Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No; 9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 01: Overview of Gerontologic Nursing

Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE

1. In 2010, the revised Standards and Scope of Gerontological Nursing Practice was published.

The nurse would use these standards to: a. promote the practice of gerontologic nursing within the acute care setting. b. define the concepts and dimensions of gerontologic nursing practice. c. elevate the practice of gerontologic nursing. d. incorporate suggested interventions from others who practice gerontologic nursing.

ANS: D

The current publishing of the Standards and Scope of Gerontological Nursing Practice in 2010 incorporates the input of gerontologic nurses from across the United States. It was not intended to promote gerontologic nursing practice within acute care settings, define concepts or dimensions of gerontologic nursing practice, or elevate the practice of gerontologic nursing.

DIF: Remembering (Knowledge) REF: Page 2 OBJ: 1-1 TOP: N/A MSC: Safe and Effective Care Environment 2. When attempting to minimize the effect of ageism on the practice of nursing older adults, a

nurse needs to first: a. recognize that nurses must act as advocates for aging patients. b. accept that this population represents a substantial portion of those requiring nursing care. c. self-reflect and formulate one’s personal view of aging and the older patient. d. recognize ageism as a form of bigotry shared by many Americans.

ANS: C

Ageism is an ever-increasing prejudicial view of the effects of the aging process and of the older population as a whole. With nurses being members of a society holding such views, it is critical that the individual nurse self-reflect on personal feelings and determine whether such feelings will affect the nursing care that he or she provides to the aging patient. Acting as an advocate is an important nursing role in all settings. Simply accepting a fact does not help end ageism, nor does recognizing ageism as a form of bigotry.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 1-9 MSC: Safe and Effective Care Environment

3. When discussing factors that have helped to increase the number of healthy, independent older

Americans, the nurse includes the importance of: a. increased availability of in-home care services. b. government support of retired citizens. c. effective antibiotic therapies. d. the development of life-extending therapies.

ANS: C

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The health and ultimate autonomy of older Americans has been positively impacted by the development of antibiotics, better sanitation, and vaccines. These public health measures have been more instrumental in increasing the numbers of healthy, independent older Americans than have in-home care services, government programs, or life-extending therapies.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 2 OBJ: 3-3 MSC: Health Promotion and Maintenance

4. Based on current data, when presenting an older adult’s discharge teaching plan, the nurse

includes the patient’s: a. nonrelated caretaker. b. paid caregiver. c. family member. d. intuitional representative.

ANS: C

Less than 4% of older adults live in a formal health care environment. The majority of the geriatric population lives at home or with family members.

DIF: Applying (Application) TOP: Nursing Process: Planning

REF: N/A OBJ: 3-3 MSC: Safe and Effective Care Environment

5. The nurse planning care for an older adult who has recently been diagnosed with rheumatoid

arthritis views the priority criterion for continued independence to be the patient’s: a. age. b. financial status. c. gender. d. functional status.

ANS: D

Maintaining the functional status of older adults may avert the onset of physical frailty and cognitive impairment, two conditions that increase the likelihood of institutionalization.

DIF: Remembering (Knowledge) TOP: Nursing Process: Planning

REF: Page 8 OBJ: 1-6 MSC: Physiologic Integrity

6. A nurse working with the older adult population is most likely to assess a need for a financial

social service’s referral for a(n): a. white male. b. black female. c. Hispanic male. d. Asian American female.

ANS: B

The poverty rate among older black women is substantially higher than that seen among males or females of other ethnic groups. White males had the least poverty.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 1-4 MSC: Safe and Effective Care Environment

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 7. Which of the following statements made by a nurse preparing to complete a health assessment

and history on an older patient reflects an understanding of the general health status of this population? a. “I’ll need to document well regarding the medications the patient is currently prescribed.” b. “I would like to understand how supportive the patient’s family members are.” c. “Most older patients are being treated for a variety of chronic health care issues.” d. “It will be interesting to see whether this patient sees herself as being healthy.”

ANS: D

It is a misconception that old age is synonymous with disease and illness. The nurse should always determine the patient’s sense of wellness and independence when conducting a health and history assessment. An assessment of medication use and family support is important for any patient. Many older adults do have chronic health conditions, but their perception is more important than a single number.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 1-4 MSC: Health Promotion

8. The nurse is caring for an older adult who has been admitted to an acute care hospital for

treatment of a fractured femur. The family expresses concern about the patient’s pending transfer to a subacute care facility. What response by the nurse is best? a. “Acute care facilities lack the long-term physical therapy support your dad requires.” b. “Your dad will be much happier in a more serene, private environment.” c. “The subacute facility will focus on helping your dad maintain his independence.” d. “Insurance, including Medicare, will cover only a limited amount of time here.”

ANS: C

The transfer of the patient to a subacute facility is based on the need to maintain the patient’s level of function and independence, a task the acute care facility is not prepared to address once the patient is physiologically stable. The patient may or may not be happier in the new setting; the nurse should not make this judgment. It is true that insurance only pays for a limited amount of time in an acute care facility, but this is not the best reason for the patient to transfer.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation MSC: Health Promotion and Maintenance

OBJ: 1-6

9. To best assure both the quality of care and the safety of the older adult patient who requires in-

home unlicensed assistive personal (UAP) assistance, the geriatric nurse: a. evaluates the competency of the UAP staff. b. assumes the roles of case manager and patient advocate. c. arranges for the needed UAP provided services. d. assesses the patient for functional limitations.

ANS: A

As more care traditionally provided by professional nurses is being transferred to UAP, the nurse must assume more responsibility for educating, training, and evaluating the competency of UAP staff to provide safe, effective care for the older adult patient.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 1-2 TOP: Communication and Documentation MSC: Safe and Effective Care Environment 10. The nurse working with older adults understands what information about certification in

gerontologic nursing? a. It is mandatory for those in long-term care settings. b. It is voluntary and shows clinical expertise in an area. c. It allows nurses to be paid by third-party payers. d. It allows nurses to advance their careers in a job.

ANS: B

Certification is voluntary and shows that a nurse has additional knowledge and expertise in a certain area of practice. It is not mandatory in specific care settings. It does not allow for third-party reimbursement. It may be part of a career ladder program, but that is not true of all work settings.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 2 OBJ: 1-2 MSC: Safe Effective Care Environment

11. A nurse works in a gerontologic clinic. What action by the nurse takes highest priority? a. Serving as a patient advocate b. Educating patients about diseases c. Helping patients remain independent d. Referring patients to home health care ANS: C

One of the challenges and priorities of the gerontologic nurse is helping patients maintain their independence.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 10 OBJ: 1-2 MSC: Health Promotion

12. A nurse is caring for an older patient in the emergency department. What information about

the patient will be most helpful in creating a plan of care? a. Baseline physical and cognitive functioning b. Living conditions and family support c. Medications and current medical problems d. Results of the Mini Mental State examination ANS: A

The nurse is encouraged to view older patients as individuals and consider their baseline physical and cognitive functional status as a standard by which to compare the patient’s current status. The other information is also important, but the basis of individualized care begins with the patient’s strengths and weaknesses.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 1-6 MSC: Health Promotion

13. The faculty member explains to students that many older Americans continue to work past the

“retirement age.” What best explains this trend?

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. Feeling healthier longer b. Changing financial outlook c. Becoming bored in retirement d. A desire to give back ANS: B

As financial situations may have declined as a result of many economic factors, more older adults work past their “retirement age.” The other options may be reasons for some to continue working, but financial necessity is the reason the majority continue to do so.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 7 OBJ: 1-3 MSC: Health Promotion

14. What information does the faculty member teach students about Medicare? a. Covers anyone with end stage renal disease b. Part A covers some prescription costs c. Part B covers inpatient hospital costs d. Part D eliminates the drug “donut hole” ANS: A

Although Medicare is primarily for those over the age of 65, it does cover people of any age with end-stage kidney disease. Part A covers hospital costs. Part B is medical insurance. The “donut hole“ was fixed by the Affordable Care Act. DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 9 OBJ: 1-3 MSC: Health Promotion

15. A nursing manager notes that many older patients are admitted to the nursing unit for acute

problems. What action can the manager take to most benefit this population? a. Provide mandatory education on the needs of the older patient. b. Provide restorative therapy programs designed for this group. c. Ensure staffing numbers are adequate for dependent patients. d. Encourage all nurses to obtain gerontologic certification.

ANS: B

Many older adults need acute care for sudden illness and injury but live in a state of functional decline, which could possibly be prevented by establishing a restorative therapy program. The other actions will help the older patients cared for in the unit, but only to limited degrees.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 1-4 MSC: Physiologic Integrity: Reduction of Risk Potential

16. The dean of a new nursing program wishes to ensure graduates are prepared to care for older

patients. What document should guide the dean in designing the curriculum? a. The Nurse Practice Act for that state b. The American Nurses Association (ANA) code of ethics for nurses c. Healthy People 2020 d. The Recommended Baccalaureate Competencies and Curricular Guidelines ANS: D

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults is an updated version of The Essentials of Baccalaureate Education for Professional Nursing Practice. This document was first published by the American Association of Colleges of Nursing (AACN) in 2008 and was updated in 2010. The other three documents do not have information about curricular requirements to prepare students to care for the older population.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 1-2 MSC: Health Promotion

17. A nurse wants to plan a community event at a retirement center. What topic would most likely

be best received? a. Heart healthy living b. Financial planning c. Avoiding scams d. Ethnic cooking classes ANS: A

Older adults are demanding more programs and services aimed at health maintenance and promotion and disease and disability prevention. Based on this information, the heart healthy living presentation would be best received.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 1-3 MSC: Health Promotion

18. What does the bedside nurse understand about his or her role in nursing research? a. Research is only done by doctorally prepared nurses. b. All nurses have a role in delivering research-based care. c. A bedside nurse can be part of a hospital research team. d. The bedside nurse can collect data if the nurse has been properly trained.

ANS: B

All nurses are charged to deliver patient-centered care based on evidence-based practice, research, quality improvement, and informatics. The bedside nurse is part of an interdisciplinary team that is responsible for redesigning the health care structure of the future.

DIF: Understanding (Comprehension) REF: Page 13 MSC: Safe Effective Care Environment: Management of Care

TOP: Teaching-Learning

MULTIPLE RESPONSE 1. The clinic nurse caring for an older diabetic patient with a sixth grade education anticipates

that the patient may experience difficulty (Select all that apply.) a. recognizing the importance of keeping clinic appointments. b. following a low-carbohydrate diet. c. paying for insulin and syringes. d. deciding on a primary health care provider. e. naming a health care surrogate.

ANS: A, B, C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Even though the educational level of the older population has steadily increased, as a population they are less educated than the general population. This deficiency can account for a lack of understanding regarding the need for medical care and the importance of following a treatment plan. These patients may also have fewer financial resources to devote to health care issues.

DIF: Analyzing (Analysis) TOP: Nursing Process: Assessment

REF: N/A OBJ: 1-4 MSC: Safe and Effective Care Environment

2. The nurse studying the history of gerontologic nursing learns which information about the

specialty? (Select all that apply.) a. The number of older Americans is diminishing. b. The geriatric nursing conference group was established in 1962. c. The gerontologic clinical nurse specialist certification was offered in 1989. d. There were no writings about the care of older persons until World War II. e. The first Standards of Practice for Geriatric Nursing was written in 1969.

ANS: B, C, E

The geriatric nursing conference group was established in 1962, the gerontologic clinical nurse specialist certification was first offered in 1989, and the first Standards of Practice for Geriatric Nursing was written in 1969. The population of older Americans is the fastestgrowing subset of the population. Writings about care of the aged can be found from as early as 1900.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 2-3 OBJ: 1-2 MSC: Nursing Process: Assessment

3. The student asks the gerontologic clinic nurse why so many older people are women. What

information does the nurse provide? (Select all that apply.) a. Reduced maternal mortality b. Decreased deaths from infectious diseases c. More deaths from chronic disease in men d. More deaths in war occur in men e. Women tend to smoke and drink less than men ANS: A, C, D

A decrease in maternal mortality, decreased deaths from infectious diseases, and more chronic illness in men account for the disparity in genders as people age.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 6 OBJ: 1-5 MSC: Health Promotion

4. The gerontologic nurse plans community programming for older women, noting what facts

about this population subgroup? (Select all that apply.) a. More likely to live alone b. Increased chance of living in poverty c. Taking care of a spouse d. Suffering many chronic diseases e. Living with extended families ANS: A, B, D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Older women have a greater chance than men of living alone and in poverty. They also have a greater degree of functional impairment and chronic disease.

DIF: Remembering (Knowledge) TOP: Nursing Process: Analysis

REF: Page 6 OBJ: 1-5 MSC: Health Promotion

5. The nurse knows that the most common causes of death in the older population result from

which diseases? (Select all that apply.) a. Cerebrovascular disease b. End-stage kidney disease c. Heart disease d. Cancer e. Diabetes ANS: A, C, D

The most common causes of death in the older population are cerebrovascular disease, heart conditions, and cancer. End-stage renal disease and diabetes are not among the top three causes of death.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 8 OBJ: 1-4 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 02: Theories of Aging Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The practitioner who believes in the free radical theory of aging is likely to recommend that

the older adult: a. avoid excessive intake of zinc or magnesium. b. supplement his or her diet with vitamins C and E. c. increase intake of complex carbohydrates. d. avoid the use of alcohol or tobacco.

ANS: B

Vitamins C and E are two naturally occurring antioxidants that appear to inhibit the functioning of the free radicals or possibly decrease their production in the body. The free radical theory of aging is not related to zinc, magnesium, carbohydrates, or alcohol and tobacco.

DIF: Applying (Application) TOP: Nursing Process: Planning

REF: N/A OBJ: 2-2 MSC: Health Promotion

2. To provide effective care to the older adult, the nurse must understand that: a. older adults are not a homogeneous sociologic group. b. little variation exists in cohort groups of older adults. c. health problems are much the same for similar age groups of older adults. d. withdrawal by an older adult is a normal physiologic response to aging.

ANS: A

The key societal issue addressed by the age stratification theory is the concept of interdependence between the aging person and society at large. This theory views the aging person as an individual element of society and also as a member, with peers, interacting in a social process. The theory attempts to explain the interdependence between older adults and society and how they constantly influence each other in a variety of ways. Variation exists among the members of a cohort. Health problems are not the same for every individual of the same age. Withdrawal by an older adult is not a normal response to aging but may be a sign of depression.

DIF: Understanding (Comprehension) TOP: Nursing Process: Planning

REF: Page 16 OBJ: 2-2 MSC: Health Promotion and Maintenance

3. The nurse is using the eight stages of life theory to help an older adult patient assess the

developmental stage of personal ego differentiation. The nurse does this by assisting the patient to: a. determine feelings regarding the effects of aging on the physical being. b. describe feelings regarding what he or she expects the future to hold. c. identify aspects of work, recreation, and family life that provide a sense of selfworth and pleasure. d. elaborate on feelings about the prospect of his or her personal death.

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

During the stage of ego differentiation versus work role preoccupation, the task for older adults is to achieve identity and feelings of worth from sources other than the work role. The onset of retirement and termination of the work role may reduce feelings of self-worth. In contrast, a person with a well-differentiated ego, who is defined by many dimensions, can replace the work role as the major defining source for self-esteem. Determining feelings related to the effects of aging, future death, or what the future may hold is not part of this theory.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 2-4 MSC: Psychosocial Integrity

4. A patient is recovering from a mild cerebral vascular accident (stroke). The home care nurse

notes that the patient is talking about updating a will and planning funeral arrangements.

Which of the following responses is most appropriate for the nurse to make? a. “You seem to be preoccupied with dying.” b. “Is there anything I can do to help you?” c. “Are you worried about dying before you get your affairs in order?” d. “Let’s focus on how you are recovering rather than on your dying.”

ANS: B

According to Peck’s expansion of Erikson’s theory, the older adult who has successfully achieved ego integrity and ego transcendence accepts death with a sense of satisfaction regarding the life led and without dwelling on its inevitability. The patient’s action reflects a healthy transition and should be supported.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 2-4 MSC: Psychosocial Integrity

5. Your patient’s spouse died recently from a sudden illness after 45 years of marriage. The

patient was the primary caregiver for the spouse during this time. The patient is now depressed and withdrawn and has verbalized feelings of uselessness. Which action by the nurse is best? a. Encourage the patient take up a hobby that will occupy some time. b. Explain that volunteering would be an excellent way to stay useful. c. Assure the patient that these feelings of sadness will pass with time. d. Ask the patient to share some cherished memories of the spouse.

ANS: B

Volunteering will help the patient to interact with people and feel productive and valued for the ability to help others as stated in the activity theory. A hobby does not offer the chance to help others. Assuring the patient that feelings will pass is false reassurance and does nothing to help the patient to be proactive. Reminiscing is a valued activity, but it is not the best choice for regaining a sense of usefulness.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 2-4 MSC: Psychosocial Integrity

6. A patient has recently been diagnosed with end-stage renal disease. The patient has cried often

throughout the day and finally confides in the nurse that “I am going home to be with my Lord.” The nurse’s best response is: a. “There is no reason to believe the end is near.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. “Do you want me to call your family?” c. “We have a wonderful chaplain if you’d like me to call him.” d. “I think this is the time for us to pray together.”

ANS: C

It is important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth while addressing spirituality as a component in holistic care without imposing upon the patient. Because the patient has made reference to the Lord, the nurse can safely offer religion-oriented spiritual care. Telling the patient there is no reason to believe that death is near does not help the patient work through emotions. Asking about calling the family is a yes/no question and is not therapeutic. The nurse is assuming too much by saying it is time to pray.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 2-4 MSC: Psychosocial Integrity

7. A nurse is responsible for the care of 20 older adults in a unit of an assisted living facility. In

order to best address the needs and wants of the entire unit’s population, the nurse: a. strictly adheres to facility policies so that all patients will be treated equally. b. encourages specific age cohorts to gather in the dayroom because they share similar interests. c. has the unit vote on which television programs will be watched each evening. d. schedules the patients’ bathing times according to their individual preferences.

ANS: D

Older adults continue to feel valued and viewed as active members of society when allowed to maintain a sense of control over their living environment by attention to personal choices and rituals. Adhering strictly to policies does not allow for individualized care. Not all in the same age cohort will have similar interests. Voting on television programs does not ensure each individual feels a sense of worth.

DIF: Applying (Application) TOP: Nursing Process: Planning

REF: N/A OBJ: 2-5 MSC: Psychosocial Integrity

8. An older patient who reports being “healthy enough to cut my own fire wood” is being

assessed prior to outpatient surgery. The nurse recognizes which assessment observation as a possible result of the wear-and-tear theory? a. Swollen finger joints b. Red, watery eyes c. Grimacing when raising left arm d. Bilaterally bruising on the forearms ANS: C

This theory proposes that cells wear out over time because of continued use. The pain caused by movement of the shoulder is the observation most likely a result of the patient’s practice of cutting his own firewood. The other choices do not demonstrate continued use that is part of the wear-and-tear theory of aging.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 2-2 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 9. A nurse cares for many older patients. Which finding should the nurse identify as pathologic

in a 72-year-old? a. Two hospitalizations in 6 months for respiratory infections b. Patient reports of sleeping only of 5 to 6 hours each night c. Thinning hair and brittle nails d. Dry, tissue paper–like skin ANS: A

Although there is an age-related decrease in immune function, reoccurring infections serious enough to require hospitalization are not considered a normal age-related finding. Decreased sleeping, thinning hair, brittle nails, and dry skin are all normal signs of aging.

DIF: Application (Apply) TOP: Nursing Process: Assessment

REF: N/A OBJ: 2-1 MSC: Physiologic Integrity

10. In planning the care for an older adult patient, the nurse will best promote health and wellness

by: a. b. c. d.

encouraging independent living and self-care. scheduling regular cardiac and respiratory health screenings. effectively delivering health-related educational information. promoting a nutritious diet and an age-appropriate exercise routine.

ANS: C

Providing well-prepared and effectively delivered health-related educational information will provide the best means of promoting a patient’s ability to impact his or her wellness and general health. Each of the other options is too narrow to be the most effective way to promote health and wellness.

DIF: Applying (Application) TOP: Nursing Process: Planning

REF: N/A OBJ: 2-5 MSC: Health Promotion

11. The student learning about aging theories understands that the main difference between

stochastic theories and nonstochastic theories is which of the following? a. Stochastic theories view aging as a random, cumulative process. b. Stochastic theories view aging as similar among all people. c. Nonstochastic theories view aging as a result of psychosocial factors. d. Nonstochastic theories are backed by research, whereas stochastic theories are not.

ANS: A

Stochastic theories view aging as a result of random events and their cumulative effects.

Nonstochastic theories view aging as a result of predetermined, timed phenomena. Both are types of biologic theories.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 17 OBJ: 2-1 MSC: Physiologic Integrity: Physiologic Adaptation

12. Which theory of aging does the student learn is related to problems with DNA transcription? a. Radical theory b. Error theory c. Cross linkage theory d. Wear-and-tear theory Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B

The error theory poses that errors in DNA transcription lead to aging. The radical theory views the effects of free radicals as critical to aging. The cross linkage theory states that normally separated molecular structures are bound together through chemical reactions and that this interferes with metabolic processes. The wear-and-tear theory postulates that normal activity causes wear and tear on the body, leading to aging.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 19 OBJ: 2-1 MSC: Physiologic Integrity: Physiologic Adaptation

13. According to which theory does cancer occur as a possible result of aging? a. Radical theory b. Error theory c. Immunity theory d. Pacemaker theory ANS: C

Immunosenescence is the term used in immunity theory to describe an age-related decrease in immune functioning. According to this theory, as people age, they are more prone to getting cancer or autoimmune diseases because of this phenomenon. This is a nonstochastic theory.

Radical and error theories are both stochastic. The pacemaker theory looks at the interrelated role of the neurologic and endocrine systems and aging.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 19 OBJ: 2-1 MSC: Physiologic Integrity: Physiologic Adaptation

14. A nurse assesses an older patient who has lost a great deal of weight in a short time. When

asked, the patient states this behavior started after the patient read a magazine article on the benefits of extreme caloric restrictions. What response by the nurse is best? a. “That research was done on rodents and not on humans.” b. “You shouldn’t restrict your calories so severely.” c. “You have lost so much weight you need dietary supplements.” d. “You can’t believe everything you read in those magazines.”

ANS: A

The metabolic theory of aging postulates that organisms have a specific metabolic lifetime and that by lowering metabolic rate, life span can be increased. However, this has been demonstrated in rodents and the nurse should educate the patient on this information. The other options do not give information that will help the patient make an informed decision as to whether or not to follow this activity.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation MSC: Physiologic Integrity: Reduction of Risk Potential

OBJ: 2-1

15. A nurse is caring for an older patient who is sedentary and does not want to participate in any

activities. What action by the nurse is best? a. Inform the patient about the consequences of immobility. b. Promote activity by explaining the “use it or lose it” concept. c. Tell the patient he or she will feel better by being more active. d. Explain the relationship of being active and being independent.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: D

Activity increases circulation, provides range of motion, and leads to clearer mental functioning. Activity helps a person remain independent and able to perform activities of daily living (ADLs) and instrumental ADLs. Presenting information in a positive light that encourages the patient to take control of one’s own health is more likely to be successful than stressing the negative such as consequences of immobility or the concept of “use it or lose it.”

Telling the patient that he or she will feel better does not give concrete information the patient can use to make decisions.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 2-4 MSC: Health Promotion

16. The nurse working with older patients teaches the student that disengagement theory

potentially causes which problem? a. Fear b. Isolation c. Anxiety d. Malnutrition ANS: B

The no-longer supported disengagement theory posed that older people withdrew from society as they aged and that this was a mutually agreed upon behavior. The result would be isolation as the person became focused solely on him- or herself. Fear, anxiety, or malnutrition could be a further consequence, but isolation and withdrawal from society was “expected” according to this theory.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 22 OBJ: 2-5 MSC: Psychosocial Integrity

17. The nurse working in a long-term care facility used the developmental theory of aging in

practice. In caring for a frail, nearly bed bound patient, how can the nurse use this theory? a. Engage the patient in intellectually stimulating activities. b. Encourage the patient to participate in chair exercises. c. Ensure that the patient participates in all the group activities. d. Give the patient small “chores” to do for the facility.

ANS: A

In this theory, being active can mean physical or intellectual activity. The nurse can engage the patient in intellectually stimulating activities that allows the person a sense of satisfaction. The other options all call for physical activity, which the patient may or may not be able to perform.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 2-4 MSC: Psychosocial Integrity

18. The nurse working at a long-term care facility notes that one patient who is usually outgoing

refuses to participate in games that require keeping score. What action by the nurse is best? a. Ask the patient why he or she won’t participate. b. Assess the patient’s level of frustration with these activities. c. Find other activities for the patient to participate in. d. Do nothing; the patient can choose activities to engage in.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B

Although it is true that patients should be able to choose activities in which to participate, the best option is to assess the patient for frustration or anxiety associated with these types of activities. Once that is determined, the nurse can find other activities the patient can engage in successfully and is willing to participate in if the games are not an option. Asking “why” questions often puts people on the defensive and is not a therapeutic communication technique.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 2-4 MSC: Psychosocial Integrity

19. The nurse planning community events for older people uses sociologic theories to guide

practice. Which activity planned by the nurse best fits these theories? a. Group exercise programs b. Volunteering at a day care c. Healthy cooking classes d. Reminiscing therapy ANS: B

Using the sociologic theories to guide care, the nurse would plan events that allowed the older adult to remain active in the community and a valued member of society. Volunteering would offer the adult a way to stay engaged and provide a service to successive generations. Exercise and cooking classes would more fit in the biologic theories. Reminiscing therapy is a technique using psychological theories. All are good ideas for activities, but the one that specifically uses sociologic theory is the volunteer work.

DIF: Applying (Application) TOP: Nursing Process: Analysis

REF: N/A OBJ: 2-2 MSC: Psychosocial Integrity

20. What statement by a patient most indicates healthy aging according to Jung? a. “I wish I had traveled more when I was younger because now I can’t.” b. “I am proud of my past accomplishments at work and home raising my kids.” c. “My leg amputation makes things harder, but I still find a way to work.” d. “I still like to read the paper and novels and enjoy a little gardening.”

ANS: C

This patient shows acceptance of past accomplishments and finds value in him- or herself despite current limitations, which is healthy aging according to Jung. The person who wants to travel more displays remorse. The focus on past accomplishments does not show current acceptance. Reading and gardening do not show acceptance of past accomplishments.

DIF: Analyzing (Analysis) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 2-2 MSC: Psychosocial Integrity

21. A nurse is trying to teach a hospitalized older patient how to self-inject insulin. The patient is

restless and does not seem to be paying attention. What action by the nurse is best? a. Ask if the patient needs to use the bathroom. b. Tell the patient you’ll try again later in the day. c. Ask if the patient prefers that you teach the family. d. Refer the patient for home health care services.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

According to Maslow, physical needs take priority over other activities. This patient may be hungry, cold, tired, or need to use the bathroom. Telling the patient you’ll try again later, asking if you should teach the family, and referring to home health care does not provide for any unmet physical needs.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 2-4 MSC: Physiologic Integrity: Basic Care and Comfort

22. The new nurse at a long-term care center asks the director of nursing why he needs to learn so

many theories of aging. What response by the director is best? a. “No theories have been proven yet.” b. “A wide range of theories allows for holistic care.” c. “It’s required knowledge for certification exams.” d. “All the theories are important, so we use them all.”

ANS: B

Using a combination of different theories, each with its own focus, allows the nurse to plan individualized, holistic nursing care.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 2-5 MSC: Psychosocial Integrity

MULTIPLE RESPONSE 1. According to Maslow, a fully actualized person displays which traits? (Select all that apply.) a. Spontaneity b. Self-direction c. Creativity d. Ethical conduct e. Acceptance of self ANS: A, B, C, E

A fully actualized person displays the following characteristics: perception of reality; acceptance of self, others, and nature; spontaneity; problem-solving ability; self-direction; detachment and the desire for privacy; freshness of peak experiences; identification with other human beings; satisfying and changing relationships with other people; a democratic character structure; creativity; and a sense of values. Maslow does not specify ethical conduct.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 24 OBJ: 2-5 MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 03: Legal and Ethical Issues Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. A nurse caring for older adult patients shows an understanding of the implementation of

standards of care when: a. dialing the telephone when the patient wants to call his daughter. b. requesting the patient’s favorite dessert on his birthday. c. closing the patient’s door when he is praying. d. reminding the patient to call for assistance before getting out of bed.

ANS: D

A standard of care is a guideline for nursing practice and establishes an expectation for the nurse to provide safe and appropriate care, such as reminding the patient to call for assistance before getting out of bed. Standards of care may be established on national or regional levels.

Dialing the phone for the patient, closing the patient’s door, and requesting a special dessert are not actions that conform to standards of care.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 3-1 MSC: Safe and Effective Care Environment

2. A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patient’s

claim that she has been physically abused. The nurse manager responds most appropriately when stating: a. “I’ll show you where you can find this state’s reporting requirements.” b. “As a nurse you are considered a ‘mandated reporter’ of elder abuse.” c. “As long as you are reasonably sure abuse has occurred, report it.” d. “You need to report any such claims directly to me.”

ANS: A

To be responsive to the legal obligation to report reasonably suspicious acts of abuse and because there is great variation among the states, nurses should determine the specific reporting requirements of their jurisdictions, including where reports and complaints are received and in what form they must be made. The statements that the nurse is a mandatory reporter and that abuse should be reported if suspected are true, but they do not help the nurse learn to handle the complaint. The manager may want to know about claims of abuse and it may be facility policy to report up the chain of command, but the nurse is responsible for filing the formal complaint.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 3-8 MSC: Safe and Effective Care Environment

3. The nurse recognizes that a nursing aide likely to abuse an older patient is one who has: a. ineffective verbal communication skills. b. little experience working with the older population. c. poor stress management skills. d. been a victim of abuse.

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

It has been shown that the primary abusers of nursing facility residents are nurse aides and orderlies who have never received training in stress management.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 32 OBJ: 3-8 MSC: Safe and Effective Care Environment

4. An older adult resident of a long-term care nursing facility frequently attempts to get out of

bed and is at risk of sustaining an injury. The nurse’s planned intervention to minimize the patient’s risk for injury is guided by: a. the patient’s right to self-determination and to be free to get out of bed. b. an understanding that nondrug interventions must be tried before medications. c. the knowledge that application of a vest restraint requires a physician’s order. d. the patient’s cognitive ability to understand and follow directions.

ANS: B

The drug use guidelines are based on the principles that certain problems can be handled with nondrug interventions and that such forms of treatment must be ruled out before drug therapy is initiated. The patient does have the right to self-determination, but the staff must ensure the patient’s safety. Vest restraints do require an order, but environmental measures must be tried before chemical or physical restraints. The patient’s cognitive abilities do not allow for unjustified physical or chemical restraints.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 35-6 OBJ: 3-7 MSC: Safe and Effective Care Environment

5. During the state inspection of a skilled nursing facility, a surveyor notes suspicion that a

particular nurse may not be providing the proper standard of care. The nurse manager informs the nurse to expect: a. a review of the situation by the state board of nursing. b. termination of employment from the facility. c. mandatory remediation related to the suspect care issues. d. unannounced reevaluation of performance within the next 3 months.

ANS: A

In such cases, the surveyor may forward the record showing the relevant findings to the appropriate state agency or board for review of the nurse’s practice, requesting a determination of whether the nurse may have violated the state’s nurse practice act.

Regulations do not specify that the nurse be terminated, have remediation, or have an unannounced reevaluation.

DIF: Understanding (Comprehension) REF: Page 37 TOP: Communication and Documentation MSC: Safe and Effective Care Environment

OBJ: 3-1

6. An 87-year-old patient is unsure of the purpose of a living will. The nurse describes its

purpose best when stating: a. “It’s a legal document that Social Services can help you create.” b. “It designates a family member to make decisions if you become incompetent.” c. “It provides a written description of your wishes in the event you become terminally ill.” d. “It assures you won’t be subjected to treatments you don’t want.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: C

Living wills are intended to provide written expressions of a patient’s wishes regarding the use of medical treatments in the event of a terminal illness or condition.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 39 OBJ: 3-10 MSC: Safe and Effective Care Environment

7. The nurse is caring for an unresponsive patient who has terminal cancer with a Do Not

Resuscitate order in effect. A family member tells the nurse, “I’ll sue you and every other nurse here if you don’t do everything possible to keep her alive.” The nurse understands that protection from legal prosecution in this situation is provided by: a. legal immunity granted when acting according to the patient’s expressed wishes. b. the legal view that the duty to put into effect the patient’s wishes falls to the physician. c. knowledge of and compliance with facility policies and procedures regarding endof-life care. d. implementing interventions that preserve the patient’s right to self-determination.

ANS: C

In this case, immunity applies only to the physician and not to the nurse because the physician is given the legal duty to put into effect the patient’s wishes. Consequently, the nurse must rely on effective communication with the physician, patient, and family, and on the quality of the facility’s policies and procedures, to be sure that his or her actions are consistent with the legally required steps.

DIF: Understanding (Comprehension) TOP: Nursing Process: Implementation

REF: Page 42 OBJ: 3-10 MSC: Safe and Effective Care Environment

8. The nurse is caring for a terminally ill older patient who has a living will that excludes

pulmonary and cardiac resuscitation. The family expresses a concern that the patient may “change her mind.” The nurse best reassures the family by stating: a. “The nursing staff will watch her very closely for any indication she has changed her mind.” b. “We will discuss her wishes with her regularly.” c. “She can change her mind about any provision in the document at any time.” d. “Your mother was very clear about her wishes when she signed the document.”

ANS: A

AMD provisions appropriately provide that people can change their minds at any time and by any means. Nurses need to be alert to any indications from a patient. Based on the person’s medical condition, subtle signs such as a gesture or a nod of the head may be easily overlooked. The patient may or may not be able to discuss her condition. Stating that the mother was very clear in her wishes does not take into account the fact that patients can change their minds any time.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 3-7 MSC: Safe and Effective Care Environment

9. A patient residing in a long-term care facility has been experiencing restlessness and has often

been found by nursing staff wandering in and out of other patients' rooms during the night.

The nurse views the patient’s PRN antipsychotic medication order as: Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. an appropriate intervention to help assure his safety. b. an option to be used only when all other nondrug interventions prove ineffective. c. inappropriate unless the physician is notified and approves its use. d. not an option because it should not be used to manage behaviors of this type.

ANS: D

Reasons for the use of antipsychotic drugs do not include behaviors such as restlessness, insomnia, yelling or screaming, inability to manage the resident, or wandering. The staff must provide nondrug alternatives to help calm the patient.

DIF: Analysis (Analyze) TOP: Nursing Process: Planning

REF: N/A OBJ: 3-7 MSC: Safe and Effective Care Environment

10. An alert but disoriented older patient lives with family members. The home health nurse,

being aware of the role of patient advocate, recognizes the obligation to report possible patient abuse based on: a. a family member stating, “It’s hard being a caregiver.” b. assessment showing bruises in the genital area. c. observation of mild changes in orientation. d. patient’s report of always being hungry.

ANS: B

Even when a patient exhibits disorientation, any report of mistreatment or neglect is to be considered reasonably suspicious and so should be reported. Bruises in the genital area raise suspicions of abuse. The family stating caregiving is hard does not mean they don’t have enough support to cope. Mild changes in orientation may be expected in a disoriented patient.

The patient who is always hungry should be followed up with a nutrition assessment, and this may or may not be a sign of abuse.

DIF: Application (Apply) TOP: Nursing Process: Assessment

REF: N/A OBJ: 3-8 MSC: Safe and Effective Care Environment

11. An older adult patient has been approached to participate in a research study. The nurse best

advocates for the patient’s right of self-determination by: a. evaluating the patient’s cognitive ability to understand the consequence of the study. b. determining what risks to the patient are involved. c. discussing the importance of the study with the patient and his family. d. encouraging the patient to discuss the decision with trusted family or friends.

ANS: A

The right to self-determination has its basis in the doctrine of informed consent. Informed consent is the process by which competent individuals are provided with information that enables them to make a reasonable decision about any treatment or intervention that is to be performed on them. The other options do not address autonomy and self-determination.

DIF Applying (Application) REF: N/A OBJ: 3-7 TOP: Communication and Documentation MSC: Safe and Effective Care Environment Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 12. A nurse responsible for the care of older adult patients shows the best understanding of the

nursing standards of practice when basing nursing care on the: a. physician’s medical orders. b. stated requests of the individual patient. c. care that a responsible geriatric nurse would provide. d. implementation of the nursing process.

ANS: C

Nursing standards of practice are measured according to the expected level of professional practice of those in similar roles and clinical fields. Nursing care is not judged against the physician’s orders, stated requests of the patient, or implementation of the nursing process.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 30 OBJ: 3-1 MSC: Safe and Effective Care Environment

13. The nurse caring for an older patient who resides in an assisted living facility is asked to

obtain and witness the patient’s signature on a living will document. The nurse responds most appropriately when stating: a. “I will, because such a document is so valuable to the patient’s plan of care.” b. “I’ll ask the patient’s family if they agree that the patient should sign the document.” c. “First I need to discuss the purpose of this document with the patient.” d. “I’m sorry but I cannot ethically do that.”

ANS: D

It is not permissible for the nurse to secure the patient’s signature or to witness the patient’s signature on a living will document. Generally speaking, an employee or owner of a facility in which the patient resides cannot witness this document.

DIF: Application (Apply) TOP: Nursing Process: Implementation

REF: N/A OBJ: 3-9 MSC: Safe and Effective Care Environment

14. A graduate nurse learns about the provisions of the Health Insurance Portability and

Accountability Act (HIPAA), which include which of the following? a. Requires employers to offer health care insurance b. Regulates the amount employers can charge for insurance c. Mandates that employers provide specific benefits d. Helps maintain coverage when a person changes jobs ANS: D

HIPAA has several provisions, one of which is that it helps people maintain health care insurance when they are changing jobs. The other statements are common misconceptions about HIPAA. DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 31 OBJ: 3-5 MSC: Safe Effective Care Environment

15. The nurse manager in a long-term care facility reviews resident care plans at what interval? a. Quarterly b. Every 60 days c. Annually Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. When changes occur

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

The resident care plan is routinely reviewed quarterly.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 33 OBJ: 3-1 MSC: Safe Effective Care Environment

16. The manager of a long-term care facility is evaluating patients’ use of drugs. The resident on

which of the following medications would be allowed to continue taking medications to control behavior? a. On anxiolytics; now able to participate in group activities b. Given a benzodiazepine at night; roommate now sleeps well c. Given sedatives; eats 100% of meals if resident is fed d. Taking an antipsychotic; no longer wanders at night ANS: A

Drugs should not be used to control behavior. If used to manage health conditions, the patient should show improvement. The patient who is now able to participate in activities shows an increase in functional ability, so this medication is therapeutic for this patient. The other patients are given drugs to control behavior.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 3-7 MSC: Safe Effective Care Environment

17. To meet current guidelines regarding incontinence in a long-term care facility, what action by

the director of nursing is best? a. Assess residents for the ability to participate in a bladder training program. b. Take all residents to the toilet every 2 hours and after meals. c. Ensure all residents wear incontinence briefs, which are changed routinely. d. Ask physicians and other providers to prescribe medications for bladder control.

ANS: A

Urinary incontinence is a common problem that can lead to several complications. The extent to which residents participate in bladder training programs is an area of focus for facility inspectors. Some residents may need routine toileting, wearing briefs, and medications, but they should all be assessed for the ability to participate in bladder training.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 3-4 MSC: Physiologic Integrity: Reduction of Risk Potential

18. The director of nursing at a long-term care facility is getting ready for the annual inspection.

What information guides the director? a. Visits cannot be unannounced. b. The director must be off site during the inspection. c. Nurses must answer questions from the inspectors. d. Results will be shared only through the mail.

ANS: C

Nurses present during inspections must answer questions posed by the inspectors. Visits can be unannounced. The director should be present during the survey. Results are shared during a conference, then a report is mailed later.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Remembering (Knowledge) REF: Page 36 TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 3-4

19. The nursing student learns about the Patient Self-Determination Act. What is a key provision

of this act? a. It establishes new rights for patients in medical facilities. b. It requires facilities to educate patients on their rights. c. It allows families to be approached for organ donation. d. It spells out the procedures for creating an advance directive.

ANS: B

The intent of this law is to ensure that patients are given information about the extent to which their rights are protected under state law. It does not establish new rights, is not related to organ donation, and does not specify procedures for advance directives.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 42 OBJ: 3-7 MSC: Safe Effective Care Environment

MULTIPLE RESPONSE 1. To best address the patient’s right to self-determination, which of the follow questions does

the nurse ask at the time the patient is admitted to a nursing facility? (Select all that apply.) a. “Do you understand what a living will and durable power of attorney are?” b. “If you have already prepared an advance care directive, can you provide it now?” c. “Are you prepared to discuss your end-of-life choices with the nursing staff?” d. “Have you discussed your end-of-life choices with your family or designated surrogate?” e. “Would you like help with preparing a living will or a durable power of attorney?”

ANS: A, B, D, E

All the correct options address the patient’s right to make an informed decision regarding health care issues by using various advance directives. The patient does not need to discuss end-of-life choices with the staff in order to exercise the right to self-determination.

DIF: Application (Apply) REF: N/A TOP: Integrated Process: Teaching-Learning MSC: Safe and Effective Care Environment

OBJ: 3-7

2. What provisions for nursing service are part of the Omnibus Budget Reconciliation Act

(OBRA) as it pertains to long-term care facilities? (Select all that apply.) a. Resident assessments b. Annual screenings c. Minimum staffing d. Ensuring resident rights e. Registered nurse educational requirements ANS: A, B, C, D

OBRA’s service requirements include resident assessments and screenings, minimum staffing requirements, and ensuring resident rights. Educational requirements for nurses are not part of this mandate.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-4 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 3. The director of nursing at a certified long-term care facility overhauls the nursing assistant

training program to include which features? (Select all that apply.) a. 12 hours of classroom content b. Training in infection control measures c. Instruction on resident rights d. 6 hours of quarterly in-service education e. Education on safety measures ANS: B, C, D, E

Requirements for a nursing assistant’s education includes training in infection control and interpersonal skills, instruction on resident rights and safety procedures, and 6 hours of education through in-services quarterly. Nursing assistants must have classroom training before working with residents, but the amount of time is not specified.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 3-3 MSC: Safe Effective Care Environment

4. The adult child of a long-term care facility resident receives a phone call from the director of

nursing stating that her parent has 30 days to move out of the home. Under what conditions can a facility require a resident to move? (Select all that apply.) a. Nonpayment for services received b. Needs exceeding what the facility can provide c. Stay is no longer required based on the resident’s medical condition d. Facility is going out of business e. Frequent disruptive behavior during the night ANS: A, B, C, D

A facility can require a resident to leave in four situations: nonpayment for services, needs that exceed what the facility can provide, the patient’s medical condition no longer warrants longterm care, or the facility is going out of business. Being disruptive is not a cause for expelling a resident.

DIF: Remembering (Knowledge) REF: Page 34 TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 3-2

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 04: Gerontologic Assessment Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The geriatric nurse recognizes that the body’s homeostatic mechanisms may be compromised

in the: a. 79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily living (ADLs). b. 73-year-old with a history of chronic bronchitis who lives with family. c. 86-year-old who lost a spouse and is moving into an assisted living facility. d. 69-year-old with peripheral vascular disease who is visited by home health care weekly.

ANS: C

Declining physiologic function and increased prevalence of disease, particularly in the old-old (age 85 or older), are in part a result of a reduction in the body’s ability to respond to stress through all of its homeostatic mechanisms. The important point is that older adults often encounter profound and repeated losses; the time between the occurrences of these losses is often short, resulting in an inadequate period for resolution and return to a baseline state, thus putting them at risk for illness. Although the other patients may have compromised homeostatic mechanisms, the 86-year-old patient is most likely to exhibit this phenomenon.

DIF: Analyzing (Analysis) TOP: Nursing Process: Diagnosis

REF: N/A OBJ: 4-2 MSC: Physiologic Integrity

2. To best minimize patient anxiety and help ensure a successful history assessment interview,

the geriatric nurse first: a. asks whether the patient has any questions about the interview. b. makes sure the interview area is comfortable and private. c. explains the reason for asking the questions. d. assures the patient that all answers will be kept confidential.

ANS: C

To ensure a successful interview, the nurse should explain the reason for the interview to the patient followed by a brief overview of the format to be followed. This helps alleviate anxiety and uncertainty, and the patient can then focus on providing the information. The other options are all important actions during the assessment interview, but they will not diminish anxiety as much as an explanation of the purpose.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 4-1 MSC: Emotional Needs Related to Health Problems

3. An older patient is admitted for bacterial pneumonia. The only abnormal assessment values

include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patient’s daughter questions the possibility of pneumonia stating, “He isn’t coughing or having any difficulty breathing.” The nurse responds most appropriately by saying: a. “We are lucky to determine the problem in its early stage.” b. “Respiratory problems develop only after the infection is well established.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. “People your dad’s age often lack the muscular strength to cough.” d. “Older adults frequently lack the typical signs of a respiratory infection.”

ANS: D

The characteristic presentation of illness in older adults is more commonly one of blunted or atypical signs and symptoms. Stating, “we are lucky to determine the problem” does not give any useful information. Respiratory problems are often present early on in younger people.

The lack of coughing is not caused by weakness.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 57 OBJ: 4-2 MSC: Physiologic Integrity

4. A nurse aide working in the geriatric unit’s dining room tells the nurse that a patient who was

oriented to time and place this morning is now confused about what day it is and why she’s “here.” The nurse appropriately directs the nurse aide to: a. take the patient back to her room and put her safely in bed. b. place a falls risk identification bracelet on the patient and add the status care plan. c. immediately take the patient’s vital signs and report them to her. d. reorient the patient to time and place frequently and document the patient’s response.

ANS: C

A sudden change in an older adult patient’s cognitive status is likely a symptom of a physiologic stressor such as an infection. The vital signs will allow the nurse to determine the presence of a fever or other deviation from the patient’s baseline vitals. The patient may or may not need or wish to go to bed, but this does not provide any data for the nurse to evaluate.

An ill patient may need to be on fall precautions, but again this does not provide data.

Reorientation may be necessary, but if the patient has an illness, this needs to be taken care of.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 4-2 MSC: Physiologic Integrity

5. The nurse most effectively implements guided reminiscence during a patient interview by: a. reminding the patient to share important memories of the past. b. scheduling several short interviews rather than one long one. c. controlling the interview by selecting the memories to be discussed. d. encouraging the patient to relive his or her memories while maintaining focus.

ANS: D

This goal-directed interviewing process helps the patient share pertinent information through remembering. The tendency to reminisce may make it difficult for the patient to stay focused on the topic, so it is the nurse’s responsibility to refocus the interview when necessary.

Reminding the patient to share memories, using several short interviews, and controlling the interview do not make best use of this technique.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 4-4 MSC: Psychosocial Integrity

6. To establish a mutually respectful relationship with an older adult patient being admitted to a

skilled nursing unit, the nurse first introduces himself and then asks: a. how the patient would like to be addressed.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. if the patient has any specific requests to make of the staff.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. the patient to share a little about his or her personal likes and dislikes. d. the patient to read the orientation materials that the facility provides.

ANS: A

Respect is shown best by acquiring knowledge regarding the preferences held by a patient; using the patient’s surname is preferred unless the patient directs the staff to do otherwise. The other options are too narrow in focus to establish a mutually respectful relationship.

DIF: Applying (Application) TOP: Integrated Process: Caring

REF: N/A OBJ: 4-4 MSC: Psychosocial Integrity

7. The nurse showing the best understanding of how personal attitude affects the interview

process during a health assessment of an older adult patient is one who: a. proceeds with the interview as if the patient were not an older adult. b. incorporates therapeutic communication into the assessment process. c. treats all patients with respect regardless of age. d. has self-reflected on his or her own feelings regarding aging.

ANS: D

The nurse’s own anxiety and fear of personal aging as well as a lack of knowledge regarding older people contribute to commonly held negative attitudes, myths, and stereotypes about older people that interfere with a successful, effective assessment interview. The nurse must acknowledge the age-related differences in this patient. The nurse does use therapeutic communication, but this may be hampered by unrealized stereotypes. The nurse should treat all patients with respect, but this statement does not give specific information on how to do so.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 4-4 MSC: Communication and Documentation

8. An older patient is being admitted to a long-term care facility. The nurse recognizes that the

primary purpose of the initial geriatric health assessment is to: a. identify the patient’s physiologic baselines. b. ultimately create a plan of care that prevents disability and dependence. c. initiate the therapeutic nurse-patient relationship. d. document self-care deficiencies that the patient exhibits.

ANS: B

Specifically, the purpose of older adult assessment is to identify patient strengths and limitations so that effective and appropriate interventions can be delivered to support, promote, or restore optimum function and to prevent disability and dependence. Physiologic baseline, therapeutic nurse-patient relationship, and self-care deficits are all important aspects of the assessment but not the major purpose for it.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 55 OBJ: 4-8 MSC: Physiologic Integrity

9. A 76-year-old postsurgical diabetic patient has reported feeling dizzy and clammy. The daily

serum glucose level shows the patient’s levels to be within normal limits. The geriatric nurse shows an understanding of established health norms for the older adult when stating: a. “This patient’s normal may not be within the typical lab norms.” b. “I’ll ask the lab to rerun the test so we can double-check the results.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. “There must be another reason for the symptoms.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. “I’ll compare the patient’s baseline lab work with today’s results.”

ANS: A

Relying on established norms for laboratory values when analyzing the assessment data of older adults could lead to incorrect conclusions. The nurse should try to determine what the patient’s normal range is after stabilizing the patient.

DIF: Understanding (Comprehension) TOP: Nursing Process: Evaluation

REF: Page 56 OBJ: 4-1 MSC: Physiologic Integrity

10. A patient is being admitted after a fall that has caused a painful leg injury. In preparing to

interview the patient for a health history, the nurse is initially concerned that: a. the family should be present to help answer questions. b. a therapeutic nurse-patient relationship should be established. c. the patient should be free of hearing and vision barriers. d. the patient’s pain should be effectively managed.

ANS: D

The acute pain the patient is experiencing will have the greatest impact on the success of the health assessment interview and must be removed as a barrier for the assessment to be successful. The other factors are important too, although depending on the cognitive status of the patient, the family may or may not need to be present.

DIF: Application (Apply) TOP: Nursing Process: Implementation

REF: N/A OBJ: 4-5 MSC: Physiologic Integrity

11. The nurse has administered the Apgar screen tool to assess an older patient’s family function

status. Upon determining that the family functions at a 4, the nurse: a. prepares to administer a more detailed tool. b. prepares to report reasonable suspicion of elder abuse. c. asks the patient to identify specific family members to include in care planning sessions. d. notifies social services that the family is not likely to be of much support to the patient.

ANS: D

An Apgar score of 4 to 6 suggests a moderately dysfunctional family, one that should not be depended on to provide physical, financial, or emotional support to the patient.

DIF: Analysis (Analyze) TOP: Nursing Process: Assessment

REF: N/A OBJ: 4-9 MSC: Psychosocial Integrity

12. The geriatric nurse admitting a patient to an assisted living facility recognizes the importance

of tools such as the Katz and the Barthel indexes because of the impact they have on: a. planning the amount of help the patient will need with ADLs. b. the patient’s ability to be realistic about achieving independence. c. creating an appropriate, patient-specific nursing care plan. d. appropriate staffing to ensure the safety needs of the patients are met.

