

A) Interrupt the flow of urine several times each time you urinate.

B) Identify the correct muscle by making the base of your penis move up and down.

C) Contract your legs and buttocks while contracting the pubococcygeal muscle.

D) Perform the exercise while standing over the toilet.

4. A nurse administers medications to an older man. Which statement if made by the client indicates understanding of the use of tamsulosin?

A) “I am so happy that this medication is working to decrease my urinary incontinence.”

B) “I now have had much less bladder pain and cramping.”

C) “My blood pressure has been higher since taking this medication.”

D) “My urine flow starts much faster now.”

5. A nurse instructs a class of older adult women about Kegel exercises. In which urinary conditions would Kegel exercises be effective? (Select all that apply.)

A) Functional incontinence B) Pelvic organ prolapse C) Stress incontinence D) Urge incontinence E) Urinary retention

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6. A nurse assesses a 70-year-old man who has high blood pressure and chronic obstructive pulmonary disease (COPD). He has been prescribed nicardipine and ipratropium inhaler. This medication combines a calcium-channel blocker and an anticholinergic. For which urinary effect should the nurse teach the client to monitor?

A) Nocturia B) Urinary tract infection (UTI) C) Urge incontinence D) Hematuria 7. An 89-year-old woman has developed urinary incontinence. The woman states, “When I have to go, I go. I can't make it to the bathroom before it leaks out.” For which type of incontinence should the nurse develop a plan of care?

A) Functional incontinence B) Urge incontinence C) Mixed incontinence D) Stress incontinence

8. A 79-year-old man was admitted to the hospital for knee arthroplasty (replacement) due to osteoarthritis. During recovery, he developed postoperative pneumonia and became incontinent of urine while recovering from this serious infection. While being treated on the acute medicine unit, he remained in bed for several days. This client's urinary incontinence and other health challenges are most likely to result in what nursing diagnosis?

A) Social isolation B) Disturbed body image C) Anxiety D) Impaired skin integrity

9. Following a prolonged hospital stay due to an exacerbation of congestive heart failure, an older adult woman has returned to the nursing home where she normally resides. The woman became incontinent of urine during her time in the hospital, a problem that nursing staff wish to now resolve. What action should her caregivers take in performing continence training?

A) Limit the woman's fluid intake to 750 mL daily, primarily before suppertime.

B) Assist the woman with toileting at timed intervals throughout the day.

C) Teach the woman about the functional and psychosocial benefits of restoring continence.

D) Perform intermittent catheterization before each meal and before bedtime.

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10. A nurse assesses an older adult 24 hours after a retropubic suspension surgical procedure. The client is confused, exhibits muscle twitching and states she is nauseated.

Which laboratory data should the nurse assess?

A) Blood urea nitrogen B) Sodium C) Hemoglobin D) White blood cell count

11. A nurse cares for a 92-year-old woman with urinary incontinence. Which age-related change is the rationale behind assisting client to the bathroom every 2 hours?

A) Decreased estrogen levels B) Degenerative changes in the cerebral cortex C) Demyelination of parasympathetic nerves D) Diminished thirst perception

12. A nurse administers medications to older adults in a long-term care facility. Which action is most appropriate when the client with dementia is newly prescribed an antimuscarinic agent for urge urinary incontinence?

A) Administer with a full glass of water B) Assess the client for drooling and diarrhea C) Monitor the client closely for worsening cognitive impairment D) Toilet the client before administering the medication

13. A home care nurse evaluated the plan care for the older woman with urge incontinence.

Which statement by the client indicates the need for further teaching?

A) “I drink enough water, but do it early in the day.”

B) “I make certain I don't get constipated.”

C) “I purchased a fancy commode for my bedroom.”

D) “I still have to get up two times each night to urinate.”

14. The nurse assesses an older woman regarding urinary health. Which interview questions are appropriate? (Select all that apply.)

A) Do you ever leak urine?

B) Do you ever wear pads or protective garments to protect your clothing from wetness?

C) Do you have any discomfort or burning when you pass urine?

D) How much alcohol do you drink each day?

E) When you urinate do you have any difficulty starting the stream or keeping the stream going?

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Answer Key 1. C 2. A 3. B 4. D 5. B, C, D 6. A 7. B 8. D 9. B 10. B 11. B 12. C 13. D 14. A, B, C

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1. Who is likely at the highest risk for orthostatic hypotension?

A) 75-year-old woman who uses a walker B) 80-year-old man who strains to void when using the bedside commode C) 60-year-old who has a long leg cast on his right leg D) 80-year-old woman who is taking Premarin

2. Which statement by an older adult indicates the need for further teaching related to cholesterol reduction?

A) “I will decrease my intake of food high in polyunsaturated fatty acids.”

B) “I will increase my intake of soybeans, walnuts and canola oil.”

C) “I will eat fish four times a week.”

D) “I will limit my intake of trans fatty acids and saturated fat.”

3. An older adult is admitted to the emergency department with dyspnea and a sudden change in level of consciousness. The nurse should assess first for which disorder?

A) Myocarditis B) Aortic aneurysm C) Cor pulmonale D) Myocardial infarction

4. Which consideration should a nurse prioritize when assessing an older adult who has arrhythmias?

A) Assess the client for adverse medication reactions.

B) Check the client's electrolytes immediately.

C) Make an assessment in relation to the client's medical history.

D) Perform auscultation before collecting the client's history.

5. Which remediable risk factor for cardiovascular disease in older adults is the most important?

A) Smoking B) Stress C) Sedentary lifestyle D) Aggressive personality

6. Older adults experience a number of changes in the structure or function of their cardiovascular system. Which change is considered to be a normal, age-related change?

A) Veins become thinner and more elastic.

B) Regulation of blood pressure and heart rate becomes less efficient.

C) Heart valves become atrophied and regurgitation occurs.

D) Heart rate becomes slower and ejection fraction increases.

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7. The nurses who provide care in a long-term care setting are aware of the high prevalence and risks of cardiovascular disease among the older adults who live at the facility. Which measure is most likely to prevent heart disease among older adults?

A) Advocating for organic dietary choices for residents B) Establishing an exercise program C) Teaching about the relationships between family history and heart disease D) Teaching residents to reduce their stress levels

8. A 79-year-old client recently experienced a syncopal (fainting) episode after standing up quickly while gardening. Which assessment is the nurse's priority?

A) “Did you experience any fatigue or blurred vision?”

B) “What did your doctor say about this?”

C) “What medications do you take?”

D) “When did you last eat a meal?”

9. A nurse who works on a geriatric long-term care unit is aware that many of the older adult clients on the unit have a documented history of orthostatic hypotension. What measure should the nurse prioritize to ensure the safety of such clients?

A) Mobilize clients within 2 hours of eating a meal.

B) Have clients take several deep breaths before standing to their feet.

C) Have clients sit on the edge of their beds for a minute or two before ambulating.

D) Encourage clients to use a bedpan or incontinence brief to prevent falls while ambulating to the bathroom.

10. A 70-year-old client has been a regular cigarette smoker since late teens and has made several attempts to quit over the years. When the nurse encourages the client to again try to quit, the client responds, “At this point in my life, I think it's probably too late.” How should the nurse best respond to the client's statement?

A) “You'll be able to avoid having a future heart attack if you quit smoking now.”

B) “Three months after your quit, you'll have the same risk of heart disease as a lifetime nonsmoker.”

