Test Bank for EBERSOLE AND HESS’ TOWARD HEALTHY AGING Human Needs and Nursing Response. 9th Edition

Chapter 01: Health and Wellness in an Aging Society Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. When asked by new parents what the life expectancy is for their African American newborn,

the nurse replies that, “2010 statistics indicate that your son: a. will have a life expectancy of approximately 65 years.” b. can realistically expect to live into his late 80s.” c. has a good chance of celebrating his 75th birthday.” d. is likely to live into his late 90s.”

ANS: C

In 2010, men in the United States at age 60 can expect to live another 22 years. The life expectancy of African American men is about 4.7 years less than white men. Of the options above, C is the only response that fits into those parameters. The other options are not supported by reliable research.

DIF: Cognitive Level: Understanding REF: p. 3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A nurse is planning care for a group of super-centenarians in an assisted living facility. The

nurse considers which of the following? a. Most super-centenarians are functionally independent or require minimal

assistance with activities of daily living b. The majority of super-centenarians have cognitive impairment c. The number of super-centenarians is expected to decrease in coming years as a result of heart disease and stroke d. It is theorized that super-centenarians survived as long as they have due to genetic mutations that made them less susceptible to common diseases ANS: A

Research supports that most super-centenarians are functionally and cognitively intact, requiring minimal assistance with ADLs. The number of super-centenarians is expected to increase in coming years as the number of older adults increases. The reason why individuals survived as long as they have is not known.

DIF: Cognitive Level: Remembering REF: p. 4 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. One reason why many “baby boomers” have multiple chronic conditions such as heart disease,

diabetes, and arthritis is that: a. they have less access to medication and other treatment regimens. b. there was a lack of importance placed on healthy living as they were growing up. c. they did not have access to immunizations against communicable disease when they were children. d. they grew up in an era of rampant poverty and malnutrition.

ANS: B

The baby boomers, individuals born between 1946 and 1964, post-WWII, have better access to medication and treatment regimens than other cohorts. They have had the benefit of the development of immunizations against communicable diseases. They grew up in an era of prosperity post-WWII. However, there was a lack of importance placed on what we now consider healthy living when they were younger. Smoking, for example, was not condoned, but was considered a symbol of status. Candy in the shape of cigarettes was popular, and there was much secondhand smoke.

DIF: Cognitive Level: Remembering REF: p. 6 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is planning an education program on wellness in a local senior citizen center. The

nurse plans to provide education on the importance of immunizations, annual physical examinations, screening for diabetes, and vision and hearing screening. It is important for the nurse to understand which of the following? a. Approximately 40% of older adults (ages 65 and older) utilize available preventive services b. Preventive strategies are more widely used in the 40-64 age group than in the 65 and over age group c. The research on health promotion strategies in older adults demonstrates that they have low efficacy d. There is an abundance of research specific to health promotion and aging ANS: A

Approximately 40% of individuals, ages 65 and older, utilize the preventive services that are available to them. However, only 24% of those between the ages of 40 and 64 do so. There is a paucity of research specific to health promotion and aging; however, the research that exists demonstrates that health promotion strategies are highly effective.

DIF: Cognitive Level: Understanding REF: p. 7 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A nurse is caring for an 85-year-old male client with diabetes in a community setting. The

nurse promotes functional wellness by which of the following activities? a. Encouraging the client maintains current levels of physical activity b. Assisting the client to receive all the recommended preventive screenings that are appropriate for his age group c. Teaching the patient how to use a rolling walker so that he can ambulate for longer distances d. Encouraging the client to attend his weekly chess games ANS: A

Maintaining existing levels of physical activity is consistent with functional wellness.

Teaching the client how to use a rolling walker enables the client to remain active at the highest level possible, which is an example of promoting functional wellness. Receiving recommended screening is an example of promoting biological wellness. The use of a rolling walker should be based on assessment of physical ability. Encouraging the client to attend weekly chess games is an example of promoting social wellness.

DIF: Cognitive Level: Applying REF: p. 10 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 6. Based on the census reports of 2010, the typical profile of a centenarian in the United States

includes which of the following characteristics? a. A Caucasian woman who lives in an urban area of a Southern state b. An African American woman who lives in a rural area of a Southern state c. A Hispanic man who lives in an urban area of a Midwestern state d. A Caucasian man who lives in a rural area of a Midwestern state ANS: A

Based on the 2010 U.S. Census data, centenarians were overwhelmingly white (82.5%), women (82.8%), and living in urban areas of the Southern states.

DIF: Cognitive Level: Applying REF: p. 5 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Primary prevention strategies for older adults include which of the following? (Select all that

apply.) a. An annual influenza immunization clinic b. A smoking cessation program c. A prostate screening program d. A cardiac rehabilitation program e. A meal planning education program for type 2 diabetics ANS: A, B

Primary prevention refers to strategies that are used to prevent an illness before it occurs and maintaining wellness across the continuum of care. Immunizations and smoking cessation are examples of primary prevention. Secondary prevention is the early detection of a disease or a health problem that has already developed. Prostate screening is an example of secondary prevention. Tertiary prevention addresses the needs of individuals who already have their wellness challenged. Cardiac rehabilitation and meal planning for diabetics are examples of tertiary prevention.

DIF: Cognitive Level: Applying REF: pp. 8–9 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Management of Care 2. A nurse organizes a health fair for older adults. The nurse’s goal is to focus on the six priority

areas identified by the National Prevention Council. Which of the following activities should the nurse include? (Select all that apply.) a. Smoking cessation b. Depression screening c. Recognizing elder abuse d. Cholesterol screening e. Fitness training

ANS: A, B, C

The six priority areas of the National Prevention Council include tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being. Smoking cessation, depression screening, and recognizing elder abuse all directly address these areas.

While cholesterol screening and fitness training are important for older adults, they do not address these six priority areas.

DIF: Cognitive Level: Analyzing REF: p. 8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. The “in-between” generation (individuals born between 1915 and 1945) were subject to which

of the following health challenges during their childhood? (Select all that apply.)

Polio Lack of fluoride in the water causing teeth to be soft and cavity prone “Pigeon Chest,” a malformation of the rib cage due to a lack of vitamin D Smallpox HIV/AIDS

a. b. c. d. e.

ANS: A, B, C

Polio was a major fear of this group; the polio vaccine was not available in the United States until 1955. In many areas water was not fluoridated. “Pigeon Chest” was common. Smallpox was a concern for the centenarians, not this generation. HIV/AIDS had not been identified in the early years of 1915-1945.

DIF: Cognitive Level: Remembering REF: p. 5 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nursing student is preparing a presentation on the Wellness-Based Model for Healthy Aging.

Which of the following concepts should the student include in the presentation? (Select all that apply.) a. Healthy aging is defined by the absence of physical illness alone b. Healthy aging is individually defined and can change over time c. There are many strategies to promote healthy aging that are believed to be helpful but do not have empirical evidence to support them d. Healthy aging cannot be achieved by only focusing on later life. It is a lifelong process e. According to this model, an individual with a chronic disease would not be considered healthy ANS: B, C, D

Healthy aging is a lifelong process that begins with birth and ends with death. The concept of healthy aging from a wellness perspective is uniquely defined by each individual and can change over time. There are challenges to implementing evidence-based practices on healthy aging because there is a paucity of research on this area. Therefore, there are many strategies that have been used and determined to be effective but do not have research evidence supporting them. The subcomponents with the wellness model are functional independence, self-care management of illness, personal growth, positive outlook, and social contribution and activities that promote one’s health.

DIF: Cognitive Level: Applying REF: p. 7 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 02: Gerontological Nursing: Past, Present, and Future Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Serious and well-controlled research studies on aging have been available: a. only in the past 60 years. b. since the turn of the 20th century. c. following the Great Depression. d. since the year 2000.

ANS: A

Only in the past 60 years have serious and carefully controlled research studies flourished.

Before that, anecdotal evidence was used to illustrate issues assumed to be universal, making all the remaining options incorrect.

DIF: Cognitive Level: Remembering REF: p. 19 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. The son of a nursing home resident asks a nurse: “What is the significance of being certified

in gerontology? I see that you are, but not all of the nurses are.” The best response by the nurse is which of the following? a. “National certification as a gerontological nurse is a way to demonstrate special knowledge in caring for older adults” b. “National certification in gerontology is required for all nurses who have worked in this setting for 2 or more years” c. “National certification is only available to nurses who have a Baccalaureate degree in nursing” d. “Only advanced practice nurses, like nurse practitioners, are certified in gerontology” ANS: A

National certification is a way to demonstrate special expertise in caring for older adults. It is not required for practice in any setting across the continuum of care, and it is not exclusive to nurses with Baccalaureate degrees. There is both a generalist and a specialist gerontological nursing certification. The generalist functions in a variety of settings providing care to older adults and their families. The specialist has advanced gerontological education at a Masters level.

DIF: Cognitive Level: Analyzing REF: pp. 20–21 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Management of Care 3. The major goal of the NICHE (Nurses Improving Care for Health System Elders) program

includes which of the following? a. Improve outcomes for hospitalized older adults b. Increase the number of older adults cared for in hospitals c. Increase the number of iatrogenic complications that occur in hospitalized older adults

d. Decrease 30-day readmission rates for hospitalized older adults ANS: A

The goal of NICHE is to improve outcomes for hospitalized older adults. Although D is a good outcome for hospitalized older adults, it is not one of the major goals of NICHE, which are broader. Options b and c are not goals that would improve care for older adults, but would be negative outcomes themselves.

DIF: Cognitive Level: Remembering REF: p. 22 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. The impact of the Patient Protection and Affordable Care Act of 2010 on gerontological

nursing includes which of the following? (Select all that apply.) a. Funding to support advanced education in gerontological nursing b. Funding to support education of faculty in gerontology c. Funding to increase the number of direct care workers in hospitals d. Funding to increase nurse-patient ratios in long-term care e. Funding for advanced training of direct care workers in long-term care ANS: A, B, E

The Patient Protection and Affordable Care Act of 2010 provides funding for advanced education in gerontology, education for faculty in gerontology, and advanced training for direct care workers in long-term care. The act does not address nurse-patient ratios or staffing issues in any setting.

DIF: Cognitive Level: Understanding REF: p. 14 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. Which of the following are true statements about the current health care workforce? (Select all

that apply.) a. Approximately 10% of registered nurses (RNs) are certified in gerontological nursing b. The number of geriatricians is expected to increase about 50% over the next 25 years c. The professions of social work, physical therapy, and psychiatry are demonstrating the same trends as nursing d. Europe and the developing countries are experiencing similar shortages in health care workers with geriatric expertise as in the United States e. It is anticipated that there will be a need for approximately 3 million additional direct care and professional health care workers by the year 2030 ANS: C, D, E

Less than 1% of RNs are certified in gerontological nursing. The number of geriatricians is decreasing, not increasing. Responses C, D, and E are all true.

DIF: Cognitive Level: Understanding REF: p. 14 TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance 3. Best practice recommendations for undergraduate nursing education in relation to gerontology

include which of the following? (Select all that apply.) a. Provision of a “stand-alone” course in gerontological nursing b. Integration of gerontological content throughout the curriculum c. Replacement of acute care pediatric clinical experiences with gerontological clinical experiences d. Recruitment of nurses with Masters and Doctoral degrees and a specialty in gerontology to faculty roles e. Requiring all undergraduate nursing students to obtain gerontological certification as a requirement for graduation ANS: A, B, D

Best practices include providing a stand-alone gerontological nursing course as well as integrating gerontology throughout the curriculum. Recruitment of nurses with a specialty in gerontology and a Masters or Doctoral degree to faculty roles is a critical step in making sure that the next generation of nurses is prepared to care for older adults. Best practices do not recommend removing pediatric clinical experiences and replacing them with gerontological experiences. Nursing certification is only available to practicing nurses who meet specific education and practice requirements. It is not applicable to nursing students.

DIF: Cognitive Level: Understanding REF: pp. 17–18 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. Goals of the Eldercare Workforce Alliance include which of the following? (Select all that

apply.) a. Mandating a minimum of a Baccalaureate degree in nursing in order to care for older adults b. Increasing wages of certified nursing assistants (CNAs) in nursing homes c. Providing loan forgiveness for individuals who assume faculty roles d. Developing a nursing certification specific to long-term care e. Adopting cost-effective care coordination models for older adults across the continuum of care ANS: B, C, E

A, B, and C are all included in the Elder Workforce Alliance goals. Options A and D are not.

DIF: Cognitive Level: Understanding REF: p. 14 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A nurse interviews for a job in a hospital that advertises that it is “elderly friendly.” The nurse

would expect to see which of the following in place? (Select all that apply.) a. An elder-assistance program to help patients remember their appointments and navigate the hospital services. b. A long-term care facility that is affiliated with the hospital c. Rooms furnished with foldout beds for family members/caregivers d. An initiative to provide gerontological education for all nurses e. An initiative to increase the number of patients referred to long-term care facilities

upon discharge from the hospital ANS: A, C, D

The guiding principles of an elder friendly facility include treating each patient as a unique individual and accommodating the patient and family’s special needs. Other principles include ensuring that the nurses are clinically competent in gerontological nursing. Tailoring the environment to support the implementation of these principles is part of this initiative. Option B is not correct as it does not relate to the concept of an elder friendly hospital. Option E is not correct since this might not be a supportive intervention for all patients.

DIF: Cognitive Level: Analyzing TOP: Integrated Process: Caring

REF: p. 22, Box 2-7 MSC: Client Needs: Psychosocial Integrity

6. Significant factors contributing to the growth of community-based care include: (Select all

that apply.) a. a decrease in the number of available nursing home beds. b. rapidly escalating health care costs. c. older adults’ preferences to “age in place.” d. inadequate numbers of nurses with gerontological specialty education. e. decreasing numbers of family caregivers.

ANS: B, C

Care will continue to move out of hospitals and long-term care facilities because of rapidly escalating health care costs and individual preferences to “age in place.” There has not been a decrease in nursing home beds. Although there are inadequate numbers of nurses with gerontological specialty training, this is not a factor that has impacted the growth of community-based care. There is projected to be a decrease in the number of family caregivers as the caregivers themselves are aging; however, this does not contribute to the growth of community-based care.

DIF: Cognitive Level: Remembering REF: p. 23 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 7. Changes in certified nursing facilities in recent years include which of the following? (Select

all that apply.) a. Increase in the number of subacute beds b. Decrease in nursing facility length of stay c. Increase in level of acuity of the residents d. Decrease in cost of care in the nursing facility e. Decrease in the number of registered nurses employed in long-term care facilities ANS: A, B, C

Certified nursing facilities have evolved over recent years. Most facilities have subacute care units that resemble hospital units caring for more patients with higher acuity than in the past.

Therefore, the average length of stay in a facility has decreased. The cost of care in the facility has increased due to the increased complexity of illnesses treated, and the number of registered nurses has increased in order to care for these complex patients.

DIF: Cognitive Level: Analyzing REF: p. 23 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

8. Which of the following factors contribute to poor outcomes for older adults during transitions

of care? (Select all that apply.) a. Inability to read and understand discharge instructions b. Inadequate financial resources to purchase medications c. Lack of desire to comply with discharge instructions d. Improved medication reconciliation during hospitalization e. High levels of nurse-patient engagement ANS: A, B

Language and literacy levels and socioeconomic factors are major contributors to poor transitions of care for older adults. A high level of nurse-patient engagement contributes to safe and effective transitions. Medication reconciliation during hospitalization, at discharge and after discharge, decreases medication discrepancies, which are the most prevalent adverse event following hospital discharge. There is no evidence that patients lack the desire to comply with discharge instructions.

DIF: Cognitive Level: Analyzing REF: p. 24 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Safety and Infection Control

Chapter 04: Cross-Cultural Caring and Aging Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A paper on culture and illness would be likely to include the statement that: a. culture is the same as ethnicity. b. ethnic groups always share common geographic origin and religion. c. ethnicity involves recognized traditions, symbols, and literature. d. most members of an ethnic group exhibit identical cultural traits.

ANS: C

Ethnicity is a complex phenomenon including traditions, symbols, literature, folklore, food preferences, and dress. It is a shared identity. Ethnicity is more than just culture. It is social differentiation based on culture. Even within ethnic groups, there is considerable diversity.

DIF: Cognitive Level: Remembering REF: p. 44 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. Ethnocentrism is defined as: a. an understanding of another’s cultural beliefs and practices. b. a conflict that occurs when an individual interacts with another whose beliefs

differ from his own. c. application of limited knowledge about one person with characteristics specific to

another person. d. a belief that one’s ethnic group is superior to that of another.

ANS: D

A belief that one’s ethnic group is superior to that of another is the definition of ethnocentrism.

Ethnocentrism does not involve an understanding of the beliefs of others. A conflict that occurs when an individual interacts with another whose beliefs differ from his own is the definition of cultural conflict. Application of limited knowledge about one person with characteristics specific to another person is the definition of stereotyping.

DIF: Cognitive Level: Remembering REF: p. 42 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. Regarding health care disparities, it is true that older adults of color have: a. equal risk factors for vulnerability as do all older adults. b. equal risk factors for vulnerability as do the young adults of color. c. increased risk factors for vulnerability if they are female. d. an increase in risk factors for vulnerability if care is provided by public facilities.

ANS: C

Older females of color have an added risk factor for vulnerability (gender) than do males of the same age and ethnic group. Ethnicity is an added factor for vulnerability. Age is an additional risk factor for vulnerability. Health care disparities are found across a wide range of clinical settings.

DIF: Cognitive Level: Remembering REF: p. 41 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. An older female patient tells a nurse the following: “In my culture, women are the silent

partner in the family. Men make all of the decisions. However, when we came to the United States, all that changed. I became an American. I am in charge of my family just like my husband.” This is an example of: a. enculturation. b. acculturation. c. ethnicity. d. culture competence.

ANS: B

Enculturation is defined as cultural beliefs passed down from one generation to the next.

Acculturation is the process by which persons from one culture adapt to another. Ethnicity is defined as the cultural group that one identifies with. Cultural competence involves stepping outside our own biases and understanding that others bring a different set of values.

DIF: Cognitive Level: Applying REF: p. 40 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. A home care nurse is caring for an older patient from a different culture who is bed-bound and

high risk for development of a pressure ulcer. The nurse discusses the plan of care with the patient’s daughter, emphasizing the importance of turning every 2 hours and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient’s daughter reports that she turns her mother occasionally. She states, “I am taking very good care of my mother. You just don’t understand; our ways do not involve doing things on schedules.” The best response by the nurse is: a. “You must follow my guidelines and turn her every 2 hours, or I will not be able to take care of her.” b. “I understand that you value your culture, but culture cannot stop you from providing good care to your mother.” c. “I understand that you care very much for your mother. Perhaps caring for her is too much for you.” d. “How can we best work together to provide the best care for your mother?”

ANS: D

In providing cross-cultural care it is important that the nurse work with the patient and family and listen carefully and find a way to include the values and beliefs of the patient in the plan of care.

DIF: Cognitive Level: Analyzing REF: p. 43 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity 6. An older patient learns that he has metastatic cancer. The patient states: “I must have angered

God.” This is an example of which type of belief? a. Biomedical b. Magico-religious

c. Naturalistic d. Ayurvedic ANS: B

Magico-religious: views illness as caused by actions of a higher authority.

Biomedical: views disease as a result of abnormalities in structure and function and disease caused by intrusion of pathogens into the body.

Naturalistic: based on the concepts of balance. Health is seen as a sign of balance.

Ayurvedic: the oldest known paradigm in the naturalistic system. Illness is seen as an imbalance.

DIF: Cognitive Level: Remembering REF: p. 46 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity 7. A female nurse is caring for an older woman from the Hasidic Jewish community. The

woman’s son is at the patient’s bedside. The nurse notes that when she communicates with the patient and her son, the son does not maintain eye contact with her and also notes that he withdraws when she attempts to shake his hand. The best response by the nurse is to: a. carry on conversation with the patient only, ignoring the son. b. continue conversing with both the patient and the son. c. ask the son to leave since he is not comfortable with her. d. ask the patient why the son will not engage with her.

ANS: B

In some cultures, direct eye contact or contact between men and women is seen as a sexual advance. This is true in the Hasidic culture. Options A and C are disrespectful to the patient and her son. Option D may put the son in an uncomfortable position.

DIF: Cognitive Level: Analyzing REF: p. 48 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. The nurse in a clinic setting that provides care for an ethnically diverse population of older

clients shows an understanding of the LEARN Model to direct the assessment process when: (Select all that apply.) a. recognizing that the client’s hands are clenched as she answers the assessment questions. b. asking the client to describe what he thinks will help him feel better. c. explaining to the client that herbal remedies may not be sufficient treatment for his chest congestion. d. acknowledging that the client has a different view of the appropriate treatment. e. suggesting to the client that it would be beneficial if she would trust her health care provider to prescribe the correct treatment.

ANS: A, B, C, D

The LEARN Model implements active listening to both the client’s verbal and nonverbal communication as a means of obtaining insight into the client’s perspective of his or her medical problem. This model also encourages the nurse to recognize that the perceptions may differ and to explain the differences in perceptions to the client. The model advocates arriving at a mutually agreed upon treatment plan rather than encouraging the client to surrender personal autonomy in the decision-making.

DIF: Cognitive Level: Remembering REF: p. 50 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. A nurse completes a cultural assessment of an older adult who is being admitted to an assisted

living facility. Reasons for completing a cultural assessment include: (Select all that apply.) a. culture guides decision-making about health, illness, and preventive care. b. culture provides direction for individuals on how to interact during health care encounters. c. culture impacts attitudes toward aging. d. all members of a culture react in the same way in similar situations. e. knowledge of culture eliminates health care disparities.

ANS: A, B, C

Although knowledge of culture has the potential to optimize care, not all individuals will respond in the same way to a specific situation. Knowledge of an individual’s culture will not eliminate health care disparities.

DIF: Cognitive Level: Understanding REF: pp. 49–50 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. A nurse in the ambulatory care setting is preparing to do an interview with a

non-English-speaking client. The nurse secures an interpreter. In order to have the most effective interview, the nurse should do which of the following? (Select all that apply.) a. Look and speak to the interpreter b. Use technical terminology to ensure accuracy c. Allow more time for the interview d. Watch the client’s nonverbal communication e. Have the interpreter check whether the client understands the communication ANS: C, D

For the most effective interview the nurse should look and speak directly to the client, avoid the use of jargon and technical terminology, observe the client’s nonverbal communications, and clarify understanding by asking the client to state in his/her own words what he or she understood, facilitated by the interpreter. The interview will take longer.

DIF: Cognitive Level: Remembering REF: p. 48 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

Chapter 05: Cognition and Learning Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Health literacy is defined as: a. the capacity to read basic health information in order to make appropriate health

decisions. b. the capacity to obtain, process, and understand basic health information needed to

make appropriate health decisions. c. the capacity to read and write in order to access health care. d. the capacity to read and execute health care documents.

ANS: B

Health literacy involves more than basic reading and writing skills. It involves the ability to obtain, process, and understand health information in order to make health care decisions.

DIF: Cognitive Level: Remembering REF: pp. 60–61 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. The daughter of an older hospitalized patient tells a nurse: “I am worried about my father. His

memory is sharper when he is at home. He is forgetful, but is functional. Since he has been hospitalized his memory problems are much worse.” The best response by the nurse is: a. “It is common for long-term memory to be more impacted by age-related changes than short-term memory.” b. “Memory changes are often worse when an individual is in an unfamiliar or stressful situation.” c. “Perhaps you are just noticing your father’s memory loss now that he is hospitalized.” d. “There is a lot of new information for your father to process here in the hospital; he is overloaded.”

ANS: B

Memory changes are often worse when the individual is in unfamiliar or stressful situations, such as a hospitalization. Option A is not true, short-term memory is impacted more than long-term memory. Options C and D are true; however, they do not address the issue that the patient’s daughter is discussing.

DIF: Cognitive Level: Analyzing REF: p. 56 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older resident in a senior community tells a nurse: “I am really worried. I joined an

exercise class, and I just learned everyone’s name yesterday, and I cannot remember them all today. Am I developing Alzheimer’s disease?” The best response by the nurse is: a. “You should be concerned. It is very unusual to forget something that you just learned.” b. “There is no reason to be concerned. Short-term memory decreases with age.” c. “Don’t worry, a decline in both short- and long-term memory is a normal part of

getting older.” d. “Although it is normal to have some changes in memory, forgetting names is very

unusual.”

ANS: B

Even though some older adults show decrements in the ability to process information, the majority of functioning remains intact. Age-associated memory impairment is used to describe memory loss that is considered normal for one’s age and educational level. It may include slowness in processing, storing, and recalling new information and difficulty remembering names and words.

DIF: Cognitive Level: Applying REF: p. 56 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is developing an educational session for a group of older adults at a senior center.

Which of the following would the nurse include in the education? (Select all that apply.) a. Attention span, language, and communication skills typically remain stable with increasing age b. Older brains slow down and take longer to process constantly increasing amounts of information c. In order to preserve brain function, it is important to engage in challenging cognitive activities d. Older adults are not able to develop new cognitive abilities e. Individuals over age 100 have a higher prevalence of dementia than younger individuals ANS: A, B, C

Older adulthood is no longer seen as a period when cognitive development is halted; it is a life stage where unique capacities are developed. Centenarians and super-centenarians have a lower prevalence of dementia then those under age 100.

DIF: Cognitive Level: Remembering REF: p. 56 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older female resident of an assisted living facility says the following to a nurse: “I am very

frightened about getting dementia. I have read a lot about brain exercises, but I am not sure what I should be doing.” The nurse formulates a response based on knowledge of which of the following? (Select all that apply.) a. Individuals should engage in some type of brain fitness activity a couple of times a week for at least 25 minutes b. Brain fitness activities are only effective if an individual has not experienced any memory problems at all c. Brain fitness activities may include computer-based games, memory training, board games, reading, and engaging in conversation d. Physical activity is important for wellness but is unrelated to brain fitness e. Individuals should choose brain exercise activities that are unfamiliar, challenging, and fun

ANS: A, C, E

Brain fitness activities are effective for individuals with normal memory or mild memory problems. Physical activity is important and has an impact on improving reaction time and working memory as well as posture, balance, and socialization.

DIF: Cognitive Level: Applying REF: p. 57 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse is planning a fall prevention education refresher session for the residents of a

long-term care facility. The individuals are all cognitively intact and range in age from 80 to 100. The previous education on fall prevention was presented 2 months ago. What special considerations should the nurse take in relation to teaching this group of older adults? (Select all that apply.) a. Make sure that all pamphlets are in large readable font (14-16 points) and include upper and lower case lettering b. Start education on falls from the beginning. It is unlikely that anyone remembers previous material c. Present all the information at once in one long session d. Ensure that there is adequate lighting in the room and that the temperature is comfortable e. Provide ongoing positive feedback during the session ANS: A, D, E

When educating older adults it is important that it is pertinent and build upon information that they already possess. It is a myth that all older adults experience memory problems. It is important to provide adequate time for learning and to use self-paced techniques.

DIF: Cognitive Level: Applying REF: pp. 57–60 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse hears a colleague state the following: “Can you believe that Mr. Jones’ daughter just

bought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn to use it.” The nurse formulates a response based on research that shows: (Select all that apply.) a. older adults comprise the fastest growing population using computers and the Internet. b. Internet use is less prevalent in individuals over age 75 than those ages 65-74. c. older American men are the fastest growing group of social networking site users. d. older adults use the Internet only for social networking and recreational uses. e. technology has the potential to improve quality of life for older adults.

ANS: A, B, E

Older adults are the fastest growing population using computers and the Internet. Internet use does decrease in those over age 75 as compared to older adults less than age 75. Older women are the fastest growing group of individuals using social networking sites. Older adults use technology for a whole host of reasons, both social and to communicate with health care providers and access health information. Technology has a large potential to improve quality of life for older adults.

DIF: Cognitive Level: Remembering

REF: p. 58

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 06: Communicating with Older Adults Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. When caring for an ill adult client, the nurse is particularly concerned that the client

communicates well since: a. assessment, planning of care, and even the therapeutic relationship is based on effective communication. b. it is the social connection that all individuals base interpersonal relationships upon. c. how well an individual communicates is a reflection on both his or her physical and emotional well-being. d. the need to communicate is a basic need of all individuals.

ANS: A

Good communication skills are the basis for accurate assessment, care planning, and the development of therapeutic relationships between the nurse and the older person. While the other options are true they do not directly address the concerns of an ailing client.

DIF: Cognitive Level: Understanding REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 2. Which statement by the nurse is the strongest example of ageism by professional nurses? a. “It takes a special nurse to provide good care to the older population of clients.” b. “It’s difficult for a nurse to develop an effective relationship with an older client

because of the barriers their age creates.” c. “It is so difficult to find nurses who are truly effective geriatric nurses.” d. “With the older population increasing so dramatically in numbers, nursing will

have a difficult time meeting their needs.”

ANS: C

Ageism affects health professionals as well as the general public and this attitude is reflected in the lack of nurses who choose to work in the field of geriatrics. The characteristics of a “good geriatric nurse” are no different than those of any effective nurse. Assuming that age produces barriers to an effective nurse-client relationship is an example of ageism. The growing number of older adults is not an example of ageism.

DIF: Cognitive Level: Understanding REF: p. 66 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. When conducting an admissions interview with an older client, the nurse observes that the

client pauses for a period of time before responding to the questions. The nurse responds to this client based on the assumption that the client is: a. exhibiting signs of mild cognitive impairment. b. nervous and having difficulty concentrating on the questions. c. reluctant to share information with someone with whom he or she has no relationship. d. sorting through his or her vast life experiences in order to answer appropriately.

ANS: D

Basically, elders may need more time to give information or answer questions simply because they have a larger life experience to draw from. Sorting through thoughts requires intervals of silence, and therefore listening carefully without rushing the elder is very important. It is an unfounded assumption to assume that the client’s response is due to senility based exclusively on his or her age. The remaining options would not be unique to an older client but might be experienced at any age.

DIF: Cognitive Level: Applying REF: p. 67 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 4. Which technique is most effective when communicating with a client who is positioned in

bed? a. Sitting in a chair at the foot of the bed b. Standing near the client’s head on his or her dominant side c. Sitting in a chair at the bedside facing the client d. Standing at the foot of the bed ANS: C

When communicating with individuals in a bed or wheelchair, position yourself at their level and directly face them rather than talking over a side rail or standing above them.

DIF: Cognitive Level: Applying REF: p. 67 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 5. Which nursing statement shows a true appreciation for an older client’s willingness to tell his

personal stories about “the war”? a. “It’s so nice to see them excited and engaged as they tell the stories.” b. “It helps their memory so much to retell their stories.” c. “I learn so much about clients when they share their life story with me.” d. “They are so proud of the things they have accomplished in their life.”

ANS: C

A memory is an incredible gift given to the nurse, a sharing of a part of oneself when one may have little else to give, and it provides insight into who the person really is telling the story.

DIF: Cognitive Level: Applying REF: p. 67 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse manager is providing a novice geriatric nurse with guidelines when encouraging an

older client to reminisce about his or her life and past experiences. Which suggestions will be included? (Select all that apply.) a. Don’t correct the client even when you suspect the memory is incorrect b. When the focus remains on sad topics, assess the client for possible depression c. Refrain from interjecting personal stories into the reminiscing process d. Expect and respect a degree of repetition

e. Use close-ended questions to help focus the reminiscing ANS: A, B, D

Suggestions for encouraging reminiscing include listening without correction or criticism, remembering that it is the client’s recollections that are important; being patient with repetition since sometimes people need to tell the same story often to come to terms with the experience, especially if it was very meaningful to them; being attuned to signs of depression in conversation (dwelling on sad topics) or changes in physical status or behavior, and providing appropriate assessment and intervention; and keeping the conversation focused on the person reminiscing, but not hesitating to share some of your own memories that relate to the situation being discussed. Use open-ended questions to encourage reminiscing since they encourage free thought.