ANS: C

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

These assessment tools are designed to assess a patient’s levels of function, particularly related to ADL. Determination of the degree of functional independence in these areas can identify a patient’s abilities and limitations, leading to appropriate interventions presented in the patient’s nursing care plan. It provides more information than just how much help the patient needs, it is not related to being realistic, and it is not designed to be used for staffing purposes.

DIF: Analysis (Analyze) TOP: Nursing Process: Assessment

REF: N/A OBJ: 4-9 MSC: Health Promotion and Maintenance

13. An older patient is reluctant to report multiple vague signs and symptoms, including lethargy,

incontinence, and weight loss that have persisted for 6 weeks. The nurse recognizes that such symptoms place the patient at great risk for: a. viral infection. b. disorientation. c. malnutrition. d. physical frailty.

ANS: D

Self-reported vague signs and symptoms such as lethargy, incontinence, decreased appetite, and weight loss can be indicators of functional impairment. Ignoring older adults’ vague symptoms exposes them to an increased risk of physical frailty (impairments in the physical abilities).

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 56 OBJ: 4-7 MSC: Health Promotion and Maintenance

14. An older patient is hospitalized after a fall that resulted in a fractured left ankle. By day 4 of

the hospitalization, which includes reduction of the fracture and analgesic drug therapy, the patient has become mildly disoriented and is incontinent of urine. The nurse explains to the family that these symptoms reflect the: a. relationship between aging and both physical and psychosocial responses to trauma. b. response exhibited by many older adults who are hospitalized. c. effects of stress-induced perceptual deficits often seen in the hospitalized older adult. d. results of the pharmacologic pain control therapy.

ANS: A

Many serious consequences are the result of the interaction of physical and psychosocial factors in the older patient. Although the other options have some degree of truth to them, the most comprehensive answer is the one that relates aging to response to trauma.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 56 OBJ: 4-2 MSC: Physiologic Integrity

15. When unsure about how to address older patients with advanced stage Alzheimer disease, the

nurse recognizes that it is best to address the patient by: a. a pet name, because the patients are not likely to respond to their given names. b. the first name, to foster a friendly, relaxed atmosphere. c. the full name, to show respect for the patients as individuals.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. a childhood nickname, because long-term memory will likely still be intact.

ANS: C

Nurses should address all older patients by their full name, including Mr. Mrs., or Miss, to show respect, unless the patient specifically requests being called something else.

DIF: Application (Apply) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 4-4

16. A nurse is working with an older patient in the gerontology clinic. The patient reports a vague

decline in function and says, “I guess I’m just getting older.” What action by the nurse is best? a. Help the patient find ways to cope with the changes. b. Assess the patient for an undetected illness. c. Ask if the patient needs any home health services. d. Find out what the patient thinks of these changes.

ANS: B

Vague changes and declining function are often attributed to aging but can be the only signs of illness. The nurse should perform a thorough assessment to look for any possible ailments. If the findings are normal and the changes are age related, the nurse can help the patient find ways to cope, ask about home health care services, and determine the patient’s thoughts on the matter.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 4-2 MSC: Physiologic Integrity

17. The nurse admitting a debilitated patient to a long-term care facility initially assesses the

patient using the Katz Index. The student asks why the nurse chose that tool. What answer by the nurse is best? a. It is quick and simple for a baseline. b. The Katz Index is mandated by Medicare. c. It is comprehensive in nature. d. It shows functioning in 12 areas.

ANS: A

The Katz Index takes only about 5 minutes to complete and rates patients as to whether they are totally independent or dependent in six basic functions. For the debilitated patient who will tire easily, this is the best choice. It is not mandated by Medicare, it is not as comprehensive as other tools, and it only shows functioning in 6 areas.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 71 OBJ: 4-9 MSC: Physiologic Integrity

18. A nurse assesses a patient using the Barthel Index and scores the patient as a 98. What

inference does the nurse draw from this assessment? a. The patient is nearly dependent in all areas measured. b. The patient is able to live independently. c. The patient is close to independent in the areas measured. d. The patient’s cognitive status impaired the assessment.

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The Barthel Index has a maximum score of 100, with the higher the score meaning more independent functioning. However, the tool developers do not state that a high score equals being able to live independently. This tool does not measure cognitive functioning.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 4-9 MSC: Physiologic Integrity

19. The staff members in a long-term care facility have noted a decline in cognitive function in

one of the residents; however, each time the resident is given the Short Portable Mental Status Questionnaire (SPMSQ), the score does not change. What action by the nursing manager is best? a. Provide in-service education on using this tool. b. Conduct the assessment him- or herself c. Switch to a different screening tool d. Determine that no changes have occurred.

ANS: C

The SPMSQ is given orally, and because it is short, it is easy to memorize. The manager should use a different tool.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 4-10 MSC: Physiologic Integrity

20. The nurse has used the Yesavage Geriatric Depression Scale (short form) and scored the

patient at a 1. What is the nurse’s best action? a. Refer the patient to a mental health practitioner. b. Assess the patient further for depression. c. Ask the patient about using antidepressant medications. d. Document findings in the patient’s medical record.

ANS: D

A score of 5 or more indicates possible depression that should be assessed further. A score of 1 indicates no or little depression risk. The nurse should document the findings. No other action is needed.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 4-10 MSC: Psychologic Integrity

21. A nurse is conducting an admission interview with an older patient admitted to a long-term

care facility. When the nurse asks about the patient’s former occupation, the patient states, “What do you care? I am long retired!” What response by the nurse is best? a. “Your job may have exposed you to some health hazards.” b. “It helps me get to know you and your background better.” c. “We have several clubs here you might be interested in.” d. “No real reason, it’s just part of our admission interview.”

ANS: A

Previous occupations may have exposed the patient to health hazards that might be important.

The question does help the nurse get to know the patient and maybe offer some activities he or she would most likely be interested in, but that’s not the main reason for the question. Saying there is no reason to ask the question puts the entire admission interview under suspicion for Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

being irrelevant.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) REF: Page 66 OBJ: 4-6 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. A nurse who cares for older adults recognizes which of the following clinical features

associated with dementia? (Select all that apply.) a. Failing to remember his or her room number b. Becoming increasingly disoriented at night c. Working on jigsaw puzzles for hours at a time d. Often referring to a cup as a canyon e. Misunderstanding when told “it’s raining cats and dogs” ANS: A, D, E

Clinical features of dementia are associated with cognitive deficiencies such as forgetfulness, lack of inquiry, inability to correctly associate proper words to objects, and concrete thinking.

DIF: Remembering (Knowledge) REF: Page 57|Page 59 OBJ: 4-3 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. The nurse using the SPICES model to assess older patients collects data on which topics?

(Select all that apply.) a. Sleep disorders b. Problems with eating c. Incontinence d. Falls e. Social situations ANS: A, B, C, D

SPICES stands for sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 70 OBJ: 4-12 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 05: Cultural Influences Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, “I

expect I’ll need a total hysterectomy because when my sister had this problem that’s what she had done.” The nurse recognizes that this woman belongs to a cultural subgroup whose health care beliefs are most influenced by the: a. biomedical model. b. magico-religious model. c. balance/harmony model. d. personal experience.

ANS: A

The patient shows a tendency to identify with the biomedical model, which views the body as a functioning machine. When a part gives out or is functioning abnormally, traditional Western medical treatment is sought and expected. The magico-religious models believe that health is a reward from a higher power. The balance/harmony models state that illness is the result of a state of imbalance in body energies. Personal experience influences all of these models.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 91 OBJ: 5-5 MSC: Psychosocial Integrity

2. A Hispanic patient explains that the Hispanic culture believes that dietary management would

be just as effective in managing her problems as medication, so the patient’s prescription has not been filled. Which action by the nurse illustrates cultural accommodation? a. Asking the patient to give more details regarding this belief b. Discussing how to add dietary preferences into the treatment plan c. Offering to have a registered nutritionist discuss the situation with the patient d. Researching the patient’s proposed dietary beliefs ANS: B

Cultural care accommodation or negotiation refers to those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture adapt to or negotiate with others for a beneficial or satisfying health outcome. The nurse can ask the patient to share more about beliefs, offer a consultation with a nutritionist, or research the beliefs, but these actions do not show accommodation.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-9

3. A geriatric nurse practitioner working with a tribe of Native Americans makes the decision to

acculturate in an attempt to provide culturally appropriate care. The nurse does this best by: a. living the values of the tribe. b. researching the tribe’s belief systems. c. learning the language of the tribe. d. residing among the tribe members.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

Acculturation is a process that occurs when a member of one cultural group adopts the values, beliefs, expectations, and behaviors of another group, usually in an attempt to become recognized as a member of the group. The other actions might be helpful in acculturating.

DIF: Applying (Application) TOP: Nursing process: Implementation

REF: N/A OBJ: 5-3 MSC: Psychosocial Integrity

4. The nurse in an assisted living facility is practicing a form of cultural bias called

ethnocentrism when: a. requesting the bridge group only use the game room for 2 hours at a time. b. encouraging Christian residents to attend mass or church services. c. repeatedly confiscating herbs and food products used in healing. d. telling potential patients who are Jewish that the facility does not have a kosher kitchen, ANS: C

Ethnocentrism is a belief that one’s own cultural group is superior to that of another’s. In nursing we have a unique culture and expect our patients to adapt to us rather than attempting to adapt to the culture of the patient. Confiscating items used in healing rituals shows ethnocentrism and disrespect to the resident. Limiting activities in a group room, encouraging people to attend church services of their religion, and letting prospective Jewish residents know that the facility does not have a kosher kitchen are not examples of ethnocentrism.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 5-6 MSC: Psychosocial Integrity

5. While caring for an older Korean patient, the nurse notes that the patient answers questions

regarding health history when asked but is otherwise silent and does not maintain eye contact.

Being culturally sensitive, the nurse recognizes that the patient’s actions are most likely a(n): a. sign of respect for the wisdom and expertise of the nurse. b. indication that he has no questions regarding the care he is receiving. c. expression of discomfort discussing personal matters. d. means of communicating his dissatisfaction with his care.

ANS: A

Asian cultures generally view eye contact as rude and are often passive in their care. The patient may or may not have further questions. It is not a sign of discomfort or dissatisfaction.

DIF: Remembering (Knowledge) REF: Page 93 TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-7

6. The culturally sensitive nurse will recognize that an older adult patient with a high-context

ethnic background will appreciate: a. not having a treatment scheduled during a favorite television program. b. both a written and verbal explanation describing how to monitor her blood sugar levels. c. a concise explanation as to why her physical therapy appointment has been canceled. d. having a conversation about her grandchildren while her dressing is changed.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: D

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The interactional patterns of high-context (universalism) patients refer to the characteristics of relationships and behaviors toward others. When a person from a high-context culture interacts with the nurse, a more personal relationship is expected. This is not related to television shows, teaching materials, or appointment cancellations.

DIF: Understanding (Comprehension) REF: Page 92 TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-7

7. In an attempt to be sensitive to varying cultural responses to touch, before shaking a patient’s

hand, the nurse will: a. offer the patient his or her upturned palm. b. wait until the patient extends his or her hand. c. establish eye contact with the patient first. d. address the patient by his or her full name.

ANS: B

The best way to show respect and implement the appropriate response is to follow the lead of the patient by waiting for the patient to extend a hand.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-7

8. A older Asian patient receiving physical therapy after hip surgery has developed a low-grade

fever. The patient explains that the fever will lessen if the treatment includes the principles of yin/yang. The nurse expects to support the patient by: a. providing privacy when his shaman visits. b. arranging for his diet to include cold foods and liquids. c. planning his physical therapy so it does not conflict with meditation. d. keeping a magical amulet under his pillow.

ANS: B

The yin/yang theory proposes that health is a result of balance within the body. A principle of this theory is that an illness is either hot or cold and must be treated by elements of the opposite state in order to put the system back into balance. It is not related to shaman visits, meditation, or amulets.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-9

9. The nurse in an assisted living facility is preparing to admit an older adult patient who speaks

very little English. The nurse decides that it is most important that an interpreter be present when the patient: a. indicates a desire to talk with the physician. b. is being oriented to the facility. c. is required to sign official documents. d. begins crying and is inconsolable.

ANS: C

The more complex the decision making, the more important it is to have an interpreter present. Although all situations would benefit from an interpreter, the most important time is when the patient is signing official documents that have legal implications.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 5-8 TOP: Communication and Documentation MSC: Psychosocial Integrity 10. When attempting to provide culturally sensitive care according to the explanatory model, the

nurse asks the patient: a. “Who will be able to help you when you go home?” b. “Do you think the treatment is helping?” c. “When did you first notice the problem?” d. “Has this illness changed your life?”

ANS: D

The gerontologic nurse uses this model to explore the meaning of the health problem from the patient’s perspective.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-7

11. The nurse is caring for an older adult patient in need of hospitalization. The nurse is aware this

patient is a member of an ethnic group that holds a collectivist perspective on community. The nurse best addresses the patient’s medical needs by: a. calling an interpreter to assure the patient is making an informed decision. b. assuring the patient that his spiritual advisor will meet him at the hospital. c. arranging for admission to a hospital that is familiar with this patient’s culture. d. offering to phone the patient’s family and ask them to come in and discuss the hospitalization.

ANS: D

People with a collectivist perspective derive their identity from affiliation with and participation in a social group such as a family or clan. The needs of the group are more important than those of the individual, and decisions are made with consideration of the effect on the whole. Health care decisions may be made by a group (such as the tribal elders) or a group leader (such as the oldest son). The other options may or may not be needed depending on the specifics of the patient’s case.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-9

12. The nurse is most effectively using the concept of future time orientation when: a. promising to help the patient call his daughter each weekend. b. offering to complete the health assessment history after the patient eats dinner. c. encouraging an older patient to keep a follow-up clinic appointment. d. arranging for a colorectal cancer screen for senior citizens.

ANS: D

In the concept of future orientation, people accept the idea that what is done now affects future health. This means that health screenings will help detect a problem today for potentially better health at a later time, days, weeks, or years ahead; it means that prevention may be worth pursuing. The other actions do not show a future orientation.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-9

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 13. The student learns that which of the following is the best definition of culture? a. A group of similarly appearing individuals b. Shared beliefs, behaviors, and expectations of groups c. Group beliefs about what is right and wrong d. Groups that come from the same part of the world ANS: B

A culture is a set of shared and learned beliefs, behaviors, and expectations among a group of people. The individuals in different cultures may or may not look similar. Group beliefs about what is right or wrong are known as values. Cultural members may come from many different parts of the world.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 87 OBJ: 5-3 MSC: Psychosocial Integrity

14. A student nurse expresses frustration to the faculty member regarding an ethnic older adult

who appears to be noncompliant. The student states, “Why can’t the patient just do what we teach her to do?” What response by the nurse is best? a. “Yes, I realize how frustrating this must be for you.” b. “People from her culture are never compliant.” c. “Maybe you can find a different way to get through.” d. “Culture dictates how people respond to others.”

ANS: D

Culture is a blueprint for responding to individuals, family, and the community. Persons from strong cultural backgrounds cannot just change their behavior when instructed to do so. The nurse explains this to the student. Stating that the nurse understands the frustration is helpful but does not give the student any information that could help him or her work with this patient. Stating that people from a certain culture are never compliant is biased and prejudicial. “Getting through” to the patient implies ethnocentrism and bias.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-7

15. A patient from a culture that differs from that of the nurse is hospitalized and near death. What

action by the nurse best demonstrates cultural care preservation? a. Allowing the family to remain at the bedside b. Pinning a healing amulet to the patient’s gown c. Offering the family food and drink in the room d. Giving the family time to be alone with the patient ANS: B

Cultural care preservation refers to those assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain and maintain their well-being, to recover from illness, or to face handicaps or death. Allowing the patient to have healing artifacts important in his or her culture nearby best demonstrates this concept. The other actions are caring but do not demonstrate this principle.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-9

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 16. The nurse uses the LEARN model when providing care. What event best demonstrates that

this model has been successful? a. The nurse learns about the patient’s culture and how it impacts care. b. The patient and nurse agree on a mutually acceptable plan of action. c. The nurse listens carefully to the patient’s concerns and beliefs. d. The patient understands how medical care will be beneficial.

ANS: B

The LEARN model includes listening to the patient, explaining your own perspectives, acknowledging the similarities and differences in both viewpoints, recommending a plan of action, and negotiating a final plan. If the patient and nurse have come to an agreement on a plan of action, this model has been successful.

DIF: Evaluating (Evaluation) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-7

17. A new nurse is caring for a patient from Appalachia. The patient seems guarded and secretive,

which frustrates the new nurse. What advice from the mentor is most appropriate? a. “Maybe you should ask to change your assignment.” b. “This is a normal behavior for this patient’s cultural group.” c. “You could try to apologize for anything you may have done.” d. “Ask the patient why she is acting so strangely around you.”

ANS: B

Patients from the Appalachian culture are typically wary and guarded around strangers and view the hospital as a place to go and die. The nurse explains this to the new nurse. Changing assignments will not help the new nurse become culturally competent. The new nurse could ask the patient if there has been some offense, but this is probably not the case. “Why” questions put people on the defensive and are not considered examples of therapeutic communication.

DIF: Understanding (Comprehension) REF: Page 87 TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-6

18. A nurse is caring for an Arab American patient in the hospital. The patient has many visitors

who seem to be tiring the patient. What action by the nurse is best? a. Limit the number of visitors the patient can have. b. Only allow family members to visit the patient. c. Suggest shorter visits to the patient’s visitors. d. Require visitors to check in at the front desk.

ANS: C

In Arab American Muslim culture, visiting the sick is a cultural value and expectation.

Although the visits may be tiring, they may also be important to the patient. The nurse can suggest shorter visits so the patient can have both the visitors and more rest. Limiting the number of visitors would violate this cultural norm as would limiting visits to family only.

Checking in at the front desk serves no useful purpose.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-6

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 19. A director of nursing works in a hospital that serves many Jehovah’s Witness patients. What

action by the nurse would best facilitate culturally appropriate health care? a. Establish a bloodless surgery program. b. Create an immunization clinic for children. c. Employ spiritual leaders from this faith. d. Allow faith healing ceremonies.

ANS: A

Jehovah’s Witnesses generally are opposed to receiving all blood products. A bloodless surgery program would be a culturally competent way to improve the health care of this population.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-5

20. An incapacitated older adult with dementia is brought to the emergency department by a

rescue squad after falling and breaking an arm. When the patient’s children arrive, they are adamantly against the patient having any medical care and insist that prayer will heal the broken arm. What action by the nurse is most appropriate? a. Allow the family to pray with the patient then escort them to the waiting room. b. Call security to keep the family from interfering with medical care. c. Check facility policies and contact the hospital social worker. d. Call the police who can force the family to accept medical care.

ANS: C

This family may be Christian Scientists, who do not believe in medical care. Health crises are thought to be errors of the mind that can be altered by prayer. The nurse should check the facility policies for treating vulnerable adults and possibly notify social work, who can assist with ensuring adequate treatment occurs as allowed by policy. Allowing the family to pray with the patient is a caring action, but this complex situation requires more intervention.

Calling security or the police will antagonize the family even more and demonstrates an adversarial relationship.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 5-6

MULTIPLE RESPONSE 1. When attempting to reflect about personal cultural awareness, the nurse asks himself or

herself which of the following quetions? (Select all that apply.) a. What image do I want to project to members of other cultures? b. What makes a culture worthy of biased treatment? c. Have my life experiences contributed to any biases regarding other cultures? d. Am I uncomfortable when interacting with members of other cultures? e. Does the patient’s culture rely on solid science to direct health care?

ANS: A, C, D

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Self-reflection implies thinking that regards how “I,” the individual, perceives/believes/behaves. Awareness of one’s thoughts and feelings about others who are culturally different from oneself is necessary to become culturally aware. No culture is “worthy” of biased treatment. “Solid” science is an ethnocentric principle.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 5-4

2. What does the nurse working with older adults from many different cultures know about the

demographics of culture in the United States? (Select all that apply.) a. Hispanics will become the largest minority group by 2030. b. Many persons of color are not counted in the census. c. The percentage of Native Americans/Native Alaskans will decrease. d. The number of refugees and immigrants is expected to decrease. e. Some Native Americans want to identify as specific tribal members.

ANS: A, B, C

Hispanics are expected to be the largest minority group in the United States by 2030. Many persons of color are not represented in the census, and this underestimates their presence. The percentage of Native Alaskans and Native Americans will rise, as will the number of immigrants/refugees. Some Native Americans may not view themselves as part of this larger group, preferring to identify as a member of a specific tribe.

DIF: Remembering (Knowledge) REF: Page 83 TOP: Communication and Documentation

OBJ: 5-1 MSC: Psychosocial Integrity

3. A nurse working in the emergency department is seeing an older patient who does not speak

English well. The nurse calls for an interpreter. The student wants to know why the patient’s minor child, who speaks English, cannot interpret. What response by the nurse is best? (Select all that apply.) a. The child may not accurately translate. b. The child and older adult may be embarrassed. c. The patient has the right to interpretation. d. Having a child interpret takes too much time. e. Privacy laws prohibit this practice.

ANS: A, B, C

Although in a true emergency the nurse may have to use a child interpreter, this practice is not recommended. The child may not have the vocabulary to translate, the child may “edit” the comments, the child or older adult may be embarrassed by the medical condition, and patients have a legal right to professional interpretation. Using an interpreter always takes more time and privacy laws do not prohibit this practice.

DIF: Understanding (Comprehension) REF: Page 93 TOP: Communication and Documentation

OBJ: 5-8 MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 06: Family Influences Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. While children voice concern about their father living alone after having a mild stroke that

resulted in only minimal disability, the patient angrily disagrees, stating that he’s always managed on his own and can do so now. The nurse can be most helpful to this family by: a. assuring them that their father’s physical limitations should not cause a safety issue. b. assisting them in identifying how they can help their father to live independently. c. offering to arrange a social service consult to arbitrate the conflict. d. suggesting that the patient accept the services of a home care aide on a short-term trial basis.

ANS: B

Preserving a patient’s autonomy through independent living is vital to a patient’s sense of well-being and can often be preserved through cooperation between family members to provide the required support. If the nurse can help the family find internal or external resources to support the patient’s desire to live independently, that is a win-win for all involved. Assuring the family that safety is not an issue does not help resolve their anxiety.

The nurse can arrange a referral but can do more to help with this situation. A short-term trial of home health services is often accepted, but it does not address the entirety of the situation.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 6-6

2. The physical changes that occur naturally as a result of the aging process often create an

autonomy versus safety issue and is most problematic when: a. protracted reaction time increases the risk for driving accidents. b. arthritic knee and hip joints make falls more prevalent. c. eyesight diminishes, making following written instruction more difficult. d. responding to warning alarms is affected because of impaired hearing acuity.

ANS: A

Research has proven that normal aging affects a variety of factors that contribute to the increased incidence of automobile accidents caused by older adult drivers. Although the other options also relate to safety, older adults are more likely to be in multiple vehicle crashes, impacting the safety of others as well as their own.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 103 OBJ: 6-2 MSC: Safe Effective Care Environment

3. When discussing stressors with the primary caregiver of an 83-year-old patient, the nurse

explores the issue of dissolving familiar social boundaries when asking: a. “Has it been a problem taking over the role of head of the family?” b. “What do you do to help relax and revitalize yourself?” c. “Do you find it difficult to ask for help when you need it?” d. “Are there any physical care tasks that you find difficult to complete?”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: D

Dissolving familiar social boundaries involves caregivers and older adults sharing intimacies such as toileting, changing briefs, or catheter care, which would otherwise not be shared.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 6-5 MSC: Psychosocial Integrity

4. The family of an 80-year-old patient shares with the nurse that they are concerned that the

patient is too frail to be living alone. The nurse’s initial intervention is to: a. help the patient express the importance of living independently to the family members. b. assess the patient’s functional abilities related to being able to safely live independently. c. have the family provide specific examples of behaviors that cause them concern. d. identify ways the family can help assure the patient’s safety while living independently.

ANS: B

The first nursing intervention is to determine through a health assessment and history the patient’s ability to perform activities of daily living (ADLs) safely while living independently.

All actions are appropriate, but assessment is the first step of the nursing process.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 6-6 MSC: Safe Effective Care Environment

5. An older patient with cognitive impairment is being cared for by family members. They have

expressed concerns about providing appropriate care as his functional level declines. The nurse responds: a. “I’m glad that you are interested enough in his care that you’ve expressed this concern.” b. “His abilities will certainly decline. This is the time to discuss other care options.” c. “You are right to be concerned. Let’s talk about issues that may come up in the future.” d. “The condition will get worse, so think about what will happen if you can’t meet his needs.”

ANS: C

Caregivers need realistic information regarding the possible progression of the disease process and how that will affect patient needs/care. The nurse provides anticipatory guidance and helps the family identify issues that may occur in the future. Stating you are glad the family voiced concerns is caring but does not address the issue. Telling the family it is time to address other care options or what they should think about is presumptuous.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Safe Effective Care Environment

OBJ: 6-6

6. An older patient who lives with family has a history of chronic alcohol abuse and poor

compliance with the medical plan. The patient has begun to experience a marked decline. His family tells the nurse that these problems are a result of their inability to care for the patient properly. The nurse best responds by: a. evaluating the care the family has been providing.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. suggesting that care should be assumed by a professional caregiver. c. helping the family recognize that the decline is a result of the patient’s condition

and personal choices. d. assuring them they are providing the patient with care motivated by love.

ANS: C

Family members often feel they have failed. They may need help to recognize when “failures” are the result of a challenging situation and not their performance. Giving objective information about the patient’s medical condition and the consequences of not following the medical regime can help alleviate guilt. The nurse may need to evaluate the care the patient gets, but that puts the entire responsibility back on the family, which is counterproductive.

Care may need to be assumed by a professional, but the nurse should first help the family with their feelings. Suggesting this prematurely can lead to increased guilt. Telling the family their care is motivated by love dismisses their concerns.

DIF: Understanding (Comprehension) REF: Page 107 TOP: Communication and Documentation

OBJ: 6-2 MSC: Psychosocial Integrity

7. An adult child is finalizing arrangements to provide in-home care for a dependent parent. In

order to best foster the long-term wellness for both the patient and the caregiver, the nurse: a. explains the patient’s plan of care in detail with both the patient and the caregiver. b. discusses the importance and availability of respite care. c. encourages the patient and caregiver to seek assistance with problems as they arise. d. provides written information regarding available in-home services.

ANS: B

The nurse should help caregivers recognize that caregiving is a job. Just as employees benefit from regular breaks and vacations, caregivers benefit from a “break” in the job. The nurse should emphasize that the need for respite care begins with the onset of caregiving.

Explaining the plan of care, encouraging the family to seek assistance, and providing written information are all appropriate, but home caregivers face multiple stressors and need to care for themselves too.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 6-7 MSC: Psychosocial Integrity

8. An 80-year-old patient with diminishing cognitive function is being discharged into the care

of his 72-year-old spouse. The nurse recognizes that besides the spouse’s physical ability to provide appropriate care, there is a need to evaluate the: a. couple’s financial resources. b. couple’s social support system. c. spouse’s cognitive level of function. d. patient’s long-term health prognosis.

ANS: C

The ability of the caregivers to provide health care to the dementia patient may be compromised if the caregivers themselves are cognitively challenged. The nurse should evaluate the spouse’s physical and cognitive abilities and the safety of the home. The other factors are important too, but safety is the key issue.

DIF:

Applying (Application)

REF: N/A

OBJ: 6-6

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Assessment

MSC: Safe Effective Care Environment

9. The family member caring for a dependent older patient tells the nurse that she feels his care

is “so out of my control.” To best assist the caregiver in achieving a sense of confidence, the nurse: a. encourages the caregiver to regularly attend the meeting of a local support group. b. identifies the skills and resources that the caregiver needs to provide for the patient. c. arranges for in-home support services to assist with care as needed. d. explores reasons why the caregiver feels such a lack of control.

ANS: B

Being able to do the tasks that need to be done, get needed support, or access community resources enhances feelings of being in control.

DIF: Application (Apply) REF: N/A TOP: Nursing Process: Assessment| Emotional Needs Related to Health Problems MSC: Safe and Effective Care Environment 10. The adult child of a patient diagnosed with Alzheimer disease has shared that he feels “so sad”

that he is not able to carry on a social conversation with the patient anymore because of her loss of memory. The nurse suggests: a. keeping conversations short while focusing on things that happened in the past. b. concentrating on doing things his mother enjoys rather than focusing on talking. c. participating in support groups that offer suggestions for communication. d. allowing his mother to pick the topic and then simply being with her “in her world.”

ANS: D

Family members must have a realistic understanding of the cognitive limitations of their loved ones and learn to communicate within those limits in order to remain emotionally connected with their family member. The patient may be better able to relate to past memories for a time.

Concentrating on activities does not help communication. Support groups may be able to give suggestions but not all patients react the same way.

DIF: Understanding (Comprehension) REF: Page 107 TOP: Communication and Documentation

OBJ: 6-4 MSC: Psychosocial Integrity

11. Adult children of a patient beginning to show early signs of cognitive decline share with the

nurse that they are reluctant to discuss financial issues because the patient “was always private about money matters.” The nurse responds most therapeutically when suggesting: a. “Maybe it would less threatening to your father if a lawyer spoke to him about the matter.” b. “Assure your dad you are only interested in making the financial arrangements he wants.” c. “A social worker can discuss the financial aspects of long-term care with your dad.” d. “This is a conversation that has to occur in order for your father to receive appropriate care.”

ANS: B Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Finances may be the last subject that parents want to talk about with their children, but it is also the most important. Children should convey that they do not want to know how much their parents have or might leave in their will; rather, they want to make sure there is a current and complete plan. A lawyer or social worker can assist in this process, but unless the patient believes the children are acting in his or her best interests, the other professionals will likely encounter resistance as well. Telling the family the conversation has to occur is paternalistic.

DIF: Understanding (Comprehension) REF: Page 101 TOP: Communication and Documentation

OBJ: 6-7 MSC: Psychosocial Integrity

12. The nurse works with older adults to help plan for possible in-home care needs knowing that

what percentage of older adults will need this type of care during their lifetimes? a. 50% b. 60% c. 75% d. 85% ANS: D

About 85% of older adults will need some type of in-home assistance during their lifetimes.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 97 OBJ: 6-1 MSC: Safe Effective Care Environment

13. The nurse working with older adults wonders why fewer of the aging patients seen in the

clinic live with their adult children than in the past. What trend most likely explains this? a. declining birth rate b. mobility of families c. rise of assisted living d. healthier older adults ANS: A

The birth rate has declined from 30.1 in 1910 to 13.8 in 2009. This trend explains why so few adult children are available to help support their aging parents. Mobility is another factor, but it is not as important as the birth rate.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 98 OBJ: 6-1 MSC: Psychosocial Integrity

14. A nurse has worked with an older adult who has mild dementia and the patient’s family to

ensure the financial status of the older person is sound and well managed on a day-to-day basis. The nurse knows planning was successful by assessing that: a. the parent and children are happy with the arrangements. b. the children have the older person’s checkbook themselves. c. one adult child pays all the bills and sends reports each month. d. the children were granted conservatorship and manage the money.

ANS: A

Financial discussions and decisions are often difficult. The best plans result in the finances being handled satisfactorily and all parties are happy with the arrangement. The children may or may not need to keep the checkbook, pay the bills, or have conservatorship.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Evaluating (Evaluation) REF: N/A OBJ: 6-4

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Evaluation

MSC: Psychosocial Integrity

15. The nurse is helping an adult child transition into the role of full-time caregiver for an older

parent with dementia. What action by the nurse is best? a. Ensure the child has information on long-term care. b. Help the child negotiate care issues with siblings. c. Teach the child about the parent’s illness. d. Offer the child information on support groups.

ANS: B

All actions are appropriate and helpful; however, family issues often arise among siblings when there are differences in expectations of assistance. The nurse can best help out in this situation by assisting the caregiver to negotiate roles among the siblings.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 6-7 MSC: Psychosocial Integrity

16. A nurse is mediating a family meeting with an older adult and four grown children. One

daughter, who has three small children of her own, keeps volunteering to do tasks until she has agreed to do about 90% of what is needed for the older adult. What action by the nurse is best? a. Praise the daughter for being so willing to do so much for her father. b. Ask the other children why they are so unwilling to help out. c. Ask the daughter if she can realistically accomplish all these items. d. Tell the daughter that she is unable to do all these things and to delegate.

ANS: C

Caregivers often overestimate their abilities. All caregivers should be asked to honestly reveal their limitations. This daughter may well be overcommitted. Praise is helpful, but it is not the best option. The nurse is mediating and is not there to criticize. Telling the daughter what to do is likely to lead to resentment.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 6-7 MSC: Psychosocial Integrity

17. A nurse is working with a family that is conflicted about care arrangements for an older parent

who continues to live at home in less than safe conditions. What action by the nurse is best? a. Identify and enlist the help of the prime mover b. Tell the family you are calling social services c. Give the family a deadline for making decisions d. Offer to give the family tours of different facilities ANS: A

Families often have a “prime mover,” the person who gets things done. The nurse can enlist this person to move on the decisions needing to be made. Threatening to call social services or giving deadlines will most likely result in entrenchment by the family. Offering to give tours will not help this family make decisions.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 6-7 MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 18. The nurse working in a diverse community would most expect the eldest son from which

community to care for aging parents? a. African Americans b. East Asian c. Native American d. Hispanic ANS: B

Many cultures consider daughters, or oldest daughter, to be responsible for the care of aging parents, but in East Asian cultures, the oldest son assumes this role.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 99 OBJ: 6-1 MSC: Psychosocial Integrity

19. The nurse working with older patients understands what fact about a health care proxy? a. It states that no resuscitation should occur if breathing or heartbeat cease. b. It can specify what treatment measures are or are not acceptable to the patient. c. It explains patient’s wishes regarding treatment if the patient cannot communicate. d. It designates a surrogate health care decision maker if the patient is incapacitated.

ANS: D

The health care proxy designates a surrogate health care decision maker if the patient is incapacitated. A do not resuscitate order prohibits cardiopulmonary resuscitation (CPR) if breathing or heartbeat stops. Specifying what treatment the patient finds unacceptable is part of the living will. Explaining wishes is in the advanced health directive.

DIF: Remembering (Knowledge) REF: Page 101 TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 6-7

20. An adult child of a parent with mild dementia is worried about the parent driving. Where does

the nurse refer the adult child to find out about safe driving courses? a. Senior Driving from AAA b. AARP Driver Safety c. Older Drivers Education d. State Department of Transportation ANS: B

AARP offers safe driving classes for people over 50. Senior driving incorporates videos, pictures, and text presentation. Older Drivers Education offers resources for families of older drivers. Each state’s department of transportation may or may not offer driving classes or resources.

DIF: Understanding (Comprehension) REF: Page 104 TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 6-7

MULTIPLE RESPONSE

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 1. The nurse is about to discuss the possible ways to meet the physical needs of an older adult

patient with the patient’s adult children. The nurse guides the discussion based on which of the following American societal realities? (Select all that apply.) a. Most dependent older adults prefer to live with family members whenever possible. b. Family members are generally the care providers for dependent older adult family members. c. Nursing facilities are generally a family’s last resort for the care of an older dependent adult. d. A family is generally willing to pay for services for the care of their older family member. e. Older dependent adults expect their adult family members to provide for care.

ANS: B, C, D

The reality of American attitudes regarding the aging adult and their needs is that family members provide most of the required care and are willing to pay for services as needed within their ability to pay. Americans view nursing homes as the last option for assuring care for their dependent older family member.

DIF: Remembering (Knowledge) REF: Page 99 TOP: Communication and Documentation

OBJ: 6-7 MSC: Psychosocial Integrity

2. The nurse working with older patients knows that which of the following items are important

to most older adults as they approach the end of life? (Select all that apply.) a. Pain and symptom control b. Having funeral arrangements c. Leaving money to children d. Personal cleanliness e. Being at peace with God ANS: A, B, D, E

The main interests of patients nearing the end of life are pain and symptom control, financial and health decision planning, funeral arrangements, being at peace with God, maintaining dignity and cleanliness, and saying goodbye.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 103 OBJ: 6-3 MSC: Psychosocial Integrity

3. The nurse is assessing a family caregiver for signs of role stress. Which assessment findings

are consistent with this condition? (Select all that apply.) a. Denial b. Anger c. Social withdrawal d. Irritability e. Restfulness ANS: A, B, C, D

Denial, anger, social withdrawal, and irritability are signs of potential caregiver stress.

Restfulness is not a sign.

DIF:

Remembering (Knowledge)

REF: Page 106

OBJ: 6-3

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Assessment

MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 07: Socioeconomic and Environmental Influences Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. Before becoming an effective advocate for the older adult patient, the nurse must: a. be familiar with the physical and mental effects of aging. b. gain insight into the patient’s world by talking with and listening to him or her. c. learn the details of the patient’s medical and social histories. d. be a member of the patient’s formal support system.

ANS: B

By listening to and consulting with older adults, the nurse develops an understanding of the values and perceptions that guide older adults’ thoughts and feelings about life. The nurse forms partnerships with older adults to defend and promote their rights. The other options are nice to know but not required to be an advocate.

DIF: Understanding (Comprehension) REF: Page 121 TOP: Nursing Process: Nursing Assessment MSC: Safe Effective Care Environment

OBJ: 7-5

2. To best respect an older patient’s autonomy when assisting him in finding appropriate,

affordable housing, the nurse: a. provides examples of various options that include assistive services. b. locates housing near a senior citizen community center to minimize social isolation. c. identifies housing close to the services he will need. d. asks the patient to provide examples of where he would like to live.

ANS: D

Whatever the housing status of the older person, it must be remembered that each person has a right to determine where to live unless he or she is proven incompetent. The other options do not help the patient maintain autonomy.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 7-5 MSC: Safe Effective Care Environment

3. A nurse working with older adults recognizes that the patient at greatest risk for homelessness

is the: a. female with a psychiatric diagnosis. b. male with a chronic illness. c. female with a history of social isolation. d. male with an alcohol abuse issue.

ANS: A

Women are increasing in numbers among the homeless older adult communities.

Approximately 30% of homeless older adults have mental illness or dementia.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 131 OBJ: 7-1 MSC: Safe Effective Care Environment

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. A nurse volunteers at a facility that provides free lunches for older adults. To minimize the

tendency of these patients to withdraw socially, the nurse: a. frequently reinforces that everyone is welcome to have lunch with the group. b. makes every effort to engage them in conversation during the meal. c. encourages them to make friends with the other patients. d. asks if they would assist those who need help with getting their food.

ANS: D

Older adults tend to feel an obligation to return favors. If someone does something for them, such as helping them to get their food, they want to be able to reciprocate. If they are financially unable to do this, they might withdraw so as not to be put in an embarrassing position.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 7-3 MSC: Psychosocial Integrity

5. When the traditional roles are blurred as an older married couple begins to experience

personal disease and disability, there will most likely be: a. a rapid decline in their mental health as well. b. a loss of self-esteem and satisfaction with life. c. increased martial stress and discord. d. increased social isolation.

ANS: B

When the older adult loses his or her traditional role, self-esteem and satisfaction with life may be affected. The other events may happen, but a frequent outcome is loss of self-esteem and life satisfaction.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 127 OBJ: 7-1 MSC: Psychosocial Integrity

6. A 69-year-old patient who has both Medicare and long-term supplemental health care

insurance shares with the nurse that he is in need of a visual examination as a follow-up after his cataract surgery. The nurse suggests that such treatment is most likely covered by: a. Medicare Part A. b. Medicare Part B. c. Medicare Part D. d. Supplemental policy.

ANS: B

A vision examination is a service covered by Medicare Part B. DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 126 OBJ: 7-4 MSC: Safe Effective Care Environment

7. The nurse recognizes that health and wellness are better among the educated older adult

population because they tend to: a. place a high value on health and wellness. b. frequently take advantage of health screening options. c. have occupations that are less physically demanding. d. manage emotional stress in a more productive manner.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B

More-educated people often have greater access to wellness programs and preventive health options because they tend to have more financial resources and health insurance coverage.

Education may lead to an increased value on health and wellness. Occupations may or may not be physically demanding. Educated older adults may not manage stress more productively.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 124 OBJ: 7-1 MSC: Health Promotion

8. Which patient is most likely to be seen at a clinic that services older adults who are at or

below the poverty level? a. A Hispanic male living with extended family b. An African American male living with a spouse c. A Hispanic female who lives alone d. An African American female who lives with her sister ANS: C

The highest rates of poverty are among Hispanic women over the age of 65 who live alone.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 123 OBJ: 7-3 MSC: Health Promotion

9. The nurse is addressing a senior citizens group that is composed of members who are 75 years

of age and older. The nurse expects that the group will be primarily: a. widows who have never worked outside of their homes. b. widowers with at least one chronic illness. c. females who have part-time jobs. d. males with pensions plus Social Security income.

ANS: A

After age 75, women outnumber men in American society. Most women in this age group did not work outside the home, so their incomes depend on their spouses’ pensions or Social Security benefits.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 123 OBJ: 7-1 MSC: Health Promotion

10. A patient who grew up during the 1930s in an urban community has been prescribed several

medications for a variety of chronic health issues. To help ensure medication compliance based on knowledge of this age cohort, the nurse: a. provides a detailed explanation about the importance of taking the medications appropriately. b. educates the patient about the cost-effectiveness of generic brands of the prescribed medications. c. includes family members with the patient in the medication education plan. d. offers suggestions on ways to minimize the risk of “forgetting” to take medication correctly.

ANS: B

Persons of this cohort (raised during the American depression of the 1930s) are generally frugal and often do not spend money, even if they have it. Suggesting a cost-effective way to Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

purchase the medications will particularly appeal to this patient.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) REF: Page 121 OBJ: 7-2 TOP: Teaching-Learning MSC: Health Promotion 11. The nurse who works with veterans from the 1940s and 1950s knows that individuals in this

cohort are more likely than older adults to: a. obtain preventative health services b. hoard money for times of need c. work hard to keep families intact d. be noncompliant with medications ANS: A

Women and men who served in the armed forces during this time became accustomed to preventive medical and dental care. Those influenced by the Great Depression are more likely to hoard money. Families started becoming more mobile. This cohort is not as likely to be noncompliant because of cohort influences.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 122 OBJ: 7-2 MSC: Health Promotion

12. An older patient appears to have few friends and little family. What action by the nurse is

best? a. Encourage the patient to stay in contact with remaining family members. b. Help the patient find new social outlets and support systems. c. Assess the patient for depression or substance abuse. d. Ask the patient why there are so few friends and family.

ANS: B

Social networks are invaluable to help mitigate the effects of major life events on health. The nurse can encourage the patient to join groups or organizations in order to make new friends.

Staying in touch with family may or may not be desired. The patient may need assessment for substance abuse, but this is not the best action. Asking “why” questions often puts people on the defensive, and this technique is not considered a therapeutic communication tool.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 7-5 MSC: Psychosocial Integrity

13. An adult child of an older adult confides in the nurse that the patient has lost most of her

friends because of her negative behavior. What action by the nurse is best? a. Ask when the patient had her last physical exam. b. Encourage the patient to be more positive. c. Ask if the patient is aware of the problem. d. Suggest the patient take antidepressants.

ANS: A

Depressed or negative older adults have trouble maintaining relationships. If this is a change in status, the nurse should determine if the patient needs a checkup to look for underlying illness. The other answers do not provide action that could possibly alleviate the situation.

Giving the patient medications without a full workup is dangerous.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 7-5 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 14. A patient is not competent to manage financial affairs. What legal recourse does the older

person have? a. Guardian b. Conservator c. Health care proxy d. Social worker ANS: B

A conservator is appointed by the courts to handle a patient’s monetary affairs. A guardian helps with nonmonetary issues. Health care proxy and social workers do not manage financial affairs.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 128 OBJ: 7-6 MSC: Safe Effective Care Environment

15. An older couple is considering moving into a retirement community. What reaction by the

nurse is best? a. “That’s a good idea to consider at your age.” b. “Check on what levels of care they provide.” c. “Do you have enough money to afford this?” d. “What does your family think of this idea?”

ANS: B

Retirement communities have differing levels of care; some are only for independent seniors, whereas others offer an array of arrangements. This is the most important factor for the couple to consider, because they may face having to move to a chosen community as their needs change.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 7-8 MSC: Psychosocial Integrity

16. An older adult is planning to move to an assisted living facility. What advice does the nurse

provide to the adult children? a. “Let your father choose what items to take with him.” b. “Warn your dad there will be little room for personal things.” c. “It is best to pick your dad up one day and move him in.” d. “Be aware your dad may suffer from depression or confusion.”

ANS: A

Individuals who move can suffer from relocation stress, which is a negative consequence of moving. If the patient has input into the facility chosen, can take tours, and can bring cherished personal items with him or her, the chances of relocation stress lessen. Although there might be limited room, it is more important for the family to let the patient take wanted items. Moving precipitously can increase the chance of relocation stress. The family should be warned about the negative reactions to moving that are possible, but this does not give them the ability to lessen the impact.

DIF: Application (Applying) TOP: Teaching-Learning

REF: N/A OBJ: 7-5 MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 17. An adult daughter brings a patient to the gerontology clinic and reports that the patient has

become increasingly withdrawn and no longer goes out during the day. What response by the nurse is best? a. Administer a mini mental state exam. b. Ask the patient why this is happening. c. Assess if the patient feels safe at home. d. Determine if abuse is occurring.

ANS: C

Patients often withdraw and become isolated when they do not feel safe in their surroundings.

The nurse should first assess the patient’s perception of safety. The other options may or may not be necessary, but “why” questions should be avoided, as they generally place people on the defensive.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 7-7 MSC: Psychosocial Integrity

18. An older woman lives alone. What action by the nurse is best to keep the patient from

becoming a victim of crime? a. Encourage the patient to take self-defense classes. b. Tell the patient that it is okay to hang up or not answer the door. c. Have the patient install a monitored security system. d. Ask if there is a neighbor who can check up on her.

ANS: B

Older people who are lonely may welcome “visits” from unscrupulous visitors. They are also less likely to hang up the phone or close the door to avoid appearing impolite. The nurse can best help this patient by telling her such behavior is not only all right, it is important for her safety. The other actions are also possible but can be costly, and the patient may not have a reliable neighbor.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 7-7 MSC: Safe Effective Care Environment

19. The nurse is presenting an educational workshop at a senior center where most of the patients

will be 75 years or older. What does the nurse consider about this population when designing the presentation? a. Most of these patients only have a high school diploma. b. Many patients will be illiterate so handouts should be simple. c. A great number of patients never attained a high school. d. A lot of these patients went to college on the GI bill.

ANS: A

Educational attainment differs with age cohorts. In this age group, the highest number of persons attained a high school diploma.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 121 OBJ: 7-2 MSC: Health Promotion

MULTIPLE RESPONSE Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 1. When preparing an educational program focused on chronic illnesses that at least a third of the

older adult population is likely to experience, the nurse includes information on which of the following? (Select all that apply.) a. The benefit of aquatic exercise b. Signs and symptoms of cataracts c. Ways to control sodium intake d. Latest technologic interventions for hearing loss e. The effects of exercise on cardiovascular health ANS: A, C, E

The most common chronic problems in 2002 were heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), Alzheimer disease, and diabetes. These exercise programs can have a positive influence on these common conditions. Cataracts and hearing loss are not included.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 125 OBJ: 7-1 MSC: Health Promotion

2. The nurse is educating an 80-year-old patient regarding a newly prescribed medication. The

nurse’s teaching strategies include which of the following? (Select all that apply.) a. Using pictures to show how the medication should be stored b. Asking the patient to use his own words to describe the medication’s possible side effects c. Avoiding written instruction in favor of verbal, face-to-face communication d. Delivering the information using a slow, deliberate manner of speech e. Repeating the information at least three times during the conversation ANS: A, B, E

Strategies such as repetition, patient restating, and varied delivery methods such as pictures, written, audio, and oral discussion are all appropriate and recommended for the older adult learner.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 124 OBJ: 7-1 MSC: Health Promotion

3. The nurse who volunteers at a community center for older people refers which people to the

Supplemental Security Income office? (Select all that apply.) a. Disabled persons b. Those who are visually impaired c. Deaf persons d. Those with minimal income e. Those who are cognitively impaired ANS: A, B, D

Individuals who are eligible for SSI include those who are very old, disabled, visually impaired, and have minimal income or assets. Being deaf or cognitively impaired are not criteria.

DIF: Remembering (Knowledge) REF: Page 122 TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 7-3

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. The nurse hears a news report about an older woman having her purse stolen. The assailant

said, “Give me your purse, old lady, or I’ll kill you.” What crimes have been committed?

(Select all that apply.) a. Assault b. Battery c. Larceny d. Robbery e. Burglary ANS: A, D

Assault is the threat of harm. Robbery is taking property by force or threat of force. Battery is actually physically harming the victim. Larceny is a noncontact crime resulting in loss of property. Burglary is the taking of property while being in the victim’s residence, place of business, or automobile without authorization.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 132 OBJ: 7-7 MSC: Safe Effective Care Environment

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 08: Health Promotion and Illness/Disability Prevention Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. When the home health nurse assists the older adult patient with rearranging furniture within

the home to prevent the patient from falling, the nurse is demonstrating: a. health promotion. b. health protection. c. health prevention. d. disease prevention.

ANS: B

The overarching goals are to attain high-quality, long lives free of preventable disease, disability, and injury; to eliminate disparities; create social and physical environments that promote health; and optimize quality of life across the life span. Health protection targets five areas including unintentional injury. Rearranging furniture to prevent falls is a health protection activity.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 8-1 MSC: Safe Effective Care Environment

2. The primary focus of the health belief model of health promotion is addressed when the nurse: a. accompanies the assisted living residents on a walk before dinner. b. asks a senior citizens’ group what health screening they want to have. c. plans a program on cooking diabetic-friendly meals in cooperation with a dietician. d. asks the patient if he believes smoking puts him at risk for lung cancer.

ANS: D

The health belief model, which was developed to determine the likelihood of an individual’s participation in health promotion, health protection, and disease prevention services, includes assessing an individual’s perception of his or her susceptibility to developing an illness.

Asking the patient about beliefs related to tobacco use and health is an activity that falls within this model. The other activities do not.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 141 OBJ: 8-2 MSC: Health Promotion

3. Financial considerations are a major barrier to the older adult’s participation in health

promotion because: a. most older adults have accepted poor health as a part of growing older. b. Medicare often does not cover the cost of preventive services. c. many already have been diagnosed with chronic illnesses. d. they generally place more value on saving their disposable income.

ANS: B

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Older adults must incur the cost of many preventive services because Medicare does not cover them all. This can be hard on the fixed, limited income of many older adults. It is not true that older adults accept poor health as inevitable. Health promotion activities can occur in the presence of chronic illnesses. Some older adults do place high value on saving money, but not all older adults are influenced by this desire.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 148 OBJ: 8-4 MSC: Health Promotion

4. To engage the older adults who frequently attend a senior citizens’ center in primary disease

prevention, the nurse: a. immunizes those attending a weekly luncheon against the H1N1 virus. b. arranges for a colorectal cancer screening at the center. c. schedules a speaker to discuss cooking for diabetic patients. d. surveys the members to identify health issues of interest to them.

ANS: A

Primary prevention refers to specific action taken to optimize the health of the older individual by helping him or her to become more resistant to disease or to ensure that the environment will be less harmful. Providing immunizations would be included in this level of prevention. Colorectal cancer screening is secondary prevention. Cooking for diabetic patients is tertiary prevention. Surveying patients does not fall into any level of prevention.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 8-5 MSC: Health Promotion

5. The nurse has the greatest impact on a patient’s health promotion when: a. evaluating a diabetic patient’s ability to administer his insulin injections. b. encouraging an obese patient to limit both fat and carbohydrate intake. c. volunteering to take blood pressures at a community health fair. d. educating the patient about vitamin D and calcium to prevent bone loss.