C) “In a way that's true, but you would feel much better about yourself if you managed to quit.”

D) “Actually, you'll start to enjoy some health benefits almost as soon as you quit.”

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11. A nurse identifies clients who are at risk for modifiable risk factors for cardiovascular disease. Who should the nurse prioritize as having modifiable cardiovascular functional consequences?

A) 54-year-old admitted to the hospital with hepatitis A B) 72-year-old after her second myocardial infarction C) 86-year-old obese woman who has type 2 diabetes D) 94-year-old with a strong family history of myocardial infarctions at an early age

12. A nurse educates an older adult recently diagnosed with hypertension. Which teaching points should the nurse include? (Select all that apply.)

A) Avoid home blood pressure monitoring.

B) Increase the daily intake of grains to 8 ounces per day.

C) Read labels and limit sodium to 1,500 g/day.

D) Walk daily for 30 minutes a day, 5 of the 7 days.

E) If your blood pressure is higher than 130/80, notify the primary health care provider.

13. A community nurse develops wellness outcomes for those at highest risk for poor management of cardiovascular disease. Which population should the nurse target?

A) Canadian woman B) Hindu men C) Immigrant Asian population D) Mentally ill persons

14. A nurse assesses an older adult for dietary habits. Which statement by the client should the nurse identify as a positive dietary habit for cardiovascular functioning?

A) “I avoid meat, and eat nuts instead.”

B) “I don't eat vegetables.”

C) “I drink 4 glasses of wine a day.”

D) “I limit my salt to 3,500 grams per day.”

15. A nurse provides education to an 82-year-old woman with postprandial hypotension.

Which interventions should be included? (Select all that apply.)

A) Avoid sitting still for prolonged periods.

B) Drink eight glasses of noncaffeinated beverages daily.

C) Eat regularly scheduled meals with breakfast as the largest.

D) Engage in regular, but not excessive, exercise.

E) Limit alcohol consumption to one drink per evening.

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Answer Key 1. B 2. A 3. D 4. C 5. A 6. B 7. B 8. C 9. C 10. D 11. C 12. B, C, D 13. A 14. A 15. A, B, D, E

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1. A nurse assesses an older adult's overall respiratory function. Which interview question would be most appropriate?

A) “Would you be interested in finding out more about environmental smoke?”

B) “Did either of your parents experience lung diseases?”

C) “Have you ever worked in a job where you were exposed to dust, fumes, smoke or other pollutants?”

D) “What do you do to actively maintain your respiratory health?”

2. A 65-year-old client with a long-standing history of chronic obstructive pulmonary disease (COPD) was placed recently on Coumadin after experiencing atrial fibrillation.

Upon discharge from the hospital, which statement by the client indicates a need for further teaching?

A) “I will continue to use smokeless tobacco since it's a lot better than smoking.”

B) “I will avoid using over-the-counter antihistamines since they can dry my mucosal secretions.”

C) “I will watch my intake of dark green leafy vegetables since they may impact the effects of Coumadin.”

D) “I will not take any herbal preparations without my health care provider's knowledge.”

3. A 70-year-old client smoked for 30 years and has a history of COPD. The spouse assists with cooking, cleaning and transportation. The spouse has become ill, and they now receive assistance from a home health nurse. Which intervention should be the priority?

A) Assisting the clients to perform activities of daily living (ADLs) B) Determining a plan for providing meals C) Setting up medications for the clients D) Smoking cessation plan

4. A nurse completes assessment of an older adult. Which physical assessment finding is within normal limits?

A) Kyphosis and increased anteroposterior diameter of the chest B) Increased intensity of lung sounds C) Decreased resonance on percussion D) Decreased adventitious sounds in lower lungs

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5. A nurse plans interventions in a skilled nursing facility to prevent lower respiratory infections. Which nursing interventions should be included in the plan? (Select all that apply.)

A) Encourage pneumonia vaccinations.

B) Encourage annual influenza vaccinations.

C) Encourage annual chest radiographs to detect tuberculosis.

D) Encourage influenza vaccinations every 5 years.

E) Encourage hand hygiene for residents and staff.

6. A nurse in a long-term care facility is aware of the effects of age-related changes to the respiratory system. Which functional consequence most likely results from age-related changes?

A) Snoring and mouth breathing B) A persistent, dry cough C) Increased sensitivity to environmental allergens D) Hemoptysis on exertion

7. A nurse admits an 81-year-old man to the hospital with aspiration pneumonia. Which risk factor should the nurse predict that the client has in his history?

A) Cigarette smoking B) Lung cancer C) Dysphagia D) Sleep apnea

8. A 78-year-old client has been brought to the emergency department from home with a sudden change in mental status accompanied by significant weakness. For which condition should the health care providers assess?

A) Alzheimer disease B) Lung cancer C) Pneumonia D) Tuberculosis

9. A community health nurse is to create initiatives to foster the health of older adults in the community. Which health promotion activity has the greatest potential to promote the respiratory health of older adult participants?

A) A lung cancer screening program B) A smoking cessation program C) A tuberculosis screening program D) A bronchitis immunization program

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10. A 72-year-old man's diagnostic testing and physical examination have resulted in a diagnosis of COPD. Which symptomatology is unexpected and will require follow-up?

(Select all that apply.)

A) Hemoptysis and orthostatic hypotension B) Chest pain and shortness of breath C) Cough and dyspnea D) Apneic spells and fatigue E) Wheezing and clubbing 11. A nurse discusses common illnesses at the local health fair. The older adult asks, “Why do all my friends seem to get pneumonia? We never did when we were younger.”

Which intervention is a priority for the nurse to include in her health teaching?

A) Examinations by health care provider B) Hand hygiene C) Jogging/running D) Yearly pneumovax

12. A nurse assesses older adults at a pulmonary clinic. Which question might best assist identify those at risk for pulmonary disorders?

A) “Do any of your children smoke?”

B) “In what state did you grow up?”

C) “What type of job did you have?”

D) “Where do you exercise?”

13. A nurse interviews an older adult with pulmonary disease. The client states, “I worked hard all my life in the shipyard, and I provided for my family. I never smoked. Why did I get this disease?” Which response by the nurse is best?

A) “It is a good thing that you never smoked.”

B) “Pulmonary disease can happen to anyone.”

C) “The work in the shipyard put you at risk.”

D) “You feel like you are being punished…”

14. A nurse plans care for a frail older adult in long-term care. Which intervention should be included in the plan of care to reduce the risk of respiratory infections?

A) Oral care B) Oxygen administration C) Pulmonary function testing D) Tracheal suctioning

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15. A nurse admits an older adult from a long-term care facility into the hospital for respiratory infection. Which diagnostic testing should the nurse anticipate?

A) Electrocardiogram B) Lung cancer screening C) Mantoux testing D) Pulmonary function testing

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Answer Key 1. C 2. A 3. B 4. A 5. A, B, E 6. A 7. C 8. C 9. B 10. C, D 11. B 12. C 13. C 14. A 15. C

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1. A nurse is teaching health interventions to an older adult with osteoarthritis. Which statement indicates that the individual needs additional teaching?

A) “I will avoid high-impact exercises.”

B) “I will get adequate intake of calcium and vitamin D.” C) “I will try to limit my use of walkers and assistive devices.”

D) “I will lose weight if it turns out that I need to.”

2. A nurse is teaching older adults at a senior center how to reduce the incidence of falls.

Which statement indicates that the nurse's teaching has been effective?