DIF: Cognitive Level: Applying REF: p. 68, Box 6-3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. Which intervention is therapeutic when facilitating communication with a cognitively

impaired older client? (Select all that apply.) a. Explain a task using simple, concise phrasing and one step at a time b. Give instructions to a group whenever possible to provide peer support c. Allow for additional time for the client to respond to questions or directions d. Use nonverbal as well as verbal cues to help get your message across to the client e. Speak loudly to gain and retain the client’s attention ANS: A, C, D

Useful strategies for communicating with individuals experiencing cognitive impairment include giving one-step directions, allowing time for the expected response, and giving clues and cues as to what you want the person to do. It is also helpful to interact with one person at a time and to speak slowly rather than loudly.

DIF: Cognitive Level: Applying REF: p. 69 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 3. Which of the following are examples of elderspeak? (Select all that apply.) a. A nursing assistant refers to one of her patients as “grandma” b. A nurse attempts to medicate a patient and states, “Now come on and be a good

girl” c. A nurse explains a procedure to a patient using simple nonmedical terms d. A nurse makes sure that she is directly facing a patient who has hearing loss when

she is speaking e. A nursing assistant tells a patient, “It is time for our bath now” ANS: A, B, E

Elderspeak is a form of patronizing speech. Examples include using diminutives or pet names, speaking very slowly, and speaking to older adults as if they were children, or using collective pronouns. Option C is not an example of elderspeak; it is appropriate to explain a procedure using nonmedical terminology. Option D is the correct manner in which to address an individual with hearing loss; facing the patient allows the patient to read lips.

DIF: Cognitive Level: Applying

REF: p. 66

TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

Chapter 07: Health Assessment Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The FANCAPES assessment tool focuses on the older adult’s: a. ability to meet personal needs to identify the amount of assistance needed. b. ability to perform instrumental activities of daily living (IADLs). c. cognitive abilities. d. level of dementia present.

ANS: A

The FANCAPES assessment tool focuses on physical functioning and evaluates the individual’s ability to meet his/her needs and how much assistance is needed to meet the needs. FANCAPES evaluates physical functioning. IADLs involve more than just physical functioning. FANCAPES does not assess cognitive function, nor does it assess dementia.

DIF: Cognitive Level: Remembering REF: p. 79 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 2. A limitation of the Katz Index of activities of daily living (ADLs) is that: a. completion of the tool requires the joint efforts of the interdisciplinary team. b. all ADLs are weighted equally. c. it puts a heavier weight on the cognitive abilities necessary to perform ADLs. d. it provides a range of performance for each task.

ANS: B

The Katz Index assigns an equal weight to all of the ADLs, and because of that, it cannot be used to identify the particular area of need or change in any one task. Any health care professional can complete the Katz Index, although input from the interdisciplinary team is valuable. The Katz Index does not address the cognitive abilities necessary to perform ADLs. The ADLs are considered in dichotomous terms only, the ability to compete the task independently or the complete inability to do so.

DIF: Cognitive Level: Remembering REF: p. 80 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 3. A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he has

been very forgetful lately, and she is concerned that he might be “senile.” The advanced practice nurse administers the clock-drawing test and the patient draws a distorted circular shape and places the numbers all on one side of the shape. Based on his performance, the nurse concludes that the patient: a. probably has Alzheimer’s disease. b. needs further evaluation. c. probably has delirium. d. needs a functional status assessment.

ANS: B

Cognitively intact persons rarely produce errors on the clock-drawing test, such as grossly distorted contour. A low score on the clock-drawing test requires further evaluation.

Alzheimer’s disease is not a diagnosis using a mental status assessment tool. It is definitively diagnosed with a brain biopsy. The clock-drawing test does not assess for delirium. A low score on the clock-drawing test does not necessarily warrant a functional status assessment.

DIF: Cognitive Level: Understanding REF: p. 81 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 4. When comparing the Older American’s Resources and Services (OARS) with the Katz Index

of ADLs, what is true? a. The Katz Index and the OARS both measure only ADL performance b. The OARS is a comprehensive assessment tool that measures ability in five areas; the Katz Index measures only ADL performance c. The OARS is used only for older adults in the long-term care setting; the Katz Index is used in all settings d. The OARS is not valid for use in older adults who are cognitively impaired, whereas the Katz Index is ANS: B

The OARS evaluates ability, disability, and capacity at which the person is able to function.

Five dimensions are assessed: social resources, economic resources, physical health, mental health, and ADLs. The Katz Index only evaluates ADL ability. Both instruments are used in a variety of care settings and are valid for use with cognitively impaired older adults.

DIF: Cognitive Level: Understanding REF: p. 84 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 5. A resident of a long-term care facility is assessed by a nurse upon admission to the facility.

The assessment includes a comprehensive health, social, and functional profile. The tool that the nurse utilizes is: a. Outcomes and Assessment Information Set (OASIS). b. Resident Assessment Instrument (RAI). c. Older Americans Resources and Services (OARS). d. Comprehensive Geriatric Assessment (CGS). e. Mini Mental Status Examination (MMSE).

ANS: B

The OASIS is used in the homecare setting. The RAI is used in the long-term care setting.

OARS is a functional status instrument. Comprehensive geriatric assessment is not a specific tool but rather an approach to assessment. The MMSE is a mental status assessment tool.

DIF: Cognitive Level: Remembering REF: p. 85 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

6. A nurse utilizes the SPICES tool (Sleep disorders, Problems with eating, Incontinence,

Confusion, Evidence of falls, and Skin breakdown) to assess an older female patient in the hospital. The nurse notes that the patient has new onset urinary incontinence. The first action by the nurse is to: a. conduct a more in-depth focused assessment of the urinary incontinence. b. call the provider and obtain an order for an antibiotic for a suspected urinary tract infection. c. send a urine specimen for culture and sensitivity. d. develop a plan of care with the patient to control episodes of incontinence.

ANS: A

SPICES is an assessment tool. Anything that indicates a problem in any of the categories warns the nurse that a more in-depth assessment is needed. The nurse needs to further assess the urinary incontinence prior to implementing any interventions.

DIF: Cognitive Level: Analyzing REF: p. 79 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse identifies a need to assess a patient’s cognitive status. The nurse chooses to use the

MMSE. The nurse knows that the patient must have which of the following abilities? (Select all that apply.) a. Number fluency b. Familiarity with analog clocks c. Ability to hear and see d. Ability to sit up for 10 minutes e. Ability to speak English ANS: A, B, C

The MMSE requires number fluency, ability to see and hear and hold a pencil, and experience with analog clocks. The instrument is available in languages other than English. It is a cognitive status exam and does not require that the patient be able to sit up.

DIF: Cognitive Level: Remembering REF: p. 81 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. Factors that complicate assessment of older adults include: (Select all that apply.) a. presence of multiple comorbid conditions. b. atypical presentation of illness. c. difficulty in differentiating symptoms of disease from normal age-related changes. d. increase in iatrogenic illness. e. lack of assessment instruments specific for the older adult population.

ANS: A, B, C, D

Factors that complicate assessment of older adults include difficulty differentiating disease symptoms from normal age-related changes, the presence of multiple comorbidities, atypical presentations of illness, and the presence of iatrogenic illness. There are many assessment tools that are designed specifically for use in the older adult population.

DIF: Cognitive Level: Remembering REF: p. 85 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse completes a functional status assessment of an older person using the Lawton IADL

instrument, a self-reported instrument. The nurse knows that limitations of self-reported measures include that: (Select all that apply.) a. individuals tend to overestimate their functional ability. b. self-reports often differ from that of proxy reports. c. self-reports are not indicative of small changes in function. d. self-reports do not provide a valid measurement of function. e. older adults are not able to complete self-reported measurements.

ANS: A, B

Individuals tend to overestimate their functional ability and often self-reported measures differ from proxy reports. Self-reported measures are a valid measurement of function, and older adults are able to complete them. The choice of tool and the type of scoring of the tool is the factor that determines if the small changes in function can be detected.

DIF: Cognitive Level: Remembering REF: p. 79 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is assessing a patient’s activities of daily living. The nurse will assess which of the

following? (Select all that apply.) a. Eating b. Continence c. Toileting d. Self-medication administration e. Bathing ANS: A, B, C, E

The basic activities of daily living include eating, transfer, toileting, bathing, continence, and dressing. Self-medication administration is an independent activity of daily living (IADL).

DIF: Cognitive Level: Remembering REF: p. 80 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 08: Laboratory Values and Diagnostics Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The nurse is reviewing the postsurgical laboratory values of an older adult client. The client’s

erythrocyte sedimentation rate (ESR) is 20 mm/hr. The nurse initially responds to this data by: a. asking the client if he or she has been diagnosed with any chronic inflammatory diseases. b. recognizing that the value is normal for older adults. c. notifying the client’s health care provider immediately. d. requesting that the laboratory rerun the test.

ANS: B

The ESR can be slightly elevated (10-20 mm/hr) in healthy older adults, especially those with a chronic disease that results in inflammation. Asking the client if he or she has such a diagnosis is not the initial response. This slight elevation does not warrant immediate notification or rerunning of the test.

DIF: Cognitive Level: Applying REF: p. 91 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. An older client in a long-term care facility is receiving an annual physical examination and is

ordered laboratory tests that include a complete blood count, serum electrolytes, and thyroid tests. When the client’s son questions why these tests are being ordered by saying, “Dad is 85 why are you bothering him?” the nurse’s response is based on an understanding that: a. the health care provider ordering the tests needs to explain the rationale to the son. b. when conducted annually, all of the tests are helpful in promoting maximum health for older adults in the long-term care setting. c. the tests are useful, but only if clinically indicated. d. the complete blood count and serum electrolytes are useful screening tests, but the usefulness of the thyroid test should be questioned.

ANS: B

Laboratory tests are a fast and accurate way of assessing key parts of an older person’s physical functioning. It is within the nurse’s scope of practice to answer the son’s question and it does not need to be referred to the health care provider. The laboratory tests are being used as annual screening and therefore do not need to be clinically indicated. Excessive sleepiness is not normal in an 85-year-old and may be a sign of a thyroid disorder.

DIF: Cognitive Level: Applying REF: p. 92 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. When asked by an older adult client, “What is the difference between my normal laboratory

values and the ones for a 55-year-old?” The nurse responds based on the understanding that there are: a. age-adjusted ranges for older adults for all of the common laboratory findings, similar to those for infants and children.

b. no age-adjusted ranges for older adults due to the large variations within the age

group and the increasing number of factors that influence the results. c. age-adjusted ranges only for the over-85 age group; there are no expected changes

in the 65- to 84-year-old age group. d. age-adjusted ranges only for the hematological tests, which are due mostly to

changes in the bone marrow.

ANS: B

There are no age-adjusted ranges for laboratory values due to the variation within the group, as well as the many chronic illnesses of older adults. The older one is, the more likely variations are to be seen. Although several age-related hematological changes occur, mainly from changes in the bone marrow, few are clinically significant.

DIF: Cognitive Level: Remembering REF: p. 88 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. An older resident of a long-term care facility diagnosed with dementia has in the last 48 hours

become more confused than usual and while usually requiring help with toileting has been incontinent of urine. The client’s health care provider orders a complete blood count and serum electrolytes. When the laboratory tests are all within normal limits, the nurse initially: a. attributes the changes in the resident’s functioning to advancing dementia. b. suggests that the resident be placed on broad-spectrum antibiotics to prevent infections. c. speaks with the health care provider regarding the changes in the client’s function and the possibility of obtaining a urine culture. d. changes the plan of care to include bladder training and implement a 24-hour calorie count.

ANS: C

Waiting for usual signs of infection or illness in older adults can be fatal. In older adults, signs of infection may be absent or not seen until the patient is septic or very ill. The nurse needs to be alert to the subtle changes in the patient. A change in mental status may be indicative of an infection. Laboratory values do not always change in older adults, often not until the patient is very ill. Placing a patient on broad-spectrum antibiotics does not prevent infections. This action may in fact cause bacteria to become drug resistant. All evidence points to the changes in functioning being attributable to acute illness. The nurse needs to respond to the acute illness first.

DIF: Cognitive Level: Applying REF: p. 90 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. An older woman with breast cancer has completed a course of external radiation and is

receiving chemotherapy. After her recent chemotherapy treatment, she complains of severe weakness, dizziness, and lethargy and is admitted to the hospital. Her platelet count is 45,000.

Based on this scenario, what nursing intervention is of the highest priority? a. Preventing falls b. Maintaining skin integrity c. Preventing infection d. Replacing fluids

ANS: A

Fall prevention is the highest priority. The patient has at least two significant risk factors for falls (unsteady gait and complaints of dizziness). She has a platelet count of 45,000; a platelet count of less than 50,000 makes one at high risk for spontaneous bleeding. The nurse must observe for overt and covert bleeding. If the patient falls, she is very likely to have a significant injury because of the low platelet count. Maintaining skin integrity would be important in this patient because she has received external radiation, which can cause alterations in skin integrity, but this is not as high a priority. Although preventing infection is an important intervention in a patient with cancer who has received radiation and chemotherapy, there is no evidence that this patient has alterations in her laboratory values related to the treatments, so fall prevention is more critical. There are no specific indications that this patient is experiencing a fluid deficit.

DIF: Cognitive Level: Analyzing REF: p. 91 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 6. A 69-year-old patient in the geriatric clinic has an annual physical examination and a

complete blood count and serum electrolytes are drawn. While the physical examination was uneventful, the laboratory results show an elevated blood urea nitrogen (BUN). The nurse will then: a. ask that the test be rerun since the client showed no physical signs of renal failure. b. review the client’s medication list since BUN can be affected by many specific medications. c. instruct the client on collecting a 24-hour urine specimen for a more detailed analysis. d. assure the client that an elevated BUN is normal in older adults.

ANS: B

BUN can be elevated as a result of certain medication therapies and so the nurse should assess for this possibility. An elevated BUN is not diagnostic of renal failure alone and will not necessarily be reflected in physical symptoms. A 24-hour urine sample will not generally be done to determine BUN levels. An elevated BUN is not expected as a normal part of aging.

Renal functioning decreases substantially with aging, but in most cases the body is able to compensate adequately with only slight increases in laboratory findings.

DIF: Cognitive Level: Applying REF: p. 96 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 7. A 78-year-old female patient was recently diagnosed with atrial fibrillation and started on

Coumadin (warfarin) for stroke prophylaxis. A nurse provides extensive education on warfarin including the need for routine blood testing. The woman states the following to a nurse: “I understand all that you have taught me, but I do not know what a good number for the INR test is.” The nurse bases her response on the knowledge that the recommended INR is: a. 1.0-2.0. b. 2.0-3.0. c. 3.0-4.0. d. 4.0-5.0.

ANS: B

Recommended INR for an individual with atrial fibrillation for stroke prevention in individuals over age 75 is 2.0-3.0.

DIF: Cognitive Level: Applying REF: p. 97 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 8. An older woman asks a nurse in the cardiology practice, “What is the ideal number that my

cholesterol levels should be? I am confused by all of the different numbers.” The nurse formulates her response on the knowledge that: a. recent guidelines from the American Heart Association state that there is no “one size fits all” recommendation and that recommendations must be individualized to each patient. b. recent guidelines from the American Heart Association provide different recommendations for individuals age 65-74, 75-84, and over age 85. c. recent guidelines from the American Heart Association recommend a total serum cholesterol level below 100. d. recent guidelines from the American Heart Association recommend a total serum cholesterol level over 200.

ANS: A

Recent guidelines from the American Heart Association state that there is no “one size fits all” recommendation and that recommendations must be individualized to each patient. Multiple factors that must be considered include family history, other risk factors for heart disease, and long-term risk-benefit ratios.

DIF: Cognitive Level: Applying REF: p. 95 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE 1. When a client asks, “What could be causing my triglycerides to be so low; I’m really careful

about my diet?” the nurse responds by asking the client: (Select all that apply.) a. “Is your type 2 diabetes well managed?” b. “Have you ever been diagnosed with renal failure?” c. “Do you have a history of pancreatitis?” d. “Are you on medication for hyperthyroidism?” e. “Could you tell me how you are careful about your diet?”

ANS: D, E

Abnormally low triglyceride levels are suggestive of malnutrition or hyperthyroidism.

Reasons for elevated levels include chronic renal failure and poorly controlled diabetes.

Severely elevated triglyceride levels (greater than 2000 mg/dL) are a strong risk factor for pancreatitis.

DIF: Cognitive Level: Applying REF: p. 95 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

2. An elderly man is brought to the geriatrics clinic by his wife because of his increasing

confusion. As part of his medical workup, the nurse practitioner orders which of the following laboratory tests? (Select all that apply.) a. Basic metabolic panel b. Vitamin D level c. Thyroid stimulating panel d. Vitamin B 12 e. Serum albumin level ANS: A, B, C, D

The following laboratory tests are part of a workup for a change in mental status: Basic metabolic panel, vitamin D level, vitamin B 12 , thyroid stimulating panel. Serum albumin is not part of a dementia workup.

DIF: Cognitive Level: Remembering REF: p. 92 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 09: Geropharmacology Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Factors that affect the pharmacokinetics of lipophilic medications in older adults include: a. greater adipose tissue ratio to body mass. b. decreased total body water. c. increased glomerular filtration rate. d. increased creatinine clearance.

ANS: A

Older adults have a higher ratio of adipose (fat) tissue where lipophilic (fat-soluble) medications can be stored thus resulting in a potential for an accumulation of the medication and potentially fatal overdoses. Older adults have a decrease in lean body mass and an increase in fat. An increased body mass would not affect lipophilic medication absorption.

Older adults have a decreased glomerular filtration rate, which begins to decline as early as age 25. Older adults have a decrease in overall kidney function.

DIF: Cognitive Level: Remembering REF: p. 103 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. Which pharmacokinetic/pharmacodynamic parameter does the aging process least affect? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: A

There is no conclusive evidence that the absorptive process is changed appreciably in older adults. Distribution, metabolism, and excretion are all affected significantly by aging.

DIF: Cognitive Level: Remembering REF: p. 107 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. What factor is an important contribution to polypharmacy in older adults? a. Inadequate communication among medical care providers b. Implementation of Medicare Part D prescription drug benefit c. Use of generic medications d. Increasing popularity of dietary and herbal supplements ANS: A

Polypharmacy is often the result of inadequate communication among specialists or between specialists and primary care providers. Medicare Part D prescription drug benefits influence the financing of medication but are not directly related to polypharmacy. Generic medications are a way to keep medication costs down. The use of herbal supplements is an important factor when examining drug interactions or adverse reactions but is not a direct factor related to polypharmacy.

DIF: Cognitive Level: Remembering REF: p. 104 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. The area in which nurses have the greatest effect on the safe, effective medication therapy of

an older client is: a. educating the client to all aspects of the medication. b. assessing for adverse reactions to the medication. c. monitoring overall health of the client as it is affected by the medication. d. evaluating the outcomes resulting from the medication.

ANS: A

Nurses have the greatest opportunity to impact medication use and improve treatment outcomes through patient education. Assessing for reactions, monitoring effects, and evaluation of outcomes all depend on the client’s understanding and compliance with the medication therapy (i.e., are affected by client education).

DIF: Cognitive Level: Analyzing REF: p. 110 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. When developing a teaching plan for an older, newly diagnosed diabetic client, the nurse best

ensures an understanding of oral hypoglycemic medications when providing: a. the package insert and assessing the client’s reading skills. b. the client with the website address for the American Diabetes Association. c. oral explanations and sending the client home with a written copy. d. the information in paragraph form as opposed to numbered line fashion.

ANS: C

Providing memory aids, such as written information including charts, is effective in reinforcing teaching. Package inserts are not always written in lay language that is understandable and appropriate to the reading level of the older adult. The font size of the print may be too small for aging eyes. Not all older adults are computer literate or comfortable with the use of the computer. This method may be more effective for younger clients. A more effective manner in which to provide written information to older adults is in the form of lists using a large-size font.

DIF: Cognitive Level: Applying REF: pp. 110–112 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 6. The nurse suspects that a client is experiencing tardive dyskinesia when observing that: a. the client can’t seem to stop moving. b. the client’s facial muscles are twisting involuntarily. c. the client not able to get up out of a chair. d. the client’s hand tremors so much that drinking from a cup is difficult.

ANS: B

Facial movements and involuntary twisting of the limbs, trunk, neck, and face is the definition of tardive dyskinesia. A compulsion to be in motion is the definition of akathisia. An inability to move is the definition of akinesia. A bilateral tremor and rigidity reflects Parkinsonian symptoms.

DIF: Cognitive Level: Remembering REF: p. 109 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 7. The Beers Criteria is an effective tool for health care professionals prescribing and/or

managing the medication therapy of older adults since it identifies medications that for this population: a. are not typically covered by drug benefit plans. b. have a higher than usual risk for injury. c. are likely to be abused. d. generally cause allergic reactions.

ANS: B

Drugs on the Beers’ list are those that have been identified to have a higher than usual risk when used in older adults. The Beers Criteria have no relation to medication financing. There is no evidence that the drugs are likely to be abused by older adults. There is no greater likelihood of these drugs causing allergic reactions.

DIF: Cognitive Level: Remembering REF: p. 108 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 8. When performing the initial assessment on a new client in a geriatric outpatients practice, the

most effective method the nurse can implement to elicit an accurate medication assessment is to ask that the client: a. make a list of all her current medications. b. work with a family member to make a list of her medications. c. bring in all of the medications that she is currently taking. d. allow her previous primary care provider to provide a list of medications.

ANS: C

The gold standard is to use the “brown bag” approach. The patient is asked to bring all medications including prescription drugs, OTC drugs, and herbal and dietary supplements.

The patient may not remember all of the medications that are being taken. As each medication is removed from the bag, necessary information is obtained. A complete medication assessment includes OTC drugs, as well as herbal and dietary supplements, not just prescription medications. Your primary source of information should be the patient if she is able to provide the information; the previous provider may not be able to provide information on supplements or OTC and herbal medications. The nurse needs to include more than just prescription medications. In addition, prescribed medications do not always reflect what is being taken.

DIF: Cognitive Level: Remembering REF: p. 110 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 9. When discussing pharmacological considerations, a 68-year-old client asks, “Why do

medications seem to act differently than they did when I was younger?” The nurse bases the response on the concept that: a. age-related changes affect the way drugs are metabolized by older adults.

b. Over-the-counter (OTC) drugs have standardized dosages that are appropriate for

all ages. c. older adults may need larger doses of medication to bring about the desired effects. d. adverse drug reactions occur with similar frequency in older adults as the general

population.

ANS: A

Age-related pharmacokinetic and pharmacodynamic changes explain why older adults react differently to medications. OTC drugs can result in altered drug outcomes since that relates to the individual’s response to the medication. Age-related changes may require smaller doses of medication in older patients than in younger patients. The rule is to “start low and go slow.”

The older a person is, the more likely he or she is to have an adverse drug reaction.

DIF: Cognitive Level: Remembering REF: p. 101 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 10. The nurse’s first response when told by a client during an assessment interview that he “can’t

take furosemide (Lasix)” is to ask: a. “Is your health care provider aware that you are allergic to Lasix?” b. “Can you describe what happened when you took Lasix?” c. “When was the last time you took Lasix?” d. “Have you any questions regarding your reaction to Lasix?”

ANS: B

It is important to document the type of allergic reaction, when the patient had it, how long it lasted, and how it was treated. Determining whether the health care provider is aware of the allergic reaction or when the medication was last taken does not have precedence over assessing the client’s reaction to the medication since neither has a direct bearing on the management of a similar reaction. Evaluating the client’s understanding of the reaction is appropriate but not as an initial response.

DIF: Cognitive Level: Remembering REF: p. 107 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 11. An 81-year-old patient is being discharged from the hospital to home. She is on seven

different medications, which are to be taken at four different times during the day. What would be most useful in helping this patient manage her medications? a. The package inserts from all of the medications for the client to read b. A pillbox with compartments for each day and each of the doses c. A written list of all the client’s medications and administration routine d. A suggestion that the client’s daughter administer the medications ANS: B

Providing a pillbox is an effective method to reinforce exactly which medications are to be given at what times. It also serves as an effective method to remind patients when they have missed a dose. Package inserts are often written in language that is not easy for patients to understand. Another consideration is that the size of the print in package inserts may be too small for aging eyes. Although providing a written list of the medications is appropriate, it does not make as much of an impact on the overall management of this patient’s medications as other options. There is no indication that this patient cannot self-administer the medications.

DIF: Cognitive Level: Remembering REF: pp. 111–112 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A 77-year-old Hispanic Catholic nun (retired) who immigrated to the United States 15 years

ago lives alone but in an apartment complex where her biological sister lives as well. She is being discharged home after a hospitalization for congestive heart failure with prescriptions for eight different medications. She is considered at risk for noncompliance due to contributing factors that include: (Select all that apply.) a. language barrier. b. living alone. c. large number of medications. d. ethnic background. e. religious background.

ANS: A, B, C

Language barriers, living alone, and a large number of medications are all factors that have been shown to contribute to noncompliance in older adults. There is no evidence that ethnic or religious background contributes to noncompliance.

DIF: Cognitive Level: Remembering REF: p. 106 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older client prescribed a transdermal morphine patch for severe chronic pain is being

educated on the appropriate administration of the medication. The nurse shows an understanding of essential information regarding this route of drug administration when stating: (Select all that apply.) a. “This is an effective route for delivering small doses of medication over long periods of time.” b. “Since you have problems with digestion, this is a good way to take your medication.” c. “Please show me how you would apply your patch.” d. “Be careful to put the patch only on your chest but change locations with each application.” e. “Be sure to avoid placing the patch on injured skin.”

ANS: A, B, C, E

Aging does increase the risk of developing an allergic reaction due to its effect on the immune system and decreased gastric motility. Transdermal medications bypass the gastrointestinal tract and so do not cause digestion problems, and their effectiveness is not affected by digestive problems. Demonstrating the application process is an excellent way to evaluate the client’s understanding and technique. Transdermal patches can be applied to areas other than the chest, such as the arms, backs, legs, and abdomen, but damaged skin should be avoided.

DIF: Cognitive Level: Remembering REF: p. 103 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An antihypertensive medication has been prescribed for an older patient with hypertension.

The patient tells a clinic nurse that he would like to take an herbal substance to help lower his blood pressure instead of the prescription medication. Which of the following should the nurse do? (Select all that apply.) a. Tell the patient that herbal substances are less effective than prescription medications b. Encourage the patient to discuss the use of an herbal substance with his primary care provider c. Explore with the patient which herbal substance he is planning on taking d. Educate the patient on possible interactions of the herbal substance with his other medications e. Instruct the patient not to take the herbal substance, as it is dangerous ANS: B, C, D

The popularity of medicinal herbs and supplements continues to rise. A major concern with the use of herbs and supplements is the potential interactions with prescribed medications. It is important that the patient share his or her use of herbs and substances with all providers and that the provider review the herbs and the prescribed medications to ensure compatibility.

DIF: Cognitive Level: Applying REF: p. 106 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 4. An older patient is prescribed warfarin for stroke prevention. A nurse is providing patient

education. Which of the following foods should the patient be taught to avoid? (Select all that apply.) a. Milk b. Whole grains c. Kale d. Spinach e. Red meats ANS: C, D

It is important to avoid “leafy green vegetables” when taking Coumadin.

DIF: Cognitive Level: Remembering REF: p. 106 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 10: The Use of Herbs and Supplements Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The nurse preparing an educational program focused on herbal supplement targets as a likely

interested group: a. Inner-city females who live below the poverty level b. White females who own their own successful businesses c. Male Hispanic Americans who are single, divorced, or widowed d. Men and women from small rural communities who are self-employed farmers ANS: B

Non-Hispanic, white, older, normal-to-underweight women with more education were found to use dietary supplements more than any other racial, ethnic, age, or gender group.

DIF: Cognitive Level: Applying REF: p. 115 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. During an admission interview, a patient tells the nurse about taking Ginkgo biloba daily. The

nurse responds to this information by inquiring whether the client: a. has ever been screened for depression. b. experiences gastrointestinal (GI) upset. c. has concerns regarding impotence. d. has reoccurring bouts of bronchitis.

ANS: B

Side effects of Ginkgo biloba include GI upset and should be assessed for by the nurse.

Neither depression, nor impotence, nor chronic bronchitis conditions are generally self-treated with Gingko biloba. These conditions are not considered typical side effects of Gingko biloba either.

DIF: Cognitive Level: Applying REF: p. 118 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older adult client is being seen for the first time at the outpatient geriatric clinic. As a

component of the nursing admission history, the nurse inquires about the use of herbs and other supplements. The basis for this inquiry is that such herbal therapy: a. may interact with prescription medications. b. is hazardous when used by older adults. c. replaces the need for prescription medications. d. causes excessive sedation in older adults.

ANS: A

The gerontological nurse has the obligation to ask questions and obtain specific information about the use of herbs and supplements because they may interact with prescription medications. When used cautiously and with knowledge of potential interactions with other medications, herbs and supplements are not hazardous. They do not replace the need for prescription medications. Not all herbs and supplements cause excessive sedation.

DIF: Cognitive Level: Applying REF: p. 124 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 4. The nurse is conducting a presurgical interview when it is noted that the older adult patient’s

medication list includes Tylenol 650 mg four times a day for arthritic pain, gingko 80 mg twice a day, and glucosamine chondroitin 500 mg three times per day. The nurse proceeds to share with the client that in order to minimize the risk for postsurgical complications, there is the need to refrain from taking: a. glucosamine chondroitin for 1-2 weeks due to a potential for excess anesthetic sedation. b. ginkgo for 2 weeks due to the potential for increased bleeding. c. Tylenol for 24-48 hours due to the potential for increased bleeding. d. gingko for 1 week due to the potential for an allergic reaction during surgery.

ANS: B

It is recommended that ginkgo be discontinued for 2 weeks preoperatively due to the potential for increased bleeding. There is no evidence that ginkgo is associated with allergic reactions during surgery. There are no recommendations for discontinuation of glucosamine chondroitin, and glucosamine is not associated with a potential for increased sedation from anesthetics.

Tylenol is not associated with a potential for increased bleeding.

DIF: Cognitive Level: Analyzing REF: p. 123, Table 10-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 5. When a nursing interview identifies that a client is daily taking doses of herbal supplements,

the nurse’s priority is to: a. evaluate the effectiveness of the herbal supplement self-treatment. b. determine why the client feels the need to take the herbal supplements. c. identify when the herbal supplementation began. d. discuss the client’s knowledge regarding the herbal supplements’ side effects.

ANS: D

The conversation about the client’s use of herbal supplements should focus first on the client’s understanding of the herbs’ uses, side effects, dosage, and safety concerns. Once the therapeutic communication has established a nonjudgmental nature, the nurse can go on to if the client feels the supplements are effective, why the client feels the need to take the supplements, and when the supplements were started.

DIF: Cognitive Level: Analyzing REF: pp. 123–124 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies

6. The nurse admitting a client to a same day surgery unit makes the decision to notify the

surgical team to cancel the procedure based on the client’s statement that: a. “Will I start taking my St. John’s wort as soon as I can eat again?” b. “I’ve haven’t taken my ginkgo for exactly 10 days.” c. “I didn’t want to risk catching a cold so I took my echinacea with just a sip of water.” d. “It seemed strange not taking my garlic pill this morning.”

ANS: D

Herbs that can affect bleeding and clotting time, such as garlic, ginger, ginkgo, and ginseng, should be especially noted and reported to the surgical team. There is no known surgery-related risk involved with the regular self-medication of St. John’s Wort or echinacea.

Ginkgo should be stopped at least 7 days prior to surgery.

