Holistic Approaches to Aging Textbook
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Course Introduction
Holistic Approaches to Aging explores the multifaceted process of aging through biological, psychological, social, and spiritual perspectives. This course examines how lifestyle, environment, community, and personal beliefs influence the aging experience, and highlights integrative strategies to promote healthy, active, and meaningful aging. Students will engage with topics such as preventive health care, nutrition, physical activity, mental wellness, social engagement, and alternative therapies, gaining a comprehensive understanding of how to support older adults in achieving optimal quality of life.
Recommended Textbook
Ebersole and Hess Gerontological Nursing and Healthy Aging Edition 1st Canadian Edition by Theris
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Chapter 1: Introduction to Healthy Aging
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Q1) A female older adult tells the nurse that she has experienced increasing fatigue and shortness of breath over the last two days. Which of the following goals is the nurse's priority?
A) Promote safety to prevent injury.
B) Complete a nutritional assessment.
C) Balance exercise and rest periods.
D) Explore the woman's complaints.
Answer: D
Q2) A man is terminally ill with end-stage prostate cancer. What is the best statement about this man's wellness?
A) Wellness is possible, even if the patient uses medication to assist in management of his medical care.
B) Wellness is unfortunately not a real option for the patient.
C) Wellness is the same thing as faith healing, and if the patient were more receptive, he could be back at work in a few weeks.
D) Nursing interventions can help empower a patient to achieve a higher level of wellness.
Answer: D
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Chapter 2: Gerontological Nursing History, Education, and Roles
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Q1) What was the first formal action the Canadian Gerontological Nursing Association (CGNA) took in relation to gerontological nursing?
A) The CGNA established the first provincial gerontological nursing association.
B) The CGNA established gerontological nursing standards.
C) The CGNA created the Canadian Association of Older Adults.
D) The CGNA formed the Canadian Association of Gerontology.
Answer: B
Q2) A nursing home executive interviews RNs to fill a full-time position for direct patient care, to maintain the standards of older adult care. Which nurse should the nursing home hire?
A) A nurse from a certified university
B) A certified gerontological nurse
C) A nurse with 15 years of experience
D) A gerontological nurse practitioner
Answer: B
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Chapter 3: Communicating With Older Adults
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Q1) The vision of a female patient is deteriorating, and she is depressed about her condition. Which of the following nursing interventions is most likely to address both conditions?
A) Provide adequate lighting without glare.
B) Maintain a consistent room arrangement.
C) Train her with low-vision assistive devices.
D) Offer your arm when ambulating in the hall.
Answer: C
Q2) Which type of question should the nurse avoid when communicating with an older person who has aphasia?
A) The nurse should avoid questions that validate understanding.
B) The nurse should avoid questions that have open-ended answers.
C) The nurse should avoid questions that require a yes or no answer.
D) The nurse should avoid asking several questions in a series.
Answer: B
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Chapter 4: Culture, Ethnicity, and Aging
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Q1) The nurse prepares a female older adult, who is Polish, for discharge through an interpreter and notes that the older adult becomes tense during the instructions about elimination. Which of the following interventions should the nurse implement?
A) Move onto the discussion about medication.
B) Ask the older adult how she feels about this topic.
C) Instruct the interpreter to repeat the instructions.
D) Have the older adult repeat the instructions for clarity.
Q2) The health care provider discusses the need for surgery with an older adult and her family. Which information about the older adult's culture is important for the nurse to collect before this discussion to facilitate the process of informed consent?
A) Attitudes about caregiving
B) Process of decision making
C) Rituals for death and dying
D) Experience with discomfort
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Chapter 5: Nursing Documentation for Optimal Care
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Q1) What is a SOAP note?
A) This is a record of supplies used in patient hygiene.
B) This is a record of an event during a patient's stay, formatted according to the Simple Object Access Protocol (SOAP), so that it can be easily transmitted between computers.
C) This is a form of bar code.
D) This is a record of patient data listing the patient's subjective complaint, objective data recorded by the nurse, the nurse's assessment of the situation, and the nurse's plan of action.
Q2) Which documentation tool does the nurse use in extended care and long-term care settings to gather definitive information on the resident's functioning?
A) Narrative patient progress notes
B) Problem-oriented documentation
C) Resource Utilization Group (RUG)
D) Resident Assessment Instrument (RAI)
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Chapter 6: Biological Theories of Aging and Physical Changes of Aging
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Q1) An older adult has been diagnosed with a nutrition imbalance. Which age-associated intestinal problem should the nurse be aware of when planning goals and interventions to improve this older adult's nutritional status?