A) “Benadryl is a safe medication to take for sleep.”

B) “It is safe to have rugs in my kitchen and bathroom.”

C) “It is safe to take a low dose of Ativan when I am anxious.”

D) “I understand that over-the-counter medications can cause falls.”

3. A 99-year-old resident has fallen. Which functional consequence of this fall most strongly affects the plan of care?

A) At much higher risk of a fracture from a fall than a younger person B) More likely to have limited range of motion, affecting performance of some activities of daily living (ADLs) C) Unlikely to develop fear of falls D) Diminished muscle strength related to muscle mass loss

4. Which nursing intervention should be the priority for a nurse working in a retirement community?

A) Using restraints to keep nursing home residents from getting out of chairs unattended B) Establishing a fall-prevention program for residents at risk C) Using cordless phones or emergency call systems for residents in assisted living D) Using a monitoring device for people who live alone in their own home

5. Which older adult is most at risk to develop osteoporosis?

A) 75-year-old Caucasian woman with chronic obstructive pulmonary disease B) 60-year-old white man with rheumatoid arthritis C) 70-year-old man with a heart disease D) 68-year-old Caucasian woman who recently had a partial hysterectomy

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6. A 79-year-old woman is scheduled to undergo hip replacement surgery after a fracture that was caused by a fall. Which age-related change may have contributed to the woman's susceptibility to bone fracture?

A) Increased protein synthesis B) Infections within the synovial capsules of the knees and ankles C) Loss of neural control of balance D) Increased bone resorption

7. While the nurse was helping an elderly resident transfer out of the bathtub, the resident grabbed on to the nurse forcefully, became rigid and exclaimed, “Help me quick,” despite the fact that the nurse was performing a safe and controlled transfer. Why might this resident have exhibited sudden anxiety during the transfer?

A) The resident may be developing a cognitive deficit.

B) The resident is experiencing age-related changes.

C) The resident may have a fear of falling.

D) The resident is ensuring safety.

8. An 82-year-old client walked 2 miles last week to enjoy the spring weather. The client says since that time, “I haven't been doing very much, I'm afraid it will hurt.” Which action by the nurse is most appropriate?

A) Discuss moderation in activity, encouraging continued movement.

B) Obtain a cane for use to improve balance and reduce the client's fears.

C) Encourage the client to walk the 2 miles every day.

D) Have the client take ibuprofen (Motrin IB) every morning.

9. A 70-year-old woman has expressed interest in preventing osteoporosis as a result of the high prevalence of the disease in her peer group. What dietary measures should the nurse recommend?

A) High intake of salmon and fortified cereals B) A high-protein, low-carbohydrate diet C) High intake of organic fruits and vegetables D) Vitamin C supplements and a high-potassium diet

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10. A nursing home has been the site of numerous falls by residents in recent months.

Which environmental factors should the nurse manager change? (Select all that apply.)

A) The hallways that lead to the dining room and common areas do not have handrails.

B) Each room has a private sink and toilet but there are only two designated rooms for bathing in the facility.

C) The bedrails on each resident's bed are kept in a raised position whenever the resident is in bed.

D) The majority of care is provided by nursing assistants, with one registered nurse overseeing the care team.

E) Medications are administered at each room by the nurse from a rolling cart.

11. The nurse cares for a client with advanced Alzheimer disease who is not mobile. The nurse has assessed the client as high risk for falls. The fall prevention program should include: (Select all that apply.)

A) Bright orange sticker on the resident's door B) Padded mattress on the floor next to the resident's bed C) Use of chest restraints when in the wheelchair D) Frequent assessment of resident for toileting needs E) Keep lights on in room and bathroom F) Place sensor pad alarm on bed

12. The 64-year-old client who went rock climbing last week and snowboarding this week is at risk for broken bones. Which functional consequence of aging most strongly increases this risk?

A) A strong musculoskeletal system helps to protect bones.

B) Reduced osteoblastic production of bone matrix C) The long bones have decreased blood flow with aging.

D) Weight-bearing activities increase calcium uptake into bones.

13. The home nurse assesses a frail older adult for fall risk using the Timed Up and Go (TUG) test. Which score places this client at high risk for falls in his home?

A) 6 B) 9 C) 12 D) 15

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14. The nurse presents at a conference regarding aging and mobility. Which age-related changes should the nurse include?

A) Bones decrease resorption due to decreased parathyroid hormone.

B) Diminished positioning sensations in the lower extremities C) Outgrowth of collagen and elastin cells D) The number of skeletal muscle fibers increases.

15. Which hospitalized older adult is at greatest risk for in-hospital hip fractures from a fall?

A) 79-year-old client B) Client receiving numerous cardiac medications C) Client with a history of hip fractures from a fall D) Client with new-onset dementia

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Answer Key 1. C 2. D 3. A 4. B 5. A 6. D 7. C 8. A 9. A 10. A, C 11. A, B, D, F 12. B 13. D 14. B 15. C

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1. A client is unresponsive and confined to bed, with limited mobility and contractures.

The skin is usually dry, and the nutrition is less than adequate. Using the Braden score, which score will be assigned to this client's risk for pressure ulcers?

A) 8, very high risk B) 8, at risk C) 18, high risk D) 18, moderate risk

2. A nurse teaches older adults about skin care and aging. Which information would be appropriate to include in this teaching? (Select all that apply.)

A) Avoid sunscreens with a sun protection factor (SPF) higher than 14.

B) Gently rub alcohol to keratosis growths to remove them.

C) Include adequate amounts of fluid and vitamins in the daily diet.

D) Use firm rubbing motions when drying your skin.

E) Use emollient moisturizing lotions after bathing.

F) When bathing or showering, use a mild, unscented soap.

3. The nurse assesses the fluid volume status of a 72-year-old client who takes Lasix (furosemide) and Pacerone (amiodarone). Which method is most reliable for assessing this client's skin turgor?

A) Ask the client to open the mouth and examine the oral mucous membranes for dryness.

B) Examine the skin on the lower legs and look for dry, scaly or rough skin.

C) Gently pinch the skin on the abdomen to see how long it takes to return to normal.

D) Squeeze the skin on back of hand to see if it remains pinched or is slow to return to normal.

4. A nurse notes a 2-mm open shallow ulcer with a red wound bed on the great toe where shoe touched the skin. Which finding should the nurse document?

A) 2-mm stage II pressure ulcer B) Stage III pressure ulcer on great toe C) 2-mm skin tear with red wound bed D) Red ulcer on the great toe 2 mm in size

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5. Which functional consequence of skin changes will affect the nursing care of older adults?

A) Older adults have an increased incidence of moles requiring intervention.

B) There is a decreased incidence of skin cancer in older adults because of an increase in melanocytes.

C) In older adults, tactile sensitivity increases and there is an intense response to cutaneous stimulation.

D) Collagen changes interfere with tensile strength of older adults' skin, causing the skin to be less resilient.

6. A gerontological nurse is aware of the changes in the structure and function of the skin and accessory glands that occur with aging. Which change is a normal accompaniment to the aging process?

A) Thickening of collagen in the dermal layers of the skin B) Cessation of eccrine and apocrine sweat gland function C) Increase in the number of melanocytes in the epidermis D) Decrease in the vascular bed of the dermis

7. A nurse is participating in a health fair that is being sponsored by a local seniors' center, discussing healthy skin and aging. Which teaching point should the nurse emphasize?