ANS: D

Health promotion includes interventions that help prevent disease and disability in a patient.

Education regarding health promotion issues has the greatest impact on the health of a patient.

The other patients already have established diseases.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 8-1 MSC: Health Promotion

6. A nurse is assessing a patient’s ability to manage existing health problems. What question by

the nurse is most helpful? a. “Can you tell me why it’s important to test your blood glucose level at least daily?” b. “What were the results of your most recent A1C blood test?” c. “Which pharmacy do you use when your prescription needs to be refilled?” d. “Have you been experiencing pain in your feet?”

ANS: B

The results of a laboratory test used to monitor glucose control will show how well the patient has been managing the various aspects of his or her treatment plan. This information is collected in the health perception/health management functional health pattern. The other Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

questions do not demonstrate the patient’s knowledge level.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 8-5 TOP: Nursing Process: Assessment MSC: Health Promotion 7. During a home visit, a nurse is assessing the nutritional awareness of an older adult patient

who lives alone. The nurse is most effective in obtaining objective information when: a. asking to see what types of foods the patient keeps readily available. b. reviewing the components of a healthy diet with the patient. c. asking the patient to describe what he or she ate for all three meals yesterday. d. observing the patient eat a meal that he or she has prepared.

ANS: D

Objective information is best obtained when observing general appearance and various body system indicators of nutritional status. Note height, weight, and fit of clothes. If possible, observe the older adult eating a meal. Food available in the home does not indicate the patient’s knowledge, as someone else may have bought the food. Asking the patient for information is requesting subjective data. Reviewing a healthy diet does not allow the patient to demonstrate knowledge.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 8-5 MSC: Physiologic Integrity

8. The nurse is discussing an older adult’s past marital history during the admission assessment.

The nurse can best determine that the patient has a healthy ability to cope with emotional stressors when the patient states: a. “After my husband died, I managed to raise and educate our two children by myself.” b. “Since my husband’s death, I’ve grown even closer to my sisters.” c. “It’s been hard since my husband died, but you manage to go on somehow.” d. “After my husband died, I married a good man who was there for me and my children.”

ANS: A

This pattern encompasses the patient’s reserve and capacity to resist challenges to selfintegrity and his or her ability to manage difficult situations. The ability to view herself as a success in fulfilling her responsibilities as a mother is evidence of healthy stress coping skills.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 8-5 MSC: Psychosocial Integrity

9. An older adult patient has recently experienced some difficulty sustaining an erection as a

result of medication he has been prescribed. The nurse best assesses the patient’s perception of his own sexuality by asking: a. “How are you and your wife coping with your sexual dysfunction?” b. “What problems has your sexual dysfunction caused between you and your wife?” c. “What impact has this dysfunction had on your ability to be intimate with your wife?” d. “Are you and your wife prepared to deal with this dysfunction over the long term?”

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Asking about the impact of the dysfunction directly assesses the patient’s satisfaction or dissatisfaction with current circumstances related to sexual function and intimacy, thus providing the best evaluation of his self-perception of the issue.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 8-5 MSC: Psychosocial Integrity

10. The nurse admitting an 89-year-old patient to an assisted living facility notes that the patient is

currently taking numerous prescribed and over-the-counter medications. The nurse’s initial intervention is to: a. confirm with the physician that all the medications are required. b. evaluate the patient’s understanding of why he is taking each medication. c. explain to the patient the dangers of taking so many different medications. d. review the listed medications for possible interactions.

ANS: D

The first nursing action is to determine if the patient’s health is at risk from possible drug interactions. The other actions might be warranted, but patient safety comes first.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 143 OBJ: 8-6 MSC: Physiologic Integrity

11. When assessing the older adult for bowel health, the nurse is most effective in obtaining

subjective data when asking: a. “Would you describe your bowel movements as usually normal?” b. “Do you have a problem with constipation?” c. “How often do you usually have a bowel movement?” d. “Have your bowel movements changed recently?”

ANS: C

Subjective data can be obtained through the health history. Asking the patient to identify how often the bowels move would establish the fundamental baseline of the patient’s elimination patterns. “Normal” is a vague term that should not be used. Asking if there are problems with constipation or if bowel habits have changed are yes/no questions, which are generally avoided.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 8-5 MSC: Physiologic Integrity

12. Using social cognitive theory, which action by the nurse will have the most impact on older

adults’ participation in health promotion behaviors? a. Creating a walking club in the community b. Offering private nutritional counseling c. Providing meals at the senior center d. Handing out educational materials ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

According to this theory, self-efficacy and outcome expectations are influenced by successful performance of the behavior, verbal encouragement, seeing similar people do the behavior, decreasing unpleasant aspects of the behavior, caring approaches to facilitate the behavior, and education about benefits. A local walking club with other seniors fulfills many of these criteria. Private nutritional counseling does not allow the participant to see others engaged in this activity. Meals may or may not be healthy or palatable. Educational materials on their own may not have great benefit.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 8-2 MSC: Health Promotion

13. The nurse wishes to participate in a community secondary prevention activity. Which activity

does the nurse choose? a. Administering blood pressure screening at a mall b. Dispensing free flu vaccinations at a clinic c. Fitting impoverished older adults with glasses d. Teaching about the risks of sun exposure ANS: A

Secondary prevention is screening and early diagnosis. It aims to find people with clinical conditions that have not yet become apparent to them. Blood pressure screening would fit this description. Flu vaccinations and teaching about sun exposure are examples of primary prevention. Fitting older adults with glasses is a tertiary prevention.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 8-5 MSC: Health Promotion

14. A patient who is homeless has not followed through with getting an influenza vaccination.

What response by the nurse to a student is most appropriate? a. “It’s hard to be proactive when you are hungry.” b. “If the patient would just come in, we have the shot.” c. “These patients never follow through on directions. d. “Too bad we can’t take the shot to him where he is.”

ANS: A

Competing priorities often cause patients to seem uninterested or “noncompliant” with health recommendations. According to Maslow, basic needs such as food, water, shelter, and safety take priority over other matters. Perhaps it is a good idea to take shots into the community, but that is not the best response by the nurse, as it does not help the student understand the situation. The other two statements are biased and show disregard for the patient’s circumstances.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 8-4 MSC: Health Promotion

15. The nurse is seeing a 68-year old woman for a physical exam in the family practice clinic. The

woman complains about having another pelvic exam. What response by the nurse is best? a. “I know it’s uncomfortable, but it’s important to do it.” b. “You are past the age where this exam is recommended.” c. “Why don’t you want to have your pelvic exam?” d. “This will be the last time you need this exam.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B

According to the U.S. Preventative Task Force, pelvic exams and pap smears can be discontinued after age 65 if prior testing was normal and the patient is not at high risk for cervical cancer. The other statements are incorrect.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 143 OBJ: 8-5 MSC: Health Promotion

16. A male patient complains about the digital rectal prostate exam and blood work for prostate-

specific antigen (PSA) and asks, “How long am I expected to do this?” What response by the nurse is best? a. “Every year for the rest of your life.” b. “Until you turn 75 years of age.” c. “You can quit when you turn 80.” d. “There are no guidelines on this.”

ANS: B

According to the U.S. Preventative Task Force, there is no evidence that continuing routine PSA screening past the age of 75 has any benefit, so the patient can forgo the blood test after he turns 75.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 143 OBJ: 8-5 MSC: Health Promotion

17. A nurse routinely assesses patients for alcohol use. What principle guides this assessment? a. The older adult must balance risks to benefits of use. b. Alcohol causes older adults to fall and should not be consumed. c. There are no data on risks or benefits after the age of 75. d. Alcohol-related diseases are more severe in older people.

ANS: A

There are both benefits and risks to drinking alcohol. The nurse must help the older patient determine which predominates when assessing and possibly counseling patients on their alcohol use.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 8-6 MSC: Safe Effective Care Environment

18. An 80-year-old woman has found a lump in her breast and is in the clinic. What question by

the nurse is most appropriate? a. How long have you had this lump? b. If it’s cancer, are you willing to treat it? c. Do you have cancer in your family? d. Are you having any pain right now?

ANS: B

All questions are appropriate; however, for a woman this age, further testing is not recommended unless the patient is willing to go through with treatment for cancer. Tumors in older women tend to be slow growing and quality of life is a bigger priority.

DIF:

Applying (Application)

REF: N/A

OBJ: 8-6

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Assessment

MSC: Physiologic Integrity

19. A nurse wishes to volunteer in a tertiary health care activity. What activity would the nurse

choose? a. Teaching about safer sexual behaviors b. Greeting women at an emergency pregnancy clinic c. Assisting women who are having radiation therapy d. Finding home health safety resources ANS: C

Tertiary prevention aims to care for established disease. Helping women having radiation therapy for cancer would fall into this realm. Teaching is primary prevention. The emergency pregnancy clinic is secondary prevention. Home safety is primary prevention.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 8-5 MSC: Health Promotion

20. A nurse is working with a woman who has been reluctant to start a walking program for her

osteoporosis. What assessment by the nurse is most important? a. Fear of falling b. Lack of time c. Lack of energy d. Pain with movement ANS: A

Fear of falling is a common fear in older adults and has special significance to those with osteoporosis. The nurse should first assess for this factor. All other factors can be possible contributors, but people usually attend to safety first.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 8-4 MSC: Psychosocial Integrity

MULTIPLE RESPONSE 1. A nurse planning primary disease prevention interventions for a 64-year-old patient includes

which of the following? (Select all that apply.) a. Giving an influenza vaccination in early autumn of each year. b. Suggesting the patient attend “Cooking to Manage Hypertension” classes taught by a registered dietician. c. Giving a pneumococcal vaccination to celebrate the patient’s 65th birthday. d. Identifying several local smoking cessation support groups. e. Providing the patient with a take-home occult stool screening kit.

ANS: A, C, D

Primary prevention refers to specific action taken to optimize the health of the older individual by helping him or her become more resistant to disease or to ensure that the environment will be less harmful.

DIF: Application (Apply) REF: N/A MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 2. A patient has not followed up with recommendations made by the nurse to participate in

cardiac rehabilitation after a myocardial infarction. What factors are most important for the nurse to assess in determining the cause of this behavior? (Select all that apply.) a. Out-of-pocket costs b. Transportation problems c. Beliefs about the benefits d. Location of the clinic e. Ethnicity of providers ANS: A, B, C, D

Many factors affect the ability and willingness of patients to engage in health promotion behaviors, including cost, transportation, beliefs, and location of the services. Ethnicity of the providers may be a consideration for some, but that is not a high priority for assessment in most patients.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 8-2 MSC: Health Promotion

3. The student learns the Medicare guidelines for preventive health and reimbursement policies.

Which statement follows the guidelines? (Select all that apply.) a. Medicare pays for an annual pneumococcal vaccination. b. Medicare covers annual influenza vaccinations. c. Pap smears and pelvic exams are covered once every 2 years. d. Annual fecal occult blood tests are covered for those who are from 50 to 85 years of age. e. A bone density scan is covered every 2 years (a co-payment is required).

ANS: B, D, E

Medicare guidelines provide reimbursement for pneumococcal vaccination once and every 5 years as recommended, an annual flu vaccination, pap smears and pelvic exams every 3 years, an annual fecal occult blood test for those who are from 50 to 85 years of age, and a bone density scan every 2 years (however, a co-payment is required) DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 142 OBJ: 8-6 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 09: Health Care Delivery Settings and Older Adults Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. What action by the nurse is most important for preventing hospital-acquired infections in the

older population? a. Appropriate hand hygiene b. Rapid isolation for infection c. Strict sterile procedures d. Ensuring patient nutrition ANS: A

Hand hygiene is the most effective infection control action the nursing staff can take.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 9-3 MSC: Safe Effective Care Environment

2. The nurse on a medical acute care unit is preparing for the admission of an 84-year-old patient

with several diagnosed chronic illnesses. The nurse begins the plan of care for this patient based on the understanding that the older adult is likely to: a. develop hospital-induced delirium. b. require special attention related to sensory deficits. c. need a social services consult before discharge. d. present with a need for a high level of nursing care.

ANS: D

The older adult is not likely to be admitted to the hospital until a high level of acuity or complications exists. The other options may be possible, but the majority of older patients are admitted at a high level of acuity.

DIF: Remembering (Understanding) TOP: Teaching-Learning

REF: Page 154 OBJ: 9-1 MSC: Physiologic Integrity

3. The nurse is planning the discharge of a 70-year-old patient who lives alone and is recovering

from a fractured ankle. What action by the nurse shows an understanding of factors affecting the patient’s ultimate return to preinjury function? a. Encourages the patient to comply with recommendations made by the physical therapist b. Arranges for the patient’s meals to be delivered daily for several weeks after discharge c. Assesses the barriers to self-ambulation that exist in the patient’s home d. Educates the patient on the importance of a diet that promotes both bone and muscle healing ANS: C

In the hospital setting, health care professionals can become so involved in addressing the acute condition that they fail to appreciate the underlying problems and how these too influence the patient’s health and recovery. Assessing for ambulation barriers in the patient’s home has a long-term effect on the patient’s ability to regain independence.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) REF: Page 154 OBJ: 9-1 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 4. The nurse in an acute care facility is caring for a patient recovering from a cerebral vascular

accident that has resulted in a mild loss of muscle function in his right arm and leg. The nurse is best addressing the patient’s need via the functional model of care when: a. assessing the patient’s right-sided muscle strength daily. b. reaffirming to the patient that physical therapy will improve his muscle strength. c. instructing the patient’s family on how to properly assist the patient in walking. d. placing the telephone where the patient can reach it with his left hand.

ANS: D

The functional model’s main goal may not be curing the disease but managing the disease, with a focus on self-care and symptom management strategies. Placing the telephone where the patient can reach it for himself is an example of a symptom management strategy. The other actions do not increase the patient’s functional abilities.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 9-2 MSC: Physiologic Integrity

5. The nurse is caring for an older adult patient who was admitted with a stage 3 pressure ulcer

on the left heel and who also has a history of Parkinson disease and chronic renal failure. To minimize the patient’s risk of developing an iatrogenic illness, the nurse: a. uses sterile technique when changing the heel’s dressings. b. reviews all the patient’s medications for possible adverse reactions. c. instructs the patient to call for assistance when needing to go to the bathroom. d. assists the patient in choosing the appropriate foods from the daily menu.

ANS: B

Adverse drug reactions frequently precipitate hospitalizations and, although often unreported, are among the most common iatrogenic events in the acute care setting. The hospital staff needs to get an accurate drug history of a patient, be aware of pharmacokinetic and pharmacodynamic changes related to aging, and have a working understanding of drugdisease, drug-drug, and drug-food interactions in older adults. Nurses should be particularly aware of drugs that may be high risk when used in older adults. The other actions are important for patient safety, but the more frequent cause of iatrogenic problems is related to medication use.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 154 OBJ: 9-3 MSC: Safe Effective Care Environment

6. The nurse best addresses the possible intrinsic factors that contribute to falls experienced by

older adult patients in an acute care setting by: a. encouraging patients to wear their glasses. b. keeping a low-level light on in the room at night. c. keeping the patient’s bed low to the floor. d. assessing the room for clutter on the floor.

ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Risk factors for hospital falls include both intrinsic and extrinsic factors. Intrinsic factors include age-related physiologic changes and diseases, as well as medications that affect cognition and balance. The other actions are important safety measures that are helpful to some patients as well, but good vision is critical for safety.

DIF: Understanding (Comprehension) TOP: Nursing Process: Implementation

REF: Page 154 OBJ: 9-6 MSC: Safe Effective Care Environment

7. The nurse caring for an older patient is concerned when the patient begins experiencing mild

confusion. The nurse notes that the vital signs are all within normal limits for this patient. To best assess related symptoms, the nurse initially: a. asks the patient to “Squeeze my hand as hard as you can.” b. reviews documentation about how the patient has been eating. c. reviews the patient’s medication for possible adverse reactions. d. asks the patient’s daughter if her mother has been confused before.

ANS: B

Anorexia is a symptom of urinary tract infection, which occurs frequently in older adults.

Subclinical infection and inflammation can occur with presenting symptoms such as acute confusion, functional capacity deterioration, anorexia, or nausea rather than the classic symptoms of fever and dysuria. Although all actions are appropriate, the nurse suspecting a urinary tract infection (UTI) will assess eating patterns.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 9-3 MSC: Physiologic Integrity

8. The nurse is caring for a confused patient. Which action by the nurse shows the best

understanding of managing the cascading effects of iatrogenic illnesses in this population cohort? a. Reorienting the patient to person, place, and time frequently b. Offering the patient liquids each time there is patient-nurse contact c. Repositioning the patient every 2 hours d. Using restraints to ensure patient safety only as a last resort ANS: D

Once older adults are hospitalized, immobilization through enforced bed rest or restraint often results in functional disability, and the subsequent occurrence of iatrogenic illnesses often represents a vicious circle, referred to as the cascade effect, in which one problem increases the person’s vulnerability to another one. Gerontologic nurses must be leaders in advocating more appropriate care and treatment of hospitalized older adults to prevent or at least reduce the occurrence of iatrogenic illness. The other actions are good nursing care but do not relate to the cascade effect.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 9-3 MSC: Physiologic Integrity

9. An 80-year-old patient with visual and hearing deficits is admitted for hip replacement

surgery. The patient has begun to show mild confusion and has become resistant to care and treatment. To minimize this problem, the nurse initially edits the patient’s care plan to include: a. frequent reorientation to people in the patient’s environment. b. putting on the patient’s glasses and hearing aid as a part of activities of daily living Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

(ADLs). c. assigning the same staff to provide patient care whenever possible. d. minimizing the number of off-unit trips for the patient.

ANS: B

Older adults have a decreased ability to negotiate within and adapt to an unfamiliar environment, which can be initially minimized by the use of hearing aids and eyeglasses, for example. The other actions may be appropriate, but until the sensory deficit is corrected, the patient will most likely remain confused.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 9-3 MSC: Physiologic Integrity

10. What action by the nurse best shows an understanding of the effects of acute hospitalization

on the functional abilities of the older patient? a. Setting goals that support a short hospitalization. b. Attempting to adapt nursing care to individual needs c. Administering a systematic functional assessment d. Assessing for a decline from original baseline function ANS: D

The nurse should assess for new onset signs or symptoms of a decline from baseline function and then implement appropriate interventions before they trigger a downward spiral of dependency and permanent impairment.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 156 OBJ: 9-3 MSC: Physiologic Integrity

11. Which statement by a resident best indicates that the resident’s psychosocial needs are being

met? a. “I’m really enjoying the opportunity to select my own mealtimes.” b. “I miss being at home, but I understand why I must live here.” c. “I appreciate being placed on the waiting list for a private room because I prefer living alone.” d. “I’m an independent person who has always made my own decisions, and I will for as long as I can.”

ANS: A

Psychosocial needs are best met when a patient is encouraged to be independent both physically and mentally. Making choices is a good example psychosocial needs being prioritized.

DIF: Understanding (Comprehension) TOP: Nursing Process: Evaluation

REF: Page 169 OBJ: 9-4 MSC: Psychosocial Integrity

12. A 70-year-old patient covered by Medicare is being admitted for stabilization of type 2

diabetes. When asked by the family why their parent’s care is being co-managed by a geriatric nurse practitioner and a physician, the best explanation is that: a. the geriatric nurse practitioner is specially trained to work with older patients. b. research has shown that this care model often results in shorter hospital stays. c. the physician and nurse practitioner will focus on different needs.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. Medicare encourages this team concept of patient care.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B

Some studies demonstrate a significant decrease in the length of stay when patients are comanaged by a nurse practitioner and an attending physician.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 177 OBJ: 9-4 MSC: Safe Effective Care Environment

13. The nurse is going to educate an older patient newly diagnosed with type 2 diabetes on how to

test serum glucose levels appropriately. The nurse shows an understanding of the adaptation of teaching techniques for this age group by: a. providing both written and verbal instructions on the skill. b. asking the patient if he has any hearing or vision deficits. c. restating the important points several times. d. asking the patient to describe the proper technique in his own words.

ANS: B

This population often experiences sensory deficits that can affect their learning capacity. The other actions are also appropriate, but if the patient has sensory deficits, they must be addressed before teaching begins.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 169 OBJ: 9-7 MSC: Physiologic Integrity

14. The nurse at an assisted living facility is caring for a 73-year-old cognitively impaired patient

who has recently been admitted. The nurse creates a care plan that strives to help maintain the patient’s independence by including: a. sufficient time for the patient to complete self-care. b. encouraging the patient to make decisions regarding self-care. c. regular assessment of the patient’s ability to provide self-care. d. regular cueing by staff to direct patient self-care.

ANS: D

Cognitively impaired individuals often need supervision and cueing rather than physical assistance to perform ADLs and instrumental activities of daily living (IADLs).

DIF: Understanding (Comprehension) REF: Page 158 TOP: Communication and Documentation

OBJ: 9-4 MSC: Health Promotion

15. An older patient has fallen twice in the hospital in the last 2 days. What action by the nurse is

best? a. Request restraint orders from the provider. b. Assess the patient for undiagnosed illness. c. Remind the patient to call for help getting up. d. Have a family member stay with the patient.

ANS: B

Falls are commonly associated with a new onset of illness in the older patient. The nurse assesses for this possibility. Restraints are a last resort. The patient may be too confused or forgetful to remember to call for help, plus this places the responsibility for safety on the patient. Family members may not be present or able to stay with the patient continuously.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 9-6 MSC: Physiologic Integrity

16. A nurse is caring for an older patient in the intensive care unit. The patient has a sudden onset

of confusion. What action by the nurse is best? a. Request a sedative from the provider. b. Attempt to reorient the patient. c. Perform a sepsis screening. d. Review lab work for today.

ANS: C

The most common presenting sign of sepsis in the older adult is confusion. The nurse assesses the patient for this condition. Sedatives and restraints are a last resort. The nurse should attempt to reorient the patient, but this is not the most important action. The nurse should also review lab work, but current assessments are more important.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 9-5 MSC: Physiologic Integrity

17. Which individual would the nurse refer to the local Area Agency on Aging? a. One who needs housekeeping services b. One who needs help with preparing taxes c. One who needs nutritious meals d. One who needs long-term care placement ANS: C

The AAA provides resources for community members on information and referral for medical and legal advice; psychologic counseling; preretirement and postretirement planning; programs to prevent abuse, neglect, and exploitation; programs to enrich life through educational and social activities; health screening and wellness promotion services; and nutrition services. The patient needing nutritious meals would most benefit from this agency.

DIF: Understanding (Comprehension) REF: Page 160 TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 9-4

18. The nursing faculty explains to students the definition of “homebound.” Which is the best

explanation of this situation? a. A person uses a wheelchair for all mobility. b. A person desires services provided at home. c. Leaving home requires great effort. d. No local agency is available to provide service.

ANS: C

Homebound implies that a person could leave the home for a legitimate medical reason, but he or she must exert a great deal of effort to do so. Being in a wheelchair does not in itself cause a person to be homebound, nor does requesting home services or not having another agency to provide services elsewhere.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 162 OBJ: 9-9 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 19. A patient is on hospice care. Which situation would result in an acute hospitalization? a. Progression of disease b. Intractable pain c. New pressure ulcer d. Bladder infection ANS: B

Inpatient care is available when the patient experiences acute or severe pain or symptom management problems. The other conditions are managed without acute hospitalization.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 167 OBJ: 9-12 MSC: Physiologic Integrity

20. Which action does the nurse delegate to the unlicensed assistive personnel (UAP) pertaining

to pressure ulcer prevention? a. Assessing the patient’s skin daily b. Keeping the patient’s skin clean and dry c. Obtaining a special overlay mattress d. Monitoring the patient’s nutritional status ANS: B

The nurse can delegate keeping a patient’s skin clean and dry to the UAP. The other actions are within the nurse’s scope of practice.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 9-17

MULTIPLE RESPONSE 1. A nurse is caring for a confused and frail patient. Which interventions will best minimize the

patient’s risk of injury related to the geriatric triad? (Select all that apply.) a. Respond to the patient’s call bell promptly. b. Ensure the bed alarm is on at all times. c. Remain with the patient when eating. d. Assess elimination needs every 2 hours while the patient is awake. e. Offer the patient fluids during each visit.

ANS: A, B, D

The geriatric triad includes falls, changes in cognitive status, and incontinence. Responding promptly to call lights, assessing for elimination needs, and having bed alarms limits falling.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 9-6 MSC: Safe Effective Care Environment

2. The nurse explains to the student the benefits of home health care. Which are benefits

typically associated with this care? (Select all that apply.) a. Less exposure to iatrogenic risks b. Less chance of becoming confused c. Better management of chronic conditions d. Better reimbursement from Medicare Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 e. Patient remains in control of environment ANS: A, B, C, E

Many benefits exist for home health care including less risk of iatrogenic illness/injury, less chance the patient will be acutely confused by the change of environment, better long-term management of chronic conditions, and control of the environment by the patient.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 162 OBJ: 9-9 MSC: Physiologic Integrity

3. What actions by the nursing staff in a long-term care facility display an awareness of resident

rights? (Select all that apply.) a. Getting informed consent for the use of an antipsychotic medication b. Reminding the unhappy resident and family about grievance processes c. Ensuring that all residents are asked if they wish to vote in an election d. Giving residents information on the ombudsman’s name and address e. Assessing residents for their ability to safely administer their medications ANS: A, B, C, E

Long-term care facilities are responsible for honoring the many rights of their residents, including setting up informed consent processes for side rails and chemical restraints, having a posted grievance policy and process, pursuing the residents’ right to vote, assessing residents for the ability to safely administer their own medications, and posting information about the ombudsman program.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 169 OBJ: 9-15 MSC: Safe Effective Care Environment

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 10: Nutrition Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. A 73-year-old patient is concerned about staying healthy for as long as possible. When asked

what lifestyle changes the patient should consider, the nurse suggests: a. “As your metabolism slows, you will need to increase your intake of fat.” b. “If you are having difficulty sleeping, a mild sedative will help you sleep.” c. “Regular exercise will help you preserve function and reduce your risk for disease.” d. “Minimize stress by being willing to ask your family for help when you need it.”

ANS: C

For the healthy aging person, research is showing that exercise (along with the resulting maintenance of muscle mass) is one of the greatest determinants of maintaining vitality and health.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 184 OBJ: 10-2 MSC: Health Promotion

2. The nurse caring for older adult patients best minimizes the patient’s risk of developing

dehydration by: a. identifying the patient’s oral fluid preferences and offering them regularly. b. carefully monitoring the effects of daily diuretics via blood sodium levels. c. minimizing the patient’s reliance on laxatives by increasing dietary fiber intake. d. carefully monitoring of the rate of infusion of all intravenous fluids prescribed.

ANS: A

Physiologically, the decreased intake can be related to altered thirst; older adults may not feel thirsty even when hypovolemic. The other actions may be appropriate for selected patients.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 10-1 MSC: Physiologic Integrity

3. A patient is newly widowed and lives alone. Which suggestion by the nurse will help the adult

children maximize the patient’s nutritional status? a. Help identify possible barriers to their mother achieving good nutritional health. b. Ensure that the patient has an adequate supply of healthy, easily prepared foods available. c. Contact a food delivery service to provide one nutritiously sound meal a day. d. Arrange a schedule that allows someone to have dinner with her each evening.

ANS: D

The lack of companionship during mealtime that can lead to depression or social isolation often causes the patient to eat poorly and thus develop a nutritional deficiency. The patient who is newly widowed may not have adjusted to this change in status. The other actions are also helpful, but they are not as important for this patient.

DIF:

Applying (Application)

REF: N/A

OBJ: 10-1

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Communication and Documentation MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. The nurse is caring for four postsurgical patients who have experienced similar abdominal

procedures and are all 68 years of age. The nurse anticipates that the patient with the greatest risk for complications resulting in an extended hospitalization has: a. a history of Crohn disease. b. developed mild confusion. c. an allergy to latex. d. severe postoperative nausea and vomiting.

ANS: A

Malnourished hospitalized patients such as those with chronic digestive disorders like Crohn disease have a greater risk of developing infections and other complications after surgery, which can significantly increase the length and costs of hospitalization and care.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 188 OBJ: 10-2 MSC: Physiologic Integrity

5. The nurse conducting a food recall assessment on an older adult patient shows an

understanding of the requirements of the process when: a. having the patient identify any existing food allergies. b. asking the family to verify the patient’s statements. c. asking how the food being discussed was prepared. d. correlating diet information with signs of malnutrition.

ANS: C

For accuracy and relevancy, the food recall must include specific information about the type of food ingested, the preparation method, and an accurate estimate of the amount.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 10-4 MSC: Physiologic Integrity

6. An older adult patient has been prescribed a specialized enteral formula after an extensive

surgical procedure. The nurse anticipates and addresses a concern of many patients in this age cohort when assuring the patient that: a. her family can easily manage the formula after she is discharged. b. Medicare will cover the expense of the treatment. c. the treatment will be discontinued as soon as she is able to eat sufficiently. d. this is the most effective form of nutrition for her at this time.

ANS: B

Specialized enteral formulas are considerably more expensive than standard formulas and should be used only when clearly indicated. The cost of such a treatment would be of great concern to this cohort. The special feeding will be discontinued as soon as possible, this is the best way to give this patient nutrition at this time, and the family can manage the feedings, but the bigger concern is cost.

DIF: Understanding (Comprehension) REF: N/A TOP: Communication and Documentation

OBJ: 10-6 MSC: Physiologic Integrity

7. During a nutritional assessment, a 79-year-old patient responds, “My weight is fine. I weigh

the same as I did 15 years ago.” The nurse responds based on the understanding that older patients: Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. generally guess their weight rather than weigh themselves. b. often rely on how their clothes fit to determine whether their weight has changed. c. sometimes experience altered metabolic problems that hide weight change. d. often exchange lean muscle mass for body fat so weight stays the same.

ANS: D

With age there is a loss of lean body mass and an increase of body fat; therefore, body weight alone can be misleading.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 191 OBJ: 10-2 MSC: Physiologic Integrity

8. An older adult patient has experienced severe nausea and vomiting for 2 days since

undergoing abdominal surgery. A prealbumin serum blood test is ordered. The nurse explains the rationale for the test to the patient’s family by saying: a. “The provider is interested in whether there is enough available protein in the blood.” b. “This test is designed to determine how the body is meeting current demands for protein.” c. “The test will tell us if the vomiting has created a problem with protein metabolism.” d. “Healing from such a surgery requires protein, and this test measures protein.”

ANS: B

This test is sensitive to sudden demands on protein synthesis and is often used in the acute care setting. Healing from surgery does require sufficient protein stores, and this test can help the nurse, dietician, and provider determine if the patient needs extra nutritional support.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 191 OBJ: 10-4 MSC: Physiologic Integrity

9. Based on recent surveys identifying nutritional information concerning the daily diet of older

adults in America, the nurse suggests: a. substituting carbohydrates with lean protein sources. b. adding calories through the addition of fruits and vegetables. c. introducing a protein at each meal. d. relying on foods that are both easy to chew and easy to digest.

ANS: B

Government-sponsored surveys have indicated that the average diet of the older adult lacks in calories, especially in the form of fruits and vegetables. The recommendations do not include substituting protein for carbohydrates, adding protein at each meal, and relying solely on foods that are easy to chew and digest, although these suggestions might be appropriate for individual patients.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 192 OBJ: 10-5 MSC: Health Promotion

10. An older adult patient with a history of a myocardial infarction tells the nurse that he takes his

daily dose of prescribed aspirin with breakfast each morning. The nurse’s response is: a. “Food interferes with the drug’s absorption, so take it between meals.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. “Taking aspirin with food increases your likelihood of stomach upset.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. “Taking the drug with food is likely to alter the taste of the food.” d. “Eating as you take the aspirin is likely to result in constipation.”

ANS: A

The absorption of aspirin occurs in the stomach and so is greatly altered by the presence of food.

The other statements are incorrect.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 197 OBJ: 10-1 MSC: Physiologic Integrity

11. The nurse notes a patient’s prealbumin is 2 mg/dL. What action by the nurse is best? a. Tell the patient to add more protein to the diet. b. Conduct a nutritional screening with a standard tool. c. Refer the patient to a registered dietician. d. Instruct the patient to maintain good nutritional habits.

ANS: C

Normal albumin levels are above 15 mg/dl. Values below 5 mg/dL are considered a marker for severe protein deficiency. The nurse should enlist the services of a registered dietician to help manage this patient. Adding more protein to the diet and conducting a nutritional screening are not the best answers because the nurse already knows the patient is severely malnourished.

Instructing the patient to maintain his or her good nutritional habits is incorrect.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 10-4 MSC: Physiologic Integrity

12. A nurse works with a patient who is malnourished. What lab value does the nurse assess for

the most up-to-date information on the patient’s status? a. Albumin b. Prealbumin c. Transferrin d. Total iron ANS: B

Prealbumin has a half-life of 2 to 3 days, so it is the most accurate measure of the patient’s current status. Albumin’s half-life is 21 days; transferrin’s half-life is 8 to10 days. Total iron does not indicate current nutritional status as accurately as the others.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 191 OBJ: 10-4 MSC: Physiologic Integrity

13. The nurse has conducted a nutrition screen on a patient using the Nutrition Screening

Initiative tool. The patient scored a 4. What action by the nurse is most appropriate? a. Refer the patient to a dietician for a nutritional assessment. b. Encourage the patient to add more protein items to the diet. c. Reinforce the patient’s good eating habits and nutrition. d. Consult the provider about adding an iron supplement.

ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

A score of 3 or higher indicates moderate to severe nutritional risk. The nurse consults a dietician for a more in-depth nutritional assessment. Adding more protein items to the diet is probably a good idea, but this is not the most comprehensive answer. The nurse can reinforce the good eating habits the patient does have, but the patient needs more intervention. The patient may or may not need an iron supplement.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 10-4

14. A nurse is caring for an observant Hindu patient who has a protein deficiency. What menu

items does the nurse select for the patient? a. Lean beef b. Chicken c. Beans d. Pork ANS: C

Hindus do not eat any meat, so to get a food high in protein, the nurse selects beans.

DIF: Remembering (Knowledge) REF: Page 196 TOP: Nursing Process: Implementation | Cultural Awareness Box MSC: Psychosocial Integrity 15. A nurse is caring for four patients. On which patient should the nurse plan to conduct a further

nutritional assessment? a. The patient who has lost 10% of body weight in 1 month b. The patient who has lost 5 pounds with exercise in 1 month c. The patient who gained 3 pounds while on vacation d. The patient who weighs 12% over ideal body weight ANS: A

Loss or gain of 5% of body weight in 1 month puts a patient at nutritional risk. The other patients are not at nutritional risk.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 190 OBJ: 10-3 MSC: Physiologic Integrity

16. A patient wants to know what “no sugar added” on a food label means. What explanation is

best? a. The food has no calories. b. No sugar was added during processing. c. The food naturally has no sugar. d. The food has 23% less sugar than normal.

ANS: B

“No sugar added” means that no sugar is added during processing (or packaging) and no ingredients are added that contain sugar. It does not mean that the food has no calories or that the food itself does not naturally contain sugar. A product with 23% less sugar than the original counterpart is labeled “low sugar.”

DIF: Understanding (Comprehension) REF: Page 196 OBJ: 10-7 Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning

MSC: Health Promotion

17. The nurse teaches older adults to reduce sodium in their diets. What is the daily recommended

limit for sodium in this population? a. 1000 mg b. 1500 mg c. 2000 mg d. 2500 mg ANS: B

The current recommendations for sodium intake in the older population limits ingestion to 1500 mg/day.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 193 OBJ: 10-7 MSC: Health Promotion

18. An older adult is worried about potassium intake. What does the nurse teach this patient? a. Unless you take a diuretic, don’t worry about potassium. b. You should take a daily potassium supplement. c. You should try to get all your potassium through food. d. Potassium is not a nutrient people generally worry about.

ANS: C

The guidelines for nutrition and older individuals state that potassium intake (4700 mg/day) should be ingested through food. Some people do need a supplement, for instance, those on potassium-wasting diuretics. Potassium is a vital nutrient, important in electrical conduction and muscle function.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 193 OBJ: 10-7 MSC: Health Promotion

19. An older patient asks why he needs a multivitamin supplement. The patient has always been

healthy, has excellent nutrition, and has never needed vitamins. What explanation by the nurse is best? a. Older people tend to eat fewer calories, so it’s harder to get nutrients. b. You need to have extra nutritional reserves in case of sudden illness. c. It’s recommended in all the nutritional guidelines for older adults. d. Now that you are older, your good nutritional habits are not enough.

ANS: A

Older people do tend to eat fewer calories, making it more difficult to get all the needed nutrients. Stating that old habits are no longer good enough is not quite accurate. Extra nutritional reserves are a good idea, but the patient may not feel vulnerable to illness. Stating that it is in the nutritional recommendations does not give the patient useful information.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 193 OBJ: 10-3 MSC: Health Promotion

20. A diabetic is struggling with the carbohydrate-controlled diet as a result of having a large

extended family with many get-togethers. What action by the nurse is best? a. Remind the patient of the consequences of poor control of diabetes.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. Tell the patient that once a month he or she can eat as desired.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Help the patient make priorities so some favorite foods can be eaten. d. Tell the patient to increase the insulin dose on get-together days.

ANS: C

Nurses working with patients who have dietary issues need to understand the social, emotional, cultural, and religious ties their patients have to food, or the interventions will not be successful. While normally maintaining a diabetic diet the patient can be assisted to prioritize foods that are “must haves” and determine how to work them into the diet.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 10-1 MSC: Health Promotion

21. An older woman asks the nurse why she “suddenly” has a deficiency in B vitamins as her

eating and cooking habits have not changed. What response by the nurse is best? a. “Something has to be different now.” b. “You can’t absorb B vitamins like before.” c. “Your need for B vitamins has increased.” d. “The guidelines have been increased.”

ANS: B

Age-related gastrointestinal changes include a decrease in intestinal pH, which lowers the ability of the gastrointestinal tract to absorb B vitamins.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 185 OBJ: 10-2 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. A patient is being discharged on total parenteral nutrition (TPN). What topics do the patient

and family need to be taught? (Select all that apply.) a. How to work the enteral feeding pump b. Care of a central venous catheter c. How to crush and give medications d. Proper use of an intravenous (IV) pump e. Actions to take if the IV becomes occluded ANS: B, D, E

TPN is administered via a large central IV line using an IV pump. The family needs to know how to use the pump, how to care for the catheter, and what to do if the IV line becomes occluded. An enteral pump is not used. Meds are not crushed and given through the TPN line.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 10-6 MSC: Physiologic Integrity

2. The student learning about gerontologic nursing knows that which features are commonly

associated with geriatric failure to thrive? (Select all that apply.) a. Impaired physical function b. Depression c. Malnutrition d. Cognitive decline e. Poor dentition Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A, B, C, D

According to one description of failure to thrive, components include impaired physical function, depression, malnutrition, and cognitive decline. Poor dentition is not specifically mentioned.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 198 OBJ: 10-2 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 11: Sleep and Activity Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. A patient reports to the nurse that he seems to be sleeping less at night but now regularly

requires at least two short naps a day. He expresses a concern that “something is wrong.” The nurse responds that: a. “Aging alters our sleep patterns, so what you describe is really quite common.” b. “Circadian sleep rhythms are controlled by the hypothalamus, which is affected by age.” c. “Sleep patterns are affected by so many things; have you been under a lot of stress lately?” d. “Can you be more specific about what you think is wrong with your sleep pattern?”

ANS: A

The decrease in nighttime sleep and the increase in daytime napping that accompanies normal aging may result from changes in the circadian aspect of sleep regulation.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 203-4 OBJ: 11-1 MSC: Physiologic Integrity

2. What is the best bedtime snack for older adult patients with failure to thrive and insomnia? a. Ice cream in a waffle cone b. Bowl of grapes c. Glass of milk and a macaroon cookie d. Cup of cream of broccoli and cheese soup ANS: D

This patient will benefit from a snack that includes protein and is warm while not providing excessive liquids.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 206 OBJ: 11-1 MSC: Physiologic Integrity

3. An older patient is being admitted to an acute care unit after surgical repair of a fractured

tibia. To minimize any negative factors affecting the patient’s ability to sleep, the nurse’s initial intervention is to: a. be sure postoperative pain is being well managed. b. manipulate the environment to manage light and noise. c. plan care to minimize the number of times the patient is disturbed. d. ask the patient about usual sleeping habits.

ANS: D

Nurses can promote sleep by first assessing the patient’s usual sleep habits and satisfaction with sleep. Managing postoperative pain, minimizing environmental stimuli, and encouraging undisturbed rest are also important, but the first step in the nursing process is assessment.

DIF:

Applying (Application)

REF: N/A

OBJ: 11-3

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. A confused older patient has been hospitalized for a cardiac problem that requires both

antihypertensive and diuretic therapies. The nurse minimizes the patient’s risk of disturbed sleep by: a. keeping the door shut so noise from the hallway is not disruptive. b. organizing care to minimize the number of times the patient is awakened. c. administering medications at least 4 hours before bedtime. d. offering to toilet the patient whenever the nurse finds the patient awake during the night.

ANS: C

The diuretic is likely to cause the patient to urinate frequently during the night if not administered appropriately. Because the patient is confused, the door should be left open.

Clustering cares is a good idea to promote sleep but is not the most important for this patient.

Offering to assist the patient to the bathroom when awake is also a good idea, but it is preferable to decrease the number of times the patient is awake.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 11-3 MSC: Physiologic Integrity

5. An older frail adult patient has begun displaying symptoms of sleep disturbance while being

hospitalized. Since these symptoms were observed, the nurse has arranged for a bed alarm to be placed near the patient because: a. lack of adequate sleep can result in delirium. b. the patient has difficulty using the call light. c. lack of sleep make the patient at risk for falls. d. the patient will remember not to get out of bed.

ANS: A

One consequence of lack of sleep for elders is delirium; the bed alarm is an intervention often used to alert staff when a patient is likely to make an ill-advised attempt at getting out of bed.

The patient may or may not be able to use the call light. The risk of falling increases with delirium. The alarm may or may not remind the patient not to get out of bed, but it will alert the staff to go into the room.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 11-3 MSC: Safe Effective Care Environment

6. An older patient reports that sleep was being severely affected by the need to urinate

frequently. The patient states he has begun restricting his fluid intake after 5 PM to help with the problem. The nurse responds: a. “Have you seen a decrease in waking up since you cut back on fluids?” b. “You need sufficient fluids, so don’t be too restrictive.” c. “You need the same amount over 24 hours, so drink enough by dinnertime.” d. “Have you had your prostate checked by your health care provider?”

ANS: C

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

It is important that older adults, who as a group are at risk for inadequate fluid intake and dehydration, not reduce the total amount of liquids drunk in 24 hours. This is a common issue in the older population, so the nurse educates the patient on the amount of fluid he or she needs in a 24-hour period. Telling the patient “don’t be too restrictive” does not give the patient information to make an informed decision on fluids. The other two questions are good assessment questions, but physiologic safety and maintenance are more important.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 206 OBJ: 11-7 MSC: Health Promotion

7. An older patient being treated for symptoms of seasonal allergies reports to the nurse that

although she is careful about her caffeine intake, she has been having trouble getting to sleep at night. The nurse responds most appropriately to this patient when stating: a. “Allergy reactions such as nasal stuffiness can cause sleep problems.” b. “If you are using over-the-counter nasal decongestants, that could be the problem.” c. “Many different foods contain hidden caffeine; be sure to check the labels.” d. “There are many different causes of sleep disturbances besides caffeine intake.”

ANS: B

Over-the-counter medications that interfere with sleep include nasal decongestants containing amphetamine-like substances. This is most important for this patient who has allergies. Food labels do not always contain information on caffeine. Although there are different causes of sleep disturbances, this options does not really give the patient useful information.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 207 OBJ: 11-3 MSC: Physiologic Integrity

8. The daughter of an older cognitively impaired patient responds to the nurse’s suggestion to

keep her father physically active by stating, “Dad is so easily agitated it would be a major battle to take him on a walk.” The nurse’s initial response is based on the understanding that: a. caregivers are often overwhelmed by the challenges of caring for such patients. b. physical exercise has been proven helpful in managing anger in such patients. c. exercise such as walking is likely to appeal to patients such as her father. d. her father’s general health and wellness will be positively affected by walking.

ANS: B

Physical exercise for the older adult with dementia is important for general physical wellbeing, but for this patient exercise may also reduce agitation. Exercise may also cause fatigue, leading to better sleep.

DIF: Understanding (Comprehension) REF: Page 211| Page 213 OBJ: 11-9 TOP: Teaching-Learning MSC: Physiologic Integrity 9. The nurse is preparing to instruct a family member regarding how to appropriately assist a 76-

year-old patient incorporate a healthy daily walk into the family’s routine. The nurse includes a suggestion that: a. a 30-minute walk after dinner is the best form of exercise for someone that age. b. if the patient appears to be having difficulty talking while walking, it is time to stop. c. the patient should be encouraged to walk a few feet farther each evening. d. the family member selects a flat, easily accessible walking path to follow.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B

To measure the appropriate intensity while walking for exercise, many apply the “talk test”: the person exercising should be able to carry on a conversation while walking. Breathing may be slightly labored, but a conversation should still be possible. The walker should not be out of breath. The other suggestions may or may not be appropriate for individual patients.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 213 OBJ: 11-9 MSC: Health Promotion

10. An older adult patient who has been seen at a neighborhood clinic for years tells the nurse that

he will be moving to live with his son in a neighboring state. The nurse impacts the patient’s health and wellness the most therapeutically when stating: a. “Be sure to reestablish with a health care provider as soon as you get settled.” b. “You seem to have a good relationship with your son; I’m sure this will be a good move.” c. “You need to continue to be compliant with your plan of care regardless of where you live.” d. “Moving often causes temporary sleep disturbances, so stick to your evening routine.”

ANS: D

Relocation often causes sleep disturbances as the person adjusts to a new environment.

Maintaining an established evening routine will help the patient sleep better. The other statements do not affect sleep.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 205 OBJ: 11-7 MSC: Health Promotion

11. A patient in the early stage of Alzheimer disease is being admitted to an assisted living

facility. The admitting nurse best addresses the patient’s need for appropriate physical activity when: a. asking the patient about activities done for recreation. b. showing the patient the exercise equipment available. c. having the activity coordinator visit with the patient. d. teaching the patient the connection between activity and memory.

ANS: A

The activity preferences of each resident should be assessed on admission in order to identify activities that the patient is likely to participate in. Keeping the patient busy and active will promote sleep. The other options are also appropriate, but assessing the patient’s preferences for leisure activity is the first step.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 11-10 MSC: Psychosocial Integrity

12. A patient with moderate dementia has been admitted to a long-term care facility. To address

the patient’s need to be engaged in purposeful activity, the nurse arranges for the patient to: a. fold some of the unit’s freshly washed washcloths and towels each afternoon. b. help decide what television programs will be on in the dayroom. c. be responsible for changing the day calendar each morning. d. remind other diabetic patients when it is time for their finger sticks.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

A meaningful activity has a purpose. The purpose may be to exercise arthritic joints or simply to have fun, but the activity should not be aimless or inappropriate for the patient’s ability.

With dementia, the other activities are not appropriate and could lead to frustration.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 11-10 MSC: Psychosocial Integrity

13. An older patient reported to the clinic nurse that since a grandson moved in a few months ago,

the patient has had problems sleeping. Which question by the nurse is most appropriate? a. “How do you feel about having a roommate?” b. “Was it your decision to invite him to move in?” c. “Has your sleep pattern changed since he moved in?” d. “Can you be more specific about the trouble you have sleeping?”

ANS: C

The introduction of a new roommate often disrupts established sleep patterns, causing sleep disturbances. The nurse should also gather information on the specifics of the problem but should start with the event that the patient relates as the start of the issue.

DIF:

Applying (Application)

REF: N/A

14. The nurse is caring for a hospitalized patient who needs vital signs and assessments every 4

hours. The nurse last assessed the patient at midnight, and at 2 AM the nurse answers the call light and helps the patient to the bathroom. To promote good sleep, what action by the nurse is best? a. Ask the patient if a sleeping medication is needed. b. Assess the patient now and again at 6 AM. c. Tell the patient you will be back in 2 hours. d. Assess the patient at 4 AM while being very quiet.

ANS: B

The nurse can use judgment to assess the patient more often than ordered. In this case, assessing the patient 2 hours early and rescheduling the next assessment conforms to the prescribed maximum time between assessments and allows the patient 4 hours of uninterrupted rest. The patient may or may not want a sleeping pill, but sleep without medication is best.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 11-6 MSC: Physiologic Integrity

15. A patient is discussing retirement with a nurse. What suggestion pertaining to sleep does the

nurse offer? a. Keep your same bedtime and nighttime routines. b. If you nap during the day you can stay up later. c. You won’t need so much sleep to be rested for work. d. Sleeping in will help revitalize your energy level.

ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

For some, retirement comes with loss of daily structure, which can affect bedtime and nighttime routines, making sleeping difficult. For best sleep the nurse suggests the patient maintain the familiar schedule.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 205 OBJ: 11-6 MSC: Physiologic Integrity

16. The nurse caring for older patients would prepare to administer which medication as a short-

term sleep aid? a. Diazepam (Valium) b. Diphenhydramine (Benadryl) c. Chloral hydrate (Somnote) d. The nurse would try other measures first ANS: D

Benzodiazepines, hypnotics, and antihistamines all have serious side effects when taken by the older population. Especially in the confused patient, the nurse should try other comfort measures first, like sticking to an established nighttime routine to cue the patient to bedtime.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 11-6 MSC: Physiologic Integrity

17. A patient reports waking up with frequent headaches and sore throat. What question by the

nurse is most appropriate? a. “Does acetaminophen (Tylenol) provide relief?” b. “Does your partner say you snore at night?” c. “Do you drink enough water during the day?” d. “Do you ever wake up with night sweats?”

ANS: B

Waking up with headaches and sore throat are manifestations of sleep apnea. Family members often say the patient snores loudly during the night and wakes up gasping. The nurse should assess for these other signs of the disorder. The other questions may or may not be appropriate if the patient does not snore at night.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 11-4 MSC: Physiologic Integrity

18. A patient wants to use an herbal preparation to help with decreased sleep. What response by

the nurse is best? a. “There are no research studies on these herbal preparations.” b. “Why don’t you try exercise during the day first?” c. “Have you had a physical exam any time recently?” d. “Why do you want to use an herbal product for insomnia?”

ANS: C

Sleep disturbances, especially new ones, may signify a physical illness. Before simply taking medications or supplements to treat the sleep disorder, the patient should have a physical exam to rule out a physical cause for the problem. The other statements are not appropriate because for patient safety, he or she should have a checkup.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 11-6

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Communication and Documentation

MSC: Physiologic Integrity

19. The nurse needs to awaken a patient to take medication in the middle of the night. The patient

has not had any sleeping medications or other preparations that would cause drowsiness. The nurse has to use vigorous stimulation to awaken the patient. What stage of sleep is this patient most likely in? a. Stage 1, non−rapid eye movement (REM) b. Stage 2, non-REM c. Stage 3, non-REM d. Stage 4, non-REM ANS: D

In stage 4 of non-REM sleep, the person needs vigorous stimulation to be awakened. In stage 1, the person is awakened easily, as in stage 2. Stage 3 requires moderate stimulation.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 203-4 OBJ: 11-3 MSC: Physiologic Integrity

20. A patient has chronic, severe asthma and takes many medications during the day. The patient

reports difficulty falling asleep at night. What medication does the nurse ask about the patient taking? a. Barbiturates b. Theophylline (Theo-24) c. Furosemide (Lasix) d. Haloperidol (Haldol) ANS: B

Theophylline is associated with difficulty falling asleep and is sometimes used in patients with asthma. The other medications are not associated with this sleep disorder or with asthma.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 11-3 MSC: Physiologic Integrity

21. The nurse has instituted bedtime routines for patients with dementia in a long-term care

facility. What assessment findings best indicate the program is effective? a. Patients are more alert and oriented during the day. b. Patients fall asleep within 20 to 30 minutes of going to bed. c. Patients appear happier and more interested in activities. d. Patients on diuretics awake less often during the night.