A) Older adults have less intrinsic factor secretion.
B) Older adults have short, broad, small intestinal villi.
C) Older adults have decreased gastric smooth muscle.
D) Older adults have decreased large intestinal motility.
Q2) The nurse designs a group exercise program at an older adult centre. Which room should the nurse choose for the program?
A) A room with a beautiful hardwood floor tastefully appointed with throw rugs
B) A spacious room with no windows but with fluorescent lighting and a natural stone floor
C) A room with an old hardwood floor and large windows overlooking a garden area
D) An end room with a linoleum floor and a fan for ventilation to compensate for the room's broken air conditioner
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Chapter 7: Social, Psychological, Spiritual, and Cognitive Aspects of Aging
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Q1) Which statement is true about the social, emotional, and spiritual well-being of older adults?
A) Contemporary society has strong norms for the behaviour of adults older than 80 years.
B) The transition to old age entails a declining level of contribution to others as one becomes increasingly dependent on them.
C) Computers and the Internet have little to contribute to older adults in their need for social support.
D) Nurses are often significant sources of social and emotional support for older adults.
Q2) An older male adult with severe knee pain tells the nurse how he lost his job and his home after starting a new business when he was 48 years old. Now he lives alone and relies on welfare. Using Jung's theory, what in this individual's life is the most pivotal in his personality development?
A) Living alone
B) Meagre income
C) Severe knee pain
D) Job loss and home loss
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Chapter 8: Nutritional Needs
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Q1) Which of the following is a true statement about nutrition for older adults?
A) The older person should be encouraged to practise strict controls on cholesterol intake to ensure protection against heart disease.
B) Transportation can be a critical factor in nutritional insufficiency in older adults.
C) Ethnic cooking is a major concern for older adults, because it makes balanced nutrition difficult to maintain.
D) There are no government programs to promote congregate dining among older adults.
Q2) Which of the following recommendations for daily food intake is correct for older adults according to Eating Well with Canada's Food Guide?
A) Seven servings of fruits and vegetables
B) Five servings of meat and alternatives
C) Four servings of milk and alternatives
D) Ten servings of grain products
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Chapter 9: Hydration and Continence
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Q1) Which of the following statements is true about fluid intake for older adults?
A) An older adult's daily total volume should be 1000 to 1500 mL.
B) Coffee is a suitable beverage for maintaining hydration.
C) Sports drinks should not be consumed, because they contain too much sugar.
D) The amount of fluid offered with medication administration should be standardized (at least 100 mL) for an older adult.
Q2) The nurse wants to begin helping an older adult, who is overweight and has urinary incontinence, with healthy bladder behaviour skills. Which intervention should the nurse implement?
A) Begin low-calorie diet for weight management.
B) Schedule voiding at two- to four-hour intervals.
C) Instruct the older adult to practise abdominal exercises.
D) Reduce the time between an urge to void and voiding.
Q3) Which one of the following signs and symptoms is characteristic of a urinary tract infection (UTI) in an older adult?
A) Fever
B) Dysuria
C) Anorexia
D) Flank pain
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Chapter 10: Rest, Sleep, and Activity
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Q1) During the night, an older female adult complains to the nurse that she has not slept more than two hours since her admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman's sleep?
A) Inquire about the sleep habits used at home.
B) Suggest that she avoid napping during the day.
C) Tell her that sleep is fragmented in older people.
D) Offer her a book or suggest she watch a movie.
Q2) The older adult residents of an assisted-living facility are preparing for a 14-day trip to Europe. Which of the following is the most important exercise for the nurse to recommend for the group?
A) Practise standing on one foot for 30 seconds.
B) Move light weights in a rowing motion eight times.
C) Stretch the hips by pulling the knee to the chest.
D) Swim laps in the pool for ten minutes continuously.
Q3) What is the difference between rest and sleep?
A) Sleep occurs with rest.
B) Rest is an extension of sleep.
C) Rest occurs only in brief periods.
D) Sleep is restorative and recuperative.
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Chapter 11: Promoting Healthy Skin and Feet
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Q1) An older adult sleeps in a recliner with his cool, greyish-coloured feet on the floor. What should the nurse investigate to assess the vascular status of this older adult?