A) “You should limit your sun exposure to a small amount each day and keep your skin protected from direct sunlight for the remainder.”

B) “Many drugs can have an effect on your skin, so it's important to avoid most over-the-counter medications.”

C) “The health of your skin is primarily determined by your genes, so all you can do is try to maintain your overall level of health.”

D) “Even if you find it difficult to do, it's important to bathe once a day.”

8. One of the functional consequences of age-related changes to the skin is an increased susceptibility to injury. Which factors contribute to this susceptibility? (Select all that apply.)

A) Decreased sensation of cutaneous pain and discomfort B) Changes in vitamin D synthesis C) Increased healing time for skin wounds D) Decreased resistance to shearing forces E) Changes in skin pigmentation

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9. A nurse on an acute care unit is disturbed by the increasing incidence of pressure ulcers among older adults. Which measure should the nurses on the unit prioritize in order to prevent the formation of pressure ulcers?

A) Apply emollient lotions with baths B) Frequent repositioning of immobilized clients C) High-protein, high-calorie diet D) Massage bony prominences each shift

10. A nurse in a long-term care facility teaches aides to assist several older adults with bathing each day. Which intervention should the nurse include in the teaching?

A) Apply perfumed products after bathing to promote hygiene and self-esteem.

B) Cleanse groin with isopropyl alcohol to eliminate potential pathogens.

C) Dry skin thoroughly; particularly between the toes and other areas where skin touches.

D) Use water that is warm to hot (100°F to 105°F) to prevent hypothermia.

11. A nurse monitors a group of older adults washing dishes in the long-term care facility's kitchen. Which action would cause the nurse to intervene?

A) Sharing perfumed hand soap B) Using hand lotion after washing dishes C) Using hot water to rinse the dishes D) Using soap to wash the dishes

12. A nurse evaluates the healing of a full-thickness skin tear on a 92-year-old resident of a long-term care facility. Which finding would support the continuation of the current treatment plan?

A) The wound with redness surrounding at 12 days B) The wound draining serosanguinous drainage at 14 days C) The wound showing 50% healing at 16 days D) Pain at the wound site at 19 days

13. A nurse monitors older adults at an assisted living facility for pressure ulcers. Which older adult is at highest risk for a pressure ulcer?

A) The obese older adult with continuous positive airway pressure (CPAP) mask B) The frail older adult with a hearing aid C) The older adult undergoing therapy for a weak hand D) The older adult preparing to walk a half marathon

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14. A nurse assesses residents of the acute care facility for pressure ulcers. Which older adult should the nurse monitor closely for pressure ulcers?

A) Asian with multiple nevi on extremities B) Ethiopian former store clerk C) Fair-skinned Caucasian woman D) Wrinkled-face East Indian vegetable picker

15. A nurse assesses older adults at risk for pressure ulcers. Which assessment tools should the nurse use to identify those who might benefit from interventions? (Select all that apply.)

A) Braden Scale B) Norton Scale C) PUSH Scale D) Reverse staging E) Waterloo Scale

16. A nurse at the dermatology office triages calls. Which client is the highest priority to follow up?

A) 2-year-old with diaper rash B) 20-year-old with red sunburn on the chest and arms C) 78-year-old with a lesion that is black, swollen and draining liquid D) 90-year-old with flat discolored spots on face

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Answer Key 1. A 2. C, E, F 3. C 4. A 5. D 6. D 7. A 8. A, C, D 9. B 10. C 11. C 12. C 13. A 14. B 15. A, B, E 16. C

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1. A nurse presents at a conference about the concept of sleep. Which statement should the nurse include in the teaching?

A) “Increased sleep efficiency is considered a normal, age-related change.”

B) “Sleep efficiency is quite consistent across different age groups.”

C) “Both pathologic conditions and age-related changes influence sleep efficiency.”

D) “Older adults often experience increased sleep latency and decreased numbers of awakenings.”

2. A nurse is responsible for the care of group of older adults on an acute medical unit. A client diagnosed with which condition should be monitored closely at night for worsening symptomatology?

A) Chronic obstructive pulmonary disease (COPD) B) Osteoarthritis and failure to thrive C) Foot cellulitis secondary to diabetic neuropathy D) Chronic anemia receiving transfusions of packed red blood cells

3. A nurse plans the care for an older adult man who consumes two alcoholic beverages each evening. Which action should be included in the plan of care?

A) Allow for a later bedtime.

B) Encourage the client to cease all alcohol intake.

C) Monitor for nocturnal awakenings.

D) Watch for an increased rapid eye movement (REM) sleep.

4. A nurse counsels an older adult with chronic insomnia. Which statement should the nurse include in the teaching?

A) “Consider making your environment more conducive to sleep.”

B) “Continuing with the hypnotic medications you've been prescribed should soon provide a solution.”

C) “Decreased sleep is a normal age-related change that you will need to accommodate.”

D) “Moderate alcohol consumption will help you fall asleep more quickly.”

5. A nurse teaches a nursing student about pharmacologic interventions for the treatment of sleep problems among older adults. Which statement by the student shows understanding of the care of those with sleep disturbances?

A) “Behavioural therapies are preferable to the use of drugs.”

B) “Benzodiazepines are the drug group likely to have the fewest adverse effects.”

C) “L-Tryptophan and melatonin are chemicals the body produces that can be supplemented to improve sleep.”

D) “Older adults should not use hypnotics or other pharmacologic aids for sleep.”

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6. A nurse orients a graduate nurse to a gerontology unit. Which statement, if made by the graduate nurse, shows understanding of normal age-related changes of sleep patterns?

A) Older adults need 10% to 20% more sleep than do younger adults.

B) Older adults have fewer sleep cycles during the night.

C) Older adults fall asleep faster and stay asleep longer than do younger adults.

D) Older adults spend less time in deep sleep.

7. A nurse in a long-term care facility has noticed that many residents of the facility spend a large amount of time in bed yet frequently complain of fatigue and sleep deprivation.

Which change in the facility's environment is most conducive with helping residents achieve adequate amounts of restful sleep?

A) Keeping the lights at a consistent, low level throughout the day and night B) Allowing residents to awake/sleep according to their own routines C) Maintaining the facility at a temperature of 78°F to 80°F during the night D) Checking on each resident every 2 hours during the night to ensure safety

8. An older adult with restless legs syndrome (RLS) has sought advice from the nurse in an effort to ease the problem. Which statement should the nurse include in the plan?

A) “There are new, over-the-counter medications that can probably resolve your RLS.” B) “RLS can be a sign of a much more serious health problem, so I'd encourage you to visit your primary care provider.”

C) “I see that your iron level is low; let's add foods high in iron to your diet.”

D) “Even though it's certainly unpleasant, RLS is a normal part of the aging process.”

9. A nurse plans care for an older adult with insomnia. The client's medication list includes zolpidem, potassium and omeprazole. Which diagnosis should the nurse include in the plan of care?

A) Risk for falls B) Risk for suicide C) Risk for powerlessness D) Risk for urinary incontinence

10. An older adult client states that he has lately been taking up to 2 hours to fall asleep at night, despite avoiding caffeine during the day and going for a brisk walk after lunch each day. Which statement by the nurse is most appropriate?

A) “We can request a prescription for a sleeping pill from your primary care provider.”

B) “I suggest a 'nightcap' before bed, as long as it's not beer or wine.”