ANS: B

People should be able to fall asleep within 20 to 30 minutes after going to bed, so this assessment finding best indicates the program is working.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 11-6 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. When assessing a patient’s report of experiencing “problems sleeping,” the nurse gathers data

related to which of the following? (Select all that apply.)

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. The patient has difficulty falling asleep. b. The patient wakes up frequently during the night. c. The patient finds it difficult to stay asleep. d. The patient experiences vivid dreams while sleeping. e. The patient has taken sleeping medication in the past.

ANS: A, B, C

Characteristics of the sleep disturbance include difficulty falling asleep, difficulty staying, asleep, frequent nocturnal awakenings, early morning awakening, and daytime sleepiness. An assessment should include questions related to the presence of these symptoms. Vivid dreams and sleeping medication are also part of a sleep history but are not characteristics of sleep disorders.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 209 OBJ: 11-5 MSC: Physiologic Integrity

2. The nurse who works with older patients explains the age-related changes in sleep to a

student. Which statements are consistent with this knowledge? (Select all that apply.) a. The amount of time spent in REM sleep increases. b. REM sleep is interrupted more by awakening at night. c. People spend more time in the lightest stage of sleep. d. Stages 3 and 4 of non-REM sleep are not as deep. e. Changes in circadian rhythm can affect sleep.

ANS: B, C, D, E

As people age, the amount of time spent in REM sleep decreases, and this stage of sleep is interrupted more often by waking up at night. Stage 1 is the lightest stage of sleep and people tend to spend more sleep time in this stage as they age. Stages 3 and 4 are not as deep. The decrease in nighttime sleeping and increase in daytime napping can be attributed to alterations in circadian rhythms.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 203-4 OBJ: 11-1 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 12: Safety Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. Which nursing intervention best demonstrates the understanding that older adults are at

increased risk for falls because of normal age-related changes? a. Speaking in a loud voice when warning the patient about safety hazards b. Turning on bright lights so the patient can see objects such as furniture c. Encouraging the patient to rise from a supine position slowly d. Advising the patient to avoid exercising painful joints ANS: C

Older adults who lie supine and then get up quickly are likely to experience the effects of lack of tissue elasticity when the blood pressure drops and a feeling of lightheadedness develops. It is important to educate older individuals to change position slowly.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 220 OBJ: 12-4 MSC: Safe Effective Care Environment

2. An older adult’s risk for a fall-related injury is directly correlated to his or her ability to regain

balance. To evaluate this ability, the nurse assesses the patient’s: a. inner ear for possible fluid buildup. b. musculoskeletal hip, ankle, and shoulder strength. c. large muscle strength in thighs and upper arms. d. gait for steadiness.

ANS: B

Older adults who lose their balance are able to right themselves to an upright position when the musculoskeletal strength of the hips, ankles, and shoulders is adequate. The inability to regain balance because of insufficient strength can result in a fall. The other options are also possibilities, but they are not as significant as hip, ankle, and shoulder strength.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 221 OBJ: 12-4 MSC: Physiologic Integrity

3. The geriatric nurse’s decision to identify a specific patient as a falls risk is primarily based on

the: a. b. c. d.

presence of visual deficiencies and musculoskeletal weakness. results determined by cognitive and physiologic assessment tools. degree of frailty and functional limitation observed. inability to follow instructions and communicate effectively.

ANS: C

Research has shown that the individual with frailty and physical functional limitations is at greatest risk for falling.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 222 OBJ: 12-4 MSC: Safe Effective Care Environment

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. An older adult has been diagnosed with presbyopia. To minimize the patient’s risk for falls,

the nurse suggests: a. that the edges of steps be painted a contrasting color. b. the patient wear sunglasses when driving. c. the patient wear a wide-brimmed hat when spending time outdoors. d. hanging blinds over sunny windows.

ANS: A

If older individuals are experiencing presbyopia, a reduction in the eye’s accommodation for changes in depth, such as when ascending or descending the stairs, instruction must be given for them to carefully watch door edges, curbs, and landing steps, which signal a change in height. Painting the edges of steps a contrasting color will make these depth changes more visible. The other suggestions are not related to this disorder.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 12-1 MSC: Safe Effective Care Environment

5. An older adult has been diagnosed with a sinus infection. To minimize the risk for a fall-

related injury, the nurse teaches the patient: a. that there is a possibility of prodromal falls. b. to take her antibiotic medication with food. c. to recognize symptoms of fluid buildup in the middle ear. d. about the increased risks of falls related to normal aging.

ANS: A

Prodromal falling refers to the onset of frequent falling heralding an acute medical problem; an infectious disease typically causes this type of fall. Educating the patient regarding the most common sources of potential falls is the cornerstone of fall prevention and management.

The other options do not relate directly to this condition.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 224 OBJ: 12-4 MSC: Safe Effective Care Environment

6. The nurse identifies the older adult patient at the greatest risk for a fall-related injury as the: a. male with a history of a vitamin deficiency. b. female with a diagnosis of osteoporosis. c. male with a cognitive deficient. d. female with a history of depression.

ANS: B

Serious injury from falling is more likely to occur among those with osteoporosis.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 223 OBJ: 12-4 MSC: Safe Effective Care Environment

7. An older patient diagnosed with dementia has begun behaviors that increase the risk of falling.

The patient’s son tells the nurse that “physical restraints may be used.” The nurse responds: a. “I’ll document that, so that the staff can use them when necessary.” b. “Physical restraints are seldom effective on patients with dementia.” c. “The staff will use physical restraints only as a last resort.” d. “There are more effective methods to use to help ensure her safety.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: D

Physical restraint use does not prevent falls and therefore should never be employed for “safety precautions.” This is the best explanation because the nurse will then need to explain the other measures that will be taken to keep the patient safe.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 223 OBJ: 12-3 MSC: Safe Effective Care Environment

8. A patient is being discharged after hip replacement surgery. The geriatric nurse recognizes that

the most effective intervention to minimize the potential of a fall injury is to: a. identify the most common causes of falls that the patient is likely to encounter. b. discuss what kind of in-home assistance the patient will need. c. impress the patient with the importance of being careful not to fall. d. educate the patient that falling is not a normal part of aging.

ANS: A

Educating the patient regarding the most common sources of potential falls is the cornerstone of fall prevention and management. The patient may or may not need home care assistance, telling the patient how important it is not to fall does not provide the patient with a plan to avoid falling, and educating the patient on normal age-related changes also does not give the patient any information on how to avoid falling.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 219 OBJ: 12-4 MSC: Safe Effective Care Environment

9. A patient is diagnosed with bilateral osteoarthritis of the knees. To best address the long-term

risk for falls, the nurse encourages the patient to: a. use assistive mobility devises when necessary. b. report exacerbation of symptoms promptly. c. add a daily walk to exercise the knees appropriately. d. take analgesic medication as prescribed to manage joint pain.

ANS: D

If joint pain develops and remains untreated, it can cause older adults to become sedentary or immobile. This phenomenon of disuse and muscle atrophy contributes to muscle weakness and can lead to an increase in falls. The other statements are also appropriate, but the patient’s pain needs to first be managed before determining if assistive devices are needed. Walking will help build strength, but the patient won’t do it if it hurts too much. Reporting symptoms does not directly affect falling.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 12-5 MSC: Safe Effective Care Environment

10. A cognitively impaired older adult patient is a resident at a skilled nursing facility. The nurse

acting as the patient’s advocate will consistently address the patient’s risk for injury issues based on: a. preferences generally expressed by cognitive patients. b. professional nursing knowledge. c. implementation of the less restrictive intervention. d. established facility policies and procedures.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: D

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

If patients are unable to make informed choices and no family members are available, the nurse must use nursing judgment and follow an acceptable standard of care to promote safety and security that are defined and described in official policies and procedure manuals. The preferences of other patients do not indicate this patient’s preferences. Professional nursing knowledge can be used but must remain within the policies. Less restrictive interventions are preferable, but again actions need to conform to policy.

DIF: Understanding (Comprehension) TOP: Nursing Process: Implementation

REF: Page 228 OBJ: 12-6 MSC: Safe Effective Care Environment

11. When appropriately addressing safety issues, the geriatric nurse plans the patient’s care plan

directed by the standard of care that requires: a. promoting both health and wellness by assuring safety. b. minimizing the patient’s risk for physical injury while preserving autonomy. c. identifying safety from injury as a patient right. d. emphasizing beneficence as a an ethical standard of nursing care.

ANS: B

When working with older adults, the gerontologic nurse must provide a standard of care that promotes safety and prevents foreseeable accidents or injuries while also respecting individuals’ autonomy to make decisions. This requires a delicate balance. The other options do not address standards.

DIF: Remembering (Knowledge) TOP: Nursing Process: Analysis

REF: Page 228 OBJ: 12-6 MSC: Safe Effective Care Environment

12. Which action is best to reduce burns in the home? a. Instruct patients to install smoke detectors, b. Tell patients to have their water heaters checked, c. Encourage patients to switch from gas to electric stoves, d. Teach patients not to smoke in their houses, ANS: B

The most common cause of burns in the home for older patients is scalding from water that is too hot. Patients should either check and reset the temperature themselves or have someone do it for them. The other actions are all helpful, but scalding remains the top cause of burns in the home for this population.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 229 OBJ: 12-7 MSC: Safe Effective Care Environment

13. A patient smokes. What advice does the nurse give this patient for safety? a. Do not smoke inside the house. b. Install working smoke detectors. c. Only smoke during the daytime. d. Install carbon monoxide detectors.

ANS: A

Smoking has been related to house fires for many years. The nurse can provide many suggestions, but not smoking inside at all is the safest option. Smoke detectors work after a fire has started. Smoking during the daytime does not eliminate the possibility of falling Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

asleep while smoking. Carbon monoxide detectors are important but not related to fire.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 12-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 14. The nurse assesses which patient as being at the highest risk for poisoning related to mixing

garden chemicals? a. The patient who has Parkinson disease with hand tremors b. The patient who has low vision or uses magnifying glasses c. The patient who has hearing impairment or wears hearing aid d. The patient who has osteoarthritis or using a wheeled walker ANS: A

The patient with hand tremors is at greatest risk because of the potential for inaccurate mixing and spillage.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 12-7 MSC: Safe Effective Care Environment

15. The student asks the nurse why ground beef and other ground meat products are more likely

to be contaminated and cause food-borne illness. What response by the nurse is best? a. It’s because they are handled more. b. They are from cheaper cuts of meat. c. They are not kept cold during shipping. d. They are made from leftover meats.

ANS: A

Ground meat products are handled more during processing, increasing the risk of being contaminated with microbes that cause food-borne illnesses.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 231 OBJ: 12-7 MSC: Safe Effective Care Environment

16. The nurse working with older patients would assess which patient as being at highest risk for

developing secondary hypothermia? a. The patient who has osteoarthritis and limited mobility b. The patient who has a raised rash on both arms c. The patient who drinks four alcoholic drinks a day d. The patient who takes furosemide (Lasix) ANS: C

Alcohol and substance abuse increase the risk of hypothermia because of decreased awareness and impaired judgment. Four drinks a day is excessive. Skin conditions can lead to hypothermia, but the rash is confined to the arms. The other two conditions are not risk factors.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 12-8 MSC: Safe Effective Care Environment

17.

A patient is brought to the emergency department after falling while shoveling snow. The patient’s core temperature is 92?0°F (33.3?0°C). What rewarming measures does the nurse prepare to initiate?

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. Warm blankets b. Warm heating lamps c. Peritoneal dialysis d. Warmed intravenous (IV) solutions ANS: D

A core temperature this low requires active internal rewarming. Warmed IV solutions are appropriate. Blankets and a heating lamp are appropriate for mild hypothermia. Peritoneal dialysis is reserved for severe cases with cardiac instability.

DIF: Applying (Application) TOP: Nursing Process: Analysis

REF: N/A OBJ: 12-8 MSC: Physiologic Integrity

18. A nurse is watching a parade during the summer and notices an older adult looking faint and

acting somewhat confused. The patient has hot dry skin. While waiting for the rescue squad, what action by the nurse is most effective? a. Spraying the person with a water mist b. Giving the person iced tea to drink c. Having the person sit down on the grass d. Pouring cold water over the person’s head ANS: A

Spraying the person with a cold-water mist will help dissipate heat, especially if the nurse then fans the person. Iced tea is a diuretic and will increase fluid loss. Having the person sit down is a good idea, as long as the person sits in the shade. Pouring cold water over the person’s head is not as effective as a water spray mist.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 12-8 MSC: Physiologic Integrity

19. The nurse teaches that which of the following is the best place to store medications? a. Bathroom medicine cabinet b. Near the kitchen sink c. In the laundry room d. In a drawer in the bedroom ANS: D

Medications should be kept away from heat, direct sunlight, and humidity. The drawer in the bedroom is the best of the options given.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 235 OBJ: 12-7 MSC: Safe Effective Care Environment

20. The nurse working with older adults understands that which age-related condition contributes

to driving safety concerns? a. Wearing glasses b. Hearing impairment c. Confusion d. Slower reflexes ANS: D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Slower reflexes and reaction times are a normal age-related change. Wearing glasses and hearing aids should correct the underlying problem and not be a cause for concern in themselves. Confusion is not a normal age-related change.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 235 OBJ: 12-11 MSC: Safe Effective Care Environment

21. A patient has had several falls ascribed to “numb feet.” What action by the nurse is best? a. Assess patient for undiagnosed diabetes. b. Instruct the patient on using a cane. c. Ensure the patient has sturdy footwear. d. Tell the patient to lift the feet when walking.

ANS: A

Numbness in the feet is caused by peripheral neuropathy, which is a complication of diabetes mellitus. The nurse plans to assess the patient for this condition. The other options do not address the lack of sensation to the feet.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 12-5 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. When assessing an older adult for intrinsic risk factors for falls, the nurse is particularly

interested in which of the following? (Select all that apply.) a. An unsteady gait when asked to walk without assistance b. The presence of throw rugs in the living room of the home c. The patient’s report that he wears corrective lenses d. An inability to see changes in height because of poor lighting e. Evidence of short-term memory deficiency ANS: A, C, E

The most salient observations for intrinsic risk factors for falls relate to gait, balance, stability, and cognition. Intrinsic risk factors are a combination of age-related changes and concurrent disease. The other two options are extrinsic factors, which relate to the environment.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 220-1 OBJ: 12-4 MSC: Safe Effective Care Environment

2. A patient is brought to the emergency department after an unexplained fall. What actions by

the nurse are most appropriate? (Select all that apply.) a. Placing the patient on a cardiac monitor b. Obtaining a urine sample for cultures c. Checking a quick bedside blood glucose d. Assessing the patient for asthma e. Performing tests for orthostatic vital signs ANS: A, B, C, D

Common causes of falls include cardiac dysrhythmias, urinary tract infection, hypoglycemia, and dehydration, so the nurse assesses for these conditions. Asthma most likely is not an issue.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 12-5 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 13: Sexuality and Aging Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. Which statement made by a nurse reflects a lack of understanding regarding sexual intimacy

and the older adult patient? a. “Older adults express less interest in intimacy as both acute and chronic illnesses develop.” b. “Sexual expression is considered an enhancement to the quality of the older adult’s life.” c. “Expressing sexual needs may be difficult or impossible for some older adults.” d. “Interest in physical contact tends to persist throughout life for both genders.”

ANS: A

Although the need to express interest in sexuality continues among older adults, they face several barriers to sexual expression, including problems arising from low desire, aging, disease, and medications; societal beliefs; and changes in social circumstances. Sexuality remains important as people age and develop chronic and acute illnesses.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 241 OBJ: 13-1 MSC: Psychosocial Integrity

2. A 70-year-old female patient shares with the nurse her concern that recently it takes more time

to achieve an organism. The nurse responds most therapeutically when answering: a. “You’ve described a common result of aging for both men and women.” b. “If you experience difficulty achieving orgasms, you should discuss that with your doctor.” c. “Your body produces fewer sex hormones now, and you need more stimulation to climax.” d. “I understand your concern. Let’s talk more about the changes you’ve noticed.”

ANS: C

In both genders, the reduced availability of sex hormones in older adults results in less rapid and less extreme vascular responses to sexual arousal. The nurse should first share this information with the patient then offer to talk more about concerns. Although this is a normal finding, simply stating this does not give the woman much information. The nurse should be willing to discuss sexual concerns with the patient and not just pass the patient along to someone else.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 223 OBJ: 13-1 MSC: Physiologic Integrity

3. A type 2 insulin-dependent diabetic 70-year-old recently lost his wife and is experiencing

impotence. Besides educating the patient on the normal effects of aging on sexual function, the nurse should initially include information regarding: a. the effect that stress has on sexual performance. b. the effect of diabetes mellitus on the vascular system. c. the link between depression and sexual dysfunction. d. sexual dysfunction related to long-term use of insulin.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B

Erectile dysfunction (ED) can occur at any age. This patient’s chronic illness and its effect on the vascular system have priority when educating the patient about possible causes of ED. After discussing physiologic causes of ED, the nurse can then turn to psychosocial causes.

Physical issues take priority over psychosocial ones.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 13-4 MSC: Physiologic Integrity

4. Upon entering the room of a cognitively impaired older adult patient, the nurse observes that

he is exposed and rubbing his genitals. The nurse’s initial concern is to: a. alert staff to be aware of this new behavior. b. provide the patient with privacy. c. assess him for possible pain and fever. d. provide a verbal cue for him to stop the behavior.

ANS: C

Dementia may result in unmet sexual needs resulting in such behavior; however, this behavior may also indicate pain, hyperthermia, or the need to be freed from a restrained situation. Later the nurse can inform staff of the behavior, particularly if it is a new behavior, and ensure the patient has privacy. There is no need to cue the patient to stop this behavior as long as it is done in a private setting.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 13-5 MSC: Physiologic Integrity

5. To effectively assess an older adult patient’s sexual needs, the nurse must initially: a. reflect on personal feelings that create barriers to effective communication with the

patient. b. be familiar with the sexual needs of the older adult population. c. assess the patient’s physical capacity to engage in sexual activities. d. inform the patient of the personal nature of the detailed questioning this

assessment requires.

ANS: A

Nurses may feel intimidated or uncomfortable questioning older adults about their sexual desires and needs. To effectively assess the patient’s sexual history, the nurse must first reflect on his or her personal attitudes concerning sex and the older adult patient. The nurse should also gather information, assess individual patients, and, if needed, let the patient know the nurse will be asking questions related to sexuality.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 243 OBJ: 13-2 MSC: Psychosocial Integrity

6. An older adult patient recovering from a radical prostatectomy is discussing his postsurgical

care plan with the nurse when he expresses concern about long-term impotence. The nurse initially responds: a. “I’d suggest a consult with a sexuality counselor for you and your partner.” b. “When you’ve healed sufficiently, we can discuss prosthetic devices that help.” c. “There are medications called phosphodiesterase inhibitors that minimize that problem.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. “While postsurgical erectile dysfunction is likely, it is generally temporary.”

ANS: D

Radical prostatectomy, a curative treatment for cancer of the prostate gland, involves a massive disturbance of hormone-producing glands, surrounding nerves, and urinary structures. This often results in temporary urinary incontinence and impotence. It may take 2 to 3 years to regain function. Referring the patient so quickly indicates a lack of willingness to discuss the issue. Prosthetic devices and medications imply the condition is permanent, and while the patient may need such assistive devices, the nurse should first provide encouraging information.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 246 OBJ: 13-4 MSC: Physiologic Integrity

7. The charge nurse on an extended care unit recognizes an immediate need for additional unit

education regarding sexuality and the older adult when overhearing a staff member state: a. “I’ve had to tell her to stop touching my breasts twice today.” b. “Someone needs to tell him to keep his pants zipped.” c. “I realize they have needs, but I’m not sure how to handle that.” d. “It’s sad that Alzheimer disease causes them to become sexual perverts.”

ANS: D

Although staff education about the sexuality and intimacy of older adults should include recognition of cues, desires, and interest in sexual activities, it needs to immediately address eliminating stereotypes, such as “the dirty old man” or “perverts.” The nurse is within his or her rights to limit behavior that includes touching inappropriately. A male patient may need to be reminded to keep his pants zipped. The staff member who is unsure how to help with sexual needs is expressing a legitimate concern.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 13-6 MSC: Psychosocial Integrity

8. An older adult female patient who has multiple sexual partners asks the nurse if the risk for

contracting HIV really does increase as we age. The nurse shows the best understanding of this risk when responding: a. “Any time one engages in sex with multiple partners, the risk for contracting HIV increases.” b. “Changes in vaginal tissue and immune function increase the risk, especially if sex is unprotected.” c. “Unless you are engaging in unprotected oral sex, your risk does not increase substantially.” d. “Yes, your risk of contracting a sexually transmitted disease (STD) including HIV, dramatically increases as you age.”

ANS: B

The age-related thinning of the vaginal mucosa and subsequent vaginal tissue disruption, as well as age-related reductions in immune function, place older adults at increased risk for HIV infection. The risk does increase with increasing numbers of sex partners, but this combined with physical changes is the critical piece of information. HIV can be contracted through any sexual activity.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 245 OBJ: 13-3 MSC: Physiologic Integrity

9. Through the open door of the patient’s room, the nurse observes a male patient and his long-

term partner in a romantic embrace. The nurse’s priority intervention is directed toward: a. reinforcing for the staff the patient’s intimacy needs. b. explaining to the patient the challenges that his relationship poses for the staff. c. offering to discuss the barriers to intimacy that the patient and his partner face. d. quietly closing the door to address the patient’s right to privacy.

ANS: D

All patients have the right to sexual expression if they are cognitively capable of making decisions. No matter the sexual orientation of the patient, privacy should be respected unless the need for safety is paramount. The nurse should close the door quietly. There is no need for other action unless the staff members need to be reminded of this information.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 13-6

10. The gerontologic nurse wants to begin assessing concerns related to sexuality among the

population of patients seen in the clinic. What action by the nurse is best? a. Give the patients questionnaires to fill out. b. Get permission to discuss sexuality with them. c. Tell the patients you are now assessing sexuality. d. Ask the patients if they have concerns about sex.

ANS: B

Many of today’s older population grew up when sexuality was not openly discussed, so they may feel uncomfortable with this topic. The nurse should bring up the subject and ask their permission to discuss this aspect of their lives. The other options are not as likely to start an open-ended conversation.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 13-7 MSC: Psychosocial Integrity

11. The nursing manager feels that intimacy needs are not being assessed or addressed by the staff

on the unit. What action by the manager is best? a. Tell the staff sexuality is expected to be assessed. b. Provide the staff with education on sexuality. c. Obtain tools for staff to use when assessing sexuality. d. Allow those with cultural objections to opt out.

ANS: B

Education is the first step in this process. Once staff members understand that sexuality is a normal part of life at any age, the manager can provide tools for staff to use for assessment.

Simply telling the staff to assess sexuality does not help them overcome their discomfort.

Persons with cultural objections should be given extra time and attention to become comfortable with the practice, but they should realize that their patients’ needs come first. The manager may be able to negotiate a comfortable agreement with these staff members.

DIF:

Applying (Application)

REF: N/A

OBJ: 13-7

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 12. The nurse notes the patient’s chart lists “dyspareunia” as a complaint. What teaching does the

nurse plan to provide? a. Use of water-soluble lubricants b. Performing Kegel exercises c. Deep breathing and relaxation d. Use of antifungal medications ANS: A

Dyspareunia is painful intercourse, which has several causes, one of which is vaginal dryness.

The nurse can teach the woman about water-soluble lubricants. Kegel exercises are not related. Deep breathing and relaxation do not address the physical issue. Antifungal medications are not warranted.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 13-4 MSC: Physiologic Integrity

13. The nurse using the permission, limited information, specific suggestions, and intensive

therapy (PLISSIT) model offers specific suggestions when: a. Referring the patient to a sex therapist. b. Discussing over-the-counter lubricants. c. Teaching safer sex practices. d. Discussing sexual positioning after hip surgery.

ANS: D

Specific suggestions are those related to concerns about how medical conditions affect or are affected by sexuality. The nurse discussing positions acceptable after hip replacement surgery is offering specific suggestions. Referring is the intensive therapy (IT) component. The other two options fall under limited information (LI).

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 13-7 MSC: Psychosocial Integrity

14. The patient who recently had a radical prostatectomy has the nursing diagnosis of ineffective

sexuality patterns. What assessment by the nurse best indicates that the goals for this diagnosis have been met? a. Patient states he can live without sex. b. Patient says that impotence is temporary. c. Patient states his needs are being met. d. Patient asks about medication for ED. ANS: C

Goals for this diagnosis are met when the patient is satisfied with means for sexual expression. The other options do not meet this criterion.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 13-7 MSC: Psychosocial Integrity

15. An older adult has begun dating after being widowed for many years. The adult confides to

the nurse about having several sexual partners. What action by the nurse is best? a. Warn the patient that the family may not appreciate the situation. b. Teach the patient about safer sexual practices including condoms.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Ask the patient if there are any medical concerns related to sex. d. Tell the patient he or she may begin to have feelings of guilt.

ANS: B

The chances of STDs, including HIV, increase with the increased number of sexual partners.

Many older patients do not know about safer sexual practices, so for patient safety, this is the priority.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 13-9 MSC: Psychosocial Integrity

16. What information about sexuality is contrary to research on sexuality in older men? a. Erections are not as firm. b. It takes longer to obtain erections. c. Erectile dysfunction is inevitable. d. Ejaculation may not be a strong.

ANS: C

Erectile dysfunction is not an inevitable part of aging. The other statements are true.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 243 OBJ: 13-3 MSC: Physiologic Integrity

17.

A patient with arthritis has difficulty participating is sex because of joint pain and stiffness.

What action by the nurse is best? a. Suggest a warm shower prior to sexual activity. b. Ask the patient if he or she needs more pain medication. c. Explore other ways of expressing sexuality. d. Refer the patient to a rheumatologist.

ANS: A

A warm shower can reduce pain and stiffness, making sexual activity more enjoyable. The patient may need more pain medication, but the sedating effects may be counterproductive.

The patient does not indicate he or she cannot or does not want to participate in sex, so suggesting other means of expression is not really addressing the core issue. Referral is possible, but the nurse needs to provide some intervention first.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 13-9 MSC: Physiologic Integrity

18. An older male patient is seen in the family practice clinic and tells the nurse he no longer

takes his metoprolol (Toprol) because “it interferes with my lifestyle.” What action by the nurse is best? a. Warn the patient of the complications of hypertension. b. Ask the patient if he can afford the medication. c. Tell the patient this drug often causes erectile dysfunction. d. Take the patient’s blood pressure and record the findings.

ANS: C

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The nurse should let the patient know that medications in this drug class often cause erectile dysfunction. The nurse can then assess the patient for this issue. Warning the patient of complications does not address the core problem and neither does taking his blood pressure.

Asking the patient if he can afford the medications can be addressed later if ED is not a problem.

REF: N/A 19. A male patient takes carbamazepine (Tegretol). The spouse reports sexual dysfunction, but the

patient adamantly denies he has this problem. What response by the nurse is best? a. Telling him, “You need to think of your wife’s needs too.” b. Telling him this is common and can be discussed if wanted. c. Questioning the patient again about sexual functioning d. Telling the doctor to change the patient’s prescription ANS: B

The nurse should provide the information that this drug causes ED and leave the door open for the patient. This way the patient knows he has “permission” to bring the topic up in the future.

Repeatedly questioning the patient about sexual functioning is not likely to encourage the nurse-patient relationship. Telling the doctor to change the prescription is overstepping the patient’s autonomy.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 13-4

20. A patient has many sexual partners but does not use condoms. What action by the nurse is

best? a. Ask the patient what he or she knows about HIV. b. Assess the patient for barriers to using condoms. c. Give the patient statistics on HIV in older adults. d. Tell the patient safer sex practices should be used.

ANS: B

The nurse should assess for barriers to implementing safer sexual practices. Simply giving the information does not help the patient implement it. Telling the patient what to do does not respect the patient’s autonomy.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 13-9 MSC: Physiologic Integrity

21. A recently widowed patient reports new onset of sexual dysfunction. There are no new

medications or illnesses. What action by the nurse is best? a. Assess the patient’s alcohol intake. b. Refer the patient for counseling. c. Ask if there are new partners. d. Have the patient speak to the doctor.

ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Alcohol can have an effect on sexual functioning. The nurse first assesses for this condition, as it is objective in nature. The patient may need a referral or to speak with the provider, but the nurse needs to intervene first. Asking the patient if there are new partners does not address the issue.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 13-7 MSC: Psychosocial Integrity

22. A patient lives in a long-term care facility and has mild dementia. The patient has been

showing interest in another resident. What action by the nurse is best? a. Determining if the resident has decision-making capacity. b. Refusing to allow the residents to be alone together. c. Asking the resident’s family if the relationship is okay. d. Providing time for the residents to be together.

ANS: A

The first step is to determine if the resident (actually both) has decision-making capacity. If so, the nurse allows them to be together and provides privacy when possible. If one or both residents are not capable of making decisions, the nurse enlists the opinion of that resident’s family.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 13-5 MSC: Safe Effective Care Environment

23. The family of a resident in an assisted living facility contacts the director to say they are

“appalled” that the resident is allowed to have pornographic magazines in the room. What response by the director is most appropriate? a. “We will take those away immediately.” b. “Your loved one has the right to have these.” c. “How do you know about these magazines?” d. “He cannot stay here if he has these in the room.”

ANS: B

A cognitively intact adult has the right to have and view legal pornographic materials in the privacy of his or her apartment. The director should inform the family of this information.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 13-9 MSC: Psychosocial Integrity

MULTIPLE RESPONSE 1. The nurse working in long-term care knows there are several barriers to sexual expression for

older patients. Which of the following are barriers? (Select all that apply.) a. Decreasing desire b. Medication side effects c. Disease processes d. Social circumstances e. Increased libido ANS: A, B, C, D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Many barriers to sexual expression exist for the older patient including decreased desire (libido), side effects of medications, disease processes, and social circumstances.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 246 OBJ: 13-6 MSC: Psychosocial Integrity

2. The nurse is learning about postmenopausal changes that can affect sexuality in women.

Which of the following are included? (Select all that apply.) a. Shortening of the vagina b. Need to void after intercourse c. Vaginal dryness d. Vaginal irritation needs investigation e. Vaginal secretions diminish ANS: A, B, C, E

Shortening of the vagina with decreased secretions and dryness as well as the need to void after intercourse are all normal changes that accompany aging. Vaginal irritation does not necessarily need investigation, as this is a normal finding also.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 243 OBJ: 13-3 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 14: Pain Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. When planning care for the older adult experiencing pain, the nurse bases interventions on the

realization that: a. generally pain control is less effective than it is for younger adults. b. this cohort is less pain sensitive than younger adults. c. older adults are more likely to verbally express pain than younger adults. d. pain is undertreated in this cohort compared to younger adults.

ANS: D

Pain is underrecognized, highly prevalent, and undertreated among older adults.

DIF: Remembering (Knowledge) TOP: Nursing Process: Analysis

REF: Page 256 OBJ: 14-4 MSC: Physiologic Integrity

2. An older patient is observed grimacing whenever walking and getting in and out of bed. When

assessed, the patient regularly denies having any pain. To best provide the patient with effective pain control, the nurse initially: a. discusses the effects of untreated pain on the patient’s general wellness. b. offers the patient a prescribed prn analgesic. c. asks the patient why he is denying the presence of pain. d. documents the symptoms that the patient is exhibiting.

ANS: A

Older adult patients actually underreport pain and are therefore at risk for undertreatment of pain, which may cause unnecessary suffering, exacerbation of the underlying disease, and reduction in activities of daily living (ADLs) and quality of life. Without this information the patient is unlikely to take the prn medication. “Why” questions are not therapeutic, as they place people on the defensive. The symptoms should be documented, but this should not be the only action.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 14-2 MSC: Physiologic Integrity

3. The nurse caring for an older adult patient experiencing carpal tunnel syndrome anticipates

the patient will best achieve pain control when prescribed a(n): a. narcotic (e.g., fentanyl). b. opioid (e.g., oxycodone). c. tricyclic antidepressant (e.g., amitriptyline [Elavil]). d. nonpharmacologic strategy (e.g., wrist bracing).

ANS: C

Neuropathic pain results from a pathophysiologic process involving the peripheral or central nervous system. These types of pain respond to unconventional analgesic drugs, such as tricyclic antidepressants. Carpal tunnel syndrome is caused by nerve injury.

DIF:

Analyzing (Analysis)

REF: N/A

OBJ: 14-8

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. When planning care for the older adult patient with a history of persistent pain, the nurse

acknowledges the effects of the mind-body connection by including: a. regular pain assessments. b. prompt response to reports of pain. c. pain consults. d. relaxation techniques.

ANS: D

Some mind-body therapies include meditation, relaxation, guided imagery, and cognitive behavioral counseling. The other actions are appropriate but not related to mind-body therapies.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 266 OBJ: 14-8 MSC: Physiologic Integrity

5. An older adult patient has been prescribed an opioid to manage chronic pain resulting from a

shoulder injury. To eliminate a common barrier to opioid drug compliance, the nurse: a. encourages the patient to use the opioid only as prescribed. b. educates the patient about the appropriate management of constipation. c. assures the patient that dizziness will decrease as therapeutic levels are reached. d. suggests the patient take the medication with meals or a snack.

ANS: B

Older adults have a high rate of discontinuation of opiates because of the resulting constipation. The treatment for constipation, especially that which is opioid induced, is readily available and should be provided as a preventive measure before starting narcotic pain medication. The other actions do not address this issue.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 263 OBJ: 14-4 MSC: Physiologic Integrity

6. The nurse is discussing pain control with an older patient who has been prescribed an opiate.

When the patient expresses concerns about the diminishing effect that the medication has had on the pain, the nurse responds: a. “It appears that the dosage you take needs to be adjusted upward.” b. “We need to be concerned about you developing a drug tolerance.” c. “This drug category is well known for its low ceiling effect.” d. “Opiate addiction is a concern when tolerance occurs.”

ANS: A

Tolerance is defined as the diminished effect of a drug while maintaining the same dosage over time. It is a characteristic of opiates when given over time. With opiates, some individuals might need higher and higher doses of a drug to maintain effectiveness. This should not be confused with addiction.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 263 OBJ: 14-8 MSC: Physiologic Integrity

7. An older patient is being treated for arthritic pain with a nonsteroidal anti-inflammatory drug

(NSAID). Which question best assesses for side effects of this medication class? a. “Have you noticed your heart skipping beats since you began taking this drug?”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. “Did you know you should not to stand up too quickly?”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. “Are you aware that you should take your pain medication with food?” d. “Have you had any episodes of shortness of breath since starting this medicine?”

ANS: C

The most common complaint associated with NSAIDs is indigestion. Indigestion may be reduced with antacid use or food consumption timed to coincide with analgesic intake.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 263 OBJ: 14-8 MSC: Physiologic Integrity

8. The nurse is caring for an older adult patient with terminal cancer who is receiving medication

via patient-controlled analgesic (PCA) pump. The nurse shows an understanding of primary end-of-life concerns when asking the patient: a. “Do you have any concerns about receiving your medication intravenously?” b. “Are you satisfied with the way your pain is being managed?” c. “Are you worried about becoming addicted to the narcotic analgesics?” d. “Do you have any questions concerning how to use the PCA properly?”

ANS: B

Terminally ill patients generally identify their main concern as pain control. The other questions do not address this issue.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-8 MSC: Physiologic Integrity

9. The nurse is performing a pain assessment when the older adult patient reports pain in his left

shoulder that radiates down into the forearm. The nurse immediately: a. recognizes that the patient is experiencing cardiac distress. b. alerts the rapid response team to provide emergency care. c. asks whether he has ever experienced this pain before. d. questions the patient about additional related symptoms.

ANS: C

Assessment is essential in differentiating acute life-threatening pain from longstanding chronic pain. Otherwise, disease progression and acute injury may go unrecognized and be attributed to preexisting disease or illness. The patient may or may not be experiencing cardiac ischemia, the rapid response team does not need to be called, and the nurse can assess for other symptoms after determining if this pain is new or not.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-6 MSC: Physiologic Integrity

10. An older adult who injured her knee several years ago tells the nurse that she has been

managing the resulting intermittent pain with a prescription for propoxyphene (Darvon). The nurse is concerned with this treatment plan, primarily because: a. less expensive alternative analgesics are available. b. this long-term need for a narcotic warrants investigation. c. aspirin would likely be as effective in managing the pain. d. the knee should not still be causing pain for the patient.

ANS: B Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The nurse needs to complete a full assessment to determine what type of pain the patient is experiencing and if a narcotic is the best alternative for the patient. Other medications may be more beneficial.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-8 MSC: Physiologic Integrity

11. The nurse is caring for a 78-year-old with a history of chronic depression. The patient

currently reports persistent left shoulder pain since having a fall a year ago. To best address the patient’s pain, the nurse initially determines: a. if the patient is still at risk for falls. b. the severity of the shoulder injury. c. how effectively depression is being managed. d. the patient’s ability to effectively cope with pain.

ANS: C

Persistent depression affects a person’s ability to cope with the pain, so it must be treated. The nurse should also assess fall risk but that is secondary to determining why the pain has lasted so long and if the patient is able to cope.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-4 MSC: Psychosocial Integrity

12. Acetaminophen (Tylenol) is prescribed for a 70-year-old with chronic pain. When the patient

reports to the nurse that the maximum daily dose of medication does not control the pain, the nurse responds: a. “Breakthrough pain can be managed with the addition of another analgesic.” b. “Transcutaneous electrical nerve stimulation (TENS) is often helpful.” c. “It sounds as though you have developed a tolerance for acetaminophen.” d. “We will need to get your physician to prescribe another analgesic for you.”

ANS: D

The patient needs a comprehensive review of pain strategies, which will probably include changing pain medication. Using the maximum dose of acetaminophen long term can cause liver damage, which is another reason the patient should switch medications if it is not working.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 14-8 MSC: Physiologic Integrity

13. An older adult patient is prescribed an analgesic to manage the joint pain resulting from

stiffness in his right shoulder. When the patient asks about alternative therapy techniques that might be helpful, the nurse suggests: a. applying ice packs to the area three to four times a day. b. placing a moderately warm heating pad to the shoulder. c. arranging for a professional massage on a weekly basis. d. discussing electrical nerve stimulation with the physician.

ANS: B

Heat is useful in decreasing pain and discomfort resulting from joint stiffness by increasing the elasticity of muscles. Ice is better for acute exacerbations. Massage may or may not help Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

but would be more expensive. Electrical nerve stimulation is not warranted.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) REF: Page 266 OBJ: 14-8 TOP: Teaching-Learning MSC: Physiologic Integrity 14. The nurse caring for an older cognitively impaired patient with osteoarthritis in both hands

assesses the patient for hand pain by: a. observing for facial grimacing when the patient uses a fork to eat. b. being alert for signs of agitation when washing the patient’s hands. c. listening to detect moaning when patient makes a fist. d. watching for signs that the patient is reluctant to shake hands.

ANS: B

Cognitively impaired patients in pain may not portray any visible signs of pain or distress or may be unable to communicate their pain. Pain may result in agitation, as well as increased pulse, respiration, blood pressure, and confusion. The other options are not as indicative of pain in the cognitively impaired older adult.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 258 OBJ: 14-4 MSC: Physiologic Integrity

15. A director of nursing in a long-term care facility was concerned after reading that as many as

80% of residents have untreated pain. What action by the director is best? a. Establish protocols for routine assessment. b. Make a “pain plan” for every resident. c. Involve family members in treating pain. d. Educate the staff on how to assess pain.

ANS: A

Nursing begins with assessment. The director should implement a protocol for routine assessments of pain in both cognitively impaired and intact residents. A “pain plan” cannot be created without this assessment data. Family members should be encouraged to provide input.

The staff may or may not need to have education on assessment.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 14-7 MSC: Physiologic Integrity

16. An older patient who lives alone is brought to the clinic by an adult child who reports the

patient has become “depressed” and no longer wants to go out of the home. What action by the nurse is best? a. Assess the patient for depression. b. Ask the patient why activities are avoided. c. Assess the patient for pain. d. Assess the patient for elder abuse.

ANS: C

Many older adults have pain that goes untreated. Consequences of untreated pain are numerous and include depression and withdrawal. The nurse should first assess for pain.

Assessing for depression or elder abuse may be warranted as well. Asking “why” questions is not therapeutic, as patients tend to become defensive.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-2 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 17. A confused patient is admitted to the hospital after suffering a fall. When asked about pain, the

patient does not respond. What action by the nurse is best? a. Ask the patient again using different words. b. Pantomime what you are asking the patient. c. Observe the patient’s nonverbal behaviors. d. Ask the family members if they think the patient has pain.

ANS: C

In some situations, the nurse cannot rely on the patient’s report of pain, so as a second method of assessment, the nurse looks to the patient’s nonverbal behaviors. The nurse should be aware, however, that the lack of specific “pain behaviors” does not indicate a lack of pain. The other options may be helpful for individual patients.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-4 MSC: Physiologic Integrity

18. A patient has just had surgery. What pain control strategy is best? a. Administer prn medications when requested. b. Give pain medications around the clock at first. c. Start with nonopioids then progress to opioids. d. Ask the patient his or her preference for medication.

ANS: B

After surgery the patient is expected to have pain. The best way to control acute pain is through round-the-clock dosing (at least at first) to keep the patient’s pain from getting out of control. The nurse should assess the patient’s preferences, but should assess preferences for pain levels, because the patient may not be experienced in receiving pain medications.

Opioids are expected for acute pain from surgery.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 14-8 MSC: Physiologic Integrity

19. An older patient is hospitalized for the first time. After giving a dose of hydromorphone

(Dilaudid), what assessment takes priority? a. Pain level b. Nausea c. Urinary retention d. Respiratory rate ANS: D

Respiratory depression is common with opioid analgesics. All assessments are appropriate; however, respiratory assessment takes priority.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-8 MSC: Safe Effective Care Environment

20. An older adult lives alone at home and is being treated for chronic pain. The home health care

nurse notes the adult is disheveled and has dirty dishes piled up in the sink. What action by the nurse is best? a. Notify adult protective services. b. Arrange for hospitalization.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Assess the patient’s pain. d. Assess the patient’s cognitive status.

ANS: C

Although all actions might be appropriate depending on circumstances, because the patient is being treated for pain and has a functional decline, the nurse should assess first for unrelieved pain.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 14-8 MSC: Physiologic Integrity

21. A patient has constipation as a side effect of opioid analgesics. What menu choice indicates

the patient understands nutritional therapy for this problem? a. Scrambled eggs b. White bread c. Canned fruit d. Oatmeal ANS: D

Constipation can be managed with high fiber and increased water. Oatmeal has the highest fiber content of the four foods listed.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 14-1 MSC: Physiologic Integrity

22. The nurse is caring for four frail patients with pain. Which patient’s pain medication

prescription does the nurse question? a. The patient taking pentazocine (Talwin) b. The patient taking acetaminophen (Tylenol) c. The patient taking ibuprofen (Motrin) d. The patient taking hydromorphone (Dilaudid) ANS: A

Talwin should not be used in frail older people because it leads to central nervous system excitement, confusion, and agitation. The other drugs are appropriate choices.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 14-8 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. When planning nursing care for an older adult who is experiencing chronic pain, the nurse

includes which of the following interventions? (Select all that apply.) a. Maintain mobility. b. Promote autonomy. c. Manage any chronically painful condition. d. Provide economical sensitive pain relief. e. Support the patient’s right to be pain-free.

ANS: A, B, C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Goals for pain management in older adults include control of chronic disease conditions that cause pain, maintenance of mobility and functional status, promotion of maximum independence, and improvement of quality of life.

DIF: Application (Apply) MSC: Physiologic Integrity

REF: N/A

TOP: Nursing Process: Planning

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 15: Infection Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. To educate patients on health promotion measures to minimize the effect of normal age-

related changes in immunity, the geriatric nurse: a. describes the effects of low-dosage antibiotic therapy on opportunistic infections. b. reinforces the usefulness of lymphocyte counts to detect new infections. c. discusses the need for yearly flu immunization. d. stresses the importance of maintaining intact skin and mucous membranes.

ANS: D

The skin is the largest immunologically active system of the body and the body’s first line of defense. With aging, the skin becomes more fragile and susceptible to breakdown or abrasion, thus negatively impacting the natural defenses. A yearly flu vaccination is important, but is too narrow in scope to be the best answer. Using antibiotics for current infections is not health promotion. Lab work is used after infection is present or suspected.

DIF:

Understanding (Comprehension)

REF: Page 271

OBJ: 15-6

2. An older adult patient who is generally in good health starts experiencing numerous colds and

now pneumonia. What factor from the nursing history most likely has placed the patient at increased risk for the development of these infections? a. A beloved pet died 6 months ago. b. The patient was diagnosed with osteoarthritis 5 years ago. c. The patient worked as an oncology nurse before retiring. d. The patient’s spouse is immunosuppressed.

ANS: A

Psychosocial factors may impact the immune status. These factors include chronic and acute stress, depression, bereavement, and social relationships. The other factors would not increase the patient’s risk for infection.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 272 OBJ: 15-3 MSC: Physiologic Integrity

3. An older patient smoked tobacco most of the adult life. When planning health promotion

education for this patient, the nurse includes information that such smoking: a. may produce alterations in the immune response. b. is a risk factor for community-acquired pneumonia. c. decreases the production of an immunoglobulin called IgA. d. increases the risk of gastric cancer.

ANS: B

Although the major host factor associated with community-acquired pneumonia is advanced age, smoking, alcohol abuse, chronic lung disease, recent history of viral upper respiratory tract infection, and neurologic disease are other contributing factors.

DIF:

Remembering (Knowledge)

REF: Page 273

OBJ: 15-4

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning

MSC: Physiologic Integrity

4. An older adult patient is experiencing problems with chewing while recovering from

extensive oral surgery. The nurse best affects this patient’s risk for infection by: a. ordering a mechanical soft diet for the patient. b. monitoring the patient regularly for any low-grade fever. c. providing regular oral care with an antibiotic mouthwash. d. asking which flavors of protein supplement drink the patient would prefer.

ANS: D

Nutritional supplements for a patient with an eating disorder or dysfunction can decrease the patient’s susceptibility to infection by providing protein. The patient still may not be able to chew a mechanically soft diet. Oral care will help but will not decrease the problem. The patient needs protein, and it is best made available as a drink because of the chewing problems.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 15-6 MSC: Physiologic Integrity

5. The nurse caring for a cognitively impaired older adult admitted to an acute care facility best

minimizes this particular patient’s risk for developing a nosocomial infection by: a. proper hand washing after each patient contact. b. admitting the patient to a private room. c. assigning staff to assist the patient with eating meals. d. screening visitors to minimize contract with pathogens.

ANS: C

Poor nutrition can contribute to a patient’s risks for developing a nosocomial infection, particularly among the older immunocompromised population. Many of the cognitively impaired older adults are already malnourished, so improving nutrition is a priority. Hand washing should occur before and after patient contact. A private room is not necessary.

Screening visitors is not the best option; good nutrition will improve the patient’s immune status, although obviously ill visitors should not visit.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 15-2 MSC: Physiologic Integrity

6. An immunosuppressed older adult patient reports symptoms of fatigue, facial rash,

intermittent low-grade fever, and painfully swollen finger joints. The nurse anticipates that diagnosis will be confirmed by: a. the presence of subcutaneous nodules on the hands. b. a positive antinuclear antibody (ANA) blood serum test. c. a liver biopsy that confirms cirrhosis. d. the presence of bilateral ocular scleritis.

ANS: B

The antinuclear antibody is one of the more specific tests for lupus; patients with lupus have a positive ANA test. The patient with an autoimmune disease is more susceptible to infection than others.

DIF:

Remembering (Knowledge)

REF: Page 273

OBJ: 15-1

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 7. The geriatric nurse identifies the patient with the greatest risk of immunosuppression as: a. having a roommate infected with MRSA. b. having numerous oral mucosal ulcers. c. receiving treatment for rheumatoid arthritis. d. being cognitively impaired.

ANS: C

Individuals receiving corticosteroids, such as for rheumatoid arthritis, have a diminished inflammatory process and decreased immunity. Open ulcers anywhere can lead to infection, but chronic steroid use places the patient at high risk. Patients with methicillin-resistant Staphylococcus aureus (MRSA) are in isolation. Being cognitively impaired does increase risk, but not as much as steroid use.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 274 OBJ: 15-5 MSC: Physiologic Integrity

8. The nurse caring for an older adult patient currently receiving traditional drug therapy for

methicillin-resistant Staphylococcus aureus (MRSA) recognizes that the patient is at risk for developing: a. Clostridium difficile infection. b. vancomycin-resistant Enterococcus (VRE) infection. c. autoimmune hepatitis. d. systemic lupus erythematosus.

ANS: B

The antibiotic of choice for MRSA infection is vancomycin. However, exposure to vancomycin is a risk factor for the acquisition of VRE. C. difficile is possible when bowel flora are disturbed, as in during antibiotic therapy. Autoimmune hepatitis and lupus are not related.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 274 OBJ: 15-5 MSC: Physiologic Integrity

9. The nurse caring for an older adult patient being treated for influenza is especially careful to

monitor and document assessment data related to: a. cognitive function. b. respiratory function. c. fluid intake. d. urinary output.

ANS: B

Pneumonia may follow influenza, so respiratory function must be assessed effectively.

The other assessments are not as high a priority.

DIF: Application (Applying) TOP: Nursing Process: Assessment

REF: N/A OBJ: 15-6 MSC: Physiologic Integrity

10. A patient who is currently being treated for rheumatoid arthritis exhibits symptoms suspicious

of tuberculosis (TB). The nurse anticipates that: a. the symptoms are a result of the patient’s rheumatoid arthritis. b. the symptoms are actually side effects of corticosteroid therapy.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. a chest radiograph will definitively confirm a diagnosis of TB. d. a purified protein derivative (PPD) skin test will likely be negative.

ANS: D

Diminished inflammatory responses may lead to false-negative results for skin tests used in the diagnosis of disease, for example, the purified protein derivative (PPD) skin test for tuberculosis. These reduced responses are even more likely to occur in people who have diseases or drug treatments that further suppress the immune system.

DIF: Remembering (Knowledge) TOP: Nursing Process: Analysis

REF: Page 275 OBJ: 15-5 MSC: Physiologic Integrity

11. The nurse wishes to control infection by manipulating the portal of entry. What action best

demonstrates this process? a. Using sterile technique to insert a catheter b. Encouraging patients to eat high-protein meals c. Ensuring housekeeping keeps rooms clean d. Providing patients with vitamin supplements ANS: A

Inserting a catheter can introduce microbes via the urinary meatus, the portal of entry. The other factors relate more to improving the status of the host and eliminating reservoirs.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 15-6 MSC: Physiologic Integrity

12. A patient is hospitalized with a nonhealing leg ulcer. Lab work does not demonstrate anemia.

What action by the nurse is best? a. Encourage the patient to choose high-protein meal items. b. Request a consultation with the registered dietician. c. Consult the physician regarding a serum zinc level. d. Consult the physician about adding an iron supplement.