A) Ability to stand during activities of daily living
B) Lateral ulcerations with brownish discoloration
C) Complaints of dull aching and peripheral edema
D) History of dyslipidemia and hypertension
Q2) The nurse plans care to protect the skin covering an older adult's greater trochanter. What is the nurse's priority intervention when the older adult is positioned on the side?
A) Turn the patient at least once every hour.
B) Place a cushion between the patient's knees.
C) Keep the patient's skin clean and dry.
D) Use the Sims' position.
Q3) Which of the following is an important consideration regarding the skin of an older adult person?
A) Generous amounts of soap should be used for cleansing.
B) Sweat glands increase in activity.
C) The skin becomes more vulnerable to damage.
D) The skin becomes darker in unexposed areas.
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Chapter 12: Maintaining Mobility and Environmental Safety
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Q1) The overall temperature in your gerontological unit is 17°C (62°F) during the evening shift. In documenting this concern to administration, which factor is the most important for the health and well-being of older adults?
A) It is not fair for older adults to have to deal with an uncomfortable environment.
B) Some of the residents are wearing blankets around their shoulders to keep warm.
C) An ambient temperature of 17°C (62° F) is unsuitable for older people because they have impaired thermoregulation.
D) It feels much warmer in the administration wing than out in the patient care areas.
Q2) The nurse can place an older adult into one of four patient rooms. Which one of the following is a suitable room for an older adult?
A) A brightly lit, blue room with cozy throw rugs.
B) A room with orange carpeting and soft lighting.
C) A brightly lit, blue room with waxed vinyl floors.
D) A room for television and crafts.
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Chapter 13: Assessment Tools in Gerontological Nursing
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Q1) The nurse assesses an older female adult in midmorning and, in a normal-toned voice, asks her, "Do you walk to the library to borrow books?" How should this nurse improve an assessment of an older adult?
A) Assess her earlier in the day.
B) Get this data from the family.
C) Use a soft voice for questions.
D) Ask her how she obtains books.
Q2) Which tool is used to assess an older adult's functional capability?
A) ADL
B) MMSE
C) OBRA
D) FIM
Q3) Why should a new nurse use a standardized assessment tool?
A) It allows for electronic data collection and analysis.
B) It increases the likelihood of collecting the most accurate data.
C) It is a substitute for possessing refined interviewing skills.
D) It provides an automated means of choosing nursing diagnoses.
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Chapter 14: Safe Medication Use for Older Adults
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Q1) The nurse provides instruction about medication safety to older adults. Which of the following instructions should the nurse provide?
A) Nausea and vomiting are common, harmless medication side effects.
B) Keep a supply of medications at the bedside for convenience.
C) Ask the health care provider to describe the purpose of the medication therapy.
D) Take your daily medications on an empty stomach with water.
Q2) The relationship of biological rhythms to variations in the body's response to drugs is known as chronopharmacology. When caring for an older adult with asthma, what information would help guide the nurse in planning the time to administer medication to the patient?
A) The asthma is most distressing before bedtime.
B) The asthma is most distressing at mid-day.
C) The asthma is most distressing between four and five A.M.
D) The asthma is most distressing after performing activities of daily living.
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Chapter 15: Living With Chronic Illness
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Q1) An older male adult who is right-handed works as a carpenter, but he has been left with a flaccid right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the plan of care to help this man achieve his optimal state of health and wellness?
A) Maintain skin integrity of the right arm.
B) Collaborate with occupational therapy.
C) Promote plaque-reversing strategies.
D) Support effective coping mechanisms.
Q2) An older female adult has gastritis, occasional migraine headaches and severe osteoporosis in the long bones, with impaired mobility and chronic pain. In the trajectory phase, what health teaching should the nurse offer to the older adult?
A) Regular exercise (at least 30 minutes daily) will increase bone density.
B) Daily intake of vitamin C 500 mg will reverse osteoporosis over time.
C) Rest periods of one to two hours throughout the day will prevent osteoporotic pain in long bones.
D) Taking nonsteroidal anti-inflammatory agents (NSAIDs) every two hours will reduce pain.
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Chapter 16: Pain and Comfort
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Q1) Which one of the following interventions would provide comfort, reduce anxiety and distress, and alleviate pain?
A) Acupuncture treatments
B) Adjuvant therapy
C) Transcutaneous electrical nerve stimulation
D) Touch
Q2) An older male adult who does not understand or speak English very well denies having pain, but he had knee replacement surgery two days before. Which is the best pain assessment tool for the nurse to apply when assessing the older adult's pain?