C) “It will benefit you to get up at the same time each morning, even if you are tired.”

D) “Move your daily walk to the late evening to make yourself tired before bed.”

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11. A nurse discusses sleep patterns with an older adult. The client states, “I feel like all I do is lie in bed awake each night.” Which response by the nurse is most appropriate?

A) “How long do you lie there each night?”

B) “Describe your pillow and mattress to me.”

C) “Do you have a history of sleep apnea?”

D) “What have you tried to get a better night's rest?”

12. A nurse presents an overview of sleep to older adults at an activity center. Which risk factors for sleep problems should the nurse include in the presentation? (Select all that apply.)

A) Boredom B) Chronic discomfort C) Dehydration D) Exercise E) Lack of light F) RLS

13. A nursing supervisor in the long-term care facility implements changes to improve environmental conditions. Which changes should be included? (Select all that apply.)

A) Assist residents to bed at 7:00 pm each day.

B) Build partitions between roommates.

C) Install low-level night lights in the bathrooms.

D) Replace light bulbs with low-light energy-efficient bulbs.

E) Set thermostat at 72°F each night.

14. A 64-year-old obese man is admitted to the hospital for treatment of heart failure secondary to alcoholism. For which negative consequence should the nurse assess?

A) Chronic pain B) Obstructive sleep apnea C) Parkinson disease D) RLS

15. An older adult at home uses earplugs to diminish street noise at night. Which statement by the nurse is appropriate?

A) “Using earplugs during sleep can damage your hearing.”

B) “I suggest a smoke alarm with blinking lights.”

C) “Your neighbors must be really loud.”

D) “This apartment sounds really unsafe.”

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Answer Key 1. C 2. A 3. C 4. A 5. A 6. D 7. B 8. C 9. A 10. C 11. C 12. A, B, F 13. B, C, E 14. B 15. B

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1. A nurse assesses an 82-year-old client who states, “That waiting room is so cold!”

Which systems should the nurse assess to determine the source of the clients sensations?

(Select all that apply.)

A) Bowel sounds B) Capillary refill time C) Oral temperature D) Respiratory rate E) Skin temperature

2. A nurse monitors a group of older adults. Which older adults are at high risk for functional consequences of altered thermoregulation? (Select all that apply.)

A) 78-year-old adult with heart failure B) 75-year-old adult with a urinary tract infection C) 80-year-old adult with vascular-type dementia D) 71-year-old participant in a wellness center E) 72-year-old adult with peptic ulcer disease

3. An 83-year-old client puts on a sweatshirt and jacket, preparing to go outside where it is currently 16°C. What interpretation should the nurse give to these actions?

A) Medication reaction B) Decrease in circulation C) Dementia affecting decision making D) Maintenance of adequate internal temperature

4. A community care nurse plans care for older adults as the fall season sets in and a cooler weather starts. Which client is at greatest risk for development of hypothermia?

A) Client who lives in an apartment building B) Client who sets the thermostat at 76°F year round C) Institutionalized older adult with cancer D) Older adult who has dementia and lives alone

5. A nurse evaluates the teaching done for an older adult with an upper respiratory infection during a heat wave. Which statement indicates a need for further teaching?

A) “The air conditioner increases the ventilation in my apartment.”

B) “I know that having diabetes will impact my body temperature.”

C) “If I have an alcoholic drink, it will affect my body temperature.”

D) “I can take an antihistamine; it will not have an effect on my temperature.”

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6. It is July in Atlanta, and 32°C in the shade. An 80-year-old client who lives alone in an apartment is struggling to stay cool. What functional consequence of the aging process increases this client's susceptibility to heat exhaustion and heat stroke?

A) Delayed and diminished sweating B) Impaired peripheral blood circulation C) Renal insufficiency D) Changes in endocrine regulation

7. A nurse who oversees the care in a nursing home is aware that the older adults who reside in the facility are vulnerable to impaired thermoregulation. What information source should the nurse prioritize when regulating the temperature in the facility?

A) The nurse's perception of heat and cold when dressed similarly to the residents B) Readings from an accurate thermometer C) The input from nursing assistant and unlicensed care providers in the facility D) The suggestions of residents who do not have cognitive impairments

8. During a period of cold weather, an older adult has been brought to the emergency department with suspected hypothermia. Which assessment should the nurse prioritize with this client?

A) Palpation of the client's extremities to determine temperature B) Assessment of the client's level of consciousness C) Assessment of the client's core body temperature D) Interviewing to determine the client's sensation of cold

9. A recent heat wave has resulted in an increase in the number of older adults who are presenting to the emergency department with actual or suspected hyperthermia. Which assessment findings are congruent with a diagnosis of hyperthermia in older adult clients? (Select all that apply.)

A) Diaphoresis B) Weakness C) Warm, dry skin D) Pallor E) Bradycardia

10. The aging process is accompanied by a number of changes in thermoregulation. Clinical phenomenon in older adults is likely to result from these changes?

A) Lack of detection of an acute infection B) Impaired protein synthesis during hot weather C) Susceptibility to skin breakdown on bony prominences D) Orthostatic hypotension

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11. A nurse on the cruise ship to Pacific Islands monitors the older adults for heat stroke in the hot weather. Who is at greatest risk for developing heat stroke?

A) 82-year-old Pacific Islander working the stand B) 80-year-old Canadian who abstains from alcoholic drinks C) 82-year-old woman who has been on the cruise for 4 weeks D) 78-year-old man with Parkinson disease

12. A nurse in the emergency department cares for an 82-year-old man. The man was found wandering the streets looking for his dog in a snowstorm. Which condition is the highest priority for the nurse to monitor?

A) Altered mental status B) Fluid volume overload C) Hyperglycemia D) Urinary tract infection

13. A nurse in the postoperative unit monitors for hypothermia. Which older adult's assessment finding indicates the onset of hypothermia?

A) Cool skin on buttocks B) Puffy face C) Shallow respirations D) Shivering

14. A nurse in the intensive care unit monitors an older adult admitted with hypothermia.

Which assessment finding indicates the need to notify the primary health care provider immediately?

A) Shivering B) Slurred speech C) Temperature of 95.5°F (35.3°C) D) Urine output of 25 mL per hour

15. During heat waves, nurses can assist to prevent heat-related illnesses in older adults.

Which information should be included in the teaching? (Select all that apply.)

A) Ensure fluid intake at or above 64 ounces per day.

B) Keep air-conditioning at or below 22°C. C) Take a cool shower three times a day.

D) Use extra soap when bathing.

E) Use ice to cool armpits up to 20 minutes.

F) Wear loose-fitting clothing.

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Answer Key 1. B, C, E 2. A, B, C 3. D 4. D 5. D 6. A 7. B 8. C 9. B, C 10. A 11. D 12. A 13. A 14. D 15. A, B, C, E, F

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1. A 65-year-old woman is speaking to her nurse at the primary care clinic. She states that it is very painful for her when she has sexual relations. She asks the nurse what she could do to alleviate the pain. Which suggestion could the nurse make to the woman?

A) Decrease the incidence of sexual relations.

B) Use a water-soluble lubricant or estrogen cream.

C) While engaging in intercourse, have your partner thrust his penis upward.

D) Use a polyisoprene (nonlatex) condom for intercourse.

2. A nurse is discussing sexual activity with older adults in a wellness clinic. Which of the following statements by an individual indicates a need for further exploration?

A) “I know my diabetes can affect my sexual activity.”