DIF: Cognitive Level: Analyzing REF: p. 123 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 7. When a client who routinely takes the herb St. John’s Wort (SJW) shares that his or her “hay

fever is really bad right now,” the nurse initially: a. notifies the primary care provider that the client has been self-medicating for hay fever. b. compares the client’s current blood pressure to his/her baseline blood pressure. c. stresses the need to avoid over-the-counter (OTC) medications containing monoamines. d. suggests that the client stop taking the herb until the hay fever has improved.

ANS: B

When taking SJW, people should be warned not to take medications containing monoamines, such as medications for nasal decongestants, hay fever, and asthma, because this combination may cause hypertension. The primary care provider should not be notified until the BP monitoring is known. Avoiding specific OTC medications and stopping the herb is information the client should have been given prior.

DIF: Cognitive Level: Analyzing REF: p. 123 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 8. The major focus regarding nursing education for the older adult regarding the use of herbal

supplements is the: a. high risk of herbal overdose since the manufacturing process lacks effective controls. b. likelihood that the client will substitute herbals for more expensive prescribed medications. c. expense of the herbal supplements since they are seldom covered by insurance. d. possibility of dangerous interactions between herbals and the client’s prescription medications.

ANS: D

A major issue in the use of herb and other supplements is the risk for interactions. This is especially a concern due to the number of medications already taken by elders. While the remaining options are all legitimate concerns, they are not unique to the older adult consumer.

DIF: Cognitive Level: Applying REF: p. 122 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 9. The nurse is confident that the client who chooses to take red rice yeast daily for dyslipidemia

has an understanding of its possible side effects when the client: a. has regular laboratory work to monitor cholesterol levels. b. shows caution by slowly rising from the chair. c. states, “If I start noticing muscle pain, I’ll stop taking the pills.” d. schedules regular, yearly glaucoma screenings.

ANS: C

Persons need to know the potential side effects of red yeast rice, similar to those of lovastatin, such as muscle pain. Regular cholesterol monitoring will not aid in the identification or management of possible side effects. The need to rise slowly from a chair is not directly related to the side effect of muscle pain. There is no current research to support the need for regular glaucoma screens as a precaution when taking red rice yeast.

DIF: Cognitive Level: Analyzing REF: p. 120 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse is confident that the client who takes glucosamine sulfate daily is conscientious of

the safety issues involved when hearing the client state: (Select all that apply.) a. “I’m always careful to buy the same brand of glucosamine sulfate.” b. “If glucosamine sulfate wasn’t safe the drug store wouldn’t sell it.” c. “My pharmacist is so helpful when I have questions about the herbals I take.” d. “The liquid form of glucosamine sulfate is what I consistently take.” e. “I made sure my physician knew that I was allergic to strawberries.”

ANS: A, C, D, E

Regarding product safety, there is no standardization among manufacturers, so the amount of active ingredients per dose among brands is inconsistent; herbs and supplements should be purchased from reputable sources; herbs are available in different forms, making accurate dosing difficult; and persons who have allergies to certain plants may have allergies to herbs in the same plant family. There is insufficient research data to confidently make a statement about the safety of such herbal therapy.

DIF: Cognitive Level: Applying REF: p. 124 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 2. An older adult is having difficulty sleeping and asks a nurse, “My neighbor told me that I

should take melatonin to help me sleep. What do you think about this?” The nurse responds to the individual’s question using the knowledge that: (Select all that apply.)

a. in the natural state melatonin is produced by the pineal gland and regulates the

sleep-wake cycle. b. melatonin is available in both immediate and extended release forms; however,

only the immediate form is effective. c. there are no significant adverse effects to melatonin. d. it must be used with caution in a patient that is taking other medications that have

central nervous system depressant effects. e. evidence shows that it is effective at decreasing sleep onset latency, improving

quality of sleep, and improving morning wakefulness.

ANS: A, D, E

In the natural state, melatonin is endogenously produced by the pineal gland and is an important signal in regulating the sleep-wake cycle. Melatonin must be used with caution in patients who are taking other medications that cause drowsiness or have central nervous system depressant effects. Studies have demonstrated that melatonin is effective at decreasing sleep onset latency, improving quality of sleep, and improving morning wakefulness.

Melatonin is available in both an immediate and extended release form, and both forms are effective. There are adverse effects to melatonin, which include dizziness, nausea, and drowsiness.

DIF: Cognitive Level: Applying REF: p. 120 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies

Chapter 11: Vision Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. You have four rooms to choose from for your older client to be admitted this afternoon.

Which room would you choose? a. A brightly lit, blue room with cozy throw rugs b. An orange-carpeted room with soft lighting and yellow walls c. A brightly lit, blue room with an EZ-Glide wax floor d. A fluorescent-lighted room with green walls and a glossy, tiled floor ANS: B

Light colors such as red, orange, and yellow are more easily seen by aging eyes. Softer lighting will help reduce some of the glare and is also easier seen by aging eyes. Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem. Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare.

DIF: Cognitive Level: Applying REF: p. 138 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older adult client shares with the nurse that, “I don’t know what it is but it seems that I

need more light for reading or even watching television as I get older.” The nurse explains that aging may cause this change due to the: a. slower ability of the pupil to adjust to changes in lighting. b. impact arcus senilis has on visual acuity c. flattening and thinning of the cornea. d. retinal changes that begin to occur with aging.

ANS: A

A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting. The changes in the retina do not account for the need for increased light that this patient is reporting.

DIF: Cognitive Level: Applying REF: p. 131 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The

nurse’s response is: a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A

The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

DIF: Cognitive Level: Remembering REF: p. 134 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. An older man tells a nurse, “The doctor says I have something wrong with my eyes,

something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight.” The nurse formulates a response based on the knowledge that: a. the lens of the eye loses elasticity causing a loss of focus for near objects. b. the cornea of the eye becomes thicker and less curved causing an increase in astigmatism. c. the lens of the eye increases in opacity causing a decrease in light refraction. d. the cornea of the eye forms a gray ring at the edges.

ANS: A

Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye. All of the other options are normal age-related changes; however, they are not related to presbyopia.

DIF: Cognitive Level: Applying REF: p. 132, Table 11-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. An older resident in a long-term care facility reports to the nurse that she has been noticing

changes in her vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with: a. cataracts. b. glaucoma. c. diabetic retinopathy. d. age-related macular degeneration.

ANS: A

Signs of cataracts include the appearance of halos around objects as light is diffused, blurring, decreased perception of light and color giving a yellow tint to most objects, and a sensitivity to glare.

DIF: Cognitive Level: Remembering REF: p. 134 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 6. An older patient reports the following symptoms to a nurse during a routine visit to the

geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. He also states, “Strangely enough my peripheral vision continues to be pretty good.” The nurse suspects that the patient has which of the following? a. Glaucoma

b. Age related macular degeneration c. Diabetic retinopathy d. Cataracts ANS: B

Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration. The other three eye diseases do not present with these symptoms.

DIF: Cognitive Level: Applying REF: pp. 135–136 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is providing glaucoma education for a group of older adults in a senior center. The

nurse knows that the following groups are most likely to develop glaucoma. (Select all that apply.) a. African Americans b. Mexican Americans c. Individuals with a family history of glaucoma d. Individuals with diabetes e. Asian Americans ANS: A, B, C, D

African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among the other high-risk groups. Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups.

DIF: Cognitive Level: Remembering REF: p. 133 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A nurse is performing preoperative teaching for an older adult who is scheduled to have a

cataract extraction and lens implant. The nurse includes which of the following in the teaching plan? (Select all that apply.) a. Avoid lifting heavy objects after the surgery b. Avoid bending from the waist after the surgery c. Take stool softeners as needed d. Maintain strict control of your blood sugar and blood pressure e. Maintain a dry sterile dressing over the eye for 10 days ANS: A, B, C

Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist. Fall prevention is also very important as is complying with eye drop administration.

Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction. There usually is not a dressing over the operative site, and not for 10 days.

DIF: Cognitive Level: Applying

REF: pp. 134–135

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: “Is there

anything that I can do to prevent progression of this disease and blindness?” The nurse includes which of the following into the response? (Select all that apply.) a. Strict control of blood glucose levels is important in slowing disease progression b. Laser photocoagulation treatments can stop progression of the disease c. Control of blood pressure and cholesterol levels are important steps slowing disease progression d. Wearing sunglasses to protect the eyes from ultraviolet light can stop disease progression e. Eating a diet high in beta-carotene can stop disease progression ANS: A, B, C

Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease. Laser treatment can reduce vision loss in 50% of patients. Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression.

DIF: Cognitive Level: Applying REF: p. 136 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is conducting an assessment of an older patient’s eyes. The nurse expects to see

which of the following normal age-related changes of the external eye? (Select all that apply.) a. The eyelids are less elastic and droopy b. The eyes are very dry c. The eyelids may not close completely d. There is a loss of eyelashes e. The lower lid may be turned outward ANS: A, B, C, E

Normal age-related changes in the external eye include a loss of elasticity causing drooping.

Eyes become drier, and the eyelids may not close completely. Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid. Loss of eyelashes is not a normal age-related change.

DIF: Cognitive Level: Remembering REF: p. 132, Table 11-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 12: Hearing Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. An older client reports to a nurse, “My daughter says there is something wrong with my

hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well.” Based on the client’s description, the nurse suspects which of the following? a. Presbycusis b. Otosclerosis c. Tinnitus d. A perforated eardrum ANS: A

Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children’s voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present.

DIF: Cognitive Level: Analyzing REF: p. 143 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older nursing home resident reports that her hearing loss is getting worse. What is the first

action of the nurse? a. Refer the resident for an evaluation for a hearing aid b. Raise her voice when speaking to the resident c. Examine the resident’s ears for cerumen impaction d. Teach the resident to read lips ANS: C

When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. Raising one’s voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

DIF: Cognitive Level: Analyzing REF: p. 144 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older patient asks a nurse, “My doctor referred me to a hearing specialist who thinks that

surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?” The nurse formulates a response based on the knowledge that:

a. b. c. d.

a cochlear implant is permanent, surgically-implanted hearing aid. a cochlear implant speeds up the conduction of sound to the auditory nerve. a cochlear implant functions as an artificial auditory nerve. a cochlear implant directly stimulates the auditory nerve.

ANS: D

A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve.

DIF: Cognitive Level: Analyzing REF: p. 146 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years

obtains a new hearing aid. Which of the following should be included in the nurse’s teaching plan? a. “Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure.” b. “With the right hearing aid, you can expect your hearing to be back to normal.” c. “Hearing aids are covered by Medicare Part B.” d. “Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise.”

ANS: D

Hearing aids do bring challenges, such as distorted speech and amplified background noise.

Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not restore hearing to normal. Medicare does not cover the cost of hearing aids.

DIF: Cognitive Level: Analyzing REF: p. 145 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse in an assisted living community notes that one of the residents who has hearing

impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.) a. Difficulty placing hearing aid properly in the ear b. Stigma associated with wearing a hearing aid c. Difficulty changing the batteries in the hearing aid d. Ineffectiveness of hearing aids for individuals with age-related hearing loss e. Hearing annoying loud noises ANS: A, B, C, E

Options A, B, C, and E are all factors associated with low use after purchase. Option D is incorrect; most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use.

DIF: Cognitive Level: Remembering

REF: p. 145

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older person reports hearing whistling in both ears when no external sounds are present

and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.) a. Exposure to loud noises b. Use of a hearing aid c. Cerumen buildup d. Side effects of medications e. Age-related changes in the middle and inner ear ANS: A, C, D

Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications.

DIF: Cognitive Level: Remembering REF: p. 149 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of

sensorineural hearing loss include: (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction. c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

ANS: D, E

A, B, and C are all associated with conductive hearing loss. Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss.

DIF: Cognitive Level: Remembering REF: p. 144 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 13: Skin Care Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The nurse is most concerned by observing when assisting with an older client’s bath: a. A firm, irregularly-shaped, pink-colored nodule b. A slightly raised multicolor lesion with an asymmetrical, irregular border c. A pearly papule with prominent blood vessels d. Rough, scaly, sandpaper-like patches that are slightly tender ANS: B

A slightly raised multicolor lesion with an asymmetrical irregular border is characteristic of melanoma that accounts for less than 5% of skin cancer cases, but it causes most skin cancer deaths. A firm, irregularly-shaped, pink-colored nodule or persistent red lesion is characteristic of squamous cell carcinoma. A pearly papule with prominent blood vessels is a characteristic of a basal cell carcinoma. A tender, rough, scaly, sandpaper-like patch is a characteristic of actinic keratoses (a precancerous lesion).

DIF: Cognitive Level: Applying REF: p. 159 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older person is admitted to the hospital with an exacerbation of congestive heart failure.

The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, “How did I get something like this?” The best response by the nurse is: a. “Scabies is highly contagious and spreads easily through physical contact.” b. “Scabies is commonly seen in older adults due to normal age-related changes in the skin.” c. “Scabies is only seen in older adults who have multiple chronic illnesses.” d. “Certain medications can make you more susceptible to contracting scabies.”

ANS: A

Scabies is caused by a tiny burrowing mite and is highly contagious and easily passed by an infected person to family members and others in close contact by direct physical content. It is not limited to older adults, and age-related changes in the skin do not cause it or make a person more susceptible. Individuals with multiple chronic conditions are not more likely to develop scabies than other individuals. There is no evidence that medications can make an individual more susceptible.

DIF: Cognitive Level: Remembering REF: p. 155 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse is providing an educational session on vaccines to a group of older adults. The nurse

is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education? a. Zostavax should only be given to individuals who have never had an episode of herpes zoster (HZ)

b. Zostavax is recommended for all individuals over age 60 that have no

contraindications to the vaccine c. Zostavax should not be given to anyone with a chronic cardiac or respiratory

condition d. Zostavax will always prevent an individual from developing Herpes Zoster ANS: B

Zostavax is recommended for all persons 60 and older who have no contraindications to the vaccine, including persons with a previous episode of Herpes Zoster (HZ) and those with chronic conditions. The vaccine does not guarantee that an individual will not get HZ; however, individuals who get the vaccine cut their risk in half and if they do get HZ, it is likely that they will get a milder case.

DIF: Cognitive Level: Remembering REF: p. 157 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right

thoracic area. The nurse suspects HZ. The patient asks the nurse, “I really don’t understand how I got shingles. I don’t even know anyone who has this infection.” The nurse includes which of the following in formulating a response to the patient? a. HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion b. HZ is caused by the same virus as chickenpox and requires exposure to an individual with active chickenpox c. HZ is caused by the same virus as chickenpox and requires direct contact with an individual with HZ d. HZ is caused by the varicella zoster virus and occurs only in individuals who were never previously exposed to the virus ANS: A

HZ is a viral infection caused by a reactivation of the latent varicella zoster virus (the same virus that causes chickenpox) within the sensory neurons of the dorsal root ganglion, decades after the initial varicella zoster infection is established. HZ is infectious until the lesions are completely crusted over. Individuals do not have to have direct contact with someone who has either chickenpox or HZ in order to have a reactivation; other factors such as illness and stress can cause the reactivation. Individuals who have HZ infection were previously exposed to the varicella zoster virus.

DIF: Cognitive Level: Applying REF: p. 157 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A nurse assesses a nursing home resident’s pressure ulcer to be a “healing stage III.” The

primary reason reverse staging is never used is because: a. even though all tissue layers are replaced as a wound heals, the healed skin is not as strong as it originally was. b. not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was. c. reimbursement in nursing homes does not allow for reverse staging to be utilized. d. the collagen layer is not replaced during wound healing.

ANS: B

Not all tissue layers are replaced as a wound heals. The wound fills with granulation tissue composed of endothelial cells, fibroblasts, collagen, and extracellular matrix. Muscle, subcutaneous fat, and dermis are not replaced. The healed skin is not as strong as it originally was. Reimbursement in long-term care is not the primary reason for not using reverse staging.

DIF: Cognitive Level: Remembering REF: p. 161 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is caring for an older adult with xerosis. Which of the following interventions should

the nurse include in the patient’s plan of care? (Select all that apply.) a. Encourage adequate fluid intake b. Encourage daily baths of at least 20 minutes c. Maintain a humid environment d. Apply water-laden emulsions to skin immediately after bathing e. Use only deodorant soaps when bathing ANS: A, C, D

Xerosis is extremely dry, itchy skin. Adequate intake of water is essential in rehydrating the skin. Long duration baths or showers should be avoided, and daily bathing may not be needed.

An environment of 60% humidity is recommended. Water-laden emulsions should be applied immediately after bathing. Deodorant soaps should be avoided except in the axilla and groin.

DIF: Cognitive Level: Applying REF: p. 154 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older patient complains of pruritus. The nurse suggests which of the following

interventions to alleviate the patient’s complaint? (Select all that apply.) a. Use only nonperfumed laundry detergent and fabric softeners b. Avoid sudden temperature changes c. Wear loose-fitting clothing d. Apply heat to affected areas e. Exercise vigorously for at least 30 minutes daily ANS: A, B, C

Pruritus is aggravated by heat, sudden temperature changes, sweating, restrictive clothing, fatigue, exercise and anxiety, perfumed detergents, and fabric softeners.

DIF: Cognitive Level: Applying REF: p. 154 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older patient tells a nurse. “The nurse practitioner told me that these ugly purple bruises on

my arms are called purpura and are due to fragile blood vessels. I still don’t understand why this happens to me.” The nurse responds based on the knowledge that: (Select all that apply.) a. purpura is due to normal age-related changes. b. the incidence of purpura increases with age.

c. purpura is a precancerous skin condition. d. individuals who take blood thinners are especially prone to purpura. e. individuals prone to purpura should make sure that affected areas are open to the

air.

ANS: A, B, D

Purpura is due to normal age-related changes and hence the incidence increases with age.

Individuals who take blood thinners are especially prone to purpura. Purpura is not a precancerous condition. Individuals who are prone to purpura are encouraged to wear protective garments such as long sleeves and long pants.

DIF: Cognitive Level: Applying REF: p. 155 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is educating a group of nursing assistants in long-term care on the prevention of skin

tears. Which of the following interventions should the nurse include in the education? (Select all that apply.) a. Lubricate the resident’s skin with moisturizers twice daily b. Ensure that the resident has adequate nutrition and hydration c. Bathe the resident in hot soapy water d. Avoid the use of lifting shifts when transferring the resident e. Dress the resident in long sleeves and long pants to protect the extremities ANS: A, B, E

Soapless bathing, tepid water, and moisturizers twice daily are recommended to prevent skin tears. Heavy soaps and hot water dry out the skin increasing the risk of skin tears. Lifting sheets are recommended as are the use of long sleeves and long pants to protect the extremities.

DIF: Cognitive Level: Applying REF: pp. 155–156, Box 13-4 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. Which of the following are subscales on the Braden Scale for predicting pressure ulcers?

(Select all that apply.) a. Nutrition b. Moisture c. Mobility d. Age e. BMI ANS: A, B, C

The six subscales of the Braden Scale are sensory perception, activity, mobility, moisture, friction and shear, and nutrition.

DIF: Cognitive Level: Remembering REF: p. 165 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 14: Nutrition Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. An older adult who is within a normal weight range asks a nurse, “I have heard that it is

important to limit the amount of fats in my diet, but I don’t know how much I should be taking in daily. Can you help me?” The best response by the nurse is: a. “Someone of your age needs to limit fats.” b. “Since you are at your ideal weight, you should limit your daily fat grams to half your weight.” c. “Fat intake will depend on the presence of any cardiac issues.” d. “Read food labels well and focus your diet on low-fat foods.”

ANS: B

A simple technique to determine how much fat a person should consume is to divide the ideal weight in half and allowing that number of grams of fat. The remaining options don’t address the issue of how much fat should be eaten daily.

DIF: Cognitive Level: Applying REF: p. 173 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A nursing student asks the instructor, “Our textbook discussed the obesity paradox in older

adults. I am not sure I understand; isn’t obesity bad for everyone?” The best response by the instructor is: a. “While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults.” b. “Obesity is usually not a concern in older adults, as most older people tend to weigh less than they did when they were younger.” c. “Obesity is a concern in all age groups; however, over the past decade obesity in older adults has decreased.” d. “Obesity in older adults is less of a concern than we once thought; individuals over age 65 with a higher BMI have a lower mortality rate.”

ANS: A

There is evidence that obesity in younger people contributes to a decreased life expectancy.

However, in older adults, it is not clear whether obesity is a predictor of mortality. Recent evidence demonstrated that for people who have survived to 70 years of age, mortality risk is lowest in those with a BMI classified as overweight. Persons who increased or decreased BMI have a greater mortality risk than those who have a stable BMI, particularly in those aged 70-79. Obesity is prevalent in older adults. The proportion of older adults who are obese has doubled in the past 30 years. More than one-third of individuals 65 years and older are obese with a higher prevalence in those 65-74 years than in those 75 years and older.

DIF: Cognitive Level: Remembering REF: p. 174 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. A nurse identifies that an older adult needs more education on nutritional needs when the

older adult states the following: a. “Since I am an older person, I need more calories because my metabolic rate is slower” b. “Since I am an older person, I need fewer calories since my metabolic rate is slower” c. “Even though I am an older person, I still need the same amount of nutrients in order to be healthy” d. “Even though I am an older person, I still need to pay attention to my diet and activity levels” ANS: A

Generally, older adults need fewer calories because they may not be as active and metabolic rates slow down. Older adults generally require the same amount of nutrients for optimal health outcomes. Older adults need to pay attention to meeting nutritional requirements and obtaining adequate physical activity for optimal health.

DIF: Cognitive Level: Applying REF: p. 172 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. An older adult asks a nurse, “I hear a lot about limiting the amount of fat in my diet and eating

a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?” The nurse bases a response on which of the following? a. 10-15% of total calories should be from fat, 30-40% from carbohydrates, and 35-75% from protein b. 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein c. 45-65% of total calories should be from fat, 20-35% from carbohydrates, and 10-35% from protein d. 20-35% of total calories should be from fat, 10-25% from carbohydrates, and 50-75% from protein ANS: B

Recommendations for older adults are that 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein.

DIF: Cognitive Level: Remembering REF: p. 173 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A hospitalized older adult who recently had surgery and a wound infection postoperatively is

noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is: a. an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization. b. an injury may cause malabsorption of nutrients. c. most hospitalized older patients do not consume adequate amounts of micro- and macronutrients. d. most hospitalized patients do not have accurate weights recorded upon admission.

ANS: A

One trajectory for malnutrition is inflammation-related malnutrition; in this situation, malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that contribute to an increased metabolic rate and impaired nutrient utilization. An injury does not necessarily cause malabsorption of nutrients. There is no evidence that most hospitalized patients do not consume adequate diets, and there is also no evidence that accurate weights are not recorded for most hospitalized patients.

DIF: Cognitive Level: Analyzing REF: p. 174 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 6. An older adult’s nutritional status is screened by a nurse using the Mini Nutritional

Assessment (MNA). The older adult scores a score of “10” on the screening portion of the tool. The best action by the nurse is to: a. refer the patient to a dietician. b. complete the assessment portion of the tool. c. conduct a 72-hour calorie count. d. initiate nutritional supplements between meals.

ANS: B

The MNA is both a screening tool and a detailed assessment. It is validated for use in individuals over age 65 and intended for use by professionals. If an individual scores less than a 12 on the screening portion of the tool, then the assessment portion must be completed. The assessment portion needs to be completed before any interventions or referrals are taken, as the information that is obtained in the assessment will guide the choice of interventions.

DIF: Cognitive Level: Applying REF: p. 180 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular

accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (Select all that apply.) a. Sit the patient upright in a chair at 90 degrees. b. Allow the patient to sit upright for 15 minutes after the meal is completed. c. Feed the patient only liquids to make swallowing easier. d. Place the solid food in the left side of the mouth. e. Have the patient swallow twice for every mouthful of food given.

ANS: A, E

When feeding a patient with dysphagia, it is important to have the patient sit upright at 90 degrees and to remain upright for an hour following the meal. Other important techniques include having the patient swallow twice for every mouthful of food given. This patient has a history of a right CVA, which would mean that the patient has left-sided weakness. The food needs to be placed in the nonimpaired side of the mouth, which in this case would be the right side. Since the patient has a CVA, the intake of “thin liquids” can increase risk for aspiration.

DIF: Cognitive Level: Applying

REF: p. 186, Box 14-18

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. Many older adults have a vitamin B 12 deficiency. Reasons for this include which of the

following? (Select all that apply.) a. Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B 12 absorption less efficient b. The major source of vitamin B 12 is sunlight, and older adults are less likely to be outdoors and absorb vitamin B 12 in this manner c. Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B 12 from food d. Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B 12 e. Certain antibiotics and anticonvulsant medication increase the risk of vitamin B 12 deficiency ANS: A, C, E

A normal age-related change in the stomach is the production of less gastric acid, which makes vitamin B 12 absorption less efficient. For most older adults, intake of vitamin B 12 is usually adequate. Use of proton pump inhibitors and H 2 receptor blockers for more than a year can lead to lower serum vitamin B 12 levels by impairing absorption of the vitamin from food. Certain antibiotics and anticonvulsants can also increase the risk of vitamin B 12 deficiency. While it is true that older adults may be outdoors less, the major source of vitamin B 12 is not sunlight. While it is also true that older adults may not consume five servings of fruits and vegetables daily, fruit and vegetables are the major sources of vitamins A, C, and E and potassium.

DIF: Cognitive Level: Remembering REF: p. 173 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. Symptoms of gastroesophageal reflux disease (GERD) in older adults include: (Select all that

apply.) a. heartburn. b. regurgitation. c. abdominal pain within one hour of eating. d. vomiting. e. fever and elevated white blood cell count.

ANS: A, B, C

Symptoms of GERD include heartburn, regurgitation, persistent cough, exacerbation of asthma, laryngitis, and intermittent chest pain. In addition, abdominal pain within one hour of eating and worsening of symptoms upon lying down are common. Vomiting is not associated with GERD and neither is fever and elevated white blood cell count.

DIF: Cognitive Level: Remembering REF: p. 177 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

4. A nurse is developing a care plan for an older adult in a long-term care facility that has a

nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (Select all that apply.) a. Assign a nursing aide to feed the resident to ensure adequate consumption of meals b. Supervise the resident during meals c. Provide a pleasant eating environment d. Provide nutritional supplements for the resident e. Assess the resident for ability to feed himself/herself ANS: B, C, D, E

Nurses hold an important role in ensuring adequate nutrition. Interventions that support this goal include supervision of eating, modification of the environment to be pleasing for eating, and assessing the individual for issues related to performance at mealtimes. Feeding a resident is not indicated unless it is known that the resident cannot feed himself/herself. It is important to promote independence as much as possible.

DIF: Cognitive Level: Applying REF: p. 183 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 15: Hydration and Oral Care Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. An older woman asks a nurse, “You always seem to be telling me that I need to drink more

water. How much water do I really need to drink?” The nurse bases her response on the knowledge that older adults should consume at least: a. 1000 mL of fluid per day. b. 1500 mL of fluid per day. c. 2000 mL of fluid per day. d. 2500 mL of fluid per day.

ANS: B

Older adults, with the exception of those who require a fluid restriction, should consume at least 1500 mL of fluid per day.

DIF: Cognitive Level: Remembering REF: p. 191 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose

of hypodermoclysis is: a. to rehydrate an individual with severe dehydration. b. to quickly administer 4-5 L of fluid within a 24-hour period. c. to rehydrate an individual with mild to moderate dehydration. d. as a supplement to IV hydration to expedite rehydration.

ANS: C

HDC is an infusion of isotonic fluids into the subcutaneous space. It is an alternative to IV administration for individuals with mild to moderate dehydration. It cannot be used in individuals with severe dehydration or for any situation requiring more than 3 L over 24 hours.

DIF: Cognitive Level: Remembering REF: p. 194 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. Which of the following statements describing oral care for the older population is correct? a. Regular dental examinations can prevent tooth loss and improve the ability to

chew healthful foods. b. Losing one’s teeth is considered a normal part of the aging process. c. Oral malignancies seldom occur in older adults so oral examinations are of low

priority. d. Preventative dental care is covered under Medicare.

ANS: A

Regular dental care is essential and can prevent tooth loss. Losing one’s teeth is not a normal part of aging; about one-quarter of adults over age 65 are edentulous. Oral cancers occur more often in older individuals. The median age at diagnosis is 61. Oral examinations can assist in early identification and treatment. Medicare does not provide any coverage for oral care services.

DIF: Cognitive Level: Remembering REF: p. 196 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to

deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include: a. speaking to the client sternly and instructing the client to open the mouth and cooperate immediately. b. having another nurse aide assist in holding the client’s mouth open with a tongue depressor. c. involving the client in the process of oral hygiene, such as using the hand over hand technique to brush the client’s teeth. d. quickly performing oral hygiene without explanation since the client is uncooperative.

ANS: C

With uncooperative individuals, it is important for the caregiver to be at eye level and explain all actions with step-by-step instructions. Speaking to the client sternly, having another nurse aide hold the patient’s mouth open, or performing oral hygiene without an explanation will only serve to agitate the patient. Involving the client and having the client participate to the extent possible is important. Using a hand over hand technique is effective.

DIF: Cognitive Level: Analyzing REF: p. 197 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A nurse is observing a nurse aide perform denture care for a resident in the nursing home. The

nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following? a. The nurse aide places a face cloth in the sink and fills the sink half full with water. b. The nurse aide uses toothpaste to clean the dentures. c. The nurse aide utilizes a specially designed denture brush to clean the dentures. d. The nurse aide stores the dentures in a denture cup filled with denture cleansing solution.

ANS: B

Toothpaste is not used to clean dentures since it abrades denture surfaces. All of the other options are correct steps in the process to cleanse dentures.

DIF: Cognitive Level: Remembering REF: p. 197, Box 15-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

1. Which of the following are age-related changes that affect hydration status? (Select all that

apply.)

Decrease in thirst sensation Decrease in total body water Decrease in ability of kidneys to maximally concentrate urine Decrease in bone marrow mass Decrease in bladder capacity

a. b. c. d. e.

ANS: A, B, C

As one ages, thirst sensation decreases and is not proportional to metabolic needs in response to dehydrating conditions. There is a decrease in total body water. The kidneys are less able to maximally concentrate urine resulting in a loss of water. While there is a decrease in bone marrow mass, this does not impact hydration status. Also, as one ages, bladder capacity decreases; however, this does not directly impact hydration status.

DIF: Cognitive Level: Remembering REF: pp. 191–192, Box 15-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A nurse is performing an admission assessment on an older patient who presented with a high

fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient’s skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (Select all that apply.) a. Poor skin turgor over the sternum b. Lower extremity weakness c. High fever d. Sunken eyes e. Cough ANS: B, D

Older adults often present atypically when dehydrated. Skin turgor over the sternum is not a reliable marker in older adults due to the loss of subcutaneous tissue with aging. Lower extremity weakness and sunken eyes may indicate dehydration. High fever and cough can be associated with many other conditions and are not typically signs of dehydration.

DIF: Cognitive Level: Applying REF: p. 193 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. Which of the following nursing interventions should be implemented to prevent dehydration

in hospitalized older adults? (Select all that apply.) a. Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection b. Limiting duration of NPO requirements for diagnostic tests and procedures c. Administering IV fluids to all hospitalized older adults d. Limiting the use of diuretic medications in hospitalized older adults e. Making sure that hospitalized patients have easy access to fluids ANS: A, B, E

In order to prevent dehydration, it is essential to closely monitor hospitalized older adults.

Any individual who develops fever, diarrhea, vomiting, or an infection should be monitoring closely by implementing intake and output records and providing additional fluids. NPO requirements for diagnostic tests and procedures should be as short as possible. It is not appropriate to administer IV fluids to all hospitalized older adults. IV fluids are administered when there is a clinical indication. It is not appropriate to limit the use of diuretics. Diuretics are an important treatment for many older patients. Hydration management involves acute and ongoing management of oral intake. Oral hydration is the first line of treatment for dehydration prevention.