A) Numeric Rating Scale
B) Verbal Descriptor Scale
C) PAINAD assessment tool
D) Visual Analogue Scale
Q3) Compared with acute pain, which of the following statements is true of persistent pain?
A) It leads to markedly altered vital signs.
B) It is usually described as a burning pain.
C) It is generally gone within four months.
D) It can bring about changes in lifestyle.
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Chapter 17: Diabetes Mellitus
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Q1) Which of the following laboratory results is a goal for reducing a person's risk for diabetes and heart disease?
A) Triglycerides over 1.69 mmol/L (150 mg/dL)
B) Cholesterol over 5.18 mmol/L (200 mg/dL)
C) High-density lipoprotein under 1.03 mmol/L (40 mg/dL)
D) Fasting blood glucose under 6.11 mmol/L (110 mg/dL)
Q2) An older male adult comes to a primary care setting, and his reason for seeking health care is to get a prescription for sildenafil (Viagra). Which laboratory report can help to explain why this individual needs sildenafil?
A) Serum potassium 4.5 mEq/L
B) Prothrombin time 13 seconds
C) Hemoglobin 140-180 g/L (14.0-18.0 g/dL)
D) Glycosylated hemoglobin (Hgb A1c) over 8%
Q3) Which one of the following is the most important goal when planning nursing care for an older patient with diabetes mellitus?
A) Stabilize the serum glucose.
B) Prevent disease progression.
C) Set walking distance goals.
D) Plan for consistent exercise.
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Page 19
Chapter 18: Bone and Joint Health
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Q1) Which of the following is a healthy practice recommended for a person at risk for osteoporosis?
A) Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with spinach covered with melted cheese for dinner; and ice cream for dessert
B) Long-term estrogen administration as adjunct therapy
C) Steak with brown rice, celery, and red wine for dinner
D) Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog on a high-fibre bun at lunch; and a cocktail before dinner
Q2) An older male adult who has hyperuricemia complains of severe pain in the right ankle. Which instruction should the nurse include in patient teaching to enhance the action of medication the patient takes for his condition?
A) Avoid dehydration by drinking water.
B) Take aspirin when joints are red and hot.
C) Comply with antihypertensive diuretic regimen.
D) Avoid game meat, asparagus, and alcohol.
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Chapter 19: Visual and Auditory Changes
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Q1) Management of glaucoma involves medications (oral or topical eye drops) to decrease intraocular pressure (IOP). Which of the following medications would be prescribed to the older adult to control and reduce the IOP in acute angle-closure glaucoma?
A) Antihistamines
B) Vasodilators
C) Beta blockers
D) Bronchodilators
Q2) Glaucoma is a major public health problem. It is estimated that 250,000 Canadians were living with glaucoma in 2009. Mr. Gonzalez, 70 years of age, has told the nurse that he is experiencing frequent headaches, poor vision in dimly lit areas, increased sensitivity to glare, "tired eyes," and some impaired peripheral vision, especially when he is driving. Which type of glaucoma is Mr. Gonzalez experiencing?
A) Primary open-angle glaucoma
B) Acute angle-closure glaucoma
C) Low tension glaucoma
D) Normal tension glaucoma
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Page 21
Chapter 20: Cardiovascular and Respiratory Disorders
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Q1) An older male adult in a cardiac rehabilitation exercise class refuses to participate in the cool-down phase of the activity, and two minutes later, he passes out but regains consciousness quickly. Which of the following instructions does the nurse include in patient teaching to reinforce to this older adult the importance of cooling down after exercise?
A) Cardiac output diminishes with age.
B) Mobility capacity decreases with age.
C) Baroreceptor function diminishes with age.
D) Sensory perception diminishes with age.
Q2) After an older adult's acute exacerbation of chronic obstructive pulmonary disease (COPD), the nurse prepares the patient for discharge to home. What is the most important patient teaching for the nurse to include for the prevention of hospitalizations for exacerbation of COPD?
A) Ease breathing by sitting upright.
B) Use low-flow oxygen for dyspnea.
C) Avoid sick people and wash hands.
D) Eat nutrient- and calorie-dense food.
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Page 22
Chapter 21: Cognitive Impairment
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Q1) An older male adult comes to the emergency department after falling at home. He reports that he cannot walk without losing his balance, and his speech is somewhat slurred. Which one of the following steps should the nurse implement for this patient?
A) Arrange to transfer him to radiology immediately.
B) Determine symptom onset or when he fell at home.
C) Organize the tissue plasminogen activator (tPA) infusion.