B) “My husband has an enlarged prostate.”

C) “I use vaginal cream to help with dryness.”

D) “I will not use petroleum jelly as a lubricant.”

3. A 64-year-old man had a myocardial infarction (MI) 2 months ago. He has recovered to the point that he is able to climb up two flights of stairs, but he and his spouse have not resumed sexual relations. Which response by the nurse is most appropriate?

A) “Is angina interfering with your sexual functioning?”

B) “This lack of libido is caused by vasoconstriction in the genital area.”

C) “You are safe to have sex; you can resume sexual relations when you desire.”

D) “You may have a problem with retrograde ejaculation.”

4. Which process should a nurse address first when assessing sexual function in older adults?

A) Identify risk factors that may interfere with the older adult's sexual functioning.

B) Assess own personal attitudes toward sexuality and aging.

C) Obtain permission from the individual to initiate a discussion on sexual relations.

D) Provide detailed information about sexual function to the older adult.

5. A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which statement indicates that the nurse's teaching has been successful?

A) “I will decrease the amount of time spent in foreplay before engaging in sexual intercourse.”

B) “I will avoid taking a warm bath before engaging in sexual activity.”

C) “I will avoid experimenting with different positions during sexual relations.”

D) “I will use a vibrator since my ability to massage is limited.”

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6. A gerontological nurse is aware that the aging process is accompanied by numerous, multifactorial changes that affect sexual wellness in older adults. Which factors among women is usually the primary cause of changes in sexual functioning?

A) Psychosocial B) Environmental C) Hormonal D) Spiritual

7. The nurse at the long-term care facility discovered a male client in bed with a female client, engaging in foreplay. How should care providers best respond to these residents' new sexual relationship?

A) Ensure that each resident's family members are aware of this development.

B) Teach the clients about sexual health promotion.

C) Accommodate the residents' relationship and provide them with appropriate privacy.

D) Have each resident assessed to ensure that the relationship is medically safe and appropriate.

8. A 78-year-old home health client has admitted to his nurse that his level of sexual activity with his wife has declined in recent months and become wholly absent over the past several weeks. The client has implied that this is due to a lack of performance, rather than lack of desire, on his part. Which assessment should the nurse prioritize in light of this revelation?

A) Medication regimen B) Musculoskeletal system and active range of motion C) Cognitive status and level of consciousness D) Cardiovascular status

9. Which older adult client is most likely to have physiologic barriers to sexual wellness?

A) Client with chronic obstructive pulmonary disease and a recent MI B) Client in the early stages of lung cancer and who is being treated for hypothyroidism C) Client with an ostomy created several years ago as treatment for colon cancer D) Client recently recovered from urinary tract infection that progressed to urosepsis

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10. A nurse who provides care in a nursing home occasionally encounters colleagues' prejudices and misperceptions around the sexual wellness of residents. Which statement reflects an appropriate view of sexual health in older adults?

A) “I think it's just so cute when residents think that they're dating each other.”

B) “We need to make sure that residents get the teaching they need before we allow a sexual relationship.”

C) “Older adults need companionship and comfort much more than they need sex.”

D) “Let's do all we can to facilitate competent residents' sexual relationships.”

11. A 52-year-old woman discusses her menstrual cycles with the nurse. The client states that she still has menses, but that she “never knows when they might begin or end.”

Which response by the nurse is most appropriate?

A) “It sounds like you are frustrated with this change; it is a difficult part of life.”

B) “Reproduction is no longer possible so that is one thing less to worry about.”

C) “We can't say how long this perimenopausal phase might last.”

D) “You are in the postmenopausal cycle and should expect further changes.”

12. A nurse in the ambulatory clinic assesses a 53-year-old woman who states, “last night all of a sudden I got really sick, got really hot and started sweating; then I had chills, and my chest was pounding.” Which action by the nurse is priority?

A) Ask if the client had been exposed to anyone who was ill.

B) Check the client's troponin and B-type natriuretic peptide (BNP) labs.

C) Discuss the client's menstrual cycle with her.

D) Review the client's medication history.

13. A nurse reviews the medications of a 58-year-old man who has erectile dysfunction.

Which prescribed medications can interfere with sexual functioning? (Select all that apply.)

A) Acetylsalicylic acid (aspirin) B) Metoprolol C) Clopidogrel D) Lisinopril E) Ezetimibe

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14. A nurse administrator incorporates older adults' sexuality into the policies of a long-term care facility. Which information should be included in this plan? (Select all that apply.)

A) Allow public masturbation.

B) Ask permission to enter a room.

C) House spouses separately.

D) Knock on door before entering.

E) Redirect inappropriate sexual behaviours.

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Answer Key 1. B 2. B 3. C 4. B 5. D 6. C 7. C 8. A 9. A 10. D 11. C 12. C 13. B, D 14. B, D, E

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1. Which statement best captures the typical character of health problems in the lives of older adults?

A) Older adults' lives are dominated by the increasing number of acute health problems due to age-related changes.

B) Most older adults experience an interplay between a number of chronic conditions and occasional acute health problems.

C) Older adults can expect a relatively consistent decline in their health over time as a result of acute health problems.

D) Chronic conditions account for the normal downward direction of an older adult's health status.

2. During assessment of an older adult, the nurse discovers that the individual has been reluctant to divulge recent losses in activities of daily living to his primary care provider. Which factor has been demonstrated to contribute to such reluctance?

A) Fearing a loss of independence if problems are disclosed.

B) Realizing that age-related changes are normally not treatable.

C) Experiencing cognitive deficits that influence decision making.

D) Recognizing that health care systems are not able to address psychosocial problems.

3. A nurse is teaching new graduates about the nature of palliative care on her unit. Which statement by a new nurse indicates a need for further teaching?

A) “I can see how important it is for us to educate patients and their families and friends on the unit.”

B) “It certainly requires a change in thinking to understand why we don't provide any medical interventions for patients.”

C) “I can see how comfort and psychosocial well-being take precedence over physical functioning.”

D) “Purpose in life and quality of life seem to be the overarching goals of palliative care.”

4. A nurse is teaching an older adult's family about the concept of caregiver burden. Which point is priority for the nurse to communicate to the family?

A) “Don't feel guilty about having to hire help. Older Canadian adults' care is currently provided by professionals and formal services.”

B) “If you do eventually feel overburdened, moving your loved one to a nursing home will provide you with relief.”

C) “You'll find it difficult to provide for your loved one's needs if you yourself don't have a strong support system.”

D) “You'll actually find that for you, the benefits of providing for your loved one outweigh the negative consequences.”

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5. Which statement by the new nurse best conveys an understanding of diabetes in older adults?

A) “A combination of lifestyle factors and age-related changes contributes to high rates of diabetes among older adults.”

B) “Development of diabetes later in life is considered a normal, age-related change.”

C) “Health care providers should avoid drawing conclusions about diabetes risk based on ethnicity.”

D) “The diagnosis of diabetes in older adults is complicated by subtle signs and symptoms.”

6. An 81-year-old client was diagnosed with colon cancer several months ago. Both the patient and the family have been made aware of the potential for metastasis and the poor prognosis associated with this disease. At what point in the client's disease trajectory should the principles of palliative care be implemented?