DIF: Cognitive Level: Applying REF: p. 194 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. An older adult complains of xerostomia. Which of the following interventions should the

nurse implement for this patient? (Select all that apply.) a. Encourage the patient to brush and floss teeth regularly. b. Encourage the patient to have regular dental screenings. c. Provide antiseptic mouthwash (e.g., Listerine) for the patient. d. Encourage adequate intake of water. e. Provide saliva substitutes.

ANS: A, B, D, E

Individuals with xerostomia should have regular dental screenings and be encouraged to practice good oral hygiene. Adequate intake of water is important, as is avoidance of alcohol and caffeine. Saliva substitutes may be helpful. Antiseptic mouthwashes usually contain alcohol, which can further dry the mouth.

DIF: Cognitive Level: Applying REF: p. 195 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a

care plan related to oral care. Which of the following should the nurse consider for this patient? (Select all that apply.) a. Oral care should be provided every four hours. b. Teeth should be brushed with a toothbrush after each tube-feeding. c. Lemon glycerin swabs should be used in between feedings to keep the mouth moist. d. Foam swabs should be used in place of a toothbrush to clean the teeth after each tube-feeding. e. Oral care should be provided only twice daily if the older adult is edentulous.

ANS: A, B

Tube-feeding is associated with significant pathologic contamination of the mouth, greater than in individuals who receive oral feeding. Oral care should be provided every 4 hours for patients with gastrostomy tubes and teeth should be brushed with a toothbrush after each feeding to decrease the risk of aspiration pneumonia. Lemon glycerin swabs should never be used for oral care, as they dry and inhibit saliva production. Foam swabs do not remove plaque as well as toothbrushes. Oral care is required even if the individual is edentulous.

DIF: Cognitive Level: Applying REF: p. 198 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 16: Elimination Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A patient tells the nurse, “Every time I laugh or cough, I wet myself.” Which type of urinary

incontinence is this patient describing? a. Urge b. Functional c. Stress d. Mixed ANS: C

Stress incontinence is defined as the loss of a small amount urine with activities that increase intraabdominal pressure such as coughing, sneezing, exercise, lifting, or bending.

DIF: Cognitive Level: Applying REF: p. 203, Box 16-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A 78-year-old patient has a history of osteoarthritis and lives alone in a two-story home. The

bathroom is on the first level and the bedroom is on the second level. The patient states, “I am so upset. I have been wetting the bed at night.” What type of incontinence does the patient most likely have? a. Mixed incontinence b. Stress incontinence c. Urge incontinence d. Functional incontinence ANS: D

Functional incontinence is defined as incontinence that is due to the individual being unable to get to the toilet as a result of barriers, including environmental barriers.

DIF: Cognitive Level: Applying REF: p. 203, Box 16-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse implements a nursing care plan for a patient with constipation. Which of the

following should the nurse include in the plan? a. Increasing fiber in the diet b. Administering aluminum hydroxide antacids c. Bed rest d. Restricting fluids ANS: A

Fluid intake of at least 1.5 L/day, unless contraindicated, is the cornerstone of constipation therapy, with fluids coming mainly from water. A gradual increase in fiber, either as supplements or incorporated into the diet, is generally recommended. Fiber helps stools become bulkier and softer and move through the body more quickly. Physical activity is important as an intervention to stimulate colon motility and bowel evacuation. Daily walking for 20-30 minutes, if tolerated, is helpful, especially after a meal. Aluminum hydroxide antacids are known to be constipating.

DIF: Cognitive Level: Applying REF: p. 214 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. Which of the following nursing actions would help minimize the psychosocial impact of

bladder and/or bowel incontinence for individuals experiencing incontinence prior to going to a group dining room? a. Assess for soiled clothing and change, if necessary. b. Toilet the client and then promptly transport to the dining room. c. Provide peri-care and fresh underclothing. d. Ask the client if toileting is needed and assist as necessary.

ANS: A

Deviations from normal bowel and bladder toileting can lead to chastisement, ostracism, and social withdrawal. By addressing incontinency issues prior to social interactions, such negative responses can be minimized. While toileting is appropriate, it does not directly address the social impact that may result from soiled and/or odorous clothing. Providing peri-care and clean underclothing is necessary only if incontinency has occurred. Asking to toilet the client is not necessarily an effective intervention when the client is consistently incontinent.

DIF: Cognitive Level: Applying REF: p. 200 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. An 89-year-old hospitalized female patient tells a nurse, “I go to the bathroom really often,

but I manage this by not drinking too much before I go to bed so I can sleep for the night.”

The patient has no pain or discomfort with voiding. The nurse considers this finding to be a: a. manifestation of urge incontinence. b. manifestation of a urinary tract infection. c. normal age-related change in an 89-year-old woman. d. manifestation of diabetes.

ANS: C

A decreased bladder capacity is a normal age-related change. Urinating frequently with no other symptoms is not a manifestation of infection or diabetes. Urge incontinence is not a correct response as the patient is not experiencing incontinence.

DIF: Cognitive Level: Applying REF: p. 201 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

1. The nurse interviewing an older adult for a nursing history recognizes that the client is

experiencing symptomology inconsistent with normal aging of the urinary tract when the client reports: (Select all that apply.) a. finding it more difficult in the last few months to start voiding. b. having two bladder infections in the last 4 years. c. getting up once or twice each night to urinate. d. occasionally experiencing pain when urinating. e. needing to urinate at least every 2 hours during the day.

ANS: A, D

Difficulty and pain are not characteristics of urination normally attributed to aging. In about 10-20% of well older adults, aging of the urinary tract is associated with an increased frequency of involuntary bladder contractions. These changes may lead to frequency, nocturia, urgency, and vulnerability to infection.

DIF: Cognitive Level: Applying REF: p. 201 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An otherwise healthy older adult reports having begun to experience problems “holding my

water.” The nurse shows an understanding of interventions that may help minimize the problem of urinary incontinency when: (Select all that apply.) a. asking whether the client smokes tobacco. b. assessing the average amount of caffeine the client drinks daily. c. asking if the client has been evaluated for diabetes recently. d. suggesting the client keep a record of the amount of fluids ingested daily. e. reviewing the client’s current medication list.

ANS: A, B, C, E

Risk factors for urinary incontinence include tobacco use, caffeine consumption, and increased urine resulting from diabetes and certain medications. Keeping record of fluid intake will have little or no impact on urine incontinence.

DIF: Cognitive Level: Applying REF: p. 202, Box 16-4 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse caring for a cognitively impaired older adult client shows an understanding of the

unique clinical symptoms of constipation in this population when: (Select all that apply.) a. checking documentation to determine if the client has had a bowel movement in the last 24-36 hours. b. questioning staff as to whether the client has any unexplained falls in the last few days. c. asking the client to name all of his or her children and grandchildren. d. requesting that the client’s temperature be taken now and again in 4 hours. e. reviewing the client’s food intake over the last 24-36 hours.

ANS: B, C, D, E

It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person. Frequency of defecation is not necessarily an indicator of constipation since it is such a personal characteristic.

DIF: Cognitive Level: Applying REF: pp. 212–213 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is caring for an older adult in a hospital who has an indwelling catheter. The nurse

assesses the patient based on the knowledge that which of the following are correct indications for an indwelling catheter? (Select all that apply.) a. To assist with incontinence management b. To manage acute urinary retention c. To assist in healing of open sacral or perineal wounds in incontinent patients d. To accurately measure urinary output in critically ill patients e. To prevent falls related to toileting in hospitalized older patients ANS: B, C, D

Indwelling urinary catheters are appropriate in the management of acute urinary retention, to assist in the healing of open sacral or perineal wounds in incontinent patients, and when accurate measurement of urinary output is essential in managing a critically ill patient.

Urinary catheters are not an appropriate intervention for the management of incontinence and do not prevent falls related to toileting in hospitalized patients.

DIF: Cognitive Level: Remembering REF: p. 209 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A 74-year-old woman who is in the hospital for rehabilitation following hip replacement has

been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient’s bladder function? (Select all that apply.) a. Assess the patient’s recent voiding pattern. b. Request an order for an indwelling catheter from the patient’s physician. c. Teach the patient how to meet hydration needs while still limiting fluid intake. d. Assist the patient to use the bathroom. e. Request an order for medication to decrease bladder spasms.

ANS: A, D

When a patient experiences new onset incontinence, the first step is assessment. Assisting the patient to the bathroom has many beneficial aspects to it and it provides a private setting where the patient is in the most normal physiological position to urinate. Placing an indwelling catheter is not a solution to urinary incontinence. Limiting fluids is not indicated in this patient. There is no indication that this patient is having bladder spasms.

DIF: Cognitive Level: Applying REF: pp. 203–204 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 17: Sleep Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A client who reported “a problem sleeping” shows an understanding of good sleep hygiene

by: a. b. c. d.

doing 10 pushups before bed to encourage a “pleasant tiredness.” seldom eating a bedtime snack. engaging in computer games as a pre-bed activity. limiting the afternoon nap to just 30 minutes.

ANS: D

Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while a bedtime snack is acceptable if the food is light and easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.

DIF: Cognitive Level: Applying REF: p. 223 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse is

confident that client education on the condition’s contributing factors has been effective when the client states: a. “A warm bath at night instead of in the morning is my new routine.” b. “Eating a banana at breakfast assures me the potassium I need.” c. “I’ve cut way back on my caffeinated coffee, teas, and sodas.” d. “I elevate my legs on a pillow so as to improve circulation.”

ANS: C

Increased caffeine use can be a contributing factor to RLS. There is no research to confirm that a warm bath prior to sleep or elevating the legs will minimize/prevent RLS. A potassium deficiency has not been identified as a contributing factor to RLS. DIF: Cognitive Level: Applying REF: pp. 228–229 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse in a long-term care facility notes that an older resident with Alzheimer’s disease

awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident’s sleep problems? a. Taking the resident outside in the garden for 45 minutes daily b. Limiting fluid intake for the resident c. Educating the resident on the association between Alzheimer’s Disease and insomnia d. Administering a mild sedative hypnotic at bedtime ANS: A

Behavioral strategies for persons with dementia include daily walks and exposure to light to enhance sleep. Limiting fluid intake may or may not be effective depending on whether or not the resident has nocturia. Educating the resident about the association between AD and insomnia may be feasible depending on the resident’s mental status but will not necessarily ameliorate the problem. Sedative hypnotics are not the first-line treatment for older adults with AD and sleep disturbances.

DIF: Cognitive Level: Applying REF: p. 224 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. An older patient asks a nurse, “I really have trouble sleeping and my doctor does not want to

prescribe a sleeping pill for me. He says they are not good for older people. I really don’t understand his response. Can you help me?” The best response by the nurse is: a. “Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep.” b. “Prescription sleeping medications have many adverse effects in older people.

Why don’t you try using an over-the-counter medication?” c. “Sleeping medications do not provide any improvement in sleep for older people.” d. “Sleep problems are common in older people. There really is nothing that you can do to help with that.”

ANS: A

Adverse effects of sleep medications, including over-the-counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep problems are common in older adults; however, there are many nonpharmacologic interventions that can be utilized to improve sleep.

DIF: Cognitive Level: Applying REF: p. 227, Box 17-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. An older adult’s diagnosis of sleep apnea is supported by nursing assessment and history data

that include: (Select all that apply.) a. followed a vegetarian diet for last 28 years. b. male gender. c. a smoking history of 1 pack a day for 45 years. d. 30 pounds over ideal weight. e. history of Crohn’s disease.

ANS: B, C, D

Rest factors for sleep apnea include being male, a smoking habit, and excess weight. There is no current research to support a connection between a vegetarian diet (possible low protein) or Crohn’s disease to the development of sleep apnea.

DIF: Cognitive Level: Applying REF: p. 227, Box 17-14 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

2. An older patient asks a nurse, “It seems like all of my friends and I have difficulty sleeping. Is

it common among older people?” The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.) a. total sleep time and sleep efficiency are reduced. b. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed. c. sleep requirements for older adults are less than that of younger adults. d. daytime napping is common. e. sleep tends to be deeper in older adults than in younger adults.

ANS: A, B, D

Normal age-related changes in older adults include a reduced total sleep time and sleep efficiency and shorter, less intense, and more evenly distributed REM sleep. Older adults tend to nap during the daytime. Sleep requirements do not decrease as one ages. Sleep tends to be objectively and subjectively lighter in older adults.

DIF: Cognitive Level: Remembering REF: p. 223, Box 17-4 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets

into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (Select all that apply.) a. Go to bed only when sleepy. b. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities. c. Engage in moderate exercise to induce fatigue. d. Do not watch television or work in bed. e. If unable to sleep, engage in enjoyable activities on the computer.

ANS: A, B, D

Some interventions to improve sleep include going to bed only when sleepy, matching the number of hours in bed to the actual hours of sleep, and reserving the bed for sleep and sex only. Engaging in exercise immediately before sleep will not assist the person in falling asleep, and use of the computer is also discouraged as it can disturb sleep.

DIF: Cognitive Level: Applying REF: p. 225 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. An older patient is diagnosed with RLS. Which of the following nonpharmacologic

interventions should the nurse include in the plan of care? (Select all that apply.) a. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities. b. Avoid caffeine, alcohol, and tobacco. c. Avoid hot baths. d. Relaxation techniques may be helpful. e. A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful.

ANS: A, B, D

Nonpharmacologic therapy includes stretching the lower extremities, mild to moderate physical activity, hot baths, massage, acupressure, relaxation techniques, and avoidance of caffeine, alcohol, and tobacco. The use of diphenhydramine (Benadryl) as a sleeping medication for older adults is not appropriate. There is also no evidence that it will decrease RLS. DIF: Cognitive Level: Applying REF: p. 225 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A long term care facility has selected sleep promotion as its quality improvement project.

Which of the following interventions would be appropriate to implement on this unit? (Select all that apply.) a. Ensuring that all residents receive evening care and are in bed by 8:00 PM b. Taking as many residents as possible outside for 30 minutes daily c. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM d. Avoiding waking residents for routine care during the night e. Limiting caffeine and fluids before bedtime ANS: B, C, D, E

Strategies to promote sleep for individuals in long term care and hospitals include allowing the resident to stay out of the bed and the room for as long as possible before bed, and not placing him/her in bed too early. Exposing individuals to sunlight for 30 minutes daily in a comfortable outdoor location is also helpful in promoting sleep. Limiting fluids and caffeine before bedtime is also helpful. Changing institutional routines to avoid waking residents for routine care and providing care when residents wake up are also successful strategies to promote sleep.

DIF: Cognitive Level: Applying REF: p. 226, Box 17-11 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 18: Physical Activity and Exercise Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A 75-year-old female asks a nurse “I know I should be moving, but how much is the right

amount of exercise for me?” The best response of the nurse is: a. “You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week.” b. “You need to engage in at least 30 minutes of moderate intensity exercise every day of the week.” c. “Since you are 75, the recommendations are 30 minutes of moderate exercise three times a week.” d. “There are no specific recommendations for someone of your age; just keep moving.”

ANS: A

Recommendations for all adults are participation in 30 minutes of moderate intensity physical activity for 5 or more days per week.

DIF: Cognitive Level: Remembering REF: p. 234 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A nurse is discussing the importance of exercise with a 78-year-old female who states: “I

know I should be exercising, but I have arthritis in my knees and it is painful. Can you recommend a type of exercise that would be beneficial and cause me less pain?” Which of the following exercises should the nurse recommend? a. Tennis b. Swimming c. Dancing d. Use of a treadmill and elliptical machine in the gym ANS: B

The high prevalence of joint diseases, such as osteoarthritis, may hamper successful performance of aerobic exercises that cause joint impact. Tennis, dancing, and use of a treadmill and elliptical machine in the gym may all cause joint impact. Swimming is a low-risk activity that provides aerobic benefit, and water-based exercises are particularly beneficial for individuals with arthritis or other mobility limitations.

DIF: Cognitive Level: Remembering REF: p. 236 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse at a senior center promotes activity by leading exercise programs. Which of the

following is a benefit of such exercise? a. Improvement of mood b. Cardiovascular stress c. Painful and stiff joints d. Depression

ANS: A

Physical activity has many benefits including improvement of mood. Physical activity improves cardiovascular health, decreases depression, and helps decrease pain and increase flexibility in the joints.

DIF: Cognitive Level: Remembering REF: p. 234 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is using the function-focused care approach to care for a hospitalized older adult. The

nurse is assisting the patient to transfer from the bed to a chair. Which of the following statements by the nurse is most congruent with this approach to care? a. “Place your hands across your chest and let us move you to the edge of the bed.” b. “Place both of your hands on the overbed trapeze and pull yourself up to a sitting position.” c. “How do you get yourself out of bed when you are at home? Why can’t you do the same thing here?” d. “It is taking you a long time to get yourself into a sitting position. Let me help you sit up.”

ANS: B

FFC is based on a philosophy of care where the nurse acknowledges the older adult’s physical and cognitive abilities and encourages the individual to function at the highest level possible.

Option B is correct because the nurse is giving step-by-step directions and allowing the patient to move independently. Option A is incorrect because the nurse is moving the patient instead of allowing the patient to move himself/herself. Option C is incorrect because although it does solicit important information from the patient, it is making the assumption that the hospital setting is the same as the home setting. The response also has a negative tone to it. Option D is incorrect because it is not allowing the patient to use as much time as needed in order to be independent.

DIF: Cognitive Level: Analyzing REF: p. 241 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. A nurse is working with an older individual who has recently started an exercise program. The

individual tells the nurse, “This exercise thing is really hard, and I absolutely hate walking on a treadmill going nowhere. I think I am going to call it quits.” Which of the following responses by the nurse will be most effective in encouraging the individual to remain in the program? a. “If you stop exercising, you will reverse all the good effects that the exercise accomplished.” b. “I will have to report that to your physician.” c. “What types of exercise do you enjoy doing?” d. “Most older people hate exercising, but they do it anyways.”

ANS: C

Providing choices, as well as making exercise fun and entertaining, is a strategy to sustain participation in an exercise program. Options A, B, and D do not address the patient’s issue of not liking a particular type of exercise.

DIF: Cognitive Level: Applying REF: p. 239 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse caring for an older hospitalized woman is concerned about promoting functional

status. Which of the following interventions should the nurse include in this patient’s plan of care? (Select all that apply.) a. Conduct a baseline functional status assessment of the patient b. Request a physical therapy referral c. Make sure that the patient has all activities of daily living performed for her d. Progressive mobility interventions e. Encouraging the patient to feed herself ANS: A, B, D, E

A baseline assessment of functional ability is important and can assist in setting appropriate goals for the hospitalized individual. Physical therapy is important in developing an individualized plan of exercises and functional mobility program. Progressive mobility interventions range from passive range of motion to safe transfers and ambulation and are important in maintaining function. Encouraging self-care activities rather than “doing for” is also important.

DIF: Cognitive Level: Remembering REF: p. 236 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. A nurse is educating a group of older adults on the benefits of an exercise program. The nurse

includes education on when not to exercise. Which of the following should the nurse include in the education? (Select all that apply.) a. Do not exercise if your resting heart rate is over 80 b. Do not exercise if your blood pressure is greater than 200 systolic and 100 diastolic c. It is important to wait 30 minutes after a big meal before engaging in vigorous exercise d. Do not exercise if a joint that you are using to exercise is red, warm, and painful e. Do not exercise if you have a fever and muscle aches ANS: B, D, E

Older adults are advised to avoid exercise if their resting heart rate is over 120, not 80. It is important to wait 2 hours after a heavy meal before engaging in vigorous exercise, but leisurely exercise such as a walk is fine.

DIF: Cognitive Level: Remembering REF: p. 240, Box 18-7 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. An older adult who has a balance disorder and has sustained repeated falls is recommended to

start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga

b. c. d. e.

Tai Chi Swimming Pilates Weight lifting

ANS: A, B

Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling. Swimming, Pilates, and weight lifting do not do this.

DIF: Cognitive Level: Remembering REF: pp. 235–236 | p. 237 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 19: Falls and Fall Risk Reduction Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Which attempt by the family to prevent an older, frail adult from falling causes the home

health nurse concern? a. Keeping several low wattage night-lights on in the evening b. Installing wooden railings on the stairway to the bathroom c. Keeping the side rails up on the client’s bed at night d. Encouraging the client to use a cane when ambulating ANS: C

Keeping side rails up have proven to be a risk factor for falls rather than a positive intervention. The remaining interventions are appropriate and generally effective.

DIF: Cognitive Level: Applying REF: p. 248 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 2. An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a

history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for Falls. A priority nursing intervention for this client is to: a. perform a fall assessment. b. keep all of the side rails up on the client’s bed at nighttime. c. place the client on bed rest so that she does not fall. d. assess the client’s dietary intake for calcium adequacy.

ANS: A

Completing a fall assessment will enable the nurse to identify and correct the risk factors for this patient. Side rails have not been found to be effective in keeping a client in bed and may actually lead to injury. Maintaining a patient on bed rest can lead to deconditioning and actually contribute to falls. Assessing the client’s dietary intake of calcium is a good intervention for this age group, but it is not a priority and will not prevent falls.

DIF: Cognitive Level: Applying REF: pp. 257–258 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 3. A nurse is assessing an older adult’s risk for falls. One of the questions that she asks is

whether the older adult has fallen in the past year. She asks this because individuals who have fallen: a. have a higher risk of falling again than persons who did not fall in the past year. b. are more likely to sustain injuries if they fall again than persons who did not fall in the past year. c. have most likely developed a fear of falling as compared to persons who did not fall in the past year. d. are most likely to have a balance disorder as compared to persons who did not fall

in the past year.

ANS: A

A history of falls is an important risk factor and individuals who have fallen have three times the risk of falling again than persons who did not fall in the past year. There is no evidence to support the other three options.

DIF: Cognitive Level: Remembering REF: p. 248 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 4. A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall

prevention and demonstrates the use of the call bell to the patient. The patient’s daughter asks: “Why don’t you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?” The best response by the nurse is: a. “Side rails have only proven to be effective in decreasing falls in patients who have already fallen.” b. “There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury.” c. “Side rails are only effective when used with patients who have dementia.” d. “Side rails do not decrease falls, but they do decrease fall-related injuries.”

ANS: B

There is no evidence to date that side rail use decreases the risk or rate of fall occurrence.

There are numerous reports and studies documenting the negative effects of side rail use, including entrapment deaths and injuries that occur when the person slips through the side rail bars or between split side rails, the side rail and the mattress, or between the head or footboard, side rail, the mattress, or between the head or footboard, side rail, and mattress.

DIF: Cognitive Level: Applying REF: p. 258 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 5. A nurse in a long-term care facility notes that there has been an increase in falls on one unit

and that many of the falls are occurring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that: a. postural changes in blood pressure are common in older adults and frequently occur around mealtimes. b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. c. residents of long term care facilities are often on many different medications, which are given at mealtimes. d. it is common practice to take long term care residents to the bathroom immediately following meals.

ANS: B

Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. Modifications such as increased water intake before eating or substituting six smaller meals daily for three larger meals may be effective.

Orthostatic hypotension is a cause of falls in older adults, but does not just occur around meal times. While it is true that residents of long term care facilities are on multiple medications and are usually toileted following meals, neither of these options addresses postprandial hypotension.

DIF: Cognitive Level: Analyzing REF: p. 251 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control MULTIPLE RESPONSE 1. Which assessment finding is a contributor to an older client’s risk for falls? (Select all that

apply.) a. Client is awaiting cataract surgery on right eye. b. Client’s type 2 diabetes is poorly controlled with diet and exercise alone. c. Client reports a fall in the last year. d. Client has a history of contact dermatitis and psoriasis. e. Client attends Tai Chi classes at the senior center.

ANS: A, B, C

The correct options are those that affect the client’s vision, presence of factors affecting sensations in the legs and feet, and a history of falls. There is no research to connect the risk of falls with either of the skin conditions mentioned. Tai Chi improves balance, which decreases risk of falls.

DIF: Cognitive Level: Applying REF: p. 253 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 2. A home health nurse is making a home visit to an older patient. A nurse conducts a home

safety assessment and screens the environment for potential hazards for falls. Which of the following are hazards in the home? (Select all that apply.) a. The absence of railings on the stairway b. Night-lights in all rooms c. Clutter throughout the home d. A small throw rug outside of the shower stall e. Grab bars in bathroom beside toilet ANS: A, C, D

The absence of railings on stairway, clutter, and throw rugs can all contribute to falls in the home. Night-lights are recommended to prevent falls as are grab bars positioned beside the toilet in the bathroom.

DIF: Cognitive Level: Applying REF: p. 248, Box 19-7 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control

3. A group of older women in an assisted living facility are talking about one of the residents

who fell and fractured her hip. The women ask a nurse the following: “It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?” In formulating a response, the nurse considers which of the following? (Select all that apply.) a. Hip fractures are a leading cause of hospitalization for older people. b. The major cause of hip fractures is falls. c. Women have significantly higher mortality rates from hip fractures than do men. d. Nearly all older patients who sustain a hip fracture will regain prefracture mobility status within 1 year. e. Hip fractures are associated with very high morbidity and mortality.

ANS: A, B, E

Hip fracture is the second leading cause of hospitalization for older people. More than 95% of hip fractures among older adults are caused by falls. Older adults who fracture a hip have a five to eight times increased risk of mortality during the first 3 months after hip fracture. This excess mortality persists for 10 years after the fracture and is higher in men. Only 50-60% of patients with hip fractures will recover their prefracture ambulation abilities in the first year postfracture. Most research on hip fractures has been conducted with older women.

DIF: Cognitive Level: Remembering REF: p. 245, Box 19-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 4. A homecare nurse visits a client in the home to conduct a fall risk assessment. The nurse

assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (Select all that apply.) a. The client has an unsteady gait. b. The client uses a cane, but the cane is not the appropriate size for the client. c. The client’s home is cluttered. d. The client is on two different medications that cause orthostatic hypotension. e. There are no grab bars in the client’s bathroom.

ANS: B, C, E

Extrinsic risk factors are external to the patient and related to the physical environment and include inadequate support devices. Options B, C, and E are extrinsic risk factors. Intrinsic risk factors are unique to each patient. Options A and D are intrinsic risk factors.

DIF: Cognitive Level: Applying REF: p. 248 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 5. A home health nurse is making a home visit to an older patient. A nurse conducts a home

safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the patient eliminate which of the following? (Select all that apply.) a. Night-lights b. Railings on the stairway c. Loose carpeting on the floors d. The use of a cane e. Excess clutter ANS: C, E

Extrinsic risk factors are external to the patient and related to the physical environment and include lack of support equipment by bathtubs and toilets, height of beds, condition of floors, poor lighting, inappropriate footwear, and improper use of or inadequate assistive devices.

Nightlights, railings on the stairway, and the use of a cane are all measures that can ameliorate some extrinsic risk factors.

DIF: Cognitive Level: Applying REF: p. 248 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control

Chapter 20: Safety and Security Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The nurse is preparing educational material concerning fire safety in the home. What research

data will be included in the material? a. Most fires occur during the daytime hours. b. Fire mortality is highest in adults older than 80 years of age. c. Most people who die in fires are killed by the flames. d. Most fires occur outside the home.

ANS: B

Fire-related mortality is three times higher in individuals over age 80. Most deaths in fires are caused by smoke injuries. Most fires occur within the home, and most fires occur at night.

DIF: Cognitive Level: Applying REF: p. 266 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 2. The nurse is recommending that a client diagnosed with moderate stage Alzheimer’s disease

attend a support group when he becomes defensive about not driving his automobile and the effects it will have on “being stuck at home.” Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization thus minimizing the effects of social isolation b. Helps with minimizing the loss as a factor in causing depression c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client ANS: B

Participants attending the driving cessation support groups had an improvement in depression scores, were less angry, and were happier. Support groups designed specifically to deal with loss of driving privileges among individuals with dementia may be important in alleviating depressive symptoms and other negative outcomes associated with cessation of driving. The remaining options represent possible outcomes but they do not have the priority that minimizing depression has for this client.

DIF: Cognitive Level: Analyzing REF: pp. 271–272 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 3. A 79-year-old client resides independently in the community. The visiting home health nurse

finds that despite it being 90 degrees Fahrenheit outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to: a. cognitive changes that diminish the individual’s awareness of temperature changes. b. age-related neurosensory changes that diminish awareness of temperature changes. c. a delirium-related acute illness that is affecting body heat production. d. age-related motor deficiencies that result in self-neglect.

ANS: B

Neurosensory changes related to aging tend to delay or diminish the individual’s awareness of temperature changes and may impair behavior or thermoregulatory responses to dangerously high or low temperatures. There is no evidence in this scenario that the client has cognitive changes, an acute illness, or is incapable of self-care, and such assumptions should not be routinely made based on age alone.

DIF: Cognitive Level: Applying REF: p. 266 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 4. A homecare nurse in an area of the country that is prone to tornadoes routinely discusses

disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment that provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses due to a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.

ANS: A

Older adults are less likely to seek assistance than younger adults in times of disaster. The remaining options are not generally proven to be true for the majority of older adults.

DIF: Cognitive Level: Applying REF: p. 269 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 5. A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement

Community (NORC). The nurse understands that NORCs are: a. purpose-built senior housing communities. b. neighborhoods or buildings where a large segment of the residents are older adults. c. communities where volunteers coordinate access to services for older adults. d. intentional collaborative housing where residents participate in the design and operation of the neighborhood.

ANS: B

NORCs are neighborhoods or buildings where a large number of the residents are older adults.

They were not purposely built as senior housing. The residents in a NORC aged in place. The village model is where volunteers coordinate access to affordable care for seniors. Cohousing is an intentional collaborative model where residents participate in the design and operation of the neighborhood.

DIF: Cognitive Level: Remembering REF: p. 275 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

1. What information should be included in an informational program to be presented on burn

prevention to a senior citizens group? (Select all that apply.) a. Do not smoke in bed or when sleepy b. Wear well-fitted clothing when cooking or when grilling outdoors c. Establish a meeting place for all family members outside of the home in case of a fire d. Establish a plan for exiting each room of your home in the case of a fire e. Have a fire extinguisher readily available in the kitchen ANS: A, B, E

Measures to prevent burns include not smoking in bed or when sleepy, not wearing loose-fitting clothing (e.g., bathrobes, nightgowns, pajamas) when cooking or around an open heat source, and installing a portable hand fire extinguisher in the kitchen. The remaining options are related to safely evacuating a home in case of a fire.

DIF: Cognitive Level: Applying REF: p. 266 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 2. Which precaution would be beneficial in minimizing an older adult’s risk of being a victim of

fraud? (Select all that apply.) a. Do not allow uninvited salespersons into your home. b. Never provide personal information to telephone sales solicitors. c. Rely on the advice of people who only friends have recommended. d. Contact the local Medicare or Medicaid service office for information when needed. e. Keep your bank account and credit card numbers with you at all times.

ANS: A, B, D

The correct options provide sound advice, but relying on friends alone for advice may not be prudent while personal information should be kept in a safe place, not necessarily on your person.

DIF: Cognitive Level: Applying REF: p. 265 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Safety and Infection Control 3. The benefits of telehealth include that it: (Select all that apply.) a. promotes self-management of illness in rural and underserved areas. b. facilitates remote physical assessment and monitoring of chronic conditions. c. decreases costs by replacing the role of the nurse with technology. d. decreases costs by reducing hospital readmissions. e. is reimbursed by all health care insurances.

ANS: A, B, D

Telehealth promotes self-management of illness and facilitates remote assessment and monitoring in rural and underserved areas. Evidence has demonstrated that it reduces costs by decreasing hospital readmission. Telehealth does not replace the role of the nurse; the technology augments the ability of the nurse to reach clients in remote areas. Unfortunately, not all health care insurers reimburse for telehealth services.