D) Perform a comprehensive neurological assessment.
Q2) Classic signs of Parkinson's disease (PD) in an older adult include tremors at rest, rigidity (stiff muscles), akinesia (poverty of movement), and postural abnormalities. Which of the following is the most conspicuous sign of PD?
A) T
B) R
C) A
D) P
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Chapter 22: Economic and Legal Issues
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Q1) Under the Canada Health Act, "medically necessary" services are publicly insured, including primary health care, care in hospitals, and surgical-dental services. How is the term "medically necessary" interpreted by the provinces and the territories?
A) There is provincial and territorial variability in terms of how some "medically necessary" services are interpreted.
B) All provinces and territories follow the same interpretation, and provide all "medically necessary" services to Canadians.
C) Home care, medications outside of hospital, physiotherapy, and optometry services are provided to all Canadians.
D) The level of funding provided for all "medically necessary" services is the same throughout Canada.
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Chapter 23: Relationships, Roles, and Transitions
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Q1) The children of an older female adult ask the nurse for advice about helping their mother heal after her husband's death. Which strategy should the nurse share with the family?
A) Appoint one family member to take the mother on outings.
B) Coordinate family expressions of care and concern.
C) Have each child plan a long trip with their mother's assistance.
D) Take the mother to community events to meet other people.
Q2) As older adults' health begins to deteriorate, caregiving often becomes the responsibility of their middle-aged children. Of the following people, who is the most likely to provide care for an aging parent?
A) A middle-aged son who is married and works full time from his home office
B) A middle-aged daughter-in-law who is a stay-at-home mother
C) A middle-aged daughter who is married and works part-time
D) A middle-aged son who is married and works part-time
Q3) Which statement is true about the relationships of older adults?
A) Loneliness is evidence of self-centredness and unwillingness to love.
B) A person may be lonely even when surrounded by other people.
C) Hostile behaviour indicates that a person prefers to be left alone.
D) A pet cannot substitute for human attention.
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Page 25
Chapter 24: Mental Health and Wellness in Later Life
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Q1) An older male adult who had radical surgery for oral cancer is refusing to see visitors and is losing weight, despite aggressive nutrition therapy. The nurse assesses this older adult and recognizes that he is not coping well and appears to be grieving. What is the most important patient outcome, in light of this nursing assessment?
A) The patient discusses how his coping mechanisms are overwhelmed.
B) The patient performs self-feedings through gastrostomy tube daily.
C) The patient uses nonverbal forms of communication effectively.
D) The patient exhibits self-confidence in regaining a sense of control.
Q2) You are evaluating the plan of care for an older adult who is alcohol-dependent. Which patient documentation indicates a need for follow-up nursing interventions by the nurse?
A) The patient states that he intends to decrease his alcohol consumption.
B) The patient arrives at his group session on time and well groomed.
C) The patient states, "I am an alcoholic because I drink ten beers a day."
D) The patient states that he understands that he needs continued treatment.
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Chapter 25: Loss, Grief, Dying, and Death in Later Life
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Q1) The son of an older adult couple ends his life suddenly and violently. The husband proceeds with living as usual. After one year, the wife remains in seclusion and is hospitalized for dehydration. Which step should the nurse implement to help improve the wife's mental health and wellness?
A) Encourage additional fluids and social activity.
B) Instruct the husband to display empathy for her.
C) Establish a trusting, caring relationship with her.
D) Ask social services for a survivors' support group.
Q2) An older patient who has end-stage pulmonary disease decides to accept care from the palliative care nurse. This older adult is most likely to benefit from the palliative care nurse in terms of which following patient need of Weisman's six needs for the dying?
A) Closure
B) Control
C) Composure
D) Cohesiveness
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Chapter 26: Care Across the Continuum
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Q1) Nurses are concerned with assessing the impact of relocation on older adults, and determining methods to mitigate any negative reactions. Which characteristic of relocation stress syndrome in a resident being transferred from acute care to a long-term care facility should the nurse be aware of?
A) Agitation
B) Feelings of loss of control
C) Presence of a caring family
D) Hallucinations
Q2) As the nurse admits an older female adult to a long-term care facility from her home of 50 years, the woman mistakes the nurse for her daughter. Which of the following diagnoses should the nurse consider carefully when planning care for this woman?
A) Hypoxia due to chronic disease
B) Relocation stress syndrome
C) Alzheimer's disease (AD)
D) Attention-seeking behaviour
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