ANS: C

Low levels of zinc can lead to poor wound healing, impaired cell-mediated immunity, and altered protein synthesis. Because other indicators of anemia are negative, the nurse should request a zinc level.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 15-2 MSC: Physiologic Integrity

13. An older patient is hospitalized for an exacerbation of chronic obstructive pulmonary disease

(COPD), for which the patient is on chronic steroid use. The patient also has a fresh dog bite on the arm, which is not reddened, swollen, and only slightly tender. The patient is afebrile, but the nurse finds the patient confused and agitated. What action by the nurse is most appropriate? a. Place the patient on fall precautions. b. Put a bed alarm on the patient’s bed. c. Call the rapid response team. d. Perform a sepsis screening exam.

ANS: D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Older adults have an age-related decrease in immune function, plus this patient is on medication that diminished immune responsiveness. With the fresh wound, the nurse would be concerned about sepsis. The patient may be septic without showing local or systemic signs of infection other than confusion. Fall precautions and bed alarms may be necessary. The rapid response team is not needed.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 15-1| 15-5 MSC: Physiologic Integrity

14. A patient claims that all food is bland since “I got old.” What suggestions does the nurse

provide to this patient? a. Add extra salt to your food. b. Try eating some tart foods. c. Eat soft food with gravy. d. Drink high-protein shakes.

ANS: B

As people age, their taste discrimination diminishes. The older adult can be advised to add extra seasoning (not salt because of concerns with cerebrovascular disease), add tart tastes, use sauces, and substitute other meats for beef. Soft food with gravy would be a good suggestion for the patient with dysphagia but would not be well received by the patient with diminished taste because of the consistency.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 15-6 MSC: Health Promotion

15. A nurse has identified an older patient as being at high risk of infection. Which assessment

data indicate that priority goals for this diagnosis have been met? a. The patient remains afebrile. b. The patient’s white blood cells (WBCs) are normal. c. The patient has no subjective complaints. d. The patient’s mental status is unchanged.

ANS: D

Older adults, with their diminished immune system, often do not develop classic signs or symptoms of infection, so a lack of fever and complaints and a normal white count do not eliminate the possibility the patient has an infection. Older adults frequently tend to have mental status changes with infection, so a normal mental status for the patient is a good sign that goals have been met.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 15-1 MSC: Physiologic Integrity

16. An older patient asks the nurse about taking Echinacea to prevent colds. What response by the

nurse is best? a. “That’s fine; it’s a very common herb.” b. “Older people should not use herbs.” c. “This herb may not be well produced.” d. “Echinacea has a deleterious effect on immunity.”

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Echinacea is a popular herb many people take to boost the immune system. However, herbs may not be produced consistently or tested thoroughly, so the patient is advised to speak to the provider about adding this herb. It has not been shown to be harmful to the immune system though.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 272 OBJ: 15-7 MSC: Physiologic Integrity

17. A student nurse is caring for a patient who has vancomycin-resistant enterococcus (VRE).

What action by the student requires the nurse to intervene? a. Washes hands for 15 seconds prior to entering the room b. Takes own stethoscope and unit Glucometer in the room c. Helps transfer the patient into a private room for isolation d. Puts on gloves and a gown prior to changing the linens ANS: B

Patients with VRE should be on isolation and have their own dedicated equipment. The nurse intervenes when the student starts to take his or her own stethoscope and the unit’s Glucometer into the room. The other actions are appropriate.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation MSC: Safe Effective Care Environment

OBJ: 15-6

MULTIPLE RESPONSE 1. The nurse caring for an older adult patient engages in appropriate cancer-related health

screening when which of the following occur? (Select all that apply.) a. Preparing a patient for a lung biopsy b. Collecting a 24-hour urine specimen c. Assisting a patient schedule a mammogram d. Drawing blood for a prostate sensitive antigen (PSA) test e. Keeping a patient NPO for a bladder biopsy ANS: A, C, D

Common types of cancer in older adults include lung cancer, breast cancer, and prostate cancer.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 273 OBJ: 15-1 MSC: Health Promotion

2. The nurse is preparing an educational facts sheet on human immunodeficiency virus (HIV)

and acquired immunodeficiency syndrome (AIDS) for older adults. What information does the nurse include? (Select all that apply.) a. Tainted blood transfusions are the greatest risk factor in older adults. b. Delayed recognition of HIV contributes to its poor prognosis. c. Twenty-five percent of AIDS cases in the United States are in persons older than 60. d. There is a short interval from HIV infection to AIDS in older adults. e. HIV and AIDS cases in this age cohort have stabilized since the late 1990s.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: B, D

The low clinical suspicion of HIV infection and delayed recognition of AIDS-defining infections contribute to the poor prognosis of HIV infection in older adults. The aging immune system is not able to eliminate the HIV residing in macrophages, lymphoid tissue, or the brain.

Because the immune system’s regenerative capacity is diminished and not all replacement cells are fully functional, the disease progresses more rapidly than in a younger cohort.

Tainted blood is not the primary means of infection in this cohort. About 31% of HIV cases are in older adults, and 17% of new HIV infections occur in people older than 50.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 274 OBJ: 15-4 MSC: Physiologic Integrity

3. The geriatric nurse caring for the older female immunosuppressed patient is particularly

concerned when the patient reports which of the following? (Select all that apply.) a. Flulike muscle aching b. Burning upon urination c. Nausea d. Night sweats e. Constipation ANS: A, B, D

Some of the more common infections in older adults include influenza (muscle aching), pneumonia, tuberculosis (night sweats), urinary tract infections (burning on urination), and shingles (herpes zoster). Nausea and constipation are not signs of these infections.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 15-6 MSC: Physiologic Integrity

4. The student learning about immunity understands that the chain of infection contains which

parts? (Select all that apply.) a. Portal of entry b. Susceptible host c. Virulence factors d. Reservoir e. Decreased immunity ANS: A, B, D

The chain of infection includes a portal of entry, a susceptible host, and a reservoir.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 270 OBJ: 15-6 MSC: Physiologic Integrity

5. A patient is receiving chemotherapy to treat cancer. What instructions does the nurse provide

the patient and family to reduce the chance of infection? (Select all that apply.) a. Take a full bath everyday if possible. b. If you can’t bathe, perform pericare. c. Avoid large crowds and ill people. d. You have to give away your pets. e. Eat high-calorie, high-protein food if able.

ANS: A, B, C, E Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Patients who are immune-suppressed should perform meticulous hygiene, stay away from exposure to illness, and eat nutritiously to help protect them from infection. Giving away pets is not required, although a family member may need to take over pet care duties.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 276-7 OBJ: 15-6 MSC: Physiologic Integrity

6. The nurse studying immunity understands that which are age-related changes in immune

system functioning? (Select all that apply.) a. Decreased number of lymphocytes b. Decreased number of T suppressor cells c. Atrophy of the thymic cortex d. Increased numbers of antibodies to self-antigens e. Decreased number of B cells ANS: B, C, D

Several age-related changes to the immune system occur, including decreased number of T suppressor cells, atrophy of the thymic cortex, and increased numbers of antibodies to selfantigens. The numbers of lymphocytes and B cells do not change.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 271 OBJ: 15-1 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 16: Chronic Illness and Rehabilitation Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse is preparing an older widowed patient with several chronic illnesses for discharge to

home. The nurse addresses the primary nursing outcome for this patient when: a. assuring the patient that social services will arrange for help with medical expenses. b. arranging for in-home assistance in areas of activities of daily living (ADLs) and nursing care as needed. c. educating the patient regarding the safety risks caused by these conditions. d. identifying barriers to ensure adherence to the prescribed drug therapies.

ANS: D

A key role for the nurse caring for an older adult with a chronic condition is to help the patient achieve optimal physical and psychosocial health. Staying adherent with drug therapy can help achieve this outcome. Payment through a third party is not guaranteed. In-home assistance may or may not be needed. Education is always needed but is not the priority for achieving optimal wellness.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 16-4 MSC: Physiologic Integrity

2. The nurse is assessing patients diagnosed with chronic disease processes for the probability of

hospitalization because of the exacerbation of related symptoms. The nurse recognizes that the patient with the highest probability is a(n): a. 72-year-old male with congestive heart failure (CHF). b. 82-year-old male with type 2 diabetes. c. 72-year-old female with chronic bronchitis. d. 82-year-old female with osteoporosis.

ANS: A

Individuals with chronic conditions typically have repeated hospitalizations to treat exacerbations of their illness. The most common reasons for hospitalization in older patients are heart disease, cancer, pneumonia, and stroke. The 72-year-old with CHF is at highest risk.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: N/A OBJ: 16-4 MSC: Physiologic Integrity

3. An older patient has developed moderate muscle weakness on the left side as a result of a

cerebral vascular accident (CVA, stroke). The nurse determines the patient possesses the healthiest view of self-wellness when heard stating: a. “I’ll certainly miss hiking, but I guess I’ll find something else to do outdoors.” b. “I was getting too old to safely practice karate.” c. “I’ve decided to take up oil painting because it’s difficult for me to knit.” d. “It was getting difficult to work in the garden anyway.”

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

After learning and mastering the requirements imposed by the condition, older adults often view themselves as “well.” With a wellness-in the-foreground perspective, the disease is only one component of their life and is not their identity, so they substitute lost abilities and resulting pleasures with others.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 16-2 MSC: Psychosocial Integrity

4. A 73-year-old patient has been diagnosed with congested heart failure (CHF). The nurse

provides the greatest support for this patient’s positive view of self-wellness by presenting information regarding: a. how to minimize the exacerbation of symptoms. b. locally available supportive services. c. the importance of adherence to medical treatment. d. the need to report symptoms promptly.

ANS: A

Many older adults now seek education about health promotion and management of their illness. The nurse can support older adults by teaching self-care management in these areas.

The other actions are also valued, but learning how to control symptoms gives patients the feeling of accomplishment.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 16-5 MSC: Physiologic Integrity

5. The nurse is caring for an older patient who recently immigrated to the United States from

Asia. To best address the patient’s apparent resistance to the medical and nursing plan of care, the nurse: a. discusses the patient’s behavior with Asian staff members. b. researches the patient’s cultural views on health care. c. requests a cultural consultation from social services. d. asks family members to discuss the patient’s views on health care.

ANS: D

Concepts of health and illness are deeply rooted in culture, race, and ethnicity and influence an individual’s (and family’s) illness perceptions and health and illness behavior. The patient’s family should have the best insight into the patient’s culturally biased beliefs. Discussing behavior with other staff members might be a privacy violation. Researching culture may be helpful, but each patient is an individual and should not be stereotyped. Social services may or may not be able to provide cultural services.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 16-5 MSC: Psychosocial Integrity

6. The nurse feels most confident that an older patient is prepared to assume self-management of

new type 2 insulin-dependent diabetes when the patient: a. is heard asking her son to check the insulin’s expiration date. b. is able to identify the symptoms of hypoglycemia. c. asks why she needs to test her glucose levels so frequently. d. inquires why she needs to have an A1C test every 3 months.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Adherence is greatly improved when the patient is in agreement with the treatment plan and shows a willingness to follow it. The patient is requesting help ensuring that the insulin is not expired. Knowledge about symptoms does not equate with adherence. Asking questions does not indicate adherence or not.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 16-2 MSC: Physiologic Integrity

7. The nurse impacts the trajectory of a patient’s type 2 insulin-dependent diabetes best by: a. evaluating the patient’s ability to administer insulin appropriately. b. providing the patient with a written copy of the treatment plan. c. explaining to the patient the importance of serum glucose control. d. providing the patient with research-based nursing care.

ANS: A

The illness trajectory can be modified by actions taken by the health care provider that directly affect the patient’s ability/interest to adhere to the treatment plan prescribed. The other actions are important but do not directly affect the illness trajectory.

DIF: Applying (Application) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 16-3 MSC: Health Promotion

8. An older patient diagnosed with severe osteoarthritis has recently moved in with his son

ecause of a history of falls. The son describes how he and his family have eagerly assumed responsibility for “meeting all Dad’s needs.” The nurse is most concerned that this environment will result in the patient: a. developing a sense of powerlessness and possibly a loss of hope. b. becoming unnecessarily physically and emotionally dependent. c. losing his will to “get better” and become independent again. d. becoming resentful and argumentative with his son’s family.

ANS: A

With no control over the meeting of his own needs, the patient may develop a sense of powerlessness, which can result in a loss of hope. The other concerns might be a problem for some patients, but powerlessness and loss of hope remain the priority.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 286 OBJ: 16-3 MSC: Psychosocial Integrity

9. To best assist an older adult patient to cope with a new diagnosis of chronic renal failure, the

nurse: a. asks the patient to describe her usual coping strategies. b. provides the patient with descriptions of new coping strategies. c. initiates discussions with the patient to explain the disease. d. offers to arrange a meeting with another patient with the diagnosis.

ANS: C

Understanding the illness and what to expect is directly related to the ability to cope. After the patient has information, the nurse can then assess psychosocial systems.

DIF:

Applying (Application)

REF: N/A

OBJ: 16-3

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 10. To best help manage health care costs in older adults, the nurse entrepreneur would do which

of the following? a. Create a telehealth system where nurses could check on patients daily. b. Provide local transportation services for older people to keep appointments. c. Create educational videos in multiple languages seen in the community. d. Build a nurse-run clinic to serve the homeless and underinsured population.

ANS: A

The majority of health care expenditure is spent on chronic illness. Patients with chronic illnesses have multiple hospitalizations for exacerbations of their conditions. Keeping chronic conditions under control would make a difference in health care cost. A telehealth service in which nurses could assess and counsel patients daily could help accomplish that goal. The other ideas are good too, but tight control of chronic conditions is a priority.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 16-5 MSC: Health Promotion

11. A nurse is working with a patient who was diagnosed with type 2 diabetes 4 months ago. The

patient’s blood sugars have stayed under control. What action by the nurse is best? a. Ask the patient what barriers to wellness still exist. b. Remind the patient about the A1C in 2 months. c. Review side effects of medications with the patient. d. Ask the patient how she or he feels about diabetes.

ANS: A

Older patients typically see chronic illness as one part of their lives. The nurse can support older adults by working with them to identify areas that may hinder progress along the wellness continuum and by teaching self-care management in these areas. The nurse should assess the patient’s needs from his or her point of view.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 16-5 MSC: Health Promotion

12. A nurse is assessing quality of life (QOL) in older individuals with chronic illnesses who

attend a community center. What information is most important to assess? a. How many days were lost to exacerbations in the last year b. How good each individual perceives his or her QOL to be c. How burdensome the patient’s treatment regime is daily d. How often the patient needs to see a health care provider ANS: B

QOL is individualized for each patient, and each person is the only one who can rate his or her quality of life. It is not dependent on objective measures such as number of health care visits or how many days were spent sick.

DIF: Application (Applying) TOP: Nursing Process: Assessment

REF: N/A OBJ: 16-1 MSC: Psychosocial Integrity

13. Nurses should evaluate health programs based on what data? a. Effect on quality of life b. Cost-benefit ratio of service Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Adherence statistics d. Ease of following through ANS: A

Quality of life should drive treatment decisions. The patient and health care provider should set goals that are mutually acceptable and promote independence and quality of life. The other factors are considerations, but quality of life is most important.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 16-5 MSC: Health Promotion

14. A student learning about the early AIDS epidemic wonders why the patients were stigmatized.

What response by the nurse was best? a. Fear of the unknown etiology b. Expense required government assistance c. Patients being ashamed of their illness d. Younger patients not having accomplishments ANS: A

Stigma arises out of specific characteristics of a disease or an unknown etiology, which causes fear. In the early days of the AIDS epidemic, not much was known about transmission, which generated fear in health care workers and the general population.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 286 OBJ: 16-3 MSC: Psychosocial Integrity

15. When working with older adults with chronic illness and exacerbations, what action by the

nurse is most appropriate? a. Continually assess the patients for adherence to the regime. b. Assess the patients for ways they can remain in control. c. Teach the patients about the illness trajectory. d. Routinely review all medications the patients are taking.

ANS: B

With exacerbations, the patient loses some control over an acute phase of the illness. The patient can be helped to maintain independence, control, and dignity by reassessing what is still within the patient’s ability and desire to control. The patient may or may not be adherent, but the nurse should not assume he or she is not. Teaching about the illness trajectory is one tool for giving control to patients. Medication reviews should be done but are not the best action.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 16-3 MSC: Psychosocial Integrity

16. An older patient has moved into an adult child’s home after an extended stay at a

rehabilitation facility. The patient complains the child is now “the boss” and the child complains about caregiving duties. What action by the nurse is best? a. Help the older patient find another place to live. b. Suggest that it is time for assisted living. c. Mediate a family meeting to discuss roles. d. Listen empathetically but let them work it out.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: C

Role reversals and role changes are common in families where an older adult has chronic illnesses. These lost roles need to be mourned by all involved. The nurse helps most in this situation by mediating a family meeting where roles, coping, and feelings can be discussed.

The nurse can help problem solve by assisting the individuals to identify ways in which they can keep their traditional roles, if even only for a short time.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 16-3 MSC: Psychosocial Integrity

17. An older adult has chronic fatigue from several illnesses. The patient is frustrated at this

symptom. What action by the nurse is best? a. Ask the patient to prioritize activities. b. Have the patient keep a fatigue diary. c. Encourage the patient to rest in the day. d. Instruct the patient on good sleep hygiene.

ANS: A

Helping the patient cope with fatigue is an important nursing intervention. The nurse should first ask the patient to prioritize the activities she or he most wants to do. Then the nurse and patient can plan strategies that will allow the patient to participate in these activities. Keeping a diary is helpful, but knowing what interests the patient most is more important. Rest and sleep are important, but they are not the priorities.

DIF: Applying (Application) TOP: Nursing process: Assessment

REF: N/A OBJ: 16-3 MSC: Psychosocial Integrity

18. An older patient has been admitted to the nursing unit after a car crash and surgery. When

does the nurse begin planning for rehabilitation? a. On admission b. When the patient is awake c. When the patient is stable d. When the family requests it ANS: A

Planning for rehabilitation, like discharge planning, begins on admission.

DIF: Remembering (Knowledge) TOP: Nursing Process: Analysis

REF: Page 289 OBJ: 16-3 MSC: Physiologic Integrity

19. A home health care nurse is conducting a functional assessment on an older woman who lives

alone. What assessment question is likely to get the best information? a. How do you manage all your medications? b. Who shops and cleans your house for you? c. Can you show me how you prepare a meal? d. What parts of your body can’t you wash?

ANS: C

Older patients may downplay or deny functional limitations, so the nurse gets more accurate data asking what the patient is able to do, rather than what she or he is not able to do.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) REF: Page 290 OBJ: 16-2

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Assessment

MSC: Physiologic Integrity

20. A nurse assesses a newly admitted patient to a nursing home using the Functional

Independence Measure (FIM) and rates the patient at 20. What action by the nurse is best? a. Arrange admission to a rehabilitation center. b. Plan care for a nearly dependent person. c. Plan care for a nearly independent person. d. Tells the family the patient is cognitively impaired.

ANS: B

Eighteen measures are accounted for in the FIM with scores ranging from 1 (dependent) to 7 (independent). A score of 20 indicates near total dependence. The FIM does not measure cognitive status.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 16-3 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. Adherence to prescribed health care treatments by a patient with a chronic disease is best

facilitated when the nurse does which of the following? (Select all that apply.) a. Provides the patient with information regarding his disease b. Assesses the patient’s ability to understand his disease c. Defines “health and wellness” for the patient d. Helps the patient identify barriers to his personal wellness e. Coordinates support services to facilitate the patient’s discharge ANS: A, B, D, E

The five As of a patient’s self-management of care includes assess, advise, agree, assist, and arrange.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 284 OBJ: 16-3 MSC: Physiologic Integrity

2. The student learning about chronic disease and illness in the older population learns which

facts about this situation? (Select all that apply.) a. One in two adults, or more than 133,000 Americans, has a chronic condition. b. Chronic disease is the leading cause of death in those over 65. c. About 75% of medical costs each year are spent on managing chronic disease. d. Formerly acute conditions are now manageable chronic diseases.. e. The focus of America’s health care services is now on chronic illness ANS: A, B, C, D

One in two adults has a chronic illness, and these problems are the leading cause of death in those over 65 and the largest cost to our health care system. One reason for this is that formerly acute, possibly fatal, conditions are now manageable as chronic conditions.

America’s health care system continues to be focused on acute care.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 282 OBJ: 16-1 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 3. The nurse understands what about the Americans with Disabilities Act? (Select all that apply.) a. It outlaws discrimination on the job because of disabilities. b. It requires state governments to fund disability services. c. It prohibits discrimination in government services to the disabled. d. It requires all buildings to be retrofitted to allow access. e. It provides funding for barrier-free buildings and parks.

ANS: A, C

The ADA outlawed discrimination on the basis of disability in employment, in programs and services provided by state and local governments, and in the provision of goods and services provided by private companies and commercial facilities. It does not mandate government payment for disability services, require buildings to be retrofitted, or provide funding for barrier-free facilities.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 289-90 OBJ: 16-1 MSC: Safe Effective Care Environment

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 17: Cancer Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. When planning an educational program on cancer for a group of older adults, the nurse

incorporates information regarding racial and ethnic patterns of cancer in the United States that includes evidence that: a. the incidence of cancer is highest among African Americans. b. Native Americans have the highest overall incident rates of cancer. c. incidence rates for lung cancer are lowest for white women. d. Hispanic women have the lowest incidence rates of cervical cancer.

ANS: A

Cancer affects Americans of all racial and ethnic groups; however, the incidence of cancer does demonstrate patterns according to racial and ethnic origins. African Americans have higher overall incidence rates than whites, whereas Hispanic Americans and Native Americans have lower incidence rates overall.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 297 OBJ: 17-2 MSC: Physiologic Integrity

2. An older adult patient asks the nurse why so many of her friends are developing cancers. The

nurse responds best when answering: a. “Cancer cells generally develop as a result of prolonged exposure to external agents.” b. “The longer we live the more exposure we have to environmental toxins.” c. “Aberrant growth seems to be the risk factor in the older adult that is not well understood.” d. “As we age, our cells are less able to regulate replication appropriately.”

ANS: D

The aging cell has a tendency toward aberration or abnormalcy as it replicates. Aberrant cell growth is related to failure of growth control mechanisms, which leads to less cell regulation during replication. Cancer occurs more commonly in replicating than in nonreplicating cell groups, which suggests that changes in internal cellular control mechanisms give rise to cancer.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 299 OBJ: 17-1 MSC: Physiologic Integrity

3. An older adult patient expresses concern about developing cancer in the future and asks the

nurse advice about cancer prevention. The nurse shares that: a. “Eating foods high in protein, such as chicken and fish, promote cell growth and repair, thus minimizing the risk.” b. “Although there are some behaviors that can help minimize your risk, the possibility of developing cancer is usually determined by age 65.” c. “Most cancers that develop after age 65 generally respond well to cancer treatment modalities.” d. “Cancers that develop late in life are generally slow growing, so they generally do Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

not contribute to this group’s mortality.”

ANS: B

Most cancers are the result of a lifelong exposure, so the risk of developing malignant disease after age 65 is probably already determined by the time one reaches that age. If exposure to promoters can be avoided or reduced and antipromoters can be used, then cancerous transformation may not take place or may be delayed. The other statements are not accurate.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 300 OBJ: 17-1 MSC: Physiologic Integrity

4. An older adult patient has rheumatoid arthritis, which limits her manual dexterity and ability

to perform breast self-examinations. To address the patient’s need for breast health promotion, the nurse teaches the patient to: a. use the palm of her hand to perform monthly breast examinations. b. schedule a mammogram every 12 months. c. check each breast while in the shower if possible. d. visit her physician yearly for a breast examination.

ANS: A

Older women, while having the highest incidence of breast cancer, have been shown to have the least knowledge about the importance of breast examination. Modifying and encouraging self−breast examination would be the most effective intervention to promote breast health.

The other actions are good but not as helpful as adapting the technique of self-exam so the woman can accomplish it.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 17-3 MSC: Health Promotion

5. Which statement, if made by an older Caucasian adult man, indicates the need for further

teaching about prostate cancer and its prevention? a. “Digital rectal examinations aren’t needed for screening.” b. “I should discuss having a yearly PSA test.” c. “Prostate cancer can look a lot like an enlarged prostate.” d. “I am not in a high-risk category for prostate cancer.”

ANS: A

The digital rectal exam and prostate-specific antigen (PSA) blood test are the two main screening methods for prostate cancer. Men should begin discussions about screening for this cancer when they are 50. The digital rectal exam is less costly than a blood test. The other statements show understanding.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 17-3 MSC: Health Promotion

6. When obtaining a health history, the nurse recognizes that an older adult patient has a risk

factor for colorectal cancer when he reports: a. that he is a vegetarian who eats soy products. b. that he often needs laxatives for constipation. c. a history of inflammatory bowel disease. d. that diarrhea occurs at least monthly.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: C

A personal or family history of colorectal cancer, polyps, or inflammatory bowel disease has been associated with increased colorectal cancer risk. The other options do not increase this patient’s risk.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 305 OBJ: 17-1 MSC: Physiologic Integrity

7. While awaiting the results of testing to determine a diagnosis of cancer, an older adult patient

asks a nurse to explain what happens when cancer metastasizes. The nurse responds: a. “It is the result of prolonged exposure to an external agent.” b. “Cancer cells convert from transformed cells into small clusters of clonal cells.” c. “Cell control mechanisms fail, giving rise to aberrant cell growth.” d. “Cancer cells move from one location to another unconnected location.”

ANS: D

Metastasis involves a change in location of the cancer cells from one organ or part of the body to another that is not directly connected. The other statements are not correct.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 299 OBJ: 17-1 MSC: Physiologic Integrity

8. The family of an older adult diagnosed with cancer asks the nurse to explain how gene therapy

might be beneficial. The nurse responds: a. “The treatment decreases blood flow to the tumor and it dies.” b. “A virus is injected into the tumor and then it can’t grow.” c. “The cancer cell’s nucleus is destroyed and the cell shrivels.” d. “Photosensitizers are introduced into the cells so lasers can kill them.”

ANS: B

Gene therapy involves the injection of a virus that makes the cancer cells incapable of reproducing.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 308 OBJ: 17-1 MSC: Physiologic Integrity

9. The nurse observes a suspicious mole on the back of an older adult who is undergoing

palliative radiotherapy for brain metastasis. The nurse suspects that the mole: a. is a result of the radiation. b. is a secondary cancer. c. will not be screened. d. was the primary cancer.

ANS: C

Screening should not be conducted if there is no intent or ability to pursue findings with more complete evaluation and treatment. The goal of screening is to detect early cancer that is amenable to treatment; this patient is undergoing palliation, which means he or she is not expected to live but is getting the radiation for symptom control.

DIF: Analyzing (Analysis) TOP: Nursing Process: Analysis

REF: N/A OBJ: 17-3 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 10. An older adult patient with breast cancer is reluctant to agree to the suggested treatment plan

because “I have heard such horrible things about radiation therapy.” The nurse responds: a. “Radiation therapy no longer causes such terrible side effects.” b. “Your chances of recovery are best when radiation is included.” c. “Ask the oncologist if there are alternative treatments.” d. “Actually there is very effective symptom control now.”

ANS: A

Cancer care has changed dramatically over the years; however, many older adults remember friends or relatives who were treated with now outdated therapies that had devastating side effects. The other statements do not address the primary concern, which is side effects of the treatment.

DIF: Understanding (Comprehension) REF: Page 309 TOP: Communication and Documentation

OBJ: 17-4 MSC: Physiologic Integrity

11. After a course of chemotherapy for cancer of the throat, an older adult patient is admitted to

the hospital with persistent nausea and vomiting. The nurse should initially assess the patient for: a. weight loss and weak gag reflex. b. anemia and poor muscle tone. c. oral inflammation and ulceration. d. dehydration and infection.

ANS: D

Drug-induced nausea and vomiting can result in dehydration, decreased caloric intake, and weight loss. Chemotherapy in general will impact the immune system’s ability to combat infections. All assessments are important, but dehydration and infection (or sepsis) need to be treated immediately.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 17-5 MSC: Physiologic Integrity

12. The daughter of an older adult woman who had a colostomy as a result of colon cancer tells

the nurse, “Mom seems to be so withdrawn; she has stopped going out with her friends and I’m really concerned.” The most relevant nursing diagnosis for the patient’s reaction is: a. Ineffective individual coping. b. Dysfunctional grieving. c. Social isolation. d. Hopelessness.

ANS: C

Voluntary social isolation may result when an older adult with cancer no longer feels comfortable in social settings because of his or her situation, including, for example, changes in body image, energy levels, or interests. Older persons with cancer may withdraw because they perceive that others are uncomfortable in their presence and because they believe, rightly or wrongly, that others are avoiding them because of the cancer diagnosis. Coping may be disturbed in this patient as well. The patient may be grieving loss of her former healthy self, and she may feel hopeless. But social isolation fits the daughter’s data.

DIF:

Applying (Application)

REF: N/A

OBJ: 17-6

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Diagnosis

MSC: Psychosocial Integrity

13. An older adult patient diagnosed with colon cancer is being evaluated for surgical removal of

the tumor. The nurse explains that the primary consideration is the: a. absence of any chronic disorders. b. absence of metastasis. c. tumor’s staging status. d. patient’s presurgical health status.

ANS: D

The curability of cancer in older adults is largely predicted by an individual’s ability to tolerate major surgery. The absence of metastasis and the tumor stage will impact additional treatments. Absence of chronic illness is not a factor in and of itself.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 309 OBJ: 17-4 MSC: Physiologic Integrity

14. An older adult patient is undergoing palliative surgery for colon cancer metastasis. The nurse

explains to the family that this intervention is intended to: a. prolong the patient’s life by several months. b. improve the effectiveness of the chemotherapy. c. relieve the pain associated with spread of the tumor. d. prevent further tumor growth.

ANS: C

Surgery may be indicated for palliative care in cases in which large primary or metastatic tumors can be reduced; the size or location of the tumor can create problems such as compression of surrounding tissues and organs, leading to pain, necrosis, or organ failure.

Palliative procedures are designed to manage symptoms.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 309 OBJ: 17-4 MSC: Physiologic Integrity

15. The nurse is admitting a patient to the hospital who has cancer and a neutrophil count of 430/

mm3. What action by the nurse is best? a. Place the patient in a private room. b. Use good handwashing with all contact. c. Place the patient in protective precautions. d. Initiate contact precautions.

ANS: C

A patient whose neutrophil count is below 500/mm3 is at extreme risk of infection and should be placed on protective isolation. A private room and good handwashing are also necessary, but the best intervention is isolation.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 17-5 MSC: Safe Effective Care Environment

16. A patient is admitted to the hospital for chemotherapy and has severe mucositis. What action

by the nurse is best? a. Provide frequent oral care with saline.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. Have the family bring the favorite mouthwash.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Document the patient’s oral assessment. d. Ensure teeth are brushed with a firm toothbrush.

ANS: A

Frequent oral care is a must for patients with mucositis. However, commercial products contain alcohol, and the patient needs gentle products that do not contain alcohol. Saline is a good option. Documentation should occur, but the nurse should act to address the problem. A soft toothbrush or swab is preferred for comfort.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 17-5 MSC: Physiologic Integrity

17. A patient has severe watery diarrhea from chemotherapy and is embarrassed having to be

cleaned up frequently. The nurse notes several open areas on the patient’s rectal area that cause pain. What nursing diagnosis takes priority? a. Acute pain b. Impaired skin integrity c. Ineffective coping d. Decreased cardiac output ANS: B

Physical needs take priority over psychosocial ones. The patient has open areas and impaired skin integrity, but no information shows decreased cardiac output. The pain is related to the impaired skin, so treating that will diminish the pain.

DIF: Analyzing (Analysis) TOP: Nursing Process: Diagnosis

REF: N/A OBJ: 17-5 MSC: Physiologic Integrity

18. An older patient getting cisplatin (Platinol) asks the nurse how it works. What is the best

response? a. Prevents RNA transcription and DNA replication b. Interferes with synthesis of chromosomal nucleic acid c. Formed from soil fungi; prevents RNA and DNA synthesis d. Binds to cell proteins and inhibit mitosis ANS: A

Cisplatin is an alkylating agent, which prevents RNA transcription and DNA replication.

Antimetabolites interfere with synthesis of chromosomal nucleic acid. Antitumor antibiotics prevent RNA and DNA synthesis. Plant alkaloids bind to cell proteins and inhibit mitosis.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 311 OBJ: 17-4 MSC: Physiologic Integrity

19. An older patient on chemotherapy is in the oncology clinic for follow-up. The nurse notes the

patient appears depressed. What action by the nurse should occur first? a. Assess the patient for depression. b. Review the patient’s chemotherapy. c. Ask the patient about suicidal ideation. d. Inquire how the patient has been feeling.

ANS: B Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The nurse should assess the patient for depression; however, prior to doing so, the nurse should review the patient’s chemotherapy. Some chemotherapy drugs can cause depression, and it may be a confusing picture. Depending on the results of the screening, asking about self-harm may be appropriate. Inquiring how the patient is feeling is appropriate, but it is not the most important action.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 17-6 MSC: Psychosocial Integrity

20. The family of an older patient recently diagnosed with cancer reports that the patient seems to

be in denial, refusing to choose treatments and planning an extended vacation. What response by the nurse is best? a. Ask the patient how he or she feels about the diagnosis. b. Tell the patient treatment started early has the best results. c. Refer the patient to a licensed mental health professional. d. Tell the family that the patient will get over it in his own time.

ANS: A

This patient may be experiencing a compensatory form of grief and not allowing him- or herself to ponder the enormity of the situation at one time. Rather, the patient may be allowing bits of information to seep into his or her existence slowly in order to make sense of it. This is adaptive and the nurse should ask the patient how he or she feels about the cancer. Telling the patient that treatment must start early may be too harsh and the patient may not be ready to make decisions. The patient probably does not need a mental health professional; rather the patient should be left to come to terms with this diagnosis on her or his own terms. Using phrases like “get over it” are judgmental and imply the patient is doing something wrong.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 17-5

MULTIPLE RESPONSE 1. The nurse is using a tool to assess the quality of life of a hospice patient. The nurse addresses

the appropriate areas of concern when asking which of the following questions? (Select all that apply.) a. “Are you able to bathe yourself?” b. “Did your grandson get the grass cut like he planned?” c. “How would you rate your pain on a scale of 1 to 10?” d. “Do you still have concerns about your will?” e. “Can we talk about why you never remarried?”

ANS: A, B, C, D

Quality of life was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The MVQOLI determines levels of symptom distress, patient ability to function, social support, affairs in order, and religious comfort or support. Asking about why the patient never married is not appropriate at this time.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 317 OBJ: 17-6 MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 2. The nurse suspects the older adult patient will require diagnostic testing for possible lung

cancer when the patient does which of the following? (Select all that apply.) a. Reports smoking two packs of cigarettes daily b. Reports severe chest pain c. Loses 10 pounds in 1 month d. Takes several naps daily e. Locates a palpable lump on the left lateral chest ANS: A, C, D

The classic clinical presentation of lung cancer is a persistent cough, sputum streaked with blood, chest pain, and recurring pneumonia or bronchitis. This constellation of symptoms is also associated with cigarette smoking, and their significance as indicators of cancer may be overlooked. Other symptoms include more systemic complaints such as anorexia, weight loss, and fatigue. Older persons more often experience dyspnea and weight loss, whereas pain is less frequent.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 301 OBJ: 17-3 MSC: Health Promotion

3. The nurse is preparing discharge education for an older patient and his family. The patient’s

hemoglobin is currently 8.2 mg/dL as a result of cancer treatment therapy. To best address the patient’s hematology status, the nurse includes instructions to do what? (Select all that apply.) a. Include eggs or an egg substitute into the daily diet. b. Avoid strenuous exercise until hemoglobin improves. c. Regularly take both a mid-morning and mid-afternoon nap. d. Have a green leafy salad with vegetables at meals. e. Check for bruising to the extremities and the gums.

ANS: A, B, C, D

Instruct the patient and family to increase rest and sleep periods as well as to incorporate foods into the diet that are high in iron, such as eggs, lean meat, green leafy vegetables, carrots, and raisins. These interventions are directed toward conserving energy and providing iron. Avoiding strenuous activity will decrease the chance of injury. Bleeding and bruising would indicate low platelet count.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 17-5 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 18: Loss and End-of-Life Issues Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse documents that a newly widowed older adult patient is likely experiencing physical

grief responses when she: a. becomes hypotensive. b. has difficulty getting up from the chair. c. reports having tightness in the chest. d. develops a red rash over her upper chest and back.

ANS: C

Physical symptoms are commonly associated with acute grief responses. Tearfulness, crying, loss of appetite, feelings of hollowness in the stomach, decreased energy, fatigue, lethargy, and sleep difficulties are common symptoms of grief. Other physical sensations may include tension, weight loss or gain, sighing, feeling something stuck in one’s throat, tightness in one’s chest or throat, heart palpitations, restlessness, shortness of breath, and dry mouth.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 326 OBJ: 18-3 MSC: Psychosocial Integrity

2. The nurse is confident that an older adult is successfully completing the tasks associated with

mourning his wife’s death when he: a. shares that, “No amount of wishing will bring her back.” b. openly cries in the presence of family and friends. c. takes cooking classes at the local community college. d. takes a female acquaintance to the movies.

ANS: D

The last task in the process of mourning is the withdrawal of emotional energy and the reinvestment in another relationship; this entails withdrawing emotional attachment to the lost person and continuing on with life.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 328 OBJ: 18-5 MSC: Psychosocial Integrity

3. Although the family of a newly widowed older adult patient lives several hours away, they are

interested in providing appropriate support. The nurse suggests it would be most helpful if they would: a. telephone daily and arrange for a neighbor to help with the shopping. b. assume responsibility for paying the bills and upkeep of the home. c. encourage the patient to move into a smaller home and learn to drive. d. include the patient in their yearly vacation plans ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Loneliness and problems associated with the tasks of daily living are two of the most common and difficult adjustments for older bereaved spouses. Calling daily will help alleviate the loneliness. Taking over responsibilities may take away the only thing the patient “has left.”

Learning to drive may be important, but the family should not encourage the patient to make a major life decision like moving now. Taking the patient on vacation is a nice idea, but this occurs yearly versus calling daily.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 18-3 MSC: Psychosocial Integrity

4. A man who recently lost his wife of 50 years shares with the nurse that he’ll “never get over

missing her.” The nurse is most therapeutic when responding: a. “We are here to help you anyway we can.” b. “Focus on the beautiful memories you have of her and your life together.” c. “Time will help you adjust to your loss.” d. “You’ll never get over your loss but you can learn to live with it.”

ANS: D

The third step in the process of mourning is the adjustment to an environment in which the deceased is missing. Older spouses have reported that they feel as though they will never “get over” their loss; instead, they have learned to live with it. It is nice to let the patient know you are here for him or her, but this does not give any useful information to help the patient.

Telling the patient to focus on memories is dismissive. The nurse should not use clichés like “time will help.”

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 18-5

5. The nurse documents that a patient is likely experiencing exaggerated grief when observing

which behavior? a. Keeps telling family and friends that her spouse “can’t be dead.” b. Re-reads her late spouses diaries nightly since the death 2 years ago. c. Develops severe abdominal pains on each anniversary of her spouse’s death. d. Becomes agitated whenever someone refers to the spouse’s death or “moving on.”

ANS: B

Exaggerated grief reactions occur when normal feelings of anxiety, depression, or hopelessness grow to unmanageable proportions. People with exaggerated grief may feel an overwhelming sense of being unable to live without the deceased person. They may lose the sense that the acute grief is transient and may continue in this intense despair for a long time.

Re-reading diaries each night is the most specific example of this type of grief.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 18-4 MSC: Psychosocial Integrity

6. The nurse is caring for an older adult who recently lost an adult child as a result of automobile

accident. They shared a home and enjoyed a healthy parent-child relationship. The nurse is confident that the patient has progressed appropriately through the mourning process when the patient is observed doing which action? a. Tells family members that her child is “in a better place.” b. Arranges for personal grief counseling.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Cries softly during the family’s first year memorial service. d. Plans a summer vacation with friends from work.

ANS: D

Mourning is often used to refer to the ritualistic behaviors in which people engage during bereavement. More recently, mourning is the term used for processes related to learning how to live with one’s loss and grief. The last task of mourning is emotionally relocating the deceased person and moving on with life. Going on a vacation with friends is a good example of this. The other actions do not show this resolution.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Assessment

REF: N/A OBJ: 18-5 MSC: Psychosocial Integrity

7. The nurse evaluates how an older adult patient will react to the death of a spouse based on

how the patient: a. expresses concern for his spouse during a prolonged illness. b. reacts when their beloved dog was sent to live with an adult child. c. demonstrates his or her philosophy of health and happiness. d. expresses how his spouse’s illness has impacted their life together.

ANS: B

One’s responses to loss and death are characterized by one’s natural reaction to all kinds of losses, not just death. People’s responses depend on their perception of the events and the meaning of the loss within the context of their lives and their physical, psychosocial, and spiritual life patterns. This behavior will likely be similar for all major losses, including the relocation of a pet. The other options do not demonstrate a grief reaction.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 18-4 MSC: Psychosocial Integrity

8. A novice hospice nurse shows the best understanding of the nursing role related to an older

adult patient’s mourning over the loss of an adult child when stating: a. “I see mourning as a very individualized process.” b. “The patient’s coping skills need to be assessed regularly.” c. “The patient needs all the help I can give to get better.” d. “Hopefully the patient will be in a healthy mental state soon.”

ANS: A

The goal of nursing care for older persons who are grieving and mourning is not to “make them feel better” quickly, although nurses are often tempted to try to do so. Nurses should assist and support bereaved persons through the grieving process, recognizing that pain is a normal and healthy response to loss and allowing bereaved persons to accomplish the tasks of mourning in their own ways.

DIF: Application (Applying) TOP: Nursing Process: Assessment

REF: N/A OBJ: 18-3 MSC: Psychosocial Integrity

9. An older adult man has been the primary caregiver for his chronically ill wife for the past 10

years. When his wife dies, the nurse prepares the family for the likely possibility that their father will express: a. guilt that he is alive while she is dead.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. deep despair for his loss.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. personal relief that she has died. d. concern that he could have cared for her better.

ANS: C

For some older persons, the grief experience may include feelings of relief and emancipation, especially after prolonged suffering or a difficult relationship. Because this may occur, the nurse should let the family know of its possibility. The other options are possible too; however, the relief response is a more universal experience.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 326 OBJ: 18-3 MSC: Psychosocial Integrity

10. A hospice nurse shows the best understanding of the personal commitment to the dying

patient by: a. providing the patient with sufficient, effective pain management therapies. b. addressing the patient’s need to feel valued by those attending to his or her death. c. being available emotionally and physically throughout the dying process. d. empathizing with the patient and his or her family and friends during the process.

ANS: C

Once a nurse becomes committed to working with a patient and family throughout the dying process, it is important to follow through on this commitment as much as possible. The other options are narrower in scope.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 18-9 MSC: Psychosocial Integrity

11. The nurse shows an understanding of the primary factor that facilitates the adjustment to the

loss of a spouse when asking: a. “Are you planning to continue to run your flower shop?” b. “How long were you and your spouse married?” c. “Does your son and his family live nearby?” d. “Do you consider yourself a religious person?”

ANS: A

For those who have strong social support and established patterns of independent interaction outside the lost relationship, the adjustment process toward creating new social roles and interactions may occur more quickly.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 18-5 MSC: Psychosocial Integrity

12. The nurse determines that the daughter of a widowed older adult patient has a poor

understanding of the grieving process when she reports that: a. “Mom is going to be okay; she is a strong, independent woman.” b. “It’s been 16 months since Dad died, but Mom still hasn’t moved on with her life.” c. “My mother has agreed to come and live with me for at least a little while.” d. “My mom cries when she looks at pictures of Dad, but I think she needs to cry.”

ANS: B

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

It used to be believed that after the first anniversary of the death, grief should be resolved.

This has been shown to be inaccurate; many factors influence the time for adjustment. Older persons who have experienced multiple losses may need more time. For some, the losses may never be resolved; a person may simply learn to live with the feelings of grief. In any case, the time needed for grieving is individualized.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 18-3 MSC: Psychosocial Integrity

13. When a 66-year-old patient dies as a result of surgical complications, the nurse begins to

facilitate the family’s acceptance of their loss by: a. preparing each family member sufficiently prior to viewing the body of their loved one. b. presenting the body of their loved one in an appropriate, respectful manner. c. assuring them that the patient received the best possible care postsurgery. d. providing them with an effective explanation of the problems that caused the patient’s death.

ANS: D

Having information about the death and the events preceding and following the death is important in helping to actualize the loss. The nurse should prepare the family members on what to expect when viewing the body and prepare the body in a respectful way as this shows respect and caring. Assurances that the patient received the best care possible may sound hollow.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 18-9 MSC: Psychosocial Integrity

14. A hospice nurse is caring for a patient and notes the patient’s spouse engaged in anticipatory

grieving. What action by the spouse best demonstrates this reaction? a. Spending time learning about the business owned by the patient b. Receiving many visitors from church and social organizations c. Delegating household tasks so the spouse can stay with the patient d. Taking long walks outside then napping for extended periods ANS: A

Anticipatory grieving includes the processes of mourning, coping, and planning that are initiated when the impending loss of a loved one becomes apparent. It serves to reduce shock, confusion, and depression. The spouse learning about a business he or she will likely have to take over shows future planning. The other actions do not.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 18-4 MSC: Psychosocial Integrity

15. The nurse knows a family whose adult child killed several people before taking his own life.

The funerals of all involved were held on the same 2 days. The nurse notes the family seems embarrassed, uncomfortable with expressions of sorrow, and wants a very quiet funeral. What type of grief does the nurse suspect the family has? a. Anticipatory b. Disenfranchised c. Masked Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. Complicated ANS: B

Disenfranchised grief occurs when the loss cannot be openly acknowledged and causes complications because there is lack of social support for the survivors. In this situation where the adult child died under such terrible circumstances, the family may feel they have no right to grieve when their child caused so many others grief. Anticipatory grief occurs when a death is impending. Masked grief is a self-protective mechanism for those who cannot bear the process of mourning. Complicated grief includes masked grief.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 327 OBJ: 18-4 MSC: Psychosocial Integrity

16. A patient has been grieving the loss of a spouse and seems to be doing surprisingly well when

a beloved pet dies. The patient demonstrates extreme signs of sadness and despair, saying, “I cannot possibly go on without Kitty.” When working with the family, what does the nurse suggest? a. Get the patient another cat. b. Suggest the patient see the physician. c. Refer the patient to a grief therapist. d. Suggest they take the patient on a trip.

ANS: C

This patient is demonstrating a delayed or postponed grief reaction. Doing “surprisingly well” may indicate a lack of grief response at the original loss, then an exaggerated reaction to a smaller, subsequent loss. The most appropriate action is to refer the patient and family to a grief counselor who can help the patient work through both losses. Getting another cat dismisses the importance of the first one. A physician visit may be needed, but a grief counselor is more appropriate. Taking the patient on a trip will not help resolve the situation.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 18-4 MSC: Psychosocial Integrity

17. The nurse in the emergency department cared for a patient who had a fatal heart attack. The

nurse goes to meet the family in the private waiting room. The nurse is acting most appropriately when responding: a. “What do you know about what happened today?” b. “I’m so sorry but your loved one has died.” c. “We did all we could, but unfortunately it was not enough.” d. “Is there someone I can call for you?”

ANS: A

Asking the family to recount what they know of the events helps them actualize the death, the first step in accepting the event. This allows the family to tell their story, at which point the nurse picks up with what happened in the emergency department. This also gives the family some time to prepare for the news of the death. Immediately stating the patient has died offers no preparation and will come as a great shock. Stating that what was done was not enough may imply that more could have been done. Asking to call for support may be confusing, as the family does not yet know the patient has died.

DIF:

Applying (Application)

REF: N/A

OBJ: 18-9

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Caring

MSC: Psychosocial Integrity

18. A nurse is assisting a patient with a life review. What action by the nurse is best? a. Ask the patient what his or her job was. b. Ask about memories the patient is proud of. c. Ask the patient about special holiday foods. d. Ask the patient to name children and grandchildren.

ANS: B

During the life review, if patients can see that their lives were meaningful and worth living, then a sense of ego integrity emerges. The nurse can best assist this by asking the patient to relate memories that evoke pride in accomplishments. The other topics can be used to guide a life review but are too narrow in focus to be the best answer.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 18-9

19. An older patient is near the end of life and the family is concerned that the patient has a

pressure ulcer because, in their view, this denotes poor care. What explanation by the nurse is best? a. “You’re right; we will try harder to care for her.” b. “I’m so sorry this is upsetting for you to see.” c. “We are doing the best we can to care for your loved one.” d. “Age-related changes can make it impossible to prevent ulcers.”

ANS: D

Age-related changes plus changes associated with the end of life can make preventing pressure ulcers nearly impossible, even with the best care. The nurse gently explains this to the family. The other statements do not give the family factual information.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 334 OBJ: 18-9 MSC: Physiologic Integrity

20. The family members of a dying patient are distressed at the patient’s restlessness and lack of

sleep. They ask the nurse to “just give her something.” What response by the nurse is best? a. Administer a sedative or hypnotic. b. Tell the family she’ll soon be sleeping enough. c. Try nonpharmacologic comfort measures. d. Explain that medications are not used in this case.

ANS: C

Nonpharmacologic comfort measures should be implemented first because of the erratic pharmacokinetics seen at the end of life. Drug responses and side effects vary widely and are difficult to control. If nonpharmacologic measures do not work, medications can be tried but must be monitored continuously.

DIF: Applying (Application) TOP: Nursing process: Implementation

REF: N/A OBJ: 18-9 MSC: Physiologic Integrity

21. A dying older patient has dyspnea, which causes anxiety. What action by the nurse is best? a. Provide oxygen for a saturation less than 90%.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. Provide a cool fan to blow on the patient.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Administer prescribed morphine sulfate. d. Administer a prescribed bronchodilator.

ANS: C

Morphine sulfate is often used for dyspnea and has the added benefit of slight sedation, which will help this patient’s anxiety. Providing oxygen based on saturations does nothing for the patient’s distress; the patient may feel short of breath, even with an oxygen saturation of 100%. A cool fan may help. There is no indication that the patient needs a bronchodilator. IF the patient has wheezing, this would be appropriate.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 18-9 MSC: Physiologic Integrity

22. A dying patient is being cared for at home. The family relates to the hospice nurse that they

are distressed that the patient no longer wants favorite food items. What response by the nurse is best? a. “Dying people don’t usually want to eat.” b. “Your loved one won’t starve to death.” c. “Why do you insist of trying to feed her?” d. “Is there another way you can show caring?”

ANS: D

Dying patients often have anorexia, and research shows that eating and drinking can actually increase distressing symptoms. However, the provision of food is universally seen as an act of caring and people place great emphasis on eating. The nurse can best help the family by helping them identify other ways to show caring. The other options do not give any useful information and could be seen as a cold response.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 18-9 MSC: Psychosocial Integrity

MULTIPLE RESPONSE 1. A nurse working with a dying patient would expect to add interventions to the care plan to

address which needs? (Select all that apply.) a. Pain b. Dyspnea c. Delirium d. Dementia e. Restlessness ANS: A, B, C, E

Pain, dyspnea, delirium, and restlessness are common symptoms experienced by patients at the end of life. Dementia may be an issue for some, but it is not considered a commonly experienced symptom.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 335 OBJ: 18-9 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 19: Laboratory and Diagnostic Tests Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The leukocyte count of an older adult patient is elevated. The nurse shows the best

understanding of the effect of aging on body function when: a. checking the patient for drug allergies before requesting an antibiotic prescription. b. asking that the patient’s temperature be taken before notifying the physician. c. encouraging the patient to drink several glasses of water and then repeat the laboratory tests. d. having the patient produce a urine sample and requesting a stat urinalysis.