DIF: Cognitive Level: Remembering REF: p. 273 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. A nurse is caring for a frail older adult in a long-term care facility and is concerned about

preventing hypothermia. Which of the following interventions should the nurse implement?

(Select all that apply.) a. Make sure that the temperature in the resident’s room is at least 65 degrees Fahrenheit. b. Cover residents well when in bed and while bathing. c. Provide a head covering for the resident. d. Maintain resident in bed covered with heavy blankets at all times. e. Provide hot, high-protein meals and bedtime snacks.

ANS: A, B, C, E

Interventions to prevent hypothermia in frail elders include maintaining an ambient temperature of no lower than 65 degrees Fahrenheit, providing a head covering whenever possible—in bed, out of bed, and particularly out-of-doors, covering patients well when in bed and when bathing, and providing hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. In addition, it is important to get the patient out of bed and provide as much exercise as possible to generate heat from muscle activity.

DIF: Cognitive Level: Remembering REF: pp. 268–269, Box 20-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. The daughter of an older patient says to a nurse, “I am so concerned that my dad is still

driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?” The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.) a. Report the person to the division of motor vehicles for license suspension. b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. c. Arrange for alternate transportation for the person. d. Confiscate the keys to the car. e. Ask the patient’s physician to write a prescription for the person to stop driving.

ANS: B, C

Options B and C are examples of the involved type of action strategies for driving cessation.

Options A, D, and E are all examples of the imposed type of action strategies for driving cessation.

DIF: Cognitive Level: Analyzing REF: pp. 271–272 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 21: Living Well with Chronic Illness Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A nurse is caring for an older adult who is in the pre-trajectory phase of the Chronic Illness

Trajectory. The nurse knows that this phase is characterized by which of the following: The absence of signs or symptoms of the illness Diagnostic testing being conducted A progressive decline in physical and or mental status A period of temporary remission from the crisis

a. b. c. d.

ANS: A

The pre-trajectory phase is characterized by the absence of signs or symptoms of the illness.

The trajectory onset includes the diagnostic period. The downward phase is characterized by a progressive decline in physical/mental status, characterized by increasing disability/symptoms.

The comeback phase is characterized as a period of temporary remission from the crisis.

DIF: Cognitive Level: Remembering REF: p. 280, Table 21-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A major difference in the diagnosis of chronic disease between younger adults and older

adults is that: a. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems. b. chronic disease is often diagnosed earlier in older adults since they are more likely to seek medical care. c. chronic disease is usually not identified in older adults because of the many age-related changes. d. chronic illness is uncommon in younger adults.

ANS: A

In a younger adult, the early signs of a pending chronic disease may be identified early enough to prevent later problems (e.g., a finding of an elevated cholesterol level). In older adults, a chronic disease may not be diagnosed until some amount of “end organ damage” has already occurred. For example, diabetic retinopathy may be found during an annual eye examination indicating that the diabetes has been present for some time. Although there are many age-related changes in the older adult, it is still possible to identify chronic illness.

Chronic illness is common in younger adults, although it is more common in older adults.

DIF: Cognitive Level: Applying REF: p. 278 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. An older man who is a smoker is hospitalized for orthopedic surgery. A nurse takes the

opportunity to provide smoking cessation education. The patient asks the nurse: “I have been smoking for most of my life, and I am an old man. Why are you wasting your time telling me to stop smoking? Isn’t it too late?” The nurse bases the response on the knowledge that: a. smoking cessation as late as age 75 can reduce premature death by up to 50%.

b. smoking cessation as late as age 75 can completely eliminate premature death. c. smoking cessation at a late age will not impact the smoker but can reduce exposure

of family members to second-hand smoke. d. smoking cessation education is only effective in individuals under age 75.

ANS: A

Smoking cessation as late as age 75 can reduce premature death by up to 50%. The remaining options are not true.

DIF: Cognitive Level: Remembering REF: p. 279 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE 1. A nurse cares for an older adult who is described as being “frail.” The nurse understands that

in order to be characterized as frail an individual must possess which of the following characteristics? (Select all that apply.) a. Slow walking speed b. Low activity level c. Self-reported exhaustion d. Taking at least five prescribed medications e. A diagnosis of at least two chronic conditions ANS: A, B, C

Frailty is defined as evidence of three of the following: unexplained weight loss, self-reported exhaustion, weak grip strength, slow walking speed, and low activity.

Neither the number of medications that an individual is prescribed nor the number of chronic conditions is part of the diagnosis of frailty.

DIF: Cognitive Level: Remembering REF: p. 281, Box 21-3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A nurse is planning health education on chronic illnesses for a group of seniors in the

community. When deciding upon which illnesses to focus upon, the nurse knows that which of the following are the most common diseases in the United States? (Select all that apply.) a. Heart disease b. Hypertension c. Asthma d. Osteoarthritis e. Diabetes ANS: A, B, D

The most common chronic diseases in the United States are heart disease, hypertension, and osteoarthritis.

DIF: Cognitive Level: Remembering REF: p. 278 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

3. The role of a nurse caring for an older patient who is in the stable phase of a chronic illness

may include which of the following? (Select all that apply.) a. Coordinating care with members of the interdisciplinary team b. Administering medications to the patient c. Providing assistance with bathing and dressing d. Ensuring that the patient’s immunizations are up to date e. Providing emergency care ANS: A, B, C

Options A, B, and C are all roles of the nurse in the stable phase of chronic illness. Option d is a role of the nurse in the preventive phase of chronic illness. Option E is a role of the nurse in the acute phase of chronic illness.

DIF: Cognitive Level: Remembering REF: p. 280 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. A nurse is teaching a group of older adults about healthy aging. The nurse discusses global

lifestyle risk factors for chronic disease. The nurse includes which of the following in the education? (Select all that apply.) a. Smoking cessation and avoidance of tobacco b. Maintenance of high levels of physical activity c. Importance of eating a balanced diet d. Development of advance directives e. Maintenance of blood pressure readings at a level of 120/80 or lower ANS: A, B, C

Major global lifestyle risk factors for the development of chronic disease include tobacco use, unhealthy diet, physical inactivity, and alcohol abuse. Development of advance directives and maintenance of healthy blood pressure readings are important, however, are not global lifestyle risk factors for chronic disease.

DIF: Cognitive Level: Applying REF: p. 279, Box 21-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 22: Cardiovascular and Cerebrovascular Health and Illness Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A nurse is auscultating an older patient’s heart and notes a systolic murmur (heard between

the S1 and S2 heart sounds. The first action by the nurse is to: a. question the patient about the presence of the murmur. b. note it in the chart as this is always a normal finding for an older adult. c. contact the medical provider as this is an abnormal finding. d. immediately implement emergency interventions.

ANS: A

In normal aging, the heart valves separating the chambers thicken and stiffen as a result of lipid deposits and collagen cross-linking. Mild systolic murmurs (between S1 and S2) are expected findings in the older adult. Aortic and mitral valves are those most commonly affected. If the nurse auscultates a systolic murmur in an asymptomatic older adult, he or she should ask about it. Most older adults will reply that they have had it for a while. If this is not the case, the person is referred to a cardiologist. If the new finding is accompanied by any significant signs or symptoms of distress, it is a medical emergency. Diastolic murmurs (heard between S2 and S1) are always indicative of a serious problem in cardiac hemodynamics and these persons are followed closely by a cardiologist.

DIF: Cognitive Level: Understanding REF: pp. 283–284 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A nurse measures an older adult’s blood pressure on the right arm and notes a reading of

150/100. The nurse waits 5 minutes and measures the blood pressure again in the right arm and obtains a reading of 152/100. What is the next action by the nurse? a. Immediately contact the medical provider. b. Measure the blood pressure in the left arm. c. Measure the blood pressure in sitting and standing positions. d. Document the findings in the medical record; elevated blood pressures are normal in older adults.

ANS: B

When an abnormal blood pressure reading is obtained, it is necessary to do two measurements, five minutes apart, confirmed in the contralateral arm. Doing orthostatic measurements is not indicated in this situation. A blood pressure reading above 140/90 is considered abnormal for an older adult.

DIF: Cognitive Level: Understanding REF: p. 285 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. A nurse is caring for an older hospitalized patient who recently suffered a myocardial

infarction (MI). The patient asks the nurse, “I didn’t even know that I had a heart attack. I did not have crushing chest pain like you see on television. Why didn’t I?” The best response by the nurse is:

a. “Older patients do not feel pain in the same way that younger patients do.” b. “Oh, that is just television. Hardly anyone has crushing chest pain when he has a

heart attack.” c. “Older people often do not have the typical signs and symptoms when they have a

heart attack.” d. “Older people never have chest pain when they have a heart attack.”

ANS: C

Symptoms of an MI can be completely atypical in an older person, such as an unexplained fall, acute change in mental status, or extreme fatigue or dyspnea. Some older patients, however, do have the typical signs and symptoms. It is not true that older people do not feel pain.

DIF: Cognitive Level: Applying REF: p. 287 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. An older adult who was diagnosed with atrial fibrillation asks a nurse, “I feel fine. I have no

symptoms at all with this heart problem, yet I am now on a blood thinner medication, which I understand can by very dangerous. Is this really necessary?” The nurse formulates a response based on the understanding that: a. Atrial fibrillation, while initially asymptomatic, will progress and become symptomatic. b. the risk of stroke is very high for a person with atrial fibrillation. c. untreated atrial fibrillation will likely cause a heart attack. d. atrial fibrillation can cause coronary heart disease.

ANS: B

The most serious complication of atrial fibrillation is stroke. Symptoms of atrial fibrillation, if they occur, are usually vague and do not worsen. While untreated atrial fibrillation can cause tachycardia as a compensatory mechanism, which can lead to myocardial ischemia, a heart attack from atrial fibrillation is not a common occurrence. Coronary heart disease can cause atrial fibrillation, not the reverse.

DIF: Cognitive Level: Applying REF: p. 288 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. An older person has sudden onset of a severe headache, left-sided facial drooping, and left

arm numbness. The person’s daughter calls 911 and the person is transported to the emergency department. The first diagnostic test that will likely be performed is a(n): a. electrocardiogram (ECG) to assess for atrial fibrillation b. computed axial tomography (CAT) scan to differentiate hemorrhagic from ischemic stroke. c. international normalized ratio to determine level of anticoagulation. d. lumbar puncture to assess for infection.

ANS: B

The first diagnostic test that will be done is a CAT scan to differentiate hemorrhagic from ischemic stroke. If it is an ischemic stroke, tissue plasminogen activator (tPA) can be administered to dissolve the clot but must be done within 3 hours. Depending on the patient’s presentation, all of the other diagnostic tests may also be done following the CAT scan.

DIF: Cognitive Level: Understanding REF: pp. 292–294 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 6. A nurse assesses the lower extremities of an older adult and notes a small ulcer between the

person’s great toe and second toe. The ulcer has well-defined edges and there is no bleeding; however, there is a small amount of necrotic tissue present. This wound is most likely a(n): a. venous ulcer. b. arterial ulcer. c. pressure ulcer d. surgical wound.

ANS: B

Arterial ulcers are often located between the toes. They usually present with well-defined edges, do not bleed, and have necrotic tissue. These features are not found in venous ulcers.

Pressure ulcers develop from unrelieved pressure. There is no indication in the description that there is unrelieved pressure. There is no mention of surgery in the scenario above.

DIF: Cognitive Level: Understanding REF: p. 291, Table 22-5 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE 1. A nurse is educating a group of older adults on the impact of lifestyle changes on

hypertension. The nurse includes which of the following in the education? (Select all that apply.) a. Learning how to read and interpret food labels b. The sodium content of commonly consumed foods c. Techniques to incorporate more physical activity into the daily routine d. The actions of calcium channel blocker medications on hypertension e. The importance of adhering to pharmacological regimens for treatment of hypertension ANS: A, B, C

Options A and B address dietary interventions to control hypertension. Option C addresses physical activity. These all involve lifestyle changes to control hypertension. Options D and E are related to pharmacological treatment of hypertension.

DIF: Cognitive Level: Applying REF: p. 286 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A homecare nurse visits an older female adult at home who has peripheral vascular disease to

monitor her status. The nurse determines that the client needs additional teaching when the client states which of the following? (Select all that apply.) a. “I need to try and elevate my legs above the level of my heart every time I sit down and all night.” b. “I really need to try and avoid sitting in one position for a long period of time.” c. “I know that I need to wear these compression stockings 24 hours a day.” d. “I will wash my feet and legs with strong antibacterial soap twice daily.”

e. “I need to examine my feet daily for any cuts, sores, or openings.”

ANS: C, D

Compression stockings are worn all day but need to be removed at bedtime. It is important to wash the feet and legs with mild soap and water frequently.

DIF: Cognitive Level: Applying REF: p. 296, Table 22-6 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. An older client is diagnosed with venous insufficiency of the lower extremities. The nurse

expects the client to display which of the following signs and symptoms? (Select all that apply.) a. Thin, shiny dry skin b. Reddish brown discoloration of the skin of the legs c. Pain when the legs are elevated d. Varicose veins e. Legs are cool to touch ANS: B, D

A reddish brown discoloration of the lower extremities and varicose veins are present with venous insufficiency. The other signs and symptoms are all associated with arterial insufficiency.

DIF: Cognitive Level: Remembering REF: p. 291, Table 22-5 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. An older patient with atrial fibrillation is prescribed warfarin for anticoagulation. Which of

the following should the nurse include in the teaching plan? (Select all that apply.) a. Frequent blood testing is required to assure that the level of anticoagulation is in the correct range. b. Limit dietary intake of vitamin K. c. Increase dietary intake of vitamin D and calcium. d. Inform the medical provider if any antibiotics are ordered from any other provider. e. Seek medical attention immediately if an injury is sustained.

ANS: A, B, D, E

Frequent blood testing is required to check the level of anticoagulation. Vitamin K is an antidote to warfarin, so the patient must limit intake of vitamin K. Warfarin interacts with most antibiotics. Since warfarin is an anticoagulant, the patient needs to seek medical attention if an injury is sustained due to risk of bleeding. Vitamin D and calcium are unrelated to warfarin.

DIF: Cognitive Level: Understanding REF: p. 288 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 23: Neurodegenerative Disorders Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The greatest risk for injury for a client with progressed Parkinson’s disease is: a. falls. b. suicide. c. bleeding ulcers. d. respiratory arrest.

ANS: A

If the client becomes off-balance, self-correction is very slow, so falls are common. While the client is monitored for depression, suicide is not a common risk for injury. Bleeding ulcers and respiratory arrest are not generally recognized as caused by this disease.

DIF: Cognitive Level: Applying REF: p. 302 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. An older adult with suspected Parkinson’s Disease has a “challenge test” performed in order

to confirm the diagnosis. The nurse understands that a “challenge test” will demonstrate which of the following? a. Immediate reversal of all symptoms of Parkinson’s Disease after administration of levodopa b. Dramatic improvement of symptoms of Parkinson’s Disease after administration of levodopa c. Dramatic improvement in gait only after administration of levodopa d. Dramatic improvement in tremor only after administration of levodopa ANS: B

A diagnosis of Parkinson’s disease is confirmed by a “challenge test” when symptoms improve dramatically after the administration of the medication levodopa.

DIF: Cognitive Level: Understanding REF: p. 301 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. A nurse is caring for an older adult with Parkinson’s Disease. The patient is receiving the

medication levodopa-carbidopa. The nurse understands that in order to maximize effectiveness, the administration schedule for this medication should adhere to which of the following? a. Administer with meals only b. Administer first thing in the morning only c. Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal d. Administer with a full 8 ounces of water and have the patient sit upright for thirty minutes after ANS: C

To maximize effectiveness, levodopa-carbidopa must be taken on an empty stomach (30-60 minutes before or 45-60 minutes after a meal).

DIF: Cognitive Level: Understanding REF: p. 302 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. While the older African American is at the highest risk for developing Alzheimer’s disease,

the nurse demonstrates an understanding of this disease process’s risk factors when assessing this population’s: a. weight and elimination patterns. b. heart rate and capillary refill status. c. blood pressure and serum lipid levels. d. muscle strength and reflex times.

ANS: C

Researchers found distinct ethnic and racial differences among persons with AD. They may have identified a gene placing African Americans at about twice the risk for developing AD than their white American counterparts. It is possible that additional risk factors are a part of this, specifically, a higher rate of cardiovascular disease. There is no current research to support a relationship between the other options and the development of AD. DIF: Cognitive Level: Understanding REF: pp. 302–303 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE 1. An older adult is diagnosed with Alzheimer’s Disease. The nurse knows that this diagnosis is

made on the presence of which of the following? (Select all that apply.) a. A decline from a previous level of functioning b. Fluctuation of symptoms over the course of a 24-hour period c. An insidious onset d. A gradual decline in cognitive abilities e. The cognitive changes worsen in the evening hours ANS: A, C, D

A diagnosis of a NCD due to AD requires (1) a decline from a previous level of functioning, (2) an insidious onset, and (3) a gradual decline in cognitive abilities. It is important to note that the changes are “greater than expected for the person’s age and educational background” and these changes can be documented with standardized neuropsychological testing. Options B and D are indicative of delirium.

DIF: Cognitive Level: Understanding REF: p. 303 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A diagnosis of Parkinson’s disease is made based on the presence of which of the following

symptoms? (Select all that apply.) a. Rigidity b. Resting tremor

c. Bradykinesia d. Orthostatic hypotension e. Progressive decline in cognitive function ANS: A, B, C

A diagnosis of Parkinson’s Disease is made based on the presence of the following symptoms: resting tremor, rigidity, bradykinesia, asymmetric onset, as well as a positive response to levodopa. Neither orthostatic hypotension nor progressive decline in cognitive function is one of the diagnostic criteria for PD. DIF: Cognitive Level: Understanding REF: p. 302, Box 23-7 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. An older patient is concerned that her neighbor was recently diagnosed with Alzheimer’s

Disease and asks a nurse what can be done to decrease the risk of Alzheimer’s Disease. The nurse includes which of the following in the response to the patient? (Select all that apply.) a. Maintain blood pressure within normal limits b. Smoking cessation c. Maintain control of blood sugar (hemoglobin A 1C ≤7) d. Eliminate fats from the diet e. Maintain ideal body weight ANS: A, B, C

Recommendations to decrease risk of neurocognitive disorders include maintaining blood pressure within normal limits, maintaining low-density lipoprotein cholesterol ≤100, maintaining hemoglobin A 1C ≤7, taking aspirin (81 mg enteric coated) for persons with risk for heart disease and without contraindications, maintaining optimal control of heart failure, and smoking cessation. Eliminating fats from the diet is not recommended. Although maintaining ideal body weight is important to prevent many other chronic illnesses, it is not cited as a factor to decrease the risk of neurocognitive disorders.

DIF: Cognitive Level: Understanding REF: p. 305, Box 23-11 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. Differences in the presentation of patients with Neurocognitive Disorder (NCD) Alzheimer’s

Disease (AD) and NCD Lewy bodies (LB) are: (Select all that apply.) a. individuals with LB develop motor symptoms, and individuals with AD do not. b. individuals with AD display impairments in judgment whereas individuals with LB do not. c. the use of traditional antipsychotic medication is contraindicated for individuals with LB. d. LB usually occurs in individuals under age 60, and AD occurs in individuals only over age 60. e. individuals with LB develop language symptoms, and individuals with AD do not.

ANS: A, C

Both AD and LB rarely occur to persons under the age of 60. Both are characterized by impairments in memory, thinking, language, judgment, and behavior. A distinct difference in the two is that persons with LB will eventually develop motor symptoms, and the use of traditional (typical) antipsychotics (e.g., Haldol) is always contraindicated.

DIF: Cognitive Level: Understanding REF: p. 299 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. An older adult is referred to a geriatric nurse practitioner because of changes in memory and

reports by family members that “there is something different about her.” The nurse practitioner evaluates the older adult for potentially reversible causes for the changes, which include: (Select all that apply.) a. depression. b. delirium. c. osteoporosis. d. rheumatoid arthritis. e. medication side effects.

ANS: A, B, E

Reversible dementia-like conditions include depression, delirium, thyroid disorders, vitamin deficiencies (especially vitamin D), and excessive alcohol intake, as well as side effects from medications. There is no evidence that rheumatoid arthritis or osteoporosis has a dementia-like condition associated with them.

DIF: Cognitive Level: Remembering REF: p. 300, Box 23-4 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 6. A nurse understands that the pathophysiology of Parkinson’s Disease includes which of the

following? (Select all that apply.) a. A deficiency of the neurotransmitter dopamine b. An inability of the neurons to absorb dopamine c. A reduction of dopamine receptors d. An accumulation of Lewy Bodies, especially in the basal ganglia e. The presence of neurofibrillary tangles and amyloid plaques in the brain ANS: A, C, D

Parkinson’s Disease is the result of a deficiency of the neurotransmitter dopamine, a reduction of dopamine receptors, and the accumulation of Lewy Bodies, especially in the basal ganglia.

The presence of neurofibrillary tangles and amyloid plaques in the brain is seen in Alzheimer’s Disease.

DIF: Cognitive Level: Understanding REF: p. 301 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 24: Endocrine and Immune Disorders Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A client is newly diagnosed with type 2 diabetes mellitus. Which diagnostic test will best

evaluate the management plan prescribed for this client? a. A yearly funduscopic examination by an ophthalmologist b. Regular foot examinations by a podiatrist c. Quarterly hemoglobin A 1C d. Biannual cholesterol testing ANS: C

Quarterly or biannual hemoglobin A 1C (Hb A 1C ) is designed to provide information regarding the averaged glucose levels for a 3-month period of time. The periodic measurement of a glycated hemoglobin test (Hb A 1C ) is the best measure of ongoing glycemic control. Eye examinations are important, but proper blood sugar control will help prevent the damaging effects of diabetes to the eyes. Proper foot care is important, but good blood sugar control will help prevent the damaging effects of diabetes on the feet. Biannual cholesterol testing is not relevant to the evaluation of type 2 diabetes mellitus.

DIF: Cognitive Level: Applying REF: p. 313 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. Which is the most likely reason that type 2 diabetes mellitus is often difficult to diagnose in

older adults? a. Presenting symptoms occur very quickly. b. The disease rarely occurs in older adults. c. The classic symptoms may not be present in older adults. d. There are no recognizable symptoms; it is a “silent killer.”

ANS: C

The symptoms are also often masked by normal aging changes and conditions common in older adults. Polydipsia often does not occur due to the decreased thirst mechanism in older adults, polyphagia is often not recognized due to normal appetite declines associated with aging, and polyuria is often not recognized due to frequent urinary tract infections in older adults. Presenting symptoms usually occur very slowly. Type 2 diabetes mellitus is very common in older adults. There are symptoms of diabetes mellitus in older adults; however, they may be different than those seen in younger adults.

DIF: Cognitive Level: Applying REF: pp. 309–310 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. Hyperglycemia is harder to detect in older adults due to which of the following? a. There is a higher tolerance for elevated levels of circulating glucose in older

adults. b. Older adults tend to metabolize glucose at a faster rate than younger adults. c. Fingerstick glucose monitoring is inaccurate in older adults.

d. The classic signs of elevated glucose levels, polyuria, polyphagia, and polydipsia

are rarely present in older adults.

ANS: A

Hyperglycemia in older adults is harder to detect than in a younger adult. With aging there is a higher tolerance for elevated levels of circulating glucose. It is not unusual to find persons with fasting glucose levels of 200-600 mg/dL or higher. It is not true that older adults metabolize glucose at a faster rate than younger adults or that fingerstick glucose monitoring is inaccurate in older adults. While it is true that older adults usually do not have the classic symptoms of elevated glucose levels, this does not explain why hyperglycemia is harder to detect in older adults.

DIF: Cognitive Level: Understanding REF: p. 311 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. A nurse is caring for an older adult who is diagnosed with type 2 Diabetes. The patient is

prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first-line therapy? a. Insulin b. Sulfonylureas c. Metformin d. Chlorpropramide ANS: C

Metformin (Glucophage) is commonly prescribed as first-line therapy; it does not cause hypoglycemia or weight gain. Sulfonylureas were used for many years as first-line agents for all persons with type 2 DM. However, they are associated with hypoglycemia and can only be used in persons who can either be aware of the signs themselves or who have a caregiver capable of doing so; therefore, Metformin is considered the first line of therapy. Insulin is used for individuals with type 2 DM; however, it is not first-line therapy. Chlorpropramide is contraindicated due to a long half-life and the fact that it can cause prolonged hypoglycemia.

DIF: Cognitive Level: Understanding REF: p. 313 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. An older adult with type 2 DM who is being treated with insulin wants to increase his activity

level and begin a walking program. What recommendations should the nurse provide to this patient? a. A walking program is not recommended for an older adult with diabetes. b. The walking regimen needs to be done on a regularly scheduled basis. c. Regular exercise should not exceed 30 minutes three times a week. d. Insulin can most probably be discontinued if the individual adheres to the walking program.

ANS: B

If the person is using insulin, exercise needs to be done on a regular rather than an erratic basis. Exercise is an important part of diabetes self-management. In some cases, exercise in conjunction with an appropriate diet may be sufficient to maintain blood glucose levels within normal levels; however, it is not likely that insulin will be able to be discontinued.

DIF: Cognitive Level: Applying REF: p. 314 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE 1. A nurse is educating an older adult with diabetes mellitus on minimizing the risk of

cardiovascular disease. The nurse focuses on lipid levels. Which of the following are the recommended goals for lipid levels? (Select all that apply.) a. Cholesterol <200 b. Low-density lipoprotein (LDL) >100 c. High-density lipoprotein (HDL) >40 (men), >50 (women) d. Hb A 1C value of ≥6.5% e. Triglycerides <150 ANS: A, C, E

Goals for acceptable lipid levels include: Cholesterol <200, LDL <100, HDL >40 (men), >50, (women) and triglycerides <150. Hb A 1C levels are not a measure of lipids.

DIF: Cognitive Level: Understanding REF: p. 312, Box 24-11 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. An older patient asks a nurse: “I went to my diabetes doctor and everything was stable. The

nurse practitioner spent the entire time teaching me about decreasing my risks of heart disease.

It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why?” The nurse formulates a response based on the understanding that: (Select all that apply.) a. promoting cardiovascular health has the potential to minimize the complications of DM. b. there is little evidence that demonstrates that the course of DM can be altered in an older adult. c. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control. d. older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease. e. diabetes is not a common chronic condition in older adults.

ANS: A, C

While glycemic control is important, more emphasis is now on the prevention and treatment of cardiovascular diseases. Research has indicated that it may take 8 years of glycemic control before benefits are seen while the benefits of better control of blood pressure and lipids are seen as early as 2-3 years. Promoting cardiovascular health has the potential to be the most efficacious in the minimization of complications in the persons with DM. Education on self-management of diabetes is important for patients of all ages. Diabetes is a common chronic condition in older adults.

DIF: Cognitive Level: Understanding REF: p. 311 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

3. A nurse is caring for an older adult who has metabolic syndrome. The nurse knows that the

following conditions are common in persons with metabolic syndrome: (Select all that apply.) a. Glucose levels that are higher than normal b. Increased waist circumference c. Blood pressure that is lower than normal d. Increased blood cholesterol levels e. Decreased triglyceride levels ANS: A, B, D

Metabolic syndrome is characterized by higher than normal glucose levels, increased waist size due to excess abdominal fat, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood.

DIF: Cognitive Level: Understanding REF: p. 310, Box 24-6 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. A nurse works in an outpatient diabetes clinic. The nurse knows that the minimum standard of

care for a patient with diabetes includes the following at each visit: (Select all that apply.) a. Monitoring weight and BP b. Inspecting the feet c. Obtaining hemoglobin A 1C d. Reviewing self-management skills e. Obtaining fasting lipid profile and serum creatinine ANS: A, B, D

Minimum standards of care for an individual with diabetes include the following at each visit: Monitoring weight and BP, inspecting feet, reviewing self-monitoring glucose record, reviewing/adjusting medications as needed, reviewing self-management skills/goals, assessing mood, counseling on tobacco and alcohol use. Obtaining hemoglobin A 1C is recommended at quarterly intervals and obtaining fasting lipid profile and serum creatinine is recommended annually.

DIF: Cognitive Level: Understanding REF: p. 312, Box 24-10 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. A nurse is educating an older adult with diabetes on glucose self-monitoring. When

developing the teaching plan, the nurse includes which of the following goals in the teaching plan? The patient will: (Select all that apply.) a. demonstrate the technique for obtaining a blood sample. b. verbalize actions to take when results indicate an error on the machine. c. state the correct timing of blood glucose monitoring. d. state the signs and symptoms of both hyperglycemia and hypoglycemia. e. demonstrate technique for storing and transporting insulin correctly.

ANS: A, B, C

Option D is important for an older person with diabetes; however, it is not directly related to glucose self-monitoring. Option E is important for a person who is taking insulin, however is not directly related to glucose self-monitoring.

DIF: Cognitive Level: Understanding

REF: p. 314, Box 24-13

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 25: Respiratory Health and Illness Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The most significant etiology for chronic obstructive pulmonary disease (COPD) is: a. tobacco use. b. chronic bronchitis. c. exposure to carcinogens in the workplace. d. emphysema.

ANS: A

Tobacco use or exposure is the most significant etiology for COPD and accounts for 80% to 90% of all cases of COPD. Exposure to certain chemicals in the work environment may be a causative factor of COPD but is not as significant as tobacco. COPD includes emphysema and chronic bronchitis.

DIF: Cognitive Level: Remembering REF: p. 321 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A nurse is organizing a support group for older individuals with COPD in the community. The

nurse knows that which of the following individuals is most likely to have COPD? a. A 75-year-old Hispanic male who is a retired truck driver and never smoked b. A 72-year-old non-Hispanic white female who never worked outside of the home and is a former smoker c. A 67-year-old African American male who is a retired physician d. A 70-year-old Asian woman who is a retired college professor ANS: B

The profile of individuals most likely to have COPD include: persons 65-75 years of age, non-Hispanic whites, women, those who are unemployed, retired or do not work, have less than a high school education, have lower incomes, are current or former smokers, and have a history of asthma. Option B meets all of the criteria listed above.

DIF: Cognitive Level: Applying REF: p. 321, Box 25-3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. Asthma is often underdiagnosed in older adults because: a. older adults frequently do not have any of the classic signs and symptoms. b. symptoms of asthma are often attributed to normal age-related changes. c. asthma is very uncommon in older adults. d. asthma symptoms are usually very mild in older adults.

ANS: B

Asthma is both underdiagnosed and undertreated in older adults. Instead, the symptoms are attributed to normal changes with aging, cardiovascular disease, or are simply labeled “COPD.” Older adults do present with the usual signs and symptoms; however, they are often overlooked. Asthma is not uncommon in older adults. Adults over 65 make up a small percentage of those with asthma, and they have the highest associated death rate than any other group. Asthma symptoms in older adults range from mild to very severe.

DIF: Cognitive Level: Understanding REF: p. 322 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. The daughter of an older patient with chronic bronchitis says to the nurse, “I don’t understand

why my father has not been prescribed antibiotics for his bronchitis. The last time I had bronchitis I got antibiotics.” The nurse considers the following when formulating a response: a. Antibiotics tend to be less effective in older adults than in younger adults. b. Antibiotics are not prescribed in chronic bronchitis since the cause is usually not bacterial. c. The routine use of antibiotics is controversial because the causal role of bacterial infection is often not clear. d. Normal age-related decreases in immune response delay the presentation of classic symptoms.

ANS: C

In chronic bronchitis, the routine use of antibiotics is controversial because the causal role of bacterial infection is often difficult to document. Antibiotics are generally indicated in frail elders when the possibility of pneumonia or an acute exacerbation of bronchitis is suspected.

There is no evidence that antibiotics are less effective in older adults or that chronic bronchitis is usually caused by a nonbacterial cause. While it is correct that a normal age-related decreased immune response may delay the presentation of classic symptoms, this does not explain why antibiotics are often not prescribed.