A) After chemotherapy and radiation therapy have been proven unsuccessful B) Early in the course of the client's cancer and before symptoms become unmanageable C) Soon after the client has made a decision to change her code status to “do not resuscitate” D) When the client's care team determines that there is less than 2 months to live

7. A client was diagnosed with type 2 diabetes. For the first several weeks after diagnosis, the client was unwilling to discuss the diagnosis. Now, the client has now begun asking the nurse questions about this disease. Which nursing diagnosis is most appropriate for this client?

A) Readiness for enhanced knowledge B) Readiness for enhanced self-care C) Readiness for enhanced power D) Readiness for enhanced comfort

8. A 68-year-old client has a long history of poor eating habits and low activity levels. The client now has a diagnosis of type 2 diabetes mellitus. Which nursing intervention should be the priority?

A) Adherence to diabetes screen protocols B) Education about the role that his lifestyle has played in his diagnosis C) Maintenance of function and activities of daily livings D) Self-care measures to aid in the management of his disease

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9. A palliative care team has taken over primary responsibility for the care of an older adult who has recently experienced a stroke. A visitor asks, “What is palliative care?”

Which response by the nurse is most appropriate?

A) “Spiritual and psychosocial care that takes place near the end of life” B) “Nursing care and medical treatment that prioritizes the wishes of patients and families” C) “The prioritization of complementary and alternative measures over biomedical interventions” D) “The provision of holistic care to patients experiencing incurable health states”

10. An older adult with a diagnosis of heart failure has been admitted to the hospital with an exacerbation of this condition. Which consequences of heart failure must the nurse monitor? (Select all that apply.)

A) Arrhythmias B) Autoimmune disorders C) Drug interactions D) Hypotension E) Sleep disorders

11. A nurse in the long-term care facility assesses an 86-year-old woman who has recently become lethargic and difficult to arouse. Her vital signs are all stable and within normal limits. Her breath sounds are diminished. Which action by the nurse should be the priority?

A) Call the family and give them an update.

B) Place her on high fall-risk precautions.

C) Send her to the emergency department.

D) Tell the aides to keep an eye on her.

12. A wellness center nurse teaches a class of older adults about healthy habits. Which intervention will make a difference in the clients' lives and as such be included by the nurse?

A) Avoid alcohol consumption.

B) Avoid fried foods and red meats.

C) Avoid secondhand smoke.

D) Avoid sunlight.

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13. A nurse cares for an older adult in a residential care program. The client has multiple chronic conditions. The client has developed dyspnea and has lost 48 kg of body weight.

Which statement by the nurse is most appropriate?

A) “Have you ever heard of palliative care?”

B) “I want to talk to you about switching our focus from cure to care.”

C) “We don't think that there is anything we can change to make you better.”

D) “Your breathing problems concern me.”

14. A nurse discusses health promotion with a group of older adult women. The nurse suggests having a Pap test done every 3 years. One woman states, “I haven't had a Pap test done since menopause, why would I do that now?” Which response by the nurse is best?

A) Annual checkup by your primary care provider to examine your ovaries is appropriate.

B) Avoidance doesn't help with diagnosis of cancers.

C) If your Pap Tests have been normal, it is recommended you have one done every 3 years.

D) Women who don't have sex are at higher risk for ovarian cancer.

15. A nurse plans discharge instructions of a 78-year-old client with newly diagnosed heart failure. The client states, “Will I be going home on hospice now that my heart is failing?” Which response by the nurse is most appropriate?

A) “Heart failure is a chronic condition that can be controlled with medication.”

B) “No, but you will have palliative care.”

C) “You must go to cardiac rehabilitation.”

D) “You will need to take medications for the rest of your life.”

16. A 73-year-old client is admitted to the hospital. A nurse assesses the client for frailty.

Which findings indicate frailty? (Select all that apply.)

A) Diminished handgrip strength B) High level of physical activity C) Intentional weight loss D) Self-reported exhaustion E) Slow walking speed

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Answer Key 1. B 2. A 3. B 4. C 5. A 6. B 7. A 8. D 9. D 10. A, C, D, E 11. C 12. C 13. B 14. C 15. A 16. A, D, E

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1. A nurse assesses an older adult following the repair of an abdominal hernia. The older adult client states, “I really hate to take pain medication.” Which response by the nurse is best?

A) “Early treatment of pain helps now and can reduce the incidence of chronic pain.”

B) “Pain medication today doesn't really have any side effects.”

C) “Tell me about your fears regarding pain medication.”

D) “This pain you are having is normal, and as you heal, the pain level will decrease.”

2. An 80-year-old Asian woman minimizes her pain in the joints and back as “normal aging.” Which action by the nurse is most appropriate?

A) Address the client's concerns regarding addiction.

B) Allow the client to choose to minimize the pain.

C) Encourage opioid use for pain relief.

D) Offer warm packs for joints.

3. A nurse assesses the pain of an older adult. Which finding indicates the presence of persistent pain?

A) The client's vital signs are unchanged.

B) The client is asleep in the chair.

C) The client has not reported pain to the nurse.

D) The client rubs hands together.

4. A nurse assesses an older adult client with confusion related to hyponatremia who reports pain. Which finding should the nurse use as a guide for choosing interventions?

A) Symptoms of hyponatremia do not include pain.

B) The client does not manifest any outward signs of pain.

C) The client is confused from the pain.

D) The client rates the pain at 8 out of 10.

5. A nurse is teaching an older adult about some of the risks associated with using opioid analgesics. Which statement best demonstrates the individual has gained a sound knowledge base?

A) “I know that if I become dependent on the drug, my doctor and I will come up with a plan to discontinue it.”

B) “I'll need to be careful that I don't become addicted to the drug over time.”

C) “If I do develop a tolerance to the drug, I can expect some withdrawal symptoms.”

D) “It sounds like I might have my dosages increased over time because of tolerance.”

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6. A nurse in a postoperative unit educates peers to overcome myths about pain in older adults. Which statement by a peer most clearly warrants further teaching?

A) “We have to be more conservative in the treatment of the older adults' pain than the younger clients.”

B) “Older adults have more health problems than do younger people, and this puts them at risk of experiencing pain.”

C) “The acute can turn into persistent pain if not treated thoroughly.”

D) “Older adults', even those with dementia, sense of pain is as strong as that of a younger person.”

7. A 79-year-old woman had a total knee replacement yesterday; she has rung her call light to report pain. What consideration should the nurse prioritize when choosing an appropriate intervention?

A) The fact that the woman has a documented history of persistent pain that precedes her surgery B) The need to ensure that the woman does not develop addiction during her course of treatment C) The fact that women consistently report a higher prevalence of persistent pain than do men D) The need to provide prompt, adequate relief of the woman's pain

8. A 74-year-old client with a history of osteoarthritis is being treated in the hospital for pneumonia and malnutrition. The nurse administered 650 mg of acetaminophen 90 minutes ago, and the client is now requesting another dose. The medication administration record has the following choices; which choice by the nurse is most appropriate?

A) Normal saline 5 ml IV B) Acetaminophen 1,000 mg PO C) Morphine 5 mg IV D) Oxycodone 5 mg PO

9. A nurse who provides care in a large, inner-city hospital comes into contact with older adults from a wide variety of cultural groups. How is culture most likely to influence the assessment and management of pain?

A) Cultural differences affect the intensity of pain.

B) Culture can dictate the appropriate expression of pain.

C) Culture should determine the choice of analgesia when treating pain.

D) Culture is unrelated to pain because pain is a physiological, rather than psychosocial, phenomenon.