ANS: B

When interpreting laboratory values and deciding the best course of treatment, the older adult should be viewed holistically: signs, symptoms, and test results, such as the patient’s temperature, should all be taken into account.

DIF: Application (Applying) TOP: Nursing Process: Assessment

REF: N/A OBJ: 19-10 MSC: Physiologic Integrity

2. The nurse helps minimize an older adult patient’s risk of developing pernicious anemia by: a. suggesting supplementing vitamin A. b. encouraging regular intake of citrus. c. identifying iron-rich foods. d. suggesting supplementing vitamin B12.

ANS: D

Malabsorption of B12 can be caused by the effect of antibodies on gastric parietal cells and a decrease in intrinsic factor, the underlying cause of pernicious anemia. The prevalence of pernicious anemia increases significantly with aging. Pernicious anemia is not associated with vitamin A, citrus, or iron.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 19-10 MSC: Physiologic Integrity

3. The nurse suspects that an acute postoperative infectious process may be developing in your

older adult patient. What abnormal finding best supports this suspicion? a. A thrombocyte count of 40,000/mm3 b. Decreasing erythrocyte sedimentation rate of 10 to 20 mm/hr c. Increasing C-reactive protein level d. Increased partial prothrombin time ANS: C

C-reactive protein is a marker present in the acute phase of an inflammatory response. The other lab values do not indicate infection.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 348 OBJ: 19-10 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. On assessing the laboratory data of an older adult patient, the nurse notes the serum potassium

level is 5.3 mEq/L. Based on this information, the nurse: a. asks if the patient has been using a nonsteroidal antiinflammatory drug (NSAID). b. determines if the patient is receiving a diuretic that promotes potassium loss. c. suggests several potassium-rich foods to supplement dietary potassium intake. d. monitors the patient’s urinary output for possible fluid retention.

ANS: A

A potassium level of 5.3 mEq/L is high. NSAIDs such as ibuprofen interfere with potassium excretion. The other answers are not related to hyperkalemia.

DIF: Application (Applying) TOP: Nursing Process: Assessment

REF: N/A OBJ: 19-3 MSC: Physiologic Integrity

5. An older adult patient is experiencing symptoms commonly associated with hyperglycemia.

Which laboratory test is most reliable for detecting hyperglycemia in older adults? a. A random serum glucose b. An oral glucose tolerance test c. An early morning urine test for glucose d. A 24-hour urine glucose test ANS: B

Appropriate glucose testing includes a fasting blood glucose, an oral glucose tolerance test, and the hemoglobin A1C. The other options are not appropriate.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 352 OBJ: 19-1 MSC: Physiologic Integrity

6. An older patient has a pressure ulcer that is resistant to healing despite aggressive therapy. The

nurse suspects the need for a protein supplement based on a(n): a. serum creatinine level of 1.1 mg/dL. b. acid phosphate level of 0.9 U/L. c. folate level of 18.2 ng/mL. d. serum albumin level of 3.1 g/dL. ANS: D

In older adults with impaired skin integrity related to pressure ulcers, assessment of the albumin level helps determine whether the protein balance is correct for proper wound healing to occur. Older adults with low albumin levels need nutritional support to promote healing of wounds. The other lab values are not related.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 352 OBJ: 19-10 MSC: Physiologic Integrity

7. An older adult patient has an elevated prostate-specific antigen (PSA) level. The nurse shares

with him that a diagnosis of prostate cancer would be confirmed with an analysis of his: a. alkaline phosphatase level. b. acid phosphatase level. c. serum amylase level. d. uric acid level.

ANS: B Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Acid phosphatase is an enzyme that is primarily located in the prostate gland. Acid phosphatase levels are used to diagnose prostate cancer and to estimate the extent of the disease. The other values are not related.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 354 OBJ: 19-10 MSC: Physiologic Integrity

8. The nurse explains to an older patient that the assessment of her thyroid health will require

both a physical examination as well as laboratory test because: a. thyroid studies are less accurate in older adults. b. symptoms are similar to those caused by various infections. c. thyroid problems can be present without overt symptoms. d. T3 levels are normally increased during aging.

ANS: C

The presence of thyroid disease in older adults can be difficult to determine and can be present without overt symptoms. Classic signs of thyroid disorders seen in younger adults are often absent or clouded because of concomitant illnesses in older adults. The other options are not correct statements.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 358 OBJ: 19-9 MSC: Physiologic Integrity

9. A 91-year-old patient learns that his urine protein is 8.2 mg/100 mL. When asked to explain

the significance of the result, the nurse replies: a. “It may be elevated because of a urinary tract infection.” b. “The result is not significant because it’s within normal limits.” c. “The level is usually elevated in people your age.” d. “Mild chronic renal failure causes a decrease in urine protein.”

ANS: A

The presence of high protein levels in the urine warrants investigation to rule out a urinary tract infection or kidney disease.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 355 OBJ: 19-6 MSC: Physiologic Integrity

10. A 71-year-old patient has a cholesterol level of 182 mg/dL. The nurse evaluates this as: a. high. b. low. c. normal. d. unknown; no norms have been established for this age group.

ANS: A

The American Heart Association views a triglyceride level of < 100 mg/dL as desirable.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 353 OBJ: 19-10 MSC: Physiologic Integrity

11. The nurse is caring for an 88-year-old patient who was admitted to the long-term care facility

after a recent conviction of driving while intoxicated. On reviewing the laboratory work and observing a folic acid level of 2 ng/ml, the nurse: Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. increases the patient’s caloric intake. b. performs a dietary assessment on the patient. c. provides the patient with sodium-rich foods. d. immediately notifies the patient’s physician.

ANS: D

This folic acid level is very low. Alcohol is known to interfere with the absorption of folate.

The nurse should immediately notify the physician. Increasing calories will not in itself increase folate levels. A dietary assessment may be warranted but is not the best response.

Sodium is not related.

DIF: Analyzing (Analysis) REF: N/A TOP: Communication and Documentation

OBJ: 19-10 MSC: Physiologic Integrity

12. A 66-year-old patient has a decreased calcium level. The nurse anticipates a(n): a. elevated sodium level. b. elevated phosphorus level. c. decreased magnesium level. d. decreased serum glucose level.

ANS: B

Calcium metabolism is one of the factors that determines phosphorus levels; an inverse relationship is present. A decrease in calcium can cause an increase in phosphorus and vice versa.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 351 OBJ: 19-10 MSC: Physiologic Integrity

13. A patient’s oxygen saturation is 98%, but the patient reports shortness of breath with activity.

What action by the nurse is best? a. Assess the patient’s hemoglobin. b. Apply oxygen at 2L/nasal cannula. c. Consult respiratory therapy. d. Administer a bronchodilator.

ANS: A

If the patient’s hemoglobin is low, there may not be sufficient oxygen in the blood for the patient’s needs. The nurse assesses the hemoglobin level. Applying oxygen may help the patient feel better but does not get to the root of the problem. Respiratory therapy and a bronchodilator are not indicated.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 19-10 MSC: Physiologic Integrity

14. A patient has increased total iron binding capacity and transferrin levels. What action by the

nurse is best? a. Prepare to administer vitamin B12. b. Encourage the patient to eat protein. c. Ensure the patient gets sun exposure. d. Prepare the patient for chelating therapy.

ANS: B Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

High levels of transferrin and iron binding capacity may indicate iron deficiency anemia, so the nurse encourages the patient to eat more protein. The other options are not appropriate.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 19-10 MSC: Physiologic Integrity

15. An older female patient develops gout and says, “Why did I get this now?” What response by

the nurse is best? a. “Gout can strike anyone at any time.” b. “Your body apparently makes more uric acid now.” c. “Uric acid rarely rises in premenopausal women.” d. “Women actually have more gout than men do.”

ANS: C

Because of the role of estrogen in the excretion of uric acid, elevated levels are usually not seen before menopause in women. The other statements are incorrect.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 347 OBJ: 19-1 MSC: Physiologic Integrity

16. An older patient takes warfarin (Coumadin). The patient’s international normalized ratio

(INR) is 1.0. What action by the nurse is best? a. Nothing; this level is therapeutic. b. Assess the patient’s diet history. c. Prepare to administer vitamin K. d. Double the warfarin dose.

ANS: B

The therapeutic INR is 2-3 (2-3.5 in some sources), so this level is not therapeutic. Foods rich in vitamin K antagonize warfarin. Before consulting the provider about adjusting the dose, the nurse should first assess the patient’s diet history to see if too many vitamin K−rich foods are being eaten. The dose may need adjustment. Vitamin K would be given for an overdose.

DIF: Analyzing (Analysis) TOP: Nursing Process: Implementation

REF: N/A OBJ: 19-10 MSC: Physiologic Integrity

17. An older adult has been admitted for dehydration. Which laboratory value correlates with this

condition? a. Na+: 160 mEq/L b. Na+: 128 mEq/L c. K+: 3.5 mEq/L d. K+: 5.2 mEq/L ANS: A

A sodium level of Na+: 160 mEq/L is high and can be seen in cases of dehydration.

Overhydration will produce a low sodium level. Potassium levels are not related.

DIF: Analyzing (Analysis) TOP: Nursing Process: Assessment

REF: N/A OBJ: 19-10 MSC: Physiologic Integrity

18. A patient has a low sodium level but normal blood osmolarity. What does the nurse Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

understand about this condition?

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. The two values are not related. b. The patient is overhydrated. c. The patient has pseudohyponatremia. d. The patient has end-stage kidney disease.

ANS: C

Pseudohyponatremia is a condition in which the serum sodium is low, but osmolarity remains normal. The patient is not overhydrated nor does he or she have end-stage renal disease.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 350 OBJ: 19-4 MSC: Physiologic Integrity

19. A patient has heart failure and takes spironolactone (aldactone). What diet selection from the

menu shows that the patient needs more education? a. A low-fat chicken salad sandwich b. Salt-free vegetable soup c. Broiled fish with lemon d. Salt substitute and pepper ANS: D

Older patients have difficulty excreting potassium because of age-related kidney changes.

This patient also takes aldactone, a potassium sparing diuretic. If the patient adds a salt substitute, normally high in potassium, the chances of developing hyperkalemia are high. The nurse needs to provide education on other ways to flavor foods. The other diet choices are fine.

DIF: Analyzing (Analysis) TOP: Nursing Process: Implementation

REF: N/A OBJ: 19-1 MSC: Physiologic Integrity

20. An older patient’s BUN is 28 mg/dL and creatinine is 0.6 mg/dL. How does the nurse interpret

these findings? a. Normal for all age groups b. Normal for older adults c. High for all age groups d. Low for older adults ANS: B

The older adult may have elevated blood urea nitrogen (BUN) because of age-related decreases in kidney function and a lowered creatinine resulting from decreased muscle mass.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 353 OBJ: 19-1 MSC: Physiologic Integrity

21. An 85-year-old patient’s blood gasses are as follows: pH 7.4, PAO2 75 mmHg, PACO2 38

mmHg, HCO3 25. What action by the nurse is best? a. Administer oxygen per facemask b. Assess the patient’s shortness of breath c. Assess the patient’s oxygen saturation d. Document the findings in the chart ANS: D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

These values are normal for the patient’s age. If the patient had complaints, the nurse would perform further assessments, but because the patient does not appear to have complaints, the nurse documents the results.

DIF: Analyzing (Analysis) REF: N/A TOP: Communication and Documentation

OBJ: 19-1 MSC: Physiologic Integrity

22. A patient was admitted for heart failure, and over the past 3 days the patient’s brain natriuretic

peptide has decreased. What action by the nurse is best? a. Prepare to administer extra diuretics. b. Continue with the plan of care. c. Prepare to intubate and ventilate the patient. d. Discuss end-of-life care with the patient.

ANS: B

A decreasing BNP indicates less fluid volume in the heart, indicating that treatment measures for CHF are working. The nurse continues with the plan of are. The other actions are not needed.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 19-8 MSC: Physiologic Integrity

23. A patient takes digoxin (Lanoxin) for heart failure with atrial fibrillation. The patient reports

yellow vision and nausea. The patient’s digoxin level is 1.9 ng/mL. How does the nurse explain the situation to the patient? a. “Even with a normal blood level you may have digoxin toxicity.” b. “You may have a gastrointestinal virus that is causing these symptoms.” c. “You may not be getting a high enough dose of digoxin; I’ll call the doctor.” d. “Your cataracts may be worsening and you may need to have them removed.”

ANS: A

This digoxin level is normal; however, older adults can get digoxin toxicity even with normal blood levels. The other answers are not accurate.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 357 OBJ: 19-1 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 20: Pharmacologic Management Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse is preparing to apply a topical cream on the arm of a cognitively impaired, anorexic

older adult patient in the terminal stage of lung cancer. The nurse carefully monitors the effectiveness of the medication because its effectiveness will be most negatively impacted by the patient’s: a. age. b. cognitive limitations. c. nutritional status. d. cancer diagnosis.

ANS: A

Topical drugs face barriers to absorption because the aged skin has decreased water content, a relative decrease in lipid content, and a decrease in tissue perfusion. These changes may result in impaired absorption of some medications that are administered via lotions, creams, ointments, and patches. The other options are not related to medication effectiveness in this situation.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 362 OBJ: 20-4 MSC: Health Promotion

2. When administering medications to older adults, the nurse shows an understanding of the

effect of aging on drug distribution by monitoring the patient’s: a. cardiac function. b. liver function. c. red blood cell count. d. plasma albumin levels.

ANS: D

With age, particularly for malnourished or frail adults, plasma albumin levels may drop and therefore should be monitored. As a result of decreased sites for protein binding, the activity of highly protein bound drugs, and any side effects caused by these drugs may be increased.

The other options may be appropriate for specific drugs, but not in general.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 362 OBJ: 20-4 MSC: Physiologic Integrity

3. An older adult patient has been prescribed warfarin (coumadin). The nurse’s primary

intervention involves daily review of the patient’s: a. prothrombin time. b. body for bruising. c. serum creatinine level. d. reflex tone.

ANS: A

Warfarin therapy is monitored by the international normalized ratio (INR) or INR with prothrombin time.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Remembering (Knowledge) REF: Page 363 OBJ: 20-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. A patient with diabetes and hypothyroidism is being admitted to an assisted living facility.

During the admission assessment, the patient reports difficulty falling asleep. The nurse shows an understanding of sleep dysfunction and the older patient when asking: a. “Have you ever been prescribed a sleeping medication?” b. “How do you feel about leaving your home to live here?” c. “How long have you been a diabetic?” d. “Are you taking medication for your thyroid problem?

ANS: D

Insomnia and anxiety are problems that commonly plague older adults. Because insomnia and anxiety often occur secondary to medication side effects or secondary to medical conditions such as dementia, thyroid abnormalities, or depression, proper diagnosis and treatment of any underlying causes of insomnia or anxiety can help this condition. The other questions are appropriate for an intake interview, but not specifically related to the insomnia.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 368 OBJ: 20-7 MSC: Physiologic Integrity

5. A patient is receiving propranolol (Inderal) for hypertension. Which outcome is the best

indicator of goal success when considering the drug’s potential effect on the patient’s quality of life? a. The patient verbalizes the importance of moderate exercise. b. The patient experiences no injuries as a result of dizziness. c. The patient’s blood pressure stays within normal limits. d. The patient describes symptoms indicative of an adverse drug reaction.

ANS: B

The main concerns with the use of antihypertensive medications in older adults are an increased risk of orthostatic hypotension and dehydration. Exercising and maintaining the blood pressure within normal limits are treatment goals but do not impact quality of life like dizziness or fainting. Having an adverse drug reaction would not improve quality of life.

DIF: Applying (Application) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 20-6 MSC: Physiologic Integrity

6. The nurse responsible for administering medications to the residents of a long-term care

facility shows an understanding of the risk of injury this population experiences when: a. confirming the patient’s identity prior to providing the medication. b. assessing the patient for a history of drug-related allergies. c. implementing the 5 rights of medication administration routinely. d. educating patients about the purpose and side efforts of their medications.

ANS: C

The Institute of Medicine (IOM) estimates that 1.5 million ADEs and 7000 deaths occur in the United States each year secondary to medication errors. Older adults are disproportionately affected; more than half of the medication errors occur in long-term care facilities and more than 500,000 occur among ambulatory Medicare patients. Some references use the 6 rights of medication administration.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 20-3 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 7. An older adult diabetic patient is mildly hypertensive. The nurse prepares to educate the

patient regarding angiotensin II–blocking agents. These drugs are especially useful in older adults because they: a. protect the kidney’s function. b. have a well-defined therapeutic window. c. are more effective than other drugs in the same class. d. can be given when liver function is compromised.

ANS: A

The ACEIs and ARBs also have demonstrated value in decreasing the chance of cardiac mortality in patients with heart failure. They also confer renal protection, which is particularly beneficial for patients with diabetes. The other statements are not related to both the patient’s conditions.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 20-6 MSC: Physiologic Integrity

8. The nurse shows an understanding of medication-related risk factors common to older adults

when asking: a. “Are you aware of the possible side effects of your medications?” b. “Do you regularly take any dietary supplements?” c. “How do you keep track of when your medications are due?” d. “How many different physicians are prescribing medications for you?”

ANS: B

About 52% of older adults living in the United States take some sort of dietary supplement on a regular basis in addition to prescription medications. This increases the potential for drugdrug interactions. The other questions are important assessment questions to include in a medication review.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 371 OBJ: 20-3 MSC: Physiologic Integrity

9. An older adult patient is having difficulty remembering when to take several of the prescribed

medications. To improve the patient’s compliance with the medication regimen, the nurse: a. asks the patient’s spouse to consistently administer the drugs. b. checks the drug guide to see if decreasing the frequency if the drugs is possible. c. informs the patient’s physician about the drug noncompliance. d. teaches the patient to administer daily pills with a pill dispenser.

ANS: D

The regimen should be simplified as much as possible; using a drug dispenser could make the daily process less complicated. If the patient is still unable to manage this task, the nurse could consult with the provider about decreasing frequency or changing medications, or the nurse could ask the spouse to administer the medications if this were acceptable to the patient. But the easiest and most cost-effective action is to try a pill dispenser.

DIF:

Application (Applying)

REF: N/A

OBJ: 20-4

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Implementation

MSC: Physiologic Integrity

10. The nurse is caring for an older adult who reports severe chronic pain. To best assess age-

related physiologic changes that could influence plans for initiating an appropriate drug regimen, the nurse prepares the patient for which laboratory evaluation? a. White blood count b. Glomerular filtration rate c. Serum complement level d. Electroencephalogram ANS: B

Many drugs are renally excreted, and there are age-related reductions in renal function. The nurse wanting to assess for such factors that influence the selection of drugs would most likely anticipate the patient having renal function studies done, including an evaluation of the patient’s glomerular filtration rate.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 363 OBJ: 20-1 MSC: Physiologic Integrity

11. An older adult patient is being assessed for possible alcohol abuse. To best assess the patient’s

risk potential, the nurse asks: a. “Have you ever experienced a memory loss as a result of consuming alcohol?” b. “Would you drink to relax after a particularly stressful day?” c. “Do you ever drink when you are alone?” d. “How many alcoholic drinks do you consume each week?”

ANS: D

The nurse should start the assessment for alcohol abuse by inquiring as to the number of drinks the patient consumes each week. The other questions can be part of an abuse assessment, but it is easiest to start with a simple, quantitative question to open the discussion.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 20-10 MSC: Psychosocial Integrity

12. An older adult patient is currently undergoing detoxification for alcohol at a rehabilitation

center. When assessing the patient using the Clinical Institute Withdrawal Assessment tool, the nurse determines the patient’s current score to be 23. The nurse: a. immediately institutes seizure precautions. b. monitors the patient’s vital signs every 2 hours. c. arranges for the patient to be transferred to an acute care hospital. d. shares with the patient that the detoxification process is almost complete.

ANS: C

The maximum score on this tool is 67, and patients who score higher than 20 should be admitted to a hospital. The other options are incorrect.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 20-10 MSC: Physiologic Integrity

13. A 68-year-old man with a history of alcohol abuse is admitted to the acute care facility for

reports of abdominal pain. Based on your understanding of alcohol withdrawal, the nurse Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

knows that if patient is currently abusing alcohol, he will most likely:

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. experience delirium tremors within 4 hours of hospitalization. b. develop withdrawal symptoms 48 to 72 hours after the last intake of alcohol. c. receive 1 ounce of alcohol every 4 hours while awake. d. be prescribed oxazepam (Serax).

ANS: B

Symptoms tend to peak 48 to 72 hours after a patient’s last drink, although they may occur within 4 to 12 hours. The patient may or may not have DTs. The patient should not receive alcohol and may or may not need medication.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 379 OBJ: 20-10 MSC: Physiologic Integrity

14. When working with a patient suspected of substance abuse, the nurse is particularly interested

in determining the cause of a patient’s: a. acute abdominal pain. b. recurring insomnia. c. extensive history of falls. d. chlordiazepoxide (Librium) prescription.

ANS: C

Frequently, the symptoms of substance abuse are subtle or atypical, or they mimic symptoms of other age-related illnesses and remain undiagnosed. Patients’ presenting symptoms may be erratic changes in affect, mood, or behavior; malnutrition; bladder and bowel incontinence; gait disturbances; and recurring falls, burns, and head trauma. Acute abdominal pain, insomnia, and prescriptions for Librium may or may not be related to substance abuse, but falling is.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 20-10 MSC: Physiologic Integrity

15. A 67-year-old woman presents at the emergency department with symptoms that suggest

possible abuse of a narcotic analgesic. To best assure the patient’s safe care, the nurse asks: a. “When did you first start using the analgesic?” b. “Have you experienced withdrawal symptoms before?” c. “Why did you initially need an analgesic?” d. “What prescribed drugs are you currently taking?”

ANS: D

First, if prescription drug abuse is suspected, the nurse should ask the patient or a family member to identify all medications that the patient is currently using. The nurse and physician can then plan for safe detoxification. In addition, the physician can try to prevent any untoward drug interactions resulting from prescribing a new medication that is contraindicated because of an existing prescription.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 20-10 MSC: Physiologic Integrity

16. Your patient reports frequent constipation as a result of prescription medications and asks the

nurse for advice about using a daily over-the-counter laxative. The most appropriate response by the nurse is to: Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. tell the patient to consult the health practitioner before using nonprescription

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

drugs. b. educate the patient about the side effects of regular laxative use. c. tell the patient to avoid laxatives because they can interfere with medications

already being taken. d. tell the patient to consult a dietician about ways to correct chronic constipation.

ANS: A

Education regarding the importance of contacting the health practitioner (physician or pharmacist) before taking nonprescription medication is essential for reducing the number of unintentional medication interactions. Educating the patient on side effects and teaching the patient nonpharmaceutical ways to manage constipation are also appropriate.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 371 OBJ: 20-8 MSC: Physiologic Integrity

17. When initially planning care for the older adult patient who is prescribed clonidine patches as

part of a smoking cessation program, the nurse: a. assesses the patient for any skin disorders on the upper arms and back. b. determines how many cigarettes or cigars the patient smokes per day. c. asks if the patient is currently taking any antihypertensive medications. d. educates the patient to the possible side effects of clonidine therapy.

ANS: C

Clonidine is an antihypertensive, so knowledge of the patient’s medication history is vital to avoid inducing hypotension. The other assessments are not related to patient safety.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 20-5 MSC: Physiologic Integrity

18. The nurse explains to ancillary staff that caffeine abuse is difficult to diagnose in the older

adult patient because caffeine intoxication symptoms: a. can be confused with normal effects of aging. b. often mimic those of some cardiac disorders. c. produce fewer symptoms in older adults than in younger adults. d. resemble the side effects of several antihypertensive drugs.

ANS: B

Caffeine stimulates the sympathetic nervous system, often producing the rapid pulse associated with cardiac disorders. Caffeine effects are not mistaken for normal signs of aging, produce fewer symptoms in older adults, or resemble side effects of antihypertensives.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 385 OBJ: 20-5 MSC: Physiologic Integrity

19. An older adult patient shares with the admitting nurse that she drinks “one shot” of whiskey

nightly to help her sleep. The nurse documents the need to: a. assess the patient for slurred speech, lack of coordination, and nystagmus. b. address the effects of alcohol abuse with the patient. c. provide the patient with an alcohol substitute. d. assess the patient for signs of agitation, as well as anxiety and seizures.

ANS: D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

It is important to assess older patients for the possibility of alcohol withdrawal if agitation, hallucinations, anxiety, or seizures develop. Because the patient admits to a shot a day, it is possible she drinks more or uses alcohol to self-medicate for problems other than insomnia.

The nurse should monitor the patient for signs of withdrawal as a priority, because this is a medical emergency. Slurred speech, lack of coordination, and nystagmus are signs of overindulging. The nurse should not provide an alcohol substitute. It is appropriate to discuss the effects of alcohol, but safety comes first.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 20-10 MSC: Physiologic Integrity

20. The nurse is assessing patients for impending alcohol withdrawal. The nurse assesses the

patient with which of the following conditions as a priority? a. Pulse, 58 beats/min; and BP 100/60 b. Pulse, 118 beats/min; and BP 160/90 c. Dozing off in chair and not recognizing staff d. Reporting muscle aches and frequent stumbling ANS: B

Manifestations of alcohol withdrawal are elevated blood pressure, elevated pulse, and autonomic hyperactivity. In addition, fever; increased hand tremors; insomnia; nausea and vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures may occur. The nurse should see the hypertensive, tachycardic patient as the priority.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 20-12 MSC: Safe Effective Care Environment

MULTIPLE RESPONSE 1. To minimize the possible complications of polypharmacy among older adult patients, the

nurse assesses this population for which of the following? (Select all that apply.) a. Number of physicians providing medical care b. Location of pharmacies where prescriptions are filled c. Presence of chronic illnesses d. Tendency to borrow medication from family or friend e. Use of over-the-counter medication to self-medicate ANS: A, B, C, E

Older adults are especially vulnerable to polypharmacy because many have one or more chronic conditions requiring several medications for management. To complicate matters, patients may see more than one provider for the same health problem and may have prescriptions filled at more than one pharmacy. Additional contributors to polypharmacy include the use of over-the-counter and alternative medicines or supplements in the treatment of conditions. As a result, the patient may end up taking duplicate drugs, similar drugs from the same drug class, and drugs that are contraindicated when taken together. Borrowing medications is not usually an issue.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 20-6 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 2. The nurse must be able to distinguish between alcohol intoxication and alcohol withdrawal to

intervene appropriately. The nurse suspects alcohol intoxication when the patient does which of the following? (Select all that apply.) a. Slurs his speech when answering questions b. Has difficulty remembering his address c. Reports seeing snakes in the corner of the room d. Documents his blood pressure as 168/90 e. Experiences difficulty when walking to the bathroom ANS: A, B, E

Signs associated with alcohol intoxication include the scent of alcohol on the breath, slurred speech, lack of coordination, unsteady gait, nystagmus, impairment in attention or memory, and stupor or coma. Manifestations of alcohol withdrawal are elevated blood pressure, elevated pulse, and autonomic hyperactivity. In addition, fever; increased hand tremors; insomnia, nausea and vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures may occur.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 379 OBJ: 20-10 MSC: Physiologic Integrity

3. A 69-year-old was prescribed a benzodiazepine 3 years ago. This medication regimen

increases the patient’s risk for injury related to drug abuse and requires frequent patient assessment for which of the following? (Select all that apply.) a. Daytime sleepiness b. Unsteady gait c. Shortness of breath d. Easy bleeding e. Forgetfulness ANS: A, B, E

Benzodiazepines can cause excessive sedation, impaired memory, decreased psychomotor performance, and balance disturbances and may lead to drug dependence and should not be prescribed for extended periods of time. Shortness of breath and bleeding are not signs of side effects.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 368 OBJ: 20-12 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 21: Cardiovascular Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse is teaching cardiovascular risk factors to a group of older adults. The nurse stresses

that cigarette smokers are four times more likely to die of sudden cardiac death than nonsmokers because smoking: a. interferes with the development of collateral coronary vessels. b. produces coronary artery stricture. c. results in carbon monoxide poisoning. d. increases platelet aggregation.

ANS: D

Smoking increases platelet aggregation and causes coronary artery spasms. Nicotine increases blood pressure and cardiac demands. Carbon monoxide in tobacco smoke decreases the oxygen-carrying capacity of the blood. Smoking does not interfere with collateral circulation or produce strictures, but it may contribute to higher levels of carbon monoxide in the blood.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 390 OBJ: 21-2 MSC: Health Promotion

2. When assessing an older, female, African American adult, the nurse notes that she has been a

type 2 insulin-dependent diabetic 10 years. The nurse notes that the patient’s greatest risk for developing secondary hypertension is her: a. gender. b. ethnic origin. c. vascular system status. d. insulin therapy.

ANS: C

Secondary hypertension identified in the vascular system refers to elevated blood pressure caused by underlying disease such as renal artery disease, renal parenchymal disorders, endocrine and metabolic disorders, central nervous system (CNS) disorders, coarctation of the aorta, and increased intravascular volume. Gender, ethnic origin, and insulin are not diseases that cause hypertension.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 392 OBJ: 21-2 MSC: Physiologic Integrity

3. When administering Lopressor to an older adult patient with hypertension, the nurse is careful

to have the patient’s care plan include a. frequent assessment for dizziness or syncope. b. education of the signs and symptoms of thromboembolism. c. regular evaluation of the patient’s muscle strength. d. regularly scheduled serum potassium levels.

ANS: A

Dizziness is an adverse reaction to beta-blockers such as Lopressor.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 398 OBJ: 21-4 MSC: Physiologic Integrity

4. The nurse educates the obese older adult patient that the single most important outcome that

will affect cardiac health is: a. compliance with drug therapy. b. adherence to the DASH diet. c. 20 minutes of exercise daily. d. a 10% reduction in weight.

ANS: D

A 10% reduction of total weight will decrease blood pressure in many overweight individuals.

This factor has significance because it underscores the importance of weight reduction in the older adult population. The other factors are important but not as significant to overall cardiac health as is weight loss.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 392 OBJ: 21-2 MSC: Health Promotion

5. To evaluate an older patient for possible renal failure as a result of chronic untreated

hypertension, nurse prepares to: a. schedule an ultrasound. b. collect a urine sample. c. monitor intake and output. d. transport the patient to radiology.

ANS: B

A urinalysis will investigate for proteinuria or other signs of renal failure.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 393 OBJ: 21-3 MSC: Physiologic Integrity

6. The nurse should assess which patient first? a. The patient with acute shortness of breath b. The patient with epigastric pain c. The patient with right arm pain d. The patient with persistent indigestion ANS: A

Older patients often have atypical signs and symptoms of cardiac ischemia, including shortness of breath, fatigue, syncope, confusion, and abdominal or back pain. Shortness of breath requires the most immediate assessment.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 21-4 MSC: Safe Effective Care Environment

7. It is suspected that an older adult patient is experiencing severe hypertension. The nurse

documents symptoms that support this diagnosis when the patient reports: a. difficulty reading the newspaper’s print. b. being fatigued after walking around the block. c. noticing that his heart “skips a beat” frequently.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. getting up from a chair too quickly makes him dizzy.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

The patient with severe hypertension may experience throbbing occipital headaches, confusion, visual loss, focal deficits, epistaxis, and coma. The other manifestations are not associated with hypertension.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 392 OBJ: 21-4 MSC: Physiologic Integrity

8. A novice nurse requires additional education on arterial vascular deficiency when suggesting

the condition’s symptoms include: a. 2+ edema in calf and foot of left leg. b. a 2-cm ulcer between the great and second toe on the left foot. c. skin on the left leg is cool to the touch. d. toenails on the left foot are thick and brittle.

ANS: A

Edema is not generally observed in cases of arterial deficiency, but rather in venous insufficiency. The other options are manifestations of arterial vascular deficiency.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 415 OBJ: 21-5 MSC: Physiologic Integrity

9. The nurse shows an understanding of how anemia symptoms present in the older population

when: a. questioning the patient about dizziness when turning from side to side in bed. b. assessing the patient for pale oral mucous membranes. c. asking whether the patient takes supplementary iron tablets. d. assessing the patient’s weekly intake of red meat.

ANS: B

Skin color is not a good indicator of pallor because of varying pigmentation. Oral mucous membranes, as well as conjunctivae and nail beds, are better indicators. The other options are not related to symptoms.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 417 OBJ: 21-5 MSC: Physiologic Integrity

10. A nurse has provided discharge teaching for an older adult patient who had a pacemaker

implanted. Which statement by the patient indicates appropriate understanding of the device? a. “The battery will need charging every 2 years or so.” b. “I’m supposed to call my doctor if my pulse is within 10 beats of my preset rate.” c. “My wife will have to be the one who makes the microwave popcorn.” d. “I’ll take my pulse each morning before my first cup of coffee.”

ANS: D

The radial pulse should be taken at the same time daily and recorded. The patient should notify the provider if the pulse is lower than the preset lower limit on the pacemaker. Battery life is longer than 2 years. Microwaves are safe to use.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 21-4 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 11. A 76-year-old patient has been recently diagnosed with cardiac valvular disease. The nurse

assesses the patient and recognizes that the medical diagnosis is supported by: a. cyanotic fingertips. b. weight loss of 10 pounds in 3 months. c. angina pain. d. shortness of breath with activity.

ANS: D

Individuals with valvular disease may be asymptomatic for many years, but with the deterioration of the valves and hypertrophic changes in the atria or ventricles, symptoms become evident. Exertional dyspnea is frequently the initial symptom. Other symptoms include dizziness, fatigue, weakness, and palpitations. The other signs are not manifestations of valve disease.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 406 OBJ: 21-4 MSC: Physiologic Integrity

12. An older patient is upset with a blood pressure reading of 180/78 mmHg. What response by

the nurse is best? a. “It looks like you need blood pressure medicine now.” b. “Most people get hypertension when they get older.” c. “With age, blood vessels stiffen, raising blood pressure.” d. “Don’t worry, there are lots of good medications for this.”

ANS: C

With age, elastin in vessel walls decreases, making them stiffer. Systolic blood pressure (SBP) is increased in older adults because of a loss of arterial distensibility resulting from arterial stiffening. The other responses do not offer any useful information on the cause of the patient’s condition.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 389 OBJ: 21-1 MSC: Health Promotion

13. An older patient is overwhelmed at the number of lifestyle changes needed to manage newly

diagnosed cardiovascular disease. What action by the nurse will reduce this barrier to teaching? a. Tell the patient even tiny changes over time make a big difference. b. Tell the patient that smoking is the biggest risk factor and needs to stop. c. Help the patient choose a change and incorporate it into daily life. d. Educate the patient on the consequences of not making changes.

ANS: C

Although it is true that small changes over time have a great impact, the nurse needs to do more by helping the patient choose a small change to implement. The nurse should help the patient work on the risk factor he or she is most willing to change. Education is important, but it will not enable the patient to make changes.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 21-5 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 14. A nurse is caring for a patient taking furosemide (Lasix). What assessment finding needs to be

reported to the provider immediately? a. Weight gain of 1/2 pound (1.1 kg) in 24 hours b. 2+/4+ pedal and pretibial edema c. Potassium level: 2.6 mEq/L d. Sodium level: 138 mEq/L ANS: C

Furosemide is a potassium-wasting diuretic and the patient’s potassium is low. This finding should be reported. The weight gain should be charted but does not need immediate reporting.

Without knowing what the patient’s baseline edema is, there is no indication this needs to be reported. The sodium level is normal DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 21-5 MSC: Physiologic Integrity

15. An older patient is prescribed nifedipine (Procardia). What teaching topic is most important to

discuss with this patient? a. Need to monitor blood pressure b. Need to follow low-salt diet c. Need to change positions slowly d. Need to add exercise to daily routine ANS: C

Calcium channel blockers such as Procardia can cause orthostatic hypotension in older adults.

The nurse educates the patient on preventing this by slow position changes. The other topics are appropriate for all patients on this medication.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 21-4 MSC: Physiologic Integrity

16. A patient had a heart attack and the nurse identifies the diagnosis as activity intolerance. What

assessment finding indicates a priority goal for this diagnosis is being met? a. Mild chest pain getting into the chair b. Feels unsteady when getting out of bed c. O2 saturation 98% after using the commode d. Less dyspnea when changing positions ANS: C

Activity intolerance is measured by changes in vital signs, electrocardiogram (ECG), and symptoms such as chest pain or shortness of breath. The oxygen saturation indicates physiologic tolerance to activity. The other options do not show physiologic tolerance.

DIF: Analyzing (Analysis) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 21-5 MSC: Physiologic Integrity

17. An older patient in the internal medicine clinic reports usually being able to walk 1 mile

without complaint. However, in the past 2 weeks, after walking just mile, the patient’s legs begin to ache. The pain goes away with rest. What action by the nurse is most appropriate? a. Elevate the patient’s legs b. Assess the pedal pulses Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Take the patient’s blood pressure d. Measure the patient for TED hose ANS: B

This patient has intermittent claudication, a sign of peripheral arterial disease. The nurse assesses the patient’s pedal pulses. Elevation will further compromise circulation and should be avoided. A blood pressure reading is taken during all health care visits. The patient does not need TED hose at this point.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 21-5 MSC: Physiologic Integrity

18. A patient has peripheral vascular disease. What statement by the patient indicates a need for

further teaching? a. I will have the podiatrist cut my toenails. b. I will be sure to wear sturdy shoes. c. I can only walk limited distances now. d. I will report any injury to my foot or leg.

ANS: C

Patients with venous insufficiency are encouraged to begin a graduated exercise program. The other statements show good understanding.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 21-5 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. The effect of aging on the cardiovascular system is evidenced by which symptoms in an older

adult performing a stress test? (Select all that apply.) a. Chest pain during exercise b. Slow increase of heart rate in response to stress c. Exercise induce dyspnea d. Slow decrease of heart rate post exercise e. Stress-induced arrhythmias ANS: B, D

During stress or stimulation, the heart rate increases more slowly; however, once elevated, it takes longer to return to the resting rate. The other manifestations are not related to ageinduced physiologic changes.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 389 OBJ: 21-1 MSC: Physiologic Integrity

2. A novice nurse is aware that normal aging can result in changes in the ECG of a 73-year-old

patient. The experienced geriatric nurse explains that these changes may include which of the following? (Select all that apply.) a. An inverted T wave b. A notched P wave c. A prolonged PR interval d. Decreased amplitude of the QRS complex Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 e. A slurred T wave ANS: B, C, D, E

The number of pacemaker cells located in the sinoatrial node decreases with age, which results in less responsiveness of the cells to adrenergic stimulation. Common aging changes that are reflected by the electrocardiogram (ECG) include a notched P wave, a prolonged PR interval, decreased amplitude of the QRS complex, and a notched or slurred T wave.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 389 OBJ: 21-1 MSC: Health Promotion

3. A nurse is planning to teach a senior citizens group heart-healthy lifestyle choices. Which

should be included? (Select all that apply.) a. Smoking cessation tips b. Low-carbohydrate food choices c. Stress management techniques d. Regular blood pressure monitoring e. Strategies to include exercise into daily routine ANS: A, C, D, E

Heart-healthy lifestyle changes concern smoking cessation, stress management, blood pressure control, exercise, weight loss, and a low-fat, low-sodium diet. Low-carbohydrate foods are not considered part of heart-healthy lifestyles.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 389 OBJ: 21-4 MSC: Health Promotion

4. An older adult recovering from a myorcardial infarction (MI) has been taking subcutaneous

heparin but is now to receive oral warfarin (Coumadin). The nurse prepares to teach the patient which topics? (Select all that apply.) a. Administration of both medications for up to 5 days b. Need to use a soft bristle toothbrush c. Use of atropine as an antidote for excessive bleeding d. Need to continue drawing partial thromboplastin times e. Need to drink at least eight cups of fluids daily ANS: A, B, D

Heparin and warfarin (Coumadin) are anticoagulants used to prevent the enlargement of existing thrombi and new clot formation after an MI. Therapeutic effects of heparin are monitored by partial thromboplastin times; the antidote is protamine sulfate. Warfarin is monitored by the international normalized ratio (INR); the antidote is vitamin K. Patients who initially receive heparin for anticoagulation and who need oral anticoagulation for maintenance usually take both forms of medication for 3 to 5 days to develop therapeutic blood levels. Bleeding is a complication. Patients need to be taught bleeding precautions.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 398 OBJ: 21-3 MSC: Physiologic Integrity

5. A 77-year-old patient is being treated for cardiac arrhythmia. The nurse determines that the

patient’s cardiac output is adequate with which assessments? (Select all that apply.) a. Urine output of 140 cc over 4 hours Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. Systolic blood pressure that remains within 20 mm of baseline

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Denial of substernal pain d. Recollection of the birthdays of all of her grandchildren e. Absence of rales and crackles ANS: A, B, D, E

The patient will maintain an adequate cardiac output, as evidenced by heart rate and rhythm within normal range, stable blood pressure, adequate peripheral pulses, mental alertness, urine output of 30 mL/hr, and clear breath sounds. Normal mentation also denotes good cardiac output, but the patient may have too many birthdays to remember, so this is not the best indicator of cognitive status.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 403 OBJ: 21-3 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 22: Respiratory Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse best maximizes an older adult’s potential to avoid developing a postsurgical

respiratory infection by: a. walking the patient to the bathroom instead of using the bedside commode. b. encouraging compliance with prescribed antibiotic therapy. c. evaluating the patient’s ability to effectively cough and deep breathe. d. offering fluids every hour while the patient is awake.

ANS: C

Older adults have a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increasing difficulty clearing secretions. The other activities also help avoid atelectasis and infection, but evaluating the patient’s ability to cough and deep breathe can indicate that other treatment measures may be needed postoperatively.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 423 OBJ: 22-1 MSC: Physiologic Integrity

2. An older adult’s pulmonary function studies indicate that his vital capacity is reduced and his

residual volume is increased. The nurse recognizes that these test results are observed in the patient’s: a. ineffective cough reflex. b. shallow breathing. c. slow respiratory rate. d. frequent respiratory infections.

ANS: B

Normal aging results in the progressive loss of elastic recoil of the lung parenchyma and conducting airways as well as reduced elastic recoil of the lung and the opposing forces of the chest wall. The lung becomes less elastic as collagenic substances surrounding the alveoli and alveolar ducts stiffen and form cross-linkages that interfere with the elastic properties of the lungs. Any and all of these structural changes make it more difficult for the older person to ventilate.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 422 OBJ: 22-1 MSC: Health Promotion

3. The nurse is concerned about an older adult patient developing toxic levels of the prescribed

theophylline when it is determined that the patient has a(n): a. one pack a day smoking habit. b. elevated serum potassium level. c. history of chronic bronchitis. d. chronic, nonproductive cough.

ANS: A

Theophylline is a medication that is affected by smoking, which increases serum drug levels.

The other factors do not affect the pharmacokinetics of this drug.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Remembering REF: Page 425 OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. The nurse is aware of the typical occurrence of comorbidities in the older adult. Motivated by

this knowledge, the nurse assesses a patient with diagnosed respiratory dysfunction for possible: a. poor wound healing of the legs and feet. b. ineffective absorption of vitamins and minerals. c. abnormal urine protein levels. d. visual problems including retinal detachment.

ANS: A

In addition, older patients are more likely to have comorbidities involving the cardiovascular and respiratory systems. Peripheral circulation is a possible cardiovascular problem that would result in poor wound healing. The other options are not related to having a respiratory dysfunction.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 425 OBJ: 22-2 MSC: Physiologic Integrity

5. Because the older adult is not as likely to exhibit the typical signs of ineffective gas exchange,

the nurse is particularly suspicious of: a. a nonproductive cough in an afebrile patient. b. irritability in a usually pleasant patient. c. pale nail beds in a patient of color. d. an elevated white blood cell (WBC) count in an 82-year-old patient.

ANS: B

An early sign of respiratory problems is a change in mental status. Because the physiologic responses to hypoxemia and hypercapnia are blunted in older patients, compensatory changes in heart rate, respiratory rate, and blood pressure may be delayed and cerebral perfusion may suffer. Mental status changes may include subtle increases in forgetfulness and irritability.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 22-1 MSC: Physiologic Integrity

6. The nurse is preparing information for the caregivers of a patient with chronic respiratory

issues. The nurse will make the greatest impact on their ability to provide quality care while maintaining the patient’s emotional well-being by including: a. suggestions regarding proper nutrition and exercise for the caregiver. b. an explanation on how to preserve the patient’s sense of autonomy. c. encouragement for the primary caregiver to set aside time for his or her own interests. d. recommendations of periodic self-reflection regarding the stressors the patient experiences.

ANS: B

Many patients with respiratory illness feel a loss of control over their lives because of their symptoms. They may become demanding and controlling in dealing with their families and friends. Well-being is enhanced by having some control over one’s life. The other options relate to the caregivers.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Teaching-Learning MSC: Psychosocial Integrity 7. An older patient admitted to the hospital with symptoms strongly suggestive of tuberculosis

(TB) has a negative Mantoux test. The nurse correctly anticipates that: a. the purified protein derivative (PPD) test will be administered. b. a chest x-ray will be ordered to detect possible infiltration. c. therapy consisting of a combination of bactericidal drugs will be initiated. d. the skin test will be repeated to achieve a booster effect.

ANS: D

Tuberculin skin testing in older patients is an unreliable indicator of TB because they are more likely to have false-negative results because of reduced immune system activity. If skin testing is used, it is recommended that the standard 5 tuberculin unit (TU) Mantoux test be given and then repeated to create a booster effect. The PPD is not recommended. The skin test is followed up with a chest x-ray. Drug therapy should not begin until the patient has a diagnosis.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 440 OBJ: 22-5 MSC: Physiologic Integrity

8. An older adult patient who has tuberculosis is being treated with the drugs isoniazid 300 mg

daily, rifampin 600 mg daily, and pyrazinamide 1500 mg daily. The nurse stresses the importance that the patient: a. wear tinted glasses when out in the sun. b. minimize contact with children younger than 3 years old. c. avoid alcohol while on the drug therapy. d. eat and drink dairy sparingly.

ANS: C

Patients should not drink alcohol while taking isoniazid. The other recommendations are incorrect.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 442 OBJ: 22-5 MSC: Physiologic Integrity

9. An 80-year-old patient is concerned about contracting pneumonia. The nurse educates her that

the key to prevention is: a. early recognition of the symptoms. b. being vaccinated per government guidelines c. minimizing contact with the public during the winter months. d. supplementing one’s daily diet with various vitamin C sources.

ANS: B

The key to pneumonia prevention is being appropriately vaccinated. All individuals should be vaccinated at age 65 unless they have conditions that lead them to earlier vaccination.

Revaccination is indicated in certain circumstances. Signs and symptoms are subtle in the aging population. Minimizing contact during winter months is an appropriate suggestion, just not the best one. Vitamin C may have immune system benefits.

DIF:

Remembering (Knowledge)

REF: Page 446

OBJ: 22-3

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning

MSC: Health Promotion

10. The nurse gives priority to assessing an older patient who presents with symptoms of acute

respiratory distress for which other condition? a. Substernal chest pain b. A history of panic attacks c. Any known allergies d. Bruising on the chest ANS: A

The symptoms of asthma and respiratory distress mimic other conditions such as myocardial ischemia. The nurse assesses for this condition as the priority over the others.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 22-2 MSC: Physiologic Integrity

11. The nurse is caring for an older adult who has been prescribed inhaled corticosteroids for

asthma. What does the nurse teach about this medication? a. Taken just before retiring for the night b. Reserved for acute attacks only c. Used in increasing doses as needed d. How to use and rinse the inhaler ANS: C

Corticosteroids are an effective long-term control medication that can be used in increasing doses as needed for asthma and related disorders. It is given by the inhalation method, so the nurse teaches the patient how to use and maintain the inhaler. The other teaching tips are incorrect.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 22-3 MSC: Physiologic Integrity

12. An older patient with severe peripheral arterial disease wishes to quit smoking. The nurse

provide education to this patient on which of the following? a. “Cold turkey” method b. Gradual reduction c. Nicotine patches d. Bupropion hydrochloride (Zyban) ANS: D

Older patients should be offered assistance to quit smoking. The cold turkey and gradual reduction methods may not work if the patient is a long-term smoker. The patient with peripheral arterial disease should not use nicotine in any form as it causes vasoconstriction.

Zyban is an appropriate choice.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 22-4 MSC: Health Promotion

13. An older adult with chronic obstructive pulmonary disease (COPD) asks why he should quit

smoking now. What response by the nurse is best? a. “It will keep your disease from getting worse.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. “There are many benefits to quitting even now.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. “It will decrease the risk of getting cancer too.” d. “You’re right; there really isn’t a reason to quit.”

ANS: B

There are many benefits to smoking cessation including reduction in the number of respiratory infections, improvement in the function of the mucociliary clearance of the lungs, decreased coughing and dyspnea, increased appetite, and decreased sputum production. This is a more comprehensive answer than keeping the disease from worsening and lowering the chance of getting cancer.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 432 OBJ: 22-4 MSC: Health Promotion

14. A patient has been taught about nutrition related to COPD. Which menu selection may

indicate a need for further teaching? a. Bagel and cream cheese b. Broiled chicken breast c. Beans and peas d. Tofu stir-fry ANS: A

Carbohydrates should not make up more than 50% of the daily intake of calories because they break down into carbon dioxide, worsening breathing. The other selections show good understanding. Of course, the nurse needs to take into consideration the amount of carbohydrates in the entire day and not just one selection.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 22-3 MSC: Health Promotion

15. An older patient is hospitalized with influenza and is prescribed amantadine (Symmetrel).

What assessment finding would indicate this drug is not appropriate for the patient? a. BUN 22 mg/dL b. Creatinine 3.2 mg/dL c. Sodium 132 mEq/L d. Potassium 4.2 mEq/L ANS: B

Amantadine can cause behavioral changes, delirium, hallucinations, agitation, and seizures, mostly in patients with impaired renal function. The creatinine is high, indicating renal disease. The other lab values are normal.

DIF: Analyzing (Analysis) TOP: Nursing Process: Assessment

REF: N/A OBJ: 22-3 MSC: Physiologic Integrity

16. A frail, older patient is in the emergency room in severe respiratory distress. The patient has

had repeated hospitalizations for the same thing. After stabilizing the patient, which action by the nurse is most appropriate? a. Determine what the patient’s end-of-life wishes are. b. Assess the family caregiver for compliance with treatment. c. Administer intravenous (IV) fluids at a rapid rate. d. Prepare to vaccinate the patient against pneumonia.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

Because of the lifesaving modalities needed to care for such a patient, the nurse and physician work together to determine what the patient’s end-of-life wishes are. In the emergency department, patient stabilization comes first, but once this has been accomplished a discussion should occur with the patient and family about further treatment desires. The family caregiver may or may not be adherent, or the patient may assume all self-care. IV fluids should not be given at a rapid rate because of the risk of heart failure. The patient should receive an immunization against pneumonia per guidelines.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 22-3 MSC: Safe Effective Care Environment

17. A patient has a pulmonary embolism and asks the nurse to explain the purpose of the heparin

infusion. What response by the nurse is best? a. “It helps dissolve the clot in your lungs.” b. “It keeps you from getting septic.” c. “It prevents the clot from getting bigger.” d. “It prevents clots from forming in your heart.”

ANS: C

Heparin keeps the clot from getting bigger and hopefully prevents further clots from forming.

It does not dissolve the clot. It does not specifically target the heart. It does not prevent sepsis.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 450 OBJ: 22-3 MSC: Physiologic Integrity

18. The nurse caring for patients using continuous positive airway pressure (CPAP) knows what

about treatment effectiveness? a. Effectiveness depends on compliance. b. It’s too expensive for many older adults. c. It is rarely effective for sleep apnea. d. Complicated settings make it hard to use.