DIF: Cognitive Level: Applying REF: p. 323 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. A nurse assesses an older patient’s blood gases. The patient is 70 years old. The nurse knows

that this patient’s maximum PO 2 is: a. 69. b. 79. c. 89. d. 99.

ANS: B

The maximal PO 2 possible at sea level can be estimated by multiplying the person’s age by 0.3 and subtracting the product from 100.

DIF: Cognitive Level: Understanding REF: p. 320, Box 25-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE

1. A nurse is assessing an older adult’s respiratory status. Which of the following are normal

age-related changes in the respiratory system? (Select all that apply.) a. Diminished cough reflex b. Stiffening of the chest wall c. Increased resistance to airflow d. Decreased respiratory rate e. Loss of elastic recoil ANS: A, B, C, E

Age-related changes include loss of elastic recoil, stiffening of the chest wall, and increased resistance to airflow leading to more effort required for movement of the diaphragm. A diminished cough reflex is a normal age-related change. A decreased respiratory rate is not a normal age-related change.

DIF: Cognitive Level: Remembering REF: p. 319 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. The nurse is preparing discharge teaching for a client diagnosed with chronic obstructive

pulmonary disease (COPD). Which nursing statement would be included in this intervention?

(Select all that apply.) a. “Are you familiar with pursed-lip breathing?” b. “It will be necessary to demonstrate postural drainage techniques with a caregiver.” c. “We will need to discuss alterations in your diet.” d. “Can you explain the purpose of the medications you have been prescribed?” e. “There are some things I’d like to discuss about adaptive sexual practices.”

ANS: A, B, D, E

Topics that will be included in this client’s discharge teaching include pursed lip breathing, postural drainage techniques, medication education, and safe sexual activity. Diet is not generally a factor in this disease process.

DIF: Cognitive Level: Applying REF: p. 321 | p. 324 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. A nurse is planning education for a group of older adults at a senior center on promoting

respiratory health. Which of the following should the nurse include in the education? (Select all that apply.) a. Annual influenza immunization b. Pneumococcal pneumonia immunization c. Smoking cessation d. Weight reduction e. Benefits of low-sodium low-fat diets ANS: A, B, C

Guidelines for good respiratory health include pneumonia immunization, annual influenza immunization, avoiding exposure to smoke and pollutants, smoking cessation, avoiding individuals with respiratory illness, promptly treating respiratory infections, and hand hygiene.

Although weight reduction and a low-sodium, low-fat diet are important, neither is directly related to respiratory health.

DIF: Cognitive Level: Understanding REF: p. 324, Box 25-11 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. A nurse practitioner is caring for a 90-year-old adult with asthma who has comorbid dementia

and severe osteoarthritis in the hands. The nurse practitioner considers inhaled medications to manage the asthma. Which of the following factors should the nurse take into consideration when developing the medication plan for this patient? (Select all that apply.) a. The patient’s ability to swallow safely b. The patient’s manual dexterity c. The patient’s age d. The patient’s cognitive status e. The patient’s mobility status ANS: B, D

Inhaled medications may be taken a number of ways. When choosing which method to order, the prescriber needs to consider the manual dexterity of the patient as well as the cognitive ability to follow directions. The patient’s age, ability to swallow, and mobility do not directly impact the ordering of inhaled medications.

DIF: Cognitive Level: Applying REF: p. 324 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. A nurse is involved in primary prevention activities related to the promotion of respiratory

health. The nurse is involved in which of the following activities? (Select all that apply.) a. Organizing an influenza vaccination clinic b. Promoting a smoking cessation program in the community c. Referring individuals with respiratory disease to the pulmonology clinic at the hospital d. Visiting a congressman representative to advocate for legislation on clean air e. Teaching individuals with COPD measures to maximize lung function ANS: A, B, D

Primary prevention includes activities such as promoting or conducting smoking cessation programs and community intervention, including organizational efforts to promote and administer preventive vaccinations such as that for influenza and pneumonia. Primary prevention includes political activism with industry leaders and environmental agencies to push for clean air and water. Referrals to specialists or teaching individuals who already have respiratory illness are not part of primary prevention.

DIF: Cognitive Level: Applying REF: pp. 324–325 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 26: Common Musculoskeletal Concerns Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. After first managing the pain being experienced by the client with gout, the treatment focuses

on: a. b. c. d.

strengthening the affected joints through a controlled exercise plan. minimizing joint disfigurement by using therapeutic splinting. preventing systemic involvement by altering the client’s diet. managing chronic pain by taking regular doses of salicylates.

ANS: C

After the acute attack, the goal is to prevent systemic spread of the disease. This may be done by avoiding drugs or foods that are high in purine and alcohol, both of which increase uric acid levels. Exercise and splinting are not effective in achieving the goal and salicylates should be avoided since they will affect the effectiveness of the prescribed medications for gout.

DIF: Cognitive Level: Applying REF: p. 336 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the

following should the nurse include in the teaching? a. Avoid foods high in purine. b. Encourage the patient to take in 1 L of fluid daily. c. Consume one glass of red wine daily. d. Recommend that the patient eat 12-16 ounces of foods high in protein such as red meat.

ANS: A

A person who is having an acute attack of gout should avoid foods that are high in purine, take in 2 L of fluid daily, avoid alcohol, and only have 4-6 ounces of foods high in protein daily.

DIF: Cognitive Level: Applying REF: p. 336 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. Which of the following manifestations would a nurse expect in a 70-year-old patient who has

the diagnosis of osteoarthritis? a. Swan neck deformity of the hand b. Subluxation of the fingers c. Heberden’s nodes on the distal phalanges d. Enlarged great toe ANS: C

Herbeden’s nodes are common in osteoarthritis. As the disease progresses, osteophytes develop in the joints of the fingers. Swan neck deformity and subluxation of the fingers are common in RA. An enlarged great toe is characteristic of gout.

DIF: Cognitive Level: Applying REF: p. 332 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. A nurse is planning an educational session on osteoporosis to be given at a senior center.

Which of the following should be discussed as preventive measures for osteoporosis? a. Following a diet with adequate amounts of calcium and vitamin D b. Increasing the intake of beverages containing phosphorus c. Having a yearly dual-energy X-ray absorptiometry DXA (or DEXA) scan d. Including isometric exercise for at least 30 minutes three times per week ANS: A

A diet with adequate amounts of calcium and vitamin D is important in preventing osteoporosis. Phosphorous is not recommended for osteoporosis prevention. The recommendation for DXA/DEXA scan is every 2 years. Exercise recommendations are for weight-bearing exercise.

DIF: Cognitive Level: Applying REF: pp. 334–335 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. A nurse is interviewing an older woman who is a new patient in an outpatient medical clinic.

Which of the following findings by the nurse is considered a risk factor for osteoporosis? a. The woman is obese and has hip pain with ambulation. b. The woman drinks three glasses of skim milk daily. c. The woman eats three to five servings of shrimp and liver per week. d. The woman has been taking corticosteroids for 10 years because of chronic pulmonary disease.

ANS: D

Bone loss is rapid in individuals who take steroids for extended periods of time.

DIF: Cognitive Level: Applying REF: p. 328 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 6. A nurse plans for the discharge of a 75-year-old patient who has the diagnosis of osteoporosis.

Which of these actions would the nurse consider first? a. Avoid stressful situations. b. Schedule an annual DXA/DEXA scan. c. Remove clutter from the floors of the home. d. Encourage consumption of a high-protein diet.

ANS: C

Individuals with osteoporosis are very high risk for falls. The most serious health complication of osteoporosis is the morbidity and mortality associated with a fall. There is no evidence that stress impacts osteoporosis. The recommendation for a DXA/DEXA scan is every 2 years. There is no evidence that a high-protein diet is important for an individual with osteoporosis.

DIF: Cognitive Level: Applying REF: pp. 328–329 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 7. Kyphosis in the older adult can be a result of which of the following? a. Osteoarthritis b. Rheumatoid arthritis c. Osteoporosis d. Gout ANS: C

Kyphosis is a common presentation in osteoporosis. Individuals can lose as much as 3 cm or more in height and develop a “c” shape to the vertebral column.

DIF: Cognitive Level: Applying REF: p. 330 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE 1. A nursing student is preparing a presentation on arthritis. The nursing student knows that

differences between osteoarthritis (OA) and rheumatoid arthritis (RA) include that: (Select all that apply.) a. both OA and RA have an acute onset in older adults. b. OA is a localized process, whereas RA may be systemic. c. OA usually impacts distal interphalangeal joints; RA impacts proximal interphalangeal joints. d. both OA and RA present with joint stiffness lasting 20-30 minutes after rest. e. initial treatment of both OA and RA is usually nonpharmacological using heat or exercise.

ANS: B, C

OA has an insidious presentation, and RA has an acute presentation. OA presents with joint stiffness, which resolves in less than 20 minutes, and RA presents with joint stiffness that lasts more than 20-30 minutes. OA is initially treated with nonpharmacological treatments such as heat or exercise, and RA is treated with medications disease-modifying antirheumatic drugs (DMARDs) immediately after diagnosis.

DIF: Cognitive Level: Understanding REF: p. 332, Table 26-3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the

following should the nurse include in the teaching? (Select all that apply.) a. Rest the joint during the acute gout attack.

b. c. d. e.

Take acetylsalicylic acid (aspirin, or ASA) to relieve pain.

Increase fluid intake to 2 L/day.

Avoid foods high in purine.

Avoid alcoholic beverages.

ANS: A, C, D, E

Individuals who are having an acute attack of gout should not take salicylates for pain. ASA is a salicylate.

DIF: Cognitive Level: Understanding REF: p. 334 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. A patient is diagnosed with osteoporosis. Which statements should the nurse include when

teaching the client about the disease? (Select all that apply.) a. Osteoporosis is common in females after menopause. b. Osteoporosis is a degenerative disease characterized by a decrease in bone density. c. The disease is congenital, caused by poor dietary intake of dairy products. d. Osteoporosis can cause pain and injury. e. Passive range of motion can prevent osteoporosis.

ANS: A, B, D

Osteoporosis is not a congenital disease. While a low intake of calcium is a factor, there are dietary sources of calcium other than dairy products. Passive range of motion cannot prevent osteoporosis.

DIF: Cognitive Level: Understanding REF: pp. 328–329 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. A nurse is teaching a group of 65-year-old patients about reducing the risk of osteoarthritis.

Which of the following would the nurse discuss as a modifiable risk factor for osteoarthritis?

(Select all that apply.) a. Female sex b. History of joint injuries c. Advancing age d. Drinking one cup of regular coffee a day e. Obesity ANS: B, E

Gender and advancing age are nonmodifiable risk factors for osteoarthritis. There is no evidence that coffee or caffeine has any relationship to the development of osteoarthritis.

DIF: Cognitive Level: Understanding REF: pp. 330–331 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 27: Pain and Comfort Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. When performing a pain assessment on a client who is aphasic, the nurse should consider: a. reports from the family or staff at the nursing home about changes in functional

status. b. that the patient is lying quietly in bed so she is not likely to be experiencing pain. c. that the patient’s previous stroke interrupted pain pathways so she does not feel

pain. d. that older adults do not tolerate opioid analgesics well and may exhibit side effects.

ANS: A

When an individual is not able to verbally communicate complaints of pain, reports from family or caregivers are important. In addition, in older adults, pain is often manifested as changes in functional status. To assume that the patient is not in pain because she is lying quietly in bed is incorrect. One should not assume that she feels no pain due to her stroke.

Older adults tolerate opioid analgesics.

DIF: Cognitive Level: Understanding REF: pp. 344–345 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. An older adult is admitted to the hospital after a serious fall. When noting that the client has

been prescribed meperidine (Demerol) for muscle pain, the nurse: a. administers the medication so as to prevent the client from developing the fear of pain. b. questions the client and family concerning any allergies to analgesic medications. c. calls the physician to question the appropriateness of this medication order. d. conducts a pain assessment and determines the client’s need for an analgesic medication.

ANS: C

Some medications used in younger adults, for example, meperidine (Demerol), are always contraindicated in the older adult. The metabolites of Demerol can cause confusion, psychotic behavior, and seizure activity. The remaining options would not be inappropriate, except for the fact that they relate to the administration of an inappropriate medication.

DIF: Cognitive Level: Understanding REF: p. 348 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 3. Compared with acute pain, persistent pain requires the nurse to: a. monitor vital signs more frequently. b. document the character of the pain as burning. c. administer analgesics at least every 4 hours. d. educate the client to the benefit of specific lifestyle changes.

ANS: D

Persistent pain can manifest itself as depression, eating and sleeping disturbances, and impaired function, all of which can lead to lifestyle changes. Persistent pain usually does not lead to markedly altered vital signs. Acute or persistent pain can manifest itself as a burning pain. Persistent pain has no time frame; it is continually persistent at varying levels of intensity.

DIF: Cognitive Level: Applying REF: p. 340, Box 27-4 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. The initial step to effect the safe management of mild to moderate acute pain that has not been

controlled with over-the-counter medications is to: a. begin acetaminophen (Tylenol) every 4 hours for 24 hours. b. supplement with nonpharmacological interventions. c. administer a single low dose of short-acting opioid and monitor for relief. d. titrate dosage of a short-acting opioid upward over 24 hours to achieve relief.

ANS: C

If pain continues, consider a single low-dose, short-acting opioid and observe the effect.

Acetaminophen is an over-the-counter analgesic and so its effect is already determined to be ineffective. Nonpharmacological interventions are only appropriate once pain management has been successfully implemented. Titrating an opioid dose upward is appropriate only after the effects of the initial dose have been determined.

DIF: Cognitive Level: Understanding REF: p. 245, Box 27-10 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 5. An older adult is being treated for severe pain resulting from a history of osteoarthritis. In her

discharge teaching, which information is most important to relay for the successful management of the pain? a. Check for incompatibilities before taking any new medications. b. Arrange to take a dose of analgesic prior to physical activity. c. Take the analgesic around-the-clock as prescribed. d. Be alert for the signs of overdose toxicity.

ANS: C

For someone with severe persistent pain it is important to achieve the highest level of pain control; it is helpful to ease the “memory of pain,” especially for those whose persistent pain is intense, like that of many chronic illnesses. This means to prevent the pain, not simply relieve it. The most effective way to do this is to provide around-the-clock (ATC) dosing, at the appropriate dosage. The other options are appropriate medication-related instructions but are not as directed toward successful management of chronic pain as is the correct option.

DIF: Cognitive Level: Applying REF: p. 347 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 6. An older client with a history of hypertension and osteoarthritis who has recently fallen and

fractured two ribs is prescribed extra strength Tylenol for the pain. What statement by the client requires further evaluation by the nurse?

a. “I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep

through the whole night.” b. “I heard that meditation may help me deal with the pain without taking all that

Tylenol.” c. “Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours

around-the-clock and my pain is gone.” d. “I make sure that I take my Tylenol with breakfast when I first get up.”

ANS: C

The maximum dose for Tylenol is 3 g per 24-hour period; two extra strength Tylenol tablets every 4 hours would mean that the client is taking 6 g and would need further evaluation.

Herbal tea may have a relaxing effect and help her sleep. Meditation is one of the alternative modalities that help some patients deal with pain. The practice of taking Tylenol with breakfast upon waking is acceptable.

DIF: Cognitive Level: Understanding REF: pp. 347–348 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 7. An older adult with gastric cancer with bone metastases is being discharged from the hospital

after beginning a regimen of opioid analgesics to control the metastatic pain. What should be included in the discharge teaching plan? a. The development of a plan to prevent constipation b. Benefits of grief counseling c. Increasing calories in the diet d. Preventing pressure ulcers ANS: A

Side effects of opioids are significant to older adults and include constipation. Because constipation is almost universal when opioids are used, the nurse should ensure that an appropriate bowel regimen is taken at the same time as the opioids. The remaining options are not specifically related to the management of the client’s pain or the effects of opioid treatment.

DIF: Cognitive Level: Understanding REF: p. 349 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 8. An older adult is currently prescribed both aspirin (81 mg) and ibuprofen daily. What

instructions are most important for the nurse to provide to assure the expected outcomes for this client? a. The medications should be taken together to ensure the effectiveness of both medications b. Take ibuprofen 30 minutes after the aspirin so as to not interfere with its effectiveness c. The aspirin will negatively affect the analgesic effect of the ibuprofen d. The medications should be taken at least 4 hours apart to minimize risk of gastric irritation ANS: B

In 2006, the Food and Drug Administration in the United States issued a warning regarding the concomitant use of aspirin (81 mg) and ibuprofen. When taken together the aspirin is less cardio-protective; that is, there is less antiplatelet effect increasing the person’s risk for a cardiac event. Persons who take immediate release aspirin and take a single dose of ibuprofen 400 mg should take the ibuprofen at least 30 minutes after or 8 hours before the aspirin.

DIF: Cognitive Level: Understanding REF: p. 348 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 9. When educating a client on the use of an adjuvant medication, which statement best

demonstrates the nurse’s understanding of this therapy? a. “These medications are used instead of opioids to decrease the likelihood of addiction.” b. “Adjuvant medications are prescribed because they seldom cause any significant side effects.” c. “These types of medications are used to eliminate the side effects of opioid medications.” d. “These drugs are used in combination with analgesics to increase the effect of the analgesics.”

ANS: D

Adjuvant medications are not analgesics but are thought to alter the perception of pain and are used with analgesics to potentiate the effect of the analgesics. Adjuvant medications are used with opioids and may have long half-lives in older adults. The nurse must monitor the patient for adverse effects. Adjuvant medications do not eliminate the side effects of opioids.

DIF: Cognitive Level: Understanding REF: pp. 348–349 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 10. An older client who was recently admitted to the subacute setting after having a knee

replacement is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement? a. Share with the patient that it’s important to get out of bed and that there is pain medication available if it does hurt. b. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain. c. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed. d. Allow the patient to remain in bed, but share that getting up will be required at least twice a day starting the next morning.

ANS: C

The administration of an as-needed analgesic 20 to 30 minutes before an activity may eliminate discomfort and fear of discomfort. It may also enhance the individual’s capacity for the activity. It is not true that performing an activity quickly will lessen the pain or that the patient will get used to the pain. A Hoyer lift is only indicated when an individual is completely immobile. Activity is an important part of rehabilitation.

DIF: Cognitive Level: Understanding

REF: p. 347

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation MULTIPLE RESPONSE 1. An older aphasic client has severe osteoarthritis, bilateral contractures of the lower extremities,

and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? (Select all that apply.) a. “Client slept throughout the night.” b. “Client winces only when turned and repositioned.” c. “Client slept during dressing change.” d. “Client cooperative during morning care.” e. “Client ate 80% of breakfast, 70% of lunch, and 100% of dinner.”

ANS: A, C, D, E

A pain cue presented by this client is the wincing when being turned, indicating that this intervention is producing pain. The remaining observations are concurrent with effective pain management.

DIF: Cognitive Level: Understanding REF: p. 345 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. An older adult is seen in the emergency department after falling and sustaining substantial soft

tissue bruising. The assessment interview notes a history of arthritic pain in several joints. The client is prescribed 650 mg of acetaminophen (Tylenol) four times per day and 800 mg of ibuprofen (Motrin) four times per day for control of the persistent arthritic pain. When providing discharge teaching, the nurse includes information regarding the signs and symptoms of: (Select all that apply.) a. gastrointestinal bleeding. b. renal impairment. c. medication interactions. d. confusion. e. increased anxiety.

ANS: A, B, C

There is no indication that the patient is at risk for mental status changes such as confusion or increased anxiety. The remaining options are directly related to the possible outcomes of long-term pain management with these medications.

DIF: Cognitive Level: Understanding REF: pp. 347–348 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 3. When individualizing pain management for a client hospitalized after major surgery, the nurse

will: (Select all that apply.) a. titrate the prescribed analgesic medication to provide effective pain management. b. assess the client for cultural beliefs that affect individual expression of pain. c. reassure the client that pain medication is available whenever he or she expresses a

need for it. d. anticipate the client’s need for pain medications. e. implement nonpharmacological pain management interventions whenever

possible.

ANS: A, B, D, E

The client will require knowledge about the frequency of the administration of the medication; if the requests are consistently made before the medication can be readministered, the treatment plan should be reevaluated and altered. The other options reflect appropriate interventions for effective pain management.

DIF: Cognitive Level: Understanding REF: pp. 347–349 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 4. A nurse is caring for an older adult with cognitive impairment who recently had hip surgery.

The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.) a. The client ate all of her meals. b. The client pushes caregivers away when they attempt to change the dressing on her hip. c. The client rocks back and forth repetitively when sitting in a chair. d. The client sleeps soundly throughout the night. e. The client cries out repeatedly when anyone approaches her.

ANS: B, C, E

Pain cues in people with communication difficulties involve changes in behavior including restlessness, resistance to care, repetitive movements, and vocalizations. Other cues include sleeplessness and decreased appetite.

DIF: Cognitive Level: Applying REF: p. 341, Box 27-6 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation

Chapter 28: Mental Health Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. When assessing an older client for indications of depression, the nurse bases the intervention

on the knowledge that: a. the older client’s symptoms may be atypical for the disorder. b. depression is a common mental disorder among the older population. c. the older client is generally willing to discuss his or her mental health symptoms. d. depression is not as commonly seen in this population as are anxiety disorders.

ANS: A

Somatic complaints are often the presenting symptoms of mental health disorders, such as depression, making diagnosis difficult. Depression is a common disorder among this population but knowing that does not aid in identifying the clients who are depressed. The remaining options are not true regarding the mental disorder of depression.

DIF: Cognitive Level: Applying REF: p. 369, Box 28-20 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. The nurse preparing educational information on common mental health disorders among the

older adult population should include: a. methods for reducing anxiety. b. a written depression screening tool. c. local schizophrenia support groups. d. signs and symptoms of alcoholism.

ANS: B

Depression is the most common mental health disorder of later life. Anxiety disorder, schizophrenia, and alcoholism are all incorrect; although these disorders are present in older adults, they occur in far fewer numbers than depression.

DIF: Cognitive Level: Applying REF: p. 369, Box 28-20 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. When an older adult reports experiencing several different stressors over the last 6 months, the

nurse demonstrates an understanding of the physiological effects of stress on the body by: a. assessing the client using the Geriatric Depression Scale (GDS). b. testing the client’s urine for red blood cells. c. screening the client for abnormally high serum glucose levels. d. inquiring as to whether the client has lost weight during that time period.

ANS: C

Research on psychoneuroimmunology has explored the relationship between psychological stress and various health conditions such as type 2 diabetes. The production of proinflammatory cytokines influencing these and other conditions can be directly stimulated by negative emotions and stressful experiences. The GDS does not identify physiological problems. There is no current research to support a connection between stress and urinary bleeding. Stress can result in either a weight gain or weight loss depending on the client’s relationship with food during the stressful period.

DIF: Cognitive Level: Applying REF: p. 353 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. An older adult client has been voluntarily admitted for treatment of alcohol dependency. In

implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging? a. Assessing the client for both depression and anxiety b. Discussing the poor prognosis of this disorder with the client c. Explaining the need for proper nutrition to minimize the effects of alcoholism d. Identifying the effects of chronic alcoholism on the human body ANS: A

Substance abuse in older adults is frequently a coping mechanism to deal with loss, anxiety, or depression. There is no evidence about the success or lack of success of treatment programs for older adults because they have not been adequately investigated. Nutritional counseling and the discussion of the long-term effects of alcoholism may be appropriate but not specific to the older adult client.

DIF: Cognitive Level: Applying REF: pp. 359–360 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. In order to focus on the older population with the greatest risk for suicide, the nurse would

conduct a depression screening that targets: a. African American men. b. white men. c. white women. d. African American women.

ANS: B

White men older than age 85 have the highest rate of suicide in the United States; they commit suicide at approximately four times the national rate.

DIF: Cognitive Level: Applying REF: p. 371 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 6. An older adult says to the nurse, “I don’t know why I can’t handle booze like I used to when I

was younger.” The nurse’s response is based on the knowledge that: a. older adults develop higher blood alcohol levels due to age-related changes in the neurological system. b. older adults develop higher blood alcohol levels due to age-related changes that

alter absorption and distribution of alcohol. c. older adults develop higher blood alcohol levels due to slowed reaction times. d. older adults develop higher blood alcohol levels due to cognitive changes.

ANS: B

Age-related changes such as increased body fat, decreased lean muscle mass, and decreased total body water content alter absorption and distribution of alcohol, increasing blood alcohol levels. Age-related neurological changes do not impact blood alcohol levels. Slowed reaction time does not impact blood alcohol levels. Cognitive changes do not impact blood alcohol levels; furthermore, not all older adults experience cognitive changes.

DIF: Cognitive Level: Understanding REF: p. 373 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 7. How should the nurse reply when an older adult asks, “How much alcohol is good for you?” a. “Alcohol isn’t good for you so avoid it as a general rule.” b. “Experts in the field recommend only one regular sized drink a day.” c. “It’s been said that red wine has health benefits, but that doesn’t mean drink a

whole bottle.” d. “If you are only drinking on special occasions, limit yourself to two drinks.”

ANS: B

Clinically significant adverse effects can occur in some individuals consuming as little as two to three drinks per day over an extended period. Because of the increased risk of adverse effects from alcohol use, the National Institute on Alcohol Abuse and Alcoholism has recommended that individuals over the age of 65 limit alcohol consumption to no more than one standard drink per day. Although the Substance Abuse and Mental Health Services Administration (SAMSHA) recommends a maximum of two drinks on any drinking occasion (holidays or other celebrations), that option does not address the more pressing issue of the daily consumption of alcohol. The other options do not address the client’s question.

DIF: Cognitive Level: Understanding REF: p. 374 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 8. An older adult has recently experienced a number of stressful life events. The client comes to

the ambulatory clinic and tells the nurse that, “On top of all I’ve had to endure, now I’ve got this flu!” In rendering care for this client, the nurse recognizes that: a. the client is exhibiting attention-seeking behaviors to substitute for poor coping skills. b. crisis and stressful situations may produce emotions that erode the health of the older people. c. the client is exhibiting learned helplessness as a result of the recent stressors. d. a period of crisis will ultimately lead to a lower level of physical and mental functioning.

ANS: B

Sustained stress can lead to physical consequences, particularly in older adults who have less reserve than younger individuals. The client has experienced some major life stressors.

Learned helplessness occurs when an individual has a perceived lack of control, which erodes the person’s personality. A period of crisis can in fact lead to a higher level of functioning.

DIF: Cognitive Level: Applying REF: pp. 353–355 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 9. An older client in an adult day care program tells the nurse, “I’m very stressed because

another neighbor passed away.” The most therapeutic response by the nurse is: a. “What do you mean by ‘stressed’?” b. “Tell me what you did when your other neighbor passed away.” c. “Are you worrying about your own death?” d. “Let’s get involved in some activities and not think about sad things.”

ANS: B

Application of what one has learned from previous situations can help dissipate the intensity of stress. Denial of the stressful event and focusing upon blessings or happiness will not lessen the stress and may in turn intensify it. While it is appropriate to ask the client to clarify what he or she is saying, it doesn’t help in this situation. This is not necessarily the time to initiate a conversation about the client’s feelings about death since doing so is likely to increase the level of stress.

DIF: Cognitive Level: Applying REF: pp. 353–355 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 10. A nurse who is caring for an older patient with bipolar disorder knows that the patient needs

additional education when the patient states: a. “Bipolar disorder often results in ‘a leveling out’ of symptoms as one ages.” b. “Relapses in bipolar disorder tend to be precipitated by medical problems.” c. “Older adults with bipolar disorder tend to be ‘rapid cyclers’.” d. “Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults.”

ANS: D

Depression is the most common psychiatric disorder in older adults. Bipolar disorders tend to level out in later life, and individuals tend to have longer periods of depression. Relapses in older adults are usually precipitated by medical problems. Older adults tend to be “rapid cyclers,” cycling from mania to deep depression in a much shorter period of time than they did when they were younger.

DIF: Cognitive Level: Understanding REF: p. 367 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 11. A nurse administers the Short Michigan Alcohol Screening Test Geriatric Version

(S-MAST-G) to an older adult. The older adult receives a score of “2.” The nurse knows that this score is indicative of: a. no problem with alcohol.

b. a problem with alcohol. c. a mild problem with alcohol. d. a severe problem with alcohol.

ANS: B

A score of 2 or more on the S-MAST-G indicates that there is an alcohol problem. This scale does not rate the severity of the problem.

DIF: Cognitive Level: Understanding REF: p. 374, Table 28-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult

and his family, which statement will the nurse use to support this intervention? (Select all that apply.) a. “This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications.” b. “ECT has been found to be more effective in older adults than in younger adults.” c. “ECT is a safe intervention for those with psychotic ideation.” d. “While there may be some short-term memory loss, most individuals find that their memory comes back within a few days.” e. “ECT results in a more immediate response to symptoms.”

ANS: A, D, E

ECT has been found to be effective in individuals who have psychotic depression and those who do not respond to antidepressant medications. ECT is equally effective in older adults as in younger adults. It is used for individuals with depression, not psychotic ideation. There is some short-term memory loss associated with ECT; however, it does resolve within a short time frame. ECT provides a more immediate response to symptoms than does medication.

DIF: Cognitive Level: Understanding REF: p. 371 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. A nurse is assisting an older adult to cope with the loss of a spouse. The nurse encourages the

person to use an emotion-focused coping strategy. Which of the following actions should the nurse take? (Select all that apply.) a. Encourage the person to cry if he or she feels like it. b. Teach the person relaxation breathing exercises. c. Encourage the person to make an action plan for the future. d. Suggest that the person reach out to his or her clergyperson. e. Suggest that the person attend a yoga class.

ANS: A, B, E

Expressing emotion, relaxation exercises, and exercise are all part of an emotion-focused coping strategy. Developing an action plan is part of a problem-focused coping strategy, and reaching out to clergy is part of a religious-focused coping strategy.

DIF: Cognitive Level: Applying

REF: p. 355, Box 28-5

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. A nurse is conducting an assessment of an older adult in a geriatric clinic. The patient states

that he drinks two to three alcoholic beverages daily. The patient has multiple chronic comorbid conditions and is on five different medications. Which of the following medications is the nurse concerned will interact with the alcohol? (Select all that apply.) a. Naproxen for pain b. Daily multivitamin c. Prozac for depression d. Celebrex for arthritis e. Toprol XL for hypertension ANS: A, C

Classifications of medications that interact with alcohol include NSAIDs and antidepressants.

There is no evidence that multivitamins, cyclooxygenase-2 (COX II) inhibitors, or beta-blockers interact with alcohol.

DIF: Cognitive Level: Applying REF: p. 374, Box 28-25 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Pharmacological and Parenteral Therapies 4. A nurse in a long-term care facility is approached by an older resident who is crying and

states: “You need to help me. The mean little men are in my room again. They are watching me from the corner and they are laughing at me. Make them go away.” The nurse accompanies the resident to the room and there is no one in the corner of the room. What is the best response by the nurse? (Select all that apply.) a. “Yup, I see them. Let me call security to haul the men away.” b. “Can you tell me what you are so frightened of?” c. “I will do my best to keep you safe.” d. “I understand that you are very frightened and upset.” e. “You know that there is no one there. Stop carrying on like this.”

ANS: B, C, D

When dealing with a patient with frightening delusion, the nurse needs to be understanding, but not pretend to agree with the delusions. The nurse needs to ask what is troubling to the patient and provide a reassurance of safety. It is important to try and understand the patient’s level of distress and what the patient is experiencing. Option A agrees with the delusion; option E does not provide reassurance or safety.