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10. An older adult with pain is to be discharged home with a prescription for oral controlled-release morphine daily for persistent pain. The client historically took an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) for pain. Which statement by the patient shows the nurse that the client understands the plan?

A) “I will be careful to take an antacid with the morphine pill.”

B) “I will only take this morphine when the NSAID doesn't work.”

C) “I will take a laxative and a stool softener to reduce my constipation.”

D) “NSAID side effects are not as bad as a morphine pill.”

11. An emergency department triage nurse receives a phone call from an older adult who states, “I am experiencing pain across my left side. It is tingling and really hurts when it gets touched.” Which response by the nurse is most appropriate?

A) “Do you have the pain right now?”

B) “Have you taken any medications?”

C) “Notify your primary health care provider today.”

D) “When did this pain start?”

12. A nurse administers IV pain medication to an older adult in the hospital. Which action by the nurse is the priority?

A) Encourage the family to leave.

B) Identify the client's expectations for relief.

C) Reassess the pain level.

D) Reposition the client.

13. A nurse plans care for an older adult with advanced dementia. Which plan is most appropriate regarding the pain treatment plan?

A) Monitor assessment findings including vital signs for indications of pain.

B) Treat pain that is implied by contractures and diagnoses of arthritis.

C) Understand that persons with dementia do not experience pain.

D) When the client begins wandering, treat the client for pain.

14. A home care nurse notes in the assessment that an older adult expresses anxiety and fatigue. The client sleeps 3 hours at a time at maximum and has had a 4.5-kg weight loss. Which intervention is the priority?

A) Assess the client's level and intensity of pain.

B) Interview the family.

C) Perform an assessment of vital signs.

D) Weigh the client.

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15. The process of nociception is important in determining the most appropriate analgesic.

Place the processes in order: A) Modulation B) Perception C) Transduction D) Transmission

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Answer Key 1. A 2. D 3. D 4. D 5. D 6. A 7. D 8. D 9. B 10. C 11. C 12. D 13. B 14. A 15. C, D, B, A

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1. A nurse on a geriatric medical care unit consults hospice for a client. Which nursing intervention should the nurse anticipate after the client begins hospice care?

A) Administering chemotherapy to a client with a diagnosis of pancreatic cancer B) Assessing the deep tendon reflexes of a client with neurologic impairment C) Infusing total parenteral nutrition to a client with dysphagia D) Providing an opioid analgesic to a client with bone metastases

2. A nurse cares for an 87-year-old client from India who has noted Hinduism as religious preference on admission records. This client is transferred to the hospice unit. Which action by the nurse best shows caring?

A) Ask the family to tell you about Hinduism.

B) Assess the client's spiritual needs.

C) Notify the family's pastor.

D) Pray with the client and family.

3. A nurse explores resources available to assist a client. Who meets the eligibility requirements for hospice care?

A) A client who is immobilized and unable to afford specialized nursing care B) A client who has experienced a stroke and been given 3 months to live C) A client with cancer who is living with uncontrolled persistent pain D) A client with acquired immunodeficiency syndrome who lacks family support to provide needed care

4. A nurse cares for an older adult who is nonresponsive and surrounded by family. Which statement by the nurse is most appropriate?

A) “I am here for you, how can I be helpful?”

B) “I know just how you feel, my mother died last month.”

C) “I'll leave you alone so that you can grieve in private.”

D) “She was a really nice lady; she did a good job raising you.”

5. An older adult client on a palliative care unit divulges to his nurse that he fears being in pain during the dying process. How should the nurse best respond to the client's admission?

A) “It sounds like you're understandably anxious about this. How can I help you to relax?”

B) “A lot of clients do have pain at the end, and we will do all we can to control it for you.”

C) “We will do all we can to address it, and you'll be able to have a peaceful passing.”

D) “Pain during the dying process actually is not nearly as common as many people believe.”

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6. A nurse cares for a 100-year-old man in hospice. The client contemplates his perspectives regarding end-of-life care. Which historical perspectives most likely represent how this client's life experiences have had a formative influence on his views on death and dying? (Select all that apply.)

A) I never thought that I would be this old.

B) My brother died in a work-related accident.

C) I outlived my children and my two wives.

D) My family shouldn't have to take care of me.

E) I lost an infant to small pox.

7. A nurse in an intensive care unit prepares to perform postmortem care on an older Jewish client. Family members are at his bedside. Which action by the nurse is appropriate?

A) Allow the family to remain with the client.

B) Liaise with the hospital chaplain to visit the family in the chapel.

C) Address the man's oldest son when discussing the client's cares.

D) Determine which family member(s) will be staying at the bedside during the cares.

8. A nurse who works in a palliative setting is aware of the need to facilitate a “good death” for as many clients as possible. Which intervention should be included?

A) Discuss openly and explicitly the client's strengths and weaknesses.

B) Ensure that a minimum of nursing interventions are performed.

C) Empower the client and family to maintain as much control as possible.

D) Emphasize spiritual needs rather than physical comfort and medical needs.

9. A 79-year-old experienced a severe stroke several days ago. The client's spouse has been told by the care team that he is unlikely to survive more than a few days and that aggressive treatment would likely be futile. The nurse has just entered the client's room to find the spouse softly crying at the bedside, making no attempt to acknowledge the nurse's presence. Which response by the nurse would be most therapeutic to the client's wife?

A) “Do you feel like he was able to live a full life?”

B) “Did you feel like you were able to discuss his treatment options thoroughly?”

C) “What is it that makes you the saddest about your husband's situation?”

D) “I am here; should I leave you alone for now?”

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10. A nurse admits an older adult to the hospice unit after the diagnosis of terminal metastasis of malignant melanoma. Which condition should the nurse anticipate?

A) Necrosis of extremities B) Hemoptysis C) Hyperglycemia D) Dyspnea

11. An emergency room nurse cares for the family of a 70-year-old Canadian African woman who died unexpectedly. In the waiting room, upon hearing of the death, two family members kneel to the floor moaning and do not respond. Which intervention by the nurse is most appropriate at this time?

A) Allow the family to grieve in this manner directing others away.

B) Assess these family members' vital signs and neurologic status.

C) Bring these family members to the body of their loved one.

D) Call an emergency response team to care for these family members.

12. A nurse manager of an intensive care unit develops plans to improve end-of-life care for clients in the unit. Which action is the priority?

A) Create a script for nurses to use when discussing hospice and palliative care.

B) Guide staff to improve communication with families about end-of-life decision making.

C) Increase communication between professionals about end-of-life decision making.

D) Survey clients and families about their end-of-life needs.

13. A quality control nurse for a large group of long-term care facilities assesses the quality of care at the end of life for the residents. An increase in which measures indicate quality care? (Select all that apply.)

A) Number of deaths in the hospital B) Number of residents who refuse treatments at the end of life C) Percentage of residents with advanced dementia D) Use of hospice services E) Number of staff trained in palliative care

14. A quality care nurse assesses the care given by a hospice. Which statement by the client best reflects dignified end-of-life care?

A) “I'm glad that my family is making all the decisions; it's too much for me.”

B) “I'm not ready to die yet; I've got a few more in me.”

C) “It is fine sharing a room; I like the company.”

D) “They listened to me and stopped the therapy.”

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Answer Key 1. D 2. B 3. B 4. A 5. B 6. A, B, C, E 7. A 8. C 9. D 10. D 11. A 12. B 13. D, E 14. D

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