ANS: A

Effectiveness is determined by compliance for nearly any regime, and unfortunately compliance with CPAP is less than 50%. The other statements are incorrect.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 451 OBJ: 22-7 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. To minimize an older adult’s risk for developing postsurgical atelectasis, the nurse does which

of the following? (Select all that apply.) a. Regularly assesses and medicates for pain b. Teaches effective deep-breathing techniques c. Provides oxygen via nasal cannula d. Encourages the patient to drink all fluids on meal trays e. Assesses lung sounds frequently ANS: A, B, D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Promotion of deep breathing, effective pain management, adequate hydration, frequent position changes, and early mobility will decrease the risk of developing atelectasis. Providing oxygen and assessing lung sounds will not prevent atelectasis from occurring.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 22-3 MSC: Physiologic Integrity

2. When teaching older adult asthmatic patients, the nurse stresses the importance of which of

the following? (Select all that apply.) a. Being alert for the early signs of breathing problems b. Fostering an effective relationship with your health care provider c. Identifying and avoid personal triggers d. Incorporating regular rest periods into your daily routine e. Increasing vitamin C consumption, especially during winter months ANS: A, B, C

The prognosis for an older adult with asthma is relatively good. Success is based on a partnership between the patient and the health care provider to properly use prescribed medications, avoid asthma triggers, identify early signs of exacerbation, and maintain a healthy lifestyle. Rest may or may not be an issue if the patient has mild asthma. Vitamin C may have immune system benefits.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 428 OBJ: 22-3 MSC: Health Promotion

3. The nurse is coordinating care for a newly admitted older adult. The patient is diagnosed with

hypertension, asthma, atrial fibrillation, mild osteoarthritis, and glaucoma. Before administering the patient’s corticosteroid medication, the nurse is especially interested in which of the following? (Select all that apply.) a. The name of the patient’s hypertension medication b. What the patient uses to manage arthritic pain c. Whether the patient feels the asthma is well controlled d. Whether the patient takes low-dose aspirin regularly e. Whether the patient has ever had glaucoma-related surgery ANS: A, B, D

Asthma may be exacerbated by the use of nonsteroidal antiinflammatory agents for arthritis, aspirin for circulation, nonselective beta-blockers for hypertension, or glaucoma eye drops that contain beta-blockers. Feeling that the asthma is under control and previous surgery are not directly related.

DIF: Application (Applying) TOP: Nursing Process: Assessment

REF: N/A OBJ: 22-3 MSC: Physiologic Integrity

4. The nurse is evaluating the effectiveness of an older patient’s self-management of asthma.

What does the nurse assess as the priority? (Select all that apply.) a. How many times a week a rescue inhaler treatment is needed b. How well the patient is able to avoid the known triggers c. Whether the patient experience frequent respiratory infections d. Whether the patient requires rest periods during the day e. Whether the patient believes he or she has the support of family and friends Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A, B

The evaluation of self-management is based on the patient’s success in following through with the plan. Determine the frequency of rescue inhaler use, success at avoiding triggers, and the patient’s ability to monitor and address lifestyle changes.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 22-3 MSC: Health Promotion

5. The nurse encouraging an older patient to start pulmonary rehabilitation shares the benefits of

the program, including which of the following? (Select all that apply.) a. Socialization b. Decreased cardiac risks c. Nutrition counseling d. Weight management e. Sports participation ANS: A, B, C, D

There are many aspects to pulmonary rehabilitation, including socialization, decreased cardiac risks, nutrition counseling, and weight management Sports are not included, although exercise is.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 435-6 OBJ: 22-6 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 23: Endocrine Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse caring for an older adult with type 2 diabetes mellitus places importance on

assessing the patient for: a. painful nodules on the fingers and toes. b. reddened rash and brittle nails on the hands. c. heartburn and flatus after meals. d. skin temperature and hair growth pattern on the legs.

ANS: D

Insulin resistance causes increased production of inflammatory cytokines correlating with the development of type 2 diabetes mellitus and atherosclerotic vascular disease, therefore skin temperature and hair growth pattern on the legs should be assessed.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 458 OBJ: 23-2 MSC: Physiologic Integrity

2. The nurse recognizes that an older adult on both antihypertensive and antidepressant drug

therapies has a specific need for: a. regular blood pressure monitoring. b. an effective history focusing on sexual function. c. an increase in daily fluid intake. d. frequent assessment of emotional stability.

ANS: B

Drugs such as oral contraceptives, hormone replacement, antihypertensives, antidepressants, or sedatives can cause a sexual arousal disorder as a side effect. In women this can manifest as female sexual dysfunction (FSD), and in men it can manifest as erectile dysfunction (ED).

DIF: Remembering (Understanding) TOP: Nursing Process: Assessment

REF: Page 471-2 OBJ: 23-2 MSC: Physiologic Integrity

3. Aware that older adult patients often present with nonclassic symptoms of type 2 diabetes

mellitus, the nurse is particularly suspicious of a patient reporting: a. bouts of diarrhea alternating with periods of constipation. b. recent problems reading and an infected sore on the toe that will not heal. c. periods of depression and severe indigestion after eating. d. dizziness when getting up too quickly and a red rash on the hands.

ANS: B

Often a newly diagnosed older individual will describe symptoms of fatigue, blurred vision, weight change (gain or loss), and infections. The other symptoms are not related.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 460 OBJ: 23-2 MSC: Physiologic Integrity

4. The nurse observes signs that a patient being assessed may have an underactive thyroid. The Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

data supporting this suspicion includes:

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. heat intolerance, low-grade fever, and patchy hair loss. b. polycythemia, tachycardia, and oral candidiasis. c. muscle cramps, fatigue, and cold intolerance. d. increased blood pressure, postural hypotension, and blurred vision.

ANS: C

Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion, which are symptoms of hypothyroidism that are often attributed to old age. Heat intolerance is often associated with hyperthyroidism. The other options are not related to thyroid dysfunction.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 470 OBJ: 23-2 MSC: Physiologic Integrity

5. The nurse is preparing to provide an older, newly diagnosed diabetic patient with information

regarding type 2 diabetes. The nurse initially: a. asks if the patient prefers a video or a pamphlet. b. invites the patient’s spouse to be present during the instruction. c. selects a quiet, well-lighted space for the class. d. ensures that the patient is pain-free and comfortably seated.

ANS: A

Cognitive function and learning styles vary, so knowing the patient’s preferred learning style facilitates education. Some individuals prefer to learn by visual methods, others by listening, and still others by experiencing contact in a hands-on approach. Controlling pain and ensuring the patient is comfortable will also facilitate learning, but it is more important to meet the patient’s preferred learning style. The other options are helpful but not as vital.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 462 OBJ: 23-2 MSC: Health Promotion

6. Which documentation demonstrates that the nurse effectively assessed an older adult diabetic

patient’s cardiac status? a. radial pulse: 88 and regular b. carotid pulses equal and strong c. BP 126/78 recumbent and 122/78 sitting d. nail beds pale in color ANS: C

To assess circulation, the nurse should take an apical pulse, noting rate and rhythm; check pedal pulses bilaterally; and note the presence of hair on the lower extremities. The nurse should take blood pressure measurements with the patient in both recumbent and sitting positions, note any dizziness associated with a change of position, and assess the respiratory rate, depth, and chest sounds.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 462 OBJ: 23-2 MSC: Physiologic Integrity

7. The nurse teaching a 79-year-old with type 2 diabetes about the importance of regular exercise

suggests that the patient: a. swim 10 laps in the community center pool three times a week.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. enroll in a daily lunch time aerobics class at the senior center.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. lift 5 pound weights in a routine of 10 repetitions in each arm. d. walk on the treadmill each morning for 30 minutes.

ANS: D

Older adults may derive the greatest benefit from morning exercise because that is the time of greatest insulin resistance. However, any exercise is better than no exercise at all. Aerobic exercise should be balanced with weight training.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 465 OBJ: 23-2 MSC: Health Promotion

8. What assessment findings support an older patient’s diagnosis of hypothyroidism? a. A 2-cm wound noted on medial aspect of left foot b. An apical rate: 98/min c. A patient report that “I always wear a sweater” d. A weight loss of 10 pounds over 6 weeks ANS: C

Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion. The other assessments are not related.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 470 OBJ: 23-2 MSC: Physiologic Integrity

9. Which assessment findings support the suspicion that an older patient has osteoporosis? a. The patient’s reports an allergy to dairy products. b. A lactase enzyme is a part of the patient’s drug regime. c. Bones in one of the patient’s lower legs are shorter than in the other. d.

The patient is

inch shorter than at his or her previous physical.

ANS: D

Dorsal kyphosis, chronic back pain, and loss of height are common signs of primary osteoporosis in older persons. The other signs do not relate to this disorder.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 471-2 OBJ: 23-2 MSC: Physiologic Integrity

10. An older patient has been diagnosed with metabolic syndrome. What action by the nurse takes

priority? a. Educate the patient on medications. b. Teach lifestyle changes the patient can manage. c. Encourage 60 minutes of aerobic activity daily. d. Instruct the patient on a low-fat diet.

ANS: B

Lifestyle changes are the mainstay of treatment for this disorder. Nurses have the primary responsibility for teaching. The patient should be included in planning so that lifestyle changes are reasonable and “doable” for the older patient. Activity and diet are part of the changes needed, but activity does not need to be so extensive and diet should not be the only topic taught. Medications are not generally used.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 23-2

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning

MSC: Health Promotion

11. A patient has type 2 diabetes. The family reports the patient has become very forgetful. What

response by the nurse is best? a. “We should assess her for Alzheimer disease.” b. “Forgetfulness is a common sign in diabetes.” c. “Have her blood sugars been under good control?” d. “Does she recognize you and know your names?”

ANS: B

Many diabetics report depression and memory problems, so the nurse explains this fact.

Forgetfulness does not necessarily indicate dementia. Asking about blood glucose is appropriate, but not related. Not recognizing family is not the same as forgetfulness.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 462 OBJ: 23-2 MSC: Physiologic Integrity

12. The family of a patient who has type 2 diabetes calls the clinic to report a very small sore on

the patient’s foot. What action by the nurse is best? a. Have the patient come to the clinic today. b. Have the family wash and bandage it. c. Tell the patient to check for a fever. d. Have the patient go to the emergency room.

ANS: A

Any ulcer or sore on a foot requires medical attention because on superficial inspection, the true degree of injury can be hidden. The patient should come to the clinic today. The family should not attempt to care for the wound and the patient does not need to take a temperature before coming in. The patient does not need to go to the emergency department at this time.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 23-2 MSC: Physiologic Integrity

13. A patient has been admitted with new atrial fibrillation. What additional diagnostic testing

does the nurse anticipate? a. Thyroid hormones b. Platelet count c. Urinalysis d. Blood glucose ANS: A

Hyperthyroidism is often seen with atrial fibrillation. Platelet count, urinalysis, and glucose are often done as part of admission, but they are not directly related to atrial fibrillation as is hyperthyroidism.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 468 OBJ: 23-2 MSC: Physiologic Integrity

14. An older patient has osteoporosis and is reluctant to exercise because “I already have a bone

problem, so how will it help?” What response by the nurse is best? a. It can improve posture, balance, and reduce falls.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. It will give you heart-healthy benefits.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Exercise will make you feel younger. d. If you join a gym, you can socialize with new people.

ANS: A

Exercise not only improves bone health but improves posture, balance, and reduces falls. The nurse should educate the patient on these benefits.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 471-2 OBJ: 23-2 MSC: Health Promotion

15. A nurse is preparing to administer metoprolol (Toprol) to an older male patient. What action

by the nurse is best regarding endocrine disorders? a. Administer the medication as ordered. b. Check the patient’s ID using two sources. c. Say, “Many men experience ED with this drug.” d. Tell the patient to discuss the side effects with his provider.

ANS: C

The nurse should instruct patients on side effects of medications. The nurse can assess if the patient wants to discuss this issue by opening the conversation with a “normalizing” statement, such as “many men have ED on this drug. Is this something you would like to discuss?” Although side effects do need to be brought up to the provider, the wording of this statement does not indicate a willingness of the nurse to engage in conversation. The other two options are correct but not related to endocrine dysfunction.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 23-2 MSC: Psychosocial Integrity

16. A type 2 diabetic patient is admitted to the hospital with a gastrointestinal illness and a blood

glucose of 480 mg/dL. After stabilizing the patient, what action by the nurse is best? a. Educate the patient on safe food handling. b. Ask if the patient took the diabetic medication. c. Teach the patient ways to avoid dehydration d. Delegate frequent blood sugars to the aide.

ANS: B

A frequent cause of hyperglycemia requiring hospitalization in diabetics is poor sick day management. The type 2 diabetic still makes insulin and so needs antihyperglycemic drugs even when ill. The nurse assesses the diabetic’s knowledge of sick day management. The other options are appropriate but not the priority. Better sick day management can possibly keep the patient from further, similar, hospitalizations.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 23-3 MSC: Health Promotion

17. A nurse is reviewing possible first-line medications for a new, older type 2 diabetic. What

contraindication does the nurse identify for metformin (Glucophage)? a. Patient drinks three to four alcoholic drinks/day b. Patient’s parents both took insulin c. Creatinine 0.9 mg/dL d. Potassium 3.8 mEq/dL Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

Patients with hepatic or renal dysfunction should not take metformin. A patient who drinks as much as three to four alcoholic drinks a day has a real risk of liver disease. The use of insulin by the parents is not related. Both kidney lab values are normal.

DIF: Analyzing (Analysis) TOP: Nursing Process: Assessment

REF: N/A OBJ: 23-3 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. The nurse is assessing an older patient with elevated plasma triglyceride levels. What other

assessment finding leads the nurse to suspect metabolic syndrome? (Select all that apply.) a. Blood pressure of 148/90 mm Hg b. A fasting blood glucose of 109 mg/dL c. Reports of frequent urination d. Weight measurement of 50 inches e. HDL level of 52 mg/dL ANS: A, B, D, E

The clinical criteria for metabolic syndrome includes increased waist circumference (population specific) plus any two of the following: (1) blood pressure greater than 129/84 mm Hg or taking hypertension medication, (2) plasma triglyceride levels over 149 mg/dL or taking triglyceride medication, (3) high-density lipid levels less than 40 mg/dL in men or less than 50 mg/dL in women or taking HDL-C medication, (4) fasting glucose greater than 99 mg/dL (including patients with diabetes).

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 458 OBJ: 23-3 MSC: Physiologic Integrity

2. The nurse is teaching a newly diagnosed diabetic patient about metformin. What information

does the nurse include? (Select all that apply.) a. Alcohol intake should be limited and taken with food. b. Overweight patients sometimes poorly tolerate metformin. c. Oral hypoglycemic agents can increase the risk of hyperglycemia. d. Metformin has been the cause of anorexia in older patients. e. Oral hypoglycemic agents affect vitamin D absorption.

ANS: A, D

Studies indicate that metformin, classified as a biguanide, may be the drug of choice for overweight patients. Side effects such as anorexia, nausea, and abdominal discomfort may, however, limit its use in older adults. Alcohol can decrease hypoglycemic awareness, so metformin should only be ingested with food. Alcohol use should also be limited.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 465 OBJ: 23-3 MSC: Physiologic Integrity

3. What assessment findings support a diagnosis of hyperthyroidism in the older adult? (Select

all that apply.) a. Tremors b. Heat intolerance Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Tachycardia

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. Palpable goiter e. Atrial fibrillation ANS: A, D, E

The classic geriatric presentation of hyperthyroidism includes tachycardia, fatigue, tremors, and nervousness in contrast to tachycardia, heat intolerance, and fatigue in younger patients.

An enlarged, palpable goiter is present in 60% of older adults with hyperthyroidism. The most common complication, occurring in 27% of geriatric hyperthyroid patients, is atrial fibrillation that does not convert back to sinus rhythm when a euthyroid state has been achieved.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 468 OBJ: 23-3 MSC: Physiologic Integrity

4. The nurse assessing patients for diabetes looks for the classic signs, including which of the

following? (Select all that apply.) a. Polyuria b. Polycythemia c. Polydipsia d. Polyphagia e. Polyandrony ANS: A, C, D

The classic signs of diabetes are polyuria, polydipsia, and polyphagia.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 460 OBJ: 23-2 MSC: Physiologic Integrity

5. When teaching an older patient about diet therapy, the nurse plans to assess for barriers to

adherence, including which factors? (Select all that apply.) a. Lifelong habits b. Cultural influences c. Finances d. Dependency e. Inability to learn ANS: A, B, C, D

Diet therapy can be problematic for older adults who have a lifetime of food habits, cultural influences on food, finances that may be limited, and dependency on others to buy or prepare food. Older adults are not unable to learn.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 23-2 MSC: Health Promotion

6. The nurse teaches an older patient safety rules for exercising. What do these rules include?

(Select all that apply.) a. Carry medical identification. b. Check blood glucose before exercising. c. Drink plenty of water. d. Have quick-acting glucose. e. Knowing signs of hyperglycemia.

ANS: A, B, C, D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Rules for safe exercise include all the above except the patient is more likely to experience hypoglycemia, so those signs and symptoms are important related to exercise.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 23-2 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 24: Gastrointestinal Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. An 80-year-old patient has nausea and vomiting related to a gastrointestinal disorder. The

nursing intervention most likely to help the patient is to: a. offer sips of soda every 15 minutes until more is tolerated. b. encourage the patient to lie in a prone position while nauseated. c. encourage the intake of high-calorie foods such as milkshakes. d. keep the patient on a nothing-by-mouth (NPO) order until the nausea subsides.

ANS: A

Nursing interventions for nausea and vomiting include many self-help measures, including drinking clear liquids, progressing from eating bland foods to solid foods, and small frequent feedings. If vomiting occurs, fluid replacement should be a priority. Sips of fluids every 15 minutes until more can be tolerated may decrease episodes of dehydration. The position of the patient is unimportant. The patient should avoid nonclear liquids such as milkshakes. If the patient cannot keep even sips down, he or she may be prescribed NPO status.

DIF: Understanding (Comprehension) TOP: Nursing Process: Implementation

REF: Page 480 OBJ: 24-6 MSC: Physiologic Integrity

2. When preparing to discharge an older patient with mild dysphagia, the nurse suggests that the

patient can minimize symptoms by: a. eating small meals every 2 to 3 hours b. cutting a sandwich into bite-sized peicees. c. eating less but choosing nutrient-dense foods. d. drinking thin liquids instead of eating solids.

ANS: A

Instruction regarding eating habits and maintaining weight and nutrition is important. For example, small, frequent meals, pureed or soft foods, and high-protein, high-calorie foods are helpful. Thin liquids are often harder to swallow than thickened ones. Nutrient-dense foods are important, but so is maintaining calorie requirements.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 488 OBJ: 24-6 MSC: Health Promotion

3. An older patient is being taught about oral gingivitis. The nurse has included instruction about

maintaining an oral hygiene program, signs and symptoms of oral infection, and the importance of maintaining regular professional dental care. What important teaching has been missed? a. Information about when to have teeth removed and dentures made b. The necessity of using a hard-bristled toothbrush to maintain cleanliness c. The importance of avoiding meat and caffeine-containing products d. The importance of adequate nutrition for maintaining oral health ANS: D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Nursing management of an older patient with gingivitis or periodontitis includes promotion of regular oral hygiene, regular preventive dental care, and maintenance of nutritional status. In addition, instructing the patient on the signs and symptoms of oral infections is also an important component of patient education. The other topics are not warranted.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 487 OBJ: 24-6 MSC: Health Promotion

4. An older adult patient has recently diagnosed gastritis. What statement made by this patient

indicates the need for further teaching? a. “The abdominal pain is caused by acidity.” b. “I should avoid taking aspirin.” c. “Smoking has little effect on my stomach problem.” d. “I could develop pernicious anemia.”

ANS: C

Acute gastritis causes transient inflammation, hemorrhages, and erosion into the gastric mucosal lining. Although the cause may be undetermined, it is frequently associated with alcoholism, aspirin or nonsteroidal antiinflammatory drug (NSAID) ingestion, smoking, and severely stressful conditions such as burns, trauma, central nervous system damage, chemotherapy, and radiotherapy. It can cause abdominal pain. Smoking is a risk factor. The patient could develop pernicious anemia.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 24-6 MSC: Physiologic Integrity

5. The nurse is planning to teach an older patient about diverticulitis. What topic does the nurse

include? a. Dietary fiber and fluids will reduce the symptoms. b. It is unusual to see diverticula in older persons. c. Abdominal cramping and severe diarrhea should be reported. d. Diverticulosis rarely reoccurs once it has been treated.

ANS: A

Teaching should include the need to eat high-fiber foods and the importance of achieving and maintaining adequate fluid status. Patients should be encouraged to consume up to 2000 mL of fluids each day, unless contraindicated by cardiac status. Older people have diverticulitis commonly. Abdominal cramping and diarrhea are expected findings. Diverticulitis usually reoccurs.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 497 OBJ: 24-5 MSC: Physiologic Integrity

6. The nurse caring for an older adult diagnosed with hyperplastic polyps instructs him that: a. this type of polyp is rarely malignant and usually does not require treatment. b. follow-up colonoscopies should be performed every 3 to 4 years after diagnosis. c. stool should be guaiac tested every week for 1 year after diagnosis. d. the presence of blood in the stool requires a repeat sigmoidoscopy examination.

ANS: D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

This type of polyp is rarely cancerous and rarely causes symptoms; however, they occasionally bleed, leaving bright red blood in the stool. A colonoscopy every 3 to 4 years is not indicated nor is testing the stool for blood for 1 year.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 24-6 MSC: Physiologic Integrity

7. An older adult reports chronic constipation. When asked why this problem has gotten worse

with age, the nurse responds: a. “As we age, our bodies require more fiber to bring about healthy bowel function.” b. “We need to discuss the proper use of laxatives to minimize constipation.” c. “It’s possible that you have lost the ability to feel when you need to move your bowels.” d. “Aging brings about decreased gastric motility that often results in constipation.”

ANS: A

The most widespread cause of constipation in older adults is diet. Diets need to include 20 to 30 mg of fiber a day and plenty of water. Some changes in nerve function and gastric motility are also possible causes, but the major cause is diet. Laxatives should only be used as a last resort.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 482 OBJ: 24-6 MSC: Health Promotion

8. An older adult patient reports episodes of fecal incontinence. The nurse provides appropriate

emotional support when assuring the patient that: a. it is a common problem that occurs in response to normal aging. b. the incontinence is rarely a result of a serious problem. c. disposable absorbent underwear will help manage the problem. d. the problem generally responds well to bowel control programs.

ANS: D

It is important to reassure older patients that control and retraining are achievable because many older adults believe that fecal incontinence is the first step on the road to permanent institutionalization. Disposable garments may be used temporarily or long term if the patient cannot complete bowel retraining. It is not a normal response to aging.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 483 OBJ: 24-6 MSC: Physiologic Integrity

9. The daughter of a dependent older patient reports to the nurse that the patient requires regular

soapsud enemas to manage chronic constipation. The nurse responds that: a. an alternative management technique should be discussed. b. enemas are generally the most effective interventions for the older adult. c. chronic constipation is best managed with oral medications. d. her mother’s diet is the most likely cause of the constipation.

ANS: A

Soapsud enemas lead to mucosal irritation and should not be used. Alternative methods to managing constipation include dietary changes and medications when needed.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) REF: Page 482 OBJ: 24-6

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning

MSC: Physiologic Integrity

10. A 74-year-old adult is experiencing dumping syndrome after gastric resection surgery. The

nurse caring for the patient instructs the patient to: a. stop smoking. b. abstain from beverages that contain caffeine. c. eat three low-carbohydrate meals daily. d. drink only between meals.

ANS: D

The institution of small, frequent meals that are low in carbohydrates will diminish the incidence of these symptoms. Resting after eating and drinking fluids between (rather than during) meals will also help alleviate these symptoms. Smoking and caffeine are not related, and eating only three meals a day is not warranted.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 492 OBJ: 24-6 MSC: Physiologic Integrity

11. A 68-year-old patient is reporting symptoms that suggest a peptic ulcer. The nurse asks the

patient if: a. the pain exacerbates when he eats fatty food. b. there is a family history of peptic ulcers. c. he smokes either cigars or cigarettes. d. he uses acetaminophen (Tylenol) for minor pain.

ANS: B

Both genetic and environmental factors have been proposed as the cause of peptic ulcers because both gastric ulcers and duodenal ulcers tend to occur in families. At present, no direct evidence exists that indicates dietary or occupational factors as causes of ulcer disease.

Acetaminophen generally does not cause gastric ulcers.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 491 OBJ: 24-6 MSC: Physiologic Integrity

12. What dietary suggestion does the nurse give the older patient to manage age-related changes

in taste? a. Add more salt to foods. b. Use a salt substitute. c. Add sugar when possible. d. Use a variety of herbs.

ANS: D

Older adults experience a decrease in taste discrimination. Various herbs can be used to spice up foods. More salt should not be added, as older adults generally should eat low-salt diets.

Salt substitutes often contain potassium, a problem for older adults who have an age-related decrease in kidney function and the ability to excrete potassium. Adding sugar is not healthy.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 24-1 MSC: Health Promotion

13. An older patient has been admitted with nausea and vomiting. What assessment takes priority?

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. Respiratory system

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. Urine output c. Blood pressure and pulse d. Skin integrity ANS: C

All assessments are appropriate; however, the concern in this older patient is dehydration, so assessment of cardiovascular status comes first. Urine output reflects cardiac output but it does not reflect as up-to-date information as do vital signs. Respiratory system and skin integrity are lower priorities for this patient.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 24-6 MSC: Safe Effective Care Environment

14. A patient is admitted with copious diarrhea. The patient is dizzy when standing, and skin

assessment reveals abrasions around the perianal area. What assessment finding demonstrates that goals for the priority nursing diagnosis have been met? a. Perianal skin abrasions are smaller in size. b. Patient does not fall while hospitalized. c. Patient sits up without dizziness. d. Patient is able to tolerate oral fluids.

ANS: D

The priority diagnosis for this patient is decreased cardiac output or fluid volume deficit, either of which is evaluated with the lack of dizziness. Falling indicates dehydration or weakness, both brought about by the cardiac output situation. Skin integrity is important but not the priority. Being able to tolerate fluids indicates treatment is going well. However, the priority diagnosis relates to cardiac output and fluid volume.

DIF: Analyzing (Analysis) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 24-7 MSC: Physiologic Integrity

15. A patient has pernicious anemia. What action by the patient and family indicates teaching for

this condition has been effective? a. Proper administration of oral vitamin B12 b. Correct technique for intramuscular (IM) injections c. Choosing aspirin over ibuprofen (Motrin) for pain d. Preparing a low-carbohydrate meal ANS: B

Pernicious anemia is typically treated with IM injections of vitamin B12. Oral preparations are not absorbed in the gastrointestinal tract. Aspirin or ibuprofen are not related, nor is a low carbohydrate diet.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 24-7 MSC: Physiologic Integrity

16. A patient is admitted with infectious diarrhea. What action by the nurse is best? a. Place the patient in contact precautions. b. Place the patient on droplet precautions. c. Use standard precautions to care for the patient. d. Prepare staff to take prophylactic antibiotics.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

Contact precautions should be used when caring for a patient with infectious diarrhea. The other options are not warranted.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 24-7 MSC: Safe Effective Care Environment

17. An older patient with hepatitis has pruritus. What advise does the nurse provide this patient? a. Keep your fingernails cut short. b. Use diphenhydramine (Benadryl). c. Hot soapy showers will help. d. Butter is a good home remedy for itching.

ANS: A

Pruritus is intense itching. The patient’s nails should be kept short to avoid injury to the skin and possible infection. Diphenhydramine is not recommended in older patients. Tepid water with little soap is best. Butter is not a home remedy for itching.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 24-7 MSC: Physiologic Integrity

18. An older patient had a stroke several months ago. The patient begins to exhibit dysphagia.

What action by the nurse is best? a. Consult with a speech-language therapist. b. Discuss the need for enteral feedings. c. Provide the patient swallowing exercises. d. Arrange for a physical exam.

ANS: D

This patient has started exhibiting difficulty swallowing months after a stroke, so the stroke is probably not the cause. Difficulty swallowing is a sign of esophageal cancer, however, so the nurse should arrange for the patient to have a physical exam. The patient may still need speech language therapy and swallowing exercises, but this is not the priority.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 24-4 MSC: Physiologic Integrity

19. An older patient is having a colostomy as part of surgery for colon cancer. What assessment

by the nurse is most important in this patient? a. Manual dexterity b. Body image c. Fear of dying d. Fluid volume status ANS: A

The older adult with diminished manual dexterity may need assistance with ostomy care. The other assessments are appropriate for patients of all ages.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 24-7 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 MULTIPLE RESPONSE 1. A 70-year-old patient has lost 25 pounds since being diagnosed with hepatitis A. To best

manage the patient’s anorexia, what does the nurse suggest? (Select all that apply.) a. A protein powder supplement added to liquids b. Several meals eaten during the day c. Megavitamins that include iron and folic acid d. A dietary assessment to identify favorite foods e. A high-carbohydrate, low-fat diet ANS: B, E

A patient with hepatitis best tolerates a high-carbohydrate, low-fat diet. Several small feedings throughout the day will help alleviate the effect of anorexia. Favorite foods can be assessed but should not be encouraged unless they meet the dietary restrictions. Protein powder may be useful but is not necessary. Megavitamins are also not warranted.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 501 OBJ: 24-6 MSC: Physiologic Integrity

2. Because of a knowledge of age-related changes in the gastrointestinal system, the nurse

encourages regular screenings for which of the following? (Select all that apply.) a. Osteoporosis b. Vitamin B deficiency c. Pernicious anemia d. Enlarged liver e. Iron deficiency anemia ANS: A, B, C, E

By the age of 60, a person’s gastric secretions decrease to 70% to 80% of those of the average adult. A decrease in pepsin may hinder protein digestion, whereas a decrease in hydrochloric acid and intrinsic factor may lead to malabsorption of iron, vitamin B12, calcium, and folic acid. This, combined with atrophy of the mucosa and a decrease in gastric secretions, increases the incidence of pernicious anemia, osteoporosis, vitamin B deficiency, and iron deficiency anemia.

DIF: Applying (Application) TOP: Nursing process: Assessment

REF: N/A OBJ: 24-2 MSC: Physiologic Integrity

3. An older adult patient is being evaluated for a possible duodenal ulcer (DU). Which of the

following assessments supports the diagnoses? (Select all that apply.) a. Passing a moderate amount of dark reddish-brown stool b. Reporting a stabbing pain in the epigastric region c. Asking for “some crackers to stop my stomach cramps” d. Reporting the need to take antacid tablets “most days” e. Having a rigid abdomen about 2 hours after eating ANS: A, C, D

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Typically the symptoms of DU are patterned by periods of exacerbation and remission and follow a pain-food-relief pattern. The pain begins 2 to 4 hours after meals, is immediately relieved by food or antacids, is located in the mid epigastrium, and may be described as a burning or cramplike pain. On physical examination, the only abnormality is possibly a tender epigastrium. A rigid abdomen could indicate a perforation of the ulcer. Stabbing epigastric pain is not a manifestation.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 491-2 OBJ: 24-4 MSC: Physiologic Integrity

4. An 82-year-old patient with a history of chronic heart and respiratory problems asks the nurse,

“What can I do to keep my hemorrhoids from acting up?” Which of the following responses made by the nurse are appropriate? (Select all that apply.) a. Ask if he experiences constipation with any regularity. b. Encourage him to increase his fluid intake to 2000 mL daily. c. Suggest he eat more whole grains and fresh fruits. d. Discuss how he should include a walk into his daily routine. e. Ask if he has a history of rectal bleeding.

ANS: A, C, D, E

Nursing management of an older patient with hemorrhoids includes the prevention and elimination of constipation. This includes a review of high-fiber, high-roughage foods, including indigestible fiber like whole grains, legumes, and fresh fruits and vegetables. An adequate intake of fluids is also important. Older patients should be encouraged to consume up to 2000 mL of fluids each day unless contraindicated. This patient has heart disease and possibly should not take in that much fluid. The nurse should encourage light exercise on a regular basis and review the importance of a regular toileting routine. Rectal bleeding should be investigated.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 24-4 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 25: Musculoskeletal Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. To best identify a risk for injury in an older adult patient, the nurse assesses for: a. decreased muscle mass in the legs. b. history of falls. c. hyperextension of the spine. d. decreased bone density.

ANS: B

Musculoskeletal aging changes increase the risk for falls in older adults. Approximately one third of those age 65 or older have falls each year. About 2% of this group is hospitalized as a result of injuries incurred during the fall. The other assessments are appropriate, but a history of falls is most predictive.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 512 OBJ: 25-2 MSC: Safe Effective Care Environment

2. A nurse is caring for the older patient who had knee replacement surgery 8 days ago. What

assessment by the nurse is most important? a. Determining whether the patient has sensation to the foot b. Asking the patient to rate his or her current pain. c. Observing the incision site for redness or drainage. d. Monitoring the calf circumference on the affected side ANS: D

Major complications after joint replacement surgery include thromboembolism (deep venous thrombosis [DVT]), joint or wound infection, blood loss, nerve injury, joint dislocation, and surgical pain. The risk of DVT is highest between the first and second week after surgery. An increase in calf circumference can indicate the presence of a DVT. The other assessments are appropriate but not as critical.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

3. A patient had hip replacement surgery. What intervention is most appropriate to prevent

dislocation? a. Instruct staff to use a fracture pan when the patient needs to toilet. b. Administer ordered pain medication prior to turning. c. Elevate the patient’s knee on the affected side with a pillow. d. Apply an abduction splint while the patient is in bed.

ANS: D

Patients who have total hip replacement surgery are at risk for hip dislocation. The hip should be maintained in a position of abduction and neutral alignment. Some physicians may require the use of pillows or abduction splints while the patient is in bed. The other actions will not prevent dislocation.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 25-5 TOP: Communication and Documentation MSC: Physiologic Integrity 4. An older adult patient who has experienced a left knee replacement asks the nurse, “When

will I be back to normal?” The nurse responds that: a. “What did the surgeon tell you about function after the surgery?” b. “Normal means different things to different people.” c. “You should be back to normal after 6 to 8 weeks.” d. “Surgery will improve your mobility but I’m not sure about being normal.”

ANS: A

The goal of total knee replacement surgery is to restore at least 90 degrees of knee flexion.

However, the patient may have unrealistic expectations, so the nurse should first assess what the patient was told the outcome would be. The other statements do not give accurate information.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

5. The nurse caring for an older patient diagnosed with spinal stenosis encourages the patient to

notify her physician if she experiences: a. sharp pain when turning her neck side-to-side. b. stabbing pain in her lower back. c. a cramping sensation in her feet. d. a burning sensation in either one or both legs.

ANS: D

Patients with spinal stenosis may develop claudication-like symptoms of burning and numbness in their lower extremities. This is a sign of cord compression and needs to be reported. The other symptoms are not as worrisome.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

6. The nurse is assisting a 65-year-old female patient with planning an exercise program to

prevent osteoporosis. The nurse shows an understanding of appropriate exercise when stating: a. “The local gym offers aerobics for seniors on Tuesday and Thursday evenings.” b. “Bicycling along the park’s 2-mile trail twice a week would be ideal.” c. “Do you have a friend who would walk with you for 30 to 60 minutes?” d. “Are you aware that rowing is an excellent exercise for strengthening bone?”

ANS: C

Exercise programs that include weight bearing and resistance have been shown to prevent bone loss. Beneficial exercises for older adults include walking, low-impact aerobics, vigorous water exercises, and racquet sports. Having a walking partner would be the best choice for this patient. The gym costs money and the classes may or may not be low impact.

Bicycling and rowing are not weight-bearing exercises and do not promote bone growth.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 25-5 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 7. An older adult patient has been casted for a fractured left wrist. Which action by the nurse

takes priority? a. Assessing capillary refill in the nail beds of the fingers of the left hand. b. Instructing the patient on how to effectively rate pain on the pain scale. c. Teaching the patient to wrap the cast in plastic when the patient showers. d. Providing the patient with a protein-enriched milkshake as a bedtime snack.

ANS: A

Excessive constriction caused by the cast could result in compartment syndrome, leading to ischemia and tissue destruction of the extremity. Any change in capillary refilling, skin color, skin temperature, or excessive pain not controlled with medication should be immediately reported to the physician. This is the priority assessment. Pain is another important assessment, but circulatory status is first. The other actions are appropriate but not the priority.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 25-3 MSC: Safe Effective Care Environment

8. An older adult patient has been admitted to the hospital with suspected Paget disease. What

clinical manifestation will help the nurse differentiate Paget disease from other types of musculoskeletal diseases? a. Red, swollen upper and lower extremity joints b. Pain on awakening that subsides with activity c. Ataxia or mild hearing loss d. Back deformity in the absence of pain ANS: C

Manifestations of Paget disease include bone pain, headache and conductive hearing loss (if the skull is affected), barreling of the chest, kyphosis, skull enlargement, and bowing of the tibia and femur. The other manifestations are not those of this disorder.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 531 OBJ: 25-4 MSC: Physiologic Integrity

9. An older confused patient is recovering from a stage IV sacral pressure ulcer. The nurse shows

an understanding of this patient’s risk for developing osteomyelitis by: a. adhering to sterile technique when changing the wound’s dressing. b. assessing and documenting the patient’s vital signs regularly. c. managing the patient’s antibiotic therapy as prescribed. d. ensuring that the patient’s diet includes sufficient protein.

ANS: A

Prevention of osteomyelitis includes using sterile technique during dressing changes and following strict wound precautions. The other actions are not as important for preventing this complication, although they are part of the patient’s nursing care plan.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 25-5 MSC: Safe Effective Care Environment

10. An older adult is diagnosed with rheumatoid arthritis. When discussing exercise with the

patient, the nurse makes the greatest positive impact on the patient’s quality of life when stating: Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. “Exercising will be important to the flexibility of your joints.”

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. “It seems to help if you have someone to exercise with.” c. “I’ll provide you with a list of gyms where you can exercise.” d. “Let’s discuss ways for you to exercise your joints.”

ANS: D

With advances in drug therapy and active participation by the patient in activities to prevent joint deformities, the patient should experience less deformity, increased comfort levels, and understanding of the disease process. By actually discussing exercise, the nurse makes the greatest impact on the patient’s quality of life. The other options are appropriate but will not have as great an impact as discussing actual exercises.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

11. The nurse is caring for an older adult patient prescribed allopurinol (Zyloprim). What action

by the nurse is best? a. Offering fresh, cold water frequently during the day b. Monitoring temperature every 4 hours c. Ensuring sufficient protein intake d. Assessing for depression symptoms daily ANS: A

To discourage the formation of renal stones, the patient should be encouraged to have a daily intake of 2 to 3 L of fluid unless contraindicated. The other actions are not related to preventing this adverse effect.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

12. A patient is being dismissed from the emergency department with an arm cast. What statement

by the patient indicates more teaching is needed? a. “I will keep the cast clean and dry.” b. “I will wiggle my thumb and fingers often.” c. “I will elevate my arm on two pillows.” d. “I can use a hanger to scratch under the cast.”

ANS: D

Nothing goes under the cast, so scratching with any type of object is not allowed. The other statements show good understanding.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 25-3 MSC: Health Promotion

13. An older patient is in the family practice clinic reporting increasing joint pain, anorexia, and

low-grade fever. The patient has a history of osteoarthritis. What action by the nurse is best? a. Document the findings on the patient’s chart. b. Assess for joint deformities and nodules. c. Tell the provider the patient needs more pain medicine. d. Encourage the patient to ask for physical therapy.

ANS: B Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Osteoarthritis does not include systemic symptoms. The nurse should assess for other causes of joint pain, including rheumatoid arthritis, which is manifested by joint deformities and subcutaneous nodules. Findings should be documented. The patient may need a change of pain medication. Physical therapy is an appropriate intervention. However, determining the source of the patient’s symptoms comes first.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 25-4 MSC: Physiologic Integrity

14. A patient’s chart contains an assessment of tophi and podagra. What medication does the

nurse plan to educate the patient on? a. Allopurinol (Zyloprim) b. Colchicine (Colcrys) c. Levadopa-carbidopa (Sinemet) d. Ibuprofen (Motrin) ANS: A

This patient has manifestations of chronic gout, which is treated with allopurinol. Colchicine is for acute attacks. Sinemet is for Parkinson disease. Ibuprofen may or may not be needed.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

15. A nurse works in a long-term care facility where many of the residents have osteoporosis. For

which resident would alendronate (Fosamax) be contraindicated? a. A patient on a continuous tube feeding b. A wheelchair-bound patient c. A patient over the age of 85 d. A male patient ANS: A

Fosamax must be taken 1 hour before meals. This would probably not be the most appropriate medication for a patient on a continuous tube feeding. The other patients are appropriate candidates for this medication.

DIF: Analyzing (Analysis) TOP: Nursing Process: Assessment

REF: N/A OBJ: 25-6 MSC: Physiologic Integrity

16. A patient is scheduled to have a lower extremity amputation. What action by the nurse takes

priority? a. Discuss stump management and prostheses. b. Ensure informed consent is on the chart. c. Determine the patient’s goal for pain control. d. Administer the preoperative antibiotic.

ANS: B

Prior to any operation, the nurse ensures informed consent is on the chart. The other options are appropriate actions, but the surgery cannot occur without consent.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 25-7 MSC: Safe Effective Care Environment

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 17. A patient has just arrived in the postanesthesia care unit after a below-the-knee amputation.

What assessment takes priority? a. Surgical dressing b. Level of pain c. Pulse and blood pressure d. Airway ANS: D

Airway is always the priority. The other assessments are important too, but airway takes precedence.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 25-7 MSC: Safe Effective Care Environment

18. After a below-the-knee amputation, a patient has disturbed body image. What action by the

patient indicates movement toward resolution of this diagnosis? a. The patient names his stump “Pete.” b. The patient attends physical therapy. c. The patient begins to change dressings. d. The patient asks questions about prosthetics.

ANS: C

The best indication that the patient has accepted this change to body image is participation in stump care. Asking questions is also a good sign but does not necessarily reflect body image.

The other two options do not demonstrate resolution of the diagnosis.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 25-7 MSC: Psychosocial Integrity

19. A patient has polymyalgia rheumatica. When teaching about medications, what information

does the nurse provide? a. “Take the full dose of antibiotics even if you are feeling better.” b. “You need to remain upright 1 hour after taking the medication.” c. “Stay away from large crowds and avoid people who are sick.” d. “Do not drink alcohol while taking this medication.”

ANS: C

This disorder is treated with corticosteroids, which can reduce the inflammatory response.

Patients should be advised on ways to avoid infection. The other statements do not relate to steroids.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

20. A patient has onychomycosis. The nurse should anticipate educating the patient on which of

the following drugs? a. Clotrimazole (Lotrimin) b. Terbinafine (Lamisil) c. Itraconazole (Sporanox) d. Methylprednisolone (Solu-Medrol) ANS: A Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Clotrimazole is used as a cream for several months on this toe fungal infection. Terbinafine and itraconazole are generally not used in older adults. The steroid methylprednisolone is not indicated.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 537 OBJ: 25-8 MSC: Physiologic Integrity

21. The nurse conducting a community-screening event for osteoporosis knows that which

woman is at highest risk? a. A slender 84-year-old Asian who smokes b. A heavy set 65-year-old Caucasian c. A 75-year-old taking a steroid “burst” d. A 68-year-old African American who consumes one drink a day ANS: A

Risk factors for osteoporosis include thin body frame, white race, advancing age, alcoholism, and smoking, among others. The 84-year-old who smokes is at highest risk despite being Asian.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 527 OBJ: 25-6 MSC: Health Promotion

MULTIPLE RESPONSE 1. To assess for osteoarthritis in an older adult patient, the nurse asks which of the following

questions? (Select all that apply.) a. “Do you have pain in your finger joints?” b. “Do your knees crackle when you bend down?” c. “Does you get dizzy when you turn your head?” d. “Does it hurt when you get up from a chair?” e. “Does your back creak when you bend over?”

ANS: A, B, D, E

The distal interphalangeals, proximal interphalangeals, knees, hips, and spine are the joints most commonly affected by osteoarthritis. These would be the questions most likely to suggest osteoarthritis. Getting dizzy is not a manifestation of this disorder.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 25-5 MSC: Physiologic Integrity

2. The nurse working with older adults knows which facts about age-related musculoskeletal

changes? (Select all that apply.) a. Muscle mass decreases, causing atrophy. b. Myocytes are replaced by fibrous tissue. c. Vertebral spaces enlarge with fluid retention. d. Posture and gait change, leading to fall risk. e. Men become bowlegged and waddle.

ANS: A, B, D

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

With age, muscle mass decreases, myocytes are replaced with fibrous tissue, and posture and gait change. Vertebral spaces narrow, leading to “shrinkage. Women become bowlegged and develop a waddling gait.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 511-2 OBJ: 25-2 MSC: Health Promotion

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 26: Urinary Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. When caring for older adults, the nurse expects to encounter the normal urinary age-related

outcome of: a. urinary incontinence. b. low-grade bladder infection. c. nocturia. d. urinary residual volume.

ANS: C

With age, increased urine formation at night leads to nocturia. The other findings are not agerelated changes.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 542 OBJ: 26-1 MSC: Health Promotion

2. An 87-year-old patient has suddenly become incontinent. What should the nurse’s first action

be? a. Review the patient’s record for medications that may be causing urinary

incontinence. b. Seek an order for an indwelling urinary catheter to prevent skin breakdown. c. Limit the patient’s fluid intake to reduce the feeling of having to void so often. d. Teach the patient to void every 2 hours when awake during the day or night.

ANS: A

Medication is a common cause of incontinence and should always be suspected as a potential cause of new incontinence. A catheter is not needed. Limiting fluids leads to dehydration.

Voiding every 2 hours at night will disrupt sleep.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 542 OBJ: 26-5 MSC: Physiologic Integrity

3. An older adult patient reports “losing urine” when she bends over or gets out of a chair. What

type of incontinence does the nurse plan interventions for? a. Overflow b. Urge c. Functional d. Stress ANS: D

Stress incontinence is commonly seen in older women who involuntarily lose urine as the result of a sudden increase in intraabdominal pressure. Overflow incontinence consists of frequent involuntary losses of small amounts of urine. Functional incontinence is manifested by loss of large volumes of urine because of a lack of awareness of the need to void or a mobility problem. Urge incontinence is accompanied by a sudden urge to void.

DIF:

Remembering (Knowledge)

REF: Page 543

OBJ: 26-3

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. When assessing the patient for urinary incontinence, which patient symptom best supports the

nursing diagnosis of overflow incontinence? a. “I have small accidents ever since I developed a cystocele.” b. “It burns so badly after I urinate that I hold it as long as I can.” c. “I can’t make it to the toilet when I feel the need to urinate.” d. “I lose small amounts of urine when I sneeze or laugh hard.”

ANS: A

Typically, individuals with overflow incontinence complain of frequent losses of small volumes of urine, which are commonly a result of cystoceles. Burning indicates a urinary tract infection. “Not making it” to the bathroom is generally functional incontinence. Losing control of the bladder with sneezing or laughing is a manifestation of stress incontinence.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 543 OBJ: 26-3 MSC: Physiologic Integrity

5. An older cognitively impaired adult patient is being discharged to a daughter’s home. The

nurse knows continued success of the patient’s bladder training for urinary incontinence primarily rests on the: a. patient’s ability to follow instructions. b. severity of the impairment of the urinary sphincter. c. patient’s ability to sense the need to urinate. d. daughter’s ability to support the training.

ANS: D

Treating urinary incontinence in individuals with cognitive impairment requires the use of other behavioral techniques that depend on the caregiver rather than the patient. The success of the techniques in large part depends on the availability and motivation of the caregiver. The other actions are not as important for the cognitively impaired person’s success.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 548 OBJ: 26-7 MSC: Physiologic Integrity

6. An older adult patient is hospitalized for after an automobile crash. The nurse recognizes

symptoms suggestive of an upper urinary tract (UTI) infection when the patient: a. voids 100 mL of urine over a 3-hour period of time. b. is not able to state where he is or what day it is. c. has an elevated red blood cell (RBC) count. d. reports burning when he urinates.

ANS: B

For many older adults, the presentation of a UTI is confusion or another change in mental status. Burning on urination would signify a lower urinary tract infection. The other two assessments are unrelated.

DIF: Analyzing (Analysis) TOP: Nursing Process: Assessment

REF: N/A OBJ: 26-16 MSC: Physiologic Integrity

7. An older adult woman has a resistant strain of pneumonia. To best minimize her risk of

developing acute renal failure, the nurse: a. monitors the patient’s serum blood urea nitrogen (BUN) levels via diagnostic Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

laboratory work. b. helps the patient select low-sodium foods from her daily menu. c. measures and records the patient’s urinary output. d. chooses an analgesic other than ibuprofen (Motrin).

ANS: D

Patients with pneumonia often have mild to moderate pain. Nonsteroidal antiinflammatory drug (NSAIDs) are common analgesics; however, they can cause acute kidney injury. Using another class of drug for pain relief will help protect the patient’s kidneys. The patient may be at risk of acute kidney injury because of dehydration or the nephrotoxic effects of certain antibiotics.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 26-11 MSC: Physiologic Integrity

8. An older patient is admitted with possible chronic renal failure (CRF). Which lab value does

the nurse notify the physician about as a priority? a. Increased calcium level b. Increased red blood cells c. Decreased BUN level d. Decreased creatinine clearance level ANS: D

The diagnosis of CRF is usually made based on a decrease in creatinine clearance, an elevation of BUN level, and a decrease in red blood cells. The other findings can be documented.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 26-16 MSC: Physiologic Integrity

9. The nurse is admitting an older patient with benign prostate hyperplasia (BPH). The nurse’s

priority questioning focuses on: a. family history of prostate disorders. b. onset of symptoms. c. psychosocial impact of the diagnosis. d. typical urinary voiding patterns.

ANS: D

The purpose of the nursing assessment for an individual with BPH is to determine the extent of prostate enlargement and its effect on function so that appropriate nursing interventions can be planned and implemented. The primary assessment focuses on the patient’s current voiding patterns.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 556 OBJ: 26-16 MSC: Physiologic Integrity

10. A patient in a long-term care facility has incontinence. What assessment by the nurse is most

important before designing interventions for this problem? a. Cognitive status b. Ambulatory status c. Cardiovascular status Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. History of childbirth

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 ANS: A

Treatment options differ between cognitively impaired and intact individuals. If the person is not intact, he or she has to rely on caregivers to maintain appropriate bladder function. The other assessments can be worked into the treatment plan.

DIF: Applying (Application) TOP: Nursing Process: Analysis

REF: N/A OBJ: 26-7 MSC: Physiologic Integrity

11. A male patient has benign prostatic enlargement. He is at risk for what type of acute kidney

injury? a. Prerenal b. Intrarenal c. Postrenal d. Combined form ANS: C

BPH would place this patient at risk for postrenal failure. Prerenal failure is often the result of decreased cardiac output or acute fluid volume loss. Intrarenal failure consists of damage to the actual nephrocytes.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 551 OBJ: 26-11 MSC: Physiologic Integrity

12. A patient has a history of smoking and now has painless hematuria. After a workup, the

patient is told the diagnosis of bladder cancer. What action by the nurse is most important? a. Allow the patient to verbalize feelings. b. Educate the patient on care of an ileal conduit. c. Teach the patient how to manage nausea. d. Offer a social work referral to complete a living will.

ANS: A

The first intervention the nurse should provide is to be present for the patient and allow the expression of feelings. It is too early to teach, the patient may or may not have an ileal conduit, and the patient may not be ready to complete a living will or other advance directive.

DIF: Application REF: N/A MSC: Psychosocial Integrity

OBJ: 26-16

TOP: Caring

13. A patient being treated for prostate cancer calls the clinic to report severe back pain. What

action by the nurse is best? a. Advise the patient to take his pain medication. b. Tell the patient to come in to the clinic today. c. Make an appointment for the patient next week. d. Encourage the patient to rest and use moist heat.

ANS: B

Prostate cancer can metastasize to the bones including the spine. If this happens, spinal cord compression can occur. The patient is advised to come into the clinic today for evaluation. The other options are not appropriate.

DIF:

Analyzing (Analysis)

REF: N/A

OBJ: 26-16

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Communication and Documentation

MSC: Physiologic Integrity

14. A male patient reports difficulty starting a urine stream and a weak urine flow. When

prompted to seek medical attention, the patient asks why, as it’s “obviously” benign prostatic hypertrophy. What response by the nurse is best? a. “You never know; it could be cancer.” b. “You should have any change checked out.” c. “Only the physician can make a diagnosis,” d. “BPH and prostate cancer have similar symptoms.”

ANS: D

The patient should have these new symptoms checked out. Although only the provider can make the diagnosis, the best answer is to explain that symptoms of BPH and cancer are similar. The other options do not give useful information.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 26-14 MSC: Physiologic Integrity

15. A patient treats chronic kidney failure with peritoneal dialysis. The patient notes the fluid

draining out of the abdomen is cloudy and foul smelling. What action by the nurse is best? a. Assess the patient for other signs of infection. b. Document the findings in the patient’s chart. c. Call the rapid response team immediately. d. Request a prescription for an antibiotic.

ANS: A

One of the complications of peritoneal dialysis is infection in the peritoneal space, or peritonitis. The nurse should fully assess the patient for infection and notify the provider.

Documentation should occur, but the nurse needs to take action first. The rapid response team is not needed. Antibiotics will probably be used to treat the infection.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 26-16 MSC: Physiologic Integrity

16. A patient is scheduled to have surgery for prostate cancer in a few weeks. What action by the

nurse is most important? a. Discuss options and their effect on sexuality. b. Ensure the patient has advance directives. c. Offer the patient a tour of the operating room. d. Determine if the patient prefers outpatient surgery.

ANS: A

Treatment for prostate cancer can affect sexual functioning, so the nurse ensures the patient knows the risks and benefits of his choices. The other options are not necessary, although any patient with a serious illness should have advance directives.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 26-15 MSC: Psychosocial Integrity

17. A patient asks how elevating the legs at night will decrease nocturia. What is the nurse’s best

response?

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. All that fluid gets into circulation before you go to bed.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 b. Decreased swelling makes it easier to ambulate at night. c. It won’t help; that’s an old wives’ tale you heard. d. This measure helps dehydrate you before bedtime.

ANS: A

Elevating the legs returns dependent fluid into circulation so the kidneys can excrete it sooner.

Without elevating the legs, that fluid movement does not happen until the patient goes to bed, contributing to nocturia. The other answers are incorrect.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 547 OBJ: 26-16 MSC: Physiologic Integrity

18. What information does the nurse share with the student about normal age-related changes in

the kidneys? a. Renal mass increases. b. The glomerular filtration rate decreases. c. Poor renal function occurs after age 65. d. There are no real age-related changes.

ANS: B

Older adults have a decreased glomerular filtration rate, decreased renal mass, but renal function can remain good up to the ninth decade.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 549 OBJ: 26-10 MSC: Health Promotion

MULTIPLE RESPONSE 1. A nurse is assessing an older patient for the possible cause of his acute urinary incontinence.

Which actions by the nurse are most important? (Select all that apply.) a. Asking when his last normal bowel movement was b. Monitoring his intake and output c. Determining if he has been screened for prostatic hypertrophy d. Asking him if he awakens during the night to urinate e. Measuring his abdominal girth ANS: A, C, D

Constipation or fecal impaction as well as an enlarged prostate gland (causing frequent nighttime urination) are commonly overlooked causes of incontinence. Intake and output and abdominal girth are not related to possible causes of incontinence.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 542 OBJ: 26-3 MSC: Physiologic Integrity

2. When preparing educational information regarding benign prostatic hyperplasia (BPH) for a

group of older male patients, the nurse includes which of the following? (Select all that apply.) a. Eighty percent of males experience the symptoms by age 80. b. Diabetes mellitus is a risk factor. c. It is only as the prostate enlarges that symptoms occur. d. The resulting urinary retention can cause urinary tract infections.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 e. Symptoms are a result of urethral obstruction.

ANS: A, C, D, E

Approximately 80% of men may be diagnosed with BPH by the age of 80. In early prostatic enlargement, the patient may be asymptomatic because the muscles may initially compensate for increased urethral resistance. As the prostate gland enlarges, the patient begins to manifest symptoms of an obstructive process. The symptoms may include hesitancy, a decrease in the force of the urinary stream, terminal dribbling, a sensation of a full bladder after voiding, and urinary retention. Urethral obstruction may cause urinary stasis, UTIs, hydronephrosis, and renal calculi. Diabetes is not a risk factor.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 556 OBJ: 26-14 MSC: Physiologic Integrity

3. An older adult patient’s urinary incontinence is being addressed by prompted voiding. The

nurse instructs all ancillary staff to do which of the following? (Select all that apply.) a. Provide only minimal fluids after 7 PM. b. Keep the patient on the toilet until voiding occurs. c. Allow the patient to void at times other than those scheduled. d. Offer toileting during the night only when the patient is awake. e. Encourage the patient to toilet himself.

ANS: C, D

The goal is to increase a patient’s awareness of the need to void and, it is hoped, to increase the frequency of self-initiated toileting. Patients are approached on a regular schedule, asked if they are wet or dry, and then prompted to toilet. A patient should never be forced to toilet or reprimanded for failing to toilet appropriately. Self-initiated toileting should not be discouraged. To relieve the stress that can occur because of sleep disruption for both caregiver and patient, toileting protocols can be modified during the nighttime hours.

DIF: Understanding (Comprehension) TOP: Nursing process: Implementation

REF: Page 549 OBJ: 26-5 MSC: Physiologic Integrity

4. A patient has a glomerular filtration rate (GFR) of 19 mL/min/1.73m2. What assessment

findings correlate with this condition? (Select all that apply.) a. Fatigue b. Weakness c. Edema d. No specific symptoms e. Headaches ANS: A, B, C

This patient is in stage 4 of chronic kidney disease. Expected assessment findings include weakness, edema, fatigue, hypertension, heart failure, impaired cognition and immune function, dry skin and pruritus, anorexia, nausea, malnutrition, increased bleeding, anemia, peripheral neuropathy, and an overall decreased quality of life. In stages 1 and 2, patients are asymptomatic. Headache is not a finding.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 26-11 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 5. The nurse working in the gerontology clinic understands which facts related to incontinence?

(Select all that apply.) a. It is a normal age-related change. b. It is an independent predictor of nursing home admission. c. It contributes to falls and injuries. d. It can disrupt sleep. e. It can lead to urinary tract infections.

ANS: B, C, D, E

Urinary incontinence is not a normal age-related development, although people commonly believe this is true. The other statements are correct.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 541-2 OBJ: 26-1 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 27: Cognitive and Neurologic Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. An older adult is experiencing age-related postural hypotension and he fears “something is

really wrong” because he is the only one in his social group experiencing the problems. The nurse responds: a. “Don’t be concerned; just be very careful about your risk for falling.” b. “You have had very thorough testing, so don’t worry about it being serious.” c. “It’s just a matter of time before they too have to watch not to get up too quickly.” d. “You just don’t have the compensating mechanisms of your friends.”

ANS: D

The age-related symptoms of postural hypotension are dizziness or lightheadedness when changing positions rapidly. However, compensatory processes in the cortex and subcortical areas of the brain help aging individuals maintain relatively normal motor performance.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 565 OBJ: 27-2 MSC: Physiologic Integrity

2. What education by the nurse is most important to address age-related changes to the senses? a. Installing auditory smoke alarms b. Having regular eye checkups c. Being aware that hearing acuity decreases with age d. Checking the expiration dates on foods such as dairy ANS: A

An age-related reduction in the senses makes it less likely that an older person will smell smoke from a fire. Loud fire alarms are important for home safety. The other factors are not as directly related to safety.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 566 OBJ: 27-2 MSC: Safe Effective Care Environment

3. The nurse is conducting an admission assessment on a mildly confused older patient. The

nurse best assures an accurate history by first: a. scoring the client’s cognitive responses. b. focusing on the client to respond. c. directing the questions to both patient and family. d. arranging a Mini-Mental State Examination (MMSE).

ANS: C

An interview with the friend or family member is an appropriate method to first implement when a patient is exhibiting confused behavior. The other options will not get accurate information for the assessment.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 566 OBJ: 27-2 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. A nurse is caring for an older patient diagnosed with acute depression. What action by the

nurse is most important to help prevent delirium in this patient? a. Reorienting the patient to the day, time and place frequently b. Being physically present to help the patient with eating meals c. Providing the patient with opportunities to discuss depression d. Administering antidepressive medication as prescribed ANS: B

Depressed older adults may neglect eating or caring for a chronic medical condition, predisposing them to the development of delirium resulting from hypoalbuminemia and possibly electrolyte imbalances. The other actions will not prevent delirium.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 27-4 MSC: Physiologic Integrity

5. When assessing an older patient displaying symptoms of delirium, the nurse focuses the

assessment on: a. the degree and duration of the symptoms. b. the amount of self-care deficiency the symptoms cause. c. identifying processes that commonly result in the symptoms. d. physiologic dysfunction resulting from the symptoms.

ANS: C

The treatment of delirium entails the identification and treatment of the underlying cause. The nurse should assess this factor as the priority. The other assessments are of lesser priority.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 27-4 MSC: Physiologic Integrity

6. An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer disease

(AD). The nurse supports that possibility when determining that the patient: a. experienced a gastric resection several years ago. b. traveled often to third world countries. c. was employed as a steelworker for 40 years. d. has a history of viral encephalitis.

ANS: D

Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD. However, advancing age is the primary risk factor. The other options are not related.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 571 OBJ: 27-5 MSC: Physiologic Integrity

7. When planning care for the older adult with advanced dementia, the nurse recognizes that the

best way to implement reality orientation is to: a. place printed labels on important items, such as the telephone. b. place a clock and calendar in the patient’s immediate environment. c. use hand gestures instead of verbal communications to demonstrate meaning. d. show the patient a picture of a toothbrush when it is time for oral hygiene.

ANS: D Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Reality orientation supports failing memory in early stages of dementia and preserves independent functioning for a longer duration. Although written messages and signs may become meaningless to individuals with advancing dementia, pictures often evoke a response.

The other options are not part of this strategy.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 579 OBJ: 27-4 MSC: Physiologic Integrity

8. A 73-year-old patient diagnosed with vascular dementia is admitted for exacerbation of

asthma. The patient has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurse’s initial response is to: a. identify the patient as being at high risk for falls. b. monitor the patient for signs of benzodiazepine withdrawal. c. notify the admitting physician immediately. d. place the patient on strict intake and output.

ANS: C

Benzodiazepines should be reserved for acute situations and not used for the long-term management of troubling behaviors. Long-term use can precipitate withdrawal if use is stopped and can possibly cause seizures. The nurse should notify the physician immediately so that plans for safely discontinuing the drug can be made.

DIF: Applying (Application) REF: N/A TOP: Communication and Documentation

OBJ: 27-6 MSC: Physiologic Integrity

9. Which of the following statements, when made by family members caring for an older patient

with dementia, indicates peaceful acceptance of the situation? a. “I’m so pleased that Mother had a good day today. I’m really very hopeful.” b. “The hospice nurses are so helpful when I need time for myself.” c. “I promised Mother I would take care of her and I’ll never leave her.” d. “It’s the least I can do for Mother since she cared for us all these years.”

ANS: B

Adjusting to the fact that dementia is irreversible and prolonged places families in situations of dealing with grief over a long period. Nurses need to encourage caregivers to take time out from their task and participate in self-care and health promotion activities. The other statements do not show this acceptance as clearly.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 27-6 MSC: Psychosocial Integrity

10. The son of a patient with possible Alzheimer disease (AD) asks the nurse if there is a

diagnostic test that can confirm the diagnosis. The nurse responds that: a. an electroencephalogram is often very useful in diagnosing AD. b. a positron emission tomography (PET) scan is a cheap but dependable tool. c. magnetic resonance imaging (MRI) is often ordered for that purpose. d. postmortem autopsy is the only definitive diagnostic tool.

ANS: D

Autopsy remains the gold standard and only definitive method for the diagnosis of AD. Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Understanding (Comprehension) REF: Page 572 OBJ: 27-5

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning

MSC: Physiologic Integrity

11. An 89-year-old diagnosed with dementia was until recently responding well to cognitive

cueing techniques. The nurse shows an understanding of dementia when sharing with staff that: a. “We will implement new interventions that address the disease’s progression.” b. “It’s important that we frequently recue the patient to improve her quality of life.” c. “The patient’s family needs to be made aware of this decline.” d. “This poor response to cueing is likely a result of advanced aging.”

ANS: A

Positive responses to selected interventions may continue for a time but may decline as the disease progresses, which results in the need to reevaluate strategies. The nursing staff cannot evaluate the patient’s quality of life; only the patient can, and this patient is not capable. The family should be informed but that is not related to understanding dementia. The change in response is the result of advancing disease, not age.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 27-6 MSC: Physiologic Integrity

12. An 80-year-old patient who is experiencing symptoms of depression and anxiety is reluctant

to comply with the prescribed treatment plan. The nurse initially addresses the issue with the patient by asking: a. “How do you feel about how others view your mental health problem?” b. “Are you concerned about paying for your psychiatric medications?” c. “Did you know that depression is common among people your age?” d. “Do you have any questions about your the mental health treatment plan?”

ANS: A

Older adults are often reluctant to seek care from a mental health professional because they grew up during a period when a strong stigma was attached to mental illness, mental hospitals, and mental treatment. The other questions do not open a discussion.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 27-8 MSC: Psychosocial Integrity

13. An older adult patient being treated for chronic obstructive pulmonary disease (COPD) is

exhibiting signs of memory loss and confusion. In planning his care, the nurse should give priority to: a. obtaining an order for a pulmonary function test (PFT). b. determining the potential of a possible adverse drug reaction. c. reorienting the patient to time, place, and person frequently. d. assessing for a family history of dementia.

ANS: B

Two of the most common side effects of many medications taken by older adults are mental confusion and disorientation. The initial action should be to determine the possible cause of the symptoms. If a cause can be found, a change might be possible. There is no indication the patient needs a PFT. Reorienting the patient is a good intervention, but it would be better to identify and eliminate the causative factor. Assessing a family history is a potential intervention as well.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) REF: N/A OBJ: 27-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 14. The nurse caring for an older adult patient recovering from cardiac surgery recognizes that it

is most appropriate to assess this patient for mental health problems because: a. cardiac surgery often results in anxiety-related issues. b. untreated depression can contribute to the patient’s morbidity risks. c. many in this age cohort have undiagnosed depression. d. hospitalization is both anxiety and depression inducing.

ANS: B

Depression can and should be treated when it occurs with other illnesses because untreated depression can delay recovery from or worsen the outcome of the other illnesses. Cardiac illness is associated with depression, but not necessarily with anxiety issues. It is true that depression in the older population is underdiagnosed. Hospitalization can lead to depression.

But the main reason to assess for depression is because of its effects on other health conditions.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 27-8 MSC: Physiologic Integrity

15. When planning care for the older adult being treated for depression, the nurse addresses the

patient’s tertiary intervention needs best by: a. helping the patient to identify the early symptoms of depression. b. helping the patient deal with the physical symptoms of depression. c. discussing with the patient how to implement new coping skills. d. educating the patient about the importance of being drug compliant.

ANS: C

Tertiary intervention refers to the restorative or rehabilitative functions that the nurse performs to assist patients in the recovery process. An important aspect of tertiary intervention involving patients with depression is teaching new coping skills to lessen the likelihood of recurring depression. Identifying early symptoms is a secondary prevention. Treating the depression will limit the physical symptoms. Education is generally considered primary prevention. However, in this case it is education on part of treatment. This is not the best answer because the nurse is not teaching about the drugs, only about the importance of being compliant.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 27-8 MSC: Physiologic Integrity

16. To best advocate for an older adult patient being prescribed medication to control newly

observed signs of confusion and aggressive behavior, the nurse: a. initiates an assessment to determine possible underlying causes of the behavior. b. contacts family to inform them of the new medication therapy being planned. c. discusses possible nonpharmaceutical treatments with the physician. d. documents a detailed description of the behaviors before administering the drugs.

ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

In this population, such symptoms may be mistakenly assumed to be a result of normal aging, so prescription medications may be ordered for anxiety, depression, aggressive and disruptive behavior, or paranoid-type behavior, without assessing the reasons for the behavior. If an underlying cause of the behavior is found, it can be treated, thereby eliminating the problem.

The other actions do not demonstrate advocacy.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 27-9 MSC: Physiologic Integrity

17. An older adult has been recently diagnosed with type 2 diabetes and mild retinal deterioration.

To best address the patient’s potential for developing situation depression, the nurse: a. assesses the patient’s coping skills. b. Encourages the patient to participate in a depression support group. c. assesses the patient’s ability to manage the symptoms. d. educates the family on early signs of depression.

ANS: A

One of the keys to successful aging is adjusting to or, perhaps more accurately, adapting to, although not necessarily accepting, changes that occur in one’s life. The nurse assesses the patient’s coping skills and methods. The patient does not need a support group before developing depression. Managing symptoms is part of coping. Educating the family is an appropriate intervention but is not the priority.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 27-8 MSC: Psychosocial Integrity

18. An older adult has a medical condition that has required hospitalization at a facility far from

home and family. To best minimize the patient’s risk for depression, the nurse: a. keeps the patient informed of the expected discharge date. b. offers to help the patient telephone family members each evening. c. reassures the patient that early discharge is a nursing goal. d. encourages the patient to place family photographs around the room.

ANS: B

The family continues to be the first source of support for older adults. This support is best achieved by regular contact through visiting or telephoning. The other options may be helpful, but they are not the best choice.

DIF: Understanding (Comprehension) REF: Page 599 TOP: Caring MSC: Psychosocial Integrity

OBJ: 27-8

19. An older patient is anxious about an upcoming diagnostic test and requests something to calm

the nerves. To best address the patient’s need, the nurse prepares to administer a PRN dose of: a. clonazepam (Klonopin). b. diazepam (Valium). c. chlordiazepoxide (Librium). d. lorazepam (Ativan).

ANS: D

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

There are two broad categories of benzodiazepines: short-acting (e.g., alprazolam [Xanax], lorazepam [Ativan], and oxazepam [Serax]) and long-acting (e.g., diazepam [Valium], chlordiazepoxide [Librium], and clonazepam [Klonopin]). The short-acting agents are preferred for older adults because of their lower potential for buildup leading to sedation and depression.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 27-9 MSC: Physiologic Integrity

20. While collecting a health history for an older adult patient, the nurse learns that the patient had

been prescribed Elavil 3 weeks ago and wants to stop taking it because “It didn’t make me feel any better.” In response to this information, the nurse shares with the patient that: a. sudden withdrawal is likely to cause a hypertensive crisis. b. depression seldom improves without medication. c. realistically it will take longer for the patient to feel an improvement. d. in time, people adjust to the side effects.

ANS: C

Older patients may need up to 12 weeks of this medication for evaluation of a full response.

Psychotropic medications need to be started low and increases should be done slowly. The other options are not correct.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 597 OBJ: 27-9 MSC: Physiologic Integrity

21. The nurse familiar with the old adult population recognizes that the patient who has the

greatest potential for successfully committing suicide is the: a. 63-year-old Asian female. b. 86-year-old Caucasian male. c. 76-year-old Hispanic female. d. 67-year-old African-American male.

ANS: B

The highest rates of suicide are among men over the age of 85.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 567 OBJ: 27-9 MSC: Psychosocial Integrity

22. A 65-year-old adult who recently lost his spouse is admitted to the hospital after a failed

suicide attempt. He presents with a sad affect and is reluctant to interact within the milieu. The nursing diagnosis with priority is: a. ineffective coping related to recent loss. b. hopelessness related to death of spouse. c. risk for loneliness related to loss of spouse. d. risk for self-directed violence related to depression.

ANS: D

This patient is at risk for another attempt at suicide, so safety is the primary concern.

DIF: Applying (Application) TOP: Nursing Process: Analysis

REF: N/A OBJ: 27-8 MSC: Psychosocial Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 23. The nurse is caring for a severely depressed older patient. To best effect change in the

patient’s emotional state, the nurse’s initial goal is to: a. plan interventions that will enhance the patient’s self-esteem. b. introduce the patient to new coping skills. c. assess the patient’s potential to self-harm. d. develop a therapeutic nurse-patient relationship.

ANS: D

The nurse’s ability to positively effect change in older adults’ responses to depression lies in the development of therapeutic relationships. Assessing risk for harm is an important safety issue but does not help the patient’s emotional state. The other two options come later after the relationship has entered its working phase.

DIF: Applying (Application) REF: N/A TOP: Caring MSC: Psychosocial Integrity

OBJ: 27-8

24. An older adult is hospitalized for treatment of a mental health disorder and is prescribed

clomipramine (Anafranil). The nurse documents that the medication is having the desired effect when the patient: a. begins sleeping 8 hours per night. b. engages in fewer ritualistic behaviors. c. reports fewer episodes of nervousness. d. exhibits no delusionary thinking.

ANS: B

This medication is a tricyclic antidepressant that is specifically helpful for obsessivecompulsive disorder (OCD). The other assessments are not specific indicators of the effectiveness of this medication.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 27-8 MSC: Physiologic Integrity

25. To help manage the potential side effects of prescribed antipsychotic medications, amantadine

(Symmetrel) may be prescribed. Which statement best indicates that the nurse understands the appropriateness of this medication for the older adult patient? a. “This medication produces few anticholinergic effects.” b. “Symmetrel is an effective dopamine agonist.” c. “Extrapyramidal symptoms are best controlled by Symmetrel.” d. “Older patients seem to have the fewest side effects on this medication.”

ANS: A

Amantadine (Symmetrel), a dopamine agonist prescribed to manage EPS, may be used, especially in older patients and in those with cardiovascular dysfunction, because of its reduced anticholinergic effects. The other statements are not accurate.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 598 OBJ: 27-8 MSC: Physiologic Integrity

MULTIPLE RESPONSE

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 1. A 72-year-old is prescribed lithium. The nurse educates the patient on the importance of

biannual evaluation of which of the following? (Select all that apply.) a. Renal function b. Serum glucose level c. Liver function d. Thyroid function e. Red blood cell count ANS: A, C, D

Renal, liver, and thyroid studies should be evaluated every 6 months because of the drug’s potential toxicity. Glucose and red blood cell count are not affected.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 597 OBJ: 27-8 MSC: Physiologic Integrity

2. A 78-year-old patient was admitted with dehydration. The nurse assesses and documents

observations that support a finding of dementia. Which of the following observations are related to dementia? (Select all that apply.) a. Forgetting what she ate for lunch today b. Crying frequently when alone c. Inability to find her way back to her room from the dayroom d. Being impatient with the nursing staff for not closing her door e. Repeatedly asking to call her son ANS: A, C, D, E

Common manifestations of dementia include repeated questions and statements, forgetting to pay bills or take medications, increasing problems with orientation, and geographic disorientation. Other symptoms of AD include pervasive forgetfulness and memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings. Personality changes may include apathy or loss of interest in previously enjoyed activities. Crying is not a classic sign of dementia, although depression often accompanies dementia and this could be a sign of depression.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 569 OBJ: 27-3 MSC: Physiologic Integrity

3. The nurse is caring for an older adult patient admitted to the hospital. What assessment

findings place the patient at risk for developing delirium during the hospitalization? (Select all that apply.) a. The patent takes medications to manage several chronic illnesses. b. The patent has a history of urinary tract infections. c. The patent is in cancer remission. d. The patent has recently been eating poorly. e. The patent experienced a mild heart attack 2 years ago.

ANS: A, B, D

The risk factors for delirium include advanced age, central nervous system diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary disorders, cardiopulmonary disorders, and sensory changes. These factors can lead to physiologic imbalances increasing the risk for confusion. Cancer remission and a heart attack 2 years prior do not increase the patient’s risk.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Remembering (Knowledge) REF: Page 569 OBJ: 27-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer

disease. The patient’s partner expresses concern about difficulty getting the patient “to eat properly.” The nurse suggests which of the following? (Select all that apply.) a. Serving meals at the same time each day b. Offering liquids in place of solid foods when possible c. Offering a calorie-dense snack at bedtime d. Cutting food into bite-sized pieces that will fit into the patient’s hand e. Asking the patent to identify favorite foods ANS: A, C, D

It is important to support the ongoing nutrition of individuals with dementia because they may experience decreased hunger and ability to taste food. People who demonstrate symptoms of moderate to severe cognitive impairment may benefit from having meals in the same place at the same time each day. Small, frequent, nutritionally dense meals and snacks should be provided. During later stages of dementia, individuals may need to be reminded to open the mouth and chew. Food should be soft and cut in small pieces. Liquids do not need to be substituted for solid food. The patient may not be able to identify favorite foods, and asking may cause frustration.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 27-6 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 28: Integumentary Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of

the scalp should include: a. cleaning lesions with a weak hydrogen peroxide solution daily. b. cleaning the scalp with a low-dose steroidal shampoo. c. applying hydrocortisone 10% to scalp lesions. d. applying selenium shampoo to the scalp.

ANS: D

A successful strategy is to wet the hair, apply selenium shampoo, and then proceed with the rest of the bath or shower. The other measures will not be successful.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 611 OBJ: 28-3 MSC: Physiologic Integrity

2. An older adult patient reports simple xerosis with mild pruritus. The nurse educates her on the

importance of: a. applying a lanolin-rich cream and avoiding scratching the areas. b. taking warm baths and gently rubbing of affected areas with a terrycloth towel. c. minimizing ingestion of fried foods and use of an antihistamine cream. d. avoiding bath oils and allowing the skin to air-dry after bathing.

ANS: A

The nurse suggests that the patient apply emollients (e.g., Lubriderm, Moisturel, or Eucerin lotion or cream), which have more lanolin or oily substances than many commercial lotions.

Time should be planned to teach the patient and family about etiologic factors and the importance of not scratching. The other options are not helpful and will not decrease the itching.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 612 OBJ: 28-3 MSC: Health Promotion

3. The nurse plans to assess for candidiasis as a priority intervention for a: a. 60-year-old with a history of bacterial pneumonia. b. 72-year-old incontinence of urine and feces. c. 58-year-old with a casted left foot. d. 90-year-old receiving antihypertensives.

ANS: B

Candidiasis is most commonly seen in diaper-clad infants, incontinent patients, and bedbound individuals and in moisture-prone areas of the body (e.g., skin folds and axillae). The other patients are not as likely to have this disorder as the incontinent patient.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 612 OBJ: 28-3 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 4. An 87-year-old patient developed herpes zoster after surgical repair of a hip fracture. The

priority nursing diagnosis is: a. impaired skin integrity related to immunologic deficit. b. self-care deficit related to severe pain and fatigue. c. risk for infection related to impaired skin integrity. d. pain related to inadequate pain relief from analgesia.

ANS: C

These vesicles are extremely vulnerable to secondary bacterial infections. The other diagnoses might be appropriate for some patients.

DIF: Applying (Application) TOP: Nursing Process: Diagnosis

REF: N/A OBJ: 28-3 MSC: Physiologic Integrity

5. The presence of which skin assessment finding, if noted on an older adult patient, should

cause the nurse to suspect a premalignancy? a. Numerous small red papules on the chest and back b. An oozing, rough, reddish macule on the ear c. An irregularly shaped mole on the face or shoulders d. Brown, greasy lesions on the neck ANS: B

Actinic keratosis begins in vascular areas as a reddish macule or papule that has a rough, yellowish brown scale that may itch or cause discomfort. Actinic keratosis may evolve into squamous cell carcinoma (SCC) if not treated, so it should receive prompt attention. Red papules, irregularly shaped moles, and brown greasy lesions are not likely to be precancerous.

DIF: Understanding (Comprehension) TOP: Nursing Process: Assessment

REF: Page 615 OBJ: 28-4 MSC: Physiologic Integrity

6. An older adult patient has been taught measures to prevent the development of skin cancer.

Which statement, if made by the patient, indicates the need for more teaching? a. “I will certainly miss my vegetable and flower gardening.” b. “I should buy a sunscreen with an SPF of 15 or higher.” c. “Now I have a good excuse to wear the straw hat my spouse hates.” d. “My cool long-sleeved shirts will work just fine while I’m golfing.”

ANS: A

The patient is still able to garden as long as he or she takes appropriate sun precautions. The other statements show good understanding.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 28-4 MSC: Health Promotion

7. When assessing the older adult patient’s skin for indications of melanoma, the nurse should

inspect for a(n): a. thick, adherent scale with a soft center. b. small, inflamed lesion that bleeds easily. c. irregularly shaped multicolored mole. d. small, purple, hard nodule beneath the skin surface.

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Melanoma’s clinical hallmark is an irregularly shaped nevus (mole), papule, or plaque that has undergone a change, particularly in color. The other options do not display the characteristic signs.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 618 OBJ: 28-4 MSC: Physiologic Integrity

8. An older adult patient newly diagnosed with peripheral vascular disease (PVD) is being

educated on the possibility of developing a foot ulcer. What assessment finding indicates the patient may have an ulcer resulting from this disease? a. Deep, necrotic, and painless sore b. Shiny, dry, cyanotic skin surrounding the ulcer c. Ulcer appears shallow, crusty with warm skin d. Sore that has dull pain and is oozing ANS: B

As the disease advances, the extremity develops a cyanotic hue and becomes cool. The skin becomes thin, shiny, and dry and has an associated loss of hair and thickened nails, all of which results from the diminished blood supply. This assessment finding indicates PVD. DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 619 OBJ: 28-5 MSC: Physiologic Integrity

9. An older adult patient has an open, draining wound on the lower medial aspect of the right

leg. The skin surrounding the wound is reddish brown with surrounding erythema and edema.

Based on this information, the nurse edits the patient’s care plan to include impaired skin integrity: a. related to altered venous circulation. b. peripheral related to arterial insufficiency. c. related to diabetic neuropathy. d. open wound related to pressure ulcer.

ANS: A

Venous ulcers are usually on the medial aspect of the lower leg, with flat or shallow craters and irregular borders, accompanied by varicosities, liposclerosis (brown ruddy color and thickened skin), and itching. Venous ulcers generate a large amount of exudate and are usually surrounded by erythema and edema. Arterial insufficiency would produce shiny, taut, hairless skin. There is no indication the patient is a diabetic. There is no indication the patient has risks for pressure ulcers.

DIF: Applying (Application) TOP: Nursing Process: Analysis

REF: N/A OBJ: 28-5 MSC: Physiologic Integrity

10. When assessing for squamous cell cancer (SCC), a home health nurse is particularly

concerned about a suspicious lesion on the: a. leg of a 60-year-old Asian female. b. neck of a 73-year-old Hispanic female. c. Lower lip of a 70-year-old African American male. d. back of a 90-year-old Caucasian male.

ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

SCC is skin cancer arising from the epidermis and is found most often on the scalp, outer ears, lower lip, and dorsum of the hands. Approximately 90% of lip lesions can be attributed to squamous cell carcinoma. SCC is more common in men and older adults. SCC is the most common skin cancer in African-Americans.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 617 OBJ: 28-4 MSC: Physiologic Integrity

11. A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis. The nurse

educates the patient to the possibility of developing: a. alopecia. b. orange-tinged urine. c. yellow-brown nails. d. cherry angiomas.

ANS: C

Changes in the nails occur in approximately 30% of patients and consist of yellow-brown discoloration with pitting, dimpling, separation of the nail plate from the underlying bed (oncolysis), thickening, and crumbling.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 610 OBJ: 28-3 MSC: Physiologic Integrity

12. The nurse of a bedridden 74-year-old woman is evaluating whether the family members

understand how to position the patient correctly. The nurse is confident the family is capable of effective positioning when it is observed that the patient’s: a. arms and legs are supported on two pillows. b. position is changed at least every 2 hours. c. neck is hyperflexed. d. elbows rest on the bed.

ANS: B

In the 1950s, Kosiak (1958) found that pressure applied to rabbits’ ears over 2 hours would result in ulceration. Thus, the universal recommendation of turning every 2 hours was established. The other observations do not show the family necessarily understands effective positioning if the patient is not turned.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 28-6 MSC: Physiologic Integrity

13. An older diabetic patient reports a candidiasis infection. When asked, the patient states all

blood sugars have been within the target range. What action by the nurse is best? a. Facilitate having a hemoglobin A1c drawn. b. Teach the patient preventive measures. c. Teach the patient about the side effects of medications. d. Review the patient’s medication history.

ANS: A

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Often candidiasis infections in diabetics indicate hyperglycemia. The patient may or may not be truthful about the blood sugar reports, or the patient may be missing periods of hyperglycemia when testing. The nurse should consult with the provider about checking an A1C. The other options are appropriate as well but do not give information as to the background cause.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 28-3 MSC: Physiologic Integrity

14. An older patient has been treated for a small basal cell carcinoma on the face. What

assessment finding indicates to the nurse that the goals for a priority diagnosis have been met? a. The patient verbalizes relief there is no metastasis. b. Wound edges are approximated without redness. c. The patient expresses satisfaction with the cosmetic outcome. d. The patient relates the need for proper sun protection.

ANS: B

All findings indicate positive resolution of various nursing diagnoses. However, physical diagnoses take priority, so the best response is the one that indicates lack of infection.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 28-4 MSC: Physiologic Integrity

15. In creating community education on various types of skin cancer, the nurse places the highest

priority on early diagnosis of melanoma because: a. it accounts for the largest number of mortalities. b. extensive surgery can be avoided if caught early. c. once it has spread there is no chance of curing it. d. it is the most commonly occurring skin cancer.

ANS: A

Melanoma only accounts for 5% of skin cancer diagnoses but causes 75% of skin cancer mortality. Therefore, it is critical that the condition is diagnosed promptly.

DIF: Remembering (Knowledge) TOP: Teaching-Learning

REF: Page 618 OBJ: 28-4 MSC: Health Promotion

16. An older diabetic patient has impaired mobility and decreased vision. The nurse examines the

patient’s feet at each clinical visit. The patient asks why this is necessary. What response by the nurse is best? a. “It’s part of our diabetic clinic visit protocol.” b. “You may not be able to see a sore on your feet.” c. “Limited mobility may keep you from checking your feet. d. “You may get an ulcer and not be able to feel it.”

ANS: D

A diabetic with peripheral neuropathy may not be able to feel injuries on the feet. The injury may progress to a nonhealing ulcer requiring amputation. If the patient had good sensation to the feet, not being able to see or limited mobility would not be as big of a barrier because the patient could report the symptoms. Foot assessment is part of a diabetic clinic protocol.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Analyzing (Analysis) REF: N/A OBJ: 28-5

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Teaching-Learning

MSC: Physiologic Integrity

17. For which patient does the nurse add compression therapy to the nursing care plan? a. Taut, white, shiny skin b. Faint pedal pulses c. Brownish skin and edema d. Large ulcer with skin graft ANS: C

Compression is the mainstay of venous ulcer treatment, and it should be applied when there is brownish skin and edema. The taut white shiny skin and faint pulses indicate arterial insufficiency, and compression will compromise circulation in those extremities even further.

A skin graft needs to be protected, as it is vulnerable until healed.

DIF: Analyzing (Analysis) TOP: Nursing Process: Planning

REF: N/A OBJ: 28-5 MSC: Physiologic Integrity

18. The nurse assesses a patient using the Braden scale. The patient scores a 13. What action is

most important to add to the patient’s care plan? a. Encourage high-protein meals and snacks b.

Turn the patient every to 2 hours c. Assess the patient’s skin daily d. Monitor patient’s prealbumin weekly ANS: B

A Braden scale score of 13 indicates high risk for developing a pressure ulcer. The most important intervention is to turn the patient frequently. Good nutrition is important for wound healing and prevention, but a high-protein snack and monitoring prealbumin do not immediately impact the patient’s skin condition. Assessing the skin will not prevent an ulcer.

DIF: Applying (Application) TOP: Nursing Process: Planning

REF: N/A OBJ: 28-7 MSC: Physiologic Integrity

19. A patient has a purulent, foul-smelling leg wound. What wound care practice is most

appropriate? a. Leave the wound open to the air. b. Administer systemic antibiotics. c. Cleanse the wound with diluted povidone iodine. d. Prepare the patient for operative débridement.

ANS: C

Antiseptics are not used on healthy granulating tissue. Povidone iodine must be diluted and only used short term. A moist environment is needed for healing; leaving the wound open to air will cause too much drying. The patient may eventually need operative débridement.

Systemic antibiotics may or may not be needed.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 28-10 MSC: Physiologic Integrity

20. A patient has a wound that is a shallow crater with surrounding erythema and warmth. What

stage pressure ulcer does the nurse chart?

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 a. Stage I b. Stage II c. Stage III d. Stage IV ANS: B

Stage II is a partial thickness ulcer that looks like an abrasion, blister, or shallow crater. A stage I pressure ulcer is redness or mottled skin that does not blanch. Stage III ulcers are full thickness deep craters. Stage IV ulcers may extend into the fascia and may be necrotic.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 630-1 OBJ: 28-5 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. The nurse knows that several age-related changes in the integumentary system increase older

adults’ risk for pressure ulcers. Which factors does this include? (Select all that apply.) a. Poor nutrition b. Living in a nursing home c. Thinning epidermis d. Decreased skin elasticity e. Vessel degeneration ANS: C, D, E

Thinning epidermis, decreased elasticity of the skin, and deterioration of the vasculature are all age-related changes increasing risk of pressure ulcer development. Poor nutrition and living in a nursing home are not expected age-related changes.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 622-4 OBJ: 28-6 | 28-2 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Chapter 29: Sensory Function Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. An older adult patient reports burning and itching eyes. On assessment, the nurse notes

swelling of the eyelid margins bilaterally. What additional data are necessary to confirm the nurse’s suspicion of blepharitis? a. The patient reports visual disturbances such as rainbow halos. b. The eyelids are reddened from seborrhea. c. The patient is being treated with anticoagulants. d. Small corneal hemorrhages are present.

ANS: B

Blepharitis is a chronic inflammation of the eyelid margins that is commonly found in older adults. It can be caused by seborrheic dermatitis or infection. The symptoms include red, swollen eyelids, matting and crusting along the base of the eyelash at the margins, small ulcerations along the lid margins, and complaints of irritation, itching, burning, tearing, and photophobia.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 642 OBJ: 29-10 MSC: Physiologic Integrity

2. The morning of her scheduled cataract extraction and intraocular lens placement of the right

eye, an older adult patient expresses concern that she will not remember her instructions for home care. Which statement is the best response to the patient’s concern? a. “Is your family going to be here while you’re in surgery?” b. “Are you anxious about the surgery?” c. “I’ll reinforce the important points.” d. “We will provide you with written instructions.”

ANS: D

Postoperative care requires teaching the patient and family home care procedures for the period after cataract surgery and should be given orally as well in written form. The patient may or may not have family present. Asking about anxiety could be important, but yes/no questions are not therapeutic. The nurse’s idea of what are the important points may differ from the patient’s.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 655 OBJ: 29-2 MSC: Physiologic Integrity

3. Your 88-year-old patient is hospitalized for a retinal detachment. He is on bed rest, and both

eyes are covered with patches. Which nursing diagnosis takes priority at this time? a. Self-esteem disturbance related to decreased independence b. High risk for altered thought processes related to visual impairment c. High risk for injury related to altered sensory perception d. Impaired social interaction related to visual deficit ANS: C Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

If the eyes are patched, safety precautions, such as keeping call lights, side rails, and necessary items within reach, must be instituted. Finally, assistance must be provided with activities of daily living (ADLs) and walking as needed to promote comfort and safety. The other diagnoses may be appropriate for selected patients.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 29-2 MSC: Safe Effective Care Environment

4. A 66-year-old patient has been diagnosed with type 2 diabetes mellitus and related vision loss.

Which statement demonstrates the ability to manage her condition? a. “I schedule my yearly eye examination for the week of my birthday.” b. “When I notice haloes around lights, I’ll know I’m developing a problem with retinopathy.” c. “My sister had diabetic retinopathy, and the vessels in her eyes were scarred.” d. “I understand that the eye problems need to be diagnosed with an ophthalmoscopic exam.”

ANS: A

Patients with diabetes should have a yearly examination by an ophthalmologist. Scheduling the exam for the week of her birthday will keep the patient from forgetting to do so. The other statements are not related to management.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 29-3 MSC: Health Promotion

5. A 77-year-old patient who is quiet and withdrawn may have a hearing deficit related to

impacted cerumen. During the nursing assessment, the nurse confirms supporting evidence of the condition when noting: a. frothy drainage from the patient’s ears. b. patient reports of dizziness. c. patient reports of a feeling of fullness in the ears. d. gray, metallic-appearing tympanic membrane.

ANS: C

Patients with cerumen buildup may complain of ear fullness, itching, and difficulty hearing.

The patient will not have frothy drainage, dizziness, or metallic-appearing tympanic membrane from cerumen.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 650 OBJ: 29-10 MSC: Physiologic Integrity

6. An older adult patient reports “ringing” in the ears. What additional data should the nurse

gather to help determine the cause of the patient’s problem? a. History of ear surgery b. Use of prescription medications c. Exercise and sleep patterns d. Nutritional status, especially protein intake ANS: B

Tinnitus can be a result of damage to inner structures caused by the toxic effect of certain drugs. The other assessment findings are not as important for this problem.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 29-10 MSC: Physiologic Integrity

7. An older patient with presbycusis has been advised to purchase a hearing aid and asks about

its function and use. Which information is most accurate to give the patient about the function of hearing aids? a. Hearing aids amplify sound but do not improve the ability to hear. b. Hearing aids improve the ability to hear by intensifying the duration of sound waves. c. Hearing aids control the input of sound waves to eliminate extraneous noise. d. Hearing aids intensify sound waves and improve the ability to hear.

ANS: A

Hearing aids amplify sound but do not improve the ability to hear. The other statements are not accurate regarding hearing aids.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 654 OBJ: 29-11 MSC: Physiologic Integrity

8. An older adult’s chart documents that she has been diagnosed with macular dysequilibrium.

Based on an understanding of this condition and the resulting vertigo, the nurse suggests that the patient: a. turn her head very slowly when looking from right to left. b. dangle her legs at the bedside before getting out of bed. c. use the wall for stabilization when ambulating in the hallway. d. be careful to be seated when flexing or hyperextending her neck.

ANS: B

Macular disequilibrium is vertigo precipitated by a change of head position in relation to the direction of gravitational force (e.g., severe dizziness when rising from bed). Dangling at the bedside and changing positions slowly will decrease the chance of injury. The other interventions do not relate to this disorder.

DIF: Understanding (Comprehension) TOP: Teaching-Learning

REF: Page 655 OBJ: 29-7 MSC: Safe Effective Care Environment

9. A 96-year-old patient reports symptoms of xerostomia. The nurse attempts to minimize the

effects of the condition by: a. providing appropriate fluids with the patient’s meals. b. cutting the patient’s meat into small bite-sized pieces. c. elevating the head of the patient’s bed at mealtimes. d. assisting the patient with oral care before each meal.

ANS: A

Xerostomia, commonly referred to as dry mouth, is a subjective sensation of abnormal oral dryness. Reduced salivary flow is a common complaint of older adults. Dry mouth in the older adult can lead to an increased risk of serious respiratory infection, impaired nutritional status, and reduced ability to communicate. Offering appropriate fluids with meals will assist with proper nutrition. The other options will not provide relief for this condition.

DIF:

Applying (Application)

REF: N/A

OBJ: 29-8

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 TOP: Nursing Process: Implementation MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 10. The preferred way for the nurse to communicate with a 72-year-old hearing-impaired patient

is to: a. speak loudly into the patient’s unaffected ear. b. exaggerate the form of each word. c. provide all communication in written form. d. speak clearly and directly, facing the person.

ANS: D

Interventions for the patient with a hearing impairment focus on aural rehabilitation and facilitation of communication. Patients should be spoken to using a clear voice and face to face, which gives the patient an unobstructed view of the speaker’s face and lips. The other techniques are not as helpful.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 653 OBJ: 29-11 MSC: Physiologic Integrity

11. A patient in a nursing home is confused, nonverbal, but pleasant. The nurse notes the patient

has suddenly become agitated and is screaming and scratching at the eyes. While the nurse is examining the patient, the patient vomits. What action by the nurse is best? a. Consult the provider about an ophthalmologic exam. b. Sedate the patient so she won’t injure herself. c. Place mitts on the patient’s hands to avoid scratches. d. Give the patient a prn medication for pain.

ANS: A

The patient could be having an episode of acute angle closure glaucoma, manifested by severe pain, nausea and vomiting, and visual disturbances. Because the patient is nonverbal, the nurse must assess for pain with behavioral changes. The nurse should contact the provider about obtaining an ophthalmologic exam to determine if the patient has glaucoma. The other interventions will not help determine the cause of the problem. The nurse should attempt to discover the source of the behavior, not just try to control it.

DIF: Analyzing (Analysis) REF: N/A TOP: Communication and Documentation

OBJ: 29-2 MSC: Physiologic Integrity

12. A patient has been admitted to the postanesthesia care unit after a trabeculectomy. What

assessment takes priority? a. Airway b. Pain c. Eye patch d. Blood pressure ANS: A

Airway always comes first when prioritizing care.

DIF: Applying (Application) TOP: Nursing Process: Assessment

REF: N/A OBJ: 29-2 MSC: Safe Effective Care Environment

13. A patient had cataract surgery without a lens implant. What teaching point is most important? a. Keep your follow-up appointment with the surgeon. b. Instill your eyedrops just like we have practiced.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 c. Do not drive and be careful going up or down stairs. d. Take acetaminophen (Tylenol) for pain.

ANS: C

If cataract surgery was performed without a lens implant, the patient will wear glasses or contact lenses but will have a decrease in depth perception. The patient should not drive and should use extra caution negotiating stairs. The other instructions are appropriate for any patient having cataract surgery.

DIF: Applying (Application) TOP: Teaching-Learning

REF: N/A OBJ: 29-2 MSC: Safe Effective Care Environment

14. A patient has Ménière disease. What statement by the patient indicates a good ability to

manage the condition? a. “Because it’s from dehydration, I can increase salt in my food.” b. “There are no medications, so I just have to learn to live with it.” c. “If I get dizzy I should lie down immediately and hold my head still.” d. “Because I have asthma, I cannot take any medications for Ménière disease.”

ANS: C

If the patient gets dizzy, he or she should lie down and hold the head still. A low-salt diet may help with fluid retention in the ear. There are several medications for Menière disease, but because of the anticholinergic properties of some of them, people with asthma, glaucoma, or BPH should be monitored closely.

DIF: Evaluating (Evaluation) TOP: Nursing Process: Evaluation

REF: N/A OBJ: 29-7 MSC: Health Promotion

15. A patient had a chemical splash into the eye at work. What action by the occupational health

nurse takes priority? a. Begin flushing the patient’s eye with cool water. b. Call emergency medical services. c. Ask about the patient’s tetanus status. d. Tape the eye closed to prevent injury.

ANS: A

The nurse should begin flushing the eye immediately. While the eye is being irrigated, the nurse can call 9-1-1 and inquire about the patient’s last tetanus shot. The eye should not be taped shut.

DIF: Applying (Application) TOP: Nursing Process: Implementation

REF: N/A OBJ: 29-8 MSC: Safe Effective Care Environment

16. A patient with glaucoma is on timolol (Timoptic). The patient also takes metoprolol (Toprol)

for hypertension. The patient reports to the clinic nurse that the eyedrops “Make me dizzy.”

What assessment by the nurse is most appropriate? a. Assess the patient’s eyedrop instillation technique. b. Determine how long the patient has been on the drops. c. Assess the patient’s gait and balance while walking. d. Ask the patient if breakfast is eaten prior to applying the eyedrops.

ANS: A Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

The patient should be using punctal occlusion (closing the lacrimal duct) when instilling these eyedrops to avoid a cumulative, systemic effect from the combination of both beta-blockers.

The nurse can assess the other factors as well, but this is the most likely cause of the dizziness.

DIF: Analyzing (Analysis) TOP: Nursing Process: Assessment

REF: N/A OBJ: 29-5 MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. When assessing the patient’s vision, the nurse should understand that older adults may report

common aging changes, including which of the following? (Select all that apply.) a. “My eyelids droop so unattractively.” b. “The whites on my eyes seem a bit yellow.” c. “The vision in my right eye seems blurry.” d. “I’ve started to use over-the-counter eye moisturizing drops.” e. “I have noticed the night driving has become more difficult.”

ANS: A, B, D, E

The eyelids lose tone and become lax, which may result in ptosis of the eyelids, redundancy of the skin of the eyelids, and malposition of the eyelids. The conjunctiva thins and yellows in appearance. In addition, this membrane may become dry because of the diminished quantity and quality of tear production. Peripheral vision decreases, night vision diminishes, and sensitivity to glare increases.

DIF: Analysis (Analyze) REF: N/A TOP: Nursing Process: Assessment| Neuromuscular

MSC: Physiologic Integrity

2. An older adult diagnosed with Ménière disease is prescribed meclizine (Antivert) and

hydrochlorothiazide (HCTZ). The nurse’s educational instructions include which of the following? (Select all that apply.) a. The need to avoid alcoholic beverages b. Instructions to take the medication with food c. Symptoms of electrolyte imbalances d. That drowsiness is a common side effect e. Stopping the medication if chest pain occurs ANS: A, C, D

Meclizine may cause drowsiness; patients should be instructed to avoid alcoholic beverages while taking this drug. A patient on a diuretic such as hydrochlorothiazide (HCTZ) needs to be monitored for evidence of fluid or electrolyte imbalances.

DIF: Application (Apply) REF: N/A TOP: Nursing Process: Implementation| Drug-Related Responses MSC: Safe and Effective Care Environment 3. Which of the following are appropriate steps to take when removing cerumen from an older

person’s ear? (Select all that apply.) a. Instill a softening agent first. b. Use hot water and hydrogen peroxide. c. Use a Waterpik inserted just inside the meatus.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 d. Have the patient lean backward.

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024 e. Drain water by having the patient lean forward toward the affected side.

ANS: A, C, E

The nurse instills a softening agent and uses warm (not hot) water mixed with hydrogen peroxide or saline to irrigate the ear. A Waterpik or other irrigating equipment is used and is inserted just inside the meatus so the tip is still visible. Tip the patient’s head toward the side being irrigated. When draining, the patient can lean forward and toward the affected side.

DIF: Remembering (Knowledge) TOP: Nursing Process: Implementation

REF: Page 650-1 OBJ: 29-6 MSC: Physiologic Integrity

4. A nurse is assessing a patient who reports moderate tinnitus. The nurse should assess the

patient for which of the following? (Select all that apply.) a. Use of ibuprofen (Motrin) b. History of excessive cerumen c. Drinking carbonated beverages d. History of frequent headaches e. Presence of hypertension ANS: A, B, D, E

Beverages with caffeine are assessed; the patient may be drinking decaffeinated cola products.

The other assessments are appropriate.

DIF: Remembering (Knowledge) TOP: Nursing Process: Assessment

REF: Page 651-2 OBJ: 29-10 MSC: Physiologic Integrity

Test Bank for Gerontologic Nursing 5th Edition by Sue E. Meiner All Chapter, ISBN No:9780323266024