DIF: Cognitive Level: Applying REF: pp. 364–365 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

Chapter 29: Care of Individuals with Neurocognitive Disorders Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The nurse is caring for an older client who experienced a hip replacement surgery 10 hours

ago. Which intervention will help minimize this client’s risk of developing delirium? a. Requesting that staff offer fluids each time they interact with the client b. Medicating the client to best facilitate restorative sleep c. Encouraging the client to remain still and thus minimize pain d. Suggesting that visitors are limited to family members only ANS: A

Encouraging fluid intake will help prevent dehydration, which is a major contributor to the development of delirium. Avoid use of sleeping medications—use music, warm milk, or noncaffeinated herbal tea to alleviate discomfort and encourage sleep. Avoid excessive bed rest; institute early mobilization as appropriate. It is appropriate to have family and visitors available to the client, within reason, since doing so will help stimulate the client cognitively.

DIF: Cognitive Level: Applying REF: p. 388, Box 29-10 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. Which intervention best addresses the principle that is the basis for communicating with a

client experiencing postsurgical delirium? a. Reminding the client that delirium is generally acute and reversible b. Assuming that the client’s statements are an attempt to express needs c. Allowing the client sufficient time to formulate an answer to questions d. Using nonverbal communication techniques to communicate with the client ANS: B

Assuming that communication and behavior are meaningful and an attempt to tell us something or express needs is vital to effective care planning for the delirious client. The acute and reversible nature of the disorder does not have impact on the need for effective communication. The remaining options focus on the client’s communication and not the greater issue of effective intercommunication between client and staff.

DIF: Cognitive Level: Analyzing REF: p. 389 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. An older client admitted to the hospital after having sustained a fall at home is diagnosed with

a right hip fracture and experienced a surgical reduction of the fracture. At 2:30 AM, she awakens from sleep insisting that her daughter is in the other room and wants to see her.

Attempts to reorient her to the surroundings are unsuccessful. In reviewing the client’s record, what data would be considered a primary risk factor for the delirium? a. History of dementia b. Death of the client’s husband last month c. The client’s age d. History of cardiac disease

ANS: A

Older people who have undergone surgery and those with dementia are particularly vulnerable to delirium. While the other options may be factors, they are not as influential as the correct option.

DIF: Cognitive Level: Applying REF: p. 383 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. An older client diagnosed with dementia resides with his daughter. When the homecare nurse

visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, “I don’t know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him.” How will the nurse respond to the client’s daughter? a. “Let’s think about what you may have done to anger your father?” b. “Let’s try to figure out what your father was trying to say with his behavior.” c. “Scratching is usually a sign of untreated pain. Do you think your father is in pain?” d. “Maybe you should consider having a home health care provider take over responsibility for your father’s physical care.”

ANS: B

Dementia often interferes with the person’s communication and the ability to understand and express thoughts and feelings. The focus needs to be on what the person is attempting to communicate through behavior. Behavioral manifestations are not necessarily signs of anger in persons with dementia. Although behavioral manifestations frequently are seen in persons with untreated pain, this is not always true. The issue here is not necessarily the individual who is providing the care but perhaps the care activity itself. It is appropriate for the daughter to provide care for her father.

DIF: Cognitive Level: Applying REF: p. 395 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. A nurse is caring for a patient with a diagnosis of delirium. Which of the following is an

expected assessment finding for this patient? a. Normal attention span b. Fluctuation in symptoms c. Normal sleep cycle d. Increased appetite ANS: B

A hallmark of delirium is fluctuation in symptoms. Patients with delirium typically have decreased attention spans and an altered sleep-wake cycle. Classic symptoms of delirium do not involve changes in appetite; however, patients often have a decreased appetite.

DIF: Cognitive Level: Understanding REF: p. 385 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE 1. Which intervention to manage wandering in clients in a long-term care facility should be

implemented? (Select all that apply.) a. Camouflaging doorways b. Close observation to identify the person’s individual patterns c. Engaging the person in social interactions d. Using physical restraints to prevent wandering to maintain safety e. Providing enclosed pathways for walking ANS: A, B, C, E

Restraints are not an effective intervention for wandering. Although they might physically prevent the person from wandering, restraints have many potential negative consequences and patient harm associated with their use. Environmental modifications such as camouflaging doorways and providing enclosed pathways, close observation to identify the person’s individual patterns, and engaging the person in social interactions are all interventions that are effective strategies to manage wandering.

DIF: Cognitive Level: Applying REF: p. 388 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. Which information will the nurse manager include when discussing the major differentiation

between delirium and dementia with novice nurses? (Select all that apply.) a. The delirious client learns to make up answers to hide his or her confusion. b. Delirium requires increased monitoring at night. c. The client diagnosed with dementia generally looks frightened. d. Dementia results in a steady decline in cognitive abilities. e. Delirium is characterized by fluctuations in alertness.

ANS: B, D, E

The correct options accurately describe the conditions. It is the client experiencing dementia who will over the course of the illness learn to confabulate to cover up his or her memory losses, and the delirious client is more likely to show fear through facial expressions.

DIF: Cognitive Level: Applying REF: p. 382, Table 29-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. A nurse is caring for a 92-year-old female patient who was admitted to the hospital 1 day after

she had outpatient cataract surgery. The patient who lives in an assisted living facility became very confused and agitated and was found wandering in the lobby of the building in her nightgown. She refused to return to her room and stated that there were “bad men” in her room. The patient has a history of dementia, diabetes, heart failure, and is on seven different medications. She was widowed 1 year ago. The nurse suspects that she has delirium. What are the patient’s risk factors for delirium? (Select all that apply.) a. Age of 92 b. Residing in an assisted living facility c. History of dementia d. Female gender e. Recent cataract surgery

ANS: A, C, E

This patient’s risk factors for delirium include her older age, history of dementia, and recent surgery. There is no evidence that living in an assisted living facility or being female increase risk of delirium.

DIF: Cognitive Level: Applying REF: pp. 383–384 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. A nurse in a long term care facility is concerned that a 94-year-old resident with dementia is

losing weight. Upon assessment, the nurse notes that the resident, who is able to feed herself independently, consumes less than 50% of each of her meal trays. Which of the following strategies can the nurse utilize to improve this resident’s intake? (Select all that apply.) a. Assign a nursing assistant to feed the resident. b. Assign a nursing assistant to sit with the resident as the resident eats. c. Serve the resident finger foods. d. Serve the resident one dish at a time. e. Alter the dining ambience to reduce distractions.

ANS: B, C, D, E

Serving the resident finger foods and one dish at a time may improve the resident’s intake at meals. Assigning a nursing assistant to sit with the resident may also accomplish the goal, as this may help in reducing environmental distractions. Because the resident can feed herself, it is important to promote that level of independence for as long as possible. Assigning someone to feed the resident will impede her independence.

DIF: Cognitive Level: Applying REF: p. 401, Box 29-31 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. A nurse is assessing an older patient with new onset confusion using the Confusion

Assessment Method (CAM). The nurse understands that in order to have a diagnosis of delirium when using the CAM, the patient must exhibit which of the following? (Select all that apply.) a. Acute onset of symptoms or fluctuating course b. Inattention c. Disorganized thinking d. Altered level of consciousness e. Alteration in level of physical activity ANS: A, B

In order to be diagnosed with delirium, using the CAM, the individual must have acute onset or fluctuating course and inattention and either disorganized thinking or altered level of consciousness. Although individuals with delirium often have either hyperactivity or hypoactivity, this is not one of the criteria assessed on the CAM. DIF: Cognitive Level: Understanding REF: p. 387, Box 29-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

Chapter 30: Economics and Health Care in Later Life Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The original intent of Social Security was to: a. provide a hospital insurance plan. b. minimize the dependency of older members on younger members of society. c. provide the blind, older adult, or disabled with adequate financial support. d. penalize women financially for numerous zero wage years while raising children.

ANS: B

The original intent of Social Security was to minimize the dependency of older members of society on younger members. Social Security is not a health insurance plan. It was designed to provide monetary support to persons at a certain age or when blind or disabled. It was not intended to meet all financial needs of the individual. Benefits are provided to individuals who worked or are married to someone who worked the number of years required.

DIF: Cognitive Level: Understanding REF: p. 407 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. When an older adult is considering long-term care insurance (LTCI), what is important for the

nurse to encourage the client to consider? a. The older one is when applying, the lower the rates will be b. It is financially better to avoid purchasing LTCI through a group policy c. It is wise to scrutinize all exclusions before enrolling d. All policies cover care at home as well as in a long-term care facility ANS: C

LTCI policies vary, and many have exclusions for specific diseases, for example, Alzheimer’s disease. It is prudent to examine the policy before purchasing. Costs increase as one ages. The best plans are those that are negotiated by a large group such as an employer, state organization, or association. Although policies are becoming more creative, they are traditionally limited to care in a long-term care facility and frequently do not cover care in the home.

DIF: Cognitive Level: Applying REF: p. 415 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. The cost of nursing home care is significant. The primary payer for nursing home care is: a. Medicare. b. Medicaid and private pay. c. Long-term care insurance. d. Medigap insurance.

ANS: B

The primary payers for nursing home care are Medicaid and private pay. Because of the potentially high co-payments associated with Medicare, persons who are able to do so often purchase supplemental insurance plans. These feature standard benefits and generally several different policies are available from which to select in each state. Plans referred to as Medigap cover only the deductibles and part of the coinsurance amounts based on Medicare-approved amounts contracted with providers. Long term care insurance does pay for nursing home, but the primary payers are Medicaid and private pay.

DIF: Cognitive Level: Remembering REF: p. 414 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. A Navy war veteran is seeking advice about getting treatment for a chronic respiratory

problem at the local veterans’ hospital. The nurse’s initial response is to ask: a. “Why aren’t you considering the local general hospital for the care that you need?” b. “Are you willing to travel to a veterans’ hospital that offers respiratory diagnostic services?” c. “Have you ever been treated at a veterans’ hospital before?” d. “Is the problem related to something that occurred while you were in the Navy?”

ANS: D

Instead of coverage of any health problems, priorities were set for those problems that were in some way deemed “service connected”; in other words, the health care problem had to be linked to the time the person was on active duty. While the other questions are not inappropriate, they do not address the issue of whether the client is illegible for care at a veterans’ hospital.

DIF: Cognitive Level: Applying REF: p. 415 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. An older adult is concerned that if her spouse, who recently suffered a stroke, is placed in a

nursing home, “they will take everything in order to pay for his care.” What response will the nurse make? a. “A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property” b. “You should consider transferring the assets to your son so that your husband will qualify for Medicaid” c. “Have you considered caring for your husband at home since Medicare will cover custodial care at home?” d. “Are you aware that your children have a legal obligation to provide financial support toward the care of disabled parents?”

ANS: A

The spouse is permitted to keep a portion of the assets, home, car, and personal property.

There is a “look back” period of 36 months to determine whether funds that were transferred would normally have been available to the individual. Medicare does not cover the cost of custodial care; it covers skilled care only. There is no legal obligation of a child to support a parent.

DIF: Cognitive Level: Applying

REF: p. 414

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 6. A 70-year-old diabetic patient has just received instruction from a nurse on glucose

self-monitoring. He tells the nurse: “I hear that those test strips cost a lot. I am not sure that I can afford anything else. The only health insurance I have is Medicare Parts A and B.” The best response by the nurse is: a. “I am sorry, but Medicaid is the only insurance that covers the cost of diabetic testing supplies.” b. “Medicare Part A will cover the cost of the supplies to manage your diabetes.” c. “Medicare Part B will cover the cost of the supplies to manage your diabetes.” d. “I am sorry, but Medigap insurance is the only insurance that covers the cost of diabetic testing supplies.”

ANS: B

Medicare Part B covers the cost of diabetic testing supplies.

DIF: Cognitive Level: Remembering REF: p. 412 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. When educating an older adult about Medicare Part D, which information will be included?

(Select all that apply.) a. It is an elective prescription drug plan with associated out-of-pocket premiums. b. All persons with either Medicare Part A or B can voluntarily purchase a Medicare Part D prescription drug plan. c. The plan covers all costs of drugs after a deductible is paid. d. The plan is not available for individuals who are receive both Medicaid and Medicare. e. This prescription drug plan requires client co-payments.

ANS: A, B, E

An individual with Medicare Part D prescription drug coverage pays a deductible and co-payments. The other options represent inaccurate information regarding Medicare Part D. DIF: Cognitive Level: Understanding REF: p. 413 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. A 70-year-old person who has Medicare Part A only is discussing the cost of health care with

a nurse. The nurse understands that Medicare Part A covers the cost of which of the following? (Select all that apply.) a. Diabetic testing supplies b. Acute hospitalization semiprivate rooms c. Intensive care unit hospitalization d. Skilled rehabilitative nursing care in a health care facility e. Prescription medications ANS: B, C, D

Medicare Part A covers the cost of acute hospitalization semiprivate rooms and any necessary medical services and supplies, which include intensive care unit costs. It covers the costs of skilled rehabilitative nursing care in a health care facility. The first 20 days are covered at 100%, days 21 to 100 with a daily co-pay of over $10, and there is no coverage after 100 days.

Diabetic testing supplies are covered under Medicare Part B and prescription medications are covered under Medicare Part D. DIF: Cognitive Level: Understanding REF: p. 412, Box 30-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. An older adult asks a nurse, “I saw an advertisement and went to a free breakfast to hear about

Medicare Advantage Plans. They sound really good, but I am not sure. Are there benefits to joining one?” The nurse relies on which of the following information when formulating a response? (Select all that apply.) a. All Medicare advantage plans have prescription drug coverage. b. Medicare advantage plans must cover all services traditionally covered by Medicare Parts A and B. c. There are no deductibles in Medicare Advantage plans. d. Medicare advantage plans may provide a cost savings to the member. e. Members must obtain a referral to see a specialist from an assigned primary care provider.

ANS: B, D, E

Medicare Advantage Plans (MAPs), or Medicare Part C, use a prospective payment system and includes traditional health maintenance organizations (HMOs) and other managed care plans. All traditional services covered by Medicare Parts A and B must be provided, and additional services, co-pays, and deductibles are predetermined. Medicare Advantage Plans may or may not provide prescription drug benefits. MAPs may provide a cost savings to the member as well as extra benefits. However, special rules must be followed, including the requirement that no care is obtained without a referral from an assigned primary care provider.

DIF: Cognitive Level: Understanding REF: p. 412 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

Chapter 31: Common Legal and Ethical Issues Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A nurse suspects that her next-door neighbor, an older woman, is a victim of elder abuse by

her daughter. What is the appropriate action for the nurse to do in this situation? a. Because the neighbor is not a patient, the nurse should not get involved. b. Visit the neighbor frequently to confirm the suspicions. c. Complete a confidential report with the adult protective services in the area. d. Ask the neighbor herself if she is being abused.

ANS: C

The best action is to make a confidential report with the local adult protective agency.

Suspected cases should be reported at once to the agency, which will send a trained investigator to determine whether an abusive or imminently dangerous situation exists and will be able to offer safety to the victim and resources to the relatives and family members. In some states with mandatory reporting, failure to report suspicions may result in civil and/or criminal penalties. Also in states with mandatory reporting, the nurse can be held liable for civil and criminal penalties for failure to report suspected cases of abuse. In states without mandatory reporting, it becomes an ethical issue if the nurse is aware of suspected abuse and does not report it. Making a personal investigation will not obtain a safe environment for the neighbor in a timely manner. Asking the neighbor about abuse will not quickly obtain a safe environment or help if needed.

DIF: Cognitive Level: Applying REF: p. 424 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. The nurse is providing care to a client diagnosed with dementia. What option is an example of

the appropriate use of implied consent by the nurse? a. Preparing to draw blood from a client’s arm after asking, “Can I see your arm?” b. Changing the client’s dressing when the client asks, “Will you change this bandage now?” c. Using the client’s monthly allowance to buy a watch when he continuously asks for the time d. Arranging for a benign mole to be removed after the client states, “I don’t like this here.”

ANS: B

The correct option demonstrates the client’s willing to have a low-risk procedure completed.

The remaining options, especially the one dealing with a surgical procedure, lack the element of client cooperation and/or understanding in the decision-making process.

DIF: Cognitive Level: Applying REF: p. 423 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. Which option is an example of elder exploitation? a. A homebound client is left alone for days at a time by the caregiver.

b. An older client is smacked if he doesn’t eat all of his food. c. A client diagnosed with Alzheimer’s disease is bathed only twice a month. d. A homebound client can only get groceries by agreeing to pay for her neighbor’s

groceries, too.

ANS: D

In elder mistreatment by exploitation, the abuser takes advantage of the older person for monetary or personal benefit. In this case, the client is being coerced to buy her neighbor’s groceries. Abandonment is defined as the desertion or willful forsaking of an older person.

Abuse is any action or inaction harming or endangering the welfare of an older adult. The definition of neglect involves failure to provide adequate care or services for an older adult.

DIF: Cognitive Level: Applying REF: pp. 419–421 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. A frail, elderly widow is admitted to the hospital after sustaining a fall. The client lives alone

and has no living relatives. After cognitive testing reveals mild cognitive impairment, the interdisciplinary team on the Acute Care for the Elderly Unit recommends long-term care placement and that a durable power of attorney for health care (DPOA-HC) be established.

When the client seems confused over what a DPOA-HC’s responsibilities are, the nurse responds that: a. “A DPOA-HC is a person you name to make health care decisions for you when you can’t make them for yourself.” b. “A DPOA-HC is a person you trust to make financial decisions for you and to manage your money.” c. “A DPOA-HC is a person appointed by the court to make sure you get good care and to manage your affairs.” d. “A DPOA-HC is a person who is appointed by the court to make nursing home placement decisions for your care.”

ANS: A

A person designated by the individual to make health care decisions when the individual is not able is the definition of durable power of attorney for health care. A power of attorney is a person designated by the individual to make financial decisions when the individual is not able to or at his or her request. The definition of a guardian is a person appointed by the court to have care, custody, and control of a disabled person and to manage personal and/or financial affairs. A guardian is able to make many more decisions than just nursing home placement decisions.

DIF: Cognitive Level: Applying REF: pp. 418–419 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. Which of the following statements made by a family caregiver would a nurse consider most

indicative of elder abuse? a. “I get so frustrated because my father used to be so competent and now cannot even feed himself.” b. “Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills.” c. “My dad wanders at night and I can’t be bothered with him. I mix sleeping pills in

his dinner so that he will fall asleep.” d. “Mom asks me to do everything for her, but I think it is better if she keeps on

doing as much as she is capable of.”

ANS: C

Option c is an example of elder mistreatment. While wandering is a serious concern, surreptitiously administering sleeping pills is not the best response to this situation and is indicative of elder mistreatment. All of the other situations described are difficult; however, there is no indication of abuse.

DIF: Cognitive Level: Analyzing REF: pp. 419–420 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 6. An older woman tearfully tells a nurse, “I must buy my neighbor all of his groceries, or he

will not drive me to the store or the doctor.” This is an example of which type of elder mistreatment? a. Financial exploitation b. Psychological abuse c. Caregiver neglect d. Abandonment ANS: A

Financial exploitation involves taking advantage of an older person for monetary gain.

DIF: Cognitive Level: Applying REF: pp. 420–421 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. When a cognitively impaired, wealthy, white client is noted to have burns on her upper back,

her son states that the patient burned herself when attempting to shower. Which statement by a member of the team reflects a need for further education on elder abuse? (Select all that apply.) a. “She is wealthy; abuse does not happen in people of financial means.” b. “Even if we are not sure, we are legally bound to report our suspicions.” c. “We need to consider that most abusers are either adult children or spouses.” d. “Her cognitive deficiencies put her at risk for elder abuse.” e. “The client is white and race places an important role in who is likely to be abused.”

ANS: A, E

Elder abuse occurs among all races and socioeconomic groups in the United States. All suspected incidences of elder abuse should be reported, even if it is just a suspicion. Most abuse occurs in the home setting, the majority of abusers are spouses or children, and the risk of abuse increases with increased dependency of the elder.

DIF: Cognitive Level: Applying REF: p. 420 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

2. A nurse is preparing education for a group of older adults and caregivers at a senior center on

elder abuse. The nurse is preparing to discuss seniors who are more likely to be abused or neglected. The nurse includes which of the following? (Select all that apply.) a. Individuals with cognitive impairment b. Individuals who abused the caregiver earlier in life c. Individuals who live in an institutional setting d. Individuals who are married and living with a spouse e. Men living alone or in a household with family members ANS: A, B, C

Individuals who are living alone are more likely to be abused. Women who are living alone or in a household with family members are more likely to be abused than are men.

DIF: Cognitive Level: Remembering REF: p. 420, Box 31-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. A nurse working in an emergency department is caring for an 89-year-old woman who was

brought to the hospital by her daughter for a fracture of the right arm. The woman is wheelchair dependent and lives with her widowed daughter who is the primary caregiver. The daughter states that her mother got up out of the wheelchair unassisted to go to the bathroom and fell. The patient cannot recall the circumstances of the fall. The patient is weeping and cradling her right arm. The patient’s history reveals two previous wrist fractures over the course of the past year. The nurse notes several large ecchymotic areas on the right hand and left arm and on the left side of the body and the back. The ecchymoses are in various stages of healing. Upon assessment, the patient is non-weight-bearing (NWB). The nurse suspects physical abuse based on which of the following findings? (Select all that apply.) a. Bruises are in various stages of healing. b. The fracture is inconsistent with the patient’s functional ability. c. Caregiver suffering stress from caring for a functionally-dependent individual. d. Patient is crying. e. Patient has a history of previous wrist fractures.

ANS: A, B

Specific signs of physical abuse include unexplained bruising or lacerations or those in unusual areas in various stages of healing, and fractures inconsistent with functional ability.

This patient has many bruises in different areas all in various stages of healing, which leads one to believe that they were sustained at different times. The patient is NWB, so the daughter’s statement that she fell while getting out of the wheelchair to go the bathroom does not match the patient’s functional abilities. While there could be caregiver stress in this situation, the scenario does not mention it. While the patient’s crying is concerning, it could be due to many other factors, including pain. A previous history of wrist fractures is concerning as well, but there are many other possible reasons for repeated fractures.

DIF: Cognitive Level: Analyzing REF: p. 424, Box 31-16 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. A nurse suspects elder mistreatment in which of the following patients seen in the emergency

department? (Select all that apply.)

a. An 85-year-old male with cardiac disease who is taking blood thinners and has

multiple bruises on his arms and hands b. An 86-year-old female nursing home resident admitted to the hospital with vaginal

bleeding and three large bruises on her inner thigh c. A 77-year-old woman who fell at home and broke her arm after tripping over her

cat d. A 73-year-old man with a history of gastric ulcers who is vomiting blood and found to be anemic and has a low BMI e. A 69-year-old man with a history of diabetes who is admitted for diabetic foot ulcers wearing dirty clothing and smells like urine ANS: B, E

An 86-year-old female nursing home resident admitted to the hospital with vaginal bleeding and three large bruises on her inner thigh has the signs of sexual abuse. The 69-year-old man with a history of diabetes who is admitted for diabetic foot ulcers and is wearing dirty clothing and smells like urine has the signs of neglect (either self or caregiver). The remaining patients do not exhibit the signs of elder mistreatment.

DIF: Cognitive Level: Applying REF: p. 424 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

Chapter 32: Long-Term Care Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Which intervention addresses a right guaranteed a long-term care facility resident? a. Ethnic foods are made available to culturally diverse residents who would like

them. b. Each resident has access to a telephone in his or her room. c. Family members are welcome at any time. d. A professional hairdresser is available 3 days a week.

ANS: C

The Bill of Rights for Long-Term Care Residents includes the right to immediate visitation and access at any time for family, health care providers, and legal advisors and the right to reasonable visitation and access for others. While generally provided, the remaining interventions are not directly related to the guaranteed rights.

DIF: Cognitive Level: Applying REF: p. 437, Box 32-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. Which statement made by the resident of a long-term care facility is evidence that the facility

is providing care in accordance with the Bill of Rights for Long-Term Care Residents?

“It’s so nice to have my hometown newspaper available here.”

“Going out to the theater with the other residents is a nice social activity.”

“I was told that if I didn’t want to change rooms, I didn’t have to.”

“The whole place was decorated so beautifully for the holidays.”

a. b. c. d.

ANS: C

The Bill of Rights for Long-Term Care Residents assures the individual the right to be transferred only for appropriate reasons as indicated by the correct option. While positive in nature, the remaining statements are not directly related to any of the guaranteed rights.

DIF: Cognitive Level: Applying REF: p. 437, Box 32-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. Which statement made by a nurse regarding a resident of a long-term care facility requires

followup by the nurse manager? a. “If he doesn’t take his medication, he’ll get no dessert tonight.” b. “She can’t take a walk outdoors today; it’s much too cold and snowy.” c. “The grandchildren have colds so they should not visit this week.” d. “I don’t understand why, but she wants a different doctor to see her.”

ANS: A

The Bill of Rights for Long-Term Care Residents assures the individual the right to be free of any form of abuse. Using a threat to gain the resident’s cooperation is a form of verbal/emotional abuse and must be addressed by the nurse manager. The client may indeed request a change in medicine providers, even if the staff is unaware of the reasoning behind the request. The remaining statements related to resident safety, not the denial of their guaranteed rights.

DIF: Cognitive Level: Applying REF: p. 437, Box 32-12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. An older married couple is considering selling their home and moving into a continuing care

retirement community (CCRC). The major benefit of a CCRC is: a. they provide affordable living for older adults. b. they have all levels of care in one location, allowing community members to easily transition between levels. c. they are paid for by Medicare. d. they allow the older adult’s family to retain ownership of the property after the owner dies.

ANS: B

A major benefit of a CCRC is that it has all levels of care in one location, which allows community members to make the transition between levels without life-disrupting moves.

Costs of a CCRC can range greatly from an affordable rate to a very large amount of money.

The cost of a CCRC is not covered by Medicare. In the majority of the CCRCs, the property reverts back to the community after the death of the owner.

DIF: Cognitive Level: Understanding REF: p. 432 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. An older adult is considering residential care/assisted living (RC/AL). The nurse knows that

the older adult needs additional teaching when the older adult states which of the following? a. “I read a recent article that stated that almost half of older adults would move to an assisted living community if they could no longer care for themselves.” b. “I am happy that Medicare pays for the cost of living in an RC/AL.” c. “I will have to check with my long term care insurance company. I heard that it might pay for RC/AL.” d. “RC/AL costs significantly less than nursing home care.”

ANS: B

Medicare does not cover the cost of RC/AL. All of the other statements are true.

DIF: Cognitive Level: Understanding REF: p. 433 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which nursing evaluation supports the fact that the goals of long-term client care have been

achieved? (Select all that apply.)

a. b. c. d. e.

Resident has participated in bath with minimal assistance from the staff.

Resident has experienced no falls since admission 3 months ago.

Resident continues to show loss of strength in upper extremities.

Resident is not required to dress or feed self since assistance is always available.

Resident demonstrates improved weight bearing on affected leg; discharge to be considered.

ANS: A, B, E

Goals of long-term care include providing a safe and supportive environment for chronically ill and functionally dependent people; restoring and maintaining the highest practicable level of functional independence; and providing coordinated interdisciplinary care to residents who plan to return to home. The remaining options show loss of function that is likely preventable and an environment that does not support autonomy and independence.

DIF: Cognitive Level: Applying REF: p. 430, Box 32-3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. A nurse is discharging an older patient after a hospitalization for a hip fracture. The patient is

a participant in a Program for All Inclusive Care for the Elderly (PACE). The nurse understands that a PACE program: (Select all that apply.) a. provides services to older people who would otherwise need a nursing home level of care. b. does not provide services to participants who reside in a nursing home. c. is only available to individuals who have both Medicare and Medicaid. d. provides medications, eyeglasses, and transportation to care. e. provides urgent and preventive care.

ANS: A, D, E

This program is a Medicaid and Medicare program that provides community services to people age 55 or older who would otherwise need a nursing home level of care. Participants must meet the criteria for nursing home admission, prefer to remain in the community, and be eligible for Medicare and Medicaid. The majority of PACE participants reside in the community; however, the program will pay for nursing home care. If the individual has Medicaid, he or she will not have to pay a monthly premium for the long-term care portion of the PACE benefit. If the individual does not qualify for Medicaid but has Medicare, there will be a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Part D Medicare drugs. PACE provides a comprehensive continuum of primary care, acute care, home care, adult day health care, nursing home care, and specialty care by an interdisciplinary team. PACE is a capitated system in which the team is provided with a monthly sum to provide all care to the enrollees, including medications, eyeglasses, and transportation to care as well as urgent and preventive care.

DIF: Cognitive Level: Understanding REF: p. 432 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. An older patient with dementia is referred for adult day services (ADS). The patient’s

daughter asks the nurse about the benefits of ADS. The nurse considers which of the following in formulating a response? (Select all that apply.) a. ADS are designed to provide social and some health services for older adults.

b. c. d. e.

ADS are covered under Medicare Part B. ADS offer respite services for caregivers from the responsibilities of caregiving.

ADS often provide educational programs and support groups for caregivers.

ADS are all staffed with registered nurses.

ANS: A, C, D

Adult day services are community-based group programs designed to provide social and some health services to adults who need supervised care in a safe setting during the day. They also offer caregivers respite from the responsibilities of caregiving, and most provide educational programs, support groups, and individual counseling for caregivers. Some ADS are private pay, and others are funded through Medicaid home and community-based waiver programs, state and local funding, and the Veterans Administration. While most ADS do have professional nursing staff, there is no mandate that they do.

DIF: Cognitive Level: Understanding REF: p. 432 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. Factors that are influencing the decrease in nursing home beds in the United States include:

(Select all that apply.) a. an increase in the use of residential care facilities. b. a shortage of certified nursing assistants (CNAs). c. increased Medicaid reimbursement for community-based care alternatives. d. a shortage of Registered Nurses who are certified in gerontology. e. the high cost of care in a nursing home.

ANS: A, C

The number of nursing home beds is decreasing in the United States as a result of the increased use of residential care facilities and more reimbursement by Medicaid programs for community-based care alternatives. However, in most areas of the country, the supply and use of nursing homes is still greater than those of other long-term care services options. While there is a shortage of certified nursing assistants as well as RNs who are certified in gerontology, this does not account for the decrease in nursing home beds in the United States.

The cost of care in a nursing home is high; however, that is not the driving factor in the decrease in the number of nursing home beds in the United States.

DIF: Cognitive Level: Understanding REF: p. 434 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. Differences between subacute care and long term care include which of the following? (Select

all that apply.) a. Subacute care is more costly than long term care. b. Patients who receive subacute care have a usual length of stay of 1 month; long term care patients have an indefinite length of stay. c. Medicare covers the costs of both subacute and long term care. d. Subacute patients tend to be younger and more cognitively intact. e. Subacute care is usually delivered in a hospital setting and long term care in a nursing home setting.

ANS: A, B, D

Subacute care is more intensive than traditional nursing home care and several times more costly. For subacute patients, the expectation is that the patient will be discharged home or to a less intensive setting, and the length of stay is usually 1 month or less. Subacute care is largely reimbursed by Medicare. Patients in subacute units are usually younger and less likely to be cognitively impaired than those in traditional nursing home care. Both subacute and long term care are delivered in a nursing home setting.

DIF: Cognitive Level: Understanding REF: p. 434 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

Chapter 33: Intimacy and Sexuality Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. The partner of a client comments, “Our sex life will certainly suffer now that he’s had a heart

attack.” Which statement is the basis for the nurse’s response? a. The client should no longer have sexual relations because of the demand on his heart. b. The energy expenditure during sex is equivalent to briskly climbing six flights of stairs. c. People with heart disease reduce their sexual activity out of fear of their condition. d. The couple will benefit from attending a cardiac support group.

ANS: C

Many individuals are not given adequate information regarding the impact of illness on sexual relations and therefore are fearful and reduce sexual activity. Changes might be needed in order to accommodate the illness, but curtailing sexual relations is not necessary. The energy expended during sex is not equivalent to briskly climbing six flights of stairs. And while the couple may benefit from attending a support group, that fact does not address the immediate situation.

DIF: Cognitive Level: Applying REF: pp. 453–454 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. Based on recent studies, which statement regarding touch and touch zones is most accurate? a. People between the ages 66 and 100 are the most often touched. b. Newly graduated nurses tend to touch clients less often than do nursing students. c. When performing peri-care, the nurse is working within the zone of intimacy. d. The comfort of touch depends on place, situation, social status, and age.

ANS: D

The comfort of touch depends on the location, situation, social status, and age. Older adults are frequently isolated and are not touched. There is no evidence to support the statement that graduate nurses touch patients less than nursing students. The zone of intimacy is within an arm’s length of the individual, and it is the space used for comforting, protecting, and lovemaking.

DIF: Cognitive Level: Applying REF: pp. 445–447 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. Which outcome regarding the effects of touch on the skin is not supported by current

research? a. Brings about sensory stimulation b. Helps relieves physical and psychosocial pain c. Is known to reduce anxiety and tension d. Improves skin integrity

ANS: D

There is no evidence that therapeutic touch improves skin integrity. There is research to support the remaining options.

DIF: Cognitive Level: Understanding REF: p. 447 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 4. Which question has priority when assessing a client for risk factors related to the use of

sildenafil (Viagra)? a. “How old are you?” b. “Are you currently being treated for hypertension?” c. “Do you have a history of respiratory infections?” d. “Have you ever been told you have prostate problems?”

ANS: B

The use of phosphodiesterase inhibitors (PE5s) such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) might be contraindicated when a client is taking certain antihypertensive medications.

DIF: Cognitive Level: Applying REF: p. 451 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 5. Symptoms of HIV are often under-recognized in older adults because: a. there is a very low incidence of HIV in older adults. b. many of the classic symptoms are also common to other conditions common in

older adults. c. presenting symptoms are markedly different from those in younger adults. d. AIDS progresses much slower in older adults so symptoms are not recognized easily.

ANS: B

The classic symptoms of weakness, anorexia, and fatigue are common to other conditions common in older adults; additionally, they may also be attributed to normal age-related changes. The incidence of AIDS in older adults is increasing, rising faster among older adults than among younger adults. The symptoms are identical in older and younger populations.

AIDS progresses more quickly in older adults than it does in younger adults.

DIF: Cognitive Level: Applying REF: p. 457 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 6. What intervention should a nurse implement when an older male diagnosed with dementia is

observed masturbating in the unit’s dayroom? a. Remove the resident from the dayroom and complete an assessment of his behavior. b. Cover the resident’s lap with a blanket and leave him in the dayroom. c. Counsel the resident by telling him that his behavior is inappropriate. d. Distract the resident so that he will stop the behavior.

ANS: A

When sexually inappropriate behavior occurs, it should be assessed, like any other behavior, as to cause, precipitating factors, and response to interventions. It is appropriate to remove the resident from the dayroom because the behavior may be distressing to staff and other residents.

Covering the resident with a blanket and leaving him in the dayroom does not address the cause of the behavior, and it might be distressing for other residents and staff. The resident has dementia and is not capable of altering his behavior based on the information that it is inappropriate. Distracting the resident will only temporarily interrupt the behavior.

DIF: Cognitive Level: Applying REF: p. 456 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 7. An older widow who is a newly admitted resident of a long-term care facility develops a

romantic relationship with a male resident. When the resident’s daughter demands that the staff “put a stop to this sexual behavior right now,” the nurse’s response is based on the understanding that: a. such activity in a long-term care facility is inappropriate. b. older adults need to express love and intimacy. c. sexual desire is usually absent in older adults. d. sexual activity can be dangerous for older adults with chronic illnesses.

ANS: B

The needs of older adults for love and intimacy remain the same regardless of whether the individuals are institutionalized. Meeting the needs of the residents for sexuality and intimacy is as important as the need for food and hydration. Sexual desire is present in older adults.

Sexual activity is not dangerous for older adults. Some accommodations for chronic conditions might be required.

DIF: Cognitive Level: Applying REF: p. 455 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 8. Which intervention has priority before touching a client’s consent zone? a. Draping the area to minimize exposure b. Having another nurse present c. Explaining why the area will be touched while asking permission d. Assuring the client that the touch is absolutely necessary ANS: C

The consent zone requires the nurse to seek out or ask permission to touch or initiate procedures to these areas. The touch should not occur unless it is absolutely necessary.

Draping is appropriate but doesn’t occur until permission is granted. Having another nurse present is not always necessary unless the touch is by a male nurse upon a female client.

DIF: Cognitive Level: Applying REF: p. 446 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

1. A nurse practitioner is using the PLISSIT model to guide a discussion of sexuality with an

older patient in the geriatric clinic. Which of the following are congruent with the PLISSIT model? (Select all that apply.) a. “What concerns or questions do you have about fulfilling your sexual needs?” b. “Let me tell you about the impact of your cardiac disease on sexual activity.” c. “I have a few suggestions on lubricants that might make intercourse more comfortable for you.” d. “Most older adults are not comfortable talking about sexuality, but it is important to do so.” e. “It is not unusual to have difficulty performing sexually as you age.”

ANS: A, B, C

The PLISSIT model is a helpful guide for discussion of sexuality with older adults. The steps of the model are Permission: Obtain permission from the client to initiate sexual discussion, Limited Information: Provide the limited information to function sexually, Specific Suggestions: Offer suggestions for dealing with problems, Intensive Therapy: Refer as appropriate for complex problems that require specialist intervention. Option A falls into the permission step, option B falls into the limited information step, and option C falls into the specific suggestion step. Options D and E do not fall into any of the steps of this model.

DIF: Cognitive Level: Applying REF: p. 459 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 2. An older man who recently had a myocardial infarction is being discharged home from the

hospital. He tells a nurse, “I am really worried about having sex with my wife. I am afraid that I am going to have another heart attack.” The best response by the nurse includes which of the following? (Select all that apply.) a. “If you are able to engage in mild to moderate physical activity without symptoms, you can resume sexual activity.” b. “You really should not engage in sexual activity until 3 months have passed post heart attack.” c. “It is best if you avoid eating a large meal for several hours before you have sexual relations.” d. “If you have chest pain while having sex, stop and rest, and take your nitroglycerin.” e. “You might want to consider some alternate positions that avoid strain.”

ANS: A, C, D, E

Individuals who are post MI who are able to engage in mild to moderate physical activity without symptoms can generally resume sexual activity; those with a complicated MI may need to resume sexual activity gradually over a longer period of time. Suggestions include avoiding large meals several hours before sex and suggesting alternative positions to avoid strain. If the individual does experience chest pain, it is important to stop and rest if he or she feels chest pain, take nitroglycerin if prescribed, and seek emergency treatment for sustained chest pain. There is no reason to wait 3 months post MI to resume sexual activity.

DIF: Cognitive Level: Applying REF: p. 453, Table 33-2 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

3. Two older residents of a long term care facility are engaged in a romantic relationship. The

residents are both cognitively intact. A nurse finds the two residents engaging in sexual activity. The response of the nurse includes which of the following? (Select all that apply.) a. Inform the residents that they cannot engage in a sexual relationship while they are residents of the facility. b. Provide a safe private area where the residents can engage in sexual activity. c. Ignore the residents’ activity. d. Provide education for the residents using the PLISSIT model. e. Contact the family members of the residents in order to get consent from them.

ANS: B, D

Residents in a long term care facility have the right to engage in sexual activity. The role of the nursing staff is to provide a safe and private area for the residents and to provide education on safe sexual practices and be open to answering questions and providing information to the residents. Ignoring the residents’ activity is not an appropriate response. Calling the residents’ family members is also not appropriate as they are cognitively intact and able to make their own decisions.

DIF: Cognitive Level: Applying REF: p. 455 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

Chapter 34: Relationships, Roles, and Transitions Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Which of the following reactions to the loss of a spouse or long-term partner is a unique

example of older adult male bereavement? a. Withdrawing from friends and family b. Remarrying within months of the loss c. Focusing on “doing” rather than “feeling” d. Experiencing moderate to severe depression ANS: B

Bereaved males may be more socially and emotionally vulnerable. Widowers adapt more slowly than widows to the loss of a spouse and often remarry quickly. The remaining options reflect reactions that are typically seen in both grieving men and women.

DIF: Cognitive Level: Applying REF: p. 465 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. Which question will best assess the ability of the LGBT older couple to successfully adjust to

the challenges of aging? a. “How long have you been in this relationship?” b. “Have you experienced prejudice and discrimination in your life?” c. “As a couple are you financially secure?” d. “Do you as a couple share similar religious beliefs?”

ANS: B

Some research has suggested that this population may adapt more successfully to old age as a result of successful coping over a lifetime with discrimination and prejudice. While the remaining options are positive factors, they do not have the same degree on influence on the development of coping skills that the correct option has.

DIF: Cognitive Level: Applying REF: pp. 469–470 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. When acting as a fictive kin, in which activity will a paid caregiver engage? a. Being responsible for paying the client’s bills b. Organizing the client’s birthday celebration c. Accompanying the client to doctor’s appointments d. Assuring the client has clean, appropriate clothing available ANS: B

Fictive kin are nonrelatives who become surrogate family members. These individuals take on instrumental and affectional attributes of family such as described in the correct option. The remaining options lack the element of affection and familial concern.

DIF: Cognitive Level: Applying REF: p. 471 TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity 4. A widowed grandmother is about to assume the role of custodial parent for her 6-year-old

grandchild. Which intervention has priority when preparing the grandmother for long-term success in this new role? a. Reviewing the developmental milestones of childhood b. Identifying local sources of child counseling services c. Discussing the common challenges of parenting a 6-year-old d. Teaching stress management and relaxation techniques ANS: D

Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning with the stress increasing over time. The introduction of the skills identified in the correct option will serve to improve and maintain the family’s quality of life. While the remaining options are appropriate, they lack attention to the long-term, fundamental barrier to a successful transition into this new role.

DIF: Cognitive Level: Applying REF: p. 476 | p. 478 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. Which behavior suggests that an older adult who has lost his life partner is successfully

managing the exploration stage of the adjustment process? a. He smiles when reminiscing about the trips they took together over the years. b. He explains that he can’t make a decision about moving “just yet.” c. He agrees to eat some of his “favorite soup” that his daughter has made. d. He is heard saying, “I’ll never get over the loss, but my life has a purpose.”

ANS: A

The exploration stage is characterized by the ability to accept the loss and look back fondly upon it. The reactionary stage would be a time when indecision is typical. During the withdrawal stage, eating is often affected. Integration is successful when the individual again shows satisfaction with his life.

DIF: Cognitive Level: Applying REF: pp. 465–466 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 6. Which activity would a couple in the reorientation phase of their retirement engage in? a. Establishing a new budget that will allow them to travel to see the grandchildren b. Reading magazines devoted to making decisions about retirement plans c. Looking for ways to “fill up the days” d. Volunteering at the local animal shelter ANS: A

The reorientation phase is one where the couple is developing a realistic and satisfactory lifestyle that would include the opportunity to travel. The near phase includes both planning and fantasizing about the retirement. The disenchantment phase is where the couple deals with letdown and boredom, while the engagement in meaningful activities such as volunteering occurs in the stability phase.

DIF: Cognitive Level: Applying

REF: p. 465, Box 34-1

TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 7. Which nursing intervention best addresses the need for social support demonstrated by an

older adult couple who will be assuming responsibility for the raising of two grandchildren? a. Facilitating a support group for children being raised by grandparents b. Helping the grandparents express their feeling regarding this unexpected role change c. Offering a monthly parenting class for this cohort of grandparents d. Suggesting couple’s therapy to assist in managing any new stress on their marriage ANS: C

Primary care grandparents with a network of social support seem to experience fewer negative consequences, but instrumental supports such as assistance with child rearing are often lacking. Education and training programs and support groups are valuable resources, and nurses can be instrumental in developing and conducting these types of interventions. While the remaining options are appropriate, they do not focus on the needs that are identified as currently unaddressed.

DIF: Cognitive Level: Applying REF: pp. 475–476 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which statements made by a couple who have recently retired support the nurse’s evaluation

that the transition to retirement has been a successful one? (Select all that apply.) a. “I’m afraid we can’t make it that weekend; we’ll be visiting the grandchildren.” b. “I’m not accustomed to sharing my kitchen with anyone else.” c. “One week I was working 50 hours and the next I didn’t have to get up until noon.” d. “I often wonder if my buddies from the plant miss me.” e. “We have found a few painless ways to reduce our monthly expenses.”

ANS: A, E

The correct options demonstrate a sense of purpose and adjustment to the realities of retirement and so that the transition has been a successful one. The remaining options suggest that the couple is not adjusting well to having each other around so much and involved in activities they previously used as being theirs alone. Feeling lonely or abandoned is also a sign of ineffective adjustment. A transition into a retirement rather than an abrupt one is also a barrier to a successful adjustment into retirement.

DIF: Cognitive Level: Applying REF: p. 464 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. Which intervention demonstrates effective care for an individual who has expressed a wish to

“retire sometime soon”? (Select all that apply.) a. Asking about when she plans to retire b. Assessing her ability to handle the stresses of retirement c. Engaging her in a conversation about her interests

d. Inquiring about the existence of any chronic illnesses e. Scheduling a full physical examination ANS: A, B, C, D, E

Talking with clients about retirement plans, providing anticipatory guidance about the transition to retirement, identifying those who may be at risk for boredom and health concerns, and referring to appropriate resources for retirement planning and support are important nursing interventions. The client could also take this time to consider prevention and lifestyle changes, which can be identified by scheduling a full physical examination.

DIF: Cognitive Level: Applying REF: pp. 464–465 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. An older woman is preparing to move in with her daughter following the death of her spouse

of 55 years. The daughter asks a nurse, “I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?” The nurse responds: (Select all that apply.) a. “Have you chosen an area of the house for your mom to live in?” b. “Have you considered scheduling regular visits for your mom with your sister who lives out of state?” c. “You have every right to be nervous; multigenerational households are usually not successful.” d. “Have you investigated what activities are available at the senior center near your home?” e. “Since your mom is so computer literate she can stay in touch with her friends when she moves.”

ANS: A, B, D, E

There are some important modifications that may need to be made when adding an older person to the household, which include arranging semiprivate living quarters if possible, scheduling regular visits to other relatives to give each family time for respite and privacy, and arranging senior activities for the older person to help keep contact with members of his or her own generation. It is important to consider how the older person will feel about giving up familiar surroundings and friends. There are a growing number of intergenerational families.

DIF: Cognitive Level: Understanding REF: p. 468, Box 34-5 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

Chapter 35: Loss, Death, and Palliative Care Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Which behavior is characteristic of grief by a disenfranchised adult child in response to a

parent’s death following a lengthy, painful illness? a. Crying out loudly while invoking “God’s help” to go on with life b. Announcing to family members, “I’ve already grieved the loss.” c. Having difficulty even deciding what to wear to the funeral d. Going on a drinking binge instead of attending the funeral ANS: D

The individual is exhibiting disenfranchised grief since situations have distanced him or her from the family, making grieving openly impossible. Pathological grief begins with a normal grieving process, but obstacles interfere with a normal evolution toward adjustment, causing reactions to be exaggerated. Anticipatory grief is a response to a real or perceived loss before the loss occurs. Acute grief is a crisis; it is a syndrome of physical and psychological symptoms of distress, often accompanied by functional disruption.

DIF: Cognitive Level: Applying REF: p. 486 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. When working with a bereaved individual, the goal of nursing interventions is to: a. assist the individual to go through the stages of grief work in the optimal order. b. assist the individual to attain a healthy adjustment to the loss experience. c. encourage the individual to talk about his or her feelings about the deceased

individual. d. offer support and advice about how to successfully achieve grief work.

ANS: B

The goal of nursing interventions when working with bereaved individuals is to help them adjust in a healthy manner. There is no optimal order in which to experience grief. Not all individuals are able to talk about their feelings, nor is it helpful for everyone. The role of nursing is to offer support, but not advice.

DIF: Cognitive Level: Understanding REF: p. 488 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. Which truism will the nurse base spousal grief counseling upon? a. Men are less likely to grieve the loss of a spouse. b. Women carry deeper attachments to their spouses than men do. c. Women are generally more likely to outlive their spouses. d. The male response to grief has been thoroughly studied and documented.

ANS: C

Three out of four women will be widowed at some point because women tend to live longer than men and frequently marry older men. There is no evidence that men grieve less than women; men and women grieve in different manners. It has not been found to be true that women carry attachments to their spouses that are less deep than men’s attachments. Male response to grief has not been studied as thoroughly as that of women; the abundance of literature on this topic deals with women.

DIF: Cognitive Level: Applying REF: pp. 483–486 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. A woman is terminally ill. Although it has never been discussed in the family or stated

outright by her physician, she is growing to believe that she will die because of her illness.

Upon which concept will the nurse base therapeutic intervention on? a. Closed awareness b. Suspected awareness c. Mutual pretense d. Open awareness ANS: B

In suspected awareness, the patient suspects that she is dying; however, it is never openly discussed. With closed awareness, the patient does not know that she is dying; it is kept secret.

With mutual pretense, there is a “let’s pretend” atmosphere, where real feelings are kept hidden. Open awareness acknowledges the reality of the approaching death.

DIF: Cognitive Level: Applying REF: pp. 491–492 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. The nurse suspects that the spouse of a terminally ill client is experiencing anticipatory grief

when he : a. dramatically reduces the time he spends attending to the client. b. refuses to leave the client’s bedside regardless of the reason. c. sobs inconsolably whenever he visits. d. spends hours recalling details of their life together.

ANS: A

Anticipatory grief is the response to a real or perceived loss such as in anticipation of the death of a loved one. Behaviors that may signal anticipatory grief include a sudden change in attitude toward the thing or person to be lost. The other options are characteristics of normal grieving.

DIF: Cognitive Level: Applying REF: p. 484 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 6. The nurse sits at the bedside of a comatose, terminally ill older client reading the wishes

expressed in the numerous cards the client has received. Which concept of grief work is the nurse addressing with this intervention? a. Everyone needs social interaction. b. The nurse needs to “attend to the patient.”

c. Hearing is believed to be the last sense to be lost. d. The individual is living until he or she is dead.

ANS: D

An individual is living until he or she has died; the nurse works with the older adult and significant others to maintain as high a quality of life as possible before, during, and after the loss or death. While the other options are true they are not directly involved in grief work.

DIF: Cognitive Level: Applying REF: p. 499 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 7. A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to

eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, the nurse should: a. explain the family’s concern to the client. b. educate the family that this is normal behavior in this situation. c. contact the physician for an order for enteral feeding. d. contact the dietitian for feeding supplements.

ANS: B

The nurse should educate the family that this is a normal part of the dying process and should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying.

Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on.

DIF: Cognitive Level: Applying REF: p. 498, Table 35-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 8. Which principle regarding grief crisis intervention is the basis for intervention planning? a. The acute phase is the most intense period of the grieving process. b. The intensity of the grief is in proportion to the expected death trajectory. c. Grief work is most effective when addressed during the acute phase of grief. d. Anticipatory grief is an expected barrier to grief work.

ANS: C

The acute phase is usually the peak time of stress and anxiety as the life and future of the individual and the family are thrown into disequilibrium. Crisis intervention is most effective here because the individual, family, and caregivers are struggling to come to terms with the knowledge. While the other options are true, they are not as directly related to intervention planning.

DIF: Cognitive Level: Applying REF: p. 483 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE

1. Which intervention is an example of countercoping for a client who has recently received a

terminal diagnosis of cancer? (Select all that apply.) a. Answering the client’s questions regarding the trajectory of his or her illness b. Offering to pray with the client and family c. Scheduling a meeting with the client and family to identify alternative end-of-life plans d. Assessing the client frequently for depression and risk of self-harm e. Being available to just listen to the client talk about dying ANS: A, C, D, E

One of the strategies of countercoping includes clarification and control. The nurse helps cope with loss and dying by helping individuals confront the loss by getting or receiving information, considering alternatives, and finding a way to make the grief manageable. The nurse helps persons resume control by encouraging them to avoid acting on impulse. It is not an acceptable practice to initiate such an intervention as asking the client to pray.

DIF: Cognitive Level: Applying REF: pp. 487–488 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. A nurse is caring for a patient in Portland, Oregon, who has a terminal illness. The patient

tells the nurse that she has made a decision “to end it all,” that she has suffered enough and is considering asking her physician to prescribe medications to help her die. The nurse knows that the regulations for physician-assisted suicide include which of the following? (Select all that apply.) a. A nurse or physician must be the one to administer the medications. b. The patient must have a prognosis of 6 months or less to live. c. The patient must be informed of all treatments and alternatives. d. The family of the patient must agree in writing to the patient’s decision. e. The patient must have received counseling to ensure that she is fully informed of the risks.

ANS: B, C

The physician-assisted suicide laws in the states of Oregon and Washington have the following requirements: The individual must be a competent adult who is free of depression and who has a prognosis of less than 6 months to live. The patient must make two requests, both verbal and in writing, repeated in 15 days, and there must be two witnesses to the request; one must not be an heir, related, or employed by the health care facility caring for the patient. The patient must have been informed of alternatives and have received counseling to ensure that the person is fully informed regarding the risks of such actions. Neither physicians nor nurses are permitted to administer the product used.

DIF: Cognitive Level: Understanding REF: pp. 496–497 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. The daughter of a patient who has a chronic illness that has reached the terminal phase talks

about the palliative care referral that the primary care provider made for her mother. Which of the following statements indicate that the daughter needs additional education about palliative care? (Select all that apply.)

a. “I know that palliative care is only available to people who have 6 months or less

to live. That is really hard to cope with.” b. “My mom still can be actively treated while receiving palliative care.” c. “I understand that the palliative care team is made up of health care professionals

of all different disciplines, not just doctors and nurses.” d. “The goal of palliative care is to prevent or to minimize suffering” e. “My mom will have to be transferred to a special unit in the hospital in order to

receive palliative care.”

ANS: A, E

While many individuals are not referred to palliative care until they are at the end of life, ideally, the earlier they are referred, the better. There is no time frame for referral regarding the point that they are in their illness. Palliative care is offered simultaneously with life-prolonging or stabilizing care for those living with chronic conditions. Palliative care uses an interprofessional model of care. Palliative care can be offered in any setting across the continuum of care and on any unit; it is a philosophy of care.

DIF: Cognitive Level: Understanding REF: p. 493 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. A patient tells a nurse that she has prepared a living will (LW). The nurse understands that a

living will: (Select all that apply.) a. is an advanced directive that is used in the situation of a person who is unable to speak for herself or himself. b. is a legally binding document in all states and territories of the United States. c. appoints a proxy to uphold the patient’s wishes. d. includes the provision that the patient’s next of kin have more authority than the appointed proxy. e. can be revoked by the patient at any time in either writing or verbally.

ANS: A, C, E

The Patient Self-Determination Act (PSDA) recognized a Living Will (LW) as an advanced directive that is specifically related to a situation in which a person is facing a terminal illness and unable to speak for herself/himself. It is a morally and, in some jurisdictions, legally binding document in which adults could express their wishes regarding end-of-life decisions for some future time when they were unable to do so for themselves. The exact requirements for a living will and the associated laws around it vary from state to state. The patient appoints a proxy to uphold his or her wishes when he or she is no longer able to do so. As the proxy is selected by the individual, the legal assumption is that a designated person has more authority than the next-of-kin. The patient can revoke an LW verbally or in writing at any time for any reason.

DIF: Cognitive Level: Understanding REF: p. 495 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity

Chapter 36: Self-Actualization, Spirituality, and Transcendence Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. Which statement best demonstrates an older adult’s success at achieving self-actualization? a. “My father was an alcoholic, but he did love us.” b. “I always feel safe when my son is visiting.” c. “My heart problems are better since I had the surgery.” d. “I’ve been elected president of my service organization again.”

ANS: A

Self-actualization is the highest level of human functioning according to Maslow and would be reflected in the ability to see both the good and the bad in others. Biological or physiological integrity, safety and security, and self-esteem are all part of the hierarchy of human needs but they are not the highest level of human functioning.

DIF: Cognitive Level: Applying REF: p. 503 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. Which description would be most characteristic of a self-actualized individual? a. An economically disadvantaged older black man who regularly checks out books

from the local library to read to neighborhood children b. A wealthy white older woman who is constantly searching for a better laxative c. A middle-class white man who was forced into an early retirement and is living in

fear of being evicted from his apartment d. The older wife of a famous celebrity who travels the world but starves herself and

seeks plastic surgery in her quest to fight the physical signs of aging ANS: A

The individual described here is displaying three of the characteristics of a self-actualized individual: altruism, courage, and self-renewal. This individual displays altruism in that he is helping others by reading to the children in the neighborhood and improving their literacy.

Despite being economically disadvantaged, he displays courage by conquering despair and giving of himself. He is also displaying self-renewal in that he is connected to the world around him and is giving back to it. The other scenarios listed are all incorrect because the individuals described are all focused on their own personal problems despite having fewer challenges than the economically disadvantaged older black man.

DIF: Cognitive Level: Applying REF: pp. 503–504 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 3. What is the role of the nurse in assisting older adults with travel interests? a. Suggesting that they travel with a seniors’ group b. Addressing arrangements to have medical care, if needed, during their travels c. Providing information regarding pet care services for their beloved dog d. Reassuring the client that their concerns about safety are unfounded

ANS: B

The role of the nurse is to assist older people by addressing potential problems and planning ahead for contingencies that would support them in continuing to experience and express their passions. Addressing potential health care needs would best fulfill this role. The remaining options are not as powerful in helping to achieve their goal of traveling.

DIF: Cognitive Level: Applying REF: p. 508 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 4. Which intervention best demonstrates that the nurse understands the spiritual needs of a

terminally ill client? a. Arranging care so that the client’s prayer time is not interrupted b. Assuming the responsibility of notifying the hospital chaplain of the client’s admission c. Providing the client with the schedule of religious services offered in the chapel d. Suggesting that the family attend worship services with the client whenever possible ANS: A

Private time for prayer, meditation, and reflection may be needed. Nurses may neglect to explore this issue with elders because religion and spirituality may not seem a high priority.

The client should be assured that religious longings and rituals are important and that opportunities will be made and respected. The nurse should never assume a client’s desire or need to see clergy or to have family accompany him or her to services, and should respond only when asked to.

DIF: Cognitive Level: Applying REF: p. 509 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 5. An elder is experiencing severe chronic pain resulting from a terminal illness. Which

intervention by the nurse would be most appropriate when he verbalizes a desire to find “some sort of meaning to all of this”? a. Introduce a sensory distraction, such as television b. Reassure him that this is normal phase that everyone experiences c. Listen and help him express his feelings about life and death d. Ask the doctor to order a psychiatric consult for possible depression ANS: C

The most appropriate intervention at this time is to listen and facilitate the expressions of feelings about life and death. The patient may have the need to talk; the role of the nurse is to assist the patient to find meaning and reconciliation. By attempting to distract the client, you are negating the patient’s feelings. It is not true that “everyone experiences it” and each person’s experience is different and the patient needs to be allowed room for expression. It is within the role of the nurse to listen to the patient and assist him in expressing concerns. A psychiatric consultation is not warranted at this time.

DIF: Cognitive Level: Applying TOP: Integrated Process: Caring

REF: p. 510 | p. 514 MSC: Client Needs: Psychosocial Integrity

6. When a terminally ill client expresses a need “for something more to help me cope with the

pain,” the nurse bases the recommendation of meditation on which principle concerning this alternative therapy? a. It is efficient and usually takes less than 5 minutes to implement. b. It has been shown to decrease anxiety and depression. c. It improves cognitive abilities. d. It has been known to eliminate emotional distress.

ANS: B

Meditation has been shown to produce a sense of calm, better health, and a higher energy levels in its wake. Meditation usually lasts 20 minutes at a time. It does not cause changes in cognitive abilities, nor does it eliminate emotional distress, but it does help manage it.

DIF: Cognitive Level: Applying REF: p. 513 MSC: Client Needs: Psychosocial Integrity

TOP: Integrated Process: Caring

7. When the daughter of a client diagnosed with moderate Alzheimer’s disease (AD) asks about

the possible benefits of enrolling her mother in art classes, the nurse’s response is based on the knowledge that: a. creative activities are not limited to cognitively intact older adults; even individuals with dementia can benefit from creative activities. b. individuals with dementia who have rational language skills can benefit from creative activities. c. cognitively impaired elders cannot benefit from creative activities due to altered brain processes. d. cognitively impaired elders are usually too agitated to participate in creative arts.

ANS: A

Creative arts offer great value to individuals with dementia; the arts offer opportunities for individuals to express themselves and their vision of the world. Language skills are not required for individuals with dementia to participate in some of the arts. Individuals with dementia can benefit from creative activities. Not all individuals with dementia are agitated.

DIF: Cognitive Level: Applying REF: pp. 506–507 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 8. Which statement best demonstrates the primary benefit of intergenerational partnering and the

activities that it creates? a. These types of activities can help establish new relationships. b. Intergenerational activities can foster a sense of meaning and purpose. c. Such partnering can increase the self-esteem of the younger people. d. These activities can decrease social isolation in the older people.

ANS: B

Intergenerational activities primarily focus on fostering a sense of meaning and purpose in those involved. Establishing new relationships, increasing self-esteem of younger people, and decreasing isolation in older people are goals, but will occur most often when the individual has a life with purpose and meaning.

DIF: Cognitive Level: Applying REF: p. 507 TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity 9. Which activity assures the nurse that the client’s wish to “leave a living legacy” has been

accomplished? a. Donating his body to the local teaching hospital for research purposes b. Discussing his experiences as a World War II veteran in Europe to a reporter c. Keeping a journal to be passed on to his great-grandchildren d. Making a pilgrimage to a location with personal religious significance ANS: A

The purpose of a living legacy is to transcend death. Anatomical gifts are an example of a living legacy. Discussing war experiences is an example of a collective/group legacy. A written journal and a religious trip represent personal/self-legacies.

DIF: Cognitive Level: Applying REF: p. 516 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. A 77-year-old client recently lost her husband to a chronic progressive neurological disease.

She has a history of osteoarthritis and hypertension and was newly diagnosed with metastatic gastric cancer. She sold her home and moved to another state to be closer to her children, but she misses her many close friends. What makes her at risk for spiritual distress? (Select all that apply.) a. Metastatic cancer b. Age (77) c. Moving far away from other family and friends d. Loss of a spouse e. Chronic conditions: hypertension and arthritis ANS: A, C, D

Conditions that most predispose an individual to spiritual distress include those that are life threatening, such as a terminal illness, loss of interpersonal support, and those that affect the ability to participate in spiritual rituals. Metastatic cancer is a life-threatening illness, and moving to another state and the loss of a husband result in the loss of interpersonal support.

Spiritual distress is not directly associated with a specific age; that is, it is not true that the older a person is, the more spiritual distress she feels. Chronic conditions are usually not associated with spiritual distress unless they affect the ability to participate in spiritual rituals, which is not indicated in this scenario.

DIF: Cognitive Level: Applying REF: p. 510 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. The nurse managers of the geriatric and pediatric units arrange an intergenerational holiday

party. The rationale for arranging such a partnering is based on which principle? (Select all that apply.) a. Intergenerational activities can help all participants establish new relationships. b. Intergenerational activities are required by state and local geriatric regulatory agencies.

c. Intergenerational activities provide the units with an opportunity to improve

interagency cooperation. d. Intergenerational activities are beneficial for older adults because they can

decrease isolation and foster a sense of meaning and purpose. e. Intergenerational activities provide youngsters with an opportunity to interact with

older adults.

ANS: A, D, E

Intergenerational activities are not required by any regulatory agency, and they do not foster interagency cooperation. The benefits are those that are individualized and client-based, such as those identified in the correct options.

DIF: Cognitive Level: Applying REF: pp. 507–508 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity